THE 
HOMCEOPATHIO 
THEORY AND PRACTICE 
OF 
' MEDICINE. 
BY 
E. E. MAHCY, ..ME, AND F. W. HUNT, M.E. 
VOLUME I. 
. .. - ti ■ ; , 
NEW-YORK: 
WILLIAM RADDE, 550 PEARL-STREET. 
Philadelphia: F. E. Boericke, 635 Arch-st.—Boston : Otis Clapp.—St. Louis 
H. C. G. Luyties.—Chicago: C. S. Halsey.—Cincinnati: Smith & Worth- 
ington.—Cleveland: John B. Hall, M.D.—Detroit: E. A. Lodge, M.D.— 
Pittsburg, Pa. : J. G. Backofen & Son.—Manchester, Eng.: H. Turner & Co., 
41 Piccadilly and 15 Market-st.—London, Eng.: H. Turner & Co., 77 Fleet 
street. 
1 8 6 8. Entered according to Act of Congress, in the year 1864, by 
WILLIAM RADDE, 
In the Clerk’s Office of the District Court of the United States for the Southern District of 
New-York. 
HEART LUDWIG, 
Printer and Stereotype, 
39 Centre-street. PREFACE. 
The authors present this work to the profession with a 
hope that it may afford some aid to the medical man in 
the midst of his arduous and, sometimes, perplexing prac- 
tical duties, as well as to the neophite who has just en- 
tered the portals of the temple of medicine. 
While w j have endeavored to present the results of 
our personal experience respecting the causes, nature, and 
treatment of diseases, we have not failed to collate, con 
dense, and illustrate the discoveries and opinions of othei 
physicians touching medicine and the collateral sciences 
We have freely quoted from the writings of other reput- 
able physicians, with a view of presenting to the pro- 
fession all the varieties and shades of opinion in the 
homoeopathic school. These views have been arranged and 
introduced in proper order under the various topics dis- 
cussed; and it is proper in this place to remark that 
many of these opinions do not accord with our own. But 
as we are advocates of the largest liberty in all that 
pertains to medical thought and medical progress, we 
have deemed it expedient to furnish as complete a tab- 
leaux of the field of homoeopathic literature as possible. 
V VI 
PREFACE. 
Our object throughout has been to present to the 
medical profession and the friends of homoeopathy a com- 
prehensive and intelligible view of the principles and 
practice of our school, as it is now represented by our 
best writers and practitioners; to embody, as far as our 
wide range of subjects permitted, the latest opinions and 
theories of investigators of every school on pathology and 
collateral sciences connected with medicine; and to give 
to all inquirers after advanced scientific truth the oppor- 
tunity to investigate our principles, and to see them tested 
by facts, as illustrated in the clinical experience of a large 
number of reliable observers. From all accumulated ma- 
terials we have aimed to sift the true from the false, and 
to condense within as small a compass as possible, all 
reliable facts bearing upon the subjects discussed. 
Medical science is yet in its infancy. Our knowledge 
of the functions of the intricate organs of the human 
body, of the causes and nature of diseases, and of the 
effects of medicines, in health and disease, is still limited, 
although progressive. If we have added a mite to the 
general advancement, and have contributed something to 
the general sum of medical knowledge, we are content. CONTENTS OF VOLUME I. 
Pags 
HISTORY OF MEDICINE, ... 33 
Egyptians, 37 
Greeks, 37 
iEsculapius, 37 
Temples, 37 
Hippocrates, 39 
Plato, 40 
Aristotle, 40 
Successors of Hippocrates,. . 43 
Alexandrian School, 41 
Study of Anatomy, 42 
Empirical School, 42 
Medicine at Rome, 42 
Asclepiades, 42 
Celsus, 43 
Druids, 43 
Roman Improvement, Her- 
culanseum and Pompeii, . 44 
Aretseus, 44 
Galen, 45 
Arabians, 47 
Libraries, 47 
Rhazes, 47 
Turks, 47 
Avicenna, 47 
Pagi 
Paracelsus, 47 
Servetus, 48 
Harvey—Circulation of the 
Blood, 48 
Regular Medicine 200 years 
ago, 49 
Ambrose Pare, 49 
Sydenham, ......... 50 
Boerliaave, 51 
Hoffmann, 51 
Cullen, 52 
Hahnemann, 52 
Discovery of the Principle of 
Homoeopathy, 54 
The Great Law of Cure,... 55 
Insanity, 56 
Hahnemann’s Works, ..... 57 
His Treatment of Cholera,. . 58 
Hahnemann’s Death and Char- 
acter, 59, 60 
His Theory of Medicine,... 60 
Medical Revolutions of the 
Present Century,. 62 
Pinel, Broussais, 63 
Louis, 64 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
Present Position of Allopathic 
Medicine, 65 
Medical Scepticism, 66 
Nervous Fluid. Dynamic Influence, 67 
Mental Impressions affecting the 
Body, 71 
Material and Natural Stimuli ... 73 
Health. Perversions of Health. 
Nature of Disease, 75 
Hygiene, 75 
Therapeutics, 75 
Specific Effects of Poisons and 
Remedies, 79 
Irritability, 82 
VII VIII 
CONTENTS. 
Pagi 
Medicinal Action, 82 
Poisons, 83 
Allopathy, 86 
Inconsistent Reasonings, 88 
Objections to Allopathic Practice, 91 
Mercury, 95 
Opium, 96 
Tartar-emetic, 98 
Cinchona, 99 
Homoeopathy, 105 
Brief Exposition of the Homoeo- 
pathic System, 106 
Modus Operandi of Remedies, .. 110 
Tabular View of the Actions of 
Remedies, 110 
Classification of Medicines, .... Ill 
Primary and Secondary Action of 
Drugs, 112 
Susceptibilities of the Organs in- 
creased by Disease, 116 
Apparent Exceptions, 121 
Natural Irritability, 117, 137 
Allopathic Admissions,.... 118, 321 
Small Doses act on a Diseased 
Organism, 120 
Reasons for using Attenuated Me- 
dicines, 121 
Hahnemann’s Experience, 122 
His Preparation of Attenuations,. 122 
Small Doses have Remedial 
Power, 123 
Imponderables admitted by all to 
be Potent Agents, 123 
Minuteness of Miasms, 125 
New Powers Developed, 127 
Some Remedies Absorbed, 130 
Weight and Dimensions of some 
powerful Agents Inappreciable, 132, 
134 
A perfect Theory of Cure not yet 
attainable, 134 
Summary of Points of Difference 
between the Old and New 
Schools, 135 
Objection to Small Doses answered, 137 
Direct Action instead of Counter- 
1*101 
Irritation applied to Healthy 
Organs, 136 
Divisibility of Matter, 139 
The Chemical Theory answered,. 140 
Homoeopathic Mode of Restoring 
Deficiencies in the Constituents 
of the Blood, 140 
Attenuations of Drugs, 142 
Considerations which Influence 
the Choice of Attenuations,... 142 
Example, 146 
Size of the Dose, 137, 147 
Medicinal Interference, 149 
Impurities of Substances Em- 
ployed in Preparing Medicines, 150 
Adjuvantia, 151 
Selection of the Proper Re- 
medy, 152, 419 
“What is the Like that Cures?”. 152 
Advantages of Minute Division,.. 154 
Repetition of Doses, 154 
Medicinal Aggravation, 155 
Selection of the Second Remedy,. 156 
Alternation of Remedies, 156 
Medicines Operating on Different 
Spheres, 158, 418 
Cures by a Single Remedy,. 157, 161 
Changing the Remedy, 159 
Antidotes, 149, 159 
Hahnemann on Antidotes,.. 160, 161 
Mode of Administering Remedies, 162 
Hahnemann’s Practice, 162 
Homoeopathic Notation, 163 
Mode of Preparing Medicines,... 163 
Proving of Drugs. Improvement 
of the Materia Medica, 164 
Semeiology—Symptoms of Disease, 165 
General Diagnosis, 166 
Figure and Attitude, 168 
Fashionable Dresb, 169 
Physical Education, 170 
Symptoms of the Tongue, 171 
Nervous System, 172 
Alimentary Canal, 172 
External Signs, 173 
Importance of Correct Diagnosis, 175 CONTENTS. 
IX 
Page 
Temperature of the body, 175 
Pathology, 177 
Alteration of Solids, 177 
Of Fluids, 180 
Congestion, 180 
Hypertrophy, 177 
Atrophy, 177 
Induration, 178 
Transformation of Tissue, 179 
Observations on the Causes of 
Diseases, 182 
Determining Causes,. 182 
Pred isposing, 182 
Exciting Causes 182 
Heat and Cold, 183 
High Degrees of Heat,... 183 
Effects of Cold, 184 
Vicissitudes, 184 
Power of Resisting Cold,. 185 
Influence of the Seasons,. 185 
Impurity of Air, 185 
Contagion, 186, 539, 542, 558 
Hereditary Tendency,... 186 
Respiration, 187 
Fatigue, 187 
Debility a Cause of In- 
flammation, 188 
A cause of Fever, .. 188 
Animal Heat, 188 
Effect of Stimulating Food, 189 
Effects of Cold Climates,. 190 
Intense Cold, 190 
Increase of Animal Food 
Required, 191 
Condition of the Capillaries 
in Inflammation,. 191, 195 
Functions first Deranged 
by the Causes of Dis- 
ease, 192 
Power of Resisting Disease,.. 193 
Primary Cause of Inflam- 
mation, 194 
Inflammation Perverted Nu- 
trition, 196 
Hypersemia induced by Ar- 
tificial Means 196 
Paqb 
Inflammation from Morbid 
Matters, 196 
Artificial Excitement of In- 
flammation, 196 
Different Effects of Cold on 
different Persons, 196 
Influence of Dress, 197 
Radiating Power of Flan- 
nel, 197 
Fitness of Clothing for 
Washing, 198 
Influence of Color, 198 
Limit of the Human Con- 
stitution to Resist Dis- 
ease, 199 
Influence of Different Periods 
of Life, 199 
Infancy, 199 
Infantile Diseases,.... 200 
Teething, 201 
Weaning, 201 
Childhood, 202 
Youth, 203 
Adolescence, 203 
Old Age, 217, 702 
Periodicity in the Actions of 
the Animal Economy,. . . 204 
Different Periods of the 
Day, 204 
Influence of Night, 205, 207 
Morning, 206 
Evening, 206 
Comparative Mortality of 
the Present with Former 
Times, 208 
Muscular Strength, 208 
Digestibility of Food, ... 209 
Influence of Cookery,. 209 
Physiological and Chemical 
Classification of Nutritive 
Substances, 210 
ARRANGEMENT AND CLAS- 
SIFICATION OF DISEASES, 211 
Acute, 211 
Chronic, 211 X 
Paob 
Sporadic, 211 
Epidemics, 211 
Number of Diseases, 211 
Object of Naming and Clas- 
sifying Diseases, 212 
Grand Divisions or Classes of Dis- 
eases, 212 
CLASS I.—DISEASES OF THE 
DIGESTIVE FUNCTION, 213 
Outline of the Process of Di- 
gestion, 213 
Taking of Food, 213 
Mastication, 213 
The Saliva, 214 
The Sense of Taste, 214 
“Quintessences,” 215 
Deglutition, 215 
Chymification, 215 
Process of Digestion, 215 
Case of St. Martin—Beau- 
mont’s Experiments,.. 215 
The Gastric Fluid,. ... 216, 281 
Its Mode of Operation,.. 217 
Phenomena of the Process of 
Chymification, 218 
Changes Effected by Diges- 
tion, 219 
Living Bodies not Digestible, 219 
Pancreatic Juice, 220 
Bile, &c., 220 
Absorption of Nutritious Mat- 
ters for the Supply of the 
Body, 221 
The Lacteals, 221 
The Blood — Physiological 
Properties, 222 
Sanguification, 222 
Lymph, 222 
Composition of the 
Blood, 223 
Nutrition, 224 
Disintegration, 224 
Nitrogen in Food,.... 225 
Quantity of Food Ne- 
cessary, 225 
CONTENTS. 
Pasi 
Ohder 1.—Diseases Affecting 
the Alimentary Canal, ... 226 
Genus I.—Affecting the Teeth and 
Gums, 226 
1. Dentition. Teething,... 226 
Process of Dentition,.. 227 
Symptoms, 227 
Treatment, 228 
Cham., Merc., Puls., 
Ipec., Aeon., Bell., 
Calcar.-carb., Coffea, 
Hyoscyamus, 228 
Canabis-Ind., Igna.,... 229 
Wisdom Teeth, 229 
Lancing the Gums,... 230 
2. Toothache.—Odontia Do- 
loroso, 230 
Gangrene, Causes.—Caries, 
Inflammation, 230 
Hot Drinks, 231,232 
Prevention of Caries,.... 232 
Treatment, 232 
Derangements of Digestion, 233 
Injuries, Mercury, 233, 234 
Bell, 234 
Cham., Staphys, Sul., 
Puls., Hyos., Aeon.,. 235 
Local Remedies, Kreo- 
sote, Arsenic, Argent- 
nitr., 236 
Minor Operations on 
Teeth, 237 
Haemorrhage, 237 
Local Anaesthetics,.... 238 
Chloroform, 238 
Galvanism, 238 
3. Tooth-edge.—Odontia Stu- 
poris, 239 
Treatment, 239 
4. Tartar.—Odontia Incrus- 
tans, 239 
Treatment, 240 
5. Affections of the Gums.— 
Gum-Boils, 240 
Treatment, 241 CONTENTS 
XI 
Paob 
Genus II.—Diseases of the Maxil- 
lary Bones, 241 
1. Abscess of the Antrum Max- 
illare, 241 
Symptoms, 241 
Purulent Secretion of 
the Antrum, 242 
Treatment, 243 
2. Fungous Tumor of the 
Antrum, 243 
Treatment Extirpation, 244 
3. Aifections of the Lower Jaw, 244 
Anatomy, 245 
4 Inflammation, 246 
5. Luxations, 246 
6. Fractures, 246 
7. Caries, 247 
Genre III.—PtyaUtm, 248 
1. Acute, 248 
2. From Mercury, 248 
3. Chronic Ptyalism, 248 
Mercur.-Corrosivus, 248 
Tartar-Emet., 249 
Nitric-Acid, Iodide of Pc 
tassium, Nitro-Mur.-Acid, 249 
4. Morbid Saliva.—Alumina,.. 249 
5. Foetid Odor of the Mouth,. 249 
6. Salivary Fistula, 250 
7. Salivary Concretions, 250 
General Remedies for Af- 
fections of the Mouth,... 250 
Mercurius, 250 
Laches., 251 
Aeon., Nux-Vom., Sul., 251 
Remedies for Affections of 
the Fauces, 252 
Genus IV.—Dysphagia.—Difficult 
Deglutition, 252 
1. From Mechanical Injury, .. 252 
Foreign Bodies in the 
Throat, 252 
2. From Nervous Irritation,.. 253 
3. Dysphagia from Spasmodic 
Constriction of the Pha- 
rynx, 254 
Pass 
General Remedies for Dys- 
phagia, 254 
Morbid Thirst, 255 
1. Excessive Thirst, .... 255 
2. Loss of Thirst, ...... 256 
Genus V.—Derangements of Di- 
gestion—Limosis, 256 
1. Anorexia—Want of Appe- 
tite, 268 
2. Bulimia.—Fames Canina— 
Morbid Appetite, 256 
Causes, 258 
Pathology, 257 
Treatment, 258 
Cases, 258 
3. Abstinence.— 258 
I. As a Remedy in Disease, 258 
II. Effects of Protracted Ab- 
stinence. Examples, 259, 261 
Symptoms, 26C 
Treatment, 262 
III. Inanition as a cause of Dis- 
ease, ... 263 
IY. Appetite, Vitiated or De- 
praved, 264 
Cases, 265 
V. Cardialgia.—Heart-Burn, . 266 
YI. Flatulency, 266, 299 
Catarrh of the Stomach, 865 
Treatment, 267 
Ipec., Puls., 267 
China, Cham., Carb.-Veg., 
Coloc., Carminatives,.. 267 
VII. Pyrosis, Water Brash,. .. 267 
Treatment, 268 
VIII. Gastrodynia.—See Index. 
IX. Nausea and Vomiting. 
Sickness at the Stomach, 268 
Emesis. Pathology. Phe- 
nomena of Vomiting,... 268 
Treatment, 270 
Puls., Cham., Coccul., 
Secale, Antim-Crud., 
Arsen., Camphor, Ipec., 270 
Cases, 270 XII 
CONTENTS. 
Pads 
X. Vomiting of Blood. Hae- 
matemesis 413 
XI. Dyspepsia, 271 
1. From Deficient Secretion 
of the Gastric Juice, 
with Inordinate Sensi- 
bility of the Nerves of 
tJie Stomach, 271 
Diagnosis, 272 
Combination of Gastric 
and Hepatic Disorder, 272 
Appetite, 272 Liver, 273 
Tongue, 273. Skin, 274 
Loss of Strength, 274 
Pulse, 274 
Effects of Slow Digestion, 275 
On the Mind, 275,278,282 
Imperfect Nutrition, 276 
Distinction between Func- 
tional Dyspepsia and 
Malignant Structural 
Disease, 276 
Nerves employed in Di- 
gestion, 278 
Causes of Deficient Gastric 
Secretion, 279 
“ Wear and Tear,” 
Malady, 279 
Exciting Causes,... 280 
Effects of Eating too 
much, 281 
Effects of Mental 
Emotions, 282 
2. Fermentation of the 
Contents of the Sto- 
mach from Deficient 
Secretion of Gastric 
Juice, 282 
Causes, Treatment. Diet, 284 
Quantity of Food,.... 284 
Hunger, 285 
Irritation from Taking 
Food in a State of 
Fever, 285 
Purity of Food Indis- 
pensable to Invalids, 286 
Paoi 
Poisonous Properties of 
Fermented or otherwise 
Deteriorated Food, 286, 312 
Cryptogamic Fungi Devel- 
oped in Fermentation,. 286 
Butter when Strong con- 
tains Infusorial Animal- 
culae, 286 
Cheese, Flour, Tainted 
Food, 287 
Exercise, 288 
Medical Treatment, .... 289 
Nux-vom., 289 
Sulphur, 291 
Pulsatilla, 291 
Bryonia, 292 
Lycopodium, 292 
Graphites, 292 
Lobelia-inflata, 293 
Calcarea-carb., 294 
Hepar-sulph.,........ 294 
Ignatia, 294 
Cedron, Case, 295 
Aperients, Use and A- 
buse of, 295 
Treatment of Fermentation 
of the Contents of the 
Stomach, 296 
Bad Teeth, 296 
Water, Remedial Pow- 
ers of, 297 
Effect of Drinking too 
little, 298 
Effect of Drinking large 
Quantities, 298 
Medical Treatment, 299 
Sanguinaria-canadensis, 299 
Phosphorus, 299 
See also pages 266 and 865 
Pepsine, 300 
Ipecac., 300 
Nux-vom., 300 
Muriatic-acid, 301 
Alcohol as a Remedy 
and as a Nutritious 
Substance, 301 CONTENTS. 
XIII 
Pagi 
Relative Advantages of 
Different Forms of 
Alcoholic Drinks, .. 302 
Wines, Brandy, 302 
3. Fermentation of the Contents 
of the Stomach, with De- 
velopment of Sarcinae, ... 303 
Diagnosis, 303 
Causes, 304 
Pathology, 304 
Treatment, 305 
Natrum-mur., 305 
Bi-Sulphite of Soda,... 306 
Sulphurous-acid, 306 
4. Sympathetic Affections of the 
Stomach, 307 
Sympathetic Disorder from 
Organic Disease of other 
Organs, 307 
Sympathetic Vomiting in 
Phthisis, 307 
Disorder of the Stomach 
from the Effects of Gall- 
Stones, see page 407 
From Abscess of the 
Liver, 407 
— From Passage of Re- 
nal Calculus,.... 308 
Gastric Disorder from Dis- 
ease of the Brain, .... 308 
Gastric Disorder from Or- 
ganic Disease of the 
Uterus, 308 
Nausea and Vomiting in 
Nervous Females, .... 308 
Sympathetic Affections of 
the Stomach in Young 
Children, 309 
Atrophia Ablactatorum, 
Marasmus from Weaning 310 
Hydrocephaloid Disease of 
Infants, 310 
Pathology, 310 
Treatment, 310 
Oenus VI.—Colica.—Colic, 311 
Bilious Derangement 311 
Paoh 
1. Cibaria—surfeit, 311 
Causes, 312 
2. Flatulent Colic, 313 
Nervous Colic, 313 
3. Bilious Colic, 314 
Causes, 315 
Endemic Colic of the West 
Indies, 315 
4. Colica Pictonum, Colic from 
Lead Poisoning, 316 
Treatment, 317 
Auxiliary Measures, .... 317 
Colocynth, 318 
Plumbum, 318 
Cases, 319 
Nux-vomica, 319 
Arsen., Cham., Veratr., 
Pulsat., Coccul.,.... 320 
Colcli., Phos., Cupr.,— 
Cases, 320 
Confirmations of the Ho- 
moeopathic Principle by 
Allopathic Authors, 321 
Jalap, Anise, Senna, .. 322 
Alum, 322 
5. Colic in Children, 322 
Treatment, 322 
Cham., Nux, Merc.,... 323 
6. Ileus. Iliac Passion, 340 
Obstruction of the Bowels, 334 
Intestinal Obstipation,. . . 340 
7. Gastrodynia. Sec Neuralgia 
Coeliaca,—Index. 
Oenus VII.—Copostatris,—Consti- 
pation, .. 323 
1. Constipation, Alvine Obstruc- 
tion, Costiveness, 323 
Varieties, 323 
Mechanical Obstruction,... 324 
Constipation, proper, .... 324 
Causes, 324 
Pathology, 326 
Treatment, 327 
Auxiliary Measures, 327 
Opium, 328. Bry., .. 329 
Enemata, 329. Nux-v., 330 XIV 
CONTENTS, 
Paoi 
Cases, 330 
Sulphur, 331. Puls., . 331 
Graphites, 331 
Cases, 331 
Yeratrum, 332 
Constipation in Children, .. 333 
Puls., Sulph., 333 
Lycopodium, 333 
2. Intestinal Obstruction, .... 334 
Treatment, 334 
Auxiliary Measures, .... 334 
Enemata, 335 
Purgatives, 335 
3. Obstruction of the Colon,.. 336 
Amusat’s Operation, .. 336 
Aconite, 336 
Electro-Magnetism, ... 337 
4. Diaphragmatic Hernia,.... 337 
Varieties, 338 
Diagnosis, 338 
5. Intestinal Intussusception, . 340 
Treatment. Manipulation, 340 
Oastrotomy 340 
Enemata. Tobacco,.. 341 
Lobelia, 341 
Belladonna, 341 
Pathogenetic Effects,.... 342 
Case, ■. 343 
Plumbum, 344 
Flexible Tube, 344 
Inflation, 344 
Crude Mercury, 344 
Oenus VIII.—Diarrhoea 345 
1. Feculent Diarrhoea, 345 
Treatment, 345 
Dulc., 346 
Arsen., 346. Capsic.,. 346 
2. Bilious Diarrhoea, 346 
Mercur., 346. Cham., 347 
Coloc., 347 
Plumbum, 347, 318 
Podophyllum, 347 
Nux-v., Thuja, Sulph.,. 347 
Sulph.-acid., 348 
Other Remedies, 348 
Nux-moschata, Case, .. 348 
Pao* 
3. Diarrhoea Adiposa, 
Oleum Ricini. Cases,... 349 
Cuprum, 349. Cases,... 349 
4. Serous Diarrhoea, 350 
Rubuscaesius, 350 
Dyospyros-virginiana, ... 350 
Coffea, 350 
5. Chronic Diarrhoea, 351 
Calcarea-carb. Case, ... 351 
6. Chronic Diarrhoea of Camps 
and Hospitals, see Colitis, 917 
Oenus IX.—Cholera. 
1. Cholera Morbus, Sporadic 
Cholera, 351 
Causes, 352 
Treatment, 353 
Yeratrum, 353 
Varieties. Cholerine Ague, 499 
Arsenicum, 353 
Coloc., 354. Cham., 354 
Puls., 354. Ipecac., 354 
2. Cholera Asiatica, 354 
History, 354 
Diagnosis, 356 
Causes, Remote, 357 
Proximate, 357 
Symptoms, 1st Stage, ... 358 
2d Stage, 359 
3d Stage, 360 
Pathology,... 361 
Treatment, Allopathic Ex- 
perience, 362 
.First Selection of Reme- 
dies by Hahnemann,. . 363 
Homoeopathic Treatment, 364 
Comparison of the Results 
reached by the two 
Schools, 364 
Treatment of the Forming 
Stage, 365 
Mental Influence, ...... 365 
Camphor, 365, 366 
Prophylactics, 365 
' Phos.-acid, 366. Sulph., 366 
Second Stage. Food,. . . 366 
Camphor,. . 366, 367, 369 CONTENTS, 
XV 
Pao* 
Veratrum, 368. Cupr., 368 
Nux, 369. Veratrum, 369 
Arsenicum, 370 
Allopathic Reports of its 
Effects, 370 
Phos.-acid, 370 
Secale-cor., ......... 370 
Rhus, Carb.-veg., 373 
Lauro-cerasus, 578 
Aconite, 373 
Adjuvantk, 375 
Allopathic Treatment,... 375 
Remedies only partially 
Homoeopathic are only 
partially successful, ... 375 
Merc., 375. Calom., 376 
3. Cholerine, 376 
Treatment, 377 
Genus X.—Intestinal Concretions,. 377 
1. Intestinal Calculus, 377 
2. Bezoar Stone, 379 
3. Scybala, 379 
Cases, 380 
Genus XI.—Helminthia—Intestinal 
Worms, 380 
Varieties of Worms found in 
the Human Body, 380 
1. Taenia, Tape-Worm, 380 
2. Trictocephalus, 380 
3. Ascarides, 38-1 
4. Lumbricoides, 381 
Diagnosis, 381 
Sympathetic Effects pro- 
duced by Worms, .... 382 
Causes, 383 
Pathology, 384 
Conditions for the Devel- 
opment of Worms, ..... 385 
Diseases connected with 
Worms, 385 
Verminous Diarrhoea, ... 386 
Treatment, 386 
Treatment of Worms in 
General, 386 
Anthelmintics, 386 
Spigelia, 387. Case, . 387 
Pao* 
Cina, Worm seed, Che- 
nopodium, 387 
Santonine, 388 
Sulphuric Ether, 388 
Oleum Terebinthinae, . 388 
Case, 389 
Aspidium-filix-mas., . . 389 
Sulph.-acid., 389 
Cases, 389 
Other Remedies, 390 
Genus XII.-Proctica—Haemorrhoids, 390 
Anatomy of the Rectum,. . . 390 
1 Haemorrhoidal Diathesis, .. 391 
Case,. 391 
2. Haemorrhoids, 392 
Bleeding Haemorrhoids, Ef- 
fects of, 392 
Case, 393 
Fluoric-acid, 393 
Lobelia, 393 
Elaterium,.. .. 393 
Haemorrlioidal Tumors,. . 393 
Internal Haemorrhoids, . . 393 
Symptoms, 394 
Causes, 394 
Treatment, 395 
Nux-v., 396. Kali-carb. 396 
Calc.-carb., 390. Thuja, 396 
Graph., 396. Sepia,. . 397 
Sulph., 397. Rhus-t.,. 397 
Hamamelis-vir., ...... 397 
Case, 397 
Aloes, 398 
3. Prolapsus Ani,—Protrusion 
of the Rectum, 398 
Causes, 398. Treatment, 399 
Order II.—Functional Derange- 
ments OP THE COLLATITIOUS 
Viscera, 399 
The Liver.—Minute Anatomy of 
the Liver, 399 
1. Functional Derangement of 
the Liver, 399 
Decarbonizing Office of 
the Lungs and Liver, 399 XVI 
CONTENTS. 
Paoi 
2. Icterus—Jaundice, 401 
Bilious Jaundice, 401 
Diagnosis, 402. Causes, 402 
Treatment, 402 
Sanguinaria, 402 
Mercury, Diseases caused by it, 403 
Its Mode of Action, 403 
Substitutive or Alterant 
Action, 403 
Its more violent Effects,.. 403 
Mercurialism, 403 
Mercurial Anaemia, 404 
Mercury in Liver Derange- 
ments, 404 
3. Jaundice without Obvious Or- 
ganic Disease of the Liver, 405 
Diagnosis, 405 
4. Jaundice from Obstruction of 
the Excretory Ducts of the 
Liver—Chololithus.—Gall- 
stone, 407 
Diagnosis, 407 
Pathology, 408 
Treatment, 408 
Olive Oil, 408 
Podophyll., 409. Case. 
Prognosis. Treatment 
of Jaundice in General, 410 
Yarious Remedies,. ... 410 
Phos.-acid., 410. Aeon. 410 
4. Melaena. Black Jaundice, . 411 
Diagnosis, 411 
Treatment, 411. Case, . 411 
Genus IV.- Visceral Venous Plethora, 412 
1. Venous Plethora of the Por- 
tal Circle, 412 
Treatment. Sepia,... 412 
Carbo-animalis, .... 413 
2. Haematemesis—Vomiting of 
Blood, 413 
Mucous Membranes, . . 413 
Diagnosis, 414. Causes, 414 
Strangulation, 415 
Convulsions, 415 
Organic Disease of the 
Liver, 415 
Pam 
Organic Disease of 
the Heart, 415 
Change in the Consti- 
tuents of the Blood, 416 
Treatment of Haematemesis, 416 
From Amenorrhaea. Case, 416 
Haemorrhage from Gastric 
Ulcer, 417 
CLASS II.—DISEASES OF THE 
RESPIRATORY FUNCTION. 
Sympathetic Relation of Organs of 
Respiration, 418 
Diseases of the Respiratory Organs, 419 
Diagnosis of Diseases of the 
Chest, 420 
Abdominal Respiration,.. 420 
Auscultation, 420 
Percussion, 421 
Modes of Employing Per- 
cussion, 422 
Order I.—Functional Diseases 
op the Respiratory Mucous 
Membrane, 423 
Genus I.—Coryza. Simple Catarrh. 
Cold, 423 
Diagnosis, 423. Pathology, 424 
Treatment, 425 
Aeon., Arsen., Nux-v.,... 425 
Mercur., Hepar, Dulc.,. .. 425 
Sulphur, Nitric-acid, .... 425 
Case, 425 
Catarrh, Epidemic. Influenza, 832 
Genus II.—Polypus 426 
Pathology, 426 
Treatment, 426 
Teucrium-marum, 427 
Cases, 427 
Symptoms of Teucrium,... 428 
Cases, 428, 429 
Thuja, 429. Sanguinaria, . 429 
Minor Operations on the Nasal 
Passages, 430 
Haemorrhage from the Nose,.. 430 
Catheterism of the Eustachian 
tube, 430 CONTENTS. 
XVII 
Paoe 
Genus III.—Ronchus, Rattling Res- 
piration, . 430 
1. Stertor, 430 
2. Wheezing, 430 
3. Obstruction to Respiration 
from Foreign Bodies in the 
Larynx or Trachea, 431 
Diagnosis, 432 
Treatment, 433 
Genus IV.—Aphonia—Lossof Voice, 433 
Genus V.—Dysphonia — Dissonant 
Voice, 434 
1. Hoarseness. Raucitas, . . . 434 
Treatment, 434 
Aeon., 434. Arnica, . 435 
Cham., Nux-v., Pulsat., 435 
Merc.-viv., Capsic., .. . 435 
Caust., Sulph., 435 
Gtnus V.—Psellismus.—Dissonant 
Speech, 435 
1. Bambalia—Stammering, . . . 435 
Treatment, 435 
Order II.—Diseases op the 
Respiration Affecting the 
Lungs, 436 
Genus I.—Gough, 437 
1. Idiopathic Cough, 436 
Sympathetic Cough, .... 437 
Treatment, 438 
Sanguinaria, 438 
Chronic Cough.—Arseni- 
cum, 438 
1. Pertussis,—Whooping Cough, 438 
Diagnosis, 438 
Pathology, 609 
Causes, 439 
Treatment, 439 
Tart.-Emetic, 439 
Trifolium-infoena, 439 
Capsicum, 440 
Coflea, 440, Bell., See p. 593 
Drosera, 440 
Mephitis Putorius, 440 
Other Remedies, 440 
Genus II.—Dyspnoea.—Embarrass- 
ed or Laborious Breathing,.... 440 
Tag* 
Healthy Respiration, 440 
Dyspnoea a Symptom of 
Various Diseases, 441 
From Increased flow 
of Blood to the Lungs, 442 
Genus III.—Asthma, 442 
Diagnosis, 442 
Causes, 443, 449 
Prognosis, 443 
Treatment, 444 
Puls., 444. Ipecac., 444 
Arsen., 444. Bry., 445 
Nux-v., 445. Bell., 446 
Cham., 446. Lobelia-inflata, 446 
Other Remedies, 447 
Thuja, 447. Bromine,.... 448 
Calcarea, .. . 448 
Genus IV.—Laryngismus—Laryn- 
gic Suffocation, 448 
1. Asthma Thymicum—Asthma 
Millarii,—Spasmus Glot- 
tidis.—Laryngismus Stri- 
dulus.—Crowing Disease,. 448 
Diagnosis, 448. Causes,.. 449 
Pathology, 450. Treatment, 451 
General Remedies, 451 
Sambucus. .Chlorine..,. 451 
Genus V.—Ephialtes—Oneirodynia, 452 
1. Oneirodynia Gravans—Incu- 
bus—Nightmare, 452 
Causes, 455 
Treatment, 454 
Nux-v., Aeon., Opi., 
Puls., Sulph., 454 
2. Ephialtes Apnoetica—Ephi- 
altes from Suspended Res- 
piration, 454 
Pathology, 455 
Treatment, 456 
CLASS III.—DISEASES OF 
THE SANGUINOUS FUNC- 
TION, 457 
Outline of the Circulation,.. 457 
Order I. Pyrectica.—Fevers,. . 458 
General Phenomena of Fever,. 458 XVIII 
CONTENTS. 
Pagb 
Functions Deranged in Fevers 459 
Diagnosis, 460 
Pathology, 460 
Causes of Fever, 461, 182 
Defective Physical Culture,. 462 
Dietetics, 463 
Influence of Cold, 464 
Congestion, 464 
Baths—Cold Shower Baths, 466 
Effects of Long-continued 
Cold, 466 
Classification of Fevers,. ... 467 
Genus I.—Ephemeral Fever,.... 467 
Genus II.—Mala/rious or Autumnal 
Fever, 468 
Conditions Necessary to De- 
velop Malarious Fevers,. 469 
Characteristic Features of 
Malarious Fever, 470 
Various Types of Ma- 
larious Fever, 471 
Extensive Prevalence of 
in New Countries,. . 472 
Genus III.—Intermittent Fever,.. 473 
Paludal Fever, 473 
Diagnosis, 474. Cold Stage,. 474 
Hot Stage, &c., 474 
Varieties, 475. Complications, 475 
Critical Days, 476 
Causes of Intermittent, 477 
Marsh Miasm. Doctrine of the 
Correlation of Forces, 478 
Prognosis, 480 
Acclimation—Prophylactic 
Measures, .... 480, 482, 491 
Theory of the Cryptogamic 
Origin of Malarious Fever, 
482, 483, 570 
Influence of Local Causes,. . 483 
Crowding of Individuals in 
Close Apartments, 484 
Moisture from the Earth,.. . 485 
Treatment of Intermittent Fever, 485 
Selection of the Proper Remedy, 485 
China, 486 
Symptoms Produced by China, 487 
Pag* 
Sulphate of Quinine, 487 
Its Physiological Action,.. . 488 
Prevention of the Destruction 
of Nerve Tissue, 488 
Its Action on the Circulation, 489 
It defibrinates the Blood,. . . 489 
Its Principal Range in Curing 
Malarious Fever, 490 
Bad Effects of Large 
Doses, 490, 514 
Its Prophylactic Powers,.. 491 
Its Modus Operandi in Anti- 
cipating the Paroxysm of 
Ague, 492 
Arsenicum, 492 
Ipecac, 494 
Apis-Mellifica, 495 
Bryonia, 495 
Eupatorium Perfoliatum, 496 
Nux-Vomica, 497 
Arnica, 498. Veratrum, 499 
Belladonna, 499 
Pulsatilla, 500 
Case, 501 
Ignatia, 501. Cocculus, 502 
Lachesis, 502 
Carbo-veget abil is.-Saba- 
dilla. Sulphur,.... 503 
Natrum-muriaticum, .. 504 
Antimonium-crud, .... 504 
Cina, 504. Capsicum, 505 
Cedron, 505. Sepia,. 506 
Staphysagria, 506 
Taraxacum, 506 
Thuja. Opium, 506 
Rhus-toxicodendron, .. 506 
Hydriodate of Potash,. 507 
Lauro-cerasus, 507 
Lycopodium, Mezereum, 507 
Coffea. Ferrum, .... 507 
Ferri-percyanidum,.... 507 
Hepar-sul. Hyosciamus, 507 
Sambucus, 507 
Calearea-carb., 508 
Camphor. Yeratrum-vir. 508 
Effects of Large Doses, 508 CONTENTS. 
XIX 
Page 
Macrotin, 509 
As a parturifacient, . 509 
2. Congestive Intermittent.— 
Sinking Chill—Malignant 
Intermittent, 510 
Character and Symptoms,.. 511 
Diagnosis and Pathology, .. 512 
Consequences of a Protracted 
Hot Stage, 512 
Splenitis, 512,937 
Prognosis, 513. Treatment, 513 
China, 486 
The Question of the Size 
of the Dose, 513 
A Large Dose of a Reme- 
dy required to Counter- 
teract a Large Dose of a 
Poison, 513 
Opium and Belladonna,. . 514 
Bad Effects of Quinine in 
Excessive Doses,. 514, 490 
Arsenicum. Case, 515 
2. Intermittent complicated with 
Catarrh of the Stomach, . 515 
Of the Intestines, 516 
Of the Duodenum, 516 
3. Congestion and Persistent 
Turgescence of the Spleen, 516 
See Splenitis, 937 
Treatment, 516 
China. Natrum-mur.,. 516 
Genus IY.—Remittent Fever, .... 516 
1. Bilious Remittent, 516 
Diagnosis, 516 
Inflammatory Bilious Fever, 517 
Symptoms, 517 
Gastric Remittent Fever, .. 519 
Diagnosis, 519 
Indications of the Tongue 
in Malarious Fevers, .. 520 
Causes, 521 
Treatment of Bilious Remit- 
tent and Gastric Fevers, 521 
2. Non-Malarious Congestive 
Fever, 522 
Diagnosis, 522 
Pag* 
Treatment, 523 
Cerebral Form, 523 
Abdominal Form, .... 523 
Pulmonary Form,.... 523 
Administration of Re- 523 
medies, 523 
3. Irritative Fever, 523 
Fever excited by Dentition, 227 
Remedies suitable for Irri- 
tative Fever,... . 228, 525 
4. Infantile Remittent, 524 
Diagnosis, 524. Causes, 524 
Treatment, 525 
Sul., Calcar., Ars., 525, 526 
Silicea, Aeon., Bell., .. 525 
Ipec., Cham., 525 
Cina, Spigelia 526 
Bry., 526. Dulc., ... 526 
Pulsatilla, 527 
5. Cerebro-Spinal Meningitis. 
Spotted Fever. Typhus 
Petecliialis, 527 
Symptoms. Case,.... 527 
Causes. Pathology, . . 528 
Treatment, 528 
Aeon., Bell., Arsen., 529 
Nux-v., Canth., Opi., 529 
China, Bry., Brandy, 529 
Malignant Double Tertian 
of the Mississippi, 529 
Treatment, 513 
6. Idiopathic Typhoid Fever of 
the South Western States, 529 
Diagnosis, 529 
Treatment, 529 
Bilious Typhoid Fever,. .. 530 
Treatment, 530 
Phosphoric-acid. Cases, 530 
Genus V.—Enecia. Continued 
Fever, 530 
1. Fever from Functional De- 
rangement, 531 
2. Fever from Inflammation, 531 
Synocha, 531 
Diagnosis, 531 
Causes, 532 XX 
CONTENTS. 
Page 
Treatment,..' 532 
Bell., Opium, Aeon., 
Stramon., Bry., Tart.- 
emet,., Ipec., Phos., 
Nux-v., Puls., Dulc., 
Arsen., Veratr.,.... 532 
Gelseminum, 532 
Mercury, 533 
Effects of Large Doses, 533 
Its Antiphlogistic Power, 533 
Typhoid Fever from Mer- 
cury, 533 
Classification of Specific 
Diseases of Irregular 
Febrile Action, 534 
General Characteristics of 
Infectious Fevers, .... 534 
Enecial Feveks. 
3. Typhus, 536 
Varieties of Typhus,.. 537, 554 
Localities, 536. Diagnosis, 538 
, Allopathic Practice Unsuc- 
cessful, 538 
Causes, 539 
Typhus a Specific Blood 
Disease, 540 
Effect of Crowding People 
together, 540, 541 
Catalysis, Septic Diseases, 541 
Process by which Putrid 
Affections are originated, 542 
Ferments introduced into 
the Blood, 542 
Operation of the Principle 
of Catalysis, 542 
Treatment of Typhus,... 543 
Cold Water, 543 
Rhus.n Bry., Arsen., 
Adeps, 544 
1. Typhus Cerebralis, 544 
f Bell., 544. Bry., 545 
Aeon., 545. Opium, .. . 545 
Rlius-tox., 546. Mercur., 547 
Acetic-acid, Acetum, .... 547 
2. Typhus Abdominalis, 547 
Treatment, 547 
Pag» 
Arsenicum, 447 
Drug-symptoms Produced 
by Bad Treatment,... 547 
Bell., 549. Bry.,.. 549 
Aeon., Opium, Rhus, 550 
Merc., 551. Camphor, 551 
Phos.-acid, 551. Bry., 551 
Carbo-vegetabilis,. . . 552 
Staphysagria, 553 
Muriatic-acid, 553 
Calcarea-carb., 555 
3. Nervous Fever.—Case of Dr. 
Spurzheim, 555 
4. Typhoid Fever. Typhus 
Abdominalis Exanthe- 
maticus.—Enteric Fever,. 557 
General Symptoms,... 557 
Causes, 557. Contagion, 557 
Character of Contagious 
Fevers, 557 
Conditions of the De- 
velopment of Fever 
Miasm, 558 
Mode of Communication, 558 
Endemic in Large Cities, 559 
Diagnosis.—Distinction 
between Typhoid and 
Typhus Fever, 560 
Pathology, 564 
The Typhous Ulcer of 
Peyer’s Glands,.... 565 
Termination of Typhous 
Ulceration, 565 
Changes in the Blood,. 565 
Treatment. See Reme- 
dies, 547 
5. Yellow Fever. Mode of 
Attack, 566 
Premonitory Stage,.. . 567 
Second Stage, 567 
Black Vomit, 567 
Notices of some former Epi- 
demics, 568 
Fever of 1825, 568 
Fever of 1839, 569 
Causes, 570 CONTENTS, 
XXI 
Pag* 
Cryptogamic Fungi—The- 
ory of the Transpor- 
tation of Yellow Fever, 
570, 571 
Contagion, 571 
The Disease may be im- 
ported, but it is rarely 
done, 572 
Pathology, 573 
Modus Operandi of the 
Specific Virus, 573 
Treatment, 574 
Ipec., 575. Camphor, 575 
Arsen., Veratr.-alb., Can- 
thar., Carb-veg., Nux- 
vomica, 575 
Bell., 575. Bry., 576 
Rhus, 576. Arsen.,.. 576 
Aeon., 577. Nux-v.,. 577 
Mercur., 577 
Effects of Calomel, 578 
Aggravation of Duodenal 
Inflammation, 578 
Veratr.-alb., 578. Sulphur, 579 
Tartar-emetic, 579 
Cantharides, 579 
Nitrate of Silver, 579 
Sulphuric-acid, 580 
Crotalus Horrid us, 580 
Symptoms Produced by 
Inoculations, 580 
Use of Crotalus in Yellow 
Fever, 581 
Results of Homoeopathic 
Treatment of Yellow 
Fever, 582 
6. Cold Plague. Pneumonia 
Typlioides, 582 
History and Symptoms, 582 
Diagnosis, 583. Causes, 583 
Pathology. Prognosis, 583 
Treatment, 584, 513 
7. Pneumo-Typhus, 584 
Treatment, 584 
Aconite, 584. Bry.,.. 584 
Phosphorus, 584 
Pag* 
Ammon.-carb., 585 
Phosphoric-acid, 585 
Other Remedies, 586 
8. Hectic Fever, 586 
Diagnosis, Causes, 586 
Treatment, 587 
Order II. — Exanthemata. 
Eruptive Fevers. 
Genus I.—Febrile Cutaneous Dis- 
eases, 587 
General Characteristics of the 
Exanthemata, 587 
Origin of Eruptive Fevers,. 587 
Communication by Contagion, 588 
Zymotic Diseases, 588 
Fomites, 588 
Prevailing Epidemics,... 588 
Palpable Contagions, 589 
Malignant Cell Formations, 589 
Impalpable Contagions,.. 589 
Epidemics Sometimes Con- 
tagious, 590 
1. Scarlatina. Scarlet Fever,. 590 
Scarlatina Simplex, 591 
Anginosa, .... 591 
Maligna, 592 
Causes, 593. Contagion, 593 
Treatment, 593 
Belladonna, 593 
Symptoms Produced by 
Poisonous Doses, 593 
Irritation of the Skin,... 595 
Homoeopathic Use, 595 
Antidotes, Hyoscy., Stra- 
monium, Opium, 595 
Aconite, 595. Ipecac.,.. 596 
Pulsatilla, 596. Zinc,... 596 
Mercur., Muriatic-acid,. .. 596 
Nitric-acid, 596. Bry.,.. 597 
Arsen., 597. Opium,... 597 
Recession of the Erup- 
tion, 597 
Sequelae of Scarlet Fever, 597, 600 
Treatment, 597 
Administration of Reme- 
dies, 597 XXII 
CONTENTS. 
Page 
Apis.-mellifica, 598 
Arum-tryphillum, .. 598 
Case, 598 
Cuprum, 598 
Case. Adeps, 599 
Ammonium-carb., .. 600 
2. Scarlet Rash, 600 
Diagnosis. Treatment, . . 600 
3. Sequelse of Scarlatina, 600 
Scarlatinal Nephritis.— 
Post Scarlatinal Dropsy, 600 
Causes, 601 
Scarlatinal Rheumatism,. 601 
Pathology, 602 
Disease of the Kidneys,. . 602 
See Volume II., p.... 21 
Pulmonary (Edema,. 602,796 
Treatment. Cases, 603 
4. Rubeola. Measles, Morbilli, 604 
Diagnosis, 604 
Febrile Stage, 604 
Eruptive Stage, 605 
Stage of Desquamation,.. 605 
Diagnosis, 605. Causes,. 606 
Treatment, 606 
Aconite, 606, 607 
Pulsatilla, 607. Bell., 607 
Bry., 608. Ipecac.,. . 608 
Mercur., 608. Sulphur, 608 
Other Remedies, 608 
Lachesis.—Case, 608 
5. Pertussis—Whooping Cough, 
438, 609 
Diagnosis, 438 
Treatment, 439, 440 
6. Roseola. 610 
Diagnosis, 610. Treatment, 610 
7. Urticaria.—Nettle-rash,.... 610 
Diagnosis, 610 
Varieties, 611. Causes,. 612 
Psoric Miasm, 612 
Sycotic Miasm, 615 
Bad Results from Sudden 
Repression of Eruption, 612 
Treatment, 613 
Aeon., Sulph., 613 
Pa<m 
Dulc., 614. Calc.,-carb., 614 
Lycopodium, 614 
Natrum-Muriaticum, .. 614 
Nitric-acid, Pulsatilla,. 61 
Ignatia, 615. Ipecac,. 61 
Other Remedies, 61 
Genus II. — Emplym — AcTiorous 
Exantliem, 615 
1. Miliaria—Miliary Fever,... 615 
Diagnosis, 615. Treatment, 616 
Diet., Aeon., Hyos., 
Cham., Bry., Ipec.,. 616 
2. Vaccinia.—Cow-pox, 617 
Mode of Performing Vac- 
cination, 617 
Time for Taking the 
Virus, 617 
Course of the Vaccine 
Disease, 618 
Permanent Evidence of 
Successful Vaccination 618 
Sources of Imperfect 
Vaccination, 618 
Permanence of Protec- 
tion of Vaccination, 619 
Propriety of Re-vaccina- 
tion, 619 
Period at which Vacci- 
nation may Prevent 
Small-pox, 619 
Irregular Course of Vac- 
cine Disease, 619 
Bad Effects of Vacci- 
nation, 620 
Distinction between 
Vaccinia and True 
Small-pox, 620 
Vaccinia a “ Similar” 
Disease, but not the 
same as Small-pox,. 621 
Homoeopathic “ Cure in 
Antecessum,” 621 
Benefit Conferred on 
the World by Vacci- 
nation, 621 CONTENTS, 
XXIII 
Pack 
Permanence of the Pro- 
tection Conferred,.. 622 
Object of Re-vaccination, 623 
ResultsofRe-vaccination, 623 
Characteristics of False 
or Imperfect Vacci- 
nation, 624 
3. Varicella.—Chicken-Pox,... 624 
Diagnosis, 624 
Causes, 625. Treatment 625 
4. Pelagra.—Description, 625 
Varieties, 626. Causes,. 627 
Genus III.—Empyesi*—Pustulous 
Exanthem 627 
1. Variola—Small-pox, 627 
Mortality of Small-pox,. . 627 
Varieties, 628 
Diagnosis, 628 
Primary Fever, 628 
Eruptive Stage, 629 
Suppurative Stage, 629 
Exsiccation, 629 
Confluent Variety, 629 
Causes—the Specific Poison 630 
Treatment, 631 
Aconite, 631. Bell.,. . 631 
Tartar-emetic, 631 
Case, 631. Sulphur,. 632 
Vaccinin. Variolin,.. 632 
Mercurius. Camphor, 632 
Consequences of Small-pox, 632 
Treatment, 632 
Chronic Ophthalmia, 
Remedies, 632 
Furunculus, 633 
Caries, 633 
Convulsions, 633 
Typhoid or Malignant 
Symptoms.—Remedies, 633 
2. Varioloid. Modified Small- 
pox, 633 
Protection of Vaccina- 
tion Perfect according 
to the Perfection of 
the Vaccine Disease, 633 
Treatment, 633 
Pagh 
Bryonia, 633 
Merc., 634 
Opium, 634. Thuja, 634 
Sycotic Origin of Small- 
pox, 634 
3. The Black Death of the 
Fourteenth Century, .... 635 
Description, 635 
4. The Oriental Plague, a Relic 
of the Epidemic of the 
Middle Ages, 636 
Treatment, 637 
Order III.—Phlogistica.—In- 
flammatory Diseases.... 637 
Inflammation, 637 
Structure of the Capillary 
Vessels, 637 
Phenomena of Inflammation,. . 638 
Stage of Incubation, 638 
Stage of Congestion,. 638 
Hypersemia,—Distended Condi- 
tion of the Part, 639 
The Seats of Inflammation,. . . 639 
Products of Inflammation,.... 640 
Organic or Structural Disease,. 640 
Effusion of Coagulable Lymph, 640 
Lymphization, 641 
Each Cell of a Texture an 
Organism in Itself, 641 
Cell Growth, 641 
Cicatrization, 642 
Serous Effusion, 642 
Objects of Inflammation, .... 643 
Adhesive Process, 643 
Obstacles to Successful Repara- 
tion of Injuries, 643 
Process of Granulation, 644 
Reparation of the Skin, 644 
Cicatrizes, Diseased State of,. . 645 
Warty Affections of, ... . 646 
Wounds of, 646 
Morbid Blastema giving rise to 
Abnormal Tissues, 646 
Diatheses, 646 
Iodic, 646 
Cancerous, 646 XXIV 
CONTENTS. 
Pao« 
To Remove the Purulent Col- 
lection, 656 
2. Abscess, Secondary, 657 
Treatment of Abscesses in 
General, 658 
Arsen., Asarum, Bell.,. 658 
Bry., Mezereum, Puls.,. 658 
Rhus-tox., 658 
Chronic Abscesses. Remedies 658 
3. Cellular Inflammation. In- 
flammation of the Cellular 
Membrane. Case, 658 
Treatment, 659. Remedies, 658 
4. Frost-Bites 659 
Effects of Excessive Cold, 660 
Process of Freezing, .... 660 
Recovery from Effects of 
Great Cold, 660 
Treatment, 660 
5. Panaris—Whitlow, 661 
Treatment, 661. Case, . 662 
6. Contusions, 662 
Arnica, 662 
7. Sprains, 662 
Dislocations. Luxations,. . 662 
Treatment, 662 
8. Periostosis, 663 
Diagnosis. Treatment,.. 663 
Incisions, 663 
Ruta Graveolens , 664 
Stone Bruise. Treatment,. 664 
Alkaline Foot-Bath, 665 
Nitrate of Silver, 665 
Arnica. Calendula, .... 665 
9. Ulceration of Cartilages of 
the Joints, 665 
Cartilage, Structure of,.. .. 665 
Treatment, 666 
Antipsorics, 666 
10. Poisoned Wounds.—Bite of 
the Rattlesnaae,.. 666 
Bromine—Bibron’s An- 
tidote, 666 
Experiments with do. 666 
Dissection Wounds, 667 
Lachesis. Case, 667 
Paqb 
Results of Imperfect Nutrition, 647 
Cell Formation, 641, 647 
Cell Development of Epithelium, 647 
Epithelium Destroyed by In- 
flammation, 647 
Diseases from Perverted Evolu- 
tion of Cells, 647 
Formation of Morbid Tissues,. 647 
Blastema, 646, 647 
Death from Imperfect Nutrition, 648 
Glycogenous Matter no longer 
produced 648 
Remote Causes of Inflammatory 
Diseases, 649 
Idiosyncracies and Predisposi- 
tions to Disease artificially 
Induced, 649 
Predisposition to Disease de- 
pends on a peculiar Physio- 
logical Condition, 649 
Treatment of Inflammation, .. 649 
Modes in which Drugs act on 
the Living Organism, 650 
Size of the Dose to be governed 
by the more or less perfect 
Homoeopathicity of the Re- 
medy to the Individual Case, 650 
Aconite. Its Specific Powers 
and Sphere of Action, 650 
Views ofVarious Authors, 650, 651 
Principal Forms of the Condi- 
tion produced by Aconite,. . 651 
Genus I.—Apostema—1. Abscess,. 652 
Formation of Abscess, 652 
Spreading or Diffuse Abscess,. 654 
Character of Pus, 653 
Purulent Collections in Lym- 
phatic Subjects, 654 
Abscesses Extending through 
the Interstices of the Cellu- 
lar Membrane, 654 
Consecutive Abscess, 654 
Process of Suppuration and Pro- 
gression in a large Abscess,. 654 
Diagnosis, 655. Prognosis, . . 656 
Treatment, 656 CONTENTS. 
XXV 
Paq* 
Bites of Insects.—Collodion, 668 
11. Malignant Pustule. Charbon668 
Causes, 668. Symptoms, 668 
Pathology, 669. Diagnosis, 669 
Anthrax.—Carbuncle, 669 
Causes, 670. Treatment, 670 
Rhus-tox., Arnica,. . .. 670 
Arsen., Cldor.-calc.,.. . 670 
Calendula, 670 
Incisions, 670. Cases, 670 
Calcarea-muriatica, ... 671 
Chloroform, 671 
Carbonate of Lead, ... 671 
12. Erysipelas. St. Anthony's 
Fire, 672 
Diagnosis, 673 
Erysipelas phlegmonodes,.. 673 
Gangrenosum, .... 674 
Neanatorum, 674 
Epidemic Erysipelas, 674 
Causes, 676. Treatment,.. 676 
Rhus-toxicodendron, .... 676 
Symptoms produced by it, 676 
Pathological Conditions 
curable by Rhus, 677 
(Edematous Erysipelas of 
the Face. Cases, .... 678 
Belladonna, Aconite,.... 679 
Opium, Bry., China, .... 680 
Tartar-emetic, 680 
External Applications,.. . 680 
Carbonate of Lead, 681 
Acetum, 681 
Inflammatory Diseases of the 
Brain and Nervous System, 681 
1. General Observations, ..... 681 
Characteristic Features of Dif- 
ferent Portions of the Brain 682 
Dangers of Depletion in Ce- 
rebral Diseases, 683 
Dynamic Causes of Disease,. 683 
Absurd Opinions of Old Au- 
thors, 684, 685 
Difficulty of Distinguishing 
between Different Cerebral 
Diseases, 686 
Paqi 
Genus II.—Injuries and Transient 
Affections of the Brain, 687 
1. Concussion of the Brain, .. 687 
Symptoms. Case, 687 
Treatment, 688 
Chronic Disease from Injury, 688 
Symptoms of more Severe 
Cases, 689 
Treatment, 689 
2. Inflammation from Injury of 
the Brain, 689 
Treatment, 690 
Fungus Cerebri, 690 
Treatment, 690 
Apparent Death from a 
Fall, 691 
3. Fullness of Blood to the 
Head, 691 
Pathology, 691 
Exciting Causes, 691 
Treatment, 692 
Nux-vomica, 692 
Other Remedies, . . 692 
4. Coup de Soleil, Sun stroke,. 692 
Aeon., Bell., Bry., Carbo-v. 692 
Glonoine. Its Sphere of 
Action, 692, 694 
Provings, 692 
Congestion of the Brain— 
Sick Headache, Vertigo, . 694 
Genus III.— Cerebral Inflammations, 695 
I. Encephalitis, 695 
Inflammation of the Medul- 
lary Substance, 695 
Inflammation of Different 
Portions of the Brain, . . 696 
Causes, 697. Pathology, 697 
Inflammation of the He- 
mispherical Ganglion, ... 697 
The Seat of the Intellec- 
tual Powers, 698 
Meningitis, 699 
Inflammation of the Dura 
Mater, 700, 710 
Otitis, Extension of, 700 
Cases, 700 XXVI 
CONTENTS. 
Pact 
Pathology, *715 
Prognosis, 716 
Treatment, 717 
Nux-Vomica. Case, 717 
3. Hydrocephalus, 71 
Water-Brain Fever, Dropsy 
of the Brain. Tubercular 
Meningitis, 718 
Acute Hydrocephalus, .... 718 
Symptoms, 718 
Diagnosis, 720. Causes, 721 
Prognosis. Treatment,.. 721 
Prophylactics, 721 
Aeon., Bell., Bry., .... 722 
Helloborus, 722 
Other Remedies, 722 
Tartar-emetic 723 
Mercury, 723 
Chronic Hydrocephalus,.. . 724 
Treatment, 724 
Aeon., Bell., Calcarea.,.. . 724 
Other Remedies, 724 
Genus IV.—Inflammatory Diseases 
of the Ear, Mouth, and Throat, 725 
1. Diagnosis of the Condition 
of the External Meatus of 
the Ear, 725 
2. Foreign Bodies in the Ears, 725 
3. Diseases of the Membrana 
Tympani, 722 
Fungous Membrane Cover- 
ing the Membrana Tympani 727 
Common in Congenital Deaf 
Mutes, 727 
Diagnosis. Treatment,.. 727 
4. Inflammation of the Mem- 
brana Tympani, 728 
Treatment,... 728 
Remedies, 729 
5. Ulcerations of the Meatus 
Extern us, 729 
Abscess of the Meatus—Otor- 
rhcea), 729. Treatment,. 729 
7. Rupture of the Membrana 
Tympani, 730 
Treatment, 730 
Page 
Osseous Deposits, 700 
Cases, 701 
Atrophy of the Brain, .... 701 
Atrophy of the Brain in Old 
Age, 702 
Induration of the Brain,... 702 
General Principles of Treat- 
ment of Inflammation of 
the Brain, 703 
Blood-letting Condemned, . 703 
Remedies, .... 703 
Cold to the Head, 703 
Homoeopathic Remedies,... 704 
Bell., 704. Aeon., 706 
Opium, 706 
Effects of Large Doses, .. 707 
Indications for Opium,. . . 708 
Alcohol, 708. Hellebore, 708 
Tartar-emetic, 708 
Poisoning by, 708 
Treatment of Inflammation 
of the Dura Mater, 709 
Case, 709 
Inflammation of the Brain 
Consequent on Scarlatina, 710 
Meningitis Caused by Sun- 
stroke, 710 
Bell., Aeon., Opium,.. 710 
Case, 711 
Derangements of the Brain 
Accompanied by Paralysis 
of the Voluntary Muscles, 711 
Case, 711 
Sleeplessness, .. 712 
Coffea., Aeon., Ignatia, 
Puls., Cham., Opium,. 712 
Hyoscyamus, 712 
Strain., Musk, Rhus., . 712 
Cuprum-aeet., Merc.-sol., 712 
Camphor, 713 
Anaemic Disease of the Brain. 
“London Cachexia,” .... 713 
2. White Softening of the 
Brain.—Ramollissment. 
Cerebral Anaemia, 713 
Diagnosis, 714. Causes 715 CONTENTS. 
XXVII 
Paoi 
Injury of the Ear by Loud 
Explosions, 730 
8. Polypus of the External 
Surface of the Membrana 
Tympani, 731 
9. Relaxation of the Membrana 
Tympani, 731 
Treatment, 731 
10. Morbid Tension of the Mem- 
brana Tympani, 731 
Treatment, 731 
Otorrhcea—Chronic, 732 
Bad Results of Suppressed 
Otorrhcea, 732 
Constitutional Treatment. 
Case, 732 
Apis-mellifica.—Case,.. 732 
11. Induration of the Membrana 
Tympani, 733 
Symptoms. Treatment, 733 
12. Ozoena, 734 
Treatment, 734 
Pseudo-ozoena from Foreign 
Bodies in the Nostrils.— 
Cases, 734 
13. Swelling and Inflammation 
of the External Nose,.. . 735 
Treatment, 735 
Group II.—Inflammation of 
Organs and Tissues Con- 
nected with the Mouth, 
and Throat, 735 
1. Glossitis — Inflammation of 
the Tongue, 735 
Diagnosis, 735. Treatment, 736 
Mercurius. Belladonna*,. 736 
Plumbum, 737 
Other Remedies, 737 
2. Herpetic Glossitis. Case,.. 737 
3. Aphtha. Thrush. Muguet. 
Stomacace, 737 
Aphtha Infantilis, .... 738 
I Pathology, 739 
Mercurial Stomatitis, 739 
Ulcero-Membranous Stoma- 
titis, 739 
Pagi 
Chronic Exanthematous 
Eruptions of the Intestinal 
Canal, 740 
Stomatitis Materna. Nursing 
Sore Mouth, 740 
General Symptoms, 740 
Diagnosis. 740. Treatment, 741 
Calc.-carb. Mercurius, .. 741 
Natrum-muriaticum, .... 741 
Nitric-acid. Muriatic-acid, 742 
Sulphuric-acid, 742 
Sulphur, 742. Veronica, 742 
Frasera, Hydrastis, 742 
Diet, 742 
4. Parotitis.—Mumps, 742 
Diagnosis, 743. Causes,. 744 
Treatment, .... 744 
Bell., Merc.-sol., Calc.-carb. 744 
Mercurial Parotitis, 744 
Parotid Gland, Induration 
of. Case, 745 
5. Tonsilitis.—Quinsy, 746 
Diagnosis, 746. Causes,. 747 
Treatment, 747 
Bell., Merc., 747. Aeon., 748 
Baryta-carb., Nux-vom., 748 
Puls., Hepar-sulph.,. .. 748 
Angina Maligna. See page 592 
6. Pharyngitis. —Inflammation 
of the Pharynx, 748 
Treatment, 749 
Remedies, 749 
Tartar-emetic, 749 
7. Laryngitis, 749 
Pathology, 749 
Diagnosis, 750 
Treatment, 750 
8. Chronic Laryngitis, 750 
Symptoms, 750 
Causes, 751. Pathology, 751 
Treatment,.... J 751 
Remedies, 751 
Tracheotomy, 751 
9. Diphtheria—Laryngitis Exu- 
dativa, 752. History,... 752 
Varieties,... 752 XXVIII 
CONTENTS. 
Page 
Nature of the Disease,. 753 
Causes, 753, 754 
General Symptoms,... 755 
Diagnosis, Distinction 
between Diphtheria and 
Croup, 757 
Between Diphtheria and 
Scarlatina, 759 
Relations between Diphtheria 
and Erysipelas, 760 
False Membranes.—Patho- 
logy of Diphtheria, 761 
Diphtheritic Deposits, 762 
Prognosis, 763 
Treatment, 763 
Chief Remedies, 763 
Mercury. Hydriodicum, 763 
Kali-bichromicum, 763,766 
Aeon., 764. Bell.,... 765 
Rhus-tox., 765. Colch., 765 
Merc, -iod atus, 765 
Cases, 765 
Bichromate of Potassa, 766 
Inhalation, 767 
Hydriodate of Potash,. 767 
Tartar-emetic, 767 
Arsenicum, 768 
Iodide of Arsenic, .... 768 
Bryonia, 768 
Capsicum-annuum,.... 769 
Carbonate of Baryta,. . 769 
Nitric-acid, 769 
Bromine, 769 
Provings, 770 
Dyscrasias Present in 
Individual Cases,. . . 771 
Cantliaris, 771 
Croton, Rhus, 771 
Nitr.-silver, 772 
Local Applications,... 772 
Bromine Mixtures, ... 773 
Alcoholic Stimulants,. 773 
Diet, 773 
10. Cynanclie Trachealis,—Croup, 774 
Diagnosis, 774 
False, or Non-membranous 
Page 
Croup, 775 
2. True or Membranous Croup, 775 
Causes, 776 
Treatment, 776 
Aconite, 777. Spongia,. 777 
Hepar, 778. Bromine,.. 778 
Caustic Ammonia, 778 
Bichromate of Potash,... 779 
Tartar-emetic, 779 
Effects of Large Doses, .. 780 
Treatment of Croup, .... 781 
High Potencies, 781 
Case, 782. Thuja, ... 782 
Apis., 782. Ipecac...... 782 
Cold Water Bandage,... 783 
Genus V.—Inflamma tory Affections 
of Organs within the Thorax, . . 784 
1. Bronchitis, 784 
Acute Bronchitis, 784 
Diagnosis, 784 
2. Capillary Bronchitis, 785 
(Edema Glottidis, 785 
Summary of Physical Signs, 787 
3. Pseudo-membranous or Plas- 
tic Bronchitis, 787 
4. Chronic Bronchitis, 788 
Complications, 789 
Treatment, 789 
Aeon., Tartar-emet., 789 
Bell., 790. Rhus, 790 
Bry., 790. Pulsatilla,... 791 
Hepar.-sul., 791 
Sanguinaria, 791 
Deobstruents, 792 
Lobelia. Pathogenesis,.. 793 
Apis-mellifica, 794 
Cedron, 795. Arsen.,... 795 
Inhalation, 795 
Other Remedies, 795 
Rhus., Merc., 796 
5. (Edema of the Lungs, 796 
Physical Signs, 797 
Treatment, 797 
6. Haemoptysis—Haemorrhage 
from the Lungs, 798 
Diagnosis, 798 Page 
Pathology, 798. Prognosis, 799 
Treatment, 799 
. Aeon., 800. . Ipecac., . . . 800 
Achillea-millefolium, .... 800 
Hamamelis-virginica, .... 800 
Pathogenesis of, 801 
7. Pneumorrhagia— Pulmonary 
Apoplexy, 802 
Diagnosis, 802 
Physical Signs, 802 
8. Congestion of the Chest in 
Children, 803 
9. Pneumonia.—Pneumonitis.— 
Peripneumonia.—Lung 
Fever, 803 
Diagnosis, 804 
Percussion, 421, 422, 805 
Latent Pneumonia, 805 
Diagnosis, 805 
Causes of Pneumonia, 806 
Prognosis, 807 
Treatment, 808 
Aeon., 808 
Bell., Bry., 808 
Tartar-emetic, .". 808 
Pathology, 809 
Homoeopathic Use in Pneu- 
monia, 810 
Bilious Pneumonia. Cases, 810 
Phosphorus, 812 
Pathogenetic Symptoms,. .. 812 
Mercurius, 813 
Pliosphoric-acid, 814 
Sulphur, 30,° 814 
Rlius tox., 814 
Typhoid Stage, 814 
Veratrum-viride, 815 
Pneumonia in Old and Feeble 
Persons, 815 
Other Remedies, 815 
10. Pneumo-thorax.—Pneumo- 
hydrothorax, 815 
Diagnosis, 816. Percussion, 817 
Vocal Phenomena, 817 
Inspection and Mensuration, 818 
Succussion, 818 
General Symptoms, 818 
Treatment, Pages 808, to 815, 
and 824 to 827 
11. Pleuritis.—Pleurisy, 819 
Diagnosis, 819. Causes,.. 820 
Acute Pleuritis, 820 
Stages of, 820. First Stage, 820 
CONTENTS. 
XXIX 
Page 
Second Stage, 821 
Third Stage, 821 
Diagnosis, 821 
Auscultation, 420, 822 
Diagnostic Symptoms be- 
tween Pleuritis and Pleu- 
rodynia or Intercostal 
Neuralgia, 823 
Treatment, 824 
Aeon. Bry., 824 
Tartar emetic, 826 
Phosphorus, 826 
Rhus-tox., 827 
Arnica. Other Remedies, 827 
12. Chronic Pleuritis, 827 
Period of Accumulation,. 827 
Period of Absorption, 828 
Diagnosis, 828 
Mediastinal Tumor, 829 
Cancer of the Mediastinum, 829 
Diagnosis, 829 
Retrospective Diagnosis.— 
Evidence of the former 
Existence of Pleuritis,.. . 830 
13. Empyema. Pyothorax,.. . 831 
Diagnosis, 831 
Perforation of the Walls of 
the Chest, 832 
Treatment, 832 
See Pleuritis, p., 824 
Pneumonia, p., 808 
Also, Articles Phthisis and 
Scrofula, Volume II. 
14. Emphysema, 832 
15. Epidemic Imflammation of 
the Pulmonary Mucous 
Membrane—Influenza,... 833 
Treatment, 833 
See also Coryza, p., 425 
Summary of Physical Signs 
of Diseases of the Lungs, 834 
Emphysema; Pleuritis,... 834 
Hydrothorax, 834 
Pneumothorax, 834 
Pulmonary Apoplexy, .... 834 
(Edema Pulmonum, 836 
Pneumonia, 836 
Tuberculosis, 836 
Tuberculous Phthisis, 838 
Diseases of the Heart and 
its Appen d ages, 838 
12. Carditis and Pericarditis, 838, 846 
Diagnosis, 838 XXX 
CONTENTS, 
Page 
Causes, 839 
13. Organic Disease of the Heart, 840 
Diagnosis, 840. Causes, . 841 
Sounds of the Heart, 841 
Symptoms Showing Dis- 
ease of the Heart, 842 
Irregular action of the Heart, 842 
Treatment, 842 
Digitalis, 842. Aconite,. 842 
Bry., 843. Arnica,.... 843 
Cannabis. Tart.-emetic,. 843 
14. Endo-carditis. Treatment,. 844 
Influence of External Treat- 
ment in Causing Metastasis 
of Rheumatism to the Heart, 844 
Aconite.—Case, 844 
Kalmia-Latifolia, 844 
Proving of, 844 
Cuprum-aceticum. Cases,. 845 
15. Pericarditis, 838, 846 
Treatment, 846. Case, . . . 846 
Lobelia-inflata, 846 
16. Chronic Aortitis and Cardo- 
Aortitis, 847 
Diseases of the Arteries,... 848 
Organization and Structure 
of the Arteries, 847 
17. Inflammation of the 
Arteries.—Arteritis, 849 
Symptoms, 849 
Diagnosis, 851. Causes, . . 851 
Pathology, 851 
Genus VI.—Inflammation of the 
Abdominal Viscera, ... 852 
1. Gastritis.—Inflammation of 
the Stomach, 852 
Inflammation of the Lining 
Membrane of the Stomach, 853 
Diagnosis, 854. Causes... 854 
Case, 854. Treatment,... 854 
Arsenicum, 854 
Veratrum-alb., 855 
Nux-vom., 855. Pulsat., 856 
Aeon., Iodine, Colch., Ipec., 856 
Gastritis from Effect of 
Boiling Water. Cases,.. 856 
from Effects of Mineral 
Acids. Cases 857 
From Irritation of 
Hard, Indigestible 
Food. Extreme Cases, 857 
From Swallowing 
Melted Lead. Case, 858 
Fagi 
v Experiments,.... 858 
Table of Powerful Mineral 
Poisons and their Antidotes,. 859 
Vascular Nerves of the Ab- 
dominal Cavity, 859 
2. Chronic Gastritis, 860 
Diagnosis, 860. Treatment, 861 
Tartar-emetic, 861 
Alcohol. Case of St. Martin, 861 
Power of Reparation of 
the Gastric Mucous Mem- 
brane, 862 
Alcoholism, 862, 863 
Habitual use of Alcoholic 
Drinks in large Quantities, 863 
Causes of Chronic Gastritis, 863 
Slow Poisons, 863 
Case of Napoleon I. Scir- 
rhus from Chronic Gas- 
tritis, 863, 865 
3. Acute Catarrhal Inflamma- 
tion of the Stomach, 515, 865 
4. Chronic Catarrhal Inflamma- 
tion of the Stomach,.... 865 
See Page, 515 
5. Ulcer of the Stomach, 866 
Diagnosis, 866. Pathology, 866 
Treatment, 867 
Aqua-calcis. Arsenicum, 867 
6. Gastromalacia—Perforatio 
Ventriculi. Perforation or 
Softening of the Stomach, 687 
Diagnosis, 867. Causes,. . 868 
Treatment, 868 
Kreasotum. Oxalic-acid, 868 
7. Self-digestion of the Stomach, 868 
Changes from the Action of 
the Gastric Fluid on the 
Stomach, 868 
Action of the Gastric Juice, 866 
See Digestion p., 217 
Increase of its Secretion by 
Irritation of the Brain,.. 870 
Excessive Activity Discover- 
able During Life, 870 
Excess of Gastric Fluid in 
Certain Diseases, 871 
Ulcer of the Stomach,. 871 
In Advanced Phthisis,. 871 
Disease of the Brain. 
Cancer. Dentition,. 871 
Diminished Power of the 
Digestive Fluid, 872 CONTENTS. 
XXXI 
Pags 
Low Temperature. Alcohol, 872 
Various Appearances found 
in the Softened Stomach 
on Dissection, 873 
8. Hypertrophy of the Coats of 
the Stomach, 873 
Diagnosis, 874 
Treatment, 874. Diet,... 874 
Remedies, 861, 868. Water, 297 
Other Remedies, 874 
9. Duodentis, 875 
Inflammation of the Duode- 
num. Pathology, 875 
Often caused by Mercury, 
Calomel, 875 
Other Causes, 876 
Treatment. See pp.,.410, 574 
10. Gastro-enteritis. Doctrines 
of Broussais, 876 
11. Endemic Gastro-enteritis.— 
Intestinal Paralysis.—Milk- 
Sickness, 877 
The Disease in Animals,.. . 877 
in Man,, 877 
Diagnosis, 878. Cause,... 879 
Pathology, 880. Prognosis,. 880 
Treatment, 880 
Homoeopathic Remedies,... 881 
12. Enteritis. Peritoneal Enteritis 881 
Causes. Treatment, 882 
Arsen., Veratr., 882 
Other Remedies, 883 
13. Follicular Enteritis, 883 
Summer Complaint, 883 
Structure of the Gastroin- 
testinal Mucous Membrane, 883 
Function of Absorption, .. . 884 
Mucous Follicles, 884 
Peyer’s Glands, 884 
Treatment of the First Stage, 884 
Diet, 884 
Diagnosis. Distinction be- 
tween Follicular Enteritis 
and Tubercular Meningitis, 885 
Causes, 886. Pathology,.. 886 
Peyerian Glands, 886 
Softening of the Intestinal 
Mucous Membrane, 887 
Sympathetic Erethism of the 
Brain, 887 
Prognosis, 888. Treatment, 888 
Aeon., Bell., Calcarea-Carb., 888 
Second Stage, 888 
Pag» 
Pathological Appearances,. 889 
Treatment of the Third 
Stage, 890 
Aeon., Bell., Mer.-sol., .... 890 
Ipec., Bry., Dulc., Veratr.-alb., 890 
Cholera Infantum—Croton 
Tiglium, 890 
14. Acute Peritonitis, 891 
Diagnosis, 891 
Puerperal Peritonitis.—Puer- 
peral Fever, 891 
Chronic Peritonitis, 892 
Causes, 892. Treatment,. 892 
Aconite and Belladonna 
the Chief Remedies,.. 892 
Other Remedies, 893 
Opium—Its Characteristic 
action in Abdominal In- 
flammation,. . . 706, 710, 893 
Peritonitis from Rupture of 
the Gall-bladder—Strangu- 
lated Hernia, Rupture of 
the Uterus, Effect of Para- 
centesis, 894 
From Perforation of the In- 
testine, 894 
15. Dysentery, 894. Diagnosis 895 
Causes—Remote, 896 
Exciting, 896 
Pathology, 897 
Congestive Stage, 897 
Inflammatory Stage, 898 
Condition of the Large In- 
testine, 898 
of the small Intestines, 899 
of the Rectum, 899 
of the Mucous Membrane, 899 
the Intestinal Follicles, 900 
Source of the Blood Dis- 
charged, 902 
Prognosis, 902 
Treatment, 904. Diet, .. . 904 
Drinks, 904. Hygiene,.. . 904 
Medical Treatment, 905 
Selection of the Specific 
Remedy, 905 
Generic Symptoms, 905 
Specific Symptoms the only 
Guide, 906 
Aeon. Cases, 906 
Characteristic Symptoms,.. 907 
Bell., 907. Colocynth,... 907 
Arsenicum, 908. Cham.,. 908 XXXII 
CONTENTS. 
Page 
Pulsatilla, 908. Ipecac,.. 909 
Mer.-sol., 909 
Mer.-Corrosivus, 909 
Merc.-viv., 910. Nux-vom., 910 
Iodide of Mercury, 911 
Merc, in Poisonous Doses,. 911 
Apis-Mellifica, 911 
Sulphuric-acid, 911 
Dulcamara, 912. China,.. 912 
Nitric-Acid, 909, 912 
Rhus-tox., 912. Veratrum-alb. 913 
Carbo-vegetabilis, 913 
Sulphur, 913 
Aggravations by Strong 
Purgatives, 914 
Warm Water Homoeopathic, 914 
Flexible Tube. Case, .... 914 
16. Mucous Dysentery—Muco- 
Euteritis, 915. Diagnosis, 915,916 
Treatment, 916. Mercur.,. 916 
Nux-vom., 916. Arsen.-alb., 916 
Chronic Ulceration of the 
Intestines, 917 
Treatment, 917 
17. Colitis—Camp Diarrhoea,.. 917 
Lientery, 917 
Purulent Diarrhoea, 917 
Treatment 918 
Aeon. Colocynth, 918 
Arsen. China, 918 
Other Remedies, 918. Diet, 918 
The National Hotel Epidemic 
(Washington), 918. Cause, 918 
18. Structural Disease of the, 
Colon, 919 
Diagnosis—Sympathetic Ef- 
fects of Structural Disease,. 919 
Symptoms of Accumulations 
in the Colon, 337, 919 
Collections in the Cae- 
cum, 920, 921 
19. Malignant Ulceration of the 
Colon, 920 
Diagnosis, 920 
Treatment,. . . 904 to 917, 921 
Carcinoma of the Rectum,. 921 
Symptoms, 921. Treatment, 922 
Page 
Also see Cancer.—Index. 
Volume II. 
Inflammatory Diseases of 
the Liver, 922 
Congestion of the Liver,.. 922 
Causes, 923. Pathology, 923, 924 
See also Page 399 
20. Acute Inflammation of the 
Liver, 924 
1. Adhesive Inflammation of 
the Liver.—Hepatitis,.... 924 
Diagnosis, 924. Pathology,. 925 
Prognosis, 926. Causes,... 926 
Suppurative Hepatitis, .... 926 
Abscess—Causes, 926 
Diagnosis, 927 
Abscesses of Large Size, . . 928 
Prognosis, 929 
21. Inflammation of the Gall- 
bladder and its Ducts, ... 929 
Diagnosis, 929. Pathology, 929 
Ulceration of the Gall-blad- 
der, 930. Pathology,... 930 
Treatment of Inflammatory 
Diseases of the Liver,. .. 930 
Aeon., 410, 930. Bry.,... 930 
Cham., 931. China, 931 
Lachesis, Bell., Merc., Nux.-v., 931 
Puls., 931. Sulph. 931 
Podophyllum, 931 
Leptandra-virginica, 932 
Nitro-muriatic-acid, 932 
22. Chronic Hepatitis, 933 
Diagnosis, 933. Causes,.. 933 
Treatment, 933 
H}Tpertrophy of the Liver,. 934 
Aurum.—Case, 934 
Fatty Degeneration of the 
Liver, 934. Causes,.... 935 
23. Cancer of the Liver, 936 
Diagnosis, 936. Causes,.. 936 
Pathology, 937. Treatment, 937 
24. Splenitis—Inflammation of 
the Spleen 512, 516, 937 
25. Pancreatitis, 941 
26. Leucothyaemia Splenica, .. 942 
27. Leucosis, 943 THE 
HOMEOPATHIC 
THEORY AND PRACTICE 
OF 
MEDICINE. 
HISTOKY OF MEDICINE. 
The Science of Medicine lias not hitherto been ranked among the 
exact sciences. Its most zealous votaries are still compelled to ac- 
knowledge that all efforts to reduce its principles to the precision of 
mathematical rules have failed; and, though we purpose to show that 
Theoretic and Practical Medicine is the grandest of all the Sciences 
and the noblest of all the Arts, we do not pretend to have discovered 
any royal road through which indolent or careless inquirers may as- 
cend its sublimest heights. Persons who desire to be successful in 
treating even simple diseases must be willing to devote some time to 
the study of the human body, the nature of disease, and the effects of 
remedies. 
The reading of primary Hand-books which may contain a mere sum- 
mary of many subjects can never qualify for the full understanding and 
correct treatment even of the most common diseases. So exten- 
sive is the field of Medical Science, so intricate are the problems in- 
volved in the theory of all complicated forms of ill health, that a 
book which can be considered a safe guide for any-body in severe cases, 
must be something more extensive than a cheap domestic Manual, though 
works of that character have performed an immense public service 
in qualifying the people to discriminate between good and bad practice, 
—between substantial merit and pompous pretension in practitioners. 
The object of the student of Medicine is the attainment of Truth as 
revealed in the human body in its relations to the created Universe 
and all his aims are consistent with the best interests of our race 
Those who study Medicine most extensively, will become most familiar 
with man’s nature in all its aspects; they will become conversant with 
the sources of physical and moral evil; and, in penetrating the mystery 
VOL. I.--3. 
33 34 
HISTORY OF MEDICINE. 
of affliction, they will learn to comprehend the laws by which nature is 
governed in her efforts to resist the powers of disease, as well as to aid 
those efforts in accomplishing their beneficent purposes. 
The origin of Medical Science is lost among the obscure traditions 
and fables of the earliest ages. The mythological history of the ancients 
derived the art of curing diseases from the direct inspiration of their gods 
and even among the moderns many authors of the highest reputation 
have attributed to Medicine a Divine origin. But, in reviewing 
progressive steps by which the most sublime of all sciences has advan- 
ced from a position in which it was a mere appendage to the priestly 
office to that of a proud and noble profession, we may safely begin with 
the assumption that individual observations must have been made by 
the earliest inhabitants of our earth; that these observations embraced 
the diseases to which they found themselves subject, as well as the 
injuries received in war or by accidents. As in modern times the 
lowest savages discovered by explorers have possessed some degree of 
medical and surgical knowledge ; it may be presumed that medicine 
in its rudest form is almost coeval with the duration of human existence. 
The sight of suffering in the earliest times must have led to the desire 
to relieve it. And when men’s small experience failed, super-natural 
means, such as charms and incantations must next be tried. 
At what period it began to be practiced as a distinct profession is 
not known. The most ancient physicians we read of were those who 
embalmed the body of the patriarch Jacob, by order of his son Joseph; 
and these physicians were the servants of Joseph, not priests, as the 
earliest physicians are supposed to have been. At that time Religion 
and Medicine had been already separated into distinct callings and 
they so continued ever afterwards. 
The Egyptians themselves attributed the invention of Medicine to 
Thoth, the Hermes, or Mercury of the Greeks. He is said to have 
written many rhings in hieroglyphic characters upon certain pillars, in 
order to perpetuate his knowledge. These were transcribed by 
Agathodemon, or the second Mercury, whose son Teut is said to have 
composed books of them which were kept in the most sacred places in 
the Egyptian temples. The books however attributed to these ancient 
personages have long been considered as forgeries ; and they were more 
probably written many ages after the time of Hermes. 
The art of curing disease was blended in the religion of Egypt with 
superstitious traditions and observances ; and it is certain that their first 
physicians were priests. They were treated by the people with the 
highest respect; and on certain public occasions they moved in solemn 
procession through the splendid temples and palaces of Thebes and 
Memphis, dressed in stately robes, and bearing the symbolic, represen- 
tative bed of the goddess of Love and Beauty. As the Egyptians, and HISTORY OF MEDICINE. 
35 
afterwards the Greeks, considered diseases as a direct manifestation 
of the displeasure of the gods, they looked to the ministers of these 
deities, the officiating priests of the temples, as the divinely favored 
agents through whose influence the pestilence might be averted. They 
believed there were thirty-six spirits or demons of the air, who divided 
the human body among them; they had names for them all; and by 
invoking them according to the part affected, the patient was cured. 
This system has prevailed in all Pagan countries. The American 
Indian priests, says Monardes, when consulted by the Caciques, took 
large quantities of tobacco smoke, fell to the ground, and after lying 
a while in a stupor, they arose and delivered the answers they had re- 
ceived from the wrorld of spirits. 
It is not known that Mercury, the father of Medicine in Egypt, em- 
ployed many natural remedies. The only prescriptions made by him 
that have been transmitted to us by the poets, consisted of the herb 
Mercury, of which he discovered the use, and the herb Moly, which he 
gave to Ulysses to secure him from the supernatural powers of Circe 
the enchantress. His successors learned the process of venesection 
from the Hippopotamus, which is said to perform the operation on itself 
by striking the leg against a pointed reed, taking care to direct the 
stroke against a vein. Cathartics, emetics, clysters and abstinence 
constituted the principal remedial measures of the early successors of 
Mercury in Egypt. Galen says that 630 years B. C. the Egyptian 
king Nechepsus wrote, that a green Jasper stone, cut in the form of a 
dragon, surrounded with rags, and applied to the epigastrium externally 
would strengthen the stomach and promote digestion. 
At a later period Medicine was divided into numerous branches or 
specialties in that country. Herodotus says: “Each physician applies 
nimself to one disease only, and not more. All places abound in phy- 
sicians : some are for the eyes, others for the head, others for the 
teeth; some devote themselves to parts about the abdomen ; and others 
entirely to internal disorders.”—[Herodotus, Euterpe, cap. 84.) 
The art of embalming, which still astonishes modern nations was per- 
formed rather as a religious rite than as an appropriate appendage to 
the medical art. In the process, says Herodotus, the brains were 
drawn through the nostrils with an iron hook; and the intestines were 
taken out through an opening in the side with a sharp stone. It is 
not probable that those engaged in the art of embalming ever acquired 
much knowledge of the structure of the human body. The decaying 
bodies of the dead.were viewed only as objects of disgust or supersti- 
tious reverence ; and among the Hebrews, who had passed a captivity 
of near four hundred years in Egypt, he who even touched a dead body 
had certain ceremonies of purification enjoined upon him; and if these 
were neglected, it was declared that his presence defiled the sacred 36 
HISTORY OF MEDICINE. 
Tabernacle, and he was separated from the congregation of Israel. On 
going out from Egypt to Canaan, the Israelites carried with them the 
hones of the patriarch Jacob, and his ear-rings were buried as amulets 
under the oak of Sichem. The Jewish priests continued to be the only 
physicians. The Law of Moses, combining enlightened principles of 
Hygiene with typical and emblematic religious observances, prescribed 
the separation of persons infected with the leprosy, and pointed ou 
the diagnostic symptoms by which the priests should pronounce upon 
the character of any cutaneous disease which should present any of 
of its features. The Law directed that any “ rising, scab, or bright 
spot” on the skin, which should “ resemble the plague of leprosy,” 
should be exhibited to a priest; “and when the hair in the plague is 
turned white, and the plague in sight be deeper than the skin of the 
flesh, it is a plague of leprosy, and the priest shall look upon him and 
pronounce him unclean,” on whose skin it occurs. The further medical 
duties required of the priests are detailed in the twelfth and fifteenth 
chapters of Leviticus. They have long been regarded as embodying 
the most profound principles of medical police; and the latest writers 
have expressed “ admiration for the wisdom and foresight which made 
such salutary regulations a religious duty.”—(RenouarcPs History of 
Medicine, p. 33.) In the course of successive centuries after the ar- 
rival of the Jews in Palestine, medicine became a separate vocation. 
Sometimes men wTere consulted who professed to be in direct communi- 
cation with the spirits or daemons of the invisible world; as the king 
of Judah sent messengers to inquire, through the priests of Baalzebub, 
the god of Ekron, whether he should recover from his disease or not. 
The author of the Apocryphal book Ecclesiasticus mentions the office 
of physician as distinct from that of a priest about 200 years before 
the Christian era; and claims that high “honor is due him for the 
uses ye may have of him;” “ For of the Most High cometh healing,” 
and the physician “ shall receive honor of the king.” Josephus says 
(lib. 8. c. 2, 5.) that Solomon the king discovered a plant which cured 
epilepsy with the aid of a charm or spell. The root was concealed in a 
ring and applied to the nostrils of the demoniac ; and the historian 
says he saw it practiced with complete success in the presence of 
Vespasian, his sons and the Tribunes of the Roman army. From this 
tradition come the stories of the Seal of Solomon: 
“ Some amulet of gems anneal’d 
In upper fires, some tabret seal’d 
With the Great Name of Solomon.” 
Which spell’d by her illumined eyes 
May teach her, where beneath the moon 
In earth or ocean, lies the boon. 
The charm that can restore so soon 
An erring spirit to the skies. (Paradise and the Peri.1 HISTORY OF MEDICINE. 
37 
The Greeks attributed the invention of medicine to several persons 
of whom Prometheus, Apollo, and iEsculapius were the most dis- 
tinguished. Being a warlike people, the art of curing disease was 
little cultivated for centuries, while the surgical department of Medicine 
was so highly esteemed that their best poet declared, that 
“A wise physician skilled our wounds to heal 
Is more than armies to the public weal.” 
They trusted much to amulets as late as the days of Pericles, who was 
pronounced insane by Theophrastus, because he wore an amulet on 
his neck. 
The most celebrated Greek physician during the fabulous ages was 
iEsculapius. Ilis skill in curing diseases was so great that he was 
highly revered by the people during life ; and, after his death it was 
believed that he had been removed from earth at the request of Pluto, who 
complained that the physician performed so many cures that he was 
rapidly diminishing the number of the dead. iEsculapius was after- 
wards ranked among the gods ; and temples were erected in which his 
pupils, Chiron, Machaon, Podalirius solicited the aid of their great 
master. Among the pupils of Chiron the Centaur were: Hercules, 
who discovered the virtues of many plants ; Aristeeus king of Arcadia, 
who first used the drug called Silphium, supposed by many to be 
asafoetida ; Theseus, Jason, Telemon, Peleus, and Achilles. The last 
named of these is said to have discovered the use of Verdigris in 
cleansing foul ulcers ; and Palamedes prevented the plague, which had 
ravaged most of the cities of the Hellespont, including Troy, from en- 
tering the Grecian Camp. His method was to confine the soldiers to 
spare diet and oblige then to use much exercise. Helen mixed opium 
with wine and gave it to the guests of Menelaus under the expressive 
name of Nepenthe, to drive away their cares. Opium was obtained from 
Thebes in Egypt, from which Tincture of Opium was called Thebaic- 
tincture. (Odyssey V.) 
The first great schools of medical knowledge among the Greeks were 
the Temples of iEsculapius. The priests who directed their erection 
knew how to select healthy locations; the reverence which the priests 
inspired in the minds of the invalids ; the invigorating effects of hope, 
change of scenery, diversion of mind; and the exercise of long journeys 
by which the temples of the god were reached; all contributed to in- 
crease the fame, as well as the successes of the priests of iEsculapius. 
Their powers were greatly enlarged by strict hygienic rules, which 
men will observe when prescribed as parts of a religious ceremony, but 
scorn and neglect when dictated by true science and common sense. 
These priests (or Asclepiades) also employed many agents of real 
power. Darwin thought the Cumsean sibyl took a few drops of the juice 38 
HISTORY OF MEDICINE. 
of the cherry laurel before ascending the prophetic tripod. Others 
suppose they used stramonium or opium. (Paris, Yol. 4, 24.) In 
some cases they pi'escribed bloodletting, purgation, emetics, friction, 
sea-bathing, and various mineral waters. Beyond all this, and exercis- 
ing a powerful influence on the sick and their friends, was the mental 
influence of the doctor-priests. Admission to the temples was only 
permitted after certain processes of purification had been undergone. 
The interrogation and the answers of the oracle were often delayed for 
a day, and one or two nights wdiile the patient remained lying in the 
temples. Abstinence, prayers, fastings, sacrifices followed. In some 
of the temples a ram or a fowl, at Cyrene a goat, and in other places 
various animals were sacrificed to iEsculapius before the will of the 
oracle was asked for. Socrates, requested in his last interview with 
his friends, that they would sacrifice for him a cock to iEsculapius. 
The answers were sometimes delayed, and sometimes mystical and dif- 
ficult of interpretation. Sometimes the divinity wTas made to appear 
in the form of a serpent, devouring the cakes upon his altar; other 
manifestations were made through dreams which were interpreted by 
the priests. The temples of the god of Medicine thus became the 
first hospitals in which the sick were regularly treated. To them those 
who could reach them brought the afflicted; and those who could not, 
in various countries, exposed the sick by the side of the highways, that 
they might receive the advice of every one who passed. {Good, Ca- 
banis, Renouard, &c.) In these early ages the knowledge that was ac- 
cumulated by such means as these wTas chiefly transmitted to posterity 
by tradition. {Strabo) 
The chief temples of iEsculapius were those of Epidaurus in the 
Peloponessus, Pergamus in Asia Minor, Rhodes in the isle of Cos, 
Cnidos, and Cyrene in Lybia. Besides these nearly one hundred have 
been enumerated in the different countries afterwards included in the 
Roman Empire. (Schulze Hist. Med.) In these temples the first re- 
corded experience of men in the treatment of diseases were transmitted 
to posterity in the form of inscriptions on plates of metal, wood or 
stone. The priests reported to new patients the history of cases which 
had been previously treated with success. The descriptions of cases 
and the methods of cure were briefly and imperfectly given; but they 
were of immense value to men in succeeding generations. They formed 
the first rudiments of that art which was in future to grow into a 
sublime and noble science, through that very method of observation 
and experiment which wras there first inaugurated in the world. These 
temples of the god of Medicine maintained their rank in the estimation 
of men long after the genius and industry of Hippocrates had reformed 
the theories and practice of ancient medicine. Democedes,who had been 
the slave of a tyrant of Sardis, became court physician to Darius, Emperor HISTOKY OF MEDICINE. 
39 
of Persia, by his success in curing the “king of kings” of a sprained 
ankle. The intellectual labors of Pythagoras, Heraclitus, and Democritus, 
had already divested it of many of its useless superstitions, when “ that 
divine old man” Hippocrates undertook to create a new science out oi 
the old materials; and then to supersede all the old by new obser- 
vations on diseases of every form. At that time anatomy and physiology 
were almost entirely unknown. The Materia Medic a of the Greeks 
•was limited to a small number of articles, and the powers of these were 
imperfectly understood. But the reformer brought to his work the 
most extensive and varied qualifications. In the ability to observe, 
collect, arrange, and methodize, he surpassed all who had preceded him. 
Inheriting the wisdom recorded in the votive tablets of the Temples as 
the “seventeenth lineal descendant of iEsculapius,” he commenced the 
labor of making a clinical report of the daily changes that occurred in 
individual cases of disease. In recording the symptoms from day to 
day, and narrowly watching the good and bad effects of his remedies, 
Hippocrates originated Clinical Medicine / through the “ bedside ex- 
perience” of the wisest and best physicians of all ages, Medicine, as a 
science and an art, has since grown to what it now is. 
Hippocrates (born 460 B. C.) lived four centuries before Christ, and 
he is the most ancient medical author whose works have descended to 
our times. Regarding his science “ as a principle of humanity, and not 
merely as a means for attaining profit and glory,” he abandoned the 
course his ancestors had pursued; and, instead of instructing the mem- 
bers of his family alone, he endeavored to communicate his knowledge 
to strangers; and thus to extend the usefulness of medicine in the 
wrorld. The “iEsclepiadean oath,” by which the mysteries of the 
science were confined to the limits of a single family, Avas now super- 
seded by the “ Hippocratic oath” or declaration still respected in Modern 
Schools. Several of his pupils became his most distinguished successors. 
Many of the works attributed to him are known to be forgeries. Brevity, 
gravity, and the absence of visionary theorizings are the characteristics 
of his writings.” 
The Theories by which Hippocrates endeavored to explain the causes 
of disease were necessarily imperfect, though generally based upon 
patient observation. His knowledge of Anatomy was limited to the 
results of the dissection of animals; and but once in his life did he 
enjoy the privilege of seeing a human skeleton. He refers much to 
the humors of the body, particularly to the blood and the bile, sup- 
posing that there were but two fluids in the body; he employs the 
same word to express his idea of a nerve, a ligament, or a tendon; he 
gives much attention to the good and bad effects of sleep, watchings, 
exercise, and rest. With him the same word is used for an artery, a 
vein, or an excretory duct; and the word aima signifies any fluid. On 40 
HISTORY OF MEDICINE. 
the subject of diet he wrote several hooks, and was particularly careful 
in selecting the food of invalids ; in observing the courses and changing 
of the winds; the irregularity of the seasons, the rising and setting of 
the stars or of certain constellations; also, the times of the solstices, 
and of the equinoxes. To all of these meteorological and astronomical 
changes he attributed effects which he has not attempted to explain. 
He thought the above causes, with many others, when operating on 
different regions of the body, produced diseases of greater or less 
malignity; some of these he accounted mortal, others dangerous, and 
the rest easily curable, according to the cause from which they originate 
or the parts of the body on which they fall. He also distinguished 
diseases into acute and chronic, into endemic, when confined to certain 
localities, and epidemic, when they seized great numbers at a time, 
passing from one place to another; of this kind the most terrible known 
to him was the plague. He also remarked that single cases of diseases 
usually epidemic sometimes appeared alone: these cases he called 
sporadic. He distinguished between those diseases which are heredi- 
tary, or born with us, and those which are contracted during life; and 
also between those that are of a milder character and those of a ma- 
lignant nature, and are less frequently overcome by medicine. The 
chief articles in his Materia Medica wrere : Hellebore, Colocynth, Elate- 
rium, oxydes and scales of Copper, Onions, Garlic, Parsley,Wine, Honey, 
Cantharides. The peculiar merit of Hippocrates is found in that great 
power of observing facts which he so eminently possessed, and so con- 
scientiously employed; in that high analytical intellect which could 
trace symptoms to their origin, and classify and arrange the vast 
number of observations made by himself and others; in that exalted 
morality which always commands respect; and in that intuitive insight 
into human character, and physical as well as moral peculiarities, by 
which minds can be controlled, and pathological conditions analyzed. 
Though but an indifferent practitioner in our view, he was the greatest 
of medical observers. Whatever may have been the merit of his suc- 
cessors, the improvements made by their master appear to have been 
so satisfactory to them, that no real advances were made for ages after 
his death, which occurred at Larissa, when he had reached the age of 
90 years. He had practised his profession at Abdera, in Thessaly, 
but chiefly at Cos; wThich he had rendered famous by making it the 
only great School of Medicine in the world. At the same time that 
Hippocrates was constructing the Science of Medicine, “the illumined 
Plato” was employed in revolutionizing philosophy. Without entering 
into the study and practice of medicine, as a profession, Plato became 
familiar with what was then known of the theory, of the science and 
the economy of the human body. He was followed by Aristotle, whose 
wonderful genius left its impress on all the intellectual pursuits of men HISTORY OF MEDICINE. 
41 
for more than a thousand years. The character of his mind was 
different from that of any philosopher who had preceded him, in that 
strange power of “grasping, as if by intuition, all the stores of 
knowledge;” while it “leaves dull learning toiling far behind.” His 
strength consisted, not in collecting with patient labor the minute facts 
of which a theory might be constructed; but in boldly penetrating the 
realms of the mysterious and unknown, and generalizing, as if by the 
aid of inspiration, the truths already known, and those which remained 
to he discovered. As a primary doctrine he regarded the soul as “the 
efficient, the final, and the formal cause of the body.” That his pro- 
found speculations should be found invariably true, could certainly 
never have been hoped for by himself, but that his genius, such as it 
was, should have sufficient inspiration in it to sway the minds of men 
for along series of ages, continues still to be a subject for the admiration 
of philosophers. Medicine in succeeding centuries permitted the 
Aristotelian Philosophy to mould her theories, when her disciples 
should have been employed in making new observations for themselves. 
Among the most distinguished successors of Hippocrates were 
Polybius, Draco, Prodicus, and Praxagoras, who ventured to deviate 
from the opinions and practice of Hippocrates. He is said to have 
cured ileus by cutting open the abdomen and intestines and sewing 
them up again. Erasistratus adhered more strictly to the doctrines ot 
the great master. He gave to the world the first regular indications 
of the pulse, and came near discovering the circulation of the blood; 
but he could not perceive the use of the two sets of cavities in the 
heart, and was afraid to bleed, lest the blood should find its way from 
the heart to the arteries which he thought contained nothing but 
spirit. 
The death of Alexander the Great, 324 B. C., was followed by the 
dismemberment of the vast empire he had erected on the ruins of 
conquered kingdoms; and his successful general and half-brother, 
Ptolemy Soter, became king of Egypt, in the year 321 B. C. Alex- 
andria, founded only seven years before, became his capital, and the 
centre of the science and learning of the Greeks. The first Ptolemy 
founded the library and museum of Alexandria, which were enlarged 
by the munificence of his successors until the literature of all nations 
were collected in the royal library of the successors of Alexander. 
After the purchase of the library of Aristotle, the largest then in the 
world, the Alexandrian collection, according to Eusebius, contained 
one hundred thousand volumina or rolls, the whole of which were 
placed “at the disposal of studious men, who were desirous to use them 
for their improvement and the advancement of science.” (Renouard, 
p. 166.) The extensive commerce in which the Greeks were engaged, 
enabled the Ptolemies to gather together the rare plants and animals 42 
HISTOKY OF MEDICINE. 
of distant climates, stimulating the curiosity of naturalists and physi- 
cians. Medicine was now divided into three branches, the dietetic, the 
pharmaceutic, and the chirurgic; these branches became entirely 
distinct and were cultivated by different individuals. 
Anatomy and Physiology now received a new impetus in the efforts 
of Herophilus and Erasistratus, who commenced the dissection of the 
human body and the vivisection of animals at Alexandria. About 287 
B. C. Serapion of Alexandria formed a new sect called the empirical. 
He retained the practice of Hippocrates; but despising his mode of 
reasoning, depended on personal experience alone. His followers used 
Castor, Opium, Cicuta and Henbane. Those who maintained the value ol 
theories were afterwards known as dogmatists; they insisted on the 
necessity of knowing the .latent as well as the evident causes of disease; 
and taught that physicians should understand the natural actions and 
functions of the body. At this period there were medical schools of 
some importance at Smyrna, Pergamus, and Epidaurus, all of which 
attracted students, and were visited by distinguished pupils from 
Alexandria. 
At Rome the study and practice of Medicine remained entirely un- 
known for more than six hundred years after the founding of the city 
{Pliny, Liber 39. Chap. 1.) Though the usual efforts of ignorant men 
to mitigate pain must have been made, there was no class of men who 
devoted themselves to the treatment of diseases alone. The people 
had faith in the priests and oracles, and the mystical responses of the 
Cumsean Sibyl were particularly reverenced. jEneid., Lib. VI. 78.) 
According to Livy, the Roman historian, the medical and religious 
sciences of the Greeks were introduced at Rome 234 years B. C. 
Fifteen years afterwards Archagatus, son of Lysanias of the Pelopones- 
sus, settled in the Eternal City as a physician and surgeon. The 
practice of surgery was considered incompatible with kindness and 
humanity, and the Romans were deeply prejudiced against everything 
from Greece; hence all the Greek colonists in Italy were regarded with 
envy or hatred by the people; and Marcus Porcius Cato, the Censor, 
particularly distinguished himself in his hatred of physicians, {Cor- 
nelius Agrippa, Arts and Sciences, p. 297) and he even meditated the 
expulsion of every man from Rome who should attempt to practice 
there. For a century more no distinguished physician appears in that 
city, till Asclepiades of Bythinia (horn 91, B. C.), who, having failed as 
a teacher of rhetoric at Rome, took up the practice of Medicine, at 
a comparatively late period of life. He at once openly opposed 
Hippocrates’ theory of natural power and sympathy or attraction, and 
engrafted upon his science the physical principles of the Epicurean 
philosophy. By the general condemnation of the practice of his co- 
temporaries, and the disparaging manner in which he spoke of all the 43 
HISTOKY OF MEDICINE. 
doctrines of his predecessors, he attracted a large share of public 
attention. “His arts,” says Pliny, were such as evex-y fashionable 
physician employs : soothing the patient and avoiding every thing that 
can give pain till nature cures him, or he sinks under the disease.” 
By these arts Asclepiades became the most fashionable practitioner oi 
his time. He declared that he deserved no credit if he should ever 
become sick himself; and by good fortune he always escaped disease 
till extreme old age, and was then killed by a fall down stairs. He 
employed the lancet in acute diseases of the chest accompanied with 
pain; incised the tonsils; and wTas the first to perform the important 
operations of laryngotomy and tracheotomy. He originated the doctrine 
of “the self-limitation of diseases, asserting that the pi'incipal cure for 
a fever was the disease itself.” ( Watson, p. 101.) 
Omthe conquest of Gaul and Britain the Homans became acquainted 
with the Druids, who were both priests and physicians. They gathered 
the Mistletoe or Yiscum Album, cutting it with a golden knife when the 
moon was only six days old. This parasitic plant, when consecrated 
by certain cei’emonies was considered the most certain remedy against 
poisons and sterility. The letter R used at the beginning of a medical 
prescription is now usually understood to be an abbreviation for the 
wrord Recipe, but was originally employed as the astrological symbol 
of Jupiter, as it was under this planet the plant prescribed wras to be 
gathered. 
Vervain was to be gathered after drinking of honey, at the rising ot 
the dog-star, at a time when no sun or moon was shining, and collected 
only writh the left hand. It then had power to cure fevers and the 
bites of serpents ; and was employed to conciliate friends. 
Immediately after Asclepiades arose Themison, the founder of the 
Methodic Sect; whose doctrines evinced equal hostility to the dog- 
matists and the empirics; he divided diseases into the two classes 
of hypertonic and atonic/ a division which with some modifications 
has descended to the present day; Thessalus, who was contemporary 
writh Nero, was a man of merit but of inoi’dinate vanity. 
Aurelius Cornelius Celsus, the first native Roman who wrote on 
Medicine, was born in the year 4, A. D. After receiving the best 
education the times afforded, he engaged in writing on various scientific 
subjects; and it is said that he served as Secretary to the Emperor 
Tiberius on his expedition to the East. Devoting himself to medicine, 
he left behind him a large work which is equally valuable for the, 
elegance of its language, and the complete knowledge it gives of the 
state of medicine at the time he wrote. The Treatise “De re Medica, 
libri octo” is the only work of Celsus that has been preserved, and it 
is not entirely complete. In many parts of it the author agrees with 
Hippocrates, and quotes largely from him. Asclepiades is his next 44 
HISTORY OF MEDICINE. 
highest authority; and after these Themison his contemporary, and 
Iderophilus and Erasistratus of the Alexandrian school. Though 
agreeing in general with Hippocrates, Celsus rejected the doctrine 
of critical days, which has been often revived and exploded, and still 
holds a place in modern works on febrile diseases. (Brit. & For. 
July, 1857, p. 61.) 
In the time of Celsus Surgery had made more progress at Rome 
than it had ever done among the Greeks or Asiatics. Many of the 
largest operations are minutely described by Celsus; and the instru- 
ments and apparatus employed by the ancient surgeons have been dis- 
played to modern eyes among the relics of the disentombed cities of 
Italy. In the year 79 A. D., while Celsus was still living at Rome, 
and was probably engaged in writing his great work “ De re Medica,” 
the Cities of Herculaneum and Pompeii were overwhelmed by a tempest 
of ashes, cinders, and lava, poured upon them by an eruption of Mount 
Vesuvius. The people with all their wealth were in a moment en- 
tombed in their own dwellings ; and all their works of art, all the para- 
phrenalia of domestic life, and all the apparatus employed in all the 
branches of science, stood still in their places, and remained unchanged 
and uninfluenced by the revolutions of seventeen centuries. Modern en- 
terprise has now disrobed the silent cities of the dead, and brought to 
light the long-buried remnants of ancient arts and sciences. Among 
them the ofiices of the physician and apothecary, and the various 
implements employed by the surgeon may be seen in the Royal Museum 
of Naples. (See Prof. Vulpes’ “lllustrazione Strumenti Chirur., 
dec.”—Dublin Quar. Jour. Med., Aug. 1852.) The Romans still trusted 
much in the powers of charms and amulets, till the Emperor Caracalla 
passed an edict that no more amulets should be worn. (Paris Pliar- 
macologia Introduc.) For 250 years, extending from the time of 
Asclepiades to Galen, Celsus was the only distinguished medical writer 
at Rome. The state of the sciences generally can be best seen in the 
works of Pliny the younger. The Romans made few discoveries, but 
they were ever ready to adapt to public uses the improvements made 
by the Greeks. Among their sanatory improvements may be noticed 
u their immense cloacos for the drainage of the city,—their public 
baths,—their care in the selection of sites for new towns, villas, and 
private residences,—their improvements in architecture, and domestic 
arrangements of dwellings,”—all of which show that the lectures of 
their Greek masters on the rules of health had been properly appre- 
ciated. Watson, Discourse,—N. Y. Acad, of Med., 1856, p. 142.) 
Of distinguished men in the distant provinces of the Empire, at this 
period, the most conspicious was Aretams of Cappadocia. Though little 
is known of his life, it is supposed that he passed part of his life in 
Egypt, and probably made his way to Rome, the great capital of the HISTORY OF MEDICINE. 
45 
empire, (Adams’ Biogr. Works of Aretceus.) He was the ablest of 
the defenders of the new doctrines of the sect called the Pneumatics; 
who taught that the body was constituted of solids, fluids, and pneuma 
or spirits, and upon the due correspondence and relationship of these 
three constituent elements depended health. The “pneuma” or spirits 
was regarded as a subtle fluid, passing from the lungs to the heart, and 
thence by the arteries distributed to all parts of the system. The heart 
was believed to be the focus or central point of the vital force or soul. 
“A dense pneuma” was supposed to cause organic obstructions. The 
description of Hypochondriasis by Aretseus is elegantly written and 
proves him to have been an accurate observer. The two Andromachi 
became conspicious at Rome, by the elder one, (the father), becoming 
physician to the Emperor Nero ; and Dioscorides, born in Cilicia in the 
latter part of the first century, wrote the only complete treatise on the 
Materia Medica now extent among the labors of antiquity. 
In the year 131 A. D., during the reign of the Emperor Hadrian, 
was born Claudius Galen at Pergamos in Asia Minor. Pursuing the 
study of medicine in his native city, in Smyrna, Corinth, and Alexandria, 
he, after travelling through Cilicia, Phoenicia, and the isles of Scyros 
and Crete, returned to Pergamus at the age of 28 years. It was not 
long till the successes of many Greek physicians attracted him west- 
ward to Rome. Here he commenced lecturing, writing and practicing 
his profession, and soon drew upon himself the envy of inferior men 
who stigmatized him as a theorist and a dealer in magic. In less than 
five years he was obliged to leave Rome, under pretence of avoiding a 
plague then raging there, which had originated at Antioch, 166 A. D., 
but he was soon recalled from his native city to attend the two Em- 
perors Aurelius and Yerus, of whom the latter died. The physician 
made the long journey on foot, and Aurelius formed so high an opinion 
of Galen, that he entrusted him with the care of his two sons; and 
Galen having predicted the recovery of one of the princes from fever 
in opposition to the opinion of other physicians, rose at once to the 
highest rank in the profession. He lived to the age of 70 years and 
died during the reign of Severus. To him is commonly attributed the 
famous maxim: “oontraria oontrariis curantur,” and the invention of 
cold and hot, dry and moist diseases. 
Galen wrote about 750 Essays on various medical subjects, constitu- 
tions and medicines. His first object was to illustrate Hippocrates 
who was then imperfectly understood by the commentators. 
Galen was evidently superior to all his contemporaries. And so 
successfully did he expose the “ deficiency of their information,” and 
the “futility of their reasoning,” that he triumphed over all his rivals} 
and “ attained a rank in the medical world, and swayed the opinions of 
physicians and the public on all points connected with medicine in a 46 
HISTORY OF MEDICINE. 
manner before and since unknown.” He lived at a time when the Roman 
Empire combined all nations into one; and when extended intercourse 
between men of different countries had developed the human mind to a 
degree that had not been reached at any former age. Of the man}'- works 
attributed to him, eighty-three are believed to be genuine. The bes 
edition of his works is that of Kuhn, in twenty volumes, 8vo. 1821-1883 
Galen attached himself to no one of the different sects into which 
he found the profession divided, and despised those who gave them- 
selves up to obey any particular master. He followed Hippocrates in 
denominating the vital principel Nature; like him he admitted the 
existence of four distinct humors, from the predominance, or de- 
ficiency, or disproportion of which originate the different tempera- 
ments of the animal frame, and the varieties in the different diseases 
to which it is subject; these humors are the blood, phlegm, yellow, 
and black bile. He likewise established three distinct kinds ot 
auras, gases or spirits, a natural, a vital, and an animal, which he 
regarded as so many instruments to distinct faculties ; referring the 
seat and action of the first chiefly to the liver, of the second to the 
heart, of the third to the brain. 
Though Galen nowhere refers to the dissection of the human body, 
he frequently examined monkeys and other animals, and made some 
important experiments in Physiology. It had been taught by Era- 
sistratus and the disciples of the Alexandrian school that the arteries 
contained only air. Galen contrived a series of experiments by 
which he demonstrated the fact that these vessels contained blood 
and blood alone. This was the most important discovery in Physi- 
ology that had ever been made: and the account he gives of the 
respiration shows also that his mind hud caught hold of some cor- 
rect ideas, which aided in the making of future discoveries. In 
pathology his views were less correct. Like Hippocrates, he sup- 
posed that the primary cause of disease existed in the fluids ; and 
he adopted the doctrine of the four elements as the basis of all his 
reasonings. He distinguished between the remote or predisposing 
causes of disease, and those now called exciting or causes near at 
hand ; and regarded the superabundance, the degeneration, or the 
putridity of the humors as the primary cause of all diseases. Upon 
this pathology his practice was based, and it was often successful, 
even when suggested by erroneous theories. In his general rules 
of regimen, diet, and the prescribing of medicines he followed Hippo- 
crates ; at Pergamos he acted both as physician and surgeon, ac- 
cording to the usage in provincial cities. In the great metropolis 
of the world he restricted himself to medicine exclusively. [Brit, do 
Nor. Med. Chir. Rev.—July 1857, p. 66.) 
After the death of Galen no medical author of high abilities appear- HISTORY OF MEDICINE. 
47 
ed for centuries ; and the reign of the “ Prince of the Latin Physicians” 
continued unshaken. Ordinary men could originate nothing new; arid 
they dared not express an opinion in opposition to the authority of 
Galen. After the overthrow of the Roman Empire of the West, the seat 
of learning and the arts was transferred to Constantinople ; but no im- 
portant discovery in medicine was made till the commencement of the 
sixteenth century. The Arabians adopted the chemical ideas which 
the learning of antiquity afforded; but they neglected the study of 
Anatomy, and the solid sciences on which alone a true system of me- 
dicine could be erected. There could he no general diffusion of medi- 
cal knowledge so long as an individual could not obtain the written 
Works of his predecessors. The few manuscripts that existed could 
only be seen in a few libraries, and the greatest collections the ancients 
had ever made were burned by ignorant or fanatical invaders or rulers 
who knew nothing of their value. The Alexandrine Library was 
destroyed by Cgesar’s soldiers, and when the Arabs conquered Egypt 
a few centuries after, all that remained of classic literature in the city 
of the Ptolemies was burned by order of the sultan Amrou. (A. D. 
640.) The Library founded by Constantine at Constantinople, contain- 
ing at least 300,000 volumes, including the works of Homer written in 
letters of gold on the entrails of serpents, was burned by order of Leo 
Isaurus the bigoted Emperor. The Vatican library of Rome was destroy- 
ed by Charles, Constable of Bourbon. In France the first Library was 
founded by King Charles V., who died in 1380. The 20 volumes be- 
queathed to him by his father were augmented by him to 700, and 
placed in the Louvre. Before printing was invented a manuscript 
was a precious treasure. A Latin breviary was kept in a few churches, 
enclosed in an iron cage. 
But little advance had been made in practical medicine since the 
time of Galen. Rhazes of the Arab Empire of Persia had described 
the small-pox and used some chemical remedies. He died A. D. 923. 
Avicenna followed him and died near 50 years later in the same city, 
(Bagdad). Averrhoes, of the Arabic capitol in Spain left a treatise on 
medicine at his death in 1206. His preceptor Avenzoar had made im- 
portant observations, and is said to have lived to the extreme age 
of 135. 
From this time no progress was made in science till the Turkish 
sultan Amurath II. took posession of Thessalonica in 1430. Theodore 
Gaza escaped from the captured city, carrying with him some valuable 
manuscripts, and reached Florence, where he was kindly received by the 
Medici family. From these manuscripts thus preserved, the stores of 
Grecian literature were gradually disseminated in Italy. But no new 
theories in medicine were promulgated till the time of Paracelsus, 
This man was born in Switzerland in 1493. Having made himself ac- 48 
HISTORY OF MEDICINE. 
quainted -with the old medical theories and chemical remedies, he 
travelled extensively, gathering up from all sources a knowledge of all 
the claims of empirics and quacks. Adopting the wildest theories of the 
alchemists, he boldly began the use of active remedies. With Mer- 
cury, Antimony, and Opium he appears to have effected some remark- 
able cures. These successful cases wrere displayed in the most pompous 
terms to all who consulted him. In 1527 he began lecturing in the 
university of Basel as the first professor of Chemistry in Europe. He 
now pretended to cure diseases by chemical remedies, burnt the w'orks 
of the ancient authors Galen and Avicenna in solemn state, and profess- 
ed to have discovered a universal remedy which would cure all manner 
of diseases, and give to his followers immortal life and health. But his 
death, in 1541, at the age of 47, exposed his vanity and blasted all 
their hopes. 
Paracelsus was the first to give Mercury internally, though the sa- 
livation it causes when externally applied, had been known to Friar 
Theodoric in the 12th century. Though Paracelsus displayed human 
insolence, conceit, and insincerity, vanity as well as immorality in the 
most extravagant degree, he rendered important services to our race. 
He broke down the despotism of the schools and sects of his time, and in- 
troduced some valuable and powerful remedies. His example and teach- 
ings excited the envy of some, the emulation of others, and the industry 
of all. (Paris, Pharmac. Vol. 1, y>. 27.) At the same time that he 
wandered from place to place, generally intoxicated, seldom changing 
his clothes, or even going to bed, he was teaching fragments of truth 
which the world could not receive till the discoveries of four centuries 
should teach men how to use them. 
The great discovery of the Circulation of the Blood was the next 
step in the progress of discovery. Michael Servetus, (born in Arragon 
in 1509) was proceeding rapidly with the researches on this subject, 
when he was charged with heresy and arrested and imprisoned through 
the influence of John Calvin, the Reformer. When Servetus had com- 
pletely established the fact of the passage of the blood through the 
lungs, he happened to pass through Geneva; there Calvin procured his 
arrest, brought against him a charge of blasphemy and heresy; and 
Servetus was found guilty and burned at the stake (in 1553) with his 
books around him, to kindle the flames. The tract on the circulation 
wras saved by one of the judges ; and wras finally traced out by Dr. Sig- 
mond through Dr. Mead and the Landgrave of Hesse Cassel. 
The discovery rested for nearly three-fourths of a century. Twrenty- 
five years after the death of Servetus, William Harvey wras born in 
Kent, England. His education w'as prosecuted abroad and in England, 
and his researches occupied his time for many years before any publi- 
cation of this theory of the circulation was made. In 1615 he was ap- HISTORY OF MEDICINE. 
49 
pointed lecturer on Anatomy and Surgery in London. In this position 
his new views which were soon to revolutionize all medical philosophy, 
became known (about 1619); but he fortified himself by every possible 
proof that the subject could admit of, before he published his first work 
on The Circulation in 1628. The publication of his theory brought upon 
him the most bitter opposition; some of his contemporaries condemned 
his doctrines as presenting an unjustifiable innovation, others declaring 
that it was no new discovery, but had been well known before. Though 
he lost popularity at the time of the publication of his discoveries, and 
his practice was diminished by it, he lived to see his opinions establish- 
ed in the scientific world; he served as physician to James I., and after- 
wards to Charles I. He became President of the College of Physicians, 
and saw his bust placed in its hall before he died in 1658. The best edi- 
tion of his works is that of the College of Physicians published in 1666. 
At this period the powerful remedies introduced by Paracel- 
sus were still in the hands of quacks only: and Yan Helmont who con- 
tracted the common itch in 1640, could not be cured by regular medi- 
cine, and had to resort to the quack remedy sulphur. 
In this century the French Parliament interdicted the use of Anti- 
mony as a medicine, and the Faculty of Paris not only forbade the 
employment of all chemical remedies, but would not even allow them 
to be mentioned in theses, and examinations. In the same century, 
also, the discovery of the valves of the veins by Amatus Lusitanus was 
denied and ridiculed by the chief anatomists of the day. 
In 1615 Solomon de Caus, the discoverer of steam-power, was im- 
prisoned by Cardinal Richelieu in the Bicetre, and there he became a 
lunatic. Lord Worcester who visited him there, thus spoke to hi§ 
keepers : “ Misfortune and captivity have deprived him of reason ; you 
have made him mad, and when you threw him into that cell you shut 
up the greatest genius of the age.” 
At this period the universities, which possessed the sole power of 
authorizing physicians to practice medicine, were mere ecclesiastical 
establishments. They taught very little, but persecuted all who at- 
tempted to learn anything not found in the writings of Galen. When 
a few men attempted to learn something of Surgery by observation 
and experience, they were persecuted by the regular Galenist priests; 
who, having been prohibited by the Pope from the practice of surgery, 
themselves gave secret lessons in this branch to their barber servants ; 
and these last became the Barber Surgeons. At this time hot irons, 
hot oil, and hot pitch were applied to Avounds to stop bleeding; and 
Guy de Chauliac, asserting that it was better to let a limb drop off 
by sphacelation than to amputate it, compressed the limb with pitch 
plasters to compel it to mortify. Ambrose Pare saw the bad results 
of such practice, and invented the mode of arresting the bleeding by 
Vol. L—4. 50 
HISTORY OF MEDICINE. 
tying the arteries, and curing the wound by mild dressings. But this 
discovery, though worth more to humanity than all the improvements 
made by the routine followers of Galen in a thousand years, was not 
permitted to be published ; and Pare was so cruelly persecuted for 
pretending to innovate upon Regular Medicine that he was compelled, 
for his own safety, to adduce garbled and incorrect extracts from the 
old authors to prove that his discoveries were made by them, and not 
by himself. 
The establishment of the important fact of the circulation of the 
blood did not, for a long period after its truth was admitted, produce all 
the advantages that might have been expected from it. For the phy- 
siologists of that day, in reasoning upon the powers by which this 
phenomenon, as well as others of the animal frame was accomplished, 
unfortunately took hold of the mechanical philosophy as their guide ; 
and the explanation of every function was immediately attempted ac- 
cording to the law of projectiles; the system was speedily pushed so 
far that it destroyed itself by the absurdity to which it was carried. 
The first English physician who introduced important improvements 
in medical practice wras Thomas Sydenham, born in 1624. After 
graduating at Cambridge he commenced practice in Westminster. De- 
voting his attention to the study of febrile diseases, and finding ample 
opportunities in an extensive practice, after six years experience he 
published in 1666 his great work “Methodus Curandi Febres.” To 
this work he afterwards added the experience of nine subsequent years ; 
and the whole of it displays the most careful observation of nature and 
the effects of remedies. In the treatment of small-pox he first introdu- 
ced the method of checking the eruptive fever by means of cool air and 
other antiphlogistic means, by which he found that the eruption and 
subsequent danger were diminished ; and the same practice has been 
since applied to other eruptive and febrile diseases. In the accurate 
histories he has left behind him of small-pox, measles, gout, hysteria, 
and some other diseases ; in his close discrimination between the dif- 
ferent varieties of the febrile maladies as they disclosed, in different 
seasons, and different years, peculiar epidemic constitutions of the 
atmosphere ; Sydenham surpassed all his predecessors, from Hippo- 
crates to his own time: and he has still maintained his rank as the first 
practitioner of his own country. He died in 1689. His work displays 
all the elements of a master mind, and will be referred to in all future 
time by the student who is ambitious to measure all the depths of the 
human intellect.—[Gooch, Diseas. Fern. &c. 1832.) 
Regular Medicine lays claim to all the accidental discoveries made 
by men who do not pretend to be making their voyages of discovery 
under her authority. The discoveries of Peruvian-bark, Vaccination, Io- 
dine, and Lemon-juice against scurvy, were made by accident. Peruvian- HISTORY OF MEDICINE. 
51 
bark was discovered by tlie Indians of South America, and was first 
brought to Spain in 1682. It remained in Spain seven years before it 
was tried by Alcaia an ecclesiastic in 1639. 
The medical profession was roused to fury by the introduction of 
this substance into popular practice. This remedy was not brought 
into the profession through the portals of the college; and the new 
discovery, says Bouillaud, had to be “ baptized in tribulation.” The 
physicians of Oliver Cromwell allowed him to die of ague rather than ad- 
minister the hated specific. In the same century the president of the 
College of Physicians committed Dr. Groenvelt to Newgate, for daring 
to prescribe Cantharides internally. 
Sydenham was followed by the great medical philosopher Boerhaave, 
who led the way to many important reforms both in theory and practice. 
He was born in Holland in 1668. After thoroughly studying the 
works of Hippocrates and Sydenham, he commenced making a selec- 
tion from all the ancient and modern authors ; and from these materials 
he constructed a new theory of Medicine, which was so well adapted 
to the existing state of science, and so ably explained and defended by 
its author, that it was generally adopted throughout Europe, and 
rendered its author a commanding authority for more than half a 
century. After several years devoted to teaching other branches he 
was appointed to the professorship of the practice of Medicine at 
Leyden in 1715. His lectures on this subject, on Chemistry and 
Botany rapidly extended his fame. Students flocked to him from all 
countries, until the little city of Leyden, which had so suddenly become 
the Medical Metropolis of the world, could scarcely furnish accom- 
modations for the votaries of science drawn together by the genius of 
Boerhaave. He died in 1737, and his fellow-citizens erected an ele- 
gant monument to his memory. His theory of the origin of diseases 
from acrimony, lentor, or other morbid changes in the fluids of the 
body, has long since been so far modified by later discoveries that it can 
scarcely be recognized in the form in which it appears in the medical 
writings of the present day. 
Hoffmann of Saxony was contemporary with Boerhaave. Appoint- 
ed by the first King of Prussia Professor of Medicine at Berlin, he in- 
troduced to the public through his lectures and his “ System of Ra- 
tional Medicine,” (a work which cost him the labor of twenty years,) 
an important modification of the humoral pathology. He has the merit 
of first directing the attention of physicians to the morbid affections 
of the nervous system, instead of framing mere mechanical or chemical 
theories ; he laid the foundation of the spasmodic hypothesis, by resolv- 
ing the origin of all diseases into a universal atony, or a universal 
spasm in the primary moving powers of the system. This theory still 
holds its place in modifying modern theories and practice. It was 52 
HISTORY OF MEDICINE. 
this doctrine, combined with that of Stahl, from "which Cullen selected 
the materials of that theory which can not yet be said to be entirely 
superseded by any more recent system. The popularity of Monro hav- 
ing made Edinburgh the chief centre of attraction for medical students, 
Cullen was appointed to a professorship there in 1756, and became at 
once a leading spirit in the profession. The humoral pathology had 
governed medical practice ; though vague notions had been disseminat- 
ed by Stahl, of the controlling power over the noxious disease- 
causing agencies, that was ever exerted by the internal rational soul, 
which resided within the animal economy and directed all its operations. 
The genius of Cullen seized upon the two prominent ideas of Hoffmann 
and Stahl and blended them into one harmonious system. His most 
important work: “The First Lines of the Practice of Physic,” in four 
volumes octavo, published in 1784 revolutionized the theories and prac- 
tice of the profession. Though, controverted by Brown and Darwin, in his 
owm time, the theories of Cullen have never been entirely exploded. 
Medicine had thus reached a proud position among the sciences at the 
close of the eighteenth century. It was already established in the 
public mind as the most sublime, the most comprehensive, and the most 
useful of all the departments of human knowledge, and was cultivated 
with enthusiasm by a vast number of men of the highest order of mind 
in both hemispheres. In the medical schools of Europe and America 
new doctrines and new discoveries were being successively announced, 
such as never entered into the imagination of the wisest of ancient sages. 
Just at this time a new theory, which seemed to set at nought all 
the accumulated wisdom of ages, wTas proclaimed to the world by a phy- 
sician of Germany. 
In 1790 Samuel Hahnemann, then residing at Leipzig, was employed 
in translating Cullen’s Materia Medica; and was dissatisfied with the 
explanation given by that author of the anti-febrile powers of the 
Peruvian-bark. He determined to discover by experiment on him- 
self, wdiat were the real properties of the bark. He took it in consider- 
able quantities, while in perfect health, and found that it produced an 
ague, similar to the intermittent marsh fever. This remarkable fact 
was treasured up in the memory of Hahnemann, until its great value 
and significance could be rendered appreciable in the light elicited by 
further observations and discoveries. 
Hahnemann was a native of the little town of Meissen, on the Elbe, 
near Dresden, in Saxony, born April 10th, 1755. His father, who 
was a painter on porcelain, enjoined the son to avoid all the liberal pro- 
fessions. But the youth managed to evade his father’s injunctions, by 
secretly contriving for himself a midnight lamp; and by its aid he was 
able to gratify his intellectual longing for knowdedge, "while the members 
of the household "were asleep. His assiduity excited the admiration of HISTORY OF MEDICINE. 
53 
the school-master, and the aspiring boy was advised to pursue a more 
intellectual vocation than his father had designed for him. The father 
was displeased, and placed him in a position where mental improvement 
was more difficult. But he was at length moved by the solicitation of 
the teacher, to permit the latter to direct his son’s studies, which he 
did till young Samuel reached the age of 20 years. [Dudgeon’s In- 
troductory lecture.) He now began his medical studies at Leipzig, 
where he supported himself by translating French and German works 
into English. From Leipzig he went to Vienna, where he studied 
under the direction of Dr. Von Quarin, who treated him with the great- 
est kindness. He graduated at the university of Erlangen in 1779, on 
which occasion he defended a dissertation, “ Consjpectus Affectuwn 
Sjoasmodicoruml He had already served Baron von Bruckenthal, 
governor of Transylvania, for some years in the capacity of physician 
and librarian. He now commenced practice at Mansfeld, but soon re- 
moved to Dessau, and afterwards to Magdeburg. After some years in 
practice, he published his first medical work, giving an account of his 
practice in Transylvania. In this work he honestly confesses, that me- 
dical experience was unsatisfactory; and admits that most of his 
patients would have fared better if left without any treatment at all. 
He had now practiced his profession eight years; and he says he had 
bestowed the most “conscientious attention” on his patients. And he 
had only “learned the delusive nature of the ordinary methods of 
treatment.” He determined to relinquish the office of physician ; a3 
he said “ it was painful” to him to “ grope in the dark, guided only by 
books in the sick-room, to prescribe according to this or that (fanciful) 
view of the nature of the disease, substances that owe to mere opinion 
their place in the “ Materia Medica.” “ I had,” says he, “ conscientious 
scruples about treating unknown morbid states in my suffering fellow 
creatures with these unknown medicines; which, being powerful sub- 
stances, may, if they be not exactly suitable, change life into death, or 
produce new affections, or chronic ailments, which are often much more 
difficult to remove than the original disease;” “ and how is the physician 
to know whether they are suitable or not, seeing that their peculiar 
special modes of action are not yet elucidated ?” “ To become in this 
way the murderer or the aggravator of the sufferings of my brethren of 
mankind, was to me a fearful thought—so fearful and distressing was 
it, that shortly after my marriage, I abandoned the practice and scarce- 
ly treated any one for fear of doing him harm,” and “occupied myself 
chiefly with chemistry and literary labors.”—(Hahnemann’s Letters 
on the necessity of a regeneration of Medicine. 1808.) 
In chemistry his talents found a wide field for successful exercise, 
and in the course of a few years prior to 1790 he published some 
valuable tests for ascertaining the purity of wine, and a treatise on 54 
niSTOKY OF MEDICINE. 
Arsenic, which is still referred to by the ablest writers, as a work of 
great originality and scientific accuracy ; and Dr. Christison quotes the 
account of poisoning by Arsenic. Berzelius admitted the claims of 
Hahnemann to distinction as a chemist. 
In 1789 he was settled in Leipzig and published a medical report 
of some forms of disease Avhich he had treated with success; and here 
he described his method of preparing “soluble Mercury.” The next 
year he made the first step towards the discovery which was in future 
to infuse a regenerating influence into the whole science of Medicine. 
His first conception of the Homoeopathic law of cure, says Dr. Hen- 
derson, was not reached by the inductive method, nor has any other 
great discovery ever been made in that manner. “ Lord Bacon’s method 
was never tried by anybody but himself.” Bacon himself once attempt- 
ed to form a new theory of heat by gathering up all the facts he could 
find that had any bearing on the subject. He then tried to arrange 
them into a theory by placing them in tables ; and, grouping them ac- 
cording to various methods, “he cross-questioned them in every possible 
way, and could educe no general law from them, for nature thus inter- 
rogated was silent; a “ memorable instance of the absurdity of attempt- 
ing to fetter discovery by any artificial rules.” [Brewster's Life of 
Newton.)—Hahnemann’s mode of proceeding was very different. Hav 
ing abandoned the practice, he still reflected on the possibility of find 
ing some more successful mode of treating disease. 
Is it, said he, “ the nature of the art that it should not be possible 
to bring it to any greater certainty ? ” Shameful, blasphemous thought 
Shall it be said that the wisdom of the Eternal Spirit could not produce 
remedies to allay the sufferings from the diseases he allows to arise ?” 
He thought there must yet be some “easy, sure, trust-worthy method,” 
by which we might learn the effects of medicines, “ as to what they are 
really, surely, and positively serviceable for.” “ The alterations which 
medicines cause on the healthy body do not occur in vain: they must 
signif y something, else why should they occur ? What if these altera- 
tions have an important, an extremely important signification ? What 
if this be the only utterance whereby these substances can impart in- 
formation to the observer, respecting the end of their being ? ” “ How do 
medicines effect what they do in disease except by their power to 
alter the healthy body? Certainly in this way alone the effects can 
occur.” 
“It follows, then, that the medicine among whose symptoms these 
characteristics of the given case of disease occur in the most complete 
manner, must most certainly have the power of curing that disease; in 
like manner that a morbid state which a certain medicinal agent is 
capable of curing, must correspond to the symptoms these medicinal 
substances are capable of producing in the healthy body. In a word, HISTORY OF MEDICINE. 
55 
medicines must only have the power of curing diseases similar to those 
they produce in the healthy body, and only manifest such morbid 
actions as they are capable of curing in disease!” 
Such were the reasonings of Hahnemann in the day when, through 
the inspiration of a highly illuminated intellect, he had grasped the 
outline form of that great Law of Cure which was in future to recon- 
struct the healing art; but which the world could not receive until it 
should be demonstrated by an amount of evidence that had never before 
been demanded for the establishment of any doctrine in physical 
science. Like Newton, meditating the tremendous problem of At- 
traction, he knew that his clairvoyant mind had seized upon one of 
the commonest facts, with which all men were familiar, and had “borne 
him away to conclusions that common minds never would have reach- 
ed.” But Hahnemann felt from the first a deep conviction that his first 
conjecture embodied an ever-living truth, and that his self-evident 
reasonings must be true also. “ If all this be not true,” said he, “ how 
was it that those violent tertian and quotidian fevers which I completely 
cured, four or six weeks ago, (without knowing how the cure was 
effected,) by means of a few drops of tincture of bark, should present 
almost exactly the same array of symptoms that I observed in myself 
yesterday and to-day, after gradually taking, while in perfect health, 
four drachms of good Cinchona-bark by way of experiment.” 
Other men had developed intermittent fever by giving bark as a 
remedy for some other condition which they did not understand. 
Hahnemann alone possessed penetration enough to perceive that the 
disease caused by Cinchona was the very same disease that it was 
capable of curing : and that the remedy, both in causing and curing 
disease must be governed by some higher law than was yet known to 
men of science. He felt assured that the Being who created the 
universe must be the wisest and most benevolent of all beings; and 
that “there must somewhere exist a principle” through which the powers 
of the remedies he had created could be rendered available for the 
promotion of the happiness of “His best loved creatures.” (See 
Henderson, p. 119.', 
Through successive steps the one idea of curing disease upon the 
simple principle of Hike by like,” took possession of his mind ; but 
extensive and varied experience could alone demonstrate to the outer 
senses of men in an age of materialism, the truth of Homoeopathy ; 
though that truth was clearly embodied in his own mind in the 
aphorism “ Similia Similibus Curantur .” To attain that precise know 
ledge which experiment can only give, he tested the powers of useful 
remedies, deadly poisons, and articles hitherto believed to be inert 
he tried them on himself, his patients, and then on his friends ; and he 
foimd that they all possessed powers new and hitherto unsuspected 56 
HISTORY OF XIEDICINF. 
His experiments often resulted in astonishing cures; but difficulties, 
such as the advocates of revolutionizing truths always meet, and such 
as no reformer ever before met, obstructed his path, and persecution, 
poverty, and the dark clouds of adversity gathered around him. To 
carry out his own principles it became necessary that he should pre- 
pare his own medicines; and in doing this he was compelled to set at 
defiance that ancient law of Germany that restricted the preparation 
of medicines to the apothecaries; public sentiment and tradition erected 
tremendous barriers in the wray of any man who dared to set at nought 
the wisdom of the wise, and threatened to scatter to the winds the 
counsels of the learned. 
In 1792 Hahnemann was requested by the reigning duke of Saxe 
Gotha to take charge of an asylum for the insane in Georgenthal, in 
the Thuringian forest. Among the patients treated by him at that time 
was the Hanoverian minister Klockenburg, who had been rendered 
insane by a satirical epigram of Kotzebue; the successful treatment of 
this case by Hahnemann created some sensation; and from his report 
of it, published in 1796, it appears that he, in that first case, instituted 
the system of treating the insane by mildness instead of coercion. He 
says: “I never allow any insane person to be punished by blows or 
painful corporeal inflictions, since there can be no punishment where 
there is no sense of responsibility; and, since such patient can not be 
improved, but must be rendered worse by such rough treatment.” It is 
believed that this is the first announcement of the modern doctrine 
which directs the moral treatment of the insane; though it Avas in that 
same year (1792), that the illustrious Pinel made his first experiment 
by unchaining the most furious maniac in the Bicetre at Paris; and, by 
treating him as a man and a friend, succeeded in restoring him to 
reason. 
But is was not by discovering new modes of curing any one disease, 
but by the initiation of a radical doctrine that was to revolutionize the 
treatment of all diseases that Hahnemann had aroused the attention, 
as well as the hostility of medical men. To maintain the ground he 
claimed, and establish his doctrines on the basis of accumulated 
experience and facts, was the Avork of many painful years. In 1795 he 
established himself in Konigslutter where he remained till 1799. During 
this time he published his “Friend to Health, a popular miscellany; his 
Pharmaceutic Lexicon; his Essay on a new principle for ascertaining the 
remedial poAvers of medicinal substances.” (Hufeland’s Journal 1796), 
and other Avorks on the absurdity of complex prescriptions and regimen 
in the treatment of febrile and periodical diseases. In 1800 the scarlet 
feArer prevailed extensively in Germany, and it was at this time that 
Hahnemann discovered the prophylactic poAver of Belladonna in averting 
this disease. For a long series of years he was depressed by poverty HISTORY OF MEDICINE. 
57 
and driven from one town of Germany to another by the persecutions 
of physicians and apothecaries. In 1803 he was without a fixed resi- 
dence; and, though he had reached the age of forty-eight years, and 
had been styled by Hufeland “ one of the most distinguished physicians 
of Germany,” he felt himself a stranger in every comer of his native 
land. At one time engaged in writing a new book; at another experi- 
menting on himself with a new remedy. Then, gathering up his family, 
his books and his medicines, he flies again before his enemies; and was 
at one time detained six weeks on the road by the turning over of his 
wagon, by which a limb of one of his children was fractured. 
In 1803 he published a work on the injurious effects of coffee, as it 
was then used. After practicing for brief periods at different places in 
the north of Germany, in 1805 he published “Esculapius in the 
Balance,” and “ The Medicine of Experience.” In the same year, 
Napoleon the First applied to the French academy to know if concen- 
trated steam, according to Fulton’s process, could propel a vessel? The 
question was answered by a burst of laughter, and the emperor -was 
extremely mortified for having shown his ignorance. “ The same body 
of philosophers rejected the proposition to light buildings by gas, as an 
impossibility: and a few years ago Mr. Arago was received with bursts 
of contemptuous laughter, when he wanted to speak of an electric tele- 
graph,—his learned confreres declaring the idea to be perfectly 
Utopian.” 
In 1808, Hahnemann wrote to Hufeland his celebrated “Letter on 
the urgent necessity for a reform in medicine,” in which he said: “I 
cannot resist the desire I feel to unveil to the public the convictions that 
now possess me. For eighteen years, I have wandered from the beaten 
track of medicine. It was a punishment to me to grope always in 
obscurity when called to wrestle with disease, and to prescribe medi- 
cinal agents which had at least an arbitrary place in the materia 
medica.” 
In 1810, while residing at Torgau, he wrote his “ Organon der 
rationellen Ileilkunde,” which was published at Dresden the same 
year. At the same time he established himse'lf in Leipzig: and, in 
order to obtain the privileges of a physician in that city, he defended 
his thesis, De Helleborismo Veterum, in 1812. 
From this time till 1821 Hahnemann was actively engaged in 
defending his new system of medicine, in teaching it, and in enlarging 
ts domains by new researches. In 1819 he published an improved 
edition of his Organon, which was further improved in a third edition, 
translated into French, English, and Italian, 1824. Homoeopathy was 
introduced into Italy by the surgeons of the Austrian army, when they 
entered Naples in 1821. But all the rising prospects of the reformer 
only strengthened the hostility of his enemies. The law which prohi- 58 
HISTORY OF MEDICINE. 
bited physicians from preparing their own medicines still existed; and 
Hahnemann, who could neither find his medicines already prepared, 
nor find apothecaries, who would obey his instructions, was compelled 
to violate it. A formidable combination of interested persons demanded 
of the government the enforcement of its own absurd statute, and 
Hahnemann the founder, the first apostle and, martyr of homoeo- 
pathy, could no longer remain in the city which was in future to erect 
a monument to ask posterity to excuse the wrong she had inflicted on 
her noblest benefactor. Driven from Leipzig, Hahnemann found an 
asylum at Anhalt-Cothen, -where Prince Frederick offered him pro- 
tection. Here he was permitted to pi'actise his profession without fear 
of apothecaries, though his enemies circulated false statements, to 
prejudice the people against him. In 1828 he completed his great 
work on “Chronic Diseases,” in five volumes; and its publication was 
followed by other smaller works, since collected in two volumes, under 
the title of “Minor Writings,” 1829 to 1834. In the work on “ Chronic 
Diseases,” he announced and explained his theory of the origin of a 
great number of the most inveterate forms of disease. He says, that 
the majority of the cases known as palsies, asthmas, dyspepsias, con- 
sumptions, headaches, epilepsies, vertigoes, &c., are caused by the 
presence of a morbid matter or miasm existing in the body. When it 
comes to the skin, it produces, some of the obstinate cutaneous 
affections, known as, leprosies, milk-crusts, scald heads, ring-worms, 
itch, herpes, pustules, &c. The term Psora, he employed as a general 
designation, not of itch, but of all the constitutional hereditary 
affections described by other authors under the head of jpsoric or dys- 
C7'asic diseases. 
In 1831, at the age of 76, whem epidemic cholera had excited the 
alarm of all the nations of Europe, Hahnemann examined the symptoms 
of the disease, as reported by those who had seen it, and predicted the 
remedies that would be found most successful in its treatment. His 
directions -were printed and circulated; and their value and accuracy 
are attested by the general success of his disciples in the treatment of 
cholera asiatica. 
The first public hospital and school for the advancement of homoeo- 
pathy was established at Leipzig, and there the theory and practice of 
the new system of medicine continues to be taught. 
When Hahnemann saw old age advancing upon him, he had the gra- 
tification of knowing, that he had not lived and labored in vain; but that 
his doctrines had been accepted by some of the progressive minds in 
all the countries of Europe, and by many in other parts of the world. 
Approaching the age of seventy years, he said: “I have paid no regard 
to either ingratitude or persecutions in the course of my life, which, HISTORY OF MEDICINE. 
59 
although toilsome, has not been without satisfaction, on account of the 
grandeur of the end I had in view.” 
“ The grandeur of the end he had in view,” was rapidly unfolding 
itself, when these words were spoken; and it has continued to expand 
with increasing splendor as successive years have passed away. His 
wife, who had witnessed and shared his trials and sufferings, without 
understanding him or sympathizing with him in the greatest of them, 
lived to see his fame safely established; and then died in 1880. At 
this time his writings had made his discoveries and successful practice 
known far from the city in which he had been almost imprisoned by 
the narrow prejudices of the people. In 1835 Mile. Melanie d’Her- 
villy, of an ancient noble family of France, visited Hahnemann at 
Cothen; and so thoroughly did she comprehend the greatness of the 
man and his discoveries, that she became one of his most distinguished 
pupils. At a later period she was united to him by marriage; and, ob- 
taining from M. Guizot, then at the head of the cabinet of Louis Phi- 
lippe of France, the privilege for her husband of practicing his pro- 
fession in Paris, she induced him to remove to that city. The royal 
ordinance granting this permission, was dated August 31,1885, and from 
that time till his death, Hahnemann was engaged in practice at Paris. 
In 1843 he had reached the age of eighty-nine, but his intellect was 
still clear; his habits of constant and patient observation made it a 
pleasure to note the symptoms of disease; and his ever-glowing bene- 
volence inspired him with an ever-burning zeal in the cause of science 
and humanity. “ He was,” says Hering, “ a true man without falsity, 
candid and open as a child. When the last fatal hour had struck for 
the sublime old man, who had preserved his vigor almost to his last 
moments; then it was the heart of his consort, who had made his last 
years the brightest of his life, was at the point of breaking. “Why 
shouldst thou,” she said, “who hast alleviated so much suffering, suffer 
in thy last hour ? Providence should have allotted thee a painless 
death?” Then he raised his voice, as he had often done when he exhorted 
his disciples to hold fast to the great principles of homoeopathy: “Why 
should I have been thus distinguished? Each of us should here attend 
to the duties which God has imposed upon him. Although man may 
honor, more or less, yet no one has any merit. God owes nothing to 
me. I to Him owe all,” With these words he took leave of the world, 
his friends, and his foes.” 
As devoted admirers of the genius of Hahnemann we are still de-s 
sirous to do no injustice to any other benefactor of our race. It will not 
be claimed, that the last victory of science had been won when the 
founder of homoeopathy closed his eyes near the gardens of the Luxem- 
bourg. But, while wre admit that important discoveries have been made 
by others which prepared the way for a higher unfolding of the prin- 60 
HISTOKY OF MEDICINE. 
ciples on which disease originates and may be removed, we must still 
claim the precise discovery made by Hahnemann, as that which of 
all others, the world most needed in the nineteenth century. Already 
the lightning had been drawn from the clouds, and all the properties 
of all the elements of the atmosphere had been examined with great 
accuracy. All the sciences, that sought to subdue the various king- 
doms of the physical wTorld had announced a succession of splendid 
victories; and strong impulses moving in minds of a high order to 
stir them up to search for the laws that ruled, and the causes and prin- 
ciples which operated in some higher sphere, above the mere physical. 
There were men enough employed in constructing the winding path- 
way by which the hill-tops might reached; the world needed a 
commanding genius, who, “seeing the towering, distant tops of 
thoughts, that men of common stature never saw,” could at once ascend 
to the point where the labors of other men were designed to end; and 
from that point take his “flight sublime” towards the brighter region 
that encircled the mountain top. It may not be necessary here to at- 
tempt to prove, that Hahnemann alone was capable of meeting the want 
of his age. 
In his mind, says Dr. Henderson, a conspicuous feature was one 
common to the German mind, which “ is impatient of ignorance where 
knowledge is impossible, most eager and enterprising, where the dark- 
ness is the thickest,” and must trust to the wings of conjecture more 
than the solid footing of observation for reaching the goal at which it 
aims. Without it the Homoeopathic Law wTould have floated through 
the world a ‘viewless spirit,’ and the extreme powTers of attenuated me- 
dicines would have never been discovered. The literary labors of 
Hahnemann extended over a wide field of labor, embracing more than 
seventy different works on chemistry and medicine, some of which 
were large volumes. He also translated about twenty-four works from the 
English, French, Italian, and Latin, on chemistry, medicine, agriculture, 
and general literature. His philosophical principles ; re thus given in 
Dr. Cl. Muller's Festival Speech, 9th April, at the Celebration of 
the 106th Anniversary of Hahnemann's birth, Leipzig:—Homoeo- 
pathy itself is “especially based on the peculiar observation of 
the dynamic element in the phenomena of life. Thus, far, from con- 
sidering the organic life in its various aspects of health, disease, even 
the medical art, and the effect of medicines on the organism as chemico- 
mechanical processes, instead of these, homoeopathy recognized therein 
the exclusive dominion of a peculiar power which is subject neither to 
the mechanical nor chemical laws, viz., the vital power; and the laws 
by which this operates are also her own. Thus not the mass—not the 
material as such, but only so far as it is vividly penetrated by this 
power, and thereby brought under the dominion of the laws of vitalitj HISTORY OF MEDICINE. 
61 
is it the object of her investigation and the scope of her efforts. Hahne- 
mann in his Organon (5th Edit. § 9, &c.) expressly recognizes an in- 
dependent vital power (autocracy) which in the healthy state of man 
as spiritual, rules to an unlimited extent over the living power of the 
material body, and keeps all its parts in a wonderfully harmonious 
tenor of sensation and activity, so that our indwelling rational spirit 
can employ itself for the higher objects of our existence, independent 
of this living instrument.” 
The material organism, considered apart from vital povTer, is capable 
of no perception, no activity, no self-support: it is only the immaterial 
that imparts to the former all its perception, and executes its vital 
action, whether in the healthy or diseased condition of the quickening 
principle. In disease, it is originally only the vital power that is mor- 
bidly out of tune, and expresses its suffering (the internal change) by 
abnormal states of the sensations and activities of the organism. The 
suffering of this diseased vital power, and the morbid powrer, and the 
morbid symptoms thereby originated, are an inseparable totality—one 
and the same thing. It is only through the psychical influence of the 
morbific evils that our psychical vital power can become diseased; and 
thus also it is only by the psychical “ dynamic” operation of medicines 
that it can be restored to health. This recognition of a purely dynamic 
efficacy in the medicines, led Hahnemann to his theory of “ potencies,” 
inasmuch as it brought him to the conclusion, that, by a systematic 
attenuation (w'hich at first he adopted merely to avoid undesirable 
primary and secondary action) combined with succussion, the dynamic 
curative powers would be exalted, and so in a manner the effect would 
he more powerful and free from interference.” 
Hahnemann as a philosopher was an opponent, aye, the very antipode 
of the modern system of materialism. 
This system of philosophy, which is the dominant one of modern 
times, is “ founded on the consideration of force and matter alone ; and, 
by virtue of and in conformity to these, of the existing and working 
aggregate of the external world. It is based conclusively on the re- 
cognition that force and matter presented inseparably one with the 
other, keep at work incessantly according to stringent laws; and that 
the immense universe, with the immense riches of its incessantly 
changing forms, and with the full machinery of its mighty restless 
movement, is only a possible and positive fact, on the supposition of and 
n conformity to the operation of force and matter. Its leading 
principle is to take as a starting-point for the discovery of results 
nothing whatever but wrhat— 
1. Each one either knows assuredly by nature, or learns by observation. 
2. Relatively, what the collective body of savans receives as posi- 
tively attested and established by observation; and 62 
HISTORY OF MEDICINE. 
3. Under all circumstances, what the rational, impartial, unprejudiced 
mind must consider as true.” (See Pere Buffier “Sur les premieres 
Yerites.”—See Fletcher’s Physiology of Pathology.) 
The whole theory of Hahnemann may be termed nothing but the 
corrollary of that of John Brown. For while the Brunonian doctrine 
of the cure of indirect debility by stimulants is unimpeachable in the 
main, yet it fails in particular instances from disregard of the special 
character of the stimulus in both causing and curing the particular 
disease. Here Hahnemann steps in and supplies the missing link, and 
it now becomes clear not only how a stimulus can cure an inflammation 
that it could cause, but also why it is not any stimulus, but only one 
of a special character that will do so. We see that this character 
must be very similar to that of the stimulus which in other circum- 
stances would produce inflammation. (Muller.) 
The leading minds of the medical profession, who preceded Hahne- 
mann, employed their highest powers in constructing general theories 
which should render close observation unnecessary. The grand object 
of pursuit has been a comprehensive theory of disease and of practice 
which shall “ bind together the scattered facts of medical knowledge, 
and converge into one point of view the laws of organic life.” It has 
been believed that such a theory “ wrould on many accounts contribute 
to the interest of society, that it would capacitate men of moderate 
abilities to practice the art of healing with real advantage to the public ; 
it wrould enable every one of literary acquirements to distinguish the 
genuine disciples of medicine from those of boastful effrontery and art- 
ful address ; and would teach mankind in some of the most important 
situations, the knowledge of themselves.”* This great desideratum of 
the medical philosophers was never realized, and the eighteenth century 
closed with the dawning light of the discoveries of Hahnemann, the im- 
portance of w7hich was not yet appreciated by himself. Other medical 
discoveries of that period are still spoken of now with admiration, though 
not then so received by the profession. Jenner who had not really 
discovered the preservative power of the vaccine disease against the 
the small-pox, but who appropriated a discovery which he had heard 
of in Gloucestershire thirty years before, was lampooned, and ridiculed, 
and contemptuously excluded from the honors and privileges of the 
college of physicians, merely for advocating before the public the 
truth of a principle w'hich had been knowi^for ages before. Ofother 
discoveries of the eighteenth and nineteenth centuries we shall not now 
undertake to give the history. 
The principal improvements in the science of medicine made during 
the nineteenth century have grown out of the researches of anatomists 
* Darwin’s Zoonomia. HISTORY OF MEDICINE. 
63 
and pathologists. Bichat, of whom Corvisart said “ no one had done 
so much in so short a time, and done it so well,” announced his dis- 
coveries and died at the beginning of the century. The old theories 
of humoralism and solidism have since been often exploded and again 
revived. As modified by Hamilton, the former was introduced into 
England by Abernethy. The two united formed the basis of the sys- 
tems of Pinel, Broussais, and later names which have receded before 
the improvements in microscopic pathology and chemistry. 
Pinel occupied the highest places of medicine ; a chair &t the faculty 
clinique, at the hospital, a seat at the institute, at the academy, titles, 
decorations, &c. &c. All drew their inspiration from him; books, 
pamphlets, journals, official and other courses were but reflections of 
the nosography, so styled, philosophical. In the sight of these 
philosophers the medical problem was stated in the terms: Given a ma- 
lady ; to determine its place in a nosographic category. {Id Art Med.) 
“ And with the calm security of a conscience at peace with itself, 
they ticketed, they described diseases as objects of natural history; 
after which, these were neatly pinned each in its case, like a butterfly 
or a beetle upon its cork, and the savans slept soundly. If some patient, 
obtuse towards the perfections of nosology insisted on being cured, 
they silenced the impertinent, and snored on louder than before. 
“ Things went on thus during fifteen years, when suddenly appeared 
upon the horizon “ L’Examen” of Broussais, a book which made a pro- 
digious stir, and created a stampede in the Pinelist Camp. 
“ Broussais, henceforth master of the battle-field, over-ran, ploughed 
and harrowed it for the reception of his new doctrines. He held 
forth that— 
“ There is no specificity in diseases,intheir causes, nor in medicines. 
11 Every disease is the cry of a suffering organ; which one, we must 
ascertain. 
“ There are but two diseases, inflammation and sub-inflammation; 
and of these two, the second only serves pro memoriam, and as a di- 
verticulum. 
The clinical problem is reduced to this: 
“ Where must we place the leeches, and how many leeches must we 
place ? ”—(Z/Montpellier Medical, 1860.) 
Matters were thus beautifully simplified, and indeed the practice was 
simpler than this: for as gastritis constituted the immense majority of 
maladies, if you did but prescribe an application of leeches to the epi- 
gastrium, you had but one chance in a thousand against you. It was 
magnificent. 
“ All the acute diseases,—fevers, exanthems : all the chronic diseases 
—-dermatoses, gout, gravel, neuroses, &c.,—all these were gastrites 01 
gastro-enterites, and all wrere treated by leeches and diet. Ah! the 64 
HISTORY OF MEDICINE. 
diet, sir, was an admirable tiling. Wlnit disease could have resisted a 
diet, more or less absolute in its severity, prolonged during weeks, dur- 
ing whole months ? 
“It is related that a patient once sought Broussais, complaining, 
“ Doctor, your regimen fatigues me to the last degree ; the diet is kill- 
ing me ; I am literally dying of hunger.” Broussais reflected a moment, 
then said, “Well, you carniverous animal! I will content you.” And 
he allowed him a teaspoonful of broth in a glass of water.” 
The medical system of Broussais was only fitted to amuse the pro- 
fession for a few short years, when there came from St. Petersburg 
another giant in the person of M. Louis; a man of immense genius, if, 
as Buffon has affirmed, genius were only patience ; M. Louis, armed 
with several thousand brute facts, which he calls observations, bravely 
flings them at the head of the colossus of Yal the Grace, and at one 
blow fells it to the ground. Broussais, after making a few imperfect 
experiments in homoeopathy on others, tried it on himself with partial 
benefit; but his friends objected, and he went back to his leeches 
and died. 
The system constructed upon the bloody ruins of the temple of 
Broussais consists in the employment of the senses rather than of the in- 
tellect. To observe is simply to take account of all that strikes the 
external senses ; to observe and count “ how many times in a hundred 
or a thousand cases a certain symptom has occurred; and deduce the 
average. As to therapeutics, the study of signs, of indications, the 
determination of medical constitutions—all that is suppressed; Ave may 
employ, ad libitum, the first remedy at hand,” no matter what may be 
the nature of the disease; and then it only remains to count on your 
fingers how many die, and how many get well under the influence of 
such or such a remedy. Indeed the game of goose is algebra beside 
such therapeutics! “ Your school,” said d’Amador, “ has devised a neAV 
method. You count facts and pretend to appreciate their value by 
their number; you add, divide, subtract; and with candid simplicity 
believe that you are perfecting the methods of art.” 
Thus the operation of the senses and statistics comprize the whole 
of medicine for M. Louis. Accordingly M. Bouilland bleeds his pa- 
tients, while M. Delarocque evacuates them excessively upAvards and 
doAvnwards, M. Piedagnel inundates them with warm water. M. Stein- 
brenncr swells them out with cold water, M. Magendie gorges them 
Avith punch, M. Serre with mercury, M. Petit with bark, M. Broca with 
quinine, Mr. A. Barthez with alum, others Arith asses’ milk, others again 
Avith alcohol; Avhile some, like M. Andral, do nothing at all;—and each 
boasts of his successes, invoking statistics, that lady of good help, Avho 
6ets every body in the right.—[JOMontpellier Medical.) 
The more rigid observers of nature now cultivating the Avide fields GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
65 
of pathology have abandoned the effort to construct a true theory by 
counting and averaging partially observed facts. In nature, says M. 
Bernard, “ there never was, nor will be, such an anomaly as an average. 
Every thing is the absolute and certain result of fixed and definite 
causes. Alter these in any way, even to the least degree, and the re- 
sults vary accordingly, and in a fixed and certain proportion. She 
knows no medium, she knows nothing but a unit; and this unit is a 
combination of facts, varying in each, and the originating results vary- 
ing correspondingly—experimentation, therefore, and the accumulation of 
facts, can alone furnish us with the key to her enigmas—and each fact 
is valuable, just in proportion as all its conditions are accurately as- 
certained, and in that proportion only; and in collecting these facts 
we should be careful not to allow “ preconceived ideas” to become “ fixed 
ideas.” The former are necessary, indispensable: we can do nothing 
without them; we should only know how to abandon them when they 
are no longer right. The preconceived idea is always interrogative ; 
it addresses the question to nature, and calmly awaits the answer; 
ceasing to question when this is received, and adopting the fact with 
the same readiness, whether opposed to, or in accordance with itself.” 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
The present position of allopathic medicine must he ascertained by- 
asking the opinions of its standard authors. A few of these may be 
permitted to speak for the profession: Prof. Christisop of the University 
of Edinburgh, addressing a class of graduates thus speaks of thera- 
peutics : “ It is of all the medical sciences the most unsettled and un- 
satisfactory in its present state, and the least advanced in its progress.” 
(Edin. Monthly Journ. Med. Sciences. Sept. 1851.) In an address 
delivered before the British Medical Association at Edinburgh in 1858, he 
said: “ Therapeutics considered as a branch, whether of medical science 
or medical art, and compared with the other branches of medicine, 
fundamentally and practically is in a backward and unsatisfactory con- 
dition. It is not enough to admit that for a good many years past we 
can neither point to a single great authority, nor to a single plausible 
or generally admitted theory as to the action of remedies, but even our 
therapeutical facts must be allowed to be too often scanty, vague, or 
insecurely founded.”—{Lancet, Aug. 7, 1858.) 
Dr. Headland of London, author of the essay on the action of me- 
dicines, when reviewing the relative operations of the various branches 
of medical science, says : “For the proper perfection of medicine as a 
rational science, two things are in the main needed: the first is, a right 
understanding of the causes and symptoms of disease;—the second, a 
Vou L—5. 66 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
correct knowledge of the action of remedies. Should our acquaintance 
with these two subjects he complete, we should then be able to do all that 
man could by any possibility effect in the alleviation of human suffer- 
ing. This sublime problem is already being unravelled at one end. 
Diagnosis and nosology are making rapid strides : and perhaps we shall 
soon know what we have to cure. But at the other end, our medical 
system is in a less satisfactory condition; and though some impatient 
men have essayed to cut the gordian knot, and have declared boldly 
on subjects of which they were entirely ignorant; yet it must be con- 
fessed, that in the understanding of the action of medicines and of their 
agency in the cure of diseases we do not so much excel our ancestors. 
While other sciences are moving and other inquiries are rapidly advan- 
cing, this subject, so momentous in its applications, has in spite of the 
earnest labors of a few talented investigators, made after all, but small 
progress.” The late Dr. Adams of Banchory, who was said to be the 
most learned man in the profession during the last half century, said: 
“ Now-a-days we have abandoned all general rules of practice, and pro- 
fess to be guided solely by experience. But variable and uncertain 
have been its results! I myself—though but verging towards the de- 
cline of life—can well remember the time when a physician would have 
run the risk of being indicted for culpable homicide if he had ventured 
to bleed a patient in common fever; about twenty-five years ago, vene- 
section in fever and in almost every disease was the established order 
of the day; and now, what shall I state is general practice that has 
been sanctioned by the experience of the present generation ? I can 
scarcely say;—so variable has the practice in fever and in many other 
diseases become of late years.” 
There is a widely-spreading skepticism in all the old systems of 
medicine. Such questions as the following are continually rising: 
“Is there such a thing as therapeutic science? Is the world considered 
as one complex individual, advancing more and more towards maturity 
in medical knowledge?” Some really believe that the controversies 
and sects are incapable of settlement: and that whilst “old divisions 
continue for ages, new ones arise to increase the distraction of the 
human mind.” To many, no doubt, the claims of homoeopathy will still 
continue to be classed as one of the multitude. Dr. Oesterlen (Medical 
Logic, Sydenham Edition, p. 238) says: “If we bring to the bedside of 
the same patient, a disciple of Brown or of Broussais, an empiric of 
the old, or one of the modern stamp, an adherent of the so-called 
Vienna anatomical or of the Giessen chemical school, a nerve-patholo- 
gist, or a blood-pathologist, each will recognize a different state of 
things. The opinion, which each forms of fever, and similar aggregates 
of symptoms, of their origin, connection and dependence upon various 
local or general changes and conditions, and of those in their relations DOCTRINES RESPECTING A VITAL PRINCIPLE. 
67 
to each other, will he different from that of the others. Each of them, 
if he reflects upon it at all, will form a different notion of all that he 
has been able to observe. He will arrange and combine the various 
phenomena in the patient after his own manner—that is in accordance 
with his own point of view. If the same remedy be administered in a 
given case, the assertions and opinions of each concerning its effects 
will equally differ; for each has expected from it different services, and 
modes of operation in accordance to his previously formed theory; he 
will, therefore, interpret what he has observed in the manner which 
best corresponds to his OAvn views; and in the remedy employed will 
acknowledge only such effects as it has been his aim to produce.” 
Such views as those from the work now quoted are common among the 
leading men of the regular profession; and one of the sharpest contro- 
versies they have engaged in- during the present century is now going 
on, to determine which is best for the patient, “Medication or Non- 
Medication.” 
Medical skepticism is openly taught from our chairs of clinical me- 
dicine, and from the seat whence Dr. Henderson was deposed for his 
revolutionary tendencies, Dr. Bennett now utters such sentiments as 
these: “At this time, medicine is undergoing a great revolution, and to 
you, gentlemen, to the rising generation, do wre look as to the agents 
who will accomplish it. Amidst the wreck of ancient systems, and the 
approaching downfall of empirical practice, you will, I trust, adhere to 
that plan of medical education which is based on anatomy and phy- 
siology. Everything promises that before long a law of true harmony 
will be formed out of the discordant materials which surround us; and 
if we your predecessors have failed, to you, I trust will belong the honor 
of building up a system of medicine, which from its consistency, sim- 
plicity, and truth, may at the same time attract the confidence of the 
public aud command the respect of the scientific world.” 
DOCTRINES RESPECTING A VITAL PRINCIPLE.—NERVOUS FLUID. 
DYNAMIC INFLUENCE. 
The universe is governed by the same divine Power that created it; 
and he exercises upon all animate and inanimate things a controlling 
influence which is perpetually in operation; but he operates in all con- 
ditions in accordance with certain fixed and invariable principles, 
usually spoken of as the Laws of Nature. All created objects are 
divided into two great classes, called living and dead; and they are all 
in some degree subject to the physical laws of nature. But living 
bodies are also endoived with a set of properties entirely different, called 
vital properties, which living matter continues to manifest so long as 
it is alive, and no longer. The study of life, its manifestations, is the 68 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
object of the science of physiology; in the state of health this vital in- 
fluence, perpetually emanating from the Creator, exercises an absolute 
sway over every portion of the body, and maintains all its functions in 
order and harmony, both of sensation and action; and when these con- 
ditions of order and harmony exist, “our indwelling rational spirit may 
freely employ these living healthy organs for the superior purposes of 
our existence.” 
Of this “vital principle” all authors on physiology and medicine 
have written something. 
“ There is not,” says professor Paine, “in the whole range of medical 
literature, one author, however devoted to the physical and chemical 
views of life, who does not evince the necessity of admitting a governing 
vita! principle, as a distinct entity, distinct from all other things in 
nature. I say, there cannot he produced one author of any considera- 
tion, who does not summon to the aid of his discussion a vital prin- 
ciple whenever he touches upon the abstract phenomena of life.” 
Thus Hippocrates speaks of the “ Phusis,” Paracelsus and Van Ilel- 
mont of “ Archaeus,” Stahl of “ Anima;” medical men of the present 
day of the “ vital principle.” “ Vis vitce, vis insitce.” 
But the reasonings of physiologists on this subject contain little of 
scientific accuracy. 
“ To speak of the vital forces, to give them a definition, to interpre 
phenomena by their aid, and yet to he ignorant of the laws which 
govern them, is doing nothing, or rather is doing wrorse than nothing 
It is to attempt an impossibility, it is to content the mind to no pur 
pose, to stop the search after truth. To state that the liver separates 
the elements of the bile from the blood by means of the vital force, 
is merely to assert that the bile is formed in the liver. By thus varying 
the expression, a dangerous illusion is established.” * 
In regard to the nature of the intelligence, or soul, and how it acts 
upon the material parts, to aid in producing the phenomena of life, 
we do not now propose to inquire. We are able to see its results, and 
appreciate its wonderful influences, but the mode of its operation we 
will not now attempt to explain. It pervades every part of the body, 
and operates in a different manner on different organs. It gives rise to 
sensation in the organs of sense, motion in the organs of motion, di- 
gestion, absorption, assimilation, respiration, circulation, &c., in the 
organs provided for these functions. 
All modifications or derangements of structure, alter the peculiar 
effects of this spiritual power; for it acts only through the medium of 
the organs as they actually exist. All deviations therefore from the 
normal organization of parts, induces corresponding alterations in the 
manifestations of the intelligence. 
* Matteucei on Living Beings. DOCTRINES RESPECTING A VITAL PRINCIPLE. 
69 
The living intelligence has no particular location, but pervades every 
portion of the nervous system, exercising a constant, and direct in- 
fluence over every organ and tissue. This is clearly apparent from the 
experiments of Philip, Stilling, Hall, and others, which prove, “ that 
the pov’er of the heart and vessels of circulation, is independent of the 
brain and spinal narrow,” and “ that the power of the muscles of 
voluntary motion, vessels of secretion, and peristaltic motion of the 
stomach and intestines, are independent of the nervous system, and 
that their relation to this system is of the same nature with that of the 
heart and vessels of circulation, the nervous powrer influencing them in 
no other way than as other stimuli and sedatives do.” 
From these and other experiments, Dr. Philip supposed, that the 
vessels possess “a principle of motion independent of their elasticity,” 
and identical with galvanism. The experiments of Magendie and later 
physiologists have shown that the hemispheres of the brain and cere- 
bellum may be removed in a mammiferous animal, and it will continue 
to experience sensation, perceiving odors, sounds, and rapid impres- 
sions. Vision, however, is abolished.” 
Dr. Dowler of New-Orleans, has instituted a series of experiments 
on the alligator, which exhibit in the clearest manner the peculiar 
operation of the living intelligence upon the organism. In one experi- 
ment Dr. D. divided the muscles of the neck, the cervical vertebrae, and 
the spinal cord, also the spinal cord between the shoulders and hips, 
destroyed the sympathetic nerve, and removed the intestinal viscera, 
“ yet, for a period of more than two hours, the alligator exhibited com- 
plete intelligence, volition, and voluntary motion in each and all 
divisions of the body. It felt, saw, defended itself / showed anger, 
fear, and even friendly attentions to its keeper, a black boy /” In 
another experiment, “ the upper portion of the skull, including a hori- 
zontal stratum of the brain, was removed! The animal performed a 
series of voluntary motions, intelligibly directed, to ward off injuries. 
The entire brain and the medulla oblongata were now removed, 
without diminishing its power to direct its limbs to any part that 
was pained by the slightest touch of a pin or knife. A metallic rod 
was passed many times within the spinal cord, completely destroying 
the spinal marrow beyond the hips. It was still found that both volun- 
tary motion and sensation remained, though their manifestations were 
greatly impaired.” 
Dr. D. concludes from these and numerous* other experiments of a 
similar nature, “ that voluntary motion is neither directly communicated 
from, n<3r regulated by the brain, or the cerubellum; that the muscles 
in connection with the spinal marrow, perform voluntary motions for 
hours after having been severed from the brain; that these motions are 
not only entirely independent of the brain, but may take place, though 70 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
imperfectly, after the destruction of the cord itself; that the trunk, as 
well as the brain, thinks, feels, and wills, or displays psychological 
phenomena j that the sensorium is not restricted to a single point, 
but is diffused, though uneyually, or in a diminished degree, in the 
periphery of the body / and that actions which take place after de- 
capitation, as described above, are in absolute contrast to keflex 
actions, being sensational, consentaneous, voluntary, and in other 
respects dissimilar.” Is it any more wonderful that the soul conduces 
to the phenomena of digestion, assimilation and appropriation, when the 
natural stimuli of these organs are presented to them, that sight 
is appreciated when the natural stimuli of the eye, the rays of light, 
are applied to this organ ? Is it any more singular that this spiritual 
stimulus should endow each structure with power to exclude all noxious 
substances, and select each its natural excitant, than that the sense of 
hearing should only appreciate one voice in the midst of a hundred 
other voices and instruments, whenever the will so directs ? 
In order to acquire a correct idea of the functions of life, it is neces- 
sary, in the first instance, to contemplate the body as a perfect machine 
—adapted in every part by a definite and special organization, to re- 
ceive different impressions according to the nature of the substances 
or excitants presented, and the offices which they are destined to per- 
form. Without doubt, chemical and mechanical forces exercise an 
important influence in the operations of this machine. The combustion 
of oxygen with the carbon at the lungs, and in other parts of the system, 
must develop heat, expansion and motive power, and mechanical causes 
may operate somewhat in adding to this force, yet all of these influences 
are wholly inadequate to accomplish and perpetuate the more com- 
plicated phenomena of life. It is then essential that another important 
agency should be everywhere present, in order to enable the organs to 
respond properly to their specific stimuli. Consequently we have “ super- 
added to the body” an intelligence, which affords a specific stimulus to 
every part; acting solely through each particular structure as it exists, 
and modified in its operation according to the modifications or altera- 
tions in the organs themselves. If the structure of the eye is injur ed} 
an imperfect image will be formed upon the retina, the intelligence will 
manifest itself through this injured structure, and this sense will be 
altogether impaired. If the structure of other organs be altered, so 
that their natural stimuli cannot be brought to bear as usual, the opera- 
tion of the spiritual stimulus will be modified in proportion, and dis- 
ordered function result. 
This mental or spiritual stimulus acts at each particular part speci- 
fically, and in a measure independently of other parts, causing irrita- 
bility of different grades in the muscular fibres, and exercising those 
peculiar properties every where. The influence likewise which it NERVOUS FLUID. 
71 
exercises upon the body as a cause of disease has never yet been pro- 
perly appreciated. 
In the ordinary waking state, the operations of the soul are mani- 
fested directly through the media of all the physical structures, and 
these manifestations are limited in extent and variety, and subject to 
certain fixed laws, having reference to the structures and stimuli act- 
ing upon them. Thus, the power and extent of vision is determined 
by the physical condition of the eyes and brain, (which furnishes them 
with blood vessels and nerves,) and the number and intensity of the 
rays of light which strike the retina. Light, in this instance, is the 
material stimulus or rather the undulatory nerve-force, which passes 
through the structure of the eye in the same manner as it passes 
through an optical instrument, producing the reflection of images upon 
the retina in a manner analogous to images formed in the camera of 
the photographer. The soul takes immediate cognizance of these 
images upon the retina, in precisely the same manner that it recognizes 
the images in the camera obscura. It is worthy of note, that these 
images may be formed upon the retina, and yet the soul be entirely 
unconscious of them; so may an absent-minded man look into the car 
mera obscura, filled with reflected figures, and derive no impressions 
from them. Without this invisible, incomprehensible, and eternal soul, 
the eye would be but a mere optical instrument, perhaps taking the 
first rank among such instruments, but entirely on a par with them, and 
subject to similar laws. No -imponderable agent, like electricity 
magnetism, or galvanism, or what has been termed animal nervous fluid, 
could ever enable it to appreciate impressions, or perform a single act 
of intelligence. 
Every structure of the organism, whether situated within the cranium, 
chest, abdomen, or in any other part, is in a similar condition in rela- 
tion to the soul, and without its presence and influence, is subject only 
to the ordinary laws of matter. 
It is the office of the soul to preside over the necessities of the phy- 
sical man—to guard against and ward off injurious influences, and 
to respond to all impressions made upon the textures. So long as the 
normal physical condition exists, and no undue influence is exerted 
upon the mind, a spiritual or vital equilibrium is maintained through- 
out the system; but if a part be attacked by an enemy in the form of 
inflammation, or if an undue impression is made upon the mind, this 
equilibrium is disturbed,—the spiritual force is unequally distributed, 
and disordered action follows. 
We append a few examples to illustrate the influence of mental im- 
pressions in modifying the action of the tissues : an individual in per- 
fect health, and undisturbed by any external influence, finds himself in 
a gallery of paintings. At one point a devoted daughter is seen brav- 72 
GENERAL -PRINCIPLES OF MEDICAL SCIENCE. 
ing the horrors of a foul dungeon, to offer from her own breast suste- 
nance to an aged and starving father, and tvhile we look, the lachrymal 
glands are excited, and unbidden tears flow freely. At an other point, 
an inhuman monster has seized an innocent child, and is in the act of 
dashing out its brains against the wTall, and while we gaze, the blood 
mounts to the brain, the cheeks glow with indignation, and the heart 
throbs violently at the bare contemplation of the outrage. Another 
tableau meets the view, and we see the executioners in the act of cast- 
ing a struggling criminal into a den of poisonous serpents, and, as we 
behold the reptiles coiled up for a deadly spring, with fiery eyes, and 
forked tongues, the blood forsakes the surface, the stomach sickens, 
the heart sinks, and a cold shudder steals over the whole system. An- 
other scene presents itself; we behold a table loaded Avith the most 
tempting viands and fruits, and an immediate change occurs in the sa- 
livary glands, the mouth fills Avith saliva, the stomach indicates its 
Avant, and a general perturbation of the digestive system ensues. The 
mere sight of an epileptic often induces a corresponding complaint in 
others ; the indulgence of bad habits in one member of a family like 
snuffling, distortion of the mouth, eyes, &c., frequently bring about the 
same habits in other members of the family. Violent emotions from 
sudden intelligence, Avhether good or bad, often induce diarrhoeas, 
syncope, catalepsy, apoplexy, mania, &c.; fear and apprehension are 
most powerful predisp>osing causes of disease, and when excessive, 
often act as exciting causes, particularly during the prevalence of epi- 
demic or contagious affections, as cholera asphyxia, small-pox, yellow 
and typhus fevers, &c. Protracted grief is a common cause of chronic 
diseases, like dyspepsia, jaundice, neuralgia, hypochondria, phthisis 
pulmonalis, &c. Intense and exclusive application to any subject, 
eventually causes disease of the brain and nervous system, and mental 
derangement. The hypochondriac, who suffers under the effects of 
morbid fancy, continues to feed his malady by pondering over his ima- 
ginary ailments ; the monomaniac, as he dAvells upon his delusion, fans 
the flame that is consuming him. If an individual in the most perfect 
health be told by several different persons that he looks pale, haggard, 
and sick, it is more than probable that the impression will exercise so 
poAverful an influence, that he will actually feel sick, and take to his 
bed ; Ave have witnessed more than one example of this kind. 
The case of the criminal is often quoted, who died of fright by the 
simple flowing of tepid water over his limb, while the attendants made 
suitable remarks on the effects of the loss of blood, till fatal syncope 
Avas produced. Professor Bennett says, a butcher was brought into 
the ofiice of a druggist, suffering from a terrible accident. “ The man 
on trying to hook up a heaAry piece of meat OArer his head, slipped, and 
the sharp hook penetrated his arm so, that he was himself suspended. DYNAMIC INFLUENCE. 
73 
On being examined, he was pale, almost pulseless, and expressed him- 
self as suffering acute agony. The arm could not be moved without 
causing excessive pain, and in cutting off the sleeve, he frequently cried 
out; yet when the arm was exposed, it was found quite uninjured, the 
hook having only traversed the sleeve.” In disease also, the manner, 
bearing, and expression of the physician, often exert the most surpriz- 
ing effects upon the patient, either in ameliorating or aggravating his 
malady. Most diseases are attended with an exalted state of the 
nervous system, and with a highly sensitive and irritable condition of 
the mental faculties. In this condition, a doleful expression of counte- 
nance, or words of doubt, discouragement and sadness, are often capable 
of plunging the patient into the most profound state of mental and 
physical depression, and thus aggravating, to a serious extent, his ma- 
lady ; while on the other hand, a cheerful face, a lively and agreeable 
manner, and words of hope and encouragement usually exercise an 
influence of the most favorable character, and conduce very materially 
in bringing about a curative action of the organism. It should never 
be forgotten, that courage, hope, confidence, and a cheerful state of 
mind, are powerful tonics, and often enable the healthy system to resist 
the influence of contagious, epidemic, and other noxious impressions, 
and the sick organism to combat successfully the destructive effects of 
disease; while fear, apprehension, grief, despair of recovery, sadness, 
and depression of spirits, by impairing the resisting powers of the eco- 
nomy, become both predisposing, and exciting causes of disease. Show 
me a physician who has attained a high reputation in the treatment of 
difficult, and dangerous cases of disease, and I will have confidence, 
that he is one who carries a cheerful face; who delights in dwelling 
upon the bright and pleasant things of life, rather than upon those 
which are gloomy and dismal; and who does not fail to infuse into his 
patients, and all around him, confidence, hope, and comfort. The ex- 
pression and bearing of such a man always act as a beacon of hope, 
to arouse the sinking energies of the patient, and to encourage him to 
strive against the depressing influence of his malady. In these and 
other analogous instances, it is the intelligence alone which is operated 
on and which diffuses its influence, not over any vital properties of the 
organism, but upon the respiratory, circulatory, digestive, and nervous 
systems. 
We have, then, constantly operating upon the machine first, what may 
be termed the material or natural stimuli, and second, the immaterial 
or spiritual stimuli, both of which are absolutely essential to the 
continued performance of the functions. In some parts of the organ- 
ism, these material excitants, must be constantly present, in order that 
the system may be kept in operation. The heart and blood vessels, 
and the respiratory organs must be incessantly acted upon ! y the 74 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
blood and atmospheric air, in order to ensure life. Other parts, like 
the stomach, lacteals, capillaries, Ac., may be deprived of their natural 
stimuli for a length of time -without causing death, but not without 
inducing derangement of function, or causing disease. These materia 
stimuli, not only exercise a highly important influence in the plieno 
mena of life, but it is upon them that morbific and other noxious im 
pressions are often made in causing disease. According to Liebig, 
“ the slightest action of a chemical agent upon the blood, exercises an 
injurious influence.” Any material deviation, then, from the natural 
properties of the inspired air, or the other stimulants of the organism, 
must constitute a source of disease. 
The other agency exerts a not less important influence over all parts 
of the body, and gives rise to its manifestations in accordance with the 
peculiar organization and modification of each structure. 
The operation of this intelligence upon the organs produces that 
peculiar state which enables them, when supplied with their material 
stimuli, to accomplish their functions. It manifests its power in the 
capillary system in enabling these vessels to exclude the red globules; 
over the lacteals, in enabling them to exclude all but the nutritious 
portions of food, over the organs of involuntary motion, in enabling 
them to respond with unformity and regularity to their material exci- 
tants ; over the nerves of sensation and motion, in enabling them to take 
cognizance of injurious foreign impressions, and to exercise voluntary 
motions; over the organs of the special senses, in enabling them to 
appreciate sight, hearing, smell, taste, and touch. This spiritual in- 
fluence operates only through the medium, of these organs and tissues, 
developing specific and harmonious manifestations, according to the 
peculiar use and structure of each part. Under its guidance the mole- 
cules are appropriated and become a part of the organism. Through 
the same influence the system is enabled to resist, to a certain extent, 
morbific and other injurious impressions. It is this stimulus which 
endows each tissue with its specific irritability, causing each part to 
recognize and respond to its own natural material excitant, and offer 
resistance to the application of all disturbing agencies. 
The soul does not leave the body, until the structures are so much 
injured, that the functions all cease operation. Many organs may be 
destroyed or rendered incapable of transmitting mental or spiritual 
impressions, yet the intelligence, entire and unaltered of itself, will 
still pervade the remaining portions of the organism. It will still mani- 
fest itself just so far as it finds normal organs and tissues to operate 
through, or manifest an influence upon. The material parts alone may 
be impaired or obliterated, but so long as there is life, the immaterial 
part must pervade the body unaltered, although its manifestations may 
be entirely changed. PERVERSIONS OF HEALTH.—NATURE OF DISEASE. 
75 
PERVERSIONS OF HEALTH.—NATURE OF DISEASE. 
The boundary between health and disease, though in some degree 
familiar to all, is not easily defined. Health in perfection is perhaps 
never seen in such a world as ours. It is usually described as a con- 
dition of the organism, in which there is “freedom from pain and un- 
easy sensations, and freedom from all those changes in the structure oi 
the body that endanger life, or impede the easy and effective exercise 
of the vital functions.” Departures from this happy state of life present 
themselves to us both in form and degree in infinite variety. 
Disease consists in some deviation from a state of health. It may 
extend no farther than to some simple derangement of function, in which 
no alteration of structure is discovered or suspected; or may be at- 
tended with appreciable change of texture, and may run a longer or 
shorter course, with or without modification from medical treatment. 
The former of these grades of disease may often be properly assigned 
to the care of the hygienist, who, by dietetic regulations, by correct 
employment, food, drinks, temperature, and pure air, may restore the 
invalid to a state of health. The physician must also be a practical 
hygienist, and able to employ auxiliary agencies with scientific pro- 
priety, as well as to select with certainty the necessary specific remedy 
On the “nature of the relations of the sciences of Therapeutics and 
Hygiene,” Dr. Dunham remarks: 
“That the province of Hygiene is, to discover whatever causes may 
have contributed to induce or perpetuate the diseased condition, and ii 
possible to remove them. 
“ That Hygiene alone is sufficient to restore many sick persons to 
health, and that it is in most cases an indispensable aid to Therapeutics. 
“That Therapeutics concerns herself only with the discovery and 
selection of an individually-specific remedy for each individual case of 
disease; which is done in accordance with a therapeutic law. This 
law may be the homoeopathic formula, or it may be some broader 
generalization,—but there can be but one law of this kind. 
“ That in so far as Hygiene is concerned, homoeopathists and allo- 
paths occupy common ground,—the philosophy of the science being 
the same for both, however modified and shaded in practical application 
by the different therapeutics of the two schools. 
“ That in Therapeutics alone, that is, in the discovery and selection 
of the individually-specific remedy for each individual case of disease, 
do we differ radically from the old school of medicine,—the allopaths 
having in fact no science of Therapeutics whatever, their philosophy 
of cure being an application of the principles of Hygiene to all dis- 
eased conditions.* 
* Homoeopathy, the science of Therapeutics. 76 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
THERAPEUTICS. 
There are but three modes of treating disease. They are distin- 
guished as follows: 
1. The Homoeopathic, which only is salutary and efficacious. It 
u alone leads in a direct way to a mild, sure and durable cure, without 
either injuring the patient, or diminishing his strength.” 
2. The Allopathic or Ileteropathic. Without regarding what is 
really diseased in the body, it attacks those parts which are sound, in 
order to draw off the malady from another quarter, and direct it to- 
wards the latter. 
3. The Antipathic or Enantiopathic, which is merely palliative. 
This consists in paying attention to only a single symptom or feature 
of the disease,—that of which the patient complains most loudly, and 
prescribes a remedy which may palliate that. For pains of every de- 
scription, Opium, which may benumb the senses and allay the pain. 
For diarrhoea, the same remedy to stop the peristaltic action, or an 
astringent to suppress the secretions. For insomnolence, the same 
remedy. For long-continued constipation, purgatives. For habitual 
debility, Wine. 
Of these different modes of treating disease, the first alone is truly 
efficient and salutary. The reason that this is true, and that all the 
others are pernicious, says Hahnemann, “is founded upon the dif- 
ference which exists between the primary action of every medicine, 
and the reaction, or secondary effects, produced by the living organism 
(the vital power;.” # 
At the present time there exists no uniform or general system of 
therapeutics, because there is no theory of disease in which universal 
confidence is reposed. The medical world being divided into several 
distinct schools, each inculcating a different doctrine concerning patho- 
logy and the methods of cure, and all endeavoring to sustain their 
favorite systems, without much regard to accuracy respecting facts, or 
to logic in their inductions, it is not surprising, that the science of 
medicine is so often looked upon by the public with distrust and dis- 
respect. We behold the vitalist denouncing the doctrines of the 
chemist and mechanician, as inconsistent and highly dangerous in 
practical operation, while all agree in ridiculing that system which is 
alone founded on accurate observation of facts, homoeopathy. 
It is doubtless true, that many new and valuable ideas may be de- 
rived from each of these conflicting schools by the medical philosopher, 
whose sole object is truth. Indeed, the coincidence of opinion between 
the father of homoeopathy and many of the most prominent advocates 
of the vital theory, like Paine, Bichat, Philip, &c., in regard to physio- 
* Hahnemann, Organon, § 63. THERAPEUTICS. 
77 
logy and pathology, is remarkable. These eminent authors not only 
agree, respecting the “properties and laws of healthy beings,” but they 
concur as to the changes and modifications which take place in dis- 
eased states of the organism. Although they entertain totally different 
views concerning the practical application of remedies, it will be ob- 
served, that the allopath often adopts the precept “ similia similibus,” 
in effecting his cures. 
Nor are there men wanting,—men, who stand high in the ranks of 
allopathy,—who unhesitatingly place the pathological and therapeutical 
doctrines of homoeopathy, far above those of either the chemical or 
physical schools. 
Thus Paine in his “Institutes of Medicine ” observes: “ It is due to 
truth {fiat justitia mat ccelum), that the physiologist concedes to the 
homoeopath, that his hypothetical views may be directed by an enlight- 
ened understanding of the properties and laws of healthy beings. 
Upon this ground, indeed, his hopes can alone repose; and even his 
doctrines in pathology and therapeutics are a thousandfold better, more 
rational, more consistent, more conducive to health and to life, than 
any or all of the tenets of the chemical or physical schools.” 
We shall not be surprised at this concession, when the opinions of 
Hahnemann are contrasted with those of many allopathic authors who 
have written since his days. 
The vitalists hold, “ that all disease consists in modification of the 
vital properties and a consequent change of function, and is, therefore, 
only a variation of the natural states, that the artificial cure consists 
in a restoration of these properties and functions, by making upon the 
former certain impressions, which enable them to obey their natural 
tendency to a state of health; that remedial agents of positive virtues 
operate like the truly morbific, but less profoundly in their therapeutical 
doses, and that the philosophy of their cure consists in establishing, in 
a direct manner, certain morbid alterations in the already diseased pro- 
perties and actions of life, which are more conducive to the natural 
tendency that exists in the vital properties to return from a morbid to 
their natural state.” {Paine) 
Hahnemann, in his “ Organonf says: “It is solely the morbidly af. 
fected vital principle which brings forth diseases : that in disease this 
spontaneous and immaterial vital principle, pervading the physical or- 
ganism, is primarily deranged by the dynamic influence of a morbific 
agent, which is inimical to life. Only this principle, thus disturbed, 
can give to the organism its abnormal sensations and incline it to the 
irregular actions which we call disease.” 
So also of the operation of remedies, Hahnemann has it, “ that the 
brief operation of the artificial morbific powers which are denominated 
medicinal, although they are stronger than natural diseases, renders it 78 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
possible that they may, nevertheless, be more easily overcome by the 
vital energies, than the latter, which are weaker. Natural diseases, 
simply because of their more tedious burdensome operation, can not be 
overcome by the unaided vital energies, until they are more strongly 
aroused by the physician, through the medium of a very similar, yet 
more powerful morbific agent, (a homoeopathic medicine). Such an 
agent, upon its administration, urges, as it were, the instinctive vital 
energies, and is substituted for the natural morbid affection hitherto 
existing. The vital energies now become affected by the medicine 
alone, yet transiently; because the medicinal disease is of short 
duration.” 
The vitalists of both schools also suppose that natural, morbific and 
remedial agents, possess certain peculiar and distinct properties, which 
enable them to exercise an influence only on particular parts of the 
system through the means of particular nerves ; “passing over, in the 
f ulfilment of this law, various intermediate nerves of more direct 
anatomical connection. ’ ’— {Paine.) 
Although we are not advocates of the vital theory thus stated, yet it 
must be conceded that this principle of elective affinity is so universal, 
as applied to the operation of the morbific and remedial agents, that 
the influence wdiich any substance of either class exerts upon the or- 
ganism, may wTith propriety be denominated its specific effect. The 
miasms of plague, of intermittent, yellow, and certain other fevers; the 
infection of contagious diseases; the virus of hydrophobia, syphilis, 
gonorrhoea, &c., all produce peculiar and specific effects upon the sys- 
tem. Each of these substances possesses the property of selecting 
that tissue for which it has an affinity, and of expending its entire pri- 
mary action upon the particular part selected. 
It is owing to this specific law, that medical men have been able to 
classify diseases ; to predict with certainty, that the exposure to the 
influence of morbific agents, under certain circumstances, will give rise 
to abnormal action in certain parts, attended with a definite and uni- 
form train of symptoms. 
It is also in virtue of this specific law, that medicines may be admi- 
nistered wdiich operate with certainty upon particular tissues and or- 
gans and effect those primary and sympathetic modifications in dis- 
eases of the organism, which enable nature to bring about safe and 
speedy cures. 
One of the chief objections urged against the therapeutical doctrines 
of homoeopathy is the supposed “ fallacy of reasoning from the effects 
of remedial agents upon healthy to morbid conditions.” {Paine’s In- 
stitutes of Medicine.) The reason adduced for this opinion, is the 
fact that diseased parts become modified in their action, and far more 
susceptible to the operation of remedies than wdien healthy. This last THI'RAPEUTIC8. 
79 
statement is doubtless true, and it stands, as we shall endeavor to show, 
at the foundation of the homoeopathic method of administering me- 
dicines. 
Although the axiom, “ contraria contrariis opponenda,v is almost 
universally acknowledged as a principle of faith among the different 
schools of allopathia, so far as theory is concerned, yet in practice, the 
principle u similia similibus curanturis as we have before observed, 
not unfrequently adopted. 
In order that a clear understanding may be acquired of the manner 
in which medicines operate, as exhibited by the old and new schools, 
we shall attempt to demonstrate:— 
1. That most morbific and remedial agents operate specifically and 
with much uniformity, both in health and in disease, as causative and 
curative agents. 
2. That all drugs produce upon the human body primary and se- 
condary effects, the first of which appear speedily, and when the dose 
has not been excessive, are of short duration, and are then succeeded 
by the second, which are of opposite character and permanent. 
3. That in disease, the susceptibility of the affected parts to the action 
of remedies is vastly greater than of the same parts when in health. 
4. That medicines, when administered in crude form, and in large 
doses, according to the doctrines and ordinary practice of the old 
school, whether applied directly to the diseased organ or tissue, or to 
a healthy structure, remote from the diseased part, are not only incom- 
petent to eradicate disease in a safe and speedy manner, but generally 
serve to aggravate the already existing symptoms, and by superindu- 
cing additional medicinal disease, complicate, to a serious extent, the 
original natural affection. 
5. That when a curable natural disease has been excited in the or- 
ganism, attended with a definite train of morbid symptoms, a medicine 
capable of causing (in large doses,) a similar series of symptoms, in 
health, will become speedily curative of such natural disease, if admi- 
nistered in the attenuated doses of homoeopathy. 
SPECIFIC EFFECTS OF MORBIFIC AND REMEDIAL AGENTS. 
All are aware that the natural poisons of certain animals, the virus 
of hydrophobia, syphilis, gonorrhoea, and sycosis ; the miasms of plague, 
and of yellow, typhus, and intermittent fevers ; the infection of con- 
tagious diseases, &c., when introduced into the circulation, produce 
specific ejfects upon the human system, and give rise to definite and 
easily recognized symptoms. 
There arc other morbific agents, like intense and protracted heat and 
cold, atmospheric vicissitudes, excessive physical and mental exertion, 80 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
violent emotions, &c., that operate in a more general, but not less spe- 
cific manner. Their operation, when carried so far as to become mor- 
bific, induces debility of the nervous system ; loss of irritability in the 
capillary vessels, which makes them incapable of excluding the red 
globules, and as a consequence, developing augmented heat, swelling, 
redness, and pain. 
The influence of almost every agent, whether morbific or medicinal, 
appears to possess a kind of elective affinity for some particular organ 
or structure of the organization.” This fact is so apparent in regard 
to morbific agents, that it scarcely requires notice; but there are many 
authors who still entertain doubts respecting the specific action of me- 
dicines. An attentive examination of the following facts, must, how- 
ever, settle that question satisfactorily in the minds of all impartial 
inquirers. 
Remedial agents operate in the same specific manner, both in health 
and in disease; but with the difference that in the latter condition, only 
a very minute quantity of the specific agents is requisite to produce a 
salutary impres sion, on account of the augmented suspectibility to 
remedial impressions which diseased parts acquire. 
1. “ A medicine administered in certain doses, and during a certain 
period of time, can produce pathological lesions analogous to those 
that characterize certain diseases.” 
2. “This same medicine, given to a healthy individual, on the same 
principles, produces the characteristic symptoms of the diseases 
whose pathological lesions it gives rise to.” 
8. “ This medicine is a specific in these same diseases.” 
4. “ Specificity is not therefore an isolated fact, but the law which 
should guide medical treatment.” (Des specifiques en medecine, 
Paris / par L. J. J. Molin). 
The experiments of Magendie, Blake, Pereira, Rau, Liebig, Muller, 
Orfila, Griesselich, Molin, Matteucci, and Philip, prove conclusively, 
that most morbific and remedial agents, when given in massive doses, 
produce their effects after having been absorbed into the blood. It 
has also been proved with equal certainty, that foreign substances, 
when absorbed into the circulation, are conveyed to those structures 
for which they have a special affinity, and there make a specific im- 
pression, which modifies the function of the part, according to the na- 
ture of the agent, and predisposition of the individual. The Idood 
serves as conducting medium merely, and if the absorbed substances do 
not possess the power of exercising an influence upon any tissue, they 
may continue to circulate through the lungs until inspired air gradually 
neutralizes them, or they may remain for an indefinite length of time, 
(as sometimes happens in cases of hydrophobic virus, and fever 
miasms, without affecting the system), and yet retain their activity SPECIFIC EFFECTS OF MORBIFIC AND REMEDIAL AGENTS. 
81 
The reason of this may be, that the tissues upon which they act, are 
in so perfect a state of vigor as to be able to resist the power of the 
noxious agent, until some cause shall enfeeble the part to be affected, 
and thus predispose it to receive the injurious impression. 
It will not be denied, that both in healthy and diseased states of the 
organism, Cantharides, Copaibse, Cubebs, the Turpentines, Juniper, 
Squills, Colchicum, Digitalis, Apis-mel. Cajeputi, and most other 
diuretics, produce their effects by acting directly or specifically upon 
the kidneys, as topical irritants; that the preparations of Mercury, 
Nitric-acid, Iodine, &c., exercise a direct and specific action upon the 
glands, mucous membranes, and skin; that Senega, Phosphorus, Ipeca- 
cuanha, tartarized Antimony, (whether taken into the stomach, or in- 
jected into the veins), and many of the resins exercise a specific action 
upon the lungs; that Aloes, Gamboge, Colocynth act specifically upon 
the stomach and rectum, while Senna, Rhubarb, Scammony, Jalap, 
and certain other cathartics, spend their effects upon all portions of 
the intestinal canal; that Ergot, Savin, Pulsatilla, Madder, Tansy, &c., 
operate specifically upon the uterus; that Belladonna, Opium, Stra- 
monium, Strychnine, Hyoscyamus, Conia, and Coffee impress specifi- 
cally some portion of the nervous system; and in a word, that almost 
every drug impresses certain tissues in preference to others, and that 
a knowledge of the manifestations to which these different impressions 
give rise, can alone enable us to combat diseases. That the above 
enumerated substances are actually absorbed, and exert a topical effect, 
is apparent from the fact, that they have often been detected in the 
blood, secretions, excretions, and even the solids of the body. 
It is asserted by Flourens, “that Opium acts specifically on the 
cerebral lobes; that Belladonna in a limited dose, affects the tubercula 
quadrigemina, and in a larger dose the cerebral lobes also; that Alco- 
hol, in a limited dose, acts exclusively on the cerebellum, but in a larger 
quantity, it affects also neighboring parts; and lastly, that Nux-voinica 
more particularly affects the medulla-oblongata.” He also states, 
“ that in birds, it is possible to observe, through the cranium, changes 
of color, (some alterations in the vascular condition of the parts) which 
these agents affect in the brain.” Pereira, in his Materia Medica, also 
declares, that “the ammoniacal, empyreumatic and phosphoric stimu- 
lants, containing Ammonia and its salts, the empyreumatic oils, Phos- 
phorus, Musk, and Castoreum, all agree in producing a primary and 
specific effect on the nervous system, the energy and activity of whose 
functions they exalt. On account of their specific influence over the 
nervous system, they are administered in various spasmodic or con- 
vulsive diseases, especially in hysteria, and also in epilepsy and chorea. 
The beneficial influence of some of the vegetable tonics, (as Cinchona), 
in intermittent diseases, should probably be referred to the specific 
VCL. 1.-6- 82 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
effects of these agents on the nervous system. The preparations of 
Arsenic, Silver, Copper, Bismuth, Zinc, &c., are usually, but I think most 
improperly, denominated tonics. They are agents, which in small and 
repeated doses, as well as in layge and poisonous doses, specifically 
affect the nervous system.” 
We are also assured by Liebig, in his work on animal chemistry 
that “we can by remedial agents exercise an influence on every part 
of an organ, by substances possessing a well-defined chemical action.” 
It will be observed, that we have adopted, in part, the views of Muller, 
in regard to the operation of morbific and remedial agents. This 
distinguished physiologist supposes, that the blood is only the “vehicle 
of introduction,” and that as it passes through the tissues of different 
organs, the medical particles with which it is impregnated “ act on one 
or more parts, which are endowed writh a peculiar susceptibility to 
their influence.” He also supposes, “that a change is effected in the 
composition of the organic matter of the parts acted on.” 
That medicinal substances induce modifications in the functions of 
the organs by topical action, is proved, as we have before observed, 
from the fact, that medicinal particles are often found in the ex- 
cretions of the affected part. The inference must follow, from a careful 
consideration of all the facts bearing upon the subject, that the functions 
of the organism are generally morbidly altered by the direct action of 
noxious substances. (For further proofs respecting the doctrine of 
absorption and topical action of drugs, see the experiments of Muller, 
Tiedemann, Gmelin, Magendie, Matteucci, Liebig, Rau, Flourens, Du- 
trochet, Blake, Hering, Mayer, Christison, Orfila, and Dumas). 
In regard to the mode in which these substances operate, we suppose 
that their primary impression is made upon the sentient extremities of 
the nerves, impairing their integrity, and rendering them incapable of 
conducting the spiritual stimulus (which is an essential condition to 
irritability,) to the extreme vessels. 
It must be borne in mind, that in all inflammations, the capillaries 
are the “instruments of disease,” that the primary impressions of all 
deleterious agents are made upon these delicate structures, and that 
all of our remedies must be directed with reference to the state of 
these vessels in curing disease, “upon these vessels, all remedial agents 
exert their curative effects, whether by their direct action, or through 
the instrumentality of the nervous power.” (Paine). 
The extreme terminations of the nerves are so highly impressible, 
that the very minutest quantity of a specific agent is capable of pro- 
ducing prompt and decided effects, while the same agent would prove 
powerless if applied to the larger nerves. Thus it is that imponderable 
substances and mental emotions are so often the causes of disease. 
Here we have one reason, also, why medicines, when administered ho- SPECIFIC EFFECTS OF MORBIFIC AND REMEDIAL AGENTS. 
83 
moeopathically, produce those happy modifications in the affected parts 
which dispose them so speedily to recovery. In connection with this, 
if we take into consideration the extreme sensibility which diseased 
parts acquire to the operation of medicinal agents, we shall be unable 
to doubt the propriety of administering medicines according to the 
homoeopathic method. 
Muller supposes, that when impressions are made by specific sub- 
stances, “changes are effected in the composition of the organic matter 
of the parts 'acted on.” Of this, however, there is no satisfactory evi- 
dence. On the contrary, we know positively, that very many cases of 
disease occur without giving rise to any change whatever in the organic 
construction of the parts affected. 
One of the first indications generally observable in an abnormal state 
of an organ or tissue, is a loss of tone, or irritability and perverted 
function of the capillary vessels. In the experiments performed on 
the blood by Philip, Alston and Gallois, it was observed, that the 
smaller vessels were the first to succumb to foreign influences, and 
then, if the potency of the agent were increased, the larger vessels 
would become affected. 
Now, when we reflect, that irritability is dependent, 1., upon a nor- 
mal organization of parts ; 2., a regular and uniform supply of natural 
material stimuli, the arterial blood, &c., and, 3., a healthy action of 
the mind, in order that the spiritual stimulus shall make its due im- 
pression, we can readily conceive, how slight a cause, moral or physical? 
morbific or remedial, may disturb or impair this irritability, and thus 
induce disease. u Every part of the organism depends for the per- 
formance of its proper functions on the receipt of arterial blood and of 
nervous influence; so alterations in the supply of either of these essen- 
tials may modify or even suspend the functions of a part.” (Pereira?s 
Materia Medica.) 
The nerves are simply the conductors of the intelligence, and so 
long as their integrity, tone or conducting power remains unimpaired, 
this essential condition of irritability will remain. If, however, any 
cause acts upon them in such a manner, as to injure or destroy 
this important property, the stimulus of the superintending spirit is 
not transmitted, and, as a consequence, disease must result from the 
absence of one of the important requisites of irritability or con- 
tractility. 
Injurious impressions may be made upon the extreme nerves either 
by deleterious matters absorbed into the blood, and brought into 
direct contact with them, or by certain external applications, like 
electricity, magnetism, heat, cold, exercise. Inflammation may be 
excited by the operation of either of these causes, by a primary 
effect upon the sentient extremities of the nerves, which induces 84 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
loss of tone and conducting power, and, as a consequence, loss of 
irritability and resisting power in the capillaries. This impression 
is not made, as some theorists would have it, upon an immaterial 
principle, but upon something material, tangible and demonstrable, 
viz., nerves themselves. 
Poisons and other noxious substances, when taken into the blood, 
are rapidly conveyed to all parts of the body; and when they ar- 
rive at the structures, upon which they have a specific action, nature 
makes an effort to expel them through these particular parts. If 
the substance be active in its effects, the impression which is made 
upon the minute nerves of the part, will be in a corresponding 
manner severe. The length of time required for foreign substances 
to produce their effects is extremely variable. Some articles, like 
several of the . salts of Potash, Juniper, the Turpentines, Asparagus, 
Indigo, Madder, &c., are expelled through the urinary organs in a 
few moments, while other substances may remain in the blood for 
an indefinite period of time, or until some predisposing cause shall 
act upon the system in such a manner as to augment its suscepti- 
bility and place it in a condition to be affected by the morbific 
agent. In some instances, the morbific agent remains harmless in 
the circulation for months, and even years, -when suddenly some 
tissue becoming enfeebled and incapable of resisting the action of 
the specific agent, the disease in all its violence bursts forth. In 
cases like these, it is quite evident, that the injurious impressions 
can not be made upon the vital properties of parts, for the effects 
must be sooner propagated and rendered apparent. Neither can we 
suppose with the advocates of the chemical hypothesis, that the 
constituents of the blood become altered and contaminated with the 
peculiar miasms or virus, for such blood introduced into the circu- 
lation of a healthy individual gives rise to nothing like the original 
disorder. We again repeat, that the blood is simply the vehicle 
which conveys the poison, and that no effects are produced until 
the structure for which the poison has the greatest affinity, has 
become ready from predisposing cause, to receive the impression of 
the deleterious agent, and thus is specifically affected. 
Why it is, that morbific and remedial agents select particular 
organs and tissues to exert their action upon, we do not know; 
but that such is the fact, all medical observers will bear witness. 
Nor is it more surprising, than that some of the natural fluids, like 
the urine, gastric juice, bile, &c., remain with impunity in some parts 
of the body, while if they gain admission to other parts, as the 
cellular substance or peritoneum, they occasion inflammation, sloughing 
and death. 
Those substances in nature, which in certain modes of application to SPECIFIC EFFECTS OF MORBIFIC AND REMEDIAL AGENTS. 
85 
the living organism produce immediate death, and in other degrees o 
their power only derange the healthful operations and produce disease 
are usually known under the name of poisons. 
Poisonous substances produce disease by three different modes:# 
1. By local destruction or irritation of the living surface to whicf 
they are applied. 
2. By producing changes in the composition of the blood. 
3. By direct changes in the nervous system. 
I. The first class of poisons embraces all substances that produce 
their effects in accordance with the laws of organic chemistry: such as 
concentrated acids, alkalis, some salts and metallic oxides, also some 
kinds of acrid vegetable matter. The effects of these articles vary 
widely according to the quantity in which they are employed, and 
they become deadly poisons or beneficent remedies according to 
the conditions under which they are used. A small quantity of 
Arsenic taken into the stomach excites a severe inflammation, with 
vomiting and diarrhoea, by which the irritated organ endeavors 
to expel the offending substance. If we take the one-thousandth 
part of a grain, a series of phenomena of a different character will be 
elicited. The minute particles of the poison having been tolerated in 
the stomach, pass out of it with its other contents; and may be ab- 
sorbed with the chyle from the inner surface of the intestines and con- 
veyed into the general circulation without producing violent symptoms. 
Thus the effect of a corrosive poison is entirely changed by merely re- 
ducing the dose. We will hereafter see, that when the dose is reduced 
to a quantity sufficiently small and finely attenuated, the agent would 
produce no perceptible effect on a person in health ; but that the 
same dose, charged with the dynamic force, which is developed by 
the process of attenuation, is capable of exerting a curative influence 
in a patient affected by a disease which is similar to that which Arsenic 
is capable of causing. 
Of this dynamic force, which is developed by trituration, and succus- 
sion in the preparation of homoeopathic attenuations, Hahnemann says: 
The discovery by which this development of the medicinal powers of 
drugs is effected “ is of inexpressible value, and so undeniable, that 
those who, from a want of knowledge of the resources of nature, con- 
sider homoeopathic attenuations as mere mechanical divisions of the 
original drug, must be struck dumb when they consult experience.” 
II. There are other substances whose particles in their ordinary state 
adhere so firmly together that in their unchanged condition they mani- 
fest no action upon the human organism except in their chemical rela- 
tions. Metallic gold, silver, tin, vegetable coal, silicea, &c., are en- 
tirely inert, even if taken in large quantities. But these apparently 
* Dr. H. Goullon. 86 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
powerless substances are, nevertheless, charged with a latent force, and 
by trituration with an inert substance, as sugar of milk, become changed 
into active medicinal agents. And the more perfectly their surface is 
atomized by trituration, i. e., their atoms are liberated, “ the more their 
latent peculiar electricity is developed, and at the same time transmitted 
to another vehicle, as is done by every electric-machine.” They7 have 
then become potentized, dynamized, having “ their latent force ren 
dered active through the solution of cohesion.” In order that this con- 
cealed or latent power might be effectually developed, Hahnemann 
directed that in preparing the first triturations, two Avhole hours should 
be consumed. 
III. Substances, chiefly Vegetable, which are active in their na- 
tural state.—Of these the number is very large, and it is remarkable 
that the chemical composition of such as are feeble in their action, is 
almost the same as that of others which are virulent poisons. They 
are all active in their natural state; but, as remedies, they require to 
be used in small quantities, and they become highly useful in remov- 
ing diseases and symptoms, such as they are capable of producing. 
ALLOPATHY. 
It would be very difficult to give a correct definition of the above 
term. The axiom, which is adopted by a portion of the disciples of 
the allopathic school, and upon which their hypothetical doctrines ar 
founded, is “ contraria contrariis opponenda.” Although distinctions 
are recognized between the antipathic or palliative, the allopathic or 
heteropathic, and the chemical methods of practice, yet in point of 
fact, they may all with propriety be resolved into one and the smue 
school. All employ venesection, emetics, purgatives, diaphoretics, and 
alteratives, to reduce inflammations; opium to allay pain and suppress 
unnatural discharges ; bark, iron, and brandy, &c., as tonics ; blisters, 
setons, moxas, issues and escharotics to produce counter irritation; re- 
vulsives, derivatives, and indeed all of those means, which are termed 
allopathic. 
Allopathists do not, however, uniformly adhere to any of the above 
doctrines, but often unconsciously encroach upon homoeopathic ground, 
and, by practicing according to the law of “ similia similibus,” effect 
their speediest and safest cures. 
Thus Rhubarb and Calomel, when administered in large, doses during 
health, cause irritation or inflammation of the membranous tissue of the 
bowels, as is indicated by the griping pains, and discharges of watery 
or mucous fluids ; yet these are favorite allopathic remedies for diar- 
rhoea and dysentery; Copaiba, Cubebs, Turpentine, and Cantharides, 
when given in large doses in health, induce inflammation of the mucous 
membranes of the urino-genital apparatus; yet these specific medicine* ALLOPATHY. 
87 
are almost invariably prescribed in tbe acute and chronic affections of 
these parts ; Ipecacuanha, in doses of twenty to thirty grains, is the most 
common emetic of the old school; yet this same school are constantly 
in the habit of administering this drug in doses of one-twelfth or one- 
sixteenth of a grain, in cases of obstinate nausea and vomiting, with the 
most happy results; inhalations also of the particles in Ipecacuanha 
cause asthma, cough, dyspnoea, &c.; yet it is a common remedy in 
small quantities for the cure of these complaints; excessive use of alco- 
holic liquors or opiates, often induces delirium tremen-s; yet Opium 
and Brandy, which exercise the same specific effect upon the brain, are 
the principal allopathic resources in curing this dangerous malady ; the 
preparations of Mercury, when given in considerable quantities, cause 
ulceration and sometimes gangrene and sloughing of the mouth and 
throat, pains in the muscles and bones, eruptions upon the skin, and 
inflammation of the bowels, attended with tenesmus, and mucous and 
bloody stools; yet for syphilitic and other ulcerations of the throat, 
pains in the limbs, eruptions, and bowel affections, the use of small 
doses of this mineral, in some form is deemed indispensable by the al- 
lopath. Sir Astley Cooper, in his Lectures observes : “ Children often 
contract syphilis in utero, and within twenty-four hours after their en- 
trance into the world, have the palms of their hands, the soles of their 
feet, and the nates covered with copper-colored eruptions ; and the nails 
begin to peel off, and if care be not taken, the little patient will sink 
under the effects of disease. In these cases you give the mother a 
quantity of Mercury, the influence of which is communicated to the 
child, through the medium of the milk, and it becomes cured of the sy- 
philitic disease.”—Cooper's Manual of Surgery by Castle.) 
This is excellent homoeopathic treatment; the Mercury in this in- 
stance is attenuated in the mother’s milk to a very great extent—pro- 
bably to such a degree that no analysis can detect it, or any scales 
weigh it, and yet Sir Astley Cooper assures us, that the infinitesimal 
quantity of Mercury, which finds its way to the milk of the mother, is 
sufficient to effect a speedy cure upon the child. In this instance 
nature, instead of art, attenuates the drug. Tartarized Antimony exer- 
cises a specific effect upon the lungs, stomach, and secretory organs, 
causing, according to Magendie, an inflammation or engorgement of the 
two first named organs, whether taken into the stomach or injected into 
the veins; yet this is the sheet-anchor of allopathy in pneumonia, 
pleurisy, and in the first stages of gastric or bilious fevers. Arsenic, 
when taken in large doses, in health, has a specific influence upon the 
nervous system, heart, skin, and alimentary canal; and this is an im 
portant old-school remedy in neuralgia, epilepsy, chorea, angina-pec- 
toris, cutaneous affections, and intermittent fevers. When nitrate of silver 
is absorbed in health, it makes a specific impression upon the nervous 88 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
system the brain, &c.; allopathists employ it in epilepsy, chorea, and 
morbid sensibility of the gastric and intestinal nerves. Large and re- 
peated doses of Nux-vomica or Strychnia, taken in health, produce “ri- 
gidity and convulsive contractions ” of the muscles ; yet in cases of trau- 
matic tetanus, Strychnia has effected cures in the hands of allopathic 
physicians, in doses of one-fourteenth to one-twentieth of a grain.— 
(See Report of a case by Dr. Fell,—N.- York Med. and Surg. Re- 
porter, No. 8.) 
The specific action of Nux-vomica under all circumstances is upon 
the cerebro-spinal system, and thence its efficacy when properly exhibited 
in tetanus, epilepsy, chorea, and hysteria. Belladonna, taken in health, 
gives rise to inflammation of the throat and a scarlet eruption upon the 
skin; and yet this remedy is highly extolled and extensively used as a 
prophylactic against scarlatina by many leading men opposed to homoeo- 
pathy. An eruption resembling psora is often produced by an exces- 
sive use of Sulphur and Iodine ; still these are the grand remedies in cu- 
taneous affections of this kind. Pereira prescribed Prussic-acid to a 
lady who had been suffering for months from gastrodynia; in a few 
hours, to the astonishment of every one, she was quite wrell. “ It can 
hardly be imagined,” says Pereira, “ that irritation of the stomach can 
be rapidly removed by a substance which is itself an irritant.” The 
direct application of blisters to surfaces affected with rheumatic, erysi- 
pelatous, and other natural cutaneous inflammations, is constantly recom- 
mended at the present time by the followers of Hippocrates. “ Ery- 
sipelas and other cutaneous inflammations may be removed by the 
direct action of Cantharides upon the part inflamed. The remedial 
agent in these cases varies the mode of inflammation, and thus intro- 
duces a modification in which the properties of life are brought into 
recuperative action(Fame’s Institutes of Medicine) ; yet they affect 
a superlative contempt for the law of “similia similibus curantur !” 
It is from experience alone, that the old-school physicians have 
learned, that Ipecac., in doses of one-twelfth to one-sixteenth of a 
grain, arrests, nausea and vomiting, and imparts tone and vigor to the 
stomach; that Calomel, in doses of one-twentieth of a grain, is invalua- 
ble for the cure of inflammation of the mucous membranes of the 
bowels: “ in cases of inflammation of the mucous tissue of the intestines, 
attended with frequent watery discharges, there is nothing comparable 
with Calomel, in doses varying from the twentieth to the eighth of a 
grain once in four to twelve hours.” (Paine’s Institutes of Medicine.) 
That Quinia, in doses of one-sixteenth or one-twentieth of a grain is 
more efficient in removing remittent and intermittent fevers, and as 
a general tonic in diseased states of the system, than when exhibited 
in quantities of from one to ten grains at a dose, is admitted by the best 
authors. “Quinia, in the dose of five to ten grains,” says Dr. Payne? ALLOPATHY. 
89 
“may speedily arrest an intermittent fever by its febrifuge virtue; but 
this is bad practice, since, by its associate tonic virtue, it is likely to 
increase or to induce local congestions; thus leaving the patient im- 
perfectly cured, and subject to relapses: I have seen, in my own family, 
the most formidable grade of remittent fever, of long duration, and at- 
tended with the foregoing complications, ardent heat, thread-like pulse, 
loss of mind, &c., and where hope of recovery had been abandoned, 
yield to less than a grain of Quinine, divided into sixteen doses.” 
(Institutes of Medicine). By experience also they have learned, that 
Strychnia in very minute quantities, will cure tetanus ; and that the 
class of remedies denominated alteratives, are capable of producing 
powerful effects upon the organism, and that too in a manner altogether 
unknown and imperceptible. 
But how do these physicians know that the virtues of these medi- 
cines cease at these points? Have they ever made honest trials of them 
in a pure form, and in doses of one-fiftieth, one-hundredth, 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 allopathy. 
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 writers have approached so near to the views of Hahnemann, 
that we are at a loss whether to rank their theoretical doctrines as ho- 
moeopathic or allopathic. 
Pereira in his Materia Medica, writes as follows: “Unguents and 
lotions are used in cutaneous diseases, ulcers, &c.; gargles in affections 
of the mouth and throat; Collyria in ophthalmic diseases, and injec- 
tions into the vagina and uterus in affections of the urino-genital or- 
gans. In all such cases, we can explain the therapeutical effect in 
no other way, than by assuming, that the medicine sets up a 
new hind 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 hind of action in the part affected, creating 
a medicinal disease, which supersedes the natural one.” 
The only fault we have to urge against the allopathists in the treat- 
ment 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, however, their 
errors in exhibiting medicines in a crude and impure form, and in un- 
necessarily large doses, we must give them the credit, (fiat justicia 90 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
mat caelum), of occasionally curing disease (although unwittingly) in 
a “rational and consistent manner.” 
“When the intestinal mucous tissue” says Dr. Paine, “is affected 
with that condition of disease which results in a preternatural 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 secre- 
tion is arrested. Whether, therefore, the Rhubarb purge, or prove 
astringent or tonic, a common principle and common laws are concerned 
throughout; an d all the sensible results depend upon certain alterar 
tions, which the 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 variousphenomenawnay take place.” {Institutes of 
Medicine.) 
The same principle directs the practitioners of the old school 
in the treatment of many other diseases, and yet they sneer at homoeo- 
pathy, and hold up their own inconsistent and uncertain doctrines as 
philosophical and correct! They thus constantly administer medicines 
after the manner of the homoeopathist, abandoning their owTn theories, 
they practice upon the principles of our modern heresy. Gentlemen 
of the old school, where is your pride, where your consistency? You 
have the boast of antiquity; you have received your “bundle of ideas” 
from Hippocrates and Galen, to whom you pay reverence and alle- 
giance; you disdain innovations, and despise discoveries and improve- 
ments ; you have withstood the changes of more than two-thousand 
years, and by your powerful dicta have continually discouraged all 
original induction, and endeavored to crush in the bud every advance- 
ment in medical knowledge. Where is now your former pride, that you 
so often practically abandon your time-sacred axiom, “ contraria con- 
trariis,” and adopt the new heresy, “similia similibus'P Perhaps the 
light of modern science and discovery breaks, against your will, 
through the crevices of your unjointed and heterogeneous theories, or 
you are startled from your propriety by the overwhelming accumula- 
tions of fact Avhich Hahnemann and his disciples have displayed 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 late distinguished editor of the “British and 
Foreign Med. Chirur. Review,” Dr. Forbes, who asserts: 
“1. That in a large proportion of the cases treated by allopathic 
physicians, the disease is cured by nature, and not by them.” ALLOPATHY. 
91 
“2. That in a less, blit still not in a small proportion, 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 proportion of diseases, i 
would fare as wrell or better with patients, in the actual condition of 
the medical art, as more generally practiced, if all remedies, at least 
all active remedies, especially drugs, wTere abandoned. We repeat our 
readiness to admit these inferences as just, and to abide the conse- 
quences of their adoption.” 
We have thus far made allusion to that part only of the allopathic 
practice, which bears some approximation to the correct method. In 
most of the instances 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 im- 
pure 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 wre come now to a more interesting and momentous part of our 
subject. It becomes our duty to lay before our readers the doctrines 
and practice of allopathy, 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 phy- 
sicians make an indiscriminate use of thq palliative, heteropatliic, and, 
in a few instances, to the homoeopathic methods of practice. 
A general idea prevails that all diseases consist in “local determi- 
nations of blood,” and that no two affections 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. 
Physicians have been led to adopt this mode of reasoning from ob- 
serving that the spontaneous appearance of cutaneous eruptions, dis- 
charges of blood, profuse perspirations, &c., occasionally afford relief 
to morbidly affected internal organs. Without reflecting that these re- 
sults are merely symptoms of the internal disorders, and that the 
causes upon which these signs depend are located in the blood, they at- 
tempt to annihilate diseases by imitating artificially these symptoms. 
In regard to the first position, we affirm that their premises are un- 
true. There are no facts, which warrant the statement, that “ no 
excessive determinations of blood can exist in the same individual at 
the same time.” Neither is it true, that the appearance 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 92 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
energy and vigor ; since it often occurs that the symptoms of the com- 
plaint are all aggravated upon the supervention of either of the above 
occurrences. 
Dr. Wilson observes, that “ there is often a remarkable tendency to 
the worst species of haemorrhages from the bowels, towards the termina- 
tion of fatal cases of phrenitis.” Dr. Eberle says, “ on the day pre- 
ceding 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 hemor- 
rhage occurred also from the mouth and gums.”—(Practice of Physic.) 
Let us suppose a case of phrenitis. We have here an inflamma- 
tion, or a congested state of the capillaries of the brain. To relieve 
this inflammation and withdraw a portion of the fluid which is con- 
cerned in the congestion, bloodletting, both general and local, is resorted 
to as a primary and indispensable means of cure. By this means the 
general strength is reduced, the pulse increased or diminished in fre- 
quency, and the temperature of the skin is altered, but the congestion 
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-irritants, in order 
that new inflammations may be created in healthy structures, which 
shall supersede that already existing in the brain. To effect this object 
purgatives of the drastic kind are exhibited, and blisters 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 inflam- 
mation. 
Let us understand the case clearly. We have a disease consisting 
solely in a loss of tone and irritability of the serous vessels of the 
brain, which prevents them from excluding the red blood, and of per- 
forming properly their functions. To obviate this condition, a quan- 
tity of blood is abstracted, and artificial or medicinal 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 vigor 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 irrita- 
bility in these vessels, and that no cure can take place, until this im- 
paired irritability is restored. In inflammation, according to Philip, 
Hastings, Eberle, Wilson, and Allan, the capillaries of the part are in 
a state of debility and passive relaxation. The immediate exciting 
cause of the inflammation may be either stimulant or sedative. In 
both instances the impression is made upon the nervous filaments of the ALLOPATHY. 
93 
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 
excitement. 
If the primary cause is directly sedative, no reaction will occur 
but a similar state of relaxation will obtain as in the former instance. 
How then, we repeat, can venesection, catharsis, and blisters effect 
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 condi- 
tions of irritability. “ Every part of the organism depends for the per- 
formance of its proper functions, on the receipt of arterial blood 
and of nervous influence ; no alterations in the supply of either of 
these essentials may modify or even suspend the functions of a party 
(Pereira,—Materia Medica.) 
How absurd and pernicious then, in inflammations, the very essence 
of which is debility and loss of tone, to detract from one of those con- 
ditions upon which this very tone and vigor 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 some small tributary 
rivulet. As well attempt to suppress the leak of a storm-tossed vessel, 
by diverting from its proper channel a portion of the stream on which 
it floats. 
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 appro- 
priate specifics, and you may then, and not till 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 func- 
tions depend; for by so doing, 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 appa- 
rent amelioration of all the symptoms, but this effect is only temporary; 
for as soon as the reaction comes on, the enfeebled capillaries again 
admit the destructive “carriers of oxygen” as before; the state of con- 
gestion and inflammation remains, while the system at large has lost 
a portion of that stimulus, which conduces so materially, not only 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 inflammation of the brain, are revulsives and cou lter 94 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
irritants. It is supposed, that by exciting the intestinal exhalents, in 
flaming the membrane of the bowels, and portions of the skin, the cir- 
culation 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 circulating as usual through this 
oigan 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 sympathetic symptoms throughout the 
body—thus complicating the already existing disease, and impairing 
the entire nervous and muscular energies—are the inflamed capillaries 
of the brain placed in a more favorable condition to recover their im- 
paired tone and irritability ? 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 he guided by common-sense and true 
philosophy, must answer in the negative. 
We object to these remedies, however, not only because they are in- 
competent to produce salutary impressions 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 preparations of Mer- 
cury, Opium, Antimony, and Bark. In a vast majority of all the cases 
treated by the practitioners 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 medicines is not considered in- 
dispensable. 
Let us then examine some of their effects, in allopathic 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 possesses the 
power in different constitutions and under certain circumstances of af- 
fecting nearly every organ and tissue of the body; and it is not in the 
power of the most judicious physician to say beforehand, where, or in 
what manner, it will exert its force. 
Some of the more common deleterious effects of Mercury are: ex- 
cessive salivation and sloughing of the gums, mouth and throat, 
gastro-enteritis, mercurial erethism, dysentery, cutaneous eruptions, 
inflammation of the periosteum and bones, nodes, excessive de- 
rangement of the nervous system, paralysis, tremors, necroses of 
the maxillary and other bones, rheumatism and ophthalmia. 
When Mercury is administered, even in a moderate quantity, no 
human being can be at all certain that one or another 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 ALLOPATHY. 
95 
form of vapor, it is of little importance, so far as its power of affecting 
the system is concerned. The following, from the editor of the Med. and 
Surg. Journillustrates the baneful influence of the vapor when inhaled: 
“ In 1810 the Triumph, man-of-war, and Phipps, schooner, received on 
hoard several tons of quicksilver, saved from the wreck of a vessel 
near Cadiz. In consequence of the rotting of the hags, the Mercury 
escaped, and the whole of the erew 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-hird,—nay, even the rats, 
mice, and cockroaches were destroyed.” 
The following cases, resulting from the employment of Calomel, have 
come under our own observation, viz., three cases of necrosis of the in- 
ferior 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 ulceration of the nose, throat, &c., skin diseases, 
affections of the bones, nodes, rheumatic affections, &c., &c. 
Professor Chapman of Philadelphia, after descanting upon the woful 
effects, which have been so often produced by Calomel, and referring to 
many disgusting cases of mercurial disease, which had come under his 
own observation, 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 patient 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 disorder, 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 ofen premature departure, 
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 from its questionable value in most 
instances of its prescription, it may justly detain our attention. Calomel 
and Opium are the common remedies in traditional practice for a large 
number of diseases. We will see to what extent they may be used in 
a practice that is philosophical. 
By glancing at the standard works on the practice of medicine, it 96 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
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 important, if not indispensible means of cure. 
The allopath is taught to believe, that Mercury excites the functions 
of all the organs,—acts specifically upon the liver, salivary glands, 
heart, lungs and nervous system,—and therefore that it may be ad- 
ministered almost universally. Regardless of the secondary sym 
pathetic affections to which it usually gives rise, he attributes all of 
these symptoms to the natural disorder, 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 followed his 
authorities and prescribed as his predecessors have done for centuries 
before him. 
Ask him, what are his views concerning inflammation, and he 
answers, that it consists in a debilitated and congested state of the 
capillaries of the part affected. Ask him, what is the methodus me- 
dendi of Mercury in cure of inflammation,—how any of its effects can 
reach the seat of the malady, the congested capillaries, 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 medica. Possessing the power, as i 
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 constantly and indiscriminately in nearly 
all protracted maladies. 
Let us then briefly examine the effects of opium in health and dis- 
ease, and see if it possesses the wonderful property of reaching every 
structure, and of counteracting so many diverse and contradictory 
symptoms. 
Its effects upon the human system, in medium doses, are in the first 
instance stimulating, but in a short time this is followed by a condi- 
tion of diminished sensibility and desire to sleep. This state “ continues 
from eight to twelve hours, and is followed by nausea, headache, 
tremors, and other symptoms of diminished and ii'regular nervous 
energy. All of the secretions, with the exception of that from the 
skin, are either suspended or diminished.” (Wood and Bache, U. S. 
Dispensatory.) These effects, 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 a large proportion of all known mala- 
dies, there exists an inflammation of an acute or sub-acute character in ALLOPATHY. 
97 
some part of the organism, and it is the presence of this inflammation 
which maintains and perpetuates the disease. We have also observed 
that all inflammations consist in a congested state of the capillaries of 
the part affected, caused and kept up by a loss of tone, resisting 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 com- 
plaint, and of restoring 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 vigor, to dry up 
most of the secretions, instead of aiding nature to give vent to the 
poisonous, and pent-up fluid; it induces nausea, headache, tremors, 
and many other medicinal symptoms of sufficient severity to make a 
healthy man sick, or to complicate to a serious extent any existing na- 
tural affection. 
If we have urged, that opiates have the power of allaying 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 con- 
cealed; other new symptoms set in, which will be unnoticed by the 
benumbed patient, while secondary sympathetic affections will be pro- 
pagated to every part of the body, aggravating and complicating the 
original disorder. 
Opium is highly extolled in low forms of fever and other complaints, 
where the powers of the system are in an exhausted condition. But 
let it be remembered, that the stimulating effect of this drug is of 
short duration, and that the corresponding reaction or depression will 
bear an exact ratio to the previous exaltation. This law is fundamen- 
tal ; for the system possesses but a definite and limited amount of vital 
power, and is capable of resisting only a limited degree of unnatural 
action or disease, so that we can readily perceive how opiates and1 
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 
favorable or otherwise. When excited artificially by medicine it is 
not productive of benefit, because this adds nothing towards invigorat- 
ing the weakened capillaries. 
“Perspiration,” says Dr. Paine, “induced by medicine is of little mo- 
ment, unless the remedy simultaneously impresses, direct y or indi- 
rectly, the parts diseased/ and then the salutary result, so far as the 
surface is concerned, depends upon special vital influences exerted by 
the remedy upon the skin and reacting sympathies. This is exempli- 
fied by the profound effects of tartarized Antimony, and Ipecacuanha, 
the uselessness of hot water, and the f equent perniciotis results of 
Voi» i.—7. 98 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
the compound powder of Ipecacuanha, when free perspiration may 
follow the administration of either. The effect, therefore, depends hut 
very little upon the evacuation from the skin, as produced by what are 
called sudorifics.” {Institutes of Medicine.) 
It is proper to observe, that Opium may, and sometimes does effect 
cures in the hands of allopathists, when given as a specific. Its cura- 
tive virtues in delirium tremens and intoxication, even in large doses, 
are well known. In these instances, the remedy impresses directly 
the part diseased, and cures homoeopathically. It is quite true, that 
an infinitesimal quantity of the drug, properly prepared, will always 
prove more efficient, speedy and safe in accomplishing the object, 
and will not give rise to the unpleasant medicinal symptoms which ne- 
cessarily 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, illustrative of this: 
“Opium,” says he, “is sometimes employed by drunkards to relieve in- 
toxication. I knew a medical man, addicted to drinking, and who for 
many years was accustomed to take a large dose of laudanum, 
whenever he wras intoxicated and was called to see a patient.” The 
specific effects of the alcoholic stimulants and opium given during 
health, are exerted as remarked elsewhere, 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 restored after some accidental benefits wrere observed 
from its use. 
The faculty of medicine, at Paris, in 1566, and 1615, passed solemn 
decrees against it, as a virulent poison, and these decrees w ere even 
sanctioned by parliament, though afterwards formally reversed. ( Vale) 
Since this period, some have loudly extolled its virtues in the treat- 
ment of a great variety of diseases, while others have as earnestly con- 
demned its use, as deleterious in all cases. 
The distinguished professor Nathan Smith, in his essay on typhus 
fever, remarks: “I have seen many cases, in wrhich 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 tartrate of Antimony, 
wTith 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 affection, 
even,at its commencement, and in the latter stages of the disease, that 
it is sometimes followed by fatal consequences.” 
In emetic doses, tartarized Antimony irritates the stomach, causes ALLOPATHY. 
99 
congestion, and sometimes inflammation of the lungs, attended with 
more or less constitutional disturbance. 
When it fails to produce emesis speedily, it often acts violently upon 
the bowels, giving rise to severe griping pains and watery evacuations. 
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 symptoms 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. Having 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 certain 
stages of most other affections, Peruvian-bark and its preparations are 
usually employed by the old school. For the cure of the former, es- 
pecially, Quinine is the remedy upon which universal reliance is placed ; 
possessing the property, when used in large and repeated doses, of 
speedily arresting the chills and fever, it is constantly prescribed for 
this malady, without the slightest knowledge of its specific powers, 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 restores the patient to health; for in a great majority of 
instances, he lingers for months or even years in a diseased and mise- 
rable condition. In these cases it is probable that a medicinal affec- 
tion is induced by the remedy, so serious in its character, as to super- 
sede temporarily the primary one. This is evident, from the fact that 
after the effects of the medicine have somewhat subsided, the original 
disorder again generally makes its appearance. In some instances, 
however, the medicinal affection is so severe as to constitute a perma- 
nent disease, and thus entirely usurp the place of the fever. 
“ Experience,” says Dr. Paine, “ shows that, though bark and its al- 
kaloids, in large doses, will often arrest intermittent fever suddenly, 
such doses are liable either to induce some congestion, especially of the 
liver or of the mucous 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, (re- 
sulting often from indurated enlargements,) but which local malady 100 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
may, and often does become, in process of time, the exciting cause of 
another attack of fever. In respect to relapses, it is not unfrequent 
that, when intermittents are suddenly stopped by a large dose of Qui- 
nine, the paroxysms return as soon as the patient begins to exercise 
much, or to take his ordinary food.”—(Institutes of Medicine.) 
We should naturally suppose that these untowrard results wrould deter 
practitioners from using so frequently 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 ad- 
vocates take credit to themselves, when they succeed in administering 
this, as well as other medicines, in larger doses than any of their con- 
temporaries, without destroying their patients. Indeed, so far has 
this destructive system been carried, of experimenting upon disease, 
that the enormous quantity of a scruple, and even half a drachm of Qui- 
nine has been exhibited at a dose, and repeated several times a day. 
These monstrous quantities create (say Wood and Bache) “ gastro- 
enteritic irritation, nausea, griping, purging, head-ache, giddiness, fever, 
somnolency, in some cases delirium, in others stupor, &c.” Paine as- 
serts that he has witnessed many of these effects “ from five grains 
only ; ” yet, as patients sometimes live in spite of this treatment, many 
persist in adhering to these desperate innovations. 
There are many other medicines employed by allopathy in the treat- 
ment of disease, besides those to which we have alluded, but in general 
they serve only as auxiliaries. In this list may be ranked diaphore- 
tics, diuretics, expectorants, refrigerants, emmenagogues, emollients, 
errhines, &c., but the articles belonging 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 specifically, like diruetics, 
emmenagogues, &c., in the hands ofallopathists, is the aggravation which 
they must necessarily cause, if the part acted upon be irritated or in- 
flamed. This objection will be clearly appreciated, when it is remem- 
bered how extremely sensitive to specific remedial impressions organs 
and tissues 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 disease, and 
secondly, the sympathetic derangement to which they give rise in 
various parts of the body, the direct tendency of which is to retard and 
counteract the recuperative efforts of nature. 
As an example of the first class, let us take the diuretic Copaibse as 
a remedy for gonorrhoea. In this example, the remedy doubtless im- 
presses directly the inflamed membrane of the urethra, but the impression 
is so violent, that either a decided increase of the inflammation ensues, 
or the discharge is suddenly suppressed, and some other org&n, as the 
bladder, kidneys, testicles, or lungs, takes on diseased action. Indeed, ALLOPATHY. 
101 
we are decidedly of opinion, that not one genuine case of virulent go- 
norrhoea can be adduced, where a safe and permanent cure has been 
effected by large doses of this balsam. 
A not unfrequent effect of Copaibse in moderate quantities, is to ex- 
cite serious disorder of the lungs. This consequence I have often 
witnessed, and I have a patient 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 result from its use. 
In some instances, a troublesome eruption makes its appearance, ren- 
dering 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 supposition that their sweating qualities 
would aid nature in throwing off the morbid humors. When the hypo- 
thesis universally obtained, that fevers were caused by an excess of one 
of the four humors, blood, phlegm, and black and yellow bile, and that 
this superabundance must be expelled through the pores of the skin, 
kidneys, &c., it was a rational deduction that the employment of dia- 
phoretics 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, discharges of blood, diarrhoea, &c., in the latter stages 
of diseases occurred in consequence of a natural amendment or a sud- 
den prostration in the powers of the affected parts, and not as an effect 
of the medicines, it is a matter of surprize that these uncertain reme- 
dies should have been retained. 
The late Prof. JV. /Smith says: “As there is more or less sweating 
in the decline of most febrile diseases, and, as a general perspiration 
is often accompanied wdth 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 ques- 
tion whether the effect has not, in this case, been mistaken for the 
cause; that is, whether the sweating is not the effect of the amend- 
ment, rather than the cause of it; and, if so, it is still more question- 
able whether sweating, produced by art in the beginning of the disease, 
wrould be attended with good effects. In all cases, where I have seen 
this sweating regimen adopted, the practice has been obviously im 
jurious.” 
Many other eminent professors, as may be readily proved, entertain 
similar views in regard to this subject. 102 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
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 be- 
ing followed by secondary sympathetic symptoms in remote parts, more 
or less severe according to the violence 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 disturbances at either of these points are 
reflected through the sympathetic nerves upon remote healthy struc- 
tures, thus complicating to a serious and often fatal extent, any dis- 
order which may already be present. 
There is scarcely any part of the machine, which is not called into 
morbid sympathetic action by derangements of the stomach and in- 
testines. Even the presence of bile or acid, in unusual quantities, 
causes pains in the head and limbs, nausea, and other affections of a 
distressing nature, until the offending substances are removed. 
All of the organs and tissues are so closely connected 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. {Muller’s Physiology.) “A particular 
state of one organ, such as inflammation, or a secreting 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 we 
apply to another.” 
How reasonable, then, to expect that artificial medicinal 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 doctrines of allopathy 
may be briefly summed up as follows : 
1. In the rude ages of the world, when the arts and sciences were in 
their infancy,—when vague, indefinite and absurd notions were enter- 
tained respecting diseases,—when anatomy, chemistry, physiology, 
pathology, botany, and even correct methods of induction wTere entirely 
unknown,—when the imaginatians of men, instead of ascertained facts, 
were appealed to in establishing theories,—and when systems of prac- 
tice 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 first appearance. As the pathological doctrines 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 established customs, the force of habit, ALLOPATHY. 
103 
education, prejudice, &c., have served to retain until our own period, 
most of the violent, unnatural and pernicious methods of treatment, in- 
vented and adopted by the founders of medicine. 
3. At the present time, every thing pertaining to the theory and 
practice of the old school is indefinite, obscure and uncertain. Scarcely 
two different allopathists entertain the same views in regard to patho 
logy, and no 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 empirically, and we might almost say, universally employed, in 
quantities too great to he beneficial or safe. 
In those cases, where refrigerants, diuretics, expectorants, &c., are 
used, they can only he looked upon as auxiliaries, and are usually ad- 
ministered without any 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 the maladies, where alone re- 
medies can prove efficient. Thus it is, that patients are so often reduced 
to the lowest point by medicines, while the disease continues its pro- 
gress 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. 
The effort, to discover specific remedies for individual diseases, is 
not yet abandoned; but it is restricted to the making of experiments 
upon the sick, and results only in infrequent cures, which are never 
satisfactory and which can not he repeated or imitated in subsequent 
cases. 
Hahnemann, in his essay, entitled: Examination of the Sources 
of the Common Materia Medicaf (Lesser Writings, p. 748), with 
a masterly and irresistible logic, that has never been surpassed, shows 
that such experimentation is nothing but crude empiricism, and that, 
though it has been in vogue for some thousands of years, it has never 
yet given us a single reliable specific. 
A great part of the medicine, given with the pretence of curing dis- 
ease, is not expected to cure, but to palliate, to cover up the loud 
complaints that the organism is everywhere uttering for help. Dr 
Parrish, Lecturer on Pharmacy, (Philadelphia) said recently: “ The 
prevailing doctrines among medical men at this time, direct, that a large 
per-centage of all the prescriptions now made contain Opium, Morphia, 
or Hyoscyamus.” Five years ago,he ascertained, that his own prescrip- 
tions averaged thus : Opiates 24 per cent; Mercurials 23 per cent; 104 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
Iodine and Iodide of Potassium 6 per cent; Cinchona and its al- 
kaloids 9 per cent. 
These were the proportions in the written prescriptions. Of the 
unwritten prescriptions the proportion of Opium was larger, as Opium 
in some form was in every house. Second in importance is Ilyoscyamus, 
Then, Conium, Belladonna, Stramonium, Cannabis-indica. 
Allopathy is a mere collective title of all the various modes of treat- 
ment not homoeopathic, and has no pretensions to a place among the 
definite curative modes by specifics. {Muller.) 
The more recent theory of specific or substitutive action teaches, 
that diseases even widely dissimilar may supersede each other, or that 
one may supersede another: we have examples of such supersessions, 
and of a new and not similar disease complicating an old one, but not 
of removing it. “ In fact, when the latter event takes place at all, it is only 
when the new disease approaches to the required degree of homoeopathi- 
city. In fine, the real fact of the matter we apprehend is simply this, that 
the degree of homoeopathicity that suffices for cure is not accurately fixed; 
and, as we recede from complete homoeopathicity, a certain margin is left 
within which specifics given in more massive doses may still have curative 
effects.” Within this margin may room enough be found for the spe- 
cificers, Rademacherians and Trousseauist substitutivists. But beyond 
that we protest against allowing any such method as an allopathic 
alterative one any positive existence at all. The great discovery of 
Hahnemann, viz., the positive homoeopathic law of specifics must not 
be let down and diluted and refined away, by giving it only a place 
as one of a sliding scale of specific actions, all on pretty much the same 
footing. No ! if we are compelled to admit as matter of fact that 
there are other actions of medicine, which we must on exceptional oc- 
casions make use of, such as the antipathic or revulsive, let us say so 
plainly, and not attempt to shade them off into the homoeopathic. {Muller.) 
In view, therefore, of the present condition of the medical art, we 
most earnestly request the allopath to pause or reflect deeply and 
seriously, before he rejects finally the most important discoveries in 
the art of curing disease, that have been made in ancient or modern 
times. 
Let him remember that a high responsibility attaches to his po- 
sition,—that the welfare, happiness and lives of his patients hang upon 
his judgment and decision,—and that an improper exhibition of re- 
medies may so complicate and aggravate the natural disease, as to con- 
sign his patient to a premature grave. Let him look about, candidly 
and impartially, and see if there are really no improvements in 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,—wThat system is most correct HOMOEOPATHY. 
105 
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 modern discovery, and found his practice only upon this 
certain basis. 
HOMCEOPATHY. 
The Discovery of the Homoeopathic Mode of treating disease is thus 
announced by Hahnemann: * 
“ By observation, reflection, and experiment, I discovered, that, in 
opposition to the old allopathic method, the true maxim; To effect a 
mild, rapid, certain, and perm anent cure, choose in every case of 
disease, a medicine which can itself produce an affection similar 
(oyoLov iraOog) to that sought to be cured. 
“ Hitherto no one has ever taught this homoeopathic mode of cure, 
no one has practiced it. But if the truth is only to be found in this 
method, as I can prove it to be, we might expect that, even though it 
remained unperceived for thousands of years, distinct traces of it 
would yet be discovered in every age? 
“And such is the fact. In all ages, the patients who have been really, 
rapidly, permanently, and evidently cured by medicines, and who did 
not merely recover by some fortuitous circumstance, or by the acute 
disease having run its allotted course, or by the powers of the system 
having in the course of time gradually attained the preponderance, 
under allopathic and antagonistic treatment, for being cured in a direct 
manner differs vastly from recovering in an indirect manner.—Such 
patients have been cured solely, (although without the knowledge of 
the physician), by means of a (homoeopathic) medicine, which possessed 
the power of producing a similar morbid state.” 
When Hahnemann first promulgated to the world his pathological 
and therapeutical views, their novelty, their entire variance from all 
preconceived opinions, and their alleged superiority over all other 
systems, when applied to the practice of the healing art, induced 
physicians to suppose the man mad, and his ideas the offspring of a 
disordered imagination. 
It was difficult to conceive that acute maladies could be cured 
without venesection, emetics, cathartics, sudorifics, refrigerants, altera- 
tives, 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 impudent sneers or senseless ridicule 
Like the illustrious Fulton, who—when he announced to his country- 
men the powers of steam, and first applied this agent to the propulsion 
* Organon.—Introduction. 106 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
of a vessel—was declared, even by his nearest friends insane, and liig 
projects visionary: like Harvey, the discoverer of the circulation of 
the blood, who was bitterly assailed “by the bigotted abettors of old- 
established systems, with whispers, innuendoes, and controversial writ- 
ings, and himself pronounced a reckless innovator, and unworthy of 
public confidence as a practitioner; like Galileo, who, after demonstrat 
ing the truth of the Copernican system was persecuted by his rivals 
and twice compelled by the inquisition to abjure 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 ridiculed, misrepresented, and 
contemned: but time has cast all the columniators 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. 
Brief Exposition of the Homoeopathic Method of Treatin g Dis- 
ease.—The following truths are established by reason and experience : 
1. There is nothing for the physician to cure in disease but the suffer- 
ings of the patient. The changes in his state which are perceptible to 
the senses comprise what is known by “the totality of the symptoms by 
which the disease points out the remedy it stands in need of.” These 
changes are internal as well as external, and the physician takes into 
his enumeration of symptoms, not only all that appear upon the sur- 
face, but all the pathological changes which he knows to be going on 
internally. 
2. Disease can not be converted into health but by the aid of medi- 
cines and agencies which are capable of producing similar disease- 
symptoms. The powers of a given remedy to produce similar symptoms 
are best learned through experiments on healthy individuals, so far as 
experimenting may safely go in such researches: where these neces- 
sarily terminate, we may learn their further powers from the accidental 
uses and abuses of the same agents in allopathic practice and cases 
of poisoning. 
3. “According to every known fact,” says Hahnemann, “it is impos- 
sible to cure a natural disease by the aid of medicines which have the 
faculty of producing a dissimilar artificial state or symptom in healthy 
persons. Therefore the allopathic method can never effect a real cure. 
Even nature never performs a cure or annihilates one disease by adding 
to it another that is dissimilar, be the intensity of the latter evtr so 
great.” 
c 
4. “Every fact serves to prove that a medicine capable of exciting 
in healthy persons a morbid symptom opposite to the disease to be 
cured, never affects any other than momentary relief in disease of long 
standing, without curing it, and suffers it to reappear after a cei'tain HOMOEOPATHY. 
107 
interval more aggravated than ever. The antipathic and purely pallia- 
tive method is, therefore, wholly opposed to the object that is to he 
attained, where the disease is an important one, and of long standing.” 
5. The homoeopathic method which employs against the totality of the 
symptoms of a natural disease a medicine that is capable of exciting ii< 
healthy persons symptoms that closely resemble those of the disease 
itself, is the only salutary method. It always annihiliates disease, or 
the purely dynamic aberrations of the vital powers, in an easy, prompt, 
and perfect manner. In this respect nature herself furnishes the 
example, when by adding to an existing disease a new one, that resem- 
bles it, she cures it promptly and effectually. 
“ A new and more intense disease suspends a prior and dissimilar 
one already existing in the body, only so long as the former continues, 
but it never cures it. If the new disease, which is dissimilar to 
the old be more powerful than the latter, it will then cause its 
suspension until the new disease has either performed its own course 
or is cured; but then the old disease reappea/rs. We are informed by 
Tulpius (Obs. Lib. 1. Obs. 8.) that two children having contracted tinea, 
ceased to experience any further attacks of epilepsy to which they had 
till then been subject: but as soon as the eruption of the head was 
removed, they were again attacked as before. Schopf saw the itch 
disappear when scurvy manifested itself, and return again after the 
cure of the latter disease. (Hufel. Journ. XV. 2.) A violent typhus 
has suspended the progress of ulcerous phthisis, which resumed its 
march immediately after the cessation of the typhoid disease (Chevalier). 
When madness manifests itself during the pulmonary disease, it effaces 
the phthisis with all its symptoms; but then the pulmonary disease 
again rears its head and kills the patient. (Reil. Memorabilia). When 
measles and small-pox exist together, and have both attacked the same 
child, it is usual for the measles which have already declared them- 
selves, to be arrested by the small-pox which bursts forth, and not to 
resume their course until after the cure of the latter; on the other hand, 
Manget has also seen the small-pox, which had fully developed itself 
after inoculation, suspended during four days by the measles which 
intervened, and, after the desquamation of which, it revived again to 
run its course. The eruption of measles on the sixth day after inocula- 
tion has been known to arrest the inflammatory operation of the latter, 
and the small-pox did not break out until the other exanthemata had 
accomplished its seven days “course.” (J. Hunter on the Venereal 
Disease) In like manner vaccine disease and scarlatina have been 
seen to suspend each other, the stronger of the two expelling for the 
time the other. 
“ It is the sam e in all diseases that are dissimilar: the stronger 
one suspends the weaker (except in cases where they blend together, 108 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
which rarely occurs in acute diseases:) but they never cure each othd 
reciprocally.” 
“In the same manner, violent treatment with allopathic remedies 
never cures a chronic disease, but merely suspends it during the 
continuance of the powerful action of a medicine incapable of exciting 
symptoms similar to those of the disease: but afterwards the latter re- 
appears, even more intense than before.” 
“Or the new disease, after having acted for a considerable time on 
the system, joins itself finally to the old one, which is dissimilar, 
and thence results a complication of twro different maladies, either of 
which is incapable of annihilating or curing the other.” In this case 
each occupies the particular region of the economy, installing itself in 
those organs writh which it sympathizes, and abandoning the others to 
the diseases that are dissimilar. Thus venereal and psoric diseases, 
being dissimilar, “ are incapable of annihilating or curing each other. 
The condition of the patient is worse under the two diseases than he 
would have been under either of them alone.” (Organon § 40, p. 112.) 
When a medicinal disease is excited which is similar to the existing 
one, and is stronger than it, the new disease supersedes the old one. 
Two diseases, says Hahnemann, “ that differ greatly in their species, 
but which bear a strong resemblance in their development and effects, 
—that is to say, in the symptoms which thgy produce, always mutually 
destroy each other when they meet together in the system. The 
stronger annihilates the weaker. Two dissimilar diseases may co-exist 
in the body, because their dissimilitude wrould allow of their occupying 
two distinct regions.” But when the diseases are similar, the stronger 
disease exercises an influence upon the same parts as the old one, and 
even throws itself, in preference, upon those which have till now been 
attacked by the latter; so that the old disease, finding no other organ 
to act upon is necessarily extinguished. Or, to express it in other 
terms, as soon as the vital powers which have till then been deranged 
by a morbific cause, are attacked with greater energy by a new power, 
very analogous to the former, but more intense, they no longer re- 
ceive any impression but from the latter, while the preceding one, re- 
duced to a state of mere dynamic power without matter, must cease to 
exist.”—(§ 45.) 
“ Of any two diseases wdiich occur in the ordinary course of nature, 
it is only that one whose symptoms are similar to the other which can 
cure or destroy it. This faculty never belongs to a dissimilar disease. 
Hence the physician may learn what are the remedies with which he 
can effect a certain cure, that is to say, with none but such as are 
homoeopathic.” 
A remedy that is perfectly homoeopathic cures the disease with- 
out any accompanying ill effects; and a disease that is of no very HOMOEOPATHY. 
109 
lon<; standing ordinarily yields, without any great degree of suffering, 
to a first dose of a well-selected remedy. When a perfectly homoeo- 
pathic remedy acts upon the body we see nothing more than symptoms 
analogous to those of the disease laboring to surmount and annihilate 
these latter symptoms by usurping their place. The remaining symp- 
toms, caused by the medicinal substance, which are often numerous, 
and correspond in no respect with the existing malady, scarcely ever 
show themselves, and the patient improves from hour to hour. The 
remedy having expended its force in those portions of the organism 
that were already a prey to existing disease, and in these parts exerted 
that specific action by which it extinguished the original disease. 
But there are a few exceptions to this general truth. “There is no 
homoeopathic remedy, however suitably chosen, that does not (espe- 
cially in a dose not small enough,) produce at least during its action, 
some slight inconveniences or fresh symptoms in very sensitive and ir- 
ritable patients. In fact it is scarcely possible for the symptoms of 
the medicine to cover those of the malady with as much precision as 
two triangles writh equal sides and angles. But these differences, which 
are of little importance in a case that terminates in a short time, are 
easily effaced by the energy of the vital principle, and the patient does 
not perceive it himself, unless he is excessively delicate. The re- 
establishment of health goes forward, notwithstanding, unless impeded 
by the influence of heterogenous medicinal agents upon the patient, 
errors of regimen, or excitement of the passions.—(Hahnemann, § 156.) 
When a true homoeopathic remedy in small dose has been given, it 
quietly annihilates the acute disease wdiich is analogous to it, without 
exciting new and non-homoeopathic symptoms; but it often happens 
that it produces at the end of one or two hours (according to the dose), 
a state something less favorable, which resembles the original disease 
so closely, that the patient supposes the primitive affection aggravated. 
But in reality it is nothing more than a medicinal disease, extremely 
similiar to the primitive one, and rather more intense in its nature. 
This trifling homoeopathic aggravation of the malady during the 
first few hours may be accepted as a happy omen that the disease will 
soon be cured, perhaps even with the first dose. The medicinal disease 
is similar to the other, but more intense than the one it is intended to 
cure. The smaller the dose of the homoeopathic remedy, the slighter 
the apparent aggravation of the disease will be, and proportionably of 
shorter duration. 
In a discussion in the Societe Med. Homoeop. de France, Feb. 20, 
1860, M. Cretin thus stated what he called the double principle enun- 
ciated by Hahnemann. 
1. The curative effect is so much the more uncertain and rare in 110 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
proporticn as the dose induces more marked and more numerous patho- 
genetic symptoms. (Superior limit.) 
2. The curative effect is so much the more sure and constant in pro- 
portion as the dose approaches that which would excite the slightest 
aggravation of existing symptoms. (Inferior limit.) 
The real nature of homoeopathic cures is thus explained by Fletcher 
on the Brunonian theory: The primary action of stimuli, and therefore 
of all specifics, as well as of all other positive agents, is in reality two- 
fold ; and in all organic diseases, such as inflammation and its conge- 
ners, fevers, increased secretion, &c.,—consists in, first, a stage of ex- 
citement, with constriction of the capillary vessels, followed by indirect 
debility with dilatation of the capillaries, and increased secretion ac- 
cording to its kind. When the homoeopathic cure takes place, the 
disease is in the stage of indirect debility, and the medicine exerts upon 
it its action, viz., that of a stimulus, and thus the cure takes place by 
antipathic action. But this must not be confounded at all with that 
action in the sense of the allopathists, for it does not refer with them to 
this view of the ultimate nature of the action of medicine, but to its 
broad meaning as primary and secondary on the healthy body. 
I. CHEMICAL, 
depending on the ciiemical affinity which exists between the drug and 
the tissues of the body. 
THE ACTION OF MEDICINES may be, 
II. MECHANICAL,, J 
or Revolutionary, j 
Consisting chiefly in violent efforts on the part of the organism to eject 
from its cavity the offending substance. 
ARSENIC. 
cold sweats, 
cramps of the ex- 
tremities. 
DIARRIHEA. 
[Primary. 
Secondary. ] 
A. GENERIC,— 
Common to all 
the members of1 
a certain class 
of DRUGS. 
CUPRUM. 
Constipation. 
produce - 
TARTAR-EM. 
YERATRUM. 
VOMITING. 
ARSENIC. 
COLD SWEATS, 
CRAMP8 Of 
the EXTREM- 
ITIES. 
DIARRIKEA. 
MERCURY. 
INCREASED 
action of the 
LIVER. 
1. CENTRAL. 
SPEEDY EF- < 
FECT of LARGE 
DOSES. 
ARSENIC. 
Poisoning, as 
the speedy re- 
sult of large 
doses. 
III. DYNAMIC,- 
PURGING. 
B. SPECIFIC.— 
Resulting from 
the dynamic ac- 
tion of the drug.- 
These are spe- 
cific, and PECU- 
LIAR to it. 
' gradual poisoning, as 
by EXHALATIONS. 
arsenic cachexia, or 
DTSCRASIA. 
Affection of the glands 
and boneis. 
VOMITING. 
vomiting. 
bones, dis- 
eases of. 
glands, ex- 
citement or 
inflamma- 
tion of. 
MERCURIAL 
CACHEXIA. 
PTYALISM. 
2. PERIPHERAL.— 
The effects appear 
more slowly; they are 
generally the result 
of small doses re- 
peatedly taken, or al- 
lowed to act for some 
time without inter- 
ruption. ( 
MARASMUS. 
eruptions on the skin. 
Skin affoc 
tions. 111 
HOMOEOPATHY 
CLASSIFICATION OF MEDICINES, 
According to their Primary Effects in Massive Doses. 
a. Anti-inflammatory. 
L 
ALTERANTS. 
2. 
b. Anti-cachectic— 
or Invigorating. 
1. Blood-letting. 
2. Emetics. 
3. Cathartics. 
4. Diuretics. 
5. Antilithics. 
6. Emmenagogues. 
7. Expectorants. 
8. Anthelmintics. 
9. Diaphoretics. 
10. Nauseants. 
II. 
EYACUANTS. 
III. 
INCITANTS, 
OR 
EXCITANTS. 
r 1. Stimnlants. 
2. Narcotics. 
3. Antispasmodics. 
4. Tonics. 
V. 5. Astringents. 
1. Baths, at Various Temperatures. 
2. Frictions. 
3. Rubefacients. 
4. Epispastics. 
5. Suppuratives. 
6. Cauterizing Counter-Irritants. 
TV 
DERIVATIVES; 
REVULSIVES; 
COUNTER-IRRITANTS 
The curative powers of drugs, says Hahnemann, are in no wise dis- 
coverable in themselves; and the pure experiments which have been 
made, even by the most skillful observers, exhibit nothing to our view 
which could be capable of rendering them medicines or curative re- 
medies, except the faculty they possess of producing manifest changes 
in the general state of the human economy, particularly with persons 
in health, in whom they excite morbid symptoms of a very decided 
character. We ought to conclude from this, that when medicines act 
as remedies they can not exercise their curative virtue by the faculty 
which they possess of modifying the general state of the economy and 
giving birth to peculiar symptoms. Consequently we ought to rely 
solely upon the morbid appearances which medicines excite in healthy 
persons,—the only possible manifestations of the curative virtues 
which they possess, in order to learn what malady each of them pro- 
duces individually, and at the same time what diseases they are capable 
of curing.” (Organon, p. 21.) 
“Medicinal substances manifest the nature of their pathogenetic 
power, and their absolute, true action on the healthy human body, in 112 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
the purest manner, when each is given singly and uncombined to healthy 
individuals. And thus we obtain the pure result of the form of disease 
that each of these medicinal substances is capable of producing ab- 
solutely, and in itself on the human body.” {Hahnemann’s Lesser 
Writings, Mar Gy’s Edition, p. 452.) 
“It is impossible that the alterations in man’s health, which medicines 
are capable of producing, can be known and observed more purely, cer- 
tainly and completely by any other method in the world than by the 
action of medicines upon healthy individuals; indeed there is no other 
way conceivable, in Avhich it were possible to obtain experience that 
shall be at all of an accurate character. Even when given in human 
diseases, in order to ascertain their effects, the peculiar symptoms 
which were solely due to a medicine can never be distinctly recognized, 
never accurately distinguished amid the tumult of morbid symptoms 
already present, so as to admit of our ascertaining which of the changes 
effected were owing to the medicines, and which to the disease.” # 
PRIMARY AND SECONDARY ACTION OF DRUGS. 
Homoeopathy teaches that the impressions which drugs produce upon 
the organism, in health and in disease, are analogous in their character. 
But there is this important difference between healthy and diseased 
structures, that large quantities of the drug are required to produce 
appreciable impressions upon the former, while the susceptibility of the 
latter is so morbidly augmented that the most minute atoms of the 
medicine are instantly effective. Not only so, but even the natural 
material stimuli of the structures can not be tolerated, but become im- 
mediate and additional causes of disease, and, if persisted in, of fatal 
disorganization. If then, wTe desire to know the precise effects of drugs 
in disease, it is necessary to prove them by taking when in health doses 
sufficiently large or so often repeated as to affect the structures sen- 
sibly and decidedly. Even if contraria contrariis opponenda be 
adopted as the law of practice, this is an important discovery, for we 
may then administer the remedies with a full knowledge of the parts 
they impress and of the exact symptoms they induce, and thus remove 
allopathy a single step from empiricism. Some eminent writers of the 
old school have distinctly shown the importance of this subject. Thus, 
Dr. Paris, in his Materia Medica, remarks, “that observation and ex- 
periment upon the effects of medicine are liable to a thousand fallacies, 
unless they are carefully repeated under the various circumstances of 
health and disease, in different climates, and on different constitutions.” 
Professor Dunglison {On New Remedies, page 7) says: “to treat 
disease methodically and effectively, the nature of the actions of the 
* Hahnemann’s Lesser Writings, 721-722 pp. PRIMARY AND SECONDARY ACTION OF DRUGS. 
113 
living tissues, in both the healthy and morbid conditions must he cor- 
rectly appreciated; the effects which the articles of the Materia Me- 
dica are capable of exerting under both those conditions must he known 
from accurate observation, and not until then can the practitioner pre- 
scribe with any well-founded prospect of success.” 
Pereira assures us, “ that in order to ascertain the action of remedial 
agents on the living body, it is necessary that we examine their influence 
both in healthy and diseased conditions. For by the first we learn the 
positive or actual power of a medicine over the body; while, by the 
second we see how that power is modified by the presence of disease.” 
(Materia Medica and Therapy Vol. I., p. 126.) 
Other equally distinguished allopathic writers now entertain the 
same views upon this point, but without taking into consideration some 
very important circumstances connected with the provings. We have 
reference to the great fact inculcated by Hahnemann, that all drugs ex- 
ercise upon tbe organism two effects, a primary and a secondary, 
and that these secondary effects are always the reverse of the primary. 
A knowledge of this truth will enable us to classify both the primary 
and the curative results of medicines, and thus more clearly to ap- 
preciate the phenomena which should guide us in their application. 
The primary symptoms make their appearance soon after the medicine 
has been taken into the stomach, and continue for a longer or shorted 
period, according to the magnitude of the dose and the condition of the 
general health; after which they disappear, and the secondary or op 
posite series of phenomena manifest themselves and remain until the 
organism recovers its equilibrium. But in a few instanc-es the power 
of drugs is displayed in such a manner that these primary or secondary 
effects appear in alternation for a considerable time, when the primary 
symptoms yield to the secondary, or serious organic derangements 
ensue. The mode of operation in these instances is probably analogous 
to that of the miasm of intermittent fever, in producing alternate chills 
and heat. Medicines of this description are termed poly crests. 
No one who has candidly tested the operation of drugs, with reference 
to this law, can for an instant deny its truth and importance; and the 
law applies not only to large doses of drugs, but to every other cause 
which unduly impresses the structures : that is in such a manner as to 
disturb that healthy balance in the operations of the organs whiclkcon- 
stitutes health. Let us examine the ordinary effects of cathartics in 
health: First, the mucous membrane of the intestinal canal is irritated 
or inflamed, and the natural consequence of inflammation follows in the 
form of increased mucous and serous secretion, increased peristaltic 
action, and a painful and loose state of the bowels : this is th% primary 
effect. After several thin discharges from the bowels, a debility and 
a depression of the parts occur, the degree of which is proportioned tc 
VOL. i.—8. 114 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
that of primary irritation; the peristaltic action becomes impaired oi 
suspended, and constipation results as the secondary effect of the drug 
There is no exception to this rule, unless the cathartic operates so 
violently as to produce a permanent inflammation and disorganization 
of the mucous membrane, in which case the primary symptoms may be 
continuous and constitute a permanent affection. Even in cases of this 
kind, however, partial reactions sometimes occur during the course of 
the malady, and secondary symptoms are manifested, in the form of 
constipation alternating with diarrhoea. These violent primary symp- 
toms rarely continue beyond a few days without resulting in serious 
structural lesion, or a healthy and permanent reaction. 
The primary effects of Opium, in large doses, are to induce sleep, 
lessen nervous and muscular sensibility, cause agreeable dreams, and 
diminish or suspend all of the secretions, with the exception of per- 
spiration, which is augmented. If the quantity taken has been mode- 
rately large, a pleasurable excitement for a short time precedes the 
soporific influence as a primary symptom. These first results continue 
from twelve to forty-eight hours, according to the magnitude of the 
dose, when the organism reacts: the exhilaration is succeeded by de- 
pression, the sopor by constant and prolonged wakefulness, morbid irri- 
tation of the whole system, a return in preternatural quantities of all 
the secretions, which had been suspended, and a suppression of the 
cutaneous secretion, which had been morbidly augmented; and the 
secondary effects of the drug are thus manifested. 
So long as diuretics continue to irritate the kidneys, they are for- 
cibly stimulated to pour out an unusual quantity of urine; but as soon 
as the specific is omitted, the organism reacts against the temporary 
irritation set up by the medicine, and a corresponding diminution of 
the urinary secretion follows, until the organ recruits from the pre- 
vious overaction, and the disturbed equilibrium is restored. 
The primary operation of stimulants gives rise to an exaltation of 
the mental and physical powers, while a corresponding depression and 
abasement invariably result as secondary consequences. 
The primary operation of Digitalis in large doses, is to retard the 
action of the heart and arteries. The reaction of the system against the 
drug, or the secondary effect, is an augmentation of this action. 
The primary symptoms caused by Aconite are intenser action of 
the circulatory vessels: the secondary consequence consists of a in- 
duction of the pulsations, in some instances as low as thirty-five in the 
minute. 
The primary effect of intense cold is to stimulate and invigorate the 
whole system; and the secondary results are loss of muscular and 
mental energy, stupor and death. 
All drugs, whatever may be the special nature of their action, give PRIMARY AND SECONDARY ACTION OF DRUGS. 
115 
rise in every part of the organism where this action manifests itself, to 
two orders of symptoms, which are generally, if not always, opposed to 
each other. Hahnemann attributed no other symptoms to the drugs 
directly, except those which he had seen develop themselves under 
their influence, and which he therefore called “primary symptoms.” 
Whereas he considered as simple reactions of the organism all those 
symptoms that succeeded the former, and which he therefore designated 
as “secondary.” Teste considers it not yet perfectly settled that the 
secondary symptom is always the contrary of the primary. (Materia 
Med., p. 48.) Hahnemann says: Every agent produces, more or less, 
“some notable change in the existing state of the vital powers, or creates 
a certain modification in the health, of longer or shorter duration: this 
change is called th% primitive effect. But our vital powers tend always 
to oppose their energy to this influence or impression. The effect that 
results from this, and which belongs to our conservative vital powers 
and their automatic force, bears the name of secondary effect or re- 
action.” 
Examples, 
The Primary Effect of dipping 
the hand in cold water is to make 
it hotter than in the common state. 
Violent exercise causes ex- 
treme heat. 
Wine stimulates and heats the 
body. 
An arm held for some time in 
freezing water becomes cold and 
pale. 
Strong coffee stimulates the phy- 
sical and mental powers. 
Opium excites somnolence or 
deep stupor. 
Opium causes first constipation. 
Purgatives increase the action 
of the bowels. 
Secondary Effect. 
After drying it becomes colder 
than before. 
Shivering and cold follow over- 
heat. 
Next day the slightest current 
of air produces chill. 
Being withdrawn and dried it 
becomes hotter than the other. 
It leaves behind it heaviness 
and drowsiness which lasts long. 
More difficult to fall asleep when 
its action is entirely expended. 
Diarrhoea follows the constipa- 
tion. 
Constipation follows the purg- 
ing. 
This law of primary and secondary action applies not only to ww- 
dicinal, but to a large proportion of morbific agents. On this suppo- 
sition we may readily account for the remissions and exacerbations 
which are observed in most fevers. It is only when the morbific in- 
fluence has been very active and the resulting inflammation violent, 
that no reactions or remissions occur. It may nevertheless be set down 
as general law, that no structure of the human body can be called into 116 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
preternatural action, or stimulated beyond a given point, without a 
speedy tendency to reaction on the part of the organism. In severe 
forms of disease, this reaction may not be apparent for weeks, and per- 
haps until organic lesion occurs ; yet, sooner or later, some reaction, 
with secondary symptoms, manifests itself. There is a healthy point 
in the functional actions of the organs—an equilibrium, if we may be 
allowed the expression, of the respiratory, circulatory, digestive, absor- 
bent, assimilative, secretory and excretory functions—which can not 
be disturbed with impunity. Stimulate one of these beyond its natural 
point, and a corresponding depression must necessarily ensue before 
the normal balance is restored. E ach tissue possesses only a definite 
amount of resisting power, and therefore every undue expenditure of 
this power entails future debility. Nature is constantly striving to 
maintain the functions in their natural condition, and this she accom- 
plishes by inducing in the different parts a reaction the reverse of the 
disturbing cause, and bearing an inverse ratio to this cause. The 
amount of strength and resisting force which is acquired from the food, 
&c., is fixed and definite; and this force is expended in limited and definite 
quantities throughout the economy, and thus secures the healthy per- 
formance of the functions. 
The practical deductions which legitimately arise from these views 
of this subject, are of the most interesting character, as regards the 
application of remedies ; for if the ideas which have here been adduced 
are correct, it is plain that the antipathic doctrine of cure is erroneous, 
while the truth of the homoeopathic becomes equally apparent. 
SUSCEPTIBILITIES OF ORGANS AND TISSUES TO THE INFLUENCE 
OF REMEDIAL AGENTS, VASTLY GREATER IN DISEASE THAN 
IN HEALTH. 
One of the principal arguments which has been adduced against 
Hahnemann’s system of Therapeutics is the supposed fallacy of judg- 
ing of the effects of medicines in disease, from their operation in 
health. It is considered that the modifications which occur in what 
are termed the “ vital properties” of parts, in a state of disease, also 
alter the action of remedical agents in a corresponding manner. 
The fact is incontrovertible, that tissues in a state of inflammation, 
do acquire properties very different from what they possess in the nor- 
mal state, but respecting the nature of these acquired properties, 
numerous facts go to prove, firstly, that the parts actually inflamed, be- 
come extremely sensitive to the impressions of specific remedies ; and, 
secondly, that the facility of absorption is promoted throughout the 
whole system. The recent experiments of Miiller and Matteucci have de- 
monstrated the fact, that in proportion as the tone of the nervous and INFLUENCE OF REMEDIAL AGENTS ON ORGANS AND TISSUES.' 
117 
muscular systems becomes impaired, or inflammation obtains, up to a 
certain point, just in the same ratio will absorption be promoted, and 
foreign agents exercise their influence. 
We have seen that inflammation consists in a “ congestion of the 
capillaries” induced by debility and the want of resisting power in 
these structures to exclude the arterial blood, and that the effects of 
inflammation of a particular organ upon the general system, are las- 
situde, pains, and other symptoms which indicate diminished nervous 
and muscular energy. That condition, therefore, which is termed 
erethism, is not, as is sometimes supposed, indicative of increased 
nervous energy, but results directly from loss of strength. 
In health the capillary vessels possess the power of excluding all of 
those constituents of the blood except the colorless fluid which is their 
natural stimulant. Although the capacity of these minute tubes is 
sufficiently large to admit the red globules with ease, yet they are en- 
dowed with a peculiar property which enables them to resist their 
entrance. 
Any cause, therefore, capable of impairing this natural irritability, 
becomes a source of debility and inflammation. 
It has been proved that, in health, most medicinal snbstanccs may 
become absorbed into the blood ; but unless they possess some pecu- 
liarly noxious qualities, they will act upon those parts for which they 
have a specific affinity, and be throwm off" in the form of excretions, 
causing in their passage through the structure on which they act, only 
a slight and perhaps unappreciable irritation. 
When taken in disease, these same substances are absorbed with 
far greater facility, and exercise the same specific affinity for parti- 
cular parts as in health ; but with the difference, that they make im- 
pressions upon the inflamed tissues, far more energetic and strongly pro- 
nounced, than when taken in a healthy state of the organism. Nor is 
is this augmented susceptibility to the influence of remedies, confined 
to the tissues primarily affected, but the whole system becomes far 
more impressible than during health. It is a well established law, that 
no one structure can be inflamed without giving rise secondarily to 
sympathetic symptoms in other parts of the economy. It matters not 
whether the paxt affected, be the lungs, stomach, skin, or 
any other structure, the whole system may be ultimately disordered, 
through remote contiguous or continuous sympathy. The connection 
between the different parts of the human body, through the media of 
the sympathetic nerves, is so close and direct, that no organ can be 
acted on by a morbific agent, without developing secondarily sympa- 
thetic symptoms more or less violent, according to the nature of the 
agent, the severity of the primary impression, and the constitution of 
the individual. 118 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
All of the organs are so designed and constructed by the Supreme 
Architect, that, in health, a certain harmony of action prevails through- 
out every part of the machine, causing every function to be executed 
with uniformity, so that no disturbance can accrue to any single part 
without impairing this healthy equilibrium. 
Dr. Paine, in speaking of this subject, presents the following views 
which will be found to coincide very nearly with the doctrines of 
Hahnemann; we only wonder that the practical deductions of these 
two distinguished authors should differ so materially: 
“ It appears, therefore, to be a most important law, that morbid states 
call into operation that function of sympathy among organs, which in 
their natural state manifest but feeble, and perhaps no direct relations 
whatever ; and that in consequence of morbid changes, remedial agents 
will operate sympathetically through the stomach, &c., upon remote 
parts, when they would have no such effect in the healthy state of the 
organs. New vital relations being developed by disease, our remedies 
continue to operate through those acquired relations so long as they 
exist.” 
Again, “ In proportion, therefore, as the susceptibility of the system 
at large is increased by morbid changes, or predisposed by morbific in- 
fluences, so, in a general sense, will the alterative action of remedial 
agents be felt in a corresponding manner.” 
Again, “ It is one of the most important law's in medicine, that the 
susceptibility of tissues and organs to the action of remedial agents, is 
more or less affected by disease. Many agents which operate powerfully 
in certain morbid states, and in certain doses, both locally and sympathe- 
tically, may be perfectly inert in the natural states of the same organs.” 
Finally, “It is worthy of repetition, that such is the analogy between 
morbific and remedial impressions, that the organs which sustain the 
former are rendered susceptible of the latter, when they might other- 
wise be insensible to the same remedial agents, in their appropriate 
doses. Take many of the most powerful agents, Arsenic, tartarized 
Antimony, Iodine, &c., and when administered in certain small and 
repeated alterative doses, they bring about the cure of the most obsti- 
nate and formidable conditions of disease ; while the same doses may 
not manifest any action upon the system, or on any part of it, under 
circumstancss of health. This manifestly depends upon an increased 
susceptibility of the organic properties in their diseased conditions, to 
the action of foreign agents, and upon an increased disposition to under- 
go changes. This law, w'hich unfolds a principle latent in health, and 
by which morbid organic properties acquire susceptibilities to salutary 
influences from agents which in health would either produce no effects, 
or lead to untoward results, and its ally, the great recuperative prin* INFLUENCE OF KEMEDIAL AGENTS ON ORGANS AND TISSUES. 
119 
ciple, impose the highest obligation upon physicians to become medical 
philosophers.”—(Paine's Institutes of Medicine.) 
Most of the positions laid down by Dr. Paine in the above quotations 
are doubtless correct; but. in all his inductions, he is laboring undei 
an important error in supposing that morbific and remedial agents 
exercise their influence only upon certain immaterial principles 01 
vital properties. 
• Can it be supposed, that when Tartarized Antimony or Ipecacu- 
anha are taken into the stomach, in emetic or diaphoretic doses, they 
act upon an immaterial property of this viscus, in causing emesis or 
diaphoresis! Can it be believed, that the diuretics, Copaibce, Cubebs, 
Turpentine, &c., operate upon the vital properties of the urinary 
apparatus in producing diuresis, or that Belladonna, Stramonium, 
Strychnia, Conia, Alcohol, and the vapors of Ether, or Chloroform, 
expend their force upon the spiritual properties of the brain and nerv- 
ous system; or that the preparations of Mercury, Iodine, &c., exercise 
their powerful influence upon the organism, by impressing immaterial, 
imponderable or vital properties? 
We think it is more consistent with known facts and sound logic, to 
suppose that all such agents exert their influence primarily upon the 
sentient extremities of the nerves, modifying the functions of those 
parts which they supply, increasing their susceptibility to the influence 
of foreign agents, and thus establishing inflammation or a new action. 
It has been remarked by Dr. Paine, as well as by other authors, that 
Arsenic, Antimony, Iodine, Mercury, &c., given in certain small 
and repeated doses in disease, are productive of decisive effects, while 
the same doses in health, would exert no appreciable influence. For 
this reason, they assert and would have us believe, that the conditions 
and properties of diseased parts are so modified and altered in all 
respects, as to be incapable of responding to the action of those medi- 
cines which operate specifically in health. 
It is quite certain that most medicinal substances may be taken in 
very small doses during health, without any apparent effect, on account 
of the power which the system then possesses of resisting the aggres- 
sions of slight foreign agents: but if the same substances be taken in 
large doses, most decided, powerful, and specific results will follow in 
all states of the system. If taken in still smaller quantities, the 
effects are yet perceptible, but less strongly marked. These results 
will be unequal in point of intensity in normal and abnormal states of 
the organism, according to the amount of disease present; but in all 
instances, their specific operations will be uniform. 
Tartarized Antimony and Ipecacuanha, in large doses, both in 
health and disease, exercise a specific influence upon the stomach, 
lungs, and skin, as is indicated by vomiting and augmented secretions 120 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
from the respiratory organs and skin. In doses of one-sixth or one 
eighth of a grain, no effect is produced upon the respiratory muscles or 
stomach, but the influence is yet visible upon the skin. If the quantity 
be diminished still farther, even to an attenuation according to the rules 
given by Hahnemann, the impression may not be perceptible, either 
upon the stomach, lungs, or skin, yet we find them capable of influencing 
the extreme nerves in a decided manner. It does not follow, because 
a patient does not vomit, purge, or sweat, that a medicine has no effect. 
On the contrary, we know that morbific agents give rise to the most 
virulent diseases without creating the slightest sensation in the system 
at the period when the noxious impression is made. The direct and 
sympathetic effects of such agents are, however, severe and dangerous. 
Experience on the most extensive scale has proved in the most 
conclusive manner, that minute quantities of medicinal agents may pro- 
duce salutary influences in the same manner; and the law obtains with 
regard to specific medicines. The effects in these instances may not 
indeed be sufficient to induce emesis, catharsis, or other violent effects 
in any part of the body; yet from the great sensibility of the minute 
nervous ramifications, they must receive impressions and be modified 
in their action, when the trunks or larger branches of nerves, would 
remain unaffected. Who shall decide when the quantity has become 
too small to produce an effect upon the most sensitive parts of the 
body? Shall the allopath, because he does not witness vomiting, purg- 
ing, or sweating; or the homoeopath, who from accurate observation in 
numerous instances, notes from infinitesimal doses, prompt and decisive 
curative effects? 
To illustrate our meaning more fully, we will suppose a certain medi- 
cine possessing the power, when given in large doses, during health, of 
affecting a particular tissue. The same substance, administered in 
very small doses under the same circumstances, has no apparent 
influence. If now, the tissue for which it has a specific affinity, 
becomes inflamed, its susceptibility is so acute, that an extremely 
minute quantity of the specific agent is capable of making potent and 
salutary impressions. 
The other parts of the organism which become disordered through 
the media of the sympathetic nerves, also acquire an exalted sensibility 
which renders them highly impressible, and capable of being acted 
upon by infinitesimal quantities of specific medicinal agents. Homoeo- 
pathic remedies, as Paine has Avell observed of medicines generally, 
act only through these “ acquired relations,” and their power ceases as 
soon as these acquired relations have been removed and health re- 
established. 
We shall appreciate, then, the importance of selecting a remedy 
which shall cover, not only the symptoms resulting directly from the INFLUENCE OF REMEDIAL AGENTS ON ORGANS AND TISSUES. 
121 
tissue primarily affected, but which shall embrace all of the remote 
sympathetic effects. In other words, we must prescribe for the “totality 
of the symptoms.” 
“It will now be apparent from what has been said in the preceding 
section, how it is that remedial agents will call into salutary reaction 
sympathies in various parts of the body not affected by disease, but 
wThose susceptibilities are increased by morbific sympathies reflected 
from the seat of absolute disease, and upon which parts the remedial 
agents might otherwise be inoperative. Whatever, too, may be the 
complexities of disease, the right remedy will be at least compatible 
with the whole condition.” (Paine’s Institutes of Medicine.) 
“A particular state of one organ, such as inflammation, or a secreting 
action in it, often causes the production of a similar state of other 
parts.” And “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.) 
An adherence in all cases to Hahnemann’s axiom : “similia simili- 
bus” in our remedial measures, is the only means by which this last 
objection can be obviated with any certainty of success. 
It is proper here to remark that there are a few apparent, though 
not real exceptions to the principles which we have advanced. A most 
remarkable one is observed in the case of tetanus, wdiere enormous 
quantities of Opium, both in a crude form and in tincture, may be 
administered by the stomach or rectum, without producing any marked 
effect. This fact, however, by no means proves that the susceptibility 
of the parts for which Opium is a specific, is diminished; but it proves 
only that absorption is prevented. If Opium is injected into the 
veins, under these circumstances, it has been found by Magendie, 
Orfila, and Muller, that it exerts its influence in the same manner and 
degree as when taken during health. 
We suppose, therefore, that in tetanus the lacteals and other absorb- 
ents, are in a state of spasm, and thus mechanically exclude the 
entrance of all substances from their structure. In this manner, 
opiates and other drugs are shut out of the circulation, and conse- 
quently, cannot be brought into contact with those parts of the nervous 
system upon which they exert their specific force, and where alone 
they possess the power of producing their legitimate effects. 
All cases of this description, are simply apparent exceptions to the 
general rule, and do not in the slightest degree invalidate the general 
principles which wTe have advanced. 
The public of Europe and America are fast rendering the same 
justice to Hahnemann and his doctrines, and the time will ere long 
arrive, when the united wrnrld will rank him by the side of those great 
men to whom we have just alluded. It is even now conceded by many 122 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
* ininent allopathic writers, that the hypothetical doctrines of homoeo 
pathy are correct. 
But when we come to the therapeutical inferences deduced from 
these opinions, we find a wide and essential difference. The allopath, 
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 the disease. 
The homoeopathist has pursued a different course. In consideration 
of the facts that the action of no two medicines upon the economy is 
the same, that almost every agent exercises a peculiar and specific in- 
fluence upon certain structures only, and that this specific effect obtains 
both in health and disease, he institutes a series of accurate experiments 
during health, in order to arrive at the pure effects of different medi- 
cinal substances. The illustrious founder of homoeopathy 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 informing 
them of the results of his own experiments; and when their observations 
were completed, he instituted comparisons, and found that the effects 
of the medicines upon the different individuals were almost uniformly 
the same. Having by extensive experiment 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 prin- 
ciple which he had previously conceived to be philosophical and true; 
and 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 active,—there usually occurring a temporary augmen- 
tation of 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 speci- 
fication, and that disease was more speedily removed than when cruder 
preparations were employed. 
In the preparation of Dilutions and Attenuations, Hahnemann 
mixed one drop of some powerful extract with 99 drops of Alcohol by 
vigorous shaking. This was thz first dilution. 
One drop of this was again mixed with 99 drops of Alcohol. This 
was the second, and so of other successive dilutions. 
In preparing the triturations, he triturated one grain of a metal or 
mineral with 99 grains of Sugar of Milk, of which one grain was tri- 
turated with 99 of Sugar of Milk for the second trituration. INFLUENCE OF REMEDIAL AGENTS ON ORGANS AND TISSUES. 
123 
The third trituration was dissolved and then treated as a fluid sub- 
stance. He carried this process to the 30th degree. 
But the principal objection ever raised against the system of homoeo- 
pathy 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 human citadel, to storm it with agents of destruction. 
Blood is made to flow, the delicate membranes of the stomach and in- 
testines 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 showers of destructive allopathic missiles 
with which the enfeebled body is constantly assailed. By these sum- 
mary means the disturbance is smothered, but the citadel is in decay 
its resources exhausted, its foundations impaired, and its strength for- 
ever diminished. 
Homoeopathy resorts to a different mode of procedure. In her re- 
medial measures she uses no unnatural violence, nor seriously disturbs 
the function of any organ: but her remedies are exhibited with a de- 
finite 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, or at least at- 
tenuated doses, and we now come to the question, whether such minute 
quantities of matter are capable of producing salutary impressions 
upon the organism when laboring under disease. 
No one will deny, that the human body during health is constantly 
being acted upon and disturbed by influences 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 suf- 
ficient to produce decided and permanent effects. Turnbull says, that 
“ so small a portion as the one-hundreth part of a grain of Aconite 
made into an ointment and rubbed upon the skin, has produced a sen- 
sation 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, vomiting, &c. 
If the leaves of Hyoscyamus or Belladonna be applied 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 the leaves of Hyosyamus or 
Belladonna to the eyes.” 
It is also well-known, says Paine, that “violent erysipelatous inflam-, 
mation over the whole surface of the body is often induced from ap- 
proaching within a few yards of several species of Rhus.” 124 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
The wild buffalo scents the hunter for a distance of more than a 
mile, and hastens from the vicinity of danger. 
The carniverous bird recognizes the odoriferous particles 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 (01. Jec. Aselli) consists of 
Iodine distributed in infinitesimal quantities throughout the oil. Ac- 
cording to an analysis 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 at- 
tenuated medicine in the treatment of scrofula and consumption is at 
the present time generally conceded. The analysis 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 sur- 
face, or otherwise introduced into the system, to give rise to all of their 
corresponding maladies. Other diseases, like scabies, leprosy, &c., 
may be communicated by the mere touch, or from inhaling the breath 
of an infected person. 
