THE 
HOMOEOPATHIC 
THEORY AND PRACTICE 
OF 
MEDICINE. 
' BY 
E. E. MARCY, M.D., AND F. W. HUNT, M.IX 
»«- 
VOL. II. 
N K W - Y O R K : 
WILLIAM RADDE, 550 PEARL-STREET. 
Philadelphia: F. E. Boericke, 635 Arch-st.—Boston: Otis Clapp.—St. Louis: 
H. C. G. Luytiks.—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.: II. 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 y*ar 1fi<U h» 
WILLIAM RADDE, 
In the Clerk's Oflice of the district Court of the United States for the Southern District of 
New-York. 
HENRY I.UDWIG, 
Printer and Stereotyper, 
S9 Centre-street CONTENTS OF VOLUME II. 
Pagijb 
Genus VII.—Inflammatory Diseases 
of the Kidneys and Urinary Organs, 9 
1. Normal Anatomy of the Kidneys, 9 
Diagnosis.—Examination of the 
Urine, 12 
Composition of, 16 
Solids, 17 
Acids, 20 
2. Bright's Disease of the Kidney— 
Desquamative, Albuminous Ne- 
phritis, . 21 
Chronic Form of Bright’s Disease, 27 
Second Stage of Bright's Disease 28 
Treatment of Desquamative Ne- 
phritis, 29 
8. Chronic Desquamative Nephritis, 44 
Dropsy, 46 
Complications. — In the Brain, 
Heart, . 49 
Liver, &c., 50 
Rheumatic and Gouty do 50 
Uraemia, 52 
Microscopic Observations, 57 
Treatment, 59 
4. Nephritis Simplex, 66 
Treatment, 68 
Poisons thrown off from the Kid- 
neys, 69 
6. Haematuria, 69 
Treatment, 70 
6. Haematuria following Scarlet Fe- 
ver, I. 600 
7. Disease of the Kidney caused by 
Surgical or Mechanical Lesions, 71 
8. Disease of Capsula Renales. Adi- 
son’s Disease, 72 
9. Cystitis, Inflammation of the 
Bladder, 75 
10. Dysuria, 77 
11. Irritable Bladder, 78 
12. Suppression of Urine, Ischuria 
Renalis, 79 
Retention of Urine, 80 
13. Ki resis—Incontinence of U.-we, 86 
Genus VIIP— Ophthalmia. — Affec- 
tions of the Eye and its Appendages, 87 
A. Acute Ophthalmia 88 
1. Affections of the Tunica Con- 
junctiva. Conjunctivitis,.... 89 
FU< 
Conjunctivitis from Extension 
of Strumous Eczema, 95 
2. Chronic Ophthalmia, 99 
3. Purulent Ophthalmia, 101 
4. Gonorrhoeal Ophthalmia, 102 
Infantile Do., 103 
5. Granular Ophthalmia. Conta- 
gious Conjunctivitis. Egyp- 
tian Ophthalmia, 103 
6. Opacity of the Cornea, 113 
B. Affections of the Deeper-Seated 
Structures of the Eye, 113 
1. Inflammation of the Cornea,... 113 
Ulceration of the Cornea, 113 
Conical Cornea, 114 
2. Iritis, 114 
Treatment, 115 
3. Choroiditis, 118 
4. Amaurosis, 120 
Treatment, 126 
5. Hydrophthalmia. — Dropsy of 
the Eye, 129 
Treatment, 131 
6. Cataract, 131 
Treatment, 133 
7. Glaucoma. Staphyloma, 134 
Treatment, 135 
8. Hypermetropia. 137 
Myopia, 138 ,140 
9. Asthenopia. Hebetudo Yisus. 
Amblyopia Presbytique, 139 
Squinting, 139 
10. Fungus Hsematodes and Cancer 
of the Eye, , 144 
C. Affections of the Appendages of 
the Eye, 144 
1. Hordeolum.—Stye, 144 
2. Entropium. — Inversion of the 
Eyelids, 145 
3. Ectropiurn. — Eversion of the 
Eyelids 145 
Exophthalmia, 146 
4. Puncta Lachrymalia, Diseases of, 146 
Fistula Lachrymalis, 146 
Stillicidium Lachrymarum, 147 
Spasmodic Contraction of the 
Eyelids 149 
Trichiasis.—Inverted Eye-lashes, 149 
Foreign Bodies in the Eye, 149 
III IV 
CONTENTS. 
Page 
Traumatic Injuries of the Eye,. 150 
D. Strumous or Scrofulous Ophthal- 
mia, 150 
Mercurial Ophthalmia, 155 
Genus IX.—Inflammatory Diseases of 
the Fibrous and Muscular Sys- 
tem, 156 
1. Irritable Inflammation, 156 
Acute llheumatism, 156 
Chronic .Rheumatism, 158 
3. Arthritis.—Gout, 162 
Treatment, 166 
4. Arthritic Dyspepsia.—-"Dyspeptic 
Gout, 168 
Treatment, 171 
5. Arthropathie.—Inflammation of 
the Joints, 174 
A. Diseases of the Soft Parts, .... 174 
Arthropathie White Swellings, 174 
1. Extra-Capsular, 174 
2. Intra-Capsular, 174 
3. Specific or Blennorrhous,.. 174 
4. Fungous, 174 
5. Synovial Arthropathia, ... 175 
Hydrarthrus, 175 
6. Cartilaginous do., 175 
7. Superficial Arthropathie of 
the Bones,. 175 
8. Deep-seated Arthropathie of 
the Bones, 176 
Treatment, 176 
Order IV.— Dysthetica — Cachexia. 
Abnormal Conditions of the Circu- 
lation Dependent on Deteriorations 
of the Blood, 177 
Blood in Health, 177 
Dyscrasias of the Plasma of the 
Blood, 180 
Influence of Disease, 181 
Proofs that the Blood becomes 
Deteriorated, 183 
Septic Influence,. .183. Vol. I. 541 
Blood Poisoning, 184 
Drug Poisoning, 185 
Latent Miasms which Originate 
Chronic Diseases, 186 
Psora, Syphilis. Sycosis. 
Metastasis from the Mucous Mem- 
brane to the Skin, 186 
Sympathetic Relations between 
them, 186 
Hereditary Dyscrasias, 187 
Allopathic Authorities, 188 
Genus I.—Ansemia, 190 
Piai 
Cerebral Ansemia. City Cachexia, 191 
Antenna Lympliatica, 191 
Genus II.— Haemorrhagia.—Haemor- 
rhages, 194 
1. Traumatic Haemorrhage, 195 
Treatment, 196 
2. Haemorrhages from Exhaustion,. 197 
Treatment, 198 
Genus III.—Purpura, 199 
1. Purpura Haemorrhagica, 199 
2. Purpura Urticans, 200 
3. Purpura Senilis, 200 
Genus IV.—Toxaemia.— Blood Poi- 
soning, 202 
1. Cachexia Mercuriale, 202 
2. Toxaemia from Effects of Tobacco, 203 
Genus V.—Phthisis.—Consumption. 
Emaciation, 205 
1. Phthisis Pulmonalis.—Pulmonary 
Consumption, 205 
Early Stage, 209 
Physical Signs, 211 
Pathology, 220 
Tubercle, 222 
Causes 225 
Hygienic Measures, 231 
Choice of Climate, 235 
Treatment, 240 
Pulmonary Haemorrhage, 255 
2. Acute Phthisis.-Quick Consump- 
tion, 256 
Granular Phthisis, 256 
3- Tuberculosis of the Bronchial 
Glands, 257 
Genus VI.—Struma.— 1. Scrofula.— 
King’s Evil, 259 
Causes, 259 
Treatment 261 
2. Arthrocace.—Scrofulous Disease 
of the Hip-Joint, 261 
3. Scrofulous Disease of the Mesen- 
teric Glands, 262 
Marasmus, 262, 267, Vol. I. 884, 890 
Treatment of Scrofulous Diseases, 268 
4. Bronchocele, Goitre, 273 
Thyroid Gland. Enlargement of, 273 
5. Parenchymatous Bronchocele,.. 274 
Treatment, 275 
6. C/etOinism.-Struma Tyrolensium. 
Cagotism, 278 
Genus VII.—Carcinus—Cancer, ... 280 
Diseased Cell-Development; 280 
1. Cancer.—Carcinoma, 282 
Cephaloma, 283 CONTENTS. 
V 
Pagi 
Scirrhus, 284 
Fungus Haimatodes, 284 
Melanosis, 284 
Ostoid, or Spina Ventoso, 284 
Cancroid—Epithelial Cancer, .. 284 
Treatment of Cancer, 285 
Cancer of the Lips, Cheeks, ... 287 
And Tongue, 289 
Buccal Cancer, 289 
Mucous Tubercle, 289 
Lupus, 289 
Cancer of the Stomach, 293 
Cancer of the Uterus,. 297 
2 Fungus Hscmatodes, 298 
Genus VIII —Lues.—1. Syphilis,... 300 
Chancre, 304 
Secondary Effects of the Poison, 308 
1. On the Mouth, Ac., 308 
2. On the Skin, 308 
3. In the Bones, Ac., 308 
Caries, 321 
Softening of the Bones, 321 
Bubo, 307. 309. 374 
Treatment of Syphilis, 309 
Mercurial Disease, 309 to 315 
Treatment of Secondary Syphi- 
lis, 317 
Chancrous Dyscrasia, 319 
Treatment of Diseases of the Mu- 
cous Membrane,.. 319 
Nodes, 321 
Syphilization, 321 
Roseola Syphilitica, 322 
Transmission of Syphilis by Vac- 
cination, 322 
Orchitis, 324 
Anomalous Diseases in Syphilitic 
Subjects, 325 
2. Sycosis, 325 
Condylomata, 326 
Fig Warts, 326 
Tuja, Proving of, 327 
Catarrh 328 
Prosopalgia and Dentalgia, .... 328 
Various' Forms of Sycotic Dis- 
eases. 329 
Genus IX.— Elephantia.—Morbus Phoeni- 
cians, 330 
1. Elephantiasis Griecorum, 874 
2. Elephantia Arabica, 330 
Genus X.—Scorbutus.—Scurvy 332 
Treatment, 336 
Purpura Scorbutica, 338 
Petechia, 339 
Paos 
Genus XI.—Exangia —Aneurism, .. 340 
Treatment, 342 
Varicose Veins, ... 344 
Circocele, 344 
Varicocele 345 
Genus XII.—Gangrena, 345 
1. Necrosis Ustilaginea, 345 
Dry Gangrene, 346 
2. Gangrene from Injury of the 
Nerves, 346 
Gangrene after Injury, 347 
Gangrene of the Lungs, 347 
3. Gangrena Senilis, 349 
4. Gangrene of the Mouth.—Gangre- 
nopsis, 352 
Mercurial Idiosyncrasy, 354 
Treatment, 356 
5. Phosphor Necrosis, 362 
Periostosis and Caries from Plios- 
phoris, 362 
Reproduction of Bone, ........ 365 
6. Ozcena, 366 
Genus XIII.—Blennorrhcea.—Gonor- 
rhoea.—Infectious Urethritis 366 
Gleet, 370 
Stricture, Diseased Prostate, .. . 373 
Sympathetic Bubo, 374 
Treatment of Gonorrhoea, 375 
Internal Remedies, 379 
Complications of Gonorrhoea,... 382 
Irritation of the Bladder, 382 
Phimosis, 382 
Cliordee, 382 
Orchitis, 382 
Chronic Induration of the Tes- 
ticle, 383 
Irritable Testis, 385 
Genus XIV.—Ulcus.—Ulcer, 385 
Irritable Ulcer 386 
Indolent do 386 
Treatment, 386 
CLASS IV—Diseases of the Ner- 
vous Function. 
Order I.— Phrenica. — Affecting the 
Intellect 388 
Mental Peculiarities of Different 
Races, 388 
Caucasian Race, 389 
Mental Derangement, 389 
Genus I.—Empathema.—Erratic Ge- 
nus, 390 
Genus II.—Derangement or Perver- 
sion of the Reasoning Faculties. 
—Insanity, 394 VI 
CONTENTS. 
Paos 
Higher and Lower Reason, 394 
1. Mania 399 
2. Monomania, 401 
Pathology of Insanity, 406 
Causes of Insanity, 409 
3. Religious Melancholy. Tlieomania,415 
Mental Extravagance, 416 
4. Moral Insanity 419 
Treatment of Insanity, 422 
Non-Restraint System, 425 
5. Influence of the Passions, 427 
Mental Emotion, 431 
Medical Treatment of Insanity,. 433 
Moral Treatment, 439 
6. Suicidal Monomania, 441 
7. Hypochondriasis, 442 
8. Oinomania—Insanity Caused by 
Alcoholic Drinks, 448 
Alcoholismus, 444 
Genus III.—Alusia —Hallucinations, 446 
1. Hallucinations. Illusions of the 
Senses, 446 
2. Anasmic Affections of the Brain, 449 
Delirium Tremens.-Mania a potu, 449 
Delirium Ebriosorum, .... 450, 452 
Prophj’lactics, .... 456 
3. Alcoholismus Chronicus, 457 
General Progressive Paralysis,.. 459 
Treatment of Alcoholism, 460 
4. Dementia, 461 
5. Nostalgia, Home-sickness, 462 
Genus IV.—Fatuity,—Idiocy, 464 
Treatment of Idiocy, 467 
Order II.—Affecting the Sensation,.. 468 
Nerves, Structure of, 468 
Physiology, 470 
Pathology of the Nervous Sys- 
tem, 471 
Disease an Exaggeration of the 
Nervous Function, 473 
Genus I.—Neuralgia, 477 
Treatment, 485 
Complications of Neuralgia 494 
1. Neuralgia from Local Irritation, 
496, 485 
2. Dental Neuralgia, 497 
3. Traumatic Neuralgia, 497 
4. Nervous Sick Headache, 498 
5. Hemicrania, Megrim, 499 
Treatment, 500 
6. Cephalalgia.—Headache, 506 
1. From Determination to the 
Head, 506 
Paob 
2. From Predisposition to Apo- 
plexy, 507 
3. From Catarrh 507 
4. Rheumatic Headache, 507 
5. From Disordered Stomach,. 507 
Treatment, Vol. I. 270 
6. From Constipation, 508 
7. Neuralgia Cceliaca.—Neuralgia of 
the Abdominal Nerves, 509 
8. Cardialgia, 510 
Idiopathic, 510 
Of Drnnkards, 512 
9. Gastralgia, 514 
Treatment, 515 
10. Gastrodynia Neuralgica, 519 
11. Nervous and Neuralgic Diseases 
of Women, 520 
12. Injuries of the Spine, 522 
1. Concussion of the Spinal Mar- 
row, 522 
2. Inflammation of the Spinal 
Marrow ... 523 
Congestion of the Spinal Cord, 524 
Lateral Curvature of the Spine, 525 
Genus II.— Myotica.— Affecting the 
Muscles, 526 
Muscular Contraction and Con- 
vulsive Diseases, 526 
Reflex Action, 528 
Spasms by Eccentric Irritation,. 529 
Disease Reflected «.n DistantParts, 530 
1. Tetanus -Trismus.-Locked Jaw, 531 
Opisthotonos, 531 
Emprostliotonos, 531 
Pathology, 533 
Treatment, 534 
Woorara and Nux-vomica, 536 
Strychnine, Tests of, 538 
Other Remedies, 539 
Tetanus, Chronic 541 
2. Hydrophobia.—Rabies, 543 
3. Angina Pectoris.—Stcrualgia, . . 552 
Acute do., 552 
Chronic do., 533 
Treatment, 557 
Palpitation of the Heart, Vol. I. 842 
Nervous Pulsations of the Aorta, 557 
Ossification of th£ Aorta, 558 
4. Strabismus.—Squinting, .. .... 560 
5. Chorea.—Saint Vitus’Dance,... 561 
Sycotic Affections of the Spinal 
Marrow and Ganglionic System, 567 
Epidemic Chorea, Religious Con- CONTENTS. 
VII 
Page 
vulsive Affection of the 19th 
Century, 567 
6. Barbiers 570 
7. Beriberia, 571 
Order III. — Systatica.— Complicat- 
ed Derangement of the Sensorial 
Functions, 572 
Genus I.—Sympathetic Affections,.. 572 
1. Nervousness, 574 
2. Antipathy 577 
Genus II.—Dinus.—Vertigo, 578 
Genus II.—Syspasia.—Convulsions,. 580 
1. From Deranged Circulation in the 
Brain, 580 
2. From‘Direct Violence, 580 
3. Convulsions of Children 582 
Treatment of Convulsions,... 584 
4. Epileptiform do., 586 
5. Cramps in the Limbs, 588 
6. Hysteria, 589 
7. Epilepsy, 593 
Idiopathic Epilepsy, 596 
Sympathetic Epilepsy 597 
Nervous Affections Resembling 
Epilepsy, 598 
Convulsive Affections Occurring 
during Sleep, 600 
Theory of Epilepsy, 601 
Causes of Epilepsy, 603 
Treatment, 605 
Genus III.—Asphyxia.—Apnce, .... 614 
1. Asphyxia from Submersion.— 
Drowning 615 
2. From Poisonous Effects of Burn- 
ing Charcoal, 615 
3. From Strangulation. Hanging,. 616 
Treatment of Asphyxia, 619 
Apparent Death.—Swooning.— 
Syncope.—Suffocation, 626 
4. Catalepsy.—Catochus.—Trance,. 627 
Diagnosis.—Signs of Death,.... 629 
5. Apoplexy, 633 
Pathology, 638 
Serous Apoplexy, 641 
Simple Apoplexy, 642 
Treatment of Apoplexy, 643 
6. Coma.—Stupor, 650 
Narcotism, 650 
Treatment of Coma, 650 
Poisoning by Opium, 651 
7. Amende Coma.-Hydrocephaloid, 654 
Effects of Lightning 655 
8. Paralysis. Palsy, 656 
Pathology, 657 
Pagb 
Paraplegia, 659 
Hemiplegia from White Soften- 
ing of the Brain, 659 
Treatment of Paralysis, 660 
Paralysis of the Auditory Nerve, 663 
Deafness from, 664 
Paralysis Metallorum, 666 
Paralysis from Spinal Affection, 668 
With Disease of the Kidneys, 669 
Inflammation of the Spinal Cord 669 
Mercurial Palsy, 671 
CLASS V.—Diseases of the Re- 
productive Function. 
Order I.— Cenotica.—Affecting the 
Secretions, 674 
1. Amenorrhoea.—Retention, Sup- 
pression of the Menses, 674 
Treatment 679 
2. Dysmenorrhcea, Painful Menstru- 
ation, 681 
Treatment, 684 
3. Menorrhagia, Profuse Menstruation 689 
Treatment, 691 
4. Leucorrhcea.—Fluor Albus, 695 
Treatment, 699 
5. Inflammation and Ulceration of 
the Os and Cervix Uteri, .... 701 
Prolapsus Uteri, 713 
6. Spermatorrhoea. — Involuntary 
Emissions, 714 
Treatment, 716 
Spinal Disease from Masturbation, 717 
7. Galactorrhcea.—Tabes Laetea, .. 718 
8. Chlorosis. Green Sickness, .... 719 
Treatment, 723 
Metritis, 729 
Order II.—Affecting the Parenchyma. 
Genus I.—Cyrtosis. 
1. Talipes -Kyllopodia.-Club-Foot, 730 
Treatment, 731 
CLASS YI.—Diseases of the Ex- 
cernent Function, 733 
Order I—Affecting Internal Surfaces, 783 
Absorption in Causing and Curing 
Disease, 733 
Genus I.—Hydrops.—Dropsy, 738 
1. Anasarca.—Cellular Dropsy,:.'.. 744 
2. Ascites.—Abdominal Dropsy, .. 745 
3. Hydrothorax, 747. 761 
4. Ovarian Dropsy, 748 
Treafment of Dropsy, 749 VIII 
Page 
5. Hydrocele Dropsy of the Testicle, 762 
6. Hydrarthrus.-Scrofulous Inflam- 
mation of the Joints,....... 764 
7. Spina Bifida.-Dropsy of the Spine, 765 
8. Urajmia.—Retention in the Blood 
of the Contents of the Urine,. 767 
Genus II.—Lithia.—1. Urinary Cal- 
culi.—Stone in the Bladder, 770 
Varieties of Calculi, 771 
2. Calculi in the Kidneys, 773 
Nephralgia Calculosa, 775 
Chemical Changes in the Urine, 776 
Mucus as a Ferment, .. 777, 783, 798 
Acid Fermentation, 781 
Products of Fermentation, 783 
Calculi formed from Urates,.... 785 
Effects of Alkalis, 789 
Treatment of Calculus, 799 
3. Diseases of the Bladder accompa- 
nying Calculus, 802 
Genus II.—Paruria, 807 
1. Hernia Humoralis, 807 
2. Fistula in Perineo, 808 
3. Diabetes, 808 
Pathology, 808 
( Treatment, 814 
4. Diabetes Complicated with Piar- 
rhsemia or Fatty Substance in 
the Blood, 815 
5. Albuminuria, 820 
Genus III.—Hydatids.-Parasitic En- 
tozoa, 822 
Hypertrophy- of Cellules, 823 
Hydatids of the Liver, 823 
Treatment, 824 
Genus IV.— Parostia.— Diseases of 
Bones, 826 
1. Exostosis, 827 
2. Osteitis, 828 
3. Enchondroma, 830 
4. Osteoid, 830 
5. Osteoporosis, 830 
Osteomalacia, 831 
Osteo-Sarcoma, 833 
6. Rachitis —Softening of the Bones, 833 
Genus V.—Adiposis.—Obesity, 836 
Atrophy, 836 
Corpulency, 837 
Treatment, 838 
Genus VI.— Malformations. Physi- 
cal Deformities, 839 
CONTENTS. 
Page 
1. Cretinism, 839 
2. Tumors, 840 
Order II.—Discuses Affecting the External 
Surface 841 
The Skin 841 
Cryptogam ie Parasites in their 
Relation to Disease, 843, 843 
Cutaneous Diseases, 845, 860 
1. Pityriasis, Dandruff, 846, 863 
2. Tinea Capitis—Scald Head 846 
3. Eczema, • 848, 860, 863 
4. Pemphigus, 851 
5. llupia, 851 
6. Ecthyma, 861 
7. Acne.—Rosy, Drop., 855 
Genus II.—Papular Eruptions, Lichen, 856 
Parasitic Vegetables on the Skin, 858 
Porrigo, 858 
Baldness 862 861, 859 
Psoriasis, 857 
Mycelium, Favus, 860 
Treatment of Parasitic Skin Dis- 
eases, 861 
Microsporon, 863 
Genus III.—Vesicular Varieties. 
1. Herpes, Tetter.—Dartre, 866 
Diagnosis, 867 
Treatment, 868 
2. Lepra—Leprosy, 870 
Lepra Grajcorum, 874 
Lepra Ansesthetica, 874 
Treatment, 878 
8. Scabies.—Psora.—Itch, 879 
Treatment 882 
4. Psora Guttata, 885 
Genus IV.—Malis. Cutaneous Ver- 
mination, 886 
1. Malis Filiaria. Guinea Worm,.. 886 
Genus V.—Ecphyma.-Cutaneous Ex- 
crescence, 887 
1. Corns, 887 
2. Diseases of the Nails, 891 
3. Onychia, 894 
4. Bunions, 895 
5. Nsevus Materni, 897 
Genus VI.—Trichosis.-Morbid Hair, 898 
1. Trichosis Pollicis.—Gray Hair,.. 898 
2. Plica Polonica.—Plaited Hair, .. 899 
Albino Skin, 901 
Sclerema, 901 
Verruca.—Warts, 901 THE 
HOMCEOPATHIC 
THEORY AND PRACTICE 
OF 
MEDICINE. 
Genus VIL—INFLAMMATORY DISEASES OF THE KIDNEYS 
AND URINARY ORGANS. 
1. NORMAL ANATOMY OF THE KIDNEYS. 
While the subject of Renal Diseases is under consideration, it may 
be interesting to present a brief anatomical and physiological de- 
scription of the healthy kidney, with the ordinary physical and chemi- 
cal character of normal urine. By such a course we enable the medi- 
cal man to compare, with facility, morbid with healthy conditions of 
the organ. The great advantages of this mode of procedure, in placing 
concisely before the reader every thing pertaining to these organs, both 
normal and abnormal, and the amount of time and labor thus saved in 
looking up reliable authorities, will be apparent to every one. 
Among the writers who have distinguished themselves in extending 
our knowledge respecting the anatomy and physiology of the diseases 
of the kidneys, we cite the following: Todd and Bowman, Phys., Anat. 
and Phys. of Man ’ George Johnson, On the Diseases of the Kid- 
ney, dec.; Hassall, The Urine in Health and Disease ; Thudicum, A 
Treatise on the Pathology of the Urine ; Basham, On Dropsy, con- 
nected with Disease of the Kidneys ; Beale, Illustrations of the 
Constituents of Urine, dec.; Rayer, Traite des Maladies des Reins / 
Lehmann, Physiological Chemistry; Becquerel, S&meiotigue des 
Urines, dec.; Frerichs, Die Brightsche Nierenkrankheit undderen 
Behandl./ Prout, On the Nature and Treatment of Stomach and 
Renal Diseases/ Scherer, Annal. der Chemie und Pharmacie; 
Christison, On Granular Degeneration of the Kidneys ‘ Bird, 
Urinary Deposits, dec.’, Bence Jones, An. Chem. in relation to 
Stomach and Renal Diseases / Solon, On Albuminuria. 10 
diseases of the sanguinous function. 
The researches of these authors have been so extensive, and their 
observations and illustrations are so minute and accurate with regard 
to everything pertaining to the kidneys, in their healthy and diseased 
states, that we shall not hesitate to avail ourselves largely of their 
valuable experience. 
The Anatomy and Physiology of the Kidneys.—Location.—The 
kidneys are located deeply in the lumbar region, on each side of the 
spine, and “directly beneath the ribs of the lumbar region.” 
Form.—Symmetrical glands, in form much like a French bean, with 
their convex margins directed outwards, and their concave borders or 
hilums, towards the spine. 
Size.—From four to four and a half inches in length, about two 
inches in breadth, and from one to one-eighth inches in thickness. 
Weight.—From four and a half to five and a half ounces. 
Anatomical Relations.—The ascending colon lies in front of the 
right, and the descending colon in front of the left kidney. A small 
portion of the duodenum touches the anterior surface of the right kid- 
ney. The spleen, and the lower part of the stomach, when distended, 
are directly over the upper portion of the anterior surface of the left 
kidney,— the former organ being in actual contact with it. The 
posterior portions of the kidneys are in close proximity to the lumbar 
and psoas muscles, and in contact with the diaphragm. 
llenal Capsule.—A strong, fibrous membrane enveloping the kid- 
neys, attached externally to a bed of adipose tissues, and internally to 
the gland itself; giving out here and there fibrous attachments to the 
cortical substance and receiving in return a number of small vessels; 
connected above with the fibrous layer of the pelvis, and at the hilum 
with the ureter. 
Renal Surface.—On the surface of the kidneys are eight to ten im- 
perfect fissures, indicating the original lobular divisions of the organ 
during intra-uterine life. Other lobular demarcations are perceptible, 
arising from a peculiar arrangement of the stellate veins upon the renal 
surface. These veins enter the cortex vertically from its surface, and 
during their passage to the hilum are recipients of blood from the 
venous plexuses of the tubuli uriniferi. 
Renal Matrix.—A tissue composed of a firm, transparent, fibro-cel- 
lular net-wrork, in w’hich the entire substance of the kidney is embedded. 
The tubes and blood-vessels of the gland traverse the matrix in all 
directions, and, in a section of the kidney, may be recognized as deep- 
red oval spots, surrounded and supported by the intervening meshes of 
the matrix. Todd and Bowman suppose that its only office is to serve 
as a support for the tubes and capillary vessels. 
Substance of the Kidney.—Anatomists have divided the kidney into 
two separate portions, termed cortical and medullary. NORMAL ANATOMY OF THE KIDNEYS. 
11 
Cortical portion.—The ext ernal and cortical portion is from two to 
six lines in thickness, of a reddish color, soft consistence, and dotted 
throughout its structure wdth a number of minute, deep-red granular 
spots—the Malphighian corpuscles. It is composed chiefly of the con- 
voluted uriniferous tubes, and the Malphighian bodies. 
Tubuli Uriniferi.—These convoluted tubes consist of a delicate 
basement membrane, attached to the matrix, and lined with epithelial 
cells, whose office it is to separate from the blood, the urea, uric acid, 
the sulphates, the phosphates, and the other solid constituents of the 
urine. These tubes terminate at, and are continuous with the Mal- 
phighian corpuscles, and are connected below with the straight tubes 
of the medullary portion, which receive the urine as it is secreted by 
the Malphighian bodies and the cells of the convoluted tubes. 
Malphighian Bodies.— Are made up of small round tufts of 
capillaries from the afferent, and terminating in the efferent vessels, 
and enclosed by capsules lined at their lower thirds with epithelium. 
Their function is to separate from the blood the aqueous portion of the 
urine. 
Medullary Portion.—The internal medullary portion constitutes 
the remaining part of the gland, is less soft than the cortical substance, 
of a deeper red than the cortical portions, although Todd and Bowman 
describe it as paler, and its substance is arranged in the form of cones, 
named from their discoverer, pyramids of Malphighi. These cones or 
pyramids are made up of the straight tubes, which are continuations 
of the convoluted secreting cortical tubes, and appear to be simply 
channels for conveying the urine from the secreting cells to the pelvis 
of the kidney. They are lined by a thin squamous epithelium which 
serves to shield the basement membrane from the irritation of the pass- 
ing urine. As the tubes proceed from the apices of the cones to the 
cortical substance, they throw off numerous anastomosing branches, 
which become more numerous, and of smaller diameter as they ap- 
proach the bases of the pyramids. The number of pyramids is usually 
placed at from ten to fifteen, and their apices float freely in the pelves 
of the kidneys. No Malphighian bodies have been observed in this 
portion of the organ. 
Renal Blood Vessels. The following is Todd and Bowrman’s de- 
scription of the vessels of the kidney: “ The renal arteries divide into 
four or five branches, which enter the kidney at the hilum between the 
vein and the ureter. These vessels are surrounded with a quantity of 
fat. They pass between the papillae to the bases of the cones, over 
which they spread. From these arteries smaller branches are given 
off, which ascend in the cortical substances nearly to the surface, and, 
in so doing, give off on all sides, a number of small terminal twigs, the 
afferent vessels of the Malphighian bodies. Arrived within the capsule. 12 
DISEASES OF THE SANGUINOUS FUNCTION. 
the small afferent vessel at once divides into four or five branches, each 
of which again divides dichotomously. The small capillary vessels 
form loops, which project towards the opening of the uriniferous tube. 
The blood is received from these vessels, which lie towards the outside 
of the tuft, by branches of the efferent vessels which converge towards 
the more central part of the tuft to form one trunk, which leaves the 
Malphighian body, and soon breaks up into a plexus of capillary vessels, 
in the meshes of which the tubes lie. The terminal arterial twigs with 
their appended tufts, when injected with Vermillion, have been compared 
not inaptly to a branch of currants.” 
Examination of Urine.— General Principles.—The first urine 
voided in the morning or at the period of longest fasting from food and 
drink, is the truest expression of the kidney secretion, and contains the 
largest proportion of solids. This the urine of the blood, as distin- 
guished from that of the food and drink. 
As an average, in relation to the general habit of body, or with a 
view to the influence of paroxysmal diseases, &c., Chossat adopted the 
method, afterwards approved by Lecanu, Becquerel, Lehmann, Thudi- 
cum, and other authorities, of collecting the whole of the urine during 
several days and nights consecutively, and mixing in one mass what 
had been voided during twenty-four hours, before proceeding to the 
analysis of this average urine. Finally, an average is taken of the 
variations during several successive periods. Lehmann insists upon 
the necessity of this method, and advises, whenever it is impracticable, 
to confine the analysis to the solids of the urine. 
For practical convenience, Thudicum advises the use of a flat-bodied 
glass, with a narrow, turned-up neck, and a mouth fitted to the require- 
ments of the sex, either funnel-shaped or elipsoid. The neck should 
fit into a gap in the front border and wall of the bed-pan so that the 
penis shall lie easily in the neck of the urinal, and no urine be lost. 
These urinals should be graduated upon a scale of fluid ounces up to 
fifty or sixty, or centimetres two thousand, with forty divisions. 
For the quantitative analysis of healthy urine, see the “Practical 
Handbook of Medical Chemistry,” by John E. Bowman, Am. ed., p. 41; 
or, “ Thudicum’s Pathology of the Urine,” Chap. 2; or “ Becquerel, 
Semeiotique des Urines,” Chap. X; or “Lehmann’s Physiological 
Chemistry,” Am. ed., Vol. 2, p. 149; or “Carpenter’s Human Physio- 
logy,” Am. ed. of 1858, p. 389. Other physical properties of urine are 
treated of in the same connection. 
For estimates of the solids of the urine, based on its specific gravity, 
&c., see also, Johnson, On Diseases of the Kidneys, p. 43 ; or Golding 
Bird, On Urinary Deposits, p. 46; or Christison, Table, lib. 7, of 
Prac. Med., Lond.: 1840, vol. iv.; or Berzelius, Lehrbuch der Ch., 
3d ed., vol. x., p. 285. NORMAL ANATOMY OF THE KIDNEYS. 
13 
For a practical approximation to the specific gravity of the whole 
urine, test, by the urinometer, that which is passed first in the morning 
and last in the evening, and then strike an average. Lehmann prefers 
the direct weighing of equal volumes in glass flasks,—thermometric 
and barometric relations being taken into account. The specific gravity 
of the glass, and the co-efficients of expansion of the air and water 
for a vacuum, by means of logarithms or a couple of algebraic equa- 
tions. See Schmidt’s Entwurf einer Untersuchens-Methode thieri- 
scher Sdfte; or Thudicum’s work pre-cited, p. 33. The Pycnometer, 
made to facilitate this operation, contains a thermometer in its stopper. 
Becquerel measures the density of urine with Baume’s areometer. 
(See p. 13.) 
Normal Urine.—Physical Characters.—Quantity in Health. 
This varies chiefly with the proportions of water, but averaging, under 
ordinary circumstances, about thirty ounces in summer and forty 
ounces in winter. The lungs and skin normally, the intestinal canal 
and serous membranes abnormally, may supply the function of the kid- 
neys in evacuating the water of the urine, but as the secretion of water 
is merely accessory, not essential to their function, so our chief atten- 
tion must be paid to the relative proportions of the different solid con- 
stituents. 
These may normally vary from 0*20 to 080, or from forty to fifty grammes 
(Becquerel), or 1000 grains (Todd and Bowman), in twenty-four hours, 
for a man who lives freely; but less for the aged, and for women and 
children, whose urine is more watery. 
Specific Gravity.—Making a fair average, it may be placed at 1020. 
But, in conditions of health, its density varies from 1010 to 1025. 
Normal urines of 1017 have 28*5 solid parts. [Lehmann.) 
Aqueous urines, when not accounted for by the quantity of fluids im- 
bibed, or by the chill and moist state of the atmosphere, are sometimes 
symptomatic of emotional agitation,—of joy, fright, anxiety, or of ner- 
vous disorders; hence they are oftenest remarked in the female. Poly- 
dypsia, anaemia, diabetes, and hysteria are cited by Becquerel as the 
states in which the urine is most aqueous. 
A healthy adult passes from thirty to forty ounces of urine in twenty- 
four hours—the quantity in summer varying from thirty to thirty-five 
ounces, and in winter from thirty-five to forty ounces. 
Of the solid constituents of healthy urine more than one-half is urea. 
This is derived in part from the metamorphoses of the tissues (probably 
the gelatinous tissues), and in part from innutritious and unassimilated 
food. The proportion of urea is increased by the use of animal food 
and active exercise, and diminished by vegetable and other non-nitro- 
genous articles. In or out of the body, it. is readily converted into 
Carbonate of Ammonia; as one atom of urea and two atoms of water 14 
DISEASES OF THE SANGUINOUS FUNCTION. 
form two atoms of Carbonate of Ammonia. The causes which deter- 
mine this conversion are various. Among them may be cited: 
In cases of uraemia, it is an interesting question, whether the morbid 
effects are due to the presence of the unchanged urea in the blood, or 
to its conversion into Carbonate of Ammonia. A careful proving of 
these two substances would aid us in deciding the point, and might af- 
ford valuable hints in treatment. 
Uric-acid exists ready formed in the blood, and is found in healthy 
urine in the form of Urate of Ammonia. Johnson supposes that it forms 
less than —„-Vo part of healthy human urine. Prout supposes that it is 
derived from the decomposition of the albuminous tissues; while Liebig 
maintains that it results from the decomposition of the nitrogenous 
tissues. 
Ammonia is another constituent of healthy urine, and is found in the 
form of Urate of Ammonia. 1000 parts of urine contain from 2'16 to 
2T9 parts of Ammonia. Hippuric acid is another healthy constituent 
of healthy urine, and forms about a/iTo part of the entire quantity ex- 
creted. This acid abounds in carbon, and is usually abundant in con- 
sumptive and other patients, whose blood is imperfectly decarbonized. 
The sulphates of healthy urine are chiefly those of Soda and Potash, 
although Sulphates of Lime, Magnesia, and Ammonia are usually 
present in minute quantities. They are supposed to be derived in part 
from the metamorphoses of the tissues, and in part from the food. Un- 
oxidized Sulphur is also found in the urine, but its precise combinations 
are not yet fully understood. According to Ronalds, from two to five 
grains of Sulphur are excreted daily. 
Phosphates of Potash, Soda, Lime, Ammonia, and Magnesia, are also 
found in minute quantities as constituents of healthy urine. They are 
also derived from the changed tissues and from food. Unoxidized Phos- 
phorus, in minute quantities, is also present in normal urine. 
From the analysis of normal urine we observe, that traces of the 
Chlorides of Sodium, Potassium, Lime, Ammonia, and Magnesia are 
present, and that they are derived chiefly from the food. 
Color.—The color of healthy urine has been termed by different 
writers, amber-colored, straw-colored, sherry-wine-colored, yellow, &c. 
We know of no term truer or more expressive, than amber-colored. As 
already observed, in infants, females, aged persons, and in certain anae- 
mic conditions, the urine is more watery, and consequently paler in 
color. 
Red urines generally indicate an excess of acid, a high specific 
gravity, and the presence of a large proportion of solids. Many causes 
may contribute to the production of highly-colored urine in health ; 
like an undue elimination of the water through the pores, abstinence 
from drinks, and the use of highly-nutritious and highly-seasoned food. NORMAL ANATOMY OF THE KIDNEYS. 
15 
The use of certain drugs and beverages may also give a red tinge to 
the urine. Red urine is also an accompaniment of many abnormal con- 
ditions, like fevers, dropsies, and maladies characterized by a rapid 
decomposition of the tissues and the blood. The acid which gives the 
red color to urine is the Bi-phosphate, or Acid-phosphate of Lime, and 
not uric or lactic-acid, as is generally supposed. 
Deep-yellow urine indicates the presence of bile. 
Dark urines—brown, blue, or black, are observed during the pro 
gress of many malignant diseases, and are due to rapid morbid changes 
m the tissues and to a decomposition of the blood. Black urine is 
sometimes voided after long-continued epileptic convulsions, in conse- 
quence of protracted and spasmodic muscular contraction. Brown, red, 
or blackish urine is sometimes due to the presence of blood. Under 
the microscope, the globules appear deformed and irregular, and they 
finally disappear. Amorphous fragments are then found similar to 
those observed in albuminous urine. 
Turbid urine indicates, first, the presence of mucus with diminished 
density, paler color, and, after standing a few hours, a separation into 
an upper and clear layer, and a lower and turbid and opaque one, with 
ammoniacal odor, in consequence of the decomposition of urea into 
carbonate of ammonia, which mucus rapidly determines. Second, 
turbid urine is also caused by the presence of pus. Such urine is less 
dense than natural, of a greenish color, clears soon after emission, and 
deposits a thick, whitish, and foetid sediment. Like mucus, it hastens 
the conversion of urea into carbonate of ammonia. Under the micros- 
cope, pus-cells are observed in the upper or transparent stratum, at first 
very numerous, but, after ten or twelve hours, (as in case of blood- 
globules), they disappear, and a kind of granules are found in their 
stead. 
Sediments.—The sediment of acid urines is composed of uric-acid 
crystals, acid urates of soda, ammonia or lime. The sediment of alka- 
line urines consists of carbonate and oxalate of lime, and ammoniaco- 
magnesium phosphates. Sediments of pus, mucus, and blood-globules 
are not unfrequently found. The composition of urinary sediments is 
so various, arising from the decomposition of the urine and its waters, 
that we can only allude to them here, and refer the reader to Becquerel, 
On the Urine, and to Thudicum’s Pathology of the Urine, for more 
minute information upon the subject. 
Acid Urine.—Normal urine is generally acid, as may be proved by 
test-paper. By standing it becomes more acid, and passes through an 
acid fermentation, resulting in the separation of reddish-yellow rhom- 
boid-shaped crystals under the microscope. Acid urine is deep-colored 
and dense, and the acidity is derived from the bi-phosphate, or acid- 
phosphate of lime, and not, as is commonly supposed, from the uric oi 16 
DISEASES OF THE SANGUINOUS FUNCTION. 
lactic acid. Liebig attributes the acidity of the urine to the presence 
of acid-phosphate of soda. Where great accuracy is not requisite, the 
urine may be tested for acidity with litmus paper. The tests should be 
applied at different periods of the day, and an average drawn ; since 
the degrees of acidity are constantly changing from the food and drink 
consumed, from fasting, exercise, &c. 
Neutral JJrine.—This is only ordinary urine very much diluted, 
like that which is observed in anaemic subjects. 
Alkaline Urine.—This is rarely observed. Its sources are blood, 
pus, and the decomposition of urine or carbonate of ammonia in the 
bladder—the last being the most frequent. The most frequent deter- 
mining cause of this alkalinity is the action of the oxygen of the air 
upon the substances cited. But the urine may be alkaline at the instant 
of its secretion in the kidney. After standing for a considerable period, 
acid urine sometimes becomes alkaline, in consequence of the decom- 
position of urea, and the development of carbonate of ammonia, am- 
monio-magnesian phosphates, and phosphate of lime. This result may 
likewise be produced by boiling urine for several hours. 
Composition of Urine.—When we consider the various circum- 
stances which are in constant operation to modify the composition of 
urine, it will not appear surprising that chemists have presented us 
with such diverse analyses. The urines of the claret-drinking French- 
man, of the beer and port-drinking Englishman, of the lime-water 
drinking Yankee, and of the fruit-consuming denizens of tropical 
climates, must of necessity present great diversities in chemical com- 
position. Even under any circumstances, the variety of food and 
drinks, atmospheric changes, habits of exercise, mental emotions, ex- 
cessive mental or physical exertion, continual modifications are oc- 
curring in the composition of the urine. It is evident, therefore, that 
any analysis which may be presented must be regarded as only an ap- 
proximation to the actual result. 
We place before our readers an analysis of Becquerel, quoted from 
Johnson’s “Diseases of the Kidney” p. 48, and another from Berzelius. 
“ This analysis of Becquerel was adopted by Dr. Prout as being the 
most accurate. Dr. Prout took as a standard, thirty-five ounces of 
sp. gr. 1020, and employing M. Becquerel’s data as the basis of his 
calculations, he obtained the results which are shown in the following 
table; the proportion of solids and liquids being thirty-three of the 
former to 967 of the latter.” 
Composition of 1000 Parts of Urine. 
Water, 967* 
Urea, 14230 
Uric-acid, -468 NORMAL ANATOMY OF THE KIDNEYS. 
17 
Organic matters in- 
separable from each 
other, 
r Lactic acid ? 
/ Coloring matter, 
f Extractive matter, 
10167 
Chlorides 
1 Phosphates 
' Sulphates 
Ammonia 
Lime 
Soda 
Potash 
Magnesia 
Salts . 
... 8135 
1000-000 
Berzelius gives us the following table as the 
Composition of 1000 Parts of Urine. 
Water, 933* 
Urea, 30-10 
Uric-acid, 1* 
Sulphate of Potassae, 3 71 
Sulphate of Soda, 3‘16 
Phosphate of Soda, 2-94 
Chloride of Sodium, 4 45 
Phosphate of Ammonia, 1-65 
Muriate of Ammonia, 1-50 
Free Lactic-acid, 
Lactate of Ammonia, 
Phosphates of Lime and Magnesia, . 
Animal matter insoluble in Alcohol, J 
17-14 
Fluoride of Calcium, a trace. 
Silica, a trace. 
Mucus of the bladder, 0"32 
1000000 
Solids of Normal Urine.— Urea. Chemical composition: C2 H4 
N2 O2 = 60., sp. gr. 1-35. Of the solid constituents of healthy urine, 
urea forms from 7 7t part. It forms fiat quadrilateral prisms, 
with aspect and taste like Nitre. It belongs to the class of organic 
bases, and forms crystalizable compounds with several of the .acids; is 
soluble in five parts of cold or two parts of boiling alcohol—in its own 
weight of cold water, and in every proportion of boiling water; is in- 
soluble in ether; is permanent in the air; fuses at 250° F., and at a 
higher temperature yields by spontaneous decomposition, ammonia, 
cyanate of ammonia, and dry solid cyanuric-acid. According to John- 
son, 270 grains, or more than half an ounce of urea is excreted by a 
healthy man in twenty-four hours. It readily results from the trans- 
formations of various azotized matters, and, when not removed by the 
kidneys, it accumulates in the blood, and appears in the saliva, the 
bile, the gastric secretions, in nearly all the humors, and is so abun- 
dant in the sweat as to form, after spontaneous evaporation, a blueish- 
white crust, especially upon the face. The quantity of urea is m- 
Vol. il—2. 18 
DISEASES OF THE SANGUINOUS FUNCTION. 
creased by all causes which determine rapid metamorphoses of the 
tissues. Its prolonged retention in the blood gives rise to what is 
termed uraemic poisoning, to which we shall refer hereafter. 
For excellent methods of ascertaining the absolute quantity of urea 
in urines, we refer the reader to Thudicum’s work on the “ Pathology 
of the Urine,” pp. 52, 67, and 69—“ Methods of Liebig, Bunsen, and 
Davy.” When the quantity of excreted urea continues above or below 
the natural standard for any considerable period, disease may be in- 
ferred. Among; the causes which determine its diminution in the 
urinary secretion are insufficient food, impaired digestion, chronic 
maladies, anaemic conditions and diseases of the convoluted tubes of 
the cortex of the kidneys. 
The principal causes which form the excretion of an excess of urea, 
are the assimilation of large quantities of nutritious food, the use of 
stimulants, febrile disorders, arid general activity of the circulatory 
and digestive functions. 
Uric-acid.—Chemical composition: C10 H4 06 N4 = C10 H2 04 N4 
+ 2IIO. Pure uric-acid, according to Brande, is a “ soft, Avhite, crys- 
talline powder; it is insipid and inodorous; it reddens moistened lit- 
mus paper. It is almost insoluble in cold water (requiring, according 
to Bensch, from 11,000 to 15,000 parts), but soluble in between 1,800 
and 1,900 parts of boiling water; it is insoluble in alcohol and in 
ether.” When it is decomposed by heat it yields carbonate of ammo- 
nia, hydrocyanic acid, empyreumatic oil, cyanuric acid, urea, and car- 
bon. It forms *468 in 1000 parts of normal urine, according to 
Becquerel. The average amount discharged by a healthy man in 
twenty-four hours is stated by Becquerel to be from 049 to 0*56 
grammes. The proportions, however, may vary much in different in- 
dividuals without any impairment of the health—such variations de- 
pending upon the quantity and quality of food and drink consumed,. 
habits of life, &c. 
Uric acid in combination with one or more bases—ammonia, soda, 
or lime—is one of the most common sediments of the urine. Uric- 
acid, being insoluble in the blood, can only exist in this fluid in the 
form of a urate—chiefly urate of soda—and is separated by the kid- 
neys, passes to the pelvis of the kidneys, to the bladder, and thence 
out of the body as a urate of soda. But, during the passage of the 
latter through the urinary organs, portions of it are often decomposed, 
and uric acid set free by the free phosphoric and lactic acids of the 
urine. This decomposition may occur in the kidney, in the bladder, or 
after the emission. 
In order to ascertain whether the urine holds in solution a urate, we 
add to it either nitric, acetic, or muriatic acid. If uric acid is speedily 
precipitated, wre infer the presence of a large quantity of the urate; NORMAL ANATOMY OF THE KIDNEYS. 
19 
but, if a long time elapses before a deposit is apparent, it indicates the 
presence of only a small quantity of the salt. In all cases of albumi- 
nuria either nitric or muriatic acid should be employed, as nitric acid 
precipitates albumen. 
The following is Dr. Golding Bird’s diagnosis of uric acid depo- 
sits : u When heated in the urine, the uric acid deposit does not dis- 
solve, the crystals merely become more opaque. They generally be- 
come more distinct, from the solution of the urate of ammonia, which 
is frequently mixed with them, and sometimes completely conceals 
them from view. Hence the best mode of discovering this deposit is 
to warm the urine, when turbid from excess of urate of ammonia, in a 
watch-glass : the acid becomes visible at the bottom of the glass as 
soon as the urate dissolves.” 
Creatine.—General Appearance. In its crystallized form it is a 
colorless, transparent, and glossy substance. 
Chemical Composition.—C8 H9 N3 04 + 2 Aq. 
Specific Gravity.—T35 to 1*34. 
Quantity in Normal TJrine, and whence derived.—An excremen- 
titious substance, derived from the muscles ; excreted from the blood 
by the kidneys, and passing thence into the bladder and out of the 
body; a constant constituent of the urine, but present in very small 
quantities. 
Quantity Passed in Health in Twenty-four Hours.—Thudicum 
places the average quantity passed in twenty-four hours at 0*305 
grammes. 
How Increased or Diminished.—The quantity is increased by 
muscular action, febrile conditions, and whatever produces rapid meta- 
morphoses of the muscular tissues. The causes which tend to dimin- 
ish it are muscular inactivity, anaemic conditions, feeble action of the 
circulatory and respiratory systems. 
Mode of Detection.—First evaporate the urine to a dry extract, 
then, with a solution of ammonia, dissolve out the creatine, and finally 
evaporate the solution of ammonia, leaving the creatine in a crystalline 
state. Under the microscope these crystals present themselves in 
various forms, but may be readily distinguished by accustomed ob- 
servers. (See Hassall on Urinary Diseases.) 
Creatinine.—General Appearance. Creatinine crystallizes in ir- 
regular groups of very transparent and light-colored crystals. They 
may be distinguished from those of creatine by their lack of lustre. 
Creatinine is usually present in the urine in a free state. Much of it 
is supposed to be derived from the conversion of creatine into creati- 
nine during its passage through the urinary organs, and after the urine 
has been evacuated. 
Chemical Composition.—Formula: C8 H7 N3 02. It is more 20 
DISEASES OF THE SANGUINOUS FUNCTION. 
soluble in water than creatine—one part dissolving in 11*5 parts of 
water at 60° F. Its chemical character is almost identical with that 
of ammonia. 
Specific Gravity.—The specific gravity of the crystals is about 
equal to 1*35. 
Proportion in Normal TJrine.—Always greater than that of crea- 
tine, from whence it is derived. 
Quantity Passed in Twenty-four Hours.—The average quantity 
passed in twenty-four hours in health, varies, according to the experi- 
ments of Thudicum, from 5-61 to 066. 
From whence Derived.—An excrementitious substance, derived in 
part from metamorphosed muscular tissue, and in part from the con- 
version of creatine into creatinine after the urine has been separated 
from the blood by the kidneys. 
Causes which Increase or Diminish It.—Like creatine, it is in- 
creased by those causes which effect a rapid disintegration of the mus- 
cular tissues, and diminished by those conditions which retard those 
muscular transformations. 
Mode of Detection.—Same as for that of creatine. 
Hifpukic Acid.—General Appearance. In its crystalline state it 
is in the form of “ delicate silky needles or rhombic prismstaste 
bitter; sparingly soluble in cold, but more readily in boiling water, 
and still more soluble in alcohol. Supposed by Liebig to be a con- 
stant constituent of normal urine, in about the same proportion as uric 
acid; but the observations of Duchek do not confirm this opinion. 
Chemical Composition.—Formula: N. C. 18. 118. 05 x Aq. It is 
readily decomposed by nitric acid, and converted into benzoic acid. 
It enters into combination with several alkaline and earthy bases to 
form the hippurates. 
Quantity in Normal Urine.—Much diversity of opinion prevails 
upon this point. According to Liebig, uric acid and hippuric acid 
are present in healthy urine, in about equal proportions; while Iloesle 
and Duchek deny that the latter is a normal ingredient of this se- 
cretion. 
Quantity Passed in Twenty four Hours.—The quantity secreted 
depends much upon the habits of the individual and the kind and 
quantity of food consumed. But the average amount may be placed 
at from 040 to 0’50 in twenty-four hours. 
From whence Derived.—It is derived principally from the non- 
nitrogenous elements of the food {Liebig). Bird supposes that it may 
owe its origin to an undue retention of carbon in the blood, from defec- 
tive action of the lungs and liver. 
How Increased or Diminished.—Increased by rest and by the uso 
of fruits, like pears, plums, cherries, apples, &c., and diminished by ac< NORMAL ANATOMY OF THE KIDNEYS. 
21 
tive exercise in cold air and rigid abstinence from stimulants, coffee, 
and meats. 
Mode of Detection.—Turbid urine indicates the presence of con- 
siderable hippuric acid, while clear urine usually contains but a small 
quantity. For other methods of detecting it see “ Thudicum on the 
Pathology of the Urine,” p. 143. 
Coloring Matter of TJrine.—Thudicum gives the name of ursema- 
tine to this substance, from the supposition that it is “ derived from 
the pigment of the blood or hsematine.” In a dry state it is of a deep 
red color, and it is this substance which communicates to urines their 
various tints. Scherer supposes that it is derived from the decompo- 
sition of blood corpuscles. It is composed chiefly of carbon. But 
little is known at present of its exact character—its derivation, chemi- 
cal reactions, &c.; but it is doubtless an effete and excrementitious 
substance. 
Fixed Salts of the Urine.—Sulphates. Of the fixed salts of 
the urine the sulphates of potassa and soda are the most abundant. 
The average quantities of each in 1000 parts of urine are as follows, 
according to Berzelius : sulphate of potassa, 3‘71; sulphate of soda, 
3T6. A small quantity of pure sulphur is also present in most 
healthy urines. They are derived in part from the metamorphoses 
of the tissues. 
Phosphates.—Berzelius gives us the following proportions of these 
salts as pertaining to normal urine : phosphate of soda, 2-94, and 
phosphate of ammonia, L65, in 1000 parts of urine. Traces of phos- 
phates of lime and magnesia are also always present in normal urine. 
Free phosphorus is said to be a constant constituent of healthy urine. 
Derived chiefly from disintegrated muscular, brain, and nervous tissues, 
and from food and drinks. Increased by mental activity and cerebral 
irritation. 
Chlorides.—These occur in normal urines in the form of chloride 
of sodium and potassium—the proportion of the former to 1000 parts 
of water being 4*45, and of the latter a trace. 
Minute quantities of the following substances are likewise found in 
all normal urines-: silica, free lactic acid, fluoride of calcium, hydro- 
chlorate of ammonia, acetate of ammonia, albuinine, gelatine, and ben- 
zoic acid. 
2. BRIGHT’S DISEASE OF THE KIDNEY. 
Synonyms.—Albuminuria.—Acute desquamative nephritis. (Johnson.)—Renal 
cachexia. (Wood).—Albuminous nephritis.—Granular degeneration of the kidneys.— 
Fatty degeneration of the kidneys.— Uraemia. 
In 1837 the attention of the medical public was first seriously directed 
to this malady by Dr. Bright, of London. Although a few previous 22 
DISEASES OF THE 8ANGUINOU8 FUNCTION. 
writers had vaguely alluded to the disease, and thrown out some hints 
with regard to its probable nature, yet to Dr. Bright belongs the credit 
of having first presented to the profession a systematic and moderately 
accurate description of the symptomatic and pathological phenomena 
of the disease. We adhere to the term “Bright’s disease” to designate 
the malady, because not one of the other names applied to it conveys 
a just impression of its actual nature. The prime cause, the ultimate 
essence of the malady is not located in the kidneys, but in the blood 
itself, in the form of retained effete matter from diseases, from the pre- 
sence of noxious drugs, from checked perspiration, &c. So long as 
these poisons remain in the blood, its normal condition is disturbed, 
and the entire organism suffers. Nature, always kindly in her instincts, 
always on the qui vive to sustain the integrity of the delicate organi- 
zation over which she has been placed in charge by the Great Archi- 
tect, strives to eliminate all disturbing agents through one or more of 
the natural emunctories of the body; and she always selects the most 
appropriate channels to throw off 'each deleterious substance. As 
examples we cite the following: 
When the poison of variola has infected the blood, the skin is selected 
as the eliminator, and the energies of the system are concentrated to 
throw out upon this part, suppurating pustules loaded with the escap- 
ing poison of small-pox. The copious discharges from the pocks 
usually suffice to relieve the blood of its morbid constituent, and thus 
enable the system to return to a normal state. But in some instances 
the pustules fail to perform their full duties as eliminators, the kidneys 
are called into requisition as auxiliaries, and, as a consequence, renal 
inflammation is sometimes the result. 
In the case of scarlatina poison, the most important eliminators are 
the skin and the mucous membrane of the throat and intestinal canal. 
When the poison is intense, and the natural recuperative forces are 
feeble, these parts fail to perform their offices efficiently, and an extra 
amount of labor devolves upon the kidneys. During the passage of 
this poison through the tubuli uriniferi, an inflammatory congestion 
is produced, which prevents the Malphighian corpuscles and the 
epithelial cells of the tubes from separating from the blood normal 
urine, and permits the passage of albumen, fibrin, and other abnormal 
constituents. 
In measles, erysipelas, and other cutaneous disorders similar con- 
ditions not unfrequently obtain. So likewise in many other conditions 
of the system; in scrofula, psora, constitutional syphilis, the presence 
in the blood of poisonous substances, like mercury, phosphorus, turpen- 
tine, copaiba, and other drugs, retained perspiration from the action of 
cold, &c., the kidneys may become inflamed in their efforts to eliminate 
these noxious influences. During this process of elimination, if the bright's disease of the kidney. 
23 
poison is directed towards the skin, eruptions and cutaneous inflam- 
mations of various kinds may result; if it is attracted to the bowels a 
diarrhoea will occur; if to the liver, hepatic inflammation will ensue ; if 
it passes out of the blood through the kidneys, we shall have the usual 
phenomena of acute desquamative nephritis, with a rapid production 
and detachment of the epithelial cells of the convoluted tubes, inflam- 
mation of the Malphighian bodies, exudation of serum, fibrin, &c. 
When renal inflammation results from any of the causes cited, it can 
only be regarded as an effect of the action of the passing irritant. To 
this effect medical men at present direct their chief attention, almost 
regardless of the more deep-seated and vital derangements which 
originate the complaint. In a therapeutical point of view the dis- 
tinction we have described is important in guiding the medical man 
to a more comprehensive and efficient mode of treatment. 
Bright’s disease may originate from other causes than those enume- 
rated. In our own practice wTe have on several occasions met with 
both acute and chronic forms of the malady, which were clearly trace- 
able to irritable bladder, and other chronic affections of this organ. 
In several of these instances incontinence of urine (especially noctur- 
nal) had existed for years previously to the renal attacks. It is highly 
probable that long-continued sympathetic irritation of the kidneys from 
urethral strictures, cystic calculi, and other causes of similar character, 
may eventually give rise to the complaint under certain circumstances. 
In a monograph recently published in Paris, entitled “La Fievre Jaune 
de La Nouvelle-Orleans,” by our friend A. J. F. Cartier, M. D., it is 
stated that albumen is often found in the urines of yellow-fever patients, 
during the second and third stages of the malady. Dr. Cartier has 
personally verified this statement in several instances. Does not this 
fact go far to prove that the immediate cause of yellow fever is a 
blood-poison, introduced from without, the tendency of which is to pro- 
duce a rapid decomposition of the blood, with consequent functional 
derangement of nearly all the organs, and finally exudation of serum 
into the stomach, black vomit, general prostration and death, unless 
the poison be eliminated during the first stage of the malady, through 
the pores, the kidneys, and other emunctories? A confirmation of this 
view consists in the fact, that when the cutaneous, renal and hepatic se- 
cretions are kept in uniform and steady action from the outset of the 
disease, recovery invariably results. 
Albuminous urine has often been detected in cases of cholera as 
phyxia, and in ship, hospital and other typhoid fevers. In these 
examples, as in the cutaneous maladies enumerated, the blood is con- 
taminated with specific morbid poisons, and during the reaction of the 
vital force to eliminate them, the kidneys become inflamed. 
One of the most common and characteristic phenomena connected 24 
DISEASES OF THE SANGUINOUS FUNCTION. 
with Bright’s disease consists in the presence of albumen in the urine; 
and from this circumstance it has received, from Martin Solon, the ap- 
pellation of albuminuria. A symptom no less common, consists in the 
retention of urea in the blood; from which fact other writers have em- 
ployed the word uraemia to designate the malady. Others still regard 
the complaint as dependent not only upon a depraved condition of the 
blood, but of the entire organism; and, in accordance with this view, 
Professor Wood, of Philadelphia, has presented us with the term renal 
cachexia, to express the disease as a unit Another constant phenome- 
non connected with the disorder is a more or less rapid production and 
detachment of the epithelial cells of the tubuli uriniferi; in con- 
sequence of which Dr. Johnson has named it desquamative nephritis. 
From the uniform presence of albumen in the urine Bayer employs 
the term albuminous nephritis. One form of the disease superinduces 
granular formations in the kidneys, from which the designation granular 
degeneration of the kidneys is derived by Dr. Christison. Another 
variety appears to be connected with waxy deposits, and these cir- 
cumstances have given rise to the terms fatty and waxy degeneration 
of the kidneys. 
When we reflect that the kidneys are effected only secondarily, and 
that all of the conditions we have cited are only isolated symptoms of 
quite different primary and deep-seated causes, we shall perceive that 
not one of the terms which have hitherto been employed to express the 
malady as a unit is strictly appropriate. For this reason, and until a 
more just and comprehensive appellation shall be devised, we shall 
still adhere to the original designation of Bright"1 s disease. 
A majority of authors have made a general division of the malady 
into the acute and chronic forms. This general arrangement we shall 
adopt in the present article, although we agree with Valleix “ that it 
is impossible to say, precisely, what are the symptoms which corres- 
pond particularly to the three forms admitted by Bright, or to the 
three degrees of Christison, or to five varieties of Martin Solon, or 
rather all of the symptoms of the malady corresponding indifferently to 
these forms, to these degrees, to these varieties.” A single division 
has a real importance in pathology, like that which has been estab- 
lished by M. Rayer. This author has described an acute and a chronic 
albuminous nephritis. The first corresponds to the two first of the six 
anatomical forms admitted by M. Rayer, and the second to the four 
last.—Guide du Medicin Practicien, par F. S. P. A alleix, p. 100. 
Acute Form.—Acute desquamative nephritis is the appellation 
given to this affection by Dr. George Johnson of London. The con- 
voluted tubules which compose the cortical portion of the kidneys are 
primarily and chiefly involved in this form of the disease, although the 
Malpliighian corpuscles and the entire gland ultimately become con- bright’s disease of the kidney. 
25 
gested and somewhat enlarged. The most notable results of this in- 
flammatory congestion are: albuminous urine, retention of urea in the 
blood, and dropsical effusions. 
Symptoms of the Disease.—Rigors or chilliness, followed by febrile 
reaction; hot and dry skin, rapid and full pulse, thirst, dryness of the 
mouth aud throat; pain in the region of the kidneys, often extending 
to the groins, thighs, penis, and testicles, and tenderness of the kidneys 
on pressure ; irritation at the neck of the bladder, and sometimes at the 
extremity of the urethra, giving rise to frequent desire to urinate, 
especially during the night; scanty, red, or smoky urine; loss of appe- 
tite, nausea, and sometimes vomiting, with other symptoms of gastric 
disturbance ; dull or acute pains in the head and limbs; restlessness 
and lassitude. These phenomena are speedily succeeded by puffiness 
of the eye-lids and face, oedematous swellings of the body and limbs, 
and dropsical effusions into the serous cavities, more or less extensive. 
The pleura is exceedingly prone to become involved in the morbid 
action and to throw into its cavity undue quantities of serum, in con- 
sequence of which wre often observe distressing paroxysms of rapid and 
difficult respiration, and palpitation of the heart from the slightest 
exertion. In all forms of the complaint these paroxysms are quite apt 
to recur at regular periods—usually every evening and night, and to 
continue for several hours with distressing severity. 
Urine.—Much diminished in quantity and sometimes almost entirely 
suppressed, usually red, from admixture with blood, or cloudy and 
turbid, of a specific gravity from 1,016 to 1,025. If the urine be placed 
in a watch-glass and slowly heated by a spirit lamp to the boiling 
point, an albuminous precipitate will be discovered; or, if a few drops 
of nitric-acid be carefully added to a small quantity of urine, the 
albuminous cloud appears and is soon precipitated. When both of 
these tests develop the precipitate, we may safely count on the presence 
of albumen in the urine. 
Under the miscroscope, the urinary sediment reveals coagulated 
fibrin, “epithelial casts,’5 epithelial cells, blood globules, and fibrinous 
casts from the inflamed urinary tubes. After the disease has con- 
tinued for two or three weeks, Dr. Johnson has sometimes observed 
oil-globules in the epithelial cells and on the surface of the epithelial 
casts. These appearances do not appear to be connected with fatty 
degeneration of the kidneys, and is deemed amenable to remedial 
measures, provided the oil-globules are in small quantities compared 
with the epithelial casts. Johnson asserts that this condition is far 
more common in adults than in children. Not unfrequently uric-acid 
crystals are observed in these urinary sediments, but they do not occur 
with sufficient uniformity to be regarded as peculiar to the disease. 26 
DISEASES OF THE SANGUINOUS FUNCTION. 
The above symptoms, if promptly met with suitable remedies, may 
terminate in complete resolution and a restoration of the organs to a 
normal condition, or they may partially subside into a sub-acute inflam 
matory condition, which may eventuate in one of the chronic forms of 
the malady; or, if the acute symptoms continue to progress unchecked 
until a certain amount of urea has accumulated in the blood, chroni 
poisoning will ensue, and drowsiness, headache, general failure of 
mental and physical power, stupor, and convulsions will terminate life. 
Morbid Anatomy. If a section of the kidney be made, it will be 
found somewhat enlarged, heavier than natural, soft, congested and 
bloody. The cortical portion is infiltrated with a dark, turbid fluid, 
and the blood-vessels are distended with a still darker fluid. Other 
dark spots from ecchymoses are observed in the tissue of the gland. 
(Rokitansky.) The cortical substance is usually thickened to the 
amount of half an inch. (Rayer.) The pyramids are also involved and 
their blood-vessels are distended with dark blood. The natural dark- 
red color of the healthy organ is changed to a .still deeper hue, and is 
dotted throughout its substance with the congested and dark Mal- 
phighian bodies. The convoluted tubuli are distended with detached 
epithelial cells, and are abnormally opaque. The fascia propria and 
the mucous membrane of the calices and pelvis are thickened, and their 
vessels injected with a brownisli-red blood. 
Causes.—By far the most frequent direct cause of the affection con- 
sists in the passage through the Malphighian corpuscles and the secret- 
ing tubes of the cortex, of effete and excrementitious matters derived 
from the blood. In the present state of knowledge it is impossible to 
determine the number of diseases which are caused or are connected 
with deterioration or contamination of the blood, and which give rise 
secondarily to renal affections during the efforts of the recuperative 
forces to eliminate them through the urinary organs. It is highly 
probable, however, that many more maladies than have hitherto been 
enumerated may safely be added to the list. 
Betained effete matters from checked perspiration, whether arising 
from exposure to cold or from other causes, is a common cause of acute 
nephritis. 
A less frequent, but by no means an uncommon cause of the disease, 
may be found in the elimination from the blood of poisonous drugs 
which have been administered by old-school physicians. Nearly all 
the resinous diuretics, like Copaibse, Turpentine, and Cubebs, as well 
as most other diuretics, like Nitrate and Hydriodate of Potassse, Digi- 
talis, Apocynum-cannabinum, Petroleum, Cantharides, and the like, are 
capable of producing so much irritation in their passage through the 
secretory tubes of the kidneys, even in small quantities, as to produce 
albuminous urine. A similar effect has been observed from the elimina- bright’s disease of the kidney. 
27 
tion of Mercury, Arsenic, and other mineral substances from the' 
blood. 
The abuse of alcoholic liquors, particularly those which are adulte- , 
rated, is mentioned as a cause of the disorder. 
Long-continued inflammation of the neck of the bladder, from 
stricture, enlarged prostate, calculi, &c., occasionally tend to develop 
albuminous nephritis from sympathetic irritation. Several cases of 
this description have fallen under our own observation. 
Mechanical injuries over the renal region may superinduce this 
variety of nephritis in scrofulous, syphilitic, gouty, and other subjects 
predisposed to the complaint. 
Prognosis.—In forming an opinion respecting the probable result 
of acute albuminous nephritis, it is necessary to regard the actual con- 
dition of the patient and the nature of the exciting cause. When it 
occurs in healthy persons, and is dependent on exposure to cold, or 
humidity, or abuse of spirituous liquors, diuretics or other drugs, or the 
elimination of effete matters during the later periods of mild diseases, 
we may generally count on a favorable issue, provided suitable remedial 
measures have been promptly adopted. 
But when it appears as a sequence to malignant scarlatina, erysi- 
pelas, typhus, yellow fever, or cholera-asphyxia, and the system of the 
patient is much contaminated and reduced from previous disease, the 
prognosis must always be regarded as doubtful, and often positively 
unfavorable. 
A scrofulous, psoric or gouty diathesis, constitutional syphilis, and 
cancerous, mercurial and arsenical cachexias are always unfavorable 
concomitants in this affection. 
Chronic Forms of Bright’s Disease.—Many attempts have been 
made to group together certain phenomena, and to classify them as 
characteristic indicators of the various forms of Bright’s disease. 
Pathology, chemistry, and microscopy have all been called into re- 
quisition as aids in determining this classification, but the subject is 
still involved in much doubt and confusion. Many eminent continental 
physicians, like Frerichs and Reinhardt, regard the different forms of 
the disease as successive stages of one primary inflammatory con- 
gestion ; the first link in the chain being inflammatory congestion, the 
second inflammatory exudation, and the third absorption. English 
and American writers for the most part recognize the existence of these 
stages, but deny that they have any necessary connection with each 
other. They assert that each of these forms is often met with as an in- 
dependent malady, and without any previously existing acute disease 
either in the kidneys or elsewhere. This argument, however, loses 
its force when we reflect that acute desquamative nephritis sometimes 28 
diseases of the sanguinous function. 
runs its course with symptoms so mild as scarcely to attract attentioa 
Thus a cold, with slight febrile symptoms, high-colored urine, and 
tenderness and pain in the lumbar region may occur repeatedly with- 
out exciting a suspicion of kidney disorder; and yet these very symp- 
toms may be dependent on inflammatory congestion of the kidneys. It 
is so common a circumstance for patients to be troubled with what is 
vulgarly termed “crick in the back” during the existence of severe 
colds, that nearly all pains in this region are included under this general 
appellation, and are passed by unheeded. In this manner the first 
stage of Bright’s disease often remains undiagnosed, and the more 
chronic stage of exudation gradually and insidiously establishes itself. 
How few there are who cannot recall one or more attacks of cold, with 
febrile reaction, scanty and red urine, nausea, and pain in the loins; 
and yet one of these unheeded attacks may constitute the first stage 
of this formidable disorder. 
In several instances we have met with chronic albuminuria in in- 
dividuals who were confident that they had never suffered from any af- 
fection of the kidneys; but who, after minute examination and careful 
reflection, have been able to call to mind previous attacks similar in 
character to acute desquamative nephritis. Adopting the views of 
Frerichs and Reinhardt, we proceed to describe— 
The Second Stage of Bkight’s Disease.—Upon the supposition 
that all forms of chronic Bright’s disease have been preceded by one 
or more inflammations of the cortical substance of the kidneys, we sub- 
mit the following additional remarks: 
It is a well-established fact that many serious chronic maladies are 
but sequences, more or less remote, of previous acute inflammations. 
Thus many cases of uterine displacements, fibrinous depositions upon 
the utero-genital structure, hypertrophies of mouth and neck of the 
uterus, and chronic ovarian disorders are distinctly traceable to pre- 
vious inflammatory conditions of these tissues. These inflammations, 
either from negligence on the parts of patients, or insufficient medical 
treatment, are only partially subdued, and are allowed to subside into 
sub-acute or chronic states, and thus to remain as nuclei for the action 
of any future morbid exciting causes. One of the most common results 
of all acute inflammations is an exudation into, or upon the affected 
tissue, with a consequent thickening or hypertrophy. This may super- 
induce morbid irritations; or it may continue to exist for months or 
years almost unnoticed, when perhaps, some additional exciting cause 
will develop a new and more serious train of symptoms. 
A pneumonia may run through its course and leave the patient well, 
with the exception of one or more points of hepatization. A future ex- 
citing cause, perhaps years afterwards, may develop in the affected 
parts softening and consumption. The first inflammation sows the bright’s disease of the kidney. 
29 
seeds, and a later exciting cause germinates them into a fatal chronic 
degeneration. 
So in the nephritic disorder, a primary inflammation, hut partially 
subdued, leaves the renal tissue thickened and obstructed by an exuded 
foreign substance; and the organ is placed in a condition to become 
readily affected by any future noxious influence that may be brought to 
bear upon it. This renal infiltration may be gradually and imper- 
ceptibly absorbed, or it may remain stationary for a long period with- 
out producing any serious inconvenience, or a second acute inflam- 
mation may be re-established, or the future elimination of some dele- 
terious substance from the blood through the oppressed gland may de- 
velop one of the chronic forms of renal degeneration. The kind of de- 
generation will be determined by the nature of the exciting cause, and 
the constitutional and acquired peculiarities of each case—some con- 
stitutions favoring the development of granulations, some fatty de- 
generations, others waxy or scrofulous degenerations, &c. 
Treatment of Acute Desquamative Nephritis, or the First Stage 
of Bright's Disease. 
Aconite.—Symptoms. Chilliness, followed by general heat, rapid 
and full pulse, thirst, dry skin and tongue, nausea, vomiting, loss of 
appetite, general restlessness ; pains in the head, back, and limbs; 
pains in the loins ; sensitiveness in the renal region ; numbness in the 
small of the back, extending as far as the lower limbs ; restless and 
sleepless during the night; scanty, bright-red, hot urine without sedi- 
ment ; urine very scanty and turbid ; retention of urine, with pressure 
in the bladder, or stitches in the region of the kidneys ; enuresis, some- 
times accompanied with profuse sweat, with diarrhoea and colic; face 
red or pale, and puffy. 
Gastric and Abdominal Phenomena.—Pressure in the stomach 
and hypochondria, accompanied with paroxysms of shortness of breath, 
and even asthmatic symptoms ; nausea and inclination to vomit—espe- 
cially in the pit of the stomach ; vomiting, with nausea, thirst, general 
heat, profuse sweat, and enuresis ; inflammation of the bowels ; perito- 
nitis ; the abdomen swollen and distended as in dropsy; ascites; diar- 
rhoea, with enuresis and colic. 
Pneumonic and Pleuritic Phenomena.—Shortness of breath, es- 
pecially when sleeping, after midnight, or when rising from the recum- 
bent posture ; paroxysms of suffocation, with anxiety, and aggravation 
of all the sufferings in the evening ; asthmatic complaints ; pneumonia 
and pleuritis in their first stages, with active febrile symptoms. 
Cardiac Phenomena.—Palpitation of the heart, with great anguish 
and difficult respiration; carditis ; palpitation of the heart, with op- 
pressive aching in the cardiac region. 
Cerebral Phenomena.—Fullness and pressure in the head; head- 30 
DISEASES OF THE SANGUINOUS FUNCTION. 
aches—stinging, beating, or lancinating, or contractive, with dullness 
of the intellect, and, finally, convulsions or coma. 
All of the symptoms are worse in the evening; pains particularly 
intolerable at night, and disappear for the most part when sitting; 
many of the symptoms appear in the evening, or early in the morning; 
ailments arising from colds. 
Pathology.—Kidneys gorged with blood; congestion of the kid- 
neys ; face puffy and bloated ; abdomen distended; effusion of yellow 
serum into the abdominal cavity. 
Clinical Remarks.—At the commencement of this malady Aconite 
is often a useful remedy. Its influence upon the nervous and circula- 
tory systems, which are always more or less seriously involved, should 
induce us to examine it among our first remedies. Nor is it alone use- 
ful against the febrile reaction of the first days of the disorder; but it 
possesses strong homoeopathic relations w7ith pneumonic, pleuritic, car- 
diac, gastro-intestinal, cerebral, and rheumatic complications. It does 
not, indeed, deserve a place as a direct specific in any form of the 
disease; but, as a modifier and controller of many troublesome acces- 
sory symptoms of a febrile character, it will be held in high estimation. 
Among the symptoms which pertain to this form of the malady is a 
persistent dryness of the skin. There are but few7 remedies more ho- 
moeopathic to this condition than Aconite. 
Ammonium-carbonic dm.—Symptoms. Chilliness, followed by fe- 
verish symptoms, which are especially troublesome in the evening and 
during the night; w?ith nausea, pressure at the stomach and chest, 
eructations, thirst, restlessness, and sleeplessness; dull, bruised, or 
shooting pains in the region of the kidneys; pains in the loins, in- 
creased by walking; violent throbbing pain in the small of the back 
and loins, when at rest; drawing pain from the small of the back to 
the thighs ; dull pain, extending from the loins and hips to the abdo- 
men ; face red and bloated, or pale and bloated ; drowsiness in the 
daytime ; weary, disturbed, and unrefreshing sleep ; mind dull and con- 
fused ; extreme lassitude and sense of fatigue ; spasmodic twitchings 
in the arms, hands, and legs. 
Gastric Phenomena.—Nausea, pressure at the stomach and chest, 
eructations, thirst; pressure at the pit of the stomach, nausea, and 
oppression after eating ; weakness of digestion. 
Thoracic Phenomena.—Dyspnoea and palpitation of the heart 
after every exertion ; difficult breathing at night; painful oppression 
of the chest; pressure at the chest, with nausea, thirst, and feverish 
symptoms. 
Cerebral and Nervous Phenomena.—Involuntary twitchings of the 
muscles of the arms, hands, and other parts of the body; impaired bright’s disease of the kidney. 
31 
memory; dullness of intellect; convulsions (from injection into tlie 
veins). 
Urine.—Very red, turbid, and foetid ; frequent urging to urinate, 
with scanty emission, especially at night; cloudy reddish urine mixed 
with blood ; involuntary emissions of urine at night; urine mostly 
cloudy, whey-like, very ammoniacal and musty; discharge of urine 
leaving.chalky spots ; symptoms worse in the evening and in the open 
air. 
Pathology.—The morbid changes which this substance produces 
in the kidneys have not as yet been investigated. Seybert asserts 
that it operates specifically upon the capsules of the kidneys. From 
the renal pains, and the marked changes of the urine, which have been 
observed during its exhibition, it may be inferred that it also acts spe- 
cifically upon the kidneys themselves. Under its use the.body becomes 
much emaciated, and the muscles soft and flabby. 
Clinical Remarks.—This remedy is indicated after tjie febrile 
symptoms have somewhat subsided, and symptoms of uraemic blood- 
poisoning obtain. Among the symptoms which particularly point to 
Ammonia are the following : pale and bloated face ; extreme lassitude; 
mind dull and stupid ; dull pains in the loins ; frequent and scanty 
urination ; urine red and turbid, or light and cloudy; gastric disor- 
ders ; dyspnoea, oppression of the chest, and palpitation of the heart 
after exertion ; involuntary twitchings of the muscles ; convulsions; 
coma. 
Apis-mellifica.—Symptoms. (Edematous swellings of the face 
and extremities ; paleness of the face ; face red and swollen ; febrile 
symptoms, with headache, pain in the loins, gastric derangement, 
hurried and difficult respiration ; pain and soreness in the region of 
the kidneys on pressure or on stooping ; constant dull pains in both 
kidneys, with a very small secretion of red urine; short, rapid, and 
anxious breathing at night; difficult and anxious respiration ; repeated 
micturition every few minutes ; frequent and painful urging to urinate, 
with scanty discharges of urine mixed with blood ; burning in the 
urethra before and after micturition ; frequent and copious discharges 
of urine. 
Pathology.—From its marked effect upon the quantity and quality 
of the urinary secretion, and the renal pains to which it gives rise, we 
infer that it operates specifically upon the kidneys, and produces mor- 
bid alterations in them analogous to those of inflammation and conges- 
tion. At present we are not in possession of any pathological facts 
with reference to its action upon the kidneys, and must therefore con- 
tent ourselves with inferences derived from pathogenetic and therapeu- 
tical observations. 
Clinical Remarks.—We have employed this medicine with benefit 32 
DISEASES OF THE SANGUINOUS FUNCTION. 
in all forms of Bright’s kidney. In the acute variety we regard the fol* 
lowing phenomena as especially indicative of Apis : moderate febrile 
symptoms, with pains in the head, back, limbs ; thirst; restlessness ; 
nausea; short, rapid, difficult, and anxious respiration ; oedematous 
swellings of the face and extremities ; ascites ; oedema pulmonalis ; 
hydrocephalus ; frequent urination, with small, red, and turbid dis- 
charges. * 
Against albuminuria following scarlatina it is one of our most im- 
portant and frequently-indicated remedies. 
Drs. Madden, Hunger, and Barker have reported a number of cases 
of post-scarlatinal dropsies, with albuminous urine, cured with the third 
dilution. 
We have been informed by Dr. B. F. Joslin, Sr., that he has cured 
two cases of acute albuminous nephritis with Apis : one in a man 
thirty-five years of age, tvhich supervened during convalescence from a 
typhoid fqver; and the other in a girl of six or seven years of age, 
which probably originated from a cold. The treatment in both in- 
stances was commenced with pellets saturated with the tincture, fol- 
lowed by the sixth, then the twelfth, and, finally, thirtieth dilution. 
The best effects followed the use of the last-named attenuation. 
Apocynum-cannabinum.—Symptoms. Slight fever, with thirst, dry 
mouth and tongue, headache, nausea, dull pains in the region of the 
kidneys and in the legs, flatulent distention of the bowels, diarrhoea, 
restlessness, scanty urine, rapid and oppressed respiration. 
Pathology.—All admit the specific action of this drug upon the 
kidneys, but we are not in possession of any facts which enable us to 
determine the kind of morbid alteration which it produces. But, from 
the few pathogenetic symptoms which have been published, we infer 
that it gives rise to an inflammatory congestion of the secreting tubules 
of the cortex. 
Clinical Remarks.—At an early period of the malady, before the 
epithelial linings of the tubuli uriniferi have become extensively in- 
jured and detached from the basement membranes, this medicine may 
be prescribed with advantage. Its specific impression under such cir- 
cumstances, both upon the blood and upon the renal tubules, may be 
of such a character as to arrest the further progress of the disease in 
some instances. By some its influence is supposed to be purely me- 
chanical—stimulating the tubules to an augmented secretion, and thus 
relieving the system of any existing excess of serum ; but it is by no 
means improbable that future provers may experience dynamic effects 
having important homoeopathic relations to the more interior and vital 
phenomena of Bright’s disease. 
Several physicians have alluded to its efficiency in removing dropsi- 
cal effusions consequent upon acute and chronic albuminuria; and in bright’s disease of the kidney. 
33 
some instances where the renal attack is slight, and the epithelium is 
not much impaired, it will accomplish all that is claimed for it by these 
gentlemen. 
Arsenicum-album.—Symptoms. Chilliness, followed by dry heat 
of skin, thirst, headache, backache, great restlessness, violent pains 
oppression and burning in the stomach, nausea; short, rapid, and diffi- 
cult respiration ; cedema of the face and ankles ; languor; weakness; 
pain and trembling of the limbs ; anxiety; confusion of ideas ; vertigo; 
yellow, red, or livid countenance ; general feeling of malaise/ conges- 
tion of the kidneys; frequent desire to urinate ; scanty, red, dense, 
albuminous, and bloody urine ; general anasarca. 
Gastro-Intestinal Phenomena.—Nausea, retching, vomiting; severe 
pains in the stomach and pit of the stomach—burning, or pressing, or 
spasmodic, or gnawing, or tearing, worse after eating and on pressure; 
distention of the stomach ; abdomen distended; spasmodic, or cut- 
ting, or burning pains in the abdomen, with heat, thirst, and loose- 
ness of the bowels ; flatulent distention of the abdomen ; ascites ; diar- 
rhoea, with frequent and painful micturition. 
Pulmonary and Cardiac Phenomena.—Suffocative oppression and 
arrest of breathing at night, or in the evening in bed; anxious and 
oppressive shortness of breath on walking, or on making any exertion; 
shortness of breath and short hacking cough, increased by exercise 
and worse at night; palpitation of the heart, particularly at night; 
pulsations irregular, with anguish and oppression of the chest; dropsy 
of the chest, with its usual concomitant symptoms. 
Cerebral and Nervous Phenomena.—Fits of anguish, with great 
weakness and tremulousness of the body; involuntary spasmodic twitch- 
ings of various parts of the body; trembling of the limbs ; general loss 
of strength ; tetanic spasms ; epileptic convulsions ; coma. 
Urine.—Congestion of the kidneys; urine scanty, high-colored, 
dense, albuminous, depositing blood-disks and casts of uriniferous tubes 
of the kidneys, and death from tetanic spasms (Jackson, of Edin- 
burgh). Frequent painful and difficult micturition ; urinary secretion 
diminished; suppression of urine (Christison). Urine scanty,, acid, 
and high-colored; renal colic extending towards the bladder, and then 
vesical tenesmus; urine sometimes increased and sometimes dimin- 
ished ; frequent urging to urinate, compelling him to rise during the 
night; involuntary micturition, even at night during sleep ; diminished 
discharge of red urine, with burning; urine turbid, dark brown,, and 
depositing a slimy sediment. 
Pathology.—Kidneys enlarged and congested; kidneys look like 
tallow; thick, turbid, purulent urine in the pelvis of the kidneys ; in 
experiments on cats Dr. Quaglio found in the bladder greenish yellow 
urine containing a large amount of albumen, fat-globules, and debris 
VOL. II. 3 34 
DISEASES OF THE SANGUINOUS FUNCTION. 
of the epithelium of the urinary tubes; reaction neutral-urea, uric acid 
and chloride of soda notably less; kidneys double the natural size, 
greatly congested, especially the cortical portion which was brown-red, 
hard, and augmented in diameter; the cut surface exuded a red and 
viscid liquor. The Malphigliian bodies were streaked with red and 
congested; the glandules filled with blood; the tubes of Bellini filled 
with fibrinous clots, dotted with sanguineous globules. Other samples 
of urine contained cylinders of fibrine, fat-globules, and albumen; 
diminution of urates, renal capsule slightly adherent, cortical substance 
yellow and friable, fibrinous exudations and fat-globules issuing from 
the openings of the canaliculi, their epithelium altered and filled with 
fat. In another case, the kidneys were enlarged, slightly hardened, 
but with a smooth and glossy surface ; many tubes of the Malphigliian 
pyramids filled with fibrin. In another case, the urine in the bladder 
was clear and yellow, containing fat-globules; crystals of uric acid and 
oxalates and the debris of epithelium of Bellini’s tubes. In the kid- 
neys, whose capsules were easily detached, there was the same fatty 
degeneration of the epithelium ; other tubes were deprived of their 
epithelium; the greater part of the canaliculi were enlarged in such a 
manner as to form granulations upon the surface of the kidneys.” {Ex- 
periments of Dr. Quaglio, on cats, with Arsenite of Potasses, see 
North Am. Horn. Jour., No. XXVII., p. 660.) 
Clinical Remarks.—Arsenicum appears to correspond in a remark- 
able manner to several stages of Bright’s disease. Its pathogenetic 
and pathological phenomena probably bear a closer resemblance to 
the symptoms and morbid appearances of Bright’s kidney, than those 
of any other medicine. In its action upon the convoluted tubes of the 
cortex, it actually gives rise to inflammatory congestion, a detachment 
of epithelium, depositions of fatty and oily matter in the epithelial cells 
of the convoluted tubes of the cortex, it actually gives rise to inflam- 
matory congestion, a detachment of epithelium, depositions of fatty and 
oily matter in the epithelial cells of the convoluted tubes, and to so 
much derangement of function as to lead to a retention in the blood of 
urea, uric-acid, and other proper salts of urine, and to the escape of 
albumen from the blood, through the Malphighian bodies into the 
urinary tubes and bladder 
There is likewise an equally remarkable analogy between many of 
the secondary and constitutional symptoms of Bright’s disease and 
those of Arsenicum. Both superinduce general anasarca, ascites, hy- 
drothorax. Both produce inflammation of the pericardium, and of the 
structures of the heart, with their accompanying disturbances. Both 
cause general emaciation, pallor of the skin, and a gradual diminution 
of vital force. Both induce inflammation of the meninges of the brain, 
effusions of serum into the ventricles, spasms, convulsions, coma. bright’s disease of the kidney. 
35 
In view of this intimate homoeopathic relation between this drug and 
acute Bright’s kidney, we have prescribed it in several instances, after 
the employment of Aconite, and usually with marked success. We 
have used the third, sixth, twelfth, and thirtieth dilutions, and have wit- 
nessed prompt and unequivocally good results from all of them. And 
when we remember how extensively the minute capillary apparatus of 
the renal structures are implicated in the acute form of the malady, 
and how essential it is that the atoms of the remedy should bear 
directly upon these infinitesimally small vessels, we shall not wonder 
that minute atoms penetrate farther, and operate more beneficially 
than crude atoms of the same medicine. 
Asparagus-officinalis.—Symptoms.—Moderate febrile reaction, 
with a sense of fatigue and somnolence, especially at about three o’clock, 
p. m.; general increase of heat with slightly accelerated pulse; rapid 
and irregular pulsations of the heart especially on exercising; slight 
pains in the kidneys during the afternoon; pains in the kidneys just 
under the false ribs; frequent and painful micturition ; urine scanty, 
brown and without sediment; frequent desire to urinate ; haematuria; 
urine limpid and exhaling an odor sui-generis / yawning and somno- 
lency; symptoms worse from motion. 
Pathology.—We are not aware that any observations have ever 
been reported touching the morbid alterations of the kidneys induced 
by this medicine. From the pathogenesis, it may be inferred that its 
action upon the convoluted tubes is only slight and transient. 
Clinical Remarks.—This remedy may sometimes be indicated, after 
the more acute symptoms have been subdued by Aconite, Mercurius, 
Kali, Arsenicum, and other potent remedies. When the urine is still 
scanty, and slightly dark, and the patient is restless and hot in the af- 
ternoon and evening, with lassitude, somnolence, and slight pains in 
the renal region on moving about, a few doses of the third dilution will 
be likely to prove beneficial. 
Cannabis-indica.—In the cerebral complications which so often ac- 
company this malady, whether in the form of occular illusions, wander- 
ing, or partial delirium, mental obtuseness, or exhilaration, spasmodic 
twitchings, or actual convulsions, this is one of our most important re- 
medies. I have recently witnessed a most excellent cure of an ap- 
parently almost hopeless case of uraemic convulsions (post scarlatinal) 
with this remedy. Under the persistent use of the remedy at the first 
dilution, for four days, the convulsions gradually ceased, the urine be- 
came abundant and natural in color—having lost all the traces of al- 
bumen, blood-globules, and other abnormal appearances. 
We regard Cannabis-indica as the most valuable of all other me- 
dicines in the convulsions consequent on this disease. 
Copaiv^e-balsamum.—Symptoms.—Chilliness in the forenoon, fol- 36 
DISEASES OF THE SANGUINOUS FUNCTION. 
lowed by febrile symptoms in the afternoon; dull and sometimes spas* 
modic pains in the lumbar region; gastric derangement; nausea,vomit- 
ing, bitter taste, burning pain in the stomach, colic, diarrhoea; difficult 
respiration and palpitation of the heart on making any exertion; diur- 
nal somnolence; vertigo; dull pain in the head; spasmodic attacks in 
various parts of the body; pale and sickly appearance; frequent desire 
to urinate ; urine scanty and passed drop by drop ; retention of urine; 
burning pain on urinating; foaming urine; balsamic or violet odor to 
the urine; general languor and uneasiness; involuntary trembling, 
and moving the extremities, head and trunk. 
Pathology.—Albumen has occasionally been detected in the urines 
of patients who have been under the influence of Balsam-copaivse for 
a considerable period. And, simultaneously with this appearance of 
albumen, there has usually been a diminution of the proper salts of the 
urine. From these circumstances it is reasonable to suppose that the 
medicine operates specifically upon the epithelial cells of the tubuli 
uriniferi, and, perhaps, the Malphighian bodies, producing in them a 
kind of inflammatory congestion. 
Clinical Remarks.—It would seem to be homoeopathic to those 
cases of post-scarlatinal dropsies occurring after an imperfect develop- 
ment, or an abrupt repulsion of the rash. Its well-known action upon 
the skin in developing an eruption similar in appearance to that of 
scarlatina, affords an additional circumstance in its favor as a remedy 
in these cases. 
Cannabis-satiya.—Symptoms.—Chills, fever, violent thirst; drink- 
ing causes tremor, shaking, coldness of the hands, knees, and feet, and 
distortion of the face; diurnal somnolence ; disturbed nocturnal sleep; 
dull, lancinating pains—slow and intermitting—in the left side of the 
back, under the last rib ; pulling pain in the renal region, extending to 
the inguinal glands, with sensation of malaise at the pit of the stomach ; 
obtuseness of mind; impaired memory; confusion of ideas ; pain and 
congested feeling in the head ; great weariness and weakness; nausea, 
vomiting; pains and spasmodic pressure in the stomach ; tetanic spasms 
of the upper limb and trunk; frequent desire to urinate, wflth tenesmus, 
sometimes accompanied with burning pains; urine red and turbid; 
urine filamentous, as if mixed with pus; painful and scanty discharge 
of bloody urine. 
Pathology.—Pus in the left kidney, not far below the pelvis. 
Clinical Remarks.—Cannabis will often be found useful in cases, 
which have been preceded by irritation of the neck of the bladder, ir- 
ritable bladder, strictures, &c. It is highly probable that the secreting 
tubes of the kidneys occasionally become inflamed and congested in 
consequence of long-continued and severe irritation in the bladder; and bright’s disease or the kidney. 
37 
it is in such cases that Cannabis, Cantharides, Apis, and the like, will 
be likely to cover the totality of the symptoms. 
Our experience with this class of remedies, in the malady under con- 
sideration, is in favor of the third dilution and upwards. 
Cantiiaris-vesicatorum.—Symptoms.—Chilliness, followed by fever, 
with headache, pains in the back and limbs, thirst, dryness of the mouth, 
anxiety, frequent pulse, scanty and red urine; face red, animated, hot, 
and burning; face and neck swollen, and eyes prominent; face pale or 
yellowish, thin and sickly; lips peeled, tongue denuded of epithelium, 
soft palate, of a deep-brown color; lips, tongue, and pharynx covered 
with vesicles; ptyalism; delirium; loss of consciousness; great forget- 
fulness; dozing, semi-stupid mood, indifference to surrounding objects ; 
headache, vertigo, sensation of weight in the head, sensation of numb- 
ness and pressure in the head; tearing, lancinating, and burning pains 
in different parts of the head; dull, pressive, lancinating, or burning 
pains in the kidneys, sometimes extending to the abdomen and thighs, 
and accompanied with urethra and hypogastrium; inflammation of the 
kidneys ; nephritis and hsematuria; general dropsy; anasarca; anasarca 
and ascites; attacks of convulsions ; frequent convulsive movements ; 
intense headache and chills, convulsions and coma ; convulsive move- 
ments, cold sweat, agony, and death; frightful convulsions and death 
at the end of two days, (the post-mortem revealed deep ulcerations 
of the stomach, intestines, kidneys and bladder); gastric derangement, 
nausea, vomiting, pains of a burning, contractive, pressing, or lancinat- 
ing character in the stomach ; flatulent distention of the stomach and 
boAvels; acute, burning pains in the umbilical region; colic, followed 
by diarrhoea; violent diarrhoea, with persistent burning pain at the 
anus; laborious respiration; accelerated and difficult respiration; 
spasmodic cough; palpitation of the heart; frequent desire to urinate, 
with vesical pain ; strangury ; urine bloody and passing off drop by 
drop; urine scanty and dark ; urine very red and covered with a black 
pellicle; urine bloody, small in quantity, and vesical tenesmus; sup- 
pression of urine ; retention of urine, with great desire to urinate ; re- 
tention of urine in cholera; hsematuria; general weakness; heat and 
sense of excoriation in all the cavities of the body. 
Pathology.—Redness of the medullary substance of the kidneys; 
redness of the pelvis of the kidneys and of the ureters; ulceration of 
the kidneys; suppuration of the kidneys; kidneys red and inflamed; 
vivid redness of the medullary substance. 
Clinical Remarks.—Like Cannabis, this remedy is especially ap- 
propriate in nephritic affections which have been preceded, or which 
are accompanied by cystic or urethral inflammation. We have already 
observed, that Bright’s disease is not unfrequently preceded and ac- 
companied by strictures of the urethra, irritable bladder, and irritation 38 
DISEASES OF THE SANGUINOUS FUNCTION. 
of the neck of the bladder; and that these maladies occasionally operate 
as exciting causes of the former affection. As a general rule, Aconite 
may precede this medicine with advantage to subdue the more acute 
symptoms; after which Cantharis may often be consulted with benefit. 
By referring to the above pathogenesis, it will be observed that it pos- 
sesses many phenomena pertaining to each form of albuminuria. Renal 
pains, scanty and high-colored urine, frequent micturition, and general 
excitement of the vascular and nervous systems, indicate its applica- 
bility in acute nephritis; while paleness and puffiness of the face, 
anasarca, dropsical effusions, dozing, semi-stupid mood, short and diffi- 
cult respiration, palpitation of the heart, gastro-intestinal derangements, 
great debility and lassitude, spasmodic twitchings, convulsions, and 
coma point to it as a remedy in many groups pertaining to the chronic 
forms of the disease. 
We were formerly in the habit of employing the first or second dilu- 
tion in water in these cases, but an enlarged experience has demon- 
strated the superiority of the more attenuated preparations of the drug. 
Digitalis-purpukea.—Symptoms.—Febrile symptoms slight; fever- 
ish shiverings, alternating with transient flushes of heat, accelerated 
pulse, and moderate tendency to perspiration; anasarca; general 
dropsy; general paleness of the skin; pale face; swelling of the 
cheeks and lips; general weakness; swelling of the feet in the day 
time, going off at night. 
Renal Phenomena.—Bruised pain in the region of the kidneys when 
stooping or moving about; tearing pains and sharp stitches in the 
small of the back during motion. 
Gastro-intestinal Phenomena: white coat upon the tongue; 
ptyalism; nausea; vomiting; burning, or lancinating, or pressing, or 
spasmodic pains in the stomach; great sense of weakness in the 
stomach; contractive, or pressing, or cutting, or pinching, or cramp- 
like pains in the abdomen; light-colored diarrhoeic stools; ascites. 
Cardiac Phenomena: pulse frequent, (primary effect), and abnor- 
mally slow and weak, (second effect); organic affection of the heart 
(principally of the left side) especially hypertrophy, with or without 
enlargement of the left ventricle ; dropsy of the pericardium; ascites 
a$id anasarca, with organic affections of the heart, after scarlet fever. 
Asthmatic respiration and palpitation of the heart, especially when 
walking. 
Cerebral Phenomena: dullness of the head; difficulty in concentrat- 
ing the mind; vertigo and trembling; pressing, burning, or lancinating 
pains in the vertex and forehead; drowsiness; lethargy; uneasy, unre- 
freshing sleep; sleep disturbed by frequent desire to urinate; general 
dullness of mind and inertia; spasms; violent convulsions: convulsive bright’s disease of the kidney. 
39 
motions and involuntary twitchings of the cheeks, and of the fingers 
and thumbs. 
TJrine: continual desire to urinate, only a little at a time, of a dark 
brown color, and hot and burning on passing; frequent desire to 
urinate during the night; excessive emission of urine day and night 
with great exhaustion; enuresis succeeded by retention of urine; sleep 
disturbed from frequent desire to urinate. 
Clinical Remarks.—Supposed to act best upon blondes with soft 
and lax muscles, or upon scrofulous subjects, or upon persons of 
phlegmatic or sanguine temperaments. This medicine operates speci- 
fically not only upon the kidneys, but also upon the circulation, redu- 
cing the frequency and force of the pulse, and thus diminishing undue 
febrile action. It is, therefore, often appropriate at the outset of acute 
Bright’s disease, either alone, or in alternation with Aconite. 
Rilliet and Barthez commend it highly in Bright’s disease of children. 
These gentlemen report twro cures of the chronic variety, in boys of 
eight and nine years of age. {Maladies des Infans, vol. 2, p. 51.) 
“ They both took Digitalis for several days consecutively, with evident 
action both on the pulse and urine. The pulse considerably diminished 
in frequency, the urine became at the same time more copious, the 
anasarca disappeared, and the urine lost all traces of albumen.” 
These gentlemen advise the persistent use of the vapor bath in con- 
junction with the internal use of Digitalis. Our knowledge respecting 
its pathogenesis and pathology is as yet quite limited and imperfect, 
yet its action upon the urinary glands is so prompt and specific as to 
render it worthy of attention in all cases of Bright’s kidney. 
Kali-nitricum.— Symptoms: Violent chilliness, with trembling of 
the whole body; coldness in the afternoon or evening, with pain in the 
vertex; shuddering in the evening, followed by heat and sweat, with- 
out thirst; heat and sweat over the whole body; chilliness, heat and 
sweat in alternation ; inflammatory conditions, with full, hard, and quick 
pulse.—Drowsiness ; dull, heavy, pressing pains in the head; pulse re- 
duced to sixty per minute ; gastric and intestinal disturbances; foetid 
breath ; thirst, without appetite ; eructations, nausea, heartburn, vomit- 
ing ; pain and pressure of the stomach; spasms of the stomach ; burn- 
ing, heaviness, fullness, faintness at the stomach; distention, fullness, 
and cutting or drawing pains in the abdomen; diarrhoea; difficult and 
oppressed breathing on ascending a stairs; violent palpitation of the 
heart, in the night, when lying on the back, or on the right side, or 
when moving about quickly; pain in the small of the back, in any posi- 
tion, continuing the whole day and night, or in the morning on waking, 
or in the evening, or during the night—of a bruised, or pressing, or 
crampy, or burning character; spasmodic, painless jerkings of the 
fingers, hands, and other parts of the body; sudden swelling of the 40 
DISEASES OF THE SANGUINOUS FUNCTION. 
body, neck, and thighs ; convulsions ; symptoms worse at night in bed; 
diminished secretion of urine; frequent desire to urinate, which con- 
tinues through the night; increase of urine, with reddish deposits, or 
with a mucous sediment; frequent emission of a pale, turbid urine; 
urine of a specific gravity of 1030 to 1040; salts of the urine greatly 
increased. 
Pathology.—During its rapid passage through the tubuli uriniferi, 
it must of necessity stimulate them more or less, and eventually super- 
induce an inflammation, and probably an exudation into the renal 
tissue. 
Clinical Remarks.—Our attention was first called to this medicine 
as a remedy in Bright’s kidney, by Dr. Warner, of Buffalo. This 
gentleman, and his partner, have been in the habit of employing it in 
suitable cases, for many years, and with highly satisfactory results. If 
we mistake not, these gentlemen have cured several well-marked cases 
of granulated kidney with the medium attenuation of this drug. 
We record our experience of its decided utility in both the acute 
and chronic forms of the malady, when there are: distressing paroxysms 
of difficult and rapid respiration, occurring during the evening and 
night, and diminishing towards morning, considerable gastric derange- 
ment, spasmodic pains at the pit of the stomach, short, hacking cough 
during the night, persistent, dull, bruised pains in the renal region. In 
such groups, we have often observed prompt and decided improvement 
from the use of the thirtieth attenuation. 
Kali-hydriodicum.—Symptoms: Chilliness, with drowsiness, com- 
mencing at the lower part of the back, and extending upwards and 
through the body; chilliness, with dryness of the mouth and thirst, in 
the evening; flushes of heat, with dullness of the head and malaise 
in the body; heat, followed by sweat in the afternoon; frequent attacks 
of dullness and heaviness of the head; general feeling of malaise / 
oedema of the eye-lids; face pale and swollen; dyspnoea; dry, hacking 
cough, with oppressed breathing; pleuritis; burning pain in the pit of 
the stomach; restless and confused sleep ; bruised pains in the small 
of the back, particularly troublesome at night; violent pain in the small 
of the back constantly; darting pains in the small of the back when 
sitting; nightly urination; blood-red urine ; painful urging to urinate; 
discharge of mucus from the urethra. 
Pathology.—From the fact that this drug, when taken internally, is 
rapidly eliminated through the kidneys, it may be inferred that it is 
capable of producing more or less irritation and congestion of the 
tubuli uriniferi. We know that it causes enlargement of the sub- 
maxillary glands, and infiltration of the surrounding cellular tissue, and 
it is not at all improbable that similar effects are produced upon the 
kidneys. bright’s disease of the kidney. 
41 
Clinical Remarks.—We have found this remedy most frequently in- 
dicated towards the termination of the acute stage of the malady, after 
the inflammatory congestion of'the renal tubes had in a great measure 
subsided, leaving the parts more or less thickened and infiltrated with 
lymph or fibrinous matters. If the case has been preceded or accom- 
panied by rheumatism or gout, the indications for its employment will, 
for the most part, be still stronger. When the renal affection is de- 
pendent upon a scrofulous diathesis, or upon the presence in the system 
of Mercury, or of syphilitic contamination, this medicine is a remedy 
of much value. Like Carbonate of Ammonia, it possesses the property 
of preventing coagulation of blood, albumen, fibrin, and milk, and of re- 
dissolving them when coagulated. 
Mercurius-sublimatiis-corrosivus. — Symptoms. Febrile symp- 
toms not strongly pronounced; irregular febrile reaction; feeling of 
heat and anxiety, which prevents sleep at night; frequent, small, quick, 
feeble, tremulous pulse ; slow, nervous, febrile conditions, with profuse 
sweats and great debility; chilliness and colic pains on motion ; swell- 
ing and redness of the face ; coated tongue, fetid breath, ptyalism; 
nausea, vomiting, violent, tearing, or burning, or pressing, or gnawing, 
or darting pains in the stomach ; diarrhoeic stools ; pains in the head, 
back, and limbs ; shortness of breath, oppression of the chest, rapid 
and difficult breathing, excessive dyspnoea, palpitation of the heart; 
headache, drowsiness, and anxiety; general condition of anasarca, ana- 
sarca of the face and limbs, face red and swollen; periodical convul- 
sive movements of the facial muscles, arms, and feet, constant trembling 
and spasms of the limbs, convulsions, general insensibility; scanty red 
urine, which is passed with difficulty; suppression of urine ; urine red, 
scanty, and albuminous ; increased secretion of light and albuminous 
urine. 
Pathology.—Kidneys enlarged and congested ; cortical portion of 
the kidneys much thickened and of a deep-red color. 
Clinical Remarks.—Twenty years ago Martin Solon advised the 
employment of Mercury, both internally and externally, as a remedy 
in Bright’s disease. Since the publication of Solon’s work on Albu- 
minarie, there has been a great diversity of opinion with regard to the 
value of mercurial preparations, some opposing their use on the ground 
that they are capable of exciting inflammation of the kidneys de novo, 
and of giving rise to albuminous urine, thus rendering them injurious 
in cases where the organ is already suffering from inflammation; while 
others, like Wood,# commend them in all forms of the disease, except 
fatty degenerations and scrofulous or cachectic complications. 
Guided by an unerring therapeutical law the homoeopathist is not 
* “ Prac. Med.,” Yol. II., p. 584. 42 
DISEASES OF THE SANGUINOUS FUNCTION. 
subjected to the conflicting opinions and practices of the empirical 
schools. The very reasons which cause doubt and confusion in the 
minds of our opponents, viz., the direct local action of Mercury upon 
the renal glands, the production of albuminous urine, and other phe- 
nomena of Bright’s disease, determine the homoeopathist in his selection 
of it as the remedy. In the doses employed by the allopathist, it is 
not surprising that a drug having such decided homoeopathic relations 
with this malady, should be productive of harm rather than benefit. 
As large and crude doses of Belladonna or Opium wrould do injury in 
acute cerebral inflammations, so must large and crude doses of Mercury 
aggravate seriously acute renal affections. But in the attenuated doses 
of homoeopathy, the results are most happy—the delicate impressions 
produced not unfrequently arresting the progress of this grave dis- 
order. In addition to the specific influence which several of the mer- 
curial preparations exert upon the kidneys, we may take into account 
their attenuating effects upon the blood and their power of promoting 
absorption of plastic exudations into the parenchyma of the organ. 
We have found it most frequently applicable in that form of the com- 
plaint, termed large white kidneys, (stage of inflammatory exudation), 
and prescribed in attenuations ranging from the third to the twelfth. 
Mercurius-iodatus.—Symptoms.—Shuddering succeeded by slight 
febrile reaction—hot and dry skin, dull pains in the head and back, 
restlessness, dryness of the mouth, thirst, morbid excitability of the 
nervous system, fetid breath, putrid or coppery taste, general anasar- 
cous condition of the entire body, glandular enlargements about the 
neck, paroxysms of rapid and difficult respiration, and pleuritic pains in 
the chest, bilious or dysenteric discharges from the bowels, scanty, red 
and hot urine; urine scanty and loaded with solid constituents, dull 
pain in the region of the kidneys. 
Pathology.—In the absence of any definite facts with regard to the 
morbid alterations produced by this substance in the kidneys, we can 
only infer that changes are induced similar to those referable to the 
action of Mercurius-sublimatus-corrosivus. Both Iodine and Mercury 
administered separately, operate specifically upon the entire glandular 
system, superinducing inflammation, congestion and plastic exudations, 
and there is no reason to suppose that wrhen in a state of chemical 
union, these peculiar properties are destroyed. 
Clinical Remarks.—Unfortunately there has not yet appeared a 
respectable proving of this valuable medicine. Even the few patho- 
genetic phenomena which we have recorded have been derived from 
observations during its administration in other maladies. But ah usu 
in morbis, we infer that it is one of our most valuable remedies in 
several forms of the disease under consideration. Especially in those 
forms which appear to be connected with scrofula, and constitutional bright’s disease of the kidney. 
43 
syphilis, it must always hold a high rank as a remedy. When the af- 
fection is complicated Avith hypertrophies, or hepatic disorders, it is 
also strongly indicated.—The lower attenuations of this medicine have 
proved most efficient in our practice. 
Mercurius-solubilis.—Symptoms.—Nightly febrile paroxysms; in 
the evening and night, chilliness, followed by heat of skin, restlessness, 
frequent emissions of urine, and involuntary jerking, twitching, and 
tossing of the head and limbs, during sleep ; chilliness and heat alter- 
nating, especially in the face, back, chest and arms ; febrile symptoms 
with profuse perspiration; chilliness, followed by heat, and violent 
thirst; febrile paroxysms, cnaracterized by a predominance of chilly 
sensations, sweats, and general feeling of malaise j drowsiness in the 
day-time and sleeplessness at night; general weakness, languor, and 
lassitude; puffiness of the face; dropsical swellings of the feet and 
legs; ascites; fetid breath; tongue coated with a white fur and some- 
what swollen; nausea, increased by eating; bitter vomiting; great 
sensitiveness and painfulness at the pit of the stomach, particularly to 
the touch; shortness of breath and dyspnoea, especially on ascending 
a stairs or in walking; stitching or burning pains in the chest; bruised, 
or cramp-like, or stitching pain in the small of the back ; visible twitch- 
ings of the fingers and hands; frequent desire to urinate, with scanty 
discharge; frequent desire to urinate during the night; scanty, fiery- 
red urine; urine dark-red or brown; urine turbid, even while leaving 
the urethra, and depositing a sediment; floculent discharges at the end 
of urination; symptoms worse during the night. 
Pathology.—We are not aware that any examples are recorded il- 
lustrative of the morbid changes superinduced in the kidneys by this 
mercurial preparation; but from its pathogenetic and therapeutical 
action upon the system, it would seem to resemble the other prepara- 
tions of Mercury in producing renal disorders. 
Clinical Remarks.—It has been found most useful in cases of 
Bright’s kidney, which have been accompanied with secondary sy- 
philis, diarrhoea, and dysentery. 
Terebinthina.—Symptoms.—Rigors, succeeded by feverish heat 
throughout the whole body, pulse hard and frequent, headache, red face, 
pain in the back, thirst, and sensation of dryness of the mucous mem- 
brane; dropsy; anasarca; ascites; general languor and loss of strength; 
drowsiness ; confusion of ideas, relieved by copious and rapid micturi- 
tion ; dyspnoea; difficult and laborious respiration, as if from congestion 
of the lungs; aching pain in the left kidney; pressure in the kidneys 
when sitting, going off during motion; sensation of heaviness and pain 
in the region of the kidneys; pain and feeling of increased warmth in 
the kidneys ; fleeting drawing in the right kidney, and thence proceed- 
ing to the right hip; violent burning, drawing pains in the region of 44 
DISEASES OF THE SANGUINOUS FUNCTION. 
the kidneys; urine scanty,red, and sometimes bloody; scanty and red, 
or clear and profuse urine; complete suppression of urine; the urine 
deposits a thick, muddy, light-yellow sediment, like wine, and has the 
smell of violets ; the urine deposits a slimy sediment twelve hours after 
micturition ; hsematuria; profuse menstruation; albuminous urine. 
Pathology.—Inflammation and congestion of the cortical portion 
of the kidneys; kidneys somewhat enlarged, softened, and of a dark- 
red color, (on animals). 
Clinical Remarks.—Professor Henderson has cured several cases 
of both acute and chronic albuminuria with this medicine. Several 
medical gentlemen of our acquaintance are in the habit of using it as 
their principal remedy in the acute form of the disease, and commend 
it in the highest terms. 
We have found the second dilution of this remedy of eminent service 
in many cases of both acute and chronic albuminuria. It will be ob- 
served that we have designated the second dilution. A large experience 
in this malady, with almost every strength of the medicine, has con- 
vinced us, that the best results can be obtained from this dilution. 
We regard Terebinthina as one of the very best remedies in Bright’s 
disease. 
Second Stage of Bright's Disease. Inflammatory Exudation. (Frerichs.) Large 
White Kidney. 
3. CHRONIC DESQUAMATIVE NEPHRITIS. (Johnson) 
This form of the disease not unfrequently exists for many months 
without attracting any special attention, and without any apparent renal 
symptoms. We have known cases to advance within a few days of a 
fatal termination with no abnormal phenomena except slight pallor of 
the skin, lassitude, and the occasional occurrence of dyspeptic symp- 
toms. 
In allusion to the insidious manner in which it sometimes becomes 
fully established, Dr. Johnson remarks as follows :* “A reference to 
case No. 13, will show that a patient may go to bed apparently in good 
health, and wdthout having experienced any symptoms which had led 
him to suspect that his kidneys were unsound. In the night he is 
seized with symptoms of suppression of urine, and of severe abdominal 
inflammation. After an illness of a few hours he dies, and his kidneys 
ire found to be so far disorganized by a disease, evidently of a chronic 
nature, that the wonder is, not that they ceased to act when they did, 
but that they had continued to discharge their functions so long. 
“Again, in case No. 14, there was precisely the same disorganization 
of the kidneys as in the instance just alluded to. The patient was 
*“ Diseases of the Kidney,” pages 170 and 171. bkigiit’s disease or the kidney. 
45 
seized, after a slight indisposition, with palsy of one side, followed by 
complete insensibility, which soon ended in death. There was no ap- 
pearance in the brain which would explain the symptoms, hut the kid- 
neys were in precisely the same state of chronic disease as those in the 
case just alluded to. The bladder was empty; no urine had been 
passed for several hours before death; and the patient’s friends had 
often noticed that his urine was scanty, but he had appeared to be in 
tolerable health, and his medical attendant was not consulted before 
the last fatal attack.” 
These slight ailments may continue for an indefinite period—usually 
from twro to eight months, when shortness of breath is observed after 
ascending a stairs, or other exertion, either accompanied or soon suc- 
ceeded by the following symptoms : pale and waxen appearance of the 
skin; considerable emaciation; oedematous condition of the face, limbs 
and often of the entire body ; usually some tenderness in the region of 
the kidneys on pressure, though this symptom is sometimes {always 
according to Becquerel) absent; dull aching pains in the lumbar re- 
gion are occasionally, but by no means generally, present; frequent 
desire to pass water, especially during the night; gastric, intestinal, 
cardiac, and pulmonary disorders are quite prone to obtain; rapid 
and difficult respiration on making the slightest exertion, and often 
very distressing paroxysmal attacks occurring every evening and 
night, lasting from ten to fifteen hours, and rendering it impossible to 
retain a recumbent position for an instant during a paroxysm; de- 
bility ; nausea; occasional vomiting; urine variable in quantity, color, 
and chemical and microscopical characters (See below) ; drowsiness ; 
obtuseness of the mental faculties ; convulsions; coma and death. 
During the course of the disorder, a great variety of symptoms, not 
strictly pertaining to the malady, are often observed. Among these 
we have noticed, burning heat in the head, particularly on the vertex, 
relieved by copious applications of Bay-rum, Cologne, &c.; a peculiar 
white appearance upon the tongue, mostly on the sides and under part, 
looking as if it had been par-boiled,—sometimes accompanied with 
burning, smarting, and soreness of the furred part, appearing and dis- 
appearing, and generally accompanied with an amelioration of the other 
symptoms during its continuance, and for a short period after its dis- 
appearance ; putrid, sickening odor of the breath; pulse sometimes 
frequent, weak and irregular (in cardiac complications), and at other 
times normal in frequency and volume; spasmodic twitchings of the 
muscles of different parts of the body, usually worse at night; severe 
paroxysms of pain at the pit of the stomach, apparently of a spasmodic 
character. Johnson alludes to the frequent occurrence of nose-bleed- 
ing and menorrhagia, and believes them to be in some way connected 
with the renal affection. 46 
DISEASES OF THE SANGUINOUS FUNCTION. 
Becquerel asserts that the disease has usually the following three 
inodes of commencement: 
a. Chills, fever, vomiting, lumhar pains, pulmonary congestion, cough, 
rales, dyspnoea. 
b. Fever and infiltration, "which shows itself in all parts of the body 
at once. This mode of attack he considers most frequent. 
c. The disease advances stealthily, and would remain unknown even 
though mortal, without an examination of the urine. 
Alterations of the Urine.—In quantity it is variable—usually more 
abundant than in health, but sometimes less. In color it is mostly 
light, or colorless, varying from a smoky water-color to a dirty brown 
hue. It very rarely contains blood-globules, but when it does the urine 
assumes the color of dirty broth. Its density is less than that of the 
acute form, although greater than that of normal urine. The specific 
gravity varies from 1005 to 1015. It has an acid reaction, and the 
usual tests precipitate albumen. 
By the microscope we may detect epithelial cells, amorphous granu- 
lar fragments, granular epithelial cylinders (the fall of the epithelial 
sheaths of the tubuli), termed by Dr. Johnson “granular casts,” and in 
a very few instances, blood-globules. These blood-globules, according 
to Johnson, become more unfrequent the farther the disease advances 
from the acute stage, until in the third stage (small contracted kidneys) 
they are never to be found. Robin asserts that epithelial cylinders 
are occasionally found in normal urine, so that these appearances alone 
would not determine the existence of Bright’s Kidney. Becquerel 
supposes that the quantity of albumen in these urines varies from nfo? 
tn —Li!— 
tU 1 U 0 U« 
Prominent Concomitant, or Secondary Phenomena. Dropsy.—• 
As soon as the normal epithelium of the convoluted tubes has become 
so far degenerated and disintegrated as to he incapable of separating 
from the blood urea, uric-acid, and the other normal solids of the urine, 
they accumulate in undue quantities in the blood, and nature strives to 
eliminate them through other channels—the skin, the serous-mem- 
branes, the intestines, the lungs, the liver, and all other available out- 
lets. During these vicarious processes of elimination, the capillaries 
of the tissues acted on, become obstructed, and their circulation im- 
peded in such a manner as to permit exudations of serum through their 
walls, and thus dropsical effusions in various parts of the body. At 
the same time the congested Malphigliian bodies allow the escape of 
undue quantities of serum, thus causing disalbumination of the blood 
from the normal standard of 70 or -riHhr to 10 and even ttmTo. It is 
evident then that two morbid conditions constitute the most direct 
causes of dropsical effusions,—by retention of excrementitious urinary 
constituents and disalbuminution of the blood. Further on we shall bright’s disease of the kidney. 
47 
again allude to this subject. Dropsy is not invariably present in this 
form of the disease, especially when the renal secretion is abundant, 
or when there are frequent and copious discharges from the bowels, by 
which the poisonous blood accumulations may be evacuated. In other 
instances the constitution appears to possess the power to resist for a 
long time the deleterious action of the retained urinary constituents, 
without the supervention of dropsy or other troublesome symptoms. 
But in general, nature asserts her rights, and opens every available 
channel in order to expel the noxious matters from the vital fluid, even 
at the risk of irritating, and of producing serous effusions from these 
new and unused tissues of elimination. The water appears to accumu- 
late in one or another place without apparent cause. Perhaps it is 
earlier and oftener observed in the face than elsewhere; and in pa- 
tients of active habits we generally find infiltration of the limbs and 
ascites. Effusion into the cavity of the chest is an early and rather 
frequent result of this disease ; but we very rarely meet with ventricu- 
lar dropsy. 
The composition of the infiltrated water is the same as that of the 
serum of the blood diluted with much water. Of one thousand parts, 
the solid constituents constitute only from ten to fifteen parts, instead 
of eighty to one thousand, as in the serum, and forty to fifty to one 
thousand, as in affections of the heart. 
In health, the proportion of albumen in the blood is from seventy or 
eighty to one thousand parts. In acute desquamative nephritis, the 
proportion is reduced below -nHfo, at which point infiltration must occur. 
In the chronic forms this disalbuminution must be still greater, to 
give rise to dropsy. 
These dropsical accumulations sometimes become so extensive as to 
cause very serious inconvenience, and not unfrequently danger to life. 
Pleural, ventricular and peritoneal effusions are the most dangerous. 
Infiltrations of the extremities and of the scrotum often become very 
extensive and troublesome ; but they may be readily and safely relieved 
by delicate scarifications. We have often adopted this mode of tempo- 
rary alleviation, and always with success and safety. 
Respiratory Apparatus.—Among the vicarious channels for the 
elimination of the excrementitious renal accumulations in the blood are 
the pulmonary structures. In the act of elimination the capillaries of 
the pleura, the pericardium and of the cellular structure of the lungs 
often become engorged, and effusions more or less extensive occur. 
Some of the first symptoms, therefore, which arrest the attention of 
both patient and physician, are shortness of breath, increased to a 
painful extent from the slightest exertion, and a sense of oppression 
throughout the entire thoracic region. In the first instance there is 
only pulmonary oedema with effusion into the air-cells of the lungs ; but 48 
DISEASES OF THE SANGUINOUS FUNCTION. 
in more advanced stages of the disorder, large and dangerous acomun- 
lations occur in the thoracic cavity. In robust and plethoric indi- 
viduals, pneumonias and bronchial affections are likely to be superin- 
duced. In scrofulous subjects hemoptysis and tubercular consumption 
are not unfrequently developed. 
We have already alluded to the periodical recurrence of evening and 
nightly paroxysms of dyspnoea. This symptom has been observed in 
both the second and third stages of the malady. It usually commences 
in the afternoon and evening, and continues with such severity as to 
prevent the patient from taking a moment’s rest in the recumbent pos- 
ture, until some time in the morning, when there is generally a remission 
for a few hours. 
During the existence of this stage, if the patient takes cold, or is 
subjected to the influence of a cold and humid atmosphere, pleurisy or 
pericarditis may occur; although these attacks are far more common 
in the stage of absorption. 
Albumen has often been detected in the urines of children suffering 
from membranous croup. The rationale of this phenomena has not 
yet been fully explained. 
Digestive Apparatus.—Another channel for the elimination of the 
retained urinary excrements, is the gastro-intestinal mucous mem- 
brane. The influence exerted upon the stomach is two-fold; firs 
in the form of irritation of the gastric mucous membrane, anc 
consequent symptoms of indigestion, like nausea, occasional vomit 
ing, eructations, acidity, flatulent distention, heart-burn, oppression 
gastric sensitiveness, &c., and secondly upon the nervous apparatus of 
the stomach, producing a train of severe neuralgic symptoms. The 
stomach sometimes becomes so seriously involved that the mucous 
membrane becomes thickened, softened, and in rare instances, ulcerated 
to a considerable extent. Severe paroxysms of neuralgic pains—usu- 
ally at the pit of the stomach, are not an unfrequent attendant upon 
the malady. We have known cases run through the entire second and 
third stages to a fatal issue, with scarcely a pain or other unpleasant 
symptom, except those which have been referred to the stomach—some- 
times by both patient and physician. 
The action of the urea, ammonia, &c., upon the intestinal mucous 
membrane produces flatulency, sensitiveness of the bowels, and diarrhoea, 
and post-mortem examinations now and then reveal redness, ulcerations( 
and softening of portions of this structure. 
Bernard detected ammonia in large quantities in the stomachs and 
intestines of dogs whose kidneys had been extirpated. This ammonia 
is supposed to arise from the conversion of urea, either in the blood- 
vessels or in the digestive canal, from contact with the secretions it 
here meets with. height's disease of the kidney. 
49 
Brain and Nervous System.—Drowsiness, convulsions, and coma 
usually terminate the life of the patient. These symptoms approach 
gradually and increase in intensity for a period varying from a few 
hours to several days, when convulsions or complete coma extinguish 
life. 
In two instances we have noticed the frequent occurrence of involun- 
tary spasmodic twitchings in various parts of the body. These attacks 
are somewhat painful, mostly confined to special parts, hut sometimes 
affecting several portions of the system at once. 
As a general rule, cerebral lesions are not found in these cases, not- 
withstanding the very grave character of this complication. The direct 
cause of these cerebral phenomena is uraemic, or according to Frerichs, 
ammoniacal contact with the cerebral tissues, or serous effusion into 
the ventricles. 
The immediate effect of uraemic or ammoniacal poisoning upon the 
cerebral and nervous tissues, is to impair their vitality and to depress 
their ordinary manifestations. This is evident from the insidious ap- 
proach and progress of the symptoms; general indifference to sur- 
rounding objects; somnolence; slowness of speech; the patient is with 
difficulty roused to a full appreciation of what is transpiring around 
him, and seems to fall asleep in the midst of a conversation, with his 
eyes open; deep and slow respiration; temporary confusion of ideas ; 
sluggish performance of all the functions. 
Cardiac Complications.—At an early period, Dr. Bright observed 
that an intimate connection existed between granular kidney and heart- 
disease. He supposed that the cardiac affections were for the most 
part due either to the stimulant action of the poisoned blood upon the 
heart itself, or upon the capillary circulation, affecting it in such a 
manner “ as to render greater action necessary to force the blood 
through the distant subdivisions of the vascular system.” Johnson, 
Rees, and other eminent English writers adopt the latter explanation. 
Hypertrophy and dilatation are the most common organic changes 
of the heart super-induced, or connected with chronic desquamative 
nephritis. And from the circumstance that valvular lesions are quite 
uncommon in these cases, it has been inferred that the abnormal blood 
constituents in their continual passage through the heart have stimu- 
lated its muscular structure into hypertrophy or dilatation. 
When the renal malady exists in gouty or rheumatic we 
shall sometimes find valvular lesions, fibrous depositions, and other 
serious organic changes which had been produced by these maladies 
before the existence of the kidney-disorder. Such instances render 
cases still more complicated and dangerous, both from the local and 
remote symptoms to which they give rise. It is highly probable that 
the kidneys and the heart often become affected simultaneously, and 
You U.—4. 50 
DISEASES OF THE BANGUINOUS FUNCTION. 
from the same cause, in individuals suffering from gout. The action 
of the excessive quantity of uric acid, the urates, &c., in their constant 
passage through the heart, producing organic changes in this organ, 
and during their elimination through the kidneys, congestion of the 
tubuli uriniferi. In examples of this kind, both organs are affected 
with equal promptness and severity, and they should both receive 
prompt and efficient attention from the physician. 
Hepatic and Spleenic Complications.—These organs sometimes 
become involved during the existence of renal disease. For reasons 
similar to those which obtain in the production of pulmonary, gastric, 
cerebral and cardiac affections, the liver, and in all probability, the 
spleen take on morbid actions of various kinds, according to the con- 
stitutional, or acquired peculiarities of patients. Examinations of the 
alvine discharges during the progress of albuminuria, always indicate 
more or less disorder of the hepatic secretion. And if the same at- 
tention were to be given to the minute changes caused by the retained 
urinary excrements upon the liver and its secretion as has been be- 
stowed upon the kidneys and the urine, tve have no doubt that much 
additional light would be thrown upon the intimate nature of the 
malady; and that many morbid conditions which are at present in- 
explicable could be satisfactorily explained. In the act of circulation 
the blood-poison is constantly brought into contact with almost all parts 
of the organism, and operates simultaneously upon those organs and 
tissues with which it has affinities—as for example, the kidneys, the 
skin, the liver, the lungs, the digestive apparatus, the serous membranes, 
&c. The results of these impressions are derangements of function or 
organic lesions, according to the amount of retained foreign matters in 
the blood, the nature and importance of the tissues involved, and the 
constitutional peculiarities of patients. And as a disordered function 
of one organ is often compensated for by extra and vicarious labors of 
other organs, a mutual morbid reaction is established between various 
tissues of the body for the general good. Each structure strives to ex- 
pel the noxious invader, each shares the general danger, and each re- 
ceives more or less injury. Johnson asserts that the liver is affected 
in a large proportion of cases of chronic nephritis, and assigns as a 
reason the frequent common origin of the two diseases, viz., high living 
and intemperance in the use of alcoholic liquors. This gentleman re- 
gards cirrhosis as the most common hepatic complication in these cases, 
although he has occasionally met with contraction and induration of 
the liver, with its usual concomitant ascites. 
Rheumatic and Gouty Complications.—The frequent occurrence 
of chronic nephritis in gouty subjects has been noticed by many writers. 
Upon the supposition that the renal affection was always associated 
with, and dependent upon a gouty diathesis, Dr. Todd gave to the third k right’s disease of the kidney. 
51 
stage of the malady the designation of Gouty Kidney. This hypothe- 
sis of Dr. Todd is doubtless erroneous ; but it is nevertheless true that 
the same abnormal blood constituents which produce the phenomena 
of gout, are also capable, under favorable circumstances, of developing 
desquamative renal disease. But as this is only one of many cases 
possessing similar powers, the designation of Dr. Todd is manifestly 
inappropriate. The renal affection is by far the most common in those 
cases of gout which appear to be associated with chronic eruptive dis- 
ease, especially porrigo and eczema. The skin and the kidneys are 
the two chief eliminators of the morbid blood-constituents, in both gout 
and rheumatism ; and it is for this reason that we so often find cuta- 
neous and renal complications in old cases of this description. The 
passage of the urates, uric acid, &c., through the cutaneous capillaries 
obstructs and retards their action, rendering them incapable of throw- 
ing oft' the effete matters presented to them, and thus causing the ac- 
cumulating matters to force their way out of the blood, in the form of 
vesicular or pustular eruptions. In passing through the kidneys the 
same substances often cause chronic nephritis. When brought in 
contact with the smaller joints they give rise to gout. Less frequently 
the renal affection has been associated with chronic rheumatism, and 
for the same reasons as those just adduced with reference to gout. 
TJtei'ine Complications.—Of eleven cases of chronic albuminuria in 
females which have come under my observation, all but one had sup- 
pression of the menses during the continuance of the disease. This 
exceptional one had frequent and exhausting attacks of menorrhagia, 
wdiich contributed much to hasten a fatal result. Johnson, while al- 
luding to the general absence of the menses in these cases, has observed 
menorrhagia in so many instances as to deem the circumstance worthy 
of special mention. Not unfrequently a sudden check to menstruation 
is the first link in the morbid chain of symptoms, which lead to al- 
buminuria; and it is not impossible that a vicarious menstruation 
through the kidneys may in some instances develop in them the malady 
in question. Rayer suggests that the constant drain from the blood of 
its haematosin, induces such a condition of anaemia as to arrest men 
struation from pure lack of vitality necessary to sustain this function. 
Alterations of the Blood.—In estimating ‘the composition of the 
blood in albuminuria, regard must be had, firstly, to the primary causes 
of the blood-contamination, and, secondly to their effects upon the kidneys, 
and the further alterations of the blood from renal obstruction. If the 
original blood-poison be one of a transient nature and easy of elimination, 
the issue will probably be favorable; but if the primary cause is of a 
chronic character, persistent, deep-seated, readily reproduced, and diffi- 
cult of removal, our opinion respecting the final result must be unfavorable. 
In the first category may be included retained perspiration, scarlatinal, 52 
DISEASES OF THE SANGUINOUS FUNCTION. 
erysipelatous, typhoid, choleraic, alcoholic, and other similar agencies; 
while in the latter class we may place chronic gout and rheumatism, 
certain chronic cutaneous affections, constitutional syphilis, scrofula, 
incurable hepatic, cardiac, and pulmonary disorders, deleterious 
drugs, &c. 
Healthy blood may be said to consist of three separate elements, 
viz : 1, the red globules, suspended in their-colorless liquor; 2, jibi'ine; 
3, serum, composed of albumen dissolved in alkaline water. Besides 
these principal elements it contains phosphates of magnesia, ammonia, 
and lime, lactates of soda and magnesia, and common salt. The analy- 
sis of Dumas of 1000 parts of healthy blood gives 790 of water, 127 of 
globules, 3 of fibrine, and 80 of solid constituents of the serum, of 
which 8 are inorganic. Any material alteration of these normal con- 
stituents induces more or less derangement of the general health ; and 
the presence of either of these elements in the urine is a sure indication 
of serious renal lesion. So any addition to the blood of substances 
foreign to it, must of necessity give rise to more or less disturbance, 
according to the nature of the contaminating agent. The most pro- 
minent alterations of the blood in chronic Bright’s disease are, defi- 
ciency of albumen in the serum, wdiich is usually of low density, great 
diminution of the red globules, and the retention of certain urinary ex- 
crements—urea, uric acid, and the several retained salts of the urine 
Andral and Gavarret made five analyses of the blood in many different 
cases of the disease, and with the following average result: of 1000 
parts of blood, they found a considerable increase of water (837*1 in 
place of 790; nearly the natural quantity of fibrine (2*7 in place of 3); 
a marked diminution of the red globules (91*8 in place of 127) ; a not- 
able diminution of the solid matters of the serum, and especially of 
albumen (68*4 in place of 80). 
Until a recent date it has been supposed that most of the secondary 
morbid phenomena incident to this affection, wTere due to the presence 
of urea in the blood, and to the action of this substance upon the 
various tissues of the organism. From this hypothesis the malady has 
received the designation of uraemia. But the experiments of Frerichs 
have placed this matter in a new light. This gentleman denies that 
the blood-poisoning is due to urea, but attributes it to carbonate of 
ammonia, which has been formed from this substance within the blood- 
vessels. He infers this from the following circumstances: ammoniacal 
odor of the breath; chemical indications of ammonia in the breath; 
traces of ammonia in the alvine discharges, and in several secretion* 
of the body—the perspiration, bile, and certain mucous and serous se- 
cretions ; and an abnormal quantity in the blood, (of which it is n 
natural constituent, and serving to retain it in a fluid state). 
As an additional confirmation of this view Frericks adduces the fact beight’s disease of t'.e kidney. 
53 
that large quantities of urea are sometimes detected in the blood of 
patients who remain free from all cerebral, and other symptoms, Avhich 
are supposed to be peculiar to uraemic poisoning. Injections of urea 
into the blood-vessels of dogs have also been made without producing 
its supposed characteristic effects upon the organism; while similar in- 
jections of carbonate of ammonia have speedily induced convulsions. 
Another circumstance confirmatory of this opinion of Frerichs, may be 
found in the fact that the pathogenesis of carbonate of ammonia cor- 
responds very closely with the phenomena of Bright’s Disease. The 
following symptoms from “ Jahr’s” Symptomen-“ codex,” page 67, de- 
monstrate this: “dropsical swellings; the head feels muddled, dull, 
stupefied; great difficulty of breathing, especially in ascending a few 
steps, or on making the least exertion ; frequent palpitation of the 
heart; severe dyspeptic symptoms ; great emaciation of the whole 
body; comatose conditions; convulsions.” Both urea and carbonate 
of ammonia are normal constituents of healthy blood, the latter in all 
probability being converted from the former by the action of tjie albu- 
men of the serum within the blood-vessels, and so long as the proper 
proportions are maintained, no disturbances or derangements of function 
occur; but Avhen urea in excess pervades the blood, it is rapidly con- 
verted into carbonate of ammonia, the blood becomes poisoned, and the 
Secondary effects of chronic nephritis due to the action of carbonate 
of ammonia, manifest themselves. When we remember with what 
facility urea may be converted into carbonate of ammonia by contact 
with fermentescible substances like albumen, mucus, and certain al- 
kalies, and that several of these substances are always present in the 
blood of patients suffering from albuminuria, the hypothesis of Frerichs 
will not appear unreasonable. So long as the normal composition of 
the blood remains unchanged, only the necessary quantity of ammonia 
to retain it in a fluid state, is converted from the circulating urea; but 
when this condition becomes changed, and new elements are added to 
the blood, other affinities occur, new chemical action takes place, in- 
ordinate quantities of ammonia are formed, and ammoniacal poisoning 
results. 
Schetlein and Renling object to this hypothesis, because that am- 
monia (CO2 Az H3) is expired during the course of many diseases, 
typhoid fevers, yellow fever, cholera-asphyxia, malignant erysipelas, 
small-pox, scarlet-fever, and similar maladies, and also in the death 
agony. In these instances the ammoniacal breath is caused by an 
actual loss of vitality and consequent decomposition of the blood, by 
which the ammonia which holds it in solution, is set free and allowed 
to escape through the lungs. In chronic nephritis quite a different 
condition obtains, since there is no actual decomposition of the blood, 
and no diminution of the normal amount of ammonia; but a constant 54 
DISEASES OF THE SANGUINOUS FUNCTION. 
excess of this substance derived from the retention and conversion of 
urea. Nature strives to eliminate this superfluous agent through the 
lungs, the intestinal canal, the skin, and perhaps other channels. It 
is doubtless true that urea also exerts a deleterious influence upon the 
system when existing in excess in the blood; but its toxical properties 
are much less important than those of ammonia. Other retained 
urinary substances are likewise capable of poisoning the blood. Gallois 
has repeatedly demonstrated this fact with regard to an excess of uric 
acid in the blood. This agent poisons in a less dose when injected 
into the blood than when taken by the stomach. It causes acceleration 
of breathing, trembling of the limbs, jerking of the muscles, subsultus, 
convulsions, tetanus and death. 
Pathological Condition of the Kidneys.— The following is an 
excellent general description of the condition of the kidneys in this 
form of the disorder. “ The kidney is still much larger and 
heavier than is natural, and smooth on its surface; but the 
sanguine congestion is diminished, or gone; while the inflammatory 
exudation into and among the proper tissues of the glands is great and 
manifest. This exudation, by its presence and its pressure within and 
around the tubules, empties the capillary vessels of their blood, and 
keeps them empty. The cortical portion of the kidney, still unduly 
broad, loses its red color, becomes pale or yellowish, and contrasts 
more strongly with the red lines of the pyramidal bodies. Gradually 
the matters exuded suffer further change, and sometimes undergo a 
fatty degeneration. The tubules lose their uniform cylindrical shape, 
and bulge a little here and there; their epithelial cells enlarge, become 
opaque, contain granular matter, and perhaps oil-globules ; finally, they 
crumble down, and are partly washed away with the aqueous portion 
of the urine which proceeds from the Malphigliian bodies.”* The kid- 
neys are generally enlarged, slightly deformed, and a little augmented 
in consistence. Granulations on red or grayish ground of the size of 
millet-seeds, accumulated or isolated, and appearing wdiiter than the 
rest of the tissues—more abundant at the two extremities, and towards 
the outside of both kidneys. The cortex thickens at the expense of 
the tubular substance. 