Miasmata, animal exhalations, electricity, magnetism, 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 phenomena. In like manner the 
laws of vitality, and of all that disturbs, promotes, or alters it, may cer- 
tainly be discovered, although we shall never learn what life is.” 
Let it be ever borne in mind, that most substances, both in the or- 
ganic and inorganic kingdoms, possess certain active principles 
which are latent and unappreciahle in the natural state, and are 
only called forth and developed by some agent or process, which 
effects a transformation or metamorphosis of the crude material. 
Heat, electricity, and magnetism, become apparent when certain phy- 
sical substances operate upon each other in such a manner as to dis- 
turb or change the original state of cohesion of particles. 
Caloric is a property common to all material substances. In the 
natural state of these substances, this active principle is latent, and 
can not be appreciated by the senses; but if friction be used, this 
agent is set free, and its power becomes manifest. 
Electricity also pervades all material bodies, and only becomes sen- 
sible when the natural state of these bodies is disturbed by friction. 
It is probable, likewise, that iron and other substances contain mag INFLUENCE OF REMEDIAL AGENTS ON ORGANS AND TISSUES. 
125 
netism in a latent state, and only require the operation of certain in- 
fluences, to develop in them the phenomena of magnetism. This is 
evident from the fact, that u the same magnet may successively mag- 
netize any number of steel-bars, without losing any portion of its origi- 
nal virtue ; from which it follows, that the magnet communicates nothing 
to the bars, but only develops, by its influence, some hidden principle.” 
(Beale’s Chemistry) These forces are all now known to be only modes 
of motion. 
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 sub- 
division of particles is effected by the action of solar heat and mois- 
ture, by trituration, or succussion ; the ultimate 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-medicinal portions, 
and reduced to such a state of attenuation as to become readily ab- 
sorbed, 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 che- 
mical properties, by the most accurate tests of chemistry or optics. 
Who, howrever, for this reason will presume to deny or doubt their tre- 
mendous, although mysterious power upon the human system ? 
When Ether or Chloroform evaporates, the cohesion between the par- 
ticles of the liquid is destroyed; its elements float in the air, and are 
capable of impressing the organism in a much more powerful, and in 
a totally different manner from any impression which could be pro- 
duced by these constituents in a less attenuated state ; as, for example, 
that of the original liquid. If a large quantity of Ether be swallowed, 
but slight effects will result; but if an imponderable quantity be intro- 
duced into the blood through the lungs, in the form of vapor, it is im- 
mediately brought into contact wTith the brain and nervous system, and 
the most astonishing effects speedily ensue. 
“ If the -nrh-oth part 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 126 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
their surfaces, and apparently independent of the law of gravitation, they 
move with the greatest facility in every direction, and, as it were, become 
alive ; from that moment only, in my opinion, drugs acquire the capa- 
city of penetrating the organism, and of exciting there a curative effect 
For if drugs, prepared in this manner, be brought in contact with the 
invisible extremities of nerves, their hyper-microscopical 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 state of health be accompanied by an ac- 
tivity 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 conduction proper to the ner- 
vous substance will be materially diminished, partially and in indivi- 
dual organs, either in consequence of a chemical change, or for some 
other reasons. But to use rather a material, 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 im- 
pediment, and their rapidity seems broken by obstructions, so in a 
similiar manner, in the diseased organism, may the electric currents, 
however feeble, leave the atoms at the diseased spots, where they, ac- 
cording to their individual properties, exert a curative or detrimental 
influence.” 
If, then, imponderable substances possess powers so unequivocal and 
potent upon the healthy subject, when the organs are in high state of 
vigor, and consequently in a good condition to resist the influence of 
foreign impressions, why may we not infer, with perfect propriety, that 
medicinal substances, equally imponderable, are capable of impressing 
the organism during disease, when the affected structures are unusually 
susceptible to extraneous influences? 
Homoeopathists suppose that the mode in which their attenuations 
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, triturated 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 substances constitute but a 
very small proportion of the original crude article, and the more per- 
fectly we separate these active from the inactive portions, the more 
pure and powerful will the remedy become. Like caloric, electricity 
xnd magnetism, the strength remains latent in their 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, INFLUENCE OF REMEDIAL AGENTS ON ORGANS AND TISSUES. 
127 
cherries and plums, bitter almonds, &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 chemical process. 
Ipecacuanha is indebted for its virtues to a principle called emetine. 
Pelletier found, upon analysis, that the brown Ipecacuanha-bark con- 
tains only sixteen per cent of impure emetine; and the red bark four- 
teen per cent. 
According to Berzelius, the impure emetine 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 all improbable, that farther researches will enable 
the chemist to free this principle from other impurities, and thus deve- 
lop a still more potent medicine. 
Opium contains but a very small per centage 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 
Narcotin, Ac. Cinchonia is composed of ten or twelve ingredients, of 
which, all but Quinia and Cinchona, are inert. Even these last, as 
usually obtained, are highly adulterated, and do not by any means re- 
present 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 properties. 
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 
spontaneously disclosed by the action of heat and moisture. Miasmata 
and other noxious exhalations are examples of this kind. 
It is a fundamental law of therapeutics, that the active properties 
of all medicinal substances can only be manifested from their surfaces; 
and it follo-ws 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 pro- 
duced; while, if the same wood be cut into small portions, so as to 
expose a large surface, and then ignited, a large and powerful flame 
will appear. 
Only a limited amount of electricity can be drawn from a given sur- 
face 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 made through an ordinary piece of iron, the surface 128 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
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 direction, the chips are 
more highly magnetized than when it is effected horizontally. Here, 
again, is an instance Avhere friction has developed properties entirely 
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 corpuscles, which in their 
turn may be diffused intimately through additional quantities of the 
medium. In this manner only, can we call forth all the latent pro- 
perties of drugs, and reduce them to that state of attenuation which is 
compatible with absorption, and which enables them to exert those 
salutary specific influences which the homoeopathic practitioner so uni- 
formly observes. 
Each atom thus minutely separated, retains the power of exercising 
its specific influence upon the organism. Quantity is of but little 
consequence, provided, that the substance is properly prepared; for an 
imponderable quantity in its highest state of development 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 particular structure, is capable of com 
municating to such structure its peculiar action, the influence being 
propagated from one molecule to another, and each acquiring the 
properties of the original atom, until the influence is expended. Ex- 
amples of this kind of action are constantly presented to the physician 
in the form of continuous sympathy. 
One inhalation of a noxious miasm, under favorable circumstances, 
is as capable of causing its specific contagion, 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 specific influence, it communicates to the surrounding 
atoms its peculiar action until the w'hole tissue is involved, 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 mole- 
cule, being put in motion, can communicate its motion to others, if in 
contact Avith them.” 
This law is applicable to both animate and inanimate matter, under 
certain circumstances. Thus, the smallest point of decayed vegetable INFLUENCE OF REMEDIAL AGENTS ON ORGANS AND TISSUES. 
129 
or animal matter, if placed in contact with healthy vegetable or animal 
substances for which it has an affinity, will communicate to the latter 
its own morbid condition. 
The smallest point of decay in a tooth, continually propagates its 
peculiar action to the surrounding parts, until the wrhole tooth is 
destroyed, or the diseased portion is removed. 
The slightest spark of fire, put in contact with a combustible 
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 these particles near it, for wdiich it has an affinity, 
and the different varieties of minerals communicate to these particles 
their own peculiar action and arrangement. 
It is asserted by the supporters of the chemical hypothesis, “that 
substances in a state of putrefaction, 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.” 
(Paris' Pharmacologia.) 
Liebig affirms that “ a body, the atoms 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 contaminated 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 conditions,” indifferently to 
other “compounds with which they may happen to communicate.” 
Every substance in nature, whether morbific or medicinal, possesses 
its own characteristic and distinct mode of action, and is only able to 
exercise or communicate this action, m a specific manner to particular 
structures. Thus, the contagion of scarlatina 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 uniform in its results upon the mucous mem- 
brane of the urethra. The virus of syphilis, although more general in 
its operation, affects only a certain class of structures. All of these 
poisonous matters are incapable of imparting their peculiar influence, 
unless they are brought into contact with those tissues for which they 
possess a “ kind of elective affinity.” There is no reason 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, 
VOL. I—9. 130 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
that most drugs possess 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 advocates of homoeopathy. From 
quotations made at page 106, it will be observed, that Hahnemann him- 
self is a firm advocate of the “ vital theory.” In common with many 
distinguished writers of the old school, he supposes all diseases to con- 
sist of certain alterations of the “vital properties” of parts, and that 
medicines cure these diseases by acting upon these (supposed) im- 
material properties in such a manner as to restore them to a normal 
state. In advocating these doctrines, Hahnemann has virtually rejected 
the theory of absorption, the truth of which has been so ably maintained 
by Muller, Pereira, Blake, and others, and thus has raised opposition to 
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 we have already 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 economy; and even Liebig 
himself advises us, that many of these substances often form “per- 
manent compounds with the different tissues.” The same author also 
remarks, “if by the introduction of a substance certain abnormal con- 
ditions are rendered normal, it will be impossible to reject the opinion, 
that this phenomenon 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 sharer 
The elements of the remedy do most certainly take a share in this 
change, but only so far as the disordered organ or tissue is concerned. 
It matters not, whether the specific agent be imponderable in quantity, 
administered through the lungs, stomach, or skin, or injected into the 
veins; it seeks that part for which it has an affinity, and there mani- 
fests its force. 
I have known persons to become salivated by the use of less than 
one half of a grain of the first trituration of Corrosive Sublimate given 
in divided doses. This can be explained in no other way than by sup- 
posing that the remedy is rendered innoxious to the absorbed vessels 
by the peculiar mode of preparation; for so small a quantity of the 
crude article has never, to our knowledge, been known to produce this INFLUENCE OF REMEDIAL AGENTS ON ORGANS AND TISSUES. 
131 
result. By trituration, the crude particles of the mineral are so minutely 
separated and diffused through the vehicle, that the delicate absorbents 
admit them into the circulation with facility, while in an unprepared 
state the remedy would be recognized as an irritaruand consequently 
excluded. 
When salivation is produced by large doses of Calomel or Blue-mass, 
it is highly probable, that evaporation occurs from the heat of the 
stomach and intestines, and that this vapor, impregnating the chyle, is 
absorbed. It has been said by the opponents of absorption,'that the 
preparations of Mercury cannot be absorbed on account of their in- 
soluble nature, and therefore that salivation is caused by an im- 
pression which is made upon the “ vital properties” of the stomach, and 
that this impression is reflected to the salivary glands through the sym- 
pathetic nerves. But, if the advocates of this doctrine will reflect, that 
Mercury evaporates at a common temperature, and that this vapor, 
when inhaled, exerts all the specific effects of the mineral, they must 
admit, that when submitted to the higher temperature of the stomach 
and bowels, this evaporation and absorption will be augmented. “ I be- 
lieve,” says Pereira, “with Buchan, Orfila, and others, that metallic 
Mercury in the finely divided state in which it must exist as vapor, 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 se- 
cretions, excretions, and solids of the body: and if any “ vital properties” 
have reflected the influence, they must have conveyed the solid sub- 
stance along bodily to the affected glands. &c. 
In considering the subject of absorption and the topical action of 
attenuated drugs, it must be remembered, 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 extreme 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 poisonous 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 their influence is more potent.” (Pereira.) 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 action.” 132 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
There is a distinct recognition of the principle of the topical or spe- 
cific action of remedial agents, although the character of this action is 
supposed to be chemical. Without entering into any discussion iipon 
this point, or attempting to explain, how morbific or remedial agents 
produce their peculiar effects, we shall remain satisfied with the po- 
sitions we have before laid dowTn, 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. 
1. Odors. When odoriferous particles are brought into contact -with 
a certain nasal structure, (the Schneiderian 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 odor, agreeable 
or otherwise, according to the nature of the exciting cause, is the result. 
In this instance, physical, but imponderable particles operate upon 
the nasal tissue by absolute contact, and impart that peculiar action 
which enables us to appreciate odors. 
2. 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 different primary rays, each 
particular ray, when brought into contact with the eye, exercises a 
special and distinct influence, giving rise to the perfect appreciation ot 
the different colors of the prism. Here again we are presented with an 
example of the specific influences of imponderable atoms upon a certain 
part of the system. On the dynamic theory the illustration is more forcible. 
3. Heat. Newton also maintained, that caloric is “ a distinct 
material substance, the particles of which repel one another, and are 
attracted by all their substances.” 
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 furnished with a still more striking in- 
stance of the power of an imponderable substance in altering and modi- 
fying the character and properties of all substances upon which it 
exercises its action. This active principle, present in all bodies, hidden 
and except when set free by friction, percussion, mix- 
ture, electricity, or combustion, possesses properties when thus libe- 
rated, surpassing in power and influence every other substance in nature; 
yet it is more subtle and imponderable than the most attenuated medi- 
cines of homoeopathy. 
4. Electricity, galvanism, magnetism, and the various gases, are INFLUENCE OF REMEDIAL AGENTS ON ORGANS AND TISSUES. 
133 
all material substances and manifest their influence physically by 
contact with the body. 
It must not be supposed, that light, heat, electricity, magnetism, &c., 
are merely imaginary properties of matter,—because they can not 
be weighed, handled and made subservient to all of those con- 
ditions which govern more crude substances. Nor must it be sup- 
posed 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, offensiveness of smell, or power of raking the 
stomach and intestines. 
Modern science has demonstrated, that by f riction, percussion, mix- 
ture, &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 disencumber these principles 
from their inactive envelops, the more potent they become. It has been 
shown that the mass of ligneous, resinous, starchy, fatty extractive, 
and coloring matters, which surround and enclose the active portions 
of vegetable substances, instead of possessing medicinal properties, 
serve only to nauseate and oppress the stomach and bowels, and thus 
complicate any existing malady. 
Pereira, and other authors opposed to our system, have endeavored 
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 exceedingly small doses of medicines can produce no effect 
upon the system, but “that the supposed homoeopathic cures are refer- 
able to a natural and spontaneous cure, aided, in many cases, by a 
strict attention to diet and regimen.”—Mater. Med. & Therapeutics.) 
This is the principal argument urged against the therapeutical doc- 
trines 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 calculation, and inform us which possesses the great- 
est weight, the medicinal particles pertaining to a drop of a thirtieth 
attenuation of a homoeopathic remedy, or the charge of electricity, 
which lays prostrate and senseless the strongest man,—or the quantity 
of sulphuretted hydrogen, or carbonic acid-gas, requisite to cause im- 
mediate death when inhaled ? Which can be most readily detected 
and appreciated by analysis, the atoms of a high attenuation of Hahne- 
mann, or the deleterious miasms which arise from vegetable or animal 
decomposition? 
Which present the greatest difficulties in examination and descrip- 
tion, the physical structure of the particles of a homoeopathic medica- 134 
GENERAL PRINCIPLES OF MEI’ICAL SCIENCE. 
merit, or that of small-pox virus ? Will the respectable Hippocratic, 
who can not recognize 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 vapor of Hydrocyanic-acid, Mercury 
or Lead, weighs? 
Let it be remembered, that not one atom of matter in the whole uni 
verse can be annihilated j transformations may be effected—the cohesion 
of particles may be changed—atoms in their ultimate state of chemical 
combination may bz physically divided into molecules, and again sub- 
divided into lesser atoms to such an extent as to baffle detection from 
the most perfect tests of chemistry or optics—new powers may be deve- 
loped in these atoms, the exact operation of which we may not at pre- 
sent 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 effect a very large amount of space. The elements of a 
few grains of gun-powder may be made with the aid of the imponder- 
able influence of caloric, to change their form, and impregnate every por- 
tion of the atmosphere of a large room. In like manner, a single grain 
of a vegetable 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 instance 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 possess, let us not deny that they may 
be endowed with properties and powders (although their modus medendi 
is a mystery to us), capable of exercising an important influence upon 
the human organism. 
But it may not be possible in the present state of human science to 
follow the operations of nature through each particular step. It may 
be that we are not yet in possession all the materials necessary for 
the erection of a perfect theory of cure • and that none of the hypo- 
theses yet advanced are entirely true. On this point we may accept 
the conclusion reached by a faithful laborer in the field of medical reforms. 
Dr. Joslin says : 
“ Many physiological and pathological problems are of such a cha- 
racter as to present to those wrho may now attempt their solution, 
elements of uncertainty similar to those encountered by previous medi- 
cal theorists; so that considered in relation to some of those collateral 
or auxiliary topics, Reformed Medicine is not destined to be exempt 
from slow development. Here lie the same rocks on which have been 
wrecked so many navigators of other times, compelled by their position 
simultaneously to encounter invisible undercurrents, and unforeseen INFLUENCE OF REMEDIAL AGENTS ON ORGANS AND TISSUES. 
135 
shifting winds. The investigator is compelled to grapple with a 
problem of numerous and uncertain elements.” But in our efforts to 
master the complex problems that rise to meet us as we progress, “ our 
position is different from that of the physiological schools. With them, 
theories of the functions of the human organism are the foundation of 
therapeutics. They are working at one unfinished monument; we a 
another. Their alterations are in a considerable degree, fundamental 
and cause dilapidations in the superstructure, and necessitate its fre- 
quent demolition and reconstruction. We build on an immovable 
foundation, and every extensive alteration involves progression. 
“ In proportion to our faith in this, will cceteris paribus, be our 
happiness and activity; for one of the most agreeable and effectual 
incitements to labor, is the certainty of success.” 
In regard to the preparation of medicines, there are several points 
of difference worthy of particular notice, between the old and new 
schools. 
1. Allopathy employs her drugs in a crude and consequently in- 
active form ; while homoeopathy makes use only of their pure essential 
principles, unencumbered by foreign matters. 
2. Allopathy employs so great an amount of artificial heat in her 
pharmaceutical operations, that a large proportion of the active pro- 
perties of her drugs is expended in evaporation; while homoeopathy 
makes use only of expression, trituration, and succussion, and thus not 
only retains all of their virtues inherent in the drug, but actually 
develops powers which would have remained latent under other cir- 
cumstances. 
3. On account of the peculiar mode of preparation, the remedies of 
allopathy are offensive to the taste, they nauseate the stomach ; and, 
by in their indigestible and irritating qualities, serve directly to induce 
gastric and intestinal derangement, and other serious medicinal symp- 
toms. 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 Martyn Paine, “ but such as exist in a fluid or very 
attenuated state, are taken up by the lacteals and absorbents.” 
So, also, in the therapeutical application of remedies, wre claim, a 136 
GENERAL PRINCIPLES OF MEDICAL 3CIENCE. 
far as accurate scientific principles and sound philosophy are concerned, 
that homoeopathy is vastly superior to allopathy. We shall briefly re- 
iterate some of the more prominent points of difference in the practice 
of the two schools. 
The system of homoeopathy is founded upon rational and scientific 
principles, inasmuch as its remedies are exhibited with a definite object, 
and the results can in most cases be predicted with mathematical 
certainty. 
The practice of allopathy must always be indirect, uncertain, and 
empirical. The violence of the remedies employed, necessarily induces 
medicinal and sympathetic affections, which, mingling with the symp- 
toms 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 treat- 
ment of very many diseases, proves conclusively that their system is 
one of guessing, 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, anew or 
alterative action in the part affected, 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 time j for 
whenever two exciting causes act upon the same part, the one possess- 
ing the most powerful action, must necessarily banish and supersede 
the weaker. Therefore, in accordance with the rules of our system, 
remedial impressions are always made directly upon the organ or 
tissue affected, and a new kind of action set up, 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 wThich are healthy 
and remote from the organ or tissue diseased, in order that revulsive, 
derivative, or counter-irritating effects may be produced, and thus 
serve to attract the fluids from the natural affection to the artificial 
one. This plan of treatment originated as wxe 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 conceded to be erroneous, we assert that a mode of practice 
deduced from such false data, must of necessity be unscientific and 
empirical. INFLUENCE OF REMEDIAL AGENTS ON OKGANS AND TISSUES. 
137 
By operating on healthy structures, the allopath accomplishes little 
or nothing towards restoring the impaired capillaries of the affected 
their original condition of strength and resistance, and conse- 
quently 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 correct 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 inflammation can be 
created in any part of the body, without giving rise to secondary sym- 
pathetic affections in oth,er and distant parts. It is evident, therefore, 
that the greater the number of structures affected with inflammation, 
whether natural or artificial, the greater will be the number of sym- 
pathetic symptoms, and consequently the more serious and complicated 
the malady. Thus we perceive the force of Dr. Forbes’ remark, “that 
in not a small proportion 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 become morbidly 
susceptible to the impressions of specific remedial agents during in- 
flammation ’ therefore it is, that extremely minute quantities of specific 
medicaments are capable of exercising powerful influences during 
disease, -which, under circumstances of health, would be productive of 
no effects whatever. This is a truth of vast importance in the admi- 
nistration of medicines, and should be thoroughly appreciated by the 
practitioner who regards the welfare of his patients. Let him remember 
that these acquired susceptibilities are so great, that even the natural 
stimuli, food, gastric juice, bile, light, &c., can not 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 prin- 
ciple 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 allo- 
pathy cannot make themselves acquainted with the powers of attenu- 
ated 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 sweating, 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 mixas, and that too, secundum artem! To be sure, they were not 
aware of any visible effects to hen the morbid agent operated upon 138 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
their systems 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 Hippo 
crates now reigns, and they are resolved to exercise their anoien 
reserved rights, and bleed, vomit, purge, sweat, and blister, ad libitum 
But why have our opponents dwelt so much upon our doses! Does not 
every homoeopathist aim and intend to give a sufficient quantity of the 
medicine at a time to effect a speedy cure; and is not this quantity 
determined by experience of simple facts ? We have different strengths 
or attenuations of each medicine, from the strongest tincture up to the 
most minute attenuation, and every homoeopathist selects that strength 
or attenuation of the drug which most speedily and safely cures his 
patient. The great point with him is, to select such a medicine as 
shall be homoeopathic to the symptoms of the disease, and then to ad- 
minister 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 efficient and less safe than finer preparations of 
the drug. This easily demonstrated truth, was not the result of 
theory or hypothesis, but originated with Hahnemann, as we have 
already seen, through necessity, on discovering that the tinctures which 
were first employed by him, in accordance with his principle, often 
produced too violent impressions upon the affected structures. What 
cared Hahnemann—what care his disciples—whether they use one or 
twenty drops of a tincture, or one grain of a twentieth attenuation ? 
Were twenty drops of a tincture, or twenty grains of a crude substance 
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 homoeopathy does not 
consist in the discovery of the efficacy of small doses, but in the 
demonstration aud practical introduction of the great doctrine of curing 
maladies by impressing diseased tissues with medicines which operate 
specifically upon these tissues themselves, rather than on distant parts. 
It matters not therefore, in regard to the homoeopathic law of cure, 
whether we use this or that strength, provided the remedy is homoeo- 
pathic 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 (if he be successful) adheres to similia 
sirnilibus as much as he who cures with the thirtieth attenuation of 
the medicine. The only question to be decided is, which strength 
cures most safely and quickly; and if facts prove, as all homoeopaths 
believe, that a preparation (apparently) weaker than the tincture is by INFLUENCE OF REMEDIAL AGENTS ON ORGANS AND TISSUES. 189 
far the most safe and efficient, then it is our duty to give these pre- 
parations the pi-eference. It is found, for example, when repeated doses 
of tincture of Belladonna are given in acute inflammation of the brain, 
that the primary symptoms from the drug manifest themselves too 
violently—that it causes dangerous and protracted medicinal aggrava- 
tion, and a tardy reaction of the organism; while a dilution of the 
remedy impresses mildly the diseased structure, causing scarcely per- 
ceptible primary symptoms, and is speedily followed by its secondary 
or curative effects. 
We shall conclude this section with a few observations by a 
distinguished chemist (allopathic) respecting the divisibility of matter, 
and some of the phenomena witnessed when a high degree of attenu- 
ation has been arrived at. These observations may at least show to 
those whose minds are not already permanently made up, 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 TrroVoTo of a square inch, and yet possess the color and all £ther 
characteristics of the largest mass. If a grain of copper be dissolved in 
Nitric-acid, and then in water of Ammonia, it will give a decided violet 
color to 892 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 
million in a cubic inch, contains only one particle of copper, 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, colors 1000 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 particles of indigo must be smaller than -2-toXuVuTooT), 
the twenty-five hundred millionth of a cubic inch. A rather more 
distinct experiment is the following: if we dissolve a fragment of silver, 
of 0.01 of a cubic line in 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 short of a billionth of a cubic line. To render the idea of this 
degree of division more distinct than the mere mention of so imper- 
fectly conceivable a number as a billion could affect, it may be added, 
that a man, to reckon with a watch, counting day and night, a single 
billion of seconds would require 31,675 years.” 
According to Doppler, a cubic inch of brimstone, broken into one 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 calculated 
in this way, that, if each trituration of the homoeopathist diminishes 
his drug a hundred times, (an exceedingly moderate allowance) the 140 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
sensible surface of a single inch of sulphur, or any other drug, shall he 
two square miles at the third trituration. 
“In the organized kingdoms of nature, even this excessive tenuity of 
matter is far surpassed. An Irish girl has spun linen yarn, of which a 
pound was 1432 English miles in length, and of which, consequently, 
17 lb 13 ounces would have girt the globe; a distinctly visible portion 
of such thread could not have weighed more than tsTToVriTtnru gr-> cotton 
has been spun so fine that a pound of the thread was 203,000 yards in 
length, and wool 168,000 yards. And yet these, so far from being ulti- 
mate particles of matter, must have contained 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 before, and of 
which it would require the heaping together of millions upon millions 
to b$ visible to the naked eye. And yet these animals live and feed, 
and have their organs for locomotion and prehension, their appetites to 
gratify, their dangers to avoid. They possess 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 comparison ; 
and that presented by nature on the one hand with magnitudes infinitely 
great, and on the other hand 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 Chemistry, by Draper, p. 19.) 
It is not by supplying deficient chemical materials to the blood that 
remedies are to cure disease. It is true, that in various diseases the 
blood is deficient in phosphates, carbonates, sulphates, lactates, acetates, 
&c., of soda, lime, or other ingredients of normal tissues; these salts 
are not, however, furnished to the blood by food, as phosphates and 
carbonates, &c., but are formed within the organism, and from material 
whence the chemist must often despair of extracting them. Whatever 
the absorbents receive, undergoes profound and radical transformations, 
provided it be not in such excess as to embarrass the functional activity 
of the organs which dispose of it. A controlling vital force then forms 
the different compounds as they are needed, instead of delegating cer- 
tain organs to select them ready made. 
Mr. Gundlach, of Cassel, shows experimentally that wax is forme 1 
from honey in the body of the bee, although the honey contained ap 
parently no trace of wax. Liebig remarks the absence of fat in tb \ INFLUENCE OF REMEDIAL. AGENTS ON ORGANS AND TISSUES. 
141 
flesh of the carnivora, which of all animals eat most fat; while the 
cow extracts butter from herbs and roots, suet from hay and fodder, &c. 
The sugar of the maple is found not in the roots, but in the woody sub- 
stance of its trunk, increasing only up to a certain height. Sugar, 
starch, gum and humic acid, so nearly allied in their composition to 
plants, are not food for them. Sugar can only be absorbed and appro- 
priated in the tree like any other foreign matter. All the animal viruses 
and venoms, hydrophobine, and the serpent-poisons are rendered inert 
by the operation of digestion in the stomach, while the most innocent 
articles of food received into the stomach of the viper furnish its body 
with all the elements of its structure and secretions, and are trans- 
formed into the deadly venom in the glands which elaborate that fluid. 
Lehmann and others have proved that sugar, found in the blood, is 
not assimilated as sugar from those aliments which most abound in 
sugar, but from the fibrine and albumen, the proportions of which are 
reduced in the blood of the hepatic vein, as compared with that of the 
portal vein. The vital force executes disintegration and reconstruction 
upon every compound presented to it. Though potash and other salts 
of alkaline base, Copaiba, Turpentine and Garlic may be detected after 
absorption in the blood, sweat, chyle, gall or splenic veins, they are 
speedily excreted with the urine. 
The patient under treatment has received in general the same kind 
of food that he took in health, but he fails in assimilative power to ex- 
tract from the food and appropriate for the uses of the organism the 
elements essential to his support. Tuberculosis is not the result of a 
deficiency of phosphates in the food, but of loss of the assimilative 
power to extract them from it. 
The object of the scientific physician is not to furnish the system 
with some infinitesimal quantity of an ingredient which is deficient in 
the blood. If iron be deficient in the blood and that agent be found a 
remedy, it becomes such not by furnishing the wanting ingredient, for 
the quantity we prescribe is not in any degree sufficient for that, but 
by enabling the organism to appropriate that which is presented to it 
in the food. The disease does not arise from deficiency of iron in the 
aliment, but “ the power of digesting, assimilating and forming the 
food into blood is defective ; and it is this power which is to be restored 
by medicine. The physician who is ignorant of this, and in treating 
such a case, regards himself as a mere caterer for supplying materials, 
will naturally conclude that he must administer ferruginous medijcine, 
and that the medicine must be given at least in quantities appreciable 
by chemical tests. 
“Neither of these conclusions has the slightest foundation in reason. 
The substance which suitably regulates the vital force in this case, will 
not necessarily or even generally be iron, but some medicine indicated 142 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
by the generality of the symptoms present. Again, the immediate ob* 
ject not being chemical but vital, it is not necessary nor desirable to 
employ a dose appreciable to chemical tests, but to the vital test, which 
is inconceivably more delicate ; the living body can be strongly and 
durably effected by a dilution, which if concentrated a billion fold would 
not produce a visible change in any lifeless re-agent. (Dr. Joslin.*) 
The question is asked, how is it possible for a perceptible influence to 
be exerted by a minute dose of an attenuated medicine “ when the same 
substance, as salt or iron, already exists in the blood and in sufficient 
quantities without it.” 
This question will only be asked by persons who “ deny that special 
increase of power called potentization which the homoeopathic medicine 
receives by minute divisions in the different stages of its preparation, 
and which gives it an efficiency vastly superior to that of the same 
quantity in the ordinary state.” To those who admit nothing and deny 
everything, it may not be easy to present satisfactory answers to all 
questions prompted by mere curiosity ; and it may not be profitable for 
us or them to spend much time in abstract reasonings which weak minds 
do not easily comprehend. The only question in this case is one of fact 
for an impartial jury to inquire into. A fact well known to many ob- 
servers is thus stated by Dr. Joslin: The quantity of Natrum-muriati- 
cum, common table-salt, “taken by almost every man, varies by many 
grains at his different meals. If he receives a few grains more at one 
meal than at the preceding one, he has no Natrum-muriaticuin symptoms 
as the consequence; and common-sense would teach a physician that 
if he should administer a few grains of the crude substance, he could 
produce no effect by it The intentional increment must be as inoperative 
as the accidental. But experience teaches that the potentized form of 
this medicine in a quantity inconceivably small makes a decided im- 
pression both on the healthy man and the patient. We are compelled 
to conclude that it has a power of affecting the system not perceptible 
in what is chemically the same substance in its ordinary state, or in 
that state in which it exists in the blood, where it is crude as compared 
with the form in which it is given by homoeopathists. A thousand 
physicians daily witness the special power of potencies of other medi. 
cines, and are thus able to confirm by analogy the preceding conclusion.” 
ATTENUATIONS OF DRUGS AND REPETITIONS OF DOSES. 
In selecting our attenuations for the cure of disease, the following 
circumstances are to be taken into consideration: 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. 
* American Horn Review, Yol. II., p. 38. ATTENUATIONS OF DRUGS AND REPETITIONS OF DOSES. 
143 
a. Age.—Infants and children of tender years, whose organisms have 
not become blunted by exposure to the ordinary stimuli of life, by im- 
proper food and drinks, and by abuse of cathartics and opiates, are in 
the most eminent degree impressible and require the highest attenu- 
ations. It is at this period that the circulation is most active, the 
nervous system most delicate, and the tissues most sensitive to the in- 
fluence of external agencies. 
At the middle period of life, when the body has arrived at maturity 
and all of the organs have acquired their full strength and vigor, 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 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, especially in acute diseases. 
During the decline of life, many circumstances which have a ten- 
dency to modify the operation of medicines, are to be considered. In- 
dividuals who have passed their lives in intemperance, who have been 
afflicted with frequent attacks of disease, and whose systems are loaded 
with the cumulative poisons of drugs, usually acquire a remarkable 
obtuseness and inactivity of the whole organism, so that the very low- 
est attenuations are requisite to effect suitable impressions. On the 
other hand, many old people, upon the verge of the second childhood, 
become sensitive, irritable, and so intensely impressible, that the higher 
preparations respond promptly and effectively. 
b. Sex.—Females are more easily acted upon by medicines than 
males, for several reasons. Perhaps the most prominent one consists 
in their superior delicacy 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 conclusion which would require a man hours of severe thought to ar- 
rive at. It is this susceptibility and delicacy of organization which 
renders the female more impressible than the male sex and which should 
always have no inconsiderable weight in the selection of attenuations. 
c. Temperament.—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 nervous system is 
most favorable to the prompt operation 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 susceptibility, may ' e 144 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
ranked the sanguine. Individuals of this temperament are charac- 
terized by great activity and energy, and by prominent development 
and vigor of the vascular system. 
Temperaments which are the least susceptible to remedial impres- 
sions, are the bilious and the lymphatic. The former is characterized 
by large muscular developments, tendency to biliary derangements, 
frequent turns of melancholy, and great powers of endurance. The 
latter is distinguished by a predominant activity of the glandular sys- 
tem, by a flabby and relaxed condition of the muscles, and by a feeble 
and rather obtuse state of the nervous system. These temperaments 
sometimes require the lowest attenuations, especially in chronic dis- 
eases. 
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 favorable to health and longe- 
vity, since no quality predominates, and the functions of the organism 
are more equalized. 
d. Constitution.—Attenuations must also be selected with a due 
regard to the constitutional peculiarities 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 violently salivated. There are 
others in whom Opium produces furious and protracted delirium ai d 
catharsis as primary effects; others cannot carry Ipecacuanha about 
their persons, or inhale the smallest quantity of it, without attacks of 
asthma; others cannot approach the rhus-plant without being poisoned; 
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 delicate 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 licentious- 
ness, and in which there is an abasement of the nervous and physical 
power, demand low attenuations. In a word, it will be found on rigid 
examination, that each individual possesses some peculiar trait which it 
will be necessary to take into consideration, when we decide respecting 
the strength 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 
descanting 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 ex- ATTENUATIONS OF DRUGS AND REPETITIONS OF DOSES. 
145 
periences so much difficulty in the management of cases of dyspepsia, 
hypochondria, and constipation, which have been induced by long-con- 
tinued abuse of cathartics; also in the affections of confirmed Opium- 
eaters, habitual drunkards, and gourmands. Individuals of these 
lasses, require low attenuations. In the same category may be ranked 
hose operatives who make a breathe-vapor of Mercury, the salts of Lead, 
itrong acids, and other poisonous substances which evaporate at 
he ordinary temperature. 
Robust persons, who pass much time in active exercise in the open 
tir, will require stronger doses than those of delicate organization and 
)f‘ studious, sedentary habits. 
2. The condition of the disordered textures.—Those parts of the 
system which are most amply supplied with nerves, are, ail 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, joints, &c. Much also depends upon 
whether the specific employed, is positive and decided in its operation. 
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 
susceptibility to medicinal impressions which inflamed structures 
acquire. We have shown that the condition of inflamed tissues becomes 
entirely changed, and that their acquired susceptibilities become so 
morbidly increased that even their natural stimuli can not be tolerated, 
but when allowed to operate, become additional and powerful sources 
of disease. The natural and healthy 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 stomach, 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 the termination of inflammatory action, when the 
sensitive extremities of the nerves succumb from intensity of excitement, 
and a condition bordering on paralysis 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 sub- 
sidence of pain, appearances of effusion or ulceration, and diminished 
sensibility of the affected 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 infini- 
testinal doses, but it teaches an important practical fact, at present 
unappreciated, but incontrovertible, and which stands at the foundation 
V0T» I.— 1 O' 146 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
of our therapeutical applications, viz., to ascend in our scale of attenudr 
dons in proportion to the violence of the inflammation, until we 
arrive at that point where the nerves of the diseased part have at- 
tained their maximum of erethism, after which we must again de- 
scend the scale in the same ratio. 
This same law applies Avith equal force to all irritations of the ner- 
rous system, even Avhen entirely unattended with the usual phenomena 
of inflammation, redness, SAvelling, heat, and pain. We have often seen 
this nervous erethism so strongly pronounced—and where there were 
no signs of vascular excitement—that a single grain of Ipecacuanha, 
or the twentieth part of a grain of tartarized Antimony, would 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 are usually irritable ; or a single grain of Jalap, 
Rheum, Calomel, or even a mental emotion, immediately cause diar- 
rhoea ; or a cup of tea or coffee taken in the evening, prevent sleep for 
a Avliole night; or the inhalation of a feAV imponderable particles of 
Ipecacuanha, give rise to both its primary and secondary specific effects 
upon the pulmonary organs. 
There may be a feAV apparent exceptions to this rule, as in the 
example already referred to respecting the inefficiency of large quan- 
tities of Opium and Laudanum in tetanus / but these exceptions are 
susceptible of ready explanation. In this disease there exists a pecu- 
liar preternatural excitement of the nerves which preside over the 
voluntary motions, and the contractility of the tissues, which induces a 
spasmodic exclusion 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 Laudanum be injected into the veins during 
tetanus, the usual effects are manifested. In this disease, therefore, 
the drug is not adsorbed, and of course can not exercise its specific 
effects upon the economy. 
It is evident, then, that in the selection of attenuations 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 ner\rous susceptibility, and call for 
the use of high attenuations; Avhile in other cases, this susceptibility 
or impressibility remains at a low grade, and consequently will only 
respond to Ioav attenuations. 
Dr. Lobethal, in alluding to this subject, makes use of the following 
anguage:—“God be praised, the times are passed when we adhered 
without examination to the prescriptions of Hahnemann, and Avhen Ave 
administered the thirtieth dilution in every case, without any regard 
either to the species of the medicine, or the individuality of the patient. 
The idea of the greatness or littleness is but relative; we cannot say ATTENUATIONS OF DRUGS AND REPETITIONS OF DOSES. 
147 
in a general manner, that some drops of the mother tincture of a certain 
medicine will be a strong dose; nor yet perhaps, that the twenty-fourth 
Dr thirtieth dynamization 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 organism, and, provided we are 
careful not to administer a too heavy one, but agreeable to take, and 
without danger, we should always give a sufficient '.ne. 
“ 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 disposal, from the actual dose of the old school up 
to the highest dilutions of which any medicine is susceptible. 
“We may establish it as a principle, that the appropriateness of large 
or small doses is in inverse proportion to the richness in nerves of the 
individual organism, 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 attenuated the dose of the indicated specific 
medicine should be, 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 Specif que. Yol. III., 1841.) 
Dr. G. H. Gross of Germany, also observes, that “homoeopathy, 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 OE MOKE DKOPS OF THE UNDILUTED TINCTUEE, as 
individual cases may demand.” * 
Dr. E. F. Ruckert, of Germany, also writes as follows: “I am satis- 
fied that the system (homoeopathy) is still progressive, and has by no 
means attained 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 majority of our school, both in Europe and 
America. 
We have not unfrequently been able to cure diseases with a high 
attenuation, after having failed with the first and second dilutions of 
the same remedy: but it has been no very uncommon occurrence 
with us to effect cures with the first attenuation after having been un- 
successful with the higher preparations. No definite rules, therefore, 
* Dr. Gross wrote this in 1840 ; but during several years preceding his death, he 
was a most decided advocate of the highest dilutions. 148 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
can be given which will apply in all cases, hut every circumstance con- 
nected with each particular case must be duly investigated, and the 
physician then exercise his own best judgment. 
The appropriateness of a particular remedy for a given set of symp- 
toms constitutes one problem, and the choice of the proper attenuation 
another, both of which are to be separately determined, according to the 
direction of Hahnemann,* by “pure experiments, careful observation, 
and correct experience.” For practical purposes the rule generally 
given is, “the more susceptible the organism, the higher the potency, 
and the finer the doses.” The theory upon which the action of high 
attenuations is to be explained is not yet settled byhomoeopathists. It 
has been proposed to apply for this purpose the law of nature mathe- 
matically demonstrated by Maupertuis, called the law of the least 
quantity of action, thus expressed by its discoverer: “The quantity 
of action necessary to effect any change in nature is the least 
possible.” 
“According to this general principle, says one of our own writers,! 
“the decisive moment is always a minimum, an infinitesimal. Apply 
this to our therapeutics, and it will be perceived that the least possible 
dose is the highest potency, and necessarily sufficient to turn the scale, 
that is to effect the cure—always provided the remedy be homoeo- 
pathically correct. 
“This law of the least action appears to be an essential and neces- 
sary complement of the law of homceopathicity, (similia similibus) 
and co-ordinate with it.” 
Experience teaches that the strictly homoeopathic remedy, selected 
according to the law similia similibus curantur, will produce aggra- 
vations when given in large doses. Dr. Verweg of the Hague opposes 
large doses: 1. as unnecessary, as the power of a remedy lies not merely 
only in its quantity; 2. because large doses obstruct the digestion and blood 
crasis, offices which ought to remain untouched in a sick state, in order 
to carry it to a happy crisis ; 8. large doses produce so many secondary 
effects, that the chief effect will appear modified or more or less 
obscured. 4. Large doses increase the effect to such a degree that 
exhaustion ensues after the too powerful irritation, stopping either the 
beginning amelioration or under less favorable circumstances causing 
death. 5. Large doses produce as many symptoms as the disease it- 
self, yea, the newly-appearing symptoms of the remedy are often more 
severe than the symptoms of the disease which we want to cure. 
6. Large doses leave after-effects of long duration. 7. Large doses, 
according to the laws of polarity, have often a contrary effect. 
It is a common opinion that the lower potencies agree with acute 
* Organon, p. 278. 
t Dr. Fincke Amer. Horn. Rev., Apr, 1840 p. 336 ATTENUATIONS OF DRUGS AND REPETITIONS OF DOSES. 
149 
and the higher ones with chronic diseases, the effect of the lower ones 
being quicker; hut coarser and more evanescent, whereas, the higher 
and highest potencies have a slower effect, but more penetrating and 
longer enduring. Such general rules are only partially correct. 
Diseases which have a chronic character throughout their course, as 
cholera, croup, &c., are generally though not always treated by low dilu- 
tions. The precursory fever of pneumonia is generally broken by low 
dilutions, whilst the higher are employed to remove the exudations 
which result from the inflammation. Exanthematous diseases and 
typhus are treated with high potencies till they localize themselves; 
hut we return to the lower when new complications arise. 
In chronic diseases, appearing acute in paroxysms, as whooping 
cough, migraine, or intermittents, the high dilutions are considered by 
Mayer most effectual. High dilutions are considered best in chronic 
catarrhs of mucous membranes, leucorrhoea, nervous and mental 
diseases, and all blood dyscrasias, new formations, as warts. 
The difference between the powers of medium dilutions and those 
much higher, is not always perceptible. Many use only a few out of 
the great range afforded us, as 1, 2, 3, 6, 12, 24, 30, 60, 200, &c. 
Trinks divides remedies into 1. Those working on the organism with 
great energy and intensity, yet fleeting in the duration of their action, 
even when given in large doses; as, Aeon., Cham., Camph., Moschus, 
Igna., Ipec., Hyoscy., Coffea, Stram., Samb., Opium. 2. Those produ- 
cing effects less strong, but more intense, deeply penetrating the organism 
and their effects lasting for a long time, such as the mineral remedies • 
Arsen., Cuprum, Merc., Sulph., Graph., Aur., Argen., the mineral acids 
and some vegetable remedies. 
Medicinal Interference.—It is considered a practical impossibility 
to exclude all active medicinal and opposing influences from the pre- 
sence of our patients, and it is asked, how can wre expect infinitesimal 
doses to produce their proper effects when they must come in contact 
with so many antidoting substances ? “ The Camphor in a drawing- 
room cabinet,—the fumes of a smoking-room,—the oil of a mineral lamp, 
which in spite of washing perfumes the fingers,” are supposed to have 
power to counteract the remedies. In answer, it can at least be said, 
that homoeopathic doses are certainly effectual in curing disease, in 
spite of antidotes and external influences. The theory may not be 
satisfactory, but the fact is certain. The explanation is attempted by 
the Monthly Horn wop. Review : “ The curative power of a medicinal 
substance, homoeopathically selected, is necessarily higher than the 
mere antidotal force of an interfering body; and for the following 
reason: The medicine owes its curative force to the receptivity of the 
diseased organism to which it happens to be homoeopathic; no twro drugs 
have an equal pathogenesis throughout, and therefore the antidote 150 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
under no circumstances can exercise a power over the disease equal tc 
the true homoeopathic remedy. The medicine is aided in its operation 
by the vital force of a diseased and highly receptive organism, while 
the antidote either acts merely upon the inert medicinal substance to 
which it is antidotal, or on organs to whose state it has no relation. 
“That the force of a remedy may be influenced to some extent by 
its antidotes is no doubt true ; but we believe that a homoeopathically- 
chosen medicine will, in all cases, and even in the presence of crude 
drugs, exert a certain curative influence upon a diseased, sensitive and 
highly receptive organism. 
The question still remains: What becomes of the impurities which 
unavoidably exist in the attenuating fluid; and why do not these im- 
purities neutralize the effects of the minute quantity of the medicine 
employed in the treatment of disease ? This question has been well 
answered by Dr. Joslin, in an essay communicated to the American 
Institute of Homoeopathy, 1858.# He shows, that every time a dis- 
solved medicine is diluted a hundred-fold, it has its minute parts, called 
molecules, made smaller and more active, i. e. potentized. On the other 
hand, “ when a dissolved substance, made a little active by a little di- 
vision, is brought in contact with the same substance in a still less di- 
vided and less active state, it unites with the latter and thus becomes 
like it, comparatively crude and inert,—it loses its special power;” that 
is, it becomes de-potentized. “ I find that this union by cohesion and 
consequently this depotentization always takes place when one portion 
of the substance is only a hundreth part more diluted than the other. 
Thus, a substance that happens to adulterate the alcohol used for po- 
tentizing a medicine, is continually combining with and practically nul- 
lifying itself, and the high potency of the medicine remains practically 
pure. In this case, the little parts, molecules of the impurity, never 
differ much in size and never differ so much in the degree and nature 
of their activity as to prevent their re-union. 
“ This statement in regard to the conditions of re-union is not a mere 
hypothesis. It is not only a necessary inference from the fact of po- 
tentization, but is in accordance with observed facts in crystallization. 
I have witnessed the crystallization of Camphor, as exhibited by the 
solar microscope, and observed phenomena which have a bearing on 
this subject.” Though no microscope has power to exhibit to the eye 
the smallest crystals first actually formed, it was observed that “ those 
first visible were in a series of groups, the larger crystals not growing 
by the addition of invisible ones, but of those smaller ones already 
formed of others still smaller. The first visible molecules unite with 
others not too dissimilar -in magnitude, frequently after rotating like 
* Proceedings of the Fifteenth Annual Meeting. ATTENUATIONS OF DRUGS AND REPETITIONS OF DOSES. 
151 
little magnets; but they do not unite in the first instance with those 
whose difference of magnitude is very great.” * 
If then it be asked: Why does not the iron or culinary salt that 
exists in the blood, “ and which is identical in name with a medicine 
administered, unite with the latter, which would thus become depoten- 
tized and inert ? ” 
To this question we answer, that whether we are able to explain the 
philosophy of the phenomenon or not, th % fact is abundantly established 
in the experience of every man who is accustomed to give our remedies 
in the medium and higher dilutions, that these remedies are active, 
though administered dissolved in water, which also contains the same 
substance in name, though in a form more crude. The fact is thus 
explained: 
“ That the union of the two, and the consequent depotentization of 
the medicine does not occur, I attribute to the discrepancy between 
their degrees of attenuation. The substance in the natural water and 
the blood, which can be detected by chemical tests, must be crude, com- 
pared with the same in our medium and higher potencies, which can 
not be thus detected. The crystalline affinities of these two kinds of 
molecules differ so widely, that they may be regarded as on different 
planes of activity: those in the natural fluid comparatively gross and 
inert, those in the potency rendered inconceivably minute and active by 
regular and consecutive attenuations. This activity, so obvious to the 
physician by the use of the vital test, has not yet attracted the atten- 
tion of the natural philosopher or chemist, because their tests are not 
sufficiently delicate.” 
Adjuyantia.—They are generally permitted : 1. When the special 
nature of the disease calls for other than medical aid, as surgical cases, 
the removal of pathological products, toxical cases. 2. WTien we are 
not permitted by the friends to rely upon the simple homoeopathic re- 
medies, but know that if we abandon the case, it will go into dangerous 
hands. 3. Where the proper remedies are not at hand, and the cir- 
cumstances compel us to do something. The occasions that can justify 
bloodletting even in the minds of old-school men are not very few. 
Leeches are of use in but few cases and we have better means of 
managing them. Purgatives are homoeopathic agents in diarrhoea and 
dysenteries; in the removal of irritating substances from the bowels 
they can sometimes be employed. 
Derivatives, though not often proper or necessary, may in good hands 
be directed under the homoeopathic law to perform good service, as we 
shall show in treating of the different forms of disease in which they 
may be useful. Hahnemann sanctioned their use in proper cases 
* Am. Horn. Review, Yol. II, p. 40. 41. 152 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
(See Chronic Diseases, Vol. I., 238.) Poultices may properly be used 
to soften abscesses; and cold and warm water can be applied with good 
effects in many cases. Electricity and its allied powers are recom- 
mended by Hahnemann. (Chronic Diseases, I., *288.) Mild forms of 
it are the electric bath, the electric wind, and friction through flannel. 
Zoomagnetism was also employed by him, as acting according to the 
law of polarity. The water of mineral springs consists only of well- 
known medicines in dilution. They would be much more successful 
than they are if they contained still smaller quantities of the drugs to 
which their virtues are attributed. 
Selection of the Proper Remedy.—The rule given by Hahne- 
mann is to choose from the many remedies before us that which presents 
the principal symptoms found in the individual case of disease. Though 
it is often difficult to find a remedy which has the whole, of them, it 
should always be fairly sought for. The remedy that will certainly 
cure, will be one that exhibits “not only tbe symptoms of the disease as 
present, but also the symptoms of the patient’s constitutional state.” 
“ Many symptoms,” says Jahr, “ which our school considers as mani- 
festations of the general disease, are considered as independent diseases 
by beginners, simply because they find particular names for individual 
diseases in the books.” “The proper selection of a remedy in chronic, 
and generally in acute diseases depends upon the following three 
points: 1 The remedy must correspond to the pathognomonic symp- 
toms of the case;—2. To the accidental symptoms which do not seem 
to be a part of the essential phenomena of the disease;—3. To all 
other diseases and morbid phenomena which we may be able to dis- 
cover in the patient. If the patient be afflicted with pneumonia, Ave 
would not only record the essential symptoms of pneumonia, but also 
the symptoms of any other affection which might happen to exist with 
the inflammation of the lungs ; and, moreover, the general morbid phe- 
nomena of the organism, no matter AA-hether the books speak of them as 
symptoms, or as independent diseases.” 
The formula of Hahnemann, that like cures like, has suggested the 
question, asked by Ilering, “ What is the like which cures t ” and also 
his ansAver, that “it is that Avhieh is characteristic.” The meaning of 
both question and answer has been elucidated with sufficient clearness 
by Dr. Wells of Brooklyn: In the treatment of dysentery, ‘What is the 
like which cures,’ and how are we to find it? In other words, Avhat are 
the characteristics, i. e., of the drug and the disease ? It is obvious at 
the first glance, that there are tAvo classes of these. One, the generic, 
which determines the case you have to treat as belonging to the genus 
dysentery, belongs alike to all the members of the genus, and without 
which no case is dysentery. The other, the specific, that which ATTENUATIONS OF DRUGS AND REPETITIONS OF DOSES. 
153 
listinguishes individual members of the genus from all other mem 
O O 
bers. 
“ It is worthy of remark, that there is in the pathogenesis of all 
drugs a class of symptoms, which in their relation to the law of cure 
are very analogous to the generic symptoms of disease. The allusion 
is to that class of symptoms which rather indicate that the organism 
revolts against drug-assault, than point out the particular active agent 
in the assault. For the same reason that generic symptoms of disease 
can rarely be availed of as guides to the selection of a curative, these 
are of comparatively little value to the prescriber. The vomiting pro- 
duced by one irritant poison is so like that of every other, that from 
this alone it cannot be told what irritant it is. So of the diarrhoea, 
nausea, thirst, loss of appetite, headache, &c. These of themselves can 
never be guides to a prescription, though the elements associated with 
them may be. It is not then to the generic symptoms of either drug 
or disease that we are to direct our attention chiefly, in our search for 
the “ like which cures.” 
“Where then are we to look for this ? Evidently in the list of those 
symptoms which individualize both the disease and the drug. That 
which distinguishes the individual case of the disease to be treated, 
from other members of its class, is to find its resemblance among those 
effects of the drug which distinguish it from other drugs. This is 
what we mean when we talk of “characteristics” as the great reliance 
of intelligent practice, and assert that with these the law of cure has 
chiefly to do. It is precisely in this relationship that the law exists. 
When we say that ‘ like cures like,’ this is the like we mean.” * 
The student of homoeopathy is always perplexed by finding a dozen 
remedies enumerated as proper for a certain disease. He sometimes 
learns to discriminate between them, and finds that every diseased state 
is capable of being covered by a single remedy and none other. Ho- 
moeopathy is the science of specifics, not in the sense that old-school 
men call Mercury a specific for syphilis, Iodine for scrofula, but in the 
sense that there are no diseases, but only diseased states,■ and every 
specific remedy, which will alone cover that state and necessarily cure 
that state. Every prescription based on nosological genera and species 
is wrong; true therapeutics lies only in the individualism of the Ma- 
teria Medica. 
3. The Character of the Medicine to he employed.—Certain sub- 
stances 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-divided par- 
ticles by a chemical combination with the oxygen of the air, for which 
* Diarrhoea and Dysentery, P. P. Wells, M.D., New-York, 1862, p 27; ibid, p. 29. 154 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
several, like Carbon, Graphites, Sulphur, Lime, &c., possess a very 
strong affinity, or whether they arise from the simple subdivision of the 
atoms of the drug, we are unable to determine. But these are the me- 
dicines which have been found especially serviceable when employed 
in high attenuations. 
On the other hand, there is a class of medicines so volatile in their 
nature, that trituration and exposure to the air and moisture deprive 
them of their active principles. Amongst these articles may be ranked 
Camphor, Ammonia, Bromine, Argenti-nitr., the Ethers, the Volatile 
Salts, &c. Medicines of this kind should always be administered in 
the lower attenuations. 
We must also be governed somewhat by the positive or negative 
character of the specific employed. Some medicines are very marked 
and prompt in their specific operation, like tartarized Antimony, Phos- 
phorus, Ipecacuanha, Belladonna, Aconite, Hyoscyamus, Stramonium, 
Opium, &c., and may ordinarily be used at rather higher attenuations 
than those whose primary effects are less prompt and strongly pro- 
nounced. 
The advantages which we obtain from a minute subdivision of crude 
substances are as follows: 
1. We develop every part of the active principle pertaining to the 
substance by breaking up all natural organization or arrangement be- 
tween its molecules, and thus exposing a large amount of active surface 
which would otherwise have remained latent. 
2. 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 
matter. 
3. 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. 
4. During the act of subdivision, it is not improbable that the atoms 
of drugs sometimes become oxydized, and thus acquire new and in- 
creased powers. 
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 effects 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 
aggravation of the symptoms, (that is, some primary effect of the drug,) 
appears, or a perceptible amelioration of the symptoms is apparent 
when the medicine should be omitted, in the first case, until the seco7b ATTENUATIONS OF DRUGS AND REPETITIONS OF DOSES. 
155 
dary or curative symptoms have appeared, and then expended them- 
selves ; and in the latter, so long as amendment continues. If the case 
demands it, recourse may again he 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 he sufficient to repeat 
the remedy every four, six, or eight hours, until primary symptoms 
(aggravation) occur, or amelioration of the symptoms evincesthe secon- 
dary or curative effects, when we may rest tranquil until the amend- 
ment ceases, and the medicine has expended its curative effect. 
In chronic maladies the remedy may be repeated once in twelve or 
twenty-four until an impression 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 subsided, 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 primary 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 im- 
pression has been produced by a single dose. It is very rare that mo- 
derate drug-symptoms are productive of unpleasant 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 rule, that the sooner we can 
produce a moderate, but decided medicinal action in a structure suffer- 
ing from chronic inflammation, the sooner will a curative reaction fol- 
low, and health result. 
“It would, therefore, appear that experience has confirmed 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 cer- 
tain, though small amount of cases, sufficient to confirm its existence as 
an essential phenomenon. 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 inconvenience.” Hence we may conclude, that a nor- 
mal dose of homoeopathic medicine, 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 importa nce. 
Likewise in the case of collateral symptoms, it is affirmed by Hahne- 
mann. that “ we cannot arrange our doses so as to escape the liability 156 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
to them in a small and practically unimportant degree.”—(Dr. Drys- 
dale: British Jour, of Jlomceop. No. XIII. p. 22.) 
In all cases of urgent acute disease, in which we can find no single 
remedy which corresponds to the symptoms, it is necessary to select 
a second remedy which shall cover the remaining symptoms, and ad- 
minister it in alternation with the first. Pneumonia is often accom- 
panied by cerebral inflammation; typhus fever, with serious disorder 
of the intestinal canal, the lungs, the brain, and nervous system; inter- 
mittent 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 alternation of remedies is both proper and necessary ; at the 
same time it must be remembered, that it is far 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 suc- 
cession. 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 
corresponds to the totality of the symptoms. 
A large proportion of homoeopathic physicians, both of Europe and 
America, now advocate a frequent repetition of doses in acute diseases, 
and in many instances alternations of the remedies. Some of those 
who have expressed themselves decidedly upon this point, are, Drs. 
Gross, Schmid, Rau, Fleischmann, Reiss, Ruckert, Lobethal, Hart- 
mann, Russell, Hull, Neidhard, Gray, Currie, Trinks, Griesselich, 
Madden, Dudgeon, Quin, &c. 
The erroneous ideas which were formerly entertained respecting the 
alternate employment of remedies, are at present nearly abandoned. 
So long as the opinion prevailed that our medicines could only operate 
in a kind of spiritual manner upon certain mysterious appendages 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 medicinal action have 
become better understood, there is no longer hesitation in alternating 
medicines whenever symptoms appear to require it. 
Some remedies continue their action for a very short time, others 
show a duration of action of thirty-five to forty days. Strong doses 
act more energetically* on both the healthy and diseased organism, 
and their action continues longer than that of weaker and smaller doses. 
In acute diseases all remedies act more energetically, but their effect 
is more evanescent. They are therefore treated by doses, if not larger, 
at least given at shorter intervals. In chronic diseases the process of 
disease is less conspicuously visible, making often great remissions and REPETITION OF REMEDIES. 
157 
.ntermissions; remedies act more slowly, with less apparent energy, 
but their effects last much longer. 
In robust irritable persons, rich in vital power, the curative effect 
appears and vanishes quickly, and the time of action is short; in tor- 
pid, phlegmatic constitutions, remedies act more slowly, but with more 
lasting effect. In childhood the primary effect of remedies is evanes- 
cent on account of the rapid process of life, and passes quickly to its 
curative effect. In old age there is a longer primary action, and a 
relatively short secondary action. The following rules are given by 
Koch: 
1. The more perfectly similar the curative potency the less neces- 
sary is a repetition of it; but repetitions in very small doses may be 
safe, and sometimes necessary to complete the cure. 2. The less per- 
fect the similarity of the curative potency, the more necessary is the 
repetition. 8. The more intense the diseased action is, the more fre- 
quently the dose may be repeated. 4. The more acute the disease the 
more frequent the repetition. 5. The more completely similar the 
curative potency to the symptoms of the disease, the more injurious the 
repetition of large doses. 
When a proper remedy has been given and amelioration results, the 
rule is not to repeat so long as'amelioration continues. Repetition is 
proper : 1. When the amendment has ceased. 2. When the receptivity 
to the effect has died out, and larger doses are necessary to have 
effect. 3. When the disease is acute the repetitions may be frequent 
and thus time is saved, the secondary products of acute inflammation 
are prevented. 4. In putrid fevers and other adynamic diseases where 
collapse is threatened. 5. When disease manifests itself in paroxysms, 
exacerbations, or spasms. In diarrhoea, colic or vomiting, repeat as 
often as the attack recurs. 
On the practice of alternating remedies, Jahr says: 
It is very common for physicians to prescribe two medicines in alter- 
nation, and this at longer or shorter intervals, according to the nature 
or intensity of the disease. This, though in some cases proper is, per- 
haps, not generally so. “The custom,” says Jahr, “ has had its origin 
in a one-sided view of the nature of disease. If the symptoms of a 
disease were viewed as they ought to he, as the phenomenal manifesta- 
tion of an internal state, and if their pathological connection and depen- 
dence upon each other were properly known, it would most probably 
never be necessary to prescribe two remedies at the same time. It is 
only wdien symptoms are viewnd superficially, without reference to their 
internal unity, that it seems as though they were disconnected and re- 
quired more than one remedy at a time. 
Though it is proper always to cure the disease by a single remedy, 
it is certain that all prescribes are not capable of always selecting 158 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
the true remedy; such must be permitted to cover the given case by 
alternating the two articles which, in their view, come nearest to it. 
If either happen to be the true specific, it will cure in spite of many 
adverse influences. Another reason for alternating, given by Jahr is 
that different groups of symptoms are often connected through patho- 
logical relations. We take an example from some affection of the 
pneumogastric nerve. 
This is a nerve of sensation and also of motion. “It is a nerve of 
sensation simply because it supplies the lining membrane of the respi- 
ratory and digestive passages, and it becomes a nerve of motion when 
it supplies the muscles and muscular coats of the same canals. The 
pneumogastric nerve supplies branches, on the one hand, to the larynx, 
the lungs, and the heart ; and on the other to the pharynx, the oeso- 
phagus, the stomach, and the solar plexus. These different parts could 
not fulfil their organic functions without the assistance or vitality which 
they derive from that nerve. The branches of the nerve are essen- 
tially the same ; the functional differences reside in the structural 
organization of the parts over which the branches are distributed. 
These anatomical facts lead to important practical results in the 
treatment of disease. Let us suppose for example, a diseased condi- 
tion of the pneumo-gastric nerve, an acute irritation of this nerve, a 
neurosis, in which the various branches of the pneumo-gastric nerve 
are principally involved ; such a pathological state would necessarily 
be characterized by the most diversified symptoms, symptoms which 
would apparently be disconnected, and yet would constitute one iden- 
tical group ; for the irritation would be the same in every branch of the 
nerve, but the symptoms characterizing the irritation would differ ac- 
cording as the structural organization of the part affected would differ 
from that of another part. We might have dryness, soreness, and heat 
in the larynx, with constant tickling, disposition to cough and hawk; 
stricture across the chest; aching pain or weight in the region of the 
heart, or palpitation of the heart; loss of appetite, and coated tongue, 
nausea, oppression of the stomach, sensitiveness and fulness or bloated- 
ness in the region and pit of the stomach, or a hard aching pain in the 
pit of the stomach ; or sensation as of a cold stone in the pit of the 
stomach ; soreness of the bowels, looseness or constipation.” &c. 
In this apparently disconnected group of symptoms we perceive that 
each one constitutes one of a unitary group connected together by the 
various branches of the pneumo-gastric nerve, and if we can find a remedy 
capable of acting on the pneumo-gastric nerve specifically so as to 
produce only a portion of these symptoms, we shall by employing it be 
able to strike at once at the seat of the disease before us. By this 
single remedy we shall more effectually subdue it than we could hope 
to do by searching the Materia Medica for a remedy that shall present OF CHANGING THE REMEDY. 
159 
all the phenomenal symptoms of the case; and, failing to find them under 
a single remedy, employing two or three remedies which may between 
them cover the whole list of symptoms. 
OF CHANGING THE REMEDY. 
It is very common to change the remedies too often. If a medicine 
has produced a decided improvement in the symptoms, that is, if the 
symptoms remain the same, hut are less intense, or if only some of them 
have disappeared and others remain with the same degree of intensity, 
the original medicine which caused this modification of the primitive 
group should be continued by all means, for this reason: that such a 
modification of the original disease is not an evolution of a new group 
of symptoms, but simply a reduction of the former symptoms to a lesser 
degree of intensity. 
Suppose a case of inflammatory rheumatism, with a full and hound- 
ing pulse, high fever, pains in the joints and bones, swelling and inflam- 
mation of certain parts, or any of the other manifold symptoms which 
characterize this disease. We prescribe Aconite. After the first 
three or four doses the fever is abated, perhaps is entirely subdued ; the 
pains in the joints and bones are less, and the inflammation is consider- 
ably reduced. This change of the symptoms does not constitute a new 
group requiring a different remedy; on the'contrary, the same remedy 
is still indicated, and if continued, will speedily remove the existing 
symptoms. 
Sometimes we find that by repeating one remedy often, even in in- 
creasing doses, the organism becomes habituated to it, and ceases 
to be affected by it. If then another remedy be substituted as an in- 
termediate or intercurrent remedy, in small dose, we may return again 
to that originally selected. Griesselich advises: 1. Change when the 
remedy has lost its effect, or has failed to produce that which we had 
expected. 2. Alternation, when two remedies are seen to be appro- 
priate for different portions of the organism; then, one is given at one 
hour and the other at another. 3. Successory remedies'. When one 
remedy is only partially effectual, another may be selected which has 
a close relation to the first; as a case not satisfactory cured by Cal- 
carea may be finished by Sulphur. Belladonna is often necessary 
after Aconite. 
Antidotes.—An antidote in the homoeopathic sense, is not a sub- 
stance which is capable of neutralizing the curative action of a drug, 
or of opposing it, as cerebro-spinal sedatives ; as Coffee antidotes 
Opium, or Camphor, Cocculus-indicus;—but which is suited to the re- 
moval of symptoms arising from medicinal aggravation by the remedy 
previously administered. Thus a well selected-medicine may be con 160 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
tinued too long, and its own symptoms may be added to those of the 
natural disease; or an inappropriate remedy may have been selected, 
producing drug-symptoms, in addition to those previously existing; 
then the homoeopathic antidote is the medicine which best covers the 
totality of the symptoms belonging both to the natural and acquired 
disease. Its administration, therefore, interrupts the action of the firs 
medicipe, because it has, itself, become the most homoeopathic of 
the two. 
In this sense Hahnemann employed homoeopathic antidotes: “ If, 
however, among the symptoms of the remedy selected, there be none 
that accurately resemble the distinctive, (characteristic,) peculiar, un- 
common symptoms of the case of the disease, and if the remedy cor- 
respond to the disease only in general, vaguely described, indefinite 
states, (nausea, debility, headache, &c.,) and if there be among the 
known medicines none more homoeopathically appropriate, in that case, 
the physician cannot promise himself any immediate favorable result 
from the employment of this unhomoeopathic medicine. (§ CLXV.) 
“Such a case however is very rare, owing to the increased number 
of medicines known, now-a-days, with regard to their pure effects, and 
the bad effects resulting from it, when it does occur, are diminished 
whenever a subsequent medicine of more accurate resemblance can be 
selected. (§ CLXYI.) 
“Thus, if there occur, during the use of this imperfectly homoeo 
pathic remedy, first employed, accessory symptoms of some moment 
then, in the case of acute diseases, we do not allow this first dose to 
act completely out, nor leave the patient to the full duration of the 
effects of the remedy, but we investigate afresh the morbid state, in 
its present altered condition, and add the remainder of the original 
symptoms to those newly developed, in tracing a new picture of the 
disease. {Organon of Medicine, § CLXVII.) 
In his elaborate work on Syphilis, published in 1789, Hahnemann 
dwells at length on the necessity of antidoting the effects of Mercury, 
when it has been used in excess for the cure of syphilis, and recom- 
mends for this purpose the administration of Hepar-sulphuris, which he 
believed was the chemical antidote of Mercury, and of many other me- 
tallic poisons. It is curious that in later years he recommends the same 
Ilepar-sulphuris as one of the dynamic antidotes for the inconveniences 
produced by small doses of Mercury unhomoeopathically administered. 
In 1798 he wrote an essay on Antidotes to some powerful vegetable 
substances, in which he attempts a classification of antidotes. He says 
the hurtful substance may be antidoted in one of four different ways: 
A. Removed, 1. By evacuation, as vomiting purging, or by excising 
a poisonous bite; 2. by enveloping, as giving suet where pieces of glass 
have been swallowed. OF CHANGING Till? REMEDY. 
161 
B. It may be altered, 1. chemically, as Hepar-sulphuris for Corrosive 
Sublimate; 2. dynamically (i. e. their potential influence on the living 
fibre removed,) as Coffee for Opium. 
Dr. Dudgeon, in his “Lectures on Homoeopathy,” says, the occasions 
for the, employment of homoeopathic antidotes are very rare. “The 
rationale of the administration of Camphor, Sweet Spirits of Nitre 
Wine, &e. in the case of over-action of a drug seems to be that thereby 
a stronger but transient and different effect is produced upon the 
nerves, whereby the feebler impression of the medicine previously 
given is effaced, and the new action, being evanescent, the nervous 
system is speedily restored to its former equilibrium—or a dynamic 
neutralization is effected.” 
Hahnemann advised the employment of one remedy at a time, not 
from the fear that one will neutrate the other, but because the result 
cannot be predicted with the desirable degree of certainty. Thus, the 
vapor of Kreosotic-oil, in a mineral oil lamp,—or Camphor, floating in 
the atmosphere, or Musk, may have a homoeopathic relation to the dis- 
ease under treatment, and the practitioner may ascribe his results to 
the wrong agent. On this subject Hahnemann says: “In no case is it 
requisite to administer more than one single and simjple medicinal 
substance at one time.” (§ CCLXXII.) “It is not conceivable, how the 
slightest dubiety could exist as to whether it was more consistent with 
nature, and more rational, to prescribe a single, well-known medicine 
at one time, in a disease, or a mixture of several differently-acting 
drugs.” (§ 273.) 
“As the true physician finds in simple medicines administered simply 
and uncombined, all that he can possibly desire (artificial morbific 
agents which are able by homoeopathic power completely to overpower, 
extinguish, and permanently cure natural diseases,) he will, mindful of 
the wise maxim, that it is wrong to attempt to effect anything with 
compound means that may be effected by simple means, never think of 
giving any but a single simple medicinal substance.” (§ 274.) 
We know that the effects of every medicine on the animal organism are 
either partially or totally annulled by another medicine of which the 
positive effects are more or less similar to the first one in its symptoms, 
its local and general tendencies and character. “ The remedies per- 
fectly similar in their positive effects annul one another; whereas, those 
whose positive effects cover only solitary organs or tendencies, annihilate 
only those symptoms in which the correspondence of similarity holds 
out.” It is allowable to use antidotes: 1. When aggravations have 
been caused by over-doses of a proper remedy, as well as by one not 
correctly selected. 2. To relieve symptoms produced on the prover of 
a remedy. 3. For the cure of medicinal dyscrasias. 4. Related or 
successory remedies act as antidotes to each other; and the greater is 
Vol. L—11. 162 
GENEKAL PKINCIPLES OF MEDICAL SCIENCE. 
their similarity in their positive symptoms the more decided are their 
effects in antidoting each other. When a medicine has been abused to 
the extent of developing a drug-disease, it may be, after long enough 
time, removed by a remedy which has some relations of similarity. 
When we are able to detect too few symptoms in a case to cdipe to a 
positive choice of a true remedy, we prescribe that which covers such 
as are visible; and then, when other symptoms appear as called out by 
the remedy tried, make a new selection, endeavoring to find one that is 
the similimum of the whole disease. 
Mode of Administering Remedies.—The practice of Hahnemann 
in later years of his life is given by Dr. Croserio, (N. Archiv.l.2.p.31,) 
who says he often witnessed its success. 
“Hahnemann always made use of the well-knowrn small globules, 
which were generally impregnated with the 30th dilution, both for acute 
and chronic diseases. Of these globules he directed one, or at most 
two, to be dissolved in a caraffe, containing from three to fifteen table- 
spoonfuls of water, and a half or a whole tablespoonful of French 
brandy. One tablespoonful only of this solution was put in a tumbler- 
ful of water, and this last the patient took by teaspoonfuls; on the first 
day one teaspoonful, on the second two, on the third three, and so on, a 
spoonful more daily until he felt some effect. He then diminished the 
dose, or discontinued the medicine entirely. In other cases he caused 
a spoonful of the first tumbler to be poured into a second tumbler of 
water, in others, from this last into a third, and so on to a sixth tumbler, 
and directed a teaspoonful to be taken from the last tumbler only 
wdien he had to do with very irritable subjects. The cases were rare 
in which he allowed a table- or a teaspoonful to be taken daily from the 
first solution made with from eight to fifteen tablespoonfuls of water. 
If he gave a powder, to be taken at once in a spoonful of water, that 
was always only milk-sugar. He never prescribed two different re- 
medies to be taken alternately, or one after the other; he would always 
first learn the effects of one remedy before he gave another, even in 
patients who were treated by him at twro-hundred leagues distance. 
Neither did he change the medicines. Even in acute diseases it was 
rare for him to give more than one spoonful once in the twenty-four 
hours. But on the other hand, in order to quiet the patient or his friends, 
he gave frequent doses of plain milk-sugar. Hahnemann appeared in 
the latter years of his practice to employ his whole dexterity in dimin- 
ishing the dose more and more. Hence he latterly employed olfaction 
very frequently. For this end he put one or two globules in a small 
medicine phial containing two drachms of Alcohol, mixed with an equal 
quantity of water, which he caused to be inhaled once or twice with 
each nostril, never oftener. My own wife was cured by him in this 
manner of a violent pleurisy in the course of five hours. In chronic OF CHANGING THE REMEDY. 
163 
diseases, happen what might, he never allowed this olfaction to be re- 
peated oftener than once a week, and he gave besides for internal use, 
nothing but plain milk-sugar; and in this manner he effected the most 
marvellous cures, even in cases in which the rest of us had been able 
to do nothing.” 
Homoeopathic Notation.—The entire system of potentizing drugs 
was invented by Hahnemann. He “created potencies out of crude 
matter, refining the drug into subtile doses, developed the medicinal 
properties of matter, making them assimilable, and thus specifically 
curative.” He thus taught, practically, how to cure with the least possible 
dose, unconsciously but surely applying the general law of the least 
quantity of action, which was discovered and mathematically established 
by Maupertuis. 
The different degrees of potentization have been designated by men 
each according to his own made of notation,* of which we will only 
notice those most likely to be generally used. 
Our own pharmaceutists have a claim to be understood, and we sup- 
pose their systems of notation are generally known. Of these 
“Smith numbers his preparations centesimally, but prepares them 
according to the decimal scale, i. e., with 10 grains of the crude sub- 
stance he triturates 90 grains of sugar of milk, which he signifies by 
the fraction -do-. Ten grains of this preparation is again incorporated 
with 90 grains of sugar of milk, which is designated I., making the first 
Hahnemannian trituration, centesimal. In this way he makes six tri- 
turations of an hour each, in preparing what is called the third tritu- 
ration, which is as high as he carries his triturations generally. They 
are marked respectively -,-V, 1, 1£, 2, 2£, 3. Expressed in fractions they 
would be do, iroir? ToVo'j iuh"ctj TiroVinnrj l,o<fo?uon* His dilutions are 
all made centesimally from the tinctures, when the medicine is prepared 
in that form, or, as with the minerals, from the third trituration. They 
are all made by hand and receive 400 succussions each. He has also 
prepared the 200th potency with Alcohol, centesimally on the remaining 
drop, and with 400 succussions each, by hand. He uses Arabic cyphers 
for his notation as above stated. For the tinctura fortis, the common 
sign 0 is used. Sometimes however, the strength of the tincture is 
expressed by a fraction, e. g., Aeon. Cham. Nux-Vom. -A-, Thuja 1. 
The fraction £ means that an equal quantity of Alcohol is added to the 
expressed juice of the plant. The fractions 4, rV, -gV, signify that one 
part of the drug has been mixed with 8,16, or 20 parts of Alcohol, (or 
Alcohol and water as the case may be), which quantity is requisite to 
insure solution. The fraction % is used to denote the mother-tincture, 
where the fresh plant is resinous; in which case it is first crushed and 
* Dr. Fincke, Homoeopathic Notation, Amer. Iiomoeop. Rev. Aug. 18G0, p. 451. 164 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
its weight of Alcohol is added and afterwards expressed; this being 
the tincture.” The system followed by Radde, Ilurlbut, and other ho- 
moeopathic pharmaceutists is essentially the same. 
PROVING OF DRUGS.—METHOD OF IMPROVING THE MATERIA 
MEDICA. 
1. In order to obtain an exhaustive proving it seems necessary to 
employ both dilutions and massive doses. 
2. “ The proving should be commenced with dilutions ; and high 
'potencies should be employed until satisfactory evidence is obtained 
that the prover is not susceptible to their action. We thus obtain one 
of the unknown quantities of our problem, viz.,—the measure of the 
susceptibility of the prover. 
3. Where a keen susceptibility is found to exist, the greatest care 
must be exercised to avoid blunting or perverting it. With this view, 
repeated experiments should be made at long intervals, with high po- 
tencies until no new varieties of symptoms are evoked. Then, after a 
long period of non-medication, the prover should take lower potencies 
and then small doses of the crude substance repeated at intervals, and 
finally after another long period of repose, large doses of crude sub- 
stance. A thorough proving, after this fashion, may require years for 
its completion,—but it will have an advantage over most of our recent 
provings, in the fact, that it will be thorough, and that it will be of per- 
manent and certain use to the practitioner. 
4. In proving with dilutions, as well as with massive doses, a long 
period of time should be occupied in testing each preparation, in order 
that the full effect may be seen in the production of the dyscrasias, &c. 
5. The greatest care should be exercised in verifying symptoms by 
repeated experiments, in order that “imaginary” symptoms on the one 
hand and chemical and mechanical symptoms on the other, may be ex- 
cluded. Every sensation felt by the prover during the progress of the 
experiment is not entitled to be included amongst the symptoms pro- 
duced by the drug.” (Dunham. Am. Horn. Dev. 1860.) 
If the symptoms of a case are minutely noted, their entire removal 
under a single remedy tends to verify the pathogenesis, but not in the 
same degree as would the recurrence of an equal number of symptoms 
in re-proving by new provers. “The morbific effects of drugs are often 
observed to be the same on the sick as on the healthy,” and they are 
probably identical even to the minutest particulars. And the principal 
reason for not relying on symptoms observed on the sick is, that we 
might be confused by introducing symptoms proper to the disease in- 
stead of those caused by the remedy.” (Dr. Joslin.) 
“A similar danger attends therapeutic verifications, and it is in one SYMPTOMS OF DISEASE. 
165 
respect greater, viz., in regard to critical days Many accurate ob- 
servers have noticed certain epochs of decline cr termination of dis- 
eases, especially those of a febrile character. The more marked of 
these changes occur on the third, seventh, eleventh, fourteenth, or 
twenty-first days. Several partial crises are observed in the progress 
of the same case, each leaving it changed by the somewhat sudden dis- 
appearance or mitigation of some of the symptoms. Now, if under a 
correct treatment each of these changes is, on the whole, a favorable 
one, and the final result happy, the several improvements and the final 
cure are not attributable merely to nature ; and on the other band, not 
merely to the medicines given immediately before the eoocnc of the 
several changes. If others had been previously administered, they 
may have equal claims as the cause of the improvement cr cure. If the 
physician neglects the observation of critical days, be may draw erro- 
neous conclusions in regard to the curative influence of a drug. The 
quotidian changes are generally appreciated. The before-mentioned 
critical days are also, in regard to some symptoms and in some degree, 
days of exacerbation, and their neglect might -vitiate the pathogenetic 
confirmations, though usually less than the therapeutic.”* To prove me- 
dicines on the healthy is the great work that devolves on our school. 
The mode then of improving our Materia Medica is by the examina- 
tion of morbific properties, and not by the direct observation of curative 
ones, on which other schools rely. The advantage of this mode was 
demonstrated by Hahnemann; but die extent to which it admits of 
being cultivated has not yet been measured. The first principles of 
Homoeopathy are already known to be fixed and eternal; but the extent 
of our resources is only beginning to be estimated; and an immense 
amount of labor is yet needed to develop the treasures that are waiting 
to be called into use m the cure of human diseases. 
SEME.OLOGY.—SYMPTOMS OF DISEASE. 
The word Symptom has been defined to consist of “ every thing or 
circumstance happening in the body of a sick person, and capable of 
being perceived by himself or others, which can be made to assist our 
judgment concerning the seat or nature of his disease, its probable 
course and termination, or its proper treatment.! From this definition 
the purposes for which the symptoms of a case are accurately stu- 
died, are, 
1. To ascertain the nature and seat of the disease; that is to form a 
clear and correct Diagnosis. 
2. To enable us to foretell the probable issue of the disease, or tc 
frame the Prognosis. 
* Joslin, Am. Horn. Rev. 1858.—f Watson’s Lectures.-Theory and Practice n. 99 166 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
3. To direct the Treatment. 
In almost every system of practical medicine the significance and 
importance of individual symptoms, and the best modes of combatting 
and removing them, have been originally derived from the empirical 
effects of remedies, rather than from observations on the nature of 
diseases. Symptoms have been divided into : 
First, Symptoms or combinations of symptoms which distinguish 
the place and nature of a disease, and called signs of the disease. 
Secondly, Those symptoms which point out to us what is to be done 
to ensure a return to health, and are called Indications of Treatment. 
The word Symptoms has been applied to such manifestations of dis- 
eased action as are obvious to all persons alike—to the nurse as well as 
to the physician. Signs are deduced from symptoms by arranging and 
comparing them, and noticing the circumstances under which they 
occur; thus signs are generally intelligible to medical eyes only. Some 
symptoms are called direct, because they point us to the exact seat of 
the diseased action; others are indirect or “declare themselves through 
the medium of the constitution at large.” ( Watson.) These sympathetic 
symptoms are compared by Darwin to the arrows shot from the bow of 
a concealed archer. They prove that there is somewhere an efficient 
cause and source of diseased action; but a careful investigation may 
discover it far away from the point which is the seat of the most con- 
spicious and tangible symptoms. With respect to the symptoms which 
consist of morbid changes, they may all be classed under three heads; 
1. Uneasy, unnatural or impaired sensations;—2. Disordered, or im- 
peded functions;—and 3. Alterations of structure or appearance, chan- 
ges of sensible qualities. When these last come within the direct 
cognizance of our senses, they are called physical signs. 
Of all the uneasy sensations pain is the most important. When pain 
or uneasiness is complained of in any part or organ, our next business 
should be to inquire whether the f unctions of that part or organ are 
disturbed or suspended. The functions of the brain and nerves, of the 
heart and blood-vessels,—of the respiratory apparatus and of the di- 
gestive organs,—are all of the highest importance; and the symptoms 
drawn from the functions belonging to the circulation are of such con- 
sequence that the pulse is to the physician what the polar-star is to the 
mariner. Its highly significant changes in frequency, regularity, full- 
ness and force will be fully explained in the appropriate place. 
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 GENERAL DIAGNOSIS. 
167 
may facilitate for his investigations of disease. Although 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 unattended 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 in- 
dicate 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 innermost recesses of the organism, and to understand its 
most profound secrets. 
It is a singular and highly interesting fact, that therms of the different 
parts of the body impart to the countenance certain characteristic and 
easily understood expressions. As these signs are involuntary and 
almost uniformly present, all will recognize their importance as diag- 
nostic phenomena. 
In forming our diagnosis, it is essential in the first instance to notice 
accurately every circumstance connected 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,&c., 
should be attentively marked. At the same time, age, sex, temperament, 
hereditary predisposition, occupation, habits of life, whether laboring 
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 (§ 206,207,209.) 
In cases of inability on the part of the patient to enter into a descrip- 
tion of the case, the friends should be called upon to give all the in- 
formation in their power in regard to the rise and progress of the dis- 
order. An attentive perusal of Hahnemann’s advice upon this subject, 
is of the utmost importance to the acquisition of a perfect portraiture 
of every complaint 
Since, however, there are some instances in which neither the patient 
nor friends are able to afford any information respecting the nature or 
seat of the affection, 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 circulatory 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 168 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
of the eyes, nose, mouth and forehead, and also whether sadness, 
moroseness, peevishness, despair, fear, grief, or joy is evinced. By 
heeding carefully these indications, we shall be greatly assisted towards 
accurate opinions in obscure and complicated cases. 
The contraction of the features, rapid dilatation and contraction of 
the nostrils, dyspnoea, with expression of anxiety, indicate acute in- 
flammation of the respiratory organs. 
Sharp features and expression of anguish, “ forehead wrinkled, brows 
knit,” eyes sunken, countenance pale, hollow cheeks, lips dry and bluish, 
indicate pain and severe inflammation of the abdominal viscera. 
General expression of countenance flushed and excited, or dull and 
stupid; eyes red and brilliant, or dull and heavy; pupils contracted or 
dilated; protrusion 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 cerebral 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 prominent and unnatural; 
face cold; sudden startings in sleep ; anxious expression; indicate or- 
ganic disease of the heart. 
Cheeks pale and blanched; lips white and puffy; a dark circle 
around the eyelids; expression of languor and debility, indicate 
chlorosis. 
Paleness and puffiness of the upper lip indicate scrofula and ver- 
minous affections. 
Eyes and face red ; rapid respiration; motions of the nostrils rapid, 
indicate simple acute fevers. 
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 mankind, it has been custom- 
ary both in barbarous and civilized countries, to distort artificially 
certain parts of the body, under the absurd notion that they were im- 
proving upon nature, and enhancing the beauty of the figure which the 
Supreme Architect had formed after his own image. 
Among some savage tribes of the Rocky Mountains it has been custom- 
ary and fashionable for the natives to flatten the forehead by long-con- 
tinued artificial pressure. This constitutes the ideal of savage beauty, 
and is their common method of improving upon the works of the Creator. 
In other barbarous countries it is customary to slit the ears and nose, 
FIGURE AND ATTITUDE. GENERAL DIAGNOSIS. 
169 
and hang from them large quantities 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 this abominable distortion consists their idea of 
female beauty. This is the Chinese improvement upon nature. 
The Turks cram their women writh “jpiilan,” after the manner of 
stuffing geese, to cause enlargement of the liver, for “jpate defoi gras? 
—that they may become enormously fleshy, and thus present to the 
admiring eyes of their lords, figures of uniform dimensions in all direc- 
tions. 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, pre- 
vent the growth and development of the feet, to slit the ears and nose, 
or cram their women; but, through the instrumentality of those “ infer- 
nal machines,” corsets and stays, the sex deem it indispensable, in 
order to be genteel, to compress entirely from its natural shape the 
most important and vital part of the organism. These unnatural 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. 
Many females of the present day, affect to contemn the symmetrical 
figures which the Creator originally formed, and which the ancient 
sculptors delighted to represent in marble, and have chosen to “ im- 
prove” on these old-fashioned notions, by partially cutting off the con- 
nection between the upper and lower parts of the body; thus reducing 
it from the shape of those models of perfection, the Yenus di Medici, 
and the Yenus 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 illustrated their ideas of beauty, but the greatest 
of modern sculptors, our illustrious countryman Powers in a MS.-letter 
before us, declines the public exhibition of his exquisite statue of Eve, 
because he had been compelled by his own sense of harmonious pro- 
portion, to present the mother of mankind in the shape which the Creator 
approved as the ultimate product and most perfect fruit of Divine in- 
telligence and energy. “Eve,” says the sculptor, “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. Iler waist if 170 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
quite too large for our modern notions of beauty, and her feet they 
are so broad and large! And did ever one see such long toes! They 
have never been wedged into form by the nice and very pretty little 
shoes worn by her lovely descendants. But Eve is very stiff and un- 
yielding in her disposition; she will not allow her waist to be reduced 
by bandaging, because she is far more comfortable as she is, and be- 
sides, she has some regard for her health, which might from such 
restraints upon her lungs, heart, liver, dec., dec., dec. I could never 
prevail upon her to wear modern shoes, for she dreads corns, which she 
says are neither convenient 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 primitive days. Taking all these 
things into consideration I think it best she should not be exhibited, as 
it might subject one 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 tor- 
ture like savages, for the purpose of distorting their bodies, and bring- 
ing them into those artificial shapes which civilized nations denominate 
genteel and graceful! 
Suppose a fashionable woman should apply corsets and stays to a 
favorite monkey, or a pet lap-dog, and so compress its body out of shape, 
wrould not the attempt be pronounced heartless, and its author, perhaps 
be indicted for cruelty to animals ? but when the same barbarity is per- 
petrated 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 great; but their posterity participate deeply in the 
consequences which result from their criminal perversity. The flat 
and narrow chests, the stooping gaits, and the pale or sallow faces 
which greet us at every step, demonstrate the extent of our physical 
degeneration. Some reform is now visible, but it moves slowly. 
But the female sex are not alone censurable. Too great a propor- 
tion of the men,—of this country especially,—become round shouldered, 
crooked and deformed from a want of free muscular exercise, and too 
close an application to business, in constrained, bent, unnatural positions. 
Physical education in latter times has been quite overlooked. Parents 
have commenced sending to school in infancy, and their embryo minds 
have been tasked with all kinds of mental exercise, while their phy- 
sical powers have been suffered to languish in heated and ill-ventilated 
rooms. Thus they have grown up with improved minds, but feeble, 
undeveloped, and perhaps crooked, or mis-shaped bodies. 
Let it ever be remembered that the mind and body exercise an in- 
fluence upon each other, and, if we would secure to the former its high- GENERAL DIAGNOSIS. 
171 
est 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 attitude is erect, an 
those positions are assumed by the body and limbs which indicate mus 
cular strength, so departures from the normal standard induce cor 
responding alterations in the position and appearance of the body. 
Thus, tremors ; position upon the back, with a constant 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 posture ; general agitation, cough; 
and appearance of anxiety indicate hydrothorax. 
Common position upon the back; rigidity and morbid involuntary 
contractions of the flexor muscles, usually of the upper extremities, in- 
dicate softening of the brain. 
Position upon the back, with the knees drawn up; head and shoul- 
ders a little elevated; dread of motion, indicate abdominal inflam- 
mation with acute pain. 
Position upon the belly; pressure of the abdomen affording relief, 
and great restlessness, 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 retention of urine. 
THE TONGUE. 
The following are a few of the diagnostic signs presented by this 
organ: 
A clean, smooth and bright red tongue, indicates inflammation of 
the gastric or intestinal mucous membrane. 
A clean and red tongue, with papillae prominent; or a furred tongue, 
with red papillae appearing through the fur, indicates scarlatina. 
A reddish and tremulous tongue indicates mania dpotu. 
A thick and yellow fur covering the tongue, with bitter taste, indicates 
biliary derangement. 
A white fur upon the tongue indicates slight fever. 
Acute symptomatic fevers effect but little change in the appearance 
of the tongue. 
A relaxed, dilated, and tremulous tongue, indicates congesti/ve or 
nervous fevers. 
A pale and flabby tongue, “ with large papilla,” indicates gastric de~ 
bility,—met with in chlorosis. 172 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
A sharp and pointed tongue is often observed in irritation and in- 
flammation of the brain. 
THE NERVOUS SYSTEM. 
Tearing, throbbing and aching pains, aggravated by contact, pressure 
or movement, indicate inflammatory action. 
Twitchings of the limbs, jerkings and shocks of the 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 swelling, heat, or red- 
ness, indicate neuralgic pains. 
Vague and wandering pains about the ankle often indicate inflam- 
mation of the, knee. 
Pains also in other healthy parts sometimes indicate inflammations 
in remote structures. 
Wakefulness indicates irritation of the nervous system. 
Irresistible inclination to sleep, with stertorous breathing, indicates 
compression, or serious disturbance of the brain. 
Twitching of the muscles during sleep, and frequent waking from 
frightful dreams, indicate organic disease of the heart; also charac- 
teristic of verminous irritation. 
Sudden, rapid and jerking movements of the head and limbs indicate 
cerebral irritation, mania a, potu, and some forms of insanity. 
If there be pain with its hidden cause in any one particular spot, it 
can only he by tracing the nerves of and from that spot, that we can 
hope to arrive at the real cause of the symptoms. u It is through the 
medium of the distribution of the cerebro-spinal nerves of sensation (the 
fifth being the true cranial sensitive nerve), that Ave are enabled to ex- 
plain those pains which are called sympathetic, but which result from 
the continuity of nerves between the cause and effect, the disease and 
the symptom. It is impossible to affix too much practical significance 
to this simple statement. External pain may be considered as an ex- 
ternal sign or demonstration of some distinct derangement. Seek its 
precise position, and see what nerve is the medium of transmitting this 
perverted sensation, and we probably reach the original or producing 
cause of the pain ; the patient may not judge correctly of the real seat 
of his disease.” (Hilton,—Lecture on Pain.) 
THE ALIMENTARY CANAL. 
The alvine discharges will afford many useful hints to the observing 
physician. 
Thus, light or clay-colored evacuations denote a lack of bile. 
Mucous and bloody stools indicate intestinal inflammation; if ac- GENERAL DIAGNOSIS. 
173 
companied 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 irritation of the bowels. 
11 Glairy, dark-green evacuations, like chopped spinage, are charac- 
teristic of hydrocephalus.” 
Very dry and hard faeces indicate a relaxed and torpid state of the 
mucous membrane of the bowels. 
Using the abdominal muscles principally in respiration, indicates in- 
flammation of the lungs. 
Using the intercostal muscles alone, indicates abdominal in- 
flammation. 
Irregular respiration, with stertorous breathing, indicates compression 
of the brain. 
Inspiration difficult, anxious and rapid, while expiration is com- 
paratively easy, is peculiar to hydrothorax. 
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 sink in water, are indi 
cative of disorganization of the lungs. 
THE RESPIRATORY ORGANS. 
THE SKIN. 
A yellow skin indicates a disordered liver. 
A sallow skin occurs in chlorosis and a few other chronic ailments. 
A pale and waxen skin denotes a deficiency of red globules in the blood. 
A blue or livid skin, in infants, indicates a pervious foramen ovale. 
A hot and dry skin denotes fever, and generally inflammation. 
A cold skin, with internal heat, indicates internal congestion. 
THE URINE. 
Urine red and scanty denotes inflammation. 
Urine, clear, limpid and abundant in nervous ajfections. 
Urine depositing a sediment indicates biliary derangement. 
The above are only a few of the more common and well-known diag- 
nostic signs. Our only object is to direct the attention of the physician 
to this subject, for there are often many things about, the general ap- 
pearance of a patient which are slight and indescribable 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 patient. 174 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
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 possible 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, auscultation, &c., as may be neces- 
sary to perfect the diagnosis. 
All true diagnosis is based upon inductions gradually drawn from 
the facts furnished by observation, pathological investigations and ex- 
periments. By careful and repeated observations we have learned to 
associate certain phenomena observed during life, with particular lesions 
found after death; and sound principles have advanced in the same 
proportion as the number of accurate observations have been collected. 
“In so far as we are able correctly to interpret symptoms, and to trace 
out in connection with them a real change of structure or function 
which affords an adequate explanation of their presence, in so far 
we are prepared to form a correct diagnosis.” * In pursuit of this object 
our especial work is to learn to group symptoms together, and to ana- 
lyze them separately in such a manner that we may be able to apply 
to them a scheme already supplied to our hand, which shall in some 
way account for their existence. A comparison is instituted between 
the probable results of the supposed malady and those presented by the 
particular case under investigation, and their correspondence is ac- 
cepted as a verification of the hypothesis. We gather together the 
fragmentary evidence furnished by the symptoms, and we apply to the 
case the known laws of cause and effect as taught by the generally ac- 
cepted theory of disease. 
The correctness of the conclusion must greatly depend on our as- 
signing the time relative value to each portion of the evidence. Though 
one symptom may be more important than another, many errors are com- 
mitted by permitting a single symptom to assume undue importance as 
a “ pathognomonic” sign. It is only correct general knowledge of dis- 
ease that can give precision to our judgment; and the result of the 
case will generally verify or disprove its accuracy. In general, the 
more numerous the symptoms which are noted in the case the better is 
the opportunity for correct diagnosis ; a second examination of a 
case brings to light new symptoms, hitherto overlooked, and compels the 
physician to throw aside a hypothesis based on insufficient premises; 
thus, when the conclusion has been reached that inflammation is 
established in a certain organ, further investigation reveals the cha- 
racter of that inflammation. 
* Barclay. Manual of Diagnosis. 1862. GENERAL DIAGNOSIS. 
175 
Temperature of the Body.—The normal temperature in the arm- 
pit of all healthy persons is 981 degrees Fall. In some diseases the 
temperature is not at first varied ; but a higher or lower temperature is 
always a sign of disease. 
The temperature is uninfluenced by hunger, eating, drinking, stimu- 
lants, rest, or exercise so long as health is undisturbed; hut when 
any of the above influences increase the temperature, this is evidence 
that disease is impending. If the temperature rises to 102 from any 
of the above influences, there must be active disease beginning, or re- 
lapse of a disease supposed to be cured. 
Depressing influences, as loss of blood, sound sleep, evacuations, &c., 
may induce a brief sinking of the temperature, such sinking lasts only 
a few hours in a healthy state ; if it continue long it shows disease, though 
the pulse, which is commonly trusted, should not indicate it. 
If in the progress of supposed typhus fever the temperature becomes 
normal, or becomes even transiently normal during the second week, 
the disease is not typhus. When either pneumonia or hsemoptoic in- 
farctus is suspected, the normal temperature decides that the latter is 
the disease. When haemorrhage occurs in a tubercular patient, if the 
temperature be normal it shows that there is no active pneumonia, and 
that tubercular action is not progressing. In a convalescent patient the 
normal temperature proves no relapse or new disease progressing. In 
intermittent fever, if the temperature does not rise at, or even before the 
time for the paroxysm to begin, it w ill not come. This occurring a second 
time shows the return of the paroxysms suspended. 
The temperature rises some hours before the feelings of the patient 
reveal it; also in cases where the paroxysms have left, the exacerba- 
tions of temperature continue to recur on successive days, as high as 
104°. Typhus may be detected by the thermometer several days be- 
fore it is seen or felt by any other symptoms. Tuberculosis, if progress- 
ing, is knowm by the' thermometer; also new complications are thus de- 
tected before they can be in any other manner. 
In general, for one degree of the thermometer the pulse rises 10 
beats per minute, but the rise of the temperature 99£ degrees, gives 
more evidence of disease than the rising of the pulse from 70 to 80 per 
minute. In a slight fever the thermometer stands at 101i°; in a 
severe one 104; in violent or dangerous fever at 106i; death is almost 
certain at 108i.# 
The importance of a correct diagnosis can scarcely be over-estimated 
by the physician, inasmuch as his treatment will always to a great ex- 
tent be determined by the opinion he may form of the nature, of the dis- 
ease. We have seen remarkable cases of failure as well as of success 
* Dr. Oehme, New-Ilamp. Horn. Med. Soc. 1863. 176 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
which turned upon correctness or error in judging of the patient’s real 
condition. The following instances of mistakes in diagnosis are given 
by Dr. 0. W. Holmes : 
“I saw Velpeau tie one of the carotid arteries for a supposed aneu- 
rism, which was only a little harmless tumor, and kill his patient. Mr. 
Dease, of Dublin, was more fortunate in a case he boldly declared an 
abscess, while others thought it an aneurism. He thrust a lancet into 
it, and proved himself in the right. Soon after, he made a similar 
diagnosis. He thrust in his lancet as before, and out gushed the patient’s 
blood and his life with it. The next morning, Mr. Dease’s patient was 
found dead and floating in his blood. He had divided the femora) 
artery. 
“ I have doomed people, and seen others doom them, over and over 
again, on the strength of physical signs, and they have lived in the 
most contumacious and scientifically unjustifiable manner as long as 
they lived, and some are living still. I see two women in the streets 
very often who were both as good as dead in the opinion of all who saw 
them in their extremity. People will insist on living sometimes, though 
manifestly moribund. In Dr. Elder’s life of Kane you will find a story 
of this sort, told by Kane himself. The captain of a ship was dying 
with scurvy, but the crew mutinied, and he gave up dying for the pre- 
sent to take care of them. 
An old lady in this city, near her end, got a little vexed about a pro 
posed change in her will; made up her mind not to die just then ; or 
dered a coach; was driven twenty miles to the house of a relative, and 
lived four years longer. Cotton Mather tells some good stories which 
he picked up in his experience, or out of his books, showing the un- 
stable equilibrium of prognosis. Simon Stone was shot in nine places, 
and as he lay for dead the Indians made two hacks with a hatchet to 
cut his head off. He got well, however, and was a lusty fellow in Cotton 
Mather’s time. Jacob Musgrave was shot with a bullet that went into 
his ear and came out of his eye on the other side. A couple of bullets 
went through his body also. Jacob got well, however, and lived many 
years. Per contra, Col. Rossitor, cracking a plum-stone with his 
teeth, broke a tooth, and lost his life. We have seen physicians dying, 
like Spigelius, from a scratch; and a man who had a crowbar shot 
through his head is alive and well. These extreme cases are warnings. 
But you can never be too cautious in your prognosis, in view of the 
2;reat uncertainty of the course of any disease not long watched, and 
the many unexpected turns it may take.” PATHOLOGY. 
177 
PATHOLOGY. 
A knowledge of general Pathology comprehends, according to Dr. 
Watson:—“1. A knowledge of the material changes to which the 
o o 
several parts of the living body are subject. 
2. A knowledge of the processes or actions by which these changes 
are wrought. 
3. A knowledge of the causes in which these processes originated. 
4. A knowledge of the consequences of the same changes, or of the 
symptoms they occasion. 
The solid parts of the animal frame may be altered in bulk, form, 
consistence, in their intimate texture, and in situation. The fluid parts 
may be changed in quantity, in quality, and in place.” lectures, p. 41. 
I. Alterations of the solid parts in Bulk: 
1. They may become larger than natural,—Hypertrophy. This is 
best illustrated in the muscular system. By constant exercise the 
muscles‘acquire preternatural volume, weight and power, according 
to a law of the animal economy that increase of function leads to in- 
crease of bulk; as when one kidney wastes, the other becomes more 
active and increases in size. The supply of blood to an organ is regu- 
lated by the demand for it. 
When hypertrophy is unattended by change of texture it is only the 
result of a more active nutrition, and is not considered as a state of dis- 
ease. We have it in the hollow contractible organs, as the heart, 
bladder, and intestines. Increased bulk in the muscular tissue of these 
organs is not always even a source of disease; Watson regards it as, 
in most cases, a compensatory change, and one conservative of life. In 
the voluntary muscles it is generally harmless; but in the involuntary 
it is often a cause or a consequence of disease. Hypertrophy is gene- 
rally connected,—1. with certain localities, as in the case of bronchocele ; 
—2. with certain congenital or acquired conditions of the body,—as the 
hypertrophy of the upper-lip in scrofulous persons, and also the 
swelling of the long bones ;—3. with certain habits of life, as full diet 
with inactivity of the body ; and—4. with the removal of certain parts 
of the body, as of the testicles in man and the ovaries in the female. 
2. Atrophy. This is a condition in which parts become smaller 
than natural without any other alteration of tissue. This depends on 
a diminished nutrition. The alterations effected by atrophy are not 
always connected with disease. Some organs of the body are destined 
only for a temporary purpose; and they disappear or diminish in size 
when their function is ended: we see this in the thymus gland, the 
supra-renal capsules, and some parts connected with the foetal cir- 
culati m. The deficiencies of hare-lip, fissures of the palate and some 
malformations of the heart, are rather instances of arrest of development 
You L—12. 178 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
than of genuine atrophy. But in the muscular system we see atrophy 
in its truest form. When a limb remains long in a state of inaction, 
whether from palsy or from pain caused by disease of a joint, there is 
a deficient supply of arterial blood, and perhaps a change in the in- 
nervation of the nerves of the part, which lessens without suspending 
the circulation. Atrophy is also directly caused by pressure on the 
large arterial trunks, or on the capillaries, thus lessening without en- 
tirely checking the flow of blood to the part. Chronic inflammation 
sometimes produces wasting of the parts occupied by it. Various 
other diseases, by interfering with the digestive functions, diminishing 
the quantity of blood, or impairing its quality, produce atrophy in a 
greater or less degree. 
II. Alterations in Form. 
III. Alterations in Consistence.—1. Induration, or hardening. 
This may arise, without any other alteration of tissue, from over-fulness 
of the vessels, as in the case of the lungs or liver. Induration of the 
hollow organs, or of the cellular parts may arise (without change of 
texture) from undue accumulation of fluids within them, as of th(© bile 
in the gall-bladder, urine in its receptacle, of gases in the stomach and 
intestines, and, lastly, of serosity in the cellular tissue, constituting 
oedema. Induration in an organ may also be caused by hypertrophy, 
from the pressing out of its fluid contents, or the pressing together of 
its soft parts: thus we see the lung rendered more solid by the com- 
pression of its solid parts against the spine in cases of effusion into the 
pleura. We also see the lung solidified and hardened in hepatization’ 
in which case the blood, or fluids separated from it, flow into, fill up, 
and obliterate the interstices of the part, making it solid, or resembling 
liver in consistence. Other instances of induration may be observed 
in cases in which irregular masses of matter are deposited within the 
body; of these, tubercle, cancer, and various malignant growths, are en- 
tirely different from any of the solids or fluids which enter into the 
healthy composition of the body. 
2. Softening. This is a change of consistence to which almost 
every tissue of the body is liable. It may effect the brain and spinal 
cord, the cellular tissue, the muscles, the mucous membranes, and 
even the bones. (See Mollities Ossium, Rachitis, dec. Index) 
The usual causes of softening of the tissues are: Inflammation, dis- 
eases of the arteries of the part, causing insufficient substance ; altered 
qualities of the blood; every cause which leads to suspended or defec- 
tive nutrition. (See Brain, Ramollissement of.) 
IV. Transformation of Tissues. In the place which should be 
occupied by one natural tissue, we sometimes find another, which last 
is thus unnatural in regard to its situation, but natural in all other 
respects. PATHOLOGY. 
179 
1. The changed or displaced tissue in some cases has had its natural 
function for a long time suspended ; and it then gradually approximates 
towards cellular tissue, which at length is all that remains of it. 
2. In other cases the transformed tissue has been accidentally called 
on to fulfil a purpose for which it was not originally destined; and it 
gradually assumes the characters of that other tissue, Avhose office it 
has taken up. 
In all these cases we see a compliance with all that is known of the 
laws that govern the progressive development of the human body. In 
the embryo all the tissues commence by being cellular, and they only 
assume other forms and characters, each on the condition of its fulfilling 
some special purpose. This explains, why there should be a tendency 
in each tissue to revert towards its primitive state, that of cellular 
tissue. This same law, or one nearly the same, regulates the hyper- 
trophy and atrophy of parts. As the nature of the original function 
determines in the first instance the nature of the tissue, we can con- 
ceive how the nature of a new accidental function imposed upon a tissue 
may determine the kind of transformation it shall suffer:—thus if a 
muscle comes to lie around and invest an unreduced joint after a dis- 
location, assuming the uses of those tissues which naturally inclose the 
joint, it becomes converted into fibrous or ligamentous tissue. But there 
is a limit to this transformation: for though nerve, muscle and gland 
are convertible into other tissues,—other tissues are not convertible 
into them. Cartilage may be transformed into bone, but never becomes 
mucous membrane. Mucous membrane may be converted into skin, 
and skin into mucous membrane ; but neither can ever be changed into 
serotts membrane. Besides these transformations of the soft tissues 
we have ossifications of the arteries, of the cartilages of the ribs, and of 
the larynx. Such changes are said to be the effects of irritation,— 
age also has some connexion with them. 
V. Changes of Situation. These changes chiefly regard the vis- 
cera. Thus in the chest a whole lung may be displaced, and compressed 
against the vertebral column by serous or gaseous effusion into the 
cavity of the plura. The same causes may dislocate the heart, when 
they operate on the left side of the thorax. In the abdomen and pelvis 
the various forms of hernia may be adduced as instances of dislocation. 
Intussusception is also a displacement of a part of the intestine. 
Morbid Changes in the Fluids of the Body.—The day is past 
when discussions need to be carried on between the advocates of ex- 
clusive Ilumoralism and those of exclusive Solidism • as it is now 
well settled that no important alteration can occur in the solids of the 
body which will not soon affect its fluids in some way; and it is also 
known that every important change in its fluids must lead to or proceed 
from a corresponding and proportionate modification of its solids. 180 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
1. The Blood. 2. The Fluids that enter the Blood. 3. The Fluids 
that proceed from the Blood. 
1. The Blood. The blood is subject to variations in quantity.— 
It may be too abundant throughout the body, constituting general 
plethora, or hypercemia. When the growth of the body has been com- 
pleted, the blood may continue to be formed in greater abundance than 
the wants of the body require. Full living and sedentary life produce 
plethora and preternatural distension of the entire vascular system. 
The blood is not only greater in quantity, but richer in fibrine and in 
red particles than perfect health requires. 
Local plethora properly exists only when a single part or organ con- 
tains more than its share of red blood; but it may exist when there is 
no general plethora; and, indeed, local terminations of blood are ex- 
tremely common in persons in whom the mass of the blood and its 
nutritive particles have been much diminished by disease. This ten- 
dency to unequal distribution of blood in the capillaries under such cir- 
cumstances is thus explained by Dr. Watson : A due supply of healthy 
blood is requisite for the performance of the functions of the brain and 
nerves: and when this supply is defective those functions become de- 
ranged, and in their turn disturb the functions of the solids and derange 
the balance of the circulation. Persons endowed with great sensibility 
are known to be very liable to partial and irregular congestions of 
blood. This local congestion may be produced by frictions on the 
surface of the body, and by various chemical or mechanical means. 
The congestion thus occasioned is not inflammation, but it is the first 
step towards it, and is of the sthenic or active character. The arteries 
have more to do with it than the veins. It is in the capillaries, which 
are distinct from and interposed between the minute arteries and the 
veins, that further changes are wrought, when the process advances a 
stage beyond mere local plethora. (Lectures, 1858, p. 62.) 
As active congestion is the parent of inflammation, so it also often 
causes haemorrhage and is relieved by it. The general or local ab- 
straction of blood is a common remedy, but not always a safe one: Ir- 
ritability of the nervous system may be aggravated by bleeding; and, 
in proportion as the nervous functions are irregularly performed, the 
tendency to unequal distribution of blood in the capillary vessels in- 
creases. 
Mechanical Congestion. In this form the veins alone are con- 
cerned ; and it is generally purely local, as when the principal vein of 
a single limb is compressed. If there be disease of the liver to the ex 
tent of preventing a free passage of the blood through that organ, con- 
gestion takes place in all those parts of the capillary system from which 
ANIMAL FLUIDS. PATHOLOGY 
181 
the blood is conveyed by the veins which ultimately unite to form the 
vena portae. 
Passive Congestion. This is the asthenic hypercemia of Andral. 
The capillaries become loaded, and the course of the blood in them is 
sluggish without any increased velocity of the blood in the arteries, 
and independently of any mechanical obstacle in the veins. We see 
instances of this in persons enfeebled by age, or disease, in whom the 
lower part of the legs, the insteps and ankles, and the skin, which forms 
the surface of old scars, are often habitually purplish, or violet-colored. 
In these cases the capillaries appear to have lost their natural elasticity; 
they readily dilate under the pressure of the blood, which being thus 
retarded accumulates in the part. This state may occur without any 
previous irritation acting on the part, or any previous active congestion. 
There is, however, frequent connexion between these contrasted con- 
ditions. Passive often succeeds active congestion: the vessels become 
dilated under the force of the active hyperaemia, and the irritation 
ceasing, they do not at once recover their tone, but remain passively 
distended. In the production of active congestion the arteries are prin- 
cipally concerned; in mechanical congestion the veins, and in passive 
congestion the capillaries. Internal as well as external parts are sub- 
ject to passive congestion; thus the lungs are very subject to engorge- 
ment of their capillaries. Striking instances of this will be given under 
the head of Congestive Fever. It has been observed that both active 
and passive congestion are liable to recur in persons and organs once 
attacked. 
Passive aud mechanical congestion often exists together. If the ca- 
pillaries of a part are much enfeebled, the mechanical effect of the 
gravity of the blood may suffice to bring them into a state of congestion. 
This explains the occurrence of a gorged condition of the posterior 
portion of the lungs (evinced by symptoms during life) in persons who 
have had no previous pulmonary disease, but have been confined for a 
long time to the supine position. Mechanical congestion, when it 
reaches a certain point, is the source of haemorrhage, and the almost 
constant precursor and immediate cause of several dropsical accumu- 
lations. Blood, poor in its materials, though not deficient in quantity, 
may also occasion dropsies. (Watson’s lectures, p. 67.) 
2. The blood may be deficient in quantity, or in its essential elements. 
This state is called anaemia, under which title it will be treated of at 
large. It constitutes the condition opposite to plethora, and is char- 
acterized by poverty of blood. It may be produced by repeated ab- 
stractions of blood, by impoverished food, by various forms of haemor- 
rhage. In such cases when blood is drawn from a vein, we observe a 
small clot floating in an abundance of serum. It is remarked that the 182 
general principles of medical science. 
red particles require more time for their restoration than the other con- 
stituents of the blood. 
GENERAL OBSERVATIONS ON THE CAUSES OF DISEASE AND 
THEIR MODES OF OPERATION. 
We hold that it is the province of the physician not only to cure dis- 
eases, but to point out the surest methods of preventing them. In order 
to do this successfully, it is necessary that he appreciate those con- 
ditions which constitute health, so as to guard against the numerous 
causes of its disturbance. In all living bodies, certain states are es- 
sential to this condition. The most important of these states are:— 
1. a soundness of the organs and tissues; 2. an adequate supply of 
nutritious food; 3. pure air, that the blood in the lungs may be oxyge- 
nated ; 4. a calm activity of mind, so that the requisite stimulus of the 
intelligence shall produce its peculiar effects upon all parts of the body; 
5. an avoidance of the various causes which debilitate, overtask, or in 
any way impair the integrity of the nervous or muscular systems ; 6. the 
practice of those means which are calculated to ensure the due per- 
formance of all the functions, as exercise, amusements, the cultivation 
of a cheerful temper, bathing, and moderation and regularity in all the 
habits of life. Thus will the functions be performed in a certain de 
finite and uniform manner, the requisite equilibrium between the supply 
and waste of the body be retained, and that state secured by whicl 
health is constituted. 
The Causes of Disease are generally divided into: Determining,; 
predisposing, exciting and proximate. It is important that these 
terms should not be confounded with each other; and also that certain 
conditions of the body, called predisposition, be carefully distinguished 
from the predisposing cause, which has produced that state. 
1. Determining Causes.—These are such as give rise constantly to 
the same affection; as poisons, asphyxiating gases, and wounding 
instruments. 
Specific Causes produce individually each a particular, peculiar dis- 
ease ; as syphilis, hydrophobia, variola. 
2. Predisposing Causes.—General predisposing causes are usually 
diffused in the atmosphere, or arise from local conditions. 
Individual local causes embrace the various conditions peculiar to 
each person, and those external circumstances, such as change of 
climate, food of bad quality or insufficient quantity, compression by 
various articles of dress, &c. The Avord “predispositionsays M. 
Chomel, “includes all that is usually implied in the so-called “dia- 
theses,” as the Amricose, melanotic, ulcerative, haemorrhagic, gangrenous, 
aneurismal or more properly atheromatous, purulent. {Gen.Pathology.) 
3. Exciting Causes.—These include the common causes of disease OBSERVATIONS ON THE CAUSES OF DISEASE. 
183 
which excite it in persons already predisposed. They consist of atmos- 
pherical changes of temperature, epidemic or other deleterious influences; 
errors of diet, regimen, &c. 
Heat and Cold.—The same overruling Power “that tempers the 
wind to the shorn lamb,” has within certain limits, and those not very 
narrow, endued man with a power of resisting the extremes of temper- 
ature and of becoming “the child of every climate and the tenant of 
every soil,” from the burning sunshine of the tropics to the profound 
frosts of the polar regions. Persons of feeble constitutions have ail- 
ments frequently recurring from the effects of agencies which they have 
not strength to resist, others pass through life meeting continually 
these same morbific causes, and successfully resisting them. In some 
parts of India the temperature ranges for a long time together from 
30° to 100° and even 110° of Fahrenheit; sometimes it has been said 
to reach 120'°, and yet these tropical climates are thickly peopled. On 
the other hand, in arctic countries where the sun appears above the 
horizon for only a short portion of the year, and the thermometer sinks 
to 40° or even 50° below Zero, we find inhabitants still, though they 
are few in number. But for a short time—and under certain cir- 
cumstances—man is capable of enduring a very much higher degree 
of heat than the general atmosphere ever attains in the hottest portions 
of the earth. It has been ascertained by repeated experiments, that 
the human body is capable of sustaining a temperature of 240° or 260 
degrees without detriment or much inconvenience. The vital resistant 
power varies in degree at different periods of life : it is feeble in infancy, 
becomes stronger as years and physical health increase; and then de- 
clines as old age advances, till it becomes so wreak that slight disturbing 
causes may stop the current of life. 
Effects of high lout not excessive degrees of Heat.—It stimulates the 
organic functions of the body; and the action of the heart is much ac- 
celerated. As in the vegetable kingdom we see the influence of in- 
creasing warmth in returning summer, in renewing the leaves and 
flowers, and their decay and fall as cold weather approaches, the same 
observation applies to man and animals in the expansion or repression 
of all those functions which they possess in common with plants. To- 
wards the Poles both man and animals are smaller than at the Equator, 
or in temperate climates. On the other hand, considerable heat, when 
applied for some time together, has a sedative influence on the animal 
functions; that is, upon the nervous system, causing languor and lassi- 
tude, a disinclination to exertion, both mental and bodily. There are 
many forms of disease distinctly traceable to heat as their cause. The 
effect of hot weather in promoting the cutaneous perspiration is 
known. Dr. James Johnson first distinctly explained the effects of high 
temperature on the skin, and indirectly on the liver, through the com 184 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
munication established by the sympathy which exists between these 
extensive organs. Experience proves that a high temperature, long 
continued, increasing the quantity of bile secreted, and altering its 
sensible qualities; and this disturbance of function is often followed 
by inflammation of the liver itself. (Johnson on tloe Liver.) (See 
Liver, Diseases of.—Lndex) 
In colder climates we witness the effects of heat in those attacks of 
vomiting and diarrhoea which are common when hot weather is fol- 
lowed by that which is colder, particularly when warm days are followed 
by colder nights. The distinction between predisposing and exciting 
causes of disease may here be clearly stated: It is well known that a 
secreting organ is never so likely to be affected by any exciting cause 
of inflammation as when the process of secretion is going on actively. 
This undue activity of the hepatic function constitutes & predisposition 
to hepatic inflammation, whilst the hot atmosphere which produces this 
predisposition holds the place of predisposing cause of the inflammation; 
but the exciting cause is exposure to cold/ one of the most common 
and best ascertained causes of inflammation in general. 
The effects of cold are in many respects directly opposite to those of 
heat. When the application of moderate cold is long continued, it acts 
as a sedative on the organic functions of both animals and vegetables. 
This appears from the shrinking of the external parts ; the superficial 
arteries become unable to transmit the blood in the usual quantity 
through the integuments. One of the earliest effects of cold is to pro- 
duce drowsiness. (See the case of Dr. Solander among the hills of 
Terra del Fuego, in “Cook’s Voyages.”) In many instances before com- 
plete torpor comes on, the action of intense cold blunts the nervous sen- 
sation and confuses the intellect, giving the person exposed to it the 
appearance of one intoxicated. 
Sudden vicissitudes of temperature are usually regarded as danger- 
ous ; and it is asserted that a previous hot state of the body augments 
the hurtful effects of cold, whether applied externally or internally. 
This broad proposition, though not quite true, may be the safest general 
doctrine, as it includes as much truth as the popular mind can generally 
be induced to receive. But the truth is, that when the heat-evolving 
power in the body is active and persistent,—if it has not been weakened 
by debilitating circumstances,—if it be not rapidly subsiding from the 
evaporation caused by perspiration,—no danger need attend even violent 
alterations of external temperature. Unusual heat of the body at the 
time when the cold is applied, so far from implying danger, is really 
the condition of safety, provided the heat is steady and permanent. The 
The more correct statement respecting the application of cold is, that 
it is dangerous,—not when the body is hot, but when the body is cooling 
after having been heated;—and this principle applies whether the cold OBSERVATIONS ON THE CATJSE8 OF DISEASE. 
185 
be applied externally or internally, to the surface of the body or to the 
mucous membrane of the stomach. The instances of death from drinking 
cold water, when the body had been heated by the rays of the sun, or 
by exercise, are of very common occurrence. 
The power of cold in exciting disease, is increased by all the circum- 
stances which debilitate the system and diminish its capability of 
evolving heat. Fasting, evacuations, fatigue, &c., lessen the vigor of 
the circulation; and the power of evolving heat is very feeble in old 
persons, in those newly born, or previously weakened by disease. The 
bad effects of cold depend partly on the intensity of the sensation it 
produces, but still more on the duration of that sensation. Cold is 
more likely, other circumstances being equal, to prove injurious when 
it is applied by a wind, or current of air, and also when it is accom- 
panied by moisture. Certain circumstances have been noticed as 
counteractive of the effects of exposure to cold, as exercise of the pas- 
sions, which engage the attention closely to one object; diminished sen- 
sibility, as in maniacs; the power of habit. 
Among the conditions of the body which diminish its power of re- 
sisting cold, sleep has been considered one of the most remarkable. 
Now, while we sleep, sensation is in a great measure suspended, and 
this seems to furnish a contradiction to the principle, that the effect of 
cold on the health depends upon the strength and duration of the sen- 
sation excited by it. This difficulty has been disposed of by asserting 
that the sleeper, who thus suffers, really does feel and is conscious of 
the sensation of cold. 
Influence of the Seasons on Health.—It is well known that the 
general health of the community fluctuates with the changing seasons. 
Thus it is noticed that diseases of the chest are most severe in Winter 
and Spring; abdominal diseases preponderate in Summer and Autumn. 
The perfection of the power of vital resistance requires prudence and 
a proper attention to external circumstances; the proper nutrition of 
the tissues must be supported by pure air, good food, the natural sti- 
mulus of the nerves and the healthy play of the different organs. It 
is reduced or destroyed by whatever lowers the nutrition of any part, 
rendering it more liable to disease from deleterious influences. 
Impurity of Air, as it commonly exists in cities, is a powerful pre- 
disposing cause of disease. It may not generate continued fever, but it 
certainly favors its propagation, and increases in a high degree 
yphoid fever in all its forms, as well as other diseases. (See Typhoid 
Fever) Impure air is a powerfnl agent in calling scrofula into ac- 
tive existence and in aggravating the strumous diathesis. Malaria 
causes intermittent and remittent fevers, with many others, which will 
be treated of in their appropriate places. 186 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
Contagion will be treated of under tbe bead of contagious exanthe- 
matic fevers. 
Hereditary Tendency.—This subject will be treated in full under 
tbe bead of Psora and Hereditary Disease. There can be little doubt 
that the health and peculiarities of the parents influence the physical 
characters of their children; it is a matter of daily observation, and 
one of the best possible illustrations of the fact is to be found in what 
are called family-likenesses. The transmission of such diseases as 
scrofula, phthisis, gout, insanity and many others are subjects of 
common observation. 
It should be firmly impressed upon the mind, that the important 
offices of respiration, circulation, digestion, assimilation, absorption, se- 
cretion, &c., are dependent upon the chemical action, which is con- 
stantly going forward within the body, between the elements of the tis- 
sues and the inspired oxygen on one hand, and a uniform supply, 
through the nerves, of spiritual stimuli on the other. When these ele- 
ments are supplied in due proportion, from the food and air, and no un- 
natural or injurious cause acts on the system, health must result. 
But if the quantity of oxygen absorbed to unite with the elements 
of the tissues, is insufficient to generate the natural amount of animal 
heat and motion, or if the strength of one or more of the tissues becomes 
from any cause, so impaired as to be incapable of offering the requisite 
resistance to the oxygen of the blood, disease ensues. In the latter 
case, the impaired state of the diseased structure does not offer suf- 
ficient contractile power to prevent the intromission of red globules 
into those parts which, in the normal state, contain only the ordinary pro- 
ducts of the transformations of the tissues. The result is, that the 
pores are obstructed, the sweat is retained in the system—thus afford- 
ing additional fuel for combustion, with the oxygen of the blood, and 
from the unnatural irritation which it causes, giving rise to accelerated 
respiration, circulation, and the other phenomena of fever. If the re- 
sisting power of the tissues continues impaired for a length of time, 
and the oxygen continues to act as usual, disorganization must follow. 
It has been proved that 32-£ ounces of oxygen enter the system of 
an adult daily, the whole of which goes into combination with the ele- 
ments of tbe food, and is thrown off through the lungs, and skin in the 
form of carbonic acid and watery vapor. 
The same quantity of carbon and nitrogen is supplied to the blood 
from the elements of the food to reproduce the material of the organs, 
which is lost by the waste or exercise of the functions. According to 
Liebig, “ the quantity of oxygen absorbed determines the amount of 
food necessary to be assimilated.” 
If then the food be property digested and assimilated, a due quantity 
of pure air be respired, and the normal integrity of the organs remain OBSERVATIONS ON THE CAUSES OF DISEASE. 
187 
unimpaired, all the structures will act with uniformity, and a healthy 
equilibrium will result. To ensure a continuance of such a condition, 
it is not only necessary to avoid all of those causes which are directly 
capable of disturbing this complicated series of functions, but to make 
use of those means which tend to invigorate the system, and aid nature 
in her operations. In civilized life, these sources of disturbance are 
almost innumerable ; but we shall endeavor to point out some of the 
more prominent, and show in what manner they operate in causing 
disease. 
In the healthy state of the system, certain structures possess the 
power of effectually excluding the red globules of the blood; thus pre- 
venting a too great change of matter, which an event of this kind would 
inevitably produce. This power is dependent for its normal action 
upon the presence of two conditions, viz.: an adequate amount of re- 
sisting power in the muscular fibres, which modern writers term con- 
tractility, and an unimpaired state of the nerves, in order that the in- 
telligence may communicate with the extreme parts, and thus afford the 
muscular fibres an additional stimulus or power of resistance. This 
stimulus, of which the nerves are the conductors, is an agent of im- 
mense importance in modifying and altering the functions of the struc- 
tures. In the normal state, its effects are apparent during the various 
perceptions and emotions which are constantly agitating us. When 
these two properties remain unimpaired every office must be duly per 
formed. 
It is true that the muscular or the nervous system may be tasked, 
for a short period, without detriment, provided that a corresponding 
degree of rest be allowed, for the weakened energies to be restored to 
their natural state. This is witnessed in severe bodily or mental labor; 
the immediate effects of which are, fatigue, lassitude, and diminished 
muscular and nervous energy. If this be succeeded by a due allow- 
ance of sleep, the waste of force is repaired, and the body resumes its 
healthy tone. If, however, this labor be continued beyond a certain 
point, and the requisite quantity of rest be withheld, the capillaries lose 
their vital power, become incapable of resisting the entrance of red 
blood and inflammation with fever is the consequence. 
Indeed, it may be laid down as a general rule, that most of those 
causes which are capable of producing disease, act by impairing the 
muscular and nervous force of the tissues to such an extent as to render 
them incapable of excluding the red globules. We know that these 
red globules are charged with oxygen, and that this gas, when in con- 
tact with parts of which the elements consist of carbon and hydrogen, 
must effect chemical changes. It matters not whether these changes 
are produced within the body or in the air, the results are in both in- 
stances the same. 188 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
It has been proved by the experiments of Bichat, Buniva, and Philip, 
that the capillaries of a healthy living animal effectually resist the in- 
troduction of fluids, even when a powerful syringe is used; but as the 
energies of the animal sink, they gradually lose their power of re- 
sistance, and allow the fluids to pass into them like “ passive and yield- 
ing tubes.” From these experiments it is evident that the capillaries 
are the first to lose their vitality, since the large arteries have been ob- 
served to retain their contractile power some hours after death. Thus 
it is that the first manifestations of disturbing causes are upon the 
surface, in the condition of chills, succeeded in a short time by unnatural 
heat and inflammation. “ Push into the aorta of a living animal by 
means of a syringe, different fine fluids and you will never see them fill 
the capillary system or issue by the exhalents ; but when the experi- 
ment is performed soon after the death of the animal, the fluid will 
pass readily into the serous capillaries, and pass out by the exhalents, 
excretory ducts, &c.” [Bichat.) 
From the above facts it is evident, that whenever the integrity of the 
extreme parts becomes impaired, the introduction of the red globules 
is permitted, which, according to chemical laws must give rise to in- 
creased evolution of heat, inflammation and thickening of the capillaries, 
and consequent obstruction to the passage of the excretions. The re- 
tention of the products of the combustion of the oxygen of the blood 
and the elements of the food, is an additional source of disturbance. 
These irritating substances induce accelerated respirations, in order 
that sufficient oxygen may be absorbed to neutralize them, and thus 
cause exaltation of temperature, increased activity of the organs and 
the phenomena of fever. 
In all our pathological inquiries, it is of the first importance, that 
we have a distinct appreciation of the laws which produce and regulate 
the phenomena of life, and, as far as practicable, of the influence of 
external agents in modifying these phenomena. 
First, the primary source of animal heat and motion, is the chemical 
action which takes place in the lungs, secondly, when the blood arrives 
at the extreme vessels, other and important chemical changes occur 
between the oxygen of the blood and the elements of the tissues, giv- 
ing rise to a great amount of caloric and motion. Now as the combus- 
tion at the lungs is the principal cause of propelling the blood through 
the arteries into the capillaries—so it is probable that the combustion 
which occurs between the oxygen of the red globules, and the elements 
of the changed tissues at the extreme vessels, is the principal source 
of the motive power which forces the blood back through the veins to 
the heart and lungs. There can be no chemical change without the 
evolution of heat, no heat without expansion, and no expansion without 
developing motive power. We are obliged to reject the doctrine that OBSERVATION'S ON THE CAUSES OF DISEASE. 
189 
the blood is brought back through the veins to the heart, by a kind of 
sitction, which this organ exercises on account of the vacuum which 
constantly occurs within its walls ; for if this motive force is all located 
at the heart, there is no way of accounting for the expenditure of the 
large amount of motive power constantly generated at the extreme 
points. We see two parts of the body where combustion is constantly 
occurring, viz., the lungs, and the extreme vessels/ and when we re- 
member that the laws which govern chemical action, whether in the 
body or the air, are similar, we can appreciate the probable force 
which must be produced at these extremities. 
Since then, the animal heat, motive force, &c., are generated prin- 
cipally at the lungs, and in the capillaries, it is evident that any cause 
which can disturb the healthy operation of either of these important 
parts, must produce immediate and serious disturbance throughout the 
whole system. 
The agents capable of inducing disease here, are numerous and dis- 
similar. In hot climates, the atmosphere being highly rarefied, a less 
volume of oxygen is absorbed at each inspiration, and consequently 
a less quantity afforded to enter into combination with the carbon 
of the system. 
On this account we observe a greater prevalence of liver and bilious 
affections in torrid than in temperate latitudes. Unless extreme care 
be taken to avoid animal food, liquors, and other articles which produce 
a large amount of carbon, this element will so abound, and the rarefied 
air which is inhaled will be wholly inadequate to effect those changes 
which serve to retain the equilibrium between the supply and the waste 
from the transformation of tissues. Here a greater quantity of the 
elements of nutrition are usually assimilated than the inspired oxygen 
can decompose. This excess of carbon and hydrogen being retained, 
the nervous and muscular force of the tissues become relaxed and en- 
feebled, so that from slight exciting causes, diseases of a bilious or 
congestive character are originated. 
We have said that the same quantity of carbon and hydrogen should 
be supplied to the blood from the elements of the food, to reproduce 
the disintegrated portion of the organs which is lost by the waste or 
exercise of the functions. That which is not acted upon by the oxygen 
in the lungs and at the skin, is taken up by the veins and carried to 
the liver, which separates those substances, (carbon, soda, &c.) inca- 
pable of reproducing the tissues, and finally depositing them in the 
gall-bladder in the form of bile. When the amount of bile exceeds the 
retentive capacity of the gall-bladder, the surplus must run over, and a 
large portion of it be conveyed into the system, thus impairing the in- 
tegrity of tissues, and laying the foundation of those diseases incident 
to warm and tropical latitudes. 190 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
In cold climates, a state of things the reverse of this ensues. Here 
the air being highly condensed, a large volume of oxygen is taken 
into the lungs at each inspiration to combine with the carbon of the 
system, and thus generate sufficient caloric to compensate for that 
which is abstracted by external cold. For this condition, all causes 
which can impair the normal state of the digestive organs must be 
avoided, in order that a sufficient amount of carbon, &c., may be assi- 
milated, to combine with the oxygen and secure the healthy equilibrium. 
The greater the exposure to external cold, the larger must be the 
supply of food and oxygen to make up for the loss of heat. 
Cold, acting unduly upon the external parts of the body, produces a 
train of symptoms similar to those caused by miasmata and other 
noxious exhalations when inhaled. The first effects in either instance, 
are to impair the energy of the extreme vessels, inducing constriction 
and chills, to be succeeded by diminished resisting power, and other 
phenomena which characterize inflammation. 
The increased action of the circulatory vessels which usually follows 
the chills, has been referred by some writers to the stimulus of a 
greater volume of blood being thrown upon these organs than is natural, 
and the increased heat which accompanies this exaltation as a result 
of the action itself. No greater error than this could be promulgated, 
for the entire source of animal heat is chemical action, and all of the 
involuntary motions must bear a direct ratio to this evolution of heat. 
If the skin, lungs, brain, or any other part, becomes from any cause in- 
capable of affording the normal resistance to the oxygen which is 
constantly brought into contact with it, an augmented chemical action 
must occur in it, with the invariable concomitants, increased heat, con- 
gestion, and fever. 
“ If a given part of the body is acted upon by continued and intense 
cold, while the other parts retain their natural temperature, there 
occurs, after a time, in consequence of the loss of heat, an accelerated 
change of matter in the cooled parts. The momentum of the force of 
the vitality, in the parts which are not cooled, is expended, as before, 
in mechanical motion; but the whole action of the inspired oxygen is 
exerted on the cooled part. In the cooled part of the body, the living 
tissues offer a less resistance to the chemical action of the inspired 
oxygen ; the power of the oxygen to unite with the elements of the 
tissues, is, at this part exalted. In the cooled part, the change of 
matter, and with it the disengagement of heat, increases; while in other 
parts of the body, the change of matter and the liberation of heat, de- 
crease. But when the cooled part by the union of the oxygen with the 
elements of the metamorphosed tissues, has recovered its original tem- 
perature, the resistance of its living parts to the oxygen conveyed to 
them again increases, as the resistance of other parts is now diminished. OBSERVATIONS ON THE CAUSES OF DISEASE. 
191 
a more rapid change of matter now occurs in them, their temperature 
rises, and along with this, if the cause of the change of matter continues 
to operate, a larger amount of vital force becomes available for mecha- 
nical purposes. If the heat is abstracted from the whole surface of 
the body, the whole action of the oxygen will be directed to the skin, 
and in a short time the change of matter must increase throughout the 
body.” [Liebig.) 
From these facts we are led to conclude that a large amount of those 
articles which abound in carbon and hydrogen should be consumed in 
cold climates, in order that sufficient materials may be constantly 
furnished to the tissues, to afford the requisite amount of resistance to 
the inspired oxygen. This is the only means by which the animal 
temperature can be kept up sufficiently to counteract the loss of heat 
which is constantly occasioned by external cold. Disease must always 
occur, when cold so intense and protracted as to impair the normal 
resisting force of the tissues, is applied to the body, in such a manner 
as to induce atony in the capillary vessels, chills, lassitude, pain, and 
other symptoms of inflammation, one of the most prolific causes of 
disease in cold climates, is generally active from without, in the form 
of sudden changes of temperature, excessive exposure to cold when the 
body is enfeebled, and in going from heated rooms into the cold air 
while perspiring. In these instances the effects produced are, debility 
and constriction of the extreme vessels, (chills), lassitude, and pains in 
limbs and head, followed, as soon as reaction comes on, by accelerated 
respiration, circulation, and other symptoms which constitute fever. 
In regard to the part or organ affected, much will depend upon the pre- 
dispositions and constitution of the patient. As a general rule, how- 
ever, the greatest impression is usually made, and the force of the 
disease expended upon the most enfeebled part. If the lungs are pre- 
disposed to disease, the exciting cause will develop pneumonia. If the 
brain or digestive organs have been debilitated by excessive exercise, 
phrenitis or gastritis will ensue. The same principle holds true with 
regard to the other organs and structures of the economy. If the whole 
system be in a normal and sound state, atmospheric vicissitudes will 
commonly merely predispose the organs to a disordered action from 
whatever farther exciting cause may occur. But repeated exposure to 
sudden changes of temperature, even in a sound state of the organs may 
produce actual disease. 
The immediate effect of the above enumerated, as well as of almost 
all other causes of disease, is to impair the integrity of the capillaries 
to such an extent a*s to render them incapable of excluding the red 
globules. The intromission of these “carriers of oxygen,” must of ne- 
cessity give rise to an increased and unnatural change of matter, with 
its concomitants, augmented heat and motion. This inflammation of 192 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
parts produces obstruction to the passage of the excretions, causing 
them to be retained within the system to serve as an additional source 
of disturbance. The nature and activity of the exciting cause, the 
part affected, and the constitution of the patient will determine the 
violence and danger of the disease. It may then be assumed with 
safety, that the chief influences which predispose to disease in all 
countries, are, extremes of heat and cold, and abrupt changes of tem- 
perature. 
In cold latitudes, those affections prevail which are induced by undue 
exposure to cold, and from the condensed state of the air respired. 
Hence pneumonic and other diseases of a purely inflammatory character. 
In hot regions, Avhere the respired air is highly rarefied, we observe 
those disorders which proceed from a deficiency of oxygen to neutralize 
the elements of the food, and from exposure to the burning rays of a 
torrid sun. Liver-complaints, yellow and congestive fevers, and those 
diseases which an excess of carbon, circulating in the blood, would pro- 
duce, are here found in abundance. 
The diseases of moderate latitudes are of a more mixed character 
milder and more subservient to the power of remedies. Here frequent 
and sudden atmospheric changes exert the greatest influence in dis- 
turbing the healthy equilibrium, and in inducing disease. 
Every living body possesses a certain definite and limited capacity 
of resistance. This capacity can only be taxed to a fixed point, withou 
deranging some of the functions and causing disease. We have seen 
that the first and most essential requisite to ensure health, is a due 
proportion between the elements of the food and the inspired oxygen. 
Now, if moderation and regularity be exercised in all the duties and 
habits of life, a sound state of the organs and a due performance of all 
the functions will follow. 
Among the parts of which the normal action is highly essential to 
the well-being of the individual, and upon which disturbing causes 
usually act, are the digestive and respiratory organs, the skin and 
nervous system. Of these, the lungs and skin are far the most fre- 
quently affected. Exposed incessantly to noxious exhalations, impure 
air, extremes of heat and cold, and sudden changes of temperature, it 
is not a matter of surprise, that most of the exciting causes of disease 
operate primarily upon one or both of these important portions of the 
general system. 
Almost all inflammations of important organs are ushered in with 
feelings of general lassitude, pains in different parts of the body, irre- 
gular respirations, and chills. It matters not whether the first im- 
pression has been made by atmospheric changes,—extremes of heat or 
cold,—or undue mental or corporeal exertion: one important phe- 
nomenon is witnessed in nearly all instances, that is a spasmodic or OBSERVATIONS ON THE CAUSES OF DISEASE. 
193 
constricted state of the extreme vessels. This constriction of the ca- 
pillaries is always attended with more or less debility, which prevents 
them, when reaction comes on, from resisting the intromission of red 
blood. Thus result obstruction to the excretions and accelerated 
changing of matter in these parts, and the other phenomena of inflam- 
mation and fever. Now, whatever organ or structure is most predis- 
posed to diseased action, must receive the greatest detriment from the 
retained secretions, and the exalted and unnatural action which per- 
vades the system. 
According to many authors the causes of inflammation may be either 
predisposing or exciting. If two individuals, one robust and regular 
in his habits, and the other delicate and irregular, be exposed to the 
same morbific influence, the former will escape, while the latter will re- 
ceive injury ; or, if the exciting cause be still more active, an impression 
will be made upon the first, which will predispose his system to dis- 
ordered action, while in the latter the same influence will cause actual 
disease. If the morbific agent be very virulent, actual disease may be 
induced in both instances, but in different degrees of severity. 
It is true, it may be asked, why it is that in hot climates the robust 
are more liable to be attacked with fevers than those of a feeble ap- 
pearance ? The reason is obvious. The system of the vigorous man 
abounds with those elements which, when properly decomposed by 
oxygen, generate the vital activity and produce strength and health. 
Now, if he indulges his appetite as usual, while he inhales a highly 
rarefied atmosphere, disease must of necessity result; for unless the 
amount of oxygen absorbed into the system be proportionate to the 
elements of the food assimilated, much of the latter must remain un- 
acted upon, and thus serve to contaminate the blood and derange the 
functions of the organs. Here a cause of disease exists, to which the 
feeble man is but little exposed. His system is characterized by a de- 
ficiency rather than an excess of carbon; his digestive organs being so 
weak that no more of the elements of nutrition are assimilated than the 
inspired oxygen can neutralize. Thus, in his case, the equilibrium 
between the supply and waste of matter is retained, and the organs re- 
main healthy. 
In the first example, a strict abstinence from animal food, liquors, 
and other articles abounding in carbon, -with care that the healthy 
function of the skin be not disturbed, will secure as great freedom from 
disease as in the other instance. It is not that the robust man is ne- 
cessarily more prone to disease than the other, but because, either from 
ignorance or imprudence, he often exposes himself uselessly to an ex- 
citing cause to which the latter is not liable. 
We contend that the man of a stout frame and vigorous constitutiQn 
is better able to resist diseases in all climates than one of a more feeble 
You L -13. 194 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
organization, provided, that lie adapts himself by his habits and dietetic 
regulations to the climate in which he resides. The grand essential 
consists in keeping up a due proportion between the elements of the 
food and the inspired oxygen. So long as this proportion is preserved, a 
vast amount of exposure can be sustained in any climate without 
detriment. 
In northern latitudes, those who are feebly organized, or of nervous 
or sanguine temperaments, suffer far more than the robust and bilious. 
In such cases it is necessary that the amount of carbon and hydrogen 
assimilated to repair the waste of the tissues, be very large, in order to 
supply the system with sufficient material to resist the action of the 
absorbent oxygen. Let it be remembered, that disease ensues when- 
ever any part of the body becomes incapable of affording a definite 
amount of resistance to the action of this gas. The principal source 
of this resistance is the carbon and hydrogen of the changed tissues; 
and if no unusual or deleterious causes operate to depress the system, 
all will be well. If, however, the digestive organs become disordered, 
and assimilation checked—the body being at the same time exposed to 
excessive cold.—The oxygen will act upon the debilitated structures 
themselves, in order to find sufficient fuel for combustion, so that the 
animal temperature may be retained. 
The phenomena of life depend upon the constant operation of two 
antagonistic elements. Their presence and activity, in suitable pro- 
portions, impart heat, strength and life, while the absence of one makes 
the other an active agent in causing disorganization and death. Ac- 
cording to Lavoisier, a quantity of oxygen is constantly being inspired 
by the healthy adult equal to 82\ oz., or 46,037 cubic inches, daily, the 
tendency of which is to neutralize and destroy the elements of the body. 
To counteract this destructive agent, the elements of the food are con- 
stantly assimilated, and are finally brought into contact with it. In 
this manner, so long as the proportion between these agents is equal, 
those chemical changes take place which generate the animal heat, 
corporeal vigor, and motive power, serving to keep in operation the 
whole machine, and ensure the normal action of every organ. The im- 
mense importance, then, of fully comprehending and appreciating the 
mutual influence and dependence of the respiratory and digestive or- 
gans upon each other will be understood by all. 
Extreme cold produces disease by permitting more oxygen to be ab- 
sorbed by the blood than can be decomposed by the products of the 
metamorphosed tissues. Those parts of the body possessing the least 
vitality must then be acted upon, and inflammation and extreme dis- 
organization ensue. % 
Extreme heat generates disease from causes directly the opposite, 
viz., a deficiency of oxygen, to neutralize the assimilated carbon and OBSERVATIONS ON THE CAUSES OF DISEASE. 
195 
hydrogen. In both instances the nervous and muscular force of the 
capillaries is so impaired as to render them incapable of excluding from 
their structure the red globules. Obstruction is thus caused, a large 
amount of heat is evolved, and the redness, swelling and pain, wrhich 
characterize inflammation, is present. 
The 'primary cause of most inflammations is a disproportion between 
the action of the oxygen of the blood and the elements of the changed 
tissues. The cause of this disproportion—acting upon those parts of 
the body most susceptible to its influence—gives rise immediately to an 
impaired state of the nerves and muscular fibres of the extreme vessels, 
rendering them incapable of preventing the intromission of the red 
blood. The first effect upon these vessels is stimulant, indicated by 
contraction, or spasm and chills. This is soo/i followed by the secon- 
dary or atonic stage, which is indicated by distention or congestion of 
the capillaries with red blood, heat, redness, and other symptoms, which 
show that the small vessels have lost their power of resisting the en- 
trance of the destructive “carriers of oxygen.” The immediate cause 
of the disturbance and disorganization which results in inflamed parts, 
is dependent solely upon the chemical action of the oxygen of the red 
globules upon the elements of the affected structure. If this is the 
case, it will be asked, why, then, disturbance and inflammation do not 
take place from the red globules in the act of blushing, or from fric- 
tion ? Because in these instances, the nervous and muscular force of 
the capillaries remains unimpaired, and they are thus enabled speedily 
to throw off this temporary accession of red blood, and resume their 
normal resistance to its further entrance. It is only by impairing the 
resisting force of these vessels in such a manner that the arterial blood 
O 
continues to enter them, that inflammation can occur. 
Even in the act of blushing, a perceptible increase of heat is ap- 
parent, and when the emotion acts intensely, and for a considerable 
period, phenomena similar to those which occur in very slight super- 
ficial inflammations, are observed; as uneasy sensations, fulness, per- 
spiration, &c. 
The virulence of the morbific influence acting upon the extreme 
vessels and the extent to which their resisting power is impaired will 
determine the violence and danger of the inflammation. 
It has been ascertained by Wilson Philip, and others, “ that where 
the inflammation of a part is greatest, the vessels are more distended, 
and the motion of the blood is slowest.” This is owing, undoubtedly, 
to the diminished contractile power of the capillaries; and it is pro- 
bable, in inflammations of a congestive character, that this contractile 
or resisting power is almost entirely destroyed. This fact is important, 
in a therapeutical point of view, inasmuch as it directs us to apply our 196 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
remedies in such a manner as to restore the loss of tone of the extreme 
vessels, as the most direct method of cure. 
The most important doctrines of modern pathology in regard to in- 
flammation are briefly presented by Dr. Richard Hughes.* “Inflamma- 
tion is merely a perverted nutrition. Let us consider what takes 
place when an irritation is applied to the web of the frog’s foot. The 
blood-vessels are seen first to contract and then to dilate beyond their 
normal calibre, thus admitting a larger quantity of blood to the part. 
This is congestion. If the irritation was not severe or prolonged, this 
condition gradually passes off without leaving morbid effects behind. 
Now in this case we have a direct excitation of the blood-vessels, caus- 
ing their contraction, and a secondary paralytic dilatation, probabty 
from exhaustion of their irritability.f But the hyperaemia thus pro- 
duced does not go on to true inflammation, if the vital powers of the 
part or of the whole body be not otherwise impaired. In healthy ani- 
mals on which the division of the cervical sympathetic has been 
practiced, no inflammation results from the increased afflux of blood to 
the corresponding side of the head and face. But Claude Bernard has 
found that if animals have been starved for a few days before the opera- 
tion, and then the vaso-motor nerves,—say those of the plura—are 
divided, intense inflammation going on even to suppuration is set up in 
the part. 
“ On the other hand, let a more intense and prolonged irritation be 
applied to the web. Here also we shall have the primary contraction 
and secondary dilatation of the arteries; but further phenomena will 
also result. There will be increased activity of circulation all about 
the part, and stagnation of the blood-current within it; and exudation 
of liquor-sanguinis will take place. This is true inflammation. In 
this case the irritation has affected, not merely the vessels but the tis- 
sues of the part itself, which by its abnormal action has perverted nu- 
trition into inflammation. 
“Upon one or other of these principles we can explain well-nigh every 
form of inflammation. The latter mode corresponds to all cases arising 
from external irritants ; from morbid poisons conveyed to the blood to 
the tissues they affect,—as the endo-carditis from the lactic acid of 
rheumatism (Richardson), and arthritis from the uric-acid of gout, 
(Garrod) / and from the effects of drugs, as the gastritis of Arsenic, the 
nephritis of Cantharis, &c. It is in this manner, also, as we shall see, 
that sympathetic or reflex inflammations are produced, in this case 
through an irritation of the tissue nerves. On the other hand, the’ 
mode in which Claude Bernard excited pleurisy in animals seems to 
* The Nervous System of the Human Body. London, 1861. 
f Aconite, Belladonna, and Ergot will produce these phenomena, as well as irri- 
tants in general. INFLUENCE OF DRESS ON DISEASE. 
197 
give the rationale of the numerous cases of inflammation caused by ex- 
posure to cold. If this agent be applied locally, we have first coldness 
and paleness from contraction of the arteries, and then,—if its applica- 
tion be discontinued—warmth and redness from their secondary dilata- 
tion. Here the sequence of phenomena ends. But if the cold has been 
severe and prolonged—as for instance, in frost-bitten parts—the re- 
action will go on to inflammation, and even to gangrene. This is on 
account of the vital depression of the tissues, as in the animals under 
Bernard condemned to starvation.” So again, six persons shall be ex- 
posed to cold: two shall escape all injurious consequences, two shall 
have simple catarrh; but the fifth shall be laid up with pneumonia, and 
the sixth with nephritis. Now, in all these persons the cold will have 
produced throughout the frame the contraction and dilatation of the 
arteries characteristic of its local action. But in the first two cases, 
the high state of the general health has caused the process to stop here. 
The third and fourth, not being quite up to the mark, suffered from a 
sub-acute inflammation of the upper respiratory mucous membrane 
which is most exposed to the air. The fifth, being in still poorer health 
had a pneumonia—the seat of the inflammation being again determined 
by local reasons; while in the sixth the kidneys were already, from 
local or other causes, in a state of impaired vitality, and thus inflam- 
mation is set up in them. This subject will be more fully illustrated 
when we come to treat of inflammatory diseases. 
INFLUENCE OF DRESS IN CAUSING OR PREVENTING DISEASE. 
The radiating power of an article of dress becomes an important 
quality in our selecting or rejecting it for a given purpose. It is well- 
known that, in general, the worst conductors of heat are the best radia- 
tors. Those who have not made the trial would be surprized to learn 
that a polished metallic vessel, filled with hot water may he made to 
cool more rapidly by giving it a covering of flannel. This radiating 
power of flannel, in addition to its had conducting quality and its power 
of absorbing moisture from the skin or the atmosphere renders it of all 
articles of clothing the safest for the invalid. While it holds the heat 
of the body from passing too rapidly off, it absorbs the extra moisture, 
with evolution of heat. It is therefore not by “ warming and heating 
at the same time” that it becomes as conservator of health, hut by 
regulating the temperature * 
The different degrees of inflammability of the silk, wrool and flax, the 
common articles of dress are easily shown by the simplest experiments. 
If a slip of each, in a woven state, is placed on a support of platinum 
foil, and held over the flame of a candle, the silk and wool will become 
* British and Foreign Medico-Chir. Review for April, 1859. 198 
GENEKAL PKINCIPLES OF MEDICAL SCIENCE. 
charred without inflaming, whilst the cotton and linen will take fire and 
consume with flame; but of the two latter, the cotton more readily and 
rapidly than the linen. Further, if slips of each be w'ound round a 
copper, Avire of |th of an inch in diameter, and used as a taper, the cotton 
brought to the lighted candle, will inflame readily, and, held perpendi- 
cularly will burn to the bottom, leaving only a trace of white ash; the 
linen will do the same, but more slowly, leaving a similar ash; but not 
so the woolen and silk,—these hardly break into flame; the flame, Avhen 
it occurs, lasts only for a moment, and leaves a coal, which burns with 
difficulty and soon goes out. The application of such results as these 
to dress, especially to women’s dress, who are so much exposed to danger 
from the taking fire of their clothes, is easily seen. 
Fitness of Clothing Materials for Washing.—The only point worthy 
of notice here relates to wool. The structure of its fibre, not smooth 
like that of silk, cotton and flax, but having minute processes or off- 
shoots, is subject to entanglement or felting, giving rise to a shrinking 
of superfices with increase of thickness; but this peculiarity can be al- 
most entirely overcome by the necessary skill in washing and drying. 
The chief obstacle to comfort in the use of linen and cotton arises 
from the use or abuse of starch, which by hardening and stiffening 
collars and handkerchiefs, it even renders them more cumbrous, and 
less convenient and agreeable. Its universal use can be seen by 
testing the different articles wdth Iodine. 
Influence of Color in Dress.—Experiments show that, other cir- 
cumstances being equal, dark colored bodies become soonest and most 
heated on exposure to the sun; and the degrees of intensity of heat are 
variable according to the degrees of intensity of color, the extremes of 
the scale being black and white. It is also proved that w hen the sun’s 
rays are absorbed by a dark surface, the heat evolved ceases to be 
radiant, in a great measure; and then it loses, consequently, its 
peculiar powers, one of which is that of exciting inflammation as wit- 
nessed in sun-burn. 
These facts tend to show that the fullest protection in hot climates 
against the heat of the sun is attained by using two colors at the same 
time, white in the outer garments exposed to the sun’s rays, black in 
the inner clothing to prevent these rays from acting injuriously on the 
skin. In the African, with a black skin, there is a strong taste for 
white clothing ; in the Arab horse of purest breed, the hair is white* 
the skin black ; and universally it is observed that though the sun’s rays 
bleach the hair, they equally darken the skin. The child that plays 
bareheaded in the sun has his hair bleached to a purer white, at the 
same time that bis skin becomes tawny or nut-brown. It has even 
been proposed to make umbrellas of two colors,—white outside and 
black beneath. To illustrate this point more fully: five vials of the PATHOLOGY AND THERAPEUTICS OF DIFFERENT PERIODS OF LIFE. 
199 
same form and size filled with a prepared mixture of weak mucilage 
and a little nitrate of silver, were placed in the sun’s rays: No. 1 was 
left uncovered; No. 2 was covered with white silk; No. 3 with black 
silk; No. 4, white silk over black silk; No. 5 with tin foil. Examined 
after three hours, the fluid in No. 1 had become almost black, its tern 
perature 75°; No. 2 dark-brown, temperature 68°; No. 3 just per 
ceptibly colored, temperature 75°; No. 4 just perceptibly colored, tem 
perature 69°; No. 5 just perceptibly colored (the tin foil had some 
minute holes, allowing the passage of some rays) its temperature was 
71°. The air at the time was 61°; water in a vial, without the addition 
of mucilage and nitrate of silver, was 64°. 
The power of the human constitution to resist the causes of disease 
is under many circumstances astonishingly great. The utmost extent 
to which this power may with impunity be tested has perhaps been 
correctly measured by the trials and privations to which the explorers 
of the polar regions have been subjected. During the recent efforts of 
American navigators in search of Sir John Franklin it has been ascer- 
tained that the power of seamen to endure fatigue may be thus 
measured: the maximum wTeight per man proper to be carried is two 
hundred and twenty pounds. Of this weight three pounds per day 
will be consumed for food and fuel, thus: one pound of bread, one 
of meat; the other pound comprise his tea, cocoa,sugar, fuel for cooking 
and other necessaries. It was found that upon this estimate the men 
could march ten miles per day for one hundred days, and endure with 
impunity a temperature of fifty to sixty degrees below the freezing 
point. (Dr. Hays.—Narrative, &c., 1861.) 
PATHOLOGY AND THERAPEUTICS OF DIFFERENT PERIODS OF 
LIFE. 
I. Period.—Infancy.—Prom birth to the completion of the first 
dentition. 
II. Childhood.—Prom completion of the first to the completion of 
the second dentition. 
III. Youth.—Boyhood.—Girlhood.—From the age of seven or 
eight years to commencement of puberty. 
IY. Adolescence.—From commencement of puberty to adult age. 
V. Adult aye.—Virility and mature age. 
YI. Declining age. 
VII. Old age. 
I. Period.—Infancy, (Infantia, from privation of speech,) extends 
from birth to about the end of the second year, or completion of the 
first dentition. 1. Preceding the sixth or seventh month all the struc 
tures are in the course of development. The bones are in process of 
ossification, the functions acquire strength and activity; the movements 200 
GENERAL PRINCIPLES OF MEDICAL 8CIENCE. 
are little under the control of the will; the perceptive powers are im- 
perfect; the attitudes are without variety, the countenance is capable 
of expressing little more than pleasure or pain to the spectator ; though 
the experienced eye of the physician may read in it the character and 
probable course of obscure diseases; aided by observations of the mo- 
tions and positions of the limbs, the tones of the voice; the changes 
of countenance, the states of the eyes and eyelids, the openness and 
contraction of the eyebrows, the appearance of the lips, nostrils, mouth, 
gums, and tongue, he may generally discriminate between the various 
forms of infantile diseases. 
Diet of Infancy.—Nature seems to have furnished the milk of the 
mother as the only suitable food; the digestive powers of the infant 
are little suited to digest anything else ; and, although substitutes for 
it have to be in many cases tried, not more than one in six or seven 
live to pass through childhood. (See Infancy.—Index.) 
Peculiarities of Infantile Diseases.—The infantile system is ex- 
tremely susceptible of external impressions, which very often excite 
disease in the lungs, suspend the action of the skin, or derange the 
digestive organs. Having passed the first stage of its existence in a 
condition of uniform temperature, the infant can but slowly accom- 
modate itself to the vicissitudes of cold and heat in the external world; 
and the surface of the body and the organs of respiration require the 
most careful protection from atmospherical vicissitudes. The digestive 
mucous surface is .equally susceptible to the effects of all unsuitable 
kinds of food, and easily irritated or inflamed; but nature has provided 
for a redress of many evils by a copious secretion of mucus from the 
internal surface of the stomach and bowels to shield that delicate sur- 
face from substances too harsh, or to lubricate the way for their speedy 
expulsion. 
The skin is also peculiarly susceptible to the effects of irritants and 
stimuli in infancy ; and the intimate sympathy between it and the diges- 
tive canal gives nature the means of relieving the internal organs from 
many serious invasions of disease by throwing an exanthematous erup- 
tion on the surface. The brain at the same epoch of life is in process 
of development; and during the first months of life vascular action is 
rapid in perfecting the organization of the organ. An extra quantity 
of blood is sent to the brain, and various external causes conspire to 
excite its easily disturbed circulation; its substance or its membranes 
are, therefore, frequently the seat of congestions, inflammations, or effu- 
sions into the cavities between the membranes. 
The infantile organism is also frequently injured by medicines or 
other influences which affect the nervous system. Opium, which is 
most commonly given to children to quiet their complaints excited by 
pain of any kind, has the most deleterious influence on the brain, in- PATHOLOGY AND THERAPEUTICS OF DIFFERENT PERIODS OF LIFE. 
201 
creasing its vascular action, and afterwards favoring congestion. Dras- 
tic cathartics are also often used, and are always injurious. In general, 
the clothing should be soft and warm; the head should be exposed to 
the mild and equable temperature of a well-ventilated room ; and the 
skin, generally, subjected to frequent ablutions with water, warm at 
first, but as the strength of the infant increases, the wTater may be gra- 
dually diminished in temperature, remembering always that the sensa- 
tion of cold can not be endured for more than one or two minutes by a 
child without endangering the vital functions, producing injurious de- 
pression, checking the healthy action of the skin, causing catarrh or 
other disease. 
The period of the first dentition is attended by all the peculiarities 
of infantile health and to these are now added the dangers of teething, 
weaning / and the development of the powers of speech and voluntary 
locomotion, the farther manifestation of instinctive desires and emotions. 
Teething is not necessarily a cause of serious disordered health, ex- 
cept in children originally feeble, imbued with hereditary or psoric dis- 
ease, and weakened by bad food and impure air. In such cases it fre- 
quently excites the most dangerous maladies. In the early stages of 
the process, itching and irritation of the gums become a source of ex- 
citement which extends to the salivary glands as well as pancreas, pro- 
ducing a flow of viscid saliva. The itching alone becomes a source of 
distress, and the child presses between them whatever it may find 
within its reach. The nervous system generally becomes excited by 
the local irritation, fever and deranged digestion follow; and sometimes 
they excite inflammation of the brain or of the digestive mucous sur- 
face. The irritation extends the whole length of the intestinal tube; 
food is imperfectly digested, and becomes, with the acrid secretions a 
new source of diarrhoea, dysentery or sympathetic convulsions. In the 
general febrile condition the lungs become involved also; and we fre- 
quently find inflammatory irritation of the digestive and respiratory 
surfaces associated in the same case ; and it is only by judicious treat- 
ment that the brain or its membranes can be saved from participating 
in the same morbid action. (See Dentition.) 
Weaning.—As soon as a few teeth have made their way through the 
gums the infant begins to be capable of subsisting on other food be- 
sides the milk of the mother. As early as the ninth month both mother 
and child will generally be benefitted by separating them entirely, or 
at least suspending the process of lactation which should never be ex- 
cluded beyond the fifteenth month. As this period approaches the 
child should be gradually accustomed to take other food, increasing the 
quantity and the frequency of taking it. Animal diet in some form will 
be necessary after the mother’s milk has been cut off. It should at 
first be in small quantity, of pure quality, easily digested, and increased 202 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
in proportion as the age of the child advances: it should be combined 
with or alternated with pure, bland and nutritious materials from the 
vegetable kingdom, varying in quality as well as quantity, and given at 
intervals varying with the advancing age and growth. 
During this whole period of lactation and dentition the infant con 
tinues liable to all the diseases of infantile life, with the addition of 
those that arise from the irritation of the teeth, and defects in the milk 
dependent on the health of the mother or nurse. At this age also infec- 
tious and exanthematous disorders are common; the mucous surfaces, 
the lymphatic glands of the abdomen and thorax are liable to disease; 
worms, and changes in the infant’s food, cause depraved or imperfect 
digestion and assimilation and conspire to originate some of the many 
diseases of infancy; among them are aphthae, rickets, tubercles, maras- 
mus, tabes mesenterica, infantile remittent fever, scrofula, and numerous 
cutaneous eruptions, all of which will be treated of under their respec- 
tive heads. 
Of the general treatment of the diseases of infancy it may here be 
said that the greatest care is always required in distinguishing the real 
source of the febrile irritation which is usually present. The head 
should always be guarded from the vascular excitement to which it is 
liable. The gums should always be examined; the child should be 
permitted to relieve the itching by biting on a ring of ivory, hard gum- 
elastic, or, still better, a gold ring. As soon as the gums are much 
swollen they should be relieved by lancing them. Other remedies 
must be employed with care, according to the indications pointed out 
under the separate diseases. 
II. Period. Childhood.—This extends from the completion of the 
first to the completion of the second dentition or to the eighth year. During 
this period the different textures and organs are rapidly developed, their 
functions are more perfect, the intellectual and moral faculties are ex- 
panded. The different textures become more solid, acquiring firmness, 
elasticity, and strength. The powers of resisting external influences 
have increased, but disease when excited is more disposed to a sthenic 
inflammatory character, effusing coagulable lymph, particularly on the 
serous surfaces. There is great susceptibility to infectious diseases, 
to pneumonia, bronchitis, inflammations of the brain, or membranes, 
stomach or other abdominal visera; glandular obstructions, chorea, 
verminous diseases, epilepsy, angina, croup, &c. 
At this pex-iod of life more active treatment can be borne than would 
be appropriate in younger children. There is a tendency to accumula- 
tions in the bowels which furnish a nidus for the generation of worms, 
and produce irritation of the digestive mucous surface, as well as of 
the nerves that proceed from it. These accumulations should be re- 
moved, or more wisely, prevented. Wholesome nourishment, active PATHOLOGY AND THERAPEUTICS OF DIFFERENT PERIODS OF LIFE. 
203 
exercise in the fresh air, ventilation of school-rooms and sleeping apart- 
ments are of the highest importance. The mental faculties should 
rather be exercised in ways of amusement and the gratification of curio- 
sity than exerted in close attention to book-studies; but the moral emo- 
tions, particularly those connected with temper and disposition should 
he moderated, restrained, or judiciously directed. Children should not 
be allowed to sleep with persons in had health or advanced age. (Cop- 
land's Diet. Yol. 1, p. 49.) 
III. Period. Youth.—Boyhood.—Girlhood.—From the age of 
seven or eight years to the commencement of puberty. At this period 
the structures of the body and the powers of the mind are undergoing pro- 
gressive improvement. There is in constitutions free from scrofulous 
or hereditary taint, a sthenic diathesis, a predominance of the sanguineo- 
nervous temperament; greater liability to idiopathic continued fever, 
with scrofulous enlargements and inflammations, affections of the lympha- 
tic glands, with various nervous affections, as epilepsy, convulsions, 
chorea; also cutaneous eruptions; inflammations of the throat and air 
passages ; tubercles of the lungs or alimentary canal, curvatures of the 
spine, intestinal worms, &c. The nervous system is highly impressible 
to physical and moral impressions; inflammatory action is strongly dis- 
posed to give rise to new formations ; and in the advanced stages of erup- 
tive or infectious fevers, inflammation is peculiarly liable to terminate 
in serous or sero-albuminous effusions. 
In the diseases of this period the same leading considerations apply 
as in those of earlier childhood. Active exercise in a pure and whole- 
some air is indispensable to full growth and permanent health. In cities 
too many persons occupy the same room; the young and the old are 
crowded into small and unventilated apartments; and academies and 
boarding-schools generally admit the same prolific source of broken 
constitutions within their walls. The mental powers are now capable 
of a further degree of improvement and growth ; and habits of life should 
be formed and encouraged which may promote future health, happi- 
ness and usefulness. 
IV. Period. Adolescence.—From the commencement of puberty 
to adult age, or to about the twentieth year in females and the twenty- 
fourth in males. The age at which puberty appears varies from twelve 
or fourteen in females to sixteen; and from fourteen or sixteen in males. 
In northern climates it is later than in southern in both sexes; and in 
sanguine and plethoric constitutions puberty is hastened by luxurious, 
habits, sleeping in crowded apartments, lying on feathers, indolence,' 
the extra-excitements of modern society, the associations of boarding- 
school-life, &c. 
At this epoch in human life the mental and physical distinction 
which exists between the sexes are developed to their fullest extent; 204 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
and with these organs and faculties the whole body and mind expand to 
sj their most perfect condition, except in those mental powers which grow 
and strengthen by the struggles and experiences of life. The organs 
of respiration reach now their full growth, the muscles acquire their 
size and due proportions. The spine, and the whole nervous sys- 
tem become completely organized ; intellectual power displays its full 
supremacy over the physical and brute creation ; the observing faculties 
are actively employed in observations of the varied and wonderful phe- 
nomena of external physical nature ; the treasured wisdom of past ages 
is eagerly grasped by the mind of the aspiring student; and the rea- 
soning powers, gathering new strength from every trial, trace effects 
back to their remote causes, generalize and reduce to clear principles 
the facts already known, and advance through the known and the pro- 
bable to the unknown, the possible, and finally to the wonderful, the 
certain, the true. 
PERIODICITY IN THE ACTIONS OF THE ANIMAL ECONOMY. 
The different periods of the day are marked by certain fluctuations 
in the vital movements of the animal economy, which have long re- 
ceived a share of the attention of scientific men. The following general 
facts on the subjects seem to be generally acknowledged. Vitality ex- 
pands during the day and concentrates during the night. 1. The 
morning is the period corresponding to youth and spring, to growth and 
reproduction. There is a higher manifestation of external life. Man 
in health feels renovated and re-invigorated by rest. As the day ad- 
vances our external senses become more acute, the memory and ideas 
more precise. Those desires manifest themselves that are the evi- 
dences of strength, of exuberant health. Spontaneous seminal emissions 
take place in the morning or in the second sleep. The greater num- 
ber of long-lived persons have been early risers. 
The internal organs, especially in persons in whom the functions 
are not nicely balanced, are more feeble in the morning. We have 
gastrodynia, anorexia, colics, nausea, as in pregnant women; bitter 
taste in the mouth, &c., denoting debility of the viscera; evacuations 
are more frequent, as in diarrhceas, cholera, salivary discharges, and 
expectorations. 
Second Period. From 9 A. M. to 3 P. M.—Excitement is at its 
highest, and diseases of excitement exacerbate. This extreme expanse 
of vitality gives the highest thoughts, and the fiercest passions ; genius 
shines in all her splendor; the sentiments are developed in their fullest 
energy. The chylopoetic viscera and hepatic system, are agitated; 
bilious diseases are increased; stimulants are more hurtful; the mu- 
cous membrane of the stomach is in an irritable state. In hot climates PERIODICITY IN THE ACTION OF THE ANIMAL ECONOMY. 
205 
a short sleep is required, hence comes' the siesta of the Spaniards. 
’Tis now that 
“ Amid his subjects safe, 
Slumbers the monarch swain.” 
Third Period. From 3 to 9 P. M.—At this time too large a meal 
may not digest well, as the vital powers are so much drawn to the sur- 
face. The various diseases of excitement have raised the pulse from 
ten to twelve heats. (/Swancke, Ilcematologie. p. 96.) The limbs 
swell; the menstrual and hsemorrhoidal flow commonly begin, from 
being long in the erect position, or from venous plethora. The laborers 
of many countries have made their principal meal at sunset. The old 
Romans and Chinese did so. This is the hour which calls for amuse- 
ments to dissipate the ideas of death, which arise in the mind when 
the body is exhausted. Melancholy is aggravated. Persons who sleep 
late become nervous and serious. 
Fourth Period. From 9 P. M. to 3 A. M.—Influence of Night. 
Horizontal position increases the blood in the brain. The diseases 
from cold, dampness, and debility increase, almost all spasms cease. 
In natural sleep the pulse is slower, and there is a general remission 
in the animal functions. Towards 2 or 3 A. M. the pulse rises; a pe- 
culiar shock is felt by some gouty, hypochondriacal or asthmatic sub- 
jects ; even epilepsy and various critical paroxysms occur at this period. 
The second sleep is lighter from the coolness of the air. At this time 
are felt other irregular actions in the diurnal circle, as the shocks felt 
by rheumatics, headaches, pain in old luxations, announcing almost every 
atmospheric change, as rain, hailstorms or dry weather. The symp- 
toms affect differently according to the time of life. In infancy the head 
is the weakest point, as the throat and chest are most vulnerable 
in youth, the stomach and liver in the adult, the bowels, urinary organs 
and haemorrhoidal vessels in old age. 
The day calls into activity the life of relation; the night increases 
the force of the organic, the nutritive life; cutaneous transpiration is 
double what it was in the day. {Bell on Periodicity.) Great sleepers, 
says Darwin, “ become fat and fair skinned.” Sleep is but the result 
of the inaction of all the apparatus which compose the machinery of 
the external functions ; and the human body could now be excited to 
many different actions at the same time, with benefit to all. The soft 
whisperings of ambition may prompt the aspiring student to encroach 
upon the hours allotted to sleep, but it will always be done at the ex- 
pense of indigestion, irregular circulation and respiration, and other 
departures from true health. Respiration and circulation are per- 
formed with energy in proportion to the numbers of organs in action ; 
thus long sleep chills the body, diminishes the circulation, and the fre- 206 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
quency of the pulse. When digestion is completed, the increase of 
fluids thrown into the circulation, excites the heart and lungs to greater 
action; but if digestion and secretion be retarded they react by sym- 
pathy on the heart and lungs and precipitate their movements. If we 
go to sleep with a tranquil condition of the system generally, and 
digestion has been imperfect, on waking in a few hours we find the 
heart beating strongly, the chest full, and the skin hot. Respiration 
and circulation are performed more slowly in the first part of the night. 
About two or three hours after midnight the external senses begin to 
awake and these two important functions are aroused also. Hence 
parturition generally takes place in the night and the morning. 
Influence of the Diurnal Revolution on Disease. Morning.— 
Most diseases remit in the morning. In mucous and intermittent 
fevers, persons who had been in agony during the night have strength 
enough in the morning to go about. Insensible perspiration is more 
abundant, hence dropsies and oedemas are diminished. Hectic fever 
ceases at this time only. There is remission in spasmodic diseases, 
and phlegmasias ; asthenic diseases are milder. 
But this same morning amelioration with increased general vigor be- 
comes the cause of the invasion of several sthenic diseases. Angina, 
vernal agues, and simple synocha increase the first hours of the day. 
Ophthalmia is more acute; haemoptysis in young persons more ge- 
nerally commences. The sweat of pthisical patients, hysteric swellings, 
pyrosis, and the irritation of Avorms are increased; in typhus the 
morning exacerbation is more violent than that of the e\a?ning. Wounds, 
ulcers, gangrene, carcinoma and phlegmons are increased in intensity. 
Influence of Mid-day.—Solar mania only comes on in the heat of 
the day and disappears at night. One Avoman became deranged pre- 
cisely at one P. M. The phrenitic become violent towards tAvo or three 
P. M. Avith chills and remarkable exacerbations. An acute arthritic 
cephalalgia came on daily at noon. (Sauvages.) The eruption of distinct 
small-pox commences at this hour. Coma, vigil, typhomania, the vio- 
lent delirium of complicated intermittents of warm climates causing 
tetanus, trismus, erysipelas, sun-stroke, are all more severe during the 
heat of the day. 
Influence of Evening.—All quartans come on in the afternoon; quo- 
tidians at early morning, and tertians toward mid-day. All catarrhal or 
heaATy phlegmonic affections, inflammations of the organs of animal life or 
of the external relations are aggravated in the eA'ening. Sick head 
aches are increased, comatose affections and apoplexies strike in tli 
evening or the night; lethargies, palsies, faintings, sudden attacks of 
hypochondriasis and hysteria, sIoav nervous fever, the oppression from 
dropsy, articular and rheumatic pains are aggravated in the evening 
and night. PERIODICITY IN THE ACTION OF THE ANIMAL ECONOMY. 
207 
An intermitting febrile hemiplegia commenced at four P. M., ceased 
at six A. M. and was cured by Bark; and a periodical cough begin- 
ning at seven P. M. was broken by Opium. Suppurative fever comes on 
with the wounded, restlessness and jactitation of nervous lesions are 
especially prominent at this period. In consumption with Vomica there 
is an insupportable anxiety at this time of the day. Itch, herpes and 
chilblains are worse in the evening. Hectic fever is worse then, though 
the patient sleeps during the day. Diseases of the throat when inflam- 
matory are worse in the evening. 
Diseases of the spleen, mesentery, obstructions of the viscera, haemor- 
rhoids, gout, dysentery, and affections of the urinary organs in the aged 
are aggravated in the evening. (Bell on Periodicity.) 
Influence of Night.—Sthenic diseases remit in the night, others 
that are milder during the day, as furious phlegmasias, catarrhs, 
croups, lymphatic disease, dropsy, cachexia, asthenic diseases increase 
in the night. But the living body is in this respect like a living clock 
wound up by nature and kept going by the rapid movements of our pla- 
net and the sun. A countess at Madrid lost her voice at sunset and 
only recovered it at early dawn. This paralysis of the recurrent nerve 
of the eighth pair ceased when she arrived at Naples, but returned when 
she reached Rome. (Humboldt.) Other cases of nocturnal paralysis, 
delirium and vertigo, beginning at the same hour have been noticed. A. 
tavern-keeper at Tarentum was rational during the day and became in- 
sane every evening as night approached. (Aristotle.) Persons affected 
with hemeralopia can see during the day, but lose their sight in the 
evening, all objects appearing as if covered -with an ash-colored veil. 
(Scarpa.) Those who have nyctalopia can see little or nothing during 
the day, but can see quite well at night with small light. Some head- 
aches begin at night, others cease at that time. A woman became in- 
sensible at sunset, and recovered her powers in the morning. Incubus 
or night-mare comes on during the first sleep of night. 
Toward two or three in the morning when the pulse has risen, ac- 
tions of another sort begin. Sydenham was surprised that gout, and 
Floyer that asthma should always begin at this time. Dropsical 
spasms, violent palpitations which wake the alarmed hypochondriac, 
or frightful dreams are then experienced. The somnambulist rises and 
moves about. Aged persons and others in slow fever are troubled with 
restless wakefulness. After this state of spasm there is a condition of 
excitation ; the consumptive sweats and hectic increases; aphthae and 
miliary eruptions of children effloresce, critical sweats in mucous fevers, 
different eruptions, as tinea and others begin to appear. The dyspep- 
tic wakes at midnight, and finds his tongue moist; at early morning his 
mouth is parched, rough and loaded. In 1691 there was an epidemic 
in which the sick after sunset were in a state of extreme depression 208 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
and almost dying during the night. In 1743 an epidemic prevailed in 
the English Army in Flanders in which there was entire remission 
during the day, and the pulse little accelerated; but, on the approach 
of night, without any chill, the fever rose suddenly and the patient was 
delirious; in the morning it had all passed away, and there appeared 
no danger during the day. 
Influence of the Diurnal Devolution on Mortality.—The greates 
number of deaths happen at early morning or after sunrise; more die 
during the day than the night by one sixth. In the evening the great- 
est mortality is upon the approach of night. 
Comparative mortality of the present with former times. According 
to the Registrar General’s Report (England). 
For every 100,000 persons living there were 
in 1679 in 1859 
deaths by small-pox 357, 42. 
“ “ fever 749, 59. 
“ “ childbirth 86, 17. 
“ “ dysentery 753, 8. 
“ “ cholera 130, 7. 
“ “ scurvy and purpura 142, 2. 
“ “ syphilis 21, 12. 
“ “ dropsy 298, 26. 
“ “ consumption 1079, 611. 
“ “ diseases of digestion 146, 95. 
“ “ children by convulsions 1175, 136. 
The statistics make the average duration of human life in England 
42 years; in France 40; Germany 37 ; Holland 38 ; Naples 36 ; show- 
ing an increase for each country of about 6 years since 1679. 
M. Flourens asserts that “ the duration of life is in proportion to 
the duration of growth; the duration of growth to that of gestation ; 
and the duration of gestation to the height of the animal.” He further 
declares that his researches show that: “the duration of growth is 
limited by the union of the bones with their epiphyses, and that in all 
animals which he has subjected to his observation, the duration of life 
is five times that of their growth. This union of the epiphyses takes place 
in man at twenty years, and hence he concludes that the normal dura- 
tion of life must be one hundred years. Nature then demands that the 
average duration of human life shall be extended up to this point.” 
The comparative muscular power of man at different ages has been 
approximated by M. Quetelet in “experiments” on this subject. His 
conclusions drawn from experiments on sea-faring men are: 
1. Muscular force increases up to forty years. 
2. The strength of back, or renal force begins to diminish at an 
earlier age than muscular force. PERIODICITY IN THE ACTION OF ANIMAL ECONOMY. 
209 
3. The renal force of a seaman at fifty is no more than that of a novice 
of sixteen years old. 
4. Those little advanced in age, and those fully advanced, are equal 
to each other in the development of muscular force. 
5. Renal force, or strength of back, doubles between the age of eleven 
and fifteen years, triples between fifteen and forty; and after that age 
decreases. Manual force in its augmentation and decrease follows an 
analogous course. 
Food is taken into the stomach for the purpose of supplying the 
body with material to rebuild the physical structures which are in the 
perpetual process of dilapidation through the wear and tear of life. 
Its value as food is estimated first by the time it requires for its con- 
version into assimilable material, 2. the quantity of blood it will make, 
and, 3. the quality or specific nature of the blood after it is formed. 
1. Digestibility of Food.—Authors on this point have generally 
considered solution as the whole of the process of digestion. The 
following general principles are derived by Moleschott from chemical 
reasoning: 
“ As all the secretions concerned in digestion contain a considerable 
proportion of water, the simple alimentary principles must, as a 
general rule, be the more digestible, the more soluble they are in 
water. The chlorides and alkaline salts pass more easily into blood 
than earths; and the organic acids than dextrin, sugar, starch, cel- 
lulose, or fat; soluble albumen or legumin easier than the coagulated 
vegetable albumen or fibrin.” It is also laid down as a further law, 
O , ... . 
“ that alimentary principles are digestible tn the ratio of the 
nearness of the relation in which they stand to the last link of the 
series of allied forms. (llandbuch der Didtetik.) 
The influence of cookery on food is of great importance in promot- 
ing its digestibility. In the common process of roasting meat, the 
outer layer of albumen becomes coagulated, and thus it prevents the 
exit of that which is still fluid within. The cellulose tissue, which 
unites the muscular fibres, is converted by gradual heat into gelatine, 
and is retained in the centre of the mass in a form ready for solution. 
At the same time the fibrin and albumen take on a form more highly 
oxydized and more capable of solution in water. The fat also is melted 
out of the fat-cells, and is directly combined with the alkali from the 
serum of the blood. (Mulder.) Thus the external layer of albumen 
forms a sort of box which keeps together the important parts of the 
aliment till they have undergone the desired modification by slow heat. 
Rapid boiling may produce the external solidification of the albumen, 
but it also dissapates the acetic acid, hardens the interior albumen 
and muscular fibre, and renders them less digestible. 
VOL. I. 14. 210 
GENERAL PRINCIPLES OF MEDICAL SCIENCE. 
'1. Albumen.—Its use is to minister to the textural repairs of the organism. It enters into the cell wall 
or periplast, which with its nuclei and nucleoli, represents an organ employed both in structural repair 
and reproduction. From the blood plasma it constructs and reproduces all the minute cell germs re- 
vealed by microscopic anatomy, C216 Nias N27 82 Oss 
2. Fibrin.—It perhaps owes its origin to albumen. In exudations it forms the nidus for development of [Protein C40II32 N50i2j 
tissues and adventitious growths, C2I6 Hi69 N27 82 068 
3. Gelatine.—Not assimilable, and is thrown off in the urine, Cis TI10 N2 O5 
4. Casein,—This only appears in the female after puberty, C288 II288 N36 S2 O90 
5. Osteine.—United with Carb. lime in the bones and white fibrous tissue. It replaces cartilagine as bone 
replaces cartilage. 
6. Plasticine, globuline, crystalline, 
Musculine. In muscular tissue,—Contractile, soluble in water and Mur.-acid. 
Osteririe, Cartilagine, Keratine. 
Mucosine, Melanine, Urosacine. 
Pepsine. 
Haematine. 
Biliverdine. 
Pancreatine. 
COMPOSITION. 
1. Water constitutes from 75 to 90 per-cent of the body. It is fixed in the composition of 
Osteine, Muscaline, .fee., and is in a gaseous state in thelialitns from the lungs HO 
2. Chloride of Sodium. Found in the blood, serum, and all the tissues, except the enamel. 
It holds the albumen in solution, and regnlates endesmosis and exosmosis Na Cl 
3. Chloride of Potash. Found in the blood-cell. 
4. Phos. Lime. With Osteine and water it forms more than half the bone structure. Phosphates 
of Magnesia, soda, and potash. 
Carbonate of Calcium gives firmness and solidity to the bones. An important remedy, Ca 0 C O 2 
Carb. Potassium, gO CO2-T-HOCO2 
“ Sodium, NaO C02 -f-10Aq. 
“ Magnesium, Mg 0 C 0 2 
f Alcohol. Not assimilable in the body. Injurious when food issnfficient. When food is deficient, 
I or of improper quality, Alcohol may lessen the too rapid waste of tissue material. Ct 116 O2 
| Tea. 
t Coffee, • Caffeine. C16 N4 IIi6 O 
'Starch. Changed into sugar by the action of saliva and pancreatic juice, CnHioOio 
Sugar. Changed into lactic acid which dissolves phosphate of lime. Found also in the liver; C12 Hll Oil 
and it undergoes the transformation in the blood called catalysis. Glucose (grape sugar), C12 H14 O14 
Fat or OH, including Oleine, Margarine, stearine, eholesterine, (bile-fat,) serolin. By oxidation 
they contribute to animal heat, facilitate absorption and assimilation of food, and upbuilding of 
the bodily textures. In the body they exist, as adipose tissue enclosed in cells, in chemical com- 
bination with other elements, and as oil-drops or fat-globules entering into most of the solids. 
. Glycerine or the sweet principle of Oils, C6 H7 Os -f Aq. 
PHYSIOLOGICAL AND CHEMICAL CLASSIFICATION OF NUTRITIVE SUBSTANCES. 
A. Those whose che- 
1 mi cal identity is pre- 
I served in the organism. 
We find them in the 
bones, the cartilage, the 
I ligaments, and in the 
blood. 
B. Those which in 
the body undergo che- 
mical transformation. 
They are non-Nit.roge- 
nized, consisting of Car- 
bon, Oxygen, Hydro- 
gen. 
C. Those which act 
by preventing an ex- 
cessive tissue-waste or 
, metamorphosis. 
I. 
Direct Nutrients, 
Consisting of Albuminoid, pro- 
teinaceous, Nitrogenized or his- 
togenetie compounds of Carbon, 
Oxygen, Hydrogen, and Nitro-. 
gen, with a minute trace of 
Sulphur and Phosphorus. They 
exist in two forms : 
1. Soluble. 
2. Insoluble. 
II. 
Indirect Nutrients. 
Non-N i trogenized 
or Proximate, Im- 
mediate principles. 
In a crude state 
they are capable of 
becoming part of 
the typical fluids 
orsolids. When tri- 
turated or dyna- 
myzed they become 
capable of acting 
on the organism as 
remedies. 
Substances employed as Food for the Support of the Tinman Organism, 
TO BE INCOBPOBATED INTO THE TISSUES AND OIIGANIZAI1LE FLUIDS, 
Are divided into, ARRANGEMENT AND CLASSIFICATION OF DISEASE. 
211 
ARRANGEMENT AND CLASSIFICATION OF 
DISEASES. 
Diseases may be arranged under two grand divisions: acute and 
chronic. 
The first division, or acute diseases, consist of rapid operations of 
the vital power in conditions more or less differing from those of the 
same organs in health. They terminate in a shorter or longer period 
of time, but are always of moderate duration. 
2. Chronic Diseases are less distinct, often almost imperceptible on 
their first appearance. They “ seize upon the organism, each according 
to its own peculiar manner, and remove it by degrees so far from the 
state of health, that the automatic vital energy which is destined to 
support the latter, and which is called the vital power, can not resist 
but in a useless and imperfect manner ; and not being potent enough 
to extinguish them herself, she is compelled to allow them to grow un- 
til, in the end, they destroy the organism.” These slowly-operating 
diseases are usually dependent on some constitutional infection or 
miasm. 
Acute disease are distinguished under two heads. 
1. Sporadic.—They attack single individuals, and arise from some 
pernicious cause to which the patient has been exposed: Eating or 
drinking too much or too little, violent impressions of physical agents, 
as cold, heat, fatigue, or mental excitement. But there is also an ag- 
gravation of the latent psoric affection, which is commonly only lulled 
by the treatment which is called successful. 
2. Epidemics.—These begin to attack individuals here and there 
{sporadically) under some meteoric or telluric influence of whose action 
but few persons are at the time susceptible. But the true epidemics 
attack many individuals at the same time; the cases begin from similar 
causes, exhibit analogous symptoms; and the diseases usually become 
contagious when they act upon close and compact masses of human 
beings. These different maladies are of a distinct nature; the individual 
cases of each disease being all of the same origin; the patients pass 
through the same conditions, run an acute course and terminate speedily 
in recovery or death. 
The whole number of deviations from a state of perfect health can 
scarcely be estimated; and it may not be possible to make any syste- 
matic arrangement of them into separate diseases specifically distinguish- 212 
ARRANGEMENT AND CLASSIFICATION OF REMEDIES. 
able from each other, as individual specimens of Natural History 
have been classified and described. But inasmuch as no subject of 
scientific inquiry can be successfully prosecuted without methodical ar- 
rangement of its most important facts and principles according to some 
system, we shall proceed to distribute the principal branches of the 
great subject of Practical Medicine into a series of natural groups of 
diseased manifestations, without claiming that any classification of dis- 
eases can ever be devised that shall be free from defects, or that a more 
perfect arrangement could in any considerable degree facilitate the 
successful application of remedies in the cure of those diseases. It is 
not in this day believed, that the proper treatment of a given case can 
ever be determined from its systematic name or position in the noso- 
logical catalogue of diseases ; it is not even pretended that truly correct 
or expressive names can ever be given to each of the vast assemblages 
of symptoms that we meet within individual cases of disease. But we 
still find that the purposes of study and conveniences for reference to 
special subjects of research are facilitated by some arrangement, (which 
may not be the most symmetrical that human genius might devise,) and 
by giving names to those groups of symptoms which are most likely to 
be found together. By the name of a disease in this work we do not 
mean a specific entity which like a bird or a plant will always be found 
to present the same precise characteristics. The name is simply 
meant to announce a group of phenomena, which are so generally 
found in company that they may be supposed to have some relationship 
■with each other, and which, taken together, present a picture easily 
recognized. 
“In such classifications,” says Lord Brougham, “we should be guided 
by views of convenience rather than by any desire to attain perfect 
symmetry; and that arrangement may be best suited to a particular 
purpose, which plants the same things in one order, and separates them 
and unites them in one way, when an arrangement which should dis- 
pose those things differently might be preferable, if we had another 
purpose to serve.” 
Our classification of diseased conditions will be derived from that 
classification of functions in a state of health, which is most obvious to 
the senses as exhibited in normal human physiology. We prefer this 
arrangement, because it is already familiar to every student of physio- 
logy, and because it presents a sufficient range for subdivisions. 
Class I. Diseases of the Digestive Function.—Derangement of 
organs employed in receiving, preparing and appropriating food for 
physical support of the body. 
Class II. Diseases of the Respiratory Function.—Derangement 
of the apparatus employed in exposing the blood to the influence of the 
atmospheric air. DISEASES of the digestive function. 
213 
Class III. Diseases of the Circulatory Function.—Disordered 
action of the apparatus employed in the mechanical circulation of the 
blood throughout the body. 
Class IY. Diseases of the Nervous Function.—Disordered action 
of the apparatus for regulating the movements and feelings of the body. 
Class Y. Diseases of the Reproductive Function.—Deranged 
action of the apparatus designed for the continuance of the species. 
Class YL Diseases of the Secernent Function.—Deranged action 
of the organs designed to carry off impurities and to remove superfluous 
and effete materials. 
CLASS I. 
DISEASES OF THE DIGESTIVE FUNCTION. 
OUTLINE OF THE PROCESS OF DIGESTION. 
In all animals we find some organ that answers the purpose of a 
stomach, which seems the most important and indispensable of all the 
animal structures; and there are some of the lower animals that con- 
sist of scarcely anything else. “A stomach,” says Jones in his Na- 
tural History, “is absolutely all that is required. A stomach,provided 
it can live, is an animal.” In man we see the most perfect and com- 
plicated arrangement of organs for the accomplishment of the process 
of digestion. The apparatus by which the materials for the nutrition 
of the body are furnished in a form available for the purposes of main- 
taining the life of the individual provides for: 1. The taking of food; 
2. Mastication or mechanical division of it, including its mixture with 
the saliva; 3. Deglutition or its conveyance to the stomach ; 4. Chy- 
mif cation or the solution and reduction of the food preparatory to its 
being brought into a condition favorable for absorption; 5. Chylifica- 
tion or the separation of the portions of the food which contain the 
chief nutritive principles in a condensed form, and freed from the coarser 
and useless parts which are left in the lower portion of the intestinal 
tube to be expelled from the system. 
1. The food, consisting of animal, vegetable or mineral substances, is 
presented to the lips in which the powers of sensation are so perfect 
that the quality of the food is perceived before it has touched the teeth. 
2. Mastication. The incisor, or front teeth begin by cutting up 
the food at the same time that the finer parts pass to the tongue, while 
the harder pass to the molar teeth at the sides of the tongue to be ground 
by their broader surfaces. As the teeth differ in size and in position, 
their power and mode of action are different; and the juices pressed 214 
DISEASES OF THE DIGESTIVE FUNCTION. 
out at different parts of the mouth are applied to the surface which is 
fitted by nature to receive and transmit to the brain the impression made 
upon the sense of taste at the same time that the nutrient juices are 
met and blended with the living fluid called the saliva. This fluid had 
begun to flow from the salivary glands before the food was taken into 
the mouth, and now, the movements of mastication, the pleasant taste 
and the suctional power of the tongue, continue to draw the saliva from 
the glands on every side, and to blend it with the food which it assists 
in dissolving, and thus fitting it for more perfect digestion in the stomach. 
The saliva secreted by the different glands differs widely in its 
characters and quantity; that of the parotid is the more watery and 
abundant, and is secreted principally during the act of mastication : 
that of the submaxillary is more scanty, hut more viscous, and is more 
plentifully secreted during excitation of the nerves of taste; that of the 
sublingual and buccal glands being the most scanty, but excessively 
glutinous, facilitating the act of deglutition; the viscous element is called 
ptyalin. The reaction of the saliva is very alkaline. The secretion is 
not constantly the same in quantity, but is intermittent, depending on 
the presence or absence of its exciting causes. It is increased by dry 
and pungent foods, lessened in amount by moist and sapid food. 
The saliva exerts no influence on albuminoid and fatty matters; hut it 
has long been known that it possesses the property of converting starch 
into sugar; this has been attributed to a certain special substance con- 
tained in it called salivary diastase. It is observed that this property 
is more conspicuous in morbid saliva, as that of salivation; complete 
putrefaction destroys it: The presence of acids also arrests decomposi- 
tion and prevents the further action of saliva on the starch. The sole 
action of insalivation on alimentary matters is to convert starch into 
dextrine and glucose or grape sugar.* 
From the pleasing and instantaneous effect produced by the sapid 
bodies on the tongue it is believed, though it can not be proved, that 
the most refined elements of savory food are in some way transmitted 
to the sensorium through the tongue, or by absorption from the sides 
and pores of the variously formed prominences of the papillae of the 
tongue. It is known that the bodily and nervous powers are sometimes 
rapidly recruited by the taking of food which there has been no tiihe to 
digest, and by wine or other stimulants which have been only held in 
the mouth. If the finer essences of the food are absorbed before the 
mass leaves the mouth, then the stomach only receives it to complete 
a process already commenced. The higher attenuations of homoeo- 
pathic medicines often produce their most striking effects when applied 
to the tongue in quantities too minute to be swallowed. Like the 
* See Bernard. Legons de Physiol. Yol. II., 1856. OUTLINE OF THE PROCESS OF DIGESTION. 
215 
“ Quintessences” of the old alchemists they produce their effects on a 
principle which is above the comprehension of the materialist. 
3. The act of swallowing is effected by the rolling of the masticated 
food back into the pharynx, or the chamber between the mouth and the 
oesophagus. ( Wilkinson.) The pharynx contracts on the soft mass and 
forces it into the oesophagus, which gives way to receive the food, and 
then contracting behind it, forces it onwards to the stomach. The 
passage for the food, having been lubricated by the saliva, and moistened 
by all the fluids taken into the mouth, the transmission to the entrance 
of the stomach in easily effected; and the action appears to be volun- 
tary, though all the parts of the process of deglutition are completely 
beyond the voluntary control of the will. 
4. Chymification.—The stomach is a vaulted chamber consisting of 
three walls or coats which extend throughout the whole of the intestinal 
tube. Its inner wall or coat is made up of a series of small compart- 
ments placed side by side, and which open into its cavity. They differ 
in construction in different parts, and are pervaded by the most delicate 
nerves and blood-vessels. The inside of the stomach consists of a kind 
of honey-comb surface, crowded with little mouths, which, when the or- 
gan is aroused are red and turgid with blood. At the same time also, 
numerous little points or papillae on the surface of the membrane are 
awakened to action, and bring forth a dissolvent liquid called the 
gastric juice. These honey-comb structures are the inferior or sub- 
stomachs, which form the natural components of the organ. 
The muscular coat of the stomach forms its middle wall. Its fibres 
run “circularly, spirally, and vertically;” and, by their systematic and 
various contractions, they agitate the food. 
Process by which Chymification is effected.—The earliest theory of 
the process of digestion, given by Hippocrates was, that the food was 
reduced to a proper state for the support of the body by putrefaction. 
Galen thought the effect was brought about by heat; Yan Ilelmont 
thought it the result of the vital energy of the soul which resided in 
the stomach. Boerhaave attributed much to the grinding action per- 
formed by that organ. Pringle and MacBride considered the process 
of digestion to be one of fermentation. At last Cheselden happened 
to conjecture that the food was dissolved “by some unknown menstru- 
um.” This hypothesis guided Spallanzini and Keaumer who first 
proved the solvent power of the gastric fluid. The present theory of 
digestion was more distinctly set forth by Dr. Beaumont in 1834, and 
has been variously modified by other observers. 
A young man named St. Martin was accidentally wounded by the 
discharge of a gun in 1822. The charge of powder and duck-shot 
entered his left side, passed obliquely forward and inward, “ blowing off 
integuments of the size of a man’s hand, fracturing and carrying away 216 
DISEASES OF THE DIGESTIVE FUNCTION. 
the anterior half of the sixth rib, fracturing the fifth, lacerating the 
lower portion of the left lobe of the lungs, the diaphragm, and perforat- 
ing the stomach.” After some weeks of fever, inflammation, and sup- 
puration the sides of the protruded portions of the stomach formed ad- 
hesions to the pleura costalis, and, the external wound being still un- 
closed, an aperture remained through which the communication could 
at any time be had with the cavity of the stomach. After the lapse of 
one year from the accident the aperture in the stomach remained two- 
and-a-lialf inches in circumference, and was ordinarily covered by a 
compress and bandage. After a few months more, a fold or doubling 
of the coats of the stomach formed a covering for closing the aperture, 
preventing the escape of the contents of the stomach, though it could 
be easily depressed with the finger. Three years after the injury was 
received Dr. Beaumont of the U. S. Army commenced a series of ex- 
periments on the process of digestion and the nature of the gastric 
fluid. TheyAvere continued with some intermissions up to 1833. They 
have since been resumed by Prof. Sewall, and the results of further ex- 
periments are given in the Amer. Jour, of Med. Sciences, 1857. 
As soon as the food swallowed enters the stomach it becomes mixed 
with the gastric juice, a fluid strongly acid from the'presence of lactic, 
or perhaps hydrochloric acid, and containing the animal principle, 
pepsine. 
The Gastric Fluid.—Its Properties, Origin, and Mode of Action. 
The pure gastric fluid when taken directly from the stomach of a 
healthy adult, and mixed only with the portion of mucus of the stomach, 
■with which it is almost always combined, is a clear transparent fluid, 
inodorous, a little saltish, and very perceptibly acid. Its taste when 
applied to the tongue, is similar to thin mucilaginous water, slightly 
acidulated with muriatic acid. It is readily diffusible in wine, water, 
or alcohol; it effervesces slightly with alkalis, and is an effectual 
solvent of all substances proper for food. It coagulates albumen, is 
powerfully antiseptic; checking the putrefaction of meat, and effectually 
restoring to healthy action old foetid sores and foul ulcerating surfaces, 
when externally applied. {Beaumont.) 
The mucus mixed with the gastric juice may be separated from it 
by filtering the mixture through fine linen or cambric; the mucus and 
frothy part of the saliva, when retained, the mucus gives the fluid a 
ropiness which may gradually subside to the bottom in loose flocculi. 
Saliva imparts to the gastric juice an azure tinge and frothy appear- 
ance; and, when in large proportion, renders it foetid in a few days; 
whereas the pure gastric juice will keep unchanged for many months. 
Professor Silliman says it may be kept for years. 
The secretion of the gastric fluid is affected through what is called a 
reflex action, which is ordinarily excited by the impression of food upon OUTLINE OF THE PROGRESS OF DIGESTION. 
217 
the nerves of the stomach. The nervous influence thus excited ciuses 
the sudden and rapid pouring out of this fluid, just as the nervous in- 
fluence called into action by mechanical irritation of the conjunctiva 
produces a flow of tears. The same secretion may also be excited by 
irritating the mucus membrane of the nostril. 
“ The gastric fluid appears to be secreted from numberless vessels, 
which are distinct and separate from the mucous follicles. These 
vessels, when viewred with a microscope appear in the shape of small luciu 
points or very fine papillae, situated in the interstices of the follicles. 
They discharge their fluid only when solicited to do so, by the presence 
of aliment or by mechanical irritation. Beaumont says when the coats 
of the stomach were seen perfectly clean and healthy and no fluid was 
in the stomach, the irritation of an elastic tube in the cavity excited a 
sensible flow of acid liquid which flowed from the tube drop by drop. 
On giving a piece of bread to eat the flow increased. {See Budd, p. 19.) 
The pure fluid never accumulates in the stomach until the presence 
of alimentary matter excites the secretory vessels to pour out their 
contents. It then begins to exude from the surface of the stomach, in 
quantity proportioned to the quantity of food received or required. On 
abstracting the contents of the stomach after the bread was eaten it 
was found partly mixed with saliva and mucus and tinged with bile, 
yellowr or clear limpid fluid then spread over the surface, trickling down 
the sides of the cavity; and after slight exercise more fluid, a very 
clear gastric juice was collected, in all about five drachms. A definite 
proportion of aliment only can be digested in a given quantity of the 
fluid. “When the fluid becomes saturated, it refuses to dissolve any 
more,” and when an excess of food is taken, it remains undigested in 
the stomach or passes into the bowels in a crude state, where it causes 
irritation, pain or nervous symptoms in other sympathizing organs. 
Though varying in physical properties from the changing condition of 
the stomach, and from the different other fluids mixed with it, the 
gastric fluid is believed to be always essentially the same substance. 
Derangements of the digestive organs, slight febrile excitement, fright, 
or other sudden affection of the passions, over-eating, and many other 
causes may produce acidity or even rancidity in the contents of the 
stomach, and lessen the solvent power of the gastric juice; and general 
febrile irritation seems entirely to suspend its secretion, at the same 
time rendering the villous coat dry, red, and irritable. Fear and anger 
check the due secretion of the fluid, the latter causing an influx of bile 
into the stomach, wrhich produces nausea or vomiting according to its 
quantity. {Budd.—Diseases of the Stomach.) 
Recent researches have led to the inference that the amount of the 
gastric juice and consequently the amount of materials needed for its 
supply, is much greater than has been hitherto imagined. Lehmann 218 
DISEASES OF THE DIGESTIVE FUNCTION. 
estimates that not less than four pounds of gastric juice is secreted daily 
by a man in health. (Lehmann's “Physiological Chemistry.'1'1 Day's 
translation. Yol. II. p. 53.) 
The researches of Dr. Prout led him to consider muriatic acid 
as the proper acid of the gastric juice. When acid is vomited, 
when a gall-stone is passing the renal duct, and when the stomach is 
empty and containing no other acids, the acid vomited is the muriatic. 
(.Budd, p. 155.) 
Phenomena of the Process of Chymification.—When the food is 
first received into the stomach this organ is stimulated to contract and 
embrace firmly the substances presented to it. The orifice at which 
the aliment entered contracts closely, to prevent its return, and the 
pyloric orifice is still more firmly constricted, to prevent its escape until 
it shall be softened and changed into chyme. The muscular fibres of 
tbe stomach towards the cardiac end persist in a firm and steady con- 
traction, which slowly pushes the mass towards the pylorus. Towards 
the pyloric aperture the movements of the fibres resemble those called 
the vermicular contractions of the muscular fibres of the intestines, 
clasping and pressing forwards the yielding material, which the vigilant 
pylorus refuses to admit so long as the softening mass contains portions 
imperfectly dissolved, or capable of irritating its excitable fibres to 
contraction. 
During the process of digestion “there is a perfect admixture of 
gastric juice and food—the particles of food are constantly changing 
their relations with each other, and they are mixed with a quantity of 
fluid consisting of the gastric juice and the fluids taken during the 
meal.” Beaumont, having often observed a large quantity of fluid in 
the stomach when little had been taken into it, suspected that water 
was synthetically formed during the process of digestion. It is more 
probably secreted as mucus in an unusually fluid state. The mixture 
of food and the solvent fluids is “perfectly heterogenous at first;” but 
the “churning motions of the stomach” and the active powers of the 
gastric juice change its appearance very rapidly. If the contents of 
the stomach be taken out in from thirty to sixty minutes after eating, a 
mixture of perfectly formed chyme and particles of unchanged food 
will be found blended together in various proportions, according to the 
condition of the stomach and the quantity of food taken. 
It has been supposed that the gastric fluid was only secreted at the 
moment of its expulsion from its secreting vessels, inasmuch as no such 
fluid is found in the stomach wdien empty or unexcited by irritants of 
any kind. But it is more probable that the gastric fluid accumulates 
in its own proper vessels during some time preceding the taking of 
food. 
“On applying aliment to the internal coat of the stomach, which in OUTLINE OF THE PROGRESS OF DIGESTION. 
219 
health is merely lubricated with mucus, innumerable minute papillae, 
the orifices, undoubtedly, of the gastric vessels, immediately throw out 
a quantity of the fluid which mixes with the food. The effect is too 
sudden and the secretion is too copious to be accounted for on the or 
dinary principles and laws governing secreting surfaces. The quiescence 
and relief,” says Beaumont, “from the unpleasant sensation which is ex- 
perienced as soon as the vessels are emptied, furnish additional proofs 
that the fluid was already secreted, and only discharged from the 
secreting vessels when their mouths were excited by the stimulus of 
food.” 
The precise nature of the changes effected by-the process of digestion 
on the various substances used as food has never been perfectly ex- 
plained. Within a few years the opinion has become prevalent that 
digestion consists in a “peculiar fermentative process.” Ure says “the 
gastric fluid is a genuine ferment.” And many efforts have been made 
to furnish by chemical combinations a substitute for the digestive fluid 
when deficient in quantity or defective in quality. Tiedemann, 
Gmelin, and Prout have shown “that the gastric fluid contains muriatic 
acid:” and Eberli has made experiments “on the digestion of food out 
of the body with water containing a few drops of the same acid.” The 
fluid used by him needed a minute quantity of the mucous secretion o 
the stomach. Schwann and Vogel have produced this digestive prin- 
ciple in a pure state and called it pepsine. Rennet, with which milk 
is congulated in making cheese, is of nearly the same nature as pepsine 
But the simplest digesting liquor is the following: “If 10,000 parts of 
water by weight be mixed with six parts of ordinary muriatic acid and 
a little rennet, a liquor is obtained capable of dissolving hard-boiled 
white of egg, beef, gluten, &c., into a transparent jelly in a few hours.” 
(lire's Diet. Arts. &c., Sup. p. 94.) 
The gastric fluid has no influence on living bodies, as is shown by 
the experiments of Spallanzini and others. If the legs and feet of a 
living frog be thrust down into the stomach of a lizard, and be confined 
in that situation, the gastric juice has no action upon them so long as 
the frog lives; but if the frog be killed and be replaced in this situation, 
they are digested to a pulp in a few hours. 
When a living frog in a state of magnetic torpor is swallowed by a 
serpent the gastric fluid does not commence digesting the skin of the 
frog while the latter continues alive. After remaining some days in tho 
stomach the imprisoned victim may be liberated, and he will return to 
his place in the neighboring brook, and join his comrades in a songJ 
In one instance of this kind we observed the frog’s skin entire, though 
it showed evidence of long maceration; and the whole body and limbs 
were reduced to the most extreme degree of emaciation. 
On fatty matters the gastric juice exerts no influence; the fat is 220 
DISEASES OF THE DIGESTIVE FUNCTION. 
simply liquefied and left to float in the mixture known as chyme. This 
>fluid has no effect on starch or sugar; but the action of the saliva on 
the starch becomes arrested as soon as the saliva becomes acidulated 
by the gastric juice. But albuminous and gelatinous substances are 
dissolved by the gastric juice, and their properties are so modified that, 
although previously not transmissible through an animal membrane 
they become capable of permeating it readily; “they become more easily 
soluble, less coagulable, gelatin ceases to gelatinize; they lose the pro- 
perty of forming insoluble combinations with most metallic salts, but 
they are so precipitated by Tannic-acid, Chloride of Mercury, and Acetate 
of Lead when mixed with Ammonia.” 
In addition to the gastric juice the stomach secretes ordinary mucus? 
and this sometimes in such large quantities as to interfere with the 
action of the gastric juice upon the food: containing more or less ex- 
crementitial matter, this mucus often becomes the exciter of fer- 
mentation. 
Atmospheric air and carbonic acid are often conveyed into the 
stomach, and from its surface they and other gases are readily absorbed. 
The pancreatic juice is a highly albuminous alkaline secretion formed 
in the pancreatic gland under the stomach. Its office, according to 
Bernard, is to redissolve albuminous matters after they have been pre- 
cipitated by the bile, from their state of solution in the gastric juice. 
Others suppose “ that fat is absorbed as neutral fat, emulsified by means 
of the pancreatic secretion, or divided into small particles each of 
which is surrounded by an albuminous envelop.” 
The Bile is one the most important fluids engaged in the process of 
digestion. Its precise office has not been well settled. It is supposed 
“to assist somewhat in emulsifying fat; it probably possesses decided 
antiseptic properties; and may precipitate albuminous matters from 
their state of solution. Its water serves as a means of transit of biliary 
matters from the blood, and of nutriment and of other soluble matters 
from the intestinal tube back again in the blood stream.” 
Other glands, opening on the inner surface of the duodenum, jejunum, 
ilium, and coecum, furnish still further supplies of fluids for the solu- 
tion, elaboration and absorption of nutritive matter; and the venous 
radicles, originating at all points of the intestinal tube, collect the 
absorbed food and pour it by the vena portarum into the liver. 
“ As a summary, then we may state, that albuminous matter, whether 
vegetable or animal, is absorbed as albumen, gelatinous matter as ge- 
latin, these being both modified by other fluids. Starch and saccharine 
matters are absorbed as grape-sugar and dextrin, and fat principally as 
neutral fat, a small portion of fatty or other acids being formed.” *f 
* Dr. Teed, Animal Chemistry, &c Amer. Jour. Med. Sci. July I860, 
t Moleschott on Food. Zurich. OUTLINE OF THE PROGRESS OF DIGESTION. 
221 
Absorption of nutritious matters prepared for supplying the waste 
of the different structures of the body.—Every part of the digestive 
apparatus is furnished with absorbing vessels which possess the faculty 
of taking up from the fluid mass, called the chyme, the purer portions 
fitted to replenish the blood with the elements necessary for the sup- 
port of life. The absorbing vessels of different parts of the intestinal 
surface select different materials suited for the wants of organs or func- 
tions with which they are respectively connected. The principle of 
“ series,” says Wilkinson, “ governs here as elsewhere; what is re- 
nounced as useless in the first cavity becomes the especial food of the 
nextand the material rejected in the second chamber is welcomed to 
the third. As the entrance to the mouth is guarded by muscles and 
teeth, a muscular guard is placed at the cardiac orifice or entrance of 
the stomach. When this cavity has assimilated its portion of the food 
it has no longer any affinity for the substances which have become un- 
welcome. The muscular coat contracts upon the mass and it passes 
into the next chamber, where it undergoes a new digestion, and is 
again pressed forwards to the next compartment of the digestive tube. 
In each of these portions of the alimentary canal solvent and appro- 
priate fluids are poured out to dilute, soften, and dissolve the food. 
They draw out its essences, alter them into suitable forms, sheathe the 
sides of the delicate conducting passages, and enable the extracted 
nutrient particles to glide smoothly to their destination. After the sa- 
liva and the gastric-fluid have done their work in the stomach, the de- 
scending pultaceous mass enters the duodenum, where it meets the more 
powerful salivas of the bile from the liver, and the secretion from the 
pancreas. These fluids complete the process of chymification, and, 
when that work is over, they stimulate the intestines to carry forwards, 
and expel the exhausted materials which are to be rejected from the 
system. 
If it be true that the finest essences of the food have, speedily after 
being taken into the mouth, found their way into the blood, or in some 
way made their impression on the sensorium, we need not doubt that 
much of the grosser food is directly assimilated in the stomach and 
absorbed into the general circulation directly from the stomach. “ The 
little veins which stand open throated on every portion of the distinctly 
ventriculated surface carry crowds of these slower individual particles 
into the bosom of the general circulation. The possibility of an imme- 
diate reception of the food by the blood, appears for the most part to 
end with the stomach.” ( Wilkinson.)—A large portion of all the fluids 
received into the stomach is directly absorbed from its surface, especially 
water, spirituous, weak saline, saccharine and albuminous solutions. 
Beyond the stomach a lower order of vessels than the veins receives 
the nutritious particles of the food; these are the lacteals. The fluid 222 
DISEASES OF THE DIGESTIVE FUNCTION. 
absorbed by them is in an intermediate form between that in which it was 
received into the stomach and the blood to which it is going. The lac- 
teals arise from the inner surface of the alimentary tube, decreasing in 
number towards the lower parts. They converge from their origin to 
the receptacle for the chyle, called the thoracic duct, a fine pipe-like 
vessel seated in front of the vertebra. It extends all the way to the 
left side of the neck, where it empties its contents into the left sub- 
clavian vein, from which it flows directly to the heart. In the thoracic 
duct the new materials for the ever-changing blood come in contact 
with some of the old materials of the ever-changing body, the lymph 
which is composed of the matters absorbed by the lymphatics, and 
collected from every part of the body. It is represented as “ the old 
spirit of the blood serving to inaugurate the new body, and thus is the 
last of the salivas, which digests and introduces the chyle itself, as the 
salivary fluids digest and alter the food.” 
The chyle, as it passes through the lacteals, bears but little resem- 
blance to the blood; but, as it advances slowly through the vessels, the 
mesenteric glands and the thoracic duct, its similarity in properties to 
the perfect blood becomes more and more marked; and, by the time it 
reaches the heart, it is intimately mixed with the venous blood. 
The Blood. Physical properties.—Arterial blood is of a red Ver- 
million color, whilst the blood of the veins is of a deeper and darker 
hue. Its temperature in the vessels is equal to that of the body ; its 
mean specific gravity is 1.055, and its quantity according to Valentin, 
in weight to that of the whole body as 1 to 4.25. When drawn from 
from the vessels its consistency changes; it becomes solid or coagu- 
lated. From this state it goes on contracting until the clot floats in 
the surrounding serous fluid. 
Sanguification.—The regeneration of the blood is chiefly effected by 
the flowing into the blood-vessels of the lymph collected by the absorb- 
ents, and chyle from the stomach and intestines. 
The lymph appears in two forms ; the one which is less perfect takes 
its origin from the blood which has transuded through the vascular 
parietes, and has not served for nutrition ; returning from all parts of 
the body, it has to pass through the lymphatic glands before it can 
reach the blood. The other species of lymph is the chief product of 
what are called the sanguineous glands. The lymph passes imme- 
diately into the blood, excepting that portion of it which mixes first 
with the chyle. 
The lymph and chyle (the wrhite blood of some writers) having 
reached the heart, undergo some chemical change, and are immedi- 
ately conveyed to the lungs, where they reject carbonic-acid gas and 
take in oxygen. From the lungs the blood is returned to the heart 
from which it is thrown out by the aorta to every part of the body. OUTLINE OF THE PROGRESS OF DIGESTION. 
223 
In passing through the different secreting organs the blood furnishes 
the materials for the various secretions. Some of the fluids separated 
from the blood are thrown off from the body entirely ; others as the 
saliva, pancreatic and gastric juices, return in part to the common re- 
servoir the blood. (MandZ.) 
The blood thus formed consists of many ingredients, of which the 
most important are: 1. The mature blood-cells, or red blood globules, 
and the colorless or young blood-cells. They derive their nourishment 
from the plasma, and give off the residua of their nutrition, and the re- 
sults of their destruction to be separated by the eliminating organs. 
Those molecules which under any form have been used in the processes 
of life, having once passed through their stage of vitality, are no more 
capable of again entering into the formation of animal principles of the 
same, or of a higher order, but are immediately eliminated by the ex- 
cretory organs ; thus the iron particles which have once entered into 
blood corpuscles which have lived their day and are being broken up, 
are no more taken into the new corpuscles ; and their place must be sup- 
plied with fresh iron from without. No particle that has become effete 
will be assimilated again, but must be expelled; “ and the organ chiefly 
containing these residua—as the spleen (and sometimes the liver)— 
forms an article of food of very indifferent quality, and frequently 
causes great intestinal disturbance. In the case of the liver other 
effete matters may be also concerned. An excessive destruction, a 
diminished supply, or a faulty assimilation, will therefore hare the same 
ultimate effects, and a condition of anaemia or of chlorosis will be the 
the result. In some cases an increased supply remedies the mischief, 
in others the destruction must be checked, and again in others the 
powers of assimilation must be increased.”* 
2. In addition to the water, sugar, albumen, and fat, the blood contains 
saline matters combined with the nitrogenous principles. These become 
separated when the albumen suffers decomposition, and then they obey 
the general laws of excrementitious matter. Sulphur, Phosphorus, Iron, 
Lime, and Magnesia are seldom used as dietetic articles, but they are 
very generally found in the blood in varying quantities; common salt 
is more constantly taken in with the food, and is always found there. 
3. The blood also contains the residua of nutrition on their way towards 
the excretory outlets through which they are to be expelled from the 
body; other unassimilable or unnecessary substances which have been 
absorbed during the process of digestion are also found in the blood 
stream till they are expelled by excreting organs. The chief of these 
are carbonic-acid, urea, uric, phosphoric, sulphuric, hippuric, lactic, and 
oxalic-acids, creatine, creatinine, biliary coloring matter, extractive, &c. 
* Dr. Teed, Amer. Med. Jour. July, 1860. p. 73. 224 
DISEASES OF THE DIGESTIVE FUNCTION. 
Nutrition.—“ The idea of life, or vital action, obviously involves 
that of change. We do not consider any being as alive which is not 
undergoing some continual alteration perceptible to the senses.” Thus 
the plant grows from a germ to a fabric of great size ; a bud or a seed 
growrs to an immense tree. It is seen as an organized structure con- 
taining within it many organic compounds. It multiplies its species 
by the production of germs similar to that from which it originated ; 
and seems to perform all these complex operations without feeling or 
thinking—without consciousness or will. Such are the functions of or- 
ganic or vegetative life. These functions are divided into those which 
maintain the structure of the individual, or nutrition, and those which 
are employed in the reproduction of the species. 
In the animal body a large number of the operations are of the same 
character with those of vegetable life. The processes of nutrition in 
animals are essentially the same as those of plants, hut, on the whole, 
much more active, in consequence of the great law impressed upon or- 
ganic beings, that all vital action causes a wraste or disintegration of the 
instruments or organs employed. It has been known from very early 
periods of the world that there is a perpetual change in the molecules 
of which the body is composed ; and there can he no doubt that this de- 
structive process is not confined to the muscles, of -which organic che- 
mistry treats, hut also occurs in the nervous and all other tissues, even 
the most dense, as the granules of the bone and ivory of the teeth. I 
was upon this incessant change of the nervous tissue that Butler (in 
his “ Analogy,”) founded one of his strongest arguments for the con 
tinuance of the soul in a state of separate and conscious existence aftei 
the wdiole of the material body shall have been entirely abandoned. 
It is now generally admitted that the process of nutrition mainly 
consists in the growth of the individual cells composing the fabric; and 
that these derive their support from the organic compounds with which 
they are supplied by the blood, just as the cells composing the simplest 
plants derive theirs from the inorganic elements which surround them: 
“ and as different species of the latter select and combine these in such 
modes and proportions as to give rise to organisms of very diversified 
forms and proportions: so is it easy to understand how the different 
parts of the fabric of the highest animals should exercise a similar 
selective power, in regard to the materials with which the blood sup- 
plies them. The structure comprising every separate portion of the 
body has a special affinity for some particular constituents of the 
blood, causing it to abstract from that fluid, and to convert into its own 
substance certain of its elements. This conversion is termed Assimi- 
lation. (Carpenter's Physiology, p. 487.) 
“As the first act of nutrition consists of an interchange between the 
cells and vessels, of portions holding certain matters in solution, it is of OUTLINE OF THE TKOGKESS OF DIGESTION. 
225 
necessity, that the molecular changes occur in the cell-fluid and cell- 
walls and not in the vessel-fluids. The parts to be nourished consist 
chiefly of C, II, N, 0; their elements being no longer used in up- 
building tissues, but entering a course of descending transitions, are 
finally expelled by the system; the matters given ofl' by the cells un- 
dergo a splitting into two portions or classes, of which one is rich in 
nitrogen, the other containing little or none of that element. This 
latter under the influence of oxygen forms C 02 and II 0, and thus 
generating heat. Hence nitrogenous food is absolutely essential to 
nutrition in 'proportion sufficient to cover this loss, while carbo- 
hydrates chiefly serve the purposes of animal heat. Where a due 
supply of nutriment is not afforded, the matters dissolved in the exos- 
mosing fluids cannot be fully replaced from the vessel-fluids ; and this 
decrease continues side by side in the cell-fluids and in the vessel-fluids, 
the latter always retaining the predominance as long as any nutrient 
matter remains capable of being assimilated; and when an osmotic 
balance is reached, the cells neither give off nor receive; life is, there- 
fore, extinguished, and, after death, they are found pale and shrunken, 
but they are not dissolved, nor is there any trace that a single cell has 
been removed, from a muscle for instance, it is only the cell contents 
that have disappeared, that is their nitrogenous matters held in solution, 
a larger portion of the water still remaining and the muscles are said 
to be watery.” * 
“As soon, therefore, as osmose ceases, the maintainance of animal heat 
ceases, because after the carbo-hydrates and fat have been consumed, 
nothing remains but this splitting of nitrogenous matters; and as soon 
as this is suspended, although there may be still inspiration of oxygen 
and absorption of it into the circulating fluid, there is no material 
on which it can act, as its action is neither on the nutrient fluid nor on 
the tissues, but on the matter given off from the tissues, which matter 
is replaced from the nutrient fluid. When, therefore, osmose ceases, the 
matter ceases to be given off, the action of the oxygen ceases from 
want of matter on which to act, heat ceases to be developed, and with 
this is the cessation of life.”f 
The quantity of food necessary for the support of the human body 
in a state of health can only be settled by repeated observations. Sir 
John Sinclair says: In the British naval service each seaman is 
allowed 26 ounces of dry nutritious vegetable food per day, to which 
is added from five to nine and a half ounces of meat; the latter if salt 
is extended to nine ounces, if fresh to only four and a half. Sugar and 
cocoa are also given. A soldier is allowed a pound of bread and three- 
fourths of a pound of meat. In the London Hospitals convalescent 
* Virchow’s Archiv. Vol. XVIII., p, 174.—f Teed op. cit* 
VOL. I.—15 226 
DISEASES OF TIIE DIGESTIVE FUNCTION. 
patients receive a pound of meat with twelve or fourteen ounces of 
bread, half a pound of potatoes, a pint of milk, and sometimes a pint 
of beer, or a half pint of porter. In the prisons in England a prisoner 
confined for three months at hard labor has a daily allowance of about 
thirty-six ounces of food, of which not more than four ounces given at 
four different meals in the week, consist of meat. In the work-houses, 
where many of the poor seek little more than a shelter, a diet some- 
what lighter is given; the hard labor, the restraint, and mental depres- 
sion which confinement produce, demand for the criminal a larger 
amount of nutriment than is needed by the man who labors and suf- 
fers less. In general terms it may be said that between twenty-five 
and thirty-five ounces is sufficient to support health. Of this, one- 
fourth or a fifth should consist of animal food. If more than this be 
taken it furnishes material for disease; if a less proportion is from the 
animal kingdom, the blood will be poorer, the cohesive powers of the 
tissues will be lessened, and diseases of a different character will result.* 
The following is the allowance for a soldier in the U. S. service, as 
directed by the Surgeon General, Nov. 1862: Full Diet.—Meat 16 
oz. avoirdupois; bread 18 oz.; potatoes 8 oz.; other vegetables 8 oz.; 
rice, hominy, or Indian meal 1.60 oz.; salt 0.16 gill; coffee 0.80 oz.; 
tea 0.12 oz.; sugar 2.40 oz.; milk 8 oz ; butter 1 oz.; flour 0.25 oz.; 
molasses, gill, 0.32; vinegar 0.32 gill. 
Low Diet.—Meat 8 oz.; bread 14 oz.; salt 0.16 gill; tea 0.240 oz.; 
sugar 2.4 oz.; milk 8 oz.; butter 1 oz.; rice, farina, corn starch, or bread 
made into pudding 2 oz. 
OKDER I.—AFFECTING- THE ALIMENTARY CANAL. 
I. Diseases of the Teeth and Maxillary Bones. 
1. DENTITION. 
Teething.—The teeth are divided into three classes; namely: 
incisors or cutting teeth, canine or dog teeth, and molars or 
grinding teeth. The first set, called the milk teeth, are twenty in 
number, consisting of eight cutting teeth in front, four canine, and 
eight grinding teeth. They are smaller and narrower than those of the 
permanent set, and generally appear in the following order: the two 
cutting teeth in the middle of the lower jaw pierce the gums about the 
end of the sixth month, and are followed in a few wTeeks by the two 
corresponding teeth of the upper jaw. After another similar interval, 
the two lateral cutting teeth in each jaw appear; sometimes the upper, 
and sometimes the lower appearing first. Four of the grinders pierce 
the gums towards the end of the twelfth month, the canine teeth (first 
* Todd and Bowman’s Physiology. Yol. 1. p. 519. DISEASES OF THE TEETH AND MAXILLAKY BONES. 
227 
the lower and then the upper) about the end of the second year, and 
lastly the remaining four grinders at the beginning of the third year. 
The process of teething generally takes place regularly and without 
much distress provided the child possesses an organism ordinarily 
healthy, has been accustomed to breathing the open air, has been fully 
nourished by the mother’s milk, herself being in good health. The only 
symptoms observable as the fifth and sixth months are passing, are, 
slight pain and tension in the gums, with increased flow of saliva, a 
slight diarrhoea, with some evidence of increased sensibility and irri- 
tability of the nervous system. In children of less favorable consti- 
tutions the natural process of dentition is liable to be variously 
deranged. 
The complicated apparatus by which the teeth are to be formed con- 
sists of a vascular and nervous pulp, covered by a very delicate mem- 
brane, and these again are invested by a fibrous membrane of very firm 
texture composed of two distinct layers. The body part of the tooth is 
secreted by the fine membrane of the pulp; and, as the ossification ad- 
vances from within outwards, the cavity occupied by the pulp is con- 
tracted, until reduced to the dimensions of the hollow of the perfect 
tooth. As soon as the ossification is completed, the inner surface of 
the fibrous coat takes on the office of secretion, and furnishes the tooth 
with its covering enamel; and, as soon as this is completed, the fibrous 
membrane is no longer of any use, and must be removed to give Avay to 
permit the tooth to advance above the gum. The removal of the in- 
vesting membrane is accomplished by the action of the absorbent 
vessels; and the increased flow of saliva, and the increased flow of 
mucus from the bowels carry off the effects of increased excitement. 
Thus, in a state of health, the process of dentition consist in a progres- 
sive growth of the tooth, and absorption of the membrane; and the two 
operations are going on at the same time, the latter progressing just 
fast enough to remove the investing membrane out of the way of the 
advancing tooth. In a state of disease this does not occur, and the 
growth of the tooth may be irregular, imperfect, or entirely suspended. 
Pressing against the investing membrane, it excites irritation and then 
inflammation. The gums become red, tumid, painful and ulcerated. 
From this focus of irritation a similar state of excitement extends down 
the prima-via to the stomach and bowels; and is also conveyed to the 
brain, and thence, by reflex action through the nerves transmitted to 
distant parts of the alimentary canal, producing the symptomatic vomit- 
ing, follicular diarrhoea, fever and convulsions which are so common and 
so fatal to children who encounter the dangers of the “second summer.” 
Thus almost any disease of infantile life may be excited by the irri- 
tation of dentition, and almost any symptoms of any of these diseases 
may be excited or augmented by this cause. Children seldom acquire 228 
DISEASES OF THE DIGESTIVE FUNCTION. 
their teeth without some local irritation and constitutional derangement 
In most cases the gums become red, enlarged and painful; fever with 
unhealthy action of the liver and digestive organs follow. 
In these cases the local irritation often furnishes its owTn remedy by 
exciting the salivary glands to greater action, secreting an unusual 
quantity of saliva, which diminishes the febrile action and thus gives 
relief. 
When the irritation is higher the constitutional excitement becomes 
more alarming. There is then diarrhoea attended with severe griping, 
faeces discolored and foetid, sometimes of clayey consistence with large 
quantities of viscid mucus; urine turbid, discolored, in small quantities, 
and sometimes accompanied w7ith purulent matter, and excoriating pain 
in passing it. Skin dry, hot; pulse rapid and fluttering, i*espiration 
quick and labored, countenance marked with extreme anxiety and pain. 
Every symptom of pneumonia is often present, the child being subject 
to taking cold as well as the usual other causes of disease. 
Continued moving of the head indicates the existence of affection of 
the brain. There are then, distressing moaning; dilated pupils; spasms 
of the muscles, increasing to alarmilig convulsions, which sometimes 
end in death. In this case, in a robust child, there is a real hypersemia 
or overcharged condition of the vessels of the brain. 
'Treatment.—So long as the febrile excitement is not excessive and 
the gums are not extensively swrollen, the child may be expected to pass 
through the process of teething without danger. If medical treatment 
be considered necessary, the following remedies maybe consulted: 
Chamomilla.—When the discharges are greenish or foetid. 
Mercurius.—There is much ptyalism and diarrhoea; discharges 
slimy, watery, bloody, and thrown off with spasmodic force of the irri- 
table intestine. 
Pulsatilla.—Cough with oppression of the chest, stomach disordered 
by rich food. 
Ipecac.—Nausea, vomiting and diarrhoea. 
Aconite.—Fever and restlessness; the patient starts up from sleep: 
skin flushed, hot and dry. 
Belladonna, after Aconite, when the head and hands are hot, and 
the face is flushed. 
Calcarea-carb.—In children who progress too slowly: imperfect de- 
velopment, tendency to rickets. 
Coffea.—Not unfrequently an irritable condition of the nervous 
system is induced by dentition, causing the child to be fretful, slightly 
feverish, and sleepless. Convulsions with grating of the teeth. Coffea 
removes this group of symptoms. 
Ilyoscyam.us.—In strongly marked nervous temperaments when the 
child is irritable, there is spasmodic motion of the eyes, restless, sleep- DISEASES OF THE TEETH AND MAXILLARY BONES. 
229 
less, inclined to cry much, grasps at things in the air, and about the 
bed, starts during sleep and smiles; this remedy will usually afford 
relief. 
Canndbis-indica.—Is indicated, when the face often flushes suddenly, 
when the head and extremities become hot during the night, when the 
child often starts and screams as if frightened, and there is an evident 
determination of the symptoms towards the brain. 
Ignatia.—Will be required in spasmodic twitchings, tendency to 
throw the head back when put to bed, with a persistently irritable and 
intractable mood. Diarrhoea of bloody mucus, with prolapsus of the 
rectum, ascarides, convulsive twitching of the corners of the mouth; 
nausea,vomiting, abdominal spasms; face red or blue: spasmodic con- 
striction of the chest. 
When dentition is progressing too slowly and the gums are much 
swollen, it is often necessary to cut the gum through with a sharp lan- 
cet. This should only be done when other remedies are failing, or where 
violent symptoms are threatening, or when the tooth is seen to be 
nearly through. 
A common case is that of a child which, for a day or two, has been in 
great distress with the general fever, diarrhoea, or constipation and 
determination to the brain. The gums are in a state of high inflamma- 
tion, stomach and liver deranged; tongue furred, pulse rapid. The gums 
are slightly incised with a sharp lancet; they, bleed freely: There is 
immediate relief. Aconite reduces the general fever still further; and 
the digestive organs are corrected also, whether diarrhoea or constipa- 
tion has been present. In more severe or more advanced cases 
further treatment is required. 
In every case of disease of the stomach or bowels, of the brain, or of 
general fever occurring during the period in which dentition should take 
place, the gums should be carefully examined; and when the gum is 
swollen and inflamed, it should be so lanced as to take off the tension 
of the membrane, permitting a single drop of blood from each tooth, 
though giving little or no pain. The objections made by ignorant 
people to this simple operation are always overcome by an explicit 
statement of the principle on which it generally gives early relief, and 
at least lessens the danger, without ever doing harm when judiciously 
performed. 
The inflammation excited by the evolution of the wisdom-tooth some- 
times extends to the establishment of ostosis, periostosis, neurosis, or 
ibsoesses which by burrowing into the sub-clavicular region have 
proved fatal. 
It may also be the cause of enlarged tonsils, or of the velum palati 
or uvula. In one case it caused hypertrophied uvula, with anorexia 
and vomiting. Fistulous ulcers from this cause are often overlooked, 230 
DISEASES OF TIIE DIGESTIVE ORGANS. 
as ordinary examination of the teeth shows them all to be sound. The 
fistula is slightly depressed, the skin around it is plaited or wrinkled, 
and, when the lower jaw is involved adheres to the bone. In one case 
cited by M. Robert, (Gaz. des Ilopit.), a second molar tooth was ex- 
tracted without relief, a sinus was then found and traced back to the 
concealed wisdom-tooth; this was extracted and gave full relief. We 
have met with no cases in which free lancing of the swollen gum 
failed to relieve the swelling and permit the tooth to appear. These 
teeth generally decay early, and, having a short root, are then better 
extracted. 
2. TOOTH-ACHE.—ODONTIA DOLOROSO. 
Caries.—This most common disease of the teeth has received the 
name caries by common consent, though perhaps Bell was more correct 
in saying that gangene would he a more proper name. 
Caries generally begins immediately under the enamel, either on the 
grinding surface or the side. 
Causes.—Predisposing.—The predisposing remote causes are: 
1. hereditary predisposition. The tendency to caries of the teeth has 
often existed in a whole family, where one of the parents was similarly 
affected; in other families, however, though the parents lost the teeth 
the children kept theirs to the age of forty or fifty years. 
The Teeth are affected in a peculiar manner by the sycotic poison 
The most obstinate algias, loosening of the teeth, degeneration of th 
gums, with sponginess and flat ulcers are the consequence. Thuja 
alone is a remedy for this condition. 
2. Many diseases of infancy, especially inflammatory diseases operat- 
ing on the pulp of the teeth are more disastrous to the young and tender 
texture than any other cause of caries, except Mercury. If the bony 
structure of the teeth, like other bones, would admit of re-union we 
would not despair of similar recoveries. If bones be broken they unite 
so as to become stronger than before. If they become diseased and 
dead, new bony matter is deposited around the dead bone, and in time 
the latter is removed by the absorbents. Not so with the teeth. When 
they are injured by fracture, inflammation or Mercury, no such pro- 
vision is made for them. A tooth is a bone within a bone ; its vessels 
are few and minute, but interspersed in a membranous substance which 
is liable to be injured by slight causes, even by a sudden change of 
temperature. Thus inflammation of the pulp of the tooth must pro- 
duce injurious effects, as the tooth has not the means of a complete 
recovery. 
Teeth generally decay in pairs; a fact which shows them to be 
capable of becoming diseased from internal causes. Thus the pulp of TOOTHACHE. 
231 
eacn tooth of the pair, though on opposite sides, must be in the same 
stage of advancement at the time they are attacked by inflammation; 
they are therefore liable to decay together. 
Mr. Tomes* says, vitiated secretions of buccal mucus, generally con- 
nected with dyspepsia are the chief cause of destruction of the teeth. 
The morbid mucus clings round the teeth, in other cases the saliva is 
perverted. 
Exciting Causes.—The disease is developed and rendered sensible 
in a greater or less degree by various exciting causes: 
1. Hot Drinks.—Any fluid warmer than the blood is destructive to 
the teeth ; cold drinks beyond a certain degree are no doubt injurious 
but not equally so. The teeth of men and animals are chemically the 
same, yet the former suffer much from diseases of the teeth, while the 
latter seldom if ever have caries or pain in the teeth. Savages are 
clear of this disease. Two cannibals brought by Capitain Cook from 
the South Sea Islands never heard of tooth-ache till they came on 
board of his vessel. The American Indians knew little or nothing of it in 
their uncivilized state. Domestic animals fed according to their natural 
habits have no diseases of the teeth ; but it is developed by feeding them 
with hot food from the distilleries. It has been said that persons em- 
ployed in surveying in the Western woods for several months and sub- 
sisting on dried meat and hard bread, noticed that their teeth became 
white without the use of the brush or the least care ; and persons who 
live on cold food never lose a tooth or suffer from tooth-ache. Slaves 
on tropical plantations seldom complain of it, except they be em- 
ployed as cooks and drink hot coffee or tea. 
The teeth of man are the last part to decay after death, resisting all 
chemical agencies and destructive gases of the grave, they remain sound 
for a century. The teeth of the Celtic chieftain exhumed at the gate 
of Paris, in 1859, had preserved their texture and enamel of perfect 
whiteness through the twenty-five centuries during which he had oc- 
cupied that tomb. 
While the body lives, the teeth are the first part of the body to decay. 
If they were foreign bodies independent of all connection with the sys- 
tem, the agents that now act upon them would be harmless. ButAvben 
they become foreign bodies their beauty decays, they become dark in 
color, and decomposition follows. 
The texture of the teeth varies in different persons. Some contain 
more carbon in the enamel than is found in others. In some the ena- 
mel is thick, in others thin. Some teeth are yellowish in color, others 
blue mixed with pearly white. These last are very frail and decay in 
early life, the bone of the teeth and the enamel in such cases are not 
so firmly united, hence they are more liable to be injured by heat. 
* System of Dental Surgery. 232 
DISK ASKS OF THE DIGESTIVE FUNCTION. 
Prevention of Caries.—1. Avoid all the exciting and remote causes. 
In infancy all inflammatory diseases should be immediately arrested, 
scarlet fever or other febrile disease should be treated with care : but in- 
flammation from diseased state of the deciduous teeth should be noticed; 
as in some cases these teeth are decayed as soon as they are cut through 
the gums ; this is commonly due to the effect of Mercury. Some think 
it corrodes the teeth by coming in contact with them when given; but it 
destroys the chance for good permanent teeth in many cases in which 
it does not produce ptyalism. In some children before all the first set 
are through they inflame, become loose and are removed. In these 
children the succeeding teeth are sure to decay early, even before they 
are fully grown. When the first teeth must be removed it should be 
done before suppuration takes place. 
Treatment of Caries or Gangrene of the Teeth.—Remove the dead 
portion from the living ; and, if practicable, the cavity should be filled 
with gold, so as to exclude air and water. If the gangrene is super- 
ficial it should be removed in the same way, and the bony part polished. 
If the bone is extremely sensitive beyond endurance, the cautery or 
caustic should be passed over its surface. 
Tooth-ache is a natural consequence of gangrene of the teeth. When 
they are decayed so as to expose the inner membrane, it would be strange 
if it did not produce pain, especially in a sanguine or nervous tempera- 
ment. The pain is generally the effect of inflammation in the inner or 
outer membrane. When it is slight some application may relieve it. 
Rut if it involves the outer as well as the inner membrane, the relief 
becomes more difficult, and extraction is the common resource. In all 
teeth that have antagonists which meet and press upon them, the con- 
tinued pressure keeps lip the inflammation, and common “tooth-ache” 
specifics prove to be only a piece of quackery. 
The temporary teeth should not be removed too early. If they are 
painful and decayed, remove them, as other teeth would be. If the per- 
manent teeth begin to protrude in wrong positions from their places be- 
ing occupied by the infantile teeth, the latter should be removed to 
make way for them to come in their proper places. 
The effect of heat and cold on inert bodies is to expand and contract 
them. On living bodies like the teeth it is the same. Iron begins to 
expand at 120° or 130° of the thermometer; the enamel of the teeth is 
much harder, more compact and more liable to crack by pressure; and 
the location of the teeth is such, that the least expansion must produce 
injury. They are firmly fixed in the jaw-bone which surrounds them, 
and on each root is a membrane containing minute blood-vessels and 
nerves, in which consists its life. Heat expands the tooth and presses 
these delicate parts between two bones—the most certain wray to destroy 
them. When the vitality of any part is destroyed we expect it to de- TOOTHACHE. 
233 
cay and enter into decomposition. The enamel is fractured by this ex- 
pansion of the teeth which are firmly in contact with each other. 
The effect of cold within certain degrees is less injurious to the teeth; 
and, if the change be not too sudden from great heat, and if it only ex- 
tends from blood heat to 60° or 70° no injury can result from it. It is 
even supposed to be beneficial. 
Derangements of Digestion always exert a deleterious influence on 
the teeth. Disease of the liver is often followed by speedy decay of 
the teeth. 
The use of acids, whether given in the treatment of fevers or eaten 
in sour fruits are destructive to the teeth. The mineral acids are 
the worst. 
Negligence in the proper care of the teeth, leaving fragments of food 
between them. Lavater, the physiognomist, says, there is one point 
on which the admirer of his art cannot possibly be mistaken: “ Who- 
ever neglects his teeth, suffering them to go to decay through indolence 
or contempt of public opinion, may be safely pronounced an unhappy 
character, with many evil propensities.” 
Injuries by Violence.—If the teeth are loosened by a blow or a fall 
they should be immediately placed accurately in the sockets and 
secured by ligatures; the gums should be allowed to bleed freely; and 
Arnica or Calendula in dilution should be employed till the inflamma- 
tion subsides. 
The effects of Mercury.—This deadly mineral is the most destruc- 
tive of all the causes of diseases of the teeth. We have an immense 
collection of cases before us which at this day need not be transcribed. 
One author describes a case of a female under its use aged 27. “ A 
few of her front lower incisors remain, but they are loose and can be 
removed by the fingers. A portion of the frontal and parietal bones 
have been removed, about two and a half inches square. Ulcerations 
cover nearly one half the head; the integuments which protect the brain 
appear soft and spongy. At first view it would appear to be a case of 
syphilis, but the attending physician assured me that it is the effect of 
Calomel. And strange indeed! he was trying to cure it with corrosive 
sublimate /” externally applied. 
Another case from the same author.—“ A young lady of nineteen 
had been long confined with fever. I found the molar and bicuspid 
teeth just ready to drop out of the lower and part of the upper jaw. 
The alveoli nearly absorbed, as if the teeth had been extracted six 
months before ; the teeth covered with a black oxyd of Mercury. The 
medicine had been administered when she was lying on her left side, 
a blister being on the right; it had remained long in contact with the 
teeth and gums.*” 
* Dr. Crane, U. States Med. and Surg. Jour. Apr. 1836. p. 334. 234 
DISEASES OF THE DIGESTIVE FUNCTION. 
The Mew-York Med. Times (Sept. 1863,) complains of the populai 
prejudice against calomel and steel when prescribed in “occasional and 
appropriate doses ” to cachectic children. The wrriter admits “ that calomel 
if given in excessive quantity will cause salivation, and that in profuse 
salivation teeth are apt to be lost;” but he still maintains “that these 
teeth are not necessarily unsound. Often they are not decayed at all.” 
They only drop out from “actual destruction of gum substance.” We 
think such arguments will not lessen the growing prejudice against the 
allopathic use of mercurials. 
Symptoms of Mercurius.—Tearing, shooting pains in the carious 
teeth or in the roots of the teeth of the whole affected side; pains in the 
head and face extending to the ear; painful swelling of the cheek and 
submaxillary glands; salivation; pain worse in the evening or night; 
aggravated by warmth of the bed, cool-damp air, or drinking any thing 
cold; “teeth on edge;” they feel loose and too long, gums swelled, 
blanched, ulcerated, discolored, readily bleeding ; itching, burning pain 
as from excoriation; nightly perspiration, vertigo, rheumatic pains in 
the limbs ; peevish contradictory humor; tendency to shed tears; shiver- 
ing, with redness of the cheeks. 
In a case of caries occurring after small-pox, Hecker used various 
medicinal compounds with success. Fortunately, says Hahnemann, “a 
portion of Mercury was contained in each of these mixtures, to which 
it may be imagined that this malady will yield (homoeopathically), be- 
cause Mercury is one of the few medicinal agents which can produce 
caries, as proved by the many excessive mercurial courses used for the 
cure of syphilis, and even of other diseases.” This metal which becomes 
so formidable when its use is prolonged, on account of the caries of 
which it then becomes the exciting cause, exercises, notwithstanding, 
a very salutary homoeopathic influence in the caries which follows 
mechanical injuries of the bones, some very remarkable instances of 
which have been given us by J. Schlegel, Jordens, and J. M. Muller. 
Another kind of caries (but not venereal) has been cured with Mercury 
by J. F. G. Neu, and J. D. Metzger. 
Belladonna.—Pain of neuralgic character in one side of the face; 
the gums feel as if ulcerated ; drawing, tearing, shooting, excessive sad- 
ness, tendency to shed tears, cutting pain in the teeth, face, and ears, 
worse in the evening after lying dowTn; congestion of the head and 
teeth; gums hot and swelled, and teeth bleed on sucking them ; ery- 
sipelatous swelling of the cheek; salivation or dryness of the mouth, 
thirst; aggravation in the open air, or on touching food, cold or warm, 
to the tooth, which feels elongated; heat and redness of the face ; pul- 
sations in the head or cheeks; worse at night; burning redness of the 
eyes ; pain appears to be in several teeth ; glandular swrellings; spasms 
and convulsions ; delirium in children teething. TOOTHACHE. 
235 
Anguish and inquietude which compel constant change of place ; 
pain in gums and teeth as if ulcerated; boring in the carious tooth as 
from congestion, itching vesicles, and burning ; renewal of the pains by 
mental labor, or after eating ; heat and redness or the face ; pulsations 
in the head or cheeks. 
Chamomilla.—Tooth-ache caused by abuse of coffee; the patient 
is irascible, and sheds tears during the pain, which is violent, jerking, 
drawing or pulsative and shooting; worse at night when warm in bed; 
hot swelling redness of the cheek; gums shining, swelled; submaxillary 
glands enlarged; pain occupying the whole of one side of the jaw, not 
fixed to a single tooth; semilateral, shooting or pulsative pain in the 
affected side of the head, ear and face; pain aggravated by hot or cold 
drink, especially coffee; pain, heat and redness of one cheek; hot per- 
spiration ; agitation and tossing; weakness and fainting; teething, with 
watery, greenish foetid diarrhoea; spasmodic symptoms. 
Staphysagria.—The pains proceed from decayed teeth or from 
stumps; it extends to the head and ears; the cheek is swollen but not 
hot; pain excited by inspiring cold air or by cold drinks; worse during 
or after eating, on touching the tooth, or only after midnight; the teeth 
become black and decay, exhibiting exfoliation; there are tubercles or 
painful excrescences on the gums which are liable to bleed. It corres- 
ponds in some respects with Sulphur. 
Sulphur.—Chronic tooth-ache; tearing, jerking, boring, stitching, 
with or without swelling of the cheeks. The teeth feel loose and 
elongated. Aggravation at night: the gums detached and diseased ; 
they bleed freely; cutaneous eruptions have in these cases been sup- 
pressed by ointments or washes. 
Pulsatilla.—The patient is of a mild, quiet, timid character; the 
pain accompanied with otalgia and pain in one side by the head ; it is 
tearing, drawing, shooting, jerking, pulsative, or gnawing, with pricking 
in the gums; pains extend to the face and head, or eye and ear; face 
pale, head hot; some shivering; dyspnoea ; pain worse in the evening 
when warm in bed ; or after midnight; pain relieved in some by cold 
water, aggravated in others. 
Hyoscyamus.—Violent tearing pulsative pain extending from the 
cheek to the forehead; swelling of the gums; pulsation in the tooth; pain 
worse in cold weather, in the morning. Congestion of blood in the 
head, with redness and heat of the face; spasms in the throat, con- 
vulsive jerkings of the fingers and hands or arms; nervous excitability 
redness and brilliancy of the eyes. 
Aconite.—When the disease is excited by recent cold; there is fever 
and the pain is extremely severe ; lancinating shocks or pulsative pains 
with congestion of blood to the head, heat in the face, redness of the 
cheek, and great agitation. When the patient is subject to rheumatism, 236 
DISEASES OF THE DIGESTIVE FUNCTION. 
Colchicum and Rhus are successful alone or in alteration with Aco 
nite. 
Other remedies, are Iodine, Kali-hydriod., Nitric-acid, Phosphorus/ 
and Silicea: Iodine, and Kali-hydr. in scrofulous subjects who have 
taken much Mercury:—Nitric-acid in cases connected with syphilis in 
the second and third stages:—Phosphorus and Silicea, in cachectic 
and rachitic individuals. 
Local Remedies.—Creosote.—Caries of the teeth, commencing by a 
small dark spot immediately under the enamel, which breaks down from 
losing support; the central cavity and the contained vessels become 
exposed. The only effective treatment here consists in the reiterated 
application of some highly stimulating specific. Camphorated spirit 
has generally been relied upon ; Nitrate of Silver sometimes answers 
well, mineral acids would do better but they act upon the surrounding 
bone, destroy the teeth. Here Creosote alone will often be found 
specific. It may be tried in cases of pure tooth-ache from exposure of 
the internal membrane without inflammation of the periosteum. It 
will generally answer to apply a small piece of cotton wret with Creo- 
sote to the cavity, permitting none of the fluid to escape outside of the 
tooth, as the caustic liquid causes a true burn wherever it touches the 
cheek or gums. It is more easily applied to the lower than to upper 
teeth. The Creosote does not exert any curative power over the 
destructive caries of the teeth. It only alleviates the present symptoms. 
(London, Med. Gaz., July 1838.) 
Arsenic.—This is still more effectual than Creosote. It was formerly 
my habit to wet a minute quantity of cotton on the point of a small 
hook, and lay upon one side of the cotton a small portion of white oxide 
of Arsenic. On inserting the cotton in the cavity of the tooth I 
generally found the pain almost immediately arrested. Of later years, 
noticing that the Creosote is likely to burn the mouth, I use the Ar- 
senic as before, but instead of the Creosote I use some other less cor- 
rosive fluid to wet the cotton. Tincture of Camphor, Aconite, Bella- 
donna, and various other fluids have been tried with success. The Ar- 
senious Acid or White Oxide of Arsenic is the best application I have 
found, and has saved from extraction many a condemned tooth. 
Nitrate of Silver.—When the tooth-ache is caused by a carious 
tooth it may very frequently be cured by a piece of solid Nitrate of 
Silver, as large as a pin’s head, inserted into the cavity. It is imme- 
diately dissolved by the moisture it finds in the tooth, it immediately 
destroys the diseased nerve and the pain ceases. (.Bulletin de Therap., 
1860.) Both of the two last named remedies are4strictly homoeopathic 
in their action. When the pain is confined to a single tooth, the ap- 
plication to the gum by friction with the finger, a saturated solu- 
tion of cochineal, will usually arrest the pain immediately. TOOTHACHE. 
237 
The treatment of tooth-ache has always been empirical, but it may 
be remarked that no remedy has ever given relief that did not act 
on the homoeopathic principle. All the local applications are of 
this character, and only act by exciting a new and similar action 
in the nerve of the decayed tooth to that which had been excited by 
some other cause. Thus relief which was sometimes permanent has 
been given by a drop of Arnica, Aconite or Belladonna tincture ap- 
plied in the cavity of the aching tooth. Oil of Cloves, Camphor and 
Oleum-carophylli, Gum-mastich dissolved in Oleum-terebinthinae, have 
often succeeded. Boerhaave employed Camphor, Ol.-carophyl., and 
Alcohol on Cotton. Better than these things is strong Nitrous-acid, 
diluted with three or four times its weight of Alcohol. Camphor dis- 
solved in Aqua-ammonia or Ether will often succeed, but none of these 
agents are reliable. 
Minor Operations on the Teeth.—Extraction of the temporary 
Teeth.—When the temporary teeth are diseased they should not be un- 
necessarily removed. If, however, the child is four or five years old, 
and there is much pain or inflammation the ulcers threatening to injure 
the other teeth, the diseased tooth may be carefully extracted with 
the forceps. 
Cutting the Gums to facilitate Dentition.—Make the incision to- 
wards the external alveoli so as to avoid injuring the membrane and 
sacs of the permanent teeth, particularly those of the incisores and 
cuspidati. Those of the bicuspides are more easily avoided being 
broader on the surface. {Blake on the Teeth) 
Filing and Sawing the Teeth.—None of the purposes for which the 
operations are performed can be effected by them. In place of these 
instruments it is now recommended to use small crooked knives or 
other cutting instruments which may be used with less injury to the 
teeth. 
Plugging the Teeth when carious.—This process may in some per- 
sons preserve the teeth from ten to forty years; it may be done with 
little trouble or pain. Pure tin is softer and may be worn better than 
gold. But both tin and lead are corroded by acids. Gold is therefore 
preferable and is not changed by any food or medicine except Mercury 
when long continued. 
Bleeding of the Gums after the Extraction of Teeth.—First wash 
the mouth in cold water, holding it for a minute in the mouth. If this 
fails to stop the bleeding try a solution of Tannin, or other common 
astringent, as Sugar-of-lead. 
Tincture of Hammamelis, or Witch Hazel, or any other preparation 
of Hammamelis that may be at hand, will almost certainly succeed. 
Pond’s extract can generally be obtained where others can not. 
Dry four of Wheat has often succeeded, when the haemorrhage was 238 
DISEASES OF THE DIGESTIVE FUNCTION. 
excessive, owing to some haemorrhagic idiosyncracy. It may be packed 
down dry into the cavity from which the tooth has been extracted, and 
permitted to remain there. Soot water, mentioned under wounds, may 
be used with success where nothing better is at hand. For pain and 
swelling, following the extraction of teeth, give Arnica, or Aconite and 
Belladonna in alternation. 
Ilyoscyamus.—For throbbing pain in the bone extremely severe. 
Silicea.—For swelling of the jaw followed by tedious suppuration. 
It may be taken often, if given in low dilution ; if higher, a dose a week 
is sufficient in a chronic case. 
Local Anaesthetics.—Dr. Fournier, of Paris, lately communicated to 
the French Academy of Sciences a mode of producing local anaesthe- 
sia, consisting in what he calls chloracetization. He says : “ If in an 
apartment, the temperature of which marks more than 63° Fahrenheit, 
the orifice of a thin glass phial, containing a quantity of pure crystal- 
lizable acetic-acid, equal to one-fourth of its capacity, and an equal 
quantity of chloroform be exactly applied to a healthy clean skin, not 
deprived of its epidermis ; and if this phial be constantly maintained at 
the temperature of the hand, a complete insensibility of that part, and 
some of the deeper ones, will be obtained in five minutes, and at the 
cost of a very slight sensation of pain. The vapors of acetic-acid and 
chloroform mixed together and applied with a glass retort to a part 
which it is intended to render insensible, the adjoining parts being pro- 
tected by a diachylon plaster from the action of these vapors, may be 
employed as anaesthetics in all operations of low surgery, and in many 
of the higher branches, in all cases where general anaesthesia may be 
considered dangerous, or declined by the patient.” 
Mr. Richardson says, “immerse the affected part in chloroform, and 
include in the part immersed as much of the adjacent structures as 
may be required; the plan consists in preventing the escape of chloro- 
form by covering it with a cup, and thus intensifying its local effect.” 
The cup is about half filled with cotton-wool, which is then saturated 
with a sufficient quantity of chloroform, generally from ten to fifteen 
drops. The time within which local insensibility is produced varies 
from seven minutes to fifteen. The local anaesthesia is not in all cases 
complete; but even where pain occurs, the remedy will be found to 
moderate it to a point within which it becomes perfectly tolerable, and 
has lost the distressing agony of tooth extraction. As soon as insen- 
ibility of the part ensues the cup should be removed, and tbe extrac 
tion immediately performed. Of sixty cases the remedy only failed in 
two to mitigate the pain. In ten cases the local insensibility during 
the extraction was complete. 
Galvanism and electro-magnetism have been successfully employed TOOTH EDGE.—TART AH. 
239 
in this city as local anaesthetics, both for the cure of tooth-ache, and 
for the purpose of extracting teeth without pain. 
3. TOOTH EDGE.—ODONTIA STUPORIS. 
Darwin says, this disease is only an imaginary one, “ first caused by 
our biting the edge of the glass or porcelain cup in infancy, and 
afterwards is re-excited by imagination alone.” He says, to u think 
of it strongly or to see it in another, excites real pain in my teeth.” 
This depends upon the reiterated motions in these nerves, that 
were formerly disagreeably affected. The influence of the asso- 
ciation of ideas in recalling disagreeable feelings formerly existing is 
illustrated in the case of Baron Van Swieten, who once saw a putrid 
carcase of a dog explode with putrefaction, and was sickened by it; he 
says, that several years after he travelled the same road, and the mere 
recollection of it threw him into the same sickness and vomiting. 
Tooth-edge generally caused by allopathic use of Mercury, or the 
eating of acid fruits. 
The following remedies have been recommended for this affection : 
Berberis; Capsicum; Lacliesis; Mercurius; Mezereum; Silicia; Spongia; 
Sulphur ; Sulphuric-acid; Tartaric-acid ; Oxide of Zinc. Of these, 
Mercury and the acids are perhaps most directly homoeopathic. 
The teeth feel dull. Phos. Sep. Zinc.-m.* 
The teeth feel dull as from acids. Mez. Phos.-acid. 
The teeth are dull, painful when chewing. Sulph. 
Dull teeth, afterwards stinging pains in the same. Ran., Seel. 
The teeth are set on edge. Aeon. 
The molares feel dull. Aur. 
Teeth set on edge and insensible. Dulc. 
4. ODONTIA INCRUSTANS—TARTAR. 
Tartar has generally been regarded as an accumulation of earthy 
matter from the saliva. Its quantity depends on the natural or con- 
stitutional state of the fluids of the mouth. In all cases its influence 
on health as well as on the teeth is highly injurious. On its first for- 
mation it is soft, and may be easily removed by a soft brush ; but it 
soon assumes a strong hardness, increasing in quantity on the necks of 
the teeth ; the gums are irritated and inflamed, the sockets and neck 
of the teeth are next destroyed; and the teeth, being left without sup- 
port, are pushed out by the tongue and lips. In children it sometimes 
increases so much as to cause separation of portions of the jaw, the 
temporary teeth, and sometimes portions of the permanent ones. 
Microscopic observation has shown that tartar is produced in the 
* Jahr, Repertory, p. 417. 240 
DISEASES OF THE DIGESTIVE FUNCTION. 
same manner as coral by animalculse, resembling the Medrejposa ocu• 
lata. By aid of a solar microscope of strong power, we have seen them, 
says Mr. Le Baume, “ in a very lively stateand from the cellular 
organization of the tartar we have no doubt of the correctness of this 
theory, which is confirmed by observations of Mr. Cooper of London. 
Le Baume thinks that after the tartar, which like coral is a mere 
nidus, adheres firmly to the teeth, the animalculge burrow in the teeth; 
and, by insinuating themselves between the teeth and gum, occasion 
disease in both. But the secretion from them is often so offensive as 
to contaminate the breath. 
Treatment.—Many efforts have been made to find some acid, mineral 
or vegetable, or other compound that will destroy the animalculae and 
their habitation, but without satisfactory results. Le Baume thinks 
that the true vinegar, (not the pyroligneous-acid sold for it,) the most 
effective. It promptly killed the animals and decomposed the concre- 
tions, so that they were easily removed by a brush. The more powerful 
acids did not answer. Let the true vinegar (Acidum Aceticum Yerum) 
diluted with rose-water, be applied to destroy the animalculse. After- 
wards the local use of powder of the Areca-nut is better than charcoal 
to prevent their re-formation. 
Removal.—If it has become hard, cutting instruments must be em- 
ployed to scrape it carefully off, in such a manner as to avoid injuring 
the enamel or gums. To prevent its return, use daily a stiff brush 
with pure water, occasionally salt and water, tincture of Bark and rose- 
water. The brush should be as stiff as will not injure the gums, should 
be used every morning and generally after eating. There is no danger 
of injuring the enamel by brushing. Tooth powders when used should 
contain nothing that can act on the teeth, and should be completely 
washed off. Artificial teeth need as much washing and brushing as 
the natural ones or more. 
Dr. Bowditch of Boston, after making microscopical observations with 
tartar or animalcular deposit upon the teeth, found that soaps and den- 
tifrices generally failed to destroy it; but the bland soap sold as 
u Babbitt’s Cytherean Cream” was effectual in dissolving it. 
5. AFFECTIONS OF THE GUMS.—GUM-BOILS. 
This name is wrongly applied to abscesses of the alveoli and cellular 
substance. Causes. Nearly always caused by the irritation of decayed 
stumps, though Dr. Bell says, they occasionally occur “ on the perios- 
teum of sound teeth.” The disease commences with inflammation of 
the periosteum, which becomes thickened, and, of course, raises the root 
from its socket so that it becomes loose and feels too long. The inflam- 
mation then rapidly extends to the surrounding parts, causing swelling DISEASES OF THE MAXILLARY BONES. 
241 
of the face with severe pain, and soon progressing to suppuration, 
which is announced by occasional sharp shooting pains through the 
part. 
Treatment.—Remove the cause. Generally the root or diseased 
tooth that caused the irritation is a foreign substance, the removal of 
which in the early stage will effect a cure. If matter be already formed 
it must be removed by a free incision near the stump that caused the 
mischief. If the gums remain inflamed and spongy it indicates the pre- 
sence of tartar, which should be removed, allowing the gums to bleed 
freely at intervals till they are entirely healed. 
Bleeding of the Gums.—Carb.-v., Merc., Natr.-mur., Nitric-acid, 
Phos., Phos.-ac., Sil., Staph., Sulph. 
Ulceration of the Gums.—Alum., Carb.-v., Kal., Lycop., Mercury, 
Natr.-mur., Staph., Sulph.-ac. 
Excrescent Gums.—Staph., Chlor-potash. 
Scorbutic affections of the Gums.—Caps., Carb.-v., Natr.-mur., 
Nitr.-ac., Staph., Sulph., Arsen., Bry., Caust., Chlor.-potash, Creos., 
Mur.-ac., Sep. 
Affections of the Gums caused by Mercury.—Carb.-v., Chin., TIepar., 
Nitr.-ac., Staph. 
Affections of the Gums caused by excessive use of common Salt 
Carb.-v., Spir.-nitr. 
For persons who lead a sedentary life, or who are phlegmatic oi 
plethoric, Capsicum. 
For persons who are lean and of a lively temperament: N.-vom. 
II. Diseases of the Maxillary Bones. 
The mucous membrane lining the large cavity in the middle of the 
superior maxillary hones, is liable to several morbid affections. The 
most important of these are: 1. Inflammation and secretion of pus. 
This a true abscess which is commonly caused by irritation and ulcera- 
tion excited by the penetration into this membrane of disease originat- 
ing in a decayed tooth. The original cause of the disease in the tooth 
may have been a blow on its surface; a fracture, or the pressure of a 
plug upon the nerve ; the irritation of food or other foreign bodies in 
the cavity, or extreme degrees of heat or cold. 
1. Abscess of the Antrum Maxillare.—When the pus formed in 
the body of the tooth escapes outwardly, no effect is produced in the 
maxillary antrum. But if the outlet from the tooth be obstructed, the 
matter “ oozes through the extremity of the fang, where the nerves and 
vessels entered, and, coming in contact with the periosteum, it separates 
it from the fang and a sac is formed precisely at the foramen.” This 
sac now continually enlarges until it bursts. “ If the fang penetrates 
You I.—16- 242 
DISEASES OF THE DIGESTIVE FUNCTION. 
the antrum, the membrane of this cavity being always continuous over 
the fangs, the pus is effused between the membrane and the bone, thui 
forming a true abscess in the antrum. The pus now accumulates by 
secretion from the surrounding parts until the distended membrane 
bursts, and the pus escapes from the antrum through the duct into the 
nose.”-—(Dr. Ilullihen. West. Med. Jour. Jan. 1837. p. 335.) 
When the fang containing pus terminates in the cells of the alveoli, 
the distension of the sac produces great pressure on the surrounding 
parts, the external, or thinner plate is absorbed, the sac enlarges and 
then bursts, effusing the pus between the alveoli and the periosteum, 
and forming an “alveolar abscess.” A fistulous opening thus esta- 
blished, remains as long as the discharge continues to be furnished from 
the highly vascular membrane, which lines the cavity of the offending 
tooth ; and a similar discharge is kept up into the antrum, which con- 
tinues to irritate its lining membrane, which becomes more extensively 
diseased. A constant discharge from the antrum into the nose may 
thus be kept up for years; the functions of the membrane are destroyed, 
and ulceration of the membrane gives rise to small fungous granula- 
tions, which may in time produce fungous tumors of the antrum 
maxillare. 
Besides the irritation of decayed teeth, abscesses of the antrum may 
originate from violent blows on the cheek ; inflammatory affections of 
the adjacent parts, and especially of the pituitary membrane lining the 
nostrils; exposure to damp and cold air; a blow on the under jaw, 
driving the molar teeth upwards, may cause a fang to penetrate the 
antrum. (See Cooper, Surg. Diet. p. 151.—Boyer, Traite des Mai. 
Chir. tom. 6. p. 131.—Jourdain, Abenethy, Gibson, dec.) 
The first symptom of maxillary abscess is a pain -which is at first 
imagined to be a tooth-ache, and usually referred to a carious tooth 
with which it may seem to be connected. The pain, however, extends 
more into the nose than that caused by a tooth; and it affects more or 
less the orbit, the eye, and the frontal sinuses. The pain if not ex- 
tremely severe is more obstinate in its persistence; and its seat is soon 
occupied by an elevated circumscribed hard tumor below the malar 
bone. In some cases this is not visible, in others it extends over the 
whole cheek, and ends in suppuration. In some again it communi- 
cates with abscess within the antrum, and in others the matter makes 
its way towards the palate, causing the palate bones to swell, and ren- 
dering them carious. It may also be discharged between the fangs or 
alveoli of the teeth, or through the nostril of the same side, when the 
patient lies with the head in a low position and turned towards the op- 
posite side. This discharge of the abscess usually takes place in three 
or four days from its commencement. 
Purulent Secretion of the Antrum Maxillare.—This disease origin* DISEASES OF THE MAXILLARY BONES. 
243 
ates in an inflammation and closure of the nasal duct, which, by retain- 
ing the mucous secretion of the lining membrane of the antrum within 
its cavity, irritates the membrane and causes it to secrete a purulent 
fluid. The usual exciting causes are, a blow on the nose, a wound in. 
the nostril, polypi of the nose, severe colds and ulcerations of the 
pituitary membrane. “ When the duct first closes no pain whatever is 
experienced in the antrum, and indeed not until it becomes filled with 
mucus ; then the following are the most common symptoms: a slight 
uneasiness in the antrum, sensation of great weight or pressure, after 
which a dull deep-seated pain supervenes, followed by an acute pain 
darting into the ear, over the eye, and in the direction of the frontal 
sinus, accompanied by a greater or less degree of tumefaction of the 
cheek.” After the walls of the antrum have been for about one or 
two months pressed upon by the accumulating secretion they give way 
and the purulent matter escapes. This fluid is of a dark color, a slimy 
consistency and the most offensive foetor. The disease progresses ra- 
pidly along the bony parietes of the maxillary sinus, rendering the bones 
carious, and resisting the treatment, which might be sufficient for the . 
cure of ordinary abscess. 
Treatment.—The treatment of abscess of the antrum maxillare con- 
sists usually in little more than in extracting one of the molar teeth 
from the affected side, and perforating the floor of the antrum to per- 
mit the escape of the accumulating fluid. The sinus may then be 
thoroughly washed out occasionally with some mild astringent or al- 
terant solution to restore the parts to healthy action ; and the ordinary 
means for the removal of local, inflammatory and ulcerative disease may 
be employed. 
The treatment of purulent secretion of the antrum is much more dif- 
ficult. The discharge of the puriform matter is not effected by the ex- 
traction of the teeth which seem most diseased; the destructive caries 
of the bone demands a surgical operation to remove the whole of the 
offending part of the upper maxillary bone, and the general treatment 
given under the section on Necrosis. (See Bones, Diseases of.) 
Fungous Tumors of the Antrum originate from ulceration of the 
lining membrane of the antrum maxillare, as described under abscess 
of that cavity. The ulceration, says Dr. Hullihen, (West. Jour. Med. 
Sei. 1837. p. 339,) generally occurs in patches over the surface of the 
membrane, and in time occasions a lesion of its vessels. At this stage 
coagulations of a bright red color may be discovered in the fluid dis- 
charged, intermixed with pus of thicker consistency. Small fungosi- 
ties now sprout up from the ulcers, which, in some states of health 
may remain for months Avithout perceptible increase. “ But when 
once these morbid affections become confined, should the slightest 
irritation occur, their mushroom-like growth is astonishing. When 244 
DISEASES OF THE DIGESTIVE FUNCTION. 
the antrum becomes filled with a fungous growth the cheek be 
gins to enlarge, and the symptoms resemble those of purulent secre- 
tion; but it may be distinguished from that disease by discharge 
through the nose and by the foetor peculiar to fungous affections. 
Treatment.—Extermination is the common remedy for fungous tumors 
of the antrum; and the whole morbid growth should be removed at the 
first operation. The difficulty is greater in a second attempt than in 
the first. The fungus will grow up again and again if the extirpation 
be not thorough and complete. Homoeopathy has cured some bad cases. 
The mode of performing the operation recommended by Desault was 
to “ remove the molar teeth and their alveolar processes, corresponding 
with the floor of the antrum, by a tooth-key or by tw'o or three strokes 
of a chisel and mallet.” (See Gibson’s Surgery, vol. 2. p. 16.) The 
process devised by Dr. Hullihen is to perforate the floor of the antrum 
through the alveolar cell left by a tooth previously removed. Through 
the small opening made by the trochar, the tumor was found to fill the 
antrum in one case ; and was so sensitive that fainting and convulsions 
were excited by touching it. After some days delay, during which a 
decoction of poppy leaves was repeatedly injected, the operation was 
continued. The gums were removed by a scalpel, and the alveoli and 
floor of the antrum were sawed out by means of a small saw. The 
cavity of the antrum wTas thus exposed from the second bicuspid tooth 
to the last molaris, the tumors were removed by scalpels prepared for 
the purpose, and the haemorrhage was checked by the application of 
the actual cautery to all the parts where the fungus was visible. In 
this case the general health was bad, the fungus repeatedly grew up 
and was repressed by successive applications of the actual cautery. 
When it had ceased to grow, the cavity was frequently washed out with 
fine soap and astringent injections; in four weeks the cavity was en- 
tirely lined with a new membrane. In another case the fungus was 
permanently destroyed by the first application of the cautery. (For 
Medical Treatment see Fungus Hcematodes.) 
3. Lower Jaw.—This bone is said to resemble a horse-shoe and 
is the largest bone that enters into the structure of the face. It con- 
sists of the chin between the anterior foramina, the sides between these 
holes and the angles, the angles and the rami or branches ascending 
from them. It has five processes; the two condyloid at the extremity 
of the rami, placed obliquely transverse, separated by a cervix and 
adapted to the glenoid cavity of the temporal bone with which it forms 
a double arthrodial joint; the two coronoid processes (from their re- 
semblance to the beak of a crow) projecting upwards about one inch 
on the front of the condyloid ; being thin its use is for the attachmen 
of strong muscles; lastly, the alveolar arch extending from the base of 
one coronoid process to the base of the other, being broader behini DISEASES OF THE MAXILLARY BONES. 
245 
than before, and serving to give insertion to the teeth. In each socket 
for the teeth is seen a great number of small holes for transmitting the 
vessels to the alveolar periosteum, which is a membrane, common to 
the fangs of the teeth and their sockets. We find one transverse ridge 
called the symphisis menti, and some other small eminences within 
and without the bone. 
No trace of suture is found in the alveolar arches, either in man or 
animals. An important fact to be remembered when we speak of the 
simultaneous growth of these processes with the teeth. This bone is 
liable to be broken in preternatural labors, fractured by blows or falls, 
but never by the extraction of the teeth, even of children ; for in them 
the roots are much shorter, and the proportions which the sockets 
bear to the jaw is so small that no dangerous power can be exerted over 
it, in the performance of the operation. In accidents of this kind, two 
more teeth are often thrown half out of the socket* 
The inferior maxillary bone varies in shape at different periods. In 
childhood the angles are scarcely perceptible, and the rami nearly on 
a line with the body of the bone. With the increase of the body and 
augmentation of the bone, teeth are added, until that period arrives at 
which decomposition equals deposition or when the nutritive matters 
no longer exceed the excrementitious. Now the body stops growth 
and the bone has its full size. 
The bone does not retain its full size to the age of decrepitude, but 
returns slowly towards the form it had in childhood. It shrinks to 
one half its size ; the coronoid processes fall back; the bone appears 
to increase in length ; the chin projects more forward, the sockets be- 
gin to perish by a new action; and the teeth, no longer supported, are 
necessarily thrust out. It is vain, therefore, to think that the teeth 
might be kept to old age. On observing the jaw-bone of an old man 
we see that the absorbent vessels have had the ascendancy and con- 
quered the depositing or secretory vessels. It thus seems that nature 
has declared that the food of the declining man shall be the same as 
that of the child.* 
The temporo-maxillary joint is composed of ligaments, cartilages, 
fibro-cartilages, synovial membrane. These condyles are covered with 
cartilage, so also are the glenoid cavities lined with them, and inter- 
posed we find the fibro-cartilage which serves as a friction wheel. 
These surfaces are kept together by three ligaments, the temporo- 
maxillary, the external, and the internal. There is no connection be- 
tween the upper lining cartilage wdiich is developed downwards over 
the upper surface of the intermediate cartilage and the lower one which 
invests its lower surface and attaches to the condyle, unless the fibro 
cartilage is so worn as to have a hole in its middle. 
* Dr. Stout, U. S. Med. Surg. Jour. 246 
DISEASES OF THE DIGESTIVE FUNCTION. 
The posterior surface of the fibro-cartilages hang very loosely at 
their back parts and are full of holes for the transmission of vascular 
twigs. The lining cartilages are connected to the entire articular, and 
the whole are covered and kept in situ by the temporo-maxillary which 
covers them as a cap, and is hence called the capsular ligament On 
the inner side of this ligament are attached two small glands which se- 
crete the synovia to lubricate the joint, and vrhich is forced out ingrea 
abundance during its action by the pressure exerted on them. 
The natural motions of this joint are : elevation and depression, pro- 
jection and retraction, and lateral action. In the carnivora, as the lion 
or tiger, the action is confined to opening and shutting; the locking of 
their huge teeth preventing any other motion. In the rodentia, as the 
rat or the beaver, we find the action limited to projection of the lower 
jaw forward and retracting it backwards. In the herbivira, those which 
chew the cud, the grinding is provided for by large pterygoid muscles. 
In man, Avho is truly omniverous, we find the combined action of the 
three classes. 
Diseases of the Lower Jaw.—4. The articulation is liable to 
disease from inflammation, caused by the use of Mercury in scarlatina; 
and it often ends in permanent immobility of the joint. 
The treatment consists in opening the mouth forcibly and dividing 
the cicatrices; the patient must then exercise the jaw by feeding on 
hard biscuit. Ineffectual attempts have been made by surgeons to in- 
troduce instruments to force open the jaw after sawing off most of the 
teeth which had to be replaced by an artificial set. 
5. Luxation of the Lower Jaw.—Partial luxation of the joint.— 
In this case the jaw’ is thrown to one side by exerting great power in 
extracting a tooth: one of the condyles thus becomes engaged and 
thrown forward on the temporal ridge. The accident is rather rare : 
the mode of reduction is the same as in 
Dislocation or Perfect Luxation.—This occurs in persons of lax 
muscular fibre, and sometimes from gaping, or blows; when it happens 
the chin projects ; the teeth of the under jaw are in advance of the 
upper teeth: the saliva dribbles, and the patient is unable to speak. 
Treatment.—Press the rami downward and backward, and elevate 
the chin. Another method is to insert a stick between the teeth and 
then knock the chin upwards. Mr. Fox says he succeeded with an or- 
dinary ruler. 
6. Fracture of the Lower Jaw.—The existence of fracture is ren- 
dered evident by the crepitus heard and felt by gently rubbing the 
broken ends of the bone together. To remedy the accident, keep the 
teeth of the two jaws asunder by inserting a piece of cork which will 
enable the patient to be fed. Then co-aptate the parts and apply an 
appropriate bandage. The teeth should be re-placed and the patient DISEASES OF THE MAXILLAEY BOXES. 
247 
confined to a fluid diet, then wait four weeks for union. If the hone is 
broken in two places, after fixing the cork, wet a piece of paste-board, 
place it externally, and apply the bandage ; and if inflammation occurs 
about the teeth, give Aeon., and bathe with Arnica. 
7. Caries of the Maxilla Inferior.—Dr. Markwick gives* the case 
of a clerk aged twenty-three, who had suffered nine years ago from 
tooth-ache and swelling of the gums; in after years the cheek swelled 
and abscesses formed, bursting sometimes externally, and not healing 
perfectly. On Jan. 18th 1860, there was “on the right cheek corres- 
ponding to the bicuspids of the lower jaw of that side a red shining 
spot which had become adherent to the jaw, with a fistulous opening in 
its centre ; and through this a thin whitish matter and sometimes saliva 
was discharged. Within, the cheek was firmly united to the bone of 
the jaw. Pain in the cheek and in the corresponding teeth, which are 
decayed.” Merc, sol 6, is given three times per day. 
After twelve days the discharge had ceased, but the opening was not 
healed, though he was free from pain. Mer. 12, twice a day. 
Fourteen days after the fistulous opening had healed; the patient 
was quite cheerful. Gave Sulphur 80, one dose at bed time. 
A week later there had been a burning pain in the cheek. Arse- 
nicum 12. This relieved the burning. A fleshy painful growth now 
occupied the fistulous opening. Merc. 6. 
A week later, there was suppuration, fluctuation, burning and itching 
in the part. Phosphorus 6. 
After two weeks the ulcer had healed. He had two teeth extracted, 
and for three days he had offensive rusty discharge from the alveola, 
tasting like iron. From this the ulcer healed and he continued well 
for five months. At the end of which, or 
Oct. 20th, the pain returned, the cheek indurated and adherent. 
There was suppuration again, after which, while using Silicea 12, it 
was better, Silicea 18, was continued for about three weeks, then Sili- 
cea 30. Under this he attained to good health. 
Case by Dr. Helmuth:—A child, aged nine months, presented an 
opening immediately under the left eye, with a sinus running on the 
outer face of the superior maxillary bone and opening beneath the upper 
lip a few lines from the fraenum; on passing a probe through the open- 
ing, it distinctly felt carious bone, and it was proposed to lay open the 
cheek by an incision, 'take away the diseased mass with a scoop or 
chisel, and afterwards prescribe the usual medicines. The parents ob 
jected, and medicines were prescribed. Aurum-mur. 6, one powdei 
every night for a week, then omit all medicine for one week 
follow this by Calcarea-carb. 2, a powder every night for a week. So 
* Brit. Journ. Hoinoeop., 1801, p. 523. 248 
DISEASES OF THE DIGESTIVE FUNCTION. 
continuing in alternation, allowing seven days between the administra 
tion of the different medicines. This course was pursued for about 
three months; in v'hich the child was perfectly cured. 
III. PTYALISM. 
1. Acute Ptyalism. (Greek Ptyalismus, to spit.) Salivation or in- 
creased flow of saliva from the salivary glands. It is seldom seen as a 
natural disease; and then it is easily cured by the following remedies, 
which have so often caused a similar state: 
2. From Mercury.—Salivation, or ptyalism, is regarded as a local 
indication that the system is under the influence of Mercury. The 
name salivation refers to the most common symptom of this state, in- 
creased flow of saliva. The following is the description of an extremely 
severe case, one which has been quite common within a few years past: 
“ tumefaction and ulceration of the gums, the tongue swollen to such an 
extent as to hang out of the patient’s mouth, and incapacitate him from 
either eating or speaking ; the salivary glands enlarged, very painful 
and inflamed, and from four to five pounds of saliva dribbling away in 
twenty-four hours ; the breath horribly foetid ; the inside of the cheeks, 
the fauces, palate, and tongue ulcerated and even gangrenous; the al- 
veolar processes attacked by necrosis, with exfoliation of dead bone and 
loss of teeth, leaving the patient, if life is spared, a hideously mangled 
spectacle. In this group of symptoms several diseases are portrayed: 
Inflammation of the salivary glands, or mumps/ ulceration of the 
cheeks going on to grangrene, or gangrenopsis, ulceration of the throat, 
and those fearful cases of inveterate syphilis, in which the bones become 
affected, Dr. Wood recommends Mercury in chronic cases of mumps. 
(Pract. Med. Vol. 22, p. 469.) Dr. Churchhill quotes Dr. Duncan, to 
show that great benefit follows the use of Mercury and chalk, in gan- 
grene of the mouth. {Diseases of Children. Churchhill, p. 489.) In 
secondary ulceration of the fauces, tongue, &c., of a venereal character, 
Mercury, in one form or other, is recommended by the majority of 
surgical writers. 
Iodide of Potassium produces salivation very similar to Mercury. 
Iodine has been employed as a remedy in mercurial salivation. 
8. Chronic Ptyalism.—Dispensary Case.—A man, aged 80, has 
suffere'd greatly from soreness of the gum$ and salivation for several 
months. He has not been under Mercury at any time to his knowledge. 
He has taken some remedies without benefit. He wTas cured in a few 
days with Merc. Cor. 3°. 
The local use of Mercurius-corros., is very effectual m curing spon- 
taneous ptyalism. Dissolve two grains of the second trituration in a 
pint of water simply taken in small quantities as a wrash for the mouth PTYALISM. 
249 
will cure obstinate cases which had resisted long courses of treat- 
ment. 
Tartar-emetic produces inflammation of the mouth and of the 
mucous membrane of the tongue, and buccal surface, violent salivation, 
dysphagia. The lips are swollen and in places excoriated. 
Dr. Maxwell advises Tartar-emetic in cases of ptyalism to be given 
in repeated doses in warm water, so as to keep the system fully under 
its influence, and the action to be assisted by warm diluent drinks. 
It is also appropriate in vesicular and pustular eruptions within and 
around the mouth, and in swellings and excoriations of the lips. High 
dilutions should be given in such cases. 
Nitric-acid.—Beddoes and other English physicians found Nitric- 
acid of great utility in salivation and ulceration of the mouth occasioned 
by the use of Mercury. Hahnemann says, “ it never could be useful in 
such cases if it did not of itself excite salivation and ulceration of the 
mouth. To produce these effects it is only necessary to bathe the sur- 
face of the body with it, as Scott and Blair observed. 
Iodide of Potassium.—This article is known to be capable of caus- 
ing salivation similar to that of Mercury; and it has even been employed 
in the old school as a remedy for the latter affection. 
Other remedies are: Bell., Calc., Canth., Colch., Dulc., Euphorb., 
Hepar., Iod., Each., Nitric-acid, Op., Sulph. 
Nitro-muriatic-acid increases the salivary flow, but does not 
like Mercury cause mortification of the gums, except it be applied in 
full strength and in large quantity. In dilutions it cures excessive 
flow of saliva, tenderness of the gums, contaminated breath. It has 
been thought to owe its properties to the chlorine only. 
4. Morbid Saliva.—Alumina.—Case by Dr. Schleistcher.—Mrs. S., 
over 90 years old, a thin, but hale old lady, after a severe altercation, 
got a salty taste in her mouth, not relieved by anything she tried. I 
found the lips pale red, the mucous membrane of the mouth and tongue 
grayish white, as if macerated in vinegar, fauces pale and dry, saliva 
tough, inspissated, in small quantity and of salty taste. Chewing and 
speaking increased the secretion of saliva; water, kept in the mouth, 
got the salty taste right off. Deglutition was difficult. Appetite good, 
but food had no relish. Thirst great for cold water, Bowels moved 
every four or five days, hard, lumpy; sleep restless, and head disturbed 
for want of sleep; pulse fifty-eight and small. Carbo 6, brought no 
relief, but Alumina 6, five pillets every four hours, cured her entirely 
in about two weeks. 
5. Foetid Odor of the Mouth.—This is commonly a symptom of 
some disease which must be cured before this symptom will cease. 
When its origin is obscure, we may give as constitutional remedies: 
Sulph., Arsen., Cinnabar, Nux-vomica, Puls., Sepia. 250 
DISEASES OF THE DIGESTIVE FUNCTION 
When there has been abuse of Mercury, the best remedies are 
Nitric-acid, Aur., Carbo-veg., Sulph., Lach., Arnica, Hepar, Iod.-mer. 
Bad smell of the mouth with foetid taste: Agar. 
Fetid smell from the mouth like old cheese, Aur.-foh, Kali-carb. 
Kal-chlor. 
Smell sometimes like garlic, sometimes putrid. Petrol. 
Smell of mouth as of pitch or cedar. Canth. 
Metallic smell of the mouth. Berb.-v. 
Smell as of clayey earth. Mang.# 
6. Salivary Fistula.—This is generally found in the neighborhood 
of the duct of the parotid: the course and termination of this canal 
should, therefore, be carefully studied. IlorneSs Operation: “ The 
fistulous orifice should be first slightly elongated by a simple incision 
made in the line of the zygomaticus major muscle : then the patient’s head 
being firmly supported by an assistant, who also holds a broad wooden 
spatula against the inside of the cheek opposite the fistula, a sharp- 
edged punch, like that used by saddlers, and large enough to excise the 
whole fistula, is pressed firmly against the cheek, so as to remove the 
diseased portion entirely, and at the same time to open the duct afresh, 
and afford a new avenue for the escape of the saliva into the mouth 
The external edges of the wound are now to be accurately closed by 
the twisted suture, and the cold-water dressing is to be applied, and 
union is accomplished.” 
7. Salivary Concretions within Stenson’s Duct.—These are white 
friable, and either round, oblong, cylindrical, or ovoid, in size varying 
from that of a millet-seed or a pea, to that of a hazelnut. They may 
be single or very numerous, (twenty or more.) They are composed of 
phosphate and carbonate of lime, held together by animal matter, and 
give rise to obliteration of the ducts and great dilatation, consequent 
upon the accumulation of the secretion. (Rokitansky, Vol. 2, p. 142.) 
Bilious Derangements of the Stomach.—The principal remedies 
are: Bryonia, Nux-vom., China, Coloc., Puls., Sulph., Arnica, Arsen. 
General, Remedies for Affections of the Mouth.—Arsenicum. 
Aphthae ; tongue Hack, brown, blue or red/ boring pain; cancer of the 
tongue; tongue white, coated, cracked; dryness of the mouth and 
tongue, with thirst; inflammation of the tongue and mouth ending in 
gangrene; numbness of the tongue; paralysis of organs of speech : 
accumulation of saliva altered in quality to bitter, bloody; offensive 
smell from the mouth / speech affected by inflammation of the organs; 
slowness or rapidity of speech ; swelling, ulcers of the tongue. 
Mercurius.—The tongue feels as if burnt: white, black or slimy thick 
coating on it; mouth dry, bleeding ; tongue swelled, hanging out, sup- 
* Jahr, Iieper , p. 447. PTYALISM. 
251 
[urating; hard, inflamed, moved with difficulty; feels numb and rough 
ptyalism ; ranulu ; saliva altered, acrid, foetid ; saltish taste; offensive 
smell from the mouth ; putrid smell; palate, tongue and gums sore; 
swelled, ulcerated; speech altered, hurried, stammering. 
Mercury, Abuse of.—Aurum, Bar.-m., Bell., Calc., Lach., Sil. 
Lachesis.—Abuse of Mercury; difficulty of speech; he is liable to 
bite his tongue ; tongue shining, black or brown, burning; rigid; cancer- 
like pain; mouth and tongue dry, with thirst; froth at the mouth; 
tongue swelled, hanging out; inflamed tongue and palate ; accumulation 
of saliva and mucus : paralysis of the organs of speech, tongue, &c. 
Ptyalism after Mercury; mouth and palate sore ; speech difficult, in- 
distinct, confined to single words, suppressed, or hurried stammering; 
according to the degree of inflammation or paralysis of the organs; 
ulcers on the palate. 
Belladonna.—Cracked tongue ; white, slimy coating on the tongue ; 
it feels cold, or dry, heavy, inflamed ; mouth dry, with thirst; froth at 
the mouth ; bleeding ; palate swelled, velum enlarged; abuse of Mer- 
cury ; ptyalism; the tongue moves with difficulty ; accumulation of 
mucus, speech suppressed by paralysis or swelling of tongue, &c.; 
tongue red, rough, saliva accumulated; tenacious; thick, viscid smell 
from the mouth; sore mouth; dumbness, or hurried altered speech 
nasal twang, &c., caused by inflammation or spasm of the organs 
stammering. 
Aconite.—Spitting of blood; burning in the tongue ; dryness of the 
mouth and tongue, with thirst; inflammation of the mouth, palate, 
velum palati, tongue ; accumulation of saliva; defects of speech from 
inflammation of organs; stammering; stinging in the tongue. 
Mux-vomica.—Aphthae: tongue black, blistered, brown, burning, 
thick coated, slimy, white, or yellowish, cracked, dry, heavy, red on the 
margins, sore, swelled, ulcerated. 
Palate blistered, sore, swelled, ulcerated. 
Mouth dry early in the morning or at night, without thirst; bleeding 
from the mouth ; inflammation of mouth, palate, velum palati, opening 
the mouth with difficulty. 
Mucus, accumulation of; smell from the mouth after eating. 
Paralysis of organs of speech ; ptyalism at night; accumulation of 
saliva, altered in character ; speech difficult from paratysis and inflam- 
mation; stammering. 
Sulphur.—Aphthae : blisters; spitting of blood ; bad smell from the4 
moutn. 
Tongue brown, burning, coated white or brown, slimy, thick; cracked, 
dry in the morning; margins rough. 
Mouth dry in the morning, with thirst; peeling off of the skin; 252 
DISEASES OF THE DIGESTIVE FUNCTION. 