Authors have differed so much respecting the classifications of the 
various forms of the disease, that some confusion exists in their symp- 
tomatic and pathological description. Thus, Dr. Bright recognizes 
three forms or varieties: Martin Solon admits five degrees or varieties: 
M. Ilayer makes a general division of the malady into, acute and 
chronic albuminous nephritis, and then subdivides these into six other 
forms—two pertaining to the acute, and four to the chronic stage of 
* “Watson’s Practice of Phys.,” p. 1028. bkight’s disease of the kidney. 
55 
the disorder: Christison admits only three degrees of the disease, the 
two first characterized by similar anatomical conditions of the kidneys, 
viz., a deposit in the cortical substance of a grayish yellow matter, 
slightly granulated in the first degree, and decidedly so in the second 
degree, the granular substance resembling cheese, and involving chiefly 
the cortical substance. He usually found more sanguineous congestion 
in the first, than in the second degree. In the third or last degree, the 
morbid deposit gradually invades the remaining tissue of the kidneys, 
impairing to a greater or less extent their normal structure and 
functions. By this it will be perceived that Christison recognizes only 
one kind of morbid change for all of his three degrees, the differences 
consisting in the extent rather than the hind of morbid action. Bright 
denies the existence of any morbid deposit in the first form: but as- 
serts that the cortical substance is transformed into a granular tissue 
in the second foi'm. In this second form he always found the kidneys 
still larger than natural, and that he could render the granulations 
more distinct by maceration. The third, fourth, and fifth forms of Mr. 
Bayer, and the second and third degrees of Martin Solon, cor- 
respond with sufficient accuracy for practical purposes, to the second 
stages of the English writers. In all instances, the volume and weight 
of the kidneys are above the normal standard, the red and marbled 
spots peculiar to the acute form, have diminished or entirely disap- 
peared, granular deposits are found in the cortical substance, and some- 
times in the tubular cones, more or less thickening of the mucous 
membrane of the pelves and calices of the kidneys, the external sur- 
face of the kidneys is ordinarily of a pale yellow color, but is now and 
then dotted with milk-white spots, and glossy, or, in a very few cases, 
with a few brown or slate-colored spots. One of the most direct and 
important effects of the disease upon the renal glands, is the partial 
or total destruction of the epithelial lining of the convoluted tubes. 
During the earlier periods of the affection, the cells are not ordinarily 
detached in very large quantities, and as these are washed off rapidly 
by the watery portion of the urine from the Malphighian bodies, the 
renal function is only moderately disturbed. But after the desquama- 
tive process has continued for a considerable period, a greater or less 
accumulation of epithelial cells takes place in the tubes, and they be- 
come so much choked up and obstructed as to prevent their reformation. 
In the mean time they become disintegrated, the tubes are distended, 
pressure is made against the remaining epithelial linings of the tubes 
and the Malphighian bodies, thus adding an additional cause of irritation 
to the renal structures. 
“A microscopic examination shows that some of the tubes become 
so completely filled by their epithelial contents, that a further formation 
of cells within them is impossible for want of room, so that the re- 56 
DISEASES OF THE SANGUINOUS FUNCTION. 
production of epithelium appears to be entirely arrested.”* After this 
process of desquamation and disintegration have continued for some 
time, “the basement membrane of the tube is thus left quite denuded, 
or with only a few broken particles of epithelium scattered over its sur- 
face”! Dr. Johnson describes another process by which the tubes 
become destroyed without any actual desquamation of epithelium. 
This process is denominated disintegration of the epithelial cells. In 
the process of desquamation the cells are thrown off from the basement 
membrane into the convoluted tubes, entire, and are either washed out 
of the tubes by the watery part of the urine, or accumulate within them 
to their injury. “Disintegration may occur, however, either in tlm 
cells which have accumulated in the tubes after being shed in an 
entire form by a process of desquamation,” or in those still attached to 
the tubes. 
“With reference to the two processes, already alluded to,” remarks 
Dr. Johnson, “by wdiich the epithelium becomes disintegrated, I have 
observed that only the true desquamative process leaves the tubes 
quite denuded, and that the disintegration of the epithelium, unaccom- 
panied by desquamation, destroys the tubes without a previous denuding 
process.” Apparently the most common “result of the destruction 
of the epithelium, is the gradual wasting of the tube.” “The 
materials which are occasionally found in the degeneration of the tubes 
are, first an unorganized fibrinous or albuminous material; second, oil; 
and third, serum.”! Johnson supposes that this fibrinous or albuminous 
material is secreted by the basement membrane after the destruction 
of its epithelial cells.” 
After the convoluted tubes have become denuded by the destruction 
of their epithelium, they occasionally become dilated into transparent 
cysts, containing serum, and sometimes thick and discolored liquids. 
In other and rare instances, some of the denuded tubes become lined 
with transparent nucleated cells, which are supposed by Johnson, to 
serve as a substitute for the normal epithelium, and whose office is “to 
secrete a serous or watery liquid.” Respecting the condition of 
the blood-vessels, they become distended wTith blood of a vitiated 
quality, their linings become irritated and thickened, and their entire 
structures become so enfeebled as to impair or suspend their normal 
functions. In allusion to this subject Johnson remarks: §“the ap- 
pearances which I have observed in the blood-vessels are such as in- 
dicate an impediment to the circulation through the inter-tubular capil- 
laries, and a consequent increase of pressure upon the vessels which, 
in the order of the circulation, lie behind these. The Malphighian 
* Diseases of the Kidney,” by Geo. Johnson, p. 212. f Loc. cit. J Johnson. 
Diseases of Kidneys, p. 228. bright’s disease of the kidney. 
57 
capillaries and the arteries have their coats remarkably thickened; 
while the walls of the inter-tubular capillaries and of the emulgent vein 
present no appearance of hypertrophy or thickening.” 
“We consider the nature of Bright’s disease* to consist in an in- 
flammatory process, which proceeds from a stage of hypersemia to one 
of stasis, and then gives rise to a product, which is not only remarkable 
by its peculiar character, but which, in well-marked cases, by its ex- 
cessive accumulation, causes a singular alteration in the appearance 
and structure of the kidney. It commonly runs, as we have already 
stated, a chronic course, with occasional exacerbations, but it is some- 
times acute.” 
The following are among the pathological degenerations observed 
■with the microscope by Kolliker in Bright’s disease, f “ The membrana 
propria is frequently thickened to OOOl, or even 0002 of a line, when 
it often presents, on the inner aspect, very delicate, closely approxi- 
mated, transverse striae. The epithelial cells, particularly in the cortical 
substance, frequently contain oil-drops in considerable quantity, so as 
often to present a deceptive resemblance to the cell of a bitty liver, 
and at the same time they are usually enlarged to a diameter of 002 
of a line. Together writh the oil, pigment granules (of the coloring 
matter of urine?) occur in them (also in the straight canals), whereas 
the concretions of uric acid and calcareous salts, which are so frequently 
met with in the canals of the tubes in the vertebrata, have not as yet 
been demonstrated with certainty in the cells themselves. Colloid- 
like, bright yellow masses are very frequent in the epithelial cells, 
which then most usually increase in size, dilate into slender cysts as 
much as 005—0'072 of a line long, and finally, by bursting, empty 
themselves of the colloid substance, whence the latter is found free 
in the uriniferous ducts, and also in the urine.” 
“ The Malphighian bodies may also expand into cysts, in which, to- 
gether with a clear fluid, the atrophied glomerulus is often visible on 
the wall.” 
“The tubuli uriniferi contain fibrine, in cylindrical masses, corres- 
ponding to the cavities of the tubules, and also the above-mentioned 
colloid-like substance / concretions in the ducts of Bellini, consisting, 
in the adult, chiefly of carbonate and phosphate of lime: in new-born 
infants, of uric-acid salts, which give the pyramids a brilliant golden- 
yellow color, and, if not exclusively, still only occur in children who 
have already respired (between the third and twentieth day after 
birth).” 
Diagnosis and Prognosis.—The principal phenomena which pertain 
to chronic albuminuria are the following: urine pale and watery, some- 
* Ilokitanski’s Path. Anat., Vol I. p. 155. f Diseases of the Kidneys, p. 228. 58 
DISEASES OF THE SANGUINOCS FUNCTION. 
times slightly turbid, or smoky—usually augmented in quantity—of 
a diminished specific gravity—of an insipid odor resembling beef- 
broth—persistently frothy on agitation—albuminous—deficient in urea 
and the normal salts, and containing “granular casts,” scattered portions 
of disintegrated epithelium, and a few entire epithelial cells; oedema 
of the feet and ankles, afterwards extending to the legs and thighs, and 
often general infiltration of the cellular tissue, and effusions into the 
serous cavities; unusual paleness of the skin, in consequence of the 
poverty of red-globules in the blood; excess of urea, carbonate of am- 
monia, and urinary salts, and a diminution of albumen and red-globules 
in the blood; and in a majority of cases dyspeptic symptoms, dryness 
of the skin, and habitual dyspnoea, especially on making any exertion. 
From acute albuminuria it may be distinguished by the lighter color 
of the urine, its greater quantity, its lower specific gravity, the pre- 
sence of granular casts, and scattered bits of disintegrated epithelium, 
absence of blood-globules, less renal irritation and pain, less febrile 
disturbance, and the less rapid progress of the malady. From hepatic, 
cardiac, and other forms of dropsy, as well as from other maladies 
having similar symptoms, it may be recognized by the presence of 
albumen, and disintegrated epithelium in the urine. 
The prospects of recovery will depend upon the duration and extent 
of the renal affection, the secondary complications to which it has given 
rise, and the curability or removal of the acting cause. If the con- 
voluted tubes have entirely lost their epithelial lining, and other 
formations have taken their place, like cysts or morbid deposits; or if 
the tubuli often having been denuded of epithelium, have shrunken and 
become nearly obliterated, a cure must not be expected. This con- 
dition will be indicated by the gradual diminution in the urine, of 
epithelium, the continued absence of urea and the normal urinary salts, 
the persistent diminution in the density and lightness of color of the 
urine, paleness of the skin, great emaciation, dropsical infiltrations and 
effusions, and other secondary ailments. A sudden diminution of the 
urinary secretion, especially in advanced stages of the disease, indicates 
immediate danger. The most common and dangerous of these se- 
condary affections are inflammations of the serous membranes of the 
thorax, abdomen, and brain, or effusions into their cavities. Of these, 
the cerebral complication is the most alarming, and the one which most 
frequently terminates life. Next in importance to this are effusions 
into the pleural and peri-cardial cavities, from whence proceed the 
distressing paroxysms of dyspnoea and palpitation of the heart which 
so often afflict the subjects of this malady. When one or more of these 
serious complications are present, and the abnormal conditions of the 
urine above alluded to obtain, the prognosis will be unfavorable. 
But when the exciting cause, is susceptible of ready removal, like bright’s disease of the kidney. 
59 
abuse of alcoholic liquors, and exposure to a cold and humid atmosphere, 
and the renal desquamation has not been of long-standing or extensive, 
a reasonable expectation of cure may be entertained. 
Yalleix in his “ Guide, du Medecin Practicien” p. 154, presents us 
with the following diagnostic table. 
Ciironio Bright’s Disease. 
Urine pale, smoky, and having an 
insipid odor. 
Its density is diminished; and it has 
lost most of its salts and urea. 
Albumen in considerable quantity, and 
always present. 
(Edema almost always commences in 
the lower limbs ; and ascites comes after- 
wards. 
Other slight symptoms of Bright’s dis- 
ease. 
Acute or Chronic Bright’s Disease. 
No fever (chronic form) or slight fever 
(acute form.) 
Dropsy. 
Never Suppuration, 
Pain in the kidneys wanting or slight. 
No painful retraction of the testicles, 
nor pains in the grandes levres, &c. 
Albuminous Urine of Bright’s 
Disease. 
No purulent globides. 
Urates and phosphates in less quantity 
than natural. 
Other symptoms of Bright’s disease. 
No pellicle (cremor) on the surface. 
Other Chronic Affections which 
produce Dropsies. 
Urine of a normal colony and preserv- 
ing a urinous odor. 
Density normal; salts and urea normal. 
Albumen in small quantity ; and only 
appearing transiently. 
In diseases of the liver, ascites precedes 
oedema. 
Characteristic symptoms of diseases of 
the heart, liver, &c. 
Simple Acute or Chronic Nephritis, 
with Albuminous Urines. 
Always pretty well marJced fever. 
Aro dropsy. 
Often terminates in suppuration. 
Pain in the kidneys more or less severe. 
Painful retraction of the testicles, and 
pain in the grandes levres, &c. 
Urine rendered Albuminous bt the 
Pressure of Pus. 
Purulent globules, distinguishable by 
the microscope. 
Salts often more abundant than in the 
normal state. 
Symptoms of inflammation of the 
urinary passage. 
Pellicle (cremor) on the surface, after 
a few hours repose. 
Treatment.—Aconitum-napelles.—Symptoms: face pale, sunken 
and bluish ; stupid expression of countenance ; skin of a deep yellow, or 
white color; heat and dryness of the skin ; coldness of the extremities ; 
sleepless and restless at night; sudden sinking of strength; paroxysms 
of suffocation with anxiety, and aggravation of the difficulty in the 
evening; respiration short, imperfect, irregular, with feeble pulsations 
of the heart; shortness of breath* especially when sleeping, after mid- 60 
DISEASES OF THE SANGUINOUS FUNCTION. 
night, or when rising from the recumbent posture; pressure in the 
stomach and hypochondria accompanied with paroxysms of shortness 
of breath, and even asthmatic symptoms; pleuritic, pneumonic, and 
cardiac complications; nausea, vomiting, thirst, general heat, profuse 
sweats, and enuresis; peritonitis; ascites; pains in the loins; sensi- 
tiveness in the region of the kidneys; numbness in the small of the 
back, extending as far as the lower limbs; drowsiness; he sleeps while 
sitting in his chair with his head bent forward ; dyspnoea, convulsions, 
paralytic weakness and death; general convulsions; convulsive move- 
ments of separate parts, the cheeks, extremities, &c.; stupor with con- 
vulsive motions of the facial muscles, and the eyes closed; loss of con- 
sciousness during the convulsions; copious discharge of urine, which 
deposits a red sediment after standing; retention of urine; enuresis, 
sometimes accompanied with profuse sweat, diarrhoea, and colic. 
Pathology.—See page 29 of this volume. 
Clinical Remarks.—When the renal affections become complicated 
with disease of the serous membranes, like pleuritis, peritonitis, and 
arachnitis, Aconite will prove an important remedy. So likewise, in 
hepatic, pneumonic, enteritic, and other inflammatory complications, it 
must always be regarded as one of our most valuable medicines. In 
such cases it must be looked upon in the light of an auxiliary rather 
than as a direct local specific. The S3unptoms are usually worse in 
the evening and early in the morning. 
Ammonium-carbonicum.—Symptoms: face pale and bloated; pale- 
ness of the face with physical and moral weakness; muscles soft and 
flabby; impaired memory; mind dull and confused; drowsiness in the 
day time; uneasy, disturbed and unrefreshing sleep at night; extreme 
lassitude and sense of fatigue ; weakness of digestion; pressure at the 
stomach, nausea, and oppression after eating; dyspnoea and palpitation 
of the heart after every exertion; difficult breathing at night; painful 
oppression of the chest; pain in the small of the back, increased by 
motion or walking; bruised or shooting pains in the region of the kid- 
neys ; violent throbbing pain in the small of the back and in the loins 
when at rest; drawing pain from the small of the back, extending to the 
abdomen and hips ; spasmodic twitchings of the arms ; convulsions ; fre- 
quent urging to urinate especially at night; involuntary emissions of 
urine at night; urine turbid, whey-like, and very ammoniacal and musty 
smelling; discharge of urine leaving chalk-like spots; cloudy, reddish 
urine mixed with blood; symptoms worse in the evening and in the 
open air. 
Pathology.—Lining membrane of the kidneys inflamed and thick- 
ened ; kidneys enlarged, soft, of a light-yellow color, and the convoluted 
tubes obstructed with detached epithelial cells (in animals). 
Clinical Remarks.—This medicine has proved very beneficial in bright’s disease of the kidney. 
61 
albuminous nephritis following scarlatina, typhoid fevers, malignant 
erysipelas and small-pox. In such cases we have observed unequivocal 
benefit from the employment of the lower attenuations. A reference 
to the pathogenesis above given will enable the physician to determine 
its homoeopathic relations with special groups of morbid symptoms. 
Apis-mellifica.— Symptoms: paleness of the face; oedematous 
swellings of the face, and extremities; nausea, eructations, heart-burn, 
rapid breathing at night; difficult and anxious respiration after exer- 
cise ; hurried and difficult respiration with fever and headache ; pain and 
soreness in the region of the kidneys on pressure or on stooping; con- 
stant dull pains in both kidneys, with very small secretion of red urine; 
frequent and copious discharge of urine; repeated micturition every 
few minutes; burning in the urethra before and after micturition; fre- 
quent and painful urging to urinate, with scanty discharges of urine 
mixed with blood. 
Pathology.—(.See Apis, p. 31, this Volume.) 
Clinical Remarks.—This is undoubtedly one of our most valuable 
remedies in both the first and second forms of Bright’s disease. If ad- 
ministered in doses sufficiently attenuated, it will often afford marked 
relief, and sometimes effect permanent cures. It is to be regretted that 
more careful experiments have not been made with reference to its 
special action upon the kidneys, and the morbid alterations it produces 
upon the secreting tubes and other portions of the renal tissue, as well 
as in the urine. This defect in proving, applies to most other drugs as 
well as to this one. 
Apocynum-oannabestum.— As a palliative in removing the dropsical 
accumulations consequent on this form of renal disease, this medicine 
is held in high estimation by many physicians of our school. Several 
medical men of this city are in the habit of prescribing “Hunt’s de- 
coction,” and, as they assure us, with much success. (See Apocynum- 
cannabinum, p. 32, this Volume.) 
Arsenicum-album.— Symptoms: face pale and sunken ; or lead- 
colored, or bluish, or yellow, livid and disfigured; face swollen from 
anasarca; face bloated, puffed, and red, or pale. Emaciation. General 
anasarca. Dropsy of the chest with the usual concomitants, suffocative 
oppression, and arrest of breathing, in the evening, or at night in bed; 
anxious and oppressive shortness of breath on walking, or on making 
any exertion; palpitation of the heart, particularly at night. Abdominal 
dropsy with the usual concomitants, indigestion, oppressive respiration, 
&c. Nausea, vomiting, eructations, distention and burning of the 
stomach after eating, sensation of faintness at the stomach, tremulous- 
ness of the body. Pain in the kidneys, extending towards the bladder, 
and then vesical tenesmus. Sense of fullness and congestion in the 
renal region. Turbid urine which deposits a sediment and looks like 62 
DISEASES OF THE SANGUINOUS FUNCTION. 
clay. Urine alternately increased and diminished. Thick, cloudy, 
pus-like urine. Frequent urging to urinate, especially during the 
night Involuntary micturition, even at night during sleep. Urine 
colorless, turbid, albuminous, and depositing a slimy sediment. Fre- 
quent, painful, and difficult micturition. Urinary secretion diminished 
or suppressed. Spasms. Convulsions. Coma. Symptoms worse in 
the evening, at night, and after eating. 
Pathology.— A reference to the pathology of Arsenicum will de- 
monstrate from a pathological point of view, its strong homoeopathic 
relations to this form of renal disease. Both the morbid alterations 
of the glands and of the constituents of urine, bear a most striking 
analogy of the present malady. 
Clinical Remarks.—We have already alluded to the remarkable 
liomoeopathicity of this medicine to acute Bright’s disease. It will 
be found equally appropriate in the chronic varieties of the affection. 
Indeed, when the renal disease is accompanied with dropsical effu- 
sions, or serious gastro-intestinal disorder, we regard Arsenicum and 
Apis as our two most reliable remedies, for they correspond not only 
to the local and immediate symptoms of the renal disorder, but to 
the more serious and secondary constitutional phenomena. These 
maladies act best at the medium and higher attenuations. 
Asparagus-officinalis.— Symptoms.—Drowsiness, lassitude, and 
dullness of intellect. Rapid and irregular pulsations of the heart, 
worse on exercise. Oppression of breathing, aggravated by exercise. 
Slight pains in the kidneys, felt mostly during the afternoon. Emission 
of a small quantity of pale, yellow urine, which soon becomes turbid 
and filled with a whitish dust, which settles after a few hours, leaving 
the urine clear: after the vessel has been emptied and rinsed, a fatty 
substance was observed to adhere to its walls. Urine abundant, limpid, 
and exhaling an odor sui generis. Frequent and painful micturition. 
Pathology.—See page 35, this Volume. 
Clinical Remarks.—This drug possesses but few symptoms which 
correspond to this form of the affection. In the few instances where it 
has apparently afforded some relief, it has been employed in from the 
third to the twelfth dilutions. 
Astacus-fluviatilis.—Symptoms: face and eye-lids puffed, great 
prostration of strength, and slight delirium. Drowsiness and tendency 
to stupor—internal coldness, great sensitiveness to the open air. Trem- 
bling in the right renal region. Sudden tearing pain in the right renal 
region, when sitting down. Emission of a large quantity of pale, 
yellow, and acid urine. Urine containing much albumen. Urine of 
a deep-yellow color and leaving a deposit. 
Clinical Remarks.—We have prescribed it with benefit in one case 
of chronic albuminuria, which appeared to be connected with gout and bright’s disease of the kidney. 
63 
chronic eczema. A persistent use of the sixth dilution of this remedy 
for a period of four weeks, twice daily, appeared to ameliorate all of the 
symptoms. 
Digitalis-purpurea.— Symptoms: paleness of the face; general 
paleness of the skin. Anasarca. Emaciation of the body. Puffiness 
of the cheeks and lips. Dull, heavy pain in the head; difficulty of 
concentrating the mind ; pressing or burning pains in the vertex or fore- 
head ; vertigo and trembling; drowsiness or lethargy; uneasy, unre- 
freshing sleep ; sleep disturbed on account of frequent desire to urinate. 
Great weakness. White fur upon the tongue; nausea, vomiting; 
ptyalism; burning, or lancinating, or pressing, or spasmodic pains in 
the stomach; sense of great weakness in the stomach. Contractive, or 
pressing, or cramp-like pains in the abdomen; ascites; diarrhoeic stools. 
Pain in the region of the kidneys as if bruised, when stooping or mov- 
ing about. Frequent desire to urinate during the night; excessive 
emission of small quantities of watery urine; frequent and copious 
emission of watery urine. General dropsy with hypertrophy of the 
heart, and other organic affections of the heart. Dropsy of the chest. 
Ascites. Ascites and anasarca with organic affections of the heart. 
Rapid and difficult respiration on exercising. Asthmatic respiration 
on walking. Pulse frequent, or slow and weak. Involuntary twitch- 
ings of the fingers, thumbs, and other muscles of the body. Spasms 
Convulsions. 
Pathology.—See Digitalis, p. 38, this Volume. 
Clinical Remarks.—It is supposed to be especially useful when 
there is a tendency to waxy or fatty degeneration of the kidney. When 
the renal disease is associated with an organic affection of the heart, it 
is often an indispensible remedy. It is supposed to operate favorably 
in patients of scrofulous dyscrasias, or in those who have been enfeebled 
by injudicious allopathic medication. 
Kali-hydriodicum.—Symptoms: face pale and swollen; oedema of 
the eye-lids. General feelings of malaise. Frequent attacks of dull- 
ness and heaviness of the head. Restless, confused sleep. Burning 
pains in the pit of the stomach. Dry hacking cough, with rapid and 
oppressive breathing. Pleuritis. Bruised pain in the small of the 
back, particularly troublesome at night. Darting pains in the small 
of the back when sitting. Painful urging to urinate. Nightly urina- 
tion. Frequent and copious emission of pale and watery urine. Dis- 
charge of mucus from the urethra. Diminution of the red globules of 
the blood. Emaciation. 
Pathology.—See page 40, this Volume. 
Clinical Reraarks.—Especially appropriate in renal disorder con- 
sequent upon chronic rheumatism, or gout, or which appears to be con- 
nected with constitutional syphilis, mercurial cachexia, or scrofula. It 64 
DISEASES OF THE SANGUINOUS FUNCTION. 
is more frequently indicated in the stage of inflammatory exudation, 
than in the acute stage. Its action upon the exudated matter is such 
as to promote its absorption, and upon the obstructed tubuli, to restore 
their impaired function. 
Kali-nitricum.—Symptoms: drowsiness; heaviness, pressure, and 
dull pains in the head. Gastric and intestinal derangements; foetid 
breath. Sudden swelling of the body, neck, and thighs. Oppressed 
breathing on ascending a stairs ; violent palpitation of the heart, and 
dyspnoea in the night, when lying on the back, or on the'right side, or 
when moving about quickly. Pain in the small of the back in any po- 
sition—constant, or in the morning on waking,'or in the evening, or 
during the night, of a bruised, or pressing, or cramp-like, or burning 
character. Spasmodic, painless jerkings of the fingers and hands. 
Pulse below the natural standard. Frequent emission of a pale, turbid 
urine; increased urine wTith reddish deposits, or with a mucous sedi- 
ment; urine of a specific gravity varying from 1030 to 1040. 
Clinical Remarks.—This is certainly a valuable remedy against 
the distressing paroxysms of oppression of the chest, and difficulty of 
breathing, which so often afflict patients suffering under granulated 
kidney. But it does more than afford relief to the dyspnoea, and other 
symptoms arising from dropsical accumulations; as several physicians 
have observed that patients have occasionally been permanently bene- 
fitted after the use of the remedy. Its best effects will be derived from 
the medium and higher attenuations. 
Mercurius-iodatus.— Symptoms: face pale, waxen, and chlorotic 
in appearance. General anasarca. Paleness of the skin; dryness of 
the skin. Irritation and ulceration of the mucous membrane of the 
air-passages. Foetid breath ; putrid or coppery taste. Paroxysms of 
rapid and difficult breathing, and pleuritic pains in the chest. Nausea; 
vomiting; eructations; bilious diarrhoea; dysenteric discharges from 
the bowels. Scrofulous degenerations of the glandular system. Morbid 
excitability of the nervous system. Dull pains in the renal region. 
Urine either increased or diminished in quantity, and of high density. 
Pathology.—See page 41, this Volume. 
Clinical Remarks.—Owing to the paucity of pathogenetic observa- 
tions, physicians have been obliged to employ this medicine more or 
less empirically. In my own practice, I have regarded its pathogene- 
sis as similar to that of the other mercurial preparations, and have pre- 
scribed it in accordance with this general resemblance. This mode is 
neither scientific nor accurate, but the good results I have observed 
from the remedy have induced me to persist in its use. That it exer- 
cises a special control over this condition of inflammatory exudation, 
modifying favorably both the morbid state of the kidneys themselves 
and of the blood, and thus ameliorating, and in some instances curing bright’s disease of the kidxey. 
65 
the totality of the symptoms, we entertain no doubt. Indeed, we be- 
lieve it to be equal, and, in some cases, superior in value to Arsenicum, 
Apis, or corrosive Mercury; and it is highly probable that future ex 
perimenters will confirm this opinion pathogenetically, pathologically 
and therapeutically. 
Mercurius-sublimatus-corrosivus.—Symptoms: pale, waxen color 
of the skin of the entire body; paleness of the face ; bluish paleness of 
the face ; puffiness of the face ; swelling of the head and face ; anasarca 
of the face and limbs. Deranged digestion: nausea; vomiting, and 
burning pains in the stomach; foetid breath. Shortness of breath ; ex- 
cessive dyspnoea; palpitation of the heart. Disposition to stupor; 
transitory soporous conditions; headache. Spasms in all the limbs. 
Urine increased in quantity, light, and albuminous; urine scanty, red, 
and albuminous; suppression of urine. 
Pathology.—Kidneys enlarged, soft, and somewhat congested. 
Clinical Remarks.—The marked specific action of this medicine 
upon the kidneys, its power in promoting absorption of exudated mat- 
ters into the renal tissues, and its influence as a modifier of the morbid 
action peculiar to this stage of Bright’s disease, render it a highly ap- 
propriate remedy. For the reasons adduced when alluding to this drug, 
we advise the employment of the medium attenuations. 
Mercurius-solubilis. — Symptoms: general paleness of the face 
and of the skin; white, clay-colored face. Puffiness of the face. Drop- 
sical swellings of the feet and legs. Drowsiness during the day, and 
sleeplessness at night. General weakness, languor, and lassitude. 
Tongue covered with a white fur, and somewhat swollen. Foetid smell 
from the mouth; nausea increased by eating; bitter vomiting; great 
pain at the pit of the stomach, worse when pressed upon. Ascites; 
shortness of breath, and dyspnoea, especially on ascending a stairs, or 
on walking. Bruised, or stitching pain in the small of the hack. 
Spasmodic twitchings of the fingers and hands. Frequent desire to 
urinate, with scanty discharges; frequent urination during the night; 
urine turbid even while leaving the urethra, and depositing a sediment; 
flocculent discharges at the end of urination. Symptoms worse during 
the night. 
Pathology.—The morbid renal alterations induced by this mercurial, 
are probably similar to those of Mercurius-sublimatus-corrosivus—en- 
largement, softening, and slight congestion. 
Clinical Remarks.—Chiefly applicable in syphilitic, hepatic and 
diarrhoeic or dysenteric complications; but quite secondary in im- 
portance to the two preparations last described. 
Mercuritts-vivus. — Symptoms: face lead-colored and bloated. 
Ptyalism, exhaustion, delirium, convulsions and death. Bad digestion; 
putrid breath; nausea; vomiting; white, apthous-like fur upon the 
Yoh. TL—5. 66 
diseases of the sanguinous function. 
tongue, extending to its undbr side. Debility, languor, pains in the 
limbs, emaciation. Dull pains in the small of the back on walking, or 
lifting any thing. 
Pathology.—Probably like Mercurius-corrosivus, it is capable of 
giving rise to enlargement, softening, and congestion of the kidneys; 
but there are not a sufficient number of facts at the present time to en- 
able us to determine its precise pathological relations with these 
glands. 
Clinical Remarks.—This medicine has been found useful in chronic 
albuminuria of children, complicated with marasmus and bowel affec- 
tions, or with constitutional syphilis. In a few eases of this kind it has 
appeared to ameliorate the morbid group with more promptness and 
certainty than the other forms of mercury. If the little patients are 
emaciated, weak, languid, without appetite, and troubled with bilious or 
dysenteric discharges, it will be certain to afford relief. 
Tekebinthina.—Symptoms: face pale and sunken. Anasarca; as- 
cites ; general dropsy. Stupefaction, and deep sleep; confused and 
languid on waking; relieved by copious and rapid micturition. In- 
creased menstruation. Dyspnoea; difficulty of breathing, with a sense 
of congestion of the- lungs. Sensation of heaviness and pain in the 
kidneys ; pain and sensation of increased warmth in the loins ; pressure 
in the kidneys when sitting, and going off during motion ; aching pains 
in the left kidney; drawing or burning pains in one or both kidneys, 
extending to the hips. Urine clear, watery, and profuse ; enuresis ; urine 
of a wine color, of the odor of violets, and depositing a thick, muddy, 
light-yellow sediment; urine depositing a slimy sediment twelve hours 
after micturition. General languor and loss of strength. 
© © 
Pathology.—See page 43, this Volume. 
Clinical Remarks.—Several distinguished homoeopathic physicians 
have commended this medicine highly in both the first and second 
stages of Bright’s kidney. We have found it most serviceable in those 
cases which appear to have been associated with chronic irritations at 
the neck of the bladder, strictures, and irritable bladder. 
4. NEPHRITIS SIMPLEX.—INFLAMMATION OF THE KIDNEYS. 
Diagnosis.—Inflammation of the kidneys commences with the or- 
dinary febrile symptoms, like slight chills, hot and dry skin; thirst; 
frequent and hard pulse, either accompanied from the first, or speedily 
succeeded by deep-seated, aching pain in the region of the kidneys} 
which soon becomes acute and pulsative; urine scanty and high- 
colored; entire inability to lie upon the healthy side, or upon the 
stomach; position mostly upon the back when reclining, or on the af- bright’s disease of the kidney. 
67 
fected side, with the dorsal and lumbar muscles flexed; inability to lie 
on the diseased side with the muscles extended; sevei'e pains upon 
rising up to the erect posture, or from the concussions arising from 
riding, walking, or running. When the disease is strongly pronounced, 
there are: absolute to walk, or even to stand upon the feet; 
pressure over the inflamed kidney does not cause pain, but any motions 
which call into exercise the deep-seated dorsal or lumbar muscles ex- 
cite acute pain; the inflammation generally attacks the left kidney; 
both kidneys are rarely affected at the same time in the first instance; 
the pain at first is aching, compressive and dull, but often becoming, in 
severe cases, violent and lancinating; the pains extend along the ureters 
to the bladder, or follow the spermatic cord to the testicles; the urine 
is very scanty, bloody, purulent, or red, or watery; constant desire to 
urinate; there are nausea, eructations, vomitings, flatulence, constipa- 
tion ; pains in the rectum from contiguous sympathy ; tenesmus; swell- 
ing and heat over the affected side, when complicated with calculi; 
there will be retraction of the testicle, numbness of the thigh, anxiety 
and more severe constitutional disturbance. 
Nephritis may readily be distinguished from lumbago, inflammation 
of the psoas muscle, and neuralgia by the character nnd direction of 
the pains, which follow the ureters to the vesiculce seminales, or the 
spermatic cords to the testicles ; also by the nausea, vomiting, constant 
desire to urinate; the partial and in some cases almost entire sup- 
pression of the urinary secretion ; the sympathetic pains in the rectum; 
and the increase of pain whenever any of the muscles which bear upon 
the kidneys are extended. 
The terminations of nephritis are resolution, suppuration, induration, 
scirrhus, or gangrene. The duration of the acute stage is usually from 
six to nine days, when one of the above terminations usually obtains. 
Its termination in resolution is indicated by a gradual return of all 
the functions to a more healthy state; increased secretion of urine, 
which deposits an abundant sediment; moderate and general perspira- 
tion ; subsidence of the pains; ability to lie on either side, or to walk 
without difficulty. 
When suppuration has taken place, the pains become less severe; 
there are chills or shiverings; dull throbbing in the region of the kid- 
neys ; sometimes appearance of pus in the urine ; a sensation of numb- 
ness and weight in the affected side; a partial subsidence of the febrile 
symptoms; and occasionally an abscess which may be recognized by 
swelling and fluctuation in the part. 
The purulent matter may be discharged by the ureters into the 
bladder, or find its way between the lumbar or internal crural muscles, 
to the thigh, or it may find its way by ulcerations into the cavity of the 
spleen, the liver, or the colon, or it may burst externally. 68 
DISEASES OF THE SANGUINOUS FUNCTION. 
In these cases fistulous passages are apt to remain for a long period 
giving issue to the pus and urine. 
In a very few instances, after the acute symptoms have subsided, 
there remains a chronic induration of the kidneys, which in the end 
degenerates into a true scirrhus. In other rare instances, when the 
inflammation has been exceedingly violent, and suitable remedial 
measures have not been employed, the vitality of the part becomes 
destroyed and gangrene is the result. The occurrence of gangrene is 
recognized by the pale, sunken, and death-like expression of counte- 
nance, cold, clammy sweats, universal prostration, constant vomiting, 
delirium, small and frequent pulse, absence of pain, hiccough, and dark 
and foetid urine. Whenever either of the last-mentioned occurrences 
take place, no hopes of cure should be entertained. 
Causes.—External injuries ; strains from violent exercise or lifting 
heavy weights ; the irritation of calculi in the kidney; sudden check 
of the perspiration from cold; abuse of medicinal or poisonous sub- 
stances which operate specifically upon the kidneys. 
Treatment.—Frequent external applications of cold wTater over the 
inflamed kidney will be of great service in reducing the superfluous 
animal heat, and thus allaying the inflammation. The water should be 
applied quite cold and repeated until the temperature of the part is 
permanently diminished, and the pain has in a measure subsided. 
The specific medicines are: Cantharides, Cannabis, Tussilagcb 
petus., Aconite, Copaivce, Terebinthince, Belladonna, Arnica, Nux- 
vomica, and Pulsatilla. 
As soon as we are called to a case of nephritis we should have im- 
mediate recourse to Aconite, either alone or in alternation wTith one of 
the other specifics, and continue it until the febrile symptoms have 
subsided. In slight cases Aconite alone as an internal remedy, together 
with thorough external applications of cold water will suffice. 
If the inflammation be of a severe grade, and there are tearing, 
drawing, and pulsative pains in the region of the kidneys, extending to 
the bladder and testicle, constant desire to urinate, scanty secretion of 
high-colored urine, inability to lie on the affected side, tenesmus, colic- 
pains, urine tinged with blood, painful micturition, Aconite in alter- 
nation with the third dilution of Cantharides, or Cannabis, or Tere- 
binth, or Tussilago-petus., or Bals.-Copaivce may be exhibited. 
Tartar-emetic.—Sharp stitches in the region of the kidneys, burn- 
ing from the rectum through the urethra, violent pressure in the 
bladder, scanty emission of urine slightly tinged with blood, accompanied 
with pain in the bladder, inflammatory red urine, depositing bloody red 
filaments when standing; dark turbid urine, watery urine -with mealy 
sediment; urine leaving white spots (antimonial urine); increased 
secretion of urine; burning after micturition. Very severe, lancinating INFLAMMATION OF THE KIDNEY. 
69 
pain in the lower part of the bladder similar to that caused by calculous 
affections (third day). Severe burning in the urethra after urinating 
(third day) ; wakes in the night with great thirst and urgent desire to 
urinate, but passes but little urine. (Second night.) 
Tartar-emetic in acute cases of Nephritis equalizes the circulation, 
subdues inflammatory action, and restores the functions of the skin. 
Mercurius.—In a case in which Nitrate of Mercury was rubbed on 
the hip and thigh, Professor Syme* says: “ intense pain immediately 
followed, and afterwards shivering; the urine was suppressed five days, 
without any insensibility, and during its suppression urea was detected 
in the blood; ptyalism appeared on the third day, became very pro- 
fuse, and was followed by exfoliation of the alveolar portion of the 
lower jaw.” Recovery took place slowly. (See p. 64, this Volume.) 
Apis-mel.—In a case of oedema of the left leg, with inflammation 
of the lymphatics, which were hard as cords, and tender to the touch, 
improvement was speedy, and manifested by increased flow of urine— 
a sign that denotes the curative action of Apis. The cure was com- 
plete. 
In a case of amenia, in which the periodical flow had been sup- 
pressed for five years: rush of blood to the head, with delirium, occa- 
sionally ; the urine had been deficient for five months ; oedema, dysp- 
noea. After taking Apis the flow of urine was at once increased; the 
oedema was lessened ; the dyspnoea relieved. The catamenia appeared 
for three hours ; the medicine was suspended till the time for the next 
period, when the discharge occurred black and clotted. The next time 
it was nearly normal, and her general health was much improved. 
Arnica is suitable for inflammation of the kidneys caused by exter- 
nal injuries, concussions, sprains from lifting, &c. 
When there is reason to suspect that suppuration is about com- 
mencing, Sulphur, Sepia, and Lycopodium may be used with advantage. 
Nephritis can sometimes be cured by Aconite alone. In all cases 
this medicine should be kept in view, since the local phenomena are 
usually accompanied by a violent fever. (.Kreussler, Therap., p. 105.) 
5. HiEMATURIA. 
Haematuria is a common result of effort to throw off by the kidneys 
morbid matters from the blood. The organs whose office it is to depu- 
rate the blood are the epithelial cells, which line the uriniferous tubes, 
and which surround the Malphighian tufts of the kidney. 
Most physiologists believe that certain toxical elements contained in 
the circulation and brought by the blood to the kidneys are liable to 
produce disease in them. {Trans. Med. Chir. Soe., London, 1857.) 
* Edinburgh Med. and Surg. Jour., Yol. XLIV. 70 
DISEASES OF THE SANGUINOUS FUNCTION. 
Thus Mr. Simon, in a paper “On sub-acute inflammation of the kid 
ney,” calls attention to the fact that to task these organs with the 
elimination of zymotic causes from the blood may give rise to structural 
disease in them, and indirectly account for the presence of abnormal 
elements in the urine. He says: “ The morbid material which thus 
stimulates the kidney in its struggle for elimination will sometimes 
consist of products of faulty digestion—the lithates or the oxalates 
sometimes of matters cast upon the kidney in consequence of sup- 
pressed function in other organs—the skin or the liver; sometimes it 
will be the mysterious ferment of a fever poison—typhus, or scarlatina. 
The following conclusions have been reached by pathologists: 
1. That the kidneys are designed to depurate the blood, not only of 
those post-organic and saline elements of the urine which would prove 
deleterious if they were retained in it, but also to eliminate certain 
morbid poisons which serve to infect the blood and give origin to the 
class of zymoses. 
2. That among those of the latter class each poison, to whose action 
the kidney is susceptible, impresses that organ in its own peculiar 
manner, invariably causing its own especial variety of structural and 
functional lesion. 
Tkeatment.—Arsenicum.—Case by Dr. Fraser, of Hull.—A man 
of previous good health and constitution, some days after a feverish attack 
with some eruption on the skin, complained of painful micturition, scanty 
secretion, slight oedema of the face. Antiplilogistics and diuretics 
failed to arrest these symptoms. 
Pain in the back ; headache; nausea; loss of appetite; dry, harsh 
skin; parched mouth; little thirst; constipation; urine scanty, and 
containing blood-globules, albumen, fibrinous casts and various forms 
of epithelia. 
Tr. Arsenicum Album 3°. 20 drops. 
Spts. Yin. q. s. 
Water 6 oz. 
Mix. Take a table-spoonful every four hours. 
Next day no improvement; can not lie down ; restless and uncom- 
fortable ; difficulty in breathing ; short, rapid respiration; dropsy in- 
creasing ; urine very red ; secretion in twenty-four hours eight ounces ; 
microscopic appearance the same. 
Fourth day.—Dropsical condition the same; general symptoms 
slightly alleviated; urine increased to twelve ounces; its color deep- 
brown, smoky, as in ordinary hsematuria; contains less albumen ; blood 
casts not so perfect in outline as before; casts of the tubuli and epi- 
thelial cells more altered, broken as if indicating the arrest of further 
extravasation. The medicine continued. 
Sixth day.—The patient can dress himself and move about with DISEASE OF THE KIDNEYS CAUSED BY LESIONS. 
71 
comfort. Quantity of urine increased to twenty-five ounces in twenty-four 
hours. Three days later the improvement was plain. Appetite good, 
bowels regular; sleep good; swelling rapidly disappearing ; quantity 
of urine increased to two quarts in twenty-four hours. The urine con- 
taining much less albumen; its specific gravity 1015, and containing 
uric acid. 
Twelfth day.—No constitutional disturbance whatever; urine has 
only a slight brownish tinge. Sp. gravity 10T6, quantity above two 
quarts in twenty-four hours. 
Sixteenth day.—Urine has only a very slight shade, produced by heat 
and Nitric-acid. The few casts that appear under the microscope 
quite transparent. 
Twenty-first day.—Secretion of urine reduced to forty ounces in twen- 
ty-four hours. Dropsy quite gone ; patient can walk out daily. 
Twenty-ninth day.—No trace of albumen in the urine; no blood- 
discs or casts discovered. 
Symptoms which led to the selection of Arsenicum in this Case.— 
Leucophlegmatic temperament of the patient; general restlessness; 
uncomfortable feeling ; parched condition of the mucous membrane, un- 
attended by increase of thirst; condition of the urine, and frequent 
scanty micturition. The action of remedy seemed not so much on the 
kidney as on the general condition of the absorbents. 
Case by Dr. Henderson.—Terebinth.—A married woman, having 
haematuria for four days, took one-twelfth of a drop every four hours. 
In twenty-four hours the sanguine appearance in the urine was quite 
gone, but there was much irritability of the bladder, pain in the region 
of the kidneys, and shootings down the limbs. Several weeks after- 
wards she had a return of the disease caused by indiscretion in diet, See. 
She was directed to take one-hundreth of a drop of Turpentine for a 
dose every few hours. The effect on the secretion was slower; it took 
five days to overcome the morbid state, but, then, no painful conse- 
quences were produced by the weaker doses. 
6. HEMATURIA FOLLOWING SCARLATINA. (See Yol. I., p. 600.) From 
Pulmonary (Edema. (See Yol. I., p. 785.) 
7. DISEASE OF THE KIDNEY CAUSED BY SURGICAL OR MECHA- 
NICAL LESIONS. 
Claude Bernard [Led. III.) says: “If you simultaneously remove the 
two kidneys of a dog, or simply tie the renal arteries, you immediately 
produce a general disturbance in the entire economy. The animal is 
powerless in expelling the excrementitial product which should pass 
off by this channel, and the whole system becomes gradually poisoned. 
At first the animal is not seriously affected; it continues to eat and 72 
DISEASES OF THE SANGUINOUS FUNCTION. 
digest its food for a certain lapse of time, which corresponds to the 
period of incubation in diseases; at a later time it is attacked with 
vomiting and purging, shortly after which it dies. 
“What takes place in a case like this? Let us endeavor to explain 
it. During the first period the urea, which can no longer be eliminated 
by the kidneys, is expelled by the intestines. It is found, together 
with the salts of ammonia in the animal’s excrements, and even in the 
gastric juice. If this new mode of elimination could be prolonged in- 
definitely the animal would not become diseased—it would not die; but 
very soon the mucous membrane of the intestines, irritated by the 
constant contact with the ammoniacal salts, undergoes morbid 
changes. On the other hand, as long as the urea is eliminated by the 
intestines, it does not find its way into the blood. This fact has been 
demonstrated experimentally by M. M. Prevost and Dumas, who have 
not, however, succeeded in explaining it. Now at a later period, when 
the mucous lining of the intestine refuses to continue this function, 
which is altogether foreign to it, the urea finds its way into the blood, 
and the animal soon expires, comatose and convulsed. 
“ When the cessation of urinary secretion depends on the ligature of 
the renal arteries, this state of things may sometimes be obviated by 
removing the ligatures; the self-same thing would also take place in 
man, if there existed an obstacle to the passage of the urine, and if it 
wrere possible to remove that obstacle; but in all cases in which the 
kidneys have been removed death has always supervened. The de- 
struction of the animal has been the invariable termination of the morbid 
series. Here then, we have a disease which can be artificially 
produced. 
If you remove only one kidney, the animal continues to live; the 
remaining organ becomes enlarged, and plays both its own part and 
that of its fellow. If you only make a division of the nerves of the kid- 
neys the animal dies. During the first few days which follow the 
operation albuminuria is produced, shortly after, inflammation of the 
kidneys begins. These organs then mortify and become decomposed; 
so that finally, they act on the economy like a septic poison, which 
inevitably leads to death. Such I consider to be the natural ex- 
planation of this apparently mysterious fact.” 
8. CAPSULA RENALES.—ADDISON'S DISEASE OF THE SUPRA- 
RENAL CAPSULES. 
Leading Characteristics.—Anaemia, general languor and debility, 
remarkable feebleness of the heart’s action, irritability of the stomach, 
and a peculiar change of color in the skin, occurring in connection 
■with a diseased condition of the supra-renal capsules. CAPSULA RENALES. 
73 
General Remarks.—The disease displays its characteristic fea- 
tures very slowly: the patient gradually fails in health ; he becomes 
languid and weak, indisposed to bodily or mental exertion; appetite 
impaired or lost; whites of the eyes become pearly; pulse small and 
feeble; or, if large, excessively soft and compressible ; the body wastes, 
but without exhibiting the dry and shrivelled skin and extreme ema- 
ciation common in malignant diseases ; slight pain or uneasiness in the 
region of the stomach; occasional vomiting; sometimes disturbed 
cerebral circulation. These symptoms are common in anaemic diseases; 
but they do not point to the seat of the local affection, and throw no 
gleam of light on the real nature of it. We may expect some malig- 
nant or strumous disease ; but we find no enlargement of the spleen, 
thyroid, thymus, or lymphatic glands, no evidence of renal disease, of 
purpura, previous diarrhoea, ague, or exposure to malaria. But, in con- 
nection with the above symptoms, we observe a most remarkable and 
characteristic discoloration of the skin, which has attracted the atten- 
tion of the patient and friends. It pervades the whole surface of the 
body, but is commonly most conspicuous on the face, neck, superior 
extremities, penis, axilla, and around the navel. The color is peculiar, 
being dingy, smoky, with various tints or shades of deep amber or 
chesnut brown. In one instance the skin was so universally and 
deeply darkened as to resemble that of a mulatto. 
In some cases the discoloration occurs in patches, or the surface 
presents a mottled or speckled appearance, in one instance being in- 
terspersed with whitish spots. This irregular distribution of pigment- 
cells, in some cases, is observed in internal tissues, as the peritoneum, 
mesentery, and omentum. 
In the progress of the disease the discoloration of the skin increases ; 
the anaemia, languor, failure of appetite, and feebleness of the heart 
become aggravated; a darkish streak appears under the commissure 
of the lips; the body wastes, but without extreme emaciation or dry 
harsh condition of the skin; pulse smaller and weaker; without special 
pain or uneasiness the patient gradually sinks and expires. In one 
acute case, in which both the supra-renal capsules were found univer- 
sally diseased, on dissection, the mottled appearance of the skin was 
very manifest, the anaemia and gastric derangement were very strongly 
marked; but the pulse was not small and feeble as usual, but was 
large, soft, and extremely compressible, and jerking on the slightest 
exertion or motion, and the patient soon died. Mr. Addison, from 
whose elaborate descriptions we have condensed this viewr of this little 
known disease, proposes by the concurrence of the above symptoms, to 
distinguish the destructive disease of the supra-renal capsules ; and he 
asserts that, whether the disease be acute or chronic, it will inevitably 74 
DISEASES OF THE SANGUINOUS FUNCTION. 
terminate in death when the lesion involves the destruction of both 
organs, (pp. 4 to 7.) 
Diagnosis.—The distinctive features are the peculiar discoloration 
of the skin. Mr. Hutchinson, in furnishing an analysis, of twenty- 
seven cases [Med. Times and Gazette), says jaundice may be dis- 
criminated from the bronzed skin caused by disease of the supra-renal 
capsules, by its own peculiar tint, by its uniform diffusion, by its 
presence in the matrices of the nails and in the conjunctivse. Brown- 
ing from exposure to the sun may be recognized by its occurrence in 
those situations only which are habitually exposed. 
Patches of pityriasis versicolor sometimes resemble those of 
bronzed skin. They are distinguished by “their limitation to the 
abdomen and chest, their defined outline, their furfuraceous surface, 
the slight itching which attends them, their contagious character, and, 
above all, the microscopic examination of the cuticle.” {Med. Times 
and Gazette. 
The bronzed color resembles that of a bronzed statue from which 
the gloss has been rubbed off, and is not changed by pressure. The 
extreme and peculiar feebleness is the next most striking symptom. 
The patient is liable to faintings, loses energy, is unable to exert 
either body or mind ; flabbiness of the muscles rather than extreme 
emaciation. 
Causes.—No others have yet been pointed out than those which 
usually originate general chronic disease, disease of the kidneys or 
spine, though none of these diseases seem necessarily connected with 
the bronzed skin or the peculiar debility. 
Pathology.—The diseased conditions of the supra-renal capsules 
hitherto observed in connection with the lyt'onzed skin are : 1. Acute 
and recent inflammations, ending in abscess ; 2. Atrophy, with fibro- 
calcareous concretions ; 3. The conversion of the viscus into a sort of 
fibroid structure, with great enlargement and induration ; 4. The de- 
posit of tubercle, or of a fibroid material resembling tubercle; 5. The 
growth of cancer. Sometimes the affection of the glands, especially 
of a cancerous nature, is secondary to disease in other parts; but it is 
observed that in many cases these organs were the only part of the 
body in which the disease was detected. When the disease of these 
glands is only partial, the severity of the general symptoms and the 
bronzing of the skin are all proportionate to the amount of the disease 
in these bodies, but have no relation whatever to the nature of that 
disease. (Hutchinson.) 
It is not yet sufficiently demonstrated whether the disease in one of 
the organs is the cause of the morbid changes in the other, and of the 
general symptoms; or “ whether the supra-renal disease and the affec- 
tion of the skin, like the intestinal ulceration and cutaneous rash of INFLAMMATION OF THE BLADDEK. 
75 
typhoid fever, are concurrently the efflorescence of some more deeply- 
seated mischief.” {Brit, and For. Med. Chir. Rev., Oct., 1856, p. 
318.) From the researches, then, of Mr. Addison and others, it seems 
to be proved that there is an intimate connection between the disease 
of the capsules and the morbid condition of the skin ; that such a con- 
dition of the skin as has been already described “is diagnostic of the' 
disease of the supra-renal capsules and “ that disease of the supra- 
renal capsules is the cause of that discoloration of the skin, and, we 
may add, of the symptoms that co-exist therewith.” 
Prognosis.—Such a large proportion of all the published cases of 
this disease have terminated fatally, that we can scarcely be justifiable 
in holding out assurances of recovery in any case in which the bronze- 
colored skin and the accompanying debility are strongly marked. In 
cases less clearly defined in their nature, and not advanced to a hope- 
less degree, it may still be found curable. 
The most efficient remedies hitherto employed are, Apis, Arsenicum, 
Bryonia, Mercurius-corr., Terebinth, Apocynum, Hellebore, Kali-hyd., 
Cantharis, Thuja, Buchu, Uva-ursa, Cubebs, Cuprum-aceticum, Gallic- 
acid. 
The best effects have been observed from the lower attenuations of 
these medicines, repeated at long intervals. 
9. CYSTITIS.—INFLAMMATION OF THE BLADDER. 
Diagnosis.—Inflammation of the bladder commences like nephritis, 
with shiverings or chills; frequent pulse; hot and dry skin; anxiety ; 
thirst; urine scanty and high-colored; nausea; vomiting; eructations, 
and constipation. In a short time the patient experiences deep-seated 
lancinating pains in the hypogastric region ; frequent desire to urinate, 
each effort giving rise to increased pain, great anxiety, and uneasiness. 
As the inflammation extends, the pains become more severe, and there 
are painful pulsations, a continual burning sensation in the bladder, with 
acute pain on making pressure in the vicinity of the inflammation, and 
when attempting to urinate, a sense of weight in the hypogastric re- 
gion; acute or dragging pains in the loins, the ureters, the perineum, 
and the anus; swelling and distention of the abdomen; great difficulty 
in voiding the faeces, on account of the sympathetic inflammation of the 
rectum ; all movements of the muscles which bear upon the bladder ex- 
cite increased pains ; and finally rigors, cadaverous expression, cold 
extremities, delirium and convulsions. If the inflammation be confined 
to the neck of the bladder, there will be an almost entire suppression 
of the urinary discharge; constant ineffectual and exceedingly painful 
efforts to urinate ; and violent pain in the perineum. If the ureters be- 
come involved, pains are frequently felt as high as the kidneys; the 76 
DISEASES OF THE SANGUINOUS FUNCTION. 
secretion of urine becomes more deranged, the suppression is more de- 
cided, and the attempts to void the urine still more painful. When the 
whole interior surface of the bladder is affected, the urine is red and 
tinged with blood, and a severe burning and throbbing i« experienced. 
Occasionally the external surface of the organ becomes inflamed, either 
on one side, on its anterior or posterior, or its superior or inferior part; 
in which case the symptoms will be in correspondence with the location 
of the malady. 
Cystitis may terminate in chronic inflammation of the bladder, in 
resolution, suppuration, or gangrene. 
The signs which indicate these different terminations are similar to 
those described under Nephritis. 
Causes.—Injuries resulting from childbirth, from the use of instru- 
ments during accouchement; from blows, concussions and falls; from 
gravel, stone, abuse of diuretics, metastasis of erysipelas, rheumatism, or 
gonorrhoea, the use of stimulating injections into the urethra, prolonged 
retention of urine, introduction of catheters or sounds into the bladder, 
suppression of the menses, and extensive inflammation (spreading) from 
neighboring parts. 
Treatment.—Aconite, Gantharides, Cannabis, Thuya-occiden, 
Terebinthina, Copaibas, Tussilago-farfar., and Asparagus are our 
best specifics. They may be employed at the first, second and third 
attenuations, either alone or in alternation with Aconite: and the doses 
repeated as the urgency of the symptoms demand. 
Aconite.—In the dysuria and fever which accompanies cystitis, espe- 
cially when it is of a synochal character, repeated doses of Aconite 
are indispensible. (Ilartmann, Ther. Ilomceop) 
Cases of ordinary cystitis, says Hering, “with painful and very 
scanty micturition, or rather the discharge of a few drops only, of deep- 
red, turbid urine, &c., can almost always be cured with Aconite, 
especially in women and children, and by repeating the dose w'henever 
the pain recommences. We ought always to consider Aconite when 
with urinary tenesmus and pains in the bladder, this region is swollen, 
■with aggravation of the pains on urinating, urine of a blood-red color, 
or mixed with small clots of blood. (Domestic Med.) 
Schwrarz gives a case of a man aged thirty, with firm muscles, and 
black hair, who after wretting his feet experienced the following 
symptoms: violent chill and afflux of blood to the head, with extreme 
pain immediately under the symphisis pubis, as wrell as behind and be- 
neath the scrotum ; continual and urgent desire to urinate ; urine burn- 
ing, red, mixed with blood, and only emitted drop by drop ; pubic region 
tense, painful to the touch, and a little hot; burning lancinating pain 
extending to the base of the urethra; disagreeable sensation at the 
meatus urinarius, decided fever; pulse a little full, hard, 115 per minute ; DYSURIA. 
77 
tongue red and dry; skin dry and hot. Aconite 18th, one drop every 
three or four hours. At the end of twenty-four hours there was a de- 
cided remission of all the symptoms. Pulse 95. Inflammation visibly 
diminished, urine less red. On the third day the pulse was 75, and 
there was no fever. The few remaining symptoms were cured by pul- 
satilla. {Exper. Horn., p>. 95.) 
Symptoms particularly indicating Aconite. — Vesical region 
swollen and painful; urinary tenesmus/ urine scanty, red, bloody 
and only emitted drop by drop; aggravation of the pains on urinating; 
strong inflammatory fever. (<Jahr.) 
In cystitis as well as in nephritis Aconite may be employed with 
success; for, although the principal indication for this remedy is the 
violent fever which accompanies the local affection, yet it acts with 
equal efficacy upon the latter. It often suffices to cure the entire af- 
fection. (Kreussler, Ther. Horn,., p. 111.) 
Triticum Repens.*—Inflammation of the Bladder produced by 
inflammation of the prostate and neck, in pain and spasms from cal- 
culus and stricture. In all of these painful affections, Triticum-repens 
is a useful remedy. We usually employ the tincture in water. 
10. DYSURIA. 
Diagnosis.—In this complaint the urine can be voided at will, but 
it usually passes away in a small spiral or divided stream, or drop by 
drop, each act being attended with burning and cutting pains at the 
neck of the bladder. There is a frequent inclination to urinate, and 
sensations of pressure and tenesmus, which constantly urge the patient 
to void his urine. The inflammation is confined to the neck of the 
bladder, and does not often give rise to constitutional disturbance. 
Causes.—Perhaps the most common.cause of dysuria is the absorp- 
tion of Cantharides. This substance exercises a specific influence so 
decidedly upon the neck of the bladder, that even a sufficient quantity 
may be absorbed from the external application of blisters to cause the 
malady. A family was poisoned by a servant, who put a tea-spoonful 
of Cantharides powdered into a quantity of ground coffee; and they 
all suffered for several days. A medical student took five or six 
pills of blistering plaister in the course of a day or two for gonorrhoea. 
Severe dysuria, with excessive burning in the urethra ensued and in- 
creased till the urine could only be voided drop by drop, and a small 
quantity of blood was mixed with it; after the pills were discontinued 
the suffering gradually subsided. 
Symptoms of Cantharides.—Retention of urine with ineffectual ef- 
* Known to farmers as Dog’s-grass, Couch-grass; grows two feet high, with stem 
trailing at the lower joints. 78 
DISEASES OF TIIE SANGUINOUS FUNCTION. 
forts to urinate, is one of the most common and painful evils which 
Cantharides produces. It ought therefore to be a salutary homoeopathic 
remedy. Hahnemann enumerates all the preceding authors who had 
tried it and shows that they all found it successful, though Huxham 
read the theories of the schools against it, and dared not try it. The 
painful micturition, scalding urine, and inflammation of the urethra are 
the symptoms of the early stage of dysuria. 
Nitrate of Potash.—In small doses it causes frequent desire to 
pass water, accompanied with pain and heat. When this condition 
exists as a consequence of disease or absorption of cantharides from a 
blistered surface, a dilution of Nitre is found to be a remedy. 
Other causes are, stimulating injections, abuse of stimulants and 
condiments, onanism, extension of gonorrhoeal inflammation, cold, tur- 
pentine, worms in the rectum; gravel, and calculi. 
Treatment.— Camphor is the specific against dysuria caused by 
the absorption of Cantharides. When it arises from other causes, 
Cannabis, Uva-ursi. Scovolo, among many others, cured a case 
where the urinary discharge was puriform, by Arbutus-uva-ursi; which 
never could have been performed, if this plant had not the property of 
exciting heat in the urethra with discharge of mucous urine. 
Belladonna.—Its effect on the urinary mucous membrane.—It 
causes frequent, painful, and scanty micturition, sometimes going on to 
strangury and hsematuria; urine diminished in quantity, often after- 
wards increased. Its use in this condition extends only till actual in- 
flammation begins; then Cantharis and Therebinthina supersede it. 
Apis is a remedy of great value in dysuria. 
11. IRRITABLE BLADDER. 
This affection arises from long-continued inflammation, which in the 
end so impairs the function of the bladder that the presence of a very 
small quantity of urine forces it to contract, and thus forms an incon- 
tinence of urine. Although this condition of the bladder may arise 
from numerous causes, which have already been enumerated, it not un- 
frequently proceeds from extension of urethritic inflammation to this 
organ, and from protracted use of diuretics. The malady is readily 
distinguished from stone by the relief which always follows the eva- 
cuation of the bladder, while this operation aggravates the painful 
sensations in the latter affection. 
This disease generally baffles all the resources of allopathy, we 
shall endeavor to show that the same remark is not true of the results 
of homoeopathic treatment. 
Treatment.—The principal remedies are, Aeon., Camphor, Can- 
nabis-sativa, Cantharides, Digitalis, Apium, Sulphur, Nux-vom., and SUPPRESSION AND RETENTION OF URINE. 
79 
demulcent drinks, of which an infusion of water-melon seeds is one of 
the best. 
12. SUPPRESSION AND RETENTION OF URINE. 
The causes capable of giving rise to suppression or retention of urine 
are so various and diversified, and the circumstances attending the 
course and progress of different cases so numerous, that our description 
must necessarily be confined to the more prominent symptoms and oc- 
currences connected with the malady. 
By the term retention of urine we mean to include all those cases 
in which the urine is secreted by the kidneys as usual, but where the 
power to evacuate the bladder is lost; while suppression of urine cor- 
responds with the affection known as ischuria renalis, in which the se- 
creting function of the kidneys is either partially or totally destroyed. 
Ischuria renalis is always attended with danger, from the peculiar 
tendency which exists in the brain to take on diseased action. When 
there is an entire suppression of the urinary secretion, from the paraly- 
sis of the kidneys, coma and effusion upon the brain occur very 
speedily. In cases of this description the saliva, the sweat, the pul- 
monary exhalations, the bile, the pancreating and gastric fluids, become 
impregnated with a fluid possessing the appearance, taste, and odor of 
urine. It has also been observed, that the liquid effused upon the 
brain, possesses a decidedly urinous smell. In cases of the disease 
dependent on inflammation of the kidneys, we shall have febrile 
symptoms, hot and dry skin, thirst, nausea, vomiting, rapid pulse, 
tenderness of the abdomen on pressure; swelling and pain in the region 
of the kidneys, frequent desire to urinate, and the passage of the small 
quantity secreted, causing great pain, urinous taste in the mouth, urin- 
ous odor of the sweat, anxiety and general uneasiness. If the sup- 
pression be total, the symptoms will be still more grave, and there will 
be early indications of serious cerebral disorder, in the form of delirium, 
rapidly succeeded by coma and effusion. 
On the other hand, in suppression depending upon paralysis of the 
kidneys, the febrile symptoms may be very slight, and there may be an 
entire absence of pain and uneasiness in the region of the kidneys or 
in the abdomen, and no desire to urinate. In these instances, the dan- 
ger is no less imminent than in the other variety, for fatal oppression 
of the brain almost invariably ensues, if the malady persists more than 
two days. Cases, however, are reported of almost total suppression for 
two or three months, in which the patients have been restored to health; 
but such instances are of rare occurrence, and should only be considered 
in the light of exceptions to the general law of the disease. 
Suppression now and then occurs from the presence of calculi or 80 
DISEASES OF THE SANGUINOUS FUNCTION. 
gravel in the structures of the kidneys, thus causing a mechanical ob- 
struction to the healthy performance of their functions. In these cases 
the foreign bodies may operate by causing inflammation, spasms, in- 
duration or ulceration. They give rise to swelling, pains, sensation of 
weight and uneasiness in the vicinity of the kidneys, to numbness of 
the thighs, retraction of the testicles, abdominal tenderness, constipa- 
tion, frequent inclination to urinate, pain and tenesmus in passing water, 
anxiety, irritability, febrile symptoms, nausea, vomitings, hiccoughs, 
pain in the lumbar region, pain and tension in the perineum, scalding 
in the urethra, pulse full and frequent, difficulty of breathing, sighing, 
delirium, convulsions. Ischuria may be distinguished from retention 
of urine from the circumstance, that in the latter disease the bladder is 
distinct, and rises up above the pubis, offering to the pressure of the 
hand a firm and resisting body, while in the former complaint this vis- 
cus is empty, falls down below the pubis, and affords no resistance or 
fluctuation. 
Retention of urine may arise from inflammation, from stricture of 
the urethra, from paralysis of the bladder, from enlargement and in- 
flammation of the prostate gland, from mechanical injuries to the blad- 
der, from abuse of stimulating diuretics, from inflammation of the rec- 
tum, from the pressure of tumors, from displacement of the uterus, from 
calculi, from the lodgment of gravel or a stone in the ureters or in the 
urethra, from thickening and obstruction of the ureters, from too long- 
continued retention of urine, and from spasms. 
The general symptoms of retention are, distention of the bladder, 
and its elevation above the pubis, pains in the region of the bladder, 
with pressing desire and ineffectual attempts to urinate, anxiety, general 
uneasiness, and more or less constitutional disturbance. 
As retention is generally but a symptom of some other malady, we 
are often presented with constitutional disturbances during an attack in 
no way dependent upon this affection. We may cite as examples of 
this kind, diseases of the brain and spinal marrow, which may have pre- 
ceded the retention for months, protracted calculous affections, chronic 
inflammations of the bladder and prostate gland, constitutional effects 
of onanism, retroversion of the uterus, and the effects of previous 
mechanical injuries. From these facts it is apparent that there may 
exist an almost endless variety of symptoms during the progress of the 
different cases of retention which are constantly occurring. 
When the malady arises from simple inflammation of the neck of the 
bladder, not complicated by any previous disease, the symptoms are, 
hot skin; frequent and hard pulse; thirst; pain in the region of the 
bladder and in the perineum, increased by pressure; restlessness; 
anxiety; constipation ; frequent inclination to pass water, with violent 
painful and ineffectual straining; shooting pains extending up the SUPPRESSION AND RETENTION OF URINE. 
81 
ureters towards the kidneys, or along the spermatic cords towards the 
testicles ; headache ; nausea; oppression at the prcecordia; and gene- 
ral feeling of fullness and distention of the abdomen. 
Retention caused by paralysis, on the other hand is accompanied 
by but few of these symptoms. Indeed many cases are recorded where 
the accumulations of urine have reached an enormous amount before the 
patients were aware of it. Other instances are mentioned where the 
distention has been so gradual and painless as to cause it to be mis- 
taken for ascites, and in more than one instance of this description, 
paracentesis abdomivalis has been resorted to as a curative measure. 
In cases like these, fifteen or twenty pints have occasionally been 
drawn off by the catheter at a single operation. It is not an uncom- 
mon result in these over-distentions, for the bladder to become united 
by adhesive inflammation to the umbilicus, and afterwards to discharge 
itself through this part by ulceration. The same occurrence some- 
times takes place into the rectum, vagina, and even into the abdominal 
cavity. In these cases, the danger from peritoneal inflammation and 
from gangrene is imminent. 
Retention may arise from spasmodic contractions about the neck 
of the bladder, giving rise to most violent and painful attempts to urin- 
ate, bearing-down pains, frequent painful erections, great sensitiveness 
of the urethra and perineum. In this variety of retention, it is always 
very difficult and sometimes absolutely impossible to pass a catheter, 
without previously allaying the irritation by fomentations or by the 
employment of suitable medicines. 
. Spasmodic retention, although sudden and violent in its onset, is not 
usually a dangerous affection. The essence of the disease consists in 
an irritation about the neck of the bladder, and is dependent upon in- 
flammation of the prostate of the rectum, of the urethra, or some other 
neighboring structure, from which it has been propagated by contiguous 
sympathy. 
But the most difficult cases of retention with which the physician 
meets, are those caused by strictures of the urethra, and enlargements 
of the prostate gland. The practitioner during his professional career, 
will sometimes be called to cases of each of these maladies, where 
nothing but an incision into the membranous portion of the urethra, 
through the stricture, or the puncture of the bladder, will save life. In 
these cases, great judgment, decision and surgical skill are indispen- 
sable to the safety of the patient. This will be conceded when wrn think 
of the rapidity with which retention may terminate in fatal cerebral 
disease, ulceration and gangrene. By these observations we by no 
means desire to deter the physician from the employment of every me- 
dicinal means in his power, so long as they can be applied without en- 
.VOL. II. 6. 82 
DISEASES OF THE SANGUINOUS FUNCTION". 
dangering the life of the patient; hut there is a point beyond which 
we cannot safely pass without resorting to one of the operations just 
alluded to ; and in making up a correct decision upon this point the best 
judgment and the highest professional knowledge are requisite. The 
following case will illustrate this subject: Mr. B., aged forty years, of 
robust constitution, had been operated upon fourteen years previously, 
for stricture in the membranous part of the urethra. An incision had 
then been made through the strictured part, a catheter introduced and 
allowed to remain a good portion of the time for several weeks, but for 
some unknown reason the opening made by the knife did not heal, and 
a fistulous passage wras formed, through which the urine has passed for 
the most part of the time since that period. For two or three years 
previous to his coming under our care, this fistulous passage has been 
gradually contracting, and he experienced, at times, retention, which 
could only be obviated by baths, formentations, injections, relaxing 
medicines, and the skillful use of the probe. Several times, however, 
we succeeded in relieving him of the attacks by these means; but on one 
occasion, being in the country, and having contracted a cold from wet- 
ting his feet, the retention recurred, accompanied with unusual inflam- 
mation and tumefaction in the fistulous tract. Persevering efforts were 
made by his medical attendant to allay the inflammation, relax the 
parts, and to draw off the water by means of catheters and probes, for 
nearly two days, but without success. The symptoms now becoming 
very urgent, he returned home and placed himself under the care of 
Drs. Brigham and myself. We found great distention of the bladder, 
constant desire to urinate, bearing-down pains in the region of the 
bladder, expression exceedingly anxious and care-worn, eyes sunken, 
mouth and throat dry, thirst, pulse rapid and feeble, great prostration, 
nausea, hiccough, delirium, frequent sighing, exhalation from the sur- 
face of the body of a urinous smell, coldness of the extremities, and a 
sluggish and unhealthy appearance at the orifice of the fistula. 
After resorting to the usual remedies in such cases, and making re- 
peated attempts with the catheter and probe, we decided, although it 
was then midnight, that an incision must be made through the perineum 
without further delay. This wras speedily effected, and the patient’s 
life thus saved, while had we delayed a few hours more, gangrene or 
congestion of the brain would probably have resulted. 
We also have in mind a case of retention from enlargement of the 
prostate, which proved fatal in consequence of the absolute refusal on the 
part of the patient to submit to the operation of puncturing the bladder. 
In this instance, the swelling and inflammation of the gland were so 
great, together with a constant tendency to spasmodic contraction of 
the neck of the bladder, whenever the catheter came in contact with 
the part, that all efforts at introduction, aided by baths, fomentations SUPPRESSION AND RETENTION OF URINE. 
83 
and relaxants were of no avail. Here a timely puncture of the bladder 
would have saved the patient’s life. 
We are well aware of the practical skill and tact necessary to effect 
an introduction of the catheter in these cases, and of the importance of 
securing the services of a skillful and experienced surgeon; but cases 
sometimes occur which baffle the most eminent surgeons in their at- 
tempts to pass a catheter by an enlarged prostate. 
Retention sometimes occurs from obstruction of the ureters by 
gravel, calculi, by thickening and induration of their walls, by hydatids 
and other unnatural formations, by the pressure of tumors in their vici- 
nity, and by occlusion from adhesive inflammation. The following signs 
indicate the existence of this variety of disease; unusual fullness, pain 
and sensation of iveight in the vicinity of the kidneys, tension along the 
track of the ureters ; nausea, vomiting, retraction of the testicles, pain 
along the spermatic cord, collapsed state of the bladder, no resistance 
to the introduction of the catheter; absence of urine in the bladder, 
and more or less constitutional disturbance. When the obstruction is 
complete, the ureters and the kidneys become so much dilated that 
urine to the amount of two or three pints sometimes accumulates in 
them, before congestion, ulceration, or gangrene supervene. 
Retention not unfrequently arises in females from a retroversion of 
the uterus, from the presence within the vagina of polypi, hydatids, of 
scirrhous enlargements, from injuries arising during difficult accouche- 
ments, from the irritation caused by acrid secretions, from the presence 
of hardened ffieces in the rectum, and from adhesion occurring between 
the walls of the vagina, in consequence of inflammation and sloughing 
of the mucous membrane. 
Causes.—The most frequent proximate cause of retention, is inflam- 
mation of some portion of the bladder. Amongst the more prominent 
causes of this inflammation, are : metastases of gout and rheumatism, 
abuse of diuretics, strains, and extension of inflammation from neighbor- 
ing parts. 
The causes which rank next in importance are strictures of the 
urethra. They occur at all periods of life, and always require the in- 
terference of the surgeon for their removal. 
Enlargement of the Prostate Gland, is a frequent cause of re- 
tention in old men. The remote cause can generally be traced to ex- 
cessive sexual indulgence in early life. This gland may become en- 
larged from mere inflammation and engorgement of its structure, or 
from scirrhous degeneration. Affections of the prostate are usually 
called into activity by undue exposure to cold and wet, by abuse of 
stimulants and by neglect of timely urinary evacuation. 
Other causes, some of which have already been alluded to, are, re- 
troversion of the uterus, obstruction of the ureters from foreign bodies, 84 
DISEASES OF THE SANGUINOUS FUNCTION. 
occlusion of the ureters from adhesive inflammation, paralysis of the 
bladder, from injury or disease of the brain or spinal marrow, from un- 
due retention of urine, from mechanical injuries, from abuse of drugs, 
from metastases of gout, thickening of the mucous membrane of the 
bladder, tumors and excrescences near the neck of the bladder, reper- 
cussed eruptions, pressure upon the bladder by tumors in its vicinity, 
scirrhus of the bladder or rectum, accumulations of hardened faeces in 
the rectum, suppression of the menses, phymosis, ulcers, external in- 
juries, blows, contusions, and falls, leucorrhoea and gonorrhoea. 
Treatment.—In all cases of suppression or retention, where there 
can exist a possible doubt in regard to the true nature of the case, we 
should avail ourselves, without delay, of the use of the catheter. If 
this instrument passes without difficulty into the cavity of the bladder 
and no discharge of urine follows its introduction, wTe may be certaii 
that the cause and seat of the difficulty is not in this viscus; while, il 
a free discharge takes place through the catheter, affording immediate 
relief to the distention, pain, and other unpleasant symptoms which 
had previously existed, wTe may be assured that the bladder, the pro- 
state gland, or some part of the urethra, is the seat of the complaint. 
To ensure an accurate diagnosis, then, we in the first instance as- 
certain whether or not a catheter can be passed into the bladder. 
Second.—If it can be, •whether easily or otherwise. 
Third.—How large an instrument can be passed. 
Fourth.—If a discharge of urine follows the introduction. 
Fifth.—If the operation is attended with pain. » 
Another important step in forming our diagnosis, consists in procur- 
ing from the patient or his friends, a minute history of his case, and 
every circumstance connected with the individual, which might have a 
bearing upon it. Thus, if we are called to an old man whose malady 
has approached gradually, who has had no febrile symptoms and little 
pain, where no resistance is offered to the introduction of a full-sized 
catheter, and where a large quantity of urine flows off, affording im- 
mediate relief to the uneasy feelings, we may with confidence pro- 
nounce the causq, paralysis of the bladder. The same law obtains in 
cases of retention succeeding injuries or diseases of the spinal marrow. 
If we have a case where the catheter passes into the bladder with 
great difficulty, on account of some obstruction near its neck, we then 
inquire whether there exists a stricture, a spasmodic contraction of the 
bladder, or an enlarged prostate gland. The following circumstances 
will enable us to decide the question satisfactorily: 
Stricture approaches gradually, as is indicated by the gradual con- 
traction of the stream of urine, the frequent and sometimes constant 
presence of a gleety discharge, and a sensation, after passing wrater, as 
if a few drops still remained behind. SUPPRESSION AND RETENTION OF URINE. 
85 
Enlarged prostate occurs, for tlie most part, in old men, is attended 
with pulsative pain over the bladder, weight in the perineum, constant 
inclination to urinate, with much straining, fever, and general uneasi- 
ness. By introducing the finger into the rectum we may often detect 
the enlargement by actual touch. 
Spasmodic contraction of the neck of the bladder usually proceeds 
from inflammation of some neighboring structure, as the prostate 
gland, the rectum, and the urethra. Spasms of this part may arise 
also from the irritation of gravel and calculi. The previous history of 
the case will enable us to decide as to the real nature of the affection 
Retention, from stricture of the urethra, can only be permanently 
cured by the gradual dilatation of the contracted part by bougies. 
Temporary relief may sometimes be afforded by the use of medicines, 
but the only permanent cure is by artificial dilatation. But much 
may be done towards effecting cures in cases of diseased prostate, by 
a judicious employment of specific medicines. Many cases of this de- 
scription owe their origin to scrofula, or to a venereal taint, or to abuse 
of mercury, or to scirrhous degeneration, for which reason our pre- 
scriptions should be made with reference to these peculiar states of the 
system, as well as to the more immediate symptoms of the complaint. 
With regard to other causes of retention, the importance of minute 
investigation into all the circumstances of each case, can not be too 
strongly insisted on; for much of our success will depend upon an 
early removal of those causes which have operated to induce the re- 
tention, and which perhaps continue to exist to perpetuate the malady. 
If a retention has been caused by a metastasis of gout or rheuma- 
tism, our selection of remedies should be made with reference to these 
general diseases, as well as to more urgent local symptoms. If the 
cause can be traced to a displacement of the uterus, to impacted faeces 
in the rectum, to inflammation of any of the surrounding tissues, to the 
presence of ascarides in the rectum, to excrescences about the neck of 
the bladder, to imperforate hymen, to unnatural adhesions within the 
vagina, to the impaction of a stone in the urethra, our attention should 
be immediately directed towards the removal of these remote causes. 
Treatment.—The following medicines will cover all of the symptoms 
which occur in suppression or retention of urine: Cannabis, Uva- 
ursi, Solidago-virga-aurea, Acid-pliosphoric, Rhus-radicans, Aco- 
nite, Pulsatilla, Nux-vomica, Arnica, Belladonna, Oleum-tere- 
binthina, Tussilago-pertuss, Camphor a, Agnus-castus, Arsenicum, 
Sulphur, Iodine, Electro-magnetism, Cantharides. 
Cantharides and Cannabis, are indicated in suppression from 
chronic inflammation of the kidneys, and in retention from long- 
continued irritation of the neck of the bladder. They may also be em- 
ployed in suppression and retention from acute inflammation of the 86 
DISEASES OF THE SANGUINOUS FUNCTION. 
kidneys and bladder, after the febrile symptoms have been subdued by 
Aconite. Hahnemann advises them in retention from paralysis of the 
neck of the bladder, and in cases of chronic retention arising from 
thickening and induration of the mucous membrane. 
Arnica is our best remedy when the functions of the kidney and 
bladder have been impaired or suspended by mechanical injuries, falls, 
contusions, sprains, blows, and concussions, or by the irritation of 
calculi. 
Rhus-radicans, Belladonna, and Solidago-virga-aurea are appli- 
cable when the disorder has proceeded from metastases of gout or 
rheumatism. These medicines may be alternated with Aconite when 
the inflammatory symptoms run high. 
Agnus-castus is an excellent specific in retention in consequence of 
paralysis of the bladder. Nux-vomica, Tussilago, Arsenicum and 
Oleum-terebinth are remedies which should command attention in 
paralytic retention. 
Spasmodic retentions are readily cured by Camphor, Belladonna 
and Aconite. 
When gravel or calculi are the exciting causes of the affection, we 
advise the employment of Uva-ursi, Solidago-virga-aurea, and Bella- 
donna. 
Affections of the prostate gland may be met by Pulsatilla, Sulphur 
Aconite, Rhus-rad., Arsenicum, and Iodine. 
Retention from onanism, from excesses in venery, are treated best 
with Acid-phosplioric, Agnus-castus, Cantharides, Cannabis, Rhus- 
radicans and Arnica. 
Administration.—The lower attenuations should be employed in 
these affections, and the doses repeated every two, three, or four hours, 
until the medicinal effect is perceptible. Auxiliary to the above medicinal 
treatment, we (may) make a thorough use of warm baths, fomenta- 
tions, bland, diluent drinks, injections by the rectum, and lastly, though 
not the least important means, electro-magnetism. This powerful 
remedy should only be employed after the inflammatory symptom? 
have been reduced, and then with extreme care and moderation. 
13. ENURESIS.—INCONTINENCE OF URINE. 
Diagnosis.—This affection may be recognized by a partial or total 
loss of power to retain in the bladder the secreted urine. When the 
loss of voluntary power over the muscles concerned is total, the urine 
continues to dribble away as fast as secreted, becoming thus an in- 
cessant source of trouble and annoyance. 
If the loss of power be only partial, the urine can be retained until 
a given amount is accumulated, when the patient is suddenly com OPHTHALMIA. 
87 
pelled to yield to the pressing demand, sans ceremonie. In other in- 
stances, the incontinence is troublesome only during sleep, and appears 
to be excited by dreams, constrained positions, &c. 
The malady is unaccompanied by febrile symptoms or pains, and 
usually occurs as a symptom of some other disease. 
Causes.—Complete eneuresis may be caused by paralysis of the 
sphincter of the bladder from constitutional causes, from external in- 
juries, from tedious and protracted labors, from the pressure of tumors, 
from calculous deposits and from abuse of diuretics. 
Partial eneuresis is a common complaint amongst children, and is 
particularly troublesome in the night during sleep. It has too often 
been attributed to habit, and negligence of proper efforts to restrain 
the discharge and punishment has been tried as a remedy, but 
generally without advantage. The disease in these cases is undoubt- 
edly associated with irritation at the neck of the bladder, originated 
by acrid urine, gravel, the irritation of worms in the rectum, &c. 
Treatment. — Cantkarides, Cannabis, /Jva-ursi, Nux-vomica, 
Oxalic-acid, Gallic-acid, Cicuta-vir., Sulphur, Calcarea-carb., Pul- 
satilla, and Phus, are the chief remedies. 
For the cure of paralytic enuresis, recourse should he had to 
Cantkarides, Nux-vomica, Phus, and Uva-ursi. 
When the disease occurs in children, our best remedies are Cantha- 
rides, Calcarea-carb., and Sulphur. 
When from external injuries, difficult accouchements, or the irritation 
of calculi, we may prescribe Arnica, Pidsatilla, Phus, and Cicuta- 
virosa. 
Administration.—The remedies should be used at the first or se- 
cond attenuations, and a dose given twice daily as long as necessary. 
Genus VIII.—OPHTHALMIA. 
INFLAMMATORY AFFECTIONS OF THE EYE AND ITS APPENDAGES. 
The eye, in the immediate vicinity of the brain, connected with this 
organ by the optic nerve, endowed with numerous delicate membranes, 
nerves and blood-vessels, with its lens, its aqueous and vitreous humors 
to conduct and modify the luminous rays in their passage to the retina, 
—all disposed in the most consummate manner to serve the end de- 
signed,—may be looked upon as a most complex and perfect optical 
instrument. It is the mirror in which are reflected the various tableaux 
of external objects for the satisfaction of the soul within, causing it to 
respond to such impressions, so that the most indifferent spectator may 
look into its depths, and see the manifestations of the perceptive 
faculties. 88 
DISEASES OF THE SANGUINOUS FUNCTION. 
The impressions of external objects derived through this medium, 
constitute our principal sources of knowledge and pleasure. Without 
this faculty we learn only by vague comparisons, suggested by touch, 
taste, smell, and hearing, by which all our conceptions are more or less 
perverted and indefinite. It is through the medium of vision, that the 
child first acquires a just idea of colors, distance, proportion, magni- 
tude, &c., and begins to reason and act by a comparison of his different 
impressions. It is through the eye alone that we appreciate the in- 
finite variety of expression in the “human face divine” and become in- 
cited to sympathy, love, pity, charity, admiration, fear, hope, hate, anger, 
and other emotions; that we enjoy the beauties and sublimities of 
nature ; that we become acquainted with the wonders of art and 
science ; and by contrasting objects with each other, that we are able 
to enrich our minds with whatever elevates us in dignity of being and 
capacity of happiness. 
The eye is, perhaps, more delicate of organization, and yet from its 
situation more exposed, than any other, to external cause of disturb- 
ance. How important then that wre obtain accurate ideas relative to its 
structure and functions, and the disorders to wdiich it is liable, that we 
may be able to protect it when well, and promptly to cure it when dis- 
eased. In our description of the diseases of the eye and its appen- 
dages, we shall adopt this classification: 
First.—Affections of the tunica conjunctiva, or outer covering of the 
eye, including: 1. Acute ophthalmia; 2. Chronic ophthalmiay 3. 
Purulent ophthalmiay 4. Gonorrhoeal ophthalmiay o. Strumous, 
or scrofulous ophthalmiay 6. Granulated lids; and 7. Opacitity of 
the cornea. 
Second.—Affections of the deeper-seated structures of the eye, in- 
cluding : 1. Inflammation of the corneay 2. Inflammation of the 
iris (iritis)y 3. Amaurosis', 4. IIy dr ophthalmia, or dropsy of the eyey 
5. Cataract' and 6. Glaucoma, Ilypermetropia, Asthenopia, f ungus 
hcematodes, and Cancer of the eye. 
Third.—Affections of the appendages of the eye, including: 1. Hor- 
deolum, or stye' 2. Entropium, or inversion of the eyelids,• 3. Ectro- 
pium, or eversion of the eyelids,; and 4. Fistula lachrymalis. 
This classification is deemed sufficient for all practical purposes, and 
much less liable to lead to confusion than one more extended. We 
shall point out the prominent affections of each structure of the eye, 
and endeavor in enumerating the causes, to make the reader acquainted 
with every thing of interest connected with each particular subject. 
Ophthalmia 
May be primitive or symptomatic, acute, or chronic,—and its causes 
may be local, or constitutional. Its manifestations may also be eon- affections of the tunica conjunctiva. 
89 
fined to the eye itself, or sympathetic symptoms may declare them- 
selves in the head, stomach, and other parts of the economy. These 
developments will depend much upon the constitution, temperature and 
habits of the patient, the causes which have operated to produce the 
malady, the severity of the inflammation, and the tissue of one eye dis- 
eased, the corresponding structure of the other eye is exceedingly prone 
to a similar morbid action, from sympathy. This may be accounted 
for from the fact that the eye receives its nerves and blood-vessels 
directly from the brain, by which the sympathetic communication be- 
tween the two organs is rendered very rapid and intense. 
Finally, we direct special attention to the therapeutical connection, 
existing between morbid conditions of particular tissues and primitive 
medicinal symptoms upon the same tissues, in health. We have al- 
ready a few specifics which impress certain structures only, and we 
trust that the time is not distant when medicines will be discovered 
capable of acting surely and specifically upon each separate part of 
the eye or its appendages. Fortunately, a few of our drugs have a 
wide range of action upon the visual organs, so that we shall be able, 
even now, to find specifics which correspond with almost any morbid 
symptoms that may present themselves. 
1. AFFECTIONS OF THE TUNICA CONJUNCTIVA. 
A. CONJUNCTIVITIS-ACUTE OPHTHALMIA. 
Conjunctivitis.—This may be 1. simple, 2. eruptive, 3. catarrhal, 4. 
purulent, 5. gonorrhoeal, 6. conjunctivitis of new-horn infants. 
Catarrhal Form. Dr. Williams* in both the acute and chronic 
stages depends upon a solution of Sulphate of Zinc in proportion of 
from two to four grains to the ounce of water, or rose water. 
In the more obstinate or chronic cases, an additional local applica- 
tion should be made by the physician himself,—the crayon of Sulphate 
of Copper, prepared as heretofore described and lightly passed over 
the inner surface of the upper lid, which is the original seat of the 
disease. 
Catarrhal ophthalmia usually begins with a reddening and swelling 
of the carunculaz and plica semilunaris/ the lining membrane of the 
lid exhibits the vessels increased both in size and brightness of color. 
Next the ocular conjunctiva becomes inflamed, and in severe cases the 
fine net-work of the vessels extends quite up to the edge of the cornea. 
It is only when this form of ophthalmia is not fully and completely 
cured in its acute stage that it lastly attacks the upper lid. 
Diagnosis.—One of the first local signs of simple inflammation of 
* On Diseases of the Eye, p. 40-41. 90 
DISEASES OF THE SANGUINOUS FUNCTION. 
the conjunctiva is an injection with red blood, of a number of.the ves- 
sels which naturally admits only white fluid. This gives to the eye 
that slight appearance of redness and distention of vessels which 
characterizes the first stage of acute ophthalmia. The eye now be- 
comes more than usually sensitive to light, smoke and dust; tears are 
easily excited; a feeling is experienced similar to that produced by 
particles of sand or dust lodged under the upper eyelid, causing the 
patient to constantly rub the eye, in order to remove what he supposes 
to be a foreign substance; a sense of heat, fullness, stiffness and ting- 
ling is felt in the globe and edges of the lids ; and slight pains begin 
to shoot through the eye. At first but a part of the vessels become in- 
jected, but as the inflammation increases, the anastomosing branches 
become involved, until finally the whole eye presents a uniform appear- 
ance of deep redness, swelling and turgidity. At this period of the 
disease, the functions of the eye are all more or less perverted ; there 
are acute pains in the ball; great intolerance to light; a profuse se- 
cretion of scalding tears ; disordered vision; agglutination of the lids 
in the morning from matter secreted by the meibomian glands; intense 
pain on moving the lids; distressing sense of distention, weight and 
rigidity of the whole organ. 
The symptoms thus far detailed, are purely local and include all 
the symptoms which are present from the commencement to the ter- 
mination of many simple cases of acute ophthalmia. But in the ma- 
jority of instances the whole system sympathises with the local affec- 
tion, and we are presented with the following additional train of con- 
stitutional or sympathetic symptoms; acute pains extending from the 
eye into the temples and anterior portion of the brain; slight chills, 
followed by accelerated respiration and circulation ; hot and dry skin; 
determination of blood to the head and face ; nausea; loss of appetite ; 
lassitude; general irritability; physical weakness; and other indi- 
cations of general fever. 
During the progress of the inflammation a peculiar appearance is 
often observed above the cornea, in the form of a circular elevation 
termed chemosis. This arises from the precaution which nature has 
taken to protect the cornea from the injurious effects of ophthalmia, by 
fixing the conjunctiva more firmly upon this portion of the globe than 
upon the other parts. By this peculiar construction, the distention of 
vessels and effusions resulting from violent inflammations, are princi- 
pally manifested in the first instance, without the cornea, and thus in 
some measure protecting this important part from the injury it might 
otherwise sustain. 
The severity of the symptoms will depend much upon the constitution 
of the patient, and the nature of the exciting cause. The disease may 
terminate in a cure, wuthout any marked alteration in the appearance AFFECTIONS OF THE TUNICA CONJUNCTIVA. 
91 
of the eye, or it may result in effusion, causing an elevation of the con- 
junctiva above the cornea; or in adhesion of some portion of the 
conjunctiva covering the cornea, and giving rise to those appearances 
known as nebulas albugo, leucoma, and opacityy or in suppuration, 
from the surface of the conjunctiva; or in ulceration of some part of 
the cornea; or in sloughing of the cornea. These appearances will be 
more particularly described in our article on opacity of the cornea. 
Causes.—Undue exposure to intense heat or cold; inordinate use 
of the eyes by a glaring or dim light; the application to the edges of 
irritating foreign substances ; mechanical injuries; extension of con- 
tiguous inflammations to the eyes; sudden changes of temperature; 
metastases of gout and rheumatism. 
Prognosis.—If appropriate remedies are administered in the early 
stage of the disease, and before any organic lesion has taken place, we 
may generally predict a speedy and perfect cure. On the contrary, if 
effusion, ulceration, or the adhesive process of the conjunctiva over the 
cornea has commenced, we must be more guarded in our prognosis, 
for under these circumstances the malady often ends either in impaired 
vision, or a total loss of sight. 
Much information may be derived respecting the probable termination 
of the malady, by a careful examination of the causes, which have been 
or may still be in operation, and of the temperament and constitution 
of the patient. For example, an individual of an irritable and nervous 
temperament, and of a delicate organization, may be affected with the 
most violent local and constitutional symptoms for a considerable period, 
without endangering the integrity of the eye; while a sanguine, ple- 
thoric, and robust patient might experience no constitutional effects, 
and but moderate local symptoms, and yet speedily suffer from serious 
disorganization of one or more of the tissues. Much will also depend 
upon our ability to remove all causes which may have conduced to the 
complaint, and to enforce upon our patients the necessary restraints 
and attention durino- the treatment. 
O 
Treatment.—The first therapeutical indication is to confine the 
patient to an apartment in which the light is mostly excluded. It must 
be remembered that this natural stimulus of the healthy eye becomes, 
during an acute inflammation of its tissues, a powerful irritant—a 
morbid agent capable of aggravating and perpetuating the disease. As 
the inflamed stomach can not tolerate its natural stimulus, the food, 
so the inflamed eye cannot endure with impunity, its ordinary stimulus, 
the light. Perfect cleanliness should be enjoined, and, in an exclusion 
of all dust, vapors, smoke, and bright rays of light. In making ap- 
plications to the eye, great care should be taken to avoid compression 
of the inflamed part, in order that the circulation may remain unob- 
structed, and that sufficient air may be admitted to the parts. 92 
DISEASES OF THE SANGUINOUS FUNCTION. 
Respecting local applications, we entertain the most exalted opinion 
of cold 'water. This may be applied by means of a few folds of soft 
linen cloth, which may be frequently dipped in the water, and after 
being partly wrung out, laid loosely over the eye and the surrounding 
parts. This application may be persisted in at suitable intervals, until 
the active symptoms have subsided, and a state of sub-acute iufiam- 
mation occurs, when recourse may be had, if deemed necessary to Col- 
lyria of a slightly stimulating character, like weak solutions of Zinc, 
Nitr.-argenti, lead, or copper. In making use of these last named 
articles, we should only employ a strength sufficient to create a decided 
medicinal action, and omit the application when this effect is apparent, 
and so long as the consequent reaction or amendment continues; for 
external remedies when judiciously employed are subject to the same 
laws ofprimary and secondary action, as when administered inter- 
nally. We shall say more upon this subject under chronic ophthalmia. 
The medicines to which we call attention, are: Belladonna, Aconite, 
Arsenicum, Sulphur, Digitalis, Euphrasia, Pulsatilla, Arnica, 
Spigelia, Mercurius-sol., Graphites, Lycopodium. 
Belladonna.—Redness, swelling, and protrusion of the ball of the 
eye; chemosis; swelling of the lids; frequent discharge of hot salt 
tears, or dryness of the eyes; spasmodic closure of the lids; flushed 
cheeks ; throbbing of the carotid and temporal arteries ; full and rapid 
pulse ; hot and dry skin. 
Great intolerance to light; pain, burning, and smarting in the eyes; 
heaviness, pressure and throbbing to the ball and lids; sharp pains in 
the orbits, extending into the brain; tearing pains in the eyes from 
within outwards ; dimness and obstruction of vision; spasmodic sensa- 
tions in the eyes. 
Nervousness; irritability; disinclination to mental labor. 
Belladonna is suitable in ophthalmia occurring in sanguine and ir- 
ritable persons, from congestions of blood to the eyes in consequence 
of exposure to cold, excessive use of the eyes, metastases of rheumatism 
and gout. It is particularly useful when constitutional symptoms show 
themselves in the form of acute or throbbing pains in the head and 
temples, hot skin, rapid pulse, flushed cheeks, dilated pupils, and per- 
verted vision. 
Pathogenetic effects of Belladonna:— 
First.—Irritation of Mucous Membranes. — Dr. Richard Hughes 
says of the effects of this remedy :—The conjunctiva is generally in- 
jected in Bell, poisoning, sometimes partially inflamed. The remedy 
does well in alternation Avith Aconite in catarrhal ophthalmia, also in 
the strumous form 
Second.—Throat.—It produces dryness, heat, soreness, and redness 
in this order. See its use in scarlatina and erysipelas. AFFECTIONS OF THE TUNICA CONJUNCTIVA. 
93 
In another paper Dr. Hughes inquires why Opium contracts and 
Belladonna dilates the pupil; and he comes to the conclusion that 
Opium contracts the pupil by depressing the sympathetic nerve and 
Bell, dilates the pupil by exciting the sympathetic nerve. 
Sensibility of the eye to Bell, is shown by Dr. De Ruyter, who states 
that a drop of a solution, containing not more than -nr»Vcnr part of 
sulphate of Atropine, when kept for some time in contact with the eye 
of a dog, sufficed to produce a dilatation of the pupil lasting for twenty 
hours. A solution of —6V<r produces a powerful dilatation in ten or 
fifteen minutes which disappears only at the end of four days. Of the 
single drop employed in this manner perhaps not one-fiftieth part is 
absorbed. 
Aconite.—Vessels of the conjunctiva injected with red blood; lips 
red and swollen; chemosis; dilatation of the pupils; lachrymation, 
worse on the slightest exposure to light, dust, or smoke; photophobia; 
flushed cheeks; hard and rapid pulse; hot and dry skin, and other 
febrile symptoms. 
Very great intolerance to light; pressing, stinging, burning, or ex’ 
ceedingly acute pains in the eyes; eyeball feels bruised, and pressed 
into the orbit; stinging and smarting of the lids; eyes very hot, 
and filled wTith scalding tears, or preternaturally dry; pressure, or 
sharp, beating or stinging pains in the head and temples; impaired 
vision, as from gauze before the eyes; general febrile disturbance. 
Much mental excitement; fear and apprehension in regard to proba- 
ble result of the case. 
Remarks.—This remedy is particularly called for when the local 
inflammation is very intense, and the constitutional symptoms run high. 
It operates most happily in plethoric, bilious, and sanguine individuals, 
who are subject to determinations of blood to the face, head and lungs. 
It is appropriate in opthalmias caused by colds, by the introduction 
of foreign substances into the eye, and by rheumatism and gout. 
Arsenicum.—Conjunctiva much congested, and of a dark red color; 
oedematous swelling of the lids ; profuse lachrymation; tears hot and 
corrosive to the cheeks ; lids dry and red ; eyelids partially closed from 
the great swelling; nightly agglutination; spasmodic movements of 
the lids, on exposure to light; ulcers on the cornea. 
Sensation as if sand had become lodged in the eye; tearing, burning, 
or stinging in the ball and lids, aggravated by motion, or on exposure 
o light; throbbing in the eyes when lying down; impaired vision; 
weakness, weariness, and tremor of the lids; great intolerance to light; 
constant inclination to rub the eyes. 
Mind weakened, and whole system rendered nervous and irritable 
by pain and suffering. 
Arsenicum is applicable to those cases which arise in weakly and 94 
DISEASES OF THE SANGUINOUS FUNCTION. 
nervous constitutions, where the pains are severe, and the disease is 
unusually obstinate. In this variety of ophthalmia, the local and 
sympathetic symptoms are very troublesome, but there is much less 
danger of serious organic lesions than in most other forms of the 
malady. It is advised in ophthalmia arising from cold, rheumatism 
and gout. 
Sulphur.—Injection of the vessels of the conjunctiva; redness and 
swelling of the lids; lachrymation, or preter-natural dryness of the 
eyes; morning agglutination of the lids; photophobia; eyes swollen 
and prominent; cornea dim; lids oedematous; distention of the con- 
junctiva from effusion. 
Pressure of the eyeballs, worse on moving them; pressure, burning, 
and itching of the lids; intolerance to the rays of the sun; twitching 
of the lids; trembling of the eyes; painful dryness of the margins of 
the lids; bruised feeling of the eyes, on motion; sensation of sand 
under the upper lid, on motion; dimness of sight. 
Sensitive ; despondent; out of humor. 
Remarks.—Sulphur is adapted to lymphatic temperaments—a scro- 
fulous or psoric dyscrasia; and may be employed in ophthalmia caused 
by repelled eruptions, abuse of mercury, or irritating matters introduced 
into the eye. 
Cases treated in the Onondago County Orphan Asylum.—(1860, 
Amer. Ilom. Rev. Vol. 2, p. 125.)—Dr. Morgan reports that its in- 
mates, averaging in number 125, had been severely afflicted by ophthalmia 
characterized by: Intense redness and swelling, profuse secretion of 
mucus and tears, excessive photophobia. New cases were constantly 
occurring, and new comers were almost sure to be attacked in spite of 
all precautions. The investigations failed to discover the cause of the 
malady; but a large majority were scrofulous subjects; the gums were 
more or less affected, some with scarcely perceptible redness and 
swelling, whilst others were extensively ulcerated. Spongy, easily 
bleeding, teeth loosened, breath offensive, salivation, &c. 
The treatment that succeeded after former failures.—Give Sulphur 
30, once a week to all well children. All affected with the ophthalmia 
wTere immediately placed under Bell, and Merc. Sol. in alternation; at- 
tenuations ranging from 3d to 12th. Repetition according to the severity 
of symptoms from every hour, to two a day; with occasionally a dose 
of Sulphur 30. 
This course of treatment was crowned with the happiest effects. No 
cases of the disease remained under treatment when the disease was 
made. Vision was not impaired in a single instance. 
Cantharides.—A man who was standing over a pan where Cantharides 
was boiling was affected with inflammation of the eyes, coryza, and swell- 
ing of the nose. Camphor was given. Next morning every thing appeared AFFECTIONS OF THE TUNICA CONJUNCTIVA. 
95 
to liim yellow, which is a symptom of poisoning by Cantharides: he 
was well in three days. Camphor is the antidote of Cantharides. 
The case of Wm. H. Prescott, the historian, is given in a late publica- 
tion by Dr. James Jackson,* of Boston, which revives the melancholy 
sympathy which long ago pervaded all minds that had been enlightened 
or influenced by his works. Mr. Prescott lost an eye by accident, when 
he was on the point of finishing his studies at Harvard;- and the other 
being compelled to perform double duty, was soon weakened, and its 
power was never recovered. Devoting himself to historical researches, 
he, by the aid of an amanuensis, composed those historical works, 
which have in all countries been regarded as among the highest of 
American literary productions ; and after much suffering from disease, 
especially from the eyes, he died January, 1859, in his sixty-third year. 
The medical treatment he received near the close of his life is given 
in this work. It seems that for the relief of a violent inflammation of 
the eye, which turned out to be rheumatic, more than seven pounds of 
blood were drawn in the course of five days, besides which he “was” 
says Dr. Jackson, “purged abundantly, was blistered freely, was kept 
in the dark, and on the lowest diet; also, the vessels of the conjunctiva 
were divided twice. 
It is not for the purpose of commenting upon this treatment that we 
have quoted the author’s exposition of it. Our creed differs from his, 
and it could not be expected that we should harmonize with him in 
measures which were, without doubt, conscientiously employed by him. 
Conjunctivitis from Extension of Strumous Eczema.—Case.—A 
boy, aged eight years, had eczema covering the face ; secretions of 
lymph and pus, with blood from capillary lesions from crusts on the 
suppurating surface; the head and face swell; eyes are concealed by 
oedema of the lids; conjunctiva injected, papillary granulations; tarsi 
agglutinated; photophobia excessive; lachrymation; the globe remain- 
ing sound. The boy, who had been bright, became stupid and irritable. 
Was treated nine months by an oculist without benefit. Iodide of iron 
caused restlessness at night and fever. Dr. Hirschell, of Dresden, pre- 
scribed Graphites 2°, one grain twice a day. On the eighth day the 
crusts began to drop; soon left the skin smooth. Light became daily 
more tolerable. On the seventeenth day inflammation had vanished. 
A daily glass of Kreuznach waters (containing Bromine). A relapse 
occurred in winter but was promptly arrested by Graphites. A year 
after the boy continued well. 
Graphites.—Acrid heat in the eyes; painful swelling and redness 
of the lids, and burning itching at their angles with muco-purulent se- 
cretion agglutinating the lids; also dry irritation of their margin; the 
light is insupportable. Adapted to ophthalmias evolved from a strumous 
*‘'Another Letter to a Young Physician,’5 &c., Boston, 1861. 96 
DISEASES OF THE SANGUINOCS FUNCTION'. 
diathesis. Lymphatic swellings, especially in subjects with light hair 
pale complexion, and deeply perverted moral symptoms. In vesicular 
eruptions as eczema, impetigo, pallae and ecthyma, clematis fails; 
though it succeeds better in scrofulous eruptions, acne and sycosis. 
In the purely conjunctival form of catarrhal ophthalmia nitrate of 
silver is almost a specific ; whereas, in ophthalmia involving the sclero- 
tica, and the Cornea it is useless, even injurious. In the former of 
these affections the best of allopathic physicians sometimes arrest the 
disease in a week which by the older system of bleeding, blistering 
and starving, sulphate of zinc and saccharum saturnia would have 
employed months. 
By the use of the crayon of sulphate of copper it is possible to de- 
stroy the inflammation without any of extreme results of nitrate of 
silver. The latter sometimes “ destroys the tissues to such an extent 
as to cause adhesion of the entire lid to the globe, or produce indelible 
stains, which often ensue when the agent is employed for a consider- 
able time.” Dr. Williams says: u Having charge, at one time, of a 
large number of ophthalmic patients in a public institution comprising 
many cases of chronic granulation of the lids, I repeatedly applied 
the crayon of sulphate of copper to one eye, and solutions of nitrate of 
silver of various strength to the other eye of the same patient.” “ In 
every instance recovery was more rapid in the eye to which the crayon 
had been applied,” and in some it wTas necessary to resort to it in those 
eyes in which the nitrate of silver had been tried. 
In the conjunctivitis of new-born children the nitrate of silver should 
be avoided, as being less safe and less useful than the other means al- 
ready described. 
Calcarea.—Diseases of the eyes in scrofulous subjects, affected with 
glandular swellings. Dr. Guinness gives a case {Brit. Jour. Homceojp. 
Vol. 5):—•“ A boy, aged three years, who had been ill twelve months, 
could not bear the least ray of light; eyelids puffed; flow of hot tears ; 
much purulent matter discharged; face swollen, pale, unhealthy; ab- 
domen large ; dejection of spirits. He wished to sit by himself in the 
dark; an eruption on the legs. Sulphur 30°, a dose every morning was 
given to him for three -weeks. This produced decided benefit. Cal- 
carea 30° was next given, with still greater advantage. Then Sulphur 
was given one w*eek and Calcarea the next, and so on during alternate 
weeks; and the child was cured.” 
Digitalis.—External Indications.— Intense redness of the con- 
junctiva; inflammation of the meibomian glands ; swelling of the lids; 
constant and profuse laehrymation; photophobia; dryness of the nose; 
morning agglutination of the lids ; tears hot and corrosive ; countenance 
bloated. 
Physical Sensations.—Aching, throbbing, burning, pressing, or AFFECTIONS OF THE TUNICA CONJUNCTIVA. 
97 
stitching pains in the affected eyeball, worse when moving or touching 
it; feeling as of sand under the lids; discharge of hot and irritating 
tears, on exposure to the open air or to light; intolerance to light; dim 
ness of sight; eyes constantly hot and painful; objects all appear un 
natural; visions before the eyes. 
Mental and moral Symptoms.—The predominant mental traits are 
despondency and mental languor. 
Remarks.—Digitalis is suited to sanguine temperaments and also to 
persons of a scrofulous habit. It has been successfully employed in 
ophthalmias consequent on colds, scrofula, and gout. 
Euphrasia also corresponds to most of the symptoms of Digitalis, 
and may sometimes be substituted to advantage in place of this last 
remedy, when the desired effect is not promptly produced. 
If, as Murray asserts, Euphrasia cures lippitudo and a certain form 
of ophthalmia, how could it otherwise produce this effect, hut by the 
faculty it possesses of exciting a kind of inflam,mation in the eyes, as 
has been remarked by Lobelius. 
The old practice of applying rose water externally in ophthalmic 
diseases, looks like a tacit avowal, that there exists in the leaves of the 
rose some curative power for diseases of the eye. This is founded upon 
the homoeopathic virtue which the rose possesses, of exciting a species 
of ophthalmia in persons who are in health, an effect, which Echtius, 
Ledelius, and Rau actually saw it produce. (Hahnemann.) 
Pulsatilla is appropriate in catarrhal or rheumatic ophthalmia, at- 
tended with pressure and burning in the eyes, as if from sand ; redness 
and swelling of the conjunctiva and lids; coryza; profuse lachrymation 
in the wind or open air; burning and itching of the eyes, inducing a 
disposition to rub them; photophobia; inflammation and secretion of 
mucus from the meibomian glands; dimness of sight; morning ag- 
glutination. 
Arnica is indispensable in ophthalmic inflammations caused by 
mechanical injuries of the eye, or of the parts in its vicinity. The re- 
medy may be used externally and internally. 
Spigelia is especially adapted to rheumatic and arthritic ophthal- 
mia ; the pains are of a pressive or stitching character, and aggravated 
by movement; the vessels of the conjunctiva are much congested; the 
cornea is dim; aching pains are experienced in the eye when touched, 
extending deep into the orbit; the upper lids swollen and stiff. 
Mercurius-sol. is proper in catarrhal and rheumatic ophthalmia. Its 
indications are: Inflammation of the eyes, attended with burning, smart- 
ing, heat and pressure, worse in the open air; sensation as if sand were 
under the upper lid; profuse lachrymation; photophobia; darting 
pains in the eyeballs; redness and swelling of the lids; dimness of 
Vol. H.—7. 98 
DISEASES OF THE SANGUINOUS FUNCTION. 
vision; pains worse when moving or touching the eye; boring pains in 
the eyes and surrounding parts. 
Other remedies are, Graphites, Lycopodium, Nux-vornica, Calca* 
rea-carb , Colocynth, Rhus, Cocculas, Cannabis, and Dulcamara, to 
which the reader is referred. 
Administration.—In very acute cases we advise the third attenua- 
tion, and a repetition of the dose every two hours until the desired im- 
pression is produced. In more mild forms of the disease we use the 
first or second attenuations, and repeat every six or eight hours, as long 
as is deemed necessary. 
Nitrate of Silver.—The common abuses of this potent remedy are 
well set forth by Dr. Williams in a recent American work on Diseases 
of the Eye.* When local applications are to be made to the eye, he 
says : Solutions are preferable to any other form, as their strength can be 
graduated to the proper degree. No ointments of any kind should ever 
be used inside the eyelids. They are liable to vary in strength, to be- 
come rancid or decomposed, and their fatty substance is ill suited for 
distributing the medicinal agent over the affected surface. He has 
“seen most serious results from the incautious use of Nitrate of Silver 
ointment in the hands of physicians” as well as in those of “ well mean- 
ing friends.” (p. 16.) 
“The abuse of strong solutions of Nitrate of Silver” is another evil to 
which I feel bound to call attention. It is apparently considered by 
some a specific for all the diseases which eyes are heir to, and is so 
lavishly employed that we not only observe, as results, a disagreeable 
olive stain of the conjunctiva, but in some instances, destruction of the 
folds of this membrane and adhesions between the lid and the globe, 
where solutions approaching to saturation have been incautiously ap- 
plied. It frequently aggravates the symptoms, and I can assert, as the 
result of many comparative trials, where the Nitrate in solutions of 
different strengths has been used for one eye, and solutions of Sulphate 
of Zinc, with perhaps the crayon of Sulphate of Copper for the other 
equally diseased eye of the same individual, that I have always found 
recovery slower in the eye to which the Nitrate of Silver was applied, 
and often been compelled to abandon its use and substitute the treat- 
ment under which the other eye had already recovered.” The Nitrate 
of Silver may still be resorted to in certain cases, but he has long ab- 
stained entirely from using it inside of the lids ; and thinks, “it would 
be a gain for ophthalmic therapeutics, if its use should become far less 
general; and when its application is followed by recovery, the same 
result would have been attained had milder means been trusted to.” 
(p. 18.) 
* A practical Guide to the study of Diseases of the Eye ; their Medical and Surgi 
cal treatment. By Henry W. Williams, M. D., &c. 8vo. pp. 317. Boston, 1862. CHRONIC OPHTHALMIA. 
99 
The Crayon of Sulphate of Copper is capable of replacing wTith great 
advantage the Nitrate of Silver, in most of the cases where this has 
been in favor, especially in the treatment of conjunctival inflammation 
and granulated lids. It does not, like the Nitrate in substance or 
strong solutions, act as a caustic, destroying the surface of the conjunc- 
tiva, but as a powerful astringent. To obtain good crayons, which is 
exceedingly important, it is almost essential to procure crystals from a 
laboratory, or to recrystallize a quantity of the Sulphate ; as when sent 
to market, the crystals are so much broken, that it is difficult to find 
suitable pieces. The part to be selected is the hard portion free from 
water of crystallization, near the apex of the crystal. This is to be 
carefully cut with a pocket-knife, or sawn into the desired shape, which 
should be that of an ordinary crayon of large diameter. It may be 
rendered as smooth as a piece of glass by rubbing with a wet rag, and 
fitted in a port-caustique. If the selection has been well made, the 
crayon will appear perfectly smooth, and if carefully wiped after each 
application, may be used a great number of times, and for .various 
patients, without danger; though, of course, as a precaution, the physi- 
cian should be provided with several, if he has to employ them upon 
those whose diseases are highly contagious. It should usually be very 
lightly applied over the whole surface of the conjunctiva of the everted 
lid. Too heavy a touch should be avoided, as, if clumsily used, it causes 
much more pain, and acts as an over-stimulus.” (Williams, p. 19.) 
“ Wrhen the eyelid is covered with small, hard and pale papillae, or as 
they are termed granulations, the best effects are seen to follow the 
light application of the Sulphate of Copper.” (Frederick Tyrrel. 
London. Vol. I., p. 137.) As regards the large and flabby form, the 
cure is slow, and is but little assisted by local scarifications and the 
application of strong solutions of Nitrate of Silver, though applied by 
a camels-hair pencil to the inverted eyelid, and carefully wiped with a 
soft sponge. The application of the Copper, even lightly, gives great 
pain; and the patient should be always allowed after it to wash the eye 
freely in cold or warm water. 
Chronic ophthalmia may arise in consequence of the subsidence of 
the active symptoms of the acute form of the disease, and the persist- 
ence of a condition of sub-acute inflammation, or from causes which 
operate gradually, and induce an atonic state of the parts, and a low 
grade of morbid action. It may continue in this chronic state for years, 
without causing any notable organic derangement, the only difficulty 
experienced being a weak, sensitive and irritable condition of the eyes. 
Diagnosis.—When chronic ophthalmia succeeds the acute, it will be 
2. CHRONIC OPHTHALMIA. 100 
DISEASES OF THE SANGUINOUS FUNCTION. 
found that a part of the vessels of the conjunctiva have recovered their 
tone and now circulate only the white blood, as formerly, while the 
larger vessels remain injected with red blood. These larger vessels, 
during the progress of the disorder, become so much distended by the 
intromission of the red globules, that a varicose dilatation often re- 
mains for a long period after the acute stage has been passed, and thus 
establishes the chronic malady. One of the prominent local symptoms, 
therefore, of chronic ophthalmia, as distinguished from the acute variety, 
is the moderately congested state of the vessels, Avhich renders the 
conjunctiva partly red and partly white. The eye is also much less 
sensitive to light, dust, and smoke; tears are not so easily excited; 
vision is improved; there is an absence of pain, burning and heat; tears 
are not so hot and acrid; the swelling of the lids is diminished, and 
febrile and sympathetic symptoms have disappeared. But the eye is 
more sensitive than natural to light; the edges of the lid are red or 
purple; nightly agglutination occurs ; the patient is unable to use the 
eyes long at a time; objects often float before the eyes, obstructing 
vision; the lids itch and tingle, mostly in the morning on rising; flow 
of tears, caused by cold air, light, wind, smoke, dust, and vapors. 
Causes.—Acute inflammation; habitual intemperance ; constant ex- 
posure to irritating vapors ; metastases of rheumatism and gout; ex- 
ternal injuries; repelled eruptions; protracted exposure to cold in a 
region of snow ; excessive use of the eyes by a strong or dim light. 
Prognosis.—Unless adhesions have taken place between the con- 
junctiva and cornea, or ulcers, cicatrixes, or effusions have formed, so 
as to obstruct the rays of light, we may expect a ready cure of the 
disease. If however disorganization has already occurred and vision 
has become obstructed, we may predict a cure of the morbid inflam- 
matory action, but only a partial restoration of sight. Habitual chronic 
ophthalmias, proceeding from intemperance, constant exposure of the 
eyes to stimulating vapors, &c., may readily be cured by removing the 
exciting causes, and having recourse to the appropriate local and inter- 
nal remedies. 
Treatment.—It is in this variety of'ophthalmia that we may expect 
to derive most benefit from the use of stimulating Collyria. The object 
of all remedies, as has before been observed, is to create a healthy 
medicinal action in the diseased part, which shall supersede the morbid 
action, and thus secure a cure. But we have also seen, that this medi- 
cinal effect must be two-fold in order to prove curative; or in other 
words, there must be a primary and a secondary effect, the former 
analogous to that of the disease, and the latter the reverse, or cura- 
tive. Whenever these two conditions result from the application of 
remedies, internal or local, a cure may be expected. Care, however, 
must always be observed, that the medicines be so adapted to the nature PURULENT OPHTHALMIA. 
101 
of the case, that the primary symptoms shall be of short duration, and sue 
ceeded by the legitimate, opposite, or curative reaction. (Vol.I. p. 112.) 
In deciding, therefore, respecting the proper strength of a local ap- 
plication to an inflamed eye, we may follow the maxims of Hahnemann, 
or, what will answer as well, adopt the following rule inculcated by Sir 
Astley Cooper, in regard to the use of Collyria, viz : “ To judge how 
far the stimulus may be carried, the criterion is exceedingly simple; 
if you find that a certain degree of smarting and pain is produced, 
which soon subsides and leaves the patient much more easy than be- 
fore, you may be convinced that the Collyrium is beneficial; if on the 
other hand, the patient experiences a great degree of pain, which does 
not subside speedily, and the vessels become turgid, you may be as- 
sured, that the Collyrium is doing harm, and that the quantity of stimu- 
lus ought to be diminished.” 
The best local stimulus we ever employed in clearly pronounced 
chronic inflammation of the eyes, is the wine of Opium (vinum opii), 
a single drop to be introduced into the eye once or twice in twenty-four 
hours, until there is a permanent reaction. When the secondary symp- 
toms do not speedily appear after the application, we may then have 
recourse to a weak solution of Sulphate of Zinc, or of Nitrate of Sil- 
ver. If these fail, a solution of Aconite may be tried. 
The internal remedies are : Arsenicum, Belladonna, Calcarea-car- 
bonica, Sulphur, Rhus, Silicea, Nux-vomica, Graphites, Phos- 
phorus. 
The indications for the use of these different medicines will be found 
under acute ophthalmia. The principal difference between the two 
forms of the malady consists in degree rather than in the quality of 
the symptoms. 
Respecting the administration and repetition of doses, we prefer the 
first, second, and third attenuations, and advise a repetition once in 
twenty-four hours until an impression is produced. 
3. PURULENT OPHTHALMIA. 
Diagnosis.—This variety of ophthalmia is more violent and destruc- 
tive, and runs its course with much greater rapidity, than that which we 
have described. It is characterized by a profuse purulent secretion 
from the conjunctiva, which collects and hardens about the lids and 
glues them together, and in this way acts as a constant irritant to the 
inflamed part. The disease commences like the simple acute ophthal- 
mia, with itching, stinging, or burning sensations in the lids and globe, 
lachrymation, sensitiveness to light, redness of the conjunctiva, which 
soon increase to an intense villous redness, as swelling of the lids, sen- 
sations as if foreign substances, like sand or sticks, were in the eye, 102 
DISEASES OF THE SANGUINOUS FUNCTION. 
and more or less indistinctness of vision. These symptoms augment 
very rapidly in intensity, the tingling sensations change to severe pains 
through the eye, sometimes extending to the temples, and even the brain 
itself; there is chemosis, the lachrymation becomes changed into a pro- 
fuse secretion of pus, either yellow or greenish ; the intolerance to ligh 
becomes more marked, the lids are very much swollen, and discharge 
much purulent matter; and there is almost a total obstruction of sight 
Constitutional symptoms frequently occur, as in simple ophthalmia, in 
the form of headache, nausea, quick pulse, hot skin, general prostration, 
&c. This acute stage terminates in a short period in a sub-acute in- 
flammation, or in ulceration and sloughing. When the former termina- 
tion happens, there is a gradual subsidence of all the symptoms, and 
the disease remains for an indefinite period in this atonic state, after 
wrhich the eye may recover its tone and healthy function. But if 
sloughing takes place, the destructive process may run on to a total 
destruction of the part, unless energetic measures are used to arrest its 
progress. 
Causes.—Sudden alternations from heat to cold ; endemic and epi- 
demic influences; the irritation of hot sand introduced into the eyes; 
metastases of rheumatism, gout, scarlatina, small pox, and measles • 
abuse of Mercury; the morbid vaginal secretion to which the eyes of 
new-born children are sometimes exposed 
4. GONORRHOEAL OPHTHALMIA. 
Diagnosis.—This variety of inflammation attacks the conjunctiva 
also, and is attended with symptoms very similar to those of purulent 
ophthalmia, but of much greater intensity. This disease is supposed to 
be the most violent and destructive of any to which the eye is subject, 
and it is not uncommon to see it proceed to the entire destruction of 
vision, notwithstanding the most early and energetic attempts to cure 
it. There is especial danger, in gonorrhoeal ophthalmia, of a speedy 
formation of ulcers of the cornea, and of rapid sloughing through the 
tunics of the eye. When, however, we are called to a case of this de- 
scription, with intense inflammation and redness of the eyes, greatly 
swollen lids, very abundant discharge of pus, or of a dry and burning 
state of the conjunctiva and lids; excruciating pains in the eyes and 
head; chemosis; great intolerance to light; hot skin; nausea; thirst; 
and other febrile symptoms; it becomes us to exercise the utmost vigi- 
lance in our remedial measures, in order to save the eyes from ulcera- 
tion and sloughing. Farther on we shall detail a method of treatment 
which will generally be found successful, even in the most severe cases. 
Nothing, however, but the strictest attention to every minute symptom GRANULAR OPHTHALMIA. 
103 
of the case, and a constant watch over medicinal effects will ensure 
success. 
The cause of this affection is unquestionably the application to the 
eyes of gonorrhoeal matter, and not, as some suppose, a metastasis ot 
the disease to the eyes. 
Another variety of purulent ophthalmia to wdiich it is proper to allude 
is that which occurs in infants shortly after birth. This disease is sup- 
posed to arise from the contact of the vaginal secretion of the matter 
with the eyes of the child during parturition. The symptoms generally 
first make their appearance in about two weeks after birth, but they 
may occur before, or several weeks after this period. The symptoms 
are similar to those of purulent ophthalmia; but for the most 
part, the inflammation is less intense, and there is much less danger 
of the speedy supervention of ulcers of the cornea. It is quite true 
that ulceration and sloughing ultimately occur in thes-e cases; but a 
longer time is afforded for our remedial efforts to take effect, and of 
course the prospect of cure thus enhanced. 
5. GRANULAR OPHTHALMIA. 
In 1825, two regiments of Neapolitan soldiers were ordered from 
Messina to Palermo in Sicily. They had scarcely taken up their 
quarters when a large number became affected with sore eyes. It was 
soon found to be rapidly extending, and many soldiers were losing their 
eyes. The king of Naples sent Quadri, the famous oculist, to investigate 
the disease. He at once decided that the disease was contagious, and 
called on any man who doubted it, to test his faith by applying some of 
the matter from a soldier’s eye to his own. His opinion of the disease 
was this: “This is the so-called Egyptian ophthalmia, which is conta- 
gious, and seated in the conjunctiva; it was brought to the sick of these 
two regiments by some soldiers who had been drafted into them before 
complete recovery, and propagated by one to another by careless use 
the same towels.” The characteristic peculiarity of the disease at its 
commencement consists in an exudatory process, and the secretion 
which is here formed during the inflammatory process, is confined to 
the palpebral conjunctiva, and serves as a vehicle for the contagion, 
The serum also which accompanies the chronic form, or the so-called 
granulations can be a constant medium for spreading the disease 
further.” 
Symptoms.—It begins as a contagious catarrhal inflammation of the 
conjunctiva, with tension in the neighborhood of the eye, and the organ 
itself feeling as if sand or dust were in it; dimness; intolerance of 
light; watery appearance, and somewhat increased secretion of tears; 
Contagious Conjunctivitis. Egyptian Ophthalmia. Granular Ophthalmia. 104 
DISEASES OF THE SANGUINOUS FUNCTION. 
slightly injected conjunctiva, and corresponding redness of the eyelids, 
with tumefaction, and a collection of mucus in the corners of the eyes and 
in the lashes. On everting the lid one could find the commencing 
granulations in crowded prominences, especially in the corners of 
the lid. 
When the disease had proceeded either slowly or rapidly from the 
first stage to the second, all the morbid appearances greatly increased; 
the characteristic secretion of mucus was more abundant; a thinner 
mucus, like white of egg, mixed with tears, flowed down the cheeks, but 
with a tendency to harden upon the cilia, and in the corners of the 
eyes, and to form crusts on those parts, so that, on waking the patient, 
the eyelids might be found stuck fast together. The intolerance of 
light and the pain increased, the latter reaching the orbits and side of 
the head. There is now intense, tensive, lancinating, and particularly 
burning pain in the eye, increased on each movement of the eyeball. 
The eyelids are bright red, swollen; and frequently an erysipelatous 
swelling extends upwards towards the forehead. When the swelling 
is somewhat abated, and the eyelid is turned outwards the conjunctiva 
is seen studded with watery, sponge-like excrescences, which are dilated 
with blood, and either look dry or hold in their interstices mucus or a 
puriform secretion. These excrescences sometimes bleed when touched. 
The conjunctiva over the sclerotic is found much reddened and injected 
with blood and sometimes even thrown into a kind of wall around the 
cornea. The palpebral conjunctiva, especially the upper portion, is 
often so swollen that it projects dark and distended through the pal- 
pebral tissue. These appearances, the hindrance to the escape of 
mucus, and consequent cloudiness of the cornea, the contraction of the 
pupil from sympathetic irritation of the iris, and finally, the febrile re- 
action, characterize the second stage of the disease. 
Third Stage.— The thin mucous secretion in the eye becomes 
changed into a thick, yellow pus-like matter, which after a time, so in- 
creases in quantity, that it escapes from beneath the upper eyelids, 
flows down the cheeks, and often causes them to ulcerate. At this point 
all the other symptoms attain their greatest intensity; the redness and 
swelling of the conjunctiva increase more and more ; and the redness 
of the upper eyelid becomes of a livid hue; the tumefaction enlarges, 
spreads to the orbital ridge, becomes dark and hard, and so overlaps 
the lower lid that the patient is no longer able to open the affected eye. 
The pain in the eye becomes more acute, spreading to the eyelids, and 
also to the globe, the orbital cavity, the forehead and temples; it is in- 
tense, burning, lancinating, penetrating, intermitting, and often ac- 
companied with evening exacerbations, reaching their intensity about 
midnight. The patient complains that he is holding his eyes over red- 
hot coals; and others say they feel the pain like to electric shocks GRANULAR OPHTHALMIA. 
105 
transmitted through the eye. The intolerance of light is intense, the 
pupil remaining contracted strongly and motionless. The swollen con- 
junctiva of the upper lid is now often projected considerably through 
the palpebral fissure and prevents the escape of the pus from the eye. 
The inner surface if now’ examined, shows the palpebral and ocular con- 
junctiva much injected and swollen, and running with pus and mucus; 
the vascular meshes were in this stage no longer distinguishable; round 
the margin of the cornea appeared a pale red, soft, irregular, mottled 
swretting, in which the cornea appeared to be buried, and was almost 
lost sight of. By drawing aside the red folds which were around the 
cornea, and which appeared on the surface smooth and level, they were 
often found to cover granulations seated on the conjunctiva. When 
the iris could be seen, it was observed to be rigid, and the pupil motion- 
less ; the whole system is excited by intense fever, accompanied in ir- 
ritable subjects by delirium at night. In this stage is recognized the 
third form or the contagious blepharo-blennorrhoea. When much 
swelling appears in the lower lid it has the effect of displacing it and 
producing ectropium. Attempts to open the eye often give rise to 
temporary ectropium. Towards the termination of this period there is 
extravasation of blood from the vessels of the palpebral conjunctiva, 
and this is followed by diminution or change in the secretion, and some- 
times by its complete cessation. 
Duration of the Disease.—The first stage lasts for a few hours or 
several days according to its severity. The latter stages are often 
prolonged for weeks. The nature of the products of inflammation is 
different in different degrees of intensity of the disease. After the acute 
form, morbid alterations and hypertrophy of the conjunctiva rarely 
remain. The chronic form is followed by a variety of products. 
Some of these are, warty growths, spongy, filamentous or cauliflower- 
like excrescences with which the conjunctiva is studded; these are 
fissured and contain pus in the interstices; though they are often dry, 
distended with blood, and softer ones bleed when touched. These 
granulations sometimes remain for a long period, resembling transparent 
milky vesicles, or milky yellowish knots with a pearly lustre, bathed in 
serum. The growths on the conjunctiva assume various forms; the 
brush-like watery exudations are usually firm and hard, of fibrinous 
character; more commonly found on the upper lid. Those on the tarsal 
portion small and in rows side by side. In other parts they are in 
groups, which in some remain a long time stationary. This roughness 
of the conjunctiva, or “trachoma,” indicates the chronic condition of the 
membrane which is the immediate cause of the roughness apparent. 
Pathdlogy and Diagnosis.—Dr. Baertl says “the peculiarity of 
granular ophthalmia in its commencement consists of the exudation of 
organizable plasma beneath the conjunctival epithelium in the form of 106 
DISEASES OF THE SANGUINOUS FUNCTION. 
small, distinctly translucent, light, and subsequently distended vesicles, 
which arrange themselves in rows like a string of pearls behind the 
tarsal margins, or may be found scattered with equal abundance over 
the whole surface; and further, the vesicles seated on the tarsal surface 
are smaller, flatter, and less regular in form. In many chronic cases 
they may remain for weeks with scarcely any abnormal vascularity of 
the conjunctiva, and without pain or uneasiness more than for heaviness 
of the lid. In the eye there is then no increase of mucus, and but 
slight cloudiness can be detected in the eye, which is only moist or 
slightly oedematous. 
On the other hand, in the acute attack the process has commenced 
before the patient suffered from pain or redness of the eye. Its duration 
is only a few hours before a notable congestion of the part takes place, 
with burning pain, feeling of sand in the eye, increased secretion of 
tears and mucus. The lids become oedematous, the conjunctiva dis- 
tended, infiltrated with simple serum, and traversed by fine, closely 
netted blood-vessels; the vesicles, clear at first, become opaque, yellow 
or gray, and finally red. 
Subsequently a deposit of plastic exudation take place into the 
parenchyma by which the conjunctiva is increased in thickness and 
thrown into folds; the membrane between the vesicular granulation is 
thickened; and growth and exudation occur at the same time, and 
also in the finer vesicular meshes that supply the papillee. 
Diagnosis.—Fleshy elevations sometimes occur on that portion of 
the conjunctiva which lines the eyelids, resembling in all respects 
granulations, and by their irritating effects upon the ball of the eye, 
give rise to troublesome inflammation, ulceration, and now and then to 
loss of sight. This affection has more frequently baffled the surgeons 
of the old school, than any other pertaining to the eye. Vene- 
section, leeching, cupping, blistering, moxas, cathartics, alteratives, 
stimulating collyria, and caustic applications have all been found en- 
tirely inefficient in its treatment, and the patients are generally doomed 
to a wretched existence for one or more years, until disorganization of 
the eyes by ulceration, leaves them in perpetual darkness. By homoeo- 
pathy, however, a new and healthy action can be created in the affected 
structure, which shall overcome and supersede the morbid action. 
These morbid granulations usually arise from an acute or sub-acute 
inflammation of the conjunctiva, occurring in individuals whose con- 
stitutions have become impaired and tainted by protracted syphilitic, 
gonorrhoeal, psoric, or scrofulous complaints. The granulations are 
rough and uneven, secrete an abundance of pus, which serves to irri- 
tate and weaken the eyes, and on every motion of the lids, operate on 
the balls as foreign substances; thus keeping up a perpetual inflamma- 
tion, and sooner or later leading to ulceration of the cornea. The dis- CONJUNCTIVITIS. 
107 
ease is for the most part confined to the upper eyelids, although we 
have seen, in some instances, the conjunctiva of the lower lids rough 
and granulated. 
O 
Occasionally we may detect the true character of the complaint by 
the thickness of the lids, and their roughness and unevenness to the 
touch; but the only certain method of investigation consists in turning 
over the lids, and thus exposing the palpebral conjunctiva to the sight. 
This disease very often proceeds to a fatal disorganization of the 
eye, without a true knowledge on the part of the physician, respecting 
the nature of the case. It is usually mistaken for one of the varie- 
ties of purulent ophthalmia. 
SIMPLE CONJUNCTIVITIS. 
CONTAGIOUS CONJUNCTIVITIS. 
1. Edges of the eyelids are partly or 
entirely hard, sensitive, and swollen; 
but the swelling does not extend beyond 
the margins. 
2. The capillary injection is in irre- 
gular branching meshes, rarely in the 
eyeball entirely red, as in contagious 
ophthalmia, and even then it only appears 
after long duration and maltreatment 
of the disease or after repeated relapses. 
3. The disease in the mild form is 
distinguished by the formation of plilyc- 
tenae and abscesses, which always arise 
side by side, on a patch of connected 
parallel vessels. 
4. The secretion contains epithelial 
cells in the earliest stage of development, 
and fatty globules from the meibomian 
follicles ; and it is moderate in quantity 
through the whole course of the disease. 
5. Serous infiltration of the sclerotic 
conjunctiva and of the eyelids is rare, 
and if present is always moderate. 
6. None of the neighboring parts ex- 
cept the nose are implicated. 
7. Conjunctiva only slightly swollen 
and velvety. 
CATARRHAL INFLAMMATION. 
1. In contagious blenorrhoea the first 
symptoms of inflammatory swelling are 
confined to the palpebral conjunctiva on 
the tarsal surface. The inflammation 
does not extend from without inwards, 
but from the point of origin, both out- 
wards and inwards. 
2. The vascular injection is uniform, 
and the single vessels indistinguishable, 
for the whole eyeball is red, the con- 
junctiva as if broken down, and of an 
opaque lustre. 
3. The inflammation in the mild form 
confined to the palpebral conjunctiva. In 
the more advanced state, a delicate 
homogeneous net-work of closely-packed 
vessels is formed over the sclerotic. 
4. The secretion contains fully de- 
veloped epithelial scales, a few mucous 
corpuscles, and no fat globules, but 
abundance of pus corpuscles. 
5. The serous infiltration and conse- 
quent bulging around the cornea, are al- 
ways present, and the swelling of the 
eyelids is considerable. 
6. The parts around the eye, and espe- 
cially the cheeks, are puffy, and the 
temporal region is often erythematous. 
The nose is only implicated when scro- 
fula is present as a complication. 
7. The conjunctiva swells so much, as 
the serous infiltration increases, that it 
projects through the fissure of the lids 
and causes ectropium of the lower lid 108 
DISEASES OF THE SANGUINOUS FUNCTION. 
8. The pain is in the first instance 
stinging and itching, in the 
corners of the eyes and on the lids; 
subsequently it is burning; in conse- 
quence of the over-distention of the ca- 
pillaries. 
9. The flow of tears is increased and 
continuous; the tears scalding ; intoler- 
ance of light considerable, and lasting 
as long as the excessive secretion of 
tears. 
10. Generally the result of atmos- 
pheric changes, especially sudden vari- 
ations of temperature, mists, damp re- 
sidence, &c., most common in spring 
and autumn. 
11. Sometimes contagious though not 
always so. 
12. Never exhibits the characteristic 
vesicles. 
13. Lower lid usually first affected. 
8. A feeling of sand or dust under the 
lids is here characteristic, and depends 
on the swelling in the 
tunic of the conjunctiva. 
9. Flow of tears diminished coinci- 
dentlv with the photophobia. Intoler- 
ance of light very great at the commence- 
ment and at the height of the disease. 
10. Occurs in hot and moist weather, 
during great electrical changes, at which 
times pre-existent disease is apt to in- 
crease in severity. 
11. Always and under all circum- 
stances contagious. 
12. The vesicles are always from the 
first distinctly visible on the conjunctiva 
of the ejrelids. 
13. The upper lid is first attacked. 
Microscopic examination by Ilawr, an oculist of Lemburg in Galicia, 
showed that in the vesicular granulations the exuded plasma is charged 
with young epithelial cells, and the epithelium itself is considerably in- 
creased in thickness by stratified deposits of new elements. In the 
case of red granulations he describes numerous vascular loops in the 
mass of young cells, which loops appear to owe their origin to increased 
development and projection of the deeper papillary bodies into the 
mass of young cells as to a new growth of cells. 
If granular ophthalmia be not checked at the commencement, the 
vesicles become organized into granules; still later, both forms of 
granulation increase in number and organization, under the influence 
of the constant friction and repeated infiltration; and at last they pre- 
sent the forms known as sarcomatous growths. 
Unfavorable products of granular conjunctivitis: acute blenorrhoea, 
ectropion, hypertrophy of the tarsus; conversion of the soft into hard 
fibrinous feebly vascular excrescences ; partial or complete atrophy of 
the conjunctiva in consequence of the pressure from the exudation 
upon the normal conjunctival tissue; synblepharon posticum, and 
entropium in consequence of this atrophy; pannus as a consecutive 
disease, caused by the friction from the rough inner surface of the lids. 
Causes.—It is usually ascribed to insufficient covering, consequent 
congestion of the head, followed by exposure to chills ; but the chief 
source of the disease must always be the contagious principle, a peculiar 
morbid product which spreads the disease from one man to another 
Other causes which promote its development are: crowding of many CONJUNCTIVITIS. 
109 
soldiers together; unfavorable climatic influences; bad location of the 
camp; exposure to high temperature; consumption of large quantities 
of spirituous drinks, &c. The disease may be epidemic in character 
instead of contagious. 