‘ptyalism after abuse of Mercury; accumulation of saliva ; frothy, salt, 
or sour. 
Defects of speech, difficult, organs of speech inflamed ; stammering. 
Remedies in Affections of the Fauces in general.—Alum, Bell.; 
Carb.-veg., Ignatia, Lachesis, Merc., Nux-vom., Phos., Puls., Sulph. 
IV. DYSPHAGIA. 
(From Greek, dys, with difficulty, and phago, to eat.) Difficulty of 
deglutition. Five different forms of this disease have been described. 
We will collect some observations of value on the following: 
1. Dysphagia from mechanical Injury of the (Esophagus.—The 
effort to swallow hard and imperfectly masticated food, may result in 
injury to the texture of the oesophagus. This tube is composed of in- 
ter-twined fibres plaited together in a way that permits considerable 
distention; but distention carried too far and too often repeated causes 
disease of the oesophagus, and this is attended by many symptoms 
common to dyspepsia. A prominent one is pain in the centre of the 
back and of the chest, which is distressing among the other anomalous 
symptoms felt by dyspeptics. This repeated swallowing of hard ill- 
masticated masses of food may cause in unhealthy cachectic persons 
a thickening of the lining membrane of the oesophagus, which often 
ends in permanent stricture and difficulty of swallowing. Dysphagia, 
when proceeding to its ultimate result, produces death by inanition, the 
passage to the stomach becoming closed. When disease had proceeded 
to a dangerous extent, Dr. Epps in one case condemned the effort to 
force down solid food. He advised to “ let it alone, subdue the excite- 
ment and anxiety; the oesophagus will not unlikely act upon the food, 
and if not digested, it will so far act upon it as to dislodge it” or enable 
it to pass gradually into the stomach, with the aid of pressure of soft 
food. (Constipation, &c., p. 29.) 
The effort to force foreign bodies down the oesophagus into the 
stomach induces perpetually-recurring spasmodic action of this mus- 
cular structure; and this contraction is only overcome by force, for 
which an instrument is used. The forcing efforts persisted in, often 
cause closure of the oesophagus, a condition ending in starvation. 
Case by Dr. Epps.—An intelligent lady swallowed a fish-bone, which 
she felt only half-way down to the stomach. A surgeon made persistent 
efforts to push it down. Her countenance indicated intelligence, but 
the eye had an anxious brightness, indicative of fearful changes going 
on in the system, caused by the deficient supply of food. The lady died 
from the injury of the oesophagus, occasioned by the efforts to force the 
hard substance into the stomach. 
Foreign Bodies in the Throat.—When the effort is made to swallow DYSPHAGIA. 
253 
substances too large or solid, and it lodges in the throat or oesophagus, 
it is desirable to learn what the substance is. The effort first is to 
compel the patient to throw it out by beating him on the spine between 
the shoulders, or by tickling the throat with a feather, or by putting 
snuff" on the tongue. If the object has passed too far down to be seized 
with forceps, and its nature is known, it may be pushed down into the 
stomach. A small gum-elastic tube, oiled, may be passed back into 
the throat; its presence near the glottis excites it to close, at the same 
time the patient makes an effort to swallow and the end of the tube 
passes at once into the oesophagus. It can now be gently pushed down- 
ward, giving no uneasiness till it touches the foreign body. If this be 
soft or smooth or soluble it is easily disposed of; if it is hard or rough 
it may still go down slowly, if aided by the swallowing of oil or butter. 
After it has passed into the stomach there is sometimes a feeling of 
something sticking there, but this soon subsides.* 
When the pain is violent, with retching, great anguish or spasms, im- 
mediate efforts must be made to bring up the irritating substance. A 
violin string, or a fine wire may be bent at the middle into a loop. This 
may be pushed down with the end-of a whalebone probang made per- 
fectly smooth, or with the smooth gum-elastic tube. If it get below 
the point of obstruction it may bring the object up when it is with- 
drawn. 
2. Dysphagia from, Nervous Irritation.—This disease generally 
occurs in “ young women of an excitable nervous system, with leucor- 
rhoea, or painful menstruation and impaired digestion.” The strongest 
language was used by these patients to express their inability to 
sallow, and they showed the greatest unwillingness even to attempt it.j 
Diagnosis.—This is made out from the general symptoms and history 
of the case. There is, in cases purely nervous, no emaciation y the 
attack comes on suddenly from slight cause, as a “nervous shock or 
slight catarrh;” there is considerable nervous excitement but no pain. 
In cases dependent on serious organic lesion there is progressive ema- 
ciation from an early period till the termination of the case. 
A case is reported by Dr. B. F. Joslin, jr., which commenced with 
symptoms of a purely nervous character; but which afterwards pro- 
ceeded to a fatal termination after a regular course of emaciation and 
protracted suffering. This patient at first (1856) complained of 
“ choking in the throat,” gastric irritation and a feeling of nervousness; 
there was difficulty of swallowing, partially by Nux 6, Mercurius, 
Pulsatilla, Ignatia, Belladonna, and Natrum-muriaticum. After death 
which occurred after three years of suffering, dissection revealed a tumor 
* Hering. 
' Diseases of the Alimentary Canal, by Dr. Habershon. 254 
DISEASES OF THE DIGESTIVE FUNCTION. 
an inch in length, “ hard and solid with numerous spiculoe of bone 
projecting from it. It was situated just above the bifurcation of the 
trachea, inclining to the right side.” Connected with the tumor was 
H a cardiac branch of the pneumogasbric nerve. The tumor had caused 
the difficulty of deglutition, not by pressing on the oesophagus, but by 
nterfering with the functions of this nerve.”* 
Dysphagia from Spasmodic Constriction of the Pharynx.— 
Hyoscyamus.—Several authors observed it to produce spasmodic con- 
striction of the throat with inability to swallow, in a very high de- 
gree. A similar case was cured by Withering with this article. [Edinb. 
Med. Com., Dec. 11, b. VI., p. 263.) 
Cocculus.—Case by Dr. Helmuth.—A woman had been unable to 
swallow either food or drink for some time and was absolutely in a state 
of starvation. Partly deserted, and partly given over by former physi- 
cians. There was stricture of the upper part of the oesophagus ; and 
she was near dying from exhaustion. I dilated the stricture sufficiently 
to allow the passage of a flexible tube into the stomach and injected 
about a pint of weak chicken broth into the viscus. This was several 
times repeated, at intervals. She immediately revived, and each day 
I introduced a larger probang. For several days the dilators were con- 
tinued without finding dilation more easy. As soon as she could 
swallow at all I administered Cocculus and Nux-vom., and occasionally 
Arsenicum, Cal.-carb. The results produced by these medicines were 
surprising. The administration of the Cocculus in particular was al- 
ways followed by the best results-! 
Dysphagia is sometimes a cause of apoplexy. Food does not descend 
instantly to the stomach, but is gradually and slowly carried downward 
by “a kind of spiral gyre-like action of the gullet itself. The diameter 
of the oesophagus gradually lessens as it nears the stomach :” It is im- 
portant also to note that “the aorta lies close to the gullet, and this 
explains why apoplexy so often follows upon the taking rapidly of large 
quantities of food at public dinners.” Swallowing in haste, there is 
not time for the oesophagus to empty itself, and it becomes distended; 
a pressure on the surrounding parts takes place; the flow of blood 
through the aorta is impeded; this impediment causes the vessels in 
the overworked and weakened part of the brain to become ruptured; 
effusion of blood takes place; and, after some hours of stertorous breath- 
ing, the patient dies. The case is regarded as one of death from apo- 
plexy, though it is really death from over-distention of the oesophagus 
and might have been averted by eating more slowly.” {Dr. Epps.) 
General Remedies for difficult Deglutition.—Acon., Alum., Ambr., 
* Amer. Horn. Rev., Yol. 2, p. 314. 
f American Horn. Review, Yol. 2, p. 114. MOEBID TIIIKST. 
255 
Ammon., Argent., Arsen., Aur.-m., Baryt., Bell., Brom., Bry., Canth., 
Carb.-v., Caus., Cham., Chinin, Cic., Con., Cupr., Dros., Fluor-ac., Ilep., 
Hyos., Ign., Ip., Lack., Nux-vom., Puls., Rhus., Sepia, Steam., Teucr., 
Tart.-em. 
Dysphagia often remains for weeks and even months as an effect of 
diphtheria. Not unfrequently the muscles of deglutition and of arti- 
culation become paralyzed during the progress of the malady, and the 
patience of both patient and physician is severaly tried before recovery 
takes place. 
Thirst is rather a symptom of many diseases than a disease itself. 
It is only when it becomes excessive that it is regarded as a mani- 
festation of disease. The desire to drink at reasonable intervals and 
in sufficient quantities to supply the body with the necessary amount 
of fluids is rather an accompaniment of health than of disease. 
Symptoms.—Thirst consists of a feeling of dryness, heat, and con- 
striction, in the back part of the mouth, pharynx, oesophagus, and some- 
times the stomach. When thirst has continued for a short time, these 
parts swell, become red: the mucous secretion ceases almost entirely ; 
that of the follicles changes, becomes thick and tenacious, the flowing 
of the saliva diminishes and its viscosity is sensibly augmented ; there 
is now inquietude, general heat; the eyes become red, the mind is 
troubled, the circulation is quickened ; respiration is laborious; the 
mouth is opened wide, in order to bring the external air into contact 
with the irritated parts, thus producing momentary ease. 
1. The causes of the development of thirst in an inordinate degree 
are such as have diminished the amount of watery fluid in the blood; 
when the atmosphere is peculiarly dry; when the body has been losing 
undue quantities of fluid; excessive fatigue; eating of salt food; all 
other causes of febrile disease. Some persons have had such extreme 
thirst as to drink from forty to sixty pints of liquid in twenty-four 
hours. 
Ali Bey in his travels through the deserts of Morocco thus describes 
the 
Symptoms of Excessive Thirst.—“ An attack of excessive thirst 
is perceived suddenly by extreme aridity of the skin; the eyes appear 
to be bloody; the tongue, and mouth, both within and without covered with 
a crust about the thickness of a crown piece; this crust is of a dark 
yellow color, of an insipid taste, and of a consistence like the soft wax 
from a bee-hive. A faintness and languor takes away all power to 
move. A kind of knot is felt in the throat, and a stricture in the dia- 
phragm, attended with great pain which interrupts respiration. Some 
IY. MORBID THIRST. 256 
DISEASES OF THE DIGESTIVE FUNCTION. 
wandering tears escape from the eyes ; and, at last the sufferer drops 
down to the earth, and in a few moments becomes unconscious of his 
situation and of all around him. These were the symptoms I witnessed 
in my fellow travellers, and which I experienced in myself.”* 
The following Remedies have relation to excessive thirst. 
Desire for cold water. Arsen., China., Eup.-per., Lobel.-card., Ruta., 
Sabad., Zinc.-m. 
Great desire for cold drinks. Angus., Dulc., Euphorb., Ledum-pal. 
Thirst for cold drinks, particularly water. Merc.-sol. 
Great thirst for cold water, with heat and dryness of throat 
Carb.-am. 
Great thirst for cold drinks in the evening, without heat. Bism. 
Unquenchable thirst, particularly for cold drinks. Verat. 
Great desire for cold drinks without heat. Bell. 
2. Loss of Thirst.—Arsen., Bell., Ferr.-acet., Ledum.-pal., Puls., 
Sep., Sassap., Tab. 
No thirst for many days. Mang. 
No thirst. Lyeopod., Natr., Sulph. 
No thirst for four days. Cycl. 
He drinks less than usual. Staph. 
No thirst or else it is excessive. 
Camph. 
Absence of thirst, with heat in the 
whole body. Hydroc.-ac. 
Y. DERANGEMENTS OF DIGESTION.—LIMOSIS. 
1. ANOREXIA.—Want of Appetite. See Dyspepsia. 
2. BULIMIA Fames Canina. Morbid Appetite. 
A disease in which the patient is affected with insatiable and perpetual 
desire of eating, beyond the wants of the system. It sometimes 
amounts to simple indulgence in excessive quantities of food. It may 
be attended with apparent good health, but it ultimately leads to ple- 
thora, disorder of the secreting functions, apoplexy or paralysis. It 
is often a symptom only of certain morbid states of the digestive 
organs. 
Causes.—1. Remote : Hereditary predisposition; the habit of eating 
too much and without mastication. The American Indians frequently 
excite it in this way; chronic debility from obstruction of the mesen- 
teric glands, liver, &c., suppression of chronic eruptions, old ulcers, &c. 
2. Immediate: Concentration of vital energy in the stomach; the 
nerves becoming more sensible and muscular coats more irritable ; and 
leading to increased secretion of the gastric-fluid; this causes the sen- 
sation of extreme hunger; and the food taken into the stomach is 
rapidly dissolved, and pressed forward into the duodenum. The con- 
centration and expenditure of vital energy is followed by torpor, debi * 
* Wonders of the World, by C. C. Clark, p. 251. DERANGEMENTS OF DIGESTION. 
257 
lit*', and a sense of faintness; abstraction of vital influanco from tlie 
b>'ain and heart; imperfect assimilation ; irritation of the digestive sur- 
face ; impure state of the blood. (Copland, vol. I. 121.) Exhaustion 
from habitual discharges, the state of pregnancy, rapid growth 
.onanism, &c. * 
Pathology.—Inordinate distention of the stomach and duodenum 
vascular, corrugated state of the mucous surface; hypertrophy of this 
organ, or flabby, softened state of its coats ; dilatation of the oesophagus. 
We have seen one case in which the degree of emaciation was equal to 
that in the last stage of phthisis ; though very large quantities of food 
were demanded. A stricture of the oesophagus near its lower extre- 
mity prevented substances swallowed from reaching the stomach and 
the oesophagus became distended to a large size. When about two 
quarts of solid and liquid food had been forced into the oesophagus the 
patient poured down after it a quart or two more of water; and, by some 
peculiar muscular efforts, so far relaxed the stricture as to enable the 
contents of the distended oesophagus to pass down into the stomach. 
On dissection the oesophagus was found about four inches in diameter; 
all its coats being hypertrophied, thickened, irritated and in parts in- 
flamed and ulcerated. 
In some cases of bulimia taenia or lumbmci exist in the intestines 
stomach or duodenum; in others there is structural disease of the liver 
pylorus, duodenum, or organic changes in the mesentery, its glands, oi 
other abdominal organs; it often exists in connection with epilepsy and 
other cerebral disease. 
Treatment.—It is usual to begin the treatment by restricting the 
amount of food ; but this can seldom be done, as the patients can never 
be trusted to govern themselves. One case is given in which three- 
hundred and seventy-nine pounds of meat and drinks were swallowed 
in the space of six days ; and yet the patient lost flesh rapidly. He 
was cured by taking food boiled to a jelly, in small quantities often re- 
peated. (Mem. Med. Soc. London. Vol. 3.) Copland saw a child seven 
years old who seized upon an uncooked rabbit, half a pound of candles 
and some butter and devoured them in quick succession, and who ordi- 
narily ate more than six other persons. This case and a similar one 
were cured by an active course of nauseating purgatives, chiefly Castor- 
oil and Oil of Turpentine. In one case the remedies caused an erup- 
tion over the body resembling porrigo favosa, accompanied by the sud- 
den disappearance of the disease. On suspending the treatment the 
eruption receded and the bulimia returned ; and it was finally cured by 
Mercurials, Purgatives, Turpentine, external use of Tartar-emetic, 
Ointment and strict diet. There is no case of this disease that will 
not yield to a judicious homoeopathic treatment. 
In one case given by Dr. Crane, (Lond. Med. Repos, vol. 17. p. 293.) 
VOL. I 17. 258 
DISEASES OF THE DIGESTIVE FUNCTION. 
the eating of large quantities of food was followed by vomiting. This 
case wras cured by compelling almost total abstinence from food for 
several weeks ; the only aliment allowed being portable soup made into 
pills. When the stomach has been inordinately distended by extra- 
ordinary quantities of food, it is better to reduce it gradually, relying 
much at the same time on an active course of anti-psoric remedies as 
Kali-carb., Pod., Iod., Sulph., exercise, and constant mental as well as 
physical employments. In some cases stimulants in small doses have 
changed the action of the stomach. In others the morbid sensibility 
has been subdued by Opium; and M. Rostan recommends small pieces 
of ice to be swallowed at regular intervals. 
In some of the most remarkable cases recorded, no course of treat- 
ment was persistently tried. Domery, the Polish soldier in Admiral 
Warren’s fleet in 1799, inherited the disease, and began to eat in large 
quantities at the age of thirteen. He would devour live cats, rats, and 
dogs, also tallow candles and the entrails of animals. In one day when 
aged twenty-one (1799) he ate four pounds of raw cow’s udder in the morn- 
ing; at half past nine A. M. he commenced on five pounds of raw beef 
and one pound of tallow candles, with one bottle of porter ; one o’clock, P. 
M. the same quantity of these articles were repeated, with three bottles of 
porter. His room being guarded to see that nothing was thrown away, 
he Avas found at two o’clock in good spirits, the skin cool, pulse regu- 
lar, having had no evacuations of any kind. At a quarter past six he 
had devoured the whole, and declared he could eat more ; but, being 
told that experiments were being made upon him, he desisted. [John- 
son, Medical and Phys. Jour. vol. 3.—Brit. Encycl. vol. 3.) 
3. ABSTINENCE.— 
I. As a Remedy in the Treatment of Disease.—The great power 
of abstinence in both health and disease render all its symptoms im- 
portant. The influence of fasting was almost as well known to Hippo- 
crates and Sydenham as it is now ; and it forms a part of the popular 
knowledge of the people of different climates. Dr. Edward Miller says 
the French and Spaniards who emigrate to the West Indies escape the 
violent diseases peculiar to the tropical climates by avoiding the strong 
diet and stimulating drinks which the English and Americans are too 
much disposed to use in all climates. (N.-Y. Med. Repos. J. p. 194.) 
When abstinence is relied on as a remedy it must, sa}7s Marshall 
Hall, be carried much farther than is usually prescribed as a part of the 
antiphlogistic regimen, and must be severe in proportion to the severity 
of the disease and the rapidity with which it is progressing. It may- 
be especially important in gastritis, hepatitis, dropsy, cancer, plethora, 
apoplexy. {Dr. C. A. Lee. Copland, vol. 1. p. 81.) Corpulent per* ABSTINENCE. 
259 
sons and those suffering from febrile or inflammatory affections endure 
abstinence to an extent that would be quickly fatal to one in health ; 
and the middle aged sustain life longer without food than the young or 
those far advanced in life. (See Remarks at pages in 190—192.) 
II. Effects of protracted Abstinence on health.—The sensations first 
excited by prolonged fasting vary according to the degree of mental and 
physical power of the individual. The sensation of hunger is generally 
strong, and every substance within reach is ravenously devoured to ap- 
pease it. Every animal, the most loathsome reptiles, are welcome. In 
a disastrous voyage to Brazil, Lerius says, “ a mouse was more valued in 
the ship than an ox had been ashore.” 
The native Australians composed a paste of ants and worms with the 
bark of trees to appease hunger; and the people of New Caledonia 
swallow lumps of earth for the same purpose, and tie ligatures, con- 
tinually increasing in tightness, around the abdomen. As the sensa- 
tion of hunger increases the mind begins to become savage and brutal. 
Men become wild and ferocious, quarrelsome, turbulent and reckless, 
resembling beasts of prey. Of one hundred and fifty persons who in 1816 
attempted to save themselves on a raft made from the wreck of the 
Medusa, West of Africa, some became delirious and deliberately walked 
into the sea; some sank into a state of drowsiness and passed hours 
in delightful visions. Others bade adieu to their comrades, saying, “fear 
nothing, I am going to get you assistance, and will soon return.” In 
the midst of the general madness some rushed on their companions 
sword in hand, demanding something to appease the hunger that was 
consuming them. Many believed they were still on board the Medusa, 
and saw ships, harbors, and an elegant city in the distance. M. Car- 
reard thought he was travelling through beautiful fields, when an officer 
said to him “ fear nothing. I am going to write to the governor ; and 
in a few hours we shall be saved.” Confused cries of the starving 
people roused them from their visions. After a night in which pain- 
ful dreams could not be distinguished from dreadful realities these 
friends awoke and asked each other if they had not heard cries of com- 
bats and groans of despair ; and every man believed he had been de- 
ceived by the illusions of some terrible dream. Around was a scene 
of horrors. Over sixty persons had died of starvation during the night 
or drowned themselves in despair; and the deepest dejection was spread 
on every face; some sat down in sadness, bitterly complaining of their 
hard fate, and the remaining wretches cut up the bodies of the dead 
to eat. 
In some cases the suffering from starvation, appears not to be so 
great. Captain Inglefield, who survived the wreck of the Centaur in 
1782, saw some die; others hung twenty-three days in the shrouds and 
were saved. Captain Kennedy did not taste food or drink for eight 260 
DISEASES OF THE DIGESTIVE FUNCTION. 
days, and yet felt none of the sensations of hunger or thirst. In these 
cases, as in many others, life was prolonged by the absorption of sea- 
water from the surface of the body. 
The length of time that entire abstinence can he endured varies in 
different persons. Hippocrates fixed the utmost limit at seven days 
This has in various modern instances been exceeded. In 1784 Thomas 
Travers remained buried in a coal-pit two hundred and seventy feet deep 
seven days and was living when extricated, and could raise his head; 
but his hands and feet were cold, and pulsation was almost extinct. He 
only lived till the next morning after food was given him. In 1783 
two girls were buried in the ruins of a house destroyed by the earth- 
quake that desolated Sicily and Calabria. One of these girls lived eleven 
days without food and the other six days; both recovered. 
Symptoms produced by entire Abstinence.—Paleness and lan- 
guor of countenance ; muscular debility and emaciation; weak small 
pulse; thirst; quickness of intellect, constipation, flaccidity of the 
muscles ; increased frequency of the pulse ; palpitations, leipothymia, 
or full syncope; head-ache, delirium; flushes of light before the eyes ; 
tinnitus auxium; slight amaurosis ; dryness of the throat; pains in the 
stomach; wakefulness, followed by delirium, mild or furious ; coldness 
of the surface and extremities ; morbid sensiblity of the organs of sense ; 
depressed temperature, followed by insensibility, stupor or coma, ter- 
minating in death; symptoms resembling these are often caused by 
rigid adherence to the antiphlogistic treatment. (Copland, vol. 1. p. 32.) 
Pathology.—Emaciation and absorption of every particle of fatty 
matter; paleness flabbiness, softening and emaciation of the muscles and 
heart; paleness of all the viscera; slight atrophy of the liver and spleen ; 
diminished size of the stomach and colon; increased vascularity of the 
brain, and sometimes of its membranes, a large proportion of the blood 
being sent to the brain to the very last. This is effected by the pres- 
sure of the atmosphere on the surface of the body generally, whilst 
the brain is guarded by the unyielding walls of the cranium. A limpid 
serous effusion is also found in the ventricles or between the mem- 
branes. {Copland) Magendie says, abstinence increases the propor- 
tion of the albumen as the quantity of blood diminishes. The quantity 
of lymph is considerable during the first third of the period of absti- 
nence ; and it increases the longer the animal fasts ; after this or 
during the other two-thirds of the time it diminishes, and before death 
there is but little lymph in the thoracic canal. {Jour, de Phys. 8. 
1861.) 
The instances in which life has been prolonged for an incredible space 
of time by a very small amount of aliment daily given are numerous and 
well attested. The negro couriers, who traverse the deserts of the 
Western coast of Africa, perform long and fatiguing journeys on about ABSTINENCE. 
261 
four ounces of food daily. The Moors often subsist eight days on three 
ounces of gum daily, without sensible injury. A caravan of one thou- 
sand persons subsisted on gum a part of the journey from Abyssinia to 
Cairo in Egypt, and gum-w'ater is often depended on to sustain life 
when other food is exhausted. An American Indian can travel long 
iourneys, carrying with him only a small quantity of parched corn. 
Shipwrecked sailors have been kept alive for many days on a small 
part of a ship’s biscuit per day to each man. Captain Bligh of the 
ship Bounty, having been placed by the mutineers in an open boat, 
with eighteen men, sailed about 3600 miles in the South Pacific Ocean, 
allowing to each man only an ounce and a quarter of biscuit per day. 
Religious visionaries have often tested the utmost powers of the human 
constitution. In 1789 Caleb Elliott attempted to fast forty days, and died 
at the end of the sixteenth of starvation. Two convicts lived in the jail of 
Edinburgh fourteen days without food, receiving liquids only. A Scotch- 
man confined in the tower of London fasted sixty days and was libe- 
rated. Morgagni says, a woman refused all sustenance except twice in 
fifty days. Dr. Willan says a visionary in 1786 refused all solid food 
and drank only a half pint or pint of water acidulated with orange 
iuice, for sixty days. He was now reduced to the appearance of a ske- 
leton on which the flesh had been dried, though the lustre of his eyes 
remained and his voice was entire. He was treated by Dr. Willan, but 
he died in a state of imbecility on the seventy-eighth day. An insane 
man took nothing but a pint and a half of water daily, and stood in one 
position thirty-eight days. He then lay down and lived nine days 
longer. Janet McLeod of Scotland, after epilepsy and fever remained 
five years in bed, receiving food only by constraint. In efforts to force 
her mouth open two of her teeth were broken. Liquids forced into her 
mouth were rejected. With her head drawn down on her breast she 
slept much, and continued to live for four years, taking no food but 
water. She afterwards gradually revived, and took a few crumbs of 
bread with milk and water, sucked from the palm of her hand ; but she 
perhaps, never entirely recovered. (See Gentleman's Mag. 1789.— 
Annu. Regis. 1768.—Encyc. Amer. vol. 13. p. 451.) 
A young man confined in a coal-pit for twelve days, subsisted on 
only a little water collected in the hollow of his hand. Dr. J. W. 
Francis says, a negro woman lived seven weeks supported only by two 
cups of water slightly medicated with wine. (A7".- Y. Med. da Rhys. 
Jour. 1823.) Professor McNaughton reports the case of a young man 
who confined himself chiefly to his room for three years, and in 1829, 
May, began to refuse taking any sustenance but water. For fifty-three 
days he lived on water alone. A few days before he died Professor 
Willoughby found his skin very cold, respiration feeble and slow ; 
effluvia from the breath and skin offensive; discharge from the lungs of 262 
DISEASES OF THE DIGESTIVE FUNCTION. 
foul reddish matter; pulse slow and feeble ; arteries extremely con 
tracted, the radial artery communicating a wiry feel; alvine evacua- 
tions infrequent; urine more natural. At the end of fifty-three days 
he died. On dissection the gall bladder was distended with muddy 
looking bile; stomach, mesentery and intestines thin and transparent 
no fat in the omentum. {Tr ansae. Albany Institute, vol. 1.—Led 
Edit. Copland. 1. 31.) 
The case of Mrs. Hays of Chester, Warren Co., N.-Y., attracted much 
attention. She was injured by a fall in 1854. Confined to bed for 
eight months, she was next affected with spasms lasting three or four 
days. During one year she took little food ; and from the 20th Feb. 
1857 it was alleged that she took neither food nor drink. The persons 
employed to •watch her day and night for a month declared that she 
neither ate nor drank; and that on food, tobacco or ardent spirits being 
brought into the room, concealed in the pockets of disinterested visi- 
tors, convulsions were always excited by any of them. Being in a state 
of almost constant spasm, deglutition was impossible; and the approach 
of persons wdio had touched bread caused violent retching. All action 
of the kidneys and bowels ceased after June, 1856. {Account by A. 
I). Milne, p. 48.—Amer. Horn. Review, 1858.) 
Treatment.—The only treatment generally required is the gra- 
dual and cautious administration of nutritious but unirritating food 
Begin with bland, farinaceous articles which are easily digested ; let 
the quantity be small, often repeated, and very slowly increased. When 
animal food is considered safe, light broths and soups may be tried be- 
fore milk, which requires good digestive power after it is coagulated. 
Sweet cream, diluted with water is more easily digested. The usual 
diet of convalescents from states of great debility will be by degrees 
allowed. Of medicinal measures few will be needed. External 
warmth, gentle frictions, mild stimulants, and mild sedative tonics will 
generally be all that will be required. The supporting, cheering, invi- 
gorating powers of hot coffee render it peculiarly serviceable in all 
cases of this kind. Febrile excitement will be controlled by Aconite, 
and determination to the brain by Belladonna. 
In nearly all cases of slight gastric disturbance, and consequent 
head-ache, nausea, lassitude, and general feelings of malaise, entire 
abstinence from food for two or three days, will allow the stomach to 
recuperate and resume its healthy function. Unfortunately, as a 
general rule in such cases, both the patient and the physician re- 
gard medical interference necessary, and thus add to the irritation by ca- 
thartics, alteratives, tonics, &c. In this manner a simple gastric irrita- 
tion, or relaxation, from over-eating, drinking, irregularities in diet, or 
improper food, which a proper abstinence of a couple of days would ABSTINENCE. 
263 
cure, is often converted into troublesome disease of weeks or even 
months duration. 
III. Inanition, as a Cause of Disease.—The morbid effects of a defi- 
cient supply of food are generally encountered in connexion with other 
deleterious agents. Thus in badly managed public institutions, and in 
the homes of the poor we meet with the consequences of cold, insufficient 
clothing, excessive labor, damp or impure atmosphere, mental depression, 
&c. From the combined influence of such causes we may have scurvy ; 
purpura hgemorrhagica; scorbutic dysentery, or diarrhoea ; typhoid fever, 
nervous or cerebral affections; emaciation; chronic ulcerations. A few 
years ago the convicts of the Miltbank Penitentiary (which is situated in 
a marsh and lower than the river adjoining), with all the above cases of 
disease around them, were restricted to a diet almost entirely vegetable, 
with no animal food but a very weak soup. The effects were: pale color, 
loss of flesh and strength; diarrhoea, dysenteries, scorbutic dysentery, 
scurvy, ataxic fevers, headaches, vertigo, convulsions, delirium, mania, 
apoplexy, &c., inability to bear the smallest loss of blood ; though dis- 
sections showed the brain in a highly vascular state; also frequent 
effusions of fluid in the ventricles or between the membranes. 
Dr. Lee (in N- Y. Jour, of Med. vol. 3. p. 53) says, ophthalmia in 
the Orphan Asylums and Long Island Farms School owed its origin to 
defective nutriment, and its propagation to want of cleanliness and ven- 
tilation, and they disappeared when these abuses were reformed. In 
1840 an epidemic diarrhoea appeared among the children at the L. I. 
Farms School, attended with mortification of different parts of the 
body ; ulceration and consequent destruction of the eyes, thin, dissolved 
state of the blood; offensive odor from the skin. It was caused by a 
diet of poor bread and tea, sweetened with molasses, the water in which 
coarse vegetables had been boiled, and the beef of which soup had been 
previously made, on alternate days. The effects, says Dr. Morrell, of 
this defective food were : loss of embonpoint, dulness, inactivity ; the 
eyes lacked lustre ; the skins exhaled an offensive odor, and medicines 
failed in their accustomed effect. These symptoms were followed by 
cholera morbus, incurable diarrhoea followed by mortification. The 
latter commenced generally near the junction of the mucous mem- 
brane and skin, with a dark spot which spread rapidly, and involved 
the parts in one mass of putridity. When the mortification was ar- 
rested atone extremity of the alimentary canal, it immediately commenced 
at the other. Ulcerations generally commenced in the cornea by a 
pearl white speck near its junction with the sclerotica; this spread 
over half the pupil, penetrated the iris and left it protruding. And 
thus one or both eyes were commonly lost before death. During the 
prevalence of the epidemic, scarlatina always terminated fatally, and 
every trifling wound progressed to gangrene. 264 
DISEASES OF THE DIGESTIVE FUNCTION. 
The insufficient supply of food furnished to the inmates of prisons 
and poor-houses causes derangement of the stomach and bowels, want of 
appetite, from defective secretion of the gastric-fluid. Chossat says, 
birds fed with too little corn, but plentifully supplied with water, fail to 
digest what they take ; it is thrown up by vomiting, carried off by diar- 
rhoea, or retained undigested. (Eecher. Exper. sur VInanition. 
Paris, 1843.) 
In cotton factories the hurried manner in which the children eat, 
and the meagre quantity of food allowed them, prevents their physical 
development and shortens their lives. “ The greater part of the time 
allotted them for dinner, and often the whole of it” is occupied by the 
children in cleaning the machinery; “ no time,” says one author, “ was 
allowed for the breakfast or afternoon meals, which were snatched in 
mouthfuls during the progress of uninterrupted labor; the refreshments 
not unfrequently remaining untouched till they became cold, and co- 
vered with dust and dirt from the cotton flyings.” The temperature of 
many mills is “ uniformly 80, 85 or 90 degrees.” As a specimen of 
the results of this system it -was shown before a committee of Parlia- 
ment that the number of operatives who reach the age of forty is in- 
credibly small. 
In 1831 of 1665 persons wTho “ struck” for wages, and whose ages 
ranged from fifteen to sixty, 1584 were below forty-five, three only had 
attained the age of between fifty-five and sixty; and not more than 
fifty-one between forty-five and fifty were counted fit to work. Mannish 
says, that of 1600 men in the factories of Lanark and Renfrew', no more 
than ten had reached the age of forty-five. Before this age they are 
too infirm to do the required amount of work, their eye-sight fails, and 
they are turned off to make room for younger men. {lee’s Edit. Cop- 
land’s Diet. vol. 1. p. 141.) 
IY. Appetite, vitiated, or depraved.—An appetite for substances 
in their nature unfit for food is common among pregnant, hysterical, 
and chlorotic females, especially at the age of puberty. It is consi- 
dered the result of an altered state of the nerves or a perverted state 
of the secretions of the stomach, connected with imperfect action of 
the digestive organs, uterus or brain. 
A form of this disease is of frequent occurrence in the Southern 
states, where it is called by common people “ cachexia.” I have seen 
many cases of it, generally in young females. They all show an irre- 
sistible propensity to eat certain kinds of loam or clay, which probably 
allays the painful sensations produced in the stomach by acidity. The 
appetite for clay and other earthy substances among the negroes in the 
West Indies was described by John Hunter, and is there considered 
endemic. In some cases the inordinate craving of the stomach is only 
assuaged for a very short time by clay; and other substances, often the VITIATED OE DEPKAVED APPETITE. 
265 
most disgusting, are taken: “ cinders, spiders, lice, insects, toads, ser- 
pents, wood, hair, paper, cotton, earth, chalk, thread, sand, vinegar, and 
other things still more revolting are often swallowed with the strangest 
voracity; and many continue till near the end of life to conceal from 
physicians and friends the cause of their numerous complaints, and 
their “ clay color.” Copland saw a seaman who would occasionally de- 
vour a whole wine-glass without injury, having previously crushed it to 
pieces with his teeth. (Lond. Med. Repos, vol. 17.) 
A case of swallowing glass with impunity is given by Camerarius. 
(Memoral. Cent. V.) In 1826 M. Orfila and others reported to the 
Royal Academy of Medicine, that glass had been taken into the 
stomach in many instances in even large quantities, without bad conse- 
quences. (Lond. Med. Repos. Nov. 1826.) It must still be admitted 
that the sharp cutting edges of broken glass cannot be safely taken 
into the stomach. Even pulverized glass is popularly regarded as a 
certain cause of death, and a woman was executed at Maysville, Ken- 
tucky, in 1880, who confessed that she caused the death of several 
children by giving them powdered glass. 
In cases of depraved appetite in which bulimia is also present the 
most incredible feats are said to have been performed. Fournier gives 
a case in Diet, des Sci. Med. (Art. Ccis. Rares,) of an insane galley 
slave whose stomach had been enlarged into an oblong square shape, 
extending over most of the abdomen and reaching into the pelvis. It 
was found on dissection to contain a piece of stave nineteen inches 
long, and half an inch in diameter; a piece of broomstick six inches 
long and another eight; twenty-two other pieces of wood of three, four 
or five inches long; a wooden spoon ; a pipe of an iron funnel; a pewter 
spoon; a piece of iron weighing nearly two ounces ; with various other 
pieces of nails, buckles, horns, knives, &c., the whole weighing twenty- 
four ounces, avoirdupois. ( Copland, Diet. vol. 1. p. 124.) 
In many marvellous cases unusual substances have been swallowed, 
merely to excite the wonder of spectators. Some persons have swal- 
lowed knives, bullets, billiard-balls, gold watches and pieces of money. 
In June, 1822, a man in New-York, who had previously swallowed and 
passed through the intestines a gold watch, chain, and seals, made his 
last effort; in the course of one day he swallowed fourteen knives. Two 
months afterwards he died, and one of the knives was found in the 
oesophagus, eleven were still in the stomach; the remaining two had 
traversed the whole line of the intestines and been discharged. (New- 
York Med. Repos. Oct. 1822.) 
In one case reported in the Boston Med. <& Surg. Jour. vol. 25, a 
girl, aged seventeen, died from the effect of eating slate-stone. In an- 
other case of inordinate appetite nine gallons of urine was discharged 
in twenty-four hours. (Ibid. vol. 27. p. 173.) 266 
DISEASES OF THE DIGESTIVE FUNCTION. 
Treatment.—In ordinary cases the appropriate homoeopathic spe 
cifics are the principal reliance in the treatment of depraved appetite 
when it appears as an idiopathic disease. The propensity to eat 
earths and other indigestible substances must be overcome by moral 
means united with treatment directed to the digestive, uterine, and other 
functions. See Chlorosis. 
Dr. Stevenson cured a lady, forty-five years old, of the clay-eating 
cachexia with small doses of finely pulverized charcoal, given regularly 
at short intervals. {Pittsburgh Med. Soc. Peg). 1826.) 
Depraved appetites, not acquired by the abuse of naturally noxious 
substances, indicate a lack of some normal constituent of the body—acid, 
alkali, or some other chemical ingredient of the fluids; and the “ in- 
stinct of the stomach,” as Hahnemann has well termed it, calls for the 
missing element. Thus in the chlorotic female who craves alkalies in the 
form of chalk, lime, slate-pencils, &c., there is a deficiency of alkaline 
principles in the system; and when this want is obviated the morbid 
appetite ceases. In these cases the cure cannot be accomplished che- 
mically, by throwing into the system alkalies in order to restore the 
proper equilibrium; but those homoeopathic medicines must be given 
which will place the organs in such a condition as to enable them to 
re-establish the normal alkaline secretions. 
This can always be readily done by selecting and administering such 
remedies as correspond to the morbid group of symptoms. Among these 
remedies may be cited China, Sulphur, Calcarea-carb., Ferrum., Phos., 
Carbo.-veg., Cantliaris. 
V. Cardialgia.—ITeart-gain.—“ Heartburn.”—This term is impro- 
perly applied to a pain in the stomach which is generally a symptom 
of dyspepsia. There is a feeling of anxiety, heat more or less violent; 
some oppression, faintness, inclination to vomit, or a plentiful discharge 
of clear lymph-like saliva. The pain may arise from different causes ; 
as, flatus, acrid or rancid substances in the stomach ; the irritation of 
the coats of the stomach by worms, acrid or pungent food, spices or 
aromatics; the free use of tea, coffee, fermented or alcoholic drinks ; 
surfeits, rheumatic, gouty diathesis, &c. The nature of this affection 
and its proper treatment will be seen under Dyspepsia. When neu- 
ralgic in its character, its nature will be seen under Gastralgia. See 
Index. 
Pyrosis is generally is only another form of cardialgia. There 
is a burning pain in the stomach attended with copious eructation, 
generally of a watery insipid fluid. See p. 267. 
YI. Flatulency.—Flatus in the stomach.—This affection is only a 
symptom of indigestion or dyspepsia. See also Catarrh of the Stomach, 
Index. 267 
FLATULENCY OF THE ABDOMEN. 
Flatulency of the Abdomen.—Abundant formation of gas in the 
b >wels. 
Symptoms.—Fulness and tension of the abdomen ; rumbling in the 
bowels severe pain; accumulation; or copious discharge of wind. 
Causes.—Indigestion; errors of diet; free use of sugar, candies, &c. 
exposure to cold. 
General Treatment.—Regulate the diet, rendering it plain, and 
moderate in quantity; restrict the quantity of sugar; avoid exposure 
to cold; keep the feet warm; rub the stomach with the warm hand or 
flannel. 
Medicinal Treatment.—Nux-vomica.—For common cases ; symp- 
toms as given under dyspepsia ; accumulation of flatus in the stomach 
or hypochondrium; a sense of great anguish; worse in the morning; 
after drinking; flatus incarcerated. 
Ipecacuanha.—Flatulency caused by over-feeding, accompanied by 
nausea and vomiting; bitter taste, nausea; empty retching; violent 
distress at the pit of the stomach; flatulent colic. 
Pulsatilla.—In cases in which there is diarrhoea and shivering; or 
where Ipecacuanha has failed ; eructations, with nausea; taste as of 
putrid meat. 
China.—Much weakness ; derangement caused by eating sour fruit; 
flatulency persistent, gas formed in large quantity; eructations tasting 
of the ingesta ; heartburn; pressure at the stomach. 
Chamomilla.—When there is much pain or diarrhoea; aching pain 
at pit of the stomach; sour eructations; flatulent colic, with compres- 
sion of the bowels. 
Carbo-vegetabilis may follow the above remedies to prevent a 
relapse. 
Colocynth.—Great pain in the abdomen from incarcerated flatus. 
Carminatives.—As wind is generated in the intestines, and as such 
generation is dependent upon a diseased state of the lining membrane 
of the intestines, it is plainly useless to use remedies to expel the wind 
mechanically. If these medicines do in some cases expel the wind, and 
this in a very imperfect manner, they certainly do not alter the dis- 
eased state in which production of the wind depends. Many fatal 
cases of flatulent disease of the bowels have been traced back to the use 
of ginger and other carminatives or stimulants for the expulsion of 
wind, which had accumulated in the bowels and even in the stomach 
VII. Pyrosis.— Water-brash.—Diagnosis.—Fits of burning sensa-. 
tion at the pit of the stomach ; burning extending up to the fauces ’ 
followed by eructation of a thin colorless liquid, which seems to be 
forced into the mouth by a kind of reversed or ruminating action of 
the stomach and oesophagus. 
Causes.—It may result from some irritation in the stomach itself 268 
DISEASES OF THE DIGESTIVE FUNCTION. 
or in some other organ which can affect it through sympathy It 
often occurs in organic diseases of the stomach, especially cancer and 
simple ulcer. It is common in pregnancy, and among people who live 
on unwholesome food. Linnaeus found it very prevalent in Lapland, in 
1732 ; it is described as endemic in many partsof Scotland, Wales, Eng- 
land, &c. It is ascribed to the common causes of dyspepsia. These 
are, coarse and innutritious food; sedentary life, intemperance ; cold and 
damp climate ; excessive labor; large losses of animal fluids ; consti- 
pation ; mental depression; pregnancy, and all other condition*, and 
influences which may interfere with the function of digestion, render- 
ing the secretions unhealthy and irritating. 
Treatment.—The power of homoeopathic remedies over this as well 
as other derangements of the digestive organs will he sufficiently dis- 
played under the head of dyspepsia. It is only necessary here to men- 
tion a few remedies. 
Nux-vomica.—This article was prescribed by Linnaeus among the 
Laplanders, and is now known to homoeopathists as one of the best 
remedies. 
Pulsatilla.—Bryonia.—Sulphuric-acid.—For symptoms, see these 
articles, under the head of Dyspepsia. 
VIII. Gastrodynia. See Gastrodynia.—Index. 
IX. Nausea and Vomiting.—Nausea.—Sickness at the Stomach. 
■—An inclination to vomit without effecting it; also a disgust of food ap- 
proaching to vomiting. It is an attendant on cardialgia and various other 
disorders, occasioning an aversion for food, an increase of saliva, dis- 
gusting ideas at the sight of various objects, loss of appetite, debi- 
lity, &c. 
Vomiting—consists in a spasmodic contraction of the diaphragm 
and abdominal muscles, followed by a rapid discharge of the contents 
of the stomach by the mouth. 
Causes.—Intemperance; indigestible food; indigestion and various 
other disorders of the stomach; mental emotions; extremes of tempe- 
rature ; fatigue. 
Nausea and vomiting are best illustrated by the operation of those 
poisons called emetics. As these agents produce the disease called 
emesis or vomiting, and also furnish us with remedies for curing it, 
however it may be induced, we will examine their mode of operation, 
and the pathology of vomiting. In the operation of an emetic we may 
discover a series of actions, which may be thus described. The emetic 
makes at first an impression on the sentient extremities of the nerves 
of the stomach. This sensation is referred to the brain; the natural 
energies of the brain are now diminished by the prostrating influence 
of the nausea ; and we observe a languor of both the mental and bodily 
powers. The peculiar excitement in the brain produces the sensation NAUSEA AND VOMITING. 
269 
which is felt in the irritated organ, and the sensation of nausea is the 
immediate and necessary result of the diminished and peculiar excite- 
ment of the brain referred to the stomach. That this is the case is 
demonstrated by the vomiting and nausea sometimes excited at the 
sight, smell, taste, or even thought of a disgusting object. 
But why does this certain degree of nausea produce contractions 
of the coats of the stomach, dec. f Here it may be sufficient to remark 
that spasmodic contraction in the muscles, &c., is generally the result 
of debility. 
The first effect of an emetic is an uneasy sensation at the stomach, 
which is followed by nausea; this increases till the pulse becomes 
feeble, frequent and irregular; the face turns pale, the skin becomes 
cold and shrunk. Vomiting at last comes on, during which the face is 
red and turgid with blood. On the cessation of the vomiting, the sick- 
ness goes off, leaving the system in a state of temporary languor from 
which it soon recovers. 
It is an important fact, that any extraordinary stimulus applied to 
the stomach, instead of increasing its motions, as it would in other 
instances, inverts them. The wisdom of such a provision will appear 
when we consider that it is intended to prevent the intrusion of food 
into the duodenum before it has undergone those neeessai'y changes in 
the stomach, by which it is prepared for the more elaborate process 
of chylification. 
The act of vomiting is not an act of the stomach alone; the brain 
is an important accessory. Magendie attributes the operation of 
vomiting exclusively to the agency of the brain upon the abdominal 
muscles, and regards the stomach as a mere passive instrument in the 
act. The influence of the nervous system is indispensable to the pro- 
duction of the act of vomiting; and we accordingly find that vomiting 
can not take place as an effect of any emetic in a case in which the 
nervous energy is suspended,—as in profound intoxication, violent 
wounds and contusions of the head; while, if the brain be only partially 
influenced, as by incipient intoxication or by a less violent blow on the 
head,—irritability is increased instead of being paralysed, and vomit- 
ing, under such circumstances, is excited by the slightest causes. This 
fact is curious and instructive. 
Perhaps the best view of the subject of emesis is that given by Dr. 
Richard Harrison, in his Gulstonian Lecture, before the Royal College 
of physicians. He observes that although the experiments of Magendie 
sufficiently demonstrate the importance of the pressure of the ab- 
dominal muscles upon the stomach in the act of vomiting, and which 
can only be explained by the influence of the nervous system, yet Ma- 
gendie attributed too much to their agency. He gives then, the follow- 
ing explanation of the phenomena of vomiting: DISEASES of the digestive function. 
‘•The irritation of the stomach makes a call upon the brain for the 
aid of the diaphragm and abdominal muscles in order to expel its con- 
tents : the diaphragm then becomes contracted and fixed, the ribs drawn 
down, and abdominal muscles drawn inwards, so that the stomach is 
pressed on all sides by voluntary muscles, which together with its own 
contractions expel the contents.” 
Now it must be obvious that where the brain from oppression or in- 
jury is unable to transmit its influence to these muscles, and disregards 
the call of the stomach, vomiting can only be excited with difficulty or 
not at all. Thus, in the same manner, persons may die of suffocation 
from injury of the brain: the respiratory muscles not receiving ner- 
vous influence, can not keep up respiration. 
General Treatment.—When vomiting has been excited by taking 
too much food, it should be regarded as an effort of nature to free the 
stomach from an over-load which would do injury if retained; and 
free drinks of warm water should be given to promote the free cleans- 
ing of the stomach. After free evacuation of the stomach, a table- 
spoonful of coffee will often restore healthy action. 
Medicinal Treatment.—Pulsatilla.—When after violent vomiting 
there remain loathing, nausea, and retchings; vomiting caused by 
greasy food or pastry; also sea-sickness. 
Chamomilla.—Vomiting caused passion; bitter bilious risings; 
bitter taste in the mouth; vomiting of green, bilious, acrid matters ; 
fulness and pressive pain in the stomach; weakness; loss of appetite; 
anxiety; dry heat; thirst; giddiness; semilateral headache. When 
caused by the state of the nerves of the stomach. Ipecac. 
Cocculus.—Sea-sickness; cardialgia after a meal; nausea when 
riding; vomiting worse when raising the head. 
Sickness of pregnancy. Cocculus. 
Alumina. Creosote. Agaricus-musc., Veratrum-vir. Secali. 
Antimonium-crudum.—Eructations tasting of the ingesta; nausea, 
vomiting of bile and mucus (also Ipecac, and Puls.) cardialgia; de- 
rangements caused by overloading the stomach. 
Arsenicum.—Violent vomiting of ingesta and liquids; also of brown 
or black substances; aversion to farinaceous food; burning pains in 
the stomach relieved for a short time by warm drinks; Asiatic cholera, 
last stage, with cold breath. 
Camphor.—Vomiting with coldness of the surface, sudden prostra- 
ion of strength ; anxiety, and burning in the stomach, cramps in the 
nuscles of the limbs; pit of the stomach painful to the touch. 
Dispensary Cases.—1. A girl aged six years, has vomited frequently 
for twelve hours, has considerable fever. Cured by Ipecac. 
2. A child aged eight years. Has vomited several times durin.:; the 
day. Cured by Ipecac 3°. DYSPEPSIA FROM DEFICIENT SECRETION OF TIIE GASTRIC JUICE. 
271 
3. A girl aged ten years. Nausea and vomiting, commencing at 
school; she looks pale and feeble. Cured by Ipecac. # 
Murray, (whom I select from numerous other authorities) informs 
us, as does also daily experience, that among the symptoms produced 
by the use of tobacco, those of vertigo, nausea, and anxiety are the 
principal. Now Diemerbroeck, when attacked with those very symp- 
toms of vertigo, nausea, and anxiety, in the course of his close atten- 
dance on the victims of epidemic diseases in Holland, removed them 
by smoking tobacco. {Hahnemann) 
X. Vomiting of Blood.—See Ilcematemesis.—Index. 
XI. Dyspepsia is an affection of the digestive organs, in which one or 
more of the several processes by which the aliment is converted into blood, 
&c. are imperfectly performed. In attempting to cure it we find it compli- 
cated in its nature, and involving, not only the stomach, but all the 
organs and distant outposts of the physical as well as the mental organ- 
ism. In every well-established case the symptoms are extremely 
numerous, ranging through all the structures and tissues of the body, 
involving nearly all of them in endless chains of sympathies and reflex 
actions. 
General Symptoms of Deranged Digestion.—Loss of appetite, 
nausea, languor; aching, tenderness and distension of the epigastrium, 
acidity, flatulency, eructations, sense of weight and fulness in the stomach 
after eating; also quick breathing, sensitiveness at the pit of the stomach 
from pressure, light clothing, &c.; pyrosis, vertigo, giddiness, sensation 
when walking, as if the pavement were rising up immediately in front; 
constipation, pressure in the stomach and epigastrium, haemorrhoids, 
sallow or yellow complexion, distention of the abdomen with flatus, 
loss of ambition and energy, sad, desponding, dread and apprehension 
respecting the future, frequent inclination to commit suicide, nights 
restless and disturbed by unpleasant dreams. In the advanced stages 
of indigestion there often supervenes a troublesome cough attended 
with occasional pains in the chest, and mucous or muco-purulent ex- 
pectoration, which some writers have termed dyspeptic phthisis. It is 
probable, in these cases, that the disease is confined to the mucous 
membranes of the respiratory organs, being a continuation or extension 
of the gastric disturbance to the pulmonary tissues. 
II. DYSPEPSIA FROM DEFICIENT SECRETION OF THE GASTRIC 
JUICE, WITH INORDINATE SENSIBILITY OF THE NERVES OF 
THE STOMACH. 
In health the stomach contains no gastric-juice, except at those times 
when food has just been taken, and, by its contact Avith the surface of 
the mucous membrane excites the secreting organs to pour out the 
gastric fluid in the needed quantity. The process by which this 272 
DISEASES OF THE DIGESTIATE FUNCTION. 
mysterious secretion is thus called into existence precisely at the very 
time and in the quantity wanted, displays a beautiful physiological 
phenomenon, and points to the solution of practical problems of the 
highest importance. The impression made by the food on the organs 
of taste, and on the surface of the stomach is first transmitted by the 
nerves to the nervous centres, and thence reflected to the secreting ap- 
paratus, upon which devolves the duty of forming the gastric-juice. L 
this apparatus is in a healthy state the quantity formed will be just 
sufficient for healthy digestion; if it is not in a healthy state, the 
gastric-juice secreted may be either deficient in quantity or vitiated 
in quality. (See p. 215.) 
Diagnosis.—The intimate relation existing between the stomach 
and other organs associated with it by reflex nervous action renders 
every form of indigestion a complicated disease. The liver and the 
stomach react upon each other; the gastric fluid and the bile become 
deficient in quantity or vitiated in character, and become additional 
agents of irritation; and in every functional derangement of any of the 
digestive organs a “ disordered condition of the gastric and intestinal 
nerves ” is gradually developed, in which all “ natural sensibilities are 
changed, becoming morbidly acute, obtuse, torpid or perverted.” This 
condition is never absent in dyspepsia when fully established, and it 
forms the connecting link between the disorders of the stomach and of 
other and far distant parts. 
Symptoms characteristic of this combination of Gastric ana 
Hepatic Disorder. Appetite ravenous, annihilated or whimsical; 
unpleasant feelings after eating; pain in the stomach and duodenum, 
imperfectly relieved by the action of purgatives, which always ulti- 
mately increase the bad symptoms. The patients who have been sub- 
jected to the common purgative treatment become more subject to 
constipation, and the result of their antipathic practice is found to be- 
come constantly less satisfactory. The large intestines become laden 
with solid and irritating matters, which continue in some cases to ac- 
cumulate for months. “ Even during the action of successive daily ca- 
thartics,” says Dr. James Johnson,* “ scybala may remain long in the 
cells of the colon; substances eaten two or three months ago, sometimes 
come away in round balls, enveloped with layers of inspissated secre- 
tions. These scybala keep up a degree of irritation, generally without 
pain, but producing, in distant parts, the most strange and anomalous 
sensations. It might be supposed that repeated cathartics had carried 
off every vestige of the contents of the large intestines ; but this is 
never accomplished by purgatives, however frequently administered.” 
A passage of small calibre, says Dr. AY are,f is indeed generally kept, 
* “On the Morbid Sensibility of the Stomach and Bowels.” 
t On Purgatives, &c. DYSPEPSIA FROM DEFICIENT SECRETION OF THE GASTRIC JUICE. 
273 
open, and through it small quantities of faeces, partially fluid, may al- 
most daily find their way. But these matters are generally composed 
of the substances more recently taken into the stomach, and mixed 
with unhealthy secretions. Very often the hardened accumulations of 
months continue to distend the cells of the colon, irritating the nerves 
which convey morbid impressions to remote parts, and they furnish 
“ the most vitiated materials to the absorbent vessels, which pour their 
contents into the portal circulation” to be employed by the liver in the 
secretion of bile. These facts furnished by allopathic observation and 
amply confirmed by our own experience we can cheerfully accept as 
true; and we repudiate the purgatives, usually trusted to by them, 
only because they give such transient relief and then increase the 
disease,—and, also because we possess better resources. ' {See Consti- 
pation.—Index) 
Liver.—Always irregular in its action, generally torpid, as mani- 
fested by paleness or want of the characteristic color of bile in the 
evacuations. In some cases the liver occasionally pours out a quantity 
of tenacious viscid bile, which adheres to the inner surface of the 
bowels, keeping up a high degree of irritation of the intestinal nerves, 
and causing various uneasy sensations in distant parts of the body, 
with fits of irritability and despondency of mind, which surpass in 
hopeless "wretchedness all physical sufferings. When the irritation 
hills on the physical sensibilities, bilious colic and excruciating pains 
and spasms of the stomach and bowels are caused by it. When the 
nervous system has been much harassed by great mental anxiety and 
other real misfortunes, the mind, instead of the body, may be the prin- 
cipal sufferer. “ It becomes,” says Dr. Johnson, (who knew aM about 
it from sad experience,) “suddenly overcast as with a cloud; some 
dreadful imaginary or real evil is magnified into terrific proportions, 
with a train of disastrous consequences from which the soul turns with 
dismay. This state of utter misery may continue for twenty-four, 
thirty-six, or forty-eight hours, when a change is effected by a discharge 
of viscid acrid bile, with the most horrible foetor; and the passing off of 
the poisonous secretion from the sentient extremities of the intestinal 
nerves at once dissolves the spell, which has power to weigh down the 
strongest mind to earth.” It is under the influence of such paroxysms 
of despair as this, that the most melancholy suicides occur. In many 
of these we know that there is no moral cause for weariness of life; 
the real cause for temporary hallucination of mind is a physical one, 
operating on the mind through its sympathy with the organs of di- 
gestion. 
Tongue.—Furred in the middle, and at its root; when the stomach 
and duodenum are irritated by food, undergoing slow and imperfect di- 
Vol. L—18. 274 
DISEASES OF THE DIGESTIVE FUNCTION. 
gestion, the papillse are elevated, the edges and tips red, and there is a 
peculiar constriction at the base of the tongue arising from sympathy 
with the stomach. When the mucous membrane is highly irritated, or 
in some degree inflamed, the tongue resembles beef-steak or cleanly 
dissected muscle. 
Eyes.—Sometimes tinged with yellow, muddy or “ lack-lustre” expres- 
sion, showing languor or irritability. Vision is sometimes remarkably 
good in dyspeptics who have reached the age of declining sight. 
Urine.—Turbid, scanty, high-colored, depositing a thick or white 
sediment; sometimes limpid and clear, though exciting more irritation 
in the bladder and urethra than when highly colored. 
Skin.—Dry, contracted; occasional partial perspiration, alternating 
with chilliness followed by heat especially of the palms of the 
hands and soles of the feet; complexion sallow, dark, or yellowish, 
commonly described as “ bilious,” showing the reflex nervous influence 
of the stomach, liver, and alimentary canal on the surface of the body- 
Emaciation is a marked feature of dyspepsia, progressing most ra- 
pidly when the disease of the liver is extensive. 
Loss of Strength.—This is proportioned to the degree of nervous 
disorder or irritation in the sentient nerves of the stomach and bowels. 
It is a distressing feeling of debility, rather than actual debility. The 
slightest muscular exertion made while digestion is going on, depresses 
the spirits and produces an intolerable feeling of exhaustion and utter 
feebleness. The same amount of exercise may be taken at another 
hour without such depressing results, showing that the debility is a 
sympathetic suffering from irritation of the alimentary canal; and it is 
always aggravated by the use of stimulants and tonics. 
Tenderness of the Epigastrium.—This exists in some degree, in 
every case, and is no evidence of organic disease, as the tenderness is 
greater in functional disease of the stomach and duodenum, than in 
actual scirrhus; it is increased by antiphlogistic measures, and is often 
diminished by good diet and even by tonics, though not generally so. 
Pain in the Stomach.—This is common, and varies in degree from 
the slightest uneasiness .to the most excruciating gastralgia, and is al- 
ways most severe -when gastritis is not present. 
Fulness of the Epigastrium.—This, when it exists, depends more 
frequently on flatulence than organic enlargement. Permanent enlarge- 
ment and hardness are often caused by chronic disease of the liver. 
The Pulse.—This may vary with almost every emotion of the mind. 
It is generally more variable in dyspepsia, and even more rapid, than 
in cases of actual inflammation of the same mucous surfaces. The 
action of the heart is so much under the influence of the stomach, that 
little dependence can be placed upon its frequency. In dyspepsia, it 
is usually quicker during digestion, and also during the passage of the 275 
DYSPEPSIA FROM DEFICIENT SECRETION OF THE GASTRIC JUICE. 
chyle along the intestines. The pulse may he eighty or ninety per 
minute during the day; and later in the evening, if the patient has not 
eaten recently, it may be reduced to sixty or less. Persons in whom 
the mind is active but who are physically feeble, have the pulse ge- 
nerally quicker in the evening, whatever be their relative state of 
health. The real dyspeptic always feels worse for some hours after 
eating; and a late supper renders him miserable for the night and the 
early part of the next day. 
The effect of slowness of digestion is, that the food continues too long 
in the stomach. Instead of being perfectly dissolved and passed for- 
wards to the duodenum in two or three hours, it sometimes lies imper- 
fectly digested for ten or twelve hours, and even in rare cases many 
days. While thus remaining in the stomach, the partially digested 
mass produces a sense of weight or uneasiness at the pit of the stomach, 
which only subsides as the task of digestion is completed and the stomach 
emptied. Sometimes a portion of some solid article remains undigested, 
and excites distressing spasmodic pain at the pyloric orifice of the 
stomach several hours after eating. In this case the pylorus is too ir- 
ritable to permit any solid to pass, and it closes spasmodically when its 
inner surface is irritated. When Dr- Beaumont was experimenting on 
St. Martin’s stomach, he on one occasion introduced the thermometer 
through the fistulous opening into the stomach, and permitted the bulb 
to pass into the pylorus. There "was immediate contraction on the in- 
strument accompanied with pain and distress. After several trials of 
the experiment, a sense of soreness remained till the next day. The 
same kind of soreness is often caused by hard or imperfectly digested 
portions of solid food remaining many hours in the stomach ; they irri- 
tate its lining membrane, causing head-ache, furred tongue, depraved 
gastric secretion, sallow complexion, and imperfect sleep. (See p.215.) 
The Brain is affected through the reflex action transmitted by the 
nerves of the stomach : as a result of this sympathy, confusion of 
thought, unsteadiness and irritability of temper, are more common 
than pain in the head, dimness of sight or vertigo. The former often 
rise to temporary alienation, and sometimes terminate in suicide. Be- 
sides these symptoms, neuralgic pains in every form and situation may 
be induced by this morbid sensibility of the stomach and bowels, and 
the irritability of nerves to which it gives rise. 
Imperfect Nutrition.—When dyspepsia continues long, it causes 
imperfection in the process of nutrition in all parts of the body. The 
blood becomes deficient in globules, the circulation is feeble, the extre- 
mities are frequently cold, the spirits depressed, and all the vital 
powers decline, till the patient becomes incapable of any considerable 
mental or physical exertion. 276 
DISEASES OF THE DIGESTIVE FUNCTION. 
DISTINCTION BETWEEN FUNCTIONAL AND MALIGNANT STRUCTURAL 
DISEASE. 
Functional Dyspepsia. 
Malignant Structural Disease. 
Color of the skin yellowish, from 
an irritated state of the gastric 
and duodenal mucous membrane. 
The countenance is “pinched,” 
and expressive of dissatisfaction 
rather than of thought and anxiety. 
Complexion and General Appearance. 
Dingy, sallow, ex-sanguine, but 
opaque appearance of the skin. 
The eyes sunken, adnata pearly : 
the countenance expresses care 
and depression, not dissatisfaction, 
but introverted thought and pee- 
vishness. 
Emaciation and Loss of Strength. 
Loss of flesh not great, and is 
speedily followed by restoration, 
with increased strength when the 
more distressing symptoms subside. 
In structural disease of the car. 
dia and oesophagus, emaciation 
proceeds to a degree not seen in 
any other disease, while the loss 
of strength is not in proportion to 
the loss of flesh. When a cancer- 
ous disease exists in any other sit- 
uation, the emaciation is seen, but 
not to the same extreme degree. 
When in the stomach or external 
to it, the prostration of strength is 
greater than would be expected 
from the violence of the other 
symptoms. 
Pain 
Much pain; diffused, intermit- 
ting, and better or worse according 
to the stage of digestion, but seldom 
of that extreme, lancinating char- 
acter that belongs to cancer, and 
is relieved by alkalies in solution. 
Pain not always present, at least 
in the early stages, even when dis- 
organization is insidiously pro- 
gressing ; but it becomes severe in 
latter stages, is of a peculiar lan- 
cinating, grinding kind, and usually 
confined to a particular spot. In 
the structural form, pain is more 
acute and more defined than in the 
areolar or colloid. 
Vomiting. 
The cause of the vomiting is ge- 
nerally obvious; the stomach con- 
tains food of bad quality, imper- 
fectly digested, vitiated secretions; 
and is always a manageable 
symptom. 
This usually occurs in some stage 
of structural disease. In the latter 
stages, the action of the muscular 
coat becomes imperfect, and the 
act of vomiting is a mere regurgi 
tation. FUNCTIONAL and malignant structural disease. 
277 
Functional Dyspepsia. 
Malignant Structural Disease. 
The fluids ejected in functional 
disease never possess this peculiar 
dark color. 
The Fluids vomited. 
The fluid is usually dark colored, 
having much the appearance of 
venous blood. 
Constipation. 
There are generally large col- 
lections in the arch of the colon: 
the relief obtained by purgatives, 
though only temporary, is usually 
accepted for the time as satisfac- 
tory. 
Always present in structural 
disease. When in the latter stages 
the disease spreads to the colon, 
dysenteric symptoms supervene. 
The discharges are covered with 
blood, or resemble the washings of 
flesh. When the seat of the accu- 
mulations is the coecum, relief 
from purgatives is very transient 
and imperfect. 
Tongue. 
Foul and covered with fur: no 
aphthae, but the acid eructations 
from the stomach cause occasional 
slight ulcerations. 
It generally continues clean to 
an advanced period of the disease, 
when there may be aphthae on its 
surface, caused always by failure 
of power, as in other chronic 
diseases. 
Flatulence. 
It is a common symptom, but is 
less oppressive than in structural 
disease: its escape gives relief. 
The gas is continually rising, is 
foetid in character, and affords little 
or no relief. 
Is imperfect; can generally di- 
gest animal food as well or better 
than things considered as lighter. 
Appetite. 
Always imperfect; the patient 
can only take farinaceous and ve- 
getable food. 
Examination by the Touch. 
The slightest pressure anywhere 
over the stomach and upper part 
of the abdomen produces pain: 
dread of being touched; pain 
chiefly caused by inflation of the 
stomach and from gases : percus- 
sion reveals its nature; morbid 
sensibility of gastric and enteric 
nerves 
Pressure only gives pain when 
made on the precise seat of the 
carcinomatous deposit, but then 
gives severe and lasting pain in 
that particular spot. When this 
is within the stomach the pain re- 
sembles that which precedes vo- 
miting. When the liver is the seat 
of disease, the pain is felt on pres- 
sure, unless the tumors be raised 
above the convex surface and are 
vascular, in which case, when the 278 
DISEASES OF THE DIGESTIVE FUNCTION. 
Functional Dyspepsia. 
Malignant Structural Disease. 
patient is thin, they can be felt 
through the parietes. 
Progress of the Disease. 
The symptoms of indigestion 
force themselves very early on the 
attention. The patient regards his 
symptoms as evidence of important 
and extensive disease; and dwells 
minutely on the circumstances of 
his case. 
The disease comes on insidious 
ly, and its history is imperfectly 
ascertained; indeed considerable 
disorganization often takes place 
before any train of appreciable 
symptoms can be observed. 
Nerves employed in Digestion.—In the nervous system we dis- 
tinguish two great classes of nerves. Those that take their origin from 
the brain ; and those that arise from the spinal marrow ; and also those 
which constitute the ganglionic system of nerves. 
The nerves which originate in the brain transmit sensations to the 
sensorium, and nervous influence to the voluntary muscles. The 
nerves which proceed from the spinal marrow regulate the functions of 
various vital organs, as the stomach, heart, liver, &c. 
Of the nerves of the first division we notice that each has its peculiai 
sensibility in health, but when inflamed or diseased they become exqui 
sitely sensible to impressions which in health they would not have felt 
Common food swallowed ceases to be felt as soon as it reaches the 
stomach ; hut a tea-spoonful of tincture of Capsicum produces a burn- 
ing heat in the same surface by inflaming its nerves. 
“ Here arises,” says Johnson, “ one of the most useful precepts in the 
art of preserving health. Whenever we call forth conscious sensation 
in the stomach, whether of a pleasurable or painful kind we offer a 
violence to that organ; the injury may be slight but it is real. When 
food of the right quality, and in the right quantity is taken into the 
healthy stomach no sensation whatever is felt; but when a full meal is 
taken which includes some stimulating article, a sensible impression is 
made on the nerves of the stomach. When this sensation is a pleasur- 
able one, when a general exhilaration is produced, the pulse is 
quickened, the face flushed, the mind more active, and the flow of ideas 
more free. But this exhilaration is transient and partial. In propor- 
tion as the ganglionic system of nerves is excited, the voluntary nerves 
and muscles are disqualified for action. These nerves of the gan- 
glionic system convey the vital power from the nervous centres to those 
organs which continue their action independent of the will, as the lungs 
or heart. In a state of health pleasurable sensations are diffused over 
the body as well as to the mind by the presence of food in the stomach DYSPEPSIA FROM DEFICIENT SECRETION OF GASTRIC JUICE. 
279 
without any conscious sensations being perceived by it. Now, if these 
same nerves in a state of health can diffuse over the system these feel 
ings of comfort it is not strange that when in a disordered state they 
ai-e equally capable of exciting the most gloomy thoughts in the mind 
and the most painful sensations in the body by the application of the 
same stimulants, whether with or without any unpleasant sensation iu 
the stomach itself.* See p. 218, 281. 
Thus wine in a state of health produces a pleasurable glow over the 
whole system; if Tartar-emetic or Digitalis be added to it, the peculiar 
distressing effects peculiar to these substances are produced on both 
body and mind. From these facts we may conclude 
1. That from the stomach a diffusive energy and pleasurable feel- 
ing may be extended to all other parts of the body, including the brain, 
which is the organ of the mind, without any distinct pleasurable sen- 
sation in the stomach itself. And 
2. That from the stomach may be diffused over the whole system, 
intellectual and corporeal, a train of morbid feelings of the most dis- 
tressing kind, with or without any distinct sensation of pain or uneasi- 
ness of the organs of digestion. 
Causes of deficient gastric Secretion.—When the eighth pair of 
nerves are divided in the neck in experiments on animals, food taken into 
the stomach remains undigested; and after death, the coats of the 
stomach are not found dissolved by the gastric-juice, as they often are 
when death has suddenly occurred at a time when the stomach contains 
a large quantity of gastric-fluid. It is, therefore, proved that the di- 
vision of the nerves, together with general injury and shock given by 
the operation, arrests the secretion of gastric-juice for the time. 
2. Feebleness of digestive power is produced by excessive fatigue, 
great mental excitement, long-continued watchfulness, the depressing 
passions of fear and anger. Men who overstrain the intellect in the 
pursuit of wealth, or whose labors are mental rather than physical, are 
liable to dyspepsia, even when their general habits of life are not the 
worst. Victorious on every field where they encountered only physical 
evils, votaries of literature and business are vanquished by that sterner 
enemy—Cake. When business becomes his only pleasure, and wear}' 
anxious thought his only recreation, the man who is the slave of reputa 
tion, wealth, or poverty, soon learns to read inhis own care-worn features 
the manifestations of that “ Wear and Teak Malady” that embitters 
life to so many mental laborers in every walk of city-life. 
3. Congestion of the gastric-mucous membrane, or inflammation in a 
slight degree, as well as inflammation of other organs exciting general 
fever. 
* On Morbid Sensibility of the Stomach and Bowels. 280 
DISEASES OF THE DIGESTIVE FUNCTION. 
4. Indolent sedentary habits. 
5. Habitual indulgence in eating too much. In some conditions the 
wants of the system are large, as in day-laborers and nursing women. 
In diabetes, though the stomach has sometimes an increased power of dis- 
solving food, a large portion of it undergoes only imperfect digestion; 
and instead of being converted into healthy chyle, it is only changed 
into the low form of saccharine matter, which passes off by the urine 
without nourishing the body. This leaves the different organs of the 
body but poorly nourished, though the mucous membrane of the stomach 
may become hypertrophied from the constant irritation of its contents ; 
and the hunger of the system is expressed in a craving for food, which 
all the nutriment swallowed cannot satisfy. But whether the quantity 
of nutritive matter taken be that which health demands or far exceeds 
that quantity, the stomach can only dissolve, in the process of healthy 
digestion, a certain amount of food. The gastric-fluid then becomes 
saturated and can dissolve no more. See p. 217. 
6. The stomach is in some persons constitutionally weak, or has 
been rendered so by the intemperate use of stimulants, the abuse of 
irritating drugs, the effects of epidemic cholera, or of other diseases. 
In all of these cases, as well as in those forms of atrophy of the gland- 
structure, elucidated by the microscopic researches of Dr. Handheld 
Jones,* the the supply of gastric-fluid is generally deficient. 
Such are a few of the causes of ordinary cases of imperfect digestion; 
but the stomach is so intimately associated with almost every other 
organ of the body, that its condition is influenced by disorder located 
in any one of them. 
Spallanzini excited his own stomach to secrete gastric-juice by irri- 
tating or tickling the fauces in the morning when it was entirely empty. 
He then caused it to expel the pure digestive fluid by vomiting, and 
found that this fluid had the power to dissolve meat and prevent its 
putrefaction. The mode by which this secretory action of the stomach 
was excited is now understood, and we are, therefore, enabled to ac- 
count for the various sympathetic affections in which the stomach sym- 
pathizes with other organs, and also to see how it transmits to distant 
parts the morbid influences that originate in its own diseased condi- 
tions. (See Reflex Action.—Index.') 
The exciting causes of dyspepsia are generally such as follow: 
Protracted depression of spirits, whether occasioned by want of occu- 
pation, deprivation of the accustomed mental and physical exercise, 
pecuniary misfortune, loss of friends, disappointment, or mortification, 
is a prominent cause of dyspepsia. This cause is very general and ex- 
tended in its operation, affecting not only the mucous structure of the 
* “ On the Morbid Conditions of the Stomach.” EFFECTS OF EATING TOO MUCH. 
281 
stomach, but the liver, the bowels, the cardiac nerves, and in soi le in- 
stances the whole nervous system. It is to this variety of indigestion 
that we should attribute many of those hypochondriacal affections, 
which are often referred exclusively to disorder of the liver. 
Next in importance to the above may be named the abuse of rich 
and highly seasoned food, stimulating drinks, coffee, tea, tobacco, irre- 
gular eating hours, and inattention to the daily fecal evacuations. 
In a state of health the sensations of the stomach are always de- 
pended on to give the proper wmrning when sufficient food has been 
taken. But, in that degree of soundness which exists in ordinary per- 
sons, the feeling of satisfaction or satiety is never perceived till the 
stomach is so far loaded that its sentient nerves are beo-innino; to be 
irritated. “ There appears,” says Beaumont, “ to be a sense of perfect 
intelligence conveyed from the stomach to the brain, which, in health, 
invariably dictates what quantity of aliment, (responding to the sense 
of hunger and its due satisfaction,) is naturally required for the pur- 
pose of life; and which, if noticed and properly attended to, would prove 
the most salutary monitor of health, and effectual preventive of, and re- 
storative from disease. It is not the sense of satiety for this is beyond 
the point of healthful indulgence, and is nature’s earliest indication of 
an abuse and overburthen of her powers to replenish the system.” 
When the needed quantity of food is taken into the stomach there is u a 
pleasurable sensation of perfect satisfaction, ease and acquiescence 
of body and mind.” But this elysium of the reasonable epicure is not 
reached except after due attention to the preliminary processes of mas- 
tication, and deliberate deglutition which are always indispensable. 
Effects of Eating too much.—First Grade of Indigestion.—The 
symptoms which follow upon taking too much food of a highly seasoned 
character are : a sense of distention occasioned by the swelling of sub- 
stances in the stomach which the gastric-fluid cannot dissolve. This 
distention, with the presence of the irritating mass of fermenting food, 
causes a feeling of uneasiness, prevents sound sleep, or occasions a 
paroxysm of night-mare ; in the morning it is followed by headache, 
confused intellect, furred tongue, unstrung nerves, and deranged secre- 
tions. A case of this kind, says Johnson, is not properly one of indi- 
gestion, but of intemperance. It is only when such irregularities in 
diet have been often repeated, and are joined to other causes which 
have the power of arousing new trains of diseased sensibilities, and 
when the nervous system, the liver, and the skin begin to react upon 
the stomach and the gastric-fluid, that, this disease of many horrors, 
called Dyspepsia, begins to be recognized. 
The gastric-fluid is so much under the influence of the nervous sys- 
tem that it is only secreted in its perfect state when the nervous sys- 
tem is also in its best condition; and the liver, skin, and stomach are 282 
DISEASES OF THE DIGESTIVE FUNCTION. 
in such direct communication through the nerves that they all become 
involved in the long train of morbid sensibilities, vitiated secretions 
and complicated sympathies which unitedly form this protean disease 
(Johnson.) 
Thus the habit of eating too much, too fast, and too carelessly, i 
seen to be one of the principal causes of that terrible derangement of 
the digestive organs, which soon involves the mental and spiritual 
powers and destroys the energies of both mind and body. Indiscretions 
in eating are said to have paralysed the spirit of the first Napoleon on 
some of the most critical occasions of his life. At the battles of Leip- 
zig and Borodino he might, by his accustomed decision in pushing un- 
favorable events, have converted them into victories. At Dresden also, 
it is asserted by Hoffmann that he would have done much more than he 
did, but for the unhappy “ effects of a shoulder of mutton stuffed with 
onions.” (London Quar. Review. 1852.) 
The influence of mental emotions in breaking down health and pre- 
venting its restoration has never been sufficiently appreciated. “ If a 
patient dies,” says M. Reveille-Parise, “we open his body, and rummage 
among the viscera, or scrutinize most narrowly all the organs and tis- 
sues, in the hope of discovering lesions of one sort or another.” One 
thing only escapes the attention of the anatomist; he is looking for 
organic effects, “ forgetting all the while that he must mount higher to 
discover their causes. These organic alterations are observed, per- 
haps, in the body of a person who has suffered deeply from mental dis- 
tress and anxiety; these have been the energetic cause of his decay, 
but they cannot be studied in the dissecting-room.” Many physicians 
of extensive experience are destitute of the ability to search out and 
understood the causes of disease; “ they cannot read the book of the 
heart; and yet it is in this book that are inscribed day by day, and 
hour by hour, all the griefs and all the miseries, and all the vanities, 
and all the fears, and all the joys of man, and in which will he found 
the most active and incessantly operating source of that frightful series 
of organic changes which constitute pathology.” 
II. FERMENTATION OF THE CONTENTS OF THE STOMACH FROM 
DEFICIENT SECRETION OF GASTRIC JUICE. 
That the gastric juice in its perfect state prevents the putrefaction 
of meat, and even arrests it when already begun, was first shown by 
Spallanzini. It is also known to prevent the acetic, lactic, and alco- 
holic fermentations; but, when the vital powers fail—when the gastric 
fluid is deficient in quantity or quality, and chemical affinities over- 
power vital forces, some of these changes may occur in the contents 
of the stomach. In these cases Lehmann regards the ferment as an FERMENTATION OF THE CONTENTS OF THE STOMACH. 
283 
unhealthy mucus, which is much disposed to fermentation, and alieady 
in a state of decomposition. In many cases, food undergoes the ordi 
nary putrefactive changes, in which sulphuretted hydrogen gas i 
evolved. This gas accumulates in the stomach, distending it painfully 
hence efforts to relieve it by eructations of sulphuretted hydrogen 
having the odor of rotten eggs ; symptomatic of this is severe fronta 
headache and chilliness, followed by febrile excitement. 
Causes.—1. Over-eating.—Eating too much, previous to severe ex- 
ercise.—Delicate persons, who feel exhausted and weak, often eat freely 
for a temporary invigoration, and immediately engage in active exercise. 
The vital powers being thus withdrawn from the stomach, the food 
remains undigested, and what is called “a surfeit” occurs. 
2. Carious Teeth.—When many decayed teeth exist, offensive saliva 
imbued with the elements of that peculiar “ gangrene” on which caries 
depends, passes into the stomach. # 
*6. Structural Disease of the Stomach.—In cancer of the stomach, 
morbid secretions are formed in that organ, which have little power to 
digest the food taken. At the same time, there may be stricture or 
morbid irritability of the pylorus, or impediment to the muscular mo- 
tions of the stomach. Any of these conditions may detain the food 
prevent its full digestion, and facilitate chemical decomposition. 
4. Food of Improper Quality.—Vegetables, fruits, new bread, ill 
fermented malt liquors, or new wines, pass rapidly into a fermentation 
by which carbonic-acid gas is evolved; the stomach becomes distended 
by the accumulated gases, and is only temporarily relieved by repeated 
eructations. Dr. Beaumont says, that on one occasion, when St. Mar- 
tin had been in the woods all day, and had eaten no food but whortle- 
berries, from, eleven A. M. to eight in the evening, the stomach was ex- 
amined through the aperture in its side. He found it “full of berries 
and chimifying aliment, frothing and foaming like fermenting beer or 
cider.” 
When food already fermenting is ingested, the chemical action con- 
tinues ; the gas evolved is belched up, if no impediment exist at the 
cardiac orifice, and the fermentation subsides when its material is ex- 
hausted. But when this aperture is obstructed or spasmodically closed, 
the gas evolved distends the stomach, and this may even destroy life. 
Cattle, eating more clover than the stomach can digest, suffer much 
distention; and, in consequence of the peculiar structure of ths stomach, 
these gases can not escape through the oesophagus. They then cause; 
enormous distention of the organ, in some cases even to bursting.f 
5. Flatulence and Distention of the Stomach from Imperfect 
* Ko>cker’s Principles of Dental Surgery, 
t Di Budd. Diseases of the Stomach, p. 177. 284 
DISEASES OF THE DIGESTIVE FUNCTION. 
Digestion.—This is commonly felt an hour or two after the principal 
meals, when the lighter form of indigestion has become chronic. Fer- 
mentation in the stomach gives rise to products which when absorbed 
into the blood, have an injurious influence on the general health. The 
food taken is only partially digested, the body is imperfectly nourished, 
the spirits depressed and all the mental and physical energies are en- 
feebled. When amid the products of unhealthy digestion, oxalic acid 
is formed, crystals of oxalate of lime may be discovered in the urine. 
Treatment.—In every form of dyspepsia we begin the treatment 
by regulating the diet, restricting it to a moderate quantity of nutritious 
but easily digested food. Every dyspeptic should avoid new bread, 
tough meats, all alcoholic or fermented liquors, extreme bodily fatigue, 
and nervous exhaustion from all other causes. But he should take 
much active exercise in the open air, and should keep the mind habit- 
ually and cheerfully employed. 
The earlier homoeopathists insisted much upon a strict diet/ and the 
belief has become common, that the fine preparations we employ will 
be neutralized by antidotal substances in the food or in the atmosphere, 
If this were true we might indeed despair of success in a city, in which 
few ever breathe uncontaminated air. The truth is, that a jprojger diet 
should always be prescribed; but we do injustice to our remedies, if 
we admit that they have so little power that they can be turned aside 
by a breath of impure gas, or the vapor of Camphor or Vinegar. “ If, ” 
says Dr. Espanet of Algeria, “ our infinitesimals are truly independent, 
insusceptible of combination and imponderable, they must exercise 
their special dynamic action, in spite of drugs, gases, or whatever sub- 
stances may be present.” “If this be not so, then, all infinitesimal 
doses are an illusion, for long before entering the body they must have 
entered into some new combination.” What are the facts witnessed by 
every homoeopathist ? One patient has been treated for days by 
ponderous doses of Mercury, Opium, or Quinine. We give a proper 
attenuated remedy and witness curative results in spite of the unfavor- 
able conditions and surroundings. Another patient is laboring under 
profound functional disturbance: “He is full of fluids, abdominal 
gases, odors, and chemical principles in abundance; his tongue is 
thickly furred, and yet a few globules penetrate the midst of this in- 
fected mass and remove the whole disease.”* It is indeed necessary 
to regulate the patient’s diet, not because wrong food is incompatible 
with proper remedies, but because it would injure the patient, if he 
were taking no medicine. 
It has been fully proved that quite as much depends on the quantity 
of food as on its quality. There appears, says Dr. Beaumont, “ to be a 
* Espanet, Jour, de la Soc. Gallicane, 1852. 3G0. FERMENTATION OF THE CONTENTS OF THE STOMACH. 
285 
sense of perfect intelligence conveyed from the stomach to the brain 
centre, which, in health, invariably decides what quantity of aliment 
(responding to the sense of hunger and to its due satisfaction), is 
naturally required for the purposes of life, which, if noticed and properly 
attended to, after thorough mastication and moderate and slow degluti- 
tion, would prove the most salutary monitor of health.” It is not the 
sense of satiety, for this is beyond the point of healthful indulgence, 
and is nature’s earliest indication of an abuse and over-burden of her 
powders to replenish the system. It occurs immediately previous to this, 
and may be known by the pleasurable sensation of perfect satisfaction, 
ease and quiescence of body and mind. The quantity of food required 
by a person in full health, varies according to the perfection of the 
digestive power, and also to the degree of exercise taken, and to the 
age and habits of the individual. Dr. SouthwTood Smith weighed eight 
men engaged in feeding the fires of a London gas company, and found 
that in one hour one of the men lost two pounds eight ounces and another 
lost four pounds three ounces by perspiration. The general result was, 
that the men employed in that work lost from two pounds to five pounds 
weight twice a day by perspiration alone.* It is plain that those who 
exercise little must perspire less, and consequently need less food. 
As the sensation of hunger depends on the condition of the brain, 
its impulses are not always correct. A voracious appetite is often a 
precursor of fever; and in a state of debility the stomach may crave 
a large amount of food, which, instead of being digested, is frequently 
retained twenty-four hours or more, causing the most distressing symp- 
toms, particularly in children, amounting in some cases to convulsions 
and even death. In a state of fever, little or no gastric fluid is secret- 
ed. Dr. Beaumont examined the stomach of St. Martin at one time 
when the villous membrane was red and dry. He complained of head- 
ache, pain and distress at the pit of the stomach, lassitude and loss of 
appetite. On making the effort to extract gastric juice from the stomach 
in this state, nothing could be obtained but a little acrid and frothy 
mucus, showing why food cannot promote strength in fever; and it 
has been often seen that undigested food remaining in the stomach 
produces all the phenomena of fever. The gastric juice not being able 
to act upon the undigested food, the stomach is irritated, just as if food 
had been introduced into the stomach, when the system was in a febrile 
state. 9 
In the treatment of chronic dyspepsia, independent of temporary 
inflammation or fever, the selection of appropriate food has long been 
regarded as an object of primary importance; but, in nearly all that, 
we have read on this subject one essential principle has been entirely 
* Philosophy of Health, p. 399. Yol. 2. 286 
DISEASES OF TIIE DIGESTIVE FUNCTION. 
overlooked. To this point it is necessary to call particular attention 
In nearly all invalid conditions, especially where evidences of im- 
paired digestive power occur, there exists in the constitution a suscep- 
tibility to the poisonous properties of all fermented or otherwise 
deteriorated articles of food. In many cases susceptibility to occult 
poisons of the ferment and putrefactive order exists as a veiled idio- 
syncracy under a variety of chronic disease-tendencies, between the 
varying manifestations of which, the patient but oscillates in different 
forms and degrees of suffering. 
In other cases this susceptibility may be a state temporarily induced by 
impairment of the vital powers from whatever cause. An almost invariable 
index of poisonifig from impurities of this kind, may be found in a sour 
or copper taste in the mouth, particularly on waking in the morning; 
also itching and smarting about the margins of the eyelids, with de- 
rangements of the digestion, including the whole train of dyspeptic 
symptoms, I have found most frequently and directly traceable to 
this cause. Prominent among these, are offensive breath; faint and 
gnawing sensations in the stomach; acidity, morbid appetite, and more 
or less constant and insupportable gastralgic pains, &c. 
It is a common but extreme mistake to suppose that if the stomach 
s not evidently disordered by what is eaten, no fault may be attached to 
the food: it is on the contrary most true, that the ferment and its 
kindred poisons being taken up into the blood, are active agencies in 
stirring up, if not in originating a great variety of diseases through 
their deteriorating qualities. I have known herpetic humor of the most 
inveterate character, and which had resisted all medication, subside 
entirely on the persistent use of a pure diet, and again be recalled 
into activity on any deviation from the same, even to the extent 
of eating one piece of fermented bread and butter, as ordinarily made. 
And to what extent many diseases may be referrable to this class of 
poisons alone, I do not pretend to decide. The subject at least merits 
a greater degree of attention than it has hitherto received from the 
medical profession. 
As suggesting a few of the common liabilities to poisonous impurities 
in diet, I instance some kinds of food, or management of it, to be 
avoided. 
Bread made by any process in which it has stood to rise previous to 
baking, contains incipiently the elements of putrefaction. Cryptogan.ic 
growths of the fungus order are developed in the fermentive process 
which is cause sufficient for its pernicious effects upon many persons, 
if not upon all who make use of it. 
Butter made from soured milk, or kept, till ever so slightly deterio- 
rated, is pervaded by a “ butyric ferment, which is composed of in- 
fusoria or animalcule shaped like a cylindrical wand,” as demonstrated by FERMENTATION OF TIIE CONTENTS OF TIIE STOMACH. 
287 
the late highly interesting and important researches in these subjects 
by M. Pasteur. (See N. A. Jour, llomoeop. Feb. 1859, p. 307.) 
Flour or meal too long ground, or kept in places not most dry arid 
airy, contract must in a poisonous degree before its existence may be 
discernible to taste or smell. Vegetables and fruits as usually kept in 
cellars and close places, contain similar health-forbidding properties. 
Cheese is an article so surcharged with the mould poison in some 
stage of development that few persons can be found proof against ill 
effects from its use. Cured or smoked meats and fish are almost in- 
variably tainted to a poisonous extent. Cooked food and other things, 
“kept over,” as cold potatoes are most likely to have acquired the 
same pernicious properties. Therefore, if fit for anybody to eat, they 
are in no wise allowable to persons not in the most robust health. 
From many experiences I am aware of the difficulties in the way of 
obtaining and enforcing a thus rectified and pure diet; but where the 
case demands it, and hopeless suffering only is the alternative, it can 
be done. In some constitutions the susceptibility to poisoning from 
deteriorated food is so innate, that from infancy, health can only be 
maintained in the degree that they are avoided entirely. 
And there are multitudes who swell the list of habitual invalidism 
and suffering till a premature end, to whom suggestions of a true diete- 
tic principle had been the most invaluable of medical advice. 
While for the invalid, food should be selected with all reference to 
other qualities of fitness, let it be essentially pure from every principle 
of decay, which in its own nature belongs, not to the life and health, 
but to the death side of things; nor is it strange, that if we would build 
up a healthy organism, we should be required to draw from the life 
and health department in our nutritive material. 
By what law or consistency of principle, we may reasonably in- 
quire, shall a given organism be susceptible in a life and death degree, 
to the potencies of homeopathic remedies—and at same time—keep 
closed doors against the actually poisonous qualities of food? 
In constitutions in which the health power is in the ascendant, a 
great degree of positiveness to all disease-producing agencies exists; 
but our concern and effort is in behalf of the large proportion of 
our humanity, in whom that health-power has proved insufficient for 
its contest with the deleterious influences it has had to meet. And to 
withdraw and abate these by every renovating and sanitary measure, 
is the most worthful labor of the true physician. 
In the field here indicated, radical and extensive is the principle 
of dietetic reform urged; and it may be long before our truer insights 
shall cease to be pained by even the most common spectacle of a 
delicate child endeavoring to maintain its hold upon physical existence 
through a piece of stale bread and rancid butter / 288 
DISEASES OF THE DIGESTIVE FUNCTION. 
Exercise.—When the due amount of exercise has been long neg- 
lected, the nervous system becomes enfeebled and irritable ; the mus- 
cles lose their tone and become more slender and flabby, and all the 
functions of assimilation and nutrition are imperfectly performed. When 
the muscles remain too long inactive, physical energy is lost; the calibre 
of the capillary vessels is diminished, a deficiency of exhalation in the 
synovia] membranes causes rigidity,and finally immobility of the joints; 
obstructions of the capillary circulation lead to organic disease, and 
inactivity of the absorbents causes the accumulation of fat, so common 
in indolent persons. This condition requires other measures than 
treatment by drugs, as these can never, unaided, restore to healthy 
action the organs that have long remained in a state of inertia from 
deficient exercise. 
Exercise of each organ induces an afflux of fluids on which its growth 
depends. Neglect of exercise enfeebles the nervous and muscular 
systems, causing inordinate sensibility and irritability of the former, 
and a flabbiness and want of tone of the latter, in which every organ 
sympathizes ; it lessens the supply of nervous energy, the activity of 
assimilation and nutrition. When muscular repose continues a long 
time, motion becomes impossible ; the muscles are debilitated, and the 
calibre of the vessels diminished. 
The effects of inactivity are manifested in the brain, abdominal and 
thoracic viscera, and on all the assimilative organs. The circulation 
absorption and nutrition languish; obstructions in the capillaries lead 
to organic disease ; and the abundant accumulation of fat in indolent 
persons only shows debility in the absorbent function, which in a healthy 
person should preserve a proper balance between the different tissues 
and structures. In such cases the bulk of the body may be enormously 
increased ; but the texture of the organs is less solid; the muscular tis- 
sue is soft, and locomotion is difficult and painful. The corpulence of 
the butcher, who eats too much animal food and exercises too little, 
furnishes no indication of firm health and long life; butchers as a class 
are much exposed to inflammatory diseases, fevers or apoplexy, &c. 
There is a certain amount of excitability furnished by the brain and 
nervous system to every organ and structure of the body, designed for 
expenditure in the discharge of the functions of the various parts ; and 
if it is not expended in exercise, it accumulates to a degree that pre- 
disposes to disease ; melancholy, hysteria, or mania may result. 
“ The languid eye, the cheek 
Deserted of its bloom; the flaccid, shrunk, 
And withered muscle, and the vapid soul, 
Reproach their owner with his love of rest.”—Cowper. MEDICAL TREATMENT OF DYSPEPSIA. 
289 
Medical Treatment.—An essential condition in the treatment of 
dyspepsia consists in the maintenance on the part of the patient, of a 
healthy, active, and cheerful state of mind. Unless this be accom- 
plished, our remedies will either be of only temporary service, or entirely 
unavailing. Next in importance, is a course of rigid dietetic regula 
tions. In proposing a bill of fare for the dyspeptic, much must depend 
upon the circumstances of each particular case. If the patient is of a 
highly bilious temperament, a much more simple diet will be requisite, 
than for one who is nervous or sanguine. As a general rule, an intel- 
ligent person will be able to select a suitable diet for himself by ob- 
serving attentively the effects which different articles exert on the 
constitution. See p. 286, 287. 
Another equally important condition in the treatment of this disease, 
is perfect regularity in all the habits of life, as eating, sleeping, alvine 
evacuations, exercise, &c. First, sufficient sleep should be allowed to 
enable the system to recover entirely from the fatigues of the preced- 
ing day; second, moderate and agreeable exercise should be taken for 
an hour or more previous to breakfast, bearing in mind that exercise, 
in order to be beneficial, must not be undertaken and performed as a 
task, but as a pleasant recreation; third, in partaking of our food, we 
should never forget, while we are thus repairing the wraste of the body 
from the exercise of the functions, &c., that this also was intended by 
our Creator to be a source of pleasure to us. Let the rational man 
therefore, especially the dyspeptic, never eat with disordered rapidity 
but slowly, so that, masticated properly, his food may be taken into the 
stomach in a fit condition for the processes of digestion. This is the 
true philosophy of eating. Finally, at a certain hour every day, perhaps 
after breakfast, an evacuation from the bowels should be solicited. It 
matters not whether the inclination be uniformly present, let the patient 
never fail in his readiness, and the bowels will soon form the habit of 
responding. So much are we the creatures of habit, that we can train 
our bodies, our organs, our appetites, tastes, &c., to almost anything we 
desire by a steady persistence in our object. 
The most approved remedies for the different grades of indigestion, 
are: 
Nux-vomica, Sulph., Pulsatilla, Bry., Lycopod., Calcar., Carb., Se- 
pia, Graph., Ignatia, China, Antimonium-crud., Corn.-circ. Ferrum., 
Phos. 
Nux-vomica.—Defective or capricious appetite in persons subject to 
haemorrhoids ; craving for stimulants or acid drinks; sour or bitter taste 
in the mouth, insipidity of food; nausea, sour eructions, regurgitations, 
waterbrash, accumulation of water or mucus in the mouth, vomiting of 
food ; drinks, epecially acids, cause suffering, griping, aching pain in the 
stomach ; colic, pinching contractions, bewilderment or destruction of 
VOL. i.—19 290 
DISEASES OF THE DIGESTIVE FUNCTION 
mind, head-ache, vertigo, general uneasiness or hypochondriacal ten- 
dencies ; oppression of breathing, chills, lassitude, indolence, drowsiness, 
feeling of fatigue and sleep ; heaviness of the head, unfitness for intel- 
lectual labor in an impaired constitution; vertigo, anxiety, paroxysms 
of fainting. Epigastrium distended; it feels tense and excessively 
tender, and burning when touched; and the clothes feel too tight. When 
there is general gastric derangement, the tongue is dry and white, or 
yellowish towards the root; there is no thirst, and too little water is 
habitually taken, at other times, there is burning thirst and heartburn, 
or cardialgia. 
Heat and flushings of the face common in persons who have been in- 
temperate ; plethoric habit; general disposition restless, choleric, iras- 
cible, irritable, disposed to dispute or command ; violent passion, par- 
oxysms of suffering caused by late hours; complexion yellowish, 
earthy; deficiency of the secretions generally; bilious constitution ; 
bowels constipated, evacuations hard and expelled with difficulty; 
disease caused by sedentary habits or intense study. 
Nux-vomica is well adapted to the cases which occur in sanguine 
or bilious temperaments, and wThich have been induced by “ high living,” 
sedentary habits, undue mental exertion, irregularity in eating, sleep- 
ing, &c. The indications for Nux are, florid or pale, sallow or yel- 
low complexion; general expression of countenance, anxious and sad, 
care worn; tongue dry, or covered with a whitish coat; occasional ful- 
ness in the region of the stomach and bowels ; craving for stimulants 
or acid drinks ; sour or bitter taste in the mouth; insipidity of food. 
Distress at the stomach after eating ; nausea, and vomiting of food ; 
eructations and regurgitations; pyrosis; distressing sense of debility; 
accumulation of wrater or mucus in the mouth ; irritability of the ner- 
vous system, with constant inclination to roam about; symptoms worse 
after meals and in the evening; constipation; haemorrhoids ; tenderness 
at the pit of the stomach on pressure; drinks especially cause suffer- 
ing ; griping, aching pain in the stomach; vertigo ; dizziness or swim- 
ming in the head, headache, particularly when rising in the morning, 
or w'alking about, bewilderment or distraction of mind ; cramp-like pains 
at the pit of the stomach, sometimes extending upwards to the dia- 
phragm and oesophagus ; colic, pinching contractions. 
Confirmed hypochondria ; constant dread of approaching misfortune. 
When the dyspepsia consists simply of impaired activity of the 
nerves of the stomach, from the causes just named, Nux is without 
doubt the appropriate specific; but it is almost an invariable oc- 
currence, that this condition of the stomach is attended with more or 
less derangement of the nervous system, manifested by loss of anima- 
tion and energy ; depressing of spirits; an invincible tendency to look 
on the dark side of affairs; trifles are exaggerated into matters of im- MEDICAL TREATMENT OF DYSPEPSIA. 
291 
portance; there is an indefinable sense of dissatisfaction, dread, and 
uneasiness, which impairs the appetite, disturbs the sleep, and almost 
unfits the individual for the ordinary duties of life, and often causes 
an urgent inclination to commit suicide ; excessive nervous irrita- 
bility. When this condition of the nervous system has existed for a 
considerable time, it receives the name of hypochondria. lor this com- 
plication, Nux alone is insufficient, but one or more of the medicines 
hereafter enumerated will be required. 
Administration.—In cases of this description, we usually prescribe 
Nux-vomica from the third to the sixth potency; a dose to be given 
each night, as long as may be necessary. 
Sulphur.—In most cases of chronic dyspepsia, at the beginning of 
the treatment; in persons addicted to alcoholic drinks, and debilitated, 
nervous and irritable persons. Acid, putrid, or sweetish taste in the 
mouth ; nausea, water-brash; smell from the mouth acid or foetid, espe- 
cially on rising in the morning; vomiting of food; taste chiefly acid or 
bitter; insipidity or too salt taste of food; repugnance to meat, bread, 
fat and milk, and craving for acids and wine ; feeling of trembling 
within the body; restlessness, such as makes long sitting very un- 
comfortable. 
Sulphur is peculiarly adapted to the treatment of cases occurring 
in persons of a scrofulous dyscrasia, and to cases in which dyspeptic 
symptoms supervene upon the disappearance of erysipelatous and other 
eruptions from the surface, also from the sudden suppression of long- 
continued haemorrhoidal discharges. In many cases of this kind 
Sulphur will be found to be a valuable remedy. 
The external marks which indicate this medicine are : pale or sal- 
low countenance; light hair; blue eyes; thin skin; white teeth; glan- 
dular swellings ; eruptions ; wreak eyes, and other signs of scrofulous 
diathesis ; distention and distress of the stomach after eating; nausea; 
vomiting; pyrosis; frequent eructations, acid or bitter; the symptoms 
occurring, for the most part, on the disappearance of these eruptions 
or discharges. 
Pulsatilla, at the third potency, is a valuable remedy in dyspepsia 
occurring in females, especially when the malady is complicated with 
deranged menstruation. If the disorder has arisen from excessive use 
of greasy and indigestible food, wine, &c., it will also prove a suitable 
remedy. 
Slight exertion in conversation causes prostration; fatigue causes 
dyspnoea; the patient is melancholy, despairing, and feels disgusted 
with life; sad, hypochondriacal, morose, irascible humor; abdomen 
tender on pressure, as if the whole inner surface was raw. 
Head-ache, thirst, chest oppressed, chiefly after a meal; disposition 
to an over-secretion of mucus in the principal organs ; inertia, and a 292 
DISEASES OF THE DIGESTIVE FUNCTION. 
feeling of constriction in the abdomen, as from incarcerated flatus 
worse toward morning, and in the left side; difficulty in digesting ani- 
mal food; milK sours in the stomach; unpleasant effects from acids, 
or farinaceous food sweetened; pains in the stomach, regurgitation or 
vomiting of food, lassitude, shivering, and frequent eructations after a 
meal; eyes slightly sore as if from sand in them. 
Sense of great fatigue, shivering, confusion and pain in the head 
or in the face; burning heat in the hands ; flow of water from the 
mouth. 
Mental and Moral Symptoms.—Sadness ; irritability; moroseness. 
Administration.—This medicine may be administered at the third 
attenuation in the morning and middle of the afternoon. 
Lycopodium, Calcarea-carb. and Sepia may be given in mild cases 
of indigestion, occurring in weakly females and children, and persons 
of a lymphatic or scrofulous constitution. They may be exhibited at 
the third attenuation, a dose each day, as long as may be necessary. 
In cases where the above remedies are indicated, a highly nutritive re- 
gimen may be enjoined with great advantage, also the constant employ- 
ment of all those means which tend to invigorate the system, like ac- 
tive exercise, sea-air, and bathing; frequent amusement for mind and 
body, &c. 
Graphites is valuable in dyspeptic symptoms which appear to be 
connected with scrofulous or arthritic affections. It will be found par- 
ticularly serviceable when they supervene upon the sudden disappear 
ance of eruptions from the skin, or the sudden suppression of old dis- 
charges, or the drying up of old sores. 
Administration, same as Lycopodium. 
Bryonia.—Dyspepsia occurring in, or worse in hot or damp-warm 
weather. Loss of appetite and great aversion to food, alternating with 
morbid craving for improper articles, as wine, strong coffee, and acids ; 
eructations of wind when the stomach is empty; or after eating, the eruc- 
tations are sour or bitter; feeling of pressure and distention of the epigas- 
trium; regurgitation or vomiting of food ; water-brash ; the epigastrium 
is tender to touch ; bowels constipated ; the temper restless and irascible. 
Bryonia, at the third attenuation or higher, is well adapted to per- 
sons of a bilious temperament, with black hair, dark complexions and 
black eyes. The particular indications for its employment are : yellow- 
ness of the skin and eyes; tongue covered with a yellowish fur; bitter 
taste ; vomiting or regurgitation of food soon after eating ; sensation of 
fulness and burning in the stomach after meals ; fulness and pains in 
the region of the liver; urine high-colored ; head confused and giddy; 
pressure in the head ; loss of memory; inability to transact business ; 
great despondency; frequent inclination to commit suicide; constant 
sighing; sleepless nights, or sleep disturbed by unpleasant dreams. MEDICAL TREATMENT OF DYSPEPSIA. 
293 
Bilious derangements, skin yellowish, dry, hot at intervals, particu- 
larly the palms of the hands and soles of the feet; slight perspiration 
towards morning; strength variable, easily exhausted. 
lobelia-inflata.—Sphere of Action.—Noack (Hygea, 1841. vol 
15) concluded from his experiments that Lobelia acts specifically upon 
the pneumogastrie nerve. (,Jeanes, Arner. Instit. Hornmjp. vol l.j 
Its most important symptoms are those displayed on the functions of 
respiration and digestion. 
Digestive Function.—Disagreeable taste in the mouth like that left 
by corrosive sublimate ; pungent taste in the mouth; flow of slimy sa- 
liva; soreness of the throat; dryness of the mouth. Burning in the 
throat; dryness of the fauces ; frequent spitting; dryness of the throat; 
tough mucus in the fauces, causing frequent hawking; pricking in the 
throat. 
Burning prickling in the throat, increased secretion of viscid saliva; 
nausea and eructations ; burning sensation rising up from the stomach; 
unpleasant sensation in the upper and back part of the pharynx; feel- 
ing as if the oesophagus contracted itself from below upward; feeling 
of pressure as from a foreign body in the whole course of the oesopha- 
gus, moving down with a vermicular motion; drawing pain in the right 
side of the throat extending up to the ear; feeling of a lump in the pit 
of the throat. 
Loss of appetite ; cough often repeated ; flatulent eructations with 
with flow of water in the mouth; acidity and heat of the stomach, ris- 
ing into the mouth with burning sensation; nausea with shivering of the 
upper part of the body ; pain, heat and oppression of the stomach, feel- 
ing of excessive uneasiness of stomach, affecting the respiration; un- 
easiness of stomach, followed by vomiting, then cold perspiration of the 
face ; nausea and perspiration; free vomiting, great prostration of 
strength; good appetite shortly afterwards ; weakness of the stomach 
from the prsecordium to the chest and downward to the umbilicus; weight 
and fulness of the stomach, worse on pressure; pain from back part 
of the stomach through to the spine ; painful constriction in the region 
of the proecordia; warmth in the stomach ; burning heartburn; run- 
ning of water in the stomach, of long duration; distention of the abdomen 
with shortness of breath ; flatulence. 
Pulsatilla.—Particularly suitable for females and persons of mild 
disposition, lymphatic temperament, pale complexion, blue eyes, light 
hair, who weep easily, are innocent, affectionate, peevish, and much dis- 
posed to seek for sympathy; with disposition to an over-secretion of 
mucus, or to heartburn. Dyspepsia originating in the abuse of Mer- 
cury, Cinchona, fat, pork, wine ; also in fright. 
The tongue feels as if burned, is covered with a thick, grayish, whit- 
ish or yellowish coating ; the taste of meat is putrid, sweetish, or bitter 294 
DISEASES OF THE DIGESTIVE FUNCTION. 
in the mouth ; want of appetite, or greediness, with gnawing pain in the 
stomach; repugnance to hot food, with craving for acids and highly 
seasoned things, wine, spirits; want of thirst; thirst deficient or extreme 
longing for spirituous, spiced or acidulated drinks. 
Pulsations in the epigastrium; vomiting of greenish, slimy or bilious 
hitter or acid substances; vomiting of food or blood, with dyspnoea 
sadness and melancholy after eating ; sufferings from eating bread; bitter 
or sour eructations, tasting of food recently taken, sensation of burn- 
ing in the throat and oesophagus ; water-brash, hiccough ; borborygmi 
and colic ; cramps in the stomach and prsecordial region after a meal; 
melancholy, great anxiety and anguish; temper excitable; dread of 
death or of appoplexy; buzzing in the ears ; head easily fatigued by in- 
tellectual toil; dyspepsia, alternating writh diarrhoea, from exposure to 
cold and dampness. 
Calcarea-carbonica.—Sympathetic or scrofulous constitution, feeble 
in body or mind, precocious or morbidly active; wide awake to suspect 
ill motives in others. 
The head feels as if compressed in a vice ; pulsative or shooting pains 
in the head, with sensation of coldness; pain increased by alcoholic 
drinks or mental exertion, extending to the cheeks ; nausea, eructations 
or expectoration of acid secretions; vesicles in the mouth and on the 
tongue ; bitter, sour, or metallic taste in the morning; clamminess or 
dryness of the mouth; want of appetite and occasional hunger after a 
meal; heat or swelling of the abdomen, with constant thirst, and little 
appetite ; craving of wine or acid stimulant drinks ; flow of water from 
the mouth, water-brash after every meal; acid regurgitations ; pinch- 
ing, cutting pains in the epigastrium; tension of the hypochondria; 
sour regurgitations after drinking milk; inclination to sleep after eat- 
ing. Constipation; stools hard, small, often consisting of undigested 
matter passed only the second, third, or fourth day; urine blood red or 
brown; general debility in a plethoric, full constitution. 
Ile^par-sulphuris.—Chronic dyspepsia, following the abuse of Mer- 
cury ; paroxysms of indigestion provoked by slight causes, with craving 
for wine, or sharp acid and stimulating drinks ; nausea in the morning; 
eructations, or vomiting of sour, bilious or mucous substances; much 
mucus in the throat; pain in the abdomen; hard, dry, and difficult 
evacuations; pressure, distention and heaviness in the epigastrium; 
bitter taste in the mouth, and of the food while eating; aversion to fat; 
great thirst; pressure on the abdomen gives uneasiness. 
Ignatia.—We have witnessed much benefit from the use of this me- 
dicine in indigestion afflicting persons of a nervous temperament. It 
covers the following symptoms, viz.: countenance pale or sallow; eyes 
constantly in motion ; general expression indicative of anguish and des- 
pair; frequent sighing; constant inclination to move about; confusion MEDIC AX, TREATMENT OF DYSPEPSIA 
295 
of ideas; loss of memory; pressure and other bad feelings in the head; 
distress at the stomach after eating; appetite variable ; tongue covered 
with a thin white fur ; entire despair of recovery; feels as if getting 
worse every day; dread of misfortune, coming want, &c.; frequent in- 
clination to commit suicide; disinclination to see or converse with 
friends or acquaintances; seeks solitude, and broods over imaginary 
troubles. 
This medicine may be given at the third attenuation—or higher,— 
a drop once in twelve hours, until an impression is made upon the 
malady. 
In cases where the nervous system is so much involved that the 
patient desires to die, and continually contemptates suicide, rather 
than suffer longer from his morbid and unfounded imaginings, and the 
wretchedness and anguish which tortures him day and night, Aurum- 
muriat. at the first or second or third trituration, will be found a re- 
medy of the utmost importance. One grain may be given twice daily 
until an amendment occurs. 
Cedron.—Sensation of heat and fulness in the stomach; distention 
and disposition to nausea; generally aggravated by rest, but relieved 
by walking and eating. 
Case.—A gentleman, aged fifty, sanguine temperament, sedentary 
habits ; uncomfortable feeling of the stomach which compelled him to 
lie down; great sensitiveness of the praecordial region; pulse small and 
hard; mouth and fauces dry ; depressed spirits and inquietude ; relieved 
by taking food. These symptoms appeared every day from ten to 
eleven, A. M., lasting from one to two hours, after which there was pros- 
tration of body and mind for an hour or two. The disease had lasted 
for eleven months. All the symptoms disappeared after taking two 
grains of Cedron first (decimal) trituration, during the apyrexia, every 
day for three days. 
The occasional use of mild aperients in certain cases of dyspepsia 
as well as in convulsions, diarrhoea, &c., caused by the presence of in- 
digestible food in the stomach and bowels, may be advisable for the 
same reason that paracentesis is recommended in urgent cases of abdo- 
minal or throracic drospy. By evacuating the unnatural accumulations, 
we not only place the disordered parts in a more favorable condition 
to recover their lost energy, but we also secure a much better state of 
things for the operation of our remedies. In obstinate constipation, 
for example, the indurated and impacted faecal matter sometimes in 
duces so great inactivity of the muscular and nervous structure of the 
intestinal canal as to amount almost to paralysis. In these cases, both 
high and low attenuations now and then prove inefficient; and it is 
here that mild aperients and injections will sometimes prove service- 
able, not, however, as curative agents, hut try speedily removiny a 296 
DISEASES OF THE DIGESTIVE FUNCTION-. 
cause of disease, and thus placing the affected parts in the best pos• 
sible condition to ensure the proper action of a homoeopathic me- 
dicine. 
On this subject, Dr. Madden, of Brighton, makes the following obser- 
vations: “It not unfrequently happens that the benefit gained by an 
immediate unloading of the bowels more than compensates for the sub- 
sequent increased tendency to constipation. This is acknowledged by 
all in the case of poisoning. No homoeopathist hesitates to give eme- 
tics and purgatives when a person has swallowed a substance which, 
if not speedily removed, will cause death; but does not the same hold 
good with an indigestible meal ? It is no doubt true that our reme- 
dies are often sufficient of themselves to overcome the evil influence 
of an occasional excess at table; yet I am convinced that it not unfre- 
quently happens, especially in childhood, that a judicious aperient 
wrnuld at once remove a state of things, which, if treated otherwise, 
would entail an illness requiring several days to overcome. There is 
much unreasonable prejudice among homoeopathic practitioners on 
this point; they will unhesitatingly condemn the use of the mildest me- 
dicinal aperient, and yet will order their patients to eat prunes, figs, 
roasted apples, green vegetables, brown bread, &c., in the hopes of pro- 
ducing the same result. But where is the difference'? A dose of 
Castor-oil, for example produces an increased action of the bowels, in 
virtue of its being an indigestible oil, which passes through the whole 
intestinal tube unchanged, and perhaps exerting some slight irritating 
effect on the mucous membrane; whereas the aliments above named 
produce the same results, in virtue of their having either a large indi- 
gestible residuum which irritates by its presence, or by their contain- 
ing vegetable acids, which directly and specifically irritate the mucous 
membrane. The result, therefore, is similar in both cases.”—(British 
Jour, of Ilomoeop. No. XXIX. p. 311.) 
In conclusion, we deem it proper to observe that aperients should 
never be employed except in very urgent cases, or in those where our 
attenuations have failed of producing the required effect. In all in- 
stances such measures must be looked upon as merely temporary ex- 
pedients. 
Treatment of Fermentation of the Contents of the Stomach. 
1. Restrict the quantity of food, while attending to its quality. Insist 
upon due exercise in the open air. Bad teeth should be removed; and 
when this is not assented to, the carious parts, particularly when 
there are large and offensive cavities, should be cauterized by Creosote 
and Arsenic ; thus: wret a small quantity of cotton in Creosote, and 
place on one side of it a minute quantity of Arsenic (white oxide of Ar- 
senic as usually sold), place this cotton in the tooth, pressing the Arse- 
nic carefully dowm to the diseased nerve. A momentary pain is felt FERMENTATION OF THE CONTENTS OF THE STOMACH. 
297 
but entirely unlike toothache; the tooth then ceases to be painful or 
to cause serious trouble. Such teeth may be filled and do good service 
for years. When neatly performed the operation is generally painless. 
2. Water.—Cold water should Ke the common drink of dyspeptics. 
I have often seen its prohibition prove injurious. “Water/’ says Pe- 
reira, “ repairs the aqueous parts of the blood expended in secretion 
and exhalation. It is a solvent of various alimentary substances, and 
assists the stomach in the act of digestion, though if taken in very large 
quantities, it may have an opposite effect, by diluting the gastric 
juice.” This caution, though properly given, is seldom necessary, as it 
is much more common to err on the side of drinking too little. Bad 
effects from drinking too much cold water are caused by : 
1. Previous over-heating, from which sudden death has often re- 
sulted. General Bruat, who in the Italian campaign of 1859 wras 
leading the first division of the French army over the top of Mount 
Cenis, was over-heated by exertion and drank a glass of snow watei 
He suddenly fell as if stricken down by a cannon ball, and imme 
diately died. 
2. Emptiness of the stomach at the time of swallowing. 
3. Excessive quantity of water taken. 
4. Extreme coldness of the water. 
When taken freely under the precautions suggested by the above 
considerations, cold water assists digestion, promotes the action of the 
kidneys, skin and all the secernent and excreting organs. It soothes 
morbid irritability of the stomach, promotes the gastric secretion; and 
enters into the living structure, forming three-fourths of the entire body. 
If a glass of pure water be taken a short time before eating, it acts 
as a real tonic, soothing that morbid craving which deceives those who 
habitually eat too much, and who have vainly tried to goad the secret- 
ing vessels to furnish gastric juice enough to dissolve all that a false 
appetite may demand. The water is also digested and thus furnishes 
the system with hydrogen and oxygen. The best effect will be obtained 
by taking the water at 50° to 60° Fahrenheit. When too cold its chill 
is followed by too much reaction, increased afflux of blood, secretion and 
absorption. Several glasses should be taken in the course of the day, 
and the quantity may be gradually increased, so long as there is no 
excessive perspiration, and when the body has not been previously 
over-heated. The surface should be kept sufficiently warm to promote 
the action of the skin, as, when the skin is cool, the water is carried 
off too rapidly by the kidneys. For the first few days at least, remarks 
Graham, the urine is limpid, colorless, highly stimulating, inodorous, 
and apparently without urea ; but after the system becomes more ac- 
customed to it, the excess of water finds its w’ay through the skin and 
lungs. When taken up in large quantities by the intestinal absorbents 298 
DISEASES OF THE DIGESTIVE FUNCTION. 
it passes, by the vena portarum, through the liver, increasing largely 
the secretion of bile, which returns into the intestines to dissolve and 
expel their accumulated sordes. 
The power of water, when takenv in unusual quantities to increas 
the transformation of organic matter or hasten the metamorphosis of 
the old tissues has been long acknowledged, but has been no where 
acted upon, except by sojourners at mineral springs or water-cures. 
Mosler, in a prize essay in 1857, communicated some experiments made 
with the purest water he wras able to obtain, containing only 2| grains 
of solid substances, and l-,-1,,- grains of Carbonic-acid in the gallon. He 
obtained the following general results: 
Abstinence from water diminished the secretions and excretions, 
principally those of the kidneys. Although the specific gravity of the 
urine was much increased, the actual total amount of solids excreted 
within a certain period was considerably diminished. This diminution 
was most remarkable in the urea, next in the chloride of Sodium and 
the Phosphoric and Sulphuric-acids. Excretion through the skin and 
lungs was also decreased, though in a less degree. The bowels wTere 
constipated, the tongue rather dry, the appetite defective. 
The effects of drinking an excess of wrater, observed by Mosler, were: 
acceleration of the total metamorphosis of matter, with hyper-excretion 
from the skin, kidneys, liver, &c. The urine contained a greater quan 
tity of solid constituents; most of urea, next of chloride of Sodium, 
then of Phosphoric and Sulphuric-acids. The body lost in weight; bu 
on the days following the increased ingestion of water, the excretions 
wrere diminished and the body gained in weight. 
These experiments are important in showing the scientific basis of 
an old practice which has fallen too much into disuse. The dyspeptic 
drinks less water, than a man in health; and, although all his secretions 
are of a more acrid character, containing an undue amount of solid 
matter in proportion to their bulk, every congested, torpid, indurated, 
or hypertrophied organ is gorged with effete matter, which, for true 
health, should have long ago been superseded by new matter. Com- 
plete restoration depends, not on a supply of good food imperfectly di- 
gested by an imperfect solvent fluid secreted from a stomach over sti- 
mulated, but on complete removal of the effete matter in advance of 
new deposition; and no remedies quicken absorption without the co- 
operation of that universal solvent pure water. This agent has often 
succeeded in diseases that had resisted all medical treatment. In some 
cases of mercurial paralysis, Mr. Piorry attempted to purge the system 
of all poisonous matters by water alone. After various measures had 
been tried in vain, the patients were directed to drink as much water 
in the course of every day as could be borne without inconvenience. 
Even three gallons per day seemed to produce no other effect than a FERMENTATION OF THE CONTENTS OF THE STOMACH. 
299 
rapid washing away of the old particles of the diseased body, and a 
substitution of new-matter through a more healthy nutrition. By this 
treatment, aided by long-continued baths, with friction, one case was 
convalescent in forty-eight hours, and four others in from three to 
five days. They all remained in the hospital, two or three Aveeks, 
without a relapse in any case. 
Medical Treatment.—Sanguinaria-canadensis.—I have for many 
years employed this remedy in some forms of dyspepsia, as Avell as in 
many other affections of the stomach, throat, liver, lungs, &c. It is 
especially useful in deficient gastric secretion, with loss of appetite, 
and periodical nausea; heartburn, nausea, and irregular chills ; torpid 
state of the liver; dyspeptic headache, terminating by regurgitation 
and vomiting of greenish bitter fluids; soreness of the abdomen, in- 
creased by eating ; feeling of heat in the stomach, chronic gastritis; 
red tongue, which burns as if from the contact of something hot; lips 
red and dry, throat hot and dry; tickling at the entrance of the larynx 
which excites cough ; cough peculiarly severe, not relieved by expecto- 
ration, Avith pain in the chest and redness of the cheeks. All these 
symptoms, when caused by cold and damp weather, in consumptive pa- 
tients Avith hecti\re symptoms—as quick pulse, burning in the palms 
of the hands or soles of the feet at night, I have often removed with 
this remedy. When the cold especially affects the frontal sinuses, 
nose, and tonsils, I have always succeeded in curing it Avith this agent 
alone. 
When digestion is imperfect from deficiency of the true gastric fluid; 
when the food undergoes chemical decomposition, and gas is evolved 
in large quantities, Sanguinaria will generally change the action of the 
stomach, and digestion Avill become more complete. When the mucous 
membrane is congested, the flatus formed by fermentation is retained 
by a spasmodic constriction of the cardia. Its irritation is reflected 
through the pneumogastric nerve upon the lungs, exciting a feeling of 
tickling ” in the entrance of the trachea, with sympathetic cough. 
See Gastric Catarrh. Index.—This peculiar dry cough will neither 
yield to the expectorants of the old school or to the usual specifics of the 
neAV; it often persists for hours, and is only relieved by eructations of gas 
from the stomach. Aromatics and stimulants fail to expel the gas : they 
only increase the erethism of the coats of the stomach. The Sanguinaria 
affords a better resource. It only relaxes the constricted cardia, 
permitting the flatus to escape, but excites a specific homoeopathic re- 
action on the whole surface of the fauces, oesophagus and stomach, su- 
perseding the morbid state by a healthy one. 
Phosphorus.—We have found this remedy more successful than any 
other for this gastric cough. It generally occurs in persons predispos- 
ed to consumption, and corresponds to Phosphorus in all its principal 300 
DISEASES-OF THE DIGESTIVE FUNCTION. 
symptoms. It is always excited by the same causes that produce a 
common catarrhal fever, and Phosphorus cures it as hereafter described 
under catarrh of the stomach. 
Pepsine.—M. Bondault of Paris has endeavored to prepare a sub- 
stitute for natural gastric juice from the Pepsine of the sheep’s sto- 
mach; adding to it a small quantity of starch and lactic-acid, he formed 
what he calls “poudre nutrimentative? It is only a very imperfect 
substitute for the natural secretion. The gastric fluid formed in the 
stomach of a healthy animal is introduced with the food into the human 
stomach; and is found to act there as it does out of the body, under the 
same conditions of heat and motion. In either situation it digests and 
dissolves the food, and in so doing suspends putrefaction. The quan- 
tity the Pepsine can dissolve is not large ; “but,” says Dr. Chambers,* 
of St. Mary’s Hospital, London, “ by its aid, a small quantity of solid 
food can be relished and digested; the foetor of the evacuations changes, 
flatulence and distressing eructations cease, there is renewed strength 
and power of assimilation, sleep becomes more natural, night sweats 
and hectic fever diminish ; dyspnoea, cough, &c. are mitigated.” Though 
all this be true it is only temporarily so. Our own well-known reme- 
dies are far better. 
Ipecacuanha.—Aching pain in the head, particularly in the temple? 
over one eye; painful burning sensation of the mouth; smarting on the 
edge of the tongue, with yellowish white coating ; sense of spasmodic 
contraction in the throat and in the chest; nausea, eructations of air or 
bitter fluid; distress from taking cold drink; vomiting, preceded by 
pain in the head—the matter thrown up consisting of green jelly-like 
or dark and tenacious substances ; sensation of emptiness and weakness 
of the stomach, followed by spasmodic pain; flatulent colic, alleviated 
by rest. 
JPux-vomica.—Hypochondriac mood, and apprehensions of misfor- 
tune and death. Excessive sensitiveness to external impressions. All 
ordinary dyspeptic symptoms develop themselves in succession, from 
the ordinary causes; but a great many Nux symptoms, are strongly 
marked. Among them are : putrid taste of the mouth; appetite capri- 
cious or entirely wanting; heat in the forehead; dizziness and cloud 
over the eyes, while eating, or immediately after, then nausea and vo- 
miting of acid or fermenting mucus occurs periodically. The stomach 
is sensitive to the slightest pressure, and for some hours after eating 
has the sense of something solid or hard; tension and cramps of the 
stomach; cardialgi a, from the abuse of coffee; chronic gastritis, simu- 
lating scirrhus or incipient cancer; pressure as from incarcerated flatus 
under the left side of the chest; stitches under the region of the liver; 
chronic hepatis, &c. 
* Braithwaite’s Retros., July, 1858, p. 78. FERMENTATION OF THE CONTENTS OF THE STOMACH. 
301 
Nux-vomica combats the dyspeptic symptoms preceding the stage 
of fermentation rather than corrects its consequences. 
Nux-vomica is directed by M. Trousseau in dyspepsias to re-establish 
the activity of the digestive functions, especially 'w hen there is consti- 
pation. “It excites the contractility of the muscular fibres of the di- 
gestive apparatus.” He prescribed Nux-vomica in a case of hysterical 
tympanitis, with constipation, crampy pains in the stomach, aggravated 
after meals by coffee, or late and early, with nausea, vomiting, water- 
brash, hypochondriac humor. (Gaz. des Ildpit. 1859. p. 36.) 
In dyspepsia with diarrhoea, M. Trousseau employs Belladonna, re- 
marking at the same time, the common property of the Solanacese, to 
to relax the bowels. He adds, however, that it would be wrong to 
neglect Belladonna in diarrhoeas dependent on an exaggerated excita- 
bility of the intestinal muscular fibre. 
Muriatic-acid.—In dyspepsias with excessive secretion of acids, M. 
Trousseau advises acids, especially the Muriatic, one to three drops in 
water, after meals, and cites several remarkable cures by this method. 
Concerning alkaline drugs and mineral waters in acid eructations he 
remarks that their use is not chemical, but altogether vital, in modify- 
ing the secretions. On the benefits of a thermal alkaline treatment of 
malarial cachexias, with visceral engorgements, he says : “ What can 
be, however, more contrary to chemical theories, than to use, in a state 
of the blood so plastic as often to occasion dropsies, a medication re- 
puted by chemical theorists the solvent par excellence of the blood ?” 
The development of that fermenting mucus which decomposes into 
foetid gases, may be prevented by any treatment that improves diges- 
tion. Among the best remedies are : Bryonia, Sulphur, Cinnabar, 
Mer.-corros., Nitro-muriatic-acid, hyposulphite of Soda. These 
and many others will be found useful, but they need to be assisted by 
ictive exercise, judicious selection of food, and mental employments 
consistent with habitual cheerfulness. 
Hypo-phosphite of Lime.—For Symptoms, generally, see Calcarea. 
Alcohol as a Remedy and as a nutritious Substance.—The special 
use of Alcohol is to “arrest destructive assimilation—to stop the over- 
active processes of life in their effects upon the organism; so that, for a 
certain period, during the stay of Alcohol in the system, less urea, less 
phosphates—less water are excreted by the kidneys, less Carbonic-acid 
by the lungs, and less digestion goes on in the alimentary canal, showing 
hat the muscles, bones, nerves, &c., are not getting rid of their effete 
tissue, but retaining it and making use of it as far as possible.” 
2. “ But at the same time they give rise in the body to defensive re- 
action,, which is prominent first, immediately after taking the dose, and 
then gives place to the special action, and on this ceasing, is again 
manifested to greater extent.” 302 
DISEASES OF THE DIGESTIVE FUNCTION. 
8. u So that if a suitable quantity be taken, and both action and reac- 
tion are allowed to exhaust themselves before the dose be repeated, 
more manifestations of life, represented by more excretion and more 
consequent renewal of the body takes place in a given time with the 
alcoholic drink than -without. There has been a positive gain in vita- 
lity, but if such a large quantity is taken at once that the reaction is 
overpowered, or if it is arrested by a continuous repetition of the dose 
the manifestation of life is kept down; the body is not renewed, because 
its effete particles are not removed and the amount of vitality must 
certainly be reckoned at a loss.” 
Combinations of Alcohol presenting peculiar Advantages.—In 
some of the finer wines Alcohol exists in combination with sugar, ex- 
tractive, vegetable essential oils, and ethers, which constitute the aroma, 
or Bouquet, and give to each its peculiar flavor. It is supposed that 
some of the favorite wines possess these elements in peculiarly happy 
proportions, which give to each its especial merits, and render it appli- 
cable to peculiar conditions. It is claimed that the Carbonic-acid gas, 
protoxide of nitrogen or “ laughing gas” and certain exhilarating ethers, 
which according to Liebig, exist in sparkling champaigne, render this 
wrine capable of producing a higher and yet less injurious stimulation 
than the same amount of Alcohol in any other form. 
With this view of its action, Dr. Cotton admits the use of wine and 
even beer. Turnbull condemns them in general, but employs them as 
a “ great solace to the patient in the advanced stage.” (p. 56.) 
When wine is given to promote nutrition it should always be given 
in small quantities largely diluted, and in combination with other nutri- 
tious and easily assimilated substances; of these the sugar contained 
in good wines is shown by Dr. Becker’s experiments to have a special 
effect in limiting the destruction of tissues containing phosphates, as 
the bones and nerves, and the ethers may possess a similar power. 
The acids and extractive matter of wTines lessen the injurious effects 
which the Alcohol alone, though diluted, exerts on the mucous mem- 
brane. It is important when Alcohol in any form is used for the pur- 
pose of arresting the metamorphosis of tissue, that constant stimula- 
tion, even in slight degree should not be too long persisted in. Some 
intervals must be permitted during which its effect may subside, and 
give the system time to “ recover its metamorphosis, so that the effete 
tissues may be duly eliminated and expelled.”* 
If brandy cr some other alcoholic fluid be preferred in a given case to 
wdne, it should always be diluted with a large proportion of water. In 
any degree of dilution they can only aid in developing adipose, never 
* Batilliat on the Wines of France. 
* British and Foreign Medico Chir. Review. FERMENTATION OF THE CONTENTS OF THE STOMACH. 
303 
of muscular tissue. They do little then towards the furnishing of mus- 
cular strength; what they can do can best be done in a highly attenu- 
ated form. Troy was taken by heroes who drank their wine forty times 
diluted with water; it was wine -imdiluted that subverted both the men- 
tal and physical powers of the Macedonian conqueror. 
III. FERMENTATION OF THE CONTENTS OF THE STOMACH, WITH 
DEVELOPMENT OF ORGANIC PRODUCTS.—SAIiCINJE. 
This form of disease from gastric fermentation was first noticed by 
Mr. John Goodsir in 1842.* A young man, aged nineteen, had suffered 
for four months from gastric disease, which resisted all ordinary treat- 
ment. On examining with the microscope some of the fluid ejected 
from the stomach, he found in it some peculiar organized living pro- 
ducts to which he gave the name of Sarcinee / they have since been ob- 
served by others. 
Diagnosis.—Distention of the stomach on waking in the morning, 
partially or entirely relieved by spontaneous regurgitation and expul- 
sion of a large quantity of a transparent or light brown fluid, which 
has the odor of fermenting wort, and is sometimes acid. After stand- 
ing a few hours, it is covered with a mass of froth like that on a pot 
of porter, and a glairy, ropy, granular matter is deposited. There is 
sometimes but little complaint of indigestion, and the pulse is undis- 
turbed ; in one bad case it was from fifty-six to eighty per minute. 
Sleep is disturbed more or less according to the quantity of ferment- 
ing matter contained in the stomach. There is sometimes perceptible 
enlargement at the epigastrium, deficiency of appetite, constipation, 
pain or burning in the region of the stomach, which is distended with 
gases, and the feeling of distress increases until it is relieved by vomit- 
ing. The microscope reveals the organized sarcinee in a square or 
slightly oblong plate, one-eighth as thick as one of its sides is long, and 
divided into four equal squares by lines crossing in the centre. 
Each quarter is subdivided by similar lines, more faintly marked, 
and the whole is like a brownish or yellow packet -g-fo or —oVu of an 
inch in length, bound with cords crossing at right angles. The fluid 
ejected from the stomach contains some lactic-acid and a trace of 
muriatic-acid. No Alcohol was found by Mr. Hardwick, though it had 
probably existed at an earlier stage of the fermentation. With sarcinee, 
sometimes occur small bodies resembling the torulce of yeast. There 
is seldom fever, but sleep is disturbed by distention of the stomach.f 
Professor Graham found the fluid to contain free Muriatic-acid, Acetic- 
* Edinb. Med. and Surg. Jour. Yol. 57. p. 430. 
| Busk, Microscop. Jour. Yol. 2. p. 321. 304 
DISEASES OF THE DIGESTIVE FUNCTION. 
acid, Alcohol, and Sugar, while Carbonic-acid was not disengaged.1* 
When the fluid ejected is alkaline, and not acid, no sarcinge have been 
found in it. The urine is generally clear, containing no albumen, and 
is of a specific gravity of 1022 to 1011, revealing under the micros- 
cope, crystals of oxalate of lime. The saliva is slightly acid, the appe- 
tite good; but free indulgence in eating is followed by distention of 
the stomach, with burning uneasiness, or agonizing pain, if the stomach 
be ulcerated. In less severe cases, the heartburn or other uneasiness 
subsides wTith the absorption or expulsion of the gastric contents. When 
the disease is more fully developed, the distress continues 1.11 relieved by 
vomiting, or by the eructation of a clear sour fermenting fluid. When it 
has continued long, the patient become emaciated, has a dry skin, slow 
pulse, and that peculiar anxious expression of countenance observed 
in persons suffering from organic disease of the stomach. 
Causes.—1. Organic Injury. In a case given by Mr. Busk, the 
diaphragm of a man, previously in good health, was ruptured, and the 
whole stomach, with portions of the other abdominal viscera, passed 
through the aperture into the left pleura. From this injury resulted 
the long train of symptoms peculiar to obstruction, detention and fer- 
mentation of the contents of the stomach, and formation of sarcinge, 
though the stomach itself was perfectly sound. In a second case, the 
spine was fractured by a fall into the hold of a ship. The vomiting of 
a fluid containing sarcinge occurred but once, and w’as followed by a re- 
turn to perfect digestion, though paralysis, from injury of the spine, 
remained. In another case, it was attendant upon the progress of a 
pleurisy, in a boy with disease of the hip-joint. Sarcinge were expelled 
from the stomach by vomiting, and after death were found in the stomach, 
but in no other portion of the intestinal canal. {Busk.)—Dr. Budd 
says, a laborer, on whom a bank of earth fell, was thrown violently on 
some pieces of board; he was in consequence affected with this spe- 
cies of stomach derangement, with palpitation and shortness of 
breath. 
Pathology.—The development of the fungi called sarcinge with 
fermentation of the contents of the stomach, is generally associated 
wTith some local injury or with structural disease of the pylorus ; fre- 
quently with that induration of the pyloric cellular tissue caused by 
spirit drinking. In one case the pyloric stricture was so complete that 
a probe could scarcely be passed. Though the patient had taken bi- 
carbonate of soda from f to one pound per week for months together, to 
relieve the acidity, there was found, after death, no thickening of the 
coats of the stomach, nor other indication of malignant disease.f 
* Dr. Jenner, Med. Times. Aug. 1851 
f Budd on Diseases of the Stomach, >. 199. FERMENTATION OF THE CONTENTS OF THE STOMACH. 
305 
The disease under consideration then presents the following pecu- 
liarities : 1. a secretion of abnormal fluids by the stomach: 2. a specific 
fermentation in these fluids and in the food imperfectly digested, “with 
the evolution of carbonic-acid and the production of torulce and sar- 
cince, leading to the formation of acetic-acid.” The essential patho- 
logical feature consists in a structural change in the stomach, which 
prevents this organ from fully discharging its contents, and causes an 
abnormal secretion of fluid which rapidly ferments. Alcoholic fer- 
mentation may be the first step ; but the alcohol is rapidly decomposed, 
no symptom of intoxication occurs, and the process ends in the forma- 
tion of acetic-acid. Though much of the acid in the fluids vomited is 
formed by fermentation after their expulsion, still the quantity formed 
within the stomach, together with its distention by the gas, greatly in- 
creases the sufferings of the patient. 
Treatment.—Allopathic clinical experience has not yet led to any 
satisfactory system of treatment. Dr. Budd says, one patient already 
mentioned after being dug out of the embankment of earth, insensible, 
was treated two years afterwards for the dyspeptic fermentation. After 
being restricted to a diet of lean meat and bread for five weeks, and 
taking two minims of Creosote in pills, three times a day the general 
symptoms abated; hut the pain in the epigastrium, flatulence, and oc- 
casional vomiting of acid eructations remained. In a second case, that 
of a spirit drinker, the disease had lasted nearly a year, and was treated 
with Creosote pills like the preceding. Colocynth and aloetic pills 
were also occasionally given. 
But slight improvement followed this treatment, and other measures 
were ineffectually tried. On resuming the first, with a full diet of lean 
meat, bread, and coffee, again there was improvement, but only up to a 
certain point. Sulphate of Zinc emetics, and five grain doses of Nux- 
vomica, thrice a day, were useless. Common salt in doses of a table- 
spoonful to a half-pint of water three times a day caused burning of 
the stomach, (as well it might,) but it mitigated the fermentation. He 
was never cured. 
In reviewing the expedients tried in the above cases we at once ob- 
serve that the remedies tried were all good, if they had only been ad- 
ministered in an attenuated form. The Creosote, Nux-vomica and the table 
salt are proper remedies in such a case. The last of these was tried 
in the case of the man who took such large quantities of bi-carbonate 
of soda. He ultimately died of complete stricture of the pylorus, the 
passage being almost entirely obliterated; and this termination was a 
reasonable one to predict under the use of large and crude doses of 
irritating drugs. Table salt or Natrum-muriaticum is, in every form, 
an important antiseptic; but it only acts well when largely diluted, as 
we find it in some mineral waters, such as that of the Blue Licks, 
Vol. I 20. 306 
DISEASES OF THE DIGESTIVE FUNCTION. 
Kentucky. I have seen its influence on some obstinate derangements 
of the stomach complicated with torpor, or chronic enlargement of the 
liver and spleen of malarial origin. About four-fifths of the solids 
contained in this water consists of pure muriate of soda; but the me- 
dicinal effect far surpasses that obtained by so small a quantity in a 
common solution, and is attributed to the large quantity of water with 
which it is combined. When still more largely diluted the effect is 
better. 
Natrum-muriaticum, in higher attenuations, is appropriate where 
there is fermentation or putrefactive change in the contents of the 
stomach, whether sarcince be discovered in the contents of the stomach 
or not, and especially when ague complications are present. 
Symptoms : Bitter, sour, or putrid taste in the mouth, want of appe- 
tite, aversion to food, or excessive craving for bitter or acid food or 
drink, the stomach feeling full and oppressed when but little has been 
taken; sour regurgitation of food, persistent heartburn, hiccough and 
nausea after eating; vomiting followed by extreme exhaustion, spas- 
modic or convulsive action of the stomach, and throbbing or burning 
at the pit of the stomach. 
Bi-Sulphite of Soda.—Its specific chemical properties constitute 
its first claim to attention. As an antiseptic, it is employed to preserve 
bodies for dissection. It also prevents the fermentation of vegetable 
juices, but owes its virtues to the affinity of its soda for vegetable acids. 
When it meets with acetic or lactic-acid, in the stomach, it is decom- 
posed, and sulphurous-&Q\i\. is liberated. 
This acid has the power to prevent alcoholic and acetous fermen- 
tation, and has been used to prevent the formation of acetic-acid in 
cider. Dr. Jenner employed it to arrest fermentation in the contents 
of the stomach. Dr. Budd dissolved two drachms of the salt in an 
ounce of wrater, giving a tea-spoonful in a wine-glass of water, as soon 
after meals as the fermentation began. Since the hypo-sulphite of soda 
is relied upon for its chemical rather than for its dynamic action, we 
consider in prescribing it, whether the sulphurous-acid formed by its 
decomposition bo appropriate to the case. The following are important 
symptoms: Most of the common symptoms of confirmed dyspepsia, 
—sour eructations, strong acid taste remaining long in the throat, 
which feels rough as if scraped, bitter taste in the mouth, nausea with 
bitter or acid vomiting, the stomach remaining sore to the touch, feeling 
full and distended by something solid, a burning in the stomach ; ob- 
stinate constipation ending in diarrhoea, with haemorrhoids, quick pulse, 
emaciation. 
I have for some years frequently prescribed the hypo-sulphite of 
t oda for dyspepsias in which gastric fermentation is a prominent symp- 
tom. It is truly a dynamic, as well as a chemical remedy and may SYMPATHETIC AFFECTIONS OF THE STOMACH. 
307 
well be tried in protracted gastric derangements in psoric constitu- 
tions. 
IY. SYMPATHETIC AFFECTIONS OF THE STOMACH. 
1. Functional disorder of the stomach from organic disease of other 
organs, may result from an influence transmitted through the nerves, 
as well as from the constitutional disturbance that may be produced by 
some change in the blood. 
Dr. Hall in his exposition of the direct and reflex action of nerves 
has explained the process by which irritation of the lung, brain, liver, 
or uterus so frequently leads to sympathetic vomiting—that is, vomit- 
ing caused by nervous influence reflected from the seat of the disease 
upon the muscles that perform the act In these cases the matters 
vomited are often acid, showing that the reflex influence excites not 
merely the act of vomiting, but also, as in the experiment of Spallan- 
zani, a secretion of gastric fluid. 
2. Sympathetic Vomiting in Phthisis.—It sometimes results from 
the reflex action excited in the stomach by irritation of the lungs when 
the cough is hard and dry, occurring as in whooping cough, only at the 
end of hard fits of coughing, when there has been no previous loss of 
appetite or of digestive power, and without pain in the stomach. This 
kind of vomiting is generally controlled by sedatives. 
A few doses of Lobelia 3d, will afford relief. See Dyspepsia. 
Later in the disease, vomiting is attended by loss of appetite, pain, 
sense of heat at the stomach, and the matter vomited is acid. These 
symptoms often continue till death; and, on dissection, the mucous 
membrane of the stomach at the cardiac end is found thin and soft; 
in some cases all the coats of the stomach are dissolved. (M\ Louis 
u OnP hthisis”) 
In these cases the disorganization does not originate in structural 
disease of the stomach, but in undue and untimely secretion of gastric juice, 
and other functional disorder excited by reflex nervous influence. In 
some cases the functional disorder may ultimately lead to an inflamma- 
tory or catarrhal state of the mucous membrane, and this may be an 
additional cause of disordered digestion; but the softening almost 
always takes place after death; and depends on the quantity of gastric 
acid the stomach may contain at death. 
In some advanced stages of phthisis there is often gastric disorder, 
especially in females, from fatty enlargement of the liver. In this 
case the liver by its increased size overlaps and compresses the pyloric 
end of the stomach, and causes that enlargement of the stomach so 
commonly found in consumptive subjects, and in some degree, to evils 308 
DISEASES OF THE DIGESTIVE FUNCTION. 
of obstructed pylorus. For this condition there is no remedy, as the 
cause consists in an incurable disease. 
3. Disorder of the stomach caused by abscess of the liver. See 
that Article. 
4. Disorder of the stomach from the effects of the passage of gall- 
stones. This is treated of under the head of Chololithus, or gall-stones. 
See Gall-stones—Index. 
5. Passage of a renal calculus may produce the same sympathetic 
nausea and vomiting as that from the passage of a gall-stone. 
6. Gastric Disorder from Disease of the Brain.—In inflammatory 
diseases of the brain, particularly in their early stage, when the symp- 
toms denote irritation rather than compression, vomiting is a frequent 
symptom; and in many persons Avho die of it, the mucous membrane of 
the cardiac end of the stomach is even found more or less dissolved 
or digested by the gastric juice. This shows that the irritation of 
the brain can not only excite the mechanical act of vomiting, but also 
that untimely secretion of gastric-acid that may prey upon the coats 
of the stomach after death. Andral says, vomiting and especially 
nausea, frequently attend on the first onset of inflammation of the 
membranes of the brain; and, after twenty-four hours they generally 
cease to attract attention. In some cases after death from brain-disease, 
the stomach is entirely sound; in a smaller number the coats of the 
stomach have undergone “self-digestion” from the action of the free acid 
which may continue to be formed so long as the gastric disorder con- 
tinues as the result of the cerebral irritation. Andral says, some pa- 
tients vomit only two or three times a day; others every hour or two 
or even every fifteen minutes, being unable to take even a spoonful of 
drink without vomiting. Some throw up enormous quantities of green 
bile, others with great effort can only throw up a little mucus. Females 
suffer more than men, and children than grown-up persons. The vomit- 
ing is sometimes attended by pain and tenderness at the epigastrium, 
but the degree of this tenderness is mainly dependent on the duration 
of the gastric disorder. When the pain of the head is severe the 
slighter pain of the stomach is little noticed. This gastric disorder is 
attended with secretion of much acid, is generally treated by Soda, 
Magnesia, chalk or bismuth. (Budd, p. 158.) 
7. Gastric Disorder from Organic Disease of the Uterus.—Dr. 
Denman caused in one case pain and vomiting, by passing a ligature 
around the polypus of the fundus of the uterus. On loosing the liga- 
ture the symptoms ceased ; on attempting to tighten it the pain and 
vomiting returned. The ligature was left on, but loose. The patient 
died in six weeks, and on post-mortem examination the uterus was 
found inverted; and the ligature had included the inverted portion 
{Gooch, Diseases, dec.) SYMPATHETIC AFFECTIONS OF THE STOMACH. 
309 
Cancer of the Uterus often causes frequent and distressing vomiting 
through the reflex nervous influence transmitted first from the uterus 
to the spine, and secondly reflected on the stomach. The vomiting in 
these cases is often attended by pain at the stomach and thirst, and 
the coats of the stomach after death may be found softened or digested; 
the reflex action having excited the secretion of gastric juice. 
Nausea and vomiting are common effects of ulcer of the neck of the 
uterus, and the distress thus originating may he very severe, at the 
same time that the uterine pain may be so slight as to be entirely 
overlooked. 
8. Nausea and vomiting are often dependent, in nervous females, on 
trifling causes. In those in whom the sensibility has been exalted by 
losses of blood or by anaemia otherwise induced, the digestion is habi- 
tually feeble; and any unwholesome or indigestible food may excite 
high irritation and vomiting; this may be kept up for weeks or months; 
though most common in women it may occur in men who have excitable 
nervous systems with feeble digestion. It generally begins in the 
evening after fatigue. The vomiting is followed by pain, or uneasiness 
at the pit of the stomach, loss of appetite and thirst, it returns after 
swallowing any food whatever, and even the simplest drinks. There 
is then severe pain at the stomach and the matters vomited are very 
bitter. In slighter cases the food is retained for a time and the mat- 
ters rejected are intensely sour. The acid thrown up may be in part 
secreted by the coats of the stomach; but the constant irritation to 
which the mucous membrane of the stomach is subjected, greatly 
weakens the digestive power; and the unhealthy and decomposing 
mucus acts upon the starchy principles of the food, which- pass into 
fermentation and evolve large quantities of lactic-acid. The stomach 
exerts a sympathetic influence on the liver, and after a few days the 
countenance becomes sallow, though only in a slight degree. This 
may remain but a short time, but the gastric symptoms often continue 
longer than those caused by the passage of gall-stones; in some cases 
for months. In one case the above symptoms were caused by loss of 
blood from haemorrhoids, and frequently returned on occasions after 
great fatigue or the taking of improper food. The haemorrhoids were 
cauterized by nitric-acid; the bleeding ceased and health improved. 
At a later period the disease returned, and the patient was confined to 
bed for four months, and vomited everything she ate. The proper 
emedies in such cases, are Nux-vomica, Podophillin, Calcarea-carb., 
Cantharides, Antimonium-crudum, Pulsatilla, and China. (Budd, 
161.) 
9. Sympathetic Affections of the Stomach in young Children.—In 
young children the secreting function of the stomach is very active, 
and they are especially liable to reflex functional disorders of other 310 
DISEASES OF THE DIGESTIVE FUNCTION. 
kinds. In them this secondary gastric disorder is often excited by 
tuberculous disease of the lung or inflammation of the brain; and, 
though they are not liable like adults to disease originating in the liver 
or uterus, they have in the process of dentition a source of irritation 
which often causes gastric disturbance and convulsive affections. These 
effects of irritation are more severe in children weakened by eruptive 
fevers, by the use of improper food, impure air, or active purgatives 
On the change of food at the weaning stage the digestive organs are 
liable to much disturbance. 
“Atrophia AMactatorumP—Marasmus from weaning.—Symp- 
toms.—Frequent vomiting, thirst, fretfulness; writhing of the body 
and plaintive cries expressive of pain. The matters vomited are sour 
and bilious, and thrown up with great effort. Diarrhoea, the evacuations 
being greenish from the presence of bile rendered green by the free 
acid secreted by the stomach, or formed by fermentation of the food. 
Second Stage.—“ Hydrocephaloid Diseases of Inf antsy [Mar- 
shallHall.) The child becomes rapidly emaciated, grows feeble, and 
exhaustion becomes more and more observable; surface cold, death. 
Pathology. Sometimes no marked evidences of previous disease 
are noticed after death; in other cases there is seen that peculiar 
softening of the coats of the stomach, and (when there has been diar- 
rhoea,) of the coats of the bowel also, that is produced after death by 
the action of the gastric juice. 
Treatment.—When dental irritation exists reduce it as much as 
possible by lancing the gums. Feed the child on the best milk or milk 
and baked flour, or with the milk of a healthy nurse. The best reme- 
dies are, Hellebore, Arsenicum, Mercurius-corros., Chamomilla, Oxalic- 
acid, China, Veratrum. For further treatment, see Follicular Enteritis. 
If this disease be not speedily remedied, the stomach disorder im- 
pedes nutrition and brings on fatal exhaustion. The constitutional dis- 
order having exhausted the functional powers of the stomach, some- 
times induces an inflammatory or catarrhal state of the mucous mem- 
brane ; on the digestive power becoming further weakened the stomach 
secretes an unhealthy mucus which promotes undue fermentation in 
the starchy principles of the food, and thus leads to the formation of 
large quantities of lactic-acid, or some other acid of the same group, 
and this produces still further disturbance, ending in death. 
Pathology. Softening of the stomach is very often found in these 
cases after death; but we have elsewhere seen that this change takes 
place after death, and does not depend on the severity or duration of 
the disorder, but on the quantity of free muriatic or lactic-acid, which 
the stomach may happen to contain at death. In severe cases of* long 
duration there is often no perceptible change discovered after death; 
in other cases, much less severe, a large quantity of one of these acids COLIC, 
311 
may be poured out into the stomach, and its coats may be found dis- 
solved after death. 
It has been common to attribute the vomiting, thirst, pain and tender- 
ness of the epigastrium in these cases, as well as the softening of the 
stomach found after death, to inflammation. But all of these symptoms 
may arise from other causes ; and in the form of disease now described 
they originate in the conditions above mentioned. At its origin, and 
long after, the disorder is functional only; and is more allied to the ex 
cited and disordered state of the intellect, in delirium tremens, or the 
excited involuntary, movements of the voluntary muscles, in chorea. 
(Budd, Diseases of Stomach, 164.) 
In health, when food is placed in the stomach, the quantity of gastric 
fluid generated is proportioned, not to the powers and capabilities of 
the stomach, but to the want of the occasion, and is just sufficient for 
complete and speedy digestion. But in disease the power is often un- 
duly expended by irregular, unnecessary and ill-directed effort. 
Genus VI.—COLICA—COLIC. 
Under this head we shall treat of several painful affections of the 
abdomen, all of which are characterized by severe griping pains in the 
bowels, with constipation, and often without vomiting. We shall notice 
the following species: 
1. Colica cibaria. From food improper in quality or excessive in 
quantity. 2. Flatulent colic. 3. Bilious colic. 4. Colica pictonum. 
5. Colic of children. 
Bilious Derangement.—This term, though without being correctly 
applied to the affections here to be noticed, is in universal use, and 
may at present be retained. The popular idea is that there is an ac- 
cumulation of bile in the system which has been absorbed from the 
gall-bladder and bile-ducts. Instead of this being true, there is gene- 
rally deficient secretion of bile ; and the importance of this fact is also 
much over-estimated by those who recognize its existence. 
Symptoms.—It occurs most frequently in persons who eat freely and 
use stimulants unnecessarily ; the skin is dingy and sallow; the spirits 
miserably depressed ; constipation; flatulence ; dull aching pain in the 
right shoulder; headache chiefly confined to the forehead, eye-brows 
and eye-lids; smarting in the eye-lids and eyes ; eyes prominent, with 
yellowish tint in their whites ; yellowness well marked on the side of 
the nose ; tongue coated with brown fur; nauseous and bitter taste iu 
the mouth on waking in the morning; appetite defective; sleep imper 
feet, disturbed by frightful dreams; melancholy despondent state of 
mind, which is haunted by an oppressive undefinable dread. ( Wright.) 
I. Surfeit.—Cibaria. The consequence of excess in eating or drink- 312 
DISEASES OF THE DIGESTIVE FUNCTION. 
ing, or of something unwholesome or improper in the fotd. It consists 
in a heavy load or oppression of the stomach, with nausea, sickness, 
impeded perspiration, and at times eruptions on the skin. (See Dys- 
pepsia, page 281.) 
Definition.—Severe twisting, griping pains in the abdomen, writh 
vomiting, and rigid contractions of the abdominal parietes, followed, in 
some cases by griping alvine evacuations, and looseness. 
Causes.—Many articles of food disagree with some persons, whether 
taken in large or small quantities. Among the worst things is fresh 
pork, which often causes sickness, vomiting, colic and dysentery. A 
similar effect is often produced by tainted meat, mildewed wheat or 
rye, (called “ sick-wTheat” in the Western states) ; cold, sour, indiges- 
tible or unwholesome fruits, cucumbers, melons, &c.; injudicious use of 
griping purgatives, as pills, senna, &c. In Africa the natives cause 
dangerous colics by using freely when warm of acid drinks prepared 
from the juice of the palm find other trees. Kaempfer says, that the 
Japanese often excited it by drinking fermented beverages, prepared 
from rice. Linnaeus imputes its prevalence among the Laplanders to 
the use of stagnant water containing animalculae. In other parts 
of the North Europe buttermilk, whey and vegetable infusions are 
fermented into acid liquors and used as a common drink. Severe 
attacks of colic often follow their use. Dr. Chisholm says, it was 
caused in his time in Devonshire by the acid cider drank by the 
laborers. In this country we have all of these or similar causes in 
constant operation. The markets are supplied by poisonous fish, mus- 
cles, lobsters, mushrooms. The smoked-meat sausages, and old cheese 
everywhere sold, often contain minute fungi, which not only cause 
severe colics, but also distressing and dangerous affections of the ner- 
vous and vascular systems. The symptoms are thus given by Dr. 
Hering: “ The poison of fat is generated in half-putrified, half-sour 
meat, blood and fat, and also in cheese, blood-puddings, liver-puddings, 
sausages, sour pork, bacon and hams, old rancid grease of any kind, 
and substances not sufficiently or regularly smoked. It is generated 
very rapidly, and things eatable to-day are poisonous to-morrow.” The 
Symptoms are: Heartburn and nausea ; a feeling of dryness in the 
throat, extending by degrees into the mouth, the nose, ears and even 
the eyes; after a few days there may be cracking of the skin on the 
eyelids, the sides of the nose and points of the fingers. The voice 
soon becomes hoarse, the pulse is slow and weak; hunger and thirst 
are very great, but the patient can scarcely swallow anything; the 
strength now becomes less, the eyelids seem lamed, the pupil dis- 
tended ; the patient does not see distinctly, but as if he were looking 
through a fog, or he sees every thing double. The abdomen at the 
same time is tight, with much pain and constipation; finally, the knees COLIC, 
313 
and feet become stiff. If the patient does not die in a few days, a 
tedious, incurable disease will remain. In the fatal cases observed 
from the eating of Wurtemberg sausages, death is preceded by the 
gradual wasting of the muscular fibre, and of all the like constituents of 
the human body. The saliva becomes viscid and emits an offensive 
smell. The patient becomes emaciated, dries into a complete mummy 
and soon dies. After death the body is stiff as if frozen, and is not 
subject to putrefaction. In the poisoned sausages no peculiar poison has 
been detected by chemistry. It has been thought possible to destroy it by 
the action of Alcohol or that of boiling water; but this is probably not 
true. Ordinarily it passes through the stomach unchanged by the 
gastric fluid, and is absorbed and carried into the blood where it acts 
on the blood-constituents as yeast does upon wort. 
II. Flatulent Colic.—Definition.—Acute pain in the bowels, with 
occasional partial remissions, flatulent distention, or spasmodic con- 
tractions, or both at the same time, relieved by pressure and the expul- 
sion of flatus. 
Pathology.—There is morbidly increased sensibility and irritability 
of some part or the whole of the bowels ; irregular distention and spas- 
modic constriction of different parts of the canal; and more or less 
generation of flatus in their tract, occasioning great distention and irre- 
gular reaction of the muscular coats. 
Nervous Colic.—The morbid irritability and increased sensibility 
of the bowels are common in females and nervous persons, who lead a 
sedentary life, permit the bowels to be constipated, give way to mental 
excitement, and are susceptible to the influence of cold. 
Symptoms.—The attack is usually sudden; the pain is felt in one or 
more points of the abdomen, may shift place frequently and be exacer- 
bated at intervals. The face is pale and anxious ; abdomen irregularly 
contracted ; and pressure on it affords slight relief. When the pain is 
extreme, a cold perspiration is forced out on the surface, and the patient 
complains of a “ sinking” feeling. The bowels are constipated; 
rumbling noise from wind constant The attack lasts from one to 
several hours, and generally terminates in gradual recovery. It is 
liable to return repeatedly, from errors of diet or mental disturbance. 
In cases most clearly consisting in accumulation of flatus, the expul- 
sion of the wind gives ease ; the distention and pain are traced along the 
course of the colon, and are felt worst in the sigmoid flexure and caecum. 
The quantity of flatus is very great; and it evidently proceeds from 
’rritation of the mucous surface of the bowels, the gaseous fluid being 
excreted from the blood by the vessels of this surface. Even if some 
of the gas be furnished from decomposing food imperfectly digested, 
the quantity of matters retained in the bowels is not sufficient to fur- 
nish all that is accumulated. In some parts the intestine is inordi- 314 
DISEASES OF THE DIGESTIVE FUNCTION. 
nately distended, in others irregularly constricted, and the retained 
flatus is propelled from one part to the other, causing severe griping 
pains and rumbling noises in the abdomen. If the attendant constipa- 
tion is relieved by enemas or otherwise, the evacuations consist chiefly 
of hard lumps, and accompanied with the escape of much flatus, the in 
testinal secretions having been entirely suppressed or much diminished 
In the more spasmodic form of the disease nausea and vomiting alter- 
nate with the constrictive pain. Injudicious treatment often develops 
ileus or enteritis. 
Causes.—Indigestible food, unripe or decayed fruits ; beer; mental 
emotions, or any other cause capable of morbidly altering or suspending 
for a time the healthy action of the stomach and bowels, in such a man- 
ner as to cause them to generate an unusual quantity of gas. 
III. Bilious Colic.—Diagnosis.—Severe griping pain, with vomit- 
ing of the contents of the stomach, and bilious or other perverted se- 
cretions; constipation or scanty evacuations, often with hiccough, tension 
of the abdomen, and restlessness ; evident deficiency of the secretions 
of the intestinal canal and associated viscera. 
Causes.—The retention in the caecum and cells of the colon of those 
excrementitious matters, which are required by nature to be thrown 
off from the bowels, produces in many persons an unhealthy state; we 
see it oftenest in persons in whom the abdominal organs are in a state 
of torpor from the influence of malaria; in persons advanced in life, or 
who lead an indolent or sedentary existence; debilitated invalids, preg- 
nant females, women of advanced age, or men who have old hernias. 
The attack is preceded by indigestion, headache, nausea, heartburn, 
constipation of the bowels, bitter taste in the mouth ; fulness about the 
caecum, the sigmoid flexure or the colon. In many cases we detect 
large accumulations of the hardened faeces in the caecum and ascend- 
ing colon. Severe griping pain is followed by sickness and bilious 
vomiting; foul tongue ; loss of appetite ; thirst, and uneasiness in the 
bowels are speedily followed by severe griping, twisting, or shooting 
pains in the umbilical region; hot skin ; painful distention of the 
stomach and abdomen ; obstinate constipation, and finally, tenderness 
of the abdomen ; yellow cast of the skin and eyes; coldness and tor- 
por of the extremities; cold sweats ; feeble or excited pulse, and other 
signs indicative of a fatal termination of the disorder. 
If irritating purgatives be now given, they produce increased pain 
and tenderness, whether they operate or not. The abdomen becomes 
tense, tender on pressure; the pulse becomes quicker, the coating on 
the tongue increases ; the tongue and mouth dryer, more red. When 
not speedily cured this condition progresses to enteritis, ileus, or 
dysentery. 
During the first stage of the malady, the patient involuntarily makes COLIC 
315 
firm pressure over the umbilicus, which affords temporary relief; and it 
it is by this symptom that we may distinguish the disease from inflam- 
mation of the bowels, in which pressure is attended with an aggravation 
of the pain. 
Causes.—Deranged function of the liver is supposed to be the chief 
cause of this disease. Authors assert that this organ is in a torpid 
condition, secreting only a small amount of bile, thus leaving the in 
gesta to be only partially acted upon by one of its natural solvents, 
and thereby rendering the half-digested food an irritant to the diges- 
tive organs. Atmospheric and other influences are known to originate 
the disease in certain seasons. 
The Endemic Colic of the West Indies, that of Madrid, and se- 
veral provinces of Spain, and that well-known as “ Bilious Colic” in 
malarious parts of the United States, seem to be only modified forms 
of the same disease. They all owe their origin in part to errors of 
diet, atmospheric vicissitudes, and other causes that derange the secre- 
tions. But these causes are in operation everywhere; and they only 
establish this peculiar malady when operating on persons saturated 
with malarial poison. This specific poison is essentially the same as 
that which causes intermittent and remittent fevers. Its effect is to 
produce a torpor of the secreting organs; impeding the functions of 
the liver and inner surface of the intestines ; there is accumulation ir 
the hepatic ducts, gall-bladder, and prima-via of bile and morbid secre 
tions, which excite painful and abortive aggravation of peristaltic ac 
tion for their expulsion. There is evident torpor or congestion of the 
liver, irritation of the duodenum ; an acrid state of the secretions, which 
are dark colored, causing great distress till removed. 
Symptoms.—Dull aching and pressing pains in the course of the 
colon ; loss of appetite ; irritability of temper, difficulty of evacuating 
the bowels ; though constipation had not preceded ; evacuations small 
in quantity, with much flatus; feels easier in bed; tongue moist, loaded 
at the root only; much thirst. After these symptoms continue two or 
three days the constipation becomes complete; evacuations cease; the 
pain becomes more severe, fixed and constant at the epigastrium, with 
a twisting pain at the umbilicus; the countenance is pale, expressive 
of pain and anxiety; the pulse is slow, small, regular and constricted, 
but not febrile ; the skin is dry, but not hot; and the urine is scanty, 
but not otherwise unnatural. The patient sits with his arms crossed 
over, and pressed upon the abdomen, and the trunk pressed forwards.j 
When in bed the thighs are drawn up and pressed upon the belly. 
Generally, soon after the constipation is established, bilious vomitings 
come on accompanied with hiccough ; the matters thrown up consist of 
those taken into the stomach, mixed with bile and glairy fluids. There 
is no sleep, but continued restlessness ; the pain is now nearly constant, 316 
DISEASES OF THE DIGESTIVE FUNCTION. 
most severe about the epigastrium and umbilicus: and it is not miti- 
gated by any position. The thirst increases as the malady proceeds ; 
but the fluids taken only aggravate the hiccough, and are immediately 
thrown oft’. The eyes are slightly yellow, and the whole surface sallow. 
In extreme cases the pain continues to be severe, the hiccough, and want 
of sleep continue; wandering delirium, and sometimes deafness come 
on; epileptic convulsions and sometimes fseculent vomiting follow and 
portend a fatal result. At this stage the abdomen which had been re- 
tracted is much distended. Purgatives, which had hitherto failed to 
operate, in the later stage excite dysenteric purging, which increase the 
prostration and hasten death. 
Prognosis.—Favorable Symptoms: Free evacuations not the result 
of drastic purgatives, followed by amelioration of abdominal pain and 
vomiting; the pulse remains below one hundred beats per minute; the hic- 
cough has not commenced, or is subsiding.— Unfavorable Symptoms : 
The tenderness, tension and tumefaction of the abdomen increase; the 
pulse becomes more quick, rising to and continuing at one hundred and 
twenty or more (in an adult). Constipation continues obstinate ; hic- 
cough is obstinate also ; tongue brown, or red and dry; restlessness 
and tossing continue. 
IY. Colica Pictonum.—Pachial gia.—Painters’ Colic.—Diagno- 
sis.—This form of colic generally attacks house-painters, plumbers, 
glaziers of earthen-ware, or workers in the different preparations of 
Lead. It is characterized by dull remitting pain, becoming constant 
and violent, extending to the back and upper and lower extremities ; 
vomiting, obstinate constipation, often followed by paralysis. 
Symptoms.—Lead colic usually commences with obscure pain of the 
abdomen, which becomes at intervals so severe that the patient tosses 
himself about, and vainly seeks a posture that will lessen his suffer- 
ings. He lies for a while on the abdomen, or presses or rubs this part 
with his hand. The pain is greatest at the pit of the stomach, but ex- 
tends to the back, the arms, loins, thighs and legs. A twisting pain is 
felt about the navel, which is first drawn inwards; and cutting pains 
shoot at times with great violence to both hypochondria and iliac fossae, 
and through the abdominal muscles. The voluntary muscles become 
so sore, that they cannot bear the slightest pressure; and the pain fre- 
quently alternates between the stomach and bowels and the external 
muscles. Sickness and constipation are early symptoms. The matter 
thrown from the stomach consists of a slimy fluid, with or without acrid 
bile, wdiich continues to be secreted, causing its own evacuation. There 
are bitter eructations, hiccough, severe headache, pains of the wrists, 
hands, ankles, soles of the feet, shoulders or neck ; these symptoms are 
worse during the night. The pulse is not affected at first, sometimes 
not at any stage. In some cases it is below the usual standard, in COLIC, 
317 
others quicker and weaker, rarely fuller or stronger. Tongue pale, soft 
and moist; papillae not erected. In most of the diseases caused by Lead, a 
blue ox purplish line is seen running along the edges of the gums just 
where they meet the teeth. The coloring matter is supposed to be 
sulphuret of Lead, formed by union of the Lead with sulphuretted Hy- 
drogen from animal matter absorbed by tartar on the roots of the 
teeth. The skin is commonly soft and moist, rarely hot. Urine free 
and often copious. Costiveness continues as the disease advances. 
When there is griping with faecal evacuations, they are in small, hard, 
dry scybalae, mixed with a dirty watery fluid containing a dark slime 
and a little blood. The abdomen is insensible to pressure ; in some 
rigid and knotted; in the latter stage often distended and slightly pain- 
ful from distention and affection of the muscles. In some cases the 
distention is owing to inflamma tion and faecal engorgement of the colon, 
which can be felt through its whole extent. The sphincters of the rectum 
and bladder are constricted. In protracted cases the pains in the back, 
loins and limbs become more violent, the debility, tremulousness, and even 
paralysis of the extensor muscles progress. Dyspnoea, palpitations, 
short dry cough, even epilepsy, coma or apoplexy supervene. Some 
cases are cured in two or three days ; others run on for two or three 
weeks or more. Many relapse several times. 
Prognosis.—Favorable Symptoms : The disease is mild and miti- 
gated by treatment.— Unfavorable Symptoms: The attack is severe 
there are hiccough, obstinate vomiting, tremulousness, and distention of 
the abdomen. The worst cases are those in which complications of 
deafness, blindness, faecal vomiting and symptoms of ileus appear. 
Treatment.—The specifics for the different kinds of colic, are Colo- 
cynth, Plumbum, Nux-vomica, Arsenicum, Chamomilla, Ilyoscya- 
mus, Stramonium, Veratrum, Cocculus, Senna, Colchicum, Phos- 
phorus, Pulsatilla, Podophyllum, Jalap. 
Auxiliary to the above remedies, we may urge upon the practitioner 
the importance of fomentations, and enemata of warm water. These 
measures, conjoined in certain cases with the tepid bath, are worthy 
of high consideration, and should never be lost sight of in the treatment 
of this, as well as other maladies of a spasmodic character. The fomen- 
tations should not only be applied to the abdomen, but to the extremi- 
ties, more especially if these parts are cold, and inclined to cramp. In 
moderate cases, fomentations, together with an ordinary enema, and the 
proper specific, will suffice to effect a speedy cure ; but if the case has 
been very violent and obstinate from neglect, or mismanagement by 
Calomel and Opium, a general warm bath, with very copious injec- 
tions of warm water while immersed in the bath, cannot be too highly 
recommended. Indeed, we have in several instances, observed the 
abdominal spasms to relax, the pains to cease, and free evacuations of 318 
DISEASES OF THE DIGESTIVE FUNCTION. 
fiscal matter and of wind to occur, while the patient was yet in the 
bath. By adopting this mode we secure the advantage of internal as 
well as external fomentations, and thus bring a safe, yet efficient re- 
medy to bear directly upon the parts affected. All who have practi- 
cally tested the soothing influence of warm water applications upon the 
nervous system, when in a state of unnatural erethism, will appreciate 
the truth of our remarks. 
Colocynth.—The medicine which is most generally applicable in the 
treatment of colic, is Colocynth. It is particularly appropriate when 
the complaint has been caused by a chill, by mental emotions, as grief, 
indigestion, mortification, &c., also when biliary derangement has been 
the exciting cause. 
Inflation of the abdomen ; position of the body bent forward, so as to 
relax the abdominal muscles ; cramps in the calves of the legs ; general 
agitation; temperature of the skin about the natural standard, or cold 
and covered with sweat; pulse natural, or but slightly increased in fre- 
quency ; tongue covered with a yellowish fur, or natural; face pale and 
indicative of intense suffering; rigidity and contraction of the abdominal 
muscles, as well as of the tendons in other parts of the body. Violent 
cramp-like contraction or cutting pains in the abdomen, generally in 
the region of the umbilicus; painful cramps in the calves of the legs ; 
sensation of faintness, with coldness and shuddering ; bitter or insipid 
taste in the mouth ; nausea ; loss of appetite; disgust for drinks ; con- 
stant inclination to move about, to grasp objects violently, and to make 
pressure against the abdomen; empty eructations ; pains in the back 
and loins, especially semilateral; obstinate constipation or small watery 
evacuations. Most intense anguish and agitation ; dejection ; extreme 
restlessness and desire to move about; fear of speedy death. 
Administration.—From the first to the sixth dilution may be em- 
ployed according to the age, sex, constitution, temperament, and seve- 
rity of the disease. A dose may be given every half hour in urgent 
cases until amendment or medicinal aggravation occurs, to be resumed 
and repeated as the exigencies of the case require. 
Plumbum.—On account of the very marked and decided specific 
action of Lead upon the colon and ileum, whether introduced into the 
blood through the stomach, rectum, lungs or skin, this drug is peculiarly 
appropriate for the treatment of some of the varieties of colic. The 
practitioner will, of course, avoid exhibiting it in that variety of colic 
which has been caused by the absorption of Lead. Rigidity and con 
traction of the abdominal muscles ; hard ridges or elevations in the ab- 
domen ; borborgymus ; frequent expulsion of offensive flatus ; eructa- 
tions ; tremblings, jerkings or cramps of the limbs ; face and skin pale, 
bluish, or yellow; surface cold, and covered with clammy sweat; 
mouth dry or moist and clammy; pulse weak, and somewhat frequent; COLIC, 
319 
body bent double. Violent constrictive, shooting, or pinching pains in 
the umbilical region; constant and urgent desire to eructate and ex- 
pel flatus ; chilliness or shuddering during the paroxysms ; sensation 
of faintness ; torpor, numbness, stiffness, and weakness in the limbs ; 
desire to press the abdomen against something hard ; extremities cold; 
Izziness; sweetish or bitter taste ; thirst; vomiting of bilious or faecal 
matters; pressure and cramps in the stomach ; obstinate constipation ; 
evacuations scybalous and difficult to expel; shooting pains in the 
loins, back, and limbs ; cramps in the feet, excessive agitation and 
restlessness. Very great anguish and uneasiness; melancholy; dis- 
couragement ; impatience. 
Administration.—Same as Colocynth. 
Case.—A delicate woman, aged twenty-six, after some heavy work 
and a fit of anger, was attacked with violent pain in the umbilical region, 
soon followed by vomiting of faeces, as if from obstruction in the intes- 
tines. Drastic cathartics were used, but with no relief. Dr. Lohrbacher 
found her with small frequent pulse, face of livid color, extremities 
cold; tearing, compressing pain; hard lumps could be felt in the um- 
bilical region as large as a fist, abdomen tender to pressure; violent 
thirst, extreme anxiety; constant vomiting of faeces. No hernia. 
Plumbum, fifth dilution, three drops in fj. of water, a teaspoonful every 
two hours. After the fourth dose there was a very dark faecal evacua- 
tion, but without apparent relief; pain and tenderness of the abdomen 
still increasing. Belladonna, 30°, five globules, one every hour, gave 
amelioration of the pain. Plumbum, 30°, a dose every three hours. 
Nine hours later a copious stool followed by cessation of the vomiting 
and recovery. 
Case by Dr. Marcy. (N. A. Jour. Ilomaiop. vol. IV. p. 343.)—A 
lady, aged thirty-six, of sanguine nervous temperament: distention and 
hardness of the caecum and ascending colon; the whole region swollen, 
and painful to the touch or on motion. Tongue dry, brown in the 
centre, skin hot and dry, much thirst, nervousness, headache, general 
depression, expression anxious, feeling of lameness in the lower extre- 
mities, sour eructations, nausea, inclination to vomit, umbilicus retracted. 
Plumbum-met. two grains, given every two hours, improved the condition 
very much in a few hours, and in a few days more entirely cured, save 
a few remaining symptoms, which disappeared after Sulph., Nux., and 
Merc.-sol. 
Nux-vomica is very useful in colic, arising from torpor of the liver, 
indicated by deficient secretion of bile, indigestion, flatulence, &c. It 
is also useful in flatulent colic, occurring in dyspeptic subjects after 
the use of improper articles of food. In cases where Nux is indicated, 
the face is pale or yellowish, the stools, previous to the attack, light 
and clay colored ; the abdomen distended ; there are frequent eructa- 320 
DISEASES OF THE DIGESTIVE FUNCTION. 
tations, hiccough, sharp and cramp-like pains in the stomach and bowels, 
and rumbling in the bowels; giddiness, sensitiveness of the stomach and 
abdomen when pressed upon. 
Administration.—This medicine may be used at the second or 
third attenuation ; a dose once in half an hour to two hours until relief 
is obtained. 
Arsenicum is specific in colic pains, coming on in regular parox- 
ysms, and attended with decided remissions. In extreme cases, it 
may also be resorted to with advantage, where the powers of the sys- 
tem have been exhausted, and other remedies seem to be incapable of 
arresting the disease. The first to the third trituration may be used, 
and repeated as circumstances may require. 
Chamomilla is advised by Hahnemann in colics of pregnant and 
parturient women, of new-born infants, and of children during dentition. 
It is also recommended for the colics of nervous and hysterical females. 
If this medicine does not afford the desired relief, resort may be had 
to Ilyoscyamus, Stramonium, or Senna. 
Administration.—A dose of the third to the sixth dilution every 
hour or two, as long as necessary. 
Veratrum, Cocculus, and Colchicum will often prove valuable in 
spasmodic and flatulent colic, occurring in nervous and hysterical fe- 
males, and in persons of a mild and phlegmatic temperament. In in 
stances where the above prescribed remedies do not correspond, let 
the indications of these latter articles be considered. 
Pulsatilla is principally useful in colics arising from the abuse of 
crude, esculent vegetables, unripe fruits, and abuse of fat and greasy 
articles of food. The pains are very severe, and usually occur a few 
hours after eating, attended with borborygmus, and the expulsion of 
large quantities of flatus. We have often seen the most prompt relief 
follow a single drop of the tincture, and we have rarely been obliged to 
repeat the dose more than two or three times. 
Phosphorus will apply to cases occurring in persons of a feeble 
organization, who have been weakened by long-continued gastric affec- 
tions, and especially for those who are afflicted with disease of the 
mesenteric glands. A dose of the third attenuation may be administered 
every two hours until relief ensues. 
Cuprum.—Case by Dr. Kissel. (Brit. Jour. Uomoeop. 1860, p. 554.) 
A married woman aged twenty-four, nursing a child several months old. 
Found her on the evening of Aug. 16, writhing in bed with outcries 
and groans, able to answer questions with difficulty. She had severe 
constrictive, pinching, tearing pains in the praecordium, remaining con- 
centrated in the same spot for an hour at a time; but a more distress- 
ing symptom was a sensation of swooning, in which she believed that 
she was in the last extremity,—that her life was about to terminate. COLIC, 
321 
Her eyes were without expression, her countenance collapsed; her ex- 
tremities cold; pulse wiry; tenderness of the third and fourth dorsal 
vertebra. Slight pressure on the stomach gave pain, though pressure 
more severe gave relief. The first attack had occurred four weeks be- 
fore this; had been free from pain in the interval. The excretions 
presented nothing unnatural. Tincture Cuprum-acet., in divided doses, 
every half hour. 
The pains and swooning sensation continued two hours, till the medi- 
cine arrived. The patient felt the influence of it every dose she took, 
and was quite well of all the symptoms after two hours from beginning 
it. The prescription was twice repeated, after which there was no 
return. 
Case II.—A lady aged thirty. Menstruation imperfect for the last year 
and a half; has had within the last eight days repeated attacks, which 
were successively more intense and lasting. On October 30, she had 
an attack still more severe ; she had severe constrictive pains in the 
praecordium, which extended along both hypochondriac regions, and 
quite into the neck, Avith oppression of the chest. She was in the 
greatest restlessness and anguish, would get out of bed, tossing herself 
about; then grasping again with both hands at the pit of the stomach, 
leaning upon it and throwing herself upon her face, she still cried 
that she must die. The praecordium was contracted; a light pressure 
upon it was painful, heavier pressure not so. The third and fourth 
dorsal vertebrae were tender, and she shrank from gentle pressure 
The attacks appeared at irregular times, and gradually extended to 
three hours. The extremities were cold, the pulse small and thin. 
Every thing else normal. She is directed to take Acet-cupri daily. 
Erom the first exhibition of Cuprum there were no more attacks; 
but two days passed before the feeling of exhaustion was quite removed. 
On November second the tenderness of the vertebrae had also dis- 
appeared. No fits occurred subsequently. 
We have often used Sulphate of Copper, third trituration, with the best 
results for nausea, vomiting,anxiety, gastric or abdominal pain, colic,&c. 
Confirmations of the Homoeopathic Principle by Allopathic 
Authors.—Muralto, says Hahnemann, saw what we may witness every 
day, viz. that Jalap, besides creating gripes in the belly, also causes 
great uneasiness and agitation. Every physician acquainted with the 
facts upon which homoeopathy rests, will find it perfectly natural, that 
the power so justly ascribed to this medicine by G. W. Wedal of allay- 
ing the gripes which are so frequent in young children, and of procur- 
ing them tranquil repose “ arises from homoeopathic influence.” 
The remark made by Murray, that oil of Aniseed allays pains of the 
stomach and flatulent colic caused by purgatives, ought not to surprise 
us, knowing that J. P. Albrecht has observed pains in the stomach 
VuL. L 21. 322 
diseases of the digestive function. 
produced by this substance ; and P. Forest saw violent colic likewise 
caused by its administration. 
It is also known and has been attested by Murray, Hillary and Spiel- 
mann, that Senna occasions a kind of colic, and produces, according to 
C. Hoffmann, flatulency and turgescence of the blood, ordinary causes 
of insomnolency. It was this inherent homoeopathic property of Senna 
which enabled Hetharding to cure with its aid patients afflicted with 
insomnolency, (Organon, p. 62). 
In cases of colic from the poison of lead, where there is reason to 
believe that any portion of the absorbed metal remains in the system, 
it is desirable to neutralize the poison by a direct chemical antidote. 
Of those proposed for this purpose, the highest claims have been made 
for Alum. It was first introduced into England by Dr. Percival from 
Ireland in 1774. It acts by converting the salts of lead it may meet 
with in the body into a comparatively innocent sulphate. It may be 
given in doses of fifteen grains every two hours. In such doses it 
sometimes purges, to restrain which it may be followed by Coloc., Senna, 
Jalap, &c. Dr. Breschet says he tried it in 150 cases with complete suc- 
cess. (Brit, and For. Med. Chir. Rev. Jan. 1851.) 
5. Colic in Children.—Nature of the Disease.—Spasm of the 
muscular fibres in some parts of the intestines or distention of the 
bowel with flatus. The affection may be acute or chronic. 
Symptoms.—In children attacked with colic there is often an in- 
creased discharge of urine, followed by agitation and impatience, con- 
stant weeping, sudden screams, contortions of the face, sleeplessness 
and twisting pain, with retraction of the umbilicus. The legs are bent 
towards the stomach; the body is twisted; and infants cannot suck 
in a recumbent position. The pain is relieved by pressure. 
Prognosis.—If the bowels move and some relief of pain follows, the 
case may he considered as progressing favorably. Unfavorable symp- 
toms are: obstinate constipation continuing; the pain being fixed in 
one spot and increased by pressure; this may denote the termination 
in inflammation of the bowels.* See Enteritis.) 
Causes.—A chill, worms, flatulency, improper diet; mental emotions. 
The mother’s milk is often poisonous to children. 
Treatment.—A warm bath and hot fomentations to the abdomen 
may give temporary relief, but the chief reliance must be on appropri- 
ate remedies. The diet must be light and nourishing, and free from 
stimulants. (See Follicular Enteritis.) 
Medicinal Treatment.—Chamomilla.—The pain has been excited 
by a chill or a fit of passion; there is anxiety, restlessness; vomiting 
and diarrhoea of bilious matters; extremely violent pain, tearing and 
drawing; one cheek pale and the other red. 
* Dr. Wood’s Edition of Hartlaub on Children. CONSTIPATION. 
323 
liux Vomica.—Colic accompanied by costiveness ; sensation as of 
a heavy weight in the lower part of the abdomen; rumbling in the 
bowels; great heat; tension of the abdomen, with short anxious and 
painful breathing; sense of fulness in the abdomen; drawing, pinching, 
pressive pains; pressure at the navel; stupefying headache; tender- 
ness of the abdomen to the touch; loss of consciousness; coldness of 
the feet during the attack. 
Mercurius.—Colic caused by worms; urgent desire to vomit; copious 
flow of water into the mouth; contractions in the stomach and hard- 
ness of the navel; cramps in the muscles of the abdomen; smarting 
of the throat; frequent hiccough; voracity; distaste for sweet things; 
constant desire to go to stool; hardness and swelling of the lower part 
of the abdomen; tensive and burning pain around the navel; risings 
from the stomach; general weakness; diarrhoea; evacuation of mucus ; 
appearance of the abdominal symptoms chiefly at night. (Ilartlaub on 
Diseases of Children, p. 111.) 
6. Ileus, Iliac Passion.—See Obstruction of the Bowels.—Index. 
7. Gastkodynia Cceliaca.—See Neuralgia Cceliaca.—Index. 
Genus VII.—COPOSTATRIS.—CONSTIPATION. 
Definition.—Prolonged retention of the fseces; or slow, imperfect, 
or difficult evacuation of them. In general and in health the intestinal 
apparatus completes its revolution once in twenty-four hours. Within 
that period the whole process of digestion, the carrying forward of the 
contents of the stomach, the absorption of the chyle, and the expulsion 
of the faeces should be accomplished; and a sensation of relief should 
be experienced by it. Any deviation from this condition may be re- 
garded as resulting in a state of constitutional disease. The different 
degrees of departure from health are thus distinguished: 
1. The evacuations are either hard, causing pain, or hard and smalb 
but still causing pain. 
2. Confinement of the Bowels.—They do not act more than once 
in forty-eight or seventy-two hours. 
3. Irregular Action of the Bowels.—They are alternately consti- 
pated and again relaxed. 
4. Delayed and Imperfect Action of the Bowels.—The patient 
continues to expel only small portions during a lengthened period, ex- 
tending sometimes to a half an hour or an hour, or the action is soon 
completed, but the sensation following is not that of relief. 
5. Inaction of the Bowels.—There is no action of the bowels for a 
week or nearly so long. There is a total absence of want to relieve 
them or it is attended with no result. It is said by Dr. Edwd. Johnson, 
1. Constipation.—Alvine Obstruction. Costiveness. 324 
DISEASES OF THE DIGESTIVE FUNCTION. 
that this condition is not always one of disease, but that the habit ex 
ists in many persons in comparative health. 
In general, the contents of the bowels are carried forward until they 
reach the sigmoid flexure of the colon. When they have passed through 
this portion of the tube they enter the rectum, which is stimulated by 
their presence to contract, and thus grasp the intestinal contents and 
expel them. In a case, however, in which the bowels do not act regu- 
larly, this inaction being dependent on the diseased constitutional state, 
affecting specially the rectum, the stimulus from the intestinal canal is 
not sufficient to cause the expulsive effort to be effective. 
1. Mechanical Obstruction.—1. Some cases of constipation, or non- 
expulsion of the faeces, are dependent on mechanical obstruction; the 
intestine is diminished in calibre by a stricture formed of a part through 
which the intestine is protruded, forming a strangulated hernia. 
2. One portion of the intestine sometimes passes into another portion, 
forming what is called an intussusception. 
8. Mechanical obstruction may arise from thickening of the internal 
coats, or by the forming of a transverse band, causing a stricture. 
4. Enlargement of surrounding organs may cause pressure upon the 
intestines and thus cause obstruction. Enlarged and hardened uterus 
often causes pressure. 
II. Constipation proper is not dependent on mechanical causes, but 
upon the modification of the vital powers associated in carrying for- 
wards the movement of the intestinal canal. It is dependent on a con- 
stitutionally diseased state, effecting either the whole or special parts 
of the entire apparatus; and for such state the only proper treatment 
must consist in measures calculated to remove these constitutional 
conditions. 
Causes.—These are often obscure, and consist of constitutionally 
diseased states, which are not cured by purgatives, but increased by 
them. If homoeopathic remedies properly selected cure the case, they 
often do not begin to remove the constipation till other attendant symp- 
toms give way. The remedy should cover the whole case, and then the 
whole of the symptoms in due order will give way. Dr. Epps says: 
In a common case the bowels do not act for three or four days; the 
patient has never had an action without purgatives; and when they do 
not act he is sure to have headache. If now a proper remedy be given; 
“ though the bowels do not act for a week, there is no headache;” thus 
proving that the medicine is curing the constitutional state, and conse- 
quently, the headache, which, like constipation, was one of the mani- 
festations of that state, does not occur, although the constipation be 
not yet removed. Constipation appears to occur principally in the large 
intestines, more especially the crecum, sigmoid flexure and the rectum. 
The latter seems to be less a receptacle than a conveyor. Generally CONSTIPATION. 
325 
when the fieces enter the rectum from the last portion of the sigmoid 
flexure, the rectum at once contracts, comes forward or draws forth 
from the last portion of the sigmoid flexure the feculent portion, and 
carries it on to expulsion. In many cases of constipation the rectum 
has lost the power, and that power is very great, of grasping the in- 
testinal contents; the cure of constipation depends much upon the re- 
storation of this power. The inaction of the bowels does not depend 
on the hardness of the faeces; they ought to acquire a certain solidity 
before expulsion, having already lost nearly the whole of their fluid 
portion before reaching the rectum. The want of grasping expulsive 
power of the rectum is the chief condition associated with constipation, 
and that want is dependent for its manifestation on the general con- 
stitutional diseased state. It seems to depend on an exhaustion or 
suspension of the nervous power of the rectum, a kind of palsy of the 
muscular fibres of the intestine itself. 
Constipation often consists in nothing more than a deficiency of the 
fluids necessary for digestion, and depends on a deficiency of the se- 
cretions or a diet in which too little liquid is taken into the stomach. 
In its simple form it generally originates in sedentary habits, and the 
neglect of attention to the regular evacuation of the bowels at a par- 
ticular hour of the day. As most persons can best go to sleep at a 
certain hour of the night or day, so are almost all other vital actions 
influenced by the law of 'periodicity. Any unexpected business 
or detention at the usual hour which breaks in upon the habit of a 
regular daily evacuation, may postpone it for the day. Among students 
and literary persons profound application of the mind diverts it from 
attention to objects of mere physical concern; also indolence, or de- 
tention and want of a convenient place near at hand, cause many to 
put off making the effort till the contents of the bowels become hardened 
by the absorption of their more fluid parts. Chemical changes may 
cause acid eructations, heartburn, flatulence, colic, diarrhoea, headache 
and fever, flushing of the face, constant fulness of the head. One of 
the usual causes of troublesome constipation is the practice of flying 
to purgatives on the slightest deficiency of the intestinal action. Many 
a slight case, which if left to itself would soon have been spontaneously 
relieved, is converted by unnecessary purgings into obstinate constipa- 
tion, ending in paralysis, spasmodic obstruction of some part of the 
bowels or complete obliteration. 
The disease then is not a primary one, but constitutes the absence 
of action in a given way; and that absence of action is caused by a 
peculiar state constitutionally diseased, which suspends the harmonic 
actions of various parts of the human frame, of which suspension of pe- 
ristaltic action is one of the manifestations. We therefore do not treat 
the constipation as a disease in itself, but as a part of the whole. 326 
DISEASES OF THE DIGESTIVE FUNCTION. 
Mr. Abernathy announced the idea in 1827 (on the Constitutional 
Origin of Local Diseases, p. 35.), that constipation is a constitutional 
disease. He said the increased discharges from the bowels under the 
influence of purgatives consisted of the morbid secretions from th 
bowels themselves; and gives a case of a child born with the oeso 
pliagus impervious, though it was otherwise healthy. No food coul 
pass to the stomach, and it died of starvation after thirteen days 
Though it took no food, the alvine evacuations were natural, correspond- 
ing in color and consistence with those of children of that age, and 
continued, though diminishing in quantity, to the last. Persons who have 
had the oesophagus obliterated by disease, and been supported by ene- 
mata, have still had the faeces naturally formed and expelled. [Dr. 
Dpps, p. 154.) 
Dr. Edw. Johnson goes so far as to say, “that none of the food taken 
is ejected as faeces from the body, but all is absorbed, all is assimi- 
lated ; and that the faeces are really the intestinal secretions formed 
into a mass and expelled.” Though this last assertion goes, in our 
opinion, beyond the truth, it still embodies an important idea of the 
highest practical importance. 
Curvature of the Spine is a common cause of constipation which 
becomes both a cause and an effect of general ill health. It is probable 
that the curvature produces pressure on the spinal nerves and modifie 
also the nervous communication with the parts of the great sympatheti 
symptom of nerves; thus by causing imperfect supply of nervous powe 
to the rectum producing constipation. 
3. Pregnancy is a cause of constipation; and injurious results often 
result from efforts to remove the constipation by purgatives. 
4. Over-excitement of the genital organs produces constipation, by 
exhausting the nervous energy of the nerves which supply the digestive 
system as well as of the spinal column generally. The loss of the 
nervous powers causes paralysis of the muscles and loss of expulsive 
power of the muscles of the rectum. Accumulations follow; and when 
the sphincters become paralysed the power of closing them is lost and 
faeces escape. 
5. Old age is attended with diminution of vital powers generally; 
torpor of the intestines is common. 
Pathology.—The whole gastro-intestinal cavity is affected with 
torpor, but is free from all signs of structural disease. The natural 
peristaltic action of the bowels is deranged through causes that dimin- 
ish the secretion of the fluids which are naturally poured out of their 
surface, rendering the faeces hard and difficult to more forward; and 
by causes that diminish the contractile power of the involuntary mus- 
cular fibres of the bowels. There is probably in this disease a defi- 
cient supply of healthy arterial blood to the glands which secrete the CONSTIPATION. 
327 
intestinal fluids, with deficient nutrition of muscular fibre and secret- 
ing glands. (Taylor, N. A. Jour. Homce. 1857, 191.) 
There is in nearly all cases of constipation a torpid state of the 
liver and great deficiency of bile. It constitutes a prominent difficulty 
in jaundice and nearly all febrile diseases, as catarrh, measles, fever 
excesses of food or stimulants, melancholy, spermatorrhoea, impotence 
female sterility from defective menstruation, amenorrhoea, chlorosis 
The appetite is capricious, digestion difficult; pain in the stomach or 
intestines, heartburn, acidity, flatulence, oppression of the stomach 
after meals, nausea and occasional vomiting; headache, slight fever, 
thirst, coated tongue, depression of spirits, melancholy, imperfect sleep; 
alvine evacuations performed with great difficulty. See p. 272. 
Treatment.—The common treatment of constipation by purgatives 
is not in accordance with any scientific law. It is only the treatment 
of a symptom to the neglect of its cause, and is always unsuccessful. 
To cure constipation requires a true knowledge of, 1. The constitu- 
tional disease of which the constipation is only a symptom. 2. Of the 
special medicine suited to the diseased state, the constipation being 
only a manifestation of that state. 3. Of the law regulating the action 
of the remedy to the diseased state. Purgatives can not cause the 
regular and permanent expulsion of the proper amount of faeces of 
the proper character. The error (says Dr. Johnson), consists in 
the manufacturing functions of the secreting arteries, there being no 
faeces to expel; an active purgative will force some kind of an eva- 
cuation, but its object is not achieved. An “excess of secretion is 
attained, but it is not a natural foecal product; it is only the exfiltration 
or outpouring of the serum of the blood into the bowels.” Though 
some temporary relief be sometimes attained in this manner, it is only 
such a relief as we could get by diminishing the volume of blood. The 
capillary system has been bled, but only depleted of its watery con- 
tents. Nothing is done towards the cure of the constipation. The 
next day the bowels are more constipated than ever. (Dr. Johnson, 
p. 167.) 
Constipation must be cured by improving the secretory powers of 
the arteries. 
Auxiliary Measures towards the Cure of Constipation. 1. En- 
deavor to establish the habit of relieving the bowels at a certain time 
every day. There is a natural tendency to the establishment of a rule 
of this kind, and it should be encouraged. The time most likely to be 
successfully fixed will be a short time after breakfast every morning 
The act of taking food having given a slight impulse to the peristaltic 
action of the intestine, it is comparatively easy to propagate this im 
pulse along the whole alimentary tract. In persons troubled with pro- 328 
DISEASES of the digestive function. 
lapsus of the rectum, it is better that the bowels be relieved on going 
to bed. 
2. Moderation in the quantity of food, and regularity in the hours 
of eating; several hours should interpose between the different meals. 
3. Frequent ablution of the body with cold water; delicate persons 
can use it as warm as is necessary to prevent chilling the surface. 
4. Frequent drinking of water, cool, but not iced. See p. 297. 
5. Frictions to the spine over its whole length. 
6. Exercise, walking or other modes of exerting the muscles of the 
limbs and abdomen. See p. 288. 
7. Avoidance of late suppers; a heavy supper keeps up digestion 
through a great part of the night.* 
Medical Treatment.—The medicine that is properly adapted to 
remove the morbid condition of the system is the proper remedy for 
the constipation, which forms a part of the said morbid condition. It 
is, therefore, impossible to enumerate all the proper remedies by which 
constipation has sometimes been cured, and give the specifics symp- 
toms of each; but since this condition is very frequently the predomi- 
nant feature of the case, and that for which we are requested to pre- 
scribe, we will give the principal remedies and the symptoms which 
direct us in the choice of each in ordinary cases. 
Opium.—Constipation caused by external circumstances exerting a 
debilitating influence on the nervous system. In acute cases when 
constipation is not habitual, but there is a want of power to relieve the 
bowels, with a feeling of constriction; desire to relieve the bowels, with 
a sensation as if they were obstructed ; pulsation, sense of weight in 
the abdomen, dull heavy pain and pressure in the stomach; beating in 
the abdomen; parched mouth, want of appetite ; thirst; determination 
of blood to the head; redness of the face; headache ; constipation in 
young children, after Nux has failed; repeat the dose, if not relieved in 
twenty-four or forty-eight hours. 
Of its power to cause or cure constipation, Hahnemann says, in the 
Organon: 
Opium, of all vegetable substances is the one whose administration in 
small doses produces the mostpowerful and obstinate constipation. How 
is it possible that it should, notwithstanding, be the most efficient remedy 
in those cases of constipation, which endanger life, were it not in virtue 
of the homoeopathic law? Opium, whose primary effects are so power- 
ful in constipating the bowels, was discovered by Trallesf to be the 
only cure in a case of ileus, what had been ineffectually treated by 
evacuants and other remedies. Bohn found, that nothing but opiates 
could act as purgatives in the colic, called miserere; and Hoffmann, in 
* Pr. Epps On Constipation p. 249. f Uses and Abuses of Opium. CONSTIPATION. 
329 
the most dangerous cases of this nature, placed his sole reliance upon 
Opium and the Anodyne, called by his name. It is true that “ two 
hundred thousand volumes have been written upon medicine, and out 
of them all we can not extract a simple explanation of the mode, in 
which Opium cures constipation; the law of homoeopathy alone gives it.” 
Bryonia.—Constipation occurring in warm weather; in the puerpural 
state, accompanied with inflammatory irritation of the abdominal organs. 
In persons of an irritable or obstinate disposition, with a tendency to 
be easily chilled and subject to rheumatism; constipation arising from 
a disordered stomach ; determination to the head and headache. 
Enem,ata.—A mild cathartic enema, employed at a particular hour 
a short time after breakfast, will generally give present relief to the 
bowels; and the habit persisted in will restore the habit of acting at a 
certain hour. The quantity thrown up must be large, and the patient, 
lying on the left side, should retain it as long as possible. It is im- 
portant that this habit be persisted in till the regular habits of health be 
restored. It is immediately after breakfast that the bowels are most 
inclined to act spontaneously, as the pressure of the distended stomach 
upon the transverse arch of the colon disposes the latter to contract 
and propel its contents into the rectum. This natural tendency should 
always be encouraged at the moment, for the activity of the absorbents 
in the bowels soon removes tbe more fluid parts, and the bulk being re- 
duced, the disposition subsides. [Hull.) 
Injections should be large in quantity and their efficacy is not per- 
manently increased by the addition of stimulants, which have been 
supposed to exert a salutary influence on the colon.—The patient 
should lie on the right side for the purpose of enabling the in- 
jected fluid to reach the ascending colon and caecum, where accumu- 
lations always exist. Here the contents of the bowels are compelled 
through sixteen out of twenty-four hours to ascend in opposition to the 
power of gravity; and here we find fulness and hardness in many cases, 
especially in chlorotic persons. Inflammation or ulceration of the 
mucous membrane of this part may be caused by long contact of har- 
dened faeces ; and irritating foetid compounds are formed by chemical 
decompositions; and irregular fatty looking masses of inspissated 
mucus secreted from a highly irritated surface, are often found in the 
evacuations. When long retained this matter becomes purulent. To 
assist in clearing out the large intestines gentle pressure and kneading 
by the hand of an assistant may aid in pressing the delayed masses 
forward. This process has sometimes been made a special basis of 
success in constipation. A German practiced it successfully in Lon- 
don, in 1847. He kneaded the abdomen over the small intestines ; and 
then, beginning from the right groin, he continued the process till the 330 
DISEASES OF THE DIGESTIVE FUNCTION. 
object was attained. But a true cure can only be reached by homoeo- 
pathic remedies. 
Mux-vomica.—Constipation resulting from too heavy a meal; from 
indigestible food, or stimulating drinks, as coffee, and lasting severa 
days; adapted to persons of irascible and lively temper; determinatio 
of blood to the head; giddiness, stupor, intoxicating heaviness in the 
head, especially in the morning, redness of the face and headache 
person of sallow complexion, loss of appetite, tendency to vomit, flatu- 
lence, pressure at the stomach, dry cough, dryness of the mouth, acid 
and bitter taste, unfitness for exercise, disturbed sleep ; general oppres- 
sion and heaviness, lassitude and drowsiness in the morning; heart- 
burn, nausea in the morning, swelling of the stomach after eating; fre- 
quent ineffectual efforts to relieve the bowels, constriction of the sphincter 
and shooting pain in the abdomen, constrictive pain in the chest, rest- 
lessness, general depression; in individuals subject to haemorrhoids ; 
tenesmus, pain in the rectum, and loins, constipation in young children. 
After it fails try Opium 2d, then Bry. 10, Yeratr. 10, Sulph. 10,Calcar.- 
Carb., and particularly Zincum. 
Tincture of Nux. one drop night and morning, increasing the dose 
one drop every day. (Becker, p. 49.) 
Abstinence from coffee and other heating drinks, exercise in the open 
air. Nux at bed-time and Sulph. in the morning are sovereign reme- 
dies for constipation; faeces are hard, dry, and evacuated with great 
pain and effort. (.Becker, p. 57.) 
Case by Dr. Henderson.—A lady, long subject to constipation, took 
Nux, third attenuation, a half drop twice a day. She began soon tc 
feel “extremely weak, sleepy all day, headache all over the forehead ; 
creeping tickling feeling in the lower limbs ; extremely cold feet; cold 
sensation in the chest; extreme exhaustion.” She did not attribute the 
symptoms to the medicine, but persevered for four days, when her symp- 
toms became alarming. The physician pronounced her suffering under 
over-doses of strychnine.” She had been taking only the one millionth 
of a drop of the mother tincture of Nux-vomica per day. (p. 263.) 
A case of constipation is given in the Medical Register, vol. 2. p. 
168. A man had been long suffering from constipation, and in the 
course of six months passed under the care of thirty different phy- 
sicians and fifty surgeons. For two weeks there had been scarcely 
any evacuation. “ His skin was nearly the color of mahogany ; there 
was a horrible sphere flowing out from him which was intolerable, there 
was scarcely any flesh upon his bones, and he scarcely resembled a 
human being. The abdomen was filled with scybalae, like a wallet of 
pebbles ;” of these “ near a peck were afterwards discharged which re- 
sembled black marbles.” 
Cases by Dr. Epps.—1. A man, aged twenty-two. Has to take me- CONSTIPATION. 
331 
dicine twice a week, has uneasy sensation at the top of the head and 
heat in the scapula. He took JSux; and a week after reports that the 
bowels have acted four days out of the seven. Other symptoms im 
proved. After taking Opium 2°, he took Sulphur which confined the 
boAvels. But he Avas entirely cured. 
2. Constipation in a Case of Ovarian Dropsy.—A woman, aged 
twenty-seven, mother of three children, had an ovarian tumor on the 
left side after confinement. In April, the tumor was tapped, and eleven 
pints of fluid drawn off. She was getting large again ; has had con- 
stant pain down the left groin, and in the back down the left side; 
bowels confined ; menstruation failed for the last two months. She has 
taken Merc.-Iod. and Elixir-Yitr. (under other hands). She took 
Nux-vomica twice, when the bowels became regular, which had never 
been the case before. See p. 291. 
Sulphur.—Habitual constipation, wTith haemorrhoids. 
It cured an elderly man who had suffered from constipation twenty 
years, accompanied by severe headaches, fulness of the stomach after 
eating, dry loaded tongue, hitherto only relieved every second day by 
aperients ; dyspepsia caused by repeated purgatives, also disease of 
lower intestines; dull pain in the liver, increased on pressure. In five 
weeks the bowels were enabled to act daily and the headaches sub 
sided. (Becker, p. 50.) 
Pulsatilla.—The same indications, as Nux-vomica. But Pulsatilla 
is particularly suited to females and children of mild phlegmatic dis- 
positions ; generally want of thirst rather than thirst, repugnance to 
fat and rich meat, suffering after taking pork and pastry, frequent and 
loose or difficult and slow evacuations; bad effects of rich greasy food, 
accompanied by moroseness and shivering. 
Graphites.—It has cured a large number of cases, generally com- 
plicated with certain other diseases. Dr. Epps gives thirty-two cases. 
Usually four globules were given each week; in one case eight glo- 
bules in sixteen days. In all constipation was a prominent feature. 
Of the second series of cases : 
1. A case of confined bowels with crusts on the face, caused by the 
application of oil to an erysipelatous surface. 2. The same with scaly 
brownish eruption. 3. Another in combination Avith erysipelas. 4. The 
same. 5. Another with ulceration on the toe. 6. A case with dry 
skin and an eruption on the skin and uterine disorder. 7. One case 
with a crustaceous eruption on the head ; stools solid. 8. Another of j 
confined bowels and eruption on the skin. 9. Tavo with ulcerated leg, 
pains in the ulcer; shooting like pins and needles; all cured,—the 
ulcer relieved. 10. Case of constipation Avith diseased knee. 11. Con- 
stipation Avith large stool, headache, eruptions on the hands, dry skin. 
12. Constipation with pains produced on action of the boAvels, Avith erup* 332 
DISEASES OF THE DIGESTIVE FUNCTION. 
tion on the skin. 13. A case with dry skin and dizziness, causing the 
patient to fall. 14. Four cases with dry skin. 15. A case with dry 
skin, great depression of spirits on which the remedy produced re- 
markable effect. 16. Constipation with great mental distress; eight 
globules given in sixteen days. 
Additional Cases.—1. A woman, aged twenty-five, has been nurs- 
ing a child for eleven months. Eyelids weak since the child was born, 
being inflamed, with angry, reddish yellow margins, having pricking 
pains in them; water comes into the eyes and prevents her seeing, 
especially at candle-light, the eyelids seem to draw down; skin dry ; con- 
stipation has been long treated without benefit; stool large and causes 
bleeding. Under the use of Graphites 12° for nine days the sight be- 
came better ; the bowels regular, acting every day; the bleeding ceased. 
{On Constipation.) 
2. A man, aged thirty, had pleurisy three years ago. Under old 
treatment he was laid up five months. Has pain through the left side 
to the shoulder; food causes a sense of weight and pain; throat sore 
from slight exposure ; pain in the back ; skin dry; great difficulty in 
passing stool and after long effort. He took Graphites, and in eight 
days was entirely better. The remedy was repeated with increased 
benefit. 
A woman, aged twenty-nine, bowels habitually confined; stools large, 
passed with blood and great pain, lasting for a whole day, following the 
passage. Graphites was given. A week after, the bowels act better, 
there is heat all over the surface, attended with faintings. Graphites 
repeated—cured. 
Her child, aged eight months, had since the fifth week a whistling, 
wheezing, with burning heat in the skin; skin dry; constipation. 
Hepar-sulph. 
The whistling got better, also the wheezing and burning heat; 
bowels better. Hepar continued. 
The heat at night afterwards returned, with constipation. Graphites 
cured. 
Constipation complicated with Hepatic Disease.—Veratrum.— 
An officer, after having yellow fever several times, suffered for thirty 
years with constipation and liver-disease, bowels never moving with- 
out purgatives, distressing headaches, and great depression of the 
nervous system. He was greatly benefitted by Nux 30, Bryon. 30, 
Yerat. 12 every second or third day in succession for two months. 
Dyspeptic symptoms ; acid and bitter eructations, fulness of the 
tomach and bowels after eating, pain in the region of the liver, constipa- 
tion, and eruptive disease covering a great part of the body. Veratrum 
first cured the skin-disease and afterwards the stomach-symptoms and 
constipation yielded. {Becker, p. 37.) tkeatment of constipation in children 
333 
Treatment of Constipation in Children.—The greater the dread 
of costiveness the greater are the objections to the use of purgatives. 
In healthy children the bowels move twice in twenty-four hours; but 
no uneasiness should be felt if these intervals should be prolonged to 
two days, and in older children to four or five. The difficulty can be 
safely overcome if we are not too impatient; if mild aperients could 
be made to answer they need not be used; violent purgatives 
are especially dangerous when the constipation is accompanied by 
hernia or other mechanical obstruction. Lobelia is a better remedy. 
A permanent cure may be promoted by exercise in the open air, by 
avoiding indigestible food and stimulating drinks, by eating slowly, 
and the avoidance of too early use of solid food, especially meat. If 
purgatives have been habitually used they must be abandoned gra- 
dually. The child should gradually be accustomed to drink cold water, 
and when the bowels must be relieved promptly it can generally be 
done by a mild injection of milk and water. Neither the nurse nor 
child should drink strong coffee. 
Medicinal Treatment.—Nux-vomica.—Dissolve only two globules 
in a tablespoonful of cold water, to be taken at bed-time every night 
till the bowels move naturally. 
Symptoms.—Constipation caused by indigestible food or by over-eat- 
ing ; after a diarrhoea has ceased spontaneously; when there is loss of 
appetite; unpleasant taste in the mouth ; tongue loaded with white 
mucus; loathing, and nausea; cuttings and painful shootings in the 
lower part of the abdomen, with tension and pressure; heat; flush- 
ing of the face; stupefying headache ; disturbed sleep; oppression; 
much heat in the lower part of the abdomen; protrusion of the bowel. 
Pulsatilla : in addition to the above symptoms ; there is: bitter taste 
in the mouth; desire to vomit; sour eructations; flow of mucus into the 
mouth ; burning sensation in the oesophagus; tension and pinching in 
the lower part of the abdomen ; sallow complexion ; shivering ; dejec- 
tion ; mild and gentle disposition. 
Sulphur.—Obstinate cases resisting other remedies, one pellet at 
bed-time once a week for a month, in psoric constitutions. 
Lycopodium.—Case by Dr. Epps.—A man, aged twenty-three, had 
constipation four years. Active temperament, appetite good, urine 
natural when passed, though often thick when cold; at times large 
quantities, pale. Heaviness in connection with the constipation. Hands 
and feet cold, Lycopodium. 
In the same month he had some numbness of the hands in the morn- 
ing for two days, Causticum. 
He afterwards wrote that he was always relieved of the irregularity 
of the bowels by alternating Nux-v. with Lycopodium or Sepia. He 334 
DISEASES OF THE DIGESTIVE FUNCTION. 
was permanently cured by them. For four years be bad been com- 
pelled to often take Castor-oil, pills and other purgatives. 
II. Intestinal Obstruction.—1. Any mechanical obstruction of the 
bowel causes an accumulation of its contents above the obstructed part; 
and this accumulation provokes such a peristaltic action as insures 
their mixture, and, strictly speaking, their reflux. 
2. Increasing distention finally brings about paralysis and inflamma- 
tion of the intestine, ending in the collapse and death of the patient. 
3. The symptoms of the several forms of obstruction (referring more 
generally to the nature of the obstacle and its situation,) usually per- 
mit an accurate diagnosis, even in the earliest stages of any given 
case. It is therefore desirable to inculcate the importance of an early 
and accurate diagnosis, which will have an important bearing on the 
treatment. Mechanical obstruction must be clearly distinguished 
from enteritis. 
Prognosis.—The cases that recover are almost invariably the pro- 
tracted ones. Intussusceptions which end by the expulsion of the 
affected part or segment of the intestine have a duration of twice to 
thrice as long as that of the fatal cases. In those cases which finally 
recover it is only in the second, or third, or even the fourth week that I 
have witnessed that remission of symptoms which announces relief of 
the obstruction, and which often precedes by a day or two the first 
healthy evacuation. (Brinton, Groonian Lecture.) 
Medical Treatment.—General principles.—1. To protract the 
duration of life by every means in our power. If we can lessen the 
rapidity and increase the duration of the malady, we multiply the 
chances of recovery. The constriction or inflammation may possibly 
end of itself by resolution, or retraction of the intusception, by efforts 
of the vis medicatrix naturae. A gradual accumulation of fluid leak- 
ing into the stricture forms a kind of wedge there; and, transmitting 
equally in all directions whatever force it may receive, it allows even 
the most distant wave of peristaltic contraction, applied at a distance, 
to tell with undiminished energy as an agent of dilatation at this point. 
Chief Indications of Treatment. — 1. To prevent distention; 2. 
to assuage pain; 3. to mitigate extensive peristalsis; 4. to support the 
patient’s strength during what is necessarily an exhausting and often 
a long illness. 
1. To prevent distention, reduce the food and drink in every avail- 
able way. Give only small and frequent sips of cool, even iced liquids 
Give the food in the shape of beef-tea, soups, &c.; and, if these ar 
tides disagree or excite vomiting, diminish the doses and try other 
articles: soda water in small quantities; wine or brandy in some cases. 
2. To lessen the pain. Opium has long been the only reliance, and 
in many instances it has been used to very great extent, far exceeding INTESTINAL OBSTRUCTION. 
335 
what could be usually borne. Belladonna, though less effectual than 
Opium in easing pain, has a specific power in this disease, that must 
not be passed lightly over. Lobelia is often successful. 
Tobacco has a specific power in an antipathic way to produce relaxa- 
tion of the constricted portion of the bowel. But in the dose it requires 
it is very dangerous. Whatever be the means we resort to, we have 
before us a task of great difficulty, and it is only, as Mr. Brinton says’ 
“by close and even unconscious reasoning; by strict scrutiny; by deep 
insight, and by a truthful and teachable habit of mind, that the treat- 
ment of diseases of such severity must be wrought out.” 
3. Enemata.—They may effectually support the patient’s strength, 
and by their mechanical action they may sometimes remove the ob- 
struction. The water they contain, when absorbed, is important both 
for the purposes of nutrition and lessening the fever and inflammation. 
Milk, broths or gruels may be employed in this way and may long 
maintain life. They may act also, by distending the bowel on the lower 
side of the obstructed point, and thus effect such a change in the posi- 
tion or arrangement of its parietes, as may release the impacted or in- 
tuscepted part. They aid also by their gentle warmth and the water, 
which may be absorbed in the immediate vicinity of the point of 
disease. 
It is chiefly in their earlier stage that they are likely to be benefi- 
cial. They should be injected slowly and gradually, and with con- 
siderable force, though with caution;—with such care that the tension, 
which an additional ounce may cause, shall subside before we attempt 
to introduce more. The patient should be willing to bear some pain, 
and the operator to give the least he can. 
Purgatives in such a case can do no good. They can not remove 
the obstruction. The enormously distended state of the intestine 
clearly indicates the folly of attempting to force a passage by purga- 
tives. This is the decided opinion of the highest living authorities. Long 
before the advanced stage of obstruction, at which purgatives could do 
good, long before the faecal vomiting which usually precedes it for 
some time, physical examination of the abdomen shows an accumula- 
tion of liquid, and the creeping, flatulent peristalsis, beneath its per- 
haps still smooth, relaxed and flattened walls. This condition shows, 
not indeed that purgatives are useless, for they have sometimes given 
relief, but rather that nature herself is preparing, within the obstructed 
bowel, the best of all purgatives: a mass admirably adapted by its 
quantity and quality, and especially by its consistence, to do whatever 
any aperient can towards opening a passage. And if, as we have con- 
cluded, there is any danger of even this stimulus being too great; if 
it is distending the bowel with such rapidity, as to paralyze its muscular 
coats, or to provoke an excessive and exhaustive peristalsis, or to ex 336 
DISEASES OF THE DIGESTIVE FUNCTION. 
cite a diffuse inflammation which so aggravates and distorts the local 
phenomena, as to destroy all chances of their restoring the permeability 
of the obstructed canal;—withhold purgatives in these cases, because 
they are not merely useless, but positively hurtful, not only in the late, 
but even in the early stage of the obstruction. 
Obstruction in the Colon.—Amusafs Operation.—Either the right 
or ascending, or the left (descending) colon may be opened to relieve 
the distention produced by an obstruction near the lower part of the 
large intestine. This operation generally permits an unwounded state 
of the peritoneum; but it can hardly be doubted that its success is 
due to other causes. Indeed, considering the circumstances of many 
of the obstructions, for which it is performed, the serious lesions, (can- 
cer or stricture,) by which they are caused, and the scarcely less serious 
accidents, (diarrhoea and haemorrhage,) by which they are often long 
preceded, practically, no doubt, this unpromising measure is mostly 
undertaken merely to palliate the suffering or to defer the approach 
of inevitable death. And yet it has been in “every way more success- 
ful than any other operation hitherto practiced for the relief of obstruc- 
tion.” This striking result is greatly favored by the circumstance that 
the physiological relations of the large intestine render the phenomena 
of its obstruction altogether slower and of later occurrence than are 
the same phenomena in obstruction of the small intestine. 
The cases, then, for which gastrotomy may with propriety be prac 
ticed are reduced to a small number. They are: obstructions, such as may 
be caused by a band of organized lymph by an adhesion; a diverticulum, 
a rent in the mesentery; a malformation of the peritoneum; a twisting 
of the intestine. 
Either one of these cases might be removed by an operation; spon- 
taneous cure is scarcely possible; if accumulation, distention and 
leakage fail to dilate the constricted segment against the pressure, 
which is often feeble, of the band or adhesion, or fail to retract it from 
the peritoneal or mesentei'ic aperture into which it has slipped, death 
seems inevitable. And even for these very cases gastrotomy should 
not be considered as the exclusive remedy. It would be hopeless if 
practiced on persons of advanced age or broken constitutions, when 
there is violent inflammation of the obstructed bowel or general peri- 
tonitis. 
Aconite.—Dr. G. H. G. Jahr, says : Aconite is the best remedy in 
all cases of incarcerated and inflamed hernia. According to the sus- 
ceptibility of the patient, we may administer it in the third, twenty- 
fourth, or two-hundredth attenuations in globules or in water, at inter- 
vals of one or two hours. In recent cases, with violent and persistent 
pains, this medicine should be employed until the violence of the symp- 
toms has subsided. It is equally appropriate in all ether incarcera- DIAPHRAGMATIC HERNIA. 
337 
tions accompanied by inflammation. (Gauwerky, Gaz. Ilom. de Leip- 
zig, vol. XI. p. 220.) 
In two cases of incarcerated hernia, accompanied by a high degree 
of inflammation, Aconite, eighteenth and twenty-fourth, repeated every 
hour, effected cures in eight and twelve hours, both patients being quite 
well on the next morning. (Goullon, Archiv de Stapf, vol. XIY. cah. 
11. p. 138.) We have also seen prompt relief from one drop of Lobelia. 
When there are, in the incarcerated parts, violent pains, burning 
like live coals, with great pain and sensitiveness at the least touch, 
nausea, bitter bilious vomiting, anguish and cold sweat, liering says, 
Aconite is the appropriate remedy, and should be given till the pains 
subside. 
When the affected parts are already rigid, painful, swollen, tense, 
hot, and red, a single dose of Aconite, twelfth, will often cure in a few 
hours. (Kreussler, Therap. Horn. p. 99.) 
Particular Symptoms indicating Aconite.—Severe inflammation 
of the affected parts ; burning pains like coals of fire or pulsations; nau- 
sea and bilious vomiting. (Jahr.) 
Electro-Magnetism..—“In Hernia par engouement I have found this 
agent most valuable. Every effort I had made for a reduction, proved 
useless, when, finally, I inserted the positive pole connected with a 
proper instrument, into the rectum, and the negative pole, connected 
with a silver plate, was placed upon the tongue ; this immediately pro- 
duced an undulating motion of the bowels, previously motionless ; no 
shock was received, nor was there any contraction of the abdominal 
muscles. The patient was soon in a state of diaphoresis, the muscles 
relaxed, and the hernia was spontaneously reduced. After removing 
the instrument from the rectum, it was followed by a copious evacua- 
tion of hardened faeces.” [Dr. II. Lassing.) 
4. DIAPHRAGMATIC HERNIA. 
Definition.—A protrusion through the diaphragm of the parts below 
it. It occurs in consequence of congenital absence of a portion of the 
diaphragm ; perforation by rupture or wounds, or a yielding of this sep- 
tum at certain points, permitting the stomach, intestines, or other abdo- 
minal viscera to enter the cavity of the chest, or to encroach more or 
less on the thoracic space. The disease is so rare that no individual 
may expect to meet more than one case in a life-time. 
Dr. Bowditch, of Boston, presented before the Boston Society for 
medical improvement in 1847 a condensed report of all the cases then 
known to have been published ; and he found in the books eighty-eight 
cases. In connection with these he gave the history in full of a case 
“in which nearly the whole of the left side of the diaphragm was want- 
You I.—22. 338 
DISEASES OF THE DIGESTIVE FUNCTION. 
ing; so that the stomach and a great part of the intestines lay in the 
left pleural cavity; compressing the lung, and forcing the heart to the 
right of the sternum.” This condition was evidently congenital. The 
subject of it died at the Massachusetts General Hospital, with fracture 
of the spine caused by a heavy blow upon it.” (Buffalo Med. Jour- 
nal, June and July. 1853.) 
Varieties of the Disease.—1. “ Parts of the abdominal viscera are 
forced through some one of the natural openings of the diaphragm, viz., 
that of the aorta, vena-cava inferior, an intercostal nerve, or the oesopha- 
gus. 2. When portions of the diaphragm are wanting,” resulting from 
congenital arrest of development. 3. “ Hernia from accidental wounds 
or lacerations. 4. When one side of the diaphragm is violently forced 
up into the chest, producing compression of the lung.” 
The effect of this displacement of the viscera is various in the dif- 
ferent conditions in which it exists. In some cases there is found in- 
flammation, after death, extending to the pleura, lungs, or abdominal 
organs. The lungs are compressed in proportion as their space is in- 
truded on; the condensation thus caused is easily removed by infla- 
tion. Pneumonia in some produces solidification of the lung. There 
is often displacement of the heart, generally to the right; and also 
pleuritic effusion. 
Diagnosis.—When the stomach or large intestine has ascended 
into the chest, a proportionate tympanitic resonance is perceived on 
percussion, and it differs in degree in proportion as the ascended vis- 
cera is distended with gas. The presence of the liver must cause dul- 
ness of sound, liquid effusion must do the same. So far as the lung is 
compressed the percussion sound elicited must be proportionately dull; 
as also when it has become solidified by inflammatory exudation. 
Auscultation reveals tympanitic resonance over that part of the 
chest upon which the hollow viscera have encroached; the degree 
varying in proportion to the extent of space within them occupied by 
gas. Over compressed portions of the lung, the percussion-sound is 
necessarily dull, still more so when the lung is solidified by exudation. 
Auscultation will show the absence of the respiratory vesicular mur- 
mur in parts compressed by intruding organs; and the same exagge- 
rated in portions of the lung of the opposite side ; Dr. Bowditch found 
in the case observed by him “gurgling, whistling, blowing” gastric or 
intestinal sounds over the seat of the hollow viscera. They were ex- 
cited at times by the act of respiration, and also when the patient 
held his breath. Metallic tinkling also was heard like that heard 
over the stomach. Some of these sounds were probably produced by 
pressing suddenly on the abdomen and thus forcing air into the intes- 
tines while yet in the pleural sac. 
The cardiac sounds are heard in the region to which it may be dis- DIAPHRAGMATIC HERNIA. 
339 
placed. The affected side of the chest is generally enlarged and its 
motion constrained. The lungs are much compressed. 
The characteristic symptoms relate to the respiration. This is 
generally though not always embarrassed, oppressed, increased in fre- 
quency ; some dyspnoea, or orthopnoea. The difficulty of breathing is 
increased by the recumbent posture, which favors the pressing of the 
viscera into the thorax. The difficulty of breathing occurs in paroxysms, 
from the greater distention of the hollow intruding viscera containing at 
times more gas, and taking up more room. In the single case, reported 
by Dr. Bowditch, the patient, aged seventeen, was able to perform the 
duties of a laborer ; he did not suffer from embarrassed respiration; and 
died, not of this affection, but from fracture of the spine. 
The diagnosis is so difficult that of the eighty-eight cases collected 
only one was determined before death. That just mentioned was also 
detected by Dr. Bowditch by physical signs. These in general are : 
dyspnoea, coming on suddenly or going off suddenly, when congenital 
the embarrassment of breathing is observed from birth. If from a rup- 
ture or wound, the dyspnoea dates from the time of the injury. The 
symptoms of the respiration are characteristic : Tympanitic percussion- 
resonance ; absence of respiratory murmur; presence of sounds iden- 
tical with those observed over the stomach and intestines, as, borbo- 
rygmi and metallic tinkling when the respiration is suspended ; dilata- 
tion of the affected side ; difficult motion, or immobility, probably ab- 
sence of vocal fremitus. 
Though these symptoms occur in emphysema the latter may be dis- 
tinguished by : its being accompanied by paroxysms of asthma; more 
or less cough and expectoration ; the sonorousness revealed by physical 
exploration is not purely tympanitic, but vesiculo-tympanitic ; dilatation 
and deficient motion especially marked at the upper part of the chest; 
bronchial rales or a modified respiratory sound more or less diffused; 
with absence of borborygmi and metallic tinkling. 
Pneumo-hydrothorax. 
Generally suddenly developed as 
the result of perforation, commen- 
cing within the pleura in the course 
of chronic pleuritis, which has pre- 
viously existed. 
Physical Signs. — Tympanitic 
resonance, absence of respiratory 
murmur, dilatation, and deficient 
mobility, abolition of fremitus. 
Positive Signs.—Metallic tink- 
ling occurs in connection with re- 
Diaphragmatic Hernia. 
Only suspected where these an- 
tecendents cannot be ascertained. 
These symptoms are also com- 
mon to diaphragmatic hernia. 
Borborygmi is a positive and pe- 
culiar sign. Tinkling and ampho- 340 
DISEASES OF THE DIGESTIVE FUNCTION. 
spiration, voice, and cough; caver- 
nous amphoric respiration and 
voice. Succussion-sound general- 
ly can be produced; fluctuation 
absent. 
ric sounds occur, but not in syn- 
chronism with acts of breathing, 
speaking, coughing; without re- 
spect to the movements of the body. 
5. INTESTINAL INTUSSUSCEPTION. 
PASSIO ILIAC A. 
Treatment.—Manipulation or Pressure.—This expedient has been 
employed to relieve obstruction, perhaps by lengthening and effacing a 
twist in the intestines. In one case a moderate palpation necessary 
to physical examination forced onward an impacted gall-stone. But in 
other cases the same degree of pressure has been sufficient to burst 
a distended and rotton bowel, and thus to kill the patient. 
Gastrotomy.—In very few instances has this operation accomplished 
any good compared with the number in which it has been performed. 
In one case intussusception has been withdrawn, in another a band has 
been divided, in another a portion of the intestine cut out, with a tumor 
attached to it. 
But there have been other cases in which by manipulation of the ab- 
domen, or by giving crude Mercury, or by violently shaking the 
the obstruction has been removed. Therefore there must be very few 
cases that can justify an operation. 
Question of the Propriety of an Operation.—The following cases 
must be excluded from consideration: 1. All intussusceptions, which 
constitute nearly half of the filial cases of obstruction recorded. 
About thirty or forty per-cent of all intussusceptions undergo a 
process which permits, and often really accomplishes the recovery of 
the patient by casting off the intussuscepted part. 
2. In the early stages of the lesion and often in the latter, that state 
of the obstruction ivhich chiefly indicates the operation is often quite 
subordinate to those local lesions which cause the pain, tenesmus 
and other signs of irritation present; so that there is a transit, and 
not any accumulation of the intestinal contents at the intussusception 
itself. The characteristic tumor, too, is a sign which belongs, not so 
much to the occurrence of the intussusception as to its progressive 
increase of length on the one hand and to the tenesmus, the enormous 
infiltration and swelling of its various layers on the other. Hence, if 
the operation were deferred until after the access of these signs, (in- 
deed if it were not practiced almost instantly) it would generally be 
rendered incapable of successful completion by adhesion of the opposed 
coats of the middle and outer layers, or in withdrawing the inflamed 
and rotton portion of the intussuscepted portion it would, at the same 
time literally withdraw the patient’s only chance of recovery. 1NTESTIXAL IXTUSSUSCEPTIOX. 
341 
8. The next group of obstructions to withdraw from consideration 
in deciding upon the operation of gastrotomy, include, one already 
alluded to—namely, that of the strictures and tumors which experience 
shows to be chiefly (though not exclusively), related to the large in- 
testine. Occupying this bowel in the great proportion of eight-ninths 
of their total number; coming on gradually; and further, suggesting 
an accurate diagnosis by their symptoms, on the one hand, and their 
signs accessible to an examination of the abdomen and the rectum 
on the other; they are grouped here, however, unscientifically, by the 
practical considerations, that 1, their nature may be generally recog- 
nized at once; and 2, the operation indicated is that of opening the 
distended colon, and not gastrotomy, and is palliative and not cura- 
tive. 
In stricture of the large intestine the institution of an artificial anus 
has been resorted to above tbe obstacle.* 
In obstruction from bands, diverticula, &c., mostly affecting the small 
intestine, gastrotomy and division of the cord-like cause of strangula- 
tion has been thought necessary; a procedure which, if interrupted by 
unforeseen impediments, may further require the institution of an artifi- 
cial anus in the most distended part. 
In obstruction by stricture the relaxing power of a tobacco enema 
has been considered to deserve one trial at least (Brinton). It has 
also been used with success in obstruction, by bands, especially by gall- 
stones. We much prefer Lobelia in only drop doses. 
In all cases opium and spirits have been used freely from the ear- 
liest stage of the disease. The bulkier liquid constituents of the food 
may be given as sparingly as possible by the mouth, but introduced 
in sufficient quantities in enemata. 
Distensive Eneinata, to precede all operations as a means of relief, 
and also to assure diagnosis. Where vomiting is excessive, nourish- 
ment sufficient to be given in this -way, in sufficient and frequent quan- 
tities. 
After recovery all food that can cause indigestible accumulations 
within the intestines must be avoided; as the bowel may have under- 
gone a change of calibre which may not permit subtances to pass which 
in health could pass without difficulty. 
Belladonna.—Flanius proposed this remedy; “knowing its action 
n diminishing the contractile force of muscular fibre, he thought that 
when applied directly to the intestinal surface, it would lessen and 
put a stop to the spasmodic constriction which occasioned the charac- 
teristic phenomena of this dangerous malady.” The theories of dif- 
ferent schools have since been invoked to explain its mode of action 
* Brinton’s Lecture, 1859. 342 
DISEASES OF THE DIGESTIVE FUNCTION. 
and its apparently contradictory effects. Though classed as a narcotic 
it was found to produce wakefulness, and to dissipate the stupor ex* 
cited by Opium. Ilow it acts in dilating the pupil? howr in nocturnal 
incontinence of urine and involuntary alvine evacuations ? these are 
questions which can not be answered by enrolling Belladonna in any 
of the systematic categories philosophers have invented. Dr. Debreyne> 
who took up the question from the homoeopathic stand-point, found it 
able to cure the same diseases it was capable of causing. In his 
monograph on this remedy, he says: “We shall observe that Mydriasic 
dilatations of the pupil are cured, and speedily too, by the direct appli- 
cation of Belladonna.” He found the same to be true of simple, 
epileptiform and hysteriform convulsions, partial or general tremblings, 
unusual motions of the arms, hands and fingers, and says : “ These 
phenomena are all occasioned by its toxical affects.” It was therefore 
a “proper agent for the restoration of those laboring under these mala- 
dies.” 
Symptoms applicable to Passio-lliaca, observed as Pathogenetic 
Phenomena produced by Belladonna. Authors have observed: 
Frequent and abundant vomiting. Epigastrium sensitive to the touch. 
Sharp pains in the stomach and lowTer belly. Extreme distention of 
the stomach and intestines, lancinating, cutting pain in the pit of the 
stomach, obliging him to hold the breath and bend the trunk. Pressure 
in the stomach as from a stone. Inflation of the abdomen, with bor- 
borygmus of the intestines of the left side. Tumefaction of the ab- 
domen which is very sensitive to the touch. Borborygmus, sensation 
of general mixture in the abdomen, -with blinding headache. Sensation 
of heat mounting upward in the abdomen, with sweating. Painful con- 
traction within the abdomen, retraction of the belly, with pain in the 
abdomen, lasting a long time. He is awakened by colic and borbo- 
rygmus, inflation of the belly; sits with the body drawn forwards; 
desire to go to stool, without result, but followed by vomiting. Pinching 
in the intestines, in the ascending and transverse colon; pain increased 
by retraction of the integuments and throwing the trunk forward to 
the left side. Spasmodic tension of the entire abdomen, preventing the 
least movement; drawing pain in the abdomen; pain as if the intestines 
had been seized by pincers; violent colic below the umbilicus; the pain 
constrictive and returning periodically; painful contraction in the um- 
bilical region, commencing in the flank and ascending to the sternum; 
sensation under the umbilicus as if the viscera were about to escape. 
Alvine evacuations retarded. Constipation and absence of stool and 
urine. Constipation and meteorism are common. In a case in which 
they ceased there was amelioration; but they returned with delirium. 
In a case treated by Wagner, “the abdomen was tense, hard, me- 
teorismic; the slightest pressure increased the pain and caused the INTESTINAL INTUSSUSCEPTION. 
343 
patient to cry out.” There were also, “twitchings, syncope, convulsions, 
with insupportable anxiety. The effect of Belladonna was surprisingly 
favorable. 
M. Sollier, fils, treated a young girl suffering from spasmodic ileus, 
with fever, great thirst, abdomen painful, inflated to an enormous de- 
gree, occasional loss of consciousness. Dr. Fiessinger treated a woman 
in whom the abdomen was enormously distended, very painful to the 
touch and covered with phlyctenae around the umbilicus; features 
greatly altered, eyes fixed, body bent, extremities cold. In a patient 
mentioned by M. Brunet, pressure gave no pain; but there was great 
agitation, and he complained of burning heat, while the body was cold 
and pulse feeble. Reaction commenced immediately after the exhibi- 
tion of Belladonna; skin became warm, pulse developed, &c. In other 
cases have been observed intense cold, alternating with vomiting, ab- 
domen distended, sensitive to pressure, meteorism, face pinched, pulse 
accelerated, contracted or strong and febrile, abdomen hard, meteo- 
ristic very sensitive; anxiety, burning thirst, dry, red tongue; eyes 
haggard, features pinched ; agitation alternating with exhaustion. In 
the exacerbations, the face becomes suffused, eyes injected and hag- 
gard, febrile aggravation; delirium both by night and day; confusion 
of ideas; fainting and unconsciousness. In all of these symptoms wrn 
perceive peritoneal inflammation which plays an important part in 
passio-iliaca. These are the same symptoms that M. Fredault gives 
as indications for the use of Belladonna in strangulated hernia. Two 
characteristic symptoms are : 1. A sort of nervous erethism manifest- 
ing itself in extreme sensitiveness of the abdomen; great agitation; 
features rapidly and profoundly altered;—2. Inflammation in the hernial 
tumor. 
These same symptoms have been regarded by physicians of the Ita- 
lian school as indications for the use of Belladonna, which they con- 
sidered as one of the most important and certain modifiers of perito- 
nitis. 
The effects of poisonous doses of Belladonna exhibit also the same 
general features, though they have been often misinterpreted. In one 
dissection, reported by Faber, the abdomen was distended, and the 
stomach filled with gangrenous patches. 
Case by Dr. Dufresne of Geneva.*—A painter aged thirty-six, had 
two attacks of lead colic; and, on a third attack of pain in the ab- 
domen and vomiting, he took purgatives and four grains of Opium daily 
with warm baths and injections for three days, followed by leeches 
without relief. The abdomen was now greatly distended, the eonvolu 
tions of the intestines visible ; a sensitive point to the left of theumbili 
* L’Art Medical, 1860. 344 
DISEASES OF THE DIGESTIVE FUNCTION. 
cus; urine scanty, features pinched, pulse feeble, incessant moaning; 
vomiting on swallowing a drop of water. Directed two hundred 
grammes of water with five drops of tincture Belladonna—one spoonful 
every half a hour. Frictions on the abdomen, with an unguent of ex- 
tract Bell, eight grammes and Axungia fifteen ditto. In eight hours the 
pain diminished ; he took iced and Seltzer-water and tea; swelling less; 
urine increased. Next day he slept; fifth day convalescence establish- 
ed. Bell, discontinued as it begins to occasion agitation and wake- 
fulness. A second case was cured by simple injections, cataplasms, and 
Belladonna 6°* Frictions with ointment of extract Bell, four grains 
to fifteen of Axungia. 
A third case presenting all the same features was cured by the same 
treatment. 
Plumbum.—Lead produces the most obstinate constipation, and 
even the iliac passion, as shown by Thunberg, Wilson, Lazuriaga and 
others. From the same authors we learn that this metal has likewise 
the virtue of curing these two affections. Angelus Sala cured a species 
of ileus, and J. Agricola another kind of constipation which endangered 
the life of the patient, by administering Lead internally. Many other 
physicians have cured the iliac passion and obstinate constipation, 
with Saturnine or lead pills ; and they acted only homoeopathically. 
Introduction of a Flexible Tube through the Sigmoid Flexure.— 
“This can only be done by a skilful hand. It may be arrested by folds 
or displacements or curvatures of the rectum, or may turn back upon 
itself, or may pass through the stricture without bringing any relief, 
or it may aggravate the distress by transmitting fluids to increase the 
distention of the dilated and paralyzed canal above the obstruction. 
It is said to be of great service in the distention associated with en- 
teritis.” {Brinton) I have many times resorted to this expedient and 
always with success. I never found any of the difficulties mentioned 
by this author and others; and feel satisfied that no case should be 
permitted to progress to a dangerous point without having this opera- 
tion carefully and skilfully performed. 
Inflation of the Lower Intestines.—There are cases on record of 
an obstruction having every symptom of an intussusception being re- 
moved by the inflation of the rectum by a bellows. Relief instantly 
followed from that severe pain accompanying the complete distention. 
In another case inflation was successfully accomplished by injecting 
the solution of a carbonate and an acid so as to cause considerable 
effervescence within the intestine, but we have always better resources. 
Crude Mercury.—It has often been given in ounce-doses, and in 
some cases with success. Its mode of action was supposed not to be 
well settled; it has certainly often done harm by increasing the dis- DIARRIKEA. 
345 
tention and the pressure which is already disposing to paralysis, in- 
flammation and gangrene. 
In intussusception of the large intestine repeated injections may be 
employed to distend the bowel to its fullest extent. 
Genus VIII.—DIARRHOEA. 
1. Fceculent Diarrhoea.—Diagnosis.—Looseness of the bowels, 
with or without griping pains; frequent discharges of feculent or thin 
and watery secreted or undigested matters; respiration, circulation, 
skin and the organs generally in a natural condition. 
Accompanying Symptoms.—Partial or complete loss of appetite; 
pain in the stomach; swelling and tension in the lower part of the 
abdomen; rumbling in the bowels; cold and dry skin; thirst; urine 
scanty ; dejection; irregular and intermittent pulse; cutting or tearing 
pains which shift their position; occasional desire to vomit; in severe 
cases there is burning in the rectum; violent straining, extreme weak- 
ness, even fainting. 
The discharges are painful or painless. The secreted discharges 
are mucaus, serous or purulent. These when feculent are, in re- 
gard to color, designated as black, brown, gray, green, red, white 
and yellow; by difference of odor, as of spoiled eggs, putrid, acid, &c. 
Causes.—Dentition, worms, irritating articles of food; raw vegeta- 
bles, as cucumbers, melons, salads; various unripe or acid-fruits, as 
plums, pine-apples, apples, green corn; food partially putrid; some kinds 
of fish, shellfish; depressing passions, as grief, fear and anxiety; fa- 
tigue, sudden changes of temperature, hectic fever, repelled eruptions, 
epidemic influences, &c. 
Prognosis.—This is generally free from danger. But when it is ac- 
companied with much pain and fever, it may, if not properly treated, 
prove fatal, or degenerate into some other disorder. It may progress 
into dysentery, or when cholera prevails epidemically, diarrhoea may 
terminate in that malady. 
General Treatment.—Warmth, a light farinaceous diet, a small 
cup of warm coffee and rest may cure moderate cases. In those more 
severe, the patient should be confined to bed, should keep the feet warm 
and wear flannel. 
Medical Treatment.—For the diarrhoeas which supervene during 
lentition, suitable remedies will be found in: Chamomilla, Ipecac, 
Dulcamara, Mercurius, Sulphur, Calcarea-carb., Rheum, Cojfea and 
Aconite. Pulsatilla is appropriate when the disease has been caused by 
the use of fat and indigestible food, and the discharges are pultaceous, 
mucous, liquid or foetid, attended with burning or excoriation of the 
anus, nausea, regurgitation, colic, and aggravation of the symptoms in 346 
DISEASES OF THE DIGESTIVE FUNCTION. 
the night. Discharges green or white mucus, very acrid. Pain before 
the evacuation, is attended with much rumbling of the bowels; the 
disposition of mind peculiar to this drug. 
Dulcamara is a remedy of the highest value in diarrhoeas, and it 
covers a much wider range than has generally been attributed to it. 
It has been employed principally in watery diarrhoeas, which have 
arisen from cold; but we have used it with distinguished success in 
bowel complaints, which have been caused by teething, worms, repelled 
eruptions, errors in diet, &c., and in which there were mucous, slimy, 
bilious, greenish and sanguineous evacuations. Dr. Rummel expresses 
the opinion, that nine-tenths of all cases of diarrhoea may be cured 
with Dulcamara. White or yellow mucous, slimy diarrhoea, with pros- 
tration of strength. The color frequently alternates between green, 
white and yellow; the desire to evacuate, attended with nausea, and 
the attack is generally the result of a chill. 
1. Painful Diarrhoea.—For severest pain: Arsen., Coloc., Jalap, 
Rheum., Rhus-tox., Senna. (Dr. Wells on Diarrhoea, dec. 1862.) 
Pain less severe: Bryonia, Carb.-veg., Caps., Cham., Merc., Nux-v., 
Petrol., Puls., Sulph., Veratr. 
Still less pain : Agar., Aur.-mur., Anac., Asaf., Spigel. 
Arsenic.—Pain burning, affecting the whole intestinal tract, dis- 
charge browrn, green, red, white, or yellowr, or black and watery; a 
mixture of mucus and faeces. Symptoms violent; great restlessness, 
prostration, cold sweat. 
Capsicum*.—Burning confined to the lower part of the rectum, with 
throbbing and sense of excoriation and pain in the back, continued after 
the evacuation. 
2. Bilious Diarrhoea.—If the discharges are mucous, slimy, or 
sanguineous, and are preceded and accompanied by griping and tenes- 
mus, our best remedies are Acid-nitr., and Mercurius-sol., in alterna- 
tion. We may use the third attenuations,—a dose after each evacua- 
tion. Other remedies are : Arsenicum, Ipecac., Sulphur, Acid-phos., 
Acid-sidph., Petroleum, Colocynth, Veratrum, Phosphorus, and 
Dulcamara. 
Mercury.—This article is familiar to all, as the agent commonly em- 
ployed to cause Diarrhoea, for the purpose of drawing off the increased 
vital action from some distant organ. Thus it has been used as a pur- 
gative. In moderate doses mercurials act without great irritation, 
merely increasing the natural secretions of the liver, pancreas, and 
mucous follicles of the bowels. In large doses, or wThen by the repeti- 
tion of smaller ones, the mineral has accumulated in the system, violent 
purging is often the consequence. It is attended with griping, and 
sometimes with sanguineous evacuations. The evacuations are frothy 
whitish, tough, and often greenish.” (Pereira vol. 1. p. 817.) DIARRHOEA. 
347 
Dr. Wood says, “I have seen the operation of Calomel in some in- 
stances so exactly like cholera morbus, that the most experienced eye 
could scarcely have detected the difference.” (Pract. Medicine, 
vol. 1. p. 674.) 
Mercury has long been a chief allopathic reliance in the treatment 
of diarrhoea, and it has succeeded best when given in minute doses, 
triturated with chalk or white sugar. Those who prescribe it in this 
form do not know that they are marching under the banner of Hahne- 
mann. The symptoms of diarrhoea most characteristic of Mercury are: 
Pain in the large intestines; discharges of green or red mucus, with 
tenesmus. 
Symptoms. Chills between, and flashingheat during the stools; tenes- 
mus ; great uneasiness before the stool; cold perspirations on the face; 
anxiety and trembling before the stool; heartburn and bitter eructa- 
tions after it; pain in the back and tenesmus continuing after it. Cin- 
nabar is one of the best forms of Mercury. 
Chamomilla.—White mucous discharges, painful, more common in 
children than in adults. Diarrhoea caused by taking cold, anger or 
chagrin; diarrhoeic stools of odor of spoiled eggs. Fever and sweat 
during sleep; excessive sensitiveness of feeling, with intolerance of noise. 
Colocynth.—The pain very sharp, doubles the patient up; he cries 
out, has slight nausea; pain relieved by the evacuations ; returns in 
paroxysms, rather neuralgic than inflammatory, affecting the whole in- 
testinal tract. 
Plumbum.—Constricting pains. See p. 318. 
Podophyllum.—Sense of constriction, but the parieties of the abdo- 
men are retracted. Discharges foeculent, yellow or dark green, of the 
odor of carrion, often accompanied with prolapsus ani, especially in 
children; diarrhoea occurs most commonly in the morning ; pains in 
abdomen and back worse during the evacuation and continue after. 
Discharges excited by eating and drinking. {Dr. Wells.) 
Mux-vomica.—Pressing or squeezing pains ; pressure more in the 
upper part of the abdomen and sides, in the colon: discharges brown, 
offensive and slimy, green, small in quantity, more frequent after eat- 
ing ; tenesmus, drawing pain in the back; prolapsus ani. 
Thuya.—Discharges frequent and with a gurgling noise ; great pros- 
tration ; short and difficult breathing; intermittent pulse; pressing 
pain in the back, rapid emaciation. 
Sulphur.—Pain with excoriation; red mucous discharges, with{ 
fever, loss of appetite and cutting pain in the bowels. 
When diarrhoea occurs during dentition, and is connected with some 
chronic cutaneous eruption, it will be necessary to exhibit Sulphur, 
either alone, or in alternation with Didcamara, Chamomilla, or Men 
curius. It has often occurred to us, that after Mercurius, Chamomilla, 348 
DISEASES OF THE DIGESTIVE FUNCTION. 
and other apparently appropriate remedies have failed to arrest the dis* 
. charge, a few doses of Sulphur have effected it. 
If the complaint appears to be characterized by prominent biliary 
derangement specific medicines will be found in Mercurius, Charno- 
milla, Pulsatilla, Nux-vomica, Arsenicum, and Bryonia. 
Sulphuric-acid.—This is one of the best remedies in almost every 
form of diarrhoea. In children who are teething, and suffering from 
nausea and vomiting, fever, thirst, bleeding spongy gums, frequent dis- 
charges mixed with bloody mucus. A single drop or two in a glass 
half full of water gives it a pleasant acid taste, and may be given by 
spoonful doses. 
For the diarrhoeas which supervene during dentition, a suitable re- 
medy will be found in Arsenicum when there are : watery, slimy, green- 
ish evacuations, with burning pain, great thirst, debility and emaciation. 
When diarrhoea arises in consequence of violent mental emotions, we 
employ Chamomilla, Ignatia, Colocynth, Veratrum, Antimonium- 
crud., Coffea, Nux-vomica, Phosphorus, Arsenicum, Pulsatilla, and 
Ferrum. 
If the discharges can be attributed to the presence of worms, we 
give Sulphur, Gina, Spigelia, Aloes, Mercurius, Nux-vomica, 
Carbo.-veg., Ferrum. 
For the diarrhoeas which occur during hectic fevers, especially if 
connected with a scrofulous dyscrasia, the appropiate medicines are 
Sulphur, Calcarea-carb., Acid-nitr., Acid-phos., Iodine, Ferrum 
Mercurius, Sepia, Kalmia. 
For painless chronic diarrhoea, we suggest, Phosphorus, Phos.- 
acid, Ferrum, Arsen., Hyos., Lycopodium, Cham., Sulph., Calcar., 
Secale-cornut., Veratrum, China, Natrum-muriaticum, Acid-nitr., 
Sulph., Lachesis, Lycopodium, Graphites, Arsenicum. 
Tris-nitrate of Bismuth.—Dr. Theophilus Thompson says, its effi- 
cacy is not surpassed by any other remedy in the wasting diarrhoea 
iccompanying phthisis. 
Nux-m,oschata.— Case by Dr. Leon.—A lady, aged forty-five, 
lymphatic temperament, diarrhoea, evacuations every two hours, small 
in quantity, and not watery, but a peculiar feature of the case was 
that after each evacuation the patient fainted entirely away. Nux- 
moschata, first dilution, two drops to a half tumblerful of water ; a 
dessert spoonful every two hours. After the first dose the patient 
said, she felt the remedy pervade her whole system, and that its in- 
fluence was especially perceptible at the seat of the disease. There 
was no more of the diarrhoea or the faintness after taking the remedy, 
and she was quite well next day.* Hahnemann also mentions the 
* U. S. Jour. Ilomoeop. vol. 1. p. 44 DIARRHOEA. 
349 
homoeopathicity of Nutmeg to diseases accompanied by fainting 
fits* 
3. Diai'rhcea Adiposa.—After the exhibition of Castor-oil there is 
frequently recognized some peculiarity in the appearance of the eva- 
cuation : “ sometimes it resembles caseous flakes or a soap-like scum, 
floating on the more fluid part of the dejection ; occasionally it is ar- 
ranged in a form not unlike bunches of grapes, or more nearly of hyda- 
tids of a white color; more generally, however, it is found mixed up 
with the faeces as a kind of emulsion, and in some few instances it has 
been discharged under the form of solid tallow-like masses.” (London 
Med. Gaz. Dr. G. Bird. vol. XV. p. 225.) 
Dr. Watson, after describing the nature and symptoms of that very 
rare disease, which is named Diarrhoea Adiposa, from the circum- 
stance of fatty matter passing from the intestinal canal, in connection 
•with the ordinary stools, says: “ With respect to the treatment in such 
cases, all the hints I can give you, are such as are furnished by the 
two following facts: Mr. Howship, in his book on morbid anatomy, men- 
tions the instance of a lady who was affected with this diarrhoea adi- 
posa, and parted with vast quantities of fat, and who was cured upon 
the principle of “ Similia similibus curantur,” for she recovered after 
swallowing a pint of sweet oil. And Dr. Elliotson, acting on this hint, 
gave his patient, who Avas laboring at the same time under diabetes, a 
quarter of a pint of Olive-oil; and the voiding of fat greatly diminished 
from that time and soon ceased entirely.” (Practice of Physic., vol. 
II. p. 505.) 
It is known that the phenomena of the excretion of fat is not peculiar 
to the action of Castor-oil, but also follows the use of Olive-oil. 
Cuprum.—Copper.—1. “ Two women, who had taken a confection 
prepared in a copper utensil, suffered from severe headache, constric- 
tion of the throat, nausea, colic, and extreme weakness. Two young 
men, having eaten of the confection more freely, had for some hours 
excruciating colic, severe pain in the mouth and throat, impeded breath- 
ing, and hurried, irregular pulse ; for twenty-four hours they suffered 
from headache and prostration of strength.” (Christison, Treatise 
on Poisons, p. 466.) 
In each of these cases debility is mentioned as a symptom. Now 
the sulphate of copper is classed by medical authors as a mineral tonic. 
As such it is frequently prescribed in those states of the system in 
which debility is the most prominent symptom. 
2. “A confectioner’s daughter took two ounces of verdigris, and died 
on the third day, under incessant vomiting and diarrhoea, attended, 
towards the close with convulsions, and then with palsy of the limbs. 
A lady and her daughter partook of “ Sauerkraut,” which had been 
* Organon, p 49. 350 
DISEASES OF TIIE DIGESTIVE FUNCTION. 
kept in a copper-pan. Soon after dinner they were attacked first with 
pain in the stomach, then with nausea and anxiety, and next with eruc- 
tation and vomiting of a green, bitter, sour, astringent matter. The 
pain afterwards shot downwards throughout the abdomen, and was 
followed by diarrhoea, afterwards by convulsions, at first transient, then 
continued, and finally by insensibility. The daughter died in twelve 
hours, the mother an hour later. 
In these cases a conspicuous symptom is diarrhoea. For this spe- 
cial symptom Cuprum has long been used as a remedy.* The sulphate 
of Copper has been used with great benefit in chronic diarrhoea and 
dysentery. It often succeeds when the ordinary vegetable astringents 
fail.” {Pereira, Mat. Med. vol. I. p. 803.) “ In extreme cases,” says 
Watson, “the sulphate of Copper has been found to have a powerful 
effect in restraining the flux. It is apt to gripe.” Then let him di- 
minish the dose, and he may still say with truth that “ given three or 
four times a day, it is frequently found successful, when previous 
attempts to remove the diarrhoea have failed.” {Princijo. and Pract., 
vol. II. p. 483.) 
4. Serous Diarrhoea.—From Debility ok Relaxation.—In the 
early stages, the cases connected with relaxation and debility may 
generally be arrested by Mercurius-sol. I have frequently arrested it 
by a single dose of the third or fourth attenuation. In persons of ad- 
vanced age whose constitutions have been broken down by other dis- 
eases, who are pale, sallow, feeble and subject to exhausting diarrhoea 
from slight exposure, or irregularity of food, I give a dose of Mercur- 
sol. in a very small powder on the tongue. In ten or fifteen minutes 
the patient will frequently express relief. These cases were all in scro- 
fulous constitutions and did not appear to have been previously injured 
by Mercury. The Dewberry, Dubus-ccesius, is regarded in the south- 
ern States as a specific. Prof. Mettaeur, of Virginia, says, the tincture 
of Diospyoros-virg. or an infusion of the unripe fruit, “ meets the indi- 
cations most perfectly.” This remedy is peculiarly efficacious in ar- 
resting diarrhoea, especially those distinguished by sero-mucous dis- 
charges without pain and the protracted cases of diarrhoea following 
the bilious fevers of the Mississippi. Rheum, Cinnabar, Arsen., Aloes 
are good remedies. (Arner. Jour., 1850. p. 390.) 
Coffee has often been employed with success in chronic diarrhoea of 
different forms. Indeed, coffee causes constipation in large doses, act- 
ing as a cathartic, by the same process that it cures it in small ones 
when it restrains diarrhoea. When the motor nerves possess their nor 
mal power, large doses, by over-exciting them, exhaust that power, and 
constipation results ; when they are weakened by other causes, the mo- 
derate stimulus of small doses of coffee removes the paralyzed state of 
* Dr. Drummond, Homoeop. among the Allopaths, p. 42. DIARRHOEA. 
351 
the nerves and cures the diarrhoea, as well as constipation attendant 
on it. 
5. Chronic Diarrhoea.—Calcarea Carbonica.—Case by Dr. Dun- 
ham. A boy, aged ten years, has had diarrhoea from the age of four. 
Of good height, but emaciated till his tissues are utterly devoid of fat, 
and muscles wonderfully attenuated. “ My thumb and finger meet with 
ease around the middle of his arm. Is active and full of fun ; appetite 
prodigious—thirst very great; distress or “ grumbling pain” in epi- 
gastric region before stool, partially relieved by pressing his hand upon 
it. Epigastrium sensitive when touched. Abdomen greatly distended, 
hard, tympanitic ; hard ovoid bodies, tangible by deep pressure on the 
abdomen. Stools five to twenty in twenty-four hours,—copious, pappy, 
dark greenish-brown, quite offensive, occurring chiefly between four 
A. M. and noon. Though copious they do not produce faintness or 
sense of weakness ; he is lively, full of mischief. Arsenicum had failed 
though fully tried. He now has twenty stools daily. 
The general dyscrasia and diathesis directed to Calcarea-carb. 
There are diseased states of the alimentary canal and of the mesenteric 
glands, depending unquestionably upon a general depressed state of 
the vascular and nervous systems. The case was not merely a diar- 
rhoea, which was only a secondary symptom. The distended, pro- 
minent abdomen, the indurated and enlarged glands, the excessive ap- 
petite, the great thirst demanding large draughts of water, the pain in 
the upper part of the abdomen just before the stool, the tender epigas- 
trium, the copious long-continued diarrhoea, without corresponding ex- 
haustion, correspond better with Calcarea-carb. Its aggravations are 
frequently in the morning, and the pain in the abdomen relieved by 
warmth. Calcarea-carb. two-hundredth dilution; two globules were 
dissolved in four ounces of water; a teaspoonful of the solution to be 
given every four hours. (Amer. Horn. Rev. 1860. p. 471.) 
From the day after this visit the lad had but one stool daily; and now 
after tenmonthsthe bowels continue to act normally, and only once every 
day. In one month the boy became ruddy and plump, having gained 
strength and twenty-two pounds of flesh ; the rotundity of the abdomen 
disappeared, and the indurated abdominal glands were no longer felt. 
The two globules of the remedy were all that he received. 
6. Chronic Diarrhoea of Camps and Hospitals.—See Colitis.— 
Index. 
Genus IX.—CHOLERA. 
Name derived from bile, pew, flow, literally a flow of bile. In 
general, however, there is an utter suspension of the biliary secretion 
1. CHOLERA MORBUS.—SPORADIC CHOLERA. 352 
DISEASES OF THE DIGESTIVE FUNCTION. 
Diagnosis.—Distressing nausea and vomiting, with great fulness 
and oppression at the stomach; severe griping or colic pains in the um- 
bilical region ; frequent watery stools; twisting cramps in the abdominal 
muscles and calves of the legs; tongue slightly furred; pulse quick 
and weak; countenance expressive of suffering and anxiety. 
Causes.—Torpor of the liver; obstruction of the biliary ducts ; eat- 
ing unripe or decayed fruits, or crude esculent vegetables ; constant ex 
posure to a cold and damp atmosphere. 
Causes and Pathology.—The lungs and liver are the great decar- 
bonizing organs of the body. The lungs are most active in cold 
weather from the part they perform in generating animal heat; in sum- 
mer the liver is stimulated by the heat to increased action, and forms 
a larger quantity of bile, which is required to perform important uses in 
the function of digestion. The peculiarity of the function of the liver con- 
sists in its reception of the blood from the stomach and intestines, and 
from this venous blood, secreting the bile. If, therefore, the liver is in 
full healthy action, the blood transmitted to it through the portal veins 
passes freely through all the minute vessels of the liver, the excess of 
carbon with -which it is laden is eliminated by the secretory apparatus, 
the purified stream flows onward to the heart, while the newly-secreted 
fluid, the bile, is poured through the biliary ducts to exert its power- 
ful chemical influences on the contents of the alimentary canal, and 
stimulate its muscular fibres to propel these contents forward to theii 
destination.—But, when the secretory cells of the liver are deranged 
in their action, the blood furnished by the portal system of vessels ac- 
cumulates in the liver, there being no other route by which it can pro- 
ceed to the heart. The liver becomes congested, engorged; and the 
spleen participates in its condition. When the spleen is full, the con- 
gestion extends to the splenic vein, thence to its tributary, the inferior 
mesenteric, and, still farther, to the vascular rete that lines the colon. 
“Now, we know,” says a late writer, “that, whenever an obstruction to 
the venous circulation exists afronte, an exudation of the serum takes 
place through the walls of the distended vessels. If we apply a ligature 
around the arm, so as to impede the circulation towards the heart, all 
the parts beyond the ligature become oedematous from the exudation 
of the serum of the blood in the distended vessels into the cellular 
tissue. In the congested state of the vascular rete of the colon, this 
exudation takes place into the colon and gives us diarrhoea.” 
When from any cause there is entire suppression of the function of 
the liver, we immediately have extreme congestion of the liver, stomach, 
large and small intestines. This condition directly leads to increased 
sensibility, (irritability,) and an exosmose of the watery portion of the 
blood of the congested part into the stomach and bowels. As it passes, 
it will wash away the epithelial scales of the mucous membrane. The CHOLERA-MORBUS. 
353 
increased sensibility in the stomach produces vomiting; in the bowels, 
frequent stools which consist of washed off epithelial scales presenting 
the appearance of rice-water. {Gayley, Amer. Jour. Med. Sci. July, 
1850. p. 85.) 
These are the usual phenomena presented in Cholera Asiatica, bu 
they are also seen in severe sporadic cases of cholera morbus. The 
hot season of almost every year furnishes occasional cases of this 
kind when there is no epidemic cholera in the country. (See Conges- 
tive Fever, Cholera form?) 
Therapeutics.—The most efficacious medicines in the treatment of 
this complaint, are, Veratrum, Arsenicum, Colocynth, Chamomilla, 
Pulsatilla, Ipecacuanha, Mercurius. 
Veratrum-album.—Countenance pale or bluish, cold and disfigured; 
eyes sunken; nose pointed; mouth parched, lips dry or cracked and 
of a dark color; surface cold or hot and dry; contraction of the mus- 
cles of the abdomen and extremities; pulse frequent and very weak; 
cold sweats; evacuations watery, light, greenish or brownish. Severe 
cutting pain in the umbilical region; violent nausea and vomiting, with 
diarrhoea ; burning sensation in the stomach ; speedy rejection of food 
or drinks; stomach and abdomen tender on pressure; cramps in the 
abdomen and in the extremities; extreme prostration; great oppression 
and distress at the stomach; intense thirst; general uneasiness. Ex 
cessive anguish; fear of death; despair of recovery; delirium. 
Administration.—This medicine may be used at from the first tf 
the third dilution, a dose every half hour, in urgent cases, until the 
requisite impression is produced. In slight cases, two or three doses 
of the third dilution, at intervals of twTo to four hours, will suffice for 
the cure. 
The author of the treatise on epidemic diseases (emdrjfu&v) (attri- 
buted to Hippocrates—at the commencement of lib. 5.) mentions a case 
of cholera morbus that resisted every remedy, and which he cured by 
means of white Hellebore alone, which, ho-wever, excites cholera itself, 
as witnessed by Forest, Sedelius, Reimann and many others. 
Arsenicum-album. The indications for this remedy are somewhat 
similar to those of Veratrum, but it is especially useful when the dis- 
ease is violent from the commencement, attended with an almost im- 
mediate prostration of strength; trembling of the limbs; severe burn- 
ing pain in the stomach; constant nausea and vomiting; diarrhoea; 
ringing in the ears; vertigo; giddiness; great anguish and restless- 
ness ; skin dry or cold, and bluish; hippoeratic countenance; eyes 
sunken, dim and suffused; thirst; distress from swallowing the blandest 
liquids; tongue and lips dry, dark and cracked; breath cold; excessive 
anguish, anxiety and despair. 
You i.—23. 354 
DISEASES OF THE DIGESTIVE FUNCTION. 
Administration.—Same as Veratrum. 
Colooyntli will occasionally serve us in cases attended with mode- 
rate nausea, vomiting and purging; violent cramp-like pains in the 
region of the navel; cramps in the extremities; tongue loaded with a 
yellow fur; bitter taste in the mouth; great dejection and anxiety, and 
general restlessness. It may be given at the third potency, every two 
hours, gradually lengthening the intervals as the pains subside. 
Chamomilla has been highly recommended -when the disease has 
been “ excited by a fit of passion.” The symptoms which point to this 
remedy are: frequent vomiting of food or of mucous, sour or bitter 
substances; great anguish and pressure at the pit of the stomach; 
cramps in the calves of the legs when lying down; tearing and cutting 
pains in the abdomen. 
Administration.—Same as Colocynth. 
Pulsatilla is chiefly useful in cholera which has been induced by 
the abuse of fat, crude and indigestible food. In cases of this descrip- 
tion, it is often promptly serviceable, administered at the first or second 
dilution, as circumstances require. 
Ipecacuanha is the remedy when vomiting is the most prominent 
and troublesome symptom. It may be given at the third potency, every 
half hour, until the symptoms abate, afterwards as the exigencies of 
the case demand. (For Mercurius, see p. 346.) 
2. cholera asiatica. 
General Remarks.—This disease, which is said to have destroyed 
more than fifty millions of human beings, and has now raged in all 
the four quarters of the globe, originated in India. A similar 
disease is endemic in that country, and has been described in a Hindoo 
work of great antiquity; it was very fatal in the time of Bontius, 1629, 
and has prevailed to some extent almost every year for at least one- 
hundred years; but the great epidemic now so much an object of terror, 
first began in the beginning of June, 1817, in its epidemic form in Jessore, 
Nuddea and other parts of the marshy districts of the Delta of the 
Ganges. At that time the artificial canals employed in irrigating the 
ground, being out of repair were overflowed and filled with stagnant 
water. The excessive rains had destroyed much of the grain raised, 
and damaged that which was saved. It was while the people in im- 
mense numbers were crowded together on the banks of the Ganges, 
living on limited supplies of spoiled or mildewed rice, that epidemic 
cholera commenced among them in a more malignant form than in any 
former year. [Dr. Fytler, Sir Gilbert Diane, Murray’s British 
India, Vol. 2, p. 192.) The first year it extended no further than the 
boundary of Bengal, but during 1818 and 1819, it diffused itself CHOLERA-ASIATICA. 
355 
throughout the whole length and breadth of India, the Burmese Empire 
and other territories of Eastern Asia and entered China in 1820. In 
1821 it traversed the shores of the Persian Gulf. In 1822 it spreau 
through parts of Arabia, Persia, Mesopotamia and Palestine; in 1823 
it invaded the Russian Territories at points to which it has several 
times since returned. In 1880 cholera advanced through the southern 
provinces of Russia and reached Moscow September, 28.* It thence 
proceeded through Poland, the Austrian and German dominions and 
crossed the British Channel to England, to Scotland and Ireland 1831. 
In 1832 the pestilence crossed the Atlantic Ocean. The first case offi- 
cially recognized, occurred June 8, 1832, at Quebec. The first subjects 
were emigrants, who were said to have come over in healthy vessels, 
having no wdiere been exposed to infection. The board of health reported 
that they were found “ in a low, unhealthy and ill-ventilated part of the 
city, crowded, &c.” (Encyc. Amer. Yol. 13, 430.) It then came direct 
to New-York, June 27, the same year, and 2521 died. 
In 1845 (September), cholera appeared at Bokhara and Samarcand. 
And, soon after, at Bagdad, where 450 died daily, of a population of 
80,000. It then followed the pilgrims to Mecca, advanced toward 
Teheran (in Nov.), but did not reach it till June, 1846. In that city, 
of a population of 130,000, nine thousand died. After an irregular 
desultory march through Persia, sometimes in opposition to the pre- 
vailing winds, at others passing large tracts untouched, it approached 
Tauris in August, then Astrabad, and proceeded westward. In October, 
1846, it appeared in the region of the Caucasus. In May, 1847, it com- 
menced at Tiflis; and thence advanced to the mouths of the Don, and 
to some parts of the coast of the Black Sea. In September it reached 
Trebizond and Ezeroum, returning at the same time to Bagdad. In October 
the official reports of the Russian officers announced the progress of 
the pestilence to the northward and westward. From the close of 
August to the middle of September, in its march through Astrakan to 
Moldavia and Wallachia, of 7248 attacked, 3342 died. [Lond. Lancet, 
Nov. 1847.) 
The northern limit of the cholera, says Boudin, “is found in Europe 
at Archangel (May, 1831, and July, 1848.). In America, it has pene- 
trated as high as Canada. It has hitherto spared Iceland, Greenland 
and Siberia. In the southern hemisphere it has shown itself but very 
exceptionally, and has there attained its southern limit at Bourbon, 
Latitude 21° south. Java was invaded by it in 1819 and 1826. Su- 
* In November, 1830, the Medico- Ghirurgical Review announced that the “ terrific 
epidemic had reached Astrachan and even Moscow. The Emperor Nicholas, who 
had seen how powerless medical science was to combat it, had already offered a 
reward of £1.100 for the best treatise on its cause, nature and cure. 356 
DISEASES OF TIIE DIGESTIVE FUNCTION. 
matra in 1853. The Cape of Good Hope and Australia have hitherto 
been spared, and America, south of the line, did not suffer until 1855.” 
Diagnosis.—Copious secretion into the stomach and bowels of a 
serous fluid, albuminous in character, free from acids or alkalies; its 
color is slightly yellowish; though often perfectly transparent; it 
generally resembles rice water, containing white flakes of the size of 
lcntiles, is seldom bloody, and is discharged from the bowels or from 
the mouth without effort. The smell is slightly albuminous, mouldy, 
sperm-like; taste insipid. 
Decrease or entire cessation of all the secretions, and excretions, 
the tears, saliva, bile, faeces, urine, perspiration, the milk and menses 
partially excepted. 
The skin is cold and void of elasticity, presenting wrinkles (facies 
cholerica), lead color. The mucous membranes are in a similar state, 
hence the tongue and breath are cold (about 70° or 72° of Fahrenheit.) 
The pulse is soft, the veins congested. 
In the muscles, tonic, sometimes clonic spasms, particularly in the 
lower extremities and abdominal muscles. 
The only characteristic feature of Asiatic cholera, by which it is 
distinguished from severe forms of sporadic cholera, consists in the fact 
of its specific origin. 
Asiatic cholera varies much in its mode of attack, violence and du- 
ration. It may seize its victim in such a manner as to produce an im- 
mediate prostration of strength, together with most of those symptoms 
which indicate an almost total loss of vitality, as a sunken and cada- 
verous expression of countenance, small and almost imperceptible pulse, 
surface of a bluish tinge and cold, cramps in the calves of the legs 
and fingers, burning in the stomach and throat, extreme anguish or 
stupidity, vomiting, diarrhoea, and an almost entire loss of power over 
the voluntary muscles. Other cases set in wTith vertigo, humming in 
the ears, oppression and burning pain at the pit of the stomach, nausea, 
vomiting, griping, purging of a liquid resembling “rice water,” Avhich 
are soon succeeded by oppression of the chest, difficulty of breathing, 
cramp-like pains in the extremities and abdominal muscles, intense 
thirst, great loss of strength, bluish color of the lips, nails and skin; 
pulse almost imperceptible, hippocratic countenance; delirium, cold, 
icy skin; profuse sweats; weak, hoarse voice, and sometimes sopor; 
with eyes half open and fixed, with partial or total loss of conscious- 
ness. A few or the whole of these symptoms may be present in any 
given case, according to the constitutional, predisposing and exciting 
cause which may exist. 
In cholera as it appeared in the United States, there was such a thing 
as a premonitory stage 'y but in tropical climates its course is described 
as one exhausting march from the beginning to the termination in CHOLERA-ASIATIC A. 
357 
death. The flow of serum into the internal cavities, whether carried 
out by vomiting or purging, or remaining in them would continue till it 
drained away the powers of life, sinking the pulse and the animal heat 
as fast as a flow of blood. 
In July, 1833, when cholera was sweeping the borders of the Gulf 
of Mexico, the city of Campeachy, in Yucatan, was considered safe 
from infection, as it was fortified with high walls and garrisoned with 
soldiers. But the cholera came; the sentinels dropped dead at their 
posts and the guards at the gates ; priests fell dead in procession, while 
carrying the saints whose intercession they invoked. The houses were 
soon closed and the streets deserted; graves ceased to be dug; and 
burials were only made by armed soldiers compelling the assistance of 
the friends. 
Causes.—Remote Cause.—Asiatic cholera originates in a peculiar 
specific poison. Originally developed by a peculiar train of circum- 
stances in the centre of a region which contained all the materials for 
the generation and propagation of organic poisons; it has been con- 
veyed by visible and invisible channels over distant continents ; in some 
of the regions it has visited it has remained but for a short time; in 
others it has found “ more suitable climate and other influences, which 
have led to its acclimation and adoption, as one of the endemics of 
the country. In those countries, as in the tropical regions of both 
hemispheres, cholera may be aroused by a series of favoring influences. 
The poison can le conveyed and planted wherever the thoroughfares 
of travel may conduct it; but the disease makes only a transient stay 
in places which furnish but little material for the growth and propaga- 
tion of the infinitesimal fungi, which may be supposed to constitute 
the agent on which the disease depends. It manifest itself as 
a peculiar subtle poison, capable of being conveyed by currents of 
wind from place to place, either dissolved in aqueous vapor, or in some 
other unknown manner. Whether this infinitesimal, imponderable 
morbific agent is generated during the prevalence of some peculiar 
conditions of the atmosphere, from vegetable or animal matters in a 
state of partial or total decomposition, or from some other source, is 
as yet a matter of speculation. Like most of the other more potent 
agents in nature, the particles of the poison are in so minute a state 
of subdivision, and so subtilely diffused in the air, that in the present 
imperfect condition of the sciences, we are entirely unable to investigate 
or appreciate their nature. That the cause or agent is material, no 
one can for a moment doubt; for it must be something or nothing • 
if it is the former, it must be composed of minute particles or atoms 
of matter, which, by being absorbed, produce those specific effects 
which constitute cholera. 
Proximate Causes.—Fear, sudden fright, nausea, grief, error of diet 358 
DISEASES OF THE DIGESTIVE FUNCTION. 
purgatives, taking cold, dampness, heat, low grounds, lower floors in a 
dwelling, crowded dwellings, as prisons, narrow streets, negative elec 
tricitv of the air. The favorable circumstances are: cold climates 
high elevation above the sea; free circulation of air. No disinfectant 
have any power to arrest the spread of the disease. The manner in 
which cold damp air excites cholera morbus may be seen under tha 
head; and all that is there said on the subject applies with equal force 
to cholera Asiatica. But the deleterious effect of moisture is denied 
by many. The Board of Health of Hew-Orleans for 1849, say: a 
dry foy prevailed during its visitation, such as Humboldt noticed, on 
the Andes as accompanying influenza. (Amer. Jour. Med., Jul. 1850. 
Predisposing Causes.—Middle age, female sex, idiocy, chronic 
diarrhoea, venous plethora, scrofula, intermittent fever, plica polonica. 
Amongst children.—Male sex, aphthae, jaundice, worms, difficult 
dentition. Persons who have once had the disease are not exempt 
from future attacks. Its course may be modified by : infancy, old age, 
ulcers on the feet, phthisis, influenza. The disease is generally excited 
by great errors of diet; intemperance, neglected diarrhoea, taking cold, 
fear, sorrow, fright, and, above all, anger. Among the worst articles 
of diet are cucumbers, melons, green corn, unripe vegetables and fruits 
of all kinds. Champagne, beer, cider, &c. in process of fermentation. 
[Dr. Ilencke of Piga.) 
Course and Progress of the Disease.—First Stage.—After slight 
premonitory symptoms, such as irritability, languor, sleepiness, imper- 
fect sleep, soft slow pulse, confusion of head, pale countenance, de- 
rangement of stomach, tendency to diarrhoea. In the first stage Cholera 
resembles Cholerine. 
This is not a premonitory stage, but the first stage of the pestilence 
itself. It often begins without any pain; and the first suspicious cir- 
cumstance observed is the absence of pain when diarrhoea begins. In 
other cases there is “pain in the epigastrium, aggravated by the touch,” 
extending to the throat and abdomen; diarrhoea, by which the contents 
of the bowels are rapidly carried off; the discharges become more light 
colored as the disease progresses; as the second stage begins they 
become more serous, the white flakes and the rice-water discharges 
appear. 
Auscultation reveals the bellows sound, first in the aorta and next 
in the heart itself; pulse softer; thirst increasing in proportion to the 
loss of fluids by diarrhoea. 
After continuing from a few hours to a week or more, this stage 
terminates in 
1. In recovery, indicated by abatement of the symptoms, gentle 
perspiration, sleep, increased urine, restored action of the liver, con- 
sistent alvine evacuations, or CHOLERA-ASIATICA. 
359 
2. In the Second Stage, with increased violence of the symptoms, 
with the true painless rice-water discharges and vomiting, and lasting 
from two to forty-eight hours. 
Symptoms.—Anguish in the chest; pressure or cramp in the stomach 
fear of death; quiet position on the back or great restlessness anxiou 
expression of countenances and lamentations ; indifference to the outei 
world, to wounds, to relatives ; tonic spasms which contract the muscles 
making them hard, round, rigid and frequently remaining after death 
They commence in the lower extremities, pass to the upper, and then 
to the muscles of the abdomen or thorax; and are severe in proportion 
to the venous obstruction and lividity, often causing the patient to cry 
out. The cramped muscles contracted into knobs and painful; feet 
distorted by continuing contractions; drowsiness and numbness in- 
crease, though the voluntary muscles retain their power, often lax, soft, 
doughy, never becoming paralyzed, but remaining rigid after death. 
Pains in the sacrum. 
Pulse.—Very soft, easily compressed, and disappearing during the 
spasm; in frequency varying from 110 to 120 per minute, thready, 
sometimes imperceptible, equally soft at carotids and heart. 
The sounds of the auricles indistinct, that of the ventricles distinctly 
revealed by auscultation near the pit of the stomach. 
Skin.—Inelastic, cold, dry, smooth, pale, becoming soon of a leaden 
color; and bluish gray, very thin; it forms wrinkles on the back of the 
hands, fingers, &c.; pinched up it remains long as left. Wounds do 
not gape, and no cutis anserina is formed by dashing cold water on 
the skin, which feels like leather. General temperature 65° to 77° 
Fahrenheit. Coldness greatest in lower extremities ; skin on fingers, 
hands and toes wrinkled. The patient still complains of heat on the 
surface, but says he is burning up within; mustard plasters redden the 
skin; itch dries up, syphilis remains, hydrops disappears; all diseases 
of the skin return with increased violence after recovery from cholera. 
General Expression of Features.—Eyeballs deeply sunken, turned 
upwards, indolent, glassy, pupil dilated; sclerotica with a bluish semi- 
circle ; look fixed; upper eyelid half closed, dark blue circles round 
the eyes, or lower eyelid with a blue semicircle; countenance pale, 
color changing from lead to violet; skin very smooth on the lips, cheeks, 
tip of the nose; nose pointed; cheeks sunken; upper eyelid drawn 
upward ; cartilages of the nose and ears very flexible ; coldness ex- 
tending from the alee nasi to the corners of the mouth. In a later stage 
cold clammy sweats. 
Tongue cold, fat, heavy or blue / mucous membrane of the mouth 
cold, feels as if tanned, uneasy, at first clean, at the transition into the 
next stage, bloated, and if the danger be great, bluish; deafness. 
Pit of the Stomach.—Oppressed, painful to the slightest touch, dis* 360 
DISEASES OF THE DIGESTIVE FUNCTION. 
tressed; burning in the epigastrium, extending to the abdomen and 
pharynx. 
Thirst.—At first moderate, afterwards unquenchable; sometimes great 
aversion to drinks, at others violent desire for water, fruits, acids, 
fresh air. 
The Effusion of Serum begins first into the lower portion of the 
bowels, alternating with the diarrhoea, watery, having fewer white flakes, 
sometimes transparent; is discharged without effort, in gushes, or passes 
involuntarily; sometimes in less violent cases, it has the consistency of 
rice-water or pea-soup, or often more like brine ; in a worse form the 
discharge is mixed with blood; in full habits, and in persons of middle 
age (twenty-four to forty) it is light red, dissolved in the effusion, with- 
out smell; in old people, dark, unmixed, and having a putrid smell; ab- 
domen sunken, and ribs protruding. 
Secretions.—These are all suppressed. (See Diagnosis.) The 
suspension of the action of the liver exerts the most important con- 
sequences. (See Cholera Morbus.) 
Breath.—Cold, inspiration deep, rather slow; expiration short, moan- 
ing; respiratory murmur distinct, somewhat jpuerile; percussion on the 
thorax before and behind, sowing emphysema. 
The Blood—is unnaturally dark and thick. In the later stages it 
is black, tarry, ropy, semi-coagulated ; in the ratio of the degree of pro- 
gress of the case. {Brit. Army Med. Reports. 1819 to 1822.—John- 
son on Ilot Climates, p. 355. 
The characteristic cholera voice is rough and hoarse; enunciation 
imperfect, owing to the want of elasticity of the mucous membrane, and 
the spasmodic constriction of the larynx; perceptible after the third or 
fourth vomiting. Frequent and annoying hiccough. 
Aggravation after midnight and towards morning; patient easier 
in the afternoon ; speedy exhaustion from slight exertion. 
Transition.—This may be : 1. Into health by subsidence of the symp- 
toms into those of cholerine ; abatement of the cold, of the dryness, the 
pulselessness, the thirst and anxiety; less vomiting; discharges green- 
ish or yellow ; sweat, cheerfulness, languor, and tranquil sleep ; later : 
urine pale yellow, clear, abundant; appetite increasing; wounds heal 
rapidly. Final recovery in from one to two weeks. Or 
2. Transition into the Third Stage.—Symptoms.—Abatement of 
vomiting ; great indifference ; consciousness remaining to the last; ex- 
treme prostration; the patient, lying on the back, sinks down to the 
foot of the bed ; some return of warmth and moisture on the skin; more 
lividity and facies cholerica; the pulse cannot be felt, later, not even 
at the carotids or heart; eyes dull and glassy when spoken to; rare, 
and not characteristic vomiting and diarrhoea; later, the stools are in- CHOLERA -ASIAT1CA. 
361 
voluntary, as if coming from a spout; respiration labored, rattling, 
almost ceasing. 
This stage lasts from one hour to two days. 
Termination, 1. in Death, preceded by cold clammy sweats, complete 
cessation of circulation and respiration ; and final paralysis of the lungs. 
Or 2. in Convalescence, which is manifested by bilious stools ; return 
of the pulse and sounds of the heart; breathing and color more natural, 
critical warm sweat. But recovery is slow, free perspiration often dimi- 
nishes the strength; and slight mental excitement, too much warmth, 
drink, or food, cause anguish, palpitation, small soft pulse, vomiting or 
diarrhoea, extreme debility, uneasy sleep. 
Or 8. The Fourth or Consecutive Stage. 
Symptoms.—First Variety.—Congestive, which is soon developed 
into a typhoid Fever, which consists in the reaction following the pre- 
ceding stage of depression. There is arterial pressure on the brain, 
spine, and its nerves, all of which were unaffected in the cholera stage. 
Inflammations subside rapidly in cholera, and wounds heal quickly in 
the convalescence. The typhoid features are clearly marked in places 
where the patients are in close dwellings and the population crowded. 
The symptoms are: quiet immovable position on the back, then sinking 
down to the foot of the bed; indifference, or satisfaction with his own 
condition; great debility; transient delirium; fixed look; dilated pupil, 
conjunctiva injected; humming in the ears; difficulty of hearing; dirty 
blue color of hands and arms, of countenance ; nostrils scurfy; tongue dry 
in the middle ; slightly swollen or oedematous; taking impressions of the 
teeth; tongue, teeth and lips covered with a dirty incrustation, little 
thirst; accelerated respiration, somewhat puerile ; articulation imperfect, 
though not hoarse; pulse perceptible again, sound of heart not clear, 
the contraction seems difficult. Later: sleepiness, followed by stupor, 
or high delirium with efforts to escape, total unconsciousness, rattling 
breath, sometimes meteorism. Finally : pulse and beating of the heart 
intermitting, very rapid, carotids pulsating very violently; the air only 
penetrates to the upper lobes of the lungs ; the breathing becomes 
slower and finally ceases: death. {Dr. Nusser of Augsburg.) 
In other cases there is abatement of the symptoms, the debility and 
the delirium ; the urine increases, is clearer ; moderate sweats, tranquil 
sleep; and final recovery. This stage lasts from five to eight days. 
{Johnson, 360.—Jackson and NeilVs Report. Phila. 1850.) 
Pathology.—Congestion of the viscera, especially the liver ; bowels 
congested in some cases, the whole tube has a blanched appearance. 
Vessels of the mesentery full of blood. Epithelial layer destroyed or 
detached. Peyer’s glands developed, also solitary glands; villi 
denuded, capillaries and proper tissue of the liver exsanguinous, but 
large blood-vessels full. 362 
DISEASES OF THE DIGESTIVE FUNCTION. 
Prognosis.—Favorable, when there is gradual subsidence of the 
symptoms, cessation of vomiting and purging, re-appearance of more 
natural evacuations, slight warm perspiration, which is C7'itioal in the 
second stage, though not later, and does not always occur. 
Unfavorable, in those who are greatly exhausted by the rice-water 
purgings; who are restless after vital warmth has returned; relapses 
generally prove fatal. Intemperate persons often die in the typhoid 
stage of cerebral typhus; consumptive patients, or those exhausted by 
venereal excesses either die or recover slowly. 
Treatment.—When the Asiatic cholera commenced its destructive 
course amongst the millions of Europe and America, the disciples of 
the ancient school of medicine stood aghast and almost powerless before 
the awful scourge, their best resources often hastening rather than re- 
tarding the work of the destroying angel. 
Up to 1882, “ Epidemic Cholera” was the prominent feature of every 
Medical Journal. The different theories and modes of treatment pro- 
posed have now little claim on our attention. One writer says: “ Vene- 
section was at one time ordered to be employed by Government! Then 
sweating was praised ; various ingenious contrivances were brought 
forth for the purpose of exciting perspiration.” 
“ Of internal remedies, Calomel and Opium were most in repute. 
But they were far from successful. Rhubarb and Magnesia super- 
seded them, and were in turn superseded by Sub.-nitrate of Bismuth? 
This was at one time regarded in Russia, as a “ specific” but was de- 
nounced in England as “inert;” but hopes were still maintained in the 
“Mustard Emetic.” Soon, however, the conclusion was reached that 
all experience “ from Ceylon to Archangel, from Orenburg to Berlin,” 
left the profession “ as far from a rational methodus medendi as they 
where when it first appeared on the banks of the Ganges.” 
The medical theorists were all of this time wildly wandering in the 
thick fogs of conjecture. M. Andral, then regarded as a leader in 
pathology, pronounced the disease of an “ enteralgic instead of an en- 
teritie character ;” and recommended “ free bleeding among the young 
and vigorous, external irritation, and plenty of Laudanum internally.” 
His neighbor and equally distinguished colleague, Jiroussais, declared 
it to be “ highly inflammatory action of the whole alimentary canal,” 
and prescribed “ ice internally, leeches to the epigastrium, and heat to 
the extremities.” 
The experience of other years and of other countries was added to 
that of twenty years in Asia and Europe. The amount of it all was 
thus summed up by the editor of the Medico-Chirurgical Review 
“ James Johnson, M.D., Physician Extraordinary to the King of Great 
Britain.” He said: “When cholera appeared in Ilindostan, the papers 
so teemed with specifics and cures, that the government put a stop to CHOLEKA-ASIATICA. 
363 
their further publication, on account of the mortality they caused.” 
“For ourselves, what shall we say? Alas ! we must own that we are 
gloomy, heartless skeptics, without so much as a grain of faith, or one 
saving particle of belief. Would that it were otherwise—Avould that 
we could only so much as imagine that cholera has been, is, or will be 
cured by the thousand and one plans of happy memory, already 
published, or to be published. 
“In point of fact, we know no better mode of treating cholera than 
when it first appeared in the island; and the really severe cases are 
just as fatal as they ever have been.” 
The degree of mortality of cholera as it had been observed in dif- 
ferent seasons and in different localities may be approximated by of- 
ficial reports: The Medical Board of Bombay, in India, reported that 
of 1294 cases Avhich received no medical assistance, every individual 
died; and that no case was known to have recovered without medical 
aid. In fourteen years, beginning with 1818, 4430 deaths occurred in 
the British Army, out of 19,494 cases in that presidency ; these re- 
sults seemed to show that medical treatment, if not the best, was better 
than none. 
Another report of five years shows that within that period twenty- 
two per-cent of the whole number attacked were carried off. In civil 
life the disease has often proved much more fatal. 
At Bushire, on the Persian Gulf, in 1821, the sixth part of all the in- 
habitants died. At Bassora, says Mr. Rich, 18,000 died, and of these 
14,000 died within a fortnight. 
In September} 1830, the epidemic invaded the Russian empire, and 
entered Moscow with a step more terrifying than that of the grand 
army of Napoleon eighteen years before. Up to the first of January 
4385 had died, equal to fifty-four out of every hundred persons attacked 
by the disease. 
It was just at this time, that Andral and Broussais were speculating 
about the “ enteritis or the “ enter algid'’ character of cholera; or 
whether the remedies should be “ antiphlogistic” or “ antispasmodic/” 
and at the same time (1830) Samuel Hahnemann in Germany, Avas en- 
deavoring to solve the true problem of cholera by a different method, 
“Collecting,” says Dr. Dake, “the symptoms given, one by one till the 
image of the hideous monster stood up before him as a living reality.” 
Then, under the guidance of the law he had been permitted to discover, 
‘ with a knowledge of drugs such as no other man ever possessed, he* 
soon arrived at Camphor, Cuprum, and Veratrum, and Avrote them 
down as the best remedies for cholera.”* The solution of Hahnemann 
Avas not accepted by the profession; pursuing their own theories the 
results they reached are well knoAvn. 
* Dr. J. P. Dake, U. States Jour. Ilomoeop. Yol. I. p. 395. 364 
DISEASES OF THE DIGESTIVE FUNCTION. 
It is universally conceded, at the present time, that homoeopathy is 
far more efficient in the treatment of cholera than any other mode of 
practice. During its prevalence in Europe, from 1831 until its disap- 
pearance, the average mortality of cases under this treatment was 
about one in twelve, while under allopathic treatment, the average was 
one in three. In Germany, Russia, France, and other European king- 
doms, where our syste.m had become known, even distinguished gentle- 
men of the old school were forced to admit its vast superiority over 
their own system; and it was undoubtedly this superior efficacy and 
success which caused so many distinguished men of Europe to inves- 
tigate the claims of the doctrine of “ similia similibus,” renounce the 
fallacies of Hippocrates and Galen, and throw their influence on the 
side of truth. 