Prognosis.—The persons most liable to attack are those most in- 
timately associated with the sick; those exposed to other common 
causes of disease; and those especially in whom, with the naked eye, 
we can detect in everting the upper lid, a small red elliptical spot 
seated in one or other, rarely in each angle, whilst the rest of the con- 
junctiva is normal, and in the centre of this spot a red projection of 
the membrane with one or more little eminences (commencing granu- 
lations), the patient all the while complaining of nothing else. A mild 
form of the disease is seen in cases in which there is congestion of the 
conjunctiva with diminished secretion. 
In a severe attack the granulations arise over the whole surface of 
the conjunctiva and cornea, and the secretions are more rapid, and 
profuse. 
The most serious cases of all are those in which not only a constant 
discharge of pus exists, hut often also ulceration and its consequences, 
appear in the course of a few hours or days. 
Convalescence is evidenced by our discovering in the conjunctiva no 
abnormal change; by the blood recovering from its morbid condition. 
Treatment.—The earliest efforts at treatment have generally been 
directed to the extermination of the above described vesicles, and thus 
to the bringing of the disease speedily to a termination at its first stage, 
and whilst it is curatively local. 
The patients who first become the subjects of granular ophthalmia 
in any locality should be immediately separated from all healthy and 
convalescent persons; the eye must be protected from light, draughts 
of air, and dust; forbid all stimulants in drink or food; no linen but 
fresh and clean must be used, and the towel he touches must not be 
used by others. 
Medical Treatment.—Aconite, Bell., Apis, Argent.-nitr., Arsen., 
Euphras., Digitalis, Mercur., Lycopod., Bhus, Sulphur, correspond 
to this disease. 
Local-Remedies.—The best local specific is the sulphate of copper 
in substance, a small piece of which is to be smoothly polished, and 
rubbed lightly over the granulations once or twice a day, following 
application with a camel’s-hair brush filled with pure water. A per- 
severing use of this substance will, as we know from experience in these 
cases, cure the most inveterate forms of the complaint. 
Among the modes of treating this disease Nitrate of Silver carefully 
applied in substance has held the first rank. It is directed to hold the 
stick of the fused Argentum-nitricum between the fingers as a pencil, 110 
DISEASES OF THE SANGUINOUS FUNCTION. 
introducing it carefully between the eyelid and the globe, while the 
patient looks upwards, and thus, to rub it lightly on the vesicles, and 
on them alone, till they are destroyed. The burning pain which follows 
is to be alleviated as it may be by washing the eye, applying wet 
cloths, &c. That the Argent.-nitricum is homoeopathic to the inflam- 
matory condition is not questioned; but many homoeopathists have ob- 
jected to this heroic application of it. General experience in this pe- 
culiar form of ophthalmia has sanctioned it; and it will most probably 
maintain its ground. 
In conjunction with the above means, we may employ one of the 
following medicines : Sulphur, Calcarea-carbonica, Hepar-sulphur, 
Iodine, Graphites, and Acid-nitric., as internal remedies. 
In selecting our internal remedy, regard must be had to the cause as 
well as the symptoms of the disease. We advise the first attenuations, 
and the dose to be repeated once in twelve or twenty-four hours, as long 
as necessary. 
Sulphur.—Commencing catarrh; tension as if sand in the eye; dry- 
ness of the eyeball; itching in the eyes and lids; disagreeable heat and 
burning as if the eye were about to inflame, accompanied by redness 
of the eye and swelling of the lids; lachrymation, and closure of 
the eye. 
Aconite.—Inflammatory and febrile symptoms commencing. The 
pain, redness, burning and heat increasing. 
Cold Lotions.—Ice-water, fomentations, &c. 
Belladonna.—The pain in the eye becoming intense and throbbing. 
In alternation with Aconite. 
Digitalis.—Pain in the eye tensive. In alternation with Mercur. in 
gonorrhoeal ophthalmia. Followed at the end by Lycopodium. 
Argent.-nitr.—Appears to be indicated in most forms of this disease 
and has in many cases induced a rapid cure. In contagious catarrhal 
ophthalmia commence with one drop of the sixth dilution, in water, 
twice a day or oftener. If improvement is not soon seen, try the third 
dilution, a drop in a tea-spoonful of water. At the same time the af- 
fected eye should be washed over with the medicine in water. At first 
ten drops of the first dilution may be tried, afterwards, a solution of 
one grain of Nitrate of silver in the ounce of water may be used by ab- 
sorption in a pledget of linen, folded and laid over the eye, and renewed 
occasionally. 
In blepharo-blenorrhoea the same local use of this article may be 
tried, even to the strength of three or four grains to one or two ounces of 
Water; diminishing the strength as the severity of the disease subsides. 
In addition to this application, the eyes should be washed repeat- 
edly with warm water; the surface of the cornea should be kept as CONJUNCTIVITIS. 
111 
clean from pus as possible ; often needing washing every half hour to 
prevent the accumulation of pus and exudations. 
In hard fibrinous granulations the morbid growths may be touched 
over with lapis infernalis, followed by cold fomentations. 
Dr. Hawr treated blepharo-blennorrhoea with drops of a solution con- 
taining five to ten grains of nitrate of silver in the ounce (after washing 
the eye) and generally with astonishingly good effects. In granular 
ophthalmia, even when accompanied by highly inflammatory symptoms, 
redness, swelling of the conjunctiva palpebrarum, redness of the eyeball 
radiating from the corneal margin, photophobia, lachrymation, spasm 
and headache, and, undeterred by the inflammatory symptoms, he touches 
with lapis infernalis the characteristic vesicles in conjunction with 
the lid, in order to avert the chronic state. A milder preparation 
consists of two parts of Nitr. silver, and two of pure nitre, and its use was 
soon followed by abatement of the symptoms and a speedy convales- 
cence. Dr. Ilawr said this treatment was better, quicker and more 
certain, even if not more pleasant than the old antiphlogistic plan. By 
cauterizing the granulations he usually got rid of the photophobia 
lachrymation, cramp and pain; he would cut off sarcomatous growths 
and then cauterize the raw surface. The Russian military surgeons 
pursue a similar practice; employing nitrate of silver six to twenty 
grains to the ounce of distilled water. 
Arsenicum.—The pain in the eye is unbearably scalding, and the eye- 
ball feels like a red hot coal in the orbital cavity. This may be in the 
early stage; and it may be used during the use of the cooling lotions. 
Arsenicum is also useful in the second stage of blennorrhoeal inflam- 
mation with suppuration of the eyelids. 
When the conjunctiva forms a wall around the cornea, the secretions 
are accumulated in the centre, so as to endanger that structure, the 
pains extend to the neighboring parts, it is proposed to cut out a portion 
of the conjunctiva with a pair of curved scissors; first raise a piece of 
the puffy membrane with the forceps, and then cut with the convex surface 
of the scissors. If the conjunctiva of the upper lid is puffed and pro- 
truding so as to prevent the opening of the eye and the necessary wash- 
ing, no harm is done by cutting off a portion, as the swelling of the eye- 
lid is at the same time diminished. 
Itupture of the Cornea.—The local application of Belladonna is the 
principal reliance. Three grains of the extract may be dissolved in 
two drachms of water, and once or twice daily dropped into the eye. 
By this means the pupil is retained in a permanent state of dilatation, 
and the sight thus preserved after the cornea is healed. 
Intense Ulceration of the Eye.—Remedies :—Arsen., Alum., Ba- 
ryta, Bella cl., Calc,, Carbo-veg., Ilepar, Lycopodium, Mercur 
Natrum-mur., Pulsat., Rhus, Sepia, or Sulph. 112 
DISEASES OF THE SANGUINOUS FUNCTION. 
Spots on the cornea-nebulae, remaining after inflammation ha3 
ceased, may be removed by the use of Apis, Arsen., Calc., Cannabis, 
Conium, Kali-iod., Lycop., Mer., Staphys. 
Purulent Ophthalmia, or Blennorrhoea AEgyptiaca, as well as the 
ophthalmia neonatorum are of sycotic origin. The first appears parti- 
cularly after re-vaccination among the soldiery. Dr. Wolf proposes 
Thuja as the remedy, though he has tried it in but few cases. He suc- 
ceeded in some with Aconite and Apis. The same treatment will also 
cure chronic ophthalmo-blenorrhoea. The greatest danger is produced 
by the localization of the sycotic poison in the brain, where it causes 
all the symptoms of the most acute inflammation; and yet after death 
no sign of inflammation is found. Such cases are of rare occurrence, 
though they originate in the suppression of a fresh blennorrhoea, or of 
a catarrh in children after vaccination, or in scarlet fever. In such 
cases Apis, Belladonna and Stramonium fail; Thuja promises to be the 
effectual remedy. In doubtful cases Aconite or Apis may be tried; 
and if the fever still progresses, one dose of Thuja 300°. 
Sclerotitis.—Though the sclerotica may be specially inflamed it is 
not commonly much diseased, except in connection with inflammation 
of other tunics or structures, which are more delicate and more essen- 
tial to the safety of the sight; therefore, in the complicated inflam- 
mations which involve the sclerotica more serious disease generally is 
going on in other structures. Thus injection of the vessels of the 
sclerotica takes place whenever the cornea or iris are seriously affected, 
or when the entire globe is attacked, or an abscess forms within it; its 
structures may become thinned from disease of the choroid; but in all 
these circumstances the alterations in other parts precede those in the 
sclerotica, and are the important objects of our attention. The sclero- 
tica in all of these cases calls for no special care, but the treatment 
necessary for the whole case depends rather on the nature and degree 
of the disease of the associated structures. 
6. OPACITY OF THE CORNEA. 
Diagnosis.—Opacities or specks upon the cornea vary much in size 
and appearance. Various appellations have been given to these dif- 
ferent opacities, as: nebula, leucoma, albugo, &c., depending upon the 
nature of the cause, and the particular tissue affected. The opacity 
may consist of slight misty or opaque spots, diffused over a part or even 
the whole of the cornea, of a light color, such as are caused by a per- 
verted secretion of the inner lamina, and termed nebula / or of small 
and circumscribed spots, of a pearl color, and entirely opaque, caused 
by a kind of false membrane under the conjunctiva, and termed leu* INFLAMMATION OF THE CORNEA. 
113 
coma/ or of cicatrices resulting from the healing of ulcers and wounds 
of the cornea, and termed albugo. 
When the disease consists of a simple diffused nebulous opacity, we 
can distinguish through it the pupil and iris, and the rays of light pass 
to the retina so as to give rise to imperfect vision; but the other kinds 
of opacity do not permit the passage of luminous rays, and, conse- 
quently, when situated in front of the pupil, destroy or seriously impair 
vision. 
The two first varieties are caused by purulent ophthalmia and granu- 
lated lids, and are results most to be dreaded, especially in constitu- 
tions tainted with scrofula, syphilis, psora, or mercury. 
Treatment.—The best local stimulus is a collyrium, composed of 
one grain of Sulphate of Zinc to four ounces of water. A few drops 
of this may be put into the affected eye, from two to four times in twen- 
ty-four hours, until the opacity begins to disappear, when we should 
omit it as long as the amendment continues. 
The internal remedies most to be relied on are: Calcarea-carb.< 
Iodine, Mercurius, Sulphur, Sepia, Arnica, Ilepar-sulphuris, Acid- 
nitricum, Aurum-muriaticum. 
Attenuations and repetitions the same as in chronic ophthalmia. 
II. AFFECTIONS OF THE DEEPER-SEATED STRUCTURES OF THE EYE 
1. INFLAMMATION OF THE CORNEA. 
Diagnosis.—Inflammation of the cornea may exist as an independent 
affection, or it may occur during the progress of iritis, and other acute 
derangements of the internal textures of the eye. Soon after the in- 
flammation sets in, a number of the serous vessels are observed to carry 
red blood; the cornea loses its brilliancy; the eyes become sensitive to 
light; a profuse secretion of tears is induced from exposure to cold, 
air, light, dust, and smoke; tension and pains are experienced in the 
eye; yellow spots, composed of pus, are observed between the lamellae 
of the cornea, by looking obliquely through the eye; these abscesses, 
if the disease continues, eventually burst internally, and discharge their 
contents into the anterior chamber, or externally, and form those trouble- 
some ulcers of the cornea, which so often endanger sight. When these 
ulcers are small and confined to the anterior portion of the cornea, they 
may often be cured without material injury te the eye; but when the 
ulceration pervades the whole lamellated structure of the cornea, it is 
not uncommon for the aqueous humor to escape through the opening, 
and even the iris itself to protrude. 
Ulceration of the Cornea.—Case by Dr. Alex. Walker. (.Month. 
Horn. Review. Vol. 5, p. 268.) A lady, after three miscarriages, &c., 
Vol. IL—8. 114 
DISEASES OF THE SANGUINOUS FUNCTION. 
and extensive hoemorrhage, found, two months after, the left eye be- 
coming weak and dim; lachrymation ensued; finally ulcers appeared 
on the cornea; these were accompanied by excessive suffering, loss of 
rest and appetite; considerable fever. In the course of a few months 
the eye seemed slightly improving; but metastasis took place to the 
right eye. The diseased condition persisted for sixteen years, during 
which eighteen different physicians and oculists in succession en- 
deavored to cure it without success. Stimulants had been prescribed 
in full variety.' The patient was found sitting with her back to the 
window; the blinds all down, room darkened; photophobia excessively 
distressing. Seven ulcers were visible on the cornea; lachrymation so 
extensive as to saturate four or five handkerchiefs in a day; inflam- 
mation higher at night, pain and suffering preventing sleep till four or 
five next morning; sclerotica and conjunctiva fiery red; meibomian 
glands much ulcerated ; outer ring of the iris dusky red ; violent pains 
in the supra-orbital and temporal regions, increasing toward evening; 
great nervous debility; depression of mind; flatulence; constipation, 
indigestion. The patient inherited a rheumatic diathesis. The latter 
fact influenced the prescription. Stimulants discontinued. Bryonia was 
given twice a day, and a dose of Aconite at bed-time. Weak collyrium of 
Bryonia to the eye. This was continued for five days, and then omitted 
for two. At the end of the first week the inflammation of the cornea, 
iris, sclerotica and conjunctiva was much reduced. After the third 
night some refreshing sleep, and improved digestion, less flatulence 
Cold water was used in the morning and after dinner, cold bath in the 
morning; diet simple, plain but nourishing; suppers forbidden. In the 
course of the treatment under which she recovered full health in a few 
weeks, she took Sulphur, Calcarea-carb., Mer.-sol., and, occasionally, 
Aconite. The remedies were generally employed in the sixth and third 
potencies. Some patients are powerfully affected by the high potencies, 
others who are insensible to the high are satisfactorily cured by the 
low. 
Conical Cornea.—Mr. Bowman’s operation for relief of this affec- 
tion consists in “puncturing the cornea near its lower margin, drawing 
out the iris by means of a short blunt hook, and securing it outside of 
the corneal wound by a fine ligature.” 
2. IRITIS. 
Diagnosis.—This peculiar affection of the eye is by no means easy 
of detection, on account of the situation of the iris, and the small num- 
ber of external symptoms which characterize the complaint. Inflam- 
mation of this texture is, however, more productive of constitutional or 
febrile symptoms than affections of the external tunics. This may in IRITIS, 
115 
part be owing to the loose attachments of the conjunctiva to the eye, 
and the more ample scope for effusions into the subjacent cellular 
tissue. 
Iritis commences with a dull, pressing, heavy, and deep-seated pain 
in the orbit; contracted pupil; change in the natural color of the iris 
to a dark, greenish, or reddish color; a moderate rose-colored blush of 
the conjunctiva; diminished power of vision, and considerable sensibili- 
ty to light. 
As the disease advances, the pains become acute, and extend from 
the eye into the temples and to the top of the head; the contraction is 
more strongly pronounced ; sparks and luminous flashes pass through 
and before the eyes; the nervous system is excited; the pulse accele- 
rated ; the skin hot and dry; the intestinal and urinary secretions are 
partially suppressed, and there are other indications of constitutional 
disturbance. 
After these severe symptoms have continued some time, the iris pre- 
sents an irregular, angular, and thickened appearance, and is covered 
with specks of yellow lymph. Small abscesses now form on the iris, 
which ultimately burst into the antex-ior chamber, which is afterwards 
usually absorbed. If extensive adhesions have formed between the iris 
and the capsule of the lens, or if the more deep-seated parts have be- 
come involved in the disease, an almost total loss of sight is the com- 
mon result. 
In some instances the inflammation extends from the iris to the re- 
tina, the choroides, the cornea, and finally involves the whole internal 
structure of the eye, when the malady will present symptoms character- 
istic of the inflammation of these different structures. In cases of this 
description, the symptoms are of the most violent character, the pains 
are exceedingly acute and painfully throbbing; there is a very rapid 
contraction of the pupil, the sight is speedily extinguished, the consti- 
tutional signs are very urgent, and the patient is always in imminent 
danger of rapid loss of vision. 
Causes.—The most common cause of iritis is the abuse of Mercury. 
Syphilis has been often assigned as a cause of it, but we believe, with- 
out just reason. It has often been observed during the treatment of 
syphilis by Mercury; but, we think, never in syphilitic diseases where 
Mercury has not been employed. Other causes are: mechanical in- 
juries, rheumatism, gout, excessive use of the eyes over minute objects. 
Treatment.—The most appropriate remedies are: 
Acid-nitr., Muriate of Gold, Cocculus, Calcarea-carb., Mux-vomica, 
Belladonna, Conium, Lycopodium, Staphysagria, Arnica, Aconite. 
LTepar-sulphuris, Nitric-acid, and Aurum-muriaticum are cura- 
tive in iritis arising from abuse of Mercury, with aching, throbbing 
and tearing pains in the orbit, sometimes extending to the top of the 116 
DISEASES OF THE SANGUINOUS FUNCTION. 
head; pains in the bones about the eyes ; fiery sparks before the eyes; 
intolerance of light; contracted pupil; partial or entire loss of vision; 
dark or greenish color of the iris; spots of yellow lymph, or ulcers on 
the iris; febrile disturbance. 
Cocculus, Nux-romica, and Belladonna are indicated in arthritic 
and rheumatic iritis, accompanied with deep-seated, lancinating, tearing, 
Or contractive pains in the ball, and extending to the top of the head; 
involuntary, spasmodic movements of the globe; irregular contraction 
of the pupil; discolored and puckered iris; photophobia; pains ag- 
gravated on moving the eyes, or stooping; luminous specks or dark ob- 
jects float before the retina; greatly impaired vision; effusion of blood 
and matter into the anterior chamber of the eye ; indications of gastric 
derangement, and of general constitutional disturbance. 
Calcarea-carbonioa, Conium, Lycopodium, and Staphysagria are 
appropriate in iritic inflammations connected with a scrofulous diathesis. 
These remedies cover: greenish or yellowish color of the iris; pupil 
much contracted and distorted; ulcers which have opened internally 
or externally; outward distention of the iris ; adhesions of the iris to 
the capsule of the lens; moderate participation of all the structures of 
the eye in the morbid action; photophobia; vision destroyed or much 
impaired; difficulty in distinguishing the iris from effused lymph and 
pus into the anterior chamber of the eye; great general irritability; 
aching, throbbing, lancinating, or pressing pains in the eye; rapid and 
irritable pulse ; restlessness; hot skin; loss of appetite; mental and 
physical prostration. 
Arnica is necessary when the disease can be traced to a wound, or 
to any mechanical injury of the eye. It may also be properly employed 
in cases which proceed from sudden exposure of the eyes to an intense 
and glaring light. 
Aconite will often be required, either in alternation with one of the 
other remedies, to control undue febrile excitement, and to remove the 
violent, congestion, which now and then occurs in iritis. 
Mercurius-corrosivus.—Case by Dr. Henderson, of Edinburgh.—■ 
A gentleman in May, 1852, had inflammation of one eye, declared rheu- 
matic by an eminent oculist in Glasgow. Bleeding, Calomel, and 
Opium rapidly improved the eye, but the mouth and tongue became 
sore and inflamed, which confined him to the house for a month, part 
of the time in bed. He afterwards relapsed several times within the 
month, though the attacks were not severe. During the winter he 
was well, but in March, 1854, he had a new and severe attack. The 
sclerotica around the cornea was closely and densely injected with 
vessels and so deeply colored as to present the appearance of ecchy- 
mosis ; aching pain in the eyeball; the iris dull color; pupil regular, iritis. 
117 
though somewhat dilated. The disease had lasted four days when the 
second homoeopathic dilution of corrosive sublimate was prescribed one 
drop every four hours. Each dose therefore consisted of only the ten- 
thousandth part of a grain of the medicine. In four days the eye Avas 
nearly well, and on the fifth day of the treatment the patient was in 
perfect health. He had taken five doses per day of the medicine. In 
a few weeks he had a slight relapse, which was cured by the same re- 
medy without confining him to the house. No mercurial disease ac- 
companied this mercurial treatment. 
Clematis.—Rheumatic iritis ; sensation of pressure upon the eyes, 
with photophobia and lachrymation, particularly in the open air; lids 
forcibly contracted in the morning, with sensation of heat. 
Administration.—The remedies may be employed at the first, second 
and third attenuations, depending upon the age and susceptibility of 
the patient, and the violence of the inflammation. The dose should be 
repeated in acute cases every two hours, until we are certain of a medi- 
cinal impression upon the diseased texture. In less urgent cases, a re- 
petition will suffice once or twice in twenty-four hours. 
Belladonna, and its alkaloid Atropine, are among the most powerful re- 
medial agents in acute iritis. Mercurius, which is also truly homoeo- 
pathic to this disease, agrees very well in alternation Avith Belladonna. 
It also acts Avell internally Avhile Belladonna is applied externally. 
Graefe advises in the slighter cases of acute iritis the application 
of a solution of Atropine (four grains to one ounce of Avater), six, eight, 
or ten times a day, and in severe cases as often as tAventy times in the 
tAventy-four hours. 
•When synechia posterior Avith broad and extensible adhesions exists, 
the tendency to the recurrence of iritis is so great, that the patient and 
doctor are both ready to adopt the severest measures—even extirpating 
the eyeball, to get rid of the ever-recurring torment, and to prevent the 
sound eye from participating sympathetically Avith the diseased one. 
In such cases Graefe performs iridectomy by excising a small portion 
of the iris. This treatment he has found efficacious in apparently the 
most desperate cases, Avhere the anterior chamber was almost effaced, 
the iris discolored and bulging very much forwards, and the globe of 
the eye softer than natural and perfectly atrophied. He has repeated 
the operation on the same eye sometimes as often as six times, and with 
great advantage. The iris regains its healthy appearance, the anterior 
chamber refills Avith aqueous humor, and the whole globe becomes firm 
The sight too is restored more or less perfectly. 
The rationale of the cure in these cases is not very clearly made out. 
Yon Graefe says: “The increased power of vision was in no way 
dependent on re-absorption of the pupillary exudations, but was 118 
DISEASES OF THE SANGUINOUS FUNCTION. 
entirely to be ascribed to an improvement of the choroidal compli- 
cations.” 
Mode of performing the Operation of Iridectomy.—The lance- 
shaped knife is introduced into the sclerotic, at the distance of half a line 
from its junction with the cornea, and pushed forwards into the anterior 
chamber. Through this wound the forceps is introduced, the iris 
seized and dragged out, and a portion, amounting to a fifth or even a 
third of the whole, cut away. The remains of the prolapsed iris are left 
in the wound.* 
3. CHOROIDITIS. 
The commencement of organic disease of the choroid, though unat- 
tended by marked symptoms of inflammation, is still a serious matter, 
as inflammation often breaks out suddenly. 
The existence then of the network or gauze, or appearance of large 
spots in the field of vision, unaccompanied by pain or uneasiness, or 
any other evidence of increased action in the vessels of the conjunctiva 
or sclerotica should meet with prompt attention. 
The organ should have perfect rest and be kept from exposure 
to bright light. Counter-irritation in the vicinity has been found par- 
tially successful; stimulating drinks are to be avoided; food should be 
regulated to that extent that the patient’s condition may direct. The 
patient’s general health must be corrected. 
Bleeding has formerly been considered indispensable ; but in many 
other cases those who have tried it, found the bleeding to aggravate the 
disease; in young, delicate females, Mr. Tyrrell {Encyclopedia'of 
Surgery, p. 90) saw “the continuance of the depletory treatment most 
injurious in augmenting the morbid action and hastening the disorgan- 
izing process.” Unfortunately, as relief frequently follows the local 
abstraction of blood, the patient on every fresh attack or relapse is de- 
sirous of resorting to the same treatment again; still finding the relief 
of short duration; the same course is resumed with temporary benefit, 
but the powers of the patient are successively reduced, and the local 
disease makes progress in disorganization; each relapse promotes fur- 
ther inflammation, and the anti-phlogistic treatment lessens the powers 
of the system to resist the progressive amaurosis; and, eventually, 
vision is completely destroyed, and the general health is at the same 
time materially injured. Mr. Tyrrell says: “I have seen several dis- 
tressing cases of permanent amaurosis resulting from such treatment, 
and I have also known many instances in which the disease has been 
* Memoirs on certain forms of Iritis, Choroiditis, and Glaucoma. Sydenham 
Society. 1859. CHOROIDITIS. 
119 
arrested and vision preserved by raising and maintaining the general 
powers” and pursuing a proper medical treatment. 
Treatment.—Ipecacuanha.—In one case the following symptoms 
were presented: A lady, aged 47, had excessively painful shootings in 
the eyeballs, could not gaze on any object without copious flow of tears; 
blue and red halo around the flame of a candle; pupils neither dilated 
nor contracted, and moved freely; vessels of the palpebral conjunctiva 
slightly injected without pain; conjunctiva and cornea uninjured; con- 
stipation ; no known cause for the inflammation. At the end of six 
weeks Dr. Tamhayn, in remembering the resemblance of the symptoms 
to those produced by the dust of Ipecacuanha on a pill-maker employed 
in a druggist’s shop, prescribed that article. 
Jan. 15th, 1858. Ipecac, twelfth dilution, two globules in 200 gram- 
mes of water; a table spoonful three times a day for six days. Jan. 22d, 
the suffering was less, gazed on objects with less difficulty; the halo 
around the candle less visible ; bowels improved. Ipecac, sixth dilution, 
two globules. Jan. 29th, improving. The patient can read and work 
in the daytime. Continued improvement, though some occasional shoot- 
ings in the eyes, more in the left eye or that first affected. Diarrhoeic 
evacuation about every morning. Ipec. twelfth dilution, two globules. 
Dr. Heniel, of Paris, gives a case in which there were lancinations 
excessively painful in the optic globes, copious flow of tears on looking 
steadily at any object. Blue and red aureoles surround the flame of 
the candle ; pupil mobile ; no external inflammation, slight injection of 
the palpebral conjunctiva. Such symptoms had been caused in a drug- 
gist, pounding Ipecac., and it was prescribed Ipec. 12°, a twro globules in 
water, three times a day for six days. The first week after there wras 
improvement; constipation removed. A wreek later, could see to read 
and sew in daylight. {LArt Medical.) 
Ammoniac.—“A glittering appearance before the eyes as of molten 
metal.” {Dr. Mleinert.) In this case, inflammation of the deeper- 
seated parts, the choroidea, &c., is present, with which amaurosis often 
commences. Traces of the change must be perceptible in the provers 
by the aid of the ophthalmoscope. 
Muriatic-acid.—Perpendicular hemiopia; thus partial paralysis of 
the nerve, perhaps exudation—extravasation of blood on the 
choroidea. 
Alumina causes vision of yellow, perhaps perceptible on the cor- 
pus vitrei and the aqueous humor,—a purely icteric symptom which 
may appear on other parts of the body. 
Mercury.—Amaurosis consequent on chronic choroiditis, is often 
if not always pathologically identical with mental imbecility conse- 
quent on chronic meningitis. In the first case the delicate structure 
of the retina, vesicular neurine which is expanded on the optic nerve, 120 
DISEASES OF THE SANGUINOUS FUNCTION. 
has been pressed upon by its vascular serous membrane, and the choroid 
and membrani Jacobi are thickened by a morbid deposit. In the second 
the vesicular neurine of the hemispherical ganglion is pressed upon by 
the thickened pia-mater and arachnoid. The success of treatment in 
inflammations of the eye should encourage us to make efforts equally 
persevering in the treatment of chronic meningitis. Mr. Tyrrell cured 
most obstinate cases of amaurosis by persevering in the use of minute 
doses of the gray mercurial powder every night or every second night 
for twelve months, taking care in all this time that it should never af- 
fect the mouth. He even said that he had often seen the cure ar- 
rested, and sometimes entirely defeated by salivation, in cases in which 
it occurred through the impatience of the invalid, who was too anxious 
to be speedily cured. By long persistence he said he had “ restored 
many a poor fellow to sight whose case had been considered hopeless.’’ 
4. AMAUROSIS. 
Impaired vision coming on suddenly or gradually, and the loss of 
sight more or less complete; it may be permanent from its first ac- 
cession, or transient, varying in degree, and returning only at inter- 
vals, sometimes in the day only or in the night only. It sometimes 
comes on after great exertion of the eyes with minute or very bright 
objects, or when the digestive powers are greatly disordered. In some 
cases the loss of sight is confined to apart of the field of vision; or ob- 
jects appear crooked, distorted, mutilated, changed in size, or inverted; 
flashes of light; shining stars, globes of light, or muscae volitantes, are 
common when the retina, is inflamed ; when the vital energies of the 
organ are exhausted, as in dyspeptics or debilitated persons; motes, 
black specks, muscse volitantes and thick mists of clouds are seen; 
double vision is caused by disease within the cranium. At a later 
stage the vision is obscured by clouds, or a net-work of gray, black, or 
white silvery, luminous red, luminous in the dark. In some cases pain 
is felt in the eyes, in others there is only a desire for stronger light, 
in others there is dryness of the eyes and nostrils; the constitution 
generally presents some peculiarities indicating hereditary diseas . or 
functional derangement of important organs; there is a un- 
meaning look in the eyes; an unsteady, uncertain gait; the motions of 
the eyes or eyelids may be impeded or palsied; the eyes unusually 
prominent; the sclerotica bluish, or ash-colored, and, in some, covered 
with small varicose veins; the eyeball is firmer to the touch or softer 
than natural. After vision is extinct, the pupil is more or less expand- 
ed and motionless, though when only one eye is amaurotic, the pupil 
of that eye follows the motions of the sound one. Sometimes both eyes AMATTEOSIS. 
121 
are amaurotic, and yet the motions of the iris continue under the 
nervous influence of subsidiary nerves, particularly of the branches of 
the third and fifth pair. The iris may contract irregularly, may pro- 
trude towards the cornea or be pressed inwards. 
Diagnosis.—Distinguished from cataract by the dimness, or loss of 
sight, being either sudden or partial, presenting the appearance of 
fly-spots, or motes covering parts of an object. In cataract, the diffi- 
culty of sight increases very slowly, and is compared to a diffused mist, 
thin cloud, or gauze, intervening between the eye and the object. 
Amaurosis, if in its first stages a cloud or mist be visible, goes on in- 
creasing till sight is extinct; but complete deprivation of sight never 
occurs in cataract. In cataract the opacity generally commences in the 
centre of the lens, and the misty appearance is most noticed when 
looking directly forward, vision being most distinct when he looks 
sideways; this seldom occurs in amaurosis. In amaurosis the patient 
desires strong light; in cataract strong light contracts the pupil and 
renders vision less perfect, as the rays have to pass through the central 
opaque part of the lens. Amaurosis is usually connected in its origin 
with headache, vertigo, and disease of the digestive organs. Cataract 
has seldom any such association. In amaurosis the pupil is either jet- 
black in health, or a pale greenish color visible when examined in a 
particular light. (Copland. Vol. I., p. 65.) In amaurosis with glau- 
coma the opacity is always greenish, in incipient cataract it is always 
grayish. In the former the opacity seems at a considerable distance 
'behind the pupil; in lenticular cataract it appears close behind the 
pupil. In posterior capsular cataract the opacity is streaked, in glau- 
comatous amaurosis it is always uniform. In the former the opacity 
seen through a double convex lens appears slightly rough; the glau- 
comatous opacity is smooth and polished. In the former the eyeball 
is of the natural degree of firmness; in glaucomatous amaurosis it is 
firmer than natural. Glaucoma progresses slowly, occupying several 
years ; in cataract the sight rapidly declines. In incipient cataract the 
contractions of the pupil are as extensive and rapid as in health; in 
amaurosis it is dilated and fixed, or its motions are limited and slow. 
In cataract the movements, eyeballs and eyelids are perfect; in amau- 
rosis they are imperfect and difficult, there is a want of direction to the 
eyes, and sometimes a slight degree of strabismus. (.Mackenzie, on 
Diseases of the Eye) 
Symptoms. —The partial or total loss of sight which particularly 
characterizes this disease, is principally dependent upon a diseased 
condition of the optic nerve and retina, although other structures oc- 
casionally participate in the disease. Amaurosis occurs at all ages, 
and in both sexes, but is most common at the period of the cessation of 
the menses in females, &nd at the age of forty or fifty years m males. 122 
DISEASES OF THE SANGUINOUS FUNCTION. 
The chief circumstances which predispose to it, are: a plethoric and 
sanguine temperament; hereditary pre-disposition; tendency to san- 
guineous congestions to the head and eyes ; and an impaired constitu- 
tion from the abuse of drugs, stimulating drinks, and venereal excesses. 
Physicians of the old school are much divided respecting the nature 
and treatment of amaurosis; some suppose it to be a debility requiring 
tonics and stimulants, while others describe it as an inflammatory af- 
fection, demanding an antiphlogistic course of treatment. In view of 
these discordant opinions, and the empirical modes of treatment based 
upon them, it is not surprising that so few amaurotic patients are cured 
by allopathic treatment. 
Amaurosis may be imperfect or perfect. In the former there is a 
partial, and in the latter a total loss of sight. In the first, the patient 
sees as through a gauze, or but half of the object, or double, or only 
when the eye is in a particular position, with respect to the object; 
while in the last, the patient cannot distinguish day from night. 
The signs of the approach of the disease are: pain in the forehead 
and temples, diminishing with the advance of the amaurosis, and ceas- 
ing when it has become complete; vertigo; weakness and cloudiness 
of vision, apparent when looking at distant or at minute objects ; 
sparks and moats, or muscae volitantes, float before the eyes, annoying 
the patient, and impairing the sight; in reading or writing, a stronger 
light than usual is demanded; a slight diminution in the brilliancy of 
the pupil. 
After these precursory symptoms, the loss of vision gradually becomes 
more complete, until after months or years there remains a condition 
of settled and more or less perfect amaurosis. In other instances, the 
disease advances with rapidity, and terminates in partial or total blind- 
ness in a few days. But it is not an uncommon occurrence for com- 
plete amaurosis to follow instantaneously, leaving the victim in blind- 
ness so profound that he cannot distinguish light from darkness. When 
either of these three conditions obtains, there are usually but few signs 
which indicate the presence of so serious an affection; the principal 
symptoms being only a dilated and immovable pupil, a loss of contrac- 
tile power in the iris, and occasionally slight strabismus. But even 
these signs are not uniformly present; for cases of complete amaurosis 
are reported, in which the pupil remained natural, or became preter- 
naturally contracted, and mobile on exposure to light, and in which the 
iris and all other visible parts of the organ were in a normal condition. 
The color of the pupil in this disease is ordinarily jet-black, with, per- 
haps, a very slight diminution of its natural brilliancy, but it sometimes 
presents a red, greenish, or white and cloudy appearance. Cases of 
this last description are often mistaken for incipient cataract, and when 
the loss of sight is but partial, it is not easy to distinguish between the AMAUROSIS. 
123 
two maladies ; but tbe following characteristics will afford us material 
assistance in deciding the matter. In cataract, the dense white ap- 
pearance is situated immediately behind the pupil, while in amaurosis 
the cloud is more deep-seated. In the former the flame of a candle ap- 
pears to he surrounded by a thin, white, diffused mist or cloud, “ which 
increases with the distance of the light,” while in the latter, “a halo or 
iris appears to encircle or emanate from the mist, the flame seeming to 
be split when at a distance.” (Stephenson.) 
The shape of the pupil is usually round, but somewhat more dilated 
than in the normal state, thus allowing a large number of luminous rays 
to enter the eye. In a few cases it loses its circular form, and becomes 
angular. 
Amaurosis is attributed by most Avriters to a paralytic condition of 
the optic nerve, retina, or to some disease of the thalami nervorum; but 
does not the peculiar immovable condition of the pupil and iris, when 
their natural stimulus, the light, strikes them, indicate a loss of sensi- 
bility and contractility in these structures ? And does not the partial 
loss of voluntary power over the globe, which occurs during the pro- 
gress of the disease, indicate a loss of tone in the whole organ ? 
We have mentioned, as one of the precursory symptoms of amaurosis, 
floats and muscae volitantes before the eyes. In the imperfect form of 
the disease, these appearances vary much in their character, and are a 
source of great annoyance to the patient. Sometimes a single black 
speck obstructs the sight; sometimes there is an appearance as if a 
dark gauze or net-work were before the eyes; sometimes as if flies, 
small objects of different forms, sparks, fireballs, and various colored 
lights, were moving in various directions. The objects are more trouble- 
some in a strong light than in dark situations, being in the former of a 
black or sombre color, and in the latter presenting themselves in the 
appearance of sudden flashes of light or fire. 
We are occasionally presented with the disease in an intermittent 
form, and, in rare instances, as a temporary attendant of some particular 
morbid condition of the system, like pregnancy, disordered menstruation, 
hysteria, worms, and the irritation of indigestible food. 
In addition to the symptoms already described, we sometimes observe 
in young and plethoric amaurotics, strongly pronounced determination 
of blood to the head and eyes, a constant stupefying headache, more or 
less redness and congestion of the eyeballs, sensitiveness of the eyes 
to light, a full and hard pulse, a sense of fullness, tension, and pain in 
the affected eye. 
It is a point worthy of note, that black eyes are far more subject to 
amaurosis than blue or gray eyes. Beer supposes that where one blue 
or gray eye becomes amaurotic, at least twenty-five or thirty black ones 124 
DISEASES OF THE 8ANGUINOUS FUNCTION. 
suffer. No satisfactory explanation has ever been suggested for this 
comparative exemption of blue or gray eyes. 
Characteristics.—Distinguished from cataract by the dimness or loss 
of sight being either sudden or partial, resembling a fly, spots or motes 
covering parts of an object. In cataract the difficulty of sight increases 
very slowly and is compared to a diffused mist, thin cloud or gauze inter- 
vening between the eye and the object. 
Prognosis.—When the cause of the disease is evident, and which 
can be removed, the patient young, constitution good, and the attendant 
disease curable, partial or entire recovery may be hoped for. When it 
has been suddenly induced, the pupil being only slightly dilated and 
still moveable, of the natural form and the eyeball not altered in 
structure, the prognosis is more favorable than when the pupil is fixed 
in a state of either expansion or contraction, or when the eyeball is 
either soft or preternaturally hard, or when the back part of the eye 
presents a greenish opacity. If the attack has been sudden, the vision 
perverted, power over the muscles of the eyelids lost, there may be 
disease within the brain. If the symptoms have been gradually de- 
veloped in succession, there may be a tumor, cyst, or exostosis within 
the cranium; and in all such cases the prognosis must be unfavorable; 
and also in all cases in which the cause has been long in operation, 
the loss of sight has been very gradual, the constitution is much im- 
paired, and the cause cannot be speedily removed. 
Amaurosis depending on morbid growths within the orbit or cranium, 
may be considered incurable; but when it depends upon a slight effu- 
sion upon the brain, or the pressure of a tumor upon the jugular vein 
of the neck, we may often effect a cure by causing the effused fluid to 
be absorbed or removed by an operation, or the extraction of the of- 
fending tumor. We once cured a case of several months duration by 
removing from the neck a tumor of the size of an orange, and thus re- 
newing the free course of blood from the head. The sight returned 
almost immediately after the operation. The loss of sight which some- 
times accompanies pregnancy and intermittent diseases, often subsides 
spontaneously after parturition, or the cure of the disease, on which 
the blindness depended. A favorable prognosis may commonly be 
entertained in those recent cases which depend on congestion of the 
optic nerve, retina, or thalami nervorum opticorum, arising from general 
plethora, suppressed menstruation or haemorrhoids. The effects also 
of mechanical injuries, lacerations, contusions and blows upon the eye, 
may frequently be cured. 
Causes. — First. — Predisposing. — Hereditary disposition; dark 
eyes; insolation; forced mental or physical exertion; excesses of pas- 
sion; pregnancy and the puerpural state; habitual stooping ; indigestion; 
abuse of stimulants; suppressed discharges; menstrual derangements; AMAUROSIS. 
125 
gout, rheumatism or scrofula; retrocession of eruptions; habitual con- 
stipation; chronic diarrhsea; typhoid fevers; use of snuff; long con- 
tinued grief; nursing too long continued; leucorrhoea; masturbation; 
excessive exercise of the sight on minute objects or in bright glaring 
light; strumous ophthalmia. 
Second.—Exciting Causes.—Over-exertion of the sight; very bright 
light, working with minute objects by lamp or gas light at late hours; 
strong shocks of electricity, as lightning; long continued over-excite- 
ment of the eye; or mechanical injuries producing contusion or con- 
cussion of the retina; strong poisons as stramonium, belladonna, poison- 
ous fungi, and fish-poison; epileptic or other convulsions; apoplexies 
or paralysis ; injuries of the fifth pair of nerves; gastric or intestinal 
irritation, from worms or other causes; hypochondriasis ; accumulations 
of bile ; frights ; neuralgia, with or without carious teeth; drying up of 
old ulcers ; cessation of the menses ; typhoid fever or scarlatina; metas- 
tasis of gout or rheumatism; syphilis and abuse of mercury. 
The causes of amaurosis may operate upon the brain itself, upon the 
optic nerve, or the retina. They may be divided into constitutional, 
and local causes. In the first class we include : repeated and protracted 
determinations of blood to the head and eyes, by unusual physical or 
mental exertion; pregnancy; suppression of natural or habitual dis- 
charges ; violent vomiting; excessive indulgence in venery; masturba- 
tion; unbridled anger, grief, and other passions; abuse of stimulants; 
large doses of opium, lead, belladonna, hyoscyamus, stramonium ; abuse 
of bitter medicines, as quassia, cinchona, chamomilla, chicory, &c.; exer- 
cise in a hot sun; general debility; derangement of the digestive 
organs; the depressing emotions; the pressure of tumors upon the 
vessels of the neck in such a manner as to prevent the return of blood 
from the brain. 
We include in the second class of causes, morbid growths within the 
orbit: mechanical injuries of the eye ; sudden transitions from darkness 
to a brilliant light; lightning; frequent use of optical instruments, like 
the telescope and microscope; exostoses within the cranium; sanguine- 
ous effusion upon the brain; injuries of the head. 
Pathology.—First.—Amaurosis is perhaps always dependent on 
some physical change in the structure of the eye, though this is not 
always perceptible on dissection. Functional amaurosis, says Beer, 
proceeds from direct depression of the vital sensibility of the eye ; or 
from inordinate excitement, and consequent exhaustion of this property 
Mackenzie thinks that in all these cases there is a certain degree of 
organic derangement, even when dissection does not reveal it. In 
nearly all cases there is sensible organic derangement. 
Second. — Congestive or inflammatory state of the retina or 
;parts adjoining:—Varicose states of vessels; Unusual injection of the 126 
DISEASES OF THE SANGL'INOUS FUNCTION. 
minute arteries of the adjoining coats and of the retina; complete re- 
tinitis / exudations of lymph under the choroid ; inflammation of the 
external surface of the sclerotic ; injection of the choroid and adhesion 
of the retina to it; thickening, morbid density of the retina; change of 
color and ossification or wasting of the retina. 
Third.—The optic nerve may be compressed or otherwise affected 
by structural changes in parts contiguous to it. (Copland, Vol. I., p. 59.) 
Fourth.—Disease of the Brain or its membranes may cause amau- 
rosis by impeding the functions of the optic nerves, although the 
structure of these nerves be uninjured. The most common of these 
are : organic lesions of the pineal and pituitary glands, sanguinous and 
serous effusions, tumors, abscesses, softening of the brain. 
Treatment.—A complete removal of all suspected causes is the first 
step. When the general symptoms denote debility; when there is 
languid circulation, muscae volitantes, or dark spectra, an alterant, 
though supporting treatment is required; light, nutritious, invigorating 
diet, change of air, moderate exercise, vegetable and mineral tonics, 
with the usual means of improving the secretions constitute the usual 
measures for restoring the nervous energies of the debilitated organ. 
When the disease is obviously connected with inflammatory action it 
is of that character which is not always benefitted by depletion. Per- 
haps the most common form of amaurosis is that consequent on chronic 
choroiditis, which is believed to be pathologically identical with that 
wThich exists in the brain in mental imbecility, consequent on chronic 
meningitis. In the former case, says Mr. Solly (On the Brain, p. 357), 
“ The delicate structure of the retina, the vesicular neurine which ex- 
pands on the optic nerve, has been pressed upon by its vesicular and 
serous membrane, the choroid and membrani Jacobi, thickened by 
morbid deposits.” In imbecility from chronic meningitis the vesicular 
neurine of the hemispherical ganglion is pressed upon by the thickened 
pia mater and arachnoid. This view of the pathology in many cases 
of amaurosis has led Mr. Tyrrell, of London, to a successful course of 
treatment. By persevering in the use of extremely small doses of 
Mercury every night or every second night for twelve months, Mr 
Tyrrell has succeeded in curing most obstinate cases of amaurosis. By 
employing such minute doses that no drug symptoms are produced 
Mercury will often restore the sight in amaurosis, even when the per- 
ception of light is destroyed; it is not entirely hopeless if the globe re- 
tains its natural consistency; neither abnormally hard, or soft and 
shrunken; when the disease is of very long continuance, then the re- 
tina and vitreous humor become sometimes implicated in the morbid 
action and partial atrophy ensues. 
Tyrrell says: “The safety of the treatment and its efficacy depend 
greatly on the support of the general powers; for while this is properly 127 
AMAUROSIS. 
sustained, the remedy can not produce any general injurious effect, 
though its operation on the local disease may proceed most beneficially.” 
If the general powers are not maintained “the effects of mercurial action 
on the system are extremely distressing and injurious, and it can rarely 
be continued long enough to remedy the amaurosis.” 
Case by Mr. Tyrrell.—“A man, aged thirty-eight, had been amau- 
rotic for seven years. He had lost the perception of light; the globes 
possessed their natural firmness and elasticity; the pupils were clear, 
but irregular, from many points of adhesion between the pupillary 
margin of the iris and the anterior capsule of the lens ; the irides were 
discolored and dull, and he had the vacant aspect of a blind person. 
Mercurial treatment was tried with good diet; but the mouth became 
tender and sclerotitis occurred. But the treatment was continued, and 
Belladonna was applied night and morning to each eyebrow. He soon 
became sensible to light, and gradually acquired the power of discern- 
ing objects ; and the adhesions between the irides and capsules of the 
lens began to give way; the pupils to assume their natural figures; by 
degrees the vision improved, inflammation subsided; the pupils became 
regular and the irides brilliant. The Mercury was continued for above 
sixteen weeks, when the amaurosis was completely subdued, and vision 
perfect.” In this case it is evident that Mercury in an attenuated form 
would have cured the amaurosis and left the patient in a better con- 
dition for permanent health. In brain affections we should be guided 
by similar principles. 
Treatment.—The specifics for the different forms of amaurosis are: 
Belladonna, Mux-vomica, China, Phosphorus, Puta-gra/veolens, 
Stramonium, Sulphur, Euphrasia, Arnica, Cannabis, llyos- 
cyamus, Stramonium, Opium, Secale. 
Belladonna.—External Indications. — Pupil dilated and immov- 
able ; strabismus; pupil black and round or angular; partial or total 
loss of vision; listless expression. 
Physical Sensations. — Power of vision diminished or extinct; 
sensation of weight and pressure in the eyeball; throbbing or stupefying 
headache; objects appear double, or wrong side up, or half concealed, 
or blurred, or surrounded by a fog or mist; dark, fiery and red bodies 
float before the eyes ; bright flashes before the eyes ; the candle seems 
surrounded by a halo of different colors; but in which the red pre- 
dominates. 
Mental and Moral Symptoms. — Mood generally irritable, but 
high spirits alternating with despondency. 
Remarks.—This remedy is called for in amaurotics of full and 
plethoric habits, and where the malady has been caused by inflam- 
mation, congestion of the optic nerve, retina, or some part of the brain. 128 
diseases of the sanguinous function. 
Nux-vomica.—External Indications. — Pupils contracted, some- 
times dilated; spasmodic motions of the eyeball; photophobia. 
Physical Sensations.—Intermittent obscuration of vision; black or 
gray moats before the eyes; stupefying headache; weakness of sight, 
w'orse in the light of day; luminous vibrations on the side of the eye; 
vertigo. 
Mental and Moral Symptoms. — Disposition melancholic and 
hypochondriacal. 
Remarks.—Nux is applicable in amaurotic complaints arising from 
excess of study and abuse of stimulants and opium. It is also indicated 
for temporary loss of sight, which sometimes accompanies intermittent 
diseases. 
China.—External Indications.—Pupils dilated and insensible, or 
slightly contracted; a white cloud deep within the eye; photophobia. 
Physical Sensations.—Indistinct and confused vision; muscae voli- 
tantes ; sudden obscurations of sight; only the outlines of objects can 
be discerned; general debility; irritability; morbid sensitiveness of the 
whole system. 
Mental and Moral Symptoms.—Disposition cheerful and languid. 
Remarks.—China will apply when the disease is of a purely atonic 
character, and has originated from excessive loss of blood or pus, or 
from protracted chronic or acute diseases. 
Phosphorus.—External Indications.—Pupils and eyes natural. 
Physical Sensations.—Sudden attacks of blindness during the day 
distant objects appear to be enveloped in smoke or mist; black spot 
before the eyes; diminished vision; he sees as through a net-work 01 
gauze; sparks before the eyes in the dark; tremulous vision; luminous 
vibrations before the eyes; the flame of a candle seems to be surrounded 
by a green halo. 
Mental and Moral Symptoms.—Spirits gloomy, dejected, and with- 
out any cheerful reaction. 
Remarks. — In amaurosis consequent on masturbation, loss of 
animal fluids, and in impoverished old people, Phosphorus is an ex- 
cellent remedy. 
Puta-grareolens.—External Indications.—Pupils contracted; in 
voluntary movements of the balls of the eyes ; spasms of the lids. 
Physical Sensations.—Sense of weight and pressure in the eye- 
balls ; weakness of the eyes; inclination to read or write by a very 
strong light; muscae volitantes; red halo surrounding the flame of a 
candle; cloudy vision; weariness of the eyes. 
Mental and Moral Symptoms.—Indifferent, irresolute and peevish. 
Remarks.—Amaurotic complaints arising from abuse of the eyes 
with optical instruments, in reading fine print, or working at small ob- HYDROPHTHALMIA, OR DROPSY OF THE EYE. 
129 
jects, and also from contusions, and other mechanical injuries, will re- 
quire the use of Ruta. 
Stramonium.—External Indications.—Pupils dilated and immov- 
able ; eyes staring, and somnolent or glistening. 
Physical Sensations.—Sense of weight and tension in the eyes; ob 
scuration of sight; objects appear small or double; black colors appear 
gray; sparks and specks float before the eyes; objects seem surrounded 
with a red or light border; cloudy vision; vertigo; headache. 
Mental and Moral Symptoms.—Disposition irritable and touchy; 
hysterical and cataleptic. 
Remarks.—Stramonium is suitable in paralytic affections of the 
optic nerve and retina; connected with deranged menstruation, hysteria, 
epilepsy and catalepsy. 
In incipient amaurosis, and frequent and sudden and short attacks 
of blindness, we may refer to Sulphur, Euphrasia, Arnica, Canna- 
bis, Ilyoscyamus, Conium, Aurum, Digitalis. 
Administration.—We are in the habit of employing from the first 
to the sixth attenuations. Repetitions should not be made more than 
once or twice in the twenty-four hours. As soon as an impression is 
apparent, we should await the result before administering again. 
5. HYDROPHTHALMIA, OR DROPSY OF THE EYE. 
Diagnosis.—This disorder proceeds from the formation of a preter 
natural quantity of the aqueous or the vitreous humors, -while the ab- 
sorbent vessels convey into the circulation only their customary amount 
of these secretions; or the humors may be formed as usual, but owing 
to some defect or loss of power of the absorbents, the natural quantity 
is not taken up and carried into the circulation. But it is highly proba- 
ble, in most cases, that the disease is dependent on a morbid condition 
of both the secerning and absorbent vessels, and the normal equilibrium 
between secretion and absorption becomes thereby destroyed. This idea 
receives confirmation from the fact, that most dropsies of the eye can be 
traced to previous inflammation of the internal textures of the organ. 
The unnatural accumulation may be confined to the aqueous humor 
in the anterior chamber, or to the vitreous humor in the posterior 
chamber, or both humors may be affected at the same time. When 
the aqueous humor is alone involved, the disease may be recognized 
by the following marks: dimensions of the cornea larger than natural ; 
increased size of the anterior chamber of the eye; turbid appearance 
of the aqueous humor; partial or total loss of motion of the iris; pupil 
natural and immovable ; iris less brilliant than natural; sense of weight 
and tension in the eyeball; weakness of sight; perversion of vision, 
Vol. II.—9. 130 
DISEASES OF THE SANGUINOUS FUNCTION. 
either in the Form of presbyopia or myopia: general loss of voluntary 
motion over the ball; partial or total loss of vision. 
When there is a preternatural accumulation of the vitreous humor, 
the enlargement of the globe is more deep-seated; the ball assumes a 
conical shape; the cornea is unusually prominent; the pupil is con- 
tracted; there is a diminution of vision; myopia; deep-seated pains; 
tension and heaviness; impaired motion of the ball; and eventually, 
total blindness. 
When the disease consists of an unnatural accumulation of both 
humors, we shall have a combination of symptoms including nearly all 
described under the aqueous and vitreous varieties of dropsy. After 
the vitreous humor has been for some time affected, its character is 
changed, and it acquires a soft and usually a watery appearance. 
In many cases, the eye attains a size so enormous as to protrude far 
from the orbit, and it is thus rendered quite impossible to close the 
lids over it. In this condition the patient has a frightful appearance, 
and the organ itself, from its exposure, is constantly irritated and in- 
flamed. 
Causes.—The immediate cause of dropsies of the eye is an undue 
action in the arteries which secrete the humors, and a diminished action 
of the absorbent vessels; or, sometimes an inordinate aqueous or 
vitreous secretion, with a normal action of the absorbents. 
Hydrophthalmia is generally supposed to depend upon some con- 
stitutional cause, like general dropsy, hydrocephalus, chlorosis, or se- 
condary syphilis; but, as a general rule, it may be traced by some pre- 
vious inflammation of the internal structures of the eye. In infants 
and young children, it is often exceedingly difficult to discover the real 
cause, especially when the external indications are obscure, and, on 
this account, the earlier history of the case can rarely be ascertained; 
but in adults, we shall often be able to discover previous sub-acute in- 
flammation in the internal structures. 
Prognosis.—The allopathists deem this disease, when fully formed, 
incurable. They find that no shedding of blood, no punishment of 
stomach, bowels, salivary glands, skin, or other inoffensive parts of the 
body, can cure or palliate it. That the prognosis is unfavorable we do 
not deny; but we believe the disease may often be cured in its early 
stages. We have treated but two cases homoeopathically; and but one 
with a favorable result. This was of six months standing, confined to 
the aqueous humor, and with but moderate distention of the cornea; 
the other case involved both humors, had continued more than a year, 
and had arrived at the condition termed “ox eye,” when the treatment 
was commenced. In this instance paracentesis became necessary, and 
the patient ultimately lost his eye. 
So long as the disease is confined to its incipient stage, and even 131 
CATARACT. 
after the unnatural accumulation has commenced, provided no serious 
disorganization has taken place in the important tissues of the eye, we 
may predict a favorable result; but if organic lesions have occurred, 
and the accumulation in the anterior or posterior chamber is consider- 
able, with total loss of sight, our prognosis must be unfavorable. 
Treatment.—If the dropsy depends upon a constitutional fault, our 
remedies must be addressed to the remote difficulties. So long as 
these continue, mere local means will be inadequate to accomplish our 
object; but constitutional and local remedies may be used in alternation 
with probable advantage. If the eye be much distended, and medicines 
do not act with sufficient promptness and energy, the operation of para- 
centesis may be made to evacuate the superabundant humors, after 
which the remedies will generally prove sufficiently powerful. 
We believe the following to be the best at present known: Bella- 
donna, China, Pulsatilla, Mercurius, Hyoscyamus, Stramonium, 
Conium,, Nux-vomica, Arsenicum, Plumbum, Aconite, Sepia, 
Sulphur. 
It is doubtful whether either of these exercises a positively specific in- 
fluence upon the secretory and absorbent vessels affected in hydroph- 
thalmia, but they are capable of acting upon the generally morbid con- 
dition upon which the local disorder depends; they thus aid in arresting 
ts progress, and occasionally in effecting cures. 
Administration.—In the same manner as advised in amaurosis. 
6. CATARACT. 
Diagnosis.—Strictly speaking, this disease belongs to the province 
of surgery rather than that of medicine ; but as homoeopathy promises 
results somewhat important in a medicinal point of view, we take the 
liberty of presenting a few? words respecting the malady in this place. 
By the term cataract is understood, an opacity of the crystalline 
lens, or its capsule, which causes an obscuration, or a total loss ot 
vision. Authors recognize and describe several varieties, both of the 
lenticular and capsular cataract, and among the most common are:— 
First.—The firm or hard cataract, peculiar to old people, and re- 
cognized by its amber color, small size, and by its density and hard- 
ness. Vision is never totally destroyed in these cases, and the struc- 
tures of the eye retain their natural contractility. 
Second.—The fluid or milky cataract, caused by a change of the 
lens into a white and semi-fluid mass, of so large a size as to nearly 
obliterate the posterior chamber, impair the motions of the pupil, and 
prevent the admission of rays of light. 
Third.—The soft or caseous cataract, which presents an appear- 
ance somewhat similar to the last variety, with the lens much enlarged, 132 
DISEASES OF THE SANGUINOUS FUNCTION. 
of a cheesy consistence, and of a light gray or sea-green color, oblite- 
ration of the posterior chamber, impaired motion of the pupil and iris, 
and either partial or total blindness. The lens in this variety, always 
presents an appearance of more firmness and consistence than in the 
milky cataract, aud the dark irregular spots or lines which sometimes 
traverse it, remain the same in all positions of the head, while those 
which are now and then observed in all the milky variety, change their 
location with every motion of the eyes. 
Capsular cataract, consisting of an opacity of the capsule 
of the crystalline lens. The opacity commences at the margin of the 
pupil, in the form of “ distinct, white, shining points, specks or streaks; 
its color, therefore, is always very light, and never altogether uniform, 
even when the disease is completely formed.” (Beer.) When this kind 
of cataract occurs in children at or soon after birth, it is called con- 
genital cataract. 
The capsular cataract does not generally continue for a long period 
before the lens becomes involved also in the opacity. When the dis- 
ease has been preceded by a good deal of inflammatory action, we may 
find cohesions of the anterior capsule of the lens with the urea; or of 
the whole of the capsule with the lens; or all the three species of ad- 
hesion may exist together.” (Beer, p. 318.) 
Cataract is sometimes complicated with amaurosis. This complica- 
tion is not always easy of detection, on account of the symptoms of 
these diseases bearing so close a resemblance. When the lens or its 
capsule are alone affected, the opacity is immediately behind the pupil, 
the iris and pupil possess some degree of mobility, and there is some 
little appreciation of light; but when amaurosis is conjoined with cata- 
ract, wTe have the same appearance of the lens or capsule, but a dilated 
and immovable pupil, an insensible and immovable state of the irts, 
and an absolute loss of vision. 
The first intimation we have of a forming cataract, is defective vision 
when attempting to read fine print, or to look at minute objects. 
As the disease advances, all objects appear indistinct; a mist is con- 
stantly before the affected eye; a strong light is required to read or 
write; a small speck now commences just behind the centre of tho 
pupil, and continues to extend until the opacity entirely obstructs the 
passage of rays of light to the eye; when the opacity is complete, a 
black ring is seen around the edge of the pupil and the sight continues 
to diminish until blindness is complete. 
Causes.—Frequent and long-continued use of the eyes in reading 
fine print, writing, or looking at minute objects by a strong light; con- 
gestion of blood to the eyes, from exercise in the hot sun, in furnaces, 
and other places where hot and bright fires are kept; exposure of the 
eyes, irritating fumes and vapors, like sulphurous acid, chlorine and CATARACT. 
133 
other gases, and the vapors of sulphuric ether, nitric, sulphuric and 
muriatic acids, hereditary predisposition, mechanical injuries, wounds 
of the capsule or lens. 
Prognosis.—When the cataract is confined to the lens, or to its 
capsule, and no complications exist from unnatural adhesions, from 
amaurotic symptoms, or from serious constitutional disturbance, a 
favorable issue may he expected. On the other hand, a dilated pupil 
an immovable iris, a profound blindness, which has been disproportion- 
ate to the gradually forming opacity, unnatural adhesions of the 
capsule, and an irritable and vitiated constitution, will render our 
prognosis unfavorable. 
Treatment.—Before resorting to the operation of couching, or ex- 
traction, as is so often done by the old school surgeons, we should al- 
ways give our medicines a fair trial. It is quite true that we have but 
few remedies which simulate this affection in their pathogenesis, yet 
the successful results which have been observed from the use of 
medicines in a few cases, render it incumbent on us to avail ourselves 
of them on all proper occasions. 
After a thorough trial with medicines, like Silicea, Graphites, Kali- 
hyd., Merc.-hyd., Calc-carl).-ac., if there is no prospect of amendment, 
the patient should be turned over to the surgeon for the necessary 
operation. 
In a few cases of incipient cataract, much benefit has followed the 
local employment of sulphuric ether vapor to the eye, and should our 
internal remedies prove fruitless, there can be no objection to a trial of 
this substance. 
As internal remedies we suggest: Silicea, Graphites, Iodine, Merc.- 
hyd., Conium, Pulsatilla, Magnesia-carb., Sulphur, Cannabis, 
Phosphorus, Digitalis, Spigelia, Euphrasia. 
Conium and Cannabis may be employed where the cataract has 
arisen from a wound or other injury to the eye. 
JCagnesia-carbonica, Pulsatilla, Digitalis, and Phosphorus, have 
proved curative in capsulo-lenticular cataract, either with or without 
abnormal adhesions, also in opacity of the lens or capsule alone. These 
remedies are useful when the disease has been accompanied with 
ophthalmia. 
Sulphur is appropriate in those cases which seem to be connected 
with a scrofulous or psoric diathesis. It has also been found curative 
n cataract complicated with amaurosis. 
Euphrasia, or Spigelia may sometimes be alternated with Sulphur 
with benefit. 
Administration.—The same as in amaurosis. 
A case is given by Dr. J. Mouremans,* of a lady, aged 77 years, 
* L’llomoeopathe Beige. 134 
DISEASES OF THE SANGUINOU8 FUNCTION. 
who had been blind four years. She is small, emaciated, of sallow 
complexion, mother of three children. Vision had become impaired 
gradually several years ago after inflammation of the eye. She then 
saw snow-flakes and spider-webs in the atmosphere. In 1856, April 
29th, she could hardly distinguish light from darkness; pupils dilated 
and mobility of the iris partially impaired, crystalline lens obscured, of 
whitish color, and uniformly shaded; no pain; inability for four years 
to continue her occupation. Euphrasia 30th, May 16th, improvement, 
continue Euphrasia, higher potency, three globules at once. 
Aug. 4th. Begins to distinguish objects but they look distorted. 
Cannabis 30, continued till Dec. 1. Condition not changed. Sulph. 
200, three globules given at once. March 2d. The crystalline lens 
appeared less clouded. Could distinguish persons though as in a mist 
Causticum 200. 
April 30th. Still saw black spots before the eyes; but vision im- 
proving, Silicea 30. At the end of May, the patient overjoyed at her 
condition, can readily distinguish all objects; could recognize the 
letters in a book; that she could devote herself again to her former oc- 
cupation. Sees a halo around the light of a candle. Phosphorus 30. 
Two months later, she came to render thanks for the benefits she 
had received. Her vision was so far improved that she could thread a 
needle, could sew and could read with ease. Three years afterwards 
the sight continued good. 
Mr. Hancock says he does not regard the disease merely as a 
choroiditis, or irido-choroiditis, with infusion into the vitreous and 
aqueous humors, as this view seems to regard results rather than 
causes. He believes “that glaucoma, whether acute or chronic, is es- 
sentially a disease of the blood and the blood-vessels, arid that the ef- 
fusion or infusion, as it may be described, is the result of this condition, 
which if not arrested, sooner or later destroys sight.” He does not 
rely on any operation for the cure of glaucoma, relying mainly upon 
constitutional remedies. 
“In acute glaucoma,” says Mr. Hanson, “the eyeball is constricted 
and marked by a circular depression at the point corresponding to the 
ciliary muscle, whilst the vessels around this part are gorged to a great 
degree. The eyeball is elongated in its antero-posterior diameter, and 
the cornea lessened in all its diameters, and rendered more conical than 
natural; whilst, when the patient turns his eyeball sideways, irregular 
bulging of the sclerotica (Staphyloma), is exposed to the view. In 
one or two cases, also, in which I performed iridectomy, the pupil was 
dilated to excess, and the iris so tense and rigid that it resembled a 
cat-gut, and could with difficulty be drawn through the wound.” The 
7. GLAUCOMA. GLAUCOMA. 
135 
pathology is not clear. This author thinks he can “ readily under- 
stand that the lateral expansion of the eyeball being, in a great degree, 
prevented by the constriction of the ciliary muscle, the force of the 
compressed fluid acts more powerfully in the antero-posterior direction; 
hence the puckering and cupping of the retina, the irregular bulging 
of the choroid, the alteration in the shape of the cornea, and elongation 
of the eyeball.” 
A more careful examination of the pathological appearances led this 
observer “ to suspect that the ophthalmoscopic and pathological ap- 
pearance of the blood-vessels were greatly enhanced by, if not in some 
instances entirely due to, the obstruction of the circulation caused by 
the undue and excessive constriction exerted upon them by the spas- 
modic or extreme contraction of the ciliary muscle, analogous to the 
spasm so often observed in the muscular fibres of the urethra, as well 
as in the sphincter muscle in certain affections of those parts. 
“This supposition was strenghtened by the character of pain so 
often described by patients as ushering in the attack of acute glaucoma; 
in one case, a lady who had been exposed to a very strong light at a 
party, felt upon her return home, as though she had received a violent 
blow upon her eye.” (Lancet, Feb., 1860.) 
Pathology.—In glaucoma the pupil is dilated, of a sea-green, bottle- 
green, or dirty-green color; the cornea is somewhat flattened anteriorly, 
and nearly as sensitive as in the natural state; the iris is,rather con- 
vex anteriorly; the globe of the eye is harder than usual; the sight is 
diminished from slight amblyopia to complete blindness; the ophthal- 
moscope, shows the papilla of the optic nerve, as it enters the globe and 
spreads out into the retina, to be concave, in place of convex, as it is 
normally; it likewise demonstrates pulsation of the arteria centralis 
retinae. Yon Graefe attributes all these symptoms to increase of 
the intra-ocular pressure. He divides glaucoma into acute and 
chronic. 
Acute glaucoma, is considered to consist in a choroiditis (or irido- 
choroiditis) with diffuse imbibition of the vitreous body and aqueous hu- 
mor, and in which increase of the intra-ocular pressure, compression 
of the retina, and the well-knowrn series of secondary symptoms, are 
produced by the increased volume of the vitreous humor. 
Treatment of Glaucoma.—This disease, previously regarded as in- 
curable, has been treated with partial success by Yon Graefe by the 
operation of iridectomy. J. W. Hulke, assistant surgeon to the 
London Ophthalmic Hospital, &c., has reported two cases thus treated. 
It is claimed that “the hardness of the eyeball, the peculiar progressive 
contraction of the field of vision, the paralyzed dilated pupil, the in- 
tense throbbing pain, the excavation of the optic nerve entrance, and 
pulsation of the retinal vessels,” are consequences of “ excessive tension 136 
DISEASES OF THE SANGUINOUS FUNCTION. 
of the eyeball, produced by a superabundance of fluid within it, which 
is probably exuded from the choroidal vessels and distends the vitreous 
humor.” “The eye being an organized living tissue, having a locular 
or cellular arrangement, the distention of its loculi with dense fluid, as 
serum, would give the whole tissue an unnatural turgidity, and stiffness. 
The fluidity of the organ, which occurs later in the disease, depends 
upon the breaking up of its dissepiments, when it shares the atrophy 
which finally involves all the ocular structures.” Yon Graefe long ago 
demonstrated a flattening of the cornea in this disease, “ by comparing 
the size of the image which the flame of a candle forms upon the glau- 
comatous cornea with that which it forms upon the healthy cornea of 
the other eye;” it is “immediately apparent that the glaucomatous 
cornea furnishes the larger image, proving that its outline has a larger 
(flatter) curve. 
“ The excavation of the optic nerve entrance” is explained in the 
Jacksonian prize essay on “Diseases of the Retina,” Dec. I860. (Archiv 
f ar Ophthalmologies) It is there shown that “the optic nerve entrance 
constitutes the weakest, the most yielding point in the fundus, where 
the first visible effects of excessive pressure would naturally be ex- 
pected.” [Medical Times and Gazette, Sept. 1, 1860, London Lancet, 
Feb. 1861, p. 144.) 
Surgical Treatment.—Yon Graefe first attempted to treat it by 
paracentesis of the eye, and he accordingly performed this operation 
repeatedly in a large number of cases; but of these only two were per- 
manently cured, though there was temporary amelioration in most. 
He next attempted to produce “permanent diminution of the intra- 
ocular pressure” by iridectomy; but the general result was not very 
satisfactory; it seemed only to cause rather a refilling of the atrophied 
or softened eye. The result, however, of the same operation “in ulce- 
rations and infiltrations of the cornea” gave hopes of further advantages 
in the other cases. 
Cases, in which this operation was performed.—First:—In the 
premonitory stage of glaucoma. In this it was successful, even when 
this stage had lasted a long time. 
Second:—Early stage of acute inflammatory glaucoma. “Vision 
was perfectly restored in all cases in which the operation was per- 
formed before the termination of two weeks from the occurrence of the 
inflammation.” Some of these cases were perfectly desperate, for 
every trace of the qualitative perception of light had been already ex- 
tinguished.” 
Third:—Later period of acute glaucoma. Here improvement "was 
obtained, though less apparent; the improvement was considerable, 
even after the inflammation had lasted many weeks, 'lprovided the 
feld of vision was not contracted, nor the optic papilla excavated.” 137 
HYPERNETKOPIA. 
In the opposite condition the operation not advised by excrutiating 
spasmodic pain, which lasted several hours.” 
He had tried Graefe’s method by iridectomy and found it objection- 
able, from 
First:—“The disfigurement resulting from the removal of a portion 
of the iris, the formation of a coloboma iridis.” 
Second:—The removal of one-fifth of the iris. 
“All agree that the smaller the quantity of iris removed the better. 
By excision of a portion of the iris, the edge of the lens, with its 
suspensory ligament passing in front of the vitreous humor to the 
ciliary process, is exposed to view. To remedy this inconvenience, 
Mr. Bowman makes an incision above, believing that the cover thus 
given to the upper lid to the margin of the lens which has been ex- 
posed by the removal of the iris contributes to the perfection of vision. 
Third:—“The loss of the power of adapting the eye to near ob- 
jects, which it in some degree retains in chronic glaucoma.” 
Operation proposed by Hanson. — “Introduce a Beer’s cataract 
knife at the outer edge of the cornea where it joins the sclerotica. The 
point of the knife is pushed obliquely backwards and downwards until 
the fibres of the sclerotica are divided obliquely for rather more than 
one-eighth of an inch. By this incision the ciliary muscle is dividedj 
whilst the accumulated fluid flows by the side of the knife.” 
8. HYPERMETROPIA. 
Defective Power of Accomodation of the Eye. 
This disease was first described by Yon Grsefe in his u Archiv fur 
Ophthalmologies 11. It has since been thoroughly investigated 
by Donders. We abridge their views, as presented by another author.”* 
By hypermetropia is meant that peculiar condition of the eye in 
which the refractive power of the eye is too low, or the optic axis (the 
antero-posterior axis) too short; we may, however, have both these 
causes co-existing. We may also diagnose the hypermetropic eye by 
its peculiar shape; it appears flatter and smaller than the normal eye, 
it does not fill out the aperture of the lids, there is a greater or less 
space (like a little pouch) between the eyeball and the canthus, more 
particularly the outer canthus. 
The normal eye unites parallel rays upon the retina with little or 
no effort of accommodation, but it also possesses the power of accom- 
modating itself without difficulty or annoyance for divergent rays, coming 
from objects six to eight inches from the eye, for a short time it can 
* Mr. J. S. Wells, Medical Times and Gazette. 138 
DISEASES OF THE SANGUINOUS FUNCTION. 
even unite rays upon the retina which come from three to four inches 
distance. The focal point of the dioptric system lies in the‘normal eye 
exactly upon the retina. 
In the myopic eye, the state of refraction is too great, or the optic 
axis too long, so that when the eye is in a state of rest, the focus of the 
dioptric system lies in front of the retina, and parallel rays (emanating 
from objects at an infinite distance) are brought to a focus before the 
retina, and only more or less divergent rays are united upon the latter. 
“Now in hypermetropia we have just the reverse of this. The re- 
fractive power of the eye is so low, or its optic axis so short, that when 
the eye is in a state of rest, parallel rays are not united upon the re- 
tina, but behind it, and only convergent rays are focussed upon the 
latter. 
Treatment.—When the eye does not possess sufficient refracting 
power to converge the parallel rays of light to a focus on the retina, 
the only successful mode of treatment consists in selecting and adapt- 
ing to the wants of the individual convex glasses which by giving the 
rays of light a sufficiently convergent direction may neutralize the 
hypermetropia. The mode of suiting the eye with glasses of the proper 
convexity is best described by Mr. W'ells, according to the theory of 
Donders. 
“The presence of hypermetropia is thus tested. If a person can see 
distant objects through a convex-glass, he is hypermetropic. The best 
object is Jmger’s test-type. The strongest glass with which the patient 
can read at a distance of twenty inches gives us the degree of hyper- 
metropia before the action of atropine. If this glass be convex 24, his 
hypermetropia equals -gV. The power of accommodation is then to be 
paralysed by a strong solution of atropine (4 grains to one ounce of 
water): after this has acted for from two to three hours, the degree of 
hypermetropia is to be again tested. In young persons with a good 
range of accommodation, the difference in the convex glass required 
before and after atropine is often very considerable. In the normal 
eye the far-point begins to recede from the eye about the age of fifty- 
five or sixty, the eye becomes hypermetropic, at eighty the hypermetro- 
pia may, according to Donders, equal -fa. 
“Range of Accommodation?—We change the hypermetropic eye 
into a normal one by means of the suitable convex glass, and then find 
the nearest point at which No. 1 of Jaeger can be read with this glass. 
If the near-point lies at seven inches, A=4. 
“It has already been pointed out that presbyopia may co-exist with 
hypermetropia. 
“ Spectacles.”—A’person suffering from hypermetropia must be gra- 
dually accustomed to wear those glasses which neutralized his hyper- 
metropia after the accommodation was paralyzed by atropine. At first ASTHENOPIA. 
139 
weaker glasses will be required, but the strength should be gradually 
increased until he has arrived at the glass which really neutralizes his 
hypermetropia. These spectacles should be worn both for far and near 
objects, shculd indeed, be always worn when the eyes are used. If the 
hypermetropia is great, or if a presbyopia co-exists, two pairs of spec- 
tacles will be required, a strong pair for reading, &c., a weaker for 
distance. 
“Hypermetropia is a very frequent cause of asthenopia and also of 
convergent strabismus. The asthenopia is produced by the overstrain- 
ing of the accommodation apparatus in reading, writing, &c., without 
the proper spectacles. We have seen that the hypermetropic eye has 
already to exert its power of accommodation more or less for distant 
objects, in viewing which the normal eye hardly uses its accommodation 
at all. How much greater must this exertion be when the hyper- 
metropic eye looks for any length of time at near objects, the rays 
from which are strongly divergent. The eye cannot keep up this great 
strain of its powrers of accommodation for any length of time, and hence 
symptoms of asthenopia soon arise. 
Hypermetropia often causes convergent strabismus. As the power 
of accommodation increases when the convergence of the optic axes is 
augmented, a person suffering from hypermetropia often squints in- 
voluntarily, in order to see more distinctly. This squint becomes per- 
manent, if the hypermetropia is not treated, and a strabismus opera- 
tion will then be required. 
The eye presents a perfectly normal appearance; its movements are 
restricted; convergence of the axes of vision takes place without diffi- 
culty; the perception of objects is generally as perfect as ever; and 
yet in spite of all this, reading, writing, or any other employment re- 
quiring near objects to be viewed, induces fatigue; objects become con- 
fused and indistinct, and a sense of tension is felt above the eyes. Such 
a height does this reach that temporary relinquishment of the employ- 
ment is rendered necessary. After resting a few moments vision be- 
comes again distinct, but the same symptoms develop themselves 
again sooner than before. The amount of labor that can be performed 
is directly proportional to the amount of rest that has been taken. 
So long as the eyes are not employed on near objects vision appears 
normal, and no disagreeable sensation is experienced. No sooner, 
however, does the patient, regardless of what he has experienced, at- 
tempt to continue his previous occupation, than the symptoms become 
more and more pronounced; the pain in the forehead grows more in- 
tense ; the eyes become red, the tears flow freely, yet the eyes them- 
9. ASTHENOPIA.—HEBETUDO VISUS. AMBLYOPIA PRESBYTIQUE. 140 
DISEASES OF THE SANGUINOUS FUNCTION. 
selves are rarely painful. As this condition becomes more aggravated, 
the patient is obliged to close his eyes and pass his hand over his fore- 
head. Has too persistent an effort been made, all work on near objects 
must be given up for a considerable period. 
Pathology.—This is little understood. Mackenzie thought the 
seat of the disease must be sought in the organs by the operation 
of which the eye adapts itself to different distances. Dr. Derby,* 
regards “an abnormal structure of the eye as lying at the root of 
the whole matter.” He says: 
The results of modern investigation show:—That the agent in the 
act of accommodation is the crystalline lens, which varies its convexity, 
without changing its position. That where objects are so distant from 
the eye that the rays coming from them may practically be regarded 
as parallel, such rays are brought to a focus on the retina without any 
accommodative effort; and that the nearer the object approaches the 
eye, the greater will be the strain on the accommodation. 
And while the far-point, or limit of distinct vision of a normal eye, 
may thus be said to lie in infinity, (rays coming from an infinite dis- 
tance being parallel) the near point of such eye—i. e. the nearest 
point for which it can accommodate progressively recedes with advan- 
cing age, constituting presbyopia when it has increased its distance from 
the eyes so much so as to cause inconvenience. 
Thus in an ideal eye the farthest point of vision should lie in in- 
finity, that is, the eye, when adapted for its farthest point, should possess 
the power of bringing parallel rays to a union on the retina without ac- 
commodative effort. 
Relatively few eyes, however, correspond to this ideal. Parallel 
rays, entering some eyes adapted for their farthest point, are brought 
to a union before the retina, so that only divergent rays, proceeding 
from objects relatively near can form perfect images on its surface. 
And parallel rays entering other eyes whose accommodative power is 
similarly relaxed, find their place of union behind the retina, to form 
perfect pictures on which the rays should enter the eye converging. 
Both of these conditions depend on a defect in the structure of the 
eye. The first constitutes myopia. The second is called by Donders 
Hypermetropia (which see page 137.) Presbyopia may exist in con- 
nection with either. In the first case the far-point lies this side of, in the 
second beyond infinity. The first requires a concave, the second a 
convex glass to give power of distinct vision at a distance. In 1858, 
Donders announced the general association of asthenopia with hyper- 
metropia and this abnormal structure of the eye. In 1860, he said of 
the last hundred cases he had examined of asthenopia, 
existed in every one. 
* Medical and Surgical Journal. ASTHENOPIA. 
141 
According to Donders “the amount of accommodation we can bring 
to bear on an object at any distance, depends, in a great measure, on 
the angle at which it is necessary to converge the axes of vision in 
order to regard the object; the rule being that the two go, to a great 
extent, hand in hand, and that the greater the convergence the more 
accommodation we can bring into play. We distinguish between ab- 
solute and relative accommodation; absolute being the whole amount 
of accommodation that exists under the most favorable circumstances, 
the near-point being taken at the greatest possible convergence of the 
visual axes, and the far-point at their nearest approach to parallelism; 
while relative accommodation is the amount that can be made use of 
at any fixed convergence of the axes of vision. Now it is found by e x- 
periment and observation that where normal eyes need, for a given con- 
vergence, half their relative accommodation, hypermetropic eyes are 
obliged to use ■§ or even more, which greatly fatigues them; and the cause 
of the asthenopic symptoms is thus simply a want of proportion be- 
tween the convergence of the axes of vision and the amount of re- 
lative accommodation that is obliged to be brought into play. 
Treatment.—It wras formerly the practice to prohibit the use of 
positive glasses for the concentration of the vision on distant objects 
and only those very weak were used for near ones. The relief they 
afforded was therefore but trifling. Now the nature of the disease be- 
ing understood, we only regard the effect desired, viz., the relief of the 
accommodation from its unnatural strain, and the restoring of the proper 
harmony between it and the convergence of the axes of vision. The 
treatment, therefore, consists in giving the patient glasses that corres- 
pond with the degree of abnormal condition and structure of his eyes. 
“The strongest convex lens with which he can see distinctly at a 
distance reduces his eye to one which needs no glass for either near or 
remote objects.” In some patients who possess only a limited power 
of accommodation, a stronger lens will be needed for work on near ob- 
jects; “and a simple mathematical process enables us to compute the 
glass with which he shall be able to work in a given distance, and in 
so doing bring into play not more than one-third of the whole amount 
of his accommodation.” 
In ascertaining the “strongest glass with which the hypermetrop 
can see in the distance,” Donders employs a solution of atropia, suf- 
ficiently strong to paralyze the accommodation, dropping this into the 
eye before the trial is made. The patient who first thought himself 
suited with a glass of twenty-four inches for distant objects; “after the 
employment of atropia, found one of six inches to be the glass re 
quire d.” 142 
DISEASES OF THE SANGUINOUS FUNCTION. 
10. FUNGUS ELEMATODES, AND CANCER OF THE EYE. 
Diagnosis.—Fungus ITcematodes bad always been confounded with 
scirrhus or cancer until Burns, Hey, and Abernethy pointed out the 
characteristics of the two diseases, both in respect to their formation 
and development, as well as their pathology. They possess several 
qualities in common, like malignancy, inevitable tendency to the de- 
struction of the affected parts, the power of contaminating the whole 
system, and giving rise ultimately to fatal constitutional symptoms; 
but in other respects they are entirely dissimilar. 
Fungus hcematodes is not usually attended with the severe stinging 
and lancinating pains of cancer; its texture is spongy and elastic, and 
is soft and apparently fluctuating under the touch, while scirrhus is 
hard and stony. When fully formed the fungous tumor is of the con- 
sistence of brain, is of a dark and livid hue, and bleeds on the slightest 
touch, while the substance of the cancer is hard, fibrous, and cartilagi- 
nous; at its commencement and during its development, the fungus is 
knotty and unequal, and thus affords a sign which distinguishes it from 
cancerous and other tumors. Fungus is more prone to occur in young 
subjects, while cancer is for the most part confined to persons past the 
middle age. Fungus of the eye commences in the posterior chamber, 
while cancer of the eye attacks primarily the conjunctiva or lachrymal 
gland. The progress of fungus is more rapid and destructive than that 
of cancer. 
The first symptom observed in fungus haematodes is defective vision, and, 
dn looking into the eye, a small shining spot is perceived at the bottom 
of it. This nucleus of the disease commences in the retina and optic 
nerve, is traversed by branches of the central artery of the retina, ab- 
sorbing it in its course, until it arrives near the iris, when it presents 
a dark amber or greenish hue, and is apt to be mistaken for cataract. 
As the enlargement increases, the ball of the eye becomes promi- 
nent, irregular, and knotty, the cornea ulcerates, and the disease dis- 
plays itself externally in the form of a soft, medullary, and purple 
fungus, bleeding at the least touch. The pupil becomes dilated and 
immovable in the early part of the disease, and also somewhat changed 
in color, which becomes a strongly-pronounced amber or brown when 
the swelling arrives at the iris. The sclerotica soon acquires a dark 
blue color, is crossed by dilated veins, and is gometimes attacked by 
the malady as well as the cornea. After the fungus has shown it- 
self externally, the absorbent glands of the jaw and neck become af- 
fected with a medullary degeneration; the countenance assumes a 
sallow and cadaverous appearance; general debility and nervous irrita- 
tion occur; loss of appetite, impaired digestion; nausea; irritable CANCER OF THE EYE. 
143 
stomach; restlessness, and the usual symptoms of hectic fever terminate 
the patient’s existence. 
Cancer of the eye, as we have before remarked, generally attacks 
persons advanced in life. This disease, unlike fungus haematodes, 
commences in the conjunctiva, caruncula lachrymalis, or lachrymal 
gland, in the form of a hard warty excrescence, which continues for an 
indefinite period, sometimes attended with twinging and lancinating 
pains, at other times free from all uneasy feelings, until finally its in- 
terior structure becomes altered in texture, an ichorous matter forms 
within the swelling, which gradually makes its way to the surface, and 
thus develops the first stage of ulceration. When arrived at this point, 
vision is destroyed, an irregular fungous mass shoots up from the ulce- 
rated point, highly vascular, of a red, brown, or livid color, and easily 
excited to haemorrhage. As the mass increases, the tissues of the eye 
become distended; the ulceration and sloughing advance ; severe lanci- 
nating pains dart through the globe; the appetite is impaired; the 
patient loses flesh, strength, and courage; sleep is disturbed; the 
countenance assumes an anxious, distressed, and sallow appearance; 
hectic fever sets in, and the sufferer speedily yields to the result. 
Hitherto the diseases under consideration have usually been deemed 
incurable by internal remedies, and on this account surgeons have ad- 
vised the early extirpation of all suspected tumors, hoping in this way 
to eradicate the affection while it is local, and before the mass of blood 
becomes contaminated. But it must be admitted, even when the opera- 
tion has been resorted to early, and under the most favorable circum- 
stances, that a lamentable want of success has for the most part, 
followed all surgical measures. Stealthy and insidious at their com- 
mencement they gradually glide along, depositing in all surrounding 
textures their destructive and fatal poison, until disorganization begins, 
when the livid, foul, and destructive phenomena appear in their hideous- 
ness, rapidly communicating their influence through the whole organ- 
ism, and baffling all efforts of the physician and surgeon. 
But though experience has so little of promise, we can not admit 
that there are no retnedies in the whole range of the materia medica 
capable of counteracting this morbid influence. We may yet find some 
medicine sufficiently specific to cure these diseases during their form- 
ing stage. We believe, indeed, that homoeopathy will, ere long, ac- 
complish all that we require in this matter. Only a limited number of 
well-authenticated homoeopathic cures of true medullary fungus, or of 
cancer, have been reported; but the results in these few cases should 
inspire us -with some confidence of success, especially during the early 
period of the maladies. 
Causes.—The immediate cause of medullary fungus and of cancer 
is involved in doubt. Some have suggested the operation of animalculae, 144 
DISEASES OF THE SANGUINOUS FUNCTION. 
others of a subtle poison, others of a kind of unhealthy inflammation 
caused by some constitutional defect. Sir Astley Cooper supposed 
the morbid degeneration always to be “preceded by a disposition in the 
constitution to its production.” 
There is unquestionably a specific morbid action in the tumor itself, 
but whether this is owing to some poison which acts specifically upon 
the particular part alone, or to some constitutional vice, we are unde- 
cided. That there are drugs capable of neutralizing this morbid influ- 
ence, whether it be constitutional or local, we entertain no doubt. The 
exciting causes are: blows, contusions, obstructions of blood from 
pressure, and mechanical injuries generally, although the disease often 
originates without any apparent or traceable cause. 
Prognosis.—In our present state of knowledge, the prognosis must 
be generally unfavorable ; but not many years will elapse before this 
state of things will change, and we shall be able to meet these terrible 
diseases with sure and efficient remedies. 
Treatment.—The homoeopathic treatment of these affections must 
be directed by the general principles of treatment of malignant diseases. 
See Fungus Haematodes and Cancer.—Index. 
Belladonna has cured malignant disease of the eye, attended with 
violent pains in the eyeball; a red shining point in the posterior 
chamber; pupils dilated and immovable; loss of vision; unusual hard- 
ness of the substance of the eye ; iris of a dark color, and covered with 
injected blood-vessels. 
Malignant affections of the eye have also been cured by Conium 
Carbo-vegetabilis, Arsenicum, Mercurius, Acid-nitr., Calcarea* 
carbonica, and Iodine. 
Administration.—The same as in amaurosis. 
III. AFFECTIONS OF THE APPENDAGES OF THE EYE. 
1. HORDEOLUM. STYE. 
Diagnosis.—This is a small boil-like swelling in the edge of the eye- 
lid, resembling in size and general appearance a barley-corn. It 
generally commences in the follicles of Meibomius, near the angle of 
the eye; it soon assumes a dark-red or purple color, and becomes pain- 
ful from the violence of the accompanying inflammation. The inflam- 
mation sometimes confines itself to the cellular membrane, and advances 
very slowly to the suppurative stage, thus causing not only highly 
troublesome local pains, but a considerable degree of febrile disturbance. 
In these cases, gangrene and sloughing of the cellular membrane is liable 
to occur, and either protract the cure, or leave the part in a condition 
liable to take on a renewed morbid action from the smallest exciting AFFECTIONS OF THE APPENDAGES OF THE EYE. 
145 
cause. In other instances, suppuration occurs speedily, the abscess 
bursts and discharges itself freely, and a prompt cure results. 
Causes.—Use of highly spiced, fat, and stimulating food: disordered 
stomach and bowels; abuse of the eyes in reading, writing, or sewing 
by gas-light: scrofulous, psoric, and other impurities of the blood. 
Treatment.—The appropriate remedies are: Sulphur, Pulsatilla, 
Staphysagria, Sepia, Lycopodium. We usually employ the third at- 
tenuation, and administer a dose twice daily until the swelling and in- 
flammation disappear. 
2. ENTROPIUM.—INVERSION OF THE EYELIDS. 
Diagnosis.—This affection consists of an unnatural turning inwards 
of the whole or a portion of the tarsus and eyelashes, in such a manner 
as to keep up a constant irritation of the globe, and thus generate a 
troublesome chronic ophthalmia. If the disease is allowed to continue 
for any length of time, the cornea loses its brilliancy, its vessels become 
injected and ulcers form; there is continued lachrymation; partial or 
entire loss of vision; great pain and annoyance from the presence of 
the offending eyelashes. 
Causes.—Cicatrices arising from previous ulceration of the tarsi 
chronic ophthalmia; relaxation and paralysis of the lids; ulceration of 
the ciliary glands. 
3. ECTROPIUM.—EVERSION OF THE EYELIDS. 
Diagnosis.—Eversion of the lids may he caused by a swelling and 
relaxation of the lining membrane of the eyelid, which presses the 
edge of the lid forward until it becomes everted, or by a contraction 
of the skin of the lid, in consequence of the healing of wounds, ulcers, 
carbuncles, burns, boils, &c. The consequences of eversion are, con- 
stant exposure of the globe to external irritating causes: chronic in- 
flammation of the eye: frequent discharge of tears: dryness of the 
ball; photophobia; nebulous spots and ulcers of the cornea. 
Causes.—The principal causes of eversion, in consequence of swell- 
ing of the lining membrane of the lid, are, protracted chronic ophthal- 
mia of a scrofulous nature: relaxation from intemperance or old age ;■ 
a diseased state of the follicles of Meibomius; morbid growths in the 
part. Other causes of eversion are, cicatrices on the skin arising from 
incisions, burns, ulcers, small-pox pustules, and carbuncles. 
Treatment.—The medicines which have been commended in these 
affections are, Hepar-sulphur., Mercurius-sol., Calcarea-carb., Digi- 
talis'., Borax. 
Should these remedies disappoint our expectations, a portion of the 
You II—10 146 
DISEASES OF THE SANGUINOUS FUNCTION. 
lid should be excised, in such a manner and in such a situation that 
the healing cicatrix will restore the displaced tarsi and cilia to their 
normal position. The operation is simple, unattended with danger, and 
quite efficient. If opacity or ulceration of the cornea has already com- 
menced when we are first called to the case, it will be advisable to 
have recourse to the operation without delay, and correct all local or 
constitutional faults afterwards with suitable medicines. 
The attenuations and repetitions of doses the same as in amaurosis. 
Exophthalmia. — Protrusion of the Eye. — Secale-cornutum.— 
Prof. Willebrand published his successes with Secale in relieving the 
partial paralysis of the ciliary muscle, which renders it difficult or 
impossible to read or sew for any length of time, or to accommodate 
the visual foci to small objects at short distances. 
He says the sphere of action of Secale is found in the vaso-motoric- 
nerves. The cases in which he has found it most beneficial are: 1. En- 
larged spleen from ague, after failure of Quinine. 2. Glalactorrhoea.— 
3. Indurations, tumefactions and catarrhal affections of the uterus. 
4. In blepharitis and pustular conjunctiva of children, preventing re- 
lapses. 
4. FISTULA LACHRYMALIS. 
Under this head authors generally include, obstruction of the puncta 
lachrymalis and of the lachrymal canals, inflammation and suppuration 
of the lining membrane of the lachrymal sac, and inflammation, thicken- 
ing and obstruction of the ductus ad nasum. 
In the most simple form of the complaint, there will be merely an 
obstruction of the puncta, arising from disease of the Meibomian 
glands, or of the eyelids, and a consequent interruption to the passage 
of tears to the lachrymal sac. The manifest symptoms in this instance 
will be, a continual watering of the eye and overflow of tears upon the 
cheek, weakness of vision, and an undue dryness of the nostril of the 
affected side. 
Another form of the complaint commences in the lachrymal sac, 
manifesting itself in the form of a small, hard, and circumscribed swell- 
ing, apparently within the sac. This swelling is quite tender to the 
touch, and gradually increases in size until suppuration occurs, when 
the parts over and around the tumor acquire a red and shining appear- 
ance, not unlike erysipelas. During the early period of the inflamma- 
tion, the puncta are closed, and tears are forced over the cheek. The 
inflammation also extends down the nasal canal, causing a degree of 
tenderness, dryness, and obstruction in the duct and nostril. If the 
suppurative process continues unchecked, the sac, after becoming much 
distended, bursts, and gives gradual exit to the enclosed pus; thus re FISTULA LACHRYMALIS. 
147 
ducing the swelling and developing a fistula of the lachrymal sac. 
During the suppurative process, the inflammatory action frequently ex- 
tends to the external textures of the eye, and if the patient be scrofu- 
lous or highly irritable, some constitutional disturbance may be present. 
If the disease is permitted to increase, or if injudicious surgical 
interference has seriously injured the affected tissues, we may expect 
adhesive inflammation between the walls of the membrane of the nasal 
duct, and permanent obstruction to the passage of tears to the nostril, 
and also a closure of the lachrymal canals. When this state of thingf 
happens, the tears run over the cheek as fast as formed; and we are 
presented with the disease termed stillicidium lachrymarum. 
Still another form of the malady consists in a primary inflammation 
and thickening of the membrane of the ductus ad nasum, which gives 
rise to a partial or total obstruction to the passage of the tears, and 
their consequent accumulation in the lachrymal sac. This undue lach- 
rymal accumulation induces distention of the part, and after a time, in- 
flammation of its lining membrane, and other consequences which we 
have before enumerated. This form of fistula is dependent upon some 
disease of the nostril, like syphilitic, scrofulous, mercurial, and can- 
cerous ulcerations, or inflammation of the nasal membrane from other 
causes. 
When the malady is fully developed, it is difficult to decide in which 
particular structure the inflammation originated: but our diagnosis will 
always be facilitated by carefully considering the causes of the affec- 
tion, and the previous inflammations. In whatever part it commences) 
the inflammation is certain to extend, sooner or later, to the contiguous 
structures. 
Causes.—Scarpa advanced the idea, that all forms of fistula lach- 
rymalis were attributable to a disease of the minute glands of Meibo- 
mius, or as inflammation of the lining membrane of the eyelid. This 
idea has been partially refuted by several eminent oculists, but there 
is, notwithstanding, much truth in the theory. According to our own 
observations, those forms of fistula which have originated in the puncta, 
or lachrymal sac, have been preceded by an inflammation of the Mei- 
bomian glands, or of the conjunctiva of the eyelids: but where the 
disease has originated in the ductus ad nasum, it may generally be 
traced to previous inflammation, ulceration, or injury to the mucous 
membrane of the nostril. 
The remote causes which predispose to the affection are: a scrofu- 
lous, syphilitic or mercurial taint; general debility and tendency to 
membranous inflammations: caries of the nasal bones; fractures and 
other injuries in the region of the lachrymal sac and nasal duct; 
Chronic ophthalmia; pressure of tumors against the lachrymal sac and 
the puncta. 148 
DISEASES OF THE SANGUINOU8 FUNCTION. 
Prognosis.—Previous to suppuration of the sac, and if there is only a 
partial obstruction in the lachrymal canals, we may anticipate a prompt 
cure by internal remedies. But if the puncta and nasal duct be en- 
tirely closed, and the suppurative stage in the sac is far advanced, our 
prognosis must be unfavorable or reserved. Much, however, must al- 
ways depend upon the condition of the system, and the causes and 
complications wdiich influence each particular case. 
Treatment.—Various methods have been proposed by surgeons for 
the cure of fistula lachrymalis, but they have proved for the most part 
unsatisfactory. The different surgical means which have been most 
commended are, the introduction of a tube or style into the nasal duct; 
the injection of the sac and nasal canal through the puncta, by means 
of Anel’s syringe, and the introduction of quicksilver. That cures 
have now and then followed each of these methods, we do not deny: 
but the numerous instances of permanent aggravation of the malady by 
their employment, render it probable that there has been altogether 
more injury than benefit from their introduction into surgical practice. 
The mode of treatment formerly in vogue of inserting canulae and 
styles into the puncta lachrymalia has been, according to Dr. Williams, 
entirely superseded by the method proposed by Mr. Bowman of London. 
This plan consists in the enlargement of the punctse, to admit of the 
use of a common-sized surgical probe (p. 67.) But this opinion is not 
generally accepted. Mr. Haynes Walton* says; “The process of Mr. 
Bowman I find tedious, and so disagreeable, that but few persons will 
submit to it sufficiently long. My practice in general, therefore is to 
dilate for a short time only, using in the first instance the smaller 
probe, and afterwards the larger one, and then to introduce a style. 
“ When there is really that degree of change in this conduit which 
imperatively calls for instrumental treatment, the wearing of a style 
is less irksome, the more beneficial and the quicker plan. In some in- 
stances where my patient’s time was short, I have introduced the style 
at once.” (p. 846.) 
The style recommended is of pure silver and should he kept of dif- 
ferent diameters, because it may be advisable to commence with a small 
one. The figure given by Mr. Walton shows a silver wire about the thir 
teenth of an inch thick and two inches and a quarter long, having its 
upper end flattened and bent to a rounded right angle. The flat bent 
portion is to prevent the instrument from slipping out of sight, and lies 
outside the lowrer lid. 
Cathcterism of the Lachrymal Passages.—La Forest showed how 
to re-establish the natural lachrymal passages without any external in- 
cision. To perform it with success the course and relations of the meati 
of the nose and their boundaries, must be correctly understood. The 
* On the Surgical Diseases of the Eye FISTULA LACHRYMALIS. 
149 
instrument employed is either a solid or hollow sound, the extremity of 
which is shaped to resemble somewhat an ordinary button-hook, the 
curvature of the blade not being so abrupt. The extremity of this 
sound is carried into the nostril in such a manner that, by a movement 
of rotation given to the instrument, it will pass beneath the inferior 
turbinated bone of the nasal fossae. This being accomplished, the 
point should be directed in the inferior orifice of the duct, which is ef- 
fected by giving to the instrument a slight movement backward and 
forward, then with half a turn, by which the handle is carried inward 
and downward, it passes through the nasal duct and enters the lachry- 
mal sac. The hollow instruments of Gensoul are preferable for this 
operation, as through them, if necessary, fluids may be injected. 
Such being the difficulties met with by the latest writers among the 
most distinguished of ophthalmic surgeons, we may regard the duty of 
homoeopathists as the more urgently pressed upon them of testing most 
fully the powers of their own remedies. It therefore becomes us to 
investigate all of the causes and accompanying symptoms of each par- 
ticular case, that we may better select remedies, and thus combat with 
a prospect of success the remote as well as the immediate symptoms. 
The following medicines have been found curative in the various 
forms and stages of the complaint: Calcarea-carb., Acid-nitr., Ilepar- 
sulph., Silicea, Aurum, Petroleum, Belladonna, Iodine, Digitalis, 
Zachesis, Lycopodium, Kali-carbonicum, Natrum-carbonicum. 
The lower attenuations are always to be preferred, and the dose re- 
peated every twelve or twenty-four hours until the disordered tissues 
are suitably impressed. 
Spasmodic Contraction of the Eyelids.—Ilyoscyamus.—Accord- 
ing to Wepfer it is capable of producing spasmodic constriction of 
the eyelids / hence Hecker succeeded in curing a case of this kind by 
accidentally adding some Ilyoscyamus to a mixture he made up at 
random. 
Trichiasis.—Treatment.—To eradicate an inverted eye'-lash, or 
bundle of them, plunge the point of a needle or fine knife, dipped in 
caustic potash allowed to deliquesce, into the dorsal margin, along 
the course of the hair or hairs, to the depth of an eighth of an inch. 
On the second or third day, remove the lashes so treated with the for- 
ceps ; they are all pulled out without any difficulty, and are blackened 
at the roots. The bulbs of ciliae are completely destroyed, never to 
be produced. No inflammation of any moment follows the operation, 
unless the whole row of ciliae be removed at a time A 
When a particle of dust or of any insoluble substance gets into the 
eye it may be removed by washing; but if soluble the water will tend 
*Dr. Williams, Braithw. Retros. 205, Part XLIII. 150 
DISEASES OF THE SANGUINOUS FUNCTION. 
to diffuse it. Putting the eye into a vessel of water and holding it 
there will often remove the cause of irritation and give relief. If the 
offensive object be caustic, a strong acid or salt, sweet-oil will mitigate 
the irritation. But if Spanish flies or dead insects be the cause of the dif- 
ficulty the oil will do injury. For sharp dusty minerals, paint, or small 
sharp particles, the white of eggs will often be sufficient; for lime, 
ashes, dye-stuffs or tobacco, cream or sour milk is the best remedy. 
We generally succeed in removing the cause of irritation, whatever 
it be, by taking hold of the eye-lashes and raising the lid in such a 
way as to expose its whole under surface to sight. The offending sub- 
stance is then likely to be brought into sight, and can easily be re- 
moved by brushing it off with a corner of a light handkerchief, or a 
piece of soft blotting paper, rolled into a small soft brush. If wet with 
saliva it may be pushed far enough back into the eye to fulfil the 
desired object. 
A particle of iron flying into the eye from a blacksmith’s anvil ad- 
heres closely where it lights. It may be removed by thrusting a bent 
hair beyond it under the lid and then drawing it forward; if visible it 
can be removed by the roll of paper, or corner of a linen cloth. 
Avoid rubbing the eye, soothe it with milk-warm water; and if the 
particle is not visible, try to sleep; the substance will generally come 
out of itself. If the eye be red and inflamed give Aconite. In scrofu- 
lous persons Aconite needs to be followed by Sulphur or Calcarea. 
(Tiering, p. 122.) 
Acetum.—Particle of quicklime in the eye. Bathe the eye with 
diluted vinegar and wash it out. 
Traumatic Injuries of the Eye.—Injuries of the crystalline lens 
from blows, general opacity is observed to follow in a few weeks from 
the reception of the blow, and in cases of such injury the prognosis 
given should be guarded. In one instance, says Dr. Williams, the ap- 
pearance of cloudiness was delayed for eight years—when cataract 
made its" appearance and required an operation for its removal.” 
The medical treatment of injuries of the eye is simple and will be 
governed by the principles laid down under Ophthalmia and Injuries, 
p. 689.) 
IY. STRUMOUS OR SCROFULOUS OPHTHALMIA. 
This disease is characterized by extreme sensitiveness of the af- 
fected organs to light. Even the slightest ray causes intense pain 
and the little patient makes every effort to avoid exposure. During 
the inflammation an eruption usually makes its appearance on the 
cheeks, in the vicinity of the eyes, and which often extends to the very 
organs themselves, thus giving rise to troublesome and dangerous STRUMOUS OR SCROFULOUS OPHTHALMIA. 
151 
ulcers. These ulcers not unfrequently extend until the structure of 
the eye becomes so far impaired, that total blindness ensues. 
Diagnosis.—Scrofulous ophthalmia presents several symptoms which 
are quite characteristic, and by the aid of which we may always form 
a ready and accurate diagnosis. The disease occurs in subjects of a 
scrofulous habit, and, in addition to the local symptoms, is accompanied 
with the general symptoms peculiar to scrofula, of which we wTill speak 
elsewhere. (See Scrofula, Index.) Indeed, these general marks will 
often aid materially in forming our opinion, particularly in slight cases. 
The light and clear complexion, blonde hair, blue eye§, tendency to 
glandular swrellings of the neck, the tumid upper lip, eruptions during 
childhood behind the ears and upon the head, sensitiveness to cold, dis- 
position to cough after colds, frequent pains and discharges from the 
ears, indicate the strumous dyscrasia, which often determine and de- 
velop inflammations of the scrofulous kind. 
The peculiar symptoms which distinguish scrofulous inflammation of 
eyes, are, the almost absolute intolerance to light; the violent spas- 
modic closure of the lids on the slightest exposure of the eyes to it, 
and the strumous eruptions which generally make their appearance in 
the neighborhood of the eyes. The light is commonly so painful, and 
the dread of exposure to it is so great, that it is exceedingly difficult 
to make a thorough examination in children, and as a general rule it is 
better to trust the voluntary efforts of the patient, in a moderate light, 
rather than to resort to much violence in attempting to force open the 
eyes. Usually, by obtaining the confidence of the patient we can per- 
suade such a display of the globes as will sufficiently satisfy us in re- 
gard to the case. The vessels of the conjunctiva'are generally much 
injected; there is a considerable discharge of purulent matter; the 
balls are stiff and painful; the lids swollen; vision impaired by the in- 
flammation, or by ulcers on the cornea; one or more ulcers form on the 
conjunctiva covering the cornea; and, if the symptoms continue to in- 
crease, the sight is finally destroyed. 
The disease varies much in its progress; is sometimes attended with 
but little redness of the conjunctiva, but slight pains in the globes, and 
but a moderate secretion of pus; at other times, during the formation 
of an ulcer, all these symptoms increase in intensity, until the case 
nearly resembles one of acute purulent ophthalmia. It is of far more 
common occurrence in children than in adults. 
Causes.—The constitutional cause, as we have seen, is a strumous 
dyscrasia. The local, or exciting causes are atmospheric vicissitudes; 
undue exposure to cold, light, dust, smoke, and irritating vapors; neg- 
lect of cleanliness. 
Prognosis.—Severe purulent ophthalmia under the most favorable 
circumstances, for the application of remedies is highly dangerous. The 152 
DISEASES OF THE SANGUINOUS FUNCTION. 
chief peril against which we have to guard, is ulceration of the cornea. 
Before this has taken place, and especially if the cornea appears bright, 
we may entertain hopes of a favorable termination of the case; hut if 
these opaque specks form while the inflammation retains its intensity, 
we must he prepared for a partial or total loss of vision. Of the diffe- 
rent kinds of ophthalmia, the gonorrhoeal is unquestionably the mosi 
rapid in its progress, and dangerous in its character. Here, nothing 
hut the most consummate judgment and coolness, with constant atten- 
tion can avert serious consequences. The other varieties of the malady 
are not quite so rapid and destructive, hut they demand the most skillful 
and energetic efforts to ward off injurious results. 
As a general rule, if we are called during early stages of the com- 
plaint, and exhibit the appropriate specifics judiciously and boldly, little 
difficulty will be experienced in inducing a speedy and happy issue to 
either of the varieties; unfortunately, however, the physician is rarely 
called until the disease is so far advanced that ulceration can not be 
prevented. It is evident, then, that the prognosis will depend upon 
the intensity of the disease, the complication which has occurred, the 
time it has existed, the constitution of the patient, and the remote and 
exciting causes. 
Treatment.— The only local application which can be advanta- 
geously used during the acute stage of purulent ophthalmia, is pure 
water, either cold or tepid. This may be employed as a lotion to the 
parts, during the course of the acute symptoms, as the judgment of the 
adviser shall dictate. When the chronic stage has set in, recourse may 
occasionally be had to stimulating collyria, like the Vinum-opii, solu- 
tions of Sulph.-zinc, Nitr.-argenti, Sulph.-cuprum, Acetat.-plumbi, 
and Aconite; but in regard to these applications, the same rules apply 
with full force here, that we have presented under the head of simple 
acute ophthalmia, when alluding to the use of collyria. 
The following remedies cover all of the symptoms which obtain in 
the different varieties of purulent ophthalmia: Arsenicum, Belladonna, 
Sulphur, Rhus-toxicodendron, Calc area - ca rhonica, Aconite, Mer- 
curius-sol., Graphites, Phosphorus, Spigelia, Digitalis, Acid-nitr., 
Hepar-sulphur, Causticum. 
Arsenicum will prove curative in purulent ophthalmia, with much 
vascular congestion of the conjunctiva; swelling of the lids ; nightly 
agglutination; photophobia; pressure and burning pains in the eye- 
balls, aggravated by moving the eyes; nebulous spots, and ulcers on 
the cornea. 
Belladona is an admirable remedy in scrofulous inflammation of the 
eyes, with very great intolerance to light; a constant inclination to 
remain in the dark, or to plunge the eyes into a pillow or some other 
Boft article ; purulent discharge ; great swelling of the lids ; spasmodic STKMMOUS OK SCROFULOUS OPHTHALMIA. 
153 
closure of the lids on exposure to light; chemosis ; tearing, throbbing, 
smarting, or stitching pains in the eyes; roaring in the ears; hot dry 
skin ; thirst; nightly agglutination; throbbing of the carotid and tem- 
poral arteries; pains in the temples and head; ulcers on the cornea; 
dimness of vision. We have cured several cases of purulent ophthalmia 
of infants, characterized by great intolerance to light, intense inflam- 
mation, throbbing of the carotid and temporal arteries, flushed cheeks, 
hot skin, and other indications of inordinate vascular excitement, with 
Belladonna, succeeded by Mercurius. We deem Belladonna one 
of our most valuable medicines in nearly all of the acute inflammations 
of the eye. The effects arising from the application of a small quan- 
tity of the extract to the eyebrows or temples are sufficient to demon- 
strate its marked specific action upon the structures of the eye. We 
have found it eminently serviceable in ophthalmia neonatorum, and in 
acute ophthalmia. 
Sulphur is an invaluable remedy in several kinds of purulent oph- 
thalmia. It is adapted to the chronic forms, with atonic distention of 
the conjunctival vessels; swollen and oedematous condition of the lids, 
with purulent discharge; suppurating ulcers on the cornea; sensation 
of itching, burning, and heat, in the eyes and lids; troublesome ag- 
glutination in the morning; diminished power of motion of the upper 
lids; pustules of the cornea ; sensitiveness to the light of the sun; 
swollen upper lip; eruptions behind the ears, and on the scalp and 
face ; pressure and burning pain in the eyes ; impaired vision. 
Sulphur is one of those remedies which will be required more or less 
frequently in all varieties of ophthalmias, not only to combat those lo- 
cal symptoms which especially correspond with it, but to ( n-rect mor- 
bid conditions of a more general and latent character, Suophur may 
occasionally be used with decided advantage in alternation with re- 
medies which appear to cover all of the manifest symptoms, but which 
do not produce prompt impressions when given singly. 
Bhus-tox, is useful in rheumatic, scrofulous, and catharral oph- 
thalmia, with much inflammation and swelling of the lid; redness of 
the balls of the eyes; profuse secretion of mucus or pus from the 
eyes and lids; oedematous swelling of the lids and the parts surround- 
ing the eyes; morning agglutination, with increased redness of the 
eyes; pain on turning the balls; lachrymation; photophobia. 
Bhus-toxicodendron.—This is one of the most important remedies 
in catharral, erysipelatous, scrofulous, and exanthematic ophthalmia. 
Many allopathic physicians commend the tincture of Bhus in scro- 
fulous ophthalmia. We can bear witness to the value of this medicine 
in scrofulous ophthalmia, and in chronic ophthalmia which is kept up 
by a discrasia of erysipelatous character. 
Calcarea-carbo7iica has been successfully employed in every variety 154 
DISEASES OF THE SANGUINODS FUNCTION. 
of purulent conjunctival inflammation. Its chief indications are: in- 
flammation, redness, .and purulent secretion from the eyeballs; swell- 
ing and redness of the eyelids; nightly, and sometimes daily aggluti- 
nation of the lids; great intolerance to light; nebulous specks and 
ulcers on the cornea; inclination to keep the eyes in darkness ; scrofu- 
lous eruptions upon the face and scalp; glandular swellings of the 
neck; swelling of the upper lips and nostrils; pustules on the cornea; 
pressing or aching pains in the eyes; corrosive inflammation in the 
edges of the lids, acrid lachrymation, general appearance indicative of 
the scrofulous dyscrasia. Dr. Dudgeon expresses the opinion that 
Calcarea u is one of our most important ophthalmic remedies and is 
surpassed by none in its applicability to the generality of cases of 
scrofulous inflammation, whether of the eye itself, or its lids; and is 
indispensable where there is marked scrofulous diathesis indicated by 
swelling of the glands,” &c. 
Aconite may often precede other remedies in every variety of puru- 
lent ophthalmia, when the inflammation runs high, and gives rise to 
febrile symptoms. Intense redness and swelling of the affected parts; 
acute pains ; accelerated circulation; violent photophobia; headache ; 
hot and dry skin; thirst; flushed cheeks; throbbing of the arteries 
about the neck, head and face ; loss of appetite, “ and perverted vision, 
point to the employment of Aconite A In some instances it may be 
alternated wTith Belladonna to advantage. 
Mercurius-sol. has proved successful in our hands in gonorrhoeal, 
scrofulous, and infantile ophthalmia; the remedy having been pre- 
ceded by Aconite. The symptoms were : violent inflammation and 
redness of the eyes ; great intolerance to light; profuse acrid or puru- 
lent secretion from the balls and lids; heat in the eyes; cutting and 
burning pains in the parts; ulcers on the cornea; cornea dim and 
misty ; sight impaired ; frequent agglutination of the lid ; gummy and 
scurfy matter on the edges of the lids. 
Graphites is one of the best remedies in scrofulous ophthalmia, 
with excessive intolerance to light; chronic congestion of the con- 
junctiva ; purulent secretion from the balls and lids ; frequent aggluti- 
nation of the lids ; ulcers on the cornea; porrigo in the face ; eyelids 
much inflamed, red, and painful; inability to open the eyes before a 
strong light; constant desire to keep the eyes covered; symptoms 
worse by day-light than by candle-light; general appearance indica- 
tive of a scrofulous diathesis. 
Phosphorus is sometimes useful in obstinate and protracted cases 
of atonic ophthalmia, which have resisted the ordinary remedies. 
There is generally inflammation and moderate redness of the eyes; 
considerable secretion of viscid mucus; sensitiveness of the eyes to 
light; heat, burning and itching of the eyes; lachrymation during the • STRAMOUS OR SCROFULOUS OPHTHALMIA. 
155 
day ; frequent and sudden attacks of blindness during the day ; floats 
before the eyes ; weakness and indistinctness of vision. 
Spigelia.—Purulent inflammation, principally affecting the eyelids, 
with sharp pains in the lids ; pressure and pains in the eyeballs, 
during motion; distention and paralysis of the upper lids; painful 
ulceration of the edges of the lids ; dimness of the cornea; general 
loss of power over the eyes. Hummel speaks highly of Spigelia in 
rheumatic and gouty inflammations attacking the cornea. 
Digitalis.—Conjunctival ophthalmias arising from colds, with acute 
inflammation, redness, sharp stitches, photophobia, secretion of puru- 
lent matter, and obstruction and dryness of the nose. 
Nitric-acid and Ilepar-sulph. are the best specifics for the re- 
moval of mercurial ophthalmia, following the abuse of this drug in 
syphilis and other diseases. The symptoms are: inflammation, swell- 
ing and redness of the conjunctiva and lids ; secretion of viscid mucu3 
or pus ; burning and smarting sensation in the eyes ; photophobia, dark 
and unhealthy ulcers.on the cornea; paralysis of the upper eyelids; 
tears easily excited; nightly agglutination; muscae volitantes and 
sparks before the eyes ; difficulty and pain in moving the eyes; pains 
in the bones and soft parts of the forehead and face. 
Chininum-sulph. has been employed with success at the first tritu- 
ration in several cases of strumous and chronic ophthalmias. When 
the malady assumes an intermittent character it will generally prove 
promptly curative. 
Euphrasia was given by Lobethal with much success in cases of 
rheumatic, strumous, and catarrhal ophthalmia, where there was “con 
siderable mucous secretion in the inflamed organ; as also in blennor- 
rhoeas of the eyes, in all of which cases we employ Euphrasia at once, 
internally and externally; in the former case, one drop of the pure 
tincture; in the latter as a collyrium, from two to five drops in four 
ounces of water.” 
Lycopodium is well adapted to scrofulous or catarrhal ophthalmia, 
and in obstinate cases of ophthalmia neonatorum. Hahnemann men- 
tions nocturnal agglutination and lachrymation by day, “as prominent 
indications for the use of Lycopodiuin.” 
We have employed Aurum with excellent effects in several cases 
of ophthalmia of mercurial and syphilitic origin. Some authors re- 
commend it highly in scrofulous ophthalmia. 
Other remedies are, Causticum, Sepia, Silicea, Staphysagria, 
China, and Chamomilla. 
Administration—In acute cases, we prefer the first, second, and 
third attenuations, atfd in the chronic stage the first attenuation. The 
remedy should be repeated in the more violent forms of the 
every half hour, until we are satisfied with the impression produced; 156 
DISEASES OF THE SANGUINOUS FUNCTION. 
but in chronic inflammations, a repetition once in tw'elve or twenty-four 
hours will suffice. During the treatment we should never neglect the 
external use of pure water, or milk and water, either cold or tepid. 
Genus IX.—INFLAMMATORY DISEASES OF THE FIBROUS 
AND MUSCULAR SYSTEM. 
1. IRRITABLE INFLAMMATIONS. 
In these diseases the blood-vessels are much less affected than the 
nerves. The patient may feel agonizing pain when no local disease is 
discoverable. 
A lady had an irritable inflammation in the foot. Various remedies 
were tried without effect. She wrent to the sea-coast and used a steam 
bath, after which the pain quickly subsided. 
The eyes are very subject to this form of disease. But it is more 
common in the breasts of young females; the lightest touch pierces to 
the shoulder, and down the arm to the fingers. It is usually connected 
with amenorrhoea and may be cured by perfect restoration of the 
menstrual function. It sometimes attacks the testicles which become 
exquisitely tender without any visible enlargement. Sir A. Cooper 
says he had t<5 remove the testicle in three cases. One of these was 
in a gentleman from South Carolina. After the surgeons of London 
had exhausted their skill on him, the torturing part was removed, and 
the patient went home quite well. 
When this disease is seated in the bladder the pain often resembles 
that from stone, and blood is discharged with the urine. The difference 
is, that the irritable bladder is most painful when distended, and that 
which contains the stone is most painful when emptied. On dissection 
the irritable bladder has been found red and resembling velvet. P. 78. 
This disease sometimes attacks the rectum. The best remedies are: 
the high attenuations of Cantharis, Apis, Cannabis-sat., lod., 
Prenanthus. These medicines will always palliate, and often cure the 
most severe cases of this kind. 
2. ACUTE RHEUMATISM. 
Diagnosis.—Acute rheumatism usually commences after an abrupt 
suppression of perspiration, in consequence of exposure to ivet, cold, 
or a highly variable temperature. It first manifests itself in the form 
of slight chills, lassitude, and general uneasiness, which are soon suc- 
ceeded by swelling, redness, pain, and augmented heat in the part af- 
fected. The pains vary much in character, being sometimes aching 
and gnawing, at others lancinating and darting, or dull and throbbing ACUTE EIIEUMATISM. 
157 
or numb, pungent, and prickling, and aggravated by movement, by ex- 
posure to drafts of cold air, and by the pressure or touch of the hand. 
In the first instance, rheumatism seizes upon the fibrous textures, but 
as the inflammatory action becomes developed, other tissues become in- 
volved, the capillaries of the neighboring parts become distended with 
red blood, and the usual phenomena are present. The larger joints 
are more subject to rheumatic inflammation than other parts of the 
body, although it is not uncommon for the inflammation to commence 
in the head, neck, chest, arms, or legs, and gradually extend into the 
neighboring joints. The more common accompanying symptoms of 
acute rheumatism, are: bitter taste in the mouth, coated tongue, rapid 
and full pulse, moderately hot skin, thirst, scanty, high-colored and 
sedimentitious urine; intense pain on moving the affected part; anxious 
and distressed expression of countenance, and occasional perspiration. 
Rheumatic inflammations are liable to shift from joint to joint, and 
sometimes to fix upon important internal organs, like the brain and its 
membranes, the pulmonary structures, and the heart and its appendages. 
So long as the malady confines itself to the joints, or to the external 
parts of the body it is unattended with danger to life ; but when metas- 
tases occur to important internal organs, the disease becomes in an 
eminent degree perilous. 
Rheumatism consists in a specific inflammation of a constitutional 
dyscrasic or psoric character, but which varies in its manifestations 
according to the anatomical structure in which it happens to locate it- 
self. Thus it may be called:— 
First.—Muscular Rheumatism, in which the specific inflammation 
is chiefly seated in the muscular structures; 
Second.—Articular Rheumatism, in which the inflammation is 
chiefly confined to the synovial membranes of the joints or to the liga- 
ments in their immediate vicinity; 
Third.—Rheumatic Neuralgia; the force of the disease being 
chiefly spent upon the nerves and their fine investing membranes. 
Rheumatism in either of the above forms may be either acute, sub- 
acute, or chronic. 
First.—Acute Muscular Rheumatism. The pain from sudden 
movement of the part is extremely great. 
Second.—Acute Articular Rheumatism is one of the most painful 
and trying of all febrile diseases, and movement of the joints produces 
ntense suffering. 
Third.—In Sub-acute Rheumatism there is little febrile action, 
little redness or tumefaction of the parts; the pain is less intense and 
agonizing, although the movement of the affected part in certain direc- 
tions may excite severe pains which may be either lancinating or spas- 
modic. 158 
DISEASES OF THE SANGUINOUS FUNCTION. 
Causes. — Acute rheumatism occurs for the most part in young, 
healthy, and robust subjects, and can be generally traced to undue ex- 
posure to cold, or to a wet and variable atmosphere. There is, how- 
ever, in most persons, who are habitually subject to rheumatism, a con- 
stitutional dyscrasia, often hereditary. Of the theory of the mode of 
transmission nothing clearly true has been written. It is argued by 
Sir Henry Holland,* that the series of actions or changes peculiar to 
those diseases which occur but once during life, and are sufficient to 
prevent their recurrence, have their seat in the blood and are carried 
on everywhere by the circulation; authors who accept this view of the 
subject have supposed that the “rheumatic, or uric acid diathesis, im- 
pressed its peculiar characteristics upon the blood, and that this fluid 
being contaminated, it became the channel through which the morbific 
cause must affect the health and well-being of posterity.” [Dr. Ludlam.) 
There is in some persons a rheumatic condition of the system which 
is little noticed till it rises to the height of acute disease. It originates 
in the free use of animal food and fermented liquors. If neglected it 
often results in violent and destructive inflammation of the organs. The 
point of attack will be that which is congenitally the weakest or which 
has become so by long-continued excitement; if the subject of attack 
be one who has long struggled with difficulties the brain is involved. 
A number of diseases may be termed rheumatic, as arising from a 
rheumatic condition of the system; we may therefore have rheumatic 
bronchitis, rheumatic diarrhoea; rheumatic inflammation following in- 
juries or surgical operations. 
Chronic rheumatism differs from the acute form in many respects; 
as for example, absence of febrile symptoms; the fixed character of the 
pains; no perceptible swelling or redness in the affected parts; the 
pains sometimes aggravated, and at other times ameliorated by walking, 
and other exercises ; great sensibility of the diseased tissues to changes 
of temperature, to humidity, and to cold; dryness and inactivity of the 
skin; rigidity in the parts, most apparent when attempting to move, or 
walk, after having been quiet for a considerable period; sedimentitious 
urine ; weakness, trembling, or numbness of the parts. 
Tkeatment.—We enumerate, as the principal remedies:—Dims, 
Bryonia, Aconite, Colchicum, Belladonna, Pulsatilla, Dulcamara, 
Mercurius, Nux-vomica, Phosphorus, Calcarea-carbonica, Vera- 
trum, Ilepar-sulphur, Arnica, Colocynth, Lycopodium, Sulphur. 
Bhus-toxicodendron.—The integuments about the joints swollen and 
red; pulse frequent and hard; urine dark, or red, and turbid. 
Physical Sensations.—Drawing and tearing, or tensive stinging and 
dragging pains in the affected parts, increased by exposure to cold, by 
* “ Medical Notes and Reflections,” p. 85. ACUTE RHEUMATISM. 
159 
rest, and by movement after having been for some time quiet; rigidity, 
lameness, and weakness of the muscles in the vicinity of the diseased 
textures ; increase of the febrile symptoms, and of the pains, at night 
in bed ; perspiration, especially during the pains ; pains alleviated by 
exercise; throbbing and burning in the knees, or ankles; painful in- 
voluntary contractions of the muscles of the calves of the legs ; chronic 
rheumatic pains occurring early in the morning, and disappearing on 
moving about. Intellect unimpaired; disposition irritable and impatient. 
Administration.—One drop of the first dilution may be given in a 
dessert spoonful of water, every two or three hours, until the pains be- 
gin to subside, or until a medicinal action is produced upon the in- 
flamed tissue. 
Bryonia.—Swelling and redness of the inflamed textures : counte- 
nance pale or sallow, or flushed and hot; tongue covered with a white 
or yellowr fur; hot and dry surface, or perspiration of an acid character 
after exercise; considerable thirst, frequent and soft pulse ; red or yel- 
lowish urine; position such as to relax the muscles bearing upon the 
diseased parts ; pains of a tearing, throbbing, or lancinating character, 
aggravated by movement, by the touch, by the contact of cold air, and 
by eating ; a relaxed state of the muscles ; perfect rest affords almost 
entire relief from suffering; bitter taste, or dryness of the mouth, wTith 
thirst; nausea; bilious vomiting ; severe pulsating headache ; morbid 
sensibility of the touch; stitching pains in the region of the liver, and 
in the intercostal muscles ; symptoms worse during the night; general 
uneasiness, anxiety, and irritability ; sleeplessness. 
Administration.—The second or third dilution may be employed — 
a dose every two, three or four hours according to the violence of the dis- 
ease. For the active febrile symptoms which occasionally accompany 
the affection, we usually prescribe Aconite and Bryonia in alternation 
with satisfactory results. 
Colchicum is a valuable remedy in both acute and chronic rheuma- 
tism. The pains are lancinating, jerking, tearing, worse at night, and 
increased by care, anxiety, or movement; or there may be only stiff- 
ness and lameness in the joints, when attempting to walk, with oede- 
matous swellings of the parts in the vicinity of the inflammation. Dr. 
Schroen commends Colchicum in those cases which resist the clearly 
indicated medicines, provided the skin is moist, and the urine turbid. 
Dr. S. advises it to be given in the form of vini seminis Colchici and 
in doses of twelve drops daily. We have found a single drop of the 
first dilution, repeated once in from three to six hours according to 
the acute or chronic nature of the case, very efficacious in several ob- 
stinate cases which had resisted the action of other medicines. 
It has been observed that Colchicum produces the symptoms of tym- 
panitis in goats which feed on this plant in pastures, Dr Meyhoffer 160 
DISEASES OF THE SANGUINOUS FUNCTION. 
says “ in at least fifty cases of tympanitis in cattle, sheep and goats, I 
gave the strong tincture of Colchicum, two or three drops at a dose, and 
always with success. The dilutions disappointed me.” 
Belladonna will prove an excellent remedy, in rheumatic attacks 
accompanied with a high degree of nervous irritability, and a morbid 
activity of the cerebral organs. The pains are very severe, especially 
at night, increased by touch, or by remaining too long in one position. 
Pulsatilla is indicated when the pains shift rapidly from one part 
to another, and are unattended with any great swelling or redness of 
the integuments; also, in chronic rheumatism characterized by weakness, 
rigidity, coldness, and sensation of weight in the disordered structures. 
Dulcarnara often proves speedily curative in rheumatic inflamma- 
tions which have been caused by exposure to cold and dampness. The 
affected parts usually feel as if bruised or beaten, and after remaining 
for some time in one position are attacked with severe pains which do 
not subside until the patient moves.about. The pains are most common 
in the back, and in the joints of the arms and legs. 
In cases of frequently-recurring rheumatism, of scrofulous or psoric 
subjects, Ave must use one or more of the folloAving medicines : Cal- 
car ea-carbonica, Sulphur, Lycopodium, Mercurius. 
When the disease has become chronic and inveterate, and abnormal 
depositions occur about the joints, with thickening of the membranous 
tissues, and permanent rigidity, Aveakness, and tenderness on motion 
a persevering employment of Bhus, or Hepar-sulphur, or Nux, or 
Phosphorus, or Veratrum, or Lachesis will induce curative results of 
the most satisfactory character. 
Other medicines Avhich have occasionally proved successful in rheu- 
matic affections, are: Colocynth, Iodine, Ferrum, China, Arsenicum, 
Arnica, Carbo-vegetabilis, and Ilyoscyamus. 
Administration.—In the acute form of the malady, we employ from 
the third to the sixth attenuations, and repeat the doses every two 
hours until a medicinal impression is evident. In chronic rheumatism, 
Ave prefer the first attenuation and prescribe a dose once or tAvice daily. 
Actea-racemosa in Acute Rheumatism.—Dr. F. R. McDonald, of 
Edinburg, has made some rapid and surprising cures with this remedy. 
He gives twenty-five to forty drops of the tincture three times a day. 
Dr. Hale says: “ Our provings shoAV it to he homoeopathic to many 
forms of rheumatism, chiefly muscular. It affects in preference the 
muscles of the hack, neck, chest and uterus. The first dilution, or two 
or three drops of the tincture repeated every hour or two, has in my 
hands acted magically in acute rheumatism of the parts above named.” 
Dr. E. A. Guilbert says he has found that cases treated by topical 
use of remedies recover much more rapidly and are less liable to re- 
lapses than others treated by internal remedies only. Actea-racemosa, HYDROPHTHALMIA, OR DROPSY OF THE EYE. 
161 
Aeon., Bhus-rad., Bhus-tox., Bell, have been tried, of these Actea is 
the most powerful. Two teaspoonsful of the tincture may be added to 
a pint of soft wTater, and used warm or cold, as the patient’s feelings 
may direct; after using the selected remedy for twelve hours, it is 
better to change for another. 
Propylamine.—Dr. Awenarius, of St. Petersburg, says he used this 
remedy in 250 cases of rheumatism, and in every case the patn and 
fever disappeared the day after its administration. Propylamine is 
prepared by distillation from herring-brine. The dose was twenty 
drops, every two hours. 
Tartar-emetic.—Rheumatic pain, burning and obstinate, in the baclc, 
left shoulder blade on turning the neck; in sacro-lumbar region before 
rising from bed: Weakness of cervical muscles that she can not hold 
her head up. (Hahnemann.) Pain in the shoulder; trembling of the 
hands ; cold hands; icy coldness of the fingers; jerking of the muscles 
of the arms and hands ; eruption of pimples in the forearm resembling 
itch; disappearing on scratching; flea-bites on the hand; ends of the 
fingers feel dead, dry, hard, without feeling for many days ; dark-colored 
spots on the fingers: rheumatism connected with porrigo or other 
eruptive diseases, particularly such as have been repelled. Itching 
pustular eruptions in the arms and hands: Tartar-emetic sometimes 
requires to be preceded by Sulphur-hepar, or other antipsorics. 
Lower Extremities.— Heaviness in the loins; rheumatic pain in 
the lower region of the knee; cold feet; very painful cramps in the 
calves of the legs in the afternoon, which disappear on walking. The 
thighs spasmodically contracted towards the bowrels, weakness of the 
legs ; coldness of the extremities; cases in which the patients have 
been reduced by protracted, watery diarrhoeas : extremities become cold 
and powerless ; frequent cramps in the calves of the legs. The third 
attenuation of this remedy is perfectly homoeopathic to this condition. 
Review of Allopathic Treatment. 
The different modes of treatment in use in some of the various 
schools are: 
1. Bleeding.—The temporary palliation of symptoms from bleeding 
is always followed by chronic rheumatism of long duration; extreme 
anaemia from which the patient scarcely ever recovers. 
2. Moderate Bleeding and Diaphoretics.—The relief is but slight 
and transient, but the evil is decided. The tendency of the disease is 
to impoverish the blood of red globules, increasing the tendency to 
chronic rheumatism, prolonging convalescence, increasing the danger 
of internal inflammations; of internal effusions into the pericardium 
and pleura, and to the synovial sacs of the joints, Dr. Todd (in his Cli- 
V<5U II.—II 162 
DISEASES OF THE SANGUINOUS FUNCTION. 
nical Lectures p. 28,) says, this treatment “also produces troublesome 
cases of delirium which do not occur under other treatment; it also pre- 
disposes to carditis and endo-carditis; and these affections, arising in a 
case in which bleeding has been practiced, are much less manageable 
than in others who have not been bled. 
3. Calomel and Opium to the extent of Ptyalism.—This is the 
alterant system of treatment; exciting one disease to cure another, 
and the new disease worse than the old. Dr. Todd thus describes the 
patient after being thus “cured”: he has “loose teeth, ulcerated 
gums and all the painful and offensive accompaniments of ptyalism; 
as bad or worse than the original disease. And then it does not in 
the least guard the patient against the accidents of internal inflamma- 
tion, pericarditis, endo-carditis, pneumonia, pleuritis, peritonitis.” He 
has often seen these come on patients who were already salivated. 
The effects of Mercury are so various on different persons that the re- 
sult can not be foreseen: and it offers no assurance of speedy cure or 
speedy convalescence. 
4. Colchicum.—Is a chief reliance in the schools for both gout and 
rheumatism. Dr. Todd says, in rheumatism he found it of no use. 
5. Treatment by Opium.—This is lately revived. It is claimed 
that Opium soothes the pain, ealms the nervous system, promotes dia- 
phoresis, does not diminish the eliminating action of the kidneys, and 
that the disease causes remarkable tolerance of the remedy. 
Lime Juice.—Dr. Inman, of the Liverpool Northern Hospital, pro- 
poses this remedy in inflammatory rheumatism. His conclusions from 
large experience are: 
1. That the worst rheumatic cases are those in which perspiration is 
most profuse. 
2. In such he has only seen lime juice fail in one case. 
3. Great improvement follows diminution of perspiration, which is 
not an eliminative effort of nature to be encouraged. 
4. That in rheumatism the blood is as poor in globules as it is in 
consumption or Bright’s disease or anaemia. The worst cases inherit 
a constitutional dyscrasia. 
ARTHRITIS.—GOUT. 
Although rheumatism and gout are described by authors as different 
diseases, it is altogether probable that the nature of the inflammatory 
action is the same in both instances. When this peculiar inflammation 
seizes upon the young and robust, and pervades the larger joints and 
the muscular structures, it receives the name of rheumatism ; but when 
individuals advanced in life, are the subjects of attack, and it appears 
in the small joints, it is recognised as gout. ARTHRITIS—GO (JT. 
163 
A fit of the gout is almost always preceded by some gastric or in- 
testinal derangement, like impaired appetite, furred tongue, bitter taste, 
acid or bitter eructations, flatulent distention of the stomach and intes- 
tines, and occasionally diarrhoea. The inflammation is, for the most 
part, situated in the ball of the great toe, but it may attack any of the 
smaller joints, and as the disease advances, the veins in the vicinity of 
the pain become distended; the integuments swollen, oedematous, and 
of a bright scarlet color; the pains become severe, of a darting throb- 
bing, or a persistent aching and burning character, increased by contact 
or by movement; there is an almost entire loss of muscular power of 
the affected parts; the pains are worse during the night, and ac- 
companied during this period by active febrile symptoms; nearly all 
the functions of the organism are sympathetically deranged; the urine 
is small in quantity, high colored, and becomes turbid on standing: 
the patient is restless, irritable, and morbidly sensitive to moral and 
physical impressions. The disorder usually arrives at its maximum of 
intensity, in two or three days from the commencement of the inflam- 
mation. At this period, the whole toe, and sometimes the foot itself, 
becomes oedematous, and numbness and prickling are frequently expe- 
rienced in the swollen textures, especially during the day; the pains 
and the nightly febrile exacerbations now commence subsiding, until at 
the end of from seven to ten days the active inflammatory symptoms have 
disappeared and left the patient with a debilitated and oedematous limb. 
When the paroxysms of acute gout occur very frequently, they 
serve, after a time to impair the constitution, and to cause permanent 
thickenings of the articular membranes, or cretaceous deposits about 
the joints, and to induce that condition of the parts which leads to 
chronic gout. This form of the complaint is characterized by dull, 
burning, or tensive pains, oedema, thickening of the membranes of the 
affected joint, with rigidity, weakness, and partial loss of muscular 
power; more or less gastric derangement, augmented sensibility of the 
mind and body to external impressions, depression of spirits, and 
general restlessness and irritability. 
Causes.— Gout is generally supposed to be hereditary, although 
cases are constantly occurring in which no natural predisposition can 
be traced. There is no doubt, however, that in the majority of in- 
stances, a hereditary predisposition exists. The exciting causes of 
gout, are: high-living, want of sufficient exercise, abuse of stimulants, 
especially wines, and general irritability of the nervous system, from 
loss of rest and irregularity in eating. 
Dr. Wolf says:—Gout in its worst and most intractable form, is the 
consequence of the sycotic dyscrasia. Tuberculosis, which has spread 
fearfully in this century, has also a relation to sycosis. Tubercles on 
the placenta are only found in the cases in which the parents are sy- 164 
DISEASES OF THE SANGUINOUS FUNCTION. 
cotic or tuberculous. Tuberculosis and warts have a near relation, as 
is proved by the tuberculous matter producing warts by inoculation. 
“Goitre and nodosities in the breasts also depend on sycotic dys- 
crasia and are to be antidoted as early as possible by one dose of Thuja. 
Goitre is in most cases a kind of critical deposition, of which tuberculosis 
becomes latent; but, if interfered with by the common remedies, tuber- 
culosis of the lungs is often the consequence. The same holds good of 
the nodosities of the breast; their operation favors cancerous destruction.” 
A timely dose of Thuja is the remedy proposed to prevent these evils. 
“Health and long life,” says Sir Wm. Temple, “are usually blessings 
of the poor, not of the rich; and the fruits of temperance, rather than 
of luxury and excess. And, indeed, if a rich man does, not in many 
things, live like a poor one, he will certainly be the worse for his 
riches ; if he does not use exercise, which is the only voluntary labor; 
if he does not restrain appetite by choice, as the other does by ne- 
cessity; if he does not practice sometimes, even abstinence and fasting, 
which is the last extreme of want and poverty; if his cares and his 
troubles increase with his riches, or his passions with his pleasures, he 
will certainly impair his health, whilst he improves his fortunes, and 
lose more than he gains by the bargain; since health is the best of all 
human possessions, and without which the rest are not relished or kindly 
enjoyed.”—(Sir Wm. Temple’s “ Works” Lond., 1770, Vol.III.,p.278.) 