Being a disease of extreme violence, and having a tendency to run 
its course with great rapidity, there was no time to apply remedies ac- 
cording to the principle contraria contrariis, nor would its severity 
permit the additional waste of strength and nervous energy which ever 
follow opiates, stimulants, and counter-irritants. A positive specific, a 
real antidote, could alone reach the seat of the disease, and arrest its 
progress ; and to the disciples of Hahnemann, is due the credit of bring- 
ing forward these specifics, and demonstrating to the world their tre- 
mendous power and efficiency over this world-wide scourge. 
Dr. Lobethal, of Germany, who had charge of a large cholera hos- 
pital (allopathic) during the prevalence of the epidemic, in 1831, and 
who treated an immense number of cholera patients homoeopathically 
in the summer of 1847, and again in 1849, observes : “ It has been re- 
served to the “ specific” healing art, generally known under the name 
of homoeopathy, to stand the test of practical observation, and to de- 
monstrate its superiority in combatting this fearful disease,, (cholera,) 
the appearance of which, followed by an immense number of well-sub- 
stantiated cures, has tended in the highest degree to the spread of the 
new healing art.” 
Dr. Buchner (“ On the results of Allopathic and Homoeopathic treat- 
ment according to Official Statements,”) says : In nineteen different 
cities 1557 patients treated homoeopathically, recovered, while only 
ninety-three died, or nearly six per-cent. Where the spirits of Cam- 
phor and the higher potencies of homoeopathic remedies were used, it 
was common for only one in a hundred to die. In 1831, in the district 
of Tischnowitz,under allopathic treatment, two-hundred and twenty-nine 
were cured and one-hundred and two died. Homoeopathists cured 
two-hundred and fifty-one, and lost twenty-seven. Dr. Baer, of Prague, 
treated allopathically one-hundred and nineteen patients, of whom he 
saved seventy-two and lost forty-seven. He then tried homoeopathy on 
eighty patients, of which he did not lose any. “ Count Nadasdy of CHOLERA-ASIATICA. 
365 
Daka, in Hungary, in the absence of professional aid, treated his sub- 
jects with spirits of Camphor. Of one-hundred and fifteen, who were 
attacked, he only lost fifteen.” (.Lutze, Practice, p. 128.) 
Treatment.—First stage.—When the cholera is preceded by nau- 
sea, loss of appetite, constant borborygmus, violent thirst, slight febrile 
symptoms, frequent thin watery discharges, absence of pain in the 
bowels, and other symptoms generally known under the term “ cho- 
lerineDr. Lobethal obtained marked benefit from Phosphoric-acid, 
repeated every two or three hours until the symptoms are better. If 
the above symptoms are attended with coated tongue, vomiting, debi- 
lity and indigestion, Ipecacuanha of the third dilution is required. 
Cholera.—When cholera has actually made its appearance, a re- 
medy which covers the exact symptoms of the case ought to imme- 
diately exhibited. Our best remedies are Veratr., Arsen., Cupr., 
Camphor, Canth., Carbo-veg. 
In the forming stage of cholera, and in cholerine, with cramps in 
the calves of the legs, give tincture of Camphor; “ and for aching or 
burning in the epigastrium, Ac.-phos., Arsen., Cupr., Phos., Veratr'. • 
for rumbling in the abdomen, Acid-phos., Ver., Phos. / for diarrhoea, 
Acid.-phos., Arsen., Ipecac., Secale, Sulph., Veratr.” (Nusser.) 
In the third stage, or collapse, Arsen., Phos., Veratr., Carbo-veg., 
lauro-cerat., are to be used. 
Daring the prevalence of cholera, much may be done towards ward- 
ing off its attacks, and thus disarming it of a portion of its terrors. The 
most important rule which we would inculcate, is the cultivation of pre- 
sence of mind under all circumstances, cheerfulness, contempt of dan- 
ger and strict temperance and regularity in all the habits of life. Other 
precautions are: frequent ablutions so as to insure perfect cleanliness, 
and a healthy action of the skin ; careful ventilation; frequent changes 
of body linen, moderate and agreeable exercise ; good company ; and 
a clear conscience. 
As a prophylactic, many European authors have highly recommended 
Camphor in tincture, in doses of a drop or two, once or twice in twenty- 
four hours. From its extensive application as a medicinal antidote we 
believe it to possess virtues of a high order as an antidote against the 
poison of cholera. 
Further Prophylactics.—Fresh pure air; the avoidance of small 
close, damp apartments or streets; cheerfulness, habitual calmness of 
mind ; regularity in all natural habits; the use of such diet and drinks 
only as can be certainly digested, without deranging the stomach or 
bowels ; substantial healthy food; avoid acids; avoid all over-exertions, 
grief, anger, fear. 
Prophylactic Medicines.—1. Cuprum. May be used during the 
prevalence of cholera when the first symptoms are felt. 366 
DISEASES OF TIIE DIGESTIVE FUNCTION. 
2. Camphor.—This is the specific remedy, having the power of kill- 
ing or destroying the animalculoe or malignant agent. In the premo- 
nitory stage, when there are spasms in the calves of the legs, and pain- 
less diarrhoea,—one drop of tincture (one part gum to five of Alcohol) 
on sugar, every three or five minutes, with some brandy and water every 
fifteen or twenty minutes. As he grows warm, give less frequently. 
Phosphoric-acid, Arsen., Cupr., Phos., Veratr., aching or burning in 
the epigastrium, rumbling in the abdomen; diarrhoea. Of these, Phos- 
phoric-acid has been generally the most successful in cases showing a 
disposition to repeated attacks. 
Arsenicum, Secale, Sulph.: diarrhoea. See p. 370, 372. 
Sulphur, thirtieth, taken twice a week, six globules in the evening, 
destroys the psoric diathesis, which favors the disease. 
When reaction begins and he begins to perspire, a little brandy and 
water will give strength. The perspiration should be kept up eight or 
ten hours. During the reaction following the use of Camphor, if head- 
ache indicates the beginning of congestion; give Belladonna. If con- 
stipation follows, give a cup of coffee without milk, and twenty-four 
hours after give a dose of Sulphur. If dysenteric symptoms, give Mer- 
curius. {Pulte, 325.) 
Second Stage.—Perfect rest in recumbent position / perfect com- 
posure of mind, cheerfulness and confidence, both in the patient and 
his attendants. 
Food: weak broth only ; it is often necessary to prohibit or restrict 
even this for some time. 
As a drink, cold water is desired, and often does good, even when it 
is constantly thrown up. In some cases it renews the vomiting and 
diarrhoea after they had been checked by medicines. Beer is often 
allowed to the convalescent. Medicines should be administered at short 
intervals, even as short as every five minutes. Ice, in small pieces, 
frequently swallowed, seems to give relief. Injections of ice-water are 
recommended "when the abdominal muscles are cramped. Frictions 
over the abdomen may be applied at the same time. 
The medicines which have been found upon the whole, most service- 
able in the treatment of this malady, as it occurs in different localities, 
and in its various forms, are : Yeratrum, Cuprum, Arsenicum, and 
Camphor. Symptoms often supervene, also, which call for the exhibi- 
tion of Secale-cornutum, Nux-vomica, Phosphorus, Phosphoric-acid, 
Ipecacuanha, Carho.-veg. 
Camphor: Distressing anxiety in the region of the heart; spasms 
of the muscles ; pulse small and rapid ; hands, feet and skin cold; lividi- 
ty especially of the lips; unelastic ; facies cholerica; anxious expres- 
sion of countenance ; tongue cold, dry, livid ; epigastric pain; thirst; 
rice-water discharges ; suppression of urine ; cold breath ; hoarse, raw CHOLERA-ASTATICA. 
367 
voice; aggravation after midnight; amelioration by rest; death in a 
few hours from apoplexy or sudden collapse. (Dr. Hencke, of Riga, 
says, Camphor is specific in these cases. Spiritus Campli.-fortis, in 
drop-doses, every five minutes, till the heat returns. 
During the prevalence of the epidemic in England and France, in 
1848—49, and in America, in 1849, almost every individual experienced 
unusual intestinal irritation and disposition to diarrhoea. In the large 
cities especially, very few exceptions to this rule could be found. Even 
the most strict regard to diet, and avoidance of all exposure, was no 
security against this weakness and rumbling of the bowels, and a cer- 
tain lassitude and uneasiness which constantly attended it. Most of 
these cases subsided without any serious disturbance ; crthers passed 
into cholerine, which could generally be controlled when promptly 
taken in hand; while those cases, which were neglected, or improperly 
managed, usually terminated in cholera. In rare instances, individuals 
would be attacked, suddenly and violently, without any apparent pre- 
monitory symptoms, but cases of this description have almost invari- 
ably occurred in those whose constitutions were impaired from intem- 
perance, disease, or who had been deprived of proper repose, by mental 
application, excitement, fear, &c. 
Dr. Hencke found Camphor a positive specific in the spasmodic 
form of cholera, “ when the patients were suddenly taken with rigor, 
and even cold in the back, which was soon followed by faintness and 
weakness, sinking sensation in the stomach, vertigo, nausea, aching, 
contracting pain in the epigastrium, gagging, vomiting, spasms in the 
calves, general tonic spasms, disappearance of the natural warmth, 
therefore coldness of the hands and the whole body, depression of the 
pulse, which could hardly be felt, lividity of the lips, anxious expres- 
sion of the countenance, &c., sometimes diarrhoea.” Dr. H. advises 
that the patient be well covered and dry heat applied to his body and 
limbs, and that strong spirits of Camphor be given in drop-doses every 
five minutes, until reaction occurs, warmth returns, and perspiration 
sets in. Dry frictions may at the same time be employed. As soon as 
we observe signs of reaction, we must either omit the remedy, or if 
the urgency of the case demands further remedial means, give the 
Camphor at the first or second dilution until reaction is fully esta- 
blished. It was a very common occurrence for a patient to be taken in 
the night, generally after midnight, with cramps in the stomach, nau- 
sea, vomiting and purging of a watery fluid, without pain or effort on the 
part of the patient; sense of exhaustion-and debility, and great anxiety. 
If these symptoms were not speedily arrested, there soon succeeded 
extreme prostration, almost constant vomiting of rice-colored fluid ; 
contractive or burning pains in the stomach; coldness of the surface; 
spasms or cramps in the calves and other parts of the body; counte 368 
DISEASES OF THE DIGESTIVE FUNCTION. 
nance sunken, altered in expression, and indicative of extreme anxiety, 
voice feeble or hoarse ; marbled appearance of the skin; skin shrunken 
and shrivelled; cold breath; cold and pasty sweat; burning thirst; 
marked loss of power in the circulatory and respiratory organs. 
Camphor, Veratrum, Arsenicum, Cuprum, Acid-hydrocyanic, 
Secale, Laurocerasus, and Carbo-veg. have been most successful in the 
epidemic of 1848 and 1849, both in Europe and America. 
Probably in no part of America did the cholera rage with more 
violence in 1849 than in Cincinnati. Two physicians, Drs. Pulte and 
Ehrmann, treated 1116 genuine cholera patients, in all stages of the 
disease, and with a loss of only thirty-five,—two Americans and 
thirty-three ‘Germans. These gentlemen also treated 1350 cases of 
cholerine, and many cases of malignant dysentery, after the subsidence 
of the cholera, without the loss of a single patient. Of the cases of 
genuine cholera asphyxia, five-hundred and thirty-eight had vomiting, 
diarrhoea and cramps—seventy of these being in a state of collapse, 
and the balance, five-hundred and seventy-eight presented with vomiting 
and rice-water discharges. These last being subjected to prompt 
treatment, were speedily restored without the supervention of more 
serious symptoms. 
The treatment adopted by Drs. P. and E., was as follows; in the first 
stage of the malady, Tincture Camphor, one or two drops every five 
minutes for one or two hours, or until profuse perspiration ensued 
which should be kept up for several hours, care being taken to keep 
the patient well-covered. This remedy was perfectly effectual in almos 
every case during the early part of the disease. 
In the second stage, when cramps, general prostration, and rapid 
sinking of the physical energies appeared, Veratrum, when the cramps 
were in the lower extremities; Cuprum, if they were in the bowels and 
breast, and Secale-cornutum were relied upon. The latter medicine 
was found of eminent service in elderly people. In cases of decided 
collapse, Arsenicum, and Carbo-veg. were the remedies employed. 
Mild frictions of the extremities with the hands alone, were the only 
external means made use of. 
In St. Louis, New-Orleans, and other cities of the West and South, 
a similar plan of treatment was adopted by homoeopathic physicians, 
and with results, which, for the most part compare favorably with those 
detailed by Drs. Pulte and Ehrmann. 
Cuprum.—Cardiac anguish; spasms; pulse soft, small, frequent; 
cold, livid, dry skin ; facies cholerica ; aching in epigastrium ; violent 
thirst; rice-water discharges, both from stomach and bowels ; every 
thing seems turning round ; suppression of urine ; voice hoarse, raw ; 
aggravation after midnight; amelioration by rest. (Nusser '.) 
Cuprum is suited for cramps in the muscles of the chest and great CHOLERA.-ASIATIC A. 
369 
oppression of the breath. It may he given in alternation with Yera- 
trum ; dissolve twelve or sixteen globules of each in four tablespoon- 
fuls of water and give a teaspoonful every fifteen minutes till the pulse 
becomes less frequent, when the cramps will subside. 
Camphor.—It is not alone as a prophylactic that this medicine has 
been advised. Hahnemann made use of it in all stages of cholera, 
but he found it particularly successful in the first stages of the malady, 
when vertigo, extreme weakness, cramps, in the calves of the legs and 
muscles of the abdomen, burning and heat in the stomach, convulsive 
distortion of the features, eyes sunken, face and hands bluish and cold, 
and anguish, dulness, loss of consciousness and hoarseness, were pre- 
sent. It has been found most useful in those cases, which have been 
almost entirely unattended with nausea, vomiting and diarrhoea. It 
has in some instances restored patients who were apparently in articulo 
mortis. 
Nux-vomica may by used when the principal sufferings seem to be 
in the stomach, as anguish, oppression at the pit of the stomach, and 
severe spasms in the stomach, also tenesmus, with an increase of the 
spasms at each discharge. 
In some severe cases, where the previous remedies have failed to 
afford 'relief, the practitioner should take into consideration, Phos., 
Phosphoric-acid, Ipecac., Carbo-veg., Canthar., Sulph,-ether, Chloric- 
ether, i&C. 
Veratrum.—Anguish at the heart; spasms of the extremities and 
abdominal muscles ; soft, small, and frequent pulse ; skin cold ; livid, 
inelastic ; facies cholerica ; tongue cold, livid, dry; epigastric pain ; 
violent thirst; effusion serous, with white flakes, upwards and down- 
wards ; suppression of urine ; cold breath ; voice hoarse, raw ; aggrava- 
tion after midnight or towards morning; amelioration by rest. At St. 
Petersburg, (Russia,) in 1849, the success of this remedy was so great 
that the pharmacies were overrun by allopaths. {Dr. Griesselich.) 
Cuprum and Veratrum may be persisted in four or six hours. If the 
cramps continue or stupor begins, give Secale-cornut. every half hour, 
for an hour or two. If there still be much nausea or retching, increased 
by motion of head or body, give Tabacum. 
Veratrum.—General coldness of the surface of the body; cold 
perspiration on the face, and sometimes over the whole surface; skin 
white, or of a bluish tinge; bluish color around the nails and of the 
lips; contraction of the muscles of the extremities; nausea, vomiting 
and purging; face pale, sunken and hippocratic ; nose cold and pointed; 
breath cold; pulse almost imperceptible; general appearance of prostra- 
tion. Painful cramps in the limbs; sensation of extreme debility and 
faintness; nausea; vomiting and purging; vertigo and confusion in 
the head; constrictive pain in the throat; oppressive and burning pain 
You L—24. 370 
DISEASES OF THE DIGESTIVE FUNCTION. 
at the pit of the stomach ; painful contraction of the abdomen; op- 
pression in the chest; fulness and pressure in the region of the heart; 
obstructed respiration; rumbling and griping in the bowels; thirst; 
great restlessness. Excessive dejection, anguish and despair; constant 
disposition to turn from side to side, or otherwise to change position; 
sometimes loss of memory, stupidity. 
Administration.—The first to the sixth dilution should be employed, 
a dose every ten, fifteen or twenty minutes in urgent cases, and ex- 
tending the intervals as the symptoms demand. 
Arsenicum-album.—Skin of a pale or bluish color and cold; face 
wan and cadaverous; eyes sunken; nose pointed; general expression 
of countenance unnatural and indicative of pain; lips bluish or black 
and dry; trembling or stiffness in the limbs; skin cold and covered 
with a clammy sweat or dry and shrivelled; pulse very weak, irregular 
and trembling; watery discharges by vomiting and purging. 
Burning pain in the stomach, worse after vomiting; cramps in the 
calves of the legs, toes and fingers; dizziness ; nausea; frequent in- 
clination to vomit and purge ; rumbling in the bowels ; ringing in the 
ears; feeling of extreme debility; very great restlessness and agita- 
tion; intense thirst; for which drinking affords but slight relief; 
spasmodic contraction and burning in the throat and oesophagus; cramp- 
like pains in the stomach and abdomen; frequent desire to pass water, 
or retention (complete surpression) of urine; difficulty of respiration 
with hoarseness; general sensation of coldness and loss of vitality. 
Intense anguish, anxiety and discouragement; dread of death; con- 
stant uneasiness; confusion of ideas ; delirium. 
Administration.—The lower potencies of this medicine should be 
used, and in urgent cases the doses may be repeated once in fifteen or 
twenty minutes until the symptoms yield, some writers extol it highly 
in alternation with Veratrum, and where either of these remedies does 
not afford prompt relief by itself, by all means let them be given in 
alternation. 
Symptoms of Arsenicum.—Anguish at the heart; indifference ; 
spasms of the extremities and abdominal muscles; pulse soft, small 
and frequent; skin inelastic, cold, livid; facies cholerica; tongue cold, 
dry, livid; aching at the epigastrium; violent thirst; serous effusion 
with flakes, upwards and downwards; suppression of urine ; cold breath; 
hoarse raw voice; aggravation after midnight; amelioration by rest. 
Previous to the first outbreak of cholera in Europe, Hufeland said, 
‘ if there is any truth in homoeopathy, Arsenic should be the remedy 
for cholera;” Arsenic is the remedy upon which homoeopaths have 
very generally relied since the first experiments were made with it for 
the cure of this fearful malady. They have endeavored to arrest the 
attention of the public to induce them to make a trial of it with little CIIOLERA-ASIATICA. 
371 
success. During the last visitation of this disease, according to the 
statistics laid before the medical board, it appeared that under homoeo- 
pathic treatment more than two-thirds of the patients recovered, whilst 
the returns from the allopathic cholera hospitals showed that upwards 
of two-thirds died. Although this committee was commissioned by 
government to examine and report the various results attending the 
different modes of medication adopted during this epidemic, they with- 
held those of the homoeopaths, believing that “ to publish the returns 
from homoeopathic practitioners would be to give an unjustifiable sanc- 
tion to an empirical practice, alike opposed to the maintenance of truth 
and the progress of science.” And yet Dr. Mac Louglilin, the me- 
dical inspector and an allopathist, said, “ all I saw Avere true cases of 
Asiatic cholera, in the various stages of the disease ; and I saw several 
cases that did well under the homoeopathic treatment, which I have no 
hesitation in saying would have sunk under any other. Were it the 
will of Providence to afflict me with cholera, and to deprive me of 
the power of prescribing for myself, I would rather be in the hands 
of a homoeopathic than of an allopathic adviser.” (Drummond, 
Homceop. amongst Allopaths. Lond. 1836, p. 50.) 
The London Lancet for Oct. 2, 1857, contains a letter from C. Black, 
M. D. “ On the value of Arsenic in Cholera.” The author, perhaps, 
did not design to advocate, homoeopathy, but his testimony is none the 
less valuable on that account. He details a severe case of cholera 
treated by the ordinary'solution of Arsenic, the Liguor-arsenicalis. 
In conclusion he says : 
“ From such data, then, I maintain the specific action of Arsenic in 
the very worst form of English cholera, and I thence infer for it a 
similar power in the malignant type of the disease. 
“In the East, where at the present moment the tenure of our Indian 
possessions depends on the maintenance of the health of our soldiers, 
this dreadful scourge is decimating the heroic band under Havelock, 
and, unless speedily checked, may possibly lose us an empire Avhich 
has cost us so much blood and treasure to win. Let the surgeons of 
the Indian army adopt this remedy—let them give it a fair and im- 
partial trial—and I feel confident that with them it will maintain the 
reputation of a specific for cholera, which I here accord to it.” In a 
second letter, published a fortnight later in the same Journal, he thus 
expounds the theory of the ratio medendi of Arsenic in curing cholera: 
“ The facts connected with the history of the rise and propagation of 
cholera, show that the proximate cause of the disease depends on the 
presence of a certain poison in the blood which has been termed the 
‘‘choleraic poison.” To the question, then, “in what respect does 
Arsenic act on the constitution in cholera ? I reply that it acts by 
neutralizing or destroying the choleraic poison in the blood; and when 372 
DISEASES OF THE DIGESTIVE FUNCTION. 
it has done so, the peculiar symptoms of the disease subside. It pro* 
duces its effect in accordance with a well-known physiological law 
that no two actions of a similar nature can go on in one and the 
same part at one and the same time ; that in short, the greater action 
destroys the less. If, then, a greater poison be given to the blood 
than the one which is already present in it, the latter must, in accor- 
dance with the above law, be destroyed.” If there be any such well- 
known physiological law as Dr. Black refers to, it is the law first pro- 
mulgated by Hahnemann in the following words : 
“ A weaker dynamic affection is permanently extinguished in the 
living organism by a stronger one, if the latter, whilst differing in kind, 
is similar to the former in its manifestations.” ( Organon, Hahnemann, 
§ XXYI.) 
This doctrine of similia similibus curantur, as announced by Hahne- 
mann, seems intelligible enough to a mind accustomed to look at it, but 
in the mind of the learned editor of the Lancet is only a meaningless 
jargon of words. When, however, the very same doctrine is announced 
by a British surgeon whose orthodoxy is not suspected, the same 
learned editor cordially endorses it. Dr. Black’s proposal to treat 
cholera with Arsenic is commended in the Lancet, because the editor 
is too ignorant to understand that it is an endorsement of homoeopathy. 
To test the Lancet more fully: Dr. Hitchman, a distinguished homoeo- 
pathist, wrote a letter commending Dr. Black’s proposal, expounding 
the homoepatliic law “in the very wrords which Hahnemann uses in ex- 
plaining the peculiarities of his doctrines; the letter was published in 
the Lancet without awakening the suspicion of its vigilant editor. 
Phosphoric-acid.—Anguish at heart; indifference ; spasms of ex- 
tremities and abdominal muscles; pulse soft, small, frequent; facies 
cholerica; epigastric aching; rice-water discharges from the bowels; 
hoarse, raw voice; aggravation after midnight. It seems very success- 
ful in the first stage (cholerine). After the vomiting begins it is con- 
sidered useless [Dr. Griesselich.). Also useful after the consecutive 
fever stage begins in a typhoid form; there are: stupid insensibility, 
optical illusions; confusion of the senses. 
Phosphorus—has all the symptoms of Phosphoric-acid, wTith the 
addition of violent thirst, and amelioration by rest. 
Secale-cor.—Distortion, jerking and convulsive movements of the 
limbs; great desire to sleep ; coldness in the back, abdomen and limbs ; 
cold clammy perspiration; suppression of urine ; pains in the extremi- 
ties ; vertigo on looking upwards, relieved by lying down. Secale has 
all the symptoms of Phosphoric-acid, with the addition of cold, dry, 
livid tongue; violent thirst; serous vomiting, with white flakes ; sup- 
pression of urine; amelioration by rest. 
In fully developed cholera asphyxia, as it occurred at Breslau, 1848 CHOLEKA-ASIATICA. 
373 
arid 1849, Dr. Scliweikert of Breslau, found Veratr. first, and Secede, 
first, a drop every five minutes, in alternation, more commonly in- 
dicated than any other remedies. When asphyxia took place, Dr. S. 
relied upon Acid-phos. j either alone or in alternation with Secale ‘ 
but in a few cases he used Tinct.-phos., first or second dilution, with 
success. 
Rhus.—Anguish at heart; spasms of the muscles of the extremities 
and abdomen; pulse soft, small, frequent; skin inelastic, cold, livid; 
facies cholerica; epigastric pain; violent thirst; serous purging; sup- 
pression of urine; cold breath; hoarse, raw voice; aggravation after 
midnight. 
In the consecutive stage, when the disease assumes the form of 
typhus-fever, with delirium. The following remedies are required: 
Carbo-vegetabilis.—In the third stage (collapse.). No pulse, livid 
countenance, hoarse voice, sunken eyes. This stage often lasts two or 
three days. This remedy, thirtieth dilution, a tea-spoonful every hour, 
for six hours. Arsenic may be alternated with it, if burning in the 
stomach and thirst continue. They may be continued for four or six 
hours and then discontinued as long; after which they may be resumed. 
Coldness of the surface often remains a long time without injury. 
Lauro-cerasus.—In the typhoid stage ; torpor and stupor; lethargy 
bordering on paralysis of the brain, or entire exhaustion of the nervous 
system; expression of countenance indicating great suffering, patient 
weak, pulse slow, eyes half closed; deep sighs and moaning. In that 
torpor which follows a severe attack of cholera, wThen the patient can 
not easily be aroused, is very weak, the pulse slow, yet the expression 
of countenance is natural, Spiritus-nitri.-dulcis is of the greatest 
benefit. (Pulte, 327.) 
Aconite.—Especial Indications for Aconite.—Strong excitement of 
the vascular system / bitter, greenish vomitings; passage of lumbrici 
with the evacuations. (Jahr.) 
Aconite, says Marchesani, is especially indicated when the eva- 
cuations are whitish, with discharges of lumbrici, excitement of the 
arterial system, producing congestion, with heat, redness, full and ac- 
celerated pulse, and palpitations. 
In 1835 Dr. Bsertl, of Venice, observed an epidemic cholera cha- 
racterized by discharges of lumbrici with the evacuations. The first 
period of this epidemic manifested itself by vertigo, pressive headaches, 
nausea with desire to vomit, coldness, vomiting and diarrhoea. In the 
Becond period, there were: vomiting of bitter and greenish matter, 
vertigo, increased heat, thirst, irritable and frequent pulse, but occasion- 
ally full and strong. At the third period the pulse became extinct, 
with icy coldness of the hands and feet, continual agitation and ac- 
celerated, short and anxious respiration. Dr. Baertl found Aconite the 374 
DISEASES OF THE DIGESTIVE FUNCTION. 
best remedy for this condition. He prescribed dessert spoonful doses 
of an aqueous solution of extract of Aconite every hour, joining with 
it, if speedy improvement did not occur, injections of a weak watery 
solution of extract of Aconite. In all stages of the malady, this treat- 
ment was followed by speedy success, generally within forty-eight 
hours. (Gazette Ilom. de Leipzig, Vol. IV., p. 161.) 
Aconite has been employed with success against the first symptoms 
of cholera, and is an indispensable medicine in the tumultuous reactions 
which follow these attacks. A fewT doses are quite sufficient to combat 
these reactions. [Kummel, Gaz. Ilom. de Leipzig, Vol. XXXV., 
p. 328.) 
In almost all cases, says Schneider, of the vascular excitement which 
accompanies the development of the first stage of simple cholera, a 
few doses of Aconite will suffice to tranquilize the pulse and equalize 
the circulation. [Gaz. Horn, de Leipzig, Vol. XXXVI., p. 277.) 
In the ischuria which accompanies cholera, Aconite, says Peterson, 
has been employed with great benefit. Three doses of the ninth at- 
tenuation afforded relief in about twelve hours. (Annales de Ilartlaub 
et Trincks, Vol. III., p. 75.) 
In a case of sporadic cholera, in a young man, following a chill and 
errors in diet, the following phenomena were present in the night: 
suddenly a cramp-like pressure and tension in the stomach; then at 
the expiration of two hours, shaking chills, nausea, vomiting of acid 
mucous matter, cramps in the legs, watery diarrhoea, cold sweats, cold- 
ness of all the limbs, agitation, convulsive movements and distortions 
of the limbs, face sunken and earthy, pulse weak, extreme muscular 
debility, eyes dull and expressionless, prostration of all the vital 
forces, inability to speak. A few minutes after a dose of Aconite, 
twenty-fourth, the vital heat returned, and the pulse became stronger; 
in two days the patient was cured. (Kamvierer, Hygea, Vol. IV., 
p. 490.) 
In Asiatic cholera, says Dr. Quin, Aconite is indicated when Vera- 
trum, Cuprum or Camphor have arrested the evacuations, and an 
inflammatory condition only remains. (Therap. du Cholera Asiatigue, 
p. 24, 27.) 
Reubel says: After the third period of cholera is happily passed 
there often returns a reaction of the vascular system, in consequence 
of which blood accumulates either in the liver, the lungs or the brain. 
The cure then depends upon the promptness with which the physician 
recognizes the seat of this congestion. In cases where the violence 
of this reaction does not permit us to distinguish at once the organ 
most threatened, we ought to make use of an aqueous solution of from 
six to ten drops of Aconite. [Ilygea, vol. VII., p. 397.) 
After the cessation of the actual cholera symptoms, sanguineous ALLOPATHIC TREATMENT OF CHOLERA. 
375 
congestions often occur, which may become so violent as to result in 
inflammations. In such cases says Tretzer, Aconite is an efficacious 
medicine. {Ilom. de Leipzig, Vol. XXXVII., p. 82.) In this con- 
secutive stage Aconite becomes important when the reaction begins with 
a full and bounding pulse, anxiety and other symptoms of fever. 
Adjuvantia.—In the beginning of the attack the patient should b6 
placed in bed, well covered, and hot bottles or stones placed around 
him; Camph. every five minutes, rising to higher dilutions in succession, 
till warmth, perspiration, &c. return. In this state he should remain 
without change for eight or ten hours; and much longer if a tendency 
to relapse remains. 
In the second stage, the covering should be still warm, but left to 
the patient’s choice. In the cramps of the muscles, friction with the 
dry hand is the best remedy. It also aids materially in restoring heat 
to the extremities. If the disease has advanced to the third stage, the 
same general external measures may be pursued. Cold drinks are 
preferred by the patient and are generally proper; but ice in small 
quantities at a time, often repeated is better. External heat can not 
be applied so as to produce w’armth of the surface, and is most oppres- 
sive. Pulte recommends wrapping the patient in a sheet wrung out of 
cold water, repeating it after a few hours, if desired, and adding another 
blanket when reaction begins. None of these measures have in them- 
selves any power to control the violent symptoms. The spasm and 
debility are only removed permanently by exciting the proper action of 
the secretory cells of the liver. “ Sanguis solvit spasma,” was an 
aphorism of Hippocrates. When the circulation is equalized the spasm 
ceases. (Gayley, Amer. Jour. 1850, p. 88.) 
Allopathic Treatment. 
All treatment that has ever been successful in the cure of cholera 
has effected it on truly homoeopathic principles. Mercurius, in some 
form, has the most clearly defined power of exciting, through successive 
over-stimulations, that exhaustion of vital power in the liver which 
leads to inaction, cessation of the function of secretion, torpor, and 
thence congestion of the organ, which forms the characteristic feature 
of cholera. The size of the dose is less material in cholera asphyxia 
than in any other disease known to me; the mucous membrane, with all 
the fine vessels through which the medicine should he absorbed, is being 
constantly loosened and washed away by the serous exudation; and 
the blood vessels are already so full that the process of absorption is 
almost entirely suspended. The danger then in giving Mercurials in 
large doses consists, not in the poisonous powers of the medicine, but 
in the failure of the absorbing vessels to take it up. The most we can 376 
DISEASES OF THE DIGESTIVE FUNCTION. 
expect is that an infinitesimal quantity may be absorbed; arid if it is, 
the disease will be arrested. In the summer of 1834, when occupied 
day and night with cholera patients, I took the disease. After the 
characteristic vomiting had proceeded for some hours, I took forty 
grains of Calomel every four minutes until one hundred and sixty 
grains had been taken. The only effect of this was, to suspend the 
vomiting immediately, and there was a gradual return to health in the 
course of two days; there was no purgative effect from the Calomel; 
and, so little did I then regard its powers for good or evil in cholera, 
that I took nothing to carry it off. The slightest perceptible tender- 
ness of the gums a few days after, reminded me that the remedy was 
not entirely insignificant. 
The extent to which Calomel has been carried in allopathic practice 
in cholera is sufficient to shoAv that the size of the dose has little to do 
with its curative effect. It is only partially homoeopathic to the disease, 
and in this imperfect degree it has shown some power in arresting 
some of the alarming symptoms, whatever sized dose has been employed. 
In 1832, cholera in a malignant form was prevailing at Campeachy, 
Yucatan. “On the seventh day of the pestilence, when the burials ex- 
ceeded three hundred,” Dr. Perrine, the American Consul, declared to 
the city council, that he “ had not yet seen one patient die who had 
retained forty grains of Calomel in the stomach one hour, administered 
■while heat and pulse yet remained.” He said: “In all cases of cholera 
the first object is to arrest the flow of serum into the intestines. That 
Calomel does this is not doubted. Whether we class it among the 
diffusible stimulants which calm irritation, or the astringents that con- 
tract the exhalent vessels, I neither know or care. Forty grains of 
Calomel will arrest this intestinal effusion. In many cases within half 
an hour the whole surface has become warm; the cramps have ceased 
and vomiting has not again returned. The size of the dose in this 
disease is unimportant, salivation may result, but it is as liable to result 
from five grains as from five hundred.” In Lexington, Ky., it was com- 
mon to take even a fourth of a pound in two days. All experience in 
this disease, as well as others, shows, that, a remedy partially homoeo- 
pathic gives only an unsatisfactory success, even wffien given in the 
largest doses. Whereas, a true specific produces the best results in 
doses which those unacquainted with the true law of cure regard as 
inefficient and inappreciable. This remark applies to all other dis- 
eases as well as to cholera. (See pages 116 to 121.) 
3. CHOLERINE. 
Cholerine.—A disease which often precedes and also follows Asia- 
tic cholera. It is a diarrhoea in which the evacuations are of the ordi- 
nary feculent character, accompanied by rumbling of the bowels and INTESTINAL CONCRETIONS. 
377 
caused by the epidemic constitution of the season under the cholera 
influence. It may be excited by debilitating influences of all kinds : 
fear, grief, &c. (Pulte, 328.) I have seen it run rapidly into well- 
marked cholera, on hearing the cry of fire in the street. In a cholera 
season it may be regarded as the beginning of the fatal pestilence, and 
should be promptly treated in whatever form it may appear. I have seen 
it excited in a whole family by the use of water from a well, that had 
not been used for a few days. In 1842, a choleroid disease was origi- 
nated in New-York by the eating of smoke-dried beef, prepared from 
diseased animals. (Ilosack's Report.) 
Treatment.—When caused by grief: Phosphoric-acid and China in 
alternation. 
If caused by fear: Chamomilla, a few small doses. 
If attended with bilious rheumatic symptoms, as headache, pains in 
the limbs, arms and back, chilliness, or approaching to a typhoid state : 
Bryonia and Rhus, in alternation, every two hours a dose, till four doses 
are taken, then wait twenty-four hours. If the diarrhoea continue, China 
and Phosphoric-acid in alternation. 
The disposition to diarrhoea which prevails in a cholera season is re- 
moved by Sulphur, two doses on successive evenings, and avoiding all 
other remedies for one or two days. 
As principal remedies for the prevention and cure of cholera, Cam- 
phor, Veratrum, Cuprum, and Sulphur are recommended to be kept 
always at hand by persons or families liable to be invaded by cholera. 
Dr. Pulte says : In 1849, these remedies with printed directions for 
their use were in the hands of every homoeopathic family in the city 
of Cincinnati. The disease was as severe and as generally fatal there 
that year as in any other city of the same size. But under homoeo- 
pathic practice 2410 patients were treated, and of these only eighty- 
five died or only about 3-1 per-cent. 
Genus X.—INTESTINAL CONCRETIONS .—ENTEROLITHUS. 
1. Intestinal Calculus.—Substances accreted into solid masses in 
some part of the alimentary canal, more frequently in the caecum or 
colon, sometimes in the stomach. Bonetus found in two instances 
stones in the stomach as large as a hen’s egg, each weighing four 
ounces. In some cases they consist chiefly of earthy deposits, in ob- 
scurely crystalized layers, around a distinct nucleus; in others they 
are composed of indigestible substances taken into the stomach as food. 
They are often formed in concentric layers and radiated from a central 
nucleus, often a gall-stone, or some foreign body. 1. The nucleus when 
a gall-stone is composed chiefly of cholesterine, the yellow coloring 
matter and the resin of the bile, surrounded by layers of a mixture of the 378 
DISEASES OF THE DIGESTIVE FUNCTION. 
phosphate of lime, and of the ammoniaco-magnesian phosphate, with 
animal matter. Haller thought, the saline constituents furnished by 
the pancreatic-juice, and the resinous parts derived from the bile. 
2. The nuclei composed of foreign bodies. These are common in 
Scotland, where the people live much on oaten bread. The beard and 
fibres of the husks of the oat resist digestion, and collecting together 
form a nucleus around which saline matter with successions of layers 
of fibres can collect. 
A case is given in Dr Cox’s Medical Museum (No. 8) of a miller’s 
horse, which had colic and obstinate obstruction of the bowels, and 
died in three days. In the caecum and colon were found one-hundred 
and thirty-four stones, of which one weighed four pounds ; it was large 
for this weight, as a common calcareous stone of the same size weighed 
three times as much. The stones were accounted for by the existence 
of the gravelly particles rubbed from the mill-stones and mixed with the 
bran fed to the horse. Mr. Siebald, of Ulm, said, he had seen a stone 
of this kind, that weighed seven pounds. In the collection of the Ame- 
rican Philosophical Society there is a stone, taken from the duodenum 
of a horse, that weighs eighteen pounds. 
Concretions of a different character are formed in the intestines of 
persons who have taken large quantities of magnesia or chalk, for the 
purpose of correcting constipation or acidity. The concretions in these 
cases consist of those earths cemented together by thick mucus. In 
some persons who have long had the bowels in a costive state, concre- 
tions are formed of faecal matters with earthy phosphates and inspis- 
sated secretions, sometimes hardened to the consistence of calculi. 
Intestinal concretions are sometimes quite large. The first Monro 
found some seven or eight inches in circumference. 
Diagnosis.—When the concretion is of a large size, and the patient 
begins to be emaciated, a very hard, painful, globular tumor may be 
felt in the abdomen, by placing the patient on his back and relaxing 
the abdominal muscles. It is found most frequently in the position of 
the caecum or ascending colon, and can in but few cases be made to 
change its place by careful manipulation. The digestive powers are 
much impaired and the patient becomes greatly debilitated and ema- 
ciated ; pulse at first little affected; much pain and tension in different 
parts of the intestines; there are occasional attacks of nausea, vomit- 
ing, tormina or purging; pain referred to one spot, and aggravated by 
taking acids or food difficult of digestion; constant disposition to go tc 
stool, and sometimes dysenteric, watery, scanty evacuations, with viscid 
ropy mucus or blood. Some patients have to abstain from solid food; 
others reject much of what they take. 
Causes.—Sedentary occupations, inactivity, indolence; injudicious 
use of Magnesia as a purgative; swallowing of husks or beards of oats, INTESTINAL CONCRETIONS. 
379 
fragments of bones, stones or seeds of fruits. Constipation onginating 
in habitual use of purgatives. 
2. Bezoar-stone.—(Persian pazachar, against poison) ; a concretion 
or calculus, of an oval or orbicular form, found in the stomach, gall 
bladder, salivary ducts, pineal gland, and especially the intestines of 
various animals. On analysis the bezoar-stone is found to consis 
chiefly of bile and resin. The oriental stories of their origin and of 
their wonderful properties are all fabulous. So efficacious were they 
once thought in counteracting the effects of poisons and as preservatives 
against contagion, that they were sold at ten times their weight in gold; 
they were also hired and worn round the neck, as in Portugal, at the 
rate of ten shillings per day. They are now regarded as nothing more 
than common gall-stones, and no value is ascribed to them. 
8. Scybala.—Intestinal concretions sometimes consist of fragments 
of sewing-threads, paper or other substances, which have been thought- 
lessly chewed and swallowed. Persons who indulge in such habits, 
often become the subjects of obscure abdominal diseases, and at length 
manifest tumors or accumulations in the caecum or colon. In one case, 
after numerous physicians had disagreed on the nature of an abdominal 
disease, a series of twelve solid masses, from the size of a filbert to that 
of a walnut, were evacuated. These concretions were found to consist 
of a substance resembling pasteboard, of a brown color, containing 
earthy particles. On maceration they exhibited nothing but coarse 
paper, partially reduced to a pulpy state, agglutinated with mucus, por- 
tions of faeces, and a little phosphate of lime. The patient had, some 
years before, been in the habit of chewing and swallowing pieces of 
coarse gray paper. Their expulsion was followed by the disappearance 
of all the symptoms. 
A Form of Intestinal Concretions is common in large cities in 
which no unusual substance has been taken or passed into the 
bowels; but there is a compact mass of considerable size in the acend- 
ing colon which passes for a tumor. The patients are all sufferers 
from dyspepsia. They can take no food without distress; they have 
formerly been in the habit of taking purgatives frequently; have ceased 
to drink water even in the smallest quantity; all the secretions are de- 
ficient; the skin is dry, swarthy, wrinkled, mummy-like ; the countenance 
devoid of animation; constipation; perspiration, if any, is thick, clammy, 
foetid ; the mind gloomy, peevish, hopeless. In some of these cases 
there is a solid stony or earthy concretion, as Monro found one of seven{ 
inches circumference ; but this is rare. Much more commonly the con- 
cretion is made up around some solid substances injudiciously swallowed; 
as the cherry-stones, of which Helm in a fatal case found three-hundred 
in the caecum and adjoining ileum. And, more frequently than any 
other intestinal concretion or tumor, we meet with faecal accumulation 380 
DISEASES OF THE DIGESTIVE FUNCTION. 
in the enlarged caecum and colon. Such was that found by Oilier in 
the case of De Saussure. After being the first to measure the crater 
of iEtna, and to explore the summit of Mont Blanc, this philosopher died 
of an accumulation in the distended caecum, which better medical treat- 
ment would have remedied. 
In some recent cases involving chiefly the ascending colon, we no- 
ticed the breath as very offensive ; tongue loaded or furred; lips and 
gums bloodless ; muscular energies much diminished; appetite almost 
extinct; some headache ; abdomen tumid; constant uneasiness caused 
by spasmodic efforts to pass the offending matter forward, threaten- 
ing dysentery; pulse very soft and weak, but nervously rapid. The 
patient inclines to crouch down forward, pressing the hand on the 
tumor. Constant moaning, and short irregular breathing ; general las- 
situde ; faintness on assuming the erect posture. The worst cases were 
females advanced in age. In all, the alvine evacuations were infrequent 
and very small; in one there was nothing passed for several weeks. 
The treatment of intestinal concretions will readily be seen under 
constipation, dyspepsia and ileus. In the cases just referred to we suc- 
ceeded in all with Nux-vomica, insisting upon a gradual but speedy re- 
turn to the habit of drinking plenty of pure fresh water. See p. 297. 330. 
Genus XI.—HELMINTHIA.—INTESTINAL WORMS. 
Species of Worms found in the Human Body.—Taenia solium ; 
Taenia lata ; Tricocephalus, or trichuris; Ascaris vermicularis ; Lum- 
bricoides. 
1. Taenia or Tape-worm.—A long tape-like worm, formed of a chain 
of flat articulations united together by a membranous border, varying 
in breadth or thickness; each of the links is possessed of independent 
vitality and capable of becoming a distinct worm. Brera describes one 
in the cabinet of the University of Pavia, which exceeded two-hundred 
and thirty feet in length. They have been seen one-liundred and fifty, 
three-hundred, and even eight-hundred feet long. (Copenhagen 
Transactions.') 
The species called armed tape-worm is found exclusively in the 
human subject and is with difficulty dislodged, as its head is armed 
with two small fangs, which it insinuates into the mucous membrane of 
the intestines. It is generally dislodged in joints which resemble 
gourd-seed. Taenia lata is unarmed and more easily expelled. 
2. Tricocephalus.—This parasite is seldom seen. Length from one 
and a fourth to two inches; external surface marked by transverse- 
lines like rings. One part of the body terminates in a filamentous 
elongation, as fine as a hair and coiled up in a very singular manner; 
another portion ends in a broad and obtuse hook, resembling the pistil INTESTINAL WORMS. 
381 
of a leguminous flower. From this extremity the worm “can put forth 
a sort of tube enveloped with a sheath.” Found in the ileum and 
caecum. (Brera, p. 44.) Dr. Stokes exhibited a preparation of a 
caecum containing the tricocephalus in his lectures. 
3. Ascaris vermicularis, or Ascarides.—Very common and often 
discharged in incredible numbers. Round and thread like, very slender 
and only from one-fourth of an inch to an inch in length. They move 
with great celerity, and when touched contract to near one-half their 
length. They reside in the large intestines, and are most abundant in 
the rectum near its termination. But they are sometimes found in the 
stomach; and Brera says, he found them in masses in the oesophagus 
of a woman. 
4. Lumbricoides.—Resemble in shape the common earth-worm ; 
white or flesh color, perfectly round and of the size of a goose-quill; 
abdomen yellow and transparent; length from four to twelve inches; 
most common in the small intestines, hut sometimes found in the 
stomach, colon, and rectum ; children more subject to them than adults. 
They are often discharged in great numbers, sometimes united in balls 
rolled together. 
Diagnosis.—Symptoms.—Worms in the intestinal canal may pro- 
duce any of the usual spasmodic or convulsive diseases. By irritating 
the nerves of the prima-via they may originate chorea, catalepsy, te- 
tanus, paralysis, mania, or convulsions. To the same cause are also 
attributed pleuritic and rheumatic pains, dysentery, remitting fever, 
hydrocephalus, consumption, chronic spasmodic cough, &c., &c. The 
presence of worms is more commonly indicated by: pale and leaden 
color of the face, occasionally flushed with fever; bluish streak under 
the eyes, which are dull and heavy; pupils dilated or much contracted ; 
lower eye-lids and upper lip tumefied, especially while sleeping; itch- 
ing in the nostrils ; picking at the nose; foetid breath; disturbed sleep, 
during which the patient grinds his teeth, is disposed to lie on the ab- 
domen, and suddenly start up and scream as if frightened ; tingling in 
the ears ; giddiness ; interrupted speech ; palpitation of the heart, mus- 
cular debility; pulse frequent, corded, or intermittent; dry spasmodic 
cough ; irregular and depraved appetite ; abdomen swelled and hard ; 
diarrhoea or constipation; evacuations unnatural, slimy and fetid; prick- 
ing and tearing pains in the abdomen; emaciation, convulsions, para- 
lysis, &c. 
Signs of Lumbricoides.—Pricking and rending pain in the umbili- 
cal region ; colic with rumbling noise in the abdomen, caused by this 
wrorm irritating the mucous membrane with the sharp cutting point of. 
its head. 
Signs of Ascarides.—Irritation and intolerable itching and prick- 
ing pain with swelling at the extremity of the rectum. They some- 382 
DISEASES OF THE DIGESTIVE FUNCTION. 
times produce inflammation of the rectum, and discharges of blood with 
tenesmus, and are exceedingly difficult to remove. 
Signs of Tcmia.—Sense of weight and pain in the abdomen ; with 
burning, arid feeling of something alive in the bowels ; “ prickings or 
rather bitings felt in the region of the stomach; the abdomen swells 
at intervals and then subsides; sense of cold in the abdomen; appetite 
voracious; complexion livid; pupils dilated; vertigo; vomiting; the legs 
vascillate and the whole body trembles convulsively ; small substances 
resembling gourd seeds or lemon seeds passed with the faeces, which 
are found to be portions of these worms. (Brera, p. 147.) Some 
authors say, there is an uneasy feeling on hearing music. Though the 
concurrence of many of the above symptoms may indicate the presence 
of worms, it is also certain that any one of them may arise from other 
causes. 
Diseases and sympathetic Effects produced by Worms.—Nympho- 
mania in females, and seminal emissions in males : epilepsy; hysteria ; 
convulsions, dilatation of the pupils; amaurosis, symptoms of hydro- 
cephalus, and even mania. Kraus says, one man of advanced age was 
effected with immoderate fits of laughter. In one case the convulsions 
caused by worms were soothed by music, like those caused by the bite 
of the tarantula. In a case, mentioned by Hoffmann, yellow vision was 
caused by worms. Many cases of mania and aphonia were relieved by 
expelling worms; one man had spasmodic action of the muscles of the 
eye, which inverted the eye-ball, causing it to present the appearance 
of a globe of flesh. A case is reported by Serres, which resembled 
hydrophobia; some cases of cures are supposed to have been of this 
kind. Stokes says, he saw a child which had convulsions, coma and 
dilated pupils; twro eminent physicians declared the case to be one of 
hydrocephalus; treatment directed to the head had no effect; but some 
lumbrici were expelled, and in two or three hours there was improve- 
ment, and a speedy recovery followed. He says, he tried to relieve a 
boy of intermitting difficulty of respiration, with wheezing, loud ring- 
ing, incessant cough coming on in the night; but Calomel, Ipecac., and 
Tartar-emetic made the case worse. There being a swollen abdomen 
and constipation, he gave some Castor-oil and Ol.-Terebinth, which 
brought away some lumbrici; following this with a syrup of cowhage 
(Dolchicos pruriens,) a large quantity of thread-worms were expelled 
and the cough ceased. A young girl had chronic bronchitis and hepa- 
tization of part of the left lung, and they gave her some cowhage 
and aloes, the cough ceased, and respiration became perfect in that 
ung. Ramsay, of London, says, haemoptysis may be caused by 
worms; Stokes says, consumption also may result from the irritation 
produced by wmrms. 
But it is quite as common to attribute too much to worms as to over- INTESTINAL WORMS. 
383 
look their existence; a disease may happen to exist at the same time 
with worms without having been caused by them. The same remedy 
which expelled the worms, may have been appropriate for the attend- 
ant disease. And children are very frequently injured by treating 
every species of intestinal irritation with anthelmintics and drastic pur- 
gatives. Nervous and hysterical persons easily imagine the presence 
of worms or other living creatures in the intestines, and can never be 
satisfied with any reasoning until they see the parasite expelled. Such 
fancies often exist in the minds of incurable hypochondriacs. 
Dr. Morton, of Ohio, proposes to distinguish diseases, caused by 
worms, by the following additional symptoms, which, when united with 
others, are “ unerring.” “ A pearly whiteness of the sclerotica of the 
eye,—a brilliant shining carmine tinge of the lips, particularly the 
upper,—and a peculiar almost indescribable expression of the alae nasi, 
which can be compared to nothing except the expression seen in the 
same organ in the facies-hyppocratica.” ( West. Med. Jour., vol. 6. p. 82.) 
Causes.—What is the origin of intestinal worms ? It has been ge- 
nerally supposed that they are introduced into the stomach, either in 
the egg-state or more fully developed in food or drink taken into the 
stomach or in the air breathed into the lungs. But it has been shown 
by Muller, that the worms found by Linnaeus in the marsh in Lap- 
land, and pronounced the same as those existing in the human body, 
have never been found in the body of any animal whatever. The intes- 
tinal worms found in the human body, exist no where in the external 
world, either in any article of food, in earth, in water, or in air. Brem- 
ser examined 15,000 species of worms in the cabinet of Vienna, and 
could easily distinguish those belonging to the human intestines. It is 
not possible that they can have originated without the body, and under- 
gone a change of structure by being transplanted to a new locality ; for 
no specimen has ever been seen which was in the transition state be- 
tween one species and the other. And the most distinguished physi- 
cians and pathologists have come to the conclusion, that they must 
have originated within the body. 
1. They have a peculiar structure, differing from all worms found 
elsewhere. 
2. The worms found in different animals have all their own pecu- 
liarities. 
3. Worms are found in different parts of the human body, in the .cel- 
lular tissue, the liver, the gall-bladder, the lungs, the trachea, the brain, 
heart, kidneys, and spleen. They have been found in the air-bladder 
of a fish, in the ovaries of a woman, in an aneurism of the mesenteric 
artery of a horse, in the anterior chamber of the eye of the horse, of 
birds that had just broken the shell; and in the human eye; in the 
human foetus; and there are worms peculiar to certain structures, that 384 
DISEASES OF THE DIGESTIVE FUNCTION. 
have never been found any where else. Though each structure lias 
worms no where else to be found; and we never find any one of them 
in the act of passing from one of these situations to another, or detect 
it in the structure from which it might be supposed to have travelled. 
Dr. Stokes thinks, that all these parasites originate in the places in 
which they are found by an original generation “ the result of one orga- 
nization taking place within another—the production in fact of a dis 
tinct being.” 
The theory of Bremser and others is that intestinal worms are 
formed by the presence of nutritious matter in the 
digestive tube. Food taken into the stomach under ordinary circum- 
stances is converted into a substance fitted to supply the waste and 
wear and tear of the living body; and when this process is not per- 
fected, it is not taken up by the absorbents, and is then converted into 
an animal substance; this theory explains why worms so frequently 
occur in cases where the assimilating powers are weak, in persons who 
have great appetites and weak digestion, and in children with diseased 
mesenteric glands. (,Stokes in London Med. Jour., May, 1834.) 
Bremser says, a monk, who had lived for sixty years in good health on 
animal food, suddenly changed his diet for one of milk and farinaceous 
vegetables. After a few days he was troubled with flatulence, sour 
eructations, colic, &c. Remedies carried off a mass of tape-worm 
The monk resumed his former habits and recoved his health. 
Pathology. — Broussais taught, that worms were always asso 
dated with a chronic inflammation of the gastric intestinal surface 
But it is known that worms exist in connection with every possible con- 
dition of the intestinal canal, even when it presents the appearance of 
perfect health. Andral says, that they are almost always enveloped 
in a quantity of mucus, and he found some redness in the place where 
they lay, which was caused by their presence. They are rapidly ge- 
nerated in some animals in their best state of health. 
Pathological Changes effected by Worms.—Fischer, of Vienna, 
saw two circular orifices in the colon of a female which communicated 
with a cavity in the peritoneum, and alumbricushad passed half its length 
from the colon into the peritoneum. A similar worm had entirely passed 
into the peritoneum. Andral saw a young man, in whom a tumor 
formed near the umbilicus, which afterwards gave way and discharged 
a lumbricus and a large quantity of puriform matter. Worms and pus 
were also found in the peritoneum on dissection. (Pathol. Anatomy.) 
Bi'emser examined a dead fish, from the abdomen of which a worm had 
made its way to the outer world, had perforated the abdomen in another 
place, and had returned part of the way into the body. In one well 
authenticated case a lumbricus was discharged through a tumor in the 
groin of a woman; and, during the progress of the case more than one- INTESTINAL WORMS. 
385 
hundred more worms passed out through the opening. In another case 
twenty-four worms were discharged through an opening, which was 
formed by ulceration in the right hypochondrium. In some of these 
cases it has been supposed, the worm that first escaped perforated the 
intestine, but in the most of them it is evident that the aperture was 
formed by inflammation and subsequent ulceration, first excited by the 
irritation of a mass of worms. The inflamed intestine forms an adhe- 
sion to the walls of the abdomen; the different structures, in their 
turn, ulcerate, and the worm and his accompanying mucus, pus, and the 
contents of the bowels are conducted to the surface. In one case, 
mentioned also by Stokes, a lumbricus made its way from an abscess 
of the liver through the parietes of the abdomen. On dissection, the 
abscess was found to have a connection with the stomach, from which 
it was supposed the parasite had passed into the liver. 
Conditions in which Worms are most rapidly produced.—Most 
common in debilitated cachectic children under six or seven years of 
age. Their digestion is imperfect; gastro-intestinal mucous mem- 
brane irritable and in a low state of vital power; food but partially 
digested undergoes some other decomposition. A diet of unripe vege- 
tables, containing too much sugar, and deficient in tonic ingredients 
favors the formation of worms. By an old law of Holland, criminals 
were often condemned to live on bread without salt. The effect, says 
an author, “was most horrible; these wretched creatures were de- 
voured by worms engendered in their own stomachs.” The want of 
salt in the food of sheep originates the disease, called the “ fluke” or 
“ rot.” It oftenest commences in low and damp pastures or where sheep 
are too much crowded together. Worms are said to be sometimes epi- 
demic, or endemic in particular localities. It is said, that the Swiss, 
who live much on vegetables, are very subject to worms. 
“Worms are to the intestinal mucous membrane, what the acarus is 
to the skin, and are best removed by the ordinary anthelmintics. The 
general or radical treatment to prevent the morbid secretions upon 
which the worms are supposed to feed is indispensible ;” but it is always 
proper to preface it by the active expulsion of the parasites. 
Dr. Epps says : [On Constipation, p. 171), “ Worms exist alive in the 
stomach and bowels. The unscientific physician gives emetics and 
purgatives to expel them,” but by this treatment he does not remove 
the diseased condition in which they originate. John Hunter first ex- 
plained the process by which the disordered stomach secretes the gas- 
tric juice of a perverted character which permits the parasites to live 
in the stomach. 
You I.—25. 386 
DISEASES OF THE DIGESTIVE FUNCTION. 
Diseases connected with the Presence of Worms. 
VERMINOUS DIARRH(EA. 
It is common during the warm seasons of spring and early summer, 
and sometimes supervenes upon cholera infantum. It continues, when 
not checked until the emaciation is extreme; and it often proves fatal, 
The attendant fever, irritability of stomach, vomiting, thin, watery, 
fetid alvine discharges, thirst, and impaired or extinct appetite corres- 
pond almost entirely with cholera infantum. But the characteristic 
symptoms which denote the presence of worms are, in the earlier stages, 
the prominent features of the disease. 
Causes.—Catarrh retroverted upon the mucous membrane of the in- 
testines ; improper use of fruit, indigestible diet. Once induced, it is 
kept up by enteric verminous irritation in children in whom these en- 
tozoa already exist. In many cases the disease is originally excited 
by them. 
Treatment.—The ordinary treatment for worms will be sufficient 
to begin with; but specific remedies for the correction of the dyscrasia 
•which favors the continual production of worms are necessarily, asso- 
ciated with treatment proper for the diarrhoea. 
Spigelia, followed by Cinnabar, will succeed in ordinary acute cases. 
In chronic, or sub-acute cases, the difficulty is greater. The patient 
is enfeebled, emaciated, and the mucous membrane of the stomach and 
bowels is rapidly becoming disorganized, and effusion on the brain is 
threatened. In these cases the treatment directed under follicular 
enteritis will be proper. 
Rheum in the form of a diluted syrup is peculiarly suited for children 
in this disease. When persistently used it changes the action of the in- 
flamed or irritated mucous membrane to a similar though different action. 
Diospyrus or Persimmon.—A tincture diluted with water has been 
highly successful in the Southern states. 
Terebinth.—This remedy is specific against worms, as well as 
against the mucous inflammation of the bowels. If diluted with some 
syrup or emulsion it may be given in doses of one drop or less. 
Diet.—In all cases permit the use of such food as is appropriate for 
follicular enteritis, {which see.) Flannel should be worn next the skin, 
which is usually cold and bloodless. 
Treatment of Worms.—The indications are : 
I. To expel the worms; II. To prevent their reproduction. 
1. Anthelmintics.—Those in popular use, which act mechanically, 
are, filings of tin, Dolchicos-pruriens, pulv. Charcoal, and Crude-mer- 
cury. Of these the second, Dolchicos-pruriens or cowhage is the 
only one much used. The legumes are beset with stiff hairs, which, INTESTINAL WORMS. 
387 
when applied to the skin, excite intolerable itching. Generally given 
in form of an emulsion to expel ascarides. 
We never prescribe any of these articles. 
Ascarides are often removed in great numbers by injections of a de- 
coction of aloes and milk ; also by injections of cold salt-water. 
Among the specifics which destroy worms by some poisonous pro- 
perty, are a great number of vegetables, most of which are remarkable 
for a strong and peculiar odor: as Valerian, Assafoetida, Camphor, 
Geoffrea-inermis, Chenopodium-anthelminticum, Artemisia-absinthium, 
Tobacco, Garlic, Spigelia-marylandica, &c. 
Spigelia-marylandica or Carolina-pink.—Its active power is in a 
bitter substance and a fixed volatile oil. The bitter extract possesses 
narcotic powers and produces intoxication, fulness of the head, ringing 
in the ears, vertigo ; water extracts the active properties. (.Bigelow's 
Med. Botany, vol. 1. p. 144.) The whole plant is active, but the root 
possesses the most power. 
Spigelia, given in large doses accelerates the pulse, flushes the face, 
produces drowsiness, and sensation of stiffness of the eyelids. (Dr. 
Thompson, Inaug. Dissert. Phil. 1802.) Eberle says, he gave three 
or four gills of a strong decoction of the root to a boy, six years of 
age, and it produced “ complete mental derangement, precisely like 
that caused by Stramonium. The boy was affected by alternate fits 
of laughing and crying; he ran about the room, talking wildly and in- 
coherently. His countenance was distorted in the most fearful man- 
ner, the pupils greatly dilated; the symptoms subsided in twenty-four 
hours. In doses too large, the Spigelia often produces slight giddi- 
ness, dimness of sight, and dilatation of the pupils. It is often given 
allopathically in doses of ten grains or more to children. The decoc- 
tion is more often used. Given in this way, it perpetuates the disease. 
We cannot sanction the use of Spigelia in poisonous doses, but we 
have long used it for the purpose of curing the drug-symptoms above 
named. 
Gina (Wormseed.)—Ascarides, lumbrici; pinching colic and irri- 
tating pain in the umbilical region from worms ; spasms of children 
from w'orms ; during the intervals they partially sleep, rubbing the nose, 
the eyes half closed ; epileptic spasms at night; whooping cough wfitli 
worms ; bluish color around the mouth. Cina is the seed of the 
Chenopodium-anthelminticum, or Jerusalem oak, a plant indigenous 
to the United States and some parts of South America. As an anthel- 
mintic the seeds are pulverized and given in doses of from twenty to 
forty grains in syrup. But the essential oil is more convenient, as it is 
very active. A child, two or three years old, may take from three to 
eight drops of the second dilution. Dr. Morton, of Ohio, says, he cured 
one-hundred successive cases of worm-disease with this article. 388 
DISEASES OF THE DIGESTIVE FUNCTION. 
We have not in twenty years found it necessary to use any of these 
poisonous anthelmintics. 
Symptoms.—Most of the symptoms appear at night. Nightly restless- 
ness ; yawning, with sudden tremor and shuddering; disposition to 
weep or complain; tickling cough; Cramps; stupefying headache; 
weariness and soreness of the eyes; dilatation of the pupils ; paleness 
of the face ; sickly appearance ; canine hunger; diarrhoea. 
Santonine.—This is a crystallizable, fusible, volatile substance se- 
parable from the terminal flowers of the Artemisia, or Chenopodium- 
santonica (Cina, Semen-contra). Discovered in 1830, by M. Kahler, 
of Diisseldorf. It produces the pathogenetic symptoms enumerated 
by Hahnemann, as peculiar to Cina : “ Heat and flushed or puffy face, 
bluish pallor around the nose and mouth, agitation, delirium, wakeful- 
ness, and insurmountable somnolence in succession; epileptiform con- 
vulsions, palpitations of the eye-brows, dysphagia, partial spasmodic 
movements of the limbs, and cramps ; dilatations of the pupils, troubles 
of sight; frequent desire to urinate, &c.”# This shows, that Cina is not 
merely a vermifuge, but that it exerts also a homoeopathic action against 
the morbid state, which results from the presence of worms; and we 
habitually see it dissipate the symptoms for which it has been exhibitedf 
either in massive doses or in infinitestimals without having expelled any 
worms. 
Dr. Gabalda gives a case (L’Art Medical), in which all the above 
symptoms wrere caused by Santonine. They subsided without the ex- 
pulsion of worms. 
M. Martini observed, that patients who had taken Santonine in full 
doses, saw all objects green after the lapse of a few minutes, an effect 
which with some patients lasted all day. This phenomenon is attri- 
buted, not to a transient coloration of the blood-serum, but to a mole- 
cular action on the retina, by which the tension and vibratory reaction 
of its nervous molecules are changed under the impression of the lumi- 
nous rays. The eye thus affected generally sees objects greenish 
yellow. 
Ascarides.—Dr. Compiret (Amer. Med. Monthly, I860.), the best 
remedy is a “ simple injection of water, containing five, ten, fifteen, or 
twenty drops of Sulphuric-ether, according to the age of the patient, 
and repeated according to the number of the worms present. This 
agent, by its subtility readily enters into and destroys the larvae ; and 
by its antispasmodic powers it allays the spasmodic and nervous symp- 
toms produced by them.” 
Oleum Terebinthinee.—This article has long been considered the 
most certain of the anthelmintics. Turpentine, says Dr. J. Smith 
* Materia Medica Pura. INTESTINAL WORMS. 
389 
seems peculiarly destructive to vegetable life ; small insects are speed- 
ily destroyed by it; indeed no other drug exerts so fatal an influence 
over the majority of parasites which infest animal and vegetable life. 
(Lond. Jour. Med. 1850.) 
It should be given several times at moderate intervals, and in this 
manner it seldom fails to destroy the tape-worm. It has been a com- 
mon though very bad practice to give 01. Terebinth in large doses. In 
this way, though it stimulates the system generally, it passes rapidly 
through the bowels ; and the quantity absorbed seldom produces stran- 
gury. Castor-oil is added to it or given after it, and bland demulcent 
drinks freely used. Others give 01. Terebinth in doses only of a few 
drops every four, five or six hours. But such doses often produce stran- 
gury. Still smaller doses have been successful in removing the follow- 
ing symptoms: dull pain in the epigastrium; sickness of stomach after 
eating; vertigo; dry, short cough; foul breath; and choking sensation 
in the throat. Worms expelled by it in such cases appear in a dis- 
solved state. When this course is long continued, strangury may be 
produced. Camphor and large quantities of diluent drinks with mucil- 
age of Gum Arabic may be given to obviate their effect. 
In 1882 Dr. Bardwell of Indiana, gave 01. Terebinth to a sailor 
from the East Indies, who was supposed to have stone in the bladder. 
He discharged seventy or eighty lumbrici. He afterwards passed bloody 
urine and vast quantities of dirty white, hair like worms from the blad- 
der ; about two thousand were discharged. He recovered. ( W. Med. 
Jour. Yol. VII., p. 354.) 
Aspidium-jilix-mas.—M. Reschier of Geneva, has obtained from 
this plant a fatty principle by digesting the root in Sulphuric-ether. 
The preparation has an oily consistence and is used to expel the tape- 
worm, in doses of one drop, made in a pill with extractive matter. Eight 
pills are often sufficient to expel the tape-worm, though sometimes 
thirty or more, in the course of several days are required. The tape- 
worm is effectually destroyed and removed by a purgative. 
Sulphuric-acid.—1. Dr. Darrach, of Quincy, 111., says : Dr. Nichols 
ordered Sulphuric-acid aromatic, one ounce, water one and a half 
pints. The patient to drink as often as he could. On the third day 
he passed of tape-worm in fragments. The dose was repeated on 
the fourth day, but there was no more of the worm. He had been 
debilitated and emaciated, had severe cough. After the tape-worm was 
expelled these ceased; and he gained flesh and strength. 
2. Thirty years ago the same remedy was used at Cape Ann, Massa- 
chusetts. A lady took a tea-spoonful of Sulph.-acid-aromaticum and 
expelled the vessel half full of the animal. 
3. A woman in Quincy, 111., kept her bed for two years and passed 
five feet of tape-worm. Turpentine was given two days without success. 390 
DISEASES OF THE DIGESTIVE FUNCTION. 
The acid was given, three doses in twenty-four hours, in sweetened 
water. A large worm was expelled, and health and flesh returned, 
(Amer. Jour. Med. Sciences, Oct., 1860, p. 377.) 
Principal Remedies for Worms.—For Ascarides, Aeon., Calcar 
Chin., S alp h.-Capri., Ferrum, Ignat., Cinnabar., Nux.-vom., Spigelia 
Sulphur. 
When accompanied by fever:—Aeon., Bell., Gina, Ferrum, Merc. 
Spigelia. 
For Lumbrici.—Aeon., Bell., Calc., Cham., Chin., Cic. Cina, Merc., 
Natrum-mur., Spigelia, Sulphur. In scrofulous children. Iod.-sulph., 
Calcarea. 
Worms with emaciation.—Arsen., Calcar-hyperphos., Cina, Graph., 
Spigelia, Cinnabar, Iodine. 
Worms with diarrhoea.—Aeon., Cina, Cinnabar, Spigelia. 
Worms writh convulsions.—Cicuta, Spigelia. We have seen the 
latter promptly successful when the convulsions were alarming and 
had resisted several remedies. A few drops on a handkerchief and 
applied to the nostrils dispelled the paroxysms of convulsions perma- 
nently. 
Genus XII.—PROCTICA.—HAEMORRHOIDS. 
Anatomical Structure of the Rectum.—The veins of the rectum 
are very tortuous and numerous, and form between the mucous mem- 
brane and the muscular coats of the intestine quite a network of ves- 
sels. The hsemorrhoidal veins unite in forming the interior mesenteric 
vein, which with the superior mesenteric vein, the vein from the spleen, 
and the gastric vein, compose by their union, the great portal system 
vein, described as supplying the liver with blood. 
As the blood is supplied to the rectum from such various sources, 
and in such abundance, the reason is apparent why in diseased states, 
blood is discharged from these vessels; and also why in cases of 
constipation blood often passes at the time of evacuation of the 
bowels. 
The external surface of the rectum has a great resemblance to the 
external surface of the oesophagus. It is smooth and polished, with- 
out any elevations and without longitudinal depressions which are so 
evident in the colon; the only marks it presents being parallel, depen- 
dent on the powerful muscular fibres which form a part of this in- 
testine. 
In the rectum the faeces accumulate, lose their thinner parts by ab- 
sorption ; they then in the healthy state become moulded into a form 
corresponding to the shape of its upper portion. When they have 
accumulated to a certain degree they excite the rectum to contraction, HEMORRHOIDAL DIATHESIS. 
391 
and a sensation is experienced causing a desire for their expulsion. 
Their escape at any other time is prevented by two muscles, the ex- 
ternal closing muscle or sphincter, and the internal closing muscle or 
sphincter which is only a portion of the former. When the will sub- 
mits to the internal prompting to expel the contents of the bowels, 
several agencies operate together in their expulsion: 
1. The muscular fibres Of the rectum contract; 2. the diaphragm 
acts by contraction which is followed by inflation of the lungs; 3. the 
muscles of the wind-pipe close the epiglottis or valve at its top, which 
prevents expiration; 4. the abdominal muscles contract, in opposition 
to the forcing down of the diaphragm and compress tbe bowels and 
force them backward and downward; 5. and last of all, the two ele- 
vatores ani, press the rectum forward and upward, and aid in the ex- 
pulsion, and thus the contraction of the sphincter is overcome. 
1. THE HEMORRHOIDAL DIATHESIS. 
This predisposition to hoemorrhoidal disease consists in a congestive 
condition of the pelvic circulation which involve not only the rectum 
but the wltole digestive tube in inflammatory, spasmodic, or neuralgic 
affections, without taking the common form of haemorrhoids. The 
patient is often treated for disease of some other name, as gastritis, 
or gastro-enteralgia, flatulent colic, engorgements of the liver, obstruc- 
tions of the portal system, and finally for insanity. In other cases 
there are congestion, inflammation or haemorrhage of the lungs or brain 
or chronic structural disease of the bronchia, nervous headache, neu- 
ralgia, asthma. 
The superiority of homoeopathic treatment in haemorrhoidal disease 
is not due to the power of our remedies to operate upon the haemor- 
rhoidal circulation, but to their specific influence on the whole system, 
in these cases especially the abdominal venous circulation. Even in 
allopathic hands certain mineral waters and a class of remedies called 
deobstruents have sometimes benefited, if they did not thoroughly 
cure, patients who suffered from diseases of the character under con- 
sideration. Dr. Porges, has analysed the cases cured by the waters 
of Carlsbad, and found them all referrible to what he calls abdominal 
venous plethora. He has also shown that the same waters in sufficient 
doses, when taken by perspns in health, produce the same diseased con- 
ditions for which he recommends their use. 
Case by Dr. Escallier.*—A lady aged fifty-three, tall, lean and 
dark, with pimples of acne rosacea on her face; speech feeble and 
painful; slight dry cough, palpitation very constant and distressing, 
* L’Art Medical. 392 
DISEASES OF THE DIGESTIVE FUNCTION. 
worse after eating, and preventing sleep; some cerebral excitement af 
fecting the hearing, causing her to imagine that she hears the report 
of cannon or exploding rockets; some maniacal paroxysms; she has 
been reduced to a milk diet; can now hardly rise from hear seat; faints 
several times in the course of the day, and is supposed to be dying; 
flatus in the stomach or bowels increase the palpitations; pulse small, 
rather frequent, with irregular intermissions; second sound of the heart 
strong; no bellows sound; no oedema of the ankles, but she had amenor- 
rhea in youth, and then had ascites, treated by puncture, then cured 
by Digitalis. Has now flatulent dyspepsia with constipation; has had 
hysteria under various forms, sometimes accompanied by gastralgia. 
Rendered worse by sea-bathing. For this condition, she was directed to 
take Arsenicum, twenty-four, and Platinum, twenty-four, in alternation, 
twice a day, with good diet. The constipation was partially removed 
on the second day. By the third day the heart was calm; she slept, 
appetite better, digestion easier. The medicine was suspended. She 
continued to improve for ten days; when, the diet disagreeing, 
she took Nux-vom. one hundred. Next day she was doing well, medicine 
suspended. Then she continued to improve; and the difficulties of the 
heart and other organs returned no more. 
2. HAEMORRHOIDS.—PILES. 
Diagnosis.—This very common and troublesome complaint will pro- 
bably demand the attention of the physician more frequently than any 
other single malady; nor when we consider the causes which originate 
it, and their almost constant and universal prevalence, shall we be sur- 
prised at this. Any cause which operates upon the rectum in such a 
manner as to impair the integrity of its vascular and muscular struc- 
tures, may induce the disease. The effects in these cases are: a per- 
manent dilatation or varicose condition of the veins, and a relaxation 
of the mucous membrane of the part, causing tumors of various sizes, 
at the verge of the anus, and within the rectum, and in some instances, 
a protrusion of a portion of the rectum itself. When this last result 
obtains we are presented with the disease known as prolapsus ani. 
Bleeding Haemorrhoids.—Many persons experience small discharges 
of blood with the faeces whenever the blood vessels of the abdomen 
are in a state of congestion from cold or an over-stimulating diet. The 
veins of the rectum are the most dependent part of that whole system 
of vessels, which should convey their contents by the vena portae 
through the capillaries of the liver. Any influence then that retards 
the flow of blood through the liver, causes an engorgement of the 
haemorrhoidal veins. 
Symptoms of Bleeding from the Beetum,.—There is a sense of Haemorrhoids. 
393 
■weight, heat, fulness, and general uneasiness in the rectum which in- 
creases for twenty-four hours; then when the bowels act, part of the 
discharge is liquid; this consists of blood, which seems poured out 
only at the time of the evacuation; or the passage of the feces pro- 
duces the rupture of the small vessels from which the haemorrhage 
proceeds. On the next day the uneasy sensation is lessened, and it 
soon ceases altogether. The patient says, he is relieved by the flow. 
This transient relief often deceives him. If it happens to be suppressed 
by treatment, he immediately suffers from abdominal venous plethora, 
as well as from cerebral symptoms. 
When the haemorrhoidal bleeding continues long it always produces 
anaemia, debility and consequent nervous symptoms. In some cases 
the loss of blood continues for months, reducing the strength more 
obviously at first than afterwards. When the loss extends to two or 
three ounces per day there is only some sensation of numbness extend- 
ing down the lower limbs, paleness of the face, &c. 
Case by Sir Benjamin Brodie.—A lady, suffered from symptoms 
of stricture of the oesophagus; she could not swallow the smallest 
morsel of solid food, and was compelled to subsist entirely on liquids 
which she swallowed with great difficulty; these symptoms continued 
to increase for three years. A bougie was passed through the oeso- 
phagus into the stomach without meeting with anj mpediment. It 
was then suspected that the dysphagia was only a symptom of some 
other disease; her face was bleached as if she had suffered from re- 
peated losses of blood, and the feet were oedematous. On further in- 
vestigation, the whole train of symptoms were found to have originated 
in the loss of blood from internal haemorrhoids. The following remedies 
are proper for such cases: Podoph., Lobelia, Hamamelis, Sepia. 
Fluoric-acid.—Congestion of blood in the rectum. 
Lobelia.—Discharge of black blood from haemorrhoids. 
Elat&rium.—Blood from haemorrhoids. 
Haemorrhoidal Tumors. — Piles or haemorrhoids are soft tumors, 
which form either within the rectum or around the anus. In the first 
place they are covered with the mucous membrane of the intestine, 
and are termed inward piles. When situated without the rectum they 
are covered entirely or in part with the common integument. 
Haemorrhoidal tumors may be external or internal—hard or soft— 
sensible or insensible. Their general appearance in regard to color, 
ize, &c., will depend much upon the amount of inflammation present, 
the causes which have been in operation, and the length of time which 
has elapsed since the commencement of the malady. 
Internal Haemorrhoids vary from the size of a pea to that of a 
large walnut. Sometimes there is a single one, in other cases several. 
They are found immediately within the sphincter, or at some distance 394 
DISEASES OF T1IE DIGESTIVE FUNCTION. 
above it, and may be attached by a narrow pedicle, or by a broad 
elongated base. In some cases they do not protrude beyond the 
sphincter, in others they are forced outward by slight straining effort. 
Symptoms of a fit of Haemorrhoids.—It is ushered in by vertigo 
dull headache, coldness of the extremities, flashes of heat, heaviness 
bloating of the abdomen, flatulence, throbbing in the abdomen, consti 
pation, palpitation of the heart, weariness, heaviness of the limbs, des 
ponding and irritable mood, disposition to melancholy, fulness of the 
parts in the vicinity of the rectum, producing heavy pain in the neck of 
the bladder and region of the prostate; strangury, pains in* the loins 
and back, weak digestion, loss of appetite, eructations, heartburn, 
mucous coating on the tongue, burning in the abdomen and anus; dis- 
position to vomit, itching of the anus and perineum, eruption on these 
parts. When these symptoms are only partially present and the veins 
of the anus are swollen, we apply to these veins the designation of 
blind piles; if the turgid vessels bleed at more or less regular periods, 
giving some relief to the distressing sensations, the bleeding tumors 
are called fluent piles. When mucus is discharged instead of blood 
they are called mucous piles. 
During “a fit of piles,” the tumors are usually red or purple, in- 
flamed, and painful, the pain is of a severe kind, aggravated to an al- 
most intolerable degree when at stool, and accompanied by tenesmus 
and frequent discharges of blood. The location and character of the 
pains vary much in different cases, being sometimes confined to the 
tumors themselves, and at others extending upwards into the intestines 
or into the perineum down the thighs, &c. The pains may be itching, 
burning, aching, throbbing, darting, or shooting, constant, or only when 
at stool, on sitting down. 
Causes.—When the mucous membrane of the rectum is much re- 
laxed, we almost always have as a complication,prolapsus ani. Al- 
though this complaint sometimes originates independently of any 
hsemorrhoidal enlargements, in the majority of (severe) cases the two 
diseases are conjoined, and this is explicable from the circumstance 
that the causes of both are generally the same. The most common of 
these causes is habitual constipation, induced, for the most part, by 
the reprehensible practice of inattention to daily alvine evacuations. 
We have before observed that the protracted presence of indurated 
foecal matters in the rectum, gives rise to a semi-paralytic condition, 
which impairs the tone of the parts, and thus induces constipation, 
piles, and prolapsus ani. The evils, then, to which this condition of 
the lower bowels give rise, may be summed up as folloAvs: first con- 
stipation, and the numerous and grave consequences which often result 
from it, in the form of determinations of blood to the brain, lungs, and 
intestinal canal; also mania, hypochondria, neuralgia, dyspepsia, bowel HAEMORRHOIDS. 
395 
affections, colic, fistula in ano, &c.; second, piles, and its train of un- 
pleasant symptoms; third,prolapsus ani. 
Other Causes of these affections, in addition to the one already 
mentioned, are, abuse of cathartics, as Aloes and Sulphur, which operate 
specifically upon the lower portion of the intestinal tube; ascarides 
excessive exercise on horseback, long continuance in the standing pos- 
ture, or in certain other constrained positions; protracted bowel com- 
plaints, general debility, dyscrasias, sedentary habits, indulgence in 
highly seasoned food, coffee, wines and liquors, tight dressing, lacing 
the epigastric region of the abdomen, and all other causes by which 
the regular course of the circulation is interfered with. Sleeping on 
feather beds, and sitting on soft chairs are common causes. 
Treatment.—The first object with the physician in the treatment 
of haemorrhoids, should be to ascertain the cause or causes upon which 
the malady depends, so that immediate and efficient measures may be 
taken to remove them. In a majority of instances the disease is un- 
questionably connected with constipation, which should therefore 
receive a due share of attention. Nothing can remove the torpid con- 
dition of the bowel, upon which the constipation depends, unless all 
indurated faecal matters be removed daily, in order that a sufficient 
time may elapse, to enable the debilitated parts to recover their im- 
paired tone. The first step necessary to secure this result is to adopt 
suitable dietetic regulations. In many instances this alone will 
suffice to regulate the bowels, and thus to remove all traces of the 
haemorrhoidal affection. Amongst the articles of food which we par- 
ticularly commend in those cases, in wdiich the stomach is not irritated 
by it, is bread made from unbolted wheat. A liberal and daily use of 
this highly nutritious substance, and of other articles of a similar 
character, with an occasional indulgence in ripe and wholesome fruits, 
and the habitual free use of cold water as a drink (see page 297), will 
often surpass our most sanguine expectations in abolishing diseases of 
the rectum. Should these simple means alone prove ineffectual after 
a thorough trial, we may then call in the aid of enemata of cold water. 
This last resource will rarely disappoint us, provided the case is recent, 
and the cause has not been too long in operation. When the haemorr- 
hoidal tumors are much inflamed and very painful, great service will 
frequently be derived from external applications of cold water, and in 
some instances, of ice, enclosed in a linen cloth, and applied to the 
parts as long as may be deemed expedient. In troublesome cases of 
prolapsus ani, also these applications and injections will sometimes 
afford prompt relief. Water moderately cool is often better than ice. 
The medicines which are entitled to the highest consideration in 
haemorrhoidal affections are, Nux-romica, Sulphur, Rhus-tox., Sepia, 396 
DISEASES OF THE DIGESTIVE FUNCTION. 
Bryonia, Lycopodium, Opium, Pulsatilla, Aloes, Carbo-vegetabilis, 
and Calcar ea-carb. 
Nux-vomica is appropriate in choleric dispositions, when the disease 
has been caused by inactive and sedentary habits, high living, use of 
coffee or spirits, or the depressing mental emotions, and is attended by 
constipation, prolapsus, and general loss of power over the muscular struc- 
ture of the rectum; stinging, burning or itching of the anus; stitches 
and shocks in the small of the back, with bruising pain; frequent con- 
stipation; unsuccessful urging to stool; congestion of blood to the 
abdomen and head; bloating of the pit of the stomach and hypochon- 
drium; heaviness of the head, inability to think; retention of urine; 
discharge of blood and mucus, &c. It may be given in the second or 
third attenuation, one grain every night as long as is deemed expedient. 
Kali-carbonicum.—Constipation owing torinactivity of the rectum, 
passage of faeces difficult, owing to their bulk; the knobs bleed and 
swell during a stool, or when the urine is passed. 
Calcarea-carbonica.—Haemorrhoids which bleed profusely, are pro- 
truded in knobs, and become painful in walking, relieved by sitting 
down; protruding and forming a bunch externally, in evacuating the 
bowels; constipation; disposition to determination to the head, when 
the haemorrhoidal flow of blood is arrested; haemorrhage in females 
having the menses too early and too profuse. 
Muriatic-acid.— Prolapsus recti when urinating; swollen, blue, 
protuberant knobs, very painful to the touch. 
Phosphorus.—Haemorrhoids appear simultaneously with chronic 
diarrhoea in which the sphincter ani is relaxed; the stools mucous, 
liquid, and passed involuntarily. 
Nitric-acid. — Old haemorrhoids, particularly after the abuse of 
Mercury with remains of condylomata and syphilis. 
Thuja.—Excrescences on the skin, or sycotic affection, remaining 
after the local symptoms have disappeared spontaneously, or been 
driven away by local means. Symptoms: Feeling of pressure on the 
haemorrhoids, with compression; swollen knobs, protruding much: 
tenesmus; itching, burning in the anus. 
Carbo-veg. — Constant bleeding at every stool with burning and 
itching in the anus; great swelling of the tumors, and lancinating pain 
in the thighs. 
Causticum.—Constipation with ineffectual efforts of defecation, when 
the knobs impede the passage of the faeces ; the pains are aggravated 
by walking, and especially by mental labor. 
Graphites.—Feeling of weight in the abdomen; chronic constipa- 
tion, with hardness in the region of the liver; hard knotty stools with 
discharge of mucus and blood; pains in the haemorrhoidal knobs ; pro- 
lapsus ani without straining, as if the sphincter were paralyzed, (see 307 
HAEMORRHOIDS. 
its use in constipation, page 331); watery leucorrhoea at the time of 
menstruation. 
/Sepia.— Its special sphere of action is the portal circulation. Its 
effect is to retard the circulation, and cause an over-loading of the 
portal vascular system with venous blood. The condition it produces, 
and which it specially cures, is aplethoria venosa, with a correspond- 
ing state of depression. (See Meyer, in Ilomceop. Viert., dec.) 
Sulphur.—Irritable disposition, tenesmus, vomiting, griping; the 
power of Sulphur to produce these symptoms enables it to cure similar 
symptoms in cases of dysentery, hsemorrhoidal diseases attended with 
tenesmus. 
Sulphur is well adapted to cases occurring in individuals tainted 
with syphilis, scrofula, psora, or mercury. If the piles bleed frequently 
and profusely, and there exists considerable inflammation of the sur- 
rounding mucous membrane, with darting pains up the bowel, tenesmus, 
discharges of mucus or of faecal matters, mixed with blood and mucus, 
this mediciue will generally prove effective. It should be given at the 
third attenuation—one grain morning and evening, until the desired 
effect is produced. In some psoric constitutions Sulphur is effectual 
when given in high attenuation and permitted to have a long-continued 
action. 
Rkus-tox., in alternation with Sulphur or Nux, has been eminently 
useful in piles and prolapsus conjoined, which appeared to be connected 
with some latent impurity of the blood. We are accustomed to use the 
first or second attenuations in these cases giving a dose daily, and 
changing the medicine every other week. 
When the hsemorrhoidal tumors protrude, and are inflamed, red, and 
painful, with profuse haemorrhage during each evacuation, we may con- 
sider Acid-nitr., Acid-mur., Aloes, Calcarea-carb., and Sepia. 
If the disease arises during pregnancy, and constipation is unusually 
obstinate, we advise Pulsatilla, Opium, Bryonia and Platina. 
Administration.—This malady responds more satisfactorily t« the 
first, second and third trituration—given in grain or drop doses, once 
or twice in twenty-four hours. 
Case by Dr. II. C. Preston. Hamamelis-mrginica is used empiri- 
cally and with success in varicosis of the haemorrhoidal veins, except 
when coagulation has reduced the veins to hard cords. 
A woman, mother of six children, middle age, had at one time vari« 
cosis of all the veins of the legs up to the groin, cramps pains in the 
legs, preventing sleep. Bandaging the legs, and use of Hamamelis 
cured for the time. At one time after delivery, when haemorrhoids 
were in the worst state, she took Hamamelis, six drops to the tumbler 
full of water, a table spoonful every hour. This, with external use of 398 
DISEASES OF THE DIGESTIVE FUNCTION. 
a tincture of the remedy, applied with linen cloths, gave entire relief 
in twenty-four hours. It did not return. 
Aloes.—In large doses it excites griping heat at the lower part of 
the rectum and haemorrhoids; frequent small evacuations, chiefly of 
mucus, attended with tenesmus; abdomen at the same time distended 
and tender; the patient complains that the “bowels feel as if scraped;'’ 
pulse quickened; sensation of constriction of the head. Under long- 
continued use of Aloes we observe emaciation; the purgative action 
becomes more uncertain; mucus and portions of lymph, and sometimes 
matter resembling fat, being passed off with much tenesmus, enteritis, 
stricture of the rectum; some degree of diuresis where squills and 
other diuretics have failed. In appreciable doses it aggravates dys- 
menorrhoea, menorrhagia, organic disease of the uterus, haemorr- 
hoids, &c. 
3. PROLAPSUS ANI.—PROTRUSION OF THE RECTUM.—FALLING OF 
THE INTESTINE. 
This affection has often been described, as consisting in an extrusion 
of the mucous and sub-mucous coats alone through the expulsive 
power of the muscular coat of the rectum. But it is really an inver- 
sion of all the coats of the intestine. The protrusion and eversion of 
the rectum is effected by the weight arid pressure of the bowels above, 
aided by the contraction of the abdominal muscles in the act of reliev- 
ing the bowels. At ordinary times, when the sphincter is contracted, 
its strength is sufficient to resist the bearing-down forces above; but 
when the bowels act, the sphincter is necessarily relaxed, and the 
strain is allowed to tell on its lateral adhesions. The rectum is indeed, 
as well as the oesophagus and colon, provided with a strong coat of 
longitudinal fibres; but its power is rendered inadequate to its object, 
and when the bowels are long constipated, the passage of a mass of 
solid faeces will carry through the rectum an everted fold. This 
generally returns but its frequent repetition renders a 
spontaneous replacement less and less perfect. 
Causes.—Habitual constipation and frequent efforts to relieve it by 
purgatives; the tenesmus attending diarrhoea or dysentery; certain 
purgatives which operate specifically upon the rectum, as Aloes, Podo- 
phyllum, Sulphur. Calomel and Blue-mass often cause it. These ar- 
ticles, therefore, are remedies for certain cases. The protrusion of the 
rectum is also often caused by straining, as from the irritation of a 
stone in the bladder, which causes involuntary bearing down. I.x 
children this effect is peculiarly liable to occur; and if the stone be 
removed by an operation, and the cause of the straining is removed, 
the prolapsus ceases to take place. It is more common in persons de- 
bilitated by disease, or by inherited discrasias. DERANGEMENTS of tiie liver. 
399 
Prolapsus is common in children, not otherwise much diseased, and 
is usually not serious, though if neglected, it may terminate in inflam- 
mation or ulceration of the part. 
Treatment.—The tumor is easily returned; place the child for two 
or three minutes in a warm bath; anoint the protruded part with olive 
oil, and then apply gentle and uniform pressure. If the protruded 
bowel is already inflamed, it may be relieved by the aid of the fol- 
lowing remedies: 
Nux-vomica; when there is constipation and hard straining. It 
has a specific influence on this disease, as well as the constipation and 
haemorrhoids often associated with it. 
Jfercurius.—When there is diarrhoea or dysentery. 
Ignatia.—Analogous in its action to Nux-vomica. 
Sulphur.—In psoric constitutions, in which there has been diarrhoea 
or dysentery, followed by costiveness, and an evident tendency to 
relapse. 
ORDER II.—FUNCTIONAL DERANGEMENTS OF THE 
COLLATITIOUS VISCERA. 
1. THE LIVER. 
The Minute Anatomy of the Liver is thus described by Dr. Hel- 
muth.# “Each lobe of the liver constitutes in itself an epitome of 
the hepatic structure, and there are two sets of veins, one artery, and 
one duct in each lobule. Of these two varieties of hepatic veins, 
the first is the intra-lobular, which occupies the centre of each lobule 
and receives the blood from a plexus, formed in each lobule by the 
radicals of the portal vein; the second variety being those veins con- 
tained in canals, formed by the bases of the lobules, applied side by 
side, and which veins for the most part receive the intra-lobular veins; 
or in other words, in each of the minute lobules of the liver we have 
first an artery (as usual in all organs) to supply the requisite suste- 
nance to the part; 2d, a vein to carry off the effete blood; then, 3dly, 
we have blood from which the bile is extracted, contained in the portal 
vein, the secretion being carried away, or received 4thly into the ul- 
timate ducts of the acini, and following these channels to the larger 
biliary canals. 
1. Functional Derangement of the Liter.—The lungs and liver 
o 
are the great decarbonizing organs of the body, and the activity of one 
of them is always in an inverse ratio to that of the other. “In the 
lungs, carbon undergoes slow combustion, accompanied by a disengage- 
ment of heat for keeping up the animal temperature and is thrown off 
* N. Jour. Ilomoeop. vol. XI. p. 48G 400 
DISEASES OF THE DIGESTIVE FUNCTION. 
as carbonic acid. In the liver, it unites with hydrogen, and small por- 
tions of hydrogen and nitrogen, and forms bile.” In summer, when the 
temperature of the air is high, there is less demand on the oxygen of 
the air, therefore the decarbonization by the lungs is less, and the 
extra labor of getting rid of the carbon which the lungs do not throw 
olf with sufficient rapidity, devolves upon the liver. This increased 
secretion, which the liver is required to perform, demands increased 
activity in the circulation of the portal system; and all the radicles 
of the veins which unite to form the vena portarum must partake of 
the acceleration. The circulation, supplying the digestive organs 
must then be more active in warm weather and in warm climates, as it 
also is after taking food. 
Besides the lungs and liver, the skin also participates in the work 
of eliminating carbon and other effete waste materials of the body. 
As the product of its secretory function we have a sebaceous matter 
for keeping the skin soft and in a healthy condition, also the perspira- 
tion furnished by the sudoriferous glands, and a large quantity of fluid 
passing off by simple evaporation. And a further duty performed by the 
skin is a partially respiratory function, by which it aids the lungs and 
liver in the function more especially assigned to them. 
The evaporation from the skin, kept up by perspiration, keeps the 
temperature of the body at the proper point for health, at the same 
time that the respiratory power of the skin is directed in aid of the 
liver in the decarbonization of the blood. When the dew-point is low, 
these processes go on satisfactorily, when it is high, the decarboniza- 
tion is less effectually performed. This relation of the skin to the 
liver in eliminating disease-causing materials from the system, is the 
ground of that sympathy between them explained by Johnson.* When 
increased heat is temporarily applied to the skin, it is stimulated to 
over-action for a time; but this increased excitement is followed by a 
corresponding depression and diminution of the natural function of the 
over-worked organ, with increased susceptibility to the action of any 
deleterious influence. When the skin and liver have been for some 
time over-excited by heat, exercise or other undue stimulant influences, 
and are in a state of consequent exhaustion, the depressing influence 
of cold is liable to produce disease by repelling the blood from the 
surface, and causing internal congestion of the internal viscera; and, 
of these, the liver, being the most exhausted organ, will naturally 
suffer most. When the over-excitement and subsequent depression have 
been great, the result may be “bilious fever;” otherwise the tonicity 
of the system is repaired by sleep and rest, and the equilibrium is 
restored. If, however, the liver has been too much or too frequently 
* On Tropical Climates, p. 19—242. derangement of the liver. 
401 
congested, it may not be able, by the re-acting powers of its vessels, to 
press out the excess of blood thro\yn upon it; and some portions of the 
organ may remain in a state of partial congestion. If the causes 
which produced this condition continue to operate, the morbid condi- 
tions they produce continue to increase. The functions of the liver 
become obviously deranged; the stomach, the large and small intestines 
become involved. The patient now complains of a bitter taste in the 
mouth on waking in the morning, furred tongue, constipated bowels, 
languor, yellow adnata, and a heavy feeling over the eyes; and the 
skin, participating in the deranged condition of the liver through the 
“cutaneo-hepatic sympathy,” referred to above, becomes pale, dry and 
sallow. If the patient continues to be exposed to the same deleterious 
influences, especially if the atmosphere be charged with marsh miasm 
or malaria, the resisting power of the system becomes progressively 
less, till a stronger determination of blood takes place to the liver, 
spleen and portal vessels, and we have the phenomena of a chill, fol- 
lowed by the consequent re-action, called fever. 
2. ICTERUS—JAUNDICE. 
This disease was so named by the ancients, from its likeness to the 
plumage of the golden thrush, of which Pliny relates, that, if a jaun 
diced person looks on one, the bird dies and the patient recovers. 
General Characteristics.—Yellowness of the skin and eyes 
faeces white, and urine of a high saffron color. The yellow color of 
the skin characteristic in jaundice, is often only a symptom of some 
chronic structural disease of the liver. In this place we shall treat of 
jaundice as a specific disease as connected chiefly with functional de- 
rangement of that organ. 
o o 
BILIARY JAUNDICE.—From Sudden Suppression of the Biliary Secretion. 
Under this title Allison and Bright have given cases of a formidable 
character. In Allison’s case there was “ pain and heat in the abdomen 
with thirst and chilliness for seven weeks; then jaundice followed in 
two days by delirium—occasional singultus, stools bilious, coma, pur. 
puric spots on the skin, death ten days from the occurrence of jaundice. 
Liver smaller than natural—flabby—light yellow—mucous membrane 
of the ducts unnaturally white.” (.Edinb. Med. Jour) 
Dr. Bright gives two cases characterized by : “ Abdominal pain— 
jaundice—tenderness of the epigastrium—occasional sickness.—Three 
weeks after the appearance of jaundice, indistinct utterance, loss of 
power in the left hand, coma and death. Liver very small, soft or flac- 
cid, and of a reddish color. No inflammation on the capsule or in the 
ducts, which were not even stained with bile—brain congested.” (Guy's 
Hospital Reports) 
Vol. i.—26. 402 
diseases of the digestive function. 
Diagnosis.—Rokitansky says, “ it is distinguished during life by its 
acute course, extreme pain in the liver, (not a constant or even frequent 
symptom,) nervous symptoms and jaundice ; finally a fatal issue after 
fever, symptoms of blood poisoning, irritation of the brain, and its mem- 
branes, hydrocephalic softening of the brain, exudation and softening 
processes generally, and especially of the mucous membranes, pneumo- 
nia, &c. The blood in the larger vessels of the liver is thin, fluid and 
of a dirty brown color.” 
Causes.—A serious lesion of the proper hepatic nucleated cells, 
which are, perhaps, sometimes entirely destroyed. The attack has 
sometimes the features of a fever accompanied by an apparent “acute 
paralysis” of the biliary functions. The subsequent head affection re- 
sembles that which may follow any organic lesion of the hepatic struc- 
ture. The excessive drowsiness, or any other symptom denoting cere- 
bral irritation or oppression should be promptly treated. 
Among the causes of jaundice from suppressed secretion of bile, 
deep grief or other strong mental emotion may be mentioned, also the 
bite of serpents or poisonous insects, the miasm of certain fevers ; the 
noxious products of depraved digestion, and certain vegetable or mineral 
poisons. In some cases it is impossible to discover any probable cause. 
Abercrombie says, in one case, which he calls “ black ramolissement 
of the liver,” there was a sudden occurrence of deep jaundice, followed 
by frequent vomiting of black matter, and great prostration ; death oc- 
curred at the end of three weeks without any cerebral symptoms. On 
dissection the liver was much diminished in size, was of black color, 
soft and disorganized throughout, like a mass of coagulated blood. The 
gall-bladder was empty and collapsed. This case was allied to gan- 
grene. (Sw Gangrene of the liver) 
Treatment.—The usual allopathic measures for serious structural 
diseases of the liver,—active purgatives, and moderate bleeding have 
never been successful. Mercurials, Nitro-muriatic-acid, Sanguinaria, 
&c., have done better. 
Sanguinaria.*—This remedy alone is capable of curing many of 
the common cases, particularly in young persons and in the spring- 
season. In those more serious cases, in which all the vital powers are 
in a state of extreme depression, other remedies may be preferred. 
Sanguinaria acts on the liver and stomach, improving digestion, increas- 
ing ii 11 the secretions, and, when long continued, improving the condi- 
tion of the pulse and skin. In cases of jaundice, dependent on ab- 
scesses and induration of portions of the liver, intestinal accumulations, 
torpor of all the secreting viscera, it should be employed for a long 
period in sensible doses. 
* Sanguinaria was first noticed by Jacob Cornuti, 1635. 4(3 
JAUNDICE. 
Mercury.—In no form of diseases have physicians, who deny the truth 
of Hahnemann’s principles, so nearly approximated to both his theory 
and his practice as in the inflammatory diseases in which their great 
reliance has been alterant remedies. Of these Mercury is the most 
important ; and when we come to employ it according to the homcco- 
pathic law of cure, avoiding the fearful medicinal aggravations or drug- 
diseases that it has so often caused, we shall find it an agent of the 
highest value. 
Diseases caused by Mercury.—1. Increased secretions of the liver 
intestinal mucous membrane, &c., causing increased evacuations Ironi 
the alimentary canal. 
2. In smaller doses it produces excitement of the salivary glands 
and glandular system generally, excited circulation, nervous irritability, 
and quickened circulation of every tissue of the body. 
3. An insensible tranquil, alterative action, which may subvert dis- 
eased action without greatly deranging the operations of health; there 
is no perceptible quickening of the circulation, no increased vital force} 
or subversion of the accustomed action of life. 
Mercury acts in causing as well as curing disease : 
1. In a manner almost homoeopathic to certain well-known diseases, 
as “ iritis, hepatitis, or hepatization of the lungs,” which ends in the 
deposition of coagulable lymph. It has been common in pushing it to 
the extent of sensibly producing these results to cause .a strumous 
or anaemic condition which ends in phthisis or scrofula. More recently 
this action of Mercury has been called substitutive, and is relied upon 
in obstinate fevers and acute inflammations, threatening the destruction 
of vital organs by suppurative or ulcerative disorganization. The drug 
disease commonly produced in the effort to cure acute or chronic in- 
flammations with Mercury is called ptyalism. It is manifested by 
tenderness, redness and swelling of the gums, increased secretion from 
the salivary glands, often progressing to ulceration of some of the 
affected parts. See p. 248. 
3. More violent Effects of Mercury.—In large doses it excites 
violent irritation of the stomach ; in smaller doses often repeated it 
soon produces excessive action of the salivary glands, or destructive 
ulceration of the mucous membrane of the mouth ajid fauces; this in- 
flammation is of an erysipelatous character, is spreading, ulcerating, 
and commonly -without suppuration. In other cases the mercurial action 
displaces the diseased action, when the fever remits its violence; but 
it yields to the superior power of the fever in every febrile exacerba- 
tion, and Mercury, therefore, is not entitled to be regarded as a true 
specific for fever. 
Mercurialism is a disease produced by the constitutional influence 
of Mercury, and presents itself under various aspects. Under mercu- 404 
DISEASES OF THE DIGESTIVE FUNCTION. 
rial action, the whole glandular and absorbent system is more active, 
the patient becomes emaciated ; all accumulations of fat are taken up 
arid thrown into the general mass of blood ; disintegration of the old 
materials of the body goes on more rapidly than the new supply fur- 
nished by recently digested food is deposited. 
Mercurial Anaemia.—Dr. Farr says, that Mercury as rapidly and 
effectually destroys the red blood as venesection. A lady was attacked 
with hsematemesis ; the stomach and liver were engorged with blood, and 
her complexion was composed of the tints of the rose and the violet. 
Under a course of Mercury, “ she was blanched in six weeks as white 
as a lily.” ( Watson’s Lectures.') It is this power of destroying the 
red blood which has given this poison its immense popularity in the 
treatment of inflammatory diseases. It being supposed that it has the 
power of suspending that kind of inflammatory action which results in 
the effusion of coagulable lymph either in serous or cellular tissues; it 
has long been the sheet-anchor of the energetic physician. By this 
power of “ defibrinizing the blood” it suspends inflammatory action and 
substitutes its own action. But, even here, it is never effectual in 
strongly phlogistic cases; and, in all the forms of inflammatory action 
in which some general dyscrasia disposes to erysipelatous, gangrenous 
or scrofulous disease, its action in minute crude doses, is just the oppo- 
site of that which is desired. Allopathic mercurialization deepens and 
forms of disease in debilitated, irritable or nervous con- 
stitutions. Having itself the power to produce these very conditions 
in the strongest persons, and being capable of curing them, when used 
in accordance with the homoeopathic law, it always reduces the vital 
disease-resisting powers in persons predisposed to any of the above 
conditions. 
Mercury in Hepatic Derangements.—When mercurials are pre- 
scribed for temporary bilious derangements with some apparently be- 
neficial effect, this “cure,” so-called, is generally of transient duration. 
The same patient, whatever the precise degree of his derangement of 
the liver may be, is almost certain to need that kind of curing very 
frequently in the course of a few years; and the oftener he is com- 
pelled to resort to the inevitable blue-pill to rouse up his torpid liver, 
the shorter are the intervals between the occasions that call for it. In 
the tropical and malarial parts of America, as well as in the Eastern 
hemisphere, we can point out in any community the persons who have 
most frequently undergone hot climates. Dr. Morehead* thus sums up 
the results of his observations on the mercurial treatment of the diseases 
most common in hot climates. “To all who have within the last twenty 
years had the opportunity of extensively observing disease in India in 
* Clinical Researches on the Diseases of India, Vol. 2, p. 206. 1857. 405 
JAUNDICE. 
all classes of the European community, the asthenic state, the dys- 
peptic symptoms, the injured teeth, the pains in the sides and loins, 
the habitual foul tongue, the constipated bowels, the pale alvine eva- 
cuations, the depressed spirits, and the sense of sinking at the epi- 
gastrium — all clearly traceable to the abuse of Mercury — must be 
familiar facts.” We seldom find in medical literature as much truth m 
one page as is embodied in the above comprehensive sentence. These 
symptoms, every one of which embodies a volume written o\ci, within 
and without with human miseries are now all known to be the common 
effects of Mercury. And it is also known that they have been caused, 
not always by a reckless heroic administration of Calomel or Blue-pill 
in dangerous diseases, but quite frequently by the most minute doses 
spoken°of in standard works. But they have been generally regarded 
as orginal diseases, or as the relics of diseases imperfectly subdued. 
The patient who suffers from any or all of them does not say he has 
been poisoned, and does not charge his physician with mal-practice. 
For further remedies see Treatment of Jaundice in general. 
3. JAUNDICE WITHOUT OBVIOUS ORGANIC DISEASE OF THE LIVER. 
Diagnosis.—Yellow color of the skin and conjunctival sometimes 
itching of the skin, yellow tint from bile in the urine, readily distin- 
guished by the eye, and also by the chemical test of Sulphuric-acid, by 
the addition of which the urine containing bile assumes a dark-green 
and afterwards a purple color; urine in jaundice sometimes appears in a 
deep vessel dark, almost black. 
The stools are generally, though not always, pale or whitish from 
deficiency of bile; and have a sour and very offensive smell. 
In most cases the bowels are constipated, as the bile has an impor- 
tant use in exciting the natural peristaltic action; though in exception- 
al cases there is chronic diarrhoea associated with the yellow color 
of the skin. 
The perspiration is also bilious and stains the linen yellow. Saliva 
sometimes yellow, with a distinctly bitter taste. 
The mucous membranes and their secretions do not participate with 
the skin in this change of color; the tongue, inside of the lips, and 
the mucus of the stomach are not tinged with bile, and that of the 
intestines is not stained except where bile continues to flow into the 
duodenum. The milk of nursing women is said to be sometimes, if not 
generally, entirely unchanged. 
The color of objects, seen by persons in this disease, is sometimes 
changed to yellow, as in the cases of Dr. J. Mason Good and some 
others. It has been often remarked that “to the jaundiced eye all 
things look yellow.” It is supposed that the ophthalmic vessels in their 406 
DISEASES OF THE DIGESTIVE FUNCTION. 
natural state do not permit the coloring matter of the bile to pass 
through them; but that when they become enlarged by disease, so as 
to admit the coloring particles of the blood, they may also give a pas- 
sage to the yellow coloring matter, whieh tinges the humors of the 
eye, thus coloring the rays of light as if they had passed through a 
piece of stained glass. 
The color of the skin varies in different in persons, being in som 
bright lemon yellow, orange or of a greenish olive hue. 
Dr. Schmidt of New-Orleans, in a memoir to be published by the 
Smithsonian Institution, proposes to prove 1. the existence of a network 
of capillary vessels, previously discovered and described by him as 
“biliary tubules,” from which start the smallest hepatic ducts. This 
network is independent of that in which the smallest branches of the 
portal hepatic artery, and veins arise. 
2. The discovery of minute lymphatics of the liver, and their origin 
in the network of biliary tubules, by which a communication between 
the hepatic vessels and the lymphatics is effected. 
3. The discovery of lymphatic vessels directly joining small hepatic 
ducts, by which a second communication between these vessels is 
established. 
4. A minute description of a system of small follicular and racemose 
glands, the ducts of which form extensive plexuses throughout the 
liver; and their relationship to the other constituents of the organ. 
5. The discovery of a communication of the lymphatics, directly 
with these glands. As many of these glands also join the hepatic 
duct, a third communication between the lymphatic and hepatic ducts 
is thus indirectly established. 
The discovery of a natural communication between the hepatic ducts 
and the lymphatics of the liver enables us to give a natural physiologi- 
cal explanation of the phenomena of jaundice, which never appears 
as a symptom of any disease where the secretion of bile is arrested, 
but often, nearly always is present where there is an abnormal or 
excessive secretion of bile through the bile-ducts, or the common bile- 
duct, into the intestine, is closed or obstructed by concretions or 
otherwise. These discoveries also explain why the lymphatics of the 
skin, or near the surface of the eye-ball are loaded with bile, giving a 
yellow or green tinge to the derma and the sclerotica, even within a 
very few hours, when the flow of bile through the gall-duct has been 
arrested by biliary calculi ; they also explain why the large lymphatics 
on the surface of the liver are frequently found filled with bile aiVr 
death.* 
* See Freiricb’s Memoir on the Liver. Transl. by Dr. Murchinson JAUNDICE. 
407 
4 JAUNDICE FROM OBSTRUCTION OF THE EXCRETORY DUCTS OF THE 
LIVER.—CHOLOLITHUS.—GALL-STONE. 
1. Any pressure, made upon the excretory ducts of the liver, will pro 
duce jaundice; such pressure may be made by tumors, seated in the 
liver itself; scirrhous pylorus; disease of the pancreas; diseased con- 
dition of the duodenum. 2. The bile-ducts may be obstructed by mu- 
cus within, or by biliary calculi in the ductus choledochus, the cystic, 
or the hepatic duct. 
A Gall-stone consists of a solid concretion from a bile, usually 
formed in the gall-bladder, and occasionally in the hepatic ducts. The 
latter are darker and more irregular on the surface, in consequence of 
the absence of an investing deposit of cholesterine. 
Gall-stones are very light considering their size. When fresh from 
the gall-bladder they usually sink in water; but, when they have been 
kept long and are quite dry, they generally float in water till they be- 
come saturated with it, and then sink slowly. Their characteristic con- 
stituent, cholesterine is lighter than water. The coloring matters of 
the bile are heavier. The lightest are those which contain the largest 
proportion of cholesterine. ’Some of these stones are composed al- 
most entirely of it. These are white, have a crystalline appearance, a 
soapy feel, and burn with a bright flame in a candle. 
Diagnosis.—In the case of a gall-stone obstructing the bile duct, 
the pain is very severe; as a stone, a half-inch or more in diameter, 
may be forcing its way through a tube no larger than a goose-quill. 
The pain is not constant, but comes and goes; there is nausea and 
vomiting of sour matters, sometimes hiccough, flatulency; the patient 
is dyspeptic, languid and gloomy. If the concretion passes into the 
intestines, the pain suddenly ceases; but such attacks, having once 
occurred, are liable to be repeated. 
The pain is distinguished from that of inflammation by the absence 
of tenderness and of fever. Pressure, instead of increasing the pain, 
generally mitigates it. At the beginning of the attack the patient keeps 
his hand firmly applied to the epigastrium or leans forward, resting the 
weight of his body on some hard substance. After there has been 
much retching the straining and vomiting produce some tenderness of 
the abdominal muscles. The pulse is not quickened by the pain, but 
is in some cases even rendered slower; the skin is cold. 
Prout, Watson and others direct when gall-stones are suspected, 
to mix the faeces with water, on the surface of which the stones, if they 
exist, will be found floating; but Watson acknowledges that he never 
but once detected a gall-stone in this way. 
The symptoms of the passage of the gall-stones through the ducts 
into the duodenum are: “ Sudden pain in the region of the gall-bladder 408 
DISEASES OF THE DIGESTIVE FUNCTION. 
commencing two or three hours after eating, resembling colic.” The 
pain continues the whole time of a dull, aching character, and is oc- 
casionally interrupted by paroxysms so excruciating, that the patient 
bends himself double, or rolls himself on the floor, pressing his hands 
firmly against the pit of the stomach, or lower part of the chest, where a 
great constriction is felt, which sometimes eases the pain. These 
paroxysms cause great exhaustion; the pulse becomes weak or slow, 
the face pallid, whole body covered with a cold sweat. There is also 
distressing nausea and frequent vomiting of very acid matters, which, 
in all cases of repeated vomiting, when the duct is not dosed, are bit- 
ter. In some cases these symptoms cease after an hour or twro, and 
generally suddenly, as the stone escapes into the duodenum. In some 
other cases in which the stone is larger, or the passage is less free, or 
where several stones pass in succession, the symptoms may continue, 
with intervals of comparative ease, for several days; sometimes, when 
the stomach has been completely emptied of food, enormous quantities 
of acid are thrown up. It is secreted from the surface of the stomach 
and shown by Prout to be muriatic-acid. (Budd on the Liver, p. 288.) 
When the paroxysm continues long the patient becomes more or less 
jaundiced; there are frequent rigors occurring at irregular intervals as 
in stricture of the urethra, or when a calculus from the kidney de- 
scends into the bladder through the ureter. 
The prognosis is generally favorable, though some cases have ter- 
minated fatally. In these cases ileus has ensued, or the gall-bladder 
or ducts have been ruptured, and the bile has been effused into the ab- 
dominal cavity. In some cases the stones are very numerous and their 
occasional passage gives constant pain and anxiety. In one severe case 
a lady passed two hundred of various sizes in two weeks. Mackin- 
tosh found twro hundred and forty in one gall-bladder, others have 
found 2000 or more; sometimes a single concretion nearly fills the 
gall-bladder. 
Pathology.—The mechanical irritation of the stone in passing 
through the gall-duct causes vomiting by nervous influence reflected on 
the muscles that perform the act of emesis, and also causes untimely 
secretion of acid in the stomach by nervous influence reflected on the 
mucous coat of the secreting apparatus. The muriatic-acid is derived 
from the decomposition of common salt in the secreting vessels of the 
stomach by a process that seems to be merely chemical. In some cases 
the vomiting takes place when there is no pain produced by the gall- 
stone ; as a worm in the intestine may cause spasmodic disorder with- 
out exciting pain in the point where it happens to lie, and an old ab- 
scess of the liver, painless in itself, may occasion frequent vomiting. 
Treatment of Jaundice from Gall-stones.—The following method 
of treatment was directed, N. A. Journal of Homoeop., vol. VII., p. JAUNDICE. 
409 
395: As soon as the pains have declared themselves, give six ounces 
of tepid olive-oil, and follow it with Aconite and Nux in alternation, 
every half hour; apply hot water fomentations and an occasional 
warm hath till the pain subsides. The oil softens the concretions, 
relaxes and dilates the duct, and thus great numbers of the stones are 
enabled to pass into the bowels and pass off with but a trifling amount 
of pain. Olive-oil dissolves the stones placed in it in a short time 
out of the body. We have treated several severe cases by this 
method and found it successful. If the stones be large and numerous 
it may be necessary to repeat the oil several times. It dissolves the 
stone, relaxes and dilates the gall-duct, and gently moves off all the 
contents of the bowels. Our object here is to not a disease, 
but to carry off an extraneous mechanical substance. 
Professor Hale gives the following case: A young lady suffered 
several years from paroxysms of supposed gastralgia, or neuralgia of 
the stomach, and was treated with Mercury, Opium, and Chloroform 
without benefit. She became “emaciated, jaundiced (her skin of the 
hue of bronze). The tongue was coated white; no appetite; headache 
most of the time; pulse quick and hard, but small; urine very scanty, 
of yellowish brown color and containing bile; pain in the epigastrium, 
extending to the region of the gall-bladder; constant, but at times ag- 
gravated in paroxysms of extreme intensity; excessive nausea, when 
the pain became severe; constipation, alternated with diarrhoea; eva- 
cuations for several weeks, destitute of bile.” 
Dr. Hale having decided the symptoms to depend upon obstruction of 
the bile-ducts by gall-stones, after some other trials, “gave one grain 
of Podophyllin in the evening. She was allowed chloroform during the 
night. In the morning she swallowed three ounces of olive-oil, at 6 
o’clock. At 9 o’clock she vomited bile, after which all pain ceased; 
at noon she had a free evacuation of the bowels, of a bilious appearance. 
At 3 P. M., another bilious stool, and with it a discharge of several 
gall-stones. The concretions were round, about the size of cherry, 
rough externally, yellowish, and when broken, showing a radiating ap- 
pearance from a common centre. In a few days, under the use of 
Aconite and Nux, the jaundice had nearly disappeared, the appetite 
returned;” in two weeks she rode into the country, and afterwards en- 
joyed good health. (NA. Jour. Horn., Nov. 1863, p. 261.) 
Jaundice is often met with, associated with conditions of general ill- 
health, with mental depression and anxiety in persons in whom no struc- 
tural disease or obstruction of the ducts of the liver can be supposed to 
exist. It has been caused by fits of anger, fear, or alarm; by the pain 
of a severe surgical operation or the dread which preceded it; grief, 
mortification, and extreme anxiety. It is observed, says Watson, that 
these cases “are often fatal, with head symptoms: convulsions, deliri- 410 
DISEASES OF TIIE DIGESTIVE FUNCTION. 
um, or coma, supervening upon the jaundice.” In the cases that prove 
fatal with such symptoms, it is supposed “that some peculiarly poisonous 
matter is evolved in the system, most probably from the decomposition 
of the retained elements of the bile.” [Mayo, Budd, Watson.) 
Jaundice sometimes succeeds violent and long-continued vomiting 
it is a symptom of both acute and chronic inflammation of the liver 
it is often caused by the depressing influence on the skin and liver in 
hot climates, and hot weather; it often accompanies pregnancy, from 
the pressure of the enlarged uterus on the liver and its ducts. 
There is a form of jaundice which is common among newly-born 
children. This is called icterus neonatorum, and is ordinarily of 
little importance, being curable by the remedies given below. 
Pkognosis.—Jaundice may be expected to terminate favorably when 
it is obviously connected with functional derangement of the liver; 
when it proceeds from some known cause of a temporary nature, and 
which can be avoided in future. When the patient is of previous good 
health, and not far advanced in life. The prognosis is unfavorable 
when the disease depends on structural hepatic disease; when it has 
arisen upon some great mental or physical shock, in a constitution pre- 
viously broken by serious disease; or when there is no visible cause 
for the jaundice in an aged person, and the color of the skin is green 
ish, approaching to black. 
Treatment of Jaundice.—The Chief Remedies are: 
Aconite, Arnica, Aurum, Bell., Bry., Calc., Canth., Cham., China 
Cocculus, Crotalus, Ilepar, Iod.-mer., Lach., Merc., Nux-v., Phos. 
Rhus, Sulph., Phos.-ac., Digit., Sanguin., Do dog)., Berberis, Canth. 
Jaundice, after anger and chagrin, or keen disappointment:—Aeon., 
Cham., China, Nux-v., Puls., Sulph., Taraxacum. 
After abuse of Cinchona:—Bell., Calc., Merc., Nux-v. 
Jaundice after abuse of Mercury :—China, Ilepar, Lach., Sulph., 
Nitric-acid. The last is also a remedy for prolapsus ani. 
Phosphoric-acid.—Pain in the liver during menstruation: feeling 
of heaviness in the liver ; stitches in the region of the liver and spleen; 
burning at one spot in the region of the liver; deficiency of bile in the 
stools; whitish-gray, red evacuations; very light yellow stools. In 
jaundiced subjects it increases the action of the kidneys, diminishing 
the bile in the urine ; inflammation of the duodenum ; jaundice in scro- 
fulous children; languor of body, inactivity of mind; bad effects of 
grief, chagrin, care, and anxiety; itching eruptions or reddish spots on 
the skin. 
Aconite.—Dark-yellow skin ; yellowness of the sclerotica ; loss of 
appetite ; disgust for meat; bitter taste in the mouth ; pain under the 
short ribs. Malaise after eating ; eructations with sourish taste; vo- 
miting of green bile, or of watery fluid; pressing in the stomach as from MEL JEN A. 
411 
a weight; violent colic, or pressing pain in the hypochondria; inflation 
of the bowels by wind; respiration embarrassed as if from enlargement 
of the liver; aching in the umbilical region; squeezing pain in the 
region of the gall-bladder, when sitting ; alvine evacuations white, thin 
watery; rumbling in the abdomen with faint feeling ; urine reddish or 
brown in the morning, depositing a sediment; constipation several 
days ; nights very restless, sleepless, full of fearful and vexatious dreams 
Head feels confused and vacant in the morning on waking. Pain all 
over as if beaten. Unusual weariness. Pulse slow, unequally full, 
soft. (Meyer.) ' 
The following concentrated remedies have been successfully used in 
the cure of jaundice : Apocynin, Chelonin, Myricin, Podophyllin, Po- 
pulin, Yeratrin, Leptandrin, Rhein, Colocynthin. They have hitherto 
been too indiscriminately used.* 
Melcena.—Two forms of this disease was described by Hippocrates : 
1. The Black Disease, Morbus Niger, Black or Green Jaundice. 
Diagnosis.—Vomiting of blackish-red concrete blood, mixed with a 
large quantity of insipid acid, or viscid phlegm. The evacuation is 
generally preceded by a pungent, tensive pain in both the hypochon- 
dria ; and its commencement is accompanied by anxiety, compressive 
pain in the prsecordia, and fainting. As the disease progresses the 
blood evacuated becomes foetid and putrid and the prostration becomes 
extreme. The disease has been supposed to depend on diseased con- 
dition of the spleen ; but it is probably always associated with some 
dyscrasia or depraved constitutional condition. Dr. Nufiez, of Madrid, 
thought it to depend on repelled herpes or other inveterate psoric dis- 
ease. (See Psora.—Index) He gives the following case : The 
Marquis of C. had formerly suffered from chronic eruptions on the legs 
and at the anus, which were expelled by Sulphur-baths. He had after- 
wards disturbed digestion, and vomited black coagulated blood. Suc- 
cessive attacks of the same character followed at intervals, accompanied 
with black alvine discharges and prostration. The patient became 
feeble, emaciated and unable to turn in bed. Dr. Nunez found him 
powerless and motionless; the least movement or cough caused nausea 
and vomiting, tongue broAvn, clay-colored; intense thirst; mouth and 
throat dry ; aching pain in the epigastric and hepatic regions, with 
constant anxiety ; obstinate constipation; pulse thready, frequent faint- 
ings ; sight obscured by a veil. He took Ipec., twelfth, in repeated 
doses, which diminished the cough and nausea. The appetite improved. 
Veratruia-alb., twelfth, removed the constipation, faintings and cold 
sweats, producing first melanotic, and on the next day natural evacua- 
tions. The patient recovered in a few days under Arsenicum, twelfth, 
and Sulphur, twelfth. 
* Concentrated Organic Remedies. By Dr. Coe. 412 
DISEASES OF THE DIGESTIVE FUNCTION. 
Treatment. Chief remedies : Aconite, Aur.-c., Ant., Nux-v., Phos.; 
Secale-cor., Ipecac., Arsenicum, Chin., Veratr.-alb., Sulph. 
Aconite.—See symptoms of this remedy under jaundice, p. 140. 
2. Melcena Cruenta.—Black Vomit.—See Yellow Fever. 
Genus IV. —VISCERAL VENOUS PLETHORA. 
There is a condition of retarded circulation, with overloading of the 
vascular system, with venous blood or blood resembling venous, called by 
Cullen physconia, and by Dr. Good parabysma, or visceral turgescence. 
The pathological state is marked by depression ; debility of the physical 
and mental powers; the muscles are feeble, and the nerves manifest 
exhaustion. 
Treatment.—Sepia.—The homoeopathicity of Sepia to venous ple- 
thora of the portal circle has been demonstrated by Dr. V. Meyer.* 
He proposes to show:— 
1. That Sepia, by primarily affecting the splanchnic nervous system, 
induces an over-loaded condition of the portal system. 
2. That all further morbid conditions are but secondary, and are 
natural results of the further development of the primary disease. 
“Action of Sepia on the Portal System. When the blood corpuscles 
lose the power of separation and of becoming reddened by oxygen, the 
quantity of the blood becomes increased and its quality deteriorated 
by the useless and defunct corpuscles which remain behind. The 
whole of the blood assumes a dark, blackish-red color, similar to venous 
blood, which has been called by Schultz melanotic blood. At first 
this abnormal blood is collected in the portal system, and subsequently 
gives a melanotic appearance to the entire mass. Various chronic 
diseases gradually appear.” 
Symptoms.—Feeling of fulness in the region of the liver ; pain under 
the last rib caused by jolting motion on a rough road. Pain and 
soreness, in the liver; flatulency; yawning; feeling of weight in the 
limbs; shooting pain in the region of the liver and kidneys; constipa- 
tion, paleness of the face ; sickly, pale countenance; eyes red; face 
and conjunctiva yellow; yellowness extending over the nose and 
around the mouth. Icy cold feet in the afternoon and evening when 
sitting. Feet remaining a long time cold in bed; cold hands and 
knees. Sweating of the feet. Ebullition of the blood, with deter 
ruination of the blood to the head and chest. Feels the pulse beat 
in the head and limbs; aching of parts of the body or limbs on 
which one lies or sits. Legs feel weak, and ache on slight exertion : 
1. VENOUS PLETHORA OF THE PORTAL CIRCLE. 
* Homoeopathische Yierteljahrschrift. HJEMETEMESTS. 
413 
faintness in the morning, loss of thought, constant chill with shivering, 
goose-skin and yawning for an hour. Blackness before the eyes ; nau- 
sea ; heat of skin, but pulse slow; dejection of spirits; timidity; intes- 
tinal flatulence ; headache with dulness and heaviness in the forehead, 
preceded by scintillations before the eyes. Profuse sweat in walking 
morning sweat over the whole body. Absence of thirst, or thirst with 
bitter taste in the mouth. Drowsiness during the day, falling asleep 
late in the evening; uneasy dreams. Nerves sensitive to the least 
noise. Despondency, weariness of life; indifference to everything; 
without sympathy ; apathetic ; mental indolence, dejection of spirits ; 
anxiety, timidity, involuntary laughing and crying. Fever charac- 
terized by slowness of the pulse, slight shivering, drowsiness, and 
absence of thirst; pressure and weight in the head. As the venous 
plethora extends there arise various disorders of the digestive organs; 
haemorrhoids, disordered respiration, spasmodic twitchings or paralysis. 
The formation of the blood is incomplete; there arise gouty or rheu- 
matic complaints, and finally dropsy. 
Carbo-animalis.—When excess of venous blood is denoted by blue- 
ness of the lips ; also, in elderly people there is blueness of the cheeks. 
2. ILEMETEMESIS.—Vomiting of Blood. 
The mucous membranes consist of a layer of epithelium spread like 
a pavement over a thin and structureless membrane, which serves to 
support it; and the blood-vessels run and ramify in the cellular tissue 
behind. It is observed that however the congestion may be induced, 
whether by impediment to the return of blood from the stomach or not, 
it is only on the open surface of the mucous membrane that the blood 
issues in any considerable quantity. The stomach may also be injected 
with colored size in the dead body, and it oozes forth from the open 
surface of the mucous membrane. It is further remarked that though 
the mucous membranes allow blood to issue upon their surfaces they 
never allow the serum of the blood or the wTatery fluid to escape with- 
out the red corpuscles. In dropsical cases resulting from the gin- 
drinker’s liver disease, though the peritoneal sac is enormously dis- 
tended with watery fluid there is no flow of serum, no drain of fluids 
from the intestine itself, beyond the slight oozing of blood already 
mentioned. When the passive congestion of the intestines from the 
obstruction to the portal circulation has continued long, the nutrition 
of the digestive organs is slower than in health. The solvent juices are 
sparingly secreted, digestion is slower and more feeble, and the bowels 
are constipated. 
The impediment to the passage of blood through the liver or chest, 
if it be created rapidly, usually causes haemorrhage from the stomach 414 
DISEASES OF THE DIGESTIVE FUNCTION. 
before it causes ascites; an equal impediment created slowly causes 
ascites before it causes haemorrhage. 
The mucous membranes compose the only tissues from which haemor- 
rhage occurs readily and from mere congestion. It hardly ever occurs 
from this cause in the brain or liver, and never in the serous or synovial 
membranes. In the mucous membranes the liability to haemorrhage is 
great in proportion to the more active function of the membrane. The 
oesophagus, urethra and urinary bladder are lined with a membrane 
which acts as a mere lining arid is little disposed to bleed. The mem- 
branes lining the stomach, the intestines and uterus, being designed 
to furnish large secretions to perform important functions in the body, 
are more vascular, and readily bleed from passive congestion of their 
vessels. Blood effused within the stomach is thrown up by vomiting. 
Diagnosis.—Previous to the vomiting there is experienced a sense 
of weight, fulness, pressure and disturbance in the stomach, nausea, 
faintness, debility, general uneasiness, giddiness and confusion in the 
head, roaring in the ears, anxiety, bitter or saltish taste in the mouth, 
loss of appetite, occasional chills and sometimes pains in the stomach, 
side or chest. The pulse is for the most part small and contracted, 
though now and then full and bounding. 
“ The haemorrhage,” says Dewees, “ no doubt generally occurs from 
the mucous membrane of the stomach, but it is thought also to proceed 
in some cases from the liver or spleen. When the blood comes from 
the former organ, it passes along the common bile-duct into the duo- 
denum, and thence regurgitates into the stomach. When the spleen 
is the source of the haemorrhage, if this be ever the case, the blood, 
it is supposed, gains admission into the stomach through the vasa 
brevia.” 
The appearance of the blood which is throwrn up, varies, being in some 
instances liquid and bright red, at other times black or coagulated. If 
the haemorrhage proceeds directly from the rupture of a blood-vessel 
in the stomach, it will be red and liquid; but if it has been conveyed 
from the liver or spleen into this organ, it will be black and perhaps 
coagulated. 
The quantity of blood which is sometimes vomited from the stomach 
is very great. I have in several instances witnessed the loss of two, 
three or even four quarts from this organ without any very serious in- 
convenience, and that too in persons whose constitutions had been im- 
paired from long-continued intemperance. A not uncommon result of 
these profuse evacuations is, however, the supervention of dropsy. 
Causes.—Intemperance, suppression of accustomed discharges, as 
haemorrhoids, catamenia, &c.; congestions and engorgements of the 
liver, spleen and pancreas, scirrhous and other ulcerations of the gastro- HiEMATEMESIS. 
415 
mucous membrane, violent inflammations, whether caused by active 
drugs or mechanical injuries. 
Causes.—1. Strangulation.—Dr. Yellowly described the effects of 
strangulation in the case of a criminal executed by hanging in 1813. 
The body which had been much convulsed in the death struggles in the 
act of dying, was opened the next day; and the stomach and its ap- 
pendages were found deeply congested with dark colored blood. The 
external vessels of the stomach were turgid, and its inner surface 
coated by dark, coagulated blood; and when this was washed off, the 
whole surface of the mucous coat was red. 
All the minute capillaries had been injected with blood and it had 
escaped by exhalation from every part of the surface of the membrane. 
2. Epileptic Convulsions.—In some severe cases, during the terrible 
spasmodic contractions of the muscles of the whole body, the face 
and neck are highly congested, and frothy saliva is forced from the 
mouth. The profound stertor that often follows the spasmodic parox- 
ysm may be succeeded by vomiting of a dark coffee-ground looking 
matter, which is shown by the microscope to consist of altered blood. 
The discharges from the bowels after such paroxysms are often black 
like pitch, which receive their color from altered blood. 
3. Organic Disease of the Liver.—In that state of altered structure 
called “ hob-nail” or gin-drinker’s liver the current of blood is impeded; 
and the stomach and intestines, which should be constantly relieved 
from excess of blood passing from all their veins through the vena 
portarum to the liver, are left in a state of congestion. In some cases 
this leads to a frequent oozing of blood from the mucous membrane, 
and in many others to a freer haemorrhage, in which case the blood is 
brought up by vomiting. When the quantity of blood is large its loss 
diminishes vital power rapidly, and this is one of the most common of 
the modes in which death is brought about; and when death occurs, 
post-mortem examination shows that the blood has exhaled from an 
unbroken mucous membrane. 
More generally the congestion is slowly induced and the minute 
vessels accommodate themselves to the increased quantity of blood 
they are compelled to retain; or a small oozing of blood takes place 
from the membrane. The patient has constant pain in the epigastrium, 
and may vomit daily a small quantity of blackened blood, which is 
generally mixed with mucus. The stools are sometimes stained with 
altered blood. 
4. Organic Disease of the Heart.—Pericarditis, with disease of the 
lungs may produce impediment to the onward course of the blood, keep- 
ing the stomach in a state of congestion. The quantity of blood effused 
on the mucous surface is small and is seldom noticed. In some cases 
the obstruction is so great as to cause vomiting of blood. 416 
DISEASES OF TIIE DIGESTIVE FUNCTION. 
Congestion from, Change in the Relative Proportion of the Con- 
stituents of the Blood.—Such change, by altering the consistence of 
the blood, and thus “rendering its propulsion more difficult, or by modi- 
fying the chemical relation which naturally exists between the blood 
and the tissues, may cause blood to pass less freely than natural through 
the capillaries.” When from any cause the condition of the blood is 
changed and plethora of the organ results, the secretion of the gastric 
fluid is lessened, and the mucous membrane is more disposed to be 
inflamed by the irritation of the undigested or unwholesome food; if 
this congestion proceeds far, a certain oozing of blood takes place 
from the open surface of the membrane. 
Diagnosis.—Vomiting of blood, especially in small blackish coagula 
showdng that the blood has escaped by oozing, and that it was coa- 
gulated before it had time to collect in a mass. 
Treatment of Hoematemesis in General.—The following remedies 
will be found useful in all cases in wThich there is no fatal organic dis- 
ease.—Aeon., China, Puls., Nux-v., Ipec., Ars., Sulph., Arn., IIam.,Millef. 
5. Amenorrhcea.—Haemorrhage from suppressed menstruation may 
occur from one of the mucous membranes, from which blood easily 
flows, and is more common from the stomach than any of them. Dr. 
Latham says in one case, Haematemesis occurred monthly in a young 
female who never menstruated. After her marriage it ceased during 
pregnancy and lactation and then returned. No uterine menstruation 
ever occurred. Haemorrhage of the stomach from this cause usually 
occurs at or near the menstrual period; while it lasts the stomach is 
painful and tender. Cullen remarked that it was scarcely ever fatal, as 
the plethora of the system is relieved by it. We have seen one fatal 
case, but it was one in which there was long-continued congestion and 
structural disease of the liver. The patient was mother of a large 
family, and was fifty-eight years old when the vomiting of blood com 
menced. Up to that time regular menstruation had continued. She 
lived in an atmosphere strongly malarious, and had suffered from many 
attacks of remittent and intermittent fevers. Her liver had been tor- 
pid for years, was in a state of habitual congestion, had often been in- 
flamed, and remained in parts of its structure permanently indurated. 
The skin was yellow, wrinkled, shrivelled, somewhat resembling the 
skin of a yellow peach, withered and dried upon the stone. The 
vomiting of blood commenced at a period when menstruation first 
failed. The quantity of blood ejected from the stomach by vomiting 
was usually about two quarts, which always relieved for the time the 
gastric distress, but left the patient in a state of extreme prostration. 
The paroxysms were at first periodical and approximating the men- 
strual periods, but they ultimately became much more frequent. 
Though temporarily relieved by medical treatment, this patient, in the CONGESTION OF THE STOMACH. 
417 
course of a year and a half, sank into extreme anaemia with permanent 
enlargement of the liver and spleen, and total failure of physical and 
intellectual power. 
Diagnosis.—Haematemesis from deranged menstruation is known by 
its occurrence at or near the time when menstruation was expected, 
and when ordinary causes of haematemesis, as extraordinary obstruc- 
tions in the liver or chest, or enlargement of the spleen are absent; 
there is in this case no reason to suspect an ulcer or other organic 
disease in the stomach, and the derangement of the stomach is not of 
long continuance. For treatment see Anaemia. 
The Treatment of Haematemesis f rom suppressed menstruation 
consists chiefly in slightly acidulated drinks, complete abstinence from 
solid food. The remedies usually indicated are: Ipecac, and Hamamelis 
in alternation. Other remedies are: Gallic-acid, Millefolium, Arnica, 
Collinsonia, Iodine, Secale, Sabina, Macrotin. 
6. Haemorrhage from ulcer of the stomach.—In this case the hae- 
morrhage issues not from any large vessel laid open by ulceration, but 
from the minute vessels of the tender surface. 
In the treatment of diseases that cause impediment to the passage 
of the blood through the liver or chest, the congestion of the stomach 
and the feebleness of digestion must he borne in mind. Though the 
congestion is secondary and can only be relieved by the means that 
can relieve the primary disease. 
Sparing diet of articles easily digested; total abstinence from in- 
toxicating drinks, except in cases where stimulants in a dilute form are 
necessary to promote the strength and can be used without irritating 
the stomach or quickening the action of the pulse. Mercury can only 
be given with safety in a form highly attenuated; stimulating diuretics 
can not be used safely. It is only in their attenuated form that they 
may not do injury to the stomach as well as to the kidneys. A per- 
sistent congestion of the stomach improperly treated always leads to 
gastritis, as continued congestion of the lung leads to bronchitis. 
When the stomach is kept in a state of congestion by obstruction of 
the blood in the liver or chest, the secretion of the gastric juice is 
diminished, and the stomach, which in full health should secrete about 
four pounds of the digestive fluid in one day, secretes far less; it can 
digest less food than in health and requires longer intervals of rest 
(See Remedies.—Argen.-nitr., Kal.-bi., p. 217.) 
Prophylactic Treatment.—Such a regimen as shall regulate the 
bowels, and the portal circulation, and thus prevent the engorgement 
of the stomach. All such measures as promote the general health, 
Nitro-muriatic-acid, in drop-doses, diluted in large quantities of water; 
Sepia and other remedies that promote menstruation. 
Yol. I.—27. 418 
DISEASES OF THE RESPIRATORY FUNCTION. 
CLASS II.-DISEASES OF THE RESPIRATORY 
EURCTTON. 
There is a sympathetic relation between the organs of respiration, cir- 
culation and digestion; and this relation is kept up through the nervous 
system. The connection between these functions is seen in the case 
of a person apparently drowned. He is taken out of the water, w ith- 
out action of the parts concerned in breathing, without pulse ; the mere 
dilatation of the lung, its repeated action will bring on the action of 
the heart. Were it not so there would be no possibility of resuscita- 
tion. This first action of the heart does not cause decarbonization of 
the blood, nor does it send arterial blood from the heart through the 
body. It only first restores sympathy between the actions of the heart 
and lungs. Inflation and compression of the lung being repeated for a 
certain time the pulse returns. (Charles BeU) 
If a. frog be rendered apparently insensible and motionless on being 
immersed in a non-respiratory gas, the heart being pricked with the 
point of a needle, begins to act, and according to its nature, acts two or 
three times, wrhen being pricked again, it renews its action; and pre- 
sently after it has acted the breath returns, and respiration becomes 
established. And when the animal has breathed once or twice it turns 
from its back and leaps about. Here we see the action of the lungs 
drawing after it the action of the heart, and then again, the action of 
the heart drawing after it the action of the lungs. 
The experiments of Mr. Colman showed, that if a narcotic were intro- 
duced into the stomach in the attempt to perform such experiments, it 
would not succeed. The explanation is this : These three organs are 
connected together, not only by proximity of situation ; but by being sup- 
plied with branches from the par vagum, which lies by the side of the 
pharynx, giving off the pharyngeal branches; coming to the larynx, it 
gives off’ the laryngeal branches ; coming down to the thorax, it gives 
off the recurrent nerve under the arch of the thorax; which course re- 
moves the particular interest attached to it, because, so long as it con- 
tinues to run from its source, distributing its branches, there is no in- 
tricacy about it, nor is there any call for its minute study. But we next 
find the nerve taking a circuitous route, the branches running up to- 
gether, and it now becomes a fair subject for close investigation and 
inference. It is observed, that the trapezius muscle acts in the pro- 
cess of respiration, but only when stimulated by the same nervous in- 
fluence by which it is connected with other parts. The nerve through 
wrhich this influence is conveyed is seen running down to the root of the 
lungs, about to expand on the lungs, but not before it sends circuitous DISEASES OF THE RESPIRATORY ORGANS. 
419 
branches back to supply those parts, which are necessarily drawn in 
the regular act of breathing. The frame, were these parts not so drawn 
in, (one branch being kept irregularly or imperfectly excited,) would 
suffer spasm or suffocation as the result. 
Now the nerve comes down into the chest, one branch passes to the 
lungs, where it throws out little branches, which unite again, and so are 
distributed to the heart. It was formerly said, that the lungs and heart 
were void of sensibility. They are not very sensible. When Harvey put 
his hand to the heart of a young gentleman, which had been laid bare 
by an injury, the youth did not know, that the organ was touched; he 
did not know they were handling him, except when the external inte- 
guments were touched. 
But with all this insensibility, as commonly expressed, we can not 
rise from a seat without a certain increase of the pulsating artery; we 
can not walk faster without quickening the action of the heart. 
DISEASES OF THE RESPIRATORY ORGANS. 
In all of our investigations touching affections of the lungs and their 
appendages, whether acute or chronic, a few preliminary inquiries are 
essential, in order that we may be able to arrive at accurate opinions 
respecting the seat, nature, treatment and probable termination of each 
particular case. Although we are to be governed, as a general rule, 
by symptoms, yet certain constitutional or accidental peculiarities con- 
nected with a given train of symptoms, might induce us to select one 
specific in preference to another, which was equally homoeopathic to 
the disease. Thus cough, copious expectorations, pains in the chest, 
tickling in the throat, &c., which had followed immediately upon 
the suppression of some chronic eruption, might be completely covered 
by Bryonia, Ipecacuanha, Phosphorus, Phosphoric-acid, Staphysagria, 
Silicea, &c., so far as the mere symptoms are concerned; but who 
would not prefer, in cases of this description, Sulphur, or some other 
specific, which would have a tendency to reproduce the eruption, while 
at the same time, it would be perfectly homoeopathic to these indica- 
tions ? So in regard to temperament, habits of life, occupation, medi- 
cinal symptoms, age, sex, climate, &c., our remedies should always be 
selected in such a manner as to bear upon any occult miasm, or other 
latent cause, which may be operating upon the organism, and thus, 
either directly or indirectly aggravating and complicating the apparent 
symptoms. See p. 152. 
When called to treat lung-affections, therefore, let the physician 
inquire, first, is there any hereditary predisposition on the part of the 
patient to scrofula, consumption, dropsy, erysipelas, nettle-rash, syphi- 
GENERAL OBSERVATIONS. 420 
DISEASES OF THE RESPIRATORY FUNCTION. 
lis, &c. ? Second, is the chest well developed and symmetrical, so that 
the lungs can have ample room to perform their functions? Third, is 
the subject, during health, put out of breath by slight exertion ? Fourth, 
has the malady supervened on, or shortly after the disappearance of an 
eruption ? Fifth, do all parts of the chest dilate equally and properly 
during inspiration, and is the respiration natural during health? 
Respecting this last question, it is proper to observe, that a difference 
of opinion exists amongst authors. Laennec, considering respiration 
natural, “when the anterior and lateral parts of the chest dilate equally 
distinctly, yet moderately, during inspiration, and when the number of 
inspirations, in a state of repose is from twelve to fifteen in the minute;” 
which Andral, Broussais, Miiiler, Forbes and others suppose, that Laen- 
nec has placed the mean number of inspirations too low. These gentle- 
men assure us, that the “ mean average of respirations is more than 
sixteen or eighteen in the minute, in the healthy adult, and that most 
persons in health breathe from eighteen to twenty-four times in a 
minute.” From much observation in reference to this subject we are 
disposed to adopt the opinion of Laennec, rather than that of Andral, 
&c., and, therefore, estimate the mean number of respirations in a 
healthy adult at fifteen or sixteen in a minute. 
DIAGNOSIS OF DISEASES OF THE CHEST. 
ABDOMINAL RESPIRATION. 
On simple inspection of the chest and abdomen, it is seen that the 
ribs scarcely move at all, while the belly rises and falls alternately 
with the descent and ascent of the diaphragm; we infer that there must 
he painful condition of the intercostal muscles, of the pleurae, render- 
ing the patient unwilling to elevate his ribs, or that there may he dis- 
ease of the spinal cord, between the origins of the phrenic nerve and 
the intercostal nerves, rendering the patient unable to raise them; or 
that this inability may arise from some disease of the lungs them- 
selves. 
Thoracic Breathing.—When the breathing is entirely performed by 
the thorax, no motion of the abdomen being perceptible, there maybe, 
affection of the diaphragm, or of the pleura, reflected over it; or dis- 
ease and tenderness within the abdomen; or peritonitis, or mere dis- 
tention of the abdomen. 
Auscultation and Percussion. 
One side of the chest may be seen to expand, while the other remains 
motionless, it may appear of the natural size ; it may be contracted or 
rounded and bulging. From all of which appearances important con- 
clusions may be deduced. AUSCULTATION AND PERCUSSION. 
421 
Auscultation is a term, used to express the investigation of disease 
through the sense of hearing, and is generally employed in the inves- 
tigation of diseases of the thorax. It is employed to express all that 
can be learned by listening to a cough or the sounds of the respiration, 
or the sounds made by striking the chest. Percussion is the term 
used to express the mode of eliciting new sounds by striking the sur- 
face of the chest. More exactly, the term auscultation denotes the art 
of distinguishing internal conditions by listening to internal sounds, by 
means of the application of the ear to the naked or thinly covered sur- 
face of the body ; or by means of some conductor of sound interposed 
between the ear and the person of the patient; when this only is ap- 
plied the operation is called immediate auscultation; when an instru- 
ment is interposed the process is called mediate. Both modes are em- 
ployed to ascertain the qualities and modifications of the voice, as re- 
flected through the chest; the peculiarities of the breathing; and the 
sounds of the heart. To Laennec we owe the discovery of auscultation 
and nearly all that is known of it, though gradual improvement is still 
being made in it. 
By percussion, which was invented by Avenbrugger, a German, a 
hundred years ago, we ascertain the degree of resonance, or want of 
resonance of the part struck. As different substances, when struck, 
give out different sounds, an experienced ear soon learns to detect by 
the sound the nature of the substance struck. Bodies that are solid or 
inelastic, give the sound dull in proportion to their thickness, or their 
want of elasticity. On the other hand, hollow vessels, those containing 
air, with thin, firm, elastic boundaries, give out a sound more or less 
approaching in its qualities to that of a drum; this is called a hollow 
sound. A wooden cask containing air only, resounds when struck ; if 
half full of water, the lower half, when struck, gives a flat sound, the 
upper half a hollow sound, less hollow however than a vessel entirely 
empty; fill it up with water and the whole is dull on percussion; take 
out the water and fill it loosely with wool, and it will give a sound on 
percussion, though less clear than when filled with air alone. 
When we make a similar experiment on the human chest, we find it 
a large cavity bounded by firm, thin, tense and elastic walls. Within 
it we find the lungs of a spongy texture when full of air, with other 
solider parts of which the heart is the principal. If a slight knock is 
made against the chest, over a portion of a healthy lung, it produces a 
resonant or hollow sound. If the lung be not there, but is pushed 
aside by something more solid which occupies the space, or by fluid, 
we hear a dead sound. If the lung be there, but has become more 
solid by disease, we also hear the dull sound. But still there are 
liabilities to mistake which render practice necessary before percussion 
may be depended on in auscultation. When we percus-s the chest over 422 
DISEASES OF THE RESPIRATORY I UNCTION. 
tlie heart, we get a positively dull sound. Avenbrugger, who invented 
percussion, and Corvisart, who brought it into public notice, employed 
only direct percussion with the ends of the fingers. More recently 
M. Piorry showed the advantage of an intermediate solid substance 
which he calls a pleximetre or “stroke measurer.” A round, 
thin, flat plate of ivory was first used by him; other substances have 
since been used; at present it is quite common to use the fingers of 
the left hand. 
Method of employing Percussion.—Place the patient, if convenient, 
in a sitting position on a firm chair in the middle of the room; at least 
in some position in which the parts to be struck be as firm as possible. 
When the front of the chest is to be percussed let the patient per- 
mit his arms to hang loosely down, while he throws the head back. 
To explore the side of the chest, let him place the hand of that side 
upon his head and lean a little to the opposite side. To try the pos- 
terior part of the chest, let the patient lean forward, the arms hanging 
loosely between his knees, the head bent downward. 
Mode of Percussing.—Bring the ends of the fingers of the right 
hand together in such a way that the ends may stand as if of equal 
length, no one projecting beyond the other. If we employ no inter- 
mediate substance, we merely strike the surface with the evenly project- 
ing ends of the fingers. To test the relative condition of the two sides, 
always try the corresponding point of the opposite side. Always 
strike on one side, and then, immediately, on the exact corresponding 
point on the opposite side, thus constantly comparing the two sides. 
If we have tried one side at the moment of inspiration, we must choose 
the moment of another inspiration to strike the other side. The fin- 
gers should be held in the same manner, and the ends forming a line 
which makes the same angle with the ribs of both sides; the same de- 
gree of force should be exerted for each, the blow not being hard 
enough to give pain, but smart and quick, the ends of the fingers being 
instantly withdrawn. When the patient can not bear it without being 
pained and distressed, it is better to omit it, as the case can always be 
made plain enough by other means of diagnosis. 
Mediate percussion produces less pain, can be employed on a spot 
precisely indicated even through the clothes; it gives a more decided 
sound though the force of the stroke is broken by the pleximeter. 
It may be also employed over oedematous or parts covered by very 
great thickness of fat, where immediate percussion would reveal noth- 
ing; though the ivory plate, employed by Piorry, gives a louder 
and clearer sound, the fingers of the left hand answer well enough in 
general. Press them closely to the surface, and strike on the backs 
of the fingers. 
The sound given out on percussion during inspiration is more reso- CORYZA. 
423 
nant than during expiration; in childhood and youth than in middle 
age; it is still less so in old age; less in females than in males; in 
thin persons than in fat. 
We beg leave in this place to recommend, in strong terms, the use 
of auscultation and percussion in the investigation of chest-diseases 
if for no other reason than to form an accurate diagnosis and prognosis 
In order to acquire skill in the use of the stethoscope, percussion, &c 
a patient and careful course of study and practice upon both healthy 
and diseased is indispensable. By this means, the physician will be 
able to pronounce with certainty the seat and nature of the malady, 
and its probable termination. As we advance in our descriptions of 
the different affections of the respiratory organs, we shall point out the 
peculiar sound elicited by percussion and auscultation, in the several 
varieties of disease. 
ORDER I.—FUNCTIONAL DISEASES OF THE RESPIRA- 
TORY MUCOUS MEMBRANE. 
Genus I.—CORYZA.—Simple Catarrh.—Defluxion, or Cold. 
Diagnosis.—Characteristic symptoms.—Sneezing, watery discharge 
from the nostrils ; increased secretion from the lachrymal glands ; slight 
headache; heavy feeling in the head; occasional chilliness, slight 
evening fever; in severer cases, sore throat, hoarseness and cough. 
It appears in different forms and with varying degrees of severity. 
Thus: 1. Coryza simplex, as fully described by Celsus, which is 
chiefly confined to the Schneiderian membrane. 2. Gravedo, or ca- 
tarrhal cephalalgia, in which the affection is chiefly seated in the 
frontal sinuses. 3. Cold in the head, involving both the sinuses and 
the mucous membrane. 4. Catarrhal sore throat, involving chiefly the 
fauces. 5. Catarrhal cough with hoarseness, the disease extending to 
the glottis and pharynx. 6. Catarrhal bronchitis, in which the bronchia 
are implicated. 7. Catarrhal ophthalmia. 8. Catarrh of the stomach. 
The nature of catarrh is influenced by the constitution of the pa- 
tient. In many persons it presents many of the features of rheuma- 
tism ; in others, there is an inflammatory state which is more charac- 
teristic of erysipelas. As each of these diseases is entirely distinct 
from inflammation, they each require a specific treatment. 
Symptoms of Coryza.—Chilliness or coldness, commencing one, two 
or more days after exposure or atmospheric change; lassitude, heavi- 
ness of the head, followed by dryness, fulness or stuffing of the nasa 
passages; frequent sneezing; dull pain and sense of weight in the 
forehead ; stiffness or uneasiness of the eyes ; increased secretion of a 
watery fluid from the nose and eyes; slight redness and tumefaction 
of the mucous surfaces of these parts. The defluxion from the eyes 424 
DISEASES OF THE RESPIRATORY FUNCTION. 
and nostrils is somewhat acrid and saline, sometimes producing slight 
excoriation of the parts over which it passes. If the disease proceeds 
in its course only a day or two after these symptoms are developed, we 
have in the evening chilliness, shiverings, followed by increased heat; 
the posterior nares, fauces, nose and eyes are affected. The patient 
complains of a sense of roughness or soreness of the throat; loss of 
sense of smell; sometimes dullness of hearing; soreness or pain ex- 
tending along the eustachian tube to the ear, with slight redness of 
the fauces and mouth; hoarseness; tickling cough; mucous fluid 
secreted from the posterior nares, fauces, pharynx and trachea. The 
voice becomes partially or entirely suppressed from oedematous fulness 
about the glottis. There are pains resembling those of rheumatism in 
the neck, head and limbs; loss of appetite, slight thirst and bowels 
constipated. The patient is unusually sensitive to the influence of 
cold, though the skin is warmer than natural, he is continually liable 
to contract fresh cold. Thus he is liable to prolong the disease or ag- 
gravate it until it assumes a more serious form. See Catarrhal Fever, 
Bronchitis, Pneumonia, Ozoena, dec. 
Pathology.—This disease consists in a specific irritation of the mu- 
cous surface of the nostrils, extending to the frontal sinuses and eyes, 
to the posterior nares, fauces, throat, and occasionally also to the 
pharynx, oesophagus, glottis and trachea, thus terminating in catarrhal 
bronchitis. It is believed that the morbific influences which originate 
catarrh, affect, primarily the organic nerves which supply the surface 
principally disordered, and through them, the system generally. Ow- 
ing to this change in the condition of the diseased texture, the func- 
tions of secretion and circulation in the part are specially deranged. 
The chief modifications of the disease arise from the degree in which 
the constitutional actions are disturbed, the extent of surface involved, 
and the grade of irritation produced in the capillaries of the part 
Prognosis.—Catarrh is generally a mild ailment, attended with no 
danger. It is more serious in aged persons, in those predisposed to 
pulmonary disease, who have already tubercles developed in the lungs; 
in those who have had haemoptysis, who are asthmatic or have suffered 
from bronchitis, pneumonia, pleurisy, or chronic catarrh in the form of 
ozoena. Unfavorable, obstinate and difficult cases are characterized 
by continued irritation, slight redness of the posterior nares and fauces, 
abundant muco-puriform discharge, or persistent progress towards 
chronic bronchitis. Aged persons; children of lymphatic temperament, 
in which the muco-purulent secretion obstructs the breathing; infants, 
becoming irritable, and showing evidence of disturbance of the cir- 
culation in the brain or chest, or obstructed croupy breathing or cough, 
or in whom the disease assumes the aspect of ozoena, are sometimes 
difficult to cure permanently. CORYZA. 
425 
Treatment.—Tartar Emetic exercises a specific influence upon 
the mucous membrane of the air-passages, producing among other 
effects, sneezing, violent coryza, chilliness, loss of taste and smell, and 
irritation of the Schneiderian membrane. It has been used with success 
in influenzas and ordinary catarrhs, also in herpetic pustular and other 
eruptions about the nostrils. It is efficient in the first, second and third 
attenuations. 
Aconite.—Almost always proper in the beginning of a cold, even 
if the appearance of fever is very slight. Also when on an increase 
of the cold, the discharge from the nose is suppressed and is followed 
by headache. 
Arsenicum.—Not much fever, heat or thirst, the patient restless, 
particularly at night; drinks often, but little at a time; is very weak 
and easily agitated; discharge acrid and corrosive ; excessive soreness 
of the nostrils and violent burning of the nose, internally and ex- 
ternally. Exercise and warmth are agreeable, and exposure does not 
aggravate the disease. 
Nux-vomica. When Arsenicum has failed to relieve ; catarrh fluid 
during the day and dry at night; mouth dry and parched, without much 
thirst; lightness of the chest, constipation; fever and chills alternate 
in the evening; great heat of the head and face. 
Mercurius.—Epidemic catarrh or influenza when many persons 
are affected with it a time ; there is constant sneezing; soreness of the 
nose, with constant watery discharge; offensive smell; profuse per- 
spiration at night; catarrh worse in the morning; there is fever, thirst; 
heat is uncomfortable, but he can not bear cold air. See Influenza. 
Ilepar.—Catarrhs caused by suppressed perspiration, in persons who 
have taken much Calomel; fever with pains in the limbs; catarrh 
renewed by every breath of wind; headache increased by motion. 
Lachesis.—Catarrhs of great severity, profuse watery running from 
the nose; with great soreness and swelling. 
Dulcamara.—Patient better when in motion than at rest; slight 
exposure renews the obstruction. 
Pulsatilla.—Loss of appetite and of smell; the mucus discharged 
is thick and yellowish, sometimes green and offensive. 
Euphrasia.—Catarrhs with discharge of white mucus from the 
nose; eyes watery, sore and running. Cepa has the same symptoms. 
Ghamomilla.—Catarrh, with ulcerated nose, chapped lips; one cheek 
ale and the other red; chills and thirst. 
Ipecacuanha.—Difficulty of breathing. 
; Sulphur.—Psoric cases, protracted and resisting other remedies. 
Nitric-acid.—Dr. Helmuth had operated on a child, eight months 
old, for hare-lip. The case was doing well, but about the second day 
a violent coryza set in, the discharge being very profuse and quite 426 
DISEASES OF THE RESPIRATORY FUNCTION. 
acrid; having seen a similar case in which the acrid discharge pre- 
vented union of the lips of the wound, the termination of which was 
unfavorable, Nitric-acid and Arsenicum were prescribed. In a day the 
coryza was arrested, and the cure, in the usual time wTas complete. In 
such cases several coatings of Collodion should be applied over the 
whole surface of the upper lips, jaws and ligatures to prevent the 
injurious influence of any nasal discharges. 
Genus II—POLYPUS. 
Polypus is a tumor, generally originating from a small pedicle, which 
was formerly supposed to consist of several roots or feet, like the 
zoophyte polypus. In some cases a polypus of the nose commences 
from a small swelling of the pituitary membrane and gradually en- 
larges until it fills up one nostril and entirely obstructs the other. 
Others commence on a carious point of some of the bones which form 
the internal surface of the nostrils. Some are so soft that they bleed 
on the slightest touch, others are hard, compact, even scirrhous. They 
always produce disturbance of the breathing, compelling the patient 
to breathe through the mouth. A large one presses upon the spongy 
bones, forcing them down on the upper maxillary, thus obstructing 
the lachrymal duct, and forcing the tears to flow out over the eyes and 
cheek. Le Dran described polypi so large as to force the ossa palati, 
and protrude the fleshy palate to a position parallel with the third 
molar teeth. The most common form bears in consistence, shape, color 
and size some resemblance to a common oyster. When both nostrils 
are occupied by polypi, the patient breathes with difficulty, and with a 
peculiar rattling noise. 
Pathology.—Polypus is believed to originate in a constitutional 
dyscrasia, further views of which we will give in the article on Sycosis. 
As the polypus always appears protruding from the mucous membrane 
which is always kept moist by the proper secretion flowing over it, and 
not exposed to the drying effect of the air, it is always softer in texture 
than the sycotic tumors or excrescences which grow from those points 
of the mucous membrane at which it unites with or is continued into 
the skin. The polypi either hang by a narrow pedicle, or present 
a bloated, wrinkled appearance, and are attached at no great distance 
from the external orifice where the access of air is still possible. They 
are highly vascular and often bleed largely when removed by surgical 
operations. 
Treatment.—Before Hahnemann’s time no treatment was relied 
upon except excision. The publication of his work on chronic diseases 
led to new efforts to discover specific remedies for the diseases pro- POLYPUS. 
427 
duced by the constitutional miasms which had hitherto baffled medical 
skill. 
The remedies which have been most successful are: Calcarea, Phos- 
phorus, Staphysagria, Teucrium, Sepia, Silicea, Sanguinaria and 
Thuja. 
Mucous Polypus, Teucrium-marum produces the principal symp- 
toms of polypi of the nasal fossae ;* irritating formication in the right 
nostril, with running of tears from the right eye ; the right nostril feels 
half stopped up and cannot be relieved by blowing or sneezing. Tear- 
ing, shooting at the summit of the right nostril; nose runs for several 
days, whenever exposed to the air; frequent obstruction of both 
nostrils. 
Puffy swelling of the nasal mucous membrane after a facial erysipe- 
las, was cured in six days by the use of the powder of Marum leaves. 
A recent polypus of the nose was cured by Marum in a short time. 
A nasal polypus already thrice torn away, has not again appeared 
after the use of Teucrium Marum, 3d, taken internally, a drop every 
evening for several months. The loss of smell of twenty years stand- 
ing was cured at the same time. 
A mucous polypus which entirely filled one nostril disappeared under 
this drug in a few weeks. ( Veith, Hygea. Yol. V., p. 450.) 
Dr. Ilermel give's a case. A lady aged twenty-five had a polypus 
in the left nostril. Within three years it was twice torn away and 
returned. Six months later it began to reappear after a cold, and was 
visibly closing the upper part of the left nostril; there were painful 
formications and shootings at the root of the nose, in the frontal sinus 
of that side; the eye ran tears, and mucus flowed copiously from that 
nostril; blowing the nose caused acute pain and bleeding; breathing 
through that side impossible. Teucrium 6th was used for a fortnight 
made no impression, the first and third were tried. At the end of 
another week there was sensible diminution, a little flow of mucus, and 
the air could traverse the nostril. In three weeks more the polypus 
had entirely disappeared, and the breathing was nearly free. A year 
after she continued wTell. But four years later her nose wras stopped 
with a cold; she feared return of polypus, took Teucrium, and was 
relieved by the first dose. 
Case by Dr. Gabalda.—A man aged 42, had mucous polypi of the 
left nasal fossa; had long felt increasing difficulty of respiration in 
both sides, worse on the right. Ordered to snuff a few drops of water 
containing Thuja tincture. No change in a fortnight. Calcar. 30th 
substituted. In a fortnight more the respiration, was freer, right nostril 
* Roth’s Materia Merlica Pura.—Dr. Hennel, in L’Art Medical, 1859. Augsburg 
Horn. Gaz. Yol. I., p. 59. 428 
DISEASES OF THE RESPIRATORY FUNCTION. 
less embarrassed than the left, in which a small polypus is visible, re- 
duced in size. Teucrium-marum 12th every morning. A month later 
rapid improvement, cure under Teucrium 30th. Kleeman, (Rust's, Ma* 
gazine, Vol. 18.) A mucous polypus which hung down almost to the 
orifice of the nostril was reduced by the snuffing of powdered Teucrium 
in two months till the air could pass up the nostril. 
C. Mayer, (Merat and Helen, Diet. univ. Mat. Med) had polypus 
from his fourteenth year; often extirpated and cauterized, but it still 
returned. Advised to snuff Teucrium he was permanently cured. 
J. Mayer gives in Huf eland’s Journal (Yol. 64.) a case of polypus 
in a child aged eleven years, cured by snuffing Teucrium, three to 
five times a day. In twelve days there was no trace of polypus left. 
During the use of the remedy there were heaviness of the head, ver- 
tigo, and bleeding from the nose. Some months later another coryza 
developed another polypus. The same powder produced more violent 
pain in the head. On the third day it was detached by sneezing. It 
did not reappear. 
Roth gives a case of a uterine polypus three inches in length, pyri- 
form, smooth and polished. Tincture of Teucrium was applied locally 
for several weeks, when the polypus withered and came away at the 
touch of a ligature. 
Nenning and Roth report each a case of failure with Teucrium. 
i Drs. Hermel, Roth, and others report numerous cures. 
Symptoms.—“ Violent titillation in the right nostril, with weeping of 
the right eye.” Titillation in the nose soon after taking the medicine, 
recurring frequently. The right nostril feels as if half closed ; obstruc- 
tion cannot be removed by ordinary efforts. Brief lancinations in 
the upper part of the right nasal cavity. Fluent coryza in the open 
air. The nose is much obstructed several times during the day and 
particularly in the evening while reading aloud. (Archiv, V.) A 
thickening of the mucous membrane of the nose, the sequence of an 
erysipelas of the face, was removed in six days by the use of powdered 
leaves of Teucrium. (Archiv, XX.) A recent nasal polypus, which 
had been three times removed by the operation did not reappear after 
Teucrium had been administered, in the dose of one drop every evening 
for several months. At the same time the sense of smell returned, 
which the patient had been deprived of for twenty years. (Husseds 
Allgemeine Zeitung, I.*) A mucous polypus which entirely filled one 
nostril was cured in a few wTeeks by the use of Teucrium. (Hygeia, Y.) 
The effect of this remedy is seen in the case of a lady, who had po- 
lypus in the right nostril. In the course of three years it had twice 
* Allg. Horn. Zeitung. Tr. by Dr. J. M. Rhees. Am. Horn. Rev. Sep., 1859, 
p. 556 POLYPUS. 
429 
been extracted but still returned. A new coryza developed it again ; 
it fills the upper part of the nostril; there are titillations and painful 
prickings in the root of the nose, and in the left frontal protuberance. 
The eye weeps much, the affected nostril discharges much mucus ; 
blowing the nose gives pain, sometimes haemorrhage ; breathing through 
that nostril impossible. July 14th, Teucrium 6th, two drops in two 
hundred grammes of water, a spoonful morning and evening. After 
fourteen days tried the first, then after a week the third. In three 
weeks the size of the tumor had diminished. On the eighth of Septem- 
ber nothing could be seen of the tumor ; some inconvenience in that 
nostril in respiration. In 1858, May 7th, the lady feared anew coryza 
would reproduce the polypus. She took Teucrium, 6th, as before. Im- 
mediately after the first dose the symptoms that gave uneasiness 
vanished. 
Polypus of the Nose.—Dr. Richards, of N.-Jer., gives the follow- 
ing case : Sarah , aged twenty-eight, bilious temperament, has po- 
lypus of the right nostril, which commenced five years ago; two years 
ago had it extracted; about a month ago it began to return. 
The polypus is of a soft gray color, and obstructs the nostril so as 
to almost wholly prevent breathing through it. Calc.-carb., 6, Staphys., 
1, given Aug. 81, 1860. Sept. 14th. No better, Teucrium, 1, three times 
a day. Improvement commenced in a week. Nov. 18th, polypus has 
disappeared, patient breathes freely through the nostril. March 5th, 
1861, continues well. 
Thuja.—Dr. Petroz, in 1852, read before the congress of homceopa- 
thists of Paris, some cases of polypus and other sycotic diseases cured 
by this remedy. One of these was that of a lady, aged forty, who had 
been treated with Sulphur for scabies when young. At thirty-four, she 
had attacks of asthma ; afterwards, her face was pale ; there was con- 
stant sense of fulness in the brain, diminution of memory; melancholy, 
flushes of heat to the face ; head too full; throbbing of the temples; 
dyspepsia; then followed metrorrhagia, and the development of a large 
uterine polypus. She was cured by Thuja, 18, a dose every two days. 
The polypus was detached on the eleventh day. Bell., Secale and 
Silicea completed the cure. 
Sanguinajria.—Some cases have been cured by the local application 
of this remedy. One was a youth, in whom the polypus projected from 
the nostril. It was first extracted by force, causing profuse haemor- 
rhage. It again grew as large as ever, and extended beyond the aloe 
nasi. Dr. Price, of New-Jersey, applied the pulverized root of Sangui- 
naria, and the tumor soon assumed a paler shrunken appearance. He 
entirely recovered. A case of a little girl and one of a man advanced 
'n life, were cured in the same manner. (Louisville Med. Jour. 1840.) 
Sanguinuria has been often used successfully as an errhine for the 430 
DISEASES OF THE RESPIRATORY FUNCTION. 
cure of polypus. Dr. Wolf directs it in the 200th potency for a severe, 
one-sided headache, which extends into the frontal sinus. Mercur.- 
corros. relieves it temporarily only. Nitric-acid is one of the best 
remedies for that condition of the pituitary membrane that predisposes 
to polypus. There are bleeding from the nose ; scorbutic state of the 
gums; swelling of the lining membrane of the throat, which often 
proceeds to laryngeal phthisis. These cases often occur in persons 
of sycotic or psoric constitution. They have been cured with Nitric- 
acid, Apis, and Fluoric-acid, each at the 30th potency or higher. 
Minor Operations on the Nasal Passages.—The extraction of nasal 
polypi, whether by forceps or ligature, requires a knowledge of the posi- 
tion and relations of the turbinated bones, and the direction of the meati 
of the nose. These abnormal groAvths may attain such proportions 
that the whole contour of the face is disfigured. Fergussen gives a 
case in which “the tumor extended from the ethnoid bone to the con- 
dyles of the occipital, and was also detached to both sides of the sep- 
tum. Two large pendulous bodies hung down into the pharynx/’* 
Haemorrhage from the Nose.—In obstinate haemorrhage from the 
nose, when the ordinary medicines have failed to arrest the bleeding, 
the posterior nares must Replugged, and a correct idea of the canals 
and cavities to be operated on is absolutely requisite before the instru- 
ment can be applied, whether the instrument be the canula of Bel- 
locque, the hog’s intestine used by Frank, or the gum-elastic bag 
of Martin St Agne.f 
Eustachian Tube.—Catheterism.—This operation is a simple one; 
but it is necessary for the operator to bear in mind that the position of 
the floor of the nares is horizontal, and that the internal opening 
of the canal is on a level with the inferior turbinated bones. J 
Genus TIL—RONCHUS — RATTLING RESPIRATION. 
1. Stertor.—A noisy kind of respiration, such as is observed in apo- 
plexy.—Snoring. It is more properly a symptom of certain patholo- 
gical conditions, which will be illustrated under coma, apoplexy, c&6*. 
2. Wheezing.—An imperfectly-developed form of asthma, called in 
some countries phthisic. We meet it in children of psoric constitu- 
tions, and elderly persons predisposed to phthisis. It is sometimes in- 
duced in horses by driving them too fast and compelling over-exertion 
of the lungs. Such horses are said to be “ wind broken."’ The most 
effectual remedy we have known tried is Nitric-acid,—a few drops in a 
pail of water. See Asthma. 
* Practical Surgery, p. 491. t Bernard and Ruette, Manual, &c. p. 192 
J Dr. Ilelmuth. BATTLING RESPIRATION. 
431 
3. Obstruction to Respiration from Foreign Bodies in the Larynx 
or Trachea.—In the act of talking or laughing at the same moment 
that something is swallowed, sometimes a portion of the food is drawn 
in with the breath and starts down 11 the wrong waythus instead of 
passing into the oesophagus it goes into the glottis, and instantaneously 
produces alarming symptoms, in some cases immediate death. 
The foreign bodies, which find their way into the larynx, are fre- 
quently much larger than the size of the glottis would seem capable of 
permitting to pass ; morsels of food, coins, grains of corn, seeds, nuts, 
teeth, bullets, nails, &c., have found their way through this narrow' 
aperture ; how they got through it has been regarded as a mystery. But 
it has been fully showrn that dilatation and contraction of the space at 
the glottis occur in regular alternation during the respiratory acts, the 
first in inspiration and the contraction during expiration. When dilated 
during inspiration, the size of the rima-glottidis is nearly double what 
it is in a state of rest. Then in the act of inspiration, if the epiglottis 
fails to protect the laryngeal opening, a foreign body passing toward 
the oesophagus may be drawn into the larynx. After its entrance, the 
vocal chords contract forcibly from its irritation and thus prevent its 
being thrown out again, hence so often a surgical operation becomes 
necessary for its removal.* 
Symptoms caused by a foreign Substance in the Trachea.—“ The 
pain caused by its presence is towards the front of the throat, before 
the oesophagus ; when in the throat the pain is further back; there is 
difficulty of breathing and of swrallowing in both cases; but, when the 
wind-pipe is obstructed, the breathing is particularly difficult, the face 
is bloated and purple, the eyes protrude ; the voice is more affected, be- 
comes hoarse, or is lost altogether; the cough is whistling or rattling, 
and threatens to terminate in suffocation. These symptoms are slight 
at first, but they gradually increase, sometimes subsiding almost entirely 
for a time and then returning with greater violence; obstruction to the 
passage of air, often producing fatal asphyxia. Some cases of this 
kind have been treated for croup, for laryngitis, or spasm of the glottis; 
these may also be mistaken for a foreign body in the trachea, &c. 
When it exists, it may be lodged in the trachea, larynx, or one of the bron- 
chi, being more frequently found in one of the latter. Dr. Gross found, 
that they had been more common in the right one. In one case it was 
transferred from the right one to the left. 
If the foreign substance is not located in but below the glottis, and 
respiration is not impeded by it, the patient may seem to be in good 
health for days and even for wreeks, without experiencing any cough or 
* Foreign Bodies in the air-passages, by Prof. S. D. Gross, of Louisville Univer- 
sity. 1854. 432 
DISEASES OF THE RESPIRATORY FUNCTION. 
other symptoms. “Suddenly, however, he will be taken with violent 
spells of coughing, almost to suffocation, the attacks resembling those 
of croup. In such cases, if Tartar-emet. or Silicea do not afford im- 
mediate relief, there is little hope remaining. Neither will an incision 
avail, if, between the attacks of coughing, the respiration becomes more 
and more difficult and heaving. By this time the lungs have become 
hepatized, and the sufferer must die, whether an opening be made into 
the larynx or not.”# 
Diagnosis.—Auscultation may reveal the fact of the existence of the 
foreign body, indicate something of its size and locality. Chloroform 
has been advised as an aid in the performance of a satisfactory ex- 
ploration. 
A dry rale, sonorous or sibilant, may be heard at the point of lodg- 
ment. It is described as whizzing, whistling, cooing, whiffing, puffing, 
snoring, any of which may indicate the fact of the existence of the 
body and its locality. A boy in Dublin was whistling through a plum- 
stone, perforated on each side, the kernel removed ; by a strong inspira- 
tion he drew the stone into the largynx, where it became fixed trans- 
versely, producing a sound as when the stone was held across the lips; 
for hours he continued this new mode of whistling, being much pleased 
with it, and it gave little inconvenience for several days; when it was 
removed by an operation. (Stokes on the Chest, p. 252.) When the 
body is lodged in one of the ventricles of the larynx the rale is heard 
on that side. If it remain long in one position it produces inflamma- 
tion and ulceration, and a moist rale is produced. When the body is 
drawn up and down by the current of air, passing in and out, a valvular 
flapping sound is the result. It has even been felt to be projected by 
the current of air against the vocal chords in the act coughing. In 
one case a pebble 'was thus felt in the trachea of a boy, and was ex- 
tracted by an operation. The symptoms are: 
“Feebleness or suppression of the vesicular murmur equally on both 
sides, if the foreign body be situated in a bronchus, the vesicular mur- 
mur on the corresponding side enfeebled or suspended, the percussion- 
resonance remaining clear, except collapse of the lung be induced. 
Feebleness or suppression of the murmur sometimes suddenly giving 
place to a well-evolved and normal respiratory sound, after an act of 
coughing, wdiich dislodges the foreign body, and carries it upward into 
the trachea. Occasionally feebleness or suppression of the vesicular 
murmur transferred from one side to the other, indicating a removal of 
the foreign body from the bronchus of one side to that of the other 
side. Exaggerated vesicular respiration on the side opposite to that 
on which the murmur is found to be diminished or suppressed. Dry 
and moist bronchial rales, after a time, more or less diffused over the 
* Hering. LOSS OF VOICE. 
433 
side corresponding to the bronchus in which the foreign body is 
lodged.”* 
Treatment.—The first efforts to give relief in these cases generally 
consist in “beating with the flat of the open hand on the back, blowing 
snuff in the nose to induce him to sneeze, or tickling the throat with a 
feather to excite vomiting, may throw it out. But if it be firmly fixed 
in the wind-pipe, it will not be brought up by any such efforts; and, if 
the symptoms become alarming, if there be danger of suffocation, the 
patient must be relieved by the operation of tracheotomy. 
Medical Treatment.!—Ipecac, may be given whenever it is ascer- 
tained that a foreign body is lodged in the wind-pipe. Free use of 
demulcent drinks. 
Belladonna.—The distress is paroxysmal, showing irritability of 
nerves and disposition. By controlling the spasmodic effort the pa- 
tient sometimes sleeps and becomes relieved by the ejection of the 
substance during sleep. 
Dust, feathers or hair, having been inhaled, cause violent cough. 
Hepar may follow Belladonna. Sugar-water or Gum-arabic water 
used freely as drink. 
Hepar for after-symptoms during recovery. 
Tartar^emetic.—Danger of immediate suffocation, symptoms resem- 
bling those of croup. Suffocative paroxysms in children who have got 
something in the throat pressing on the larynx. 
Opium.—Suffocative paroxysms of distressed breathing. The par 
tient becomes purple in the face. 
Silicea.—When after trying Tartar-emetic the attacks return con- 
tinually, or, if there is a cough attended with an offensive smell. Con- 
tinue, morning and evening, until the obstruction is removed by cough- 
ing. In tedious cases, Hepar may be alterated with Silicea. 
Genus IV.—APHONIA—LOSS OF VOICE. 
Dumbness or loss of voice may arise from various causes, none of 
which need be treated of at length in this place. The different species 
described by authors are: 1. Aphonia from absence of the tongue. 
2. Aphonia from tumor of the fauces or near the glottis. 3. Aphonia 
from disease of the trachea. 4. Aphonia atonica from paralysis or 
loss of nervous energy. 
1. Aphonia from defect of the Organs of Speech.—Two hundred 
years ago it was supposed that dumbness was always dependent on or- 
ganic defect of the organs of speech. It is now known that persons 
* Flint’s Diseases of the Respiratory Organs, p. 626. 
Vol. L—28. 
f Hering. 434 
DISEASES OF TIIE RESPIRATORY FUNCTION. 
who are deaf and dumb are almost exclusively capable of producing 
vocal sounds, and indeed of speaking and reading, and that they are 
only dumb, because they are deaf; they cannot imitate, because they 
cannot hear the articulate sounds made by others. There are a few 
cases of malformation or defects of the organs of speech from injury. 
In the states of North Africa cutting out the tongue has been often 
inflicted as a punishment. The subjects of this cruel operation retain 
the sense of taste for ordinary sapid substances, but acids and bitter 
articles cause intense suffering. 
2. Aphonia from Disease.—The diseases which cause loss of voice 
are generally of an inflammatory character, and will be sufficiently 
referred to under their respective names. On curing the accompany- 
ing disease the voice is restored. 
3. Aphonia from breathing caustic vapoi'S. 
Ammonia.—A young lady lost her voice entirely from exposure to 
cold. Numerous remedies were tried in vain for three months ; she at 
last regained it in three days by inhaling ammoniacal vapor, disengaged 
from a mixture of a solution of the hydrochlorate of Ammonia and 
carbonate of Potash. See Bromine, Iodine.—Index. 
4. Aphonia Surdorum.—Deaf-dumbness. See Deafness. Index. 
Gends y.—dyspiionia.—dissonant voice. 
1. HOARSENESS—RAUCITAS. 
Nature of the Disorder.—A peculiar condition of the mucous 
membrane which lines the larynx or trachea. The affection may be 
acute or chronic. 
Symptoms.—Rough and indistinct voice and cough, sometimes ac- 
companied by pain; asthma, and rattling in the throat. When caused 
by a chill, the disorder is mostly associated with a hard dry cough, or 
with expectoration of a watery saline fluid; after a few days, much 
viscid white mucus is discharged. Other catarrhal symptoms often 
occur. The hoarseness is observed only when the patient coughs or 
speaks, or when the lungs contract, and not during inspiration.* 
Causes.—A chill; congestion of blood in the neighborhood of the 
throat. Relaxation or partial destruction of the tissues of the larynx 
or throat. 
Prognosis.—Hoarseness is generally temporary and soon yields to 
judicious treatment; in rare cases it continues for years, even for life. 
Treatment.—Aconite when there is any fever beginning or antici- 
pated ; when the disease has been recently excited by cold; heat of 
face and hands with cold feet; shivering. 
* Hartlaub. HOARSENESS. 
435 
Arnica may be diluted with water and used as a gargle when the 
affection seems to depend on a relaxed state of the lining membrane 
of the pharynx, tonsils and adjacent parts. 
Chamomilla,—Suited especially for children; there is hoarseness 
with catarrh, tough mucus in the throat, dryness, burning and thirst; 
the temper irritable ; easily vexed, morose, taciturn.* 
JYux-vomica.—Persons of quarrelsome, obstinate, headstrong and 
sulky disposition. There is a rough, deep, dry cough, arising from 
dryness, tension, and soreness of the throat; the mucus not loose; 
heat and chills alternating, causing cough, with pain in the throat; 
voice hoarse, weak, deep and dry; obstruction of the nose ; slight pain 
while breathing; sleeplessness at night; cold feet and hands in the 
afternoon, followed by fever and thirst; confusion of the head in the 
morning; peevishness ; aversion to labor; irritable, fretful disposition ; 
obstinacy. 
Pulsatilla.—Roughness, hoarseness and pain at the back of the 
throat; roughness in the palate, with dryness of the mouth; tenderness 
of the throat, during deglutition; cold in the head, with discharge of 
bloody mucus from the nose; cough, with expectoration and pain in 
the chest; tickling of the throat, which excites coughing, and which is 
worse in the evening; shivering with drawing pain in the limbs; fever 
towards evening, followed by external coldness, fatigue and depression, 
dry heat at night; disturbed sleep, troubled with dreams; silent, tear- 
ful. irresolute disposition; fickleness. 
Mercur-vivus.—The voice is hoarse and rough; burning and tick- 
ling in the larynx; disposition to perspire, but the sweat giving no 
relief; exposure to the air aggravates. 
Capsicum.—Hoarseness with itching and obstruction of the nose; 
cough, producing pain in different places. 
Causticum.—Obstinate hoarseness, with catarrh; soreness of the 
chest and throat. In obstinate cases a psoric influence in the consti- 
tution may be suspected and Cinnabar will give the patient the benefit 
of its valuable anti-psoric powers. 
Sulphur.—A dose of the Aiirtieth attenuation, once a week, will often 
remove obstinate hoarseness. Acid-mur. is one of the best remedies. 
Genus VI.—PSELLISMUS.— DISSONANT SPEECH. 
1. Bambalia.—Stammering.—Hesitation of speech consists in an 
interrupted articulation, accompanied generally with more or less of 
straining and distortion of the features. When owing to serious mal- 
formation of the tongue or other organs of speech it may be incurable. 
* Hering. 436 
DISEASES OF THE RESPIRATORY FUNCTION. 
But in all the cases we have seen, the disease was of a spasmodic cha- 
racter; the cure is generally possible and sometimes easy. It generally 
arises from the effort to speak while drawing in the breath, which can 
be avoided by an exertion of the will. Let the patient begin by filling 
the chest well before he tries to articulate the first wTord, and then 
slowly enunciate one word after another. Let him avoid the usual 
hurried repetition of the same syllable; and, when one oral position 
threatens to become spasmodically permanent, let him simply open the 
mouth, allowing simple sound to escape, A still more specific direc- 
tion is the following: Let the stammerer begin at once to beat time for 
every word he utters, either in talking or reading, just as if singing 
the words. If this does not stop the hesitancy, then try beating time 
for every syllable, and afterwards gradually run into beating for words, 
and then for sentences. The beating can be done with the foot, or 
with a hand, or one finger. Thus: “When [beat] in [beat] the [beat] 
course [beat] of [beat] hu-[beat] man [beat] e- [beat] vents,” [beat] &c. 
A persistent course of measuring the words until the stammerer can 
read and talk straight forward, though slowly, for an hour at a time, 
will overcome the habit of stammering in very many, if not all ex- 
treme cases. 
Internal Medicinal Treatment must be directed to the cure of ner- 
vous peculiarities of the patient’s constitution. Mercurius-sol., Ignatia, 
Aconite, Belladonna and Pulsatilla are the most important remedies. 
ORDER II.—DISEASES OF THE RESPIRATION AFFECT* 
ING THE LUNGS. 
Genus I.—COUGH. 
1. IDIOPATHIC COUGH. 
In most instances cough is one of the symptoms of inflammatory 
action, either of the parenchyma of the lungs, or of some membrane 
connected with the respiratory organs; but coughs occasionally arise 
and reduce the patient to a very low state of hectic fever, without the 
presence of any inflammatory action, except that which is produced 
by the act of coughing, from an elongation and relaxation of the uvula, 
from the pressure of tumors and swellings in the throat, trachea or 
thorax, from hypertrophy and other organic affections of the heart, and 
from accumulations of serum or pus within the thorax. The process 
by which this symptom of disease is produced consists in closing the 
glottis, and then making a sudden or strong expiration. Its purpose is 
the dislodgement of mucus, which may have collected in excess in the 
air passages, or it requires the admission of a certain quantity of air, 
and the possession of a certain degree of muscular strength. Patients 
often die from want of strength to expel the accumulating mucus and COUGH, 
437 
phlegm. A case is given of a boy who was dying of croup, being 
about to suffocate from the accumulated mucus in the trachea which 
he could not expel, because he could not draw in air enough to inflate 
the lungs beyond the collected mucus. An opening was made into the 
trachea; he drew in a long breath and coughed up the mucus through 
the rima-glottidis. (.Med. Chir. Transactions.) 
Cough may also be excited by other causes besides the accumulation 
of mucus in the air-passages. The sensation that prompts to cough 
may be caused by: slight irritation about the glottis ; a long trailing, 
tickling uvula; inspiration of irritating vapors; pressure upon the re- 
spiratory organs. 
Sympathetic Cough.—Irritation of the nerves of the stomach may 
excite a sympathetic cough. (See Catarrh of the Stomach.) We see 
therefore that mere cough is not a diagnostic symptom, which by itself 
can reveal to us the nature of the disease of which it is but a symptom. 
We have in several instances speedily succeeded in removing trouble- 
some coughs, and of restoring patients to health, who were apparently 
in the last stages of pulmonary consumption, by clipping off a portion 
of an elongated uvula. It is not uncommon that protracted and trou- 
blesome coughs are promptly cured by the removal of tumors in the 
neck, by the puncturing of abscesses in the throat or chest, or by 
evacuating from the thorax an effused fluid. It behooves us, therefore, 
in all cases of cough, where the cause is not perfectly apparent, to 
make our investigations with reference to the above enumerated com- 
plications, in order that surgical measures may be resorted to on all 
suitable occasions. 
Ijfc is to be feared that errors are sometimes committed by gentlemen 
of our school, in underrating the value and importance of surgery, as 
a means of curing disease. When the cause is of such a nature that 
our remedies are at best slow and uncertain, while speedy and safe 
removal may be affected by a surgical operation, we should never 
hesitate in our choice. Even in cases like paracentesis abdominalis, or 
paracentesis thoracis, where only a troublesome symptom is removed, 
we often accomplish much good by placing the patient in the best 
possible condition for the favorable operation of remedial agents. But 
in the examples of obstinate tumors and abscesses, pressing unduly 
upon some part of the respiratory apparatus, the aid of the surgeon is 
often indispensible. 
Many individuals are troubled with coughs in temperate latitudes 
from an inherent debility of the lungs, and a want of vigor to resist 
the stimulating influence of cold air. Such persons often succumb 
eventually from phthisis without having experienced any actual in- 
flammation of the pulmonary structure. 438 
DISEASES OF THE RESPIRATORY FUNCTION. 
Others, from excesses of various kinds acquire a predisposition ti 
coughs from the most trivial exciting causes. 
Treatment.—Appropriate remedies for all ordinary kinds of cough, 
may be selected from those elsewhere referred to, when treating of 
the different affections of the respiratory organs. 
Chronic Cough.—Case by I)r. Drysdale.—Arsenicum.—A patient 
had suffered for a year with a cough which came on in paroxysms; it 
was worse on lying down at night, with dyspnoea, and was relieved after 
an hour’s coughing by the expectoration of tough mucus; the appe- 
tite bad; gnawing pain at the epigastrium an hour or two after meals; 
diarrhoea for the last month. Urine scanty, clear, but passed frequently 
and with difficulty. Cured by Arsenicum in two weeks. 
Sanguinaria.—In dry and humid coughs of almost every form, and 
chronic coughs following inflammations, acute or chronic, Sanguinaria 
is one of the best remedies. In these cases there is irritation of the 
bronchial membrane. In many cases the cough is kept up by irrita- 
tion of the stomach, torpor of the liver, tendencies to headache; and 
in females spinal irritation. In all of these cases Sanguinaria is pe- 
culiarly appropriate ; and in none of them is its success to be attributed 
to its power of exciting expectoration. It is most useful in the pre- 
tubercular stage of phthisis, the follicular inflammation of the throat; 
chronic catarrh. In phthisis it helps to prolong life, even in the 
later stages. 
Diagnosis.—Most writers recognize three destinct stages in hoop- 
ing-cough, viz: first, the forming stage, presenting symptoms like 
ordinary catarrh, as sneezing, watery eyes, dry cough, headache, con- 
striction and oppression at the chest, feverish nights, &c., which con 
tinue for two or three weeks, when the second or convulsive stage sets 
in. At this period of the malady, there are violent paroxysms of cough 
of a convulsive and suffocative character. This cough is distinguished 
from others by a peculiar stridulous or whooping sound, which occurs 
during inspiration, while the expirations are interrupted by frequent 
fits of coughing. This whooping sound is owing to a spasmodic con- 
traction ef the glottis, which renders respiration very difficult, and 
gives rise to a sense of obstruction and impending suffocation. This 
spasm and contraction, together with a tickling in the throat come on 
previous to the paroxysms and subside somewhat after the coughing 
has ceased. The duration of the paroxysms varies from one to five 
minutes, at the termination of which there is often vomiting: or ex- 
pectoration of mucus. This stage usually acquires its greatest degree 
of violence in from one to two weeks, and its continuance is from five 
to six weeks, when the third, or stage of declension commences. At 
2. PERTUSSIS.—HOOPING-COUGH. COUGH, 
439 
this period all of the symptoms gradually become milder; the parox- 
ysms are less frequent,—the cough less urgent; the contraction and 
obstruction less strongly marked, until at the end of two or four weeks 
more, under favorable circumstances, all of the symptoms have dis- 
appeared. 
Causes.—Pertussis is unquestionably attributable to the absorption 
into the organism of a miasm of a specific nature. We know nothing 
of its chemical or physical character; but in this, like other maladies, 
the system must be rendered susceptible by previous preparation, or 
predisposition, to enable the miasm to exercise its specific effects and 
induce the phenomena of hooping-cough. 
Whether this specific miasm operates primarily upon the mucous 
membrane of the air passages, the stomach, the diaphragm, the lungs, 
or the eighth pair of nerves, we are unable to decide in a satisfactory 
manner. It wTould seem that the advocates of each particular opinion 
in regard to its primary location, have found in their autopsical ex- 
aminations, appearances which indicated that there had been inflamma- 
tion in each of the structures alluded to. That the pneumogastric and 
other nerves, as well as the membrane of the glottis, larynx, kc., are 
involved either as a primary or secondary effect of the contagion, there 
can be no question. 
The causes which act upon the organism in such a manner as to 
render it susceptible to the action of the miasm, are, atmospheric 
vicissitudes, colds, debility and chronic diseases of the respiratory 
organs, inhalation of irritating substances, fatigue and exhaustion of 
the physical or nervous system. 
Dr. Wolf, in his work on Psoric Diseases, says: “hooping-cough has 
become a stationary disease, in consequence of the universal practice 
of vaccination. It often appears after vaccination or re-vaccination, or 
vaccination exerts a salutary influence upon it.” 
Treatment.—Tartar-emetic.—When the paroxysms of coughing are 
accompanied by vomiting, diarrhoea, great weakness, rapid and feeble 
pulse, cold and clammy skin, great tenderness, and irritability of the 
larynx, and trachea; flushed face. Tartar-emetic about the second 
or third trituration meets all the symptoms. It is often proper to alter- 
nate it with Belladonna. 
Tnfolium-infmna.—Common Clover.—This remedy has, says Dr. 
Foster, “ a wonderful effect in relieving hooping-cough. 
“ The remedy is purely empirical, but it nevertheless cures most 
cases in a few days.” On this subject Dr. Hale remarks: 
Instead of “ empirical” the doctor should have written “ homoeopa 
thic” for it certainly is indicated by the law of Shnilia. The so 
called “hay asthma” is due to the influence of the medicinal principle 
of clover, which escapes partially during the process of curing. It 440 
DISEASES OF THE RESPIRATORY FUNCTION. 
seems to reside principally in the impalpable dust which arises from 
the clover. It has been supposed that this dust produced its effects by 
its mechanical action alone. The same has been asserted of Ipecac., 
yet we know that Ipecac, in small doses relieves many forms of asthma, 
and various spasmodic coughs. The Trifolium deserves a trial in 
many affections of the bronchia and lungs. It is homoeopathic to spas 
modic asthma. It causes a similar disease in man; and horses who eat 
clover, get the “ heaves,” which is hut a form of asthma. Dr. llale 
says, it causes spasmodic cough in horses ; a cough which much re- 
sembles hooping-cough, and the cough arising from spasmodic croup. 
Capsicum.—Dr. Morgan, of 111., says, he cured promptly a severe 
case of hooping-cough with three pellets of Capsicum, 3° centesimal, 
every three hours. Having seen the result in this case, he gave it to 
a half dozen or more other patients in whom the disease had not, any 
more than in the first one. In every case in which it was faithfully 
used, it was successful in immediate suspension of the disease; and the 
improvement was permanent. 
Cojfea.—Coffee, “ Cafe l’eau” hot and well sugared, a tea-spoonful for 
a child, two years old: allow a good diet of minced meats, moderate 
quantity of milk and farinaceous food. Prohibiting confectionaries. 
In one case, a child had alarming paroxysms of coughing, which 
threatened suffocation and fainting, till relieved by vomiting; the coffee 
mitigated all the symptoms. We have often used it with success in 
severe cases. Coffee acts both on the stomach and on the nerves. 
The chief remedies for pertussis are: Bell., see Exanthemata.— 
Index. Drosera,—pertussis after measles, with haemorrhage from the 
nose or mouth. Mephitisputorius.—The most effectual in all common 
cases. Other remedies are: Acid-mur., Cup.-sul., Cup.-met., Acid-nitr., 
Ammon.-mur., Veratr.-alb., Aeon., Canth., Allium-sat., Senega. 
Genus II.—DYSPNCEA.— EMBARRASSED OR LABORIOUS BREATHING. 
In a healthy adult under ordinary circumstances, the act of respira- 
tion is performed, unconsciously almost, about eighteen times in a 
minute, nearly equal to one act of respiration for about every four 
beats of the heart. In certain diseased conditions the frequency of 
inspirations and expirations may be increased or diminished. Dys- 
pnoea is applied to that deviation from the natural manner of alternately 
expanding the thorax and permitting it to collapse, in which this act of 
breathing is performed with labor, usually in a hurried but imperfect 
manner. This irregularity and difficulty depend on an altered propor- 
tion between the quantity of air that reaches the lungs, and the quan- 
tity of blood that is sent into them from the right ventricle of the heart 
to be converted into arterial blood. DYSPNOEA. 
441 
Respiration is a movement, that is carried on unconsciously during 
sleep, but which is also subject to the occasional control of the will. It 
is supposed, that the presence of venous blood in the capillary vessels 
of the lungs excites the pulmonary branches of the par-vagum ; this ex- 
citement is transmitted to the brain and reflected on the motor branches 
of the nerves, which supply the muscles of respiration; by these muscles 
more powerful efforts to alternately expand and contract the chest are 
made in an excited irregular manner; and their failure to completely ac- 
complish their object is accompanied with a feeling of distress. In or- 
dinary health the sensation indicating the “ want of breath” is so slight 
and so exactly apportioned to the need of the individual, that it is 
scarcely felt and is not attended to, and is at once appeased by the im- 
mediate aeration of the blood. It is only, when it is not relieved by the ad- 
mission of air that the sensation of “want of breath” becomes ex- 
tremely painful; then all the voluntary muscles of respiration are 
forcibly called into action to assist in the mechanical process of pro 
polling and aerating the blood. 
In various forms of disease dyspnoea becomes a prominent and alarm- 
ing feature. Thus in croup and laryngitis, the inlet for the air is nar- 
rowed at its entrance to the lungs; more blood then passes to the lungs 
than can be supplied with oxygen, and instinctive efforts are aroused 
to make up by numerous short inspirations the work which should be 
better performed by a few full ones. If the obstruction to the passage 
of air increases, the bad effects of the half-decarbonized blood circulat- 
ing in the arteries begin to be perceptible. It begins to linger and 
stagnate in the lungs; the lips become livid, the skin grows dusky, 
showing the accumulation of carbon in the blood. 
In any condition in which the quantity of blood flowing to the lungs 
continues the same as in health, while the air inspired, is dispropor- 
tionately small, dyspnoea will be produced. When a portion of the 
lung loses its spongy texture and becomes rapidly solid, so no air can 
penetrate it, though blood also ceases to penetrate it; the same quan- 
tity of blood flows towards it from the right side of the heart into the 
pulmonary artery, and the portions of the lungs still pervious receive 
an excessive quantity; therefore there is great deficiency of oxygen for 
this excess of blood and dyspnoea. The same effect may arise from 
obliteration of the pulmonary vessels in one part by pressure of fluid in 
the pleura; enlargement of the heart; dropsy or tumors of any kind 
within the chest; or pressure upward against the diaphragm by en- 
largement of organs within the abdomen, from tumors, ascites, obesity, 
pregnancy or full stomach. Dyspnoea may also be caused by disease 
of the walls of the chest, or by restricted capacity of the chest by dis- 
ease, rigidity or pain preventing its expansion, or by palsy of the 
muscles depended on to expand it. 442 
DISEASES OF THE RESPIKATOKY FUNCTION. 
Dyspnoea from increased Flow of Blood to the Lungs.—Under ac- 
tive exercise the pressure of the muscles upon the veins propels the 
blood with greater velocity to the right side of the heart; the heart 
contracts more frequently in proportion as it is more rapidly filled with 
blood; an increased quantity is sent to the pulmonary artery ; and the 
breathing must be more rapid to supply this excess of blood with air 
the individual is out of breath, he is in a state of dyspnoea, though tem- 
porarily so. We also see dyspnoea in some states of fever, and in all 
other cases in which the equilibrium between the blood sent to the lungs 
and the air supplied for its oxygenation. Such disordered conditions 
show, how intimately the functions of the heart and those of the lungs 
are dependent on each other; and also that dyspnoea considered in it- 
self is not a diagnostic symptom revealing what organ is suffering or 
how it is affected, whether the fault is in the heart or the lungs, or 
whether neither or both of them are in fault. For treatment see Asthma. 
Diagnosis.—For a week or two previous to an attack of asthma, the 
patient will often be troubled with sneezing every morning, itching in 
the inner canthi of the eyes, irritation of the throat, with constant dis- 
position to hem or hack, lassitude, dull pains in the head, back, and 
limbs, loss of appetite, dry hacking cough, and great depression of spirits. 
The attack most commonly commences during the night, with tight- 
ness and constriction about the chest; urgent and distressing dyspnoea, 
aggravated by the slightest movement; inspirations short and strong, 
while the expirations are long, labored and wheezing; great and rapid 
movement of the nostrils; countenance bloated and livid, and indica- 
tive of intense distress and anxiety; inclination to retain the erect po- 
sition ; even during the forming stage there is inability to lie upon the 
right side or back; more or less pricking or burning heat after the 
attack commences, aggravated by scratching; sometimes aggravated 
by eating even bread; respiration very difficult, as if from want of air, 
yet the wind from a fan or the draught from a door or window, stops 
the breath, and can not be borne; face and forehead livid, or pale; 
sharp pain through the temples; inability to lie upon a feather bed 
from the first; during the paroxysm must constantly retain the erect 
posture; the dyspnoea, &c., worse in the night, and remitting during 
the day; dry cough in the first instance, sometimes, but not always, 
followed in a few hours by expectoration of a viscid mucus; perfume 
of flowers, hay, &c., increases the symptoms, and almost puts a stop to 
the breath during the paroxysms; extremities cold ; respiration through 
the mouth ; attacks brought on from excitement, particularly grief and 
fear; also certain odors or irritating substances inhaled; palpitation 
during the attack; the attack occurs for the most part during the 
Genus III.—ASTHMA. ASTHMA. 
443 
season of flowers ; tongue foul; breath offensive; eructations; flatu- 
lency ; urgent desire for cool, fresh air; pulse variable. 
Causes.—First, the causes of the paroxysms; and second, the 
causes of the disease. The former are usually easily ascertained; but 
it is often very difficult to point out the latter, or those influences 
which have disposed him to fall into the asthmatic state on the occur- 
rence of the ordinary irritations are divided. The authors betAveeri 
those who say that asthma has at the root of it some oi'ganic disease 
within the chest, and those who deny that genuine spasmodic asthma 
ever depends on organic lung-disease, and maintain that it is always a 
pure neurosis. 
It was observed by Hahnemann that asthma always occurs in 
individuals who are suffering from some chronic miasm. In numerous 
instances we have been able to trace a direct connection between 
asthma and an attack of urticaria, but partially developed, and then 
suddenly suppressed. Indeed it may be safely asserted that a majority 
of the cases of true asthma, are attributable to this or to some other 
miasm, which has been thrown, from some exciting cause, upon some 
portion of the respiratory apparatus. We are confirmed in this opin- 
ion, from the fact that in several instances where an attack of asthma 
has been seriously threatened, and even commenced, we have been able 
to cut it short by administering a remedy like Puls., Bry., and Cupr- 
acet., which had the effect to develop the nettle-rash, and thus relieve 
the air-passages. See page 449, Causes, dec. 
Other causes which are, properly speaking, exciting causes, may be 
enumerated, as humid easterly winds, atmospheric vicissitudes, and 
electricity in the air; inhalation of certain medicinal and other irritat- 
ing substances, like Ipecac., the odors of certain plants, the inhalation 
of the imponderable particles of which often causes severe paroxysms 
of the malady; also indigestible food, anger, fear, the irritation of preg- 
nancy, spinal disease, sedentary habits, &c. 
Prognosis.—“Asthma,” says Dr. Salter, “never kills,” at least he has 
never seen a case in which a paroxysm proved fatal. When a patient 
dies from the contingencies of the disorder, he does so from the organic 
changes in the heart and lungs which have gradually progressed. An 
unfavorable prognosis must be made when there is obstinate persist- 
ence of expectoration, and chronic cough, as both of these symptoms 
show that the lining membrane of the air-passages is the seat of or- 
ganic change. 
“If the patient is young, the chest sound, the attacks short, the in- 
tervals long; if there is no permanent shortness of breath, no cough 
or expectoration; if the attacks are getting milder or rarer, and if the 
exciting cause is clear and such as may be obviated, then a favorable 
prognosis may be given. If the patient is old, the lungs damaged, the 444 
DISEASES OF THE RESPIRATORY FUNCTION. 
attacks frequent and severe, the breathing never quite free, coughing 
and spitting constant, the disease apparently gaining ground, and the 
exciting cause occult, or irremediable, then, in view of all or any of these 
cii ‘umstances, there is no alternative, but to give an unfavorable 
prognosis.” {Dr. Salter on Asth/na.) 
Treatment. — Pulsatilla, Ipecacuanha, Arsenicum, Bryonia, 
Nux-vomica, Belladonna, China, Sulphur, lobelia-injlata, Cojfea, 
Digitalis, Acid-hydrocyanic, Moschus are the principal 
remedies in this complaint. 
Pulsatilla is indicated in cases occurring in persons of a mild tem- 
per, light complexion, hair and eyes, from suppressed or confined urti- 
caria or other rash, cessation or other derangement of the menses, and 
inhalation of the vapor of Sulphur. The external indications are: 
Short, suffocating and extremely difficult respiration, as if from want 
of sufficient air, or choked by some irritating substance; the patient 
is obliged to retain the erect posture; his movements are rapid and 
his whole appearance indicates great distress and anxiety; tongue 
loaded with a thick coating; breath offensive; frequent eructations; 
hiccough; countenance pale, sometimes alternating with redness; 
attacks usually coming on in the night during sleep. 
Cramp-like and constrictive tension of the chest or larynx; respira- 
tion impeded and distressing, increased by motion, walking in the open 
air, or by eating; short spasmodic cough, nausea; palpitation of the 
heart; sensation of fulness and distention in the stomach; throbbing 
pain in the forehead; bad taste in the mouth; cramp-like pains in the 
abdomen; itching, burning or prickling sensation in the skin, in the 
evening or during the night; pains in the limbs ; nausea and vomiting; 
smarting or burning pain in the canthi, and pressure in the eyeballs. 
Very great depression of spirits, and melancholy from the onset of 
the symptoms; intense anxiety; agitation and dread of suffocation 
during the paroxysms. 
Administration.—From the third to the sixth dilution may be used 
—a dose every half hour in urgent cases—until aggravation or amend- 
ment occurs. 
Ipecacuanha — In asthma, caused by the suppression of miliaria, 
urticaria, and by the inhalation of irritating vapors, Ip>ecacuanha at 
the first to the third attenuation, may be exhibited. The signs which 
particularly indicate this medicine, are : Spasmodic contraction of the 
larynx and chest; anxious sighing or panting respiration; palpitation 
of the heart; air seems full of dust; face pale ; extremities cold, 
nausea; vomiting; coated tongue; insipid or bitter taste; dry, spas- 
modic cough ; irritability ; impatience and fear of death. 
Arsenicum-album, is a valuable remedy in bad cases, occurring 
from suppressed eruptions or catarrh, also in persons of feeble or im* ASTIIMA. 
445 
paired constitutions, whether from excesses, previous sickness or old 
age. The following symptoms point especially to this medicine, viz: 
feeling of extreme lassitude and debility; difficult, stifling dyspnoea, 
with attacks of suffocation; spasmodic constriction of the larynx and 
chest; respiration short, anxious and wheezing; irregular throbbings 
of the heart; sufferings aggravated at night by lying down, movement, 
eating, mental excitements, or exposure to the cool fresh air; disten- 
tion and cramp-like pains in the abdomen; frequent eructations; nau- 
sea ; vomiting; burning sensation at the stomach; foetid breath; smart- 
ing or burning sensation in the throat; oppressive burning pains in the 
eyes; face pale or bluish; anxious aud desponding. The first to the 
third trituration may be employed, regulating the repetition according 
to the urgency of the symptoms. 
“It is a common practice in China, for asthmatics to smoke Arsenic, 
and with the greatest relief to the disease. A very interesting case is 
related, in which a French lady did the same, in consequence of hear- 
ing the above. She commenced with a quarter of a grain, swallowing 
the smoke. From being in a state of constant breathlessness and 
suffering, unable to lie down or make the slightest exertion, she is 
now able to go abroad, and is rarely threatened with an attack oftener 
than once in three or four months, and that is at once checked by 
smoking Arsenic.” 
The Liquor Arsenicalis is said to be much more efficacious than the 
Ars.-alb. It seems to be more prompt and energetic when Arsenicum 
is indicated. It should be prepared with distilled water instead of 
Alcohol. The most efficacious and satisfactory method of treating 
asthma, is with the Arsenical solution—first dil. and Kali-hyd., first 
trit. (dec.) in alternation, every hour or two, or three times a day, as cir- 
cumstances demand. 
Bryonia is applicable in cases arising from suppressed eruptions, 
or rashes but partially developed. It is also appropriate in cases com- 
plicated with catarrhal and pulmonary disorder. 
The paroxysm usually occurs in the night; the respiration is diffi- 
cult, short, sighing, impeded by stingings in the chest, and aggravated 
by exercise; there are oppressive, tensive or contractive pain in the 
chest; cramp-like pains, cuttings or shootings in the abdomen; bitter 
or acid eructations; throbbing or pressive pains in the head, increased 
by movement; pressure and burning pain in the eyes on motion. It 
may be exhibited in the same manner as Pulsatilla. 
Asthma, which has been caused by derangement of the disgestive 
functions, excessive study and watching, sedentary habits, abuse of 
drugs, liquors, coffee, &c., may often be cured by the use of Nux. 
The Abovsymptoms are, weight and constriction at the chest; great 
difficulty of breathing; aggravation of the symptoms in the night, on 446 
DISK ASKS OF THE IlKSPIRATOEY FUNCTION. 
walking, eating or lying down in the evening; heat and burning in the 
chest; bitter and acid eructations; pressure and contractive pains in 
the stomach and epigastrium ; palpitation of the heart; short, dry, 
spasmodic cough, sometimes attended with a scraping in the throat; 
foetid breath; loaded tongue; heartburn; distention of the abdomen 
after eating; heaviness or tearing, throbbing, drawing or jerking pains 
in the head; frequent sneezing, with coryza; hypochondria, anxiety 
and irritability. It may be employed in the same manner as Pulsa- 
tilla. 
Belladonna has been especially recommended in cases occurring in 
females of an irritable constitution, also in cases where there exists a 
tendency to spasms, or any organic lesion. Hartmann asserts that it 
“ often proves radically curative after the exhibition of some inter- 
current remedy, particularly in cases which have not become too 
chronic by repeated relapses, under which circumstances we must have 
recourse to Sulphur, Caloarea, or some other antipsoric.” 
It is particularly called for when the paroxysms come on in fits of 
short, difficult, irregular and suffocating respiration, accompanied by 
dry cough; pressure on the chest; violent beatings of the heart; 
vertigo, swimming or darting pains in the head; pains in the small of 
the back and limbs; cramps indifferent parts of the body; anxiety, 
irritability, and fretfulness. 
A dose of the second or third dilution every hour or two until an 
impression is produced. 
Chamomilla is an important remedy in the flatulent asthma of 
children, also in that following a suppressed catarrh. It is likewise 
specific in those attacks which are caused by anger, grief, fear, &c., 
in adults. Among the symptoms which point to it may be mentioned 
distention and sense of fulness of the stomach and bowels; pressure, 
anxiety, and fulness in the region of the heart, short, wheezing respira- 
tion; great restlessness; dry irritating cough; bad taste; tainted 
breath. 
Administration.—Same as Belladonna. 
Lobelia-inflata.—Dr. M. Cutler says: he had been an asthmatic 
for ten years, during which time he tried all known modes of treat- 
ment, getting better results from Ictodes-foetida (skunk-cabbage) than 
any thing else. When an attack, the most severe he ever had, came 
on, he took a table-spoonful of tincture of Lobelia, the fresh plant, fully 
saturated,—at a time when the difficulty of breathing was extreme 
In three or four minutes the breathing was as free as it ever was; there 
was no nausea. In ten minutes took another spoonful, which occasioned 
sickness. In ten minutes more he took a third, which produced 
moderate vomiting and a prickling sensation through the whole system, 
even to the extremities of the fingers and toes. The urinary passages ASTHMA. 
447 
were affected with smarting in passing urine. These symptoms soon 
subsided, and a vigor was restored to the constitution Avhich he had 
not experienced for years. He had no attack afterwards, and had only 
on a few occasions a few of the symptoms. Before taking the Lobelia 
he scarcely passed a night without more or less of them; and often 
was unable to lie in bed. In other cases he found it to give relief, but 
it affected different persons in different ways. A tea-spoonful produced 
emesis in some. Nausea in some degree was thought necessary. He 
thought his own case one of “ convulsive asthma from pulmonic irrita- 
tion of effused serum. Dr. W. P. Barton gave it to lady who had nar- 
row and compressed thorax, subject for years to asthma. The above 
excessive and dangerous doses only cured because the remedy is 
capable of causing asthma. 
The Lobelia-longiflora, which grows in the West Indies, spreads 
such deleterious exhalations around it that an asthmatic oppression of 
the chest is felt on approaching within many feet of it as it stands in 
the corner of a room. (Ingenhouz.) Darwin thus alludes to it: 
“ And fell Lobelia’s suffocating breath 
Loads the damp pinions of the gale with death.” 
Botanic Barden. 
Lobelia-injlata is a remedy of great value in cases of spasmodic 
asthma induced by humidity, and certain other conditions of the at- 
mosphere. It is indicated when the attack is preceded or accompanied 
by a kind of “ prickly sensation through the whole system, even to the 
extremities of the fingers and toes,” constriction across the chest; short, 
anxious and wheezing respiration; nausea; vomiting; sense of pros- 
tration; trembling of the limbs; giddiness and headache, spasmodic 
cough; burning sensation in passing urine; intermittent pulse; cramp- 
like pains in the abdomen; cold sweats. 
Administration.—Potencies from the third to the sixth,—a dose 
every two to four hours, as the symptoms require. 
There are other remedies, like Coffea, Ignatia, Stramonium, China, 
Arnica, dec., which should always be borne in mind by the prac- 
titioner; for instances may occur where one or more of them will 
be required. 
In cases of asthma of long standing, and which appear to be con- 
nected with some chronic miasm lurking in the organism, Sulphur, 
Digitalis, Acid-hydrocyanic, Calcarea, &c., are worthy of consideration, 
and will sometimes effect cures when the other medicines enumerated 
have disappointed our expectations. 
Thuja.—Dr. Wolf says of this remedy that it corresponds to all forms 
of asthma; and in the course of the cure by Thuja it is not uncom- 
mon to see the sycotic gonorrhoea appear and re-appear in its primitive 
form, and with apparent relief of all other morbid symptoms. Often 448 
DISEASES OF THE RESPIRATORY FUNCTION. 
also, we find the above described affections appear as the immediate 
consequence of vaccination. (See 449, Causes, &c.) 
Bromine.—Dr. Douglas says a dyspnoea of ten years standing in a 
girl sixteen years of age, which had remained after measles, and was 
so violent that the girl was sometimes not able to walk fast or go up- 
stairs without feeling very much exhausted, disappeared after taking 
five doses of Bromine 30° of five pellets each. It is one of the few 
drugs that produce the croupous false membrane in the air-passages. 
Calcarea.—Dr. Luther reported a case of a girl aged seven years, 
who presented all the appearances of permeability of the ductus ar 
teriosus, namely dyspnoea, irregularity of circulation, blue discoloration 
of the skin, &c. Calcarea 30° effected a radical cure in six weeks. 
Genus IV.—LARYNGISMUS.—Laryngio Suffocation. 
1. ASTHMA THYMICUM—ASTHMA MILLARIL-SPASMUS GLOTTIDIS-LARYN- 
GISMUS STRIDULUS.—CROWING DISEASE OF CHILDREN. 
This disease was first described by Dr. John Clarke, and then by 
Dr. Simson, 1761, Dr. John Millar in 1769, Dr. Davies, 1826. It 
consists essentially of a constriction of the glottis, which impedes the 
passage of the air into the chest, even in the mildest cases, and some- 
times suspends altogether for a time the respiratory function. 
Diagnosis.—The child has an interruption of the breathing, and 
after vehement struggles at length succeeds in drawing in its breath 
with a shrill sound like the peculiar inspiration of croup and hooping 
cough. These attacks are paroxysmal, and vary in frequency, severity 
and duration. The intervals become shorter as the disease advances. 
In the earlier stages the attack is often slight, and soon stops with 
a fit of crying, which is succeeded by a refreshing sleep. The severity 
increases in violence and becomes unyielding. In the early stages the 
attacks begin generally in the night, but afterwards they come on at 
any time from trifling causes. It is evident that there is an unusual 
approximation of the sides of the glottis as in hooping-cough or 
croup. When the closure is not perfect, the child breathes, but hur- 
riedly, and the countenance is bluish, eyes staring, and each inspiration 
is attended with a crowing noise. Where more complete, respiration 
is entirely suspended for a while; the child makes vehement struggles, 
termed convulsive, to recover its breath; at various intervals, from a 
few seconds up to a minute or in some to two minutes, air is admitted, 
and this rush of air, passing through a narrow chink produces this 
peculiar sound. A fit of coughing or crying follows and the paroxysm 
ends ; or, if the glottis does not open at the end of two or three minutes, 
the child dies of asphyxia; pallid and exhausted, it falls lifeless on the 
nurse’s arm, and is said to have died in a fit. LARYNGISMUS. 
449 
During the struggles for the recovery of breath all the muscles sup- 
plied by the respiratory system of nerves are in violent action; the 
face is pale and cadaverous, and the external veins turgid with highly 
carbonized blood. When it ends in death, sometimes we have true 
convulsions, but generally slight. 
Contraction of the flexors of the thumb, fingers, wrists, ankles and 
toes has been considered as characteristic. 
The sound of mucus in the trachea, as the child wTakes from sleep, 
breathing for some moments unusually hard, is caused by the increased 
secretion of mucus; the sound is more observable just before a parox- 
ysm. In some cases it is one of the most striking symptoms, lasting 
for weeks or even months without interruption, and so resembling 
hooping-cough as not to be distinguished from it. It has been con- 
founded with catarrh with increased secretion, but in the crowing dis- 
ease the lining membrane of the fauces, nares and frontal sinuses are 
free from disease.* 
The convulsions are common, but the disease may exist without them, 
convulsions do not always indicate cerebral congestion. Dr. Merriman 
gives two cases of children who died in the fits, in which no trace of 
cerebral congestion could be found after death; he only found a collec- 
tion of small glandular swellings on the neck, pressing upon the par- 
vagum. 
It is also noticed that when the crowing is caused by dentition, the 
symptoms do not vanish instantly upon cutting the gum and the starting 
of the tooth through it, but they pass off gradually; some time being 
required for the irritation and tumid state of the cervical glands to 
subside. 
Causes.—Laryngeal suffocative asthma is perhaps in all cases de- 
pendent on the presence in the system of some one of those constitu- 
tional miasms which Hahnemann has shown to lie at the foundation of 
nearly all chronic diseases. In his great work on that subject he gives 
many cases gleaned from various authors, in which asthmatic suffocative 
diseases originated in repelled cutaneous eruptions, as itch, herpes, 
&c. Scrofula is one of the most widely-diffused miasms. See Scrofula, 
Psora, and Blood, Diseased states of. 
Causes of the Paroxysm.—They consist in all influences which can 
close the glottis involuntarily. The breathlessness which commonly pre- 
cedes the sonorous inspiration cannot arise from the closing of the rima 
glottidis, which in such cases is perfectly normal, but must depend on 
defective power in those agents whose office it is to open that narrow 
aperture. The “ crowing inspiration which is nature’s imperfect cure 
of the temporary suspension of breathing, arises from the glottis being 
* Laryngismus Stridulus, by Hugh Ley, M. D., London, p. 480 
You I.—29. 450 
DISEASES OF THE RESPIRATORY FUNCTION. 
partially open for the admission of air, and remaining so until some 
expulsive expiration, such as screaming crying, coughing, or belching 
shall mechanically burst open the flood-gates and perfect the recovery 
from the paroxysm.” 
Pathology.—The symptoms of this disease seem to show its spas- 
modic character; hut it has been rendered more probable by observation 
H that the glottis is closed by the usual exertion of some of the ordi- 
nary functions, as swallowing, &c.,” and that it remains “ partially or 
totally closed from some want of vigor in those antagonistic powers 
which should again sufficiently open the glottis for the purpose of re- 
spiration.” It is proved that children of strumous constitutions are 
almost the only ones affected with it; and whatever be the remote 
cause of the malady, the only pathological fact which exists in all the 
cases is an enlargement of the thoracic or cervical absorbent glands. 
Relation between the Pathology of the Disease and its Symptoms. 
Charles Bell says: “the knowledge of the nerves of respiration dis- 
tributed in the neck, throat, and thorax will enlighten the physician 
in distinguishing the symptoms of disease.” In the present case we 
notice that the two clusters of glands subject to this enlargement or 
induration during infancy are in the neighborhood of vital organs; 
and when enlarged they must exert a pernicious influence on the parts 
with which they are in contact. In children the absorbent glands are 
seldom enlarged so as to press much upon the trachea, but may obstruct 
the lymphatics or interrupt the functions of the nerves, and there may 
he much enlargement of the glands at the root of the lungs before 
and behind the bronchia, blending with others on the arch of the aorta, 
and frequently between the origin of the carotids, which are but con- 
tinuations of those that follow the course of the trachea downward. 
It is therefore probable that the recurrent nerve at its origin may be 
subjected to its injurious influence, as this nerve upon the right side 
turns round upon the subclavian artery as it emerges from the innomi- 
nata, behind which the nerve passes close to the origin of the carotid 
upon the side; whilst the left recurrent nerve winds round the arch 
itself of the aorta, generally between the carotid and subclavian ar- 
teries, upon and about which these glands are situated. 
If the deeper-seated chain of glands be enlarged, they may effect 
the recurrent in its course; for they lie in the cellular tissue and form 
a cushion for that nerve. Now what would be the precise effect of 
such pressure upon the recurrent? This much seems proved,“ that this 
disease, the spasmodic character of which has been conceded without 
examination is more allied to paralysis than to a. convulsive move- 
ment.” The symptoms are not those of excitement either of the par- 
vagum or of the recurrents, but resemble those which are proved by 
physiologists to result from an annihilation of the powers and attributes LARYNGISMUS. 
451 
of those nerves, as where they have been tied or divided, or the portion 
of a nerve excised. 
Treatment.—1. Of the constitutional state which predisposes to 
laryngismus. This must be attempted by the antipsoric remedies best 
suited for each special case. See Scrofula, Asthma, Sycosis, Psora, 
2. Treatment of the Paroxysm.—Remedies. Aconite, Bell., Ipecac., 
Sambucus, Arsenicum, Baryta-carb., Cham., Coffea, Cuprum, Moschus, 
Bry., Nux-vom., Puls., Sulph., Iod.-sul., Calc.-carb., Ammon-carb. 
Sambucus.—Slumber with half open eyes and mouth; on awaking 
from it he could not draw a breath, and was compelled to sit up, where- 
upon respiration was very hurried, with wheezing in the chest, as if 
he should suffocate; he lashed about with his hands ; the head and 
face were bloated and bluish; he was hot without thirst; weeping at 
the approach of a paroxysm; without cough ; manifestations especially 
at night, from twelve to four o’clock. 
Chlorine.—Dr. Carroll Dunham says, that chlorine gas in cold water 
produced in his own case the following symptoms: “Inspiration un- 
impeded and could be effected in the natural manner, but expiration 
was absolutely impossible, and the impossibility arose, not from any 
inability of the muscles of expiration, but from a closure of the rima 
glottidis, expiration being felt to be impossible, inspiration was again 
attempted, and was accomplished, fully and easily, although the act 
was attended by a slight crowing noise. Expiration which was again 
attempted, was impossible as before. By these successive operations 
the lungs became inflated to a most painful degree, but so firmly did 
the glottis appear to be closed, that it seemed as though air might 
pass through any part of the thoracic walls more readily than by the 
way of the larynx. This arrest of respiration having endured for 
about a minute, the face becoming turbid and livid, partial coma super- 
vened, the spasm relaxed, and respiration became free again.” 
These symptoms had been excited by only washing the mouth with 
“a weak solution of chlorine gas in cold water.” On another occasion 
he saw the same train of symptoms produced by inhalation of chlorine 
gas. In a proving of chlorine a similar effect is indicated. Pereira 
says: the attempt to inhale it “ produces spasm of the glottis.” 
Dr. Dunham gives the following case:* “An infant seven months 
old, well developed and large; fourth child of healthy parents; was 
seized three weeks ago, with spasmodic affection of the respiratory 
organs; would suddenly, without warning, make a long inspiration with 
a slight crowing noise; attempt to exhale would fail; another crowing 
inspiration followed by forcible ineffectual effort to exhale. This suc- 
cession of spasmodic efforts would follow each other till the child be- 
* American Horn. Review, Vol. II., p. 20. 452 
DISEASES OF THE RESPIRATORY FUNCTION. 
came blue around the mouth, and sank into partial unconsciousness; 
free respiration would then follow, and then a deep sleep. Sometimes 
convulsive movements appeared as the paroxysm was subsiding. Attacks 
came on after excitement, frequently during sleep, most common after 
midnight, as many as thirty or forty attacks in twenty-four hours. 
Emaciation progressing rapidly, losing appetite, strength and playful- 
ness; face pale and bloated; eyes dull und glassy. Homoeopathic 
treatment and change of air had failed; an older child of the same 
family had died during the past year with the same affection, terminat- 
ing in four weeks in convulsions. In that case autopsy revealed no 
organic lesion; simply emaciation and atrophy. The disease had 
evidently advanced almost to the second or convulsive stage in which 
the prognosis is decidedly unfavorable. 
A saturated solution of chlorine gas in water at 60° Fahrenheit was 
prepared; of this was made the-first centesimal dilution, retaining still 
the odor of chlorine. Of this twenty drops were dissolved in four table- 
spoonfuls of water; a tea-spoonful to be given in a porcelain spoon? 
every two hours. A few drops to be placed in the mouth at the be- 
ginning of each paroxysm. Beginning at four, p. m, June 24th, when 
the child had had forty paroxysms within the last twenty-four hours. 
“ During the succeeding twenty-four hours there occurred but four 
paroxysms ; only one of which began with any severity, and this one 
was instantly arrested midway by a few drops of the solution placed 
upon the child’s tongue. During the night of the 26th not a single 
paroxysm. Appetite and playfulness returned, the bloated aspect of 
the face and dulness of the eye disappeared.” 
Genus V.—EPHIALTES.—ONEIRODYNIA. 
I. ONEIRODYNIA G R A V A N S. - INC U B US. — NIG HT M A R E. 
Ephialtes was so called from the belief of the ancients, that a demon 
leaped upon the breast and prevented its expansion to draw in the 
breath. 
Some nervous or indisposed persons are oppressed during sleep with 
a heavy pressing sensation on the chest, by which respiration is im- 
peded, or the circulation of the blood intercepted to such a degree as 
to threaten suffocation. Frightful ideas are recollected on waking, 
which have occupied the dreaming mind. Frequent attempts are made 
to cry out, but often without effect, and the horrors and agitations felt 
by the patient are inexpressibly frightful. In the more severe cases, 
the patient seems at the commencement of the paroxysm in a profound 
sleep and suffering imaginary troubles in an unpleasant dream. 
The uneasiness of the dream increases and ends with the conscious- EPHIALTES. 
453 
ness of being in bed and asleep ; he feels oppressed with some weight 
that bears down and prevents breathing, and feels sensations the most 
painful that can be conceived. As he becomes partially awake, he 
makes violent efforts to move the limbs; but no muscle obeys the will; 
and every exertion exhausts the remaining strength, and appears to be 
the last; the heart beats rapidly, sometimes wTith palpitation; the coun- 
tenance is ghastly; the eyes half-open. If let alone the sufferer re- 
mains a minute or two, and then recovers all at once the power of voli- 
tion ; he jumps out of bed or turns in it till quite awake. If this is not 
done, another paroxysm be expected as the propensity to sleep is 
irresistible; and immediate sleep is surely followed by another par- 
oxysm. Some hear singing in the ears and see spectres before the 
eyes; some acceleration of the pulse and palpitation of the heart re- 
main; and if the patient does not fully awake, he may retain some re- 
membrance of his horrible imaginings as of some fearful supernatural 
visitation. It is said, that the most intelligent persons have been de- 
ceived in this way, and could only avoid it by rousing themselves fully 
to a full consciousness of their condition. The amiable poet Cowper 
thought, he “was hunted by spiritual hounds every night;” and could 
not tell whether it arose from his state of health or the divine displea- 
sure. When the digestive organs are in certain states of disease, there 
may be preternatural pulsations from one end of the alimentary canal 
to the other. A man of Cowper’s morbid sensibilities might easily 
combine from his sensations and his dreams, a vision of spiritual hounds. 
Forestus thought himself pressed by a black dog, so that he could not 
move. Night-mare and its accompaniments may be expected by con- 
templative, hypochondriacal persons, subject to nervous diseases, when 
the stomach is over-loaded by indigestible substances. 
Yirgil, if not a sufferer from night-mare, was acquainted with it. He 
says: (Book 12, line 1213, iEneid,) 
“ And as when heavy sleep has closed the sight, 
And sickly fancy labors in the night, 
We seem to run; and destitute of force, 
Our sinking limbs forsake us in our course ; 
In vain we heave for breath ; in vain we cry ; 
The nerves unbraced their usual strength deny ; 
And on the tongue the faultering accents die.” 
Walter Scott also knew something of night-mare, which he thus de* 
cribes in the “Lady of the Lake 
“ In broken dreams the image rose 
Of various perils pains and woes: 
His steed now founders in the brake : 
Now sinks his barge upon the lake; 
Now leader of a broken host, 
His standards fall, his honor lost. 454 
DISEASES OF THE KESPIKATOKY FUNCTION. 
Then from his couch may heavenly light 
Chase this dread phantom of the night.” 
Causes.—The distressing sensations of the patient in some cases 
originate in a large quantity of wind, or indigestible material in the 
stomach, which is oppressed with a full supper taken at a late hour 
The stomach expanded with acid-gas, presses against the diaphragm 
preventing its descent, and thus impeding respiration. The stomach is 
generally acid in persons subject to this disease. Inflation of the intes- 
tines also produces disturbed respiration or mental perturbations. 
Sleeping on the back seems to have some influence in causing this 
disease. The patient seems to himself to be on his hack, and to be kept 
down by some external power. The above are the causes which most 
commonly operate; but neither any one of these, nor yet the stopping 
of the circulation in the heart or of any particular part; neither a full 
stomach nor an empty one can always be charged with causing it. 
Treatment.—Persons subject to it, should eat but little in the eve- 
ning, and take light food at all times; drink no wine, beer, nor coffee. 
Weak black tea may be taken, but the free drinking of water is better. 
Milk and soup are both heavier for some dyspeptics than solids of pro- 
per quality and quantity. (See Dyspepsia.) The patient should bathe 
the head and neck in cold water in the evening in summer, or rub the 
face, neck and back of the head, throat, chest, &c., with a wet cloth or 
sponge, and drink cold water on going to bed. 
Remedies.—Nux-vomica.—Disorder of digestion caused by spiri- 
tuous liquors, strong-beer, too high living, sedentary habits. Take it 
every night. 
Aconite.—When the disease occurs in children and women, and is 
accompanied by much heat, thirst, palpitation of heart, determination 
of blood to the head or chest; oppressed breathing, nervousness, un- 
easiness ; also for headache, febrile excitement following the attacks. 
Opium.—Paroxysms violent; patient lying with his eyes half closed, 
snoring, the mouth open, rattling in the throat, the breathing irregular, 
face much distorted, and covered with cold perspiration, extremities 
convulsed. 
Pulsatilla.—Considerable derangement of the digestive apparatus 
from high living. 
o o 
Sulphur and Silicea.—In occasional doses, when the attacks con- 
tinue to recur after having taken the above remedies. 
2. EPHIALTES APNCEATICA.—Ephialtes from Suspended Respiration. 
Diagnosis.—This form of ephialtes occurs in persons of nervous tem- 
perament, who inherit certain psoric or other constitutional maladies, 
or have been broken down in health by the influences of malaria or EPHIALTliS APNCEATICA. 
455 
Mercury. There is generally derangement of digestion manifesting it- 
self in a depraved appetite, craving for indigestible articles; disposi- 
tion to cheAv paper, rags, or charcoal, &c. The sleep becomes at first 
disturbed, and then occasionally too sound, attended with troubled 
dreams. In the worst cases the patient after being somewhat wearied, 
or eaten a supper only a little heavier than usual, retires to rest in ap- 
parent health. Immediately after he becomes fully asleep, he begins 
to breathe gradually less and less deeply. The amount of air taken in 
at each expansion of the lungs is successively smaller, till he lies as in 
a profound stupor, breathing so faintly that the respirations can not be 
heard or counted. During the same time the beatings of the heart also 
have been becoming gradually fainter; and the pulse, which on going 
to sleep was full and strong, has diminished in force till the beats have 
become almost insensible. For the length of time that breathing can 
be dispensed with the patient seems in a profound trance, insensible to 
all ordinary noises or even to efforts of others to wake him. At length a 
struggle within to renew the act of breathing manifests the return of 
consciousness. Breathing is at first impossible, the face becomes 
darker under spasmodic, fruitless efforts to “ catch the breath.” 
The features are distorted and the whole frame convulsed with agony 
some seconds, which seem to observers very long ones; at last the first 
spasmodic expulsion of air is announced in a fearful scream, which 
thrills and rouses every body near, whilst the patient through convul- 
sive and protracted efforts is succeeding in the restoration of ordinary 
respiration. The first paroxysm on going to sleep is ordinarily the 
most severe; but he is liable to others during the night, and at other 
times on falling asleep. 
Pathology.—Sir Charles Bell* has sufficiently demonstrated the im- 
portance of the Respiratory System of Nerves in securing “a wide- 
spreading means of connexion between parts that are remote, to pro- 
vide for freedom in the simple act of breathing.”! He has also ex- 
plained the process by which the act of respiration, which “proceeds 
so equally during sleep, is uninterrupted in the insensibility of apo- 
plexy ; and how it continues when the head of an animal is crushed, 
the brain deeply injured, or the head altogether removed.” It is 
through the respiratory system of nerves that the processes of respira- 
tion and the other involuntary vital actions are carried on; and in 
health, they proceed as regularly during sleep as at any other time. 
But there are some diseased conditions in which the suspension of the 
voluntary actions is accompanied by the cessation of action in the 
involuntary nerves also.J 
* British and Foreign Medico-Chir. Review, April, 1852, p. 396. 
t Nervous System of the Human Body, pages 71, 72. 
J Appendix, p 214. 456 
DISEASES OF THE RESPIRATORY FUNCTION. 
A surgeon from the West Indies, who had suffered from a malignant 
fever with erysipelas, and had taken large quantities of Calomel, con- 
sulted Mr. Bell for the following spasmodic affection: “On falling 
asleep, just at the moment when volition and sensibility cease, the in- 
voluntary motions also stop, with a sensation of death, under which 
he awakes, generally convulsed. 
“His medical friends have sat by him and watched him, and they 
have found that when sleep is overpowering him, the breathing becomes 
slower and weaker, the heart and pulse also fall low, and cease to beat 
as sleep comes on, and after a short time he awakes in tremor. This 
gentleman is very naturally in much apprehension that some of these 
attacks may terminate existence. But he is young, and I think the 
attack is essentially different from the case of angina jpectoris. The 
case presents us a lively idea of what would result were the involun- 
tary nerves subjected to the same law of the nerves of sense and voli- 
tion ; for then sleep, by overpowering both, would be death!” 
We have met with a few cases of this character, in all of which the 
pathological condition corresponded in general with the case given by 
Mr. Bell. These patients all (but one) had resided in a malarious 
region; they had taken considerable quantities of Mercury and Sulph.- 
quinine to cure intermittent or remittent fevers; and the respiratory 
phenomena were nearly the same in all. The spasms came on at first 
exclusively during sleep, producing the greatest imaginable distress 
and terror. One of these cases was peculiarly severe, and caused the 
patient and friends extreme suffering and anxiety for several years. 
This patient wras a boy belonging to an intellectual and nervous 
family; he had had ague occasionally, and been cured under different 
modes of treatment. At the age of ten years he became subject to spas- 
modic attacks, commencing always in sleep. The whole progress and 
pathology of the case corresponded entirely with that given by Mr. 
Bell. It resisted all treatment for six-and-a-half years, and the boy 
ultimately died of another disease. The other cases referred to were 
cured by Nux-vomica and regulations of diet. DISEASES OF THE SANGUINOUS FUNCTION. 
457 
CLASS III—DISEASES OF THE SANGUINOUS 
FUNCTION. 
The heart is the most remarkable muscle of the body, lying ob- 
liquely in the chest between the two lungs, its base pointing upwards 
in the direction of the right shoulder, the apex pointing to the space 
between the fifth and sixth ribs. It is inclosed in a peculiar capsule, 
called the pericardium, consisting in a fibrous layer without, and a 
serous membrane within; the cavity between the heart and pericar- 
dium generally "contains more or less fluid which lubricates the heart 
on the outside and renders its local motions easy. 
The heart comprises four cavities, consisting of one auricle and ven- 
tricle on each side; the right pair of cavities being devoted to the cir- 
culation of the venous blood, the left pair to that of the arterial blood. 
The upper cavities, called the auricles, constitute the base of the heart, 
the ventricles -which are much stronger than the auricles, form the apex. 
The heart thus constructed is the prime-mover of the circulation of 
the blood. When this indispensable function is perfectly performed, 
the physician generally feels that, though something else may be 
'wrong, the centre of the blood-system remains well balanced, and 
something may be done towards restoring the normal functions of other 
portions of the machinery. When the blood, which contains the ele- 
ments of life, growth and reparation starts on its circuit to the remote 
portion of the organism, it sets out from the heart, beginning its jour- 
ney at the left ventricle. By the contraction of that cavity the living 
fluid is forced into the aorta, from which is to be distributed into all 
the high-ways and by-ways of the body. After ramifying through the 
remotest and finest capillary branches of the arteries, it finds its wray 
into the minute corresponding tubules which constitute the beginnings 
of the veins; these, uniting with each other as they proceed towards 
the centre, pour all their contents into the two great trunks, called the 
venae cavae ; and they unload themselves, moment by moment, into the 
right auricle. Though the blood has already reached the heart, it is 
not yet at the point from which it started, to reach which, another jour- 
ney must be performed. The right auricle contracts on the blood and 
forces it into the right ventricle by which it is sent oif through the 
pulmonary artery, to the lungs ; and there it ramifies through the many 
minute branches of this artery, till it enters the finest vessels of the 
pulmonary veins. These collect it from all portions of the blood, and 
concentrate it in thfe four large venous trunks which pour it back into 
the left auricle of the heart; and this cavity at once contracts upon it 
and drives it through the opening valve into the left ventricle from 458 
DISEASES OF THE SANGUINOUS FUNCTION. 
which the circuit was commenced. Such is a brief outline of the cir- 
culation of the blood in health. We proceed to treat in regular order 
of its principal accidents, modifications, and derangements generally 
spoken of as Febrile and Infiammatory Diseases. 
ORDER I.—PYRECTICA.—FEVERS. 
It lias been estimated by good observers that one-balf of all the 
human family have died from febrile diseases; and yet a clear and 
faultless definition of Fever has never been written. The acutest in- 
tellects in every age have been employed on the subject, but nothing 
important has been added to the analysis of its phenomena made by 
Hippocrates. The word signifying fever, in nearly all languages, sig- 
nifies to burn or to boil, but heat alone does not constitute fever. 
Boerhaave endeavored to ascertain the essential characteristics of fever 
by collecting from all authors the symptoms of all the different fevers, 
and then throwing out all symptoms that did not appear in every fever. 
In this way he reduced the essential symptoms to three only,—shiver- 
ing, frequent jpulse, heat. But no one of these symptoms is always 
present. Shivering only occurs in cases that progress rapidly, the 
pulse may be slow instead of quick, even as low as thirty or forty beats 
per minute; the heat is often below that of health. Cullen added to 
Boerhaave’s definition, “languor, lassitude, and other signs of debility, 
together with derangement of the functions, particularly a want of 
vigor in the limbs without any primary local affection.” None of these 
symptoms are present in all cases. Wilson Philip {On Fevers, p. 10) 
endeavors to correct Cullen’s definition, and gives the essential symp- 
toms of fever in “languor, lassitude, and other signs of debility,” all 
of which occur in other diseases as well as in fever. In our own day 
the following definition has been given by Dr. Wood of Philadelphia: 
“Fever is an acute affection of the system, in which all the functions 
are more or less deranged; the most striking phenomena being sen- 
sorial or nervous irregularity, increased frequency of pulse, increased 
heat, and disinclination for food. The essence of the affection is uni- 
versal derangement of the functions.” {Practice of Medicine.) Per- 
haps no definition yet given is more radically defective. Fever can 
not be defined in few words. We must take all the symptoms given 
by all the above authors, and admit that any one or more of them may 
be absent in an individual case. We must also distinguish between 
the phenomena usually expressed by the term fever, and those diseases 
called “fevers,” in which this state occurs as the leading phenomenon. 
“Fever,” says Dr. Smith of London, “is not an entity, it is a series of 
events, and our object in investigating it is not to discover what consti- 
tutes its essence; but what events invariably occur in the series, and in FEVERS. 
459 
what order they constantly occur. These will include all that we 
shall ever know of what is termed the nature of fever.’’ We do not 
look for the events which constitute fever in “the external symptoms 
of internal and generally invisible conditions.” We must look for 
them in the state of the organs. (On Fevers, p. 56.) 
Functions deranged in Fever.—Dr. Smith says (p. 60): “The evi- 
dence is as complete as observation during life and inspection after 
death can make it that a morbid change does take place in a certain 
number of organs. These organs are: 1. the nervous system; 2. the 
circulating; 3. those organs that constitute, the systems of secretion 
and excretion. The chain of diseased organs consists of the brain 
and spinal cord; the heart and arteries, especially their capillary ex- 
tremities ; the secreting and excreting organs, which in fact are com- 
posed essentially of the capillary extremities of the arteries; the 
secreting and excreting extremities of these arteries, especially as 
they terminate in the external skin and in the mucous membranes 
which form the internal skin.” This is the circle of diseased actions. 
“There never was a case of fever in which all these organs arid func- 
tions were not more or less in a disordered state; and this complete 
circle of organs were never in this morbid state without fever. A de 
viation from a healthy state in one or in two circles will not produce 
fever; there must be deviation in the three circles before fever can exist. 
“ Such are the common phenomena of fever, not only invariably in 
their occurrence, but in their concurrence in a particular order. 
Derangement of secretions and excretions is never first in the series, 
derangement of the nerves and sensorial functions never comes last; 
derangement of the circulatory system is never first, or last, but is 
always the second in the order of succession.” (Smith on Fevers, 
London, p. 60.) 
A majority of the profession at the present day, however, suppose 
with Cullen, that the prime causes which produce fevers, 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 impression is made upon the extreme nerves of the 
part acted on; and that the whole system is aifected to a greater or 
less extent, secondarily, thus giving rise to that congeries of symptoms 
which constitute fever. 
The skin, the nervous system, the circulation, the respiration, the, 
secretions, and indeed the whole body partake 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 460 
DISEASES OF THE SANGUINOUS FUNCTION. 
those structures for which they have an affinity or attraction, thus im- 
parting those peculiar and specific actions which induce fevers. 
Diagnosis.—The external signs of the pathological condition which 
constitutes fever are variable in the different forms in which it appears. 
Though life and death depend on our correct discrimination between 
conditions which may require measures of treatment entirely opposite; 
though certain states of the vital organs, if allowed to remain long, 
must terminate in fatal changes of structure, and we know' that certain 
remedies, if applied in due season, are capable of removing these con- 
ditions ; a most intricate problem is presented to the mind of the prac- 
titioner in every case of fever. The external characters and the in- 
ternal states exhibited to the mind in individual cases, demand for their 
analysis the clearest exercise of the intellect and tfie most extensive 
knowdedge of the resources of science. “Fevers differ in different 
countries, in different seasons, and in different individuals. The cir- 
cumstances which excite and develop these varieties of fevers are of 
the utmost importance, as they are often intimately connected with 
those causes which may render the disease mild in its character or 
fearfully mortal.” The methods of distinguishing between the different 
febrile maladies will be given under the respective diseases. 
Distinction between Fever and Inflammation.—Fever differs from 
inflammation in being an affection of the whole nervous and vascular 
systems ; in inflammation there is an affection of those systems in some 
one organ; fever is an affection of the heart and large arteries, while 
inflammation is more an affection of the capillaries. In inflammation 
there is an enlargement of the diameter of the capillary vessels, with 
slower movement of the globules of the blood, and in this state the 
old practice of bleeding from the large veins was seen to reduce the 
action of the heart and arteries while the capillaries wrere but little 
influenced. 
Pathology.—The question of the relations necessarily existing be- 
tween fever and inflammation wTas first brought prominently before the 
medical profession by Broussais. This great pathologist, having found 
inflammation a more frequent attendant on fever than had been pre- 
viously suspected, endeavored to prove that these two pathological 
states wrere so intimately related that the one must be, necessarily, the 
outgrowth of the other. The general experience of the profession has 
sanctioned a part without confirming the whole of the doctrines of 
Broussais. It is now believed that fever may sometimes be essential, 
or idiopathic, and sometimes syynjptomatic. 
The probability is, that some causes act locally on one organ exclu- 
sively, others act generally on several organs, some universally on all. 
But when an essential fever arises from a cause acting upon a particu- 
lar part, the first impression, after setting the febrile movement a- FEVERS. 
461 
gtfing, is no longer absolutely necessary to it, and may cease altogether 
otherwise the fever would he symptomatic of the local affection. 
Causes of Fever.—The causes of fever are either predisposing, or 
exciting. Any thing which debilitates the organism, or impairs the 
tone and resisting power of'the nervous or muscular system may be de- 
nominated a predisposing cause of disease. Under this head may be 
ranked excessive physical or mental exertion, protracted grief, anxiety, 
fear, chagrin, and disappointment, deprivation of well-ventilated dwell- 
ings, 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 
predisposition. 
Those causes which induce fever by a direct impression are termed 
exciting causes. Miasmata, contagious and epidemic effluvia, noxious 
gases, extreme and protracted heat or cold, and sudden changes of tem- 
perature; local injuries and inflammations, however excited; vicissi- 
tudes of temperature; exposure to great heats, cold, or damp air; too 
free use of stimulating food; electrical influences ; atmospheric impuri- 
ties ; epidemic influence; miasmata. 
All of the causes, however, which we have ranked under the head 
of predisposing, may, and often do become, under favorable circum- 
stances, actual exciting causes of fever. See Observations on the 
Causes of Disease, p. 182. 
It is equally true, also, as we have before observed, that wrhat 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 certain point, by 
moral or physical, morbific or remedial agencies without exciting actual 
disease; but if the influence be carried beyond this point, an im- 
paired condition of the capillaries acted on, will ensue, with the usual 
concomitants, inflammation and fever. Even the natural maladies, 
scarlet fever, measles, small-pox, chicken-pox, 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 suscep 
tibilities 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 Avay 
impair the normal integrity of the organism, will be recognized. In- 462 
DISEASES OF THE SANGUTNOUS FUNCTION. 
deed, we believe, that such a course wight he pursued, 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. 
A few of the means which we would recommend to accomplish this 
object would be 
1. A proper system of physical education. 
The first and most essential condition for the enjoyment 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 physical 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 body; athletic sports, games, 
&c., should be established suitable for all ages and conditions ; Avhere 
the man of mature 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 establish in their place infant gym- 
nasiums for the culture of their infant bodies. Let is see no more in- 
tellectual “ infant prodigies,” with their pale, sickly faces, arid their 
feeble and half developed forms, but show us in their stead, physical 
pi’odigies with their rosy cheeks, their plump, firm, and well-grown 
muscles, and with elasticity and buoyancy, reminding us constantly of 
perfect health. Show us your children of six, eight, or ten years of 
age wild, bouncing, and overflowing with animal spirits, rather than 
your prim, well-mannered, delicate, 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, spontaneous, and unrestrained. It is 
a principle of their natures, absolutely essential to their wTell-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 to the country, for in 
the former every thing is forced and unnatural; children are born into 
hot-houses, heated with anthracite coal to the temperature of seventy- 
five or eighty degrees of Fahrenheit. Here do these unfortunates pass 
the best part of their existence, encompassed by every thing which is FEVERS, 
463 
unnatural and artificial, and inhaling an atmosphere deprived of a por- 
tion of its oxygen, and impregnated with carbonic and other noxious 
gases, until, while yet young in years, they arrive at 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 become desert wastes. This remark is, beyond question, 
true, and it is only necessary to look into any of our large towns and be- 
hold the numerous worn-out and impotent wrecks of the wealthy fami- 
lies, who have been inhabitants for two or three generations, to be con- 
vinced of the fact. 
The second means, which we would advise to secure health, would 
be a correct system of dietetics. The use of all kinds of animal and 
vegetable substances, which are not perfectly pure, digestible, and 
healthy, should be rigidly prohibited. In order to accomplish this ob- 
ject, we do not believe that better rules could be adopted, than those 
instituted and commanded by Moses for the Jews. Amongst the articles 
forbidden in the dietetic regulations of the great Hebrew law-giver, we 
find pork excluded, from the supposition that the swine is unclean and 
unhealthy. When we consider how frequently that animal is affected 
with that dreadful malady, scrofula, and also how filthy and disgusting 
are its habits, it is not surprising that any person who is at all particu- 
lar as to the quality of food he consumes, and who possesses ordinary 
powers of observation, should denounce this offensive and diseased ani- 
mal as unfit for food. But this abominable stuff in all its different 
forms is consumed by Christians everywhere. Lard constitutes the 
culinary expletive wdiich serves to connect the ingredients of almost 
every dish in one greasy union. 
Whether the uses of pork and its preparations have any agency in 
causing scrofula we leave for others to determine. An argument, how- 
ever, which tends to establish the affirmative is in the fact, that amongst 
the strict Jews, and all of those nations where this 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 brief, care in regard to the selection of proper articles of food, 
suitable methods of cookery, avoidance of fat and condiments, stimu- 
lant, narcotic, and hot drinks, and regularity in partaking of meals, will 
enable 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. See Remarks on 
Purity of Food at pages 285, 286. 
Finally, we would recommend the establishment of such a state of 
society as would recognize no pursuit or custom as legal or respectable, 464 
DISEASES OF THE SANGUINOUS FUNCTION. 
except such as should conduce directly to the health, morals and general 
welfare of the community. 
COLD.—CHILL. 
INFLUENCE OF CHILL FROM SUDDEN EXPOSURE. 
When a person becomes chilled from sudden exposure to cold and 
wet, he loses a large share of vital warmth and animal or vital gal- 
vanism. A common accident is a fall through the ice, followed by 
protracted exposure to cold air in the wet clothes. In such cases the 
clothes should be changed for dry Ones, when possible, and when this is 
not, as much water should be squeezed out as may be done by the hands, 
and heat developed by active exercise. 
The advantage to be gained by exercise consists in the free, full 
respiration and accelerated circulation of the blood. In extreme cold 
weather the wet clothes freeze on the outer surface, while the internal 
warmth generated by the exercise and rapid respiration produce per- 
spiration, which has the effect of a vapor-bath; and injury from cold 
is prevented, if care be taken in a final change of clothing. 
The mere change of clothing after exposure to cold and wet is not 
sufficient for safety, even if a warm room can be soon reached. If free 
circulation of the blood, and respiration and perspiration be not brough 
about by active exercise, there will be a sense of chilliness, alternating 
with flashes of fever, and these chills indicating congestions of some 
internal organs, liable to become established into more permanent local 
inflammation with fever may return at irregular intervals for several 
days or merge themselves in some more serious disease. 
This condition of the blood-vessels is considered by some writers as 
a primary affection; by others, as by Dr. Wood, it is believed to be 
“always an effect of some pre-existing morbid state or action; and it 
is a partial view which is directed to this effect alone, without embra- 
cing the other elements that enter into the complex-phenomena pre- 
sented by the part congested.” There is probably no form of conges- 
tion which may not be traced to some one of the morbid effects already 
described, and its varieties have consequently been treated of along 
writh the other phenomena or effects of these states respectively. 
Sources of Active Congestion.—1. Irritation or inflammation; 2. 
depression; 3. physical agency. In every case of excessive capillary 
excitement there is an increased flow of blood to the part affected, and 
an accumulation in the vessels of that part; and any excessive or un- 
healthy excitement constitutes either irritation or inflammation, the 
latter beginning where the former ends. “Congestion, therefore, is 
nothing more than a phenomenon of one of these latter affections.” 
But the term congestion should be restricted to “that condition in COLD.--CHILL 
465 
which the vessels are merely engorged, and the peculiar features of 
congestion have not yet made their appearance.” In this sense, con- 
gestion is simply a phenomenon of irritation. It is not the disease 
itself, but is merely the sign of a disease. The real seat of the mor 
bid action is not in the blood; it must be in the vessels themselves 
“ The disease is, in fact, some peculiar modification, not well under 
stood, of the solid tissues, of which a change in the innervation al 
ways, probably, constitutes an essential part, and which is induced by 
the operation of some excitant, unhealthy either in its nature or de- 
gree. In other words it is an irritation.” ( Wood.) 
Passive Congestion.—In this abnormal condition the blood accumu- 
lates in the vessels of a part, because it is not carried forward so 
rapidly as it enters by the ordinary movement of the circulation. 
Causes.—1. Want of due degree of that action which is necessary 
to its transmission, that is from depression. 2. Physical difficulty or 
obstruction. 
The depression which gives rise to congestion may be general, or 
confined to a particular organ. It is common in diseases attended with 
great and sudden prostration. The heart, participating in this pros- 
tration, is unable to transmit the blood so rapidly as it is conveyed 
towards it by the continued action of the capillaries, and by the forces 
which move the blood in the veins. This fluid, therefore, necessarily 
accumulates in the right side of the heart, and the great venous trunks 
and consequently in those organs with which these trunks more imme 
diately communicate, viz: in the brain, liver, and through this latter 
organ, in the abdominal viscera generally. Thus: a blow upon the 
head, or any severe shock, temporarily paralyzing the cerebral actions; 
certain mental emotious tend to produce syncope; the chill of fevers, 
especially those of a typhous or malignant character, and the prostra- 
tion of violent internal spasm of the stomach, all occasion internal 
congestions consequent upon depression in the movements of the heart. 
The alarming phenomena which attend these affections, the feeble 
pulse, the cold extremities, the pale and shrunken skin, and the fre- 
quently suspended or impaired intellectual functions are not caused by 
the congestion, for it “is a mere effect of the prostration, and ceases 
when the heart resumes its usual energy.” The error of ascribing 
these alarming phenomena to the internal sanguinous engorgements, 
and directing the treatment accordingly has led many practitioners to 
overlook the collapse of the nervous system, and the feeble movement 
of the heart, though they are both overwhelmed by some powerfully 
depressing influence. The title of “ Congestive,” generally applied to 
those affections, in which that condition forms a prominent feature is 
objected to by Dr. Wood; but the nomenclature of diseases can 
scarcely be reformed in a satisfactory manner • and we still employ 
Vol. I.—30. 466 
DISEASES OF THE SANGUINOUS FUNCTION. 
this term, as well as all others, as they are universally known and 
understood. 
BATHS.—COLD SHOWER-BATHS AFTER HOT-AIR-BATHS. 
1. Pure experimentation proves that the primary action of the hot 
air-bath, of the temperature of from 110° to 140° Fahrenheit is to ex- 
cite and stimulate the system; to raise the temperature of the body, 
to accelerate the pulse, and to produce a copious excretion from the 
pores of the skin. A sensation of oppression is for a moment felt, and 
disappears as soon as the perspiration begins to break out. This con- 
dition is soon superseded by the opposite group of phenomena, viz.: 
The prover experiences a chill, or cold sensation all over the body; he 
looks pale; the pulse is much reduced, is feeble and slow. He feels 
weak and depressed. He shivers, and collapse soon takes place. This 
condition constitutes the secondary action of the hot air-bath, or the 
reaction of the organism, which may terminate, in death. 
2d. That the primary action of a cold water-shower-bath, at the 
temperature of from 32° to 60°, or 80° produces a general sensation 
of frigidity all over the body; takes the pulse down; shortens the 
breath, when the shock is sudden; the face becomes pale; and the 
prover experiences more or less chills and shivering. An opposite 
group of symptoms occurs, which constitute its secondary action, viz.: 
a gradual restoration of the equilibrium of vital action, followed by an 
agreeable sensation of warmth all over the body. The pulse rises; 
the face becomes florid; the breath is free; and a copious discharge 
of urine ensues. These being the pathogenetic effects of heat and 
cold in the forms already expressed, it follows that the therapeutic 
properties of the latter are evidently manifested, when used im- 
mediately after the former; because, our therapeutic law teaches us, 
to treat pathological conditions, in their primary state, by administer- 
ing a remedy whose secondary action is similar to the primary action 
of the case, and vice versa. The proof of this kind of action and 
reaction, which is a principle universal in nature, equally operative in 
therapeutics as in physics, will be found in the hundreds of remedies 
contained in our materia medica. 
The effects of long-continued exposure to cold and moisture are quite 
different from those of sudden exposure. The powers of the body are 
at first diminished by the depressing powers of the cold; and many 
important functions are immediately deranged, diminished or com- 
pletely arrested. At the same time, if some vital force is not ex- 
pended in the processes of secretion and depuration, the system will 
become loaded with matters that should be thrown off; the accumula- 
tions of effete matters that the perfect performance of the secretory func- CLASSIFICATION OF FEYEES. 
467 
tions would have carried off, now interfere with all the vital functions; 
and this too at a time when the powers of life are debilitated and de- 
pressed by cold or its consequent reactions. 
The removal of the person who has been thus exposed to a room, 
warm enough to restore the animal heat, is far from being all he needs. 
The restoration of the heat itself is dangerous, if it be not slowly and 
carefully done. The diffusible stimulants commonly resorted to to restore 
the warmth of health, very often go beyond the mission entrusted to 
them and excite fever or inflammation which demand judicious treat- 
ment. 
Classification of Fevers# 
We shall arrange the various febrile diseases under the following 
general divisions or genera: I. Ephemeral fevers; those which arise 
from slight temporary causes; and which terminate spontaneously wdien 
their exciting cause is withdrawn. 
II. Malarial or Autumnal Fever. Originating in malaria or marsh- 
miasm ; a specific form of disease, whether resembling other diseases in 
external symptoms or not. It subdivides in two species as commonly 
observed, though in their origin they are essentially the same. 
III. Intermittent Fevers. 
IY. Remittent Fevers. 
Y. Continued Fevers. 
YI. Exanthemata.—Eruptive Fevers. 
The different specific forms of fever will be treated of under one or 
another of these general heads. 
In each of these fevers there are certain peculiar characteristics 
which serve to distinguish them from it and from all other maladies. Not- 
withstanding 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, predispositions, habits, &c., 
tend to modify the character of each particular case, that all instances 
of the same malady must necessarily present different trains of symp- 
toms. It will readily be perceived, therefore, how impossible it is to 
prescribe for the name of a disease instead of symptoms. It is there- 
fore scarcely necessary to express our opinion, that any classification 
of diseases whatever, 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: 
1. The forming stage. 468 
DISEASES OF THE SANGUINOBS FUNCTION. 
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 
classifications and divisions are entirely arbitrary and artificial, and can 
only be used for the purpose of facilitating diagnostic examinations. 
Genus II.—MALARIOUS OR AUTUMNAL FEVER. 
Of all fevers, those which have pervaded the world most extensively 
in all ages and countries have been attributed to one cause, now usu- 
ally designated as Miasm or Malaria. This mysterious agency, which 
in ancient ages was regarded as a demon of darkness, continues to be 
developed under all the conditions that could bring it into being three 
thousand years ago; and it has no where been destroyed, except in 
small territories that have happened to come under a higher civilization 
than the nations have yet reached. If it be sometimes losing ground 
in one place it is always gaining elsewhere. In all the places where 
Febkis, the goddess who anciently presided over fevers, was ever 
worshipped, the blighting influence of Mal-aria or bad air, continues 
to preside as the tutelary genius that human science has not yet been 
able to expel. From the Appenines in Italy to the sea shore, and for 
a distance of two hundred miles north and south her power is as great 
as when her temples were most honored; and, instead of improving 
under the influence of modern civilization, it has been gradually grow- 
ing worse. Rome which in ancient times was uninhabitable for two 
months in every year is more noted for malignant intermittents than 
it was in the time of the Republic. From the Pontine marshes, fifty 
miles south of the city to the Tiber the intensity of the malaria has 
been long increasing. For two hundred years the Ague has resisted 
all the resources of science; and has held possession of the Palatine 
Hill, the Circus Maximus, the Forum and nearly the whole of the an- 
cient city. It has outlived the throne of the Caesars, and the Iron 
Crown of the Lombards, claims joint sovereignty in the Vatican, and 
promises well to outlive the Eternal City itself. 
Malarious Fever in its various forms of Autumnal Intermittent, 
Remittent or Bilious Fevers, is extensively prevalent in all parts of the 
American Continent. In the United States it is seen annually in all 
the Territories between the Gulf of Mexico and the Rio Grande and 
the forty-fourth degree of North latitude. South of thirty-three degrees 
it extends from the Mountains to the Atlantic Ocean; farther north it MALARIOUS FEVER. 
469 
is less known east of the Alleghanies. In the south-west it is found 
in all the valleys on both sides of the Cordilleras of Mexico. In the 
Northern Territories of the United States, malarious diseases exist on 
all the fertile plains and forests of the Mississippi Valley, and on all 
the tributaries of the Missouri as far west as the western parts of 
Dacota, Nebraska, and the middle of Colorado, six-hundred miles above 
St. Louis. 
In considering the conditions that impose geographical limits and 
give prevalence to autumnal fever, it is, says Dr. Drake “ a safe gene- 
ralization to affirm, that, all other circumstances being equal, autumnal 
fever prevails most where the amount of organic matter is greatest, and 
least where it is least.”* 
Conditions necessary to develop Malarious Fever.— These are: 
1. Decaying organic matter for supplying the material for the ge- 
neration of the poisonous agent, whatever that agent may be. 
2. Surface water, which, by impregnating the air with water, gives 
a high dew point, promotes those chemical actions in certain soils sup- 
posed to generate malarious exhalations ; favors the growth and decom- 
position of a luxurious vegetation, produces animalculae and micros- 
copic plants; and, through evaporation and condensation, produces 
electrical changes ; all of which effects of surface water have been sup- 
posed to cause malarious fever. 
3. Elevated Temperature.—These diseases prevail extensively and 
virulently in warm climates, and become milder and less general as we 
pass from the tropics towards the poles. 
These conditions which combine to originate malarious diseases and 
the phenomena by which they are characterized, are essentially the 
same in all ages and countries. All observers have remarked the same 
general features of these diseases, wherever observed, differing only in 
the degree of condensation in which the marsh poison exists in the 
various localities. All observers have remarked the general vital 
degeneration produced on all the inhabitants of the malarious districts ; 
and it has often been noticed that the most disastrous results may 
follow a residence in a marshy region in persons who have never suf- 
fered from intermittent fever in a regular form. The description given 
by Montfalcon, of the inhabitants of La Bresse, in France, is appli- 
cable to the residents in many portions of the American Republic. 
He says: 
“Each child languishes and grows thin; a yellow tint tinges his skin 
and eyes; the viscera become engorged ; and he probably dies before 
he has attained his seventh year; or if he reaches this age he does not 
live but vegetates, he continues cachectic, oedematous, subject to putrid 
* Diseases of the Mississippi Yalley. 470 
DISEASES OF THE SANGUINOUS FUNCTION. 
and malignant fevers, to endless autumnal remittents, and to passive 
haemorrhages, to ulcers of the extremities, which heal with great diffi- 
culty ; and the miserable being is scarcely able to fight against the 
diseases which convert his life into a prolonged dying. The inhabi- 
tant of the Bresse, having perhaps arrived at his twentieth or thirtieth 
year, the disorganization commences, his faculties become enfeebled; 
and, generally, the age of fifty years is the limit of his life.” 
When a resident of the Pontine Marshes Avas asked how it was pos- 
sible to live in so unhealthy a place, he replied :—“We do not live— 
we die !” 
In localities where the marsh poison exists in a concentrated form 
we remark : an imperfection of physical development; engorgment of 
the abdominal viscera, especially of the spleen; general inertia, and tor- 
por of intelligence ; an appearance of apathy passing in some cases into 
idiocy ; atony, and diminished power of reaction of the nervous centres ; 
in short, all the physical, intellectual and emotional faculties are de- 
pressed, and the duration of life is diminished. 
Characteristic Features of Malarious Fevers.—These vary in dif- 
ferent seasons and in different localities. Besides the usual ensemble 
of symptoms commonly included under the term fever, the disease may 
simulate almost any other disease. We may have the external symp- 
toms of cholera morbus, Asiatic cholera, dysentery, bilious diarrhoea, 
menorrhagia, enteritis, inflammation of the brain, or of any other organ. 
Even tetanus may be the only outward expression of a paroxysm of 
autumnal fever. 
In those sudden and violent attacks properly called congestive, there 
is a collapse, a sinking of the dynamic powers similar to that seen in 
malignant cholera; though there is not the same exhaustion of the cir- 
culating fluids. In the congestive form of malarious fever the collapse 
is in the nervous and cerebral symptoms. “ The cerebral and nervous 
influence is prostrated as a primary effect of the specific poison that 
causes the disease.” 
The diagnosis of autumnal fever does not rest on any generally ob- 
served assemblage of symptoms, but on the attendant circumstances 
which may accompany the accession of the disease in its origin. We 
may consider the locality in which the patient resides, his recent his- 
tory, the season, the epidemic constitution of the atmosphere, and the 
exciting causes to which the attack may be attributed; and from these, 
with the concurring evidences of the existence of malaria presented by 
the case before us, the true nature of the disease may be determined. 
Forms and Varieties of Malarious Fever.—In the United States, 
and especially throughout the Mississippi Valley, two great varieties 
of these fevers may be distinguished: 
1. Fevers of open excitement.—2. Congestive Fever. MALAKIOUS FEVER. 
471 
These forms of fever are not distinct diseases ; they are only different 
manifestations of the same disease, operating in a different way, on dif- 
ferent persons, according to their individual states of general health. 
It is observed by Dr. Monette, of Mississippi,* that “ the tone of fibre, 
and degree of tension in the Northern constitution, resists the febrile 
influences, especially those of a debilitating or relaxing nature; whilst 
the natives of the South, whose systems are already relaxed and ener- 
vated by the climate, are obliged to take greater precautions to escape 
the endemic of the country. Strangers arriving from the North, are 
usually only attacked by the fever in its simplest form, with open ex- 
citement, which is easily subdued. But if the same person remains to 
be attacked after spending a second or third summer in the country, 
depletion will not be well borne ; and, at a later period, after migration 
from the North, he will be more likely to be attacked by the fever in 
its congestive form.” 
Farther Northward, and in the region bordering on the North- 
Western lakes, we only observe that the effects of malaria are mani- 
fested in different degrees somewhat'proportioned to the powers of the 
constitution to resist its influence. 
When the atmosphere holds a large quantity of the specific poison, 
a few days, or even a few hours may be sufficient to develop the dis- 
ease in some form. When the amount of poison in the air is smaller, 
it might require a year or two to bring the system so far under its in- 
fluence that the common proximate causes of disease will excite mala- 
rious fever. 
This fever, when established, may assume any one of the various 
types usually observed, thus : 
1. When the atmosphere is strongly saturated with marsh-poison the 
most trifling exposure to vicissitudes of temperature or exhausting 
exercise will develop true intermittent fever, or “ shaking ague.” 
2. When there is less malaria in the air, but other causes combine 
with it to derange the ordinary operations of the different organs, the 
disease produced is characterized by less chill, but this is followed by 
fever of longer duration. The intermission, if complete, is still very 
short; the chill and fever run more into each other; and we have the 
form of disease known in the West as “chill fever.” 
3. When the amount of malaria in the air is still smaller than in the 
locality where the last form is most prevalent, but the miasm is assisted 
by great exposure, extreme heat of the weather, or excessive bodily 
fatigue, the disease resulting is called “ remitting fever,” there being 
only a remission, no intermission of the fever. 
4. When malaria, existing in a greater or less degree, is aided by ex 
* Fevers of Mississippi. Western Med. Journal, 1850 472 
DISEASES OF THE SANGUINOUS FUNCTION. 
posure to cold air long continued, or other strong causes of disease, 
the effect of the marsh-poison is almost obliterated by the strength of 
the exciting causes of the attack, or some epidemic influence. The re- 
mission in this case is scarcely perceptible, and the case is called 
one of continued fever. 
5. Any of the preceding forms of malarious fever, inefficiently treated, 
may terminate at the end of the first, or of the second week in a lower 
form called, though improperly, typhoid fever. The remission is not 
perceptible, or scarcely so. 
6. An attack of fever in any of the foregoing types, occurring in an 
individual already greatly prostrated or exhausted by previous ill 
health is liable to assume the form much dreaded in the newer territo- 
ries and known as congestive fewer. 
Sinking Chills, or Malignant intermittent Fever.—This form of 
disease is always mortal when not arrested by medical treatment; and 
it is a common remark that “none survive the third paroxysm.” In 
some localities beyond the range of enlightened medical practice, it 
constitutes in autumn the principal outlet of human life. 
1811 was a season of unusual sickness near the hanks of the Mis- 
sissippi and Missouri. The Missouri rose to an unusual height in 
June; the waters of the small rivers were backed far up in their chan- 
nels, flooding their banks and covering quantities of luxuriant vegeta- 
tion. This was succeeded by very dry hot weather. Bilious and in- 
termittent fevers then commenced in a form of unusual severity. 
In the years 1819, 1820, 1821, all the region bordering on the Mis- 
sissippi, Illinois, and Missouri suffered much from malarious fever. Im- 
migrants in immense numbers had recently arrived in the countries 
then being rapidly settled. Multitudes were living in new and open 
cabins of green timber; they were drinking the stagnant water from 
creeks and ponds; a luxuriant vegetation was growing and decay- 
ing around them; and they were suffering all the other evils attendant 
on the settlement of a new country. Of these people large numbers 
died. The summer of 1820 was the hottest and dryest ever known in 
the Western States. For weeks in succession the thermometer was 
at 96° in the shade, for hours in the day ; not a cloud came over the 
sun. Fevers were unusually violent, malignant and unmanageable; ir 
many cases at St. Louis and the adjoining country were seen every mark 
of yellow fever. Bilious fever appeared in its most malignant form. 
The contents of the stomach thrown up by vomiting were black and 
foetid. Lake Creve Coeur, (seventeen miles from St. Louis and near 
the Missouri river, several miles long,) was entirely stagnant, covered 
with thick scum, sending forth a disgusting smell, and the fish died in it. 
The same general sickness prevailed in the South beyond Cape Girar- INTERMITTENT FEVER. 
473 
dean, (150 miles distant, and along the Missouri above to the highest 
inhabited points, sixty miles above St. Louis. 
At Vincennes and other points in Indiana, disease triumphed. A 
gentleman, who lived through those times says, u nothing was so dis- 
heartening as the cloudless sky and burning sun, which continued un- 
changed for weeks in succession. The small town of Hindostan, thirty- 
eight miles East of Vincennes, begun in 1819, contained seventy or 
eighty families at the beginning of 1820. The heavy beech, poplar 
and oak timber was cut down; the logs were left on the ground ; the 
bark became loose, and intolerable stench proceeded from the timber. 
Fever was rapidly developed and about two-thirds of the people died, 
though there was no visible local cause for disease. 
The summer of 1821 was a sickly one throughout the United States 
and in foreign countries. In the West it was less severe. St. Louis 
had a population of 5000, of which 136 died. The place had no police 
regulations; the people were crowded into poor and small dwellings, 
and filth accumulated. No such season has been known since. (fRev. 
J. M. Peck of Illinois.) 
In 1820 and 1821, bilious fever was prevalent in all parts of the 
Union, even in the hilly and mountainous districts of Pennsylvania, 
Virginia, and the Green Mountains of Vermont. 
INTERMITTENT FEVER. 
Intermittent Fever.—We have observed, that each type of fever is 
marked by certain symptoms, which distinguish it from all other varie- 
ties. The type under consideration presents its chief features in a 
very characteristic 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 de- 
rangement of the cerebro-spinal system. The regularity and distinct- 
ness 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 combination of symptoms termed fever, is uni- 
versally present during the paroxysms and since upon the whole it 
bears a closer resemblance to febrile than neuralgic or ganglionic 
affections, we will continue to employ the old classification. 
In the different forms of intermittent fever, the interval which elapses 
between the commencement of one paroxysm and another, varies ; 
some cases having an interval of twenty-four, forty-eight, and others 
seventy-two hours from one attack to another. From this circumstance 
the different types have been designated—quoditian, or twenty-four 
hour type ; tertian, or forty-eight hour type, quartan, or seventy-two 474 
DISEASES OF THE SANGUINOU8 FUNCTION. 
liour 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', second, the hot', third, the sweat stages. 
Preceding the cold stage, there usually occur general feelings of 
lassitude, debility, uneasiness, and pains in the head, back or loins, and 
sometimes slight sensations of external and internal cold. There is 
also a loss of appetite, disinclination to bodily or mental exertion, and 
a constant disposition to stretch or yawn. 
As the cold stage actually commences the extremities feel cold and 
contracted ; the surface becomes pale, shrunken, rough, with diminished 
sensibility; a sensation of cold along the spine, extending into the tho- 
rax and abdomen; the coldness soon diffuses itself throughout the 
whole body; universal tremors, external 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 mental prostration. 
The pulse is variable ; it may be slow, rapid, weak, oppressed, or in- 
termitting. 
The temperature of the body is usually natural, with the exception 
of the extremities. 
The duration of this stage is exceedingly various ; sometimes ter- 
minating 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 experienced previous to the hot stage; 
at other times neuralgic or rheumatic pains, or coma, precede the 
second stage. 
Ilot 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 ; respi- 
ration 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 continuing twelve, and 
sixteen hours. In some instances the hot stage even continues several 
days, when it becomes a continued fever; or it may assume the re- 
mittent form. 
Sweating Stage.—After the hot stage has run its course, a per- 
spiration makes its appearance upon the forehead and extremities, 
which is soon diffused over the whole body. As the sweating becomes 
more and more profuse, the febrile symptoms, with the pains and un- INTERMITTENT FEVER. 
475 
easy sensations gradually subside, until the paroxysm terminates in a 
perfect state of apyrexia, or convalescence. 
The above is a general description of the ordinary course of a parox 
ysm of intermittent; but in some instances these stages are reversed, o_ 
one or more of them may be absent, or if present, only a few of the 
symptoms enumerated will be recognized. 
Writers have divided intermittents into four varieties, viz.: first, the 
inflammatory ; second, the congestive • third, the gastric • fourth, the 
malignant intermittents. 
This division is made from the fact, that the different types, under 
certain circumstances, partake of the general character which these 
terms indicate. Thus, the inflammatory variety generally occurs 
during the winter and spring. Quoditians are more prone to partake 
of this modification than tertians or quartans. Patients laboring under 
this variety rarely enjoy perfect intermissions between the paroxysms, 
and they are often left with permanent disorders of the liver, lungs, &c. 
The congestive variety is very uncommon. It seldom attacks any 
except persons of feeble, relaxed, and exhausted constitutions, in whom 
there is not sufficient vigor to accomplish a perfect reaction. The 
brain is the organ which usually suffers most, and coma often super- 
venes during the cold stage, which ends in death. 
The gastric variety presents prominent symptoms of gastric derange- 
ment from the first, a superabundance of the biliary secretion, furred 
and bitter tongue, with nausea and vomiting. It is peculiar to tem- 
perate latitudes, and usually occurs in the autumn. 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 common in hot latitudes. They 
are attended with extreme debility from the onset; respiration is feebly 
and imperfectly performed, and the blood is only partially oxygenated, 
diarrhoea now and then ensues, and a rapid prostration 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 indu- 
rations, &c., often succeed fever and ague. These affections have been 
looked upon as secondary consequences of fever, while in point of fact 
they are often medicinal diseases, superinduced by the abuse of Mer- 
cury and Bark. 
These drugs are empirically employed by the allopath for the cure 
of this malady in all its various forms; whether inflammatory symp- 
toms predominate, whether there is congestion of the brain, lungs, or 
liver, or whether the system is exhausted by previous 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 476 
DISEASES OF THE SANGUINOUS FUNCTION. 
actually cure the malady? When the paroxysms are arrested by the 
use of these herculean doses, are the seeds of the disease eradicated, 
and is there no danger of a relapse? Let the candid practitioner of 
the old school answer. 
It is the opinion of some eminent allopaths that large doses of Qui- 
nine often suspend chills and fever, by superinducing in the liver or 
some other important viscus, a serious medicinal inflammation or con- 
gestion, which usurps temporarily, the place of the intermittent. The 
effect of this truly allopathic measure is, however, only of short dura- 
tion, for the paroxysms return again as soon as the artificial disease 
has somewhat abated, or from some slight exciting 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 original affection. 
Critical Days. — Many accurate observers have noticed certain 
epochs of decline or determination of diseases, especially those of the 
febrile character. The most marked of these changes occur on the 3d, 
7th, 11th, 14th and 21st days. Several partial crises are observed in 
the progress of the same case, each leaving it changed by the some- 
what sudden depression or mitigation of some of the symptoms. Now, 
if under the current treatment each of these changes is, on the whole, 
a favorable one, and the final result happy, the several improvements 
and the final cure are not attributable merely to nature; and on the 
other hand, not merely to medicines given immediately before the 
access of the several changes. If others have been previously ad- 
ministered, they may have equal claims as the cause of the improve- 
ment or cure. If the physician neglects the observation of the critical 
days he may draw erroneous conclusions in regard to the curative in- 
fluence of the drug. The quotidian changes are generally appreciated; 
the before mentioned critical days are also in regard to some symp- 
toms and in some degrees, the days of exacerbation ; and their neglect 
might vitiate the pathogenetic confirmation, though usually less than 
the therapeutic. (Minor on Fever, p. 213.) 
Every regular continued fever has one or more quotidian exacerbations 
and remissions; and besides this, certain other uniform and stated 
revolutions. It does in fact pay regard to certain or definite periods 
at which there is more or less effort, and at which likewise the disease 
inclines to terminate either in the beginning of convalescence or in the 
sinking of the patient. Of these periods the 7th, 14th and 20tli or 
21st seem of primary importance, while the 5th and 9th are only of 
secondary importance. There is some effort on the 3d and 11th, but 
less likely to be successful. Crisis on the 4th day is very rare. 
Those of the shorter periods are more important in fevers of only 
seven days duration than on those of fourteen days; and generally the INTERMITTENT FEYER. 
477 
longer the duration of the fever is the more permanent are the critical 
efforts. The mildest continued fever seldom terminates, except at one 
of these periods, and the worst cases seldom end in sinking, except at 
one of these times. 
A seven-days’ case generally terminates on the 8d, 5th, or 9th 
day, and a fourteen-days’ case on the 3d, 5th, 7th or 9th. Bad 
treatment is generally not obviously injurious, except at one of these 
periods; and good treatment leaves the patient to begin to convalesce 
at a critical period. At one of them the case is decided. Death waits 
for the crisis, except in malignant congestive intermittents, typhoid 
pneumonia, or dysentery, cholera, &c. The exhaustion in the first con- 
gestion may not leave vital power for reaction. 
In a regular case of continued fever the crisis is not before the 
seventh day, nor after the fourteenth day. Accidental circumstances 
may extend it beyond or shorten it within it, or may change a fourteen- 
days case to three, or more rarely, four weeks; bad management still 
farther. 
After the seventh they incline to go on to the 11th. What is called 
going beyond this is generally an irritation, depending on debility and 
morbid excitability. But acute cases, by proper treatment, should be 
made to follow the laws of acute fevers; bad treatment degenerates 
them into chronic diseases; as sub-acute disease of the lungs is fol- 
lowed by hectic ; which, like an intermittent, has defined laws, but no 
definite period of duration. 
By obtaining a perfect crisis we decide upon life and death; by par- 
tial crises we decide upon the duration, but not on the event. The an- 
cients describe complete crisis as occurring suddenly upon a striking 
exacerbation of the most essential symptoms: as sweating, ptyalism, 
vomiting, purging, haemorrhage from the nose, rectum or uterus, thick 
sediment in the urine, eruptions, tumors, &c., with or without treat- 
ment. Inert treatment permits diseases to follow their natural laws. 
Bad treatment may exhaust the vital powers and render the system too 
feeble to go through with it. Good treatment conducts the patient 
through the danger, moderating the force of the disease and saving the 
vital energies. 
Causes.—The common, if not the only cause of intermittent fever 
is a peculiar miasm which arises during the progress of vegetable de- 
composition, 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 marshy ground. The decompositition 
of vegetable matters by the aid of solar heat and moisture, is the only 
condition requisite to develop the morbific principle. 
Other exciting causes occasionally give rise to fever and ague, as 478 
DISEASES OF THE SANGUINOUS FUNCTION. 
intestinal irritation from indigestible food, as worms, sudden suppression 
of old discharges and atmospheric vicissitudes; but these causes sel- 
dom if ever produce a genuine, periodically recurring ague, except in 
persons fully imbued with the specific malarial poison. 
The pernicious form of intermittent fever shows itself in its most 
violent and dangerous aspects in swampy countries, during hot and dry 
summers, in places where large quantities of vegetables decay. The 
poison displays itself in the humid air of marshy places, spreading 
rapidly after sunset, and accompanied by large numbers of flies and 
other insects. The danger of taking the disease is greater during 
sleep, especially after sunset, and windows should be shut from sunset 
to sunrise. The bed should never be near a wall. The dress should 
be warm, silk should be worn next the skin. 
“Paludal fevers,” says Boudin (Geog. et Stat. Med. Carte phys. 
meteorol. du globe terre) “extend in the northern hemisphere from the 
equator to a boreal limit which, at least on the old continent would 
correspond with the isothermal curve of 53 (Fahrenheit), but which in 
the Atlantic Ocean, might be represented by a line passing from Que- 
bec, in Canada, to the coast of Norway, towards the 59th parallel. 
This line excludes Scotland, the Hebrides, the Orcades, the Shetlands, 
Faroe, and Seeland. In the Southern hemisphere, the domain is much 
more circumscribed, and its Southern limit does not even reach the 
isotherm of 59°. Paludal fevers extend high in Sweden, but are rare 
in Norway. South America, beyond the tropics, is very little affected 
by them, even where stagnant waters and marshes abound, and where 
the mean annual temperature is higher considerably than that of 
Southern Europe or Algeria. Corrientes, Montevideo, and the isles of 
the Uruguay river, where lagoons and pools of water are left after the 
overflow of the country, have been especially remarked for their ex- 
emption from fevers. (,Saurel. Theses de Montpellier, 1851 and 1853.) 
Malaria is most rapidly developed when the weather is hot, the wet 
surface of the marsh much exposed to light, covered with a rapidly 
growing vegetation, which upon the drying up of the water dies and 
becomes the food of a new race of cryptogamic fungi. These grow 
rapidly, but are extremely minute and of poisonous quality. Persons 
exposed during the night to the damp and chilly air, contaminated with 
malaria, or who drink impure water, soon lose their healthy color, look 
care-worn, exhausted and dyspeptic. The skin is now of a brownish- 
yellow color, the aspect of the countenance is that of a patient in col- 
lapse, and in detached places, bloated. Dropsy soon follows ; the eyes 
are sunk in their orbits, the muscles are flabby and lose their motive 
power. Sometimes there are slight febrile symptoms; scurvy accom- 
panies or follows dropsy; the mind becomes obtuse and even idiotic. 
The doctrine of the Correlation of Forces has been applied to the INTERMITTENT FEVER. 
479 
explanation of the theory of the origin of intermittents by Dr. Lord 
of Chicago. We can only here give a summary of his conclusions.* 
“1. All physical changes, pathological, physiological or chemical are 
the result of force. 
“2. Force manifests itself only through the vibration of molecules. 
“ 3. Molecules aggregate only when compelled by extraneous force. 
“4. Every mass of matter may have a force specific and peculiar to 
itself, or common to many other material bodies. Hence the force of 
one body may differ from that of another, or of all others. 
“ 5. A dissimilar force will produce differing vibrations or oscillations, 
and of course produce different results. 
“6. The human organism is subject to the same laws as other matter, 
in its every organ, tissue, ganglion and cell. 
“7. The force of one mass may neutralize, modify or correllate that 
of any others. Thus the resident force of a ganglion may modify or 
correllate any passing force. 
“8. Normal nerve force oscillates only through the axis cylinder of 
the nerve. Toxical forces, or those of the poisons proper, and zymo- 
tic, probably are confined to the same track. 
“Imponderables seem to pass along the periphery. They may act 
mechanically, however, when in excess. Mechanical force pervades 
the entire cord, and has no specific or peculiar character, but may dis- 
order different organs or tissues equally or unequally, alike or unlike, 
while the effects of electricity and the vegetable and mineral and ani- 
mal poisons are each, under the same circumstances, uniform and specific, 
differing only in intensity until disorganization commences. 
“All these forces when not correllated to nerve-force are disturbers 
of the economy; disease-producers; and essentially, though not tech- 
nically, toxical. 
“In this sense, however, I shall hereafter use the word toxical. 
“9. Each of the ganglia has a resident and peculiar type-force, which 
modifies the character of the vibration passing through it. Thus the 
cardiac ganglion or plexus, that which goes to the heart, the semi-lunar, 
that to the stomach, &c., &c. 
“ 10. Though the principal changes take place in the ganglia, doubt- 
less the plexuses of each tissue have a general or common modifying 
power; while the connecting recti-linear nerve-trunks must pass the 
vibration almost or altogether unchanged. 
“11. Several differing vibrations may obviously pass down the axis 
cylinder of a nerve at the same time with little or no interference. 
“12. Differential or modified vibration, probably, depends for the most 
part on differential cell-form or molecular arrangement of its tissues, 
and the status of its connective or interstitial matter.” 
* 111. State Med. Asso. Transact. N. A. Jour. Homoeop., Aug. 1863, p. 117. 480 
DISEASES OF THE SANGUINOUS FUNCTION. 
Prognosis.—When the constitution is good, intermittent fever should 
he always regarded as curable in every case. When there is a cachectic 
state, the case is more difficult; it is more stubborn in cases in which 
the paroxysm anticipates the hour of return, and such are inclining 
toward the severer or remittent type. Strong and lasting chills are 
symptoms of malignity; when the duration of the fever is long, the 
intermission is short, and the tendency is, first to remittent and then to 
typhoid continued fever; when perspiration is deficient, the tendency 
is to assume a worse form of the disease. Nursing babes suffering 
with this disease and dentition at the same time are liable to hydro- 
cephalus; aged persons are in danger of the congestive or sinking 
chills, and pregnant females to abortion and its consequences. The 
disease neglected or inefficiently treated is likely to continue for many 
months, and relapses are more common than in almost any other disease. 
“A simple intermittent fever, even when left to take its course, rarely, 
perhaps never, proves directly fatal; but it may derange the structure 
of some organ, or generate a kind of cachexia, or spanmmia, from 
which, as pathological causes, other, and, at last, fatal consequences 
may follow.” Inflammatory intermittents, left to themselves, are not 
generally immediately fatal; but, by establishing a permanent inflam- 
mation in some vital organ they may end in the total derangement of 
health, and, finally, in death. 
Inflammatory remittents are much more dangerous. Though not 
directly fatal, they are liable to run into a typhoid form, which, if it 
does not result in death immediately, must always be regarded as a 
serious form of disease, demanding immediate and proper treatment. 
“Malignant intermittent fever is always fatal when not arrested by 
prompt and efficient treatment; and many die of it every autumn, its 
true character not being perceived in time, or the patient residing 
beyond the range of enlightened medical practice. Where this variety 
prevails, therefore, it constitutes in autumn the chief outlet of human 
life. Malignant remittents are not so common as intermittents, but 
more difficult of cure and, therefore, much oftener fatal.” 
ACCLIMATION. 
Prophylactic Measures and Precautions.—The atmosphere in 
which man lives, besides the gases fitted for respiration, contains other 
emanations and deleterious agents which exert a disturbing influence 
on health. The human body is endowed with a power of reaction and 
resistance to these influences; and, in every act of resistance, increased 
energy and vigor are developed by the effort. “ A man plunges into 
cold water, which disturbs the vital force ; it recedes from the surface. 
If the impression is not too violent, it reacts. If the plunge is repeated ACCLIMATION. 
481 
this impression is not so great, the resistance being greater. With 
every plunge the impression lessens, and resistance increases, until no 
disturbance is created. This increased power of resistance is the 
principle of acclimation.” (Bayard’s Address, 1853.) When we have 
long been accustomed to the atmosphere, and all the vicissitudes of 
temperature, and the endemic influences of a certain climate, the system* 
habituated to their impressions, has become so far invigorated by its 
reactive efforts that the deleterious agents without cease to produce 
any perceptible effect. If we now remove to a different climate we 
come in contact with a new series of subtle and deleterious influences 
which make new impressions on the sensitive organism, and provoke 
new resisting and reactive powrnrs. When the powers of resistance are 
so far cultivated that the causes of disease peculiar to the new locality 
make no impression, beyond what they make on a native of the place, 
acclimation is said to be complete. 
To enable emigrants to pass safely through the process of accli- 
mation, many rules and systems of management have been proposed. 
In passing to a warmer and more unhealthy climate, attention should 
be paid to 
1. Diet.—This should be of a lighter character than that formerly 
used; it should be plain, unirritating, and consisting chiefly of vege- 
tables, particularly during the first summer. The old system of diet 
which prescribed salt meats in hot weather in the South, has cost 
thousands of lives. During the second summer, more freedom may be 
allowed; after full acclimation a generous diet is recommended, as it 
gives tone to the system and enables it to resist morbific influences. 
2. Diiinks. All stimulants are highly injurious. The whole gastric 
system is already in a state of high stimulation. All direct stimulants 
retard acclimation and increase its dangers, aggravating all the dele- 
terious effects of the hot climate. 