Pathology.—Concerning the nature of the calcareous degeneration 
in the arteries of gouty subjects, Dr. Garrod says (“ On the Nature 
and Treatment of Gout” London, 1859, p. 246):— 
“ I have carefully examined those found on the valves of the heart, 
and the atheroma from the aorta of several gouty patients, having ex- 
tensive chalk-stones, but have always failed to discover the least trace 
of uric acid; but the tabular crystals of cholesterine were often present 
in such matter.” He remarks (page 510): “To consider the calcareous 
deposits as a proof of gouty inflammation, is altogether an error; for I 
have shown that in gouty subjects, with concretions of urate of soda in 
nearly all the joints, the deposits from the aorta were of a different 
character, consisting either of phosphate or carbonate of lime, or of 
cholesterine and fatty matter.” 
Calcareous degeneration of the arteries has long ago been observed. 
Mr. H. Watson (“Medical Commentaries,” Yol. I., 1782) found, in the 
body of extremely gouty subjects the thoracic aorta healthy; but this 
vessel in the abdomen was ossified from the diaphragm to the iliacs. 
Morgagni (Yol. II., p. 619) gives the case of Cardinal Cornelli, who died 
in his sixty-fourth year from metastasis of gout to the heart. He was 
exceedingly corpulent. After death, the gall-bladder was found to 
contain a calculus; the right kidney contained eleven calculi, most of 
them of considerable magnitude. The cartilages of the trachea were ARTHRITIS. GOUT. 
165 
hard; the aorta was somewhat dilated in the thorax, and in its course 
through the thorax and abdomen some ossification had taken place. 
Dr. Saunders (.Edinb. Med. and Surg. Journ., Yol. XXX., p. 167) de- 
scribes the case of a baronet, who died in his sixty-fifth year, and who 
had been “the subject of severe paroxysms of gout and politics for 
many years.” The coronary arteries of the heart were completely os- 
sified, and the inner surface of the aorta also exhibited ossific forma- 
tions in different stages. Dr. Cheyne says of one gouty subject, aged 
sixty years, that “ the aorta was studded with steatomatous and earthy 
concretions.” The post-mortem examination of George IV., King of 
England, whose habits of life, frequent attacks of gout, and great corpu- 
lence, during the latter years of his reign, were matters of notoriety, 
revealed the effects of gout on an extensive scale. It was found that 
the “three semilunar valves at the beginning of the aorta were ossified 
throughout their substance, and the inner coat of that blood-vessel 
presented an irregular surface and was in many parts ossified.” Signed: 
Henry Halford, Matthew John Tierney, Astley Paston Cooper, B. C. 
Brodie. The Times” Friday, July 2d, 1830.) 
Dr. Garrod discovered urea in the blood in 1847. Since that time 
the following general results of chemical discovery have been reached: 
First.—The quantity of urea or uric acid contained in the blood in 
health is so small that it is hardly possible to discover it. 
Second.—In gout the blood contains it in considerable quantities in 
the state of urate of soda. It can be separated from the blood in 
acicular needles or rhombic crystals of uric acid. 
Third.—In acute rheumatism the blood contains no more uric acid 
than in health. 
Fourth.—In a person under gout the serum of an ordinary blister 
yields uric acid, except when the part to which the blister is applied 
is affected with a gouty inflammation. 
Fifth.—Perspiration seldom contains uric acid secreted from the 
blood in gout, instead of being greater, is less than usual. In the re- 
gular stage of acute gout, the return is scanty and the uric acid 
measured by the twenty-four hours’ secretion is also diminished. That 
this acid is thrown out in much larger quantities as the disease is pass- 
ing off, and it then may amount to even far above the patient’s daily 
average. 
In chronic stages of gout the excretion of uric acid becomes much 
faster decreased, the urea remaining but little affected; the deposits 
of urates are now more rarely seen, and the urine frequently contains 
a little albumen. Even in the intervals between the attacks, it is 
noticed that a deficient elimination of uric acid may point out that the 
kidneys have undergone some structural change. 
The chief fact arrived at by these late researches, is this: that in 166 
DISEASES OF THE SANGUINOUS FUNCTION. 
every instance gouty inflammation is accompanied by a deposition of 
urate of soda in a crystalline form; and this is considered a pathogno- 
mic phenomenon, seeing that it is not found after rheumatic nor any 
other inflammation. Numerous examinations have been made of sub- 
jects who had had gout in every degree, from the most severe and in- 
veterate form to those who had only suffered in a single joint; and 
this particular condition was present in them all. 
Treatment.—Diet.—This should be very light, chiefly amylaceous; 
diluents should be freely used; alcoholic stimulants should be avoided, 
except under peculiar circumstances. 
Dr. Garrod recommends simple alkaline medicines in alternation 
with small doses of Colchicum. 
Sesqui-carbonate of Ammonia.—When the vital powers are at a 
low ebb, and there exist great vascular and nervous depresssion. At 
the same time omit the Colchicum or use it in small doses. (Braithw. 
Retrosp., No. 41, p. 36.) 
Local Applications.—Covering the part with cotton batting over 
which is spread oiled silk to protect the joint. 
Employ all the agents capable of promoting the excretions, especially 
the kidneys and skin; restore the digestive organs to a healthy state, 
they being in all cases deranged. 
Carbonate of Lithia.—Lithia possesses the remarkable property of 
possessing the most soluble salt of uric acid that is known. And, 
seeing that the insolubility of the acid and many of its salts leads to 
the formation of gravel and calculus, and probably to the deposition in 
gout the salts of this alkali offer a most promising remedy. . Dr. Gar- 
rod says he has used them to considerable extent. (Lancet, 1859, 
p. 645.) 
The principal remedies for acute gout, are: Bryonia, Nux-vomica, 
Colchicum, Bell., Aconite, Rhus, Pulsatilla, Actea-spicata, Actea- 
racemosa, Guiacum, Arnica, Arsenicum, China, Ledum, Sabina, 
Cantharides. For chronic gout, the best remedies are: Calcarea- 
carbonica, Sulphur, Phosphoric-acid, Aurum-muriate, Lodine, 
Llepar-sulphur, Phosphorus, Mercurius, Sepia, Silicea. 
It will very commonly happen that several of these medicines will 
cover most of the manifest symptoms which are usually present in gout, 
but in making our selection, the strictest regard should be had to all 
the remote and exciting causes which may have exercised an influence 
in originating the malady, in order that we may strike deeply at the 
foundation of the disturbance, as well as at the more immediate and 
visible phenomena. 
In prescribing for gout, we may be governed by the general indica- 
tions for the different medicines, as pointed out in the last section. 
Sabina••—Red shining swelling, accompanied by haemorrhage of a ARTHRITIS. GOUT. 
167 
bright red color. Dr.Hendricks, of Germany, said, he cured a case of 
this kind by means of two doses of Sabina. Boenninghausen says, he 
found Sabina the most efficient remedy in gout. And, since it produces 
condylomata, it may be suspected that this malady so much dreaded 
by our fathers may have a sycotic anamnesis. 
Colchicum is an irritant cathartic, emetic, and diuretic; it has 
some sedative action on the circulation, and has been long regarded 
as the specific for gout and rheumatism. Effects of large doses: it is 
an energetic, acrid, narcotic poison, producing severe vomiting, urgent 
diarrhoea; dryness and burning of the throat, excessive colic and heat 
in the abdomen, great depression of the circulation and sometimes sup- 
pression of urine. In some cases death results from exhaustion follow- 
ing inflammation of the bowels; death sometimes preceded by head- 
ache, delirium, stupor and insensibility, showing its action on the ner- 
vous system. All of these symptoms have been caused by two drachms. 
It was introduced into general practice by Sir Everard Home as a re- 
medy for gout. It acts specifically in small doses, increasing the ex- 
cretion of urea, even -when it does not increase the urine ; it is observed 
to produce all its best effects when it operates without purging. 
Given in the large doses usually thought necessary for gout it often 
removes the local symptoms of pain and inflammation ; but it has a 
tendency to “ leave the disease much stronger in the system, and leads 
to still more calamitous, because still more constant pains of the chronic 
form of the disease.” (Seudamore, On Gout, p. 108.) We have often seen 
its action prompt, and, at least temporarily, beneficial. When given in 
doses short of such as excite purging in acute cases, it apparently 
moderates the local inflammation and arterial excitement, makes the 
pulse smaller, softer and less frequent; mitigating considerably the 
severity of the pain. Mr. Iladen, in a work on Colchicum (1820) says, 
itil controlled the action of the heart and arteries, curing those states 
of the constitution called diseases of excitement.” 
Sir II. Halford, in a communication to the Royal Society, says from 
his long experience, there is no disease for which he prescribed with 
so much confidence as gout. He found the disease common in every 
part of the body, the eye, the kidneys, urethra, prostate gland, tonsils; 
it may appear as angina tonsillaris. An eminent physician tried long 
to cure one such case, and at last plunged a lancet into the tonsil. 
Only a little blood flowed; but in a few minutes the disease seized 
violently on the ball of the great toe, and the angina was forgotten. 
Colchicum was his exclusive remedy. The celebrated Eau Medici- 
nale, a secret remedy for gout was composed of it. 
Iihus-tox.—Gout or rheumatism occurring in the spring season 
symptoms aggravated by external heat, and generally by rest, and 
manifested by evening and night. See p. 158. 168 
DISEASES OF THE SANGUINOUS FUNCTION 
4. ARTHRITIC DYSPEPSIA.—DYSPEPTIC GOUT. 
Causes.—Gout in its irregular forms usually occurs in persons of 
constitutions naturally feeble, or those weakened by debauchery and 
excess, or worn out by the cares, fatigues, and accidents of life. It 
has commonly been supposed that the gouty diathesis depends upon a 
morbific matter which was in some way eliminated from the system. 
But this theory, though easily constructed, has furnished little practical 
proof of its correctness. More recently it has been held to have its 
origin in dyspepsia; but the best writers have shown that, although 
symptoms of disturbed digestion are frequent, if not invariable a ttendants 
• upon gout, they are themselves originated by the same remote cause 
on which is based the gouty diathesis with all its attendant manifesta- 
tions of disordered health. 
Dr. Gairdner {On Gout, its Causes and Cure, London, 1849, 
pp. 232), says: “One of the most remarkable results of arthritic in- 
digestion is the presence of acid in nearly all the excretions of the 
body. This has of late been called the uric acid diathesis.” But the 
term diathesis should be applied to denote a condition of the constitu- 
tion, “ not a simple affection of certain fluids of the body.” 
Though this acid condition is very general; since Dr. Garrod has 
proved the existence of uric acid in the blood, and Wollaston found it 
in the joints; Landerer discovered it between the coats of the aorta, 
and others have shown that it constitutes a part of various fluids of the 
body in a state of disease; but we still object to the term expressed in 
“ uric acid diathesis,” for various other acids have also been found in 
the secretions. Berthollet thought that the acid of the sweat was the 
phosphoric, Berzelius and Anselmino showed it to be lactic. Thenard 
found it acetic; and in cases of dyspepsia we have, no doubt, the 
hydrochloric, the lactic and the acetic in the stomach. Again, we 
have urates in the urine, not only in gout, but from indigestion, ephe- 
meral fever, and other diseases. Dr. Prout savs “ the lithate of am- 
monia in the urine is one of the most common attendants of slight 
dyspepsia from errors of diet.” In the course of severe, general dis- 
eases, the same substance appears in the urine in a less transient 
form; “when no food has been taken into the stomach, and when 
therefore its formation can only be attributed to secondary mal-assimi- 
lation of the albuminous contents of the blood and albuminous tissues.” 
Gairdner says, there are also durable deposits of urate of ammonia 
without much constitutional disturbance, where there was no disintegra- 
tion of the tissues, and no probable interruption of ordinary wholesome 
nutrition. He also says that he has often seen cases of true regular 
gout, in which there was no evidence of excess of urates in the urine ; DYSPEPTIC GOUT. 
169 
he therefore believes “that the expulsion of urates from the system 
through the urine, and of other acid and earthy matters through this 
and others excretions, is to be looked upon only as one of the many 
consequences or symptoms of gout.” It can not then be doubted, that 
uric acid, as well as urea, is a constant and necessary ingredient of 
pure and healthy blood; that though derived from the food, they 
are not imbibed with it, but are formed within the body, and enter the 
blood in the earlier stages of assimilation. It is not known that they 
serve any useful purpose, and they are probably refuse or effete 
matters, which, if not duly eliminated from the blood by the kidneys, 
are productive of much disturbance to health. The disappearance of 
these substances in the urine and their accumulation in the blood are 
merely frequent symptoms and consequences of gout, which is itself, 
again, the cause of other important phenomena. Among these are:— 
The general cachectic condition seen in gout, causing distressing 
headaches, somnolence, and indifference; the various shades of dyspep- 
sia, with which the gouty are afflicted; and sometimes sudden trans- 
lations of diseased action to vital organs, as the heart or stomach, caus- 
ing such violence as to result in sudden death. 
It was the opinion of Liebig and Woehler that uric acid was the 
parent of the urea; but Dr. Gairdner was convinced by long-continued 
observations that the explanation of many morbid phenomena will be 
found in the altered relation of the urea and the uric acid to each 
other; and that in certain morbid states of the system, the nascent 
urea becomes uric acid during the assimilation of the food; and in pro- 
portion as the amount of uric acid in the urine is increased, that of the 
urea is diminished. Dr. Gairdner therefore believes that in a state of 
health, the elements necessary for the composition of urea are separated 
from the blood ; but that, under the influence of the gouty diathesis, 
the secretion of uric acid takes place in greater abundance. 
The chemical composition of uric acid is such that to convert urea 
into it the chief change required is the addition of carbon. We may now 
suppose, says Dr. Gairdner, that uric acid and urea are formed during 
the process of respiration, and circumstances in the condition of the 
patient may cause the one or the other to preponderate. In the history 
of gout we find many symptoms which show that decarbonization of the 
blood is deficient: thus we have “ the blue lips, the swollen veins, the 
bloated complexion, the skin diseases, and general cachectic condition.” 
“ When the biood is perfectly oxygenated, the heart and vessels are 
roused to energetic contraction;” but when the expiration of carbonic 
acid has been incomplete, the absorption of oxygen diminished, and a 
portion of venous blood carried forward into the arterial system, the 
circulation is slackened, a depressing influence is exercised on the 
brain and nervous system, congestion takes place in the vessels, and 170 
DISEASES OF THE SANGUINOUS FUNCTION. 
the condition already pointed out as favorable to the creation of a gouty 
diathesis is speedily brought about. 
This state of things is promoted by all circumstances which diminish 
the exhalation of Carbonic-acid from the lungs, as repose of body, sleep, 
confined air, intense and long-continued mental employment, anxiety 
and depression of mind. In one case given by Dr. Gairdner in which 
thirty-six ounces of urine were passed in twenty-four hours, four parts of 
urea in one thousand of urine had disappeared, thus “ sixty-eight grains 
of urea were suppressed in the urine, to reappear in the system in some 
noxious form or other.” And to this change in the secretions of the 
body, the suppression of a healthy evacuation, and its reappearance in a 
more noxious form, and the retention in the blood of a poisonous in- 
gredient is attributed the formation of the urates and all their inju- 
rious effects. The correctness of this theory is confirmed by compar- 
ing the quantity of urine secreted during sleep with that passed in the 
day; the condition of urine in an asthmatic patient breathing with 
difficulty; that passed by males and females; and that passed by in- 
dividuals living on different kinds of food. 
Exciting Causes.—Gout being a disease of the sedentary, the su- 
pine, the luxurious liver, and frequently of the student and over-taxed 
man of business, all its exciting causes are such as increase the mass 
of the circulating fluids, while they impede the full arterialization of the 
blood, and cause its accumulation in the venous system. Chronic dis- 
eases are mere modes of decay of the system. This is true whether 
they depend on original defect, errors and habits of life, or of declining 
age; but no disease more remarkably exemplifies the progress of de- 
cay than gout. Originating often in the luxurious indolence of a sen- 
sual ancestry, its characteristic symptoms are chiefly exhibited in the 
decline of life; but it lies1 'concealed in the constitution of the young. 
The diseases of children and growing youths often give indications of 
the presence of arthritic disease; through succeeding years its progress 
is gradual but steady and certain, if its great causes be permitted to 
continue their operation. 
Pathology.—Since the days of Dr. Brown, the pupil of Cullen, gout 
has been regarded by many as an asthenic or non-inflammatory disease. 
That inflammation is not essential to gout is rendered probable by its 
rapid occurrence and dispersion in different localities; the languid cir- 
culation of gouty persons; the rare occurrence of the disease at that 
period of life when inflammation most commonly occurs, and also in 
robust individuals. Its appropriate subjects, according to Dr. Gairdner, 
are: “ The heavy and corpulent, those who have loaded viscera and 
languid circulation ; persons of inactive temperaments and lazy habits; 
those in whom other diseases assume indolent and cachectic forms.” “It 
shuns the stout and healthy laborer; it siezes the fat and dull farmer. DYSPEPTIC GOUT. 
171 
It seldom visits the active and athletic sportsman; it revels in tho 
blood and joints of the exhausted debauchee.” “Were gout essen- 
tially inflammatory, it might be presumed that inflammation would be 
its primordial local symptom, and in this case we should surely expect 
that it would sometimes run the ordinary course of phlegmonous dis- 
ease. Not only is this not the case, but there is something in the na- 
ture of the disease which prevents the inflammation that supervenes in 
gout ever running into the suppurative process. I never saw but one 
instance of phlegmon in gout, and I never saw a more ill-conditioned 
and offensive discharge.” “The terminations of gout, and its vicarious 
and cognate diseases also mark its nature. They are suppression of 
the natural evacuations, spasm, cramp, dispepsia, melancholy, apoplexy, 
and dropsy.” (Gairdner on Gout.) 
The first condition essential to the formation of the gouty diathesis 
seems to consist in venous congestion. The capillary and nutrient 
vessels, distributed on the extreme and sentient fibrillse of the nerves, 
being in the same distended condition as the larger venous trunks, and 
being bound down by the firm fasciae in which the gout has its usual 
seat, caused by their pressure upon the nerves, the painful phenomena 
that attend the disease. The contents of the over-distended vessels 
being compressed between the power derived from the heart and arte- 
rial system, urging it forward on its course, and the antagonistic resis- 
tance of the great veins leading to the right auricle, cause occasionally, 
the capillaries to give way, causing a true haemorrhage in the part 
affected. If the rupture takes place in a minute capillary, carrying the 
serous portion of the blood only, oedema is the consequence, but if the 
burst vessel be one carrying red blood, a true ecchymosis is formed. 
{Gairdner, Amer. Jour. Med. Sri., Oct. 1849. p. 427.) 
The essential pathology of gout appears then to consist in an in- 
creased pressure of the blood from its accumulation in the great veins 
and an altered state of that fluid leading to the formation of uric arid 
instead of urea ; these results depending on too copious an assimila- 
tion of nutriment, on defective respiration, and on a deficiency of the 
evacuation from the liver, kidneys and skin. The plethoric state thus 
created causes in strong constitutions the painful manifestations of re- 
gular atonic forms of the same disease. The mystery of hereditary 
influence in developing gout through those causes of disease which in 
better constitutions would only have produced a phlegmonic inflam- 
mation may not yet be clearly understood. But it is unquestionable 
that this disease, though revealing itself by the outward manifestations 
called gout, is indeed due to a particular tendency of the constitution 
of which no explanation has yet been given. 
Treatment.—Prophylactic.—This is chiefly hygienic. As the in- 
cipient signs of gout are visible in infancy, in those families in which 172 
DISEASES OF THE SANGUINOUS FUNCTION. 
gout is a more certain inheritance than the patrimonial estate, it is im 
portant to commence from birth a rational course of eclectic and hy- 
gienic treatment that may extinguish or prevent the development of the 
concealed “ family curse”. 
The diet of children who are known to be heirs of this “ heritage of. 
woe/’ should be regulated with great care. They should always be 
allowed the temperate use of a wholesome, nourishing diet; should 
abstain from heating drinks, take active exercise in the open air, parti- 
cularly the free pure air of the country; cheerfulness of mind and the 
avoiding of every sensual excess from puberty upwards; and the cheer- 
ful labors and active exercise and excitement of a country farm life, 
are among the principal means of preventing the occurrence of gout. 
In a form of gout in old persons manifested by swollen articulations 
of the hands, with slight derangement of the stomach, faltering in the 
action of the heart, and intermissions of the pulse, iron is the best 
and perhaps the only remedy. The Saccharine-carbonate (.Edinb. 
Fharmacoj?.), citrate and tartrate are the best forms. 
ColdWater.—This is always dangerous when applied externally, es- 
pecially when it has any chilling effect. 
Colchicum.—This has the reputation of a specific; and not without 
some foundation, since it is known to cause the more free expulsion of 
urea from the system. It is found that the increase of urea is accom- 
panied by diminution of urates in the urine. The action of Colchicum is 
supposed to be through the nervous system. 
Colchicum is most beneficial in cases of regular gout without injury 
of the organs. Cases of atonic gout are less relieved by it; and in 
them it often produces low and depressed feelings. 
It is most useful after the disease has expended its first violence, 
when the fever has abated, the oedematous swelling of the part is es- 
tablished, and the bowels relieved. 
Persons who have gone through a regular fit of gout should seek to 
pass a holiday of perfect rest in the pure bracing air of the country, 
with as much exercise as their feeble state will enable them to take. 
Thd lungs should be thoroughly expanded, the assimilation of food 
should be perfected, and a pure, wTell oxygenated blood should be 
worked into the organic textures and moving structures of the body 
by active exercise in a high and healthy region, at some fashionable 
watering place, on the sea coast or the springs. 
Irregular Forms of Gout.—In sudden and alarming attacks which 
sometimes arise from metastasis of gout from distant points to more im- 
portant organs it is difficult often to decide upon a prompt, successful, 
and safe mode of treatment. Opium and powerful stimulants are often 
too freely used when they are unnecessary; and very frequently the 
most painful and alarming symptoms excited by some mental emotion, arthritic dyspefsia. 
173 
disturbance of the circulation, or more commonly, indigestion, subside 
on their causes being removed. To discriminate between these cases, 
and those in which prompt measures of the heroic character are ne- 
cessary, requires the highest degree of judgment. But in any event 
the physician best merits the confidence of the people who is never 
without resources, which are both palliative and safe; and who never 
suffers himself to be hurried into a decision by the clamor of patients 
or their friends. If there be little change in the pulse, though there 
be intense suffering and vomiting, the case admits of some delay and 
deliberate action; w7hereas, those in which the action of the heart is 
greatly depressed, and where there is little acute pain, are the cases 
that call most imperatively for prompt and effectual aid. 
Metastasis to the Heart.—The patients in whom this frequently takes 
place are seldom free from structural disease of that organ; there are 
earthy formations disturbing the action of the valves and injuring the 
functions of the coronary arteries, by which the nutrition of the heart is 
impeded ; or a fatty degeneration of the muscular substance, leading to 
dilatation of the cavities. 
Treatment.—The first of these is incurable, though the homoeo- 
pathic remedies wTe shall propose for it may be tried. 
The fatty degeneration, it is believed, may be removed by putting an 
end to the secretion of oil globules within the fibres of the muscular 
structure of the heart, and by restoring that of fibrin. 
For this purpose a diet composed of little hydrocarbonaceous matter, 
and furnishing the albuminous elements of the blood, that is a more 
animal diet with pure air, and well-regulated exercise are recommended. 
Neither Colchicum, purgatives, nor laxatives are suitable to such cases ; 
but the use of tonics, continued for months, has been often successful. 
Gallic acid has been used with great benefit. 
Metastasis of Gout to the Head.—“ It occurs with every degree of 
suffering; the headaches from which those persons suffer in whom the 
excretions of urates and urea have, from any cause, been suddenly di- 
minished or temporarily arrested, are only a commencement of this 
affection, which may well be likened to the effect of a poison. I believe 
that the substance of the brain itself is the part usually affected in 
these cases; and my reasons are that they are never attended with de- 
lirium or wandering, but always accompanied by stupor and somnolency; 
and that wThen they terminate in apoplexy, the ruptured vessel is found 
in the cerebral substance.” (Gairdner.) 
Treatment.—Colchicum in minute doses is useful by increasing the 
urea carried off in the urine. Mild purgatives may be useful when 
given with caution. See Remedies, p. 166. 
Belladonna is probably the most potent remedy in this form of me- 174 
DISEASES OF THE SANGUINOUS FUNCTION. 
tastatic gout. When there are decided febrile symptoms present, it 
should be alternated with Aconite or Gelseminum. 
Cannabis-indica is also a remedy of great value in cases of this kind. 
5. ARTHROPATHIE.—INFLAMMATIONS OF THE JOINTS. 
arthropathie.-white swellings. 
The Diseases of the Joints are divided into two grand divisions: 
A. Diseases of the Soft Parts. 
External. 
White swellings of Bell; and diseases referred 
by Brodie to the ligaments. 
Hydarthrus. 
Internal 
Capsular 
JB. Cartilaginous, superficial, bony and 
deep-seated or parenchymatous bony arthropathie. 
All of these forms of arthropathie may be, either rheumatic, scro- 
fulous, tuberculous, syphilitic, scorbutic, cancerous, &c.; or simply in- 
flammatory. 
1. Extra Capsular Arthropathie.—Stiffness, pain, irregular swell- 
ing, without effusion into the joint. This is generally a slight disease 
requiring some treatment corresponding with other phlegmonous, erysi- 
pelatous affections, or inere engorgement of the subcutaneous tissue, 
perhaps the bursae mucosa. If purulent collections are discovered we 
have to use the bistoury. 
2. Pure Capsular Arthropathie.—Caused by sprains, external vio- 
lence or rheumatic affections accompanied with pain on certain move- 
ments, aud sometimes increased by pressure. These causes produce a 
swelling of the extracapsular layers, which leads to internal effusion. 
It is a more serious lesion than the preceding; and it often proceeds 
forward to more serious disease yet to be described. It requires the 
most careful but efficient medication. Allopathic treatment involves 
“ resolvent ointments, large blisters, compression and mercury.” 
3. Specific orBlenorrhous Arthropathie.—This comes on suddenly; 
it is soon characterized by an abundant effusion; with little pain in the 
first stage, it acquires all the characters of an acute arthritis in the 
second. The common treatment is rather evacuant and revulsive than 
antiphlogistic; blisters, mercurial frictions, compression, evacuants, 
embrocations. They are never successful. 
4. Fungous Arthropathie.— This is sometimes a primary, though 
oftener a consecutive disease ; always mild, little painful. It is an- 
nounced by an elastic, thickened enlargement, sometimes rolling under 
the finger, like a foreign body; occasionally, without effusion, the joint 
may acquire an enormous volume, without absolute hindrance to loco- ARTHROPATHIE. 
175 
motion. It is generally serious from its obstinacy, sometimes resisting 
every thing. It never yields to bloodletting. The surgeons rely chiefly 
on blisters, resolvent ointments, cauteries, moxas, setons, escharotics, 
compression and debilitating doses of calomel. Brodie speaks of this case 
as one of “ morbid change of structure,” which he thinks to arise from 
“morbid action in the synovial membrane, which loses its natural orga- 
nization (like the fungus articuli of the German writers,) becoming con- 
verted into a thick pulpy substance of a light brown or reddish color, 
intersected by numerous white lines. The disease seems to be peculiar 
to the synovial membranes having some affinities with tubercle, scirrhus, 
and fungus hsematodes, in all of which the natural character is destroyed 
and a new one added. This change is most common in the knee-joint, 
where it is usually attributed to cold or sprains. In some cases we find 
what are called loose cartilages. 
5. Pure Synovial Arthropathie.—Ilydarthrus.—This is a dropsy 
of the joint from inflammation of the synovial membrane, and subse- 
quent effusion. It is essentially characterized “ by a serous effusion 
without pain, or sensible thickening of the articular envelops, slightly 
hindering the movements of the joints. Here the surgeon has generally 
resorted to purgatives, mercurials, Colchicum or diuretics, associated 
with large blisters and resolvent frictions,” and generally with very little 
success. All of these forms of disease have the common character of 
swelling and superficial pain from the beginning; and they never last 
long without changing the form of the part. The synovial membrane 
is proved to extend over the cartilages of the incrustation and the inter- 
articular fat, as the conjunctiva covers the cornea; and it has a strong 
functional and anatomical resemblance to the serous membranes. It 
seems that the disease seldom or never originates in the ligaments, but 
almost always in the synovial membranes, which are quite as often dis- 
eased as any part of the body. Cruvelhier says [Diet. De. Med.) the dis- 
ease consists in nineteen out of twenty cases, of a chronic inflammation, 
commencing in this membrane, even when other tissues become involved. 
D. 6. Cartilaginous Arthropathia.—This consists in an ulceration 
of the articular cartilages and of the synovial membranes investing them.. 
There is a mechanical affection embracing ulceration and contusion of 
the cartilages and ulceration of the synovial membrane / or from the 
pressure of the cartilaginous surfaces on one another: it may be com- 
pared to a crushing, wasting, or excoriation of the organic plates. It 
comes on suddenly, and is announced by a crackling and by acute pain 
that ceases entirely while the limb is still, and recurs on certain move- 
ments. It is sometimes complicated by extending to the bones. A 
cure is commonly effected by absolute repose, or after the disappearance 
of the cartilaginous rugosities. 
7. Superficial Arthropathie' of the Bones.—This is generally over- 176 
DISEASES OF THE SANGUINOUS FUNCTION. 
looked, as its cause is internal. It is announced by a dull pain where 
the joint is at rest, and acute intolerable pain is excited by the smallest 
motion. The effusion, swelling, &c., are secondary. The surgeons 
usually begin its treatment by bleeding, cups, leeches, mercurial pur- 
gatives. All of these measures, however, fail to give relief, and they 
resort to embrocations, blisters, or compression; then to moxas, the 
cautery, and, especially, absolute rest. They generally resort at last to 
amputation, or the inflammation terminates in anchylosis. 
8. Deep-seated Artropathia of the Bones.— Scrofulous Disease 
of the Joints.—When it involves the epiphyses and not the shafts of 
the bone it is regarded as having its origin in the cancellous structure 
of the bone and has a malignant character. There is a dull deep pain 
during motion as well as when at rest; worst at night; there is no heat 
or swelling at first. It may last for months or years without effusion ; 
sometimes it invades the cartilages of the incrustation, producing an 
excessively painful affection. It often embraces the head of the bone, 
where it gives rise to symptoms of mild acute inflammation, and finally 
assumes the character of exostosis with inflammation or ostitis. It is al- 
ways tedious, often requiring amputation, and never ending happily until 
the elimination of the necrosed or altered tissue. It requires internal re- 
medies. The common treatment consists of blisters, cauteries, moxa, but 
avoiding compression and other topical applications. Pain, the primary 
symptom of disease of the hard parts may exist for weeks or months 
without swelling. {M. Velpeau, Memoir sur les Tumeurs Blanches. 
Exposition nouvelle de ces Maladies, par Gustave Jeanselm, Paris) 
Treatment.—The appropriate remedies in these cases are, Sulphur, 
Silicea, Calearea-carb., Iodine, Rhus-tox., Arsenicum, China, Phosphorus, 
Acid-phos. 
In order to prove effective these medicines must be given in the high 
attenuations, and be repeated at long intervals, in strict accordance 
with the directions of Hahnemann. 
An expert selection of the remedies, high potencies, very rare repeti- 
tions of the doses, and patience, have often enabled homoeopathic physi- 
cians to perform cures which have amazed the surgeons of the old school. 
In these cases such a regime should be enjoined as shall promote 
the general health and rigor of tjie system. 
Compression is a resource of great power. Apply a roller bandage 
so as to fill up all external inequalities; begin the application below 
the joint and extend a few inches above it. Blisters, ointments, &c., can 
be used at the same time. We may make permanent compression by 
pasting each surface of the bandage by starch or paste, and applying 
pieces of paste-board, as is often done in dressing fractures of the ex- 
tremities. The patient may now rise and walk; and it is almost im- 
possible for the joint to swell again. DYSTHETICA. 
177 
ORDER IV.-DYSTHETICA. - CACHEXIA. - ABNORMAL 
CONDITIONS OF THE CIRCULATION DEPENDENT 
ON DETERIORATIONS OF THE BLOOD. 
Microscopical Examination of the Blood.—The red globules in 
man are small round discs, of which the central part of each appears 
shadowed or transparent, according as it is approximated to or re- 
moved from the focus of the lens. The central part seems to he the 
thinnest of the globule, which is depressed on both sides ; and when 
placed on the field of the microscope, it presents the appearance of an 
elongated 8. The edge forms a thick ridge all around, more colored 
than the central part. The size of the blood globules varies in dif- 
ferent animals. The elephant has the largest globules, among the 
mammalia, and the ruminantia the smallest. {Mandl. Anatomy and 
Physiology.) 
The blood globules are suspended in a colorless fluid called plasma 
l.quor sanguinis, or serum. In frogs it can he separated from the 
globules by filtering, though human blood can not be filtered. 
White Globules. — These are small colorless finely granulated 
corpuscles, soluble in water, and strong refractors of light. Some are 
round and include two or three granules; these are true lymphatic 
globules, arising at least in part from lymph mixed with blood. The 
other white globules are also generally round, though sometimes oblong, 
or irregular, with edges slightly serrated. They are the product of the 
coagulation of the fibrin. {Mandl.) 
State of the Blood in the Vessels.—Many authors have believed 
that the blood possessed some mysterious powers of vitality. Ac- 
cording to the observations of Kolk, Treviranus, and others, the 
globules of blood possess a rotatory motion during life, independently 
of the motion arising from the impulse of the heart; and this motion 
continues till coagulution takes place. Schulz of Berlin has shown 
that the blood globules have a power “ by which they mov.e on by 
themselves, surrounded by envelops of coloring matter, and keeping 
at a distance from each other.” Copland imputes this forfce to the 
influence exerted by the ganglial nerves on the interior of the ves- 
sels on which they are distributed. (See Vol. I. p. 843.) To this force 
of mutual repulsion we attribute the fluidity of the blood; but there is 
another force by which the blood globules are .attracted by the tissues 
when brought in contact with them in passing through the minutest 
vessels. This latter force, first examined by Schultz, “may be com- 
pared to a vortex, whence globules constantly pass from the arterial 
or terminal capillaries, and are lost in the different tissues. So that 
although the vital endowment of the blood is manifested by its fluidity 
Vol. IL—12. 178 
DISEASES OF THE SANGUINOUS FUNCTION. 
in the vessels, it assumes an opposite manifestation in the capillaries, 
where this fluid is brought within the sphere of the vitality of the dif- 
ferent structures ; each one attracting from it those constituents ol 
which itself is formed, and which are always present in healthy blood” 
“ Thus we see organization commencing in the chyle, advancing 
further in the blood, and reaching its acme in the vital attraction of the 
constituents of the tissues from the blood circulating in the capillaries 
which supply them. At this part of the circle, where the arterial 
capillaries, with the fluid circulating through them, become, as it wTere, 
confounded w7ith the tissues in wdiich they are distributed, there ap- 
pears to be not only a constant attraction of particles by the tissues 
from the blood, but also an equal extrication of other particles from 
them into the blood received by the radicles of the veins.” {Schultz) 
Coagulation of the Blood. — In the process of coagulation the red 
globules of the blood are principally concerned; “it being chiefly the 
result of the loss of the vital motion w7hich these globules possess in 
the vessels, and of the attraction existing between the coloring en- 
velops and central bodies. As the vital attraction which keeps the 
red substance fixed around the whitish corpuscles, ceases soon after 
the removal of the blood from the veins, these bodies can then obey 
the force which tends to unite them, and they then form a net-wrork, 
in whose meshes the liberated red particles are entangled, and thus 
produce the phenomena of coagulation. If the coagulum be exposed to 
a stream of water, the colored matter is washed away, while the ag- 
gregates formed by the colorless corpuscles remain in the form of 
filaments in which may be recognized an analogous structure to mus- 
cular fibre, and constitute the fibrine of the blood. 
The phenomenon of the coagulation of the blood, is due to the eva- 
poration of its ammonia, on exposure to the air. The blood is retained 
in a liquid state in the blood-vessels by the pressure of ammonia; and 
just in proportion to the loss or diminution of this substance, will it 
retain or lose its fluidity. 
This may be readily demonstrated by draining blood from the arm 
into an exhausted receiver. Thus excluded from the oxygen of the 
air, it remains fluid; but if we expose it and collect the products of 
evaporation, it coagulates, and ammonia is found as one of the products 
of evaporation. This coagulated blood may be again redissolved, by 
incorporating ammonia with it at the proper temperature. 
A knowledge of this fact may prove useful in many maladies which 
are accompanied with more or less decomposition of the blood, as 
diphtheria, typhus, malignant scarlatina, yellow fever, &c. 
Plasma.—Constituents of Plasma.—Water, fibrin, albumen, color- 
less corpuscles, votatile matter, fatty compounds, and salts. 
Plasma passes through all the capillary vessels, permeating all or- ALTERATIONS OF BLOOD IN DISEASE. 
179 
gans and tissues; and at various points the glands or deporating or- 
gans, remove from it the substances that if retained would injure its 
qualities. Many fluid substances, received by the stomach, enter the 
plasma and mingle with the fluid of the blood. These substances pos- 
sess medicinal power of some kind, and they effect one organ or an- 
other, according to their specific properties. 
1. The poisons taken into the stomach produce symptoms which 
manifest themselves in some one organ or more, but they do not cause 
the production of contagious matter in the blood. 
2. Poisons inhaled from the atmosphere by the lungs often produce 
contagious matters in the blood. Thus showing that the two parts of 
the blood have distinct pathological relations. Experiments show that 
large quantities of some substances can be thrown into the blood with- 
out great injury, if not in some cases, with benefit. In 1831 and 
1832 the effort was made to replenish the exhausted blood-vessels of 
patients sinking from cholera by injecting saline substances into the 
veins. In one case five gallons of saline liquid was injected into a vein in 
the course of four days : nine and a half pounds thrown in the Space of 18 
minutes (May 29), and a few hours afterwards 10 pounds more with 4 
ounces of albumen. In a few hours 10 pounds, with 10 grains of sulphate 
of quinine; 10 pounds more of the solution the same day. June 2, *six 
and a half pounds with six drops of solution of Morphia. June 19 th, the 
patient was reported as w'ell, and left the hospital. 
Such facts, with the varying aspects of the people we meet with 
every day, show that the blood is constantly changing in its composi- 
tion ; and no two efforts at chemical analysis present similar results. 
That the blood may be maintained in its highest state of perfection, 
and fitter for the supply of all the materials requisite for maintaining 
the system in health, and those materials only, it is necessary that 
the functions of sanguification, nutrition, depuration, secretion, and 
absorption should be kept in the most healthful condition. As they 
by their combined action convey into the general circulation the sub- 
stances necessary for the supply of the waste of the body, or carry 
out of it those materials which are unfit for its purposes ; so, also they 
may derange health by throwing into the blood poisonous matters 
taken up from the different absorbing surfaces, or by retaining within 
the blood these worthless or deleterious substances which the welfare 
of the body requires should be rejected and thrown off. 
Changes in the Quality of the Blood.—The chemical constituents 
of the blood vary in different states of disease. The relative proportion 
of Albumen is increased in cases of active dropsy, and in most of the 
exanthemata, especially before the eruption appears. In many in- 
flammatory diseases the quantity is twice as great as in health, and the 
blood feels viscid to the touch. (Gendrin, Bright, Blackall, tfec.) The 180 
DISEASES OF THE SANGUINOUS FUNCTION. 
watery portion of the blood varies from the influence of depletion, many 
fevers, and other chronic diseases. The coloring matter in the blood 
is changed in some febrile and malignant diseases, and after the 
operation of some virulent poisons, or morbid secretions.—The fibrine 
varies according to the extent to which blood-letting may have been pre- 
viously carried, and the degree of vital energy present, or the febrile 
or inflammatory action prevailing. It varies in its quality in the last 
stages of some chronic diseases, in the cold stage of congestive fevers, 
and after exposure to extreme cold, forming fibrinous concretions on 
the lining coats of the blood vessels. In pestilential cholera, asphyxia 
and hydi’ophobia the blood of the arteries has been found resembling 
venous blood. The electrical state of the blood is also changed by 
disease; and its temperature has been observed to vary from 86° to 
104°, according to the degree of nervous power in connection with 
vascular action.— (See Vol. I. p. 175.) 
The huffy coat seen on the surface of blood drawn from patients 
suffering from inflammation is only conspicuous in inflammations of the 
serous membranes, the lungs, and other viscera; it is less strongly 
marked in children, in pregnant or puerpural females who have'been 
often bled, in rheumatic subjects, and when drawn from a large-sized 
vein. The buff is also seen in some cases of anmmia and chlorosis; 
the blood in these diseases having lost its globules and retained its 
fibrin. In general anmmia there is a deficiency of blood globules ; in 
health they exist in proportion 119 to 1000 parts of blood; whereas in 
anaemic patients they may be reduced to 65 parts in 1000. When 
anaemia arises spontaneously, says Andral, and also in pregnancy, and 
diseases produced by lead, the globules alone are deficient; but where 
this condition is produced by repeated blood-letting the blood comes 
to be deficient also in fibrine and albumen. In plethora the blood 
globules are increased from 119 parts in a thousand in health to 141 
parts, the fibrine remaining in only the normal quantity. (See Andral 
“ On the Blood in Disease,” 1844.) 
But other changes in the intimate nature of the blood, which chemis- 
try has no power to detect, occur in the course of various diseases, 
In many recorded instances the blood has been proved to have poison- 
ous qualities; and terrible effects have resulted from its contact with 
the skin, cellular membrane, or wounded parts of persons previously in. 
health. Even the foetor from the blood of diseased persons has often 
caused malignant and fatal diseases. 
Distemjperature or Dyscrasias of the Plasma of the Blood.—There 
are many varieties of changes of health, moods, tempers, feelings, de- 
pendent on the qualities of the blood. They may be caused by bad 
diet as well as other causes, and may be cured by attention to proper 
diet, good air and the proper regulation of the various functions; the ALTERATIONS OF BLOOD IN DISEASE. 
181 
plasma having been changed in character, is restored by proper 
management, food or medicines, which restore to a healthy state the 
skin, kidneys, bowels. While the unhealthy state of the blood con- 
tinues, the simplest wounds fester and ulcerate; there are eruptions, 
pustules or boils on the skin, slight external injury provokes chronic 
and ulcerative forms of inflammation with or without fever, appearing 
as scrofula or scurvy. In sailors at sea dieted on salt provisions, 
who about the ship in a hot climate with the feet exposed, every 
mosquito bite ulcerates and the wound increases in size daily, resisting 
all local treatment till the diet is changed. Under proper food, and 
cooler air the wounds heal spontaneously. In some hospitals, bad diet, 
and air cause fractures to remain long without uniting, on removing to 
better air recovery takes place. After formidable surgical operations, 
if the blood is in good condition, free from any constitutional taint, 
there is early and safe recovery. In unhealthy subjects trifling 
wounds degenerate into chronic ulcerations. 
In the latter case it is asked, (says Addison, Braithwaite’s Betrosp., 
No. 41,) which constituent of the blood is diseased ? Is it the plasma, 
or the portion from which the elements of repair are taken? Mr. 
Hunter says: “ A person may have a sore upon the leg which is granu- 
lating freely, when all at once the granulations shall lose their life and 
fade away. New granulations may afterwards spring up and these 
shall undergo the same process, and so they will continue to go on, if 
some alterations in the nature of the parts be not produced in the 
plasma of the blood. The nature of the granulations will be deter- 
mined by differences in the quality of the plasma.” 
It is thus shown that forms of inflammation, suppuration and ulcera- 
tion are produced and kept up by distemperature or unhealthiness of 
the blood, more particularly of its plasma. And that a depurative 
operation is often performed in the plasma by forms of local inflam- 
mation may be argued from the eruption of small-pox. 
In scarlet fever it is supposed from the properties of the particles of 
the exfoliating epidermis that the contagious matter from the blood is 
discharged by the vesicular action. In gout, that the offending matter is 
discharged from the blood by the local inflammation is also concluded 
from the morbid material deposited in the parts inflamed. Further 
evidences of the truth of this view are found in the great work of Roki- 
tansky on Pathological Anatomy, and in the Lectures of M. Paget. 
In ordinary inflammation the speedy separation of the plasma, or 
sinking of the corpuscles which occasions buffed blood indicates a 
change in the relative qualities of the two parts of the blood. We 
have accordingly the yellowish, greenish, purplish hues, and the floccu- 
lated appearance like curdled soap in the plasma of buffed blood before 
its coagulation, in different cases of inflammation. 182 
DISEASES OF THE SANGUINOUS FUNCTION. 
The microscope reveals differences between the blood constituents 
when taken from the sphere of the inflammation or exterior to it. 
(Addison, on Inflammation.) 
In the act of sloughing or separation of dead matter from the ad 
junct texture blood-vessels are severed by the process, and they are 
separated without bleeding. In abscesses and ulcerations from thorns 
or other foreign bodies impacted in the flesh, great changes may occur 
without bleeding. {Brit. Med. Journ., April, 1859.) 
In all cases of repair where exudations and new growth appear, the 
blood-vessels undergo the change from fibrous to corpuscular. Their 
component elements retrograde. This change is exemplified in granula- 
tions, the vessels of which bleed on the slightest touch, and we believe 
that in places of inflammation from disordered qualities of the plasma, 
the coats of the blood-vessels undergo the same changes. 
Now as the plasma is the part of the blood that plays a conspicuous 
part in these changes, so it is not difficult to comprehend how it may be 
relieved of hurtful materials by inflammation. 
“That sores give rise to very different kinds of pus,” says Hunter, 
“is very evident to the naked eye; and that the different parts of which 
the blood is composed, will come away in different proportions, we can 
make no doubt; and we find that whatever is in solution in the blood 
comes away more in one kind of pus than another.” It may then be 
presumed that inflammation exercises a therapeutical action in dis- 
ordered conditions of the blood. 
Zimmermann and Simon regard the fibrin as an exuvial matter or ex- 
cretion of the corpuscles. Is there any incongruity in finding it to be 
an essential material, used in the maintenance and repair of the com- 
mon blood-distributing tissue? 
How does matter pass f rom the corpuscles into the Plasma f — 
Addison says it can be shown by experiment that molecular and tailed 
forms of some material substance may be seen issuing out of them and 
passing into the plasma, without much alteration of their form or color 
and to any one who witnesses the experiment there can be no difficulty 
in concluding that the corpuscles, in their natural state, discharge 
matter into the plasma. 
He therefore concludes:—That the corpuscles of blood are sustained 
in their vital and chemical qualities by the plasma and the air; and 
also that their excretions are passed partly into the plasma and partly 
into the air; and these properties of the corpuscles being established, 
there are some broad and acknowledged facts respecting venous blood 
which claim our attention.” {Brit. Med. Jour., 1859, p. 352.) 
Causes of Changes in the State of the Blood.—First.—Causes 
which vitiate the fluids from which the Blood is formed.—Unhealthy 
food deranges the digestive function and poisons the circulating fluids. ALTERATIONS OF BLOOD IN DISEASE. 
183 
The long-continued use of salt provisions, when too exclusively used, 
produces scurvy. Diseased rye causes chronic arteritis and gangrene 
of the extremities, diseased or putrid flesh has often induced malignant 
diseases; and the blood after death has been found fluid, dissolved, or 
blackish. 
The habitual use of any article possessing medicinal powers has an 
influence on health. Acids, alkalis, turpentine, and all the chemical 
salts change the character and composition of the blood. The dried 
stale fish, used so extensively in some of the extreme parts of Northern 
Europe, produce diseases of that order which always arise from an im- 
pure state of the blood; and eating freely of fresh animal food, by 
increasing the fibrine and richness of the blood also predisposes to dis- 
ease but of another order. Excesses in eating and drinking cause a 
large amount of disease in civilized life. 
An imperfect performance of the functions by which morbid sub- 
stances are expelled from the blood is one of the principal causes of 
disease. Perfect health requires a full performance of all the functions 
of depuration, including respiration, perspiration, and secretion by all 
the organs whose office is to eliminate effete or injurious substances 
from the blood. 
Proofs that the Blood itself becomes poisonous in some diseases.— 
The blood in some diseases undergoes vital changes by which a poison 
capable of reproducing itself is originated. Dr. Home communicated 
measles by means of blood taken from persons affected with that disease. 
Duhamel gives the case of a butcher, who, having put in his mouth the 
knife with which an over-driven ox had been slaughtered, had his tongue 
and throat swollen a few hours afterwards, and an eruption of black 
pustules over his body. He died in four days. Another person having 
wTounded himself in the hand with a bone of the same ox, was seized 
with inflammation of the arm, followed by mortification and death. 
Two females experienced gangrenous inflammation from a few drops of 
the same animal having fallen upon the hand of the one, and on the 
cheek of the other. 
By numerous experiments it has been proved that inoculation with 
the blood of diseased animals, or simple contact with it, may produce 
the malignant pustule in men. Dupuy and Leuret introduced blood 
taken from a horse affected with malignant carbuncle into the cellular 
tissue and veins of a sound horse and thus communicated to him the 
same disease. The serious effects which follow wounds received in 
the dissection of bodies recently dead, as well as in those in which 
putrefaction has commenced, are quite common. “ The septic influence 
of certain animal secretions and poisons on the tissues to which they are 
applied and on the frame generally; are among the most important 
phenomena of disease.” See Yol. I. p. 541. 184 
DISEASES OF TIIE SANGUINOUS FUNCTION. 
Louis de Castro says the blood of two plague patients infected th-0 
air of their apartment with a foetid odor; Zacutus reports the history 
of three persons who were struck dead by the odor exhaled from the 
blood drawn from the vein of a person infected with the plague. Muralt 
states that a cadaverous foetor emanates from the blood of persons af- 
fected with this malady; and Baglivi mentions that a nearly similar 
phenomenon was observed in the blood of patients in the advanced 
stages of a very fatal epidemic fever. Haller refers to a case of fever, 
in which he predicted from this symptom alone a fatal result. In- 
stances have been published by Zurinus, Alprunner, and Vater, in which 
physicians were dangerously infected by the foetor of the blood ab- 
stracted from the veins of persons in malignant diseases. Many have 
suffered in slighter degree from the same cause in more common dis- 
eases. Pringle says, an individual who had inhaled the blood of a dy- 
senteric patient which had stood for some time, was attacked by the 
same disease. Morton has given the case of a woman in malignant 
fever whose blood was so offensive, when taken from the arm, that the 
surgeon and assistants fainted from breathing the odor. 
The blood of cattle affected with “ the spleen.'1 is so poisonous that 
if the blood of such an animal only falls upon the hand it may cause 
dangerous disease; and the skinning or tanning the skins may have a 
similar effect. Their flesh, though salted and smoked, is a poison, and 
always produces death or lingering, incurable disease. 
Symptoms of Spleen in Cattle.—The animal looks sad and dull; it 
stumbles and trembles, particularly after drinking; the skin is hot, 
breath short; and while the symptoms progress, inflammatory tumors 
are formed. 
The Treatment of Cattle in this disease is hitherto confined to 
throwing cold water on them. Hering says, if this does not save them, 
they must die. The use of cold water is depended on to preserve other 
animals from the infection; those which die are buried in'a deep pit 
without being touched writh the hands. Every thing that has been in 
contact with the diseased animal is to be burned, buried, or purified 
■with chloride of lime-water. 
When this disease is communicated to man the infected person be- 
gins to feel “melancholy, weak, and chilly; red spots, black in the 
centre, show themselves on different parts of the body; these soon be- 
come bluish tumors, and, eventually, inflammatory gangrenous ulcers. 
The treatment is not satisfactory. Bleeding is dangerous; warm and 
moist poultices also do harm. It is thought best to rely on quiet, strict 
diet, drinking plentifully of cold water, and frequently throwing it over 
the patient, drying him quickly afterwards. Internally give Arsenicum, 
not too frequently.” {Hering) 
In 1770, Fontana instituted a series of experiments on the effects of ALTERATIONS OF THE BLOOD IN DISEASE. 
185 
the poison of the viper on animals. lie procured 3000 vipers and em- 
ployed 4000 animals which were bitten by the vipers in his presence, 
or otherwise subjected to the operation of the poison. From his six- 
thousand, experiments, he deduced the following results: In many 
instances, on injecting the poison into the jugular vein of rabbits, 
employing seven seconds in the operation, the animals cried out the 
moment the venom entered the vessel, were seized with violent con- 
vulsions and died in two minutes or less. 
The blood in all the large vessels and also in the heart and auricles 
was black and coagulated. The action of the venom and its effect on 
the blood are almost instantaneous. The color of the blood is 
suddenly changed, and becomes from bright red immediately black; 
this effect is succeeded by the sudden coagulation in the heart, auricles, 
liver and large venous trunks. Thus “the circulation is totally stopped 
and the animal dies.” The poison of a serpent applied to a naked nerve 
diffuses its influence with instantaneous rapidity. Dr. Mead says, the 
bite of a rattlesnake killed a dog in a quarter of a minute. Such is the 
close connection between the sanguiferous and nervous system that pain 
and irritation will effect a change, even in the appearance of the blood. 
Many drugs have shown, when regularly taken for a certain period, 
the power to produce degeneration of the blood, altering its composi- 
tion and appearance, thus producing dyscrasias or cachexias, each pre- 
senting its own peculiarities. Thus, Mr. Sharp, in a late work (London, 
1861), gives the effects of Titanium in causing and curing “Blood Dis- 
ease.” He found it to operate upon: First.—The Stomach, bringing 
on nausea, loss of appetite, and feeling of discomfort. 
Second.— The Brain and Nerves: giddiness, imperfect vision, the 
peculiarity being that half an object only could be seen at once; desire 
to keep the eyelids closed. 
Third.—The Blood:—a perceptible derangement of the whole 
system, which could not, without danger, have been carried further.” 
He also “ found Titanium a most valuable remedy for certain cases of 
degeneration of the blood, for which no good remedy was known 
before.” 
LATENT MIASMS OR BLOOD-DYSCRASIAS WHICH ORIGINATE OR 
PERPETUATE OBSTINATE CHRONIC DISEASES.—PSORA—SYPHI- 
LIS.—SYCOSIS. 
Hahnemann says (Organon, §. 204, p. 183): “ If we except all chronic 
maladies which depend upon a mode of living habitually unhealthy, as 
well as those innumerable factitious diseases, (V. §. 74), which arise 
from the senseless, protracted, the assaulting and ruinous treatment, 
even of slight diseases, by allopathic physicians, then all the remainder, 
without exception, are occasioned by the development of these three 186 
DISEASES OF THE SANGUINOUS FUNCTION. 
chronic miasms, viz. internal syphilis, internal sycosis, but especially, 
and in an infinitely greater proportion, internal psora. Each of these 
is in possession of the entire organism, and has penetrated it in all its 
parts, before the respective primary representative and local symptom 
makes its appearance, which prevents the bursting forth of its corres- 
ponding miasm in another form, and is manifested in psora by a pecu- 
liar eruption, in syphilis by chancre and bubo, and sycosis in condylo- 
mata. Either of these chronic miasms being deprived of its local 
symptoms will, sooner or later under the influence of natural causes, 
become developed, burst forth, and multiply the incredible multitude 
of chronic diseases which for ages has afflicted the human race.” 
We perceive that the observation made by Hahnemann led him to 
believe that some one of these latent miasms or poisons constituted the 
basis of all chronic diseases; that these miasms might remain latent 
whether derived from inheritance or from infection; that there was no 
limit to the duration of their action; nor could revulsives ever by turn- 
ing the vital force into new channels effect a real cure. This mode of 
proceeding might give the disease a newT outward form, but it would only 
render the system more feeble and less able to react. Hahnemann 
says: “ The more I examine the ordinary cures, the more I am convin- 
ced that they are not direct transformations of disease converted into 
health, but revolutionary disturbances of the order of things by medi- 
cines, which, without being actually appropriate, possessed sufficient 
power to give matters another (morbid) shape : these are wdiat are 
called cures. 
“The hysterical ailments of yonder lady wrere successfully removed 
by me.” “No! they were only changed into a metrorrhagia.” After 
some time I am greeted by a shout of triumph. “ Excuse me! I have 
also succeeded in putting a stop to the uterine hoemorrhage.” But do 
you not see, on the other hand the skin has become sallow, the white 
of the eye has acquired a yellowr hue, the evacuations from the bowels 
have become grayish white and the urine orange-colored. “And thus, 
the so-called cures go on like the shifting scenes of one and the same 
tragedy.” 
The frequent metastases of disease from the mucous membrane to 
the skin and its sudden recession to the internal surface have long been 
familiar to medical men. 
The identity of structure of the skin and the internal mucous mem- 
brane as wrell as their identity of use is so well known that we may 
easily perceive that the eyes of pathologists could not avoid perceiving 
the possibility of the frequent metastasis of disease from one of these 
surfaces to the other. Wilson says: 
“The skin is the exterior investment of the body, which it senes to 
cover and protect. It is continuous at the apertures of the internal ALTERATIONS OF BLOOD IN DISEASE. 
187 
cavities with the lining membrane of those cavities, the internal skin 
or mucous membrane. Mucous membrane is analogous to the cuta- 
neous covering of the exterior of the body, and resembles that tissue , 
very closely in its structure. The epithelium is the epidermis of the 
mucous membrane. Throughout the pharynx and oesophagus, it resembles 
the epidermis, both in appearance and character. 
That they exchange physiological functions is shown by Carpenter: 
“ It is interesting to observe that when a portion of the cutaneous sur- 
face has been turned inwards, so as form part of the boundary of one 
of the internal cavities (as in plastic operations for the restoration of 
lips, eyelids, &c.), it undergoes a gradual modification of character and 
comes after a time to present the appearance of an ordinary mucous 
membrane.” It is well known also that “when a portion of the mucous 
membrane is in the same manner turned to the surface, it assume, the 
appearance and the functions of the true skin.” 
M. Trousseau, of Hotel-Dieu, Paris, thus gives in the Gaz. des IIop. 
1857, p. 550) the fullest admission of the truth of Hahnemann’s doc- 
trine of psora: “The herpetic, syphilitic and strumous diatheses are 
equally manifested by cutaneous lesions and by those of mucous mem- 
branes. For the syphilitic diathesis, this is universally conceded: for 
the dartrous, do we not daily witness the transition of affections from 
the skin toward the internal organs, in gradation from the more super- 
ficial to the deeper, revealing unity of origin and cause ? An eczma 
first appears upon the lip or nose; next, in the form of a chronic coryza 
or ozoena, as it traverses the sinuosities of the nasal fossae; next the 
coryza may become an angina, taking the granular character of a her- 
petic angina. Women who suffer with uterine catarrhs the most intract- 
able, have a chronic eczema of the uterus as others of the skin. And 
why should we shut our eyes to similar manifestations in the bronchiae, 
or gastro-intestinal canal, betrayed in each site by functional derange- 
ments peculiar to the organ attacked ? How often do we not witness the 
coincidence, or rather succession, of these internal lesions upon the ces- 
sation of herpetic manifestations on the skin ? ” “ How often have sul- 
phurous waters, so potent in bronchial and uterine catarrhs, cured them 
only by reaching the herpetic diathesis ? At Cauterets, Bagneros, 
Luchou, Enghein, Aix-la-Chapelle, among the patients under treatment 
for chronic catarrhs by these mineral springs, you will find that the 
greater number have had, if not through their lives, at least in their 
youth, decided herpetic manifestations; and that whenever they reap- 
pear upon the surface, the internal organs cease to suffer. 
“A dartrous subject may have to day no tetter: a strumous subject 
no scrofula; but the dartrous or strumous diathesis exists potentially, 
even during a latency of five, ten, twenty or forty years. 
“ Diatheses are impressed upon the constitutions of patients; they 188 
DISEASES OF THE SANGUINOUS FUNCTION. 
descend to the child with the organic likeness of his parents; and as 
the child having reached his fortieth year, will then bear the greatest 
physical resemblance to his parent at forty, so the dartrous diathesis, 
until then latent but hereditary, may make its first appearance on the 
skin.” 
“Hence the indication for a prophylactic treatment against diathesic 
affections. The best recent work on this subject is that of Mr. Gastier. 
Complications of Diseases.—M. Trousseau says: “A herpetic sub- 
ject, having actually no dartre, takes a cold, gets a sore throat; the 
herpetic element is awakened by this irritation, takes possession of the 
field and occasions a dartrous angina. In an arthritic subject, the dia- 
thesic expression may supervene upon a sprain, however slight, which 
serves as a pretext for the localization of a regular attack of gout. 
The child of strumous parents may not reveal his scrofula until an ar- 
ticular rheumatism degenerates into white swelling. In all of these 
cases the treatment must of course be general, and directed against the 
diathesis. 
We can bring from all standard allopathic authors instructive obser- 
vations which prove the truth of Hahnemann’s opinions. Dr. Budd* ex- 
presses the common opinion that a morbid material within the organism 
produces the various skin-diseases and says that this morbid matter is 
liable from many causes, to be repelled from the surface, and, in conse- 
quence, produce various internal disorders. Willan says :f “The peculiar 
morbid matter of the disease, which was before detained in the part af- 
fected and held in union with it, being now suddenly loosed and set afloat 
in the general circulation, has become free to fix on internal organs — 
or, circulating any where with the blood, to affect the system at large.” 
The repulsion of these morbid miasms is just as important to the pre- 
sent popular allopathic pathology as it was to Hahnemann’s. According 
to Dr. Budd, Pujol, and Schoenlein, important internal organs, as the 
lungs and the blood-vessels, are liable to become most seriously diseased 
from this morbid matter locating upon them, after being set free from 
the external surface. In this way they account for the occurrence of 
consumption, and many other local affections commonly called scrofulous. 
Prof. Schoenlein, of Berlin, gives the case of a weaver aged thirty-four, 
who at the age of nine years took the itch which lasted three years. 
He was then cured by Sulphur ointment. Nine months ago he began 
to suffer from oppression of the chest, difficulty of breathing, weariness, 
palpitation of the heart, &c., on running, ascending the stair-case. In 
four months the disease became more violent, becoming established as 
an affection of the aortic valves, hypertrophy of the left ventricle, with 
simultaneous enlargement of the left lobe of the liver, and commencing 
hydrops. 
* Medical Gazette, 1850. Med. Chir. Trans. 1842. f Cutaneous Diseases. STRUMA. SCROFULA. 
189 
The cause of this disease is referred by the author to the repelled 
itch at nine years of age. He says, Authenrieth directed attention to 
the q/for-diseases of the itch in 1807, before Hahnemann. He says 
he admits the existence of the acarus insect, as he has seen it, but it 
does not invalidate the old dogma of sequela to the itch. “ How does 
the itch develop itself? Small spots first exhibit themselves, from 
which the itch pustules are formed. The existence of the acarus of 
the itch has not been proved; wTe might then call this a filius ante 
patrium. An evident contradiction. Again, the disciples of Raspail 
do not go so far as to assert that all itch-pustules are provided with this 
insect. If the acarus be the cause of the disease, why is not this in- 
sect present in every pustule ? ” He has “ no doubt respecting the 
existence of after or secondary diseases of the itch.” “ It may not be 
generally known that an ulceration of the skin, of a peculiar kind, forms, 
especially in old people, principally about the knuckles or joints of the 
lower extremities, in consequence of the itch (the secretion of which 
ulceration is contagious), and which has obtained the name Ulcus pso- 
ricum, and no one will assert here that this ulceration was so formed by 
the itch insect; now, if this ulceration is caused to heal up suddenly, 
internal diseases of a peculiar character are produced, not only such 
as are created by the drying up of old sores, but peculiar forms of 
disease. This fact appears to me one of the most striking features in 
favor of the possibility of q/’Ar’-diseases resulting from the suppression 
of the itch.” And “ I confess that the reasons above given have im- 
pressed me with the most perfect conviction that itch is capable of pro- 
ducing after-diseases.” 
It is evident that Hahnemann did not intend to restrict the term 
psora to the special disease designated by Schoenlein and others as 
“ the itch,” but embraced a wider field including scaly, tettery, papular 
and other eruptions. Hahnemann cured the pustular eruptions he re- 
ferred to with very minute doses of sulphur. It is known that the 
specific disease caused by the acarus is not so easily cured. It is not 
certain that Sulphur alone is a true remedy for it. 
The whole allopathic school regard repelled diseases as capable of 
causing dangerous manifestations on internal organs ; but they never go 
far enough to recognize the existence of the poison if it has never ma- 
nifested itself on the surface in a visible eruption. Hahnemann goes 
beyond them all in discovering “ the latent poison lurking within the 
organism, never having manifested its presence by any external signs,” 
though able there to “seize upon the springs of health as surely as 
though it wrere repelled from the circumference.” (Adams, U. S. Jour, 
of Ilomceop., Vol. I., p. 471.) The signification he himself attached to 
the term psora must be learned from his owTn words. 
Hahnemann says : “I call it psora, with a view of giving it a general 190 
DISEASES OF THE SANGUINOUS FUNCTION. 
designation.” He never taught that the psora cause of disease was 
limited in its application to the itch. He says: “ I am persuaded that 
not only the majority of the innumerable skin-diseases which have been 
described and distinguished by Willan, but also almost all the pseudo- 
organizations, &c., are with few exceptions, merely the products of the 
multiform psora.” He evidently meant to teach that the great number 
of chronic diseases which afflict our race, “are due to a poison or 
miasm, latent in the body, acquired by the individual, or in some in- 
stances both, which becoming roused into action, ultimates in consump- 
tion, dyspepsias, haemorrhoids, asthmas, epilepsies.” * This same 
miasm, as he called it, when thrown out towards the circumference, and 
ultimated upon the outer surface of the body, manifests itself in the 
form of boils, carbuncles, cancers, scald-head, tetters,” &c. “ The term 
psora is a term of ancient origin, being used quite indiscriminately 
to designate every variety of chronic cutaneous disease.” Hahnemann’s 
psoric doctrine was familiar to all the old writers; and is equally fami- 
liar to the modern pathologists under the term of dyscrasia. 
Genus I—ANAEMIA. 
General Remarks.—According to Trousseau the existence of a 
certain proportion of iron is essential to the perfection of the blood in 
its different offices of supplying the proper nutritious materials for the 
support of the body and stimulating the various organs to perform their 
proper actions. The quantity of iron is smaller in women and children 
than in men, and women are most subject to anaemia. 
Causes.—Uterine haemorrhage; losses of blood from any cause; im- 
perfect digestion and assimilation of food; variable appetite; constipa- 
tion alternated with diarrhoea ; menorrhagia. 
Treatment.—When anaemia arises from recent haemorrhages or 
other debilitating losses, it may be remedied by Ferrum, China, 
Natrum-mur., JYux-vom., <&c. 
Ferrum has always been successful in pure cases of anaemia where 
the paleness and debility were dependent on an impoverished state of 
the blood, unconnected with local irritation or obscure inflammation. 
The remedial powers of iron in various forms have long been known. 
In all cases of anaemia from losses of blood or other fluids the soluble 
forms of iron are most successful, as they are styptic as well as tonic. 
Trousseau gives the carbonate, or limatura ferri, incorporated in bread, 
and continues it long after the countenance has resumed its florid color. 
It is appropriate in any form in chlorosis and in the paleness and de- 
* Prof. Adams, St. Louis, U. States Jour. Horn., Yol. I. 468. Hahnemann, 
Chronic Diseases Yol. IV. CEREBRAL anaemia. 
191 
bility which precede the deranged menses; and it cures scarcely any 
disease that is not connected with defective constitution of the blood. 
It is improper in all phlogistic cases. 
Iron is proper in all angemic cases of amenorrhoea; dysmenorrhoea; 
in dropsies dependent on impoverished state of the blood; in intermit- 
tents in which there is predisposition to hgemorrhages, congestions, or 
dropical infiltrations. We have seen many cases of this kind cured by 
chalybeate mineral waters and many more by Prussiate of iron. (Ferro- 
cyanate of Iron.) For the Abuses of Iron see Remarks on Ferrum, 
under Phthisis pulmonalis. 
2. CEREBRAL ANJEMIA.—“ CITY CACHEXIA.” 
Morbid conditions of the brain of an angemic character occur from 
long-continued dyspepsia, confinement in impure atmosphere. This 
cachexia of the great cities presents the following symptoms: Loss of 
appetite, confusion, giddiness in the head, violent sickness; sleepless 
nights; horrid dreams; waking suddenly in the night: noises in the 
head and ears, like the singing of a tea-kettle, or like something struck 
close to the ear, or water thrown on a hot iron, or a muffled drum at a 
distance; falling to sleep and suddenly awakened by a feeling as if a 
sky rocket had rushed through the brain; occasional deafness; head- 
ache ; black and bright spots dance before the eyes; languid, weak, ir- 
ritable pulse; cold skin; pale flabby tongue. Occasionally there is 
partial loss of memory; sudden startings up in the night; giddiness of 
the head; depressed spirits. 
Treatment.—Better, though restricted diet, change of air; exercise 
without fatigue. 
Remedies. — Nitro-muriatic-acid, Pyro-phosphate of Per rum, 
Cinnabar in scrofulous cases, Sulphur 30th, one dose, repeating only 
at long intervals. Sulpliuric-acid. 
3. Anaemia Lymphatica.—In six cases of this affection given by Dr. 
Wilkes, in the Guy’s Hospital reports, a “ uniformity of lesion existed, 
too remarkable to constitute merely a coincidence of lesion between 
the lymphatic glands and the spleen, and therefore, there is without 
doubt a peculiar form of affection involving these organs, accompanied 
by ansemic cachexia, prostration and death.” 
Pathology.—There is no excess of white corpuscles, but deficiency 
of the red, with the usual signs of progressive angemia in either sex 
alike in the treatment. The glands enlarged were, the inguinal, some- 
times the cervical, or axillary, or all at once progressing along the ab- 
dominal and thoracic glands to a fatal termination. A chain of tumors 
is sometimes encircling the arch of the aorta, or accompanying it along 192 
DISEASES OF THE SANGTTINOUS FUNCTION. 
the spine to the pelvis. The structure is fibro-nucleated, or fibro- 
plastic. [Med. Chir. Trans., Yol 17.) 
The spleen is not merely enlarged, but exhibits a. lardaceous depo- 
sit, white or yellow, either finely disseminated or seeming to compose 
a large portion of the mass of the organ. Its duration may extend over 
several years. 
Treatment.—In all cases recorded, the hospital treatment, consist- 
ing chiefly of iron was unsuccessful. A homoeopathic use of the Iodide 
of iron, Iod.-potassium, Mercurius-hyd., or a general antipsoric treat- 
ment would be attended with better results. 
A general anti-psoric treatment should be employed in the first in- 
stance. A favorable change, and perhaps a complete cure, may follow 
this course. 
The medicines should be used at high potencies, and repeated but 
rarely. 
Should a cure not result in a reasonable time, we should consult 
Ferrum-hydriod., Kali-hydriod., Mercurius-hydriod., and Iodine. These 
last remedies may be prescribed at the first, second, or third attenuations 
4. Other Forms of Chronic Disease associated with a Latent or 
Repelled Dyscrasia.—Hahnemann, in his efforts to unravel the mys- 
tery of chronic diseases, explored a few thousand of the volumes which 
contained what was then called the medical experience of the wrorld, and 
found an immense number of cases recorded in which the suppression 
of skin-diseases originated other maladies equally obstinate and much 
more serious. 
In his work on “Chronic Diseases,” published in 1828, he gives a 
large collection of cases from various authors in which the following, 
among other chronic and some acute diseases wrere obviously originated 
by the repulsion of psoric affections from the skin: First,—asthma; 
suffocating catarrh; asthma with bloating and blueness of the face and 
general swelling; asthma with hydrothorax; pleurisy and inflam- 
mation of the chest; pleurisy and cough; obstinate and violent 
cough; haemoptysis; consumption; collections of pus in the chest; 
collections of pus in the mesentery; great disorganization of various 
viscera; cerebral degeneration; hydrocephalus ; ulcers in the stomach; 
sphacelus of the stomach and duodenum; general dropsy; ascites ; 
enlargement of the scrotum; swelling and redness of the whole 
body; jaundice ; swelling of the parotid glands ; swelling of the cervical 
glands; dimness of sight and presbyopia; ophthalmia; cataract; amau- 
rosis ; deafness; enteritis; haemorrhoids and haemorrhage from the 
rectum; pains in the abdomen; diabetes ; suppression of urine ; erysipe- 
las ; acrid, ichorous discharges; ulcers; caries of the bones; osseous 
swelling of the knee; pains in the bones; rachitis and marasmus in in 
fants; fever with disorder of the kidneys ; fever following external cure TREATMENT OF BLOOD IN ITS MORBID STATES. 
193 
of the scald head; fever with opisthotonos ; fever with throat disease; 
tertian intermittent fever; quartan intermittent fever; vertigo and total 
prostration of strength; epileptic vertigo; epilepsy with dizziness; con- 
vulsions in many forms ; apoplexy; paralysis ; melancholy and delirium. 
We select the following cases in which repelled eruptions caused 
disease of the eyes : 
First.—Dimness of Sight and Presbyopia.—A girl, aged thirteen, 
had the itch, covering the limbs, face and other parts. It was removed 
at length by ointments, containing zinc and sulphur. Immediately after- 
wards her sight became gradually weak. Dark bodies passed before 
the eyes, which were seen from without, floating in the aqueous humor 
of the anterior chamber. At the same time the patient could not dis- 
tinguish small objects without the aid of glasses, and the pupils were 
dilated. (Hoffmann, Consul. Med) 
Second.— Ophthalmia from repelled Eruption.—A young woman 
had an abundant psoric eruption on the legs, with large ulcers below 
and behind the knee. The small-pox with which she became infected, 
freed her from this exanthem. There ensued during two years a moist 
inflammation of the whole eye, and of the eyelid, with itching and ul- 
ceration, and the perception of dark bodies moving before the eyes. 
The patient became infected with itch by wearing for three days the 
stockings of another child. The third day she was attacked with fever, 
dry cough, tension in the chest and tendency to vomit. Next day there 
was perspiration with erysipelas of both legs which soon degenerated 
into the real itch, from which time the sight improved. ( Wedel, Snetter, 
Hallmann. 1776, Koenigl. 210.) 
Third.—A man, in whom the psoric eruption had been removed, but 
who was in other respects well, became affected with cataract. 
{Ludwig, Advers. II. 157.) 
Fourth.—A repelled itch, excited amaurosis, which ceased on tne 
reappearance of the psoric eruption. (.Northof,, Diss. de Scabie, 1792.) 
Fifth.—A robust man who had been treated for the itch by repel- 
ling it from the skin became affected with gutta serena, and remained 
blind till his death at an advanced age. {Ludwig) 
Sixth.—In another case amaurosis, with frightful headache, was 
caused by curing itch on the surface. {Fabricius, Cent. II. obs. 39.) 
The usual means generally resorted to to furnish the best materials 
for the formation of the blood: are the expulsion of impure matters 
from it through the secretory functions; the support of the vital 
energies; the evacuation from the prima-via of all morbid secretions; 
and the restoration of general healthy action through the influence of 
tonics. Besides all of these results homoeopathic remedies aim at the 
Treatment of Morbid States of the Blood. 
VOL. II. 13. 194 
DISEASES OF THE SANGUINOUS FUNCTION. 
more deeply-seated causes of disease, and strike at tire hidden 
sources of hereditary evils and transmitted maladies. 
Though old school men aim at the same thing, they defeat them- 
selves by excessive medication, and thus produce aggravations instead 
of satisfactory cures. On this point Hahnemann says: 
“ When the patient afflicted with itch, after taking Sulphur, complains 
that the cutaneous eruption grows worse, the physician who is ignorant 
of the cause, consoles himself by saying that the itch comes out entirely 
before it can be cured; in reality the exanthema is caused by the 
Sulphur, and assumes an appearance similar to aggravated itch. Leroy 
says, viola-tricolor commences its action by rendering the cutaneous 
eruption of the face worse, though it subsequently effected a cure. The 
dose was too large, though the remedy was homoeopathic. 
Lyssons says {Med. Transac., Yol. II., London, 1772): the skin-dis- 
eases which yield with the greatest certainty to elm-bark, are those 
which it first aggravates. If he had given smaller doses he would not 
have caused the aggravations. 
In chronic (psoric) diseases the aggravation produced by homoeo- 
pathic remedies (antipsorics) occurs from time to time for several days ; 
after remedies whose action continues long we may see during the first 
six, eight or ten days some apparent aggravations of the original 
malady. “When these days are past, the curative effect of the remedy 
continues for some days longer.” 
We are often called upon to prescribe for the results of disease, as 
well as for disease actually existing; even here, however, we are 
governed by all perceptible symptoms now existing, whether they 
evidence present diseased action or show where diseased action has 
been progressing at a former time. We find these results of former 
diseass in all protracted cases, in all chronic diseases. 
It has been already shown that remarkable diminution or exhaustion 
of nervous energy generally renders the blood dark-colored, prevents 
its fibrinous particles from adhering into a coagulum when removed 
from the veins, causes a disposition of the coloring matter to separate 
from the central corpuscles, and occasions a diminution of its saline in- 
gredients. It has been also seen that various articles received through 
any channel into the blood change its chemical and physical character. 
We may then be able to correct diseased states of the blood by intro- 
ducing medicinal agents through the same channels. Page 178. 
First.—Treatment of cases, in which bujfy or inflammatory blood 
is present.—Gelseminum, Aconite, Stibium, Ipecac., Fry., Arc. 
Second.—Blood with loose Coagulum, Ac.—This state arises from 
weak, nervous influence and vascular action, and is usually treated 
with tonics, or stimular ts, chalybeates, mineral acids, and metallic 
salts. When the blood is of a dark color, Ammonia, Arsenicum, HAEMORRHAGES. 
195 
Carbo-veg., China, are to be considered. In diseases, in which the 
blood is thin and dissolved as in scurvy, also in malignant and 
adynamic diseases, vegetable acids, as the citric acid, or vinegar, are 
the chief remedies. Vinegar was used by the Carthaginians and 
Romans in ail their campaigns; and it has a tendency to prevent the 
attenuation of the blood caused by excessive fatigue. The power of 
citric acid is now well known in preventing scurvy. (See Copland, Vol. 
I. p. 248.) 
Genus n.—IIJEMORRIIAGIA.—ILEMORRIIAGES. 
Bichat made the first real advances into the field of pathology which 
is now so extensive; and to him we owe the first rational generalization 
of facts in the study of haemorrhages. He showed that there are 
general features which are common to all spontaneous flowings of 
blood, and classifies them according to the organs in which they occur. 
We proceed to notice the most important forms of haemorrhage. 
Treatment of Haemorrhage from Wounds.—A wound, well closed 
and dressed, generally ceases to bleed. When there is danger of bleed- 
ing a eompress may be applied over it and retained by a bandage. 
Cold water, immediately applied, will stop bleeding from small vessels. 
When the bleeding vessel is larger, as some about the throat, thigh 
or arms, the whole limb or side of the neck may be compressed by pla- 
cing a finger on the trunk of the bleeding vessel. If it be an artery the 
fact is known by the blood being of a light vermillion red color, flowing 
out in jets at intervals as the pulse beats. In this case the danger is 
greater, and the best surgical measures are imperiously required. 
Temporary safety may be procured by binding a bandage tight around 
the limb between the wound and the heart so as to compress the bleed- 
ing artery, the location of which is known by its beating. If the 
bleeding does not at once cease, find the exact site of the artery, feeling 
for the pulsation with the finger, place directly on the spot a piece of 
cork and press it down upon the artery till the bleeding is effectually 
stopped. A bandage applied around the limb, so as to compress the 
cork firmly on the artery, will restrain the flow of blood till better 
means can be obtained. 
Give only cold drinks, keep the limb elevated; place no unnecessary 
dressings over the wound; keep it cool with cold water. If fainting 
occurs it is beneficial, as it permits coagulation of the blood. If the 
faintness comes on after great loss of blood, the patient becomes blue 
1. TRAUMATIC HAEMORRHAGE. 196 
DISEASES OF THE SANGUINOUS FUNCTION 
in the face, has twitching of the limbs, there is danger. Give China, 
If he does not revive sufficiently give good wine. (.Tiering.) 
When the loss of blood is likely to become serious, the tying of the 
bleeding artery is the only reliance. This even when the vessel is 
small requires some skill and knowledge of general surgical principles. 
These have been greatly improved within the present century. It was 
a maxim of Hunter to “ take care of the vasa vasorum,” and of Scarpa, 
Crampton and Travers, that we should “ never cut the arterial tissue.” 
Physic and Cooper improved the practice by using a ligature possessing 
the property dissolubility. Cooper first used it in 1814. And A. 
Cooper in 1817 tied the femoral artery of a man aged 80, and healed 
the wound by the first intention; which proved the great superiority 
of this method over that of Scarpa. 
It has been proposed to combine all the advantages of former me- 
thods. The rule of avoiding the cutting of the true vasa-vasorum is 
good; these minute vessels should not be strangulated with the liga- 
ture. To avoid this, and yet secure the vessels, Cooper directs the 
ligature to be made of buckskin, very soft, and a little broader than 
the thickness of the skin; and it should not be to tightly drawn. The 
wound will generally heal by the first intention; and, if it should not, 
there will be no suppuration and the wound will soon close; and a 
capsule will surround the ligature if the capillaries are not too much 
injured ; or the ligature will be surrounded by lymph, and will soon be 
dissolved. After using the animal ligatures several years no second- 
ary haemorrhage has resulted; the ligature never slipped, other appli- 
cations were never necessary; and the w'ound nearly always healed 
by the first intention. 
As traumatic haemorrhages arise for the most part, from strictly 
local injuries, the treatment cannot be regarded as with the scope of 
any general therapeutic law. The local appliances of the surgeon 
will therefore be regarded in these cases. But when the general 
system becomes involved, and diseased action becomes developed, then 
our law of cure comes in play, and the appropriate homoeopathic medi- 
cines must be prescribed. 
Styptic for Local Application.—The following formulae has been 
published by M. Hannon: (Bulletin Gen. de Therap.) 
Benzoic acid, 1 part: Sulphate of Alumina and potash, 3 parts; 
ergotine of bonjean, 3 parts ; water, 25 parts. Mix. 
The wdiole is to be boiled for half an hour in a porcelain capsule, 
constantly stirring, and replacing the evaporated water by hot water. 
Evaporated with the constant agitation to the consistence of an ex- 
tract, it presents a chocolate-brown color, strongly astringent taste, 
and an odor of ergotine. This, says M. Hannon, is the most ener- HAEMORRHAGES FROM EXHALATION. 
197 
getic styptic at present known, whether applied externally or admin* 
istered internally. 
Creosote.—When this is not at hand, take the black glutinous drops 
which hang in old chimneys where wood is burned. A portion as large 
as a pea may be dissolved 'in a table spoonful of brandy, then diffused 
in a glass of water, and dropped into the wound. 
Leech Bites ought never to be inflicted on suffering children; but 
many people will use them, and some will neglect the patient long 
enough afterwards to permit him to bleed to death. To stop leech 
bites from bleeding it is sufficient to hold the finger for a considerable 
time on the wound, and apply over it a good plaster of some adhesive 
plaster or sticking wax, such as that used by gardeners or shoe- 
makers. (Bering.) 
Punctured Wounds made with blunt and rough instruments do 
not heal well from the bottom unless they are thoroughly cleansed; 
and they often require to suppurate, for which they need poulticing or 
some slightly stimulating embrocation. Some of those mentioned under 
ulcers will answer. If the external aperture is small it may close up 
before the interior part is well. If the closing can not be otherwise 
prevented insert into it a tent made of a smooth piece of the bark of 
CJlmus-f ulva, or slippery elm. It is inserted without pain; and it 
expands gradually, thus enlarging the aperture. 
Causes of Spontaneous Haemorrhages. Dr. Joslin, in an article on 
the Meteorology of Haemorrhage, in 1843, showed, that in many cases of 
bleeding from the lungs and uterus the barometer was generally fall- 
ing on the days of attack in a greater proportion of instances than 
could with any degree of probability be attributed to accident: thus 
out of 54 cases, it was falling in 35, at the time of the attack, rising 
in 18, and stationary in one only. 
Treatment.—For active haemorrhages, we should examine Aconite, 
Gelseminum, Millefolium, Ipecac, Veratrum-viride, Digitalis, Arnica, 
China. For passive, and venous haemorrhages, the more commonly 
indicated medicines are, Hamamelis, Collinsonia, Secale, Sabina, 
Ferrum-hyd, Calendula, Ammonium-carb. 
For haemorrhages occurring during the progress of maladies of a 
typhoid or malignant character, we must refer to Arsenicum, Ammo- 
niacum-carb., Carbo-veg., China, Muriatic-acid, Gallic-acid, Fhus-tox., 
Secale. 
2. HAEMORRHAGES FROM EXHALATION. 
1. Haemorrhage from exhalation may happen wherever exhalents 
terminate; and they have their seats in the mucous surfaces, as the 
nasal passages, bronchia, stomach, intestines, bladder, &c. They also 198 
DISEASES OF THE SANGUINOUS FUNCTION'. 
occur in the serous membranes, as we sometimes find bloody serosity m 
the intestinal cavity ; and also in the cellular tissue. Such are those 
which produce scorbutic spots. Those of the skin are of rare occur- 
rence. Finally, glands, have been observed to exhale blood. 
Haemorrhages by exhalation in mucous' membranes, as elsewhere 
are of two species: passive and active. Active, when they are ac- 
companied with development of the vital forces; thus they have this 
character in the nasal passages when we notice a titillating sensation, 
together with a slight pain and redness. At other times they are en- 
tirely passive, as when they occur near the close of some organic af- 
fection characterised by debility. 
Symptoms of Excessive Loss of Blood.—The loss of blood mani- 
fests itself in paleness, coldness of the surface; dimness of sight is a 
prominent symptom. Marshall Hall describes a case of a lady dying 
from uterine haemorrhage. The pulse was imperceptible and she was 
“ tossing in that restless state which is so fatal a sign in these terrible 
cases. She asked: ‘Am I in any danger? How dark it is! I can’t 
see! ’ The light of the window was shining full upon the bed. The 
pupil was completely dilated and motionless before the light.” 
When women recover from this state, or have lost much blood, they 
will probably have distressing headache with throbbing of the head; 
noise in the ears, colorless complexion ; quick weak pulse, all of which 
symptoms are greatly increased by exertion. 
For such symptoms some formerly tried bloodletting; if they found 
relief for a few hours it was always followed by renewal of the nausea, 
throbbing headache worse than before. Indeed, the condition is one 
of anemia; it is the acute state of what is otherwise called chlorosis ; 
that pale-faced amenorrhoea which occurs either in puberty or after 
life, and is cured by a similar treatment. 
Ipecac.—Many old authors succeeded in curing hemorrhages with 
Ipecac., while others, as Murray, Scott, and Geoffroy saw hemorrhage 
caused by it. 
If F. Hoffmann praises the efficacy of Millefoil in various cases of 
haemorrhage; if G. E. Stahl, Buchwald and Loeseke have found this 
plant useful in excessive hcemorrhoidal flux; if Quarin and the 
Editors of the Breslauer Sammlungen speak of the cure it has ef- 
fected in hemoptysis ; and finally, if Thomasius, (according to Haller), 
has used it successfully in uterine haemorrhage; these cures are 
evidently owing to the power possessed by the plant of exciting in- 
testinal hcemorrhage and hoemMuria, as observed by G. Hoffmann, 
and more especially of producing epistaxis, as confirmed by Boecker 
Hemorrhage from the Lungs. See Yol. I. p. 797; 
Hemorrhage from the Stomach. Yol. I. pp. 413, 866. 
Hemorrhage from the Teeth. Yol. I. p. 237. PURPURA HEMORRHAGICA. 
199 
Haemorrhage from the Kidneys. Vol. I. pp. 785, 600. Vol. II. p. 70. 
Haemorrhage from the Rectum. Yol. I. p. 392. 
Haemorrhage from the Nose. Yol. I. p. 430. 
GENUS III.—PURPURA. 
This name is applied to an efflorescence consisting of small, distinct, 
purple specks and patches, attended by general debility, but with little 
appearance of fever. The efflorescence depends upon an extravasation 
of blood from the fine vessels under the cuticle. The only form of it 
that deserves our attention is: 
1. PURPURA HEMORRHAGICA. 
Diagnosis.—The disease is characterized by the appearance on the 
skin of petechia, or purple spots of large size interspersed with vibices 
and ecchymoses, resembling the marks made by the stroke of a whip, 
or by violent bruises. They appear first on the legs, afterwards on 
the thighs, arms and trunk of the body; the hands are seldom marked 
with them and the face remains free. On their first appearance the 
spots are of a bright red color, but they soon become purple or livid; 
and when about to disappear they change to a brown or yellowish 
hue; the cuticle over them appears smooth and shining, but is not 
sensibly elevated, except in a few rare cases in which it has been seen 
raised into a sort of vesicle containing black blood, especially on the 
tongue, gums, palate, and inside of the cheek. The gentlest pressure 
on the skin, as that of feeling the pulse, will often leave a purple blotch 
like that left after a severe bruise. 
Purpura hsemorrhagica occurs in persons who have a constitutional 
tendency to haemorrhages, from all the surfaces covered by the de- 
licate epithelium as well as from the skin; they are therefore subject 
to large losses of blood which are often rapidly fatal. Sometimes the 
haemorrhage occurs every day at a stated hour; at other times there 
is a slow, but almost incessant oozing of blood from the gums, nostrils, 
throat, inside of the cheeks, tongue or lips; sometimes from the lining 
membrane of the eyelids, the urethra or external ear; also from the 
internal cavities of the lungs, stomach, bowels, uterus, kidneys and 
bladder. 
Symptoms.—The appearance of the disease is preceded by great 
lassitude, faintness, pains in the limbs, though in some cases the pa- 
tient had been in previous good health. The feelings most complained 
of are extreme debility and depression of spirits; the pulse is feeble 
and frequent; and there are heat, flushing of the surface, perspira- 
tion and other accompaniments of fever. When the disease has con- 200 
DISEASES OF THE SANGUINOUS FUNCTION. 
tinued for some time the patient becomes sallow and emaciated; the 
lower extremities show oedematous swelling which afterwards extends 
to other parts of the body. The duration of the disease is in some cases 
limited to a few days, in others it has continued for months, and even 
years. It occurs at all periods of life, but is more common among 
women, and in boys before the age of puberty. 
Causes.—Depressing influences which operate by depressing the 
vital powers; sedentary occupations; residence inclose crowded situa- 
tions ; consequences of acute exanthematous diseases, as small-pox, 
measles, or puerpural confinement; the ancients attributed the haemor- 
rhages which attend purpura haemorrhagica to morbid enlargement of 
the spleen. In children it is often originated by insufficient or im- 
proper food; in nursing women its causes are similar to those which in 
other persons produce stomatitis materna. (See Yol. I., p. 740.) 
Treatment.—When it occurs in women and others too much con- 
fined witliin-doors or imperfectly nourished by food, the treatment will 
be commenced by improving the diet and prescribing change of air, 
exercise, travelling, at least by being carried abroad. When there has 
been no restriction of diet, no close confinement, and no debilitating 
disease has preceded, a different course may be suggested which in its 
details will be regulated by the peculiar circumstances and features 
of the individual case. 
2. Purpura Urticans.— Diagnosis.— This form of purpura com- 
mences with the appearance of rounded and reddish elevations of the 
cuticle resembling the wheals of nettle-rash, but without the itching and 
tingling of that disease. The tumors gradually dilate, but within one or 
two days they subside to the level of the surrounding skin; their hue be- 
comes darker, and finally livid. They are most common on the legs where 
they appear with petechige, but they also appear on the arms, thighs 
and breasts. It usually occurs in summer, and lasts from three to five 
weeks. It is occasionally preceded by stiffness and weight of the limbs, 
and some oedema accompanies it. 
3. Purpura Senilis appears principally along the outside of the 
forearm in elderly women, in successive dark-purple blotches of an 
irregular form, and various in size. Each of these continues for seven 
or ten days, and then the extravasated blood is absorbed. 
Treatment.—The principal remedies are: China, Hamamelis, Ar- 
senicum, Sulphur.-acid, Gallic-acid, Ammonium-carb., Secale, Carbo-veg. 
Acetate of Copper.—A girl aged seven years and a half, has had on 
her skin for eight days, dark red spots from the size of a millet-seed 
to that of a shilling; the spots especially occupied the upper half of 
the body, the chest, upper arms, face, and mucous membrane of the 
mouth. Otherwise the health seemed undisturbed. The urine in nor- 
mal condition. For five days the chloride of iron was administered, but PURPURA HEMORRHAGICA. 
201 
the spots only increased in size. On the forehead, both eyelids, and 
elbows, bluish ecchymoses of the circumference and height of half a 
walnut arose. From one alveolar process from which the child had 
herself extracted an incisor tooth two days before, blood constantly 
flowed; her cheeks and lips were pale ; her strength gone. Something 
of the acid order was given which checked the haemorrhage; but after 
eight days’ trial it was given up, for fresh spots appeared; and a boil 
of the size of a moderate apple developed itself on each shin-bone. 
The acetate of copper was given in solution, (a few drops per 
hour,) July 9th, and it at once arrested the progress of the disease 
July 13th. A smart itching of the spotted portions set in; this was 
followed by the usual change of the purple hue of the ecchymosis 
shining through the‘skin which became green and yellow. And by a 
week more all morbid symptoms had disappeared. (Dovnmes.) 
2. A child aged seven years, complexion dark blond, showed a great 
number of dark purple red (but not bleeding) spots of various sizes, 
which had made their appearance twenty-four hours before, and occu- 
pied almost exclusively the upper part of the body, including the 
tongue. General health not otherwise changed, urine of ordinary color 
and chemical properties. Arnica was tried, but it failed to do good, 
and produced visible aggravation. After four days (or Oct. 31st, 1818,) 
frequent bleedings of the tongue commenced; the strength decreased. 
Acetate of copper employed after this (in a solution of gum water 
and cinnamon water) produced in this case also a rapid and perfect 
cure, preceded by the same itching of the skin and change of color. 
(JDommes.) 
3. Dr. Marx, of Cologne, court physician, reported the following: 
“A man of melancholic temperament, who had been taken ill on a jour- 
ney, consulted Dr. Marx in 1772. He complained of feebleness and 
want of appetite, had a dry cough, not very severe, and at times expec- 
torated blood. On various parts of his skin bluish red spots were seen, 
and reddish blue stripes under the tongue. Pulse small and irregular; 
blood occurred in the urine and stool and also in the saliva. Respira- 
tion difficult, with cold and hot fits. The above solution of copper 
vitriol in cinnamon water. In three weeks all morbid symptoms had 
disappeared, and the patient was able to continue his journey. (.British 
Jour. Ilom., 1860, p. 542.) 
4. Case by Dr. Searcy. (Transaction of the Med. Society of Ten- 
nessee.) A girl aged twrelve years, after fever for nine days, was con- 
valescing. Was very pale and feeble; fainted on being raised; sur- 
face unnaturally cool; restlessness ; thirst; headache ; tongue pale 
and flabby; pulse scarcely perceptible and extremely frequent; tender- 
ness of epigastrium ; bowels constipated ; and constant oozing of blood 
from the nares and throat for forty-eight hours, causing extreme ex- 202 
DISEASES OF THE SANGUINOUS FUNCTION. 
haustion. On the face a few red and blue patches; also on other parts, 
as the limbs, inside of the lips and cheeks, from the size of a pin-head 
to a five-penny piece. 
She has always been delicate, is nervous-sanguine, bleeds often from 
the nose in health. Haemorrhagic tendency or scrofula not known in 
the family. She took small doses of Saccharum-saturni, every hour for 
seven hours, at which time the bleeding ceased. Solution of the same 
injected into the nares. A blister was applied to the back of the neck 
and to the calf of each leg. The pulse became stronger; still there is 
thirst, tender epigastrium; tongue pale and flabby. Under the use of 
elixir-vitrol, lemonade, light food, &c. She recovered. Sulph.-quinine 
and the mineral acid perhaps insured the favorable result. Under 
them the purpural patches ceased to appear on the skin and the old 
ones faded away as strength improved. 
GENUS IV.—TOXAEMIA. -BLOOD-POISON. 
1. Toxcemia Mercuriale.—Persons long exposed to breathing mer- 
curial vapor suffer depression of the vital powers; the process of animal 
calorification is imperfect; and it is quite common for such persons to 
he affected with ulcerations of the mouth and fauces, and with “ pain- 
ful or rheumatic affections of the periosteum, joints, limbs and liga- 
ments, particularly after exposure to cold.” Eruptions occur on the 
surface of the body writh other phenomena, “to which the term pseudo- 
syphilis has been applied; as well as many of those symptoms usually 
denominated cachectic.” The same effects occur from what is called 
“ a mild, hut long-continued mercurial course.” 
The poisonous influence of Mercury was exhibited on a grand scale on 
hoard the British ship referred to at Vol. I, p. 95. Thirty tons of the 
liquid metal was picked up and confined in bladders placed in barrels 
stowed away in boxes in the bread room. The bladders were wet and 
soon decayed; the heat of the weather caused them to burst; and 
the greater portion of the metal was secured in casks, though a large 
quantity escaped and found its wTay into the crevices in the lower parts 
of the ship, wrhere being covered with bilge-water it soon began to be 
decomposed. Then efforts were made to purify the ship by removing 
the bilge-water, provisions and stores, and washing every part of the 
suspected surface: and every man employed in this work or in the stew- 
ard’s apartment, was speedily affected with the poison. Ptyalism be- 
gan among the officers and men, and further attacks continued to occur 
for two months or more. Nearly all the sheep, pigs, goats, poultry, 
mice, cats and dogs speedily died. Canary birds, fed on food corked up 
in bottles, also died. Many persons suffered from severe ulcerations of 
the mouth, partial paralysis, bowel complaints. Old ulcers previously ANAEMIA, 
203 
healed, broke out again, and assumed a gangrenous appearance. The 
mercurial vapor developed phthisis pulmonalis in three men who had 
never before been on the sick-list; they all died. Two more were left 
at Gibraltar with confirmed phthisis. In two ptyalism degenerated into 
gangrene of the cheeks and tongue and ended in death. A woman 
confined with a broken limb lost all her teeth, and many exfoliations 
took place from the upper and lower jaws. The poisonous effects were 
then attributed to mercury soaked in the bread, and 7,940 pounds of 
biscuit were condemned as unfit for use; but it was afterwards ascer- 
tained that the poison was chiefly received into the system in a state 
of vapor. 
When gradually introduced into the system, mercury produces: tu- 
mors that are slowly developed; severe ptyalism, gangrene and ulce- 
ration of the mouth and throat; palsy, various nervous and inflammatory 
affections indifferent parts of the body; protracted dysentery. The 
effects observed on the slaves who work in the quicksilver-mines of 
Almaden, are: Swellings of the parotids, aphthous sore throat; sali- 
vation, eruptions, pustules ; scurvy and tremors. Herat mentions one 
death from profuse salivation and gangrene, and two others from mer- 
curial marasmus. A barometer-maker and his assistant slept in a room 
in which mercury in a pot on a stove was heated by a fire made by mis- 
take. The latter lost all his teeth by salivation, the former was affected 
w7ith shaking palsy which lasted the rest of his life. 
Ptyalism is sometimes excited by a wrarm bath containing an ounce 
of corrosive sublimate in twelve gallons of water repeated every three 
days. The effect is seen after the third bath, if not sooner. This power- 
ful agent is sometimes applied as an escharotic for the removal of can- 
cers. In the case of a lady on whom we had declined to make an appli- 
cation of this kind an itinerant practitioner applied a plaster of this 
poison an inch and a half in diameter on the surface of a cancer on the 
breast. He encouraged her to endure the agony it inflicted by assuring 
her that the swelling mammary veins were only the “the roots” of the 
cancer (“ the crabs claws ” ), which were being rapidly extracted. She 
lived several days under the local torture of the burning escharotic and 
the irritative fever; and then died under the constitutional effects of 
mercury, including the gastric inflammation and dysentery caused by 
the poison when taken internally. 
2. Tox —-J'roiii the Poisonous Effects of Tobacco.—In 1849, the 
French Minister of the Interior requested the Academy of Medicine 
to appoint a Commission to examine and report upon the health of 
workmen employed in the manufacture of tobacco. Dr. Melier Avas 
appointed to perform that duty. His Report says : 
“ The manufacture of tobacco effects, in the long run, upon a certain 
number of workmen, a profound and specific change deserving all at- 204 
DISEASES OF THE SANGUINOUS FUNCTION. 
tention. There is a peculiar alteration of the complexion—not simple 
discoloration or mere pallor, hut a gray sallowness—a mixed shade 
between chlororis and certain cachexim. The physiognomy is so far 
modified by it, that a practiced eye might with some exceptions, 
recognize those who have long worked in tobacco. 
“ The preparations of Iron remedy this state, and restore to the 
workmen their primitive color. Mr. Ilunteaux, the physician attached 
to the Gros Caillon hospital, has remarked that workers in tobacco, 
when bled, in the cases where bleeding appears to be indicated, do not 
present a buffy coat upon the blood; or if there be one, it is usually 
very soft. Is the blood then modified to such a point that a part of 
the fibrine has disappeared ? 
“They fall awTay and change rapidly. We have seen a fine-looking 
soldier, aged 29, who, on leaving the first Lancers, entered the factory 
a year ago fresh and fleshy. Now he is thin, and his complexion has 
the peculiar sallow; he has lost his strength. Another mentioned 
that he had lost ten pounds in a short time. It is believed that the 
average of life is shortened among workmen employed in tobacco. 
Most of the aged workmen are asthmatic, or at least short-breathed. 
“ The first impression has something more or less painful for work- 
men who enter the factory, and they have, nearly all, a certain diffi- 
culty in accustoming themselves to it. Many can not become inured 
to it, and have to leave the factory. We have known but one out of 
five who was able to remain, of those who entered during our visits. 
One out of five ! these are figures that deserve to be noted. But this 
is certainly not the case wTith smokers. They suffer,—indeed their 
first sensations are intolerable; but a kind of silly pride resists dis- 
gust and pain. They suffer, but they smoke; then the disgust les- 
sens, the pain is blunted, the habit formed, and the evil takes its 
course. Hence we often meet, among habitual smokers, men who, 
by reason of their temperament, or of certain innate peculiarities, w ould 
certainly have been obliged to renounce the frequentation of the fac- 
tory, and to whom tobacco must be especially hurtful.” (Journal de 
Societ. Gallicane.) 
Dr. Teste of Paris says many of the ordinary infirmities of the 
votaries of tobacco are attributed by themselves to some other origin. 
Thus, one digests badly; another has palpitations ; a third finds his 
sight failing in the evening, or can read only by closing one eye, as if 
he squinted; a fourth complains of itching wfith red or yellowish spots 
on his chest and shoulders ; a fifth has stitches in the side, darting 
pains in the temples, or buzzing in the ears, &c., or corns on his feet 
so painful as even to prevent sleep at night. Though many organisms 
bear for a long time the poisonous powers of tobacco, they are never 
secure acainst the sudden outbreak of acute symptoms. Beyond the PHTHISIS PULMONALIS. 
205 
point of saturation there is every thing to be feared. In one case a 
gentleman aged forty-two who smoked seven or eight cigars a day from 
his twentieth year without inconvenience. He complains now of “ir- 
ritation of the bowels, has considerable emaciation, especially of the 
lower extremities; general sense of weakness ; chilliness ; absense of 
fever; the pulse rather weak, hut regular, never more than seventy 
or seventy-two, even after meals ; temper mild though keenly anxious 
about his condition; sleep bad, often interrupted by cough or colic ; 
skin natural, tongue clean; appetite great; faintness when the meal 
is delayed; fits of canine hunger ; does not spit even in smoking; 
pinching of the stomach after a meal; followed by diarrhoeic stool, 
recurring three or four times during the day; irritation of throat or wind- 
pipe ; violent spells of dry cough especially at night; dull pains in the 
sides, alternating with sore throat; stools often diarrhoeic, often violently 
so, with hard gripings, sometimes lasting several days, followed by 
constipation. 
In this case all treatment failed till smoking was abandoned, “ and 
then almost immediately the digestive functions returned to their nor- 
mal state. In another well-marked case in which the derangements 
caused by tobacco were very extensive and the army physicians had 
diagnosed cancer of the pylorus. Dr. Teste failed with all his remedies. 
In the course of two years he found the patient in perfect health. To 
the inquiry “ how he had been cured the patient replied, as if confiding 
a secret: “ I smoked—you did not know that, perhaps. One fine day 
I stopped smoking, and from that day my cure dated.” {Jour. Sog. 
de Gallicane.) For other Drug Diseases see their Names.—Index. 
PHTHISIS PULMONALIS.—CONSUMPTION. 
Tjie Name.—Phthisis (from, to consume.) 
Synonyms.—Tabes Pulmonalis, of Cullen, Marasmus Phthisis of 
Good. It has been defined to be “ a depraved constitutional state, tend- 
ing to the deposition of tubercle in the air-cells of the lungs.” 
Prominent Sytmptoms.—Emaciation; debility; cough; hectic fever; 
purulent expectoration. 
Diagnosis, Progress and Termination.—The most common period 
for the occurrence of phthisis is between the ages of eighteen and 
thirty; and it is probable that more deaths occur in persons under the 
age of eighteen, than after thirty. It is calculated by Drs. Forbes and 
Clark, “that above one-quarter of the individuals who die before the age 
of puberty, die of tubercles! ” It is also estimated by the latter gen- 
tleman, “ that the maximum of mortality in this disease is at thirty, 
and that from this point it gradually diminishes.” No age, however, is 
exempt from it; for infancy, childhood, youth, manhood, and extreme 206 
DISEASES OF THE SANGUINOUS FUNCTION. 
old age, are all more or less subject to its withering influence. Be- 
tween the ages of two and fifteen years about three-fifths of the deaths 
occur in tuberculous subjects. From this age to twenty-five the vic- 
tims embrace the young of both sexes, particularly those who possess 
the finest and rarest moral and mental endowments, and the subtlest 
tintelligence. To the young female, just reaching “the verge of woman- 
hood,” when Hope comes to her with the most enchanting promises, 
the angel of ill approaches also, in the guise of consumption ; and the 
two contend until the last is the victor, and his triumph is celebrated 
with all the displays of unaffected wo. Many a young man who has 
scaled the difficult heights that obstructed an ambitious vision, is 
about to grasp the prize upon which his eagle-eye has been steadily 
fixed through years of varying toils and storms ; but the moment he dares 
to dream of rest, the enemy that has dogged his steps, unseen, through 
half his career, is disclosed, and leads him from the presence of Hope 
to that of Despair. With what a profound interest must the physician 
contemplate a disease of which the path is constantly thus marked! 
Tubercular phthisis, when once fully developed, is beyond question 
incurable by medical means. The physician may palliate symptoms, 
and often protract for a considerable period the fatal termination of 
the malady; but he can not remove those foreign accumulations which 
constitute tubercles, either by a gradual absorption or in any other 
manner, so as to prevent the formation of ulcerous excavations ; nor 
can he heal these ulcerous cavities when once formed, since they are 
constantly being disturbed and irritated by the incessant motions of 
the lungs. The few instances of spontaneous cures of ulcerated lungs 
reported by Laennec and others, are only exceptions to the general 
principle which we have advanced. Much, however, may be done in 
the early stages of phthisis, while the tubercles are yet small, and but 
slightly irritated to retain them in a latent condition for an indefinite 
number of years. We are aware that in some instances there will be 
great difficulty, even on the part of the physician, in detecting the 
insidious advances of the disease at this early period, but by watching 
with great care every slight indication of disturbance connected with 
the respiratory organs, by ascertaining whether any hereditary pre- 
disposition exists in the family, by examining the physical conforma- 
tion of the chest, the respirations, as relates to their strength, free- 
dom, number per minute, and whether unduly increased by exercise; 
and finally, by investigating minutely the previous history of the indi- 
vidual, in order to be able to judge whether any cause may have been 
in operation which might originate the disorder, we may be able to 
advise such measures as shall retain the tubercles in a latent and un- 
developed condition, and thus for years prolong life. 
Development.—Stages of the Disease.—1. State of crude tubercle.— PHTHISIS rULMONALIS. 
207 
Small disseminated tuberculous deposits. 2. Stage of abundant de- 
position, involving solidification, followed by softening. 3. Stage of 
excavation,—the tubercles having softened and, in discharging formed 
cavities. 
The laws observed by tuberculosis in its progress are the following: 
In a vast majority of cases the deposit takes place at or near the apex 
of the lung; beginning on one side before the other lung is attacked; 
but the opposite lung is subsequently affected in a vast majority of 
cases. In the far greater proportion of fatal cases it is found that both 
lungs have been affected, but the deposit is most extensive on the side 
first involved. 
Precursory Phenomena.—The positive appearance of tubercle in 
the lungs is preceded by a period of ill health, frequently well marked, 
and capable of being easily recognized. The constitutional cachexia 
manifests itself before its most dreaded consequences have become ap- 
parent. Louis asserts that “tuberculization commences from six months 
to two years before its announcement by cough or any obvious pectoral 
symptoms.” Dr. Hogg thus sums up the symptoms of this stage: 
“Emaciation, susceptibility to bronchical catarrh, mental lassitude, 
failing of bodily strength, shortness of breath, weakness of sight, 
falling off of the hair, frequent perspirations, occasional palpitations or 
unsatisfactory state of the digestive organs and the alimentary canal.”* 
The incipient stage of consumption is thus characterized: “ a slow but 
marked diminution of bodily vigor for which no good reason can be 
assigned, compels the individual to abandon many of his accustomed 
pursuits; the spirits, nevertheless, are good, and not only is the idea 
of consumption never entertained, but any allusion to it is at once ri- 
diculed. So general indeed is this hopeful condition—this almost 
instinctive blindness to the real cause of distress—that in their absence, 
however suspicious certain symptoms appear, these may, with much 
probability of accuracy, be pronounced unconnected with phthisis. In 
phthisis, when fully established, the features are somewhat sharpened; 
the movements of the body are hurried and anxious ; the mental con- 
dition is irritable and capricious, whilst every act betrays an effort— 
sometimes instinctive, and at other times voluntary—to conceal the 
presence of disease. {Dr. Cotton.)—The appetite is uncertain; and there 
are frequent indications of imperfect digestion as well as tendency to 
passive diarrhoea and headache. The pulse varies in different cases, 
but is generally small, and easily excited. The sleep is restless, un- 
refreshing, and occasionally attended by perspirations. Loss of weight 
is of invariable occurrence; sometimes the decrease is so rapid that it 
will attract the attention of the friends ; at other times the patient 
* Practical Observations on Prevention of Consumption. P. 42. 208 
DISEASES OF THE SANGUINOUS FUNCTION. 
needs to be weighed at considerable intervals to detect it.” In a few 
instances the emaciation has been so rapid that several pounds have 
been lost within a few days. It is when a number of the above symp- 
toms are found together, when “ the patient’s antecedents, his occu 
pations and habits of life, or any other circumstances, seem to be con- 
ducive to phthisis,” that the physician is reluctantly compelled to re- 
gard the sum total of the evidence presented to his mind as conclusive 
that consumption is becoming positively established. 
Females are more subject to consumption than males," and their 
education, habits of life, their absurd modes of dress and the require- 
ments of civilized society are well calculated to excite this disease. In 
New-York the proportion of deaths from consumption was: 
For the year 1860.—Whole No. of Deaths 22,710. From Phthisis 3,186. 
“ “ “ 1861.— “ “ « “ 22,117. “ “ 3,025. 
“ “ “ 1862.— “ “ “ « 21,214. « “ 3,170. 
Of these, in 1860, Males 1,627.—Females 1,559. 
“ “ in 1861, “ 1,576.— “ 1,449. 
But no general conclusions can be drawn from these statistics, as of 
8,025 of the above deaths from phthisis, only 950 occurred in persons 
born in the United States. 
Symptoms that precede the Formation of Tubercle. — Shorter 
breathing, less breath motion, feeble and shorter inspiratory sounds 
and particularly the vesicular more or less general over both lungs 
Expiration is quick, forcible, and perfect; deep inspiration, thougl 
possible, is not effected until the attention of the patient is directed t 
it; and commonly after repeated trials, the air is diminished in ordinary 
breathing. 
General atonic Condition of the Body. — Sense of weakness and 
languor, loss of flesh, and weight; loss of physical strength; pulse 
and respiration increased in frequency; complexion denoting mal- 
nutrition ; irritability of the mucous surfaces ; the chest is flattened in 
original conformation,or becomes so during the progress of the disease; 
the features from being round and placid acquire a sharp and faded 
look, especially in the morning, when the eye lacks expression; there 
is dullness of sound on percussion ; cough and haemoptysis exist in some 
cases though not in all; bowels constipated or unnaturally relaxed; the 
urine deposits lithates; and nervous and dyspeptic symptoms appear.f 
“The existence of tubercles can not always be positively determined 
by physical examination, as they may be so minute or so partially 
clustered as not materially to interfere writh vesicular respiration.” 
“ But,” says Scudamore, “ if a patient have lost strength and flesh with- 
out apparent cause, have recently become short-breathed on slight 
* See Reports by Louis, Forbes, Skoda, Laennec, Andral, Clark, Young, &c. 
f Dr. Smith.—Brompton Hospital for Consumption. PHTHISIS PULMONALIS. 
209 
exertion, especially on making a slight ascent; if there be more or less 
dry cough, quick pulse, night-restlessness and perhaps some dullness 
on percussion here and there in the upper parts of the chest, wo have 
reason to fear that tubercles are formed. If others of the family have 
died of the same disease the suspicion is painfully increased.” As the 
disease progresses there is a slight increase of arterial action, the pulse 
ranging from 80 to 90, increasing towards evening, and being, also, 
small and quick; the equilibrium, too, of the circulation is disturbed, 
causing coldness of the hands and feet, and in the case of young females 
this unequal distribution of the blood often occasions irregularity, dimi- 
nution, or even total suppression of the menses, as if nature made an 
effort to economize “the blood,” being conscious of its vast importance.* 
The patient in whom this disease is insidiously fixing its grasp, 
breathes when in repose more frequently than in full health; the ex- 
pirations and inspirations are unequal in point of time ; and he is put 
out of breath by the slightest exercise; his chest is neither large, full, 
nor well developed; its movements are unnatural during inspiration 
or expiration; there is tightness or pain in the thorax; he inherits a 
psoric or scrofulous constitution; he has cough from the slightest ex- 
posure, especially in the morning; his chest is inclined to become con- 
tracted, hence he stoops when sitting or walking. 
Amongst the first signs which should lead us to suspect latent 
phthisis, are, an ill-formed thorax, respirations above the natural stand- 
ard, and greatly accelerated on slight exercise, and the existence of a 
hereditary taint. Whenever these signs obtain, the chest should be at 
once explored by auscultation and percussion, so that if tubercles are 
discovered, immediate measures may be taken to keep back or prevent 
their development. Sometimes a slight dry cough, with tightness and 
pains in the lungs, are the first symptoms which announce the affec 
tion; at other times the disease supervenes suddenly, after a pleurisy 
or an influenza, or some other acute malady. In the majority of in 
stances, however, th.e symptoms occur in the order enumerated, viz. 
habitual shortness of breath, especially after exertion, short and drj 
cough, burning in the palms of the hands and soles of the feet, con 
striction and pains in the chest on inspiration, sensitiveness of tha 
lungs to cold. These symptoms may remain stationary for months oi 
years, when from some exciting cause the pulse becomes unnaturally 
frequent, there are febrile exacerbations in the evening, and generally 
about noon, the respiration becomes more rapid and laborious, being 
often executed by the diaphragm; the anterior and lateral parts of the 
chest dilate unequally during inspiration and expiration, particularly in 
the recumbent posture; the catamenia in female subjects cease, a mucous 
* Scudamore on Phthisis. 
You IL—14. 210 
DISEASES OF TIIE SANGUINOUS FUNCTION. 
expectoration occurs; profuse night sweats and diarrhoea set in: the 
body wastes away; the expectoration becomes gradually more purulent 
and abundant; the body is bent forward; as the tubercles soften, the 
gurgling or rattle of the matter may be heard either with the naked 
ear or through the stethoscope ; the cough is cavernous; the respiration 
and rattle also become cavernous, and pectoriloquism is heard as soon 
as the softened tuberculous matter is thrown off, and the cavity be- 
comes empty; the sound on percussion still continues dull, but now and 
then a peculiar metallic sound is evident. As the disease progresses 
towards the last stage, and the cavities acquire a large size, the re- 
spiration, voice and cough give forth the peculiar hollow, metallic sound 
or buzzing, termed amphoric resonance. The whole body now presents 
the appearance of extreme emaciation, the face is pale, cadaverous, and 
frequently tinged with a waxen or lemon hue, the lips and roots of the 
nails are bluish, the nose pointed, the voice becomes hoarse, the mouth 
and throat aphthous, the feet oedematous; occasional delirium at night; 
and there is a continual failing of the powers of life until death ensues. 
After the development of tubercles the same symptoms continue, and 
to them are added evidence of obstruction in certain localities; this 
condition is manifested by the wavy or jerking respiration, or prolonged 
expiration; there is less clearness of sound on percussion, showing ob- 
struction and solidification. The lessened vital capacity (say 100 
cubic inches at the earliest moment of recognized tubercle) is far greater 
than the tubercle yet deposited (in the earliest moment we could re- 
cognize it) could cause by displacement of air. The alae nasi become 
slightly dilated; and the mouth takes a peculiar drawn expression, 
readily recognized. The predisposition to tubercle may exist for years, 
perhaps even from birth; but in many cases it is of short duration, the 
disease being originated by many causes in healthy persons. The cir- 
culation becomes accelerated towards evening, when the eye acquires 
an unnatural degree of brilliancy; and the constituents of the blood, 
which in health administer to the support and growth of the body, are 
converted into a morbid material. 
Respiratory Sounds.—In the earliest stages they are more feeble 
than in health, for an uncertain period before flattening of the chest 
occurs. The respiratory sounds in health are limited to the bronchia 
and to the air vesicles. Xbe bronchial sounds in health are only heard 
over the large bronchia; in disease they are heard over their smallest 
ramifications. The vesicular sounds are heard wherever there are air 
vesicles in action; they are feeble when the vesicular action is feeble; 
and they must be in some degree feeble to permit the bronchial sounds 
to be heard. Lessened vesicular action is evidence of lessened move- 
ment of the lungs. Lessened chemical and physical change in respira- 
tion, after the flattening of the chest is added, vesicular respiration, PHTHISIS PULMONALIS. 
211 
bronchial or harsh respiration, with flattening of the chest, all exist be- 
fore tubercle is deposited. 
Phi sical Signs.—Percussion.—Tubercular deposit occasions dimi 
nution of normal vesicular resonance, as soon as the disease begins to 
manifest its existence by other symptoms. The existence of small dis- 
seminated collections of tubercle is revealed by “ simple dullness, slight 
or moderate in degree, and more or less extensive, at the summit on 
one side, compared with the resonance on the other side. To deter- 
mine the fact of slight or moderate relative dullness, percussion is to 
be practiced on both sides alternately, at corresponding points. Ob- 
serve the symmetrical conformation of the two sides of the chest. If 
there be spinal curvature, natural defect of form, remains of preceding 
pleurisy which disturb the symmetry, the value of percussion is de- 
stroyed. In well-formed persons in good health, the region of the 
apex of the left lung, below the clavicle, gives a more sonorous sound, 
more vesicular and of lower pitch than on the right side. If then we 
find distinct dullness at this point on the left, it is more significant than 
it would be on the right side. 
All physical explorations of the chest require not only a natural 
good perception of sounds, but also that it be cultivated. A good 
musical ear will detect a variation in the pitch of the sound which an- 
other person would not perceive. 
Diagnosis.—One of the first symptoms which announces the ap- 
proach of phthisis, is an undue shortness of breath after exercise. If, 
in addition to this, there are haemoptysis, wandering pains, constriction 
and tightness at the chest, great sensitiveness of the lungs to cold air, 
a dry morning cough, a dull sound in the clavicular region on percus- 
sion, and a partial or total absence of the respiratory murmur, the most 
serious apprehensions may be entertained. 
Let all remember, also, that it is only at this early stage of the 
malady, that our preventive and remedial measures can be brought to 
bear with any assurance of success, and on this account we shall dwell 
particularly upon these primary indications, trusting that we may in 
this way impress upon the minds of all their vital importance. 
In all of our investigations of diseases of the chest, it is a matter of 
importance in the first instance, to ascertain whether any hereditary 
predisposition exists on the part of the patient to tuberculous affections, 
secondly, whether from occupation, previous habits, excesses, protracted 
mental anxiety and depression, and frequent exposure, without a sup- 
ply of wholesome, nutritious food, the patient has not acquired those 
peculiarities of constitution which render him susceptible to attacks of 
phthisis; and thirdly, whether the physical development of the chest 
is such that the lungs can have ample room to exercise their functions. 
In making up our diagnosis in the early stage of any given case, 212 
DISEASES OF THE SANGUINOUS FUNCTION. 
much will depend upon the presence or absence of these remote causes, 
for most of the symptoms enumerated may exist in a man with a large 
and well-formed chest, and with no hereditary or acquired predisposi- 
tion to the malady, and yet excite no serious apprehensions, while the 
same symptoms in an individual with a narrow, flat, and ill-shaped 
thorax, with a predisposition to the disease, wTould induce us to form a 
diagnosis of an entirely different character. Commencing then, with 
the primitive symptoms of consumption, we shall notice first:— 
The Respiration. -— “ Healthy respiration,” according to Marshall 
Hall, “is performed with ease and freedom, and without the aid of the 
auxiliary muscles, in any of the usual positions of the body. It is ef- 
fected by a nearly equal elevation of the ribs, and depression of the 
diaphragm, except in females, in whom the thorax is observed to move 
more than in men; each side of the thorax moves also in an equal 
degree, and inspiration and expiration occupy nearly equal spaces of 
time.” 
Laennec considers the 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.” 
Andral puts the mean average of respirations in a healthy adult, at 
more than sixteen or eighteen in the minute, Magendie at twenty, and 
some writers even as high as twenty-six. 
Taking then the mean number of respirations of a healthy adult to 
be eighteen per minute, and bearing in mind the natural movements of 
the healthy thorax during inspiration and expiration, we shall be en- 
abled to form a pretty satisfactory opinion respecting the condition of 
the respiratory organs, by judicious comparisons of different stages of 
disease with the supposed natural standard. 
We are convinced from much observation, that Laennec, Andral and 
Louis, have laid quite too little stress upon this important indication; 
for, although individuals may now and then be short-breathed who ha\ o 
no tendency towards diseases of the lungs, yet, when taken in coir- 
junction with a hereditary predisposition, unusual susceptibility o? 
the lungs to cold, slight, dry hacking cough, narrow, or flat chest, or 
occasional wandering pains in the chest, we may be certain that mis- 
chief is threatened. 
A very fleshy person, or one afflicted with disease of the heart, and 
certain other maladies may be short-breathed after slight exercise ; but 
these cases can never be mistaken by the observing physician as 
phthisical, since the history of the case, as wrell as the general aspect 
of the patient, sufficiently mark the distinction in all instances. 
Whenever, therefore, an individual has more than the usual number 
of respirations during repose, the expirations and inspirations being PHTHISIS PULMONALIS. 
213 
unequal in point of time, and lie is put out of breath upon the slightest 
exercise, it is the duty of the physician to ascertain the cause of this 
unsound action, and whether consumption is not insidiously approach- 
ing. Is his chest large, full, arid, well developed,—are its movements 
natural during inspiration and expiration,—is scrofula hereditary in his 
family,—is he troubled with tightness or pains in the thorax,—is he sub- 
ject to cough upon the slightest exposure,—is he inclined to stoop 
when sitting or walking,—is his respiration sighing,—has he a slight 
morning cough,—finally, is the sound in the clavicular region, or in 
any other part of the chest, dull on percussion, and is the natural re- 
spiratory murmur absent at this, or any other point ? Upon the presence 
or absence of these symptoms will depend our diagnosis. Taken as a 
whole, they indicate clearly the existence of phthisis pulmonalis ; and 
where there is a family tendency to phthisis, even dull sound on per- 
cussion, and absence of the respiratory murmurs, with dyspnoea after 
ascending the stairs, or other moderate exercise, will warrant the 
opinion that tubercles exist in the lungs. If, furthermore, one or 
more of the other signs enumerated obtain, our opinion must be still 
more decided and unfavorable. 
Auscultation.—The more important diagnostic criteria are the 
modified respiratory sounds. If the respiratory sounds are free from 
any abnormal modification tuberculous deposit can hardly exist. When 
small, disseminated tuberculous deposits exist they produce the modi- 
fied respiratory sounds designated as broncho-vesicular respiration. 
It embraces all the elements of bronchial respiration, except that the 
inspiratory sound is not wholly tubular, but presents the tubular and 
vesicular qualities combined, called by some authors “ rude, by others 
Karsh and dry respiration. If all the characters of the broncho-vesi- 
cular respiration are present, we shall have an inspiratory sound, neither 
purely tubular nor vesicular in quality, but a mixture of both (broncho- 
vesicular), the duration somewhat shortened (unfinished), the pitch 
raised; a brief interval, followed by an expiratory sound, prolonged, 
frequently longer and more intense than the inspiration, and higher in 
pitch. In making all explorations, auscultation as well as percussion 
is to be practiced at the summit of the chest on both sides, and the 
phenomena carefully compared. 
Broncho-vesicular respiration, in conjunction with other signs and 
with symptoms, is diagnostic of a tuberculous deposit not producing 
complete solidification, extending over a considerable space, at or near 
tne apex of the lung. A skillful auscultator will nearly always be able 
to detect this condition when it exists. It must be remembered that on 
the right side in front at the summit the inspiratory sound is fre- 
quently less intense, less vesicular, and higher in pitch, than on the 
left side, and that a prolonged expiration on the right side, occasion- 214 
DISEASES OF THE SANGUINOUS FUNCTION. 
ally more intense and higher in pitch than the inspiratory sound, anl 
sometimes existing alone, is observed in healthy persons. Thus 
the broncho-vesicular respiration indicates, more clearly, tubercular 
deposit, if heard at the apex of the left than at that part of the right 
lung. 
Broncho-vesicular respiration continues limited to one side of the 
chest, even when tubercles exist in both, until the deposit of tuber- 
culous matter becomes abundant; it is observed that the “pitch and 
vesicular quality of the inspiration, the relative intensity, duration and 
pitch of the expiration” are nearly or quite normal in the lung least 
affected. This is accounted for by supposing that “ when the increased 
density at the summit of one lung is sufficient to occasion a distinct 
modification of the respiratory sound, the activity of the other lung 
is sufficiently increased for the normal character to be maintained, 
notwithstanding the presence of a certain number of tubercles, without 
giving rise necessarily to a wTell-marked exaggerated respiration, 
“ though this does occur in, comparatively,” few cases. 
Dr. Flint gives the following “ Summary of the Physical Signs 
belonging to Pulmonary Tuberculosis : 
“Diminished vesicular resonance on percussion at the summit of the 
chest, varying in degree from slight dullness to a near approach to 
flatness ; present on one or on both sides, but in the latter case more 
marked on one side; the dullness, in general, proportionate to the 
abundance of the tuberculous deposit; increased sonorousness oc- 
casionally observed at the summit of the left side, due to transmitted 
gastric resonance, the sound tympanitic in quality and high in pitch; 
the vesicular frequently replaced by a tympanitic sound on either side, 
when the sonorousness is not increased, constituting tympanitic dull- 
ness. 
“ An increased sense of resistance in proportion to the amount of 
crude tubercle. A tympanitic resonance over a circumscribed space 
at the summit, present and absent at different examinations, in some 
cases presenting an amphoric and the cracked-metal intonation, con- 
stituting the evidence afforded by percussion of the existence and 
situation of tuberculous excavations. 
“ On ausculation, the broncho-vesicular and the bronchial respiration, 
the latter denoting tuberculous solidification. Frequently, with these 
modifications, diminished intensity of the respiratory sounds; oc- 
casionally suppression of all respiratory sound; interrupted; or jerking 
respiration. Exaggerated vesicular murmur on the side, either healthy 
or least affected; the crepitant, sub-crepitant, sibilant, or sonorous, 
mucous, and crackling, or crumpling rales, occurring as contingent 
signs, their significance dependent on their being found within a cir- 
cumscribed area at the summit of the chest; abnormal transmission of PHTHISIS PULMONALIS. 
215 
the heart-sounds, especially at the right summit; increased vocal 
resonance when situated on the left side at the summit; an acute and 
more or less intense souffle, or bellow’s sound, accompanying whis- 
pered words, especially if present on the left side ; broncophony, and 
occasionally transmission of speech, complete or incomplete, over- 
tuberculous solidification, a friction sound, limited to the summit oi 
the chest. 
“The cavernous respiration, occasionally observed, alternating with 
suppression or gurgling, occasionally amphoric, and very infrequently, 
pectoriloquy, constituting the evidence, afforded by auscultating the 
respiration, of the existence of and situation of the excavations; the 
characters of the cavernous and bronchial modifications of the re- 
spiration, sometimes combined (broncho-cavernous respiration); splash- 
ing, an impulse, seen and felt, existing within a circumscribed space 
at the summit—signs of cavities furnished by the act of coughing ; 
occasionally, when the cavity is very large, metallic tinkling. 
“ By inspection, flattening, or depression, at the summit, either con- 
fined to one side, or more marked on one side than on the other; the 
clavicle generally more prominent, but occasionally receding with the 
ribs ; diminished expansibility with the act of inspiration; the range 
of motion found to be lessened, as well as size of the chest at the sum- 
mit, by mensuration. 
“ Disparity at the summit of the chest in vocal fremitus, provided it 
be found to be greater on the left .side. 
A splashing succussion-sound in some cases a very large exca- 
vation.”—(.Diseases of the Respiratory Organs, p. 501.) 
Dr. Mac Limont claims that simultaneous percussion and auscul- 
tation can be employed with great benefit, and that the double stetho- 
scope of Dr. Cammann (which permits the auscultator to face the patient) 
removes all the obstacles to the combined use of these two means of 
investigation at the same time. “ The advantage of this is very great, 
the sound elicited by percussion is thus intensified to an extraordinary 
degree, and conveyed to both ears with a distinctness very different 
from the vibrations that reach the auditory nerve in the usual way, 
i. e. through the medium of the atmosphere.” “ By this method, far 
better than any other, we may discover that earliest indication of or- 
ganic lesion in phthisis, a certain obscurity of sound arising from a 
condensed pulmonary parenchyma; but no less satisfactory is it as a 
means of establishing a differential diagnosis in those cases in which 
we are sometimes at a loss to distinguish whether the dull sound is due 
to effusion or to induration of the pulmonary tissue; as also in cases 
of cavities, in which it may be desirable to ascertain whether they 
contain air or liquids, or both : if air only, then auscultatory percussion 
yields a far clearer sound than can possibly be got by the ordinary 216 
diseases of the sanguinous function. 
method; but if, as is most commonly the case in large cavities, air and 
fluids co-exist, then by this means the hydro-aerie sound may be heard 
very distinctly; while for recognizing that valuable evidence of a pul- 
monary vomica, the “bruit de post fele” there is no means so accurate 
as the one I am now recommending. As a mode too of ascertaining 
the exact size and form of some of the internal organs, the liver, 
kidneys, heart, spleen, ovarian cyst, fibrous tumors of the uterus, &c., 
auscultatory percussion promises to be of signal service.”* “ When the 
object is to ascertain the size or condition of an organ far removed 
from the surface, and where the impulse has to be communicated 
through an external covering of some thickness—as in percussing the 
abdominal organs,” then the solid cylinder of cedar, as used by Dr. 
Cammann, or the pleximetre, should be preferred to the double 
stethoscope. 
Progress of Phthisis in its later Stages.—When the disease has 
advanced to the stage in which the febrile exacerbations, and the rapid 
respirations, the profuse night-sweats, the mucous expectoration and 
exhausting diarrhoea show the inevitable termination of the patient’s 
sufferings not far distant; he knows himself to be failing from week to 
week; but still he daily describes his condition as being “ better.” In 
females menstruation has already ceased and emaciation progresses. 
“ As the tubercles soften, the gurgling or rattle of the matter found 
may be heard with or without the stethoscope. The cough is caver- 
nous ; the respiration and rattle also become cavernous ; pectoriloquism 
is heard as soon as the softened tuberculous matter is thrown off, and 
the cavity becomes empty: the sound on percussion still continues 
dull; but now and then a peculiar metallic sound is evident. As the 
disease advances towards the last stage, and the cavities acquire a 
large size, the respiration, voice and cough give forth the peculiar 
hollow metallic sound or buzzing termed amphoric resonance. The 
whole body now presents the appearance of extreme emaciation ; the 
face is pale, cadaverous, and frequently tinged with a waxen or lemon 
hue; the lips and roots of the nails are bluish, the nose pointed, the 
voice becomes hoarse, the mouth and throat aphthous; the feet oede- 
matous; there is occasional delirium at night; and continual failing 
of the powers of life until death ensues. 
M. Beau, of La Charite, mentions in addition to the premonitory 
headache, a more reliable symptom, which he says is very constantly 
found: a peculiar “ pain felt on pressure in the popliteal region, or on 
the thigh a little above the knee.” 
Second Stage.—Signs of the existence of Tubercle.—Obstructed 
breathing; wavy or jerking inspiration, and prolonged expiration, in- 
* British Journal of Ilomoeop. July, 18G4, p. 432 FHTHISIS PULMONALIS. 
217 
creasing locally as the accumulation increases. The obstruction re- 
quired to produce these signs must be partial and lateral, as opposed 
to complete and terminal: that is, it must occur in the course of the 
airway and leave a portion of the conduit open, so that the air may be 
forced beyond it. 
After an uncertain period there will be further moist sounds, indica- 
tive of air passing through fluid which' is then softened tubercle. The 
softening of the tubercle is not a corroding process like that of ulce- 
ration, but is simply the imbibition by endesmosis of fluid by which the 
tubercular mass softens; it obtains the fluid by which it is softened from 
the walls of its cell. The process may be non-inflammatory; but exode 
of pus corpuscles always occurs at some period, and that is presumed 
to be the result of inflammatory action. The reason for the destruction 
of the tissue is not simply the softening of the tubercle, nor any in- 
flammatory or ulcerative action; but the basement membrane and ca- 
pillaries, having ceased to act for a time, lose their vitality, and are 
ready to decay, and they only wait for a partial emptying of their con- 
tents in order to break down. Destruction of the tissue is indicated by 
moist, fine, crepitant rales in the tubercular mass. The softening of the 
tubercle and the destruction of the cell-walls having begun, it only re- 
mains that those processes shall go on until all the tubercles have 
been eliminated, and a cavity results; and the whole are but steps to 
one process, and in truth are one stage of the disease. With softening, 
the bronchia are reopened, and the air is admitted which produces the 
moist sounds, and ultimately all the signs which are indicative of a 
cavity; but, with the restoration of respiration, there is no increase of 
respiratory changes, since the air-cells in that part are destroyed, or 
perhaps removed. With the formation of a cavity the lung falls in, as 
do also the parts of the chest immediately covering it, and the dull 
sound on percussion will in part have disappeared. 
Thus the essential signs of the three stages of consumption are 
1. Lessened action; — 2. Obstructed action; — 3. Destroyed lung. 
In proportion as structural disorganization progresses in the disease 
there is reaction or compensatory effort set up by nature, by which one 
part of the lung is made to do a double share of duty when another part 
becomes incapable of performing its function; and the entire system 
quietly accommodates itself to the newly-induced condition. 
Conditions of the Throat in Phthisis.—1. There is a state of pallor 
without injection of the vessels and without desquamation or inflamma- 
tory action. It is common in the early stages, particularly in persons 
engaged in public speaking, and is shown by dryness and disposition 
to cough; sensation generally referred to the fauces, pharynx and upper 
♦Smith, Braith waite’s Retrospect, July, 1857, p. 67, &c. 218 
DISEASES OF THE SANGUINOUS FUNCTION. 
part of the larynx alone. It is most annoying in the early morning, 
and on changes of temperature demanding frequent efforts to “ clear 
the throat, causing hoarseness, rawness.” The surface does not always 
appear dry, but it is smooth and shining, and the parts are attenuated. 
The anterior arch is atrophied, whilst the posterior stands out in sharp 
relief and the intervening space is large and excavated from the ab- 
sorption of fat from the areolar tissue, and oftentimes from diminution 
in the size of the tonsilar glands. The latter organs seem to be of a 
looser texture, and to have their superficial follicles projecting. This 
condition is one of lessened tonicity wTith increased sensibility, and with 
a diminution in the secreting function of the epithelium and mucous 
follicles. It may or may not be associated with derangement in the 
excretory organs, and is amenable temporarily to local treatment, as 
well as to the influence of constitutional remedies. In this stage, the 
lungs are not-positively diseased and the study of the rational signs is 
attended with difficulty. 
Second Condition.—Pallor of various parts of the fauces, injection 
of defined vessels in some parts with more or less diffusion in others, 
and at each the parts appear to be loose and relaxed. The distended 
vessels are most evident in the uvula, and the diffused redness on and 
between the arches and upon the tonsils. Enlarged mucous follicles 
are very marked in many instances, chiefly in the pharynx, uvula and 
arches, as colored vegetations. Ulceration of some of the follicles of 
the tonsil, and chiefly at its upper part, the uvula is enlarged and elon- 
gated. 
In this condition there is less sensation of dryness and irritability 
of fauces than the last; but there is a troublesome sense of constriction 
or irritability at the lowest part of the trachea in the neck. There is 
a sensation of phlegm adhering to parts about the fauces which keeps 
up cough to detach it: There is disordered action of the alimentary 
canal or the liver. 
Tiiibd Condition.—Desquamation, Fibrinous Deposition, or Ul- 
ceration:*—The desquamation occurs in patches, with, or without fibri- 
nous exudation, and chiefly in the pharynx or arches of the fauces. 
The fibrinous exudation lies as a layer upon the denuded mucous sur- 
face and may be partially removed by a brush; the 'parts are of a 
reddish and dull hue, and hoarseness progressively increased in inten- 
sity. Most complaint of the throat after, not during a meal. The 
tonsils are enlarged and red, the fauces laterally contracted; there is 
soreness on pressure on the sides of the pomum Adami. 
/State of the Alimentary Canal in Phthisis.—There is an excess 
of acidity which more than neutralizes the alkaline secretions of the 
* Dr. Smith, Braithwaite, July, 1857, p. G8. PHTHISIS PULMONALIS. 
219 
saliva and pancreatic juice. These fluids are therefore incapable of 
“transforming the carbonaceous constituents of vegetable food into oil, 
or of so preparing fatty matter introduced into the system as will render 
them easily assimilable. In consequence, more albuminous than fatty 
matters enter the blood, and the accessary waste of structure is sup- 
plied by the absorption of the adipose tissue of the body,—hence the 
emaciation which characterizes the disease.* “ The body is not nour- 
ished,” says Dr. Paris. “ The patient having, lived as long as one particle 
of fat remains that could be absorbed for his support, dies of atrophy.” 
“ In the meamvhile the lungs, not having so much carbon to excrete in 
the form of carbonic-acid, become especially liable to local congestions, 
leading to exudations of an albuminous kind which is tubercle.”* 
Pulmonary Symptoms.—As emaciation progresses and strength 
declines, cough makes its appearance; with increased breathlessness 
haemoptysis occurs; pains in the chest; nocturnal perspirations ; dys- 
peptic symptoms become more troublesome; percussion denotes con- 
solidation of some portions of the lung, in a vast majority of cases at 
the apex; auscultation now proves that at this part air is but feebly 
and with difficulty permeating its structure. During the second stage, 
the stethoscope gives evidence of the softening of the tubercular masses* 
during the third and last, the presence of a cavity is, by the same 
means, rendered manifest. The general symptoms are those of the 
first stage, only in much greater intensity. The cough becomes attended 
with expectoration, varying alike in its quality and degree. As the dis 
ease advances the pulse rises, emaciation becomes extreme, and all the 
symptoms point to a rapidly fatal termination. {Dr. Pope, Brit. Journ. 