Dr. Barton, of New Orleans, says that of 1226 deaths which occurred 
in the Charity House of that city in 1885, only nine had completed the 
process of acclimation. He says, he knows of no circumstance in which 
stimulating drinks are necessary in that climate for health, “ whether in 
exposure to wet, heat, or fatigue,” and believes them a “ counterfeit 
good” in all cases. (Address. Med. Col. Louisiana.) 
3. Clothing.—This should always be adapted to existing circum- 
stances. In all climates, whatever malarious poisons may exist in the 
atmosphere, the influence of changes of temperature on the skin is the 
principal exciting cause of disease; and, in adapting the thickness of 
clothing to the state of the w’eather, the error most commonly committed 
is in dressing too light. In hot weather, when not exposed to direct 
action of the sun, light clothing is appropriate. But, when the external 
heat is greater than that of the human body, clothing, too light, should 
You I.—31. 482 
DISEASES OF THE SANGUINOU8 FUNCTION. 
be a bad conductor of caloric. Flannel should be worn next the skin 
in every climate, not only when the weather becomes suddenly colder, 
but before the change occurs, and in anticipation of it, by all who are 
liable to the diseases of an unhealthy climate. Clothing sufficiently 
warm is indispensible. 
4. All habits of life which invigorate and promote health, are im- 
portant. 
General Prophylactic Measures.—1. Avoid all depressing passions. 
Fear, grief and anxiety cause the blood to recede from the surface, 
producing ashy paleness of the skin. 2. Avoid over-indulgence in food 
of any kind ; over-distention of the alimentary canal produces congestion 
of the portal system (Carpenter, Physiol. p. 543.) All rich food con- 
taining fatty matter predisposes to fever. Fat contains 80 per cent, of 
carbon, peas and beans 37 per cent., potatoes 12, and bread 30. An 
excess of rich animal diet throws increased labor on the liver to carry 
off the excess of carbon. 3. Avoid the hot sun by day and the cold 
damp air of the night. When the dampness of the air is precipitated 
by frost, the danger of exposure is less. The air then becomes a bad 
conductor of electricity and heat, and has a bracing effect. Put on an 
extra amount of warm clothing as soon as the air begins to be colder. 
Prudent officers sailing in tropical climates always command their men 
to put on their flannel jackets at or before sunset. Those who do not 
obey are liable to be attacked with fever. Wherever malaria exists its 
baneful effects are always heightened by sudden changes of temperature; 
where the daily range of the thermometer is great these effects are 
most visible. By wearing flannel next the skin the system is shielded 
from the influence of these viscissitudes of temperature. 4. A warm 
fire made every evening in the apartment occupied is indispensible to 
health, whether it be needed for comfort or not. Pliny refers to the 
more ancient authorities of Empedocles and Hippocrates to prove its 
utility. Lascisci made the same observation at Rome. Sir J. Clarke 
says, “ A person may sleep with perfect safety in the centre of the 
Pontine marshes, by having his room well heated by a fire during the 
night.” {Sanative influence of Climate, p. 117.) Napoleon I. relied 
much upon the protective influence of fires when his armies were en- 
camped in the worst districts of Italy. McCulloch says, “ In Africa, a 
superintendent engaged in directing the cutting of wood erected thirty 
earthen furnaces on the spot where his men were at work, lighting 
them every day. Before this he had always from forty to forty-eight 
of his workmen sick; when in a short time they were reduced to twelve, 
then to four, and finally to one.” {On Malaria, p. 285.) This fact 
with all others bearing upon the same point are easily explained on 
the cryptogamic theory of the origin of malarious fever. We also see 
how cooks, engineers and others who work near the fire, were exempt ACCLIMATION. 
483 
from the sweating epidemic; and can explain the “danger of sleeping 
in mouldy sheets, and the sternutation excited by turning over old books 
and papers. No known poison but that of organic living fungi is ca- 
pable of being disarmed of its virulence by dryness and great heat. 
Hot weather only promotes the growth of the poison. 5. In choosing 
a location, for a residence or temporary encampment, avoid all stagnant 
ponds of water, particularly those that are in process of drying up. In 
June, 1809, the British army marching through a dry, rocky and ele- 
vated country on the borders of Portugal, found the mountain streams 
dried up from long-continued hot weather, some of the regiments en- 
camped near the stagnant pools yet remaining in the bed of the stream. 
Some of the men were attacked with remittent fever the next morning ; 
and that type of fever continued exclusively among the troops that had 
bivouacked near those stagnant pools. After the battle of Talavera the 
army retreated to the plains of Estramadura and encamped along the 
banks of the Guadiana river, which was then so nearly dried up as to 
consist only of “ lines of detached pools in the courses that had 
formerly been rivers.” Here they were attacked by remittent fevers 
of such destructive malignity that the enemy and all Europe believed 
that the British host was extirpated. This fact, to which any desired 
number of the same character can be added, is given by Mr. Ferguson, 
of the British army, to prove the truth of a theory of his own. {On 
Marsh Poison, p. 5.) It at least illustrates the danger of exposure to 
an atmosphere saturated with malaria; arid also that the dried bed of 
a nearly obsolete river furnishes the best possible ground for its rapid 
development.* (See Yellow Fever—Causes.) 
Influence of Local Causes on the Health of Armies.—Camp dis- 
eases most abound near the muddy banks of large rivers, near swamps 
and ponds, and on grounds from which the timber has been recently 
removed. The distance to which the malaria of a swamp or of the mar- 
gin of a river can be borne by currents of air, may not always be posi- 
tively determined; but it is generally possible to either remove a camp 
out of the reach of the poison or to apply some remedies that may 
“ weaken the force of its pernicious impressions.” 
“ The remedies,” says Dr. Robert Johnson, Inspector General of 
Hospitals of the English army,f “ consist in the interposition of rising 
grounds, woods, or such other impediments as serve to break the cur- 
rent in its progress from the noxious source. It is an obvious fact that 
the noxious cause, or the exhalation in which it is enveloped, ascends as i 
traverses the adjacent plain, and that its impression is augmented by the 
adventitious force with which it strikes upon the subject of its action. 
“ It is thus that a position of 300 paces from the margin of a swamp, 
* See Amer. Homoeop. Review, Nov. 1859, p. 50. f Report for the year 1846. 484 
DISEASES OF THE SANGUINOUS FUNCTION. 
on a level with the swamp itself, or but moderately elevated, is less un- 
healthy than one at 600 paces on the same line of direction on an ex- 
posed height. The cause here strikes fully in its ascent; and as the 
atmosphere has a more varied temperature, and the succussions of the 
air are more irregular on the height than on the plain, the impression 
is more forcible, and the noxious effect more strongly marked. In ac- 
cordance with this principle, it is almost uniformly true, caeterisparibus, 
that diseases are more common, at least more violent, in broken, irre- 
gular, and hilly countries, where the temperature is liable to sudden 
changes, and where blasts descend with fury from the mountains, than 
in large and extensive inclined plains under the action of equal and 
gentle breezes only. 
“ From this fact, it becomes an object of the first consideration, in 
selecting ground for encampment, to guard against the impression of 
strong winds on their own account, independently of their proceeding 
from swamps, and noxious soils. 
“ It is proved by experience, in armies as in civil life, that injury 
does not often result from simple wTetting with rain when the person is 
fairly exposed in the open air, and habitually inured to the contin- 
gencies of weather. Irregular troops, which act in the advanced line 
of armies, and which have no other shelter from weather than a hedge 
or tree, rarely experience sickness—never, at least, the sickness which 
proceeds from contagion; hence it is inferred that the shelter of tents 
is not necessary for the preservation of health. Irregular troops, with 
contingent shelter only, are comparatively healthy, while sickness often 
rages with violence in the same scenae, among those who have all the 
protection against the inclemencies of weather which can be furnished 
by canvas. The fact is verified by experience, and the cause of it is 
not difficult of explanation. When the earth is damp, the action of 
heat on its surface occasions the interior moisture to ascend. The heat 
of the bodies of a given number of men, confined within a tent of a 
given dimension, raises the temperature within the tent beyond the 
temperature of the common air outside the tent. The ascent of moisture 
is thus encouraged, generally by a change of temperature of the tent, 
and more particularly by the immediate or near contact of the heated 
bodies of men with the surface of the earth. Moisture, as exhaled from 
the earth, is considered by observers of fact to be a cause which acts 
injuriously on health. Produced artificially by the accumulation of 
individuals in close tents, it may reasonably be supposed to produce its 
usual effects on armies. A cause of contagious influence, of fatal effect, 
is thus generated by accumulating soldiers in close and crowded tents, 
under the pretext of defending them from the inclemencies of the 
weather; and hence it is, that the means wrhich are provided for the 
preservation of health, are actually the causes of destruction of life. TEE ATM EXT OF IXTEEMITTENT FEYEK. 
485 
“ There are two causes which more evidently act upon the health of 
troops in the field than any other, namely, moisture exhaled direct from 
the surface of the earth in undue quantity, and emanations of a pecu- 
liar character arising from diseased action in the animal system in a 
mass of men crowded together. These are the principal, and they are 
important.” 
The following remedy is proposed: A carpet of painted canvas 
spread on the floor of the tent, prevents the exhalations of moisture 
from the surface of the earth; it is convenient, is always ready, it is 
less expensive than straw, and requires to be fresh painted only once a 
year. A light roof is a defense against the vertical sun, or rain falling 
perpendicularly; while side walls of moderate height are only employed 
as a protection against driving rains. 
Tkeatment of Intermittent Fever.—Remove the patient, if the cir- 
cumstances permit it, to a dry habitation in a healthy place, free from 
malaria. The rooms should be off the ground, the air pure, and ren- 
dered dry by fires; it should also have the benefit of the sun. The 
clothing should be warm, diet moderate, easy of digestion ; alcoholic 
drinks and all intemperance in eating should be strictly forbidden. Be- 
fore the expected paroxysm but little nourishment should be taken. 
During the chill the patient may have more covering and some warm 
teas, but no stimulants. The heat of the fire only increases the chill 
and the subsequent fever. 
During the fever remove some of the covering to be put on again 
during the sweating stage, but regulating it with care, that unnecessary 
perspiration be not excited by excess of heat. 
Selection of the Proper Remedy.—Dr. Baertl* says: A fever 
remedy must not only cover the cause of the fever, as it may now pre- 
sent itself, already complicated with artificial medicinal effects; but it 
must also reach the organic, the symptomatic and vital condition corres- 
ponding to the character and speciality of the fever in its physiological 
effects. Every fever remedy must act on the nervous system, and 
especially on the vaso-motor part of it; and it is only then, when such 
a remedy, although well chosen, does not effect a cure, that the anti- 
psorics are indicated, as entering more deeply into the vegetative 
sphere of life, and thus enabling them to remove cachexias. The type 
of the fever gives no indication here; but we have to consider the re- 
lations between the chills, heat, sweating, thirst, and the other accom- 
panying ailments ; as also the time of the return and termination of the 
paroxysm. The whole disease, paroxysm and apyrexia, must be taken 
as a unit, for frequently the paroxysm itself is void of characteristic 
symptoms. 
* Homoeopathic Views and Experiences in the Treatment of Intermittent Fevers. 
By Hr. Joseph Baertl. Sondershauseu, 1859. 486 
DISEASES OF THE SANGUINOUS FUNCTION. 
Time of giving the Remedy.—The best time is at the expiration 
of the paroxysm, and when the interval is short, begin giving as soon 
as the perspiration commences; repeating it several hours before the 
next chill is expected. Or it may be given at regular intervals. 
After the disease is broken, it is advisable to keep up the action of 
the remedy in lengthened intervals, to prevent a return of the disease 
If the remedy has failed to keep off the expected paroxysm, it must b 
repeated or another remedy chosen. Sometimes the proper remedy is 
followed by an aggravation of the paroxysm, and frequently a latent 
psora is aroused by the fever. 
The remedies most commonly made use of in this malady, are China 
and Arsenicum. The following will also be found appropriate in many 
instances : Ipecacuanha, Bryonia, Eupatorium-perfoliatum, Nux- 
vomica, Veratrum-alb., Belladonna, Carbo-veg., Pulsatilla, Anti- 
momium-crudum, Ignatia, Cocculus, Lachesis, Sabadilla, Sulphur, 
Cina, Natrum-muriaticum, Capsicum, Apis. Cornine. Salicine. 
China.—Yellowish color 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; palpitation of the heart; 
short cough.” (Ha/rtlaub.) During the intermission, yellowish, clay- 
colored countenance; 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; swell- 
ing in the region of the spleen; eyes red and sensitive.” (Knorre'.) 
Quotidian fevers with pale countenance; cold and 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. Paroxysm 
preceded by palpitation of the heart, sneezing, anguish, nausea, thirst> 
bulimia, headache, and colic. Thirst before and after the shiverings, 
or during the sweating stagej coldness 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 chills, attended with thirst and followed by sweat; or no chills, 
but fever with urgent thirst, and afterwards with perspiration. Hart- 
mann advises China, when we have during the paroxysm 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, confusion of the head; transient vertigo; variable ap- 
petite; thirst; drowsiness after meals; uneasy sensation in the pit of 
the stomach; nausea; constipation; general debility. Knon’e has TREATMENT OF INTERMITTENT FEVER. 
487 
cured the quotidian type, attended 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 fever with violent chills, heat and thirst, followed by perspira- 
tion. During the paroxysm and intermission, there were bitter taste 
eructations, and vomiting; aching pains in the pit of the stomach, and 
in the region 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, lasts until evening, and is 
succeeded by perspiration during the night. 
Confusion of ideas and drowsiness during the paroxysm and inter- 
mission; anxiety; discouragement; great activity of the mind; some- 
times delirium. 
Intermittent with want of strength, debility, and anaemia, deep affec- 
tion of the blood-life, and super-irritation of the nervous system, (irri- 
tation of the spinal marrow, pressure on the spine between the shoul- 
der-blades, painful, especially during the chill); great weakness ajso in 
the apyrexia, quick development of dropsy and axaemia, decomposition 
of the blood from urinary crystals and deposits, swelling of the spleen 
and liver. China is especially curative where a long-lasting impres- 
sion of the paludal miasma acts depressingly upon the vegetative 
life and the preparation of the blood, over-irritating the nerves, pro- 
ducing swelling of the liver and spleen, sallow complexion, general 
cachexia, anaemia and hydnemia. (Arsenicum, Ferrum.) All the 
stages clearly defined, severe and long-lasting. Apyrexia, in the 
beginning without symptoms, or only symptoms of injured digestion, 
similar to the apyrexia of Sweat predominant. 
Thirst between the chill and heat, or after the heat; sweat even in the 
apyrexia. Paludal intermittents, if not cured by a few doses of China, 
need always for their removal a few doses of the antipsorics. Inter- 
mittents appearing as pure neuroses, the so-called febris intermittens 
larvata, as paroxysmal cough, convulsions, paralysis, epilepsy, sopor or 
mania, if no other remedy corresponds better to the totality of the 
symptoms. 
Symptoms produced by Cinchona, according to the old authors.— 
Oppression of the stomach; vomiting; diarrhoea; syncope; great debi- 
lity, a form of jaundice; bitterness of the mouth; tension of the ab- 
domen. It was for precisely these evils in cases of intermittents 
other authors recommend the Cinchona alone. Its poAver of curing 
exhaustion, indigestion and loss of appetite, resulting from acute fevers, 
(particularly when the fevers have been treated by venesection, eva- 488 
DISEASES OF THE SANGUINOUS FUNCTION. 
cuants, and debilitants), depends on the faculty it possesses of de- 
pressing excessively the vital powers, producing mental and bodily 
exhaustion, indigestion and loss of appetite. (.Hahnemann, Mater 
Med. III.) 
Admlnistkation.—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 intermissions. 
.Sulphate of Quinine.—The importance of this article in the hands 
of men of every school in the treatment of many forms of disease 
justifies an analysis of the researches hitherto made in view of ascer- 
taining its true physiological action. 
Quinine has a powerful affinity for the nervous system. It is a law 
of the animal economy that no function can be performed without loss 
of substance. Muscular motion implies the loss of fibrine; and any 
activity of the brain and nervous system involves a corresponding meta- 
morphoses of this tissue. The waste of nervous tissue, or in other 
words, the activity of the function of innervation is usually accelerated, 
being in a direct ratio to the sum of the phosphates found in the urine."' 
It has been proved by experiments that Quinine given in a state of 
health augments the amount of phosphates, and consequently, increases 
nervous action. Dr. Ranke [Med. Times and Gazette, May 30,1857,) 
ascertained by experiment that the paroxysm of fever greatly increased 
the amount of phosphoric-acid; showing most clearly that the nervous 
system plays an important part in the paroxysm of ague. Dr. Ham- 
mond (Amer. Jour. Med. Sciences) found while experimenting on him- 
self during an attack of intermittent fever, that on the day of the first 
paroxysm the amount of phosphoric-acid found in the urine was 69.18,' 
next day, that of the intermission, 52.95. Third day (paroxysm) 72.95. 
Fourth day (intermission) 55.27. On this, fourth day, Quinine was 
taken. Next day, being the day for the paroxysm, and when the 
amount of phosphoric-acid, calculating from the average, would have 
been 71.06, it fell to 56.22, but a trifle above that excreted on the days 
of intermission. # 
But rapid disintegration of nervous tissue is not confined to inter- 
mittents. It is a permanent element in nearly all severer forms of 
fever. General debility, and non-performance of function are doubt- 
less due to this case. Continued experiment led Dr. Hammond to the 
conclusion that “Quinine has the power to prevent much of this great 
waste of nerve-material.” It not only prevents destruction of nerve- 
tissue, but, by its well-known effects on the function of nutrition, con- 
tributes greatly to the reparative process. It may therefore be 
* Dr. Nevison, Amcr. Jour. Med. Sciences, 1861, p. 51. TREATMENT OF INTERMITTENT FEWER. 
489 
regarded as the great conservator of the nervous system in conditions 
of febrile excitement or nervous prostration. 
Its Action on the Circulation.—It has the power of giving con- 
tractile action to the capillaries in every part of the system. Dr. Cor- 
rigan, physician in ordinary to the Queen in Ireland, says: It has the 
same power “in giving contractility to the capillaries in the lungs 
which we know it to possess in so marked a degree over the capillaries 
and venous radicles in the spleen.” 
This power gives control over nearly all forms of venous and capil- 
lary congestion which it is impossible to obtain by any other known 
agent. It approximates the pulsations to the healthy standard, render- 
ing them slower when too quick, and quicker when too slow. It enters the 
blood-vessels and goes the round of the circulation. Tiedemann and 
Gmelin long ago found it in the blood of a patient to whom it had 
been administered; and in from three to twelve hours after it was taken, 
it appears in the urine, as shown by Dr. Bence Jones, M. Brignet and 
others. 
Quinine diminishes the amount of uric-acid in the blood. Dr. 
Ranke tried it in three individuals in health, and found that under the 
influence of the Quinine the uric-acid was diminished nearly one-half. 
Dr. Hammond made a series of observations during an attack of inter- 
mittent fever, where, as in all fevers, the amount of uric-acid is always 
greatly increased. He found in this case the quantity promptly reduced 
more than one-half by the action of the Quinine. 
But Quinine defibrinates the blood, rendering it fluid and uneoagu- 
lable. Dr. Samuel Garden shows this in the Dublin Quarterly for Au- 
gust, 1856. It is further proved by the experiments of Baldwin, Melier, 
Brignet and others, which may throw light on its power of subduing 
many forms of inflammation, arising under the influence of malaria. 
The diseases to which Quinine is especially adapted contain an im- 
portant neuropathic element. The innervation may be either deficient, 
irregular or excessive; all, however, imply the existence of, or ul- 
timately produce debility. Many derangements of the circulation, 
nutrition, sensation and muscular motion are included as 
sequelae. (Dr. Nevison.) 
An example of excessive innervation is manifest in precocious chil- 
dren. The vivacity, intellectual and moral development indicate a de- 
gree of nervous activity altogether disproportioned to the restorative 
or nutritive function; early decay is the result. The diseases accom- 
panied with derangement of the circulation are attended with general 
or local congestion, conspicuous among them are intermittent, remittent, 
continued and pernicious fevers, and many diseases usually regarded as 
inflammatory. Derangements of secretion, excretion and calorification 490 
DISEASES OF THE SANGUINOUS FUNCTION. 
follow in the train of disordered circulation, and imply disturbance of 
the ganglionic system. 
Sulphate of Quinine is in any dose in some way homoeopathic to ma- 
larious bilious fever, of every grade in which there is merely irritation 
without local inflammation. It is adapted to the treatment of open 
fever where the high phlogistic symptoms have been subdued by other 
measures, or before local inflammation is established. But it is injuri- 
ous in a high degree in the doses commonly employed in bilious fever, 
with gastro-intestinal irritation. In these cases the head suffers in- 
tensely from full doses of Quinine ; and, where there is tendency to intes- 
tinal irritation, the Quinine speedily causes dryness of the mouth, dry 
and red tongue, with general irritation. It is safer in the early stages 
before the local irritation is established than after its has become fixed 
in local inflammation. The Callissaya-bark is superior to Quinine in 
all the bilious fevers, possessing powers very different. 
Quinine in ordinary doses is injurious in cases of an asthenic cha- 
racter; in an impaired condition of the general system where there is 
an atonic state of the general circulation, and symptoms of adynamia, 
Quinine diminishes still farther the force of the circulation, and in- 
creases the frequency of the pulse with all signs of irritable debility. 
It is certainly wrong to call it a stimulant in such cases. It is injuri- 
ous in all cases attended with pale skin, sallow complexion, feeble and 
quick, or weak and sluggish pulse; irregular biliary secretion, and in 
cases of extreme debility in which there is a tendency to syncope in 
the erect posture ; throbbing in the head ; tinnitus aurium; palpitation 
and vertigo. It is highly injurious in violent congestive fever with cere- 
bral congestion; or the collapse stage of common remittent, malignant 
and typhus. In all of these cases Quinine never fails to induce a 
quicker and more irritable pulse, thirst and cerebral congestion; and 
whilst each dose of it increases the danger, Wine and Camphor sustain 
the failing powers. 
In fevers of an opposite or phlogistic character, Quinine produces the 
ordinary effects of a stimulant, more decidedly than the Bark itself. 
Dr. Monette says: “ A full dose is followed by increase of temperature 
of the surface and fulness of the vessels of the head. When full and 
frequent doses are taken, the countenance generally becomes flushed 
and the vessels of the head very full; there is confusion and heaviness 
of the head and ringing in the ears.” In a few cases these effects go so 
far as to cause a singular form of delirium resembling that produced 
by an overdose of Stramonium. 
MM. Itard and Piorry say, they have often known permanent and 
complete deafness follow’ the use of Quinine in large doses. All prac- 
titioners of large experience have seen the same thing. 
M. Guersant says, a physician in France believed that Quinine onlj TREATMENT OF INTERMITTENT FEVER. 
491 
failed to cure ague when the dose was too small. Such was the state 
of mind of our colleague when his wife was attacked with ague. He 
gave her sixteen grammes (92.604 grs.) of Sulph. Quinine in a very 
short space of time. The patient soon fell into a state of stupor with 
weight in the head, dazzling, and then blindness and deafness. M. 
Bazire, conceiving that these new symptoms were due to the approach 
of a new paroxysm of pernicious ague, gave his wife twenty-five 
grammes more of the drug. After the taking of this considerable dose 
the symptoms increased with frightful rapidity. The patient became 
more completely deaf and blind, her respiration embarrassed ; pulse 
very bad, skin cold. At this time the physician was greatly alarmed 
by the great number of bad agues abounding in the province, and the 
failures he had experienced had thrown him into despair; he now saw 
in dismay the malady again triumphant; and the remedy he had thought 
invincible was utterly powerless ; fortunately for the wife he took the 
disease himself; dosed himself as effectually as he had her, and ended 
the disease and his own life together. {Diet, de Med.) 
Prophylactic Powers of Quinine.—In the years 1840—41 the 
English government sent an expedition into Africa to explore the 
sources of the Niger river. Two ships carried the party with all the 
materials that could promote the comfort of the men with extra contri 
vances to purify the air on board; and they were expected to make a 
protracted stay in that malarious region. Of these two ships’ crews 
none escaped the African fever; and, after two years’ struggle 
with malaria, a few returned alive to England. In 1854—55 the 
same government sent out another expedition of two ships designed 
to remain in the Niger two years. The men generally escaped the 
fever by taking Quinine. Each man was ordered to take five grains 
of Quinine every morning before exposure on the decks of the vessels, 
while in the river. After repeated trials it was found, that after leav- 
ing the river for the ocean it was necessary to continue the Quinine for 
fifteen days after leaving the river. This practice was continued for 
five months annually for two years. In December, 1858, the crew had 
been encamped twelve months on the Niger, and the men maintained 
robust health. In the malarious regions of the United States the use 
of Quinine has been tested as a prophylactic. Dr. de Saussure, of 
Charleston, S. C.,* mentions many cases of persons who took it regu- 
larly for many years, visiting the sickliest locations, as the rice-fields, 
every day. They all escaped the fever. When they became careless 
and omitted the antidote they had attacks of it. A rail-road contrac- 
tor on the Charleston and Savannah R. R. had one hundred and fifty 
unacclimatcd North Carolina negroes at work in a notoriously unheal- 
* Medical Intelligencer. Feb. 1860. 492 
DISEASES OF THE SANGUINOUS FUNCTION. 
thy region, lie carried with him some pounds of Quinine, took it 
daily, and compelled all his laborers to take it. He reported at the 
end of the season, that not one of the men had the fever. Dr. Living- 
stone says, by the aid of Quinine his party in Africa were able to 
“ ward off the pernicious fevers of the country.” Half grain doses 
have always in our hands proved effectual. . 
Modus operandi of Quinine in anticipating the Paroxysm of 
Ague.—Dr. Wood* says: “Every consideration in connection with the 
peculiarities of intermittent fever diseases leads to the conclusion that 
the paroxysms are produced by an influence acting through the cerebral 
centres; and if these can be preoccupied by a strong impression from some 
other source, they may be rendered insensible to the morbid influence, 
and the paroxysm is therefore set aside. Quinine is characterized by 
its disposition to act energetically on certain nervous centres, which 
are probably the same as those through which the cause on the dis- 
ease operates. Quinine therefore interrupts the succession of parox- 
ysms.” The theory given by Hahnemann (Organon of Medicine, 
Fourth Am. Edition, 1860, Sect. 43, p. 115, &c.) is much more clear 
and satisfactory. Dr. Holcombe considers that the malaria and the 
Quinine act on the same tissue, in a more or less similar manner, and 
the stronger excludes the weaker. By inducing the Quinine disease 
within the interval, the ague disease can not act upon the pre-occupied 
tissue. He thinks the disease can be still more perfectly met by some 
additions to the Quinine; and that to render it certainly effectual the 
dose must be appreciable and the remedy thoroughly homoeopathic.f 
We prefer to correct the system first by other proper treatment, and 
then the case will be curable by this or some other remedy. 
Arsenicum.—The internal use of Arsenic in the treatment of skin- 
diseases has often developed ague. M. Biet says, he has often ob- 
served “a certain periodicity in the symptoms following the use of it. 
It is well known that it frequently- cures ague neuralgia and other 
intermittent diseases.” 
Symptoms.—Face puffed and earthy, or countenance anxious, sunken, 
and of a yellow tint; pendiculations and drawing in the limbs during 
the cold stage ; pungent and burning feel of the skin during the fever; 
dropsical swelling; trembling of the limbs during the sweating stage ; 
pulse irregular, or quick, weak, small, and frequent, or suppressed and 
trembling; tongue bluish, white, or bright red; diminished urine; 
night-sweats; face red during the fever, but pale and sunken during 
the intermission.—Aggravation of the existing symptoms just pre- 
vious to, or during the attack; paroxysms imperfectly developed; 
chills and heat alternating ; periods of attack regular, and generally 
* Therapeutics. Yol. I. p. 261. f North Amer. Jour. Homoeop. 1861. p. 16. TREATMENT OF INTERMITTENT FEVER. 
493 
in tlie mornir*g 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 hiccough ; 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 j>ains. Dr. Hartlaub has cured chills without 
thirst, followed by fever wdth or without thirst, and then by perspira- 
tion ; before the chill, vertigo; fainting; pains in the side, chest, ab- 
domen and back ; stretching and yawning ; during the chill, anxiety; 
pains in the head, back, limbs, and pit of the stomach: stretching and 
yawning; 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 debility; 
pains in the head, chest, back, and limbs. Depression of spirits, and 
irritability previous to the attack; anxiety, uneasiness, confusion of 
ideas, which gradually increase until the sweating commences; oc- 
casionally delirium during the hot stage. 
Arsenicum has been found efficient in the cure of intermittent fever, 
which has lasted already some time, and withstood remedies seemingly 
indicated. In fevers with short chills, but protracted heat, or where 
the sweating did not occur; malarious paludal fevers accompanied by 
mucous and bilious vomiting, watery diarrhoea, burning sensations, 
especially in the pit of the stomach, syncope, great anxiety, remarkable 
collapse of the vital power, inquietude and great thirst, especially 
dui’ing the day and burning heat. Arsenicum is most appropriate when 
the whole vascular and nervous systems are deeply implicated, caused 
by malignant endemic or climatic influences, especially malaria, and 
producing disorganizations of the liver and spleen. The fever having 
already lasted some time, and, perhaps been maltreated with Quinine, 
has produced a general cachexia, especially a dropsical or putrid state. 
The paroxysms are long continued and severe, especially the heat; the 
apyrexia never complete. Arsenicum produces no perfectly formed 
fever j all the stages of the paroxysm are either ill-defined or one 494 
DISEASE OF THE SANGUINOUS FUNCTION. 
of them is wanting; rapid sinking of the vital power; debility of a 
a torpid character. 
M. Bodin, physician general of the French army in Algeria, says, 
he often failed to cure the agues of that country with Quinine, though 
he succeeded with Arsenic. With “a single dose that did not exceed 
Toir of a grain” he “radically cured fevers contracted in Algeria or 
Senegal, and which had resisted various means of cure, including 
Sulph.-quinine, &c. He often succeeded in a short time in putting an 
end to the quotidian, tertian, and quartan agues contracted in latitudes 
the most various, often complicated with chronic engorgements of the 
abdominal viscera. (Traite de Fiev. Intermit, p. 280.) Of two 
hundred and sixty-six cases one hundred and’ eighty-one were cured 
by Arsenic, of these fifty-seven had resisted Quinine. 
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 Cinchona and other 
articles, have produced no effect. We 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 intermittent, 
or fever and ague, provided the symptoms correspond, although several 
authors especially commend it in the tertian and quartan forms. 
Ipecacuanha.—At the beginning of Intermittents, where the sub* 
jective difficulties of digestion and breathing have not yet got seated. 
Intermittents caused by errors in diet. Intermittents complicated 
with gastricismus, and in relapses, after abuse of China. It suits sen- 
sitive juvenile persons. Thirst totally wanting, or only trifling, during 
the chill. Chills predominant, with special irritation of the upper part 
of the spine (China and Nux.\ therefore with occipital pains and ten- 
sive pressure of the neck, spasmodic dyspnoea, spasmodic cough. Heat 
trifling, more external, often with cold hands and feet, or only heat in 
the face. Sweating entirely missing (Arsenicum), or only appearing, 
sour smelling, about midnight. Reduced secretion of urine. Apyrexia 
with gastric symptoms. 
Sallow Skin.—Before the shiverings, uneasiness, stretching and 
lassitude, with cold sweat on the forehead; tongue clean or loaded; 
during the apyrexia, countenance pale or yellowish. Slight chills, 
followed by much heat; or, severe chills with little heat; aggravation 
of the rigors from external heat; thirst only during the chill; nausea, 
vomiting, and other signs of gastric disturbance, manifest during the 
heat; also, constriction of the chest. Watzke advises Ipecac., when 
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 treatment of intermittent fever. 
495 
sweating stage, with little or no thirst; the a,pyrexia, with want of 
appetite, bitter taste, oppression at the stomach, and pale face. Hart- 
laub 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, oppres- 
sion, contraction, pain in the chest, and cough ; during the biter- 
mission, bitter taste of food, much saliva, loss of appetite, vomiting 
after eating, lassitude, sleeplessness. 
Before the chill, dulness of intellect and sleeplessness; during the 
chill confusion of ideas, irritability, impatience and indisposition to 
mental effort. 
Administration.—Same as China. 
Remarks.—This remedy has been most frequently used in fevers of 
the quotidian and tertian types. Lobethal, Hartmann, Boenninghausen, 
Schmidt, Fleischmann, Watzke, Madden, Trinks, Elwert and Rumel have 
expressed themselves strongly in favor of the low dilutions of Ipecac., 
in this disease. Others have succeeded with higher potencies but in 
peculiar cases. 
Apis-mellifica.—Wolf and Hering recommend Apis as the specific 
against every sort of intermittent fever, no matter how complicated 
the case. As intermittent fever-poison acts as an alterative on the 
whole sanguification, and on all the nerves, spinal as well as ganglionic, 
Apis-mellifica does the same. Its action is direct, whereas other fever 
remedies correspond only to certain individualities. 
Bryonia.—Simultaneous affections of the organs of the chest and 
abdomen; chill and heat moderate ; sweating predominant and lasting; 
thirst strong during the chill and heat; excruciating, dry, racking cough 
during the chill, with stitches in the chest; bilious symptoms; rheu- 
matic pains in the extremities. 
Pleuralgia.—During the shiverings, 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. 
Pleuritic Ague.—Preceding the cold stage, vertigo, 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 burning heat and thirst; universal dry heat, external and 
internal; spasmodic cough; vertigo and headache during the fever; 
shooting pains in the side and abdomen; 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 496 
DISEASES OF THE SANGUINOUS FUNCTION. 
complexion, and night sweats. Irascibility and disposition 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 apyrexia. 
Eupatorium,-perfoliatum.—This is a remedy which we have found 
highly serviceable in many cases which have been complicated by the 
abuse of Calomel and Quinine. It is particularly indicated when the 
liver is much implicated. An intelligent homoeopathist who resides in 
a fever and ague district at the West, informs us that he has for many 
years past made use of a small quantity of an exceedingly weak infu- 
sion of this agent as a prophylactic against this 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. We have often used it with success. 
Yellow tinge of the skin and eyes; eyes dull, heavy and sunken; 
lips pale or bluish, dry and cracked. 
Principal Symptoms.—Irregular development of the paroxysms; 
frequent slight chills previous to the commencement 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, until 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 fatigue, languor, and 
debility; constant inclination to sleep; nocturnal sweats. 
Dr. Williamson advises Eupatorium in the quotidian and tertian 
types, when the following symptoms are present: paroxysm com- 
mencing in the morning; thirst several hours before the chill, con- 
tinuing 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 shivering during the chill than is 
warranted by the degree of coldness; retching and vomiting at the 
conclusion of the chill; distressing pain in the scrobiculus cordis 
throughout the chill and heat; chill beginning at nine o’clock in the 
morning; throbbing headache during the chill and heat; violent pain 
in- the head and back before the chill; inconsiderable perspiration, 
or none at all; fever in the forenoon, preceded by thirst early in the 
morning, but no chill; attended 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. During the paroxysm, con- 
fusion of ideas and ringing in the ears; discouragement; indifference 
to life; dullness of conception, and discontent during the apyrexia. 
Administration.—One drop of the first dilution in a spoonful of 497 
TREATMENT OF INTERMITTENT FEVER. 
water during the apyrexia. As a prophylactic against mtermittents, 
one drop of the tincture two or three times a week. 
JSux-vomica.—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, some- 
times with a disagreeable acid smell; partial or one-sided sweat; pulse 
hard, full and frequent, or small, quick and feeble, or intermittent; dry- 
ness of the lips ; tongue coated white or yellow. First stage preceded 
by external and internal cold and yawning; chills usually at night, or 
in the morning ; aggravated by motion, drinking, 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 come alternately. 
Watzke gives us the following indications: Chills with thirst; head- 
ache, loss of consciousness or delirium, painful and inflexible limbs, con- 
tracted feel of the muscles. Chills last four or five hours, and not 
followed by heat or perspiration. After the chill exhaustion ; pains in 
the hypochondria from distention; thirst and want of appetite ; tongue 
white; feet swollen; 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; weak- 
ness and faintness. Hartlaub has cured chills with or without external 
coldness,and without thirst; followed by fever with thirst, and succeeded 
or not by perspiration. The chill may be slight and short, or violent 
and protracted, with shaking and chattering of the teeth, and blue 
nails; fever attended with perspiration 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, vomiting of water, bile, 
slime and food; red urine; during the intermission, headache ; ver- 
tigo ; trembling of the head on motion; pain in the forehead; acid 
eructations; 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 in the belly ; constipation ; pressing at the neck of the bladder 
after urinating; drawing in the limbs ; weakness. Hartmann employs 
it when, at the commencement of the paroxysm, there are, paralytic, 
weakness of the limbs ; disordered stomach ; vertigo, and sudden pros- 
tration of strength. 
During the chills, stupid or delirious; during the fever, anxious, 
Vol. I.—32. 498 
DISEASES OF THE SANGUINOUS FUNCTION. 
melancholy, sad, timid, apprehensive of death. Occasionally monoma 
nia during the progress of the disease. 
The sphere of action of Nux-vomica is such that it is specific in 
primary affections of the spinal or the ganglionic system; gastric 
troubles with nervous origin, -where the stomach, bowels and liver are 
so morbidly affected, that the apyrexia shows considerable evidences 
of deranged digestion, even to vomiting and constipation. Intermittents 
caused by taking cold, errors in diet in hot-headed irritable males, who 
easily get angry; also indicated in fevers with primary affections of 
the spinal nerves or the ganglionic system; when during the paroxysm, 
twitchings, tetanus, trembling, sacral pains, sensitiveness of the spine 
to pressure, paralytic feelings in the extremities, sleep between the 
chill and heat (Ignatia). Yellow skin, the person thin, dark colored, 
of choleric, sanguine temperament. After Arsenicum, Nux is one of 
the best remedies, even in paludal fevers. Also in malarial fevers with 
symptoms similar to those of Cina, constipation being a prominent 
symptom. 
In the usual Nux-paroxysm the chill is predominant; every little 
motion, even drinking, aggravates the chill, -with severe pressing head- 
ache and congestion. Hands and feet ice cold; blue nails; no thirst; 
then continuous heat, with pressive frontal headache; redness of the 
face and thirst, followed by sweating; apyrexia, vertigo, heaviness and 
dullness of the head; pressive throbbing headache in the sinciput and 
temples. Waxy paleness of the face; toothache; tongue clean or 
covered with a brown thick mucus; taste bitter, sour, or lost; malaise 
and bitter vomiting; stitches in the liver and in the right side of the 
chest; sensitiveness and painfulness of the stomach to the touch; 
bloating, pressive contractive pain in the stomach; painfulness and 
bloatedness of the left hypochondrium; enlargement of the spleen, 
bearing no touch, impossibility of lying on the left side. Constipation, 
stitches in the anus, dry cough at night, general ailments, loss of flesh; 
debility, anxiety, inconsolability, with bitter crying; touchiness, being 
easily excited to anger. Intermittent, with nervous symptoms, emanat- 
ing from the spinal cord and reflecting themselves in other organs. 
Apoplectic intermittent with vertigo, anxiety, febrile shivering, delirium 
with lively visions and tension in the stomach. 
Administration.—Two drops of the twelfth dilution in an ounce of 
water, a dessert-spoonful each night. If a cure is not effected at the 
end of a week, give a drop of the first dilution once in six hours, until 
the symptoms disappear. 
Remarks.—Nux is particularly applicable to the quotidian and ter- 
tian types. If the individual has been an intemperate drinker or luxu- 
rious and sedentary in his habits, the indications are still stronger. 
Arnica.—Inclination to remain quiet. TREATMENT OF INTERMITTENT FEVER. 
499 
Principal Symptoms.—Chills occur in the evening; thirst; con- 
traction of the features. In the hot stage, pain in the back and limbs; 
shiverings, from the slightest exposure; the hot and sweating stages 
are of short duration. In the apyrexia, pain in the stomach; loss of 
appetite and general appearance of wretchedness and debility. Ob- 
stinate ; reckless; quarrelsome. . 
Administration.—Dr. Shue has been accustomed 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 apyrexia. 
Veratrum-album.—One of the best remedies. Severe chills with 
feeling of internal heat or both together; cold sweat of the body, or 
only cold frontal sweat; great thirst, especially during the chill and 
sweating; paralytic debility; anxiety; quick collapse of the strength; 
slow pulse which seems to fade away; watery vomiting and diarrhoea; 
cadaveric color of the face; delirium; cramps. Most of the symp- 
toms also in the apyrexia : decomposition of the blood with sugillations. 
In such dangerous cases, also in asphyctic intermittents, Yeratrum is 
far preferable to Arsenicum. 
Cholerine Ague—Cold and clammy perspiration on the forehead; 
shuddering. In the hot stage, coma and red or purplish cheeks ; pulse 
slow and almost extinct, or small, quick and intermittent; tongue red 
and dry; 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 pro- 
tracted, and accompanied with headache ; short, dry cough; fever with 
external coldness ; urine dark colored ; diarrhoea or constipation ; coma. 
In the third stage, profuse perspiration with thirst and drowsiness. 
Hermann prescribes Yeratrum when the chills are followed by sweat 
and afterwards coldness. Or, chills followed by fever with thirst; 
vertigo; nausea, and pain in the back, succeeded by fever with de- 
lirium ; flushed face, and tendency to sleep. After the paroxysm, mor- 
bid appetite. Or, cold stage, without the hot or sweating stage. 
In the cold stage, confusion of ideas ; in the hot stage, coma; during 
the apyrexia, restlessness and sometimes mental alienation. 
Administration.—One drop of the first dilution in an ounce of 
water—a table-spoonful two or three times between the paroxysms. 
Belladonna.—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; shiverings alter- 
nating; rigors, followed by heat; during the fever, burning thirst; 
headache ; shootings in the temples ; great sensibility to impressions ; 
delirium; sweat only of the parts covered; stitches in the chest; dim- 
ness of sight; quarrelsome and passionate during the paroxysm, or great 500 
DISEASES OF THE SANGUINOUS FUNCTION. 
agitation; mistrustful; constant dread of evil; visions of frightful or 
ludicrous objects; delirium. Predominant alfection of the vascular 
system; fevers simulating nervous fever, or phrenitis; congestions to 
the brain during the fever; vertigo; redness of the face; heat of the 
head; delirium; sopor; dreams and phantasies; palpitation; pulsation 
of the arteries of the neck, heat predominating; spleen swollen and 
painful, especially during the chill; swelling of the whole abdomen, of 
the eyelids, and of the lower extremities; sallow face; nearly total 
prostration of the digestive and reproductive sphere; great irritability 
and crossness in persons usually very patient. 
Administration.—A drop of the third dilution in water, every four 
hours between the paroxysms. 
Pulsatilla.—Intermittent with chlorotic quality of the blood, and 
corresponding imperfection of nutrition, with nervous debility com- 
bined with irritability; dyspepsia and amenorrhoea, paroxysms begin- 
ning at night or in the evening. Characteristics of Pulsatilla are, a 
long chill, little heat, and absence of thirst / the different stages, ex- 
cept the chills, have no great power; they run into one-another. During 
the chill, paleness of the face, heaviness of head, and cephalalgia; 
anxiety; sometimes mucous vomiting, and oppression of the chest. 
During the heat, moderate thirst, headache, redness of the face, and 
bloated appearance; painfulness, sighing, and complaining, anxious 
breathing; chilliness in uncovering; nausea; diarrhoea, followed by 
sweat; vertigo; oppression of the chest; palpitation; pains in the 
sacrum and extremities ; fainting spells ; and in women, amenorrhoea. 
During the apyrexia, headache ; seething of the blood ; palpitations ; 
different disorders of digestion ; moist cough, and disposition to weep; 
urine plenty and pale ; shivering during the apyrexia. Suitable in 
new cases, where the whole picture resembles chlorosis; paroxysms 
weakly developed and therefore easily overlooked. Dropsical swellings 
are cured by Pulsatilla only in the beginning of intermittents, but not 
when they are the sequelae of the deeply-affected energy of the vascu- 
lar life ; sweating only on one side of the body.—Face pale during the 
hot 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, grayish, or yellowish; chills in the evening or 
afternoon ; vertigo ; pain and heaviness in the head ; sensation of cold 
from slight exposure ; irregular diffusion of heat, chiefly in the face, or 
on one side ; absence of thirst; after the paroxysm, headache, oppres- 
sion of the chest, moist cough, bitter taste. Or, chills without thirst, 
fever with thirst, and dull headache ; sweating very slight. Or, chills 
commencing with vomiting, with slight thirst during the cold, hot and TREATMENT OF INTERMITTENT FEVER. 
501 
sweating stages ; diarrhoea; loss of appetite. During the paroxysm, 
anxiety ; sadness ; taciturnity ; 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 diave been incited by abuse of fat and 
indigestible food, or are connected with any derangement of the men- 
strual function, Pulsatilla is appropriate. It has been most frequently 
employed in the quartan type. 
Case by Dr. Pearson, Iowa.—“In the months of August, September 
and October, 1859, I frequently prescribed for as many as thirty cases 
of chills and fever daily, and found no remedies equal to Pulsatilla and 
Cedron, at from the sixth to the thirtieth attenuations.” And “when 
ague has been suppressed by Quinine, or more particularly with 
Chinoidine, and has again returned, there is no remedy so likely to 
effect a cure as Pulsatilla.” In one violent case where Pulsatilla 6° was 
given, after a long allopathic course had failed, the chill returned with 
augmented severity. The same remedy 3° permitted it to return two 
hours sooner, the chill being extremely violent, and lasting three hours 
before reaction appeared. It was then prescribed at the thirtieth di- 
lution, every three hours, and there was no other attack. (U. S. Jour. 
Horn., vol. I., p. 480.) 
Ignatia.—Purely nervous intermittent, especially if caused by fright 
or terror; apyrexia of the intermission complete; paroxysms short, 
changing, irregular, or the various stages running into each other; 
chills and heat occurring simultaneously in different parts of the body, 
most of the symptoms obscure or lightly displayed to outward appear- 
ance ; sudden attacks ; suitable for females. The fever begins often in 
the afternoon and lasts the whole night; the patient irascible, can not 
describe his sufferings, which are augmented by every noise. Compare 
with Cina. 
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. Rigors/ 
with thirst for cold water; nausea and vomiting ; pain in the back 
and limbs; oppression at the chest; loose, short cough; coldness re- 
lieved by external heat; heat general during the second stage; ver- 
tigo ; 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 
Occasionally delirious during the fever ; suppressed grief, with sigh- 
ing ; timid, sad, irresolute, and inclined to weep during the apyrexia. 502 
DISEASES OF THE SANGUINOUS FUNCTION. 
Administration.—Same as Belladonna. 
Cocculus.—Trembling during the first stage ; redness of the cheeks 
during the heat; pulse full, hard, and frequent; tongue clean or 
loaded. 
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 ; apyrexia, accompanied with vertigo; dull 
pain in the head, and general debility. 
Apprehension of approaching evil; fear of death, during the parox- 
ysm ; sadness and discouragement during the apyrexia. 
Administration.—Two drops of the third dilution in an ounce of 
of water—a tablespoonful every four hours between the paroxysms. 
Lachesis.—Face pale, or leaden, discolored 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 ; agi- 
tation and tossing in the cold and hot stages; pulse intermittent, or 
feeble and frequent; tongue dry in the second stage. Most of the 
time icy coldness of the limbs; rigors only partial; pains in the limbs; 
fever at night or in the evening, with headache. 
Carbo-vegetabilis.—Thirst only during the chill, or diminishing 
during the heat; offensive-smelling perspiration; anxiety, despondency 
and despair; weak, scarcely perceptible pulse; cachexia, with in- 
creased irritability; burning pains; flatulency; abuse of Quinine; 
venous abdominal affections ; oppression of the chest; rheumatic affec- 
tions of the joints and bones ; cold feet. 
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. 
Tertian type, kept up by awakened psora; rigors, preceded by throb- 
bing of the temples ; rending in the teeth and bones; and attended with 
thirst and sense of prostration; hot stage, attended with thirst or 
without thirst; headache; vertigo; impaired vision; nausea; pains 
in the stomach and chest; acid sweats in the morning; in the inter- 
mission, paleness; emaciation ; distention of the stomach; headache ; 
loss of appetite ; lassitude and disturbed sleep. Anxiety and fear in 
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. 
Remarks.—This remedy was supposed by Hahnemann to be of es- 
pecial service, in those old and obstinate cases of intermittent 
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. In the apyrexia, melancholy, violent jealousy j TREATMENT OF INTERMITTENT FEVER. 
503 
weakness of memory; during the paroxysm, delirium ; loquacity ; irri- 
tability. 
Administration.—One grain of the third trituration in two ounces 
of water—a dessert-spoonful every twelve hours until the desired elfec 
is obstained. 
Sahadilla.—The coldness predominates; affections of the spina 
marrow and digestive organs, with pains in the bones of extremities 
stretching, bloatedness of the stomach, oppression of the chest, spas- 
modic cough. During the apyrexia, bruised feeling all over. In the 
cold stage, trembling of the limbs, spasmodic cough; in the hot stage, 
yawning and stretching ; pulse variable ; tongue natural. 
The different stages imperfectly 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. 
During the paroxysm, inability to collect or arrange the thoughts; 
delusions of the imagination with respect to ones self; delirium. 
Remarks.—This remedy is useful when the malady has been pre- 
ceded for some time by gastric derangement, or in cases complicated 
by abuse of Quinine. 
Administration.—Same as Veratrum. 
Sulphur.—Intermittent, coming on in the evening or night, with 
more or less chills; then thirst during the heat and sweating, head- 
ache, congestions of the chest, with dyspnoea, delirium, stitches and 
swelling of the spleen. 
Intermittent with itching urticaria, appearing during the paroxysm; 
thirst before or during the chill; heat and sweating in persons who have 
had the itch; complexion sallow, yellow albuginea; pain, swelling and 
hardness of the spleen; white-coated tongue. Whenever the remedy 
seemingly well-indicated fails to break the fever, and psora may be 
justly suspected, and where the symptoms lead us to Sulphur, the use 
of this remedy, especially in the lower triturations, will hardly disap- 
point us. 
Symptoms.—Countenance pale or hot during the first stage ; circum- 
scribed 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. 
Previous to the first stage, 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. 
In the apyrexia, sadness, with frequent inclination to weep; during 504 
DISEASES OF THE SANGUINOUS FUNCTION. 
the paroxysm, irritable and peevish; thoughts incline to relign us 
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. 
Natrum-muriaticum.—One of the best antipsorics. After abuse 
of China, even in malarious agues, if connected with psora, in tedious 
cases, but where the disorganization of the assimilative organs is not 
too far advanced. Terrible stitching headache, especially during the 
heat. Disturbances in the digestive organs, disorganization of the 
spleen. Thirst in all the stages of the fever; vomiting, continual 
chilliness even in the apyrexia. Twitchings of the extremities, ulcera- 
tion round the lips, yawning, stretching, sleepiness, debility, sallow' 
complexion. 
Hartlaub commends this remedy in chills with little or no thirst; 
sharp pains in the forehead, back, and bones ; short breath; yawning 
and sleepiness, 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; head- 
ache; weak eyes; bitter taste; no appetite; great thirst; pit of the 
stomach painful to the touch; sleepy in the daytime, but sleepless at 
night; lassitude and debility. It also cures tertian and quotidian 
types with chills only. 
Administration.—A drop of the first dilution once in four hours 
between the paroxysms. 
Antimonium-crudum.—Face and eyes of a yellowish hue; yellow 
or wrhitish fur upon the tongue; pulse quick or slow. 
Tertian type; short chills, followed by fever, with pain in the chest 
and pit of the stomach; predominance of gastric or bilious symptoms; 
frequent nausea and vomiting; bitter taste in the mouth; thirst; diar- 
rhoea ; distention of the stomach. 
During the apyrexia, indifference to life ; during the paroxysm 
peevish ; dread of misfortune; out of humor. 
Administration.—Two drops of the third dilution in an ounce of 
water,—a table-spoonful once in six hours during the intermission. 
Cina.—Malarial intermittentswith cholera symptoms. The dilated 
pupil and the perfectly clean tongue are characteristics. 
with pale face and the predominating nervous affections similar to worm- 
attacks ; itching in the nose; spasms combined with some choleraic 
symptoms; paroxysm in the afternoon, after meals. Before the chill, 
malaise; nausea; drawing in the extremities; sometimes vomiting of a TREATMENT OF INTERMITTENT FEYER. 
505 
little fluid. During the chill, paleness and coldness of the face; chills 
all over the body; shortness of breath; stitches in the side; cold 
hands and feet; nausea; vomiting of food, bile and mucus. During 
the heat, delirium; headache; paleness of the face; vomiting; severe 
thirst for cold drinks; colic and watery serous diarrhoea, following one 
another quickly, and debilitating the patient. The sweating stage, 
either entirely wanting, or general sweat over the whole body; or 
partial on the face ; or cold sweat on the hands and the feet. During the 
apyrexia, the collapsed state continues, but the tongue is clean, and the 
patient ravenous for food. Sometimes dry cough. 
Hermann Gross, and others have found Gina curative when during 
the paroxysm there are, pale countenance; canine appetite; headache; 
nausea; foul breath; during the intermission, cold face; morbid appe- 
tite; lassitude; occasional sweats. 
Capsicum.—Phlegmatic temperament; flabby mucous constitution; 
pleuritic pains, not relieved by Bryonia/ chill predominant; thirst in 
the chill, or during the chill and heat. 
Dr. Morgan of 111., says: “Even when insufficient to cure, Capsicum 
3d, in frequent doses, will often ameliorate the paroxysm of ague.” 
Dr. Curtis published a “cured of soporose ague, evidently of a malignant 
character,” with one drop doses of the mother tincture of Capsicum. 
{N. A. Jour. Horn.) 
Symptoms.—Hartlaub advises it in chills with thirst; headache, 
mucoits 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 intermission, ash-colored 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 abuses of Quinine. 
Gedron.—Feverish paroxysm every day (quotidian) in some provers, 
and every other day (tertian) in others, towards 8 o’clock, p. m., pre- 
ceded by depressed spirits, dulness of senses, and pressive headache 
at noon; cramps, then contracting and tearing pains in the upper and 
lower extremities, with a cold sensation in the hands and feet; mouth 
dry, great thirst, and desire for cold water; chills and shivering; 
sometimes very strong shuddering of the whole body; palpitation of 
the heart and hurried respiration ; pulse weak and oppressed. These 
symptoms lasted from one to two hours, and varied much in intensity; 
they were followed by a sensation of dry heat, and then of a profuse 
perspiration, full and quick pulse with animated red face ; cold and 
pale in the apyrexia; thirst and desire for warm drinks. 
Hundreds of cases of intermittent fever, of different types, have 506 
DISEASES OF THE SANGUINOUS FUNCTION. 
been successfully treated with Cedron, in different countries since 
1847 many of which had resisted the action of other drugs, previously 
administered by physicians of both schools. Cedron was given im- 
mediately after the heat, and as soon as the sweat had commenced; 
and, again, from two to three hours before the usual time of return of 
the next paroxysm. It is homoeopathic to agues, endemic to warm, 
damp, and low marshy regions, being capable of effecting the healthy 
organism precisely as the natural disease does. (Casanova, Petros.) 
Cedron is an efficient prophylactic to those forms of fever produced 
by malaria of warm seasons, in low marshy regions; when taken oppor- 
tunely and in suitable doses, it prevents their development, as has often 
been demonstrated in Spain, Africa, and South America. This sort 
of antagonism certainly gives immunity to those constantly exposed 
to the deleterious disease-producing agents of those regions, whilst 
under the influence of the drug. But in using it as a prophylactic, 
care should be taken not to repeat the dose too frequently, otherwise 
pathogenetic effects will be produced by it. 
Sepia.—General cold feeling, with pressure on the temples and over 
the eyes ; during the heat, vertigo, even to insensibility; sweating over 
the whole body, Avith anxiety, without thirst, but with dryness in the 
throat; nightly perspiration ; cold sweat on the chest, back and thighs 
at night; sour night-sweats; offensively-smelling sweat; urine brown 
and acridly smelling; perfect absence of thirst. See p. 412. 
Staphysagria.—Evening chills Avithout heat. Scurvy. 
Taraxacum. — Quotidian intermittent with much perspiration. 
Nightly sweat, restless sleep, great thirst, loss of strength. Chills in 
the fresh air. 
Thuya-occidentalis.—Chills and sweat without fever. 
Opium.—Intermittent caused by fright, with cerebral symptoms 
prominent; sopor, coma, or convulsions. Congestive chills. 
Phus-toxicodendron. — Intermittent caused by getting wet, with 
great nervous depression and exhaustion; spinal irritability; digestive 
derangements, especially in the mucous membranes; therefore bad 
assimilation; catarrhs, coryza, gastric troubles, thirst, pains in the back 
and extremities; spasms; tearing pains in the head; sleeplessness, 
formication and sensation of paralysis in the extremities; general de- 
bility; urticaria; colic; diarrhoea; jaundice; sleeplessness, Avith tossing 
about; thirst at night; palpitations, with anxiety and pressure in the 
pit or the stomach. 
Symptoms.—The character of the eruptions and the fever produced 
by Rhus are peculiar. Tractile feeling of the scalp as though one 
was pulled by the hair; disfigured and distorted face, the left side ap- 
peared contracted and the right elongated; black, inflamed, itching 
pustules covering the Avhole body; yelloAvish saliva. TREATMENT OF INTERMITTENT FEVER. 
507 
Hydriodate of Potash.—Intermittent in a scrof ulous constitution. 
Paroxysms severe; chill not mitigated by external heat; dryness in 
the mouth ; thirst during the chill• heat and then sweat; ascites fol 
lowed by general dropsy. 
Laurocerasus.—(Aq.-amydalus-amarar). Purely nervous intpr 
termittentj great thirst before the chill‘ chill relieved by externa 
warmth. (Ignatia). Dry cough with tickling in the throat during thi 
chill; general heat with headache, but without thirst or cough. General 
sweat; urine pale. During the apyrexia, tongue clean; appetite good; 
bowels and sleep regular; spine not sensitive ; general debility. 
Lycopodium.—Malaise ; sour vomiting; severe chills ; hardly any 
heat, followed by dreamy slef p and sour-smelling sweat. Severe thirst 
after sweat; bloatedness of the face and hands after the chill; inter- 
mittent with anasarca. 
Mezereum.—During the chill, dyspnoea, with constrictive feeling in 
the chest, front and back ; dryness in part of the mouth ; accumulation 
of saliva in the front part of the mouth, without thirst; sleepiness in 
a warm room during the chill; intermittents, consisting only of chills 
with thirst. 
Coffea.—Chills and heat changing quickly; horripilations ; restless- 
ness ; colic. 
Ferrum.—Appropriate in cases similar to those suited with Arseni 
cum and China. Intermittent fever writh pure debility; anaemia; decay 
of nutrition; congestions to the head and chest, with wTatery decompo- 
sition of the blood, especially after abuse of China, or long-lasting in- 
termittent ; paroxysm not severe, but long-lasting, especially the sweat- 
ing; change of type; large infarctus abdominis/ liver and spleen 
swollen; muscular power visibly decreasing • eyes red, lids swollen, 
with mucous secretion of meibomian glands; sweet taste in the mouth; 
black or dark-violet spots on the skin, sharply circumscribed; some- 
times black discoloration of a whole extremity; debility, even to para- 
lysis ; general dropsy. 
Ferri-percyanidum.—Prussian-blue, is the best of the preparation 
of iron for intermittent fever. 
Ilepar-sulphuris-calc. — Urticaria, with itching over the wThole 
body; then chill, followed by heat and thirst; fluid evacuations from 
the bowrels ; borborygmi, slight bilious vomiting; bitter taste ; sensation 
of formication in the arms; urine dark colored, with sediments. 
ILyoscyamus.—Quartan and quotidian fevers, with spasms in the 
calves and stomach; insensibility, delirium, and during the apyrexia 
fiery wheels before the eyes and hiccough; intermittent with dry noc- 
turnal cough; afternoon chills, with spinal pains ; epilepsy. 
Sambucus.—Profuse weakening perspiration, even in the apyrexia, 
esDecially at night; chilly horripilations over the whole body, with fine 508 
DISEASES OF THE SANGUINOUS FUNCTION. 
stitching formication; icy cold hands and feet, especially from the 
knee downward; burning hot feeling in the face, with moderately warm 
body and icy-cold feet, without thirst; a good many hours after dry 
heat has left, there is perspiration in the face; profuse sweat without 
thirst in the night; on awaking from sleep, perspiration all over. 
Calcarea-carbonica. — Swelling of the abdominal glands ; hard 
bloated abdomen; inclination to diarrhoea, alternating with obstruction; 
thirst, especially during the chill, with tearing pains in the lower ex- 
tremities ; spleen swollen and painful; headache during the fever; 
urine plentiful. 
Camphor.—In doses of one drop only, given on the first appearance 
of the symptoms foreboding a chill, this remedy often arrests the 
paroxysm, and it does not return.* 
It is admitted by all homoeopathists, that, among the vast number of 
remedies known to be sometimes successful in the cure of intermittent 
fever, it is often difficult to select the true specific, which, in the finest 
dose, will be promptly effectual in a given case. It is still true, how- 
ever, that there are many remedies which come near enough to almost 
every case of uncomplicated ague to overcome its worst features, and 
then either cure entirely by being repeated, or render the case promptly 
curable by the next remedy. It is true that “ simple cases are essen- 
tially alike ; and China, Nux-vomica, Bryonia, Ipecac., Arsenicum, 
Tartar.-em., Gelseminum and Camphor are efficient remedies.” Of 
these it is known that China, Quinine, Arsenicum or Nux-vomica 
in some attenuation and in a certain dose will cure, perhaps, every 
simple case. 
Veratrum-viride.—General Local Effects.—Locally applied it is 
capable of producing irritation, rubefaction and even vesiccation of the 
surface. Snuffed into the nostrils the powder is a strong errhine and 
sternutatory ; it produces an acrid impression on the mouth and fauces 
when chewed; when swallowed it causes uneasiness in the epigastrium, 
then nausea and vomiting; the latter effect often persists long, is 
attended with much retching, sometimes hiccough. Dr. Osgood says, 
the vomiting in his case was affected by spasmodic affection of the 
stomach itself, without help from the diaphragm or abdominal muscles; 
sensation of a ball rising to the throat, the result of spasmodic con- 
traction of the tube; nausea not severe, but the prostration very strik- 
ing; vomiting occurs only three-fourths of an hour after taking it. 
(Much longer than after Veratrum-album/) it seldom if ever purges. 
General Symptoms.—Doses insufficient to vomit cause epigastric 
uneasiness; sometimes chilliness; diminution of the frequency of the 
pulse; sense of weakness in certain muscles, or want of due command 
* Dr. Morgan, U. States Jour. Horn., vol. II., p. 500. TREATMENT OF INTERMITTENT FEYER. 
509 
of them, through direct sedative influence upon the nerve-centres. 
The pulse has been reduced by this agent as low as thirty-five per 
minute without the least nausea or vomiting; feeling of numbness, ting- 
ling felt about the joints, previous to vomiting, during the process and 
after it. The farmers of New England formerly soaked corn with it 
and scattered it to poison the crows. After a short time the crows 
that had eaten it became incapable of rapid motion or flight and were 
readily caught. If left long undisturbed they recovered. 
Effects on the Circulation.—When carried far enough to cause 
nausea and vomiting, the pulse falls from seventy-five or eighty to 
thirty-five or forty, becomes more small and feeble, occasionally al- 
most imperceptible; surface pale, covered with cold sweat; sensation 
of chilliness, or tingling or numbness; headache; vertigo; dimness 
of vision; dilated pupils; faintness, feeling as of stiffness of certain 
muscles, want of command of them; prostration sometimes becomes 
alarming; though no fatal case is reported. These depressing effects 
on the nervous system are accompanied with stimulation of the se- 
cretory functions. Salivary, pulmonary, biliary, and urinary secretions 
are increased, when nausea and vomiting are excited, and that of the skin 
also during the continuance of the nausea. It does not appear to be 
a specific against plastic inflammation, but against vascular irritation 
and congestion. 
Macrotin.—Macrotrys, Cimifuga, or Squaw-root, has many symptoms 
in which it resembles Quinine, both being given in large doses. When 
given freely it operates largely on the brain and nervous centres; it 
causes vertigo; dimness of vision; unpleasant feeling, even pain in 
the head ; flushed face. 
It has a decided and well-marked influence over the capillary system 
of vessels, moderately increasing all the secretions, particularly those 
of the skin, kidneys and bronchial mucous membrane. 
It increases the amount of solids in the urine, without largely increas- 
ing the quantity of water. 
As a parturifacient it was in general use among the Indians ; it was 
early employed in New England to accelerate the parturient process, 
and for this it is recommended by Bigelow; it is now much used in 
place of Ergot. 
Dr. Tully says in many instances it produced abortion when it had 
been prescribed for cough. All of the above effects are commonly known 
to result from Quinine. 
In morbid heat and dryness of skin from irritative fever, it abates the 
irritation and is followed by relaxation and gentle moisture, its action 
in these cases corresponds well with Quinine, which in alternation with 
Opium is regarded by many practitioners as the most certain diapho- 
retic ever used. 510 
DISEASES OF THE SANGUINOUS FUNCTION. 
CONGESTIVE INTERMITTENT FEVER. 
SINKING CHILL.-MALIGNANT INTERMITTENT. 
The name Congestive Fever is usually employed, not under the idea 
that congestion exists in this fever alone, but because the congestion, 
though only a symptom, is such n, prominent one in this form of fever, 
that it constitutes its most striking feature. 
By congestive fever is understood that form of autumnal disease in 
which the vital force is depressed by the influence of the miasmatic 
poison below the point of successful reaction. The heart, in conse- 
quence of this depression of vital force, is unable to give due circula- 
tion to the blood, which consequently becomes congested in the internal 
organs and large venous trunks. If the vital energies do not utterly 
fail in the first paroxysm, they become still more depressed in each 
succeeding one ; the venous congestion becomes greater and more 
perilous, the struggles of the heart become fainter, till they cease al- 
together in the second or third paroxysm. In some cases the patient 
dies in the first paroxysm, without any fever supervening; in others 
the chill is followed by little or no febrile reaction, and this stage is 
succeeded by a fatal cold stage. 
Congestive Intermittent is not a new disease, specifically distinct 
from ordinary intermittent, but a severe form of the same disease, oc- 
curring in a patient whose general health is already greatly prostrated 
and deranged. It is little more than the cold stage of an ordinary ague, 
deepened and prolonged in consequence of constitutional exhaustion of 
the vital powers from the effects of previous disease. Dr. Drake says : 
The innervation is scathed, the circulation is enfeebled; the blood, 
largely withdrawn from the more external parts, circulates with diffi- 
culty through the internal or visceral system, which is rendered ple- 
thoric, and the great organs, as the stomach, spleen, liver, lungs, heart, 
and brain, are, respectively liable to pernicious engorgements or ob- 
structions greatly increasing the danger. A failure in the function of 
respiration, in the co-operative action of the brain, and in the projectile 
power of the heart, combine to diminish the aeration of the blood, which, 
deteriorated in its constitution, contributes still further to sink the 
powers of life. This condition of the respiratory function diminishes 
the heat of the body, which is moreover reduced by the failure of the 
calorific function of the skin, from the combined lesions of the nervous 
and circulatory systems, while the ready transudation, which the re- 
laxed integument permits, of the serous portion of the blood, and the 
copious exhalation which takes place, accelerates the cooling. The 
patient dies under the combined influence of depression of the vital 
forces, and that consequential engorgement of some important organ, CONGESTIVE INTERMITTENT FEVER. 
511 
which has procured for this fever the epithet congestive. Or, should 
a partial icaction occur—should he survive two or three paroxysms to 
expire in a fourth or fifth, as occasionally happens, a low inflammation 
may be superadded to passive hyperaemia.” 
Symptoms.—The patient has the usual premonitions of ague, but 
feels peculiarly languid, restless and feeble; these warnings are per- 
ceptible in most cases for a day or two. The disease then more clearly 
announces itself with a chill; the patient feels restless and much op- 
pressed ; the skin is pale and shrivelled; the extremities become very 
cold ; features contracted; lips purple ; tongue pointed and of a leaden 
hue, or pule, cold and clammy; pulse feeble, quick, frequent, irregular, 
intermitting ; tendons corded ; occasional rigors, and sometimes shaking 
chills, though the patient rarely complains of coldness. There is no 
acute pain, but a dull, heavy aching in the head, back and limbs. There 
is generally great thirst with nausea and vomiting. The skin continues 
to grow colder and is bedewed with cold, unnatural perspiration ; there 
are indescribable restlessness, oppression and disposition to throwT the 
limbs about; if the patient rises he is giddy, staggers, perhaps falls. 
He feels oppressed with excessive heat, calls for ice, for cold water in 
his face and breast, and while his skin is cold and wet, wishes to be 
constantly fanned. A copious swreat suddenly breaks out, and as sudden- 
ly disappears ; the skin becomes motley and bluish, its sensibility is 
impaired, the impress of the fingers remains some seconds after pres- 
sure is removed; sometimes there is ecchymosis in dependent parts ; 
respiration is irregular, with frequent sighing, great anxiety, the coun- 
tenance haggard; eyes suffused; harassing hiccough. In some cases 
there is a watery purging resembling Asiatic cholera, which sinks the 
patient rapidly. He always complains of a distressing sense of sink- 
ing, incubus of the chest or feeling of suffocation ; he lies without 
breathing for a minute, and then gasps for breath; respires again in a 
hurried manner, says he “will die for want of breathrises and rushes 
towards the window, staggers and throws himself on another bed or on 
the floor; the pulse which had been a mere flutter, now ceases at the 
wrist; there is a moment of unusual anguish, then a gasp or two for 
breath ; and the heart ceases to beat, the case terminating in death, six 
or eight hours from the access, the sufferer retaining his senses to the 
last. In other cases the patient lies unconsciously in a state of deep 
comatose sleep for some hours before death. 
In those cases in which reaction is excited by the free use of stimu- 
lants, the fatal termination is delayed for some hours, at the end of 
which the patient dies comatose. When a partial reaction takes place 
from the natural efforts, the skin becomes warm, though the extremities 
are still cold. The pulse is 150 per minute, and may fall to 120. 
There is some mitigation of the patient’s distress; he passes into a 512 
DISEASES OF TIIE SANGUINOUS FUNCTION. 
series of uneasy, interrupted slumbers, until near twenty-four hours 
from the first attack; when another paroxysm comes on which only 
terminates in fatal collapse. 
Diagnosis and Pathology.—The seat of the congestion is indicated 
by the severity of the symptoms pointing to the organ suffering most 
intensely. In many cases the spleen becomes engorged in a few hours 
to such an extent as to be found double the natural size. The same is 
partially true of the liver. Congestion of the lungs to some extent is 
always present, and is generally a fatal complication. It is known by 
great oppression, laborious breathing, heaving of the chest, sense of 
suffocation, and rapidly sinking into fatal collapse. Congestion of the 
lorain is the most alarming of all local congestions. It is marked by 
deep coma; low muttering delirium; rolling of the head from side to 
side, and drawing it backwards ; dilatation of the pupils, optical illu- 
sions ; and raging delirium in the cases in which reaction is brought 
about by stimulants. 
Consequences of a Protracted Hot Stage in a Severe Case.—1. A 
subsidence of the general fever is not always accompanied by a return 
of the congested viscera to a state approaching to health. It may 
happen that some one or more of the organs “ will remain in a state 
of hyperaemia, and pass into inflammation. These are, generally the 
viscera of the abdomen, chiefly the spleen, liver, and gastro-enteric 
membrane. 
“ 2. Splenitis,” (says Dr. Drake) “ is so common an accident of our 
autumnal fevers, especiall your inflammatory intermittents, as to suggest 
that we can no where look for the true anatomical character of that 
fever more successfully than in the spleen. Why it should be so great 
a sufferer cannot, perhaps, be told, except that it becomes greatly en- 
gorged in the forming stage of the fever. 
“ 3. Next to the spleen, or equally with it, the liver is liable to fall 
into inflammation upon the accession of the hot stage ; but this is more 
especially the case in the remittent type. 
“ 4. The mucous membrane of the stomach and duodenum, with that 
of the common gall duct, are liable to pass into the same condition. 
“ Thus all the subdiaphragmatic viscera, except the pancreas, are 
subject to inflammation in this fever. Sometimes, however, from 
idiosyncracy, or the cooperative action of certain causes, inflammation 
of the brain, or its envelops, may happen ; and when the fever makes 
its attack late in autumn, the combined action of vicissitudes of tem- 
perature and of the specific cause, developed at an earlier period, may 
determine the inflammation upon the lungs or pleura. Wherever the 
inflammation may be seated, it complicates the case, and creates a new 
kind of danger. Although it may abate with the subsidence of the 
hot stage, it does not cease. The affected organ shows signs of suffer- CONGESTIVE INTERMITTENT FEVER. 
513 
ing during the apyrexia, which it renders imperfect. The succeeding 
exacerbation may be prolonged by it, and an intermittent may thus be 
converted into a remittent; while the latter, not unfrequently, as al- 
ready said, passes nearly into a continued type, from the same patho- 
logical cause. But the most dreaded combination of this kind, which 
we meet with, is that in which an inflammation of an organ is associated 
with such a depression of the general forces of the system, that but a 
feeble reaction occurs. That this is a reality, both the symptoms and 
post-mortem appearances have shown. Such inflammations are never 
very acute. The organ is greatly engorged, but the actions which 
constitute inflammation are very feeble, and often more conspicuous than 
the vestiges of true inflammation. Between these cases and mere con- 
gestion of the organ, there is often but a shnde of anatomical difference.” 
{Dr. Drake, Diseases of the Mississippi Valley.) 
Prognosis.—Favorable Indications.—The successive exacerbations 
of the fever become lighter and of shorter duration; the external heat 
and dryness of the skin diminish; the pulse, which had been above 
100 per minute (in an adult), throughout the remission, is reduced to 
88 and then to 72, showing complete absence of the fever; the gastric 
distress, pain and tenderness of the epigastrium, the pain in the head 
and back, are diminishing; the skin becomes soft and moist, the tongue 
less coated, the countenance more cheerful, and sleep is quiet and re- 
freshing for some hours ; the remissions become longer and more dis- 
tinct till complete intermission is followed by protracted convalescence. 
Unfavorable progress of a severe case is manifested by the absence of 
any of these evidences of amelioration ; and in their stead, there is pro- 
gressive increase in the severity of the symptoms, which finally give 
place to those above mentioned as marking the approach to a fatal 
termination. 
The remedies that have proved successful in the treatment of inter- 
mittents in every form are such as act primarily on the ganglionic sys- 
tem of nerves. Dr. Hale observes “ that they may produce a conges- 
tion of some of the nervous centres and thus be capable of creating in 
healthy subjects symptoms analogous to ague. This explanation of 
their modus operandi would agree with Dr. Lord’s theory, that inter- 
mittents arise from a retardation of nerve-force in the ganglia.”* The 
remedies that have been used with success in congestive intermittents 
are limited in number. It is only necessary here to refer to China, 
Arsenicum, JVux., Opium.. (See p. 486, 492, 497, 506.) The size of 
the dose is the only difficulty.'When the malarious poison is strong, and 
the quantity taken by the patient is large, the dose of the remedy, 
though a true antidote, may require to be larger. And this is evidently 
* Transac 111. Med. Associa 1862. p. 49. See p. 478 this volume. 
"Vol. I.—33. 514 
DISEASES OF THE SANGUINOUS FUNCTION. 
true when the selected remedy is only partially homoeopathic to the 
case. This subject is illustrated by the quantity of one narcotic 
poison required to antidote a large quantity of another narcotic 
which it is only a partial similimum. We select a case showing the 
effect of poisonous doses of Opium in counteracting the effect of a 
poisonous dose of Aconite.* 
A female patient in the Pennsylvania Hospital took by mistake a 
dessert-spoonful of tincture of the root of Aconite. She immediately com- 
plained of extreme prostration, and a peculiar feeling of numbness and 
tingling over the whole surface of the skin. She was found, three- 
fourths of an hour afterward by Dr. Benton, “ lying in a sort of stupor, 
the pulse at the wrist imperceptible, countenance pallid, extremities 
cold and the surface bathed in a cold perspiration.” An active emetic 
was given to evacuate the stomach. Then an ounce of brandy, with 
forty minims of Laudanum were given, and repeated every fifteen 
minutes, until five ounces of Brandy and about three drachms of Lau- 
danum had been taken; when the pulse was found to have risen to sixty 
beats per minute, though still extremely intermittent. The Brandy 
and Laudanum were now given at intervals of half an hour, until, in 
the course of four hours from the commencement, she had taken five 
and a half drachms of Laudanum without any symptoms of narcotism. 
The pulse had now risen to ninety per minute, and warmth had re- 
turned to the extremities. The Brandy and Laudanum were then only 
given at longer intervals; next morning the pulse was eighty. The 
patient recovered without any bad symptoms. 
Miasm is a poison that acts by depressing the vital force; but a given 
amount of miasm will not produce the same degree of prostration in 
all persons who are subject to its influence ; therefore the quantity of 
a remedy only partially homoeopathic to the case “must be proportioned 
to tbe susceptibility of the nervous centres to be acted upon,—the ap- 
titude of the vital telegraph to convey the impression,—and the venous 
and nervous congestion to be overcome.” 
But, if we admit on theoretic grounds that there may be conditions 
in which massive doses of strong agents may be justifiably given, we 
can not apologize for the immense doses of Sulphate of Quinine now 
popularly given in the different forms of autumnal fever. When small 
doses do not succeed and do it without bad results, the largest will fail, 
or will at least produce injurious aggravations. If drug-symptoms are 
excited by small doses it is evident that still worse results will follow 
large ones. The following symptoms embrace the principle charac- 
teristic symptoms of Quinine, when given in too large doses in this 
disease : a swelling pulse, tingling in the ears; pushed farther, it pro- 
* Med. and Surgical Reporter. Vol. VIII. p. 362. CONGESTIVE INTERMITTENT FEVER. 
515 
duces : painful fulness of the brain, alarming sounds, ringing in the 
ears, deafness, slight delirium, twitching of the tendons and hiccough, 
iffequently repeated, heroic doses exhaust the vital powers, cause in- 
direct debility and thus hasten that collapse which it is supposed to be 
capable of averting. 
When taken in the unreasonable quantities of “ twenty, forty, and 
one hundred grains” its effects are thus described: Its action on the 
brain becomes apparent. “ Strange sounds distract the ears. The 
patient may imagine himself in a thunder-storm, with lightnings flash- 
ing in his closed eyes, and burning in his brain, and still be sinking all 
the time. The remedy, failing to counteract the disease, has attacked 
the vital organs, and is prostrating still further the vital force. A 
grain of Morphine will not give a moment’s rest. Diffusible stimuli 
only add fuel to the flame that burns within. Rubefacients give no re- 
lief though used till the skin is sore ; and the capillaries are injected 
till the surface is purple. The patient rolls from side to side; throws 
his limbs in every direction, calls for ice or cold water, which is rejected 
as soon as swallowed; he asks to be fanned, and for water to be 
thrown in his face.” 
The size of the dose, within reasonable limits, is less important than 
the accuracy of the prescriber in selecting the proper remedy. The 
true specific will cure in a minute dose; and many practitioners re- 
strict themselves to the high potencies in the minutest doses. These 
doses are efficient in good hands. 
Arsenicum.—Case by Dr. Pearson, Iowa.—A strong muscular man, 
of previous good health, except chills and fever some months previous, 
for whiqh he had taken large doses of Quinine. Has now great dis- 
tress from severe cramp-like burning pain in the region of the cardiac 
orifice of the stomach ; the extremities are cold ; the pulse quick, but 
not full; restlessness; disposition to change his position every few 
minutes ; frequent attacks of nausea and vomiting. He took of Ar- 
senicum, thirtieth, four drops in four ounces of water, two tea-spoon- 
fuls, at first, and repeated it in fifteen minutes. In twenty minutes he 
was much better, and was entirely relieved in less than an hour. He 
took no other medicine, and there was no succeeding paroxysm. 
Of the efficacy of Arsenicum in lower potencies we have the most 
ample proofs. 
The complications of intermittents present us with the greatest dif- 
ficulties in practice. 
Intermittent complicated with catarrh of the stomach, Nux-v., Ipec., 
Puls., Natr.-mur., Sepia. Dr. Kapka reported, that “ after the wars of 
1850 and 1851, he treated a great many Austrian officers, who Avere 
suffering from obstinate intermittents, with chronic catarrh of the 
stomach, for which they had been maltreated with Quinine. He cured 516 
DISEASES OF THE SANGUINOUS FUNCTION. 
them with Nux and Ipecac., and afterwards small doses of Quinine, 
first trituration, during the intermission. (Report. Germ. Central- 
Verein.) 
When the catarrh involves the intestines—Cham., Ipecac., Phos., 
Puls., Verat., Arsen. 
Catarrh involving the duodenum—Cham., Merc., China, Nux-vom., 
Sep., Sulph. 
Anaemia following ague—China, Ferrum-cyan., Arsen., Calc., Puls. 
Congestion and persistent turgescence of the spleen is a common 
attendant and consequence of intermittents. Besides its primary func- 
tions as a component part of the chylopoetic system, the spleen forms 
also a natural reservoir for the reception of extra portions of the blood 
when suddenly repelled from the external surface, and driven in upon 
interior organs; in this manner it shields the vessels of remote parts 
from sudden and excessive distention. It is therefore liable to morbid 
turgescence upon any sudden disturbance of the body, as after an am- 
putation of a leg or an arm ; but more frequently on the occurrence 
of the cold stage of fever. This is more conspicuous in persons who 
are already in a diseased state, and the spleen is inclined to atrophy, 
induration or inflammation from previous successive chills. 
Treatment.—The best treatment for chronic enlargement of the 
spleen is that which permanently cures the ague with which it is con- 
nected. The remedies known to be most efficient in restoring this 
organ to its normal size and condition are : China and Natrum-muria- 
ticum. We have seen abundant proofs of their powder in this wray. It 
is only necessary to continue them for a sufficient time in very small 
doses. Bromide of Potassium is also a remedy. t 
Gknus IV.—REMITTENT FEVER. 
Bilious remittent fever prevails in all countries and localities where 
paludal malaria is developed in the connection with a high degree of 
atmospherical temperature. 
Diagnosis.—In general the remissions of the fever between the 
daily periods of high excitement are well marked, the patient feeling 
much relieved; in other cases the mitigation is but slight, and the 
fever has almost a continued form. There are always irritability of 
the stomach, a sense of oppression and distress at the epigastrium, 
pain in the head, back and limbs ; and the prostration of strength pro- 
gresses rapidly from the commencement of the disease. 
The milder form of bilious remittent fever is generally preceded for 
some days, by listlessness, languor, bitter taste in the mouth, nausea, 
aversion from food ; indescribable uneasiness and sense of fulness about 
1. BILIOUS KEMITTENT. BILIOUS REMITTENT FEVER. 
517 
the epigastrium, torpor of the liver, constipation, heaviness of the head, 
pain over the eyes. The first appearance of active disease is the com- 
mencement of a slight chill or sense of coldness, which creeps up the 
hack; it does not amount to coldness over the surface and extremities, 
hut is much more unpleasant than mere want of heat. In the course 
of a few minutes the coldness is succeeded by flashes of heat; and in 
the course of one or two hours the whole surface becomes hot; “the 
skin is dry and constricted, the face flushed and turgid, the eyes red 
and suffused, the respiration hurried and uneven, the pulse quick and 
frequent, hut rarely tense ; there is great prostration of strength, with 
considerable restlessness and watchfulness. The patient complains of 
pain and a sense of fulness, weight, and tension of the head, pain of 
the hack and extremities, particularly of the calves of the legs ;—and 
there is a sense of weight or oppression, and often of pain at the epi- 
gastrium,” wdiich point is generally tender on pressure, even when no 
pain is complained of. The stomach is more or less irritable ; in some 
cases the nausea is distressing, in others everything swallowed is in- 
stantly rejected. Vomiting is a common symptom from the commence- 
ment, but oftener it begins about the third day or later; the matters 
thrown up being yellow, greenish, or bright green. The tongue is at 
first moist, red at the edges, with a whitish, light-brown, or yellowish 
fur of considerable thickness on its upper surface, and there is con- 
stant thirst. The bowels are constipated, the urine diminished in 
quantity and high colored. After fever has lasted two or three days, 
the shin becomes yellow, the adnata of the eyes showing it first. The 
exacerbation lasts from eight to twelve hours, when there is abatement 
of the symptoms. In milder cases the skin becomes moist and the 
patient falls into a refreshing sleep ; in cases more severe the skin con- 
tinues hot and dry, and the patient is still restless and sleeps irregu- 
larly. After some hours of comparative comfort the patient finds the 
fever again rising; and this exacerbation progresses in intensity till it 
reaches the same height, or exceeds that of the previous day. 
Inflammatory Form of Bilious Fever.—The symptoms are the 
same as in the ordinary form of the fever, just described, but they all 
appear in an aggravated degree. The paroxysm of fever is more 
violent and continues longer; the remission is shorter and less per- 
ceptible. 
Phenomena of the Ilot Stage.*—1. The sensibilities, previously 
blunted become morbidly acute; pain occurs in parts not previously 
affected, and in parts where dull pain was previously felt it now be- 
comes acute. 
2. The circulation is quickened, the heart acts with increased force, 
* Dr. Francis Condie—Addenda to Watson’s Lectures, p. 502. 518 
DISEASES OF THE SANGUINOUS FUNCTION. 
throwing the blood to the periphery, from which it rapidly returns 
towards the centre. 
3. The heat-producing function is first restored, and then it speedily 
becomes excessive; intolerance of external heat is augmented. 
4. The liver, which had been torpid and inactive before the com 
mencement of the attack (see page 400), becomes more active than in 
health, producing generally a large flow of bile; but the bilious hue 
becomes deeper, “showing that the bile is again absorbed into the blood, 
or its elements largely increased. 
5. After the reaction has reached its height it gradually begins to 
abate, though in severe cases the skin remains hot and dry for a few 
hours; the action of the heart and arteries gradually subside in force 
and frequency, the skin becomes softer, and in the milder cases it 
relaxes into more or less perspiration. If this relaxation continues for 
many hours the case is considered a mild one. If it be but partial, of 
short duration, if the pulse continues frequent, (one hundred beats per 
minute in an adult), the pain in the head, though mitigated, continues 
to be felt, the fever does not intermit, but only remits, showing the 
case to be one of a more serious character than a regular intermittent. 
In the height of the exacerbation the skin is “intensely hot, the eyes 
are suffused, of a muddy, yellowish hue and often dull and languid; 
there are intense pain and a sense of insupportable weight and tension 
of the head ; aversion from light and sound is ordinarily present, and 
occasionally delirium; there are great thirst, and a feeling, often almost 
insupportable, of oppression at the chest, the respiration being quick 
and laborious, frequently regular; the pains in the back and extremi- 
ties are often of great severity; the pulse is quick, frequent, and more 
or less tense ; occasionally it exhibits some degree of irregularity ; the 
nausea and vomiting is generally peculiarly distressing—the matter 
discharged being a thick ropy fluid, of a yellow darkish brown, or green 
color; the bowels are costive, or if open, discharge with tenesmus and 
griping, a thin watery fluid: “There is always an intolerable sense of 
oppression or constriction at the epigastrium, accompanied by a degree 
of tenderness which renders the slightest amount of pressure insup- 
portable—or a severe pain and burning, attended in many cases with 
great nausea, and frequent ineffectual efforts to vomit.” There is great 
restlessness, agitation and watchfulness ; the skin becomes gradually 
brownish, bronzed, or deeply yellow, which is more particularly marked 
upon the breast; there is also a constant hawking and spitting of small 
quantities of a tough glairy mucus. 
When inflammatory bilious fever is permitted to go on for a few days 
uninfluenced by treatment, the powers of life begin to fail. The sur- 
face gradually becomes cool, and covered partially or generally with a 
cold clammy sweat; the pulse becomes smaller and weaker; the tongue REMITTENT fever. 
519 
is covered with a dark thick coating, continuing dry and chapped to a 
late stage; the respiration short, quick, and difficult; the abdomen 
sometimes remaining swollen and tympanitic ; but more frequently this 
state is reduced by dark dysenteric evacuations, which become a 
length more and more fluid; finally they are frequent, and in 
voluntary, while the patient sinks into a state of stupor, which onl} 
terminates in death. 
In remittent as in intermittent fever there is a periodical exacerba- 
tion followed by a remission; and the paroxysms, like those of ague, 
though coming every day, are most violent on every second day, In 
the milder cases the exacerbation comes on successively later, day by 
day, as the disease recedes toward the intermittent type; in more 
serious cases, instead of being postponed beyond the regular hour, the 
paroxysm anticipates it, and the case assumes more and more the fea- 
tures of continued or typhoid fever; the remissions, then, become less 
and less observable, and the disease assumes that low form which when 
protracted beyond the second week is knowTn in the West as malarial 
typhoid fever. 
2. Gastric Remittent Fever.—Characteristic Symptoms.—“Bitter 
taste in the mouth; great thirst, with craving for cool and acidulated 
drinks; frequent vomiting of a green or dark-brown fluid; total loss of 
appetite and disgust for every kind of food; great weight and anxiety 
at the proecordia; pain and tenderness at the epigastrium; intense 
pain of the loins and knees; soreness of the calves of the legs; severe 
and constant pain of the forehead; tongue coated in the centre with a 
thick layer of yellowish mucus, and red at the sides and tip; the re- 
missions are distinctly marked; bowels costive, or when discharges 
take place, these are thin and watery, often attended with griping and 
tenesmus; in the course of protracted cases the stools, not unfrequently, 
consist of a reddish fluid resembling the wrashing of meat.” In a 
later stage the “tongue becomes dry, cracked, and covered with a dark- 
brown or blackish crust; upon the separation of which, the tongue pre- 
sents a smooth, shining and red surface. In the advanced stage, there 
is often retention of urine, difficulty of swallowing fluids, meteorism of 
the abdomen;” and, in fatal cases, colliquative diarrhoea, exhaustion, 
coma, and death. In most fevers of the lower Mississippi, we have, 
first or last, irritation or subacute inflammation of the mucous mem- 
brane. In some cases it begins with the attack, in others it is to be the 
effect of common medical treatment. When it exists it becomes the 
source of the principal difficulty in the case. As inflammation becomes 
established the tongue assumes a clean dry, or glabrous and red ap- 
pearance. When there is some degree of inflammation in the perito- 
neal coats of the abdomen and intestines at the onset as well as in the 
advanced stages of all continued or remittent fevers, the slightest ten- 520 
DISEASES OF THE SANGUINOUS FUNCTION. 
derness over the peritoneum must warn us of these conditions. This 
sub-acute intestinal inflammation in the progress of fevers is often in- 
sidious in its approach. Pain or soreness is at first hardly perceptible. 
Dr. Armstrong says in this “secondary inflammation, the sensibility of 
the nervous system is mostly diminished before the occurrence of the 
inflammation.” If not checked, it rapidly progresses and speedily in- 
volves the general nervous and arterial systems. It is often mistaken 
for asthenic excitement, and every common remedial measure accele- 
rates the catastrophe. The patient dies, says Dr. Monette, “under ex- 
citement without local origin, and which we are unable to subdue.” 
When febrile irritable excitement continues more than a few days 
without apparent equivalent cause, we suspect sub-acute intestinal in- 
flammation. A doughy feeling of the abdomen on pressure will prove 
it unequivocally, whether there is much pain or not. The treatment 
must be the same as that of peritonitis. 
Of the abuse of blisters and purgatives in these cases, Dr. Monette 
says: “I have seen blisters applied to overcome irritation of the brain 
and of the general system, which would have been speedily relieved by 
a laxative, followed by an opiate in a little weak toddy. We often find 
cases of fever prostrated by a free use of purgatives or other anti- 
phlogistics, which have only acted as causes of debility and irritation.” 
These cases, he says, “require only rest, opiates and weak brandy- 
toddy, which would sustain the circulation and calm the nervous irrita- 
tion, while antiphlogistics would increase all the dangers. Calomel is 
especially pernicious; but opiates in small quantities of the milder 
preparations indispensable. The prejudice against them only applies 
to extreme doses and improper cases.” (Monette, Fevers of Missis- 
sippi. W. Med. Jour., Feb. 1840, p. 125.) 
Now these are the very cases in which we long ago found Opium an 
efficient remedy, and it was successful, because it is homoeopathic to 
the torpor of the secretions and the nervous and mental stupor which 
form the chief characteristics of these cases. 
Indications of the Tongue in Malarious Fever.—The tongue is 
the great index by which the physician estimates the pathological con- 
dition of the digestive organs, the whole mucous membrane, and to a 
great extent of the entire system. The tongue and the pulse may al- 
most be called “the two eyes of diagnosis.” The following indications 
of the tongue are the result of extensive observations. 
1. A pale moist tongue, covered with mucus indicates great torpor 
in the portal circulation, or in the coeliac; a languid circulation and 
functional torpor in the viscera of the coeliac circle, especially the sto- 
mach and liver, sometimes torpor of the brain also, with deficient men- 
tal energy. In any stage of fever in which this condition is seen, 
stimulants are borne without injury. If the ton0ue begins to REMITTENT FEVER. 
521 
show red edges, or become red and dry on its surface, whether rougher 
or smoother, all stimulants must be discontinued, and no drinks, but 
demulcents, diluents and mucilages can be allowed. The redness 
shows change from torpor to increased action and sensibility. In this 
condition irritant purgatives, Calomel and all carminative substances 
often given with it, are peculiarly injurious. 
2. White tongue, or of a natural healthy color, but covered over 
with white fur, like white powder sprinkled over it, shows less visceral 
torpor and some irritation of the mucous membrane of the stomach; 
but the free exhibition of stimulants is certain to do great injury. 
Calomel in small doses, repeated, increases the irritation which tends 
to the development of inflammation and typhoid fever. 
3. Red tongue, moist and raw, denotes extreme irritation of the mu- 
cous membrane of the stomach, almost reaching sub-acute inflammation, 
but without congestion of the viscera. When the other coats of the sto- 
mach are inflamed the tongue becomes dry and red, more intensely so at 
the edges. In this condition of the tongue, no matter what the general 
symptoms may be, no stimulating drinks or food can be borne. The 
inflammation which already exists will certainly become rapidly and 
fatally worse, if any alcoholic drinks, meats, richly seasoned food of 
any kind or spices or carminatives are allowed. Calomel in this state 
is still more injurious than in the last mentioned, and Quinine never 
fails to aggravate what appeared before as a remittent fever, exerting a 
most deleterious influence, and rendering the case far less manageable 
by proper treatment. (.Monette.) 
4. Dry, red chapped tongue.—This shows inflammation of plileg- 
masial character, affecting all the coats of the stomach or intestines 
or both. The treatment can only be that which is proper in acute 
gastritis, which see. 
5. Red, dry and smooth or glabrous Tongue.—This indicates a 
condition similar to the last, but more especially inflammation of the 
mucous membrane, differing probably in degree. The treatment is the 
same. 
6. Brown Tongue, moist and covered with thick brown fur.— 
This shows a high degree of irritation in the lower bowels, with rather 
defective action of the stomach. Here irritation has often been trans- 
ferred from the stomach and small intestines; or the lower bowels are 
loaded with sordes accumulated during a stage of torpor of the secret- 
ing organs which formed the first stage of the fever. The treatment 
must be the same as proper in colitis, as given under that head. 
Causks.—These are the same as the causes of intermittent fever. 
It is common for unacclimated persons to be attacked with remittent 
fever; and after some days to find it changed, naturally or by the in- 
fluence of treatment, into regular intermittent. After residing for years 522 
DISEASES OF THE SANGUINOUS FUNCTION. 
in a malarious region persons who have often suffered from ague are 
still liable to occasional attacks of it, on encountering too much fatigue 
or sudden exposure. But unacclimated persons would have remittent 
fever from less severe causes; and all of both classes might be subject 
to either form of malarious fever in seasons more than ordinarily sickly; 
but strangers would be likely to be more violently affected. 
Treatment of Bilious Remittent and Gastric Fevers.—The fol- 
lowing remedies will be successful in the different forms of remittent 
fever; for a given case it will be necessary to select a single remedy 
at a time according as the symptoms may be found to correspond. See 
the symptoms as given at the page referred to from each of the follow- 
ing remedies: 
When the gastric symptoms are predominant: Ipecac., Nux-vomica, 
Puls., Bry., Cham., Lobelia, Eupatorium, Veratr.-alb., Tart.-emetic. 
When the bilious symptoms predominate: Aeon., Bry., Cham., Nux- 
vom., Puls., Arsen., Coloc., Ipec., Sulph. 
When there is evident irritation of the mucous membrane of the 
stomach and bowels : Bell., Chin., Mercur., Puls., Ilhus-tox., Arsenicum, 
Cham., Cina, Dulc., Nux-vomica. 
When the symptoms denote the existence of worms : Cina, Cinnabar, 
Spigelia, Aeon., Sulphur. 
2. NON-MALARIOUS CONGESTIVE FEVER. 
Diagnosis.—The precursory stage of congestive fever is char- 
acterized by restlessness, irritability, indisposition to mental or bodily 
exertion, fatigue from the slightest exercise, vertigo, giddiness, appre- 
hension, pulse often below the natural standard. This stage continues 
from a few hours to six or seven days, when the second stage develops 
itself. 
The symptoms will now he modified in accordance with the organ 
which 'sustains the violence of the attack. If the brain be the suffer- 
ing structure, the patient will complain of headache, oppression or 
tightness in the head, pupils contracted or dilated, the ideas confused, 
the pulse slow and laboring, and finally, coma, paralysis, and convul- 
sions may supervene. 
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; uneasiness, 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 NON-MALARIOUS CONGESTIVE FEVER. 
523 
and obstructed respiration; pulse irregular or intermitting; cough; 
face and skin purple 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 ener- 
gies of the system are below the natural standard, the pulse is gene- 
rally unusually slow 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 quan- 
tities of cold water when the body is heated, insufficient clothing, im- 
proper food, severe mental or physical exertion, sudden news, grief, 
fear, depression, disappointment, mortification, &c. 
Treatment.—The remedies which have been used with most success 
in congestive fever, are, for the cerebral form, Bell., Aeon., Opium, 
Strain., Ilyoscyamus, Conium-mac., Coffea., Mosch. and Camphor. 
For the abdominal form, Ipecac., Veratr., Arsen., Nux, Cuprum, 
Mercur., Phos., Carbo-veg., Secale-cor., Rhus, Bry., Ars. 
For the pulmonary form, Bry on., Aeon., Phos., Lachesis, Senega, 
Rhus-tox., Tart.-emet., Ilyos., Ammonium-carl). 
Administration.—Congestive fevers often attack the organism sud- 
denly and violently, and if not promptly 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 reasonable time, if no effects are apparent, give a 
still stronger dose or repeat 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 pos- 
sible, 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 im- 
pressibility of the whole organism, and we can readily apply an antidote 
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 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. 
3. IRRITATIVE FEVER. 
Under this title are embraced all those cases of idiopathic fever 
which arise from causes of irritation that have nothing specific or pe- 
culiar in their mode of action. The cause maybe trifling and may only 524 
DISEASES OF THE SANGUINOU8 FUNCTION. 
induce an over-excitement of one or more of the functions. This ex- 
citement may be propagated, by nervous communication or otherwise, 
to different parts of the system, and throw all the functions into a state 
of derangement which will be capable of sustaining itself for a longer 
or shorter time after the direct cause of excitement shall have ceased 
to operate. The fever does not depend, like the phlegmasiae upon 
the continuance of any local disease ; but, having been once excited, it 
it goes on by independent action to its natural termination. ( Wood.) 
This termination may be reached in a very few hours, or may be post- 
poned for several days; but when the disease runs on beyond the 
fourth or fifth day, it is generally attended by local inflammation, 
which will be most frequently found in the stomach and intestines. 
For the Irritative Fever excited by Dentition, see page 227. 
The treatment of Irritative Fever may be generally restricted to the 
removal of the exciting causes. The remedies ordinarily needed will 
be found at pages 228 and 525. 
This is a disease peculiar to childhood and is usually caused by the 
use of unhealthy and indigestible food, the irritation of teething, worms, 
repelled eruptions, sudden drying up of ulcers, discharges, &c. The 
affection is characterized by prominent disorder of the stomach and in- 
testines, in most instances, but occasionally the brain or lungs seem to 
he 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, rest- 
lessness, thirst, and wandering pains in the back, bowels and limbs. 
When the hot stage is fully developed, the patient refers most of his 
sufferings to the stomach and intestines; they become painful, tender 
upon pressure, and there is either obstinate constipation or diarrhoea. 
The evacuations are usually darkish, offensive, and indicative of a de- 
ficiency of bile. When the disease is concentrated in the stomach, 
there is burning thirst writh 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 without the aid of appropriate remedies, lesions will occur 
in the digestive tube, or disorder of the brain or lungs will be likely to 
supervene. 
Causes.—Undue exposure to cold, sudden change of temperature, 
improper food, worms, teething, repelled eruptions, abrupt suppression 
of accustomed evacuations, and the injudicious use of irritating medi- 
cines. 
4. INFANTILE REMITTENT. INFANTILE REMITTENT. 
525 
Treatment.—The remedies suitable for the treatment of this affec- 
tion are in the first stage the higher dilutions of Aconite, followed by 
those medicines 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 ad- 
vantage ; Ipecacuanha, Gina, Chamomilla, Mercurius, Belladonna, 
Arsenicum, Pulsatilla, Nux-vomica, Sprig elia, Sulphur. 
Since in most instances the gastro-intestinal mucous membrane is the 
seat of the malady, it will be necessary to make a free use of Ipeca- 
cuanha, Merc., Pulsatilla, Nux, Cham., Calcamara. Should the brain 
or lungs become involved, Belladonna, Bryonia, Nux, Opium and 
Stramonium will prove efficient remedies. 
Dr. Drysdale has found this fever, as it occurs in England, exceed- 
ingly intractable, notwithstanding the most assiduous care and atten- 
tion on the part of both physician and friends. In children of scro- 
fulous constitutions, it has been known to persist for months, in spite 
of every remedial measure. In cases of this description, he advises 
Sulphur, Calcarea, Arsenicum 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 perspiration, &c., serve to de- 
velop the affection. In instances of this kind, Aconite, Belladonna 
and Chamomilla are peculiarly appropriate remedies, and will gene- 
rally 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 twrelve hours, until every sign of undue irritability has 
disappeared. Hartmann commends a few doses of Coffea-cruda, or of 
Calcarea-ca/rbonica, 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 irritability; loathing of food; dark, yellow, slimy, or 
green diarrhoea, we may give a grain of the third trituration of Ipeca- 
cuanha, or a drop of the sixth dilution of Chamomilla, once in two 
hours, as long as is deemed necessary. 
If the disease is still farther advanced, and the countenance has as- 
sumed 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 pain in the stomach and intestines; thirst; 526 
DISEASES OF THE SANGEINOUS FENOTION. 
constant nausea ; the smallest quantity of food or drink, increasing the 
burning and distress, until they are rejected; watery diarrhoea, with 
smarting and tenesmus ; great prostration; frightful dreams; anguish 
end 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 tea-spoonful 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, or the slightest noise; with 
flushed cheeks; red, glistening and protruded eyes ; hot head ; constant 
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 ; dilatated or contracted pupils ; short and oppressed respiration, 
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 constipation, frequent 
desire to urinate; burning heat of the whole body; morning exacer- 
bations ; rigidity of the limbs; or drawing, contractive sensations 
through the body; occasional spasms; frequent trembling both when 
sleeping and after an exertion; shudderings and chills from the least 
contact of cold air; great sensitiveness of the whole body; unpleasant 
symptoms often excited by motion of contact; and indications of gastric 
or bilious disorder, wre may employ Nux-vomioa, at the twelfth dilution 
—a drop in water, every two, three or four hours, as circumstances re- 
quire. 
When the malady has been caused by the irritation of worms, it will 
be necessary to use Cina, or /Sjpigelia. These medicines may be em- 
ployed at the third attenuation, and a dose given three times daily un- 
til the morbid disposition of the alimentary canal is corrected. 
Bi'yonia is applicable in cases attended with disorder of the pul- 
monary 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; alter- 
nating 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. SPOTTED FEVER. 
527 
If the attack is attributable to abuse of fat, crude and indigestible 
food, and is accompanied with prominent gastric derangement, Pulsa- 
tilla should be employed at the sixth dilution—a drop every four hours 
until the disturbance is corrected. 
5. CEREBRO-SPINAL MENINGITIS.—SPOTTED FEVER. 
An epidemic known by the above names is prevailing at this time in 
some portions of the United States and is regarded as the same disease 
as was so extensively fatal in the years 1812—14, and again in Vir- 
ginia in 1822. In more recent times, it appeared in Michigan during 
the winter of 1848—1849, and caused a large number of deaths in 
various places in that state. It was generally regarded as a typhoid 
congestive fever, and was treated with exciting stimulants on the sur- 
face, and muriated Tincture of Iron and Cantharides Tincture internally, 
aided by concentrated food of a stimulating nutritious character. Es- 
sence of beef and egg-nogg were favorite articles. 
The present epidemic presents the same general features as it has 
appeared in different parts of the country. It has hitherto generally 
baffled the efforts of physicians, and proved fatal in a few hours. 
Symptoms.—It commences with a chill, which had not been antici- 
pated by any premonitory symptoms. The patient thinks he has the 
ague, and expects the cold stage to be followed by the usual degree 
of fever. Instead, however, of the common reaction and development 
of heat on the surface the chilly condition and the shrunken appear- 
ance of the skin and features continue for a long time ; and the patient 
gradually sinks into a state of stupor from which he rarely revives. 
In the course of a few hours the muscles are observed to be rigid; 
the pupils of the eyes become insensible either to light or touch; the 
surface of the body becomes extremely sensitive to the touch ; the 
head is drawn back, the jaws fixed ; the breath is drawn forcibly, with 
a hissing sound, as if by great effort through the closed teeth ; the 
patient is blind and deaf. In children, the stupor is liable to be 
broken by frequent convulsions. As the disease progresses the stupor 
increases ; large dark spots rise upon the skin, some of them proceed- 
ing to form blisters. In some cases the patient lingers for some days, 
during which all the nerves of sensation, and those of motion belonging 
to the lower extremities, are paralyzed, and he is both deaf and blind. 
In some cases there is a partial revival from the stupor, and apparent 
convalescence begins; but in only an hour or two a fearful delirium 
follows; the stupor becomes gradually more profound than ever, and 
death speedily ensues. In the few cases in which recovery takes place, 
it is only after a protracted course of typhoid fever; and paralysis, 
loss of sight, or of hearing is generally permanent, if not remedied. 
Case.—A boy, aged fifteen, was suddenly attacked by a chill in the 528 
DISEASES OF TIIE SANGUINOUS FUNCTION. 
forepart of the day, and having the usual symptoms of a common form 
of ague, excited little attention ; as several hours passed without re- 
action, the family became alarmed, and a physician was called, who ar- 
rived about 11, p. m. The boy was then lying in a state of partial 
stupor, from which he could be easily aroused to answer questions; 
there was hurried breathing ; flushed face ; pulse imperceptible; hands 
quite cold; head slightly thrown back; muscles of the neck some- 
what rigid; pupils dilated; limbs and body covered with large spots, 
some of which were red and others purple or black; a few of the black 
spots elevated and resembling blisters. No reaction could be excited 
by the strong stimulants used, and the boy died in a short time; the 
face after death turned quite black. 
In the same manner it is common for death to result upon the full 
development of the cold stage, no reaction following, except when 
brought about by stimulants. The characteristic symptom is the ap- 
pearance of spots on the skin which give the popular name of “spotted 
fever.” If the patient lives through the first stage of prostration, 
fever succeeds, which is of a strongly-marked typhoid character; there 
is then hurried breathing; pain in the back and head ; flushed face of 
a dark, red, or purplish hue ; tongue dry and brown or black; stupor 
and delirium ; in nearly all cases there is evident disease of the spine. 
Causes.—Cerebro-spinal meningitis is not a contagious disease, but 
depends remotely on a peculiar epidemic influence not yet understood. 
In the localities in which it has prevailed, it evidently has manifested 
its power in places where the common autumnal intermittents and re- 
mittents have already debilitated the constitution in most of the in- 
habitants ; and then it selects from them such as are in a peculiar 
state of predisposition to be attacked by violent disease from any 
common cause. Such are the persons who, in other seasons in the 
same localities, are liable at almost any time to be suddenly over- 
whelmed by a congestive chill from which there may be no recovery 
or return of consciousness. 
Pathology.—The pathological features of this disease can not be 
distinguished from those of congestive intermittent. There is the same 
adynamic condition of the patient previous to the attack, and the same 
organs are involved in the congestion. In cerebro-spinal meningitis 
there is generally a more complete concentration of the morbific in- 
fluence on the brain and spinal column; and in the cases that live 
through the first stage these structures are the seat of inflammation, 
which becomes permanent instead of giving place to a new cold 
stage. 
Treatment.—This must be conducted on the same general principles 
as we are governed by in congestive intermittent. During the parox- IDIOPATHIC TYPHOID. 
529 
ysm the reaction will be brought about by the same measures as are 
employed to remove a congestive chill. 
General Remedies.—The following remedies have been used with 
success: Aconite, Bell., Arsenicum, Nux-vomica, Cantharides, Opium 
China, Bryonia. 
Brandy.—For the purpose of supporting the vital powers, and pre 
venting threatening collapse, or for arousing the system from that state, 
it is a universal practice to give Brandy; and this is generally done 
without much regard to the quantity that may be required. In general, 
small doses may be safely tried and the effect observed. When it is 
truly indicated, its homoeopathicity to the case is evidenced by its 
soothing and restoring influence ; and it is observed to quiet the irritated 
stomach, calm the excited brain, and render the pulse stronger and 
slower. It acts unfavorably when it causes nausea, pain in the stomach, 
headache or symptoms of intoxication. 
Malignant Double Tertian of the Mississippi.—A severe parox- 
ysm of chill at ten in the morning and a light one at four, p. m. on the 
following day. Some patients die in the first cold stage, sinking imme- 
diately into fatal collapse ; and few survive the third chill without very 
active treatment has preceded it. In many cases the stomach and 
bowels take on a choleric action. Some after one or two convulsions 
sink into profound coma, and in these cases, where there is a show of re- 
action, it is feeble, irregular and terminates in icy coldness of the skin 
the tongue moist, very pale and clean, or covered with a blue moist 
fur; little thirst. For Treatment see Congestive Intermittent. 
This “sinking chill” has been mistaken for Armstrong’s congestive 
typhus, but they are antipodes in pathological condition. {Dr. Ilogg, 
Wmerx of Natchez. &cd 
6. Idiopathic Typhoid Fever of the South- Western States. 
Diagnosis.—Typhoid Fever. 
More insidious in its approach 
than typhus. 
Color of the eruption is different. 
Diarrhoea and intestinal haemor- 
rhage are common attendants. 
Expression of countenance that 
of intense anxiety. 
Complexion clear, flush of bright 
pink. 
Typhus. 
Often seen at New-Orleans in 
the winter-months. 
Initiatory stage more brief. The 
patient yields immediately to pros- 
tration. 
Never present in typhus. 
Expression stolid, apathetic, 
amounting almost to idiocy. 
Complexion thick, and flush of 
a dark, dusky red color. 
Treatment.—In the initiatory stage, Dr. Kellogg succeeded with a 
few doses of Bryonia in the morning and Nux-vomica at night. 
Yol. i.—34 530 
DISEASES OF THE SANGUINOUS FUNCTION. 
Second Stage.—Arsenicum and Rhus-tox. the chief remedies. These 
remedies with Belladonna, Bryonia, and China were always successful, 
with no other aids than occasional sponging with cold water. 
Bilious Typhoid Fever.—Phosphoric-acid.—Dr. Pearson, of Mt. 
Pleasant, Iowa, gives a case: A young man, aged nineteen, having 
been sick ten days and abandoned by his physician as incurable. 
Symptoms :—wild, muttering delirium, talking incoherently; in- 
ability to articulate distinctly, or to protrude his tongue, which was 
dry, covered with a dark fur, and tremulous; pulse weak, one hundred 
and fifty per minute; extremities cold ; diarrhoeic stools, which wTere 
passed involuntarily. 
Phosphoric-acid, 12°, four drops in four ounces of water, two tea- 
spoonfuls every two hours. In twelve hours improving; pulse one 
hundred and twenty, bowels better. There was then gradual improve- 
ment, so that in forty-eight hours consciousness was restored and the 
diarrhoea had entirely ceased. Recovered in less than three weeks. 
Took only Phosphoric-acid, 12°, Bryonia, 12°, and Rhus-toxicodendron, 
12°. 
A similar case which -was regarded as an extreme one, was treated 
in the same manner. A girl, aged thirteen years, thoroughly drugged 
by two physicians, under whose care a sister had died, presented all 
the symptoms of typhus in the worst form : unconsciousness, involuntary 
diarrhoea; pulse weak, and one hundred and fifty per minute. This 
case was cured by the above remedies at the thirtieth attenuation. 
An obstinate cough, threatening consumption, remaining after recovery 
from the fever, required Sulphur and Iodine, 200°, in alternation every 
four hours. Four months after the last visit it was “impossible to re- 
cognize in the healthy looking girl, the slightest resemblance to the 
emaciated patient previously treated.” Dr. Pearson says : “Phosphoric- 
acid is the only medicine I hav§ ever found capable of making a speedy 
impression on the pulse in this disease; and whoever prescribes it be- 
low the 12th°, and continues to repeat it often, will run the risk of 
losing his patient. These conclusions cannot well be called hasty, 
since years of experience have amply confirmed them.” Some diseases, 
both acute and chronic, appear to require for their successful treat- 
ment medicines as high at least as the twelfth attenuation. Among 
the former are some cases of typhoid, typhus, and lung fevers. 
Genus V. —ENECIA 
CONTINUED FEVER. 
In this division of fevers may be included those arising from func- 
tional derangement, from inflammation, from congestion, typhus, dec continued fever. 
531 
1 FEVER FROM FUNCTIONAL DERANGEMENT. 
Diagnosis.—This is generally the mildest and least dangerous of ali 
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 increased action 
of the heart and arteries, dry and hot skin, thirst, furred tongue, scanty 
and high-colored 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 immediate convalescence ensues; but if 
it be allowed to continue unopposed, although it occasionally subsides 
spontaneously, it generally terminates in one or the other forms of con- 
tinued 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. 
Treatment.—Aconite, from the first to the third dilution, if ad- 
ministered early, is sufficient to cure most cases of this form of fever; 
but if the disorder is neglected until inflammation or congestion oc- 
curs in some structure, then those medicines which operate specifically 
upon the parts affected, are to be employed, selecting those, of course, 
the pathogenetic symptoms of which cover the most perfectly those 
of the malady. 
Diagnosis.—In this form of fever the general symptoms, as hot and 
dry skin, rapid and full pulse, dyspnoea, 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 membranes of the brain, 
the face becomes flushed, the eyes red and sparkling or protruded, 
staring, and distorted, the carotids throb violently, pupils contracted 
or dilated, expression unnatural, furious delirium, pulse full, rapid, and 
finally, if the disorder progresses, sopor, muttering delirium, subsultus 
tendinum, and convulsions. 
If the disease attacks the lungs, we shall have rapid, anxious and 
'.oppressed respiration, shooting pains in the thorax, troublesome cough 
with difficult expectoration, 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 
2. FEVER FROM INFLAMMATION. (SYNOCHA.) 532 
DISEASE OF THE SANGUINOUS FUNCTION. 
peculiar to inflammation of this tissue, as nausea and vomiting, pains 
in the bowels, increased on pressure, tongue red, countenance expres- 
sive of anguish, thirst, bowels hot and swollen. 
Causes.—Atmospheric vicissitudes, extremes of cold or heat, errors 
in diet, and over-exertion. Inflammatory fever often succeeds neglected 
or mismanaged fevers from functional derangement, especially in cases 
where some organ has been previously debilitated, and in this manner 
rendered susceptible to inflammatory action. Indeed, it is probable 
that inflammations 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 func- 
tional derangements. Whenever, therefore, any structure of the or- 
ganism is in a state of unnatural irritation or debility, this constitutes 
a powerful predisposing cause of inflammatory fever, which only re- 
quires some farther morbific influence to ensure its full development. 
Treatment.—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 ac- 
tion of the heart and arteries, and is, therefore, particularly appro- 
priate in those cases distinguished from the first by full and rapid 
pulse,'hot and dry skin, thirst, &c. 
In those instances where cerebral disorder predominates, Bella- 
donna., Opium., and Stramonium will be found essential in the treat- 
ment, either alone, or in alternation with Aconite. 
If the pulmonary tissues are inflamed, suitable remedies may be found 
in Bryonia, Tartar-emetic, Ipecacuanha, and Phosphorus. 
For gastro-enteritic inflammation, recourse must be had to one or 
more of the following medicines, viz.: Merc., Mux., Ipecac., Pulsa- 
tilla, Dulcamara, Chamomilla, Arsenicum, and Veratrum. 
Administration.;—In the selection of remedies much depends upon 
the age, sex, temperament, as well as the peculiarities of each parti- 
cular case. For children and adults who are very impressible, we ad- 
vise 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 pre- 
scribed beforehand; every thing must of necessity depend upon the 
nature and violence of the disease, and the effect which each particular 
dose produces. 
Gelseminum.—Fever resulting from atmospheric changes; or follow- 
ing sudden check of perspiration. 
Symptoms.—General irritability, confusion of head and flying pains; 
soreness of the throat; irritation of the nasal passages; heat of face, INFLAMMATORY FEVER. 
533 
with injected conjunctiva; painful cough; cerebral headache, with a 
full, crowded sensation, worse in forehead and temple ; pain in back and 
limbs ; resembling lumbago ; soreness of muscles; chills, increased by 
movement; skin dry and hot to the feel; restlessness ; pulse accelerat- 
ed, full and bounding; thirst and sleepnessness. A drenching per- 
spiration often follows a dose of the third or twelfth attenuation, with 
long continued sleep; and the patient arouses, relieved of all his suffer- 
ings, except a feeling of prostration. Appetite deficient. 
Mercury in Inflammatory Fever.—Mercurial fever is described by 
Dieterich as a form of fever “ which comes on a few days after the use 
of large doses of Mercury, characterized by great restlessness, dryness 
of the mouth, headache, loss of appetite, nausea, hot and dry skin, quick 
pulse, red gums, and swollen tongue; it usually terminates in a critical 
discharge (as profuse salivation, purging or sweating). (Pereira, Mat. 
Med. Yol. I. p. 815) states that, during salivation by Mercury, the 
blood, when drawn from a vein, puts on the same appearances as it 
does in inflammatory diseases. Druitt thus describes mercurial fever: 
“ Increased heat; preternaturally frequent, hard and vibratory pulse ; 
pain and aching in the head, back and limbs, with a sense of lassitude 
and weakness; general deficiency of the secretions; dry and white 
tongue; thirst, nausea and loss of appetite ; the blood generally buffed 
and cupped.” {Surgeon's Vade Mecum. p. 5, Druitt.) “ As the fever 
declines, if a favorable termination occur, the system not uncommonly 
relieves itself by a critical evacuation;—from the skin, by abundant 
acid perspiration; from the kidneys by the free deposition of lithates 
in the urine.” (Erichsen, Science and Art of Surgery, p. 18.) “ The 
preparations of Mercury act as direct antiphlogistic agents, lessening 
the quantity of fibrin in the blood, and equalizing the circulation.” 
{ibid. p. 17.) Dr. Pereira says, Mercury is used “ in inflammation 
most successfully, and this mineral is hence named an antiphlogistic; 
but its curative power is not satisfactorily accounted for by the equali- 
zation of the circulation, the augmentation of the secretions, or the in- 
creased activity of the absorbents.” {Mat. Med. Yol. I. p. 826.) 
Typhoid and Typhus Fevers, from the effect of Mercury, are thus 
decribed by Mr. Pearson and by Mr. Dieterich, under the name of 
“ adynamic mercurial fever.” “ It is characterized by great depression 
of strength, a sense of anxiety about the praecordia, frequent sighing, 
trembling, partial or complete, a small, quick pulse, sometimes vomit- 
ing, a pale, contracted countenance, and a sense of coldness. When 
these symptoms are present, a sudden and violent exertion of the animal 
power will occasionally prove fatal.” Dr. Christison states that Mer- 
cury produces an eruption of purple spots. {On Poisons, Christison, 
p. 407.) 
Typhus and typhoid fevers commence very similarly to inflammatory 534 
DISEASES OF THE SANGUINOUS FUNCTION-. 
fever, but, instead of terminating in a critical discharge, increase in 
severity; and the essential symptoms are great prostration of strength, 
tendency to death, frequent, soft and compressible pulse, a pale, death- 
like countenance, dry tongue, and the eruption of a mulberry rash in 
typhus,—in typhoid, of rose-colored spots. Dr. Pereira has several 
times used mercurials as siliagogues in fever, and for the most par 
with advantage. [Mater. Med. Yol. I. p. 825.) Dr. Copland says, his 
impression is that death after salivation has been established is very 
rare. [Diet. Pract. Med. Yol. II. p. 929.) Dr. Macartney has never 
known it fail in arresting the progress of the disease, “ provided the 
fever be not combined with visceral affections, or characterized from the 
beginning with unusual prostration of strength.” [Treatise on Inflam- 
mation., p. 162.) The grand genus of Continued Fevers has been 
extended to embrace all the Diseases of Irregular Febrile reaction. 
The reaction is sometimes intense, and may be promptly arrested, 
and subject to a thousand aberrations, as if the vital forces obeyed the 
toxic cause, which is invisible hut powerful. 
In these diseases the whole organism is affected, and at the end of a 
certain preparatory period, the affection manifests itself either upon 
the skin, or upon the mucous membrane, in an appreciable pathological 
product; the pathological product consists either in an eruption, a 
ganglion or flux. 
The blood in all of these diseases suffers a profound alteration, a 
veritable decomposition, as has been well demonstrated by Prof. Andral 
and others. 
This grand genus of Febrile diseases is divided into two groups. 
Enecial Fevers. 
Typhus. 
Typhoid fever. 
Plague. 
Yellow fever. 
Typhoid pneumonia. 
Hectic fever. 
Eruptive Fevers. 
Small-pox. 
Measles. 
Scarlatina. 
Urticaria febrilis. 
Sudor Anglicus. 
Anthrax. 
Pertussis. 
Each of these diseases is the product of a peculiar infection, of a 
poisoning of the organism, of a profound alteration of the animal sub- 
stance effected by a specific miasm or virus. The precise nature of 
these infections may not be perfectly known; but their effects are 
sufficiently characteristic to enable us to select the proper remedies in 
individual cases. 
Each of these miasms is capable of producing a specific disease in a 
healthy person, even though he be living in accordance with the best 
of ordinary hygienic principles. Of the general characteristics of these 
diseases which manifest themselves in every case, a few are: DISEASES OF IRREGULAR FEBRILE ACTION. 
535 
Profound alteration of the fluids of the body, before they pro luce 
appreciable local lesion. 
Depression or sometimes complete prostration; sometimes an aber- 
ration of the febrile reaction which seems to be controlled by a more 
powerful morbid force. 
This deleterious agent controls, masters, crushes; destroying in 
few days the most vigorous constitutions, and at other times sparing th 
most delicate. 
The susceptibility of the patient to remove the impression of the 
poison varies in different persons, depending on some idiosyncracy, 
some peculiarity of the constitution, or some previously existing state 
of health. From the instant that the morbid leaven begins to operate 
the physiological laws are entirely changed. The vital reaction ceases 
to be a safe-guard to the organism. The curative effects of nature may 
be aided, but they are too feeble to be trusted. Our whole dependence 
must be upon specific remedies. 
The effects of some specific poisons on the organism exposes to us in 
a partial degree the nature of the virus that causes these fevers. 
There is some resemblance between the plague and the bite of the 
viper:—between yellow fever and the bite of the Lachesis-trigono- 
cephalus, and also of the Rattlesnake;—between vaccine and small- 
pox;—between poisoning by White Hellebore or preparations of Copper 
and cholera ;—between the effects of small doses of Arsenic and typhoid 
fever. 
The affinity and intimate relations which unite the exanthematous 
wTith the typhoid and pestilential group of fevers may be seen in many 
of their characteristic features ; thus : 
In the exanthematic fever the eruption is sometimes insignificant; 
and we often see in typhoid fevers the skin covered with vesicles or 
papillae ; and in cholera there is a constant alteration of Brunners 
follicles. 
The confluent small-pox, and typhus offer a very similar lesion of the 
intestinal glands. Rapou says, in one case the characteristics of typhus 
and small-pox were so blended that he could not distinguish between 
them. (Rapou on Typhoid Fever.) 
The consecutive fever of cholera is a true typhoid fever; and cholera 
is also accompanied by sweat. We remember a case during the epi- 
demic of 1834, where there was profuse perspiration from the beginning 
of the disease till death, and there was no other symptom observable 
neither diarrhoea or vomiting. 536 
DISEASES OF THE SANGOTNOUS FUNCTION. 
3. 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 exhalations of animal or 
vegetable matters in a state of putrefaction, (Dewees, Bancroft, &c.) 
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 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. (Nathan Smith, Mackintosh, &c.) 
Some suppose it contagious, and others non-contagious. 
The word Typhus was originally used to denote a fever, the promi- 
nent feature of which consisted of a state of stupor,—or, more correctly, 
a disease that “ burns with a concealed and smothered flame.” It ap- 
pears to belong exclusively to the North temperate zone, and even here 
it avoids extreme latitudes. As yellow and intermittent fevers occur 
in warmer climates and near the level of the sea, so typhus fever and 
those resembling it have their base in a high latitude, and at a greater 
elevation. Typhus fever is seldom seen far beyond the parallel of 45° 
North. It is neither seen among the fur-stations of the Hudson’s Bay 
Company, nor among the Esquimaux in their unventilated snow-huts. 
In Western Europe it prevails between the parallels of 44° and 60° 
North. In Siberia it has not been observed; it decreases with eleva- 
tion, and to this cause has been attributed its absence from the hospital 
at Madrid, 1995 feet above the level of the sea. It occurs in every 
season, but is most prevalent in autumn and winter. In most of the 
cities of Europe typhus has become endemic, and it has never been ab- 
sent from Vienna since the wars of the first French empire. It oc- 
casionally spreads as an epidemic, extending to distant continents. In 
New-York it has appeared, after crossing the Atlantic, in 1818,1827, 
1828, 1837, and 1846-1847. In the last-named year 1396 died of 
typhus, and 657 of dysentery in the hospitals, generally of a typhoid 
character. In one year 239,480 immigrants arrived in this country; 
bringing the fever with them in crowded and ill-ventilated ships, and 
carrying it into the tents and hovels which became their first homes in 
America. Some vessels had lost from thirty-five to one hundred 
on the passage. Of 100,000 persons who left the British Isles in one 
year, 5000 died at sea, 3389 at Grosse Isle ; the whole number of 
deaths being more than 40,000. (Report to Amer. Medical Associa- 
tion. 1848.) 
Of the 160,134 immigrants of the year 1847, who landed at New- 
York, 5,277 fever patients were admitted into the marine hospital at TYPHUS, 
537 
Staten Island, and 662 died. The whole number of deaths from typhus 
that year at the quarantine hospital and in the city of New-York was 
estimated at scarcely less than 2000. 
During the Crimean war, typhus fever commenced in the French and 
ussian armies in the summer of 1855 ; and soon after the capture of 
Sebastopol (in September) it began to assume an epidemic character. 
“From that time till May, 1856, it ravaged the armies of the Crimea 
with a fury unknown since the great epidemics of the imperial wars.” 
[Report on Diseases of the Army of the East. 1856.) 
Respecting its nature and seat, it has had the honor 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 Broussais, of France, made 
the discovery that its place was the gastro-intestinal mucous membrane, 
and that Hippocrates, Galen, Celsus, Stahl, Boerhaave, Cullen, Hoff- 
mann, Brown, and other authors, had been laboring under a succession 
of errors, upon the subject for more than two thousand years. Still 
later, some theorists have found out that its position is in the brain and 
nervous system; while a few very 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 respect- 
ing it. One class of medical men suppose it to be a disease affecting 
principally the brain and ganglionic system of nerves. Another class 
suppose its action to be in “ the mucous membranes and lymphatic 
glands, especially those of the ileum, whence it has been termed typhus 
abdominalis.” {Hartmann.) 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 confuted, be- 
cause 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 pos- 
sesses. 
The malady assumes different characteristics according to the pre- 
disposition of the individual when exposed to the influence of the con- 
tagion. If his system has been debilitated by over-exertion of body or 
mind, by grief, care, misfortune, disappointment or shame, the brain 
and nervous system will be prominently affected, and we shall be pre- 
ented with that variety termed cerebral typhus. 
Should the stomach and intestines happen to be in a state of irri- 
tation and debility when the contagion is absorbed, they will receive 
the impression, and we shall have what is denominated abdominal 
typhus. 538 
DISEASES OF THE SANGUINOUS FUNCTION. 
If the organ predisposed be the lungs, the morbific agent will spend 
its effects at this point, and pneumo-typhus be the result. 
So long, however, as the whole organism remains in a perfectly sound 
and vigorous condition, with the mind cheerful and moderately active, 
it will be able to resist the influence of the miasm, and in all probabili- 
ty escape the malady. The law is fundamental and cannot be too 
often inculcated, that just in proportion as the organism, or any part 
of it, diverges from the normal standard, in the same ratio will the sus- 
ceptibility of such affected structures to morbific or remedial influences 
be increased. 
Diagnosis.—The symptoms -which appear at the commencement of 
typhus, are: lassitude, debility, sense of fatigue, impaired memory, 
slight chills, alternating with flushes of heat, dull pains in the head, 
back and limbs, loss of appetite, and melancholy. These symptoms 
often continue one or two weeks, the patient not feeling sick enough to 
take his bed, or sufficiently well to attend to his occupation, when he 
becomes more restless during the night, delirium sets in, he is obliged 
to keep his bed from debility, his tongue, which was at first coated 
with a thin, white fur, becomes dark, dry, and cracked, and as the dis- 
ease advances, the old fur passes off, leaving the surface red, glazed, 
and dry. As the disease progresses, the eyes become suffused, the 
countenance loses its natural expression, the muscles are weak and 
tremulous, a viscid saliva is secreted, which collects and dries upon the 
lips and teeth, the surface acquires a dingy color, there are subsultus 
tendinum, defective vision, partial loss of hearing, a tendency to slide 
down to the foot of the bed, involuntary discharges from the bowels 
and bladder, picking at the bed-clothes, low muttering delirium, and, 
finally, coma, convulsions and death. 
The symptoms and course of the complaint will, of course, be modi- 
fied in accordance with the severity of the attack, the part affected, 
and the plan of treatment pursued. 
If we may be allowed to judge from the opinions which have from 
time to time been expressed by some of the eldest, most experienced 
and distinguished members of the old school, upon this subject, we will 
say, that the course of treatment ordinarily recommended and pursued 
by allopathists, is productive of far more injury than benefit in typhus. 
In proof of this we quote from the work on typhus fever, by Prof. 
Nathan Smith of Yale College, published 1831. 
After commenting upon the various contradictory methods of treat- 
ment advised by different authors, as the antiphlogistic, stimulant, tonic, 
derivative, &c., he says: “I am clearly of opinion that we had better 
leave the disease to cure itself, as remedies, especially powerful ones, 
are more likely to do harm than good.” TYPHUS. 
539 
In another place he declares, that “ the use of powerful means, with 
a view of curing; this disease is liable to do great mischief ” 
O O 
These are the matured sentiments of a man who was not only a man 
of books, but who enjoyed an immense practice in several of the dif 
ferent New England States for a period of more than forty years 
Many other, more recent authors have avowed similar views, and al 
though they do not yet admit the truths of the new law and principles 
of cure, they entertain an entire lack of confidence in the therapeutical 
doctrines of the old system, so far as typhus, as well as many other 
maladies are concerned. It may, then, with much propriety be affirmed, 
that serious injury is often inflicted in typhus by allopathic treatment, 
and that many of the symptoms above enumerated are aggravated, if 
not actually superinduced by blood-letting, counter-irritants, and power- 
ful drugs. For the distinguishing characteristics of typhus and typhoid 
see Typhoid Fever.—Diagnosis. 
Causes.—The presumption is very strong that the cause of typhus 
is a specific agent, sui generis, and that it is set free from the animal 
body during the course of a fever, or when a number of individuals are 
crowded together in close, filthy, and ill-ventilated apartments. This 
specific poison rarely, if ever, makes a serious impression, unless the 
organism is previously predisposed to its influence. When all of the 
organs are in a normal condition, and operate in a healthy manner, an 
equilibrium is maintained throughout the system which enables it to 
resist the action of noxious agents. The ideas which we have here 
advanced in regard to the specific nature of typhus-contagion, were 
maintained by a number of medical men many years ago. Amongst 
whom there may be named Dr. Smith, of Conn., who gives the fol- 
lowing reasons in support of this opinion: “ On the Connecticut river, 
for two-hundred miles from north to south, and on all its tributary 
streams on both sides, for a hundred miles in width, there has been no 
instance of any person’s having contracted the intermitting fever, from 
the first settlement of the country to the present time; and yet the 
typhus-fever has prevailed, more or less, in every township within that 
tract of country.” 
If, as many writers assert, the miasms of intermittent, yellow, and 
typhus fevers are analogous, should we not constantly witness these 
maladies running into each other, or assuming indiscriminately these 
different forms in the same location ? But a still stronger reason is ad 
duced by Dr. Smith in support of his position; he asserts that “there 
is a remarkable odor arising from a person affected with typhus, so 
peculiar, that I feel assured, that upon entering a room blindfolded, 
where a person has been confined for some length of time, I should be 
able to distinguish it from all other febrile affections. This is an addi- 
tional circumstance in favor of the existence of the specific cause 540 
DISEASES OF THE SANGUINOUS FUNCTION. 
assigned above, as several other diseases which arise from contagion 
are attended by an odor peculiar to each, which, when once fixed in 
the mind, enables a person to recognize their presence ever after 
This is strongly evinced in small-pox, measles, malignant sore 
throat, &c.” 
It is also a fact worthy of note that typhus-fever was entirely un- 
known to the savage tribes of America previous to the settlement of 
the whites; and even at the present time, those bands which have not 
been contaminated by the civilizing aggressions of the usurpers of the 
soil, but continue their wild, roving, active and simple modes of life, 
are not at all subject to this fever. The moment, however, they for- 
sake their simple and primitive customs, and adopt our dissipated and 
enervating habits, enclosing themselves in close, ill-ventilated, and 
heated apartments, drinking of spirituous liquors, using freely of con- 
diments, tobacco, tea, coffee and rich, greasy and indigestible food, 
they become affected with contagious and miasmatic disorders, and 
often die in great numbers. This fact goes to prove that typhus is a 
disease pertaining exclusively to civilized life, and that it requires the 
unnatural and artificial customs and habits of the white race to ensure 
its production. 
Typhus originates in circumstances tending to impair the essen- 
tial or vital properties of the blood, more especially over-crowding, de- 
fective ventilation, insufficient nourishment, and hence its prevalence in 
times of scarcity and famine. Its accession is marked by no special 
symptoms, but such as occur in many acute diseases : chilliness, alternat- 
ing with heat of skin; quickened pulse succeeded by muscular pros- 
tration ; more or less sensorial disturbance; and between the fifth and 
eighth day, a peculiar morbillous-like eruption not fading on pressure, 
and persistent—the duration of the fever being about fourteen, seldom 
exceeding twenty-one days. In fatal cases, there is no specific lesion, 
congestion of the internal organs being the only change observed. If 
there be other lesions they are superadded or accidental. (Tweedie.) 
Typhus is pre-eminently the type of a blood-disease; the fever-poi- 
son acting primarily on the blood, and leaving, after death, little trace 
of structural change ; prevailing extensively as an epidemic; and when 
once established from whatever cause it may have been induced, it 
spreads by contagion, regardless of age, sex, or local circumstances. 
But, as the constituents of animal and vegetable substances are so 
nearly identical, it has been supposed that the typhus-poison may also 
arise from vegetable decomposition in close and heated apartments. 
Of one thing we may be assured respecting both animal and vegetable 
matters: that when decomposition occurs in dark, damp, and confined 
places, a far more active and virulent miasm is generated, than when 
the same substances undergo transformations in the open air. TYPHUS. 
541 
The effect of crowding men together in close quarters, badly ven- 
tilated, has been shown on a large scale in India. At one time the 
English government held in confinement 40,000 of the native Hindoos 
of whom from 4,000 to 10,000 died every year. The average mortality 
by crowded and unventilated barracks in the English army has some- 
times been enormous, as at Barrackpore, where the number of deaths 
from fever and cholera seldom fell short of one-tenth of their whole 
number; while officers and other inhabitants who lived in well-ventilated 
houses, did not find the place particularly unhealthy. Among the 
marching regiments, the soldiers who were packed together at night, 
ten or twelve in one tent, lost from one-tenth to one-sixth of their num- 
ber, when the thermometer was at 96°, while the officers and their wives 
were generally exempt from disease. In 1756, 140 British prisoners 
were confined for one night in the celebrated Black Hole in Calcutta, 
a prison only eighteen feet square with two small windows. The want 
of air caused the death of 123 prisoners out of the whole number. 
Most of those who survived till morning were seized with putrid fever 
and died within a few days more. 
On the first of Dec. 1848,150 deck-passengers of the steamer Lon- 
donderry were ordered below by the captain, and the hatches closed 
upon them; seventy were found dead the next morning. 
CATALYSIS. SEPTIC DISEASES.-DISEASES OF FERMENTATION. 
1 
When we desire to render an animal insensible to the action of Wor- 
rara or Strychnine, placed where it can be absorbed, we try to lower its 
physical powers. If we desire to preserve it against contagious dis- 
eases we must increase those powers. 
But these septic poisons are almost invariably organic substances, 
and are produced within the living organization. In some cases the 
poison is formed within a special apparatus, as in hydrophobia. (See 
that Disease.) 
But there are other virulent diseases in which the blood really ap- 
pears to contain the morbid principles; This is the case with glanders. 
And it is a well-known fact, that healthy horses, and even men, may be 
affected with the blood of a diseased horse, as well as with the slimy 
matter that escapes from the nose and mouth. 
The animal secretions do not contain it, though at the same time the 
pathological fluids—the pus, the fluid contained in hydrocele and other 
morbid secretions do. For this reason alone are the autopsies performed 
in animals that die of the glanders attended with so much danger; the 
virus pervades the whole system, and the slightest wound is sufficient 
to inoculate the complaint. 
Contagious pneumonia in horned cattle could not be communicated 
by inoculation of the blood, or any of the fluids of the body. That 542 
DISEASES OF THE SANGUINOUS FUNCTION. 
virus chooses the lungs for its exclusive seat, and the liquids therein 
contained, pus, lymph, &c., are alone capable of communicating it 
This virus is very virulent, as whatever part of the body is the seat of 
inoculation, becomes rapidly inflamed and mortified. 
Process by which Putrid Affections are originated.—Nothing is 
easier than to produce putrid diseases in animals. Thus, when trans- 
fusion is performed under ordinary conditions—when the blood is con- 
veyed directly from one animal into the veins of another—no accident 
is produced; but if the blood is allowed to remain for a short space of 
time in contact with the atmosphere, and if the serum is then injected 
into the vessels, all the symptoms of putrid resorption are observed, 
and the animals die after exhibiting all the characteristic symptoms of 
putrid infection. (Bernard.) 
The blood, therefore, is capable of acquiring toxic properties without 
the intervention of any foreign principle, merely through the modifica- 
tions which take place when life is extinct. The same results may be 
excited without even drawing blood from the veins. If the blood of a 
fasting animal is directly injected into the veins of a healthy one, the 
latter is poisoned in the same manner as before, and yet the blood in 
this case has not undergone any previous decomposition. The in- 
troduction of foreign principles of course acts upon the blood with still 
more intensity; nearly all the substances known under the name of 
Ferments are endowed with the property of communicating a delete- 
rious influence to this fluid. When yeast is introduced into an animal’s 
veins, passive haemorrhage and other adynamic symptoms are imme- 
diately produced and death takes place in a few days. Now if the 
animal blood is transfused in rapid succession, exactly the same effect 
is produced, as if yeast and not blood had been poured into the vessels. 
It seems likely that in this case a series of decompositions takes 
place within the blood, and which give rise to other ferments. The 
well-known experiment related in Pringle’s work on Army Diseases ap- 
pears to correspond with our own experiments. In order to prove the 
influence of putrid emanations even at a distance on the chemical 
phenomena of life, he plunged a thread into the yolk of a rotten egg 
and then suspended it in a jar containing the yolk of another egg, and 
he found that under these circumstances, decomposition took place with 
far greater rapidity than usual. (Claude Bernard. 1860.) 
We therefore see that all these series of phenomena hold intimate 
relation to that mysterious chemical process known under the name of 
catalysis. The theory of fermentation is at present imperfectly known? 
and there exists a whole series of diseases which evidently result from 
the chemical diseases that take place within the body. 
By the operation of the principle of catalysis, one substance may 
be brought to so act upon another as to develop in it latent pow.. & 543 
TYPHUS. 
and properties not hitherto seen. A few drops of diluted Sulphuric- 
acid boiled with starch, sets in operation an action which decomposes 
any quantity of starch, and causes these decomposed elements to re- 
arrange themselves in a new and different manner under the form of 
dextrine, and finally of cane-sugar. At the expiration of this process 
the acid may be removed unaltered in quantity or in quality. A few 
drops of another acid would not have answered the same purpose. 
This law of Catalysis holds good with regard to the operation of homooe- 
pathic remedies. If in finitesimal atoms of homoeopathic medicines can 
be brought into contact with tissues with which they have no relations 
or affinities, no special effects are observed; but when these atoms are 
brought to bear upon disordered parts with which they are in homoeo- 
pathic rapport, we witness effects as wonderful as those of the magnet 
in vivifying unlimited numbers of atoms of unmagnetized steel. There 
must be a relation between the diseased part and the remedy. (See 
articles on this subject, JV. A. Journal of Homceop., Yol. II., p. 21. 
and Yol. YII., p. 81.) 
Treatment.—In the management of inflammatory typhus the liberal 
use of cold water, both internally and externally, has been found highly 
beneficial, and there is no doubt of its immense power as a curative 
agent, when judiciously employed. As early as 1796 the free use of 
water was strenuously recommended by Dr. Nathan Smith. In speak- 
ing of the hot stage of typhus, he says: “The most effectual mode of 
reducing the temperature of the body, is by the use of cold water, 
which may be taken internally or applied externally,” by which means 
“we may lessen the heat to any degree we please.” 
“ The method which I have adopted is to turn down the bed-clothes, 
and to dash from a pint to a gallon of cold water on the patient’s head, 
face and body, so as to wet both the bed and body-linen thoroughly. 
As soon as the linen and bed-clothes are dry, if the heat returns again, 
the water should be again applied until the heat is subdued.” 
We are aware that physicians have been deterred from the free ex- 
ternal use of cold water in fevers, through fear of aggravating existing 
inflammation, causing metastases, congestions, &c., by repelling the 
blood from the surface to the internal organs, but the danger from this 
cause is purely imaginary; for cold water, externally applied, not only 
operates by abstracting the superfluous heat, and reducing the animal 
temperature, but it also acts as a tonic, imparting tone and vigor to the 
debilitated and relaxed capillaries in which the morbid action is sup- 
posed to reside. 
In slight cases, frequent sponging of the surface will be sufficient to 
accomplish our object; but in more severe instances the method above 
recommended may be resorted to. 
By adopting this course of treatment, while at the same time we ad 544 
DISEASES OF THE SANGUINOUS FUNCTION. 
minister appropriate remedies, the disease will run a milder course, 
and most of the grave symptoms too often witnessed will be absent 
It has been a question whether typhus can ever be cut short by reme- 
dies; some maintaining that it may be broken up in the first stage, 
while others are of opinion, that it must have its course; upon this 
point, Dr. Drysdale observes: “We do not believe it possible to cure 
typhus; all we can do is, to conduct it to a favorable termination by 
carefully watching and curing all the intercurrent affections so apt to 
appear in it, by judicious management. At the same time we have al- 
ways given the remedies usually recommended, especially Bhus, Bry- 
onia, and Arsenicum, and we believe that convalescence will be much 
hastened by judicious treatment.” Dr. D. advises the use of brandy 
and wine in addition to our remedies during the stage of collapse, 
“ especially when there is great want of animal heat, and the pulse is 
very quick and small, attended with much trembling of the hands, and 
constant muttering delirium.” 
The appropriate remedies will be determined by the form the malady 
assumes, and the exact nature of each particular case. 
Adeps.—Dr. Taylor (in his New Treatment of Febrile Diseases, 
1850, London) says, he treated numerous cases of inflammatory and 
fevers, measles and other exanthemata by rubbing equal parts of lard 
and suet into the skin, and using no internal remedies. He says, it 
reduces the frequency of the pulse and wards off the typhoid con- 
dition; the dry and brown tongue becomes clean; the patient falls into 
a sound sleep; delirium and their symptoms subside. Repeat it two 
or three times a day. 
Belladonna, Bryonia, Opium, and Bhus, will cover most of the 
symptoms which are ordinarily present in this form. The following 
are the indications for these medicines. 
Belladonna.—Countenance flushed and bloated; eyes red and 
sparkling, or dull and turbid; or pale, brownish and glassy; wild ex- 
pression, stupid, fixed, or wandering look; visible pulsation of the caro- 
tids ; respiration irregular, short and quick or slow and deep; pupils 
contracted or dilated, generally immovable ; pulse variable, but gene- 
rally quick and resisting ; tongue red, moist or dry, or yellowish white; 
breath offensive; urine brownish or red; spasm; distortion of the 
face and eyes; head very hot, while the extremities are cool. 
Fulness and heavy pain in the head; strong pulsation of the caro- 
tids and arteries of the head; double vision, sparks before the eyes, 
or weak sight, humming in the ears; inflammation of the throat, chest 
and abdomen ; pains, heaviness, or numbness of the limbs ; palpitation 
of the heart; pressure and cramp-like pains in the stomach; dryness 
TYPHUS CEREBRALIS. TYPHUS CEREBRALIS. 
545 
of the mouth ; adipsia or thirst; continued watchfulness or lethargy; 
constipation or diarrhoea with tenesmus; constant moaning. 
Mental or Moral Symptoms.—State of mind apathetic ; or irrita- 
bility of temper; illusions of the senses, and frightful visions; or 
gloomy, suspicious ; constant moaning, or drowsiness ; profound coma 
Administration.—A drop of the third dilution in water every two 
hours until the desired impression is produced. In many persons the 
higher dilutions are more prompt in their action. 
Remarks.—Belladonna is indicated in typhus presenting a sub- 
synochal character. It is contra-indicated in great depression of the 
cerebral and nervous energy; but applies in vascular and nervous 
erethism. 
Bryonia.—Face swollen, red and burning ; eyes red and swollen or 
dull, glassy, turbid or sparkling and suffused dryness of the nose; 
groans; respiration difficult, short, rapid, anxious, or sighing; thick 
and tenacious expectoration; petechiae ; mouth dry; tongue dry, and 
coated with a dirty or yellowish fur; lips brown and dry; trembling 
of the limbs and appearance of great weariness and debility; pulse 
variable ; urine pale, or brownish without sediment. 
Fulness, heaviness, and pressure in the head, from within outwards, 
worse on movement; confusion and dull pains in the head; vertigo 
buzzing in the ears ; dulness or acuteness of hearing: sensation of dry 
ness in the throat; profuse sweat during heat; bitter, sour or putrid 
taste ; thirst; nausea; hiccough or pressure at the stomach ; constipa- 
tion ; abdomen inflated; weariness and pains in the back, loins and 
limbs, aggravated by motion; abdominal pains ; drowsy during the day j 
restless in the night, with delirium. 
Irascibility ; passion; fear of the future ; anxiety; fear; stupidity; 
delirium, with raving respecting business ; visions on closing both eyes. 
Administration.—Same as Belladonna. 
Remarks.—Bryonia is applicable in the cerebral and abdominal va- 
rieties, and in typhoid pneumonia, especially in the first period before 
.the muscular and nervous strength have become materially depressed. 
After the system is reduced to a certain extent, it may be alternated 
with one of the other remedies with benefit. Bryonia is often appro- 
priate after Belladonna. 
Aconite.—Tn the first stages of this as well as in most other maladies 
in which there is excessive action of the circulatory vessels, Aconite is 
an indispensable remedy. Its properties and uses are so well known 
and have already been so fully presented, that nothing further need be 
given here. Its powers in reducing the general febrile action may need 
the aid of some other measures in subduing important local inflam- 
mation. 
Opium.—Face dark red, or brownish, hot and bloated; pupils di 
Vol. i.—35. 546 
DISEASES OF THE SANGUINOUS FUNCTION. 
lated and immovable; lower jaw hanging from relaxation; lethargy, 
with snoring; mouth and eyes open; irregular and slow respiration ; 
pulse sIoav or suppressed; bluish color of the skin; convulsive move- 
ments of the limbs; offensive black faeces; involuntary evacuations: 
urine scanty, high colored, depositing a brick-dust sediment. 
Sensation of great heaviness in the head, vertigo, dizziness, buzzing 
in the ears ; general diminution, or entire loss of sensibility; cloudiness 
of sight; paralysis of the tongue; sensation of weight and pulsations 
in the stomach and abdomen; difficulty in evacuating the bladder; 
great oppression at the chest; hoarse, dry cough, with bloody expec- 
toration; troublesome itching of the skin; convulsions. 
Stupor; loss of consciousness ; delirium ; frightful visions. 
Administration.—A drop of the third dilution in an ounce or more 
of water, a table-spoonful once in two hours, until a medicinal aggrava- 
tion or amendment occurs,—afterwards repeat according to the exigen- 
cies of the case. 
jRhus-toxicodmdron. — Petechias; face red and swollen; blue 
circle around the eyes; nose pointed; lips dry, brownish or black; 
eyes red, with viscid secretion at the angles; eyes fixed and dull; nose 
dry, swollen, and tender when touched; tongue dry, red or dark; mouth 
filled with viscid mucus, which collects upon the teeth, forming sordes; 
constipation or diarrhoea; teeth dry, white and shining; color and con- 
sistence of faeces variable; retention or incontinence of urine; clear 
red, or turbid urine; paralysis of the lower extremities ; pulse quick 
and small; coma, with snoring and moaning. 
Stupefaction; vertigo ; dizziness ; bruised sensation within the head; 
soreness of the scalp; painful oppression in the stomach; pulsations 
in the epigastric region ; spasms and pinchings in the abdomen ; pains 
in different parts as if from a bruise, worse during repose, or at night, 
and relieved by movement; great weakness ; tendency to faintness; 
pain and difficulty in swallowing; tenesmus, with loose slimy, frothy, 
sanguineous, white, yellow or red evacuations; constant and pressing 
desire to urinate; oppression at the chest, with difficult respiration ;, 
soreness in the limbs, back, and neck, when touched or at rest; raw 
feeling in the throat and chest; excessive weakness; trembling or 
sweats. 
Muttering delirium, or coma somnolentum with snoring; anguish and 
digestion in the evening and at night; inclination to weep; fear of 
death ; frequent sighing. 
Rhus alone is not a specific for typhus fever, but it develops in the 
gastro-intestinal mucous membrane symptoms similar to those it pro- 
duces on the skin. This condition is an extensive erythema with rais- 
ing of the epithelium into pustules or serous vesicles. 
This erythema is not just like that of typhus fever; these last are TYPHUS ABDOMINALIS. 
547 
like variola-pustules and have been compared to them : they run a 
fixed course. Hahnemann found Rhus effectual in curing the epidemic 
typhus of 1813. 
It suits more particularly the pathological states which exist in what 
is called typhoid enteritis. Here the low typhoid state depends on the 
sympathetic effects of the acute inflammation of the skin and mucous 
membrane, when this inflammation affects a large number of nervous 
papillae which are spread over these surfaces. Whereas in typhus the 
adynamia, coma, seem to constitute the foundation of the disease. 
Administration. A drop of the first dilution in an ounce of water; 
a dessert-spoonful every two hours; if no decided effect ensues after 
a reasonable time, give a drop of the mother tincture in a table-spoon- 
ful of water, repeating as may be necessary. 
In many cases a higher dilution will do better than either of the above. 
We have seen the thirtieth of Rhus successful in a case in which the 
sixth did not appear to do well. 
Mercurius-vivus.—Has been often successfully employed in cases 
where there is great weakness, rapid sinking of strength, profuse per- 
spiration, fainting fits, trembling and numbness of the limbs, cramps and 
convulsive movements, great agitation and uneasiness of body and mind. 
Acetic-acid is often the only remedy that is necessary, as has been 
proven in many epidemics prevailing in whole villages and cities. 
When the pulse and strength begin to fail, then Arnica may be used 
with great success in alternation with the acid. 
Acetum.—Sponge the body with vinegar and water. 
TYPHUS ABDOMINALIS. 
Treatment.—From the close analogy of appearances produced upon 
the intestinal canal by fatal doses of Arsenicum \nd by fatal abdomi- 
nal typhus, it would be a natural conclusion that Arsenicum is for this 
disease a valuable homoeopathic remedy. There has been, however, 
a wide difference of opinion between some of our most eminent practi- 
tioners. Many, like Hausmann, Fleischmann, G-umpendorf, Stapf, 
Jahr, Henderson, Laurie, Currie, and Hartmann, have eulogized Arse- 
nicum for this form of typhus, in the most enthusiastic manner; at the 
same time a few, as Wurmb, Lorentz, &c., have denied that it possesses 
any special curative properties in any stage of the malady. 
The weight of testimony is in favor of Arsenicum when judiciously 
employed; and indeed we believe in those cases of ulceration of the 
mucous membrane of the ileum, Peyer’s glands, &c., and in those in- 
stances where the blood becomes congested in different parts of the in- 
testinal canal, giving rise eventually to spacelation if unopposed, that 
Arsenicum is a specific of positive and decided power. In support of 
this opinion, we refer with confidence to the numerous hospital and 548 
DISEASES OF THE SANGUINOUS FUNCTION. 
private reports that have been published in Europe within a few years, 
In relation to the cause or causes of the ulcers so often discovered 
by the Hippocratics in. autopsical examinations of those who have died 
of typhus abdominalis, an allopathic physician of forty years’ standing 
in Massachusetts, Silas Brown, makes the following inquiries in the 
Boston Medical and Surgical Journal. After expressing himself as 
“ fully persuaded that one of the great secrets of curing patients is not 
to kill them,” he proceeds : “ I should like to be informed whether there 
is not danger in giving inwardly, in any quantity, Strychnia, Creosote, 
Prussic Acid, Nitrate of Silver, and a host of other virulent caustic 
poisons; and whether some of them would not have a tendency to 
cauterize or constringe the delicate absorbents and other vessels of the 
digestive organs; and whether such medicines have congeniality or 
affinity enough with the membranous and vascular portions with which 
they come in contact, to become sanative medical agents; or whether 
they would not have a tendency to produce obstructions and those 
ulcers which we meet with in the post-mortem examinations of those 
subjects who die of typhus fever? He requests an answer, and we 
venture the suggestion that he may safely adopt an affirmative one. 
Arsenicum.—Skin dry or yellowish, or cold and bluish; reddish or 
dark spots on the skin; petechise; eyes dull, glazed, and sunken; pu- 
pils contracted; face shrunken, hollow, pale and cadaverous, or yellow 
ish, bluish, or leaden colored; expression of countenance distorted and 
unnatural; cold sweat on the forehead; lips dark, dry, and cracked; 
teeth dry, white and shining; sordes upon the teeth; tongue dry, 
shrivelled, bluish or black, with trembling and inability to protrude it; 
faeces variable, generally loose, darkish or greenish, and foetid; urine 
reddish, brownish, yellow, or turbid; tympanitis; guggling noise of 
liquids swallowed; respiration short and anxious; cramps in the legs; 
pulse irregular, or quick, weak, small and frequent, or feeble and 
trembling; voice sepulchral and tremulous; coma or low muttering de- 
lirium, trembling of the limbs; subsultus tendinum; sometimes deaf- 
ness; hippocratic countenance; colliquative sweats; extreme debility or 
complete prostration; burning and heat at the pit of the stomach and 
epigastrium; nausea, and vomiting especially after eating or drinking; 
violent pains and burnings in the abdomen, generally on the left side; 
sometimes only pain on pressure; pains in the right hypochondrium; 
stitches in the side with anxious and difficult breathing; universal loss 
of strength and excessive restlessness; stools dark, greenish, putrid, 
foetid and involuntary; head painful, weak, confused, as if stunned; 
distention of the abdomen; stiffness of the limbs. The patient is dis- 
satisfied, restless, anxious, discouraged; or muttering; delirious; sleep 
disturbed, with unpleasant visions. 
Administration.—In extreme cases, a grain of the second or third TYPHUS ABBOMINALIS. 
549 
trituration may be given every half hour, gradually lengthening the in- 
tervals as circumstances require. 
Remarks.—Arsenicum is especially serviceable in the third stage 
of abdominal typhus, when ulcers have formed. It will also frequently 
apply in the second stage wrhen the bowels become relaxed. 
Belladonna.—Countenance flushed and bloated; eyes red and spark- 
ling, or dull and turbid; or pale, brownish and glassy; wild expression, 
stupid, fixed, or wandering look ; visible pulsation of the carotids; re 
spiration irregular, short and quick, or slow and deep ; pupils con- 
tracted or dilated, generally immovable ; pulse variable, but generally 
quick and resisting; tongue red, moist or dry, or yellowish white; 
breath offensive ; urine brownish or red; spasms ; distortion of the face 
and eyes ; head very hot while the extremities are cool. 
Fulness and heavy pain in the head; vertigo; dizziness; violent 
throbbings in the head ; strong pulsation of the carotids, and arteries 
of the head; double vision, sparks before the eyes, or weak sight; 
humming in the ears ; inflammation of the throat, chest, and abdomen; 
pains, heaviness, or numbness of the limbs ; palpitation of the heart; 
pressure and cramp-like pains in the stomach; dryness of the mouth ; 
adipsia, or thirst; continued watchfulness or lethargy ; constipation, 
or diarrhoea with tenesmus ; constant moaning. 
State of mind apathetic ; or irritability of temper; illusions of the 
senses, and frightful visions; or gloomy, suspicious; constant moan- 
ing, or drowsiness ; profound coma. 
Administration.—A drop of the third dilution in water once in two 
hours until the desired impression is produced. 
Remarks.—Belladonna is indicated in typhus, presenting a subsy- 
nochal character. It is contra-indicated in great depression of the cere- 
bral and nervous energy; but applies in vascular and nervous erethism. 
Bryonia.—Face red, burning, and swollen, or dull, glassy, turbid, or 
sparkling and suffused; dryness of the nose; groans; respiration dif- 
ficult, short, rapid, anxious, or sighing; thick and tenacious expectora- 
tion ; petechige ; mouth dry, and coated with a dirty or yellowish fur ; 
lips brown and dry; trembling of the limbs, and appearance of great 
weariness and debility ; pulse variable; urine pale, or brownish and 
without sediment. 
Fulness, heaviness, and pressure in the head, from within outwards, 
worse on movement; confusion and dull pains in the head ; vertigo ; 
buzzing in the ears; dulness or acuteness of hearing; sensation of 
dryness in the throat; profuse sweat during the heat; bitter, sour or 
putrid taste ; thirst; nausea; hiccough, or pressure at the stomach; 
constipation; abdomen inflated; weariness and pains in the back, loins, 
and limbs, aggravated by motion; abdominal pains ; drowsy during the 
day j restless in the night, with delirium. 550 
DISEASES OF THE SANGUINOUS FUNCTION. 
Irascibility; passion; fear of the future; anxiety; fear; stupidity, 
delirium, with raving respecting business; visions on closing the eyes 
Administration.—Same as Belladonna. 
Remarks.—Bryonia is applicable in the cerebral and abdominal va- 
rieties, and in typhoid pneumonia, especially in the first period before 
the muscular and nervous strength have become materially depressed. 
After the nervous system is reduced to a certain extent, it may be al- 
ternated with one of the other remedies with benefit. Bryonia may 
often follow Belladonna with propriety. 
AcoQiite.—In the first stages of this as well as in most other mala- 
dies in which there is excessive action of the circulatory vessels, Aco- 
nite is an indispensible remedy. Its properties are will be fully de- 
scribed under Inflammation. See Index. It is only necessary here 
to advise the young practitioner that while endeavoring to reduce the 
force of the general circulation, according to principles already ex- 
plained, he should not neglect important local inflammations. It may 
be administered in the same manner as Belladonna. 
Opium.—Face dark red, or brownish, hot and bloated ; pupils dilated 
and immovable; lowrer jaw hanging from relaxation; lethargy, with 
snoring; mouth and eyes open; irregular and slow respiration; pulse 
slow or suppressed ; bluish color of the skin ; convulsive movements of 
the limbs; offensive black faeces; involuntary evacuations; urine 
scanty, high colored, depositing a brick-dust sediment; sensation of 
great heaviness in the head, vertigo, dizziness, buzzing in the ears 
general diminution, or entire loss of sensibility; cloudiness of sight; 
paralysis of the tongue; sensation of weight and pulsations in the 
stomach and abdomen; difficulty in evacuating the bladder; great op- 
pression at the chest; hoarse dry cough, with bloody expectoration ; 
troublesome itching of the skin; convulsions; stupor; loss of con 
sciousness ; delirium; frightful visions. 
Administration.—A drop of the third dilution in an ounce of water 
—a. table-spoonful once in two hours until a medicinal aggravation or 
an amendment occurs,—afterwards repeat according to the exigencies 
of the case. 
Rhus-toxicodendron.—This remedy is particularly adapted to the 
nervous forms of typhus, and may often be used with advantage in 
cerebral typhus after Bryonia, or Aconite, or in ganglionic typhus, 
when the following symptoms present themselves : 
Petechiae ; face red and swollen ; blue circle around the eyes ; nose 
pointed; lips dry, browish or black; eyes red, with viscid secretion at 
the angles; eyes fixed and dull; nose dry, swollen, and tender when 
touched; tongue dry, red, or dark; mouth filled with viscid mucus, 
which collects upon the teeth, forming sordes; constipation or diar- TYPIITTS ABDOMINALIS. 
551 
rhoea; teeth white, dry and shining; color and consistence of feces 
variable ; retention or incontinence of urine ; clear, red, or turbid urine; 
paralysis of the lower extremities; pulse quick and small; coma, with 
snoring or moaning; stupefaction ; vertigo ; dizziness; bruised sensa- 
tion within the head; soreness of the scalp; painful oppression in the 
stomach ; pulsations in the epigastric region; spasms and pinchings in 
the abdomen; pains in different parts as if from a bruise, worse during 
repose, or at night, and relieved by movement; great weakness; ten- 
dency to faintness; pain and difficulty in swallowing; tenesmus, with 
loose, slimy, frothy, sanguineous, white, yellow, or red evacuations; 
constant and pressing desire to urinate; oppression at the chest, with 
difficult respiration ; soreness in the limbs, back and neck, when touched 
or at rest; raw feeling in the throat and chest; excessive weakness, 
tremblings, sweats; muttering delirium, or coma somnolentum, with 
snoring; anguish and dejection in the evening and at night; inclination 
too weep ; fear of death; frequent sighing. 
Administration.—A drop of the first dilution in an ounce of water; 
a desert-spoonful every two or four hours. If no decided effect ensues 
after a reasonable time, give a drop of the mother tincture in a table- 
spoonful of water, repeating as may be necessary. 
Mercurius-vivus has been successfully employed in cases where 
there is great weakness, rapid sinking of strength, profuse perspiration, 
fainting fits, trembling and numbness of the limbs, cramps and convul- 
sive movements, great agitation and uneasiness of body and mind. 
Camphor.—Huxham was highly successful with this remedy in the 
so-called slow nervous fevers, in which the temperature of the body is 
lowered, the sensibility is depressed, and the vital powers greatly di- 
minished. He was enabled to succeed because Camphor is capable of 
producing a state similar in every respect, as observed by G. Alexander, 
Cullen, and F. Hoffmann. 
Phosphoric-acid.—General stupor of all the organs, apathy, dizzi- 
ness ; tongue dry and cracked ; teeth covered with a coating, lips black; 
cough frequent and dry; lying constantly on the back or side; con- 
tinual delirium or dull mutterings; subsultus tendinum; fixed 
with hollow, glassy eyes; extreme slowness in replying the questions ; 
petechia or clear brown spots; desire to escape; skin dry and burning; 
stools aqueous, abundant, and involuntary; scorbutic alteration of the 
buccal mucous membrane; cold perspiration on the face, hands, and 
pit of the stomach; pulse frequent, feeble and intermittent. This 
remedy was given by Rapou in injections to arrest intestinal haemor- 
rhage, a symptom of great danger. Nitric-acid is also effectual for 
the same purpose; four drops in two or three ounces of water. 
Bryonia.—Cases assuming the form of cerebral typhus; violent de- 
lirium, with intense febrile heat, great thirst and dryness; vesicular 552 
DISEASES OF THE SANGUINOUS FUNCTION. 
eruption in the mouth; abdomen swollen, epigastrium tender; urine 
dark; shooting pains in the sides of the chest, drowsiness during the 
day, restlessness at night, small and soft pulse; clammy perspiration ; 
trembling of the hands. Dr. Anelli of Presburg, succeeded with this 
remedy in those cases in which a severe chill and vertigo were followed 
by persistent heat for two days. A diminution of heat was followed 
by delirium, loss of consciousness, reaching in the course of two weeks 
profound stupor. In these cases the abdominal symptoms were absent 
and a majority of them terminated fatally under allopathic treatment 
Rhus-toxicodendron.—Appropriate in all the stages of the disease, 
especially in cases that take the form of nervous fever, with stupor; 
also, when exhausting alvine discharges induce great prostration. Rhus 
moderates the fatal colliquative diarrhoea, and diminishes the cerebral 
congestion. Confusion and shooting pains in the head; dry, burning 
heat; tension and stiffness, or wandering pains in the nape of the neck 
and breasts, aggravated in the evening by motion; fatigue and lassi- 
tude ; when the nervous symptoms appear and the tongue is coated; 
there is diarrhoea, with borborygmus, chills, vertigo, with irregular 
closing of the eyelids; alterations of the colors of the face; dryness 
of the throat, vomiting, yawning, heaviness of the head; pressure on 
the eyes; painful sensibility to light and noise; defective memory; ten- 
dency to delirium; underlip and tongue dark. Rhus, in the pre- 
monitory stage often presents the full development of the fever. (See 
United States Journal of Homoeopathy, 1860, p. 590.) 
Carbo-vegetabilis is also a remedy of importance in the last stages 
of abdominal, and in all stages of putrid typhus. In the former, it may 
sometimes be exhibited in alternation with Arsenicum, with good effect. 
The following are the symptoms : Hippocratic countenance ; face pale, 
yellowish, or dingy; eyes sunken and glazed, with nocturnal agglutina- 
tion ; lips dry and cracked; tongue dry, dark and tremulous; position 
upon the back ; cold, clammy sweat; pulse rapid, trembling, and almost 
imperceptible; tremblings and jerkings of the limbs; urine red and 
high colored; faeces putrid and offensive; an entire prostration of the 
animal powers ; heavy, pressing, or drawing pains in the head; ulcera- 
tion and bleeding of the gums; rattling in the throat; cramp-like 
pressing, or burning pains in the stomach and intestines; burning 
pains and oppression at the chest; rigidity or complete paralysis and 
relaxation of the nape of the neck and limbs; bowels swollen and 
tender on pressure ; feet, legs and hands cold; numbness of the limbs; 
coma or sleeplessness, with muttering delirium, mind dull, confused, 
wandering, or stupid. 
Administration.—A dose of the third trituration may be given in 
water, every half hour, in extreme cases, until the necessary impression 
is made. TYPHUS ABDOMUSTALIS. 
553 
Hartmann recommends Staphysagria in the first stage of the dis- 
ease, when the following symptoms appear: “ Sordes on the teeth, pale 
and bleeding gums, with painful swelling of the gums, and rapid decay 
of the teeth; vanishing of thoughts and ideas; weakness of memory; 
dulness of mind, great indifference and ill-humor; vertigo, with stupe- 
fying headache ; dimness of the eyes, itching, stinging, and heat of the 
canthi; fulness in the pit of the stomach, with frequent hiccough and 
vomiting; tension across the hypochondria, oppressing the breathing; 
pressure, weight and tension in the abdomen; cutting pain in bowels, 
with nausea, copious diarrhoeic stools.” 
Muriatic-acid is a highly important remedy in many cases of ad- 
vanced typhus, when the patient is stupid, unconscious of surrounding 
occurrences, and extremely prostrate. Other symptoms are, constant 
tendency to settle down towards the foot of the bed, low muttering de- 
lirium, groaning in sleep, moaning, picking at the bed-clothes; inability 
to protrude the tongue, dry heat, with transient and partial sweats; 
general uneasiness, “ depression of the lower jaw, digging with the head 
into the pillow, turning up the whites of the eyes, slavering, &c.” 
(Hempel.) We may employ the first to the third dilution—a drop in a 
drachm of water, every two hours, as long as necessary. 
Phosphorus.—Dr. Kidd says he has found Phosphorus a valuable 
remedy in the treatment of the typhus which devastated Ireland during 
the years 1847 and 48. 
Phus-tox., Bryonia and Arsenicum are also highly commended by 
Dr. Kidd when “ from the very commencement, the heat of skin and 
acceleration of pulse are very inconsiderable, and in the middle and 
latter stages, are almost invariably below the natural standard. For 
two or three days the patient would labor under lassitude and languor, 
with loss of appetite and of sleep, the tongue being generally the first 
index of the probable mischief in store. About the fourth or fifth day, 
the disease being generally well marked, with a very slight heat of 
skin, which feels soft and clammy, being covered with moisture, (not 
like the ordinary feel of a perspiring skin, as if the skin were damped, 
and by some contrivance the evaporation prevented;) the pulse very 
little, if at all altered, except in strength, which even at this period 
would be somewhat deficient; the tongue presented a most character- 
istic appearance; in general dry, hard and glazed, like brown leather, 
or deeply covered with brown or blackish fur. In some cases it ap- 
peared soft, moist and tremulous, covered with a perfect and uniform 
layer of pure white paste or mucus, (this in generally omened a very 
severe and dangerous form of the disease;) the gums and teeth became 
covered with brownish incrustations; thirst being incessant and in- 
satiable, with nausea and vomiting; in many cases abdominal symptoms, 
as tension and tympanitic resonance of the abdominal walls, with 554 
DISEASES OF THE SANGUINOUS FUNCTION. 
tenderness and shooting pain over either iliac region, (in general the 
right;) bowels seldom costive, in general relaxed, with or without pain ; 
urine in a few cases suppressed, in most unchanged; head in general 
implicated ; in most from the beginning, with aching and heaviness at 
the forehead, throbbing at the temples, vertigo, sense of emptiness and 
bewilderment; delirium mostly at night, with low muttering, or writh 
stupid, heavy insensibility and incoherence of speech. The eyes ap- 
peared dull, inanimate, and listless, with the head instinctively turned 
from the light. In a few cases towards their termination, a peculiar 
sort of stolid deafness supervened, which gradually disappeared as con- 
valescence advanced. 
“ Almost invariably the lower extremities were complained of being 
dead and numbed, rendering the least motion impossible, (but without 
any actual pain,) the feet and legs feeling cold and damp. 
“ General debility and prostration set in early in the disease, and 
proved the most obstinate of the symptoms.” (Truths and tlieir Re- 
ception, &c., by J Kidd, M. D. London, 1849.) Dr. K. relied upon 
the four medicines above named in this form of the malady, and the 
results show a mortality of less than two per-cent. His success in the 
numerous cases of continued fever which came under his care was no 
less gratifying. The low dilutions were employed for the most part; 
but in a few cases drop doses of the tinctures were deemed neces- 
sary. 
The other medicines necessary in the treatment of certain stages of 
this, as well as the other forms of typhus are: Rhus-tox., Acid-nitr., 
Nux-vomSecale-cor., Mercur, Opium, Camph., China, Nux-mos., 
Valer., Stram., Ilyos., and Lach. These remedies will all occasionally 
be called into requisition, so that their effects upon :he human system 
should be well understood and appreciated. v 
It will be observed that we have divided, typhus into hut three va- 
rieties. Other authors add a typhus putridus, typhus contagiousus, 
typhus lentus, typhuspetechialis, &c. In practice, however, we seldom 
find any one of these forms distinct and unmixed * but the brain, ner- 
vous system, lungs, and abnormal viscera partake more or less in the 
general disturbance, causing each particular case to present peculiar 
and diverse symptoms. So in regard to the treatment of this fever, it 
will often be found, from its commencement to its termination, to re- 
quire one or more of the medicines which we have placed under each 
form of the malady. The systematic connections are so strongly pro- 
nounced, between the important organs in which the different varieties 
of typhus are located, that one can not be affected without imparting 
the disorder to others. 
Physiologists note it as a curious fact, that no two human faces are 
exactly alike, and it may be asserted with equal safety, that no two in TYPHUS ABDOMEN ALTS. 
555 
stances of typhus fever ever presented, from first to last, precisely the 
same symptoms. Therefore it is, that in all cases of this as well as of 
other maladies, we must trust to symptoms alone, and be guided by 
them in the application of our remedies, rather than by the name of 
the disease. Our nomenclatures and classifications unquestionably 
facilitate the investigations and diagnosis of complicated cases, but they 
can be of very little importance in the practical exhibition of medi- 
cines. 
Dr. Baertl who treated about thirty cases of this disease,* found it 
contagious, though commencing as an epidemic. 
Treatment.—In the forming stage, Puls, and Nux. 
When the fever and cerebral congestion are already manifest, Aeon, 
and Bell., beginning with the former. 
Merc.-dulc., third trituration,—Marked sensitiveness in the coecal 
region; stools greenish, bloody, slimy, with tenesmus; burning in the 
anus; frequent pinching in the bowels, every two or three hours. In 
the course of twelve to twenty-four hours the stools become less fre- 
quent, more consistent, become yellowish or brownish. Other symp- 
toms at the same time improve. 
Calcarea-carbonica.—Dr. Baertl cured all his cases which progressed 
to the third stage with this remedy, giving only Bell., 12°, every six 
or three hours. 
Symptoms.—The diarrhoea increased and the strength declined; the 
delirium and waking visions became more prominent. If amendmen 
did not soon occur, Calc.-carb., 6°, was given alone every six or three 
hours, one drop in a spoonful of water. Under this treatment the dis- 
ease rarely lasted beyond the 21st day of the disease. Even the 
worst cases recovered under the use of these two last medicines, espe- 
cially the Calcarea. In contrast we give a case of allopathic practice. 
Case of Dr. Spurzheim.—He had been sick both in England and 
France, and had submitted to medical treatment; and from its effects 
he had inferred that it was not safe to place too much confidence in the 
skill of the faculty or the virtue of drugs. He said he was present 
when Cuvier was bled and protested against it, believing that literary 
men did not bear that evacuation well. He stated that his own con- 
stitution was very irritable, and from childhood he could never bear the 
powers of medicines. He was therefore in his last illness averse to all 
medicines. When over-persuaded he took one drachm of Epsom-salts 
saying it would purge too much, which it did, and was checked with 
Opium. 
Dr. Jackson who thenceforward attended him says: On the 80th 
October his tongue was perfectly dry, except a line on each side, dark 
* Horn. Vierteljahrsschrift, Vol. XII. Part. 1. 556 
DISEASES OF THE SANGUTNOUS FUNCTION. 
but not thickly coated; much thirst, no appetite ; occasional purgatives 
had been given, pulse 96, firm, and with the hardness of age rather 
than disease, though he was only 55. Pulse intermitted frequently, 
though he said this had been the case for three years without any other 
Symptom of diseased heart; respiration natural. Could expand his 
chest freely; he struck it and it resounded well; declared he had no 
symptom of disease of that cavity; skin rather soft but slightly hot and 
dry; free from pain; no bad feeling in the head; occasional uneasi- 
ness in the bowels, which he always removed at will with a lavement; 
nothing morbid in his evacuations; most distressing symptoms were, 
extreme restlessness, appearance of impatience, and very great watch 
fulness. 
From this to Nov. 5th the symptoms gradually grew worse, without 
much change from day to day. On the 31st Oct., skin very moist, but 
no other amendment. Exacerbation again in the evening, continuing 
as usual to 8 or 4 a. m. Some sleep, though not more than three 
hours in the night; at times he showed great impatience and irritability 
of temper, of which there was nothing in his usual health. This state 
passed insensibly into delirium. 
Nov. 5th he was plainly worse; pulse quicker, though retaining in a 
good degree its firmness. The tongue, which had been perfectly dry 
from the beginning, now diminished in volume as if its whole substance 
was dried; respiration somewhat irregular; frequent twitchings of the 
muscles; picking of the bed-clothes; delirium increased. Next day 
the bad symptoms much worse; disposed to coma with intervals of de- 
lirium; respiration more hurried and irregular, some rattle in the 
throat; pulse now 120, more feeble and unequal in force. From this 
time all the symptoms were of unfavorable character, till the night of 
Nov. 10th, he died a little after midnight. 
The name of the disease was not perfectly decided. Dr. Jackson 
said: “ Call it a continued fever, in which nervous symptoms pre- 
dominated ; there was no putrescency, no strong inflammatory symp- 
toms. If called a pure typhus the name would mislead many. It may 
be called a synochus, though not without dispute.” “ I would de- 
scribe the disease thus: It was a continued fever in which symptoms 
of the access came on insidiously and were alone for many days. The 
symptoms of the other stages were never permanent, those of crisis 
never appeared; there was no evidence of any inflammation any 
where; if it did exist it must be called latent. On the 30th of October 
he was in the third week of the fever, though he had not been confined 
to the house a week. In this advanced stage I have learned that 
medicine is not of any avail.” (Capen's Biography of Spurzheim, 
p. 130. Boston, 1832.) TYPHOID FEVER. 
557 
TYPHUS ABDOMINALIS EXANTHEMATICUS. ENTERIC FEVER 
4. TYPHOID FEVER. 
General Symptoms.—Shooting, throbbing headache in the forehead 
and occiput; vertigo ; dry cough, gradually becoming worse, increasing 
the headache; prostration, apparent from the patient’s aspect; these 
symptoms followed by a general rigor, subsequently alternating with 
heat, finally ending in continuous dry burning heat; temperature of the 
skin much increased. Pulse from the commencement accelerated, full, 
though rather soft, 100 to 120 per minute. Rush of blood to the head; 
redness of the face; noise in the ears; tongue clean or furred white, 
subsequently becoming dry; impaired taste ; pressure in the praecordial 
region, or especially in that of the spleen; no appetite, thirst, con- 
stipation or diarrhoea; evacuations of fluid, yellowish or greenish ap- 
pearance ; later these are mixed with flakes or with blood; pinching 
pain in the bowels, and often burning pain in the anus ; in the third 
stage there is meteorism of the abdomen; pressure on the abdomen 
causes rumbling there, especially in the region of the caecum. 
Urine scanty, turning muddy after standing a short time, and de- 
positing a copious sediment; and later in the disease is diminished in 
quantity. 
In the latter part of the disease the lips, teeth and tongue are covered 
with brown sordes, are very dry, and the patient longs for water, the 
strength declines and the patient becomes emaciated. 
As the disease progresses nervous symptoms become more prominent 
In this stage there is strong delirium, inducing many patients to ge 
out of bed. The nights from the commencement were very restless as 
the patient lay in a stupefied state. This uneasiness increases with 
the delirium, till a soporous state terminates in entire unconsciousness; 
the tongue is then drier, the pulse becomes more rapid and weaker; 
the breathing more hurried and labored. A characteristic of this form 
of typhus is a kind of purpura on the surface, consisting of small red 
spots, some of which are elevated; they begin to come out on the 
abdomen, and in some cases extend over the limbs; it varies in depth 
of color, according to the severity of the disease from a pink to bluish- 
red. In the later stage the skin becomes cooler. In many cases the 
sputa were mixed with streaks of blood, and were expectorated with 
difficulty. 
Causes.—Intestinal fever is a contagious disease. The following 
characteristic features distinguish contagious fevers: 
1. There is in contagious fevers a latent period after the occurrence 
of the affection. 
2. There is exemption conferred by one attack against any future 
attacks. • 558 
DISEASES OF TIIE SANGU1NOUS FUNCTION. 
3. Large numbers of persons, though freely exposed to the fever- 
poison, yet remain proof against it. 
The immunity conferred by one attack against a future one was first 
pointed out by Bretonneau. He said that in thirty years he never saw 
an instance of this fever occurring twice in one person. Chomel says, 
no authentic case has been recorded, although the number of cases of 
typhoid fever annually studied is large. M. Louis, the greatest au- 
thority on this subject, living or dead, says, the town of Caumont was 
twice swept by an epidemic of this fever, with an interval of eight 
years between, and all persons attacked by the first visitation were 
spared on the second. Dr. Budd says, he has sought for seven years 
for persons who in their lives had typhoid fever more than once. He 
has found four probable cases in all. But he remembered many who 
performed for weeks and sometimes for months together the office of 
nursing others, and were incapable of taking the disease themselves. 
Conditions for the growth and development of the specific fever- 
poison. The operation of all the poisons belonging to this group is 
entirely dependent on their own reproduction in the living body. This 
has been proved in the case of small-pox by inoculations on the grand- 
est scale. In regard to all other contagious diseases we may not be 
able to understand all that is involved in “the latest period.” “But it 
is,” says Dr. Budd, “ as clear as day that its root lies in the infinitesimal 
minuteness of the dose, which inoculation experimentally shows to be 
sufficient to the speedy effect of the morbid poison ; and to the intimate 
nature of the material conditions which protect for the remainder of 
life the body that has once gone through one of those diseases against 
any future attack from it, may, possibly, always transcend our means 
of research. The disease, called small-pox, occurs but once in life 
simply, because the small-pox-poison can not grow again in the body in 
which it has once bred. The same is true of intestinal fever.” 
The minute speck that is inserted by inoculation is so inappreciable 
that the inoculated body takes at first no distinct recognizance of its 
presence. It issues before long in a new stock sufficient to poison to 
death the body, in which it is propagated, and sufficient also to impart 
the seeds of death to myriads of others. Germ and offspring, seed and 
crop, lie both before us distinctly displayed, as the seed corn and the 
product of the farmer’s cornfield. 
In intestinal fever, as in small-pox, it is the act of growth (with all 
that is incident to it) that kills. “ The living human body is the soil 
in which this specific poison breeds and multiplies ; and that most spe- 
cific of all processes which constitutes the fever itself is the process 
by which the multiplication is effected.” 
From what surface is the specific poison cast off by which the dis- 
ease is propagated? All the emanations from the sick are infectious, TYPHOID FEVER. 
559 
Itrat what is thrown off from the intestines is comparatively more viru- 
lent than any thing else. 
The only means of preventing their exciting the disease in other 
persons must consist in sufficient provision being made for preventing 
the discharges from the human intestines from contaminating the soil 
and air of the inhabited area. Without this the most complete venti- 
lation is insufficient. 
There is no safety but in good drains from houses, and water closets 
in the best condition. Otherwise the disorder, which possesses such 
virulent powers of propagation by contagion may become a most 
deadly scourge. The alvine evacuations should be swept far away 
from the house in which the sufferer lies. If this be not done, and 
the discharges are allowed to accumulate day by day upon the soil in 
which the dwelling stands, and to exhale their poison into the air 
breathed by the inmates, or to distil it slowly into the water they drink, 
most fatal results may be anticipated. The sanatary arrangement just 
named has power almost invariably to prevent the spread of fever, but 
in their absence every member of the family may be stricken down in 
succession. Like malignant cholera, dysentery, and yellow fever, intes- 
tinal fever is one that infects the ground, thus a quasi-miasmatic 
character attaches to them all. 
All the morbid products thrown off by the intestinal fever patient 
contain matters in which the fever-poison has set its seal in the most 
consummate fashion. They are the most specific of all the exuvia 
from the diseased body. And the sewer, which is their common recep- 
tacle, is as the direct continuation of the diseased intestine. 
As the poison that produces typhus fever acts on the blood alone, 
that which causes typhoid enteric fever operates on the blood, but also 
induces special lesions in the solids. It is a specific disease, not con- 
tagious in the proper sense of that word, and caused generally by vi- 
tiated air containing the emanations from large bodies of human be- 
ings crowded together, aided by mental and bodily fatigue. 
The precise nature of those emanations which produce this fever 
are unknown. Impure air of every kind is unhealthy; but the offen- 
sive gases generated from decomposing animal or vegetable substances 
may cause disease, nausea, and great depression of the vital powers; 
yet this fever seldom results from any of them. Mr. Brown, of Cha tham, 
(Eng.,) has endeavored to show that typhoid has always originated 
“from the application to the alimentary canal of the excretia of the 
intestines that have undergone alterations outside of the body.” Thus 
“faecal matters (altered in their nature) are swallowed in almost all 
towns and cities, and even in lone houses in the country, in conse- 
quence of the proximity of wells to privies and drainshence, “ blood 
poisoning and disordered sympathetic nerve-force result, the skin and 560 
DISEASES OF THE SANGUINOUS FUNCTION. 
glands of the small intestine become diseased,” and “typhoid fever, 
which is essentially a privy-soil fever, is originated; but night soil can 
give rise to other diseases, as cholera, diarrhoea, and dysentery. Oc- 
casionally the opening of a long-closed privy is directly followed by 
typhoid fever of a malignant type.” {Brit. Med. Jour. 1858.) 
Typhoid fever is never absent from large cities. Where it has become 
endemic. At certain times its powder is heightened by great meteoro 
logical or other changes; and, in imitation of plague, cholera, or yel 
low fever, it marches forth from its strong-hold, and reigns in both city 
and country as an epidemic. 
It is generally admitted that typhus fever is induced by the respir- 
ing of air charged with a large per-centage of effete animal matters 
thrown off from the lungs or skin of masses of people occupying 
crow'ded apartments. It is essentially a product of over-crowding, and 
is different from typhoid fever. In one experiment “an animal extrac- 
tive matter was obtained from the respiratory and cutaneous excretia 
of numerous individuals congregated in one apartment. This extrac- 
tive matter was injected into the blood of a dog. The animal died of 
low fever in fourteen days ; which it will be observed, constitutes the 
full period of typhus fever. {Braithw. Retr. 1858. p. 21.) 
Distinction between Typhoid and Typhus Fever. 
Has less of an epidemic, and 
more of a local character. 
Is known by its leaving well- 
marked traces on the organism 
after death. 
Typhoid or Enteric Fever. 
Typhus is pre-eminently the type 
of a blood disease—the fever poi 
son acting primarily on the blood, 
and leaving, after death, little trace 
of structural change ; prevailing 
extensively as an epidemic ; and, 
when once induced, it spreads by 
by contagion, regardless of age, sex 
or local circumstances. (Tweedie.) 
Typhus. 
Epistaxis, 
Present in one-third of the cases, j 
Hearing. 
Seldom or never occurs. 
Equally affected in both dis- 
eases. 
Deafness more or less complete, 
Eyes. 
Conjunctiva but slightly inject- 
ed ; pupils larger than natural. 
Conjunctiva much more con- 
stantly and intensely injected; 
pupils abnormally contracted. 
Tongue. 
Generally moist. When dry, | Covered with thin white mucus 
it is often small, red, glazed, and j in the early stage; less frequently TYPHOID fever. 
561 
Typhoid or Enteric Fever. 
Tvphus. 
fissured; when brown, its hue is 
less deep,—yellowish, rather than 
blackish-brown, with red tip and 
edges; surface smooth, covered with 
pale brownish-yellow fur, and ap- 
pearing red between the fissures. 
Scarcely able to protrude the 
tongue. 
moist throughout the disease. Only 
one-fifth of a large number could 
protrude the tongue ; showing ex- 
treme prostration. The tongue, 
teeth and lips were then covered 
with a dark-fuliginous incrusta- 
tion, nearly black ; surface shriv- 
elled or fissured, sometimes coat- 
ed with blood. The sordes exhi- 
bit blood discs from local haemor- 
rhage. 
Intestinal Hemorrhage. 
Occurs in one-third of the cases. 
Seldom or never occurs except 
from haemorrhoids. Constipation 
more persistent; no gurgling over 
the region of the caecum. 
Constipation followed by watery 
diarrhoea with griping. Abdomen 
inflated; noise excited by pressure 
over the right iliac fossa. 
Appetite and Thirst. 
No difference between the two 
diseases. 
Pulse. 
It fluctuates from day to day. 
Cough and Physical Signs. 
Sonorous rale present in eleven- 
twelfths of the cases. 
Dulness of the lung rare. 
In only one-third of the cases. 
Dulness of the most depressing 
part of the chest, from intense con- 
gestion of the lung, is common. 
Frequent in both diseases. 
Sloughing. 
Erysipelas. 
Occurs in nearly one-third of 
the cases. 
In less than one-twentieth of the 
of the cases. 
Cadaveric Rigidity. 
Continued lono;er. 
Ceased quickly after death. 
Discoloration of the Walls of the Abdomen, and of Skin cover- 
ing large Veins. 
Seldom seen. 
Yol. l—36. 
Very frequent 562 
diseases of the sanguinous function. 
Typhoid or Enteric Fever. 
Typhus. 
Progresses further than in 
typhus. 
In protracted cases it is extreme. 
Emaciation. 
Spots on the Skin. 
None visible after death. 
| Continue visible after death. 
After death, the vessels of the 
pia-mater were abnormally filled 
with blood in one-third of the cases; 
intensely injected in one of fifteen 
cases ; the cerebral substance con- 
gested in one-seventh of the cases. 
Head, 
In many cases, no trace of dis- 
ease discovered in any organ. The 
pia-mater and arachnoid separated 
with abnormal facility in nine of 
eleven cases ; the vessels of the 
pia-mater were congested in nearly 
one-half, and intensely congested 
in one-fifth of the whole of the 
cases. Cerebral substance abnor- 
mally congested in one-half. 
Age. 
More common in persons under 
forty years of age. 
More common in persons over 
fifty. 
Mode of Attack, 
Disease commences insidiously 
and progresses slowly. Heat of skin 
moderate or absent. 
Heat more marked in the early 
stage and in the exacerbations. 
Early symptoms more violent; 
their accession more sudden. 
Duration. 
Average duration in fatal cases, 
twenty-two days. In some instan- 
ces it extends to forty, fifty, or 
sixty days. 
In fatal cases fourteen days. 
Few or none live beyond the twen- 
tieth. 
Of a different character, though 
of a reddish hue. 
The spots disappear on pressure, 
last but for a few days only, and 
are succeeded by a fresh eruption 
as long as the disease continues. 
Eruption, 
Is known as the mulberry rash. 
It all comes out early in the dis- 
ease ; at first elevated, then darker. 
Is seen in three-fourths of the 
cases, and in all over twenty-two 
years old. Appears from the third 
to the seventh day, first on the 
trunk anteriorly, the spots varying 
in size from a point to three or 
four lines in diameter, having an 
irregular outline. Sometimes few typhoid fever. 
563 
Typhoid or Enteric Fever. 
Typhus. 
in number; oftener, numerous small 
spots uniting to form large ones. 
Color dusky-pinkish, afterwards 
more dark, each patch remaining 
till the disease terminates. The 
depth of the color is proportioned 
to the gravity of the fever. 
Miliary Vesicles, or Sudaminjs. 
May be seen in both diseases in I 
patients under forty years of age. | 
Not seen in patients over forty. 
Not indicative of extreme pros- 
tration, countenance anxious, com- 
plexion clear, flush of brightish 
pink color on one or both cheeks, 
circumscribed. 
Expression, Manner, Hue of Face, &c. 
Countenance less anxious, com- 
plexion thick and muddy, flush of 
the face uniform and of dusky 
red color. 
It disappears only about the 
fourteenth or seventeenth day. 
Headache. 
Rarely absent in the beginning. 
Disappears about the tenth or 
twelfth day, or after that time 
comes at intervals. 
Delirium, 
In some cases it occurs before 
the fourteenth day, in others by 
the eighth; slowly increasing in 
severity. 
Begins before the fourteenth, 
and is then less violent. Some- 
times noisy, but more often low 
and muttering. 
Begins after the fourteenth day. | 
Somnolence, 
Begins before the fourteenth day. 
Coma-Vigil. 
Seldom or never occurs. 
| It occurs in one-fifth of the cases 
They occur in equal degree in 
both diseases. 
Spasmodic Movements. 
Involuntary Discharges from the Bladder and Bowels. 
Occur at a late period. 
Loss of Muscular Power. 
Occur at an early period. 
One-fourth of the patients keep 
he bed entirely before the seventh 
day. Prostration not great before 
the fourteenth to the twentieth. 
Patients all keep their beds en 
tirely before the seventh day. 
Prostration extreme by the ninth, 
Loss of expression of the face. 564 
DISEASES OF THE SANGUINOUS FUNCTION. 
Typhoid or Enteric Fever. 
Typhus. 
Haemorrhage into the Cavity of the Arachnoid. 
Not found in any case. 
Occurs in one-eighth of the 
cases examined. 
Ulcerated in one-third of the 
fatal cases. 
Pharynx. 
Not seen in any case. 
(Esophagus, 
Ulcerated in one-fifthteenth of 
the cases. 
Free from ulceration. 
Stomach, 
Mucous membrane not softened 
throughout its whole extent in any 
case of fifteen. 
In a very few cases it is soften- 
ed ; in some all the coats of the 
stomach softened. 
Peyer’s patches, and the corres- 
ponding mesenteric glands are in- 
variably diseased. In sixty cases of 
typhoid fever in the Crimean hos- 
pitals, these glands were affected 
in fifty-nine. 
Small Intestines and Mesenteric Glands. 
Invariably normal. 
Large Intestines. 
Mucous membrane found ulce- 
rated after death in more than a 
a third of the cases. 
In no instance found ulcerated. 
Enlarged in all cases; softened 
in one-third of the cases onlv. 
% 
Spleen. 
Before the age of fifty it is en- 
larged ; after fifty it is smaller ; 
and softened as in typhoid. The 
bile is thicker and of dark green 
color. Kidneys, liver, and pancreas 
more flabby than in typhoid. Heart 
flabby, lining membrane darker red 
than in typhoid. 
Pathology.—The first morbid change observed in the intestine in 
enteric fever is slight swelling of the mucous membrane, covering 
Peyers patches ; to this rapidly succeeds the deposit of typhous matter, 
which soon presents the appearance of a deep brown or yellow sloughy 
patch ; this is in a short time detached, leaving a cavity or ulcer on the 
inner surface of the intestine, known by the name of a typhous ulcer. 
The seat of the lesion is the lower third of the small intestine, the 
number and size of the ulcers increasing as they approach the carnal 
valve. TYPHOID FEYER. 
565 
The typhous ulcer, when it corresponds to the infiltration and detach- 
ment of a large Peyerian gland, is elliptical in form; when it corres* 
ponds to a solitary follicle, or a rounded patch, or to the partial detach- 
ment of a glandular plexus, it is round; when corresponding to a par- 
tial detachment, it is irregular or sinuous. 
The ulcer varies in size from that of a hemp-seed or pea to that of a 
half crown. 
The patches are placed opposite to the insertion of the mesentery, 
their long diameters being always parallel to the longitudinal axis of 
the intestines. The typhous ulcer was only seen by Rokitansky to 
form a zone in one instance out of many hundreds. 
The base of the ulcer is formed by the delicate layer of sub-mucous 
tissue, which covers the muscular coat, a well-defined fringe of mucous 
membrane forming the margin. 
Termination of the typhous ulceration.—Mild cases terminate in 
resolution; in severe ones the ulcers may cicatrize. In one or more 
patches in patients who have died from other causes, smooth polished 
ulcers have been seen near the caecum. They were covered with a thin 
transparent pellicle, continuous with the sub-mucous tissue around the 
ulceration. 
The conditions necessary for the favorable healing of the ulcers are: 
1. the cessation of the deposition of the typhous matter, and complete 
extinction of the typhous dyscrasia; and 2., the holding out of the vital 
powers to withstand the exhaustion caused by the ulcerative process. 
When cicatrization does not take place the destructive process of 
ulceration successively lays bare the mucous, the areolar and muscular 
coats, until the thin transparent peritoneum alone remains. When com- 
plete perforation takes place, the contents of the intestines escape into 
the peritonial cavity and give rise to acute peritonitis. The perforation 
is usually very small and is found in the centre of the ulcerated patch. 
This occurred in 20 out of 1820 cases in the London Fever Hospital. 
(.Tweedie, Lumleian Lectures, 1858.) 
Chanyes in the Blood.— In typhus and typhoid fevers the blood be. 
comes altered in its chemical composition. The quantity of fibrin is 
never above the normal standard, but diminishes in proportion to the 
duration of the disease; the blood corpuscles increase; but the red 
color and fibrinous consistence are lost. That the blood is liable to 
alterations in its consistence in disease, will be shown under the head 
of diseased states of the blood. It was remarked by Borden, that 
blood is fluid fleshand it is known that it contains the same proxi- 
mate principles as the solids of the body, and also that it is organized and 
apparently endowed with vitality. Dr. Stephens says, that he and other 
practitioners of the West Indies observed that in persons exposed to 
the fever-producing malaria, the blood was altered before other symptoms 566 
DISEASES OF THE SANGUINOUS FUNCTION. 
of fever were discovered. From this altered state of the blood in typhous 
fevers arise the nasal and intestinal haemorrhages that often occur be 
fore their termination. For Treatment see page 547. 
Mode of Attack.—In some cases it may strike its victim suddenly 
prostrate, overwhelming in its severity the whole system, and thus 
preventing any reaction of the capillary 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 unaccustomed to hot regions, he will be more susceptible to the 
action of the poison than if he had been previously 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 susceptibility 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 tropical climate, do so in that physical condition which the require- 
ments, habits and regimen of the former naturally generate. In a pre- 
vious 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 sufficient carbon and hydrogen to resist and neutralize 
the action of the inspired oxygen. With these habits, appropriate only 
where a condensed atmosphere is respired, individuals seek the tropics 
with bodies abounding in carbon, and continuing, in most instances, 
their accustomed regimen of animal food and stimulants, thus burden- 
ing their systems with an amount of the elements of nutrition far greater 
than the oxygen contained in the rarefied air which they inhale can de- 
compose. See page 186. 
It is probable, therefore, that one of the chief predisposing causes 
of yellow fever, is the presence of a greater amount of carbon in the 
system than the inspired air can properly act upon. The exact equili- 
brium between the supply of the elements of the food and the absorbed 
oxygen, is disturbed; and the carbon predominates, and all of those de- 
rangements, which proceed from a superabundance of this agent neces- 
sarily ensue. 
The inhabitants of tropical climates have comparatively but little 
desire for animal food, but prefer farinaceous diet, vegetables and 
fruits; in this manner naturally securing to themselves a due propor- 
tion between the elements assimilated and the oxygen absorbed ; while 
the inhabitants of the north find it necessary to consume large quanti- 
5. YELLOW FEVER. YELLOW FEVER. 
567 
ties of meat and other articles abounding in the elements of nutrition 
in order to preserve a healthy equilibrium. We, therefore, strongly 
urge it upon persons 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 enjoj 
as great an immunity from this dreadful scourge as the natives them 
selves. 
Premonitory Symptoms.—Giddiness, wandering pains in the back 
and limbs. “ cold in the head,” slight chills, nausea, headache and fre- 
quent sensations of faintness. Later appears a febrile paroxysm, fol- 
lowed by a perfect lull of the symptoms; subsequent appearance of 
jaundice, haemorrhages, gastric irritability, dysuria. 
Second Stage.—After early symptoms have continued a few hours, 
a decided reaction occurs; the circulation becomes excited, the face 
flushed, the eyes red, brilliant, injected; pulse from 100 to 130; there 
are violent pains in the head, back, loins and extremities, distress of 
the stomach, and vomiting of acid bilious matters ; the surface becomes 
dry und burning hot; mouth and throat dry, with intense thirst and 
sometimes delirium; urine scanty and high colored; tongue covered 
with a pasty white coat, with red edges and apex; in some cases mu- 
cous or bilious vomiting. 
The duration of this paroxysm is usually about twenty-four hours, 
although occasionally it continues, thirty-six hours or more, after which 
there is generally a remission of all the symptoms, except a distressing 
sensation in the stomach, with nausea and vomiting. The patient re- 
mains in this state with a considerable degree of comfort for a few 
hours, with partial perspiration, when there is a recurrence of many of 
the former symptoms in an aggravated form. The stomach noAV be- 
comes extremely painful, burning and sensitive; vomiting is violent and 
incessant; flatulence, thirst, and nausea; the fluids ejected are of a 
darker color; there is often diarrhoea, generally constipation; the skin 
and eyes acquire a yellow lemon tinge; there is tossing and restless- 
ness ; dysuria; and the mind becomes confused and wandering. The 
pain in the head, back and limbs are less violent than before, and the 
pulse, tongue and skin may remain nearly natural; but the case is 
hourly becoming worse, and the fever assumes a typhoid character. 
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 greenish yellow, brownish or claret-colored vomiting ; the com 
plete development of the dreaded “ black vomit” leaving but a ray of 
hope. At this period the temperature of the skin falls, and the powers 
of the system all sink rapidly; the pulse flags, and perhaps intermks; 
the tongue becomes dry, black and shrivelled ; the breathing irregular 568 
DISEASES OF THE SANGUINOUS FUNCTION. 
and laborious; cramps seize tlie calves of the legs and tbe bowels , 
the whole countenance loses its natural life-like expression; the ex- 
tremities become cold; colliquative sweats, petechia in protracted 
cases; diarrhoea, haemorrhages, loss cf intellect and coma occur, and, 
filially, convulsions and dissolution end 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 pecu- 
liar circumstances of the individual attacked. We give a few memo- 
randa of some of the earlier epidemics. 
In 1825 the yellow fever was carried to Washington, Mississippi, by 
the people, flying from Natchez. Its course there is given by Dr. 
Monette : The commencement in almost every case was between mid- 
night and morning, with stretching or uneasiness and yawning, slight 
sensation of cold, though not a chill; the rigors short and followed by 
ardent fever; skin hot and dry, harsh to the touch; countenance 
flushed, and scarlet color; indescribable anxiety; eyes watery or 
suffused with blood. Pain in various parts of the body, worst in the 
head, eye-balls and back; sensation of soreness in the left umbilical 
region; functional derangement extensive; disease hastening on to a 
fatal termination. During the first days of the disease, frequent eruc- 
tation of wind; burning and distention of the stomach. The stage of 
excitement continued from to 3 days. Then the stage of collapse 
ensued; pulse became feeble, extremities and surface cold; when free 
stimulation can alone prevent extinction of life. A stupor generally 
prevailed from the commencement, wfith fulness in the head, tightness 
across the eye-brows, pain and soreness in the upper portion of the 
globe of the eye and levator muscles; the patient therefore lay with 
eyes closed, and inattentive to surrounding objects. Delirium in the 
lighter form common, but not furious. The tongue livid, in the first 
stage covered with white mucus ; in advanced stage, brownish, dry and 
extremely rough. The surface hot and dry until collapse commenced ; 
in severe cases no means succeeded in exciting favorable diaphoresis 
till the approach of death was shown by the clammy and cold sweat. 
Pulse, in first stage 90 to 120, full, frequent and soft; and this con- 
tinued till death approached, when it became quicker, more feeble, 
progressively imperceptible. In some the pulse was diminished in 
activity by treatment. It then continued for 36 to 40 hours before 
death, slow,full and soft; apparently in all respects the pulse of perfect 
health, though death was rapidly approaching. The bowels were at 
first inactive; after purging was excited, the evacuations continued 
copious, numerous and watery, covered with white scum, seeming to be 
the mucous membrane of the bowels; great prostration and the hippo- YELLOW FEVEK. 
569 
cratic countenance soon followed tlie operation of a purgative. No bile 
was passed from the stomach or bowels. The skin was not yellow in 
all cases. In some the whole body was deeply tinged like jaundice; 
especially just before death. The lungs are always deeply affected, and 
the disease seems to invade the body through the lungs. 
Epidemic of 1839.—The population of Natchez in August was 
estimated at 5000, of these 255 died of yellow fever, besides a few 
more who were taken to the country. Many left the city on the com- 
mencement of the disease, and by the first of October not more than 
1500 remained. Large numbers of the acclimated and blacks took the 
fever, of whom some died who had had it before. It commenced insidi- 
ously ; many seemed exhilarated and boasted of their good health but 
a few hours before they Avere attacked. Others were greatly depressed, 
and indifferent to surrounding objects ; horripilation increased till there 
Avas slight coldness of the hands and feet and sense of chilliness down 
the spine ; lasting from a few minutes to some hours. In the mild cases 
the excitement was free; pulse from 85 to 100, full, firm, resisting. 
Skin hot and dry, and seldom yelloAV. Pain in the head, back and 
limbs moderate ; restless, watchful, but rarely delirious ; tongue moist 
and clean, or covered with thin white fur; considerable thirst; after 
a feAV hours the stomach irritable and sore to the touch; frequent vom- 
iting of fluid resembling that of 1837; boAvels slow; urine scanty and 
high colored; in fatal -cases it Avas entirely suspended. In these sore- 
ness of the abdomen and vomiting increased; hiccough common; in 
some cases a morbid secretion of gas by the stomach was more dis- 
tressing than the vomiting. 
In more violent forms of the disease there was no appreciable chill; 
skin cool or moderately w’arm and of a leaden hue; excitement irre- 
gular, pulse varied from 100 to 130, with throbbing of the carotids; 
shrunk features; cold or cool extremeties; little pain; great oppres- 
sion of the stomach, Avith soreness to the touch in some cases; tongue 
moist, pale, expanded, Avith a pale blue fur and red edges; thirst and 
distressing vomiting; constipation obstinate; evacuations, if procured, 
of a dark and muddy cast, or liquid and nearly colorless; urine scanty 
thick, dark; resembling black vomit, or totally suspended. In some 
cases black vomit early, and death occurred within three days. Many 
seemed to die Avithout signs of inflammation; but from ner\rous ex- 
haustion. In these there was no black vomit. The skin became in- 
variably yelloAV after death. 
Haemorrhage from the nose Avas favorable, but from the mouth, 
bowels or kidneys always unfavorable, and generally followed by death. 
The si<ms of convalescence or death were obscure. One man who 
had been sick six days Avas mortified, and death took place in ten 
hours more; though then, there Avere no symptoms of approaching 570 
DISEASES OF THE SANGUINOUS FUNCTION. 
death. The mind was calm, pulse open, soft, 80 per minute, stomach 
quiet, but bowels liquid. No prophylactic but temperance was effect- 
ual. Calomel was relied on by many; but several were attacked when 
under its influence, and some died when highly salivated, though i 
was generally favorable. (Dr. Hogg, W. Med. Jour., 1840, p. 418.) 
Causes.—When animal and vegetable matters are submitted, for 
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 generated, which, under 
favorable circumstances, will cause yellow fever. Concerning th# 
nature of this miasm, nothing is positively knowm; but it is evident 
that the continued high degree of temperature to which these substan- 
ces are exposed, and the confinement of their noxious emanations within 
the limits of crowded cities develops a more virulent morbific agent 
than originates from a similar exposure of the same matters in the 
open country, or to a more irregular and less intense heat, such as 
usually occurs in more temperate localities. Among predisposing 
causes we mention:—too free use of animal food and stimulants; irre- 
gular habits, mental anxiety, depression of spirits, fear, grief, exposure 
to night air or to a burning sun, and, indeed, whatever else tends to de- 
bilitate the organism. 
The nature of the specific poison that produces yellow fever, is still 
an enigma among medical philosophers. The opinion is gaining ground 
that the specific cause of this disease consists of minute fungous spo- 
rules. Mr. Hassell says, (Lancet, Feb., 1853,) that the matter of 
“ black vomit,” examined by him with the microscope, consisted of a 
vast number of irregular, browm-colored bodies, resembling blood discs, 
shrivelled and discolored, but insoluble in Acetic-acid. From this in- 
solubility he inferred that they could not be blood discs, and that they 
must be sporules of a microscopic fungus, and that they might be im- 
portants agents in keeping up the vomiting. 
The relation between yellow fever and intermittents will wre think be 
found to consist in their being each produced by a specific malaria 
consisting of an infinitesimal fungus entirely distinct from all others, 
though in many respects they obey similar laws, as has been fully 
illustrated by Dr. J. K. Mitchell, of Philadelphia. 
On no other theory yet proposed can we explain the introduction of 
yellow fever by means of trunks and unwashed clothing from infected 
places into new localities w7here it never appeared before. It has sure- 
ly been often proved that yellow fever is a non-contagious disease; 
but it is equally w7ell established that it can be introduced. 
Thus, Dr. Holcombe, {N. Amer. Jour. Jlomceop., 1856,) says he has 
seen enough in this year alone, to say nothing of twro years previous, 
to convince him that the yellow7 fever as it appears on the banks of the YELLOW FEVER. 
571 
Mississippi, is u a palpably contagious disease, communicable by con- 
tact of a person’s clothing. This little village of Waterproof, La., 
never presented a case of it until this year. It has raged above and 
below us, but never appeared amongst our population, the autumnal 
remittents and malignant intermittents when prevailing here were never 
known to turn into yellow fever, or be mistaken for it. A stranger 
from New-Orleans, sick of the disease, is landed from a boat, he con- 
valesces and leaves; but in the course of a week others are taken, and 
very soon the constantly increasing virus infects the whole atmosphere, 
and we have more than 100 cases in the course of a month. A gentle- 
man residing several miles out of Natchez rides into town to see his 
brother’s family, sick of yellow fever, assured by the physician of its 
non-contagious nature. In a few days he sickens; next his wife, then 
the chamber-maid, then their children, and so on until 12 or 13 cases 
occur, all the persons in the place being exempt except those who came 
near the sick persons or the sick rooms. A negro accompanying liis 
young master to college, is taken sick one night at a gentleman’s coun- 
try-seat remote from all towns and public roads, where every one else 
is and has been for weeks in perfect health. He gets well and goes 
away; but several of the family who were with him sicken, and three 
die of black vomit. It is now found that the same disease has also 
broken out at the place the negro started from, he having had the 
germs of the complaint in his system in a state of incubation. We need 
pot adduce more examples. We have seen and heard of so many 
similar cases that we feel impelled to recommend unprotected, unac- 
climated persons to get out of its way, and to lend our cordial support 
to all sanatary, hygienic and quarantine regulations which may promise 
deliverance from its visitations.” 
These facts certainly prove that yellow fever can be conveyed from 
one place to another, and from one person to another; but we are also 
obliged to accept a vast number of other well-attested facts which 
would, if seen alone, prove that the disease is not always communicable 
by contact. We think, however, that all the facts on both sides of this 
long-debated question are explicable on the theory above alluded to. 
Yellow fever, if not always communicable by contact, is beyond all 
question a comm,unicable disease; one that may be carried in trunks 
or clothing, in filth and animal impurities, which in darkness and damp- 
ness furnish the most favorable place for the growth of cell-spores. 
When thus carried to a northern city, these minute cryptogamic fungi 
encounter the usual difficulties of tropical plants attempting to estab- 
lish themselves where the soil and climate are not the most favorable 
They may grow in New-York, though transplanted from Havana or 
Yera Cruz; but if they do grow it must be under the most favorable 
conditions; the soil, temperature, &c., on which the prosperity of the 572 
DISEASES OF THE SANGUINOUS FUNCTION. 
whole tribe of fungi depends, must be favorable. The germs, when once 
ashore, may slowly migrate towards the land, and even by chance be 
wafted to other neighboring spots, where they may grow and create 
new foci of disease. As in such places yellow fever is an exotic, it 
cannot flourish as successfully as in its native climate; and it is always 
destroyed by the first frost. We thus see how it is that yellow fever, 
though not contagious, can be imported that it spreads but little in 
northern villages ; that it may become epidemic in cities in which great 
impurities are permitted to accumulate; that in the warmer cities of 
the South it may originate from cell-spores of the preceding season 
which the mild winter had not entirely destroyed. 
It is then easy to understand how yellow fever may be imported, 
and wre can also understand why it is rarely done. We may see why 
a disease not contagious may travel occasionally to a hamlet or vil- 
lage. And we may “account for its apparently spontaneous appear- 
ance in such places as Charleston, Savannah, and New-Orleans, in 
which the winter may not be severe enough to kill the germs, but may 
so effect them as to make their reaction difficult or partial.” The 
New-Orleans Board of Health in the report of 1860, thus concludes : 
“ The data which precede are, we believe, amply sufficient to con- 
vince the most skeptical of the spontaneous occurrence of sporadic 
yellow fever in New-Orleans. We hope they will prove sufficient to 
men of the profession, as the medical history of the year 1860. The 
logical conclusion we may draw from the facts which we have cited, is, 
that it is of the utmost importance to protect the city from the impor- 
tation of yellow fever, since the imported fever tends evidently to be- 
come epidemic, whilst indigenous yellow fever appears, on the con- 
trary, to assume a sporadic character.” 
With the history of yellow fever before us, we are able to under- 
stand how a crew, perfectly healthy, may bring with them in the closed 
hold of their ship the germs of disease, which may afterwards infect 
those w'ho unload the ship. These first cases may, after a few days 
be followed by other cases in the vicinity, originating from a new crop 
of cell-spores grown upon the land. On this theory we can explain, 
more satisfactorily than on any we have examined, the anomalies and 
inconsistencies of Asiatic cholera; “its progress along streams, its 
preference for the damp parts of cities, its domestication in India,” its 
capricious choice of places in which to break out anew. We must 
presume that the specific causes of these two diseases are distinct from 
each other; but that the producing cause of each, most probably 
“ consists of invisible organic spores, which are capable of being con- 
veyed in the atmosphere, reproducing themselves where the proper soil 
is found in which they can grow, and dying out when this appropriate 
soil is not found.” Sec “ Causes of Malarious and Epidemic J)is- YELLOW FEYER. 
573 
eases,” by J. K. Mitchell, M.D. Phila. 1847 and 1859. Also Aimer. 
Ilom. Review. Yol. II. p. 49. 
Pathology.—Dissection of those who have died of this fever has shown 
no evidence of inflammation as the cause of death. Neither fibrinous 
effusions, adhesions, thickening, indurations or ulcerations, the common 
traces of inflammation have been found. The burning of the stomach, 
the tenderness on pressure are only evidence of “a perverted applica- 
tion of the nervous energies, emanating from the nervous centres,” with 
depraved secretion, especially in the liver and kidneys. “ The next 
remarkable effect, says Dr. Holcombe, “is the stasis of the blood; and 
when we recollect that the blood-vessels are supplied with nerves from 
the great sympathetic, we may readily conceive the dependence of this 
symptom, also, on the state of the ganglionic centres. The next symp- 
tom wTe might expect to be arrest of secretion, and so it is. A diseased 
organ already secreting badly, or abnormally, in which deteriorated 
blood stagnates, is not likely to secrete at all. The liver is generally 
the first to stop working; the kidneys the last. The matter vomited 
for some time previous to black vomit has seldoin a trace of bile. Ab- 
sorption, however, is still comparatively active. The bile last exuded 
from the hepatic cells, and stagnating in the radicles of the biliary 
duct, from absence of the vis a tergo, is taken up into the circulation, 
and gives the yellow tinge to the urine, skin, conjunctive. &c. The 
same thing happens in jaundice, and is a symptom of very little impor- 
tance. The state of the liver, in yellow fever, is but one link in a long 
chain of morbid phenomena, and by no means the most essential one. 
The absorption of the last particles of urea, secreted in the cortical 
portion of the kidneys, is a more dangerous symptom, because urea is 
a prompt and fatal poison to the nerve centres.” [N. Amer. Jour. 
Horn. Yol. III. p. 489.) 
There is a progressive poisoning of the blood in yellow fever, as in 
other zymotic diseases. This “ deterioration of the blood is not pro- 
duced by the multiplication of virus in the molecular form.” The virus 
enters the blood when the disease is propagated by contagion. It acts 
on the nerve centres as do other absorbed poisons, and the changes it 
produces there cause the vitiation of the blood that is seen in yellow 
fever. The change of color is often produced by apparently trifling 
causes. “ A fit of passion produced almost instant jaundice, absorp- 
tion of bile, effusion of yellow serum into the cellular tissue, conjunc- 
tive, &c., in Murat, when he wras king of Naples.” 
The hemorrhagic transudation of the second stage depends upon 
“the want of plasticity and arterialization of the blood, and the relaxed 
state of the capillaries, induced by their abnormal innervation.” Black 
vomit, the most dreaded of these exudations is blood chemically modi- 
fied by the gastric secretions. The vomiting preceding its appearance is 574 
DISEASES OF THE SANGUINOUS FUNCTION. 
almost always intensely acid. The blood is poured out by a kind of 
exosmosis / for the membranes are free from any trace of rupture. 
The albuminous part of the effused fluid is coagulated into that finely- 
granulated state, compared to coffee-grounds, while the coloring matter 
already dark by carbonaceous matters, is rendered pitch-black by the 
sulphuretted hydrogen and other chemical agents always present in 
the intestinal tube. This coffee-ground substance is only found in that 
tube, the haemorrhages from other points being uniformly of dissolved, 
molasses-like blood.” (Ilolcombe on Yellow Fever.) 
Yellow fever shows itself in its most fatal form when concentrated, 
as on board a ship, and it can from such a point be propagated to an 
indefinite extent; but when it is diluted by being spread over a large 
part of a town, its virulence is greatly diminished; it then can only be 
propagated in the milder form, and is still further modified by being 
communicated from one person to another. The conclusions reached 
by Dr. Neidhard are: 
1. That yellow fever will only show its most deadly effects when in 
its most concentrated form; 2. that there must be a peculiar suscep- 
tibility.of the individual to this particular poison at the time of his ex- 
posure, in order to show its most fatal effects. These observations hold 
good with all epidemics. 
The epidemic commenced in 1853 in Philadelphia, in the vicinity of 
a vessel which had arrived from Cuba, on the 12th of July. The crew 
were reported healthy on their arrival, but the hold emitted an offen- 
sive smell, when the bilge-water under her flooring was agitated by the 
pumps. The disease spread from the centre of South-street wharf, in 
the vicinity. The official reports showed 107 cases with a mortality 
of nearly eighty per-cent. Dr. Gilbert, the port-physician, and Drs. 
Sewell and Stokes reported, that black vomit occurred in twenty-six 
out of forty-four cases, and exhibited under the microscope the true 
blood corpuscles; the peculiar yellow, sometimes bronzed skin, was 
more apparent after death. The post-mortem examinations, made in 
eleven cases, showed invariably the yellow or ochre-colored liver, and 
the coffee-ground fluid or melanic blood in the stomach and intestines, 
as the true evidences of the malignant form of the fever. 
Treatment.—The remedies most commonly applicable to the treat- 
ment of this affection are, Ipecacuanha, Belladonna, Bryonia, Rhus, 
Arsenicum, and Aconite. The other medicines likely to prove ser- 
viceable are Nux-vomica, Mercurius, Veratrum, China, Sulphur 
Cantharides, Carho-vegetabilis, and Crotalus. Dr. Taft, of New 
Orleans, whose success in the treatment of yellow fever was so great 
as to attract the marked attention of a large number of citizens, and 
raised high expectations of important improvements in the manage- 
ment of this disease, relied chiefly upon the following remedies: YELLOW7 FEYEK. 
575 
In the first stage : Aconite, Ipecacuanha, Belladonna, Bryonia,, 
which were often used also in the next stage.—Second and third 
stages. — In addition to the above : Bhus-tox., Arsenicum, Veratrum, 
Cantharides, Carbo-veg., Nux-vom. These medicines were usually 
employed by Dr. Taft at the first attenuation, and frequently repeated, 
either singly or in alternation, as the circumstances of each case ap- 
peared to require. 
Camphor.—In the cold stage tincture of Camphor, one drop every 
ten minutes, is effectual here as it is in the cold stage of epidemic cho- 
lera and of intermittent fever. Its primary effect “is a great reduc- 
tion of animal temperature.” The effect is but transient, it needs to be 
often repeated, and it is soon out of the way of the next remedy. 
Aconite and Belladonna in alternation are the specific remedies for 
the first stage. “ They are complements to each other in making out 
the whole morbid picture.” These remedies followed by Ipecacuanha 
were sufficient for all the milder cases in late epidemics. 
In the yellow' fever of the Mississippi Drs. Holcombe and Davis of 
Natchez used, in addition to the above, the following remedies : Arse- 
nicum, Lachesis, Crotalus, Mercurius, Colocynth, or Phosphorus. 
Veratrum for vomiting and abdominal pains. Tartar-emetic for pro- 
longed and distressing nausea ; also Chamomilla in cases of women 
and children. Cantharides for strangury, Nux-vomica in intemperate 
persons ; Chamomilla, Sabina, or Secale generally caused the symp- 
toms of threatened abortion to disappear. Rhus and Bryonia for the 
prostration, which followed the acute stage of the disease. Bell., 
Coffea, Hyoscyamus for nervous sleeplessness. 
When the first symptoms declare themselves, as dizziness, slight 
chills, pains in-the back and limbs, uneasy sensations at the epigas- 
trium, with nausea, vomiting, and sensation of faintness, Ipecacuanha, 
at the third attenuation, should be immediately exhibited. This re- 
medy may also be found serviceable during the second and third stages 
in alternation with some other article. During the further progress 
of the disease the following remedies will be found available. 
Belladonna.—Glowing redness and bloated appearance of the face ; 
eyes bright red and sparkling, or fixed, glistening and prominent; 
tongue loaded with whitish mucus, or yellowish, or brownish; pulse 
variable. 
Dry burning heat; sharp, darting and shooting pains in the head ; 
throbbings in the head ; burning thirst; painful heaviness and cramp- 
like pains in the back, loins, and legs ; pressure, cramplike, and con- 
tractive pains in the stomach; inclination to vomit, or violent vo- 
mitings. 
During the remission, melancholy; dejection ; when reaction comes 
on, great agitation, with continual tossing and anguish. 576 
DISEASES OF THE SANGCINOUS FUNCTION. 
Administration.—Belladonna is for the most part applicable 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 vio- 
lence of the symptoms. 
Bryonia.—Skin yellow ; eyes red, or dull and glassy, or sparkling 
and filled with tears ; pulse rapid, and full or weak. 
Severe pain and sensation in the stomach, vomiting, particularly after 
drinking; burning thirst; pains in the back and limbs; headache ag- 
gravated by movement; eyes painful on motion; sense of fullness and 
oppression in the stomach and intestines. 
Anxiety, with dread and apprehension respecting the future ; loss 
of memory; delirium. 
Administration.—Two drops of the first dilution in an ounce of 
water,—a dessert-spoonful every two hours until an impression is pro- 
duced. 
Bhus.—Surface of a dirty yellow color; eyes glazed and sunken; 
tongue dry and black ; lips dry and brownish; pulse quick and small; 
loquacious delirium, or coma with stertorous breathing; constant 
moaning. 
Distressing pain and burning in the stomach ; nausea and vomit- 
ing ; paralysis of the lower extremities; spasms in the abdomen; want 
of power over the abdominal muscles; colic ; diarrhoea; difficulty in 
deglutition, and pain on swallowing. 
Intellect dull and clouded ; constant uneasiness ; delirium. 
Administration. Two drops of the third dilution in an ounce of 
water, a dessert-spoonful at intervals of one, two or three hours or more 
as the symptoms may require. When prompt effects are not observed 
from the third dilution, the first may be substituted in drop-doses. 
The higher dilutions in some cases are more effectual than the low. 
Arsenicum.—Face of a yellowish or bluish color; 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. 
Sense of extreme debility; dull throbbing, stunning or shooting 
pains in the head; burning or sharp and darting pain in the epigas- 
trium or in the region of the liver; limbs feel stiff’ and useless; fre- 
quent evacuations with tenesmus, or painless and involuntary; oppres- 
sion at the chest with rapid and anxious respiration; cramps in the 
calves of legs; great oppression at the stomach, with violent vomiting, 
especially after drinking; drawing and cramp-like pains in the ab- 
domen ; sensation as if a weight was pressing upon the abdomen. 
Indifference ; weakness of memory; stupidity; delirium, with great 
flow of ideas ; loss of consciousness and of sense; raving. YELLOW' FEVER. 
577 
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 dangerous cases the intervals of administration 
may be lengthened as circumstances may require. 
Aconite.—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. 
Violent febrile reaction; sensation of intense heat; great thirst; 
acute pains in the temples, forehead, or on one side of the head ; 
vertigo on rising; eyes weak and sensitive to light; pains and sore- 
ness in the back and limbs ; nausea ; general sense of debility ; great 
heat and irritability of the stomach; short and anxious respiration. 
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. Aco- 
nite and Belladonna may sometimes be alternated with benefit in the 
first periods 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 many physicians, who have treated the disease 
Aconite has been recommended as a specific for this disease. 
Nux-vomica.—Skin yellow; face pale or yellowish; especially 
round the nose and mouth; lower part of the sclerotica yellow; eyes 
inflamed with redness of the conjunctiva ; eyes surrounded 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. 
Burning pains in the stomach ; pressure or cramp-like pains in the 
epigastrium; vomiting of acid, bilious, or mucous matters; frequent 
and violent hiccough ; eyes sensitive to light; vertigo, or pains in the 
head ; tremors of the limbs ; cramps in different parts ; thirst for beer, 
brandy, or some stimulant; contraction of the abdominal muscles ; 
loose discharges of slimy or bilious matters or blood; burning pains 
at the neck of the bladder, with difficulty in urinating; coldness, para- 
lysis, and cramps in the legs; feet benumbed and cramped. 
Excessive anxiety, uneasiness, fear of death; despair, or loss of 
consciousness and delirium, with moaning, or muttering. 
Administration.—Two drops of the third dilution in one ounce of 
water,—a dessert-spoonful once in from two to six hours. 
Mercurius.—Yellow color of the skin ; eyes red, blood-vessels of 
sclerotica injected; eyes sensitive to light: paralysis of one or more 
limbs ; tongue with moist thick white fur, or dry and brown mucus , 
VOL. I 37. 578 
DISEASES OF THE SANGUINOUS FUNCTION. 
faeces variable ; pulse irregular, or quick strong, and intermittent, or 
weak and trembling. 
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 bi 
lious matters ; burning pain and tenderness of the stomach; consti- 
pation, or diarrhoea, with discharges of mucus, bile or blood ; coldness 
of the arms and legs, with cramps ; excitability and sensibility of all 
the organs. 
Anguish and agitation; weakness of memory ; apprehensions ; dis- 
couragement; moroseness; raving. 
Administration.—A grain of the third trituration in one ounce of 
water,—a dessert-spoonful every two, four, or six hours. 
In a case of poisoning by Calomel, related by Hoffmann, black vo- 
miting is mentioned as the chief symptom. This symptom is almost 
peculiar to yellow fever. Dr. Wood says, he “ has employed Calomel 
in some bad cases of this disease, with the happiest results. In one 
of them the matter ejected from the stomach had begun to assume the 
flaky character of black vomit, and yet the patient recovered.” (.Pract. 
Med. Vol. I. p. 320.) It is only successful in homoeopathic doses. 
In the catarrhal bilious fever of 1838, Dr. Monette says, “ the irrita- 
tion of the bronchial tissue, upon the use of Calomel, was speedily 
transferred to the alimentary canal, and many fatal cases occurred under 
this practice.” 
In extreme irritation of the stomach from duodenal inflammation 
Calomel increases the intensity of the disease. It is the peculiar sen- 
sibility of this portion of the alimentary canal to Calomel that gives 
Calomel its importance in general practice. “ In inflammation of the 
duodenum there is the most deadly sickness with efforts to vomit; ten- 
derness over the region of the stomach; and the pylorus seems per- 
manently constricted so as to prevent the passage of all ingesta. If 
the inflammation is severe or protracted, the skin becomes yellow. 
This symptom is present in duodenal inflammation, whether the case 
assumes the form of jaundice, bilious fever or yellow fever. 
Veratrum-album.—Face of a yellowish or bluish color, cold and 
covered with cold perspiration; eyes dull, clouded, yellowish and 
watery; lips and tongue dry, brown and cracked; hiccough ; cold- 
ness 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. 
General prostration of strength ; confusion of head or vertigo ; deaf- 
ness ; difficult deglutition; 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. YELLOW FEVER. 
579 
Timid ; despondent; restless, loss of sense; coma or violent de- 
lirium. 
Administration.—A drop of the third dilution in an ounce of water; 
a dessert-spoonful frequently repeated until an effect is apparent. 
Sulphur.—External Indications.—Face pale, or yellowish ; eyes 
red, or yellowish; aphthae in the mouth; tongue dry, rough, and red- 
dish, or with white or brownish, bloody or purulent saliva. 
Physical Sensations.—Dizziness, or sharp pains in the head; itch- 
ing and burning pain in the eyes ; roaring in the ears ; nausea, -with 
trembling and weakness; 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; unde- 
cided; wrandering. 
Administration.—A grain of the third trituration in an ounce of 
wrater; a dessert-spoonful every four or six hours, extending or dimi- 
nishing the intervals according to the exigencies of the case. 
Tartar-emetic.—Dr. Leon, of New-York, formerly of New-Orleans, 
says, that in yellow fever he found the following symptoms yield rea- 
dily to this remedy: nausea or vomiting, with a sense of sinking at the 
stomach, as if the patient would not survive a moment; general pros- 
tration of the whole system; white fur on the tongue ; profuse cold 
perspiration; rapid and weak pulse; drowsiness, and disposition to go 
to stool. He gave one grain of the first trituration to six ounces of 
water, in doses of a dessert-spoonful every hour or two. This course 
generally subdued this group of symptoms within twenty-four hours. 
Dr. Leon also employed it with success in the bilious fever of Loui- 
siana and Mexico. 
Cantharides—is sometimes indicated in the third stage with com- 
plete insensibility, cramps in the abdominal muscles and legs, suppres- 
sion of urine; haemorrhages 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 decided impression is produced. 
Carbo-vegetabilis.—Has been employed with success in the third 
stage. 
Nitrate of Silver.—Dr. Holcombe used it with success when the 
patient, in spite of the preceding remedies, was sinking; “ the vomit- 
ing became worse, with brownish stains in the matter ejected,” or ap- 
pearances indicating haemorrhage from the gastric mucous membrane. 
He used the second centesimal trituration. Even this small dose, of a 
teaspoonful from a half tumbler of water, in which had been dissolved 
“one ten-thousandth part of a grain of Nitrate of Silver,” often pro- 
duced the aggravation of nausea. When this remedy or Laehesis did 
not produce improvement the case was considered hopeless. 580 
DISEASES OF THE SANGUINOUS FUNCTION. 
Sulphuric-acid.—Yellow fever, with haemorrhage and symptoms 
resembling gastritis ; large shreds of mucous membrane being ejected. 
Crotalus-horridus.—Dr. Holcombe, in 1853, pointed out the resem- 
blance of the symptoms of yellow fever to the pathogenetic effects pro- 
duced by the virus of certain serpents, particularly Crotalus and 
Lachesis, and from the use of the latter substance he obtained satis- 
factory results. 
The next year Dr. W. L. Humboldt said he had already tried the 
experiment of inoculating with the virus of the rattle-snake, as a pro- 
phylactic against yellow fever; and that, in the course of nine years, 
he had inoculated 1438 individuals in New-Orleans, of whom only 
seven afterwards took the disease, and two died. He says he derived 
the idea from the observation that galley-slaves, brought from Mexico 
to Vera Cruz, if bitten by vipers on the way, always had decided symp- 
toms of yellow fever. His process consisted in inoculating with the 
virus of some serpent (not known to others), and treating the symp- 
toms produced with the poison with a syrup of the Mikamia-guaco, 
the well-known antidote to all snake-poisons. 
In 1854, Dr. Humboldt made his experiments of inoculation on a 
large scale, in Cuba, under the auspices of the Governor General. 
Symptoms produced by Inoculation, as modified by the Gua- 
co.—At the moment of inoculation, vertigo, which soon passes away 
nervous trembling, which is rarer, but lasts a long time. 
After seven hours the pulse is permanently modified; it is either too 
frequent or too slow, stronger or weaker. In eleven hours there is 
febrile heat. At the end of fourteen hours, headache, want of appe- 
tite, thirst. At the end of sixteen hours, red countenance, injection 
of the conjunctiva, epiphora. 
The swelling of the gums is observed from the commencement, to 
which are added slight colic-pains produced by the remedy (Guaco), 
which the patient has taken immediately after inoculation. 
At the end of eighteen hours, pain in the gums, the margins of which 
redden round the teeth ; pain of the salivary glands and in the direc- 
tion of the different nervous branches of the face and teeth. 
In nineteen hours, pains in the lower jaw, and in the direction of the 
submaxillary nerve ; lassitude. 
In twenty hours, bitter taste ; drowsiness, coryza, and oedema of the 
face. 
In twenty-two hours, constrictive sensation of the throat, without 
visible alteration of the mucous membrane. 
In twenty-three hours, yellow jaundice. In twenty-four hours, hse- 
morrhage from the gums. 
In twenty-eight hours, yellowness of the sclerotica, and shivering. YELLOW FEVER. 
581 
In twenty-nine hours, angina tonsillaris. In thirty hours, pain in 
the kidneys. 
In thirty-six hours, swelling of the eyelids. In thirty-eight hours, 
pain of the muscles and joints. 
In forty hours, toothache. In seventy-two hours, swelling of the 
lower lip. At different hours, sexual excitement. During convales- 
cence, itching of the cuticle ; cutaneous eruptions of various kinds. 
The inoculation always produced a decided effect on the pulse. In 
those who had naturally a quick pulse the inoculation caused a dimi- 
nution of its frequency, while it accelerated the pulse in those in whom 
it was naturally slow. On the whole, the number of cases in which the 
pulse was diminished was greater than that in which it wras accele-: 
rated in proportion of sixty-two to twelve. There was also a notable 
weakening of the force of the pulse in every case. 
Headache was one of the most common symptoms. It lasted on an 
average twenty-one hours. It was usually seated in the frontal and 
orbital region. Increased heat of skin in all, whether the pulse was 
increased or diminished in frequency. 
Deglutition was difficult in all cases, the tongue coated in most. 
Itching of the skin was complained of after the acute symptoms had 
subsided. 
Manzini, the reporter of Humboldt’s experiments, arrives at the con- 
clusion that “ the inoculations produce a portrait of the most important 
phenomena of yellow fever. These consist of an expression of counte- 
nance of a peculiar kind, similar to that in eruptive forms ; to which 
is joined a drunken appearance in the eyes, which are injected; after 
which come headache and pain in the loins, the changes in the gums, 
and, later, the jaundice, the hemorrhages, and suppression of urine.” 
From the work of Dr. Neidhard, of Philadelphia, On the Efficacy 
of Crotalus-horridus in Yellow Fever,” &c. (New-York, Radde, 1860), 
we learn that the inoculations of Humboldt embraced 2477 individuals 
belonging to the Royal Army and Navy. The exact result of this is 
not given. On page 77 it is stated that “out of 701 inoculated at the 
Military Hospital, 121 were attacked by yellow fever, of whom 47 died.” 
Whether the inoculation was successful or not in its object, it at 
least furnished us with a well-defined group of symptoms, closely re- 
sembling yellow fever. 
Dr. Neidhard had only the opportunity of observing the results of 
Crotalus on five cases during the epidemic of 1853 ; but the good 
effects he observed in these cases, from the use of Crotalus in the 
second and third trituration, leads him to believe it to be the sovereign 
remedy in yellow fever. He employs it only in triturations, as alcohol 
destroys the virus. He also had the opportunity of employing it in a 
few cases in 1858, where it was again efficacious, except in the case 582 
DISEASES OF THE SANGUINOUS FUNCTION. 
of one patient, whose constitution had been undermined by intempe- 
rance, having taken six or seven glasses of brandy per diem. 
Diet.—Arrow-root, rice water, black tea with a little sugar and 
cream in it, are proper in the first stage, as well as the second in 
which canine hunger is sometimes distressing. A teaspoonful of pure 
cream, at considerable intervals, is safe and agreeable. Small quan 
tities of ice at a time, held in the mouth, relieve the thirst. 
The results of homoeopathic treatment are well shown by the expe- 
rience of Drs. Holcombe and Davis in Natchez, in 1853. The former 
treated 140 cases of unequivocal yellow fever, losing 9 cases. Dr. F. 
A. W. Davis, who is called by Dr. Holcombe “the able pioneer of ho- 
moeopathy in this region,” treated 415 cases, of which 24 died. In 
subsequent years these cases were extended to 1016 cases in all, of 
which 55 died, equal to a mortality of 5.4 per cent. 
6. COLD PLAGUE.—Pneumonia Typhoides. 
This once dreaded epidemic has presented itself under different as- 
pects in different parts of the American republic, and has now become 
so far domesticated as to have lost its original specific character. 
Its first appearance was in Connecticut, in 1771; and next in Vir- 
ginia, in 1796. In 1812 it made its appearance in New-York and 
several of the New-England States ; and about 1814 spread over the 
new States of the West. In subsequent years it grew milder or less 
decided in its characteristic features, and attracted less attention. As 
late as 1823-4 some cases occurred in Missouri. Wherever it ap- 
peared all diseases immediately assumed its peculiar livery, and fre- 
quently terminated in death unexpectedly. 
The Typhoid Pneumonia, called “ cold plague,” from the coldness 
and torpor of the skin in its first stage, was a pneumonia combined 
with a remittent bilious fever of a typhoid type. Sometimes the pneu- 
monic feature predominated, sometimes those of typhus fever. 
Symptoms.—The disease began with a chill of unusually long dura- 
tion, and the danger was generally proportioned to its length. Some- 
times there was sudden prostration of strength and perfect torpor of 
the skin. Sometimes there was congestion of the lungs, evinced by 
violent pain in the chest, difficulty of breathing, pain in the back, and 
in some one or all the limbs ; nausea and vomiting of bilious matter; 
usual symptoms of bilious fever; yellow eyes, skin, and tongue ; others 
had a dysenteric disease. But generally the pneumonic symptoms 
were the most alarming. The pain in the chest extremely acute in some, 
was only a heavy stricture and heaviness in others, with difficulty of 
respiration. The tongue at first coated with white, with yellow middle 
and lively red at the edges. Cough; expectoration tinged with blood. COLD PLAGUE. 
583 
In other cases the chest was less affected, hut the symptoms showed 
extreme debility, disposition to syncope. The heat of the skin was 
sometimes diminished, seldom increased. The pulse was in many 
cases little altered, in others, it was slow, remittent, depressed ; or, if 
frequent, not tense, but feeling like an elastic tube partially filled. 
The bowels were generally constipated, even when dysentery attended. 
The head was painful, delirious; there were false perception ending in 
stupor. Sickness of stomach and vomiting. 
Diagnosis.—This was always sufficiently clear upon observing the 
chief symptoms already given, and recognizing the fact of the preva- 
lence of the epidemic. In sporadic cases the decision might not be 
positive, but the features of prostration and coldness of the skin, long 
continued, were characteristic. 
Causes.—The only remote cause must be sought in a peculiar epi- 
demic state of the atmosphere, which can not be explained. It cannot 
depend on anything that is common to all places where the disease 
appeared, for it extended over large tracts of country in which no gene- 
rally prevailing causes of disease could exist. Wherever its influence 
reached, all the inhabitants who lived within the territory invaded, 
became subject to some diseases bearing some part of its general 
character. Where it prevails it may be excited by all the usual 
causes of disease, which in some other situation would cause fever, 
ague, dysentery, pneumonia, or other disease. It is most likely to 
commence in warm damp weather; to attack those who live on poor 
diet, or wear insufficient clothing; young persons exposed in bad 
weather, or who have been debilitated by previous disease, are pecu- 
liarly liable to attack. But no class of persons can claim exemption 
from its power. 
Pathology.—Dissection has shown the heart and large vessels, and 
particularly the lungs, engorged and distended with blood. The air 
cells were so congested that the air could not come in contact with the 
minute ramifications of the bronchia. This peculiar congestion of the 
lungs was the chief cause of sudden death in most cases. When life 
was prolonged a sufficient time it ended in inflammation. Congestion 
of the other viscera, ending also in inflammation, existed in bad cases 
in which the lungs suffered less. In all of these its pathology was 
almost identical with that of typhus fever. 
Prognosis.—This was favorable if the treatment commenced early; 
but this was not general, and a large proportion, perhaps nearly one- 
third of the persons attacked, died. Among the unfavorable signs 
were : Heavy stupor and coma, in a case that had commenced with a 
protracted cold stage, with slow reaction ; tongue covered with dark 
brown crust; purple or bluish spots about the lips, breasts, and arms, 
giving the disease the name of “ spotted fever.” 584 
DISEASES OF THE SANGUINOUS FUNCTION. 
Treatment.—On this point it is only necessary now to refer to the 
remedies given below, and to the treatment of congestive malarial 
'ever, p. 513. 
7. PNEUMO TYPHUS. 
The medicines which have proved most efficient in this form of dis- 
ease are : Aconite, Bryonia, Phosphorus, Ammonia-carb., Acid- 
phosph., and Merc.-viv. When the affection is characterized by 
accelerated circulation, great heat of skin, thirst, difficult, anxious, 
short, and rapid breathing, with painful stitches in the chest and side, 
when inspiring; cough on motion; full, hard, and rapid pulse, Aconite 
should be administered. A dose of the third dilution, every hour or 
two, until an impression is made upon the symptoms. 
After Aconite has been administered, and symptoms remain unsub- 
dued, it wdll be necessary to resort to some of the following remedies, 
the instructions for which wTe proceed to describe. 
Bryonia.—Symptoms the same as under cerebral typhus, p. 545. 
Physical Sensations.—Confusion, fullness, heaviness, and swimming 
in the head ; headache, aggravated by movement or opening the eyes; 
respiration difficult, short, anxious, rapid, or sighing ; oppression of the 
chest; stinging in the chest when coughing or breathing deeply. 
Shooting pains in the chest, side, and abdomen ; pains in the limbs on 
movement; nose swmllen, dry, and painful to the touch ; throat dry, 
with sharp pains when touched or in motion ; nausea and oppression 
at the stomach ; constipation and diarrhoea alternating, the one in the 
night, the other during the day; urine scanty and high colored ; cough, 
with stingings and stitches in chest and side, with yellowish or bloody 
expectoration, or pains in the head; shooting pains under the left 
shoulder-blade when coughing; tongue dry, contracted, dark, or yel- 
low ; pulse rapid and full, or quick, weak, and irregular. 
Administration.—Same as under cerebral typhus, p. 545. 
Phosphorous. External Indications.—Yellow, brown, coppery, or 
bluish spots upon the skin; viscid secretion about the eyes, particu- 
larly at night; quivering of the eyelids ; dryness and obstruction of 
the nose ; face pale, dingy, or red and bloated ; eyes sunken and sur- 
rounded by a dark circle ; lips dry and bluish ; ulcers at the corners 
of the mouth ; tongue with a dry and dark, or whitish fur; pulse quick 
and hard. 
Stunning headache, vertigo, and dizziness, worse in the morning; 
smarting or burning sensation in the eyes ; throbbing in the ears; 
deafness ; offensive discharge from the nose ; dryness and raw sensa- 
tion in the throat; nausea and pains in the stomach ; uneasiness and 
painful contraction of the abdomen ; stitches and roughness in the PNEUMO TYPHUS. 
585 
chest; expectoration of mucus, slimy, sanguineous, or purulent matter; 
sharp pains in the shoulder-blades ; stiffness of the neck ; trembling, 
coldness, and numbness of the limbs ; great oppression at the chest, 
with distressed and anxious respiration. 
Mental and Moral Symptoms.—Despondency, anguish, and fear, 
especially at night; disposition to weep or laugh. 
Administration.—A drop of the third dilution in an ounce of water; 
a dessert-spoonful once in two to six hours, until an effect is percep- 
tible. 
Ammoniunb-carl).—Miliary eruptions, or redness of the skin; eyes 
dry; nose obstructed with dry coryza.; face pale and bloated; lips 
dry and dark colored ; faeces in small hard lumps ; respiration short 
and anxious ; breath offensive ; tongue covered with slime or vesicles; 
pulse weak and rapid. 
Great restlessness at night; drowsy during the day; disturbed sleep 
at night, with frightful dreams ; pains in the head; nausea; ringing in 
the ears, worse at night; sensation of excoriation in the mouth and 
throat; constant thirst; constipation and itching at the anus ; fre- 
quent desire to urinate during the night; hoarse, or short dry cough, 
with tickling and roughness in the throat; mucous and sanguineous 
expectoration; sharp pains in the chest and sides, on coughing, breath- 
ing, or moving; drawing pains in the nape of the neck and small of the 
back; extremities stiff and numb ; cramps, coldness, and swelling of 
the feet; excessive weakness of the limbs ; right side worse than the 
left. 
Discouragement; anxiety; oppression ; anguish ; sad, weak, timid; 
mental distress, worse at night. 
Administration.—A grain of the first trituration every two, four, or 
six hours, as the nature of the case requires. 
Acidum-phosphoricum.—Eruption of small pimples on the skin; 
redness of the skin; coma; eyes dull, glassy, fixed, with pupils dilated; 
coryza, with redness of the nostrils ; face pale, or covered with pimples; 
teeth yellow; gums swollen and bleeding; tongue covered with thick 
and adhesive mucus ; faeces hard, knotted, and slimy; urine clear or 
white, depositing a white sediment; pulse quick and weak. 
Great physical and mental prostration ; pains in the chest, abdomen, 
and head, worse during repose, relieved by motion; head confused, 
bewildered, with pains when moving it; eyes weak and sensitive to 
candle-light; music painful to the ears ; cheeks hot and burning; 
nausea and oppression at the stomach; diarrhoea; frequent inclination 
to urinate ; tightness and oppression in the chest; cough, with puru- 
lent expectoration ; sharp pains in the chest; burning sensation in the 
hands and feet. 
Indifferent, taciturn, peevish, stupid. 586 
DISEASES OF THE SANGUINOUS FUNCTION. 
Administration.—Suitable in some cases of advanced pneumo-ty 
phus. A dose of the third dilution may be given once in four to six 
hours. 
The following medicines may be named as appropriate under certain 
circumstances in pneumo-typhus, viz.: Lachesis, Tart.-emet., Senega 
Mercur., Lobelia-injlata, Rhus, Arsenicum. 
8. HECTIC FEVER. 
Diagnosis.—The ordinary symptoms of this fever are : daily febrile 
paroxysms, general debility, emaciation; skin pale, face often tinged 
with the “ hectic flush,” irritable stomach, loss of appetite, moderate 
thirst, night sweats, tendency to perspire through the day, diarrhoea, 
pulse quick, small, and sharp. 
Causes.—The combination of symptoms denominated hectic fever 
in most cases, proceed from long-continued and profuse suppuration, 
but they may arise from protracted local irritation without suppura- 
tion. Some writers suppose that hectic can only proceed from the 
absorption of pus; but this is erroneous, as the symptoms of hectic 
often make their appearance before suppuration occurs. In nearly all 
instances it is a secondary affection, consequent upon either protracted 
disease in some vital part, some of the joints, or of some extensive sur- 
face. It proceeds more readily from diseases of the “bones, ligaments, 
and tendons, than from those of the muscles, skin, cellular membrane, 
&c.” {Sir A. Cooper.) 
It may, then, be considered as a constitutional disturbance, origi- 
nated and kept up by some previous local disease, and which cannot 
be permanently cured until the original cause upon which it is depen- 
dent is eradicated or removed. 
In those cases where it is kept up by the incurable diseases of the 
joints, bones of the extremities, or other parts which can be safely re- 
moved by the surgeon, amputation or excision should be at once re- 
sorted to, and the hectic symptoms will speedily disappear. Mr. Hun- 
ter remarks that “ a hectic pulse at one hundred and twenty has been 
known to sink to ninety in a few hours after the removal of the hectic 
cause.” Several instances have occurred in our own practice in which 
an almost immediate and entire cessation of the hectic symptoms, such 
as sleepless nights, febrile paroxysms, night sweats, diarrhoea, rapid 
pulse, &c., has resulted from amputation or excision of the offending 
parts. , 
When the original cause is a suppuration of some important organ, 
like the lungs, liver, stomach, &c., our prognosis must generally be 
unfavorable. In these instances it is of the utmost importance to the 
homoeopathic practitioner that he make a thorough investigation of ERUPTIVE FEVERS. 
587 
all remote causes, in order to arrive at an accurate knowledge of the 
latent and original sources of the malady. He will thus be able to 
direct his remedial applications with judgment, and afford to his pa 
tients the only possible chance of cure. 
Treatment. -In the selection of remedies everything must of ne 
cessity depend upon the original cause—its seat, nature, and violence 
and upon the secondary consequences to which it gives rise. It should 
always be a prime object to direct our most potent remedies with per- 
severence against the local affection, and if any latent or apparent in- 
fluences exist, against these also. 
If we are called to a case of hectic fever, proceeding from an inflam- 
mation of a scrofulous character, advantage will be derived from the 
use of some of the following medicines : Sulphur, Aurum-mur., Cal- 
carea, China, Iodine, Ol.-jecor.-asel., Acid.-nitr., Acid.-mur., 
Acid.-pKos., Phos., Arsenicum, Silicea, and Mercurius. 
In cases proceeding from syphilitic or mercurial diseases of the 
bones, ligaments, &c., the medicines adapted to the cure of these dis- 
orders should be selected. 
If a chronic miasm, whether psoric or otherwise, originated the dis- 
turbance, then strike deeply at the original cause with anti-psorics 
as well as at present symptoms, and good results may accrue in appa 
rently desperate cases. 
ORDER II.—EXANTHEMATA. 
Eruptive Fevers. 
Genus I—FEBRILE CUTANEOUS DISEASES. 
The general characteristics of the exanthemata are derived from: 
1. The presence and course of the accompanying fever. 
2. The course of the eruption, which is very likely to be symmetri- 
cal on both sides of the body. 
3. From the law of universal susceptibility. 
4. From the law of contagious origin. 
5. From the law of non-recurrence. 
6. From the law of epidemic diffusion. 
The fever is almost always inflammatory, as in nineteen-twentieths 
of the cases of small pox and measles. Low nervous fever charac 
terizes scarlatina and erysipelas. Malignant fever appears in 
cases of small-pox and scarlatina. 
Origin of Eruptive Fevers.—It was believed long before the dis- 
covery of vaccination that eruptive fevers were originally derived from 
cattle. As late as 1844 small-pox, measles, and scarlet fever were 
unknown in Australia and Tasmania. 588 
DISEASES OF THE 8ANGUINOUS FUNCTION. 
Communication by Contagion.—The infective poison or materia 
'■ morbi may obtain access to the human body by three modes : 
1. By inhalation of air tainted by the breath or perspiration of the 
patient. This is called infection, and is seen in small-pox, measles, 
plague, typhus, scarlatina. 
2. Miasms gain access by solution in the fluids or humors, and sub- 
sequent application to the unbroken surface. In this way psora, tinea 
capitis, gonorrhoea, and venereal disease are communicated from one 
person to another. This mode is called contagion, a contactu corpo- 
ris. In this case the materies morbi must be dissolved. The germ 
of disease is conveyed in the fluid form into the interior of the frame, 
where it mixes with and taints the blood. 
3. Some of the morbid poisons are not admitted into the body unless 
they are applied to an abraded or wounded surface. Of this kind are 
hydrophobia, vaccinia, farcinoma or glanders. 
Dr. Farr, in his Fourth Report proposes to call “all those diseases 
which have the property of communicating their own action and affect- 
ing analogous transformations, zymotic diseases (from £iytow, to fer- 
ment), and the disease itself zymozio. Zymotic diseases will compre- 
hend all those associated under the names of epidemic, endemic, and 
contagious maladies.” 
One remarkable characteristic of zymotic miasms is, that they operate 
upon the healthy body without the aid of predisposing causes. A man 
in perfect health contracts small-pox or measles ; and this state of the 
body is the best possible for insuring the success of inoculation and 
vaccination. There are then no predisposing causes of these diseases. 
“ All miasms of animal origin are capable of attaching themselves 
to fomites, and (provided they be excluded from the air,) of retaining 
their communicating property to a considerable length of time. This 
great law of nature is of universal application, and is the foundation 
of that important practical measure, quarantine. Thus tinea capitis 
spreads by means of hats, combs and brushes; Egyptian ophthalmia 
by towels and sponges; small-pox and typhus by clothes and bedding * 
plague by personal apparel, and all rags or substances of rough surface 
or downy texture. Forty days was formerly considered a sufficient 
period to permit the poison to develop itself into an active form; it is 
now known that the incubative stage of the plague never exceeds seven 
days. Therefore a week of quarantine would be sufficient; and two 
weeks should satisfy the most scrupulous anxiety. The poison may be 
carried in clothes of wool, cotton, leather, every kind of apparel. Me- 
tallic substances can not harbor contagion. 
Each year is distinguished by the supremacy of some master-epide- 
mic of either small-pox, measles, scarlatina, whooping cough, erysipelas. 
In some years, says Dr. Gregory, more die from one of these diseases, 589 
ERUPTIVE FEVERS. 
in another year from another; but it is observed that about the same 
number in the aggregate die each year; as putting all together, 350,000 
must annually die in England and Wales. The question has been 
asked, “ Why this vicarious mortality ?” It is answered that “ the 
sickly hot house-plants of the nursery must be weeded out. If they 
don't die of one epidemic they must of the next.” 
Effects of the Matter of Contagion on the Human Organism.— 
1. Palpable Contagions.—In every form of parasitic, fungous or 
mere cell organization the poisons which are capable of reproducing 
themselves in the body have the power of exciting the most fearful 
commotions in its various organs. The lo-wer organized beings of both 
the animal and vegetable world are always developed in the midst of 
previously existing disorganization, putrefaction, impurity. When trans- 
planted to any soil suitable for their growth and propagation, they are 
always deleterious though they differ in the degree of their malignity. 
The injury caused by the lichens and mosses to trees on which they 
grow may be small. The strength of the live-oak of the South allows 
it to spare without perceptible injury the small amount of sap needed 
by the creeping tillandsia usneoides. A considerable degree of health 
may exist in persons whose intestines are infested with the lumbricus 
or other parasites. But we think they are always deleterious to some 
degree ; and, generally, they are highly, fearfully so ; and “ many dis- 
eases are proved to be dependent upon or arise from parasites.” (Mit- 
chell.) Some parasites are peculiar to the human body, and have never 
been found any where else. In some diseases the true materies morbi 
is believed to consist of minute parisitic animalcules, and in other 
diseases the poison is found in the form of minute fungous plants. 
Either when transplanted into a human body, “ finds,” says Dr. Dickson, 
“ in the diseased body its nidus, its soil, its local habitat; its trans- 
ference to a healthy body is followed by the production of such disease 
as fosters it and propagates and multiplies it infinitely.” 
A malignant, diseased or contagious cell, such as we have in a case 
of cancer, is always found in the animal body in connection with that 
specific form of disease. When it is transplanted to another body it 
can commence the work of multiplying itself or of transmitting the 
materials of growth and supply into a pernicious organized structure, 
every new cell of which will be like itself, and like it capable of self- 
multiplication. This mode of vegetable increase and germination has 
been supposed to be really a form of fermentation. In the case of 
each specific poison there is a peculiarity which distinguishes it from 
all others. See Cancer. 
2. Impalpable Contagions.—These are known only by their power- 
ful effects, being always invisible and imponderable, but efficiently 
active at considerable distances. They are chiefly, perhaps entirely, 590 
DISEASES OF THE SANGUINOUS FUNCTION. 
confined to the febrile class of contagious or infectious diseases, whereas 
none of the non-febrile contagions are diffusible in the air, but require 
contact. In small-pox the atmosphere of the patient becomes charged 
with contagious atoms, which have been eliminated from the body and 
adiated from it. In some instances it may be supposed that the ani- 
mal exhalations accumulating among the densely crowded population 
of cities, furnish all the elements essential to the germination and 
growth of the organic germs, whether fungous or animalcular, of which 
contagion consists; they may then multiply and propagate themselves 
in the atmosphere, and may extend widely, promptly among the crowded 
population of large cities. Diseases commonly contagious or infectious 
within short distances only, are then said to become epidemic, pesti- 
lentially prevalent. Healthy bodies may be infected in great numbers 
without any known approach to a diseased body. Dr. Dickson says, 
in 1847-48 he “attended forty patients with small-pox,” not one of 
whom had been exposed to it. In none of these did it arise sponta- 
neously ; the seeds of the disease w'ere imported from abroad. Among 
the diseases which display contagion in both the palpable and im- 
palpable forms, we may enumerate small-pox, plague, erysipelas, hos- 
pital gangrene, varicella, scarlatina, measles, and some others. Glan- 
ders which always originates among horses, may be communicated 
among them by inoculation as well as by diffusion in the air; in com- 
mon with vaccine and hydrophobia it is communicable to man only by 
inoculation or direct contact to an abraded surface. (Amer. Jour. 
July, 1849, p. 107-118.) 
3. Zymotic Diseases which are always Epidemic and sometimes 
Contagious.—Here we may enumerate typhus, pertussis, puerpural 
fever, infectious dysentery, yellow fever, and cholera Asiatica. These 
diseases are all possessed of separate specific characters, are capable 
of diffusion in the atmosphere as epidemics; though they are contagious, 
at least communicable in some degree; they are self-multiplying; and 
the specific poison of each is capable of exciting its own peculiar fer- 
mentation by which it can radiate from a single centre the germs by 
which thousands can be infected from a single centre. 
1. SCARLATINA.—SCARLET FEVER. 
This fever has been divided into three varieties, namely: 
1. Scarlatina simplex/ 2. Scarlatina anginosa ; 3. Scarlatina 
maligna. 
In its simple form scarlet fever is not attended with danger, but runs 
its course mildly like a simple continued fever, and terminates in five 
or six days in convalescence. 
In the other varieties, however, inflammations and congestions often 591 
SCARLET fever. 
supervene soon after the attack, and if not promptly met by suitable 
remedies, gangrene, sloughing and fatal disorganizations occur in the 
throat, larynx and other important parts of the organism. 
Scarlet fever is of much more frequent occurrence in the fall and 
winter than during the summer months. Its attacks are usually con- 
fined to children that have passed the nursing period, and persons under 
twenty years of age; but it may occur at any time of life from infancy 
to old age. 
l. scarlatina simplex. 
Diagnosis.—Shiverings, succeeded by heat, moderate thirst, frequent 
pulse, slight soreness of the throat, nausea, loss of appetite, headache. 
After these symptoms have continued about forty-eight hours, a scar- 
let eruption makes its appearance upon the face, extending gradually 
downwards to the neck, trunk and extremities. This eruption consists 
of an immense number of fine pimples, (aptly compared by Dr. Arm- 
strong to a boiled lobster shell,) either running together and diffusing 
themselves uniformly over the skin, or appearing in patches in different 
parts of the body. Upon the appearance of this eruption many un- 
pleasant symptoms, as nausea, oppression at the stomach, dyspnoea, &c., 
abate, and the case then progresses until the fourth or fifth day of the 
fever, when desquamation of the cuticle takes place, and a happy con- 
valescence usually ensues. 
II. SCARLATINA ANGINOSA. 
Diagnosis.—The anginose variety of scarlet fever is ushered in with 
chilliness and shiverings, succeeded by intense heat and pungency of 
the skin, frequent and hard pulse, nausea, vomiting, headache, sore 
throat, painful deglutition, intense thirst, pain and tenderness of the 
epigastrium, abdomen tender; pain and stiffness of the neck; tongue 
covered with a whitish or yellowish fur, through which the papillae 
are seen red, inflamed and prominent; fauces, throat and tonsils swol- 
len, deep red, inflamed or ulcerated; eyes red and injected; voice thick 
and hoarse; sometimes dyspnoea and cough, and universal tenderness 
of the whole surface. 
These symptoms continue for an indefinite period, varying from two 
to five days, when the eruption shows itself, being uniformly diffused 
over the body; the skin desquamates in from six to eight days from the 
commencement of the fever, the febrile symptoms all subside, the ulcers 
in the throat granulate kindly, and a speedy convalescence obtains. 
On the contrary, if the eruption prematurely disappears from the sur- 
face, the ulcers assume a foul and unhealthy appearance, secreting an 
an acrid and highly irritating fluid; while the fever continues to rage 
with unabated severity, we may have a supervention of abdominal, 592 
DISEASES OF TIIE SANGUINOUS FUNCTION. 
bronchial, or cerebral inflammation, which will complicate the malady 
in a serious and perhaps fatal manner. 
“ In this fever,” says Dr. Southwood Smith, “ the temperature, as in- 
dicated by the thermometer, rises several degrees higher than in any 
other.” The pulse is also more rapid and strong than in almost any other 
fever, indicating conclusively that it is an affection of an inflammatory 
character. 
III. SCARLATINA MALIGNA. 
Diagnosis.—Scarlatina maligna was formerly known in some parts 
of our country under the name of “ putrid sore throat,” and is at present 
designated by some writers as scarlatina typhoides. It is unquestion- 
ably one of the most dangerous maladies with which the physician has 
to contend. It generally commences with the common precursory 
symptoms of the anginose form, which, however, very soon give way to 
a train of symptoms bearing a close resemblance to typhus. The 
eruption is either entirely wanting, or makes its appearance only par- 
tially, in irregular blotches of a pale color; the heat of the skin often 
subsides below the natural standard; the pulse becomes very frequent 
and weak; the countenance assumes a besotted expression; the eyes 
become dull and suffused; the throat is filled with ash-colored ulcers; 
fauces, larynx and bronchia inflamed and swollen; an acrid discharge 
issues from the nostrils; the tongue, at first red, soon becomes dry and 
black; the surface in the advanced stages acquires a dark red oi 
mahogany color, and petechia, diarrhoea and haemorrhage finally ensue 
The ulcers in the throat often slough, and extend in all directions, in- 
volving in their ravages the cartilages of the larynx and the soft parts 
within the nostrils. 
If the disease seizes particularly upon the brain, lungs or abdominal 
viscera, there will be a predominance of those symptoms which charac- 
terize the disorders of these particular parts. From the tendency of 
this malady to these different organs, some authors have subdivided 
scarlatina maligna into the inflammatory, congestive, and mixed varie- 
ties. Examples have occasionally occurred in our own practice, in 
which, in the very onset of the malady, those symptoms have appeared, 
indicating congestion of the brain,—as coma; slow, oppressed and 
noisy respiration; sighing; face pale or livid; skin cold; pulse slow 
and irregular; pupils contracted or dilated. In these cases the erup- 
tion seldom comes out well, but is of a pale color, and shows itself 
irregularly in different parts of the body. 
In other instances the inflammation seizes upon the laryngeal, bron- 
chial, or intestinal mucous membranes, thus often deciding the case 
against the patient, when the local affection of the throat seemed to 
be progressing favorably. SCARLATINA. 
593 
Causes.—Scarlatina can only proceed from a specific morbific con- 
tagion, respecting the nature of which we are entirely ignorant. 
Whether this contagion is generated and diffused solely by those suf- 
fering under the disease, or whether, as some pathologists assert, it may 
be generated in the atmosphere independently of the animal body, is 
a question which admits of discussion, although we entertain the former 
opinion. Of this we are confident, that when the agent is infinites- 
sirnally diffused in the air, it is capable of being absorbed into the 
circulation or at least of making its morbific impression on the sentient 
extremities of the nerves of the air-passages, and thus producing its 
specific effect on the organism. 
Some have doubted the contagiousness of this affection, because 
certain individuals of families occasionally escape, while others are 
affected; but let it be remembered, that this happens now and then in 
small-pox, plague, typhus, and all other maladies which are universally 
deemed contagious. 
We have before observed, that the contagion of typhus can not make 
a serious impression upon the organism, so long as every part is in a 
state of perfect health and vigor. The same remark will apply with 
equal truth to scarlatina. In these cases the tissues on which the 
poison operates are stronger than the noxious influence, and are thus 
enabled to resist its action until some cause predisposes the system to 
receive the impression. 
Treatment.—Belladonna.—The provings of Belladonna upon the 
healthy subject, as well as the numerous successful experiments made 
at the bed-side of the sick, have stamped it as a remedy of distin- 
guished importance in the treatment of scarlet fever. It has even 
been extolled by eminent practitioners of the old school, and in some 
instances adopted, both as a remedy in this disease and as a valuable 
prophylactic against it. 
In scarlatina simplex, an occasional dose of this medicine at the 
third attenuation, will suffice to conduct the patient safely through the 
malady. Should the fever run high, the Belladonna may be advan- 
tageously preceded by Aconite. 
In the anginose form, where there is intense inflammatory excite- 
ment, swelling and soreness of the throat, painful deglutition, quick 
pulse, burning hot skin, nausea, tenderness of the epigastrium, Bella- 
donna is still the grand remedy. If the fever assumes a violent cha- 
racter, evincing a tendency to excite the inflammatory action in any 
particular structure, Aconite may here also be administered with ad- 
vantage, either by itself, or in alternation with Belladonna. So long 
as the local inflammation in the throat is retained within due bounds, 
and the eruption sIioavs itself in a proper manner, remaining out a 
sufficient length of time, we shall receive ample aid from these potent 
You i.—38. 594 
DISEASE OF THE 6ANGUINOUS FUNCTION. 
remedies. The following special symptoms of Belladonna are given 
by Drs. Curre, Hermann, Laurie, &c.: 
Spots of a scarlet or deep red color on the face, or other parts of the 
body; swelling of the submaxillary glands, and those of the neck; 
eyes red, sparkling and convulsed, or fixed, shining and prominent; 
pupils dilated or contracted; tongue red, hot and dry, or white in the 
centre, with red edges; throat, tonsils, uvula and velum-palati dry, in- 
flamed and swollen; suppuration of the tonsils; strong pulsations of 
the temporal arteries; inflammation of the stomach and abdomen; 
constipation, or involuntary evacuations; urine turbid, of a brownish 
red or yellow color with a red or whitish sediment; pulse small and 
quick, or strong and quick, or full and slow, or small and slowT, or hard 
and tense ; pulsations of the carotids; face hot, red and bloated; 
sweat with the heat, or after it. 
Vertigo, confusion, fullness, heaviness, pressure; shooting or expan- 
sive pain in the head, aggravated by motion of the head or eyes, by 
contact, and by cold air, mitigated by holding the head back, and by 
supporting it; mouth dry and hot; dryness and burning in the throat, 
with painful and difficult deglutition; loss of appetite; nausea and 
vomiting; great thirst; sense of fullness and distention in the stomach 
and abdomen after eating; drawing pains in the back and shoulders; 
difficult respiration ; violent cough; shiverings, alternating with heat, 
or followed by heat, worse in the evening or night; adypsia, or exces- 
sive thirst; dry, burning heat. 
Great agitation and tossing about; anguish and inquietude in the 
afternoon and night; delirium, with muttering groans and cries; vivid 
and frightful dreams ; starting from sleep with fright, groans and cries; 
ill humor and irritability. 
In the seven cases, given by Pereira,* of poisoning by Bell., the 
symptoms seen were : “ Dryness of the fauces, causing excessive diffi- 
culty of swallowing and alteration of the voice; second, scarlet erup- 
tion on the arms and legs. The boyf at Guy’s Hospital poisoned with 
Belladonna-berries had swollen face, throat hot and dry, hands and 
face flushed; could not swallow. The man, aged seventy-five years, 
who took four or five grains extract of Bell, by mistake, lost the power 
of articulation ; mouth and fauces as dry as a chip. The chief action 
of the Belladonna was on the medulla-oblongata.J In the case re- 
ported by Mr. Wade,§ the extract locally applied, caused “the mucous 
membrane from the posterior third of the palate, as far down as could 
be seen, to show a deep crimson color, and the tonsils were much en- 
larged.” Christison speaks of “ redness of the throat” in one case, 
* Materia Med. Late Editions. f Taylor on Poisons. 
| Provincial Med. avid Surg. Association Proceedings. 
$ Lond. Med. and Pkys. Journal. Apr. 1827. SCARLET FEVER. 
595 
and aphthous inflammation of this part in two others. It seems there- 
fore that this dryness of the throat is the result of the arrest of secre- 
tion which accompanies congestion and inflammation, and that Bella- 
donna is a tissue irritant to this portion of the alimentary mucous 
membrane. Hence its therapeutic value in various forms of angina. 
Irritation of the Shin caused by Belladonna *—It produces simple 
redness, redness with swelling, (usually in the face,) or scarlatinoid 
eruption. 
Homoeopathic use.—Belladonna easily cures erythema, simple non- 
vesicular erysipelas. Carbuncle, furuncle, and whitlow, are all of an 
erysipelatous nature, and all require Belladonna. Puerpural fever is 
partially under the control of Belladonna; and this curative power in 
this disease depends on the disease being related to erysipelas, having 
its location in the peritoneum. In scarlatina the essential symptoms, 
the rash, the angina, the delirium are under its control, the fever 
and renal inflammation are beyond its control. Its prophylactic power 
in this disease arises from the power all specifics possess of previously 
occupying the ground; thus all becoming prophylactic of those dis- 
eases in which they are curative, as Quinine is of ague, Cuprum of 
cholera, and Mercury of syphilis. 
Antidotes to Belladonna poisoning.—Mineral alkalies—Ammonia, 
Potash, Soda, Opium. Its most nearly related medicines: Hyoscyamus 
and Stramonium. The three are thought by some chemists to possess 
a common active principle, like Ignatia and Nux-vomica. Opium is 
now regarded as the most certain antidote to the poison of Bella- 
donna as well as Aconite. See p. 514. 
Aconite.—Face red, hot and bloated, or alternately red and pale; 
skin dry and hot; forehead cold, and tips of the ears hot; deep red- 
ness of the throat; bilious or mucous vomitings; urine scanty, deep 
red, with brick-colored sediment; pulse hard, frequent; respiration 
rapid and difficult. 
Physical Sensations.—Oppression or throbbing in the head, aggra- 
vated by motion; talking, rising up, &c.; better in the open air; great 
sensibility of affected parts to the touch, or on movement; pains in the 
joints and limbs ; fainting and weakness; extreme thirst; coldness of 
the surface; with internal heat, or burning over the whole body; pain 
in the throat in swallowing; bitter or putrid taste; loss of appetite; 
sense of swelling, weight or pressure in the praecordial region; hot 
and burning urine; bruised pains in the loins, back, and nape of the 
neck. 
Discouragement and agitation ; noise appears insupportable; humor 
changeable; at one time sad, depressed, irritable, contradictory, des- 
* Dr. Richard Hughes. 596 
DISEASES OF THE SANGUINOUS FUNCTION. 
pairing, at other times excited, gay, and full of hope; inquietude under 
disease, and even despair respecting a cure. 
Ipecacuanha.—If there is slight fever through the day, but an in- 
crease in the evening, with sleeplessness, sadness, despondency, and 
tears, Ipecacuanha is our remedy. 
Face pale, sallow, yellowish, and bloated, with livid circles around 
the eyes ; tongue loaded with a white or yellowish fur; profuse secre- 
tion of saliva; vomiting of green bilious, acid, slimy, or gelatinous 
matter; sweat; foetid breath ; turbid urine, with sediment like brick-dust. 
Nausea and vomiting of drinks or food; no appetite; insipid and 
clammy taste; adypsia; violent itching of the skin; empty risings ; 
great uneasiness in the stomach and epigastrium; feeling of empti- 
ness and flaccidity in the stomach ; sensation of debility in the bowels, 
worse on motion; colic with agitation ; tossing, with cries ; diarrhoea, 
with nausea; griping and vomiting. 
Anxiety and fear of death ; moroseness ; cries, and howling; vague 
desire for different things. 
Pulsatilla.—When the disease commences with prominent derange- 
ment of the stomach and bowels, headache, vertigo, shiverings, weak- 
ness, nausea, and bleeding at the nose, soon succeeded by hasty anx- 
ious and oppressed respiration, mucous vomiting, taste of food, longing 
for acids, spirits or beer, Pulsatilla is appropriate. 
In scarlatina occurring in individuals of decidedly scrofulous dys- 
crasias, Sulphur or Calcarea-carbonica may be required. 
Zinc.—This remedy has been recommended by Dr. Elb, of Dresden, 
in cases where paralysis of the brain is threatened, or where it already 
exists. He has also used it with success in the malignant form, with 
violent delirium, alternating with sopor; icy coldness of the skin from 
sunken vitality ; small and frequent pulse, and fixed and stupid expres- 
sion of the eyes. Dr. E. usually employed the first trituration in doses 
of one grain every two or six hours. 
Mercurius.—Occasionally troublesome ulcers form in the mouth, 
throat, and upon the tonsils, covered with ash-colored sloughs; deglu- 
tition becomes exceedingly difficult, and is attended with a stinging 
pain ; the fluids which the patient attempts to swallow, often escaping 
through his mouth and nose, with perhaps an acrid discharge from the 
nostrils, and profuse secretion of saliva. Under these circumstances 
Mercurius is the proper remedy. 
Muriatic-acid.—In malignant scarlet fever, where in addition to the 
above symptoms, we have inflamed, swollen, and tender salivary glands, 
dark-colored ulcers, with a decided tendency to slough and extend, 
together with great debility, lassitude, tremors, obtuseness of intellect, 
cold extremities, amd other signs of a typhoid condition, Muriatic- 
or Nitric-acid, from the first to the third dilution should be exhibited. SCARLET FEVER. 
597 
Bryonia.—If in connection with the above symptoms there should 
be present a considerable amount of pulmonary or cerebral excite- 
ment, indicated by delirium, restlessness, contracted or dilated pupils, 
heaviness and dull pain in the head on motion, difficult, anxious, and 
sighing respiration, sensation of weight and pressure upon the chest, 
troublesome, hacking cough, with soreness and sensitiveness of the 
whole surface, Bryonia, the third dilution, or higher in some con- 
stitutions. 
Arsenicum.—Arsenicum is a remedy of great power in the advan- 
ced stage of malignant scarlatina, where there are extreme prostra- 
tion, pain in the stomach and abdomen, diarrhoea, eruption of a livid or 
mahogany color; ulcers dark and foul, tongue and lips dry and black, 
pulse extremely frequent and wreak; cold and clammy sweats, hippo- 
cratic countenance. This remedy has often rescued patients from 
the grave who have been given over in despair by physicians of the 
old school. 
Opium.—Should profound coma supervene during the course of the 
malady, with snoring, and open mouth, open and convulsed eyes, red 
and puffed face, hanging jaw, difficult slow or intermittent respiration, 
convulsive movements of different muscles, retention of urine, Opium 
will he found to be the best specific; and we are satisfied that it will 
rarely disappoint our expectations in cases of this description. 
Becession of the Eruption.—When the rash suddenly disappears 
during the eruptive stage, Drs. Schmidt, Hartmann, and others recom- 
mend very highly Acetat.-cuprum as a specific against this symptom. 
Sulphur, Iodine, Bryonia, Phosphorus, and Belladonna, all de- 
serve consideration, and will, in some cases promptly restore eruptions 
which have been prematurely repelled. 
The other remedies which may be consulted in cases where those 
above described do not accord with the symptoms, are: Cinna., Nux- 
vom., Carb.-veg., Rhus-tox., Stram., Phos., Kreosote, Ilyos. 
For the troublesome sequelae, which sometimes follow scarlet fever, 
as dropsical affections, purulent otorrhoea, deafness, furunculi, en- 
largements and suppuration of the glands of the neck, axilla and 
groin, appropriate remedies may be found in Apis-mel., Arsen. 
Dig., Hellebore, Sulph., Hepar, Senega, Cham., Aur.-murand 
Mercurius. 
Administration.—We most frequently employ the first, second and 
third attenuations, hut in young and impressible children, we often re- 
sort to the higher dilutions with the most satisfactory result. Some 
cases are characterized from the commencement by a high state of vas- 
cular and nervous excitement, others evince a loss of vascular and 
nervous power, and a very low grade of impressibility. The propriety, 
therefore, of the employment of both the high and low attenuations in 598 
DISEASES OF THE SANGUINOUS FUNCTION. 
different instances is evident. If dilutions are used, a drop may be 
given at a dose, in a drachm of water; but if the triturations are se- 
lected, one grain is a sufficient dose, given dry or in water. We ad- 
vise a frequent repetition of the dose until decided changes arise from 
the remedy, or until we are satisfied that it is not producing the re 
quired effect upon the disordered structures. 
Apis-mellijica.—Heat, redness, irritation of the skin, great rest- 
lessness and nervous agitation ; sensitiveness of the entire surface of 
the body; oedematous and erythematous appearance around the ulcers 
in the throat; frequent and painful urination; redness, heat and burn- 
ing of the tongue ; disturbed sleep and thirst. The third dilution of 
Apis has given speedy relief in many cases. 
For its use in the dropsy following scarlatina, see that article, 
page 603. 
Arum-triphillum.—Case by Dr. Lippe, Phila.*—A boy, aged six 
years, had scarlatina, Feb. 14th, 1861. Began in the form common in 
severe cases; was treated with high dilutions of Belladonna (200), 
Tartar-emetic, Sulphur, &c. On the next morning he was covered by 
the eruption and appeared up to the 17th to be doing well. But then “his 
nose was stuffed up, corners of the mouth sore, could only breathe with 
his mouth open, Lycopodium, 200th.” On the 18th he had had a bad 
night, very delirious, the nose had discharged a good deal of thin watery 
ichorous fluid, nose sore, lips very sore, cracked and bleeding, as well 
as the corners of the mouth, the mouth felt so sore inside that he was 
unwilling to drink ; tongue red, papillae swollen and standing up, be- 
tween the abdomen and the legs sore moist places, the same on the 
os*coccygis,the sub-maxillary glands swollen, pulse 140, hard and full; 
voice hoarse. Arum-triphyllum six pellets, sixth, dissolved in a half 
tumblerful of water, one teaspoonful every two hours. On the 19th he 
was slightly better. Arum-tr., thirtieth. On the 20th still better, me- 
dicine continued. On the 21st improvement more decided; had passed 
quantities of pale urine and hawked up much mucus. Continued to 
improve without further treatment till March 13th, when he had violent 
coryza, cured by Nitric-acid 200, one dose. A week later had at night 
hoarse, dry, croupy cough, great hoarseness, cured by Hepar, 200. 
Chief indications for Arum-tr.:—great sore feeling of the mouth, red 
tongue, elevated papillae, corners of the mouth and lips cracked ; stop- 
page of the nose without much coryza ; urine abundant and pale ; sub- 
maxillary glands swollen; eruption all over the body; much itching 
and restlessness ; great hoarseness, which continues to increase, though 
other symptoms improve. 
Cuprum.—Rademacher gives the following case: “A man in the 
* Amer. Horn Review. Yol. III. p. 28. SCARLET FEVER. 
599 
flower of his age. On the first day of the fever the pulse was strong, 
full, quick; the angina moderate. Head painful; face red ; eyes 
brilliant; urine clear and acid, and darker than natural. Natrum- 
nitricum was given. On the second day there appeared a slight red- 
ness on various spots of the body, and all the symptoms were aggra 
vated. On the third day the symptoms were increased, the ejms wer 
reddened, and the urine darker, but still acid and growing turbid on 
cooling. The Nitrate of Soda was now given up. But the physician 
waited till next morning to learn more fully the character of the mor- 
bid state. On the following morning the indications were plain, but 
the life of the patient was in great danger. He could not rise in bed, 
his head was in the state that precedes delirium, or was in the first 
stage of it; the memory so weak that he could not find the desired 
words, though conscious that he used the wrong ones. The pulse 
quicker, but had lost its fullness. Eruption as before. The urine 
dark, acid, and turbid on cooling.” Rademacher thought the whole 
phenomena, viz.: the peculiar state of the head, weakness of the 
muscles, and acid urine, pointed out a condition curable by Copper. 
He directed small doses of acetated tincture of Copper to be taken 
at regular intervals within twenty-four hours. The effect was remark- 
able on the same day. About twelve hours after commencing this 
remedy the progress of the disease was brought to a stand, and to- 
wards evening the head was evidently better. Next morning the 
patient was free from all dangerous symptoms. 
Dr. Kissel says, on this subject: “ The diseased process, arrived at 
a certain point, can thus be arrested by Copper, but the exanthema 
must run its course, though new eruptions of it and extension of the 
disease to the meninges can be prevented. In some cases of this 
disease, with diarrhoea, it is advised to give the Cuprum in an oleagi- 
nous emulsion. 
In some epidemics of measles, varioloid, and erysipelas of the face, 
Cuprum-aceticum has been found the specific. 
Adeps.—Dr. Schneemann, of Hanover, proposed the inunction of 
the body by lard. Dr. Ebers treated thirteen cases in this manner, 
of which he cured twelve,' the remaining one being hopeless when com- 
menced. At the same time he was engaged in treating nine other 
cases in the common (allopathic) method, of which he lost five and 
cured four. He concludes : 
1. That inunction with lard does not interfere with the appearance 
of the eruption on the third day, and its decline on the fourth or fifth 
2. That other complications of the disease disappeared more favor 
ably under this treatment than under any other. 
3. Under this treatment there was no desquamation; and in no case 
was there any subsequent anasarca. 600 
DISEASES OF THE SANGCINOUS FUNCTION. 
4. This treatment destroys the contagious principle. The lard 
should be well rubbed in warm on the skin, to be absorbed morning 
and evening. 
Ammonium-carl).—When scarlatina assumes a typhoid character, 
and there is any tendency to decomposition of the blood, this is a re- 
medy of great value. Many eminent physicians of our school rely 
upon this drug in nearly all cases of scarlatina maligna, and their suc- 
cess has been highly gratifying. 
It should be prescribed in the first trituration—always recently pre- 
pared. 
2. SCARLET RASH. 
This appears to be a modified form of scarlatina. It is generally 
met with in complication with that disease, small-pox, or measles. 
Diagnosis.—The eruption is darker than that of scarlet fever, being 
almost purple ; the pressure of the finger leaves no white mark ; and, 
on passing the finger over the skin, small grains are felt beneath it. 
The disease does not run a regular and definite course, like other 
eruptive diseases. The efflorescence may disappear suddenly or may 
spread over the body; the parts of the surface covered by the erup- 
tion are liable to perspiration. Persons who have once suffered from 
it are not exempt from future attacks. 
Prognosis.—It is not generally as dangerous as scarlatina. When 
the efflorescence disappears suddenly alarming symptoms sometimes 
follow. The sore throat is not generally as severe as in scarlatina; it 
is sometimes present when the eruption is wanting. 
Treatment.—Aconite alone is generally sufficient to cure this dis- 
ease when it is uncomplicated. 
Coffea.—After Aconite, when there is restlessness, agitation, pain 
in the head or extremities. 
Bell.—The scarlet rash complicated with true scarlet fever, sore 
throat, and pain in the head or delirium. 
Ipecac.—The rash attended by nausea, vomiting, or diarrhoea. 
Bryonia.—After Ipecac., in cases in which there is congestion of 
the chest, hurried respiration, pleuritic pain. 
3. SEQUELS OF SCARLATINA. 
Scarlatinal Nephritis. Post Scarlatinal Dropsy. 
This disease appears in three different forms : 1. That in which the 
disease commences primarily from the state of the skin as disordered 
by the specific scarlatina poison, aggravated by exposure to cold. 
This form of dropsy usually makes its appearance in from ten to 
twenty days after the subsidence of the original symptoms. The swell- 
ing is first observed in the face and upper part of the body, to which SCARLET FEVER. 
601 
i sometimes confined, though more generally it extends over the 
.ole body. In severe cases the urine is thick, scanty, and dark 
jlored, passed only at intervals, or almost entirely suppressed. There 
is more or less fever, with night restlessness. In mild cases the con- 
dition of the urine is but little changed. 
In the first stage the disease seems to consist in a dropsy of the sub- 
cutaneous cellular tissue ; but in the second stage it generally involves 
more or less deeply some vital organ; the effusion is discovered on the 
brain, in the chest, within the pericardium, or in the abdomen; and the 
disease runs a rapid course, giving little time for efficient treatment. 
The extent of the anasarcous swelling does not always indicate the 
degree of danger, and, in many cases, the child is beyond the reach 
of medical skill before the parents are alarmed. 
Causes.—This disease is generally excited by exposure to cold at 
too early a period after an imperfect recovery from scarlatina. It is 
remarked, too, that it quite commonly occurs in children who have had 
the original disease in a light form, especially in the milder epidemics. 
Tweedie says it has “never been observed to supervene in cases of 
malignant scarlatina.” 
The cause of post scarlatinal dropsy is attributable to the passage 
of t’he debris of the fever through the tubuli uriniferi, thus producing 
in them irritation, congestion, retention of urine, and the usual pheno- 
mena of albuminuria. The urine is usually albuminous, and the symp- 
toms disappear as soon as the kidneys are relieved. 
2. The second form of scarlatinal dropsy is that in which “the 
dropsy arises from disease of the kidneys themselves, consequent 
upon the scarlatina virus locating upon them, instead of being deve- 
loped on the skin.” In this form of the disease the danger consists, 
not in the concentration of the force of the virus upon some vital organ, 
as is common in the preceding variety, but from the deadly influence 
of the malignant poison exerting its power primarily upon the kidneys. 
These great eliminating organs fail immediately to perform their office; 
before the oedema has exerted any injurious influence in other parts 
of the body, death may supervene from reabsorption of the uraemic 
poison which they should have expelled from the system.* 
3. Scarlatinal Rheumatism.f—In this form, about the time that 
the eruption is followed by desquamation, there becomes visible a pe- 
culiar inflammation, manifested by shining redness, swelling, and in- 
tense pains in the ankles and wrists. It resembles arthritic inflamma- 
tion in its great tendency to metastasis to the heart; but it differs 
from all ordinary arthritic inflammation by its strong tendency to 
* Dr. J. II. Frost. Amer. Horn. Rev. Vol. II., p. 433. 
f Braithwaite’s Retrosp. No. 33, p. 30. 602 
DISEASES OF THE SANUUINOUS FUNCTION. 
purulent effusion into the affected joints, and great swelling in the 
neck, enlargement of the submaxillary gland, and other marks of acute 
scrofulosis. It is sometimes epidemic. 
Such cases are generally fatal.* 
Pathology.—In scarlatinal, as in every other form of dropsy, the 
kidneys are more or less affected. And the concentration of the force 
of the disease upon these organs is the most insidious and danger- 
ous form in which it can terminate. In the skin the capillary ves- 
sels are more or less congested and obstructed, even in mild cases ; 
and the same inflammatory action which diminishes the secretion 
of urine prevents perspiration; this causes great increase in the 
fluid exhaled, as inflammation of the serous membranes, as the peri- 
toneum usually causes dropsical accumulations in the cavity of the 
abdomen ; and that of the arachnoid and its divisions produces hydro- 
cephalus.f 
Dropsy after scarlatina, says Tweedie, “ is of an acute or sub-acute 
kind; arising from increased action of the sanguiferous system, the 
consequence of this increased action is the effusion of serous fluid into 
the external tissues of the body, or, where there is still greater vascu- 
lar excitement, into one or other of these cavities.” 
“As the scarlatina subsides desquamation begins, and the urine be- 
comes even more abundant than in health ; but this desquamation, by 
preventing the return of the skin to the performance of its proper 
functions, perpetuates the evil influence exerted by the primary dis- 
ease, and continues to impose a double duty on the kidneys—a burden 
evidently greater than they can long sustain. And so, when convales- 
cence seems almost complete, dropsy ensues from the failure of the 
kidneys to carry off the unusual exhalation, while at the same time 
attempting to do their own work and that of the skin. Or, where from 
exposure to cold in this period, a still more serious impression is re- 
flected from the tender skin upon the already over-burdened kidneys, 
they become congested and entirely obstructed; the uraemic poison, 
accumulating for a short time, and finding no outlet from the system, 
is suddenly reabsorbed, and coma, vomiting, and convulsions close the 
scene.$ 
Dr. West, on diseases of children, says: 
“ The chief suffering, however, is referred to the chest from pulmo- 
nary oedema; the respiration is labored and accelerated, and the child 
is frequently unable to assume the recumbent posture, and is moreover 
distressed by a frequent hacking cough. Under these circumstances 
life is sometimes prolonged for several days, though in a state of ex- 
treme suffering, remedies proving unable either to increase the action 
* Frost. f Cragie’s Pathol. Anat. p. 190. \ Dr. Frost. SCARLET FEVER. 
603 
of the kidneys, or to relieve the dropsy. Death is sometimes preceded 
by a sudden aggravation of the signs of disorder of the respiratory 
organs, which assumes all the painful characteristics of oedema of the 
lungs; and in other cases, a comatose condition comes on, such as often 
precedes death from Bright’s disease in the adult.” 
Dr. B. F. Joslin, Jr., gives some cases, treated at the Half-Orphan 
Asylum, N.-Y., winter of 1860. (Amer. Ilomceojp. Review, 1860. 
p. 839.) 
Charles Smith, aged six. Feb. 29th. Fever ; red eruptions ; vomit- 
ing; headache. Pulsatilla 80.—March 1st, w'hite dry tongue; redness 
continues, Aeon. 30. 2d, Pulsatilla 30. Doing well till the 16th. 
Then stiff neck; glands swollen, Bell. 30 and Merc. 30. 21st, inflam- 
mation in front of neck to the right side with deep swelling, Bell. 30. 
23d, opened abcess on neck, Sulph. 30. 26th, oedema of face, Apis 
30. 27th, seems better ; pulse 92, Apis 30. 28th, face more swollen; 
no oedema of feet; pulse 80, irregularly intermittent, Apis 1. 29th, face 
not so much puffed; pulse 100, regular, Apis 1. April 2d, pulse 76, 
not quite regulur, Apis 1. 3d, less swelling of face, pulse 100, Apis 
1. 5th, feels well; less swelling of face ; pulse 92, not quite regular, 
Apis 1. 8th, skin hot; thirst; pulse 148; respiration good 32 ; the 
weather is to-day rainy and close, and has an unfavorable influence 
on his case, Aeon. 30 and Bell. 30. 