Horn., Jan. 1862, p. 19.) 
Urinary Secretion.—The urine in phthisis and in all lesions of the 
nervous centres is deficient in urea. There is therefore an equivalent 
excess of this constituent in the blood, as in Bright’s disease. [Pey- 
noso.) 
Functions of the Skin.—These become impaired, and the skin becomes 
pale as well as moist and clammy, while the inability to take a proper 
amount of active exercise has a tendency to produce engorgement of 
most of the internal viscera, and consequent disturbance of their func- 
tions ; while the non-elaboration of healthy blood produces badly assi- 
milated chyle, “ which is supposed to favor the formation of tubercle, 
which is deposited in the lungs or other organs. When the lungs pre- 
sent the point of attraction and become the probable seat for tubercu- 
lous deposition, the patient begins to be specially subject to colds, ca- 
tarrhal attacks, after the least exposure. In these catarrhal affections 
originate that obstinate bronchitis which so generally precedes or 
accompanies phthisis.” 
* Bennet.—Gelston. 220 
DISEASES OF THE SANGUINOUS FUNC1ION. 
Incompatible Diseases.—M. Beau, of La Charite, in a recent lecture 
speaks of the rare occurrence of phthisis in hysterical subjects. The 
same immunity from phthisis has been observed in persons suffering from 
asthma and emphysema of the lungs. This immunity is not universal. 
Tubercle causes increased density in the lung in which it is deposit- 
ed. The first deposits, called miliary tubercles, are in the form of small 
isolated patches separated from each other by intervening parenchyma 
in a healthy state. The density of these morbid patches may be but 
slight; but the obstruction of the air from their pressure on the small 
bronchial tubes, abridging the respiratory processes on the parts af- 
fected, causing collapse of the cells not filled with tuberculous matter, 
increases still further the density. When the deposits enlarge, by con- 
stant accretion they form more solid continuous masses called tuber- 
culous solidifications. When the tubercular'accretions are small and 
the intervening parenchyma becomes solidified by inflammatory exuda- 
tion, the physical signs are the same, showing solidification; and the 
crepitant rale will prove pneumonitis, which under the attendant circum- 
stances will be evidence of tubercle. In the progress of softening, 
ulceration and evacuation of the liquefied tuberculous matter is liable 
to be attended with symptoms of the deposition of fresh material in 
the surrounding parenchyma, which gives signs of solidification while 
crude tubercle is being deposited throughout the whole lung; the 
physical signs then vary as the excavations become larger in propor- 
tion to the solidified part. 
Circumscribed bronchitis may be taken as evidence of tuberculosis; 
and the presence of fluid in the tubes, produced either by bronchitis, or 
derived from cavities in connection with the bronchia furnishes im- 
portant indications. The lung as it solidifies by deposition of tubercle 
becomes less and less expansible: and the succession of attacks of 
circumscribed dry pleuritis over the points of the lung occupied by 
tubercle contribute to the establishment of the fact that tuberculosis 
is positively advancing. 
Pathology.—The primary nature of phthisis is not understood, and 
widely different views of its pathology have been given by different 
authors. A late writer, Dr. Cotton, says: “ It is a peculiar and ob- 
scure condition of the whole system, in which, instead of the healthy 
nutritive material required for the growth and reparation of the body, 
there is produced in the blood a morbid substance which sooner or 
later appears as tubercle, or tuberculous matter in the pulmonary 
structures.” This state of the system he regards as identical with that 
known as struma or scrofula: 
“In consumption, as in many other maladies, we are permitted to 
recognize the disease only in its effects. It is evident that there must 
be something which constitutes the malady: but it would be vain to PHTHISIS PULMONALIS. 
221 
search after it; it has no individuality; — it is a process which, like 
many others, is so subtile and far removed, even from our conceptions, 
that it seems destined to remain forever beyond our reach; we are al- 
lowed to do nothing more than study its law's, and, in some measure 
control its actions” (p. 2 and 3). We regard consumption, with a vast 
number of chronic diseases as a product of some latent dycrasia, which, 
through generalized by Hahnemann under the generic name “psora,” 
may present peculiarities in individual cases; but they can only be 
cured by constitutional remedies. 
Dr. Epps defines phthisis to be a disease depending upon a cachexia 
differing in different cases, each case of phthisis having a “ special 
cachexia,” of its own. Dr. Hogg considers it as depending on “constitu- 
tional debility, on a wTant of power in the system, on an impaired state 
of the digestive” organs—in a wTord, “on a strumous diathesis.” (p. 3.) 
Dr. Bennett considers phthisis to consist of “ a mal-nutrition arising 
from imperfect assimilation.” Dr. Turnbull says he believes the con- 
dition wdiich causes the development of tubercles to depend on “ a state 
of imperfect nutrition; a condition in which the digestive organs are 
unable to manufacture from the food a perfect kind of blood, capable of 
nourishing every part, without allowing some imperfectly-formed par- 
ticles to escape at the time.”* This author elsewhere gives the opinion 
that “imperfect digestion, combined with deficient oxydation or a wTant 
of uniformity in the action of the oxygen on the blood, and through 
this fluid in the whole system, is the main cause.f Dr. Pope thus con- 
cludes: “Mal-nutrition of the tissues is undoubtedly one of its earliest 
features as it is one of its most fatal characteristics; but in order to 
the development of tubercle, the imperfect digestion producing it must 
occur while the constitution is under the influence of a cachexia peculiar 
in its nature, tending under certain circumstances to the production of 
tubercle. Dyspepsia, however severe and intractable, does not necessa- 
rily culminate in phthisis. (Brit. Journ. Horn. No. LXXIX., p. 18.) 
Dr. Gregg, of Canandaigua, N. Y., regards the tuberculous deposit 
as “ simply the result of a perverted secretion of the mucous mem- 
branes} and says this is equally true, whether such perversion has 
originated in the individual who is suffering, or whether he has inherit- 
ed the predisposition or taint from his ancestry.” He thinks his ex- 
perience proves “ that the great natural law discovered by Plahnemann, 
when “properly applied, is amply competent not only to stay and 
cure the disease in cases where it has not yet extensively broken down 
the structure of the lungs, but also, so to eradicate the tuberculous 
tendency as to cut off all transmission of this tendency by inheritance.” 
* An Inquiry how far Consumption is curable. 
T Progress of Improvement in the Treatment of Consumption. By James Turn, 
bull, London, 1853. 222 
DISEASES OF THE SANGUINOUS FUNCTION. 
Development of Tubercle.—Tubercle, the proximate cause of jhthi- 
sis, says Dr. Mac Limont,* is “ a material formed and deposited from 
the blood, and the condition of this fluid most conducive to its pro- 
duction consists in an excess of fibrin and a diminution of the red 
globules.” But every person in this condition is not in a state of in- 
cubative tuberculosis; for “in addition to all this and much more, there 
is required for the production and deposit of tubercle, a remote cause 
—a diathesis—hereditary and not acquired ”—the deposit of tubercle 
is the result of depraved innervation, and that the main chance of 
benefiting the patient consists in the early discovery of the symp- 
toms,” and bringing to bear upon them all the curative influences within 
our power. 
The appearance of the tuberculous formations vary in different sub- 
jects, some being small as millet-seeds and irregular in shape, either 
distinct, or running into each other, of the consistence of cheese, and 
of a light yellowish color. This variety, which is by far the most com- 
mon, has been termed the miliary tubercle. 
Another variety is called the granular tubercle, which according to 
Laennec, is only the ordinary tubercle in its first stage. Bayle believed 
the miliary granulations to be distinct from tubercles, while Mackin- 
tosh supposed them to be genuine tubercles, but sui generis. 
Bayle, Laennec, and others, also assert that they have met with a few 
cases which they term encysted tubercle. Other writers speak of the 
occasional occurrence of this variety of tubercle, it being semi-trans- 
parent, whitish, and in consistence like hard cheese. 
Laennec describes, likewise three kinds of tuberculous infiltration, 
viz : the irregular, the gray, and the yellow. This infiltration is gene- 
rally formed around tuberculous excavations, but it may exist where 
there are no tubercles. It is something found in large masses,” oc- 
cupying the whole lobe of the lung, and having no connection with the 
miliary tubercle.” (Mackintosh.) 
Respecting the nature of these tuberculous formations, there is a 
wide difference of opinion. Broussais supposed that “irritation, or 
inflammation, were only degrees of the same affection, and that they 
may produce, indifferently, tubercles, encephaloid cancer, melanosis, 
fibrous, bony, cartilaginous growths, &c.” 
Laennec and Andral maintain tha t they are “accidental productions, 
foreign to the natural organization of the lungs,” and caused by an 
aberration in the nutrition of the organ. Others are of opinion that 
tubercles are primitively hydatids. 
In the first stage of development tuberculous matter is “a gray, 
*Brit. Journ. Homoeop., No. 77, p. 429. PHTHISIS PULMONALIS. 
223 
semi-transparent substance, which gradually becomes yellow, opaque, 
and very dense. Afterwards it softens, and gradually acquires a 
fluidity nearly equal to that of pus; it being then expelled through the 
bronchia, cavities are left, vulgarly known by the name of ulcers of the 
lungs, but which I shall designate tubercular excavations.” (Laennec.) 
The exposition of the origin and development of the matter of tubercle 
given by Dr. Curtis* has at least the merit of clearness and plausibi- 
lity. He traces “ the first link in the chain of morbid action,” not to 
the blood nor result of inflammation but to “ the ultimate cell struc- 
ture.” “ Here, in the ultimate cells the first perverted action is found 
—a molecular and cell growTth, whose function and development is ab- 
normal and degenerative, and which has a power of producing in other 
tissues, the same morbid peculiarities that characterize itself. But 
whence originated the mother cell of this perverted mass? It could 
not have sprung from the blood, because the blood has no direct forma- 
tive power—neither could it have had a spontaneous development; 
it must have been derived from a once normal cell; but, in order for 
such a derivation, the normal cell must have undergone a transforma- 
tion so as to become abnormal. And we can account for it in no other 
way than by regarding it as originating in some peculiar revolution 
that has taken place in the parent cell, by which its function has been 
perverted and its physical and vital tendencies changed. Such a re- 
volution could not have been produced excepting through a disturbance 
of the just equilibrium existing between the vital and chemical forces 
acting within it, and by which its functional and reproductive revolu- 
tions are governed. This change in the character and products of a 
once normal cell having taken place, other cells resembling it in every 
particular, the offspring of the first, would necessarily be produced in 
a very short time, on the principle that ‘ like produces like.’ And in 
accordance with the law of molecular motion, these abnormal cells 
would have the power of imparting their own motion to other cells with 
which they might be in contact. Thus we can readily perceive how 
this morbid action may readily extend and increase locally. And by 
the unnatural and depraved products of perverted function being ab- 
sorbed into the circulation, ‘ the life of his blood is touched corruptibly,’ 
and the morbid material becomes diffused through all the tissues of the 
body, and thereby sooner or later eventuates in death.” 
Bearing upon this point, and in opposition to the doctrine of “free 
cell development,” Prof. Virchow says: “ Even in pathology, we can 
now go so far as to establish, as a general principle, that no develop- 
ment of any kind begins de novo, and, consequently as to reject the 
theory of equivocal, (spontaneous) generation just as much in the his- 
* St. Louis Medical and Surg. Journal, Sept. 1861. 224 
DISEASES OF THE SANGUINOUS FEHCTION. 
tory of the development of individual parts as we do in that of en- 
tire organisms. Just as little as we can now admit that a tamia can 
arise out of saburral mucus, or that out of the residue of the decom- 
position of animal or vegetable matter an infusorial animalcule, a fun- 
gus or an alga, can be formed; equally little are we disposed to con- 
cede, either in physiological or pathological histology, that a new cell 
can build itself up out of any non-cellular substance. Where a cell 
arises, there a cell must have previously existed (omnis cellula e 
cellula,) just as an animal can spring only from an animal—a plant only 
from a plant.” 
Anatomical Character of Tubercle.— Rokitansky showed that 
tubercles originally occur in the lungs in two forms : 1. “The in- 
terstitial tubercular granulation, round grayish bodies found discrete or 
collected into heaps: their seat is the interstitial tissue between the 
smaller lobuli and the cells of the lungs and on the walls of the cells 
themselves. This is the most common form of deposition.—2. Tuber- 
culous infiltration. This consists in a deposition in the pulmonary 
cells, as a result of the process identical with common pneumonia, ex- 
cept that the lymph deposited in the cells, instead of being resolved 
or running into pus, becomes, from the influence of tubercular diathesis, 
the yellow tuberculous matter, thus constituting hepatization by 
means of a tuberculous deposit. This form is always the result of a 
high degree of the peculiar tubercular diathesis.” {Dr. Gelston, Brit. 
Med. Jour. Oct. 1860, p. 603.) 
Microscopical Structure.—Tubercular matter “consists of corpus- 
cles which are characteristic of tubercle, “ and of granules and mi- 
nute molecules. The corpuscles have no nuclei, and are considered 
to be undeveloped cells, which approach more or less nearly to the 
exudation or plastic cells of healthy inflammatory deposits. The 
miliary tubercle has some appearance of cells and fibres, but the crude 
yellow tubercle has no appearance of organization, and during soften- 
ing the corpuscles swell, burst and discharge granules.” 
Chemical Character of Tubercle.—“The formula of tubercle ac- 
cording to Simon, is : C 43 IT 35 N6. 014, Caseine: Prot. 10 S. 1.”* 
The organic component parts of tubercle, as given by Vogel, Cerutti 
and others, are: caseine, with some fat and a little albumen. Others 
have found albumen, gelatine, and fibrine, cholesterine, &c., showing 
that the composition is not always precisely the same. It is supposed 
by Fletcher and others to be “ an organized mass.” 
“ Tubercle,” aecording to Simon, Anel and Rokitansky, consists in 
a misdevelopment of the protein ingredients of the lymph and blood, 
the essence of which lies in the solidification of something which 
*Dr. Gelston. Brit. Jour. Homoeopathy. Oct. 1, 1860, pp. 598, 599. PHTHISIS PULMONALIS. 
225 
should remain fluid: this is due to the proteine ingredient precipitated 
in combination with oxygen. Hence most likely to take place in the 
glands where lymph is brought into combination with arterial blood, 
and in the lungs where it meets with the oxygen of the air, it may 
arrive any where when chemical reaction occurs with a nutritive 
blastema. In accordance with this, all the great leaders of modern 
pathology agree on the formula that ‘ venosity of the blood excludes 
tubercle.”* It also explains the beneficial effects of dietetic measures, 
cod-liver oil, spirituous liquids, and the “ carbonaceous atmosphere of 
swamps in arresting or retarding tubercular development.” 
Tuberculous blood is “ defective in vital qualities ; the red globules 
are deficient in number and defective in structure; the globulin, 
hoemetin, and iron are all deficient. The serum of the blood is vitiated 
in quality: the water, albumen and lime in excess.” The albumen 
may be defective in a tendency to be converted into casein, which does 
not exist in the blood in its native state. The fibrine is deficient in 
quantity and imperfect in quality; also the fats, alkaline and earthy 
salts, especially the chlorides and phosphites of potassa and soda. The 
quantity of albumen in proportion to other ingredients in the blood has 
been remarked to be more nearly uniform than that of any other prin- 
ciple, being about 70 or 80 parts in 1000. “ It would seem,” says 
Gairdner, “ as if nature had found it necessary to have at hand some- 
thing like an unvarying stock of the raw material out of which all the 
other principles of the blood might be fashioned, according to the va- 
rying states and requirements of the organism. One particularly 
interesting point in connection with this view is found in the fact that, 
relatively, the albumen and the blood globules appear to alternate 
with one another in their several proportions—“if the globules fall 
off in amount, the albumen is increased; and vice versa, when the 
globules abound, the albumen is diminished.” 
Causes of Phthisis.—The causes of consumption may be divided 
into: first, the constitutional; second, the accidental • third, the 
exciting. 
1. Under the first head may be included, first hereditary scrofulous 
taint; second, hereditary impurities of the blood of a syphilitic, 
erysipelatous or psoric character; third, imperfect organization of the 
thorax, feeble constitution; and fourth, a melancholic nervous tem- 
perament. 
The principal causes which induce consumption, are: hereditary 
transmission from parents who have themselves inherited the disease, 
or who, originated it in their offspring by becoming enfeebled. 
2. The most prominent accidental causes, are, confinement in close 
VOL. II. 15- 
*N. Am. Jour. Homoeop. May, 1857. 226 
DISEASES OF THE SANGUINOUS FUNCTION. 
crowded, and ill-ventilated apartments, protracted mental depression, 
insufficient nourishment, unwholesome food, intemperance, damp 
and unprotected habitations, masturbation, the habit of stooping, and 
thus contracting the capacity of the chest, light clothing, late hours, 
over-excitement, abuse of drugs, especially mercury and opium, want 
of exercise and abuse of tobacco, neglect of proper clothing and 
cleanliness; excessive labor mental depression, anxiety and care, 
which exhaust the nervous force; too early marriage or excessive 
sexual indulgence, which lays the foundation of premature decay in 
parents, and scrofula in children. Fonteret* says: “ If the exhaustion 
consequent on debauchery is not always a cause of sudden death, it is 
infallibly attended Avith the loss of strength necessary to labor, and 
develops a peculiar aptitude to certain diseases. How many affections 
of the spinal cord, how many forms of paralysis, of disease of the 
chest, cancers of the cervix uteri, &c., arise from vicious indulgence ?” 
The children born under “ concubinage are few in number,” are 
“ puny, scrofulous, and are liable to a mortality greater by one-half 
than legitimate children.” A large proportion of the cases of con- 
sumption seen among young men arise from the vice of masturbation. 
A higher and purer physical and spiritual education than boys or 
young men now anywhere receive is one of the most imperious demands 
of this progressive age. 
3. Exciting Causes.—Those which determine the local deposition of 
tuberculous matter after constitutional predisposition is established 
are : confinement in early life to close, croAvded, ill-\rentilated resi- 
dences, factories, Avork-shops, or school-rooms ; deficient or improper 
diet; irregularities of various kinds; over-taxing the mental and 
physical poAvers of children in schools. Experiments on rabbits prove 
that insufficient nourishment, damp air and the exclusion of light favor 
the development of tubercular deposits. 
Certain kinds of food favor the development of scrofula, of these 
pork is the worst that is in general use. 
Leavened bread, whether made light by yeast or any other process, 
which requires the dough to stand and sour before baking, aids in 
developing scrofula, dyspepsia and a long train of nervous diseases. 
4. The exciting causes are : atmospheric vicissitudes suppression of 
the perspiration by cold, imperfectly subdued acute diseases of the 
pulmonary organs, repelled cutaneous eruptions, inhalation of irritating 
vapors, &c., external injuries. Of these proximate causes, cold is 
considered by most authors as by far the most common and dangerous. 
* Consumption, its Nature, Prevention and Homoeopathic Treatment. By Wm. 
Hitchman, M.D., F.L.S. Phila. 1859. 
Hygiene physique et morale, &c., of Workmen in Large Towns, &c. By A. L. 
Fonteret. PHTHISIS PULMONALIS. 
227 
It is probable, liowever, that cold of itself is by no means so injurious 
as has been generally supposed, but that the sudden alternations Irora 
heat to cold which obtain in the temperate latitudes, exert far more in- 
fluence in engendering phthisis, than the severe but steady cold of 
more northern regions. Indeed, some recent writers have strongly re- 
commended a change from temporate to cold latitudes, as far more 
advantageous to consumptive subjects than a warm climate. In this 
opinion we do not coincide, since the highly condensed air of the for- 
mer must act as a constant and powerful stimulus to the already irri- 
table tubercles. We much prefer a warm, mild, and equable climate in 
these cases. 
Phthisis is promoted among females by the erroneous education and 
habits of life of the women of the civilized countries. Born and reared 
during infancy in hot-houses, where the invigorating breath of heaven 
rarely penetrates ; their childish intellects crammed with ideas which 
they are unable to understand, while their physical frames are per- 
mitted to wither in the crowded school-room, without that free and 
abundant exercise and indulgence in childish sports, which are so ab- 
solutely essential to their growth and well-being; submitted at the 
period of puberty to those instruments of torture and distortion, stays, 
in order that the symmetrical figures which God in his wisdom has 
given them, may be contracted sufficiently to meet the ideas of an 
abominable fashion ; rejecting constant and vigorous exercise in the 
open air, early hours, regular habits, and all those means which tend 
to promote physical strength and vigor: is it strange, in view of these 
things, that the seeds of phthisis are so often and so early planted? 
There are habits also prevalent among the youth of the male sex, which 
conduce in an alarming degree to generate and develop physical af- 
fections. The vice to which we allude, from false delicacy, from its 
solitary nature, and from the very gradual manner in which it impairs 
the nervous system and undermines the constitution, has either been 
entirely overlooked, or but slightly touched upon by writers. But un- 
less we are much deceived, a very large number of consumptive cases, 
especially in young men, are attributable to masturbation as their re- 
mote cause ; and we are sure that those who have minutely investigated 
the previous histories of consumptive patients, will fully coincide 
with us. 
It is quite true that there are many other habits and customs which 
pertain to refined society that also have their effect in engendering 
phthisis, but we believe that the cause just touched upon has been 
productive of more evil amongst the youth of the male sex than any 
other causes combined. This cause applies to some slight extent to 
females, but, compared with the male sex, it is trivial and unimpor* 228 
DISEASES OF THE SANGTJINOUS FUNCTION. 
tant, for the reason that women are by nature purer, less sensual and 
less addicted to gross carnal thoughts, than a majority of the other sex. 
Let parents, then, banish all mawkish delicacy upon the subject, 
and caution their children against this dreadful evil. Let them talk 
plainly, and display before their minds the inevitable consequences, in 
the form of consumption, idiocy, lumbar abscess, &c., to which an 
indulgence in this degrading and pernicious vice so surely leads. 
Physical Conformation of the Thorax.—One of the causes which 
especially favors the formation and development of tubercles, is a 
small, flat, and contracted chest. This want of symmetry and pro- 
portion may he owing to natural organization, or it may be acquired 
from indulgence in sedentary habits, stooping, a neglect to keep the 
body in the erect posture, and to breathe in that full, free, and vigorous 
manner which is so essential to the development and well-being of the 
lungs. 
If the thorax is naturally contracted and ill-shaped, a suitable course 
of physical cu'*ure should be promptly adopted and persisted in until 
it has acquired mfficient size and symmetry. This result is practicable 
in all cases by steady perseverance and energy on the part of the 
patient. 
The means of accomplishing this desirable end, are, gymnastic and 
other exercises, which particularly bring into action the muscles of the 
chest, constant exercise with the body erect, in the open air, the habit 
of taking long, free and full inspirations, in order that all portions of 
the lungs may receive a due proportion of air, and thus execute their 
functions properly, and lastly, the use of tubes for the purpose of exer- 
cising more efficiently the pulmonary organs. By a regular and syste- 
matic employment of these means, the size of the chest may be in- 
creased to a surprising extent, and the lungs made to acquire a degree 
of strength and vigor which could have been attained by no other 
method. 
There are other instances where well-formed chests are contracted 
and weakened, by the wearing of tight clothing, stays, &c., and by 
sedentary occupations and habits, with the body constantly inclined 
forward and bent over. These pernicious habits are so commonly in- 
dulged in, and have become so much a part of our social system, that 
their importance influences,—their baneful consequences upon the most 
vital part of the organism, are almost entirely overlooked. Yet no one 
who reasons at all can be unaware of the dangerous and undermining 
effects of these things; and to those whose pride, or indolence, or im- 
becility, still prompts them to persist in such habits, we would say, and 
without much sympathy for their sufferings, “ you have sown the wind 
and you shall reap the whirlwind.” 
Hereditary and acquired Predisposition to Phthsis. An PHTHISIS PULMONALIS. 
229 
alarming circumstance connected with the history of any individual, 
even when no symptoms point to an approaching consumption, is here- 
ditary predisposition to tuberculous disease of the lungs. To know 
that the seeds of a dreadful malady are implanted in the system, liable 
at any moment to be roused into activity by the numerous exciting 
causes which prevail, is enough, one would naturally suppose, to call 
forth all the energies of the individual in order that he may escape the 
threatened evil;—yet how few under such circumstances use proper 
means of prevention, and exercise that care and attention towards 
themselves which these cases require! 
But the root of the evil must be traced further back to those inju- 
dicious marriage connections, where one or both of the parties are la- 
boring under a scrofulous taint. It appears singular that intelligent 
persons of this description should be willing to enter the matrimonial 
state when they are so certain of entailing upon their offspring disease, 
misery, and an early death ; yet how often do we see the desire for 
temporary self-gratification, for riches, display, or pride, outweigh the 
potent reason named, and induce the unfortunate victim of the malady, 
to herself and her children into almost certain future suffering! 
A predisposition to phthisical affections is often acquired by con- 
stant exposure in small, damp, and ill-ventilated habitations, insufficient 
clothing, scanty and unwholesome food, free use of pork, incessant oc- 
cupation in close rooms and constrained positions, masturbation, pro- 
tracted depression of spirits, and certain occupations, as those of the 
stone-cutter, scythe-grinder, &c. 
All of these causes exert a powerful influence in bringing the system 
into that condition which renders it peculiarly susceptible to tuber- 
culous formations in the lungs, and for this reason should be avoided 
as much as possible by individuals, and should receive the attention 
of all benevolent men. 
Contagion.—Dr. R. Rogerson.* Phthisis is certainly not infectious 
through the atmosphere as small-pox or scarlet fever, but when the 
strong and vigorous come in contact with the phthisical breath, it must 
have some effect in giving rise to the disease. Sleeping in the same 
bed, breathing the same polluted atmosphere in the same bed-closet, 
and inhaling the very breath which the diseased lung is giving off, in 
fact the effluvia from the diseased lung coming in actual contact during 
inspiration with the healthy lung: and such a state of matters existing 
for weeks and months, must undoubtedly prove injurious and detri- 
mental, and may be expected to leave some traces behind. The tuber- 
cular emanations coming in contact with the blood through the medium 
of the lungs, alter the chemical composition of the blood, and thus pre- 
British Journal of Homoeop. Oct. I860, p. 689. 230 
DISEASES OF THE SANGUINOUS FUNCTION. 
dispose to tubercular disease. The individual who has in this way 
been predisposed to consumption is more liable to have the pulmonary 
organs affected from other ordinary causes of disease. If these causes, 
whether consisting of malaria, putrid exhalations or contagion, operate 
with dynamic power when received through the lungs, it is not possible 
the putrid gases evolved from the lungs of the consumptive can be in- 
nocent. In the case of other infections the conditions of attack or 
immunity from the effects of the invisible poison consist in the quantity 
breathed and in the degree of physical resisting power. Whatever 
vitiates the blood, obstructs the functions of the lungs, debilitates the 
system, and predisposes to tubercular disease. 
Prognosis.—Consumption has been generally regarded as an incur- 
able disease. Cases of cure have been published; but the favorable 
termination has in nearly all of them been ascribed, to the restorative 
powers of nature acting under circumstances in which unfavorable in- 
fluences wmre accidentally withdrawn. Dr. Hughes Benett gives one 
of these cases in the Edin. Month. Med. Jour., March, 1850. This 
author refers to various others who have published cases in which “ all 
the functional symptoms and physical signs of the disease, even in its 
most advanced stage were present, a,nd yet, the individual has survived 
many years and died of some other disorder; and on dis- 
section, cicatrices and concretions were found in the lungs.” (Practice 
of Medicine, p. 717.) 
How far this happy result of treatment or of nature’s unaided powers 
has ever been brought about by remedies, and how far the common fa- 
tal termination of phthisis is really caused by active treatment may 
remain for the present undecided. Allopathic authors agree that the 
practice that prevailed a half century ago, and even that which is 
not yet entirely abandoned by some of their number, never succeeded 
in curing any, and must have shortened the lives of the annual 
thousands who have died in their hands. Homoeopathy promises at 
least to do no injury: some of its practitioners claim to do much better. 
Dr. Epps in his work on “ Consumption, its Nature and Treatment 
p. 111.) says: “ The alleged incurability of phthisis is the declaration 
of an error. It is the creation of an impossibility out of a difficulty.” 
He regards the disease as certainly curable because the Hahneman- 
nian Law of Cure is inflexible in its results when its application is 
understood; but we fear all his cases will hardly be recognized as cases 
of true phthisis; and men of every school willingly admit that many 
alarming cases have been known to recover without any treatment 
whatever. Dr. Flint reported twenty-four cases of “ arrest ” of consump- 
tion of whom thirteen recovered fully. The result in all was attributed 
to: Avoidance of depletion, mercurials, emetics, low diet, and con- 
finement, and other changes in the habits of life. PHTHISIS PULMONAUIS. 
231 
Haemorrhage from the lungs so often occurs in phthisical patients 
that phthisis is generally represented as the consequence of the 
haemorrhage ; but this is not always true. M. Louis says ; “ no pro- 
position is at the present day more satisfactorily proved, in the opinion 
of all accurate observers, than the extreme rarity of haemoptysis of any 
amount, unless as a dependence upon tubercles. It is impossible, then 
in the existing state of things to regard haemoptysis as a cause of 
tubercles.* Dr. Evans, of Dublin, says, his observations show that 
when profuse the haemoptyses, which are sometimes observed in young 
people may give rise to the phthisical predisposition, and thus operate 
as the cause of tubercle.f The rarity of haemorrhage at an advanced 
stage of phthisis was shown by Laennec to depend upon obliteration 
of the vessels in the neighborhood of cavities. It has been established 
by the inquiries of Van der Kolk and Giullot, that the branches of 
the pulmonary artery stop short at a certain distance of one, two, or 
three lines from tubercles of gray granulations; and the more these 
adventitious productions increase in size, the further do the divisions of 
the artery stop from their perimeter. To such a degree is this true, 
that when tubercles are of large size or have given place to cavities, 
they may be surrounded by a sort of involucrum, ten lines broad into 
which no ramification of the artery makes its way. 
Hygienic Measures.—The most important are: Laborious exercise 
in the open air, conjoined with agreeable mental occupation. It is 
generally advisable to avoid long-continued confinement to any one 
business. It is well known that consumptives almost uniformly enter- 
tain sanguine expectations of recovery, but they expect to be cured 
without their making any efforts themselves. The disease creates hopes 
that are never to be realized, at the same time that it takes away the 
strength, the energy and perseverance necessary for accomplishing 
even all that might be done by faithful and persistent efforts. “ A 
passive expectation of recovery and calm acquiescence in the prospect 
of a fatal termination ” are characteristic of curable cases. And anions: 
these it seems that recovery was the result of exertions involving un- 
usual energy, or innate force of character, or of physical and mental 
efforts made under circumstances peculiarly calculated to call, them 
out. Exercise is only useful in the open air, which promotes digestion, 
and improved secretion; and the disease is much more prevalent among 
persons who follow sedentary and in-door occupations, than among those 
employed in the open air. 
Dietetic Treatment.— In undertaking to “contend with success 
against the most cruel enemy of the human “ we immediately 
* Researches on Phthisis, p. 506. f Lectures on Phthisis, p. 193. 
I Louis on Phthisis, 232 
DISEASES OF THE SANGUINOUS FUNCTION. 
perceive the importance of fortifying well all the outposts. As the 
chief pathological characteristic of consumption is seen in mal-nutri- 
tion or mal-assimilation, no mode of treatment has ever succeeded in 
curing it that co-operated with the disease by starving the patient 
The phthisical invalid should be encouraged to eat, not all he can and 
whatever he pleases, but all he can digest and assimilate. In choosing 
the articles to be allowed and the quantity of each, the skill of the 
physician will be as severely tested as it will in selecting specific re- 
medies. The powers of the patient should never be lowered by a re- 
stricted diet; but a selection should be made from such simple and 
plain articles as are found in the patient’s daily experience to be highly 
nutritious, and, at the same time easily digested, producing the least 
possible gastric or abdominal irritation. It is not only necessary that 
all the material constituents of the body shall be taken in the food in 
sufficient quantities, but that the digestive and assimilative powers 
shall be kept up to the standard of healty action. 
Each individual case requires careful study: it is desirable to allow 
considerable variety; to cause it to be taken at some well considered, 
but nearly regular intervals; after food is taken rest should be allowed 
for a sufficient time to permit digestion to proceed without disturbance; 
and exercise should be afterwards enjoined as far as the patient’s 
strength will allow. Active exercise increases strength as much by 
promoting digestion as by compelling the lungs to perform full 
breathing. 
The ends to be attained are: 
1. The removal of the cachexia on which the progress of the dis- 
ease depends. 
2. The consequent arrest of the disease; and , 
3. Promotion of the process of restoration. 
As all of these ends are attainable by general measures which de- 
velop and strengthen the physical powers of the system, we will con- 
sider them separately. 
Selection of Food.—Animal food is indispensable to the consump- 
tive, whatever may be the theories or experience of persons in better 
health. The patient must endeavor to suit his taste and digestive powers 
by testing the properties in succession of a few such articles as the 
following: milk, eggs, pure cream, beef-steak, fresh fish, &c., at the 
same time, taking a due proportion each meal of thfe best bread, sago, 
rice, cocoa, sugar, with small quantities of tea or coffee, or beer, but 
taking a full supply of fluid in free drinks of pure water. Of a few 
important articles it is necessary to speak separately. 
Fork.—It has been believed from the earliest ages that swine’s-flesh 
was injurious to human health. Among the Hebrews it was considered 
as a cause of scrofula, and hence was prohibited by the law of Moses, and PHTHISIS PULMONALIS. 
233 
to this prohibition is still attributed the exemption of the Jews and 
Mahomedans from scrofula and consumption. In America the merits 
of pork have been tested on the largest scale, and the preponderance 
of authority is evidently against it. The filthy habits of the hog; the 
fact that he has always been known to be subject to tubercular disease; 
the significance of the name scrofula or “ swine disease,” translated 
from the Greek name of the same signification; extensive observation 
m a country in which more hogs are produced and eaten than in any 
other country, all conspire to convince us that pork should be avoided 
by all persons, especially by invalids and such as have consumptive or 
scrofulous tendencies. 
Milk, the first article furnished by nature for the use of the higher 
order of animals, and “ the only material throughout the range of or- 
ganized being so prepared is a complex mixture of saccharine, oily, 
and albuminous principles. It is too complex a mixture to suit the views 
of a theorist; but it is “ a kind of prototype of what an alimentary 
substance should be, and its character was established before theories 
were invented.”! When digestion is reasonably good it is as nutritious 
as any other article. In dyspeptic cases the coagulum formed of it in 
the stomach by the gastric juice is too heavy and solid. Sweet cream 
is better, but should be taken in small quantity. In large cities nearly 
all milk is rather doubtful; that from cows kept in stables should never 
be allowed. Milk originally pure, condensed by “ dessication,” is the 
best -we have tested in New-York city. 
The relative degree of digestibility of a few common articles is thus 
given as ascertained by experiment. Rice, well boiled, requires for 
digestion one hour. Sago, 1 hour 45 minutes. Tapioca, 2 hours. Milk, 
boiled, 2 hrs. Yenison steak, 1 h. 35 m. Turkey (wild), 2 hrs. 18 m. 
Lamb, fresh, 2 hrs. 30 m. Eggs, raw, 2 hrs. Eggs, whipped, 1 h. 
30 m. Trout, fresh, 1 h. 30 m. Oysters fresh, raw, 2 hrs. 55 m. 
Fresh heef, rare, roasted, 3 hrs. Pork, fat and lean, roasted, 5 hrs. 
15 m. Pork, stewed, 3 hrs. Mutton fresh, roasted, 3 hrs. 15 m. Bread, 
wheat, fresh baked, 3 hrs. 30 m. Potatoes, boiled, 3 hrs. 30 m. Soup, 
beef, 4 hrs. Chicken soup, 3 hrs. Oyster do., 3 hrs. 30 m. Barley do., 
1 h. 30 m. 
Bread. All invalids, but especially consumptives and dyspeptics, 
should rely much on bread; and they ought never to eat any that is not 
free from all poisonous or impure elements. We have often spoken 
against the use of bread made light by yeast and leaven, still so much 
in use.J Pure bread is the desideratum; and it must be free from the 
poisonous fungi of which yeast and leaven consist. There are now se- 
* Prout. f Graves’ Lectures. Dublin. 
fSee North Amer. Journal of Homoeop., Feb. 1859. Also U. States Journal 
of Homoeop., Yol. I., p. 293. 234 
DISEASES OF THE SANGUINOUS FUNCTION. 
veral resources which enable us to avoid these old-fashioned poisons 
1. The “Aerated or Unfermented Bread ” (Broadway and Thirty-fourth 
street,) New-York, which we have found satisfactory in many cases. 
2. The “Acid Phosphate of Soda.” 3. There is also a “ prepared 
flour ” which is said to contain the same ingredients as the last. 4. The 
bread made light by the effervescence of muriatic-acid and bi-carb. of 
soda, described in the article already referred to. By restricting the 
patient to bread made according to some of these modes, with unleaven- 
ed crackers, sea-biscuit, &c., we should be able to bring him up to a 
better grade of health and strength than he would ever reach under 
the old poison diet of “stale bread.” 
Fish contain most of the essential elements of a nutritious diet, as 
fibrine, gelatine and albumen, with much phosphorus and hydrogen. 
They therefore possess some stimulating powers which render them 
“rather irritating than plethoric and substantial.”* Fresh fish are 
better suited for the phthisical than for the dyspeptic. 
Sugar. The carbonaceous elementary principles have been shown 
to be beneficial in supporting the failing strength and flesh of consump- 
tives; the operatives of the sugar-houses are said to enjoy a compara- 
tive immunity from phthisical disease. The syrups so much in popular 
use owe much of the little good they do to the sugar they contain. 
Whatever selection we may make for the proper physical support of 
the failing or threatened invalid, it is an imperative duty to support 
and develop his powers by nourishing food which will agree with him, 
whether it would suit another or not. No patient’s life was ever pro- 
longed by vain efforts to starve out the fever that seems to be con- 
suming him. 
4. As an important means for promoting a healthy action of the 
skin, and equalizing the circulation, too much can not be written 
in praise of external applications of cold water. These applications 
should be employed daily, either in the form of baths, sponging, or the 
wet sheets; in many instances the greatest service will be derived from 
using cold wTater applications to the chest in such a manner as to bring 
out an eruption. 
The effect of this remedy is to impart tone and vigor to the cutaneous 
structures, and to allay in a decided manner nervous irritation. 
5. Another valuable preventive, as well as remedial agent in lung 
affections, consists in the cultivation of a cheerful and happy disposi- 
tion. The invalid must never brood over his ailments; for by gloomy 
ponderings upon his case, he is quite prone to exaggerate symptoms, 
imagine complaints which have no existence, and thus detract from his 
prospect of recovery. 
* Brillat Savarin. PHTHISIS PULMONALIS. 
235 
Laennec ranks the depressing emotions as among the most prominent 
accidental causes of phthisis, and we are quite satisfied that he has not 
over-estimated their importance. 
6. (And finally,) we recommend a strict avoidance of all excesses, 
whether in the pleasures of the table, wine, and liquors, or in the indul- 
gence of any thing that over-stimulates and fatigues the mind or body. 
Treatment.—In all cases when it is well ascertained that tubercles 
exist in the lungs, either in a latent or partially developed state, the 
following course should be adopted, as far as circumstances will ad- 
mit, viz: 
1. First, an immediate removal to an equable, mild, dry and healthy 
climate. In making this selection, we should choose the interior of 
the country, rather than the coast, in order, as far as possible, to be 
away from the influence of the breezes which blow from the ocean. 
“ The advantage of a mild and sunny climate, is that daily exercise in 
the open air can be taken; and so not only can the natural spirits, but 
the functions of digestion, respiration, and the skin be kept up to a 
comparatively natural and healthy standard.” But there are other con- 
siderations which in late years have led many to doubt the real su- 
periority of a warm over a cold and dry climate; and there is scarcely 
any northern country that has not, by somebody, been recommended 
as furnishing a favorable residence for consumptives. It is true that 
even diseased lungs will bear a cold, dry climate much better than one 
in which the conditions of cold and damp are combined; and in some 
cases in Avhom disease is really, though slowly progressing, a cold, dry 
and bracing air is much more salutary than a warm, humid and re- 
laxing one. Still the preponderance of authority is in favor of sending 
the patient in whom phthisis has been detected in the incubative 
stage, for the winter months to a climate where he may enjoy “mild 
dry, and somewhat tonic air,” particularly if he is of a lymphatic tem- 
perament. 
Dr. Mac I imont who spent a sufficient length of time at various 
places noted for possessing peculiar advantages, mentions Mentone, 
Nice, Cannes, and Hyeres ; but, upon comparing his descriptions ot 
the claims of these places, we can see no special merit in any of them. 
Nice seems to be preferred for patients “with whom a sea-air agrees.” 
The more advanced cases of disease, as well as those in which a con- 
siderable amount of acute inflammatory action exists, being charac- 
terized by dry cougb, accelerated pulse, and much feverishness, will 
derive more benefit from a softer and more sedative air than that pos- 
sessed by either of the places above named; and Madeira, Egypt, 
Malaga, Rome, and Pau, offer these advantages. Madeira possesses 
“an atmosphere free from extremes and sudden alterations, of great 
barometrical and thermometrical uniformity, a winter temperature 236 
DISEASES OF THE SANGUINOUS FUNCTION. 
averaging 64°, and totally exempt from cold winds. “ But on the other 
hand, Madeira is undoubtedly relaxing, predisposing to various af- 
fections of the stomach and bowels, and altogether unsuited for chil- 
dren and healthy adults.” (British Journal of Homoeopathy. July, 
1861, p. 441.) 
Egypt possesses, “ like Madeira, a high winter and spring tem- 
perature, great uniformity, and absolute freedom from high and cold 
winds, yet though quite as mild and balmy, it is neither damp nor 
relaxing.” 
In Upper Egypt the climate is “ so free from rain and moisture, 
so balmy yet invigorating and restorative, as not only to prove highly 
curative in diseases of the respiratory organs from its direct action 
thereon, but is well calculated to improve the general health and 
spirits, and to repair the waste which so constantly follows in the train 
of these diseases.” But unfortunately it is too far off; it costs too 
much of health and money to reach it or to stay in it; and few invalids 
can avail themselves of its blessings. 
Rome has a “ still, serene, soft, bright atmosphere during the winter 
months, but it is subject to great and sudden atmospheric alternations 
in the spring. It is of all the others most relaxing, liable to produce 
'disturbance of the stomach and bowels, gastric and bilious affections, 
diarrhoea, dysentery, and malarious fever. 
Pan, is colder in winter than any of the above; considerable rain 
falls at this season; but in spring the weather is “dry, mild, sunny, 
and remarkably free from the disturbance of winds.” The air is very 
soothing, and is well suited to invalids of a nervous and irritable tem- 
perament; but it disagrees “with persons subject to irritable bowels, 
or those of a lymphatic and strumous habit.” 
In England, particular localities have had their advocates. Dr. 
Pope recommends “ the hills of Malvern or Ilkley as infinitely better 
adapted to the early stage of the disease” than the “ warm, moist and 
relaxing atmosphere of the Southern Coast.” Dr. Epps recommends 
the village of Warlingham, situated among the Surrey Hills, about 16 
miles from London. There, he says, there is no water except at the 
depth of 300 feet, and the water used is rain-water; and a walk or a 
drive exposed to the sun on the south-west and protected on the east 
by a high hedge, “ affords the means of exercise even on a cold and 
sunless day.” (P. 218.) 
The climate of the United States presents all the varieties of the 
temperate zone, without furnishing a single retreat to which we are 
able to point as a safe asylum for the consumptive, though the com- 
parative advantages of different localities have been often urged upon 
our attention. The trance-dream of the invalid is a climate of uni- 
form temperature/ and in search of it he examines the claims of all PHTHISIS PULMONALIS. 
237 
the four continents and the five zones of the earth, to find that it no- 
where exists. America does not pretend to furnish a spot that can 
approximate freedom from “ sudden changes.” We have now the 
means of comparing one point with another, as we have accumulated 
meteorological observations on the largest scale; but observers are 
not yet agreed on the lessons taught by these voluminous tables. We 
will contrast the highest and lowest points of the thermometer for two 
successive winters as observed at places remote from each other, as 
given in Blodget's “ Climatology of the United States 
Months. 
1855- 
-56. 
1855- 
56. 
1855-56. 
FORT 
SNELLING. 
FORT COLUMBUS, N. Y. 
FORT INDEPENDENCE, 
Boston. 
Max. 
Min. Range. 
Max. 
Min. 
Range. 
Max. Min. Range. 
O 
O 
o 
O 
O 
O 
O O 
0 
December, 
44 
30 
77 
52 
14 
38 
52 7 
45 
January, 
32 
34 
64 
36 
6 
42 
36 5 
41 
February, 
42 
31 
73 
40 
4 
36 
41 1 
32 
1856- 
57. 
1856-57. 
1856-57. 
Max. 
Min. 
Range. 
Max. 
Min. Range. 
Max. Min. Range, 
O 
O 
O 
O 
O 
o 
O O 
0 
December, 
35 
15 
50 
47 
4 
43 
54 13 
41 
January, 
28 
35 
63 
36 
5 
41 
54 9 
45 
February, 
42 
35 
77 
60 
6 
54 
45 6 
39 
Years. 
FORT 
SNELLING. 
NEW-YORK. 
BOSTON. 
Max. 
Min. Range. 
Max. 
Min. Range. 
Max. Min. Range. 
O 
O 
o 
O 
O 
o 
O o 
o 
1855. 
96 
33 
129 
92 
6 
98 
98 5 
103 
1856. 
95 
32 
187 
95 
6 
101 
98 5 
103 
1857. 
91 
35 
126 
91 
15 
76 
91 13 
104 
It will be seen by comparing the statistics, says Dr. Lewis, of St. 
Paul, Min., that, although “uniformity is not characteristic” of the 
climate of either the Atlantic Coast, or that of Minnesota, “the 
range of temperature for both is limited to very different points on the 
thermometric scale.” At New-York “the Mercury vibrates fitfully 
from a point above to one below freezing.” In Minnesota its vi- 
brations are from one freezing point to another—its more usual range 
in winter being from 15° below to 15° above zero.” It does not 
usually rise so high as the freezing point during the winter months. 
It is therefore claimed, that the climate of Minnesota, though colder 
than that of the Atlantic Coast presents less variation between freezing 
and thawing ; and that fluctuations of temperature between one point and 
another in a dry cold atmosphere has little influence on health.* Of 
the relative advantages of one part of our country over another we 
Tave many learned essays, but we must omit any comparison between 
* Amer. Med. Times. Yol. IV. p. 162. 238 
DISEASES OF THE SANGUINOUS FUNCTION. 
them. The following remarks by Dr. Dunham, of Newburgh, N. Y., are 
important. He says, the treatment of phthisis in Brooklin was in hia 
hands most unsatisfactory ; but he finds it in Newburgh to be “ very 
amenable to treatment, and although in cases in which the disease is 
far advanced, he can boast of no cures, yet the relief afforded even to 
such cases is very remarkable, constant, and enduring for a period to 
which his previous observations of the disease offers no parallel.” 
On the climate of the Bahamas, he says: “ Nassau enjoys a climate 
totally different from any portion of the United States or of the West 
Indies proper. There are utterly unknown “ the sudden alternations 
of temperature, the searching damp chilliness suddenly succeeding a 
scorching heat, the humid penetrating north-east winds sweeping 
down our Atlantic Coast on the west edge of the Gulf Stream—which 
make the climates of Charleston, Savannah, and St. Augustine so 
trying to invalids with pulmonary and rheumatic diseases.” The 
climate of Nassau is remarkably uniform—being free from the oc- 
casional cold of the Florida coast, and from the extreme heat of Cuba 
and Santa Cruz. Yellow fever has been long unknown, intermittents 
are never seen, and bilious fevers are rare; phthisis though not un- 
frequent among the blacks, is rare among the whites.* 
For incipient phthisis this climate permits the invalid to spend his 
whole time in the open air; the bracing trade-wind prevents him from 
falling into the lassitude common to tropical regions. Here within 
four or five days sail, by steam of New-York, the invalid can find 
English society, refinement, and hospitality aloof from the usual seat 
of epidemic and contagious diseases, and the variable land climate of 
the American Continent. In the months of February and March, 
which might be expected to furnish the greatest vicissitudes of tem- 
perature, there is only an average daily range of the thermometer 
of 5-£° for March. While at Pau, in the south of France, it is 
at Nice 8£°, and at Rome 11°. At Nassau in February the lowest 
temperature was 71° and the highest 85° on the 28th, and the ascent 
from the one to the other was uniform. 
Wherever the patient may reside, it is agreed by men of every 
shade of opinion that the patient should constantly enjoy “ a pure, 
warm, dry air, a constant and free in-door ventilation, at the same time 
that he is supplied with a highly nutritious food. It is claimed that 
attention to these points alone have often led to the removal of the 
tubercular predisposition. It is advised to “ avoid the places at which 
consumptives are congregated; but to seek such as afford incitements 
and resources for physical exertion,” and to encourage travelling 
abroad, not as a task, but as a means of mental gratification. 
*Amer. Horaoeop. Review. Sept. 1859, p, 550. PHTHISIS PULMONALIS. 
239 
Daily exercise should be taken in the open air. By this we do not 
mean that snail-like moping around, with the body coiled up, and a 
countenance the picture of melancholy and despair; but that vigorous, 
free and cheerful exercise which invigorates and expands the physical 
powers, and cheers the mind. Exercise, to be beneficial, should be 
employed in such a manner as to bring all of the muscles into moderate 
and agreeable action, and as a pleasant recreation, rather than a ne- 
cessary task. By this means the organism is strengthened, the cir- 
culation equalized, the “blue-devils” exorcised, and the pulmonary 
organs placed in the best possible condition to recover themselves. 
In pursuing this course of physical exercise, regard should be had 
to those gymnastic and other sports which tend to expand and strength- 
en the thorax. Too much can not be said with reference to the im- 
portance of this subject, also the erect position of the body, and the 
habitual custom of taking deep and free inspirations; for the muscles 
of the chest, as well as of the other parts of the body, waste away and 
become enervated without constant exercise in a natural manner. 
In connection with this course, we must strongly advise the frequent 
use of breathing tubes. Having experienced decided benefit from 
employment of this kind of exercise of the lungs, and having often 
seen it adopted by others with prompt and marked advantage, we 
speak confidently of its efficacy in debility of the pulmonary organs. 
Systematic employment of physical movements is now accepted 
as an efficient means of averting consumption. The contraction of 
the chest in phthisical patients is in part owing to hereditary confor- 
mation, but it is generally increased by indolent and sedentary habits. 
However it may have originated, much can be done towards correcting 
it, and in correcting a defective conformation many other accompani- 
ments of imperfect respiration will be removed. 
A systematic course of exercises which shall especially bring into 
play the muscles of the chest and keep the body erect, will greatly 
enlarge the capacity of the chest; the lungs may be made to receive 
a much larger quantity of air; but it is necessary that this course of 
health-giving exercises shall be commenced before hopeless structural 
disease already exists, and that it be so directed as not to give 
“ fatigue and exhaustion in the nervous system out of all proportion 
to the effect upon the muscles.” The general indication, says Dr. C. 
F. Taylor,* “will be met by employing the muscles in such a manner 
that, while they are made to act with more or less force, no greater 
demand shall be made upon the nervous system than can be easily 
and healthfully responded to. 
“ The first thing to be attended to and never to be lost sight of for 
* Theory and Practice of the Movement Cure, p. 212. 240 
DISEASES OF THE SANGTTINOTTS FUNCTION. 
a moment, is the circulation of the blood. Feebleness of the heart’s 
action, imperfect respiration, poor quality and small quantity of the 
blood, and especially want of affinity between the blood and the 
tissues, all conspire to produce the livid countenance, cold extremities, 
and consequent pectoral congestion and oppression so characteristic of 
pulmonary consumption.” The specific movements by which these 
conditions may at least be greatly improved we will not here describe 
in detail. It is advised to “ act almost wholly and very perseveringly 
on the extremities, by rotations of the feet, hands, arms, and legs, and 
by flexions and extensions of the same,” but “there should never be 
any attempts to expand the chest, till after the peripheric circulation 
has been improved.” After a proper distribution of the fluids has been 
secured and maintained, improved health is sure to follow. 
Medical Treatment.—The great danger is that of over-medication. 
The invalid who to-day is acknowledged to be in the incipient stage of 
consumption is already suffering from the effects of many agents taken 
as remedies; and each after a fair trial has been condemned. When 
the true remedy is selected it is quite common to defeat its good effect 
by frequent repetition, by alternating with other remedies, or to change 
speedily for something else. We are much more likely to succeed by 
carefully selecting the most appropriate remedy and give only a single 
dose. In some cases we should wait for perhaps a few days, in many 
cases even several weeks before repeating. But few patients or phy 
sicians have patience for such long delays. We may hope, in curable 
cases, to succeed with some of the following remedies: Jecorus-aselli, 
Sidphur, Ilepar-sulphur, Calcarea-carbonica, Mercurius, Stannum, 
Ferrum, Silicea, Sepia, Phosphorus, Phosph.-acid., lobelia, San- 
guinaria, Acid-nitricum, Prosera, lycopodium, Ilypophosphite of 
Lime, Lac herns. Iodine, Iod.-poiassce, Arnica, Sambucus, Bella- 
donna, Ilamamelis, China, Alcohol. 
Preliminary or First Stage. — Asellum-jecoris or Cod-Liver 
Oil.—It has been believed in all ages that oleaginous substances have 
some beneficial influence in the treatment of consumption, whether 
their action was to be attributed to their medicinal or to their nutritious 
properties. It at least supplies nutriment in a concentrated form, and 
it also holds in solution a fine attenuation of Iodine. 
Cod-liver oil is usually easily digested; when the stomach will not 
digest it, Pulsatilla or Creasote may correct the weakness of this organ. 
When cod-liver oil acts beneficially we accept its aid, but we do not 
accept the reasonings of those who have tried to explain its mode of 
operating. Dr. Madden, (British Jour. Ilomcep., Yol. VI., p. 433.), 
shows that the effects of the oil are quite similar to those obtained by 
the provers of Iodine. Dr. Pope, in a later number of the same Journal, 
considers that this oil “presents us with food, in the shape of oil, of a PHTHISIS PULMONALIS. 
241 
highly nutritious easily assimilable character, and at the same time 
with a medicine homoeopathic to the tubercular diathesis,” and by it 
the most happy curative effects are often produced. Though it be 
rendered probable that Iodine is the only real curative agent in these 
cases it is by no means improbable that its medium, the animal oil, 
which is composed principally of carbon and hydrogen, may serve the 
purpose of neutralizing a portion of the inspired oxygen, which would 
otherwise act upon the weakened lungs themselves. It is at least re- 
garded as one of the most efficient remedies known; but it is admitted 
on all hands that it can only cure in earlier stages, and that it needs 
to be long persisted in; Dr. Turnbull continued its use for several 
years. 
Symptoms.—“ The patient is thin, loses flesh rapidly; the complexion 
is pale, the cheek frequently surmounted by a pink flush; the lips ex- 
sanguine ; the appetite very deficient; the power of digestion feeble; 
the bowels easily deranged; a sense of languor or weariness is felt 
after slight exertion; respiration short and hurried; when tubercular 
deposit takes place in the lung, the cough speedily becomes trouble- 
some and the physical signs of disease rapidly defined.” If the history 
of the case shows hereditary predisposition to tubercle, Iodine alone 
is homoeopathic to these cases, both before and after tubercles are 
formed. The quantity varies according to the digestive powers of the 
patient; “ but a dessert-spoonful of the pure, clear, pale-colored variety 
iv ill accomplish all that can be obtained from it.”* 
It is to be regretted that so few positive specifies have been dis- 
covered for the cure of tubercular phthisis, but we are sanguine in the 
belief that many such remedies will sooner or later be found. 
Cod-liver oil is still given in the third stage in some cases with 
success; it is believed to be less suited to those presenting the follow- 
ing characteristics ; emaciation not.strongly marked; complexion pale 
and heavy looking; cheeks puffy; muscular tissue flaccid; the areolar 
tissue distended with serum; appetite capricious, rather than deficient; 
nutrition perverted rather than positively checked ; bowels inclined to 
constipation rather than to diarrhoea, but often extremely irregular; 
cough slight but decided; difficulty of breathing often well marked, 
especially on going up-stairs or walking rather more rapidly than 
usual; there is also in general palpitation. These cases show a here- 
ditary predisposition, and evidences of phthisis are visible in childhood; 
development of the frame seems prevented by some depressing consti- 
tutional influence; the complexion is pasty, the muscles soft and 
flabby; the bones are inclined to curve; the circulation is languid; 
strength is feeble and all the usual physical energy of early life is 
absent. Here likewise 
Vol.ii._16. 
* Pope, p. 35. 242 
DISEASES OF THE 6ANGUINOU8 FUNCTION. 
Calcarea-carbonica is suited for the symptoms detailed under the 
last-named remedy. 
In similar cases which have advanced to the second stage, Lycopo- 
dium or Nitric-acid will generally he found more useful than Calcarea. 
Sulphur.—This is perhaps the most perfect specific for phthisis in 
its unmixed psoric form, not only when it follows pneumonia, but also 
when the disease is hereditary, and in the period of purulent 
expectoration. 
In cases of incipient phthisis it should only be given at long in- 
tervals, a single dose should be allowed to operate for several weeks 
undisturbed. Dr. Nunez, of Madrid, says, he has cured some cases of 
confirmed phthisis by this remedy. Teste says, “if it has not cured 
phthisis it has at least retarded it for several years. ” * 
Hahnemann f regarded phthisis pulmonalis as a psoric disease, and 
Sulphur as the first of antipsoric remedies. He refers to six cases in 
wdiich consumption was caused by the repulsion of psora from the 
skin; later writers have admitted that Sulphur is a specific for itch, 
and also for the diseases caused by its recession. 
Sulphur is specifically suited for phthisis in psoric constitutions, of 
lymphatic temperament subject to venous plethora and haemorrhoids. 
There is predisposition to take cold from slight exposure, running into 
chronic catarrh; eruptions resembling those of scrofula appear on the 
skin; rheumatic pains without swelling; drawing pains in the limbs; 
unsteady gait and tremor of the hands: great general prostration; 
nervous exhaustion following debilitating losses; numbness of different 
parts, paralysis and emaciation; pains worse at night, relieved by ex- 
ternal warmth; drowsiness, and disturbed sleep; disturbing dreams; 
hallucinations, timidity. 
The patient curable by Sulphur has generally some eruptive disease 
of the skin or has had such affection (not necessarily the itch), repelled 
from the surface at some former time ; he is subject to abscesses, boils, 
or swelling of the glands; hectic fever followed by night sweats, or 
profuse sweat from slight heat or exercise. There is hypochondriac 
sadness; disposition to weep; irritated taciturn disposition; the head 
is dizzy; intolerance of light. 
The face is pale, wan, blanched, sickly, bloated, with wrinkled coun- 
tenance ; blue margins around the eyes; hepatic spots in the skin; 
swelling of the gums ; dryness of the tongue ; favus on the skin. 
The throat is dry; mucous expectoration; sore throat, vesicles on the 
surface ; pressure in the throat as if from a lump ; tonsils red, swelled; 
uvula elongated. Putrid taste in the morning, ravenous appetite or 
loss of appetite ; acidity of stomach and sour eructations ; heartburn; 
morning nausea; waterbrash ; acid vomiting. 
* Materia Medica, p. 108. t Chronic Diseases, Yol. II., p. 325. PHTHISIS PULMONALIS. 
243 
The stomach is painful on pressure ; swelling, burning, and cramplike 
contraction or spasm of the stomach; malaise before a meal; nausea 
after eating. 
In the abdomen there is pain, with sensitiveness of the surface; 
spasmodic contractive colic; cutting pain and nausea followed bj diar- 
rhoea and tenesmus; haemorrhoids; constipation with pain and pressure 
on the rectum as if it would protrude; mucous stools streaked with 
blood, passed with ascarides or lumbrici; strangury; foetid urine. 
The throat feels rough, the larynx dry, sore, its sides swollen and 
feeling as if something lodged there. Hoarseness or loss of voice. 
Catarrh, fluent coryza, rawness or spasmodic constriction of the chest. 
Cough dry, short and hacking, and after a meal exciting retching or 
vomiting. At a later stage the cough is looser, raising thick mucus, 
then greenish masses ; the cough excites violent headache, which in 
the occiput is pulsative ; spitting of blood. 
The breathing is spasmodically arrested; asthma excited by a long 
or rapid walk, or ascending the stairs ; suffocative paroxysms, especially 
coming on at night; talking causes weak feeling of the chest; oppres- 
sion or contractive pain there. Neuralgic stitches of the chest, extend- 
ing to the sternum or back. Palpitation of the heart; anxious throb- 
bing with flush of the face, or rush of blood to the head ; leucorrhoea ; 
irregular menstruation; cold hands and feet. It may not be proved 
that Sulphur has cured confirmed phthisis in advanced stages ; but, 
says Teste, “there is no doubt, however, that serious affection of the 
air passages have frequently been arrested by its use ; affections, 
which, without being tuberculous phthisis, would nevertheless have 
been equally fatal.”* 
Sulphur and Ilepar-sulphur should always be selected when the 
pulmonary affection can be clearly traced to abruptly suppressed psora, 
whatever may be the general character of the symptoms. If, however, 
symptoms are present which point strongly to some other medicine, an 
alternation may be resorted to. 
Uepar-sulphuris.—Dr. Busch, of Strasburg, in 1860, reported cures 
of phthisis effected by Ilepar and Aconite, others have used it with 
success in incipient cases. The patient has an unhealthy skin which 
cracks or chaps and runs into suppuration or ulceration from slight in- 
juries ; is subject to pimples and blotches ; he sweats from the slightest 
exercise, and also profusely at night. He is mentally irritable, im- 
patient ; has vertigo with pain in the head; falling off of the hair 
erysipelatous eruptions of the face. In the throat there is a feeling 
of something sticking, or rough scraping or stinging stitches ; rawness 
of the fauces, swelled tonsils; expectoration mixed with blood. 
* Materia Med., p. 168. 244 
DISEASES OF THE SANGUINOUS FUNCTION. 
Putrid taste in the mouth, loathing of food; eructations without 
smell or taste, vomiting, water-brash. 
Cough with rawness and scraping of the throat and oppression of the 
chest. Violent deep cough with retching; dry cough in paroxysms, 
worse at night; haemoptysis; short breath; suffocative cough am1 
asthma, and palpitation of the heart. Teste* says, Hepar has cured 
cases in which there were “ stitches in the eyes; photophobia; dis- 
charge and fetid pus from the ear, erysipelas of the face; dryness of 
the throat; scraping of the throat, with difficulty of talking; canine 
hunger, eruptions; paroxysms of nausea with coldness and paleness; 
swelling and pressure or pain at the epigastrium,” &c. Hahnemann 
says, it cured cases in which mental symptoms were prominent; as, 
dissatisfaction with one’s self and others; unpleasant recollections; 
dreamy atrabilious mood; a ferocious malignant spleen, though occurring 
in a person of benevolent and merry disposition.! 
Calcarea-ca/t'bonica.—Hahnemann attributed important anti-psoric 
powers to this remedy. It is said to apply more than any other re- 
medy to diseases of the reproductive system; it is especially useful in 
the diseases of childhood and is the best reliance for the correction 
of mal-nutrition. It acts specifically on the mucous membranes, on 
the fibrous and osseous system; on the nervous, the serous, the 
venous and the lymphatic systems. Persons curable by it are of 
lymphatic temperament, scrofulous or rickety, show plethora of the 
veins ; easily take cold, are frail, poorly fed but tend to grow fat. Its 
application in consumption is chiefly restricted to cases in which these 
features predominate. The patient is feeble in body and mind, though 
in some cases mentally precocious, and often regarded as a genius; he 
is subject to depression of spirits ; weeping mood; restless and anxious ; 
has no hope of recovery, is hypochondriacal; the hair falls off; the eyes 
are feeble; can not bear gas-light; and he suffers from all possible de- 
rangements of digestion; the nervous system becomes excessively ir- 
ritable especially in females; there is hysteria a fault-finding mood; 
nervous exhaustion, especially menorrhagia, in males spermatorrhoea, 
or exhausting emissions. It is proper in the stage of purulent ex- 
pectoration, especially after Sulphur or Nitr.-acid. 
Silicea.—This remedy embraces most of the symptoms that belong 
to the phthisical dyscrasia, consequently, it is a remedy of value for the 
constitutional condition in congenital or hereditary cases. The dyspeptic 
symptoms peculiar to consumption are also nearly the same as under 
Ilepar. The symptoms that show themselves in the respiratory system 
are thus given: roughness and sore feeling in the larynx, with dry 
hacking cough, causing soreness of the chest. Hoarseness with ccugh, 
* Mater. Med., p. 293. f Chronic Diseases, Vol II., 283. PHTHISIS PULMONALIS. 
245 
suffocative night cough; excessive, continual cough, with discharge of 
translucent mucus or bloody mucus. Vomiting of purulent matter 
when coughing. Ulceration of the lungs. Discharge of clear, pure 
blood with deep hollow cough; the chest painful as if bruised. Short- 
ness of breath, felt on walking or exercising. Weakness and oppression 
of the chest; aching pain in the sternum; congestion of blood in the 
chest, with chilliness of the surface. Oppressive heaviness in the 
region of the heart and palpitation when sitting still. 
Stannum.—Several authors have cured a species of phthisis, hectic 
fever, chronic catarrh, mucous asthma with tin. And Stahl has ob- 
served that it is capable of producing a species of phthisis. 
Consumption occasionally arises in those whose lungs are naturally 
weak and irritable, in consequence of violent and protracted syphilitic 
attacks. In these instances the most suitable remedies are, Mercurius, 
Acid-nitr., Fotassce-iodide, and llepar-sulphur. 
When phthisis is threatened during the progress of chlorosis, or in 
consequence of anaemia, some form of Ferrum is indicated. 
Ferrum.— Dr. Muller has recommended Ferrum as a remedy for 
phthisis, and it is nowr becoming popular in Germany. (Report. Dis- 
pensary, Leipsic, 1852.) 
Dr. Luther (Brit. Journcd of Ilomceop., April, 1860, p. 335), says 
that at a village of four hundred inhabitants, near Wittenberg, in Prussia, 
“ consumption is unknown • arid other forms of scrofula are of the 
rarest occurrence, whilst in neighboring villages that lie higher, these 
disorders are common.” This valley is supposed to owe its protective in- 
fluence against phthisis to a large number of chalybeate springs, some 
of which contain carbonates, and others strong sulpho-aluminous 
ehalybeates. The inhabitants attribute their freedom from phthisis and 
their notorious good health and longevity to this chalybeate water which 
they use for all purposes. We can not suppose that the unlimited use 
of iron in any form can be safe to consumptives. It first became popu- 
lar upon the recommendation of M. Trousseau more than thirty years 
ago. He has since discovered that though there was apparent improve- 
ment in his hospital cases of chlorosis and anaemia, they all afterwards 
died of phthisis, hastened to a fatal termination by his treatment. In 
December, 1859, this author, finding the profession still following the 
wrong trail on which he stai-ted them thirty years ago, thought it ne- 
cessai'y to publish at length his confession and recantation of the pro- 
fessional sins of his earlier years.* For twenty years he has been di- 
minishing his doses. He is now' afraid to give iron in any quantity in 
any case in which constitutional tendencies to phthisis are suspected. 
The profession at large can not countermarch so easily. We hope that 
* Gazette des Ilopitaux, Dec 22, 1859. 246 
DISEASES OF THE SANGUINOUS FUNCTION. 
within the next quarter of a century they will learn to come back to the 
true ground of safety and efficiency. 
M. Trousseau has proved, what homoeopathists knew before, that iron 
is a remedy for consumption, because it is capable of exciting it. In 
our doses it is able to cure the symptoms which in his doses it caused 
in so many cases. 
The cases in which Ferrum is specially valuable are those inwhichf 
“ the patient is usually between twenty and thirty years of age; his 
family history is free from any hereditary taint or tubercle ; he is of a 
sanguine temperament, of a florid complexion, with an active circula- 
tion, and an easily-excited nervous system; the disease has been ex- 
cited by neglected catarrh, causes which originated mal-nutrition with 
frequent inflammatory attacks upon the pulmonary organs. Epistaxis, 
haemoptysis, headache, congestions in various parts are easily excited; 
hectic fever runs high, and the loss of strength is very rapid, there is 
dyspnoea, vomiting of food, or lienteria. For this form of phthisis, Dr. 
Clotar Muller very confidently recommends the Perchloride of Ferrum, 
in doses of one to three drops, of the first to the sixth decimal dilution. 
See a translation of his paper, British Journal of IIomoeop., Yol. 18. 
The form of iron with which we have succeeded best, is the Pyro- 
phosphate. In the third trituration it has always improved anaemic, 
dyspeptic, or chlorotic cases. 
The second stage of these cases is best met by Phosphorus or Bro- 
mine. The frequent attacks of congestion and inflammation which mark 
their course are best met by Aconite, Bryonia, and Belladonna. In the 
third stage Dr. Muller recommends the Iron again. 
Lobelia-in fata.—Lobelia has been used empirically on such a 
large scale in the United States, that its powers, are well known. 
When proved homoeopathieally it develops a train of symptoms ana- 
logous to those of Sulphur. In phthisis it corresponds to the consti- 
tutional psoric symptoms generally, to all the stomach derangements 
* that are common in the later stages, to the catarrhal fever of the first 
stage and to the intermittent hectic of the second. Besides these im- 
portant features it presents the following bronchial symptoms: 
Burning in the throat; dryness of the throat; burning prickling in 
the throat, increased secretion of viscid saliva, nausea and eructations. 
Sensation of a lump in the pit of the throat, impeding deglutition. Sen- 
sation in the oesophagus, as if something were rising in it. Titillation 
in the larynx, with frequent short, drjT cough. Sensation of a foreign 
body in the throat impeding the breathing and swallowing. Tightness 
of the chest, with short and laborious breathing. Chronic dyspnoea ; 
paroxysmal asthma; pains in the chest increased by deep inspiration ; 
deep-seated pain in the region of the heart. Its special sphere of 
t Dr. Pope. PHTHISIS PULMONALIS. 
247 
action has been assigned to the pneumogastric nerve. It certainly 
affects promptly all the organs supplied by this nerve. It also operates 
decidedly upon the skin, producing a peculiar form of herpes, formerly 
called “ James River Tetter.” It was common on that river and cured 
by Lobelia.* 
Saiiguinaria-canadensis.—This is one of the best agents we have 
for the prevention, if not the cure of consumption. In allopathic 
doses it acts as a tonic, narcotic, stimulant, or emetic, according to 
the dose employed. In doses of from eight to twenty grains it produces 
nausea, heat in the stomach, faintness, often vertigo, indistinct vision 
and finally emesis. In smaller doses, after continuing its use five or 
six days, its effects on the pulse resemble those of Digitalis. We have 
long been familiar with its powers in many forms of pulmonary, 
bronchial, hepatic and gastric disease. We have used it with success in 
patients who were subject to distressing affections of the chest, re- 
peated attacks of pneumonia, haemoptysis, and spasmodic attacks re- 
sembling pertussis. Also in protracted catarrhal fever which leaves 
obstinate cough and threatening consumption. The cough has generally 
been mitigated, the pulse diminished in frequency, the powers of the 
whole digestive system increased; the appetite is always improved, or 
regulated in cases where it has been morbidly great. 
Symptoms.—Coryza, rawness of the throat, pain in the breast, cough, 
salivation, looseness of the teeth. Dryness of the lips; the tongue 
feels sore as if burned; white-coated sore feeling of the epigastrium, 
increased by eating; burning heat in the stomach, with headache; 
gastritis ; nausea, vomiting with headache, periodic nausea, nausea and 
chill, diarrhoea, torpor and atony pf the liver with colic ; throbbing, 
beating in the abdomen; flatulent distention of indurations in the ab- 
domen, haemorrhoids. 
Chronic dryness in the throat; continual severe dry cough, with pain 
in the chest and circumscribed redness of the cheeks, tormenting cough 
with expectoration. The peculiar cough, emaciation and hectic fever 
of pulmonary consumption. 
Hydrothorax, asthma, pneumonia, and pneumonia typhoides; pain in 
the chest with cough and expectoration. Burning and pressing in the 
breast and back; palpitation of the heart, burning of the palms of the 
hands and soles of the feet at night. 
In chronic forms of pneumonia the first stages of phthisis, in hepati 
zation of the lungs and bronchitis; putrid 'sore throat. 
We have bad much allopathic experience with this remedy in dis- 
eases presenting the above symptoms and do not like to acknowledge 
that all former successes were gained in violation of law. It has ap 
* Transactions of Amer. Institute of Homoeopathy. Yol. I. 248 
DISEASES OF THE SANGUINOUS FUNCTION. 
peared to us that the remedy is truly homoeopathic to all symptoms 
enumerated and a vast number more; but that it sometimes produces 
its curative effect by a local primary action, and in other cases it cures 
by its secondary action. 
Phosphorus.—In incipient as well as confirmed phthisis in persons 
of meagre, slender form ; fair complexions, and strong sexual feelings. 
When in the lower lobes and of an asthenic type, in children and young 
girls of delicate constitutions, with dry short cough, shortness of breath, 
great emaciation, tendency to diarrhoea, or perspiration, it is useful. 
Case.—Dr. Fincke gives (Amer. Homoeopathic Review, Mar. 1861, 
p. 285) the case of a woman aged thirty-four years, “ dark complexion 
and sanguino-nervous temperament,” who had “ hard cough, hurting her 
chest and head, with a pressing forward of the eyes; and thick yellowish 
purulent expectoration, excited by burning pains in the pit of the throat, 
which continued during the coughing; dullness under the right clavicle ; 
mucous rattle in the right upper lung anteriorly, in expiration and in- 
spiration : puerile respiration in left upper lung; pains under the ster- 
num when sewing; great emaciation; sallow countenance; hollow 
sunken eyes with dark rings around; irregular chills.” Phos. tuVo* 
Seven days later: “ Patient much improved; she still coughed hard es- 
pecially in cold weather. Phos. -g-aVir* After that all the symptoms 
disappeared.” 
It is well known that Phosphorus is a necessary constituent of all 
healthy nerve structure. And in some conditions of Ioav nervous vigor 
its employment may be of service. As it enters largely into the com- 
position of most nutritive kinds of grain, and was not placed there 
without purpose. It is no specific for phthisis, though it acts usefully 
on certain states of lowered nervous energy. 
The hypo-phosphites have not yet established their claim to the title 
of specifics for consumption; and they never will, especially in allo- 
pathic hands. “ Ignorant of the homoeopathic action which is the true 
cause of the success of specific remedies when properly administered, 
they give quantities so great, as, in most instances to aggravate the 
symptoms of the malady. Occasionally these medicines give 'indi- 
cations of their value in successful results, simply because the physi- 
cian exhibits by accident a small dose, or finds a patient not very 
accessible or responsive to homoeopathic action.” Phosphorus has been 
known for half a century to be a remedy for consumption; but allo- 
pathic experience soon proved it not always safe. Dr. Churchill then 
brings it up in a combination which is safe; but it is speedily pro- 
nounced inert. Our experience with the hypo-phosphite of lime has 
not been entirely unsatisfactory. In the course of three or four years 
we have generally succeeded in obtaining as good results from it as 
from Calcarea-carbonica in cases not widely different from those in PHTHISIS PULMONALIS. 
249 
which the latter is known to he specific. In small doses of the third 
trituration it certainly improves digestion and assimilation. We have 
not found it a specific for tuberculosis. Its precise sphere of action 
has not yet been pointed out. 
Dr osera-rotundifolia—Sun-dew. Yicat (Treatise on the Poi- 
sonous Plants of Switzerland) says, the Droseras are “acrid and 
corrosive; they cause ulceration of the skin and injure the teeth. 
Triturated with salt they are used as vesicatories. The sun-dew is sold 
in the shops as a useful remedy in coughs, asthma, ulceration of the 
lung, &c.; still it is certainly poisonous for sheep ; it affects their liver 
and lungs, and causes a cough, that makes them waste away slowly.” 
Hahnemann refers to Borrhichius to prove that “it causes a very vio- 
lent cough among sheep.” Several medical men of former times em- 
ployed it in “ cough and in phthisis with purulent expectoration.” The 
plant was first described and figured by Dodoens, of Belgium, in the 
sixteenth century, under the name of rorellaprima major. 
Linnaeus directed the acrid juice for application to warts and corns; 
Haller says it causes excoriations and ulcers of the skin. A German 
botanist, named Siegesbeck, in 1716, says, the plant is injurious to 
sheep, particularly by exciting a cough, which is often fatal. He and 
also Heermann (Erfurt 1715) found it to allay asthma, remove hoarse- 
ness, and restore the lost strength. The tincture was found useful in 
catarrhal fevers (influenza), epidemic whooping cough (as that 
of 1712.) 
Auscultatory Signs.—Cases in which it was successful: dullness 
more or less extensive, weakness of the respiratory murmur, roughness 
of inspiration or expiration, respiration in several impulses, prolonged 
expiration, souffle behind the capsula. 
Functional Signs : Cough generally dry, oppression, spitting of 
blood, thoracic pains, night-sweats, emaciation. Under the influence 
of Drosera, when the general state of the patient was good, Dr. 
Curie says, he has seen all these symptoms disappear. The cases in 
which it promises little are, those in which thef ever is of a continued 
character; where the food is not duly assimilated, as is often the case 
with phthisical patients who have large cavities, and some others 
where the stethoscopic signs were not strongly marked. Even in 
these, it gave relief for the first week, and when it failed the patient 
died more quietly. 
, Dr. Eugene Curie read before the Academy of Sciences of France, 
September 2, 1861, the results of his experiments on the physiological 
and therapeutical properties of the Droseras.* He says : 
He chose the domestic cat as an animal to experiment upon, from 
* Bulletin de la Societe Medicaie Homceopatliique de Paris, Nov. 1861. 250 
DISEASES OF THE SANGUINOU8 FUNCTION. 
the opinion that tubercles had never been found in them. He gave to 
one cat fifteen centigrammes per day of Drosera, triturated with sugar 
of milk, and killed him with it at the end of six weeks. He gave to an- 
other at first a drop at a dose, which was afterwards increased till it 
amounted to 1600 drops per day, of the spirituous tincture evaporated 
in the air, and latterly in vacuo. This animal was killed at the end of 
one year. A third has been using the drug for six months, and shows 
the same symptoms as the two former. 
Symptoms Produced.—All three had diarrhoea at the commence- 
ment, and a marked weakness of voice was noticed after six weeks. 
They could utter sounds but they could not be heard, though at the 
commencement their cries gave great annoyance to the neighbors. 
Appearances on Dissection.—In the two animals dissected. The 
first on being opened showed beneath the pleura some almost ge- 
latinous deposits surrounded by an anomalous redness. The changes 
in the lungs were not such as revealed tubercle to the eye but they 
were plainly revealed by the microscope; and Dr. Gratiolet, of the 
Museum Department, satisfied himself that these deposits were of a 
tubercular nature. There was also in this animal considerable en- 
largement of the mesenteric glands. 
The second cat killed after one year of experimental treatment, 
showed “ lesions consisting of small white granules, the size of a pin’s 
head, situated beneath the pleura, and surrounded by a very red in- 
jection that penetrated into the pulmonary tissue, but was unaccom- 
panied by induration. These granules were only found under the pul- 
monary pleura. None were noticed in the parenchyma of the lungs. 
These gray granulations were moderately hard : they could be 
crushed on the glass, and showed under the microscope the following 
characters: irregular corpuscles, granular internally and externally ; 
the external granulations brilliant and somewhat characteristic. Most 
of the corpuscles were six seven-thousands of a millimetre in diameter, 
almost unaffected by acetic acid. Though some other accessory 
elements were met with, the attention was chiefly confined to the tuber- 
cular structure which constituted the principal mass of the granulation, 
and left no room for doubt as to its character. 
There was also enormous development of the submaxillary glands, 
the hypertrophy of the glands of Peyer ; and the shut vesicles of 
the large intestine, which contained an opaque fluid that showed 
under the microscope granular corpuscles. In the spleen they were 
“ so much developed that they could be seen through the exterior 
covering ; and the spleen, when cut into, seemed to be formed entirely 
of them. They were decidedly larger, than a large pin’s head, and 
contained in the interior a mass of glandular corpuscles. 
It then appears that Drosera causes the production of tubercular PHTHISIS PULMOHALIS. 
251 
elements in the lungs, and acts at the same time on the lymphatic 
system in general, thus presenting the analogy recognized in all ages 
between the tubercular affection and the lymphatic, not to say scrofulous 
temperament. In these experiments the hypertrophy of the lymphatic 
organs was a hypertrophy of the proper elements of the organs, and 
was unaccompanied by any plastic deposit. 
Use in Tubercular Disease.—Dr. Curie says, Drosera has been 
used with success in doses of from four to twenty drops of the tincture 
in twenty-four hours. 
Lycopodium.—A case by Dr. Gregg, (On Phthisis, dec. Canan- 
daigua, JSf. Y., 1859, p. 56). A young lady, aged twenty-four, in 
whom a strong hereditary tendency to consumption existed, had “ severe 
pain through the left lung, with soreness, cough, and considerable 
emaciation. These symptoms had continued some weeks and were 
increasing in severity. Lycopodium corresponded most nearly with 
her symptoms, and was given for two weeks. There were then “ dis- 
covered hard lumps or knots in the muscles upon her shoulder-blades, 
whom proved to be boils that were very painful, and which, when they 
came to discharge, left pits in the flesh a half inch to three quarters 
in depth. The pain and soreness of the lung were both relieved as 
soon as the boils began to form, while the cough subsided with the 
pain.” The pulmonic symptoms disappeared, returning only once 
afterwards from taking cold, and were promptly relieved by the same 
medicine. The author is confident that there was tuberculous matter 
already deposited in the left lung when first examined; the symptoms 
gave full evidence of the fact, and the patient had lost two brothers 
within two years by consumption. 
Lycopodium.—Phthisis developed by neglected catarrh" or pneu- 
monia; there is hectic cough, with purulent expectoration. Tubercular 
consumption following haemoptysis, suitable after Calcar., Sil., Phos. 
Cuprum is said to hasten the suppuration of indurated glands, and 
thus to be unsafe in advanced cases. But, says Dr. Kissel,# it is 
possible that the inflammation set up round the tubercles may be 
curable by Copper, as it is in some cases by Nitre, or Ferrum. The 
bursting of vomica in the lungs otherwise healthy “may be hastened by 
Copper, and the unhealthy suppuration made healthy so that the cure 
is thus made possible.” He gives a case of a boy, aged eleven, in whom 
“a slight, unfrequent, dry cough,” became gradually stronger and 
more troublesome. The expectoration became thicker, at length yellow 
and sweetish in taste. The boy was confined in bed and wasted away 
For weeks he had chills and heat in the evening, and sweats in the 
morning. Complexion sallow, eyes deep set; skin moist and flaccid 
pulse small and frequent. Percussion yielded a dull sound below both 
* British Journal of Homoeop. Oct. 1860, p 540. 252 
DISEASES OF THE SANGUINOUS FUNCTION. 
clavicles, and beneath the scapulae, and the respiratory murmur was 
in these places indistinct and scarcely audible; by very deep inspira- 
tion there was a slight ronchus sibilans. Tongue clear, and taste 
natural; appetite bad. Daily five to eight very foetid, watery, brownish 
stools. There was no hereditary predisposition to tubercles. Ordered 
six drops of tincture of Acetate of Copper every hour. 
Four days later it was seen that the diarrhoea had ceased and the 
appetite had returned; the morning sweats and evening fever were 
more moderate, the cough was less frequent, and the expectoration 
diminished. The Copper was continued for fourteen days more, when 
there remained no more morbid symptoms. The percussion and 
auscultation symptoms had vanished; and the patient continued well. 
We have often seen good results from the third trituration of Cuprum- 
sulph. in advanced cases of phthisis. In a recent case, though it failed 
to save life, it produced such palliation of the cough and restlessness 
that the intelligent attendants were afraid to give the minute powder 
in solution as often as it had been ordered. They thought it must be 
strongly sedative. In curable cases in psoric constitutions we have 
found the general dyscrasia and debility slowly removed. “ Its effects 
are best shown where there is great and permanent structural change 
in the stomach. Excessive vomiting with great exertions, and ex- 
tremely oppressive anxiety. Violent pain in the stomach ; oppression 
of the stomach, colic, obstinate constipation; diarrhoea; nocturnal 
emissions.”* 
In the third stage, Arsenicum and Sulphur will be found appropriate. 
Dr. Pope says: In a well-marked case of acute tuberculosis, of ap- 
parently hopeless character, in a girl of a highly strumous constitution, 
Arsenicum' and Calcarea, given alternately produced a most rapid and 
unexpected change resulting in complete recovery. 
Kreosote.—Constant, spasmodic, violent cough accompanied by 
violent retching: the expectoration copious, mucous and purulent; the 
patient can not lie down without great distress; stitching pains in the 
chest; bitter taste in the mouth; cadaverous breath ; frequent green- 
ish, watery diarrhoea; hectic fever; copious secretion of the mucous 
membranes and abscesses which are excessively offensive in character, 
accompanied with depression of nervous power. In these conditions, 
says Dr. Kurtz, Kreosote is much more effectual than Arsenic, which is 
usually prescribed.—(Ilygea.) 
China, is given in the third stage of phthisis. In a discussion on 
this disease reported in Transactions of the British Homoeopathic 
Society, No. 3, Drs. Kidd and Yedham spoke most highly of the 
results they had obtained from the pure tincture of China in the ad- 
vanced stage of phthisis. The power of China and the Sulphate of 
* Noack and Trinks. PHTHISIS PULMONALIS. 
253 
Quinine in arresting the destructive metamorphosis of tissues is only 
beginning to be appreciated. See Vol. I., p. 488. 
Bromine.—An article in the Monthly Horn. Review, Nov. 1861, 
recommends Bromine as a valuable remedy in acute tuberculosis. 
Phosphorus in combination with Lime.—Dr. Churchill in his 
paper in the Dublin Hospital Gazette, Aug. 18, 1847, states that 
the “proximate cause, or at all events, an essential condition of the 
tubercular diathesis is the decrease in the system of the Phosphorus 
which it contains in an “ oxygenizable state of the Hypo-phosphites 
of Lime and Soda, he says : These articles are soluble and assimilable. 
They induce “ manifest increase of nervous power, sometimes even 
from the first day of their administration, together with an unusual 
feeling of comfort and strength. At the same time the nervous symp- 
toms, if they have any, disappear ; also functional derangements, irri- 
tation of the intestinal mucous surfaces. The appetite increases often 
in an extraordinary manner. The evacuations become regular and 
more abundant; the perspirations, if they have existed, cease ; sleep 
becomes calm and profound.” He reported in 1858, thirty-five cases, 
all of whom, he says, were in the second or third stage of phthisis. 
Of these “nine were completely cured, eleven experienced great 
amelioration, and fourteen died.” 
The experiments of Dr. Churchill have now been repeated on a large 
scale in Europe and America, and a great amount of experience has 
been published. The hypo-phosphite of Lime, when successful at 
all, is so in minute and attenuated doses ; we give it, not to supply 
either Phosphorus or Lime to the blood, but as the means of dynamically 
correcting functional derangements, and thus enabling the system to 
select from the food the various basic elements necessary for the 
blood. 
Alcohol in Large Doses.—Alcohol in phthisis is often capable of 
affording transient relief from symptoms which might not long require 
its use ; it is also useful in small doses in nearly all cases; but it is a 
perilous remedy when prescribed in large doses for conditions which 
we know will demand its constant repetition for a long period. Its in- 
fluence is proved to be curative to a certain extent, but there must be 
some limit to the size of the dose. It is prescribed by some practi- 
tioners in this city on the presumption that there is something in 
consumptive diseases to give the debilitated sufferers perfect immunity 
from the bad consequences of this poison.—If we had only to look to 
the lungs and the general tubercular condition we might safely give 
large quantities of alcohol; but the stomach is also the seat of disease 
in nearly all consumptives. For weeks or months before death they 
suffer from pain and tenderness of the epigastrium, loss of appetite, 
thirst, frequent vomiting of acid matters. These symptoms often cause 254 
DISEASES OF THE SANGUINOUS FUNCTION. 
more difficulty than the pulmonary disease ; and after death, M. Louis 
found the stomach softened or partially destroyed in texture in about 
one-fifth of the fatal cases ; and he supposed this change to be the result 
of inflammation. It is probable that he was mistaken in his opinion on 
this point, and that the solution of the coats of the stomach is effected 
by the action of the gastric fluid which has retained its digestive 
power after death. But can it be possible that burning, irritating 
draughts of alcohol even largely diluted, can exert any soothing or 
invigorating influence upon a patient affected with any of the symptoms 
just enumerated? See Vol. I., 668. 861. 
The influence of Alcohol on the liver must not he overlooked. In 
all the commonest cases of phthisis in every stage, the liver is in a state 
of torpor or congestion; the blood which should flow rapidly through 
it from the stomach finds its course obstructed; the capillaries of the 
mucous membrane of the latter organ are congested; the appetite, 
though sufficiently craving, is capricious, morbid. If strong brandy 
can be taken without sensible and immediate injury, it is because the 
case is nat a bad one. If it be long co itinued it must increase and 
render incurable the structural disease that already exists. If in large 
doses it does not intoxicate, it can only be that our patient has al- 
ready reached that deplorable condition in which he finds it “ impos- 
sible to get drunkif it does intoxicate, it shows that the patient has 
already entered upon that downward course of physical and moral de- 
gradation in which recovery of health is impossible; and if it were 
possible, to the patient whose earthly existence is thus prolonged, life 
itself would be of little value. 
In the effort to support the strength of a consumptive patient by 
stimulants, we encounter a danger which in acute diseases is not feared. 
The patient who has passed the crisis of an acute disease sustained by 
stimulants can hear to have the dose repeated at intervals for the pur- 
pose of keeping up uniform action, since we know that it will not long 
be needed. In chronic cases, if we attempt to avert the depression 
which follows the exhilaration of each dose, we may indeed effect it for 
a time; but the augmented reaction is increased in force each time it 
is postponed; and it becomes at last so painfully depressing that the 
patient can not resist the instinct that prompts to the effort to put it off 
again, though at the expense of rendering recovery hopeless.* So de- 
cidedly has Alcohol been seen to produce injurious effects in all the 
febrile forms of the disease, that many authors have decidedly forbidden 
all stimulating drinks; as Dr. Epps (p. 237.) says, 11 Wine is poison in 
this disease and so is ale (in reference to the sick, pale ale) is deep- 
dyed delusion.” 
Haemorrhage from the lungs is supposed to occur in more than half 
* Brit, and Foreign Med. Chir. Review. PHTHISIS PULMONALIS. 
255 
the whole number of patients affected with phthisis. When profuse, and 
the blood of a bright arterial color, we have almost uniformly relied 
on Hamamelis, alternated with Aconite. Millefolium is often effectual. 
In a case in which the life of the patient seemed endangered by mental 
excitement, we gave a solution of Tannate of Quinia 3; followed by 
almost instantaneous curative effects. See Yol. I., p. 800. 
Aconite and Arnica are the medicines commonly prescribed, and 
these are our best remedies when the haemorrhage is active.* 
Acetate of Iron has given more prompt and marked results than 
any other remedy—a drop or a two-drop dose every twenty minutes ; 
or less frequently, in proportion to the severity of the attack. 
This preparation is an uncertain one, and subject to rapid chemical 
decomposition on exposure to the air, or on being united with water. 
The Per-chloride is more manageable and perhaps equally effica- 
cious. 
All the salts of Iron seem to be similar in their mode of action. 
Ipecac, is oftefi given with success. 
Dr. Kidd says Turpentine, five or six drops every six hours, is a most 
efficient remedy. 
Mr. Yeldham relies greatly on China. In the form of Tannate of 
Quinia, as mentioned above it acts almost instantaneously, and is unob- 
jectionable in a patient saturated with ague poison, and in momentary 
dread of death. 
The most absolute rest and silence; cold applications to the chest; 
a small piece of ice held in the mouth, are recommended as highly im- 
portant. 
Acalipha-indica.—Introduced to the profession in this country by 
Dr. Tonnieire, of Calcutta, in a letter to Dr. W. E. Payne. While taking 
it for jaundice it seemed to bring on cough and haemoptysis; it was 
then used in consumptive cases with haemorrhage; in three cases it 
promptly checked the bleeding. 
Dr. W. II. Holcombe says, a negro had pneumonia for which he was 
treated by cupping and blistering, Aconite and Phosphorus. “He got 
up and about, but remained weak and spiritless, had no appetite, and was 
constantly hawking up mouthfuls of fluid red blood. There was little 
or no pain in the chest, or cough, no night sweats, but some emaciation, 
and remarkable slowness of pulse.” Ipec. 3. and Hamamelis 3. lessened 
the red blood for a day, but the next it was red as ever. “The crepitant 
rale was heard over the upper half of both lungs, and there was slight 
dullness on percussion.” For three or four weeks the disease resisted 
all treatment devised, and was growing worse: “ constant and severe pain 
in the chest, on distressing cough, pulse one hundred to one hundred 
and twenty, expectoration of liquid blood more profuse ; dullness on per- 
* Dr. Pope, p. 37. 256 
DISEASES OF THE SANGUINOU8 FUNCTION. 
cussion increased, emaciation progressing ; the patient gloomy and de- 
spairing, though very unwilling to die ; pains in the chest; nightly cough 
and the bloody expectorations were distressing. Gave Acalipha-indica, 
twenty drops of seventh dilution in a glass of water, — a spoonful every 
two hours. 
Next morning the bleeding had ceased, pain and cough greatly de- 
creased. In a day more, pain, cough and expectoration all gone. Ten 
days later the man felt perfectly well, fine appetite, perfect secretions 
walked five miles home. 
2. ACUTE PHTHISIS.—ACUTE CONSUMPTION. 
GRANULAR PHTHISIS.-PHTHISIS GRANULEUSE. 
Though ordinary consumption is eminently a chronic disease, lasting 
several months or more, we frequently meet with cases which pass ra- 
pidly through all its different stages, and end fatally. Dr. Flint 
one patient had been in good health when he was attacked by haemor- 
rhage from the lungs. He passed rapidly into confirmed phthisis, and 
died in seventeen days from the first attack. But in these cases there 
is perhaps always a predisposition and often a latent tubercular deposit 
already existing, as in that same case, in which there had also been a 
slight haemorrhage several months before, though the subsequent hack- 
ing cough without expectoration was so slight as to excite no appre- 
hension. 
In true acute phthisis there is no known or suspected tubercular de- 
posit till the acute disease begins; but, after that time, the deposit is 
remarkably abundant, extensive, and it undergoes the changes of soften- 
ing and expectoration with great rapidity. 
More correctly still is this name given to the form of the disease, in 
which there is an accumulation in great numbers of gray semi-trans- 
parent granulations, either remaining isolated, or coalescing, and giving 
rise to a species of infiltration. This is thought to be essentially distinct 
in its nature from ordinary phthisis. The granular deposit may effect 
both lungs, and death may ensue before there is time for softening and 
excavation. 
Diagnosis.—The tubercular deposit being developed in both lungs 
so equally, the dullness on percussion is not so distinctive as in chronic 
phthisis. Auscultation may only furnish such phenomena, as the vibrat- 
ing and bubbling sounds, and sub-crepitant rale, belonging to acute 
bronchitis. There are not the exaggerated resonance, broncophony and 
fremitus that denote tuberculous solidification. 
Symptoms.—Chills, followed by some degree of fever; pulse rapid 
with heat and dryness of the surface; great muscular prostration; BRONCHIAL PHTHISIS. 
257 
notable increase in the frequency of the respirations, with or without 
great suffering from dyspnoea; lividity of the prolabia; towards the 
end of the disease, quiet delirium; subsultus tendinum and sometimes 
incontinence of urine may occur before death; pain in the chest 
not severe ; cough more or less violent, dry, or with small expectoration, 
sometimes bloody. The progress is so rapid that emaciation does not 
occur to the extent it does in chronic phthisis. 
Acute Phthisis is less strongly marked than chronic phthisis. If 
the positive symptoms of the latter form of disease are present in an 
inferior degree, but the case is progressing rapidly, then acute phthisis 
may be suspected. 
From the frequency of respirations, dyspnoea, lividity and rapidity 
of circulation we might infer disease of the heart; but the latter 
ought to be positively known by conclusive physical signs, and thus 
distinguished. 
Acute phthisis is distinguished from pneumonitis by the latter 
having physical signs which show solidification over the whole lung 
(in adults) commonly the lower lobe, and it travels from lobe to lobe. 
In the former the disease is developed simultaneously in both lungs, 
the upper portions of the lungs being most affected. 
Treatment.—Our main reliance must be placed upon the following 
remedies in this malady: Aconite, Phosphorus, Stibium, Bryonia, 
Stannum, Mercurius-hydriodicum, Ammonium-carbonicum, Kali- 
hydriodicum, Digitalis, Lobelia-infiata. For the most part, we pre- 
scribe these medicines at the first attenuations. 
TUBERCULOSIS OE THE BRONCHIAL GLANDS.—BRONCHIAL PHTHISIS. 
Enlargement of the bronchial glands is a common accompaniment of 
pulmonary tuberculosis, though the symptoms during life do not always 
suggest this condition. In the cases in wdiich tuberculosis is limited to 
these glands they may increase considerably in size; they may go 
through processes similar to those which they undergo in the lungs, 
producing cavities communicating with the bronchia, or the oesopha- 
gus, or even the pleural cavity. The glands primarily affected are 
those situated near the bronchia; thence the disease extends to the 
glands imbedded in the lungs, in the direction of the bronchial sub- 
divisions, also to those in the pericardium, the oesophagus, and the large 
vessels in the anterior mediastinum. 
It is only wThen the bronchial glands are the seat of tuberculous de- 
posit, when at the same time tubercles are not present in the lungs, 
that the disease gets the appellation of bronchial phthisis. It is a 
disease peculiar to childhood, and is rare then, for generally cases be- 
ginning in this form soon run into true pulmonary phthisis. 
VoL. II.—17. 258 
DISEASES OF THE SANGUINOUS FUNCTION. 
Prognosis. Recovery takes place in a few cases only: the rest are 
fatal, generall y by progressing into confirmed phthisis pulmonalis. 
Diagnosis.—This is difficult, as explorations of the chest are with 
difficulty made in children’s cases; it is difficult in them to distinguish 
this disease from true tubercular consumption. 
Bronchial Phthisis is common after bronchitis, and its symptoms 
continue to appear. The cough assumes a paroxysmal character like 
that of whooping-cough. There may be oedema of the face and swell- 
ing of the veins of the neck, arising from the pressure of the bronchial 
glands on the vena cava. Respiration more or less hurried; loss of flesh 
observable, but with great fluctuations in degree.* Lymphatic glands 
of the neck frequently enlarged. 
Physical Signs.—Pressure of enlarged bronchial glands on one of 
the bronchi may produce feebleness or suppression of the respiratory 
sound on one side. Dullness in the interscapular region on percussion; 
broncial respiration remains in its ordinary site, the interscapular space 
behind, and in the neighborhood of the sterno-clavicular junction in front, 
and there it may be exaggerated. Mucous rales, and perhaps gurgling 
sounds in the same vicinity. If phthisis pulmonalis exist it will be re- 
cognized by the persisting cough, cinneration, night-sweats, &c., clia- 
racterestic of that disease. 
In simple acute bronchitis there is generally disparity of resonance 
between the two sides on percussion; and the bronchial rales are less 
marked, but more manifest at the summit of the chest; less abundant 
expectoration; dyspnoea and increased frequency of respiration, 
greater than in ordinary acute bronchitis, but less marked, less dan- 
gerous, and the course of the disease longer than acute general capil- 
lary bronchitis. 
Acute Bronchitis. 
Generally not present, except diarrhoea, 
which may occur in the latter stages, 
when the tuberculization affects the 
intestines. 
There is no eruption. 
Accelerated breathing a marked fea- 
ture, with dyspnoea more distinct and 
severe than in any case of typhoid. 
No such preliminary stage. Mental 
symptoms less marked, appear later. 
Typhoid Fever. 
Has characteristic abdominal symp- 
toms : as tympanitis, iliac tenderness, 
gurgling, diarrhoea. 
The Typhoid eruption is positive when 
well marked ; but is not always present. 
This only present when it is compli- 
cated with pneumonitis, which physical 
signs should detect. 
Preceded by a preliminary stage; 
mental characteristic phenomena appear 
early and are very prominent. Pul- 
monary symptoms only show them- 
selves at a late period, not at the be- 
ginning. 
* West on Diseases of Children, p. 283. SCROFULA. 
259 
In thac very rapid, and generally fatal form of phthisis, described as 
acute pulmonary tuberculosis, or tubercular pneumonia, the symptoms 
correspond to Phosphorus. Iodine or Hepar-sulphur. 
Phosphorus in health produces emaciation, glandular affections, 
scrofula, hectic fever, night-sweat, falling off of the hair, dry and 
burning throat, hawking of mucus, chronic looseness of the bowels, 
aphonia, cough with rawness and hoarseness, cough with purulent 
expectoration, also of blood or tenacious mucus, heavy fullness and 
tightness of the chest, palpitation of the heart, pneumonia, phthisis. 
Treatment.—Our principal remedies in this disease are, Phospho- 
rus, Iodine, Kali-hyd., Kali-bichrom., Bryonia, Kali-phosphite, 
Sanguinaria, Carbo-veg., Ilepar-sulph., Calcarea-ca.rb., Ammonia- 
carb., Senega, Mercurius-hyd., Prosera, Belladonna. 
We have witnessed the best results from the first and second at- 
tenuations of these medicines. 
Prussiate of Potash.—We find this remedy strongly recommended 
for phthisical catarrh and also in pulmonary tuberculosis attended 
with “excessive cough and expectoration; inordinate action of the 
heart and hectic fever.” (Dr. Dutcher, Med. Reporter, Yol. VIII., 
p. 408. Lancet, Cincinnati, Feb. 1862. Dr. Smart, Maine Amer. 
Jour. Med. Sci. No. 13.) 
Permanganate of Potash.—This is a new remedy not yet well 
proved. It is the best of all known disinfectants and is believed to 
possess the depurative and other useful properties of other preparations 
of Potassa. 
GENUS VI. — STRUMA. 
1. SCROFULA.—KING’S EVIL. 
This disease was described by the Greeks under the appellation 
icoTpaOeg from %o2 poc, hog, and by the Latins scrop hides, (from scro- 
ll ha, female swine.) This name had its origin in the well-known fact, 
that scrofula was a disease peculiar to the above-named animal. 
The blood of scrofulous subjects has been found to differ materially 
from that of healthy individuals. In the former, there is a super- 
abundance of serum and a deficiency of the fibrinous portion, and the 
solids which are generated from this blood are, in consequence, lax, 
feeble, and incapable of resisting exposure, fatigue and disease. 
Scrofula is for the most part hereditary, but the physician is fre- 
quently presented with well-marked cases • of the acquired disease. 
The circumstances which favor the formation of an original scrofulous 
dyscrasia, are: cold and damp habitations, want of healthy and 
nutritious food, constant confinement at labor in close and ill-ventilated 260 
DISEASES OF THE SANGUINOUS FUNCTION. 
rooms, and finally, the use of pork in all its forms, as a principal 
article of food. Respecting this last cause, we submit to a few re- 
marks: Since the time of Moses, a large portion of mankind have 
looked upon swine as an impure animal and unfit for food. Its im- 
purity consists of a disorder of a purely scrofulous character which is 
inherent in this animal and peculiar to it, and is constantly being de* 
veloped, especially during confinement and subjection to the ordinary 
modes of feeding. 
Recent observations show that the new disease called trichinasis 
originates in the use of flesh of hogs, which, though appearing 
healthy, have in their flesh the germs of the living flesh-worms or 
trichina. When pork containing them is taken into the stomach the 
calcareous capsule which invests the parasite is digested: the flesh- 
worms are set free ; and in one day or less they begin to multiply in 
vast numbers. They then irritate the mucous intestinal membrane, 
pierce the walls of the intestines and ultimately make their way to the 
muscular fibres which they eat and destroy. On one occasion in Ger- 
many all persons who ate of the sausages prepared from a single hog, 
“died the slow death of exhaustion from nervous irritation, fever, and 
loss of muscular power. No case was benefitted by medical treatment.” 
It is absurd to argue that flesh contaminated with the scrofulous 
miasm, can not communicate to the healthy body, after digestion, its 
morbid particles. The poison pervades every atom of the affected 
flesh, and no washing or digestion can destroy or banish the noxious 
quality. 
Scrofula is most common in temperate latitudes, where the changes 
of temperature are abrupt, and where the atmosphere is much of the time 
loaded with moisture. The miasm operates upon almost every struc- 
ture ; glands, skin, ligaments, membranes, muscles, and bones, all 
succumb to its attacks. 
Diagnosis.—The signs which are supposed to indicate the scro- 
fulous habit, are : precocity of intellect; blonde hair; light com- 
plexion ; blue eyes: soft and delicate cheeks ; lips thick red ; 
“ frequent swelling of the upper lip and nose,” edges of the eyelids red 
and prone to inflammation; scurf and eruptions on the scalp; large 
head; sensitiveness to cold ; ends of the fingers blunt instead of ta- 
pering ; muscles soft and flabby ; morbid sexual propensities. These 
marks are generally supposed to characterize the scrofulous habit, but 
it has occurred to us to witness far more cases of scrofula in individuals 
the very opposite of this description; but whether or not this is the 
result of accident or whether an erroneous impression has prevailed 
upon the subject we will not now attempt to decide. Amongst the 
most common and simple manifestations of scrofula may be ranked, 
glandular swellings of the neck. SCROFULA. 
261 
These enlargements may occur very frequently during childhood, 
in the form of what are vulgarly termed “ kernels,” on different parts of 
the neck. They are excited into activity by taking cold, by currents 
of air upon the neck, by measles, scarlatina, and whooping cough, 
and either remain for a long time stationary and inactive, or run on to 
more violent inflammation and suppuration. These swellings sometimes 
attain a very large size, involving most of the glands of the neck, and 
remain in this condition for many years. More frequently, however, 
owing to injudicious allopathic treatment, the swellings are dispersed 
by external applications, the malady is forced to embody itself upon 
the lungs, and a fatal phthisis pulmonalis is the result. 
The next form of scrofula to which we shall call attention, is that in 
which the joints become affected. The most important of these affec- 
tions are the 
2. WHITE SWELLING. (ARTIIROCACE,) AND THE HIP-DISEASE. 
The approach of these maladies is commonly gradual and insidious. 
Occasional pains are complained of in the diseased joint, after exer- 
cise ; the motions of the limb gradually become impaired, and vague 
pains are experienced in the neighboring joints, which induce the be- 
lief that healthy parts are the seat of the inflammation. As the disease 
advances, the ligaments, cartilages, and other structures composing 
the joint become so much thickened by the inflammatory action, that 
the limb after a time becomes stiff, and the joint immovable. In some 
instances the inflammation is arrested at this point, the suppurative 
process is prevented, and a recovery by what is called anchylosis, 
takes place. But in the majority of cases the disorder proceeds on 
to suppuration, the whole structure of the joint becomes involved in 
this action, a profuse discharge of matter takes place from the part, 
constitutional disturbance is manifest in the form of emaciation, de- 
bility, night-sweats, and other symptoms of hectic fever, and the 
patient soon succumbs. Scrofulous affections of the joints are very 
difficult of detection in their early stages. The pains are so vague and 
indefinite, as scarcely to attract attention: there is little or no swelling 
or discoloration over the disordered part; and there is no derange- 
ment of the general health which indicates that the organism is suf- 
fering under a serious malady. It is for this reason that the disease 
is allowed to make serious progress before its true nature is suspected. 
Like its near relative, the consumption, it strikes silently, but deeply 
and fatally. See p. 176. 
Another scrofulous disease, common in infancy, is known as 262 
DISEASES OF THE SANGUINOUS FUNCTION. 
3. STRUMOUS DISEASE OF THE MESENTERIC GLANDS. 
The characteristic signs of this malady, are : Wasting of the limbs, 
pale and alternated appearance of the skin, tumefaction and tender- 
ness of the abdomen, sunken eyes ; irregular state of the bowels, 
variable appetite, passage of partially digested food, general irritability. 
After the disorder is seated, the process of absorption is suspended, so 
that only a small amount of nutriment arrives at the blood, and the 
sufferer is soon reduced to that condition which medical men recognize 
as marasmus. See Yol. I., p. 884, 890. 
Although the mesenteric glands sometimes suppurate, yet much 
more frequently the victims to mesenteric disease die from actual star- 
vation. 
The only hope of cure in these cases is in a detection of the malady 
at its onset, and the services of a thoroughly competent physician. 
In a previous chapter we have already treated of another, and per- 
haps the most dangerous form of scrofula, under the head of phthisis 
pulmonalis, or tubercular consumption, to which we refer the reader. 
There are other scrofulous affections of the different parts of the 
organism, as the brain, the liver, the skin, the spleen, and the spinal 
marrow. The Index under proper heads may be consulted with refe- 
rence to this subject. 
Hahnemann has included scrofula as a form of psora, but evidently 
on insufficient grounds. Psora is contagious, scrofula non-contagious. 
The matter of psoric eruption is capable of communicating its simili- 
tude by inoculation ; that of scrofula is innocuous when inoculated. 
Psora, in its specific development upon the skin, assumes the appear- 
ance of a vesicular eruption; scrofula makes its appearance in the 
form of extensive ulcers, abscesses, &c. The psoric miasm exercises 
its specific affinity upon the skin; the scrofulous miasm upon the 
glandular system. Psora is no respecter of persons, but attacks all 
constitutions, temperaments, and organizations alike ; scrofola is sup- 
posed to select its subjects from those who are daintily formed, and 
possess peculiarities of organization ; psora is readily cured by anti- 
psorics; scrofula always requires much time, and is often absolutely 
incurable by any course of treatment. Psora can not be artificially 
acquired, by any particular mode of life, or any particular food : with 
scrofula it is the reverse. Finally, the development of the psoric 
miasm, when it is clear and apparent, is always specific and uniform, 
viz : in the vesicular eruptions of a peculiar appearance upon the sur- 
face, and the malady is unequivocally contagious; while the develop- 
ment of the scrofulous miasm is subject to very great variations, but 
for the most part attacking the glands, rather than the skin, and de- 
cidedly non-contagious. SCROFULA, 
263 
Causes.—The scrofulous habit is, in most instances, inherited. In 
its hereditary subjects we may notice from birth radical unsoundness 
of constitution, an irritability, sensitiveness to slight exposures, prone- 
ness to catarrhal difficulties, and an inability to resist diseases, which 
is non-apparent in healthy children. The acquired scrofulous habit 
is generally amongst the poor, who are ill-fed, clad, and housed. We 
have before alluded to the causes which especially induce this variety 
of the disease; they are also the chief exciting influences of the 
hereditary dyscrasia. Atmospheric vicissitudes, abuse of stimulants, 
venereal excesses, masturbation, intestinal irritation, excessive mental 
and physical occupation, scarlatina, measles, abuse of mercury, iodine 
and other drugs which unduly stimulate the glandular system, also ex- 
cite the latent disorder. 
Treatment.—It has been observed that scrofulous persons are pe- 
culiarly sensitive to cold, and that abrupt changes from heat to cold, 
in a moist region, are especially calculated to cail into active operation 
the latent malady. For this reason it behooves those who are liable 
to this affection, whether by hereditary or acquired predisposition, to 
dwell, if possible, in a warm and equable climate. When the lungs 
become affected, this course will often be necessary in order to save 
life. In all scrofulous diseases, too much stress can not well be laid 
upon the importance of a mild, dry, and uniform temperature. 
The food of scrofulous subjects should always be of the most nutri- 
tious character, in order that a due proportion of fibrine may be intro- 
duced into the blood. Fresh meats, like beef, mutton, venison, fowls, 
and veal should constitute the principle articles of food; and bread, 
rice and other farinaceous substances should be made to take the place 
of watery and succulent vegetables. • Porter, ale, and light wines may 
also be used moderately with advantage. 
Much exercise in the open air is also essential. In taking exercise, 
it is of the utmost importance that the mind should be agreeably occu- 
pied, for if we walk or ride as a task, we shall obtain very little 
benefit. 
Bathing, both in fresh and salt water, is also a means of securing 
a healthy action of the skin, and of imparting tone and vigor to the 
whole system. 
The clothing should always be adapted to the season, and in tem- 
perate and cold latitudes we strongly advise the buckskin wrapper to 
be worn over thin linen, silk, or Canton-flannel under-shirt. We com- 
mend the use of these garments during the winter from personal ex- 
perience. Yol. I., p. 197. 
The remedies most deserving of confidence in the treatment of scro- 
fula, in its various forms, are: Sulphur, Ilepar-sulph., Mercurius, Io- 
dine, Baryta, Dulcamara, Conium, Belladonna, Lycopodium, Sepia., 264 
DISEASES OF THE SANGUINOUS FUNCTION. 
Calcarea-cafb., Rhus-tox., Aurum-muriaticum, China, Ferrurn- 
iodide, Mercurius, Oleum-jecoris-aselli. 
Sulphur.—Scrofulous ulcers on different parts of the surface; 
humid eruptions behind the ears; purulent discharges from the ears ; 
scrofulous ophthalmia of children, with eruptions about the eyes, and 
ulcers on the cornea; chronic enlargement of the tonsils ; enlarged 
ovaria; swelling of the axillary glands ; swelled nose; frequent nose- 
bleed ; swelled upper-lip ; swelling of the glands under the lower jaw ; 
enlargement and suppuration of the inguinal glands; swelling of the 
posterior cervical glands ; white swelling of the knee; emaciation; 
chronic inflammation of the eye-lids; scrofulous ophthalmia, attended 
with great intolerance of light, and sense of fullness and distention of 
the lids; pulmonary cough, with sticking pains in the chest, and co- 
pious purulent expectoration ; inflammation and pain in the knee and 
hip-joints ; itching pimples upon the scalp, and pain at the roots of 
the hairs ; stitching pains in the ears and in the parotid glands ; pain- 
ful swelling of the upper-lip and alas, of the nose; pain in the region 
of the liver after exercise; pain in the abdomen on pressure, and in the 
inguinal glands ; sensation of weariness and fatigue in all the limbs ; 
want of vitality, sensitiveness to cold; pains worse during cold weather; 
despondency, alternating with gaiety; irritable, insolent and dis- 
contented. 
Administration.—One grain of the third trituration every twenty- 
four hours, until the beneficial effects are visible. 
In the treatment of scrofula, as in all chronic diseases, we generally 
succeed best with the remedies given in the higher dilutions and re- 
peated at longer intervals than we usually depend on in acute cases. 
On this point Dr. Lutze says: 
“ In cases of chronic diseases, or diseases which run a long course, 
have existed for years, and deeply taint the organism, as deafness, 
blindness, gout, paralysis, old eruptions, open sores and old ulcers, 
fistulse, herpes, curvatures of the back and bones, caries of the bones, 
the medicine should never be frequently repeated, nor should the 
same medicine be given twice in succession. Each dose should be 
allowed sufficient time to develop its full effect, since it is the subse- 
quent action of the drug that achieves a cure.” 
In such cases the practice of the author now is to dissolve “ three 
to five pellets of the 30 th potency in a cupful of fresh water, of 
which I give a swallow morning and evening for four or five 
days, after which I allow the medicine to act for three or four 
months, sometimes even for five or six months, or even longer, 
%f the improvement continues: if it should cease, and three months 
should have elapsed, I then give another remedy. 
“ The reason why I do not give another remedy under three months SCROFULA. 
265 
(except in case a ;ute symptoms supervene,) is, because I have noticed 
that the primary action of the drug is sometimes not developed under 
two or three months, after which a cure takes place, which could not 
have been accomplished if I had not waited a sufficient length of time 
to allow the medicine to manifest its full action, or if I had interfered 
with it by the untimely repetion of the dose. 
“ The curative process should not be viewed as materially as it very 
frequently is. The properly-selected remedy starts the cure, the 
natural curative power finishes it.” 
Sulphur.—Case by Dr. Lutze.—“Mr. H. from Holstein. Age 40 
years. Almost constant pain in the left side of the chest; frequent 
yawning, sneezing and eructations. Occasional pain and swelling in the 
pit of the stomach, empty eructations when pressing upon this region. 
Deaf of the left ear from his infancy. Swelling at times of the left 
cheek, at other times of the mouth, nose and eye. Stiffness in the nape 
of the neck. Drawing pains in the left thigh. Weakness of the stomach 
and nerves. In former years, inflammation of the glands and lungs. 
He had the itch when young, which had been removed with an oint- 
ment. I sent him four powders, to be taken in eight weeks. No. 1 
containing four pellets of Sulphur 30, which were to be dissolved in a 
cupful of water, a swallow to be taken morning and night for four days. 
After eight weeks the following report was sent to me: A few weeks 
after taking the medicine, all the symptoms grew worse, but in three 
weeks a general improvement set in. The left ear began to discharge 
again, which had not been the case for years, and the flatulence and 
pains in the chest have abated, so that the patient feels much better. 
I sent four powders of Sugar of Milk, for the effect of Sulphur now first 
began to show itself. The next report being still more favorable, I 
continued the non-medicinal powders. Twelve months after the com- 
mencement of the treatment, I received the following report: 1 The hear- 
ing of the left ear, which had been deaf these thirty-two years, is re- 
stored, and I am cured, except a small swelling near the left eye and 
some stiffness of the nape of the neck.’ Another non-medicinal dose 
completed the cure. One dose of Sulphur 30 did all this in the space 
of four months.” 
After some other cases as strong or stronger in the testimony they 
give in favor of the principle contended for by Dr. Lutze, he thus con- 
cludes this section: 
“These cases show that no second dose of a remedy should be given 
as long as the first dose has not exhausted its action, and in cases 
where no effect is observed, as in case of deaf and dumb patients, we 
allow a dose to act at least for three to five months; since it is impos- 
sible to know what is going on in the interior of the organism, and it is 
so easy to injure the salutary action of a drug by the untimely exhibi- 266 
DISEASES OF THE SANGUIN0U8 FUNCTION. 
tion of another remedy of which we have had repeated instances in the 
case of externally perceptible ailments.” 
Iodine.—Hahnemann (Chronic DiseasesYol.il.) says : “ Iodine is 
particularly indicated by the following symptoms: Dizziness in the 
morning; beatings in the head; smarting in the eyes ; buzzing in the 
ears; hardness of hearing ; coated tongue ; salivation ; taste of soap in 
the mouth ; sour eructations with burning; heartburn after eating heavy 
food; canine hunger; nausea; shifting of flatulence ; meteorism; con- 
stipation ; wetting the bed; delay of the menses ; cough ; old morning 
cough ; difficulty of breathing; external swelling of the neck ; lassitude 
of the arms in the morning, in the bed; numbness of the fingers; dis- 
tortion of the bones ; dryness of the skin ; night sweat.” Teste says, 
these are only the secondary symptoms of Iodine, and that the primary 
ones are exceedingly similar to Ipecac. The effect of excessive doses 
may be seen in a case given by Dr. Gairdner in a work on Iodine : A 
young English lady had bronchocele for which Iodine was prescribed 
Eor a time the action was favorable and the tumor was diminished; but 
a gnawing pain commenced in the stomach; great oppression and anx- 
iety. The remedy was pressed further. In a week she became ema- 
ciated ; there were vomiting, pain in the abdomen most severe; thirst 
distressing ; alarming diarrhoea; excrutiating pain in the stomach; vio- 
lent cramps and convulsive actions of the muscles, arms, back, and 
legs; vomiting and purging of feculent, thin, bloody, slimy, or dark 
green matters, streaked with blood; tongue loaded with thick crust of 
the same color; countenance pale, contracted with peculiar expression, 
denoting abdominal suffering; pulse small, hard, frequent, scarcely to 
be numbered; inability to swallow. She was only relieved by repeated 
warm anodyne embrocations to the pit of the stomach and feet; hot 
bath. For ten days she had frequent attacks of diarrhoea, with intense 
abdominal pain; arms and body became almost fleshless; the breasts, 
which had been large, were almost flat; calves of the legs almost dis- 
appeared; thighs little larger than the wrists in health. Dr. Gairdner 
says, he never before saw such rapid and complete emaciation; and 
the French nurse exclaimed “ de Charnee /” She was subject to re- 
lapses for many months, with frequent, violent spasms of the stomach. 
Her nervous system was so deranged that she never enjoyed one hour 
free from the most wretched depression of spirits. 
A work by M. le Dr. Labourdette, shows the therapeutic advantage 
of the milk of animals, medicated by digestive assimilation, in passing 
certain drugs in an infinitesimal form through their bodies. This work 
was discussed in the French Academy of Medicine, April 26,1859, in the 
course of which M. Trousseau proclaimed the dynamic action of drugs 
and showed that their curative power in the smallest doses was not de- 
pendent on contact of the drug in its crude form with the living organ- SCROFULA. 
267 
ism. Iron, he said, was now known to be only assimilated in infini- 
tesimal proportions, and was chiefly useful in stimulating the assimilative 
organs to help themselves from the common food ; that milk from a cow 
or nurse will act by virtue of dynamic properties, imparted by the gene- 
ral state determined in the animal, irrespective of the quantity of 
mercury which it contains. M. Chatin gives in the Gazette des Jlopi- 
taux cases of goitre, cured by the administration of vegetables, con- 
taining Iodine, after Iodine in a crude state had failed. 
Marasmus.—Iodine.—M. Grange having advised the use of iodized 
food for goitrous patients. M. Rilliet of Geneva, where goitre is very 
prevalent, made a trituration of Hydriodate of Potash, to be given in the 
food in the proportion of one part to a thousand, which was supposed 
to be perfectly innocent; and thus seasoned the food of those for whom 
he prescribed. But he soon found unsatisfactory results. * 
“ Two ladies, past 60, and a gentleman, past 45, belonging to differ- 
ent families,” wrere attacked by “ emaciation, palpitations, accelerated 
pulse, general trembling, great nervous mobility and diriflnution of 
strength.” M. Rilliet had forgotten his iodized food, and was perplexed. 
Was it “ incipient heart-disease, latent diabetes, or a chloro-anaemic 
state, due to causes undetermined?” He had seen similar symptoms 
follow’ the use of Hydriodate of Potash, in doses of of a grain daily; 
made out the nature of the new’ disease; and cured his three patients 
in the course of several months. One relapsed by going to the sea- 
side, came near phthisis, and recovered after a country residence and 
drinking asses’ milk. Another lady near 60, by a short residence on 
the seaboard, “ returning to Geneva, she was excessively thin, her pulse 
at 130, and her nervous system highly excited. She recovered in twro 
months under change of air and drinking asses’ milk. These two pa- 
tients had taken no Iodine, and must have inhaled it in the sea air. M. 
Rilliet concludes in opposition to the authors who had recommended 
iodized food: 
1. “That the long-continued absorption of small doses of an iodized 
salt, whether mingled with wrater, air, or food, is not free from danger. 
2. That the inhabitants of certain localities are more than others ex- 
posed to iodic toxication.” 3. That this special susceptibility depends 
on the Iodine in the air, water, or aliments furnished in these places. 
4. That iodic poisoning is more to be dreaded when given in small than 
in large doses. 5. That these results are more to be feared in persons 
advanced in life; and w’hen Iodine is taken by persons past the fortieth 
year, it should be suspended on the first symptoms of saturation. These 
symptoms are: “ Canine appetite, emaciation, palpitations, nervous sus- 
ceptibility.” 
Dr. Rilliet might have saved himself and his patients some trouble 
* Gazette Hebdomadaire. 268 
diseases of the sanguinous function. 
by studying the pathogenesis of Iodine long ago, given by Hahnemann: * 
“ Over-excitement of the whole nervous system; ebullition of blood and 
pulsations over the whole body, increased by any effort; trembling, 
tottering gait; great debility; atrophy; extreme emaciation ; general 
oedema. Pulse accelerated, hard and stnall; consumptive fever; vari- 
able appetite—either excessive or absent; digestion very feeble ; dys- 
pepsia ; suffocation; is blown on going up-stairs, with violent palpitations 
and cramp-like pains about the heart on the least effort.” 
Exercise.—Muscular Motion.—This being a disease in which the 
lymphatics are specially implicated, and these vessels having no central 
organ of impulse, like the heart, to propel their contents forward, the 
support given to their walls by the feeble tissue surrounding them is but 
small, and some additional aid to propel the fluid is necessary. The 
lymph itself is imperfect, arising from imperfect nutrition; and all these 
circumstances conspire to cause stagnation in the lymphatic vessels, and 
those glandular enlargements characteristic of scrofula. Muscular con- 
tractions, wThen not accompanied by nervous exhaustion, propel the lymph 
forward and toward the general current of the venous circulation. The 
walls of the lymphatics are supported by the tonicity of the adjacent 
tissue ; and the lymph itself is more perfect, because the functions of 
the muscular and glandular systems are more perfectly performed. 
Animal Magnetism.—This disease was called centuries ago the 
“King’s Evil,” because it was believed that the sovereign was imbued 
with a peculiar virtue, by which he could cure it by the laying of his 
hand on the diseased person. The first king of England who was sup- 
posed to have this virtue, was Edward the Confessor, f The power was 
transmitted to his successors. In the reign of Charles the Second, in 
the course of fourteen years, no less than 92,107 patients were touched 
by the king’s hand; and according to Dr. Richard Wiseman, Sergeant 
Surgeon to the king, the most of these were cured or benefitted. | 
The power of Edward the Confessor to cure scrofulous disease by 
the “ laying on of hands,” was so fully believed in by the people of 
England that Shakspeare introduces it as a feature in that monarch’s 
character in the tragedy of Macbeth. (Act IV., Vol. I. p. 334). Mal- 
colm inquires of the doctor: 
“Comes the king forth, I pray you? 
Doctor. Aye, sir : There are a crew of wretched souls 
That sir: his cure. Their malady subdues 
The great essay of art, but at his touch, 
Such sanctity hath Heaven given his hand, 
They instantly amend. 
Malcolm. I thank you, Doctor. 
* Materia Medica Pura. t Million of Facts. 
J “ Surgical Treatises on Tumors, Ulcers, &c.” SCROFULA. 
269 
Mac Duff. What is this disease he means ? 
Malcolm. ’Tis called ‘ The Evil!’ 
A most miraculous work in this good king; 
Which often, since my here-remain in England, 
I have seen him do. How he solicits Heaven 
Himself best knows ; but strangely visited people, 
All swollen and ulcerous, pitiful to the eye, 
The mere despair of surgery he cures ; 
Hanging a golden stamp about their necks, 
Put on with holy prayers. And ’tis spoken, 
To the succeeding royalty, he leaves 
The healing benediction. With this strange virtue, 
He hath a heavenly gift of prophecy ; 
And sundry blessings hang about his throne 
That speak him full of grace.” 
Phus-tox.—External indications : Tinea capitis ; soft tubercles on 1 ke 
hairy scalp; scrofulous ophthalmia, with photophobia, and an erupt* Dn 
about the eyes ; chronic swelling and induration of the parotid glaud, 
the axillary, and other glands; enlargement of the bones ; herpetic 
and moist or dry scurfy eruptions in different parts of the body ; swell- 
ing and other signs of inflammation in the hip and knee-joints. 
Pain in the hip-joint, increased on pressing the trochanter major, 
and attended with the shortening of the limb, and alternating pains in 
the knee; pains of white-swelling, and scrofulous affections of the 
ankle-joint; scalp painful to the touch, or from moving the hair back- 
wards ; inflammation and tenderness of the edges of the eye-lids ; eyes 
sensitive to light; eye-lids itch and feel swollen ; crusty eruption in 
the nose, and about the mouth; repugnance to bread and other food; 
stitches in the side ; short, or anxious, and painful cough ; oppression 
of the chest; glandular swellings, painful when touched; stiffness and 
lameness of the limbs; very sensitive to the open air; pains worst 
during inaction, or in the cold air. 
Ill humor; languor; disinclination to all mental or bodily exertion. 
Administration.—A drop of the third dilution each day, as long as 
may be seemed necessary. 
Iodine.—Enlargement of the cervical parotid, thyroid and tonsil 
glands: scrofulous inflammation of the knee, with swelling, heat, and 
redness; elongated and enlarged uvula; induration of the os uteri; 
glandular indurations in different parts of the body; rough and dry 
skin; general emaciation ; hectic appearance. 
Physical Sensations.—Catarrhal affections of the mucous mem- 
branes depending on scrofula ; swelling and pain in the liver; inflam- 
mation in the knee, with stitches and burning, and increased pain on 
motion of the joint or from pressure; contraction of the oesophagus 
from enlargement and inflammation of the glands and mucous mem- 270 
DISEASES OF THE SANGUINOUS FUNCTION. 
brane, with stitching pains during deglutition; enlarged mesenteric 
glands; tumid abdomen with pains on pressure; swelling and pain in 
the bronchial glands ; glandular swellings about the neck and axilla, 
painful, especially on pressure; itching and pimples on the arms and 
chest; general debility; hectic fever; pains aggravated by exercise, 
by contact and by warmth. Nervous irritability and increased sensi- 
tiveness to external impressions. 
Administration.—Same as Rhus. 
Baryta-mur.—Chronic induration of the cervical glands ; scrofulous 
eruptions and ulcerations; tinea capitis; enlargement of the liver, of 
the testes, and of the mammae ; chronic inflammation of the eyelids. 
Physical Sensations.—Itching eruptions of the scalp ; general ema- 
ciation and debility ; scrofulous disease of the throat, aggravated after 
cold ; scrofulous affections of the ears, attended with throbbing and 
itching, and discharge of purulent matter; inflammation and suppura- 
tion of the tonsils; pains in the affected joints and in the long bones; 
liability to sore throat after every cold ; disease of the mesenteric 
glands in children; pains, mostly on the left side, when sitting, and re- 
lieved by exercise in the open air; adapted to old men and young 
children. Imbecility ; absence of mind ; impaired intellectual powers. 
Administration.—The second or third attenuation may be given— 
a dose daily—until the requisite impression is produced. 
Dulcamara. — External Indications. — Moist and suppurating 
herpes, forming crusts, or scurvy, branlike eruptions ; swellings of the 
cervical and submaxillary and inguinal glands; swelling of the calf of 
the leg; emaciation; scrofulous inflammation of the eyelids. 
Physical Sensations.—Pains in the enlarged glands, particularly on 
motion; great susceptibility to cold ; pains in the joints on exposure to 
cold; pains worse during rest; paralysis of the upper eyelids; phthisis 
pulmonalis, before the tubercles commence softening ; pulmonary symp- 
toms brought on by repeated colds; pains in the chest; febrile symp- 
toms ; lassitude; bruised sensations. Disposition restless, angry, and 
quarrelsome. 
Administration.—In the same manner as Baryta. 
Conium-maculatum.—Swelling, induration, and suppuration of the 
external glands ; malignant scrofula ; caries of the bones ; scrofulous 
photophobia; diseased mesentric glands in children; enlargement and 
induration of the liver and pancreas. Scrofulous swellings, which 
evince a disposition to run into schirrous degenerations; pains in the' 
bones and in the malignant ulcerations; inflammation, swelling and pain 
in the ovaries; painful swelling of the uterus ; pain in the region of the 
liver, when walking; purulent expectoration from softened tubercles ; 
intolerance to light, in consequence of scrofulous ophthalmia; dull pain 
in the knee, when stepping; bruised and sore feeling in the calves of SCROFULA. 
271 
the legs ; pains worse durii g rest and in the night. Dullness of intel- 
lect ; want of memory; irritability. 
Remarks.—For indurated glands, Dr. Johannsen asserts that “Co- 
nium in the second dilution stands highest as a remedy, and next to it 
Mercurius-solubilis.” 
Clematis-erect a.—(Boenninghausen) Clinical indications for this 
remedy:—Indurations, resulting from inflammation; glandular indura- 
tions of inguinal glands; of the testicles ; of the penis ; of the urethra; 
interrupted emission of urine ; purulent urine ; purulent deposit in the 
urine ; general eruptions ; squamous exanthemata; squamous tetters ; 
herpes, with shooting pains ; horror of bathing one’s-self; exacerbation 
from application of lotions (in diseases of the skin); the same from 
warm fomentations. 
Clematis is particularly suited to persons of mature age, to those of 
florid complexions ; of relaxed, cachectic, and scrofulous constitutions. 
Administration.— We advise the third attenuation—a dose daily 
until its effects are apparent. 
Belladonna.—Glandular swellings, with suppuration; ulcers; ema- 
ciation ; inflammation and swelling of the bones; eyelids inflamed; 
ulcers upon the cornea; photophobia; swelling of the lips, nose, tongue, 
uvula, tonsils ; bleeding at the nose ; swelling and spongy gums. In- 
flammation and pains in the enlarged glands, and in the periosteum and 
bones; diseased mesenteric glands, with atrophy; inflammation of the 
eyes, with heat, redness, and great intolerance to light; pain in the 
ball of the eye; double vision ; roaring in the ears ; painful swelling of 
the parotid gland; soreness of the throat; impeded deglutition; lame- 
iess of the limbs,when moved; smarting and burning pains in the hip- 
joint, increased by contact or motion, and during the night; painful 
ulcers on the skin ; sensitiveness to cold air; adapted to the scrofulous 
affections of children and females of a mild temper. Irritability; 
amorous, nervous, excitable, talkative. 
Administration.—Same as Conium. 
Lycojpodium.—For the scrofulous dyscrasia, and especially where 
the periosteum, bones, and cervical glands are affected. This remedy 
is adapted to lymphatic constitutions. 
Sepia will be found an efficacious remedy in scrofulous females who 
are troubled with irregularities in the menstrual functions. It has been 
employed successfully in indurations of the uterus, corrosive leucorr- 
hoea, and in pulmonary phthisis with profuse purulent expectoration. 
Calcarea-carb.—According to Hahnemann, Carbonate of Lime is 
indispensable in those cases where the menses appear too early and 
are too profuse. It is also appropriate in young persons of scrofulous 
habits. In children presenting the usual marks of the scrofulous dys- 
crasia, it is one of our most valuable remedies. It is highly recom- 272 
DISEASES OF THE SANGUINOUS FUNCTION. 
mended likewise in the scrofulous ophthalmiae of children, particularly 
after ulcers have formed on the cornea. Also in marasmus, arising 
from diseased mesenteric glands, it is an admirable remedy in alterna- 
tion with Iodine. Scrofulous eruptions and ulcers of children often 
yield to this remedy, after Sulphur, Mercurius, and Hepar-sulphuris 
have been used in vain. 
Ilepar-sulphuris is adapted to the cure of scrofulous ophthal- 
mia with profuse lachrymation, and much mucous discharge from the 
meibomian glands, and in morbus coxarius or coxalgia, after a purulent 
discharge has occurred. This medicine is proper for scrofulous and 
lymphatic constitutions. 
“Arsenicum is one of the most important remedies in scrofula, for 
removing indurations of the glands and deformities of the hones, for 
regulating the discharges from the bowels, and for restoring the skin 
to a healthy state. Also in scrofulous ophthalmia it is of great ser- 
vice.” {Dr. Johannson, Homoeopathic Journal, Vol. I., No. 11.) 
Administration.—As a general rule, the first to the third attenua- 
tions should be selected, and the doses repeated once or twice daily, 
until a satisfactory impression is produced on the affected structure. 
Mercurius.—This remedy is advised by Hahnemann in scrofula, 
combined with syphilis. The glandular inflammations will be charac- 
terized by a diffused redness, much swelling and gnawing, stinging or 
darting pains, worse at night in bed. It should be consulted in affec- 
tions of the bones, the joints, the eyes, and in eruptions and ulcers 
upon the surface. The following preparations of Mercurius we es- 
pecially commend in scrofula: Merc.-solMerc.-iod., and Merc.-prce- 
cip.-rubrum. 
Aurum-mur., Ferrum, and China are worthy of consideration in 
protracted and obstinate cases, where the strength of the patient has 
become much impaired, and but little impression has been made by 
the previous remedies. 
Hartmann observes that he has derived essential benefit from Oleum- 
jecoris-aselli, {cod-liver oil) in every form of the disease, especially 
in the precursory stage, wThen no particular organ was affected; the 
patient looked pale, emaciated, the muscles became flabby, the patient 
showed an aversion to meat and vegetables, and wanted to eat bread 
and butter all the time. I gave it in tea-spoonful doses, morning and 
evening, almost always with success. In scrofulous affections of bones 
it likewise proved useful, but less so in other forms of the disease.” 
{Hartmann's Chronic Diseases, Yol. III., p. 54.) 
Dr. J. H. Bennett, of London, has found the cod-liver oil of great 
service in scrofulous cases characterized by general or local atrophy, 
But in scrofulous affections in which the general health continues 
unimpaired, and the digestive functions are not deranged, Dr. B. BRONCHOCELE. 
273 
advises Iodine. We have employed the oil in doses of a drachm, 
three times daily, with eminent success in almost every form of 
scrofula. 
For scrofulous ulcers with callous edges, and fistulas, Silicea alone 
or in alternation with Phosphorus, Acid-phosphoric., and Conium 
were found by Dr. Johannsen most useful. 
When the ulcers are greenish and offensive, Carb.-veg., or Mer- 
curius-dulc. is advised. 
In scrofulous ophthalmia, indurated glands, and diseases of the 
bones, Arsenicum, Conium, Mercur.-sol., Hepar-sul. and Aurum, are 
the best remedies. 
BRONCHOCELE — GOITRE. 
This disease is characterized by a tumor on the front of the neck, 
seated between the trachea and the skin, occupying principally the 
typhoid gland. It is a true hypertrophy and is divided into three prin- 
cipal forms, accordingly as the vascular, glandular, or connective 
tissues are involved. 
1. Vascular Goitre.—a. Congestion of the Thyroid Gland.—• 
This gland is abundantly supplied by large vessels distributed in lax 
cellular tissue ; and it is the organ, next to the spleen, most liable to 
considerable changes of size from congestion. The effects of congestion 
generally go no farther than simply to engorge the gland with blood. 
Sudden turgescence of the gland during life, is often found to have 
originated from suppressed menstruation, and in young persons from 
masturbation. In some cases it becomes permanent, especially after 
puberty in females subject to amenorrhoea. 
b. Thyroidean Apoplexy.—Excessive turgescence of the gland 
may cause a rupture of a vessel, and the effusion of blood. M. Bach 
says, he has found coagula of blood enclosed in a dense cellular pouch. 
The coagulum undergoes the same changes as in other apoplexies, and 
may lay the foundation of what is called cystic goitre. The vessels 
of the gland may become atrophied by the pressure. The goitre may 
become smaller and harder. A cicatricial tissue may form and extend 
into other tissues and render the gland extremely hard. A calcareous 
deposit may be found in this cicatricial tissue. 
c. Aneurismal Goitre.—This has been described, but is extremely 
rare. 
d. Vascular Parenchymatous Goitre.—The part becomes isolated 
from the sound parts by condensed cellular tissue, so that the de- 
generated lobules may be easily enucleated. The lobule is deep red, 
the granular structure disappearing. The vessels are sometimes dilated 
and gorged with blood; the vessels toward the centre are dilated, tho 274 
DISEASES OF THE SANGUINOUS FUNCTION. 
surrounding tissue becomes denser, the capsules almost disappearing. 
The minute vessels of the capillary system become encrusted with cal- 
careous matter. (.Ecker.) 
2. Parenchymatous Bronchocele.—This consists of hypertrophy 
of the thyroid gland, properly, an abnormal development of the glandu- 
lar capsules distended by a gelatinous fluid. Dr. Bach found some 
capsules containing within them others, the inner being separated from 
the outer one by a fluid, and being formed of cells like those constitut- 
ing the normal contents of the capsules almost all containing a nucleus 
some enclosing one or more young cells. The centre of the capsule 
appears hollow and contains young capsules. When these are a half 
millimetre in length they are already diseased. Gelatinous snbstance 
enters the capsules by endesmosis and distends the anhistous membrane. 
The young capsules are formed of cells by endogenous generation, and 
are clothed later by an anhistous membrane. The young cells of the 
young cysts only acquire nuclei at a later period. Rokitansky says, 
the thyroid gland is endowed with great powers of reproduction. This 
hypertrophy of this gland is often endemic ; it may exist at birth. The 
child respires long and deeply, with a feeble plaintive tone, heard at 
considerable distance; expiration is painful; drinking may be im- 
possible. Bach saw a child suffocated by the pressure of the external 
part of the gland so far as to produce irritation on the pneumo-gastric 
nerve. A symptom indicating this was the excretion of an enormous 
quantity of bronchial foam. He thinks some cases of thymus asthma 
are due to a posterior development of the thyroid. 
Treatment.—Aconite in acute cases ; in chronic enlargement of the 
gland give Iodine, Iodide of Potash, Calcarea. 
3. Transformations in tiie Structure of the Thyroid Tissues. 
—The stroma of this gland is a fibro-cellular tissue in which ramifies 
a net-work of blood-vessels. It is liable to be changed in part into 
fibrous tissue, and its primordial texture is the same as that of normal 
fibrin. One of the characters of accidental fibrous tissue is its 
retractibility; it may also undergo the fatty, osseous, or cretaceous 
(chalky) transformation. Air may also be effused amidst the cellular 
tissue, and other new products may be there developed. 
a. Cellular Goitre.—Ilildenreieh saw a goitre which grew very 
rapidly in a man aged sixty. It consisted of cells irregularly shaped, 
some of their cavities intercommunicating, and their walls containing 
cartilaginous or osseous matter, and consisting mainly of new fibrous 
tissue. The fluid within them was serous, gelatinous, and bloody. 
The glandular element was not visible. 
b. Emphysematous Goitre.—Larrey’s “ aerien.” It is produced by 
rupture of some portion of the air-tube. 
c. •Cystic Goitre.—A cyst is developed in the midst of the normal BRONCHOCELE. 
275 
elements of the thyroid gland, and contains new fluid or solid for- 
mation. It may originate from a pathological blastema, inflammation, 
the transformation of an apoplectic coagulum, or the degeneration of 
glandular capsules. 
Scirrhus, Encephaloid, tubercle, and hydatids of the thyroid have 
not yet been proved to exist, though Larrey, and others, have described 
some of them. The walls of the cystic goitre consist of a layer of 
cellular tissue amidst which fibres are deposited. New vessels are 
developed within the walls, and its internal surface is lined with 
epithelium. Posteriorly the walls are very thin and transparent. The 
vessels pressing the wall forward become weakened and are often rup- 
tured from evacuation of the cell-fluid. The wall may pass into a state 
of cartilage, (enchondroma,) and in the course of years may become 
ossified. The contents of the cyst may be : 1. Serum from blood 
effused, or endesmosis; but it contains no fibrin, is incapable of or- 
ganization, but may be absorbed. Other products may be formed as 
the serosity disappears,—such as crystals of cholesterine, and salts of 
lime. 2. Colloid matter, a colorless or yellowish gelatinous mass, 
containing no cells. {Bach. Mem. Imjper. Acad. Med.) 
Causes.—Bronchocele is an endemic disease, being remarkably 
prevalent in certain localities, as Derbyshire, England, and the deep 
damp valleys of the Alps. But the precise physical peculiarities of 
these localities has not yet been ascertained. It is not confined to 
certain elevations or latitudes, and has been observed in every climate in 
both hemispheres. Its origin is usually ascribed to the water used by 
the inhabitants of the region where it most prevails. Popular belief 
refers goitre to the use of snow-water, and we have seen the goitrous 
tumor enlarge during the use of snow-water in winter; but certain 
fountains and rivers are more notorious as sources of this disease, of 
which the Saskatchawan river, in British North-America, is one of 
the most remarkable. Dr. Richardson attributes its influence to the 
presence of magnesian lime-stone, which he found in that river. {Nar- 
rative of Franklin's Expedition to the Polar /Sea, dec.) Dr. M’Clelland 
has endeavored to show, that goitre in India is everywhere found in 
the localities in which the water is impregnated with carbonate of 
lime. In the United States we find lime-stone water in every part of 
many states, and in almost every locality we meet with cases of en- 
larged thyroid gland. They are more common in women, and especially 
those subject to ovarian activity. 
Treatment.—At a moderately early period of this malady, we 
entertain no doubt, respecting the entire success of an expert homoeo- 
pathic treatment. The influence of minute doses of carefully selected 
remedies, over these glandular enlargements, is often truly astonishing 
But to prove most efficient the higher potencies must be employed. 276 
DISEASES OF THE SANGUINOUS FUNCTION. 
The principal remedies are: Iodine, Calcarea-carb., Kali-hyd. 
Merc.-hyd., Hepar-sulph., Arsenicum-hyd., Kali-brom., Sepia, Silicea, 
Bromine, Conium, Spongia. 
We usually prescribe Iodine, Calcarea, Ilepar, Arsenicum, Sepia, 
Silicea, Conium and Spongia in the high attenuations repeated at long 
intervals. Kali-hyd., Kali-brom., and Mercurius-hyd., at the first and 
second triturations, and the dose repeated two or three times a day. 
Iodine.—Its best powers are displayed in causing the absorption of 
the products of exudation, and of capsules in process of transformation 
into colloid matter. It never causes the absorption of voluminous 
cystic goitres containing colloid matter; it exerts no action on those 
cysts containing serosity, or such as have undergone tertiary trans- 
formations. It has no effect upon cellular goitre or in that accompanied 
by carcinomatous or other morbid products. 
Iodine may be expected to be successful in dispersing “the parenchy- 
matous cystic goitre, on condition that this is principally due to the 
degeneration of the capsules, and that the vascular element does not 
predominate.” [Mem. Imper. Acad, de Med. Paris, 1855.) 
Dr. Henderson said in his first edition, that Iodine was known as a 
remedy for goitre before it was known to be capable of causing it; and 
homoeopathists prescribed it as a homoeopathic remedy, “ because they 
believed, and had no doubt that experience would ultimately prove 
that its curative action was dependent on its capacity to produce the 
disease ; though the circumstances necessai’y for such a pathogenetic 
effect have not yet been discovered.” In his second edition he says: 
The expectation expressed in his former edition has has been ful- 
filled. A man taking five grains of Ilydriodate of Potash twice a day, 
after eight days became affected with “a rapidly growing swelling of 
the thyroid gland.” [Brit. Jour.) 
Spongia.—In the thirteenth century x-oasted sponge was employed 
in this disease by Arnold de Yilleneuve. It is used homoeopathically 
for the following symptoms : Moral and physical debility; tendency 
to start; paroxysms of anguish: sense of weariness in the upper 
portion of the body, and numbness in the lower portion ; alternate sad- 
ness and mirthfulness; fever with shuddei-ing in the back and coldness 
all over, followed by dry heat, or accompanied with sweat; dryness in 
the day-time; sleep full of dreams and fantastic visions, which some- 
times continue after waking; frequent waking with a stai’t; itching of 
the skin, as if sweat would break out; red spots ; rush of blood to the 
head; vertigo as if one would fall sideways or backwards; oppressive 
headache, at the top of the head, at the occiput or temples; stitch in 
the temples; oppressive pain in the forehead from within outwards 
fullness of the head, with heat, which is perceived by the hand, and 
sometimes sudden flow of saliva; semi-lateral headache ; sensitivenes BRONCHOCELE. 
277 
and itching of the hairy scalp; stitches in the eyes; redness and 
burning of the eyes ; lachrymation; heaviness and nightly agglutina- 
tions of the lids ; myopia ; constrictive otalgia ; retention and thicken- 
ing of the nasal mucus; nose-bleed; pale face, with sunken eyes and 
anxiety in the features; crampy pain in the articulations of the jaw ; 
blisters at the edges of the tongue, and in the inner surface of the 
cheeks; stitches in the throat; pricking sensation above the throat- 
pit ; induration of the submaxillary glands and of the thyroid body ; 
sickness at the stomach; sensation of sickness and faintness at the 
stomach, as if one had drunk a quantity of warm water; sour re- 
gurgitations ; vomiting ; constrictive pains at the stomach; pinching in 
the abdomen. Cutting colic after a meal; crampy pains in the 
groins ; swelling of the inguinal glands; diarrhoeic stools, with tenes- 
mus ; hard stools ; formication in the rectum; smarting at the anus ; 
increase of the urinary secretion; urine with a white yellow or grayish 
sediment; crampy pain in the testicles; induration of the testicles; 
premature and profuse menses. Great dryness of the larynx with short 
and barking cough ; embarrassed breathing as if the larynx and trachea 
were narrower; pain at the larynx when touching it; hoarseness, dry, 
hollow, wheezing cough, worse in the evening; excited by a sense of 
tickling and burning in the larynx and trachea; crampy pains in the 
whole chest; vascular excitement on the chest on performing the least 
movements, with dyspnoea ; anxiety, nausea and weakness, as if one 
wTould faint; anxious pain on the region of the heart; crampy pain in 
the cervical muscles ; stitches in the shoulder-blades ; wrenching pains 
at the shoulder-joint; bearing down at the elbow; drawing stitches in 
the fore-arms and hands ; swelling of the hands ; numbness at the end 
of the fingers ; twitching of the glutei muscles ; acute stitches in the 
thighs, above the knees and in the feet; stiffness of the lower ex- 
tremities. 
Spongia acts for several weeks, and is still more than Iodine a 
specific for goitre ; Hahnemann says : [Materia Mediea jPura, Vol II.), 
“ The particular swelling of the thyroid body to which the name goitre 
is given, and which is peculiar to the inhabitants of low valleys and the 
adjoining plains, depends upon a conjuncture of circumstances, which, 
although mostly unknown to us, yet seem to remain pretty much the 
same, and for that reason, constitute a disease which remains es- 
sentially the same, and against which a drug which has once effected 
a cure, ought to sIioav itself efficacious, it would seem in every case.” 
Teste says, he found many cases of goitre to resist Spongia, and he 
treated them with Ipecac, Iodium, and Bromine. 
Camphor is said to antidote Spongia. 
Calcarea.—As we have seen that calcareous waters cause goitre, 
it is also found to be a remedy. A case of diarrhoea of eighteen 278 
DISEASES OF THE SANGUINOUS FUNCTION. 
months’ duration in a child, in which physical development was con. 
siderably retarded was cured by Calcarea 30. Another rickety child 
was transformed into a healthy one by taking pounded egg-shells mixed 
with the food. Other cases might be given. 
Case by Dr. Croserio : — “A boy aged fifteen, extremely scrofulous, 
was stunted in his growth, and very thin. His limbs "were slight, and 
his head too large for his body. He suffered from violent headaches 
when attempting to make any mental exertion. He was very timid, 
afraid to be alone in the dark. Two doses of Calcarea, after one of 
Sulphur, at the interval of four or five days, between the doses, brought 
about so favorable a change that in six months he gained great increase 
of height and strength as -well as size of limb. 
“ The specificity of Calcarea on the system of nutrition indicates its 
general usefulness during the general period of development, and in 
diseases accompanied by excessive emaciation or obesity.” 
Ipecac.—Dr. Teste gives occasional doses of Ipecac, ivith marked 
success in the treatment of goitre. For aggravations caused by it he 
regards Yeratrum-album as the best antidote. 
5. CRETINISM.—STRUMA TYROLENSIUM.—CAGOTISM. 
Description.—Imperfect formation or development of the body, es- 
pecially of the cranium; mental imbecility and physical deformity in 
various degrees; the organic or vegetative functions remaining in full 
activity; goitre present in some cases, though not in all. 
The stature of the cretin is seldom above four and half feet, gene- 
rally less; cranium deformed and of a conical shape,—the forehead 
being thrown backwards, narrowed and flattened; frontal sinuses large ; 
the occiput nearly on a line with the neck, as in ruminating animals; 
flesh soft and flaccid; face broad and short; skin wrinkled, yellowish 
or pale and cadaverous, dirty, and covered with chronic eruptions ; the 
ears large, standing out from the head; the tongue is thick, hanging 
out of the mouth, which is large, open and slavering; the lower jaw 
elongated strong and prominent; eyelids thick; eyes red, small, but 
prominent, watery, far apart and squinting; pupils contracted but not 
sensible to light; nose flat; and the whole countenance is idiotic, void 
of expression, or expressive only of lasciviousness ; the chest is narrow; 
the abdomen and mammae large and pendulous; the neck is short and 
thick or long and thin ; limbs crooked, short, distorted; the lower limbs 
shorter than the upper; fingers long; the gait imperfect and waddling. 
The senses are generally defective, hearing and speech imperfect; in- 
tellect absent or only partially developed; cretins are in all respects 
slovenly sensual, gluttonous and beastly. They die early, generally be . CRETINISM. 
279 
low the age of thirty, before which time they present the appearance 
of advancing age. 
Causes.—Cretinism, like goitre, depends for its origin on endemic 
causes. In the deep, narrow, damp, malarious valleys of the Alps, the 
people reside in small filthy houses built up under the ledges of the 
rocks; in those which are most filthy, hot and close in the narrow ra- 
vines of the Valais, one of the Swiss cantons, where the air is stagnant, 
and the rays of the sun are intercepted or reflected from the mountains, 
cretinism and goitre appear in their most intense forms. “As we as- 
cend the neighboring mountains cretinism disappears and only goitre 
is seen. When we reach a certain altitude, or above 8000 feet, both 
maladies vanish.” The principal cooperating agencies which aid in 
producing the disease are: poverty, bad food, drunkenness, indolence 
sensuality and low debauchery of the parents, which naturally result in 
the infirmity of their children. The water in regions where cretinism 
prevails, contain calcareous and other mineral substances in solution; 
and cretinism, as well as goitre are to a considerable extent patho- 
genetic effects, or drug diseases produced by these agents long-used. 
Treatment.—The first remedial measure in the treatment of cre- 
tinism is the removal of the patient from the influence of local causes 
which have originated the disease. The experiment has been made on 
a satisfactory scale by Dr. Juggenbuhl, who has established a hospital 
for cretin children in a high and healthy region on the Abendberg in 
the Bernese Alps. By devoting his whole attention to the recovery of 
these mosthopeless objects of philanthi*opic compassion he has succeeded 
in restoring about one-third of all that came under his care to health 
and the exercise of reason, and greatly improved all others. Cretinism 
generally makes its appearance in the second year, and from three to 
six are necessary to effect a cure; though at an early stage it is effected 
in one or two. This institution gave to the world the first example of 
the power of education and health-promoting influences in removing 
the physical evils which accompany idiocy; and it has been imitated in 
this country and elsewhere in the numerous asylums for idiots. 
The influence of a proper physical training is no where better shown 
than in the cure of idiocy and cretinism. Dr. Odet, a physician of Switzer- 
land, who was himself a cretin, chose cretinism as the subject of his 
thesis, when examined at Montpellier, for the degree of M. D. In liis 
dissertation he says, “it was by following these curative means that a 
learned physician, whom I am proud to own as a near relation, has been, 
enabled to replace me in the rank of a man.” “ It was also by forti- 
fying the physical system that we were enabled to develop, little by 
little, the intelligence of my youngest brother, who while still an in- 
fant, was separated from his mother by order of his physician. Cre- 
tinism seized upon his intellectual faculties under the mask of some of 280 
DISEASES OF THE SANGUINOUS FUNCTION. 
the maladies incident to childhood. In the second stage the treatment 
was commenced, but time and patience were necessary. At the age of 
eight years he began to make himself understood, at nine he arti- 
culated some entire phrases, and at eleven he was fitted to enter an 
academy.” 
Case by Dr. Juggenbuhl.—M. D. of Fribourg, was five years old on 
his entrance. His parents were healthy, but they inhabited the lower 
part of the town, which was subject to cretinism; one of his brothers 
was also a cretin. M. was slow in learning to hold up his head, to 
stand and to walk. The glands of the neck were swollen. He had 
strabismus, a thick tongue and the rudiments of goitre. lie soon 
learned the letters of the alphabet and to pronounce little phrases; but 
his memory was so feeble that he would often forget on one day that 
which he had learned the day previous. An exercise much prolonged 
could alone remedy this evil. But his physical strength progressed 
gradually with his moral powers. His complexion is now animated 
and has the tint of health; his step is firm and his body robust; 
thanks to gymnastic exercises and good air. He can already read a little 
and distinguish colors. Remedies.—See Scrofula and Goitre, p. 276. 
Genus VI.—CARCINUS.—CANCER. 
DISEASES CHARACTERIZED BY VITIATED OR DISEASED CELL 
DEVELOPMENT. 
The difference, says Williams, between a primitive cell and a mass 
of organized structure, is not simply one of magnitude. The primitive 
cell, though not strictly an organized body is infinitely less complex 
than the mass, and constitutes the ultimate limit of organized structure. 
When the formative blastema assumes the attributes of organization, a 
cell is the first visible form under which it presents itself; it is an atom 
of organic matter; so that the ultimate cells of organs are the imme- 
diate agents of the organic processes / the elaboration of nutrient 
matter, in all its stages and disintegrations for the purpose of secretion 
and elimination, are essentially cell-phenomena. 
Organic laws to which the cells, in common with larger masses, 
are subjected.—1. A definite scale of development is assigned to 
the primary organic cells proper to the various structures of the body. 
These cells pass through prescribed gradations of growth, the duration 
of their life period being equally pre-limited. The typical elements 
of a primary cell are three only; first an external sac (cell membrane); 
then a smaller vesicle (nucleus), which contains a smaller (nucleolus). 
Apply this description to the ovum / first is the vitelline capsule—the 
second the germinal vesicle, enclosing the third, the germinal spot. CANCER. 
281 
Mr. Budge, the German micrographer, reduced a frog to a state of 
emaciation and then laid hare a small muscle of the leg, and under the 
aid of a microscope counted with precision the number of its elementary 
fibres. By proper feeding he now restored the animal to health, and 
when its size was fully restored, he counted with the same minuteness 
the elementary fibres of the same muscle. He found that the fibres 
were considerably increased, as well in number as enlarged in bulk. 
Primary cells propagate themselves by the reproduction of others 
like themselves. When the malignant tendency has been once es- 
tablished in a part by the organization of a cancerous primary cell, 
in virtue of this power inherent in the cell of multiplying its kind, the 
continuance of the destructive process in the part is certain and in- 
evitable. 
Diseased Manifestation of Cell-Development.—Morbid tissue is 
generated within the economy in strict conformity with the laws that 
preside over foetal development. But, as we have already seen, both 
nervous influence and catalytical agency, give rise to a variety of dis- 
eases when they are swayed by disease-causing influences from their 
natural course. Thus also in some cases the power of histological 
evolution may create positive disorder in the system. An immense 
and uninterrupted movement takes place within the organs of which 
the body is composed, for the purpose of supplying new tissue in the 
place of those which are no longer fit to accomplish the functions de- 
volving upon them; let this unceasing activity be diverted from its 
proper channel, and the production of tubercle, cancer, and all kinds 
of morbid deposits will be the immediate consequence. 
We here find, as in other cases, an evident connection between the 
phenomena of health and disease,—between physiological activity and 
pathological influence. It is in this light that we are led by the re- 
searches of Virchow to look at this subject. 
General View of Cell-Formation.—1. Some diseases result in the 
first place from total absence or considerable deficiency of normal evo- 
lution on a given point. The mucous membrane of the intestinal canal 
affords a fine example of incessant development. New layers of epi- 
thelium are continually being secreted to line its inner surface; but 
the living medium, or blastem, is necessary to their production, and 
whenever this blastem itself happens to be altered in its essential 
properties—the modification which always occurs in inflammation, the 
epithelium disappears, and is no longer regenerated. (See Vol. I., p. 
646, and Vol. II., p. 181.) 
Cholera also exhibits an example of this ; for it has been incontestibly 
proved that in this disease the vessels that ramify in the internal 
surface of the intestines are completely laid bare. 282 
DISEASES OF THE SANGUINOUS FUNCTION. 
1. CANCER.—CARCINOMA. 
The name was given by the Greeks, and derived from itapiuvog, a 
crab, from the large blue veins, resembling the crabs-claws, which 
appear upon its surface. A painful scirrhous tumor, which terminates 
in a fatal ulcer. (Cullen.') 
Conditions Essential to the Production of Cancer.—1. Consti- 
tutional causes which lead to the development of the cancerous element 
in the blood by deranging the functions which preserve this fluid in a 
healthy state : 2. Local causes which separate the morbid material 
and transform it into cancerous deposit, which may replace the propel 
textures of the part or become incorporated with them. The cancerous 
element must first exist in the general circulating fluid before the local 
•injury, or perverted nutrition from some other cause can produce 
cancer. When these proper conditions exist, any organized structure 
may be involved by the disease. 
Progress and Development of Cancer.—Its earliest condition is 
that of a blastema, or fluid. It is described as a firm, compact 
amorphous substance, resembling coagulated fibrine, sometimes con- 
taining molecular granules of modified protein or fat. In this blastema, 
cells are developed which are supposed to be of a specific nature, 
presenting appearances different from the cells of the ordinary healthy 
tissues; the cell-wall and its nucleoli, and granules are generally 
larger, more varied in form, as round, oval, caudate; the cell-wall is 
also extremely thin and pale ; and the action of acetic acid renders it 
so transparent as to display the neucleus and its nucleoli distinctly. 
Some of the granules, nucleoli, and nuclei, are without any distinct 
cell-wall; they all progress to the stage of parent-cells ; each possesses 
amazing reproductive power, and is supposed to produce a second. In 
some cases a fibrous tissue is developed from the blastema, most 
probably from the cells; and when formed it resembles the condensed 
or indurated tissue of other parts ; but it is regarded as a new formation, 
and forms the chief portion of scirrhus, the most common variety ol 
cancerous growth. (,Southam, Virchow, Vogel. See Brit. Med 
Jour. Jan. 1858, p. 5.) 
Though the specific character of cancer-cells may be suspected, it 
has not been demonstrated; and efforts to diagnose the ultimate nature 
of cancerous growth by the microscope have led some observers into 
errors. (Nelaton, Clin. Surg., Phila. 1855, p.457. See Velpeau, 
Lebert, Pobin, Mandl.) The cells found in cancerous growths may 
then be regarded as the same as those found in ordinary healthy 
growths ; but, the blastema derived from the blood being in a diseased 
state, the cells are developed under a specific influence. The cancerous 
blastema being more highly organized, that of tubercle may be CANCEE. 
283 
transformed into the caudate or fibro-plastic cells with their nuclei and 
granules; and these may reproduce others like themselves, or may 
go beyond this and form fibrous tissues of imperfect organization; and 
these have only a brief duration. 
In the ordinary effused lymph of inflammation or of healthy granula- 
tions, the cell is endowed with the power of progressive development, 
from the fibro-plastic cell, into filamentous tissue, and then, into the 
healthy permanent structures. (Southam, Brit. Med. Jour. Braithw. 
Betrosp. July, 1858, p. 28.) 
Diagnosis.—When the cancerous action commences in a tumor 
which has long been inactive, it is attended with frequent shooting 
pains; the skin that covers it becomes discolored, and, at length ul- 
cerated. Pearson says, “ when a malignant scirrhus or watery ex- 
crescence has proceeded to a period of ulceration, attended with a 
constant sense of ardent and, occasionally shooting pains, is irregular 
in its figure, and presents an unequal surface ; if it discharges sordid, 
sanious, fetid matter; if the edges of the sore be thick, indurated, 
and often exquisitely painful, sometimes inverted, at others retorted, 
and exhibit a serrated appearance; and should the ulcer in its progress 
be frequently attended with haemorrhage, in consequence of the 
erosion of blood-vessels ; there will be little hazard of mistake in call- 
ing it a cancerous ulcer.” When a cancerous tumor of the breast 
is ready to break open, it generally becomes prominent in some 
minute point, attended with an increase of the peculiar kind of burning 
shooting pain already felt in a slighter degree; a corroding ichor 
transudes through the skin forming an ulcer. Ulcers of the cancerous 
nature discharge a thin, acrid sanies which corrodes the parts; the 
lips are thick, dark colored, retorted; and fungous excrescences often 
grow from them, attended with excruciating, pungent, lancinating, 
burning pains, and sometimes with bleeding. Though every hard 
tumor of the female breast is not a cancer, all such as occur aftei 
the cessation of the menses may be regarded with suspicion. 
Pathology.—Thus far the microscope has only shown that the 
primary elements of morbid growths do not materially differ from those 
of the normal tissues; and that these constituents vary in the degree 
of their development, their mode of arrangement and in their relative 
proportion to each other. In innocent tumors the difference is slight; 
but in malignant growths there is a general want of order in the dis- 
tribution of all the elements and structures that enter into their com- 
position. The following division of the varieties of cancerous growths 
is based on the microscopic disclosures of their minute structure : 
1. Gelatiniform or colloid cancer ; marked by an excess of blastema. 
2. Cephaloma, medullary, or soft cancer; characterized by an ex- 
cess of cells. 284 
DISEASES OF THE SANGUINOUS FUNCTION 
3. Scirrhus, petrous, or hard cancer, in which the fibrous tissue pre- 
dominates. It forms a hard, unequal, indolent tumor, small in the 
beginning and increasing gradually. 
These different forms may occur separately or in different parts of 
the same tumor. 
The other varieties of carcinomatous disease are modifications of the 
above. Among them are : 
4. Hsematoid cancer, or fungus hamiatodes, in which there is an 
excess of blood, free or enclosed in vessels. 
5. Melanosis, in which there is a superabundance of coloring pig- 
ment within the cells; 
6. Ostoid cancer, or spina ventosa, in which the osseous tissue 
predominates; 
7. Cancroid, or epithelial cancer, containing an excess of epithelial 
cells; 
8. Lardaceous, or reticular cancer, in which fat-globules are infil- 
trated through the morbid deposit. (Southam, from WedVs Patliol., 
page 535.) 
The microscope also shows that the cancerous deposit exists in the 
surrounding structures where it would not be suspected. The cells and 
granules extend along the areolar tissue, entering into the tissue itself, 
and even into the nerves and coats of the blood-vessels; the natural 
structures being absorbed the cancerous deposit supplies their place. 
(Paget, Pathol.) 
The transformation of a tumor innocent in character into one more 
malignant can scarcely ever take place, though a few instances are 
given, by Sir Astley Cooper, and Mr. Brodie, in which fatty tumors 
have taken on malignant action. (Lectures, Path, and Surg., 1846.) 
Simple cysts sometimes become the seat of cancer, both in the ovaries 
and mamma as well as other parts. (Southam, Manchester Pispens. 
Brit. Med. Jour. Jan., 1858.) 
The best microscopists and pathologists of the present day deny the 
possibility of distinguishing the cancer-cell. Virchow assures us that 
he has never seen a cell-formation in cancerous structures of peculiar 
attributes. Bilbroth, who has paid great attention to the minute 
structure of cancerous growths admits that it is impossible to classify 
tumors from their microscopic appearance. He alludes to instances 
in which the same structure may be healthful in one case and malignant 
in another. Virchow demonstrates that simple connective tissue with 
its natural cellular bodies may become the focus of a structural 
metamorphosis; und sees no reason why one shall not change into the 
other. He thinks then that cancer is by no means a characteristic 
strictly defined, and under all circumstances the same process. In 
one part of the body it may at one time be a healthy structure and be CANCER. 
285 
cancerous at another time. The hyperplasy of cells does not apply to 
all forms of cancer. In scirrhus, the proliferation of cells is very 
scanty. 
Treatment.—1. External Applications.—The success claimed by 
the advocates for the local treatment of cancer has nearly always re- 
sulted from an error in diagnosis. Pretenders always claim to have 
some infallible specific, the composition of which they dare not reveal 
to the public; but they generally succeed in curing a large number of 
trifling sores and tumors which they declare to be cancers. Ignorant 
people do not question the accuracy of the impostor’s diagnosis and 
wonder at his success. When cancer really exists it can scarcely, at 
any stage, be treated by local applications without hastening the 
progress of the suspected tumor into an active cancer. The removal 
of the suspected part by the knife promises nothing better. “ In a 
large proportion,” says Sir Benjamin Brodie, “ of cases, in which the 
operation is performed, the patient is not alive two years afterwards ; 
and in a great many cases, instead of the operation stopping the dis- 
ease, it actually seems to hasten its progress ; moreover, the operation 
itself is not free from danger.” The testimony of all prominent sur- 
geons of our time will be found to confirm the correctness of this 
opinion. 
It is a principle in surgical practice, says Mr. Syme, “ that malignant 
tumors, or sores should be left free from disturbance, or completely 
removed, since tampering with them by irritating applications is the 
most certain means of exciting disease in the lymphatic glands or 
other textures.” When the nature of the disease is settled, and its 
rapid progress inevitable it should be promptly removed when its lo- 
cality and extent are such that entire removal is possible. Even 
when the nature of the tumor is doubtful, it is far better to remove 
it -when small, than to incur the risk of this most terrible of diseases ; 
though the disease may sometimes appear again, from constitutional 
tendency, or from the -whole not being removed. “ But when the 
tumor has been originated by some accident, not spontaneously; 
when it is not really cancerous in its nature; when the patient is other- 
wise healthy, when no appearance of malignancy is seen in the cancer; 
when the adjacent glands and absorbents are still unaffected; and the 
parts involved do not require that very important nerves or arteries bo 
cut, the operation may be expected to terminate successfully; but in 
such cases it is hardly possible to imagine one that would justify the 
use of the knife.” 
The Treatment of Cancer by Caustics has been more generally 
followed than any other; and up to the present time the profession 
cling to it as a lingering relic of the ancient faith. The best recent 
authorities for a modified escharotic, or “ enucleating” treatment of 286 
DISEASES OF TIIE SANGUINOUS FUNCTION. 
cancer are Drs. Mac Limont and Marston. (See the British Journal 
of Homoeopathy. May 1864, p. 481.) 
After a preliminary treatment, with which we find no fault, the 
following “ Mode of Procedure for the Removal of the Cancerous 
Tumor of the Breast” is given. “ When the skin was entire, the size 
and bearings of the tumor were carefully ascertained and mapped out 
on the breast with Nitrate of Silver or Vermillion-pigment. A mixture 
of ice and salt was in one of the cases applied to the tumor, so as to 
deaden the local sensibility; this effected, and the parts carefully 
dried; the skin over the tumor was destroyed by means of undiluted 
Nitric-acid, the action of which was kept up till the skin assumed a 
tawny and yellow aspect; (about thirty seconds being generally suf- 
ficient to produce this condition.) The part was now well douched 
with cold water, and a piece of lint applied to the surface, spread with 
equal parts of a paste (composed of a strong decoction of Hydrastis 
root, powdered Hydrastis, Chloride of Zinc and Flour,) and Stramonium 
ointment. On removing this dressing at the end of twenty-four hours, 
a yellow, hard, and dry eschar will be found to have formed. The 
amount of pain following the application of the acid varied with the ex- 
tent of surface to be destroyed ; but the congelation of the parts very 
materially lessened this suffering, which might otherwise be rather 
severe. But we always found that much after-suffering was saved by 
endurance of a little temporary smarting caused by the acid; for when 
applied too timidly, the skin was only partially destroyed, and the 
action of the paste thereon gave rise to some suffering. 
“ On removing the dressing, a slight amount of erythema is some- 
times visible around the eschar, which presents a yellow, horny, and 
dry appearance. 
“ Throughout the entire extent of this eschar vertical incisions are 
made with a sharp scalpel to the depth of about one-twentieth of an 
inch, care being taken not to draw blood. These incisions should be 
parallel to one another, at a distance of about half an inch apart, and 
into each is inserted a thin slip of calico smeared with the paste ; over 
the whole a light compress should be applied, kept in its place by a 
strip of adhesive plaster. The incisions are deepened and the dress- 
ings renewed usually every day, and this is continued until the paste 
has percolated the entire mass of the tumor.” 
The depth to wThich the incisions are carried “ must be left to the 
judgment of the operator. If the knife be used too freely, th 
bleeding will embarrass and annoy both the surgeon and the patient,” 
as well as materially increase the pain, produced in the living tissues 
by the paste. On the other hand, if the scalpel be too timidly used, 
the action may be too circumscribed or arrested too soon.” 
The time required for the separation of the slough varies with the CANCER. 
287 
size of the tumor. In general at about the end of a fortnight from the 
first operation a line of demarcation forms around the entire tumor, 
invariably commencing at its upper or least dependent portion; this 
deepens from day to day; the living and healthy tissues beneath gra- 
nulate and rise, pushing the tumor out; so that at a period verging 
from four to seven weeks, the entire mass is thrown off, leaving a much 
smaller chasm than might be expected judging from the size of the 
slough itself.” The wound gradually takes on a clean and healthy 
aspect, free from even the secretion of pus which follows the removal 
of cancer by the knife. And not only is the evil effect of the absorp- 
tion of pus avoided by this method of operating, but all putridity and 
effluvium are effectually counteracted by the antiseptic nature of the 
paste. The constitutional irritation which follows the operation, is but 
slight; the dressing of the wound after the removal of the slough 
consists only in the daily application of cotton-wool spread with Stra- 
monium ointment. It is claimed that the process of removing cancers 
by enucleation is applicable in many cases in which even the old 
surgeons would have feared to employ the knife; that it permits the 
removal of only such portions of the diseased part as may appear ne- 
cessary at the time of operating. It is only regarded as likely to be 
unsuccessful or injurious in cases in which cancerous disease has al- 
ready extended into the arm-pit, or to internal organs,—as the brain, 
uterus, mesenteric glands, stomach, or lungs; also in the cases in 
which local disease has extended to parts involving anatomical diffi- 
culties which would render surgical interference unjustifiable. 
Cancer of the Face, Lips, Cheeks, Nose and Tongue. — 
MedicaWtt'reatment.—Cancer is said to be more common on the 
lower lip, out it is often met with on other parts of the face. It de- 
velops itself out of a scurfy or ulcerated spot Avhich gradually gives 
rise to scurfy excrescences, &c.; or a portion of the lip becomes 
hard and swollen; it then becomes intensely painful and breaks. The 
cancer gradually involves the skin of the chin, the mucous membrane 
of the mouth, the gums, submaxillary glands,' destroying the whole 
lip and the bones. Some ulcers of the lip become malignant without 
being cancerous, especially syphilitic ulcers. 
Cancer of the tongue generally commences with a hard circumscribed 
swelling on one or the other side of the tongue; it is marked by 
lancinating pains, the swelling breaks, and extends rapidly. Ulcers 
in the spongy tissue of the tongue frequently become obstinate, or are 
rendered so from constant moistening by the saliva, or by the irritation 
of points of decayed teeth. The papillm frequently become hyper- 
trophied, forming spongy excrescences.—Syphilitic ulcers of the tongue 
often degenerate into cancerous ulcers. 
Cancers of these parts, as well as every other part, depend upon a 288 
DISEASES OF THE SANGUINOUS FUNCTION. 
peculiar specific disposition of the organism which may be hereditary. 
The disease may be developed by a blow or contusion; by treating an 
ulcer, an induration of or excrescence of the face, lips, or nose, by ex- 
ternal irritating applications. It may be developed by the progress 
of scrofula, syphilis ; or the suppression of habitual secretions, &e 
{Hartmann. Yol. 4, p. 31.) 
Prognosis.—When small, cancer of these parts may he cured; the 
prognosis is unfavorable when the cancer is large, the constitution en- 
feebled, and the disease has returned again after an operation. Ex- 
cision is generally useless, causes unnecessary suffering, and usually 
hastens the fatal termination. 
Arsenicum.—This is the most important remedy. We prefer the 
high potencies as we know the disease incurable by any crude medi- 
cines, however appropriate to the symptoms. We begin with the 
thirtieth dilution at least, repeating at short intervals, (every six hours) 
till some perceptible effect be produced. {Hartmann.) 
Symptoms.—Burning swelling in the nose with pain on contact; 
tumor in the nose ; ulceration of the nostrils, high up, with discharge 
of fetid ichor; — ulcers in the whole face ; wart-shaped ulcer on the 
cheek ; dry cracked lips, brown streak in the lips, as if burnt; bleed- 
ing of the lower lip ; ulcerated eruption around the lips; cancer-like 
eruption on the lower lip, with thick crust, hard, pad-shaped edges 
with burning pain, particularly when the parts become cold, and with 
a lardaceous bottom; spreading ulcer on the lip, painful in the 
evening, when in the bed, with tearing and smarting in the day-time 
during motion, which is worst when touching the ulcer and in the 
open air, disturbing the night’s rest; corrosion of the edge of the 
tongue, in front, with smarting; the tongue is blackish, cracked. 
Arsenicum often needs some other remedy with it; but it is undoubtedly 
the principal remedy when the cancerous dyscrasia has tainted the system. 
It is specific for cancer of the nose, tongue, and alveolae. {Hartmann.) 
Arsenic, says Hahnemann, is such a powerful agent that we can 
not decide whether it is more hurtful in the hands of the rash than 
salutary in those of the prudent. It has effected remarkable cures of 
cancer of the face, as described by Fallopius, Bernhardt, Ronnow and 
others. Its true power in this direction depends on its homoeopathic 
power of producing in healthy persons very painf ul tubercles, which 
are cured with difficulty, as witnessed by Amatus Lusitanus; very 
deep a'nd malignant ulcerations, according to the testimony of Hein- 
reich and Knape, and cancerous ulcers by Heinze. The ancients were 
unanimous in their praise of arsenical plasters against pestilential buboes 
and carbuncles; while Degnier and Pfann saw it give rise “to inflam* 
matory tumors which quickly turn to gangrene,” and Verzascha and 
Pfann saw it produce “ carbuncles and malignant pustules.” CANCER. 
289 
Buccal Cancer.—Cancer of Tobacco-Smokers.—Dr. Buisson, of 
Montpelier, has published sixty-eight cases occurring in smokers. The 
disease is becoming more frequent, having hardly been noticed in the 
last century. The lower lip is most frequently affected; the Spanish 
habit of expelling smoke through th3 nostrils produces epithelial vege- 
tations in the nostrils. Dentists now find it difficult to fix the plates 
for teeth in the mouths of chewers and smokers on account of the 
softening and degenerescence of the mucous membrane and sub-mucous 
tissue. A. Vogel and Reischaur, (chemists,) found tobacco-smoke in- 
variably to contain sulphuretted hydrogen and prussic-acid. 
In syphilis it is often seen that smoking localizes the syphilitic 
virus, producing the mucous tubercle in the part of the mouth 
familiarly occupied by the pipe or segar. 
Lupus.—At a meeting of the Central Society of Homoeopathic 
Physicians, of Germany, (1861) Dr. Mayer related a cure of a lupus 
on the lower eye-lid by Apis 6. A few months afterwards lupus 
showed itself again on the ala nasi, but Apis was now of no avail. 
Kirsch remarked, that Apis is not indicated in lupus; but Apis stands 
in a closer relation to the eye-lid, than to the nose. 
Cancer of the Tongue.—Sempervivum-tectorum. —Live-for- 
ever.—1. Dr. Maly, of Glatz, says: a sickly woman, at the change of 
life, had a swelling at the margin of the tongue, as large as a bean: 
burning pain on shutting the mouth; occasionally bleeding; in- 
tolerable at night; disturbing sleep; made -worse by acids; swelling 
like a cyst with two small knots, one bleeding; over the swelling three 
varicose veins. Tried Aurum, Arsenicum, Carbo-veg., in fourth, tenth 
and sixth potency; but it grew harder, larger, and impeded speech. 
Sempervivum-tectorwn juice was applied externally three times a day- 
It made the tumor smaller, but it afterwards inflamed and became very 
sensitive. Then tried two drops of the second dilution internally. This 
daily reduced the tumor to one-third in ten days, menstruation reappeared, 
which continued five days ; tumor gradually reduced in size to asmall 
pea; then less sensitive, and the patient did not return to the hospital. 
2. General B. had an ulcer on the tongue, left margin; tried 
Alumina, and Mer.-corrosivus; ulcer three-fourths to one-half inch 
deep with sharp edges, hard foundation of bluish color with four knots 
size of lentils; two large veins, sensitive while eating. 
Sempervivum-tect., first centesimal dilution in water, twice a day, 
externally applied. Second day less painful, could eat; edges smoother. 
In three or four days the veins smaller; small reddish tumors paler. 
Fifth and sixth day they disappeared, leaving the base of the ulcer 
covered w-ith whitish membrane. Seventh to ninth day, medicine 
omitted, sensibility greater. Tenth day repeated; ulcer smaller; veins 
very small. Case lost sight of. 
You II.—19. 290 
DISEASES OF THE SANGUINOUS FUNCTION-. 
3. A married woman, aged twenty-seven, had for ten days pain 
under the tongue, impeding eating and talking. On lower surface, 
near the root, is a bluish-red swelling, size of a half bean, smooth, 
hut hard; on the other side a large vein; at one point a membranous 
exudation. 
Semperviv.-iect. sixth. Two doses, one every other day, for four 
days ; no pain; after eight days much smaller ; menstruation restored 
though pregnant six months ; in three weeks nothing remains but a 
somewhat enlarged vein.—{Homoeopath. News.) 
Hydrastis Canadensis.—Dr. Bayes, of Cambridge, states, that he 
“has found the Hydrastis exercise a marked influence in relieving the 
pain of cancer, while at the same time, it has improved the general 
health of the patient.” But he has also seen, “ that very sudden pros- 
tration of strength has accompanied the continued use of the remedy 
beyond a certain point.” Dr. Bradshaw, {Brit. Journal of Homoeo- 
pathy. Oct., 1861,) gives five cases in which Hydrastis was used with 
the following results : In case No. 1. the patient suffered from “ un- 
mistakable carcinoma” of the left breast. He “ gave her one pilule of 
Hydrastis four-times a day,” with benefit to her general health; 
and he speaks of the remedy as “evidently exerting an absorbing, 
counteracting influence over the scirrhous tumor.” 
In another case of scirrhous tumor in the left breast the disease 
“ remained stationary.” 
“In a third case of cancerous ulceration of the cervix and os-uteri, 
there was some mitigation for a few weeks, but, ultimately the patient 
died.” A fourth case received no benefit. In a sixth case of cancerous 
disease of the os and cervix-uteri, Hydrastis was given for six months. 
The patient “ lingers on, suffering less, and the disease seems arrested.” 
In the second case (by Mr. Bradshaw) he says : “ the medicine made 
the patient feel so wretchedly ill that she feared it would kill her: the 
heart was beating irregularly and tumultuously, and she looked nervous 
and ill.” Dr. Bayes now says, this corresponds with his observation 
of “ the rapid prostration which often follows the administration of too 
large a dose of Hydrastis.” This train of symptoms he has “ met with 
in several cases where the mother-tincture was given.” He therefore 
thinks, that the medicine should not be administrated in too frequent 
doses, or in too low dilutions. The plan he has found most beneficial 
was “ to begin with the thirtieth dilution, giving three globules every 
night, for a fortnight; then a pilule of the twelfth dilution twice a day, 
for another fortnight, followed by the sixth, the third, and finally half- 
drop doses of the mother-tincture, in the same way, giving a fortnight 
to each dilution, &c. He approves Dr. Pattison’s suggestion to avoid 
rubbing the tumor, but to apply “ a lotion over the parts by means of 
moistened linen rags.” CANCER. 
291 
A cold infusion of the remedy is thus prepared: “ jii. of the pow- 
dered Hydrastis to a half pint of water. Allow it to stand four days, 
then strain and keep in a cold place.” This is said to be of great ser 
vice as an application to ulcerated surfaces. 
The later experience of Dr. Bayes with this remedy is highly im- 
portant: A case of cancer on the left breast in a young unmarried 
woman, referred to in his first paper, came under his care, March 19, 
1860. “ The tumor was as large as a small hen’s egg; the nipple 
retracted and the skin puckered. She had been for two years under 
allopathic care, and was strongly advised to submit to an operation. 
The tumor soon ceased to be painful, and had totally disappeared on 
Feb. 20, 1861. 
Cases at the Cambridge Homoeopathic Dispensary. Case first. 
A lady, aged forty-one, married—inflamed indurated breast—found on 
the seventeenth Feb. to be scirrhus. 
Hydrastis 8. iv. gtt. in a half pint of water. A table-spoonful 
twice a day. Up to March twentieth no change. Hydrastis-tinct. 
gtt. xii. Aqua-dist. 3ii. a tea-spoonful every night. 
This treatment was continued without much variation, till June 
eleventh. “The tumor has rapidly disappeared, there is still some 
slight pain. A pilule of Arnica every morning, Conium 80 every 
third night. 
July fourth, the breast remains quite well; some slight indigestion. 
Nux 6, &c. 
Case 2. —A married woman, has ovarian tumor of the right side, 
with severe pain, especially in walking. Has had a cancer excised 
in the right breast. May fourth, prescribed Hydrastis-can. 30. every 
third night. 
Aconite twice a day. 
May eleventh.—Pain lessened though still severe at night. Rhus. 
Twenty-sixth.—Pain almost gone ; tumor still remains, and is weighty. 
Hydrastis 3. given three times a day. 
June fourth.—Still better.—Continue. 
Thirteenth.—Much the same. Iodine 3. gtt. in a pint of water, a 
table-spoonful twice a day. 
June twenty-sixth.—Better. Mercur.-sol. 6. every night. 
July fourth.—Still better. Repeat—and give Merc.-iod. 1., gr. ii. 
every third night. 
July ninth.—Discharged cured. 
Case 3.—Mrs. L.—July 2, 1860.—Cancer of the right breast, hard, 
nodulated, very painful at times ; skin had a bluish appearance over 
the tumor, is puckered, and adherent over a portion of the surface the 
size of a shilling; tumor not adherent to the ribs. 
December twenty-fourth.—She has been under the influence of 292 
DISEASES OF THE SANGUINOUS FUNCTION. 
Hydrastis, and is better; the tumor under its use lias decreased in size, 
and was scarcely ever painful, has still a bluish appearance, and is 
yet adherent to the skin. Occasional intercurrent remedies have been 
given to meet occasional symptoms. 
Case 4.—A widow, aged seventy-seven, has cancer of the right 
breast. The tumor is unattached to the skin or ribs. There is a small 
hard moveable tumor, also, just above the clavicle. She has occasionally 
severe pains. Hydrastis was used externally and internally from 
August 24, 1860, to October, 1861. The tumors have not increased, 
are less painful, and the patient is in excellent health. The Hydrastis 
has been used in the thirtieth dilution, also as low as the mother- 
tincture. A lotion of Hydrast. mother-tincture gtt. x. Aq. dist. fxvi., 
has been applied twice a day. 
Case 5.—Mrs. B., aged twenty-five. Admitted Sept. 12, 1860. 
The cervical glands of the left side of the neck are enlarged, apparently 
three, and have a stony, hard feeling. A tumor of similar character was 
excised at the Allopathic Hospital, some years since, and a deep scar 
remains. Some months after the operation, these glands enlarged, 
and are now very painful. Calcarea-carb. 30, gl. iii. every third 
night, &c. 
Oct. third.—Better. Calc.-carb. 12, a pilule every second night. 
Twenty-fourth.—The hardness remains ; there is occasional shooting 
pain. Hydrastis, 8., a pilule every night. 
Nov. fifth.—Much better; the swelling decidedly less. Continue. 
Twenty-third.—Better. Suffers from indigestion. Repeat Hydrastis, 
and Nux.vom., a pilule twice a day. 
Dec. seventh.—Greatly better. Repeat pil. Hydrast. 
Twenty-sixth.—Remains better; no pain. Repeat the pilule. 
Feb. thirteenth.—Still better, and feels so well she is allowed to re- 
turn to her home, (sixteen miles away,) to remain if there be no return 
of the pain or increase of tumor. Hydrast. mother-tincture 3ii. Two 
drops in a little water twice a day when in pain. 
Case 6.—Mrs. D., aged fifty-five. Admitted Dec. 10,1860. Tumor 
on the dorsum of the foot; occasionally painful; has had it two years ; 
it is stony-hard, the size of a walnut, and nodulated. Excision Lad 
been advised at the Hospital. Hydras.-can. 3. a pilule twice a day. 
Tinct. Hydras. 3i. Aqua-dist. 3ijs. to be rubbed in every night. 
May sixth.—The tumor was almost removed, not being larger than 
a pea. 
Case 7.—Mrs. A., aged forty-five. Admitted Dec. 10,1860. Scirrhus 
of the breast. Hydrastis lotion, and Arsenicum 6; a pilule twice a 
day. This patient was suffering also from phthisis, for which she took 
Bryonia, Phosphorus and other medicines. The Hydrastis lotion al- CANCER OF THE STOMACH. 
293 
ways removes the pain in the scirrhous breast. Continues under 
treatment. 
Case 8.—Mr. G., aged fifty. Admitted April 28, 1864. Confined 
to bed with a large open cancer of the left breast. Under the use of 
Hydrastis she continued to improve till, on March 5, 1860, she was 
so far removed as to be able to go out daily and to do her house-work. 
“ The cancerous ulceration has considerably diminished; it secretes 
a far healthier pus, and her general health has greatly improved. In 
her case the Hydrastis has been discontinued at times, from its pro- 
ducing the depressing effect on the heart’s action alluded to before. 
Case 9.—Admitted July 21, 1860. Mr. Freeman, the surgeon’s 
notes say: u Mrs. J., aged thirty-seven. Health good. Has stony- 
hard tumor in left breast, unattached to skin, perfectly moveable, the 
size of a large filbert, surface somewhat nodulated; suffers from 
lancinating pains. Had first Hydrastis 12, a pilule twice a day; after- 
wards, Hydrast. mother-tincture, a third of a drop, three times a day; 
she had intercurrently, a few doses of Nux-v. for dyspeptic symptoms. 
The tumor became painless and gradually lessened till a portion, like 
a vein filled with coagulum, the size of a crow-quill,, and a third of an 
inch long, remained. I wished her to continue the treatment, but she 
thought herself well and remained away. I saw her in May, 1861, 
and she then was quite well, neither pain nor induration remaining.” 
Aconite.—In several forms of cancer we have observed essential 
benefit from the use of Aconite. Whether its ameliorating action has 
been due to its influence upon the circulation, the nervous system, or 
the pores of the skin, we know not; but that it possesses some peculiar 
power in modifying the constitutional ravages of cancerous degenera- 
tions, we have had ample proof. 
We are in the habit of prescribing the first decimal dilution in 
water. 
CANCER OF THE STOMACH. 
General Remarks.—Cancer of the stomach may begin in an elderly 
person, hitherto free from dyspepsia, by at first capricious, and after- 
wards diminished appetite; by occasional nausea or vomiting, a sense 
of uneasiness and distention of the stomach. The complexion is first 
pale and unhealthy; it afterwards acquires a muddy yellowish, or faint 
greenish hue. The gastric symptoms increase, and vomiting becomes 
more frequent and urgent; the local uneasiness deepens into pain; 
and both pain and vomiting are aggravated by food. At a later period 
haemorrhage generally occurs. It is usually small in amount, and about 
the same time a tumor becomes perceptible in the middle of the 
epigastric region; as the disease progresses, all of these symptoms 294 
DISEASES OF THE SANGUINOU8 FUNCTION. 
increase ; debility and emaciation follow, and these soon lead to extreme 
prostration, anasarca, delirium and death. 
In many cases these symptoms are complicated by ascites, jaundice, 
perforation of the coats of the stomach, fistula, or phlebitis. In others 
there arise symptoms showing cancerous deposit in other organs, es- 
pecially the lungs and liver. The disease usually advances towards its 
termination with a speed and severity constantly accelerating; and, 
perhaps, most generally ends in death in about one year from its first 
invasion. (Brinton. Brit, and For. Med. Chiv. liev., Oct. 1857.) 
Diagnosis.—In cancer of the stomach the appetite usually fails en- 
tirely. In ulcer of the stomach it becomes capricious ; sometimes in- 
ordinate ; but the patient learns to avoid eating as far as possible, in 
order to avoid the pain which follows it; though he still has some 
degree of appetite. Whereas, in cancer the anorexia or absence of ap- 
petite seems to be a specific result of the disease. As such it seems 
to be affected through the same nervous channels which ordinarily 
transmit the sensations of hunger and satiety. The anorexia, there- 
fore, is seen to commence at a very early stage of the deposits of can- 
cerous matter in the coats of the stomach ; and preceding all other 
local symptoms. It is most clearly marked in the younger subjects, 
and in the softer varieties of cancerous deposit, and is equally marked 
in the cases of males or females. 
The pain in cancer remits in violence frequently, but scarcely ever 
intermits. Its site does not indicate the seat of the cancer; though 
cancer of the lesser curvature seems to be connected with pain in the 
inter-scapular region, which is often peculiarly severe in some cases : 
and a marked inflammation of the posterior portion of the stomach 
seems to cause pain ranging from the middle of the dorsal to the 
lower part of the lumbar region. The pain in cancer of the stomach 
is first lancinating; beginning at an early stage and rapidly assuming 
a marked severity. In the course of a few days it becomes so severe 
as to leave most other symptoms out of view. The pain of gastric 
ulcer may intermit, and is increased by food ; but that of gastric can- 
cer neither subsides after digestion is accomplished, nor after the 
stomach is emptied by vomiting. In later stages of the disease the 
pain sometimes subsides or changes in character. Some patients de- 
scribe it as a dull, slow, gnawing, or burning, with a sense of weight, 
oppression, tightness, and distention and soreness on pressure in the 
epigastrium. The dull burning belongs rather to the stage in which 
the process of ulceration is going on in the cancer, rather than in the 
stage of its deposition. It may then be increased by food, is referred 
to a small spot, and may be partially relieved by vomiting. 
The vomiting more frequently attends cancer of the pylorus than 
that of any other part; it often begins when the cancerous deposit is CANCER OF THE STOMACH. 
295 
very small, and seems to be connected chiefly with local irritation of 
the nerves distributed to the seat of the disease. At a later stage, 
when the softening and ulceration of the cancerous deposit has re- 
moved the mucous Inembrane, we have vomiting of a different order. 
The subjacent tissue being exposed, becomes highly irritable; and 
vomiting is excited by almost every thing taken into the stomach. It 
then generally occurs at short intervals throughout the disease, though 
not in every case. The matter thrown up is large in quantity, has a 
yeasty appearance, and contains sarcina torula and fragments of de- 
stroyed membrane and cancer-cells. There is often at this period of 
gastric cancer a torpor, or suspension of the peristaltic action of the 
stomach, either from paralysis of the nerves, destruction of a portion 
of the muscular fibres by the process of ulceration, or weakening by 
their undue extension. 
The haemorrhage occurs in, perhaps, half the cases, though some 
writers have observed it still more frequently. Of those in which it does 
occur, at least seven-eighths, show the blood so mixed with the gastric 
juice, food, bile, or softened cancerous substance, as to present the 
appearance rather of coffee-grounds than of blood. The degree of 
congestion which causes the haemorrhage is small in the earlier stage 
of the cancerous deposit; but it afterwards becomes more considerable ; 
and the flow of blood may then be so great as to cause death. When 
this occurs, dissection shows: 1. that the blood had proceeded from 
the sub-mucous plexuses, or from the minute capillaries of the inter- 
gastric surface, and not from any large arterial trunks ; 2. From ves- 
sels destroyed by ulceration; or, 3. From the erosion of large vessels 
external to the stomach. 
The coffee-grounds appearance may be observed in cases of ulcer of 
the stomach, though there is generally less of it than in cancer. The 
characteristic cancer-cell growth, can be detected in the matters ex- 
pelled from the stomach, when the disease has reached the stage in 
which these cells are thrown off by exfoliation or sloughing. The 
microscopical examination can be made by diluting the fresh liquids 
expelled by vomiting, and placing a portion under the field of a micros- 
cope of sufficient power. 
The diagnosis may be further assisted by manual examination of the 
external surface of the abdomen. The tumor may at least be detected, 
though its nature must be made out by comparison of the various con- 
curring symptoms. 
The color of the skin in gastric cancer is “ a muddy greenish pal- 
lor.” The original or pathognomic cachexia is “regarded as the result 
of the humeral disease which precedes, and brings about the cancerous 
deposit.” (Brinton.) 
The cachectic asnect of gastric cancer often imitates that of ulcer 296 
DISEASES OF THE SANGUINOUS FUNCTION. 
of the stomach, and the resemblance is sometimes so close as to defy 
distinction; both diseases involve a similar general condition, the 
joint product of ulceration, haemorrhage, vomiting, pain, starvation. 
Wherever cachexia precedes these circumstances, -or is present in a 
degree utterly disproportionate to what their aggregate influence might 
lead us to expect, it becomes a leading, almost pathognomonic 
symptom. 
A case was published by Dr. Porter, of New-London, Conn., of a 
man aged sixty-six, who had good health up to two months before his 
death, though he had some regurgitation of food and slight fullness 
after eating, but no pain. The coffee-grounds vomiting commenced 
Dec. 19, 1847; but he continued to attend to business till January 3, 
nineteen days before his death. Jan. 14, he threw off a large quantity 
of uncoagulated blood mixed with coffee-grounds, and this was often 
repeated afterwards. He had, however, scarcely any pain. Near the 
close of life there was an indefinable distress, a sense of sinking and 
emptiness, like faintness from want of food. Still there was none of the 
lancinating pain common in cancer, only some enlargement like a 
small tumor near the pylorus or duodenum. There wTas none of the 
“dingy, sallow, exsanguinous, yet opaque appearance so common in 
cancerous diseases.” On dissection a scirrhous tumor, the size of half 
a small orange, occupied the pylorus and adjoining portions of the 
stomach, somewhat hypertrophied, mainly hard, but some ulceration 
had commenced. (Amer. Jour. April, 1848, p. 378.) 
Prognosis.—Cancer of the stomach may be regarded as one of the 
most hopeless forms of this most terrible of human diseases. It is 
dreaded, not so much because of its being almost uniformly fatal, but 
for the insufferable pain which attends on it throughout so much of its 
course. The duration, says Dr. Brinton, of cancer “may be estimated 
at about thirty-six months from the first appearance of the symptoms; 
but few cases survive the twenty-fourth, and some have sunk under 
extreme suffering at the end of a single month. 
Treatment.—This can only be palliative. The mildest measures 
can alone be used without injury, though Arsenicum may be tried in 
homoeopathic doses far enough to test its powers, which are sometimes 
surprisingly great. 
Lime-water may often be employed in quieting the stomach ; but its 
remedial powers seem confined to the stage of ulceration from chronic 
gastritis. 
Although in fully developed cancer of the stomach, no just hopes 
can be entertained of effecting a cure, we may do much to palliate suf 
fering, and even to prolong life, with judiciously-selected homoeopathic 
medicines. Among these may be cited, Arsenicum, Cicuta, Conium, CANCER. 
297 
Veratrum-alb., Yeratrum-viride, Kreosote, Mercurius-corr., Thuja, 
Carbo-animalis, Ipecac., Tabac., Cannabis-ind. 
Clematis.—Induration of the lymphatic glands of the breast, when 
painful to the touch ; appearance of cancerous degeneration ; ulceration 
Avith pulsating, burning and lancinating pains along the borders of the 
ulcer, particularly upon being handled. 
CANCER OF THE UTERUS. 
Symptoms.—Incipient Stage.—Sharp and lancinating fugitive pains 
in the hack and loins, across the supra-pubic region, or shooting along 
the front of the thigh, or along the course of the sciatic nerve, inducing 
numbness or debility of the whole limb. A tumor or decided fullness 
in one or the other iliac fossae, fixed pain or tenderness appearing to 
issue out of the abdominal ring, irritation of the bladder with dysuria ; 
sensation at the termination of the rectum like that of haemorrhoids. 
Menstruation may be regular, but there are often bursts of haemorrhage 
at the period or in the interval. After the disease has continued long 
the appetite is impaired, sleep disturbed, the flesh wastes and becomes 
softer, countenance pale and expressive of distress. 
The os uteri is hard at the margin, or fissured, projecting more than 
natural, and irregular in form. In the situation of the muciperous 
glands, several hard well defined projections like grains of shot under 
the mucous membrane ; pressure on them gives pain or makes sickness 
at the stomach. The cervix is slightly enlarged and tender; circum- 
ference of the os uteri, especially between the projecting glandulse, feels 
turgid and presents a deep crimson color. No thickening or other 
alteration of the parts adjoining. At the connection Avith the cervix 
the movement is free ; no consolidation of the uterus wdth the neigh- 
boring contents of the pelvis. The morbid change seems entirely con- 
fined to the os uteri, with an anomalous tingling in front and inside of 
the thighs. These last for a few hours, or a day or two and then dis- 
appear, perhaps for weeks, but again and again return in the same 
situation, for a long time not increasing in severity. Internally the 
feeling of tenderness increases. There is noAV slight irritability of the 
bladder; but appetite, digestion and sleep may continue good; the 
pulse not changed, as in many other uterine affections of serious 
character. The patient does not yet anticipate danger. 
When the disease assumes a more dangerous form the first change 
takes place in and around the muciperous glandules which exist in 
such numbers in the cervix and margin of the os uteri. They become 
indurated by the deposition of scirrhous matter around them, and by 
thickening of their coats, in consequence of which they feel at first 
almost like grains of shot or gravel under the mucous membrane. 298 
DISEASES OF THE SANGUINOUS FUNCTION. 
The further symptoms correspond more nearly with those of cancer 
in other organs. See p. 282. llemedies, p. 285 to 297. 
FUNGUS HiEMATODES. 
Case of Field-marshal Count liadetzhy.—In July and Augus 
1839, this distinguished Austrian general was attacked with congestion 
of the head and vertigo ; and soon after it passed oft' there commenced 
a pressure in the right eye, inflammation of the eyelids, lachrymation, 
occasional protrusion of the eye, and pressure in the forehead. He 
was relieved by remedies, but the under eyelid remained inflamed. In 
May, 1840, there was another attack of vertigo; after it he was well 
except one eye. October 9th. The Marshal, on the occasion of a 
great review was exposed during five hours to extremes of temperature 
and fatigue. Towards evening his face became red, he had fever with 
great pain in the right side of the head; the right eye was inflamed 
and protruding from the orbit; pulse full and hard. He was relieved 
by homoeopathic remedies; but lachrymation of the right eye continued 
and there was a small swelling in the external angle. About the end 
of October further exposures were followed by the appearance of a 
small tumor commencing at the inner angle of the eye near the lower 
lid; the external tumor enlarged; the eye protruded, and there was pain 
in the head. Dr. Hartung, medical counsellor to his Excellency, pre 
scribed the ordinary homoeopathic remedies, beginning with Aconite 
and all the symptoms of immediate urgency were, for the time, removed. 
But the growth of the fungous tumors could not be stayed. That above 
the external angle assumed a purple color, that between the eye-ball 
and the lower lid became fungus-like, elastic, granulous, purple, and 
painless. The eye became protruded and turned from its normal axis 
of vision, so that the pupil stood looking outwards and upwards, the 
ball restricted in its motions, but the power of vision uninjured. 
At the beginning of the next year, the case beginning to be regarded 
as incurable, Dr. Hartung made an official report to Vienna, and fur- 
ther medical counsel was ordered by the Emperor. The tumors had 
increased to one-third of an inch each in diameter, and the fungous 
growth was evident around the whole circumference of the eye-ball 
which began to protrude more sensibly. Vision began to suffer; towards 
the external angle objects were only partially visible ; the conjunctiva 
was softened, and dark-red, approaching to blue ; lids glued together 
in the morning; sensibility to light increasing in the day-time; lachry- 
mation, heat, dryness and pain at night becoming worse. A consultation 
was held on the 26th of January, at which the consulting allopathic 
physicians, Drs. Jager and Flurer, declared the case as hopeless, 
“ after forty years of experience.” Dr. Hartung despondingly resumed FUNGUS ELEHATODES. 
299 
the sole direction of the case. The distinguished patient was now 
eighty years of age. On the 19th of February, 1841, the appearances 
threatening scirrhus had changed; haemorrhage had begun, the tumors 
had diminished in size and were less painful. The report of this date, 
shows improvement in vision and general health; and diminution of 
pain. March 16th. The fungus which at its greatest size had been 
three inches in circumference had been reduced to a small tumor 
which was visible only on drawing down the under lid; the eye moved 
freely in the orbit, and the power of vision was restored. April 22d. 
The tumor had so far diminished that only a slight projection on the 
lid remained. The Marshal was employed in his usual duties, expos- 
ing himself to “a low temperature,and again in the increased heat of 
the sun. He continued in his former mode of life, without any injury 
to the eye. The disease was regarded as cured, and no further reports 
were required.” 
The remedies used during the treatment of the Austrian Field- 
marshal’s case are recapitulated by Dr- Hartung in his communication 
of June 12th, 1841. They were : Arsenicum 10°; PsorinlO3; Her- 
petin 10° ; Carbo-animalis 10°; and Thuja-occident. He observed 
“ that the first three remedies aggravated the disease.” He then pre- 
pared Thuja 10°, one drop in three ounces of distilled water, a table- 
spoonful three times a day. “ The first day appeared all the symptoms 
that his Excellency had occasionally suffered for years ; as : headache 
in the right side of the forehead, cough, particularly at night, slight 
diarrhoea, pain in the kidneys, with a sandy sediment in the urine, 
itching, and a reddish rash-like eruption on the inner side of the thigh; 
the night was quiet, with the exception of the cough. The second day 
the feelings were the same, but when pointed to they were gone away 
like a breath. Third day no more pain; itching in the inner angle, 
secretion of a milky and rather cream-like moisture on the whole 
extent of the fungus. After this the eye was moistened with the solu- 
tion of Thuja every two hours. On the fourth day there was no pain; 
the secretion increased; the fungus appeared to be diminishing; fifth, 
sixth, and seventh days, no pain. The secretion increased, the lower 
part of the fungus diminished, to the astonishment of all who had pre- 
viously seen it. On the eighth day after the first use of the Thuja I 
gave Carbo-animalis 10°, 3. Effect first and second days as after the 
Thuja; the pain in the forehead appeared, only it extended itself to 
the left side, and to the ear, like a breath passing over. The secretion 
continued; no pain in the eye. The third, fourth, fifth, sixth, and 
seventh days, no headache; the secretion continued. I now every 
morning touched the protruding fungus with a fine pencil, moistened 
with the fourth dilution of Carbo-anim. The Thuja was continued on 
the circumference. The fungus diminished, and the eye retreated 300 
DISEASES OF THE SANGUINOUS FUNCTION. 
within the orbit.” By continuing these two remedies in alternation 
every eight days, in the course of a month and a half the whole fungus 
had disappeared, and the eye moved as well as the other in its orbit. 
At the same time various other constitutional symptoms disappeared. 
The Field-marshal continued in good health to extreme old age ; and 
sent a public testimonial of gratitude to his physician. 
GENUS VII.—LUES.-1. SYPHILIS. 
This disease was unknown to the Greek and Roman physicians, as 
no allusion is made to it by any of their medical authors, historians or 
poets; and much discussion has taken place respecting its first intro- 
duction into Europe. All the modern authors who first described it, 
(collected by Luisinus, Astrue, and Girtanner) in the latter years of 
the fifteenth century comment upon it as “ morbus novus,” “ morbus 
gnotus.” Peter Pinctor traces the origin of the disease to the time of 
the conjunction of Mars, Venus, Jupiter, and Mercury, A.D. 1483, at 
which time he thinks this disease must have originated; but Fulgosi 
dates it at October, 1492; Sanchez and Hensler in 1493. Others 
contended that it originated in Hispaniola. It is certain, however, that 
it was first distinctly recognized, says Dr. Simpson, of Edinburgh, dur- 
ing the invasion of Italy by the victorious army of Charles VIII. of 
France; and it first broke out extensively at Naples when the French 
took possession of that city in the spring of 1495. This army carried 
the disease with them to France, Switzerland, Germany, Flanders, &c. 
In 1497, it had reached Aberdeen in Scotland. Six months later the 
new disease was made the subject of municipal regulation in Edin- 
burgh. Infected persons were banished from the town to the sands of 
Leith, there to remain “till God shall provide for their health.” Those 
who took upon then the cure of the infected were banished with their 
patients, and if either should return to the city in violation of the edict 
they were to be burned on the cheek with a branding iron. James IV. 
who was then king of Scotland was much engaged in experimental re- 
searches after the philosopher’s stone, or the “ quinta essentia,” and was 
withal learned in the arts of medicine and surgery. In his practice of 
surgery he was more liberal than any philanthropist of our noble pro- 
fession of these days. He not only bled his patients for nothing, but 
gave them eighteen shillings Scotch into the bargain. The record 
show s that his operations wrere not always successful. One woman with 
cataract was left entirely blind, for which a partial atonement was 
made by the usual eighteen shillings, Scotch. 
The experience of this king in the treatment of syphilis is not 
recorded, but the sums of money given by him to patients affected with 
it are regularly set down to his credit. SYPHILIS. 
301 
Wm. Dunbar, the Scottish poet to the royal household, who preceded 
Burns by nearly three centuries, employed his genius in commemorat- 
ing the coming in of the new plague. Gunbrecht and Brandt wrote in 
1496, that the disease had already invaded France, Germany and Bri- 
tain. In 1502, the privy expense book of Elizabeth of York, queen of 
Henry VII., shows that the benevolent lady paid a surgeon for curing 
a certain mendicant of the French malady the sum of twenty shillings. 
During a great portion of the sixteenth century, it was so contagious 
in some parts of Europe, that it was communicated by lying in the 
same bed, by the clothes, gloves, money, or breath of the patient. A 
variety of syphilis also prevailed in Canada some years ago, of so viru- 
lent a nature, that it was communicated by the breath and by contact. 
Dr. Thompson, “ thinks it probable that the disease has existed, more 
or less, and under different grades of severity, in all ages, and that it 
has thousands of times been originated de novo." 
Professor Simpson, from a historical review of the earliest notices of 
syphilis on record, arrives at the following pathological opinion: 
I. That syphilis was a species of disease new to Europe when it first 
excited the attention of physicians and historians in the last years of 
the fifteenth century. 
II. That it is a species of disease distinct and different alike, first, 
from gonorrhoea; and, second, from Greek leprosy, (with both of which 
diseases it has been occasionally confounded); for both of these mala- 
dies existed and were abundantly recognized in Britain long before the 
date of the. introduction of syphilis. 
III. When the disease first broke out it was regarded by physicians 
and the public as communicable, and constantly communicated from 
the infected to the healthy by the employment of the clothes, vessels, 
baths, &c., used by those suffering with it, and by the slightest contact, 
or even breathing the same air with them. One of the gravest charges 
against Cardinal Wolsey when he was arraigned before the House of 
Lords in 1529, was, as given in the indictment; that “the same Lord- 
cardinal, knowing himself to have the foul and contagious disease of 
the great pox broken out upon him in divers places of his body, came 
daily to your grace (the king) rowning in your ear, and blowing upon 
your most noble grace, with his perillous and infective breath, to the 
marvellous danger of your highness, if God, of his infinite goodness, 
had not better provided for your highness,” &c., &c.* 
For many years after its outbreak sexual intercourse does not appear 
to have been suspected as the mode of its propagation; the primary 
affections of the several organs were not noticed as constant symptoms. 
Their attention was chiefly directed to the secondary symptoms, such 
as: The hideous eruptions on the skin, the ulcers of the throat, tho 
* Lancet, 1861, p. 172. 302 
DISEASES OF TOE SANGUINOUS FUNCTION. 
exostoses, and nocturnal pains in the bones, &c. The rapidity with 
which it spread over Europe led men to suppose that it travelled as an 
epidemic without waiting for the slow process of communication by con- 
tact. It was on the 4th of Dec., 1494, that the army of Charles VIII, 
entered Rome; they reached Naples February 21st, 1795, and eva- 
cuated the city May 20th. On the 24th the Spanish general Cordova 
landed in Sicily. The battle of Fuornovo was fought July 5th, king 
Ferdinand returned to Naples the next day. The last remnant of the 
French army returned to France about the end of the following year. 
Within less than two years the Aberdeen edict was issued (April 23d, 
1497), only forty-eight days after that of Paris, which was dated 
March 6th. The disease soon swept off vast numbers of the dissolute 
princes and dignitaries in all countries. The emperor Charles V., Pope 
Alexander VI., kings and cardinals, princes and bishops, peers and 
priests, are recorded among its victims. Indeed the manners of the 
dignitaries of every nominally Christian country were so much worse 
than the masses were able to believe, that they stealthily transmitted 
this most loathesome of all diseases so rapidly from one city to another 
that the malady itself was at first mistaken for a pestilential epidemic. 
The causes which may have conduced to vary its character at differ- 
ent periods, are numerous; and we suggest the following as a few 
of them. 
It has been observed that exposure of the body to a cold, humid 
atmosphere, excessive fatigue, changes of diet and of climate, un- 
wholesome food, and neglect of cleanliness, favor the rapid progress 
and destructiveness of the malady; while a dry, wTarm and equable 
temperature, cleanliness, nutritious food, and comfortable lodgings are 
circumstances wdiich conduce to render it comparatively mild. Thus 
its violence during the siege of Naples in 1495 may also be explained, 
when we bear in mind the forced marches, the changes of climate and 
of diet, and the constant excitement and fatigue to wdiich the soldiers 
were exposed. The same severity marked its prevalence in the British 
army in Portugal, while the natives themselves wrere but slightly 
affected, although exposed to similar contamination. 
One of our army surgeons recently informed us that the same diffi- 
culty was experienced among our soldiers during the Mexican campaign 
in 1847, and 1848; they contracted the disorder, while the Mexicans 
experienced but slight inconvenience, although exposed to the same 
virus. The argument also holds good with respect to sailors who are 
so constantly subjected to the vicissitudes of temperature, the noxious 
air of vessels, and the stale, salt provisions used at sea. 
May it not, then, be fairly inferred, that whatever causes impair the 
forces of the organism, serve also to render it less able to resist the 
deleterious influence of the syphilitic poison ? SYPHILIS. 
303 
In regard to the doctrine of Hahnemann respecting the identity of 
syphilis and sycosis, we agree with Hartmann, that the mass of evi- 
dence upon the subject renders it almost conclusive that the two 
diseases are distinct in their nature. The origin of each is a specific 
morbid poison, capable of impressing the organism in a distinct and 
peculiar manner. 
Diagnosis.—There are unquestionably a great variety of ulcers 
which make their appearance upon the genitals, communicated by 
contact with diseased subjects, which are, nevertheless, not syphilitic, 
and which will heal over without causing constitutional symptoms, 
simply by the aid of mild dressings. The true syphilite chancre is now 
of rare occurrence, but the great majority of those intractable ulcers 
which are looked upon as real venereal chancres, are nothing more, 
primarily, than simple non-infectious sores, which have been converted 
into an unhealthy condition by the abuse of mercury. Who can doubt 
this fact when he contemplates the dreadful effects which a course of 
mercury often produces on the healthy organism? who could be 
tempted, in health to take the enormous quantities of this drug which 
are deemed necessary for the cure of syphilis ? Let the provings of it 
—let the horrible consequences which its accidental absorption some- 
times occasions upon the surface,—in the mucous membranes,—the 
bones,—the glands and the nervous system, answer. For our part, we 
would prefer the syphilitic poison itself, rather than the uncontrollable 
ravages of such an enemy as mercury in allopathic administrations is 
admitted to be by the fair-minded of those even who most earnestly 
defend its use. 
In order to be fully convinced that many of the effects of mercury 
are improperly attributed to the action of the syphilitic virus, it is 
only necessary to regard carefully the symptoms which are constantly 
presented to our observation in what are called venereal affections, and 
to notice the opinions of many of the most eminent medical observers. 
Thus, Sir Astley Cooper in his lectures, used to observe, “ do not think 
that it is a rare occurrence for the penis to be destroyed by mercury/ 
no, a chancre that has remained weeks in a healthy state, shall become 
irritable, and by mal-treatment, by the injudicious and improper use of 
mercury shall slough and end in the destruction of the penis; this is not 
a rare case, and is attributed to the venereal disease, but in reality is an 
effect of the improper use of mercury.” {Castle's Manual of Surgery, 
p. 280.) The great Hahnemann constantly alludes to the pernicious 
results of the abuse of this drug in the hands of the allopathist. 
There can be no question that those dreadful mutilatious of the 
penis, of the nose, the palate, the eyes, of the surface of the body, and 
the nodes and caries of the bones, which we occasionally observe, are 
all effects of mercury and not of syphilis/ and it is in the highest 304 
DISEASES OF THE SANGUINOUS FUNCTION. 
degree probable that the immunity enjoyed by the Portuguese, the 
Mexicans, and certain other nations, from the severe forms of this 
malady, is attributable solely to the fact that they use no mercury in 
its treatment. 
Chancre.—The primary chancre usually presents itself on some part 
of the genital organs, in from three to seven days after contamination, 
in the form of a darkish red pimple, attended with slight itching, and 
surrounded by an erysipelatous blush. In a short time matter forms 
in the centre of the pimple, and an excavated ulcer, with a yellowish 
surface, hard and ragged edges, and an indurated base, makes its ap- 
pearance, marking the sore as a true chancre. The most common seat 
of primary chancre is on the inside of the prepuce and the corona 
glandis, but it occasionally occurs on the glans and external parts of 
the genitals. 
Many varieties of venereal chancre have been described by authors, 
as the simple, the indolent, the irritable, the sloughing, the in- 
durated, the phagedenic of Carmichael, the superficial of Mr. Evans, 
the Hunterian, &c.; but as these diversities in the appearance of the 
chancre are not owing to any difference in the character of the virus, 
but to the condition of the patient as regards constitution, tempera- 
ment, and mode of life, at the period of contamination, we should ab- 
stain from making those minute classifications which some writers have 
attempted. 
The circumstances which may operate to modify the character and 
appearance of a simple chancre, or which may conduce to develop 
primarily an intractible and destructive one, are numerous. 
Individuals whose constitutions have been impaired by abuse of sti- 
mulants, undue exposure, hardship and fatigue, and insufficient nourish- 
ment, are liable to be attacked from the first with that variety which is 
denominated the indurated sloughing chancre. 
Those whose systems have been loaded with mercury, and enfeebled 
by previous disease, are peculiarly subject to that description which is 
termed irritable and sloughing. Persons who go from temperate to 
tropical climates, are especially in danger of the phagedenic variety. 
Scrofula and scurvy also predispose the system to this form of it. 
The simple chancre is by far the most common, particularly in tem- 
perate latitudes, and usually occurs to individuals of a sound consti- 
tution. Some have supposed the cause of this variety to consist in 
“ gonorrhoeal matter and other morbid vaginal secretions,” brought in 
contact with the penis during coition; but of this there is no proof. 
The simple ulcer very often becomes converted into an irritable, 
sloughing, or erysipelatous one, by some excess or imprudence which 
impairs the vigor of the body, or by the abuse of mercury. On the 
other hand, so long as the constitution remains sound and unimpaired, SYPHILIS. 
305 
resistance is offered to the action of the virus, and the secondary im=* 
pression which it makes will be very slight, and in some instances im 
perceptible. It is in cases of this description that we sometimes wit- 
ness spontaneous cures of what was originally true syphilitic con 
tamination. 
The most certain marks of a true syphilitic chancre are: the exca- 
vated surface, the hard, ragged edges, and the indurated base. These 
appearances, taken in connection with the previous history of the case, 
will generally enable us to decide with sufficient certainty respecting 
the character of the sore; but where any doubt exists, we would most 
strongly commend the practice discovered and successfully adopted by 
Ricord of Paris, of inoculating a sound part with matter from a sus- 
pected ulcer. In case a second chancre is produced by this operation, 
there will no longer remain a question in regard to the true nature of 
the malady. 
After the syphilitic poison has passed from the chancre through the 
absorbent glands of the groin into the blood, it possesses a specific 
affinity for only three parts of the body, viz.: “The mucous membrane 
of the throat and nose ; the skin, or surface of the body ; and the bones, 
with their periosteal coverings,” {Sir A. Cooper's lecture). Thus it will 
. be remarked that the internal organs are never impressed by this 
virus; and this fact should induce the allopath to pause before he 
loads the system with a poison which spares scarcely a single structure 
during its operation. 
Hunter taught that “ the venereal disease ” presented “ no variety 
of species,” and that “no difference can be produced in the manifesta- 
tion of the disease by a difference in the malignity of the purulent 
matter; the same pus exercises, on different individuals, actions totally 
dissimilar from one another, the diverse nature of which depends on 
the constitution and the general state of the economy at the time of 
the infection.* M. Ricord, the most distinguished of French authors 
on this subject up to a recent date, held the same opinion. In his 
letters he says (p. 149.) “Up to the present time, we are justified in 
denying the existence of more than one virus.”f But in his latest 
work which he bequeaths to posterity as his last legacy and the results 
of thirty years’ experience, he admits that “ the chancre is no longer a 
morbid unit, but a mixed manifestation, belonging to two distinct 
pathological species. The one of these is the simple chancre, the 
other, the indurated or infecting chancre. The latter creates consti- 
tutional symptoms, the former is one with soft base, an affection purely 
local, which limits its effects to the region which attacks, which never 
exercises a general influence upon the system, which is never ac- 
companied by constitutionel affections. In other words it is a 
* Lectures on Chancre, by M. Ricord, 1859, p. 34. f On Syphilitic Virus. Chap. T. 
Vou il—20. 306 
DISEASES OF THE SANGUINOUS FUNCTION. 
chancre ichich does not affect the economy—a chancre without sy- 
philis.” Upon this theory a great number of the discrepancies in 
regard to the origin of the disease may be reconciled. “The simple 
chancre” existed in the early ages of the world and may be the same 
referred to the in the Mosaic law, and also in the works of Celsus and 
Galen; the contagious or more malignant disease originated in the 
15th century and spread as an epidemic; it consists of the infecting 
chancre and its constitutional manifestations.* 
Diagnosis between simple and infectious Chancre. 
Simple non-contagious chancre. 
“The simple chancre has a soft base, 
or presents only an inflammatory thick- 
ening ; it does not react upon the glands, 
or influences them in a peculiar manner 
by producing almost certainly an inflam- 
matory, adenite, acute, mono-glandular 
suppuration, and furnishing most gene- 
rally an inoculable pus. 
“ Chancre with edges neatly shaped, 
and cut perpendicularly ; the floor irre- 
gular and worm-eaten. 
“ Chancre ordinarily multiple, or mul- 
tiplying itself by a series of inoculations 
of the neighboring parts. 
“ Chancre with virulent pus, conta- 
gious par excellence preserving during a 
long period, the characters which con- 
stitute its specificity. 
“ Lastly, a chancre with a destructive 
and invading tendency ; the form of ul- 
ceration the most apt to experience the 
phagedenic complication.” M. Ricord, 
p. 31. 
A simple chancre is not found on the 
head. 
Differential Diagnosis. 
Dr. Helmuth has gleaned from the works of M. Ricord the following 
characteristic symptoms of each form of chancre. 
Simple Non-infecting Chancre. 
1. Never noticed upon the cephalic 
region. 
2. Develops rapidly. 
3. Surface irregular ; floor fretted or 
worm-eaten. 
4. Edges neatly shaped, cut perpen- 
dicularly, as if cut out with a punch. 
Indurated Infecting Chancre. 
1. Every part of the body liable to in- 
vasion (therefore chancre on the head 
may be pronounced infecting.) 
2. Develops slowly. 
3. Surface smooth ; floor lardaceous. 
4. Edges sloping, as though made 
with a gouge. 
* Helmuth, U. S. Journ. Horn, Yol. 2, p. 476. SYrniLis, 
307 
Non-infecting. 
5. Edges undermined. 
6. Border abrupt. 
7. No induration. 
8. No induration. 
9. Suppurates profusely ; the suppu- 
ration being one of the most fertile 
sources from which the pus is derived. 
10. Pus in the highest degree con- 
tagious, persisting during the entire 
existence of the chancre. 
11. Generally multiple from its origin, 
or becomes so by inoculation. 
12. Tendency to invade the neighbor- 
ing structures. 
BUBO. 
13. Not necessarily present. 
14. Mono-glandular. 
15. Suppurating almost certainly, and 
furnishing most generally an inoculable 
pus. 
16. No fixed period of development. 
Simple. 
17. The simple chancre is most likely 
to undergo the phagedenic complication. 
18. In virgin subjects transmitted in 
its form—that is a simple chancre. 
19. Transmitted to syphilitic subjects 
either as a simple or an indurated chan- 
cre ; the form which is reproduced pro- 
bably depending on the nature of its ori- 
gin—that is to say, the chancre which 
gives birth to it.”* 
Infecting. 
5. Edges adherent. 
6. Border gradually lost in the floor 
of the ulceration, giving to the ulcer the 
appearance of a cupola. 
7. Induration surrounding the ulcer 
on all sides, forming for it a kind of bed 
(pathognomonic.) 
8. Induration commences from the 
first, (if not produced in a few days, will 
not become so.) 
9. Suppurates little, producing but a 
small quantity of serosity, most fre- 
quently sanious and ill-formed. 
10. Pus rapidly loses its specificity, 
at all events for the infected subject, who 
in a few days becomes refractory to in- 
oculation with his own virus. 
11. Generally solitary. Inmost cases 
a single chancre giving rise to contagion. 
12. Inverse disposition. Its limits are 
soon defined. 
BUBO. 
13. No infecting chancre without an 
indurated symptomatic bubo. 
14. Affecting several or all the glands, 
15. Extreme hardness ; independent 
of each other; no tendency of them- 
selves to inflammation or suppuration. 
16. Produced in course of first or 
second week ; rarely noticed later ; ge- 
nerally coincident with induration. 
Indurated. 
17. Barely assumes the phagedenic 
deviation. 
18. Transmitted in its species in vir- 
gin subjects; that is to say, an indu- 
rated chancre. 
19. Transmitted to previously infected 
subjects under the form of a chancre 
with a soft base, analogous in appearance 
to the complication.* 
Comparative number of cases. 
20. M. Fournier in three months at 
the Midi in Paris. saw two hundred and 
fifteen cases. Of two hundred and seven 
of these cases sixty-five had bubo ; with- 
out bubo one hundred and forty-two. 
20. In the same period, one hundred 
and twenty-six of the indurated and in- 
fecting. 
* Prof. Helmuth, U. States Journal of Homoeopathy, Yol. 2,480, 481. 308 
DISEASES OF THE SANGUINOUS FUNCTION. 
The secondary, or specific effects of the syphilitic virus, after 
its entrance into the blood, are: 
First. Upon the mucous membrane of the mouth and throat, which 
becomes red and inflamed, and covered in some parts with pimples, 
which soon degenerate into ulcers, resembling in many respects the 
primary simple chancre. These ulcerations extend into the nostrils, 
and sometimes even into the larynx itself, giving rise to loss of voice, 
severe cough, violent constitutional disturbance, and death. In cases 
which have been improperly treated, the bony palate and the nasal 
hones become affected, and exfoliate, and thus cause those disgusting 
mutilations of the nose and face wdiich so often stare the old-school- 
physician in the face. 
Second. Manifestations of the action of the absorbed virus m 
the shin: — 
These are: Slightly elevated copper-colored elevations of different 
sizes, attended -with uneasy or itching sensations, sometimes coveied 
with a kind of scurf or scale, or, in other instances, with incrustations 
or ulcerations. These eruptions make their appearance on the face, 
head, breast, palms of the hands, and arms. Eruptions, which are 
called tubercular, often appear on the scalp, the eye-brows, the breast, 
hack, and arms, and ultimately form very troublesome ulcers. In 
healthy subjects these secondary eruptions are not very troublesome, 
being simply copper-colored blotches, covered with a thin scurf; but 
in irritable and impaired constitutions they often assume the character 
of foul and sloughing ulcers. The particular variety of these secondary 
eruptions will be determined by the peculiarities of constitution in 
each individual case, and not from any original difference in the virus 
itself. 
Third. Action of the venereal poison upon the osseous structure, 
and its periosteal covering. The morbid inflammation in the first 
instance upon the periosteum, causing severe nocturnal pains, and 
some tumefaction in the affected region. If the malady continues to 
increase, an osseous deposit will be formed between the periosteum and 
the bone, constituting wdiat is termed venereal node. This node, in 
its early stages, does not usually give rise to much inflammation of the 
surrounding skin, nor is it attended with a great amount of pain, but 
after it has existed for a considerable time, and particularly if the 
patient has been drugged with mercurial preparations, it becomes quite 
painful, especially during the night. The ordinary location of venereal 
nodes is on the anterior portion of the tibia, or on the surface of the 
cranial bones. 
We believe that the above enumerated symptoms constitute all of 
the legitimate effects resulting from the action of the absorbed syphi- 
litic virus. The great variety of eruptions and ulcerations described SYPHILIS. 
309 
by Hartmann and others, are attributable to other causes, operating 
either by themselves, or in conjunction with the venereal poison. It 
is of vast importance in affections of this description to distinguish, 
with all possible accuracy between the syphilitic action and that of 
mercury, scrofula, and other causes. Farther on we shall endeavor 
to make this distinction as clear as possible. 
Bubo.—Another primary manifestation of syphilis consists in an 
enlargement of one or more of the absorbent glands of the groin, termed 
bubo. This enlargement usually succeeds the chancre, and is caused 
by the absorption of the virus of the latter. It is rare in real syphilis 
that more than one gland in each groin becomes affected with the virus, 
although some of the other glands now and then become slightly 
swollen from sympathy. The swelling ordinarily partakes of an in- 
flammatory character, and if not opposed by appropriate remedies, 
runs on to suppuration, and sometimes to sloughing. 
The disease has been supposed to be purely local, until after the 
swelling in the groin has preceded to the suppurative stage; but this 
is evidently erroneous, from the fact that secondary symptoms not un- 
frequently occur, without there having been any previous enlargement 
in the groin. (See Bubo, Sympathetic) 
Bubo sometimes makes its appearance without the previous existence 
of a chancre, but such instances are by no means common. Swelling 
of a non-venereal character may likewise occur in the groin from a 
strain, or from too great violence or bruising of the part. But as 
chancre for the most part precedes the bubo, there will rarely occur 
any difficulty in our diagnosis. 
Treatment.—Mercury. Mercurial Disease.—Keller says, it can 
no longer be doubted, that the so-called syphilitic ulcers in the ex- 
tremities of the following character are the result of mercurial ca- 
chexia. They are characterized by their grouping and renal form, by 
their serpiginous advance at their convex border, and their healing 
. and skinning over at their concave border; the same is true of the 
so-called angina syphilitica, with serpiginous ulcers on the palate, 
throat, or root of the tongue, giving rise to aphonia, so often described 
as a characteristic of syphilis. The common reliance is on Iod.- 
potassa for eliminating the Mercury from the system. 
Hahnemann, Gross, Hartmann, Hunter, Abernethy, and many other 
distinguished members of the profession, entertained the opinion that 
the constitutional symptoms of syphilis are always progressive, and 
never disappear, unless opposed by medicine; but the fact is now 
completely established, not only that Mercury is not necessary for 
the cure of either the primary or secondary symptoms, but that they 
often terminate in a spontaneous cure without any medicine. 
We are assured by Dr. Ferguson, and other surgeons, who havo 310 
DISEASES OF THE SANGUINOUS FUNCTION. 
observed the disease in Portugal, that the natives cure themselves per- 
manently of the primary symptoms by topical applications ; and of the 
secondary effects, by decoctions of sarsaparilla and sudorifics. They 
remark, that “ the virulence of the disease has there been so much 
mitigated, that, after running a certain course, (commonly a mild 
one) through the respective order of parts, according to the known 
laws of its progress, it exhausts itself, and ceases spontaneously.” 
{Med. Chir. Trans. Yol. IV., pp. 2 — 5.) This is still further cor- 
roborated by the numerous cures of the primary and constitutional 
symptoms recorded by Messrs. Hose, Pease, Hennen, Guthrie, Good, 
and Whympor, without Mercury, or any other means than simple 
dressings. In the cases which they describe, no caries of the hones 
occurred, as is so commonly observed when Mercury is used; “ and in 
no instance was there that uniform progress -with unrelenting fury, 
from one order of symptoms, and parts affected, to another, which is 
considered an essential characteristic of true syphilis. {Med. and 
Chir. Trans. Yol. YIII., p. 422.) 
Hahnemann, and most of his disciples, as well as Hunter and other 
eminent allopathists, entertained an opinion that the chancre is simply 
the vicarious symptom of the internal disease, and that by removing 
this ulcer by external applications, “the disease is forced to em- 
body itself externally, in the more troublesome and speedily suppu 
rating bubo. And, after this, too, has been removed, as is foolishly 
done, by external treatment, the disease is forced to manifest itself 
throughout the organism with all the secondary symptoms of a fully 
developed syphilis. This unavoidable development of the internal 
syphilitic disease generally takes place after the lapse of two or three 
months.”—{Hahnemann!s Chronic Diseases, p. 116.) 
We speak advisedly when we pronounce this last assumption al- 
together erroneous; for we have repeatedly seen true venereal 
chancres cured by topical treatment alone, while the patients have 
remained entirely free from any secondary manifestations for years 
afterwards. When a student of medicine, the author passed some 
time at the United States Marine Hospital, Chelsea, then under the 
superintendence of the able and accomplished Dr. Stedman. In this 
institution the internal use of Mercury had been dispensed with in the 
cure of syphilis, for several years previous to my entrance; and I 
ascertained that it was a very rare occurrence to observe secondary 
symptoms in those who had been cured in the hospital, although 
patients were constantly returning with other complaints, who had 
been cured of chancre years previous. The treatment chiefly relied 
on consisted of topical applications of a mild character, the internal 
use of decoctions of sarsaparilla, and a rigid regimen. The ordinary SYPHILIS. 
311 
period for the cure of Mercury chancre, was from three to four weeks; 
and for bubo, from six to eight weeks. 
So long as the chancre exists, the matter generated in the con- 
taminated part continues to be re-absorbed, and so to supply new fuel 
to the mass of the blood; it is therefore important to change the 
morbid action of the ulcer, and heal it up as soon as possible. The 
matter formed in ulcers of the mucous membrane of the throat, which 
have arisen from the constitutional effects of syphilis, is also capable 
of propagating the disease by contact with abraded surfaces, or by 
being directly re-absorbed into the blood. There is reason to believe, 
therefore, if all these ulcers be speedily healed by topical treatment, 
so that the blood shall only contain a given quantity of the virus, this 
limited amount will gradually become diluted, by the constant addition 
of new and healthy blood, and by its frequent circulation through the 
lungs, so that its power to impress the structure is finally lost, and the 
parts which have already been affected, gradually recover their 
healthy tone. 
In advocating the practice of topical applications, however, we do 
by no means wish to be understood as placing entire reliance upon 
them, to the exclusion of other remedies. We only assert that local 
applications are capable of effecting speedy cures of chancres, thus of 
destroying these sources of contamination, and placing the blood in 
the most favorable condition to be purified by the inspired oxygen, by 
the newly-formed blood and by remedial agents. A morbid action is 
set up in the chancre, which causes it to generate matter of virulent 
quality. This is evident from the fact that the matter of buboes and 
other venereal abscesses, as well as the blood of syphilitic persons, 
is incapable of causing contamination in the healthy. We repeat, 
then, heal the chancres as soon as possible, by destroying their mor- 
bid action, with some local application which shall induce a healthy 
medicinal action, and we have already done much towards abridging 
the power of the disease. Our admirable specifics, will, then, readily 
accomplish what remains to be done in perfecting a cure. 
The remedial agents which we have found most useful in the 
management of syphilis, are :—Topical: — Nitr.-argenti, Acid-nitric, 
Zinc-chlorid., Mercur.-prcecip.-rubrum., Kreosote. Internal: The 
preparations of Mercury, Aurum-mur., Thuja, Acid-nitr., Sulphur, 
Hepar-sulph., Sarsaparilla, Silicea, Mezereum, Ilydr.-potassce. 
In the treatment of chancre, our attention should be directed in the 
first instance to the cauterization of the sore, in order to change as 
speedily as possible the morbid action. For this purpose, either of 
the first-named medicines may be employed, although in most cases 
we prefer the Nitrate of Silver in substance. After a healthy action 
has been excited in the ulcer, by these applications, lotions of simple 312 
DISEASES OF THE SANGUINOUS FUNCTION. 
water may be employed until the cure is established. It will be well 
to keep a dossil of lint moistened with water constantly upon the 
ulcer. This course, in conjunction with the remedies advised below, 
will generally effect speedy and permanent restoration. 
Treatment of Chancre.—In the treatment of the simple form 
of chancre, if we admit the correctness of the opinions deduced from 
the largest experience, we have a local disease, but it is & poisonous 
sore, which is secreting a poisonous pus, which must be destroyed. 
The treatment therefore is essentially surgical. As in cases where 
poisons have been taken into the stomach, we begin with dislodging, 
or neutralizing the poison before we try to cure the symptoms pro- 
duced by the poison, so in the case of the simple, non-infecting 
chancre, we must, says Ricord, “ reduce the specific ulceration to the 
state of common ulcer, and transform a wound possessing a special 
principle for its maintenance into a wTound which has no longer such 
a resource.” (Ilelmuth.) 
For the cure of the primary infecting sore Mercurius, third tritura- 
tion, in some form is certainly the most efficient agent. 
In the local treatment to be adopted in the simple chancre, Ricord 
says, we should “reject at once all mild caustics, which only act more 
or less as anodynes. That which is required in this instance, is a 
destructive agent.” He says, he has successively tried the “Vienna 
paste, Potass, Nitric-acid, the actual cautenr, &c..” but proposes a 
new agent which is peculiarly efficacious. “ This caustic consists of 
Sulphuric-acid, mixed with powalered vegetable charcoal in the pro- 
portions necessary to form a half-solid paste.” It is proposed by this 
application to “ destroy the poison, and convert the chancre into a 
simple wound, which will proceed rapidly to cicatrization.” Dr. 
Helmuth says, he tried this application in eleven cases of simple 
chancre with “ the most surprising results. Define well the chancre, 
find it to be certainly the non-contagious ulcer, and no internal 
treatment is required.” 
Of the internal remedies, Mercury is the most important. By 
comparing the pure effects of the different preparations of this drug 
upon the healthy human organization, with the constitutional effects 
of the syphilite virus, it will be observed that the former are capable 
of causing all the symptoms of the latter, as well as may others which 
are peculiar to the drug. According to Pereira, the effects of Mer- 
cury in large doses are: 
First. On the mucous membrane of the nose and throat: ulcera- 
tions of the mouth, gums, throat, and nose, which are often followed 
by extensive sloughing of the parts. 
Second. On the skin or surface of the body : eczema-mer cur idle, 
erythsma-rnercuriale, sjpilosis-mercurialis, miliaria-mercurialis, SYPHILIS. 
313 
and other cutaneous eruptions which bear a close resemblance to 
herpes, impetigo, psydrasia, and the copper-colored eruptions of 
syphilis. 
Third. On the bones and their periosteal coverings: “ inflammation 
of the bones or periosteum, and the consequent production of nodes 
(symphoresis periostei mercurialis.”) 
C f all the medicines used in the treatment of lues, says Hahne- 
mann, Mercury is the only one that has stood the test of experience 
They coincide in their action in many points. Thus: 
The venereal poison produces on the skin pustules, scales and 
tubercles. Mercury produces similar defoedations of the skin. Sy- 
philis excites inflammation of the periosteum and caries of the bones. 
Mercury does the same. Lues produces inflammation of the iris ; the 
same is a very common occurrence as a consequence of Mercury. 
Ulceration of the throat is common from syphilis; the same often re- 
sults from Mercury. Ulcers on the organs of reproduction result from 
both the poison and the remedy; thus furnishing another proof of the 
doctrine of Hahnemann. 
Mercury, though a partial similimum to venereal disease, is not a per- 
fect one; and sometimes produces drug-symptoms which obstinately 
remain beside those of syphilis. There are frequently seen “ cases 
of venereal chancrous disease, especially when complicated with psora, 
and even with gonorrhoea sycotica, which, far from being cured by 
considerable and repeated doses of inappropriate mercurial prepara- 
tions, station themselves in the organism alongside of the chronic 
mercurial disease, which develops itself gradually, and form together 
a monstrous complication generally designated by the name of masked 
syphilis (pseudo-syphilis,) a state of disease which, if not absolutely 
incurable, cannot, at least, but with the greatest difficulty, be changed 
into health.” For, “ besides the morbid symptoms analogous to those 
of the venereal disease, which wTould be capable of curing the same 
homoeopathically, Mercury produces a crowd of others, which bear no 
resemblance whatever to those of syphilis, and which, when ad- 
ministered in large doses, especially where there is a complication 
with psora, as is frequently the case, engenders fresh evils, and com- 
mits terrible ravages in the body.” (§ 41.) 
By the above it will be seen that all of those parts capable of being 
impressed by the venereal virus, are also acted on by Mercury. That 
the operation of the latter is often more violent and destructive than 
the former, will not at this day be questioned. 
Erythema, lepra, erysipelas, miliary eruptions, herpes, and impetigo 
are mentioned by Pereira, and others, as skin-affections, which have 
arisen from the ill effects of Mercury. These symptoms are: ulcerated 
mouth and throat, periosteal nodes, iritis, and mercurial cachexia, a 314 
DISEASES OF THE SANGUINOUS FUNCTION. 
morbid state characterized, according to Mr. Travers, “by irritable 
circulation, extreme pallor and emaciation, an acute and rapid hectic, 
and an almost invariable termination in phthisis a picture of the 
phenomenon following venereal infection, which possesses the truth- 
fulness of a daguerreotype. The capability possessed by this medi- 
cine of producing in a healthy individual the special and collective 
phenomena characterizing the venereal disease cannot be denied; 
consequently, wrhen exhibited with the intention of curing the malady 
the indications of the lawr, “ similia similibus curantur” are fulfilled 
in every particular; yet it is used by the majority of practitioners, 
wTho sneer at homoeopathy.” Erichsen, when recommending this 
mineral, says : “ Looking, therefore, upon Mercury as the only remedy 
we possess that influences directly and permanently the venereal 
poison, I think that it should always be administered in a full course, 
during some period of the treatment of constitutional syphilis,” 
(Principles and Pract. Surgery, Erichsen, p. 426.) 
But in addition to the symptoms just enumerated, Mercury, in large 
doses, causes almost innumerable other symptoms, which have no 
bearing upon the subject of this chapter, except as indicating its 
danger in the hands of allopathists. 
In the above quotation from a distinguished allopathic writer the 
analogy between the effects produced by the venereal poison and those 
produced by Mercury may be seen ; and the difficulty of distinguishing 
between mercurial and syphilitic in the old school mode of practice 
may be readily inferred. 
For an accurate and complete description of the pure effects of 
Mercury upon the healthy organism we refer to the provings of Hahne- 
mann and other homoeopathists. 
Hahnemann preferred the fluid Quicksilver, carried up to the 
decillionth degree, over all other preparations in the treatment of both 
primary and secondary syphilis. 
For the cure of primary chancre, Hartmann recommends the first 
or third preparation of Mercurius-solubilis, in doses of one grain, 
night and morning. If no improvement occurs wdthin the first eight 
days, he gives a lowTer trituration of Merc.-prcBcip.-rubrum, in doses 
of one-sixth of a grain, twro or three times a day. In the Hunterian, 
■phagedenic, and the elevated indurated chancres, Hahnemann em- 
ploys the Red-precipitate, in its lower attenuations, from the first. 
Dr. C. Muller, of Leipsic, is also most decidedly in favor of the Red- 
precipitate, or the Ilydr.-sulph.-rub., in the treatment of syphilitic 
chancres and buboes, in whatever state they may present themselves. 
He advises a grain of the first trituration to be given twdee a day until 
the ulcers have nearly healed. For painful nodes and other syphilitic 
affections of the bones Hydriod.-potassce is advised. 8¥PHILIS. 
315 
We have also made use of tne Precipitate at the third attenuation, 
with marked advantage, in uncomplicated syphilis ; and have known the 
best results, also, from the Ilydr.-7nur.-cor., in both the primary and 
secondary forms of the malady. For the cure of troublesome secondary 
symptoms, in the form of cutaneous eruptions, glandular enlargements, 
and nodes, the Protoiodide of Mercury has extraordinary power. 
Speedy cures have been effected by it after the other mercurial pre- 
parations had failed. It may be used at the third attenuation, in doses 
of a grain, twice a day, until the eruptions disappear. 
Only against syphilis, says Dr. Wolf, Mercury and Iodine are in- 
dispensable. “ Pure syphilis requires Mercurius ; for the combination 
of syphilis and sycosis, Iodine—only one dose 30° must be given. 
Where a cure is not affected by it, it is a sure sign that one or the 
other of the following three impediments hinders the cure : 
1. Abuse of Mercury or Iodine. The first can be remedied by one 
dose of Mercury, 6000°, the second by Iodine one dose, 5000° ; where 
both have been abused, it is necessary to give, first Mercury, 6000°, 
and afterwards Thuja, 1000°. 
2. The second impediment is the predominating influence of the 
psoric poison. This requires one dose of Sulphur, 30°, or in case of 
abuse of Sulphur, Sulphur, 6000° (after the previous dose of Mer- 
curius 30° has left the case unfinished.) 
3. The third impediment is the predominating influence of the sycotic 
poison. (See Sycosis.—Index.) Syphilitic ulcers require Kali-bichro- 
mate, 30°, one dose, where the cure remains unfinished ; after it San- 
guinaria 30°.” 
M. Diday, in advocating the treatment of infantile syphilis indirectly 
through the medium of the milk, (in answering the objection that 
chemistry is not able to detect infinitesimal doses of medicines in the 
milk when thus charged with Mercury, says:) “I am willing to admit 
that chemistry has for the present told us all it can tell. Must this 
infiniteswnal quantity of Mercury be estimated in reference to its 
curative power, by that of the salts which we dissolve in our labora- 
tories ? An extremely small quantity of Sulphur or of Alkali con- 
tained in the waters of Bareges or Vichy cures, in twenty-five or thirty 
days, affections which had previously resisted the largest officinal 
doses of Sulphuret of Potassium or Bicarbonate of Soda. Has nature 
denied herself the same privilege in the combination which she effects 
in the living organism ? A vulgar adage tells us that a man lives by 
what he digests, not by what he eats. In the same way, it is the re- 
medy absorbed, not the remedy ingested which effects the cure. And 
if a molecule of Mercury, reduced by the milky secretion to the state 
of combination most conformable to the special conditions presented 
by the child, and reaching the stomach continually arrives there in a 316 
DISEASES OF THE SANGUINOUS FUNCTION. 
form and at times .in which its passage into the absorbent system is 
ensured, — if, moreover, this molecule (as facts prove) suffices to cure 
it,—in the name of what science can its effects be compared to those 
of the portion of a salt which we force it, twice a day, to swallow re- 
pugnantly, without even knowing whether it will not immediately be 
rejected and passed off with the stools.” (Infantile Syphilis, Diday, 
“ New Sydenham Society,” p. 240.) 
When syphilis is complicated by psora, or any other chronic disease, 
suitable remedies should be alternated with the mercurials. 
Muriate of Gold ranks next in importance to Mercury, as a re- 
medy in secondary syphilis. The late Taft, of New-Orleans, employed 
it in secondary ulcers and eruptions which would not yield to Mercury, 
with the most gratifying results. In syphilitic eruptions of long stand- 
ing, we have often administered it with entire success. The second or 
third trituration may be employed, in half grain doses, night and 
morning, as long as is necessary. 
Nitric-acid will be serviceable in many cases of ill-conditioned 
chancres, which seem to withstand the curative force of Mercury. It 
is also of great value in contracted secondary cases, accompanied with 
emaciation, debility, caries of the bones, unhealthy ulcers upon the 
surface, and great derangement of the nervous system. If these 
symptoms have been aggravated by abuse of Mercurials, the indication 
is still stronger for the Acid. The first, second and third dilutions 
are to be preferred in these cases, a dose to be given twice daily until 
the disease yields. 
Sulphur, Uepar-sulph., and Ilydr.-sulph.-rubr., are the proper 
specifics when the chancre occurs in psoric constitutions. As a general 
rule, the two first should be alternated with some mercurial prepara- 
tions. 
Ily dr.-potasses, is eminently worthy of consideration in the indolent 
glandular swellings which sometimes originate from a combination of 
syphilis and scrofula. It is also an efficient medicine in the treatment 
of venereal nodes. 
Silicea, Mezereum, and Sarsaparilla are often valuable auxiliaries 
in syphilis complicated with scrofula. These medicines should also 
be given in alternation with some other suitable specific. 
In conclusion, we call attention to the following reliable mark of cure 
alluded to by Hahnemann in his Chronic Diseases : “ So long as the 
original spot upon which the chancre had been developed, exhibits a 
reddish morbid looking, red, or bluish scar, we may be sure that the 
internal disease is not completely cured ; whereas, if the chancre has 
been removed by the internal remedy, the original spot of the chancre 
can no longer be traced, on account of that spot being covered by as 
healthy-colored a skin as the rest of the body.” SYPHILIS. 
317 
Treatment of Secondary Syphilis.—Secondary syphilis consists 
in the introduction of a poison into the blood; and the cure of it, in 
the neutralization of that poison. 
The attainment of this object must he sought in the careful, judicious, 
and prolonged use of medicines ; and in the adoption of such measures, 
hygienic and dietetic, as are best calculated to sustain the patient’s con- 
stitutional powers. 
First, then, as regards medicines. It is beyond a question that, as 
with the original sore, so with many of the constitutional symptoms 
which result from it, Mercury is one of the most efficacious remedies. 
We constantly meet with cases in which the primary and secondary 
diseases coexist, and in which the Mercury given for the one cures the 
other at the same time, several examples of this are reported further on. 
There is commonly in these instances this advantage, viz., that Mercury 
has not been previously administered and it is precisely in such cases 
that the curative action of the medicine is most decided. The same 
thing holds good with reference to the secondary symptoms. If Mercury 
has been given to any considerable extent for the cure of the chancre, the 
benefit to be derived from its administration in the treatment of secon- 
dary symptoms will be much less marked, than in those cases in which 
it has been given in very minute quantities, or not at all. In either of 
the latter instances, unless there exist some special circumstance to for- 
bid its use, Mercury is often of the utmost value in combatting the ear- 
lier secondary diseases of the skin; the erythema, papules, and squamae. 
Over the more inveterate eruptions, it has comparatively little power. 
When, therefore, a well-marked and undoubted case of secondary erup- 
tion presents itself, following closely, or at no great distance upon the 
primary disease and in which the patient has not been mercurialized, it 
is well to commence the treatment with one of the lower dilutions of the 
Iodide or Bin-iodide of Mercury—the second or third decimal, in two- 
grain-doses, twice a day. This should be steadily persisted in until the 
eruption has vanished, or until it appears certain that the medicine 
has effected all the good that can reasonably be looked for from it. In 
many constitutions these eruptive disorders are remarkably obstinate, 
and no remedy will exercise a sudden influence over them. The Mer- 
cury having had a fair trial, if it fail in effecting a complete cure, 
another medicine must be resorted to. 
Kali-hydriodicum claims our next attention; this is a remedy of 
undoubted power in treating the secondary diseases of syphilis; and 
in the majority of cases of skin affections, as well as affections of other 
tissues, its aid is required in expediting or completing the cure. In ob- 
stinate cases, especially those occurring in scrofulous constitutions—and 
they are the most obstinate, it is a good plan to give this medicine alter- 
nately with the Bin-iodide of Mercury, not in alternate doses, but during 318 
DISEASES OF THE SANGUINOUS FUNCTION. 
alternate weeks, i. e. the Kali-hydriod. one week, the Mercurius-hin- 
iodidus the next and so on. Excellent results will often spring from 
the alternate action of these and other remedies; and the more so, the 
less rapid the alternations. To obtain its full curative action in syphili- 
tic diseases, the Kali-hydriodicum, like the preparations of Mercury, 
must not be administered in too small doses. “ I am in the habit of 
giving two grains of the salt three times a day, in aqueous solution. 
The principal indications for its use are—a scrofulous and debilitated 
constitution; enlarged glands in the groin, the throat or neck; the 
previous exhibition of Mercury in excess, marked by red and inflamed 
gums, sore throat, foul breath, nocturnal bone-pains.”—(Yeldham.) 
It was at one time the almost universal persuasion, that secondary 
syphilis was incurable, and even now this opinion has its adherents. 
On the other hand, there are those who, more sanguine than wise, do 
not hesitate to promise their patients speedy and permanent cure. The 
truth, as in most other cases, lies between extremes. There is no 
doubt that in recent cases of secondary disease, occurring in good 
constitutions, and where the system has not been saturated with Mer- 
cury, complete and permanent eradication of the symptoms may be 
safely prognosticated. On the other hand, it is equally certain that, 
when the taint has once entered the circulation of persons of depraved, 
scrofulous, and broken-down constitutions, it may but too confidently 
be predicted, that, though secondary symptoms may, for a time, ap- 
pear to be successfully combatted, relapses will occur with more or less 
virulence for many years, and, possibly, for the remainder of the 
patient’s life. 
“The treatment in former times, of primary syphilis with destructive 
doses of Mercury, by inducing the very state of the system, I have 
just described, had much to do with the development of secondary dis- 
eases in their most inveterate and intractable forms. Modern science, 
better instructed, obviates much of this mischief, by avoiding the use 
of Mercury altogether in treating some cases of primary ulcer, and 
by giving it in more moderate quantities, when it is employed. Still, 
I am convinced there is room for yet greater improvement, and that 
homoeopathy points out the way to it; and to this important point we 
now proceed to direct our attention.” 
The connection of psora and syphilis, says Dr. Wolf, is proved by 
the fact that since the appearance of syphilis the lepra has become 
very scarce. 
The syphilitic dyscrasia has three characteristic peculiarities: 
1. Want of flexibility of the limbs, which refuse to obey the impulse 
of the will. The joints, on moving, make a painful crepitating noise. 
2. Shuddering when going to stool, and, 3. sleeplessnes without 
apparent cause. SYPHILIS. 
319 
Di. Wolf says, primary syphilis may remain stationary for twenty 
years; but if the chancre is treated actively, and Mercury in large 
doses be given, and the ulcer healed by force, the slow chancrous 
dyscrrasia is generally the result. 
The outbreak of the secondary symptoms is, generally, caused by 
taking a severe cold, often showing itself in an attack similar to acute 
gout. The combination of the syphilitic and mercurial poisons greatly 
aggravates all pre-existing morbid conditions ; the liability to take 
cold is greatly augmented, the worst form of coryza, with offensive 
corroding secretion is produced, the glands are affected, and a great 
disposition to parenchymatous inflammations, ulcerations, dissolution 
of the blood, &c., is produced. 
But all this suffering Mercury alone can produce, without its com- 
bination with syphilitic poison. Mercury and Iodine are the very 
worst poisons, and should never be used but in syphilis. The affections 
of the mucous membrane, so often treated by Mercury, will also yield 
to Apis. Scrofula, tubercles, tumor, and goitre will also vield to 
Thuja.—(Wolf.) 
Treatment of the Diseases of the Mucous Membrane.—These 
diseases, as has been already suggested, are often, induced by exposure 
to cold. When so induced, if the patient be at the time, or has re- 
cently been, affected with syphilis, these cases acquire a peculiar char- 
acter from that circumstance—they become chronic, secrete copiously 
and the tonsillary glands may become much enlarged, and deeply ul- 
cerated. These attacks though of a syphilitic type, have their origin 
in catarrh and their early arrest may sometimes be effected by the 
usual remedies for catarrhal sore throat, viz.: Aconite, Bell., Apis, 
and Mer.-corrosivus. After Aconite has been exhibited to reduce 
any general febrile excitement, as well as to act on the local disorder, 
Apis is often very efficacious, in drop doses of the third decimal 
tincture. If it fail, Belladonna, Lachesis, and Merc.-corr. may be had 
recourse to. 
In cases of inflammation, or ulceration, of the same part, in company 
with other secondary symptoms—of the skin, for example—if Mercury 
have not already been administered to excess, the Iodide or Bin-iodide 
of that metal, in one grain doses of the second or third decimal should 
be administered twice a day. The throat will often get well pari- 
passu with other symptoms ; but should the disease persist when these 
have vanished, the treatment may be directed against it especially, 
Acidium-nitricum is here a useful remedy, and may be given internally, 
in five-drop doses of the second decimal tincture, three times a day ; 
and at the same time a gargle, composed of the pure acid of half a 
drachm in six ounces of water, maybe employed locally. This though 
beneficial in some cases, is far less efficacious than the Argentum-nit. 320 
DISEASES OF THE SANGUINOUS FUNCTION. 
“ This may be applied in its solid form when practicable, or in solution, 
in the proportion of five grains to the ounce of distilled water; the 
throat should be mopped with this once br twice a day. I employ this 
medicine in one of these forms in the majority of cases of syphilitic 
sore throat, and the comfort derived from it is immense.” 
It is beyond dispute that some persons are more susceptible than 
others to constitutional syphilis. It is equally certain that the scro- 
fulous constitution is that which is most exposed to its attack. That 
being so, the importance of attending to the general health of the 
patient, during the course of secondary syphilis, is self-evident. He 
should carefully observe all those measures calculated to maintain his 
health in the finest possible condition. In those early secondary 
diseases of which we have been speaking—of the skin and throat— 
being, as they commonly are, inflammatory and febrile, he should in- 
dulge in alcoholic drinks very sparingly, or not at all, at least in the 
earlier stages. He should live on plain, good nutritious food. In 
keeping with this, as well as in reference to the depression of the ge- 
neral powers which commonly characterize constitutional syphilis, Cod- 
liver oil is an agent of first-rate importance. “ Possessing the advantage 
of not being medicinal, and therefore not interfering with the action of 
medicines, I find it in many cases more than a substitute for the re- 
nowned sarsaparilla—a medicine which, when there is no particular 
indication for other remedies, may be prescribed with the greatest ad 
vantage. A small quantity of cod-liver oil is sufficient—a dessert- 
spoonful, taken every night at bed time. Larger quantities, taken at 
other periods of the day, are apt to do more harm than good by nause- 
ating the patient, and destroying his appetite. If the throat or mouth 
be affected, he should strictly avoid smoking. He should not over- 
fatigue himself. For skin diseases he should take a warm bath twice 
a week. He should clothe himself judiciously, and carefully guard 
against the common causes of cold.”—( Yeldham.') 
The following medicines may, also, be administered with manifest 
benefit, viz.: Acid.-sulphur., Borax, Lachesis, Phosphorus, Ilepar-sul- 
phuris, and Sulphur. 
Clematis erecta.—(Ruckert.) In one case of chronic bubo the tumor 
had persisted after the suppression of a blenorrhagia. It was of oval 
form, of the size of a walnut, and the integument was of a deep red, 
for five years, allopathic remedies had failed; the Carbo-animalis, 
Mercurius, Ilepar, Sulph., Iodium, and Silicea were given for three 
months without result. Clematis made a cure in eight days. 
Syphilitic diseases of the bones.—Syphilitic affections of the 
nose require Aurum 200° one dose every twenty-four hours for seven 
days.—{Wolf) 
Tophi, exostoses, &c.—They are only produced by the abuse of SYPHILIS. 
321 
Mercury, therefore Mercury 6000° must be given. Where caries has 
already set in and the cure does not progress after that dose of Mer- 
cury, Silicea SO0 is the best remedy, and this potency is the best 
Where in the most severe cases Silicea cannot accomplish the cure 
one dose of Sulphur 30° is yet required. Where the bone pains do 
not quickly yield the Mercury, Apis 30° in dilution, or Aconite and 
Apis in alternation will be likely to succeed. 
Softening of the bones, swelling and curvature, yield to Acid.- 
fluoric 2000°, one dose. [Dr. Wolf.) 
Brittleness, dessication, and fragility of the bones. These yield to 
Calcarea-carb. 200° in dilution, one dose daily for five days. 
Nodes.—Case by Dr. Ilelmuth.—A gentleman applied for relief 
for ulcerated nostrils, enlargement of the turbinated bones, and a node 
which gave intense pain. The patient had been mercuralized for sy- 
philis two years previously. I gave him the third trituration of Aurum- 
mur., followed this with Mezereum, and Asafoetida, and cured him in 
four months. 
Syjohilization.—In 1844, M. Auzias Turenne, of France, commen- 
ced a series of experiments with the object of testing the correctness 
of John Hunter’s opinion on the non-communicability of syphilis to the 
lower animals. By inoculating monkeys with chancre matter Turenne 
succeeded in producing a disease having all the characteristics of a 
true chancre; also communicated true chancre from animals to the 
human subject. Finally he reached the conclusion that, by a prolonged 
series of successive inoculations with the syphilitic poison, a constitu- 
tional state or diathesis was at length produced in wdiich the system was 
no longer susceptible to the action of the syphilitic virus; as a person who 
has had small-pox cannot take the disease a second time. Though the 
proposition of Turenne to treat syphilis by repeated syphilitic inocula- 
tions was rejected by the French academy of medicine in 1850, the 
experiment was tried on a large scale in various hospitals. In May,. 
1851, Sperino of Turin reported fifty-two cases treated by syphilization. 
These cases showed that by a regular course of successive inoculations* 
all venereal symptoms of all former infections were eradicated. All 
old “ ulcers healed, and buboes, recent nodular enlargement of bones, 
and cutaneous stains or blotches disappeared altogether.” 
Professor Boeck, of the university of Norway, in a work published in 
1854, says, he has cured the “most inveterate cases of syphilis by sub- 
jecting the patient to a series of inoculations, at intervals of six, five, 
or three days, and permitting the chancres thus produced to run their 
usual course. This mode of inoculation consists of making several 
small punctures at one time on the arms or thighs. These punctures 
become real indurated chancres in about five days. Before these have 
reached the stage of induration, others may be initiated in the neigh- 
Y u.. M.—21. 322 
DISEASES OF THE SANGUINOUS FUNCTION. 
boring parts, and thus the process must be kept up until complete im 
munity is attained; and when this point is reached all the old symptoms 
of syphilis gradually disappear. It is not proposed by these authors 
to practice syphilitic inoculation for the purpose of producing immunity 
from new attacks, but for the purpose of curing those terrible cases of 
the disease in which all common measures would fail if tried, and in 
which extraordinary measures have proved worse than the original 
disease. 
/Symptoms which have been Cured by Syphilization.—Ecthyma 
syphilitica of the whole body; syphilitic tubercles between the toes, in 
the fauces, in the angles of the mouth; pains in the legs; pains in the 
clavicles and in the humeral bones; psoric eruptions on the palms of 
the hands; general debility; large syphilitic sores on the left thigh in 
one case which had been treated with mercury in childhood for in- 
herited roseola syphilitica, and ulcers of the throat; papular syphilitic 
affection of the throat; syphilitic lichen; syphilitic tubercular affection 
with syphilitic serpinginous lupus ; fever with erysipelatous eruptions 
near the chancres caused by inoculation; sores on the lower limbs; 
roseola syphilitica on the face, breast, and thighs; mucous tubercles 
over the inner surface of the labia, and also on the mucous membrane 
of the mouth ; papular eruption over various parts of the body; ulcera- 
tion of the fauces and genitals; syphilitic iritis. In some cases in 
which mercurials and Iodide of Potassium had been tried without be- 
nefit, syphilization only partially carried out, has rendered the system 
susceptible to the curative influence of either of these remedies. In 
all the cases reported, there has been an evident and progressive im- 
provement in the general health ; and no relapses occurred. How far 
the process of syphilitic inoculation may hereafter succeed in eradicat- 
ing the venereal virus from the diseased constitutions of degenerate and 
suffering humanity remains to be seen. The destructive operations 
of four centuries of progressive poisoning are around us. M. Auzias 
Turenne proposes to make the chronic miasm of syphilis available on 
a principle analogous to that under which vaccination triumphs over 
and averts the ravages of small-pox. 
Transmission of Syphilis by Vaccination.—That the secondary 
symptoms of syphilis can be inoculated on persons wTho have never 
been infected with the disease, has been thoroughly proven by experi- 
ments and the clinical experience of a great number of observers in 
this country and in Europe. Until the time of Hunter, syphilis in 
every stage was believed to be highly contagious, and contact with 
any of the secretions, or even exposure to the breath of those suffering 
from constitutional infection, was dreaded. Hunter tested the com- 
municability of the secondary lesions by numerous inoculations upon 
those who had already suffered from syphilis, and all failing, he esta- SYPHILIS. 
323 
blished the dogma that the secondary manifestations of the disease are 
not inoculable. It was believed to be morally wrong to inoculate per- 
sons with syphilis who had not already experienced it, and the errone- 
ous conclusion of Hunter was permitted to pass without correction. But 
recent and direct experiments “on persons who have never had the 
disease, and accumulation of evidence from clinical experience,” have 
compelled the most persistent adherents of Hunter’s teaching to 
acknowledge that the secondary symptoms of syphilis can be trans- 
mitted by inoculation to persons who have never been infected by it; 
and that the analogy between syphilis and some other infectious 
diseases is sufficiently demonstrated. 
Syphilis has been repeatedly communicated by means of pus from 
syphilitic ecthyma pustules, from the secretions from condylomata, 
and from specific ulcerations of mucous membranes by inoculating per- 
sons who never had the disease. “ The blood of a syphilitic patient 
has also been made the means of communicating the disease by ap- 
plying it to a scarified surface on a non-infected subject.” 
“ It is perhaps from direct inoculation with the blood of a syphilitic 
patient, the lancet being charged with it, that the operation of vaccinat- 
ing has been the means of introducing syphilis; yet there is a consi- 
derable amount of evidence in favor of the possibility of inoculation 
through clear vaccine lymph and pus. A number of observers, mostly 
French, have given their attention to this subject, and the evidence 
certainly seems conclusive in favor of the propagation, not only when 
the blood of syphilitic persons had been used alone, or mixed with the 
virus, but when only lymph from the vesicle had been introduced. 
“ We believe that enough has been adduced in proof of the occa- 
sional infection of syphilis through vaccination, be it either blood, 
lymph, or pus, to induce practitioners to be exceedingly cautious in 
the selection of virus, and it is with the object of impressing this 
caution that we now discuss the subject.” It is not an uncommon 
thing, as every practitioner knows, to see ordinary eruptions on the 
skin of children attributed to vaccination, yet it is probable that real 
syphilitic disease, introduced by vaccination, has sometimes appeared, 
and not been recognized, because not suspected. 
“ It should be borne in mind by observers that vaccination with pure 
matter is sometimes the exciting cause of syphilitic eruptions in in- 
fants already under the syphilitic diathesis ; in the same manner that 
it gives rise to non-specific eruptions in strumous subjects. The his 
tory of the case, and the order of evolution of the symptoms are 
generally sufficient to establish the diagnosis. For instance, the ap- 
pearance of the eruption within a few days or weeks after vaccination, 
without the ordinary period of incubation of syphilis, will render it 324 
DISEASES OF THE SANGUINOUS FUNCTION. 
probable that the disease was already latent in the system.”- -{Bum 
stead on Venereal Diseases.) 
In regard to the selection of vaccine matter, with a view to insure 
safety from syphilitic taint, the following rules have been laid down : 
1. Examine carefully the child from whom the lymph is taken. 
2. Try to learn the state of the parents’ health. 
3. Choose, in obtaining lymph, such children as have passed the 
fourth or fifth month, as hereditary syphilis, in general, appears before 
that age. 
4. Do not use the lymph after the eighth day of the existence of 
the vesicle, as the lymph on the ninth or tenth days becomes dull, by 
mixture with pus, which latter may be of an infectious nature. 
5. In taking lymph with the lancet, avoid haemorrhage, as there is 
less danger with pure transparent lymph. 
In a recent publication a record appears of the communication of 
syphilis to forty-six children by vaccination in the village of Rivolta, 
Piedmont. In these cases the symptoms of syphilis appeared on an 
average on the twentieth day. The symptoms of genuine syphilis by 
vaccination, after a regular incubation period, wrould be fever and 
debility, papules on the skin, pustules, swelled lymphatics, ulcerations 
of the mucous membranes, &c. The principal appearances noted after 
the disease had existed some time, in the forty-six cases alluded to, 
wrere mucous tubercles on the verge of the anus and genital organs, 
sores on the lips and fauces, swelling of lymphatics, syphilitic erup- 
tions, induration of the cellular tissue, &c. — {Med. and Surgical 
Reporter, May 17,1862.) 
Dr. Whitehead says, syphilis may be communicated through the at- 
mosphere. It may also be transmitted through lactation: the nurse 
may infect the child, and the child the nurse. It may be communi- 
cated by inoculation, by vaccination, and by contact of the raw surface. 
Bietts says, it may even be communicated through the sound skin: 
“ that there are certain forms of syphilis with which every species of 
contact may prove dangerous.” 
Tartar-emetic is recommended by Dr. Smee for syphilis. He 
gives the first and second triturations every four hours. Dr. Willebrand, 
of Finland, says, it alone cured cases of primary chancre in from ten to 
twenty days; no application but water dressing was made to the sore. 
In a few cases it failed where there was much induration. It has 
cured secondary syphilis and syphilitic eruptions, aided only by clean- 
liness, repose, and regulated diet. In bubo it has succeeded in reducing 
the inflammatory swelling. 
Tartar-emetic often reduces the swelling and the pain in orchitis. 
Nitric-acid.—Where the blood has already a great tendency to 
dissolution, with great want of strength, sugillations of blood, bleeding SYCOSIS. 
325 
from the nose, lungs, or intestines, with a scorbutic state of the gums, 
Nitric-acid is the proper remedy. In chronic cases, says Dr. Wolf, 
one dose 30°; in more acute cases, one dose 30° every twenty-four 
hours for three days; and in the worst cases, Nitric Acid 30° in dilu- 
tion, every one to three hours, till amelioration takes place. Inflam- 
mation of the lungs on syphilitic ground is also to be treated by Nitric- 
acid, and where this does not suffice, Sanguinaria 200°, every three 
hours. 
Lycopodium.—Where the syphilitic poison has concentrated itself 
on the liver, and consensually affects the spleen, kidneys and genital 
organs, Lycopodium 200° is the proper remedy. Magnesia-muriat. and 
Natrum-muriaticum only aggravate the symptoms in such cases, even 
where they seem to correspond to the symptoms. This explains why 
the sea-bath is so injurious after syphilitic affections. 
Lycopodium is the best remedy in those dangerous uterine haemor- 
rhages in syphilitic and mercurial cachexia. We give the 200° in 
dilution every three hours ; and the same remedy holds good in cases 
of bloody urine, of hypochrondriasis and hysteria, originating in the 
above-stated combination of the syphilitic and mercurial poisons.— 
(Wolf.) 
Dr. Wolf says, “the third great impediment to the cure of syphilis 
is the predominating influence of sycosis, or the poison of sycotic gon- 
orrhoea.The sycotic poison is the result of a combination of psora 
and syphilis in their highest potency. “ It is a dyscrasia which has 
spread fearfully, and in a hitherto inexplicable manner, since the 
beginning of the present century ; so much so, that if this progression 
should continue on at the same rate, the very existence of mankind is 
in jeopardy.” 
The sycotic poison greatly increases the disposition to all those 
every-day illnesses, and it renders all diseases more obstinate and 
pernicious. 
Affections produced by Sycosis on the different Organs.—Affec- 
tion of the teeth with loosening of the roots and falling out, with the 
most obstinate form of prosopalgia, alternating sometimes with the 
most insufferable cephalalgia; affections of the mouth, with cracks on 
the lower lip, with peeling of the epithelium, small flat, whitish ulcers, 
&c. Hypochondriasis; pain in the muscles, spasms, giddiness, dead- 
ness of the tips of the fingers and toes; constipation, breath smelling 
like carrion, affection of the mucous membrane, and inferior character 
of its secretions ; tubercles, warts, fungous excrescences, varicose veins, 
deposition of bacon-like fat, gout, chronic catarrh of the urinary or- 
gans, Bright’s disease of the kidney, diabetes meliitus. 
2. SYCOSIS. 326 
DISEASES OF THE SANGUINOUS FUNCTION. 
Dr. Wolf supposes small-pox to be the efflorescence of the sycotic 
poison, and that vaccination is the channel through which this virus 
is often communicated. He says the most prominent symptoms of 
sycosis, after syphilis or leucorrhoea, without any previous affection, 
are sometimes observed as the result of vaccination. There is also 
great tendency to self-abuse, affections of the testicles, ovaries, eyes, 
ears, teeth, and hairs, weakness of the nerves and head, giddiness, pa- 
ralytic affections, spasms, and asthma. Chlorosis, anomalies of men- 
struation, diabetes, tuberculosis, &c., appear as an immediate conse- 
quence of vaccination. And most of the above-named diseases are the 
standing and predominating diseases of the present day. 
Dr. Wolf says: Influenza, typhus, and whooping cough, wTith great 
tendency to tuberculosis, have also become standing diseases in a 
hitherto unheard of manner. The “ progressive paralysis,” a newly 
described disease; and a common mental disease, described by him as 
“ grosserwahn,” are prevailing diseases following upon the continual 
poisoning of successive generations by impure vaccine or sycotic 
poison. 
The Egyptian ophthalmo-blennorrhoea has become a standing disease 
amongst the soldiery, and very often follows vaccination, and it is well 
known that gonorrhoeal ophthalmia and the above mentioned form bear 
the closest resemblance. 
Condylomata.—A secondary affection complicated by syphilis and 
sycosis. 
Fig Warts.—“ Flattish, pale colored, secreting a very foetid ichor, 
that come on almost every part of the body, as on the penis, behind 
the glans, on the scrotum, around the anus, on the thighs; also on the 
hairy scalp, the corners of the mouth, the lips, especially their red 
part, on the tonsils, &e. On their apices there are not unfrequently 
small ulcers, scabs, blisters; those on the face sometimes resemble 
variolous pustules. Along with them occur syphilitic symptoms in the 
shape of a tuberculous pustule, like acne or variola, the base of which 
seems to be indurated. “ On the hairy scalp they had a dark red base, 
were covered with scabs, or had a pustule in their centre.” Occasion- 
ally, condylomatous ulcers are present at the same time, the surface 
of which is spongy, dry or moist, and white, not excavated, but nearly 
on a level with the surface of the skin, or sometimes elevated above it, 
resembling a wart, and not only on the genitals on both sides, but also, 
like the condylomata themselves, on other situations. This form of 
disease is hard to cure, and when cured leaves behind it red elevated, 
pimples, which depart gradually and often leave deep cicatrices. 
Treatment. — Tartar-emetic.—Dr. Kraul of Rastatt employed 
Tartar-emetic, twice a-day, in the case of a man who had extensive warty 
excrescences behind the glans. After a week the warts were dimin- SYCOSIS. 
327 
ished in size, and in five weeks a cure was effected.—(Jlufeland’s 
Journal, Vol. V., p. 241.) In the Militiirarztliche Ze itimg, 3d 
year, pp. 239, 240, is a case in which Tartar-emetic was found useful 
in urethritis; also in syphilitic ulcers of the throat, sore mouth, ulcers 
of the fauces, and primary chancre of the penis. It also cured sy- 
philitic cutaneous affections, and one case of paraphimosis. Of thirty 
cases treated by it only one had a relapse. (See also Allg. Horn. 
Zeitung. Vol. 21, p. 276.) 
Dr. Baertl* says, he began to use this remedy in such cases as the 
above in 1845, and has been generally successful. When condylomata 
could be traced to chancre and gonorrhoea, he gave the remedy, one 
to two grains in six ounces of distilled water, a table-spoonful every 
three hours. After a week he employed it externally ; from three to 
four grains dissolved in two ounces distilled water; the warty ex- 
crescences were moistened with this twice a day by means of a thick 
roll of lint soaked in the solution. Another piece of rag or lint wet 
with the same was placed over this, and the part bandaged up. The 
patient was kept on rather low diet, chiefly of vegetables, farinaceous 
food, rice, &c. He was prohibited from fatiguing exercise. The re- 
medy was continued perhaps for weeks, though, externally it some- 
times occasioned pain; but the patient found his disease improving, 
and bore it cheerfully. No relapse remembered. 
Thuja.—Dr. Wolf gives the following general results obtained from 
the proving of this remedy on himself as well as on more than one 
hundred persons of every age and sex, the entire proving having de- 
veloped 1,050 symptoms. General results : 
1. Irritation of the mucous membrane of the genital organs, extend- 
ing itself over all organs. 
2. Changing of. the naturally mild secretion into one of an acrid, 
corroding infectious quality. 
3. Over-irritation of the nerves, with tendency to centripetal 
paralysis. 
4. Disturbance of the digestion and sanguification, tendency to de- 
struction, dissolution of the fluids, and of the whole organism. It will 
thus be seen that Thuja corresponds in every respect Avith the sycotic 
poison, and thus offers itself as a remedy against the following dis- 
eases which are the consequences of the sycotic poison. 
Sycotic Gonorrhoea.—The genuine poisonous figwart gonorrhaea is 
best cured by Thuja 30°, one dose being given. In the more recent 
cases a few days, seven to fourteen, are required. When, however 
the disease is hereditary, or Avhere abuse has preceded, a long time 
and the attenuations 3003 to 1000° are required. 
♦Horn. Vierteljahrsschrift, Yol. I., port 1. 328 
DISEASES OF THE SANGUINOUS FUNCTION. 
Iodine is the only remedy that antidotes Thuja. The actions of Thuja 
should be left undisturbed, and it is seldom necessary to give Aconite 
as an intercurrent remedy where inflammatory symptoms show 
themselves. 
In some cases the sycotic infection does not show itself by gonorrhoea, 
but shows itself only in irritation of the genital organs, constriction of 
the urethra, urging to urinate, wetting the bed, and irresistible desire 
to self-abuse, which has become common among small children. It 
has been often traced as its cause to vaccination. The best remedy is 
Thuja 30° one dose. 
Catarrh.—The continued poisoning extending from the mucous 
membrane of the genital organs upward produce the most severe and 
lasting catarrhal affection of the intestinal canal first, and afterwards 
of the respiratory organs. Whitish ulcerations on the corners of the 
mouth, cracks on the lips, and flat ulcers in the inside of the mouth, 
&c., characterize it. 
Thuja produces all of these symptoms and cures them. 
Psoric and Syphilitic Dyscrasia, combined with Sulphurism 
and Mercurialism.—It seems that Thuja (in high potency) can cure 
even these cases. In a sycotic ground, the scrofula is changed into 
tuberculosis ; caries is changed into spina ventosa. All diseases have 
been rendered more or less pernicious and unmanageable by the 
sycotic dyscrasia produced by the vaccination. The anti-psoric and 
anti-syphilitic remedies are without avail against these cases. The 
Thuja alone makes the diseases curable, and the remedies which be- 
fore the administration of the Thuja, were of no avail, now become 
efficacious. 
Rules for the Administration of the Thuja.—The 30th, 300th, 
and 1000th potencies have proved the most efficient. In fresh cases, 
where the patient is free from all inherited or acquired dyscrasias and 
medicinal diseases, and the younger or the older the patient, the more 
the thirtieth potency is in its proper place. The older the dyscrasia, 
and the more complicated the case is, the higher must be the potency. 
Only one single dose of one globule must be given; and all crises, 
particularly severe catarrhal affections, must be left to take their 
course. 
Only in cases of great necessity, the following remedies may be used: 
China, against great weakness. 
Ferri-acet., 2 , where there is a disposition towards dissolution of 
the blood. Severe pains may be treated by magnetic manipulations. 
Fevers mostly require Aconite, Nux, and Apis. All anti-psoric 
and anti-syphilitic remedies must be avoided. 
The action of Thuja must, in some cases, be aided. This can be 
done by Tartar-emetic, which is also an antidote to the sycotic SYCOSIS. 
329 
poison, at least as far as it is the result of vaccination. Dr. Wolf 
says, he obtained very favorable results from Tartar-emetic in in- 
fluenza, whooping-cough, croup, all sorts of catarrh, typhus, chlorosis, 
&c. To small children, where there is no danger in delay, one dose 
of Tartar-emetic 80° should be given; in more acute cases, Tartar- 
emetic SO3 in solution every one, two or three hours; in grown per- 
sons Tartar-emetic every two to six hours may be given. The most 
obstinate forms of megrim, prosopalgia and odontalgia are removed 
by Argentum-nitr. 200°. 
The following remedies act favorably in some cases, though not 
direct antidotes to the sycotic poison. 
Cyclamen.—In diplopia., and one-sided headaches. 
Acid-benzoicuvn, in some cases of diseases of the urinary organs 
and the heart. 
Anacardium in weakness of mind. 