April 9th, feels well and appears so ; pulse 96; had rapid respira- 
tion all night, but is now quite easy; last night, evacuation in bed, 
Aeon, and Bell. 10th, Doing well; pulse 104, Apis 1. 11th, respira- 
tion good, still has some swelling of face, Apis 1. 12th, pulse 114, 
respiration 28, Apis 1. 13th, says he feels well, but does not appear 
quite so bright as usual; no appetite; pulse 116, Apis 1. 14th, appe- 
tite better; pulse 112, Apis. 16th, doing well; pulse 92, Apis 1. 
17th, doing well, pulse 100, Apis 1. 18th, seems well, Hepar 30. Has 
remained well. 
We have seen a case cured in the following manner. A boy of 
five years, whose brother had just died of the same form of disease, 
relapsed after a supposed recovery from scarlatina. Immediately the 
action of the kidneys was almost entirely suspended and the dropsical 
bloating commenced. The same allopathic physician under whose 
treatment the brother had died was now called. He proposed blis- 
ters, which were objected to; a homoeopathist was called, who made 
his best efforts for four days, without any apparent result. The 
si cal accumula tion increased. At this stage a poultice of flax-seed of 
large size and wTarm was prescribed and it was applied to a large sur- 
face, covering the region of the kidneys, and demulcent drinks wrere 
given. Immediate improvement wras seen. A free perspiration and 604 
DISEASES OF THE SANGUINOUS FUNCTION. 
increased flow of urine commenced, the inflammatory and dropsical 
symptoms rapidly subsided, and the little boy speedily recovered. 
See an interesting case of desquamative nephritis in the U. S. Jour- 
nal of Homoeopathy (Vol. I. p. 271.), cured by Arsen. 3° and Apis 3°. 
4. RUBEOLA.—MEASLES.—MORBILLI. 
Formerly, measles and scarlet fever were described and treated as 
one and the same disease, the differences which were observed in dif- 
ferent cases being ascribed to modifications originating from peculiari- 
ties of constitution, the state of the atmosphere, and other accidental 
causes. About fifty years ago, however, Withering and several other 
writers recognized a distinction between them; and measles, for the 
first time, was accurately described and ranked as a distinct malady. 
As it generally occurs, it is unattended with danger, unless interfered 
with by purgatives, emetics, and infusions. Fortunately, it is confined for 
the most part to children, for when adults are the subjects of attack, 
it is far more severe and dangerous. Like scarlatina, one attack 
renders the subject secure against any future operation of the con- 
tagion. 
This disease frequently appears as an epidemic, especially in the 
spring. It is generally mild, though sometimes extremely violent and 
dangerous. It occurs in every climate, attacking principally children, 
though older persons are liable to it, if they have hitherto escaped it. 
The disease is generally communicated by contagion, and it breaks out 
ten or fifteen days after the infection. 
Diagnosis.—Spots that are generally more or less raised on the 
skin ; they are one or two lines in diameter, and at first they resemble 
flea-bites; they generally cluster in groups, having an irregular shape 
somewhat resembling a half moon. Several days previous to the ap- 
pearance of the spots, the patient is affected with catarrhal symptoms, 
such as short dry cough, red eyes, with lachrymation, frequent sneez- 
ing ; the spots remain upon the skin for three or four days, after which 
they scale off. While the spots are out the cough and redness of the 
eyes continue. The desquamation of the epidermis is sometimes 
the only sign by which we are able to recognize the existence of the 
eruption. 
The disease runs its course in three stages: 
1st Stage.—The Febrile Stage.—The febrile stage lasts three days 
and sometimes a little more. The fever is remittent and attended with 
the catarrhal symptoms ; sensitiveness and light inflammation of the 
eyes; puffiness of the eyelids; lachrymation; photophobia; frequent 
sneezing and discharge of water from the nose; troublesome, short and 
dry cough, with hoarseness and difficulty of breathing, frequently ac- MEASLES 
605 
companied by moaning; roughness and slight soreness of the fauces ; 
pain in the back or epigastrium; aching in the forehead, delirium, 
spasmodic symptoms; diarrhoea ; white-coated tongue, with bright red 
edges. During the period of dentition, and in children generally all 
the inflammatory symptoms are more violent than in full-grown per- 
sons ; hut the suffering and accompanying pulmonic or cerebral con- 
gestions, the oppression of the chest and the after phenomena which 
often render the disease formidable, are all more severe and threaten- 
ing in adults. In all the more serious symptoms continue to increase 
in severity till the eruption appears on the skin. 
2d Stage.—The Eruptive Stage.—The eruption appears at the 
end of the third or fourth day ; generally in the face, arms and breast. 
The spots increase in number and distinctness for three or four days, 
and if they are very numerous, are attended with swelling of the face 
and hands. The fever and uneasiness increase, the eyes continue sen- 
sitive to light; the cough increases to bronchitis or pneumonia. 
On the fourth day the symptoms abate; the eruption then grows 
paler, and if the fever should continue it must be because there is an- 
other complication, or because of the violent irritation of the skin, in 
consequence of the severity of the eruption. 
8d Stage.—Desquamation.—The scaling off commences in the 
sixth or seventh day, and sometimes even later. If the eruption be 
slight, the scaling is scarcely perceptible ; in its stead we perceive the 
healthy sweat, the critical urine and diarrhoea, terminating in the dis 
appearance of all the remaining phenomena of the disease. 
In this stage the patient is often exposed to real danger. The ca- 
tarrh may increase to pneumonia, which is followed by hectic fever, 
hydrothorax, haemoptysis, and in scrofulous subjects by real consump- 
tion. Measles may be likewise followed by other cachexias, such as 
otorrhoea, with pain and deafness, obstinate inflammation, &c. 
During the fever, the cough is often very troublesome, and sometimes 
terminates in inflammation of the bronchia or lungs. Schroen thus 
describes the malady; “ small red spots, in the centre of which we 
generally find a white pimple. These spots soon become confluent, 
and spread over the whole body after being preceded by catarrhal 
fever for three or four days, attended with redness of the mucous mem- 
brane of the mouth, with cough, catarrh, dread of light, and flow of 
tears. They disappear upon pressure, and develop themselves again 
from the centre towards the periphery after the pressure is removed. 
The pimple becomes a small yellow prominence in the course of six- 
teen hours, when a scurfy desquamation commences.” 
The attentive observer will have no difficulty in distinguishing this 
malady from scarlatina by the following diagnostic symptoms: The 
'primary symptoms of measles are red and watery eyes, sneezing, 606 
DISEASES OF TIIE SANGUINOUS FUNCTION. 
fluent coryza, short cough and some hoarseness. These signs, which 
are almost uniformly present in this disease, are usually wanting in 
scarlet fever. In the general character and appearance of the erup- 
tion there is also a marked difference. The scarlatina rash is com- 
posed of innumerable fine pimples, resembling in appearance the shell 
of a boiled lobster, uniformly diffused over the surface, and of a bright 
scarlet color. The eruption of measles appears in spots (sometimes 
papular) resembling flea-bites, which run together and form semi-lunar 
patches. There is a roughness or elevation where the eruption exists, 
perceptible to the touch; and which is not usually observed in scarla- 
tina. But one of the best marks of distinction is the difference in the 
color of the rash, that of measles being a purplish, or darkish scarlet, 
■while that of scarlet fever is a light scarlet. 
Measles is a disease, which, under different circumstances, assumes a 
great variety of forms, both as to its general character and violence. 
During some seasons it prevails as a mild and simple affection, requir- 
ing little or no treatment; while at other periods it assumes a highly 
inflammatory, congestive or typhous character. Sometimes almost all 
cases seem to have a tendency to run on to pneumonia; at other times 
cerebral or typhoid symptoms predominate ; in still other instances, 
gastric disorder prevails; but in the great mass of cases the malady 
is mild and tractable. 
In contemplating the numerous varieties of this, as well as of most 
other diseases, the impartial physician must acknowledge the utter un- 
certainty and empiricism of prescriptions guided only by the name of 
the disease. 
Causes.—In common with the other contagious disorders, measles 
arises from a specific morbific contagion. This has been amply proved 
by Home, Dewees, Speranza, and Majendie, who, in numerous instances, 
succeeded in communicating this affection by inoculation. The season 
of the year, the condition of the atmosphere, and the peculiar circum- 
stances of the individuals exposed, exercise a powerful and perhaps 
controlling influence, in determining the character of the epidemic. 
When measles happens to prevail during seasons of influenza, typhus, 
or dysentery, the disease will partake of the peculiar character of the 
existing epidemic, and its course will be modified accordingly. 
Treatment.—The most common medicines in the treatment of 
measles are Aconite and Pulsatilla; next in importance stand Bryo- 
nia, Bell., Ipecac., Merc., Sulph., Cupr.-acet., Rhus., Acid.-phos., 
Arsen., Cham, and Stibium. 
Schroen recognizes five different varieties of measles, founded upon 
the characteristic symptoms present in each given case; viz., first the 
simple or erethistic, in which Aconite is the appropriate remedy; 
second, the inflammatory, requiring the use of Aconite, Bryonia and MEASLES. 
607 
Belladonna ; third, the gastric, demanding the employment of Bryo- 
nia, Pulsatilla, Chamomilla, Ipecacuanha, and Veratrum / fourth, 
the typhus, or irregular, calling for Phus.-tox., China, Nux-vom., 
and Belladonna', fifth, the septic, or malignant, corresponding with 
Acid.-phos., Acid.-sulph., Acid.-mur., Opii and Arsenicum. 
At the commencement of an attack, when heat, thirst, quick pulse, 
red, inflamed and watery eyes, sneezing, fluent coryza, cough, dyspnoea, 
oppression at the chest, and sore throat are present, Aconite at the 
third potency is the most suitable remedy. So long as the disease 
progresses mildly, running through its regular stages in due form, no 
other medicine will be requisite to complete the cure. Even in those 
complications which call for the use of other medicines, as pneumonia, 
croup, cerebral, or gastric disturbance, whether occurring before, dur- 
ing, or subsequent to the eruption, should the inflammatory excitement 
run high, Aconite will still be required. Its repetition must, of course, 
be subject to the circumstances of each particular case. 
When there exists a predominance of catarrhal symptoms, and a 
tardiness in the appearance of the eruption, we have an appropriate re- 
medy in Pulsatilla. This medicine may often succeed Aconite with 
peculiar advantage in the catarrhal forms of more than ordinary se- 
verity. In these cases some writers claim for this agent important 
prophylactic properties. It is also a valuable remedy in retrocession 
of measles, attended with one or more of the following symptoms: 
hoarseness, swelling of the parotids, puffiness of the face, pain in the 
ears, discharges from the ears, hardness of hearing, dry, short cough, 
great restlessness, pains in the head, back and loins, and mucous di- 
arrhoea. 
Dr. Croserio believes Pidsatilla to be especially adapted to measles, 
not only as a remedy, but as a prophylactic. He asserts that “ it is to 
this disease almost what Belladonna is to scarlet fever. The precur- 
sory symptoms of measles accord perfectly with the febrile symptoms 
of Pulsatilla, viz.: chills, heat, lassitude, throbbing pains in the head, 
anxiety, nausea, vomiting of bile, or glairy mucous, violent coryza, red 
eyes, lachrymation, photophobia. Then follow pricking of the skin, red 
spots like flea-bites, excoriation and creeping in the throat, difficult de- 
glutition, dry, fatiguing cough, epistaxis, &c. If given in the precur- 
sory stage, I have often seen the disease terminate in abundant per- 
spiration in twenty-four hours.” 
Belladonna is indicated when the throat is much inflamed and swol- 
len, with very painful and difficult deglutition, short, hacking, throat 
cough, inflamed eyes; nervous, uneasy, and sometimes delirious; hurried 
respiration; headache, intense thirst, dry, hot skin, and signs of cere- 
bral disturbance. It has likewise been recommended in cases of sudden 
disappearance of the eruption, after having been out one or two days. 608 
DISEASES OF THE SANGUINOUS FUNCTION. 
“ When the eruption suddenly disappears and is succeeded by fever, 
violent headache and breathlessness, great benefit will be derived from 
the administration of Aconite and A rsenicum alternately; and after- 
wards, when the head appears to be the chief point of attack, indicated 
by excrutiating headache, screaming or moaning during the night, 
Belladonna and Cuprum-aceticum, repeated every hour or two, will 
afford marked relief.” (British Jour, of Horn., No. XXIV. p. 232.) 
Bryonia will apply in cases attended with marked pectoral symp- 
toms, like stitches or darting pains in the side and chest, anxious* 
sighing, difficult and painful respiration, and very great general un- 
easiness. 
“ Hartmann says that Bryonia “ is also a powerful remedy in retro- 
cescent measles, in reproducing the eruption on the surface, or in ren- 
dering its disappearance harmless. In these I give Bryonia in the 
fifteenth dilution, and notice that it is chiefly indicated, if after the 
retrocession of the eruption a morbid affection of the eyes supervenes* 
which resembles that which I lately noticed when speaking of oph- 
thalmia.” 
Ipecacuanha should be administered when there is gastric disorder, 
indicated by nausea, vomiting, pain and oppression in the stomach, and 
inability to retain food or drinks. 
For the ulcers which sometimes form in the mouth and throat, also 
the glandular swellings which occur in the neck, Mercurius is a valu- 
able specific. 
As a remedy for the restoration of retrocescent measles, as wrell as 
for the inflammatory affections of the eyes, which now and then remain 
as sequelae of this malady, Sulphur is sometimes a remedy of the 
highest importance. Many cases, after having apparently run their 
courses in a mild and regular manner, leave the patient wTith some an- 
noying dregs, like discharges from the ears, wTeak eyes, eruptions of 
various kinds, or chronic cough, with profuse expectoration ; they are 
attributable to some miasm, which has been roused during the course 
of the disease. For the cure of cases of this kind, Sidphur is an in- 
dispensable agent. 
We occasionally meet with nervous or typhoid symptoms which render 
the use of Arsen., Bhus-tox., Stramonium, Op. and Phos. necessary; 
whatever symptoms present themselves, the judicious physician will be 
able to select from the great number of medicines of which the pure 
effects are knowTn. 
Lachesis.—Case by Dr. C. Dunham.—A girl aged 9 years, had 
scarlatina three months ago very severely; it left her delicate and deaf. 
Exposed to measles ; eruption appeared six days after, “ along with a 
copious discharge from the ears.” Two days after the discharge and 
eruption suddenly ceased. She became immediately feeble and pros- WHOOPIXG COUGH. 
609 
trate ; there were wild, muttering delirium; thirst; singular, biting heat 
of the skin. Third day of the disease: She had lain in alternate 
stupor and delirium for 24 hours; delirium, low, muttering; pulse soft, 
wavy, hardly to be counted; calor mordax; respiration rapid, whistling, 
attended with moaning; occasional cough, and a grasping at the throat 
as if to tear the clothing from it. Pupils widely dilated; no stool for 
two days; urine scanty; countenance cadaverous; odor of breath pu- 
trescent. At 11a. m. she took Lachesis 30°, six globules in water, a 
tea-spoonful every two hours. 
At six p. m. she was sitting up in an arm-chair playing with some 
toys ; rational; skin pleasant temperature ; pulse 80, regular and soft. 
After the second dose she had slept quietly, had no more delirium or 
thirst. She took no more medicine; the rash did not re-appear; but 
she convalesced steadily from this point 
5. PERTUSSIS.—Whooping Cough. 
From the time of Autenreith, the relationship between whooping- 
cough and other acute exanthematous fevers has been suspected. Dr. 
Yolz claims that pertussis should be classed among the exanthemata, 
for the following reasons: It often appears as an epidemic ; it is con- 
tagious ; children are more certain to be attacked by it than adults • 
it occurs but once in a life-time, and has some relation to measles; it 
pursues a regular and uninterrupted career in the individual; all of 
which peculiarities show a strong similitude between whooping cough 
and the exanthematous fevers. There is indeed seldom any eruption 
visible in this disease; but in many cases of the common exanthemata 
the eruption is wanting. Neumann has seen whooping cough accom- 
panied by an eruption resembling measles in form, but having the color 
of scarlatina and appearing chiefly on the breast and arms. This 
eruption is rare, but it has been seen by others. The pathology of 
pertussis presents some changes in the glands of the mucous membrane 
of the intestinal canal, which Rokitansky regarded as peculiar to cer- 
tain forms of disease,'including the exanthemata. Yolz concludes that 
pertussis is to be classed among the diseases produced by an abnormal 
change in the blood. He found no remedy but Belladonna available 
in its severity. (Hdser’s Arehiv, Bd. IY.) Belladonna has often pro- 
duced the eruption on the skin above mentioned, and entirely controlled 
the cough at the same time. This has been more successful when the 
aggravation is carried to the extent of “ reddening the skin,” than any 
other old school treatment. It reveals the nature of the disease, and 
shows at the same time that Belladonna is only a partial similimum to it. 
For History and Treatment, see p. 438,439. 
Vol. I.——39 610 
DISEASES OF THE SANGUINOUS FUNCTION 
C. ROSEOLA. 
Diagnosis.—This is one of the mildest and least dangerous of all 
the eruptive fevers. It is characterized by an eruption or efflorescence 
of a rose color, preceded and accompanied by some slight symptoms 
of febrile disturbance. The rash shows itself on the third or fourth 
day of the fever, and comes out in distinct and irregular spots upon 
different parts of the surface, or the spots run together, giving to the 
skin an almost uniform redness. The cuticle is neither elevated, nor 
is there any appearance of papulae; but a simple blush of a rose color 
characterizes the eruption, and serves as a mark of distinction between 
it and that of other diseases of this kind. The appearance of the rash 
is often attended with itching and tingling, which are present more or 
less until the eruption vanishes, which is usually in five or six days, 
without desquamation of the cuticle or any unpleasant after symp- 
toms. 
Causes.—Roseola is for the most part confined to infants and females. 
It arises from undue exposure to cold, after having been confined in a 
warm room, indigestible food, dentition, gastro-intestinal irritation, and 
the abuse of stimulating infusions, cathartics, &c. 
Treatment.—Rigid dietetic regulations, a moderate, dry and equal 
temperature, mental and physical rest and quietness, and an entire ex- 
clusion of all “herb teas” and other “domestic remedies,” will generally 
secure the patient from any ill consequences from this simple affection. 
7. URTICARIA—NETTLE RASH. 
Diagnosis.—The primary symptoms of urticaria are, languor, op- 
pression, and sickness at the stomach, foul tongue, bitter taste, giddiness, 
creeping chills, succeeded by preternatural heat of skin and thirst. Dur- 
ing the early period of the disease, elevated, circular and florid spots 
or weals, each with a whitish spot or point in its centre, appear, some- 
times in only one part of the body, at other times generally diffused 
over the whole surface. These weals are attended with an exceeding- 
ly itching, stinging and burning sensation, somewhat resem- 
bling the stings of nettles. The itching, as well as the febrile excite- 
ment, is always worse in the evening or during the night; but when 
the eruption is upon the surface, the nausea and distress at the stomach 
abate, and do not return until another eruptive period, unless there is 
a sudden retrocession of the weals. Frequently the blotches are ele- 
vated, rough to the feel, numb and insensible, and resembling stings. 
When deep seated in the skin, they are brought to light by friction and 
scratching. Sometimes they appear in a few hours. They are ex- 
ceedingly evanescent, and frequently appear and disappear on the same NETTLE RASH. 
611 
day. Both in shape and sensation they resemble the blotches occa- 
sioned by nettles, and are distinguished by the peculiarity of disap- 
pearing in warm and coming out in cold weather. They are liable to 
constant changes of locality, to such a degree that a blotch does not 
in some cases remain in one spot an hour at a time. Their retrocession 
is seldom accompanied by any material alteration of health, but is 
sometimes attended by slight fainting and headache, with some degree 
of fever. 
In some instances the eruption appears suddenly without any febrile 
or other premonitory symptoms, and without any apparent exciting 
cause. At other times, certain articles of food, like shell-fish, porgies, 
esculent vegetables, acid fruits, or stimulants, like wine, spirits, hot 
ptisans, condiments or frictions upon the skin, seem to become its ex- 
citing causes. It usually terminates in a few days, but now and then 
it persists many months, sometimes apparent upon the skin, at others 
suppressed. 
“ Its sudden disappearance without leaving a trace behind, and its 
equally sudden reappearance, are quite characteristic. Inclination to 
vomit is also present in all the varieties of this disease, and vomiting 
frequently occurs as a crisis.” {Schroen.) 
Some nosologists have divided this malady into twro, and some into 
four varieties ; and others, like Bateman, and a few of the older writers, 
have gone so far as to recognize and describe seven ; but these fine 
and arbitrary distinctions are not founded in nature, and therefore offer 
no aid in diagnosis ; while, on the other hand, there is danger that they 
may confuse and embarrass the inexperienced practitioner. We know 
that the eruption is very irregular in regard to the periods of its ap- 
pearance, and also in the size, form, general aspect, and diffusion of the 
weals; yet we see no necessity for complicating our classification with 
so many varieties, for we might with as much propriety go on with 
divisions, ad infinitum, as to stop after having described six or seven 
genera, since the most acute nosologist will scarcely be able to dis- 
cover any two cases presenting precisely the same symptoms in all 
respects. 
If, however, we were to adopt any classification, it would be that of 
Schroen, who distinguished two forms of the malady, the acute and the 
chronic. Under the former he includes: first, urticaria maculosa, 
or spots of different degrees of redness, attended with sensation of for- 
mication and intense itching ; second, urticaria vesicularis, or vesi- 
cular prominence, with empty and almost transparent apices ; third, 
urticaria tuberosa, or hard, tense, and painful tuberosities, generally 
appearing in the night. Amongst the chronic varieties he ranks urti- 
caria evanida, resembling the urticaria tuberosa, appearing on expo- 612 
DISEASES OF TIIE SANGUINOUS FUNCTION. 
Bure to cold, and disappearing on the application of warmth. This 
variety sometimes continues for weeks and even months. 
Causes.—The remote cause of nettle-rash is supposed to consist of 
specific miasm, either generated within the organism or introduced 
from without, and which is liable to be roused into action by numerous 
exciting causes. The proofs of this are numerous, and we think satis- 
factory ; for, if it were merely an effect or symptom of one of the vari- 
ous exciting causes, like indigestible food, certain kinds of fish, acid 
fruits, vegetables, wines, liquors, &c., it would disappear as soon as the 
exciting cause was withdrawn, and all irritation from this source ob- 
viated ; but, in very many instances, no such result takes place, and, 
after the noxious article has been entirely removed, and the part pre- 
viously deranged restored to its usual normal condition, there is a per- 
sistence of the urticaria for months, and even years—it appearing and 
disappearing at frequent intervals, without the slightest apparent rea- 
son. 
Another fact which sustains this opinion is that, if the eruption be 
suddenly repelled by the use of lotions or cathartics, serious internal 
disorders frequently supervene as a consequence of the retrocession, 
which terminate, if the weals are not reproduced either spontaneously 
or artificially, in dissolution. A painful case, illustrative of this posi- 
tion, occurred under our observation a few years since. The patient 
was a lovely and highly interesting young lady, who for some slight 
exciting cause was afflicted with urticaria, although previously she 
had remained for many years in excellent health. The malady 
annoyed her by turns for more than three months, when, from the 
application of a lead water lotion, the external symptoms suddenly 
vanished, leaving in their place wandering pains in the chest and side, 
some cough, fits of oppression at the chest, and difficulty of breathing. 
These symptoms of pulmonary disturbance continued to increase, until 
she was pronounced by two eminent physicians of a neighboring city 
to be past cure with tubercular consumption. About this period the 
case came under our charge, in what seemed to be the last stages of 
consumption. Notwithstanding, however, the unpromising condition 
of affairs, the patient slowly but gradually recruited, so that in six or 
seven months the abscess which had existed in one lobe of her lungs 
was healed, and the lungs, with her whole system, were restored to a 
comparatively sound and healthy state. In this condition she con- 
tinued for nearly two years, when a second attack of urticaria super- 
vened, affording still farther relief for a few days from all remaining 
difficulties, and the rash permanently disappeared. From this time 
her symptoms were all aggravated, her old complaints returned, the 
luugs again became ulcerated, so that in a few months the malady 
adviJ*med to a fatal termination. Is this an isolated instance ? With- NETTLE RASH. 
613 
out doubt the experience of almost every physician could furnish one 
or more cases of the same description. 
This example offers conclusive evidence that an intimate connection 
existed between the two diseases, and that, whenever the rash was 
upon the surface, nothing disturbed the lungs ; while, the moment re- 
trocession ensued, pulmonary symptoms manifested themselves. If 
urticaria is a purely local disease, depending upon a distention or 
spasm of the extreme cutaneous vessels, how can the suppression of 
such local inflammation affect so seriously internal organs ? 
It must be confessed that our knowledge respecting the causes and 
intimate nature of cutaneous affections is at present quite limited; but 
when we take into consideration the fact that so many internal consti- 
tutional maladies take their exit through the surface in the form of 
eruption, we are constrained to believe that this is almost uniformly 
only a symptom of some internal disorder. 
Treatment.—As it is of the first importance in all cutaneous dis- 
eases that the eruption should be urged and retained upon the surface, 
in order that the miasm may not fall upon any vital organ, we should 
select our remedies chiefly from those which exercise a specific action 
upon the skin. 
Another point, of no less importance in the management of eruptive 
fevers, consists in securing for the patient a dry, moderate, and equable 
temperature. This precaution, combined with cleanliness, and a placid 
and composed frame of mind, will always aid us materially in our thera- 
peutical measures. 
The medicines which are the most appropriate for the treatment of 
this complaint are: Aeon., Sulph., Dulc., Rhus., Calc.-carb., Lycop., 
Natr.-mur., Aeid.-nitrie., Puls., Ignat., Ipecac. 
Aconite will only be required in those cases which are attended 
with undue febrile and nervous irritation. It may be administered as 
advised under measles. 
Sulphur.—This medicine should always be prescribed in cases 
occurring in individuals of a marked scrofulous dyscrasia, when the fol- 
lowing symptoms are present: 
General appearance of debility; pale, sallow, and sickly expression 
of face ; redness of the margins of the eyelids; swellings of the glands 
of the neck. 
Eruption and violent itchings, occurring in the night from the heat 
of the bed, and occasionally from exposure to cold air; great sensitive- 
ess to cold ; dizziness and pains in the head ; spasmodic twitchings 
of the eyelids ; bad taste in the mouth ; nausea; pyrosis ; weakness 
and oppression at the chest. 
Melancholy, sadness, irritability. 
In a case in which there was fever at night, derangement of stomach, 614 
diseases of the sanguinous function. 
itching eruption on the skin over most of the body, occasionally reced 
ing when it caused nausea and pain in the stomach, pains in the limbs 
Aconite, followed by Sulphur, cured in a day or two. Relief in a few 
hours. 
Administration.—One grain of the third trituration in twTo ounce 
of distilled water ; a dessert-spoonful once in twelve hours. 
Dulcamara is useful in urticaria which proceeds from taking cold 
and is attended with nausea, vomiting, oppression at the stomach, heat 
of skin, thirst, bitter taste, diarrhoea, and great general uneasiness. 
The symptoms are aggravated at night, during repose, and by the heat 
of a room ; but they disappear in the open air. 
Administration.—A drop of the third dilution, in a small quantity 
of water, may be given once in six to twelve hours. 
Rhus-tox.—Eruption, attended with itching and burning during 
inaction, or on entering a room from the open air ; disappearance of 
the W'eals on exercise, followed by shifting rheumatic pains, pains and 
pressure in the stomach, difficult respiration and anguish. This medi- 
cine is particularly applicable in urticaria vesicularis. 
Administration.—Same as Dulcamara. 
Calcarea-carbonica is indicated in cases where the rash vanishes 
on going into the fresh air, and is excited by the application of cold 
water; face yellow, upper lip swollen, skin rough and covered with 
goose-pimples, stunning lateral pains in the head, with nausea and 
vertigo at night or in the morning on waking, wTith faintness; anxiety 
anguish, apprehension. 
Remarks.—Calcarea-carbonica is suitable in obstinate chronic ur- 
ticaria, especially when occurring in scrofulous or cachectic constitu- 
tions. It is sometimes necessary to persist in the use of this remedy 
for several weeks. 
Administration.—A drop of the third dilution in an ounce of water; 
a dessert spoonful once or twice in the twenty-four hours. 
Lycopodium.—Rash and itching during repose, headache in the 
afternoon or at night, smarting of the eyes by candlelight, nausea when 
in a hot room, relieved in the air, silent and peevish. 
Administration.—Same as Calcarea-carbonica. 
Natrum-muriaticum, at the sixth potency, may be prescribed when 
there are languor, uneasiness, nausea, headache, weakness when lying 
down at night, relieved on rising in the morning, eruption coming out 
after violent exercise. 
Nitric-acid, third dilution, will be proper for patients of a debilitat- 
ing night-sweats, weak, enfeebled, subject to haemorrhages from the 
bowels, lungs, nose, &c., and rash caused by exposure and cold air. A 
drop should be prescribed, twro or three times daily. 
Pulsatilla, sixth dilution, when the elevations are redder than the ACHOROUS EXANTHEM. 
615 
skin, when the itching is of a burning or pricking character, worse at 
night in bed, in a hot room, or by scratching; better in the open air, 
worse every other evening ; heaviness and disposition to numbness in 
the limbs ; great sensibility to the open air. 
Ignatia, sixth dilution, is particularly adapted to attacks occurring 
in nervous and hysterical females ; the eruption is brought out by 
exercise, and is often preceded by nervous symptoms ; there is also 
fullness and pressure of the head, with sparks before the eyes; also 
sighing and irregular respirations. 
Ipecacuanha, third trituration, is useful in cases attended with ex- 
cessive vomiting, oppression at the chest, and dyspnoea; it is also a 
valuable remedy in asthma from suppressed urticaria. 
Other remedies worthy of consideration are : Arsenicum, Balsam- 
copaibas, Iodine, and Bryonia, in the chronic forms ; and in the acute 
varieties, Clematis, Staphysagria, and Belladonna, for urticaria 
vesicularis; TJrtica and Ilepar-sulphur, for urticaria tuberosa / 
Mercurius, Iodine, Aurum-muriaticum, and Sepia for urticaria 
maculosa. 
Administration.—The above remedies may be given dissolved in 
pure water. They may be repeated in six, eight, or twelve hours, ac 
cording to the urgency of the symptoms. In all cases of this descrip- 
tion, where a latent miasm is suspected to exist, a persevering and 
judicious course of anti-psoric treatment should be adopted after the 
eruption has disappeared and the acute symptoms have subsided. 
Urticaria, pemphigus, as well as herpes zoster, being often depen- 
dent on the sycotic poison, are sometimes very obstinate. In some 
cases Dr. Wolf succeeded with Thuja, 30°, where Apis had failed, 
though the latter had cured urticaria in various forms. 
Genus II.—EMPLYSIS.—Achorous Exanthem. 
1. MILIARIA.—Miliary Fever. 
Diagnosis.—This disease is ushered in with lassitude, slight creep- 
ing chills, pain in the loins and lower extremities, oppression at the 
prmcordia, cough, general uneasiness, more or less heat and thirst, 
rapid pulse, and high-colored urine. These precursory symptoms con- 
tinue about five days, when a very fine eruption, resembling millet 
seeds, makes its appearance on different parts of the body. The little 
vesicles which compose this eruption are round, hard, and transparent, 
becoming after a time opaque. As they are about coming out there is 
an itching, stinging, and burning sensation in the skin, the oppression 
at the chest and stomach is increased in severity, and, in general, a 
profuse perspiration, of a disagreeable sour odor, breaks out over the 616 
DISEASES OF THE SANGUINOUS FUNCTION. 
whole surface. After two or three days the vesicles become opaque, 
then soon dry up and fall off in the form of a scurf. 
Some writers consider miliary fever as a purely symptomatic affec- 
tion, while others, with equal tenacity, maintain that it often occurs 
idiopathically. According to our own opinion it is not improbable that 
it may be dependent upon some latent miasm, which only requires an 
exciting cause, like puerperal fever, heating and stimulating ptisans, 
undue exposure in heated and close rooms, &c., to call it into action. 
We are confirmed in this opinion from the fact that in nearly every case 
with which we have been made acquainted, where the eruption has re- 
troceded, whether by improper use of external lotions or otherwise, 
there has been a supervention of some serious internal disorder. 
If this view of the cause of the malady be correct the therapeutical 
indications are evident, and the prudent physician will use every means 
which our specific medicines afford to aid nature in casting off the 
poison from the system through the medium of the skin. 
Treatment.—In conjunction with our internal remedies, it is essen- 
tial that the patient be kept in a dry apartment, of uniform tempera- 
ture, and be confined to a strict dietetic regimen. By these means we 
shall prevent the retrocession of the rash from the sudden application 
of external cold, and avoid those unpleasant complications which errors 
in diet are so apt to induce. A strict adherence to the above rules, 
with an occasional dose of Aconite of the third dilution, will generally 
suffice for the cure of this complaint. 
After the eruption has manifested itself, if the patient is troubled 
with a train of nervous symptoms—like sleeplessness, general uneasi- 
ness, partial loss of power over the voluntary muscles, spasmodic 
twitchings, and constant desire to change position—a dose of the sixth 
dilution of Ilyoscyamus may be given, and repeated as circumstances 
require. 
Should the brain become affected in any stage of the disease, Bella- 
donna may be exhibited, in the same manner as advised under measles. 
Chamomilla, at the tenth potency, should be administered when 
infants and children are the subjects of attack. If the malady com- 
mences with strong febrile excitement, this medicine may be preceded 
by Acomte. 
Bryonia is also highly recommended in cases of miliaria in infants 
and parturient women. It may be administered in the same manner 
as Belladonna. 
Ipecacuanha will apply when the eruption is accompanied with 
laborious and noisy respiration, nausea or vomiting, groaning, aversion 
to food, chilliness alternating with flushes of heat, and sweet, insipid 
taste. The third trituration should be employed—one grain every four 
or six hours, until the symptoms yield. COW-POX. 
617 
2. VACCINIA.—Cow-Pox. 
The genuine cow-pox appears on the teats of the coav in the form 
of vesicles of a blue color, approaching to livid. These vesicles are 
elevated at the margin and depressed in the centre. They are sur- 
rounded with inflammation. The fluid they contain is limpid. The 
animals are indisposed ; and the secretion of milk is lessened. They 
are locally treated by solution of Sulphate of Zinc and Copper, other- 
wise they would degenerate into ulcers which are exceedingly trouble- 
some. Saccharum-saturni would probably be better as a wash. Simi- 
lar effects were induced on the hands of the milkers. They have some 
fever and swelling of the glands of the axillae. The active matter 
may excite the disease if applied anywhere to the abraded surface. 
Mode of performing Vaccination.—Make a very oblique punc- 
ture with the point of the lancet in the arm, near the insertion of the 
deltoid muscle, the lancet being charged with the fluid matter. To 
render the infection more certain, take more of the virus and draw 
it across the puncture. Sometimes it is inserted in more than one 
place. 
Dr. Hoffmann, of Poughkeepsie, N.-Y., says:* 
He has succeeded in different ways ; one is “ to grasp the arm of the 
child, so as to tighten the skin on the part selected, (perhaps over the 
lower part of the body of the deltoid muscle, and, with the point of 
a sharp lancet, charged with the fluid matter, make a very small oblique 
puncture in the skin. If the puncture be small, causing only the ap- 
pearance but no flow of blood, the virus, being deposited beneath a 
valve-like portion of the skin, is very likely to be absorbed.” But, in 
order to render the infection more certain, the lancet may be charged 
again and an additional amount of the virus laid upon the puncture. 
The small amount of fluid, including a minute quantity of blood, that 
now lies within and upon the puncture should be permitted to remain 
exposed to the air till it coagulates or dries. It should then be shielded 
from pressure or disturbance. A small piece of court-plaster may be 
placed over the wound, but, if it can be shielded by sufficient care 
without this, it is perhaps better. 
Second Mode.—Having obtained some of the fluid virus fresh, or 
(if not able to get it,) pulverized a small amount of the scab with a 
drop of water on the bottom of a glass or plate; proceed by charging 
the point of a sharp lancet with the virus, and making in rapid succes- 
sion five or six scarifications in one direction, then crossing them by 
the same number, and finally rubbing the flat blade smoothly over. 
The Time for talcing the Virus.—It may answer as soon as the 
* U. S. Jour. Homoeop. Vol. II. p. 334. 618 
DISEASES OF THE SANGUINOUS FUNCTION. 
matter is formed; but if taken too early, the vesicle may be injured. 
It is better to leave it untouched till the eighth day, when its power is 
at its best degree of perfection. At an earlier period it may be used 
with safety, yet with less certainty of success. 
Course of the Vaccine Disease.—The first sign of infection begins 
about the third day. A small red spot rather elevated appears at the 
place where the puncture was made. It may be retarded by various 
causes, and may be prevented by any other disorder, as dentition or 
debility. 
Too much inflammation occurring within two or three days after 
inoculation often attends when the operation is unsuccessful. 
The areola begins to enlarge about the ninth day and declines about 
the eleventh and twelfth day when it begins to dry. The drying pro- 
cess begins with a brown spot in the centre. In proportion as this en- 
larges, the surrounding efflorescence increases till at length nothing 
remains but the circular scab of the dark brown mahogany color ap- 
proaching to black. 
The true, genuine cow-pox pustule, which is a reliable proof of the 
prophylactic virtue of the vaccine, is “flat and depressed in the centre; 
and on the eighth or ninth day is surrounded with an inflammatory 
redness, which is the chief sign that the organism has been thoroughly 
infected with the vaccine. If the pustule be full and convex, and if it 
begin to rise three or four days after vaccination was performed, the 
prophylactic power of the virus can not be relied upon; the matter 
was perhaps too old, or was otherwise not good. 
Permanent Evidence of successful Vaccination.—1. The proper 
vaccine scar should be distinctly defined after a lapse of twenty years; 
in order to this it is indispensable that the scab should remain on, or 
that cicatrization should not be completed till the twenty-first day. In 
some it is completed by fourteen or fifteen. Then “ vaccination is im- 
perfect.” 
2. The true and perfect vaccine scar is circular or nearly so. When 
common inflammation supervenes early, the scar is irregular in form 
and the system is still open to small-pox more or less modified. The 
diameter of the circular scar is not material; but we think the largest 
compatible with safety equal to a dime in size. 
3. The vaccine scar should be indented and radiate; though this 
mark is not insisted on as a sine-qua-non, in proof of perfect vac- 
cination. 
Sources of Imperfection of Vaccination.—1. Effete virus. Always 
use fresh matter, or from scabs perfectly preserved. 2. Pre-occupation 
of the system by some other important diseased process, as dentition, 
vesicular inflammation, fever, whooping-cough, porrigo favosa, or COW-POX. 
619 
herpes. 8. Lastly, advanced period of life when vaccination is per- 
formed. 
The real virus from the cow is so difficult to procure, that the 
safest method is to select it from the healthiest child of the healthies 
parents. There is grea difference in the power of the scabs in pro- 
ducing the vaccine disease. The best and most reliable are of a dark 
brown color, easily pulverized, and as brittle as,glass. Those of poorer 
quality are pale, will bend but not break ; they are with difficulty pul- 
verized, and are composed chiefly of fibrine. 
Observations on many thousands of cases lead to the following con- 
clusions : 
1. That every individual is subject to vaccination. 2. Re-vaccina- 
tion is not necessary before puberty. 8. At puberty the system under- 
goes a change which makes vaccination again necessary. 4. Vacci- 
nation when perfect is a sure preventative of small-pox. 5. Re-vac- 
cination is a sure preventative of varioloid. 6. The third vaccination 
is inert. 7. The system is susceptible of varioloid after puberty 
whenever the individual without re-vaccination is exposed to small-pox. 
8. Re-vaccination is not generally necessary if the first operation was per- 
formed after puberty. 9. Those who disregard vaccination are always 
liable to small-pox when exposed to it. 10. That if every individual were 
perfectly vaccinated before puberty, and re-vaccinated afterwards, small 
pox would disappear from the earth. 
Of the Period at which Vaccination may be performed with th 
hope of preventing Small-pox.—The infection when communicated 
is not indicated by any perceptible symptoms; and it is, therefore, im- 
possible to define the period when vaccination will no longer be able 
to ward off the small-pox. Hartmann says : K If small-pox shall have 
attacked one member of a family and other members of the family 
have not been vaccinated, vaccination will prove inefficient to protect 
them from the disease.” We have seen vaccination effectual in saving a 
whole family, one of whom already had the small-pox and was lying in 
their midst. 
Irregular Course of Vaccine Disease.—Hartmann says, he has 
seen “ on the seventh day of vaccination metastasis to glandular 
organs.” This is not dangerous though the diseased action be trans- 
ferred to the testicles or parotid glands; as it generally disappears of 
itself on the ninth or eleventh day, when the nervous and vesicular ex- 
citement has subsided. It has frequently happened, that “ morbid 
toms which would not yield to any remedy, such as chronic inflamma-' 
tion of the meibomian glands, or the discharge of badly-smelling pus 
from the ears, ceased entirely after vaccination.” In such cases the 
vaccine disease ran its regular course, and was accompanied by more 
fever than usual. 620 
DISEASES OF THE SANGUINOUS FUNCTION. 
Bad Results of Vaccination.—A Massachusetts paper of April, 
.I860, says: “A large number of persons in Westport, Mass., recently 
inoculated with vaccine matter obtained from the city physician of 
Boston, have been afflicted in an extraodinary manner. A Mr. Fletcher 
died in a few days after being vaccinated. His arm commenced swell 
ing and mortification soon took place.” 
Dr. Williams, of the Cleveland Medical College, says: “ A few 
years ago the City Council of Cleveland passed an order requiring the 
positive vaccination of all persons who had not been previously vac- 
cinated. The order made no distinction among cases and w*as indis- 
criminately carried into execution. The results were in some cases 
truly alarming. In several children terrific ulcerations and disorganiz- 
ing inflammations followed which ended in death. Others recovered, 
but retained for a long time malignant sores, extending to the bone, or 
nearly laying it bare around the arm. Those who performed the vac- 
cination claimed that the matter they used was perfectly pure.” (JY. A. 
Jour. Ilomoeop. Nov. 1857. p. 153.) 
Bad Results of Vaccination from the diseased Condition of the Pa- 
tient.—A physician of Poughkeepsie, N.-Y., vaccinated an apparently 
healthy child and in a week was summoned to look at the child. “ It 
was covered with deep, ugly looking ulcers, secreting thin, acrid pus. 
It had hitherto been the picture of health; it was now feeble, emaci- 
ated, its voice having a piping sound.” The virus was known to be 
from a healthy child whose parents were also healthy; other children 
had been vaccinated with the best results from the same virus. The 
physician found in this case that the parents of the child were more 
or less diseased, the father confessing to have syphilis when young. 
The matter for the performance of vaccination should be only taken 
from healthy subjects, free from all eruptions or glandular diseases. 
But the best matter may excite a latent dyscrasia in a patient supposed 
to be healthy. Hence proper antipsoric treatment should precede as 
well as follow vaccination. 
Distinction between Vaccinia and true Small-pox.—In claiming 
the appropriateness of the vaccine disease as a remedy to prevent 
small-pox it is not pretended that the two diseases are precisely alike 
in their nature. Indeed, they are not alike but only similar. The 
distinction is thus drawn by Dr. Henderson, of Edinburgh. 1. The 
mildest case of modified small-pox in which only a half dozen pocks 
occur on the skin is capable of producing by inoculation or contagion 
nothing but small-pox; and it may produce severe and even fatal 
small-pox in others, vaccinia may be said, however, to be still milder 
than the mildest small-pox. 
2. Dilute small-pox virus with water and thus weaken it to the lowest COW-POX. 
621 
potency; it is still capable of acting by inoculation, and it will still 
produce small-pox, not a solitary vaccine vesicle. 
3. Dilute small pox virus with cow’s milk and it is said, by Dr. Basil 
Thiele, that according to 3000 experiments, made by him, inoculation 
with the mixture will produce the vaccine vesicle and not the small- 
pox eruption ; the two diseases then are not identical. If only similar, 
very similar it may be, the conclusion manifestly is that vaccination, 
by producing a disease similar to the small-pox, and which can occur 
only once in a life, prevents the occurrence of small-pox; that in a 
word, vaccination acts homoeopathically, or according to the law of 
similars. {On Homoeopathy, p. 240.) 
Vaccination, says Hahnemann, can not protect us from small-pox by 
acting otherwise than homoeopathically. The diseases are similar in 
appearing generally but once in the course of a person’s life; they 
leave behind cicatrices equally deep; they both occasion tumefaction 
of the axillary glands; they have fevers that are analogous; an in- 
flamed areola around each pock; and finally ophthalmia and convul- 
sions. Other traits of close resemblance often exist between the two 
maladies. 
“ The cow-pox would even destroy the small-pox on its first appear- 
ance, that is, it would cure this disease when already present were not 
the small-pox stronger than it. To produce this effect, then it only 
wants the excess of power, which according to the law of nature ought 
to accompany the homoeopathic resemblance, in order to effect a cure. 
(§ CLVIII.) Vaccination, considered as a homoeopathic remedy, cannot, 
therefore, prove efficacious except when employed previous to the ap- 
pearance of the small-pox, which is the stronger of the two.” 
“ When so employed, it excites a disease very analogous (and conse- 
quently homoeopathic) to the small-pox, after whose course, the human 
body, which as usual, can only be attacked once with a disease of this 
nature, is henceforward protected against a similar contagion.* 
IIow much Benefit has Vaccination conferred on the World ? 
In 1806 the bills of mortality seemed to show that the average dura- 
tion of human life was twenty-eight years ; in 1836 a committee of the 
New-York Medical Society estimated the average duration of life at 
thirty-three years, and they credited vaccination with having done more 
than any other sanatary measure for thus adding five years to the length 
of human life. Before vaccination was discovered, one-tenth of the 
whole human race died of small-pox taken in the natural way. Only 
* This mode of homoeopathic cure in antecessum (which is called preservation or 
prophylaxis) also appears possible in many other cases. For example, by carry- 
ing on our persons Sulphur, we think we are preserved from the itch, which is so 
common among wool-workers ; and by taking the smallest possible dose of Bella- 
donna, we are protected from scarlet fever. (Organon.) 622 
DISEASES OF THE SANGUINOUS FUNCTION. 
three years before Jenner’s discovery 36,000 died in England in one 
year. His discovery promised to banish the most fatal of the dis- 
eases which preyed upon the health and happiness of the human fa- 
mily. And now, after the experiments of three-score years medical tes- 
timony proves that vaccination is the only protective means for guarding 
against small-pox, and that when the system is fully under the vaccine 
influence the protection is perfect. When this is doubtful, there is as 
yet no resource known but re-vaccination; and, if after trying it there 
be a doubt remaining, there is no resource but to repeat the operation 
till the best vaccine virus that can be found can produce no effect upon 
the system. Let re-vaccination be tried on all who have been vacci- 
nated in infancy or youth; let the matter be selected with care; and 
the protection given may be regarded as complete. It can not be said 
that a single vaccination gives that perfect protection. The longer the 
interval since vaccination has been practiced, the greater chance of 
exciting true vaccine disease by re-vaccination. The influence of the 
vaccine is not certainly for life, but for a term of years, which varies 
in different constitutions, from ten to fifteen years, often much longer; 
in some persons it extends through life. Lorette’s experiments led to 
the conclusion “ that matter taken from a secondary pustule will pro- 
duce a full and complete primary vaccine disease. We see the same 
in small-pox, where the varioloid often communicates confluent small- 
pox.” 
Permanence of the Power of Vaccination.—I. “ Is the preserva- 
tive virtue of the vaccine virus absolute, or only temporary?” 
In 1842 the French Academy des Sciences offered prizes for the 
settlement of this question; and it required that if the latter opinion 
should be reached the answer to the question should “ determine by 
precise experiments and authentic facts the period during which vac- 
cination preserves from variola.” The answer which was accepted by 
the Society was given by M. Serres. He says: 
“ The comparison of results enables us to draw three conclusions :— 
1. The preservative power of vaccination is absolute and general for 
eight or nine years after its performance, and even to the tenth or 
twelfth year in a great proportion of cases. 
2. When this period is passed, and especially under the influence of 
epidemics, a part of the number vaccinated, and a part only are liable 
to variola. 
3. The greater number of the vaccinated are probably protected 
for life. 
II. “ Has the cow-pox a more certain or permanent preservative 
power than virus already employed during the greater or less number 
of successive re-vaccinations ?” COW-POX. 
623 
Answer.—The local effects of the new virus are more marked; but 
the preservative power is not proportionate to these. 
1. Small-pox, says Serres, appeared at the college of Soreze and 
attacked forty pupils of whom only two had been vaccinated. All the 
remaining pupils, two hundred in number, were vaccinated and small 
pox ceased. 
2. In 1821 small-pox attacked twelve children at Mantua foundling 
hospital, the remaining two hundred were vaccinated, and the disease 
disappeared. 
III. “ Supposing the preservative power of the vaccine to become 
enfeebled by lapse of time, should we renew it, and by what means ?” 
Means proposed for Renewal of the Virus.—Inoculate the cow 
with the grease from the heel of the horse, or with true small-pox from 
the human subject. Both of these expedients have often failed, but 
they have often succeeded. It is best to seek the true vaccine virus 
at its source as proposed by Jenner. 
IY. “ Is it necessary to vaccinate the same person several times 9 
And if so, after how long an interval ?” 
Answer.—The preservation is almost absolute up to the period of 
adolescence. After that period certain of the vaccinated are liable to 
attacks of variola until the age of thirty or forty years. After that 
period their preservation is almost absolute and certain. The only re- 
liance to arrest epidemics is in re-vaccination. The fact that the vac- 
cine disease may be excited by re-vaccination is no evidence that the 
patient would have taken the small-pox. But the process of re-vacci- 
nation does arrest epidemic small-pox; and this fact, fairly and fre- 
quently observed, has silenced the opposition of all Europe. 
To ensure the safety of the army the Prussian government issued 
an order March 6th, 1831, demanding the re-vaccination of all who 
entered the army. The order was made absolute; and all surgeons 
were compelled to report their results to the royal military council 
every year. The report for 1833 concludes : that “ there were strong 
grounds of doubt of the extent of the protective agency of vaccination. 
Either from the possible failure of the original operation, or from the 
effect wearing out by lapse of time, enough had been proved to justify 
the re-vaccination; and that after the re-vaccination of all doubtful 
men there were no cases of small-pox or varioloid, though the men had 
been closely in contact with very many cases of small-pox.” 
In France the Academy of Medicine appointed a committee to in- 
vestigate the same point. M. Lorette reported that he re-vaccinated 3600 
persons. In one canton where epidemic varioloid prevailed, out of 
eighty-six re-vaccinated, twelve presented examples of a second eruption 
so regular and perfect that it was impossible to distinguish it from the 
primary disease. Of these he says two-thirds presented vaccine cica- 624 
DISEASES OF THE SANGUINOUS FUNCTION 
trices too deep and well defined to leave any doubt of the perfection 
of the primary vaccination; therefore these individuals exhibited ex- 
amples of two distinct and perfect eruptions of vaccina. 
The period after the first vaccination influences the success of a 
second trial. Before the age of ten years, re-vaccination only produced 
false vaccinia. Another committee decided that “ re-vaccination was 
most successful for the young and middle aged.” Hufeland says 
“ Varioloid attacks almost exclusively adult subjects, or those who have 
been vaccinated from ten to twenty years.” 
A committee of New-York physicians in 1836 reported that the per- 
sons attacked with varioloid in the United States “ were such as had 
been vaccinated from fifteen to thirty-five years before; and hardly in 
any case did it affect those who had been vaccinated within ten 
years. 
Characteristics of False or Imperfect Vaccine Disease.—It begins 
by the first or second day, is developed with such rapidity that it attains 
its height by the time the genuine begins to show itself. The pustule 
presents no central depression, is without a silvery lustre, and has no 
elevated rim; it rises nicely to a point, and thus becomes crowned with 
a yellow or dirty layer, which bursts and gives out a single flake of 
matter; this when dried resembles gum in appearance; and this is all 
accomplished in eight or ten days at farthest. There is now little doubt 
that the false vaccine is owing to matter too far advanced, or to the re- 
sistance offered by the economy from previous vaccination or vario- 
lation. 
3. VARICELLA.—Chicken-Pox. 
Diagnosis.—There are a few points of similarity between milder 
cases of small-pox and the more severe forms of varicella which require 
an acute observer to discriminate between them during the early part 
of the attack. Both diseases commence with similar primary fever, 
which continues until the eruption makes its re-appearance; the pus- 
tules in both instances resemble each other; both are alike contagious 
and communicable by inocculation. 
At the eruptive period, however, an attentive observer will perceive 
that the resemblance usually ceases, for the pustules of variola make 
their appearance in a uniform manner, first on the face, then successively 
upon the neck, arms, breast, body and lower extremities, occupying 
usually but twenty-four hours for the completion of the eruption, we have 
seen it take several days, while the pustules of varicella come out in 
repeated series, first upon the breast, then upon the face, head, arms, 
body and lower extremities, and require three or four days before the 
eruption is complete. Therefore we often observe during the progress PELAGRA. 
625 
of the latter, some vesicles drying up, some in a state of partial deve- 
lopment, while others are but making their first appearance. The vesi- 
cles of chicken-pox contain a whitish or yellowish lymph, which seldom 
advances far towards the suppurating stage, and even in those case 
where pus is formed, there is never any secondary or suppurative fever 
as in variola. 
Causes.—Varicella, like other contagious diseases, is a distinct af- 
fection, and proceeds from a peculiar specific cause. This is apparent 
from the fact that inoculation with varicellous matter never gives rise 
to any other malady than varicella itself. 
It is not only a much milder disease than small-pox or varioloid, but 
is of much shorter duration, running its course generally in six or seven 
days, when the pocks all disappear, leaving smooth surfaces. 
Treatment.—Varicella, as it commonly occurs, requires no medicinal 
treatment. A due regard to diet, avoidance of exposure to cold, damp- 
ness, &c., being only necessary to ensure its safe progress. 
In cases where the malady assumes unusual severity, manifested by 
a high grade of febrile excitement, determinations of blood to the 
brain, lungs or abdominal organs, then the medicines that are homoeo- 
pathic to the existing symptoms may be administered. 
The remedies most frequently used in such cases are, Aconite, Goff., 
Bell., Merc., Bhus-tox., and Suljphur. The strength of the medicines 
as well as the repetitions of the doses, the same as under varioloid. 
4. PELAGRA. 
Dr. James Johnson, one of the “ most accomplished medical scholars 
in the world,” thus describes this disease, known as “ the scourge of 
Italy The phenomena which result from the physical operation of 
climate on the human race, and which are equally curious and melan- 
choly to contemplate, may he seen in a large scale in the great hos- 
pital of Milan—the pelagra of the Lombardo-Venetian plains. 
This horrible malady has been observed since the middle of the 
last century, and is rapidly increasing. It has been supposed that one- 
seventh of the population may be affected by it. 
It begins by an erysipelatous eruption on the skin which breaks out 
in the spring, continues till autumn, and disappears in winter, chiefly 
affecting those parts of the surface that are habitually exposed to the 
air or sun. This cutaneous symbol of an internal disorder is accom- 
panied or preceded by remarkable debility lassitude, melancholy, 
moroseness, hypochondriasm, and sometimes a strong propensity to 
suicide. Year after year the cutaneous eruption and annual disorder 
* Johnson, On Change of Air, p. 54. 
You I.—40. 626 
DISEASES OF THE SANGUINOUS FUNCTION. 
become more and more aggravated, with shorter and shorter intervals 
in winter. At length the surface ceases to clear itself, becomes per- 
manently enveloped in a thick, livid, leprous crust somewhat resembling 
the dried and black skin of a fish. By this time the vital functions are 
reduced to a lowT ebb, and frequently the intellectual faculties also. 
The miserable victim loses the use of his limbs, particularly the infe- 
rior extremities; he is tormented with violent colic, headache, nausea, 
flatulence and heartburn—the appetite being either weak or voracious. 
The countenance is sombre; teeth rotton, inside of the mouth ulcer- 
ated. Mucous membrane highly irritable; diarrhoea; burning pain in 
the head and along the spine, from whence it radiates to various other 
parts, but more especially to the palms of the hands and soles of the 
feet, tormenting the wretched victim by day, and depriving him com- 
pletely from sleep at night! He frequently feels as if an electric spark 
darted from the brain, and flew to the eye-balls, the ears and nostrils, 
burning and consuming these parts. To these seven afflictions of the 
body are often added hallucinations of mind. The patient fancies he 
hears the incessant noise of mill-stones grinding near him,—of ham- 
mers resounding on anvils, of bells ringing, or the discordant cries of 
various animals. Advancing further the disease sometimes takes the 
form of various other maladies, as tetanus, convulsions, epilepsy, dropsy, 
marasmus, mania. Over the beds of the Milan hospital are written 
the compound names atropia pelagrina, hydrops pelagrina, paralysis 
pelagrina, &c. The patient at last ceases to suffer and death relieves 
him when disease has reduced him to an appearance resembling a 
mummy. Many anticipate a fearful death by the dreadful expedient of 
suicide, and the tendency to self-destruction by drowning is so general 
that the suicidal disposition was called by one writer “ Ilydromania.” 
Pelagra most frequently affects persons living in the country, including 
the lower classes of the people; it may effect persons of every age 
down to children. It is found in the whole of the flat country on both 
sides of the Po, especially the level plain between that river and the 
Alps. It has been described by many native authors, including Strambi, 
Trapolli, Soler, Zanati. 
Such is a disease which afflicts one-seventh of the population of that 
delightful land, the climate of which has been eulogized by every an- 
cient and modern poet, painter, novelist and romantic tourist. Words- 
worth saw the beauties of external nature, and enjoyed them as Virgil 
has taught all men to appreciate them nineteen centuries ago. Rogers 
found among the same scenes only the sunniest spot of earth: 
“ Where the world danced, 
Listening to Monto quaffing grarnolete, 
And reading in the eyes that sparkled round, 
Ten thousand love adventures written there.” (Rogers’ Italy.) 8M ALL-POX. 
627 
Causes.—The cause of this frightful malady is no more known than 
the cause “of hepatitis on the coast of Coromandel, of elephantiasis in 
Malabar, beriberi in Ceylon, barbadoes-leg in the Antilles, goitre 
among the Alps, the plica polonica in Poland, cretinism in the Valais, 
or malaria in the Campagna di Roma. It is an emanation from the 
soil, whether conveyed in the air, the food, or the water. If any of 
these endemics above named originated in the filthy habits of the peo- 
ple, we ought to have them in Sion, or the Jew’s quarter in Rome, the 
narrow lanes of Naples, and the allies of filth in all Italian towns and 
cities. But the Jew’s quarter of Rome is the filthiest and the health- 
iest spot in that famous city. The inhabitants of some wretched Nea- 
politan villages are eaten up with dirt, starvation and malaria; but no 
goitre, elephantiasis or cretinism is ever seen there. Each country 
then which produces its peculiar endemic, produces them from hidden 
sources that human sagacity has not yet been able to penetrate. Medi- 
cal men have generally thought palagria in Lombardy to result from 
the poverty and wretched condition of the poor. No doubt this pov- 
erty and the filthy habits of the people in many places contribute to 
call forth and perpetuate a disease which proper sanitary conditions 
and correct medical treatment ought to exterminate. 
Genus III.— EMPYESrS.— PUSTULOUS EXANTREM, 
1. VARIOLA.—Small-Pox. 
The Greeks and Romans knew nothing of small-pox. The first 
notice of any disease that presents any of the chief features of small- 
pox occurs in a chapter of Procopius in Bello Bersico (lib. II., chap. 
22.) where he describes a dreadful pestilence which began at Pelusium 
in Egypt in about the year 544 a. d., or 1318 years ago. It spread 
towards Alexandria on one side and Palestine on the other. A very 
short time afterwards unequivocal traces of small-pox are seen in the 
countries bordering on the Mediterranean. Bruce, the traveller in Abys- 
sinia, supposes it to have first appeared in the year a.d. 522. But it was 
not clearly described till it was done by Rhazes of Bagdad in the 
year 900. From the east small-pox travelled westward, and reached 
England just before the year 900. (Lectures on the Exanthemata, by 
Dr. George Gregory, St. Thomas Hospital, 1843.) In 1527 it was 
brought to America. 
So long as no means were known of mitigating the severity of small- 
pox the number of deaths from this disease was enormous in every 
country to which it had found its way. Before the introduction of in- 
or, ulation, and when the disease was always taken in the natural way, 
the number of deaths was one in six, and a large proportion of those 
who escaped with life were dreadfully disfigured. Under the influence 628 
DISEASES OF TIIE SANGUINOU8 FUNCTION. 
of inoculation the deaths were reduced to one in fifty; and further im- 
provement in the treatment by physicians reduced the deaths to one 
in two hundred. But the disease was more widely diffused by these 
efforts to diminish its mortality. There were more sources from which 
small-pox could be taken in the natural way. Inoculation therefore 
made its way to public confidence through much opposition; and it was 
not fully established in the public mind after eighty years of discussion 
and experiment. In England alone 40,000 persons annually died of 
small-pox. Dr. Lettsom estimated the deaths in Europe at 210,000 per 
annum; and Bernoulli made the annual number of deaths in the w orld 
at 600,000. 
A half century before the discovery of inoculation, 72 persons out 
of every 1000 of the population died of small-pox. In forty years 
after this discovery, or after 1770, the deaths rose to 85 per 1000 in- 
habitants. And such was the condition of the world when Jenner be- 
gan his experiments on the powers of vaccination to supercede small- 
pox. In 1798 he performed his grand experiment of inoculating Sir 
James Phipps with small-pox, relying on only a previous vaccination to 
protect him from the more fatal disease. The result was successful. 
The patient found himself insusceptible to the small-pox poison; and the 
world rejoiced in the hope that the most loathesome and dangerous of 
known diseases was about to be banished from the world. 
Varieties of Small-pox.—Two varieties of this disease have gene- 
rally been recognized by nosologists; one termed distinct, the other 
confluent. 
1. The former of these is more mild and less dangerous than the 
latter, being attended writh less severe constitutional disturbance, and 
having detached, distinct pustules, fewer in number, and which are 
surrounded by a pale-red areola. 
2. The confluent variety is distinguished by the pustules running 
together and meeting each other, the surface presenting the appear- 
ance of a uniform and homogeneous swelling. 
Diagnosis.—An eruption consisting of acuminated pustules which 
first appear on the third, fourth or fifth day of the contagious fever in 
the shape of red spots; these spots gradually elevate themselves into 
pustules during three days, suppurate for three other days, after which 
they dry up and form scabs, which in falling off leave small irregular 
cicatrices. This is the course of a single pock. As the breaking out 
of the fresh pocks continues for three days, the period of dessication 
terminates about a fortnight after the appearance of the first pock. 
Small-pox may be divided into the following stages or periods, viz : 
1. The primary fever / 2. the eruptive stage • 3. the maturing 
period; 4. the period of exsiccation. 
1. The primary fever in the distinct variety is u.-hered in with SMALL-POX. 
629 
lassitude, rigors, pains in the head, back and loins, slight sore throat, 
soon followed by nausea and vomiting, pain at the epigastrium, often 
severe, with tenderness on pressure, hot and dry skin, thirst, scanty 
and high-colored urine ; these symptoms continue for about three days, 
when the eruptive stage begins. 
Eruptive Stage.—The eruption first comes out in small red spots or 
points, which in the course of forty-eight hours become rounded into 
pimples with vesicles upon their tops and slight depressions in the centre. 
They show themselves first upon the face, and then in irregular suc- 
cession upon the scalp, neck, arms, breast, body, and lower extremities, 
requiring about twenty-four hours for the full development of the erup- 
tion. After this period, there is a marked remission of all the febrile 
symptoms, which continues for three or four days. 
The Maturing or Supurative Stage now commences. There is 
now a renewal of the febrile disturbance still more violent than at first, 
which commonly continues during the remaining course of the disease. 
This period continues from three to five days, when the serous fluid 
within the pustules acquires a purulent character, becoming thick and 
yellow. On the tenth or eleventh day, the pustules burst, giving vent 
to the matter which collects upon the surface of the pock, forming dark 
scabs or crusts, which in a few days fall oft', leaving the skin scurfy and 
sometimes pitted. 
Now commences the period of exsiccation, which occupies from 
three to five days ; after which, if the malady has pursued a moderate 
course, the morbid symptoms all subside, and convalescence ensues. 
Thus it will be perceived that the regular course of the disease occu- 
pies about fifteen days ; this course, however, is subject to modifications 
from a great variety of causes, such as the supervention of pneumonia, 
bronchitis, ophthalmia, abdominal inflammations, disease of the glands, 
retrocession of the eruption, &c. 
Confluent Variety. - In this variety the primary fever is of a more 
violent character, the eruptive period more irregular, usually commen- 
cing at the end of two days from the onset of the malady; there are 
often spasmodic twitchings of the muscles, at, or previous to the ap- 
pearance of the pustules, the secondary or suppurative fever frequently 
assumes a typhoid form, salivation occurs about the period of the erup- 
tion, after which the tongue, mouth, and throat become dry and dark; 
pocks form in the mouth, throat, larynx, pharynx, rectum, and urethra; 
and occasionally symptoms manifest themselves which indicate a high 
degree of malignancy. The face is often much swollen and disfigured 
from the pustules running into each other, so that the eyes become en- 
tirely closed, and the nostrils obstructed. The matter of the pustules 
is of a dusky color, and is sometimes so acrid as to irritate the sur- 
rounding skin. 630 
DISEASES OF TIIE SANGUINOUS FUNCTION. 
What has been denominated varioloid is nothing more or less than 
an exceedingly mild form of small-pox, modified by previous vaccination, 
or some other accidental influence. The primary fever is very 
mild, the eruption distributed over the body in patches, the suppu- 
rating process slight and imperfect, attended with little or no secon 
dary fever. 
Causes.—All agree that small-pox variola proceeds from a specific 
morbific poison, sui generis. There are, however, causes constantly in 
operation, which exert a powerful influence in modifying or aggravat- 
ing the character of the malady, respecting the nature of which authors 
are not so well acquainted. At some periods small-pox is charac 
terized by a high degree of putridity, the symptoms assuming a low 
typhoid form, and a majority of the cases proving speedily fatal in spite 
of all remedial measures. At other seasons we may have a predomi- 
nance of pulmonary or cerebral symptoms, attended with a high grade 
of synochal fever, and requiring a very different course of treatment 
from the form above mentioned. Again it may run its course in a re- 
gular and moderate manner, without serious complication from distur- 
bance of any capital organs, and demanding but little aid from reme- 
dial agents. Some writers have supposed that these different modifi- 
cations were owing to certain occult conditions in the atmosphere, and 
also that the existence at the same time of other epidemics, has a ma- 
terial influence over the character and progress of small-pox. This is 
no doubt true ; but there are other causes more under our control, which 
are of no less importance, as predisposing agents to the more violent 
forms of the malady. The most prominent of these are small and ill- 
ventilated dwellings, a lack of healthy and nutritious food, want of 
cleanliness, insufficient clothing, immoderate use of ales and impure in- 
toxicating liquors; and the pernicious custom of crowding together in 
the same apartments, a number of individuals, who thus inhale, a good 
part of the time, a vitiated and unhealthy atmosphere. The fatality 
of small-pox when it seizes upon this degraded class, indicates the im- 
portance of the influences just enumerated in aggravating the charac- 
ter of the malady. Does it not then behoove the guardians of the 
public health during the prevalence of contagious affections to look 
well to these deleterious agencies and remove from their towns the 
filth, dissipation and corruption of these hot-beds of contagion. 
Dr. Granger, of St. Louis, has employed both variolin, and vaccinin, 
extensively as remedies in variola, and with excellent results. He in- 
forms us, that under their use the pustules shrink away before arriving 
at maturity, and that the severity and duration of the disease is much 
diminished. He also observes that it is rare that indentations follow 
the use of these medicines. He employs the second and third tritu- 
rations. SMALL-POX. 
631 
Treatment.—The following are the ordinary medicines, used in the 
treatment of small-pox : Aconite, Belladonna, Rhus-tox., Vaccinin, 
Variolin, Sulphur, Opium, Mercurius, Bryonia, Pulsatilla, Nux- 
vom., Carbo-veg., Arsenicum, Stibium. 
Aconite, second or third dilution, is the proper medicine during the 
primary fever, provided the attack is regular, and there exists no ten- 
dency to inflammation or congestion of any important organ. 
In case the eruption is slow in making its appearance, or the process 
should be attended with great internal oppression, either Rhus or Sul- 
phur, third attenuation, may be exhibited; a dose every three or four 
hours. 
Belladonna is the specific, when, during any part of the malady, 
inflammation or congestion attacks the brain. In cases of this descrip- 
tion this remedy exercises a twofold effect; first, by its special action 
upon the cerebral organs, and second, by its power of forcing and of 
retaining the eruption upon the surface. The third dilution may be 
used in these instances—one drop every two hours until amelioration 
of the symptoms is evident. 
Tartar-emetic.—The identity of the Tartar-emetic pustule with that of 
small-pox induced Dr. Liedbeck, of Stockholm, to try its effect in this 
disease. He says, he has never seen a case of small-pox terminate fa- 
tally when treated by Tartar-emetic. In small doses it moderates the 
fever and the pustules run their course without leaving a vestige of 
their presence. He gives one-half to a grain, dissolved in a pint of 
water, a table-spoonful every four hours. The first dose often makes 
the tongue clear, the fever subsides, and the difficulty of swallowing is 
less. Dr. Berg says, it is the only remedy to be relied upon when 
there is irritation of the respiratory mucous membrane. 
In the epidemic of Stockholm, of 1838, this complication caused all 
the deaths. After nine years further experience he would refer to 
administration of tartarized antimony as the substitute for vaccination. 
In confluent small-pox, it reduces the fever, allays the irritation of the 
skin better than any other remedy. Dr. Stewart, of Natchez, says, he 
has used it in small-pox for several years. 
Case.—J. H , a boy aged four years, has had fever for four days ; 
eruption slowly appearing. Fever too high to the full development of 
the eruption. Aconite and Tartar-emetic. The next day the eruption 
was more full; the third day fever less ; urine still deficient and high 
colored. Epigastrium full, bloated; eruption maturing. Fifth day, 
the fever high; eruption very full over the whole surface; body and 
limbs swollen; eruption confluent over the face and some other parts. 
From this time the Tartar-emetic was given constantly, and Bryonia 
only one day. There was a steady progression in the maturation and 632 
DISEASES OF THE SANGUINOUS FUNCTION. 
then in the dessication of the pustules. On the fourteenth day the 
fever was gone, the scabs separated, the skin only remaining tender. 
Sulphur.—At the commencement of the attack, and about the pe- 
riod of dessication, it will often prove exceedingly serviceable in deter- 
mining the eruption to the surface, and in disposing it to progress 
kindly. In individuals who suffer from a psoric taint, it cannot well be 
dispensed with. It may he administered at the third trituration, in 
grain doses, and repeated sufficiently often to ensure the favorable 
appearance of the eruption. It has been used to prevent the pitting 
of the skin. 
Vaccinin and Variolin have been highly extolled as a remedy in 
all stages of this affection. It is said, that by the use of these agents 
variola is rendered a very mild and harmless disease. It is claimed 
by those who have made considerable use of them, that all of the 
stages of the malady are shortened in duration, and that a majority of 
the cases thus treated resemble varioloid rather than real small-pox. 
These medicines have been used in the form of trituration of the third 
attenuation. 
Variolin is an isopathic remedy. Hartmann says: “after control- 
ling the eruptive fever, congestion of the brain, delirium, burning heat 
of the skin, dryness of the tongue, thirst, &c., by Bell. I have suc- 
ceeded in shortening the course of the eruption and preventing the ex- 
cessive suppuration with Variolin.” 
Mercur.—Fever violent, nose throat, eyes severely affected. Ptya- 
lism. See p. 634. 
When there is much swelling of the face, fomentations of tepid milk. 
Camphor.—Sudden dessication of the pustules and disappearance of 
swelling of the face are indications of approaching death. Repeated 
doses of Camphor will rouse the system. It is only possible to main- 
tain life by the use of stimulants. 
Prognosis.—Small-pox is a most painful, dangerous and disgusting 
disease. The more numerous the pocks, particularly in the face, the 
more complicated the disease. 
Old or enfeebled persons, and pregnant women, are particularly 
liable to death from small-pox. The disease is more fatal when it ap- 
pears in an epidemic form; is more so at the middle of the epidemic 
than at its beginning or end. Convulsions occurring before the erup- 
tion appears do not indicate danger; but they are highly dangerous 
when they occur during the period of dessication. There is great 
danger when the eruption appears very suddenly, and in clusters, or 
when the pocks are depressed, pale, discolored or sanguinous. Dis- 
charges of blood from the kidneys and bowels are highly dangerous. 
Consequences of Small-pox.— Chronic Ophthalmia. — Ilepar- 
sulph., Digitalis, Sulphur, Rhus, Arsenicum, Merc.-hyd., and Euphrasia. VARIOLOID. 
633 
Frequently recurring Boils.—Sulphur, Mercurius, Cinna, Kali-hyd. 
Caries after Small-pox.—Asarum, Silicea, Mezereum, Aurum, 
Phos., Nitric-acid. 
Convulsions occurring in children during the eruptive and febrile 
stage. Expose to cool air; give Aconite and Belladonna at short in- 
tervals ; enemas of tepid -water. If the child be pale, with cold extre- 
mities, frequent emission of pale urine, there is a nervous disposition 
predisposing to spasms. Put' the patient in a warm bath and admi- 
nister Zinc, third trituration one dose every hour. 
If the convulsions depend on gastric irritation or worms, treat those 
conditions. 
In the eruptive stage more than any other the pocks incline to be- 
come malignant by combining with typhoid or putrid symptoms, or 
disappear suddenly. In these cases Arsenicum, Ammonia-curb., 
Bhus-tox., Bryonia, and Nitric-acid, will be required. 
2. VARIOLOID.—Modified Small-Pox 
After Jenner and his followers had succeeded in the course of a 
thirty years’ war in convincing the public of both hemispheres that 
vaccination was the true and perfect preventive of small-pox, it was 
thought that the grand desideratum was reached, and nobody feared 
the dying out again of the virtue of the remedy. But a new disease began 
to show itself, attacking those who had been protected by vaccination. 
It was called varioloid, from its resemblance to true variola. The 
question was asked, “ What is varioloid V” 
A multitude of indubitable facts warrant us to conclude that it is 
merely a modification of small-pox; that it produces in unprotected 
persons genuine variola; in a few instances it has produced the con- 
fluent form of the disease and even death. It then appears that vac- 
cination is not a perfect preservative against small-pox. The question 
arises, “ To what extent is it to be relied upon ?” Physicians have been 
unwilling to admit failure or imperfection in any thing that has been 
generally advocated. And the opinion given by Dr. John Bell in a 
dissertation that obtained the Boylston prize for the year 1825 con- 
tinues to receive the sanction of the profession. He says : “ Reason 
and probability are highly in favor of the truth of Dr. Jenner’s opinion 
that the security which vaccination offers is in direct proportion to the 
degree of perfection of the vaccine process; and that in consequence 
it is advisable re re-vaccinate as long as any effect is produced.” It is 
claimed that this advice of Jenner, if followed, would keep varioloid out 
of the world. 
Bryonia will he called for if pneumonic symptoms obtain rT'Vu»<=» 634 
DISEASES OF THE SANGUINOUS FUNCTION. 
remedy will also prove serviceable in typhoid forms, attended with 
gastric or biliary derangements. 
Bryonia may be administered in mild cases, at the third dilution, 
and in severe congestive forms at the first—a drop every two or three 
hours in water. 
Mercurius-viv., third trituration, should be administered, if saliva 
tion, ulcerated throat, or diarrhoea with bloody stools, and tenesmus 
occur. It is also a remedy of value during the suppurative stage, and 
in the ophthalmias which often accompany and succeed the variolous 
attack. 
Opium, at the third dilution, will always be appropriate whenever 
coma and nervous sensibility, stertorous respiration, convulsive move- 
ments, and impaired muscular action supervene during the progress of 
the malady. 
In cases of great malignancy, with a tendency to gangrene and other 
symptoms evincing a low typhous grade, Carbo-veg., Acid-nitr., Acid- 
mur., or Arsenicum may prove serviceable when all hopes from other 
remedies have been abandoned. From the first to the third attenua- 
tions should be employed in these instances. The age, sex, tempera- 
ment, and the peculiar circumstances connected with each particular 
case, must determine the proper strength of the medicine and the fre- 
quency of its repetition. 
Thuja.—Concerning the three miasms, psora, syphilis and sycosis, it is 
true that we have no certain means of distinguishing between them so as 
to be certain in a given case which predominates. For a large majority 
of the symptoms in chronic diseases are such as are found among the 
symptoms of all three of the miasms, and we have not yet been able 
to make a sifting and separation of them. Boenninghausen says he 
was the first to discover the almost specific powTer of Thuja in small- 
pox, in diabetes mellitus, in certain malignant aphthae, in children, in 
volvulus, &c. He says the identity of variola with sycosis seems suffi- 
ciently demonstrated; the great extension of the miasm through the 
process of inoculation is placed beyond a doubt; and the treatment of 
numerous chronic diseases, of which psora has hitherto erroneously 
been regarded as the anamnesis has taken quite another aspect, and 
has become much more certain. 
It is believed that small-pox, as well as the vaccina, are of sycotic 
origin. The vaccine is the result of the inoculation of the cow with 
small-pox matter. Dr. Wolf says, “ Sycotic patients are greatly disposed 
to infection by small-pox. Thuja is the true antidote against small-pox 
virus; and after vaccination a dose of Thuja should be given as soor 
as possible to antidote the poison.” 
Tartar-emetic is as successful in varioloid as in variola. THE PLAGUE. 
635 
3. THE BLACK DEATH OF THE FOURTEENTH CENTURY. 
This disease was the same as the oriental plague. It was marked 
by inflammatory boils and tumors of the glands, imposthumes on the 
thighs and arms, which proceeded to suppuration, discharging offensive 
matter. Buboes formed in the groin, an infallible sign of the oriental 
plague. In some cases there were blisters and black spots over the 
body, separate or confluent. In many, one of these symptoms alone 
caused death. Others recovered after passing through them all. Some 
became stupefied and fell into deep sleep, losing the power of speech 
from palsy of the tongue; others remained sleepless without rest; 
fauces and tongue black as if diffused with blood ; burning thirst which 
no drink would quench; some ended their own lives in despair. The 
disease was contagious; it spread from the attendants of the sick 
through whole families, till, often, the last one died. All of this is 
common in the oriental plague. But the black death presented other 
symptoms not generally seen before or since. The organs of respira- 
tion were seized with putrid inflammation; there was violent pain in 
the chest, expectoration of blood; the breath giving a pestiferous odor. 
In some an ardent fever with evacuations of blood were fatal in three 
days. Buboes, inflammatory tumors did not at first appear; but the 
disease in form of a carbuncular affection of the lungs destroyed life 
before other symptoms could be developed. Later, there were buboe 
in the axillae and groins, inflammatory boils over the body; and it wa 
not till after seven months that some patients recovered from matured 
buboes. In Egypt the inflammation of the lungs was predominant and 
destroyed life quickly and infallibly, with burning heat and expectora- 
tion of blood. In Florence the buboes or pest-boils were predominant 
in the beginning; they wmre as large as an apple, beginning in the groin, 
then coming out on other parts; black and blue spots were thickly 
diffused over the body, and they proved equally fatal with the pest-boils. 
No power of medicine brought relief; nearly all died after these signs 
appeared, in the first three days, and without appearance of fever. 
In Germany the symptoms were the same. In Austria is was 
specially malignant at Vienna: red spots, black boils or tumid glands 
portended death as early as the third day. In France many were 
struck as if by lightning and died on the spot. Those with tumors 
buboes, &c. died on the third day. 
In England the symptoms were nearly as alarming; spitting 
vomiting of blood was sometimes fatal immediately, or in twelve hours, 
always within two days; boils on the surface portended certain death. 
Authors describe buboes, boils, “knobs or swellings in the groin or ax- 
illa, blains, blisters, pimples, wheals or plague sores.” In some a 
vesicle scarcely perceptible gave little distress, but it was a lodgement 636 
DISEASES OF THE SANGUINOUS FUNCTION. 
for the poison which spread inwardly and soon brought out the fatal 
boils, or carbuncular inflammation fell upon the most important viscera; 
epistaxis, coughing up of blood, haematuria, fluxes of blood from the 
bowels are mentioned as fatal symptoms by the only two medical au- 
thors whose descriptions have reached us. They saw the disease in 
1348, 1360, 1373, 1382. 
After its first fury was spent the pestilence passed into the oriental 
plague. 
Causes.—The black death was, no doubt, dependent on a specific 
poison, Avhether this was or was not the same as that which originated 
the oriental plague. It certainly showed itself in increased virulence 
as its sphere of operation enlarged and degenerated into the more ordi- 
nary form of plague about the time that it withdrew from Europe. It 
is probable that the filthy lodging and bad food of the people of Europe, 
their imperfect clothing, the severe seasons and absolute scarcity in 
that century favored the spread of the pestilence in an aggravated form. 
Like the plague of the East it was marked by being highly contagi- 
ous, affecting animals as Avell as man; the breath of the sick communi- 
cated the infection to all who approached them. Parents abandoned their 
children, children their parents; those who fled from the city carried 
the seeds of disease to the country. Sailors at sea found death in the air 
of their favorite element. Ships were seen drifting about the seas and 
dashing against the shores; and wThen land was reached their crews 
had perished to the last man. 
It is supposed that the plague in some form has often appeared in 
Europe, though the histories that have reached us are quite imperfect; 
and that improved modes of living among the various nations have ban- 
ished it in latter times. Everything connected with food, clothing and 
lodging, even among the poorest, has been greatly improved beyond all 
that any body could have thought possible 500 years ago. The plague 
prevailed in Edinburgh in 1513-14, in 1520, 1568, 1574, 1585, 1604, 
1606, and for the last time in 1645. In England it has appeared at 
later dates. In 1665 it made its final appearance and carried off 
68,000 of the inhabitants of London; the next year the great fire de- 
stroyed the greater portion of the ill-ventilated dwellings of the crowded 
parts. The introduction of water into the city and improved buildings 
afterwards probably contributed to the banishment of the plague from 
Britain. (See Epidemics of the Middle Ages. B. Hecker. Berlin, 
1833. 12mo. p. 205. Webster’s History of Epidemics, 1800.) 
4. THE PLAGUE.-PESTIS. 
The plague is said to resemble in many respects malignant typhus. 
The only phenomena which serve to distinguish it from this fever, being INFLAMMATION. 
637 
the numerous buboes and carbuncles which appear on the body. By many 
it is supposed to be really nothing more or less than a genuine typhus 
fever, rendered peculiarly putrid and malignant by the atmospheric and 
other influences which prevail in Egypt and the other oriental nations 
in which it has prevailed. As in the worst grades of typhus, maculae, 
petechiae, diarrhoea, haemorrhages from the bowels, &c., generally su- 
pervene in the advanced stages of the disorder, in addition to the buboes 
and carbuncles. The enforcement of quarantine laws has banished 
the plague from Constantinople since 1837. 
Our knowledge in relation to this disease is so limited, it being de- 
rived from the imperfect descriptions we have seen by other writers 
that no attempt will here be made to detail its symptoms. But if we 
may be allowed to judge of its nature from those phenomena which 
seem to be characteristic, we suppose the following remedies will corres- 
pond with its manifestations, and prove to it homoeopathic, namely: 
Arsen., Acid-nitr., Rhus-tox., Veratrum, Merc., Bell., Chin., Ipecac., 
Carbo-veg. 
ORDER III.-PHLOGISTIOA 
Inflammatory Diseases 
INFLAMMATION. 
Structure of the Capillary Vessels.—These minute termina 
tions of the larger blood-vessels are always the seat of inflammation 
Their walls are so exquisitely thin and transparent that it is almost im 
possible to see them; and the precise point at which the arteries ter- 
minate and the veins begin can not be determined. "We will, therefore, 
seek an analogy in the excretory duct of the liver, and trace it into the 
organ. At first, it consists plainly enough of two tunics, which, as they 
extend into the liver, become so excessively attenuated, that we are un- 
able to separate them or distinguish them from the surrounding struc- 
tures. The inner coat must extend to the extreme end of the tube, or 
the acrid bile would too much irritate the delicate surface it covers. 
We may presume that in all these fine structures both tubes are pre- 
served. Bichat and Beclard thought otherwise, and that the capillary 
vessel was formed entirely from the inner coat of the blood-vessels, 
excluding the others. We think, however, that both tubes are retained, 
though we are unable to demonstrate them to the eye, and that 
the capillaries are nourished and animated, like the rest of the 
vascular system, by vessels still more minute, and nerves so exces- 
sively delicate, as to elude the most powerful microscope. (Gross, 
Elements.) This view is confirmed by the later observations of Muller, 
[Elements of Physiol, p. 877,) and the researches of Schwann, with 638 
DISEASES OF THE SANGUINOUS FUNCTION. 
magnifying glasses of high powers, on the arteries of the mesentery 
of the frog. He says, “Muller decides the question as to the capil- 
laries having distinct parietes;” and their circular fibres are arranged 
as they are in arteries.” 
Phenomena of Inflammation.—Increased sensibility is produced by 
some hurtful agent. The system tries to dislodge it by reflecting the 
local impression on the brain and nerves, and through them to the 
heart, which is excited to increased action and sympathy. The heart 
next sends more blood than natural to the part, and the capillaries are 
perceptibly enlarged. These fine vessels have the power of contract- 
ing and dilating, but they have no vermicular motion, and are there- 
fore unable to carry on the circulation without the propulsive action 
of the heart. The action of the heart increases slowly, but the in- 
crease is soon perceptible. (See p. 196.) 
Inflammation may be studied under its different aspects in three 
stages: 1. The Stage of Inciibation. We see this stage displayed, 
when we irritate the fin of a fish, or the web of a frog’s foot. In health 
these parts show under the microscope numerous vessels filled with 
red blood, rolling along in beautiful order. If the part be now irri- 
tated with hot water or alcohol, the vessel will be enlarged by the 
crowding of the blood into them by the increased sympathetic action 
of the heart. Hundreds of vessels, previously invisible, shoot out in 
different directions, connecting themselves with the sides of the former 
ones. These vessels were there before, and only become visible on the 
red blood being forced into them. The blood globules travel with dif- 
ficulty till they reach the extremities of the veins, which, being larger, 
the blood-globules rush into them as into a vortex. If the exciting 
cause be now removed, the part becomes gradually restored to health. 
Second Stage.—Congestion.—If the exciting cause continues in ope- 
ration an increased determination to the irritated part continues to ac- 
cumulate in it an unnatural quantity of blood. After a short stage of 
congestion or engorgement the third stage or that of inflammation pro- 
per ensues. There is now an excessive reaction ; increased heat, red- 
ness, pain, fulness of the vessels, increase of bulk of the whole part 
affected. This proceeds to terminate in suppuration or gangrene, if 
it should not first subside by resolution. 
When it has progressed to the point of exhausting the vital powers, 
the circulation ceases, the blood assumes a dark color, and the coats 
of the vessels become so soft as to give way at the slightest pressure 
and the healthy actions are finally suspended. The part is now red, 
not, painful, tumid, and its molecular intervals are filled with coagulat- 
ing lymph. The capillaries contain thick, viscid, partially clotted blood, 
adhering with great tenacity to the inner surface, preventing artificial 
injections or the removal of the blood by washing or by pressure. Iu INFLAMMATION. 
639 
violent cases the blood Aoays through the A'essels and forms new ones 
along the cellular tissue, and through these new vessels it afterwards 
circulates. This last phenomenon, which Avas noticed by Klacken- 
brunner in the mesentery of the rabbit, is analogous to what occurs in 
the organization of adventitious membranes. Contrary to Avhat might 
be expected, he found that it took longer to excite inflammation in 
highly vascular organs, as the lungs and peritoneum, than in those of 
loAver circulation, as the liver and kidneys; but, Avhen it is once 
established in the organs of high vascularity it progresses with the 
greatest rapidity. 
The distended Condition of the Part.—This arises from the in- 
creased quantity of blood attracted to it. The blood is dark, thick and 
viscid, rendering artificial injections difficult. The force of the arteries 
in urging forwards the blood is not increased in the vicinity of the 
inflammation, but the intensity is generally greater at the centre, and 
gradually diminishes as we recede from that point to the surrounding 
textures. 
The cause of all active congestion resides in a condition of evanescent 
or enduring paralysis of the blood-vessels, as we can not discover, in 
any mechanical obstacle occurring at any point of the circle of circula- 
tion, adequate cause for the determination to any other point of a great- 
er sanguineous afflux. All local hypersemia may with propriety be 
referred to the supervising regulation of the peripheral circulation— 
that is to say, of the nerves Avhich supply the blood-vessels. (Journal ds 
Physiologie, by Brown Sequard.) “It is no less true that local anae- 
mia may equally result from irritation of these same nerves; but as 
their action is transitory, their excitation must be sustained, in order 
that the effects produced shall maintain an equal degree of intensity. 
As a prototype of such active congestion, Ave may cite the redness and 
pallor of the face, inasmuch as, by their appearance and disappear- 
ance, they show themselves to be directly under the control of nervous 
influence.” In such a locality congestion is a trifling thing; in other 
organs it becomes far more serious. “ There are viscera, enveloped in 
thin, inextensible membranes,” as the brain, the medulla, the lungs, 
liver, spleen, kidneys, &c.” It is only necessary to recall their struc- 
ture and functions to be satisfied that such phenomena, simple and in- 
offensive though they may be elseAvhere, may here involve the graimst 
consequences. 
The Seats of Inflammation.—Inflammations are very frequent in 
almost every structure of the body. Even the nails, epidermis, and 
hair seem to possess their fine capillary \mssels, though their existence 
has often been denied. And these structures are also susceptible of 
inflammation. In children the skin and mucous structures are in a 
high degree more liable to inflammation than the cellular or serous 640 
DISEASES OF THE SANGUINOUS FUNCTION. 
tissue; and it is usually well marked, violent, and rapid in is course 
The synovial membranes, the fibrous ligaments, bones, and cartilages 
inflame with difficulty, but when they do the suffering is very great. 
The blood-vessels, nerves and absorbents may become inflamed, but 
their conservative powers are remarkable; as in gangrene they often 
retain their vitality while the surrounding parts are passing rapidly 
into a state of putrefaction. The organs most commonly affected in 
this country are the lungs, spleen, liver, uterus, and brain. The heart, 
ovaries, thyroid body, pancreas, prostate gland, testicles, and kidneys 
are less commonly inflamed. 
Products of Inflammation.—Organic or Structural Disease.— 
Under this title is included all permanent changes in the texture of an 
organ ; and all temporary changes in the tissues. It is doubted by 
many, whether there can be any mere functional disease; as all phy- 
siological change may be presumed to be accompanied by, at least, 
temporary change in the anatomical elements. {Gross.) 
All organic changes are believed to be the result of acute or chronic 
inflammation; or of other less known modes of altered action, which, 
like inflammation, can change the nature of the products of nutrition 
and secretion, and thus create pathological products of peculiar and 
permanent character. 
Every inflammation, irritation or morbid action is originally local or 
'partial. It always makes its first impression upon some particular 
part and this impression, after having continued awhile extends to some 
other. Morbid action, or irritation of the mucous membrane of the 
stomach is at first local, or more properly, partial, and may afterwards 
extend to the sub-mucous cellular tissue, then to the muscular-fibrous 
and finally to the peritoneal covering. Thus that which was at first a 
partial becomes a general disease. 
The period of life, in wdiich inflammation is most common and most 
dangerous is from its very beginning to the age of ten years; nearly 
one-half the entire mortality occurs within this period. Fatal affec- 
tions of the skin, mucous, and lymphatic systems carry off immense 
numbers of children, and inflammation of the arachnoid membrane are 
almost equally frequent. Pleuritis, pneumonitis, cerebritis, hepatitis, 
carditis, phlebitis, arteritis are frequent before manhood, and afterwards 
not uncommon. At the age of puberty the hitherto dormant genital 
organs are roused into activity; and then, diseases of these structures 
become very common; and these organs also deeply sympathize with 
the viscera, developing organic diseases of the uterus, ovaries, mam- 
mal and testicles. Diseases of the bladder are rare in the young, but 
very common in the old. 
Tiie Effusion of Coagulable Lymph is always an important result 
of the process of inflammation. It is usually of a slight opaline cast INFLAMMATION. 
641 
though sometimes pale or milky white, or reddish from admixture of 
haematorine. When first deposited it is a soft, fluid, somewhat ropy in 
consistence, throwing itself out in small filaments. After some time 
its watery particles are absorbed, it becomes more consistent, and is 
finally converted, in many cases, into a firm, dense structure, having 
the attributes of cellular tissue, fibrous membrane, or even cartilage or 
bone. The time required to effect this change varies from a fewr 
weeks to many months. Eibrine of the blood is only one of the ele- 
ments of coagulable lymph, but the most important for the albumen of 
the serum is also a part of its composition. It is not a mere excretion 
extravasated from the blood-vessels, but a secretion formed out of the 
blood, and discharged from the capillaries. The red globules may 
contribute to its production and they, although altered to make it har- 
monize with their alterated elements of the fluid, may aid in that spon- 
taneous formation of red blood in the effused lymph. 
The object of the effusion of coagulable lymph with fibrine is to 
establish the union or adhesion of normal surfaces, which adhesions 
we think are excited by the irritation of the coagulum. Carswell and 
other pathologists think the adhesions of fibrine identical with the ad- 
hesions of the polypi in the heart to the columnae carneae, a mode in 
which, it is probable, vegetations of the valves of the heart are formed 
Carswell admits two genera of analogous formations, one from coagu 
lable lymph, the other from fibrine ; while Gross admits only the latter 
The analogous tissues which Gross admits are : the cellular, serous, mu 
cous, cutaneous, vascular, including the erectile, adipose, horny, includ 
ing the cuticle, hair and nails,—fibrous, cartilaginous, and osseous, each 
of which may be in connexion with its archetype in the healthy system. 
Lymphization has been generally considered as nature’s standing pre- 
scription for incised wounds : cut arteries, lacerated wounds, attended 
necessarily with sloughing, are to be filled up by this process, broken 
bones are to be re-united and necrosed bones replaced; diffusion of 
pus restrained; and tubercular cavities are occasionally filled. Tbe 
fatal effects of internal mortifications and sloughing may be averted; 
aneurism of the arteries obliterated ; great surgical operations ren- 
dered admissible; and the stumps of amputated limbs healed. 
u Each component cell of a texture is an organism of itself. It ab- 
sorbs, by endesmotic action, through its slender wall, the oxygen from 
the blood-tide, and the nutrient materials from the liquor sanguinis. 
Itself a microscopical object, it performs the double function of histoge- 
netic respiration and assimilation. When either of these functions is 
impaired, the integrity of the tissues will sooner or later be blasted, 
and one or another variety of structural lesion be the necessary result. 
Tuberculosis, scrofula, and the various forms of cancer are held to be 
but manifestations of diseased action involving the solids, and having 
You I.—41. 642 
DISEASES OF THE SANGUINOUS FUNCTION. 
their origin in some such source. Do not understand us as teaching 
that these disorders consist essentially of morbid alterations in the 
forms, or even in a derangement of function in the individual compo- 
nent cells of the muscular, nervous, cellular, or other tissues—for ive 
do not accept any such material doctrine in explanation of the nature 
of diseased processes, but simply that the first evidence which we may 
have of the existence of certain maladies is a structural lesion which 
renders it plain to be seen that the healthy organization of the parts is 
endangered.” Thus although the ‘-morbid anatomy of tuberculosis 
and of cancer is not all there is of the disease, it will nevertheless 
afford us the most substantial token of its existence and ravages.” 
Through this beautiful process of cell-growth must be made all nu- 
tritive repairs by which structural lesions of whatever variety are re- 
medied ; repairs in the bones, the ligaments, the muscles, the nerves, the 
blood-vessels, or in the cutaneous or mucous surfaces, must be effected 
through it. The old doctrine of the restitution of injured parts by 
“the exudation of coagulable lymph,” is exploded; and w-e now learr 
that these little cells first select and then so appropriate their structural 
elements as to carry the newly organizing bone through the successive 
steps of mucous, cartiliginous and finally to the osseous or perfect 
stage.* 
Healthy cicatrization “ depends, therefore, upon the development of 
healthy granulations in cell-form. The marginal skin stretches and 
draws nearer the centre of the wound, while the capillaries inosculate 
with those of adjacent tissues.” 
Sometimes the adhesive and plastic character of the lymph, and its 
long-continued contraction and shrinking up are the sources of diffi- 
culties. After extensive loss of skin by sloughing from fire, the new 
texture often produces deformity. Also, in inflammations of the cheek, 
adhesions and indurations compress the jaws against each other from 
the same cause. The eyelid may become agglutinated to the ball, the 
larynx fatally closed up with false membrane, the urethra nearly obli- 
terated ; the intestines combined into a compact mass; the lungs and 
pleura cemented to each other, and the viscera compressed till they be- 
come atrophied. 
Serous Effusion.—This result of inflammation constitutes one of 
the modes by which resolution or discussion is effected. Serous 
effusion is the result of inflammation of a mild grade. An apparent 
objection to this statement is found in the fact that effusion sometimes 
occurs when there is simply an obstruction in the circulation. Thus, 
anasarca of the legs from obstruction of the femoral artery ; and the 
face, neck and arms may be loaded with serum from compression of the 
* Dr. Ludlam, Lecture, Ilomceop. Clinique, Chicago, 1862. INFLAMMATION. 
643 
veins conveying the blood from these parts ; abdominal dropsy follows 
obstruction of the portal veins. Contraction of the auriculo-ventri- 
cular orifice impeding the flow of blood produces dropsy, and also 
oedema of the legs and feet. It is questioned whether these conditions 
are the results of inflammation, or of obstruction without it. The exact 
condition of the vessels is not easily known. In ascites we have a 
large collection of water following obvious inflammation, without any 
trace of inflammation being perceptible after death. But in some cases 
the signs of inflammation, the discoloration, &c.,—vanish at the approach 
of death or during the last struggles of life ; and in others these 
changes take place long before. Want of redness does not prove the 
absence of inflammation, which is certainly shown by accumulations 
of water and opacity of the affected membrane. If there be specks, 
patches, or bands of fibrine, all doubt ceases. 
Can obstruction, to the extent necessary to cause effusion, exist with- 
out producing a state identical with inflammation or identical with it? 
To this it is answered that the condition required is impossible. The 
obstruction must cause congestion in all the parts from which the 
vessel should return the blood; and this state can not long exist with- 
out producing inflammation,—an altered condition of the sensibility of 
the parts, redness and effusion of serum. 
Objects of Inflammation.—Inflammation, granulation and pus may 
arise for two distinct objects: 1. For the cure of mechanical injury; 
for the discharge of sloughs and foreign substances from the solid 
textures ; and, secondly, as a means of cure in disordered plasma. 
1. In injuries to the common tissue, wounds, ulcerations, contusions 
and fractures, the process of reparation comprises inflammation, gra- 
nulation, suppuration, and ulceration. New blood-vessels are formed 
without bleeding, and there are discharges of pus. If physical hin- 
drances interpose, the process is protracted and made chronic until 
these are removed. If they can not be removed, the life of the person 
is endangered and may be destroyed, unless amputation be performed. 
In the diseased conditions of the blood from unwholesomeness of 
food, privations or other causes, re-actions of some kind arise for its 
depuration. These also comprise inflammation, granulations, suppura- 
tion, and ulceration; furuncles, boils, pustules, eruptions and gout. 
If hindrances interpose,—if the causes of distemperature of the 
blood from the above causes be not abated, the process is protracted 
and made chronic, until they are removed, and in many cases the qua 
lities of the plasma must be altered or improved by thorough change 
of diet or habits of life. 
In surgical cases, comprising injuries of the solid texture, the re- 
actions arise for the healing of wounds, the discharge of sloughs, dead 
matter and foreign bodies. There is direct evidence of what occasions 644 
DISEASES OF THE SANGUINOUS FUNCTION. 
the action, what it accomplishes, and why it is protracted or danger- 
ous. In the other group,—disorders of the blood (or medical cases; 
the influence of the re-action, the qualities of the fluid of the blood can 
only be inferred from the collateral events; and these in gout, small- 
pox and other exanthematous fevers point unequivocally to the thera- 
peutical characters of inflammation. The surgeon may sometimes go 
directly to the bottom of an unhealthy ulcerating wound and remove 
some obstacle to entire recovery, by an operation which nature was not 
competent to perform, and the patient is restored to health. 
In other cases of severe injury, as of a compound fracture, or a 
crushed joint, the surgeon surveys the whole of the injured parts, and 
he has time and opportunity before therapeutical re-action,—that is 
before inflammation, suppuration, granulation and ulceration have com- 
menced,—to estimate the true extent of the injury. He weighs care- 
fully in his mind the powers of nature, the degree of general health 
of the patient, and decides upon the question whether nature is com- 
petent to perform a full reparation of the injury, or whether she would 
make such bad work of it, that it is safer to amputate the limb, leav- 
ing her an easier task to perform. 
The inflammations encountered by the physician depend much on 
the qualities of the blood itself. And here he must take the constitu- 
tion as he finds it with its impure or imperfect fluids, and try by reme- 
dies to restore them to a state compatible with a return of the orga- 
nism to a state of health. 
This is the finishing stage of the adhesive process, and the comple- 
tion of the process of granulation. It is rapid in proportion as the 
diameter of the ulcer is small, the surface level, and the secretion of 
pus diminished. A reason of the difficulty with which a sinus heals is 
the advanced secretion of pus from its surface. Others are, its limited 
contact with the skin, and the non-development of granulations, which 
mmediately appear as soon as the sinus is laid open. When an ulcer 
has formed upon an old cicatrix, its healing is usually tedious. This is 
owing to the defective quantity of surrounding free cellular membrane 
for the formation of granulation, and to the imperfect condition of the 
circulation in secondary formations. Mr. Travers says, the skin which 
forms on the surface of an ulcer, abscess, or wound is always formed 
from the vessels of the skin of the margin of the wound, and never by 
the vessels of the granulation. We always observe it “ gradually ad- 
vancing from the margin, and equally reducing the diameter of the sore 
from day to dayand we never see the skinning process without this 
preparation of the border. The process is quicker or slower in pro- 
portion to the distance of the skin from the centre ; the insular patches 
observed upon the bed of an ulcer, especially unhealthy ones, may al- 
ways be traced to a portion of undestroyed skin; and, finally, “ the INFLAMMATION. 
645 
cicatrization beneath the surface, as of abscesses and fistula?, is not by 
the formation of skin, or of proper granulation, but by an adhesive pro- 
cess, which tacks the skin to the subjacent cellular texture condensed 
by inflammation, drawing it inwards into folds and puckers; in short, 
a process similar to that which wTe see in obliteration of cists by pres- 
sure, and in the formation of solid tumors to which the skin becomes 
adherent during their growth.” 
In those cases in which the skin forms rapidly over an ulcer it has 
been supposed that the vessels of the surface indirectly aid in the pro- 
cess. This results from the contraction of the granulations, in their 
union and levelling, giving a glazed appearance to their surface as the 
secretion ceases and the pellicle begins to form. But the act of cica- 
trization consists not in any fresh deposit; it is simply the last stage 
or completion of vascularization which renders the transparent lymph 
surface nebulous or opaque, and this always commences from the margin, 
whence the vessels are derived, and is progressive from the circum- 
ference to the centre. The actual formation of membrane is never ac- 
complished, such as could be separated by fair dissection at any stage, 
from a cicatrix: ‘ “ it is a permanently opaque, unsecreting surface, a 
condensation of the new lymph with the cellular texture beneath or 
surrounding it, serving the negative purpose of a semi-organized cover- 
ing, simply the protection of the part. Like all other new structures, 
it is a copy, and differs, as all copies do, whether of nature or art, from 
the original.” (Travers Physiol, of Inflamm., p. 207.) 
Cicatrices, diseased states of.—The structure is imperfect, but 
generally not painful; though when large and deep-seated, and when 
connected with parts affected by any disease, they become more painful 
than surrounding parts, and are more sensitive to changes of weather, 
needing more protection. When situated over moveable parts, the 
movement of muscles pains the cicatrix. It passes easily into inflam- 
mation, and an erythema progresses readily to ulceration. The inflam- 
mation often ends in gangrene. After a certain period many of the 
arteries of the structure become hardened into cords and impermeable 
to the finest fluids. Varicose veins sometimes ramify in cicatrices or 
beneath them. These imperfect structures may be involved in oedema, 
in ecchymosis, and in hypertrophy of its own substance or of the neigh- 
boring skin. They may be the seat of conical elevations like corns, 
but which can be removed by thorough washing; and also, of other 
horny substances of large size. M. Hutin saw one in form of a spiral 
horn, ten centimetres in length. They are usually smaller, being hard 
at their extremity and softer near the point of implantation. They 
often arise from the extremity of the stump after amputation, and 
chiefly of the thigh, where the cicatrice had been subject to much 
pressure. 646 
DISEASES OF THE SANGUINOUS FUNCTION. 
Mr. Hawkins has described a warty affection of cicatrices. M. 
Hutin says, he found one of these as large as a small nut, and resem- 
bling the warts of the fingers; another resembled fungus lioematodes 
and grew from a portion of the cicatrice of a large ulcer of the leg. 
It may be that these growths are forms of cancer, which often attack 
the cicatrices of the lower extremity. 
A soldier who had received some wounds on the left ear and left 
shoulder had some vegetations from the bottoms of the wounds, which 
were mistaken for granulations which were restrained by nitrate of 
silver. In forty days the wounds healed, but the vegetations continued 
to grow and were removed some years afterwards; but they were re- 
produced with the same activity, though in thirteen other wounds no- 
thing of the kind was seen. 
We may also in cicatrices have cysts, cartilaginous and osseous de- 
posits', the latter are surrounded by cellular membrane as & periosteum. 
Contusions lead to rapid ulceration in this tissue. Wounds of cica- 
trices may heal by the first intention, but the reparation is often de- 
fective ; and suppuration is likely to destroy all the old cicatrix.— 
(Hut-iris Prize Essay, Memoires de VAcad. Imperial. Paris, 1855.) 
Morbid Blastema giving rise to Tissues endowed with Abnor- 
mal Properties.—Those general dispositions of the economy known 
under the name of diatheses, are of this kind. They are supposed, in 
the first instance, to be accidentally produced (for disease must begin 
somewhere), but which, once called into existence, possess the powei 
of maintaining themselves in being. 
Thus when food, insufficient in quantity, or of an unwholesome kind, 
has reduced an animal, previously in good health, to a consumptive 
state, its offspring often inherits the morbid disposition which in the 
parent was purely accidental, and syphilis, that well-known source of 
heteromorphous production, is frequently transmitted from parent to 
child. 
Some of these pathological dispositions or diatheses are the result 
of a profound change in the fluids of the economy; sometimes they 
originate in the introduction of particular poisons, which, when they 
have once penetrated into the system, can in no way be expelled. If 
the poison be one that none of the organism can eliminate it is clear 
that, after penetrating into the torrent of the circulation, if it nowhere 
find an issue, it remains to become the origin of permanent modifica- 
tions in the economy. 
Thus Iodine, when once introduced into the blood, is not eliminated 
for a long space of time, on account of the affinity which the salivary 
glands exhibit for this substance. We have then an instance of a body 
which cannot (for a time, at least) be expelled, and the animal is 
during this period laid under the iodic diathesis. Individuals affected INFLAMMATION. 
647 
with cancer are not properly in a state of disease so long as the organ 
in which it is situated is not essential to life; a cancer of a limb may 
possibly be removed without bringing the general system into immi 
nent danger. When cancer attacks the liver, if the disease is no 
extensive, the morbid productions are separated by large tracts of 
sound tissue, which continue, as usual, to secrete the bile, and grap 
sugar still exists within the glandular tissue. But, at a later period 
by the disintegration of the elements which constitute the morbid pro- 
duction, the whole economy has become poisoned by pouring into the 
general circulation of fluids impregnated with the noxious principles; 
then, indeed, the affection becomes a general disease, and its nature 
entirely changes. The cancer is not a diathesis in itself, but the con- 
sequent cachectic state is that properly so called. 
Results of Imperfect Nutrition.—After each meal, when absorp- 
tion has taken place, the epithelium which covers the villosities fall 
off, and is renewed during the interval which elapses before food is 
again introduced into the digestive apparatus. A remarkable instance 
of the rapidity with which tissue may be produced. 
But when, through some agency of disease, epithelium is no longer 
secreted, what results ? 
No obstacle is henceforth opposed to serous exudation from the 
vessels; no protecting surface resists the introduction of various 
poisons into the blood, and no regulating power of absorption exists. 
In this manner many diseases are traced back to suspended activity 
of animal evolution as their primary cause. 
Chronic inflammation of the trachea and bronchial tubes likewise 
destroys the epithelium of the parts, the utility of which is well known. 
Other diseases arise, not from interrupted, but from perverted evolu- 
tion. Cells that pursue a regular course in their development com- 
prise three distinct elements : 1. An envelop or cellular paries, the 
physical properties of which take a permanent share in its action ; 2. 
Liquid contents, the importance of which is principally derived from 
their chemical composition; and lastly, 3. A nucleus in which the 
powers of development appear to reside. 
As soon as a morbid state of nutrition supervenes, the contents of 
the cell are liable to alteration. Whether pigment or fatty substances, 
or calcareous salts are therein deposited, morbid tissues are gradually 
formed, and disease is introduced into the system; it may then be pre- 
sumed that all heteromorphous tissues entirely resemble normal ones, 
and are subject to the same natural laws. 
This great principle was first explained by Muller, who is styled the 
creator of cellular pathology. Virchow has since extended discovery 
in the same direction. 
The intercellular tissue, or blastema, says Virchow, c institutes the 648 
DISEASES OF THE SAXGUIXOUS FUNCTIOX. 
“territory of the cells.” In order that it should be able to develop the 
cells it is necessary that it should contain the elements necessary for 
this purpose. It must always contain glycose, albumen, and fat; the 
absence of a single one of these three substances is a barrier to cell 
evolution. And we therefore constantly find them existing in the 
tissues of the embryo as well as of the adult. 
Bichat, in his great work on Life and Death, undertook to inform us 
of the many ways of dying, but there still remains another, that of 
dying from imperfect nutrition. Patients often die without showing 
after death the slightest modification in the anatomical condition of the 
organs. In physiological experiments on dogs, death is often caused 
by complete exhaustion. We see them arrive at the last stage of ema- 
ciation, although the appetite continues unimpaired till the last mo- 
ment, and the lacteals are found gorged with chyle, though after death 
no pathological changes are perceptible. 
What is the latent cause of this singular process ? Nutrition, when 
considered in the depths of our organs, is, in fact, nothing more than a 
peculiar mode of evolution. The e’conomy produces within itself sub- 
stances indispensable to life. Glycogenous matter affords us an ex- 
ample of this ; formed within the body by a special process, it plays 
an immense part in histological phenomena. As soons as it fails to be 
supplied, epithelium is no longer produced ; various diseases are the 
immediate result, and, under similar circumstances, life is inevitably 
brought to a close. The physiological act called nutrition compre- 
hends, therefore, two distinct parts : formation of cells is the first, 
creation of blastema the second. And the latter is no less indispen- 
sable than the former ; as soon as pathological influence arrests either 
the one or the other, death is the consequence. 
There exist, therefore, two distinct modes of dying: 1. Life is cut 
short at once by an important injury to some essential organ; or, 
2. It gradually fails through imperfect nutrition ; and this latter ter- 
mination is the ordinary result in acute diseases. In certain cases 
glycogenous matter is no longer produced ; and, after a given space 
of time, the patient dies, although the appetite remains unimpaired till 
the last moment. In making the post-mortem examination the lacteals 
are found in a state of repletion ; but, when analyzed, the fluids of the 
economy no longer present the slightest vestige of sugar. Death then 
supervenes, and is the mere result of suspended activity in organs for 
which proper nourishment is no longer provided. 
We now conclude that we shall not find the system of laws govern- 
ing the animal economy peculiar to its pathological condition, but that 
the laws of physiology of health, fairly interpreted, are sufficient to 
explain the philosophy of all vital phenomena whether of health or 
disease. INFLAMMATION. 
649 
Remote Causes of Inflammatory Diseases.—We find in animals 
various predispositions, which not only modify the action of medicines 
administered to them, but also render them liable to diseases entirely 
different when suffering from causes entirely similar. “ Being about to 
perform certain experiments on animals kept fasting for a long space 
of time, I left some dogs without food for several days; but, during the 
late severe frosts, these animals died unexpectedly. In making the 
autopsy, we discovered pneumonia in one case, pleuritis in another, 
and inflammation of the bowels in the last two. Thus under conditions 
perfectly identical, these animals were afflicted with totally different 
diseases. But similar results may be obtained at will by the physio- 
logist. When rabbits are placed under total abstinence they generally 
live a fortnight or three weeks; but, when certain branches of the 
sympathetic nerve have been previously divided, the animals die within 
a few days, when deprived of food, through acute inflammation of the 
viscera connected with the nervous twigs that have been divided. 
When, some time ago, I commenced this series of experiments, I dis- 
covered that the section of large divisions of the sympathetic nerve 
was apparently unattended with the slightest inconvenience as long as 
the health of these animals remained perfect. Some of them even 
became pregnant, and brought forth their young; but, as soon as a 
general debilitation of the system arose from want of proper nourish- 
ment acute inflammation was produced in the organs deprived of ner- 
vous influence. We had therefore succeeded in artificially producing 
particular idiosyncrasies in these animals, and could predict with per- 
fect certainty that as soon as health failed disease would arise on a 
given point. 
“ Morbid predispositions must, therefore, be viewed in the light of 
peculiar physiological conditions, which, in most cases, depend upon 
the nervous system; and an immense progress would be realized in 
medicine if it were possible to diagnosticate in a state of health the 
predisposition to disease, and foretell the coming danger.” (Claud 
Bernard on Experimental Physiology. Lecture V.) 
Treatment of Inflammation.—Turning now to the therapeutics of 
inflammation it is clear that we may attack it in two ways. Through 
the medium of the vaso-motor nerves we may act on the blood-vessels, 
and through that of the cerebro-spinal nerves, or directly upon the 
inflamed tissue. The rule according to which we prescribe would lead 
us in the former case to select such remedies as are known to produce 
primary contraction and secondary dilation of the arteries of the part, 
whose effects therefrom would accordingly be stated in our provings to 
be congestion. According to the second mode we should choose a 
counter-irritant of the part affected, which, according to'the law of 
similars, would extinguish the irritation already existing. Thus, in 650 
DISEASES OF THE SANGUINOUS FUNCTION. 
gastritis we might give Belladonna, which is a vaso-motor excitant, or 
Arsenic, which is a tissue-irritant to the gastric mucous membrane. 
And perhaps a better effect would be obtained by alternating the two 
than by giving either singly. 
“ It appears from this that there are at least two modes in whicl 
drugs, chosen according to the rule ‘ similia similibus,’ act in the re 
cesses of the organism. In the case of tissue-irritants there is a rea 
substitution of a drug-action, similar to the morbid process going on in 
the part, for the latter action itself, and an extinguishment of it thereby. 
This is Hahnemann’s own earlier rationale- of homoeopathic cure, and 
so far appears to be correct. But when vaso-motor excitants are given 
to relieve inflammation, the theory of Fletcher holds good, and their 
action (save in the first brief stage of contraction, which rarely comes 
under treatment) is really antipathic, although the law of similars will 
suffice to guide in tlieir selection. And a very important rule for the 
dose will form a corollary to these principles. When we are treating 
inflammation of any part with its proper tissue-irritant the dose must 
be small, and may be infinitesimal; When we are exhibiting a vaso- 
motor excitant the dose must be moderately large. The instance of 
gastritis elsewhere cited may again serve to illustrate this rule : Dr. 
Hughes says, “ during my earlier inquiries into homoeopathy I had a 
case of acute gastritis under my care which I treated with five drop 
doses of tincture of Belladonna. Shortly after commencing to practice 
liomoeopathy I met with a similar case, for which I prescribed Arseni- 
cum, 12. On comparing the two cases I hardly know which was cured 
with the most gratifying rapidity. Consider what would have been 
the result had I reversed the proportions of dose, and the value of the 
rule will become still more apparent.” 
Of the remedies for inflammation we shall here speak of Aconite 
only. Other remedies will be considered under the separate diseases. 
Aconite.—The views of the various homoeopathic authors may be 
thus summarily presented : 
Dr. Scroen says, Aconite “ supplies the place of the whole antiphlo- 
gistic apparatus of the antiphlogistic school,” is far superior to blood- 
letting, salts, mercurials, and fomentations, in certainty as well as in 
harmlessness. He regards it as “an indispensable remedy in all those 
cases in which, through violent reaction of the organism, there is added 
to the primary affection of a single system or organ, a general febrile 
disturbance, which is manifested by precursory, often deep-seated 
shaking chills, followed by local or general long-continued heat, hot 
dry red skin, quick full pulse, bright eyes, violent continuing thirst, 
total loss of appetite, hot urine, restlessness, sleeplessness, exhaustion, 
more or less violent delirium, with distinctly marked paroxysms and 
remissions.” {Ilygea, V., 97.) INFLAMMATION. 
651 
Heicheheim says, “Aconite is the specific remedy,” “ in all phlegmo- 
nous inflammatory diseases in which the arterial capillary system is 
more particularly affected, and the inflammation itself exhibits propor- 
tionate reaction of the vital power.” “ The more distinctly marked in 
the given case is the increase of the arterial circulation, if it be limited 
by the affected organ—as, for example, in inflammation of the lungs 
and heart, or by the constitutional structure of the individual affected 
—so much the more certainly will Aconite prove a curative remedy.” 
[Hygea, V., 203.) 
Griesselich says its proportionate field of action is, in “ acute dis- 
eases, marked by excessive and preponderating activity of the arterial 
system. Its operation on the arterial system is unmistakeable ; its re- 
action upon the nervous and lymphatic systems easily substantiated 
from physiological principles. Aconite corresponds most to individuals 
with a prominent phlogistic tendency.” 
Wurm says that, in addition to allaying fever in inflammation of the 
lungs, “ it acts specifically upon the parenchyma of the lungs, and that 
this action is greatly assisted by the powerful influence it possesses 
upon the arterial blood current.” (Hygea, IX., 53.) 
“ In pleuritic effusion, if the plastic material predominates, Aconite 
should be given; not that it ‘acts upon the pleuritic effusion itself,’ bu 
because it is necessary ‘ in breaking up the fever.’” Wolff says, the 
utility of Aconite in inflammation does not depend on “ its specific re 
lation to the totality of the inflammatory process, but only to one factoi 
of it, the morbid movements of the blood and its stagnation.” (Hygea, 
XVIII., 253.) Diez says, Aconite “ corresponds to the first stage of 
inflammation; as such, and apart from its various modifications, it oc- 
cupies the foremost rank among all the medical plants that have been 
proved up to the present time.” 
According to Meyer, “Aconite’s sphere of action is manifested prin- 
cipally in the ganglionic system, and exercises here its special in- 
fluence upon the nerves of the capillary vessels, exciting fevers, con- 
gestions, and inflammations. It is subordinate in its action to the 
apparatus of the motor nerves, where—apparently in consequence of 
congestion—it sometimes excites convulsions and a paralytic condition. 
In the sphere of the sensory nerves it increases, on the one hand, their 
activity, and calls forth a variety of painful sensations; and, on the 
other hand, depresses their sensibility till it reaches total extinction. 
On the central nerve fibres, or upon the mind and disposition, it 
duces an elevating effect, producing depression only in its reciprocal' 
action. For the rest it seems to have a special relation to the secre- 
tion and separation of bile.” (Ifomceop. VierteljahrschI., 390.) 
Schneider thus sums up the principal forms of the condition pro- 
duced by Aconite: 652 
DISEASES OF THE SANGUINOUS FUNCTION. 
“1. Synocha and inflammation, arising from primordial irritation of 
Sthe nerves of the central vessels, as distinguished from exanthematous 
and traumatic irritation, which proceeds from original irritation of the 
nerves of the vessels of the periphery. 
“ 2. Rheumatism; viz.: Those congestive or inflammatory painful 
affections of the joints, muscles, or sensory nerves which arise in con- 
sequence of cold. 
“ 3. Gastroses ; also with predominant affections of the liver, amount- 
ing to jaundice. 
“4. Paralysis of the nerves of the blood-vessels, as in cholera. 
“ 5. Convulsions/ but we regard all kinds of convulsions as conse- 
cutive, proceeding from anosmia or hyperoemia in the centre of the 
higher nerve life. 
“6. Paralysis in the sphere of the physical nervous system.” (Hand- 
buck der reinen Pharmacodynamik, I., 39.) 
Genus I.—APOSTEMA.—1. ABSCESS. 
From abscedere, to depart, to separate ; because parts which were 
before contiguous become separated. Abscessio, impostkume: a col- 
lection of pus in the cellular membrane, the viscera, or the bones, pre- 
ceded by inflammation. Abscesses receive different names according 
to the position in which they are situated. The disease is always the 
effect of a preceding inflammation. 
General Remarks.—When an inflammation begins the tempera- 
ture of the part is increased, its vessels are injected with more blood, 
which at first extends only to the vessels which previously carried red 
blood; the vessels are distended and their powers of resistance les- 
sened ; the more fluid parts of the red fluid escape into the texture of 
the part, rendering it more compact, but more friable or capable of 
laceration. As inflammation progresses the tissues pass from a dense 
but friable state to that of softening, proceeding to a pulpy condition 
as more and more of the fluid parts of the blood are infiltrated into 
inflamed substance; soon the molecules of the tissues become com- 
bined with the infiltrated fluid, and all distinct traces of a proper or- 
ganization are lost. The fluid poured out from the extreme capillaries 
gradually distends the surrounding parts, partially dissolving the tissues 
in which it is effused. A limit is set to the extension of the cavity, 
now forming, by effusion of coagulable lymph from the vessels, which, 
being less highly involved in the disease, retain more of their vital 
energy. The lymph thus thrown out presents a barrier to the wider 
diffusion of the fluid forming within the cavity. In cachectic or debili- 
tated subjects the vital powers of the adjoining parts are too feeble to 
permit this effusion of coagulable lymph, and the pus or fluid matter ABSCESS. 
653 
formed in the abscess may diffuse itself in the cellular membrane, like 
water in anasarca. 
The formation of pus is effected by the collection in the central 
point of the inflamed structure of minute portions of sero-albuminous 
or sero-sanguinous matter. These minute collections become more 
abundant, approach each other, the intervening tissue becomes soft- 
ened, and the small cells unite in one cavity; the effused fluid changes 
from thin albuminous lymph to pus/ having lost its coloring matter, 
and dissolved the fragments of the disorganized tissues, it forms a ho- 
mogeneous whitish fluid, which produces little irritating effect on the 
tender surface of the cavity containing it. This surface becomes co- 
vered with a grayish pellicle, presenting all the appearance of a true 
membrane, which in dense structures becomes very dense, forming 
thick cysts. It acts as a secreting and absorbing surface, and through 
it the more fluid parts of the pus are absorbed, and further modifica- 
tions of its character effected. 
Second Form of Abscess / Spreading or Diffuse Abscess.—In de- 
bilitated or cachectic constitutions the regular course of abscess is 
modified by the operation of certain noxious causes, which entirely 
change its course and termination. These causes are : the presence 
of various animal poisons; animal and vegetable matter in a state of 
putrefaction, which produce a septic effect on the living textures. The 
effect of these influences is that the inflammatory action, and the for- 
mation of pus is not circumscribed by the boundary of coagulable 
lymph which is poured out by vessels around an abscess in a healthier 
subject, and the pus formed may be widely diffused in the cellular 
membrane. In these imperfectly formed abscesses we see inflamma- 
tion in the ataxic or asthenic form; it is conspicuous in some kinds 
of erysipelas, or after wounds inoculated with animal poisons, and 
characterized by want of vital resistance, and a speedy solution of vital 
cohesion in the affected tissues. The influence of the nerves is rapidly 
destroyed, and the fluid parts of the blood are effused into the relaxed 
tissues in the form of a watery or puriform sanies. 
Diffusive abscess may commence in the cellular tissue, and more 
rarely in the liver, lungs, or other internal viscera. As it progresses 
the nervous powers presiding over the organic and assimilating func- 
tions are much depressed; the watery or putrid sero-sanguinous or 
albuminous effusion commences very early; the whole process of 
the formation of pus is rapidly completed ; the sanious fluid flows ex- 
tensively through the feeble resisting force of the debilitated cellular 
membrane and adjoining textures, which become gangrenous and are 
dissolved in the effused fluid. 
The pus secreted in this form of abscess is sometimes limpid, red 
dened, and highly fluid; sometimes white, again more highly colored, 654 
DISEASES OF THE SANGUINOUS FUNCTION. 
brownish, and sometimes of a green color, becoming more offensive in 
odor in proportion as air is admitted to the diseased surface. 
Third Form of Abscess.—In lymphatic temperaments and scrofu- 
lous constitutions deep-seated or superficial and fluctuating tumors 
and purulent collections are formed without much appearance of active 
inflammation. In chronic cases the appearance of the pus formed is 
frequently yellowish, serous, and transparent, containing albuminous 
or fibrinous fiocculi; and the external skin remains free, moveable, and 
unaltered. 
Fourth Form of Abscess.—The pus formed in indolent abscesses 
frequently finds its way through the interstices of the cellular mem- 
brane to distinct parts. This is common in diseases of the hip-joint, 
and in abscesses formed in the vertebra or their fibro-cartilages. In 
these cases it may travel beneath the pleura to a more depending posi- 
tion, or descend behind the peritoneum, under the crural arch, and 
sometimes through the inguinal ring. Many other forms are often seen. 
Consecutive Abscess.—Sometimes the pus formed by suppuration 
in one part is absorbed, and the absorption is followed by a deposition 
of similar matter in some other organ. In puerpural cases inflamma- 
tion of the uterus and its veins is sometimes fatal; and, on dissection, 
collections of pus are found in various remote organs. After injuries 
of the head abscesses are found in the liver or lungs. In many other 
diseases similar collections of pus are found. In all of these cases the 
energies and vital powers of the system are impaired by previous ill 
health, and the prostration is increased by the inflammation and sub- 
sequent suppuration, and by the poisonous influence of the putrid 
matter absorbed. 
The process by which a deep-seated abscess progresses towards the 
surface of the body is highly interesting and important in a practical 
point of view. As the inflammatory action and the secretion of puru- 
lent matter proceed, the extension of morbid action advances most 
rapidly on that side on which the structures are most distended and 
and stretched by the accumulating fluid. The inflammatory action 
thus induced in the adjoining texture leads to the pouring out of lymph 
which, with the pressure of the swelling, causes adhesion of the abscess 
to the adjoining part, the absorption of the solid elements, with attenua- 
tion, and lastly ulceration. When the morbid process is approaching 
the surface we see marks of inflammatory irritation, and infer that the 
adhesion has taken place beneath; and that an incision may safely be 
made to the centre of the abscess below, if we begin in the centre of 
the inflamed integuments. In this progressive manner we see an abscess 
of the liver make its way gradually through the membranes and tex- 
tures of the parietes of the abdomen to the external skin; and in some 
cases taking an opposite direction, we observe its gradual extension ABSCESS. 
655 
through the diaphragm, and the lungs to empty itself into the bronchii. 
In its course it produces adhesion between the liver and diaphragm, 
then ulceration of the diaphragm, adhesion of that membrane to the 
lung adjoining, then inflammation and suppuration of that organ. The 
parts thus successively invaded undergo the inflammatory and softening 
process in succession; the purulent matter finds its way to a distant 
outlet in that direction in which the inflammatory action most readily 
advances; and the successive “reddening, inflammation, adhesion, soften- 
ing, and absorption of the various structures, as the tumor advances 
exteriorly, are the guides to treatment in these formations.” The pro- 
gress and spontaneous opening of abscesses which have progressed from 
the interior to the surface terminates in the erosion of the attenuated 
integuments, and the discharge, at intervals of the accumulated con- 
tents. 
Diagnosis.—Inflammation intense in degree, rapid in its progress, 
in any part in which the cellular tissue is a prominent part may be 
presumed to be progressing towards suppuration when a throbbing 
pulsative pain has continued for some time, and is slowly diminishing. 
The repulsations are isochronous with the heart’s action ; weight and 
tension of the part; diminution of febrile action, succeeded by “ large, 
broad, open, soft, or undulating pulse ; irregular chills or rigors, ex- 
tending along the back, loins or lower extremities. If the matter 
be not now soon evacuated there are symptoms of chronic irritation; 
frequent and small pulse, heat or burning of the palms of the hands 
and soles of the feet; irregular fits of perspiration, and night sweats; 
loss of strength and all the characteristics of hectic fever; this is ul- 
timately followed by colliquative diarrhoea, and other signs of permanent 
irritation and constitutional contamination of the blood and rapid sink- 
ing of the vital powers. 
When the inflammation has terminated in suppuration the tumefied 
part becomes changed in appearance. It is less diffused, smaller in 
circumference, and more concentrated, elevated, prominent and softened 
at the centre of the surface. The more prominent part acquires a 
dark red, and afterwards, a bluish tint. A distinct fluctuation may be 
felt beneath it; though this not always very distinct. But the external 
signs may be assisted in pointing out the existence, the stage and the 
serious character of an abscess, by the constitutional predisposition to 
form purulent collections of matter in many persons whose vital energies 
are depressed. In patients of the lymphatic temperament, pale visage, 
who have been debilitated by previous disease, in those in whom the 
suppurative has continued for some time and been suddenly checked 
by an operation, the tendency to form abscesses is strong. A sudden 
suppression of any secretion predisposes to abscess as the drying up 656 
DISEASES OF THE SANGUINOCS FUNCTION. 
of the mammary secretion often originates an abscess without any other 
perceptible cause. 
Prognosis.—The danger from abscesses is in proportion to their 
size, and the severity of the disease by which they have been occa- 
sioned ; the extent of their internal surface; depth at which they are 
seated ; the indolence of their action; deficiency of vital powers of the 
constitution ; the intensity of the symptoms accompanying or produced 
by them; importance of the viscera in which they are seated; the di- 
rection they take, the chances of their evacuation; and the means of 
renovation and repair possessed by the constitution. Consecutive ab- 
scesses are always dangerous from the exhaustion dependent on the 
primary disease. 
Treatment.—Indications of Cure.—First, to remove the purulent 
collection. Second, to procure the obliteration of the cavity in which 
it was lodged. 
1. Matter may be absorbed from the interior surface of an abscess, 
conveyed through the circulation and eliminated from the system by 
the various excretory organs. The means usually resorted to to promote 
this object are: Frictions with stimulating substances, as Ammoniacum, 
Iodine, Iodide of Potassium, cold, warm, or tepid affusions on the part. 
A great variety of stimulating, discutient liniments, &c., are in common 
use; but their powers are only applicable to a small proportion of the 
cases that commonly occur. Abscesses preceded by acute or active 
inflammation can very seldom be removed by any local excitants, and 
the opening of them is therefore inevitable. The subsidence of inflam 
matory action does not generally follow the formation of pus, and gene 
ral and local treatment must still be directed to its more complete 
removal. So long as pain, redness, heat, tension of the skin remain, 
leeches, or other modes of capillary depletion may be useful. Emollient 
and astringent applications may also be necessary to reduce the inflam- 
mation of the surrounding tissue, favor the resolution of the parts not 
yet suppurated, limit the quantity of the morbid secretion, and prepare 
the abscess for being opened with the best prospect of success. Even 
these measures sometimes favor the absorption of pus; and this sooth- 
ing course will promote the favorable suppuration and lessen the general 
irritation till the thinning of the skin at the most prominent part of the 
tumor indicates the necessity of opening it. 
Consecutive and spreading abscesses arising in unhealthy constitu- 
tions enfeebled by previous disease, ataxic inflammation from a specific 
cause, inflammation of the veins or morbid secretions of purulent matter 
absorbed into the circulation, require a restorative treatment, combined 
with all the means that promote the healthy action of the digestive 
organs. 
When the puriform matter is not likely to be immediately absorbed ABSCESS. 
657 
the abscess should be opened by an incision of the necessary size and 
depth. The operation should be more promptly performed in propor- 
tion to the irritation produced by the accumulating pus ; its deleterious 
effects on the general health; its depth, and the danger of discharging 
itself internally; and the vicinity of important organs, blood-vessels 
or nerves, which are injuriously affected by the increasing pressure of 
the abscess. In many cases it is necessaiy to exercise the greatest 
care in opening large collections of puriform matter, as in lumbar ab- 
scess and some others. When large incisions are at once made, and 
large evacuations encouraged, the vacuity left is immediately filled by 
atmospheric air, and an increased state of irritation of the lining mem- 
brane of the abscess is produced. To avert this injurious effect of the 
admission of air, Dupuytren advised that abscesses of this character 
should be opened “ by successive punctures, the margins of which 
should be immediately closed, upon the evacuation of that part of the 
contents which are first expelled by the reaction of their parietes.” 
2. Abscess, Secondary.—Secondary abscesses of a severe and even 
fatal character often follow injuries and surgical operations which were 
not dangerous of themselves. These secondary collections of pus take 
place in distant parts of the body, and often in organs essential to life; 
they seem not to be necessarily connected with any previous external 
injury, and are sometimes induced spontaneously, and independent of 
any injury or operation. It has been shown that the usual pathologi- 
cal appearances found after death, in these cases, consist “ in deposits 
of purulent matter, inflammatory congestions, effusions of coagulable 
lymph, sero-purulent effusions, effusions of sanies or bloody serum, ad- 
hesions of contiguous surfaces, ulcerations and disorganizations of dif- 
ferent structures, as of the eye and of the tissues about the joints.” 
(Dr. Lee's Note to Copland’s Dictionary. Vol. I., p. 26.) The or- 
gans most frequently affected are the lungs, liver, brain, spleen, the 
knee and shoulder-joints. In such cases the inner coats of the veins 
in the neighborhood of the primary injury are found inflamed, and 
purulent matter is generally found within the cavity of the veins. 
There is, therefore, reason to believe that phlebitis is always attended 
with secondary local affections. The secondary abscesses are known 
to occur in connection with phlebitis, whether the pus in the veins is 
free to enter the circulation or is circumscribed by a barrier of lymph, 
thrown out to prevent the pus from contaminating the blood. Dr. Wat- 
son, in the American Journal of Med. Sciences (Vol. XXI., pp. 37, 
74), has shown that the existence of pus within the free cavity of the 
veins does not necessarily lead to the formation of secondary abscesses 
elsewhere; and that the secondary disorders of a different character 
which often follow operations, the high inflammatory excitement, and 
the exhausting influence of hectic fever, may result in consequences in 658 
diseases of the sanguinocs function. 
no way connected with the disease of the veins. He shows that the 
secondary depositions of pus are not always, if they ever are, the re- 
sult of the absorption of matter from one place and its transportation 
to another locality; “ and that, as they occur in all parts of the body 
without any definite relation to the part primarily affected, they cannot 
be attributed to any special sympathies between the parts first diseased 
and those subsequently involved.” He therefore believes secondary 
abscesses can only arise from the effects of “ a vitiated condition of 
the blood, induced by the purulent matter, or other morbid exhalations 
of inflamed veins, mixing with the blood, and thus exciting local inflam- 
mation in the parts secondarily diseased.” 
Treatment of Abscesses in General.—For Acute Abscesses.— 
Arsenicum.—Intolerable burning pains during the fever; or, the ab- 
scess to become gangrenous, or is accompanied by great de- 
bility. 
Asarum.—Abscesses discharging a colorless serous pus; violent 
pains on contact, and great sensitiveness of the surrounding parts. 
jBell.—Pressure, burning, and stinging in the abscess; cheesy and 
flocculent pus. Hepatic abscess following inflammation. 
Bryonia.—The tumor is either very red or very pale, with tensive 
pain. 
Mezereum.—Abscesses of fibrous parts and tendons • or following 
the abuse of Mercury. 
Pulsatilla.—The abscess bleeds readily, with stinging or cutting 
pains; or there are itching, burning, and stinging in the surrounding 
parts. Abscess originating in varices. 
Phus-tox.—Abscesses of the axillary or parotid glands; the swell- 
ing is painful to the touch, or discharges a bloody serous pus. 
Chronic Abscesses.—Remedies: Asarum, Aurum, Calc., Carb.-veg., 
Con., Hep., Iod., Laur., Lycopod., Mangan., Merc.-corr., Nitr.-acid., 
Phos., Sepia, Silicea, Sulph. 
3. CELLULAR INFLAMMATION.—Inflammation of the Cellular Membrane. 
That fever often excites inflammation is well known. These se- 
condary local inflammations generally arise during the fever, and often 
lead to fatal results. 
In the decline of certain cases of autumnal fever, we often meet with 
a form of inflammation affecting the extremities called “ fever sores,” 
boils, abscesses, &c. They are generally considered signs of a favor- 
able termination of the fever; but they are not causes of recovery, and 
occur generally in cases that convalesce slowly, and manifest much 
irritability; death may follow from extensive suppuration. We give a 
case by Dr. Drake of Cincinnati: CELLULAR INFLAMMATION. 
659 
An engineer after ague had febrile and inflammatory symptoms 
which came out in furuncles and inflammations of the cellular tissue 
on the head and neck, fore-arm, on the scapula, between the fifth and 
sixth rib near the sternum ; some suppurated, others remained solid. 
Near the heart was strong pulsation; the disease then attacked the 
brain. There were jactitation, headache, heat of scalp, fierce expression 
of the eye, delirium, insanity, vigilance, coma, variable pulse ; later 
there were spasmodic twitchings of the eyelids; convulsions; partial 
hemiplegia; after some suppuration took place the vehement action of 
the right carotid abated, but the left took on a similar increased action, 
with contraction of the eye of that side which became engorged with 
blood. Under the antiphlogistic treatment he declined, though suppu- 
ration was protracted; he became extremely emaciated; cordials, tonics, 
anodynes were all injurious and the patient died. On dissection, the 
cellular substance from the forehead to the clavicle, from the chin and 
occiput was filled with pus; a great portion of the vessels, nerves and 
muscles converted into an unorganized putrid mass, especially at the 
angle of the jaw; parotid gland not distinguishable; cellular substance 
over parietal and part of the temporal bone disorganized; also over 
cervical vertebra. Carotid artery had lost its cellular coat, its sub- 
stance inflamed; extremity of the maxillary bone without and within 
denuded of its periosteum; other abscesses contained only pus. The 
pulsating tumor near the heart w’as found to consist of an abscess within 
the sternum and the cartilages of the ribs, resting on the pericardium, 
having the pleura within and the attenuated walls of the chest without; 
the pulsation had been transmitted through the tumor from the impulse 
of the heart. 
Treatment.—Counter-irritation has long been regarded by old 
school physicians as an important resource; and even the homoeopa- 
thist may admit that it is to a limited extent useful. The following aro 
in general in use: sinapisms, rubefacients, frictions, moxas, caustics, 
issues, hot baths, as well as cold ones ; and, in a wider sense, counter- 
irritants may include emetics, purgatives, and even mental impressions 
These agents are used to excite a powerful impression upon the system, 
which in many cases proves beneficial and removes the morbid action. 
Cayenne pepper produces redness and burning pain when applied to 
the healthy fauces, but acts as a sedative in the sore throat of scarlet fever. 
A concentrated solution of acetate of lead, applied to the skin, denuded 
of its epidermis, or to mucous membranes, creates irritation and pain 
the same, when sufficiently diluted, is a soothing and sedative application, 
when this state is the result of disease or injury. Remedies, p. 658. 
4. Frost Bites.—Cold when applied to a part to the extent of diminish- 
ing the temperature below the common healthy standard always acts as 
a sedative or depressant. It has been known from the earliest ages 660 
DISEASES OF THE SANGUINOUS FUNCTION. 
that cold is capable of producing entire sensibility; but it was not em- 
ployed for this purpose as a means of preventing the pain of surgical 
operations till its power and safety in producing entire sensibility was 
demonstrated by Dr. Arnott in 1848. 
Excessive cold first causes extreme redness as the result of the 
relaxed condition of the walls of the blood-vessels; this is followed by 
a peculiar biting or stinging pain, induced by the pressure of the dis- 
tended vessels upon the nerve branches, and also by the influence of 
the cold directly on the nerves themselves. 
After still farther exposure of the part to intense cold the extreme 
redness with a portion of the congestion disappears, until there is 
a sudden sting and the part becomes white, painless, stiff, and is 
frozen. All the vital processes cease. Innervation, circulation, sen- 
sation and all the usual functions of vitality are entirely obliterated. 
The liquids and semi-solids become solid, crystalize and consequently 
expand and press upon the more compact structures, which, only when 
exposed for a longer time still, will become frozen also. 
The process of congelation commences on the surface, extending 
from the surface and the point of exposure inwardly; the freezing of 
the plasma taking place more readily than that of the floating cor- 
puscles, which are driven away from the parts frozen, thus giving the 
bloodless appearance ordinarily observed in frozen tissues. 
Recovery from the Effects of great Cold.—As the freezing com- 
menced on the surface, driving the floating solids of the blood towards 
the heart, the thawing should commence from within and progress 
toward the surface, so that the part last frozen should be first thawed, 
else there may be a stratum of unthawed structure between the surface 
and the actively vital structures, thus cutting off all innervation and 
allowing chemical changes to commence uncontrolled by vital force, 
which chemical changes occur speedily in animal structures whenever 
the vital force is withdrawn. When the thawing takes place from 
within, innervation follows, and the parts are under the influence of the 
vital force, as fast as they can thaw; the nerve aura can then penetrate 
by degrees through the reviving portion of the member which may be 
restored to a healthy condition with far less injury than might be anti- 
cipated. 
Treatment.—Rub the part for a few minutes with snow just in the 
process of thawing, or which is light and feathery, having recently 
fallen; but this only when the patient has been brought into a room 
in which the temperature is above the freezing point; and it must be 
continued for only a short time, as the frozen part must become warmer 
than snow before vital action can be restored in it. When the snow is 
too cold it rather increases and perpetuates the injury. When it is 
less than the freezing temperature it may be applied with advantage, 661 
CELLULAR INFLAMMATION. 
as it retards the thawing of the surface till the natural heat of the 
body within can slowly penetrate the frozen structures, bringing 
warmth and vitality toward the surface. But even melting snow 
should not be applied by friction; and any other substance which can, 
without freezing more deeply, just retard the process of thawing on 
the surface, will be quite as good, often better and safer than snow. 
When the nose, cheeks, forehead, or ears are frozen, a shawl, coat 
collar, or the cap drawn over the part will usually protect it till it 
gradually thaws. The foot or hand, when frozen, should remain co- 
vered with some woolen fabric, and no more heat should be applied to 
them than the rest of the system requires. They should be kept near 
the freezing point, and the circulation gradually and cautiously per- 
mitted to reestablish itself. The rubbing of frozen parts with snow, as 
commonly practiced, is uniformly injurious. Rubbing with the warm 
hand may restore the heat of the frozen surface, but cannot cause 
blood to flow through vessels that are congealed and closed with frozen 
crystals further inward. 
Frost-bites should be treated without mechanical pressure, friction, 
or manipulation; and protected from rapid elevation of temperature 
of the surface by enveloping the part in soft and melting snow enclosed 
in a piece of flannel, silk, or linen. Moisture itself does no good, 
though a cloth wet with cold water may be better than the wrarmer air 
of the room. 
The temperature must be gradually permitted to rise to that of 
health, but without any friction or unnecessary disturbance. Usually, 
if a part has been frozen quite solid, when vitality is established the 
epidermis becomes separated from the dermis, and blebs or blisters are 
formed by the exudation of the serum of the blood through the injured 
vessels. These blisters may be treated as blisters formed by scalds 
and burns. 
When a frost-bite has been very severe and deep, unless the utmost 
care is taken to have it thaw properly and slowly, the parts are quite 
apt to slough. Such slough must be managed according to the gene- 
ral principles of surgery. If a bone or a part of a bone has been 
frozen it is quite likely to die, although the frozen portion may never 
be detached from that which remains alive, but it may become diapho- 
nous, and require amputation or removal. 
5. Panaris, Whitlow.—The remedies hitherto found most effica- 
cious in checking the progress of wdiitlow are : 
Hepar: Arsenicum, Calc., Phos.-ac., Nitr.-ac., Petrol., Sepia, Caus. 
Lachesis: Panaritia under the nail; between the tendons. 
Silicea: Inflammation of the tendons and their sheaths. 
Sulphur, alternated with Silicea every eight days, to prevent recur- 
rence of the disease. 662 
DISEASES OF THE SANGUINOUS FUNCTION. 
Merc.-cor., followed by Ilepar. 
Alum, if abscess forms. 
Dispensary Case.—A lady, aged forty-one, has felon on the right 
fore-finger. The deep-seated, excruciating, and long-persistent pain 
shows that the inflammation is seated beneath the periosteum. I 
already involves the first joint, and is extending upwards; the paiu 
runs up to the shoulder. No sleep last night. Incision half an inch 
long, with the bistoury, penetrating to the bone. Poultice. Next 
day discharging slowly. Slept last night. Poultice continued. Reco- 
very rapid. 
A groom at a livery stable has whitlow, involving first and second 
joint of right middle finger. Pain has prevented quiet sleep for two 
or three days. Whole finger largely swollen. Inflammation would 
continue to extend along the bone, and could not for two or three 
weeks relieve itself by perforating the periosteum. Incision to the 
bone, from near the first joint, a half inch, reaching the bone. Poul- 
tice continued two or three days more. Recovery rapid. 
6. Contusions. Arnica.—Persons wTho have received a blow or con- 
tusion feel pains in the side, a desire to vomit, lancinating and burning 
pains in the hypochondria, all of which are accompanied with anxiety, 
tremors, and involuntary starts, similar to those produced by an elec- 
tric shock, formication in the parts that have received the injury, &c. 
As Arnica-montana produces similar symptoms, according to the 
observations of Meza, Vicat, Crichton, Collins, Anskow, Stoll, and 
J. C. Lange,* it may be easily conceived that this plant will cure the 
effects of a blow, fall, or contusion, as is familiar to the experience of 
a host of physicians, and even of whole nations, for centuries past. 
7. Sprains.—A limb after a fall or other violence is painful, does 
not admit of being moved, sivells, and turns red. 
Treatment.—Apply a lotion of cold water containing Arnica, and 
give it internally. Bryonia or Rhus may be used after the more 
acute symptoms have subsided. 
Dislocations, Luxations.—The removal of the head of a bone from 
its corresponding articular cavity. It is characterized by violent pain, 
loss of motion, swelling, alteration in the shape, length, and direction 
of the limb. There is an unnatural depression or prominence in the 
vicinity of the injured joint, and a peculiar rigidity of the limb. The 
deformity is apparent on comparing the injured with the sound limb. 
The treatment consists in setting the limb; then giving Arnica, or 
Aconite if the injured part be becoming red and inflamed. Apply 
cold water or diluted Arnica. This will be occasionally repeated till 
the inflammation has subsided ; after this the limb must be occasion- 
ally moved to ensure against the joint growdng stiff. 
* Hahnemann, Mat. Med., I. CELLULAR inflammation. 
663 
8. PERIOSTOSIS 
Diagnosis, 
Inflammatory fever; the swell- 
ing, if the disease be in the tibia 
or femur, is diffused: not limited 
to the larger joints—ankle or knee; 
but it occupies a wider range, and 
is cedematous in its character. 
Acute Periostosis. 
High inflammatory fever, with 
swelling of the limb and grea 
pain, increased by pressure, so 
that the patient is nearly helpless, 
and shrinks from the touch of the 
surgeon, in dread of the torture to 
be inflicted by an examination. 
Acute Rheumatism. 
Pain. 
The chief diagnostic mark is 
found in the seat of the pain. In 
this disease little or no pain is 
caused by pressure, unless it be 
made over the seat of the disease 
in the course of the infected bone. 
In the early stage you may move 
the limb, at the knee or the ankle, 
and press the ligaments and ten- 
dons without producing pain; but 
the slightest pressure on the bone 
excites intense suffering, and the 
pain cannot be borne for a moment. 
The attack usually succeeds to 
injury. 
Pressure over the bone, as the 
tibia or the muscles of the thigh, 
or around the femur, in rheuma- 
tism, rarely causes much pain, but 
moving the limb causes intense 
pain. 
The attack not caused by injury. 
Treatment.—The hospital surgeons content themselves at the onset 
of the disease, when the bone affected lies near the surface (as the 
tibia), with local applications. These, however, cannot be relied on 
when the affected bone is deep seated. 
Incisions.—The only reliance of unquestionable power in true peri- 
ostosis, by which the extension of the ulceration along the bone can be 
arrested and further mischief averted, is a free incision, extending 
through the periosteum to the bone. In a case in which no fluctua- 
tion is perceptible it is best to cut down boldly, through the thick 
vastus externus to the bone, if there is full evidence that the pe- 
riosteum of the femur is acutely inflamed. In such a case, Qr. Cur- 
ling says, “ the incision revealed a small quantity of pus confined be- 
neath the muscle. The membrane was partly detached, and in a few 
hours extensive mischief would have ensued. This was arrested by 
the incision, the pain and inflammatory fever rapidly subsided, an 
health was speedily restored.” 
In another case the periosteum was extensively detached, and so 664 
DISEASES OF THE SANGUINOUS FUNCTION 
distended by the pus effused beneath it that, when an opening was 
made, the matter gushed out with force over the surgeorrs clothes. 
The necrosis in this case was very extensive, the inflammation had 
affected the cancellous structure in the lower end of the tibia, jeopar- 
dizing the safety of the ankle-joint; additional incisions were required, 
after which the inflammation in the periosteum and the necrosis ceased 
to extend, and the work of restoration was set up. 
Periostosis consequent on injury is a common cause of necrosis in 
the long bones. When only a small portion of the bone is denuded 
by the injury and the subsequent inflammation, and the wound, after 
discharging pus a few days, gradually fills up till a small sinus is left, 
no further treatment is generally directed, even if a small portion of 
the bone remain denuded. But such treatment generally ends in fur- 
ther trouble. When more permanent treatment is demanded, the fol- 
lowing may be necessary: cut down to the bone, and chisel away a 
small portion, so as to enlarge the aperture, extract any loose pieces 
of bone, and chisel away such parts of the bone as are unsound. 
Huta-grav.—It is the distinguishing, and perhaps peculiar feature 
of Ruta, that it produces, in an eminent degree, pains of a pressive and 
bruised character in the muscles, and especially in the periosteum and 
bones. Many drugs produce pain in the back and limbs, apparently 
in the periosteum or bones. But these pains from other drugs seem 
not to be directly upon the periosteum or bones, but indirectly through 
the spinal column and nervous system. The pains are sympathetic, 
are attended by different trains of concomitant symptoms, and are of 
quite a different pathological character. But the pains of Ruta seem 
to be the direct effect of the drug upon the periosteum and bones. 
Thus the pain of the os coccygis, as if bruised. 
Stone Bruise.*—A disease of the feet, usually caused by walking 
or jumping on the stones, and occurring in young persons who go Avith- 
out shoes during the warm season. Persons liable to this disease 
acquire generally, by going barefooted, a thick sole to the foot, on 
which slight pressure, even blows, can make but small impression. 
But severe pressure, or the bruise caused by jumping on stones, though 
not injuring the skin, may bruise the parts beneath, even the perios- 
teum, and cause deep-seated inflammation and suppuration in the 
plantar fascia, or in the cushion of the under surface of the toes or of 
the bed of the foot. Such an abscess progresses slowly, may be less 
painful than a boil or carbuncle, and less liable to produce constitu- 
tional disturbance, and yet it may demand surgical treatment 
If a deep-seated inflammation commences in the toes, the plantar 
surface of the foot, or the heel, the foot should be soaked for a long 
* Jour, of Rational Medicine. Cincinnati, March, 1862. p. 83. cellular inflammation. 
665 
time in a quite warm and weak solution of alkali, as saleratus. This will 
partially dissolve or soften the thickened cuticle, which may then be 
scraped olf, and the skin shaved over the central portion of the inflam- 
mation. The persistent use of a hot alkaline foot-bath, with due efforts 
to scrape off the hardened skin, will put a stop to the inflammation; at 
least we may thus diminish the extent of it. 
The limb should be now kept in a horizontal position, foot enveloped 
in water slightly warm and alkaline. If, in spite of this treatment, an 
abscess form, the pus must be let out by the abscess lancet or bistou- 
ry. After this some cauterize the abscess by inserting to its bottom a 
stick of Nitrate of Silver, evacuating the pus by repeated injections 
of warm water, warm infusion of Arnica leaves, or, still better, of Ca- 
lendula. Some inject into the cavity Lugol’s solution of Iodide of Po- 
tassium, to start a new action in its interior surface. 
Ulceration of the Cartilages of the Joints.—This formidable 
disease does not always reveal in its outward symptoms its real char- 
acter. It may at first be only regarded as an ordinary abscess, with 
little inflammatory excitement, heat, or local tenderness; but it excites 
suspicion by the degree of lameness of the foot, and by some of the 
common phenomena of stone bruise or of ordinary abscess. 
It may be caused by the extension to the cartilages of the inflam- 
mation of a bunion, ganglion, an abscess, or constitutional derange- 
ment. When it involves the cartilages of the foot it is often very ob- 
stinate and difficult to cure. 
Anatomy.—Four distinct varieties of cartilage are recognized: 1. 
That of ossification of the bones of the cranium; 2. That which pre- 
cedes the ossification of the long and short bones, the patellse, and the 
bones of the tarsus ; 3. The cartilage of adults, as over the nasal bones, 
at the ends of the ribs, joining them to the sternum, and between the 
vertebrae of the spine; and, 4. The fibroid variety, into which that at 
the end of the ribs changes in old persons, and in the canaliculi which 
are analogous to the haversian canals in bones. 
The first and second varieties contain a few blood-vessels, but 
neither the third nor fourth varieties, while in a healthy condition, 
ever contain any blood-vessels. 
The cartilages that enter into the structure of the feet are of the 
second variety, which may be found in children, even after the second 
dentition. If from direct injury or constitutional cause the cartilages 
of the foot of a child less than ten years old become diseased and ulce- 
rate, the minute blood-vessels will swell, and the foot manifest the usual 
symptoms of inflammation; and being difficult of access, as well as liable 
to constant irritation and injury, the disease will be liable to be of long 
standing, and at the best to result in a permanent deformity of the foot, 
and anchylosis of the bones. 666 
diseases of the sanguinous function. 
Treatment.—This must be directed to the correction of the psoric 
or scrofulous condition of the constitution. The foot must be kept at 
rest; pus when it forms must be removed by incision; and then local 
treatment can be employed to wash out and excite to healthy action in 
the interior of the abscess. If some part, as a tendon, cartilage, or 
bone, is apparently dying or dead, it may be touched with a minute 
quantity of strong Nitric-acid, applied by a probe or stick. If a broken 
blood-vessel is inclined to bleed, the Perchloride of Iron may be ap- 
plied to restrain it. 
Internally we endeavor to meet the constitutional condition by anti- 
psoric remedies. After some trial of these, homoeopathic attenua- 
tions of Hypophosphate of Lime, or Hypophosphate of Iron, will keep 
up the strength, promote the digestive power, and produce some specific 
effect in promoting ossification and curing the periostosis, which in- 
clines to extend along the bones. A firm bony union of the cartilagi- 
nous surfaces is often the best thing the case admits of; and it is best 
to promote this result by good and pure diet, perfect rest, and invigo- 
rating internal treatment. 
10. Poisoned Wounds, Bite of the Rattlesnake.—Bromine, Bi- 
broil’s Antidote.—The composition was thus given to Prince Paul of 
Wirtemburg, in his travels in 1854: 
It.—Potassii-iodidi, 4 grs. 
Hydrar.-chlor., 2 grs. 
Brominii, 4 drachms. 
Give ten drops of this mixture, diluted with a table-spoonful of 
brandy or wine, to be repeated if necessary. It must be kept in glass 
stoppered vials, well secured. Prince Paul says, Prof. Bibron allowed 
a rattlesnake to bite him in the lips and cheeks; and then, by taking 
his antidote, he prevented all unpleasant or alarming symptoms: 
In 1857, in the course of an expedition to the Rocky Mountains, 
some experiments were made with this remedy, afterwards reported by 
Dr. W. A. Hammond, since Surgeon General U. S. Army. 
1. July 2, the Hospital Steward was bitten by a large rattlesnake 
(crotalus confluentus) which inflicted a deep wound, and hung by his 
fangs to the finger for a second or two before he could be detached. 
Four minutes afterwards a dose of the antidote was given. The symp- 
toms almost immediately disappeared. After forty minutes the pain 
and swelling returned, attended with much throbbing. Repeated the 
antidote. In less than five minutes the finger regained its natural ap- 
pearance, and all pain and pulsation had vanished. The man resumed 
his duties an hour from the accident. 
2. A large rattlesnake was made to bite a wolf (canis occidentalis) 
about three months old, wounding the animal severely in the left flank 
In fifteen minutes the leg was much swollen ; the wolf showed signs CELLULAR INFLAMMATION. 
667 
of great uneasiness, yawning, stretching, and looking about in an 
anxious manner. The symptoms increased in intensity; it became 
unable to stand, drowsy, slightly convulsed. Thirty minutes from the 
infliction of the wound gave six drops of the antidote. Almost instan- 
taneously the symptoms disappeared. In a few minutes the animal ate 
a large piece of meat. 
3. The following day the same snake was made to bite the wolf three 
times in the space of five minutes, in the flank, neck, and cheek. In 
two minutes the wolf was unable to stand; gasping respiration, a fixed 
expression of the countenance showed the effect of the poison. Some 
delay in getting the antidote ready; before it was given all signs of 
life had apparently ceased. Nevertheless six drops were placed far 
down the throat, where it apparently remained, as there was no effort 
to swallow. In one minute respiration again commenced, and the heart 
could be felt to pulsate. But the wolf lived twenty-seven minutes, and 
then died comatose. 
4. A large crotalus confluentus brought from the Rocky Mountains 
was made to bite a dog, five months old, in the right shoulder. In ten 
minutes the poison caused gasping respiration, inability to stand. Be- 
fore the antidote could be given the dog became unable to swallow 
and he was perfectly senseless, dying in forty-five minutes after the 
infliction of the bite; very slight swelling observed in the wounded part. 
5. Only forty-five minutes after the last experiment the same snake 
was made to bite another dog, of the same age as the last, in the lower 
jaw, near the mouth. At the end of three minutes, and before any vio- 
lent symptoms ensued, a dose of the antidote was given. The dog 
swallowed it readily. In five minutes he seemed uneasy. Respiration 
was accelerated; he preferred to lie down in the shade. At the end 
of fifteen minutes he could stand with difficulty, and the effect of the 
poison seemed to increase. Another dose was given, nearly half of 
which wras lost. Slight swelling of the face and neck; when roused 
he would walk a few yards, though with difficulty; he preferred to 
rest. In an hour from the bite he seemed better; took some milk; in 
two hours he appeared well, a small swelling remaining under the jaw, 
which disappeared by next morning. (See Brit, and For. Med. 
Chir. Review, 1858, p. 403.—Gen. Marcy's Prairie Traveller, &c.) 
Dissection Wounds.—Case by Dr. C. Dunham.—Lachesis.—Dis- 
section wound in the index finger, received in making autopsy of a woman 
who died of puerpural peritonitis. In a week the finger had 
in size; hand and forearm much swollen and oedematous; a hard and red' 
line extends from the wrist to the axilla ; axillary glands swollen ; arm 
and hand intensely painful; whole left side partially paralyzed. Ex- 
treme prostration causes the disease to be mistaken for typhus; low mut- 
tering delirium at night; marked aggravation, suffering, and prostration 668 
DISEASES OF THE SANGUINOUS FUNCTION. 
on awaking from sleep. General condition growing steadily worse, 
'<j abscesses forming under the deep fibrous tissues of the finger and 
hand. Allopathic surgeons in attendance advised Calomel and Opium, 
and gave a discouraging prognosis. Dr. Dunham refused their ad- 
vice ; took Lachesis, 12, the first dose on the third day, and repeated 
it thrice daily for five days. The constitutional symptoms had now 
vanished. The recovery of the finger was slow but complete. 
Bites of Insects.—Collodion.—This is the best application to the 
poisoned wounds made by insects. It gives perfect relief to the bites 
of mosquitoes, and is also the best application to the stings of bees. 
Arnicated Collod. is the best. Other remedies are : Brom., Amm., Caust. 
One of the very best local applications for the bites of insects is the 
tincture of Apis-mellifica. It usually affords prompt relief. 
11. Malignant Pustule, Chakbon.—In addition to a peculiar pre- 
disposition on the part of the patient, Larrey thought the disease was 
caused by “ the general or partial absorption of certain deleterious 
gaseous effluvia, very abundant in some marshy districts in the middle 
of France. These mephitic emanations are formed more frequently 
when the first heats of summer open the pores of the earth, and cause 
the decomposition of the animal and vegetable substances.” “The 
places most exposed to these emanations are the sewers or cemeteries 
which remain covered with snow during the winter, the neighborhood 
of stagnant waters, or those temporary ponds formed by the melting 
snows or rains of winter, in which are engendered a great quantity of 
reptiles. These ponds, in drying up, leave a prodigious number of ani- 
malculse, which putrefying, generate these pernicious exhalations.” 
Persons exposed to the impure atmosphere of such localities; or 
butchers, tanners, cooks, &c., who come in contact with the flesh or 
skins of animals that have died from malignant diseases are liable to 
be attacked with this disease. There have been instances of the in- 
fection being conveyed by flies from diseased animals to the human 
race. 
A symptomatic variety attacks persons who are predisposed to such 
diseases and are then exposed to malaria which excites this pustule or 
some analogous disease. 
Symptoms.—The disease commences with a disagreeable itching, 
with shooting pains in the place where the tumor was forming, and 
following the course of the nerves. This point becomes red and 
slightly swollen; the patient thinks he has been bitten by some poi- 
sonous insect. Soon yellow vesicles appear on the spot, filled with 
lemon-colored serum. An areola forms around it, at first red, then 
livid, and producing vesicles like the first. The swelling extends to 
surrounding parts ; the vesicles burst, and the fluid escapes. The der- 
moid tissue in the centre now becomes black, dried up, and hard like CELLULAR inflammation. 
669 
a piece of black leather, it is sunken, and adheres strongly to the parts 
beneath, while the areola enlarges, assumes a livid color, and becomes 
gangrenous. It often attacks the genitals of children. 
The itching with which the affection begins is followed by tension, 
numbness, and slight throbbing pains; and there is general uneasiness 
pains follow in the head; vertigo and disposition to vomit; no appe- 
tite ; disturbed sleep, dreams and delirium. Pulse at first weak and 
slow, and lessening as the disease advances; respiration labored; urine 
deficient; constipation; hiccough; moral faculties disordered. In 
malignant cases the symptoms rapidly increase ; the slough spreads; 
the vesicles break and discharge a green or reddish fluid. 
The tumor is elevated ; the general functions disordered. When the 
vital powers are too much depressed to form the circumscribing of true 
inflammation around the tumor, and confine the disease to one spot, the 
dry form of gangrene extends rapidly in depth and breadth ; the gan- 
grenous matter is absorbed by the lymphatics ; the patient becomes 
prostrated, having frequent faintings, hiccough, oppressed respiration; 
palpitation of the heart, and greater depression of the pulse; then fol- 
low drowsiness, vertigo, suspension of the intellectual faculties, and 
finally death. 
Pathology.—In the fatal cases the carbuncle is found “gangre- 
nous, the stomach and intestines filled with tainted gas, and spotted 
with points of gangrene ; epiploon yellow and flabby; whole venous 
system gorged with liquid blood.” (.Larrey.) 
Malignant Pustule. 
Diagnosis. 
Carbuncle. 
The skin is primarily, and the 
cellular tissue secondarily involved. 
May occur on any part of the body, 
but always in relation to the epi- 
thelium, whether on the skin or 
mucous membrane. 
Generally young or middle-aged 
persons. 
Commences in forming a vesicle. 
Not many openings; there is 
one, but it is larger, and without 
defined edge. 
Generally appears on the back 
of the neck or in the loins, where 
there is a dense fibrous fascia; and 
it arises in connection with the 
areolar tissue beneath such fascia. 
Commonly old persons, seldom 
middle-aged. 
No vesicle is formed. 
Small pin-hole openings commu- 
nicate with the gangrene beneath, 
and discharging drops of matter. 
Carbuncle.—Anthrax.—A painful, hard, flattened, circumscribed 
tumor, but slightly elevated above the skin, extending through the en- 
tire cuticle, and even beneath it, so as at times to be an inch or more 
deep. The surface is red, of a mahogany tint, then purple, then livid , 
and after the parts heal up the skin still remains red or of a deep 
brown, and the discoloration remains for some weeks. 670 
DISEASES OF THE SANGUINOUS FUNCTION. 
The pain is peculiar, throbbing, and burning; when the carbuncle 
is fully formed the surface is livid or purple, the cuticle becomes raised 
into blisters, there are numerous points of pustulation, and as the pus 
escapes the cuticle appears to be pierced with small perforations, 
through which a core beneath may be seen. The core is made up of 
a slough of the fibrous tissue of the inner part of the skin, and as it 
loses its vitality that tissue appears to be converted into a grayish or 
whitish pulp, apparently soft and mixed with an ichorous purulent 
fluid. The entire surface of the carbuncle is filled with the perfora- 
tions thn ugh which this fluid oozes. Or a considerable space of the 
skin may lose its vitality, turn black, slough, and leave a large opening 
in the co»e. Carbuncles vary in size from an inch to several inches 
in diameter, and are from an inch to an inch and a half in depth. 
They are always attended with more or less danger from the great and 
long-continued pain they cause, from the exhaustion of the sloughing 
process, from the febrile excitement, from its aptitude to excite erysipe- 
las, and from the fact that the disease usually occurs in those already 
in feeble health.* 
Causes.—The Registrar-General of Scotland, in his Report for 
1862, says that from the breaking out of pleuro-pneumonia among the 
cattle in that country a few years ago, carbuncle, a disease formerly 
very rare, has become comparatively common. Dr. Livingston observed 
in Africa that, if the flesh of animals that die of disease be eaten it 
causes carbuncle in the persons who eat it; and that neither boiling 
nor roasting the flesh, nor cooking it in any way, gets rid of the poison. 
Though the cattle affected by the disease be killed before they die of 
it, “ still the poison is in them.” The Report suggests the possibility 
of the origin of diphtheria from the use of diseased flesh. 
Treatment.—The most prompt and certain relief is given by mak- 
ing a crucial incision quite through the diseased structure, and even 
extending a little beyond its boundary into the sound part. The pa- 
tient is generally relieved almost instantaneously from the distressing 
shooting pains. In dividing the tumor it seems as if the knife passed 
through a honeycomb. A soothing poultice should be applied to pro- 
mote the full discharge. 
Medical Treatment.—The remedies are: IZhus-tox., Arnica. 
Arsenicum : Carbuncle taken from cattle. Bell., Hyos., Nitr.-ac. 
Calcar ea-muriatica: Silicea, Sulph. 
Chloride of Lime : Calendula. 
Dr. Helmuth says, he treated three severe cases, in one of which 
‘ the disease extended over the whole forehead, and required crucial 
incisions three or four inches in length. In the second case a large 
* Jour. Rational Med. March, 1862. p. 83. CELLULAR INFLAMMATION. 
671 
and extremely painful anthrax appeared just above the tendon of the 
quadriceps extensor, and involved the tissues beneath to such a degree 
that an abscess formed underneath and threatened the joint. And, in 
the third, three large and painful tumors developed themselves on the 
neck. The internal treatment was Arsenicum for the intense burning, 
and, in an early stage, free incisions, the parts being constantly co- 
vered with a thick compress, saturated with a hot solution of Calen- 
dula and water. The effect of the remedy in hastening the generally 
tardy separation of the slough, in allaying the pain, aniF more pai ticu- 
larly in bringing the disease to a speedy termination, was surprising. 
Moreover the aqueous solution of Calendula can be poured into deep 
wounds with great benefit, and with much alleviation of pain.” 
Calcarea-muriatica was recommended by Rademacher in 1832. 
Dr. Kallenbach of Utrecht says that he had been for near twenty 
years afflicted with boils every three or four years, which, under the 
use of “ Arnica, Hepar and poultices,” tormented him “ ten or fourteen 
days before the so-called core” could be extracted. On a late occasion 
“ a boil the size of an apple formed in the perinaeum, and after eight 
days” in spite of the usual remedies he was confined to bed and unable 
to move. “ The formation of matter (my age being 65) went on slowly, 
and the fluctuations were barely perceptible, so that from past experi- 
ence I counted on another eight days delay. Then came into my me- 
mory Rademachers recommendation, and I began to apply a solution 
of Muriate of Lime, two drachms to three ounces of water. The same 
night was quiet and almost free from pain. In twelve hours the boil 
opened of itself, and discharged about one-third of its volume of thin 
bloody pus. Under the continuance of the same application the open- 
ing closed in a few hours, and the remainder of the swelling was dis- 
persed by resolution in a few days, instead of passing into suppuration.” 
(Tlornceop. Klinik. May, 1861.) 
Chloroform.—Dr. Hardy reports some interesting cases of prompt 
relief to most violent pain in carbuncle, haemorrhoids, irritable bladder, 
difficult menstruation, ulceration of the os uteri, cancer of the rectum, 
&c., by the topical application of the vapor of chloroform. Intense 
pain, even when it does not cause death, may interfere with the action 
of remedies ; and it is proper to relieve or remove it by any reasonable 
means in our power. 
Carbonate of Lead.— White Lead.—As an external application, in a 
case of a huge carbuncle on the loins of a man rapidly extending in 
spite of free incisions, linseed poultices, and common general treat- 
ment, a thick wide circle of white lead in linseed oil was applied. 
From that time there was no advance of the disease; the centre ra- 
pidly broke up, and recovery followed. Warm poultices often increase 
the inflammation of carbuncles. 672 
DISEASES OF THE SANGUINOUS FUNCTION. 
The white lead seems to act in two ways : 1. It effectually excludes 
the air which is a great irritant; 2. It is a direct homoeopathic sedative 
to the sentient nerve filaments, rendering them less disposed to become 
involved in the progressive inflammation. 
12. ERYSIPELAS.—ST. ANTHONY’S FIRE. 
Erysipelas presents itself under so many different aspects, and so 
often makes its appearance in connection with other morbid conditions 
of the system, that any description which shall cover all its various 
phases, is scarcely possible. The structures upon which it seizes are 
the skin, the cellular tissue, and the internal organs, especially the 
brain and the lungs. It may exist in a chronic form, unattended by 
febrile, or other constitutional disturbance, and persist for a long period 
—displaying itself at intervals, upon the surface, in the form of slight 
superficial inflammations; or sometimes passing to an internal organ, 
and producing temporary derangement of function; while at other 
times it will remain latent and inactive. But it very frequently appears 
in an acute form, either as an idiopathic or a symptomatic affection. 
It is in this active condition that erysipelas has proved so formidable 
to the old-school physician and surgeon. It was in this form of the 
malady, that the late celebrated Liston, conscious of the inefficiency of 
allopathic remedies, was induced to adopt homoeopathic treatment in 
the numerous symptomatic cases from surgical operations, wounds, &c. 
which came under his care, the results of which were so satisfactory 
to Mr. Liston and the friends of homoeopathy. (See Reports of North 
London Hospital, 1836.—7 and 8.) 
Erysipelas prevails most commonly in the spring and autumn, and 
not unfrequently it assumes an epidemic character. Females are like* 
wise more subject to its attacks than males. 
The circumstances which operate to modify the character and course 
of the malady are very numerous. In some instances a peculiar state 
of the atmosphere exists, which serves to develop the affection in a highly 
malignant form, in those who are predisposed to its influence. At other 
times, the effluvia arising from those who are suffering from the disease, 
appears to possess contagious qualities, and to be capable of communi- 
cating the morbid influence to those who came within its reach. Cases 
of this kind are usually severe and malignant—attacking the cellular 
tissue with a low grade of inflammation, which is exceedingly prone to 
terminate in gangrene, and not unfrequently to extend its ravages to 
the brain and lungs. The habits and constitution of the individual 
likewise exercise an important influence in determining the character 
of the disease. Excessive indulgence in malt-liquors and impure spi 
rits and the exclusive use of fresh meat, reduce the system to a con- ERYSIPELAS. 
673 
dition peculiarly favorable to the development of malignant erysipelas, 
whenever slight exciting causes operate. So also general debility, a 
dropsical tendency, a scrofulous or scorbutic habit, or any other dys- 
crasia, will be likely to determine a dangerous form of the complaint. 
Diagnosis.—Erysipelas is sometimes preceded by general lassitude, 
depression of spirits, and protracted rigors, followed by accelerated 
circulation, hot skin, thirst, headache, wandering pains in the back and 
limbs, and general restlessness; or it may make its appearance with- 
out any premonitory symptoms, except perhaps slight chills, succeeded 
in a few days by fever; or it may occur during an attack of pneumo- 
nia, typhus, bilious or gastric fever; or after wounds, or other injuries, 
in different parts of the body, especially of the scalp; or it may arise 
suddenly from violent mental emotions, as terror, joy, anger, &c. When 
the inflammation is confined to the skin, the malady runs its course in 
a mild and simple manner, and the accompanying symptoms will be 
merely stiff, heavy, burning, or pungent sensation in the part affected, 
impaired appetite, slight febrile disturbance, and noctural restlessness. 
The inflammation generally comes out in blotches, which sometimes run 
together, and after a few days, are covered with vesicles filled with a 
limpid or yellowish fluid. These blotches vary from a light red to a 
dark red, or purplish color, becoming white under pressure, but again 
resuming their original appearance as soon as the pressure is removed 
As the disease is about subsiding, the color of these spots changes to 
a pale or dirty yellow, after which desquamation of the cuticle takes 
place. 
When the malady is complicated by gastric or biliary derangement, 
we may have a high grade of febrile excitement, and the other phe- 
nomena which usually attend affections of this kind. In these instances, 
the erysipelatous inflammation is apt to be more violent, and to extend 
deeper, than when no complications exist. The tumefaction is more 
extensive and deep-seated, the inflammation is more intense, the hard- 
ness greater, and the pain more profound, in this variety, than in that 
first described. Some authors have designated this variety the erysipe- 
las phlegmonodes. The most common seat of this phlegmon is in the 
face and head, although it occasionally attacks other parts of the body. 
Another and highly malignant variety of erysipelas prevails at cer- 
tain seasons, and attacking more particularly females after confine- 
ment, and individuals who have already been enfeebled by other dis- 
eases. The tumefaction in these instances is more soft and spongy 
than in the preceding varieties—often pitting on pressure; the skin 
assumes a pale, waxen, or sallow color; the temperature of the parts 
is sometimes above and at other times below the natural standard; the 
skin of the affected parts presents a smooth and glossy appearance; 
vesicles containing a limpid or yellowish serum, are diffused over the 
VOL. I.— 13. 674 
DISEASES OF THE SANGUINOUS FUNCTION. 
swelling; sensations of stiffness, -weight, and deep-seated burning pains 
are experienced; followed, if the disease advances, by nausea, vomiting, 
obtusion of the senses, rapid and feeble, or slow and full pulse; con- 
stant inclination to sleep, and finally profound coma; stertorous respi- 
ration; contracted or dilated pupils, either partially or wholly insensible 
to light; protrusion of the lips at each expiration; frothing at the 
mouth ; diminished temperature of the skin; livid and inactive appear- 
ance of the diseased part, and general and rapid abasement of the 
energies of the system. This form of the disease has been recognized 
under the term erysipelas oedematodes, from the resemblance of the 
affected parts to dropsical swellings. 
Erysipelas gangrenosum.—In this form of the disease there is 
evinced a strong disposition, from the commencement, to terminate in 
gangrenous degeneration. The inflammation is confined principally to 
the sub-cutaneous cellular tissue; the swelling is hard and inelastic; 
the color of the skin is dark red or purple; large vesicles filled with 
an acrid fluid form on the surface, presenting a sluggish and gangre- 
nous tendency; the accompanying fever is of a low typhoid character; 
the muscular and nervous energies are below the natural standard: de- 
lirium or coma are for the most part present, and suppuration, gan- 
grene and sloughing soon supervene. 
Erysipelas neanatorum.—Erysipelas of this form attacks new-born 
children. The inflammation is generally confined to the lower part of 
the body in the first instance, but sometimes extends over the whole 
surface. The character of the attack depends much upon the consti- 
tution and predisposition of the child; although, commonly, the inflam- 
mation is of a high grade, the swollen parts very painful and tender, 
and disposed to suppurate and slough. The course of the complaint 
varies from two to four Aveeks. 
Another, and very common kind of erysipelas is observed in old 
people and in cachectic and intemperate persons. It is unattended 
with febrile disturbance, or much pain; but it is apt to make its appear- 
ance from very slight exciting causes, it becomes a constant annoyance. 
When the inflammation is upon the surface, the subject feels well; but 
on its disappearance there often occur internal pains, congestions, and 
numerous unpleasant symptoms, which lead to the inference that the 
disorder is dependent on some internal miasm. Frank terms this form 
habitual erysipelas. 
A number of other varieties have been described, founded upon the 
disease as it has prevailed in different localities and climates, and as 
modified by various forms of disease which may have accompanied it. 
We only aim to give a general outline of the complaint with its charac- 
teristic phenomena. 
Epidemic Erysipelas.—This formidable disease invaded various ERYSIPELAS. 
675 
parts of the United States and Canada about 1841. In 1842, 43, 44, 
45, it prevailed, at one time or another, in almost every Western state. 
It afterwards gradually diminished in virulence, losing its most striking 
characteristics. A single case will furnish a sufficient history of the 
epidemic as we often saw it during those years. 
Mrs. M., aged 25, was in good health on the evening of the 19tli of 
March, 1844, felt some pain and soreness in one nostril and through 
the head. During the night the pain increased, the nose swelled and 
the eyes could not be opened. In the morning erysipelatous inflam- 
mation was extending along the angle of the right jaw. At 9 p. m. the 
pulse was 100 in frequency; arterial action not strong; skin moist; 
but the inflamed surface fiery red; pain burning and confined to the 
skin; heat of the surface generally not great. The swelling and red- 
ness, however, continued to extend, assuming a deep dark-red color. At 
4 a. m. on the 21st the pulse was 120; pain in the head ; much worse 
among the parotids and salivary glands. During the morning the pulse 
130, in the afternoon 140. The face largely swollen over the right 
side and red on the left. Pain in the head continued. The tongue, 
from the beginning coated, now dry and red. Appearances continue 
the same through the evening. Pulse constantly 135 to 140. Swelling 
extending upwards through the hair. The swelling closes the right 
eye. 
March 22d, 8 a.m. The pain is now scarcely felt, though the swell- 
ing of the face is such as would be made by adding two inches in thick- 
ness at the middle of the cheek and extending it down the neck and up 
to the top of the head. Color dark mahogany color; pulse 136. The 
throat collects full of thick mucus which seems coming off. The patient 
thinks she is better. The pain in the back and legs is gone; intellect 
little disturbed, mammary secretion increasing, though the pulse is still 
too frequent to assure her safety. 
At 6 p.m. the swelling was slightly diminished on the points first in- 
vaded, but is increasing on the top of the head and on the other side 
of the face; some discharge from the nostrils ; pulse improving (120); 
superficial inflammation still slowly spreading, but with less swelling. 
Prom this time the disease declined. 23d, pulse 120 in the evening; 
face and head still very large; skin dark; nose running bloody serum; 
slight pain in the head. Skin thickened and red quite down to the 
neck, front and back. Itching of the skin and subsidence of the swell- 
ing and pain give assurance of resolution in the parts first invaded. 
24th free from pain; pulse at 6 a.m. 110. Swelling slowly subsiding, 
though the eruption spreads down the neck ; both eyes still out of sight 
from the swelling of the lids. 
25th. Slowly improving; pulse 104. The eruption has ceased to 676 
DISEASES OF THE SANGUINOUS FUNCTION. 
extend; appetite good; little perspiration; tongue moist and of natural 
appearance. Full recovery about the seventh day. 
Causes.—There is much difference of opinion respecting the causes 
of erysipelas. Some attribute it to a local cutaneous vice; some to a 
degeneration of the blood in consequence of improper food, abuse of 
stimulants, &c.; some to a derangement of the biliary organs ; some to 
atmospheric influences; while others entertain the opinion that it is 
dependent upon a peculiar dyscrasia which is constantly present as a 
predisposing cause. This opinion appears to us reasonable; but 
whether this dyscrasia is in all instances hereditary, or whether it may 
be acquired by intemperance, unwholesome food, or from contaminated 
air, we are not as yet always able to determine. 
The more common exciting causes of erysipelas are, debility and 
loss of resisting power from disease, abuse of stimulants, violent emo- 
tions of the mind, undue exposure to cold, certain states of the atmos- 
phere, accouchment, disordered stomach and bowels, confinement in 
close and crowded apartments, and wounds. 
Eberle says, u the inflammation which is produced by the recent 
leaves of the Rhus-toxicodendron, is strictly of an erysipelatous cha- 
racter.” This, however, is an error, for although a close similarity 
exists between the two inflammations, the careful observer will be able 
to distinguish decided marks of difference. 
Treatment.—The important medicines in the treatment of erysipe- 
las &YQ,Rhus-tox., Belladonna, Aconite, Sulphur, Opium, Graphites, 
Arsenicum, Carbo-veg., Merc., Phosphorus, Pulsatilla, Acidphos., 
Acid-nitric., Silicea, China, Ilepar-sulph., Lachesis, Bryonia, 
Chamomilla, Clematis, Euphorbia and Apis. 
Rhus-toxicodendron.—External indications.—Inflammation con- 
fined to the skin, numerous vesicular blotches, attended with itching 
and burning sensation; swelling and redness of the face, worse in the 
eyelids, around the eyes, and in the lobules of the ears, attended with 
burning and itching; swelling in the scalp; erysipelatous inflammation 
of the scrotum in new-born children; distinct or confluent vesicles, 
containing an acrid, limpid, or yellowish fluid, with redness of the skin 
over the whole surface of the body; partial or entire closure of the 
eyelids; swelling and hardness of the alce-nasi; gangrenous ulcers ; hot 
and dry skin; rapid and full pulse ; urine small in quantity, dark and 
turbid. 
Physical Sensations.—Burning, itching, and stinging of the affected 
parts, aggravated by scratching; irritation and sometimes excoriation 
of the skin from contact of the vesicular discharge; the itching and 
burning sensations worse in the evening; stiffness and sense of immo- 
bility in the swollen parts ; bruised feeling in the limbs and back; 
general sensation of heat, both externally and internally, occasionally ERYSIPELAS. 
677 
interrupted by slight rigors; mouth filled with saliva, or dry, with or 
without thirst; dryness and obstruction of the nose, relieved by 
draughts of cold air, or by being fanned; painful pulsations in the 
internal ears, when resting on the affected side; scalp swollen and 
painful to the touch ; eyes painful on motion ; dull, heavy pain in the 
head, aggravated by motion or stooping. 
Mental and Moral Symptoms.—Obtuseness of intellect, stupefac- 
tion, and weakness of memory; sadness, anxiety, and despondency 
towards evening, and during the night; nightly delirium. 
Administration.—A drop of the second or third dilution in water, 
once in two to four hours. 
Remarks.—Ruoff and Schroen consider Rhus particularly appli- 
cable in vesicular erysipelas, which is confined to the skin; but if 
symptoms indicative of serious cerebral disorder are present, they pre- 
fer Belladonna. It has been used with success in infantile erysipelas. 
Symptoms produced by Rhus-toxicodendron.—Blistering of the 
skin. The head swells to a very large size. Fontana thus poisoned 
himself three times when experimenting. 
Inhalation of the atmosphere of Rhus-toxicodendron produces in a 
few days or even hours: itching; swelling, redness ; pain, pustules, 
which are more or less vesicular; there is fever, malaise, oppression, 
lasting several days ; death has resulted. 
In 1825 Lavini experimenting with Rhus juice inoculated the first 
phalanx of the index-finger with two drops of the juice, leaving it only 
in contact for two minutes. In twenty-five days the following symp- 
toms arose suddenly : great heat in the mouth and throat; rapid and 
large swelling of the cheek, upper lips and eyelids; in the night fol- 
lowing, swelling of the fore-arms to double the natural size; dry, tense 
and burning skin ; intolerable itching, 
Rhus affects the integuments and membranes rather than the cellu- 
lar tissue and the muscles, which are more under the influence of Ar- 
nica. It differs from Ledum-palustre by its tendency to spread instead 
of confining itself to a narrow space. 
Pathological Conditions curable by Rhus-tox.—Sense of fullness 
about the head; worse when stooping; sensation in the brain as if 
bruised, or fluctuating; stupefying headache, such as exists in acute 
fevers, or that caused by intoxication with Brandy. 
Redness or paleness of the face ; margins around the eyes ; pointed 
nose; comatous drowsiness, occasionally delirium; coldness of the 
surface; numbness of the limbs ; general sinking of strength ; frequent 
but oppressed pulse. It is employed successfully in many diseases, 
among which are the following. Acute hydrocephalus; serous and 
sanguinous apoplexy, erysipelas; paralysis; epistaxis. {Teste.) 
Symptoms.—Tingling in the hairy scalp, forehead, nose, or the 678 
DISEASES OF THE SANGUINOUS FUNCTION. 
whole face ; cracking and ulceration of the red border of the lips; hot 
swelling of the upper lip; burning pustules around the mouth, fol- 
lowed by dry, brownish crusts ; heat and smarting over the face ; paro- 
titis. Enormous swelling of the whole head (erysipelas); itching of 
trunk and extremities, burning, itching made worse by scratching 
burns, chilblains ; consequences of sun-stroke; it has even cured me 
ningitis from this cause. It has cured erysipelas, pemphigus, zona 
eczema, hot and painful engorgements of the sub-cutaneous glands; 
rheumatic pains which are very violent and always spread over a large 
surface, as at the nape of the neck, loins and extremities ; gout, espe- 
cially when characterized by cutaneous symptoms ; hydarthrus ; warts 
on the hands; red or colorless infiltrations of the extremities with 
burning pains; erythematous gastritis and gastro-enteritis, with the 
mouth hot as if burnt; strong desire for cold drinks ; red and dry 
tongue, covered with a sort of false membrane, vesicles being visible 
beneath ; burning at the stomach. 
(Edematous Erysipelas of the Face.—Dr. E. A. Guilbert, Dubuque, 
Iowa, advises the topical application of remedies. He gives cases 
illustrating the treatment, in one of which he applied Arsenic for twelve 
hours, followed by Rhus. Improvement within the first twelve hours, 
and in thirty-six hours the case was out of danger. 
In a second case Aeon., Rhus-tox., Rhus-rad., Iodine, and Belladonna 
were used. 
Third case. Arsenic and Rhus-rad. internally and the same reme 
dies externally; impression made on the disease in twenty-four hours 
Attenuations, first to sixth, tincture, twenty drops to a pint of water. 
A vigorous and plethoric man, blind from cataract of both eyes, 
had erysipelas, involving the face, scalp, neck, and upper third of the 
chest “erratically leaping thence to the dorsal surface of the hands, 
and the plantar surface of the head,” features hideously disfigured ; 
eyes closed, lower maxilla almost immoveable, owing to the extraordi- 
nary tumefaction of the tissues involved; color of the affected parts 
bluish-red, and the heat thereof most pungent; dangerous cerebral 
symptoms from the second day to the subsidence of the disease. In 
this case, no topical application was used but strong tincture of Iodine, 
to create a barrier, by which the march of the inflammation might be 
arrested; and when that barrier was reached, the disease was suddenly 
translated to the hands and feet. He recovered slowly under Aeon., 
Bell., Arsen., Rhus-tox. 
In another case remedies wrere used topically. A boy of nine 
years was treated internally for several days by Arsen, and Bell. The 
same remedies were used topically; beginning at nine o’clock on one 
evening, they produced evident amendment by next morning. In an- 
other case a boy, aged nineteen, had been under treatment several ERYSIPELAS. 
679 
days; “the disease was still extending its ravages, and the cerebral 
symptoms were particularly ominous.” Arsen, and Bhus-rad. were 
used internally, and the same (twenty drops of the tincture to a pint 
of water,) locally applied ; “ an impression was made on the disease 
within twenty-four hours, and the patient rapidly convalesced.” 
Belladonna.—External Indications.—Skin swollen, red, hot, and 
painful; cheeks, eyelids, nose, lips, and forehead, swollen, tense, shin 
ing and painful to the touch; eyes red, prominent, and glistening, or 
dull and cloud}7; pupils dilated or contracted; whole head swollen and 
painful; obstruction of the nostrils; inflammation and enlargement of 
the parotid glands; hardness of hearing; redness and swelling of the 
tonsils and throat; urine scanty, dark, yellow, or reddish, clear or tur- 
bid ; vesicular inflammation, with intense febrile excitement; tongue 
and lips dry; sordes upon the teeth; occasionally spasms, tremblings 
and rigidity of the limbs; pulse generally full and quick. 
Physical Sensations.—Tension and pressure, or sharp, throbbing 
pains in the head; scalp very painful, especially on pressure ; violent 
heat and burning of the inflamed parts; dryness, smarting, or burning 
of the eyes; disordered vision; stitching and throbbing pains in the 
ears, both externally and internally; roaring and humming in the ears, 
mouth, and throat, dry, hot, and painful; sticking and burning sensa- 
tion in the throat when swallowing; aversion to food and drinks, or 
violent thirst for cold drinks; bad taste in the mouth, bitter eructations, 
and other signs showing biliary and gastric derangement; short, 
anxious, and difficult inspirations; great weariness and uneasiness; 
pains worse in the afternoon and at night, and aggravated by contact 
or movement. 
Mental and Moral Symptoms.—Vertigo, confusion of ideas, or 
loss of consciousness, or delirium, violent at night, but moderate during 
the day; or melancholy, despondent, and apathetic. 
Administration.—A drop of the third dilution in water every two 
or three hours, according to the severity of the symptoms. 
Remarks.—It was chiefly from the employment of Belladonna and 
Aconite that Liston produced the successful results in the North Lon- 
don Hospital, and in private practice, to which we have already alluded. 
It is applicable when we believe it to have been excited by intemperance 
and violent emotions of the mind. Also in nearly all cases of erysi- 
pelas where there exists prominent cerebral disorder. In these cases, 
should it not cover all the important symptoms, we may give some 
other appropriate medicine in alternation. 
Whenever febrile symptoms are strongly pronounced, and there 
exists a decidedly augmented action of the circulatory vessels, Aconite 
will be required, either alone or in alternation with some other remedy. 680 
DISEASES OF THE SANGUINOUS FUNCTION. 
It should be used in the first, second, or third dilutions—a drop in 
water as often as the exigencies of the case may demand. 
Opium is indicated in those cases which supervene during pneu- 
monia,, typhoid, and other fevers, and present the following signs: pro- 
found coma ; stertorous respiration ; eyes dull and watery; pupils dilated 
and immovable; general appearance stupid and besotted; spasmodic 
motions in different parts of the body; pulse slow and feeble, or slow, 
intermittent and full; inability to rouse the patient. The second or 
third dilution may be employed—a drop every half hour until an 
impression is produced. 
When ulcers have formed, and there is a disposition to gangrenous 
degeneration, we must refer to Arsen., Carb.-veg., Sulph., Lachesis, 
Euphorb., Sil., Clematis, Acid-nitr., and Acid-phos. 
In erysipelas phlegmonodes, when the inflammation is extending into 
the cellular tissue, our best remedies are Bell., Graph., Hepar-sul., 
Merc., Phos., Sil. and Sulph. 
If the inflammation exhibits a tendency to shift from place to place, 
and is attended with gastric or intestinal derangement, and constantly 
shifting pains, Pulsatilla will prove specific. 
Bryonia has been strongly recommended when the inflammation 
takes place about the joints, and is accompanied by rheumatic pains. 
China will often prove serviceable during convalescence from severe 
and protracted attacks, when the energies of the system have been ex- 
hausted, and there is great irritability of the nervous system. Some 
of the signs which point to this medicine, are emaciation, oedema of 
the limbs, deficiency of the animal heat, pale countenance, great de- 
bility, ringing in the ears, disturbed sleep. 
Tartar-emetic*—In bilious erysipelas, or in the form that originates 
in strongly marked gastric disorder, Tartar-emetic often diminishes 
the inflammation, increases the perspiration and urine. Dr. Welsh 
thinks it acts specifically on erysipelas of every form, whether of high 
inflammation, low fever, vomiting or purging. It does not appear, how- 
ever, to be so generally useful as Rhus and Bell. It succeeds best in 
cases accompanied with constant nausea, bilious vomiting, watery or 
brownish diarrhoea, cold sweats and great prostration of the vital 
forces. 
External applications to the affected surfaces, in the form of blis- 
ters, and of nitrate of silver, have sometimes been supplied with 
success ; though they are in accordance with our principle of cure, it be- 
comes us to give them attention only as subordinate to internal remedies, 
M. Velpeau, of Paris, says, he treated one thousand cases of erysi- 
pelas and recorded the history of four hundred of them. He relied 
only on external remedies, some of these were: blisters, nitrate of sil- 
ver, Mercurial-ointment, hog’s lard, white precipitate ointment, Sul- BRAIN AND NERVOUS SYSTEM. 
681 
phuric-acid, Hydrochloric, Citric, Tartaric, and dilute Acetous-acid; 
common salt and water, liquid Nitrate of Mercury, bird-peck punctures, 
and Camphor; and found no benefit from any of them. He then re- 
nounced them all in despair, till he came to think the disease might 
consist in a blood poison, to be corrected by iron. He tried nine drops 
of the Sulph.-ferri in forty ounces of water. He found that this, when lo- 
cally applied cured the disease where it existed, but would not prevent 
its spreading. 
Carbonate of Lead.—This is far superior to the common lead lotions, 
hot fomentations, Nitrate of Silver, Collodion. After painting the skin 
with white lead paint, the tight shining skin soon becomes wrinkled 
and shrunken; the inflammation rarely extends after the second or 
third painting. Apply it by means of a feather over the affected part, 
and a little beyond the margin. But no local treatment must be de- 
pended on in any form of erysipelas. Rhus and Belladonna are the 
true specifics. Let them be given alternately, followed by Rhus in 
vesicular cases. 
Respecting the administration of the remedies above enumerated, 
we suggest, as a general rule, the employment of first, second, and 
third attenuations ; but in cases of infants and young children, we may 
go up to the tenth, or twelfth dilution. In acute cases, the dose should 
be repeated once in two to four hours ; but in the chronic varieties, 
two or three times daily will suffice. 
Acetum.—Cleghorn, a brewer of Edinburgh, recommended the ap- 
plication of vinegar to burnt surfaces, continuing it till the pain 
abated. The eschars to be covered with poultices, and afterwards 
sprinkled with finely pulverized chalk. 
DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 
General Observations.—If the soul of man manifests itself through 
the healthy organism in a certain definite manner, and if these mani- 
festations are modified precisely in accordance with the abnormal con- 
ditions which the organs and tissues may acquire, the importance of a 
correct understanding of the exact healthy functions of all the struc- 
tures, and of their alterations during disease, will be truly appreciated. 
Unfortunately for science, the profusion of hypotheses, the arbitrary 
assumption of ancient ideas for facts, as well as the inherent difficul- 
ties attending the pathology of diseases of the cerebro-spinal system, 
have until recently retarded the onward progress relative to their na- 
ture and treatment, until Sir Charles Bell demonstrated that the 
nerves which arise from the posterior column of the spinal marrow 
were devoted to sensation ’ those of the anterior column to muscular 
contraction ; while the middle column gives origin to the respiratory 682 
DISEASES OF THE SANGUINOUS FUNCTION. 
'nerves, the most erroneous and contradictory notions were entertained 
respecting the functions of the nervous system. 
Magendie, Flourens, Abercrombie, Hall, Solly, Serres, Bennett, and 
Andral have also thrown much light upon the functions of particular 
portions of the brain, but much remains to be done in this important 
field of discovery. And it is only by banishing from our medical voca- 
bulary all vague and obscure expressions, and contemplating the body 
as a complicated machine, actuated and kept in operation by an in- 
telligence that pervades every part, and in conjunction with its ma- 
terial stimuli, giving rise to sight in the organ of sight,—hearing, taste, 
smell, digestion, assimilation, calorification, motion, &c., in their several 
organs,—and perceptions, memory, comparisons and ratiocination, by 
their operation upon a combination of organs, that we can arrive at 
accurate conclusions. 
The cerebral organs may be affected throughout their whole extent, 
or in isolated parts alone; but whatever condition obtains, diseases of 
certain sections of the brain usually give rise to peculiar and well de- 
fined symptoms. Thus, compression of the brain, whether from effused 
blood, serum or pus, depression of a portion of the cranium, or a con- 
gested and relaxed condition of the cerebral vessels, give rise to coma, 
with slow pulse and stertorous respiration; organic lesions of the 
brain, to paralysis of one or more parts of the body, depending upon 
the extent of the lesion and the part affected; irritation of the brain 
to convulsions; disease of the cortical substance or hemispherical 
ganglia, to delirium and 7nania / of the medullary or tubular struc- 
ture, to convulsions / effusion within the ventricles, to dementia / 
effusion upon the surface of the brain, to lethargy / inflammation of 
either lateral lobe of the cerebellum, to paralysis of the lower ex- 
tremity of the opposite side ‘ inflammation of the middle lobe to saty- 
riasis (Hall,) of the arachnoid and pia mater, to delirium/ ramollis- 
sement, to torpor of the intellectual faculties and loss of muscular 
power. 
So strongly marked are these signs, that pathologists have made 
somewhat minute classifications of the diseases of the brain, as of the 
arachnoidof the pia-mater, of the cortical, or the medullary part, 
the base, the tuber-annulare, the hemispheres, and the cerebellum.— 
But it is to be observed in most cerebral affections, that inflamma- 
tions of particular structures rarely exist uncomplicated with more or 
less disease of the surrounding parts, and on this account we meet 
with a great diversity of symptoms during their progress. For this 
reason, if no other, it is more consistent to prescribe for the totality 
of the symptoms than for the mere name of the disease. By the former 
course we pursue a definite object and apply our remedies with an as- 
surance of success, even if we are in error respecting the pathology BRAIN AND NERVOUS SYSTEM. 
683 
of the case ; while by the latter method, we are liable to mistake the 
location and nature of the malady, and thus adopt a pernicious mode 
ot practice. For example, by mistaking the cerebral symptoms of a 
typhus fever for encephalitis, or the ancernic condition of the brain 
which obtains in true delirium tremens, in some cases of apoplexy, in 
epilepsy, and in ramollissement, for acute inflammation, and resort- 
ing to the old remedies for the cure of the latter, viz: copious vene- 
sections, the most disastrous results might be apprehended. It is now 
a well-ascertained fact, that delirium, coma, hydrocephalus, and even 
ramollissement, may result from an anaemic, as well as an m/awma- 
tory condition of the brain. Drs. Abercrombie and Marshall Hall recog- 
nize still another comatose condition independent of disease of the brain, 
and arising from exhaustion of the general system, occurring during 
the last stages of certain diseases; but from the fact that this coma 
generally occurs after prostrated bowel complaints where Opium has 
been used as the principal remedy, we are of opinion that a real cere- 
bral disease has been superinduced by the remedy. 
For the cure of the symptoms above named, arising from an anaemic 
condition of the brain, tonics, stimulants, and a nutritious regimen are 
leemed essential by the practitioners of the old school. Blood-let- 
ting and antiphlogistics in these cases are fatal. But when the 
same symptoms arise from an inflammatory condition of the ence- 
phalon, a treatment directly the reverse is supposed to be necessary 
to save life, like venesection, leeching, purging, blisters, &c. Now, 
when we contemplate the great uncertainty attending the diagnosis in 
these two forms of disease, and the danger which must attend mis- 
takes in treatment originating from errors, respecting the peculiar con- 
dition of the brain, is it strange that people have no more confidence 
in allopathy ? 
We have before remarked, that morbific substances, in order to de- 
velop diseased action in the organism, must be taken into the blood and 
conveyed to those tissues upon which they exert a specific morbific 
influence, there producing those alterations, (probably upon the sen- 
tient extremities of the nerves,) which constitute disease. It is only 
necessary to refer to the examples to which we have alluded in an- 
other part of this work to render this supposition entirely probable. 
It is also equally evident, from the multitude of experiments by 
Muller, Magendie, Orfila, Pereira, Hahnemann, Trinks, Philips, Flou- 
rens, and Bichat, that poisonous drugs and all medicinal substances 
operate in the same manner in producing their specific poisonous or 
medicinal effects. 
There are other causes constantly operating upon the system, of a 
character entirely different from those to which allusion has just been 
made, and which may with propriety be termed spiritual or dynamic. 684 
DISEASES OF THE SANGUINOUS FUNCTION. 
Thus violent mental disturbance may cause epilepsy or apoplexy— 
chagrin and grief, biliary derangements, jaundice, and dyspepsia,— 
sudden news, whether good or bad, diarrhoea,—anger, fear, disappoint- 
ment, and ill news, sometimes instantly destroy the appetite; fear and 
apprehension predispose to contagious disorders; the sight of blood 
induces syncope ; and of human suffering, pain and disorder in the 
stomach. In these cases, the unusual mental excitement determines an 
unnatural amount of blood to certain parts, the blood-vessels and nerves 
of such parts are oppressed, and disease results. 
But it is of vast importance that these spiritual or dynamic causes 
be not confounded with those that are merely material, or those mani- 
festations of the physical usually designated as imponderable. 
Although cerebral affections may arise under favoring circumstances, 
from the absorption of morbific and medicinal substances, and from 
spiritual or dynamic influences, yet the latter rank first in importance, 
especially in what are termed chronic cerebral maladies. In the 
treatment of brain diseases, therefore, too much importance cannot be 
attached to an accurate knowledge of these causes; for it is only by 
their prompt removal, together with a judicious application of remedial 
agents, that we can expect complete success. 
The curious reader will find much to amuse, if not instruct, by 
tracing the medical history of cerebral maladies from Hippocrates to 
the present time. Throughout all of this period, notwithstanding the 
numerous changes of opinion respecting their nature, causes, &c., one 
striking fact will always be observed, viz.: that the treatment for all of 
these complaints has remained almost the same as that first instituted by 
the very respectable heathen philosopher, Hippocrates, until the time 
of Hahnemann. 
Up to the time of Sydenham no advance in the knowledge of cerebral 
affections had been made. This celebrated author supposed the cause 
of many brain diseases, as lethargy, coma, paralysis, &c., to consist in a 
u viscid condition of the blood and lymph, which obstructed the pores 
of the brain, and dulled the animal spirits. While the viscid blood 
forces its way into the brain, through the two carotids, it leaves in 
its passage a slimy m atter, through which the animal spirits pass- 
ing, stick by the way, and so the pores of the brain are obstructed 
{Sydenham and Salmon, Pract. Phys., p. 203.) 
Their indications of cure were: First, “ to evacuate the redundancy 
of phlegm and choler, or to carry off that vicious acid which has 
created the viscosity of the blood. Second, to altei the present dys- 
crasia of the blood. Third, to open the pores of the brain now ob- 
structed, and give a free passage to the spirits. Fourth, to strengthen 
the weakened parts, quicken the dull spirits, and increase their store 
01 stock” {ibid.) BRAIN AND NERVOUS SYSTEM. 
685 
To fulfill these indications of cure the fathers of allopathy adopted 
almost precisely the same treatment as that which prevails with their 
brethren of the present day, viz.: blood-letting, emetics, cathartics, “ to 
purge off the phlegm and eholer.” Antimonials and alteratives “ to 
cut up the gross phlegm,, dissolve the coagulums of the blood and 
humors, and excite the animal spirits to a brisker and morre lively 
air.'1'1 Paracelsus and Yan Helmont particularly commended opiates 
and narcotics in chronic affections of the brain. If Ave refer to the 
most recent Avriters on insanity and other cerebral affections, we shall 
find not only the same remedies retained, hut the same diversity of 
opinions respecting the application of these remedies ; some trusting to 
venesection and purges, some to tonics, while others depend upon 
opiates and narcotics. 
In a book which is noAV before us, published in 1587 by “ AndreAv 
Boord, Doctor of Physic—an Englishman,” the opinion is given that 
maniacs are possessed of devils, and he advises for their cure, in addition 
to blood-letting, cathartics, &c., that they should be sent to Rome to 
be made whole. He says that “ Avithin the precincts of St. Peter’s 
church, without St. Peter’s chapel, standeth a pillar of white marble, 
grated round about with ironthat this pillar is one to which our 
Lord “ did lie in himself at his delivery unto Pontius Pilate; and that 
the Romans say that all persons possessed of the devil from divers 
countries” who were brought thither “ were made whole.” 
The same Avriter supposes the cause of phrenitis to consist of “water 
or Avind enclosed in the headand the remedies were “ to purge the 
head with sternutatories and the bowels with physic.” 
Modern pathologists do not attribute mania to demoniacal possession, 
or phrenitis to “ wind being enclosed in the head—coma, lethargy and 
paralysis are not supposed to be caused by “viscid blood rushing into 
the brain through the two carotids, and leaving in its passage a slimy 
matter, through which the animal spirits passing, stick by the way,” 
hut they ha\Te demonstrated that inflammation, irritation, organic 
lesion, and compression give rise to the phenomena which characterize 
the different diseases of the brain. But, notwithstanding this change 
of opinion in a pathological point of view, the therapeutical doctrines 
remain the same as formerly, with the single exception of advising ma- 
niacs to be sent to the marble pillar at Rome. 
Blood-letting, probably to let out the “ slimy” part of the blood; 
emetics and purgatives to “ purge off the phlegm and eholerirritating 
and inflaming the intestinal canal in order to cure a disease located in 
the brain, and now and then an opiate to cover up symptoms when too 
troublesome, are still resorted to by gentlemen of the old school. 
It is to be hoped that the time is not far distant when all such indi- 
rect and unreasonable practices for the cure of diseases, will be entirely 686 
DISEASES OF THE SANGUTNOUS FUNCTION. 
superseded by the more direct and philosophical method of treat- 
ment which has been instituted by the father of homoeopathy and his 
disciples. 
Probably in no class of maladies has allopathy been so much at 
fault as in her classification of cerebral affections. Each author who 
has written upon the subject, has taken upon himself to promulgate 
pathological views different from those of his predecessors, and from 
these views to form new classifications and new modes of treatment. 
While some nosologists recognize inflammation of the arachnoid, of the 
pia mater, of the cineritious or cortical substance, of the medullary, or 
tubular structure, of the different lobes of the cerebellum, of the tuber 
annulare, &c., as distinct diseases requiring different modes of treat- 
ment ; others, as Frank, describe inflammation of the hemispheres of 
the brain, the cerebellum, and their common envelops, as a single dis- 
ease under the general term, encephalitis, and demanding for its cure 
a definite course of treatment. Thus : “ IIinflammation du cerveau, 
du cervelet, de leur enveloppes communes ne presente pas, selon la 
difference de son siege, des symptomes distinctifs surs et constants.” 
So also Solly in his work on the human brain at page 322 remarks, 
“ I have long felt convinced that there is no such thing as inflammation 
of the pia mater, independent of the brain, and that much mischief has 
accrued from our systematic writers treating of inflammation of the 
membranes of the brain as distinct from inflammation of the brain it- 
self.” The same writer lays down the following broad principles, viz.: 
“ That inflammation of the brain is a depressing disease, and that, as a 
.general rule, general blood-letting is not often admissible. That, al- 
though, blood-letting may sometimes be attended with relief, at the same 
time, the good derived from it is seldom permanent.” Again,11II riiexiste 
j)as de signes certains qui annoncent le siege de l’encephalite, qui 
caracterisent la phlogose superficielle et l’inflammation phlegmoneuse 
avec tendance a la suppuration. Ces varietes n’offrent pas des carac- 
teres differentiels assez constants pour distinguer la frenesie de la 
cephalite. L’invasion soubite de la douleur, la violence de la fievre la 
stupeur des organes des sens et de l’entendement, bientot suive de 
l’extinction de leurs fhcutes, ne prouvent pas l’inflammation de la pulpe 
cerebrale.” (Frank.) 
In view of these radical differences of opinion, and from the gene- 
rally acknowledged fact, that no single structure within the cranium can 
become inflamed without involving to a greater or less extent other 
portions of the cerebral region, we shall adopt the following classi- 
fication : 
A. Injuries and transient diseases of the brain. 
I>. Encephalitis, embracing acute inflammation of the hemispheres, 
the cerebellum and tbeir membranes; under which head we shall point CONCUSSION OF THE BRAIN. 
687 
out, as clearly as possible, the peculiar symptoms which are supposed 
to characterize affections of the different parts. 
C. The diseases which occasionally result from encephalitis, as ra* 
mollissement and hydrocephalus. 
Genus III.—INJURIES AND TRANSIENT AFFECTIONS OF THE 
BRAIN. 
1. CONCUSSION OF THE BRAIN. 
Pathology.—In concussion of die brain, as soon as the blow 
which strikes the skull has caused the symptoms of concussion, 
the physical disturbance of the brain, whatever it may be, has been 
produced, and the continuance of the symptoms must depend on the 
continuance of the structural or molecular disturbance. But the actual 
condition of the brain is not known, and has received no explanation. 
Symptoms.—The patient who in a state of perfect health receives a 
violent blow on the head in an instant loses his consciousness, and lies 
dead to the world around him. In some cases this insensibility lasts 
only a few minutes, in others for days : the patient remaining in a kind 
of sleep insensible to ordinary stimuli. He may perceive an extra- 
ordinary bright light, or may take some notice of his name loudly called 
near him; but ordinary noises he does not notice. As he recovers, he 
begins to answer questions, but incoherently. These symptoms dis- 
appear by degrees, after lasting from some days to as many weeks. 
The pathological condition of the brain in a state of concussion has 
been little understood. It can hardly be that a long continuance of 
the usual symptoms of concussion can be caused by any temporary 
disturbance of the vascular system of the brain. It is more probable 
that they “depend upon something more intimately associated with the 
structure of the brain itself. The most appropriate physiological term 
for concussion of the brain is, perhaps, 1 collapse’ or ‘ shock” and 
“that the function of the part is rendered very imperfect, is evident by 
the insensibility of the bruised skin, and its coldness or diminished 
temperature.” {Ililton) 
If inflammation supervene, another group of symptoms follows. This 
inflammation is rather of the substance and lining membrane of the 
ventricles than of the cortical substance, and all the symptoms are 
decided and clear from the first; but often the effect of the concus- 
sion passes over quickly and the patient is considered out of danger; 
but after a few days, meningitis supervenes in such a form as to be 
overlooked by the friends. 
A boy, aged fourteen, fell from a scaffold seventy feet, first striking 
the lower part of the abdomen and afterwards the head; was seen in a 688 
DISEASES OF THE SANGUINOUS FUNCTION. 
few minutes afterwards. He was pale, cold, insensible, and almost 
pulseless. Received at the hospital he was partially sensible only; 
he became wildly delirious. The pulse rising to 100, then to 144, 
afterwards falling to 100. It must ever be kept in mind that when once 
the delicate texture of the ganglion is in a state of acute inflammation, 
it soon becomes disorganized, and all medical treatment is un- 
availing. 
Treatment.—As in external bruises and shocks to parts of the sur- 
face, we rely chiefly on rest, giving the best opportunity for the favor- 
able employment of nature’s own efforts, the same means are our best 
reliance in concussions of the brain. “ Give the brain absolute rest; 
rely on nature’s reaction,” only aiding it by such homoeopathic remedies 
as have been proved to have power to aid the reactive powers of nature. 
One system long ago tried consisted in depletion, which has been now 
fully abandoned; another equally bad, more recently in fashion con- 
sists in “hurrying on reaction by excessive stimulation with brandy or 
ammonia.” The brain which has been violently shocked by concussion 
is “ defective, if not in structure, certainly in its vital endowments, and is 
therefore unequal to its ordinary duties. It recovers itself slowly; it 
then soon becomes fatigued from use,” over-stimulations lead to in- 
flammation. 
The brain requires absolute rest, absence of occupation, for its com- 
plete recovery; as external parts that have suffered from severe con 
tusion and have apparently recovered from the immediate effect, if too 
early or too much used, will become painful and assume a chronic in 
flammatory condition resulting in local thickening or ulceration, so the 
brain, though it may not manifest its disturbance by pain, is still more 
liable to go into some more serious condition of disease from excite- 
ment, stimulation or want of due rest. 
Many of the chronic affections of the brain we meet with in practice 
are the result of concussion, perhaps trifling, as, a transient shake of 
the brain, slight or severe blows, or a fall upon the head. The im- 
mediate effects of the shock having passed off quickly, may have al- 
most been forgotten. A sudden bound or recoil of the brain may in- 
stantly follow a railway collision, and may produce only a temporary 
confusion of thought to be remembered for a short time only. But we 
often hear of sudden deaths following at a long interval after a concus- 
sion of the brain. We may then consider that the brain that has been 
subjected to concussion or bruising, is not necessarily injured to the 
extent of laceration or extravasation of blood, but as having suffered 
molecular disturbance in its exquisitely delicate structure, this struc- 
ture having a function belonging to it which requires molecular per- 
fection to enable its fine endowments to be made manifest Now, since 
we know that other parts of coarser texture require weeks or even CONCUSSION OF TIIE BRAIN. 
689 
months of rest after injuries before their functions can be fully per- 
formed, we must not deny to the delicate texture of the brain a period 
of rest as long or longer before we again impose upon it the perform- 
ance of its ordinary functions. Rest is the chief nurse employed by 
nature in restoring to health the body after injuries. 
Causes.—A blow on the head, a fall, or a violent shaking of the body, 
when the violence is not very severe there will be some mental dis- 
order, vertigo, dimness of vision, trembling of the limbs, sickness of 
stomach. 
Symptoms of more severe Cases.—The accident is immediately 
followed by insensibility, relaxation of the extremities, coldness of the 
skin, feebleness and irregularity of pulse, difficulty of breathing, dila- 
tation of the pupil, sometimes nausea and vomiting; breathing, though 
weak and laborious, usually free from stertor or snoring. These symp- 
toms are followed by gradual return of warmth of the body, the breath- 
ing more natural, the pulse rises, sensibility is partially restored, the 
patient is capable of being roused out of sleep or lethargy in which 
he was found, and can answer questions concerning his injury. 
When the stupor and other primary symptoms have passed away, 
inflammation of the brain of an active character begins to be deve- 
loped ; and, if not arrested, it proceeds to a termination in effusion. 
Concussion of other parts of the body may injure the brain * 
sometimes internal parts are distended or torn; pains arise which in- 
crease the following day; violent headache, giddiness, pains in the 
chest, asthma, hacking cough, spitting of blood, pain in the back, pains 
in the abdomen are common symptoms. 
Treatment.—As soon as reaction has taken place after the injury, 
the circulation will become accelerated, and symptoms of approaching 
inflammation will obtain. The more common phenomena of this re- 
active stage are, headache, more or less mental perversion, flushed 
face, hot head, and moderate febrile symptoms. For this condition, 
Belladonna, first dilution in wrater, is the appropriate remedy. 
Should the fever become quite active, a few doses of Aconite may 
be administered. 
For other effects of concussions of the brain we suggest the follow- 
ing medicines as likely to be required: Calendula, Stramonium, Can- 
nabis-ind., Rhus-tox., Opium, Hyosciamus. 
Arnica is the chief remedy. The patient should keep quiet, drink 
plenty of water; wash the parts bruised with cold water containing a 
few drops of Arnica. Allow the simplest food, no stimulants, spices, 
salt or acids. 
2. Inflammation from Inf try of the Brain.—After injuries of the 
head the membranes are liable to become inflamed. The symptoms 
are nearly the same as those of inflammation of the brain itself: great 
Vox,. I.—44. 690 
diseases of the sanguinous function. 
pain; the scalp becomes oedematous; the edges of the wound become 
glossy, or shining; there is discharge of serum and blood; sometimes 
the parts have a sloughy appearance; the countenance is much flushed; 
the carotid arteries beat with great force; frequent rigors, sometimes 
followed by hemiplegia; and the patient quickly becomes comatose. 
The inflammation of the brain or its membranes does not generally be- 
gin immediately after the injury. Sometimes a week or two elapse 
before it attracts attention. When the dura mater alone is wounded, 
there is generally a high degree of inflammation; when it and the pia 
mater are injured, there is generally fungus cerebri, and the consequent 
inflammation is less severe. 
Treatment.—The first question that arises in the mind of the sur- 
geon is the necessity of an operation to remove or elevate depressed or 
broken fragments of bone. The circumstances which render trej)hin- 
ing necessary are: 1. When there is extravasation of blood between 
the dura mater and the cranium; 2. In compound fracture, when a 
portion of the skull is depressed, with symptoms of compression of the 
brain; 3. In simple fracture, with depression of bone, when symptoms 
of compression continue after depletion and early efforts to remove it 
have failed; 4. In some cases when there is purulent matter collected 
between the dura mater and cranium. 
In the early part of this century it was the practice to trepan and 
raise the bone wherever there was suspicion that it was depressed; more 
recently these cases have been treated very differently. Abernethy 
published some cases that recovered without trephining, that would 
have needed it, according to the old rule. Lawrence, in a lecture, 
(Medical Gazette, Yol. 21, p. 345,) gave a case of a boy who recovered 
without an operation, in whom the skull was fractured and depressed, 
the brain wounded, and portions of it extravasated through the lacera- 
tion of the scalp. 
The medical treatment is the same as that of inflammation of the 
brain. 
Fungus Cerebri.—After injury of the brain, accompanied by removal 
of a small portion of the cranium, there often arises a fungous excres- 
cent growth from the substance of the brain, which grows luxuriantly 
and presses outward through the aperture of the skull. 
Treatment.—Its growth must be prevented or repressed as soon as 
it is discovered, and the growth restrained until the dura mater covers 
it. Wet a piece of lint with Aqua-calcis and apply it to the fungus 
with adhesive plaster placed over it. Next day the fungus will be 
lessened. Take now a large piece of lint, and strap it as before with 
adhesive plaster, to compress slightly the protruding growth. Continue 
this process till the fungus is restrained within the dura mater, where 
it must be steadily maintained until the membrane heals over it. FULLNESS OF BLOOD TO THE HEAD. 
691 
Apparent Death from a Fall.—Place the patient carefully on a 
bed, with the head elevated, and put a few globules of Arnica dissolved 
in water upon his tongue. The old practice of bleeding is highly in- 
jurious, though the drawing of a minute quantity of blood may accele- 
rate restoration. The Arnica may be repeated at short intervals till 
there are signs of life. If he partially recovers after any quantity of 
blood has been drawn, or if he have lost blood from the injury, give 
China, a few drops of wine at a time, and afterwards Arnica. 
3. Fullness of Blood to the Head.—Symptoms.—Great heat of head; 
flushes of heat; sensation of fullness in the head; confusion in the 
head; loss of memory; vertigo; noise in the ears ; deafness ; spots before 
the eyes; oppression at the chest; faintness; constipation generally 
present; numbness of the extremities also. 
Pathology.—There could be little seen by inspection of the brain 
in this state. “ A little extra pressure on the brain from increased 
heart’s action, or the reverse; a delay of blood in the vessels; a sort 
of atonic congestion ; an over-distention or an exsanguinated state, so 
well represented in Dr. Burrow’s plate, representing the brain of an 
animal dead from haemorrhage ; an impoverished state of the blood” 
may any of them produce similar conditions. 
Exciting Causes.—1. Disease of the Heart.—This organ may be 
feeble, hypertrophied, be in a state of “ fatty degeneration,”* or other- 
wise structurally diseased. This is one of the most common causes of 
apoplexy. 
2. Debility, from naturally feeble physical development, or from 
recent illness, haemorrhages following labor, profuse menstruation, 
haemorrhoids. 
3. Indigestion gives rise to faintness, vertigo and congestive head- 
aches. 
4. Mental labor causes many forms of headache, amongst others 
congestive spots before the eyes, vertigo, confusion of sight, inability 
to think, and in some cases to paralysis, which when not gone too far 
may be averted by relaxing mental efforts. 
5. A diseased state of the brain or vessels. 
6. Irregularity in eating and drinking; swallowing the food without 
properly masticating it, or not allowing sufficient time for meals; fast- 
ing too long, as men in offices too often do. The habit of taking 
stimulants. 
7. Suppression of natural discharges, drying up of old sores, the 
sudden recession of eruptive disease of the skin, particularly after ex- 
ternal lotions or unguents have been applied. 
* Drury, British Homoeop Soc. Annals, No. 2. 692 
DISEASES OF THE SANGUINOCS FUNCTION. 
Treatment.—Aconite.—The arteries of the head are felt to throb 
as the pulse beats ; the veins of the head and neck swell; the head 
feels full; the patient feels dizzy, especially when stooping or walk- 
ing in the sun; feels as if the head over the eyes would burst; worse 
when stooping or coughing. There is sparkling, flickering before the 
eyes ; seeing double, buzzing in the ears, frequent fainting, stunning, 
heavy sleep. Cold applications are also •beneficial. Abstain from 
coffee, wine, and ardent spirits ; drink freely of cold water, and wash the 
head and neck frequently with it. 
Nux-vomica.— Aconite has been tried, with little benefit; the pa- 
tient is very irritable and passionate ; has been much constipated; is 
of sedentary habits, and uses ardent spirits. 
4. Coup de Soleil, Sun-Stroke.—Aconite is generally sufficient to 
correct the effect of direct exposure to the sun. A dose every fifteen 
minutes till better ; or, in alternation with Bell. 
Belladonna.—Severe jerking, burning, shooting pains on one side 
of the head, or violent pressure in the forehead, increased by motion, 
stooping, noise, or a glare of light. It follows Aconite well in children 
teething, amenorrhcea in young females, and generally where there is 
febrile excitement, with determination of blood to the brain. The head 
feels full, and aches as if it would split; worse when stooping or walk- 
ing, or from slight agitation of mind ; hot fever, thirst, restlessness, 
anxiety, rage or great irritation, fear of surrounding objects, lamenta- 
tion, weeping. 
Bryonia.—The patient is very peevish in the morning, cannot bear 
his clothes, is more passionate and cross than plaintive and despond- 
ing, is apprehensive of future evil; heat from great exertion, heat of 
the sun or a hot fire ; head too full, loss of appetite, especially in the 
morning; thirst, fever, trembling, nausea, vomiting, or diarrhoea. 
Carbo-veg.—Headache and heaviness from overheating ; heaviness, 
throbbing, and pressure over the eyes, pains in the eyes, aggravated 
by looking fixedly at any object. 
Glonoine.—Dr. Wm. Payne, of Maine,* refers to three cases re- 
ported by Dr. John Fox in the Phila. Jour, of Homceop., Vol. III., 
p. 856, in which is shown the prompt action of this remedy over this 
fearful and hitherto unmanageable disease. It is believed that Glo- 
noine, or Nitro-glycerine, is homoeopathic to such diseases only as have 
their origin in the brain, and which exhibit primary and consecutive 
symptoms similar to those produced by the drug in the healthy organ- 
ism.” 
“ The primary impression of the Glonoine is upon the cerebrospinal 
organs. The pain, dizziness, whirling, pressure, throbbing, fullness 
* Proceedings of the 17th Annual Meeting of the Amer. Inst, of Homoeop, COUP DE SOLEIL. 
693 
confusion of ideas, shocks, undulation, sensation of balancing, impaired 
sight and hearing, &c., all point to the encephalic mass as the seat of 
the primary impression ; whilst the rapid varying of the pulse, throb- 
bing of the carotids, diminished appetite, deathlike sinking at the epi- 
gastrium, nausea and vomiting, muscular trembling, spasms, weakness, 
&c., as strongly indicate the consecutive effects of the drug upon other 
organs through the great sympathetic. 
“ All the provings of this drug, that have come under my own obser- 
vation, point directly to the nerve-mass as the seat of attack.” In all 
but two of the twenty-six observations published in the British Jour- 
nal of Homoeopathy, by Dr. Dudgeon, on the pathogenesy of G-lonoine, 
we find the first development of symptoms in the encephalic mass. 
“ The throbbing headache has been first exhibited in nearly every 
prover.” “ The character of the headache shows that its origin is in 
the encephalic mass, and not in a remote organ or tissue. A Glonoine 
headache is throbbing, with fullness and upward pressure, and a sensa- 
tion as if a ligature were drawn tightly around the neck; and there is 
often connected wTith the above symptoms disturbance of the circula- 
tion, throbbing of the carotids, rapidity of pulse, palpitation of the 
heart, nausea, perhaps vomiting ; but these latter symptoms seem to be 
consecutive effects, indicating a more general implication of the organ- 
ism. They occur after the throbbing headache, or the lightness and 
dizziness of the head which precede the throbbing headache.” In 
cases in which we find the symptoms developed in the order above 
given we may administer Glonoine with implicit confidence. In no 
other form of palpitation of the heart, in no idiopathic affection of the 
stomach, indicated by deathlike sinking, or nausea and vomiting; in no 
case of disturbed circulation, dependent on a primary affection of the 
circulatory system, or any tissue other than the nerve-mass, do we re- 
gard it as homoeopathic. 
Dr. Colby, of Concord, New-Hampshire, took (June 17, 1856, at ten 
a. m.,) two drops of the first decimal dilution. First and immediate 
effect, confusion of ideas and loss of strength. Sight and hearing both 
affected, indistinct. Fullness and pressure in forepart and top of head, 
with throbbing, pulsation, and confusion of all the senses. Sensation 
of balancing, requiring a constant effort to keep the head erect, which 
inclined to drop as on going to sleep ; undulating sensation, increased 
by every turn of the head. Sick, faint, deathlike sinking at the epigas- 
trium, with nausea, such as results from excessive dizziness, induced 
by rapid whirling of the body. Great weakness in middle portions of 
the thighs and arms. All the symptoms continued two hours without 
abatement, when the inhalation of Camphor seemed to mitigate some 
of the symptoms, but the more prominent ones remained uninfluenced. 
At the expiration of four hours fullness and throbbing of head con- 694 
DISEASES OF THE SANGUINOU8 FUNCTION. 
tinued unabated, together with dull headache, which appeared rather 
to increase till retiring for the night. Awoke on the following morn- 
ing with the same fullness and throbbing, which occupied the whole 
forepart of the head, and appeared to be deep-seated.” 
Spheke of Action.—Meyer says,* Glonoine attacks first the organ 
of circulation—the heart. The symptoms are : painful feeling of 
fullness and constriction in the cardiac region, which sometimes ex- 
tends to the throat, and simultaneously with which the pulse decreases 
in frequency. Soon after this comes a feeling of heat in the heart, as 
the spasmodic constriction subsides ; its activity is increased, the im- 
pulse of the heart is perceived by means of the stethoscope to be loud, 
stronger, and irregular. This increased force of circulation is ob- 
served in all the larger arteries ; and the jugular veins are sensibly 
distended; pulse increases rapidly in frequency and fullness (some- 
times from sixty beats to one hundred and twenty per minute), some- 
times irregular or intermittent; feeling of anxiety and restlessness. 
Painful sensations in the heart; sharp pains extending through to 
the supra-scapular muscle. 
Congestion of the brain follows soon on the vascular excitement; 
fullness and heaviness of the head as if from weight, extending as far 
as the eyes and ears; then comes a feeling as if all the blood of the 
body had ascended to the head ; constriction as if from a band, or a3 
if the brain were distended in all directions ; as if the cranium were 
too small; as if the brain would burst; as if the brain moved when the 
head was shaken ; constant heat of the face, with throbbing; head 
confused, as if from drunkenness ; squeezing pain and pressure, espe- 
cially feeling as from below upwards, and from within outwards ; 
sticking, cutting, jerking, soreness, bruised sensation in the head with 
soreness, very severe, causing a feeling of desperation, and the pressive 
pain in the occiput to cause failure of the senses ; sometimes the pain 
causes syncope and loss of consciousness, with sweat. Aggravated by 
gentle shaking, not by violent shaking ; pain worse on expiration. 
The pain is generally in the temples, vertex, and occiput, beginning 
in the occiput, and with wravelike motion ascending from the heart. 
Vertigo, arising on stooping, shaking the head, or inclining it back- 
wards ; sensation like that of stepping ashore after a long voyage on a, 
boat; the headache accompanied by heat of the face, hard pulse ; 
nausea and vomiting ; usual severe cephalalgia wanting in these cases. 
Headache relieved by rest, or sleep, in the open air, or compression of 
the head. 
Eyes.—Feeling of heat and confusion ; balls injected and protrude, 
pupils dilated ; the lower lids are reddened, puffed, and have some- 
* Allgemeine Horn. Zeitung, 64, 49. ENCEPHALITIS. 
695 
times a darkened appearance, or a blue ring under them ; eye unsteady 
and trembling ; occasionally it is staring. Sparks and flashes of light; 
a cloud appears before the eyes and affects the sight. Heaviness, 
pressure, sticking, and soreness in the eyes and the orbits. 
Genus III.—CEREBRAL INFLAMMATIONS. 
Diagnosis.—There are certain symptoms which are common to the 
first stages of all acute inflammations of the cerebral organs; and 
which, taken by themselves, afford no indication of the actual seat of 
the disorder. These symptoms are : a vague sensation of coldness in 
the first instance, perhaps succeeded by occasional flushes of heat, las- 
situde, anxiety, sadness, irritability, often alternating with great exal- 
tation of the intellectual faculties ; hilarity, sudden bursts of laughter, 
petulance, unwonted impudence and vulgarity; redness of the skin, 
heat; pain, pressure, or tension in the head ; strong pulsations of the 
carotids and temporal arteries ; singing noises in the head, vertigo, 
weakness of memory, frightful dreams, fantastic visions when awake; 
trembling of the limbs, nausea, vomiting ; eyes bloodshot, great sensi- 
bility to light; constant wakefulness ; acuteness or dullness of hear- 
ing ; mouth and tongue dry; urine copious, yellow, and thin as water 
The symptoms which usually obtain in the second stages of these 
affections are : stupidity, coma, paralysis, eyes suffused and dull, be- 
sotted expression of countenance, strabismus, position upon the back, 
pupils dilated; suppression of urine, and general loss of muscular power. 
The signs which are supposed to be peculiar to the first stage of in- 
flammation of the cortical substance, or hemispherical ganglion, and 
the membranes of the brain, are: early derangement of the intellectual 
faculties ; fixed pain in the upper part of the head ; hot and dry skin; 
conjunctiva injected and red ; eyes brilliant, ferocious, fixed, and into- 
lerant of light; tone rough, violent, and defiant; face red and swollen; 
inclination to do himself and others injury; great exaltation of muscu- 
lar strength ; strong pulsations of the carotid and temporal arteries; 
constant watchfulness; continued and rapid motions of the head; im- 
patience, irritability, and constant agitation. 
Inflammation of the Medullary Substance.—The first stage is re- 
cognized by the following symptoms : vague chills, deep-seated head- 
ache or vertigo ; vomiting, lassitude, trembling of the limbs; convul- 
sions before any signs of mental disorder, anxiety, sadness, great 
agitation, arms continually raised towards the head, position mostly 
on the back, noises in the head. This disease is so insidious in its 
approach that convulsions may occur as the very first symptom. In 
instances like this it is probable that inflammation exists in the me- 
1. ENCEPHALITIS. 696 
DISEASES OF THE SANGUINOU8 FUNCTION. 
dullary substance alone, without involving in the slightest degree the 
gray matter of the convolutions surrounding this part, or the envelops 
of the brain. We are forced to this conclusion if we adopt the opinions 
of Bouillaud, Golly, Duchatelet, Hall, and Bennett, who suppose the 
cineritious, or cortical substance of the brain to be “ immediately con- 
nected with the intellectual powers,” while the medullary portion pre 
sides over the muscular powers of the organism. Therefore, after an 
injury to the head, if the intellect is only impaired, we may be certain 
that the hemispherical ganglion is the seat of the injury; while if, in 
addition, there are involuntary convulsive motions soon after the acci- 
dent, we may be equally sure that the medullary substance has also 
received detriment. 
Inflammation of the medullary structure is more prone than either 
of the other cerebral inflammations to terminate rapidly in softening, 
and for this reason it is incumbent upon physicians to exercise the 
greatest care in their investigations of this class of maladies, and to 
apply their remedial measures with due promptness. 
The most prominent secondary symptoms of disease of this portion 
of the brain are muscular paralysis, and loss of sensation in the parts 
affected. 
According to Marshall Hall, “ disease of a lateral lobe of the cere- 
bellum induces paralysis of the opposite side, and chiefly of the lower 
extremity. Disease of the middle lobe of the cerebellum is denoted 
by erection of the penis. Disease of the medulla oblongata induces 
paralysis of the respiratory muscles, and consequently, when complete, 
instant death.” 
We have now enumerated those symptoms which are supposed to 
characterize the inflammations of the different cerebral structures, and 
in this connection, we call the attention of homoeopathic practitioners 
especially to this subject, with reference to the therapeutic application 
of medicines. Flourens has demonstrated, by experiments upon birds, 
that Belladonna, Opium,, and Alcohol uniformly exercise a specific 
action upon certain portions of the brain. Hahnemann and his dis- 
ciples have also proved that large doses of these articles taken in 
health, uniformly give rise to those physical and mental manifestations 
which pathologists have shown to proceed from disease of these same 
parts. When therefore, in our provings of drugs, it is observed that 
the prominent symptoms are derangement of the intellectual faculties, 
exaltation of the mental and muscular powers, eyes bloodshot, and ex- 
pression furious and defiant, manner violent and overbearing, voice 
loud and rough, throbbing pain in the head, face red and swollen, we 
may be certain that a specific effect has been produced upon the w- 
tical substance of the brain. If, instead of these symptoms, we are 
presented with convulsions, paralysis, and general depression of the ENCEPHALITIS. 
697 
powers of the system, we may infer that the drug has acted specifically 
upon the medullary portion of the brain. The same law obtains in rela- 
tion to those symptoms, which characterize diseases of the different lobes 
of the cerebellum, of the medulla oblongata, of the different portions of 
the spinal marrow, of the nerves, and indeed of all other parts of the 
organism. 
Causes.—“ There is no single cause,” says Solly, “ which so fre- 
quently produces inflammation of the hemispherical ganglion, or me- 
ningitis as sudden emotion, whether of joy or fear. The latter is, how- 
ever, much more common.” Other causes are, fractures and contu- 
sions of the cranium ; insufficient sleep; intense protracted thought 
upon a particular subject, disappointed love or ambition, repelled erup- 
tions, whether by natural causes or by the abuse of ointments; expo- 
sure to cold, or to a burning sun ; abuse of Opium and spirituous 
liquors; metastasis of rheumatism, gout, or erysipelas, suppression of 
the lochial and other habitual discharges. It often arises during the 
progress of pneumonia, scarlatina, erysipelas, otitis, and intestinal 
affections. 
The most common predisposing causes are, plethora, a passionate 
and excitable disposition, want of exercise, high living and abuse of 
stimulants. 
Pathology.—Inflammation of the Hemispherical Ganglion.— 
One of the most important laws of vital action which pathology has 
yet unfolded is, “ that the first effect of the first stage of inflammation 
of neurine is to excite and to exalt to an unnatural degree exactly the 
same kind of power, which we have reason to believe resides in it in 
the normal state. The first effect of inflammation of the surface of 
the brain is to excite the faculties to produce great irritability of tem- 
per, and constant restlessness and desire for action. If the inflamma- 
tion be arrested at this point, the patient recovers his reason; but if 
it pursues its ravages undisturbed, limiting its destructive effect to the 
spot where it commenced, without extending to that portion of the 
brain which is beneath, it annihilates the intellect, but does not affect 
the muscular system. If the inflammation travels farther, reaching 
the instruments by which the will travels to the muscles, it first pro- 
duces convulsive action in those muscles which afterwards become 
perfectly paralytic. In this case the integrity of the neurine, through 
which volition travels to call these muscles into action is compromised, 
and its power therefore as an instrument for the production of voluntary 
motion is destroyed. 
The first symptom of inflammation of the tract of sensation is the 
exaltation of sensibility of the part, both where the nerves of sensa- 
tion originate, and also in the brain itself where they terminate. 
The first effect of increased arterial action of the hemispherical 698 
diseases of the sanguinous function. 
ganglion is to exalt the intellect; it may not last long and may be 
unnoticed; but to a certain point, the person who takes Alcohol, feels 
more lively; his ideas come more rapidly and clearly; he expresses 
them in better language, with greater facility and more rapidly. This 
passes off speedily. If the stimulus be continued, the brain becomes 
oppressed; the muscles of the tongue sluggish; the speech thick an 
indistinct; ideas confused; language incoherent; he loses conscious- 
ness and becomes insensible to the external world. 
These views are based on the following positions : 
1. The hemispherical ganglia are intimately connected with the in- 
tellectual powers ; and it is in them peculiarly, and not in the whole 
cerebral mass that these powers reside. 
2. The medullary substance beneath is in all probability merely the 
passive servant of the cineritious substance, as the conductor of its 
commands to the muscles, or of the various impressions made on the pe- 
ripheral extremities of the nerves of the senses, which the central 
power receives, and with which it works. (See Works of M. Foville, 
Pinel, Grandchamp, and Bouillaud.) 
The gray substance of the brain presides over intellectual pheno- 
mena, and the white over movements. 
M. Bouillaud says : “ Those physicians, who have recently employed 
themselves in the study of mental alienation, have remarked, that it 
wras always accompanied with a disorganization, more or less deep, of 
the cortical substance of the superior convolutions of the brain; and it 
has been truly observed by MM. Parent and Martinet, that delirium is 
connected with inflammation of that portion of the arachnoid tha t covers 
the convexity of the brain.” The seat of the intelligence therefore 
“ is in the cortical substance of the superior part of the brain.” 
It seems not possible to separate, in diagnosis or treatment, the in- 
flammation of the arachnoid and pia mater, and it is also impossible to 
separate between these membranes and inflammation of the hemisphe- 
rical ganglion, or cortical substance of the brain. 
Aberration of Mind without Complaint of Pain. “ There is a 
remarkable restlessness, quick and impatient manner ; obstinate watch- 
fulness ; incessant, rapid talking; rambling from one subject to another 
with little connection, and without actual hallucination. He kmrns 
those about him; answers questions distinctly; the pulse rapid, but 
without other symptoms of fever; case often mistaken for mania and 
hence lightly treated; but it is an affection of very great danger, and 
often rapidly fatal.” 
Pathology.—Its nature is obscure ; on dissection little is observed 
but a highly vascular state of the pia mater, without any actual result 
of inflammation. 
Effects of Inflammation of the Substance of the Hemispheres CEREBRAL INFLAMMATION. 
699 
—The Tubular Neurine.—Its sensibility may be exalted first and 
impaired afterward, and muscular contraction may be excited first and 
destroyed afterwards, without the intellectual powers being affected, 
when the inflammation is confined to that portion of the cerebral sub- 
stance which is within the gray matter of the convolutions, that matter 
remaining itself unaffected. Important conclusions may be drawn 
from these facts. 
Inflammation of the substance of the hemispheres, or rather the tu- 
bular portion is characterized by the appearance of convulsions pre- 
vious to any sign of mental excitement. It frequently terminates ra- 
pidly in ramolissement, after having commenced very insidiously. 
Sometimes a peculiar headache described as “ most uncomfortable,” 
is followed by vomiting, a symptom that should never be neglected. 
The convulsions are sometimes followed by coma, which may be re- 
garded as a sign of danger, though some recover after a few hours ; 
and the patient feels better after some days. But convulsions return 
without any warning and in fatal coma. 
These cerebral diseases are often intermittent, but Quinine and all 
stimulants have been found deleterious. The pupil of one eye, at 
least, is at first contracted and then dilated. 
When any injury of the head is immediately followed by convul 
sions, it is generally a sign of very serious injury to the substance of 
the brain, usually a laceration. 
When convulsions after a few days follow a blow on the head they 
must be promptly treated, as they denote inflammatory mischief in the 
tubular structure or under surface of the ganglion. 
Meningitis.—This term was employed by Abercrombie to express 
the disease of these two membranes, to distinguish from that of the 
dura mater. 
Andral says, most of the lesions described under arachnitis, have 
been in the pia mater rather than in the arachnoid. Abercrombie and 
others describe this under the name phrenitis. 
Symptoms.—Watchfulness, acute headache, impatience of light, 
suffusion of the eyes and maniacal delirium. This affection is, how- 
ever, seldom met with as an idiopathic disease, except in few cases in 
which it is brought on by abuse of strong liquors, and in warm elimates 
by exposure to the intense heat of the sun. 
As a symptomatic affection is often seen as a phenomenon belong- 
ing to fever, and in mania; a condition resembling it occurs after in- 
juries. 
It is probable, that in this form of the disease the inflammation is 
primarily seated in the membranes of the brain. When fatal, it is 
generally by a rapid sinking of the vital powers supervening upon the 
high excitement without producing much disorganization of the parts 700 
DISEASES OF THE 6ANGUINOUS FUNCTION. 
which appear to have been the seat of the disease ; for the eases which 
are referrible to this class, when they terminate fatally, are generally 
rapid in their progress.” 
Inflammation of the Duka Mater.—The dura mater may be in- 
flamed without affecting the pia mater; and the arachnoid is said to 
be inflamed without involving the subjacent pia mater. But, says 
Watson, “ it seems scarcely possible, that inflammation of the pia 
mater should take place without implicating also the surface of the 
convolutions.” 
Case by Watson.—A man with a small incised wound of the scalp 
had it dressed, and it was considered trivial. In a few days he came 
to the hospital, perfectly paralytic of one side of the body. The skull 
was trepanned; he was perfectly calm. The dura mater at the point 
under the wound was inflamed, and there was pus effused over the 
arachnoid covering the cerebral convolutions on the same side. He 
sank quietly into a state of coma without the slightest incoherency or 
delirium; no convulsions ; and no other morbid appearances wTere found 
within the cranium. 
Otitis.—Inflammation of the dura mater sometimes occurs continu- 
ously from the petrous portion of the temporal bone and the lining 
membrane of the internal ear. Sometimes without any disease of the 
bone it extends along the path of the auditory nerve. This is common 
among the poor of scrofulous diathesis, more frequent in childhood 
than in adult age. 
This inflammation of the dura mater from otitis or inflammation of 
the internal ear should make us guarded in our diagnosis of it. 
Treatment.—Mild, unstimulating lotions may be carefully used in 
the ear, but not farther than is necessary for cleanliness; but the chief 
reliance must be upon internal remedies. See Otitis and Scrofula. 
Case by Mr. Solly.—A case is given of inflammation of the lining 
membrane of the ear, extending along the neurilemma of the nerve to 
the cerebrum. A child, five years old, had otitis and discharge from 
the ear from birth. Complained of ear-ache seven days ago, when the 
discharge stopped; face pale; skin not discolored; head violently 
drawn back; found deep-seated abscess, pus very offensive. She was 
in great pain till twenty hours before death, she became comatose. 
Post mortem revealed abscess in the cerebellum; thickening of the 
neurilemma of the auditory nerve, the whole sheath filled with pus; 
surface of the bone denuded, not carious. 
Osseous Deposits.—The dura mater is a nutritive membrane of bone, 
sometimes its vessels over-do their work and deposit bone in small 
patches, sometimes in the dura mater lining the skull, sometimes on 
the falx and tentorium. It always acts as an irritant body. 
Case.—An extremely irritable, violent-tempered man cut his throat ATROPHY OF THE BRAIN. 
701 
m a watch-house. Mr. Solly found, on post-mortem examination, some 
u rough bony deposits on the falx-major. The same is frequently re- 
marked in cases of mental irritability amounting to insanity. 
One man was peculiarly irritable all his life ; and latterly he became 
so passionate, that his outbursts of passion were beyond his control, 
and were excited by the merest trifle. He died rather from intestinal 
than from cerebral disease. The bones of the head were found thinner 
than natural, especially in the frontal and temporal regions. The ex- 
ternal surface of the dura mater was healthy, on its internal surface 
were bony deposits, three in number. Some softening of the brain in 
the neighborhood of the diseased deposits. The bony deposits had ir- 
regular pointed edges, very rough. 
“ The extreme thickness of skull, which are frequently found in insane 
patients, must be regarded as the result of long-continued and general 
hypersemia of the dura mater. We have seen a case in which entire de- 
mentia was conspicuously marked in a middle-aged man, who wandered 
about the shore of Lake Michigan. His skull was not originally well- 
developed ; it was extraordinarily thick, and, at various points on its 
inner surface, there were stiff, black hairs, projecting from the bone 
against the membrane. 
Spicula of bone, shooting from the surface of the skull, internally 
are generally abnormal projections of normal growths. In some cases, 
after a severe blow on the head, they lacerate the brain, wdiich has 
been moved and shaken. Enlarged projections of the clinoid pro- 
cesses sometimes attend epilepsy. A woman, aged thirty-two, had epi- 
lepsy at the age of twelve years, following a fall and blow on the back 
of the head; latterly the fits occur sometimes four or five times in a 
night, then missing four or five days. Temper exceedingly irritable; 
the mind became imbecile. 
In the right temporal sphenoidal fissure was found a projection of 
bone one-sixth of an inch long, sharp and at its point, wide and broad 
at the base, projecting like a spine from the squamous portion of the 
temporal bone ; and in the middle lobe of the brain corresponding was 
a distinct softening of the cortical substance. 
Atrophy of the Brain.—The brain in whole or in part may be 
atrophied; partial atrophy is most common. It may arise from arrest 
of development in the foetal state. The acephalous foetus is the most 
complete illustration of this. Sometimes the arrest of development 
is confined to the hemispherical ganglion and then the brain retains 
the same condition permanently, which in a normal state would be merely 
one of its stages of growdh. Cruveilhier describes another form of 
atrophy, as resulting from the pressure of serous effusion into the ven- 
tricles in childhood; this, however, is simply a case of chronic hydro- 
cephalus in childhood, which causing dilatatim of the left ventricle at 702 
DISEASES OF THE SANGUINOUS FUNCTION. 
the expense of the tubular portion of the hemispheres, has been par- 
tially absorbed, and hence the paralysis. 
The hemispherical ganglion or cortical substance was neither atro- 
phied nor absorbed, but in normal quantity, as demonstrated by the 
section; and the rugae on the surface were much more numerous on 
that side, and hence the preservation of the intellect. 
Third Form.—This follows chronic inflammation of the hemisphe- 
rical ganglion; we often see it in the brain of old-standing cases of 
insanity, where the patient has sunk into complete fatuity. The con- 
volutions are then narrow and pinched, almost sharp, instead of being 
flat and rounded, full and plump. In some cases the ganglion is ac- 
tually thinner, as may be seen on section. 
4. Senile Atrophy of the Brain.—In very old age, the brain, 
like other organs, is less perfectly nourished, and, like other organs, it 
shrinks in bulk. The wide fissures between the convolutions are 
filled with that beautiful protector, the cerebro-spinal fluid; this is now 
in excess, but it is not to be considered as morbid; it is a cushion which 
nature has provided to supply the deficiency of the brain. 
Nevertheless the brain of old persons is more easily injured than 
that of the adult, from its being “more easily shaken in its case.” We 
meet cases, where the brain is lacerated by a blow on the skull, 
without fracture,—an accident seldom seen in the younger subject. 
Case.—A woman, aged sixty-nine, on going down-stairs, fell and re- 
ceived a contused wound, which exposed the bone over the right eye, 
but without any fracture or further injury visible ; she was in a state 
of insensibility till death; she was actively treated, but died on the 
evening of the next day. On dissection, the brain did not fill the skull 
completely, and there was extensive effusion of blood into the left ven- 
tricle, some on the right from laceration of the left corpus striatum 
and thalamus. 
Thus it is not strange that mental imbecility should become a cha- 
racteristic feature of extreme age. It has been thus described: 
“ On his staff 
Bending he leaned ; and from his weary eye, 
Distressing sight! a single tear-drop wept. 
None followed, for the fount of tears was dry. 
Alone and last, it fell from wrinkle down 
To wrinkle, till it lost itself, drunk by 
The withered cheek, on which again no smile 
Should come, or drop of tenderness be seen.” 
Induration of the Brain.—This structural change is believed to 
be the result of hypersemia of the part, perhaps that state which pre- 
cedes softening of the brain. It is often found in insane persons. 
Pinel saw it in one woman who died in a state of insanity. INFLAMMATION OF THE BRAIN. 
703 
M. Payen saw it in a girl, six years old, of melancholy temperament, 
though intelligent; she had from her birth contraction of the right 
wrist and foot, together with slight atrophy, and incomplete hemiplegia 
of the same side. Andral thought the induration the result of a slow 
inflammation. (Pathol. Anat. p. 75.) 
General induration of the brain, says Copland, generally occasions 
loss of memory, confusion of thought, derangement of mental mani- 
festations, causing insanity without lucid intervals. Towards the last 
of life insanity is complete. 
The signs of the partial induration of the brain are : progressive 
defect of memory; inattention or inability to pursue a long train of 
ideas; indifference to momentary impressions and to present or future 
occurrences ; difficulty of articulation; derangement of the ideas, with 
partial loss of the affections, appetites and desires ; ultimately increased 
defect of speech, palsy, convulsions, or want of power of the muscles ; 
fatuity, general or partial wasting, and death. (Copland, Vol. I, 221.) 
General Principles of Treatment of Inflammation of the Brain. 
—1. The disease is always serious and should be judiciously treated 
from the commencement. 
2. It does not in any case call for blood-letting, and, when depletion 
appears to do good at the time, it is only fallacious and temporary. 
3. The best resources against the delirium are Opium, Hyoscyamus, 
Stramonium, Cannabis-ind., Belladonna, or other remedies homoeo- 
pathic to that state. Cooling applications to the head are only ad- 
juvants, not primary remedial agents. 
4. Aconite is the great specific for cases purely inflammatory. 
5. Mercury long continued and in minute doses has cured bad cases 
even in allopathic hands. It is partially homoeopathic to cerebral and 
meningeal inflammation and may be employed with safety as low as 
the third attenuation, in which form its best effects may be attained. 
6. Moral influence is indispensible in the homoeopathic management 
of all diseases, in proportion as they effect the intellect. 
7. Never lose patience in a chronic case, nor try to hasten the cure 
by increasing doses. 
The time has been, when nobody thought of treating any inflamma- 
tion without bleeding from the arm; and of all diseases inflammation 
of the brain would be the last in which this powerful resource would 
be neglected. It is useless to deny the dangerous power of the 
lancet. 
When cerebral disease has supervened upon the suppression of hae- 
morrhoids, it is highly necessary to restore the haemorrhoidal flow. 
Cold Applications to the Head.—We prefer cool water to the ice 
that is commonly directed, let the water be so applied as to cool the 
head gently and permanently; evaporating lotions are beneficial when 704 
DISEASES OF THE SANGUINOUS FUNCTION. 
kept up in a regular and judicious manner. The cold dash is the 
most powerful refrigerator, but it must be used with caution. Aber- 
crombie says, he has seen a strong man thrown into a state approach- 
ing asphyxia, who, but a few minutes before was in such a state of 
maniacal excitement that four men could not hold him. 
Though the good effects of the cold dash appear real when they are 
applied with care, they are only temporary; and then the following re 
action is only an exasperation of the original disease. Its best effects 
need to be watched. Cold is homoeopathic to these conditions, but it 
must not be applied on allopathic or antipathic principles. The feel- 
ings of the patient may be employed as a safe-guide, but can not al- 
ways be ascertained. 
In our selection of remedies, therefore, we should always endeavor 
to choose those of which the action has been shown by pathological 
facts, as well as by provings, to be positively specific upon the struc- 
ture affected. It is of especial importance that due regard be paid to 
the causes which may have conduced to the attack. An encephalitis 
which has followed immediately upon the suppression of a lochial dis- 
charge, a habitual nasal haemorrhage, or the retrocession of an eruption 
by improper external applications, not only requires a remedy which 
shall cover all the manifest symptoms, but one which at the same time 
shall operate in such a manner as to bring back the original discharge, 
or eruption. If disappointment, pecuniary embarrassments, fright, or 
political or religious excitement has been the exciting cause, the mind 
of the patient should be soothed and attracted into new and agreeable 
trains of thought. By these means we shall prepare the organism to 
receive our remedies in the most favorable manner. * 
The principal remedies employed in encephalitis, are : for inflamma- 
tion of the medullary substance alone : Belladonna, Aconite, Opium, 
Hyoscyamus, Stramonium, Cannabis-indica, Moschus, Chamo- 
milla, Laurocerasus, and Ignatia. 
For paralysis : Moschus, Plumbum, Acid-oxalic, Mux-vomica, 
Opium, Oleander, Cannabis-indica. 
For metastasis, or extension of rheumatism to the brain : Phus-rad., 
Rhus-tox., Bryonia, and Belladonna. 
When the disease has arisen in consequence of repelled eruptions : 
Spigelia, Cuprum-acetat., Tartar-emetic, Bryonia, Sulphur, Tabac., 
and Belladonna. 
Belladonna.—The disease presents itself with febrile symptoms, 
accompanied with dryness of the mouth, tongue, and throat; difficult 
deglutition, nausea, vomiting; confusion of the head ; giddiness ; dila- 
tation of the pupils; injection of the conjunctiva; eyes suffused, 
brilliant, furious, and protruded, imperfect vision; gay delirium; in- 
creased secretion of urine, and frequent desire to evacuate the bladder; INFLAMMATION OF THE BRAIN. 
705 
heaviness, pressure, or throbbing pain in the head ; roaring in the ears ; 
vertigo, with nausea. 
Dr. Bigel gives the following indications for Belladonna, when chil- 
dren are the subjects of this disease. The children constantly press 
their heads into their pillows, they are startled by the least noise or 
light, there are: snoring sleep, great heat of the head, face red and 
puffed, with visible beating of the arteries of the head and neck, 
swollen veins, and occasionally hydrophobic phenomena. 
During the period of dentition, and directly after being weaned, chil- 
dren are particularly prone to attacks of inflammation of the brain. At 
this age the child is exceedingly sensitive, and there is an unusual 
tendency of blood towards the brain ; but if the signs of cerebral dis- 
turbance be closely watched, we shall find no difficulty in combating 
them successfully at the onset with Belladonna. 
Symptoms: Face hot,red, and swollen; eyes red, sparkling, and fixed, 
or half open and distorted; pupils contracted; visible throbbing of the 
carotid and temporal arteries; veins of the head distended; constant 
boring with the head into the pillow; paralysis of one or more parts ; con- 
vulsive movements ; rapid, small, or intermittent pulse; subsultus ten- 
dinum ; distortion of the features ; grinding of the teeth ; tongue bright 
red, and cracked; urine scanty and suppressed. 
Sharp, throbbing, or confused pain in the head; great restlessness 
and agitation; intolerance to sound and light; thirst; head and face 
very hot; limbs cold with internal burning heat; roaring or humming 
in the ears; deafness; inability to speak or to swallow ; nausea and 
vomiting during the course of the disease; sparks, flashes, or visions 
before the eyes. ■* 
Great sensitiveness of the nervous system ; violent delirium at night: 
profound sleep ; mania ; hydrophobic symptoms. 
Belladonna is likewise especially necessary in inflammations of the 
brain proceeding from metastases of scarlatina, measles, erysipelas, 
and small-pox. 
Its specific action is upon the cortical substance, the tubercula qua- 
drigemina, and the membranes of the brain. When febrile symptoms 
are strongly pronounced, it should be preceded by Aconite, or given in 
alternation with it. 
Boenninghausen says, a girl, eight years of age, with violent cere- 
bral inflammation of a high grade, was cured by a single dose of Bella- 
donna, 2000 (Jenichen), the child having been given up as incurable by a 
previous attendant, and neither the 30th nor the 200th of Belladonna 
had succeeded. 
Administration.—We advise from the first to the third attenuation 
for adults, and from the third to the sixth or thirtieth for children. As 
Vol. I.—45 706 
DISEASES OF THE SANGUINOUS FUNCTION. 
a general rule, the dose may be repeated every two hours until the re 
quired impression is produced upon the inflamed structure. 
Aconite.—There is no proof that Aconite affects specifically either 
the brain or its investing membranes. In autopsical examinations of 
those who have died from the effects of poisonous doses, no traces of 
inflammation have been found in the cortical substance, or the mem- 
branes of the brain, and but slight marks of action in the medullary 
structure. The prominent symptoms to which large doses give rise, 
are : numbness and tingling of the parts about the mouth and throat, 
and of the extremities, vomiting, contracted pupil, and failure of the 
circulation. The intellectual powers remain unaffected, and neither 
convulsions nor stupor usually occur. 
Dr. Lombard, of Geneva, in his clinical practice, and in his experi- 
ments on animals, found that the iaternal exhibition of Aconite gene- 
rally had the effect of “ rendering the pulsations less frequent, with- 
out irregularity, and consequently, that it exerted a decidedly sedative 
effect upon the heart; whence he infers that it is a proper remedy in 
inflammatory affections in general.” See opinions on the powers of 
Aconite given at page 650, 651. 
Others have observed that its pidmary effect was to stimulate the 
action of the heart and arteries, and cause a universal glow over the 
surface; while the secondary effect was decidedly sedative upon the 
circulatory vessels. 
Its effects are so manifest upon the action of the heart and arteries, 
that its use will be of eminent service in all those cases of encephalitis, 
or congestion, dependent upon a plethoric state of the system, or organic 
disease of the heart. It should also be given during the existence of 
active febrile symptoms, in all cerebral affections, and generally in al- 
ternation with some positive specific, in order that the malady may be 
met at all points. Attenuation and repetition of doses the same as 
Belladonna. 
Opium,.—It is conceded by both schools that Opium, when exhi- 
bited in moderate doses, exercises upon the human constitution two 
different effects—a primary and a secondary—which are of directly 
opposite characters. The first of these effects is invariably stimu- 
lant, as is evinced by such phenomena as increased force and fre- 
quency of the pulse, dryness of the mouth and throat, a pleasant glow 
upon the skin, exaltation of the mental faculties and of the muscular 
system, a sense of intoxication, and temporary retention of the stools. 
The secondary.manifestations are, general diminution of sensibility 
throughout the body, a feeling of relaxation and calmness, tremuious- 
ness in the limbs, disinclination to exercise, pulse full and slow, drow- 
siness, dryness of the mouth and throat, thirst, nausea, and finally, if 
a large dose has been taken, slow and laborious respiration, spasmodic INFLAMMATION OF THE BKAIN. 
707 
contractions of the muscles, eyes half closed, pupils dilated or con- 
tracted, and insensible to the light; bloated, suffused and besotted ex- 
pression of countenance, cold and clammy extremities ; respiration, 
gasping, rattling, stertorous, face pale, sunken, and death-like, rigidity 
of the jaws, entire insensibility to external impressions, pulse thready, 
and almost entirely imperceptible. 
It is supposed “ that the active principle of Opium is conveyed into 
the circulation, and operates upon the brain, and probably upon the 
nervous system at large by immediate contact with their interior 
structure.” (U. S. Dispens. p. 476.) 
Opium is generally supposed to cause death by suspending the “ ce- 
rebral influence necessary to sustain the respiratory function; and it is 
supposed also, that the heart ceases to act in consequence of the ces- 
sation of the respiration.” (Brodie.) 
From these facts we infer that the specific action of Opium is prin- 
cipally upon the medulla oblongata, although the other symptoms in- 
dicate that there has been some action upon other parts of the brain, 
and also upon the skin and lungs. 
In autopsical examinations of .those who have died from the effects 
of this substance, extravasated blood has been found in the brain, dis- 
tention of the sinuses, and of all the cerebral vessels ; but it is pro- 
bable that many of these appearances are results of the impeded res- 
piration, the imperfect decarbonization of the blood, and the impaired 
circulation which have arisen from a paralysis of that portion of the 
cerebral mass which presides over the respiratory functions, rather 
than from any specific operation of the Opium upon these different 
structures. 
Opium in small doses has always been observed to excite the vene- 
real propensities, and has been used for this purpose for a long period 
by the Turks, Chinese, and Egyptians. This fact viewed phrenologi- 
cally, affords another proof of its specific action upon the cerebellum. 
In proof that the active principle of Opium is absorbed, and ope- 
rates by actual contact in producing its specific effects, we quote the 
following from Pereira and Barbier: “The odor of Opium is frequent- 
ly recognisable in the secretions, exhalations and breaths of persons 
poisoned by it, and the secretions, in some cases, appear to possess 
narcotic properties.” 
Our own opinion derived from post-mortem examinations of those 
who have been poisoned by Opium, and from the effects, to wdiich it 
usually gives rise, is, that it exercises, first, a specific action upon the 
cerebellum and medulla oblongata. If the drug be taken in moderate 
doses, this action is in the first instance excitant, producing venereal 
desires, erections, accelerated respirations ; circulation, and augmented 
muscular force; and secondarily, sedative, as is shown by the languid, 708 
DISEASES OF THE SANGUINOUS FUNCTION. 
relaxed and calm state of the whole system, the diminution in the 
number of respirations, and in the action of the circulatory vessels. 
If taken in very large doses, the parts appear to be paralyzed at once, 
and all those organs the functions of which are dependent upon the 
integrity of this part of the brain, cease to act. 
Another specific effect of Opium is upon the skin, as is evinced by 
the perspiration and its odor, and the eruption to which it occasionally 
gives rise. Nor is it at all improbable that it may operate somewhat 
upon the par-vagum, or the lungs themselves. 
The most prominent indications, therefore, for the use of Opium, are : 
exaltation of the physical and mental powers, succeeded by depression 
and calmness, dry throat and mouth ; agreeable reveries; dreams; 
pulse at first rapid and full, afterwards slow and feeble ; drowsiness; 
disinclination to muscular exertion, slow, irregular, and stertorous res- 
piration, profound coma; pallid, sunken and ghastly face; immovable, 
contracted or dilated pupils ; rigidity of the jaws, cold and clammy ex- 
tremities ; complete insensibility to external impressions, and some- 
times convulsive twitchings, extinction of the pulse; interrupted and 
gasping respiration; and finally death. It may he administered in 
the same manner as Belladonna. 
Alcohol.—/Spirituous Wines in small doses have cured, homoeopa- 
thically, fevers that were purely inflammatory. Of this several au- 
thors have published cases. Asclepiades cured inflammation of the 
brain by administering a small quantity of Wine. A case of fever- 
ish delirium, attended wdth stertorous breathing, similar to that state 
of deep intoxication which Wine produces, was cured by Rademacher 
in a single night. (Hufeland's Journal, XVI. p. 92.) “ Can any one 
deny the power of a medicinal irritation analogous to the disease itself 
in either of these cases?” 
Hellebore.—In the last stage, when serous exudation has already oc- 
curred ; especially in cases where there are stupor, paleness of the face ; 
suspension of the dominion of the mind over the body. Dr. Roth says, 
he treated one child with inflammation of the brain with Helleborus, 
300, where Bell, had failed. 
Tartar-emetic.—Disease of the Nervous Centres.—Dr. Chris- 
tison (“ On Poisons,” p. 479), gives the following fatal case: The pa- 
tient had been ill two days before seen by a medical man, and was 
suffering “ from vomiting, excessive purging and convulsions. On the 
third day he had great pain and tension in the region of the stomach, 
and appeared like a man in a state of intoxication. In the course of 
the day the whole belly became swelled, and at night delirium super- 
vened. Next day all the symptoms were aggravated; towards evening 
the delirium became furious, convulsions followed, and he died during 
the night.” (Christison, p. 480.) inflammation of the dura mater. 
709 
On dissection, Mr. Hartley’s cases presented the following appear- 
ances : “ On opening the cranium of the boy, the dura mater was found 
very vascular, the longitudinal sinus contained a coagulum of lymph, 
and but very little blood. The vessels of the surface of the brain 
were very much injected with dark blood, the whole surface having a 
deep purple color. Every portion of the brain, when cut, presented 
many bloody points, the medulla oblongata and cerebellum were also 
extremely vascular. In the body of the girl, the arachnoid membrane 
was more opaque than usual.” 
In the symptoms observed during life, we have an appearance of in- 
toxication, delirium eventually becoming furious, and convulsions. The 
morbid appearances present us with a complete picture of inflammation 
of the brain and its membranes. The congestion of the medulla 
oblongata and cerebellum, with the convulsions observed during life, 
point to epilepsy, which Van der Kolk believes to depend, in many 
cases on this cause. Dr. Wood recommends Tartar-emetic in doses 
of from one-fourth to one-eighth of a grain, every two hours in the treat- 
ment of inflammation of the brain. (Principles and Practice of 
Medicine. Yol. II.) Dr. Graves witnessed beneficial results from 
Tartar-emetic in the advanced stages of typhus fever accompanied 
with intense cerebral excitement, manifested by loss of sleep, delirium, 
&c. (Med. Gazette, XX. p. 538.) Dr. Greenwood says, he cured a 
case of delirium tremens with Tartar-emetic, commencing with small 
doses, which he increased till he wound up the treatment wdth four 
doses of injuriously large size. (Lancet, 1835 and 1836. Yol. III. p. 
142.) In epilepsy Yan der Kolk has “found the greatest benefit from 
Tartar-emetic alone, in powders or pills, in which form, on account of 
its slower absorption, it is less likely to produce nausea and vomiting 
(in these cases to be avoided) than in solution.” (Spinal Cord, <&c., 
Van der Kolk, “ New Sydenham Society,” p. 277.) 
Treatment of Inflammation of the Dura Mater.—In a case 
which arose from secondary syphilis, there was necrosis from nodes of 
portions of the frontal and parietal bones, but without symptoms of cere- 
bral irritation. Two days after admission into the hospital the patient 
became drowsy and semi-comatose. He was actively treated, but got 
rapidly worse ; and in twenty-four hours he came under the specific 
influence of Mercury ; “ and it was most delightful to see the rapidity 
with which the cloud was removed from his intellect/’ In forty-eight 
hours he could answer questions ; the syphilitic symptoms improved 
apidly; the nodes became healthy; some large rupial sores on his 
thighs and legs improved, and he rapidly recovered. (Solly.) 
Case.—A man, aged twenty-five, had iritis and secondary eruption; 
became wild in his manner, left the hospital without hat or coat in cold 
weather, and remained out all day. Next day had inflammatory rheu- 710 
diseases of the sanguinous function. 
matism ; this grew better, but he had headache, expression of counte- 
nance vacant, wild and suspicious ; there was inflammation of the dura 
mater from metastasis of the rheumatic inflammation. He was not in- 
temperate and there was no hereditary insanity. Under the influence 
of Mercury and Colchicum, &c., he recovered. 
Inflammation of the dura mater often causes insanity, and the skul 
is found thickened and vascular, and the arachnoid also. Solly found 
in one case thickness of the os-frontis producing melancholia, especially 
over the organs of mirthfulness, ideality, and hope ; symptoms: con- 
stant crying and moaning. In these cases “ disease commenced with 
chronic inflammation of the dura mater of the anterior part of the 
brain, producing an ordinary periostosis, thickening of the bone. The 
thickened bone pressed on the above organs, and partially on the re- 
flective organs; there being no inflammation of the arachnoid and pia 
mater, there was no maniacal excitement. 
Inflammation of the Brain from Scarlatina.—The child is some- 
times attacked with inflammation of the brain before the eruption ap- 
pears and is misunderstood. Many children die in this way, and the 
real cause of death is not known till other children exhibit the scarla- 
tinal eruption on the skin. For the treatment proper in these cases 
see Scarlatina. 
Again, sometimes the subject of scarlatina when recovering from 
what was called a mild attack, is suddenly seized with headache and 
blindness with or without convulsions. This new attack is sometimes 
preceded by anasarca which follows scarlatina. The symptoms are in- 
deed those of effusion on the brain, but they are truly inflammatory 
though never curable by antiphlogistic treatment. See Scarlatina, 
Dropsy after, p. 601. 
Meningitis caused by Sun-Stroke.—Belladonna.—Boring with 
the head into the pillow; sensitiveness to light and noise] violent 
burning and stitching pains in the head; red, sparkling eyes, with 
furious look ; red and bloated face ; stupor with distorted, half-opened 
eyes ; heat in the head, with violent throbbing of the carotids ; swell- 
ing of the veins of the head; loss of consciousness and speech, or mut- 
tering, violent delirium; convulsive movements of the limbs; spasmo- 
dic constriction of the throat with difficult deglutition and other 
hydrophobic symptoms ; vomiting; involuntary discharge of urine and 
faeces. 
Aconite.—Inflammatory fever, delirium, violent burningpains through 
the whole brain, especially in the forehead; red and bloated face, red 
eyes, &c. 
Opium.—Lethargy, loss of consciousness; stertorous breathing 
with the eyes half-closed; and stupefaction after waking; frequent vo- INFLAMMATION OF THE BRAIN. 
711 
miting ; complete listlessness and dullness of sense, the patient not de- 
siring nor complaining of any tiling. 
Case.—A lady of 48 years, married but without children, had droop- 
ing of the right eyelid and violent pain in the head. The lid droops 
over the eyeball and she can only raise it half way. She can com- 
mand the left one; quivering motion in both eyelids and eyeballs 
vision of the right eye imperfect and hazy ; shooting and pricking pair 
m the ball of the right eye ; feeling of pressure and pain on the left side 
of the head and face. Feels as if going delirious; countenance wild 
and anxious; eyes staring and unnatural. Nervous feeling over the 
wdiole body; feels pricking like pins and needles ; the eyeball flutters ; 
right arm and leg numb; the left never feels so; passes a pint of blood 
a week from haemorrhoids ; has had much mental agitation and distress 
after the discharge. Six months ago the uterus was displaced, hard 
and shrunken; menstruation but once (two months ago) in that time ; 
was then relieved by it. Pulse quick, irritable; tongue rather pale, 
not furred; appetite and sleep good; feels week. She took Hydrar- 
gyri cum creta two grains night and morning for two and half months. 
The paralysis of the eyelid was restored, and she felt nearly well. 
She disappeared for two months. Returned, eyelid and general appear- 
ance worse ; pain in the back of the head and top of the neck ; at times 
something seems to pass over the eyes and make her blind. Sometimes 
sensations so horrible that she feels as if she were going mad. Some 
loss of power of the right side across the right leg—it feels numb and 
heavy. Began to feel worse as mercurial action declined, though moral 
causes produced the relapse. Mercury again continued for four 
months ; improvement considerable ; sight restored; head easy; spirits, 
appetite and strength good ; mind composed ; feels comfortable. 
Certain Derangements of the Brain and nervous System accom- 
panied by Paralysis of the voluntary Muscles.—Mr. Colles of Dublin 
gives eight cases. {Mercury in Affections of the Nervous System, 
p. 828.) 
Case.—A woman, aged fifty years, has for two years suffered severe 
family afflictions, loss of property, and has become subject to “ great 
confusion in the back of the head;” it has extended to the right side 
of the head also. Latterly she has avoided all society; there is failure 
of memory, increasing for the last six months, defective memory of 
words or of place where she laid things; confusion in the head when 
she tries to read, do needle-work, or recollect things; temper becoming 
extremely peevish and irritable; constant sickness of the stomach like 
sea-sickness; dizziness of the head and staggering in walking; good 
appetite ; constipation ; sleeps heavily; no emaciation; pulse 96. She 
took Mercury in purgative doses and in four days had mercurial 
dysentery and soreness of the mouth; though she was injured in many 712 
DISEASES OF THE SANGUINOUS FUNCTION. 
respects by the extent to which it was carried. The Mercury should 
have been attenuated and then given in small doses, producing the 
specific homoeopathic effect without the mercurial drug disease. 
Sleeplessness.—This is generally the result of the manner of living, 
when not associated with other diseases. Some persons cannot sleep 
if they eat anything in the evening before going to bed. Others only 
sleep soundly by eating before going to bed. Exercise in the open air 
in the evening, when not carried too far, favors natural sleep. The 
use of coffee and tea are the most common causes of nervous sleep- 
lessness. 
Cojfea.—Sleeplessness caused by exciting agreeable news. Bene- 
ficial to children. 
Aconite.—When caused by agitating events. 
Ignatia.—Sleeplessness caused by dejection, grief, &c. 
Pulsatilla.—When caused by surfeit. 
Chamomilla.—Caused by abdominal symptoms, flatulence, &c. 
Opium.—When various figures and visions appear before the eyes 
and prevent sleep. In general Opium is suitable for old persons. The 
general state of the health must be corrected; the cause of the sleep- 
lessness must be studied. * 
Ilyoscyamus.—M. Fouquier, of La Charite, gave {Archives gene- 
rates de Med., 1828,) the results of his experiments with this remedy 
on 200 patients. His conclusion embraces the symptoms it produced 
in massive doses. “ Until it be absolutely necessary to procure rend- 
ing headache, with vertigo, fantastic reveries, burning thirst, loss of 
sight, perversion of taste with insupportable disgust for every sort of 
food without a single wink of sleep, this remedy must continue utterly 
useless, and in the mean time should be banished from every Pharma- 
copoeia.” He denies that it ever acts as a hypnotic. 
Ilyoscyamus, Stramonium and Mush, are applicable in cases at- 
tended with complete loss of sense; convulsive or spasmodic move- 
ments ; closed eyes ; low muttering delirium ; constant movements with 
the hands; dilatation of the pupils; rapid and anxious respiration; 
frequent sighing. 
If inflammation of the brain has arisen in consequence of a sup- 
pressed otorrhoea, Sulphur should be employed. In those cases which 
occur in children from teething, Chamomilla, Belladonna and Aconite 
are our most reliable remedies. 
In cases of metastasis or extensions of rheumatic inflammations to 
the brain, Bhus-radicans and Phus-tox. are our best remedies. 
Cuprum-acetat. should be given in cases which have arisen from re- 
pelled eruptions. 
WThen encephalitis threatens to run into dropsy of the brain, Mer- 
curius-sol. is the best remedy to counteract the tendency of effusion. SOFTENING OF THE BRAIN. 
713 
If the disease has arisen from exposure to the sun, repeated doses of 
Camphor are highly recommended. 
Administration.—Our attenuations may range from the first to the 
sixth, and the doses repeated every two, three, or four hours, according 
to the severity of the symptoms. 
A morbid condition of the brain of anaemic character occurs from 
long-continued dyspepsia, confinement in impure atmosphere, and other 
prostrating causes. This is called “ London cachexy.” It is charac- 
terized by loss of appetite, confusion, giddiness, violent sickness of the 
stomach, sleepless nights, horrid dreams, waking suddenly in a fright, 
noises in the ears like the singing of a tea-kettle, or like something struck 
close to the ear, or wrnter thrown on hot iron, or a muffled drum at a 
distance; falling to sleep and suddenly awakened by a feeling as if a 
sky-rocket had suddenly rushed through the brain; transient deafness; 
headaches; black and bright spots dance before the eyes; languid, 
weak, irritable pulse ; cold skin; pale flabby tongue. Sometimes there 
is a partial loss of memory, sudden startings up at night, frequent diz- 
ziness and depressed spirits. [Solly, On the Brain, p. 288.) 
The only treatment required in these cases, consists in a better diet, 
restricted to proper articles in reasonable quantity; change of air; ex- 
ercise to the extent of slight fatigue; proper attention to the state of 
the stomach, liver, bowels, &c. 
2. WHITE SOFTENING OF THE BRAIN. 
Ramollissement.—Cerebral anaemia long continued produces white 
softening of the brain. It may be connected with hydrocephalus} 
or be independent of it. It often occurs in infants, being caused 
by hydrocephalus, and in old men it arises from disease of the 
arteries. Mr. Abercombie says: “ This peculiar softening of the 
cerebral matter is analogous to gangrene in other parts of the body; 
and, like gangrene, it may arise from two different causes—inflam- 
mation, and failure of the circulation from disease of the arteries.” 
Both of these forms of gangrene are familiar to all observers, though 
their origin is very different. Ossification of the arteries of the brain 
is common in elderly people, and is a frequent source of apoplexy with 
extravasation of blood at advanced periods of life. 
It is not yet decided whether ramollissement, or softening of the 
brain, proceeds from inflammation, or is a disease sui generis. Many 
of the French pathologists suppose it to be the result of inflammation; 
while others, as Rostan, believe it to be a disease sui generis. Aber- 
crombie believes it may arise from either inflammation or from a con- 
dition of the cerebral structure analogous to those parts which have 
become gangrenous in other parts of the body, while Solly supposes 714 
DISEASES OF THE SANGUINOUS FUNCTION. 
that it may arise from inflammation, from a total failure of the circu- 
lation, and from local and general anaemia.” Dr. Burnet recognizes 
two kinds of cerebral and spinal softening, an inflammatory and a 
non-inflammatory, and “ which may always be distinguished from each 
other by the microscope.” 
Inflammation of the tubular structure is more prone to terminate in 
softening than any other portion of the brain, and it is usually very in- 
sidious in its approach. 
Diagnosis.—Softening of the brain may supervene suddenly upon an 
attack of acute inflammation, like hydrocephalus, or it may make its 
appearance in a gradual and imperceptible manner. Some of the cha- 
racteristic symptoms of ramollissement are: Insensibility, dilated pu- 
pils, slight muttering delirium, paralysis, contraction of the flexor 
muscles, constipation, and a urinous smell. 
Those cases which have arisen from an anaemic condition of the 
brain, or from an obliteration of the arteries which supply this organ, 
are usually slow in their progress, and manifest themselves by a gradual 
failure of the memory, drowsiness and cedematous state of the body* 
occasional wandering of the mind, especially during the night, general 
languor, slow, dragging and imperfect articulation, constipation, loss of 
energy and ambition, and an almost entire absence of pain or febrile 
symptoms. 
Dr. Todd of King’s College directs us to examine in all cases of 
hemiplegia the condition of the muscles of the paralysed limbs; to 
“flex the fore-arm upon the arm and the leg upon the thigh; and care- 
fully ascertain which, if any, of the muscles offer resistance to our 
efforts, and the degree of resistance. Sometimes the biceps alone re- 
sists, and sometimes the triceps; flaccidity, slight resistance and ab- 
solute rigidity denote different states of the brain. Thus the perfectly 
flaccid condition of the muscles of the palsied limbs indicates cerebral 
lesion distinctly atrophic in its nature, the opposite of inflammatory. 
The vital powers are below par; the action is of a lowT kind, and there 
is a tendency to wasting. A resisting state of the paralysed muscles 
shows that the cerebral lesion is of an irritative kind ; perhaps there is 
“ a small apoplectic clot with laceration by the effused blood of some 
of the healthy brain-substance immediately adjoining it. When the 
palsied muscles are hard and rigid, and almost in a tetanic condition, 
the brain lesion is of a more distinctly and decidedly irritative kind,” 
it may be even of an inflammatory nature. These are the cases which, 
when the resistance is slighter, or the muscles perfectly flaccid, may 
be remedied by Aconite, Belladonna, or Mercury. But these reme- 
dies are not alone sufficient. When the intellectual powers remain 
perfect or nearly so, the seat of the lesion is in the part of the 
brain concerned in voluntary actions—the corpus striatum and optic BAMOLISSEMENT. 
715 
thalamus, and parts adjacent. Softening of the brain is not attended 
with the prolonged coma, which almost always follows the apoplectic 
effusion of blood on the brain. Consciousness is retained, though the 
articulation is imperfect. 
Causes.—Long-continued anxiety; over-exertion in business ; vene- 
real exhaustion; use of stimulants and low diet; depression. White 
softening of the brain generally depends on some cause which cuts off 
the normal supply of blood from the brain, or some part of it. Ligatures 
placed on the co.mmon carotid artery, have speedily caused hemiplegia 
of the opposite side. Dr. Todd says the application of the ligature was 
in one case followed in two days by hemiplegia of the opposite side, 
without any loss of consciousness; dissection showed white softening 
of the cerebral hemisphere of the same side as that of the carotid tied. 
In another case a dissecting aneurism, formed by a stream of blood 
from a slit in the aorta, extended for an inch and a half up the right 
common carotid. It there coagulated and formed a plug, which com- 
pletely obliterated the carotid artery. Two days after the accident the 
patient became suddenly hemiplegic on the left side. Consciousness 
■was retained, the muscles were perfectly flaccid and reflexed, and life 
continued eleven days. Dissection revealed white softening of all the 
parts of the right hemisphere of the brain -which are supplied with blood 
by this artery. 
This disease occurs most frequently in persons above fifty years of 
age; and in many of them it is preceded by a change in the coats of 
the arteries, especially in those of the brain. This change consists in 
the deposition of earthy and fatty matter in the walls of the vessels, 
and is known by the term atheroma. These deposits impede the blood 
in the capillary vessels of the brain, which, being less perfectly nour- 
»shed, passes into a softened state. The disease is thus seen to be 
one of a purely atrophic nature. It is in such cases that true apoplexy 
generally occurs. This is usually preceded by unsteadiness of gait, loss 
of mental and physical power, eccentricities of conduct, despondency. 
(Todd, Med. Times, Febr., 1858.) 
Dr. Bennett (Edinb. Med. and Surg. Jour., Yol. 58, 59 and 60,) 
has explained the process of ramollissement of the brain, and thus 
sums up his conclusions (Yol. 60, p. 398.): 
1. That two kinds of cerebral and spinal softening exist,—an inflam- 
matory and a non-inflammatory affection, and they may be distinguished 
from each other by the microscope. 
2. That inflammatory softening is characterized by the presence of 
exudation, corpuscles and granules; whilst in the non-inflammatory 
these bodies are never found. 
3 That the nature of inflammatory softening consists in the forma- 
tion and development of nucleated cells in the exuded blood plasma 716 
DISEASES OF THE SANGUINOUS FUNCTION. 
whilst the nature of the non-inflammatory softening consists in the 
mechanical destruction or maceration of the nervous tissues in serum, 
or is the result of putrefaction. 
4. That non-inflammatory softening, unaccompanied by haemorrhage, 
is usually post mortem, and causes no symptoms ; whilst uncomplicated 
inflammatory softening always causes marked symptoms which, however, 
vary according to the seat of the lesion. 
5. That the inflammatory and non-inflammatory softening have fre- 
quently been confounded together by morbid anatomists, it being im- 
possible to distinguish the one from the other with any certainty by the 
naked eye. 
6. That inflammation in the nervous centres has in several instances 
been demonstrated by means of the microscope after it has escaped the 
search of good morbid anatomists and been indicated by most equivocal 
symptoms. 
7. That very different colored softening has, at various times, been 
found to be connected with inflammation; but that yellow and white 
softening are most frequently inflammatory, whilst fawn-colored soften- 
ing is non-inflammatory. 
8. That red softening usually depends on congestion or the direct 
extravasation of blood; yellow softening on the imbibition of the color- 
ing matter of the blood; fawn and gray-colored softenings on the pre- 
sence of gray exudation corpuscles; and white softenings, in the great 
majority of cases, are post mortem, and the result of maceration in 
serum. 
9. In no instance has softening of nervous centres been traced to 
the presence or infiltration of pus. 
10. That inflammation of the central parts of the brain generally 
produce well-marked lesions of sensation and motion; whilst in inflam- 
mation of the peripheral portion, lesions of intelligence are commonly 
well pronounced. 
11. That in idiopathic inflammatory softening of the brain, the con- 
traction in one or more limbs is a common symptom. 
12. That the fawn-colored spots described by Dr. Sims are no evi- 
dence of the cure of inflammatory softening. 
13. That inflammation accompanying haemorrhages is consecutive. 
14. The softening surrounding apoplectic clots or sangineous infil- 
tration is no proof of inflammatory action. 
Prognosis.—Ramolissement of the brain was formerly considered as 
almost inevitably fatal. Regarded as always inflammatory and treated 
by depleting measures, the vital powers became rapidly more de- 
pressed. In those cases of fatty and earthy degeneration of the coats 
of the blood-vessels it may still be considered hopeless. But in cases 
which originate from the obliteration of the arteries it may still be pos 717 
sible to support the cerebral powers until a collateral circulation may 
be established through other vessels which may restore and maintain 
the normal nutrition ; this is often seen where the main artery of a 
limb has been tied. By this process it seems that simple white sof- 
tening may be repaired ; but in very many cases it never takes place, 
In these the palsied limbs are never restored; their temperature falls 
below that of health ; the paralysed parts become oedematous ; strength 
gradually declines and death follows; though existence may be pro- 
longed through months and even years. 
Treatment.—Begin by endeavoring to improve the state of the 
blood, and uphold the patient’s strength in every way consistent with 
the degree of digestive power remaining. At first Ammonia and Chloric- 
ether may be given every four hours or less, after the hemiplegic at- 
tack ; to these we may add wine, coffee, Quinine and other tonics and 
stimulants may be added. When the patient appears rapidly sinking, 
he may be revived by stimulants, and of these strong coffee in large 
quantities is one of the best. All the attendant symptoms, as the slow 
pulse, fainting fits, convulsions, &c., denote extreme anaemic debility, 
rather than congestion. Many of these cases occur in persons who 
have lived freely and are accustomed to stimulating food; and a fre- 
quent cause of their worst symptoms is found in dietetic restrictions. 
Let the generous diet to which he was formerly confined be restored, 
especially the wine, the animal food, and add to it iron and other tonics. 
Mr. Skey, of St. Bartholomew’s Hospital, says, he has treated nine or 
ten cases of ramolissement on the stimulating plan. These patients all 
had a slow pulse, some had alarming syncope, both of which symptoms 
depend on the state of the heart, and are always improved by tonics 
In one case he gave a pint of claret a day, in place of water gruel, and 
quinine and iron in place of leeches, antimony, graypowder and 
mindererus. 
Ramolissement, from whatever cause it may proceed, is seldom 
cured. As remedies, however, we suggest Opium, llyoscyamus, 
China, Secale-cornutum, Carbo-vegetabilis, Belladonna, Xux-vom., 
and Phos. 
Nux-vomiea.—D. E. M. Hale gives a case (N. A. Jour. Ilom. 
Vol. XI.) of a physician aged 60, a man of large frame, and originally 
possessing much strength and considerable power of endurance. For 
some years he had occasional paroxysms of “sick headache, excruciat- 
ing pain and vomiting, was affected by a certain absent-mindedness, 
loss of memory, and an eccentricity of manner. His mind became 
clouded at times, his speech hesitating and slow. 
Two years after he had an attack similar to an apoplectic seizure. 
This left him, with partial loss of motion in the lower extremities. He 
recovered from this attack, so much as to be able to ride and even -walk 
RAMOLISSEMENT. 718 
DISEASES OF THE SANGUINOUS FUNCTION. 
over his farm, and attend to his domestic affairs, but he had the head 
aches, mental obtuseness, &c., worse than before. One year from this 
attack, he had another, much more serious. It came upon him while 
in the barn-yard and he was found several hours after lying upon the 
ground completely insensible, comatose, with stertorous breathing. 
After three weeks of allopathic treatment, he was in a condition ap- 
proaching to general paralysis of the voluntary muscles. His lower 
extremities completely paralysed, they still retained sensation, but not 
in a normal degree; the tendons were somewhat contracted, upper ex- 
tremities partially paralysed, the face was partially distorted, power of 
speech lost. Gelseminum improved the febrile condition and the passive 
cerebral congestion; he appeared much better. The case was con- 
sidered to be one of ataxic or chronic softening of the brain, of the 
variety denominated “ red-softening”—from chronic venous congestion 
and capillary haemorrhage. 
Nux-vomica, 3. produced in a week decided amendment. The tongue 
became moist and clear, breath less offensive, greater power of articu- 
lation, less distortion of the features, and the return of some power of 
motion in the legs. He can turn in bed with a little assistance. There 
was slow but steady improvement in all except the mental condition, 
which remained cloudy and idiotic as ever. Phosphorus was then alter- 
nated with Nux, with decided benefit. Further improvement, followed 
from Citrate of Iron and Strychnine. 
A distressing headache and vomiting was prevented from returning 
in regular paroxysms by Cuprum-aceticum, 2°, given every three hours, 
for the twelve hours, preceding the expected paroxysm, and until its 
subsidence. Phosphate of Zinc, first dec. trit., one grain one hour before 
meals, cured it entirely. 
3. HYDROCEPHALUS. 
WATER-BRAIN FEVER. DROPSY OF THE BRAIN. TUBERCULAR MENINGITIS. 
General Remarks.—No satisfactory account of this disease appears 
in any of the ancient authors. The first clear and full description of 
it was given by Whytt, in a Dissertation published in 1768, which is 
even now regarded as one of the best that has ever been written on this 
subject It may be divided into three stages : 1st, that of excitement; 
2d, that of effusion; 3d, of convulsions. 
ACUTE HYDROCEPHALUS. 
Diagnosis.—This is a malady almost peculiar to infancy and child- 
hood. The symptoms which indicate its approach, are neither very 
uniform nor regular. Indeed, so various and uncertain are these symp- 
toms, that some writers suppose the effusion to be dependent upon a HYDROCEPHALUS. 
719 
debilitated condition of the membranes, analogous to dropsy, while others 
attribute it to inflammation in all cases. 
It may appear suddenly with most of the phenomena we have de- 
signated as encephalitis, viz.: febrile symptoms, quick pulse, fits of 
screaming, expression bold and furious, eyes bloodshot and brilliant; 
great heat of the head, nausea, vomiting, noise and light painful ; con- 
vulsions, ending in coma and death in a few days. In cases of this de- 
scription there exists unquestionably acute inflammation of the meninges 
of the brain; and the effusion commences almost simultaneously with 
the inflammation. 
In other instances, the disease approaches insidiously, presenting no 
marked symptoms for some days. The child will perhaps be observed 
to be petulent, to complain of some pain in the head, to become easily 
fatigued, to have occasional flushes of heat, to be restless at night, oc- 
casionally to grind the teeth, to have lost the appetite, and to prefer 
the recumbent position. After these symptoms have continued for an 
indefinite period, the more serious signs'of effusion present themselves, 
as: general diminution of sensibility, less frequent and more ir- 
regular pulse, greater debility, constant inclination to keep the bed, 
or to be held in the arms, dilatation or contraction of the pupils, 
frequent sighs, strabismus, or an unnatural expression of the eyes, 
turning inwards of the feet and hands, slight convulsive twitchings of 
the face, upper-lip and arms, automatic movements of the hands towards 
the head, rolling the head from side to side, constant motion of the lips, 
convulsions, paralysis. 
The pulse at the beginning of this disease is always slow, in very few 
cases exceeding one hundred, in some eighty, and in a few as low as fifty- 
four per minute; but this lasts only a very short time after the head- 
ache, and vomiting begin. There is then a reaction and the pulse rises 
to one hundred and thirty, and in some to one hundred and sixty. It 
is full, but more easily compressible than in inflammation of the brain, 
called encephalitis ; it has a perceptible variation in the rythm of the 
artery and in the regularity of the strokes, varying in frequency even 
during the same minute. There is a distinct intermission every seven, 
seventeen or twenty pulsations, and some of the pulsations may be felt 
soft, weak, and fluttering. In the second stage, the pulse sinks and 
becomes slow, labored, intermittent and irregular, and is easily quick- 
ened by motion or mental disturbance to double the number of pulsa- 
tions per minute. ( Whytt, Ilennis, Green, Smith on Hydrocephalus, 
p. 31. Rilliet and Barthez) 
Abdominal Organs.—The appetite is not entirely lost: but vomiting 
almost always occurs on the first day, rarely later, though sometimes 
continuing longer than the second or third. M. Piel says of this sign: 
“ If in a child that has been vaccinated or had the small pox, whc 720 
DISEASES OF THE SANGUINOUS FUNCTION. 
digests well, and is suffering neither from bronchitis nor pertussis, 
vomiting, whether simple or bilious, accompanied or preceded by a 
more or less continued headache, there is every reason to fear an ap- 
proaching meningitis, especially if the child is tuberculous.” The 
vomiting is spontaneous and unattended with nausea, and after its oc- 
currence food is often taken with avidity. Constipation is generally 
conjoined with vomiting, and is generally followed by diarrhoea before 
the disease terminates. 
Retraction of the walls of the Abdomen generally occurs about the 
sixth day. Rilliet and Barthez say: The belly becomes depressed at 
its centre and takes the form of a boat; the contraction being some- 
times carried so far as to allow the beating of the aorta to be felt. It 
is almost a constant symptom, and does not depend on the constipation 
or the subsequent diarrhoea. It is almost exclusively in cerebral af- 
fections that we have observed this symptom.” 
The urine is of a deep amber hue, of high specific gravity, sometimes 
milky, and deposits a whitish slimy sediment, smells offensively shortly 
after being passed, and occasioning strangury. It differs in color from 
the dark-brown or porter-colored urine, seen in inflammation of the 
brain, which contains more urea and less of lithates than that of hydro- 
cephalus. (.Ilydroceph., p. 9.) 
Cerebral Symptoms. Vertigo, stupor and coma follow the charac- 
teristic headache : dilatation of the pupil, spasmodic contraction of the 
eyelids, &c. 
Diagnosis.—Distinction from Phrenitis.—The headache of hydro 
cephalus is of a lancinating, paroxysmal character, and accompanied 
by voluntary ejaculations. If the child be directed to shake the head 
he tries, but suddenly he stops, utters a piercing cry, holding the head 
fast between the hands. The head feels heavy and full anteriorly, and 
there is a disposition to rest its frontal surface against the pillow. 
Vertigo approaches more gradually and lasts longer than in phrenitis, 
and is especially felt on assuming the erect posture. “ The stupor is 
more intense and longer continued than in other cerebral affections. 
Rheumatic and colicky pains are found oftener in the abdomen, with 
tenderness along the cervical and dorsal vertebrae which increase as 
the disease advances. The respiration and pulse do not observe their 
usual consentaneous action. The pulse may beat 140 or 160 per mi- 
nute, while the respirations are only 40 or 50.” But “ the respiratory 
effort is usually performed in a hurried convulsive manner, and there 
is a marked increase in the duration of the expiratory act and the pe- 
riod of repose; deep and prolonged sighing intervenes, and consider- 
ably diminishes the amount of the respiratory movements.” The faecal 
evacuations in this disease are more “ tenaceous, gluey, and glossy in 
their properties, with a more cadaverous smell, than in phrenitis or HYDROCEPHALUS. 
721 
other febrile affections. The pupil is always dilated in idiopathic 
hydrocephalus, and it is only when the disease is complicated with in- 
flammation of the brain or its membranes that it is permanently con- 
tracted. The spasmodic contraction of the eyelids peculiar to this 
affection is attributed to irritation of the filaments of the fifth pair sup- 
plying the orbicularis; and from the same cause there often exists 
itching of the alae nasi, and lower lobe of the ear. The auditory nerve 
is acutely sensible to impressions, but the olfactory becomes obtuse. 
Cerebral Auscultation has been proposed as a means of distin- 
guishing hydrocephalus, but thus far without important results. 
Causes.—The predisposition to hydrocephalus is often inherited from 
scrofulous or unhealthy parents. The latent cause most common is a 
strumous or lymphatic constitution, which has most frequently origi- 
nated in the highly excitable condition of a nervous and irritable 
mother. A woman, whose brain and nerves are liable at all times to 
be extraordinarily excited, whether by causes of great or small impor- 
tance, always transmits to her child a feeble, ill-nourished, scrofulous 
or otherwise unhealthy body, and an irritable weak or ill-balanced 
mind. This disease may also result from the want of suitable food, 
clothing, exercise in the open air. The health of children depends in 
a great degree on that of the parents, their habits of life, and general 
management. Let dwellings be improved; let food be selected with 
greater regard to its healthful qualities ; and let children be properly 
fed, clothed, and habituated to the appropriate degree of exercise in the 
fresh air, and they will be less burdensome to themselves, their parents, 
and the community. Hydrocephalus is often one of the tubercular forms 
of disease inherited from phthisical, scrofulous or dyspeptic parents. 
Pathology.—This disease is an idiopathic nervous fever with a de- 
position of tubercular matter in the meninges of the brain, in its most 
common and well-marked form. In some cases there is a limpid effusion 
of serum, softening or slight opacity of the membranes, either on their 
surface or at the base of the brain. In other cases there are signs of 
tubercular deposit in various organs of the thorax and abdomen. Hy- 
drocephalus, says Dr. Smith, “ is not in essence an inflammation, much 
less a dropsy; but it may or may not be accompanied with inflamma- 
tion in its origin,”—it may or may not lead to effusion in its progress. 
{On Hydrocephalus, p. 68.) 
Prognosis.—This disease once developed in that kind of constitution 
which, of all others is most likely to be effected by it, has not often 
been cured. In constitutions not hopelessly tubercular it can be gene- 
rally treated with success. 
Treatment.—Prophylactic Measures.—In children suffering but 
trifling indisposition, to outward appearance, but in whose families the 
disease has already manifested itself by attacking other children, hy- 
Vol. I.—46. 722 
DISEASES OF THE SANGUINOUS FUNCTION. 
drocephalus may be feared, and all useful means for maintaining the 
general health should be employed. Due attention should be paid to 
all the secretions, the state of the skin, the physical strength and all 
the indications of morbid activity of the brain, precocity of intellect. 
&e. All invigorating measures should be immediately employed and 
all mental excitement avoided. It is easier to criticise one mode of 
treatment than to propose another that will be certainly successful. 
Hitherto the most successful treatment has been directed to the pro- 
ducing of a favorable crisis by the steady and uniform action of all the 
abdominal and cutaneous exhalents by means of homoeopathic remedies 
A warm bath may often be found useful, though it must be employed 
with great caution. And it may be useful in some bad cases if the 
warm water be allowed to come up high enough to cover the chest at 
the same time that cold, graduated to the strength of the patient, may 
be applied carefully to the head. A sponge cap,—formed of pieces 
of thin sponge sewed together and to a leather border to secure it, may 
be made to absorb any cooling mixture desired, and then, by its evapo- 
ration the head may be carefully cooled; and, in this way, the excess 
of blood may be driven from the head, at the same time that it is drawn 
to the extremities and surface of the body. We have better resources. 
The medicines which we would suggest jn this affection are: Bella- 
donna, Digitalis, Cannabis-ind., Hellebore, Apis-mel., Nux-vomica, 
Phosphorus, Stramonium, Tartar-emetic, Veratrum, Aconite, Ar- 
nica, Arsenicum, Bry., Cuprum-met., Iod.-arsen., and Canthar. 
During the first stage of the acute variety, our most reliable remedies 
are Aconite and Belladonna. These should be given as often as once 
in two hours, until a manifest effect has been produced, after which we 
may repeat as circumstances require. 
Bryonia.—If the inflammation has not been promptly subdued by 
the use of Aconite and Belladonna, but signs of effusion manifest 
themselves in the form of “ deep red, or almost browrn face ; eyes rolling 
in their orbits, sometimes closed, and at others wide open; lips dry; 
tongue covered with a brownish yellow fur; tension and swelling of the 
abdomen; constipation; generally retention of urine, or difficulty of 
passing it; respiration quick, anxious and sighing; deglutition difficult; 
skin of the whole body dry and burning, Bryonia acts surprisingly.” 
(Bigel.) 
Ilelleborus-niger has been successfully employed in many apparently 
hopeless cases, which were attended with coldness and insensibility of 
the surface; rapid and feeble pulse; convulsions and spasmodic ri- 
gidity ; face pale and swollen; constant rolling of the head from side 
to side ; moaning; general prostration. 
After decided marks of effusion obtain, Digitalis, Merc.-sol., Bellar 
donna, Veratrum and Arnica deserve our consideration. HYDROCEPHALUS. 
723 
Mux-vomica and Stramonium will be required when great agitation, 
flushed face, convulsions, strabismus, haggard and staring look, in- 
voluntary twitchings of the muscles, dilated or contracted pupils, groan- 
ing and crying, and opisthotonos are present. 
Phosphorus and Tartar-emetic will be found useful in hydroce- 
phalus, depending upon metastasis of some disease to the brain, and in 
cases occurring in worn-out constitutions. 
Administration.—The first, second and third attenuations may be 
used, and the doses repeated once in from four to six hours. 
Apis-mel. is another remedy of importance. Several acute cases 
are reported in the Brit. Jour. of Homoeopathy and elsewhere. 
Kali-hydroicum, first decimal trituration, in grain doses, every 
three hours, has often cured apparently hopeless cases. 
Tartar-emetic.—Laennec used it to reduce the inflammatory action, 
and restore the secretions of the abdominal organs. In chronic cases 
Recamier used a bath of one ounce of Tartar-emetic to the pail-full of 
water. He thought it reduced the size of the head and acted as a 
diuretic. We can only rely upon internal remedies. 
Mercury.—The treatment of inflammatory diseases by Mercurials 
was commenced by Dr. Dobson in England in 1775. It was of course 
used on a large scale, and the quantity sometimes employed seems in- 
credible in this age. The following case treated by Dr. Kuhn of the 
Pennsylvania University, in 1814, is reported by Prof. Chapman of the 
same school. A child, six years of age, passed through the different 
stages of hydrocephalus, taking repeated and large doses of Calomel. 
When the phenomena of effusion on the brain became evident, the 
doctor commenced rubbing the whole surface of the body twice a day 
with mercurial ointment of double strength. Long gloves made to 
reach to the arm-pits, stockings extending to the groins, a wide belt 
around the abdomen, and a cap on the head, were all thickly lined with 
mercurial ointment. On the 14th morning, a slight ulceration of the 
gums was perceptible, and some improvement was apparent; but the 
treatment was only discontinued after fourteen and a half pounds of 
the strong ointment had been consumed. “ Recovery” followed with- 
out any perceptible inconvenience from the Mercury absorbed. 
The reckless employment of Mercury has very often resulted in the 
sudden development of most disastrous effects even when the quantity 
given has been very small, and where a high degree of caution and com- 
mon judgment have been exercised. Every physician who has precribed 
much Mercury in any form knows that its action is uncertain and ca- 
pricious in a great proportion of all the cases in which it is tried in a 
crude form. It can only be used successfully and safely in the ho- 
moeopathic form. Mercurius-corr., or Mercurius-hydriod. employed at 
the second triturations, have produced excellent effects in many cases. 724 
DISEASES OF THE SANGUINOUS FUNCTION. 
chronic hydrocephalus. 
Diagnosis.—Chronic hydrocephalus is usually the result of a very 
slight inflammatory action, which has progressed very slowly and insi- 
diously. The characteristic indications which distinguish it from other 
affections are, gradual emaciation, feebleness, unnatural enlargement 
of the head, occasional giddiness, and now and then strabismus. 
Treatment.—The medicines we would suggest in this disease are: 
Belladonna, Digitalis, Nux-vomica, Phosphorus, Stramonium, 
Tartar-emetic, Veratrum, Aconite, Apis, Cann.-ind., Merc.-cor., 
Arwuca, Arsenicum, Kali-hyd., Calcarea, Sulphur. 
First Stage of the Acute Variety.—Our most reliable remedies 
here are first Aconite, followed by Belladonna. They should be given 
even singly or in alternation as often as one in two hours, until a mani- 
fest effect has been produced, after which we may extend the intervals 
as circumstances may require. 
We usually commence the treatment of this malady with Sulphur, 
followed by Calcarea, both in the higher attenuations. These medi- 
cines have the effect to modify the scrofulous dyscrasia which is often 
present, and to prepare the system for the favorable reception of other 
remedies. 
Next to these drugs in value we should rank Kali-hyd., Digitalis, 
Arsenicum-alb., and Hyd., Apis, Cannabis-ind., and Mercurius-corr. 
These medicines should be prescribed in palpable doses, and repeated 
often. 
Case by Dr. Norton.—Calcarea.—A boy, aged one year, had been 
previously under allopathic treatment. His appearance was scarcely 
human; the head was immense, with open fontanelles, and squinting 
eyes; his only attempt at speech or vocal sound was a distressing 
grunt; the skin was hanging in loose folds; emaciation; very tumid 
abdomen; diarrhoea, alternating with hard scybalae, passed from him as 
from a senseless animal; periodical convulsions, amounting to opis- 
thotonos; he drank milk greedily, through a tube, and till satisfied he 
continued the grunting noise. After a dose of Calcarea 200°, he was 
much improved. Calcarea 200° and Sulphur 200° were given in 
weekly doses, one medicine one week, the other the next week, and so 
on alternately. In six months he was quite well.” [Brit. Jour, of 
Horn., Vol. VII. 
Dr. Liedbeck has recorded some cases of hydrocephalus success- 
fully treated with Ferrum-aceticum. [Brit. Monthly Rev., Vol. V 
p. 39.) DISEASES OF THE EAR. 
725 
Genus IV.—INFLAMMATORY DISEASES OF THE EAR, MOUTH AND 
THROAT. 
1. Diagnosis of Diseased Condition of the Meatus Extern us.—• 
Facility in conducting an examination of the meatus externus and 
forming a correct judgment of its true condition can only be acquired 
by considerable experience. To judge accurately of the nature and 
extent of the disease that may be present it is necessary to have a clear 
idea of the healthy appearance of the part. This knowledge can only 
be acquired by the careful inspection of the meatus in a large number 
of healthy individuals. 
Mode of Conducting the Examination.—Placing the patient in a 
favorable condition to permit the rays of the sun to fall directly into 
the ear, and then gently pull the upper portion of the auricle upwards 
and backward; and if the whole cavity can not then be well examined, 
a speculum of some kind is required. “ The instrument employed by 
Dr. Toynbee is a modification of the cone introduced by Gruber and 
Wilde. The portion which enters the meatus is of the same circum- 
ference throughout, but oval, like a flattened cylinder, corresponding 
to the oval shape of the outer meatus.” “ In order to hold the spe- 
culum more firmly, it is desirable that the expanded portion should be 
somewhat flattened; and this flattening should be at right angles 
with that of the small extremity.” The “ forceps speculum,” formerly 
used with the design of dilating the meatus, is now rejected as unfitted 
for that purpose. 
When the sun is not in a favorable position for the direct falling of 
its rays in the exact direction required, a mirror can be so adjusted 
outside of the physician’s office window as to reflect the sun’s rays into 
the ear of a patient, sitting in any part of the room. When the sun is 
obscured an artificial light may be substituted. This can best be done 
by throwing the light of a good lamp or gas-burner through the spe- 
culum into the ear by means of a concave reflector, having a small 
opening in the centre, through which the surgeon can look. Specula 
with magnifying lenses are sometimes advantageously employed. 
In cases of otorrhoea, where there is a discharge from the meatus, 
the ear should be gently syringed, and carefully dried by means of a 
small tuft of cotton, before the inspection of the meatus is attempted. 
2. Foreign Bodies in the Ears.—The symptoms commonly excited 
are, intense pain; alarming inflammation which is propagated to deep- 
seated parts ; ulceration and granulations in the meatus, which may be- 
come closed; deafness is the common result. 
Treatment.—The foreign body must be removed, but the effort to 
do it must be made with the greatest caution, as the offending substance 
may be thrust still further in, the membrana tympani ruptured, and 726 
DISEASES OF THE SAJVGUINOUS FUNCTION. 
the body enter the cavity within. Forceps can scarcely be used, as 
they must be insinuated between the sides of the meatus and the body. 
Perhaps the best instrument is a steel-stylet, tapering from one ex- 
tremity to the other, that the end in the hand may be stiff* enough for 
a handle. The other end like a small probe, obtusely flattened later 
ally and bent at the point.—This point is to be insinuated beyond the 
foreign body, and the instrument used as a lever to bring it out. 
If this mode does not answer, try forceps with very large slender 
blades, bent nearly at the right angles about an inch from their points, 
which should be thin, a little convex on the outside, and slightly 
curved inward. They are bent that the hand may not exclude the light. 
After removing the object the ear should be deterged by warm milk 
and water. Many are mistaken about the existence of the substance 
in the ear; at all events it is necessary to be careful to avoid irritating 
the external meatus in efforts to remove what is not there. 
When an insect has got into the ear, place the patient on the opposite 
side and pour sweet-oil in the ear. The insect will probably become 
visible and may be removed by a roll of paper or small forceps. 
Extraneous bodies, as gravel, shot, beads, cherry-stones, pieces of 
wood, peas, beans, &c., when put by children into their ears, excite in- 
flammation and swelling. They will generally be removed by slender 
forceps, or by a hair-pin bent into an obtuse angle. This forms a 
round smooth wire spatula so curved that it can enter far into the 
external ear without injury, and, passing beyond the offending sub- 
stance, withdraw it. A horse-hair bent into a spatula-form and wrapped 
with a thread to form the handle, can be pushed farther into the ear 
than the wire spatula, and if used with skill, will almost always bring 
the extraneous matter -with it. 
If, before effort is made to extract the foreign body, inflammation and 
swelling of the membrane lining the ear has proceeded so far that no- 
thing can be introduced within the ear, the fever is also high, and there 
is pain in the head, we begin by reducing the inflammation. Aconite 
and Belladonna may be given in alternation so long as they seem to 
exert an influence in allaying the inflammation. Warm fomentations 
exert a homoeopathic influence by being applied directly over the ear. 
Soft cloths wet in warm water may be laid so thickly over the ear as 
to keep warm for considerable time. A few drops of Glycerine may 
be dropped in the ear before the wet cloths are applied. A drop of 
Lactucarium in the Glycerine soothes the pain without doing any injury. 
In one case a child had pushed the part of a fine comb into the ear, and 
when examined the meatus was so swollen that the comb could not be 
seen, and there was no room to insert any instrument. By fomenting 
the ear the swelling was reduced till the comb was visible, and then 
extracted with curved forceps. diseases of the ear. 
727 
3. Diseases of tiie Membrana Tympani.—1. Fungous Membrane 
covering the membrana tympani.—This membrane in new-born infants 
is over-spread in the external side by thick fungous membrane, which 
soon disappears by suppuration. When this continues to adhere to the 
drum, instead of separating, it produces deafness. This is probably the 
condition of most of the congenital deaf mutes. A deaf mute of 
Chartres, in 1803, began to hear at twenty-four years of age; another, 
(says Riolan,) began to hear after the membrane was perforated with a 
tooth-pick. At Nantes, a man deaf and dumb from his birth, at the 
age of twenty-eight began to hear and speak. 
The existence of this deciduous membrane has indeed hardly been 
demonstrated. It is said that the suppuration is often imperceptible, 
and that when the suppuration is going on the pus blends with the ce- 
rumen of the ear, it is with difficulty distinguished, and must be 
often and carefully examined. The wax during the suppuration is 
changed in smell and color, the question of ability to hear is hardly 
settled till the child is old enough to answer some questions. This 
fungous membrane corresponds with the membrana pupillaris. 
Diagnosis.—To ascertain whether this be the cause of deafness; ex- 
pose the ear to a strong light, directing the rays of the sun into the 
external meatus. If the bottom be seen to be pearly white, smooth, 
sensible to the probe, we may be certain, that there is no false mem- 
brane ; but if the bottom be seen of red fungus, little or not at all 
sensible to the probe, we may be assured the false membrane exists. 
Treatment.—It has been proposed to destroy it by irritating it by 
acrid medicines, or to cause it to desquamate by dry, mild corrosives. 
But these measures cause unnecessary inflammation and sometimes the 
inflammation thus excited only thickens the membrane ; as often hap- 
pens in efforts to destroy false membrane on the eye. Hildanus says, 
a child, eight years old, had discharge from the ears. An empiric in- 
jected into it an acrid fluid, which produced intolerable pain and inflam- 
mation ; it was afterwards insensible to the loudest sound. 
A child, aged six years, had inflammation of the ear excited by a 
glass-bead as large as a pea; there was continual pain, afterwards in- 
creased by cold and moisture. Then there began to be felt numbness, 
first in the left arm, then the hand, next the leg, finally the whole side. 
A dry cough and attacks of epilepsy followed; the arm atrophied ; but 
all of these symptoms ceased on the extraction of the bead. These 
cases show that any substance introduced into the ear may be followed 
by dangerous consequences. 
Sassy prefers puncturing the membrana tympani, as “it restores 
hearing more promptly than any other method; and to prevent closure 
of the pupil a small portion of a gum-elastic tube or sound may be in- 728 
DISEASES OF THE SANGUINOUS FUNCTION. 
Berfced in the opening, which should for a time be repeated every day.” 
(Diseases of the Ear.) This is now abandoned. 
Valuable internal remedies for this form of deafness are : Kali-hy- 
driod., Mereurius-hydriod., Sulphur. We prefer the low attenuations, 
given every night for a considerable period. 
4. Inflammation of the Membrana Tympani.—This inflammation 
generally extends to the adjoining parts. It may terminate by resolution, 
suppuration, seldom by catarrhal effusion, though this last is the ordi- 
nary termination of chronic inflammation. 
Causes.—The most common cause is picking the ears; any other ir- 
ritation may produce it. Foreign bodies in the ear, retrocession of 
external eruptions, as itch from the skin, or tinea capitis, are common 
causes. 
Symptoms.—Acute pain and fever, increased by the slightest noise 
or opening the mouth, show acute inflammation. Chronic inflamma- 
tion ; less painful; mucous or serous excretion; itching within the 
ear; at later stages the hearing is difficult from the thickness of the 
membrane. 
Acute inflammation is generally soon cured. Chronic generally 
leaves some hardness of hearing after it. 
Treatment.—1. The measures that reduce inflammation in general. 
2. If the disease has been caused by the repulsion of eruptions, the 
case must be treated by antipsoric remedies capable of reproducing or 
curing the original eruption. 
3. Some advise the softening of the secretion by emollient vapors, 
washing the ears out with warm soothing liquids ; lay over the ears 
cotton-batting wet with warm oil of almonds. 
Local washes injected into the ear. Cleansing the ear with mild 
warm suds of Castile-soap. 
External irritation to the back of the ear has been much practiced. 
Blisters have produced bad effects, as in the following case: A sol- 
dier, who had passed many nights on guard during the siege of Lyons, 
had rheumatic pain in the ear. This afterwards ceased, but there re- 
mained a buzzing noise in the ear and difficulty of hearing. A blister 
was applied over the mastoid region which increased the buzzing sound. 
Another surgeon healed the blister, and applied another on the arm, 
which cured both the buzzing and the deafness. 
Madame G , in Paris, had inflammation of the external meatus 
of both ears, involving the membrana tympani. After a great many 
remedies, the inflammation was apparently subdued by caustic over the 
mastoid region on each side. To the inflammation now succeeded a 
degree of deafness, which every day grew worse ; it having commenced 
the same day that the caustic was applied. These and many similar 
cases show that blisters, caustics and especially issues produce con- DISEASES OF THE EAR. 
729 
gestion in the mastoid cells instead of relieving them and hence these 
drains become causes of deafness. (Sassy, on Diseases of the Ear 
Paris, p. 45.) 
In the first period of the inflammation, give Aconite and Belladonna, 
every four hours until the acute symptoms have subsided. After this 
Ilepar, Mercurius-corrosivus, Graphites, and- China will probably be in- 
dicated. 
In the use of local applications extreme caution should be used, in 
order that no undue irritation shall be excited or kept up, by their em- 
ployment. Much injury is often produced by too frequent and too ac- 
tive local appliances. In these cases, as in many others, unassisted 
nature not unfrequently restores affected parts, which the efforts of art 
would only have injured. 
5. Ulcerations of the Meatus Externus.—No membranes of the 
body seem so often the seat of local diseases as the part of the tegu- 
mentary system which lines the orifices of canals leading to internal 
cavities. Here the skin and mucous membrane are blended into and 
insensibly assuming the character of each other. Thus the muco-cuti- 
cular membrane of the lips, that of the meatus, the prepuce and the nose 
are characterized by the combined qualities of the skin and mucous mem- 
brane, perform the offices of each other and participate also in each 
other’s diseases. Thus also these different membranes influence each 
other by sympathy called continuous. A morbid state of the mucous 
lining of the stomach diffuses itself along the membrane till it comes 
to the skin, and this is also true in regard to disease located in the 
skin. Thus we have cases of disease within and without. This ac- 
counts for the frequency and obstinacy of ulcers of the meatus, eyelids, 
lips, prepuce, &c. 
In some of these regions morbific humors seek for an outlet, forming 
ulcers, frequently of scrofulous or psoric character. 
6. Abscess of the Meatus.—This is known by the purulent discharge 
as more sanious than pus commonly is. It requires local cleansing 
with fine soap and water, and protection from the cold air. And then 
it needs constitutional treatment for the general psoric or scrofulous 
diathesis, which is always present in patients in whom the abscess 
tends to become chronic. The hearing is soon injured, the morbid 
granulations grow up and overspread the membrane, excluding the un- 
dulations of the air; or the ulcer spreading more slowly destroys the 
membrane, the delicate small bones and extends to the accoustic nerve. 
Treatment.—If the disease is of recent origin, we may at once cure 
it by cleansing the meatus with washes of water with Castile-soap, and 
treat the general condition, as it may be febrile, scrofulous or other- 
wise. Other more remote irritations must be removed. Difficult den- 
tition is often accompanied by abscesses within or behind the ears 730 
DISEASES OF THE SANGUINOUS FUNCTION. 
Irritation from the stomach from noxious indigestible food, worms, &c., 
increase general fever and determinations to the head. These sources 
of irritation must he sought for and removed. The constitutional 
treatment and proper cleansing of the ear ought to he successful with- 
out the local mineral injections recommended by authors. In those 
cases in which the abscess becomes chronic and lasts for years, we 
must always succeed by internal treatment of the general dyscrasia as 
has been done in many cases of which we give a few examples, p. 732. 
Hepar-sulph., Calcarea-carb., Sepia, Mercurius-hydroid., Aurum- 
met., and Silicea are the medicines most likely to be required in this 
affection. If the disease is recent the lower attenuations should be 
employed ; but if of long standing, the higher preparations should he 
prescribed at long intervals. 
7. Rupture or the Membrana Tympani.—Causes.—Violent use of 
ear-picks, sneezing, erosion of the membrane by acrid pus. This cause 
is the most common. 
The accident is usually known by air proceeding from the ear with 
a buzzing sound, so that a hair or the flame of a wax-candle shows the 
current. If injections are thrown into the ear, the fluid comes out 
through the mouth or nose; also by injecting*a fluid into the eusta- 
chian tube it passes out through the ear. 
Treatment.—Art has done nothing to restore the perforated mem- 
brane. Nature can do with it as she does the puncture of the mem- 
brane made by art. If the membrane is much injured, the hearing is 
injured or lost, as the small bones of the inner ear are connected with 
this membrane and it is essential to hearing. Some recommend a false 
membrane to keep out the external air, but a little wad of cotton is 
sufficient. The disease is incurable by art; but a constitutional treat- 
ment with proper antipsoric remedies will greatly improve the patient’s 
general condition, and avert further progress of local disease. 
Many cases of rupture of the membrana tympani originate in the se- 
vere concussion of the air from the firing of cannon; gunners, particu- 
larly in the naval service, aware of the great danger to which the ear 
is exposed, plug their ears well with wool. The wrool gives only par- 
tial protection. The effect of position with reference to the gun is pe- 
culiar ; those men who stand nearest the muzzle feel the report most 
and those who are to leewTard suffer more than those to windward 
Some protection to the ear is said to be afforded by keeping the mouth 
open when listening to heavy firing. During the French revolution a 
dog, w'hich stood near a cannon, was seen to run away and complain 
loudly when it was fired. Blood ran from his ears ; he ran into a house 
and died. The membrana tympani was found ruptured. 
Dr. Von Mosckzisker says, the injury of the ear by loud explosions 
may be obviated by u saturating a piece of cotton in a solution of Gly- diseases of the ear. 
731 
cerine and Belladonna, and placing it as far within the ear as possible. 
This solution forms a coating for the surface of the membrane, and 
with the addition of the cotton protects the drum of the ear to the 
fullest extent. It can be afterwards washed out with warm water.” 
8. Polypus of the External Surface of the Membrana Tympani 
—This may originate in any cause which produces irritation of the 
part. Adynamic or ataxic fever frequently end in deafness, accom- 
panied by long-continued suppuration and polypus of the ear. 
Sassy says: “ A young man, aged twenty-two, had adynamic fevei 
ten years before; it left him deaf, with suppuration and buzzing sound 
in the ear. Injections of the Eau de Balarac thrown into the auditory 
passage caused the polypus which made these symptoms to drop off. 
The polypus was like a strawberry, attached by a slender pedicle to 
the membrane. Separation of this caused a slight bleeding only. The 
suppuration and sound ceased and the hearing was immediately and 
permanently restored.” When polypus exists, examination quickly 
shows its presence, but not the point of attachment. It can always be 
removed by twisting it off, or by a cutting instrument, by ligature, or by 
local applications, always duly associated with internal remedies. In 
one case of polypus of the external ear, which completely filled the 
cavity, a cure was effected by Scultetus in part by tearing away and 
in part by the application of the actual cautery. A young girl had 
an excrescence growing from the external ear implanted deeply in the 
cavity, and issuing more than half an inch; it was regarded as a true 
polypus fungus and emitted a foetid purulent discharge from its surface. 
It was removed by lacerations. See p. 426. 
9. Relaxation of the Membrana Tympani.—The membrane pro- 
trudes in the form of a pouch. It may be caused by violent coughing; 
violent inspiration; sneezing; an accumulation of mucus, pus, or Tari- 
ffed air in the tympanum. 
In the latter case it is sufficient to depress the membrane which may 
easily be seen protruding. It may be effected by the end of the probe, 
and the cavity stuffed gently with cotton or lint for forty-eight hours. 
Removing this, a few injections of a mild astringent water occasionally 
repeated for a few days. A weak solution of Sulphate of Zinc will be 
sufficient. 
10. Morbid Tension of the Membrana Tympani.—This may be 
caused by such diseases of the brain and its appendages as produce mor- 
bid acuteness of the sensations. Inflammation of the eustachian tube 
sometimes causes morbid acuteness of hearing. The slightest noise 
disturbs. In some persons the North or North-east wind makes some 
persons peculiarly uncomfortable, with neuralgic pain and sensitive* 
ness of the face, teeth and ears. The South wind relieves them. 
Treatment.—Cure the fever and neuralgia with Aconite, Bell., 732 
DISEASES OF THE SANGUINOUS FUNCTION. 
Baths and vapors, emollient soothing applications to the internal ear; 
fresh glycerine dropped into the ear over which cotton may be applied • 
protection from cold, removal of decayed sensitive teeth, &c. 
Ot^eikea.—Chronic.—The question of the propriety of suppress- 
ing chronic discharges from the ears has perplexed all allopathic au- 
thors. They have concluded that if we make the effort, we must blis- 
ter, purge and give mercurial alternatives at the same; and even then 
the discharge must only be suppressed with slowness and extreme cau- 
tion. They sometimes venture to arrest it in young persons, and also 
where the disease is the result of suppressed evacuations. 
Frederick Hoffmann cured cases of chronic otorrhoea by scarifying 
haemorrhoids and applying leeches to them. A young girl had sup- 
pression of urine and was immediately affected with discharge from 
the ears. On restoration of the former excretion the latter im- 
mediately ceased. (M. Alard, J)e Voreille.) A woman had otorrhoea 
for six months, following on suppression of the menses. When the 
latter re-appeared, the purulent flow from the ears ceased sponta- 
neously. 
But in all ordinary cases suppression of otorrhoea has been pronoun- 
ced dangerous by ancient and modern authors. The effects witnessed 
of suppression have been convulsions, epilepsy, and death. A Vene- 
tian who had an old discharge from his ear arrested, says Sadabert, 
speedily died. A robust and sanguine man, aged sixty, had a consi- 
derable otorrhoea of twenty-five years standing, though in other respects 
he was well. The matter discharged was foetid and very thick. This 
discharge, says Duverney, “ being suddenly stopped the man died in 
twenty-four hours of apoplexy.” Alard says, “an attorney of Paris had 
an ear discharging copiously of matter for a long time ; the humor be- 
ing repelled by cold, the ear became the seat of a violent inflammation, 
which induced violent symptoms, followed by death.” Similar events, 
says the author, should instruct us to be careful to cure these dis- 
charges from the ear while they are recent and not permit them to be- 
come chronic. (Duverney, Traite de Torgane de Vouie. p. 121.) 
Dr. Richards, of N.-J., gives a case of a scrofulous girl, aged nine 
years, who had been troubled for six years with constant purulent dis- 
charge from the left ear. She was treated with Sulphur SO, Hepar- 
sulph. 30, Calc.-carb. 30, and Lycopodium 30, for several weeks. Of 
these remedies Hepar and Calc.-carb. seemed to have some effect, the 
others had none. Feb. 13, 1860, gave them Aurum sixth, six pellets 
three times a day. March 5th, improving. March 28th, cured. Feb. 
of next year there had been no return. ( U. S. Jour. Ilommop. Vol. 
II. p. 491.) 
Ajpis-mel.—Dr. Munger cured a case with the following symp- 
toms with this remedy: Hard, red, somewhat conical swellings, usually DISEASES OF THE EAR. 
733 
on the lower extremities below the knees, but sometimes in the arms, 
and occasionally on other parts. Some no larger than a dime, others 
an inch or two in diameter; heat, redness, extreme soreness, a burning, 
smarting, stinging pain. In from two to six days the spots became 
livid; the swelling, heat and pain subside; but new spots continue to 
appear; slight general swelling of the limbs ; little febrile excitement. 
{New Materia Mediea.) 
11. Induration of the Membrana Tymjpani.—This membrane some- 
times becomes hard, as if cartilaginous or bony. This state may arise, 
1. from inflammation, tumefaction of the glands of the septum, an affec- 
tion which Bartholin declares very common in persons affected with 
abdominal dropsy; 2. from venereal disease ; 3. from intemperance in 
drinking ; 4. from age. 
Symptoms.—Deafness, diminished sensibility of the membrane if it 
be only hardened; but if it be ossified it becomes insensible to the 
probe; then there is want of elasticity, and when firmly ossified the 
membrane emits a sound when struck with the instrument. If the in- 
duration proceed from the venereal virus the expansion of the ear is 
covered with scales easily detached, leaving the organ red; though 
these scales may arise from predisposition to the tetter. A case was 
seen in the Hotel Dieu in Lyon who was completely covered with the 
scales. The nails, hands and feet were hard, thick and of dirty white 
color; ears red and scabby, and hearing difficult. 
Treatment.—Some of these cases have been treated by surgeons 
with injections, others by puncturing the membrani tympani; others 
again by injections through the eustachian tube. 
1. Perforation of the membrane has succeeded when this septum was 
cartilaginous or ossified, the rest of the organ remaining healthy. Also 
in stoppage of the eustachian tube when is is impossible to remove this 
obstacle by other means at hand. Also when owing to malformation, 
chronic swelling or polypus of the nostrils. 
2. This operation is insufficient when the cavity of the drum is ob- 
structed by matter which is so thick that it cannot pass through the 
artificial opening. 
3. It will be useless when deafness depends on paralysis of the audi- 
tory nerve. 
4. It will be equally so in cases of deafness which proceeds from 
catarrhal affections and nervous irritation. 
5. When deafness is the consequence of adynamic and ataxic fevers, 
and the eustachian tube unobstructed, this operation will be in- 
effectual. 
6. This operation, excepting in the first-named cases above, should 
be rejected from the means of treating deafness. 734 
diseases of the sanguinous function. 
In these cases, a long-continued course of antipsoric, or anti-venereal 
remedies, will always produce good results. 
Induration of the membrani tympani and consequent deafness, often 
occur in scrofulous subjects who have suffered from syphilitic affections. 
Such cases are always more or less benefitted by the high potencies 
of Mer curias, Sulphur, Nitric-acid, Calcarea-carb., Llepar-sulph., 
Lycopodium, and Kali-hydriod. 
12. Ozcena.—Ulceration of the lining membrane of the nostrils, at- 
tended with foetid discharge, and sometimes followed by destruction of 
the cartilages, and by caries of the bones of the nose. In some cases 
there is a large accumulation of thick mucus, or incrustations which 
sometimes block up entirely the passages of the nose. When not 
checked, it progresses among the cartilages and bones of the nose, and 
extends to the cheek, producing frightful deformity. See p. 423. 
Causes.—It is generally excited by exposure of the face to cold, but 
the extreme cases are connected with either a scrofulous or syphilitic 
discrasia. 
Treatment.—Remedies.—Teucrium, Sulphur, Pulsatilla, Bell., La- 
chesis, Lycopodium, Causticum. 
Syphilitic ozcena.—Mercur.-sulphuret, Hepar, Aurum, Nitric-acid, 
Lycopodium, Lachesis, Conium. 
Scrofulous ozcena.—Phosphorus, Silicea, Nitric-acid, Conium. 
Arsenicum.—One of the best specifics. Symptoms: pains severe, 
burning and throbbing. 
Lycopodium.—Discharge thick and yellowish. 
Pseudo-ozoena from Foreign Bodies in the Nostrils.—Dr. Culbert 
of Newburgh, N. Y., gives some cases* presenting the following symp- 
toms : “ At first there is merely a feeling of stuffiness and obstruction 
of the nostril. The natural secretion of the nose not escaping freely, 
sooner or later putrefy, and give rise to an ill odor. This putrid mass, 
again, acting as a local irritant, causes increased redness and vascu- 
larity,—in a few weeks or months, congestion and ulceration of the 
Schneiderian membrane, foul secretions, foetid smell and the symptoms 
of constitutional ozoena.” 
In one case a boy, aged four years and a half, had offensive discharge 
from the left nostril through which he was unable to breathe. As the 
family was scrofulous, one member having died of phthisis, and a son 
suffering from hip-joint disease, this nose affection was considered of 
similar origin. The lining membrane of the nostril was congested, 
bleeding when touched, foetid liquid oozing from it. By bringing a 
strong light upon the affected spot, a grayish white substance was 
found, resembling a mass of concreted pus, as large as half a small 
* U. States Jour, of Horn., Yol. I. p. 73. INFLAMMATION of the tongue. 
735 
pea. A small string of mucus-coated substance was drawn down with 
forceps, and was found to be wool from a rose-blanket; following came 
a tea-spoonful of thick mucus mixed with blood. Washing with tepid 
soap-suds speedily cured the ozoena. 
In another case, a boy of three years had been treated several 
months for ozoena with Hydriodide of Potash, Sarsaparilla, and local 
use of Nitrate of Silver. A roll of paper was extracted; castile soap 
washings cured the ozoena in a few days. 
A third child, aged four years, had been treated with Arsenicum 
30°, 60° and 100° without effect. After a putrid pumpkin-seed had 
been blown from the nostril, the child got well without treatment. 
A fourth case was supposed for several weeks to be one of worms; 
showed itching of the nose, pain at its root, headache; face swollen; 
eyes red, sensitive to light. Injecting the nostril with water excited 
sneezing; a grain of wheat was then extracted with a forceps. It had 
lain so long in the upper part of the nostril that it had germinated, “hav- 
ing a root and blade attached; it was one and a quarter inches long.” 
13. Swelling and Inflammation of the External Nose.— 
Treatment.—When caused by a blow, contusion, or fall, Arnica is the 
best remedy. Calendula is also useful. If caused by abuse of Mer- 
cury, give Azarum, Aur., Bell., Ilepar, or Suljoh. Redness of the 
nose, caused by intemperate drinking: Arsen., Calc., Puls., Suljph. 
Redness in scrofulous patients: Iodide, Merc., Suljph., Phos., Calc. 
Copper-redness: Arsen., Cugyr. 
II. INFLAMMATION OF ORGANS AND TISSUES CONNECTED WITH 
THE DIGESTIVE SYSTEM. 
1. GLOSSITIS.—INFLAMMATION OF THE TONGUE. 
Glossitis.—Inflammation of the Tongue.—Inflammation of the 
tongue is by no means a common affection, but cases now and then occur 
in which this organ is so enormously inflamed and swollen, as to place 
the sufferer in imminent danger of suffocation. It may arise spon- 
taneously, with hut few and slight premonitory symptoms of its ap- 
proach, or it may proceed from derangements of the stomach, sudden 
changes of temperature, and the application of irritating or poisonous 
substances. Generally it runs its course rapidly, and if not met by 
prompt and efficient measures, will so fill the mouth and throat as to 
suspend respiration. 
Diagnosis.—Previous to the pain and swelling of the tongue, the 
patient is affected with slight chills, loss of appetite, lassitude, indica- 
tions of disordered stomach, dull pains in the head and back, succeeded 
by throbbing and aching pains in the tongue, heat of the skin, and 
rapid pulse. The tongue now commences swelling, and often pro- 736 
diseases of the sanguinous function. 
gresses, if the inflammation is not arrested, to an alarming extent. 
It is usually red and dry, but in some instances continues moist through 
all the disease. 
Causes.—Derangements of the stomach, exposure to strong currents 
of air, mercurial salivation, small-pox, the application of irritating sub- 
stances, stings of insects, certain poisons. 
Treatment.—The physician is sometimes summoned to cases of 
this description, where the danger of suffocation is so threatening, as 
hardly to render it prudent to await the operation of remedies. In these 
instances free and deep incisions should be made into tho substance 
of the tongue in a parallel direction, which will afford prompt tempo- 
rary relief, and thus allow us time for the action of our specific remedies. 
The remedies which will apply specifically in these cases are, Mer- 
curius, Belladonna, Plumbum, Aurum, Ilejpar, Calendula, Arnica, 
Nitric-acid, Kali-hyd. 
Mercurius-sol.—Expression of countenance anxious and terrified • 
tongue inflamed, swollen, red, dry or moist; respiration exceedingly 
difficult; pulse rapid and full; constant inclination to keep an upright 
position; skin hot and dry. 
Febrile Symptoms.—Heat; thirst; pains in the head, hack and 
limbs; throbbing, stinging, or aching pains in the tongue; mouth and 
throat filled with the swollen organ, giving rise to a dreadful sense of 
suffocation; symptoms somewhat aggravated during the night; rapid 
sinking of strength; respiration rather better in the air, and on gentle 
motion; deglutition partially or entirely suspended. 
Excessive anguish, apprehension, and constant and insurmountable 
dread of immediate suffocation. 
Administration.—Divide two grains of the third trituration into six 
equal parts,—one powder, dry upon the tongue every half hour in 
urgent cases until there is relief, or a medicinal aggravation. In less 
severe cases the medicine may be given once in two, four or six hours, 
according to the symptoms. 
Marcus gives (Magazin ii.) a case of inflammatory swelling of the 
tongue and of the pharynx, which he cured with Mercury. The daily 
experience of all old school physicians, at least, proves that Mercury 
has a specific tendency to produce inflammation and tumefacUon of 
the internal parts of the mouth; even when applied on the skin it 
produces these same effects. 
Belladonna.—Face red; eyes bloodshot, or suffused; tongue in- 
flamed, red, dry and swollen; violent pulsations of the carotid and 
temporal arteries; pulse rapid and bounding. 
Congestion of the blood to the head; throbbing pain in the head; 
eyes sensitive to the light; skin hot and dry; thirst; throbbing, dart- 
ing or drawing pains in the tongue; difficult and anxious respiration: APHTHA. 
737 
deglutition extremely difficult or entirely suspended; sense of suffo- 
cation. 
Great agitation ; fear of death ; anxious and depressed. 
Administration.—A drop of the third dilution on two grains of 
sugar of milk; divide into four equal parts, and exhibit one dry upon 
the tongue once in one, two or three hours, as the urgency of the case 
may demand. 
Plumbum.—Plumbum is appropriate in cases of chronic swelling 
of the tongue, with numbness and partial paralysis. Convulsive trem- 
ors and general muscular debility are other indications for the employ- 
ment of this remedy. 
In cases of glossitis proceeding from the abuse of Mercury, recourse 
may he had to Aurum-muriaticum, Kali-hyd., Nitric-acid, and 
Hepar-sulph. If the inflammation be owing to a wound or injury, 
Arnica is the proper remedy. 
Herpetic Glossitis.—Diagnosis. Redness of the mucous mem- 
brane and development of the papillae, or exfoliation of the epidermis 
thelium; at a later period, partial induration, fissures, ulcerations and 
transformations of the epidermic tissue, smarting, shooting pains caused 
by contact of food and drink, while the sensation of dryness is perma- 
nent. There is generally also a dyspeptic state, either with or 
without haemorrhoids / and the glossitis follows in a remarkable 
manner the modifications which this general herpetic state under- 
goes. When the disease becomes well established, the fissures show 
indurated edges, become deep and are often taken for a syphilitic 
affection, even for cancer. It is often treated by cauterizations which 
may cicatrize the fissure; hut it soon breaks again, and every cauteri- 
zation increases the inflammation or induration. Dr. Escallier {IdArt 
Medical. 1861.) gives the case of a native of Yucatan, in whom the 
disease commenced in 1846. He had sought a cure in Mexico, and by 
a voyage to Europe ; had been five times cauterized and found himself 
worse after each trial; he had been treated with Mercury, and longer 
by Iodide of Potassium. He was at last subjected to homoeopathic 
treatment. He took Sulphur 10° in water, Nov. 2. There was gradual 
improvement. Nov. 4, Staphysagria 6°, was directed; on the 22d the 
digestion and action of the bowels had been good; the tongue moved 
easily and was nearly healed. He continued under treatment till the 
summer of next year; and during this time took Staphysagria 12°, 
Sulphur 80°. Borax for Aphthae, Orpiment and Sulphur 12°, &c. 
Finally returned to Yucatan quite well. 
Aphtha in adults occurs most frequently in the course of other dis- 
eases, and then it indicates debility, imperfect digestion and mal- 
You i.—47. 
APHTHA.—THRUSH.—Muguet.— Stomacace. 738 
DISEASES OF THE SANGUINOUS FUNCTION. 
nutrition. The worst cases are those called stomatitis materna in 
nursing females and those of infantile aphtha in children at the period 
of lactation. We shall treat of them separately. 
1. Aphtha Infantilis.—This disease appears in small white ulcers 
upon the tongue, gums, and around the mouth and palate, resembling 
small particles of curdled milk. When the disease is mild, it is con- 
fined to these parts ; but when it is violent and of long standing, it 
generally extends through the whole course of the alimentary canal, 
at least in the oesophagus, so far as is supplied by reflected epidermis. 
We have here in the mouth and upon the tongue the white, creamy, 
circular spots, which are scattered but tend to coalesce at their margins. 
These spots form little islands of a matter which at first is very white, 
and not easily destroyed or removed. The islands consist of a species 
of small grains which are distinct and opaque, having nothing resembling 
vesicles filled with liquid. On the inner surface of the cheeks these 
productions bear a close resemblance to milk-curds arranged in clots. 
Among patients having a continuous coating of thrush,—the exudation 
having become yellowish or brownish in consequence of matters vom- 
ited, of blood effused, or of medicines taken, the pellicles are less re- 
sisting, easily broken and their adherence to the mucous membrane is 
delicate. The deposit is smooth, and in consequence of its not involving 
the deeper layer of epithelium, is not accompanied by ulceration. 
The salivation is not extremely abundant. It is known, that in some 
cases of children the milk is quickly acidulated in the mouth. In mild 
cases of muguet, the saliva becomes diminished by the acidity of the 
buccal mucus, as is proved by the reddening of litmus paper when it is 
brought into contact with the mucous membrane. 
The disease in severe cases is attended by drowsiness, sickness, 
feverishness, severe purgings, flatulencies and other disagreeable symp- 
toms, the surface remains brown or bluish after the loosening and sepa- 
ration of the crusts; the local affection runs into a bad kind of gangre- 
nous ulceration; the discharges from the bowels contain slime and shreds. 
Aphtha sometimes appears as a chronic disease in warm, moist and 
malarious climates. It begins with evident derangement of the stomach, 
acidity and uneasy feeling or burning in the stomach, increasing gradu- 
ally in violence. After some time, small pimples of the size of a pin’s 
head appear on the tip and edges of the tongue ; these soon spread 
over the whole inside of the mouth, causing tenderness and rawness, 
till the patient can not take any solid food; acid and stimulating drinks 
cause pungent burning pain. There is little febrile heat; but the skin 
is dry, the countenance pale, the pulse is small, the extremities cold. 
In debilitated children improperly nourished the aphthous ulcerations 
become gangrenous ; the edges shrink, become flabby and ragged; a 
brownish slough forms in the centre ; and on coming off, a granulated APHTHA. 
739 
surface of vermillion color remains ; the ulcers become covered with 
a brown, creamy fluid, which exhales a gangrenous odor; the parts 
around the ulcers become tumid, soft, and of a violet hue. The saliva 
becomes foetid, ropy, flowing from the half open mouth. Countenance 
pale and puffy ; the pulse feeble ; surface of the body pallid, deficient in 
sensibility. The vomiting and diarrhoea become profuse, exhausting; 
abdomen tympanitic; hiccough and eructations precede complete ex- 
haustion and death. 
Pathology.—When a portion of the pseudo-membranous layer that 
spreads over the inside of the mouth, fauces and oesophagus is minutely 
examined, the following appearances are seen by aid of the microscope: 
The substance is composed entirely of a collection of cryptogamic plants. 
M. Gruby says, the roots are cylindrical in form, transparent, and about 
-rhrth part of a millimetre in diameter, and implanted in the cellules 
of the epithelium. During their development, projections from these 
roots penetrate the entire series of cellules of which the epithelium 
is composed, to arrive at the free surface of the mucous membrane. 
These parasitic plants have some resemblance to the cryptogamic 
plant called the sporotrichium. They are fragile, easily detached by 
the movements of the tongue and lips; and, by mixing with the food, 
they are carried downward; and thus they become transplanted to other 
portions of the lining membrane of the oesophagus, and in some in- 
stances to the lower intestines. Children in whom this extension of the 
disease takes place to any great extent, fall into a state of marasmus, 
and soon die. (See Drs. Gruby, Berg, Oesterlein arid Condie.) 
2. Mercurial Stomatitis.—In this form of aphtha, which is only a 
result of mercurial poisoning, the salivation appears in advance of the 
membranous formations. This salivation differs entirely from that 
which accompanies other pseudo-membranous affections. 
The appearance of the false membranes of mercurial stomatitis is 
that of grayish concretions which are not very adherent, and which 
are frequently covered by ulcerations. They have been observed upon 
the tongue and upon the cheeks, with elevations which correspond to 
the intervals between the teeth, and which are frequently more reddened 
than the remaining mucous membrane, of which the tint is grayish or 
ash-colored. 
3. Ulceromembranous Stomatitis.—The appearance here is alto- 
gether different from the last. In such cases there is always some 
ulceration beneath a soft and yellowish cast. This cast is sometimes 
strongly adherent in its middle portion. The ulceration is frequently 
covered by a simple whitish exudation, or by sanious pus. The edges 
are swollen, the base ecchymosed, and sometimes of a brownish color. 
The submaxillary glands are engorged. When the ulceration is located 
upon the dental borders we find the alveoli occupied by a chalky pulp • 740 
DISEASES OF THE SANGUINOUS FUNCTION. 
the gums are raised, fungous, of a reddish or violet red hue. (Ldboulbene 
on Pseudo-membranes.) 
4. Chronic Exanthematous Eruptions of the Intestinal Canal. 
Symptoms.—General indefinable debility and emaciation; a condition 
often of broken and impaired health without any very appreciable 
cause; the muscular system easily fatigued and exhausted; sometimes 
so much palpitation as to lead to the idea of heart-disease; the cir- 
culation weak, as shown by the coldness of the extremities, diminution 
of nervous power, irritability, &c. Direct evidence of the presence of 
and tendency to mucous eruptions in such subjects, can generally be 
obtained by carefully examining the state of the mucous membrane 
within sight. Spots of eruption and sometimes ulcerations left by them, 
will frequently be detected on the inside of the lips and cheeks and on 
the gums and tongue. The tongue, with the mucous membrane lining 
the cheeks, is not unfrequently so swollen as to be marked and indented 
by the impression of the teeth. Sometimes when thus enlarged, the 
tongue is whiter than usual; but in other cases we see it red and ir- 
ritable, and one or more distinct and broad patches of eruption are seen 
upon its surface. {Dr. Simpson of Edinburgh.') 
Acute exanthematous inflammations generally form a “complementary 
addition to eruptions on the general integument sometimes they 
are “ vicarious with the crisis of an exanthema upon the skin, which 
from various influences of which we are ignorant, is insufficiently de- 
veloped sometimes they constitute a specific eruption, arising from 
a special relation between the general disease and a particular tract 
of mucous membrane. The two first of these varieties appear on the 
mucous membrane, where it joins the original seat of the disease, as in 
the mouth, pharynx, tracheal passages, conjunctiva, or urethra. The 
last kind is confined to particular parts of the mucous system, as the 
ileum in .typhus, or the colon in dysentery.”! Chronic exanthematous 
affections have as yet been little studied. 
5. STOMATITIS MATERNA.—NURSING SORE THROAT. 
General Symptoms.—Anaemia is seldom wanting in well-marked 
cases. The complexion is less waxy and clear than in chlorosis, with 
more of the sallow and cadaverous shade than is seen in other diseases. 
The tint is peculiar, and is recognized at first sight. It is dependent 
on the anaemia, and in common with the other symptoms is attributed 
to local irritation and suffering superadded to a cachexia which is in 
some cases related to scrofula, in others to scorbutus. 
The Diagnosis generally turns on the general condition of the pa- 
* Dr. Helmuth. U. States Jour. Horn. Yol. I., p 407. 
t Rokitansky, Path. Anat Yol. III. p. 55. STOMATITIS materna. 
741 
tient. The disease presents the peculiar characteristic local symp- 
toms and is found in subjects who are either enciente, or in some one 
of the stages of recovery from the puerpural state. The aphthae of 
advanced phthisis, with which it is often confounded, is a different and 
much more fatal disease. 
Treatment of Stomatitis.—Arsenicum-album.—Stomatitis oc- 
curring in malarious districts, most of whom have been injured by 
Quinine; or where the water is more or less stagnant, and impreg- 
nated with the common causes of malarious fever. There is a de- 
praved condition of the system analogous to typhus; the local erup- 
tion is vesicular in character; there is dryness and inflammation of 
the buccal mucous surfaces. The edges of the tongue are ulcerated; 
aphthae, violent burning pains; swollen and readily bleeding gums, 
looseness of the teeth; debility; sinking. 
Calcarea-carbonica.—Dr. Ludlam gives the following indications : 
In cases where disorders of digestion, in pregnant or lying-in women 
are due to a stomatitis which may be either latent, or may have already 
so far localized itself that its real nature may be known; the constitu- 
tion of the patient is scrofulous or consumptive; there is inveterate 
diarrhoea,not relieved by other remedies. There is “great dryness of 
the mouth and tongue, with a sense of roughness and stinging; a dry, 
hitter, sour, or metallic taste in the mouth; great aversion to boiled 
food, and to meats in particular; inclination to salt diet, or to eat such 
forbidden articles, as pickles, dirt, chalk, slate-pencils, tkc., strong and 
unconquerable desire to sleep after dinner or tea; nausea, with acid 
eructations ; vomiting of the ingesta; profuse colliquative diarrhoea, the 
stools being sometimes quite undigested ; faintness, with swooning, after 
stool or exercise ; a sudden metastasis of the eruption from the mouth 
to the alimentary mucous membrane ; acidity of the urine, with burn 
ning of the urethra, &c. The third decimal trituration, repeated thrice 
daily. {Amer. Horn. Review. 1860. p. 252.) 
Mercurius.—Red, spongy, receding, ulcerated gums, with burning 
pains at night, soreness when touched; loose teeth, inflamed, sore, ul- 
cerated tongue and mouth, covered with aphthae; foetid cadaverous 
smell of the mouth and ulcers; saliva profuse, foetid, bloody; ulcera- 
tion of the stenonian duct; tongue swollen, stiff, hard, or moist and co- 
vered with white mucous; face pale, chills; burning diarrhoeic stools. 
The eruption on the mucous membrane assumes the form of ulcers, 
more or less corroding and destructive of the tissues, and there is pro- 
fuse secretion of saliva. When the corroding tendency is manifest and 
the breath has an offensive putrefactive odor it is recommended to al- 
ternate the Mercurius-vivus once in four hours. 
Ratrum,-mur.—Swollen gums, readily bleeding; sensitiveness to 
cold or hot substances , ulcers and blisters in the mouth, on the tongue 742 
DISEASES OF THE SANGUUnOUS FUNCTION. 
and gums, with burning pain and impeded speech; ptyalism, rigidity 
of tongue. 
Nitric-acid.—Bleeding; white swollen gums ; loose teeth ; sore 
mouth with stinging pains ; foetid smell of the mouth ; ptyalism. 
Huriat.-acid.—This is one of the best constitutional remedies; i 
is recommended where it is believed that the disease has a parasitica 
character. 
Nux-vomica.—In incipient cases first manifested “ through perverse 
disorders of the nutritive system; suspend it when the eruption appears 
in the mouth, especially after diarrhoeic symptoms begin. 
Sulphuric-acid.—Aphthae in the mouth ; swollen, ulcerated and rea- 
dily bleeding gums; profuse ptyalism. 
Sulphur.—Gums bleeding and receding from the teeth, with throb- 
bing pains ; blisters and aphthae in the mouth and on the tongue, with 
burning and soreness when eating ; foetid and sour smell of the mouth; 
ptyalism, or bloody saliva; tongue thickly coated, whitish or brownish; 
slimy, greenish stools, with tenesmus; rash; restlessness at night. 
Veronica-baccaburga.—Dr. Prentice of Freeport, 111., says, he has 
used this plant in the first decimal trituration with great success for 
years; also applying it as a local wash. 
Local Treatment. Dr. Curran, of Hannibal, Missouri, recommends 
the Oleum-juglandis (Butternut-oil). All local treatment will fail ex 
cept when associated with appropriate constitutional remedies. 
Frasera-carolinensis.—Dr. Murch directs a gargle of an infusion 
of this plant for the mouth, also for the nipple when very sore and sur- 
rounded with vesicles. Hydrastis is a still better remedy. 
For further remedies see page 248. Also Scurvy.—Index. 
Diet.—This must be that which is best calculated to promote the 
general health, allowing for all peculiarities of condition and idiosyn- 
cracies of the patient. It must be as nutritious as can be digested 
and assimilated. 
It may include, beef-tea, oyster-soup, good, dry, mealy potatoes also. 
Vegetable acids, as baked apples, oranges, or weak lemonade. Many 
of the cases which have baffled allopathic skill and are not promptly 
cured by homoeopathists, are scorbutic in their character and can not 
be cured without these grateful acids. 
4. PAROTITIS.—MUMPS. 
This affection is classed by writers as an epidemic. It more com- 
monly attacks children, than adults, and generally makes its appear- 
ance during cold and damp seasons. Its cause is a specific morbific 
contagion, which may be generated during certain peculiar conditions 
of the atmosphere, or it may be communicated from the bodies of those 
Having the disorder. MUMPS, 
743 
Diagnosis.—Slight febrile disturbance, followed by swelling and 
pain in one or both parotid glands. Under favorable circumstances 
the local affection continues to progress until the end of the fourth day, 
at which time the inflammation and swelling have reached their height, 
then tumefaction and pain gradually subside, until at the end of about 
seven or eight days from the commencement, all traces of the com- 
plaint have departed. As soon as the inflammation has fairly de- 
clared itself in the glands, the patient experiences much difficulty 
and pain in moving his jaws, masticating, or even the sight of savory 
food, especially acids. 
It is highly important during its progress, that there be no exposure 
on the part of the patient, either to cold or dampness, nor from any 
undue mental or physical excitement. In this manner we may guard 
against those troublesome metastases to the brain, mammae and testes, 
which sometimes supervene from improper exposure, external appli- 
cations, &c. 
The pain of the swollen part is of a tensive character, combined with 
pressure, rendering both chewing and swallowing difficult. When the 
disease affects one side only, the face appears drawn to one side. 
Often the cellular tissue and the skin overlying the gland are inflamed, 
and then the patient seems to have erysipelas. 
Sympathetic swellings often affect only one testicle, and then it has 
been noticed only on the side opposite to the seat of the mumps. The 
scrotum over the testicle is more or less swollen and red. Sometimes 
after the disappearance of the mumps a metastatic inflammation of the 
testicle is developed, when there is shooting or bruised pain in it. 
In mumps there is generally fever, a full tense pulse and great heat; 
head hot, aching hot feeling of the head; shooting hard pain in the 
affected parotid; redness of the face, in some cases of the conjunctiva; 
photophobia and flow of acrid tears ; thirst; constipation. 
A severe epidemic of cynanche parotidea catarrhalis is described by 
Dr. Baertl. {Brit. Jour. Ilomceop. 1861.) The disease was preceded 
by feelings of general illness; ill-humor; prostration of strength, dis- 
turbed restless sleep, want of appetite, shivering, alternating with heat; 
headache, extending to the neck ; coryza and uneasiness. A few days 
afterwards the region in front and beneath the ear became swollen and 
hard, generally also red and painful; sometimes nearly the whole neck 
swelled also, and the sub-maxillary glands and tonsils were affected. 
The fever in some epidemics affects the chest, when there is cough 
with but little expectoration of mucus ; heat and aching of the chest; 
there is also sleepiness; restless sleep at night, starting on falling 
asleep, and horrible dreams. In these severe cases the patients are 
prostrated and depressed at the commencement of the disease. 
Duration of the disease: about one week, at most fourteen days. 744 
DISEASES OF THE SANGUINOUS FUNCTION. 
Causes contributing to its Development.—Atmospheric influences. 
Suppression of the perspiration, a catarrhal predisposition. 
Termination of the disease, usually in resolution on the third or 
fourth day by a general warm perspiration. The sleep becomes more 
tranquil, the fever declines, the swelling subsides, and other morbid 
symptoms disappear. 
Treatment.—But little medicinal treatment is required in this ma- 
lady, provided the precautions just alluded to are heeded ; a few doses 
of the sixth dilution of Mercurius-sol. being all that is necessary to 
conduct the patient happily through the attack. 
Sometimes, however, coma and other alarming symptoms of cerebral 
disorder, suddenly appear from metastasis of the disease to the brain, 
which require the prompt administration of Belladonna, Opium, or 
other cerebral specifics. More commonly, however, the metastasis oc- 
curs to the mammae or testes, causing inflammation, swelling, indura- 
tion, and occasionally suppuration in these glands. The remedies in 
these cases are Mercur.-sol., Bell., Nux., Puls., and Aeon. See the 
particular indications for these medicines under “ Inflammation of 
the Mammae and Testes.” 
In severe cases, keep the patient in bed, covering him with a moderate 
supply of clothing; regulate the food and drinks. 
The external swelling may be covered with dry flannel; the swollen 
scrotum should be placed in an elevated position and covered with dry 
cloths and supported by a suspensory bandage. 
Belladonna.—In the epidemic described by Dr. Baertl, it proved a 
specific, effecting rapid amendment and cure. It was generally given 
in the third dilution, a few drops in several ounces of distilled water, 
a table-spoonful every three hours. On the decline of the disease the 
intervals are lengthened. 
Mercurius-solubilis.—Used with success when the inflammation is 
not highly marked. It should be given as high as the third trituration, 
and in the milder cases, when it will be effectual if given only once per 
day. 
Calcarea-carbonica.—In cases in which the course of the disease is 
slow, and almost without fever. 
Mercurial Parotitis.—This form of parotitis never exists as a pri- 
mary affection, but follows other diseases in which Mercury has been 
used. When the original malady has arrived at that stage in which it 
seems entirely subdued, and the patient is lingering between disease 
and convalescence, he suddenly complains of a pain and swelling be- 
neath and in front of the ear. The affected spot soon shows a throb- 
bing tumor, which is extremely tender to pressure by the finger or the 
pillow ; and it increases, becoming painful, lancinating on every motion 
of the jaw, spreading anteriorly with great rapidity. In a few hours, MUMPS, 
745 
the whole side of the head becomes involved; the eyelids, lower jaw 
side of the neck, the cellular tissue of the neighboring parts, the 
periosteum, muscles and parenchyma of the glands, are all included in 
one mass of inflamed tissues rapidly advancing towards suppuration. 
The skin over the tumor is red, smooth, tense and glossy; when felt 
by the hand, it emits a peculiar burning heat, and the hand feels as if 
pricked by needles. The surface resembles an inflamed spleen, co- 
vered with serous membrane. 
As the disease advances, the pain becomes more intense, burning, 
and lancinating. Swallowing is now exceedingly painful. The coun- 
tenance is flushed and livid, and suffocation begins to be threatened. 
When the intumescence has reached its height, the pain subsides. The 
head has now a feeling of dull heaviness ; the tumor becomes livid; 
there is deafness of the ear of the affected side, low muttering deli- 
rium, with other symptoms of cerebral oppression and deep nervous 
prostration. The tumor at this period begins to present evidences of 
suppuration ; it becomes soft and fluctuating; the abscess soon bursts 
spontaneously, and discharges generally in small quantities a sero-pu- 
rulent matter, from a surface which is beginning to assume a gangrenous 
appearance. But the discharge is not followed by the slightest im- 
provement ; the parotid gland continues hard and firm; the cellular 
tissue begins to slough off in flakes and masses resembling wet tow; 
the pulse, which in the beginning of the disease was hard, quick and 
contracted, becomes now small, weak, and about one hundred and fifty 
per minute; the cerebral excitement continues to increase till the pa- 
tient sinks from exhaustion, or, if the abscess makes its spontaneous 
opening inwardly he suddenly dies from strangulation. The disease 
usually runs its course in four or five days ; it never occurs during the 
progress of active ptyalism, but follows a sudden subsidence of the or- 
dinary form of mercurial action, or supersedes it in peculiar constitu- 
tions. This is only one of the many disastrous results that have often 
followed the use of Mercury even in small doses. The physician whose 
prescription has caused one such result, as the disease above described, 
has suspended his patient’s life and his own reputation against the 
mere dust of the apothecary’s scales, and is astonished to find that he 
has lost them both. 
Parotid Gland, Induration of.—Case of Baron Kaczkowsky of 
Vienna.*—The baron says he took cold in 1840, from exposure while 
performing a difficult surgical operation, which induced a rheumatic 
attack. He was treated with various drastic remedies, cataplasms of 
mustard, Russian steam-baths, &c. The swelling of the joints sub- 
sided, but the parts remained very sensitive to changes of temperature, 
* Monthly Magazine of the Ilomoeopathists of Austria. 746 
DISEASES OF THE SANGUINOUS FUNCTION. 
with evident proneness to rheumatic pains and disposition £o inflam- 
mation of the throat. This ultimated in hypertrophy of the tonsils, 
which wrere at length removed by excision. The throat disease termi- 
nated in “ an inflammation and swelling of the glands beneath the right 
ear. In spite of the remedies employed it became indurated and en- 
larged to the size of a man’s fist, extending to the clavicle and causing 
violent pain upon turning the neck.” After the whole medical and 
surgical therapeutics had been exhausted, and the baron in the course 
of six years had undergone every variety of treatment without even 
the slightest relief, the swelling was larger than ever. In April, 1851, 
he was induced to try homoeopathic remedies. He took every morning 
one drop of Belladonna of the sixth dynamization, alternated every 
second day by one grain of Hepar- sulphur in the evening, of the same 
potency. In two days striking improvement was manifested in the in- 
durated swelling of the gland, and the homogenous, hard mass began 
to disperse into separate smaller and painless knots; and in like pro- 
portions the motions of the neck became easier. Before the end of 
July the swelling as well as the pain and stiffness of the neck had en- 
tirely disappeared. Certain hsemorrhoidal complaints that had troubled 
him for a long time had also totally ceased. 
Diagnosis.—Febrile symptoms, succeeded in a few hours by sore- 
ness of the throat, painful deglutition, swelling, and smooth, shining 
scarlet redness of the tonsils, uvula and soft palate. As the tonsils 
continue to enlarge, deglutition and respiration become more difficult, 
the voice is changed, the pains increase in severity, extending often 
through the eustachian tubes into the ears, the tongue becomes covered 
with a thick yellow fur; there is an abundance of viscid saliva on the 
tongue and tonsils; the breath acquires an exceedingly offensive odor, 
which, according to Mackintosh, proceeds from sebaceous matter es- 
caping from the mucous follicles. 
The disease may terminate in resolution, suppuration, or in perma- 
nent induration. When the appropriate remedies are administered at 
the commencement, the inflammation usually resolves itself without 
suppuration. If no medicines are given, or those only which are in- 
appropriate, the disorder usually progresses until suppuration ensues, 
when an artificial opening is made, or the tonsil bursts spontaneously, 
and the swelling and inflammation gradually subside. 
Not unfrequently the tonsils become affected with chronic enlarge- 
ments and indurations, from frequent and partially subdued acute 
attacks, which prove exceedingly troublesome by their proneness to 
take an acute inflammation for the slightest exciting causes. 
TONSILITIS QUINSY. QUINSY. 
747 
There is often reason to suppose that chronic enlargements of the 
tonsils often lead to cough and expectoration of purulent matter, which 
are confounded with and erroneously attributed to chronic bron 
chitis, &c. 
Causes.—The predisposing causes are : Inherited scrofulous dis 
crasia, irritability, chronic enlargement of the tonsils from mercuria 
salivations, and derangements of the stomach and bowels. The common 
exciting causes are, cold, atmospheric viscissitudes, wet feet, and the 
common causes of fever or inflammation. 
Treatment.—The best remedies for tonsilitis are: Belladonna, 
Mercurius, Aconite, Baryta-carl)., JSux, Pulsatilla, Jleyjar-suljjh. 
and Kali-bichrom. 
Belladonna.—Cheeks flushed; violent pulsations of the carotids; 
enlargement of tonsils perceptible on the outside of the throat; tonsils, 
uvula and soft palate, inflamed, dark, red and swollen; tongue dry, or 
covered with a thick, transparent and tenacious mucous; skin hot; 
pulse full, hard and frequent; voice hoarse, stifled or suppressed. 
Headache; burning and shooting pains in the throat, when swallow- 
ing; constant inclination to swallow; choking sensation; tonsils pain- 
ful to the touch; putrid or bitter taste; thirst; eyes sensitive to the 
light; stitches extending into the ears; deafness from obstruction of 
the orifice of the eustachian tube ; burning fever. 
Uneasiness and dejection; worse at night, and occasionally delirium 
Administration.—Two drops of the third dilution to two grains of 
sugar of milk. Divide into six parts and exhibit one dry, once in two 
to four hours, as long as possible. 
Mercurius.—Offensive, putrid odor from the mouth ; tongue covered 
with a thick, yellow fur; mouth dry or filled with viscid saliva; uvula 
elongated and red; tonsils and soft palate dark red, inflamed and en- 
larged ; roots of the tongue red and swollen; ulcers in the mouth and 
throat; enlargement of the parotid or sub-maxillary glands; pulse fre- 
quent and moderately full. 
Heat, alternating with chills ; frequent profuse sweats; stinging and 
shooting pain in the throat, particularly when swallowing; very great 
difficulty in swallowing; although frequent inclination; glands of the 
neck painful on motion of the jaws, at sight of savory food, or on 
swallowing; the pains and difficulty of deglutition worse at night; pains 
darting through the eustachian tube to the ears and parotid glands; 
loss of appetite and disgust for food; putrid or coppery taste; thirst 
for cold drinks; symptoms migitated during repose in bed. 
Morose ; dejected; uneasy; out of humor. 
Administration.—Divide four grains of the third trituration into six 
powders,—give one dry, upon the tongue, once in four to six hours until 
an impression is apparent. 748 
DISEASES of the sanguinous function. 
Aconite is a suitable remedy in cases of tonsilitis attended with a 
high grade of arterial reaction, painful deglutition, bright redness of 
the fauces, uvula and tonsils, with pricking or burning pains when 
swallowing. 
Administration.—A drop of the third dilution to two grains of sugar 
of milk. Divide into four parts, and give one dry, once in two hours 
until the symptoms abate. 
Baryta-carbonica may be given in cases of catarrhal tonsilitis, 
where there is suppuration of the tonsils, swollen and elongated uvula, 
rawr, scraping or shooting pain on swallowing, obstruction, as if by a 
plug in the throat, bad taste, offensive breath, especially in the morning, 
and discharge of sebaceous matter from the follicles of the throat. 
Administration.—The same as Aconite. 
Nux-vomica.—When derangement of the stomach appears to be the 
prime predisposing cause of the complaint, and when the symptoms of 
the acute attack are, scraping pains during deglutition, or when inhaling 
cold air, obstruction from the enlarged tonsils, choking and spasmodic 
contractions of the throat when swallowing, Nux-vomica is the specific 
remedy indicated. It may be given at the third dilution, by means of 
sugar, like Aconite. 
Pulsatilla will apply in cases arising from a chill by being wet, wet 
feet, &c. The signs for this remedy are, burning, scraping, smarting 
or shooting pains in the throat when swallowing; deglutition obstructed 
by viscid mucus which adheres to the tonsils and fauces ; pains worse 
in the afternoon and evening; bitter or saltish taste in the mouth, loss 
of appetite; unnatural taste of food; tongue furred with a thick yellow 
coat, and breath offensive. 
Administration.—A drop of the third dilution on sugar. Divide 
into four parts, and let one be given dry, once in four hours until the 
desired effect is produced. 
Ilejpar-sulphur has been much employed in those habitual cases of 
inflammation and suppuration of the tonsils which appear to owe their 
origin to a scrofulous dyscrasia. This medicine occasionally arrests 
the disease and prevents suppuration, after Belladonna, Mercurius 
and Aconite have entirely failed to produce an impression. It may be 
given in grain doses, at the third trituration, once in two hours. 
5. ANGINA MALIGNA.—Putrid Sore Throat. 
See Scarlatina Maligna, p. 592. 
6. PHARYNGITIS.—Inflammation of the Pharynx. 
The pharynx, the muscular funnel-shaped bag at the back part of the 
mouth which terminates in the oesophagus, is liable to inflammation from 
cold as well as from other causes. INFLAMMATION OF THE PHARYNX. 
749 
Tkeatment.—Aconite.—Simple and uncomplicated inflammation or 
“ sore throat.” Other remedies are : Bell., Canth., Lach., Merc. 
Inflammation with spasmodic constriction of the fauces : Bell., Ilyos, 
Lachesis,Stram., Yeratr.-alb., Arsen., Coccul.,Ignatia, Laur.-cer., Lycop., 
Nux-vom., Opium. 
Sensation of a foreign body in the throat:—Arsen., Ign., Merc., 
Nux-vom., Puls., Bell., Lach., Sulph., Lobelia. 
Inflammation of the Yelum palati: Ac., Coff., Merc., Cinnabar, Nux.- 
vomica. 
Inflammation of the uvula: Bell., Coff., Cinnabar, Nux-vom., Calc., 
Senega, Sulph., Sanguinaria. 
Tartar-emetic.—Pharynx and oesophagus violently inflamed; sore 
throat; disagreeable sensation about the palate ; pustules covering the 
mucous membrane of the pharynx and oesophagus; Dysphagia, w7ith 
difficult breathing; palate bright red, swollen and covered with tena- 
ceous mucus and vesicles; sudden swelling of the cervical glands and 
tonsils; burning in the same parts. Heat in the throat; difficulty 
of swallovdng and of breathing, in consequence of the swelling of the 
isthmus of the fauces; great sensitiveness of the oesophagus. 
Swrelling and redness of the throat, with large secretion of mucous, 
often present in epidemic catarrhs and influenzas; pustular eruptions 
in the throat, whether caused by small-pox or other cause; convul- 
sions from tonsilitis/ erysipelatous sore throat; mercurial ulceration 
of the throat. 
7. LARYNGITIS. 
Laryngitis is an inflammation of the mucous membrane of the 
larynx, sometimes extending to the epiglottis. It is regarded as a dan- 
gerous disease not so much from the extent or severity of the inflam- 
mation which constitutes it as from the situation in which it is deve- 
loped. Inflammation of the larynx even of small extent is always 
alarming; it is particularly so in young subjects in whom the forma- 
tion of the so-called false membrane takes place. The reason for the 
deposition of this plastic exudation in children only is not well 
known. Dr. Williams says: “ that the inflammation involves the 
sub-mucous areolar tissue, which is very abundant during youth; and 
that the natural product of the phlegmonous inflammation transudes 
readily through the thin delicate mucous membrane proper to that 
age.” In the case of the adult, the infiltration consequent upon inflam- 
mation pushes or swells out the mucous membrane, too thick already 
to admit of serous transudation, and terminates in that frightfully fatal 
disorder, oedema glottitis. On the other hand the same inflammation 
produces precisely the same result with respect to the lymphatic ves- 
sels, so numerous in this region, namely the secretion of lymph in ab- 750 
DISEASES OF THE SANGUINOU8 FUNCTION. 
normal quantities; but the tenuity of the mucous membrane in the 
young allows the lymph to ooze through, and coming in contact with 
the atmospheric air, to coagulate, and with the fibrin of the blood to 
form the so-called false membrane. It will be seen that the patholo- 
gical process is the same in both, only that in the one the mucous 
membrane is infiltrated—that is oedematous; and in the other, the 
mucous tissue permits the complete transudation of the lymph and 
the consequent formation of an adventitious membrane on its surface. 
“ The explanation, therefore, would seem to be anatomical rather 
than physiological. That atmospheric air is necessary to the forma- 
tion of this false membrane will be readily admitted when the history 
and nature of plastic lymph is understood. The lymphatic glands and 
vessels are essentially skin organs, and no where exist so abundantly 
as beneath the mucous tissue of the respiratory organs. Very few are 
found in the brain, while the pleura is completely “ gridironed” with 
them. The fibrin of the lymph possesses the peculiarity that, under 
ordinary circumstances, it does not coagulate within the lymphatic 
vessels either before or after death; while blood itself clots in many 
cases, during life, but always after death; so that “ of all fluids of the 
body, the blood alone possesses inherently the quality of coagulation.” 
Coagulated lymph is never found in the lymphatic vessels either be- 
fore or after death, “ but that coagulation commences as soon as the 
lymph is brought into contact with the open air.” It has then been 
Supposed that the lymph proper contains no finished fibrin, but that it 
becomes complete, either from contact with the atmospheric air, or 
under abnormal relations, through the importation of altered morbid 
matter. 
Diagnosis. 
Croup, or Tracheitis. 
Croup seldom occurs in adult life. 
No pain in swallowing. 
The croupy symptoms set in suddenly, 
or after a slight cold; no pain on swallow- 
ing; no swelling of the epiglottis or 
throat. 
Laryngitis. 
Is common in adults. 
There is pain on swallowing. 
The croupy symptoms have super- 
vened upon an attack of scarlatina, 
measles, small-pox, tonsillitis or ordinary 
sore throat. 
Treatment.—Our principal remedies for laryngitis are: Aconite, 
Kali-bichrom., Caust., Spongia, Fluor-ac., Nitr.-acHepar, lod., 
Kali-hydriod., Sanguinaria, Calc., Arsen. 
8. CHRONIC LARYNGITIS 
Symptoms.—Complete loss of voice, sibilant cough, and the larynx 
painful on pressure ; expectoration of a thin but a viscid mucus, occa- 
sionally pus, painful deglutition, owing to an inflammation of the 
epiglottis, and emaciation; as the disease progresses it has all the 
symptoms of phthisis pulmonalis, with which it is frequently connected CHRONING LARYNGITIS. 
751 
Causes.—Many causes have been assigned for the increasing pre- 
valence of this disease. Clergymen who read their discourses are 
more subject to it than lawyers and political orators; for the reason 
that reading is a purely mechanical operation, whereas extempore 
speaking is both mental as well as mechanical. It is, therefore, this 
mental, this vital nervous influence, which protects the lawyer and 
stump-speaker, while the lack of it punishes the preacher. The ex- 
tempore speaker “ gives his mind” to his argument, and thus lends the 
muscles of speech extra and recuperative energy; while the reading 
clergymen from a colder and calmer sense of duty, allows his organs 
of speech to flag and fail. Chronic laryngitis is the result; for it is 
only when under a strong earnest desire to say something, from what- 
ever exciting cause, that the vocal chords can be kept faithful to their 
functions. In mere mechanical reading, there is an absence of that 
vital energy which affords the power to resist the “ wear and tear” of 
the enunciating organs. The vocal chords were made originally to 
give the means of expressing our thoughts. They were never intended 
for reading merely, consequently when we have something to say, the 
brain lends the requisite amount of nervous energy to protect the vocal 
chords from injury in discharge of their duties. The lawyer speaks 
generally from the spirit of the moment; the brain co-operates with 
the vocal chords in giving expression to his thoughts, and thus saves 
them from irritation and disease. {Dr. Ward. U. S. Jour., Vol. IL. 
p. 58.) 
Pathology.—(Edema glottitis, inflammation of the mucous surfaces, 
ulceration, ossification, caries and necrosis of the cartilages. 
Treatment.—The topical application of Nitrate of Stiver has long 
been the principal dependence of physicians. Though this powerful 
agent has a direct influence in modifying the condition of the mucous 
membranes, we have better resources in the proper homoeopathic re- 
medies. The application of Iodine to indolent ulcerations of the la- 
rynx, has also been much relied upon. 
Internal Remedies.—Arsenicum, Calcarea, Sanguinaria. 
Nitric-acid 30°.—In that bad form of throat disease in which in- 
flammation of the mucous membrane ends in laryngeal phthisis. When 
this fails, Apis 30° ; then Fluoric-acid 10° ; in the most serious cases 
the 2000° ; in more acute cases 200° in dilution, once in five days. 
Tracheotomy.—In the cases in which the inflammation originally 
in the trachea extends upwards, involving the larynx, the epiglottis 
and the pharynx successfully, or pass downwards into the ramifications 
of the bronchia, tracheotomy can not be successful in giving relief. 
But in those other cases in which the inflammation is confined to the 
larynx the patient may be saved by tracheotomy. When the trachea 
alone is affected it should not be tried. Still if there be doubt of the 752 
diseases of the sanguinous function. 
seat of inflammation the patient should have the benefit of the doubt, 
as many lives have been saved by tracheotomy. M. Trousseau saved 
39 out of 150 cases ; others have met with better success. If there be a 
bare prospect that the patient would recover without an operation the 
operation does not lessen the chance: besides, as soon as the patient 
breathes through the tube in the throat, the atmospheric air which has 
been shown to be the chief agent in the formation of the fibro-plastic mem- 
brane, ceases to rush into the lungs through the throat; and thus the 
formation of the false membrane is arrested. When inflammation has 
extended to the bronchia and lungs, tracheotomy is worse than useless. 
9 DIPHTHERIA.—Labyngitis Exudativa. 
In 1818 Brettonneau wrote a description of an epidemic which pre- 
vailed at Tours, in France, which he considered as a new disease and 
designated by the term diphtherite. He believed that the disease came 
from Egypt and that it first manifests its presence in the nasal 
mucous membrane. It afterwards became common in other parts of 
Europe. 
After having prevailed for some years in the neighborhood of Bou- 
logne, in France, the disease crossed to England about 1856. 
In September, 1858, diphtheria began to be regarded as an epidemic 
in Albany, N.-Y., between that time and February, 1859, about two 
hundred and fifty deaths occurred in the city and its immediate vici 
nity. Dr. Paine estimated that the whole number of persons who 
were in some degree affected by the epidemic would embrace about one- 
fourth of the entire population. 
It was regarded as an epidemic that had crossed the Atlantic, but 
nobody pretends to tell on what day it appeared. 
In the autumn of 1858 it commenced in Nova Scotia, and was strongly 
epidemic during the winter. 
In the city of New-York the first case of diphtheria was that of an 
infant, eighteen days old, reported May 3, 1857. But one other case 
occurred that year; and both of these were probably something else. 
In 1858 the number of deaths reported by the physicians of this 
city was five ; in 1859, the number was fifty-three ; in 1860, 422 ; in 
1862, 594. 
Definition.—Diphtheria or diphtherite, is a word used to signify a 
specific disease, which should be classed among the zymoses, and is 
characterized, locally, by the formation of a false membrane upon mu 
cous or abraded cutaneous surfaces. 
Varieties.—We recognize but two varieties, the simple and malig- 
nant ; though diphtheria may become complicated with other diseases. 
These two grades of the disease are essentially the same in their nature DIPHTHERIA. 
753 
In this they resemble many other diseases; thus we have cholera 
morbus resembling in its general features the more dreaded cholera 
maligna. We have different forms and grades also of scarlatina and 
many other diseases. 
Diphtheria, then, is not a new disease, but a modification of a disease 
long known; and the two types under which it now appears, differ “ in 
proportion as they are modified by season, climate, epidemic constitu- 
tion of the atmosphere, and other sources of propagation and develop- 
ment of a specific zymotic cause, as well as in the individual organic 
susceptibilities of persons who are seized.” 
“ These contingencies make the types convertible,” and cases of each 
may appear in the same house. Some practitioners find nearly all 
their cases curable and others find many malignant ones. “ Or in a 
family of children, one may have the disease in the more severe, the 
others in the milder form. In this regard, as well as in the fact that chil- 
dren seized with the diphtheria at a later period of its prevalence do 
not have it so badly as at first, it resembles scarlatina and other epi- 
demic disorders.” {ClinicalLectures on Diphtheria. Dr. R. Ludlam. 
Chicago, 1863. p. 7.) 
Nature of the Disease.—It is always endemic, sometimes ap- 
proaching the epidemic, but never the contagious character, affecting 
in all places persons subject to glandular enlargements, or to catar- 
rhal or croupal affections. Nearly all who die with it have such pre- 
dispositions, and worst in syphilitic and scrofulous subjects. In 1858, 
says W. H. Eddie, Esq., it appeared at Barton-upon-Humber, and for a 
few weeks it was connected with scarlatina. After that period, “ diph- 
theria began unequivocally to show itself as a distinct disease; appear- 
ing in some who had had scarlatina and were perfectly recovered, and 
in others who were grown up and remembered having had scarlatina in 
their childhood.” 
Diphtheria is a zymotic disease. Its characteristic symptoms are 
evidently the product of blood poisoning ; and its first cause must be 
sought for in “ a specific virus which vitiates and depraves” the blood, 
and, through it, the structure and function of certain solids. 
Dr. Ludlam reaches the following conclusions respecting the nature 
of the disease: 
“ 1. Diphtheria arises from a specific invisible cause, which in order 
to produce its legitimate pathological fruits, must first be introduced 
into the blood. 
“ 2. The means for the introduction of this virus into the blood are 
two in number, viz. through the respiration and by inoculation. 
“8. We can not conceive of an epidemic cause which fails to occa- 
sion more or less contamination of the atmosphere. Local circum- 
stances may concentrate such a taint, and thus render susceptible per- 
You L—48. 754 
DISEASES OF THE SANGUINOUS FUNCTION. 
sons in a community more liable to contract the disease from breathing 
this atmosphere. 
“ 4. In exceptional cases the diphtheria may spread in this manner 
by a thorough poisoning of the air which is breathed ; but as a rule 
it is much more feebly contagious than either of the eruptive fevers. 
There is no evidence that it is ever conveyed by fomites. 
“ 5. The only known method of successful inoculation is that a por- 
tion of the vitiated secretions from either the mucous membranes or 
the skin of a diphtheritic subject be applied to an absorbent surface. 
“ 6. Both these methods of communicating the disease will fail un- 
less the individual constitution and local habits and surroundings of the 
subject afford a congenial soil in which the specific cause may develop 
its specific effects.” 
“ All of these symptoms and sequelae point to the constitutional cha- 
racter of diphtheria. There is no question but it is a systemic, and not 
merely a local disorder which owes its essential characteristics to the 
presence of a species of parasitic growth, whether it be algous or fun- 
gous. It is zymotic in its origin, its characteristics, and its sequelae. 
It is a disease per se, and not alone a dyscrasia. Like the typhoid 
fever, it has its general and its especial lesions, the one systemic and 
the other local.” 
Dr. Bade, of the Norwich Hospital (England), says, the specific cause 
of diphtheria is a depressing poison which acts primarily on the 
nervous system, as is often shown in the apparently causeless and 
sudden sinking and death of patients not considered to be in danger; 
and in other cases of longer duration, in some peculiar forms of para- 
lysis, occurring at some weeks from the date of the first attack of the 
disease. This paralysis is not due to mere poverty of blood or to the 
spancemia induced by the preceding disease, but rather to the presence 
in the system throughout all the stages of the disease of a specific 
poison whose special affinity is for the nervous tissue. Its action on 
this tissue is shown in the first instance by a general vital depression, 
and, subsequently, by a more or less complete suspension of the func- 
tion of particular nerves or systems of nerves and loss of power of the 
limbs. (Lancet, Oct. 1859. p. 214.) 
After reviewing the facts of the question as they are presented by 
observation and the published opinions of others we conclude : 
That diphtheria is a specific disease dependent for its origin on 
1. A peculiar morbific epidemic influence, which for an unknown 
pexiod has been recognized in a large portion, at least, of Europe and 
America, and which so far affects all the inhabitants of large tracts of 
country at a time, that all common forms of disease are liable to be 
more or less modification by the prevailing epidemic. 
2. A predisposition to disease consisting in a psoric, dyscrasic, or DIPHTHERIA. 
755 
strumous constitution, liability to glandular swellings, catarrhal, cy- 
nanchal, or erysipelatous disease. 
3. The common exciting causes of disease conspiring with the above 
conditions in individuals ; sudden changes of temperature, exposure to 
severe cold, or to damp or chilly air long continued; derangement of 
the digestive organs. 
General Symptoms.—In the type, which is the most common in some 
localities, the patient is suddenly, (generally in the morning,) seized 
with violent vomiting of a thin yellowish-white matter of a very offen- 
sive character; then purging of a fluid of similar appearance and smell 
These dejections last for an hour or more, and are followed by great 
prostration and stupor. The patient lies for many hours in a heavy 
sleep, is with difficulty aroused, and immediately sleeps again. The 
skin is hot, pulse 100, though in children perhaps 140 or 160, tongue 
bright red; great thirst; drink taken with avidity to be instantly re- 
turned by vomiting. In other localities the purging does not occur. 
The odor of the breath is characteristic and peculiarly offensive, 
and often it gives the first conclusive evidence of the danger impend- 
ing, when other symptoms have revealed nothing to alarm. The breath 
is infected by specific zymotic poison operating on the secretions of the 
affected parts as well as on the blood generally. 
The throat is sore, though it does not feel so; the vigilant physician 
examines it and finds, in the early stage, the tonsils, soft palate and 
back of the pharynx, presenting a bright shining appearance ; the 
small vessels are not seen individually injected as in many sore throats ; 
but the part appears as if brightly painted and then varnished. Hang- 
ing from the velum to the tongue is seen in this stage a transparent 
film of a tenacious fluid which bursts before the expired breath and 
sends its particles over the mouth and the instrument used to depress 
the tongue. The next moment a similar curtain is formed. 
After a period of a few hours (10 to 16) the condition of the patient 
is changed. The stupor has passed off and delirium takes its place; 
there is high fever, quick breathing, the voice thick or shrill; short 
dry cough; children show evidences of coming croup; neck puffy and 
flushed, tongue coated with white fur ; the parts of the throat at first 
so brilliantly red are thickly coated with a whitish substance in spots, 
which in a very short period conglomerate and form one thick plastic 
deposit, which in time may cover the whole palate to the teeth, appear- 
ing as if the whole mouth were lined with plaster-of-Paris. 
The violent delirium now subsides; the powers of life fail rapidly; 
horrible sensations of choking and suffocation come on ; the sufferer 
tears at his neck with his nails and tries to tear open his mouth, though 
* Lancet, 1859. p. 306. 756 
DISEASES OF THE SANGUINOUS FUNCTION. 
retaining full power of swallowing; and greedily takes down any fluid 
offered him; livid spots on the extremities show purpura; white offen- 
sive diarrhoeic discharges from the bowels become incessant; there is 
muttering delirium; and, in a long tetanic convulsion, death closes the 
scene. 
The cases of true diphtheria are not numerous in any locality yet 
invaded by this disease. It is characterized by the peculiar wash- 
leather exudation; foetid discharge from the nostrils; phagedenic ul- 
ceration of tongue, gums and fauces, profound general adynamia, often 
from the very beginning of the disease. Dr. Dake describes it as pre- 
senting, in the severer cases, aphthous ulcers on the tongue, palate, 
tonsils, &c., “ small and rapid pulse, with moisture of the surface, and 
general debility.” In a still higher grade, in which two deaths occur- 
red in seventy-four cases, there were: “ white elevated spots on the 
tonsils, uvula, arches of the palate, or posterior wall of the pharynx, 
appearing like the mucous membrane, raised, thickened, hardened, 
and whitened, in patches varying in size from the smallest fish-scale to 
that of a piece of white kid, sufficient to cover the entire throat and 
buccal cavity. These patches have a border of deep red, and, when 
removed, leave a raw, rough, and often bleeding surface. They some- 
times form and spread very rapidly. Under successful treatment they 
loosen, break, and are thrown off in fragments, with a sanious and 
bloody discharge. The breath is very offensive; the pulse small, and 
generally rapid, with copious perspiration, and in the later stages, ex- 
treme debility.” 
In sixteen cases, of whom four died, there occurred in addition to the 
symptoms already given: “ Constant cough, provoked by swallowing, 
and worse when lying; hoarseness and rasping respiration, such as 
characterize membranous croup.” In some cases “ the peculiar mem- 
brane is visible, covering the epiglottis.” In three cases this mem- 
brane came away in fragments, leaving a rough and bleeding surface. 
In but one case it formed a second time on the same spot. “ One patch 
of the membrane thrown off and preserved in Alcohol, is nearly an 
inch square, of the thickness of the heaviest kid, of spongy texture, 
and of yellowish white color. The under surface is rough with eleva- 
tions and depressions corresponding with the granulations of the ton- 
sil whence it came. Upon close examination it appears like the mu- 
cous membrane thickened by an intestinal deposit of a white cheesy 
substance ; it must have left the surface of the tonsil, whence it came, 
completely minus a mucous membrane ’ (JY. A. Jour. Ilomoeop. Feb. 
1862.) 
Dr. Kinch, of New-Jersey, sent to the New-York Pathological So- 
ciety (Jan. 1862) “ a membranous cast of the trachea, bronchii, and 
larger divisions of the bronchial tubes which had been expectorated in DIPHTHERIA. 
757 
a fit of coughing by a girl, aged eleven years on the fifteenth day of the 
disease. The breathing was afterwards easier, but the patient refused 
to swallow anything, even water, and died after two days. 
Diagnosis.—Distinction between 
DIPHTHERIA and CROUP. 
1. Seat of the Disease. 
Diphtheria. 
Its primary and essential feature con- 
sists in the exudation of an albuminous 
or coagulable effusion on the mucous 
surface of the fauces and air passages. 
This effusion almost always commences 
on the tonsils and pharynx, extending 
thence along the nares, velum pendu- 
lum palati, and sometimes downward 
to the larynx, which it seldom passes 
beyond; but it may proceed to the 
trachea and even along the oesophagus 
into the stomach. When the false mem- 
brane extends into the trachea, the 
distressing dyspnoea and other symp- 
toms of true croup may be produced. In 
unusual cases a plastic exudation re- 
sembling that of diphtheria has been 
seen on other parts. In one case it cov- 
ered the conjunctiva of one eye ; in an- 
other the surface of a burn upon the arm. 
Symptoms those of diphtheria. 
Croup. 
Genuine croup is almost always seated 
in the trachea and lower portion of the 
larynx. It commences there and very 
rarely presents any appearance of the 
disease in the pharynx or any part of the 
fauces. It is always so completely re- 
stricted to the region of the glottis that 
the general febrile disease gives little 
concern. There is no epigastric uneasi- 
ness, vomiting or diarrhoea. Pseudo- 
membranous croup is a very rare affec- 
tion, is confined to the larynx and trachea, 
and is neither malignant nor infectious. 
Diphtheria. 
It usually selects feeble, lymphatic 
subjects, with defective vitality, who are 
surrounded by unfavorable conditions. 
The inflammation tends from an early 
stage to assume a gangrenous and putrid 
character. The accompanying fever is 
typhoid. The profound adynamia is 
different from that seen in the latter 
stages of croup. Under this adynamic 
fever the vital powers are exhausted. 
Diphtheria is essentially a zymotic dis- 
ease. The specific poison is a depressing 
toxic agent which acts directly on the 
nervous system. 
Croup. 
Croup is essentially a sthenic disease, 
it is highly inflammatory in its nature, 
generally traceable to exposure, to cold 
and damp air ; it is seldom epidemic and 
never contagious. The symptomatic 
fever is inflammatory throughout its 
course. It has been caused by some 
known exposure, as sudden suppression 
of perspiration, wet feet, or a current of 
cold damp air. 
Common to all ages, but most fatal 
amongst children and young persons. 
Period of Life, 
Confined to the period of infancy; it 
generally attacks the robust and well 
fed. 758 
DISEASES OF THE SANGLTNOUS FUNCTION. 
Character of the Effusion. 
Diphtheria. 
In very light cases there is no effu- 
sion, and when there is its features 
are not uniform or permanent. Some- 
times the matter effused consists of a 
firm lymph-like albuminous deposition, 
and is the product of an active inflam- 
mation of the fauces, as in cynanche 
pharyngea and tonsillaris; in other cases 
it is “ soft, shreddy, in patches on one 
or both tonsils, the palate or fauces, re- 
sembling sloughy mucous membrane; it 
is accompanied by all symptoms of ty- 
phus fever, as in cynanche maligna, and 
in some of the worst forms of scarlatina 
or measles. In such cases the false 
membrane is formed by a thin pulta- 
ceous exudation which is rather mucous 
than fibrinous. In other cases the de- 
posit consists of a few small patches upon 
one or both tonsils, the palate or fauces 
only. In all cases of diphtheria the effu- 
sion seems incapable of organization. 
Croup. 
The false membrane in laryngeal croup 
is strong, dense, fibrinous, often organ- 
ized ; and it often exhibits a well-marked 
vascular derangement. 
Principal Symptoms. 
Diphtheria. 
When the disease is confined to the 
upper part of the larynx, as it usually is, 
we never observe the sharp sibilation 
of croup; we do not see the spasms 
with fits of suffocation, but a kind of 
“ ronchus mucosus,” in the course of 
forty-eight hours, with marks of a slow 
and progressive asphyxia, during which 
discharge from the nose becomes foetid. 
In no locality have we yet found all 
cases presenting the peculiar diphtheritic 
exudation, though we may distinctly 
recognize all the other distinctive fea- 
tures of the epidemic. We find the 
same erysipelatous-looking patches of in- 
flamed surface on the tonsils ; the same 
swelling of the glands of the parotid and 
submaxillary region; the same disposi- 
tion to a low state of the system ; and 
we find these states in the same locali- 
ties and in the same families in which 
the more strongly-marked cases of true 
diphtheria are seen. The imperfectly 
Croup. 
There is a sharp hoarse cough, which 
is afterwards stifled ; spasms of the la- 
rynx are followed at last by asphyxia 
and suffocation. The agitation and ex- 
treme agony which distinguish the last 
stage of croup contrast strongly with the 
livid pallor of the surface, the delirium, 
profound depression, somnolent tran- 
quility and adynamia which belong to 
the same stage of diphtheria. 
The dyspnoea is paroxysmal, invari- 
ably worse at night; in the intervals 
the breathing is almost natural; the 
patient alternates between suffocation 
and repose. There is no eruption; no 
acrid coryza; no especial liability to 
haemorrhages from the mucous mem- 
branes, no alimentary disorder ; no al- 
buminaria. The glands of the neck are 
not swollen; there is no after-tendency 
to paralytic prostration. Croup cannot 
be communicated by inoculation. DIPHTHERIA. 
759 
developed cases are certainly cases of 
the same disease, produced by the same 
morbific influence. Adults are parti- 
cularly liable to the disease in this 
form. Some albuminuria is common. 
Distinction between Diphtheria and Scarlatina. 
Diphtheria has been supposed by many to be only a “ suppressed 
or masked scarlatina.” These two diseases have some features in 
common. Thus,—in both there are : 
Enlargement and inflammation of the tonsils" and glands of the neck ; 
ulceration; a rash upon the skin which does not appear in all cases; 
similar premonitory symptoms ; general depravation of blood, shown 
by a tendency to gangrene ; albuminuria is also common to both. 
This resemblance of diphtheria in some of its symptoms to scarla- 
tina has led many authors to believe that the two diseases were essen- 
tially the same though slightly modified by some epidemic influence. 
But to this it is answered that diphtheria has prevailed as an epidemic 
in many localities where scarlatina was not only absent, but had not 
been heard of for years. 
That there is much confusion in the minds of physicians in regard to 
the diagnosis between this disease and some others is evident by the 
fact that consulting physicians very often disagree about the name that 
should be applied to the case before them. “ From the history of the 
progress of diphtheria for the last few years its existence would seem 
to be in some measure connected with scarlet fever.” In 1858 the 
two diseases prevailed very extensively together in England. “ In 
New-York City, during 1860, when diphtheria had become a common 
disease, we had more scarlatina than was ever before seen in this city.” 
Physicians, however, frequently “ confound the two diseases.” 
Diphtheria. 
Scarlatina. 
The invasion is generally insidious. 
The heat is slight, and subsides early. 
The invasion is sudden and violent. 
The fever continues high ; the skin hot. 
Liability to a Second Attack. 
Many persons have had a second at- 
tack several weeks after apparent re- 
covery. Dr. Dake saw nine cases each 
of which had it a second time. 
The patient recovering from this dis- 
ease is not generally liable to a second 
attack. His having had diphtheria does 
not protect him from scarlatina. 
The Eruption. 
The eruption, or rash, when there is 
any, appears suddenly and disappears 
as suddenly, is more like that of measles 
than scarlatina, and is not followed by 
desquamation. 
The eruption is a prominent feature 
in the disease. The rash does not come 
out suddenly; and, alter remaining on 
the skin for some number of days, ter* 
minates its course by desquamation. 760 
DISEASES OF THE SANGUINOUS FUNCTION. 
The Angina. 
Commences by patches on the tonsils, 
&c.; it shows in spreading, a great ten- 
dency to invade the respiratory pas- 
sages. In many cases there, is no false 
membrane formed, since death occurs 
before there is time for it. In slight 
cases there is none that attracts at- 
tention. 
Diphtheria. 
The angina tends to localize itself in 
the whole cavity of the fauces and pos- 
terior nares, and rather to invade the 
oesophagus than the larynx. 
Scarlatina. 
Dropsical Affections. 
Dropsy after diphtheria has not been 
noticed in this country. 
Anasarca and other forms of dropsy 
are common after scarlet fever has ap- 
peared to be terminating in health. 
Albuminuria, 
The mucous membrane of the throat The albumen is chiefly eliminated by 
generally eliminates most of the albumen. the kidneys. 
Mode of Termination in Death. 
Death takes place from the extreme 
prostration; and the symptoms by 
which it is preceded are those which re- 
sult from the action of a malignant 
septic poison. This poison, in cases of 
slow recovery, still shows its power in 
general vital depression ; particularly in 
the peculiar form of paralysis that often 
follows diphtheria. 
The direct cause of death from scarla- 
tina may be :—1. Suflocation ; 2. Cere- 
bral congestion or effusion; or 3. Dropsy 
or other sequelae of true scarlatina. 
In all of these affections there is a high 
degree of toxaemia, but it does not show 
its effect in the general or partial para- 
lysis that often follows diphtheria. 
Diphtheria and Scarlatina Anginosa, known by the 
Synonyms “ ulcerous sore throat” of Fothergill, “ angina putrida ma- 
ligna” of the older writers ; the “ pharyngite pultacee” of Yalleix. 
The coating on the tonsils, &c., con- 
sists of an erysipelatous redness, which 
is soon superseded by patches of a gray, 
tenacious firm transparent membrane. 
The tonsils and contiguous tissue are 
covered with a thick heavy pultaceous 
exudation of dull whitish or dirty look- 
ing color. 
Diphtheria and Syphilitic Ulcer on the Tonsils. 
The diseased surface is not depressed; 
the membrane can be separated from the 
tonsil. 
In this last affection the surface is de- 
pressed, except in secondary syphilis, and 
the false membrane is adherent. 
Relations between Diphtheria and Erysipelas.—John Hunter, who 
has been generally regarded as the Newton of modern physiology, said 
lie thought diphtheritic angina to have “ something of the erysipelatous 
disposition.” He believed that the erysipelatous inflammation produces 
results the very opposite of those to which common inflammation gives 
rise, namely, in the serous membranes suppuration, and in the mucous 
membranes effusions of lymph. In many respects we find points of 
resemblance between erysipelas and diphtheria. Stephenson and others 761 
DIPHTHERIA. 
have considered cynanche maligna and scarlatina maligna as forms of 
erysipelas. 
Points of coincidence between these diseases are: 
They both depend on occult causes little understood, and are always 
found in subjects who are predisposed by previous bad health to be 
attacked by some disease, and naturally fall under the sway of the pre- 
vailing epidemic whatever that may be; they both attack more readily 
persons of a scrofulous diathesis ; “ both prevail most in damp districts 
and damp weatherand “ both yield to the same class of remedies.” 
Patients who have ever been affected by either of these diseases are 
afterwards good subjects for an attack by the other. Dr. Dake says 
he saw four cases in which erysipelas spread over the face after the 
peculiar false membrane of diphtheria had disappeared. In these cases 
as in all others erysipelas affects the skin as diphtheria does the mu- 
cous membrane. 
The distinction between diphtheria and erysipelas may then be 
considered as so obvious to any observer that the features by which 
they may be distinguished need not here be detailed in contrast. 
On the interpretation of the term false membrane. Laboulbene 
offers the following: 
false membrane is a morbid product which is most frequent- 
ly deposited upon a tegumentary surface,—either of mucous or 
serous membrane, sometimes adventitiously and which is formed or 
exuded by that part of the body which it invests.” [On Pseudo- 
Membranes. Paris, 1861.) 
Now the diphtheritic poison, introduced into the human organism, is 
held to have two especial and peculiar affinities,—one for the nervous 
centres, and the other for the mucous structures which line the internal 
cavities. These remarkable predilections are everywhere recognized. 
One conspicuous and characteristic feature, which is of great prac- 
tical importance, is that diphtheria has an unfortunate tendency to in- 
vade the respiratory passages, the nasal fossae, the larynx and the tra- 
chea. Muguet occupies a portion of the alimentary tract, the oesopha- 
gus and stomach, but does not extend to the respiratory mucous sur- 
faces. 
On the Pathology of Diphtheria.—Dr. Wilks* states, that in the 
cases that had passed under his own observation a parasitic fungus was 
always present on the affected part; and at first he was disposed to be- 
lieve this peculiar growth constituted the essential characteristic of the 
disease. He then says, his attention being directed to this matter, “I 
took the opportunity to examine the films which occasionally form on 
the mouths of those sick with various diseases, and upon submitting 
* Med. Times and Gazette, p. 354. 762 
DISEASES OF THE SANGUINOUS FUNCTION. 
them to a microscopic test, felt some surprize in witnessing in all fun- 
gous growths which I have not been able to distinguish from that of 
diphtheria.” He mentions the case of a woman who had died under 
his care wTith acute cerebro-spinal meningitis; on examining whose 
pharynx after death, a pellicle was found composed of the parasitic 
growth. Several other instances are recorded in which the same 
growth wras detected, when there was no diphtheritic disease properly 
so called. Dr. Laycock found the fungus called oidium albicans in only 
a single case of diphtheria. 
Diphtheritic deposits according to Laboulbene, are: “plastic pro- 
ducts which are morbid, and which are deposited upon a tegumen- 
tary surface, the skin or mucous membrane, by exudation upon those 
parts which they are to invest, and are not persistent” 
Appearance of the Deposit.—In patients seized with diphtheria 
in the mouth and pharynx, says M. Laboulbene, “ we remark the exis- 
tence of plastic products of a grayish or yellowish hue, and which ap- 
pear to be located upon the thickened mucous membrane. At different 
periods of their formation these pseudo-membranes are opaque, some- 
what delicate, and thicker towards the centre; others are whitish, 
grayish, or yellowish. The first, or the more delicate, are easily de- 
tached ; the adhesion and tenacity of the latter being wrell-marked, 
they adhere to the mucous membrane. They form more or less ex- 
tended plates or layers, and not little islands which tend to coalesce. 
In some cases the plastic product envelops the whole tonsil, again the 
uvula, and sometimes it forms a lardaceous coating located at the base 
of the pharynx. The subjacent mucous membrane which is reddened, 
is bloody in little patches, but the surface is not ulcerated ; the mucous 
membrane, which surrounds the cast is tumefied. The sub-maxillary 
glands are congested, painful and the neck is swollen. 
“If the examination is repeated at a more advanced stage of the dis- 
order, we discover the false membranes in a state of putrid solution. 
These detach themselves in shreds wdiich are mingled with the saliva, 
or w hich are attached to the posterior part of the mouth by some points 
upon their surface. Below, and where the plastic product is not ad- 
herent, the diphtheritic false membrane has been reproduced. In 
appearance it resembles an ulcer which has exfoliated shreds of de- 
cayed mucous membrane. 
Certain disorders of innervation belong as much to the natural his- 
tory of diphtheria, as does the lesion of the superior alimentary and 
respiratory passages. 
The exceeding and immediate prostration, which is disproportionate 
to the duration or the severity of the illness, the losses sustained, or 
to the balance of the symptoms; the excess of heat, and other dis- 
orders of calorification; the rapid pulse, the type of the fever; the DIPHTHERIA. 
763 
character of the delirium; the dilated pupil; the anesthesia, which is 
partial or complete ; the hyperesthesia of the surface ; a feeble uncer- 
tainty of gait, stiffness and lameness of the muscles of the neck; in 
continence of urine, with or without involuntary stools; all bespeak a 
more or less profound disturbance of function in the nerve centres of 
animal and organic life. There is no question but these centres are 
poisoned, and hence the above train of symptoms. 
Prognosis.—Children below eight years of age are less likely to 
survive a severe attack of diphtheria than older persons. Those who 
are predisposed to croup are particularly difficult to cure, as in them 
if the disease go on beyond four or five days, there is danger of the 
propagation of the diphtherite process to the larynx. Dr. Willard, of 
Albany, reported to theN. Y. State Med. Soc., 1859, only three deaths of 
adults among 188 cases. When we hear the peculiar noise caused by 
the glottis when it becomes involved in the disease a bad prognosis of 
the case is necessarily formed; also, when the violent symptoms have 
subsided and yet debility remains. Dr. Cretin, of Paris, says “ that in 
membranous angina as in severe fevers, the issue is rarely favorable, 
unless convalescence is prompt. In all of these cases where there is 
not a speedy renovation when the apparent causes of debility are re- 
moved there is one sufficient cause for failure, that is “ a poison in- 
fecting the general systein • it is not the local disorder.” The con 
stitutional predisposition accounts for the great fatality of the disease 
in certain families. Dr. Paine says in the winter of 1858—59, at Al- 
bany, “ in 15 families there were in each two deaths ; in four families, in 
each 3 deaths, and in one household four children were swept away by 
the pestilence.” Dr. Dake, who lost 7 cases only out of 193, says: 
“ Those who died were all subject to glandular enlargements except 
three, aged by one year. A female, aged 38, had great enlargement of 
the tonsils, parotid and submaxillary glands, irritation of the nasal duct, 
foetor of breath.” The disease is more fatal in some localities than in 
others. Though it has often appeared in places usually healthy, it is 
certainly more fatal in cities and villages in which the people live 
closely crowded together in damp and ill-ventilated dwellings. 
Treatment of Diphtheria.—A persistent use of the proper homoeo- 
pathic remedies will cure nearly all cases of this malady. We have 
treated more than 200 cases, including many of the malignant type, 
and our losses have not been one per cent. We make this observation 
for the purpose of impressing upon the medical man the vast import- 
ance of selecting arid of continuing the very few really specific medi 
cines at our command for the cure. 
The two great remedies are Kali-bichromicum, and Mercurius-hydri- 
odicum. The first triturations of both drugs should be employed; the 
first, dissolved in water (so as to tinge the water yellow), arid the other 764 
DISEASES OF THE SANGUINOUS FUNCTION. 
to be taken dry on the tongue. These medicines, repeated every hour 
or two, in alternation, will suffice to cure nearly every case. We have 
used the Biniodide of Mercury, in place of the Hydriodate with the 
same good results. 
These medicines are sine qua nons in this malady, and should be 
boldly and persistently given until the deposits have disappeared. 
A dose or two of Aconite and Belladonna, may now and then be 
required, but they should be deemed and used as quite subordinate to 
the precited medicines. 
From the commencement, meat-broths, wine whey, milk punch, 
brandy and water, and the like should be judiciously administered, in 
order to support the strength and counteract the typhoid tendency of 
the disease. 
Occasional inhalations of the vapor of Ammonia water, will often 
aid in detaching the albuminous depositions, and thus often relieve the 
sense of threatened suffocation. Ammonia is an excellent solvent of 
albumen, and will often conduce materially to the comfort and safety of 
the patient. 
It may sometimes be used internally with advantage, when typhoid 
symptoms are strongly marked, and there are indications of decompo- 
sition of the blood. But it also must be secondary to the medicines 
first named. 
These few observations comprise our own experience, and as such 
we offer it to the profession. Below we have collected the views of 
many other physicians, both American and European. 
The treatment of diphtheria is necessarily based upon correct prin- 
ciples of its pathology. It may be advantageous to group, the different 
remedies under the various indications they are calculated to fulfil. 
The Constitutional Treatment—For the Febrile Symptoms :—Aconite 
Belladonna, Gelseminum, Rhus-toxicodendron, Baptisia, Bryonia.— 
For Cerebral Disorder:—Phosphorus, Bell., Opium, Conium-maculat.— 
For the Mouth and Throat Symptoms:—Mercurius, Iodine, Mercurius- 
iodatus, Cantharis, Bi-chromate of Potassa, Rhus-tox., Iodide of Ar- 
senic, Baptisia, Nitric-acid, Apis-mellifica, Baryta-carb, Belladonna.— 
For the Coryza:—Do. the gastric and Alimentary Disorder;—Nux- 
vom., Bryonia, Opium, Yeratrum-alb., Phosphoric-acid, Arsenicum-alb., 
Nitric-acid, Arsen.-iodatus, Merc.-iodatus, Cantharis.—-For the Erup- 
tion:—Bell., Rhus-tox., Bryonia, Pulsatilla, Nitric-acid, Arsenic-alb., 
Cantharis.—For the Urinary Disorder:—Aeon., Merc.-iodatus, Can- 
tharis, Apis-mel., Ammon-acetat., Mer.-cor., Phos.-acid, Colchicum.— 
For the extreme Debility:—Cantharis,* Ferrum-aceticum, and China. 
Aconite—Is one of the first remedies in the forming stage of the 
* Ludlarn on Diphtheria. DIPIITHEKIA. 
765 
disease. It has been common to give it in tincture (two to three drops 
in a glass of water,) in doses proportioned to the age or condition. 
The third dilution is better in ordinary cases. 
Belladonna.—In the simplest form of diffusive inflammation in 
which no marked peculiarity was observed, a few doses in solution suf- 
ficed to affect a revolution in a short time. Or, if with some swelling 
of the tonsils there was a bright scarlet redness, uniformly extending 
over the mucous membrane, it was generally continued at intervals 
during the stage of excitement, or inflammation. 
Rhus-tox.—When the inflammation of the fauces is of a dark red, 
or if there are dark crimson patches scattered over the inflamed sur- 
face, adynamic tendency. 
Colchicum, has been found speedily efficacious for the engorged 
state of the tonsils with fever and headache. 
Mercurius-iodatus.—Dr. Ludlam thus sums up the principal con- 
ditions for which this remedy is appropriate: 1. It is “ most appro- 
priate to those examples and epidemics of diphtheria in which the 
deposit is located upon the mouth, tonsils, uvula, velum palati, the 
pharynx or some portion of the alimentary tract. 
2. To those cases in which the function of the mucous follicles is so 
deranged as to produce in considerable quantity, the tough and viscid 
secretion. 
3. The deposit should be of limited extent, of feeble organization 
transparent, pellicular, albuminous, and easily detached. 
4. To those cases in which there is but a feeble effort at re-organi- 
zation of the false membrane, when it has been removed, or has dropped 
off spontaneously. 
5. To such examples of diphtheria as are characterized by marked 
disorder of one portion or another of the alimentary system.” The 
Proto-iodide of Mercury is preferred to the Bin-iodide. (Lectures on 
Diphtheria, p. 104.) 
As soon as the least appearance of membranous deposit or any 
swelling of the glands of the neck is observed, we may commence with 
this remedy, and continue it till the symptoms are completely oblite- 
rated. Dr. Paine says he gave it in the first trituration, and the effect 
“ in arresting and detaching the false membrane was in many cases 
most gratifying.” 
Dr. Preston says, in 1852, he had some success with Bin-iodide of 
Mercury and Bromine. (Philad. Horn. Jour., 1852.) He the 
following case in the IT. S. Jour, of Homoeopathy,~Vol. I. p. 226. 
A boy, aged nine years, residing near a family in which four children 
had recently died of diphtheria, attacked on the morning of Sept. 16th, 
1859, with high fever, inclined to sleep all day; fever increasing till 
night when he had delirium; pulse 160 per minute; when aroused he 766 
DISEASES OF THE SANGUINOUS FUNCTION. 
complains of difficulty of swallowing, headache, &c.; desires to be 
allowed to go to sleep; refuses all food. 
Give Aeon. 3° and Bell. 3°, every hour alternately. 
Sept. 18. Found the whole tonsils and palate considerably swollen 
and covered with false membranes, which also lay in patches on the 
pharyngeal mucous membrane; he swallows with difficulty; breath 
foetid; breathing hoarse; pulse 120; an eruption appearing over the 
surface resembling scarlatina miliaris, but the skin rather pale than 
red, as in scarlatina. Give Bell. 3°, Proto-iod.-Merc. 3°, alternately 
every hour. Meat-broths as food. 
Was better next day, but three days later was much worse; hoarse- 
ness ; difficulty of breathing ; refused food and drink all day ; took no 
wine for two days. Weaker than five days before ; no ulceration ; 
palate natural; fauces still very red; pulse 60; rough breathing in 
the larynx; breath more foetid; bloody discharge from the nostrils ; 
eruption entirely gone. 
“ Give Bell, and Merc.-Proto-iodide alternately every hour; insist on 
the taking of the wine three times a day with as much nourishment as 
possible. 
“ The next day the breathing was easier, the mucous membrane quite 
clear and very red; swallowing easier; more appetite. Three days later 
he was quite well.” 
Dr. Siiss Hahnemann treated a severe case successfully with Merc.- 
iod. internally, and Tinct.-ferri-Mur. locally. 
Bi-chromate of Potassa.—Diphtheritic effusion on the superior 
portion of the pharynx, nares, larynx, trachea and bronchial tubes, even 
down to their ultimate ramifications ; the deposit of firm texture, pearly 
in appearance, elastic, fibrinous, securely attached to the subjacent in- 
tegument. Cases in which a transfer of the local disorder to the larynx 
or trachea is threatened; there is soreness of the larynx when pressed 
from before backwards; aphonia, croupy inspiration or cough; desire 
of the patient to lie with the head thrown far backwards in order to 
throw open the glottis; tonsils enveloped by a thick and well organ- 
ized deposit; incessant cough. Tendency to ulceration and deposit 
upon remote mucous surfaces, as the uterine and respiratory epithelial 
surfaces. When putrid symptoms begin to be manifested the Bi- 
chromate should be superseded by Iodide of Arsenic, Nitr.-acid, or 
Carbo-veg. The Bi-chromate is recommended in the second decimal 
trituration, to be repeated every one, three or four hours. 
Dr. Lord, of Chicago, reporting a severe case to the 111. State Asso- 
ciation, says it produces aggravation even when given in moderate 
doses: 
“ When the Bi-chromate was given with intervals of an hour or more, 
the patient uniformly got worse. The cough was almost constant, ex- DIPHTHERIA. 
767 
cept in the night, when asleep. It ran up from a slight hacking to 
suffocation, which was only prevented by a means which I have pur- 
posely omitted to mention that I might direct your attention more 
particularly to it. After the 20th day, whenever the cough became 
dry, and respiration, whistling and suffocation seemed imminent, in- 
halations of the Bi-chromate were used with prompt relief; of course, 
it was only temporary, but it was a respite. But for it death must 
have ensued. It did not fail in a. single instance of easing the breath- 
ing and loosening the cough, and ejection of membrane or large quan- 
tities of stringy mucus followed. 
“ The method was simple. Two or three grains of Bi-chr. 2, were put 
into a small tin-teapot, and half a tea-cup of hot water poured on. The 
vapor passing from the spout was inhaled. I do not think that any 
medicines given in this case, but the Aeon, and Bi-chr., had any good 
effect. 
“ I was so well satisfied of this that in all subsequent cases I have 
trusted entirely to the Bi-chr. as the specific remedy, and have had no 
reason to repent it. Other remedies may be required, but that is the 
remedy''1—(Transactions, &c., 1862.) 
Ilydriodate of Potash.—Dr. H. Robinson, Jr., of Auburn, N. Y., 
writes: “ I would like to recommend to the notice of physicians the 
use of the Ilydriodate of Potash in diphtheria. I find nowhere in any 
of our authors the mention of this drug in this disease; but in quite an 
extensive practice in this disease, I have used no remedy with such 
happy results as this. Doses the same as the Bi-chromate. 
Tartar-emetic.—This remedy has been shown by Laboulbene to be 
capable of producing the false membrane in the cavity of the mouth, 
especially on the tongue. They are described as “ having the form of 
irregularly rounded patches, whitish or grayish in color, somewhat 
thick, of a marked consistence and firmly adherent. In the oesophagus 
they are small, delicate, pale and easily detached from the subjacent 
tissue. Beneath the pseudo-membrane the surface of the tongue is ex- 
coriated, ecchymosed, wrinkled, and forms an elevated margin around 
the plastic deposit which is red and somewhat extended. The oesopha- 
geal mucous membrane is ulcerated; the borders of this ulceration are 
not elevated, but enclosed by a red circle, the base being softened and 
grayish, and, at some points, ecchymosed.” 
This remedy is advised by Dr. Ludlam for the following conditions. 
Sudden swelling of the cervical glands and tonsils in scrofulous chil- 
dren, who are predisposed to catarrhal or asthmatic affections; occlu- 
sion of the larynx or lower respiratory channels by excess of mucus, 
of a feebly-organized plasma, with cough, dysphagia, difficulty of 
breathing; gasping which compels the patient to sit upright, or to seek 
the open air; retching or obstinate vomiting of tenacious mucus, with- 768 
DISEASES OF THE SANGUINOUS FUNCTION. 
out any considerable thirst; small circular patches, like small-pox 
pustules, in and upon the mouth and tongue ; hepatization of the lungs 
impending or progressing by closure of the pulmonary air-vesicles, by 
solidification of effused serum. Cases in which a prevailing influenza 
attacks a patient predisposed to catarrhal disorders of the respiratory 
mucous membrane. 
Arsenicum.—The breath foetid; the lining of the nostrils dis- 
charging a viscid foul secretion; great and increasing prostration of 
strength. After the separation of the false membranes, it may remove 
the extreme tenderness which remains, as well as keep up the vital 
energies. 
Iodide of Arsenic seems more efficient than any other form of Ar- 
senic when there is putrid offensiveness of the breath, especially in the 
later stage of the disease. 
Bi'yonia.—M. Curie, in a discussion in the Homoeopathic Med. Soc. 
of Paris, (Febr. 20th, I860,) says, Bryonia has the “ pathogenetic pro- 
perty of forming false membranes, which the other remedies do not 
possess (though Bromine, Chlor.-potash, and Chloride of iron have some 
such power in lighter degree). The false membranes formed by 
Bryonia are not those developed by an irritant local action as a corro- 
sive poison. Teste gives a case of false membranes in the mouth de- 
veloped by Bryonia. Orfila in his Toxicology mentions another in 
which they appeared in the rectum, in consequence of an injection of 
Bryonia. M. Curie exhibited to the Society preparations of the tongue, 
the trachea and the lungs of a rabbit to which he “ had administered 
Bryonia for eight months ; at first giving two drops of tincture per day, 
a dose which was progressively augmented to 250 drops at last.” 
There was formed “ a pseudo-membranous firm tube, which lines the 
trachea, and on the one hand, penetrates the second and third ramifi- 
cations of the bronchia; and on the other hand lines the whole of the 
larynx. Some false membrane existed also in the mouth, at the base 
of the tongue; but these not being so strongly organized have disap- 
peared in the alcohol.” This was not the effect of an irritant liquid 
into the bronchia. The false membrane grew little by little, and per- 
mitted the trachea to enlarge for the passage of air. Autopsy showed 
the trachea abnormally enlarged. The rabbit died in full vigor from 
an accident. The membranous tube having detached itself at the level 
of the larynx by an effort, perhaps the shock of a cough, brought on by 
the introduction of a drop of liquid.” 
This proving of Bryonia by M. Curie was declared by M. Cretin “ the 
most brilliant experiment that has ever been made in homoeopathy. 
He has demonstrated writh specimens in his hand, the homoeopathicity 
in laryngo-tracheal diphtherite, of a remedy too much neglected. Put 
Bell., Ilepar, Iodine, Spongia, &c., to the same test, prove that each DIPHTHERIA. 
769 
of these produces peculiar functional disorders, and you will have made 
a grand step in science.” 
Capsicum-annuum.—Dr. Dake :* u Sensations of heat; burning and 
soreness in the mouth and throat; congested appearance of the mucous 
membrane; pain in swallowing; ptyalism; contracted feeling in the 
throat; heat and throbbing in the head; vertigo; epistaxis; increased 
rapidity of the pulse; fever; nausea; strangury.” It has long been 
regarded as an efficient remedy in cynancke maligna and scarlatina 
anginosa. It promotes “ the separation of the sloughs, and improves 
the constitutional symptoms.” “ Its extraordinary power to control the 
capillary circulation, to bring excess of blood, and thence to scatter 
more than it has brought, will enable it to remove congestions to reduce 
SAvellings, as promptly, if not as effectually as Belladonna.” 
Carb-baryta.—A case by Dr. Preston (St. Johns, N. B.).f A girl, 
aged eleven years. Sept. 19th, 1859. Tonsils very much enlarged, 
externally and internally; neck very stiff and painful on motion ; mem- 
branes of the tonsils, palate and fauces quite, red without much diffi- 
culty of swallowing; no exudation in the throat; no hoarseness; no 
fever, but great depression and weakness. 
To take strong nutritious food, with wine, and a dose of Carb.-baryta 
every two hours. 
Next day, this child and another much better. Medicine continued 
at longer intervals, diet the same. Recovered in a few days. 
Nitric-acid.—Burning of the tongue, mouth and pharynx; inflam 
mation of the mucous membrane of those parts; ptyalism; ulcerated 
spots; spreading ulcers in the mouth and throat; swelling of the sub- 
maxillary and parotid glands; obstructed nares; fluent coryza; epis- 
taxis ; putrid-smelling breath; frequent urging to urinate; red and 
whitish deposit in urine. Hoarseness; dry, barking cough; worse at 
night; ear-ache; hardness of hearing; pains in various parts like 
rheumatism; swelling and inflammation of the face, like erysipelas; 
loss of appetite; aversion to food; nausea; pain in the stomach; 
chilliness; paleness; excessive languor; profuse sweat; extreme 
debility. 
Regarding diphtheria not as a local but general affection, Dr. Dake 
thinks “ there is no remedy more capable of meeting the disease, with- 
out and within, locally and constitutionally. It not only touches the 
patchwork, but also follows on through every avenue, traversed by the 
destroyer, quickening the powers of gland, mucous membrane, and 
stomach, for its expulsion, the repair of tissue, and the support. 
Bromine.—Recommended by Dr, W. E. Payne, 1847, for membranous 
* N. A. Jour, of Homoeop., Yol. X. p. 431. 
t U. S. Jour, of Homoeop., Yol. I. p. 227. 
You L- 49. 770 
DISEASES OF THE SANGUINOUS FUNCTION. 
croup (Amer. Jour. Ilommop., Yol. I.), by Dr. A. S. Ball, of N. Y 
(North Am. Jour. Ilomozop., Yol. II.), Dr. H. C. Preston, also in 1853, 
(Phil. Jour. Ilom., Yol. I.), Dr. Kirsch of Wiesbaden ; all of these 
physicians succeeded in curing cases of membranous croup with it. 
Dr. J. P. Dake gives the following indications : 
“ Soreness and smarting in the throat; ptyalism; hoarseness ; rough, 
dry cough; sensation of contraction in the wind-pipe; fluent coryza; ‘ 
also nasal obstruction ; epistaxis; ear-ache ; alternate chills and heats; 
violent inflammation of the mucous membrane of the fauces, oesophagus, 
also of the larynx and trachea; these parts are coated with coagulable 
lymph, which obstructs almost entirely the air passage. A dingy brown- 
ish, granular, firmly-adhering exudation over the mucous membrane of 
the oesophagus.” 
The physiological provings of Brom., and its effect on patients 
(syphilis and scrofulosis) produce a pathological picture, correspond- 
ing fully to the symptoms of diphtheria in its different stages and 
forms, but it shows also the local process of exudations so character- 
istic to this disease. Trinks gives us from different sources the followT- 
ing symptoms: Tough yellow, or watery mucus flowing from the nose. 
Salivation with increased secretion of mucus in mouth and fauces. In- 
sensibility of the skin, especially of the fauces. Severe inflammation 
of the fauces, oesophagus and covering of it wdth plastic lymph. Severe 
inflammation of larynx and trachea with exudation of plastic lymph, 
nearly closing those organs. 
Hulte, Rames and Pluhe found after a large application of Bromine 
coryza, the eyes full of tears, injection of the conjunctiva with in- 
creased sensibility to light. In larger doses (si per day) it produced 
intoxication without any agitation, great malaise, vanishing of strength, 
decrease of the powers of vision and hearing, loss of sexual feeling, 
insensibility of the skin, even stitches were not felt; fauces and pharynx 
losing every reflex motion. 
Dr. Bering, of Philadelphia, seems to have been more successful 
than practitioners generally.* He says he treated within three months 
about fifty or sixty cases wdth marked symptoms of diphtheria, and 
about the same number of light cases. They “ all recovered within 
seven days, except a few of the so-called scrofulous diathesis, which 
required more time.” The medicine at first relied on was Belladonna. 
In some cases Bryonia or Antimonium-crudum, which latter cor- 
responded to the genus epidemicus particularly well. After the first 
medicine Lachesis was indicated by the great sensibility to the touch* 
on the throat, with or without a swelling. 
Every single dose of any of the medicines, even in the worst cases, 
* Transactions of American Institute of Homoeopathy, 17th Annual Meeting. DIPHTHERIA. 
771 
I allowed about twenty-four hours to act before I decided to make a 
change The lowest potency given was the 200° of Jenichen; gene- 
rally I used them higher, giving always on repetition a higher de- 
gree.” 
M. de la Pommerais, of Paris, said at a meeting of the Societe Horn, 
de France,* February 20, 1860, he thought we had been too much pre- 
occupied with the contagious or epidemic element of the disease and 
had neglected the psoric, syphilitic or sycotic element, which consti- 
tutes the hereditary predisposition. To this neglect he ascribes the 
greater part of his failures. According to Hahnemann’s “ Treatise on 
Chronic Maladies,” one of these three poisons is likely, on various 
occasions, either to change the nature of the existing disease, or to ag- 
gravate its intensity. We ought, therefore, in some cases to employ the 
anti-psoric remedies. There are some cases where we shall be 
obliged to recognize the appropriateness of Hepar-sul., Merc., or Brom. 
where we suspect something besides the contagious or diphtheritic 
element. Besides the symptoms, proper to a given disease, we have to 
consider the constitution of the subject, his predispositions, in a word 
his “ idiosyncracy,” all that makes up his individuality, physiological, 
or pathological. In a case of diphtheria, if the parents have been 
tainted with one of those primitive maladies to which we ascribe the 
after-existence of all the various chronic affections, can we believe that 
such an angina would not be more severe than one which attacked a 
healthy organism. This view of the subject accounts for the failure 
of remedies which are homoeopathic to the obvious symptoms. In 
these cases it is necessary to give a dose or two of an anti-psoric 
remedy in order to enable the proper specific to act with its full force 
upon the disease. We must individualize even in great epidemics, but 
the totality of the symptoms includes the idiosyncracy. 
Cantharis.—M. Bretonneau has noticed the similarity between the 
debility produced by this agent and that produced by the diphtheria 
poison. In each there may be seen the following symptoms : Coldness 
which resists external heat; adynamia even to the complete extinction 
of muscular power, no movements remaining but those of the heart 
and of respiration; the pulse falls to fifty, thirty or twenty.five beats 
per minute ; corresponding decrease in expiratory movements ; at last 
extinction of life. Cantharis produces apparent death. Successive 
fits of lethargy being prolonged more than twenty minutes, without 
any symptoms of life; then there is a slow resuscitation until the 
poisoned animals become able to stand and walk; subsequently there 
was a more prolonged relapse ending in complete extinction of life. 
Dr. Williamson, of Philadelphia, says:—“The result of the adoption 
* Bulletin. &c., Yol. 1. 772 
DISEASES OF THE SANGUINOU3 FUNCTION. 
in my practice of Croton, Canth., and Rhus as the principal reme- 
dies in the treatment of the throat symptoms in diphtheria, has 
been to diminish the mortality one-half. A careful study of the 
pathogeneses of these drugs, and a full consideration of their well- 
known sphere of action in the treatment of other diseases, would lead 
one to anticipate important results in the treatment of diphtheria, and 
after repeated trials I have found the anticipation to be be fully 
justified.” 
“ I generally administer the remedies in water, in the proportion of 
ten drops of the first decimal dilution, to a common-sized tumbler half 
full of water, and give by teaspoonful doses in the usual manner.” 
Nitrate of Silver.—The local treatment is still the chief reliance 
of the old school. Dr. McDonald says, (Lancet, Oct., 1859, p. 307,) 
by skillful application of strong solution of lunar caustic to the glazed 
red surface, the fungoid matter may not be developed; or if it be 
formed it may be separated from the surface and brought away. But 
if this be effected, the constitutional disease is not subdued. The 
poison is yet to be eliminated from the system and the vital powers 
remain yet to be supported. The solution directed is that of one-half 
drachm to the fluid ounce of water. Such was the allopathic reliance 
in the treatment of diphtheria at Albany, in 1859. 
Dr. George P. May, of Edinburgh, describes the disease in three de- 
grees of severity, and says he has seen several hundred cases. He 
says the lighter forms of it “ yielded to a few applications of a strong 
solution of Nitrate or Silver, which was best applied with a soft brush, 
as this permits to be visible the point to which it is to be applied.* 
Aceto-Nitrate of Copper.—This active agent operates on a similar 
principle when locally applied. Internally 'we have used it with good 
results. 
It is advised to “introduce a feather into the fauces every two hours 
for the purpose of absorbing the noxious mucous.” This draws away 
large quantities of the substance which forms into false membrane, and 
is an important adjunct to other remedial measures. 
Local application of Nitrate of Silver muriated tincture of Iron, 
or Iodine, possess no curative virtues. In virtue of their escharotic 
influence, they may remove temporarily the deposits upon the tonsils 
and throat, but they speedily reform; the patient continues to fail in 
strength and vitality, and sooner or later succumbs under the typhoid 
symptoms consequent upon the blood-poisoning. 
Let no one therefore rely at all upon local applications in the cure 
of this malady ; but strike the cause and seat of the destroyer in the 
blood itself by the proper specifics. 
* Lancet, Nov. 1859, p. 409. DIPHTHERIA. 
773 
In the more malignant forms he succeeded with Tincture Sesqui- 
chloride of Iron, applied two or three times in twenty-four hours. 
Counter-irritation to the throat should be avoided, especially in 
children. Mustard produces troublesome excoriations. A piece of 
folded linen, wet with tepid water, is least inconvenient; cover it with 
oiled silk or gutta percha. 
Small pieces of ice may be held in the mouth. 
The following mixture is proposed for local use by Dr. Meyerhoffer, 
(HirscheVs Klinik, 1863): 
Brom. 0,1 gtt. xx. 
Glycerini puri f i. 
A camel’s-hair penpil is moistened with the fluid and carried over all 
places, covered with the exudation. To get a direct influence on the 
larynx, the first trituration of the Brom.-kali may be blown quickly into 
the larynx one or two grains through a flexed glass tube during an in- 
spiration. In children, who refuse pertinaciously the introduction of 
the probang, or wrhere the glandular swellings render it impossible to 
open the mouth, it may be blown into the mouth during sleep. Its 
local effect is quickly seen in the greater facility with which the patches 
dissolve, getting more friable and disconnected; furthermore, no fresh 
exudations appear any more on the cleansed mucous membrane; except 
where the exudation is very firm, it will take a little more time. 
The blowing in of the Brom.-kali commonly produces severe cough- 
ing spells, during which the false tubulous membranes are expecto- 
rated. Local applications give temporary benefit. 
Alcoholic Stimulants.—Brandy and wine, says Dr. Dake, “ only 
serve to quicken the circulation, hurry morbid as wrell as normal pro- 
cesses, and thus precipitate the approaching danger. While the disease 
is yet in the system, in active progress, though far out of superficial 
view, stimulants increase the safety of the patient, and favor final re- 
covery in the same way, and to the same extent that a double pressure 
of steam and a redoubled velocity would increase the safety and put in 
sound condition, a locomotive that is defective in the boiler, weak in 
cylinder, and loose at every joint. Worse than that, the stimulation 
exhausts the limited vital powers, the steam necessary to propel the 
engine, without the ability to furnish more.” 
During the entire course of the disease we have always derived un- 
equivocal benefit from the use of stimulants. 
Diet.—In bad cases a stimulating and nutritious diet is demanded 
from the commencement. Port wine every hour, warm milk, yolk of 
eggs beaten up in wine, strong coffee, beef-tea, white wine-whey, though 
it is useless to load the stomach with food that cannot be digested. A 
liberal allowance of salt is permitted in every kind of food. 774 
DISEASES OF THE SANGUINOUS FUNCTION. 
Barley-water acidulated with lemon-juice, or mixed with honey, cu* 
rant jelly or blanc mange. 
After the first week, animal broths, perhaps given by enema. 
In the early stages of all cases of diphtheria the use of meat-broths 
is actually indispensible. All cases may not absolutely require alco 
liolic or wine stimulants from the onset of the disorder, but duWng it 
course, stimulants will be useful in nearly all cases. 
10. CYNANCHE TRACHEALIS.-CROUP. 
Until the present century this disease was confounded with whoop- 
ing cough, asthma and bronchitis, and the fatal, cases were supposed 
to be violent forms of one of these maladies. 
In the hands of the allopath, croup has ever proved a most formidable 
and fatal disease. Acting, in the application of their remedial mea- 
sures, only indirectly upon the part affected, by venesection, leeches, 
blisters, emetics, mercurial cathartics, expectorants, &c., it is not a 
matter of surprise that they are so often baffled in subduing a malady 
of so violent a character as the one under consideration. 
It is especially in diseases of this nature, that the truth and value 
of a system of practice may be satisfactorily tested; for it is here that 
a prompt, efficient and specific remedy is imperatively demanded, in 
order that the progressing inflammation may be at once arrested and 
the patient saved. These are the cases that try the truth and sound 
ness of a theory; w7hich convince the public,—who appreciate facts if 
they do not comprehend abstruse theories—which school possesses the 
knowledge and skill that should command approbation and support. 
On the result of these tests wre are willing to rest the claims of homoeo- 
pathy. Indeed the records of the homoeopathic practice show conclu- 
sively a large balance in its favor, over the other systems in all mala- 
dies of an acute as well as chronic character. 
Croup rarely occurs after the age of seven years, and may therefore 
be accounted a disease almost peculiar to childhood. Its seat is in the 
mucous membrane of the larynx, trachea and bronchia, and sometimes 
of the fauces and palate. 
Diagnosis.—Croup may with propriety be divided into two principal 
varieties, viz.: first, the false,pseudo or non-memhrarums, comprising, 
however, under this head the spasmodic, catarrhal and slightly in- 
flammatory kinds; and second, the true, or membranous croup. 
Some recent writers have distinguished four distinct varieties, each 
one forming a distinct and independent disease, and not liable to run 
into either of the other forms. 
It is doubtless true that these several varieties do often exist as dis- 
tinct and clearly defined maladies, and that the remedies homoeopathic CROUP, 
775 
to these varieties are almost entirely distinct, but we are by no means 
certain that different forms do not run into each other. Be this as it 
may, it is of importance that an accurate knowledge should be acquired 
respecting the seat, nature and symptoms of the malady in all its 
forms, so that we can exhibit without delay a remedy which shall b® 
truly specific and homoeopathic. 
1. False or non-membranous Croup. — Spasmodic croup usuall} 
makes its appearance suddenly, with considerable difficulty of breath- 
ing, noisy and wheezing inspirations, a short, dry, hoarse cough, occur- 
ring but rarely, and an entire absence of febrile symptoms. 
Catarrhal croup also commences suddenly, with a “ croupy cough,” 
hoarse voice, shrill, wheezing and sonorous inspirations, oppression and 
tightness at the chest, and sudden attacks of dyspnoea; but in a feu) 
days the croupy character will wear off of itself, leaving simple 
catarrhal symptoms only.” ( Watson.) 
In the simple inflammatory croup, in addition to the loud,.harsh 
and wheezing respiration, and hoarse, croupy cough, we have usually 
sore throat, some thirst, and nightly febrile exacerbations. This, like 
the preceding variety, will often wear off spontaneously, leaving only 
some slight symptoms behind. 
An important peculiarity of all the varieties of false croup, consists 
in the suddenness of their attacks. Children may retire to their beds 
in the most perfect health, and yet in an hour or two be disturbed from 
a sound sleep with an apparently alarming attack of croup. It is im- 
portant, however, that all should be aware that these seemingly danger- 
ous cases are much less to be dreaded than those which make their 
appearance in a more slow and insidious manner, as will be seen by the 
following description of the true croup. 
In all the varieties above described, although there may be difficult, 
labored, anxious, and wheezing respiration,' hoarse, harsh and croupy 
cough, hoarse voice, and the patient may seem to be in imminent dan- 
ger of suffocation, yet the fact that the attack has occurred suddenly, 
and that the cough bears no resemblance to the dreadful metallic 
cough of real croup, will afford us sure indications of its nature, and 
enable us to assure those interested that the attack will speedily be 
subdued. 
2. True or membranous croup, is usually ushered in with the or- 
dinary symptoms of catarrh, as chilliness, sneezing, some soreness of 
the throat, hot skin, thirst, slightly accelerated pulse, hoarse voice, and 
some little impediment in respiration. At this period a whistling or 
“ buzzing sound may be heard at the rima glottidis by placing the ear 
upon the back of the neck, or over the larynx.” ( Ware.) Even at this 
early period the commencement of the false membrane may be observed 
upon the tonsils, and sometimes upon the uvula and pharynx, which 776 
DISEASES OF THE SANGUINOUS FUNCTION. 
gradually increases in thickness and strength, unless the peculiar in- 
flammation be arrested. 
As the disease advances, the febrile symptoms increase, the respi- 
ration gradually becomes more labored and difficult, the inspirations, 
particularly after coughing, being slow, sawing, sonorous or ringing, 
while the expirations are quick; the cough is dry and gives forth a 
metallic sound; the voice becomes more shrill, the pulse is frequent 
and small, the expression of countenance swollen and anxious; the 
head is thrown back; the extremities are cold, while the rest of the 
body retains its exalted temperature; there is often a profuse perspi- 
ration, until finally the respiration is so much impeded that the blood 
is but slightly oxygenated; the cheeks and lips become livid, the eyes 
red and sunken, the pulse extremely small and frequent, the whole 
organism prostrated, and the child expires in a state of asphyxia or 
suffocation. 
In membranous croup the inflammation is of a peculiar character; 
for from the very commencement of the attack, the mucous membrane 
continues to pour out coagulable lymph, which becomes adherent to the 
parts affected, forming the tough artificial tube known as false mem- 
brane. We believe that the progress of this fictitious formation is 
never entirely arrested until a healthy medicinal inflammation is made 
to supercede the peculiar morbid action. 
“ The false membrane which so frequently forms on blisters, is, of 
itself, sufficient to prove that it is much less to the degree than to the 
nature of the inflammation, that we are to attribute this concretion or 
coagulation of pus in certain cases.” (Laennec.) 
Causes.—A cold and damp atmosphere, wet feet, and exposure to 
the air which blows from seas and lakes. It appears to be necessary 
also that there should be a certain predisposition on the part of the 
patient, in order to contract the disease, since all of the children of 
some families are constantly liable to its attacks, while those of other 
families, constantly exposed to precisely the same influences, are 
exempted. This predisposition may frequently be traced back through 
several generations, wdiile in other families the reverse is true, no in- 
stances of the malady having ever been known to exist in them. Croup 
sometimes follows as a sequence of scarlatina, measles, &c., and has 
by some writers been confounded with the former disease, and from this 
circumstance has originated the idea of its contagious nature. 
Treatment.—Spasmodic Croup.—Aconite, Spongia, Hyoscyamus, 
Belladonna, Nux, Musk, Cuprum, Ipecac., Camphor and Lobelia 
injlata. 
Catarrhal Croup.—Aconite, Tartar-emetic, Spongia, Hepar• 
sulph., Drossera, Lachesis, Sambucus, Chamomilla and Nux. CROUP. 
777 
Simple Inflammatory Croup.—Aconite, Spongia, Hepar, Tartar- 
emetic, Phosph., Iodine and Belladonna. 
True or Membranous Croup.—Kali-bichrom, Bromine, Ammo- 
nia-caustic, Hepar-sulph., Argentum-nitr., Sambucus, Spongia, 
Iodine, Senega, Tartar-emetic. 
Aconite Croup.—Invasion in the evening, after first sleep, preceded 
by restlessness, accelerated pulse and dryness of the skin. The patient 
usually rouses from sleep, with restless, impatient movements, tosses 
from side to side, cannot be calmed, and, on attempting to swallow, 
cries as if from soreness and pain in the throat, followed immediately 
by a shrill, barking cough. The cough is frequent, following every 
expiratory effort, but absent during inpiration. This seems to result 
from a tickling sensation, excited by the rush of air from the lungs, 
through the over-sensitive and irritated larynx. The sibilant, stridulous, 
or sawing respiratory sound is also heard only during the expiratory 
act, and not during inspiration, as in some other forms of croup. 
The stridulous respiratory sound and cough, are concurrent and pre- 
sent only during expiration, which appears to be characteristic of 
aconite croup. The cough is more or less paroxymal, but the stridulous 
breathing continuous, till after midnight, when both gradually remit, 
and towards morning nearly or wholly disappear, but often to return 
on the following night. 
Some five years since our attention was first attracted to the above 
peculiar concurrence of the stridulous respiratory sound, and barking 
cough, in the case of a boy about four years old. The disease resisted 
all our efforts for four days. No remedy touched it, but we gave 
Aconite, when the whole trouble vanished as if by enchantment. 
(Dr. Paine, of Bath, Me.) 
The following excellent indications for the employment of Spongia, 
Ilepar-sulph., Bromine, Caustic-ammonia, Kali-bichrom, and Pot- 
ash, were arranged by several homoeopathic physicians of Pressburgh, 
and translated for the Homoeopathic Examiner by Dr. Hempel. 
Spongia Croup.—“ Hollow cough, with expectoration, and pain in 
the chest and trachea; roughness in the throat (night cough with 
weeping expression); breathing aggravated, as from a plug in the 
throat, slow or quick ; panting; larynx painful, as if from pressure— 
worse when touched; scratching, burning and constrictive sensation 
in the larynx; painful feeling of swelling in the cervical glands near 
the larynx and trachea; stinging in the throat and sensation in the 
outer parts of the neck, as if something were pressing out, morning and 
evening ; painful tension on the left side of and near the pomum Adami, 
when turning the head to the right side; the eyes are sunken; the 
urine deposits a thick, grayish-white sediment; general morning sweat; 
pulse quick and hard; drowsiness; lassitude of the whole body; out 778 
DISEASES OF THE SANGUINOUS FUNCTION. 
of humor; every thing puts him out of humor, even talking and answer- 
ing questions.” 
Dr. Paine says :* “ It seems that Sjpongia covers nearly the same 
symptoms as Aconite, with this difference and addition: in Spongia 
croup, the stridulous respiratory sound is always during inspiration, 
and the cough less constant, and excited only by the inspiratory act; 
and the cough and sibilant respiratory sound are not so constantly 
concurrent as in Aconite croup. There is also, in Spongia croup, 
fluent coryza, and sometimes sneezing, with saliva drivelling from the 
mouth, which we do not see in Aconite croup. Neither of these re- 
medies have any homoeopathic relation with membranous croup, either 
in their symptomatic or pathologic bearing; and, in such cases, the 
time expended in their use, is, in our judgment, so much time lost.” 
Teste says, this remedy is, in general, only applicable in the second 
stage of croup, though he does not hesitate to place it in the first rank 
in the treatment of acute and chronic affections of the serous mem- 
branes, (pleurisy, pericarditis, peritonitis, &c.). 
Hepar Croup.—•“ Violent fits of cough, as if he would suffocate or 
vomit; deep distress, occasioned by the tightness of breathing; husky, 
accompanied with painful soreness of the chest at every turn of cough, 
which is violent, the air rushing violently against the larynx, occasion- 
ing a pain in that part; sensation of scraping; scratching, with mucous 
expectoration; the cough being caused by tittilation in the throat, 
or by a scraping in the trachea, and increased unto vomiting by a deep 
inspiration; weakness of the organs of speech and chest, which prevents 
talking aloud; short breathing, pressure in the throat, occasioning a 
constrictive feeling as if he should be suffocated; urine pale, clear 
while being emitted, afterwards becoming turbid and thick, depositing a 
•white sediment, or flocculent, turbid, while being emitted, or dark 
yellow; burning during emission; great unconquerable drowsiness; 
profuse sweat, day and night; viscid profuse night sweat; sweat before 
midnight; sad, apprehensive and inclined to weep. 
Bromine Croup.—Formation of pseudo-membrane in the larynx and 
trachea; spasm in the larynx occasioning suffocation ; cough with croup 
sound, hoarse, wheezing, fatiguing, not permitting one to utter a word; 
sneezing, with violent suffocative fits; respiration characterized by 
mucous rattling; wheezing ; alternately slow and suffocative, and hur- 
ried and superficial; breathing painful, oppressed, gasping for air; heat 
in the face; increased secretion of urine; pulse rather hard, slow at 
first, afterwards accelerated.” 
Caustic Ammonia Croup.—“ Deep, weak voice; fatiguing, inter- 
rupted speech; increased secretion of. mucus in the bronchia; violent 
* U. States Jour, of Horn., Yol. I. CROUP 
779 
cough, with copious expectoration of mucus, especially after drinking; 
difficult, rattling, labored breathing ; stertorous breathing ; suffocative 
fits; spasm of the chest.” 
Bi-chromate of Potash Croijp.—“ Symptoms approach gradually 
and insidiously; at first, slight difficulty of breathing when the mouth 
is closed; slight elevations of temperature; pulse irregular and inter- 
mittent, or frequent and small; as the disease progresses, the difficulty 
of breathing increases; the sound of the air as it passes through the 
trachea is shrill, whistling, as if it passed through a metallic tube; 
voice hoarse; cough not frequent, but hoarse, dry, barking and me- 
tallic / deglutition painful; tonsils and larynx red, swollen and covered 
with an appearance of false membrane ; after a time, breathing affected 
in part by the action of the abdominal muscles, and those of the neck 
and shoulder-blades; head inclined backwards; breath offensive; 
finally diminished temperature of the skin ; prostration ; stupor.” 
The medicines, of which the pathogenetic symptoms are here de- 
tailed, are those which are most completely specific against croup. It 
is true that the other articles alluded to, as Aconite, Iodine, Bella- 
donna, Nux, Hyoscyamus, Sambucus, Tartar-emetic, Lachesis, 
Phosphorus, Prosser a, Arsenicum, &c., cover many of the symptoms 
usually present, especially in non-membranous croup, but they canno 
be considered positive and reliable specifics against the disease fully 
developed. So far, however, as certain special indications are con 
cerned, these medicines may often be employed with great advantage 
The following is Dr. Bosh’s method of treating croup: “If the dis- 
ease begins, as it frequently does, with an inflammatory fever, then I 
give first, according to the circumstances, every quarter of an hour, 
one or two drops of Aconite (the dilution, second or third, depending 
upon the age), and then I let the child rest from one to two hours, 
when I give the remedy, which I found in my practice to be the main 
remedy, Spongia, first, second, or third dilutions, according to the se- 
verity of the disease; eight drops, in four ounces of water,—of this 
every quarter to a half hour, or, in less intense cases, only every hour, 
half a table-spoonful. If the disease has proceeded further, and para- 
lytic signs are perceptible (by continued obstruction of the respiration, 
congestions of the brain, &c.), then I give Spongia alternately with 
Phosphorus. If, notwithstanding these means, the disease increases, 
I give Spongia in alternation with Tartar-emetic.” 
Tartar-emetic.—Feeble voice, burning under the sternum, cough 
and sneezing. Tittilation in the larynx, inducing cough ; cough with 
vomiting. Mucous rale in the bronchia with oppression. Eating ex- 
cites cough and vomiting of food, and glairy mucous. Short, hoarse 
cough caused by tickling in the middle of the larynx, heat and sweats 
on the forehead when coughing, which is very fatiguing. 780 
DISEASES OF THE SANGUINOUS ‘FUNCTION. 
Tartar-emetic is not only useful in the early stage of croup, but it 
is also indicated when there are signs indicative of partial paralysis of 
the pneumogastric nerve; viz.: face livid and cold; cold sweat on the 
forehead or body; respiration exceedingly difficult, short, hoarse, shrill, 
or whistling; head thrown back ; pulse small and rapid, or feeble and 
slow; great weakness, anxiety and uneasiness ; difficulty in swallowing; 
short, hoarse and barking cough; disposition to sleep. The remedy 
should be given in the first attenuation, and the dose repeated every 
twenty or thirty minutes, until relief is obtained. 
Pathology.—Larynx and trachea covered with large pustules de- 
pressed in the centre. Mucous membrane of the larynx and trachea red 
and injected. 
The indications for this remedy in croup are based on the predomi- 
nating symptoms of partial paralysis of the pneumogastric nerve. The 
short, hoarse, nearly suffocative breathing is accompanied by a whist- 
ling noise heard even at a distance, whilst the thorax expands only with 
the greatest muscular effort, and the greatest anxiety, uneasiness and 
prostration are manifested. The head is thrown backward; the face 
livid and cold; the forehead and sometimes the whole body are covered 
with a cold sweat; the pulse small and very much accelerated, or de- 
pressed and slow; the patient drinks with great difficulty, owing to the 
spasm and complete contraction of the muscles of the throat. 
The remedy must be given at short intervals and generally succeeds 
best in a low dilution. If given every fifteen or thirty minutes the 
symptoms often diminish rapidly without inducing vomiting, purging, or 
profuse sweat. The child falls into a gentle sleep; the cough soon be- 
comes loose and expectoration begins to be more free: it consists some- 
times of a thick lumpy, greenish mucus ; the skin becomes moderately 
warm, the pulse more natural. In cases in which the deposition of 
plastic lymph in the form of false membrane has not yet commenced, 
Tartar-emetic is one of the most efficient remedies: and is generally 
more applicable than any other remedy in all the ordinary inflammatory 
and spasmodic varieties of the disease. It has been very effectual in 
the first stages of inflammatory croup, with hoarse, barking cough, 
rough and hoarse voice, great painfulness of the larynx, with danger of 
suffocation when touching or turning the throat, when talking or taking 
breath ; bright redness of the throat, spasmodic constriction of the 
throat, whistling, laborious respiration, wheezing and rattling in the 
larynx and bronchial tubes, the use of this drug in alternation with 
Belladonna is our most reliable remedy. In cases of this kind Bella- 
donna has not received due appreciation. It is homoeopathic to a ma- 
jority of the cases that occur, and we believe that a prompt and reason- 
able employment of these two drugs will speedily break up fifty per CROUP. 
781 
cent, of all the cases that occur in practice. [Dr. Marcy. New 
Materia Medica, p. 436.) 
In spasmodic croup Dr. Dunford relies upon Aconite, Ilyoscyamus, 
and Belladonna. 
When in addition to high febrile excitement, the local croupy symp- 
toms are urgent, we must alternate the proper local specific with 
Aconite. In this way we may often give Spongia, or Uepar-sulph., 
and Aconite. When the disease obstinately resists Aconite, Spongia, 
Uepar-sulph., Tartar-emetic, both alone and in alternation, we may 
consult Phosphorus, Lachesis, Sambucus, Senega-pol., &c. 
As we progress in the knowledge of medicinal substances, a still 
greater number of pure specifies will undoubtedly be added to our ma- 
teria medica. Before taking leave of this subject, we ask attention par- 
ticularly to the employment of one remedy, previously named, for the 
cure of membranous croup. We refer to the Nitrate of Silver as a 
direct application to the affected membrane. For some years we have 
been in the habit of employing a strong solution of this salt, by means 
nr a sponge moistened with it, and introduced into the larynx; and in 
several instances the most satisfactory results have followed. This 
remedy has been used to a considerable extent by French as well as 
American physicians, and in many cases they have saved life when 
every other means had failed. The principle on which it cures, how- 
ever, is strictly homoeopathic, for it is due solely to the medicinal or 
artificial action of the remedy, that the morbid croupy inflammation 
is superseded, and the false membrane gradually destroyed and ex- 
pelled. 
It may be used in any stage of true croup, and will sometimes effect 
a cure when every internal remedy has failed. 
A little tact will enable the physician to apply the solution to the 
larynx, or trachea, in an efficient manner and with perfect safety. 
Administration.—In the treatment of croup we generally employ 
the lower potencies. In regard to the repetition of doses, no definite 
rules can be given, but the practitioner must be guided by the variety 
of the disease, the severity of the symptoms and the effects of his re- 
medies. 
Boeninghausen's Treatment of Group.—He gives five powders. 
Thus: No. 1 and 2, Aconite 200° ; 3 and 5, Ilepar-sulphur 200°; 
4, Spongia 200°. 
He says, the true symptoms of croup nearly always disappear after 
the first powder, if no other remedies have been given. One hour 
should always pass between 1 and 2! If there be improvement after 
No. 1, the next, No. 2, should only be given after twelve or eighteen 
hours. No. 1 and 2 remove the inflammatory symptoms, No. 3 removes 
the cough and prevents the return. 782 
DISEASES OF THE SANGUINOUS FUNCTION. 
Hahnemann experimented with the thirtieth dilution for twenty 
years and then decided that remedies at that potency were efficient in 
curing disease. 
Boeninghausen says, he began trying high potencies in 1843 on a 
more extensive scale. At the end of seventeen years he says, that the 
result has been so satisfactory, that he prefers them decidedly to all 
lower dynamizations, and he shall never return to the lower attenua- 
tions. He has treated many cases as usual, and when the two-hundreth 
power failed, he only succeeded by using Jenichen’s high potencies. 
He understands that these latter were prepared on Hahnemann’s scale 
of one-hundred, potentizing each dilution with thirty shakes of an un- 
usually powerful arm. 
Jenichen commenced his high potentization January 1st, 1846, in 
trying to bring Arsenic up to the 8000°, and he finally carried it to the 
40,000°, and found it to surpass all other potencies of Arsenic. 
Dr. Wolf thinks, that “ Croup has become more frequent and un- 
manageable through the influence of vaccination. He says, Boening- 
hausen’s five powders have become famous against croup, and that he 
has often used the same remedies in the second or third potency gene- 
rally with success, though now and then a child will die of paralysis. 
He can not decide whether the high potencies have been more suc- 
cessful in his hands than the lower. Where it is possible, he would 
give a dose of Thuya at the beginning, and afterwards nothing but 
Aconite 2°, 3°, or 200°. Apis appears also to be an excellent remedy 
in alternation with Aconite, and afterwards one dose of Thuya, 30°. 
Case by Dr. Kenyon of Buffalo.—A child three years old had 
croup. In the night the mother gave Aconite, Spongia, Tartar- 
emetic, Mercurius-iodatus. The child grew worse. They tried hive- 
syrup till vomiting gave temporary relief. The symptoms returned. 
Cold compresses applied to the neck; mustard to the feet and 
wrists; used hot mustard-bath, then gave hive-syrup the third time. 
Five minutes after, Dr. Kenyon found the cough dry and shrill, breath- 
ing whistling with violent heaving of the chest, contortions of the 
face; skin dry and hot, pulse nothing but a tremulous motion. He 
feared, the Aconite could not succeed, if given in five minutes after 
the large dessert-spoonful of hive-syrup: but the case was growing 
worse. Aconite 200° was given, the child wrapped in a dry, warm 
blanket, the cold compress being left on the throat. Relief was mani- 
fest in less than half an hour. Aconite 200° repeated. Then Hepar 
200°. After the last the child slept quietly two hours. Two hours 
later there was hoarseness, for which Aconite 200° was given. 
Ipecacuanha.—Dr. Teste {Mate'iia Medica, p. 364) says, he has 
seen Ipecacuanha arrest the following symptoms with such marked 
rapidity that he can not help believing it capable of producing similar CROUP. 
783 
symptoms, if not in full-grown persons, at any rate in healthy children: 
“ Rapid bloating of the mucous membrane of the pharynx, and very 
probably also of the larynx and trachea. 
“ Secretion, on the inflamed surface of this membrane, of a thick, 
plastic, whitish, mother of pearl humor, looking at first like small white 
or grayish points, either on the tonsils, or on the pillars of the palate, 
or even in the pharynx. 
“ If we unite these symptoms to those mentioned before, we shall 
have as complete an image of croup as possible.” 
Teste relies upon Bryonia and Ipecac, to a large extent in croup, 
employing them in the attenuations and in alternation. 
At the same time he admits that croup may be cured by many other 
remedies, and also that “all the analogues of Ipecac, are capable of 
producing, each in its own degree, not only the general croup, but even 
the pseudo-membranous exudation which constitutes the pathognomonic 
sign of croup, and that they must therefore be capable of curing this 
disease.” Peculiar constitutions may require other remedies. In the 
sub-acute form there may be occasion for “Pulsat., Silic., Spong., 
Ilepar, &c., in preference to Ipecac, or Bryon. But I maintain that 
these cases are rare, and that, as a general rule, Ipecac, and Bryon. 
constitute the specific remedies for croup.” 
“ Ipecac, is almost the only remedy that is indicated in all cases of 
very acute inflammation of the throat, wind-pipe, bronchia, and even 
the parenchyma oi the lungs, no matter what the cause of the inflam- 
mation may have been, when the patient is from six to ten months old, 
with blond hair, of a sanguine and lively disposition, and if it is more 
particularly at night that the disease reaches its acme, or first 
breaks out.” 
Dr. Holcombe says, he never lost a case of croup, out of a large 
number. His treatment consists in: 1. Applying a cold water bandage 
to the throat at an early period. This is imperative; and he would not 
take the responsibility of a case, when this was objected to. 
2. Aconite and Spongia alternately every 15 minutes or half hour till 
better or evidently worse. If growing worse, Iodine or Bromine in 
such doses as leave a sensible taste to the solution, every fifteen minute.-, 
or half hour, the intervals to be lengthened as ameliora tion is perceptible. 
If the disease progresses, give Kali-bichrom. Ilepar, Phosphorus 
and Tartar-emetic are best adapted to pulmonary irritation which re- 
mains after the exudative stage is arrested. 
Teste’s plan of Bryon. and Ipecac, he thinks better adapted to bron - 
chitis than to laryngitis or tracheitis. Dr. Hering gives Tartar-emet. in 
nauseating doses, but this is antipathic, not homoeopathic treatment : 
the pathogenesis of Tartar-emetic does not resemble the early stage 
of true croup. 784 
DISEASES OF THE SANGUINOUS FUNCTION. 
Genus V.-INFLAMMATORY AFFECTIONS OF THE ORGANS WITHIN 
THE THORAX. 
These diseases may be divided into the following groups: 1. Those 
affecting the bronchial tubes; 2. Those more immediately connected 
with the air-cells and pulmonary parenchyma; o. Those seated in the 
pleura; 4. Diseases affecting the trachea. 
This appears in two forms : 1. Common acute bronchitis consists in 
inflammation confined to the larger subdivisions of the bronchi; 2. Ca- 
pillary bronchitis consists in inflammation restricted to the minute 
branches, or extending from them to include the larger divisions also; 
here the smaller ramifications are affected, but not the proper capillary 
tubes or terminal twigs of the bronchial tree. Bronchitis may also 
exist as an idiopathic affection, or co-exist with other diseases of the 
lungs or other organs; it may be general or circumscribed. 
1. BRONCHITIS 
ACUTE BRONCHITIS. 
This complaint is of most frequent occurrence in old age and in 
childhood. Its seat is in the mucous membrane of the bronchia, but 
authors assure us that the bronchial inflammation is always accom 
panied with considerable “ sanguineous congestion of the lungs/’ 
Effusion into the substance of the lungs, is peculiarly apt to occur in this 
disease, and it is to this circumstance that its danger is to be attri- 
buted. 
Diagnosis.—Constriction and aching sensation, extending over the 
whole chest; breathing very much oppressed, quick, anxious, irregular, 
labored; the voluntary muscles of respiration often called into play; 
expectoration is at first dry, but it soon becomes viscid and frothy, and 
sometimes streaked with blood; more or less cough, hoarse and pain- 
ful in children; throbbing pain in the forehead and aching pain in the 
eyes, aggravated on coughing; face red or pallid; tongue moist and 
covered with a white fur; bowels costive; temperature of the skin 
nearly natural, but sometimes hot and dry ; pulse at first but little in- 
creased in frequency, becoming, as the disease advances, very rapid; 
urine scanty and high colored; vertigo; rattling in the throat and 
chest; wheezing respiration. As the malady approaches towards a 
fatal termination, the skin becomes suffused with a cold perspiration; 
the cheeks and lips pale and livid; the extremities cold; rattling and 
sense of suffocation in the throat; extreme prostration and complete 
insensibility. 
The peculiar respiration (the mucous rale or rattle of Laennec) which BRONCHITIS. 
785 
is so apparent is owing to the “ passage of air through the diseased se- 
cretion of the air passages, and be heard by placing the ear to 
the chest, long before it becomes so severe as to be distinguished by 
any other means.” {Mackintosh.) 
The inflammation of bronchitis is of a much more intense character 
than that which is present in catarrh or influenza, and there is always 
more or less sanguineous congestion of the lungs. Many of the more 
urgent symptoms of the complaint are due to this last circumstance, 
like the great difficulty of breathing; the painful sense of tightness; 
stricture and oppression in the chest; wheezing respiration; severe 
cough ; pallid countenance ; vertigo ; pain in the head, &c. During 
the progress of this disease, the substance of the lungs often becomes 
hepatized. 
Summary of Physical Signs.—In acute Bronchitis.—Percussion- 
resonance clear on both sides of the chest. In the early stage, before 
liquid secretion takes place, the dry rales, especially the sonorous, 
irregularly present in a certain proportion of cases. After secretion, 
the moist rales frequently commingled wTith the dry. The rales heard 
on both sides. The respiratory murmur at the upper portion of the 
chest in front exaggerated and harsh in the early stage, subsequently 
liable to be diminished or suppressed over a part or the whole of the 
chest. Sometimes reproduced suddenly after an act of coughing. In 
some mild cases preserving its normal intensity and characters. A 
ronchal fremitus occasionally present. 
2. Capillary Bronchitis.—This disease was formerly known by the 
title of peri-pneumonia notha, or suffocative catarrh. It consists 
anatomically in an irregular contraction of the calibre of the minute 
tubes, the presence of liquid within these tubes, and obstruction to the 
passage of air to and from the vesicles. This obstruction causes the 
principal physical signs. 
Capillary Bronchitis. 
The reverse obtains in this disease. 
Diagnosis, 
(Edema Glottidis. 
The seat of the obstruction is indicated 
by the sudden arrest of the inspiration, 
the expiration remaining free; when 
there is no pulmonary complication, 
auscultation discovers only diminution 
or abolition of the vesicular murmur; 
not the rales of capillary bronchitis. 
The finger carried to the top of the 
larynx proves the existence of oedema 
by the touch. 
Spasm of the Glottis.—Common in 
early life, rare in adults. It is parox- 
ysmal, the respiration in the intervals 
being either free, or but slightly em- 
Difficulty of respiration, although in 
creasing at times, is persisting. 
Vol. I.—.50. 786 
DISEASES OF THE 6ANGUINOUS FUNCTION. 
Capillary Bronchitis, i 
(Edema Olottidis. 
barrassed. It is characterized by a 
sonorous crowing inspiration, distinct.Ye 
of its laryngeal origin. 
Pulse not increased in frequency. 
No positive signs of inflammation. 
Laryngitis in the Adult and Croup 
in Children —Voice hoarse, husky, 
or extinguished. In croup the soronous 
tubular breathing and cough are diagnos- 
tic. 
No signs of inflammation. 
Asthma, orthopnoea and defective hae- 
matosis evident. 
Sonorous and sibilant rales well mark- 
ed. But here the chief element Ls 
spasm. The affection is paroxysmal, 
though often of long duration. The 
patient is known to be subject to them. 
Previous signs denote emphysema. 
The pulse may remain unaffected, and 
is never greatly accelerated. 
Acute Bronchial Inflammation in 
a Person affected with Emphysema. 
—When the inflammation extends be- 
yond the larger, but not to the minute 
branches, there is suffering and laborious 
respiration, impaired oxygenation of 
blood. When there is emphysema, the 
sonorous and sibilant rales are present 
with mucous rales, but not the sub- 
crepitant. The case is less dangerous 
than acute bronchitis, as is shown by the 
less excited pulse. 
The dyspnoea is great in proportion 
to the obstruction. Spasm of the mus- 
cular fibres of the bronchial tubes. 
Lobular Pneumonitis. Broncho- 
pneumonia.—Peculiar to young sub- 
jects. 
Inflammation extends from the larger 
tubes to a certain number of the air- 
cells of the lobules on each side, limited 
only to the minute, to the intermediate 
minute branches leading to the inflamed 
lobules. 
Pulse increased m frequency. 
Voice unaffected. 
Auscultation shows signs of inflam- 
mation. 
Orthopnoea and defective haematosis 
in minute bronchial branches, and physi- 
cal signs nearly the same as in asthma. 
Sonorous and sibilant rales. 
The affection is inflammatory, and not 
habitual nor paroxysmal. 
Pulse greatly accelerated. 
These symptoms are the same as in 
acute bronchial inflammation extending 
to, but not beyond the smaller branches. 
But the symptoms all more serious, pulse 
more frequent, indicating inflammation. 
Peculiar to young subjects. 
Inflammation extends from the larger 
to the minute bronchial tubes through- 
out the lungs, perhaps the air-cells, the 
lobules, in parts, become implicated. 
Ordinary bronchitis exists in both 
these diseases. 
Dyspnoea and hurried respirations in 
both. But in capillary bronchitis is a 
serious disease. Respirations frequent; 
asphyxiating symptoms strongly marked 
A less grave disease. BRONCHITIS, 
787 
by dyspnoea, restlessness, lividity; ca- 
reer more rapid. 
Sub-crepitant rale throughout the 
lungs, diffused over the surfaee of the 
chest. 
Capillary Bronchitis. 
Sub-crepitant rale belongs to both 
affections, but here it is limited in its 
seat to the minute tubes in immediate 
relation to the inflamed lobules. Thus 
it is confined to certain portions. 
Astlma. 
“ Summary of Physical Signs of Acute Capillary Bronchitis.—• 
Percussion resonance on both sides not diminished, but often exagge- 
rated ; sonorous and sibilant rales diffused over the chest, the latter 
more prominent and abundant than in ordinary bronchitis ; the sub- 
crepitant rale on both sides, and observed especially at the inferior 
posterior portion of the chest; coarse and fine mucous rales inter- 
mingled to a greater or less extent.”—[Flint.) 
3. Pseudo-Membranous or Plastic Bronchitis.—Characterized by 
the exudation of fibrin on the mucous surface of the smaller bronchial 
tubes, forming what is termed false membrane, identical with the de- 
posit which takes place within the larynx and trachea in croup. It 
commences not in the trachea as in croup, to extend downwards, but 
in the minute branches, and extends upwards towards the trachea. 
Symptoms.—Cough, preceded by dyspnoea, is followed by expecto- 
ration of croupal matter. These characteristic sputa are expectorated 
at intervals varying greatly in different cases, days, weeks, months and 
sometimes years intervening; the remaining symptoms in these attacks 
are those of acute or subacute bronchitis. The expectoration of false 
membrane may be followed by relief more or less perfect; collapse of 
pulmonary lobules or solidification from an extension of the inflam- 
mation to the air-cells will add to the gravity of the symptoms and the 
danger. When the exudation is general throughout the lungs, the 
symptoms of acute bronchitis are urgent, and the disease may prove 
rapidly fatal. When but limited portions of the lungs are affected, re- 
covery takes place after the expectoration of the membranous products. 
This disease is rare. It is more common in males than females; 
is most common between the ages of twenty and fifty. It affects per- 
sons debilitated by previous ill health; may be acute or chronic. 
Diagnosis.—Summary of Physical Signs.—In addition to the 
physical phenomena, positive and negative incident to other varieties 
of bronchitis, “ a peculiar valvular or flapping sound (bruit de soujpajpe) 
has been observed, the sub-crepitant rale, if present, less diffused than 
in most cases of capillary bronchitis.” 
Causes.—Protracted exposure to cold; alternations from heat to 
cold; inhalations of dust and other irritative substances; insufficient 
clothing, and improper exposure of the throat and neck, after much 
talking, public speaking, or singing 
It is now generally believed that one great cause of the very frequent 788 
DISEASES OF THE SANGTJINOUS FUNCTION. 
occurrence of chronic bronchitis may be found in the reprehensible 
fashion of shaving the beard. That this ornament was given by the 
Creator for some useful purpose, there can be no doubt, for in fashion- 
ing the human body, he gave nothing unbecoming a perfect man, nothing 
useless, nothing superfluous. Hair being an imperfect conductor of 
caloric, is admirably calculated to retain the animal warmth of that 
part of the body which is so constantly and necessarily exposed to the 
weather, and thus to protect this important portion of the respiratory 
passage from the injurious effects of sudden checks of perspiration. 
When one exercises for hours his vocal organs, with the unremitted 
activity of a public declamation, the pores of the skin in the vicinity of 
the throat and chest become relaxed, so that when he enters the open 
air, the whole force of the atmosphere bears upon these parts, and he 
sooner or later contracts a bronchitis; while, had he the flowing beard 
with which his Maker has endowed him, uncut, to protect these im- 
portant parts he wTould escape any degree of exposure unharmed. 
The fact that the Jew's and other people who wear their beard long, 
are but rarely afflicted with bronchitis and analogous disorders, is now 
generally considered a forcible argument in support of these views. 
CHRONIC BRONCHITIS. 
Chronic bronchitis is at present an exceedingly common and fashion- 
able disease. From the fact of its occurring for the most part in 
clergymen, lawyers and other public speakers, is has acquired “caste” 
and, therefore, it may be that every slight affection of the respiratory 
apparatus is now denominated bronchitis. It occurs at all periods of 
life, and, in general, is insidious in its approach, though it occasionally 
succeeds to acute bronchitis. 
When the disease follows an acute attack, the patient will be left 
with some cough; expectoration of viscid or puriform sputa; dyspnoea 
on the slightest exertion ; noctural exacerbations of fever; emaciation, 
and in some instances hectic symptoms. 
The stethoscope usually gives us the sound of the crepitous ronchus 
at certain points, and now and then over the whole chest, while at the 
same time the respiratory murmur may often be heard. 
Those cases which come on more insidiously, will be often found 
complicated with chronic laryngitis, indicated by hoarseness of the 
voice; raw or scraping sensation in the larynx, and extending over 
the chest; copious expectoration of opaque or purulent sputa, which 
affords relief to the patient; hoarse, hollow and painful cough; in- 
creased susceptibility to changes of temperature; night sweats, and 
general debility. 
When the expectoration is copious, we shall have the crepitous BRONCHITIS. 
789 
ronchus, either at isolated points or over the whole chest; hut if there 
is no expectoration, then the sound which will be elicited by auscul- 
tation, resembles snoring, and has been termed “ dry sonorous rattle /” 
or in some instances, the “ sibilaus rattle,” like the chirping of birds. 
Laennec also mentions a clicking sound, which he compares to the 
action of a valve. 
Percussion affords us no aid in our investigations of bronchitis, but 
pressure with the hand upon the chest, will often enable us to detect 
the mucous rattle without difficulty. 
Complications of Bronchitis.—Bronchitis is frequently associated 
with laryngitis, and with inflammation of the fauces extending downward 
from the pharynx. This complication is often attendant on scarlatina, 
or follows that disease after it had appeared to be terminating favor- 
ably. Bronchitis often follows measles, continued fevers, tracheitis, 
whooping cough, catarrh of the stomach and chronic hepatitis. 
Dilatation of the Bronchi.—This is one of the sequelae of 
chronic bronchitis, or of whooping cough complicated with this disease. 
The expectoration is copious and puriform, and according to M. Louis 
it is foetid. 
Ulceration of the Bronchi.—This alteration of structure is fre- 
quently attendant on the advanced stages of chronic bronchitis, more 
frequently however when complicated with tubercular phthisis. It is 
often found in cases in which bronchitis has been caused by the me- 
chanical irritation of mineral, vegetable or animal molecules. The exis- 
tence of ulceration of the bronchi is not always suspected, as the signs 
accompanying it are the same as those which accompany the most 
chronic states of bronchitis or tubercular consumption. 
Treatment of Bronchitis.—The medicines most worthy of con- 
sideration in the treatment of acute bronchitis, are Aconite, Tartar- 
emetic, Belladonna, Bryonia, Jlepar-sulph., Carbo-vegetabilis, 
Spongia, Ammonia-carb., Bhus-tox., Mercurius, Sulphur, Sambucus, 
Arsenicum, Digitalis, Ilyoscyamus, Pulsatilla, Sanguinaria. 
Aconite.—As in other inflammatory diseases, Aconite is also in- 
dicated in acute bronchitis, whenever there is a rapid and full pulse, 
hot skin, and other symptoms indicative of a high state of febrile ex- 
citement. It may be given at the second or third potency, and re- 
peated every hour, till a decided amendment ensues. 
Tartar-emetic is indicated when there are severe paroxysms of 
coughing, with suffocative obstruction of respiration; wheezing respira- 
tion ; mucous ronchus; very great shortness of breath, with anxious 
oppression at the chest; great anxiety and agitation ; palpitation of the 
heart; pain in the back and loins; pressure on the eyes ; pains in the 
head; thirst 
During the progress of acute and chronic bronchial affections: severe 790 
DISEASES OF THE SANGUINOUS FUNCTION. 
paroxysms of coughing, with rattling of mucus in the bronchia, difficult 
respiration, palpitation of the heart, nausea, vomiting, hoarseness, weak- 
ness ; easy perspiration, cough aggravated by eating, speaking, inhaling 
cold air, or lying down. Repeated doses of the first trituration rarely 
fail to afford prompt relief in such cases. 
Administration.—A grain of the first trituration of Tartar-emeti 
to four ounces of water,—a tea-spoonful every one, two, three, or four 
hours, as the urgency of the symptoms may demand. 
Belladonna.—Cases of acute bronchitis, in which the predominant 
symptoms are: oppression and weight at the chest; short anxious and 
rapid respiration; shaking, spasmodic cough, and decided cerebral dis- 
turbance from the commencement of the attack. 
Administration.—Same as Bryonia. 
Bhus-toxicodendron.—Worse in the evening, at night, and with per- 
fect rest. Symptoms lessened by rising from the bed and walking 
about, on the other hand they are aggravated by external cold, while 
frictions, warm applications alleviate them. Though gentle exercise 
relieves them, they are aggravated by all rough movements or severe 
exertions. 
In a case of violent cough accompanied by convulsive paroxysms, 
with considerable oppression and mucous rale continued through the 
day, but redoubling its violence toward evening, after all treatment 
had failed, Rhus 5th was given. The patient slept eight hours, and 
the cough diminished daily. It returned in subsequent winters, but 
was always relieved by the same remedy. 
Another case in which fatigue paroxysms came on worse in the eve- 
ning towrard eight o’clock. Rhus 12th produced aggravation the first eve- 
ning ; but there was great improvement the same night. Hepar-sulph. 
was given for the catarrhal cough remaining. 
Bryonia.—Headache aggravated by movement; pressure in the eyes; 
dryness in the throat; respiration difficult, short and anxious; pressure on 
the chest as if from a weight; stingingsin the chest; cough with stingings 
in the chest, or with severe aching pains in the head. In the acute at- 
tacks of children with suffocative cough, very great oppression at the 
chest, exceedingly difficult, rapid and anxious, or sighing respiration, 
loud mucous ronchus, rapid pulse, hot skin, thirst, great agitation and 
anxiety, this remedy is also especially called for. 
The marked characteristics are: aggravation upon movements in the 
open air, after eating, and towards midnight. 
It may be exhibited at the first to the sixth potency, and frequently 
repeated until the disease subsides. The practitioner may sometimes 
alternate it with Aconite with benefit. 
Nux-rovnica.—Symptoms analogous to those of Bryonia: like them, 
they are aggravated by motion, after eating and in the open air; but BRONCHITIS. 
791 
chey display their full strength about two, p. m., Rhus about midnight, 
and upon waking in the morning. They are also strongly marked at the 
beginning of the motion, by continuance of which they are diminished. 
Pulsatilla.—Effects particularly discernible in the afternoon and 
evening, and in the recumbent posture ; they are lessened by motion 
this not so decidedly as under Rhus-tox: but unlike the latter they are 
aggravated by local heat and relieved by cooling applications. 
Pulsatilla is specially indicated in bronchitis in which the cough is 
dry in the first part of the complaint, but soon becomes moist, “with 
easy expectoration of abundant yellow matter; sometimes with nausea, 
or retching, or a sensation of reversion in the stomach, as if about to 
vomit. The cough occurs principally at night, on lying down; pro- 
ceeds from a tickling or itching in the larynx, or by scraping and dry- 
ness in the trachea, accompanied with fatiguing pains in the abdomen, 
and stitches in the back, shoulders, sides, or chest, and relieved on 
rising up in the bed.” (Croserio.) It may be given in the same man- 
ner as Bryonia. 
In chronic bronchitis, Ilejpar-Suljph. is an important specific for the 
following characteristic symptoms: anxious, hoarse, and wheezing 
respiration, much aggravated on lying down; attacks of suffocation 
which force the patient to throw the head back, in order to take breath 
dyspnoea,; dry cough and hollow cough; cough with expectoration of 
mucus ; hoarseness of voice; exacerbations of fever in the afterpart of 
the day, succeeded by night-sweats. In cases which seem to have been 
connected with suppression of salt-rheum, or other eruptive disease, o 
metastasis of arthritic inflammations, this remedy is frequently appli- 
cable. It is also useful in those cases which threaten to terminate in 
tubercular consumption. 
The third trituration may be used : a dose from two to four times in 
twenty-four hours. 
Sanguinaria-canadensis.—This plant was first noticed by Cornuti 
in 1635, in Canada, and was cultivated in England before 1640. Lin- 
ngeus first settled the name. It belongs to the class Polyandria order 
monognia, in the sexual system, and the natural order Papaveracege. 
Analysis shows it to contain : 1. Sanguinarine; 2. Porphoxin ; 3. 
Puccine ; 4. Chelidonic acid; 5. Fecula; 6. Saccharine matter; 7. 
Vegetable albumen; 8. Orange-colored resin ; 9. Fixed oil; 10. Ex- 
tractive matter; 11. Lignin; 12. Gum. 
Sanguinarine, discovered by Dr. Dana, constitutes the active prin 
ciple of the plant. Experiments, performed on animals by Dr. Fenwick, 
of Montreal, show that in its concentrated form, Sanguinaria is ex- 
tremely irritating to man and animals, affecting principally the stomach 
and bowels. An excessive quantity produces: Violent vomiting, a 
burning sensation in the stomach, tormenting thirst, faintness, vertigo, 792 
DISEASES OF THE SANGUINOUS FUNCTION". 
indistinct vision, alarming prostration of strength. In more moderate 
doses its effects are emetic-nauseant, expectorant, diaphoretic; also, in 
a lighter degree it acts as a narcotic, sedative stimulant, and alterant. It 
has long been known as an emmenagogue, escharotic and errhine. It 
has been employed in pneumonia, phthisis, bronchitis, catarrh, asthma, 
croup, diphtheria, cynanehe-maligna and pertussis. 
Sanguinaria stands at the head of the class of remedies known in 
the books as Deobstruents. They are supposed to produce a general 
change of action or condition in the whole secernent and absorbent 
system; more especially they remove torpor and occasion improved and 
increased secretions from the liver and from all the glandular viscera. 
In this way it has been supposed, they relieve various dysthetic or 
cachectic diseases, and certain affeotions of the skin; induce a direct 
resolution of many atonic, acute, and sub-acute, or chronic inflammations 
of the viscera, muscles and joints. These effects are entirely indepen- 
dent of any direct change in the degree of vital energies of the arterial 
system, or any material evacuations of any sort as necessary accom- 
paniments. In short, when curative effects are obtained, they are ob- 
tained through the homoeopathic action of the remedy. 
In the concentrated form Sanguinaria is extremely irritating, affect- 
ing principally the mucous membrane of the stomach and bowels. A 
dose of from eight to twenty grains produces: violent vomiting with 
quickly-diffused, transient nervous thrill; burning sensation in the 
stomach; faintness extending to the whole system, the thrill extending 
to the fingers and toes; tormenting thirst; faintness; vertigo; indis- 
tinct vision; alarming prostration. (Dr. Tully. Arner. Medical 
Recorder. 1827.) In moderate doses it causes vomiting, nausea, ex- 
pectoration, diaphoresis. It has also some narcotic, sedative stimulant 
and alterative properties; it diminishes the frequency of the pulse, 
and is used as an emmenogogue, escharotic and errhine. It is used in 
affections of the chest and throat; pneumonia, phthisis, bronchitis, ca- 
tarrh, asthma, croup, diphtheria, cynanche maligna and pertussis. It 
has also been used with success in rheumatism, jaundice, dyspepsia, 
hydrothorax. It rarely diminishes the frequency of the pulse, till it 
has been continued for a week or ten days. 
It has been successful in protracted and distressing affections of the 
chest with repeated attacks of pneumonia, haemorrhage from the lungs, 
constitutional debility, habitual returns of spasmodic obstructions of 
respiration, in plethoric persons who suffer with extreme difficulty of 
respiration, the cheeks and hands becoming livid, pulse full, soft vibrat- 
ing, easily compressed. In protracted catarrhal affections, assuming the 
appearance of incipient consumption, it often gives complete relief; 
though in many cases no amendment is perceptible till the remedy ha- 
been employed for about two weeks. After ten days or more the cough BRONCHITIS. 
793 
begins to abate, tlie pulse diminishes in frequency, and this abatement 
goes on slowly and regularly till all symptoms of irritation disappear. 
At the same time, the appetite improves, digestion and the pulse are 
improved. The action of the mucous membrane of the bronchia is in- 
creased or diminished according to the condition; it is specifically af- 
fected beneficially. When emetic doses are given, the quantity of 
fluids evacuated is small; the nausea is of short duration; there is no 
refrigerant, diaphoretic, diuretic, or purgative power.—It differs from 
other emetics in the peculiar shock or nervous thrill that it sends 
throughout the system; and its beneficial effects are more specially ob- 
tained through the sedative and nauseating property it shows in large 
doses in acute cases, and the deobstruent power displayed by small 
doses in chronic cases. 
It is specially adapted to the pretubercular stage in phthisis also in 
the second or third stages; it renders expectoration easier, breathing 
clearer, lessens the spasmodic efforts to cough ; it acts here as an ex- 
pectorant and mild stimulant. 
In chronic bronchitis it allays the cough and irritation of the folli- 
cular inflammation of the throat. In chronic catarrh associated with 
emphysema, in coryza and cold in the head it has been much em- 
ployed ; also in membranous croup. 
In croupal diphtheria it acts with energy, producing a thrilling 
effect upon the whole mucous membrane of the fauces and respiratory 
tract, with a feeling of warmth. In the form of decoction it seems to 
give vitality to the suffering throat. 
An acetous decoction of Sanguinaria as a gargle is invaluable. 
Lobelia.—Cough, sneezing, with gaping and flatulent eructation. 
Short, dry cough. 
Chest.—General tightness of the chest with short and somewhat 
laborious breathing. Involuntary disposition to keep the mouth open 
to breathe ; oppression of the chest, tightness of the chest, with heat in 
the forehead. Sensation of fullness of the chest; breathing short and 
superficial; 24 respirations in a minute. Oppression causing deep 
breaths to betaken; deep inspirations to relieve oppressive pain in the 
epigastrium ; accelerated breathing; breath seems insufficient; inclina- 
tion to sigh ; short inspiration; slow expiration; difficulty in holding 
the breath ; tickling, smarting sensation in the larynx; irritation to 
cough; feels oppressed; tickling, on taking deep breath, under lower 
part of the sternum. Feeling of a lump in the throat, impeding deglu- 
tition and respiration. Chronic dyspnoea, with feeling of a lump in the 
throat above the sternum, impeding deglutition and respiration; par- 
oxysmal asthma; pain inchest increased by deep inspiration; burning 
feeling in the breast, passing upward. 
/Senega.—The Polygala-senega, Seneca-snake-root, is a popular re 794 
DISEASES OF THE SANGUINOUS FUNCTION'. 
medy for croup ; given in a weak infusion it sometimes cures by causing 
free expectoration. There is a proving by Stapf. (.Additions, dec.) 
Larynx and Trachea.—Scraping and dry contractive irritation in 
the throat; roughness and dryness with cough; dryness in the throat, 
impeding speech ; dry cough with oppression of the chest and rough- 
ness in the throat; disagreeable, long-continued cough; increased short, 
hacking cough in the open air; increased secretion of mucous inflam- 
matory swelling of the fauces. 
Chest.—Frequent and deep inspirations; oppression of the chest 
when going up-stairs; oppression of the chest with slight shooting 
pains; tightness and dull pressure on the chest; pain under the right 
scapula when coughing or drawing deep breath; aching pain in the 
chest, as if forcibly compressed; dull stitches in the left side when ly- 
ing down or sitting; burning sensation under the sternum.' Sore and 
violent pain in the chest on sneezing ; congestions of blood in the chest 
oppression in the chest with flushes of heat in the face ; frequent pulse, 
worse in the afternoon ; pain in the region of the heart during deep in- 
spiration ; general sensitiveness and pain in the walls of the thorax. 
Urine.—Frequent emission of urine with greenish tinge, depositing 
a cloudy sediment. Urine at first mixed with mucous filaments, after- 
wards it becomes thick and cloudy, or cloudy immediately after its 
emission; burning in the urethra before and after micturition; burning 
in the urethra in the morning in urinating. 
© © 
Mouth.—Smarting burning in the region of the palate; dryness of 
the mouth; prickling and stinging in the mouth, with accumulation of 
saliva; ptyalism ; putrid smell from the mouth ; white-coated tongue ; 
burning at the tip of the tongue ; bad taste in the mouth; metallic 
taste ; increased thirst; loss of appetite ; eructations ; deranged di- 
gestion; nausea; retching; vomiting of watery mucus; painful and 
gnawing sensation in the stomach ; feeling of emptiness ; aching or 
spasm of stomach; burning followed by retching and vomiting; feeling 
of hunger and gnawing beloAv the pit of the stomach ; pressure on the 
pit of the stomach ; shifting boring pain in the umbilical region; stools 
increased in frequency and fluidity. 
Apis-mel.—Chronic tendency to inflammation of the upper part of 
the alimentary and respiratory organs, popularly comprised under the 
name of bronchitis. It is characterized by recurrence of the troubles 
after every cold, particularly exposure to wet; highly inflamed or 
mottled appearance of the fauces and contiguous parts; constant dis- 
charge of a tough, stringy, clear phlegm, which produces a tendency 
to hawk frequently; hoarseness and huskiness of the voice, and re- 
turning after every cold, even if repeatedly cauterized. In a case of a 
minister who complained of cold, sore throat, great horseness, pain 
from talking, Apis 3°, a few doses restored him so thoroughly that he BRONCHITIS. 
795 
was able to fulfill his clerical duties only two days afterwards. Many 
months afterwards a similar attack was cured by the same remedy. 
Cedron.—Dr. Casanova gives a case of a gentleman in whom chronic 
bronchitis had lasted fourteen years. Predominant symptom: a trouble 
some cough 'which came regularly every morning about six o’clock and 
lasted two or three hours, after which he remained perfectly free from 
it during the rest of the day. It wTas at first dry, with oppressed rat- 
tling respiration, becoming easier when expectoration became free; 
expectoration viscous, frothy, with some streaks of blood. Inhalation 
of tincture of Belladonna in hot water gave some temporary relief. 
Cedron 3° in solution was given at night; it was so efficacious that it 
checked the troublesome periodical cough at once. Cedron is no spe- 
cific for bronchitis. “ The specificity lies in the relationship -which 
exists between the period, producing powers of the remedy and the 
periodicity of the disease, no matter what the other symptoms may be. 
Arsenicum.—In one case of chronic bronchitis, the face was bluish 
and the expression anxious; the eyes were injected; the intercostal 
spaces prominent; percussion clear; the heart displaced, and the beat 
of the apex felt in the scrobiculus cordis; fine rales in some parts and 
coarse in other parts throughout the chest; respiration short and quick. 
He was obliged to sit up constantly and grasp the side of the bed 
pulse 90, small and intermittent; liver one inch below the ribs; the 
diaphragm also depressed; oedema of the feet; constant dyspnoea. 
Immediate relief after the first dose of Arsenicum, and almost well in 
four days. Cured. 
Arsenic Inhalation.—M. Trousseau orders the inhalation of the 
fumes of Arsenious-acid, by means of cigarettes, each charged with 
one-fifth of a grain of Arsenic, and three or four of them being used 
during the day, the smoke being inspired as deeply as possible. It is 
said to give much temporary relief. 
When bronchitis is complicated wfith angina trachealis, we may 
resort to Spongia with confidence, either alone or in alternation -with 
Ilepar-sulph. If febrile symptoms run high, these remedies should 
be preceded by Aconite. 
When suffocation is threatened from loss of tone and power of the 
respiratory organs, rendering them incapable of expelling the morbid 
secretions which obstruct the free entrance of air into the pulmonary 
structure, Ammonium-carh., Rhus-tox., Sambucus, Arsenicum, Digi- 
talis, liyosciamus and Stannum are worthy of careful examination. 
In making our selection from these medicines, regard should not only 
be had to the actual symptoms present, but to the temperament, here- 
ditary predisposition, and the remote cause of the disease. For exam- 
ple, if in any given case, the indications actually present point equally 
to Ilepar-sulph. and Rhus-tox,, but if the attack was found to be con- 796 
DISEASES OF THE SANGUINOUS FUNCTION. 
nected with a repelled eruption, our choice would evidently rest upon 
the former medicine; Avhile if the disease Avas found to be dependent 
upon an arthritic habit Rhus Avould be the appropriate remedy. 
In the last stages of acute bronchitis, when there is danger that the 
malady will run into the chronic form, Sulphur has been highly lauded 
by many eminent practitioners. If the disease occurs in persons of 
lymphatic constitutions, and subject to eruptions, swelling of the glands, 
&c., this remedy can scarcely be dispensed with during the progress 
of the attack. 
For the profuse and debilitating sweats which now and then occur 
during the continuance of the symptoms, valuable specifics will be found 
in Mercurius, Acid-nitr., Acid-phos. Many physicians have com- 
mended Carbo-veg., in the strongest terms, in chronic bronchitis, and 
it has doubtless effected many excellent cures. It may be used at the 
third attenuation, one grain once or twice daily. 
Mercury.—Aggravation occurs at night, and in bed; but this aggra- 
vation begins and ends Avith the night strictly so called; its pains are 
increased by the warmth of the bed and are not increased by cold, and 
are rendered more acute by motion. Compare this remedy with Rhus- 
tox., Bry. and Pulsatilla. 
5. (EDEMA OF THE LUNGS.-PULMONARY (EDEMA. 
The serous effusion takes place primarily and chiefly within the air- 
cells, but the infiltration extends to the intervesicular areolar tissue 
The volume of the affected lungs is slightly augmented; it does not 
collapse or crepitate on pressure. A yellowish limpid fluid, somewhat 
frothy, oozes in abundance on cutting the lungs, showing that some 
air finds access to the cells; the texture is solid, resisting, non-elastic, 
pitting on pressure as in sub-cutaneous oedema. 
(Edema of the lungs may in some degree be found in most of the 
lung diseases which terminate in death; in the congestion which is 
found in the latter stage of fevers, and may even be developed after 
death. As a separate disease it is always dependent on some previous 
malady; as scarlatina, organic disease of the heart with mitral re- 
gurgitation or obstruction, or hypertrophy affecting the left ventricle ; 
Bright’s disease, or morbid blood conditions, such as give rise to drop- 
sies elsewhere. It may progress rapidly and be speedily fatal; then 
called serous apoplexy of the lungs. 
Physical Signs.—There is dullness on percussion over the affected 
part. When the lung is made dense by serous infiltration, as when 
solidified from inflammatory exudation or tubercle the sound may be 
tympanitic over the lung. The resistance of the thoracic Avail over the 
lung becomes notably increased. A subcrepitant rale is caused in the PULMONARY CEDEMA. 
797 
air-cells and minute bronchial tubes, and discovered by auscultation. 
In other respects the respiratory sound is bronclio-vesicular, though 
not so strongly marked as in inflammatory or tuberculous solidification; 
the high-pitched metallic sound often heard in the latter is wanting. 
Great feebleness and suppression of the respiratory sound belong to 
oedema rather than to pneumonitis or tuberculosis. 
If the above given physical signs are found in a case in which 
there is evident organic affection of the heart, obstruction of the pul- 
monary circulation, such as belong to diseases which affect the mitral 
orifice, or in conjunction with general dropsy, the oedema may be con- 
sidered as established with considerable certainty; provided, we have 
evidence against pneumonitis ; such as the absence of pain, of the rust- 
colored sputa of fever, “ and of the physical signs, which denote solidi- 
fication of the lung from the deposit of inflammatory exudation, viz., 
a well-marked and intense bronchial respiration, broncophony and the 
true crepitant rale. The latter sign, however, may be present in cases 
of oedema.” Hypostatic congestion always affects the lower and pos- 
terior portion of the lungs. (Edema is also more common in the same 
parts. If oedema should occur in the superior and anterior portion of 
the chest, this mark becomes a diagnostic. Hydrothorax may be dis- 
tinguished by the change of level of the liquid on the change of posi 
tion by the patient. (See that article.) 
“ Summary of Physical Signs.—Absence of vesicular resonance 
on percussion, with increased parietal resistance; sub-crepitant and 
occasionally, crepitant rale; broncho-vesicular, or the bronchial respi- 
ration, never intense or metallic; absence of respiratory sound; in- 
creased vocal resonance and fremitus uncertain, and rarely, if ever pre- 
sent, in a marked degree.” (Flint, Respiratory Organs, p. 515.) 
Treatment.—When pulmonary oedema follows scarlatina it is always 
accompanied by congestion of the kidneys. The chief remedies for 
this condition are: Apis and Arsenicum. 
Apis.—First dilution. (Edematous and erysipelatous appearance 
in the throat; rapid and laborious breathing, worse usually at night; 
face and lips livid; puffed face and eyelids. 
Arsenicum.—(Second dilution.) General and rapid sinking of 
strength; oedema of the face; bleeding from the nose ; bluish lips, 
black sores at corners of the mouth, ulcerating; foetid smell of throat, 
involuntary micturition; hsematuria; suffocative paroxysms of oppres- 
sive or arrested breathing. 
Other remedies are: Digitalis, (first dilution); Nitrum, (first 
trituration); Cannabis-indica, (first dilution); Kali-hydriod., (first 
trituration); Apocynum-cann. (tincture); Mercur.-hydriod., (first tritura- 
tion.) Bry. (first dilution); Terebinth (first dilution). 798 
diseases of the sanguinous function. 
6. HAEMOPTYSIS. 
Seat of the Disease.—The mucous membrane throughout its distri- 
bution in the lungs, their appendages and the fauces, being liable to 
sanguinous exhalations, we distinguish its immediate position thus: 
1. When the haemorrhage is from the latter structures, there is 
merely hawking without any pulmonary oppression, coughing or vas- 
cular excitement. On examination of the throat, we shall in some in- 
stances perceive the source from whence it comes. 
2. Haemoptysis proper. It appears in two forms : 
1. From the mucous membrane of the lungs; 
2. From the tissue of the lungs. 
Diagnosis.—The latter, affecting the lung itself, is generally accom- 
panied with all the violent symptoms, coming on more suddenly, and 
with such intense oppression as even to threaten suffocation. 
External Exploration.—This cannot always he trusted ; but much 
may be learned by it. In haemorrhage of the mucous membrane, the 
chest on percussion is perfectly sonorous, and the stethoscope betrays 
the mucous rattle proportionate to the quantity of blood contained in 
the bronchia. Percussion, when pulmonary engorgement is consider- 
able, elicits a dull sound over the affected part, and the stethoscope 
shows the want of the respiratory murmur in it, and the crepitus in- 
stead of the mucous rattle. In ambiguous cases these resources fail, 
as when the two affections are united, or the engorgement is slight, or 
is seated in a portion of the lungs beyond the reach of percussion, 
In any view, percussion is rather a point of curiosity than of practical 
utility. But in chronic lesions, as tubercles, hepatization, &c., of which 
haemoptysis may be the effect, the discussion is important and is hap- 
pily easy. Skill in applying these means gives the power of decid- 
ing at once with tolerable certainty. 
Pathology.—The post-mortem appearances vary according to the 
conditions. The appearances after death from haemorrhage have been 
seldom observed, as death seldom results from it. In the most simple 
cases, caused merely by turgescence of the vessels of the tissue, little 
is seen except the surface covered with blood, the congestion having 
been relieved by the previous effusion. When there has been actually 
phlogosis, the ordinary signs of that state are seen. And, if a chronic 
case, there are changes of structure, thickened, and either softer or 
more indurated or condensed than natural, with occasional fibrinous 
concretions in the form of polypi. 
Extravasations in the parenchyma are rare and resemble much those 
appearances in cerebral apoplexy. Looking at the lung thus affected, 
we shall discover such portions of it circumscribed from one to two or 
three inches, of a deep dark-red color and of a density equal to the HAEMOPTYSIS. 
799 
completest hepatization. Cutting into these portions, they are found 
to consist of the concrete blood,—the surrounding tissue being crepitant 
and of the usual color, or as if tinged with blood. 
In more complicated forms, there are discoverable in different in- 
stances, besides tubercles in their several stages of development, all 
those organic lesions to which the lungs are exposed. Extending our 
researches further, we may find the heart, liver, spleen or other viscera 
variously diseased; while the lungs shall escape in some cases and 
suffer in others. In the former case the irritation which caused the 
effusion of blood is entirely of a derivative nature. 
Prognosis.—Inactive haemoptysis is generally far more intractable 
than active haemorrhage. But the degree of danger is influenced by 
the position whence the bleeding proceeds, and still more by the patho- 
logical condition. Coming from the larynx and adjacent structures, 
it has been deemed less alarming, but it is sometimes serious even 
when principally confined to the fauces. But it is presumed that the 
larynx was at the time, or subsequently became involved,— and when 
haemorrhage from this structure are precursory symptoms as they are 
apt to be, probably the lungs were previously affected, the morbid 
action ascending upwards; or it may be the reverse, the irritation de- 
scending till the whole pulmonary system became engaged. Caused by 
tubercle or by any other organic lesion, an unfavorable result is sooner 
or later to be anticipated; such as emanate from the pulmonary sub- 
stance itself, are almost uniformly and speedily fatal, but these are of rare 
occurrence. Belonging to the mucous membrane, there is little danger, 
even when the haemorrhage is copious. Death indeed seldom happens 
as an immediate consequence of haemoptysis. Ileberden says, in sixty 
years practice he never lost a case by it. Dr. Chapman says, his 
practice of forty years supplies him with very few instances, and thinks 
none of these were from the mucous membrane. 
The chief source of alarm in this disease is the apprehension, fre- 
quently well grounded, that it is an outward expression of disease of 
the lungs, especially tubercular. Exempt from tubercles they appear 
to suffer no more from haemorrhage than other parts. In many cases 
we see the bleedings from the lungs repeated, year after year, and 
ultimately do well. A distinguished person in a neighboring city, who 
died at the age of ninety, was subject to very frequent haemorrhages 
from the lungs nearly two-thirds of his life. It is, however, always 
desirable to effect a cure. The existence of haemoptysis shows an undue 
afflux of blood to these organs, an undue irritation which causes their 
determination; and it is certain that this is the very state of things 
that, by continuance, is so apt to lay. the foundation of permanent mis- 
chief. 
Treatment.—The principal remedies are: A con., Hamamelis, 800 
DISEASES OF THE SANGUINOUS FUNCTION. 
Millefolium, Arnica, China, Ferrum, Ipecac., Nitric-acid., Bry., 
Phos., Sulph., Arsen., Crocus, Bell., Ilyosc., Nux-vom., Op., Puls., 
Rlius-tox. 
Aconite.—The paroxysm is preceded by fullness or congestion of 
the chest, with burning pain; palpitation of the heart, anguish, rest- 
lessness, aggravation on lying down; pale face; expression of agony 
in the countenance; copious discharge of blood from the lungs even 
when coughing a little. 
Arnica.—The haemorrhage is caused by mechanical injury, fall, 
blow on the breast or back, expectoration of black and coagulated blood 
wfith heavy breathing, stitching, burning and contraction in the chest, 
palpitation of the heart; great heat in the abdomen, and fainting fits; 
or, discharge of bright-red, frothy blood, mixed with mucus and coag- 
ulated lumps; tickling under the sternum; stitching in the head, and 
bruised pain in the region of the ribs when coughing. A dose of 
Aconite may generally precede Arnica. 
Ipecac.—Symptoms remaining after Aconite: Taste of blood in the 
mouth ; frequent hacking with expectoration of blood-streaked mucus; 
nausea and debility. After Arsen, if the paroxysm recurs. 
Achillea-millefolium.—Hafnie recommended this plant in 1720 as 
a remedy for haemorrhoids. It has a specific power over haemorrhages 
in various forms. In the form of tincture in drop doses it has ofter 
cured haemoptysis. Dr. Ruckert (Annales Horn. Allem., Vol. I. p. 114 
says: A woman, aged forty-eight years, had every evening for eigh 
days, spitting of blood, followed by a cough, bringing on a fresh ex 
pectoration of vermillion-colored blood, a pint in quantity, followed 
extreme debility. She took Millefolium only three times in the course 
of three days, and was cured. 
2. A young man, subject to attacks of cough with expectoration of 
pure blood, wras cured by a single dose. (Gross.) 
llamamelis-virginica, Witch-hazel.—There has as yet been no 
complete proving of this remedy; but the clinical experience of many 
physicians goes to establish its value in certain forms of haemorrhages, 
especially haemorrhoids and haemoptysis. It was used by the surgeons 
of General Wayne’s army, in 1794, in the treatment of gunshot-wounds, 
bruises, sprains and haemorrhages. Within a fewr years it has come 
into popular use for the same purposes. Homoeopathists have em- 
ployed it with success in all cases of injury accompanied by bleeding 
where Arnica wTould otherwise be used, and attribute to Hamamelis 
some of the powers also of Aconite. Its sphere of action is supposed to 
embrace specially the whole field of venous congestions which result in 
haemorrhage. In one case in which it was given by Dr. Davison for 
haemorrhoids, (London Horn. Review, 1859,) it produced the following 
symptoms: “ A peculiar pricking pain from the wrist to the shoulder, HAEMOPTYSIS. 
801 
which pain was increased by pressure along the course of the super- 
ficial veins.” On suspending the remedy these symptoms subsided 
Further use of it cured the haemorrhoids. They, however, returned 
after some months, and Hamamelis was resumed (two drops of the 
tincture in six ounces of tvater; one table-spoonful every three hours.) 
“ After taking four doses the haemorrhoids were better; but the pa- 
tient became alarmed by the pricking pain in the region of the heart. 
Two days later this pain had become very severe, and was renewed 
in the course of the superficial veins of both arms. It continued to in- 
crease in intensity for ten days, and was then cured by Arnica 12°; 
while under this treatment a peculiar tightness of the chest which had 
been felt from childhood was permanently cured. 
Dr. Thomas {Brit. Jemrn. of Homceop., Jan., 1858) gives the follow- 
ing synopsis of the powers of Hamamelis : Haemorrhages from all 
mucous membranes; those with asthenia or anaemia. Diseases of the 
veins, inflammation of the veins, varices, haemorrhoids, circocele, varico- 
cele, evil effects of loss of blood, carbuncles, boils, abscesses, and in- 
iuries from falls. 
Byes.—Painful inflammations ; excessive congestion of the con- 
junctiva. 
Nose.—Bleeding from the nose ; feeling of tightness over the bridge 
of the nose ; crowding pressure in the forehead between the eyes, with 
a benumbed sensation over the whole forehead. 
Stomach.—Painful vomitings of blood. 
Abdomen.—Varicose veins. 
Anus.—Loss of dark blood by stool in typhoid fever. Bleeding and 
painful piles. Those characterized by burning, soreness, fullness and 
rawness ; weakness and weariness in the back, or feeling as if the back 
would break. Piles with profuse haemorrhage. 
Kidneys.—Bloody urine. 
Sexual Organs.—Circocele and varicocele. Uterine haemorrhage, 
(bright-red blood). Milk-leg, swelling of the labia, groin and thigh; 
difficulty of moving the leg; painful but benumbed sensation of the 
limb ; swelling commencing at the ankle ; difficult motion of the limb 
from stiffness and pain in the hip. Leucorrhoea; active or passive 
uterine haemorrhage ; dysuria; tenderness, of the os uteriagonizing 
soreness over the whole abdomen after a violent blow on the ovarian 
region. Ovarian inflammation. 
Larynx and Trachea.—Cough and haemoptysis with taste as of 
sulphur in the mouth, and dull frontal headache. Tickling cough with 
taste as of blood on awakening. 
Chest.—Return of inflammation of the diaphragm, with labored re- 
spiration, oppressive tightness of the lower part of the thorax; inability 
to make a deep and full respiration; when attempting to assume the 
Vou l—51. 802 
DISEASES OF THE SANGUINOUS FUNCTION. 
recumbent position, breathing impossible; a crowding fullness of the 
neck and head, and sensation that prevents him from lying down; in- 
ability to make a deep respiration when standing up. 
Lower Extremities.—Varicose ulcers, varicose veins, milk-leg, in- 
flammation of the femoral vein or of all the veins of the leg; with ery- 
sipelatous spots near the groin and over the vein, spreading over half 
the thigh; swelling of the entire leg and foot with tension; heat and 
pale appearance of the limb; urine scanty, containing sediment; tym- 
panitis; oedema of the whole body, limbs and face. 
Skin.—Purpura haemorrhagica, with epistaxis and congestion of the 
conjunctiva. 
Particular Indications.—The pains are often unbearable, with 
great sensitiveness to the touch, and fear of exciting new pain on 
moving. 
7. PNEUMORRHAGIA.—PULMONARY APOPLEXY. 
Definition.—Extravasation of blood into the parenchyma of the 
lungs. This may take place primarily either into the air-cells, or into 
the interlobular and intervesicular areolar tissue; the blood in both 
cases, coagulating and forming a consolidated mass resembling in density 
a hepatized portion of lung. The space thus solidified is generally 
small, seldom exceeding four cubic inches, generally confined to one spot, 
sometimes in several distinct ones. In very few cases it involves a 
lobe or an entire lung. (Edema may extend around the extravasation. 
It may terminate by absorption; also by suppuration, or gangrene of 
the lung. When there is much laceration of the pulmonary structure 
a cavity is formed containing fluid and coagulated blood. These have 
been discharged into the pleural sac. The extravasations are commonly 
deep seated in the parenchyma of the lungs, near the roots of the 
lungs or in the posterior portion of the lower lobes. 
When the extravasation of blood takes place into the bronchial tubes 
the haemorrhage is manifested externally as haemoptysis, it occurs only 
when the blood gains access to the air-cells. In the greater number 
of pulmonary apoplexies the haemorrhage is externally displayed in 
haemorrhage from the lungs. 
Diagnosis.—The expectoration of blood, though it reveals extrava- 
sation into the texture of the lung is not proportioned to its extent; and 
then it appears only in a small proportion of cases. In others the 
diagnosis is difficult. Besides haemoptysis there will be cough expecto- 
ration, and embarrassed respiration; but they occur in other forms of 
disease. When they come on suddenly in one free from lung affection 
or when the patient has had such attacks before, they may be suspected 
to be dependent on pneumorrhagia. The disease is frequently seen in PNEUMONIA. 
803 
association with heart disease, as hypertrophy of the right ventricle or 
affection of the mitral valves, as contraction or patency of the mitral 
orifice. 
Summary of physical Signs.—“The evidence of circumscribed soli- 
dification, furnished by percussion and auscultation, present in a certain 
proportion of cases only; moist bronchial rales occasionally observed; 
cavernous signs succeeding those denoting solidification in some 
instances.” 
8. CONGESTION OF THE CHEST IN CHILDREN. 
Nature of the Disorder.—Enlargement of the capillary and other 
bloodvessels of the lungs with partial stagnation of blood. The affection 
may be slight and may then pass away speedily, or may become serious 
and terminate in inflammation or dangerous haemorrhage from the lungs. 
Symptoms.—Oppression of the chest; palpitation of the heart; diffi- 
culty of breathing; sighing; anxiety. These symptoms are often follow- 
ed by spitting of blood, or confirmed inflammation involving the pleura, 
heart or other organs as as the lungs. 
Prognosis.—The severity of the attack and the previous health 
of patient may indicate the degree of danger. Children threatened 
with phthisis are liable to have that disease developed by congestion of 
the lungs; if the attack be violent it may end in inflammation. 
Causes.—Plethoric habit associated with tendency to affections of 
the chest; over-exertion; extremes of temperature; repression of dis- 
charges, eruptions or perspiration. 
General Treatment.—Belladonna. Before inflammation is estab- 
lished; when there is an irritative condition, with dry cough, and diffi- 
culty of breathing. 
Aconite.—When the congestion is accompanied with chill which 
may be expected to be followed by fever, it generally arrests the con- 
gestion and prevents the development of fever or inflammation. 
9. PNEUMONIA—PNEUMONITIS.—PERIPNEUMONIA—LUNG FEVER. 
It has been estimated that in the cities of New-York and Brooklyn 
pneumonia causes nearly one-tenth of the deaths from all diseases; 
and that probably this proportion may hold good in other portions of 
our country. It has been claimed by the advocates of homoeopathy 
that that system of practice where tried has reduced this mortality to 
only one-half what the old mode of treatment has been obliged to per- 
mit, or to five per cent, on the whole number of deaths. 
Inflammation of the lungs begins with chilliness, in some cases in- 
creasing to a shaking chill followed by heat. During the heat the 804 
DISEASES OF THE SANGUINOUS FUNCTION. 
patient experiences a pressure deep in the chest, which soon increases 
to an intense and seated pain. The pain may vary in degree, and 
may be described as acute, burning, cutting, sticking, aching, dull, op- 
pressive, constrictive, and is accompanied by deep anxiety. 
In this pain we observe the commencement of inflammation which 
extends from the seat of pain to the surrounding parts of the lungs 
and pleura; and it may involve one or both lungs. The respiration is 
impeded, painful, anxious, superficial, and is carried on only with the 
uninflamed portions of the lungs; and when inflammation occupies both 
lungs the motion of respiration is only visible in the labored action of 
the abdominal muscles and diaphragm, the thorax not expanding and 
rising as in health. 
In some cages of pneumonia the pain is wanting and then othei 
symptoms must be depended on. 
Diagnosis.—The symptoms of lung fever vary so much in different 
cases, that an exact portrait, which-shall be recognisable in all instances, 
can hardly be given. The signs, howrever, which are more particularly 
characteristic may be enumerated as follows: dull or deep-seated pain, 
or tightness in the chest; frequent short cough, with expectoration of 
t a viscid, tenacious matter of a yellow green, -or pale color, sometimes 
tinged with blood; rapid and difficult respiration; inclination for the 
most part to lie upon the affected side, or the back; great heat of the 
skin; headache; thirst; rapid and full pulse (though this symptom is not 
uniformly present, as the disease sometimes runs on to a fatal termina- 
tion without any material change in the pulse); general restlessness; 
urine scanty, very red; and sometimes scalding. The character of the 
expectoration during the first stage of pneumonia is supposed by many 
to afford a characteristic mark of the malady: and it is from this cir- 
cumstance thatLaennec has denominated the sputa expectorated, pneu, 
monic, or glutinous. During the stage of hepatization, the sputa di- 
minish in quantity, become lighter in color and less transparent, until 
finally, when the third stage supervenes, expectoration of almost a 
mucous character occurs. 
Pneumonia is characterized by: deep cough, at times dry, at times 
accompanied by expectoration; sometimes spontaneous and frequent, 
again excited by deep breathing, talking, or swallowing; expectoration 
tenacious, sticky, at first semi-transparent, slimy, afterwards bloody, 
saffron or rust color. The patient generally lies on the back. 
The fever is acute, not intermittent, though almost disappearing in 
the morning, and increasing in the evening. The pulse is soft in the 
morning, becomes in the evening hard and bounding. The cough be- 
comes also more violent. When the disease continues long the fever 
takes a typhoid form; and after it has reached its climax it manifests 
its effect on the brain and its membranes by delirium. PNEUMONIA. 
805 
The face is intensely red; the head feels dull and painful, there is 
intense thirst; the urine diminished in quantity, and dark red. 
All of these symptoms show inflammation of the lungs, but this is 
more decidedly proved by percussion: by which means it can be deter- 
mined whether the inflammation is still confined to the stage of inflam- 
matory engorgement or has passed to the stage of hepatization. 
Percussion.—When the organic tension of the pulmonary cells is 
diminished in consequence of the exudation of bloody serum, percussion 
yields a tympanitic sound, which is at first clear and full, but becomes 
much less so as the condensation of the pulmonary tissue, in consequence 
of the congestion, increases. As soon as the process of hepatization be- 
gins the percussion sound becomes dull, insonorous and hollow. When 
exudation has set in, the so-called crepitant rattle is heard during an 
inspiration, and during cough. When a portion of the lungs into which 
one of the larger bronchial tubes opens, hepatizes, communication be- 
tween the air in the lungs and the column of air in the trachea and 
larynx is interrupted: this gives rise to peculiar sounds, termed bronchial 
respiration, bronchophony and consonant rattle. These three sounds 
are not heard when the bronchus is stopped up, or when the voice and 
respiration of the patient are feeble. Over the hepatized portion we 
always hear a peculiar whiffing, bronchial respiration, but never the vesi- 
cular murmur. 
Sometimes pneumonia is complicated by more or less derangement 
of the biliary organs, when we shall have superadded to the lung affec- 
tion the symptoms indicative of such derangement. This variety of the 
complaint is termed: bilious pneumonia. 
Latent Pneumonia.—This modification of the disease depends upon 
a certain peculiarity of constitution and is entirely unlike ordinary 
pneumonia. It seems to commence by the second stage, or that of he- 
patization. M. Saucerotte describes it as follows: ‘■'Premonitory symp- 
toms, either entirely absent, or of slight importance, consisting of las- 
situde, with shivering, loss of appetite, and but little fever.” 
General Symptoms.—The temperature of the skin is not sensibly 
augmented; the pungent heat of ordinary pneumonia seldom present; 
pulse usually but little affected; respiration natural, and no pain in the 
chest. Percussion always elicits a dull sound over a considerable ex- 
tent, and bronchial respiration is audible over the same locality. In 
some cases slight crepitation may be heard around the hepatized spot.” 
“Progress and duration variable. In some cases we have seen the 
disease linger for six or seven weeks. When the case terminates favor- 
rbly the dullness gradually disappears, and the bronchial souffle is re- 
placed by crepitation; respiration becomes more free, and the general 
aspect of the patient improves.” 
Piagnosis.—Pleurisy is the affection with which latent pneumonia 806 
DISEASES OF THE SANGUINOUS FUNCTION. 
is apt to be confounded. In chronic pleurisy, however, there is more 
constantly a pain in the side, and the region of the dullness varies with 
the position of the patient. Apoplexy, and the bulging of the inter- 
costal spaces, shortly clear up the diagnosis. The history of the case 
distinguishes it from phthisis. 
“Causes.—For the most part, exposure to cold.” Dr. Saucerotte’ 
sole internal remedy in this affection is Tartar-emetic, which is the 
homoeopathic specific in similar cases. 
Causes of Pneumonia.—This disease is peculiar to temperate and 
cold latitudes, and usually occurs during the winter-months. The usual 
causes are: undue exposure to intense cold; sudden suppression of 
perspiration; epidemic influences, and the inhalation of noxious vapors 
or gases. Laennec and Forbes assert, that pneumonia is frequently 
induced by the bite of the rattlesnake (Crotalus-horridus), and of other 
venomous serpents; and that it may also arise from the “ injection of 
various medicinal substances into the veins.” These assertions go far 
to prove a specific action of these substances upon the respiratory 
organs, and may afford a valuable hint respecting their homoeopathic 
application in pneumonia. Pneumonia is most frequent between the 
ages of 17 and 50 years. The predisposing causes are: 
Tuberculous Diathesis; previous pneumonia; suppressed dis- 
charges of blood. 
Exciting Causes.—Atmospheric influences ; North-east winds ; more 
frequent at the end of winter and the commencement of spring. In 
summer when the air suddenly becomes cool after sultry heat; taking 
cold after being heated by dancing or other severe exercise; the 
breathing of mechanical or chemical irritants ; strong vapors of various 
kinds; vapors of muriatic or nitric acid; arsenious vapors; inhaling 
plaster, lime, coal-dust, flour or wTool-dust; fracture of the rib, or pene- 
trating stab, or gun-shot wound. 
Viewed anatomically, inflammation of the substance of the lungs 
] rese s, according to Laennec three different degrees or stages, Avhich 
he designates, first, engorgement,or congestion; second, hepatization; 
third, purulent infiltration. 
In the first degree, the lung loses in a measure its crepitous feel, is 
of a livid color, and more solid than natural. 
In the second degree, the lung presents the appearance of liver; it 
is not crepitous, is heavier than in the first degree, and shows a granular 
:>ppearance when cut into, or :orn asunder. Laennec, Andral and Louis 
suppose this hepatization to be owing to the conversion of the air-cells 
into solid grains, by the hardening of a concrete fluid, which is poured 
out during the inflammation; while Dr. Williams supposes, that “these 
granulations contain no viscid mucus, but consist of little bunches of PNEUMONIA. 
807 
vesicles, which have been obliterated by the swelling of their mem- 
branous tunics, and the enlargement of their blood-vessels. 
In the third degree, the external appearance of the lung is similar to 
that of the second degree, but of a lighter color. The same heavy 
hard, and granular character obtains, but when the lung is cut into, a 
yellowish and purulent matter makes its appearance. As the disease 
advances, the granular condition disappears, and purulent abscesses 
take its place. 
The phenomena elicited by auscultation and percussion during the 
stage of engorgement are the crejpitous ronchus, the respiratory sound 
being yet audible, and the ordinary healthy sound on percussion. 
As soon as hepatization has occurred, percussion over the affected 
part yields a dull sound, and neither the respiratory murmur, nor the 
crepitous rhonchus can longer be heard. There are other sounds, like 
bronchophony, a kind of blowing, &c., which may exist in certain cases 
of hepatization, but these are so vague and uncertain, that immense 
practice is requisite to enable the physician to form an accurate judg- 
ment respecting them. 
After the first stage has existed a little time, and the pus begins to 
soften, the mucous rhonchus may be heard in the bronchia. In some 
instances the pus is not expectorated or absorbed, but forms an abscess 
in some parts of the pulmonary tissue. We shall then have a mucous 
rhonchus over the seat of the abscess, also pectoriloquy, and what is 
termed a “bronchial cavernous cough. 
Pkognosis.—Pneumonia is a serious, but not necessarily a fatal dis- 
ease in any case. When the general and local symptoms subside 
gradually; the fever, pain and cough abate; the matters expectorated 
become normal; the respiration becomes easy and regular, it may be 
decided that the patient is on the road to recovery; though auscultation 
and percussion show that there is still morbid condition remaining, it 
may be predicted that prudent management may provide against a re- 
lapse. 
Unfavorable Terminations.—1. The plastic exudations change, 
taking a tubercular character. 2. An abscess forms in the lungs. 3. 
When the hepatization has lasted too long to admit of resolution, death 
may take place by excessive congestion or complication with an affec- 
tion of the heart, or in consequence of some secondary disease. Re- 
covery may be expected in young and vigorous subjects, and in persons 
who are attacked for the first time. It is more favorable in simple 
than in compound pneumonia, or when the inflamed lung was previously 
partially hepatized, or otherwise changed in structure. 
When the disease terminates favorably, and resolution takes place, 
it will be found that the lungs gradually and by successive degrees re- 
turn to their original state, as is indicated by the diminution of the 808 
DISEASES OF THE SANGUINOUS FUNCTION. 
crepitous rhonchus, and the return to the natural respiratory sound, 
when the inflammation had ceased at the first stage ; also by the re- 
appearance of the crepitous rhonchus, &c., when the malady had pro- 
gressed to the second and third stages. 
Treatment.—The prominent medicines for the treatment of pneu- 
monia are : Aconite, Bryonia, Belladonna, Tartar-emetic, Phos- 
phorus, Ipecac., Sambucus, Sulphur, Lachesis, Rhus-tox., Arsenicum, 
Mercurius, Acid-phosph., Arnica. It is remarked of auscultation and 
percussion, that they may furnish us with a knowledge of the con- 
dition of the lungs, and they thus become helps, but not an authority in 
selecting the remedy. This knowledge may “ direct us to the class of 
remedies, from which the proper one may be chosen. The individuali- 
zation of the remedy must be reached by the comparison of the symp- 
toms with the drug.” {Dr. P. P. Wells.) 
Aconite.—Synochal sthenic fever, with pulse hard, quick and full, 
face red, chilliness and heat expressive; pains in the chest violent; 
respiration oppressed and accompanied with anxiety. - 
In the first stage of the disease, when symptoms indicative of a high 
grade of febrile excitement are present, as hot and dry skin, great 
thirst, rapid and hard pulse, scanty and high-colored urine, &c., Aconite 
and Belladonna may be given in alternation, until the inflammatory 
symptoms subside. These remedies are often alone sufficient to break 
up the disease in this stage ; and even when they fail to effect a com- 
plete cure, they generally moderate most essentially the fever and 
mitigate all the other symptoms. 
If, after the subsidence of these symptoms, stitches in the side, diffi- 
cult and anxious respirations, and troublesome cough continue to harass 
the patient, recourse must be had to Bryonia. 
Bryonia.—The inflammation occasioned by exposure to dry and cold 
weather; by straining, or other violent muscular exertions; when the 
fever is not very violent or fully developed. The pains are moderate; 
the sputa white, slimy, streaked with blood, the cough loose and the 
oppression is not excessive, attended with constant desire to draw breath. 
Rheumatic or bruised pains in the muscles of the chest and extremities. 
When, however, the second stage, or hepatization, has occurred, in- 
dicated by dull sound on percussion, bronchial respiration,&c.,we should 
at once have recourse to Tartar-emetic or Phosphorus. 
Tartar-emetic.—The external indications which point to this remedy 
are: dull sound on percussion ; absence of the respiratory murmur, or 
bronchophony; skin cold, and covered with a clammy sweat; consider- 
able expectoration of a yellowish or brownish color, and mixed with 
blood; pulse small, soft and frequent; tongue covered with a dry and 
dark fur, and perhaps red at the edges. 
Great oppression and difficulty of breathing; cough loose, and ac- PNEUMONIA. 
809 
companied with rattling of mucus (.Mailer); burning under the sternum, 
and sometimes as high up as the throat; sensation as if the chest were 
lined with velvet; want of air and want of breath previous to the 
paroxysms of coughing; also pneumonia biliosa, with gastric and 
bilious symptoms, as yellow tinge of the skin ; yellow or brownish fui 
upon the tongue; bitter taste; nausea and bilious vomiting; yellow 
or dark urine; headache; general sensation of lassitude and debility. 
Merital and moral Symptoms.—Anxiety; restlessness; confusion 
of ideas ; sometimes furious delirium. 
Pathology of Pneumonia caused by Tartar-emetic.—The lungs, 
says Magendie, are of an orange color, or violet; the tissue hepatizedj 
gorged with blood at some parts, or resembling the substance of the 
spleen; lungs inflamed or hepatized. Dyspnoea followed by hepatiza- 
tion of the lung, produced and also removed by Tartar-emetic. In ani- 
mals poisoned by it, the action on the lungs is more strongly marked 
when they are slowly poisoned. It also produces intense tracheo- 
bronchitis, developed along with the pneumonia, which shows its great 
efficiency in these forms of disease. 
The specific Tartar-emetic treatment against inflammation of the 
lungs was commenced by Rasori in 1808. It wTas adopted and recom- 
mended by Laennec, who appears to have been more successful than 
was common in that day. It has been largely followed in this coun- 
try, but not generally to the extent recommended by the French 
and Italian practitioners. Even when it partially subdues the pulmon- 
ary inflammation, the remedy in these large doses shows its poisonous 
powers in developing abdominal symptoms, when the patient is con- 
sidered as doing well under the remedy. Dr. Billing says, in some 
cases the patient becomes restless, thirst is augmented; discharges 
from the bowels are increasing in quantity; then the abdomen becomes 
tympanitic and tender. The patient, who had acquired the power of 
retaining in the stomach large doses of the drug, now vomits, or makes 
efforts to do so; the tongue is dry and pointed; there are jactitations, 
anxiety of countenance, delirium, stupor and death. Sometimes there 
is jaundice; pulse frequent, hard and thready; ‘the matters vomited 
have the appearance of those in yellow fever. While these things are 
progressing, the original disease subsides rapidly. This, with the oc- 
currence of the slightest tympanitis, shows that the remedy is pro- 
ducing gastro-intestinal irritation and inflammation. 
If Tartar-emetic be given according to the contra-stimulant theory 
in massive doses, the aim is to produce a drug-disease of such intensity 
that it will throw the original disease entirely into the shade. The 
doses given are so large, that direct vomiting and purging might be ex- 
pected to result; but by persisting in its use “ toleration ” of the 
remedy is attained, and it is for a time retained in the stomach. But 810 
DISEASES OF THE SANGUINOUS FUNCTION. 
even then it can never be predicted with certainty, that this tolerance 
will long continue. It is claimed, that in some cases the pneunomic 
symptoms subside under the remedy, but it is certain that in many 
other cases fatal purging, vomiting and prostration ensue. 
Symptoms of Tartar-emetic in Pneumonia.—Short, difficult and 
oppressed breathing; frequent short, dry and painful cough wifti ex- 
pectoration of frothy, sanguinous sputa (rusty expectoration); dull 
sound on percussion, mucous and crepitant rale; pressure and con- 
striction of the chest; rapid and strong, or rapid and feeble pulse; 
febrile symptoms, hepatization. 
This remedy seems to be specially suitable during the decline of the 
disease, when the bronchia or pulmonary vessels are full of a thick 
viscid secretion, which the patient finds it difficult to expel, when this 
substance is no longer tinged with blood. It is most appropriate during 
the resolution of the hepatization and in bronchitis, when the breath- 
ing is difficult and when there is a sub-crepitant or mucous rattle in the 
lungs, often accompanied by fits of suffocation with spasmodic cough. 
Tartar-emetic, in a low trituration given in such cases, affords prompt 
relief. In pneumonia it does not cause vomiting in children; but, if 
given for simple bronchial catarrh, every spoonful of a solution of one 
grain of the first trituration to four ounces ot water may cause vomiting. 
In such cases dilute still farther. 
Dr. Cl. Muller says: “It is indicated by: little or no stinging pain, 
great oppression and difficulty of breathing; loose cough with mucous 
rattling, and alleviation of the oppression by expectoration which is 
very profuse; the sputa contain little or no blood, but a quantity of 
mucus; a portion of the lungs is hepatized (stage of splenization as 
well as of red hepatization), the percussion-sound over a larger or 
smaller portion of the thorax is dull, with increased resonance; a por- 
tion of the thoracic walls adjoining the before-mentioned region has 
either tympanitic or normal sound. Auscultation reveals broncophony, 
the bronchial respiration and consequent rattle.” 
In bilious pneumonia Tartar-emetic is indicated by the following 
symptoms: slight bilious tinge of the skin, albuginea, alae-nasi, and 
corners of the mouth; yellow, brownish coating of the tongue ; bitter 
taste, disposition to vomit, nausea, vomiting; saffron-colored urine; 
stinging pain under the right false ribs, or pain in the pit of the 
stomach; frequent eructations and hiccough; violent aching, boring 
pain in the frontal region ; sometimes increasing to furious delirium to- 
wards evening; the cough is frequently attended with vomiting, with 
scanty expectoration of somewhat blood-streaked frothy saffron-colored 
mucus. 
Case.—A man, aged 73, intemperate and suffering from heart-dis- 
ease, had double pneumonia; he took one grain of Tartar-emetic in PNEUMONIA. 
811 
four ounces of water, a dessert spoonful every two hours. He continued 
delirious during eight days, but recovered and could walk on the six- 
teenth day. {Brit. Journ. Ilomoeop.) 
“Magendie ascribes to emetic Tartar a specific power of causing en 
gorgement or inflammation of the lungs; for he found on opening the 
bodies of animals killed by it, that the lungs were of an orange-red 01 
violet color, incapable of crepitating, gorged with blood, and here and 
there hepatized.” “ It has also been assumed that the same effects are 
produced in human pulmonary organs.” Jules Cloquet says, a man 
died of apoplexy, who within five days of his death had taken 40 grains 
of Tartar-emetic. On examining “the lungs very irregular, blackish 
spots which extended more or less deeply into the parenchyma of 
this organ were observed.” Pereira says, he can not understand how 
Tartar-emetic can have a tendency to inflame the lungs, since it is 
known to prove particularly useful in the treatment of such cases. 
{Materia Med. Yol. I., p. 698.) A homoeopathist is not much perplexed 
by this question. 
Case by Mr. Hartley: A boy aged three and a girl aged five, wrere 
poisoned by Tartar-emetic. After death it is recorded, that in the boy 
the lower lobe of the right lung was redder than natural, and serum 
was effused in the pleura; the girl presented similar appearances 
(Lancet, April, 1846, p. 460.) “Painful respiration” is a symptom of 
poisoning by this article. (See Taylor. Med. Jurisp't'udenee, p. 118. 
It is proved by the pathogenesis of this remedy that it is capable oi 
causing as well as of curing the following symptoms and conditions : 
Short, difficult and oppressed respiration; frequent, short, dry and 
painful cough, with expectoration of frothy, sanguineous sputa (rusty 
expectoration); dull sound on percussion, mucous and sub-crepitant 
rale; pressure and constriction of the chest; rapid and strong, or rapid 
and feeble pulse ; febrile symptoms and hepatization present an ex- 
cellent simile to a certain form of pneumonia, and ample clinical ob- 
servation has confirmed the utility of the remedy. But in order to 
avail ourselves of its full benefit, it must not be employed stronger than 
the first, second, and third attenuations. With these minute doses the 
requisite curative impressions can be produced upon the affected lungs 
with certainty, promptness and safety. {Marcy. New Mad. Med. 434.) 
Dr. Ozanne, of Paris, says of this remedy: “ It appears to me to be 
suited to the particular state in which the bronchi or pulmonary vessels 
are full of a thick viscid secretion, which the patient finds it difficult to 
expel, when that substance is no longer tinged with blood. Hence it is 
most appropriate in pneumonia during the resolution of hepatization, 
and in bronchitis when at the same time the breathing is difficult, there 
is a sub-crepitant or mucous rattle in the lungs. This condition is often 
accompanied by fits of suffocation, with spasmodic cough. In such 812 
DISEASES OF THE SANGUINOUS FUNCTION. 
cases Tartar-emetic gives very rapid relief. The first trituration does 
not usually cause vomiting in children ; but if given for simple bronchial 
catarrh, every spoonful of a solution of one grain of the first in four 
ounces of water will cause vomiting. 
Phosphorus.—Phosphorus has been highly extolled also in the 
second stage of pneumonia, and in certain cases of pleuro-pneumonia, 
where Aconite and Bryonia have failed in effecting a cure. Dr. Fleisch- 
mann has used it successfully in all the stages of lung-fever. 
Symptoms.—Violent pneumonia with sticking pains in the chest, 
excited or aggravated by coughing or breathing also in pleuro-pneu- 
monia, when they are violent and extend over a large surface, when a 
large portion of the lungs is inflamed with dyspnoea, the cough is dry, 
and the sputa rust-colored (a characteristic symptom of Phosphorus). 
Phosphorus is in many cases the only remedy and it affords relief in 
four or eight hours. Give two or three drops of the third or fourth 
dilution every two or three hours. Sometimes when the attack is very 
violent in the commencement, Phosphorus has to be given in alternate 
doses with Aconite or Belladonna. This alternation may be neces- 
sary in the second stage of pneumonia when the percussion-sound over 
the affected portion of the lungs is dull, and broncophony or bronchial 
respiration, or perhaps consonant rattle, is heard. 
Phosphorus is also indicated when the inflammation threatens to as- 
sume the typhoid character, the physical symptoms of approaching 
paralysis of the lungs denote the passage of the inflammation into the 
stage of gray hepatization or purulent infiltration of the pulmonary 
parenchyma, attended with remarkable depression of the mental facul- 
ties; mild delirium and grasping at flocks; subsultus tendinum; rapid 
prostration; cold viscid sweats; small, frequent feeble pulse; dim eyes, 
sunken countenance, dry lips and tongue; short and difficult breathing 
oppression and anguish; difficult cough and respiration. 
Barchner, Griesselich, Horner, Bosch, and Schellhammer have em- 
ployed it with advantage when the third stage had set in writh great 
prostration, livid or liippocratic countenance, sunken eyes, cold viscid 
sweats, tremulous and feeble pulse, dry and dark lips and tongue, diffi- 
cult expectoration of a brown or rust-coloi’, extreme anguish, subsultus 
tendinum, muttering or furious delirium, with grasping at flocks, sense 
of suffocation, involuntary stools. 
Muller describes the special pathogenetic symptoms of Phosphorus 
having reference to pneumonia, as follows: “ Sticking and violent 
stitches in various parts of the chest, left and right side, sometimes ac- 
companied with burning, in rest and during motion, especially when 
sitting and taking an inspiration; pain in the chest, especially during 
an inspiration; itching in the interior of the chest, with dry cough ; 
feeling of heaviness in the chest; anxiety in the chest, with arrest of PNEUMONIA. 
813 
breathing, and beating in the right side of the chest; great oppression 
of breathing; great shortness of breath ; oppressive tightness, and ten- 
sive sensation in the chest, as if a band were encircling it; tension and 
dryness in the chest; constrictive clawing and pressing in the upper 
part of the chest; loud rattling breathing ; dry, hollow cough, without 
expectoration ; a sort of hacking cough, with huskiness of the chest, 
and expectoration of some mucus; cough with expectoration of trans- 
parent mucus, accompanied with tensive pain, and afterwards with 
sticking pain in the chest; fatiguing cough, with white tenacious ex- 
pectoration ; the expectorated mucus is streaked with blood; bloody 
expectoration, with mucus, accompanied with short, slight cough; 
coughing up small clots of pus, with smarting burning behind the 
sternum; sticking pain in the pit of the stomach when coughing, com- 
pelling one to lay the hand upon the pit; short breath after every turn 
of cough.” 
From the above it will be seen that Phosphorus includes a greater 
range of symptoms than Tartar-emetic. In typhoid pneumonia espe- 
cially it is often of distinguished service where hepatization has occurred, 
and the symptoms point to the third stage. 
Administration.—It may be employed at the first, second, or third 
attenuation, and the dose repeated according to the severity of the 
case. In typhoid pneumonia, as well as in cases attended from the 
first with great debility and prostration of the energies of the system, 
Rhus-tox. will be found a remedy of much efficiency, either alone, or in 
alternation with some other specific. Should the case be complicated 
with pains in the chest or side, or of a rheumatic character, Rhus- 
radicans may occasionally be employed with advantage. This medi- 
cine is usually given after Aconite and Bryonia. 
Mercurius.—Allopathic writers have not yet recorded any cases in 
which the symptoms or pathological conditions, characteristic of pneu- 
monia or carditis, have been produced in the human subject by the 
use of Mercury; though experiments on the lower animals have shown 
that pneumonia may be produced by this article. But Orfila has noticed, 
“the lining membrane of the heart, in one part or another, most com- 
monly on the valves, invariably presenting spots of a cherry-red or al- 
most black color, and on one occasion these spots were so soft, that 
slight friction made little cavities.” (Christison, On Poisons, p. 390.) 
From experiments of M. Gaspard, made by injecting solutions of the 
ichloride of Mercury into the blood, the morbid appearances presented 
.n the lungs varied, but are summed up in the following words: “ either 
black ecchymosed spots or black tubercular masses, some inflamed, 
others gangrenous, others suppurated; or finally, regular abscesses, 
suppurated ; or finally, regular abscesses, separated from one another 
by healthy pulmonary tissue.” {Journal de Physiologie, I., p. 165.) 814 
DISEASES OF THE SANGUINOUS FUNCTION. 
Symptoms.—Crampy, tensive pain in the left side of the chest, with 
violent oppression of breathing, which is sometimes increased by a 
burning, lancinating pain ; there is also cough which is at first dry and 
afterwards accompanied wTith bloody expectoration; the pulse is hurried, 
full; much thirst; the fever manifests symptoms of nervous irritation, 
great heat, profuse foetid sweats, nightly delirium; violent pains in the 
limbs; vertigo ; dry mouth and throat; great sensitiveness and painful- 
ness of the region of the liver and epigastrium, and of the pit of the 
stomach. 
When the disease assumes the more typhoid character, and there 
are profuse sweats and great debility; when there is congestion of 
blood to the brain, slight delirium, and quick and strong beating of the 
arteries; when cough is still present, with difficult, blood-tinged expec- 
toration, Mercurius is to be given. 
Phosphoric-acid.—In conditions similar to Mercurius: There is 
extreme debility and diarrhoea, loss of consciousness ; strong, irregular, 
frequent and intermitting pulse; distention of the temporal arteries,&c. 
Sulphur 30is an important remedy in certain protracted cases of 
pneumonia, occurring in psoric or scrofulous subjects, and which 
threaten to terminate in phthisis. Indeed in most of those cases of 
chronic pneumonia which seem to have arrived at a fixed point, the 
patient neither improving nor apparently retrograding, we should al- 
ways bear in mind this powerful antipsoric. 
When the disease has reduced the patient, notwithstanding our reme- 
dies, to a state of extreme prostration, with a very short breath on the 
slightest exertion ; dry and dark tongue and lips; extreme anguish, 
stitches in the side; great thirst; diarrhoea; ringing and buzzing in 
the ears, Arsenicum is the proper remedy. In examples of this de- 
scription, the remedy should be frequently repeated until a decided im- 
pression is produced. 
Rhus-toxicodendron.—Typhoid Stage. In persons of middle age 
pneumonia often assumes a typhoid character. The symptoms of this 
stage develop themselves gradually, and the pains in the chest increase 
in violence during the course of the disease. The pulse is frequent, 
small, easily compressible; the pains, which the patient never defines 
or complains of very positively, are constant, without intermission. In 
robust persons typhoid-pneumonia frequently appears like true pneu- 
monia, with a full, strong pulse, and without any of the characteristic 
typhoid-symptoms; but the sentient system is principally affected. Th 
patient lies in a state of half stupefaction, is more or less delirious, 
complains too little, although the disease is very violent. He is in a 
state of stupor with stertorous breathing, and his eyes half open ; he ia 
roused with difficulty, and is scarcely conscious of any thing after 
waking. In this condition Phosphoric-acid is also appropriate, particu- PNEUMO-HYDROTIIORAX. 
815 
larly when the expectoration is purulent and the patient is troubled 
with profuse night-sweats. 
American Hellebore.— Veratrum-vir. This drug possesses a great 
power of calming nervous excitement, and reducing the force and 
frequency of the heart’s action; in pneumonia, pleuritis, acute rheuma- 
tism, croup, iritis, and other inflammatory diseases, when the pulse 
is strong. 
It has operated with great efficiency in metritis, and puerperal fever, 
alternated with Belladonna. It is never necessary to cause emesis. 
One-fifth or one-tenth of a drop in water every two hours is generally 
sufficient. 
But it is in pneumonia, that the Yerat.-v. shotos its most specific 
powers. Dr. Hale says, “it is the only remedy which will absolutely 
cut short the pneumonic inflammation before the seventh day. In my 
hands it has frequently arrested the progress of the disease on the 
third, fourth and fifth days, and a rapid convalescence followed in every 
instance.” 
If the pulmonary inflammation threatens to run into gangrene, as 
will be indicated by foetid and greenish or dark expectoration, Arsenicum 
is appropriate, as are also sometimes Carbo-veg. and China. 
Pneumonia occurring in old and feeble persons, and attended with 
symptoms showing a low grade of inflammatory action, will require the 
use of Phosphorus, Ipecacuanha, Sandmens, Veratrum, Nux- 
vomica, China, Belladonna, Lachesis, Lycopodium and Cantharis. 
Arnica is applicable in pulmonary inflammations proceeding from 
mechanical injuries. 
The symptoms of pneumonia and bronchitis combined, will be covered 
by Tartar-emetic, Aconite, Mercurius, Phosphorus, Capsicum, 
Bryonia, Carbo-veg., Pulsatilla, Senega and Nux-vomica. 
We usually select one of the low attenuations, and repeat the dose 
once in two, three or four hours, until a marked impression is produced 
upon the symptoms. 
10. PNEUMO-THORAX.—PNEUMO-HYDROTIIORAX. 
Definition.—A diseased condition consisting in the accumulation 
of air or gas within the pleural sac, unaccompanied by liquid effusion. 
This disease is ‘ certainly very rare ; and many doubt whether “the 
secretion or exhalation of air or gas from the pleural surfaces” is ever 
seen. Pleural rupture over the dilated cells in vesicular emphysema, 
or of the blebs whi*ch are occasionally formed in the interlobular variety 
of this disease is a rare accident which may give rise to an accumulation 
of air in the pleura, and it may for a time be accompanied by any morbid 
product; but inflammation must soon result, and effusion must follow 816 
DISEASES OF THE SANGUINOUS FUNCTION. 
PNEUMO-HYDROTHORAX. 
When, bj any mode, air or gas finds its way into the pleural cavity 
effusion of liquid either precedes or follows; and the resulting condition 
is called pneumo-hydrothorax. In medical treatment it is only neces- 
sary to consider the latter. 
Diagnosis.—Pneumo-hydrothorax is never a primitive disease, bu 
is the effect of some antecedent condition. Generally it is a complica- 
tion of pulmonary tuberculosis ; in this case it arises from a perforation 
of the lung resulting from rupture of the pleura over a cavity or a col- 
lection of softened tubercle, broken into during an act of coughing. 
Pneumo-thorax is th*en developed, and acute pleuritis follows with liquid 
accumulation; the symptoms vary according to the size of the per- 
foration, its persistence in remaining open, and the freedom of com- 
munication between the bronchial tubes and the pleural cavity. It oc- 
curs more frequently on the left than the right side, on the postero- 
lateral surface between the third and sixth ribs ( Walshs). It may oc- 
cur in connection with circumscribed gangrene of the lung, the pleura 
giving way over the eschar, inducing perforation and pleuritis; in con- 
nection with pulmonary apoplexy, tuberculous affection of bronchial 
glands, abscess, cancer, and hydatids, by ulceration commencing in the 
pleura, in cases of chronic pleuritis and empyema. 
In certain cases of empyema abscesses situated in the walls of the 
chest may result in an external communication with the pleural cavity 
The disease is produced traumatically by penetrating wounds pf fhe 
chest, or injuries of the lung from the fractured extremities of ribs, or 
by contusions. In a few cases a fistulous communication has been 
originated in some way between the oesophagus, or the stomach and 
the pleural sac, and through this opening gases have found their way 
into the latter cavity. In very rare cases, chemical decomposition of 
the effused fluid in the pleura has caused the development of gas. 
Physical Signs.—The chest yields on percussion over the space oc- 
cupied by the air within “a marked degree of sonorousness, purely 
tympanitic in quality, high in pitch, approaching frequently in intensity 
as well as character the sound in abdominal tympanitis. This clear 
hollowness is always found at or near the summit of the chest, extending 
downward a greater or less distance, unless the lung be attached at its 
upper portion so as to prevent its compression and the ascent of the 
gaseous fluid. The presence of the condensed lung situated usually at 
the superior and posterior portion of the chest, may give rise to dullness 
in that situation. If air or gas is present without liquid effusion the 
tympanitic sonorousness may be diffused over the greater part of the 
affected side. But as more or less liquid is almost invariably present, 
the sonorousness extends to a certain point, and below this point there PNEUMO-HYDROTHORAX. 
817 
is flatness on percussion.” “The escape of fluid by expectoration, or by 
external discharge, will of course effect the quantity within the chest, 
and thus occasion fluctuation in the amount.” There is also variation 
in the quantity of air introduced, as well as in that produced by chemi 
cal changes. The tympanitic flatness of sound extends not only down 
to the level of the fluid, but also some distance below it, so tliat the 
amount of fluid contained is about twice what is indicated by percus- 
sion. (Skoda.) When the quantity of gas is so large as to distend the 
walls of the chest the sonorousness of the sound is diminished, becoming 
duller, though still tympanitic. 
Evidence furnished by Percussion.—In pneumo-hydrothorax the 
tympanitic sonorousness is greater the nearer we go to the summit of 
the lungs. When gas exists in the stomach instead of the pleura the 
tympanitic sonorousness also exists but it is greater below, diminishing 
as we ascend. 
The same tympanitic sonorousness is found in some cases of simple 
pleuritis, over the compressed lung, but it is less strongly marked, and 
is not purely tympanitic, but vesiculo-tympanitic, and the relative de- 
gree of sonorousness between the upper and lower part of the lung is 
not changed by change of posture. The walls of the chest are not so 
elastic, though “auscultation shows in the one case, the lung to be in 
contact with, and in the other case to be removed from the walls of the 
chest above the liquid.” 
Over a lung solidified by inflammatory exudation, the bronchial re- 
spiration and broncophony is associated with the tympanitic sonorous- 
ness, and “ this combination is proof against pneumo-hydrothorax, and 
for the existence of pulmonary solidification.” 
In emphysema the resonance is exaggerated, but it is vesiculo-tym- 
panitic, and there is evidence that there is no liquid in the chest. In 
pneumo-hydrothorax the amphoric modification of the cavernous respi- 
ration is strongly marked. In general the intensity of the sound is 
proportionate to the size of the fistula, and the calibre of the bronchial 
tubes to which it leads. 
The respiratory sound is suppressed over the space occupied by liquid 
effusion; the bronchial respiration is discovered at the summit pos- 
teriorly, above the compressed lung which is also generally solidified 
by tuberculous deposit. Tuberculous cavities in the compressed lung 
may sometimes be ascertained by physical signs. On the healthy side 
the respiratory sound is exaggerated. 
Vocal Phenomena.—The resonance is absent below the level of the 
liquid effusion; feeble, or more or less marked over the space occupied 
by air or gas, with amphoric intonation: at the summit over the com- 
pressed lung there is marked resonance, broncophony, or pectoriloquy. 
Metallic tinkling is almost pathognomonic of pneumo-hydrothorax, at 
Yol. L—52. 818 
diseases of the sanguinous function. 
least in cases involving perforation of the lung. It is heard nowhere 
else, except rarely in large tuberculous excavations, or in the stomach 
where it is unconnected with respiration, voice or cough. 
Inspection and Mensuration.—The affected side is permanently 
expanded, and its movements accordingly limited. The accumulation 
of air and liquid may lead to great dilatation and complete immobility, 
even with forced breathing. The intercostal spaces are widened and 
pushed outward, sometimes beyond the level of the ribs; the diaphragm 
is depressed, the mediastinum displaced, the heart dislocated, being 
transferred, in some instances, to the right of the sternum. The signs 
furnished by inspection then are the same as those presented in chronic 
pleuritis or emphysema. Percussion and auscultation are necessary 
to supply the information necessary to enable us to distinguish be- 
tween them. 
In chronic pleuritis and empyema with dilatation, the affected side 
is flat on percussion, with absence of respiratory sound in the great 
majority of instances, except a small space at the summit. There is 
neither the tympanitic sonorousness over the affected side, cavernous, 
or amphoric respiration or metallic tinkling. 
Dilatation of the chest is not always visible externally in pneumo- 
hydrothorax ; for liquid and air or gas may exist in the pleural sac, and 
find room by compressing the lung without sensibly enlarging the 
thorax. Palpitation furnishes only evidence of diminution or addition 
of vocal fremitus and fluctuation in this disease, in empyema, and 
chronic pleuritis. 
Succussion.—When air and liquid are contained in the pleural 
cavity, moving the trunk of the person to and fro, with the ear applied 
to the chest, produces the splashing noise resembling that caused by 
shaking a bottle partly filled with water. This sound is almost pathog- 
nomonic of pneumo-hydrothorax, and was noticed by Hippocrates. It 
occurs very rarely in pulmonary tuberculosis, where there may be a 
large excavation, partially filled with fluid. The distinction between 
tubercular consumption and pneumo-hydrothorax can always be made 
out by comparing the previous history of the individual case and the 
other general symptoms with those of each of these diseases, which are 
widely different. 
General Symptoms of Pneumo-IIydrothorax.—It generally oc- 
curs in connection with tuberculosis which has resulted in the perfora- 
tion of a lung, perhaps during an act of coughing. Immediately after 
the rupture of the lung, there is “sudden acute pain in the chest, 
speedily followed by great dyspnoea, hurried respiration, frequency of 
pulse, prostration, lividity, perspiration, diminished or suppressed ex- 
pectoration, occasionally loss of voice, and an expression of great 
anxiety. At first and for a brief period, the affection may be simply PLEURISY. 
819 
pneumo-thorax; but acute pleuritis is generally quickly developed, with 
more or less liquid effusion; and the disease soon eventuates in pneu- 
mo-hydrothrax.” There are cases, however, in which all of these 
symptoms are produced in simple pleuritis, and others in which they 
are not all present, though pneumo-hydrothorax has taken place. In 
the latter case the perforation is small and the escape of air and morbid 
products into the pleural sac, and the subsequent inflammation in the 
pleura progress slowly; adhesions already existing may offer obstruction 
to the rapid accumulation of air and liquid. The intense dyspnoea 
which at first follows the rupture, becomes after a time diminished, and 
the respiration and circulation become adjusted to the morbid condition, 
and the patient suffers less, though the accumulation of air and morbid 
products within the pleura becomes larger. 
Prognosis.—When pneumo-hydrothorax occurs as a complication of 
phthisis, it generally runs rapidly forward to a fatal termination; but a 
few patients partially recover and live several years, taking some exer- 
cise, and even performing some labor. 
Treatment.—See remedies, pages 808 to 815, and 824 to 827. 
PLEURITIS.—PLEURISY. 
Diagnosis.—This malady commences with lassitude, chills, and other 
febrile symptoms, succeeded in a short time by the following local phe- 
nomena : “ The stitch, dyspnoea, cough and recumbency on the affected 
side were given as characteristics by Laennec. Dr. Wurmbe, of Vienna, 
maintains, however, that the posture of the patient is usually upon the 
back.” The inspirations are short and rapid, and attended with severe 
sharp stitches, unless the inflammation be very slight, in which case 
but little alteration will be observed in the breathing; there is often 
experienced a sense of tightness and oppression at the chest; there is 
generally little or no cough unless the lungs or the bronchia are in- 
volved, when there occurs a short and dry cough, with but a small 
quantity of glairy expectoration, and very painful; the pulse is rapid 
and full; skin hot and dry; urine scanty, and of a deep red or dark 
color; the pain is almost invariably confined to one side of the chest, 
and increased by inspiration, coughing, and movement; urgent thirst; 
great dyspncea; constant inclination to lie upon the affected side or 
back; abdominal respiration, and pain in the intercostal spaces on 
pressure. These symptoms are speedily succeeded by others, which 
indicate that effusion has taken place. Laennec, Johnson, and Mackin- 
tosh believe, that effusion commences as soon as the inflammation is 
established ; while others, equally eminent, contend that a considerable 
period elapses before it occurs. But the weight of testimony seems to 
be in favor of the opinion of the former gentlemen. Amongst the 820 
DISEASES OF THE SANGUINOUS FUNCTION. 
signs which are characteristic of pleurisy with effusion, are, increased 
size of the affected part of the chest, apparent to the eye or by men- 
suration ; also aegophony, perceptible by the stethoscope from the com- 
mencement of the inflammation, or after a moderate quantity of fluid 
has been effused, disappearing when the effusion becomes very large 
in quantity, and reappearing as absorption takes place, and the liquid 
diminishes; dull sound on percussion, and failure of the respiratory 
murmur in the affected side. 
Should the lungs happen to be involved, the sputa will be tinged or 
streaked with blood, and more copious than in simple pleuritis. Other 
symptoms will also obtain which characterize pleuro-pneumonia. 
The effusion of pleurisy may be either of a plastic, serous, or haemor- 
rhagic character. The severity of the febrile, and other symptoms 
will depend upon the rapidity of the effusion, and its quality and 
quantity. 
Causes.—Atmospheric vicissitudes, sudden checking of the perspira- 
tion ; metastases of rheumatism, erysipelas, gout, &c., mechanical in - 
juries, surgical operations upon cancerous and scrofulous parts. We 
have witnessed two cases of pleurisy which supervened as a consequence 
of surgical operations. One of these cases occurred after amputation 
of the thigh for a malignant disease of the leg and proved speedily 
fatal. The other case came on about two weeks after excising a large 
fungous tumor from the breast of a female, which also proved fatal. 
Both of these cases were unusually violent, and ran their course with 
great rapidity. It is worthy of remark, that in both, the wrounds made by 
the operation were progressing as favorably as usual. Whether pleurisy 
in these cases is attributable, as some writers suppose, to the absorption 
of pus into the system, or to some other cause we may not now be able 
to determine; but that the disease is peculiarly violent and fatal, has 
been observed by all who have witnessed its occurrence. 
1. acute pleuritis. 
Next to bronchitis and pneumonitis in order of frequency of occurrence, 
pleuritis occurs as a most common thoracic disease. When not con- 
nected with tuberculosis or pneumonitis it is commonly a general disease 
of the pleura of one side. When confined to one side it is called 
single pleuritis, double pleuritis when it involves both sides. 
Stages of Pkogkess.—First. The period from the commencement 
of the inflammation to the accumulation of an appreciable quantity of 
liquid effusion within the pleural sac. This is the dry period. 
Second. The stage of effusion, in which liqhid accumulation is pro- 
gressing. 
Third. Period of absorption of the liquid effusion. 
Pathology of the First Stage.—The whole inner surface of the PLEURISY. 
821 
pleural sac has diffused over it plastic lymph, or it appears in patches, 
varying in size. It is supposed that in the initial period of this stage 
there is an abnormal dryness of the membrane, which causes certain 
sounds heard at this stage. 
Second Stage.—Liquid effusion is poured out from the inflamed sur- 
face which sinks by its weight to the bottom of the sac, compressing 
the lung, and displacing it in a direction upward and backward, when 
not prevented by morbid adhesions. The bulk of the lung being dimi- 
nished and the air expelled from it, it becomes a condensed mass, and 
is said to be carnified, later the fluid enlarges the size of the chest, 
depressing the diaphragm, stomach and liver, displacing the heart. 
Third Stage.—The effused fluid diminishes in quantity and is finally 
dispersed by absorption. The compressed lung then expands, and 
slowly regains it former volume, except in certain cases in which that 
volume is never attained. Contractions of the chest often persist, and 
the relations of parts previously displaced are only restored after long 
intervals, if ever. The pleural surfaces again come into contact as the 
effused liquid diminishes, though these surfaces are roughened by a 
fibrinous coating more or less solidified. Finally the surface of the lung 
and costal pleura become united by adhesion through the complete or- 
ganization of the intervening plastic lymph. These physical conditions 
apply to both acute and chronic pleuritis, though the effects of inflam- 
mation are more fully marked in the chronic form of the disease. 
Diagnosis.—Physical Signs furnished by Percussion. Before the 
accumulation of liquid so far as to fill some portion of the pleural cavity 
at the bottom of the chest and raise the lung above it, the sonorous- 
ness on percussion is not much altered. Moderate or slight diminution 
of the vesicular resonance, replaced by a tympanitic sonorousness, indi- 
cates a lessening of the capacity of the lung, on account of the pain 
which accompanies the act of inspiration, the exudation of plastic 
lymph, on the pleural surfaces. If the patient will disregard the pain 
he can inflate the lung to the full size, and then the sonorousness is re- 
stored; though without this extra effort, the resonance is diminished 
over the whole or the greater part of the side affected. Percussion in 
this disease gives pain, unless very lightly performed. 
The stage of effusion progresses rapidly, in some cases it supervenes 
in a few hours from the attack; it is seldom delayed beyond the third 
or fourth day; the liquid now accumulates around the base of the lung, 
and abolishes the vesicular resonance upwards over a space corres- 
ponding to the amount of effusion. The percussion sound is flat, ex- 
cept a gastric or intestinal tympanitic sonorousness be transmitted from 
below. Vesicular resonance is invariably abolished; the sound becomes 
flat; elasticity of the thoracic wall is diminished; and the upper 
boundary of the flatness is the limit below which the sense of resistance 822 
DISEASES OF THE SANGUINOU8 FUNCTION. 
s increased. The boundary of flatness varies in different positions of 
the patient, as the liquid changes its position when he turns another 
point lower. In some cases the boundary of flatness, which marks the 
level of the liquid is varied from the horizontal (though the position bo 
vertical), by previous morbid adhesions, holding the lung down by an 
attachment sufficient to resist the upward pressure of the fluid. “ Per- 
fect flatness, although not conclusive evidence of the presence of liquid, 
for it may be caused by an intra-thoracic tumor, and occasionally even 
by consolidation of the lung, warrants a strong presumption that effusion 
exists. And this presumption is rendered still stronger by the flat- 
ness being found to extend from the base of the chest upward. The 
line indicating its upper limits being well defined, and pursuing a di- 
rection, if the body be in a vertical position, extending horizontally, 
or nearly so, around the affected side.” [Flint, Respiratory Organs, 
p. 544.) 
When the liquid is being removed by absorption, vesicular resonance 
gradually returns from above downward as the level of the fluid is 
lowered, but toward the base of the chest the flatness continues for a long 
time. The displacement of the mediastinum toward the opposite side 
is gradually changed into a displacement of the mediastinum toward the 
affected side. 
Auscultation reveals feeble respiration in the affected side during 
the stage of liquid accumulation. The intensity of the respiratory 
sound is lessened by the restrained expansion of the affected side. 
Want of continuity in the respiratory movements caused by the pain 
produces an interrupted or jerking murmur. During the stage of ef- 
fusion the respiration is rendered more feeble in proportion as the lung 
becomes compressed. When the quantity of the fluid fills two-thirds of 
the chest the respiratory sound becomes very different in the upper and 
lower portions. Over the condensed lung the respiratory sound is 
broncho-vesicular, or bronchial, as the degree of condensation is 
greater or smaller. In some instances it is loud, in others feeble: be- 
low the line of flatness on percussion it is frequently suppressed, the 
sounds of the heart being transmitted through the mass of liquid with 
increased intensity. In pleuritis in young children the bronchial re- 
spiration is more extensive than in adults of an equal degree of fluid 
accumulation and lung condensation. In common cases the bronchial 
respiration is more intense and seems nearer the ear over the condensed 
lung; over the liquid it is more feeble and seems more distant. When 
the effusion is very copious, the respiratory sound is usually suppressed 
over the greater portion of the chest, except, perhaps, at its summit, 
below the clavicles and in the upper portion of the inter-scapular re- 
gion. When the bronchial respiration is very loud and persistent there 
is reason to suspect that the lung is consolidated. PLEURISY. 
823 
Diagnostic Symptoms of Acute Pleukitis.—During the first period, 
pain is a prominent symptom. It is sharp and lancinating, felt most at 
the moment of inspiration, shortening that act and interrupting it, 
though in character it may resemble pleuralgia. In pleuritis it is com- 
monly felt at the lower part of the affected side, laterally, and in front, 
though sometimes extending to the back or over the whole side, even 
sometimes extending to the opposite side or abdomen. As effusion 
takes place the pain diminishes, and finally almost ceases. 
Respirations at first frequent and short, first because of the pain, 
afterwards from the encroachment of the fluid, which compresses and 
diminishes the capacity of the lung. When the effusion takes place 
rapidly there is dyspnoea. 
Cough, almost always present; it is dry, spasmodically excited at 
first, and partially suppressed to save the pain it excites. We will en- 
deavor to distinguish between 
ACUTE PLEURITIS and PLEURODYNIA, or INTERCOS- 
TAL NEURALGIA. 
The physical phenomena of acute pleu- 
ritis are wanting, though there may be 
diminished expansion of the side; feeble- 
ness of respiratory murmur, and some 
relative dullness, due to restrained move- 
ments from pain. 
Affected side often extremely sensi- 
tive. 
Fever is not generally present. 
Not general. 
Not present. 
No chill or fever. 
Acute Pneumonitis. 
Marked dullness on percussion over a 
certain portion of the affected side begins 
early. If the upper lobe is first in- 
flamed, the dullness is at the summit, and 
on the anterior surface, the posterior 
surface below the scapula remaining re- 
sonant on percussion. 
But more commonly, inflammation 
begins in the lower lobe. Dullness is 
then found bounded on the chest by a 
line pursuing the direction of the inter 
lobar fissure; the boundary not varying 
with the change of position of the 
patient. 
The existence of fever is always a 
prominent feature, and proves the case 
more inflammatory than neuralgia. 
Friction sound, after the first stage. 
Serous effusion gives positive evidence 
of inflammation. At first the pain may be 
merely neuralgic but then inflammation 
soon follows. Chill, increased pain and 
fever precede the latter. 
The reverse of Pneumonitis after ef- 
fusion takes place. 
The line showing the boundary of 
dullness varies as the patient changes 
posture. The liquid accumulates rapid- 
ly, and flatness on percussion extends 
over a larger portion of the affected side. 
When the quantity of liquid in the 
pleura is large there is flatness on per- 
cussion. 824 
DISEASES OF THE SANGUINOUS FUNCTION. 
Actjte Pleuritis. 
Acute Pneumonitis. 
This is usually associated with sup- 
pression of respiratory sound ; if any 
bronchial respiration, it is feeble, ap- 
pearing distant. 
These are absent when there is effu- 
sion. 
Sometimes .Egophony. 
Vocal fremitus is abolished by liquid 
effusion. 
There is enlargement of the affected 
side ; intercostal depressions effaced. 
The heart, diaphragm and mediastinum 
are displaced, when the effusion is large. 
Though an entire lung may become 
solidified, a single lobe is first at- 
tacked ; and the dullness extends slowly 
to other parts. 
Solidification of the lung produces 
only dullness; in some cases the vesicu- 
lar is replaced by tympanitic sonorous- 
ness. The dullness, accompanied by 
bronchial respiration, often, intense, me- 
tallic, as if near the ear. 
There is increased vocal resonance, 
broncophony, occasionally pectoriloquy. 
is rare. Vocal fremitus 
is exaggerated by solidification. 
Enlargement slight; intercostal de- 
pressions remain. 
These are little perceptible in pneu- 
monitis. 
Rusty expectoration and crepitant rale 
are very common, almost pathognomic 
Treatment.—The most valuable remedies in the treatment of pleu- 
risy are: Aconite, Bryonia, Tartar-emetic, Phosphorus, Arsenicum, 
Rhus-tox., and Arnica. During the progress of the disorder we should 
also bear in mind Sulphur, Scilla, Rhus-rad., Lachesis, Silicea, and 
China. 
Aconite is eminently appropriate, either alone or in alternation with 
other specifics, whenever the inflammatory action runs high, accompa- 
nied with hot skin, quick and full pulse, urgent thirst, and general sus- 
pension of the secretory functions. Wurmbe and Trinks commend it in 
the highest terms in that variety of pleuritis which is characterized by 
the plastic nature of the effusion, and the severity of its inflammatory 
fever. It should be exhibited at the very commencement of the dis- 
ease, and in the lowest potencies, and repeated in urgent cases every 
hour until the fever subsides. 
Bi'yonia is a specific of great value in the malady under considera- 
tion, and the power which it possesses of promptly controlling and sub- 
duing the most violent cases of pleurisy, is a matter of astonishment to 
us, who formerly believed copious and repeated venesections to be the 
only safe means of effecting a cure. We have treated a great number 
of cases, in which Bryonia has been our chief remedy, and we have 
not failed in a single case, but our cures have been far more prompt, 
pleasant and satisfactory, than we ever effected under the old treat- 
ment. The effusion has invariably been more successfully absorbed, 
and the pleura and lungs as well as the system at large have more per- 
fectly recovered their original tone and vigor than in cases which have 
W anting. PLEURISY. 
825 
been treated by the old method. Nor will this appear at all strange, 
when it is remembered, that by one method the structure actually dis- 
eased is alone acted upon, while by the other the whole organism is 
subjected to the influence of the most powerful medicines, impairing the 
integrity and vigor of almost every part, without producing any certain 
or decided effect upon the pleura, or any other pulmonary tissue. 
Let the skeptical allopath prove upon his own person in health the 
pure effects of Bryonia, Tartar-emetic, Phosphorus, Lachesis, 
Scilla, &c., upon the respiratory organs, and then test them judiciously 
in cases of disease after the homoeopathic principle, similia similibus, 
and he will forever abandon the uncertainties and dangers of the lancet, 
mercurials, counter-irritants, &c. 
Bryonia may follow or alternate with Aconite advantageously. The 
external indications are: cheeks flushed and hot, dry or moist; re- 
spirations short and rapid, and performed principally with the abdominal 
muscles ; position upon the affected side ; pulse quick and full; tongue 
dry; breath hot; urine scanty, and red or dark; dull sound on per- 
cussion of the affected side; respiratory murmur indistinct or entirely 
•wanting. 
Physical Sensations.—Stinging, shooting or burning pains in the 
side, aggravated on inspiration, coughing, or movement; respiration 
difficult, short, anxious and rapid; sense of tightness; a weight or op- 
pression at the chest; painful cough, dry or with expectoration of a 
glairy sputa, sometimes tinged with blood; great heat of skin, alter- 
nating with frequent coldness and shivering; urgent thirst; pain in the 
intercostal spaces on pressure; weariness and inclination to retain the 
recumbent position. 
Mental and moral Symptoms.—Anxious, apprehensive, desponding; 
fear, irritability, peevishness, restlessness. 
In the plastic form Aconite is more appropriate. Bryonia is the 
specific for pleuritic serous effusions; fever, with violent shooting pains 
in the chest. In pleuritic effusions which follow a simple course with- 
out any dyscrasia, Sulphur seems well adapted for the removal of the 
effusion, especially after the fever subsides. (Wurrnbe.) 
In pleuro-pneumonia Wurmbe and Caspar recommend Bryonia, 
especially in the second stage; in cases not very extensive, but in- 
volving the mucous and serous membranes; there is severe stabbing 
pain in the chest, even when it does not seem to correspond with the 
seat and extent of the infiltration of the lungs; the pleura is deeply 
implicated, and there is moderate oedema of the lungs ; when the oadema 
becomes more considerable, Tartar-emetic is to be preferred. 
Administration.—A dose of the first dilution every hour, alone or 
in alternation with Aconite, until the pain, difficulty of breathing, &c. 
are relieved. 826 
DISEASES OF THE SANGUINOUS FUNCTION. 
Ta/rtar-emetic.—According to Magendie this medicine possesses the 
specific power of causing engorgement and inflammation of the lungs 
when given in large doses. There can be no doubt, that it is an ab- 
solute and decided specific over the respiratory organs, as well as the 
gastro-intestinal mucous membrane. This has been demonstrated by 
Cloquet, Muller, Magendie, Gross, and others, by autopsical examina 
tions and by numerous provings upon persons in health. 
It is a common remedy in the old school in affections of the respira- 
tory organs; yet they are entirely ignorant of its curative action. It 
is only necessary to refer to the unsatisfactory and contradictory opin- 
ions of Laennec, Rasori, Broussais, Eberle, Payne, Blake, and Barbier, 
upon this subject, to be convinced of the utter want of accurate know- 
ledge and uncertainty of principle amongst allopathists in the admin- 
istration of medicines. 
The homoeopathist on the contrary, demonstrates by numerous pro- 
vings in health, that it exerts a specific force upon the lungs and their 
appendages, and he therefore gives it in inflammations of these organs 
with confidence and success. With him there is no random and crude 
speculation,—no breaking down of the organism by violence, hoping in 
the general ruin to crush the malady, but, having a definite object, and 
seeing his goal, he quietly, safely and surely attains it. 
The indications for Tartar-emetic are: face flushed, hot and dry, 
or pale, wan and anxious, and covered with sweat; respirations short 
and obstructed; surface burning hot and dry, or cold and bathed with 
cold perspiration; pulse quick, weak, or full; tongue moist and clean, 
or loaded with a white or brown fur; urine scalding hot, red or brown; 
mucous or bloody expectoration; general appearance indicative of great 
anxiety and physical prostration. 
Respiration short, difficult, obstructed, and attended with stinging or 
shooting pains ; cough with expectoration of mucus, sometimes tinged 
with blood; violent throbbing of the heart; coldness and shivering 
whenever the bed-clothes are raised, or on motion ; fever with adypsia 
or moderate thirst; lassitude, debility, and disposition to syncope ; 
trembling of the limbs from the slightest exertion; sense of suffocation. 
Agitation ; apprehension ; discouragement; despair. 
Administration.—Two grains of the first trituration of Tartar-emet. 
may be dissolved in a tumblerful of pure water, and given in teaspoon- 
ful doses, every one, two, three, or four hours, as the urgency of the 
case may demand. 
Phospho?'us.—Countenance pale, alternating with redness ; eyes 
hollow and surrounded by a blue circle ; respiration short, difficult and 
no’sy; tongue dry; pulse quick and hard; expectoration slimy or 
bloody. PLEURISY. 
827 
Respiration rapid, short and difficult; lancinating pains in the chest, 
mostly on the left side; sharp pains on pressing the intercostal 
spaces; anguish, fullness and tension of the chest; palpitation of 
the heart; dry, shaking cough, or cough with expectoration of th 
bloody mucus; weakness, pain, and trembling of the limbs; mouth and 
throat dry; thirst. 
Uneasiness ; melancholy ; anguish ; dread of the future ; indifference 
to every thing; passionate and irritable. 
Administration.—Same as Bryonia. 
After the more violent febrile symptoms have subsided, and those of 
effusion into the cavity of the pleura remain, as enlargement of the af- 
fected side, dull sound on percussion, absence of the respiratory mur- 
mur, oppression and constriction of the chest; difficult and short breath- 
ing, with occasional attacks of suffocation ; dry cough ; coldness of the 
body; clammy sweats ; anxiety and general sense of prostration, Ar- 
senicum is our remedy. It may be given in these cases at the third 
potency, a dose once in two to four hours, lengthening the intervals as 
improvement occurs. 
Bhus-tox. is sometimes useful after the febrile symptoms have sub- 
sided, and there yet remain wandering pains in the chest, shortness of 
breath, and general debility. In cases also which have arisen from 
metastasis of rheumatism or gout, this remedy is peculiarly appropriate. 
It may be administered in the same manner as Bryonia. 
Arnica is our best specific when inflammation of the pleura has 
arisen from contusion, bruise, or other injury. It may be used inter- 
nally in one of the lower dilutions; externally, a lotion made of a 
drachm of the tincture to twelve ounces of water may be applied to the 
contused part. 
The other medicines which will frequently be found highly service- 
able in some of the sequela of pleuritis are: Sulphur, Scilla-mar.} 
Bhus-rad., Lachesis, Silicea, and China. Sulphur especially is re- 
commended by Wurmbe in plastic pleurisy, and in cases complicated with 
pneumonia and hepatization, after Aconite has moderated the more 
active symptoms. He uses the tincture. 
2. CHRONIC PLEURITIS. 
This affection seldom follows or is preceded by acute pleuritis. In 
general the inflammation i$ sub-acute from the first; and the effusion 
commonly attains to a much larger amount than is observed in the 
acute variety. It is very often overlooked, and may only be detected 
by physical exploration. 
First period.—That of Accumulation .—This continues while the 828 
DISEASES OF THE SANGUINOUS FUNCTION. 
liquid is accumulating in the pleural sac or remains stationary. It i? 
generally of brief duration. 
Second period.—Stage of Absorption.—This may extend through a 
few weeks and even several months. 
Diagnosis.—Percussion gives a flat sound on the whole or greater 
part of the affected side ; tympanitic resonance at the summit; marked 
want of resistance and elasticity of the thoracic parieties ; showing the 
pleural sac to be filled with fluid, compressing the lung into a small 
space. If any bronchial respiration is perceived, it is feeble, and sounds 
as if distant, except at the summit in front, and in the inter-scapular 
region. On the healthy side the respiratory murmur is intensified, but 
vesicular; greater vocal resonance in the inter-scapular space of the 
affected side. 
Inspection shows immobility and enlargement of the affected side, 
and on the opposite respiratory movement increased. Ribs of the af- 
fected side raised towards a horizontal direction; intercostal de- 
pressions effaced; bulging between the ribs, nipple raised and removed 
further from the median line. Measurements show increase of size, 
perhaps to the extent of two inches. 
The heart is displaced from the affected side and pulsates sometimes 
far from the natural position. Mediastinum displaced laterally; 
diaphragm depressed ; this may press the liver downwards to make it 
project below the ribs. 
During the second stage these signs gradually change towards the 
normal condition, but rarely reaching it; when the absorption is com- 
pleted the contraction which began in the upper portion of the chest 
becoming general, the displaced organs recede towards their natural 
position. The whole process often extends through several months. 
Chronic Pledritis is not generally manifested by severe pain; 
cough and expectoration are not much complained of. The cough is 
more generally dry, except when there has been ulceration extending 
from the pleural sac into the bronchia, causing pneumo-hydrothorax. 
Other symptoms deceive superficial observers. Respirations but slightly 
increased in frequency; exercise or speaking reveal want of breath, 
dyspnoea and lividity of the prolabia, removed by rest. The pulse 
varies from 80 to 120 per minute; night-sweats, not always preceded 
by fever; slight chills occasionally felt, even when no tuberculosis; 
some indigestion common ; but often the appetite is morbidly craving, 
and food digested without distress; pallid countenance not always 
present; emaciation not generally noticed. Strength often not much 
diminished; many continue laborious occupations though the chest on 
one side is filled with fluid undergoing a slow absorption. 
The patient is generally supposed to suffer the effects of a “ dumb 
ague,” bilious fever imperfectly cured, dyspepsia, general debility, dis- 829 
PLELTKISY. 
ease of the heart, chronic liver-complaint, or hepatization of the lung. 
The distinction, which shall separate it from each of these, is perhaps 
only to be drawn by physical exploration. If there be flatness over 
more or less of the chest in cases of chronic pleuritis, the probabilities 
are against pneumonitis. The acute inflammation of the parenchyma 
of the lung would have manifested itself by pain, rusty expectoration, 
fever, and confinement to bed for some days or more; and chronic 
pneumonitis, in such conditions as we find present, is not a common oc- 
currence, either as a consequence of acute pneumonitis or as a primary 
affection. 
The diseases liable to be mistaken for Chronic Pleuritis.—Infil- 
trated cancer of the lungs is not common. It may produce contraction 
of the affected side of the chest, and may resemble the pleuritis in the 
stage of absorption. 
Mediastinal Tumor may lead to dilatation, and give rise to symp- 
toms resembling those of pleuritis in the stage of liquid accumulation. 
Cancer of the lungs is more uniformly accompanied with cough and 
expectoration; the latter more abundant; it becomes purulent, re- 
sembling red or black currant jelly ; haemoptysis is frequent, pain more 
prominent and persisting than in pleuritis; pulse little affected till the 
disease is quite advanced. Contraction of chest not so great; the loss of 
strength, emaciation, and pallor denote the progress of a grave, serious 
malady. 
Cancer of the mediastinum may extend into both sides of the chesty 
causing flatness on percussion, &c., not limited to one side. The 
pressure of the tumor may efface intercostal depressions, and unfre- 
quently, a sense of fluctuation; but these effects are more rare than 
when the side is dilated by the presence of liquid. The dilatation from 
a cancerous or other tumor is often partial or circumscribed, irregular, 
and extends from above downward. In chronic pleuritis the dilatation 
is from below upward, is general and more regular in shape. Dyspnoea 
is more constant and prominent, if the tumor is considerable in size. 
If a tumor cause displacement of the heart and diaphragm other 
symptoms are added to those caused by accumulation of liquid: There 
is also “oedema of the face, lividity, swelling of the veins, dysphagia, as 
well as marked dyspnoea,” which are caused by pressure on the air- 
tubes, large vessels, nerves and oesophagus. 
Physical Signs.—Cancer of the Lungs or Mediastinum.—Percus- 
sion reveals bronchial respiration and increased vocal resonance, or 
broncophony is often found over parts of the chest where the percus- 
sion-sound is dull or flat. These signs show pulmonary solidification. 
In chronic pleuritis there is absence of respiratory murmur and aboli- 
tion of vocal resonance below the level of the liquid. These signs with 
flatness on percussion eminently show the presence of liquid; vocal fre- 830 
DISEASES OF TIIE SANGUINOUS FUNCTION. 
mitus may be preserved or increased in cases of cancerous infiltration 
or tumor; it is uniformly abolished below the level of the fluid in 
chronic pleuritis; and flatness of the chest extends from the base more 
or less upwards. In the former affections percussion reveals vesicular 
resonance at or near the base of the chest below the limit of flatness or 
dullness. « 
Retrospective Diagnosis.—Examination of the Chest to deter- 
mine whether Pleuritis has not existed at a former time.* — “ Di- 
minished width of the chest, apparent on inspection in the great ma- 
jority of cases. Depression or flattening at the summit of the affected 
side, almost invariably observed; but occasionally enlargement, which 
probably denotes abnormal dilatation of the cells or emphysema. The 
reduction in size is also shown by mensuration. The shoulder 
generally depressed; but in some instances this is not apparent, and it 
may be even raised above the level of that on the opposite side. The 
nipple usually depressed, but not invariably, and nearer the median 
line. The lower ribs converging, sometimes almost overlapping; the 
upper ribs diverging. The distance from the posterior margin of the 
scapula to the spinal column lessened, often in a notable degree; an 
exception to this rule obtaining in some instances, when lateral cur- 
vature of the spine takes place, the concavity looking toward the af- 
fected side. Projection of the lower portion of the scapula occurring 
in a certain proportion of instances; also depression of the inferior angle 
below the level of that on the opposite side. The respiratory movements 
almost uniformly diminished in a degree more or less marked; the ex- 
pansibility on the opposite side being at the same time exaggerated. 
Comparative dullness on percussion; the contrast rendered more strik- 
ing by the great clearness of percussion-resonance on the opposite side. 
A vesiculo-tympanitic resonance at the summit, conjoined with enlarge- 
ment, denoting the supervention of emphysema. Feebleness of respira- 
tory sound over the entire side, with few exceptions; and on the oppo- 
site side, an unusually intense vesicular murmur. A bronchial respira- 
tion sometimes observed in the inter-scapular space, and in other parts 
of the side. In the latter, especially associated with broncophony, 
probably denoting dilatation of the bronchial tubes. The respiration in 
a certain proportion of cases, broncho-vesicular. The vocal resonance 
sometimes greater, but not uniformly. The same remark applicable to 
vocal fremitus. Curvature of the spine in some cases, the inclination 
usually lateral, the concavity toward the affected side. The position 
of the heart frequently normal, but in some instances displacement of 
this organ; it being found to the left of its natural position and ele- 
vated, if the pleuritis be seated in the left side.” After pleuritis of the 
* Flint on the Respiratory Organs, P. 577. EMPYEMA. 
831 
right side the heart is sometimes permanently drawn toward the right 
side. Such are phenomena observed in persons who have formerly 
suffered from chronic pleuritis, after complete recovery from the same, 
except there be remaining, in some instances, emphysema and dilata- 
tion of the bronchial tubes. 
3. EMPYEMA.—PYOTHORAX, 
A collection of pus within the cavity of the chest is one of the ter- 
minations of pleuritic inflammation. The termination of pleurisy in 
empyema is attended by difficulty of breathing, particularly on lying 
on the side opposite the affected one; and an oedematous swelling is 
generally externally perceptible. 
Diagnosis.—Purulent accumulation within the thorax, the tumor 
showing itself without the ribs is regarded simply as a superficial 
abscess. But the mistake of so regarding it is avoided by employing 
physical exploration; if the physical signs reveal the existence of a 
large collection of fluid within the pleural sac, it may be inferred that 
there is a communication between the fluid within the chest and that 
immediately beneath the skin. We can also by compressing the tumor, 
if there be such interior communication, reduce the fluid from the out- 
side of the ribs, through the perforation, making it entirely disappear 
by forcing its contents into the thorax; and if the tumor contains fluid 
which communicates freely with liquid in the chest, it will be observed 
to rise and fall with the successive acts of inspiration. The appearance 
of the tumor which belongs to empyema is not preceded by acute in- 
flammation, pain, swelling, heat or redness. If the tumor be opened 
under the erroneous impression that it is merely a subcutaneous abscess, 
the abundance of the discharge of pus will lead to the discovery of 
the error. 
When the fluctuating tumor pulsates synchronously with the beating 
of the heart, it might be mistaken for aneurism; but it is developed too 
rapidly, the liquid contents are too superficial, and the fluctuation of 
pus is evident. The bellows’ murmur and thrill of aneurism are want- 
ing and the certain presence of liquid in the chest removes all doubt 
as to its character. 
Having discovered by physical signs that the pleural sac contains 
liquid of some kind, it is desirable to determine its nature as precisely 
as possible: It may be supposed to be purulent, if the quantity of 
liquid be large and it remains stationary, or continues to increase in 
spite of judicious treatment, calculated to cause its absorption. Serous 
fluid should have been at least diminished; but pus is more likely to 
increase rather than diminish; repeated exploration may assure us 
whether the quantity increases or diminishes. Positive certainty can 
only be reached by paracetesis thoracis. Dr. Morrill Wyman, of 832 
DISEASES OF THE SANGUINOUS FUNCTION. 
Cambridge, Mass., proposed to perform this operation most safely by 
using “a small canula which is attached by a flexible tube to a suction- 
pump, so constructed that the fluid may be removed from the chest 
through the canula, and discharged through the pump by another aper- 
ture. (Amer. Jour. Med. Sciences, April, 1852.) 
It is the tendency of this disease to terminate by progressing toward 
the surface; and, by means of ulceration and a fistulous communica- 
tion, the contents of the pleural sac are discharged spontaneously, 
either directly through the thoracic parietes, or indirectly through 
some natural outlet, as the bronchial tubes. It has resulted in dis- 
charge of pus into the alimentary canal. When sudden and copious 
expectoration takes pla'ce from the lungs when the pleura was known 
to have been filled with pus, it may be considered certain that the ul- 
ceration has commenced within the pleural sac; speedily, however, we 
have evidence of the existence of air within the thorax and the exist- 
ing disease is known as pneumo-hydrothorax. {Flint.) 
Perforation of the Walls of the Chest.—The purulent fluid col- 
lecting beneath the thoracic integument first forms a fluctuating tumor 
which is evidently situated outside of the ribs. If there has not before 
been proof of the existence of an accumulation of liquid, this tumor 
may be mistaken for an external abscess. If physical signs show that 
liquid really exists in the chest, we may suppose the subcutaneous 
collection to be connected with that within. In this case the fluid be 
neath the skin can be pressed back into the chest through the opening 
by which it found its way towards the surface; the tumor would rise 
and fall with the successive acts of inspiration and expiration; and L 
opened by mistake, the large quantity of pus discharged will prove 
error in diagnosis. 
Treatment.—In all ordinary cases the proper use of remedies in the 
earlier stages of pleuritis will prevent its proceeding to a termination 
in the formation of pus. When, however, it has by neglect, or in pecu- 
liar constitutions proceeded to suppuration, the treatment will be 
governed by the following principles: 1. The constitutional predisposi- 
tion of the patient to scrofulous or tubercular disease ; 2. the treatment 
proper for abscesses in general. See the Articles Phthisis, Scrofula 
Abscess, Pleuritis, Pneumonia. 3. The operation of paracentesis may 
be necessary in some cases. 