The length of time required for a radical cure of sycotic disease 
differs greatly. In some cases from one, to three, four or five years 
may be required. But only by adhering to the above rules, which are 
the result of iong and extensive experience can a satisfactory degree 
of success be obtained ; and thus may be restored to mankind the 
greatest earthly boon that has yet been sought for—a sound mind in 
a sound body. 
Helminthia.—Worms in sycotic subjects are best removed by 
Thuja, which, by antidoting the sycotic poison, cures also the dis- 
position to worms. 
Varices, varicocele, haemorrhoidal tumors, black stools, &c., are 
becoming constantly more prevalent. When they are not cured by 
the old remedies, Sulphur, Pulsatilla, Lycopodium or Fluoric-acid, 
they have a sycotic origin, and are best treated by Thuja. 
Painfulness and swelling of the liver and spleen ; the former giving 
rise to depositions of fat and pigment and to the formation of sugar; 
the latter causing chlorosis and leucaemia in women, and cadaverous 
look and hypochondriasis oftener in men; fatty tumors, the fatty 
liver, heart, &c., are all cured or prevented by a timely use of Thuja. 
The same is present in diabetes mellitus, which is often the immediate 
consequence of vaccination or re-vaccination, and has been observed 
in children before the age of puberty, a case hitherto unheard of. All 
these affections of the liver run their course without any symptoms 
of jaundice. 
Degeneration of the skin, nails, and toes is caused by the sycotic 
poison ; also sweating of the hands and feet, panaritium, the pains in 
the soles or heels not depending on any organic lesions or disorganiza- 
tion of the parts, corns, chilblains, &c. All of these mostly depend 
on the sycotic poison and are therefore curable by Thuja. The con- 330 
DISEASES OF THE 8ANGUINOUS FUNCTION. 
tinuation of the sycotic poisoning, reaching the respiratory organs, 
produces extraordinarily severe catarrhs of the nose, with a secretion 
similar in color and odor to the secretion of the sycotic gonorrhoea, 
and this with considerable relief to all other symptoms. Where, how 
ever, this natural crisis is in some way checked, it gives rise to a 
bronchial catarrh, which often increases to phthisis. 
Thuja.—Case by Dr. Kellogg, of Troy, New-York.* A man aged 
forty, had a protruding pedicillated sycotic excrescence, one-third of an 
inch in length, on the verge of the anus, secreting a foetid mucus re- 
quiring the changing of his cloths during the day, and frequent ab- 
lutions ; a great source of irritation and annoyance. It was proposed 
to exsiccate and cauterize it; but presenting a marked case for Thuja, 
both in the local affection arid in a general sycotic diathesis, as the 
patient showed several small excrescences of similar character on other 
parts of the body; Thuja was given in a dose of one drop of the 
tincture. The sycotic fungus disappeared without receiving further 
attention, and was forgotten till no trace of it remained. The sycotic 
diathesis in this case was inherited from the mother who was subject 
to fatty tumors originating in the same morbid idiosyncrasy. In a case 
such as Avas here cured by a single dose of one remedy a spontaneous 
cure never occurs. 
GEN ITS IX.—ELEPIIA N TI A. 
MORBUS PIICENICIENS. 
Morbus Phoeniciens.—A disease so called from the limbs of persons 
affected with it growing scaly, rough, and very large, at an advanced 
period, like the legs of an elephant. The disease attacks the whole 
body, but principally affects the legs or feet, which appear somewhat 
like those of the elephant. 
Some authors describe two species: 1. Elephantiasis graecorum. 
2. E. arabicum. 
The. first is described by Aretaeus, as beginning with tubercular 
swelling of the face. See Lepra Anoesthetica. 
2. Elephantiasis Arabicum.—This is the true elephantiasis. It 
consists in a slow hypertrophy of the skin, areolar tissues and bones, 
and in their infiltration with a peculiar cacoplastic deposit. The 
epidermis is thickened and the papillae enlarged, though not much 
so: The true areolar tissue is thickened, its areolae expanded, and 
filled with oily or gelatinous looking matter. In cases which Druitt 
examined, “ the microscopical appearances were those of hypertrophy 
* U. S. Jour. Homoeop. Yol I.. p. 57. 331 
of the tissue involved. The bones also of the affected limb became 
enlarged and heavy.” 
This is a disease almost peculiar to hot climates though we have 
some cases of it in New-York. The dark races are more liable to it 
than the fair. In India it is particularly liable to attack the scrotum 
which it converts into a huge tumor. In the West Indies the leg is its 
favorite seat; hence the term “ Barbadoes leg.” 
It begins insidiously, with feverish or aguish symptoms; pain in the 
leg about to be attacked; firm, doughy swelling resembling phlegmasia 
alba dolens; and some tenderness of the lymphatic glands. In the 
course of months, or perhaps of years, the patient suffers a repetition 
of these attacks. The limb becomes permanently swelled, and in con* 
firmed cases, presents a huge, misshapen, useless member like the 
leg of an elephant, hard and almost insensible to the touch, yet pain- 
ful. A foetid discharge is liable to ooze from the skin; or ulcers may 
form, and if not very extensive, may diminish the pain, and seem to 
eliminate something noxious. (.Elements of Surgery.) 
Symptoms : The skin becomes thick, rough, wrinkly, unctuous, and 
void of hair, and gradually losing the sense of feeling. By many 
writers it is considered a species of leprosy; but it is radically distinct 
in its nature, and often exists many years without being accompanied 
with any of the symptoms characteristic of that disease. 
Elephantiasis comes on gradually without much previous indisposi- 
tion ; but generally the person is seized with a coldness and shivering, 
pains in the head, back and loins, with some degree of nausea. A 
slight fever then ensues, and a severe pain is felt in one of the in- 
guinal glands, which after a short time, becomes hard, swelled and in- 
flamed. No suppuration, however, ensues; but a red streak may be 
observed running down the thigh from the inflamed gland to the leg. 
As the inflammation increases in all the parts, the fever gradually 
abates, and, perhaps, after two or three days continuance, it goes off. 
It, however, returns at uncertain periods, leaving the leg greatly swol- 
len with varicose, turgid veins, the skin rough and rugged, and a 
thickened membrana cellulosa. Scales appear also on the surface, 
which do not fall off, but are enlarged by the increasing thickness of 
the membranes ; uneven lumps, with deep fissures are formed, and the 
leg and foot become at last of an enormous size. A person may labor 
under this disease many years without finding much alteration in his 
general health, except during the continuance of the attacks; and 
perhaps the chief inconvenience he will experience is the enormous 
bulky leg which he drags about with him. The incumbrance has in- 
deed induced many who labored under this disease to submit to an 
amputation; but the operation seldom proves a radical cure, as the 
other leg frequently becomes affected. Hilary observed, that he never 
ELEPHANTIA. 332 
DISEASES OF THE SANGUENOUS FUNCTION. 
saw both legs swelled at the same time. Instances have, however, 
fallen under the notice of other physicians, in which both legs be- 
came of frightful and prodigious size. 
Causes.—Elephantiasis has generally been supposed to arise in 
consequence of some slight attack of fever, on the cessation of which 
the morbid matter produces obstruction in the lymphatics and veins of 
the leg, occasioning distention and tumefaction of the limb, which is 
afterwards overspread with uneven lumps and deep fissures. 
Treatment.—The usual remedy proposed is the knife; Mr Dalton 
(of Guiana, Lancet, 1846, p. 453) shows, that in the earlier stages 
the disease may at least be controlled if not checked. 
Prof. Carnochan, of New-York, was the first to attempt to cure this 
disease by applying a ligature to the artery by which the diseased 
limb is mainly supplied with blood; and he has published a few cases 
in which he tried this practice with apparent success. Dr. Erich- 
sen, of London, has since pursued the same treatment by tying the 
anterior tibial artery to cure the disease in the foot. Other cases have 
also been reported, all of which are said to have been successful. 
(See Charleston Med. Journal, March, 1860.) In Dr. Ogier’s case, 
that of a negro, aged twenty-six, the disease had existed for five 
years, and the size of the leg and foot was such, that they had be- 
come a burden, and amputation was desired. The femoral artery was 
tied with a hempen ligature. The next day the reaction was high, the 
pulse rising to 180 per minute. This was controlled by Veratrum- 
viride. The leg and foot decreased on the second day to half the size 
preceding the operation. Three months later they had subsided to 
nearly the natural size; the patient walked about and felt no pain or 
uneasiness. 
These cases, in which there is seen a gratifying result of surgical 
skill can not yet be accepted as satisfactory cures of disease. The 
original dyscrasia which existed in every case was still there; and a 
a long course of constitutional treatment was needed to remove it. 
The only remedies which have power to remove elephantia are those 
which have been successfully used for lepra in its different forms. 
These are : Arsenicum, Alumina, Carbo-animalis, Carbo-veg., Caus., 
Graph,, Natr., Petroleum, Phos., Sepia, Sil., Sulphur. Arsenicum 
has hitherto been most successful. (See Lepra-Anasthetica. Index.) 
Genus X.—SCORBUTUS.—SCURVY. 
The name scorbutus is from the German scharboch, or Dutch scor- 
beclc, sore mouth. 
Characteristics.—Extreme debility; complexion pale and bloated; SCOKBUTU8. 
333 
spongy gums; livid spots on the skin; breath offensive; cedematous 
swellings of the legs; haemorrhages; foul ulcers; urine foetid; stools 
extremely offensive. 
It is not yet a century since scurvy was regarded by all civilized 
nations as the most terrible scourge of the naval service. In those 
times when it was said of u Britannia” that 
“ Her inarch was on the mountain wave, 
Her home was on the deep,” 
how often did this disease strike down with blighting paralysis “ the 
right arm of the nation’s defence!” It was common, says Sir John 
Herschel, to see “ death to the number of eight or ten a day in a 
moderate ship’s company; bodies sewn up in hammocks and washing 
about the decks for want of strength and spirits on the part of the miser- 
able survivers to cast them over board.” So tremendous were the ravages 
of scurvy, that in the year 1726 Admiral Hosier sailed with seven 
ships of the line to the West Indies; and before he was able to complete 
his voyage he lost two entire crews, burying his entire ships’ com- 
panies twice over, and then, in consequence, died himself of a 
broken heart. 
Lord Anson, during his voyage round the world, lost more than 
four-fifths of his officers and men. Sir Richard Hawkins states, that 
within his own naval experience he had known more than ten thousand 
men perish from scurvy. In 1778, Dr. Johnson thus described a sea- 
life : “ As to the sailor, when you look down from the quarter-deck 
to the space below, you see the utmost extremity of human misery,— 
such crowding, such filth, such stench! ” “A ship is a prison with 
the chance of being drowned ; it is worse—worse in every respect— 
worse air, worse food, worse company! ” 
Although this disease has been considered as almost annihilated 
from modern naval service, under exceptional circumstances it oc- 
casionally occurs again. During the war with Mexico, in 1846, several 
of the largest American ships were rendered entirely useless by the 
prevalence of scurvy among the officers and crew in an aggravated 
form. When the Raritan was ordered northward from Vera Cruz, she 
had on board more than two-hundred cases of the most malignant scurvy, 
and but few of the crew on duty were free from the disease. {Dr. Foltz’s 
Report, 1848.) 
It has also appeared in some of the recent polar expeditions. Sir 
L. McClintock gives a melancholy narrative of the suffering of Lieut. 
Hobson, of the expedition in search of Sir John Franklin. Scurvy is 
still common in the merchant service, though the mortality s not now 
generally great. In 1859, of 1.72,506 seamen who sailed from England 
there were only thirty-seven deaths from scurvy. 334 
DISEASES OF THE SANGTTINOUS FUNCTION. 
General Symptoms.—The appetite in cases of scurvy is usually 
good, alvine evacuations, healthy in general, though in some cases 
there is diarrhoea. The urine has not been found to present any ma- 
terial departure from a state of health, in specific gravity, alkalinity, 
acidity, or freedom from albumen. The patient is liable to be sleep- 
less at night, but has but little disturbance of intellect. In bad cases 
the pulse becomes very rapid, even as high as 130 or 140 per minute. 
There is some heat of skin, with febrile excitement and free perspira- 
tion at night—a constitutional condition approaching to that of hectic ; 
and these symptoms usually indicate fibrinous effusion. In milder 
cases a dry and harsh skin has been given as a characteristic; ema- 
ciation not generally great even in extreme cases. 
Diagnosis.—To the practiced eye, the external aspect frequently 
reveals at once the internal derangement. There is seen a “ smooth 
or contracted browr, the passive or acting nostril, the parted or com- 
pressed lips, the dull or brilliant eye, the many shades of color, the 
expression derived from mental action, intermingled with that result- 
ing from perverted organic function.” As in consumption, the brilliant 
eye, and pale or hectic flushed face alone might reveal the story of 
fatal disease ; in Bright’s disease the puffed, waxy aspect of the victim, 
are strongly characteristic; in pneumonia the general capillary in- 
jection of the face is almost a sufficient diagnostic; amenorrhoea is 
seen in the chlorotic aspect; the sufferer from ague betrays the lo- 
cality of his residence by the sallow anaemic complexion and wearied 
look. Scurvy has also its peculiar characteristics. The face of the 
patient reveals deficiency as well as depraved blood. It is sallow, 
dingy, earthy, and sometimes appears dirty; the conjunctiva is clear 
and transparent, the eye unusually bright, with dilated pupil, and blood- 
less lips. The countenance is generally passive and devoid of ex- 
pression, though in severe cases, expressing a sense of dread. In 
some cases the gums are so much enlarged that there is a visible pro- 
jection of one or both cheeks. The smell of the breath is highly of- 
fensive, peculiar to this disease, but nearly resembling the smell of 
animal substances in a state of putrefaction. The sloughing state of 
the gums when present scarcely aggravates the offensive smell. The 
margins of the gums are spongy, forming a hypertrophied mass, pro- 
jecting between the teeth and much inclined to bleed; their color 
varies from deep-red to a livid blue or black, which contrasts strongly 
with the pale, amende appearance of the lips, tongue and inside of 
the cheeks; the teeth are often loosened by ulceration and even 
sloughing of the gums; the tongue usually presents a clean surface. 
The patient is generally found lying on his back, his head rather 
depressed, as in that position the weakened heart can best do its 
work; the bed-clothes are sometimes elevated by the raised, contracted 8COKBUTUS. 
335 
knee. The surface of the body gives evidences of the damaged con- 
dition of blood in the exudation of its constituents—the blood discs, the 
fibrin, and more rarely the serum.—The colored corpuscles are extra- 
vasated in the form of small haemorrhagic, purpuric spots, from a small 
point to a large pea, of a vivid claret color, or larger bruise-like stains 
commonly found on the lower extremities, of a size from that of a 
crown-piece to that of the length of the whole limb, and commencing 
around cicatrices of old wounds. Effusions of fibrin take place on dif- 
ferent parts, especially of the lower extremities, the fibrin being poured 
out beneath the skin, or between the tendons and bones of the knee 
and ankle-joints, and fixes them as in a splint; when in the popliteal 
space the effusion produces the characteristic contraction of the knee- 
joint; beneath the skin or around the muscles, it makes the fleshy 
portion of the thigh or leg indurated, and it resists pressure as bone ; 
on the surface of the tibia, or of other bones beneath the skin the 
effusion gives rise to node-like swellings, which are often tender and 
resemble those of syphilis, except in their not being accompanied with 
exacerbation of the pain at night. The skin is firmly adherent to the 
effused fibrin, cannot be pinched up, and is generally of a brownish 
hue; and every part in which the fibrin is effused is painful and ten- 
der. In some cases there occur passive haemorrhages from the nose, 
the mouth or intestines, seldom, if ever, from the lungs, stomach or 
bladder. 
A tendency to fatal syncope is a very striking feature of scurvy. 
Scorbutic patients, not particularly reduced in strength, or emaciated, 
may, on a sudden over-exertion, as on rising to the erect position sud- 
denly, sometimes fall down in a swoon from which they do not recover. 
In one instance, on board the Dreadnought, says Dr. Ward, a man in 
the prime of life, in fair condition of flesh, and apparent strength, 
“ had been chatting in a loud and cheerful tone of voice, when on 
suddenly rising from bed to the night-stool, he fell down in a state of 
syncope ; and before the medical attendant could reach him he was 
dead.” 
Dr. Trinks says : “ The plastic exudations which give a board-like 
hardness, and the bleeding only from ulcers, are “ to him” essential 
differential symptoms,” by which he distinguishes scurvy from the 
muscular disease of Werlhof. 
Pathology.—The blood of scorbutic patients is deficient in red 
corpuscles, and super-abounds in fibrin. The former has been found 
reduced to 48 parts in 1000, and the latter increased to three times 
its normal quantity. A microscopical examination shows some of the 
blood-corpuscles “ shrivelled or ellipsoidal in appearance.” In a case 
already mentioned of sudden and fatal syncope, the heart was found 
very pale and flabby; lungs healthy; some effusion of serum into the 336 
DISEASES OF THE SANGUINOU3 FUNCTION. 
pleura; no traces of inflammation ; abdominal viscera deficient in 
blood; corresponding to external bruises of the tibiae, and on the inner 
sides of the calves, there was extensive extravasation of blood into the 
subcutaneous cellular tissue. Other subjects exhibit extreme anaemia 
and prostration ; projecting ulcerated gums; ecchymosis on the sur- 
face of dependent parts, ifcc. In an other case, Mr. Bask, of the 
Dreadnought, found the belly of the gastrocnemius muscle enveloped 
in a sheath of fibrin, a third of an inch thick, distinctly vascular, 
showing the texture to be a product of modified nutrition, becoming 
organized. Dr. Budd, examined a scorbutic node on the tibia; “ On 
cutting down over the tibia, he found under the fascia a thin layer of 
coagulated blood, but no sensible extravasation of the size, and no 
injection of the clot. On cutting deeper, the periosteum was found 
separated from the bone for the length of six or seven inches by solid 
fibrinous effusion, or clot of chocolate-color, and a line or two in 
thickness. On the periosteal and osteal surfaces of this clot there 
was a slight extravasation of the size, but the clot itself was beauti- 
fully injected.” The periosteum was itself thickened and infiltrated 
with blood, and when gently stripped from the clot, many vessels in the 
form of threads were seen to pass from one to the other; some of them 
filled with size; some vessels were also seen filled with size, coming 
from the clot and entering the bone. Dr. Budd found also, ecchymoses 
in the peritoneum, and in the mucous and muscular coats of the in- 
testinal canal. Dissection reveals little after death that was not 
equally manifest during life. 
Prognosis.—Of the cases under good medical treatment not more 
than one in a hundred die. 
Treatment.—This is generally confined to restoration to the food 
of the elements, the deficiency of which has caused the disease. 
Thussome propose to cure it by giving the patient plenty of po- 
tatoes ; and they are most beneficial when used raw. 
Others give the salts of Potash. 
Othei’S Sulphur, Phosphorus, &c. 
Others advise cheese, milk, or beef, because nitrogenous substances 
are wanting. 
Some suppose that lemon-juice acts only by restoring the potash- 
salts needed in a perfect diet. 
Citric-add.—This is now well established as a remedy for scurvy. 
It seems also to be capable of causing the disease. Dr. Stevens, in 
his work on the blood (page 451,) says : In one instance the acid of 
lemon-juice produced scurvy. “The scurvy was decidedly brought 
on by the excessive use of Citric-acid which an American gentleman 
had recommended to be freely used as a preventative of yellow’ fever. SCOKI5UTUS. 
337 
His own conviction as well as mine was that the scurvy was brought 
on by the Citric-acid.” 
Lemon-juice, as a remedy against scurvy was first noticed in the 
third Epistle of Rosseus, dated 1564. It is there stated that some 
Dutch sailors suffering from scurvy were returning to Spain in a ship 
in which were part of a cargo of lemons and oranges. They accidentally 
discovered that their use of these articles was the means by which 
they recovered their health. (Encyc. Pract. Med. Vol. III., p. 695.) 
It is mentioned as a remedy by Woodall, in 1636. (Military and 
Domestic Medicine, p. 165.) In 1600 Commodore Lancaster sailed 
from England in company with three other ships for the Cape of 
Good Hope. On reaching Saldana Bay, the Commodore’s crew were 
in perfect health from the administration to each of his men of three 
table-spoonfuls of lemon-juice every morning; whereas the other ships 
were so sickly as to be unmanageable for want of hands, and the com- 
mander was obliged to send men on board to take in their sails and 
hoist out their boats. Different authors wrote on the efficacy of this 
article in preventing scurvy. But it was not till Sir Gilbert Blane, in 
his first voyage as fleet-physician, in 1780, presented a memorial to 
the Admiralty on the subject, that any systematic effort was made to 
introduce it into the nautical diet. At that time the number of cases of 
scurvy received into Haslar Hospital was 1457; in 1806 there -was 
but one. 
The dietetic treatment of scurvy rests upon the fact that protein is 
the basis of albumen, fibrin, casein, and these are the foundations or 
essential elements of all the tissues; and this starting point of the 
aforesaid animal principles must be obtained from similar elements in 
the vegetable kingdom. Liebig says: “ It may be laid down as a 
law, founded on experience, that vegetables produce in their organism 
compounds of protein; and that out of these compounds of protein, the 
various tissues and parts of the animal body are developed by the vital 
force, with the aid of the oxygen of the atmosphere and of the elements 
of water.” 
Chemistry has demonstrated that the blood of animals is formed 
from substances which contain a large proportion of protein: and we 
find that men, when they are compelled to subsist for a long period 
almost exclusively upon animal food, become diseased from imperfect 
nutrition, the diseases taking always some of the forms of scurvy. 
Analysis of the blood of a patient on board the Dreadnought Hospital 
ship (off Greenwich,) showed: 
Blood in Scurvy: Water 849.9; solid constituents 150.1; fibrin 6.5; 
albumen 84.0 ; blood-corpuscles 87.8 ; salts 9.7. 
Healthy Blood: Water 788.8; solid constituents 211.2 ; fibrin 3.3: 
Albumen 67.2 ; blood-corpuscles 133.7; salts 6.8. 
Vol. il—22. 338 
DISEASES OF THE SANGUINOUS FUNCTION. 
Lime-juice.—From two to three ounces of lime-juice with a proper 
amount of sugar is given daily; occasionally oranges may be eaten; 
milk and beef-tea, when solid food is forbidden by the soreness of the 
gums; otherwise allow a diet of potatoes, vegetable soup, beef and 
bread. When there is marked anaemia, a recumbent position must be 
strictly maintained, as there is great risk of fatal syncope from sud- 
denly throwing on the heart more work than it can accomplish. Proper 
diet and rest are alone perfectly adequate to the cure of the worst 
forms of the disease. Mental influences, such as the sense of se- 
curity, escape from the influences of bad diet that caused the disease, 
and the protection and rest of the hospital on shore give important aid 
in the cure of scorbutic affections. 
Carbonate of Ammonia.—Dr. Huxham had a patient who had 
habituated himself to eat large quantities of Carbonate of Ammonia. 
The consequence was that he brought on a hectic fever, vast 
haemorrhages from the intestines, nose and gums, while every one of 
his teeth dropped out, and he could eat nothing solid. He wasted away 
in flesh, and his muscles became as soft and flabby as those of a new- 
born infant. He broke out all over the body in pustules ; after being 
persuaded to leave off the pernicious practice he lived only for a few 
months, and died in the highest degree of marasmus. 
Dr. Trinks has reported two cases cured by Mercurius. Dr. Kafka 
gives an obstinate case cured by an electuary of Carbo-ligni-tiliae. Dr. 
Forster, of Gorlitz, (Germany) says, he cures all his cases in the jail 
of that city, speedily and safely with hot baths. 
Chlorate of Potash.—Mr. Craner, of the Dreadnought Hospital,* 
says, this remedy cures sponginess of the gums more rapidly than any 
other. He gives it with lime-juice, but thinks the chlorate cures 
more rapidly without the acid-juice than with it. Curing the gums 
enables the patient to take food much better. 
The chlorate cures all inflammations of the mouth and gums, what- 
ever their cause may be, except those clearly syphilitic or cancerous. 
He says it will cure true cancer of the mouth if taken early. In pur- 
pura haemorrhagica it hardens the gums and prevents their bleeding, 
but has no influence on the disease. It is a speedy remedy in mer- 
curial ptyalism. 
Purpura Scorbutica—This form of purpura is usually seen during 
the prevalence of scurvy, and is considered as belonging to that dis- 
ease; hence we introduce it in this place. It is characterized by 
“deep, brown and liver-colored blotches, varying in size from the point 
of a finger to the whole extent embraced from the knee to the foot, or 
involving the whole of the inside of the thigh.” It consists of an ef- 
* Med. Times and Gazette, 1857, p. 476. SCORBUTUS. 
339 
fusion of decomposed blood in the cellular tissue, sometimes presenting 
tbe appearance of small petechia or flea bites, extending over most of 
the body, and attended by itching or pricking. In one case in the 
blockading fleet off Vera Cruz (1846,) the face of a petty officer pre- 
sented the appearance of having been washed with diluted ink before 
other symptoms of illness appeared. The patient felt well, performed 
his duties all day aloft, and desired to return to them, but was not al- 
lowed. The following day he was confined to his cot; the purpura 
appeared on the extremities, the gums and mouth became more sore, 
and severe pain racked every joint and limb. See Vol. II. p. 199. 
Treatment.—In addition to the dietetic treatment demanded by 
scorbutic influence when present, our reliance in every form of pur- 
pura must be placed on the following remedies: Arsenicum, Am- 
monium-carb., China, Hamamelis, Phus-tox., Gallic-acid, Sul- 
phuric-acid, Secale-cor., Carbo-veg., Ferrum, Sulphur, Ilepar- 
sulph., Calcarea-carb., Phosphorus, Phosphoric-acid, Mercurius- 
hyd., Apis, Cantharis. 
When the malady has succeeded a severe attack of typhoid fever 
with great debility, diarrhoea, abdominal tenderness, thirst or adip- 
sia, oedema of the extremities, rightly restlessness and jactitation, 
and great emaciation, Arsenicum, third dilution in water, will give 
speedy relief. 
Phus-tox., at the same dilution, may often be prescribed for the 
same group of symptoms after Arsenicum. 
When the disease occurs as a sequence of small-pox, or measles, or 
scarlet-fever, or erysipelas, Ammonium-carb., China, Phus-tox-, 
Hepar-sxdph., and Apis are our best remedies. We usually employ 
the first and second attenuation of these drugs. 
Phosphorus and Phosphoric-acid have been successful in cases 
which were apparently connected with sexual excesses, and seminal 
losses. 
China and Ferrum will be required in chlorotic patients afflicted 
with the disease. We have observed the best results from palpable 
doses of these remedies; although cures have been effected with the 
higher potencies. 
Mercurius-hyd., followed by China, have effected cures of cases 
occurring in persons suffering from chronic hepatic disorders. Can- 
tharis is also an excellent remedy in cases of this description. 
The higher potencies of Calcarea-carb. and Sulphur will be de- 
manded in cases dependent on, or connected with a scrofulous dys- 
crasia. 340 
DISEASES OF THE SANGUINOUS FUNCTION. 
Genus XI.—EXANGIA.—ANEURISM. 
Aneurism consists in a dilatation of the parietes of an artery. It 
generally embraces the entire circumference of the vessel, and may 
extend to a greater or less distance, even to the entire length of the 
aorta. When all the coats of the artery are dilated but not ruptured 
the case is one of “ true aneurism.” The vessel is frequently thinner 
than natural, the middle coat is deprived of its elasticity, and the ves. 
sel yields like a vein to the impetus of the blood. In other cases the 
coats of the dilated portion are hypertrophied. 
Dilatation with rupture of one or more of the coats constitutes “false 
aneurism,” as described by the old authors. The internal and middle 
coats are frequently ruptured; the blood comes in contact with the 
external or cellular sheath, dilating it to a pouch or sac. The tumor 
thus formed presses upon the surrounding cellular tissue, condensing 
it, and thus acquiring an additional envelop, often much thicker than 
the cellular sheath of vessel originally. “ The interior of the sac con- 
tains fibrinous coagula arranged in concentric layers the more exterior 
of which frequently become so dense as to be distinguished with diffi- 
culty from the parietes of the sac.” (Copland, Vol. 1. p. 132.) The 
parts surrounding the tumor become attached to it through irritation 
at first, but are afterwards worn away by absorption promoted by the 
pulsations. In some cases the internal arterial tunics are perforated, 
which is followed by haemorrhage; this may immediately terminate in 
death, or may be checked by the obstructions furnished by the sur- 
rounding tissues; when it forms “ diffused aneurism,” as described 
by various authors. 
Diagnosis.—Aneurism, when deep-seated, presents no positive signs 
of its existence. Dr. Hope says he has met with many cases in which 
large aneurisms existed without awakening even a suspicion in the 
mind of the medical attendant. Sometimes it occasions no inconveni- 
ence, and is only revealed by the sudden death of the patient who had 
considered himself in perfect health. (On Diseasas of the Heart.) 
Aneurism of the aorta may be suspected when there is a sense of 
oppression of the chest; dissimilarity of the pulse of the wrists; but 
these symptoms may also arise from other causes. Corvisart pointed 
out a “purring tremor1'1 beneath the middle and upper part of the 
sternum, when the aneurism is in the descending aorta, and above the 
clavicles in aneurism of the arch ; but this is often indistinct and may 
also arise from other causes. A wheezing or sibillous respiration and 
a whispering or croaking voice, with anxious and laborious breathing, 
are caused by aneurism of the aorta when the tumor presses on the 
large bronchi; pressure on the oesophagus obstructs deglutition, ANEURISM. 
341 
renders it painful, and sometimes impossible. Erosion of the bodies 
of the vertebra by the pulsation of an aneurism produces a gnawing or 
boring pain in the spine; pressure on the brachial plexus of nerves 
causes aching of the left shoulder, extending to the neck and scapula, 
impaired power, and numbness of the arm; pulsation beneath the ster- 
num, or above the clavicles, violent pulsations of the carotids ; but none 
of these symptoms alone are conclusive signs of aneurism of the aorta. 
A perceptible tumor is visible about the fifth and sixth ribs of the right 
side when aneurism of the ascending aorta attains a certain size; its 
seat varies when the aorta is enlarged in other parts. The strong pul- 
sations always present in the tumor indicate its nature; the indica- 
tions furnished by all preceding symptoms are of doubtful value. In 
advanced stages of aneurism of the aorta there are coughs with mu- 
cous or bloody expectoration, dyspnoea, spasmodic attacks of suffoca- 
tion, pain in the left shoulder, axilla, inner side of the arm, left side of 
the neck, pricking pains in the tumor, whizzing or rushing at the top of 
the sternum or under it; dragging downwards of the larynx, generally 
without fever, (iCopland, Diet. Dr act. Med. 1.) 
The distinguishing symptoms of true aneurism in the various arte- 
ries are: extraordinary throbbing in a particular spot occupied by a 
small pulsating tumor, which disappears when compressed, but returns 
when the pressure is removed. Without change of color in the skin 
the tumor increases in size, and in the same ratio the pulsation di- 
minishes. The coagulated blood lodged in the sac of the large aneu- 
rism prevents the obliteration of the tumor by pressure and lessens 
the communication into the artery beyond it. The pulse below the 
swelling becomes weak: and small, and the limb becomes cold and oede- 
matous. 
There are three species of aneurism: 1. True Aneurism which is 
known by the presence of a pulsating tumor. 2. False or Spurious 
Aneurism in which there is always an aperture in the artery from 
which the blood gushes into the cellular substance. 3. Varicose 
Aneurism. This species of aneurism can only happen where a vein 
runs over an artery; as where the brachial artery is punctured in 
opening a vein. The blood from the artery rushes from the artery into 
the vein which becomes varicose. 
Causes.—Aneurism of the aorta is more common in males than 
females. It is caused by inflammatory irritation of the coats of the 
vessel by which its elasticity and vital power of resistance are dimin- 
ished ; the habitual use of ardent spirits; augmented action of the 
heart produced by mental excitement and corporeal exertion ; hyper- 
trophy of the left ventricle consequent upon chronic inflammation of the 
vessel, and influenced by moral and physical causes; excessive mental 342 
DISEASES OF THE SANGUINOTTS FUNCTION. 
emotions; violent physical exertions suddenly made ; though a mor- 
bid state of the vessel has generally existed previously. 
Prognosis.—Aneurisms sometimes terminate favorably by gradual 
contraction of the sac and absorption of the coagula; by compression 
exerted upon and above the sac; by gangrene of the sac and oblite- 
ration of the artery; by the influence of inflammation in the vicinity, 
and the closure of the artery by the coagulable lymph thrown out; and 
by adhesive inflammation within the artery closing its calibre. When 
the artery involved is large, and beyond the reach of a surgical ope- 
ration, the danger is always great; as the aneurism is liable to be rup- 
tured by a trifling accident, and death usually results from haemorrhage 
in a few seconds. “The fatal event may be generally foreseen, as the 
part about to give way becomes particularly tense, elevated, thin, soft, 
and of a dark purple color.” (Hooper, p. 67.) 
Treatment.—Nature’s effort towards the cure of aneurism is direct- 
ed to the throwing out of coagulable lymph which, with the fibrine of 
the blood, forms a layer, more or less organized on the inner surface 
of the artery. The researches of John Hunter show'that this effort of 
nature can be assisted by measures which promote the general health, 
and improve the vital energies, but restrain or retard the action of the 
heart. “ Strict quietude of body and mind, a light digestible diet, the 
careful avoidance of spirituous and malt liquors, are indispensible 
auxiliary measures.” “ Change of air is beneficial, but all active exer- 
cise is hazardous; the digestive secreting and excreting functions 
should be attended to. The circulation may be partially controlled 
by small doses of Digitalis. The application of ice to the tumor 
has been advised by several European physicians. In one case re- 
ported in the Med. Repository, 1817, ice was kept on the tumor night 
and day for several weeks, by means of an ox bladder.” “ The skin 
soon began to shrink, and by perseverance in the employment of the 
remedy the tumor wholly disappeared.” Though in this case the dis- 
ease returned, and in some other cases the ice treatment has produced 
distress, it has been successful in some cases, in which the pressure 
was probably more beneficial than the coldness of the ice. 
A case of spontaneous cure of aneurism of the femoral artery by the 
concretion of its sides was reported in a letter by Dr. L. Spalding to 
Dr. S. L. Mitchell. 
In some cases pressure made upon the artery above the tumor has 
succeeded ; but the only treatment relied upon by modern surgeons is 
that first performed by John Hunter in 1785. A ligature is applied 
to the artery at some distance above the aueurismal tumor; the cur- 
rent of blood being thus interrupted, the tumor ceases to enlarge, and 
may soon begin to be diminished by absorption. The artery being 
tied at a distance from the diseased point is likely to be in a sound ANEURISM. 
343 
state, the adhesion of its sides is more certainly effected, the wound is 
more simple and easily healed, the circulation is carried on through 
anastomosing vessels, and the system is less disturbed than by an ope 
ration performed upon or near the tumor. (.Erichsen's Ohs. on 
Aneurism, p. 374.) 
Compression has been successfully employed to remedy aneurism 
by diminishing the flow of blood through the artery without obstruct- 
ing it. “ A partial current through the sac enables the fibrine to be 
readily entangled in the parietes of the sac in the first instance, and 
this goes on increasing until it becomes filled: the collateral branches 
having been previously enlarged, the circulation is readily carried on 
through them.” The compression is effected by two or three small 
“ clamps” by which a graduated degree of pressure can be exerted; and 
when too much irritation is given in one place it is slackened while 
the necessary pressure is kept up by others. This treatment, proposed 
by Hutton in 1842, and since improved by others, has been successful 
in several cases. It is always safe and often applicable where the 
operation by ligature was contra-indicated. (Bellinghampp. 14. 
Dublin, 1845.) 
In 1859, Mr. Hart proposed to the Royal Med. and Chirurgical 
Society to retard the current of blood in the vessels of the limb by 
flexion of the leg upon the thigh. Cases illustrating the merit of this 
procedure have since been given where the formerly trusted methods 
had failed. Mr. Hart says : “The object in healing aneurism is not 
to cut off the supply of blood, or altogether at once arrest the circula- 
tion in it, but to cause such a retardation in it as will lead to the gra- 
dual deposit of fibrinous laminse in the interior, and so effect its gra- 
dual consolidation. The former method is uncertain and dangerous; 
the latter safe and permanent in its results.” To attain this partial 
arrest of the circulation in the limb, a flannel bandage is rolled around 
the leg from the foot upwards, sloping below the tumor, so as not to 
compress it in any way. The leg is then bent on the thigh, retained 
in a fixed position, by means of three pieces of bandage attached to 
the ankle and along the leg. Confinement to bed is unnecessary, 
the patient can move about the room with a crutch. After a few 
hours the limb will require to be released from its restrained position; 
but, after an interval of a night, it is again bound up and retained so 
for several days. Absolute necessity for the retention of the flexed 
position will probably be gone in a week, but, as a measure of precau- 
tion, it is desirable that it be kept up for some days longer. To re- 
lieve the stift’ness and aching of the knee-joint which results from its 
forced position, Mr. Hart uses a linament of chloroform and oil. Per- 
haps Arnica would be more efficacious than Chloroform. The flexion 
should be employed with care and graduated. Some distinguished 344 
diseases of the sanguinous function. 
surgeons have recommended this mode of treating popliteal aneurism. 
Varicose Veins.—Lower Extremity.—1. Spontaneous superficial 
varicose in the lower extremity arise after deep-seated varicose of the 
corresponding part of the same limb. 
2. Varicose of the sub-muscular veins may exist without manifesting 
the disease in the superficial ones; but the latter always ultimately 
appear. 
3. Phlebectasis of the lower limbs does not begin in the subcutane- 
ous vessels or in the saphena interna more than any other vein, but 
from deep-seated veins in general. They are first affected with dila- 
tation and valvular insufficiency, and these lesions are thence propa- 
gated to the sub-aponeurotic vessels. 
4. Dissection shows this state of facts and the distribution of the 
veins of the lower limbs reveals the cause of them. 
5. These facts show the reason of frequent relapses after superficial 
varicose veins appear to have been cured. 
T reatmekt.—Ilamamelis-viryinica.—Venous Congestions.—- 
Since 1851, Dr. H. C. Preston (JY. Am. Jour. Ilomoeop. Aug. 1857, 
p. 28), says he has prescribed it in about fifty cases of varicose veins 
of the lower extremity; and in no single instance has it failed to make 
a decided impression, and in a great majority of cases he has made a 
radical cure. 
First bandage the limb tightly from the arch of the foot to a little 
above the knee. The best bandage is an elastic silk stocking manu- 
factured for the purpose. Under this are compresses laid over the 
dilated veins and kept wet with Hamamelis tincture or Pond’s Ex- 
tract. The same remedy is given internally three times a day, the 
third dilution. 
Some cases accompanied with indolent ulcers in the tibia have been 
under treatment for a year; but most cases have been cured in less 
than half the time. 
Varicose of the Spermatic Vein.—Circocele.—This disease has 
been seldom cured, and only palliated by Sir Astley Cooper and 
others. A case is given by Dr. George Barrow, of Taunton, Mass. 
A merchant, of scrofulous constitution, had swollen testicle of four or 
five times its natural size, hard and painful. He was not benefitted by 
Pulsatilla, Bell., Clematis, Rhus.-tox., continued for a week. He then 
took Pond’s Extract of Hammamelis in drop doses every two hours. 
The scrotum was enveloped in a bandage kept wet with a dilution of 
one part of the tincture of Hamamelis to two parts of alcohol and 
water. In twenty-four hours he was free from pain, the swelling gra- 
dually disappeared, a silk suspensory bandage (without the collodion 
which he had before used), enabled him to return to business, and he 
was soon quite well. ANEURISM. 
345 
Varicocele.—This is a similar affection of veins of the scrotum, and 
is a common accompaniment to circocele. It may be cured by the 
same treatment. 
Treatment.—Secale.—Characteristic symptoms. Hepatitis ter- 
minating in gangrene. Great feeling of coldness in the back and ab- 
domen.—Putrid, foetid colliquative, diarrhoea. Sudden, striking change 
of features with deep, sunken eye-balls, surrounded with blue margins, 
constant nausea and vomiting after taking the least food, frequent 
diarrhoea, with watery, slimy evacuations, shrivelled skin which feels 
cool to the hand, inexpressible feeling of burning and anxiety in tho 
pit of the stomach, hoarse, hollow voice, suppression of urine, cramp 
in the calves, paralysis of the upper extremities, scarcely perceptible 
pulse and unquenchable thirst. Violent drawing in the spermatic cord, 
so the testicles appeared to be drawn up to the inguinal ring.—Con- 
gestion of blood to the uterus. Excessive uterine contractions so that 
the uterus seemed to burst. Slow breathing, thirteen respirations in 
the minute. Spasm of the pleura with suffocative catarrh, speechless- 
ness and subsultus tendinum. The limbs become pale, cold and 
shrivelled as if they had been lying in water a long time. Gangrene 
of the limbs, the limbs becoming suddenly cold and lead-colored and 
losing all sensibility. The skin is dry and brittle. The skin all over 
looks lead-colored, the parts becoming shrivelled and insensible and 
not emitting a drop of blood on being cut into. Burning of the skin 
as if a spark of fire has fallen on it. Large ecchymosis, blood-blisters 
on the extremities becoming gangrenous; black, suppurating blisters. 
1. Raphania Gangrenosa.—Necrosis JJstilaginea.—General ma- 
laise, tiredness, restless sleep with dreams, anguish ; wandering pains in 
the back and lower limbs, spasmodic contractions of these parts; frequent 
attacks of violent pain and spasms, flushes of heat; pulse and appetite 
unchanged; abdomen distended and painful; urine clear and copious. 
Gradually the convulsed limb feels numb. It becomes exceedingly 
painful; pulse hurried, contracted; feeble; sweat on the face and head; 
hands and feet icy-cold, and can not be made warm. Erysipelas some- 
times on the extremities. 
At once the coldness increases, while the pains in the extremities 
cease. The extremity begins to show dry gangrene, in some humid; 
in the dry it is livid, the skin withered, wrinkled, turns yellow, then 
the limb becomes black, dry and hard as horn. If humid, the extremity 
swells; phlyctenae filled with bloody serum form in the skin; the 
muscles become soft, and gangrenous parts spread a foetid odor of 
putrefaction; pulse more and more feeble; languor becomes extreme 
and there is a torpid fever, features become shrunken; fainting fits, 
GENUS XII.—GANGRENU. 346 
DISEASES OF THE SANGUINOUS FUNCTION. 
delirium, coma, exhaustive diarrhoea; and, when the symptoms of gan- 
grene have reached a certain height, death takes place. 
In a few cases the dead part separates by suppuration. In many 
cases the diseased limbs remain mutilated, atrophied, paralysed. One 
loses the toes, another a foot, a leg up to the knee or a whole limb; 
when suppuration is profuse he dies of hectic fever. 
Solanum-nigrum.—Hahnemann (.Lesser Writings, Yol. I, p. 162) 
recommended this as the most certain remedy. Dr. Gross reports 
several cases treated by it: 
1. A farmer, afflicted with epileptic spasms and rage, was cured by 
Solanum-nigrum, after he was unconscious, and his limbs distorted by 
spasms. 
2. His younger brother had painful creeping in the extremities 
with curvature of the hands; this was common in this district and con- 
sidered as incurable. Gave him four pellets of this remedy of the 30°. 
In a few days it was reported that he was well. Two other children 
were affected in the same manner. They were cured; and also several 
other patients in that vicinity. 
3. A boy, six years old; hands and feet bent inwards ; was able to 
stand only a minute or two, though the involuntary contraction of the 
flexor muscles gave him the appearance as if he would jump, and 
caused risus sardonicus in the facial muscles. Gave him Solanum-nigr. 
15°, two pellets. 
Next day he was unable to stand; hands bent inwards more than 
before; third day the same; fourth day, all symptoms of spasm dis- 
appeared. 
Rapliania was epidemic in 1770, and 1771 in the district of Zelle, 
described by Taube in his history of it, 1783. It was then very often 
fatal; in this and in another epidemic there were convulsions and tonic 
spasms curving inward of the extremities; the wrist-joint entirely bent 
inwards; fingers drawn to the palms of the hands, and elbow to the 
chest; even tetanus. Epilepsy idiocy, rage, and risus sardonicus. 
All of these symptoms were removed in a few days by Solanum- 
nigrum. 
The gangrenous symptom is the one for which Ergot is the cause, 
and is also the probable remedy. 
2. Gangrene from Injury of the Nerves.—Sir B. Brodie, has seen the 
heel begin to mortify twenty-four hours after a lesion of the spinal 
cord, and few surgeons have not seen ulcerations and even eschars 
appear upon the sacrum and elsewhere, in the first week after a frac- 
ture or luxation of the spine. Entire section of a nerve has no such 
effect. Mr. Brown-Sequard says, he has “ seen hundreds of animals 
survive whole months, the section of the cord, and present in the parts GANGRENE. 
347 
paralyzed no other lesion of nutrition than an atrophy, generally slow 
in showing itself. 
Gangrene after Injury.—Lachesis.*■—1. A hoy, aged nine or ten 
years. Severe injury from the explosion of a pistol held in the clenched 
hand, which was much torn to pieces; small finger with its metacarpal 
bone left hanging at the wrist by a bundle of flesh, skin and tendons; 
soft parts in palm of the hands loosened from the bones. Effort to save 
the finger. Dressed with Arnica and water. Inflammation followed, 
though union by the first intention took place in part of it and granu- 
lation progressed: “but at the junction of the finger with the hand, on 
the lower part of the palm, there was a spot nearly the size of a twenty- 
five cent piece, puffed up, of an ash-gray color, emitting an exceedingly 
offensive odor; gangrene had commenced. One dose of Lachesis 6° 
arrested the process in a few hours. The dead portion sloughed off 
shortly after, and the healing process went unintem'ujptedly to a 
favorable termination. 
2. A young man, whose tibia and fibula were crushed under a large 
grindstone, ankle joint contused and lacerated. Dressed with Arnica 
and gave it internally. On the seventh day gangrene commenced with 
bluish purple vesicles for some distance round the wound, covering a 
dirty-ash-gray ground, and offensive odor. Amputation now the only 
resource of surgery. Lachesis 6° was tried in one dose. In six hours 
the nature of the case was entirely changed, in twenty-four hours the 
blisters had disappeared, swelling gone down; two days later the dead 
portions sloughed off*; the wounds granulated favorably and the foot 
was saved. 
In a third case gangrene supervened on a scalded limb. A boy, 
aged seventeen, fell with one leg into a kettle of boiling soap, destroy- 
ing the skin and adipose covering of the limb to the body. The ninth 
day the dead portions so far as they were loose came away, exposing 
the fascia in places. Discharge of pus, profuse ; muscles irritable and 
jerking spasmodically. On the twelfth day suspicious points on the 
exposed fascia emitted intolerable stench. Fascia puffed up, presenting 
purplish brown appearance and discharging bloody sanies. Thus gan- 
grene had commenced. It was arrested by one dose of Lachesis 6°. 
Three days later the fascia sloughed away, leaving healthy ulcers which 
soon healed. Some other parts presented appearance of gangrene, and 
were corrected by Lachesis. The cure was complete, though with 
permanent flexion of the leg upon the thigh. 
Gangrene of the Lungs.—Divisible into two forms, both very rare. 
1. Diffuse ; in which a considerable extent of the lung is affected, 
* Dr. D. M. Dake, U. S. Jour. Ilomoeop., Yol. I., 60. 348 
DISEASES OF THE SANGUINOUS FUNCTION. 
as the whole or part of a lobe, the boundaries being but imperfectly 
defined. 
2. Circumscribed gangrene is more limited in extent and distinctly 
separated from the remainder of the pulmonary structure. It varies 
from the size of a bean to that of a hen’s egg, sometimes confined to 
one point, often found in several. It terminates as elsewhere in 
sloughing. The decomposed lung substance, reduced to a dark green- 
ish fetid, diffluent mass, is evacuated generally through the bronchial 
tubes, but occasionally into the pleural cavity. The evacuation ended, 
a cavity remains. This cavity remains in some cases for a long time, 
even years in some cases; cicatrization takes place when the case does 
not terminate in death. 
In the early period of the disease the pulmonary structure is soli- 
dified over the inflamed part when it occurs from pneumonitis; when 
the gangrene is preceded by pneumonitis exudation and oedema extend 
around the eschar. The cavity remaining after evacuation is distin- 
guished by physical signs. Bronchitis occurs in the tubes near the 
gangrene, which, with the fluids in the tubes, are also recognized in the 
same manner. The seat of circumscribed gangrene often occurs in the 
inferior lobes near the surface. Diffuse gangrene generally attacks 
the upper lobes. 
Diagnosis.—This is seldom made out before gangrenous matter ap- 
pears in the expectoration, as the disease is developed in an insidious 
manner. It is first suspected from the intense effluvium, rendering 
the atmosphere insupportable. Diminished vesicular resonance on per- 
cussion, or dullness is more or less marked according to the size of the 
gangrenous portion of the lung, and of the solidification dependent on 
the exudation and oedema. When the lung is inflamed preceding the 
gangrene the dullness extends over the entire lobe. When the gangrene 
is circumscribed the percussion dullness is confined to a small spot, 
and may not be detected. Percussion gives no evidence of gangrene 
when it follows pneumonitis; dullness when it exists may not be referred 
to gangrene. Auscultation gives the respiratory and vocal signs of 
solidification, viz., elements of bronchial respiration and increased vocal 
resonance or bronchophony during the decomposing processes, feebleness 
or extinction of respiratory sound may be observed, also absence of 
reverberation and transmission of the voice. Bubbling rales, mucous 
or sub-crepitant, are heard in the vicinity of the affected part, owing to 
bronchitis, and later to liquid in the bronchial tubes derived from ex- 
cavation. Cavernous signs succeed those of solidification after dis- 
charge. A remarkable foetor is the most characteristic trait of the 
disease; it is called gangrenous. 
Gangrene of the lungs is not a primary affection, but occurs in con- 
nection with fever, epilepsy, brain affections involving insanity, effects of GANGEENE. 
349 
intemperance. The foetor of the breath, often unendurable when there 
is cough without expectoration is characteristic. 
The matter expectorated is at first grayish white or greenish, resem- 
bling portions of gangrenous lung found after death. Later the matter 
is purulent, and less offensive in odor. The breath and expectoration 
furnish the diagnostics ; the gangrenous foetor is not sufficient. If the 
expectoration suddenly assume a gangrenous foetor, at the same time 
becoming copious and presenting the appearances characteristic of de- 
composed pulmonary substance, the existence of gangrene is quite cer- 
tain; especially if prior to the eruption of this peculiar matter the 
expectoration has been slight or altogether wanting. The case is 
clearer if there had been previously ascertained circumscribed solidifi- 
cation, and if cavernous signs afterwards appear in the same locality. 
If peculiar foetor occur in the course of bronchitis it rarely ever be- 
comes so intense as in gangrene; it has been developed less suddenly 
little or no gangrenous matter ever appears in the expectoration; no 
sign of solidification preceded, none of cavernous excavation follows it. 
An abscess following pneumonitis may furnish purulent expectora- 
tion, sometimes foetid, but never so intensely so. The matter dis- 
charged is not the dark, sanious, liquified gangrenous lung-substance 
above described. 
Small portions of lung substance within a tuberculous cavity may 
communicate a gangrenous odor to the expectoration, but not to the 
true gangrenous extent. The previous history may distinguish the 
two cases. 
Pneumo hydrothorax may be distinguished by the symptoms given 
under that head. Gangrene of the lungs occurs oftenest in children, 
next in adults, then in aged persons. 
/Summary of Physical Signs.—“Dullness on percussion, varying 
in degree and extent, unless the gangrenous portion be quite limited, 
and deeply-seated. Bronchial respiration, or suppression of respira- 
tory sound within the area of dullness on percussion ; increased vocal 
resonance or bronchophony and fremitus occasionally present; mucous 
or subcrepitant rales in the vicinity of the gangrenous portion; possi- 
bly, a true crepitant rale; subsequent to the occurrence of fetid ex- 
pectoration, cavernous respiration, gurgling, and in some cases pec- 
toriloquy.” Remedies: Laches., I*hos., Arsen. 
4. Gangkena Senilis.—Spontaneous Gangrene.—A form of gan- 
grene which generally commences in the feet of aged persons, or at least 
those past the middle age of life, though younger persons have been 
attacked by it. 
But it generally occurs in aged persons in whom the arteries have 
become ossified, more or less contracted, sometimes obliterated. The 
ossification generally extends well up the leg. In some cases the femo- 350 
DISEASES OF THE SANGUINOUS FUNCTION. 
ral artery, instead of being ossified, has become converted into an im- 
pervious gristly cord; the change in all these cases seems to be the 
effect of a gradual degeneration of the tissue, without previous inflam- 
mation. 
Premonitory Symptoms of Senile Gangrene.—There is for some 
months or years before gangrene is perceived, occasional pain of the 
toes and lower limbs, followed with numbness and some difficulty of 
keeping the feet warm. After the feet have been cold and are become 
warm again they become quite painful Avith a sense of weakness in the 
muscles. The patient can walk quite well for a short distance, but is 
soon exhausted; after one or two years he finds little blood in the feet, 
the heart is easily excited to unwonted action by running, walking up- 
stairs, lifting weights, by excitement of passion; the circulation is ob- 
structed, the action of the heart is liable to stop, and syncope will 
follow. These premonitory symptoms may continue for years, and 
then the mortification will suddenly follow on some trifling inflamma- 
tion. A corn may have been cut too deep till it bleeds, and inflamma- 
tion and gangrene follow'. Or the foot has been too cold, and then 
placed too near the fire to Avarm it; the toes inflame slightly and then 
mortify. Small blisters resembling those of severe erysipelas soon 
burst and expose dead cutis vera. The flesh though dead has not the 
usual black appearance of mortification; from not being supplied with 
blood, the dead portions often appear quite white, thus deceiving by 
this appearance the careless observer. 
The gangrene may be confined to one toe or may extend to several, 
or to the foot. The pain sometimes slight, at other times excruciating. 
When mortification begins, a little line of inflammation appears at the 
margin of the gangrene which sloAvly creeps over the toes and up the 
foot, and the mortification follows it; the patient feeling all the time 
quite well in all other respects. 
In the course of some months the disease begins to progress more 
rapidly ; the inflammation followed by the gangrene extends farther 
up the toes and feet; a fresh attack of inflammation affects the gene- 
ral system; the morbid fluids existing in the diseased part begin to 
be absorbed; the pulse becomes feeble and rapid; the appetite fails; 
the skin is more hot, the patient sinks into a state of stupor, and, in a 
feAT days more he dies. 
Treatment.—The first idea of the old surgeons was amputation; 
but this Avas long ago given up. The only efforts now relied upon are: 
1, to check the inflammation by general and local measures. 2, to 
relieve the pain, support the strength till the dead portions can slough 
off, leaving the stump to heal by granulation. 
Good diet, such as can be digested, must be furnished ; digestion, 
assimilation and exertion must be kept in as healthy a condition as GANGRENE. 
351 
possible. Stimulants, as ale, porter, beer, &c., must be used as far as 
they can be made agreeable. The patient must be confined to bed, 
warmly covered, first with some mild ointment, after which the best 
covering for diseased limbs is carded wool, as recommended by Mr. 
Vance, surgeon at the Greenwich Hospital. It was also tried by Sir 
B. Brodie with success in many cases. It should be applied in large 
quantities over the whole limb as high as the hip, sewing a silk hand 
kerchief loosely over it to keep it in place, and kept on several days. 
This application ensures the quiet of the limb, protects it from changes 
of temperature; and even the diseased arteries gradually assume a 
more healthy condition under its influence. It should be continued till 
full recovery; and then a soft wToolen stocking and drawers should still 
be worn next the skin. 
When the progress of mortification is arrested the line of demarca- 
tion is seen separating between the living and dead parts. The sepa- 
ration generally progresses till the flesh is entirely detached, and after 
a time even the bones become loose. The tendons and ligaments may 
need to be cut, but neither the flesh nor the bones should be severed 
by an operation. Cutting off a portion of the dead flesh does no good, 
and an incision into the live flesh is almost certain to be followed by a 
spread of the mortification. 
To control the offensive odor of the dead flesh, employ a wash of 
chloride of lime, or chloride of zinc, though carefully guarding against 
wetting with it the living parts. A good disinfectant is a dry powder 
prepared by rubbing together 100 parts of plaster of Paris with 5 parts 
of coal tar. This may be applied to gangrenous surfaces, or to any 
other that is offensive, as it makes a good dressing spread on lint. 
Tar water, winch contains Ivreosote, is also a good disinfectant. 
When the gangrene spreads rapidly and the life of the patient is in 
danger, it is advised to destroy the vitality of the surface parts of the 
limb in advance of the inflammation and to consolidate the dead flesh 
of the sloughs while they are separating, so as to allow a distinct line 
of separation to be established between the dead and live flesh. Strong 
nitric-acid appears to answrer this purpose better than any thing else, 
though the operation is very painful. First dip a piece of wool in the 
acid, wipe its surfii,ce, and apply the wool to all the surface for some 
distance beyond the gangrene. After one or two applications of strong 
acid, usually, the dead portion will begin to slough off'; the acid should 
afterwards only be reapplied where the slough does not appear readily 
to separate from the living flesh. 
When the spontaneous gangrene attacks the extremities of young 
persons, the arteries of the legs or feet having become plugged up with 
fibrinous exudations, the brain is quite liable to be simultaneously 
affected. The treatment consists in, horizontal position, quietude, 352 
DISEASES OF THE SANGUINOUS FUNCTION. 
calming arterial excitement with Aconite, avoiding mental agitation 
and anxiety. Aconite alternated with Belladonna will control the fe- 
brile and cerebral excitement better than any thing else. Hitherto 
the reliance has generally been on Opiates to quiet the pain and irri- 
tation, stimulants, as Ammonia and lemon-juice, China, Lach., Arsen., 
&c. The application of a large quantity of wool around the limb with 
proper internal treatment, and good diet will sustain the vital powers 
till the dead parts have time to separate. 
5 GANGRENE OF THE MOUTH. GANGRENOPSIS. GANGRENA ORIS. 
The recent order of Surgeon-General Hammond, prohibiting the use 
of calomel in the United States Army, recalls to our recollection the 
observations of former years, in which this disease as a poisonous effect 
of mercury was more common than it appears to be now. It does not 
indeed occur as a common effect of mercury in good constitutions, even 
when that article is injudiciously used, but is almost always pre- 
ceded by some other constitutional disease, as intermittent fever, scar- 
latina, or some epidemic. It is peculiarly liable to attack children 
over two years of age, or between the periods of the first and second 
dentitions, who are much reduced by protracted fevers, or mucous in- 
flammations. It has long been known that children are with difficulty 
salivated, hence it has been common to prescribe calomel recklessly 
in trifling diseases; and very often, instead of an ordinary ptyalism 
the physician finds on his hands a case of gangrenous inflammation. 
Professor Dugas of Augusta, Ga., (in the Southern Medical and Surg. 
Journal, Oct. 1850,) says: “there are few communities in this section 
of the country in which there may not be found some living evidences 
of the havoc of mercury upon the face.” 
Symptoms.—The disease ordinarily appears in patients who have 
suffered from ague or some pernicious fever. When the original dis- 
ease is subsiding a foul sloughing ulcer is observed on the gums near 
some decayed tooth, or in points which have shown effects of mercury. 
The local disease extends by a process of sloughing rather than by 
ulceration. The surface of the ulcer is jagged, covered with dark 
offensive cream-colored sloughs. In some children, previous to the 
commencement of this disease, there is general ill health for weeks; 
derangement of the digestive organs; alternate constipation, bilious 
diarrhoea ; abdomen swollen and general emaciation. The patient is 
suspected to be suffering from the effects of worms, and one dose after 
another of calomel is given. The worms are not discovered, but after 
some days the mouth is observed to be sore. The epithelium is sound, 
except in one spot, perhaps adjoining a single tooth, which has been 
partially decayed before. At this point the gum is converted into a GANGRENE. 
353 
grayish, cineritious slough, slightly receding from the body of the tooth 
which is becoming loose, and the investing membrane is found diseased. 
The case is not considered alarming, and an astringent wash is thought 
sufficient; but, in a few days the friends begin to be alarmed. There 
is now fever, pulse 100 per* minute; no appearance of exhaustion, the 
eye is clear, and the intellect undisturbed. But the cheek and eyelid 
of the affected side are swollen and red over a large surface, but with 
a round grayish patch in the centre; and this, on looking closely, is 
black at the edge, and the circumference surrounded by a circle of 
brighter red. The centre is ashy or tawny in color, soft and slightly 
depressed. This circular spot is already gangrenous j it penetrates 
the whole thickness of the cheek, the dark slough extends to the dis- 
eased part of the jaw where the first ulcer appeared, and is seen to be 
gradually extending on every side. Caries is extending from the tooth 
along the jaw. The teeth become loose and the patient sometimes 
plucks them out with his fingers. “ I saw a child at my first visit 
watched by an attendant to keep it from pulling out its teeth. If not 
cured the disease progresses to an early termination in death; the 
mind remaining clear, and the child continuing to take food and drinks 
while the power of swallowing remains.” 
In adults the course of the affection is about the same. It begins 
in persons whose health is already broken by previous disease. They 
have generally taken much medicine, have perhaps had mercurial sore 
mouth more than once to cure bilious fevers and supposed chronie 
hepatitis, quinine to cure agues, and hydragogue purgatives to cure drop- 
sical affections. The physician finds the patient in a case of this kind 
in a slight chill, or after imperfect reaction. Some pain in the head ; 
tongue coated, edges red. He gives one or two purging doses of Calo- 
mel, with common accompaniments. The fever seems better; but all 
is not right; the strength does not return. The mouth is observed 
slightly sore, and the ptyalism is expected to finish the cure. But it 
does not: the breath is found very offensive; further purgatives are 
given, and strong astringent lotions are used for the mouth. The case 
goes on for some days, and all is thought to be improving.. But the 
breath has a peculiar foetor, and some certain spot is pointed out as 
painful. The cheek is swollen, pale at first, then red, glossy; eyelid 
oedematous, nearly closing the eye. The mouth within shows a black 
or grayish eschar, either on the gum or inside of the cheek. Gangrene 
has already commenced; and it slowly but certainly extends towards 
the orbit, along the jaw, soon perforating the cheek. Death is on the 
march, though the patient says, he feels “pretty well;” the pulse is 
good, the fever is scarcely perceptible, and he takes sufficient food; 
Under any common treatment he will die in a few days.. 
Causes.—All the malarious fevers, scarlatina, measles,, and other 
vol. il—23. 354 
DISEASES OF THE SANGUINOUS FUNCTION. 
epidemics are capable of so deranging the general health as to render 
the system peculiarly susceptible to the most deadly influence of Mer- 
cury. And there are some constitutions which naturally present this 
susceptibility to the influence of this poison, such persons being so 
sensible to its effect that they can not take the smallest particle of it 
without being salivated or otherwise poisoned. In them their pecu- 
liarity constitutes an idiosyncracy which has not originated in any of 
the above causes. But of all known agents Mercury itself is most 
destructive. The patient who has taken it oftenest for former diseases 
is most susceptible to its wrnrst effects. He becomes more and more 
sensitive to its poisonous manifestations, until he can not take calomel 
in the most minute quantity without a sore mouth which keeps him in 
agony for weeks.—In some cases ptyalism continues for months, and its 
relics last through life. When excited it does not supersede the fever 
for wdiich it was given. The mercurial cachexia has been developed 
in him by former uses of the poison; and when he is attacked by al- 
most any febrile disease, if we make a fair record of all his symptoms 
wre shall find them to be precisely covered by the one hydra, Mercury. 
The homoeopathist asks: “Is not Mercury then the proper remedy?” 
It is sufficient here to say, that when the disease has not been caused 
by Mercury, it, in some attenuation is a proper remedy. But when the 
disease has been caused by Mercury, the symptoms presented by the 
effects of this agent do not show a disease similar to the one from 
which the patient is suffering. We see only the identical enemy that 
we have been called upon to combat. We have not proposed to treat 
arsenical poisoning by administering more Arsenic, and we will not 
now depend on Beelzebub to cast out Beelzebub. But we have evidence 
enough to prove that Mercury, even in attenuations, can not be given 
in a true mercurial disease without greatly aggravating it. And when 
the condition exists which simulates the premonitory stage of mercurial 
disease, massive doses of Mercury can only be administered at the 
hazard of producing that fearful medicinal aggravation in which mer- 
curial gangrene consists. Large doses of Mercury are bad enough 
anywhere, but here, where this powerful poison is the exact similimum 
of the disease, it always furnishes new evidence of the truth of Hahne- 
mann’s exposition of the law which should regulate the size of doses 
of a remedy, which should be curative when properly administered. 
He says: (Organon, § 275.) “If too strong a dose of a remedy that 
is entirely homoeopathic be given it will infallibly injure the patient, 
though the medicinal substance be of ever so salutary a nature ; the 
impression it makes is felt more sensibly, because in virtue of its ho- 
moeopathic character, the remedy acts precisely on those parts of the 
organism which have already been most exposed to the attacks of the 
natural disease. GANGRENE. 
355 
§ 276. Even a homoeopathic medicine is, on this account, always in- 
jurious Avhen given in too large a dose, and hurtful to the patient in 
proportion to the extent of the quantity administered. But the increase 
of the dose itself is also prejudicial in the same degree as the remedy 
is homoeopathic and the potency higher;* and a strong dose of such 
medicinal substance (which bears no analogy whatever to the disease) 
of equal strength; for in that case, the homoeopathic aggravation 
(see Orgapon, § 157 to 160.)—that is to say, the artificial malady, 
which is very analogous to the natural one excited by the remedy in 
the most suffering parts of the organism—is carried to a height that is 
injurious; whereas, if it had been confined within proper limits, it 
would have effected a gentle, prompt, and certain cure. It is true the 
patient no longer suffers from the primitive malady which has been 
homoeopathically destroyed, but he suffers so much more from the me- 
dicinal one which was much too powerful, and from unnecessary 
debility.” 
That Mercury is the common, if not the universal cause of gangrene 
of the mouth is generally admitted. We have now seen the reason 
that, while its effects are bad enough in almost any case, they are most 
terribly destructive in constitutions -which are already in that condition 
of morbid sensibility to its powers which this poison is itself capable 
of producing. In malarious districts gangrenopsis is regarded as 
endemic : and in certain localities Mercury is thought more dangerous 
than elsewhere. 
Professor Dugas says, he has “ a vivid recollection of a family of 
five children, three of whom had, during the same autumn, been suc- 
cessively attacked writh remittent fever, and they both died, with most 
awful sloughing of the cheeks and lips. They were all treated with 
Calomel.” When the two remaining children took the same fever, 
another mode of treatment without Calomel was tried, and “ they re- 
covered without gangrenopsis.” 
That all cases of gangrenopsis are caused by Mercury is generally 
believed, though a few cases have occurred in which it was considered 
certain no Mercury had been given; and in these cases it is supposed 
that other debilitating causes of disease may produce a condition 
resembling the mercurial dyscrasia. That Hahnemann understood the 
subject is clear from the above quotations, as well as from other state- 
ments in various parts of his works. That he as well as others have 
often cured diseases which simulated mercurial poisoning, by giving 
this same article in attenuated doses, is well known. 
* The praise bestowed of late years, by some few homoeopathists on the larger 
doses, depends on this, that they choose low dynamizations of the medicine to be 
administered, as 1 myself used to do twenty years ago, from not knowing any 
better, or that the medicine selected was not perfectly homoeopathic.” 356 
DISEASES OF THE SANGTJINOUS FUNCTION. 
Treatment.—This must be directed first, to correcting the general 
febrile and dyscrasial condition, and second, to the arrest of the local 
affection which results from the former. Generally the local affection 
can not be arrested till the fever is subdued. There have been a few 
cases which ceased spontaneously upon a gradual subsidence of the 
fever, with but little treatment of any kind. In one case in Indiana, 
a child, after the sphacelation had produced a large aperture in the 
cheek, seemed to be cured by the application of sweet cream to the 
raw surface from which the mortified part had separated. Healthy 
granulations immediately commenced, and the destroyed structure was 
restored, leaving very little deformity. 
Aconite is one of the first remedies in the early stage, so far as it 
is indicated by the common symptoms for which Aconite is generally 
proper in all other febrile affections. We omit the symptoms here. 
(xelseminum has been recommended in the place of Aconite. Our 
observations lead us to prefer Aconite. 
Mercurius is a true specific for all the milder cases in which we 
are certain that not a particle of Mercury has been given to cause the 
disease. Where we can not ascertain whether it has been given or not, 
it is dangerous to hazard a trial of it in any of the lower triturations. 
IIow high would be safe; and whether the highest would have any 
power over a true mercurial gangrene of the mouth, we leave to be 
answered by those who have tried it. 
Chlorate of Potash.—This, in the language of the old books, is a 
powerful “ siliagogue,” displaying a well-knowrn elective action on the 
glands and mucous membrane of the mouth and pharynx. Being in 
this respect a similimum to Mercury, it is perhaps the most efficient 
agent known for counteracting its poisonous effects. In cases where 
Mercury has caused excessive salivation the chlorate has often been 
employed to arrest it. Even men wdio think the extreme effects of 
Mercury are necessary in the cure of many diseases, often employ the 
chlorate of potash to “check the formidable mercurial disease, and 
permit the Mercury at the same time to be continued without danger.” 
The practice is to use the chlorate in solution, washing the inflamed or 
ulcerated surface at short intervals, permitting small doses of it to pass 
into the stomach in a state of weak solution. At the Ilopital Sainte- 
Eugenie it has been used largely for ulcero-membranous stomatitis and 
is always successful.* Dr. Dethan proposed “ to employ it in the form 
of pastiles, so that the patient may have at hand a remedy against the 
injurious effects of a mercurial course.” Ricord and Fournier have 
found the remedy successful in this form. In gangrene of the mouth 
from Mercury and in some other diseases connected with malarial and 
* L’Union Medicale, 1857. GANGRENE. 
357 
epidemic fevers it is considered as the most efficacious remedy hitherto 
discovered. Mr. Fraser of England recommends it as an application 
to cancerous and other ill-conditioned ulcers. As a deodorizing agent 
it is one of the best known; and this fact indicates its appropriate appli- 
cation in other gangrenous conditions as well as gangrena oris. A weak 
solution dispersed by damp towels in. different parts of the room is suf- 
ficient to remove the most offensive odor. For these various purposes 
we have often employed it. Permanate of Potash has similar powers. 
Iodide of Potassium.—This article is also regarded as a specifio 
for the poisonous effects of Mercury. 
Symptoms.—In scrofulous constitutions subject to rheumatism, who 
have been injured by mercurial and other debilitating remedies: chilliness 
followed by general fever; dryness of the mouth followed by salivation; 
profuse serous discharge from the nose; inflammation of the mucous 
membrane of the nose and eyelids; eyelids oedematous; catarrhal in- 
flammation of the Schneiderian membrane extending to the frontal 
sinuses. Paleness of the face followed by redness and swelling of the 
face and tongue ; lacerating pain in the jaw bones and teeth. Enlarge- 
ment and inflammation of the parotid and submaxillary glands; ulcera- 
tion and swelling of the gums. Ulceration of the tongue and mouth 
without salivation; otherwise ptyalism with great swelling of the 
tongue; excessive ulceration of the mucous membrane of the mouth; 
bloody saliva. Throat dry, hot, with burning, dull stinging pain; violent, 
continual and excessive thirst; flatulence in the stomach; nausea, vo- 
miting ; inflammation of the stomach; burning pain at the pit of the 
stomach. Pain in the region of the kidneys; urine diminished in 
quantity, high colored, mixed with mucus or blood; progressive and 
rapid emaciation and anaemia; palpitation of the heart. 
Arsenicum.—This remedy has cured gangrenopsis in persons living 
in marshy, malarious districts. The symptoms are those of Arsenic 
generally, and the fever inclining to intermittent paroxysms. There 
are: blisters on the tongue; upper surface of the tongue white, mem- 
brane thickened; aphthae; superficial ulcers on the edge of the 
tongue; disagreeable taste, astringent or bitter; frequent spitting; 
bloody saliva; heat and pain in the fauces; oesophagus, stomach and 
abdomen; throat and uvula swollen and red; occasional convulsive 
cramps in the throat; difficulty in speaking or swallowing; want of 
appetite; thirst not generally remarkable; sometimes thirst with an- 
guish, perplexity; hopelessness; face often pale, cold, at other times 
red, puffy, oedematous ; cachectic oedema of the legs ; inflamed surface 
over the parotid glands; erysipelatous redness and swelling of the 
face ; teeth aching, margin of gums on the teeth ulcerated; great ema- 
ciation, such as caused by Iodide of Potassium. Cases have been cured 
by Arsenicum in Fowler’s solution, after the sloughing had destroyed 358 
DISEASES OF THE SANGUINOUS FUNCTION. 
one-fourth of the lower lip ; salivation profuse. The fever had been 
previously reduced by other means. Some local measures have ge- 
nerally been tried, and part of the good result has been attributed to 
them. One case was treated by local application of dilute muriatic 
acid, camphorated Alcohol fomentations. In the absence of fever Ar- 
senic (in Fowler’s solution), was given to the extent of producing 
distress of the stomach. The sloughing ceased, granulation commen- 
ced under cerate and lint dressings. Little deformity remained. The 
sloughing did not prove critical or abate the fever. 
Ammonia-sesquicarbonas.—Sub-carbonate of Ammonia.—This 
remedy has been used with success, in small doses, or in the same 
manner as the Chlor-potassa. Dr. Wallace, of the Dublin Hospital, 
cured several severe cases with five grain doses. It is also known to 
cause a similar disease. Dr. Huxham had a patient who made a 
proving of Carbonate of Ammonia on himself. He accustomed himself 
to eat large quantities of it. “The consequence was that he brought 
on a hectic fever, vast haemorrhages from the intestines, nose, and 
gums, while every one of his teeth dropped out, and he could eat no- 
thing solid. His flesh wasted, the muscles became soft and flabby, he 
broke out in pustules, and died in a few months.” 
Case by Dr. Douglas of Milwaulde, October 21.—A lady, slender, 
and of scrofulous diathesis, suffers from “ great prostration; pains of 
head and back ; skin hot and dry; pulse 110, small and weak; the 
gums are swollen, red, separated from the teeth, and pus oozing from 
them when pressed, the edges dark, and some of the points black and 
gangrenous; ulcerated points on the edges of the tongue ; the left half 
of the roof of the mouth covered with confluent patches of superficial 
ulcerations, some points of which are gangrenous ; intolerable odor 
from the mouth. For two days has had a chill in the morning, lasting 
from two to three hours. Ammonium-carbonicum, 3°, two grains in 
four oz. water; a teaspoonful every two hours. 
“ Oct. 22.—Mouth and gums greatly improved ; dark color disap- 
peared ; minute sloughs have fallen off; pulse 84, full and stronger. 
Had the usual chill this morning for two hours, followed by fever. 
Continue the Ammonia-carb., alternated with Nux. On the first feeling 
of chill to-morrow, take Gelseminum.” The. next day the chill com- 
menced, but it immediately ceased on taking the Gelseminum, and in 20 
minutes perspiration followed without fever. The ulcers healed in two 
or three days more.”—(U. States Jour., llomceop., Yol. 1., Appen.p. 5.) 
Tartar-emetic.—T his is one of the most efficient remedies for the 
inflammation caused by Mercury, so long as 'nothing but inf animation 
is visible. When mortification commences we no longer rely upon it. 
Symptoms.—Mouth dry, inflamed, red; tongue covered with raised 
papillae, bright red, dry in the centre, sometimes moist, clear, gray oi GANGRENE. 
359 
coated white, covered with small pustules ; difficulty of protruding it; 
embarrassment of speech, gums spongy as in scurvy; the epithelial 
lining, buccal cavity, and lips and throat excoriated, swollen, red; 
violent salivation. We have long used it in the third or fourth dilution 
in curing severe salivation, and always with good result. The centre of 
its sphere of action is in the stomach, and not the mouth. We omit 
further symptoms. 
There are many other internal remedies suitable for this disease, but 
few practitioners have patience to wait on them to produce their proper 
effects. By their own anxiety, or the urgent solicitation of the friends, 
they are generally driven to try the power of local applications. There 
is, indeed, no good reason for rejecting topical measures, for they may 
he each, as Hahnemann says, “ Homoeopathic to the case in its own 
way.” The remedies which might be expected to be successful are 
sufficiently numerous. We can only mention a few that have succeeded. 
Sulphate of Copper.—Dr. Coates recommended a solution of this 
article, and also Tincture of Cinchona, as a lotion for the local treat- 
ment of this disease. Either of them will be successfnl in only the 
mild cases. The former, in a saturated solution, is often successful in 
those more severe. It may he tried when the previous health has not 
been had; when ash-colored ulcer is first observed, and before the 
fatal gangrene has clearly shown its character. The ulcer may be 
touched three or four times a day till improvement is manifest. In the 
whole course of the disease suitable internal remedies must be 
employed. 
Hydropiper (.Polygonum-hydropiper,) Water-pepper, Smariweed 
—An infusion or decoction of this common plant has long been used 
by farriers for the cure of salivation in horses. On trying it for Mer- 
curial ptyalism, it has succeeded in all the cases in which we have 
known it tried. It has also cured the follicular stomatitis of nursing: 
women. 
Muriatic-acid.—Symptoms.—Dryness of the mouth, followed by 
free salivation ; the tongue becomes sore, with red, burning vesicles 
and blisters on the edges ; ulcers with black base and inverted edges; 
palate inflamed; fauces raw, burning, smarting; toothache, with pain 
in the malar bones, ears, and temples; burning pain, swelling, inflam- 
mation in the gums. 
Scorbutic Gums.—Hahnemann, in his Chronic Diseases, gives many 
more symptoms ; and we have still more scattered through the books; 
but among them all there has been no proving carried far enough to 
develop the peculiar and extreme effects which this corrosive acid is 
capable of producing; and it is only of these extreme effects which spe- 
cially concerns us in treating the present disease. In cases of acci- 
dental poisoning we see many more symptoms applicable here, but in- 360 
DISEASES OF THE SANGUINOUS FUNCTION. 
stead of collecting them now, we will bring up some clinical facts 
which will sufficiently illustrate the operation of the remedy in curing 
gangrene of the mouth. 
Muriatic-acid.—Van Swieten, the leading Professor of the Vienna 
Medical School in the middle of the last century, says he used “un- 
diluted Muriatic-acid with great success,” as a local application to 
arrest gangrenous ulceration of the mouth. In this country it was in- 
troduced into practice by Dr. Jackson in 1826. In the Medical 
Recorder, Vol. XII., he says the result of its application in the cases 
in which he tried it:—“ It presently stopped the gangrene; and soon 
after the eschar separated from the parts in which there was life. 
Nor have I ever known its application to fail me, except whero 
the gums were entirely putrid, and the jaw-bone was affected; for then 
I could not prevent its being carious ; but if the soft parts only in the 
inside of the mouth are gangrenous, it will certainly cure them.” 
The most instructive reported case we have seen is given by Dr. 
James White in the Transactions of the “Fairfield Medical Associa- 
tion, Ohio:—* 
“A boy, aged eight years, had measles, then epidemic. Fever, efflor- 
escence, heat of skin, slight chilliness, headache, pain in the chest, 
much increased by dry incessant cough; tongue coated and red at tip 
and edges; epigastrium very tender and tense. As a child, aged three 
or four years, had recently died in the vicinity from gangrene of the 
mouth, under all the horrible circumstances incident to that disease, no 
Calomel or Tartar-emetic were given in the treatment of this case. 
Some common measures, of which bleeding and mild purgatives were 
the most objectionable, were considered sufficient, and the boy was 
thought to be doing well when the dreaded gangrene appeared. 
There was first seen a superficial slough on the gums covering two 
of the molar teeth on the right side, upper-jaw; gums on the opposite 
side sound. No foetor of breath or flow' of saliva; there was little 
danger apprehended. 
“ In a few days the slough had increased ; the periosteum of the 
teeth and alveolar processes wTere implicated, the breath was slightly 
foetid; some irritative fever. Common antiphilogistic treatment was 
tried a few days, without benefit” 
The Report proceeds :— 
“ March 1st.—The gums eaten out between two teeth. 2d.—One 
tooth loose, ulceration continues. 3d.—Spreading rapidly, and ex- 
tends to the cheek. 4th.—A tooth extracted. A lotion of diluted 
Muriatic-acid and honey applied. 5th.—The application continued; 
the swelling of the cheek increased. 6th.—The application continued . 
* Louisville Medical Journal, Vol. 2, p. 433. GANGRENE. 
361 
flesh separated from the jaw-hone three-fourths of an inch by a half- 
inch. The lotion and charcoal applied. 7th.—The same treatment 
continued ; another tooth extracted.” 
The case was now considered hopeless. No case after reaching this 
stage had in that region been known to recover. The right cheek was 
tense, swollen, pallid, and glossy; intumescence extending to the 
right eye, which was closed, and to the lips, drawing the right com 
missure to one side, from which the saliva copiously flowed. The 
whole expression frightfully distorted; the breath had the characteris- 
tic foetid odor. Caries had nowT seized upon the jaw, from which the 
teeth were extracted, and the cheek appeared internally hollowed out 
in space equal to half a dollar, and covered with a black, thick slough. 
Mortification appeared to extend from the jaw and cheek, high upwards 
towards the orbit, and was rapidly perforating the cheek. There was 
still fever, but the skin was soft and slightly moist; pulse of good 
strength, mind clear, apparently without pain. Appetite good: he 
takes chicken broth, gruel, panada. No tonics given; blisters also 
avoided, as in all cases in which they had been tried they had appeared 
to increase the general irritation, and give unnecessary pain. 
“March 8.— Undiluted Muriatic-acid was then applied at 4 p.m., 
and repeated at 6, and then every hour till 8 a.m. The mortification 
was then found to be arrested, and reaction and sensibility of the parts 
acute. Application repeated twice on the 10th; sensibility still acute. 
From the 11th to the 19th Tincture of Myrrh and Alum were employ- 
ed. The appearances favorable.” 
It is then proved that the undiluted Muriatic-acid, locally applied, 
can arrest the mortification of the soft parts, and even subdue the 
caries of the jaw. 
Mode of applying the Acid.—Make a swab by wrapping a soft rag 
on the end of a stick. Charging this with the acid, carry it up to every 
part of the mortified surface. It gives no uneasiness so long as it 
touches only the gangrened parts, except by the inspiration of the 
fumes of the acid. As the parts in which vitality remains are reached, 
the pain begins to be felt, and soon would become intense if the wash- 
ing with the acid were continued. At first it only dissolves away the 
mortified flesh as water dissolves the snow. When it comes to the 
living flesh in which the inflammation is at work, the new stimulant at 
once excites another though similar inflammation, and under this 
enlivening influence the old disease gives place to the new. The wound 
immediately puts on a healthy appearance; granulations and healthy pus 
are visible, the swelling subsides, and the general health in all respects 
immediately improves. 
In the case above detailed, some exfoliated portions of the jaw-bone 362 
diseases of the sanguinoits function. 
were removed before the process of reparation could satisfactorily be- 
gin. The deformity remaining after recovery was slight. 
Nitric-acid has also been employed with success in the same man- 
ner as Muriatic-acid. The symptoms are nearly the same in regard to 
gangrene of the mouth. They both act by exciting a newr but similar 
inflammation to that already existing. This new inflammation, if car- 
ried far enough, would end in destructive mortification of all the parts 
to which it is applied. But, if we stop the application of them as soon 
as we have dissolved all the parts already dead, and when we have 
only touched and aroused with the new stimulant the part that is not 
yet dead, but which is rapidly progressing towards it, we only bring 
that portion of the structure sufficiently under the dominion of the new 
irritant to supersede the old one. It may be regarded as crude homoeo- 
pathy, and exceptions may be taken to the strength of the acids em- 
ployed. We do not say that dilutions of some other local stimulants 
would ,not answer in the worst cases: we know that the true homoeo- 
pathist has many other resources that we have not yet mentioned ; and 
with some of them he will generally succeed without resorting to the 
acids at all. But he will still claim that in the local application of 
Arnica, Nitrate of Silver, or even Cantharides, for the prompt cure of 
local inflammations similar to those they are severally capable of caus- 
ing, he is still within the jurisdiction of the Hahnemannian Law of 
Cure, of which a full exposition is given elsewhere. 
5. PHOSPHOR-NECROSIS. 
The breathing of air containing the vapor of Phosphorus, causes va- 
rious forms of disease, as bronchitis, and even phthisis pulmonalis, caries 
of the maxillary bones, abortion, &c. Dr. Dupagnier found the air con- 
taining the agent to consist chiefly of Hypo-phosphoric-acid, with small 
quantities of Phosphoretted Hydrogen, and some Phosphoric-acid, or 
Phosphorus in the form of vapor. The breath of the people who suffer 
from inhaling it becomes luminous in the dark. 
Diagnosis.—The first complaint is of a slight soreness or pain in one 
or more teeth in either jaw. This pain varies in intensity, and soon 
extends to the entire maxilla. The periosteum, and in a later period, 
the soft parts begin to swell and become painful on pressure; the 
gums and cheeks swell, become tender, and erysipelatous inflammation 
extends over the surface of half the affected jaw, progressing towards 
the ear and neck. With this local inflammatory condition the general 
system sympathizes; the latent causes of disease, which have hitherto 
remained dormant in the system are roused into activity, and 
tuberculosis, or some other psoric or dyscrasic affection assumes its 
preponderating influence over the blighted and disintegrating frame. PHOSPHOR-NECKOSIS. 
363 
Causes.—The disease originates only from Phosphorus or Phospho 
ric-acid gas taken into the system by inhalation. Though the opera- 
tives in the match factories are employed during the day in rooms ill 
ventilated, and the noxious gas is brought into contact with the body 
generally, with the mucous membrane of the air passages as well as 
the whole cutaneous surface, it is only through the mucous membrane 
of the mouth that the poison obtains access to the bony structure which 
is to become the principal seat of its ravages. Microscopic researches 
have shown that the pathogenetic effects of Phosphorus begin in the 
periosteum which covers the alveolor processes, except in those very 
common cases in which the recent extraction of a.tooth, or a large 
cavity in a decayed one, furnishes to the destructive agent a more direct 
admission to the osseous tissue. Dr. Geist says that in all cases of 
phosphor-necrosis, he has found one or two carious teeth, which fur- 
nished the first point of localization in the jaw. It is certain, however, 
that although there be no carious teeth, and none have been extracted, 
the poison, when habitually breathed in a condensed form, may be ab- 
sorbed through the mucous membrane covering the alveolar processes 
in sufficient quantities to imitate the true periostosis, which never ceases 
till necrosis is established in the bone beneath. The degree of rapidity 
with ■which it progresses may be influenced by the age of the patient, 
and the degree of concentration of the poisonous vapor. From the mo- 
ment that the periostosis begins, the nutrition of the bone is impaired, 
the periosteum is separated from the bone, and a morbid and offensive 
matter is formed between them. , 
Pathology.—In every form of caries, says Rokitansky, the sanious 
bone, examined in the recent state, presents various appearances, 
according with the progress which the disease has made. In superficial 
caries, the compact bone is rough and corroded under a covering of 
sanies; its medullary canals are unequally dilated; the tissues con- 
tained in them are partly reduced to a mere friable mass, or flabby, 
warty excrescences, which readily bleed, a re developed from them, which 
shoot outward in considereble quantity over the rough surface of the 
bone. The bone always appears porous or spongy, according to the 
contents of the medullary canals; in the first case discolored —in the 
second case rough in various ways. In cases of caries of the spongy 
texture, when the formation of granulations is luxuriant, the bone as- 
sumes a dark livid redness ; it becomes soft, and resembles a piece of flesh 
permeated by a fine, delicate, bony texture. It is said by Delpech, Re- 
ran!, Ponget and Sanson, that a peculiar fatty matter is produced; 
though according to Monret, the gelatin has not disappeared from the 
bone. The carious bone, in the macerated, dry state, appears rough 
as if corroded, and acquires a spongy, porous, worm-eaten appearance 
by reason of the unequally dilated medullary canals, which in several 364 
DISEASES OF THE SANGUINOUS FUNCTION. 
places have formed into holes, and which perforate it. The cells of its 
spongy substance are dilated, and their parietes are attenuated and 
broken down like the grating of trellis-work. 
The researches of Vauquelin show that, in caries, the organic con- 
stituents of the bone are increased, whilst the carbonate of lime is 
slightly diminished, and the phosphate of lime reduced in a much 
larg-er proportion. In an osteophyte-like crust deposited around a 
carious tibia, the phosphate of lime was still more diminished. 
In France and Germany this disease has been common for several 
years, and it attracted the attention of the profession about 1847. In 
the United States it has increased rapidly since about the same period. 
Treatment.—Surgical.—The following case sufficiently illustrates 
the treatment given to these cases in the hospitals.* A wax taper dipper 
had been working in this business seventeen years before disease and 
ulceration of his gums commenced. Thirteen months ago he had pain 
and swelling about the lower jaw, commencing in one of the right in- 
cisor teeth. An abscess formed and burst externally in the neighbor- 
hood of the tooth. Admitted to the Royal Free Hospital, Dec. 28, 1859. 
“His face generally was much swollen, exhibiting the peculiar pasty 
appearance witnessed in necrosis of the jaw arising from the fumes of 
Phosphorus. Several fistulae were noticed at the low er margin of the 
law, communicating with the dead bone, and giving passage to the 
matter. On opening the mouth the lower jawr was seen exposed, denud- 
ed of the periosteum, and quite black and clear; it was also slightly 
moveable. 
Operation.—April 9th, 1859. Chloroform was administered to the 
extent of producing complete anaesthesia. The surgeon then proceeded 
to saw through the symphisis of the lower jaw, within the mouth, and 
by the aid of the forceps, the left half of the bone was drawn out entire, 
without its condyle, but with the ascending ramus. The same proceeding 
wras then employed with the right half of the jaw, which came away 
with equal facility, but with the condyle, which appeared to be healthy. 
The haemorrhage was not great, and it spontaneously ceased. For three 
or four days after the operation there was some pain in the face, but this 
gradually diminished, and soon ceased entirely. The health now be- 
gan to improve under a liberal diet, and appetite and strength returned. 
The investing periosteum, from which the old bone had been carefully 
separated, soon began to throw out fresh osseous material and a new 
lower jaw was in process of formation. The pasty appearance of the 
face and puffiness of the cheeks, however, still remained, and are the 
most prominent consequences of the affection. The patient left the 
hospital in a short time completely restored in health, and able to arti- 
culate his words with tolerable distinctness. 
* London Lancet. Sept. 1859. p. 241. PHOSPHOR-NECROSIS. 
365 
On examining the hone, when cleaned and dried, it was found to he 
quite massive, and of nearly double the w eight of the healthy bone. 
It was covered in some places with unhealthy lymph, which was undei* 
going osseous transformation. 
The reproduction of bone by the natural action of the periosteum 
which has been left behind when the bone wTas removed was practically 
demonstrated many years ago by Professor Dudley of Transylvania 
University, Ky. He found that the periosteum, when carefully sepa- 
rated from the old bone beneath, and preserved in a healthy state, pro- 
ceeded at once to the act of depositing the osseous material in regular 
layers, thus forming a new bone to take the place of the old one. This 
practice has now become common, and in a considerable degree success- 
ful. The periosteum throws out new layers of bone, which by invest- 
ing the old bone, give strength if not symmetry to the mutilated mem- 
ber. In these cases the old bone is seen within the new formation. 
A jaw bone thus reconstructed by nature, in following out the intentions 
of art, is generally somewhat larger and more irregular in shape than 
that wrhich has been removed.* 
Homceqpathic Treatment.—The successful treatment by homoeo- 
pathic remedies of some cases of caries of the maxillary bones arising 
from different causes has shown that our remedies when correctly em- 
ployed have a powder over this fearful disease to an extent not yet fully 
appreciated. We have collected in the United States Journal of Ho- 
moeopathy some cases which illustrate the proper treatment. In the 
case of a scrofulous girl, aged nine years, in whom caries of the upper 
maxilla following typhoid fever was progressing, and there was pain in 
the bones and teeth, Aurum-muriaticum was prescribed Feb. 12. 
On the 18th the pain had subsided after the extraction of a large por- 
tion of the carious jaw bone. It was removed without pain, having 
spontaneously separated from the healthy portion of the bone. Muri- 
atic-acid was afterwards used; then Angustura for deafness and ri- 
gidity of the masseter muscle. Silicea 3° was employed from March 11, 
to April 10, after which no medicine was needed. 
In a case reported by Dr. Perkins (American Homoeopathic Review, 
N. Y. Central Homoeopathic Dispensary) a man had necrosis of the 
jaw for four months. Dr. Mott had advised excision of the jaw; the side 
of the face was much swollen, and a discharge continued from an open 
abscess communicating with the diseased bone. Dec. 11th he took 
Phosphorus 30° in solution. On the loth he was much better; discharge 
and swelling less. Repeat Phos. 30°. He continued improving, took 
no medicine. Jan. 30, swelling almost gone; orifice healing up; gene- 
ral health, excellent. Feb. 15, no signs of disease. 
This subject is continued at length in U. States Journal of Horn., Yol. 2. p. 303 to 
314. “ Phosphor Necrosis.” 366 
DISEASES OF THE SANGUINOUS FUNCTION. 
A case by Dr. Lilienthal, Northern Homoeopathic Dispensary, N. Y 
A young man, aged 18. Chronic periostosis of the bones of the nose 
caused by working a year and a half in a match factory. He commen- 
ced March 15th to take in alternation Aurum and Calcarea-carb. March 
22, he was better. A dilution of Nitric-acid was applied locally. The 
medicine was continued till April 25, when he was considered well. 
Several months afterwards he continued so. See Yol. I., p. 247. 
Ozcena.—This name is applied to any inflammatory ulceration of 
the Schneiderian membrane attended with a foetid discharge. The 
principal remedies are : Aurum, Merc., Phos., Alum,., Asar., Calc., 
Cic., Con., Lack., Puls., Sulph. For syphilitic ozoena: Merc. If 
this has been too much used : Aur., Jlepar, Nitric-ac., Sulph., Thuja. 
Aurum.—Dr. Harper, in a recent work,* gives the following: A 
dwarf, aged sixteen years, with large head, joints tumid, long bones 
curved, whose family was scrofulous, the father having died of phthisis, 
had ozoena of four years’ standing. The offensive matter runs over the 
upper lip, is sometimes greenish or yellow, and is so acrid that it ex- 
coriates the skin. The smell is so offensive that no body can go near 
her; and she uses twenty handkerchiefs per week. The mucous mem- 
brane of the nose is red and inflamed, and she perspires profusely every 
night from the middle of the body downwards. Aurum, twice a day, 
s prescribed. June 23, she improved considerably in three weeks. 
A month later the dose to be taken only once a day. August 9th, 
Merc.-sol. 3°, had been tried without improvement, Aurum 3° resumed. 
Up to Nov. 8, she gradually improved. There was still rather a large 
discharge of mucus from the nose, and the girl used four or five hand- 
kerchiefs in fourteen days, instead of fifty, as formerly. But there is 
now no purulent discharge, no smell perceptible, unless after taking 
cold. The general health is excellent. See Yol. I., p. 734. 
GENUS XIII.—BLENNORRIKEA.—GONORRIICEA. 
INFECTIOUS URETHRITIS.—INFLAMMATION OF THE URETHRA. 
The term gonorrhoea, derived from two Greek words, yovrj, 
and peu), to flow, is very generally used by American and English phy- 
sicians to designate this malady. Dr. Swediaur, perceiving the errone- 
ous impression which this definition might convey, substituted another 
erm no less etymologically inaccurate, blennorrhoea, or blennorrhagia, 
derived from two other Greek words, BAtvva, mucus, and pew, to flow. 
But modern researches having demonstrated that the involuntary dis- 
charge which is characteristic of the disease, does not consist of semen 
or mucus, hut of a purulent and infectious matter, we think the errone- 
* “ Homoeopathy tested by Facts,” Edinburgh, 1858. GONORRIICEA. 
367 
dus terms commonly employed to designate the complaint should he 
abolished. Many reasons may be adduced against naming the affection 
from the supposed character of the discharge; for notwithstanding, as 
a general rule it is decidedly purulent) cases occasionally occur where, 
from the intensity of the inflammation, there is no discharge at all, and 
constituting that form of the disease denominated by French -writers 
“ blennorrhagie s6che.” The matter is likewise sometimes composed 
of a mixture of pus, mucus, semen and blood. For these reasons we 
prefer to make use of the more general term urethritis. Inflammation 
of the urethra may indeed arise from other causes than the application 
of the specific gonorrhoeal infection, and present all of the symptoms 
peculiar to the venereal inflammation; but the malady is none the less 
urethritis on this account, although the secretion accompanying the in- 
flammation is not infectious ; so may an inflammation of the eye owe 
its origin to the application of venereal matter, external irritants, at- 
mospheric changes, injuries, scrofula, and abuse of stimulants, and yet, 
notwithstanding these different causes, the disease is none the less 
ophthalmia. All secreting surfaces are liable to be irritated when 
operated on by certain unnatural stimuli. The mucous membrane of 
the throat, the bronchia, the lungs, the nostrils, the frontal sinuses, and 
the conjunctiva of the eye, are all subject to different grades and kinds 
of inflammation, and their secretions to become changed in quality and 
quantity, according to the morbid cause which has been in operation. 
The lining membrane of the urethra is also subject to the same laws; 
it may become inflamed and pour out a purulent discharge from the 
presence of calculi in the bladder, from gout and rheumatism, from 
acrid urine, from the absorption of certain diuretics, from ulcers, from 
mechanical injuries, and finally from the application of infectious matter 
from a venereal subject. In a very large majority of cases urethritis 
may arise from the cause last mentioned. This morbid virus induces 
a specific inflammation in the urethra of so troublesome and inveterate a 
character as often to baffle all the remedial measures of the most skillful 
and experienced men. The inflammation is supposed by some to be of 
the erysipelatous kind, and generally attacks the lacunae of the urethra. 
All who have had much experience in this disease, will agree with 
us that it is one of the most intractable with which we have to deal: 
“ Mackintosh assures us that he has been more annoyed and disgusted 
in conducting the treatment of gonorrhoea than of any other affection.” 
Of the primary source of infectious urethritis we are at present 
ignorant, but the doctrine entertained by the ancients, and so strenu- 
ously advocated by John Hunter and his contemporaries, in regard to 
the identity of the gonorrhoeal and syphilitic virus, is now universally 
abandoned. The disease under consideration is one of a purely local 
character, and if left to itsolf, under favorable circumstances, will ulti- 368 
DISEASES OF THE SANGUINOUS FUNCTION. 
mately terminate in spontaneous recovery. It is a matter of doubt 
whether ulcers of the urethra ever proceed from this inflammation, 
when entirely uncomplicated, but it is probable that the few cases 
which have been reported by Sir Astley Cooper and others, in which 
the malady w*as connected with ulcerations, were attributable to the 
application of the virus of both affections. 
We have in several instances, inoculated individuals with matter of 
infectious urethritis, but have never been able to produce a chancre or 
any well-marked constitutional symptoms. We have, in one instance, 
also witnessed the introduction of the gonorrhoeal virus into the blood, 
but without giving rise to any appreciable effects. While on the other 
hand, it is well-known, that if syphilitic virus be inoculated or intro- 
duced directly into the mass of the blood, the symptoms of syphilis 
speedily result. The application of gonorrhoeal matter to the eye, 
gives rise to a very violent and dangerous purulent ophthalmia; while 
the application of syphilitic virus to this organ, causes an ulcer, 
generally circumscribed, and unaccompanied by violent or dangerous 
inflammation of the surrounding parts. The application of the former 
to the anus causes inflammation with augmented secretion, and change 
in its character from mucus to pus; the application of the syphilitic 
poison, causes chancre and its concomitants. 
The susceptibility to the gonorrhoeal virus varies greatly in different 
persons, according to the difference in the degree of natural sensitiveness 
in the mucous membrane lining the urethra. There is also an acquired 
insusceptibility to gonorrhoea. Repeated attacks render the membrane 
less susceptible; and the first attack is generally the most severe. 
The blennorrhoea is often suspended during attacks of acute disease, 
but it invariably reappears again after the subsidence of the febrile 
symptoms. 
From these facts it may be fairly inferred, that gonorrhoeal matter 
contains a specific morbid principle, capable of producing a peculiar 
inflammation and discharge, when brought in contact with mucous sur- 
faces. This inflammation and discharge presents a uniform appearance 
quite unlike what occurs in leucorrhoea, in several particulars. The 
matter of the former is infectious, while that of the latter is non- 
infectious; the inflammation of the former is of the erysipelatous kind, 
while the condition of the mucous membrane in the latter is more 
allied to relaxation and debility than to inflammation; the former can 
only arise from the contact of gonorrhoeal matter with a mucous sur- 
face, while the latter never proceeds from any cause of this kind, but 
from constitutional weakness, confinements, venereal excesses, want of 
exercise, and other debilitating habits. 
We may also infer, from what has been observed, that the syphilitic 
matter likewise contains a specific morbid virus, sui generis, and only GONORRHOEA. 
369 
capable of exciting chancre, when applied to abraded or delicate sur- 
faces. 
It should always be remembered, that every morbid substance 
capable of impressing the organism, contains a certain specific morbid 
'principle, which usually operates in a definite manner, causing a uni- 
form train of symptoms, and requiring a certain specific medicinal 
agent to affect a prompt cure. These morbid principles only exist in 
infinitesimal quantities in their media, and on this account we are un- 
able to detect or analyze them, but we ought none the less to acknow- 
ledge their presence, appreciate their influence, and endeavor, if possi- 
ble, to discover their specific antidotes. 
The whole course of a case of gonorrhoea, inflammation of, and 
discharge from the urethra, may be divided into four stages: 
First Stage.—Lasting from one to two days.—Symptoms : a slight 
tickling or tingling, at the orifice of the urethra, and the flow of a 
small quantity of thin, transparent mucus, or milk-like discharge. 
Second Stage.—Inflammatory.—The meatus of the urethra becomes 
red and swollen; the discharge becomes copious, thick and milky, 
yellow, or greenish; the act of micturition is attended with pain and 
scalding, whilst erections and chordee torment the patient at night. 
During this stage the most distressing complications occur, such as 
irritation of the bladder, inflammation of the testicle, and of the prostate 
gland. 
Third Stage.—Sub-acute Inflammation.—The foregoing symptoms 
subside. There is slight irritation in urinating and the discharge of 
yellow matter continues. This stage is protracted and is liable to 
terminate in the 
Fourth Stage.—Gleet.—There is usually little pain or irritation, 
but there is occasional emission of a transparent or milky secretion. 
The discharge at this stage is supposed to lose its infectious property; 
but the exact period at which this change in its character takes place 
can not be known. 
Diagnosis. — The ordinary period at which infectious urethritis 
makes its appearance after infection is from two to four days. We 
have known it to commence in a few instances, in eight or ten hours 
after exposure, and we have likewise occasionally observed an interval 
of six weeks to elapse before its onset. Some constitutions possess the 
power of resisting the action of the poison to such a degree as to 
constitute an almost entire exemption from the disease; others again 
are so highly susceptible, either from natural organization, or from 
abuse of stimulants, that the slightest touch of the contaminating 
poison speedily communicates the inflammation. 
The disease commences by a tingling or itching sensation at the 
orifice of the urethra, which is noticed especially when urinating. In a 
You II.—24. 370 
DISEASES OF THE SANGUINOU8 FUNCTION. 
short time, the lips of the urethra become red and swollen; the blood- 
vessels of the organ are distended; the inflammation increases and 
extends up the passage for an inch or two; there is a burning or 
scalding pain on passing water; an increased secretion takes place 
from the part affected, at first of a mucous character, but as the inflam- 
mation increases presenting a purulent appearance, of a yellow color, 
or if the disease is violent, green and sanious. The urine, which often 
contains some thread-like substances, arising from the inflammatory 
action, flows from the urethra in a diminished, spiral or divided stream. 
In & first attack the inflammation does not usually confine itself to 
the extremity of the urethra, but extends along the canal to the pro- 
state gland, and even to the bladder itself. Not unfrequently it attacks 
the glans penis and the fraanum, in which case it often occasions an 
effusion between the prepuce and the glans, wrA phymosis. 
When the inflammation is intense, and extends up as far as the neck 
of the bladder, there is a frequent and urgent desire to urinate, the 
ardor urince becomes more extensive and painful, involuntary and 
painful erections occur, chiefly during the night, and sometimes cause 
distressing emissions of semen ; sympathetic irritation is communicated 
to the perineum, occasioning painful sensations when evacuating the 
bowels, or the bladder ; there is more or less inflammation and effusion 
of lymph into the corpora spongiosa, giving rise to those adhesions and 
painful contractions termed chordee; the glands of the groin become 
irritated and enlarged, and there is a partial or even total suppression 
of the discharge, in which latter case the disease is termed dry 
urethritis, or “blenorrhagie seche.” 
In old subjects who have often been infected the inflammation is 
quite prone to attack the prostate gland, and give rise to those un- 
pleasant symptoms enumerated when alluding to affections of this 
structure. 
If the disease be left to itself, and the patient is strictly prudent 
and temperate, a spontaneous recovery will eventually take place; but 
from improper medical treatment, undue exposure, or excesses of 
different kinds, the disease often terminates in gleet, strictures, ab- 
scesses, diseased prostate, irritable bladder, hernia humeralis, inflam- 
mation of the testicle and epididymis, or bubo. 
The acute stage of urethritis, under ordinary circumstances, ter- 
minates in from one to three weeks, when, if suitable remedies have 
been employed, the discharge ceases, and the parts speedily recover 
their tone ; but in the majority of instances, the acute stage runs into 
a chronic inflammation, when it receives the name of gleet. 
Fourth Stage.— Gleet.—After the inflammatory symptoms of go- 
norrhoea have subsided, there is a continuance of a fluid discharge, va- 
rying in color and consistency, in some cases mucous in others puru- GONORRHOEA. 
371 
lent. The quantity is generally small, often not more than a few drops 
in the course of twenty-four hours ; whilst at times it ceases entirely for 
days together, returning without assignable cause or in consequence of 
some excitement in the way of diet or exercise. Though most commonly 
the result of an acute attack of gonorrhoea, mild cases of that disease, 
also, not unfrequently run on and assume the true character of gleet. 
In this stage of disorder, the painful symptoms peculiar to the first 
period, ardor-urince, frequent inclination to urinate, chordee, spasmo- 
dic pains in the region of the perineum, and the heat and swelling of 
the penis subside, and we observe little else than an increase and al- 
teration in the character of a secretion from the urethra. This dis- 
charge, which during the acute symptoms was purulent, and of a yellow 
or greenish color, now presents a light mucous appearance, sometimes 
transparent and ropy. The character of this discharge, however, is 
often temporarily changed again to a purulent matter of a yellow or even 
green color, sometimes sanious, from over-exercise, excesses in drinking 
or eating, sexual intercourse, and exposure to protracted heat or cold. 
The discharge of a simple gleet usually proceeds from the lacunae of 
the urethra. Some writers have promulgated the dangerous doctrine 
that the matter of gleet is not infectious; but this is an error, for we 
have known many well authenticated instances where virulent urethri- 
tis has arisen from the application of gleety matter. 
When a gleet has been permitted to continue for a long time, and 
particularly if the case has been injudiciously treated by inordinate do- 
ses of Copaibae, Cubebs, Turpentine, and the endless train of irritating 
injections, there often supervenes a 
Stkicture of the Urethra.—This consists in a chronic thickening 
cf the lining membrane of the urethra, amounting in some cases to 
stricture; in others the mere irregularity of the canal, is a common 
source of gleet. When, after a fair trial of other means the discharge 
continues, the passage should be explored with a bougie. Whether the 
stricture be only partially or perfectly formed it may soon be dispersed 
by the use of the bougie introduced every three or four days, and per- 
mitted to remain a quarter of an hour or more each time. The slight irri- 
tation thus induced is sufficient to cure. Too frequent introduction of the 
bougie excites too much inflammation, which is a medicinal aggravation. 
A stricture may occur during the height of acute urethritis, from tu- 
mefaction of the mucous membrane of the canal, or from the irritation 
caused by improper or unskillful introduction of bougies, and by strong 
injections. The obstruction in some cases of this description is so com- 
plete, that very painful retentions of urine, with the accompanying symp- 
toms, supervene, requiring the most prompt remedial measures in order 
to ward off the necessity of puncturing the bladder. 372 
DISEASES OF THE SANGUINOUS FUNCTION. 
This variety of stricture may be removed in a short time by proper 
medicines, without the aid of a surgeon. 
There is a second variety of stricture not necessarily connected 
with infectious urethritis, termed spasmodic stricture. The disease 
consists in a sudden spasmodic contraction of some portion of the 
urinary canal, which impedes the flow, and sometimes causes a partial 
retention. These spasmodic contractions may arise from mechanical 
injuries, diseased prostate, or stimulating diuretics, but they are for the 
most part connected with permanent stricture. 
The third variety of stricture, which is by far the most common and 
serious, is termed the permanent stricture. Its approach is so gra- 
dual and imperceptible, that individuals rarely suspect any thing of the 
kind until it has made considerable progress. The disease arises from 
a gradual thickening of the mucous membrane of the urethra, from 
badly-treated or long-continued inflammation. 
The first symptoms observable in this stricture are : a sensation 
after urinating as if a few drops remained behind, stream diminished 
in size, and issuing from the urethra in a spiral form or split in several 
parts; straining to pass water more rapidly through the obstructed 
canal; aggravation of all the symptoms on wetting the feet, taking 
cold, over-exercise, fatigue and venereal excesses. In this stricture 
there is always more or less discharge of a ropy kind of mucus, which 
is often temporarily changed by excesses, into a purulent or bloody 
matter. This complaint is quite apt to induce inguinal hernia, from the 
straining efforts employed in urinating. It is probable that two-thirds 
of the cases treated as simple gleets and which so frequently baffle the 
physician are in reality dependent, solely on this kind of stricture. 
In bad cases of permanent stricture, the urine is passed drop by 
drop, the distention and pain in the region of the bladder become very 
severe, much constitutional irritation occurs, and the patient is unable 
to rest day or night. Whenever this state of things obtains, immediate 
recourse should be had to bougies. 
The removal of a permanent stricture can only be accomplished by 
means of the knife, or the application of caustic, or by gradual dilation 
by means of bougies. The cure by the latter means is, at the present 
time almost universally recommended. We have found a bougie made 
of the dry bark of the ulmus fulva or slippery elm to possess many 
advantages. By holding it in warm water the surface becomes muci- 
laginous ; it then passes with great facility; and by permitting it to 
remain but a few minutes, it expands and dilates the stricture. 
Almost all strictures are located far up the canal of the urethra, 
behind its bulb, but they may occur near the extremity of the penis or 
three, four, or five inches above this point. 
An occasional consequence of stricture is disease of the prostate gland. GONOKKH(EA. 
373 
DISEASED PROSTATE 
May also be ranked amongst the occasional consequences of repeated 
attacks of urethritis. During the continuance of the latter affection, 
in an acute and obstinate case, not only the urethra, but the prostate, 
the bladder, and the testicles receive an unusual supply of blood, in 
consequence of which they become irritated, and often enlarged, from 
depositions of coagulable lymph. This condition of things may exist 
without attracting much attention until the individual is advanced in 
years, when a scirrhous degeneration, or an abscess, is exceedingly apt 
to result. Either lobe of the prostate may become enlarged separately, 
or the whole three may be involved; but the most troublesome symp- 
toms arise from an enlargement of the middle lobe, on account of its 
proximity to the orifice of the urinary canal. This painful and trouble- 
some affection usually occurs in acute and obstinate gonorrhoeas in 
scrofulous and irritable constitutions. The inflammation beginning 
at the orifice of the urethra extends upwards towards the bladder, in- 
volving the prostate in its course. 
Sy7nptoms.—Heavy, pressive aching in the perinaeum extending 
often to the rectum, causing a degree of tenesmus. The patient can 
neither sit nor bear pressure over the prostate, which swells and may 
be felt internally. There is irritation of the bladder; partial or com- 
plete obstruction of the flow of urine, which is often mixed with blood. 
The gonorrhoeal discharge generally diminished or suppressed. 
Sir Astley Cooper was of opinion, that enlargement of this gland is 
attributable to advanced age, rather than disease; but from the fact, 
that persons who have been afflicted in this manner have almost in- 
variably been subject to repeated venereal attacks in early life, we may 
fairly infer, that a predisposition is always established in the structure, 
which renders it liable to take on diseased action when the powers of 
the organism have become impaired by age. 
Enlargement of the lateral lobes of the prostate may be readily de- 
tected by introducing the finger into the rectum. The middle lobe may 
always be felt by the catheter when much enlarged, and it will 
generally be found exceedingly difficult to pass it by the gland into the 
bladder. By directing the point of the instrument, (which should be 
of the medium size), slightly upwards, and depressing the handle at 
the proper time, the object may usually be accomplished. But of all 
others, these cases require great delicacy of touch and practical tact 
to enable the operator to succeed facilely, and without doing injury to 
the irritated parts. 
Diseases of the prostate are quite liable to become aggravated by 
over-exertion, riding, acrid urine, exposure to wet and cold, and stimu- 
lating drinks. 374 
DISEASES OF THE SANGUINOU8 FUNCTION. 
Another exceedingly unpleasant consequence of neglected or b*dly 
treated urethritis, is the disease termed sympathetic bubo. 
Sympathetic Bubo.—These buboes are called sympathetic, in con- 
tradistinction to those which proceed from syphilitic infection. The 
frequent occurrence of such tumors during the course of urethritis, 
probably first led medical men to confound this disease with syphilis. 
But on close examination, the sympathetic bubo will be found to be 
composed of several enlarged glands, while that of syphilis is an en- 
largement of a single gland. 
The sympathetic bubo is not usually attended with great pain, nor 
does it run on to suppuration, unless the patient is decidedly scrofu- 
lous ; while the syphilitic bubo is attended with much inflammation and 
pain, and is very prone to advance to the suppurative stage. A very 
large majority of sympathetic buboes subside spontaneously, and re- 
quire no medicinal treatment. 
\w females, all of the symptoms of the disease are lighter than in 
the male sex. Indeed, the similarity between this affection and leucorr- 
hcea is so great, that it sometimes is a matter of great difficulty to dis- 
tinguish between them. 
Mr. Travers asserts that the urethra itself is rarely affected in fe- 
males, but that the inflammation attacks the clitoris, the inferior com- 
missure of the labia and rapha, the nymphse, and the parts (Cowper’s 
glands,) around the orifice of the urethra. (See p. 307, 309, Vol. II.) 
In the worst form of the complaint, as it occurs in women, the labia? 
the nymphae, and the clitoris become swollen and painful, the inflam- 
mation extends to the uterus and bladder, and there will be frequent 
inclination to urinate, severe scalding by the water, and a purulent ir- 
ritating discharge. But all of these symptoms are often met with in 
inflammatory leucorrhoea, and the discharge itself even acquires so 
acrid a character as to become capable of propagating a similar disease 
by contact. In many instances such results have led to unfounded 
suspicions. 
The following are the surest diagnostic marks with which we are 
acquainted between the two diseases : Leucorrhoea is gradual in its 
progress, and may be generally traced to constitutional debility, or to 
difficult and protracted labors, or mechanical injuries, especially from 
the use of obstetrical instruments. It is usually accompanied also by 
prolapsus uteri, or dragging pain, or tired feeling in the left side, bear- 
ing-down pains, and general feelings of relaxation and debility. 
Gonorrhoeal inflammation is sudden and rapid in its approach, and 
attacks individuals in the soundest health : the symptoms acquire their 
greatest severity in one or two weeks, and the discharge causes a 
deep-colored (yellow or greenish) stain upon the linen, surrounded by 
a palish color. 375 
GONORRHOEA. 
A careful attention to tlie history of each individual case, will aid us 
materially in forming a correct diagnosis. 
Pathology.—In some cases the discharge issues from the lacuna 
magna, situated a short distance up the urethra. In that case a drop 
of the discharge may at most times be pressed out of the urethra with 
little effort. In other cases it proceeds from chronic relaxation of 
the membrane higher up the passage towards the bladder, or from the 
prostate gland, or more commonly still from a stricture. The explo- 
ration Avith a bougie reveals the existence of stricture; if none be 
found on trying it, and if ordinary injections fail to arrest the dis- 
charge, we may infer that the disease has its origin in some irritation 
or relaxation of the deeper-seated portions of the urethra. 
Prognosis.—The duration of an attack of gonorrhoea cannot be 
estimated with any degree of accuracy. One case will get well in a 
few days, whilst another assumes the most aggravated character, de- 
veloping many complications, and hangs about for months. A scrofu- 
lous constitution, and an irritable nervous temperament are more likely 
to belong to those cases which take on the more serious aspects ; in 
some of these treatment has to be protracted e£ to an almost indefinite 
period.” 
Treatment.—Infectious urethritis is at the present time almost 
universally regarded as a local disease,—confined in its first stages to 
a small portion of the mucous membrane of the urethra. It is true 
that the inflammation often extends up the urinary canal to the pros- 
tate gland, and to the bladder; but it is highly probable that these 
secondary symptoms are owing to bad treatment, or imprudence on the 
part of patients, rather than to the natural and legitimate tendency of 
the malady. We adopt this opinion from having often observed spon- 
taneous cures occur in six or eight weeks without medicine of any 
kind, and without any structure but the urethra becoming affected,— 
the patients having simply placed themselves under a rigid dietetic 
regimen. 
For therapeutical purposes the course of the disease may be subdi- 
vided as follows : First. The preventive period, or that which inter- 
venes between exposure and the first symptoms of the malady. The 
average duration of this period is about three days. 
Second. Th § forming stage, or the period which elapses from the 
commencement of the prickling, tingling or itching sensation, with 
slight redness and swelling of the orifice of the urethra, and a slight 
oozing of mucous or limpid matter, up to the period Avhen the inflam- 
mation has extended to the fossa havicularis, and become strongly 
pronounced, with a purulent discharge of a yellow or greenish color. 
This stage usually lasts from twelve to forty-eight hours. 
Third. The acute or inflammatory stage, including the period which 376 
DISEASES OF THE SANGUINOUS FUNCTION. 
commences at the termination of the last stage, and the subsidence of 
the ardor urince, the acute inflammation of the urethra, the swelling 
and tenderness of the penis, and the change of the yellow or greenish 
secretion, to one of a light, transparent and ropy, or a muco-purulenf 
character. The natural duration of this stage, when proper restrictions 
are used as to diet, stimulants, and exercise, is from one to two weeks. 
Fourth. The chronic stage, or that form of the malady termed gleet. 
Now as our object, in accordance with the homoeopathic doctrine of 
cure, is to produce in the tissue morbidly affected, a new7 and healthy 
medicinal action, which shall supersede the morbid inflammation, we 
apply our remedies directly to the diseased part, instead of bringing 
them in contact w7ith it through the stomach, blood, and kidneys. The 
malady is not constitutional,—there is no other structure of the econo- 
my affected, or upon which we wish to act,—but our sole object is to 
prevent or to remove a simple local inflammation. 
Our remedies then, during the first or preventive period, are the 
occasional injections into the urethra, of nitrate of silver (in the pro- 
portion of two or three grains to the ounce of distilled,) or of sulphate 
of zinc, in the proportion of four grains to the ounce of water. The 
occasional use of these injections after an exposure, with strict tem- 
perance and quiet, will usually prevent the occurrence of the disease. 
These remedies neutralize the absorbed virus before it has time to im- 
pair the function of the membrane with which it is in contact, and thus 
its powrer to do injury is summarily destroyed. 
Diet.—During the acute stage the diet should be light and unstimu- 
lating; all stimulating drinks and active exercise should be avoided. 
There is also a certain and speedy cure for the second ox forming 
stage. The symptoms of this stage, as we have seen, are a tingling or 
itching at the end of the urethra, with a slight redness, and a slightly 
increased secretion of mucus. The remedy for this stage is a satu- 
rated solution of nitrate of silver, a small quantity of which is to be 
applied, by means of a small syringe, or by a small bit of sponge to 
the urethra for an inch in extent. The solution should be delicately 
and rapidly applied, and a quantity used just sufficient to give the 
portion of the membrane touched, a white cast. This causes a smart 
but healthy medicinal inflammation which subsides in about twenty- 
four hours, leaving the structure cured. This course is strictly ho- 
moeopathic, for w7e impress directly the tissue affected, produce a power- 
ful medicinal aggravation of the symptoms, and overwhelm the dis- 
ease by substituting temporarily, another inflammatory action. No un- 
pleasant consequences ever result from the use of this remedy, when it 
is employed before the commencement of the third or acute stage. Our 
experience with this solution has been extensive, and we therefore GONORRHOEA. 
377 
confidently recommend it as a perfectly safe and sure remedy in this 
stage of the complaint. 
During the third or acute stage, it is a question whether any reme- 
dies, either general or topical, can be employed with any material ad- 
vantage, with the exception of the internal use of Aconite, which may 
he given to shorten the inflammatory stage. This medicine is particu- 
larly applicable when febrile symptoms are present. Throughout this 
stage, the patient should be restricted to the most rigid vegetable or 
farinaceous diet, to cold water, arid prohibited from taking much exer- 
cise. Ablutions with cold water, should be often employed, in order 
to keep the parts as free as possible from the irritating discharge. 
After the urgent symptoms have subsided under the use of Aconite and 
the other means we have just pointed out, and the fourth or chronic 
stage has commenced, we may resort to injections composed of one grain 
of Sulphate of Zinc to f vii. of water. These injections, in order to be 
efficient, must be repeated every half hour during the day, until the 
discharge ceases. It will be of no service to use this solution three or 
four times in the day, for the chief object is to wash out the urethra 
as fast as the matter forms, and thus prevent the constant reabsorption 
which which would otherwise take place. 
The principal reason why urethritis is so difficult to cure, when once 
fully established, is, that the matter itself being infectious, and liable 
to be constantly reabsorbed, thus operates as a continual exciting 
cause. If at any given instant, the whole urethra could be restored to 
perfect health, a single drop of the morbid secretion which it had been 
pouring out, applied to the part, would be sufficient to re-excitethe dis- 
ease in all its violence. It is evident, then, that the discharge must 
be arrested abruptly by the remedy employed, or we must use our in- 
jections sufficiently often to dilute and remove the virus as fast as 
formed, and at the same time to change the morbid action of the 
membrane to a healthy medicinal action. 
In regard to the plan of making an application to the urethra, of a 
medicine so powerful as to arrest the discharge suddenly, like the 
solution mentioned under our second head, it is attended in this stage 
of the affection with many dangers. The canal of the urethra is gene- 
rally affected so high up as to render the certain application of this or 
any other sufficiently powerful solution entirely impracticable. 
But the other method to which we have alluded is one of entire 
feasibility and safety, and is for the most part attended with success, 
when the discharge is entirely unconnected with a stricture. It is 
proper to observe that in all cases the patient should urinate previous 
to the use of the injections. Another injection which we have some- 
times used with marked success in this stage, is a mixture of Calom,el 378 
DISEASES OF THE SANGUINOUS FUNCTION. 
and Olive-oil, in the proportion of a drachm to the ounce, once or 
twice a day until the cessation of the diseased action. 
If however, notwithstanding the thorough and persevering employ- 
ment of the zinc-solution and the mixture of calomel and oil, the dis- 
charge still continues, recourse should be had to the introduction of 
bougies, either plain or smeared with a cerate containing a sufficient 
quantity of pulverized Nitrate of Silver. These should be carefully in- 
troduced two or three times a week, until they have stimulated the 
diseased membrane to a natural and healthy action. 
The folloAving local remedies are effectual when judiciously em- 
ployed :— 
Ilydrastis-canadensis.—An infusion may be made of indefinite 
strength, as of an ounce of the root to a pint of water. It may be 
thrown into the urethra through a syringe, and retained for two or three 
minutes. It may be tried every night at first, and afterwards oftener 
if the effect is satisfactory. 
Liquor-j)l'U7nl)i-diacetas.—May be used in the same manner. 
Slightly cold, or tepid water alone, used as an injection, is safe at 
any stage, and almost always hastens recovery. 
The above plan of treatment we believe to be more efficient, safe, 
and consonant with the true principles of cure than any other which 
has yet been promulgated ; yet we do not claim for it infallibility. 
"VVe can only assure our readers that we have thoroughly tested every 
theory and process which has been proposed by either school, and that 
after all of this practical experience, we have presented them with 
what we deem the best method of treatment in this disgusting malady. 
Dr. Blake, of California, lias arrived at the following conclusions:— 
1. Gonorrhoea is a purely local disease, with nothing specific 
about it. 
& That the pi’incipal cause of the difficulty experienced in curing it 
is in the contact of the urine with the inflamed surface of the urethra, 
3. By always washing out the urethra after urinating we remove the 
cause that keeps up the inflammation, which can then be subdued by 
purely local means, in two or three days. 
4. That there are different forms of gonorrhoea, as there are of oph- 
thalmia. 
It is proposed to wash out the urethra with injections of cold water 
each time after urinating. For the cure of disease, washes of sulphate 
of zinc ; for the more severe cases, the chloride of zinc; in the most 
severe, of nitrate of silver. Chloride of zinc two to three grains to the 
ounce of water, diluting it if it cause much pain. (Pacific Med. and 
Surg. Journal, Feb. 1862.) 
Internal Remedies.— Cantharis, Cannabis, Mercunus, Tussila- 
go, Mux-vomica, Cubehs, Pulsatilla, Copaiba, Sulph ur, and Perrurru GONOKKHCEA. 
379 
The selection will generally he made by constitutional rather than by 
local indications. There is generally a depressed state of general 
health, for which Nux-vomica and Sulphur are important remedies. 
Cinnabaris is one of the best forms of mercury. 
Pulsatilla in chronic affections of the urinary organs, in phlegma- 
tic and scrofulous constitutions. 
Aconite.—In the early stages of the disease, when the inflamma- 
tory symptoms are rapidly developed and run high, Avhen the scalding 
is severe, the discharge copious ; erections at night frequent and pain- 
ful, and general symptoms febrile ; Aconite in drop doses, of second or 
third dilution, perhaps in alternation with another appropriate remedy. 
Mercurius-corrosivus.—In the early stage may be alternated with 
Aconite ; in two or three drop doses of second or third dilution (deci- 
mal.) These two remedies seldom fail to subdue the more violent symp- 
toms. The Corrosive is apparently the most efficacious of the mercu- 
rials. The Merc.-sol. seems less efficient. 
Cantharis.—In acute cases in which the membrane of a large por- 
tion of the urinary tract is implicated; the irritation extends from the 
orifice of the urethra to the bladder; scalding and burning along the 
passage; frequent and painful urging to urinate. It may be alter- 
nated with Aconite. A drop dose of the third dilution every six hours 
is often effectual. 
Cannabis-sativa.—When the more active inflammatory symptoms 
have been mitigated by Aconite, Merc.-corros., or Cantharis, and there 
still exist considerable irritation and burning in micturition, swelling 
and redness of the orifice of the urethra, copious white or yellow dis- 
charge. It seems to hold about the same place in homoeopathy that 
Copaiba does in the old school; but it is free from any of the incon- 
veniences of that remedy. Dr. Yeldham says, “to do any good it must 
be given in palpable doses. I am in the habit of prescribing from five 
to ten, or even fifteen drops of the mother tincture three or four times 
a day. In my own practice the dilutions have proved nearly or quite 
inert.” 
Balsam of Copaiba.—All the standard authors testify to the merits 
of this remedy in blennorrhagia as well as in vesical catarrh, nephritis, 
ulceration of the kidneys, bladder and prostate, orchitis, cephalalgia, 
&c. These same men say, the remedy must be “used with prudence,” 
for it is capable of causing swelling of the testicle, obstinate cephalal- 
gia and weight of the head. It has also caused as well as cured 
haemorrhoids; sharp pain in the urethra, inflammation in all the urinary 
passages, retention of urine, phlegmasia of the bladder. 
Copaiba is a powerful homoeopathic remedy in gonorrhoea, but it 
acts chiefly as a local agent ; and thus, like Cannabis, it requires to 
he glvon in palpable doses, which its objectionable taste and smell, and 380 
DISEASES OF THE SANGUINOUS FUNCTION. 
its effects on the stomach render difficult to the patient. The best 
mode of giving it is in capsules, which conceal its taste. Dr. Yeldham 
says, he failed entirely with it in attenuations. That its action is only 
local was considered to be proved by the experiment of Ricord. This 
celebrated author says : “ In one case there was urethral fistula at two 
and a half inches from the meatus,” blennorrhagia occurred in the 
vesical portion of the urethra, but it spread itself forwards to the balanic 
region. The use of Copaiba caused the disappearance of the discharge 
in that portion of the urethra situated behind the fistula, viz., that 
which was under the influence of the urine. But the discharge from 
the portion anterior to the fistula, viz., that portion of the canal which 
did not come into contact with the urine persisted. Injections caused 
its disappearance.” In another case of fistula of the urethra the result 
of Copaiba was the same. When taken in palpable doses and the 
urine was allowed to escape through the fistula at the middle of the 
urethra, the Copaiba coming in contact locally with the inflamed sur- 
face cured it; while the part of the urethra in front of the fistula, 
through which the urine with the Copaiba did not pass continued 
diseased as before. Afterwards when the urine was made to pass all 
through the canal the Copaiba diluted in it cured that portion also. 
These experiments show that Copaiba is a homoeopathic specific for 
urethritis when applied directly to the inflamed surface. Whether it 
has any dynamic power over the same disease in attenuations remains 
to be seen. 
Cubebs.—Dr. L. De Parseval, (Bulletin de la Societe Medicate, 
1860), gives the following symptoms : Specific action on the genito- 
urinary apparatus producing inflammation or phlogosis of the urethra, 
bladder, testicles; ardent fever; ardor urinae, redness of the face ; re- 
tention of urine, cutaneous eruptions; allopathic authors also say, the 
Cubebs produced all of these symptoms and “ despite this the cure of 
the gonorrhoea has taken place.” M.M. Trousseau and Pidoux say, 
Cubebs have become popular in the treatment of this disease, “ which 
rationally, this agent must greatly exaggerate.” The facts of experi- 
ence show, “ that Cubeba acts more beneficially the sooner its employ- 
ment is instituted after the beginning of the blennorrhagia.” 
Thuja.—Corresponds generally with Cannabis, and may be employed 
in the same class of cases and in the same stages; particularly indi- 
cated when there are warty growths on the corona glandis, prepuce or 
about the anus. The above are generally the most useful remedies. 
Capsicum.—When the burning along the urethral canal is intense. 
Nux-vomica,—when the digestive functions are disturbed, and 
when the irritation extends to the rectum, causing frequent and dis- 
tressing urgings to stool, with protruding haemorrhoids. 
Turpentine.—It excites inflammation of the urinary organ.?. M.M. GOITOEEHCEA. 
381 
Merat and Leus say, the terebinthinates irritate the mucous membranes 
and the organs covered by them rendering their functions painful. 
Continued for some time they produce painful and bloody micturition. 
Dr. Despres who took a large quantity in the course of fifteen days 
died from inflammation of the urinary organs. Turpentine produces 
spasm of the bladder, strangury, bloody urine, violent pain in the re- 
gion of this organ. It also causes pain and heat in the lumbar and 
hypogastric regions, especially the kidneys, (Trousseau and Pidowx,) 
acute cystitis, vesical tenesmus, urethral pain, ardor urinse, dysuria, 
smarting sensation increasing to urethritis, scanty, red, bloody urine, 
painful erections as in gonorrhoea, with chordee. In all of these affec- 
tions it has long been employed with success, also in purulent and 
foetid gonorrhoea. Barbier, Trousseau, Pidoux, &c., all expected from 
their doses of turpentine some aggravation, but the good results were 
afterwards seen. They call its mode of curative action “ a substitutive 
irritation. In proper attenuations the curative effects are reached 
without the aggravation. 
Chlorate of Potash.—“ Dr. Irwin (an Army Surgeon) uses no other 
remedy in urethral inflammation than Chlorate of Potash. His method 
of using it is as follows: one drachm of the salt, dissolved in eight 
ounces of water, of which an injection is given every hour for twelve 
hours. At the end of this time, the discharge has become changed 
and diminished; alloAving the remedy to be gradually discontinued un- 
til the second or third day, when the disease will be generally found 
to have ceased.” 
This method is so harmless, so little likely to injure, by excessive 
irritation, causing a stricture, as compared with the caustics usually 
employed, that its merits should be tested. “I am now using it in one 
case with apparent benefit.” (Dr. llale.) 
Tartar-emetic has occasionally cured obstinate gleets with prompt- 
ness. Among its symptoms are : constant sticking pain in the pos- 
terior portion of the urethra, flaccidity of the penis, general debility, or 
complete impotence ; pustules on the thighs and scrotum ; pains in the 
testicles. Dr. Marcy says he cured two cases of involuntary emissions 
which had occurred as often as once in twenty-four hours for many 
months. 
Ferrum.—Tinct. Ferri-sesquichlorid. Several drops in water three 
times a day, in debilitated ansemic constitutions. The pyrophosphate of 
iron, third decimal trituration is about the best of the iron preparations. 
General invigorating influences, as change of air, temperance in 
living, local or general bathing with tepid or cold water, are important 
aids in the treatment. 
Injections may finish the cure imperfectly accomplished by general 
treatment. 382 
diseases of the sanguinous function. 
Complications of Gonorrhoea.—The chief of these are: Irritation 
and inflammation of the bladder, of the prostate gland, phimosis, chor- 
dee, erysipelas. 
1. Irritation of the Bladder.—Symptoms: Painful and incessant 
urging to pass water, pain increasing at the moment after evacuation. 
Urine generally loaded with mucus, and in some cases intermixed with 
blood; suddenness of the call to urinate, usually at short intervals ; 
aching pain in the region of the bladder; accelerated pulse, loss of 
appetite, and debility consequent on the fever. 
Treatment.—Aconite and Cantharis in alternation will generally 
subdue the fever and inflammation in a few hours. Aconite may be 
alternated with Belladonna in ordinary febrile cases. In more chro- 
nic cases, Nux-vomica, Pulsatilla and Sulphur. Other chief remedies 
are Cannabis, Lycopodium, Terebinthina.’, Uva-ursi, Copaibcef 
and Iodine. 
Camphor has been used with success in six-drop doses of the tinc- 
ture for the violent and spasmodic urging to pass water. (See p. 75 to 
78, this volume.) 
2. Phimosis.—This is less severe and obstinate than when it re- 
sults from chancre. In some cases the prepuce becomes thickened 
and constricted, is difficult to be retracted and an irritating discharge 
may accumulate beneath it. Ample cleansings with warm water and 
fine soap. The general remedies appropriate for the disease in gene- 
ral will be sufficient to cure it. 
8. Chordee.—This gives much pain and prevents rest. The usua1 
treatment designed for the fever and inflammation will subdue it. 
4. Orchitis.—Inflammation of the Testicle.—Causes.—It usual- 
ly occurs after the suppression of urethral blennorrhoea, when the dis- 
charge either ceases entirely or becomes very slight. It arises in 
connection with gonorrhoea either sympathetically by propagation of 
the inflammation of the urethra to the testicles, or by metastasis aftei 
suppression of the discharge. The cause of the extension of the ure 
thral inflammation to the testicles, is having gonorrhoea and not wear 
ing a suspensory bandage when riding, dancing, &c., alcoholic liquors, 
coition, use of purgatives, cubebs, copaiba, turpentine, taking a chill 
The cause of metastatic orchitis is often injections with cold water, or 
with saturnine solutions to suppress the discharge. In ordinary cases 
general fever begins with a hard stunning head-ache, which sometimes 
asts, at least at intervals, for twenty-four hours, before the local dis 
ease becomes apparent. Then begin pain, swelling, extreme tender- 
ness of one of the testicles which continues to increase during the first 
two days, and reaches the size of a small closed fist. The scrotum be- 
comes red and tender; the spermatic cord extending from the testicle 
up the groin and round the loin of the affected side, becomes painful, GONORRHOEA. 
383 
enlarged in size. In some cases the appearance of the scrotum cor- 
responds with that of scrotal hernia, the pulse is small, quick, and jerk- 
ing ; there is shivering, thirst, and loss of appetite in some cases; be- 
ginning with a soft spongy feeling, the testicle soon enlarges to the size 
of a fist and more. Sometimes it goes from one testicle to the other. 
The pain in it is often shooting or pressive. The discharge from the 
urethra is diminished or suspended during the attack, and often returns 
when the inflammation subsides. The epididymis is usually most in- 
flamed and swollen, and an examination of the orifice of the urethra 
usually shows its nature. 
Treatment.—Our first care in this complaint should be to suspend 
the inflamed organ by means of a suitable apparatus, in such a man- 
ner as to afford complete support in all positions, and thus prevent the 
enlarged gland from dragging upon the spermatic cord. The recum- 
bent posture should be strictly enjoined, and we should have constant- 
ly applied to the parts cloths wet with cold water. As soon as the 
cloths are warmed by contact with the inflamed testicle, they should 
be again dipped and reapplied until the heat and inflammation have 
disappeared. 
If the disease has arisen from sudden suppression of urethritis, or 
from the use of powerful injections during the acute stage, we may 
give Mercurius, Aconite, Nux-vomica, Spongia, Clematis, or Iodine. 
When it has been caused by the injudicious introduction of bougies, 
Arnica, Aconite, and Pulsatilla, will be found applicable. 
In cases where the inflammation has degenerated into a chronic in- 
duration of the testicles, our best remedies are, Awrum, Acid-nitric, 
Rhododendron, Sulphur, Mercurius, Spigelia, Iodine, and Cicuta. 
Aconite.—When the inflammation resists Belladonna, and the fever 
is prominent, alternate the two remedies. It may alone overcome the 
disease. 
Case.—A man aged twTenty-seven years, contracted a gonorrhoea 
with inflammation at first in the left testicle, and afterwards at the ex- 
piration of six months the right testicle became involved. Both testi- 
cles considerably swollen, hard, hot, and very sensitive to the touch ; 
scrotum red; constrictive, tensive, pressive pains, extending even into 
the bowrels and the thighs, augmenting by jerking paroxysms, and 
worse in the afternoon and night; moderate fever, increased thirst, 
sleep disturbed in consequence of the pain—Pulsatilla, Clematis, Nux- 
vomica and Nitric-acid were employed without success. Aconite third 
one drop every three hours, effected a cure in four days. (Guyler, 
Archiv de Stapf Vol. XIX. Cah. 2, p. 156.) 
IIlladonna.—The patient should be confined to the horizontal po- 
sition, wear a suspensory loosely attached, so that the testicle should 
not hang down, and a thick soft linen cloth laid under the scrotum to 384 
DISEASES OF THE SANGUINOUS FUNCTION. 
keep it in the horizontal position. With these adjuvants Belladonna 
has been generally successful, given only as high as the third dilution. 
If the pain does not rapidly yield, a cold wet compress applied to the 
part and renewed as often as it dries. Symptoms: the patient is ex- 
cessively sensitive and nervous ; there is intolerance of pain which 
partakes of the neuralgic character. 
Nux-vomica, when shooting pain in the testicle persists after the 
use of the preceding. Nux-v. 6, has succeeded in removing it. 
Pulsatilla—May follow Aconite; and these two remedies alone 
often cure the disease. ( Yeldham, p. 28.) 
Aurum—The pain in the spermatic cord is of a neuralgic character 
and is more severe in the cord than in the testicle, but is very distress- 
ing ; the cord is enlarged to two or three times its natural size, being 
larger toward the abdominal ring. (Yeldham, p. 29.) 
Arnica lotion to the painful region. 
Tartar-emetic.—In cases conjoined with gastric symptoms, as fur- 
red tongue, bad taste, eructations, want of appetite, constipation, &c. 
When orchitis, is very severe, Tartar-emetic has often a marked 
effect in reducing the inflammation and relieving the pain. 
Diet.—Light unirritating food similar to that allowed in ordinary 
inflammatory affections. 
When after the removal of the orchitis the gonorrhoea returns, Pe« 
troselinum and Sulphur may be given in alternation with advantage 
When hardness of the epididymis remains, Sulphur 1, a grain daily for 
several days has succeeded. 
Iodine is often useful in alternation with Sulphur. 