See an interesting case by Dr. Helmuth, U. S. Jour. Homoeop. Yol. 
I. p. 489. 
4. EMPHYSEMA. 
Emphysema consists only of a swelling or enlargement from the ad- 
mission of air into the cellular membrane. It is commonly caused by 
a wound or injury of the thorax, which has affected the lungs; in which INFLUENZA. 
833 
case the air passes from the injured lung through the wound into the 
surrounding cellular membrane; and from thence it spreads over the 
body. In some remarkable cases it arises spontaneously immediately 
after delivery without any known cause. 
Emphysema is marked by an evident crackling noise ; elasticity upon 
pressure; difficulty of breathing, oppression, and anxiety. The skin 
over the enlarged part is tense, elastic, and crepitating. 
This affection is generally without danger; but it may be more or 
less serious, according to the extent of the injury with which it is asso- 
ciated. The only treatment required will be that proper for the in- 
jury, and the control of the attendant inflammation and fever. 
5. EPIDEMIC INFLAMMATION OF THE PULMONARY MUCOUS MEM- 
BRANE.—INFLUENZA. 
This disease is usually described as an aggravated form of coryza ; 
but it is far more serious than that disease as it commonly appears, 
and is Essentially different in its nature. Arising from a specific cause, 
and spreading rapidly as an epidemic, it has often been simultaneously 
manifested in almost the same hour in every part of a large city; and 
in a very brief period it traversed kingdoms and crossed oceans, pre- 
senting everywhere the same general features. For centuries it was 
believed to originate in some mysterious influence of the stars; hence 
the Italian name influenza. It was also called influenze del aria, in 
fluence of the cold. 
In addition to the symptoms of simple catarrh (described at p. 423) 
we find in influenza an immediate aggravation of all the febrile symp- 
toms: hoarseness; severe cough, either dry and racking, or hollow and 
loose; wheezing, or difficult respiration; impaired appetite; soreness, 
oppression, or stitches in the throat and chest on coughing; inca- 
pacity for mental or physical exertion; bowels constipated or relaxed. 
Sometimes the inflammation appears to extend to the membrane of 
the thorax and of the bronchial tubes, giving rise to sharp, stitching 
pains, or a sensation of rawness in these parts; severe and painful 
chest cough; thick, tenacious, and semi-purulent expectoration ; op- 
pression of the chest and difficult respiration. In these instances, the 
inflammation is of a lower grade than obtains in acute bronchitis, 
pleuritis, or laryngitis, and consequently the symptoms are more slight 
and less dangerous. 
Treatment.—The chief remedies are, Nux., Arsenicum, Mer- 
curius, Dulcamara, Stibium, Cepa, Ammonium, Carbon, Ipecac., 
Causticum, Belladonna, Bryonia, Pulsatilla, Chamomilla. Their 
separate indications are given at p. 425. Camphor is promptly effectual. 
Vol. I.-53. 834 
DISEASES OF THE SANGUINOUS FUNCTION. 
SUMMARY OF PHYSICAL SIGNS 
Name 
of the 
Disease. 
INSPECTION, PALPATION, MENSURATION. 
PERCUSSION. 
Thobax. 
Muscles. 
Dia- 
phragm. 
Livek. 
Heakt. 
EMTIIYSE- 
MA. 
Dilated, espe- 
cially in regio 
mammaria. Like 
a barrel — elasti- 
city wanting. 
(Compare Pneu- 
mo-thorax.) 
Moveable, not 
pushed out. 
Pressed 
down. 
Pressed 
down. 
Pressed 
down and to 
the inside: 
not moved 
over the me- 
dium line. 
Clear sound, not 
tympanitic, even 
where the sound 
is dull, as over 
the liver and 
heart. Clear tym- 
panitic sound in 
limited vesicular 
emphysema. 
PLEURI- 
TIS. 
Inferior dilata- 
tion with little 
or no motion. In 
left-sided pleuri- 
tis that side wid- 
er than the right 
one. 
Not moveable, 
—pressed out. 
Pushed 
down. 
Pushed 
down. 
Pushed to 
the right side 
over the me- 
dian line, 
soon in left- 
sided exuda- 
tions. 
Empty, dull, 
firstly towards 
the back and be- 
low. 
» 
HYDRO- 
THORAX. 
As in pleuritis. 
Some moveable, 
but not pushed 
out. 
As in pleu- 
rit. 
As in pleu- 
rit. 
As in pleu- 
rit. 
As in pleurit. 
PNEUMO- 
THORAX 
Increased con- 
vexity of the left 
side, and enlarge- 
ment of it, espe- 
cially in simulta- 
neous exudation. 
Great elasticity 
of the walls of the 
chest 
Muscles show 
prominently out- 
ward : nearly pa- 
ralytic ; increas- 
ed elasticity; 
yielding in per- 
cussion. 
In left-sided 
pneumo-tho- 
rax the heart 
in scrobicu- 
lis cordis; or 
as in pleuri- 
tis, pushed 
to the right 
side. 
Clear and tym- 
panitic in front, 
with metallic 
second sound, es- 
pecially on per- 
cussion, during 
auscultation (not 
tympanitic, only 
during large ten- 
sion of the tho- 
rax) even on the 
back, where 
there is fluid exu- 
dation, tympani- 
tic sound, mode- 
rated down only 
by milder per- 
cussion and large 
quantity of fluid. 
Apopt.exta- 
pulmonum. 
Bleeding 
from the 
Lungs. 
Only in large 
bleedings on the 
periphery dull 
sound, with re-; 
sistance of the 1 
Anger. DISEASES OF THE LUNGS. 
835 
OF DISEASES OF THE LUNGS. 
AUSCULTATION. 
DIAGNOSTIC REMARKS. 
Breathing. 
Sounds 
(Murmurs.) 
Voice. 
Never bronchial; 
stretched and increas- 
ed expiration. Dimin- 
ution of the sound of 
respiration, but vesi- 
cular in front—may 
be even heard on the 
back in the hepatic 
region. 
Kales dry, hu- 
mid, whistling, 
surring, hum- 
ming at the ex- 
piration. 
Vibrations visi- 
ble by the hand; 
not increased. 
\ 
Muscles of the throat hypertrophied. Dia- 
meter of the chest from before backwards 
increased; chest little moveable; respiratory 
murmur may be wanting entirely; rattling 
murmurs more in the upper portion. On 
account of bronchial mucous membrane, raw 
vesicular breathing: imperfect rattling as in 
small vesicles. In larger vesicles dry vesi- 
cular rattling. The interlobular emphysein 
may physically not be diagnosed. 
Differences from Pleurisy: Erect posi- 
tion preferred; wall of the thorax elastic; 
thorax superiorly dilated; in pleuritis the 
contrary; dilatation below. 
Weak, bronchial 
breathing in the cor- 
ner of the shoulder- 
blade. Breathing tri- 
fling or entirely gone. 
In large exudation no 
breathing on the an- 
terior side. 
Friction sound 
in the beginning 
and end of the 
disease, (rattling 
murmur more 
seldom than in 
pneumonia.) 
Vibration not felt 
by the hand. Bron- 
cophony weak. 
/Kgophony near the 
corners of the sca- 
pula frequently. 
The larger circumference of the left tho- 
rax (usually smaller than the right) is diag- 
nostically of importance. Encysted exuda- 
tions and resorption after the physical symp- 
toms. Diagnostic differences: 1st, From 
pneumonia: The hollow dull sound appears 
quicker; more resistance of the thorax in 
pleurisy. Pneumonia neither dislodges the 
intercostal muscles nor other organs from 
their position. 2d, From pneumothorax: 
Percussion remains the same in pleurisy in 
every position. 
Sequela of Pleuritis: Hydropical mixture 
of blood with dilatation of the l ight heart, 
and great exudation. Atrophy of the lungs; 
sinking in of the thorax; friction sound is 
favorable, proving a plastic exudation. In 
phthisis pleuritis is circumscribed. 
As in plourit. after 
exudation. 
No friction 
sound. 
As in pleuritis. 
Never vesicular; on 
the back of the thorax 
uncertain. 
Rattling, sur- 
ring, whistling; 
sounds, with 
ringing noise; 
sounds of falling 
drops on sitting 
up. Metallic 
tinkling; espe- 
cially strong in 
coughing and 
talking. 
Vibration want- 
ing. Metallic sound 
and resonance in 
speaking and 
coughing. Ampho- 
ric sound. Gurg- 
ling after sound on 
the back. 
The surest symptom is the noise of fluc- 
tuation in motion or shaking the patient. 
Metallic sound may be wanting, or only be 
heard at different times on the same patient. 
Change of position, changing also the posi- 
tion of the exudation, modifies also the per- 
cussion sound. (Difference from pleurisy.) 
Enlargement of thorax rapidly, in emphy- 
sema slowly. Fluid exudation can only be 
diagnosed, when in large quantity, giving a 
dull sound. In pneumothorax from degene- 
rate exudation the quantity of air is less. 
Clear sonorous sound of the enlarged left 
side with pulsation of the point of the heart 
on the right side proves fully the existence 
of pneumothorax. 
Decreased vesicular 
breathing, or sus- 
pended breathing on 
a small space in in- 
farctus and crepitant 
ronchus around the 
part. Bronchial 
breathing, when the 
infarctus extends 
over a larger space. 
Moist, large ve- 
sicular rattling 
during _ the 
cough, especially 
between the 
shoulder-blades, 
and in the tra- 
chea. When the 
blood is fluid, 
rattling, surring, 
whistling noises. 
Broncophony on- 
ly by large extent 
of infarction. 
Diagnosis.—More negatively by exclusion 
of concurring cases: Small bleedings and 
small infarctus give no physical symptoms. 
The same is the case with larger ones, going 
inward and surrounded by tissue containing 
air. Accumulation of mucus may be taken 
for fluid blood, both giving a moist rattle. 
Haimorrhage is hardly ever so extensive as 
to make itself known by inspection and pal- 
pation. 836 
DISEASES OF THE 8ANGTTINOUS FUNCTION. 
Kamb 
of the 
Disease. 
INSPECTION, PALPATION, MENSURATION. 
PERCUSSION. 
Thorax. 
Muscles. 
Dia- 
phragm. 
Litre. 
Heart. 
(EDEMA- 
PULMONUM. 
Chest less mov- 
eable, especially 
in comparison to 
the exertion. 
Normal. 
Normal. 
Normal. 
Nearly normal; 
in some cases 
more clear, and 
somewhat tym- 
panitic. At the 
approach of 
death weakened 
and deadened to- 
wards the back; 
in front some- 
what tympanitic. 
PNEUMO- 
NIA. 
Thorax sunk in 
and flattened; 
where indurated 
pieces, shrunk 
Muscles always 
moveable, never 
pushed out. Ex- 
tension uneven. 
The suffering 
side moves rela- 
tively less. 
Normal. 
Normal. 
Normal. 
1st Stage—Nor- 
mal in the begin- 
ning ; in pneu- 
monia near the 
periphery tym- 
panitic and full 
resistance of the 
percussing fin- 
ger. Increasing 
Idullness of the 
sound. The 
healthy parts 
around it give a 
full clear sound. 
2 d <Staj7«.-Sound 
dull and deaden- 
ed. Resistance 
increased. 
8 d Stage.-Sound 
full and clear 
again.Sometimes 
tympanitic as in 
the first stage: at 
last normal. 
TUBERCU- 
LOSIS. 
Crude Tu- 
bercles. 
The known 
phthisical habit: 
chest wider be- 
low, narrower 
above, (in conse- 
quence of swell- 
ing of the liver 
and sinking in of 
the thorax. 
Intercostal mus- 
cles less move- 
able ; upper part 
of the chest be- 
ing less raised. 
One-sided motion 
of respiration; 
intercostal spa- 
and 
motion of the 
heart visible 
there. 
Normal. 
Normal. 
Position 
normal, but 
the stroke 
stronger and 
more diffus- 
ed. Second 
sound of pul- 
monary arte- 
ry increased, 
pulsations of 
the subja- 
cent vessels 
on the apex 
of the lung 
clearly per- 
ceptible. 
Normal in the 
beginning, after 
a while deaden- 
ed in the regio 
colli, over the 
apex of the lung, 
in regio clavicu- 
lar, next to the 
shoulder joint, 
over the crest of 
t he scapula, in- 
creased resis- 
tance, want of vi- 
brations. Fuller 
sound of the 
neighboring 
parts and in the 
sides and below, 
(on account of 
the increased ex- 
tension of the 
cells.) Tympani- 
tic sound next to 
the sternum 
(through the em- 
physema of the 
edges. DISEASES OF THE LUNGS. 
837 
AUSCULTATION. 
DIAGNOSTIC REMARKS. 
Breathing. 
Sounds 
(Murmurs.) 
Voice. 
Lessened respira- 
tory murmur; cell 
breathing higher, 
nearly hissing; never 
bronchial breathing. 
(Different from pneu- 
monia.) 
Moist crepitant 
ronchus, as in 
pneumonia, espe- 
cially on the 
back. According 
to the extent of 
the bronchial 
branches large 
vesicular unry th- 
mical murmurs. 
In simultaneous 
bronchial affec- 
tion rattling 
sounds (surring, 
whistling, hiss- 
ing) with the ex- 
ception of the 
consonant. 
Never bronco- 
phony. 
The acute circumscribed oedema shows 
sometimes even vesicular breathing, usually 
diminished and crepitation; auscultation the 
same in acute and chronic oedema. In chro- 
nic the motion of the thorax not in propor- 
tion to the exertion. The hands laid on feci 
the vibrations of the internal moving tough 
masses. The partial chronic oedema chooses 
more the lower regions, giving a dull sound 
on light percussions, or moist rattling sounds. 
Simultaneous pleuritic exudation pushes the 
heart away. 
1st (Stag'e.-Increas- 
ed vesicular breath- 
ing; puerile respira- 
tion ; rougher breath- 
ing with cell-breath- 
ing. 
2d Nfr/g'e.-Bronchial 
breathing. 
Stage. -Bronchial 
Breathing, receding 
more and more; for 
some time rough 
breathing, diminish- 
ed cell-breathing. 
ls< Stage.—Cre- 
pitant ronchus at 
in spiration, or (in 
simultaneous 
bronchial affec- 
tion) ; dry and 
moist, but not 
consonant rat- 
tling noises cov- 
ering the crepi- 
tation. 
2d Stage.-Con- 
sonant rattling 
noise, surring, 
whistling, pur- 
ring. 
3rt*Strtfire.-Moist 
rattling and cre- 
pitation at inspi- 
ration and expi- 
ration. 
Vibration felt ev- 
erywhere. In the 
second stage bron- 
cophony. 
In 1 st stage, cell breathing covered by the 
rattling noises, heard again at the expiration. 
2d Stage.—Emphysema on the margins or 
serous infiltrations in the neighboring parts 
may produce ty-mpanitic sound. Also when 
the pneumonia does not pass through the 
whole thickness. Consonant rattling mur- 
murs are known by their high clear sound, 
by the dull empty sound on percussion, and 
by the greater resistance over the suffering 
part. Palpitation increased over the hepa- 
tizedpart. The indurated hepatization shows 
the symptoms of the second stage increased 
and continued. In abscess of the lung: 
sound full tympanitic, noise of the cracked 
pot, metallic sound. Breathing strongly 
bronchial, churning sound as in a bottle 
shaken, or rattling murmurs; cavernous voice 
with metallic sound, amphoric resonance. 
Lobular pneumonia of grown persons can not. 
be physically diagnosed; it has only the 
symptoms of catarrh; lobular pneumonia of 
children gives the same symptoms as the 
croupous of grow-n persons. Pneumonia 
differs from bronchitis in the deadened sound, 
resistance of the suffering part, bronchial 
breathing, and development of stages.—Com 
parison of both lungs is necessary. They 
may be in different stages of pneumonia. 
Isolated tubercles 
have symptoms most- 
ly belonging to bron- 
chial catarrh. Ac- 
cording to Stokes: in- 
creased respiratory 
murmur; dry, sharp, 
long-continuing expi- 
ratory sound, with 
crepitant ronchus. 
Weak respiration in a 
circumscribed point. 
Continued murmur- 
ing breathing, with- 
out pause, after the 
expiration and stop- 
ped inspiration in two 
or more pauses. 
Symptoms of catarrh 
and pleuritis only in 
the upper parts. In 
conglomerated tuber- 
cles in great exten- 
sion bronchial breath- 
ing. 
Sequela of ca- 
tarrh ; Bonchus 
sibilans; dry- 
cracking, moist 
rattling. Conso- 
nant rattling 
sounds over a 
thickened plane. 
Voice in solita- 
ry tubercles not 
strenghtened.Bron- 
cophony in con- 
glomerated tuber- 
cles in large exten- 
sion. 
No safe physical symptoms for the first 
stages of tuberculosis. Pneumonia in the 
upper part of the lung frequently indicates 
tubercular infiltration. 838 
DISEASES OF THE SANG U1NOUS FUNCTION, 
N A M E 
of the 
Disease. 
INSPECTION, PALPATION, MENSURATION. 
PERCUSSION. 
Thoeax. 
Muscles. 
Dia- 
phragm. 
Lives. 
Heaet. 
TUBERCU- 
LOUS 
PHTHISIS. 
Thorax flatten- 
ed ; great sink- 
ing in of the cla- 
vicular region. 
Over a vomica 
the thorax sinks 
in. 
Intercostal mus- 
cles sunk in ; re- 
gion below the 
clavicle immove- 
able; the upper 
portions do not 
expand during 
breathing. 
Where the vomi- 
ca reaches the pe- 
riphery the inter- 
mediate spaces 
are pushed out. 
Stroke of 
the heart and 
sounds au- 
dible in a 
large vomica 
with metal- 
lic sound. 
Sound normal, 
if air-holding pa- 
renchyma sur-i 
rounds the vomi-j 
ca; tympanitic 
in large and su- 
perficially situat- 
ed caverns; me- 
tallic sound and 
cracked-pot mur- 
murs in very 
large caverns. 
Large deep-seat- 
ed vomica, sur- 
rounded by 
thickened sub- 
stance, and con- 
taining air give a 
weak tympanitic 
sound. 
• 
DISEASES OF THE HEART AND ITS APPENDAGES. 
The heart and its appendages are subject to several kinds of morbid 
action, which authors have described under the terms angina pectoris, 
hypertrophy, and dilatation of the heart, diseases of the valves, car- 
ditis, and peri-carditis, and palpitation. Many of the symptoms of 
these affections are similar, but we shall endeavor, in the following 
brief description, to point out a sufficient number of signs to enable the 
physician to form a ready and accurate diagnosis. 
12. CARDITIS AND PERICARDITIS, 
Diagnosis.—Inflammation of the fleshy substance of the heart, un- 
complicated by disease of the pericardium, of the pleura, or of the 
aorta, is an occurrence so rarely met with, that some authors have de- 
scribed under one general head, the symptoms resulting from inflam- 
mations of the heart and its appendages. The signs usually present 
in carditis often render our diagnosis very obscure, on account of their 
resemblance to affections of the lungs, and of the pleura, and of their 
frequent complication with the latter. Frank believes that much of 
the uncertainty which prevails respecting cardiac affections, is attribut- 
able to the general neglect of the profession in investigating the move- 
ments of the heart during disease, and in examining its morbid ap- 
pearances in those who have died in consequence of diseases of the 
chest,. 1111 n’est pas doteux que, si les hommes de Vart obsei'vaient 
avec la mime attention les mouvements et les vibrations du coeur CARDITIS AND PERICARDITIS, 
839 
AUSCULTATION. 
DIAGNOSTIC REMARKS. 
Breatuino. 
Sounds 
(Murmurs.) 
Voice. 
Vomic® surround- 
ed by air-holding pa- 
renchyma, show only 
catarrhal symptoms; 
at the utmost un- 
certain breathing: 
or: small vomica-, 
through the influence 
of the bronchia, or: 
Larger ones (espe- 
cially on inspiration 
and coughing: 
Extensive vomica? 
■with bronchial tubes 
and containing a good 
deal of air, give: 
Bronchial breathing 
and surring (churn- 
ing sound as in bot- 
tles shaken); metal- 
lic sound, amphoric 
resonance, and : 
Consonant rattling 
murmurs with metal- 
lic sound and am- 
phoric resonance. 
Rattling mur- 
murs. 
Increased rat- 
tling murmurs. 
Large vesicular 
murmurs, not 
uniform. 
Vibrations of the 
voice and cough 
felt in superficial 
vomicae. 
Broncophony 
with metallic sound 
and amphoric re- 
sonance in extend- 
ed vomica;. 
The tuberculous infiltration shows the 
■same symptoms as the second stage of pneu- 
monia. If rattling mucus appears during 
their softening, it indicates vomicae. -Only 
where the percussion sound is empty anil 
clear, at any rate tympanitic, do we feel jus- 
tified in diagnosing excavations from the 
clear and sharply consonant rattling mur- 
murs over a tuberculous infiltrated portion 
of the lung. In acute miliary tuberculosis: 
Never bronchial breathing, always signs of 
mobility, rattling murmurs, crepitations. 
In subclavian artery of the suffering side 
sometimes stronger pulsation by pressure 
after a stoppage of the tuberculosis. 
There are diseases of the heart, with such 
influence on the lungs as to prove by their 
physical signs the absence of tuberculosis. 
que les battements des arteres, slls multiplaient leurs recherches sur 
les cadavres, ils viendraient a bout dissiper les epaisses tenelrres qui 
environment les maladies de Vorgane central de la circulation.” 
(Frank.) 
The ordinary symptoms of inflammation of the heart and its envelop, 
the pericardium, are acute pains in the region of the heart, increased 
by motion, or on assuming the horizontal posture; sense of fullness and 
oppression in the chest; palpitation from the slightest exertion, or from 
mental excitement; rapid, difficult, and irregular respiration ; short, dry 
spasmodic cough; rapid, small, irregular, and intermittent pulsations of 
the heart and arteries; great anxiety, dread of suffocation; “absence of 
the respiratory murmur, and dull sound on percussion.” {Fall.) General 
febrile disturbance almost always accompanies the inflammation, 
although the heat is unequally distributed, some parts being intensely 
hot, while other parts are cold. The countenance is always expressive 
of anxiety and distress, the patient is desponding, irritable, and rest- 
less, and experiences alarming palpitations, faintness on rising up in 
bed, or on talking. 
Causes.—Protracted grief; anxiety, or mortification; violent mus- 
cular efforts ; external injuries ; asthmatic, and other pulmonary affec- 
tions ; metastasis of rheumatism, or gout. 
Influence of Mental Emotions on the Heart.—Fear, grief, and 
mental anxiety make the greatest depredations on the functions and 
structure of the heart. It was Corvisart who first in modern times drew 
especial attention to diseases of the heart, having his attention strongly 840 
DISEASES OF THE SANGUINOUS FUNCTION. 
drawn to the subject by the melancholy examples of it, which were 
known to have been developed by the exciting scenes of the French 
Revolution. But many of the ancients have observed similar diseases. 
Chrysostom describes sorrow as a cruel torture to the soul, consuming 
the body and gnawing the very heart. Agrippa alludes to the palpi- 
tations of the heart and syncope induced by fear. But the most re- 
markable passage in all the old authors is the following by Melancthon’ 
“ Sorrow strikes the heart and makes it palpitate and pine away with 
great pain ; and the black blood drawn from the spleen and diffused 
under the ribs on the left side makes those perilous hypochondriacal 
flatulences which happen to those that are troubled with sorrow.” This 
is a true picture of cardiac disorder from nervous irritation of grief or 
sorrow. (Johnson on the Liver, c&c., p. 209.) 
Broken Heart.—The question of the possibility of rupture of the 
heart by violent mental emotion has often been discussed. 1. Zimmer- 
mann gives one authentic case, in that of Philip the Fifth of Spain. On 
hearing, that his army had been defeated near Plaisance, he was over- 
come with grief and suddenly died. The author says, on opening his 
body the heart was found ruptured. 
2. At the Hospital de Sal Petriere in Paris, Mary Glinn, a widow, 
70 years of age, and of remarkably good health previously, was as- 
tounded with the horrible intelligence that her daughter with two 
children in her arms had thrown herself out of a window and been 
dashed in pieces. The mother was so affected that she changed to the 
color of a negro in one night. The black color was permanent, and she 
died in two years of pulmonic disease. (Jour. De Med., 1817.) 
13. ORGANIC DISEASE OF THE HEART. 
Diagnosis.—The patient affected with organic disease of the heart, 
in addition to other bodily sufferings, manifests habitual irritability, 
melancholy, despair,* suicidal tendencies, hysteria and hypochon- 
driasis.f 
“Gastric, cerebral and cardiac irritation,” says Dr.Forbes, constitute 
in many cases such a strong chain of disease, of which every part in- 
fluences and strengthens every other part,; that, therefore, no plan of 
treatment that does not embrace the whole can be attended with suc- 
cess. The subjects of heart-disease are liable to hajmorrhage which is 
a very important symptom, as also is the change of position in bed. 
“The assumption in bed of a position previously intolerable is a sign 
of extremely bad omen.” Syncope, epilepsy and apoplexy are corn- 
* Corvisart. f Kreysig. ORGANIC DISEASE OF THE HEART. 
841 
mon; and in many cases of convulsions disease of the heart appears tc 
he the essential cause.* 
Watson says (Lectures, p.744), that while palpitations aud functional 
irregularities of the heart’s action are frequently dyspeptic symptoms, 
so structural change in the heart is very apt to derange the 
digestive functions. Flatulence is one of the most common and 
distressing symptoms; and free eructation wonderfully mitigates the 
cardiac distress, by relieving the diaphragm from the upward pressure 
of gas, which had embarrassed the motions of the heart: dyspnoea and 
cough. 
There are also in these cases an impeded and sluggish circulation 
of blood from the abdominal viscera; this causes congestions of various 
parts; the liver is enlarged, grows tender, and its functions are de- 
ranged. 
The circulation through the brain is disturbed; this causes head- 
aches, giddiness, causeless apprehension, cowardice, and irritability 
developed in men previously intrepid and of strong, firm nerves ; pro- 
pensity to frightful and distressing dreams; sudden startings from 
sleep in agitation and alarm; one or more chambers of the heart (See 
page 457.) may become thicker and stronger than natural, while the 
capacity of that chamber or of the others may remain natural; in other 
cases the thickening of the muscular texture is accompanied by corres- 
ponding enlargement of the cavity also, constituting hypertrophy with 
dilatation. 
Causes.—Some mechanical obstacle prevents the free and thorough 
exit of blood from the chamber, or hinders the easy play of the organ. 
In the former condition there is a gradual yielding of the sides of the 
affected chamber to the continual and undue pressure of the accumu- 
lated blood against them; in the latter there is a striving action of the 
muscle to overcome the hindrance, or to counterbalance the obstacle. 
Thus the muscle, compelled to do extra-labor, grows in thickness while 
performing it. If it could increase in strength in proportion to its in- 
creased labor, it might resist the internal pressure, and there would be 
no dilatation of the cavity within. In very many cases it fails to in- 
crease in strength in the necessary ratio; there is therefore some dila- 
tation, and this and the hypertrophy commonly progress together for 
a series of years or for life. 
Sounds of the Heart in Health.—The heart may be heard by the 
ear alone, or through the stethoscope, to beat within the space corres- 
ponding to the lower half of the sternum and the cartilages of the fifth 
and sixth left ribs; about two inches below the nipple and one inch 
* Dr. J. J. C. Moll. Dissertation on the Connection of Heart-Disease and Con- 
vulsions. 1823. 842 
DISEASES OF THE SANGUINOUS FUNCTION. 
from it towards the sternum. When the heart is larger than natural, 
it may be heard over a larger space. It may also be heard over a com- 
paratively large space when the lung between the ear and the heart has 
become hepatized, or solidified by the presence of crude tubercles or 
cancerous deposits; also when the chest contains a liquid from pleurisy 
Symptoms usually present in Disease of the Heart.—Pain, palpi 
tation, or excessive action of the heart, perceptible to the patient; ir- 
regular, or intermittent action discovered in the pulse ; dyspnoea; 
cough; dropsical accumulations; haemorrhages; various affections of 
the nervous system, as increased and morbid sensibility or nervousness. 
These symptoms, though present when there is organic disease of the 
heart, often arise from other more trifling causes. 
Irregular Action of the Heart consists in derangement or discord 
of rythmical movements, and is discovered by the pulse at the wrist. 
The pulse fluctuates in frequency, in strength and in regularity ; some 
beats succeed each other very rapidly, and are followed by others 
more slow and full. Some beats are omitted entirely, and are made up 
for by the next one being full and strong. 
Treatment. Digitalis, Aconite, Bryonia, Arnica, Cannabis, 
Pulsatilla, Lachesis, Spigelia, Iodine, and Arsenicum are the me- 
dicines commonly employed in this malady. 
Digitalis, on account of its specific power over the sympathetic 
nerve and the cardiac plexus, is especially adapted to those cases of 
pericarditis which have been caused by violent emotions and proti'acted 
grief, care and anxiety. The special indications are; sharp stitches, 
or contractive pains in the region of the heart; uneasy sensations in 
the left side of the chest, often extending to the shoulder and arm; 
palpitations, excited by talking, movement, or on lying down, particu- 
larly on the left side; pulse rapid, weak and irregular, or slow, soft, 
and intermittent; sense of oppression and anguish in the thorax; gene- 
ral weakness; frequent attacks of faintness; respiration slow, diffi- 
cult, and unsatisfactory, or short, painful and sighing; frequent flushes 
of heat in the chest, face and head, while the extremities remain cold; 
general feeling of anxiety and despondency. A drop of the second or 
third dilution should be prescribed in water every two hours. 
Aconite is a suitable remedy Avhen the movements of the heart and 
arteries are more rapid and vigorous than in health, and when the con- 
gestion to the heart is accompanied by an unusual degree of erethism. 
The pains in the cardiac region are of a constrictive, oppressive or 
lancinating character; the breathing is short, anxious, and labored ; the 
pulse is rapid, strong and intermittent; the action of the heart is ex- 
alted and often irregular; febrile symptoms are strongly pronounced; 
the patient inclines to sit with his body bent forward, in order to relax 
the muscles of the thorax, and thus to obviate the liability to pain from ORGANIC DISEASE OF THE HEART. 
843 
this cause. The first or second dilution of Aconite may he selected, 
and a single drop administered in water every two, three or four hours, 
as the nature and severity of the case may demand. 
Bryonia will occasionally be required in inflammations of the heart 
and its appendages, which are complicated by disorder of the pulmonary 
structures. It will likewise prove servicable in cases which are con 
nected with rheumatism or gout. The following are its indications 
drawing and stitching pains in the chest, aggravated by breathing, or 
by movement; rapid, anxious and painful respiration; dry, spasmodic 
and painful cough ; lancinating pains, extending into the shoulders and 
back, between the shoulder-blades; oppression in the chest, which 
causes frequent sighing; determinations of blood to the chest and head; 
rapid, weak, and intermittent pulse; anxious, depressed and irritable. 
Its administration is the same as Aconite. 
Arnica is chiefly useful when the inflammation has been caused by 
external injuries, like contusions, wounds, &c. The special indications 
are : lancinating pains in the region of the heart; oppression at the 
chest; great difficulty of breathing; short, dry and irritating cough; 
sharp pains through the heart, which cause faintness; irregular action 
of the heart; pains and dyspnoea, increased by mental or physical 
exertion. 
It may be given in the same manner as Aconite. 
Cannabis, Pulsatilla, Lachesis, Iodine, and Arsenicum have been 
employed with success in cardiac inflammations which have arisen 
from suppression of eruptions or the drying up of old ulcers. They 
may be used at the second or third attenuations,—the repetitions of 
doses to be governed by the urgency of the symptoms, and the medi- 
cinal or other effects produced. 
Should the disease terminate in dropsy of the pericardium, our best 
remedies are: Arsenicum, Ajpis-mel., and Iodine. We prefer the 
first or second attenuations,—a dose once in six hours until an im- 
pression is evident. 
Tartar-emetic is a powerful therapeutic agent. It controls the action 
of the heart and arterial system, lowers the force and frequency of the 
pulse, depresses the action of the vascular system generally, increases 
the urinary secretion, and produces diaphoresis. 
In pleuritis it is necessary to give it with caution, as its emetic effect 
produces extreme pain. It is generally more useful in inflammations 
of the mucous membranes than the serous, which are more under the 
influence of Mercurius. 
In palpable doses Tartar-emetic is antipathic. It is proper in very 
small doses, when there is short, difficult and imperfect respiration; 
feeble action of the heart and arteries; nausea; diminishing animal 844 
DISEASES OF THE SANGUINOUS FUNCTION. 
heat; impaired muscular and nervous force. These effects are pro- 
duced by the primary action of the drug. 
Spigelia.—Dr. Epps says, he obtained good results in carditis from 
metastasis by Cannabis after Spigelia. 
Calcarea.—In a case of considerable hypertrophy of the heart, which 
had been treated two years allopathically, milk disagreeing with the 
patient, there was considerable amendment from repeated doses of 
Calcarea / and Spigelia completed the cure. (Croserio.) 
14. ENDO-CARDITIS. 
Treatment.—The most important remedies in the treatment of endo 
carditis are, Aconite, Veratrum-viride, Digitalis, Kali-hydriodicum, 
Bryonia, Mercur., Arsen., Spigelia, Lactic-acid, Kalmia, Cuprum-acet 
These medicines should, in most cases, he used in the lower atte. 
nuations, and the doses frequently repeated until the disease begins to 
yield. 
The venerable Dr. Hirsch, of Prague, says, that in the course of his 
twenty-four years experience he saw much mischief done by the treat- 
ment of rheumatism by alcoholic embrocations; and charges that 
organic diseases of the heart frequently result from this treatment. 
Dr. Jaeger, of Elgin, 111., gives one severe case of rheumatism, which 
was recovering well under homoeopathic treatment, when the patient 
was induced by the persuasion of a friend to try the external applica- 
tion of a strong solution of common salt in French brandy. The ap- 
plication appeared to relieve the shoulder, but the disease took posses- 
sion of the knee. The solution drove it from the knee and the patient 
slept well for one night. But, in the morning he wTas suddenly attacked 
by the most intense chill, followed by palpitation of the heart, with an 
indescribable anxiety and violent dyspnoea. “I found at my visit the 
countenance of the patient much changed ; face pale, lips cyanosic, his 
looks unsteady, very restless and crying for help. The palpitation was 
exceedingly strong, tumultuous and unrythmical, and was distinctly 
visible in the region of the apex of the heart; the pulse considerably 
accelerated and irregular ; the tongue and extremities cold.” 
Aconite in solution, every five minutes one table-spoonful. After one 
hour, amelioration of symptoms, and in the afternoon the patient lay 
very quiet; the palpitation and pulse better, countenance cheerful, 
profuse perspiration all night and good sleep. 
In the morning he was free from the endo-carditis but the pain in the 
right shoulder-joint was again felt. This was removed by the alternate 
use of Bryonia and Mercurius-solubilis, continued for three days. Nc 
abnormal sound of the heart remained. ( United States Jour. Ilom 
YoL I., p. 424.) 
Kahnia-latifolia, has the most remarkable power over the pulse of ENDOCARDITIS. 
845 
any remedy in the materia medica, except Digitalis, and perhaps w© 
shall find its best powers in diseases of the heart which alternate with 
rheumatism. It is a narcotic, poisoning domestic animals, and the 
honey made from its flowers is poisonous; also the flesh of birds as 
quails and pheasants. Indians killed themselves with infusion of the 
leaves, which externally applied produce subsultus, startings and con- 
vulsions. 
Symptoms of Poisoning: Nausea, with entire loss of sight; conti- 
nued retching, pain in the crown of the head, extending down the cer- 
vical vertebrae ; cold extremities ; pulse imperceptible ; when the pulse 
returned it was only forty per minute. Peculiar noise while breathing 
like that from spasmodic affection of the glottis; paleness of face ; ex- 
cessive nausea. {Am. Inst. Horn., Yol. I.) 
Hering proved both with high and low dilutions. 
Cujprum-acet.— Dr. Kissel.—First. A patient, aged twenty-five 
years, had cold and hot fits, both intense, ending in permanent high 
fever. There was first pressure under the lower part of the sternum, 
and oppression of the chest. After three days pain, rheumatic heat 
and redness in the knee joints, with immobility; then in the hips; 
lastly, of the elbows. Pressure on these joints is painful, and they are 
all swollen. Can not move any joint, the affection beginning in the 
shoulder; obliged to lie still, quite helpless. His head is free; skin 
moderately warm; pulse eighty-five, full, quick pulsation of the heart 
and the tone feeble and dull, as if it came from a great depth; tongue 
slightly coated with white; stool normal; urine deep yellow, clear 
frothy, and acid. After seven days, during wThich time some other 
treatment was tried, and at the end of which the inflammatory affection 
had moved from the joints above named to the ankles, he is directed to 
take Cujpvi-acet-tincture. 
The next day the pains in the ankle are gone and no new ones ap- 
pearing elsewhere. Pulse sixty, soft, full; urine bright yellow, clear, 
acid; heart pulsation and tone less feeble. 
Two days later the patient could walk about the room. Kecovered. 
Second. Another case was that of a man, aged forty, who had chill, 
heat, palpitation of the heart, oppression of the chest, pressure under 
the sternum and in the prsecordium, had vomited. 
Two days after. Auscultation revealed a bellows sound at every 
other beat of the heart; feeble pulsation of the heart; and tongue 
hickly coated. An alkaline mixture having first been tried with some 
mprovement. Acet-cupri was given for five days when he was well. 
Third. A lady, aged forty-five, who was first treated by bloodlet- 
ting. She had at first chill, heat, palpitation of the heart, oppres- 
sion of the chest, pressure under the sternum and in the prsecordium, 
great feebleness and tearing pains in the limbs, not affecting the joints, 846 
DISEASES OF THE SANGUINOUS FUNCTION. 
stools normal; urine reddish and turbid, with red flaky sediment, and 
acid. Instead of the second beat of the heart Dr. Kissel heard a bel- 
lows sound and friction sound. The pulse soft, thin, one hundred. 
She lost twelve ounces of blood with no benefit. 
March 1. In the night she had a paroxysm with more severe op- 
pression of the chest, restlessness; the palpitation with feeling of 
anguish increased. Cured with Cujpr. 
15. pericarditis. 
Treatment.—The principal remedies are, Aconite, Brvonia, Spige- 
lia, Arsenicum, Apis, Kali-hyd., Lobelia, Gelseminum, Mercurius-hyd., 
Digitalis, Veratrum-vir., Cannabis-ind., Apocynum-cannab. 
We usually prescribe these medicines in palpable doses, frequently 
repeated. 
Case.—By Dr. Laurie. — Bryonia. A girl, aged thirteen, com- 
plained of severe darting pains in all her joints, which were swollen, 
tense, shining and sensitive to touch. The face was flushed and 
anxious ; tongue furred and white ; mouth parched; great thirst; skin 
hot and dry; pulse one hundred and thirty, full and bounding; breathing 
hurried; the heart’s impulse abnormally strong; the pulsations loud, 
accelerated, and re-duplicated; about- the middle of the sternum a 
gentle rustling sound was audible. Aconite 3° was prescribed. 
On the second day the fever was less, but she could not lie on the 
left side; the breathing quick and laborious; and friction sound in- 
creased in extent and loudness and audible in all positions. She had 
passed a restless night, and was now and then delirious; the joints in- 
flamed and painful, Belladonna 3° was given. In the evening the 
rheumatic sufferings were alleviated; the heart sounds the same; skin 
hot and dry. Aconite 3° again given. On the third day she had per- 
spired freely; pains of the joints aggravated by movement; a darting 
pain through the heart in sitting up in bed; the friction sound con- 
tinued the same. Bryonia 3° was given. On the fourth day there was 
improvement. On the tenth day she w-as convalescent. 
Lobelia-infiata.—Slight deep-seated pain in the region of the heart. 
Burning pain in a small spot under the right breast near the epigas- 
trium ; on a quick movement of the body, deep breathing, sneezing, a 
feeling as if something had fallen out of its place and went back again 
with great pain. Violent boring pain through the back under the right 
shoulder, becoming more painful by motion: the painful place feels as 
if palsied. 
Pressing pain at the left side of the lower part of the sternum. Pain 
about the third, fourth and fifth dorsal vertebra. 
Rheumatic pains between the scapula. Muscular stitches over the 
ribs of the left side near the spine. CHRONIC AORTITIS AND CARDO-AORTITIS. 
847 
16. CHRONIC AORTITIS AND CARDO-AORTITIS. 
Diagnosis.—Dyspnoea and anasarca are the prominent symptoms* 
but a great many others are present in each case. 
The patient is likely to be a man of full strength and courage, but 
about the time of the turn of age he becomes suddenly undermined by 
an extraordinary but obscure disease which may carry him prematurely 
to the grave. He has not had apoplexy, diabetes, hypochondriasis, 
nor inflammation of the urinary passages, nor visceral tumors. But a 
great change has come over him, he has become ill-humored; common 
affairs of life trouble him; he has become excessively anxious about 
everything,—business, fortune, position, present and future conditions; 
he has perhaps become miserly; he shuns society, but fears to be alone 
with himself. Restricting himself within his own family, he is 
disturbed by noise, irritated by “trifles light as airhe excuses himself 
a moment afterwards and laments that he has lost his self-control. He* 
now suffers from ennui, then sadness. His friends try to amuse him 
and find it impossible. The crowded party or the theatre oppress him. 
His food distresses him by day and with fearful dreams at night; he 
wakes in agitation. Going abroad, the walking oppresses him; there 
is contraction or pain at some point of the chest, as at the lower end of 
the sternum, or lower down and towards the left side; his head 
becomes confused, there is vertigo, jolting of a carriage fatigues; on 
moving slowly he drops to sleep; he is easily chilled, but can not bear 
the air of a close room. Stomach feels empty, hollow, no appetite, bad 
taste in the mouth; he imagines that his heart is flaccid and power- 
less ; some acquire a morbid appetite, become gluttons; but the counte- 
nance becomes more sallow and the flesh falls away. 
After many fluctuations between better and worse, the symptoms of 
chronic aortitis are confirmed; the dyspnoea becomes habitual, or re- 
turns by spells ; the nocturnal agitation is aggravated, the skin becomes 
livid and dry, sometimes cold, or cold in one part and hot in another; 
urine scanty, turbid, palpitations by spells, pulse small, irregular, un- 
equal, frequent; generally the feet swell, and the oedema pro- 
gresses from the ankles to the legs, the thighs, loins, and coats of the 
abdomen. After some weeks, oftener months, this state passes into the 
third or last period. 
The patient now, says Dr. Tessier,* becomes sleepless ; he desires to 
sleep, but'instantly rises and runs about the room; he sits down, then 
rises; he shuns the fire, which increases the dyspnoea; but his anasarca 
has enfeebled his power to endure the cold; he can not find an easy 
position, and passes days and nights for weeks in torture. A time 
* L’Art Medical, 1861. 848 
DISEASES OF THE SANGUINOUS FUNCTION. 
comes at last when torpor of brain predisposes to sleep. There come 
moments of oblivion alternated with delirium. The dyspnoea is followed 
by orthopnoea, tending to apnoea, till suffocation is threatened. There 
is next, cough, expectoration, streaked or tinged with blood, then dark, 
blackish; hydrothorax on one or both sides; oedema, congestions, even 
pulmonary apoplexies; bronchitis; accumulations of mucus. The 
countenance is haggard; cheeks flaecid or face puffed, pallid; anasarca 
encroaching; legs almost bursting; dropsical cushions extending up 
the loins, and in front to the umbilicus, scrotum, &c., enormously dis- 
tended, extreme difficulty of micturition ; excoriations ; oedema of the 
arms, hands, fingers. Constipation now insuperable; every general 
movement causes suffocation. Finally the skin becomes marbled, 
ecchymosed; phlyctenae of lowrer limbs; gangrenous spots, precede 
death. 
DISEASES OF THE ARTERIES. 
1. Organization and Structure of the Arteries.—The arterial 
vessels are essentially constituted: 1. Of an external coat consisting of 
a very delicate and condensed cellulo-filamentous tissue ; 2. Of a middle 
coat composed of fibres, and bundles of fibres which surround the vessel 
in a circular direction, but which differ in chemical and physical pro- 
perties, as well as in form from muscular fibres. They resemble what 
is elsewhere called the elastic tissues. The elastic tissues are dis- 
tinguished from all other tissues by their yellow color and the peculiar 
mode of division and anastomoses among their fibres. Like the cellu- 
lar tissues they yield gelatine by boiling. The elasticity of arteries 
depends on their elastic properties and not on any muscular fibres in- 
terwoven in their structure. 3. The third coat is a very delicate cellu- 
lar tissue or pellicle in which the minute vessels which supply the ar- 
teries, and which proceed from the adjoining parts terminate. Here 
also the ultimate distributions of the arterial nerves are supposed to 
ramify, though they can not be clearly traced further than the proper 
fibrous tunic. This is the most vascular of the arterial tunics and in it 
many of the pathological states to be described first originate. 4. “An 
internal membrane, presenting no linear or fibrous structure, semi-trans- 
parent, more readily detached from the one next to it in the longitudi- 
nal than in the transverse direction, and fragile. This delicate mem- 
brane is not possessed of vessels carrying red blood in the healthy 
state, but it is penetrated by minute red vessels when inflamed.” It 
lines the canals of the vessels conveying red blood, and the cavities of 
the heart. 
The arteries are surrounded by loose sheaths of cellular tissue 
which permit the vessels to accommodate themselves to their varying INFLAMMATION OF THE ARTERIES. 
state of constriction or dilatation and to transmit to them the vessels 
and nerves employed in their nutrition. During life they are considered 
as in a state of distension by the blood impelled into them by the con- 
traction of the heart; when the blood ceases to distend the vessels 
when the heart’s action is withdrawn they contract to expel from theii 
cavities the fluid already received. [Copland.) 
The arteries are surrounded by a reticulum formed by the ganglial 
nerves, and they receive minute fibrils of these nerves which convey 
the nervous influence from the brain to these vessels, and perform an 
important part in the changes effected by the brain and spinal marrow 
in the functions and diseases of the arteries, as well as on the patho- 
logy of the blood, and assimilation of the chyle. 
Diseases of the Arteries.— Nervous Affections.— 1. Neuralgia of 
the arteries is “characterized by acute pain in their course, with in- 
crease of their pulsations and bellows sound:” distinguished from in- 
flammation by its sudden accession, and the sudden remission of the 
symptoms. 
2. Violent pulsation of the arteries. A loud bellows sound heard in 
some of the principal arteries, with violent pulsation but without severe 
pain. It is most common after large losses of blood. (Copland, Mar- 
shal Hall.) 
Causes.—Ossification of the interior of the ascending aorta, which 
generally produces preternatural pulsation above the clavicles; a pecu- 
liar state of the nerves in hysterical females and nervous irritable per- 
sons ; adhesions of the pericardium produce spasmodic contractions ot 
the heart for many months or a year or two after an attack of pericar- 
ditis; pulsations may be occasioned by tumors, serous effusions, &c., 
which come in contact with the aorta and transmit to the surface its 
pulsations; they may arise from the use of mercury; from spinal irrita- 
tion, the excessive use of tobacco, opium, and other narcotics. (See 
Copland's Diet. Geddings, &c.) 
17. INFLAMMATION OF THE ARTERIES.—ARTERITIS. 
Arteritis is defined as characterized by “great and tumultuous vascu- 
lar excitement, palpitations, sense of heat and throbbing in the course 
of the principal arteries, followed by collapse of the vital energies, and 
occasionally by gangrene of the limb.” {Copland, Diet. Yol. I. p. 126.) 
It is a disease of not unfrequent occurrence, but not always easily re- 
cognized. The inflammation of a small portion of a single artery, as 
that produced by the application of a ligature is attended only by a 
small increase of sensibility, heat or tumefaction; the artery may be 
obliterated without exciting any perceptible general fever. When the 
arteries extending to a considerable portion of the system are inflamed, 
fever more or less violent always attends the inflammation. It begins 
You I.—54. 850 
DISEASES OF THE SANGUINOUS FUNCTION. 
in alternation with slight chills, followed by flashes of heat; and, as it 
proceeds the pulsations of the heart and arteries become violent: “ there 
is red suffusion with capillary injection of the skin, burning heat, un- 
quenchable thirst, extreme restlessness, jactitation and general distress, 
laborious and hurried respiration, and sometimes a dry harassing 
cough.” (Geddings, Amer. Cyclop. Pract. Med., &c.) 
When the inflammation embraces the aorta there is a sense of heat 
beneath the sternum or in the vicinity of its upper extremity; some- 
times a sensation like that of a “ hot iron, drawn along the course of the 
aorta, descends as low as the crural arteries.” When the arteries of the 
the extremities are affected the pain may simulate rheumatism, fixing 
itself upon a particular part which is tender to the touch, and the in- 
flamed vessel may be felt through the integuments when it is super- 
ficial. The pulsation is violent along the whole course of the artery 
until the thickening of the arterial coats diminishes the size of the ca- 
vity of the vessel, and the elasticity of its walls ; the throbbing and ex- 
pansion of the vessel are afterwards chiefly “confined to the portion 
above the principal seat of the inflammation, while lower down the 
pulsation becomes feeble, and, when obliteration takes place, ceases al- 
together.” When the carotid artery is affected there is pain and 
tenderness and strong pulsation along the side of the neck, and in all 
the arteries of the head, flashes of light before the eyes, obscuration of 
vision, or the objects seen are tinged with an unnatural color; ringing 
or roaring in the ears ; in some cases delirium, convulsions or apoplexy. 
The veins and capillaries of the affected part are always preternatu- 
rally turgid and injected with blood from the excited arteries. 
From the commencement of the disease the heart beats violently; 
there are palpitations when its lining membrane is affected; the pulse is 
full, strong, and sometimes so frequent as scarcely to be counted. In 
one of Frank’s cases it was from 185 to 200 per minute ; the respiration 
is hurried, embarrassed, amounting to distressing orthopnoea; dry 
cough, sometimes haemoptysis. The tongue is red on the edges, its pu- 
pillae erect, the base and middle covered with thick yellow fur. The 
thirst is intense; the stomach irritable, bowels constipated; urine high 
colored, sometimes bloody; strangury ; preternatural turgescence of the 
capillary vessels; surface deep red or mottled. 
At a later stage the inflamed arteries become loaded with coagulated 
blood, the coats of the vessels are thickened; general anxiety and dis- 
tress increase; the pulse becomes quicker, small, wiry, weak, irregular, 
with a peculiar sharp thrill. The palpitations and dyspnoea become 
more distressing; vertigo or syncope follow the slightest exertion; the 
tongue is dry, scabrous, covered with brown sordes; intense thirst; 
sunken cadaverous expression of countenance, sinking of the vital 
powers, delirium, subsultus tendinum, or convulsive movements. INFLAMMATION OF THE ARTERIES. 
851 
diarrhoea, and purplish hue of the skin mark the progress towards a 
fatal termination. When the inflammation has invaded one of the prin- 
cipal arteries of the extremities, the fibrinous concretions, formed by 
the coagulation of the blood within, gradually obliterate the cavity of 
the vessel, the pulsation begins to be perceptible above the seat of the 
inflammation, and the part below becomes at length pulseless, cold and 
numb. When the obliteration is complete the limb becomes oedema- 
tous, the blood accumulates in the radicles of the veins, and appears in 
dark ecchymoses, the part is cold and numb; small purplish phlycte- 
nae appear; when the anastomosing vessels are insufficient to supply the 
part with blood, the affected part becomes gangrenous. The powers 
of life are now more hopelessly prostrated, the pulse still more 
frequent, small, sharp, and irregular; the clammy sweats more profuse, 
delirium ends in profound coma; involuntary evacuations, hiccough and 
coldness of the extremities mark the progress of fatal disease; and 
death is ushered in by convulsions. (Geddivgs, CoplandFrank, c&e.) 
When arteritis terminates favorably it sometimes pursues a regular 
courts for a week, exacerbating twice in the twenty-four hours, and 
then terminates by a free perspiration, haemorrhage or the deposit of 
a copious sediment in the urine. (Puchelt, System de Med.) 
Diagnosis.—There are no symptoms peculiar to this disease. It 
may be inferred when any considerable number of the above symptoms 
are present; when the heat and pain are chiefly felt along the course 
of the arteries, with strongly marked impetuosity of action propagated 
from the larger to the smaller arteries; and when anasarcous injection 
of the surface or of the limbs is followed by viscations or ecchymosed 
patches on the skin. 
Causes.—The predisposing causes are, gouty or rheumatic diathe- 
sis; middle and advanced periods of life; epidemic influences; cold and 
damp climate ; stimulating food; spirituous liquors ; plethoric habits* 
sanguine and irritable temperaments; hot weather; effects of syphilis 
or mercury ; suppression of accustomed discharges, nervous or spasmo- 
dic diseases ; defective action of the kidneys, liver, skin, &e. 
Exciting causes. Great cold, and congelation of parts, followed b;y 
heat; excessive heat, wounds and surgical operations, amputations or 
ligature of arteries, umbilical cord, &c., violent muscular action; injury 
from extension of a part lacerating the internal coat of a vessel; fits of 
passion; great exhaustion; animal, vegetable or mineral poisons ab- 
sorbed ; suppressed exanthamatous fevers or eruptive diseases, as 
measles, scarlatina, erysipelas ; absorption of sanious matter from the 
uterus in paerpural fever. (Copland, Portal, Breschet.) 
Pathology.—First. When arteritis arises from external causes which 
are local in their operations, it is generally confined to a part only of the 
arterial system ; it usually affects all the coats of the vessels ; and the 852 
DISEASES OF THE SANGUINOTJS FUNCTION. 
inflammation is sthenic in its character. The common consequences 
of inflammation result from it. The coagulable lymph effused on the 
interior surface of the vessel forms fibrinous concretions and false mem- 
branes which obstruct or obliterate its cavity. The vessels of the wTalls 
of the artery are injected with red blood, thickened or softened; and 
there is occasional suppuration or ulceration of its internal membrane. 
Second. When the disease originates from causes existing within 
the vessels, when complicated with malignant and eruptive fevers, ery- 
sipelas, or the absorption of morbid secretions into the general circula- 
tion, the febrile excitement is rapidly followed by asthenic symptoms, 
Inflammation extends through the whole arterial system involving in 
many instances the lining membranes of the heart, as well as the veins. 
In these cases dissection shows dark red or violet injection of the inner 
membrane and connecting cellular tissue ; softening of these tissues and 
infiltration of the parieties of the arteries. (Copland, Breschet.) 
Prognosis.—The prognosis of arteritis is more unfavorable than 
most other febrile diseases of equal severity. Its immediate effects in 
acute cases are generally serious; but the disease is still more danger- 
ous when it is complicated with other diseases. Some of the worst 
cases are those which supervene in the progress of eruptive diseases 
in which the eruption is prematurely suppressed; and when it arises in 
the course of small-pox, erysipelas, phlebitis, or puerpural fever, the in- 
flammation extends through the lining membranes of all the arteries and 
veins; and a morbid influence from the poisonous humors received into the 
blood vessels vitiates the blood itself and prostrates the nervous powers. 
Treatment.—The general treatment of arteritis will be the same as 
that of other inflammations and febrile diseases. The same specific re- 
medies may be employed in subduing diseased action, supporting the 
general strength; the same rules of diet will be necessary; and when 
the disease assumes a chronic form, the same local and general treat- 
ment will be continued. In every case the proper management will 
depend greatly on the character of the constitution and that of the dis- 
ease with which the existing malady is complicated. See the general 
treatment of inflammation and inflammatory fever. 
Genus VI.—INFLAMMATION OF THE ABDOMINAL VISCERA. 
1. GASTRITIS.—INFLAMMATION OF THE STOMACH. 
When severe inflammation of the stomach results from direct local 
injury, whether this be caused by mere mechanical irritation, or by the 
action of heat or strong acids the local symptoms are: excruciating 
pain and frequent vomiting; heart’s action depressed, which may be 
so extreme as to destroy life; and the inability to eat or digest may 
cause death also. But if there be some restoration of the vital powers INFLAMMATION OF THE STOMACH. 
853 
by which the most essential functions are resumed, there may be nc 
high degree of resulting fever, and no serious disorder of the functions 
of the brain. 
When the irritation from undigested, alcoholic drinks, or irritating 
drugs, excites only slight inflammation, there is but little constitutional 
disorder, and the stomach rapidly recovers its general healthy state. 
But these recuperative powers depend much on the previous state of 
the stomach, nervous system, and the muscular power of the heart. The 
degree of injury which in some persons would do but little harm, would 
in another cause terrible irritability of the stomach, or excessive pain 
or collapse. Some persons previously in good health have died 
speedily and unexpectedly after a gluttonous meal of some indigestible 
substance. In such cases the immediate cause of death is faintness 
or stoppage of the heart’s action, under the influence of pain. The 
heart has perhaps been previously in a diseased state, or the vital 
powers have been weakened by intemperate habits. (Budd, p. 79.) 
INFLAMMATION OF THE LINING MEMBRANE OF THE STOMACH. 
Inflammation is a generic term, which is applicable to a great many 
specific forms of disease which may be designated by different names 
according to its peculiar nature or its specific cause. Thus we have 
rheumatic, gouty, syphilitic, suppurative or adhesive inflammation ac- 
cording to its cause. 
First.—The rheumatic inflammation of a joint may lead to the effusion 
of a fluid that does not coagulate; it is commonly soon absorbed. 
Second.—Inflammation of the pericardium and of the valves of the 
heart which so frequently co-exists with the inflammation of the joints 
and is excited by the same agent, leads to the effusion of coagulable 
lymph, and produces lasting and permanent changes of structure. 
Inflammation of the mucous membrane may produce 
First.—Secretion of viscid, opaque or otherwise altered mucus. 
Second.—Effusion of plastic lymph, forming a layer or coating over 
the surface. 
Third.—Formation of pus. 
In the air-tubes the different kinds of inflammation may exist and 
their products may be expectorated separately and thus examined se- 
parately, and may also be examined separately in the dead body. But 
in the stomach the products of secretion are blended with the contents 
of the stomach; and they are all liable to be speedily changed by the 
action of the gastric juice. If they pass into the intestines they be- 
come still more confusedly blended with the various fluids they meet 
with. Inspection of the secretions of the mucous membranes has there- 
fore taught us little of the nature of the diseased surface by which they 
are furnished. 854 
DISEASES OF THE SANGUINOUS FUNCTION. 
Diagnosis.—Burning, pricking, or lancinating pains in the stomach; 
nausea and vomiting, great soreness, tenderness, and pain on motion or 
pressure, intense thirst for cold drinks, which are ejected almost as 
soon as swallowed, affording some temporary relief, pricking and sore 
ness in the throat and oesophagus, tongue red at the tip and on the 
edges, and covered through the centre with a white or yellowish fur 
position mostly on the back or side, with the limbs drawn up and the 
abdominal muscles relaxed, great depression, anxiety, and fear of death; 
pulse rapid, sharp, contracted, sometimes almost threadlike; bowels 
constipated; disgust for food and warm drink, either of which is ex- 
pelled as soon as received into the stomach; and in severe cases there 
is delirium and fever of a synochal grade; unusual fullness in the epi- 
gastric region, and often, of the abdomen. As the disease progresses 
the extremities become cold, the features contracted and sunken, the 
eyes glazed or suffused, and finally diarrhoea, cold sweats, coma, and 
convulsions supervene. When death occurs, it is usually caused by 
ulceration or spacelation of some portion of the mucous and sub-mu- 
cous coats of the stomach. 
Causes.—Excessive use of highly seasoned food, stimulating drinks, 
the introduction of irritating substances into the stomach, poisons, in- 
juries, and the use of emetics, drastic purgatives, stimulants, and other 
medicinal poisons with which allopathic practice, governed by no scien- 
tific knowledge, frequently induces this and other diseases, and destroys 
the existence it is intended to preserve. 
Case. — Maria Ladan drank by mistake a tea-spoonful of Aqua- 
fortis / the most violent symptoms supervened. Under palliative 
treatment these effects gradually subsided. After some time she passed 
from the bowels a long membranous substance rolled up and which re- 
presented the form of the oesophagus and stomach. This was found 
to be the interior membrane of those organs. From this time forward 
the sensibility of the digestive organs became excessive; and, after two 
months of suffering, she experienced a sudden shock and died. (Paris 
and Fonblanque, p. 147.) 
Treatment.—The ordinary remedies used in the treatment of gastri- 
tis are Arsenicum, Veratrum, j\tux, Pulsatilla, Aconites Iodine, 
Ipecacuanha. 
Arsenicum.— Countenance contracted, sunken, and expressive of 
ivnguish and anxiety; stomach swollen and hot to the touch ; position 
upon the back; respiration short, rapid, and suppressed; tongue red, 
clean, or red on the edges with a dirty fur in the centre; pulse con- 
tracted, tense, and frequent; voice hoarse, stifled, and suppressed; skin 
dry and hot, with perhaps cold and clammy extremities. 
Burning, sharp, or shooting pain in the stomach; aggravation of the 
sufferings from motion, pressure, coughing, and inspiration; scraping INFLAMMATION OF THE STOMACH. 
855 
and burning pain in the throat and oesophagus; weakness and trem- 
bling of the limbs ; urgent thirst for cold drinks ; persistent nausea and 
vomiting; all food and drinks speedily and violently rejected; exceed- 
ing tenderness in the epigastric region on pressure; respiration sup 
pressed and painful. 
Intense anxiety, anguish, depression, and despair; expectation of 
speedy death ; sometimes delirium. 
Administration.—Two drops of the sixth dilution in an ounce of 
water; a dessert-spoonful once in two to four hours, until the proper 
impression is made upon the inflammation. 
Veratrum.—Hippocratic countenance ; nose pointed ; eyes sunken 
and glazed; lips bluish and dry; tongue red at the tip and on the 
edges, with a dark, dry fur running through the centre; pulse quick, 
weak, and almost imperceptible ; stomach and abdomen distended; ex- 
tremities cold, and covered with a clammy sweat; position on the back, 
with the knees drawn up; hiccough; and whole appearance indicative 
of extreme prostration. 
Feeling of great exhaustion ; burning pain in the stomach ; rough ; 
dry, and scraping sensation in the throat, rendering deglutition difficult 
and painful; great soreness in the epigastric region; short, trouble- 
some cough; severe and continued nausea and vomiting; great dread 
of warm food and drinks; intense thirst for cold drinks, inability to re- 
tain anything upon the stomach; spasmodic contractions of the throat, 
oesophagus, and abdominal muscles; hiccough; painful respiration. 
Excessive dejection, discouragement, and sadness; fear of death, 
complete despair; delirium. 
Administration.—In urgent cases we may give a dose of the sixth 
dilution in water, once every hour until an amendment declares itself, 
or there occurs a well-pronounced medicinal aggravation. "We may 
then await the result, and hold ourselves in readiness to repeat this, or 
whatever other medicine may more fully correspond with the symptoms 
that may arise. 
Nux-vorriica.—Face bloated; eyelids red, weak, and watery; stomach 
distended; tongue tremulous, red, and clean, or furred with a whitish 
coat in the centre ; offensive breath ; frequent hiccough; pulse frequent, 
small and feeble. 
Burning pain in the stomach, with pulsations and spasmodic con- 
tractions in the epigastric region; nausea and vomiting, aggravated 
after eating and drinking; tenderness and pain in the pit of the 
stomach when pressed, or during movement; contraction and obstruction 
in the oesophagus when attempting to swallow; painful sensation of dis- 
location of the stomach ; dizziness and confusion of the head, on rising 
from the recumbent position, or in attempting to walk; sour or bitter 
eructations. 856 
diseases of the sanguinous function. 
Mental and moral symptoms : great uneasiness and anxiety ; morose, 
peevish, sad, and often disposition to commit suicide. 
Administration.—This medicine is peculiarly appropriate in those 
cases which are induced by abuse of coffee, wine, spirits, condiments 
and stimulating food. One drop of the sixth dilution to an ounce of 
water; a table-spoonful once in two to four hours, so long as the 
symptoms remain stationary. Occasionally we shall have conjoined 
with the above symptoms, cerebral disorder, indicated by delirium, 
optical illusions, and great derangement of the nervous system. In 
such instances an occasional dose of Belladonna will prove specific. 
Pulsatilla is a valuable remedy when the inflammation is brought 
on by the use of crude, indigestible, and irritating food. It covers the 
following symptoms: pressing or shooting pains in the stomach; pulsa- 
tions in the pit of the stomach; epigastrium sensitive, and painful to 
the touch, or on pressure: nausea and vomiting after eating or drink- 
ing ; nausea and disagreeable feeling extending even to the oesophagus 
and throat; regurgitation of food; eructations; hiccough; painful dis- 
tention of the stomach; pulse quick and small; and bitter taste in the 
mouth. 
Aconite, at the third or the sixth dilution, will do good service when 
the febrile symptoms run high; to be repeated often until amendment 
ensues, either alone or in alternation with the gastric specifics, as the 
nature of the case may demand. 
Iodine, at the third potency, has afforded relief in inflammations of 
the stomach caused by abuse of Mercury and other irritating drugs. 
The indications for its use are: frequent nausea; vomitings, especially 
after eating; burning pains and pulsations in the stomach, pyrosis, sour 
eructations, contraction and burning of the oesophagus; pulse frequent, 
small and hard. 
Colchicum is an important remedy in cases of metastasis of rheuma- 
tism to the stomach. It acts specifically as an irritant to the stomach, 
even when injected into the veins. 
Ipecacuanha', a single dose at the sixth potency, will sometimes af- 
ford prompt relief in cases where vomiting is violent and incessant. 
It is applicable to inflammations caused by excessive doses of Tar- 
tarized-antimony, Corrosive-sublimate, Arsenic, c&c., for t-he pur- 
pose of allaying the excessive irritation and vomiting which follow 
poisonous doses of these articles. 
Gastritis from the Effect of boiling Water.—A few years 
ago M. Bretonneau poured three ounces of boiling water into the 
stomach of a young dog. The animal uttered frightful cries and 
vomited violently several times. The next day it appeared languid 
and oppressed, drank with avidity, but refused food. Convalescence 
commenced on the third day and progressed up to the seventh when INFLAMMATION OF THE STOMACH. 
857 
the dog was killed, having the evening before caressed his master and 
rolled at his feet in play. On dissection the mucous membrane, the 
underlying cellular tissue, and over a large space the muscular coat of 
the stomach, were found in a state of gangrene. 
In another experiment he threw into the stomach eight ounces of 
boiling water of each of four cats in such a manner as not to in- 
jure the oesophagus. Three days afterwards they played together and 
snatched food from each other. They wTere then killed, and in their 
stomachs were found marks of injury like those observed in former ex- 
periments. (JBudd, p. 78.) 
From the Effects of Mineral Acids.—Dr. Budd says (p. 78) a 
man swallowed Sulphuric-acid, which destroyed the entire lining mem- 
brane of the oesophagus and charred a small portion of the lining mem- 
brane of the stomach. Of the lining membrane of the oesophagus a 
large portion was brought up entire, and is now preserved in the 
museum of the college (King-street, St. James's.) The man lived 
many months, and at length died from the combined effects of stricture 
of the oesophagus and tuberculous disease of the lung. 
A case is given in the Medical Gazette (Sept. 11, 1846) of a patient 
■who swallowed Nitric-acid and lived twenty-three days. After death 
the mucous membrane was almost entirely destroyed. 
These cases and others like them, show that the effects of these 
poisons are mainly due to their local action. The acid chars the tissue 
with which it comes in contact; coagulates the blood in its minute ves- 
sels. So long then as the acid is sufficiently concentrated to have this 
chemical effect it is not absorbed into the general circulating fluid; al- 
though it may continue to permeate the tissues as it would permeate 
dead membranes. 
Inflammation of the Stomach from the direct irritation of hard 
indigestible substances. 
Symptoms.—Pain in the stomach, sense of heat there, occasional 
vomiting of matters tinged with blood. When the injury done the 
stomach is very great, the pain is severe, the pulse depressed, and as 
in severe peritonitis, the pulse is small and rapid, the skin cold and 
clammy, countenance shrunk. These symptoms are followed by some 
degree of fever. And when no poison is retained in the stomach or ab- 
sorbed into the blood, no great nervous or constitutional disturbance is 
seen. The stomach possesses remarkable powers of tolerating the pre- 
sence of irritating substances, accommodating its action to the necessi- 
ties created by new emergencies, and recovering its original condition 
after they are expelled. 
In December, 1705, a sailor, in imitation of a juggler, swallowed four- 
teen clasp knives, most of which were nearly four inches long, and a 
full inch in the extreme breadth. The mechanical irritation and in- 858 
DISEASES OF THE SANGCINOUS FUNCTION. 
flammation caused severe pain in the stomach, frequent vomiting and 
loss of flesh, fragments of the knives passed into bowels ; and, though 
the man eventually died in Guy’s Hospital in March, 1809, there was 
little fever, and not much disturbance of the nervous system at any 
time. In less than two months after the knives were swallowed (Jan 
1806) he moved about, and at times performed the duties of a sweeper 
In the course of the following autumn his strength and flesh improved, 
he ate and drank voraciously, and performed various easy duties in the 
ship (Dr. Marcet, Med. Chir. Transactions, Vol. 12). Numerous 
corroded blades and other fragments of the knives found in the stomach 
after death are preserved in the museum of Guy’s Hospital. 
Inflammation of the Stomach from swallowing melted lead.— 
Henry Hull, a man 94 years of age, who w ith two other men had charge 
of the Eddystone Lighthouse in the winter of 1755. At two o’clock 
on the morning of Dec. 2d, fire broke out in the lantern, and Hull at- 
tempted to extinguish the fire by throwing water four yards higher 
than his head. While looking upward, a quantity of molten lead fell 
in a torrent from the roof upon his head and face, over his clothes, 
burning his neck and shoulders through his shirt collar. From a violent 
burning sensation felt internally he thought some of the lead had passed 
down into the stomach. After the fire had burned eight hours, Hull 
and his comrades were found in a state of partial stupefaction in a cave 
on the east side of the rock to which they had retreated to avoid the 
falling of the timber, and red hot bolts upon them. They were taken 
off the rock by boatmen, who threw them a rope, by which they were 
drawn off to the boat. Taken to Plymouth, 14 miles distant, Hull was 
treated by Dr. Spry. The patient in a hoarse voice told all who saw 
him, that a mass of lead wTas certainly in his stomach; but the physician 
considered the statement incredible, as he did not suppose a human 
being could live in that condition, through such suffering, exposure and 
fatigue ; and the symptoms were not very strongly marked, till the sixth 
day, when he was thought to be better. Continuing to take his medi- 
cines and food, both liquid and solid, there was little change till the tenth 
or eleventh day, when he suddenly grewr worse; on the twelfth day 
he wTas seized with cold sweats and spasms, and soon afterwards 
expired. 
On dissection, Dr. Spry found the cardiac portion and orifice of the 
stomach greatly inflamed and ulcerated, the coats of the lower portion 
were burnt; “ and from the great cavity of it took out a great piece of 
lead,” weighing seven ounces, five drs., eight grs. 
The history of this case w7as transmitted to the Royal Society by 
Dr. Spry, but that body regarded it as incredible and they deferred 
reading it till further proof of its authenticity were received. Dr. Spry, 
to establish his veracity, made further experiments on dogs and fowls POWERFUL POISONS AND THEIR ANTIDOTES. 
859 
In one of these he poured molten lead through a funnel down the throat 
of a dog that had fasted for twenty-four hours. The next day the dog 
was very brisk, and on being killed, six drachms and one scruple o 
lead were found in its stomach. The internal coat was much cor 
rugated, but was not excoriated. 
Dr. Spry gave to another dog a half pint of milk, and soon after 
wards poured molten lead down its throat. The dog immediately after 
took freely of milk as if nothing was the matter with him, and continued 
to do so for three days. When quite lively he was killed, and six 
ounces and two drachms of lead were taken from the stomach. “ The 
pharynx and cardiac orifice of the stomach were a little inflamed and 
excoriated, biV die oesophagus and stomach seemed in no manner af- 
fected.” Tnese experiments being attested by the oaths of Dr. Spry 
and others, were reported to the Royal Society and published in its 
transactions. 
TABLE OF POWERFUL POISONS AND THEIR ANTIDOTES. 
Poisons. 
First. — Gases. — Gas produced in 
wells, privies, &c., deprived of fresh air. 
Vapor of charcoal. 
Second.—Acids.—Prussic or Mineral 
Acids. 
Sulphuric, Muriatic, Nitric, Phos- 
phoric Acid, Spirits of Vinegar, and 
strong Wine Vinegar. 
Vinegar. 
Third. — Alkaline Poisons. — Pot 
and Pearl Ashes, Lapis-infernalis, Salt 
and Oil of Tartar. 
Fourth. — Metallic Poisons. — Ar- 
senic. 
Corrosive Sublimate ; Copper ; Ver- 
digris. 
Lead. 
Lunar Caustic, Nitrate of Silver. 
Tin. 
Antidotes. 
Chloride of Lime. 
Vinegar and Vapor of Vinegar. 
Spirits of Hartshorn. 
Tepid Soap-suds, Magnesia. 
Chalk, powdered and mixed with 
water. 
Wood-ashes mixed with water. 
Potash or Soda. 
Vinegar; Lemon-juice, and other 
Acids. 
Sour milk ; mucilaginous drinks and 
injections. 
Soap-suds, White of Eggs with Wa- 
ter ; Sugar-water; milk ; Rust of Iron. 
Hydrated per Oxide of Iron, in large 
doses. 
White of Eggs in water; Sugar-water; 
Milk; Starch from Wheat-flour. 
Epsom Salts; Glauber’s Salts. 
Common Salt, dissolved in water. 
Sugar, White of Eggs, and Milk. 
Vascular Nerves of the Abdominal Cavity. — Our knowledge of 
the influence of the vagus on the stomach wants further confirmation 860 
DISEASES OF THE SANGUINOUS FUNCTION. 
and extension. Cl. Bernard, on examining the fluids of the stomach of 
a dog by means of a gastric fistula, saw the pale rose tint, which was 
present during the absence of food in the organ, change to deep red, 
under the influence of mechanical irritation, and this last give place to 
complete discoloration of the mucous membrane. After section of the 
great sympathetic in the neck, the discoloration persisted, even when 
the membrane was irritated. In experimenting with similar conditions, 
Panum observed the membrane return to its original color, four, six and 
twenty-two hours after the operation. 
2. CHRONIC GASTRITIS —CHRONIC INFLAMMATION OF THE STOMACH 
Diagnosis.—Many of the symptoms of this malady are similar in 
character to those which occur in the acute form, but there is a mate- 
rial difference in regard to their grade of violence in the two diseases. 
Sometimes chronic gastritis is the result of a partially subdued chronic 
attack, which from various causes is kept up for a long period in this 
state of sub-acute inflammation. At other times it comes on slowly 
and insidiously, from a combination of causes operating at the same 
time. Amongst the symptoms which usually attend this complaint 
may be enumerated the following: pain and tenderness in some par- 
ticular part of the stomach, excited by pressure or by certain kinds 
of food and drinks ; frequent vomiting of food and drink soon after 
they are swallowed; loss of appetite ; putrid taste in the mouth ; 
thirst; foetid breath ; acid or bitter eructations ; acidity; distention 
of the stomach with wind, which causes distressing vertigo and pains 
in the epigastric and hypochondriac regions ; tongue red and clean, or 
furred in the middle with a dirty fur; melancholy; peevishness; irri- 
tability ; discouragement, and, finally, hectic fever, emaciation, sudden 
prostration, and death. 
The symptoms are identical with dyspepsia. There is no fever; the 
pain, flatulence, intense acidity, loss of appetite, &c., are the same in 
both. If the disease has become chronic it may be considered as 
most probably gastritis, at least if it has continued long, and been 
treated as dyspepsia. 
The distinction between chronic gastritis and phthisis may be thus 
made out: 
CHRONTC GASTRITIS. 
PHTHISIS. 
The cough and pulmonary symptoms 
have, perhaps, not continued long; have 
been treated as pulmonary disease with- 
out success. The symptoms are not 
accompanied by important lesions ; and, 
if the cough, labored respiration, &c , 
have continued for a considerable time, 
Recollect that, if the symptoms be- 
long to the lungs, the disease must, in 
two or three days, produce lesions ca- 
pable of being easily detected. If we 
cannot find these we may refer the phe- 
nomena to irritation, most 
commonly of the stomach. In those CHRONIC GASTRITIS. 
861 
we may set it down as belonging to the 
stomach. 
The gastritis may be nearly latent, 
and may want the most of those S}7mp- 
toms by which it is commonly attended. 
cases in which the sympathetic irrita- 
tion is most strongly marked the local 
symptoms of the disease are most appa- 
rent. 
Treatment.—The medicines to which we have alluded under acute 
gastritis, will be the most applicable in the ordinary forms of the 
chronic form of the same disease. The following medicines will like- 
wise cover many symptoms of sub-acute gastritis, namely Bismuth, 
Baryta-muriatis, Bryonia, Cuprum-metallicum, Digitalis-pur., 
Ilyoscyamus, Ignatia, Mercur., Phosphorus, Arnica. 
Tartar-emetic. — The higher attenuations are valuable in a large 
class of gastric derangements; nausea and vomiting that accompany 
chronic gastritis ; loss of nervous energy of the stomach ; enfeebled and 
irritated state of the mucous membrane ; nausea, oppression, tightness 
in the epigastric region, heaviness in the head, distaste for food; lassi- 
tude, accompanying dyspeptic and bilious symptoms. 
Inflammation of the Stomach, vomiting of matter tinged- with 
blood. Praecordial anxiety after eating, pain in the epigastrium, burn- 
ing heat in the stomach, which increases so much as to cause syncope. 
Epigastric region swollen and painful rotary movement at the epigas- 
trium in the evening on lying down; with strong and rapid pulsations 
at the heart. (Hahnemann.) 
Alcohol.—In the case of St. Martin, a Canadian, who, in conse- 
quence of a gun-shot wound, had a permanent fistulous opening 
through the abdominal parietes into the stomach, the rare opportunity 
was afforded of seeing much that went on in the stomach during diges- 
tion. At one time Dr. Beaumont observed that the interior of the 
stomach exhibited erythematous and aphthous patches on the mucous 
surface, caused by the drinking of ardent spirits during the preceding 
eight or ten days ; but there was no pain, and the patient had a good 
appetite. This state continued several days; the secretions wyere 
vitiated, and the small quantity of gastric juice extracted by a syringe 
from the stomach was vitiated and impure in appearance. At another 
time the small quantity of this fluid extracted, in the morning before 
eating, was mixed with an unusual proportion of vitiated mucus, saliva, 
and bile, tinged lightly with blood, which appeared to exude from the 
surface of the erythematous and irritable patches of aphthous inflam- 
mation. On succeeding days the same morbid appearances were ob- 
served. The aphthous patches grew larger and more numerous, the 
mucous covering became thicker, the gastric secretions more vitiated 
and purulent, resembling the discharges from the bowels in protracted 
cases of chronic dysentery; yet, with all this evidence of local disease 
of the stomach, there wras little derangement of its functions, and ne 862 
DISEASES OF THE SANGUINOU8 FUNCTION. 
pain, except an uneasy sensation in the epigastrium. There was some 
vertigo, some dimness and yellowness of vision, a thin yellowish coating 
on the tongue, the countenance sallow, pulse uniform and regulai, ap- 
petite good, sleep as good as usual.* 
But, during all this period, the appetite, though sufficiently craving, 
was not that of health. Digestion, when the stomach is in this state, 
is very imperfect, and under a full diet and indulgence in stimulants 
there can be no recovery of the lost strength. Affc°r being confined 
for a few days to a restricted diet, avoiding stimulants entirely, an im- 
provement was visible. On the sixth day of observation, at eight 
o’clock in the morning, before eating, the stomach was observed to be 
u empty, its coats clean and healthy as usual; secretions less vitiated; 
extracted two ounces of gastric juice of more natural and healthy ap- 
pearance, with the usual gastric acid flavor; he complains of no uneasy 
sensations, nor of the slightest symptoms of indisposition; says he feels 
perfectly well, and has a voracious appetite.”f 
The accuracy of Dr. Beaumont’s observations have been attested by 
Professor Sewall, of Washington, D. C., and they have been more re- 
cently confirmed by other All observations show that 
large quantities of alcohol may be taken repeatedly without exciting 
the pain and sensible systems of inflammation in other delicate sur- 
faces ; but that inflammation is nevertheless excited by the harsh 
action of the stimulant, and digestion is deranged and health under- 
mined before the cause of the insidious danger is suspected. It has 
also been shown that the inflammation excited by a too free indulgence 
in stimulants soon subsides under the influence of low diet and cooling 
drinks. “ Such,” says Dr. Budd, “ is the power of reparation possessed 
by the lining membrane, without which it would be unfit for the func- 
tions of digestion. When, in consequence of the continuance of appe- 
tite, the usual diet continues to be taken, the surface of the stomach is 
long in recovering its healthy state ; in many cases it continues fretted 
and sore, under an amount of food that in a healthy condition would 
produce no irritation.” 
When brandy is prescribed as a medicine it is quite common to 
begin with doses small enough to avoid a rapid development of those 
drug-symptoms which are often found at last far worse than the origi- 
nal disease. After repeated exhilarations, alternated with depressions, 
not permitted to last long, the confidence of the patient is gained, and 
Brandy becomes established in reputation as the real “ staff of life. 
Now, whatever the progress of the original disease, the remedy will 
* Beaumont on Digestion, 
f Ibid. 
J See Amer. Jour. Med. Sciences. 1857. INFLAMMATION OF THE STOMACH. 
863 
soon assume a conspicuous position. The chronic disease which Alco- 
hol generally creates is slowly developed, and in many cases it is not 
possible to refer to any serious lesion of the nervous system, appre- 
ciable during life or discoverable after death. There are some men 
who can drink habitually six or eight glasses of brandy daily, for seve- 
ral years, without greatly deranging their health, but these are extra- 
ordinary men. It is much more common to see a gradual change 
come over the habitual spirit-drinker, until he finds himself in the 
height of a paroxysm of delirium tremens, from which he never recovers. 
The symptoms of Alcohol, habitually taken, are thus given by Dr 
IIuss, of Sweden : “ In some cases the patient begins to find his diges- 
tive powers impaired, he becomes dyspeptic, and can only eat solid 
food by taking a drink of brandy with each mouthful; some, when 
trying to keep sober, take only vinegar or spices.” In other cases 
there may not be intoxication at any time. In many the morbid 
symptoms begin with “ loss of appetite, indigestion, nausea, vomiting, 
occasional diarrhoea; emaciation and cachexia; pustular eruptions, 
eructations, and offensive breath; there is soon serious functional 
disease of the liver, kidneys, heart, and the coats of these vessels, 
which finally lead to chronic structural disease of those organs. At a 
later stage we have fatal serous effusions or general dropsy, hgemor- 
rhages, extravasations, or apoplexies. Intercurrently with these states 
are sometimes seen fits of intoxication, delirium tremens, sexual de- 
bility, suicidal melancholy; and life terminates with epileptiform con- 
vulsions, general paralysis, or idiocy.” 
Causes.—The most powerful predisposing causes of this malady are 
protracted sufferings under the depressing mental emotions, and the 
habitual use of irritating drugs. It often succeeds to acute gastritis 
which has been but partially subdued. It may also arise from high 
living, the abuse of wdne, liquors, coffee, &c., repelled eruptions, metas- 
tasis of rheumatism and gout, injuries, and occasionally as a conse- 
quence of other diseases which have been badly managed. 
Slow Poisons.—There are instances of poisonous substances re- 
tained for a considerable time in the stomach before their effects are 
felt. It has been said that pulverized diamonds, or glass, enamel, &c., 
slowly lacerate the coat of the stomach, and thus destroy life. On the 
same principle it is said that human hair, chopped very fine, constitutes 
the active ingredient of a slow poison employed in Turkey for the pur- 
pose of inducing a chronic disease resembling cancer in the stomach. 
{Paris and Fonblanque on Poisons.) 
The most celebrated case of this disease recorded in tl>e books is 
that of Napoleon I., who died at St. Helena, May, 1821. The Empe- 
ror had avoided medicine generally during his life, as he had no faith 
in physicians. His plan was, when he was unwell, to balance his con- 864 
DISEASES OF THE 8ANGUINOUS FUNCTION. 
dition of health by running into an opposite extreme from that which 
caused the disease ; thus, as he said, restoring the equilibrium of 
nature. If he had been long inactive he would ride about sixty miles, 
or hunt a whole day. If he had already borne great fatigue he would 
resign himself to rest for t'wenty-four hours. During the latter por- 
tion of his captivity his health became more and more deranged. The 
disease was called hepatitis. “ The lymphatic system was deranged 
and his blood circulated with difficulty. Nature had endowed him 
with two important advantages : that of sleeping whenever he needed 
repose, at any time or place, and, second, that of a constitution inca- 
pable of committing any excess, either in eating or drinking; the least 
excess caused his stomach to revolt immediately.” 
In his last illness he -was only attended by Dr. Antomarchi and Mr. 
Arnott. They had a consultation March 25th. The Emperor had 
long been laboring under some severe derangement of the function of 
digestion: he had nausea and vomiting, especially after taking food; 
obstinate constipation ; great wasting of flesh and strength. On the 
17th of March he had an attack of fever, for which he was treated 
with emetics, cathartics, and antimonials. On the 25th he still suf- 
fered from heat, great prostration of strength, pain in the epigastrium, 
most distressing vomiting, and constipation. April 1, evening, Dr. An- 
tomarchi requested Dr. Arnott’s aid. Passing “through a labyrinth 
of passages and rooms dimly lighted they reached the Emperor’s bed 
room. There wTas no light whatever in it—it was perfectly dark.” Dr. 
Arnott was introduced by Count Montholon; he inquired into the 
symptoms in the dark, as no light was permitted. The pulse was 
tranquil, the heat moderate ; moisture on the skin rather more than 
natural; much pain in the abdomen, hut no tension or hardness per- 
ceptible on examination ; the bowels slow; appetite bad; voice strong; 
some cough. Several severe fits of vomiting followed, notwithstanding 
purgatives had been recently given with temporary relief. The matter 
vomited on the night of April 11th was “ black mucus.” After this he 
became quite exhausted, and expressed the opinion that medicine 
would be of no avail. He took some jelly with wine, which he re- 
tained. He afterwards asked: “ How long does a man live who eats 
so little as I do ?” He now continued better and worse till the latter 
end of April, when hiccoughing came on, and all the symptoms were 
aggravated. May 4th there was a total loss of muscular motion ; the 
under-jaw had dropped ; the eyes were fixed; the pulse varied from 
102 to 110 per minute, small, weak, and easily compressed. 
He was now evidently d}dng; but sinapisms were applied to his 
feet, and blisters to the legs and sternum. They had no effect—all 
the symptoms increased. At eleven minutes before six, p. m., of the 
21st of May, he died, at the age of fifty-two years. His dissolution INFLAMMATION OF THE STOMACH. 
865 
wras so calm that not a sigh escaped him, and his attendants had no 
thought that his end was so near. His last words were “ tete arm&e ” 
distinctly uttered at five o’clock, a. m. ; what association the words had 
in his mind could not be known. “ His countenance after death wTas 
calm and serene, and as having in it something commanding and 
noble.” 
Post-Mortem Examination.—The whole of the internal surface of 
the stomach “was a mass of cancerous disease, or scirrhus portions 
advancing to cancer. The contents of the stomach consisted only of a 
large quantity of fluid, resembling coffee-grounds, or black grumous 
matter mixed with some specks of blood, which he had been accus- 
tomed to vomit. The remainder of the abdominal viscera were in a 
healthy state. 
3. ACUTE CATARRHAL INFLAMMATION OF THE STOMACH 
This is an affection of frequent occurrence, attended with little dan- 
ger. It is usually cured without medicine by the observance of a 
regulated diet. When it originates in cold, mental emotions, night 
watching, or endemic or epidemic influences, it is more severe than 
when it arises from some direct affection of the stomach. It is usually 
cured without difficulty by Aeon., when the fever is perceptible ; Pul 
satilla, Bryonia, Nux-vom., Ipecac., Arsen. 
In some cases, associated with intestinal catarrh and great tympani 
tis, Coloc. and Carbo-veg. See also page 515. 
4. CHRONIC CATARRHAL INFLAMMATION OF THE STOMACH. 
The researches of Broussais and Andral have established the doc- 
trine that this disease is identical with gastritis in pathology. The 
patients complain of loss of appetite ; tongue coated; taste sour or 
insipid ; directly after a slight meal there is fullness or feeling of dis- 
tention of the epigastrium ; this is followed by a tasteless, sourish, or 
putrid eructation ; food taken is afterwards tasted ; there may be an- 
noying heartburn, at times nausea and sickness; vomiting seldom 
occurs ; evacuations from the bowels either normal, hard, infrequent, 
or loose. General health only affected by long continuance of the dis- 
order, when there comes slight weakness, emaciation, and hypochon- 
driacal humor, generally no fever; sleep little disturbed, except per- 
haps by troublesome dreams or nightmare. The most frequent reflex 
symptom is headache, more or less violent; stomach somewhat dis- 
tended ; pain on pressure in the epigastrium very slight. See p. 515. 
You I.—55. 866 
DISEASES OF THE SANGUINOUS FUNCTION. 
General Remarks.—It commonly begins with obstinate vomiting, 
showing either congestion or inflammation of the stomach. In some 
cases the vomiting recurs almost daily for months after signs of active 
inflammation have subsided. The stomach becomes distended and 
feels like a large tumor, which is removed by the expulsion of a gallon 
or more of fluid. 
There is a greater liability to perforation in the cases of young fe- 
males, contrasted with the greater frequency of the occurrence of ulcer 
of the stomach in advancing life. 
Diagnosis.—Pain, whether epigastric or dorsal, increased by pres- 
sure ; and this symptom is considered by Brinton as an “ important 
test.” But it may only be considered as indicating an inflammatory 
irritation of the mucous surface of the stomach, rendering it tender and 
irritable. It may concur with ulcer, but is not a sign of it. To assure 
us of the existence of ulcer the numerous symptoms commonly attend- 
ing it must be well marked. The pain is accompanied with vomiting 
and haemorrhage at some stage of the malady in nearly all cases. 
When we meet with a case of sudden profuse gastric haemorrhage we 
consider the probabilities of its being connected with scirrosis of the 
liver, vicarious menstruation, purpura, or heart disease. If it cannot 
be attributed to any of these it may be suspected to arise from ulcera- 
tion. It is true that we meet with many cases of gastric haemorrhage, 
complicated with lowered nerve-power and malarious disorder, apart 
from any special gastric affection. “ The gastric mucous membrane 
may be flushed by reason of the paralysis of the arterial nerves, and 
luemorrhage may then occur by capillary rupture, in the same way as 
it does in epistaxis.” (Brinton. London, 1857.) Ague is regarded 
by Dr. Brinton as a cause of ulcer of the stomach ; it may rather be 
regarded as a cause of haemorrhage only. And the existence of hepa- 
tic scirrosis or other portal derangement should also be considered as 
possible. The former may occur in perfectly temperate persons, in 
those young in life, and may declare itself by haemorrhage, with or 
without dropsy. A case of this kind long occupied our attention a few 
years ago. 
Pathology.—There is nothing specific in the nature of ulcer of the 
stomach. It may originate in various ways; and wdien it terminates 
fatally it is likely to be by perforation of the stomach. When this 
occurs there is a violent paroxysm, attended with unusual pain in the 
abdomen, ending in collapse and death in a few hours. The abdomen 
is found distended with air and fluid similar to that vomited; the 
stomach greatly enlarged, its coats thickened, especially in the parts 
near the ulcer, which is more common near the pylorus. 
5. ULCER OF THE STOMACH. SOFTENING OF THE STOMACH. 
867 
Treatment. Diet.—Give only bland nutriment, in small quantity 
and at short intervals, to avoid distending the stomach. Dr. Brinton 
then proposes to give Opium, to relieve the pain, check irritation, and 
support the strength. It is regarded as possessing the most reliable 
powers for buoying up the nervous energies and checking the expendi- 
ture of the tissues generally. In one case Dr. Parker, of Boston, re- 
lieved the vomiting and effected temporary improvement by giving 
syrup of Iodide of Iron, a few drops three times a day; though the pa- 
tient died a year after on the disease progressing to perforation of the 
stomach. {Trans. Soc. Med. Trnjpr. 1850.) 
Aqua-calcis, Calcarea-caustica (Quick-lime).—Eructations of air; 
regurgitations of food ; inflammation of the mucous membrane ; nausea 
and vomiting of a sour fluid ; raising of a frothy yeasty fluid ; spasmo- 
dic contraction of the stomach. 
Arsenicum.—Nausea and vomiting after eating or drinking, with 
great exertions, mixed with mucus and water, with bitter taste ; thick 
glassy mucus, or brownish black substances, with great exhaustion. 
6. GASTROMALACIA.—Perforatio Yentriculi. 
A softening of the membranes of the stomach always precedes the 
formation of ulcers and suppurative process which takes place in tuber- 
culous and carcinomatous formations. Most common among children 
of from a few weeks to two years old. (Hartmann, vol. iv., p. 83.) 
Diagnosis.—The most remarkable peculiarities consist in symptoms 
resembling, cholera, gastritis, hydrocephalatous fever, or slow nervous 
typhus. The mild cases begin with loss of appetite, peevishness, low 
spirits, eructations of food, aphthse, persistent diarrhoea, vomiting, the 
sleep restless, and the child has a pale and distressed appearance 
Fever increases, and is attended by obstinate diarrhoea—the discharges 
consisting of a watery mucus with putrid odor, and mixed up with gray 
green filaments and flocks ; the abdomen becomes distended, the head 
and extremities cold, while the abdomen continues burning with heat, 
rapid emaciation, especially shown about the neck. There is constant 
sleep, or the child is aroused with difficulty. Sometimes the disease 
breaks out suddenly with violent fever, restlessness, screaming from 
pain ; there is quick pulse and insatiable thirst. The abdomen is dis- 
tended, the region of the stomach hot to the touch and painful when 
pressed; the lower limbs are drawn up to the abdomen. There is 
repeated and persistent vomiting of greenish-slimy sour-smelling fluid; 
and diarrhoea of which the discharges consist of watery, green, acrid, 
sour-smelling stools ; the breathing is oppressed, with dry cough, while 
PERFORATION OF THE STOMACH.-SOFTENING OF THE STOMACH. 868 
DISEASES OF THE SANGUINOUS FUNCTION. 
the breath and skin are cool. These symptoms are followed by ex- 
tremely rapid collapse of the features and emaciation; the screams 
gradually change to a mere moaning, stupor and delirium increase, and 
terminate in convulsions and death. 
Causes.—Infantile age; scrofulous or tubercular diathesis ; epidemic 
influences; the usual causes of autumnal fever; atmospheric vicissi- 
tudes ; swallowing corrosive saliva in cases of gangrenous diseases of 
the mouth and adjoining parts. {Hartmann.) Disease of the brain, 
as hydrocephalus and tubercular meningitis. (Rokitansky, &c.) 
Prognosis.—Discouraging, but not always hopeless ; the symptoms 
when most urgent often arise from a pathological condition, which may 
be changed by the usual remedies. 
Treatment.—Begin by treating the general febrile and inflamma- 
tory symptoms on the general principles which are usually found suc- 
cessful in other gastric affections. For these and the cephalalgia, 
Aconite, Belladonna, or Bryonia may first be tried. After these 
have subdued the fever and mitigated the local symptoms, if there be 
persistent diarrhoea, give a few drops of Calc.-acet. per day. It is a 
good remedy for troublesome dentition and also for scrofulous affections 
in children, and is better than Calc.-carl), in this disease. (Hart- 
mann.) Hypo-phosphite of Lime is one of the best remedies. When 
the diarrhoea becomes habitual, and the central organ of the abdomi- 
nal system of nerves becomes more deeply invaded, Phosphoric-acid 
is more effectual. Tartar-emetic, in a low attenuation, is successful 
in the cases in which the predominate ; when there is 
evidence of actual gastromalacia, with erosion of the coats of the 
stomach, this remedy should be given in a high dilution only. Arseni- 
cum, Sulphuric-acid, and Argentum-nitratum have cured some cases. 
Kreosotum is said by Dr. Arnold to be the principal remedy in 
this disease. He uses the second trituration, others prefer the sixth. 
He says, under its use the symptoms soon abate, and finally disap- 
pear—the emaciation requiring its persistence for a considerable time. 
Oxalic-acid. Softening of the stomach; burning pain, hiccough, 
vomiting, erosion of the mucous membrane. 
7. SELF-DIGESTION OF THE STOMACH, or, 
Changes in the Coats of the Stomach from the Action of the Gastric Fluid after Death 
This change of the structure of the coats of the stomach is visible in 
a large proportion of the bodies examined after death, though it is 
usually attributed to disease. The earlier pathologists, from Morgani 
downward often observed the mucous membrane of the stomach as well 
as all its tissues in a softened state; but the real nature of the change 
was not understood till John Hunter found it in a remarkable degree in 
the stomach of a man who after eating a hearty supper of cold meat, SELF-DIGESTION OF THE STOMACH. 
869 
cheese, bread and ale, was suddenly killed by a single blow which had 
fractured his skull. On dissection Hunter was perplexed on finding 
the stomach so far dissolved at its greater end that part of its contents 
had escaped into the cavity of the abdomen. A second case was seen, 
at St. George’s Hospital, in a man who died a few hours after receiving 
a blow on his head which fractured his skull. He afterwards found the 
same appearance in many other cases, most of whom had died from in- 
juries of the cranium; and in one man who had been hanged. In some 
cases the digestive action had extended through the diaphragm, into 
the spleen, and was beginning to corrode the surface of the lung. On 
making an extensive series of observations, he concluded that there 
were few stomachs after death which were not in some decree marked 
by this post-mortem digestive action, that it was most plainly seen in 
persons who had died violent deaths, and who had recently taken food. 
Spallanzini was led by Hunter’s observations to extend his own on the 
nature of digestion and concluded as Hunter already had done that the 
gastric juice was a true menstruum or dissolving fluid; and that its ac- 
tion on the food might continue after death; also that when so em- 
ployed while still remaining in the stomach at a proper temperature, it 
was capable of digesting the coats of the stomach itself. Later observers 
have amply confirmed the truth of these opinions. Although little has 
been recently said on the subject, it is well known that the fluid formed 
by the stomach for the digestion of food during life becomes an agent 
of destruction to the same tissue that formed it, as soon as the vital 
power leaves the body. 
Circumstances that favor Self-digestion.—The process is most 
active when the temperature is greatest; hence Hunter, Budd and 
others found it very frequently in hot weather, others looking for it in 
winter have less frequently observed it. Thus it is necessary first, 
that there should be a certain quantity of active gastric fluid in the 
stomach, or at least, muriatic or lactic acid. The temperature for some 
hours about 98°. The stimulus of food after eating excites a full flow 
of gastric fluid into the stomach, which, if death be suddenly brought 
about by some external cause, goes on dissolving the contents of the 
stomach and the viscus itself, particularly at its large or cardiac end, 
where the fluid collects, and where the mucous membrane is thinner 
and less protected by mucus. When digestion is not going on there is 
no gastric juice in the stomach. (See Digestion, p. 217.) 
Action of the Gastric Juice in the Process of Digesting the Coats of the Stomach. 
It first renders the mucous membrane firmer and thinner, making it 
capable of removal by pressure of the fingers; the blood in the capil- 
laries is blackened. If the capillaries are full when the action com- 
mences it turns the softened membrane of a grayish brown and renders 870 
DISEASES OF THE SANGU1NOUS FUNCTION. 
it paste-like and opaque; but if tbe minute vessels are empty, the* 
softened tissue is rendered gelatinous and transparent. Similar changes 
are effected in albuminous structures out of the body. In a higher 
degree of the digestive process, the coats of the stomach are eaten 
entirely through the edges of the opening, says Hunter, “ appear to be 
naif dissolved,” the fleshy parts appear “ pulpy, tender and ragged,” like 
flesh half digested, or half dissolved by a caustic alkali. In the pylo- 
ric portion of the stomach perforation is less frequently seen, but the 
edges of the folds seen on its contracted surface become softened, and 
when the capillaries were empty at the beginning of the process, the 
folds appear as whitish, semi-transparent lines or narrow bands, which 
have a brownish tint when the capillaries have been congested. In 
some cases the gastric fluid having regurgitated through the cardiac 
orifice, perhaps from spasmodic action of the gastric muscular fibres in 
articulo mortis, lodges in and dissolves the lower end of the oesophagus; 
here, also, the projecting folds of the under or back part of the oeso- 
phagus being acted on first. 
It is known that irritation from other causes than the presence of 
food may excite a flow of gastric fluid into the stomach. Spallanzini 
obtained some from his own stomach by tickling the fauces and thus 
exciting vomiting before breakfast in the morning; and the fluid was 
known to be pure from its power to dissolve meat. In one case, given 
by Dr. Budd, it seemed that the flow of the gastric fluid into the stomach 
was excited by irritation of the brain by an injury so severe as to f'rac 
ture the skull. A gentleman was thrown from his horse in the park in 
London before dinner, and when the stomach was probably quite empty 
and he remained insensible till his death, twenty hours after the fall. 
On examination eighteen hours after death, the great end of the stomach 
was completely dissolved and the digestive action was extending to the 
adjoining parts. As the stomach was supposed to be quite empty when 
the accident occurred, and the pbwer of swallowing was entirely lost by 
the shock, nothing was taken afterwards; it is therefore probable that 
the gastric juice by which the stomach was dissolved after death, was 
secreted under the influence of the irritation of the brain and spinal 
nerves, resulting from the injury; and, being undiluted by food in the 
stomach, its active powers were expended on the coats of the stomach. 
When death results from ordinary diseases, the appetite having been 
weakened, the power of the digestive fluid is feeble and seldom acts so 
powerfully on the coats of the stomach. 
Solution of the Coats of the Stomach by the Gastric Juice after Death from excessive 
Acidity discoverable during Life. 
Though in health the gastric juice is only secreted when food is 
taken, hut in certain diseases it is secreted when the stomach is SELF-DIGESTION OF THE STOMACH. 
871 
empty. In some catarrhal states of the stomach lactic acid is formed 
by fermentation of the saccharine principles of the food; and this acid 
forms with the mucous membrane of the stomach a digesting mixture 
which continues its activity after death; and the coats of the stomach 
are more or less digested or destroyed. 
First. Symptoms of the presence of free gastric juice or of a digest- 
ing fluid in a stomach otherwise empty are met with during life in cases 
of simple ulcer of the stomach. Pain in the epigastrium is felt when 
there is no food in the stomach; there are thirst, impaired appetite, fre- 
quent sour eructations with occasional vomiting of sour food; probably 
the flow" of juice is excited in the empty stomach by the irritation of 
the ulcer or its secretions, as it was in Spallanzini’s experiments by 
the mechanical irritation of pebbles or of bits of sponge or glass. 
Second. Gastric Disorder in advanced Phthisis.—For some weeks 
or months before death there is pain and tenderness of the epigastrium; 
loss of appetite, thirst, frequent nausea and vomiting of matters slightly 
acid. These symptoms exhaust the strength, and often give more 
distress than the diseased lung; and are probably excited by the irrita- 
tion of that organ. In persons who have died of phthisis, the mucous, 
muscular and serous coats of the great end of the stomach are often 
found dissolved, leaving a large aperture with ragged, flocculent edges. 
Louis found this condition in about one-fifth of the consumptive cases 
he dissected. 
Third. Some inflammatory diseases of the brain cause gastric dis- 
order ; as frequent vomiting and nausea; pain in the stomach, thirst, 
loss of appetite ; this gastric disorder is associated with increased se- 
cretion of the gastric fluid or its presence in the otherwise empty 
stomach. In typhoid fever the same excess of acid often accompanies 
the delirium or other brain symptoms of that disease. When there has 
been pain and soreness of the stomach, and vomiting for some days be- 
fore death, the stomach has been found partially digested after death. 
The softened tissues are of a rust color, from the presence of blood 
gravitating to the lowest part of the stomach. 
Fourth. Cancer of the uterus, peritonitis and other abdominal dis- 
eases which lead to functional disorder of the stomach. In all these 
instances the pathological change is believed to be effected after death. 
Fifth. In infants during the period of dentition, the stomach and 
parts of the intestines are often found in a softened state after death. It 
is common in those who have died from hydrocephalus, phthisis, or the 
exhaustion consequent on eruptive fevers or improper food after wean- 
ing. Symptoms during life : frequent vomiting, loss of appetite, great 
thirst, crying as from pain; diarrhoea; discharges from the bowels 
green, like spinach, supposed to be caused by the presence of bile acted 
on by muriatic or lactic acid from the stomach. In children the 872 
DISEASES OF THE SANGUINOUS FUNCTION. 
functional gastric disorder rapidly exhausts the strength, causing col- 
lapse and death. 
Softening of the stomach then is usually found in persons who die of 
disease in some other organ, and of those diseases especially which 
have long been known to lead to secondary functional disorder of 
the stomach. This secondary disorder of the stomach is produced through 
the intervention of the nervous system. The excessive secretion of 
acid in the stomach in these cases is effected through reflex nervous in- 
fluence from the other diseased part thrown back from the brain through 
the nerves ; and the secondary disorder of the stomach thus excited af- 
fects the secreting apparatus of the stomach as well as its muscular 
coat. The extra gastric juice thus formed when not needed is wrasted in 
merely exerting an irritation on the coats of the stomach; and when it 
has passed away and more food is taken it is but imperfectly digested 
and becomes a new source of offence to the mucous membrane, causing 
it to secrete an unhealthy mucus ; and this acts as a ferment in forming 
lactic acid from the saccharine elements of the food. 
In phthisis the stomach is often found enlarged as well as softened; 
being often found three or four times its usual size. It is believed to 
have been caused by the enlarged fatty degeneration of the liver 
which always exists in these cases. The enlarged liver compresses 
the pyloric division of the stomach and prevents the wasted and 
weakened muscular fibres from propelling the contents through the py- 
lorus. Some of the acid then remains in the stomach and softens its 
tissues after death. 
Influences that diminish the power of the digestive fluid. —■ 
First. Low temperature.— Spallanzini found that its powers were 
only perfect when the temperature was near that of the human body 
or near 100°. When cooled to 60° the action becomes very slow and 
feeble. Second. Antacids taken into the stomach render the gastric 
juice inert, as was proved by the experiments of Schwann on artificial 
digestion Avith rennet. He destroyed its poAver by carbonate of potash, 
and restored it by adding the proper quantity of hydrochloric acid. 
Ammonia is sometimes given just before death to avert the sense of 
sinking. If the juice be in small quantity it Avill be neutralized by the 
Ammonia and the digestion of the stomach prevented. The same may 
in some degree result from the transudation of the alkaline serum 
of the blood after death. 
Alcohol.—It is often given in large quantities in the vain hope of 
relieving the sense of sinking. If not absorbed before the circulation 
ceases it may prevent the action of the gastric fluid on the stomach. 
Many medicines given when the stomach is full and digestion going on 
arrest that process. They have often been given in large quantities 
Ayithout regard to their strong deranging poAvers. (Budd, p. 25, &c.) HYPERTROPHY OF THE COATS OF THE STOMACH. 
873 
Diagnosis.— Varieties exhibited by the stomach on dissection.— 
1. Pulpy softening of the stomach from self-digestion. 
2. Gelatinous softening of the stomach from self-digestion. 
Cruveillier gives these distinctions, and Rokitansky specifies three 
varieties; but they both regard them as the results of disease. Dr 
Budd is confident that they all result from the action of the gastric 
iuice. He gives the essential characters of this change: 
1. Softening of the mucous membrane, over a considerable space 
in the great end of the stomach and along the edges of the folds, ex- 
tending from this towards the pyloric end. 
2. A blackening of the blood in the tissues so acted upon, 
giving various shades of brown to the softened tissues when much 
blood was contained in them at the time of death. • 
3. The softened tissues have an acid reaction; they putrefy less 
readily than other parts, as the gastric juice exerts on them an anti- 
septic power. 
Gelatiniform softening appears to be nothing more than the result 
of the same process occurring in a stomach, the capillaries in the 
coats of which were empty of blood at death; and they are thence 
rendered more or less transparent or gelatiniform, as all albuminous 
tissues are when acted upon by the gastric juice or by acetic acid. 
8. HYPERTROPHY OF THE COATS OF THE STOMACH. 
This has been by many writers considered as an earlier stage of 
Carcinoma of the Stomach / but Dr. Alderson of the Hull Infirmary 
says, it differs materially from that affection, and is much more com- 
mon. The subjects of hypertrophy of the gastric mucous membrane 
are generally between the ages of forty and fifty, who have used alco- 
holic drinks too freely. It has seldom been seen except in the pyloric 
portion of the stomach. The disease generally commences in a state 
of irritation or chronic inflammation which render the lining of the 
pyloric orifice of the stomach so exquisitely sensitive that the contents 
of the stomach excite it to contract spasmodically. The natural efforts 
to overcome this obstruction cause a spontaneous or “ instinctive” de- 
position of nutritive material in these coats which thickens them and 
adds to their power of resistance. The indigestion attendant on this 
state of the stomach tempts the sufferer to take stimulants daily to ex- 
cite the stomach to increased action; thus keeping up for weeks or 
months an unnaturally increased capillary circulation of the mucous 
membrane; the muscular coat partakes of the irritation and the hyper- 
trophy extends to it. When a section of the muscular coat of the 
stomach is made, the interlacing of the muscular fibres is very con- 
spicuous. {Alderson, on the Stomach dec.) 874 
DISEASES OF THE SANGUINOU8 FUNCTION. 
Diagnosis.—The general system is not much affected till the disease 
is far advanced. The most striking early symptoms are morning sick- 
ness and want of appetite; and in the later stages constant retching 
and nausea; drinks are much desired; but, whatever their quality be 
they are instantly rejected, and a dark colored fluid is vomited in large 
quantity. Every thing taken into the stomach gives pain, and is im 
mediately thrown up, accompanied by large quantities of the vitiated 
secretions from the mucous lining of the stomach. There are frequent 
alternating heats and chills; the pulse is quick and the tongue furred; 
the pain is often felt at the pit of the stomach, but not invariably, 
though it is more common in cases arising from unsubdued chronic in- 
flammation than in those depending on mere obstruction of the pylo- 
rus. Emaciation is not a symptom of this disease, and its absence 
materially distinguishes it from carcinoma of the stomach. 
Treatment.—This has not yet been generally satisfactory in any of 
the structural diseases of the alimentary canal, and the chief reliance 
is upon palliative measures which might be successful if there was no 
malignant disease, and those specific remedies which are supposed to 
have some power in controlling carcinoma whether in this system of 
organs or in others more external. 
The first symptoms of structural disease resemble those of disordered 
function, but they are really the consequence of actual change of 
structure. We begin by attempting to restore healthy secretions and 
to counteract the constitutional tendency to the morbid deposit. As 
soon as structural disease in the pyloric portion of the stomach is sus- 
pected let all stimulants and internal irritating medicines be sus- 
pended ; restrict the diet to the least irritating substances : milk, beef- 
tea, mucilages, and farinacious articles may be allowed, and when the 
disease affects the oesophagus and cardia, but few things can be taken 
and them we can not prohibit. Solids may be swallowed when fluids 
can not. Rest, pure air, mental and physical quiet are indispensible. 
External irritation, applied over the seat of the disease or to the spine, 
has been supposed in the early stage to check local inflammation. 
The celebrated Bichat employed it in his own case. 
When the disease is so fully established that the mucous membrane 
has given way, counter-irritants can not be useful; and before this 
stage is reached we have better resources in the homoeopathic reme- 
dies already mentioned under Gastritis, (p. 861.); Ulcer of the 
Stomach, Gastromalacia, (p. 868,) and hereafter under Carcinoma 
of the stomach in its incipient stages. Of these, Oxalic-acid, Kreo- 
sote, Arsenicum, Merc.-cor., Tartar-emet., and Argentum-nitr. are most 
reliable. 
The internal use of water, as directed, page 297, will contribute 
very much to the favorable effects of remedies. DUODENITIS. 
875 
9. DUODENITIS. 
Inflammation of the Duodenum. — The disease called jaundice 
consists very generally in inflammation of the duodenum, though the 
icteric hue of the skin is not a necessary attendant upon duodenitis 
and is often independent of any mechanical obstruction of the biliary 
ducts. In some cases the jaundice is accompanied with duodenitis 
and we have the yellow skin at the same time that the bile is flowing 
freely. See p. 401. 
Bichat first showed that where jaundice had existed during life there 
had sometimes been no obstruction in the liver or ducts; but in such 
cases there was more or less inflammation of that part of the tube into 
which the bile is discharged, and this observation led ultimately to the 
discovery of the connection between inflammation of the duodenum and 
jaundice. In speaking of the sympathies which depend on continuity 
of surface Bichat refers to the connection between the surfaces of the 
mucous membrane and the ducts that open into them, and endeavors to 
show that the natural mode of exciting all the secretory glands is a 
stimulus applied to the surface on which their ducts open. As examples 
he instances the effect of food and other substances to the mucous 
membrane of the mouth in stimulating the salivary glands; the effect 
which stimulants applied to the conjunctiva or nose have on the lachry- 
mal glands. Hence it is concluded that when the mucous membrane of 
the duodenum is thrown into a state of excitement we may have a con- 
sequent affection of the liver, for the duodenum has the same relation 
to the liver that the mouth has to the parotid gland. 
It is now decided that the cause of yellowness in what is called 
yellow fever, is disease of the upper part of the digestive tube, in which 
the duodenum is always involved; and that the disease itself, (the 
Typhus Icterodes of some nosologists), has been found to be to a 
large extent connected with inflammation of the stomach and duode- 
num. During the epidemic of 1826 many cases of the fever prevailing 
presented a striking resemblance to yellow-fever, in intense jaundice 
and inflammation of the upper part of the digestive tube. In the in- 
vestigations of Bush and Lawrence on yellow fever we find that few 
bodies were examined by them in which there wTas jaundice in connec- 
tion with liv#r disease, but in all cases there was intense duodenitis or 
enteritis. 
And even where the duodenum is not inflamed, continued use of calo-1 
rnel may cause an irritated condition of the duodenum as well as of 
the whole system. The large quantities of green bile poured out by 
the liver produce the greatest irritation. When this excessive flow of 
bile exists as the result of febrile irritation of the liver and duodenum 
allopathic doses of calomel (by causing medicinal aggravation), keep 876 
DISEASES OF THE SANGUINOUS FUNCTION. 
up this discharge and all its disastrous accompaniments. Ptyalism 
can not here be induced by any quantity or repetition of doses; and, if 
it could, would not arrest the disease until the force of the fever is 
broken by other means. “ Calomel,” says Dr. Monette, “ is the Sampson 
of the Materia Medica, and like him has slain its thousands when 
wrongly directed. It is generally improper when the tongue is clean 
and red, whether it be dry, or smooth and moist; also when the tongue 
is dry and rough, whether brown or red. These appearances always 
show different grades of mucous inflammation, and in all of these calo- 
mel (as well as quinine), is injurious.” 
This picture by a good observer is well drawn, and fortunately so 
much truth needs not to be thrown away, because it was spoken by an 
author who then did not see its full value. By “ turning the picture up- 
side down” it becomes more true to nature and to our purposes than it 
was to those of the author. The picture he gives us of the injurious 
effects of calomel is that precisely which we would have tried to draw 
of the curative powers of that celebrated agent when used in an at- 
tenuated form. 
Causes.—Ulceration of the duodenum has been excited by causes 
acting only on the surface of the body. Mr. Carl (in Med. Chir. Trans- 
ac. Yol. 24) gives twelve cases which originated in burns. It is certain 
that the burns could not by direct action produce this injury. It must 
depend upon the diseased constitutional state caused by the burn. A 
transfer of this diseased constitutional state, induced in the skin by a 
burn must have taken place, and thus the lining membrane of the in- 
testinal tube became affected. 
Treatment.—See pages 410 and 574. 
10. GASTRO-ENTERITIS. 
Broussais, in his “ Medical Doctrines and Symptoms of Nosology? 
gives in a compact form a synopsis of the modern doctrine on this 
subject. 
first.—Inflammation of the mucous membrane of the stomach can 
never be verified by dissection, but in connection with inflammation of 
the internal membrane of the small intestines; it should therefore be 
called “ gastro-enteritis.” 
Second.—Inflammation of the internal mucous membrane of the small 
intestines is sometimes seen in the dead body without any correspond- 
ing state of the stomach; but this isolated enteritis can never be posi- 
tively recognized in the living body. 
Third.—Gastro-enteritis presents itself in two forms, the one being 
marked by the predominance of the gastric, the other by the excess of 
intestinal disease. The pain of stomach, the nausea, vomiting, and in MILK-SICKNESS. 
877 
ability to bear nourishment characterize the gastritis; the power of 
satisfying the thirst, the rapid absorption of fluid swallowed, are signs 
of the predominance of enteritis. The other symptoms are common 
tt> both, with few exceptions. 
Fourth.—Acute inflammation of the mucous membrane of the small 
intestines, without affection of the peritoneum, is not attended with 
colic pain, in the majority of cases, but only with a sense of heat, or 
malaise, or constipation of the bowels. Invaginations of this part of 
the intestines seldom cause ileus, or even pain, except slight colic. 
Fifth.—Colic, diarrhoea, and tenesmus are the proper signs of in- 
flammation of the mucous membrane of the colon. 
Treatment.—See Gastritis. 
11. ENDEMIC GASTRO-ENTERITIS.—Intestinal Paralysis. Milk Sickness. 
Milk-sickness is an endemic disease known only in certain localities 
of the new and little cultivated parts of the Western States, unknown 
to foreign authors. 
The Disease in Animals.—In its active form the animal is affected 
with universal tremor, lassitude and inability to make physical exertion ; 
it is restless and anxious; the muscles are rigid and lose their power 
of action, after being fixed for some time in one position. Cattle have 
been mangled and torn by hogs while they lay trembling and un- 
able to move. Thirst is ungovernable ; and the drinking of water only 
hastens the fatal termination. The bowels are completely constipated 
and there is a peculiar foetor arising from the skin. The appearances 
on dissection show that the intestines have lost all vital power before 
death ; and their contents are dry and parched. In animals the dis- 
ease commonly runs for some time an insidious course, and its existence 
is not suspected till the milk, cheese or beef is eaten. The first alarm 
is often excited by the sudden seizure of the calf with the characteristic 
“ trembles ” and vomiting immediately after it has sucked heartily. 
Dogs, hogs and buzzards have been often found dead by the side of 
dead bodies on which they had been feeding. Animals that recover 
scarcely ever regain their former strength. We have seen dogs attacked 
by the “ trembles” after running, though they had been for many years 
considered as fully recovered from the original diiease. 
The Disease in Man.—When the quantity of the poison taken has 
been small, there is at first only a feeling of weakness, stiffness of the 
joints, especially the knees, trembling and anxiety, great depression of 
mental and bodily powers, oppression of the stomach, nausea and con- 
stipation. The pulse is slow and irregular, or excited as if by some ir- 
ritating agent. In some cases the patient, by remaining quiet, may 
escape the impending attack, but the slightest exertion develops the 878 
DISEASES OF TIIE SANGUINOUS FUNCTION. 
effects of the poison. Suspected animals, when offered for sale, are 
tested by subjecting them to violent exercise, which speedily reveals 
the presence of the poison by bringing on a paroxysm of the character- 
istic “trembles.” 
In the more active form the patient is suddenly seized with vomiting, 
peculiar distress and burning at the pit of the stomach ; anxiety, rest- 
lessness, anxious and uneasy countenance, with great prostration. 
Vomiting gives but a few minutes rest, when the same symptoms re- 
turn. Unquenchable thirst calls constantly for water alone, which in 
a few seconds is rejected by the stomach. All cold drinks increase 
the vomiting, though it returns at regular intervals if nothing be taken. 
There is a peculiar foetor from the body which none can mistake who 
have once entered a room pervaded by it. This symptom is often the 
first to excite alarm, and purgatives are often resorted to, to avert the 
dreaded attack. As the disease progresses, the extremities become 
cold, though the heat of the chest and epigastrium is increased. There 
is little apparent fever, though the skin is dry, without huskiness ; often 
it is cool and natural. The face, though cold, often shows the external 
appearance of high fever, with dusky purplish hue, showing want of 
action in the extreme arteries, especially of the lungs. There is violent 
palpitation of the heart, a peculiar burning distress, a feeling of heavy 
nausea, or other extreme uneasiness at the pit of the stomach ; and this 
organ being contracted into a globular mass by the spasmodic action 
of its muscular fibres, is believed by the patient to contain a quantity 
of some acrid substance that could be expelled by vomiting. There is 
constant desire to change the posture of the body, and the limbs are 
constantly thrown into new positions. The tongue is clean, though 
slightly furred; pulse not much excited. The matters ejected from the 
stomach are generally without color, sometimes dark-green, and of a 
ropy consistence. In the latter stages of the disease, the symptoms 
increase in severity; and though after four or five days the vomiting 
ceases, the nausea still continues to be as distressing as ever. The 
bowels seem to have lost all vitality; the brain becomes implicated, 
and there is a low muttering delirium, with great insensibility and 
torpor of the whole system. In some cases the black or “ coffee-grounds 
vomiting” precedes the termination in death. 
Diagnosis.—Milk-sickness may be distinguished from acute gastritis 
by the constantly recurring vomiting, which in gastritis only takes place 
when something is swallowed which irritates the stomach. The peculiar 
foetor of the body and of the matters vomited is clearly characteristic ; 
and the extreme torpidity of the intestines, as if from complete para- 
lysis, is so different from constipation arising from deficiency of the 
natural secretions, that it could hardly be mistaken in a district where 
milk-sickness could be suspected. In late years congestive fever has MILK-SICKNESS. 
879 
often simulated this disease, but the former is generally traceable to 
the commonly-known existing causes of fever, and the manner of attack 
in the two diseases is quite different. 
Cause.—The only cause of milk-sickness is a specific poison re- 
ceived into the human system by the taking of animal food Avhich con- 
tains it. What this poison really consists of has never been definitely 
settled. After reviewing many thousand pages devoted to the discussion 
cf the subject, I am satisfied that the cryptogamic vegetable theory is 
the only one that can explain the immense mass of conflicting facts we 
have collected. In 1840, Dr. Winans, of Green county, Ohio, gave the 
opinion, “ that the disease is produced by the Champignon, or at least 
some of the mushroom tribe. It never prevails except adjacent to thick, 
shady forests. When woods are cleared off, it vanishes; and it never 
prevails in prairies or open grounds of any kind.” He says, he was led 
to this opinion “ by reading of the poisoning of some inhabitants of the 
West Indies by champignons or mushrooms. Those gathered from 
dense forests were poisonous, while others from open grounds were 
eaten with impunity. I notice in our forests many mushrooms of small 
growth and gaudy colors, some deep-red, others yellow or brown, I also 
observe many growing upon beds of moss, of which animals are remark- 
ably fond.” * 
It is not probable indeed, that any of the large species of mushrooms, 
which are common objects of botanical observation, can be proved to be 
the cause of this mysterious disease; but there are vast numbers of 
smaller fungi which escape the attention of naturalists, though all of 
them are known to be poisonous. The localities suited to their growth, 
their habits, minute size and well-established toxicological properties 
indicate some species of the tribe as the probable source of this fatal 
disease, which has furnished a subject of curiosity and wonder during 
the whole of the present century. 
Of the many supposed causes of milk-sickness it is not now necessary 
to speak at length. In Eastern Ohio it has been attributed to the Caltha- 
palustris, or marsh marygold. In a part of Kentucky it was believed 
to be caused by the Symphorea-glomerata. On the Wabash it was 
ascribed to the Eupatorium-ageritoides ’ and by others to the Ehus- 
toxicodendron. In Tennessee Dr. Nagle recently reached the con- 
clusion, that the disease could be artificially produced by feeding 
animals with fungus-grass.f But of all these plants it is sufficient to 
say, that they all grow in profusion in places where this peculiar dis- 
ease was never seen; and that they are all well-known, and have failed 
to cause the disease in any authenticated case when fully tried. This 
* Western Medical Journal. 1840. p. 191. 
t Nashville Journal. Oct. 1859. 880 
DISEASES OF THE SANGUINOUS FUNCTION. 
disease has originated in places, where no unknown plant, large 
enough to attract the eye of a botanist, could by any search be found. 
The examination of mineral waters has led to no better results. The 
sickening of some of Lewis and Clark’s men on the first exploring ex- 
pedition to Oregon in 1804, is referred to, as furnishing an analogous 
case ; and the spring from which they drank was said to contain Cobalt 
or Arsenic. More recently Dr. Evans, of Monroe county, Ky., has at 
tributed the disease to water in the vicinity of a lead-mine. But all 
reasonings of this kind seem to be set aside by the fact, that we have 
often seen localities where milk-sickness has displayed its most fearful 
powers and ivhere no water of any kind could be found. 
All observations yet published refer us at last to the poisonous 
cryptogamic plants, perhaps those of the most minute size, for an ade- 
quate cause of a disease involved in so much mystery. All other 
plants are better known, and, when rigidly tested, produce no disease 
resembling the object of our present search, though many of them are 
known to be poisonous. 
Pathology.—In the most strongly marked cases, the first stage, or 
that of depression, is probably one of congestion of the stomach and 
large intestines, and this is followed by inflammation of these organs. 
The torpor of the whole nervous system is such, that but little effect is 
at first produced by any remedy that has been tried. At a later stage 
gastritis and spasmodic or paralytic suspension of the functions of the 
large intestines, especially the colon, prevents the passage through the 
prima via of any thing taken into the stomach. The extension of in- 
flammation to the diaphragm is pointed out by the hiccough, which, 
though a symptom of gangrene in many other diseases, is not so here. 
Some patients have lingered more than two weeks and then died with 
the usual symptoms of gangrene, and yet on dissection there was no such 
thing found, and death appeared to have resulted from complete ex- 
haustion. 
Prognosis.—The disease is dangerous according to the violence of 
the attack and the degree of influence exerted by medicines. Children 
are less liable to take it, and they also recover more easily than older 
persons. Intemperate persons are more susceptible than others, and 
their cases are less manageable, in consequence of the impaired con- 
dition of their digestive organs and the general enervation produced by 
habitual stimulation. 
Treatment.—The disease in its worst forms has hardly ever been 
subjected to homoeopathic treatment. Nearly all who have encountered 
it, have tried to restore the natural action of the stomach and bowels 
by purgatives, and scarcely ever with success. Every thing given pro- 
motes the persistent vomiting. Even Calomel is generally rejected, 
and when retained, it produces little effect. Enemas also fail to reach MILK-SICKNESS. 
881 
the seat of the obstruction. When mild purgatives and enemas have 
re-excited the natural peristaltic action of the intestines, a slow re- 
covery has followed; active purgatives have always failed. Croton- 
oil has been often tried, but it only increased the irritability of the 
stomach without any purgative operation. JSfux-vomica would effec 
the object by a different process. 
It was long a popular and not unsuccessful practice in the Western 
States to administer various animal oils, as lard, butter, goose oil, bear’s 
oil, &c. Another successful mode sometimes resorted to consists in 
introducing into the colon, through the sigmoid flexure, a gum-elastic 
tube about eighteen inches in length, and injecting through it a large 
quantity of some warm oleaginous liquid. The best thing for this pur- 
pose is chicken-broth. As soon as one, two or three quarts of this fluid 
are thrown into the abdomen, which becomes largely distended with it, 
the skin and the whole system give evidence of an immediate change 
for the better. The relaxed skin is immediately covered by a gentle 
perspiration ; the pulse rises in strength at the same time that it di- 
minishes in frequency (from one hundred and twenty-four to eighty per 
minute). All the soothing, relaxing influences of the warm bath, all 
the benefits promised by the use of oils and mild purgatives, are directly 
gained at the same time that the sinking powers of life are supported 
by a nutritious fluid which is rapidly absorbed from the whole surface 
of the large intestine. 
Homoeopathic Remedies.—The most reliable will be found to be 
Arsenicum, Tabacum, Veratrum, Nux-vomica and Antimonium. 
Arsenicum.—Countenance sunken, nose sharp, face pale, and covered 
with cold sweat, expression of fear, anxiety, of utter misery; lips and 
tongue bluish, distorted by twitching movements; tongue burning, or 
cold and moist, white in the middle ; disgusting taste ; nausea extremely 
distressing; appetite when returning, capricious, morbid; thirst un- 
quenchable ; hard retching and persistent nausea before vomiting and 
continuing constantly after it; constriction and cramp-like contraction 
of the stomach; vomiting always after drinking; burning sensation in 
the stomach with pain in the abdomen and nausea; pressure on the 
epigastrium causes uneasiness; burning heat in the intestines ; respira- 
tion much oppressed, shortness of breath; action of the heart weak and 
quick; hiccough ; hands and feet icy cold; hands trembling; hands and 
forearms livid as in the cold stage of cholera; coldness of the hands, 
feet, face, nose and ears; with great prostration and debility; coldness 
of the body can not be diminished by external warmth; cold thick per- 
spiration on the skin; convulsive, small, rapid, irregular pulse, hardly 
perceptible. Great physical restlessness and anguish ; eyes sunken; 
unable to lie still for a moment; throwing himself here and there in- 
cessantly, and tossing from side to side; followed by relaxation and 
Vol. I.—56- 882 
diseases of the sanguinous function. 
physical apathy; sudden and involuntary muscular contractions; 
paroxysms of fainting during which the coldness of the surface in- 
creases ; emaciation, and rapid diminution of flesh. 
12. ENTERITIS. 
Under this head we shall proceed to describe two varieties of in- 
testinal inflammation, the peritoneal and muscular, and that of the 
mucous membrane. The older writers have confounded peritoneal en- 
teritis with ordinary acute peritonitis; but the researches of modern 
pathologists have pointed out the true location and nature of these dif- 
ferent maladies. 
peritoneal enteritis. 
Diagnosis.—Lassitude, rigors, chills, acute pain in some part of the 
abdomen, swelling and exceeding tenderness in the affected part, nau- 
sea, vomiting, obstinate and persistent constipation, urgent thirst, bit- 
ter taste, loss of appetite, parched mouth, hot skin, inspirations short 
and painful, position on the back with knees drawn up, and inclination 
to preserve the recumbent posture, pulse frequent, tense, contracted 
and irregular, urine scanty and high colored. 
The above symptoms will be modified according to the particular lo- 
cation of the inflammation. If the small intestines are the principal 
seat of the disorder, symptoms will obtain which simulate gastritis; 
if the colon be the part affected we may expect symptoms resembling 
hepatitis to be present. This form of enteritis is violent and rapid in 
its course, and according to most writers is “ particularly prone to ter- 
minate in gangrene. When this termination is about taking place the 
pain suddenly subsides, the pulse sinks rapidly, the countenance be- 
comes pale and cadaverous, the extremities cold, the surface covered 
with a cold clammy sweat, and hiccough, slight delirium, and oc- 
casionally convulsions close the scene. This affection is seldom pro- 
tracted beyond the seventh or eighth day, without terminating either in 
resolution or in death.’’ (Eberle.) 
Causes.—The employment of irritating cathartics like calomel, jalap, 
croton-oil, aloes, scammony, colocynth, gamboge, &c., poisons, alcoholic 
liquors, sudden suppression of accustomed discharges, repelled erup- 
tions, worms, external injuries, persistent constipation, atmospheric 
changes. 
Treatment.—Arsenicum, Veratrum, Aloes, Aconite, JVux-rom., 
Lycopodium, Opium, Ipecacuanha, Sulphur, Plumbum, Phus- 
tox.) Ac.-cuprum. 
Administration.—The principal remedies in the treatment of this 
malady are Arsenicum and Veratrum. They may be given at the FOLLICULAR ENTERITIS. 
883 
third potency, at intervals of one to four hours, according to the severity 
of the symptoms. Should vomiting be very violent and persistent, after 
the proper administration of Arsenicum or Veratrum, recourse should 
be had to Ipecac., third attenuation. When the inflammation attacks 
the large intestine, Aloes and Plumbum may be given in some cases, 
at the third dilution, after Veratrum and Arsenicum. If the disorder 
has arisen from repelled eruptions, or metastasis of rheumatism, gout, 
erysipelas, &c., we may resort to Sulphur, Phus, or Ac.-cuprum, as 
circumstances require. During the course of the disease Aconite will 
occasionally be found useful in controlling the action of the heart and 
arteries. It may be given at the second potency, either alone or in al- 
ternation with another appropriate remedy, according to the symptoms. 
Auxiliary to the above remedies, the employment of fomentations, 
either of warm or cold Avater, as the case may demand, prove of eminent 
service. Cloths should be wrung out, and applied over the affected 
part, (care being taken to protect the body-linen and bed-clothes), re- 
newing them once in fifteen or twenty minutes, when the inflammation 
and pain are severe. 
13. FOLLICULAR ENTERITIS. 
Structure of tlie Gastro-Intestinal Mucous Membrane. — The 
Epithelium, which lines the whole alimentary canal with all its ap- 
pendices, even to the minutest ramifications of their tubes, also covers 
the skin; it forms the surface of all the serous and synovial cavities, 
and lines the heart, blood-vessels, lymphatic glands, and all other se- 
creting surfaces. On the external surface of the body, it consists of 
numerous layers of minute scales or laminae which are easily separated 
by rubbing the skin with a flesh-brush. These scales are formed by 
the drying of the vesicles or cells of which the epidermis primarily 
consists. The structure of the epithelium which lines the mucous 
membrane of the intestinal canal is essentially the same. It consists 
of spheroid cells of very small size, each containing within it a roundish 
oval nucleus, which is a hollow sphere, and sometimes encloses within 
it a nucleolus more minute. They are situated on a primary membrane, 
from which they appear to grow; are bound together by a delicate tis- 
sue, and are believed to perform important services in the function of 
secretion. The epithelial cells are constantly undergoing the process 
of further development. Those composing the outer layer burst and 
discharge their contents, and the next layer of cells is pressed forwards 
to supply the place of the former. “New cells,” says Sharpey, “are 
developed from germs contained in the basement m,embrane, and are 
formed and nourished from the blood which transudes from the blood- 
vessels beneath. No vessels enter the tissue of the epithelium, but the 
nutrient fluid penetrates a certain way into the growing mass, and the 884 
DISEASES OF THE SANGUINOUS FUNCTION. 
cells continue to assimilate this fluid, and pass through their change? 
at a distance from, and independently of the blood-vessels.” Even in 
the finest vascular network of mucous membrane, as well as in the mus- 
cular structure, the nutrient fluid, on exuding from the vessels, has to 
penetrate the adjoining mass by transudation, in order to reach and 
yield new substance at every point where secretion or renovation is 
going on. 
As the mucous membrane of the alimentary canal performs the im- 
portant function of absorption, and its covering of epithelial cells are 
at the same time the agents by which the secretion of mucous is ef- 
fected, its structure must be highly complicated. The extent of its 
surface is prodigiously increased by means of numerous folds and pro- 
jections, as well as by the pits or follicular depressions dispersed along 
its whole extent. And it is believed that the function of absorption 
is performed by the epithelial cells of the villi which cover the folds 
and projections on this surface ; while that of secretion is performed by 
those cells which line the follicular pits and depressions dispersed along 
its whole extent. The villi, like the spongioles of the roots of plants, 
are endowed with the peculiar property of selecting the nutritive fluid 
and conveying it to the lacteals. These absorbents do not reach into 
the extremity of the villi; and they do not open on the surface of the 
mucous membrane by any appreciable apertures ; but the end of each 
villus is composed of a loose spongy tissue, in which a number of cells 
may be seen in various stages of development, during the process of 
absorbing the chyle. 
In health this delicate surface of the mucous membrane is either of 
a grayish-white or yellow color, from the coloring principle of the bile, 
or of a darkish livid hue, from the imbibition of blood. It adheres 
closely to the subjacent tissue, and can only be detached with difficulty. 
The solitary glands of the small intestines and colon, as well as the 
villous layer and the glands of Lieberkuhn, are invisible to the naked 
eye. The patches of Peyer’s glands may be distinguished at the ear- 
liest period of life by their greater opacity when the membrane is held 
up to the light. When distinctly seen they are always in some degree 
diseased. The largest patches are situated near the ilio-caecal valve; 
the smallest are in the jejunum. They vary in number from 18 to 36 
patches, and are referred by pathologists to atrophy of the mucous 
membrane. 
In the first stage of this follicular enteritis, when the disease consists 
chiefly of an abnormal development of the mucous follicles of the di- 
gestive organs, the fever and irritation can always be removed by 
change of air, proper temperature and clothing, restricted diet with oidy 
a few doses of Aconite and perhaps Calcarea-carb. or Merc. The 
child should occupy a large airy room ; should lie on a mattrass rather FOLLICULAR ENTERITIS. 
885 
than on a feather-bed; and cleanliness and comfort should he secured 
by proper washings, bathings, &c. When there is much fever, dryness 
of skin and restlessness, a warm bath procures better rest and dimin- 
ishes the internal local disease. It may be repeated at intervals regu- 
lated by the violence of the fever, and continued each time just long- 
enough to show evident relaxation. If the external heat should be in- 
creased by the bath it will be found to have reduced the internal irri- 
tation, and this is always a real gain which facilitates recovery. 
The diet should be regulated with the greatest care. Nothing is so 
good for a child in health, as the mother’s milk when it is perfect; and 
when her health is good it must be almost exclusively relied on, giving 
reasonable care in her choice of food and attention to health in all 
other respects. But there are cases in which the mother’s milk acts 
as a poison, even when her health is considered good. In these cases 
it acts as a drastic purgative, passing off from the bowels in a curdled 
state, undigested, but giving severe griping pain. Here it is necessary 
to prohibit the milk entirely. Sometimes by changing the food for a 
single day the child so far improves as to be able to bear the milk 
again; but in other cases it never agrees with the child again. 
Diagnosis. — First stage, diarrhoea, succeeded about the second 
day, sometimes later, by vomiting and remittent fever with evening 
exacerbations. Pulse varying with the fever, small and quick, or full 
and tense; slight delirium, when the brain is sympathetically affected; 
there is then a fierce wild expression of the countenance, which at 
other times is bright and animated; the stools are thin, watery, pasty, 
or mushy, and variable in color, sometimes resembling mucus in color, 
or like eggs chopped and scalded with water. The vomiting occurs 
three or four times a day, the matters thrown up consist of the food 
but little changed, or only mixed with mucus. The milk of the nurse 
is thrown up in an acid, coagulated state. The skin is generally dry, 
warmest on the head and abdomen, while the lower extremities are 
cooler; respiration little affected; tongue moist, red at the tip and edges, 
with a yellow or brownish coating toward its base; sleep generally 
quiet, except when the fever is highest: the child is then irritable and 
restless. As the disease progresses the abdomen grows tense, tumid, 
painful on pressure; and the thirst becomes more intense. 
Characteristics of 
Frequent discharges from the bowels. 
The bowels are primarily affected. The 
cerebral symptoms occur only in the 
later stages of the disease ; there is then 
drowsiness or stupor. The rattling of 
Follicular Enteritis. 
The bowels are usually torpid; the 
brain is the primary seat of the disease, 
and it eommonly occurs in delicate 
scrofulous children. The pain in the 
head is intermittent, and is manifested 
Tubercular Meningitis. 886 
DISEASES OF THE SANGUINOUS FUNCTION. 
wind in the stomach and the lenticular 
spots seen in typhoid fever are absent, 
and there is agitation and delirium at 
night. 
by a peculiar cry, disturbed sleep, toss- 
ing about of the hands, rolling of the 
head from side to side, moaning, grinding 
the teeth, delirium, and a peculiar ex 
pression of countenance ; the drowsiness 
and stupor often accompanied by con 
vulsions. 
Causes.—The heated, confined, and impure air of the city in summer 
acts directly on the skin, and indirectly on the mucous membrane. 
The irritation of the teeth during the process of dentition, produces in- 
flammation and even ulceration in the lining membrane of the mouth; 
and since the same membrane extends throughout the whole intestinal 
canal, the irritation is usually propagated along this delicate surface, 
producing indigestion, vomiting or diarrhoea; and at the same time there 
is also increased development and activity of the muciperous follicles. 
If this period of infantile life could be passed in a pure atmosphere of 
a moderate temperature, the disturbance of the health caused by denti- 
tion might not be very great; but it is always sufficiently so to strongly 
predispose to disease, and to aid other agencies in exciting or perpe- 
tuating diseases of the most serious character; and often such maladies 
are excited by dentition alone. The other causes which originate the 
fatal “summer-complaint” of cities and towns are: improper food 
whether too stimulating or indigestible; irritating drugs; vicissitudes 
of temperature; insufficient clothing in the summer, when hot days are 
succeeded by cool nights; intestinal worms, and all other irritating 
substances originating in, or received into the digestive organs. But 
in addition to all these causes which operate in the country as well as 
the metropolis, there is certainly a zymotic or other poisonous miasm 
in the air of all large cities, which conspires with bad diet, bad clothing 
and inefficient medical treatment to originate this disease, as well as 
render it more unmanageable when excited by other causes. A large 
proportion of the cases in large cities occur in ill-ventilated houses, 
situated in courts and alleys in which bad air stagnates, and filth ac- 
cumulates, where light is deficient, and where heat during the summer 
months is intense. 
Pathology.—Effects of Congestion. 1. In the mucous membrane. 
The membrane presents a rose-red or cherry-red color, diffused in iso- 
lated patches, or in arborizing trunks. It is diminished in consistency 
but still adheres firmly. 
2. The glands of Peyer, which occupy the free border of the intes- 
tine, are rendered more red and prominent. These glands are only 
mucous follicles which are not perceptible until about the fourth 
month, or about the time when nature by pushing forward the teeth is 
preparing the digestive organs to digest and assimilate a higher order 
of food, they are found distributed over every part of the intestinal sur- FOLLICULAR ENTERITIS. 
887 
face, and each receives an artery, a vein and a nerve. These follicles 
perform an active part in the process of digestion by furnishing the 
surface of these organs with a fluid which assists in the elaboration of 
the food. In carnivorous animals, as dogs and lions, they are largely 
developed. From them is usually discharged the excess of mucous 
fluids thrown off by diarrhoea at the time of teething. In severer cases 
of cholera infantum and follicular enteritis they are inflamed, and in 
protracted cases are destroyed by ulceration. 
3. Inflammation of the Peyerian Glands.—When this disease has 
continued in the chronic form the patches show gray-blue or slate-gray 
color, contrasting with the mucous membrane, which is quite pale. The 
tissue appears atrophied or elevated according to the stage at which 
death took place. As inflammation of the Peyerian glands constitutes 
the essential pathological basis of follicular enteritis, or summer com- 
plaint; so a continuation of the same diseased action in the same 
glands becomes the anatomical base of marasmus or atrophy. These 
inflammatory affections are extremely common; whereas enlargement 
of the mesenteric glands, aphthous formations, gastro-malacia, &c., are 
comparatively rare. 
4. Softening of the Intestinal Mucous Membrane.—This patholo- 
gical change of structure occurs more frequently in the small intestine 
than in the colon. The adhesion of the mucous membrane to the tis- 
sue below it is lessened; it becomes oedematous, homogeneous, pulpy, 
and easily lacerated. When this state continues long, the red color it 
presents in earlier stages disappears, as the inflammation subsides. 
The softened membrane becomes white, in the same manner as the 
softened brain does in ramolissement, and from the same cause. 
It is thus seen that acute inflammation of the Peyerian glands is the 
most frequent and dangerous of the diseases of children during the first 
and second years of life. That it is a real inflam7nation is proved by 
the fact that tubercular disease is seldom complicated with it, inflam- 
matory affections of the lungs and purulent effusion in the brain are 
quite common, and frequently cause the fatal termination. 
In children of a tubercular diathesis, secondary acute inflammation 
of Peyer’s glands, as well as of the solitary glands, often occurs; but it 
is observed that abdominal tubercles and typhoid fever belong almost 
exclusively to the second and later years of life; whilst follicular ente- 
ritis is peculiarly severe and fatal in the first year, which is to every 
child, especially in the city, the most perilous of earthly existence. 
“ In summer complaint, resulting apparently from dental irritation, 
the brain is predisposed to erethism; it is sympathetically affected; 
the irritation of the terminal branches of the second and third divisions 
of the fifth pair is transmitted through the pneumogastric and sympa- 
thetic system of nerves, on the organs of assimilation, giving rise tc 888 
diseases of tiie sanguinous function. 
the various phenomena of this disease.” There are, however, cases in 
which the affection of the brain is primary. “ The fever, vomiting and 
diarrhoea, together wfith the general malaise, which are among the first 
symptoms, seem to point unequivocally to derangement of the nervous 
centres as the cause of impaired assimilation; these symptoms always 
originate from a brain lesion, whether induced by agencies operating 
primarily upon the tissue of the brain, or secondarily from irritation 
elsewhere. 
Prognosis.—Favorable.—When the pulse becomes slower, the skin 
warmer ; when the vomiting ceases, the alvine discharges become more 
frequent and natural; a gentle perspiration appears ©ver the whole 
surface. 
Unfavorable.—The pulse continues quick, feeble and more ir- 
regular ; the skin is cold, the discharges continue, increasing in fre- 
quency and resemble the washings of meat; the uneasiness and rest- 
lessness increase; the limbs are tossed about in restless agony, or be- 
come rigid and partially paralysed. Cerebral symptoms, as stupor, 
and delirium increase. The pulse becomes imperceptible, the surface 
cold. 
Treatment.—Prophylactic.—When the hot weather of summer ar- 
rives, examine the general condition of every child in which marks of 
indisposition are noticed; and if convenient let each be removed to the 
country, or at least to the most healthy situation attainable. From 
the commencement to the termination of the process of dentition the 
teeth should receive special attention. After the first teeth come 
through, the child may be allowed a greater variety in food; but what- 
ever is used should be often prepared fresh, and never kept long enough 
to permit it to undergo any change. Mucilaginous drinks, rice, barley, 
farina, pure starch, toast-water, sago, tapioca, and many other articles 
are in common use. 
Medical Treatment.—Follicular enteritis is in its first stage an in- 
cipient inflammation. As soon as all exciting causes of irritation are 
removed, Aconite will be found a specific for the congestive stage of 
the irritation and fever. It is indispensable when there is great heat 
of the skin, thirst, sleeplessness, or agitated sleep ; fretfulness with in- 
flammation of the mucous follicles imperfectly established. It may be 
alternated with Belladonna when the head is the chief seat of suffer- 
ing, or with Mercurius when the dysenteric symptoms are prominent, 
or with Calcarea-carbonica when the child shows imperfect develop- 
ment, rickets, softness of the bones, slow ossification, or scrofula. 
Second Stage.—The disease if not arrested in its first stage advances 
to the second, in which the same general features are presented, though 
in an aggravated degree. The vomiting becomes less frequent, but the 
alvine discharges are more painful, accompanied bv nausea and great FOLLICULAR ENTERITIS. 
889 
prostration; and the limbs are drawn up towards the abdomen. The 
matters evacuated become more watery, stained with blood, or more 
generally of a dark-green color. The abdomen now becomes tumid or 
painful on pressure; its temperature increases while the extremities 
are cool. As the disease progresses, the pulse increases in frequency 
from one hundred and thirty to one hundred and fifty per minute, and 
often intermittent, irregular or entirely imperceptible. Emaciation pro- 
gresses till the skin hangs about the neck in folds ; the eyes are sunken 
in the orbits, with a dark areola around each; the nose becomes sharp, 
the lips shrivelled, the feet oedematous; the skin loses its sensibility, 
and the flies are permitted to collect on the face; petechise come out 
on the skin ; the tongue is dry, encrusted and covered with aphthae; 
deglutition is painful; the mouth dry and the child thrusts its fingers 
far back towards its throat. The appetite is capricious; thirst constant; 
an eruption of minute vesicles often come out on the chest. As death 
approaches, the brain becomes more strongly engorged with blood 
the eyes are suffused, the lids tumid, conjunctiva injected; the pupils 
are generally dilated, though they contract on exposure to light; the 
hand is frequently raised to the head; twitchings of the muscles, and 
throwing back the head, portend convulsions, which often terminate in 
death. 
Pathological Appearances.—Autopsical examination of children 
who die of the disease at this stage, show: Inflammation and softening 
of the mucous membrane; ulceration of the follicles, particularly of the 
large intestine. The inner surface of the stomach is less changed, 
though it is sometimes injected and softened; the change of structure 
extending to all the coats. More frequently there is found a layer of 
whitish opaque mucous covering the lining membrane of the stomach; 
the mucous follicles of the stomach and intestines are visible, the mu- 
cous membrane of the latter being softened and pale. The duodenum 
is often inflamed, presenting a shade of pink, with injection of the 
minute vessels. The large intestine is generally inflamed and softened, 
sometimes in bands extending longitudinally for several inches, injected 
with fine arteries, and of a deeper red than the surrounding membrane. 
In some cases the whole lining membrane of the colon is thickened and 
of a vivid red. The follicles of the colon, having been the points first 
inflamed, proceed to ulceration as the inflammation extends to the sur- 
face around them. The rectum presents the deepest ulcerations; its 
lining membrane being thickened, inflamed, or covered with a thick 
layer of mucus. 
The brain or its membranes, in all cases after death consequent on 
the above symptoms, present marks of active disease. The pia-mater is 
more or less distended or injected. The arachnoid is pale and moist, 
with effusion into the sub-arachnoid cellular tissue. When the brain 890 
DISEASES OF THE SANGUINOUS FUNCTION. 
itself has not been the seat of active inflammation, it is usually injected 
showing that congestion had existed at the time of death. 
Treatment of Follicular Enteritis in the Third Stage.—1. Aconite 
is specific for the hot and dry skin, flushed face, tormina and tenesmus; 
pain in the head and back; flushes of heat alternating with chills; 
burning pain in the abdomen ; eyes glistening and painful, suffused and 
red; urine high-colored; alvine-discharges watery, frequent, attended 
with nausea and exhaustion, manifested by paleness and perspiration, 
followed by reaction and fever; mourning and weeping. 
Belladonna, in alternation with Aconite, in all the periods of active 
febrile excitement. 
Mercurius-solubilis.—This "with other preparations of Mercury is 
peculiarly applicable in cases in which the symptoms most resemble 
dysentery in children that exhibit scrofulous tendencies, who are often 
affected with glandular swellings of cutaneous eruptions. They are 
pale, sickly ; precocious in intellect; suffer much from slow and imper- 
fect dentition, during which the superficial glands about the neck are 
enlarged. When the intestines become slightly irritated from any 
cause, the resulting inflammation assumes a dysenteric form. Consti- 
pation is more or less complete ; and instead of natural faeces the evacu- 
ations consist of bloody mucus, passed with pain, tenemus and nausea. 
In other cases of cholera-infantum, in which the stools are watery and 
of a dark-green color, frothy, or composed of undigested, chopped mat- 
ter, mixed sometimes with dead lumbrici, Mercurius has given imme- 
diate relief. When the chronic stage, usually called marasmus, com- 
mences, when emaciation is progressing, and aphthous crusts begin to 
form on the lining membrane of the mouth, Mercurius-sol. generally 
destroys the parasites of which the crusts consist. 
Ipecacuanha.—Serous diarrhoea, with vomiting of green or white 
mucus, with much griping pain; nausea, eructations, flatulent colic, 
faintness from excessive efforts to vomit, pain in the head relieved by 
vomiting. 
Bryonia.—Diarrhoea, thirst, and vomiting, caused by cold or by ex- 
cessive hot weather. The heat is more internal than on the surface. 
Digestion is imperfect; all food disagrees, causing acidity, pain in the 
head, pleuritic pain in the sides of the chest, constipation, dry cough 
with quick, anxious breathing. 
Dulcamara.—The diarrhoea is excited by exposure to cold, damp 
air, and commences with cold and aching in the epigastrium. 
Veratrum-album. Senna, Kreosotum, Tartar-emetic, Arsenicumy 
chronic cases tending to marasmus, Iodine, emaciation, Argentum- 
nitricum. Rhus-toxicodendron. 
Choleka Infantum.—Croton-tiglium. Vomiting; purging; stools 
watery; sunken countenance; cold extremities ; fever of remittent type ACUTE PERITONITIS. 
891 
stools light-colored, at times offensive; emaciation; cadaverous coun- 
tenance; sunken eyes; stools resembling gray neurine and marked by 
extreme and sudden debility after each evacuation, sometimes compli- 
cated with dentition, and constituting that formerly called “ nervous 
diarrhoea,” intermittent diarrhoea.* 
14. ACUTE PERITONITIS. 
Diagnosis.—Three varieties of this disease have been recognized, 
viz: first, acute peritonitis; second, puerperal peritonitis ; third, chro 
nic peritonitis. • ' 
1. Acute peritonitis is usually ushered in with more or less of the 
ordinary symptoms of fever, as lassitude, irregular chills, succeeded by 
flushes of heat, headache, frequent pulse, uneasiness, or pressure in the 
region of the stomach, nausea, and loss of appetite. These symptoms 
are speedily succeeded, and occasionally accompanied by a pain and 
tenderness in the abdomen, either confined to circumscribed points, oi 
universally diffused over its whole extent. Generally the abdomen is 
exquisitely tender and painful upon pressure, often rendering the weight 
of the bed-clothes intolerable; but in some instances the pain is slight 
from the commencement to the fatal termination of the malady. The 
tongue is moist and covered with a white fur in the first instance, which 
soon becomes dark and dry in the centre, with red edges. The bowels 
are constipated, but may be readily acted upon by appropriate reme- 
dies. The pulse is commonly frequent, tense, corded, wiry, though in 
some instances it varies but little from the natural standard. This, 
like most other inflammations of the abdominal viscera, imparts to the 
countenance a contracted, sharp and anxious expression, indicative of 
both acute physical and mental suffering. The patient inclines to re- 
lax those muscles which operate upon the abdominal parietes, and on 
this account we find him with his legs drawn up, his head and shoulders 
elevated, and his respiration short, imperfect, and exercised almost en- 
tirely by the muscles of the chest. 
In severe cases of peritonitis we have acute pain diffused over the 
whole abdomen, aggravated by movement or by pressure; even the 
weight of the bed-clothes is sometimes insupportable. The abdomen 
is swollen and inflated with air; the skin is hot and pungent; the 
pulse is frequent and small; the stomach irritable; the breathing hur- 
ried, and the countenance expressive of acute suffering. 
2. Puerperal peritonitis is that aggravated and specific form of the' 
disease, which occurs in females after confinement, and is known as 
puerperal fever. It differs from ordinary peritonitis in being more 
gudden and violent in its attack and in having a tendency to run its 
* 111. State Horn. Med. Association Proceedings. 1860. 892 
diseases of the sanguinous function. 
course with greater rapidity. It occasionally rages as an epidemic, 
and is by far the most agonizing and fatal disease to which women are 
exposed after parturition. Among the first symptoms are pain and ten- 
derness in the hypogastric region, occurring soon after delivery, and 
succeeded by chills, &c. The lochia are generally entirely suppressed, 
though some eminent authors assert, that they have found this dis- 
charge but little affected and never entirely suspended. The secretion 
of milk is also either partially or entirely suppressed ; and if the se- 
cretion has not yet taken place, it does not occur at all. In many cases 
of both forms of peritonitis the brain is affected at an early period and 
demands special attention. 
In regard to the precise character this malady may be likely to as- 
sume, much will depend upon the peculiar constitution of the individual, 
the season of the year, the prevalence of epidemic or contagious in- 
fluences. “There is,” says Dewees, “an entire extinction of the mater- 
nal feeling,” and this he regards as one of the most remarkable features 
of the disease. There is also strangury with frequent efforts to evacuate 
the bladder, producing constant burning pain. 
3. Chronic peritonitis, although often consequent upon a partially 
subdued acute attack, may also arise independently from sudden chan- 
ges of temperature, insufficient clothing, irritating food, external injuries, 
surgical operations and chronic bowel-complaints. Many of the symp- 
toms of this disease are like those of dyspepsia, as sensation of fullness, 
distention, weight, and occasional pains in the region of the stomach 
and bowels, constipation, loss of appetite, depression of spirits, restless- 
ness at night, distress and pain, aggravated after eating, emaciation, 
thirst, frequent pulse', foul tongue, &c. This form of peritonitis may 
terminate in a few weeks, or it may run on for a year or more, and then 
result in ulcerations opening into the intestines. 
Causes.—Certain occult conditions of the atmosphere ; undue ex- 
posure to cold ; excessive physical exertion ; injuries ; labor; miscar- 
riage ; over-exertion, when the organism is weakened by previous 
disease; atmospheric vicissitudes ; metastasis of rheumatism and gout; 
suppressed discharges, &c. 
Treatment.—The most important remedies in the treatment of peri- 
tonitis are: Aconite, Belladonna, Bryonia, Arnica, Bismuth, 
Chamomilla, Coffea, Colocynth, Ipecac., Mercurius, Nux-vom., Pul- 
satilla, Bhus-tox., Sulphur, Veratrum, Arsen. 
Administration.—We advise the employment of the first three at- 
tenuations, and a repetition of the dose every one, two or three hours, 
according to the urgency of the case. 
In the treatment of acute peritonitis we have, in most cases, relied 
upon Aconite and Belladonna in alternation, at the first dilution. We 
believe that nine out of every ten cases may be cured with these two ACUTE PERITONITIS. 
893 
remedies. When the malady has made much progress, and the vitality 
of the system has become much enfeebled, with weak and rapid pulse, 
tympanitic abdomen, parched mouth and tongue, cold extremities, deli- 
rium, and other phenomena of a typhoid character, Rhus and Arseni 
cum will be required. They may be prescribed in alternation, in the 
second or third dilutions. 
Should cerebral symptoms become strongly pronounced, in connec- 
tion with a marked typhoid condition, Opium or Belladonna may be 
required in alternation with Rhus or Arsenicum. Apis will be de- 
manded in cases tending to result in dropsical effusions, and in cases 
complicated with derangements of the kidneys or bladder. 
Should diarrhoea ensue during the progress of the disease, we may 
consult Arsenicum, Veratrum, Mercurius, and Ipecac. 
Opium.—In some extraordinary cases of abdominal inflammation 
some peculiar and little understood properties of Opium may become 
highly important. The action of Opium on the cerebro-spinal-nervous 
system is evident in the calmer and quieter condition of sufferers from 
peritonitis ; it renders the sensorium less impressionable and the system 
less liable to be exhausted by the disease. Its action on the sympa- 
thetic and vaso-motor nerves is probably similar, as it will relax con- 
tracted arteries, and admit a freer transit of the blood. This is pro- 
bably the rationale of its beneficial effects in the cold stage of ague, 
and in similar conditions; it does away with the contraction of the 
superficial vessels and skin. In many choleraic attacks, which have 
much resemblance at first to an attack of ague, a dose of Opium and 
chloric ether is of the greatest efficiency. So in exposure to severe cold 
and in gangrmna-senilis, the beneficial effect of Opium probably depends 
on its preventing the arrest of the circulation in the limbs and super- 
ficial parts, by keeping the arteries, especially the smaller vessels, re- 
laxed and patent. At the same time it protects the heart from the 
depressing, inhibitory influence of the cold, and so enables the circula- 
tion to be well sustained. The latter remark will also apply to the 
case of peritonitis and of the shock from burns. {Dr. C. Ilandfield 
Jones, in Brit. Med. Journal, 1861.) 
It is therefore a tissue sedative. If the action of the heart be in 
danger of failing from asthenia, the administration of Opium in my 
opinion is unsafe from this very sedative effect. Yet where the de- 
pression is the result of violent irritation in another part, as for instance 
in peritonitis, the action of the heart may greatly improve under the 
Opium. The narcotic, by rendering the cardiac ganglia less impres- 
sionable, takes off all the inhibitory effect of the peritoneal irritation. 
{Jones on Tissue Sedatives. British Med. Journ.—See Symp- 
toms of Opium, pages 706, 710. 
In peritonitis from rupture of the gall-bladder, strangulated hernia, 894 
diseases of the sanguinous function. 
rupture of the uterus, Opium in the necessary doses to control the pain 
furnishes the only reliance generally thought of. 
In two cases of peritonitis after tapping, when the patients were in a 
low state previous to the operation, large doses of Opium, without loss 
of blood, removed the inflammation and saved life.—In such cases the 
patient is generally cachectic, and labors under visceral obstructions ; 
and collapse generally follows the operation. In one case, Ur. Graves 
tapped a woman, who was apparently in the last stage of ascites. The 
operation was followed by peritonitis; there was constant vomiting, 
hippocratic countenance, cold extremities, abdomen exquisitely tender, 
pulse one hundred and sixty per minute and scarcely perceptible. Dr. 
Graves gave one and a half drops of Laudanum, expecting only to pal- 
liate the pain. The patient fell into a sleep from which she awoke 
refreshed, with a warmer surface and fuller pulse. Opium in small 
doses often repeated cured her. 
Peritonitis from Escape of the Intestinal Contents into the 
Peritoneum.—Oj>ium. When there has been perforation of the in- 
testine, by ulceration or otherwise, and escape of faecal matters into the 
serous cavity of the peritoneum, or when there has been discharged into 
that cavity the contents of an abscess, or when peritonitis follows the 
operation of paracentesis abdominis in debilitated subjects, there is 
usually no resource but Opium. 
Dr. Stokes says : “ A more appalling calamity can hardly arise than 
perforation of the intestine and escape of its contents among the bowels, 
with the rapid and exhausting peritonitis that will follow. It generally 
occurs in the course of a wasting disease, as typhoid or enteric fever.” 
The only indications are, to support strength and prevent further effu- 
sion, so that nature may have time and opportunity to surround what 
has been already extravasated with coagulable lymph. Large doses 
of Opium may effect these objects. The operation of a purgative is 
certain death. 
14. DYSENTERY. 
Perhaps no disease known to American practitioners annually causes 
more deaths than dysentery. It is almost constantly present, in every 
season, and almost every locality. In malarious districts it appears 
as a form of remittent, typhoid, or congestive fever; when the causes 
of scurvy exist, the scorbutic affection takes the dysenteric form as the 
most direct to a fatal termination; and everywhere the usual causes 
of fevers and inflammations excite the common form of intestinal in- 
flammation known by this name. In 1860 the number of deaths from 
dysentery in the United States was 10.461. 
Tn tropical climates the American seaman finds dysentery his most 895 
DYSENTERY. 
formidable enemy. At one time, in the East Indies, the U. S. Ship 
Constitution had one-half of her crew affected by dysentery; and 
scarcely a vessel returns from the tropics without bringing back a 
number of dangerous cases. American seamen, accustomed to full 
diet and free use of stimulants, suffer more, perhaps, than men of any 
other nation from inflammatory and febrile diseases in hot climates. 
Diagnosis.—This disease sometimes commences with griping pains 
in the bowels, with freguent discharges of mucus mixed with blood, 
attended during the evacuations with more or less straining and 
burning pain. After the first two or three evacuations nothing but 
mucus or mucus and blood are passed. Occasionally the griping and 
diarrhoea are preceded by lassitude, chills, weakness, and pains in the 
limbs, thirst, bad taste in the mouth, furred tongue, hot and dry skin, 
frequent and hard pulse, anxiety, and general restlessness. The dis- 
ease is peculiarly apt to be ushered in with these last-named symptoms 
when it has been caused by sudden suppression of perspiration, atmos- 
pheric vicissitudes, or miasmatic influences. The appearance of the 
fluids discharged will depend much upon the climate, temperament, the 
exciting cause, and the particular portion of the intestinal canal af- 
fected. If the small intestines are chiefly disordered the evacuations 
will consist of dark watery matter with mucus and blood, while inflam- 
mation of the colon and rectum will give rise to discharges of pure 
mucus and blood, preceded and attended by distressing tormina 
and inclination to remain a good part of the time at stool. These 
discharges, which are highly offensive, afford some temporary relief to 
the patient, only to be renewed with increased severity. There are 
tenderness of the bowels on pressure, pain and burning in urinating, 
inclination to lie upon the back with the knees drawn up, great de- 
pression of spirits, short and painful inspirations, universal heat and 
dryness of the skin, more or less derangement in the function of the 
liver, indicated by a jaundiced hue of the skin, and the absence of bile 
in the evacuations; rapid emaciation, loss of strength, and increasing 
disinclination to physical effort. As the disease advances towards a 
fatal termination the countenance assumes a contracted and cadaverous 
expression, the pulse sinks, the evacuations become more foetid, and 
are discharged involuntarily, the pains abate or cease entirely, a cold 
sweat occurs, hiccough, delirium, cramps, and extreme prostration ob- 
tain, and then death. 
Dysentery is distinguished from haemorrhoids by the fever and in- 
flammation which attends dysentery; its rapid and peculiar course; 
the character of the discharges, which, in haemorrhoids, though marked 
with blood, are otherwise natural; by the well-marked haemorrhoidal 
tumors, which are not attended by the cutting pains in the abdomen 
which attends dysentery. 896 
diseases of the sanguinous function. 
Causes, Remote.—Sydenham says, researches after the remote 
causes of disease “feed the vanity and engross the thoughts of curious 
inquirers; their discovery is impossible.” In a great part of our 
country the remote cause of dysentery is the same as that of bilious 
fever—that poisonous miasm already treated of under Malaria, p. 477. 
In exciting dysentery its malignant powers are exerted, mainly, on a 
different set of organs ; but its nature is essentially the same. Dr 
Calhoun, in his edition of Gregory’s Practice, says dysentery is gene- 
rally a form of bilious remittent fever; and in this opinion all Ameri- 
can authors agree. It is endemic in all localities where marsh fever 
prevails (Rodener, Williams, Wagner). In places calculated to 
develop malaria and diffuse it in confined air this disease is rapidly 
propagated ; it is even said to become contagious in some peculiar 
conditions. It spreads most rapidly in prison-ships, jails, camps, poor- 
houses. It is increased by famine, hardships, and the breathing of air 
contaminated with vegetable and animal effluvia; and, under such cir- 
cumstances, typhus with petechia and hospital gangrene are common. 
The potent agent which is capable of communicating the disease seems 
to be so highly volatile as to be carried in the atmosphere, as it is 
clearly conveyed by the exhalations from the close privies used by 
those suffering with the disease. The close alliance between dysen- 
tery and other malarious or epidemic diseases shows that its origin is 
in some way similar to theirs. Epidemic dysenteries are frequently 
preceded or followed by cholera, or fever of a typhoid character, in the 
same patient. 
Among the predisposing causes may be mentioned: cachectic con- 
dition, constipation, frequent abdominal diseases, dropsies, scurvy. 
Exciting Causes.—Cold, chills, exposure to cold damp air; sleeping 
in the open air and on wet ground. Some kinds of food are peculiarly 
liable to excite it. Fresh pork has done it in many cases known to 
us. In hot climates the exemption which the Jews are said to enjoy 
from dysentery has been attributed to the dietetic prohibitions of the 
Mosaic Law; and the prevalence of the disease among Negroes is 
often attributable to their use of crude and indigestible food, green 
fruits, melons, cucumbers, bad water, excessive quantities of strong 
food, &c. Ripe fruits are generally innocent, and in some instances 
curative (Tissot). In the South, where great numbers of negroes are 
annually carried off by epidemic dysentery, it has often been arrested 
by allowing them to eat freely of ripe blackberries. Dr. McLeod, of 
the U. S. Ship Constitution, says the French on the East India sta- 
tion had to a great extent avoided dysentery, by allowing none but 
distilled water to be drunk, or otherwise that which had purified itself 
by spontaneous fermentation in the course of at least two months. (Dr 
Harrisy Chief Bureau Med. and /Surg., U. S. Wavy.) DYSENTERY. 
897 
Pathology.—The results of dissection show pathological changes 
in various abdominal organs, which, according to their frequency, are 
arranged under the following heads : 
1. The cases in which appearances of inflammation are confined to 
the internal surface of the caecum, colon, rectum, and a small portior 
of the ileum. 
2. Cases in which they are confined to the internal surface of the 
caecum, colon, and a small portion of the termination of the ileum. 
8. Cases in which these appearances are confined to the internal 
surface of the caecum and colon. 
4. Cases in which the internal surface of the digestive tube, through- 
out its entire length, shows traces of inflammation (O’Pierne, p. 79). 
The primitive seat of dysentery is the mucous membrane of the 
intestinal canal, and its nature is strictly inflammatory. The disease 
is not a mere “ colitis,” as given by the author of that article in the 
Diet. Med. Chirur. Pratiques. Constipation is usually the first 
symptom ; the contents of the lower intestines become hard, indurated, 
irritating. Nature then tries to throw off the burdensome scybalae, 
and glairy mucus and bloody serum come away with pain and strain- 
ing. The first morbid actions which produce it consist in the determi- 
nation of blood from the surface of the body to the abdominal organs, 
particularly the liver, stomach, and intestines. The small intestines 
receive more arteries and veins, and they are more highly organized 
than the large ; and there is perfect freedom of anastomosis between 
all the arteries, and an absence of valves in all the veins of both small 
and large intestines. Of the blood diverted from the surface, the 
small intestines then receive more than the large ; and the acrid and 
vitiated bile formed at this stage must pass along the irritated sur- 
face of the small intestines, and must generally excite or exasperate 
inflammation. 
The nature of the disease is, first, of a congestive, secondly, of an ir- 
ritative, and lastly of an inflammatory character. The general pheno- 
mena presented by an ordinary attack of dysentery clearly illustrates 
its pathology. Exposure to cold, or cold and damp air when the body 
is overheated, repels the blood from the surface to the internal mucous 
membrane, wThich is closely united with the skin by sympathy. The 
congestion of the internal organs is marked by rigor, want of ap- 
petite ; nausea, and paleness of the skin. This engorgement of these 
organs breaks up the equilibrium between the vascular and nervous 
systems, and soon the latter becomes excited in an equal degree with 
the former. This is the irritative stage, which is marked by the be- 
ginning of the wandering tormina, but there is as yet no effusion of 
blood, but all the hepatic and intestinal secretions are arrested. When 
the patient at this stage suddenly dies from some other cause, “the 
Voi*. L—57. 898 
DISEASES OF THE SANGUINOUS FUNCTION. 
solitary glands in the rectum, sigmoid flexure of the colon, or the coecum 
are swollen, forming round prominences on the surface of the mucous 
membrane, varying in size from a millet seed to a full-sized shot. These 
prominences are of a uniform pale-red color, or have a ring of bright- 
ness on their base, or present this evidence of vascular turgescence 
only at their summit.” (Baly.) 
Inflammatory Stage.—The whole mucous membrane of the entire 
digestive canal, with the continuation of this membrane lining the bili- 
ary and pancreatic ducts in all their ramifications, become involved 
in inflammation. From this extensive surface the morbidly sensitive 
secreting vessels pour out vitiated and irritating secretions. The effu- 
sion of blood from the intestinal surface might be expected to relieve 
the engorged organs; but the whole contents of the intestines are too 
acrid and irritating to pass forward without adding to the general distress. 
The small intestines are excited to irregular spasmodic contractions, 
which cause intense cutting pains called tormina. Thus do the origi- 
nal contents of the bowels and their acrid secretions reach the large 
intestines, to which they are generally very promptly admitted by the 
ileo-caecal valve. 
The Condition of the Large Intestines in dysentery, in which the 
chief characteristic feature of the disease consists, has been imper- 
fectly explained by pathologists. Dr. O’Bierne of Dublin approaches 
a clear exposition of the subject, and we will modify his ideas to meet 
our own. (See New Views of the Process of Defecation, Pathol., 
dec., Diseases of Stomach, Bowels, dec. 1834. p. 81.) 
In all ordinary states of health the rectum is firmly contracted, but 
easily gives way to the gentle pressure by which the bowels are eva- 
cuated. As soon as the inflammation which constitutes dysentery be- 
gins the whole mucous surface of the rectum is involved in it; and, be- 
coming exquisitely sensitive, it contracts with spasmodic power, and 
prevents the passage of all solid substances, permitting only fluids, as 
blood, mucus, or flatus to escape. The bowTels are indeed completely 
constipated. The contents of the upper bowels then being passed 
freely forward to the caecum and colon, arc retained within these ca- 
pacious sewers of the body, being prevented by the ileo-caecal valve 
from returning into the ileum. This “principle of accumulation of 
faeces in the caecum and colon” is applicable to many other diseases, but is 
peculiarly important and characteristic in dysentery. Here alimentary 
matters, blood, air, and vitiated secretions are propelled forward by in 
creased peristaltic contractions behind. The lining membrane of the 
colon is already inflamed; and it now becomes subjected to a high 
degree of mechanical and chemical irritation. This irritation and dis- 
tention soon arouses the abdominal muscles to frequent and violent ex- 
pulsive efforts; but they are generally ineffectual; for the upper an- DYSENTERY. 
899 
nulus or entrance of the rectum is inflamed in the same degree as the 
surface of the colon, and is so excessively irritable that the pressure of 
the harsh matters above only excite it to more violent contraction. 
Even the blood and mucus which are constantly being discharged are 
to a large extent poured out from the inflamed surface of this upper en- 
trance of the rectum. It is the point which presents the greatest dif- 
ficulty in the treatment of dysentery; and just here ulcerations are 
more frequently found after death; though they are found in every 
portion of the cmcum, the transverse arch and sigmoid flexure of the 
colon. The ulcerations would be found much more numerous and ex- 
tensive, did not nature make an effort to arrest the activity of the in- 
flammatory process, first by a diminution in the activity of the secretory 
functions of the small intestines, which no longer pour out such large 
quantities of acrid and vitiated secretions; and secondly: the inflam- 
mation of the mucous membrane of the upper annulus of the rectum 
becomes extended to the muscular structure of the same organ. These 
muscular fibres becoming weakened by disease have less power to keep 
the cavity so obstinately closed; hence some fluids, as blood, mucus, 
flatus, and some fluid faeces are permitted to escape, as the disease 
progresses to a chronic form. Some solid as well as fluid faeces and 
sometimes purulent matter are permitted to pass. 
The Condition of the Small Intestines is very different from that of 
the large intestines. From the beginning of the attack they relieve them- 
selves from the presence of their contents, with all the morbid secre- 
tions poured out by their own vessels. The blood poured out from the 
minute vessels on their inner surface relieves in some degree the en- 
gorgement with which the disease commenced. And it is only in the 
lower part of the ilium, when the caecum and colon are so fully dis- 
tended as to admit further accumulations reluctantly, that alimentary 
matters and morbid secretions can stagnate and produce any great 
degree of local irritation. 
Condition of the Rectum. In the early stage its “mucous mem- 
brane is attacked by inflammation simultaneously with that of the whole 
superior portion of the canal, and copiously pours out blood and a vitiat- 
ed mucous secretion; ” but its great muscular power enables it to pass 
off these fluids and discharge them, being in some degree relieved by 
the effusion of blood from its surface. But in later stages, when the 
disease advances towards a chronic form and ulceration extends to 
the upper annulus of the rectum, the whole of this intestine becomes 
similarly affected, and, in many chronic cases, it is extensively dis- 
organized. (O'Bierne, p. 84.) 
Appearances of the Mucous Membrane.—Redness and swelling of 
the plaits of the membrane ; infiltration of sub-mucous cellular tissue, 
redness and softening, disposed to bleed; “ the epithelium of the mu- 900 
DISEASES OF THE SANGUINOUS FUNCTION. 
cous membrane is elevated into small miliary vesicles, and is cast off in 
minute portions, or is easily detached,” the membrane beneath appear- 
ing excoriated. The swollen solitary glands are surrounded by deep 
and extensive redness, and some of the prominent points are disor- 
ganized. As the disease progresses the color of the mucous membrane 
becomes of a rose, or bright red, or reddish brown. The disorganized 
portions form minute yellowish sloughs, easily separated from the sur- 
rounding tissue. The mucous tissue is macerated to softening; the 
layers continually extend in depth, and larger portions are excoriated 
or laid bare, leaving small ulcer-like cavities in the spots previously 
occupied by the enlarged glands. The softening extends over the sur 
face in large stripes or in smaller circumscribed spots. [Humphreys, 
p. 13.) 
Changes in the Intestinal Follicles.—From the sixth to the tenth 
day they become dilated, and form small ulcers, covered with a pseu- 
do-membranous material. Numerous dark points are found along the 
whole length of the large intestine, discernible with the naked eye, 
surrounded by whitish plain broad elevations, which mark the mouths 
of swelled follicles. The surrounding membrane, besides being red 
and tumid, is covered with a rough layer, composed of epithelium and 
fibrine. Frequently the central dark point is replaced by a small 
grayish ulcerous opening which leads to the base of the krypt. Some 
of these ulcers are two or three lines in diameter. (Gely.) “These 
small ulcers,” says Baly, “are produced by a process of mortification, 
and not of ulceration.” 
The serous infiltration penetrates by degrees into the muscular tis- 
sue ; hence the intestine may become thickened to extend from three 
to five lines; at the same time the muscular coat contracts and presses 
the folds of the mucous coat inward, producing a hypertrophied ap- 
pearance. As the disease advances, some parts of the surface become 
overlaid wfith a dark-red or brownish scurf which adheres firmly and 
degenerates into a dark substance which is thrown off in tubular patches, 
called spacelated membrane. “From the destruction of the mucous 
membrane the muscular and even peritoneal folds may be exposed, and 
even entire perforation at times be produced.” (Humphreys, 15. Ro- 
JcitansJcy.) If death does not occur at an early stage and the disease 
assumes the chronic form, the ulcers enlarge and secrete a quantity of 
transparent opaque or yellowish fluid. (Italy.) 
This disease, as we meet it in the malarious portions of the Western 
States, is usually more fatal than any other form of febrile affection. For 
at least twenty-five years it has been the disease most frequently en- 
countered, and, through many years of that period, the disease most 
dreaded we have always found it curable by any treatment that dislodged 
hardened scybalae or masses of faeces from the colon; and long ago DYSENTERY. 
901 
learned to regard the inflammation and ulceration of the colon at or 
near its termination in the rectum as the cause of death in nearly all 
fatal cases. Dr. Bowling, of Southern Kentucky, says, that after much 
unsatisfactory experience, he examined the body of a negro, who had 
died suddenly. The usual appearances were found, including the con- 
gestion of the portal circle and inflammation of the colon. The cells 
of this intestine contained a quantity of hardened faeces, covered with 
tenacious glassy mucus, wrhich seemed to confine the scybalae to the 
cells. The tormina and tenesmus, excited by the spasmodic efforts to 
expel these irritating masses, “had been distressing beyond the power 
of description; and death had seemed to result from the violence of 
the pain rather than the termination of the disease. I do not now be- 
lieve these scybalae to be the cause of the disease, but I do believe 
that accumulations in the colon are the cause of death.” ( West. Med. 
Jour. 1840, p. 166—173.) 
At a late stage of the progress of a severe case, says Dr. Baly, of 
the Millbank Penitentiary, “ the small sloughs enclosing the solitary 
glands are found to have been thrown off; the thin superficial layer of 
the surrounding mucous membrane which had lost its vitality, is also 
gone, leaving erosions of the surface ; and the mucous membrane with 
the sub-mucus tissue is in most cases much thickened and turgid with 
blood and serum. The cavities which contained the spacelated solitary 
glands appear as small round ulcers with sharply cut edges, resembling 
holes made with a punch, and give to the inner surface of the intestine 
somewhat of the aspect of a worm-eaten piece of wood.” In some 
places the ulcers communicate with each other at their deepest part, 
and in others they coalesce in their whole depth, after the destruction 
of the septa of mucous membrane, which had previously separated 
many small ulcers. When the intestine is only partially affected, the 
rugae are the portions chiefly occupied by the small ulcers. The large 
ulcers also are usually situated on the same prominent parts, and these 
commonly'extend in depth to the muscular coat, and often perforate it as 
well as the serous coat. There are other cases of equal severity, in 
which morbid results of a different character are found after death. 
The entire mucous membrane appears in these cases to be simultane- 
ously destroyed in larger or smaller tracts ; the inflammation spreads 
more uniformly over the surface, the membranous folds become gan- 
grenous and detached, leaving large ulcer-like excavations. {Baly, on 
Dysentery, p. 10.) In young adults, previously healthy, the mucous 
membrane around the gangrenous parts is intensely red, but in old and 
feeble persons it is often pale. At an early period the sloughs are 
dark-green in color and of firm consistence, but detached and leaving 
irregular excavations. In all parts of the intestinal mucous membrane, 
except the caecum, the disease expends its principal force on the trails- 902 
DISEASES OF THE SANGUINOUS FUNCTION. 
verse rugae and other prominent points of the surface; hut the caecum 
which is nearly devoid of rugae is frequently the seat of dysenteric 
ulcers, which, “whatever their size or shape, originate by a process of 
sloughing and not by simple ulceration.” (Baly.) 
“ Two forms, then, of structural change attend cases of acute dysen- 
tery of the second degree of severity. In the chronic stage they still 
retain distinctive characters. In the one we have large ulcers of ir- 
regular shape, chiefly occupying the situations of the rugae and longi- 
tudinal hands, while in the other the predominant feature is constituted 
by the small round ulcers. When the inflammatory action has con- 
tinued long in a sub-acute form, the sub-mucous coat in both cases is 
found thickened and, at an advanced period of the disease, much indu- 
rated in the situation of the ulcers. The contraction of these thickened 
parts in the manner of the cicatrices of burns, is sometimes productive 
of stricture of the intestine.” 
When the lower part of the intestine is the seat of the disease, “ a 
tolerably accurate estimate of the extent of mucous membrane affected 
may be formed from the mere quantity of bloody mucus discharged. 
The source of this bloody and mucous discharge in the acute stage of 
dysentery is not the solitary glands, but the tubular follicles of the 
mucous membrane. The granular matter contained in the solitary 
glands is composed of solid particles of flattened figure, and strongly 
defined outline, resembling the nuclei of certain cells or globules; the 
contents of the cells sometimes consist of epithelial particles; at other 
times they are composed of round nucleated globules exactly resem- 
bling those of mucus. “Now the bloody mucus discharged in dysentery 
is composed of such nucleated globules, generally mixed with numerous 
blood-discs. Sometimes the globules are seen here and there still con- 
nected together in a cylindrical mass, such as they form while in the 
tubular follicle; the puriform matter occasionally discharged in dysen- 
tery has probably the same source. In the chronic stage of dysentery, 
also, pus or a puriform matter is often excreted. But here this matter 
seems to have a different source, it probably comes in the severer cases 
from the enlarged and diseased solitary glands, and in the most severe 
cases from the numerous ulcers, which have been left after the destruc- 
tion of the glands, and of smaller or larger portions of the mucous mem- 
brane.” {Baly, on Dysentery. London, 1847. p. 120.) 
Prognosis.—The prognosis will vary according to the climate, the 
location, the season of the year, the constitution of the patient, and its 
complications with typhus, cholera, or other maladies. 
Hot and alluvial regions, abounding in luxuriant vegetation which is 
constantly undergoing decomposition, and filling the air with miasmatic 
particles, predispose the system to dysenteric affections, and serve to 
render them violent and dangerous. Low, marshy, and damp situations DYSENTERY. 
903 
favor the formation of the disease more than elevated and dry locations. 
It is far more common, severe, and fatal in the months of July and 
August in this country, than at any other season of the year; and it is 
rare that individuals who are strongly predisposed to it entirely escape 
during these months. When it is succeeded or accompanied with typhoid 
symptoms, or when it occurs as a symptom of typhus fever, it may be 
looked on as a malady of the most dangerous character, and one which 
will require the most judiciously-directed resources of our art. In 
these instances we have to combat, not only the local intestinal dis- 
order, but also constitutional symptoms of the greatest severity. During 
the prevalence of Asiatic cholera, dysentery has been observed to as- 
sume a more malignant form than in those years when this destruc- 
tive epidemic has not prevailed. While the cholera was destroying its 
thousands weekly in our large cities, during the summer of 1849, a 
malignant dysentery prevailed in most of the smaller cities and towns, 
sweeping oft’ numbers entirely unprecedented. In these last examples, 
the epidemic influence was not sufficiently active to generate the actual 
cholera asphyxia, but it conduced to aggravate, very materially, the 
type of dysentery. The constitution and previous health of the 
persons attacked often determine the degree of danger. Young 
children, pregnant females, and very old persons are considered least 
likely to recover. Abortion is very often excited by the disease ; and 
in some epidemics it is generally followed by puerpural fever which is 
often fatal. In those rapid cases in which gangrene speedily follows 
inflammation, the mucous membrane is swollen and of a dark purple 
color, its texture is disorganized, the color black, green or brown. In 
these cases death results in a very short .time. 
Unfavorable symptoms are: extreme severity of the attack, evinced 
by high inflammation progressing rapidly; at a later stage the dis- 
charges are mixed with fragments of cast-off epithelium, pseudo-mem- 
brane, bloody water, and gangrenous exfoliated membrane; dark 
brown fluid with cadaverous smell, or coffee-ground deposits. An eva- 
cuation recurring at regular intervals of reddish or dark-colored water, 
or resembling the -washings of fresh meat, indicates -well-established 
local inflammation kept up by hardened masses of faeces, which fiarsh 
purgatives can not expel, and yet, which always terminate in complete 
exhaustion and death, when the offending mass is permitted to remain; 
great exhaustion; increase of the cutting pains ; distension of the ab- 
domen ; vomiting in later stages ; increased agitation; hiccough; cold- 
ness of the skin and tongue ; pulse above 120 per minute and increasing 
in frequency, becoming small and irregular; delirium; paralysis oi 
lower extremities; sunken lead-colored face; ecchymosis; putrid aphthae 
6udden cessation of pain ; increasing emaciation; colliquative diarrhoea, 
&c. When life is prolonged, as it often is for several weeks, the de- 904 
DISEASES OF THE SANGUINOUS FUNCTION. 
stroyed parts of the membrane become softened, and the sloughs sepa- 
rate. “It seems scarcely possible,” says Baly, “that life should be 
long maintained with a portion of the alimentary canal in such a state 
as this; but where the gangrenous process has not affected the coats so 
deeply, the patients survive for some time the loss by sloughing of the 
mucous membrane, and of the sub-mucous tissue, through more than half 
the length of the large intestines.” 
Treatment.—The first object is to counteract all the unfavorable 
circumstances in which the disease originated. Pure air, cleanliness, 
perfect rest, and prompt removal of putrid effuvia from the evacuations 
are indispensible. While the air of the room should be moderately 
cool the skin should be kept comfortably warm, and every care taken 
to avoid all expenditure of strength; all rising from the bed should, if 
possible, be avoided. 
The diet should be restricted to the most mild and unirritating ar- 
ticles. Well-cooked milk and flour-gruel have been generally allowed; 
but it is better to give at first no animal food whatever. Barley-water, 
gum-water, slippery elm-water, mucilaginous articles, such as sago, or 
the finest gruel of farina, pure starch, arrow-root, oat-meal or rice-flour 
will furnish a sufficient variety till the disease is arrested. Of fruits 
the finest grapes or black-berries, fully ripe, and freed from the seeds 
and hulls are almost the only ones that may be considered safe. These 
and also whortle-berries are known to often cure dysentery. In Europe, 
the use of fruits was proved a century ago to prevent as well as cure 
dysentery. (Tissot.) In scorbutic epidemics they are sometimes found 
specific remedies. Mutton broth, from its mild, oily qualities, has been 
often prescribed, but we have very often seen the disease excited by 
broths arid soups of different kinds, and regard all fresh meats and all 
preparations of them, as dangerous in every stage of the disease. Milk 
and farinaceous articles are allowed by nearly all writers. 
Drinks.—Pure water made mucilaginous with slippery elm, gum- 
arabic, or by beating up the albumen of an egg in a pint of water, toast 
water or black tea, weak, are as good as any thing for drink. But all 
drinks should be moderately warm, never cold. The treatment of 
dysentery by cold drinks, arid ice-water injections is founded upon a false 
view of its pathology; and, although it is still persisted in by many who 
have charge of public hospitals, as well as in private practice, it causes 
uniformly increased suffering and cures none, though some of the milder 
cases may survive its pernicious influence. 
On ship-board in hot climates the subject of hygiene becomes in the 
highest degree important. Dampness exists everywhere through all 
the apartments; and frequent washings are required to keep the ship 
in a state of sufficient purity. It it now considered most judicious to 
flood the decks with water and wash them thoroughly when the weather DVSENTERY. 
905 
is bright, and evaporation will be rapid; but when cold damp raw 
W'eatber prevails, the health and comfort of the crew is best promoted 
by dry cleaning. Lord Collingwood, the model naval commander, re- 
lied chiefly upon “attention to keeping the ship dry, (rarely permitting 
washing, even between decks), frequent ventilation of hammocks and 
clothes, and circulation below of fresh air.” (Memoirs, p. 266.) As 
the result of this system he reports in October, 1803, “H. B. M. Ship 
Venerable, eighteen weeks at sea, very rotten. On sick list none.” 
“H. M. Ship Ocean, off" Toulon, May 15, 1808. Long time at sea, never 
getting fresh beef nor a vegetable; not one man sick.” (Mem., p. 265.) 
“This flag-ship had usually 800 men; on one occasion was more than 
a year and a half without going into port; during that time never had 
more than six, and generally but four on the sick-list.” (Ibid, p. 266.) 
If similar results can not be reached in tropical climates they might 
be approximated in all climates. {Dr. Me Sherry, Amer. Med. Jour., 
Oct. 1849, p. 406.) 
Medical Treatment. — Selection of the Proper Remedy. The 
question has been asked “In dysentery, what is the ‘like,’ which cures, 
and how are we to find it?” * We must learn to distinguish it by se- 
parating between the two classes of symptoms, the generic and the 
specific. The generic symptoms belong to all cases of this disease. 
They are: “Freguent, for the most part small discharges from the 
rectum of blood, or mucus, or both, with colic pains, tenesmus, and 
fever? If we seek for a remedy that covers these symptoms only, we 
may well be confused with the vast number of remedies under which 
they are found. We may try one after another before we stumble on 
the right one, feeling all the way that there is no precision attainable 
in the application of the boasted law of cure. Though these symp- 
toms have only misled us, they certainly are “striking” symptoms. 
“They stand on the very surface, and are the first to arrest the atten- 
tion. And yet we have failed to cure.” Why have we failed? Be- 
cause the symptoms we have attended to were such as might have 
been produced by a large number of irritating agents and we could not 
distinguish which one was specifically qualified to do it. 
The generic symptoms of disease are analogous to those symptoms 
in the pathogenesis of a large class of drugs, “which rather indicate that 
the organism revolts against drug assault, than point out the particular 
active agent in the assault;” as “the vomiting produced by one irritant 
poison is so like that of every other, that from this alone it can not be 
told what that irritant is.” The generic symptoms, then, in which so 
many drugs agree must be excluded from the circle of curative rela- 
tionship.” “Where then are we to look for this? Evidently in the 
* Diarrhoea and Dysentery, by Dr. P. P. Wells, pp. 26—31. 906 
DISEASES OF THE 8ANGUINOUS FUNCTION. 
list of those symptoms which individualize both the disease and the 
drug. That which distinguishes the individual case of the disease 
to be treated from other cases of the same disease, is to find its re- 
semblance among those effects of the drug which distinguish it from 
other drugs. This is what we mean when we talk of characteristics. 
When we say like cures like, this is the Hike’ we mean.” 
The principal remedies are: Mercurius, Arsenicum, Chamomilla, 
Pulsatilla, Oolocynth, Aconite, Ipecacuanha, Nux-vomica, Carbo- 
veg., Sulphur, Dulcamara, Aloes, Acid-nitr., Acid-mur. 
Aconite one drop, or twenty pilules of the sixth potency may be dis- 
solved in six or eight spoonsful of water, and a tea-spoonful given every 
hour in urgent cases till the fever moderates; then at longer intervals, 
or till followed by the next remedy. 
Symptoms of Aconite: Skin hot and dry; high inflammatory fever; 
colic pains and tormina; frequent small soft stools with tenesmus’ 
rheumatic pains in the head, neck, shoulders: heat, chills, thirst, 
(See Symptoms of Aeon., p. 651.) In every form of dysentery it is 
the remedy first to be thought of. Dr. L. Pratt, of 111. says (State Horn. 
Med. Asso., 1859) that the patients who took Aconite in small doses 
every half hour during the first twenty-four or forty-eight hours re- 
covered much sooner than the others (U. St. Journ. Homoeop., Vol I., 
p. 146.) 
Aconite is the best remedy when dysentery occurs during very hot 
weather, followed by cold nights, and when the case is characterized by 
a violent chill, great heat and thirst, with rheumatic pains in the limbs, 
head, neck, and shoulders. (Tiering) 
In epidemic dysentery with inflammatory symptoms, it is necessary 
to administer at first a few doses of Aconite, before we can count on 
the efficacy of Mercurius. Here Aconite proves its efficacy as an anti- 
phlogistic, in curing the inflammation in 24 hours. But it is necessary 
to repeat the doses at intervals of from four to six hours. (Engelhardt, 
Communications. Pratiques, Cap. Ill, p. 34.) 
A little girl, ten years old, had dysentery, took Yeratrum twelfth, 
on the twentieth of September. On the twenty-second, a dose of 
Aeon, and many doses of Mercur-sol. twelfth. On the twenty-fourth 
of September there were: griping pains of such violence as to cause 
her to scream with pain; frequent alvine evacuations, bloody mucus, 
greenish, and mixed with whitish fibres; nausea, retchings, and occasion- 
ally mucous vomitings; bowels much bloated, and excessively sensitive 
to the touch; violent thirst, painful micturition, skin dry and very hot, 
headache and delirium. 
After the administration of Aconite, twenty-fourth, a dose every four 
hours, the external heat ceased on the next day, thirst still remained, 
the gripes were less severe, the stools less frequent, less painful and DYSENTERY. 
907 
less bloody, micturition not painful, still some delirium during the night, 
no perspiration. (.Engelhardt, Commen. Prat., p. 25.) 
Symptoms particularly characteristic.—Inflammatory fever. Skii 
hot and dry, great thirst, rheumatic pains in the limbs, headache 
greenish and bloody stools, acute pains in the intestines. {Jahr.) 
Aloes.—This remedy has often caused dysentery when given as a 
purgative in different forms of fever. The abdomen is distended and 
sensitive to the touch; the colon is inflamed, particularly at its termi- 
nation in the rectum; pressing, burning and rending pains along the 
course of the colon; fluid slimy, evacuations mixed with blood; tenes- 
mus, heat, faintness, burning in the rectum; colic, haemorrhoids; exco- 
riations ; heat, thirst, tongue dry and red, congestion of the abdomen. 
Rau says, he used Aloes with distinguished success in purely in- 
flammatory dysentery. The indications are : abdomen distended and 
tender to the touch; stools slimy and mixed with blood, or thin and 
watery; urine scanty and high-colored; tongue red and dry; pulse full 
and rapid; skin hot and dry, &c. 
Severe pressing, cutting and burning pains in the lower part of the 
abdomen; violent tenesmus and smarting in the rectum, during the eva- 
cuations, with sharp pains extending to the sacrum and abdomen; high 
fever; pain in urinating, &c. 
Anxiety and general indications of nervous excitement. 
Administration.—Same as Chamomilla. 
Belladonna. Alternates well with Aconite in sanguine tempera- 
ments, of full habit, lively ardent disposition, with tendency of blood to 
the head, distention of superficial vessels, face red and hot; delirium; 
whitish tongue, the tip dry; spasmodic pain of the bowels, distended, 
sensitive abdomen; tenesmus and fruitless urging to stool; violent press- 
ing; intense thirst and sleeplessness. 
Colocynth.—Cramp-like, colicky pains in the bowels, with inflamma- 
tion of the whole abdomen; slimy or bilious evacuations, with pains and 
contractions at the rectum; bitter taste, with urgent desire for cold 
drinks; nausea and vomiting of bilious fluids; shooting and cramp-like 
pains on one side of the body; pains in the head, and throbbing of the 
temporal arteries. 
This is one of the best remedies, and applicable to almost every form 
of dysentery, especially for: “Violent colic pains, griping in the hypo- 
gastric region, causing the patient to bend together, restlessness, fre- 
quent evacuations of greenish yellow or watery mucus,” afterwards 
streaked with blood or bloody mucus; pain relieved by the evacuation 
but soon returning on taking food or drink, tenesmus only slight; full- 
ness and pressure in the abdomen, white-coated tongue, chills, thirst 
and febrile heat, irritable dejected state of mind. (Humphreys, p. 59.) 
Broackes says, two globules of Colocynth, given immediately on the be- 908 
DISEASES OF THE SANGUINOUS FUNCTION. 
ginning of the disease, cured one case in twenty-four hours. In other 
cases, after beginning with Chamomilla, a single dose of Colocynth gave 
relief in six hours, and nothing further was given. Meyer gives it for 
dysentery with severe colic pains and pressure on the rectum; Trink’s 
regards tenesmus as a characteristic of Coloc. 
Arsenicum-aXbum.—Where dysentery has arisen from the abuse of 
drastic and other debilitating medicines, after excessive loss of blood, 
or after the organism has been enfeebled from previous disease, Arse- 
nicum will be found an efficient remedy. It is also peculiarly useful 
in dysenteric affections, occurring in individuals of a nervous, dropsi- 
cal, or lymphatic constitution, and when the disease is attended with 
typhoid complications. 
General appearance of debility and prostration; trembling or stiffness 
of the limbs; face pale or yellowish, hollow or cadaverous; position on 
the back, with tendency to sink to the foot of the bed; eyes dull and 
sunken; lips dry and dark-colored; tongue dry and brownish; abdomen 
swollen and hard, or tympanitic; fseces offensive, putrid, and variable 
in color, but generally slimy and streaked with blood, or greenish or 
darkish; skin cold and bluish, or dry and shrivelled; breathing short 
and oppressed; pulse frequent, small, thready, sometimes irregular. 
Violent, sharp and cramp-like pains in the abdomen, accompanied 
with nausea and vomiting; sensation of fullness and burning in the 
bowels; frequent eructations; flatulency; frequent evacuations with 
some tenesmus, burning pain at the anus, with nausea; retention of 
urine, or burning pain in making water; pain increased by the slightest 
motion; faintness upon the least exertion; great tenderness of the ab- 
domen ; colliquative sweats; entire inability to sit up, or make any ef- 
fort; puffiness of the eyes or cheeks; disturbed sleep, with constant 
jerking of the limbs, and tossing. 
Sad; desponding; anxious; discouraged; irritability; impatience; 
delirium; loss of consciousness. 
Administration.— One grain of the first trituration to two ounces 
of distilled water.—A tea spoonful once in two or three hours until the 
required effect is produced. 
Chamomilla,—A useful remedy in dysenteric affections arising from 
a sudden chill, from difficult and protracted dentition, from violent grief 
or passion. It applies especially to affections of this nature which oc- 
cur in women and children; and, when judiciously prescribed, will often 
act promptly and efficiently. Laurie prescribes it in cases attended 
with inflammatory symptoms, after these symptoms have been partially 
subdued by Aconite. It may be given at the third potency as circum- 
stances may require. 
Pulsatilla.—This remedy has been highly recommended in fall 
dysenteries, and in some cases of chronic dysentery. The indications DYSENTERY. 
909 
for its use are nausea, vomiting, bad feeling in the bead; bruised sen- 
sation in the integuments of the abdomen; cutting pains in the bowels, 
with discharges of sanguineous mucus ; pain in the small of the back; 
chilliness, especially towards night; bad taste in the mouth; eructations, 
acid or bitter; prickling or numbness of the skin; constant inclination 
to sleep during the day; yelloiv tinge of the skin. 
Administration.—Four drops of the third dilution to an ounce of 
distilled water; a dessert spoonful every two, four or six hours in acute 
cases. One dose every afternoon in chronic dysentery. 
Treatment.—Ipecac. Dysenteries occurring in autumn, in which 
there is great nausea; repugnance to food; vomiting; pain in the region 
of the stomach ; coated tongue ; pressing headache; slimy stools, after- 
wards mixed with blood, with violent urging; tenesmus following foetid 
discharges; more chilliness than heat; evening exacerbations. Dysen- 
tery in its early stage, where cramps prevail; also in the latter stages 
after inflammatory symptoms are removed, great weakness of the intes- 
tines and tendency to tenesmus remaining. 
Mercurius-sol.—This form of Mercury is more particularly adapted 
to the treatment of those cases, which are principally located in the 
upper portion of the intestinal canal. 
Yellowish color of the skin; offensive breath ; tongue covered with 
a white, thick, tenacious mucus; distention in the upper part of the 
abdomen; evacuations of foetid mucus and bilious matter of a darkish or 
green color, or of bloody mucus; prolapsus of the rectum, which is red 
and inflamed; urine of a deep red or brown color and offensive ; posi- 
tion, respiration, pulse, temperature, thirst, &c., the same as under 
Merc.-cor. 
Violent cutting pains in the abdomen, accompanied by shivering 
during and after the evacuations; great tenderness on pressure in the 
region of the small intestines; frequent desire to evacuate the bowels, 
accompanied by violent tenesmus; discharges small in quantity; ag- 
gravation of pains at night; frequent and urgent desire; nausea and 
vomiting, with pain in the stomach; thirst for cold drinks ; cramps and 
contractions in the umbilical region; weakness and rapid sinking of 
strength ; painful sense of distention in the abdomen; sense of fatigue 
and great weakness in the limbs. 
Morose peevish; irritable; great anguish and discouragement; pee- 
vish ; quarrelsome. 
Administration the same as Merc.-corrosivus. 
Remarks.—In malignant dysentery, Mercurius-sol. and Nitric-acid 
are remedies of the highest importance. In all cases where the symp- 
toms are not covered by one of them alone, we may use them in alter- 
nation or alternate either writh another appropriate remedy. 
Mercurius-corrosivus.—Autumnal dysenteries of the most violent 910 
form. The disease seems to be caused by cold nights succeeding hot 
days, in persons saturated with marsh-miasm. Symptoms are: Verj 
frequent small stools of bloody mucus, or of chopped-up greenish masses 
mixed with blood, continuing day and night with almost constant 
cuttings in the bowels, and an unsupportable and painful urging and 
tenesmus. Sometimes the dysenteric discharges are bilious, very 
foetid green or brownish ; frequently after long-continued violent strain- 
ing and pressing, a little bloody mucus only is discharged; the tenes- 
mus scarcely abating for a moment, and then returning again. The 
colic pains, griping and cutting in the bowrels are very severe, often ex- 
tend to the back writh chills, heat, thirst and anxiety. 
This remedy is more efficacious in the higher than the lower attenua- 
tions. Prepare by dissolving the pure crystals in distilled water for 
the first attenuation, dilute Alcohol for the second, pure Alcohol for the 
third. Give of the twelfth or higher potence, every hour, till some im- 
provement is manifested, then at longer intervals. Becker says, a few 
doses of the sixth dilution were sufficient to stop the most violent at- 
tacks. In one case, antiphlogistics did not diminish the anxiety, the 
tenesmus, or thirst, and sanguineous mucus mixed with blood was 
vomited every ten minutes. On the third day he took Mercur.-corros., 
sixteenth, which cured him in a few days. (p. 102.) 
Administration.—One grain of the third trituration may be given 
every hour until the violence of the disease is subdued, when the inter- 
vals may be lengthened, or the medicine suspended, according to the 
exigencies of the case. Sometimes when the symptoms of this remedy 
as well as those of Colocynth are present, these twro articles may be 
given in alternations and their beneficial influence will be speedily 
manifested. In inflammatory cases alternate with Aconite. 
Merourius-mvus.—General range of symptoms the same as Mer- 
curius-soland mode of administration the same. It has been used 
quite frequently and always with success. 
Nux-vomica.—As dysentery scarcely ever occurs except in con- 
nexion wdth constipation, Nux-vomica often prevents it, by removing the 
constipation that leads to it. It is useful also when the disease is about 
to assume an adynamic or an intermittent type. Indications : “ frequent 
small stools, consisting of bloody mucus, or when from time to time 
scybalm are seen in the discharges.” But for this purpose it should 
be used at the beginning of the disease. “ Frequent small slimy stools 
writh urging and tenesmus; violent cutting pains about the umbilical 
region; intense heat; great thirst, or pitch-like ragged or villous dis- 
charges ; pressure on the rectum.” Urine suppressed, or voided by 
drops, after repeated fruitless efforts; retching or vomiting; bitter putrid 
taste in the mouth; confusion of intellect; aggravation in morning 
hours; tendency to haemorrhoids. 
DISEASES OF THE SANGUINOUS FUNCTION. DYSENTERY. 
911 
Nux-vomica sometimes effects a speedy cure in protracted dysenteric 
discharges, which appear to be kept up from relaxation and loss of 
tone in the abdominal mucous membrane rather than from actual in- 
flammation. By imparting tone and vigor to the enfeebled nerves of 
the stomach and intestines, it cures the disease, and enables these or- 
gans to resume their healthy functions. The indications for its employ- 
ment are: fullness and distention of the abdomen; contractive or 
cramp-like pains in the umbilical, epigastric, or hypochondriac region; 
frequent, small evacuations of mucus and bloody matters ; contractive 
pain in the rectum during the discharges; bowels and cheeks hot; 
thirst; faeces offensive. 
Administration.—A drop of the third dilution may be given every 
two to six hours, as the urgency of the symptoms demand, until an im- 
pression upon the disease is apparent. 
Iodide of Mercury.—(III. State Horn. Med. Association, 1859.) In 
first or second triturations it was successful in cases wThere Merc.-sol., 
Merc.-viv., Coloc., Nux-vom., Podophyl. had failed. The evacuations con- 
taining less blood but more of green mucus, violent tenesmus and grip- 
ing pains. Evacuations twenty-four to forty in twenty-four hours. 
Iod.-mer. produced most satisfactory and surprising results. Only two 
doses being in many cases sufficient to change the dark, grass-green 
discharges to a whitish fermenting character, with from six to twenty 
ascarides. (Dr. C. A. Jaeger. Elgin.) 
Dr. Christison says, a man tried to cure himself of rheumatism by 
having half a drachm of Corros.-sublim. rubbed into the affected part 
before going to bed. It produced at the time only a sensation of heat 
in the part, but during the night there were pains in the stomach, 
retching and vomiting. Purging and tenesmus followed and became in- 
cessant, producing extreme debility; the arm to the shoulder was 
largely swollen, red and blistered. Next day there was a brassy taste 
in the mouth, tenderness of the gums, regular salivation supervened, 
(On Poisons, p. 392.) 
Apis-mel.—Dr. Wolf recommends Apis for almost every form of 
dysentery. Dr. Lorbacher, of Germany, says, he has found it effective, 
where Mercury had entirely failed. 
Sulpliuric-acid has been highly commended in putrid dysentery. 
Indications: thin, bloody, and very foetid stools; red or darkish urine, 
turbid, or depositing a dirty sediment; burning, hot skin; aphthae; 
petechiae; blood-blisters; vomiting of water and food. 
Frequent inclination to go to stool, with severe tenesmus; nausea 
and vomiting; desire for acids, fresh fruits, &c. 
Indifferent or irritable; irascible and peevish. It may be given in 
the same manner as Nitric-acid. 912 
DISEASES OF THE SANGUINOUS FUNCTION. 
In bilious, catarrhal, erethistic and rheumatic forms of dysentery 
examine Colocynth, Puls., Nux-vom., CuprCham., China, Phus., 
Sulph., Ipecac., Pule., Euphor., Canth., Antim.-crud., Rheum. 
We have often observed the most decided benefit follow the employ 
ment of enemata of moderately cold water in dysenteric inflammations 
Administered after each evacuation they afford evident relief. 
jDulcamara may be used in dysentery arising from cold, and at 
tended with cutting pains in the intestines, bloody discharges, burning 
and itching of the rectum, heat of skin and thirst. It may be pre- 
scribed at the third potency,—a dose once in two to six hours, ac- 
cording to circumstances. 
China—Cases which seem to have a malarious origin, and assume 
the intermitting form. The stools in other instances assume a black, 
putrid character, and the disease fails to yield to Arsenicum or Carbo- 
veg. We have seen cases of malarious dysentery, in which the patients 
were rapidly sinking into a hopeless typhoid state, rapidly change their 
character under the use of China, given in a fine trituration or tincture. 
In a few hours the black foetid sores on the skin assume a red inflam- 
matory appearance. In the last stage of this form of the disease Bark, 
Wine and Brandy are often indispensible. But we should make every 
effort to subdue the inflammation before this stage is reached. 
Nitric-acid.—Constant pressing in the rectum without any or only 
very slight discharge; bloody dysenteric stools with tenesmus, fever 
and headache over the whole head. Frequent stools consisting only 
of mucus, sometimes with cuttings in the abdomen and violent tenes- 
mus, constant urging to stool with only slight discharge of slimy mucus. 
Long urging and pressing; small fluid evacuations, passing off with 
great difficulty; great heat; thirst, with unequal intermitting pulse. 
Dr. Ereitag has related the results of a poisoning case by Nitric- 
acid, and Clotar Muller considered the case a highly interesting one, 
inasmuch as the mouth and pharynx showed very little erosions; the 
ileum perfectly healthy, and only in the colon was found a state per- 
fectly corresponding with the pathology of dysentery. 
Rhus-toxicodendron.—In dysenteries where typhoid symptoms ap- 
pear, the patient is weak, becoming emaciated ; the plasticity of the 
blood is diminished; the stools are of sanguineous mucus, often passing 
off voluntarily without pain or tenesmus ; incontinence of urine; great 
weakness and prostration; bleeding from the nose ; confusion of head; 
evening-chills, followed by heat with excessive thirst, dejection and 
anxiety also form further indications for its employment. Broackes 
says: In a case of a child of eight years there was pain over the right 
eyelid ; violent colic in the epigastrium ; evacuations painful; mucous, 
blood-stained, containing ascarides and pure blood; thirst; general 
coldness; paleness; emaciation; fever in the afternoon, ceasing to- DYSENTERY. 
913 
wards evening. After Sulphur, Mercurius-corros. and Colocynth failed, 
Ilhus three times repeated cured. 
Veratrum.—Watery sanguineous flocculent discharges, in which 
portions of faeces are manifestly present, or dysentery with vomiting; 
coldness of the surface; extraordinary weakness ; cramps in the mus- 
cles of the legs; cold sweat; retention of urine; evacuations more 
frequent at night than by day, with colic, chills, and rarely tenesmus. 
Tartar-emetic.—Becker says, Broackes cured a case of dysentery 
with this remedy. The skin was dry; sharp, shooting pains in the ab- 
domen ; thirst; bitter taste in the mouth ; bilious and bloody evacua- 
tions. A few doses cured in three or four days. 
It is more appropriate after dysentery, cholera-infantum, cholera or 
abdominal typhus, when there remains great prostration, frequent cold 
sweats, colic pains, distention of the abdomen, tenderness on pressure, 
nausea, diarrhoea, borborygmus, putrid eructations, rapid, weak pulse, 
&c. (.Marcy, New Mater. Med., page 426. Also proper in dysentery, 
after the tenesmus, mucous and bloody discharges have nearly subsided, 
the patient remaining weak from brownish, sanguineous discharges ac- 
companied by nausea and occasional vomiting. The third trituration 
preferred. 
Carbo-vegetabilis.—Adynamic or malignant dysentery: putrid stools 
great prostration, pressure on the rectum and burning, burning pains 
cold breath, cold surface. 
Carbo-veg. may succeed or alternate with Arsenicum in certain low 
forms of dysentery, when the former does not act with efficiency. It 
may be given for the same train of symptoms and at the same potency 
as Arsenicum. 
Sulphur.—In many of the worst cases where the disease yields 
slowly after other remedies have been tried, or where there is a psoric 
poison or dyscrasia, perhaps inherited, which prevents the proper re- 
medy from taking effect. Characteristic symptoms: mucous stools 
streaked with blood; violent tenesmus; frequent urging to stool, espe» 
cially at night; discharges of mucus, with or without blood, preceded 
by cuttings in the abdomen with tenesmus, fever, vomiting and griping 
pain, irritable disposition, haemorrhoids, &c. The thirtieth attenuation 
is more effectual than any lower. 
Sulphur deserves consideration in instances where the more ordinary 
remedies fail in affording prompt relief, and especially if any latent 
miasm is suspected to have conduced to the disease, or prevented the 
usual action of medicines administered. It is often serviceable in the 
dysenteries of hsemorrhoidal patients. 
In no disease have allopathic physicians come nearer reaching the 
true ground without finding it, than in the treatment of this disease by 
mild purgatives. It is useless to pass in review the long catalogue of 
Vol. I.—58. 914 
DISEASES OF THE SANGUINOUS FUNCTION. 
the articles they have tried, and show in each the reason of their 
failure. In severe autumnal dysenteries purgatives always aggravate 
the disease instead of curing it. Often have we seen a common case 
of bilious remittent fever take the form of a most dangerous dysentery 
from the operation of a common purgative. The people accustomed to 
relieve the common constipation in the marshy districts with pills, 
composed in part of Aloes, Gamboge, Calomel, &c., try the same re- 
medy in fever. Small doses fail to operate and they are followed by 
large ones. At length a large evacuation is procured though with great 
irritation. It is followed by several others in succession. Each suc- 
ceeding discharge is more fluid than the last. In a day or two the 
evacuations take place at regular intervals of three or four hours, and 
consist of reddish water only. The pulse was one hundred per minute 
on the first day; it gradually increases to one hundred and twenty in 
an adult, and continues to increase in frequency. Is it possible that 
further purging is needed now ? In some cases a purgative syrup, of 
which Rhubarb is the strongest ingredient, may pass through the bowels, 
carry a small quantity of solid faecal matter. If this occurs, a change 
is affected for the better. But if it will not pass, a few large injections 
of warm water with some oleaginous substance in it may he thrown far 
up the colon and, aiding the purgative, may wash out the inflamed 
colon. In a bad case it will either not pass into the colon, or will he 
instantly expelled, bringing nothing with it. Just here many a case 
has been abandoned as hopeless, and death has always followed. 
There is one resource more in the flexible gum-elastic tube first used 
in dysentery by Dr. O’Bierne, of Dublin, though often used by others 
for other purposes. In one case, after all common efforts had been 
made for twelve hours and the patient was rapidly sinking, we directed 
the gradual and careful introduction of the tube through the rectum 
into the colon. When the upper end of the tube had entered the sig- 
moid flexure, it encountered an obstruction, which for several minutes 
resisted its passage. The tube was made to press its way gently 
through a solid mass of some inches in length, when it passed the ob- 
struction it moved freely several inches further. About three pints of 
tepid water, or weak beef-tea, was now thrown up through the tube with 
a common syringe. The quantity of water, though not large, was suf- 
ficient to dissolve away by degrees the solid mass through which the 
tube had passed. A sudden and permanent change was at once visible. 
The pulse was immediately reduced in frequency below one hundred 
per minute; perspiration was established; the skin recovered a natural 
warmth; and the spasmodic action of the large intestines and abdomi- 
nal muscles gradually subsided. 
In none of the common cases of dysentery is this treatment neces- 
sary. Indeed under judicious homoeopathic treatment few cases, if MIJCOUS DYSENTERY. 
915 
any, would ever run into the condition above described. But such cases 
will be met with among patients who have passed through the perils of 
other systems of treatment, and the characteristic of the true phy- 
sician is, that he is never without a resource. 
The single objection of the tenderness of the rectum and the diffi- 
culty of passing any substance through the curvatures of this canal and 
the colon is only met by the consideration, that although these difficul- 
ties are real, there are cases where it is better to meet them than to 
do worse. In no case have we directed this treatment, except where 
death would have resulted from any common allopathic efforts. In 
every instance life was manifestly saved by the course pursued, and 
the result was at least satisfactory to those interested. 
16. MUCOUS DYSENTERY.—MUCO-ENTERITIS. 
Dr. Chambers* says : The excreted matters vary greatly in appear- 
ance, presenting almost every aspect but a healthy one. Sometimes 
they are light-colored and abundant, of a faint, putrid smell, and con- 
taining principally unaltered food; sometimes they are dark, like pitch, 
scanty and slimy. There is often separated from them, when fluid, a 
good deal of oily matter, probably derived from undigested adipose 
tissue of the victuals. The mucus itself may look like lumps of fat, 
being in white, opaque masses, which however are easily distinguished 
in the microscope by the presence of the usual globules of mucus. At 
other times it has more the appearance of macaroni, drawn out into 
adhesive strings. The appetite is always very bad. The urine is high- 
colored and thick; but, except when the disorder is at the worst, it is 
most frequently natural. The pain in the abdomen is very difficult to 
assign to any particular spot. If any one place is fixed upon, it is 
usually either the right hypochondrium, or the neighborhood of the 
navel, and sometimes the sensation seems to follow the food from the 
former to the latter situation. Sometimes acute attacks of spasmodic 
pain around the waist come on, and sometimes the skin around the 
navel is so sensitive, that the case might be almost mistaken for one 
of perforation or peritonitis. There is almost always distressing flatu- 
lence, causing palpitation. Intestinal mucous flux has very generally 
a periodic character. The patient is pretty well for a week, or a fort- 
night, or a month, and then the symptoms above described, or an ag- 
gravation of them occur. 
Prognosis.—“It can hardly be immediately fatal of itself, yet it re- 
duces the body not unfrequently to such a state of anaemia, that other 
diseases supervene and conduct the patient to the grave. I have known 
* Digestion and its Derangements. 916 
DISEASES OF THE SANGUINOUS FUNCTION. 
degeneration of the kidneys so induced, which finally destroyed by 
dropsy and diarrhoea.” 
Treatment.—Hygienic Measures.—Long and hurried journeys may 
be injurious, but some variation of air and scenery is often very benefi- 
cial and often produces an immediate change in the appearance and 
smell of the faeces, which is often speedily followed by return to health 
and strength. Riding is specially beneficial as it induces more active 
secretion of the liver and promotes absorption from the bowels. Dr. 
Chambers says, “ the foetor of putridity, which it is the business of the 
bile to prevent, and the undissolved muscular fibre, which it is the 
business of the bowels to take up, disappear simultaneously from the 
stools.” 
Of the value of sleep in chronic diseases he says: “It is sadly under, 
estimated by medical men; ” and “ there is probably no disorder in 
which this is so important as in the mucous flux of the intestines, and 
I have known the expedient of lying in bed till 9 o’clock in the morning, 
make treatment effective, which previously had been perfectly useless.” 
Diagnosis. 
Violent abdominal pains, aggravated 
by pressure and accompanied by vomit- 
ing, and marked symptoms of inflam- 
matory fever. The more numerous the 
coats of the intestine implicated in the 
inflammatory process, the more acute 
and violent the symptoms. 
Uncomplicated peritonitis is almost 
invariably attended with constipation. 
Acute Enteritis. 
The mucous coat being less sensitive 
than the serous or peritoneal coat, the 
suffering and danger are less extreme 
and threatening. 
Inflammation of the enteric mucous 
membrane is not generally attended by 
constipation ; but almost invariably by 
diarrhoea or ctysentery. 
Muco-Enteeitis. 
Treatment.—Mercurius.—Cases resembling genuine dysentery with 
symptoms of acute sthenic inflammation, the evacuations being com- 
posed of a mixture of blood and mucus ; urging, tenesmus, with febrile 
and inflammatory and bilious symptoms, marked by rheumatic lesion 
of the muscular coat of the lower bowels; acute cases of recent origin, 
aggravated by night, while the patient is lying down. 
Mux-vomica.—The discharges from the bowels consist of simple 
mucus in small quantity, voided with considerable pain in the rectum, 
and urging, which is sometimes ineffectual; mucus of green color and 
excoriating in character; dyspeptic symptoms, including persistent 
anorexia, with a sallow complexion and some colic marked and de- 
cided. 
Arsenicum-album.—It has some especial relation to the gastric and 
enteric mucous membrane : sensitiveness of the pnecordial region,, ir- 
ritability of the stomach; more or less thirst, with vomiting of the fluid COLITIS. 
917 
taken; alternate constipation and diarrhoea, with yellow, slimy stc ols ; 
tenesmus; sense of excoriation at the anus, debility and emaciation. 
Chronic Ulceration of the Intestines.—Dr. Chambers {Digestive 
Organs and their Diseases') says: There is no disorder, of which 
emaciation is so marked a feature throughout its whole course, as 
chronic ulceration of the whole intestines. Ulcerations of the coecum, 
tubercular or not, produce as much, nay often more diarrhoea, but they 
are not by any means so distinguished in their power of reducing the 
patient. In this lesion of the ilia even the parts, which are not the ac- 
tual seat of disease, seem incapacitated from absorbing nutriment, and 
the victuals pass through the alimentary canal in the same state, as 
when they left the stomach, except being made putrid by chemical de- 
position ; all the stages of digestion are equally suspended. 
Remedies.—Arsenicum, Calcarea, Ilepar-sulph., Nitric-acid, Si- 
licea, Phosphorus. 
17. COLITIS.—CAMP-DIARRH(EA. 
In that form of intestinal disease that prevails extensively in the 
Mississippi valley, and was extremely common among the soldiers and 
volunteers of the American army in the war with Mexico, (more recently 
known as the camp-diarrhoea in all the American armies) medical treat- 
ment was peculiarly unsuccessful; and it has been asserted, that more 
men died of this disease than did from the bullets of the Mexicans. 
(See Prof. Adams. U. S. Jour. Ilomceop. Yol. I., p. 65, &c.) 
Predisposing Causes.—Previous derangement of the bowels and 
debility. It most commonly attacked persons not acclimated to a mala- 
rious climate, and varied much in its intensity in different cases. 
1. Mucous diarrhoea.—Discharges composed entirely of gelatinous 
mucus, pale gray, mixed with white slime or mucus. 
2. Serous diarrhoea.—Discharge merely a clear or muddy water. 
3. Bilious diarrhoea.—Evacuations more or less tinged with bile. 
4. Lientery.—Evacuations consisting mostly of undigested food, 
paste-like, and sometimes in a state of fermentation, frothy, like chalk 
and beer. 
5. Purulent diarrhoea.—Evacuations consisting partially or entirely 
of pus. 
In none of these forms is blood generally passed, though the tormina, 
and tenesmus are extremely distressing and exhaustive. In moderate 
cases the pain in the abdomen is only felt before each evacuation. 
This takes place every three or four hours, is attended with much 
rumbling uneasiness and feeling of prostration; the appetite being at 
the same time morbidly craving. In severer cases the stools occur fif- 
teen or twenty times in twenty-four hours; and sometimes become 918 
DISEASES OF THE SANGUINOUS FUNCTION. 
quite liquid and often involuntary. The pain in some of these cases 
becomes excruciating, in some even causing fainting; emaciation and 
debility progress. When the disease involves the mesenteric glands 
there is hectic fever well marked. The abdomen is flat, inelastic, and 
retracted, though sometimes it becomes tympanitic. The skin is dry 
shrivelled and desquamating, and of a sallow hue. The inflammation 
in many cases involves the caecum, and there is dull aching pain in its 
region. Sometimes this becomes acute for a time, during which the 
countenance expresses anguish, sadness, and extreme dejection ; it is 
worse a few hours after eating, may be excited by riding, or other jolting 
exercise, by anger, or wrong diet. In severe cases the inflammation 
of the caecum proceeds to disorganization in the course of ten or fifteen 
days. This severe inflammation of this organ is detected by the “round, 
doughy, inelastic tumefaction of this organ, felt on pressure with the 
hand. After death in fatal cases may be found “a mass of disease 
and inflammation with induration in the right iliac region.” [Adams.) 
Treatment.—Aconite in the earlier stages of colitis will of itself 
prove efficacious in removing every vestige of the disease. To make 
a deep impression on the disorder and diminish the congestion and 
inflammation of the engorged mucous membrane give the pure tinc- 
ture in repeated doses during ten or twelve hours. Aconite is the 
great remedy of colitis, controlling all its symptoms. 
Colocynth.—After Aconite, when tenesmus and tormina continue. 
For Lientery give Arsenicum and China in alternation; also for 
chronic colitis, with debility and emaciation. 
Mucous Diarrhoea.—Arnica, Pulsatilla, Chamomilla, Merc.-sol.— 
When stools are muddy and watery: Arsenicum, Cham., Dulc., China, 
Ferrum, Pliosphoric-acid, Pulsatilla, Rhus. 
Bilious Diarrhoea.—Mer.-corrosivus, Dulc., Puls., Podophyllum. 
Pui'ulent Diarrhoea.—Arnica, Silicea, Phos. 
Pursue a rigorous dietetic system, keep the colon as empty as pos- 
sible till the disease is cured, guard against atmospheric influences. 
Bathing and frictions to the surface. [Prof. R. E. IF. Adams, 
St. Louis) 
The National Hotel Epidemic at Washington, D. C., in the 
summer of 1857, is believed to have originated in a poisonous miasm 
generated in stagnant w’ater and the accumulations of animal and vege- 
table materials left to putrefy in the sewers and communicating with 
the privies of the house. At the time of the outbreak of the disease 
the water from the Potomac was unusually high, and flowed through 
the Tiber, having for a time overflowed the low and filthy foundations 
of the Hotel. When thus established in a house crowded with occu- 
pants the cause of the disease followed the usual laws of infectious 
dysenteries. The germs by which the disease communicated itself to STRUCTURAL DISEASE OF THE COLON. 
919 
new subjects consisted of organized, though excessively minute spo- 
rules, capable of reproducing themselves, and so extremely minute as to 
be able to diffuse themselves to some extent in the air. 
18. STRUCTURAL DISEASE OF THE COLON. 
Diagnosis.—Sympathetic effects of Structural Disease.—The kid- 
neys and bladder, being immediately in the vicinity, are often much ir- 
ritated during attacks of colic, but these aifections are but secondary, 
and subside when the colic is relieved. Numerous other symptoms are 
sometimes traced to disease of the colon which in other cases are con- 
sidered as primary diseases or symptoms of other secondary disorders. 
Some of these are: Epilepsy, loss of power approaching to paraplegia, 
pains simulating rheumatism, cramps, spasms in the limbs, &c. Any 
of these alarming symptoms may be excited by nervous irritation originat- 
ing in the colon and communicated to the brain and spinal marrow. 
A single attack of epilepsy is sometimes induced by this irritation in 
younger persons, who may not afterwards be subject to it. In habitual 
epileptics, irritation of the canal, more particularly of the colon, multi- 
plies the number of the attacks and increases their severity. 
Symptoms of faecal accumulations in the Colon.—The structure 
and position of the colon show that nature has not designed that col- 
lections should take place here as they do in the coecum. The colon 
is not supported in its position in the same way, and, therefore, its 
weight, when fully loaded conveys an uneasy sensation, described as if 
something was dragging the bowels away from the stomach; the arch 
thus gives notice by pain that matters are retained within it for which 
it was not constructed. There is also a pain under the left shoulder- 
blade which is relieved by pressure, referred to the external respira- 
tory nerve through the medium of the stomach. The collections in the 
arch of the colon interfere mechanically with the stomach, and cause 
the dyspeptic symptoms that come on when the stomach is empty and 
in a disordered state; as eructations of wind, pyrosis, and other severe 
symptoms often mistaken for structural disease, great and long con- 
tinued pain, fullness of the abdomen, pains in the lower extremities, las- 
situde, despondency of mind, &c., which cause the patient to regard his 
disease as structural and beyond the reach of the simpler remedial 
measures, and he flies from one active purgative to another to find only 
temporary relief, followed by increased debility and local accumula- 
tions. (.Condensed from Alder son, Diseases of Stomach, dec.) 
To review all the diseases of the colon, says Alderson, would be to 
recapitulate the whole train of dyspeptic symptoms. When the colon 
is obviously the point of derangement and the seat of pain, and the 
more prominent symptoms are not those of a more dyspeptic character, 920 
DISEASES OF THE SANGUINOUS FUNCTION. 
accumulations to a large amount, accompanied by a large evolution of 
gas generally exist. This often leads to severe colic. Collections in 
the coecum do not produce such distressing dyspeptic symptoms as 
when they take place in the arch; the coecum is so bound down by 
membrane, and so preserved in its natural position, and it is so sup- 
ported from the effects of gravity by lying on the side of the pelvis, 
that it is only from distention that pain is felt in this spot. 
The coecum being out of the current appears to be the natural depot 
where collections to some extent are always intended to exist. There 
are probably especial reasons for this delay, and though the function 
of the appendix vermiformis is not well understood, it is presumed that 
some change takes place at this point for which delay is neeessary. 
The coecum is also situated out of the reach of other organs and is less 
likely by its state of distention to interfere with them. The mere col- 
lection, therefore, of matters within the coecum is not necessarily a 
cause of colic, as it is designed as a depot for a specific purpose, un- 
less, by too long continuance here, decomposition or fermentation 
should take place. In this case gas may be evolved, which being ob- 
structed by accumulations in the colon above, may excite severe pain 
from distention of the intestine. (Alder son.) 
19. MALIGNANT ULCERATION OF THE COLON. 
This disease would hardly be considered as carcinomatous except for 
the accompanying secondary deposit of encephaloid matter in the liver, 
as there occurs no such deposit at the seat of ulceration. 
Diagnosis.—The general symptoms are those that accompany can- 
cerous deposits in other parts of the system; loss of flesh, change of 
color and complexion anxious countenance; pulse and tongue natural 
to a very late period. When ulceration occurs in the colon its com- 
mencement is marked by dysenteric symptoms which appear many 
months before the disease approaches a crisis. When the symptoms 
become chronic, the ulceration progresses through the coats, and, as 
an instinctive effort of nature to prevent rupture into the cavity of the 
abdomen, lymph is poured out, and neighboring organs as the bladder, 
or vagina, agglutinated together. The lymph thus thrown out is of a 
smoky hue, of a melanotic tinge, and is easily torn through. A shiver- 
ing fit, accompanied by delirium, marks the time when perforation is 
effected through the coats. 
This instinctive or preservative process of throwing out lymph is 
properly but a prolonged process of destruction. It occurs only in 
chronic disease, and where the constitution is in a failing state, and 
never in early life or in acute disease, where we would naturally look 
for such a restorative effort of nature. In one case of malignant ul- CANCER OF THE RECTUM. 
921 
ceratioa in the sigmoid flexure of the colon, lymph was poured out, and 
adhesion took place between the intestine and the bladder; the contents 
of the colon passed through the bladder; and the urine in turn pro- 
duced irritation of the rectum. The patient had through life suffered 
from indigestion, from gall-stones, and spasms of the gall-ducts. After 
death, a large gall-stone was found in the gall-bladder, and the liver 
was extensively studded with encephaloid deposit. 
Ulceration of the coecum of a character not malignant, is a common 
result of obstinate constipation. {Alderson, on Diseases of the 
Stomach and Alimentary Canal, Lond. 1847.) 
Treatment.—In malignant structural disease of the colon we can 
trust only to those specifics mentioned under cancer of the stomach, 
and those mild palliative measures which may soothe if they can not 
cure. 
In many cases positive relief may be given by regarding the case as 
one of functional derangement already terminating in local hypertrophy 
or other structural disease of the affected organ; and making judicious 
efforts to wash out the offending accumulations from the entire colon. 
Here all the measures we have presented under Dysentery are avail- 
able. Active purgatives, which in most cases may be suspected to 
have caused the disease, are highly dangerous, as they destroy the tone 
of the digestive organs, and however persistently used, may never dis- 
lodge the contents of the cells of the colon. “The peculiar construction 
of the colon,” says Alderson, “admits of a passage along the course of a 
channel, the sides of which consist of so many loaded cells ; thus, though 
there is action of the bowels, the disturbing cause may still remain, 
and can only be fully dislodged by a change of aperient and other re- 
medies.” It is certain that large collections in the colon may exist, 
and be for a long time retained, while at the same time a daily evacua- 
tion of some kind may take place. This fact is made the basis of a 
purgative treatment which only perpetuates and increases the difficulty. 
(,See Ware on Purgatives, cfee.) The only treatment admissible in 
cases of structural disease of the colon are those already pointed out 
under Dysentery and Colitis. See pp. 904 to 917. 
20. CARCINOMA OF THE RECTUM.—Cancer of the Rectum. 
Symptoms.—Local pain, sometimes dull and aching, at others acute 
and lancinating; sense of weight and confinement in the part, with un- 
easiness around the loins and pubes; numbness in the hips and thighs, 
aggravated by standing, walking, or sitting, relieved by lying down. 
Operation of the bowels increases distress. The faeces passed in a 
liquid state or in small fragments, and, after repeated efforts, blood and 
mucus expelled with them. Females suffer in addition from irritation 922 
diseases of the sanguinous function. 
of the bladder, pain in urinating, incontinence of urine, &c., bearing 
down of the uterus, also from faecal accumulations ; fits of abdominal 
distention and pain, with tenderness, hiccough and vomiting. 
Treatment.—In these melancholy cases palliation may be the only 
thing possible; and, in our efforts to reach this, we must resort to such 
expedients as have been tried. When we have given a trial to the con- 
stitutional remedies, which are found successful in cancer in other lo- 
calities, we may be driven back to mere palliatives. It is proposed to 
allay the pain with Opium in a solid form, or with Morphine, extract 
of Stramonium, or other narcotics. Solid Opium taken into the stomach 
acts better than it does applied locally to the diseased surface, though 
many use a watery infusion of Opium, adding to it Acetate of Lead. As 
constipation increases the pain of the diseased part and hastens its 
progress, it is desirable to prevent it by only such means as are en- 
tirely unobjectionable. The free drinking of water, if it can be borne 
to a sufficient extent, is the best reliance; injections of blood-wrarm 
water may be used when they give no pain. Purgatives of almost every 
form are injurious and must be avoided. 
In the use of Opium we are not expecting to cure, but only to palliate 
in incurable cases. In these, if we begin with it, it should only be in 
the latter stages, when the pain is extreme and when there is no pro- 
bability of continuing it long. The constipation it causes ceases to be 
an objection after the patient has become habituated to its operation. 
For further remedies see Cancer in its different forms.—Index— 
Volume II. 
INFLAMMATORY DISEASES OF THE LIVER. 
1. Congestion; 
2. Inflammation, and its consequences; 
3. Diseases which result from an abnormal nutrition of the liver, or 
from “ faulty secretion 
4. Diseases which result from some growth foreign to the natural 
structure. 
5. Jaundice.—See page 401, 405. 
Congestion of the Liver.—General Remarks. See Article Con- 
gestion. This disease is generally compicated with congestion of 
other abdominal organs. It may take place suddenly from a sudden 
suspension of the cutaneous perspiration, which very frequently hap- 
pens from a slight change of temperature after exposure to great heat. 
The complexion is usually purplish with a mixture of dingy yellow. 
Diagnosis.—When the circulation of the liver is unusually impeded 
and the organ is materially engorged with blood the liver increases in INFLAMMATION OF THE LIYEK. 
923 
size. Its edge can be felt two or three inches below the false ribs. If 
the congestion be relieved by treatment, by diuretics or by rest, the 
organ returns to its former volume. Enlargement and subsidence thus 
alternately follow each other in quick succession. In judging of its 
relative size and position it must be noted that it naturally sinks an 
inch or two lower after a full inspiration, or when the patient is in the 
erect position and that it can be pushed down by fluid in the cavity oi 
the pleura, or by a bloated emphysematous lung. {Rudd, Diseases 
of the Liver, p. 41.) It may be sufficiently distinguished from in- 
flammation by the shortness of the time that has elapsed from its com- 
mencement; the evidence plainly visible of imperfect decarbonization 
of the blood, and the presence of the materials from which the bile 
should have been secreted. 
Causes.—Sudden exposure to cold after great heat. It is a com- 
mon disease in malarious districts where all the functions are deranged 
by the poisonous influence of marsh miasm. {See Malaria) In autumn, 
when hot days are succeeded by cold nights, the action of the liver is 
checked by a sudden chill, or by long-continued exposure to air not 
extremely cold. All the causes of congestive fevers may excite con- 
gestion of the liver in persons in whom the organ has been debilitated 
or injured by marsh fevers imperfectly cured, and by the reckless use 
of mercurials. In ague the liver is almost always temporarily engorged 
with blood; in purpura congestion of a different character occurs; but 
it requires a very different treatment. 
Pathology.—The condition of the internal secretory apparatus of 
the liver in a state of congestion is easily comprehended when the 
minute anatomy of the hepatic parenchyma is recalled to the mind. 
“The lobules of the liver,” says Dr. Budd, “ are spaces mapped out by 
the ultimate twigs of the portal vein, which are hairy, as it were, with 
capillaries springing immediately from them on every side, and forming 
a close and continuous network ; and the interstices of these capillaries 
are filled with nucleated cells. It is in these cells that the vital 
chemistry of secretion goes on. It is seen by the microscope that in 
different livers, the cells vary in size; that in some they are almost 
transparent, in others opaque, and apparently more solid; that in some 
they contain but a few very small oil globules, while in others, they 
are distended almost to bursting with globules of oil; that in some they 
are colorless or nearly so, and in others yellow with bile; that in some 
specimens, again, they are broken down and destroyed.” In some cases 
the cells are only slowly reproduced; and, without complete destruction 
they become less productive of new cells, so that at length the number 
of active cells is much diminished. These differences in the condition 
of the cells cause corresponding differences in the size, color and tex- 
ture of the liver. (Diseases of the Liver, p. 197.) 924 
DISEASE8 OF THE SANGUINOU8 FUNCTION. 
The first effect of congestion of the liver is to suspend the secretion 
of the bile, permitting the large quantity of carbon usually carried off 
in this secretion to remain in the blood. In addition to the retained 
carbon there are left in the blood those numerous impurities which the 
veins from the stomach and intestines carry to the liver to be there 
thrown out, and also, all the waste materials collected by the absorbents 
from the wear and decay of the same organs. All of these matters 
are unfit to form new blood or serve any other purpose in the body. 
And yet, a sudden suspension of the biliary secretion throws all these 
elements of disease again upon the general circulation. When the con- 
gestion continues for a considerable time, the proper secretory appara- 
tus (the nucleated cells) of the liver seems to be more and more in- 
jured until it may become irretrievably damaged; and then the secre- 
tion of bile almost entirely ceases. Dr. Budd gives some cases in 
which the common bile duct of the liver had been entirely closed; and 
“ the liver had entirely lost its lobular appearance and contained no 
nucleated cells; so that, when a portion of it was examined under the 
microscope nothing was seen but free oil globules and irregular par- 
ticles of greenish or yellow biliary matter.” The same effect may arise 
from other serious lesion of the extreme vessels or biliary tubules, as 
we see in that granular state of the liver so frequent in drunkards, 
called Cirrhosis. 
ACUTE INFLAMMATION OF THE LIVER. 
1. Adhesive Inflammation. 
2. Suppurative do. 
3. Gangrenous do. 
4. Inflammation of the Veins. 
5. Inflammation of the Gall Bladder and Ducts. 
ADHESIVE INFLAMMATION.—HEPATITIS. 
1. Inflammation attended with the effusion of coagidable Lymjph 
may exist on the surface of the liver, or may penetrate the parenchy- 
matous substance of the organ. The latter is most important and is 
most common. It is characterized by well-marked symptoms of in- 
flammation of the liver, pain in the right side, vomiting, fever and 
yellowness of the skin. When these symptoms have continued for a 
time they subside; but the patient does not regain his former health. 
The liver has been permanently injured; part of its secreting substance 
has become atrophied from closure of the small portal veins. The 
patient still has difficult digestion, has a sallow complexion, and does 
not recover his former strength. 
O 
Diagnosis.—When the disease occupies the convex surface of the INFLAMMATION OF THE LIYEK. 
925 
liver, we shall have fullness and severe pain in the region of this organ, 
increased on pressure, either of a sharp, aching or burning character; 
pains extending into the chest, under the clavicle, between the shoul- 
der-blades, into the top of the right shoulder, and sometimes down the 
arm; short, dry cough; dyspnoea; difficulty in lying upon the left side; 
hot and dry skin; thirst; scanty and high-colored urine; constipation; 
clay-colored evacuations; full, hard, and frequent pulse; headache, and 
more or less mental disorder. If the inflammation is in the concave 
portion of the liver, we shall have, in addition to the symptoms already 
enumerated, distressing nausea and vomiting; tongue covered with a 
white or yellow fur; bitter taste; urgent thirst; an aggravation of the 
pain in the hypochondrium on pressure; urine scanty, and of a dark 
yellow or saffron color; eyes and skin tinged with yellow; bowels con- 
stipated or relaxed; pains in the back and limbs; ideas confused; mind 
clouded or delirious. 
In most instances of acute hepatitis, it is highly probable that the 
peritoneal covering of the liver is implicated to a greater or less ex- 
tent, and this may serve to render the pains more severe, and the ac- 
companying symptoms more violent. 
The characteristic symptoms of adhesive hepatitis vary according 
to the acuteness of the attack and the stage in which it comes under 
our notice. Pain and tenderness over the region of the liver in a spirit 
drinker may be regarded as suspicious. When the organ has become 
seriously diseased the complexion is always jaundiced and the skin 
dry and rough. There is in most cases a tendency to ascites. “ If 
the subject of diseased liver,” says James Johnson, “will not forsake at 
once the use of intoxicating drinks, his fate is sealed; and bloated 
dropsy with all its horrors will soon be upon him.” [Morbid Sensibility 
of Stomach, dec) Haemorrhagic phenomena are common: bleeding 
from the nose or rectum, haemorrhoids, purpuric spots on the face; en- 
larged or varicose veins of the abdomen, arising from impediment to 
the free return of blood along the deep-seated vessels. The portal 
circulation is at first chiefly involved, hence the ascites often exists 
alone, and without oedema of the legs or any other part. In a later 
stage the oedema of other parts is established, showing a more per- 
manent and serious form of the disease. 
Causes.—Habitual drinking of alcoholic liquors; exposure to vicis- 
situdes of weather; residence in hot climates; all the causes of deranged 
functions of the chylopoetic viscera; organic affections of the 
stomach, &c. 
Pathology.—On dissection lymph is found effused into the areolar 
tissue in the portal canals; and, if life be long continued after the ef- 
fusion took place, all the considerable branches of the portal vein are 
found surrounded in some places to a distance of half an inch by new 926 
DISEASES OF THE SANGUINOUS FUNCTION. 
fibrous tissue, which sometimes contracts and puckers the adjacent 
portions of the liver. The main branches of the vein are pervious, but 
many of the small twigs that spring from them are obliterated; and 
the parts supplied by these branches are atrophied, reducing that much 
of the liver in bulk. There are also thick false membranes on the cap- 
sula of the liver, or extensive adhesions between this and the neighbor- 
ing organs. The deposition of lymph having rendered the parenchyma 
of the liver tougher and more indurated than in health, its. tissue is 
paler than natural, contains but a small quantity of blood; and it is 
sometimes yellowish from accumulation of biliary matter in the cells. 
This gives in section the yellowish gray color of impure bees-wax, for 
which reason the French have called the disease cirrhosis, (Greek 
Kirros, yellowish), the “gin-drinkers’ liver.” In its early stage the vis- 
cus is enlarged; but, later, the more watery parts are absorbed; the 
lobular part receives less blood and wTastes till it becomes smaller than 
in health. When hepatitis is caused by ardent spirits, the alcohol, 
being carried directly to the parenchyma of the liver, makes its first 
impression on it; and here we find the first traces of structural disease, 
the capsule and investing membrane being secondarily affected. In 
dogs poisoned by alcohol, says Percy of Birmingham, the spirit could 
be extracted from the liver in greater quantities than from the blood, 
brain, or other organs. (Prize Essay) M. Becquerel has shown that 
in about half the cases of cirrhosis there is also disease of the heart. 
(Archiv. Generate, 1840.) 
Pkognosis.—This is only unfavorable when extensive structural dis- 
ease already exists and the dropsical symptoms show important com- 
plications in other organs. Hepatitis, however induced, is a curable 
disease so long as permanent organic alterations have not been de- 
veloped in the intimate structure of the liver. The extent to which 
these may be believed to be present; and the degree in which the 
general system is already involved in the consequences of obstructions 
and cessation of function already in existence, must govern our estimate 
of the degree and proximity of danger. 
2. Suppurative Inflammation of the Liver.—Not only is the liver 
subject to the formation of abscesses, as the legitimate result of a com- 
mon inflammation of that organ, it is peculiarly liable to the formation 
of abscesses of a peculiar character, wThich have been supposed to be 
in some way related to suppuration going on in some other organ. 
Causes.—It may occur from a blow or other mechanical injury on 
the side, (Andral,) but it more frequently arises from inflammation of 
some vein and consequent contamination of the blood with pus. An 
abscess of the liver, and more frequently the lungs, often follows in- 
juries or surgical operations. It is believed that the immediate cause 
of the abscess consists in the presence of some poisonous substance, INFLAMMATION OF THE LIVER. 
927 
commonly pus, conveyed from the inner surface of a vein to the minute 
capillaries of the lungs where they excite suppurative inflammation. 
If any of the purulent globules pass through the capillaries of the lungs, 
and proceed to other organs, they become arrested in some of them, ex- 
cite inflammation progressing rapidly into abscess. {Budd, on Dis- 
eases of the Liver.) When abscess of the liver, lungs, heart or spleen 
follows injury of the head, we may believe that suppurative suppuration 
of a vein somewhere exists, either in the soft parts or between the tables 
of the skull. (See Researches by Dance, Cruveilhier and Larrey in 
France, and Arnott in England) The purulent matter must, in such 
cases, pass through the capillaries of the lungs, hence these “metastatic 
abscesses are more common in the lungs than elsewhere. But, if the 
seat of the suppurative phlebitis be in one of the veins that go to form 
the venm portae, “ the pus will be carried first to the liver; and then 
the abscess will be found in it alone. Cruveilhier injected Mercury 
into one of the the mesenteric veins, and found that it was stopped in its 
course through the liver, and caused circumscribed abscesses through- 
out its substance. When the Mercury was injected into the cruval vein, 
it was stopped in the lungs, and the abscesses were formed there. 
When the mesenteric veins become inflamed from any cause, as they 
may do after operations on the rectum or for strangulated hernia, the 
abscess formed as a consequence of translated pus is always in the liver 
alone, as there the peccant matter is stopped. {Dance and Cruveil- 
hier.) 
Abscess of the liver is most frequently caused by ulceration of some 
part of the alimentary canal, or of the gall-bladder or ducts, the veins 
of which parts empty into the portal system. They convey the purulent 
matter, the poisonous fluids generated by the softening of tissues, and 
also the foetid gases and liquid contents of the large intestine; all 
these contaminating fluids, when absorbed, must pass directly to the 
liver. There the fluids that readily dissolve in the blood cause diffuse 
inflammation of the liver. Morbid matters that do not readily mix with 
the blood, as pus, or globules of Mercury, produce small circumscribed 
abscesses. (Budd, p. 64.) 
Broussais first showed, that ulceration of the stomach often led to 
hepatic abscesses. {/Stokes. Cyclop. Bract. Med) Ulceration of the 
gall-bladder and ducts, which are nourished by the hepatic artery, and 
not by the portal vein, cause ulcers of the liver in the same manner as 
that of the parts already mentioned. Another cause of purulent ab- 
scesses in the liver is the deadly miasm developed in marshy regions 
in hot climates. 
Diagnosis.—The characteristic features are not well marked, and the 
disease is often overlooked during life. The pain in the side or shoul- 
der, the vomiting and the jaundiced color looked for are often absent. 928 
DISEASES OF THE SANGUINOU8 FUNCTION. 
(.Andral, Abercombie, Annesley.) When the pain in the right shout- 
der exists, it indicates, that the disease is in the right lobe of the liver. 
Tension, or rigidity of the right rectus muscle may be found in other 
forms of liver-disease. When the pain yields to tonics, we may presume 
it was neuralgic, if to Colchicum or Alkalis, we may presume it was 
of gouty origin, if to depletion and purgatives it must have been inflam- 
matory or congestive. Of the action of Mercury it has been said by 
Mr. Annesley, that its specific powers can not be induced after sup- 
puration has taken place. {Med. Chir. Hev. Yol. 47, p. 503.) 
Abscess of the liver may generally be distinguished by the presence 
of a soft tumor, which may be felt under the ribs of the right side, fluc- 
tuating on pressure. If by rupture of the abscess, pus is discharged, 
the matter is distinguished by its resemblance to wine dregs, with some 
mixture of bile. There is jaundiced color of the skin, rapidly increasing 
emaciation of the whole body, and the fever peculiar to hepatic phthisis 
with periodical exacerbations. 
The termination of acute hepatitis in suppuration is announced by 
rigors, a sense of sinking in the prmcordia, night-sweats, prickly sense 
of creeping in the skin; fullness and sense of weight about the margin 
of the ribs; dull, throbbing pain in the liver. (See Abscess, p. 652.) 
If fluctuation be distinctly felt under the ribs, aud we may believe, that 
the suppuration is complete, and the abscess not at too great a depth, 
it should be opened. When the pain and general fullness are diminished 
and replaced by a distinct tumor without acute pain; if it is soft and 
fluctuating at the apex, elastic, yet livid or red on the surface, while 
the base is somewhat hardened and elevated, we may puncture the ab- 
scess with confidence in a successful result. The inflammation which 
leads to abscess is often confined to the substance of the liver, and does 
not involve its capsule. As the abscess approaches the surface, ad- 
hesive inflammation of the peritoneum immediately above it usually 
takes place, and a small quantity of lymph is poured out, which causes 
adhesion between the wall of the abscess and the parts with which it is 
brought into contact. These adhesions are often of very small extent, 
sometimes they do not form at all and the abscess bursts into the cavity 
of the peritoneum, causing speedy collapse and death. By opening an 
abscess of the liver before adhesions have formed, we may be directly 
instrumental in bringing on this fatal issue,—the pus may escape into 
the cavity of the peritoneum, and the patient die in a few hours, ob 
viously in consequence of the operation. Another danger is also en- 
countered in allowing air to enter the cavity of the abscess and decom- 
position of both results, air and pus, and fresh inflammatory action is 
developed. 
Abscesses of the liver often attain an immense size. Dr. Budd saw 
one that contained two quarts of pus. Annesley examined one that INFLAMMATION OF THE GALL-BLADDER. 
929 
contained ninety ounces, and Dr. Inman of Liverpool saw one that con- 
tained thirteen pints. 
Prognosis.—The abscess may burst externally through the walls of 
the abdomen, inwardly into the lung or pleura, into an intestine, or into 
the cavity of the abdomen. The opinion formerly entertained that the 
pus could be absorbed and eliminated from the pleura is erroneous. 
Pus-globules are too large to enter the minute blood-vessels, or to es- 
cape from them. The matter found in the bladder during the progress 
of purulent phlebitis is not pus, though it has the appearance of it. 
The microscope shows it to be composed of “ beautiful phosphatic 
crystals.” (Budd. Diseases of the liver, p. 78.) 
Cragie says, that besides the abcess discharging into the abdominal 
cavity, the pus may pass through the air-cells into the bronchi, by the 
adhesive process into some part of the intestinal canal, the stomach, 
transverse arch of the colon or even the duodenum, and Rokitansky 
mentions several other outlets, as into the gall-bladder, or one of the 
larger branches of the hepatic duct; through the diaphragm into the 
pericardium, and even into the large vessels, as the vena cava. He 
mentions a case, in which a communication was established between 
a hepatic abscess and the venae portae and the duodenum. A case is 
given in the London Medical Repos. (July, 1827), in which an abscess 
of the liver spontaneously made its way into the chest, and the purulent 
matter was evacuated by paracentesis thoracis. 
21. INFLAMMATION OF THE GALL-BLADDER AND DUCTS. 
Symptoms.—Pain in the situation of the duct, followed, in two or 
three days, by jaundice and distinction of the gall-bladder; fever, 
constipation, nausea, vomiting; pain, limited to a small spot in the 
situation of the common duct. 
Causes.—Mechanical irritation of gall-stones, which in turn are 
promoted in their growth by the thickening of the lining membrane of 
the ducts. 
Diagnosis.—Distinguished from inflammatory jaundice by the early 
appearance of a large, moveable, pear-shaped tumor, produced by pro- 
jection of the gall-bladder, this is painful and tender. 
Pathology.—In a case, given by Graves (Clinical Medicine), the 
pain during life had been confined to a point between the right hy- 
pochondrium and epigastrium, was greatly increased by pressure. On 
dissection, the gall-bladder was distended, being completely filled with 
a dark-green mass of a, tenacious viscid nature, apparently lymph. It 
was of the shape of the gall-bladder. On removing it, the lining mem- 
brane of the gall-bladder was found of a bright scarlet color and villous 
appearance, not softened or ulcerated, the -walls of the gall-bladder 
Yw, L-59 930 
diseases of the sanguinous function. 
much thickened; no obstruction or vascularity in the common duct, 
the cystic or h-epatic ducts; duodenum and stomach stained with bile, 
but otherwise healthy. 
Ulceration of the Gall-Bladder.—This lesion often occurs in re- 
mittent fever of the more severe forms, as the Walcheren fever, as de 
scribed by Sir Gilbert Blane, and the Sierra Leone fever. {Dr. Boyle) 
In the more temperate climates this affection is connected with tbc 
presence of gall-stones, which also often close the cystic, or even the 
common biliary duct. This last condition always terminates in incur- 
able jaundice, and ultimately certain death. The gall-bladder in some 
cases acquires a large size. 
Pathology.—When the gall-bladder and ducts become thus largely 
distended, the proper nucleated cells of the liver, which secrete the 
bile are damaged or totally destroyed, the capillaries waste, and the 
whole organ shrinks and no longer presents any appearance of distinct 
lobules. ( Williams, in Gufs IIosp. Reports.) Nothing is now visi- 
ble in these structures but minute free fatty particles and floating 
granular matter. In cases of closure of the common duct, there is often 
present a voracious appetite, arising as in diabetes from an imperfect 
digestion of food. Hsematemesis is a frequent symptom of this as well 
as other forms of hepatic disease; the cause is seen in the obstruction, 
of the circulation through the portal vein. This produces a back-pres- 
sure upon the current of blood in the gastric and mesenteric veins. 
In some cases of obstructed secretion of bile, the brain is affected 
with delirium, coma or convulsions before death, which is often at a 
long period after the disease begins. In some cases the common gall- 
duct has been closed, and the parenchyma of the liver was in a great 
degree atrophied at the same time; and thus for several years there 
was suspension of the secretion of the bile and of its excretion also. 
The duration of life under such circumstances depends on the condition 
of the other chylopoetic viscera, the nature of the food taken and the 
state of the other excretory functions. Death, however, always ulti- 
mately follows this state from gradual but progressive wasting from 
impaired nutrition. The use of ox-gall in pill, after eating, is not a 
substitute for the natural secretion. 
Treatment of Inflammatory Diseases of the Liter.—The prin- 
cipal remedies are: Aeon., Bell., Bry., Cham., Chin., Lachesis, Merc., 
Nux-vom., Puls., Sulph. 
Aconite—Inflammation of the liver with fever, stitches in the region 
of the liver; intolerable pain; moaning; tossing about; anguish, and 
dread of death. (For further symptoms see p. 410.) 
Bryonia.—Aching pains, with tension in the hypochondria; yellow- 
coated tongue; violent oppression of the chest, with hurried, anxious 
breathing; constipation; aggravation of the pains by motion. INFLAMMATION OF THE LIVER. 
931 
Chamomilla.—Dull aching pains, not aggravated either by pressure, 
motion, or breathing; pressure in the stomach; tension in the hy- 
pochondria; oppression of the chesty yellow color of the skin; yellow- 
coated tongue; bitter taste in the mouth, and paroxysms of anguish. 
China.—Disease of the liver, originating in malaria; aggravation 
every other day, with stitching, aching pains; swelling and hardness 
of the region of the liver and stomach; headache; bitter taste in the 
mouth, and yellow-coated tongue. 
Lachesis.—Disease of the liver, caused by intemperance; after 
Aeon., Merc., and Bell, have been used without sufficient effect. 
Belladonna.—Aching pains extending to the chest and shoulder; 
distention in the pit of the stomach ; tension in the region of the 
stomach; labored and anxious breathing; congestion of blood to the 
head ; obscuration of sight; vertigo with fainting; burning thirst; anx- 
ious tossing about and sleeplessness. It may be given after Aconite, 
in alternation with Mercury or Lachesis. 
Mercurius.—After Aconite, Bell, and Lachesis have been used with 
partially good results ; and there remain aching pains, which do not 
permit one to lie on the right side; bitter taste in the mouth; loss of 
appetite; thirst; constant chills; very yellow color of the skin and 
eyes. For effects of Mercury more at length see page 403 to 405. 
Nux-vomica.—Stitching or beating pains, with excessive sensitive- 
ness of the region of the liver to the touch; bitter and sour taste; 
vomiting or nausea; pressure in the hypochondria and region of the 
stomach, with short breath; thirst; red urine; headache ; vertigo, and 
paroxysms of anguish. 
Pulsatilla.—Paroxysms of anguish, especially at night; diarrhoea; 
greenish and slimy stools ; desire to vomit; bitter taste in the mouth; 
yellow-coated tongue; oppressed chest; tension in the hypochondria 
and pressure in the stomach. 
Sulphur.—Chronic cases in psoric constitutions, persisting after 
Nux-vomica and the above remedies have been partially successful. 
Podophyllum.—Appetite voracious ; eating followed by nausea and 
vomiting. Diarrhoea immediately after eating or drinking. Stomach 
sour; eructations; nausea; fullness of the head; vomiting an hour 
after eating, and then craving for food immediately afterwards ; extreme 
nausea continued for several hours ; heartburn; waterbrash and heat of 
the stomach ; exudations of hot flatus very sour. Sensation of hollow- 
ness in the epigastrium; throbbing in the epigastrium and stitches from 
coughing. Gastric affection attended by depression of spirits. 
Fullness of the right side of the abdomen with flatulence and stitches; 
weight and dragging in the region of the descending colon; colic with 
retraction of the abdominal muscles; pain in the transverse colon, fol- 
lowed by diarrhoea; pidn in the bowels relieved by warmth and by 932 
DISEASES OF THE SANGUINOUS FUNCTION. 
bending the body forward; the pain attended by coldness, pain, heat 
and perspiration. It diminishes the frequency of the pulse from seventy- 
six to sixty-one. 
Chronic hepatitis with constipation; fullness and soreness of the right 
hypochondrium; constipation with flatulence and headache ; constipa- 
tion with remittent fever; fmces dry and hard; extreme weakness with 
cutting pain in the intestines after stool; chalk-like stools, very offen- 
sive, with gagging and incessant thirst in children; large countenance ; 
sunken and blue under the eyes. 
Chronic diarrhoea with prolapsus ani at every stool; prolapsus ani 
with diarrhoea for six years in an adult; descent of the rectum from 
small exertion, followed by stool or discharge of thick, transparent mu- 
cus mixed with blood; involuntary discharge of urine during sleep; 
diminished secretion; suppression; leucorrhoea with bearing down, 
producing prolapsus uteri; pain in the region of the ovaria. 
In 1819 Dr. Snow gave a decoction made from one ounce of the 
root, simmered down from a pint to four ounces, to a full grown dog. 
In ten minutes after the last dose, the pulsations of the heart were very 
weak and from fifty to fifty-five per minute. In an hour he vomited. 
There was copious salivation, no narcosis; he vomited almost in- 
cessantly till he died. 
Leptandra-virginica. Culver’s physic Blackroot. Tall Veronica. 
Corresponds in a slight degree to mercurials in its action on the liver. 
It is said to promote the biliary secretion in a gradual manner, cor- 
recting the secretion and leading to restoration to the healthy action 
of the bowels, when they have been affected with diarrhoea, cholera in- 
fantum, dysentery, or constipation; and when there is habitual torpor 
of the liver, jaundice, haemorrhoids, dyspepsia. 
When suppuration has occurred and the abscess has been favorably 
evacuated, one of the best remedies is Nitro-muriatic-acid. 
Nitro-muriatic-acid Foot-bath.—Add one-half ounce of the acid to a 
gallon of water, increasing the strength, if the skin will bear it without 
irritation; and use it thirty or forty minutes every evening. 
Nitro-muriatic-acid.—Has been used with success in chronic he- 
patitis with obstinate constipation, torpor of the liver, dyspepsia, some 
forms of scrofula, and many cases of pseudo-syphilis. It has a prompt 
and decided effect on the biliary secretion, and determines the action 
to the skin. 
It is best suited to cases of chronic hepatitis with indolent engorge- 
ments of the capillary and parenchymatous structures. In its deob- 
struent properties it corresponds partially with Mercury. 
In attenuated doses it is applicable in inflammatory cases where un- 
diluted it could only increase inflammation and fever. Whether applied 
externally or internally its effects are the same. When the doses are CHRONIC HEPATITIS. 
933 
too large, it produces excessive secretion of acrid bile, which irritates 
the bowels, producing tenesmus and bloody discharges. Diluted and in 
small doses it cures these conditions and exerts a curative influence 
on diseases of the parenchymatous structures, the glandular system, 
secerning, secreting and absorbing surfaces. 
22. CHRONIC HEPATITIS. 
Diagnosis.—The symptoms of chronic liver complaint are somewhat 
similar to those of the acute form, hut more mild in their character. 
For example, the pain in the right hypochondrium is dull, heavy, and 
dragging, that in the shoulder and arm of a vague and heavy kind; the 
skin is somewhat hot and dry; the tongue furred; the countenance and 
albuginea yellow; the urine and perspiration of a dark or yellowish 
color; the bowels costive, sometimes alternating with diarrhoea; 
evacuations light; occasional cramp-like pains in the stomach; great 
weakness and loss of energy throughout the entire system; inclination 
to sleep a good part of the time ; trembling of the knees on the slightest 
exercise ; dejection and indifference to life ; enlargement and induration 
of the liver. 
Causes.—This is a disease of hot, rather than of temperate latitudes, 
and may arise from a too free use of animal food, stimulating drinks, 
and other articles abounding in carbon. As the blood passes through 
the liver, its office is (inpart) to separate the carbon, &c., which is not 
wanted in the system. We can therefore readily perceive how prone 
this important organ must be to be overtasked in so rarefied a tempera- 
ture, unless the utmost care is taken to retain the organs in a healthy 
state, as well as to avoid highly seasoned animal food, stimulants, &c. 
The chronic form of hepatitis often follows, and is a consequence of 
dyspepsia. Indeed, there are but few, if any, cases of the latter dis- 
order, which are entirely unattended with derangement of the liver. 
Want of exercise, depression of spirits, misfortune, sudden suppres- 
sion of perspiration, accustomed discharges, &c., may often exercise a 
powerful influence in inducing this disease. 
Treatment.—The best remedies are: Aeon., Mercur., Bry., Nux- 
vom., Sulphur, Aurum, Lachesis, Lycopodium, Nat/rum-magnes.- 
mur., Alum.-amb., Calc., Chin., Sil., Chelidonium, Ignatia, Iodine, 
Conium, Pulsatilla, Podophyl., Leptandra, Sanguinaria. 
For Swelling or Induration of the Liver. — Arsen., Calc., Chin., 
Fux-vom., Sulph., Graph., Mercurius, Natrum-mur., Taraxacum. 
Abscesses of the Liver.—Lachesis, Silicea, Bell., Ilepar. 
Administration.—The medicines may be used from the first to the 
sixth attenuations, and repeated, in acute cases, every two, four, or six 
hours, according to circumstances. In chronic hepatitis, a dose of the 934 
DISEASES OF THE SANGUINOUS FUNCTION. 
appropriate specific should he given once or twice in the twenty-foui 
hours, at the same time inculcating the importance of rigid dietetic re- 
gulations. 
In chronic hepatitis there is a peculiarly dry and harsh state of the 
skin, and on this account we strongly advise the daily use of cold 
sponging, or bathing, to he followed by vigorous exercise in order that 
the pores may be opened, and the cutaneous functions thus restored. 
Hypertrophy of the Liver.—Aurum. — A gentleman, aged forty- 
five, dark complexion, had undergone long courses of treatment within 
the last ten years; and now presents the following symptoms'. Weight 
in the right side of the abdomen; occasional sharp pain felt there; 
quick darting, and alternating with a similar pain in the upper arm; 
obstinate constipation; urine scanty, colorless during the first hours, 
then turbid, with brick-dust sediment; little appetite; deep sadness; 
discouragement; desire for death, and inclination to suicide, notwith- 
standing the open profession of religious ideas. The right hypochon- 
drium gives resistance on palpation. In pressing the palm of the hand 
under the false ribs, from in front backwards are felt three hard lumps 
belonging to the thin edge of the liver; this pressure causes sharp 
pains, and much difficulty of breathing. The left side sound from the 
umbilicus. No disturbance of the circulation. 
Treatment.—Aurum 6°, a drop in 120 grammes of water, a tea- 
spoonful in the evening. Diet exclusively of white meats, fish, and 
fresh vegetables. Avoid all milk and fermented drinks. At the end 
of one week no change, Saccharum-lactis for ten days. By that time 
the stools were regular; urine normal. The patient feels less heavy, 
less sad, more confident. Aurum 30°, 4 globules. A week later the 
whole condition was improved; stools free, appetite better; he is 
calmer; no further ideas of suicide ; some pain in the right hypochon- 
drium on pressure. Magnes.-mur. 6°, one drop in 120 grammes of water. 
A month later, cheerful, appetite and stools normal; no pains, no longer 
pain in region of the liver on pressure. Magnes.-mur. 6° one drop. 
The efficacy of Aurum is most marked when the local symptoms are 
added to the mental troubles, deep sadness and desire for death which 
so often accompany liver diseases; these moral symptoms are indispen- 
sable to its success. 
A priest, of whose liver the left lobe was enormously hypertrophied, 
presenting the corporeal but not the moral symptoms. Aurum 6° and 
30° were continued three months without effect. Nux and Magnes.- 
mur. failed, and he had already been drinking the Vichy waters several 
years ; within the last two months the engorgement considerably dimi- 
nished under Sulphur 30°, alternated every fortnight with Lycopodium 
30°. (Journal de /Society Gallicane, July, 1859.) 
Fatty Degeneration of the Liver. - Mr. Bowman has shown that the INFLAMMATION OF THE LIYEK. 
935 
greater portion of the superabundant fatty matter in the liver exists in 
the form of oil-globules within the proper nucleated cells of the affected 
organ. In this disease the number and size of these oil-globules is 
enormously increased; in some cases one-half the entire bulk of the 
liver is composed of them, and it is often much larger than natural. 
When the quantity of oil is less the liver presents what is called the 
“Nutmeg” appearance. The functions of the organ may not be much 
deranged, though the distention of the abdomen causes inconvenience. 
But, as the disease advances, the increase of the fatty matter, which 
was first destined to constitute a portion of the bile becomes a poison, 
by its presence obstructing the process of secretion. As fat contains 
50 per cent, of carbon, its secretion at first is a protective measure. 
Diagnosis.—The great enlargement of the abdomen in the region of 
the liver in a corpulent inactive person, particularly of a lymphatic 
temperament, may be suspected to be of this nature. Though no posi- 
tive characteristics have been pointed out. As the disease progresses, 
the effects on the general system and on the tuberculous degeneration 
of the lungs make its character intelligible. ( Williams, on the Patho- 
logy of Cells) 
Causes.—Corpulent tendency generally; inactive life ; gross and full 
living; free use of heavy malt liquors ; oily food in excess, or vegetable 
products which are chemically nearly the same, as potatoes, sugar, &c. 
“ Sugar furnishes a material for respiration which is soluble in the 
blood, and is acted upon more readily than the insoluble fat, which is 
thus protected and laid up in the system. Alcohol has a still stronger 
protecting power, and for similar reasons.” (Budd.) Magendie found 
that dogs fed too exclusively on oleaginous matters, as butter and lard, 
died of inanition although they became remarkably fat; in all the liver 
was fatty. Wasting disease: of consumptive patients about one-third 
have accumulations of fat in the liver, and in many cases about the 
heart, though its muscular tissue is wasting at the same time. [Louis.) 
“ The mode by which the fat is accumulated is displayed in all those 
diseases in which emaciation is a striking feature;” in the process of 
wasting, the fat stored up in the body is largely taken up by the veins, 
so that it comes to be in excess in the blood, and is then laid hold of 
by the hepatic cells which have a natural affinity for it.” In fatty de- 
generation of the liver then the essential disease consists in the ac- 
cumulation of fat in the veins from the food beyond what the organs 
of nutrition can properly appropriate; it is lodged in the liver on the 
effort being made by that organ to eliminate it from the system. Faulty 
assimilation is then the essential disease. 
Mr. Bowman says in one-third of the cases in which the lungs are 
disorganized the epithelium cells of the liver become more or less 
gorged with adipose particles. It is noticed that no fat globule has 936 
DISEASES OF THE SANGUINOUS FUNCTION. 
yet been found within the nuclear cell. It always occupies the inter 
val between the nuclear and outer capsule. (Williams.) 
During the progress of fatty degeneration of the liver the parenchy- 
mal cells distended by accumulated fat, fail to perform their part in 
the process of secretion and they eventually burst. A universal sus- 
pension of the secreting agency takes place; and thus the last avenue 
for the elimination of the carbon from the blood suffers fatal obstruction, 
and the whole body is soon oppressed by its accumulation in the blood. 
(See Cell Formation, p. 641, 646, 647.) 
Tkeatment.—The remedies most likely to correct these structural 
degenerations of the liver must be sought for among those already 
enumerated under the forms of hepatic disease. Taraxacum, Muriate 
of Ammonia, Nitro-muriatic-acia, Mercur.-proto-oxide, Podophyl., 
Leptand., Sanguinaria and Aurum are the most important. 
23. CANCER OF THE LIVER. 
This is one of the most severe as well as the most common of struc- 
tural diseases of the liver. It appears in the form of disseminated 
cancer, as we have already seen disseminated abscesses in the section 
on suppurative inflammation of the liver. 
Diagnosis.—The most significant symptom is enlargement of the 
liver till it reaches below the false ribs, even to the brim of the pelvis; 
its surface is then often tuberculated with cancerous growths, and is 
felt to be irregular and knobby to the feel on applying the hand. The 
size is diminished in but few cases. In some there is ascitic effusion, 
hut seldom so much as in cirrhosis/ jaundice is common. The enlarge- 
ment comes on in the middle of life, is progressive; there is no probable 
cause for it. There is no obstructed circulation in the chest, the patient 
is not consumptive, has not been intemperate to cause cirrhosis; when 
many of these circumstances are present, cancer of the liver may be 
expected, especially if it be of great size and is nodulous or uneven, 
there is no longer room for doubt. Constant pain and tenderness also 
are almost decisive symptoms of cancer. (Budd, p. 326.) 
Causes.—Cancer of the liver is generally consequent on cancer in 
some other part, especially the stomach or mammae. In few cases it 
originates in the liver. When cancer exists in some other organ, the 
liver, next to the lungs, is most likely to be the seat to which if will be 
likely to be transferred. The reason is, that the entire venous blood 
of the stomach and intestines has to pass through its substance, and all 
abnormal substances contained by the blood are liable to be detained 
in the capillary vessels. The cells of pus, of oancer, and other morbid 
degenerations are apt to be arrested in their course. The matters thus 
arrested become foci of purulent cancerous or other disease of the INFLAMMATION OF THE SPLEEN. 
937 
parenchyma of the liver. When therefore the stomach or any portion 
of the intestines become affected with cancer, we may expect the liver 
to become the depository of some of the morbific germs. These are 
likely to be located in a great many different points, often hundreds. 
Some of these are found of the size of a bean, or even as large as an 
orange ; others are so minute that they are distinguished with difficulty. 
Pathology.—Cancerous tumors in the liver are sometimes white 
and fibrous, usually termed scirrhous / but more frequently they are 
soft or medullary; in a few subjects they are found of both kinds. We 
find the same variety in cancer of the liver as in other organs. In 
some soft cancers we find some with but few vessels, in a substance 
pulpy and whitish, resembling softened brain, called by Laennec en- 
cejphaloid. In others the tumors are extremely vascular, resembling 
fungus hsematodes; others again are melanotic. The color of the mela- 
notic tumors of the liver varies according to the pigment they contain, 
and they are found of every shade from light-brown to black. (Budd, 
p. 302.) (See Cell Formation, Diseased, p. 646.) 
The prognosis is always unfavorable, such cases being in general 
ultimately fatal. 
Treatment.—The only reliance will be upon the general treatment 
of cancer, to which we refer. The worst treatment is that which is 
quite likely in most cases to be adopted. The use of large or often 
repeated doses of Mercury can only prove speedily injurious by ex- 
hausting the patient’s strength, and always aggravating the local 
malady. But much benefit will be derived from minute homoeopathic 
doses of Mercurius-hyd.; also from Kali-hyd., Iodine, Silicea, Arseni- 
cum, Arsenicum-hyd., Cannabis, Aconite, Hepar-sulph., Calcarea-carb. 
24. SPLENITIS.—INFLAMMATION OF THE SPLEEN. 
The function of the spleen has been regarded as more abscure than 
that of any other of the abdominal viscera. From its immediate con- 
nection with the stomach and the several organs pertaining to the 
portal system, it is believed to be at least a “ chylopoetic agentand 
it may be classed with the lymphatic glands, which in its anatomical 
character it closely resembles. This organ is only found in those 
classes of animals in which a distinct lymphatic system exists; and 
its size is always proportioned to the development of that system. 
When the spleen becomes hypertrophied, the lymphatic glands are 
often inflamed, as a sympathetic phenomenon; hypertrophy of the spleen 
is also often a consequence of disease of the lymphatic glands of the 
abdomen. The mesenteric glands have also been observed to become 
enlarged after extirpation of the spleen (Mayer and Czermak), and 938 
DISEASES OF THE SANGUINOU8 FUNCTION. 
the thyroid gland also became enlarged after the same mutilation, 
(Tiedemann.) Thus there is a vicarious activity of other lymphatic 
glands to supply the action of the removed spleen. 
There was a time when physiologists thought to ascertain the func- 
tion of this organ by removing it from animals. At first they seemed 
to get along well; and soon, says Mr. Abernathy, “ every man who 
could procure a dog was cutting out the spleen, and publishing the 
history of the case.” But disappointment followed. The dogs, which 
had improved in appetite on the loss of the spleen, all died after trying 
for a short time to live without it; and the experimenters confessed 
that nature must have had some object in creating it. 
Forms of Diseases of the Spleen.—1. Hyper cemia with con- 
sequent Hypertrophy.—This consists in a morbid increase of the 
vital activity of the spleen. It results in intumescence, and then in 
alterations of structure, such as fibrinous, fatty, albuminous, serous, or 
other degeneration of structure. In malarious countries, enlargement 
of the spleen or “ ague cake” is as common as the ague which origi- 
nates it. 
2. Atrophy of the Spleen.—Phlebolitia.—Morbid diminution of the 
vital activity of the spleen. 
3. Sehnen-Fleisch.—Exudation of firm, white, tendon-like, in- 
separable exudations which appear on the upper surface of the spleen, 
as well as on some organs. 
4. Cartilaginous, bony, and earthy degeneration of the spleen. 
5. Episplenitis.—Inflammation of the capsule of the spleen. 
6. Splenitis.—Inflammation of the spleen. It may be acute or 
chronic ; and may terminate in hepatization, suppuration, softening, or 
gangrene. 
7. Spleno-Phlebitis.—Inflammation of the splenic veins. 
8. Other structural diseases of the spleen have been described under 
the names of emphysema of the spleen, jysm6?c»-morphosis, including 
melanosis, lipoma, and steatoma, hydatids, acephalocysts, scirrhus, 
and tubercles. The accidental injuries described consist of rupture 
of the spleen, rupture of the splenic artery, with or without the for- 
mation of aneurism, rupture of the splenic vein, and wounds of the 
spleen. 
The distinction between these obscure forms of disease, in an organ 
to which no very influential position has been assigned by medical 
philosophers, and the specific treatment proper to each cannot be 
given in detail without devoting to the subject a space disproportionate 
to its importance. We shall be content with a general view of essential 
points only. 
Diagnosis.—The symptoms which indicate the existence of splenic 
inflammation are liable to be confounded with those of disease of the INFLAMMATION OF THE SPLEEN. 
939 
left lung, the heart, the diaphragm, peritoneum, the stomach, the left 
lobe of the liver, the cauda of the pancreas, the omentum, the descend- 
ing colon, or the left kidney. The symptoms which more particularly 
point to disease of the spleen are : location of the seat of complaint in 
the left hypochondrium ; functional disturbance of the stomach; thirst, 
variable appetite, as desire for unusual articles of food, sour or bitter 
taste in the mouth; acid eructations; redness, dryness, with whitish 
or yellowT coating on the tongue, with indentations of its edges; spongi- 
ness of the gums, with offensive breath; ptyalism, nausea and vomiting; 
diarrhoea only occasionally; perceptible hardness or intumescence felt 
by the hand in the region of the spleen; obstinate constipation and 
occasional colic pains. 
The disturbance of the respiration is only secondary. The fever 
corresponds with that seen in the more common forms of disease of 
the liver. The morbid condition of the blood is manifested by ecchy- 
mosis, pemphigus or pompholyx, erysipelas, erythema, herpes, and 
other eruptions on the skin; also by haemorrhages from the stomach 
and bowels, melaena, &c. 
Causes of Splenitis.—The spleen being deeply concealed beneath 
the short ribs, is not often injured by mechanical causes or severe 
blows or falls on the left side, except when diseased. In cases in which 
tumefaction and softening of the liver are already present, violent con- 
cussions may produce a rupture of its enveloping membrane, and give 
rise to a fatal haemorrhage into the abdominal cavity. The spleen 
is liable to be wTounded when morbidly enlarged, or when during di- 
gestion it is distended with blood. In one case given by Mayer, a lum- 
bricoid worm, wdiich had penetrated the coats of the colon, entered 
deeply into the substance of the spleen, and caused active splenitis. 
Other causes of this disease are: drinking of ice-cold water when the 
body is overheated; sudden chilling of the surface after exposure in 
the sun; sudden arrest of menstruation, or of haemorrhoidal bleeding; 
over-distention of the organ with blood after the amputation of a limb; 
long-continued running or swimming, or excessive dancing; tumefac- 
tion and inflammation of the spleen occur in drunkards, in gluttons, 
and in persons under the influence of malaria, from distention and irri- 
tation of the texture of the organ, as well as through the morbid changes 
produced in the composition of the blood. Splenitis has been caused 
by terror, fear, grief, despondency, and other depressing emotions. 
Bree describes a case in a female who had been, in a frolic, six times 
immersed in the sea. The immoderate use of alcoholic drinks by 
overloading the blood with carbon, produces a dyscrasia which is con- 
nected either with simple tumefaction of the spleen, with tumefaction 
and softening, or with dropsy or scirrhous hardening. Disease of the 940 
DITEASES OF THE SANGUINOU8 FUNCTION. 
spleen is produced, also by drinking the water of marshy grounls, 
and has been often observed in persons subject to epilepsy. 
Articles of food supposed to predispose to disease of the spleen art: 
grains rich in amylaceous matter, peas and beans, potatoes, the fat 
vegetable oils, sugar, in short, all nutritive substances which introduce 
into the blood a large amount of carbon and hydrogen. 
Narcotics, especially hydrocyanic-acid, when taken in a certain 
quantity, produce a decomposition of the entire mass of the circulating 
fluid, reducing the blood to a black, thin fluid, and are enumerated 
among the causes of softening and distention of the spleen; though 
H. Meyer, in his experiments with hydrocyanic-acid on different animals, 
never found the blood-cells altered, and says nothing of morbid ap- 
pearances in the spleen. Sulphuret of Ammonia and sulphuretted 
hydrogen, also the miasm of typhus and different kinds of malaria are 
known to produce similar effects upon the blood. 
Certain employments and habits predispose to abdominal plethora. 
Among these are shoe-making, weaving, and many others in which we 
see sedentary position of the body, continued with much pressure or 
bruising of the abdomen. 
Meteorological causes have been enumerated under malaria (pages 
477, 469, 399). 
Treatment.—Congestion and inflammation of this organ are so com- 
monly met writh in connection with intermittent fever, that we have al- 
ready noticed them under that head. (See pages 512,516.) The phy- 
siology of the spleen being notin all respects satisfactory,the treatment 
of its diseases is generally embraced in that of the general affections 
in which they are involved. In addition to remedies already men- 
tioned some others have been thought to act specifically on the spleen. 
The most important of these is the Iodide of Potassium. 
It is generally conceded, that a great destruction of blood-cells oc- 
curs in the spleen. In cases of ague we often observe congestive en- 
largement of this organ followed rapidly by anaemia. A short course 
of Iodide of Potassium, especially taken early, is general followed by 
subsidence of the congestion, diminution of the size of the organ, and a 
stop of the anaemia. The modus operandi is not the point in question; 
it is certain that there is primarily congestion; that this is accompanied 
by destruction of the blood-cells; and this results in anaemia because 
the iron is discharged, and fresh, red corpuscles are not formed in 
sufficient quantity to replenish the loss; but when the congestion is 
removed, the destruction of blood-cells ceases, and the anaemia is soon 
replaced by the ruddiness of health. 
Other Remedies are : China, (see page 489, this volume.) Natrum- 
muriaticum, (Symptoms, p. 504.) Common Salt is a popular remedy INFLAMMATION OF THE PANCREAS. 
941 
25. PANCREATITIS.—INFLAMMATION OF THE PANCREAS. 
The office of the pancreas is supposed to relate to the complete con- 
version of chyme into chyle. (See page 220.) It is also probable 
that it has something to do with the conversion of chyle into blood, 
or in the formation of hsematozine, since great emaciation and anaemia 
have been observed in cases in which chronic disease and obstruction 
of this viscus terminated in death. The diseases of the pancreas are 
divided into: 
1. Functional Disorder.—Alterations in the quality or quantity 
of the pancreatic fluid. The only known symptoms of this condition 
are : indigestion, emaciation, anaemia, imperfect sanguification and as- 
similation. Brunner made the experiment of extirpating the pancreas ; 
but he only learned by his cruelty that the alvine evacuations became 
scanty and indurated. 
Copland has endeavored to show that the fluid discharged from the 
stomach in pyrosis, consists chiefly of augmented pancreatic fluid re- 
gurgitated into the stomach, there occasioning pain and irritation, 
followed by its rejection. Dupuytren, with less plausibility, attributed 
the enormous fluid discharge in epidemic cholera to an excessive se- 
cretion from this viscus. 
2. Inflammation of the Pancreas.—Diagnosis.—There is deep- 
seated pain somewhat below the pit of the stomach, or between this 
part and the umbilicus, extending to the back and under the left shoulder- 
blade ; there are also occasional vomiting of an albuminous and ropy 
fluid; great thirst, and symptomatic fever. This inflammation may 
be either acute, sub-acute or chronic. Its existence may be inferred 
when the pain beneath the pit of the stomach is increased by bending 
the body forwards, and is but little affected by pressure. There is a 
sense of constriction or of anxiety at the praecordia; unusual dryness 
of the fauces, thirst and symptomatic fever; feeling of heat and tension 
at the epigastrium; and, the organ being much tumefied when inflamed, 
there is pressure upon the bile-ducts, producing jaundice. In some 
cases, a hard, painful, deep-seated tumor is felt between the scrobiculis 
cordis and the umbilicus, entirely distinct from the liver and the sto- 
mach. Occasionally there is a flow of ropy fluid into the stomach which 
is discharged without retching, nausea or anorexia; in other cases 
there is nausea, with vomiting of a ropy mucous fluid of a whitish-gray 
color, or tinged with bile; and the flow of saliva is increased; the 
bowels at the same time are confined. At other times there is a 
mucous, loose diarrhoea with ropy fluid evacuations. 
Chronic pancreatitis presents the above symptoms in a less per- 
ceptible form; the pain at the epigastrium, the tension and heat are 942 
DISEASES OF THE SANGUINOUS FUNCTION. 
felt only after a meal, or are aggravated by it. There are flatulence, 
eructations, pyrosis, and uneasiness in the back; some enlargement or 
tumor; the pyrosis appears every morning; salivation occurs in some 
instances. 
Pancreatitis terminates in: 1. resolution; 2. The effusion of co- 
agulable lymph on the surface of the organ; 3. suppuration; 4. gan- 
grene ; 5. chronic enlargement and induration. 
Causes.—The first and most pernicious cause of this disease is 
abuse of Mercury. The following also operate in a deleterious manner 
on this organ as well as on the system generally. Tobacco in all the 
modes in which it is used; abuse of alcoholic drinks; frequent resort 
to purgatives; falls, blows, or other injuries ; extension of inflammation 
from other organs. Pancreatitis also occurs sympathetically of inflam- 
mation of the salivary glands. In one case the parotids were greatly 
enlarged, but they diminished rapidly in size, and this was followed by 
symptoms of disease of the pancreas; on its subsidence, there was 
inflammation of the testicle; which was again superceded by inflam- 
mation of the parotid, ending in suppuration. 
Treatment.—In seeking for remedies capable of affecting the pan- 
creas specifically, we must endeavor to meet the sjunptoms of the in- 
dividual case with some of the medicines known to be applicable to 
analogous diseases in other organs of the digestive system. When 
there is evident inflammation, we can only rely upon Aeon., Mercur., 
Bry., Arsenicum, Tartar-emetic, Iodine, Kali-hydriodicum. 
When the case is protracted, we can find remedies among those 
described under dyspepsia and chronic diseases of the liver, jaundice, 
&c. When chronic pancreatitis is evidently connected with a cancer- 
ous or scrofulous dyscrasia, it will be cured by the treatment given 
under those diseases. See pages 284 to 296. 
26. LEUCOTHYASMIA SPLENICA. 
In this disease, first described by Dr. Hughes Bennett, of Edinburgh, 
the blood displays an excess of the white corpuscles; but there is not 
the extreme ansemia seen in anaemia lymphatica. Dr. Wilks regards 
the last-named as a destructive process in the lymphatic glands affected. 
The present disease is characterized also by epistaxis, purpura, and 
other haemorrhagic tendencies, with wasting of the body; and the 
patient needs to keep the bed. The invasion has been gradual in the 
cases observed. 
Causes.—Ague has in all cases preceded the full formation of this 
disease. In one case, examined after death, the spleen was very much 
enlarged; but there was no distinct circumscribed deposit as in anaemia 
lymphatica. LEUCOSIS. 
943 
27. LEUCOSIS. 
This is a condition of the system which is essentially anaemic, 
though associated with nervous exhaustion. It is closely related to 
chlorosis. It may appear in men, women, and children as well as in 
old age. Symptoms: 
The tongue is pale, like a piece of raw veal; often coated, moist; 
deeply-marked with impressions from the teeth, flaccid, often tremulous, 
almost bloodless; muscular system powerless; countenance pale, as 
from effects of lead; lips blanched, often red; when red, it is only 
for a short period; in the highest form of this affection the tongue is 
slightly swollen; when the lips are red, there is nervous irritability 
with less apparent exhaustion. 
In this disease, as well as in phthisis, and some other dyscrasias 
connected with deficiency of some of the normal elements of the blood, 
it is now believed that the secretions and excretions abound in an ex- 
cessive amount of phosphates; and, in proportion to this excessive loss 
of materials essential to healthy blood, the consequent debility and 
symptomatic fever continually progress. Hence, in surgical cases of 
wounds, abscesses, or sloughing, occurring in such patients, it is per- 
petually necessary to assist the digestive organs in the assimilation of 
food duly supplied with all the elements essential to healthy nutrition ; 
and a positive necessity exists for producing a normal phosphatized 
blood to furnish healthy exudations for uniting wounds and fractures. 
“ The idea,” “says Lehmann,“ that the plasticity of an exudation is de- 
pendent on the quantity of fibrin it contains is erroneous.” Some 
plastic exudations are without fibrin, and some non-plastic contain it. 
But the plasticity of the exudations is constantly associated with the 
presence of soluble phosphates. The integrity of the textures, there- 
fore, depends upon their supply just as much as in their first organi- 
zation, wherein special providential design is exercised. In the ex- 
ample of incubation, the egg phosphates are placed in the yolk of the 
egg for the early nutrition of the embryo chick, and glycero-phosphate 
is provided in the shell for the double purpose of affording protection 
during gestation, and nutritious support during the latter period of 
embryo development, by endesmosis through the albumen, and the 
consequent thinning of the shell preparatory to the young animal’s 
escape at maturity from its imprisonment. Chossat produced rickets 
artificially in animals by restricting them to food which contained no 
phosphate of lime. 
During the period of human gestation, if there be a deficiency of 
phosphatic salts taken in the food and assimilated, supplementary de- 
mands are made upon the mother’s own tissues to furnish the necessary 
supply of these ingredients for the growth and development of the 944 
DISEASES OF THE SANGUINOU8 FUNCTION. 
child. The parent soon manifests the loss by complaining of defective 
secretions ; dyspepsia, stitches, neuralgic pains ; absorption of fat and 
muscle; pinched features; and the long train of symptoms usually 
ascribed to the irritation of uterine expansion and reflex excitement. 
This disease has been cured by small doses of Hypophosphite of 
Potash three or four times a day, taken in diluted form. This salt is 
readily dissolved by animal fluids, and is speedily converted into a 
phosphate. The ground of preference of the hypophosphites over the 
phosphates as remedies, consists in the fact that the latter require for 
their solution weak acids which are not invariably present in the 
alimentary canal; then bread and animal food cease to nourish through 
the failure of the mucous secretions ; and we see how the Hypophos- 
phites of Potash or Soda may reach the lacteals and be taken into the 
blood when.the phosphites might not be absorbed. (Bischojf.) Phos- 
phorus, says Corewinder, “ is the element which accompanies nitrogen- 
ous matter in all its phases.” We are therefore justifiable in imi- 
tating nature in “accompanying nitrogenous food with the most soluble 
and absorbable salt of phosphorus” in all the forms of disease in which a 
deficiency of the phosphates is known to exist. The following are a 
few of these troublesome and often serious affections : 1. Consequences 
of lactation too long continued / dentition in feeble, pale, and scro- 
fulous children; leucothyaemia/ (See page 924.) general ancemia 
(see p. 712). Mercurial cachexia (p. 404); profuse catarrhal and 
leucorrhceal discharges ; all inordinate suppurations / myalgia, or 
neuralgic muscular pains often mistaken for inflammation; some forms 
of dyspepsia. 
Other remedies for leucosis and kindred affections; Calcarea~carb. 
(see pages 351, 448, 507, 614, 228). China / Ferrum / (page 507); 
Ignatia (p. 507). 
28. MESENTERITIS.—See Marasmus.—Index.