Clematis.—Dr. Hirschel regards Clematis, as the principal remedy 
in the treatment of orchitis, especially when it supervenes on exposure 
to cold, after blennorrhagia, and if the testicle be indurated, sensitive 
to pressure, the scrotum red, swollen, with tearing, drawing pains, and 
retraction of the spermatic cords and region adjacent. Ruckert gives 
tnese indications for blennorrliagic orchitis : “ painful induration with 
sensation as though grains of sand were disseminated upon the surface 
of the organ—sequence of ill-treated blenorrhagia.” In a case after 
oxposure to cold and damp, a blenorrhagia was accompanied with vio- 
lent pains in both testicles,nocturnal aggravation, with fever; testicles 
hard, swollen, and highly sensitive to pressure ; scrotum red and tense ; 
discharge nearly suspended. Clematis 12°, two doses in three days. 
The symptoms subsided during the interval, and the discharge re-ap- 
peared. The swelling of the epididymis continuing, Aurum 12°, com- 
pleted the cure. (Attomyr, by Leon Simon, jr.) 
In another case in which, from fatigue in hunting, a blenorrhagia 
was succeeded by orchitis with phimosis, and ulceration ol the pre- ULCER, 
385 
ly the left, became enormous; the scrotum red and tense as in hernia; 
fever intense with furious delirium. After Aconite, Clematis completed 
the cure. Indications : the testicle is hard, swollen and painful, with 
sensation of traction upon the spermatic cord. If it feels bruised to 
the touch, with tension of the groin, upper thigh, and scrotum, Ruckert 
gives Clematis 12° and Spongia 30°, or Clematis alone every twelve or 
twenty-four hours. Various indurations of the testicle, not of syphili- 
tic origin, have been cured by Clematis. Dr. Destirne disputes the 
power of Clematis in the above cases, and refers the recovery to natu- 
ral resolution. 
Irritable Testis.—Clematis.—A case of gonorrhoea had lasted 
many years. Cold had developed orchitis, the part swelling to the size 
of a child’s head. The patient became sad and misanthropic. The 
following year, moist itching spots appeared on the palm of the hand, 
general condition improved; when the spots receded he had colics. 
He had intermitting pains in the left testicle, faintness and retraction 
when the organ was touched. Other symptoms were relieved by other 
remedies; the pains of the testicle were relieved by Clematis 1° for a 
whole summer; when they returned the year following they were dissi- 
pated by the same remedy. 
GENUS XIV.—ULCUS.-ULCER. 
An ulcer is defined as a purulent solution of continuity of the soft 
parts of an animal body; (the name ulcus, derived from eX/cog, a sore). 
Ulcers may arise from any of the causes that produce inflammation, 
from wounds, from irritation of the absorbents by specific poisons, 
from any of the blood poisons already treated of, as scurvy, cancer, 
scrofula, or the venereal virus. 
Causes.—The proximate or immediate cause is an increased action 
of the absorbents, and a spocific action of the arteries, by which a 
fluid is separated from the blood upon the ulcerated surface. 
Varieties of Ulcers.—1. Simple ulcer, arising generally from a 
superficial iniury, as a wound, bruise, abscess, or burn. (See Volume 
I.,p. 641; Vol. II., p. 181). 
2. Sinuous ulcer, which runs under the integuments. Its orifice is 
narrow, but not callous. 
3. The fistulous ulcer, or fistula, a deep ulcer, with a narrow and 
callous orifice. 
4. The fungous ulcer, the surface of which is covered with fungous 
flesh. 
5. The gangrenous ulcer, which is livid, foetid, and gangrenous. 
6. The scorbutic ulcer, which occurs in persons subject to the in* 
fiuence of scurvy. 
yol. ii.—25. 386 
DISEASES OF THE SANGUINOUS FUNCTION. 
7. The venereal ulcer, which occurs in the course of the venereal 
disease. 
8. The cancerous ulcer, or open cancer. (See Cancer, page 282, 
Vol. II.) 
9. The irritable ulcer, dependent on a psoric dyscrasia in the blood 
though excited by local causes. The edges of the sore are ragged, 
undermined, and sometimes serrated or notched. The surrounding 
surface is red or inflamed; the bottom of the cavity is composed of 
irregular hollows, which contain a thin, greenish, or reddish, acrid 
matter, which excoriates the adjoining skin. Instead of the healthy 
granulating surface, described in Vol. I., page 643, there is a white, or 
dark-red, spongy mass, which is irritable, extremely painful, and bleed- 
ing on the slightest touch. This form of ulcer occurs in persons who 
eat and drink too freely, or have suffered from fevers. When seated 
on the leg or ankle it becomes extremely painful and difficult to heal, 
and is called a “fever sore” (See Yol. II., p. 181; Yol. I., p. 647). 
Indolent ulcers are common on the leg, in slovenly and intemperate 
persons. The surface of this form of ulcer is flat, has a shining ap- 
pearance, and is covered with a wdiitish or dark-gray crust, which is 
exceedingly tenacious. Generally there is a profuse discharge of vis- 
cous cohesive fluid. The edges of the sore are elevated, smooth and 
rounded, the surrounding parts are swollen or hard, and the whole limb 
enlarged; but generally there is but little pain. 
10. Carious Cancer, dependent upon carious bone. 
11. The Scrofulous Ulcer which occurs only in scrofulous consti- 
tutions. 
It is known by its having arisen from indolent tumors, by its dis- 
charging a viscid glairy matter, and its indolent nature. (See Scrofu- 
la, Vol. II. p. 259.) 
12. Varicose Ulcer.—This occurs on the inner side of the leg or 
thigh in persons who have varmose veins. 
Treatment of Ulcers.—Ulcers are always curable by the simplest 
dressings, and the natural powers of reparation when they occur in 
healthy constitutions. Obstinate ulcers are invariably the result of 
some dyscrasia of the organism which should become the special ob- 
ject of attention. Even simple ulcers should be healed slowly, and 
under the use of proper internal remedies this can always be done. 
The following are the principal remedies: 
Arsen., Lach., Asarum., Bell., Calc., Carh-veg., Conium, Cuprum, 
Graphites,- Lycopodium, Merc., Phos.-acid, Rhus., Sil., Sulph., Canth., 
Cheh, Clematis, Solanum. 
Arsenicum.—Indolent ulcers on the leg, in old, feeble, or cachectic 
persons; scorbutic or scrofulous ulcers which are flat and superficial, 
or hard, callous and burning ; ulcers which resemble cancer ; fungous, ULCEK. 
387 
varicose ulcers of gray color with red areoloe, black or whitish-spotted 
surface ; those that bleed readily, suppurate, are inflamed, putrid, pha- 
gedenic and very painful, itching, smarting, burning, tearing or drawing. 
Lachesis.—Indolent ulcers in old scorbutic or scrofulous subjects ; 
effects of Mercury, fungous ulcers; deep, varicose, indented, bluish 
spotted, discolored, with red areolae, turning black or spotted; ulcers 
which bleed or become gangrenous, spread, and are surrounded by 
pustules. 
Sulphur.—Every form of indolent ulcer in psoric constitutions; in 
persons subject to asthma, urticaria, herpes or scrofula; fistulous, ca- 
rious or cancerous sores ; fungous or varicose ulcers, with indented 
edges, or red areolae; ulcers which turn black, suppurate or become 
putrid, without pain, of with boring and throbbing pains. 
Carbo-vegetabilis.—Ulcers which burn and smell offensively; atonic 
or indolent sores in old persons; scorbutic, fistulous, and scrofulous 
ulcers; those with hard callous edges ; fungous, varicose ulcers of 
yellow or black color, which bleed and become putrid, phagedenic and 
painless or torpid; otherwise very painful, ichorous, burning, and foetid. 
Cantharides.—Redness, inflammation and gangrene of the surface; 
excessive debility, languor, and emaciation; exudation of a serous li- 
quid from a vesicated surface; itching and lacerating ulcers of the 
leg ; strangury, and tenesmus of the bladder. 
Case by Dr. Burdick, New- York.—A gentleman who had suffered 
from paralysis for sixteen years had a chronic ulcer on the calf of the 
leg. The surface presented a watery blister from which was discharged 
about one quart of serum per day. He was cured by the internal use 
of Cantharides. 
Solanum.—All the species of this genus of plants are good remedies 
in malignant ulcers as well as carbuncles. One of the best local ap- 
plications is the tomato. The powers of Solanum-nigrum in gan- 
grene are referred to at page 346, this volume. 388 
DISEASES OF THE NERVOUS FUNCTION. 
CLASS IV.—DISEASES OF THE NERVOUS FUNC- 
TION. 
ORDEIt I.—PHRENIC A.—AFFECTING THE INTELLECT. 
MENTAL DERANGEMENT. 
The brain and nerves constitute the master tissue of the human 
body. It is superiority of brain, either in structure or conformation, 
which mainly creates the distinction between different individuals and 
different races. A thorough knowledge of this wonderful structure 
would enable us to explain some of the most mysterious inconsisten- 
cies and contradictions in human character, and many of the strangest 
events in human history; and would also render us more capable of 
comprehending the grand destiny of the human family. 
The problem of man’s objects and achievements on earth has only 
been partially solved by history, because historians have but partially 
understood his physical or mental constitution. The ancients thought 
him “an intelligence served by organs.” Modern philosophers have 
set themselves to investigate the “organs,” and to explain away the 
“intelligence” into non-entity. We shall not enter into the contro- 
versy between them; but will endeavor to collect for practical uses the 
best results of observations and experiments which may illustrate the 
nature and treatment of the diseases which affect the human intellect. 
In estimating the probable future of our world, the mental peculiari- 
ties and capacities of different races and nations must be taken into 
the account. Modern research has shown that national characteris- 
tics have continued unchanged from the remotest ages. The Arabians 
are just what they were in the days of the patriarchs. Very recently 
it was declared by ethnologists, that the Hindoos had altered in 
nothing since they were described by the earliest writers; and we 
knoAV that thirty-five hundred years have made no difference in the skin, 
the hair, or the features of the Negro. The characteristics of the 
Jew may be recognized in the sculptures of Luxor and Karnac in 
Egypt, where they were depicted more than thirty centuries ago; and 
they bear the most striking resemblance to the Jews of the present 
day. Neither their residence in Palestine, nor their subsequent ban- 
ishment into every country and climate of the world have made any 
sensible change in the personal frame, the form of the head, the color 
of the skin, or the lineaments of the countenance. (Crania Aviericana.) 
The permanence of national characteristics in the features of well- 
known races is displayed in Egypt for the longest period known in MENTAL DERANGEMENT. 
389 
history. By the researches of M. Auguzre Mariette, in 1854, the most 
perfect specimens of the Egyptians, as they were in the time of the 
Shepherd Kings and Pharaohs and the builders of the Pyramids are 
placed side by side with their modern descendants; and they are 
shown to be identical in form and every feature, though about five 
thousand years of time intervened between them. (See Morton, 
Gliddon, also Dr. Helmuth, TJ. S. Journal of llomazop., Yol. I., p. 
682.) 
The primary origin of the diversity and peculiarity of races presents 
a question which we will not enter upon here. 
The present aspect of the nations gives reason for believing that 
the Caucasian race of men are soon to subjugate the whole habitable 
earth. Great Britain, says Dr. Caldwell,* “ is but a speck in the 
waves, and yet her power is felt and acknowledged in every corner 
of the earth.” The North American Republic exhibits a further 
development of the same Gothic Caucasian race, variously modi- 
fied by Celtic additions. Its future is not to be calculated until other 
elements than those which appear in past history are brought to bear 
upon a problem yet unsolved; it will at least be a powek among the 
nations, of which no one will fail to feel the influence. And what is 
the source of all this power? Its manifestation depends on the mental 
characteristics of the Anglo-Saxon mind in its union with “the largest, 
best developed, best conditioned brain belonging to the human family. 
No matter how good the forms of other parts of the body may be, they 
owe that also to perfection of brain.” Anglo-Saxons are known to 
compose the most highly endowed division of the Caucasian race; 
“their brains are larger, better proportioned, and, from temperament 
and exercise they are in better condition for efficient action.” (Cald- 
well.) It is of the deranged action of this wonderful structure that 
jie come now to speak. 
Under the general term Insanity it is common to speak of all or 
any of the usual perturbations of the intellect. There is no correct 
definition of the word. Perhaps, as Halford says, “ insanity, like sense, 
admits of no definition.” One of the best efforts at a definition is 
that of Dr. Wright, of the Bethlehem Hospital. “ Insanity is a dis- 
ease of one or more faculties of the mind, of the diseased manifesta- 
tion of which the individual is unconscious, or not able to control.” 
Some of the existing definitions would nearly depopulate all the 
asylums ; others would confine in straight jackets, not only their authors, 
but nine-tenths of their readers. 
The Roman law spoke only of two species of mental derange- 
ment, Mento Capito, et furioso. The Prussian law distinguishes 
* Louisville Med. and Physical Journal. 390 
DISEASES OF THE NERVOUS FUNCTION. 
maniacs and idiots. The French law speaks of amenia, insanity, 
idiocy, without defining the divisions. 
Genera and Species of Intellectual Derangement.—Morbid 
physical conditions may produce derangement of the intellect in vari- 
ous modes and degrees, to some of which the following names may be 
applied: 
’ Species. 
1. Erratic Genius. 
2. Empathema entontica.—Impassioned ex 
citement. 
3. E. atonica.—Depression, Absence of pas- 
sion. 
4. E. inane.—Hair-brained passion. 
5. E. nostalgia.—Home-sickness. 
Genus I. 
Empathema, 
Ungovernable 
Passion. 
1. Insanity of the affective faculties. 
2. Insanity of the reasoning faculties. 
3. Insanity involving both the affective and reason- 
ing faculties. 
4. Mania may include any one of the species, and 
indicates fury combined writh insanity. 
5. Melancholia,—either of the above species of in- 
sanity combined with fear and anxiety. 
6. Monomania. 
Genus II. 
Ecphrosia. 
Insanity. 
I.—That the brain is the organ through which the intelligent mind 
carries on its intercourse with the external world need not now be 
proved. The great desideratum for which all men perpetually seek on 
earth is “ a sound mind in a sound body.” 
Diagnosis.—Mental alienation includes all cases where the mind is 
incoherent or deficient in comprehending those plain facts which 
require the least exertion of understanding, whether from natural or 
morbid imbecility, or morbid perversion of its faculties or operations, 
by which the mind becomes incapable of distinguishing between the 
right and wrong of certain principles, which are generally admitted. 
No general definition will include every case. The mind in the in- 
sane has either lost or perverted its accustomed powers, or never had 
them. We include not under the term insanity the common mental 
eccentricities which often appear in the strongest intellects ; they may 
often arise from abstraction of the mind from passing scenes and events, 
and are called absence of mind. Every thinking man experiences 
this to some extent. But when they usurp supremacy from .continually 
revolving in one set of ideas, and overcome the judgment, and impair 
understanding, generally, the individual comes under the scope of 
mental alienation. 
1. Erratic Genius.—Men of genius, in all ages of the world’s history, MENTAL DERANGEMENT. 
391 
have very generally been in some abnormal condition; and much of 
what they did do has been fairly attributed to constitutional peculiari 
ties or to the morbid activity of some of their mental faculties. We 
mention a few examples only. 
1. Richard Porson, Professor of Greek in the University of Cam- 
bridge, was distinguished for great acuteness and solidity of judg- 
ment, intense application, and a stupendous memory. His immense 
erudition had rendered him an object of general admiration; and 
his head, being the subject of general curiosity, was subjected 
to a post-mortem inspection by the anatomists. The account given 
of the dissection says that, “ to the consternation of all phreno- 
logists, but to the consolation of all blockheads, his skull was found 
to be thicker than that of any man that had been dissected in Europe.” 
The phenomenon was considered inexplicable, and Dr. Gall was con- 
sulted. The founder of phrenology regarded the case as a perplexing 
one, and only answered: “ How so much knowledge could get into such 
a, cranium as that I cannot indeed comprehend; but I can well under- 
stand that, having got into it, it would never be able to get out again” 
2. Dr. Gall, the founder of the science of phrenology, died at Paris 
in 1828. It was thought proper that the man who had examined so 
many heads should have his own examined also. Again, the anatomists 
were astonished to find a cranium thicker than had ever been seen 
since the death of Porson—at least twice as thick as any other they 
could find—and the channels, worn by the throbbing of the arteries of 
the dura-mater on the inner surface of the parietal bones, were deeper 
than had ever before been seen. The soul had made a happy escape 
from a massive prison where it had long struggled with storms without 
and physical disease within. The last enemy that assailed it was 
allopathic medicine. The disease was a true gastritis which should 
not have been fatal. But a conclave of physicians gave him twenty 
grains of Quinine per day, for five days, and the tenant of the strong 
old castle surrendered it into their hands. 
8. We find many examples among illustrious men, of intense activity 
of mind, accompanied by some extraordinary development of the bones 
of the head. Cardinal Ximenes, Archbishop of Toledo, and Prime 
Minister of Spain, wherever he went, whether toiling incessantly for 
the reform of the Spanish government, under Ferdinand and Isabella, 
converting the Moors to the Catholic religion, or leading a military 
expedition to the coast of Africa, was continually tormented with a 
pain in the head which no remedy would remove. The warrior states- 
man, in the costume of an archbishop, with a suit of armor over it, was 
little more than a “ living skeleton.” He is described as “ gaunt, grace- 
less and unprepossessing; his austerities had reduced him to a walk- 
ing anatomy, though his carriage was erect, his forehead unwrinkled, 392 
DTSKAaE* OF TIIE SANGUINOUS FUNCTION. 
his features sharp and thin, his eyes small, dark, and deep set, and the 
general expression of his countenance repulsive and severe.” Such 
was the appearance of the tall and ghostly leader who stormed the 
Moorish fortress of Moran, in Africa, and put the garrison to the sword. 
When tortured with neuralgia, he governed Spain by the force of his 
iron will; and whon asked by what authority he ruled, he only pointed 
to his cannon. The Cardinal died in 1517, and his head was examined 
forty years afterwards. It was found so compact and solid that every 
vestige of the sutures was obliterated, and the whole cranium formed 
one hard and firm bone-. To this peculiarity of his skull the Abbe 
Richard attributed the statesman’s sufferings during life. 
4. The same author says that when Cardinal Richelieu died in 1642, 
the reason why he had never suffered from headache-s was seen; twelve 
small circular perforations were found penetrating the skull; “ and 
through these the vapors from his brain had continually exhaled.” 
This was the statesman who carried on wars for and against the differ- 
ent sects and governments of Christendom, and then “ covered up all 
his crimes with the red mantle” of murder and assassination. To such 
a man life is unhappy and death terrible. 
Baron Larrey, the chief surgeon of the first Napoleon, says his 
illustrious associate in the army in Egypt, Monge, made him a visit 
many years after the downfall of the Empire. “ The good old man,” 
says Larrey, “ shed tears of sorrow” when he spoke of the loss of al 
his former patrons, offices, and titles. Profound melancholy and in 
tolerable weariness of life darkened all his later years. After death 
it was found that the arteries of his brain were ossified, many of them 
hardened into bone. The mind and the body had acted and reacted 
upon each other. Fourcroy, the chemist, closed his life, also, in gloomy 
wretchedness; and in his brain, also, the arteries were found ossified. 
Among the English poets there has been no one of whom everybody 
knows so much, and at the same time understands so little, as Lord 
Byron. The mere phrenologist inspects all the portraits, busts and 
memorials of the poet that can be found, and feels but partially satis- 
fied. There is evidently something both higher and deeper in Byron’s 
genius than physical conformation of the head would ever reveal. 
There is a loftier spirituality, as well a lower sensualism in his brilliant 
works, than the shape and size of the brain could alone have shown 
us. He had other physical peculiarities than those displayed there; 
he was the subject of disease through many years of his life; he in- 
herited a feeble, irritable constitution, and suffered all his life the pen- 
alties of ancestral vices ; and all that he achieved or endured on earth 
only cultivated a morbid activity of the brain and nerves. 
Inspired by a misanthropic hatred of much that was wrong in his 
own country, and by admiration of some remnant of the ancient patri- EEEATIC GENIES. 
393 
otism in the modern Greeks, he devoted his life, energies, and fortune 
to the liberation of the land of Demosthenes. There, under the influ- 
ence of malaria, great mental exertion and despondency, he exhausted 
the powers of his over-active brain, and died on the 19th of April, 
1824, having reluctantly submitted to a “copious bleeding,” which 
settled the question of life and death with a reasonable degree of 
promptness. The post-mortem examination solved many of the mys- 
teries of his life, and partially unravelled the perplexed web of the 
many contradictions in his character. The skull, like that of Cardinal 
Ximenes, presented the most remarkable compactness, having no 
sutures between the several parts of it; but all the different bones 
were perfectly consolidated into one, without any intermediate diploe,— 
the head resembling that of a man half a century older than the poet; 
the medullary substance preponderated largely over the cortical por- 
tion ; the convolutions very numerous ; the fissures deep. There were 
also evidences of long-continued irritation, such as could not fail to 
influence his mental capacities and feelings. It was this state of the 
brain that heightened and intensified his passions, and produced many 
of the wildest aberrations of his erratic genius. It was this, added to 
the usual morbid sensibilities of the digestive organs, and the long- 
persistent constipation and torpor common to literary men, that made 
the man who possessed the loftiest poetical genius of his time wish 
for death at a period of life when men, whose minds and bodies are 
more in harmony, are only beginning to live. Disease, which neither 
he nor the physicians could understand, drove him to desire severance 
from all the relations of a world which promised so little for humanity, 
and nothing for him. Ignorant himself of any rational medical treat- 
ment, he made no effort to relieve himself from any of his miseries. 
A true estimate, then, of the character and genius of Byron, can 
only be made by taking into the account the size, form and relative 
activity of the brain; the causes which operated through all his life 
to render him morbidly irritable; his British education and travels in 
classic lands ; his inherited rank and wealth ; the physical constitution 
■which he inherited, encumbered by the diseases and vices of an aristo- 
cratic ancestry. When we have seen some of the same passions and 
wayward tendencies developed by himself, and have measured the 
power of all the surrounding influences to cultivate all that was good 
and all that was evil in such a man, then, and not before, may we claim 
that we understand him. 
But the physicians of our period regard all perversions of the men- 
tal faculty as mere symptoms of some morbid condition of the brain. 
Indeed so completely have thesephysical causes and mental effects been 
classified, that the precise location and the kind of morbid action in the 
brain, which produce nearly all mental disorders, can be designated. 394 
DISEASES OF THE NERVOUS FUNCTION. 
The practical med cal man of to-day looks only to the material brain 
itself in order to so.ve any question of perverted or deranged intellect. 
He combats the ravings of the fierce and violent maniac, by throwing 
a dose of Belladonna upon his inflamed tubercula quadrigemina • or 
the tremulous movements and the frightful visions of the inebriate, by 
bringing into contact with his excited brain and nervous system, Opium 
and Cannabis-indica; or the melancholy and despair of the hypochon- 
driac, by doses of Aurum and Ignatia; or the homicidal or suicidal 
perversions of the monomaniac by Stramonium, Aurum, Hyoscyamus, 
or other appropriate remedy. 
Intellectual perversions, which were formerly regarded as mysterious 
spiritual afflictions of Providence, are now known to be only symptoms 
of some disease of the brain and nervous system, and to be just as 
amenable to medical treatment as any other malady. 
Genus II.—DERANGEMENT OR PERVERSION OF THE 
REASONING FACULTIES—INSANITY. 
Derangement of the intellect has always been regarded as a 
mysterious disease. Dr. Rush said, that in attempting to write out 
his own observations on the “ Diseases of the Mind,” he felt that he 
was about to venture on consecrated ground. No theory of the phi- 
losophy of the mind, either in health or disease, has ever been gene- 
rally accepted ; and a question of the sanity or insanity of the mind 
in a given case, often presents the most difficult problem ever presented 
to the physician. 
Knowledge and wisdom have generally been confounded; and even 
now the distinction between the metaphysical or higher reasoning 
power, and that which reasons on the facts furnished by the evidence 
of the senses is not generally recognized; but it is believed that the 
separate existence and action of these two powers of the mind admit 
of demonstration. A few compressed statements on the subject are 
sufficient for our present purpose. 
It lias been believed by the wisest philosophers of all ages, that the 
human intellect possessed a higher reasoning power than that em- 
ployed in reasoning on the material objects around them. It was ob- 
served by the earliest students of human nature, that some men who 
could reason acutely on all questions presented to the senses could 
never comprehend anything of higher abstract truth j and a distinc- 
tion was drawn between physical or sensuous, material subjects and 
those which were metaphysical—that is beyond or above the physical. 
It was this higher reasoning power, which was known as pure reason, 
which the Greeks deified under the name of Minerva, or the goddess INSANITY. 
395 
of wisdom. She was the impersonation of that highest faculty which 
perceives truth intuitively, before it has time to demonstrate it through 
the slow processes of the external senses. Instead of having grown 
up during the course of successive years through the ordinary stages 
of life, she is represented as having sprung forth from the brain of 
Jupiter, armed with the spear of victory, and the far-seeing eye of 
inspired wisdom. 
The ancients distinguished between the higher reason and the lower 
reason, called by many authors judgment or understanding. Plato, 
Seneca, and Aristotle made this distinction; and in modern times, 
Leighton, Harrington, Lord Bacon, Kant, Coleridge, and all other 
philosophers, except such as are imbued with the materialism of Locke, 
have confined the understanding to the office of reasoning on the 
objects of the external world, and called it “ the faculty of judging 
according to sense.” Animals, say these authors, have the power of 
understanding, as applied to the things of time and sense, but they 
have no perception of the subjects of metaphysical or spiritual con- 
templation, which are the proper objects of pure reason. 
In its highest condition of development the nervous mechanism has 
a three-fold operation: 1. objective ideas, which arise in external facts; 
2. subjective ideas, which exist in registered impressions; 3. impres- 
sional ideas, as the abstract truths of geometry, the issue of pure 
reason, and are therefore to be attributed to the essential nature of 
the soul. 
It is believed that an impression made upon either of the senses is 
conveyed by a nerve connected with it to one of the ganglia at the 
base of the brain. Upon the vesicular contents of this, the change, 
whether chemical or mechanical, is made, which afterwards in some 
WTay corresponds to the outward and material object which caused the 
impression. Not, by any means, that this change impressed upon the 
ganglia necessarily at all resembles its material correspondent in form 
and color, &c.; it is simply conventional with the mind, as are the 
letters of a book, or in the dots and dashes of the telegraphic mes- 
sage. The act of remembering, then, is nothing but fixing the atten- 
tion upon those ganglia, and thus discovering the changes which have 
taken place. 
We may conjecture that these impressions on the ganglia are finally 
transferred to the mind proper, and form, therefore, an integral portion 
of it, thus constituting the faculty usually called memory. 
General Symptoms of Insanity.—In total or partial perversion 
of intellect the concatenation of ideas is broken, as in dreams,—pro- 
ducing incongruous combinations, which are repugnant to reason and 
common reflection. The person in whom the intellect is thus deranged 
may manifest it in different ways, and very often it is difficult to decide 396 
DISEASES OF THE NERVOU8 FUNCTION. 
whether any of the visible symptoms constitute positive evidence of 
insanity. “ The tearing of clothes so common in this disease was one 
of the usual manifestations of deep distress among the Jews, probably 
from its being one of the natural signs among the nations of the east. 
The hallooing, stamping, and rattling of chains common among mad 
people are designed to excite counter-impressions upon their ears, to 
suspend or overcome the anguish of their minds; they wound and 
mangle their bodies for the same purpose. Even when there is sing- 
ing and laughter, there is reason to believe that the heart is oppressed 
with sadness. The sadness and seeming apathy of manalgia are not 
always evidence of the absence of misery. ‘ The willow weeps,’ says 
the poet, ‘ but cannot feelthe torpid maniac feels, but cannot weep. 
One insane person declared, that his sufferings from imaginary evils 
were vastly greater than any real ones could be.” 
Insanity appears in various aspects, according to the causes in 
which it has originated. Some are gay and seemingly happy; some 
imagine themselves superior beings, and assume the importance of their 
supposed situation; some are delighted with flowers, some with play- 
things ; some are revengeful and furious; others are silent. Thus 
they drag out their miserable existence. In one respect they are all 
alike ; all have incoherency of conception and incongruous ideas on 
at least one subject, which may have caused their malady. Some con- 
sider themselves utterly miserable, and resort to various efforts to drive 
out their anguish of mind; they laugh, scream, cry, and especially 
seek to obtain ardent spirits and tobacco. Some, though previously 
silent and gloomy, become lively and loquacious as soon as tobacco is 
given them, or ardent spirits promised; they are cunning, suspicious, 
alive to injury, and quick in avenging it. 
Insanity Involving the Affective Faculties ok Feelings, 
while the Intellect or Reasoning Power remains sound.— 
Austerity of conduct and tyranical disposition often present the 
principal visible evidence of a grade of insanity which no defect of 
reasoning power betrays. “ In a well-attested case, a father systema- 
tically persecuted his children for many years, during which time he 
passed in the world for a man of great talent and probity; and it was 
only after the history of his life had been sifted by the best physicians 
that a tinge of insanity could be found in it.” He had started in life 
with impractical notions of propriety of conduct, which he failed to 
realize in his children. He therefore conceived such a hatred for 
them that he persecuted them even to destitution and charges of the 
worst crimes. His success in prosecuting his plans, and in common 
business evinced anything but insanity [Halford). A strongly-marked INSANITY. 
397 
case of this kind is finely painted by M. Chateaubriand in the person 
of his father.* 
M. Pinel gives the case of a man who had periodical fits of insanity, 
in which he was seized with incontrollable fury which inspired him to 
a propensity to take up any weapon he could find, and knock on the 
head the first person who came in his sight. He experienced a kind 
of internal combat between this propensity to destroy, and the pro- 
found horror that arose in his mind at the contemplation of such a 
crime. There was no mark of wandering of memory, imagination or 
judgment. Although devoted to the happiness of his wife, he came 
near killing her, and had only time to bid her run to avoid his fury. 
“ He said to me,” says Pinel, “ during his seclusion, that his tendency 
to commit murder was absolutely forced and involuntary. All his 
lucid intervals were marked by expressions of melancholy and remorse; 
and so great did his disgust of life become, that he often wished to put 
an end to his own existence. ‘ What reason,’ said he, £ have I to wish 
to destroy the superintendent of the hospital who treats me with so 
much kindness; and yet, in my moments of fury, I am tempted to rush 
upon him as well as others, and plunge a dagger into his heart.’ ” (Sur 
LAlienation Mentale, p. 202). 
Hospitals for the insane are never without some examples of mania, 
marked by acts of extravagance or with a kind of judg- 
ment preserved in all its integrity, if we judge of it by conversations. 
The lunatic gives the most just and precise answers to the questions 
of the curious; no incoherence of ideas are discernible; he reads and 
writes letters as if his understanding were perfectly sound ; and yet, by 
a singular contrast, he tears in pieces his clothes and bed-covers, and 
always finds some plausible reason to justify his wandering and his 
fury. Such cases have been referred to as proving the plurality of 
the organs of the brain. 
It is remarked that it is common for the insane to reason correctly, 
though from false premises. The man who believes himself to be 
composed of glass, reasons correctly in being afraid of being broken 
to pieces. The Prince of the House of Bourbon, who believed himself 
to be a plant, reasoned correctly in standing in a garden, and insisted 
on being watered with the other plants. The lunatic in the cell of 
the Pennsylvania Hospital, who thought the wheel-work of the universe 
moved only by his direction, was right in being afraid to withdraw his 
regulating hand from it; “ for,” said he, “ it depends on me to move 
the balance-wheel of heaven, and if ever I should stop, the whole 
universe would stand still.” 
The point at which the mind may be said to become unsound is not 
* Memoirs of M. Chateaubriand, 1861. 398 
DISEASES OF THE NERVOUS FUNCTION. 
easily ascertained, and strange mistakes arise in trying to draw the 
exact line. The people of the city of Abdera believed Democritus in- 
sane, and sent for Hippocrates to cure him, but Hippocrates decided that 
not Democritus but the people of Abdera were insane. Much learn- 
ing was thought to have made the Apostle Paul mad, because from 
persecuting the Christians he became a strenuous advocate of the same 
doctrines he had opposed. Whatever opinions are not generally re- 
ceived are charged to the insanity of those who accept them, till rea- 
son and experience overpower our prejudices and convince us that “we 
the people,” have for once been wrong. In religious as well as political 
controversies each party pities the weakness and disordered minds that 
can be satisfied with the creed of the opposing party. 
Whenever an individual is merely apparently absurd in matters of 
opinion which do not affect what may be called the elementary prin- 
ciples of feeling or conduct, we need not fear that these errors will 
lead to insanity. An illusion may exist in regard to particular sub- 
jects in the mind of a man of genius, and it may lead him to indulge 
in eccentric whims and fancies; whilst the points on which the illusion 
exists are utterly indifferent to the well-being of all about him, and on 
every other subject his conceptions are clear and his conclusions cor- 
rect Pythagoras believed that he had lived in former ages, had in- 
habited different bodies, and in the shape of Euphorbus, had assisted 
at the siege of Troy, where he was killed by Menelaus. Tasso believed 
that he was visited by a familiar spirit with whom he conversed aloud. 
The hero of Cervantes, Don Quixotte, is a good specimen of this grade 
of insanity. “ If,” says a celebrated writer, “ the circle in which this 
absurdity revolves is so small that it touches nobody, a man is only 
called singular. But if its orbit is so extended to run across the path 
of others, he is insane.”* 
When the body is healthy and the mind sound, our beliefs, emotions 
and actions are induced by mental processes more or less complete, more 
or less accurate, but in all cases there is some kind of foundation for our 
belief, we believe because we have evidence, good or bad. But the insane 
believe without evidence. Persons who have recovered from mental de- 
rangement, say they had no reason at all for believing as they did in ab- 
surd and impossible things ; there was the thought in their minds with the 
undoubting confidence in its truth ; but how it came there they know as 
little as how it went away. Some persons on the verge of melancholy 
say they are wretched, but know not why; that they have everything 
to make them happy and yet feel no interest in life, they feel a wretch- 
edness for which they can give no reason. Some who have murdered 
those who never offended them, say they are urged to it by a strange 
* Medical Recorder, 1827, p. 481. MANIA 
399 
impulse, totally different from that which urges a sane man to commit 
such acts. 
Legal authorities say that to prove insanity it is necessary to prove 
“ insane belief.” But in what does insane belief consist ? Is it some- 
thing either physically impossible or totally groundless ? Many igno- 
rant persons, not insane, can be led to believe in physical impossibili- 
ties, while many of the insane are possessed with one absorbing 
idea for which there is a foundation in reason and in fact. The East 
India captain, mentioned by Gooch, who, while a law suit concerning 
his father’s will was pending, became insane, and imagined that he had 
suddenly come into possession of d£100,000 a year, had no foundation, 
whatever, for that belief; but he immediately acted upon it; com- 
menced an extravagant style of living, offered his physician a carriage 
and horses ; and at length went abroad to dethrone the Turkish Sul- 
tan, promising his friend a magnificent seraglio ; all of which, of course, 
failed of accomplishment. But there are other cases in which “in- 
sane belief” is founded upon real facts. 
Legal Definition of Insanity.—“ It is our duty to recognize no 
form of mental unsoundness which is not positively the product of dis- 
ease.” {Dr. Winslow, Lettsomian Lecture, 1855.) 
A “delusion” is not to be acknowledged unless it be the product of 
a diseased intellect. Dr. Winslow says : “ No notion of the mind how- 
ever ridiculous, illogical, fallacious, and absurd, should be admitted to 
be a delusion, or evidence of unsound mind, unless it be obviously and 
unmistakeably the product of a diseased intellect.” The test of insan- 
ity in all cases should be “ the comparison of the mind of the alleged 
lunatic, at the period of suspected insanity, with its prior, natural, and 
healthy manifestations;” the consideration “ of the intellect in relation 
to itself to no artificial a jpriori testy 
This example is given:—Dr. Forbes {Brit, and For. Med. Chir. 
Dev., July, 1855, p. 214,) was called by a husband to certify to the in- 
sanity of his wife, whom he found at the first interview raving inco- 
herently. On further inquiry, and on a second interview, he “ learned 
from her ordinary medical attendant that her raving was a very fre- 
quent and usual exhibition of uncontrolled temper, and that what at 
first appeared as incoherence was derived from the trifling nature of 
the cause of the offence. There was nothing whatever unusual in her 
conduct at the time, however strange it might have appeared when com- 
pared with the average standard of lady-like manners.” 
1. M A N I A, 
Consists of an entire perversion and derangement of the intellectual 
faculties. The patient seizes at the same time upon topics the most 400 
DISEASES OF THE NERVOUS FUNCTION. 
dissimilar, passing from one to the other, without order or arrangement, 
and reasons, draws inferences and forms opinions without any regard 
to logic or common sense. The intellect is deranged on all subjects ; 
and the moral qualities indicate their perversion, by ferocity, unnatural 
hatreds, rage, quarrelsomeness, continual desire to do mischief, and 
an urgent propensity to carry into immediate effect any fancy which 
may strike the imagination. At the same time, the patient is perfectly 
conscious of his identity,—has a kind of idea of right and wrong, and 
is fully aware of what he is doing; but the mind operates through a 
diseased organ, the healthy equilibrium is lost, vague and absurd fan- 
cies take the place of true perceptions, and the individual is impelled 
to obey the dictates of his diseased imaginings. Mania is usually 
unaccompanied by fever, except, perhaps, at its very commencement, 
although there is a great exaltation of the mental and muscular pow- 
ers. It has also been observed that maniacs are capable of enduring 
the most severe bodily inflictions, and the most intense cold, without 
evincing much consciousness of pain,— also extreme and protracted 
hunger and thirst, without serious inconvenience. 
“ Insanity,” says Dr. Brigham, “ often commences in a very insidious 
manner. Some appear to be deranged only as regards their feelings 
or moral qualities. They are noticed to be different from what they 
formerly were; to be more restless and sleepless, or unnaturally 
morose and irritable. Some manifest an unfounded dread of evil, say 
but little, shun society, and are suspicious of their dearest friends and 
relatives; while others are unusually vivacious and pleasant, or quar 
relsome and abusive. Such changes of character and habits will 
usually be found to be subsequent to some reverse of fortune, loss of 
friends or sickness, and should excite alarm. Persons thus affected 
will converse rationally, and in company, or before strangers, will con- 
ceal their peculiarities; and thus are known to be insane but to very 
few, until some violent act leads to an investigation, and then it is 
found they have long been partially deranged. This is the case with 
most of those who commit suicide. Often insanity exists in a slight 
degree for months, and it is only noticed by the most intimate friends 
or relatives, and then suddenly assumes an alarming form, leading, in 
some instances, to homicide, and in others to self-destruction.” 
Frank asserts that “mania may alternate with hypochondria, melan- 
cholia, or dementia; that it may be continued, remittent, or intermit- 
tent. Intermittent mania returns every eight days, every month, every 
three months, every year, every two years,” &c. According to the 
same author, “ mania may terminate by many crises, mucous or bloody 
stools, vomitings, ptyalism, leucorrhoea, epistaxis, re-establishment of 
the menses or of suppressed haemorrhoids, varices, eruptions, ery- 
sipelas and boils. It may terminate by continued or intermittent MONOMANIA. 
401 
fevers. It may degenerate into melancholia, or dementia. The dis- 
eases with which maniacs finally succumb, are: cerebral fever, apo- 
plexy, inflammation of the meninges, phthisis pulmonalis, and ulceration 
of the intestines.” Complete exhaustion, also, of the physical and 
mental forces is a common termination of insanity. 
2. MONOMANIA, 
Is characterized by derangement upon some particular subject, which 
constantly occupies the thoughts, to the almost entire exclusion of 
everything else. When the patient’s attention is diverted from the 
subject of his insanity, he reasons correctly and converses rationally 
upon all other topics presented to him; and even upon the subject of 
his derangement he reasons correctly upon his false data. Monomania 
may be of a gay or of a sad character, but in a majority of instances 
the monomaniac dwells upon a painful train of ideas. Sometimes a 
prey to the most absurd fears and dreads, as of poverty, being vio- 
lently killed, suicide, homicide, of having committed the unpardonable 
sin, or of some serious impending calamity. Sometimes he imagines 
himself a clock, and stands in a corner of the room through the day, 
swinging his arms like a pendulum; or an animal, and imitates, as far 
as possible, its peculiarities; or that he has no legs or arms, and there- 
fore refuses to walk or help himself; or that he is full, and therefore 
cannot eat or drink any more; or, like J. J. Rosseau, that all men are 
his enemies, and are seeking to ruin him. At other times he imagines 
himself to be the Savior, or a great prophet, or the emperor of the 
world, or some renowned statesman, philosopher or general, and swells 
about, issuing orders suitable to his fancied dignity. 
Monomania may exist in a light form for a long period, without 
attracting particular attention. We have at the present time under 
our care two patients who have tormented themselves a good part of 
the time for years, and who have reduced to a wretched 
state of health, with the dread of committing suicide or homicide; 
and yet they had the firmness to conceal their morbid condition from 
their friends. We have known other individuals who have been 
thrown into phthisis pulmonalis by silently brooding for a long time 
over some apprehended misfortune, like loss of property. The mind, 
like the body, requires rest and diversion; one set of muscles cannot 
be constantly exercised without becoming impaired in their functions; 
nor can the mind dwell upon a single train of ideas exclusively and 
for a long period of time without becoming deranged. 
This malady, like mania, may be continued, remittent, or intermit- 
tent. The cure is generally preceded by some crisis, either physical 
or moral. The physical crises are : eruptions, sweats, vomitings and 
vol. il—26. 402 
DISEASES OF THE NEEVOUS FUNCTION. 
diarhoeas, tumors, fevers, acute inflammations of the brain. The 
moral crises consist of all those emotions or passions which, by violently 
pressing the brain, are capable of exciting a new action, which shall 
supersede the morbid affection. Under this head may be ranked sud- 
den and startling news, fright, rage, violent grief, &c. 
In some cases the reasoning power is impaired, but not wholly lost. 
Such persons sometimes reason with extreme acuteness, at the same 
time tha t they are deficient in the powers of perception. They reason 
from false premises, as we see many persons who are acknowledged to 
be sane, though their minds are not of the strongest. In the truly 
insane, the imagination very generally usurps authority over the rea- 
soning faculties ; and then the mind is like a ship in a stormy ocean 
without helm or rudder, driven before every wind. All persons in 
whom the imaginative faculty, or “Ideality” is very active, occasion- 
ally betray something of its preponderance over the reasoning power; 
thus,—us said by Dryden : 
“ Great wit and madness nearly are allied, 
And thin partitions do their walls divide.” 
Insanity presents itself in various aspects, according to the causes in 
which it has originated. Some are gay and seemingly happy; some 
imagine themselves superior beings and assume the importance of their 
supposed situation; some are delighted with flowers, some with play- 
things; some are revengeful and furious; others are silent. And 
thus, under their various delusions and imaginary joys or sorrows, 
they drag out the weary months and years of a blighted life. In one 
respect they are all alike : all have incoherency of conception and 
incongruous ideas on at least one subject, which may have caused 
their malady. Some consider themselves utterly miserable, arid resort 
to various efforts to drive out their anguish of mind. They laugh, 
scream, cry, and especially seek to obtain ardent spirits and tobacco. 
Some previously silent and gloomy, become lively and loquacious as 
soon as tobacco is given them, or ardent spirits promised; they are 
cunning, suspicious, alive to injury, and quick at avenging it. 
The legal decision of the question of insanity is one of the most im- 
portant as well as the most difficult ever presented to a court of justice. 
It may involve the punishment of an individual with death for the com- 
mission of an act, the moral guilt of which he is, from his unhappy 
state of mind, unable to judge ; or the imprisonment of a sane man 
who, driven by rage, and perhaps impetuosity of temper, may exhibit 
some of those manifestations which the inexperienced and ignorant 
may call signs of madness. In either of these cases, and a vast num- 
ber more, the greatest injustice and cruelty have been committed 
through the ignorance of physicians and the wickedness of designing MONOMANIA. 
403 
men. In every case we should be extremely cautious. The inexperi- 
ence 1 should never give a positive opinion in a doubtful case. The 
probable motives by which an accused person could have been actu- 
ated must always be thoroughly studied, remembering that the state 
of mind at the time of the trial may differ widely from its condition at 
the time of committing the crime. 
The investigation of a case of insanity requires the highest degree of 
professional skill, the most scrupulous delicacy in approaching the 
subject, an exquisite tact and ingenuity in tracing symptoms to their 
source, the most profound knowledge of the secret springs of human 
action, and all the diversified considerations by which the mind may be 
arrested, awed or conciliated. It will only be by acquiring an almost 
despotic ascendancy over the individual whose intellect is “ lost in the 
stormy desert of the brain,” that the physician can penetrate to the 
deeply hidden fountains of mental disquietude, and secret sources of 
physical disease. It will only be by gaining an intimate knowledge of 
the reciprocal action of mind and body on each other that the mystery 
of a perverted intellect can be comprehended. 
Distinction between Real and Feigned Insanity. 
Real Insanity. 
Feigned Insanity. 
When the of the real mad- 
man is over, he tries to conceal his ma- 
lady ; he feels the unhappy infirmity 
of his nature, and shrinks from obser- 
vation. 
There is a peculiar cast of countenance 
which the experienced can detect, and 
which is difficult to counterfeit, parti- 
cularly the sudden transition in the ex- 
pression of the eye, from an unmeaning 
vagueness to a flushing intensity, when 
particular actions or passions are ex- 
cited. 
All the organs of sense are perverted : 
he will bear the most offensive effluvia 
and the most violent noises. He is 
wholly inattentive to physical wants, 
can endure long watchfulness ; though 
all insane patients cannot equally en- 
dure privations. He tries to convince 
ou that he is not insane, and this effort 
furnishes the strongest evidence that he 
is so; he always betrays a morbid 
watchfulness to see if you suspect him 
of it. So far from endeavoring to give 
convincing proofs of his insanity, he 
The pretender to insanity is apt to 
overact his part. In company he is 
boisterous; when alone silent. He 
finds it difficult to sustain his assumed 
character for any length of time. 
He endeavors to give convincing 
proofs of his madness. Some are so 
acute as to deceive us in this point; but 
so badly does he Imitate the expression, 
and so difficult is it to keep up the de- 
ception that his powers of endurance 
fail, where one truly insane would per- 
sist for an indefinite time. 
He finds it a difficult task to submit 
to the long watchings, fastings, and ex- 
posures to cold that the really insane 
endure without noticing them. He can- 
not avoid sleeping; he cannot mimic 
the solemn dignity of real madness, 
nor imitate the peculiar expression. 404 
DISEASES OF THE NEBVOUS FUNCTION. 
shrinks from observation ; but betrays 
in every look that he is afraid you think 
him insane, just as a dishonest man fears 
somebody will suspect him of dis- 
honesty ; and when reason returns he 
avoids the most' remote allusion to his 
malady. He feels the humiliating con- 
dition which it has pleased the Al- 
mighty to permit to fall upon him ; and 
instead of being clamorous and deter- 
mined to obtain his freedom, he seems 
insulted if his disease be alluded to ; he 
is silent, submissive, unobtrusive, and 
deeply humiliated. 
In real insanity we often see displays of astonishing intellectual 
efforts exhibited in a great many different aspects; hut we more fre- 
quently see these displays in the exercise of the imaginative than the 
reasoning faculties. The dramatic poet Lee, wrote the Tragedy of 
Nero and several other plays in the Bethlehem Hospital for lunatics; 
and was, at times, excited to the fury of the wildest maniac. And yet 
all his plays were acted with applause before the same people who 
were only beginning to appreciate Shakspeare. Another English poet 
wrote a poem descriptive of his melancholy situation. Christopher 
Smart wrote his verses on the walls of his cell. Shakspeare, the mas- 
ter of the human passions and of the human heart, delineates in Ham- 
let and in King Lear the different forms of madness arising from grief. 
In Lear we see the characteristics of an arbitrary monarch, defying the 
fury of the elements; in the beautiful Ophelia the fondness for flowers, 
and the vai'ious emblems of sorrow. In Hamlet we have a form of in- 
sanity more feigned than real, which has perplexed jurists as well as 
physicians. 
Physical Symptoms of Insanity.—The eyes are more frequently 
dark; and the hair dark and dry; complexion swarthy, secretion from 
the nose diminished. Dr. Hill says maniacs have a peculiar foetid 
odor emitted from the body. This is certainly not universal, but we 
have personally remarked it in a large number of cases. 
Arterial action is generally increased in the insane. Dr. Rush says 
it is generally stronger than in health. In 1794, two men were con- 
demned to die for high treason against the United States, in one of the 
western counties of Pennsylvania. One of these was said to have be- 
come insane after sentence of death had been pronounced upon him. 
A physician consulted declared the insanity feigned. President Wash- 
ington ordered a consultation of physicians. Drs. Shippen, Griffiths, 
and Rush examined the man and were not satisfied with the symptoms 
presented. Dr. Rush thought that the acceleration of the pulse “ to MONOMANIA. 
405 
more than twenty beats above what it would be in health,” would justify 
the decision that the man was insane. Dr. Shippen ascribed the quick- 
ness of the pulse to fear. We could not now accept the opinion of 
either of these great men as correct. But the influence of Dr. Rush 
prevailed with the President, and the man was pardoned. 
But the most difficult cases that come before the court, involving the 
existence of insanity, are those in which it is the desire and interest 
of the insane person to conceal his malady. On this point Lord Erskine 
on one occasion said: “It is agreed by all jurists and is established by 
the law of this country and every other country, that it is the reason of 
a man which makes him accountable for his actions, and the absence 
of reason acquits him of crime. This principle is indisputable; yet 
so fearfully and wonderfully are we made, so infinitely subtle is the 
spiritual part of our being, so difficult is it to trace with accuracy the 
effect of diseased intellect upon human action, that I may appeal to 
all who hear me, whether there are any causes more difficult, or which 
indeed so often confound the learning of judges themselves, as when 
insanity or the effects and consequences of insanity, become the sub- 
jects of legal consideration and judgment.” On another occasion the 
same great lawyer said: on one case he used every effort in vain before 
a court to prove an individual insane, until Dr. Sims came in and ex- 
plained the nature and cause of the malady. His lordship then ad- 
dressed the patient on that point, and he quickly evinced insanity to 
the full satisfaction of the court. 
The descriptions of melancholy by Shakespeare are always accu- 
rate : “ I have of late, wherefor I know not, lost all my spirits,—for- 
gone all custom of exercise; and indeed it goes so heavily with my 
disposition, that this goodly frame, the earth, seems to me a sterile 
promontory; this most excellent canopy, the air,—look you, this brave 
overhanging firmament, this majestic roof fretted with golden fires— 
why, it appears no other thing to me than a pestilent congregation of 
vapors.” In all the forms of madness Shakespeare’s portraitures are 
acknowledged to be as faultless as his intuitional analysis of human 
characters as exhibited in men in their normal state. It has been 
supposed that he made the subject of insanity a particular study, as 
Crabbe and Scott certainly did after him. The various forms of the 
malady he has described—the perfect keeping of each throughout the 
complications of dramatic action—the exact adjustment of the pecu- 
liar kind of madness to the circumstances which introduce it, and to 
the previous character of “ the sound man,” leave us lost in astonish- 
ment. His test of madness given in Hamlet has been employed by 
physicians in determining the existence of the malady when other 
tests had failed to detect it. 406 
DISEASES OF THE NERVOUS FUNCTION. 
“ Ecstacy! 
My pulse as yours doth temperately keep time 
Aird makes as healthful music. It is not madness 
That I have uttered ; bring me to the test, 
And I the matter will ke-wokd which madness 
Would gambol from.” 
A case of this is given by Halford. 
Of the authors of our time none have more correctly described in- 
sanity than George Crabbe. He made it a subject of such special 
study that he has been styled by a philosopher “ the anatomist of the 
human soul;” and Byron characterized him as “ nature’s sternest 
painter, yet the best.” 
Pathology.—The pathology of insanity has perplexed all writers 
who have attempted it. Men afraid of encouraging materialism have 
represented the mind as so entirely independent of the body and so 
far above it, as to be entirely beyond its influence. And, finding no 
means of reaching the mind, except through some of the sentient 
avenues of the body, they have abandoned the subject of insanity as 
one that the physical agencies of material medicines cannot reach. 
Our theory is that insanity always, when not dependent on, is, at 
least, associated with physical disease of the body. The extent of 
physical derangement is different in individual cases, and hence, its 
mental manifestation may be various. 
1. The gradual development of mind from infancy to manhood, and 
then its diminution in power as old age approaches, is in exact propor- 
tion to the development of brain, when the influence of education and 
disease are taken into the account. 
2. Insanity is a hereditary disease, as weak digestion, deranged 
hepatic systems, and other peculiar organizations descend from parents 
to children, and no one hesitates to refer these to the organization. 
3. Insanity occurs at all periods of life when the mind is at the 
highest activity, when the organization is most perfectly developed, 
and in the highest degree of activity; hence it is more liable to be 
over-excited and thus become diseased. 
4. Bodily injuries do often produce insanity. Early dyspepsia, hard 
study, or labor without rest produce it. Females, during menstruation, 
pregnancy, and after delivery, often become insane from the influence 
of powerful and peculiar actions going on in the system. 
5. The influence of the weather on insanity, shows it to be a disease 
affected by those influences which operate upon the body. The sup- 
posed influence of the moon on this disease gave rise to the name 
“ lunacy.” 
Cerebral Hemispheres.—Physiologists are agreed “ that the gray 
matter of the cerebral convolutions is the true middle point at which PATHOLOGY. 
407 
mind touches matter; where impressions become sensations, and the 
will develops itself into action; and in whose generated force alono 
(in the present state of being) the intellect finds its means of opera- 
tion. With the gray matter of this centre no nerve is directly con- 
nected ; but multitudes of white fibres pass from its cells to unite it 
with the motor and sensory centres, the ganglia at the base of the 
brain. 
“ Morbid affections of the gray substance of the cerebral hemis- 
pheres alone, will manifest themselves in various derangements of in- 
tellect. They arise either from deficiency or super-abundance of the 
quantity of blood supplied to them, or from vitiation of its quality; 
from the irritation of various poisons, generated within or introduced 
from without, or from idiopathic inflammation of the substance itself. 
To this head belong syncope, coma, and delirium in their various 
shades and complications. Whenever these symptoms appear, whether 
as the result of disease or of drug-action, we may be sure that the 
cerebral hemispheres are directly or indirectly affected.”* 
To understand these morbid conditions, if we imagine the process 
of secretion “ arrested by cutting off the supply of blood,” we have 
syncope. The want of blood may arise either from insufficient action 
of the heart, or from contraction of the cerebral arteries; the former 
being the cause of the syncope of Digitalis, the latter that of Hy- 
drocyanic-acid. On the other hand, when the cerebral hemispheres 
are oppressed by abnormal congestion, we have coma, not the “spurious 
hydrocephalus of Gooch and Marshall Hall, which is merely a state 
of cerebral exhaustion, for which Zinc is, perhaps, the pathogenetic 
analogue,” but the true coma, corresponding to oppressed secretion 
from congestion or effusion; and it corresponds in the former case to 
Opium, and in the latter, perhaps, to Hellebore. Simple inflammation 
of the brain gives, first, increased generation of force, on account of 
active determination of blood, and secondly, perverted secretion through 
the irritation of the cells. The first effect of Opium is increased 
secretion without perversion; while Belladonna, with its congeners, 
Hyoscyamus and Stramonium, produce perverted secretion, without 
increase (delirium) or with increase (mania).” 
Induration of the brain, from long-continued sub-acute inflammation, 
is a frequent cause of insanity. In recent and slight cases of this 
malady, the intellectual faculties exhibit no very prominent derange- 
ment, but as the induration progresses and extends, the hallucination 
becomes more strongly pronounced, until eventually complete fatuity 
is the consequence. Solly believes that chronic inflammation of the 
dura mater is a very frequent cause of insanity. In jpost-mortem ex 
* Dr. Richard Hughes, on the Nervous System, London, 1861. 408 
DISEASES OF THE NERVOUS Ft NOTION. 
animations of those who have died demented, Esquirol has observed 
softening or increased density of the brain, adherence of the arach- 
noid, thickenings, atrophy and defective organization of the brain or 
cranium. See Vol. I., p. 702. 
In monomania, Pinel, Frank, and Esquirol assure us, “ that organic 
lesion of the lungs and abdominal viscera, are more frequent than 
alterations of the brain.” The latter writer supposes displacements 
of the transverse colon, to be amongst the most common of these 
derangements, and this is supposed to account for the constipation and 
the pains in the epigastric region, which are usually present in this 
variety of insanity. 
Many cases have been reported in which no organic lesions have 
been found after death, either in the brain or the abdominal cavity, 
and on this account some authors recognize a nervous or vital mono- 
mania. It is probable, however, in all cases of mental derangement, 
that either the brain or its membranes are in a diseased condition, 
although our ordinary modes of examination may not enable us in all 
cases to detect it. But whether our perceptions be able to detect the 
departure from true physical health or not, we are satisfied that every 
form of mental derangement is associated with physical disease of the 
brain. It may not in all cases, or even in a majority of cases, originate 
there. It is a true neurosis, at least, and often originates in the diges- 
tive system. The nervous system of the stomach is, in every case of 
morbid sensibility of the stomach, reflected on the encephalon, which 
is then secondarily affected, giving rise to all the extravagant and in- 
congruous imaginations of the hypochondriac. The direct influence 
of the condition of the brain upon the mind may be seen in a few well- 
marked phenomena, observed by unquestioned authors. Sir Astley 
Cooper says : “ A young man had lost a portion of the skull just above 
the eye-brow; I distinctly saw the pulsation of the brain; it was re- 
gular and slow; but at the same time he was agitated by some opposi- 
tion to his wishes, and directly the blood was sent with increased force 
to the brain, and the pulsation became frequent and violent.” If we 
omit to keep the mind free from agitation, our other means in the 
treatment of injuries to the brain will be unavailing. (Lectures on 
Surgery, Yol. 2, p. 279). 
Effect of Sleep on the Action of the Brain.—Blumenbach saw in 
one case the brain sink when the patient was asleep, and swell again 
with blood the moment when he awoke.— (Elliotson's Edition, p. 283.) 
Dr. Perquin says he saw in the Hospital of Montpellier, in 1821, a 
female who lost a portion of the scalp, skull, and dura mater. When 
she was in a dreamless sleep, the brain was without motion, and lay 
within the cranium. When sleep was imperfect and agitated by 
dreams, the brain moved and protruded without the craniu"' forming CAUSES OF INSANITY. 
409 
hernia cerebri. Vivid dreams protruded it considerably; wakefulness 
still more. A similar case is given in the Med. Chir. Review, (Oct., 
1833, p. 336.) When excited by fear or anger, the young man’s brain 
protruded greatly, so as to disturb the dressings, and throbbed tumul- 
tuously. Thus the brain, like the muscles, is more fully supplied with 
blood when in a state of activity than when at rest 
Change of Size of the Brain.—Sir Charles Bell says : (Anat. 
Vol. II., p. 390), “ We have found that the bones of the head are 
moulded to the brain; and the peculiar shapes of the bones of the 
head are determined by the original peculiarities in the shape of the 
brain” Again: “I have seen one striking instance of the skull de- 
creasing in size with the brain. It occurred in an individual who died 
at the age of thirty-two, after having labored under chronic insanity 
for upwards of ten years, and whose mental weakness advanced in 
proportion to the shrinking of the skull. The diminution of his head 
in size attracted his own attention during life.” 
Cuvier is still more explicit. He says : “ In all mammiferous animals 
the brain is moulded in the cavity of the cranium which it fills exactly. 
So that the description of the osseous part affords us a knowledge of, 
at least, the external form of the medullary mass within.” “ Magendie 
says “ the only way to estimate the volume of the brain in a living per- 
son is to take the dimensions of the skull.” 
Delirium characterizes inf animation of the periphery and is com- 
monly wanting in inflammation of the deep-seated portions. Delirium 
marks disease in that portion of the brain in which the mental organs 
are located by the phrenologists. 
Arachnitis.—“ There is a remarkable difference between the symp- 
toms of arachnitis of the convexity of the brain and that of the base. 
The researches of some celebrated French pathologists led them, after 
a most careful series of investigations, to adopt this opinion, which is 
borne out by my own observations and appears to me to be founded in 
truth. In arachnitis then of the convexity of the brain, we have per- 
manent and violent symptoms; early and marked delirium; sleepless- 
ness, and then coma. But in arachnitis of the base of the brain the 
symptoms are more latent and insidious; there is some pain, and the 
coma that follows is profound; but there is often no delirium. Patho- 
logy shows that we may have most extensive local disease in the 
central parts of the brain, that we may have inflammation, suppuration, 
abscess, and apoplexy, without the slightest degree of delirium.” In- 
deed the central portions of the brain appear more connected with 
another function of animal life—that of muscular motion and sensa- 
tion.—Dr. Stokes, Dublin. 
Causes.—The causes of insanity may be divided into physi(?al and 
moral. Physical Causes.—Injuries inflicted upon the Uead.—Dr. 410 
DISEASES OF THE NERVOUS FUNCTION. 
Winslow says; “ The importance of this subject cannot be exaggerated. 
Repeatedly have I found cases of epilepsy bidding defiance to all 
treatment, tumors, abscesses, cancers, and softening of the brain, as 
well as insanity in its more formidable types under my care, whose 
origin could unquestionably be traced back, for varying periods of one 
two, five, eight, ten, fifteen, and even twenty years, to damage done to 
the delicate structure of the brain by injuries inflicted upon the head! 
Injuries of this character occurring in persons of a strumous habit, or 
to those suffering from long-continued debilitating diseases, impaired 
and perverted nutrition, over-wrought and anxious minds, or inheriting 
a constitutional liability to mental or cerebral disease, are frequently 
followed by serious and often fatal results.” * 
Poisons, <&c.—Medicinal substances capable of powerfully im- 
pressing the cerebral organs; irritating gases, as carbonic-acid gas, 
nitrous-oxyd gas; vapors of ether and chloroform ; alcoholic liquors, 
opium; opiates, and other narcotics ; mercury, electric shocks, sun- 
strokes, excessive labor, violent exertions, straining, masturbation, 
protracted sea-sickness, exposure to great degrees of heat, sudden 
exposure to cold water; other diseases, repelled eruptions, excesses in 
sexual pleasure, drying up of old ulcers, or of accustomed issues; turn 
of life, suppression of menstrual or lochial discharge, metastasis of 
rheumatism, gout or other disease ; syphilis. 
Want of sleep is the “most frequent and immediate cause of in- 
sanity, and one of the most important to guard against.” Dr. Brigham 
dwells upon this cause with much earnestness, and endeavors to m- 
press upon all, the vast importance of “securing sound and abundant 
sleep.” “Long-continued wakefulness,” says he, “disorders the whole 
system. The appetite becomes impaired, the secretions diminished or 
changed, the mind dejected, and soon waking dreams occur, and 
strange phantoms appear, which at first may be transient, but ulti- 
mately take possession of the mind, and madness or death ensues.” 
Moral Causes.—These comprise : over-exertion of the intellectual 
powers, violent emotions, excessive and protracted grief or mortifica- 
tion, disappointed love and ambition, jealousy, remorse, anxiety, exclu- 
sive and protracted thought upon a single subject, or a single train of 
ideas, religious enthusiasm, vivid and unrestrained imagination, im- 
proper mental education. 
Importance of early Physical and Moral Education.—In order 
that insanity may be averted from those who are physically predisposed 
to it, “ Great pains should be taken to form a character not subject to 
strong emotions, passions, and caprice. The utmost attention should 
be given to securing a good bodily constitution. Such children should 
* “ Obscure Diseases of the Brain and Disorders of the Mind.” CAUSES OF INSANITY. 
411 
be confined but little at school; they should be encouraged to run 
about the fields, and take much exercise in the open air, and thus 
secure the equal and proper development of all the organs of the 
body. They should not have the intellect unduly tasked. Very early ' 
cultivation of the mind, and the excitement of the feelings by the i 
strife for the praise and the honor awarded to great efforts of mind 
and memory, are injurious to children, and to those who inherit a ten* 
dency to nervous diseases or insanity, most pernicious. In after life, 
persons thus predisposed to insanity should be careful to avoid engag- 
ing in any exciting or perplexing business or study, and should strive, 
under all circumstances, to preserve great equanimity of temper.” 
(Dr. Brigham's Sixth Annual Deport.) 
Effects of Over-exertion, Mental and Physical.—The restless, en- 
terprising Caucasian, in his march towards the empire of the globe, 
finds many obstacles in his path which never trouble the lethargic 
brains of other less intellectual races. Civilization is endeavoring to 
subdue the earth at an immense expense of muscular and mental effort. 
We find man now more restless than ever, though the age in which we 
live be 
“ The heir of all the ages in the foremost files of time 
though it makes more rapid discoveries and advances than any former 
age could do; there is a general feeling of “ unrest,” anxiety, impa- 
tience, restrained expression. This “ Stoic eye and aspect stern” 
which everywhere “ mask hearts where grief hath little left to learn,” 
may be seen in every street and thoroughfare of every city in the 
world. “ The race of life,” says Carlyle, “ has become intense ; the 
runners are treading on each others’ heels; woe to him who stops to 
tie his shoe-strings.” 
1. The struggle for wealth, fame, and position in civilized society de- 
mands an intensity of effort, which none but sound minds in sound 
bodies can endure without exhaustion. There is everywhere over-ex- 
ertion of mind, without corresponding physical labor; there is effort 
to work the brain more and the body less; to speculate upon a small 
amount of borrowed capital, paying high interest, high rents, and 
meeting the requirements of society by making heavy sacrifices of 
mental tranquility, as well a.s of moral principle. 
In some walks of human industry, machinery has not yet superseded 
human muscles, and here we find that competition and surplus labor 
are ever at work in goading on the exhausted bodily powers to work 
against time, at over hours, or under such peculiar disadvantages as 
render the labor to be performed little less than a slave-like task of 
endurance. The hod-carriers, the coal-heavers and the factory chil- 
dren are wearing out their physical energies by excessive toil, and 412 
DISEASES OF THE NERVOUS FUNCTION. 
many are endeavoring to drown mental anxiety by the use of stimu- 
lants ; and the barrister, the student, the editor and the author, who 
labor for twelve or sixteen hours per day, exhaust the powers of life 
in over-action of the brain, at the same time that they permit their 
physical powers to decline for want of exercise. In neither of these 
classes of persons are the deleterious effects witnessed due to physical 
or even to mental labor alone. Dr. Arnold, of Rugby, said, “ It is not 
the work that injures a man, it is the vexation that does it.” The labor 
alone might be performed without injury; but we now see it always 
performed under an intense pressure of emotional excitement. The 
men who perform the physical as well as mental labor are the subjects 
of restless thought; they are involved in hazardous speculations and 
momentous undertakings; and the sleepless hours of night, and the 
waking hours of anxiety by day, contribute continually to the increase 
of insanity observed in modern times. That this state of things will 
long continue, and the excessive excitement of the brain and nerves, 
to which all classes of our people are continually subject, will here- 
after increase the relative number of sufferers from this fearful disease, 
let us not presume to doubt 
2. Mental excitement, arising from moral, political, or pecuniary 
causes of anxiety, produce derangements of physical health, and these 
involve the brain and nervous system secondarily, if not primarily. 
3. The tendency of the popular literature of our time is to cultivate 
a morbid activity of the imagination, which is far more injurious to 
physical and mental health than over-action of the reflective faculties. 
The reading as well as writing reflective works of fiction produce a 
temporary excitement, which is followed by depression ; this state is 
succeeded by a re-actional pyrexia, much more exhausting to the vital 
powers than any degree of equable and continuous exertion of the 
reasoning faculties. Exercise of the reflecting powers upon tangible, 
attainable objects, whether in the investigation of questions of juris- 
prudence, philosophy or natural science have never caused insanity or 
shortened life. Of the last ten Lord Chancellors of England, begin- 
ning with Lord Thurlow, all lived to the average age of 76 years. The 
average age of the more distinguished English poets, from Spencer 
to Byron, was but 52. Thus musicians and poets die young. Philo- 
sophers and lawyers live to a greater age. Men of science, who at- 
tempt impossible objects, may become insane from over-effort of mind, 
as a machinist does in striving after the “ perpetual motion.” He 
strains his faculties to reach objects that are not in that way to be 
reached, while, like Hugh Miller, he exclaims : “ My brain is burning!” 
The ambitious scholar destroys physical health in toiling for acquisi 
tions he can never use. “The spirit of the times may be portrayed 
by an artist, as the unfortunate Kirke White, pursuing his nocturnal MONOMANIA. 
413 
study with a wet towel round his heated head, pale, faint, and trem- 
bling, lest his sands of life should run out before his insatiable appe- 
tite would be satisfied with acquisitions and praise.” The effort to 
work the brain more and the body less, is a general cause of insanity 
at the present time. In every department of labor and business there 
is an intensity of mental effort to accomplish that which physical 
labor formerly toiled to perform. The mail-carrier of 1825, is de- 
scribed as “ a merry, robust fellow, loaded with capes, top-boots, and 
driving at the rate of ten miles an hour.” 
“ He whistles as he goes, light-hearted wretch, 
Cold and yet cheerful—messenger of grief 
Perhaps to thousands, and of joy to some,— 
To him indifferent whether joy or grief.” 
The mail-carrier of our time is “ a pallid, meagre, sharp-visaged man, 
clad in a short blue jacket, and devoid of all superfluous clothing or 
impediment; but with a restless look that shows the rapidity with 
which he is accustomed to move, guiding hundreds through the air.” 
This restless, reckless man, who directs the railway locomotive at the 
rate of thirty miles an hour is a type of the time of the ascendency 
of mind over matter. 
The man of capital is obliged to develop new powers and combina- 
tions of powers to enable him to compete with the numerous enter- 
prising and adventurous fortune worshippers who surround him. The 
laborer must work earlier and later ; and under this perpetual stir and 
agitation, the nervous systems of men and women generally are much 
more irritable than they were a quarter of a century ago; all the 
causes of insanity are thus, in the present day, on the increase. Miss 
Dix said, in 1860, that ten years ago she estimated the proper subjects 
for lunatic asylums at 1 per 1,000 of the population; now she estimates 
them at 1 to 490. 
The increase of insanity among American women is in part ac- 
counted for by the increasing number of household duties that the 
present demands of society impose upon women who are not able to 
employ a sufficient amount of domestic help. Civilization is defined 
as “the art of keeping up appearances.” In the effort to keep up a 
good exterior, it is common to see the heart-broken and discouraged 
wife or widow, “lose in turn her appetite, her rest, and her strength; 
her nervous system becomes prostrated, and sinking under her burdens, 
she seeks rest in the lunatic asylum.” 
The remote and predisposing causes of insanity are, in a large pro- 
portion of cases, traceable to “ malign influences of childhood.” Dr. 
Butler says: “ When the duty of making home happy shall be better 
realized, we shall have in our land less of vice and crime, and much 
less of insanity. The neglect of physical training, and the imperfect 414 
DISEASES OF THE NERVOUS FUNCTION. 
physical development consequent on this neglect, are strikingly evident 
among our female patients. The various causes of insanity usually 
classified under ‘ ill health, intense mental and bodily effort, grief, do- 
mestic unhappiness,’ &c., may very frequently be traced, in their pri- 
mary influences, to the one cause of the want of physical stamina.”* 
In a previous report the same physician says: “ Not one girl in ten in 
these days enjoys really sound rugged health.” For the correction of 
this state of things he knows no remedy but the enforcement through 
life of health-giving active exercise. This alone can give “ strong, 
and vigorous health, perfect digestion, and no nervousness. An Eng- 
lish girl, accustomed to all weather and thick shoes, considers a half a 
dozen miles a trifling walk, and she takes it day after day. The ma- 
jority of American girls, with their thin shoes, would regard such a 
walk as nearly impossible.”! 
Hereditary Predisposition.—Insanity is, of all diseases, most cer- 
tainly known to be hereditary; though the predisposition may not 
show itself in every family, or may not be developed into obvious dis- 
ease in many of its members. Though children often escape insanity, 
the hereditary susceptibility is seen in the grand children. It is be- 
lieved that the predisposition is more frequently inherited from the 
mother than the father. ‘‘I have seen in one hospital, two sisters from 
one family, and a brother and sister from another; also a father and 
his daughter. In New-York city there are cases of several insane in 
one family. I know a mother and daughter who have been in the 
Blackwell’s Island Hospital; another daughter has been insane at 
times, another is always partially idiotic. They all inherit an eczema 
which produces insanity when it recedes to the brain.” 
ldiosyncracy.—The word signifies an abnormal sensibility to drug- 
action, or such relations to a certain drug as that drug produces in the 
prover symptoms that occur in no other person in a sensible degree, 
and which bear no analogy to the symptoms which others experience. 
Of such idiosyncracies we have examples in persons who are liable to 
attacks of “ hay asthma” and “ rose catarrh.” 
As generally employed, the word idiosyncracy means only “sus- 
ceptibility unusually acute, but not abnormal sensibility.” Some 
persons are peculiarly susceptible to certain influences, as to certain 
diseases. Some have a peculiar susceptibility to certain remedies, and 
may succeed in obtaining symptoms from it that others fail to perceive. 
Claude Bernard says, we may take it for granted that, not only mor 
bid, but, also, physiological predispositions exist in man as well as in 
the lower animals. Even in the best health, in which the individual 
retains his own peculiar habit of body, he is more liable to some dis- 
* Report of the Hartford Insane Asylum, 1860. f Report of 1848. 415 
THEOMANIA, 
eases than to others; and many conditions that are habitual to one 
individual can be mated with another, by bringing him down to a simi- 
lar state of health, and this is to be done by operation through the 
nervous system. 
The difference between different races of horses consists more in 
the difference between nerves than Hood. An irritable, sensitive, 
highly organized nervous system is in fact the peculiarity which 
separates the race-horse from one of the diminutive ponies from the 
hilly countries. 
The difference between individuals may be naturally expected to be 
far more tensive in man than in other living beings. Hypnotism is a 
peculiar state which can only be produced in a small number of highly 
sensitive and nervous patients; and all the phenomena of somnambu- 
lism fall under a similar general rule. It is, therefore, evident, that 
idiosyncracies are only peculiar susceptibilities which exist in the 
normal state in various individuals. 
In conditions of disease, the vital powers of the living body are 
changed, so that medicinal agents and poisons do not produce the same 
effect that they do in health. In some diseases medicines, even in 
massive doses, have very little power: 1. Because absorption is almost 
suspended ; and 2, because the nervous system is strongly depressed. 
Where secretion is over-excited, the absorbent surfaces lose their pro- 
perties. The inner surface of the salivary gland in a state of health, 
rapidly absorbs strychnine and woorara; when secretion is rapid, ab- 
sorption is more slow. In cholera no substance whatever is absorbed 
from the intestinal walls while the characteristic discharge continues. 
In mania absorption is suspended. After the crisis is past it is 
restored. 
RELIGIOUS MELANCHOLY.—TIIEOMANIA. 
In this form of insanity the patient thinks himself the subject of 
Divine anger. How far such an opinion as an article of permanent 
belief is entirely unreasonable must depend much upon the theory of 
the Divine government that the individual may have adopted. Dr. 
Gooch thought that a large portion of the race had good reason for 
apprehensions on the subject of a future life. “ When we consider,” 
said he, “ the certainty of death and the magnitude of the question in- 
volved, it seems more reasonable to feel anxiety and even terror about it, 
than indifference. But experience shows that people so long as they keep 
their sound senses, bear the thought with sufficient lightness for all the 
uses of this world.” Dr. Johnson made the following distiction be- 
tween religious melancholy and that interest in religious subjects which 
their importance may well justify. “Madness frequently discovers 416 
DISEASES OF THE NEKYOUS FUNCTION. 
itself merely by unnecessary deviation from the usual modes of the 
world. My poor friend, the poet Smart, showed the disturbance of his 
mind by falling on his knees and praying in the street, or any other 
unusual place. Now, although rationally speaking, it is greater mad- 
ness not to pray at all, than to pray as Smart did, I am afraid there 
are many who do not pray, and yet their understanding is not called 
in question.” 
The incipient stage of religious melancholy is pourtrayed by Crabbe, 
in the description of the young female who earnestly desired to escape 
from earth. She says: 
“ And here is something, sister, in my brain, 
I know not what—it is a cure for pain ; 
But is not Death ! no beckoning hand I see, 
No voice I hear that comes alone to me ; 
It is not Death but change: I am not now 
As I was once, nor can I tell you how : 
Nor is it madness—ask and you shall find 
In my replies the soundness of my mind : 
O ! I should be a trouble all day long ; 
A very torment if my head were wrong.” 
At times there is upon her features seen 
What moves suspicion.—She is too serene. 
Such is the motion of a drunken man 
Who steps sedately just to show he can.” 
Mental Extravagance.—Men devoted to abstraction and fiction lose 
the realities of life in an ideal world of their own. Their excentrici 
ties then are not extraordinary. They create and converse with theii 
own imaginary beings till it is not strange if their views of real life 
should become absurd. The question is, do their productions arise 
from a heated imagination or are they the result of calm reflection, in- 
vention, and profound observation. 
Rousseau had powerful and luxuriant imagination which could clothe 
the most common-place objects in splendid and illusory forms; but we 
see also in the man intense morbid imagination. His favorite dogma 
was that natural was superior to civilized man. He saw humanity only 
as it may now be seen amid the superficial false splendor and the re- 
volting corruptions of the rich, and degradation of the poor of a great 
city; and then set his imagination to picture out the contrast between 
this perverted civilization and an imaginary life of simple nature. 
Having not seen savage life he painted it as he fancied it might be, 
associating with it everything virtuous, delightful and happy. The 
influence of the imaginative writers has softened many of the rough 
features of our nature, but they have also cultivated an abnormal effemi- 
nate sentimentalism; raised extravagant theories and airy castles 
that the uncultivated heart wildly hopes to see realized, without fur- 
nishing true instruction in the way by which they may be reached. THEOMANIA. 
417 
Imagination, poetry, and eloquence kindle the unregenerate mind into 
ungovernable passions, which take possession of whole communities. 
Thus Caesar was murdered by his friends. Henry the Fourth of France 
by Ravaillac, and Kotzebue, the poet by an infatuated German student 
and in our owrn time, demagogues play upon the passions of the multi 
tude ; and men exert their power in exciting revolutions which they 
know not how to control or direct to good objects. 
The success of M. Esquirol in demonstrating the existence of par- 
tial insanity has led to a more humane administration of the criminal 
law; but it is not to be denied that medical men have often been in- 
fluenced by acute counsellors to detect a. case of monomania or “moral 
insanity,” where a little better education and wholesome restraint ought 
to have made a good citizen. The plea of moral insanity has become 
so common in criminal cases, that scarcely any murderer omits to try 
its efficiency, and we regret that medical testimony in such cases is 
not more highly respected. In a late murder trial in this city the 
judge in his charge to the jury said, he ‘ ‘could make very little of the 
medical testimony, either in the case then before him, or any other that 
he had been called upon to hear.” The frequency of this form of de- 
rangement, which is in fact much more common than any other, indi- 
cates the great importance of considering the most effectual modes of 
controlling or preventing it. The best view of it we find is that given 
by the Rev. J. Barlow, late Secretary of the Royal Institution, in a 
small work “ On Man’s Powder over Himself to Prevent or Control In- 
sanity.” The principal position contended for by this author is, “ that 
the difference between sanity and insanity consists in the degree of 
self-control exercised hy the individual.” Now, when we consider in 
how many cases insanity is caused by self-indulgence, and by want of 
that rigid discipline of mind which of all things is the most important 
lesson, he is required to learn between the cradle and the grave, we see 
the importance of inculcating everywhere self-culture and self-control. 
In the first report to which w’e turn, of 256 cases of insanity produced 
hy physical causes, we find 127, or more than one-half resulted from 
defective moral control. Of these 64 became insane from abuse of 
stimulant drinks ; from masturbation, 23 ; libertinism, 24 ; use of mer- 
cury, 16. Among the other usually named moral causes of insanity 
we find “ domestic griefs, reverses of fortune, jealousy, injured self- 
love, religious enthusiasm.” But do not these ordinary trials of temper 
and moral courage come to us all, and exert what influence they can ? 
And might not some of them, if not moderated by firmness, humility, 
and correct ideas of the uncertainty and brief direction of human hap- 
piness, pervert the powers of reason. The man of strong mind may be 
agitated by passion, or lured to evil indulgence by temptation; but he 
represses the wild thoughts that rush through his mind, and seeks for 
Yol. ii.—27. 418 
DISEASES OF THE NERVOUS FUNCTION. 
better and truer impressions from without or from within; “ the man 
of weak mind yields to them, and then he is insane.” Dr. Connolly 
truly says : “ Seeing that any feeling in excess—the love of pleasure, 
or of ease, or of money, or of expense, or of applause, or that of self- 
denial, or anger, jealousy, hope too sanguine, or sorrow too much in- 
dulged—may become independent of the restraint of the comparing 
powers,” we must perpetually inculcate the importance of cherishing 
“ that governing and protecting action of the mind by careful cultiva- 
tion and exercise.” 
“ Whoever will converse with lunatics, will soon be satisfied that a 
very small portion of them consists of persons whose talents have been 
regularly and judiciously cultivated. The advice of Crabbe, if follow- 
ed, would have saved many an unhappy mortal from the sad expe- 
riences of insanity : 
“But ah ! though time can yield relief, 
And soften woes it cannot cure ; 
Would we not suffer pain and grief, 
To have our reasm sound ami sure ? 
Then let us keep our bosoms pure, 
Our fancy's favorite flights repress ; 
Prepare the body to endure, 
And bend the mind to meet distress.” 
Prichard describes as moral insanity that variety called by Pinel 
“manie de caractere.” It is a slight perversion of the instincts and 
affections which renders the individual a scourge to all around him, 
and which is yet unattended with any mental delusion. These are 
turbulent, unmanageable beings, choleric in disposition, committing 
various censurable acts, which they are always ready to justify by 
plausible reasons; and who become to their friends and families a con- 
tinued source of inquietude and grief. They commit mischief for 
amusement, malice, or wickedness, and are incapable of application or 
labor. They break, disarrange, and destroy everything. Individuals 
afflicted by this partial perversion of the disposition, commit out-of-the- 
way actions, and maintain the most singular and absurd conversations, 
well knowing all the while what they do and what they say. The 
understanding suffers no lesion; the patient is enabled to justify his 
proceedings with a surprising connection and lucidity of ideas and 
expressions. There is but an instinctive perversion,—a general ex- 
altation of the bad propensities, but rarely to the extent of insanity. 
When this perversion of the affections complicates ordinary insanity, 
the “lunatic becomes the most insupportable of beings, creating eter- 
nal confusion and quarrels among the other inmates, and their attend- 
ants, which seems the chief object of their lives.” 
Since we cannot here go into Medical Jurisprudence of In- 
sanity, it is proper to refer to one or two of the best authorities on INSANITY.—PROGNOSIS. 
419 
that subject. The work of Wharton and Little, published in Philadel 
phia, 1855, (pp. 815,) contains two long chapters on the abuse of the 
plea, of Moral Insanity in criminal cases. See also Wharton’s Crimi- 
nal Law • and Dr. Little on the Psychological branch of the subject; 
Wm. C. Townsend on Modern State Trials; Taylor’s Medical Ju- 
risprudence / Blackwood’s Magazine, 1850, p. 548. The best known 
of American works on this branch is that of Dr. T. Romeyn Beck, 
who died at Albany, Nov. 19, 1855. At the Convention of the 
National Association of Superintendents of Hospitals for the Insane, 
held in New-York, May 19, 1868, Dr. McFarland, of Illinois read a 
paper on the Minor Forms of Insanity, in which he stated that he had 
examined 2,400 cases of insanity without finding one of “ Moral In- 
sanity;” and he also quoted another observer, who found only one 
case among two thousand insane persons. 
Prognosis.—The first question asked by the friends of the insane 
patient will be: “Is there any probable chance for recovery?” The 
answer will be influenced by the causes of the disease, and must be 
given only after mature consideration. 
We too often regard insanity as hopelessly incurable. It is very 
often cured when it arises from temporary causes, such as the follow- 
ing: derangements of the digestive organs; menstrual irregularities; 
sudden suppression of an external eruption, or ulcers of long continu- 
ance; metastasis of gout ; utero-gestation ; consequences of parturition. 
Any of these causes having originated the disease by producing undue 
determination to the brain, may be removed by proper treatment; and 
the diseased organs restored to their natural functions, the mind re- 
sumes its natural powers. But an apparent recovery must always be 
looked upon with extreme caution, if not with distrust; ample allow- 
ance must be made for the proverbial cunning of the truly insane; and 
many do really improve to an extent that raises the highest expec- 
tations in the minds of their friends, “ and then suddenly assume an 
alarming form, leading in some instances to homicide, and in others to 
self-destruction.” (.Dr. Brigham.) 
Mania may alternate with other forms of insanity, and thus change 
its aspect. It may be continued, remittent or intermittent, returning 
at variable intervals. When it does really terminate, it is often mani- 
fested by some physical crisis, as: “Mucous or bloody stools, vomiting, 
ptyalism,leucorrhoea,epistaxis, re-establishment of the menses, or of sup- 
pressed hoeinorrhoids, varices, eruptions, erysipelas, or boils. It may 
terminate bjr continued or intermittent fever, or may degenerate into 
some more hopeless condition, as melancholia or dementia.’ (Frank.) 
The cases less likely to be cured are: those in which insanity is 
associated with organic diseases of the brain, or hereditary predispo- 
sition ; insanity produced by moral causes; melancholia, especially 420 
DISEASES OF THE NERVOUS FUNCTION. 
in persons advanced in life; men are more difficult to cure than women, 
religious mania, or that excited by religious enthusiasm; cases caused 
by morbid excitement of the imagination to the extent of overcoming 
the reasoning powers; in such cases the wildest phantoms constantly 
hold possession of the unhappy sufferer’s mind. 
In the more hopeless cases certain physical peculiarities reveal 
the extent of the physical disease associated with, if it did not produce 
the mental disease. There is great torpor of the alimentary canal 
from atony of the chylopoetic viscera, or from primary derangement of 
the nerves of these viscera. Strong doses of purgatives were formerly 
given to such patients and they wTere found remarkably insensible 
to their effects. The skin is generally swarthy and dry. Dr. Hasbun 
examined 265 insane patients, and found that 205 of them had swart l>y 
skin; the remaining 60 had fair skin, with light brown hair. Dr, 
Rush found the secretion from the nose suppressed in two-thirds of the 
patients in the Pennsylvania Hospital. 
In cases that terminate fatally, the diseases under which maniacs 
generally die are: Brain-fever, apoplexy, inflammation of the menin- 
ges of the brain, phthisis pulmonalis, ulceration of the intestines, or 
complete exhaustion of the physical and mental forces. The symp- 
toms of a speedy termination in death correspond more nearly with 
those of a fatal termination in other diseases. The usual symptoms 
of a sinking of the powers of life are often accompanied by a speedy 
subsidence of the mental symptoms of insanity. 
Sir H. Halford gives a case of a man aged twenty-four, who, after 
free use of Mercury, took cold, had fever and delirium on the 5th 
day. On the 7th the excitement was high. He stood erect in his bed, 
his eyes flashing fire,—vras exquisitely alive to every movement 
about him, and was so irascible that none could approach without 
exciting him to the greatest degree of fury. He was put under co- 
ercion, and Tartar-emetic in grain doses. On the 11th day he be- 
came quite calm, and seemed much better. He had repeatedly said 
that he should die, made arrangements for all business affairs, pay- 
ing debts, &c. Sent messages to his mother, and talked much of a 
sister who had been dead for a year or two, whom he would now fol- 
low. “ I asked,” says Halford, “ if he had slept, and whether his 
pulse had come down. The messenger answered that he had not 
slept, and that the pulse w’as quicker than ever. Then I perceived 
that the specious improvement was unreal, and that the clearing up 
of his mind was a fatal symptom, a lightening up of the vital powrers 
before their total extinction; and I said, he will die forthwith. En- 
tering the room he did not notice us. His eyes were fixed on vacancy 
he was occupied entirely within himself, and all we could distinguish 
was an indistinct mention of his sister. His hands were cold, pulse INSANITY TREATMENT. 
421 
indistinct and rapid. He died the same night.” [On Death and 
Madness, p. 96.) 
Treatment.—Up to the close of the last century, insanity was 
everywhere treated as a crime, by confinement in a dungeon with 
chains and fetters. From the time that Hahnemann took charge of 
the Asylum for the Insane at Georgenthal, in Thuringia, at the request 
of the Duke of Saxe-Gotha, to the present time, a slowly progressing 
reform has been making its way in the world. It was only two years 
after Hahnemann had conceived the grand idea of a homoeopathic law 
of cure applied to the treatment of all ordinary diseases of the mind, 
and succeeded in restoring the intellect of the Hanoverian minister, 
Klockenburg, who had been driven to insanity by a satire of the poet, 
Kotzebue. It was in 1792 that Klockenburg was cured; and in the 
same year, Pinel, acting under some high intuition, which transcended 
all the wisdom of the medical schools, cured his first patient by knock- 
ing off the chains of the most boisterous of the raving patients of 
the Bicetre of Paris, and treating him as a man and friend. Since 
that time insanity has been regarded as a curable disease. Hahne- 
mann’s account of his first experience in the “non-restraint” system 
of treatment was first published in 1796, showing that he and Pinel 
were its first advocates. Truth travels slowly in this world; and now, 
after more than three-score years of further experiment, insanity is a 
most formidable enemy of human happiness. So lately as 1842 there 
were but few hospitals for the insane in the United States; and in 
the States where none existed, the public prisons and private dungeons 
were often occupied by chained and fettered maniacs. In that year we 
saw in one of the newer States several patients handcuffed and 
chained as criminals, in private houses ; and each one of these kept a 
whole neighborhood in terror. 
We all remember that but a few years have passed since there 
might be witnessed in every city or county of our country, 
“ A sight—the saddest seen in time !— 
A man to-day the gloiy of his kind, 
In reason clear, in understanding large, 
To-morrow chained and whipped 
By servile hands ; sitting on dismal straw, 
And gnashing with his teeth against the chain, 
The iron chain that bound him hand and foot: 
And striving still to send his glaring eye 
Beyond the wide circumference of his woe.” 
A modern Italian author says he “saw a lunatic who sat for twenty- 
five years on a stone floor, beating the stones with his chains, without 
leaning to rest himself day or night.” “ Surely,” says Dr. Johnson, 
«there is scarcely anything in the pages of Dante’s Inferno more tre 
mendous than this!” 422 
DISEASES OF THE NERVOUS FUNCTION. 
The treatment of insanity is, at this day, generally conducted in 
public asylums, in which only one-half of the Hahnemannian idea is 
carried out. Though these institutions are endowed with wealth of 
nations or states, the reliance of those who have them in charge is 
mainly upon moral management / but even this is in accordance with 
the homoeopathic law, as far as it goes. We do not object to it; we 
desire to see it promoted and extended. But Hahnemann also pro- 
posed a medical treatment, which was successful in his hands, and in 
the hands of his followers also; though they have been compelled to 
treat their patients under the same disadvantages that embarrassed all 
other physicians before asylums for the insane existed, controlling 
them as well as they could at their homes. The insane have a right 
to share the benefits of the best influences of the asylum, and at the 
same time, the best medical treatment that homoeopathy can bestow. 
The successful treatment of insanity requires an extraordinary 
capacity for comprehending and applying all the agencies that have 
power to influence the human mind in disease, as well as in health; 
and a degree of tact and versatility in applying those remedial mea- 
sures to the circumstances of individual cases, which can only be ac- 
quired by extensive observation and experience, based on a thorough 
knowledge of the results attained by the profession at large. 
Moral Trp:atmknt.—A majority of the cases of insanity arise from 
moral causes, such as undue exercise of the emotions and passions. 
It was this observation that led Hahnemann to employ moral influences 
of a similar character in the cure of his first patient; and thqs, in a 
manner entirely homoeopathic, although the idea of similia similibus 
was then only forming itself into shape in his own mind, moral influ- 
ence was effectually directed to the driving out of morbid moral im- 
pressions. The general course of moral treatment consists in calming 
and soothing the mind, and in gradually drawing into it an entirely 
new train of ideas and mental associations. By degrees the intellec- 
tual powers become withdrawn from the old channels; and being em- 
ployed on new objects the morbidly active faculties have time for rest 
and renovation. The importance of abstracting the mind from all 
accustomed associations and thoughts has been generally admitted; 
and for the opportunity to accomplish this object, it has been common 
in our time, to remove deranged persons from their accustomed resi- 
dences, and from all association with their immediate friends. For 
this reason alone the patient is placed in an asylum where his personal 
safety and that of others can be provided for by proper restraints, and 
such influences may be brought to bear upon the mind as shall fill it 
with new ideas to the exclusion of old ones. INSANITY—TREATMENT. 
423 
But it is not merely the residence of a patient within the massive 
walls and iron-grated windows, the bolts and bars of an asylum, sur- 
sounded by other patients more insane than himself, and the conscious- 
ness that he is a prisoner, abandoned by all who were once dear to 
him, that cures insanity; these accompaniments of the public asylum 
system, instead of being a benefit to the lunatic, are all in themselves 
injurious. Though many recover, it is not by these agencies that they 
recover. All the triumphs of homoeopathy have been achieved without 
their influence. When his personal safety and that of others can be 
secured in a small circle of intelligent, discreet friends, who possess 
the knowledge that hospital employees are supposed to have, and the 
sympathy for the patient’s real sufferings, which they too seldom feel; 
where he may he so treated that he does not know that he is a prisoner, 
and where his self-respect shall not he rudely touched, his dominant 
phantasies ridiculed, or his morbid sensibilities harshly invaded ; then, 
under the influence of such surroundings, and the personal presence 
of a true-hearted and true-minded physician, fully imbued with the 
principles of Hahnemann, may be restored to reason many a blasted 
intellect, over which existing institutions have no power. 
The system of treatment which confines the maniac to the cells, 
the fetters, and to the society of maniacs is never the best. The 
patient who has ever known prosperity, too intensely feels the degra- 
dation to which he is reduced. The asylum to which he is consigned 
is no home to him. Many are only taken thither by a course of de- 
ception, and they only discover, on their arrival at the strong castle, 
which they regard as a prison, that they have been betrayed by their 
best friends. These friends have been unwilling to exercise force 
openly, and now console themselves with the reflection that if, on 
reaching the asylum, the maniac is unwilling to remain, there are 
means of compulsion there which can be employed without the public 
exposure that 'would have been necessary in calling on sheriffs and 
policemen. The patient, on arriving at the asylum, discovers that he 
has been deceived by those he has known longest and has most con- 
fided in; he becomes, of course, suspicious of the officers of the insti- 
tution, who are strangers to him, and hence their influence is greatly 
impaired. The patient, believing that he has been brought to the 
asylum by treachery, thinks he has a moral right to employ any arti- 
fice by means of which he may effect his escape. He is, therefore, 
necessarily kept only as a prisoner, closely confined, and watched as a 
criminal. If insane persons must be removed from their homes to a 
public asylum, let them be frankly told by those who have them in 
charge, why they are to be removed, and where they are to be placed. 
If then they resist, and force must be employed, let it be so; but let 
not the unhappy exiles from their homes be distressed by the belief 424 
DISEASES OF THE NEKVOUS FUNCTION. 
that they are the victims of a fraud practiced upon them by theii 
dearest friends. 
If we succeed in raising him mentally and spiritually we must begin 
by respecting him as a man. Every human being claims some degree 
of consideration and sympathy; and if we expect to succeed in draw- 
ing the wrecked mind from the ocean depths of despair, we must begin 
by seeking points of contact in his character as it is, by which we 
may gradually bend it out of its false direction, not attempting to 
break it abruptly off. The insane man, generally does not know that he 
is insane and inferior to others; hence the impossibility of gaining his 
confidence so long as you treat him with contempt. Indeed, as long 
as you mentally regard him as an inferior, you can exert no personal 
influence over his mind. One striking characteristic of the insane is 
a preternatural quickening of the perceptive powers, by which he is 
enabled to read, as if by intuition, the minds of persons around him; 
at the same time those persons generally betray by their actions their 
belief that he is deficient in those very powers. 
The ideas of Hahnemann on the moral treatment of the insane are 
thus given in the Organon: “ When the extent of physical disease is 
small and the insanity has originated in mental causes; if it is still 
kept up by them, is still recent, and has not yet made any great inroad 
upon the physical organism, it may be possible to overcome it entirely 
by moral means alone. Whether this be attempted or not, it is still 
necessary to employ mental agencies in the management of the patient. 
He must be treated ‘with a show of confidence, bestowing on him 
friendly exhortations and friendly advice.’ But we are never restricted 
to mental agencies alone, though Regular Medicine is compelled to 
rely on them exclusively. In every case it is necessary that the phy- 
sician, and all employed in the management of the insane, should ex- 
ercise the highest degree of discretion. ‘ To the furious maniac we 
are to oppose tranquility and unshaken firmness, free from fear; to the 
patient who vents his sufferings in grief and lamentation, silent pity 
that is expressed by the countenance and gestures; to senseless prat- 
tle, a silence not 'wholly inattentive / to disgusting and detestable 
demeanor and similar discourse, entire inattention. As regards the in- 
jury and damage the maniac may commit, we are merely to anticipate 
and prevent it, without ever expressing a word of reproach to him; 
every thing ought to be so ordered that punishments and the infliction 
of bodily suffering may be dispensed with.’ ” (Organon, § 228.) 
Each patient should be allowed all the liberty consistent with safety; 
every effort should be made to excite in the patient’s mind the senti- 
ment of self-respect, and ambition for the good opinion of others; to 
draw out the sparks of social affection; to occupy his attention; to 
exercise his judgment in useful employment; to divert him from his THEOMANIA. 
425 
hallucinations to amusements; to conciliate and soothe him by kind- 
ness and gentleness of manners ; at the same time to make him per- 
ceive the impolicy as well as folly of his erroneous conduct by the 
constant privations, and the prompt and decisive restraints to which 
he must find himself immediately subjected. 
In England, Dr. Conolly has more recently attempted to carry the 
non-restraint system of practice to the highest perfection, at Hanwell, 
London; and his work, published in 1856,* gives the best view of this 
practice, in contrast with that which had recently prevailed in asylums 
generally. He says: “ that the mere abolition of fetters and restraints 
constitutes only a part of what is called the 1 non-restraint system.’ 
Accepted in its full and true sense, it is a complete system of manage- 
ment of insane patients, of which the operation begins the moment a 
patient is admitted over the threshhold of an asylum. And it is a 
part of the non-restraint system to remember, whatever the state and 
circumstances of the patient may be, that he comes to the asylum to 
be cured—or, if incurable, to be protected and taken care of and kept 
out of mischief, and tranquilized; and that the straight-waistcoat effects 
none of these objects. It belongs to the days of mechanical re- 
straints, when every evil of seclusion was combined with every possi- 
ble suffering incidental to the confinement of the arms and legs, and 
the whole body ; and the patient, excited and feverish from his malady, 
and heated and exasperated from the previous struggle, was left to lie 
in a constrained and comfortless position, and to suffer thirst, and to 
become subjected to all the miseries of unavoidable uncleanliness. 
With such treatment the patient commonly became furious. All kind 
attentions being incompatible with such disregard and neglect of him, 
there was no avenue to a good understanding between him and the 
attendants, whom he then, and long afterwards looked upon as enemies 
and tormentors. In the old asylums, every arrangement was princi- 
pally made for security and control; in the new, every arrangement 
is made for the cure of the malady, or the comfort of the patient. 
The great principle of the new system is to exclude all hurtful excite- 
ment from a brain already disposed to excitement. We must study to 
remove from an insane person every influence that can farther excite 
his brain, and to surround him with such as, acting soothingly upon 
both body and mind, may favor the brain’s rest, and promote the 
recovery of its normal action.” 
Among the improvements yet to be made in the practical depart- 
ment of public asylums, arrangements are particularly needed for 
what may be called “an individualized treatment. None but those 
daily familiar with the events of asylums, can duly appreciate the 
* “ On the Treatment of the Insane without Mechanical Restraints.” 426 
DISEASES OF THE NE11VOUS FUNCTION. 
great effects of such treatment in special cases. The physician must 
be able to command the services of a staff of kind and conscientious 
attendants trained by himself. If they are accustomed to the sight of 
their patients in the humiliating condition of restraint, and allowed to 
impose restraints whenever a patient is wayward or irritable, for every 
irregular action, and for every violent word, they can not be taught to 
treat the same patient with any show of respect, much less with any 
constant manifestation of humane regard.” 
The principal substitutes for restraint, in violent cases, suggested 
by late authors, consist only in short seclusion and the “padded room.” 
The latter is regarded by Dr. Conolly as “ an auxiliary without 
which it is questionable whether or not restraints could be entirely 
dispensed with in any large asylum.” Its great advantage, “in all 
cases of high excitement, is that it renders both mechanical restraints 
and muscular force unnecessary for the control of the most violent 
patients.” 
“By these various appliances—some of them simply of small signifi- 
cance, and perhaps almost wearisome in detail, but conjoined forming a 
system directed to one object—the whole constitution of an asylum, 
and the transactions and incidents of every day are made remedial. 
Every thing done by every officer, and every word spoken by the sane 
to the insane, is in conformity to one plan, directed by a chief phy- 
sician, carried out in all its details by efficient and faithful officers, and 
having for its sole object the happiness of the patients, the relief or 
cure of all the griefs and troubles of the heart, and the restoration of 
composure and power of the mind. These in their union, constitute 
the system of managing the insane without mechanical restraints.”* 
Though the padded-room, so highly commended by Dr. Conolly, may 
not be in all cases a substitute for mechanical coercion, it may essen- 
tially aid in the exercise of that systematic kindness and forbearance 
which is the sine qua non to successful medical treatment of the 
lunatic. It at least gives essential assistance in the delirium of epi- 
leptics ; in “many states of extreme exhaustion, with jactitation of 
the limbs occasionally occurring before death from acute mania; in 
some suicidal cases; and sometimes in the conduct of a patient suffer- 
ing a paroxysm of acute mania.” It also possesses the property of 
deadening sound and diminishing the disturbance of many patients by 
one.” f 
Personal Pestraint in the treatment of the insane should be 
avoided, except in extraordinary cases. In some extreme cases of 
puerperal and other exhaustive forms of mania, and in cases in which 
* l)r. Conolly on the Treatment of the Insane, p. 106 
t British and For. Med. Chirurgical Review, A pi il, 1857, p. 222. GRIEF. 
427 
delusion compels the patient to stand on his feet until utter exhaus- 
tion, some degree of personal restraint has been found necessary. 
The best mode of securing this restraint, without injury to the patient, 
is that devised by Dr. Wyman of the McLean Asylum, (Somerville, 
Mass.) It was called the bed-strap, and consisted of an arrangement 
of webbing and buckles, by which the patient could be kept in the re- 
cumbent position in bed, yet with liberty to change from side to side, 
effecting its object with the greatest gentleness. {Report for 1849.) 
Influence of the Passions in Causing and Curing Insanity.— 
The resources of medicine are not confined to the Materia-Medica; 
and all our resources are in this day needed. In the treatment of 
every form of disease, it is, says Sir Astley Cooper, “ The duty of the 
physician to support hope, preserve tranquility, and to inspire cheer- 
fulness, even when he is doubtful of the issue.” A kind expression, 
an unobtrusive inquiry, a word in season, betokening interest and 
regard, may serve to draw out the real cause of a pining malady, which 
has long resisted the best efforts, and may thus lead to its cure. And 
a noble effort of the soul may bid defiance to physical agony, and put 
a temporary check to the onwTard march of death. 
If a patient submits himself to his fate without repining; if he 
yields to the advice of friends, and consents to all the remedial mea- 
sures proposed, he generally does well. On the contrary, if he 
bitterly deplores his fate, is too anxious about the means of cure, and 
impatient when relief can not at once be obtained ; we may then con- 
sider that a constitutional irritation highly unfavorable to recovery 
exists. In the present period of high political excitement and mental 
disquietude “moral therapeutics” possess a higher value than in 
former times. Among all classes of the people wre see the effects of 
the various excitements of progressive civilization, of misdirected 
education, of commercial vicissitudes, political agitation. To these 
causes of physical and mental disease we must add the influence of 
the various passions, of which the effects of a few prominent ones may 
be briefly given: 
Grief.—The specific effects of grief are often witnessed by phy- 
sicians, when their efforts to prolong life have been unsuccessful. 
It lowers the action of the heart and arteries and all the physical 
powers; arrests the secretions, especially that of the liver, and pro- 
duces a low feverish state ; there is defect of animal heat, the appetite 
fails, the mind becomes weaker. The three worst forms of disease to 
which man is liable,—insanity, cancer, and fungus haematodes may 
arise from excessive grief. Anxiety of mind produces diseases of the 
chest. The nerves and muscles lose their accustomed tone and 
energy. Over-anxiety sometimes causes sudden death from cerebral 
or cardiac lesion. A clergyman who had preached at an hour when 428 
DISEASES OF THE NERVOUS FUNCTION. 
he was in a state of great anxiety to return home to his wife, who was 
dangerously ill, fell dead in the pulpit, immediately after he had 
finished the services. Diseases of the heart were little attended to 
before the French revolution; but the trying scenes of that period 
called forth such a multitude of cases of that disease that a volume 
was soon written on the subject by Corvisart, who ultimately died of 
the same disease. The state of the stomach is modified by every 
impression on the mind; and thus arise dyspepsia, haemorrhoids, hypo- 
chondriasis, jaundice, &c. 
Grief.—Consequences of: * Remedies. 
Ignatia.—Silent concealed grief, combined with mortification, sup- 
pressed vexation; silent grief, caused by misplaced affections or losses, 
and constantly preying upon the the mind. Spasmodic fits, caused by 
grief or mortification. 
Also when vomiting, sickness of the stomach, headache and giddi- 
ness. 
Phosphoric-acid, when Ignatia fails. The patient is very quiet, 
taciturn, has a slow fever, great exhaustion, the patient scarcely able 
to speak. 
Phosphoric-acid.—The patient is wasting away, treats others con- 
temptuously, does not wish to speak, perspires much in the morning, 
is sleepy and stupid. 
Ilyoscyamus.—The patient is jealous, violent in his motions, quar- 
relsome, delirious. 
Lachesis—He talks much, changes the subject of conversation 
abruptly. 
Platinum>.—He treats with contempt persons previously esteemed; 
confesses that he is tempted to kill them. In females menstruation is 
excited by fright, grief, or fear. 
Cocculus.—Headache and nervousness following grief, loss of sleep 
from watching over sick friends. 
Sulphu'h.—Entire sleeplessness, continuing for many nights. 
Dera/ngement of Intellect from Mortification, Belladonna, Phos- 
phoric-acid after Bell, fails. 
Ilyoscyamus.—Sleeplessness from home-sickness; hot flushed face. 
Capsicum, when Hyoscyamus fails. 
Merc.-vivus.—The patient is very weak, trembles, is uneasy, agitated 
at night, is chilly, perspires during the night, quarrelsome, obstinate, 
sensitive, manifesting great anxiety. 
Staphysagria.—Protracted effects of grief; the patient is irritable, 
cross, uneasy, fearful, dejected, anticipating danger, dreads the future, 
frets and grieves constantly, is sleepy during the day, restless at 
night, perspires night and day, loses the hair, the voice becomes feeble. 
* Hering. FEAR, 
429 
Fear exerts a stronger influence over the powers of the body than 
any other emotion. When a patient declares that he cannot recover, 
this prepossession does much to deprive the constitution of the powers 
necessary to restore the body to health. A man came to Sir A. 
Cooper with a stone in the bladder; the bladder was examined by a 
sound and the stone was touched. The patient was unwilling to believe 
it, as he said he could never endure the pain of an operation for 
extracting it. The thought of it so weighed down his mental powers 
that he returned to the country, and in a few days died. {Surgical 
Tectures.) 
Under the influence of fear, the whole muscular system, involuntary 
as well as voluntary, is relaxed and unstrung; the skin is chilly and 
damp; the body is unable to originate its accustomed amount of heat; 
the circulation is hurried and irregular; and the blood is unequally 
distributed; the breathing is short and rapid, or takes place in inter- 
mitted deep-drawn efforts; the nervous system of sensation is, for the 
time, in a state of exquisite and over-wrought tension, but soon to be 
followed by one of relaxation and exhaustion. Thus all the effects 
of fear or terror in a high degree are essentially depressing and 
enervating. When the emotion is lighter in degree the effects are 
of the same general character. Cases are given in which serious 
and fatal diseases have been developed by merely talking of them in 
a way to make a well person fully believe he was becoming danger- 
ously ill. Fear renders the system more susceptible to the morbific 
influence of contagious or epidemic fevers; it produces relaxation of 
the sphincters, causing eneuresis, diarrhoea, dysentery, abortion. 
Cholera has more frequently been caused by fear than any other dis- 
ease. The only counteracting influences are confidence and hope. 
Under their influence physicians meet the pestilence in its own 
domain, among sick and dying, and hold up the JEgis of Minerva to 
shield a terrified people from its destroying powers. 
Treatment of Symptoms caused by Fear.—To children, when exces- 
sively timorous, give Aeon, in the evening and Bell, in the morning. 
For diarrhoea, caused by fear, Opium or Veratrum. 
Body very hot and limbs cold. Pulsatilla. 
Stupefaction, difficulty of swallowing, convulsions, laughing when 
asleep, starting, constant apprehension, desire to escape. Ilyos- 
cyamus. 
Agreeable surprise, pleasurable sensations, with great excitement, 
trembling, fainting, &c. Coffea. 
Fright, sudden noise, &c. Opium immediately after the fright. 
If half an hour has elapsed, Aeon., returning to Opium, if not 
relieved. 
Fright with terror. Opium. 430 
DISEASES OF THE NERVOUS FUNCTION. 
Opium.—Fright, when extreme, causes pains in the forehead, sour 
eructations, stupor, internal heat, agitation, heaviness in the abdomen, 
coldness of the body, trembling or nervous twitching, oppression of the 
chest, stiffness of the limbs, unnatural sleep, difficulty of breathing, &c. 
Fright with vexation. Aconite. 
Fright followed by sadness or grief. Ignatia. 
Aconite, when opium fails. 
Fright followed by twitching of the limbs, convulsions, insensibility, 
momentary blindness, difficulty of breathing, involuntary evacuations. 
Opium. 
Ignatia, where Opium fails. 
Fright in Children causing spasms, screaming, trembling, twitch- 
ings in the arms and legs ; head hot, perspiration and redness of face. 
Opium. 
Belladonna, if Opium fails. 
Ignatia, if the face is very pale. 
Veratrum; face very cold; involuntary evacuations. (Ilering.) 
Fear has also been employed as a curative agent in diseases which 
it has excited. Boerhave had a number of epileptic patients in a 
hospital seized at once with epilepsy from sympathy with a person 
who fell down in convulsions before them. He ordered in the hearing 
of the patients that hot irons should be prepared and applied to the 
next person who fell into a fit of the same kind; but no fit occurred 
afterwards. An officer in the Indian army had asthma, and could 
only breathe in an erect posture. A party of the enemy broke into 
the camp. The officer mounted his horse and used his sword most 
efficiently. A semi-paralytic lady, who had been helpless for years, 
•was frightened by fire in the house, and rushed into the street. 
Hildanus says that a man disguised as a ghost took a patient confined 
with the gout down-stairs and left him. The terrified man found his 
way up again, and never afterwards had the gout. Dr. Rush says a 
man suffering with the gout was alarmed by a window into his room 
being broken by the shaft of a wagon being driven through. The 
patient leaped from the bed in a violent passion, forgetting his 
crutches. Dr. Gregory says an officer at sea was cured of gout 
by an alarm of fire. Watson says, “a fit of the gout has sometimes 
been drought on by a mental shock.” We have seen a severe paroxysm 
of intermittent fever dispelled in the case of a very robust man, when 
he saw a favorite child seized with convulsions, caused by the same 
disease. 
Anger.—Anger causes tension of the muscles in every part of the 
body, impeding the free course of the arterial circulation; and the 
disordered breathing disturbs the easy transit of the blood through the 
lungs, and this current is thrown back upon the heart; this organ, in ANGER, 
431 
consequence, labors with inordinate and irregular power to propel it 
with redoubled force. Hence it is that, under its violent influence, a 
blood vessel may give way in some part, or even “the golden bowl” 
may itself be “ broken at the fountain.” In this w7ay many noted 
persons have died suddenly. 
A gentleman, while engaged in entertaining a number of his friends, 
stamped with his foot in anger at one of his servants. The excite- 
ment immediately brought on an attack of haemoptysis, and which 
ultimately resulted in his death. John Hunter ascribed the com- 
mencement of his heart-disease to a fit of passion. 
Broussais and other physiologists, have asserted that rage is capa- 
ble of generating a most virulent poison, especially in the saliva. They 
refer to numerous instances in which wounds from enraged animals 
have been followed by effects that could only be accounted for by sup- 
posing some virus communicated. {Med. Chh'ur. Rev., Yol. 47, 
p. 369). 
The influence of mental emotions on the body in the course and 
progress of disease meets us at every step in practice. The fretful, 
irritable child suffers more with croup or pertussis than one of milder 
disposition. Children are considered more difficult to treat since they 
are less able to explain their feelings ; but, when we consider the de- 
pressing powers of the stronger emotions and passions of adult life, 
we acknowledge that it is in persons of mature age, engaged in com- 
batting the perilous scenes of civilized life, that the most perplexing 
problems of practice arise. In diseases of the respiration impatience 
and feverish fretfulness always increase the patient’s sufferings. In- 
stead of quiet resignation we see him restless, boisterously moving 
from one position to another; breathing deeply at one moment and ex- 
pelling the air from the lungs by loud groans and murmurings at the 
next. The progress of phthisis is said to be retarded by sustained 
equanimity and resignation. In some cases we see a peculiar calm- 
ness and mental tranquility, which disarms the disease of much of 
that irritable feverishness that so rapidly wears out life. In impatient 
persons every thing goes forward unsatisfactorily; every motion gives 
pain, every thought is one of vexation, every sound is a discord. 
Treatment of Symptoms Caused by Anger. — Nux-vomica.— 
Violent tempered persons who feel unwell after being in a passion. 
Staphysagria.—Persons not of sanguine temperament. Anger, with 
just indignation. 
Staphysagria.—Vexation, accompanied by just and violent indigna- 
tion, and abhorence of the thing that has occurred; he rejects every 
thins that is offered him. 
Platinum.—Derangement of mind from anger. 
Chamomilla.—Violent rage in children, causing convulsions. 432 
DISEASES OF THE NEKYOUS FUNCTION. 
Arnica.—Children violently excited, weeping, with frequent attacks 
of cough. 
Ignatia.—Grief or shame, the consequence of vexation 
Bryonia.—The same, followed by cold or chills; the patient is 
irritable. 
Colocynth.—Vexation, accompanied with pain in the bowels, in- 
creased by taking food. 
Chamomilla.—Vexation, attended with violent fits of anger and 
great heat, cough, palpitation of the heart, asthma, spasms in the chest, 
threatening suffocation; derangement of digestion, manifested by bitter 
taste, cutting pains in the bowels, vomiting of bile, headache, fever 
with heat and thirst, redness of the face and eyes, agitation, bilious 
fever or jaundice. 
Pulsatilla.—In persons of a naturally mild disposition, where 
Colocynth or Chamomilla have failed. 
Influence of the Mind on the Body.—Plato says, in his Char- 
mides, that “ all diseases of the body proceed from the soul.” The 
expression of the countenance is mind visible. Bad news weakens 
the action of the heart. Disgust oppresses the lungs and partially 
suspends all the functions of the system. An emotion of shame 
flushes the face; fear blanches it; joy illumes it, and an instant thrill 
electrifies a million of nerves. Surprise hurries the pulse, delirum in- 
fuses giant energy. Violent emotion sometimes causes instant death. 
The influence of depressing mental emotions is too often overlooked. 
“ If a man dies,” says M. Reveille-Parise, of the Paris Academy of 
Medicine, “ we open his body, rummage among the viscera, and scru- 
tinize most narrowly all the organs and tissues in the hope of discover- 
ing lesions of one sort or another; there is not a small vessel, mem- 
brane, cavity, or follicle which is not examined ; nothing escapes the 
eyes of the anatomist.” But one thing beyond his eye-sight does 
escape him. u He is looking at merely organic effects, forgetting all 
the while that he must mount higher to discover their causes. These 
organic alterations are observed, perhaps, in the body of a person who 
has suffered deeply from mental distress and anxiety ; these have been 
the energetic causes of his decay; hut they cannot be studied in the 
dissecting-room. Many physicians of extensive experience are desti- 
tute of the ability of searching out and understanding the moral 
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, and all the hopes of man, and in which will be 
found the most active and incessant principle of the frightful series 
of organic changes which constitute pathology.” 
Monomaniacs may sometimes be cured, however, by indulging them INFLUENCE OF THE MIND ON THE BODY. 
433 
in their delusions, and encouraging them in the hope of being able to 
remove the cause. The late Dr. George McLellan once had a case in 
point: a highly intelligent merchant was firmly poss essed with the 
idea that there was a living eel in his stomach; and he so tormented 
himself with the delusion that he became seriously ill, and was obliged 
to abandon business. He had employed many eminent, physicians who 
all ridiculed his delusion, and endeavored to convince him of its ab- 
surdity, but all to no effect; the idea continued firmly fixed, and his 
general health continued to suffer, when as a last resort, and in disgust 
at the ignorance and obstinacy of all physicians, he called on Dr. 
McLellan, who, on investigating the case, decided to indulge the 
patient in his delusion; he accordingly assured him that he had a 
monstrous living eel in his stomach, but that he could give him a me- 
dicine which wrould destroy the animal, and carry it off by way of the 
bowels. Accordingly, a long prescription was written, amounting to a 
powerful drastic purgative, and the patient directed to take it. At its 
operation, the attendant was advised to slip a mutilated eel into the 
vessel, and convince the invalid that it had passed from him. The 
stratagem succeeded admirably, and the man was directly restored to 
health, mental and bodily. 
Frank mentions the case of an individual “who did not wish to 
urinate for fear of producing a new deluge; he was told that if he 
persisted in his sad resolution, a fire would occur and burn up the 
universe. He hastened to urinate, and his delirium vanished.” 
Another monomaniac believed himself damned; one of his friends, 
habited as an angel, entered his chamber during his sleep, holding in 
one hand a flambeau, and in the other a glistening sword. He an- 
nounced to him in behalf of God the pardon of his crimes, and the 
patient was restored to health. “Another monomaniac imagined there 
were rabbit-burrows in his head. To cure this illusion, they made a 
crucial incision in his scalp, and showed him bloody rabbits, which 
they said had retired from the wound.” 
Much, however, must depend upon the peculiar circumstances at- 
tending each particular case, in applying our moral treatment; but a& 
a general rule,uniform kindness, respectful treatment, proper discipline,, 
and a perseverance in all those means which tend to direct the mind' 
into new channels, as games, music, gymnastic exercises, mechanical 
or agricultural labor, exhibitions, &c., will enhance very materially,- 
our success in the treatment of this class of maladies. 
Medical Treatment.—In entering upon the medical treatment of' 
a case of insanity it is necessary: 1. To take notice of all the symp- 
toms presented in the case before the mental phenomena attracted; 
attention. We need the previous history of the patient. 
2. To compare these symptoms with the physical symptoms which, 
Vci. it.—28. 434 
DISEASES OF THE NERVOUS FUNCTION. 
remain, though at present nearly overshadowed by the mental ones, 
which alone attract the attention of the friends. 
3. To note, with minute accuracy, all the mental manifestations in 
detail; and, 
4. To compare the totality of the symptoms of the entire case with 
those of such remedies as can come nearest to furnishing a similar 
train of symptoms. 
Thus, Aconite seldom effects a rapid and permanent cure when the 
temper of the patient is quiet and even; or Nux-vomica, when the 
disposition is mild and phlegmatic; or Pulsatilla, when it is lively, 
serene, or obstinate; or Ignatia, when the mind is unchangeable and 
little susceptible of either fear or grief. 
Almost all affections of the mind and disposition are nothing more 
than diseases of the body, in wdiich the changes of the moral faculties 
(more or less rapidly) become predominant over all the other symp- 
toms, which are diminishing; they finish by assuming the character 
of a partial disease and almost of a local affection. 
Diseases of the Mind and Temper, when serious and persistent, 
are almost always associated with some psoric or constitutional dyscra- 
sia, and can only be effectually cured by antipsoric remedies. But in 
all other diseases the mind is more or less involved; and none of them 
are successfully treated by remedies that do not cover all the mental 
as well as physical symptoms. Sometimes, in a psoric constitution, 
the mind is calm and gentle until the painful part of the affection is 
cured; and then the patient becomes ungrateful, obdurate, or mali- 
cious, as he had formerly been before the so-called bodily disease showed 
itself. If, in such cases, curing the bodily disease develops another 
phase of the inveterate psora, we must continue our treatment until it 
is driven from the mind as well as the body. Fortunately, we have, 
mot only numerous remedies that act directly on the “ Mind and Dis- 
position,” in these cases, but we have none that do not so act when 
mental symptoms exist to call out their powers. In every disease the 
mental symptoms must be provided for. 
Remedies.—Insanity.—Aeon., Agar., Ant.-Crud., Arsen., Bell., 
Cann., Canthar., Caust., Coecul., Con., Cupr., Dale., Ilyoscyam., 
Opium, Sec.-cornu., Stram., Sulph., Veratr., Zinc. 
Insanity, with haughtiness: Ilyoscy., Stram., Veratr. 
u Mirthful: Crocus., Ignat., Stram. 
“ Mild: Croc., Veratr. 
u Religious : Veratr., Stramonium, Platinum. 
u Talkative: Stram. 
“ Furious : Ilyoscy., Stram. 
The remedies which have perhaps been most frequently successful 
.n the cure of insanity are : Opium, Belladonna, Nux-vomica, Aeon- INFLUENCE OF THE MIND ON THE BODY. 
435 
ite, Igncitia, Ilgoscyamus, Stramonium, Pulsatilla, Veratram, 
feW, Conium, Helleborus, Aurum, aud Aurum-muriaticum. 
Opium is suitable in all cases of dementia, attended with sopor, 
stupefaction of the senses; general loss of mind and sensation; indif- 
ference to pain or pleasure; strange visions; laborious respiration* 
constipation, with bloating of the abdomen; face pale, or red, or brown- 
ish ; diminished temperature of the skin; full and slow pulse; spas- 
modic movements and trembling of the limbs; rage with fixed ideas; 
lethargic drowsiness with loss of consciousness ; mania, with fantasti- 
cal or fixed ideas, which induce a belief in the patient that he is from 
home ; frightful visions, of mice, scorpions, &c.; convulsive movements 
and trembling of the limbs, anguish, fury; inability to go to sleep, 
though there exists great sleepiness; constipation with meteorisma; 
congestion of the head with redness of the face, &c. Delirium tremens. 
Aconite.—When there are frequent and full pulse, hot and dry skin, 
thirst, and other febrile symptoms, with congestion of blood to the head, 
and a general exaltation of the muscular and mental powers, Aconite 
may be employed to remove this condition. 
Nux-vomica is suitable for suicidal monomania, attended with great 
anguish, and desire to go from place to place; also in nervous hypo- 
chondria arising from derangement of the stomach and liver; also men- 
tal derangement arising from mortification ; from excessive study; 
from suppressed haemorrhoids. It is sometimes useful to remove the 
constipation which is so frequently present in insanity; also watery 
diarrhoea. 
Nux-vomica is generally the best remedy when insanity follows the 
excessive use of coffee, wine or spirits, a night debauch, or excessive 
mental labor; when menstruation is too frequent; the stomach de- 
ranged ; the temper irritable; sad and desponding mood, he is rest- 
less, feels anguish and desires to destroy himself; or is apprehen- 
sive of death ; loss of consciousness, raving, frightful visions, sleepless- 
ness, unreasonable answers and actions ; paleness and bloatedness, 
redness and heat of the face, with congestion of the head; stammering, 
starting and trembling of the limbs, bewilderment and heaviness of the 
head; fullness and inertia of the abdomen; pressure, heaviness, and 
squeezing in the pit of stomach, epigastrium and hypochondria; retch- 
ing or vomiting of ingesta, or of bilious matter; sleeplessness, with 
starts; is excessively sensitive to noise, odors, &c., also to light and 
music; he moans and scolds during the pains; is inconsolable on ac 
count of trifles ; is offended at little faults or neglects ; is disposed to 
censure and quarrel. 
Ilgoscyamus.—This drug is capable of producing a species of men- 
tal derangement characterized by a kind of stupefaction, as observed 
by many authors cited by Hahnemann. It was this form of mental 436 
DISEASES OF THE NERVOUS FUNCTION. 
disease that was cured with this plant by Fothergill, Storck, Ilelhvick 
and Ofterdinger. Hahnemann says: “ A man who became deranged 
through jealousy, was for a long time tormented by Mayer Abramson 
with remedies that produced no effect on him, when under the name of 
a soporific he one day administered Hyoscyamus which cured him 
speedily. Had he known that this plant excites jealousy and madness 
in persons who are in health, and had he been acquainted with the 
homoeopathic law, (the only natural basis of therapeutics), he would 
have been able to select this remedy at the beginning of his experi- 
ments. 
Symptoms.—Anxiety and fear; is apprehensive of being betrayed, 
poisoned, sold or bitten by animals. Loquacious, jealous; phrenzy, 
rage; thinks he is possessed by evil spirits; throws off his clothes; ges- 
ticulates, makes grimaces, taps upon his head and nose, makes foolish 
and unmeaning jestures. The mania comes on in paroxysms, alter- 
nately with epileptic fits; or the patient is sleepless; there is con- 
tinued delirium, great anguish and fear, especially at night; a desire 
to run away; visions of dead persons; fury; raving about business 
matters ; trembling of the limbs. 
Belladonna.—Furious and violent derangement, or merry and silly 
craziness; face red and hot; expression gay, or ferocious with fixed 
look; eyes brilliant, pupils dilated; head hot; spasms; startings; 
sanguine choleric temperament; impressible nervous system; derange- 
ment after suppression of erysipelas, after meningitis, typhus or apo- 
plexy. Despondent and wishes to die ; moaning and crying ; anxious, 
restless, cannot remain quiet in one place. Vertigo ; headache from 
congestion of blood to the head; sleeplessness with great distress, 
agitation, unquietude uneasiness and anguish ; frightful dreams, start- 
ing suddenly from sleep ; spasms or stiffness of the limbs; constant 
inclination to change the position of the limbs; visions, thirst, general 
sensation of uneasiness and discontent; timidity, disposition to cry of 
hide himself: he is distrustful and apprehensive of imaginary things, 
is excessively sensitive. Furious mania; rage, or sadness, despair, un- 
consciousness, frightful visions of spectres, devils, soldiers, war, bulls, 
with impulse to run away, or to hide ; mistrust, timidity, fear of death 
or quarrelsomeness, disposition to spit, strike, bite, and tear everything, 
or to pull out the teeth; cries, barking, and conversing with the dead ; 
apprehension and fear of death, preference for solitude, wishes to be 
alone; repugnance to conversation; laconic style of speech; apathy, 
ill humor, irascibility and moroseness; he is irritable; howls and 
screams, is quarrelsome, breaks out in a rage with convulsions and grit- 
ting of the teeth; staring look; he does not recognize his own rela- 
tions ; tears, bites, spits, strikes about. He is fitful; excessively mirth- 
ful, frantic ; he sings, whistles, smiles or laughs; he sees visions of INFLUENCE OF TIIE MIND ON THE BODY. 
437 
beautiful or frightful images, ghosts, black dogs ; is delirious, raving, 
expresses himself in moanings, lamentations, and prayers; ridiculous 
buffoonery ; haggard eyes, with fixed and furious look; puffed face ; 
strong desire to gaze at the sun, or a fire; slaver and froth at the 
mouth; stammering ; burning thirst or repugnance to drink, with dys- 
phagia; jerks and starts; trembling of the limbs and especially of 
the hands; sleeplessness with agitation, &c. 
Pathological Anatomy.—Congestion of the vessels of the brain; 
injection of the vessels of the dura mater, pia mater, and substance of 
the brain with black blood. 
Clinical Cases.—Dr. Norton says, a case of mania, caused by dis- 
appointed love, was cured with Ignatia and Belladonna. A case of 
puerpural mania was cured with Belladonna alone. In this case there 
was great excitement; also jealousy and quarrelsome mood; the lochia 
and milk were suppressed; the patient had a destructive tendency, and 
attempted to strike; was spitting at others. It may be remarked that 
nearly all cases of puerperal mania are characterized by jealousy, 
which shows the uterine source of the disease. 
A third case of mania, attributed to sunstroke, was also cured by Bell, 
only. The symptoms were : fear, dread, weeping, restlessness, talk- 
ing nonsense, making grimaces. 
A fourth case of mania was cured with Bell, only, in four days, after 
having been long under allopathic treatment. Symptoms : crying, rav- 
ing, spitting, staring eyes, fearful oaths and imprecations, delusions, 
foaming at the mouth, difficult deglutition. (See Dr. BelluominUs 
Monograph on Belladonna.) 
Agaricus-muscarius.—Delirium, stupor, blindness, convulsions, 
muscular debility, paralysis, and drowsiness. Gastro-intestinal irritation, 
nausea, vomiting, purging, and abdominal pain. Depression of the 
vascular system; pulse small and feeble, extremities cold,body covered 
with a cold sweat. In some, local irritation alone is seen; in others, 
narcotism. (Pereira. Mater. Med.) 
Dr. Black* says: “ This, like others of the poisonous fungi, exerts 
a violent action on the brain and spinal cord; it produces excessive 
sensitiveness to all external impressions ; with weakness, twitching of 
the muscles, irregular convulsive movements; desire to dance; so far 
resembling the action of Belladonna, Stramonium, Cuprum-aceticum, 
and Lachesis. It excites great sensibility of the skin (in this respect 
the opposite of Plumbum, which causes cutaneous anaesthesia), so 
that the slighest pressure produces intense pain; and a very slight 
blow causes ecchymosis, resembling in the former symptom Silicea, 
and in the latter Conium and Lachesis. 
* Brit. Jour. Iloinoeop., Yol. Y. 438 
DISEASES OF THE NERVOUS FUNCTION. 
Tartar-emehc has been recommended by Dr. Fleming when there 
is full hard pulse and hot dry skin, with maniacal excitement He pro- 
poses it in doses that shall produce a general relaxation of the system, 
free perspiration, soft pulse, and clear skin. He also advises it in 
puerpural insanity. We do not approve of his use of the remedy in 
such doses as produce only antipathic effects; but we regard it as 
homoeopathic to many of the physical manifestations accompanying 
mental derangement: for these its use is highly important. But the 
crude doses of this drug or any other, though they may occasionally 
afford temporary relief by creating revulsion to healthy parts, always 
result in reactions which aggravate the original malady. We 
should never be misled by apparent benefits arising from the primary 
action of remedies. The reaction of the recuperative forces against 
the primary action of all crude drugs, always tends to the production 
of an opposite andperrnanent group of symptoms; and the perturba- 
tions to healthy structures, caused by these primary actions, must 
necessarily complicate, to a serious extent, any disease already present.” 
{New Materia Medica. p. 419.) 
Aconite.—Fear, and presentiment of approaching death; impulse 
to run away from the house, or from the bed; gloominess, taciturnity, 
and laconic style in speaking; paroxysms of anguish, convulsions, 
cold perspiration, congestion of blood in the chest or head, palpita- 
tion of the heart, and praecordial anxiety; delirium, with laughter and 
tears alternately. 
Hahnemann shows that, although Aconite is the true remedy for 
acute insanity in a febrile or inflammatory form, it can only be suc- 
cessful in cases in which the characteristic symptoms of Aconite con- 
stitute the whole case. In other cases it only removes its own part 
of the disease, leaving the patient only in that state of ill-health in 
which the acute attack found him. Thus: 
A patient who previously manifested some dyscratic bodily disease/ 
without remarkable mental peculiarities, is suddenly thrown into 
strong mental excitement by overpowering emotions, as fear, grief, intoxi- 
cation, &c.; and is at once pronounced by the friends insane. In 
such cases, Aconite, Belladonna, Stramonium, Hyoscyamus, or Mer- 
cury may remove the transient but violent furor, and bring back the 
psora to its former latent condition. In this condition the friends 
receive the patient from the asylum and regard him as cured. Though 
really the real malady has only changed its base of operations, and is 
not cured, even though he may have taken homoeopathic specifics for 
the state of mental excitement. A perfect cure can only be effected 
by the persistent use of antipsorics, which cover both the mental and 
the physical symptoms.” (Organon, § 121.) 
Case by Dr. Lutze.—An idiotic youth, aged 17, had been pro- SUICIDAL MONOMANIA. 
439 
nounced incurable at the Royal Prussian Lunatic Asylum. Had in 
childhood been well; but several years ago an eruptive disease on the 
head was suppressed by an external application. He then became 
sleepless; then saw frightful spectra; became delirious with paroxysms 
of rage and trials to escape. Finally he became taciturn, peevish, 
and lastly, completely apathetic, so that he was unconscious of his 
natural wants. Sulphur being indicated by the cause and Belladonna 
by the symptoms, I gave both medicines (30 in dilution) in alter 
nation, six pellets, in a cup full of water, a spoonful morning and 
evening for four days. On the eighth day he showed improvement, in 
four weeks gave occasionally a rational answer; in three months he 
talked coherently, wrote letters to his friends and discovered mistakes 
in the accounts of an employee. He was completely restored, after 
all other treatment had failed. 
Suicidal Monomania.—Dr. J. P. Jousset,* reviews the remedies, 
which, when tried on a healthy subject, produced phenomena resem- 
bling those seen in suicidal monomania. 
1. Anxious Suicide.—Anxious desire for death. Arsenicum, 
Aurum, Bell., Carbo.-veg., Hepar.-sul., Merc., Nux-vom., Pulsatilla, 
Rhus-tox., Silicea. 
Arsenicum, Nux-vom. and Pulsatilla produce, anxiety with palpi- 
tations or constrictions of the heart. Bell, and Mercur. develop a 
longing for death, accompanied by hysterical phenomena and involun- 
tary crying, which is aggravated at the monthly periods more particu- 
larly : 
Arsenicum.—Suicidal and even homicidal monomania. Hahnemann 
says: The prover is tormented by a fear of not being able to refrain 
from committing murder; the anxiety is habitually accompanied by 
heats, tremors of the limbs, palpitations of the heart, oppression; it is 
generally manifested at night and after meals. 
On the Moral Treatment of Religious Melancholy.—The 
following remarks are made by M. Frank: “The physician should 
endeavor to substitute a new passion in the place of the dominant one; 
for example, hope for despair, mildness for rage, &c. He should care- 
fully prohibit monomaniacs from listening to mystical lecturers, or 
conversations, and all religious discussions. In the mean'time, when 
the delirium consists in the fear of the judgments of God, or want of 
confidence in his mercy, we can sometimes cure the patient by instruct- 
ing him in the true principles of religion. But it is not necessary to 
insist, if the melancholic, instead of relishing the solid reasons which 
we give him, finds in these conversations a new aliment to his delirium. 
The consolations of religion are always useful to persons whom 
* Medicine Practique par J. P. Frank. 440 
DISEASES OF THE .NERVOUS FUNCTION. 
reverses of fortune, domestic chagrin, unfortunate love, &c., have 
plunged into a melancholic state. We have seen a case of melancholia 
with propensity to commit suicide, fixed by excess of study, and of 
masturbation; the patient suffered moreover much from hypochondria. 
Voyages, distractions, and rigid diet produced only momentary relief. 
The consolations of religion, a rigorous observance of continence and 
of other Christian virtues gradually operated a cure. We have re- 
examined this patient at the end of six years ; he enjoys perfect health, 
and when a sad idea comes to darken his imagination, the most simple 
practice of religion suffices to restore his mind to calmness and 
serenity. Religion is capable of operating similar cures daily: it 
acts upon the heart of man with much more force than all the argu- 
ments of philosophy. But its happy influence is unknown to the 
sceptical; and it can hardly be employed on those who need to be 
argued into a belief in the truths of Christianity, inasmuch as such 
reasons may confuse the already bewildered mind of the lunatic. To 
such we can only hold out such consolations as virtue and true philo- 
sophy afford. The study of the natural sciences, especially such as 
cultivate the observing faculties and make small draft on the thinking- 
powers are always useful in such as can be interested in them.” 
Many cases of religious insanity are successfully treated by moral 
measures alone; but there is nearly always present some degree of 
physical disease; and we always have it in our power to prescribe 
remedies which have power over the physical as well as the mental 
symptoms. In every case, therefore, some one or more of these reme- 
dies should be tried. The following are supposed to deserve special 
attention: Platinum, Sepia, Annum, Pulsatilla, Lycopodium, 
Belladonna. 
In selecting a remedy, the principal difficulty is in the ascertain- 
ing precisely the seat and source of the melancholy, the corporeal 
malady which in most cases commenced long anterior to the mental 
affection. Hence the mere covering of the mental symptoms is not 
enough for the cure. It is necessary not only to treat skilfully the 
melancholy which gives the prominent feature of the case, but also all 
physical diseases that happen to have preceded, or to exist with it. 
But the greatest obstacles to the cure of religious melancholy arise in 
the patient’s mental surroundings and his social position. The phy- 
sician who does not in himself combine the wisdom of the physiologist, 
psychologist, philosopher, as well as the theologian, can neither exert 
the true healing influence upon his patient, nor counteract the inju- 
rious iufiuences of indiscreet friends or incompetent clergymen. 
Platina,—Ravings respecting past events, with singing, laughing, 
weeping, dancing, grimaces and gesticulations; obstinacy or iras- 
cibility and quarrelsomeness, vanity, with disposition to reproach SUICIDAL MONOMANIA. 
441 
others with their defects; contempt for other persons, with inordinate 
self-esteem; increased sexual desire; constipation and inertia in the 
abdomen; excessive anguish and depression of spirits, with palpitation 
of the heart, timidity and great dread of death; frightful visions, with 
fear, fixed ideas which lead to a belief that all persons are demons, 
trembling of the hands and feet; anguish of the heart; absence of 
mind; dread of death ; furor uterihus ; constipation ; small and feeble 
pulse. 
Dr. Gross# gives a remarkable case cured by this remedy. An 
unmarried lady of sixty years, in the Alpine Valley of Algau, brought 
up in wealth, but educated to active industry and the forms of religion, 
became chlorotic at the age of eighteen; menses too early, profuse, 
painful; had headache, toothache, pains in stomach and abdomen; 
constipation for years, weakness of the back, weariness of arms, legs, 
chilliness, expecting death; leaving off work made her worse. She 
then became low-spirited, weeping, anxiety, nausea, distention of the 
abdomen; trembling of lower limbs, leading her to seek relief in the 
open air; thus excited, she could neither sit nor lie; slept only three 
or four hours per night; forced to run about much among the people, 
though repugnance to people remained ; before the menstrual periods 
globus hystericus j at the age of thirty-two she became enciente/ her 
child soon died. She became taciturn, solitary, devotional. At the 
age of forty-eight, when the catamenia had been absent for months, 
followed by leucorrhoea, she confined herself to her room. For twelve 
years she remained in it. Spent her time in deep meditation, or 
praying aloud, complaining, weeping, rejecting cooked food. She took 
no notice of anything; but at night ran about her room without object. 
A physician bled her, and rubbed croton oil on the stomach. She con- 
fessed to the priest that she suffered unspeakable pangs of conscience 
for her former error, believed she had incurred the penalty of dam- 
nation. “The priest increased her terrors and demanded of her that 
she should be more devotional and more benevolent. She became so 
more and more; and, having lost all hope, she approached nearer 
and nearer to absolute despair. In the still night-hours she bemoaned 
her misery to the dumb walls of her room, praying aloud, wringing her 
hands, and beseeching that she might be delivered from the hell of 
her conscience.” Twice during these years she attempted self- 
destruction ; once by leaping from the window and running toward the 
river, and next day by attempting to hang herself upon the iron grat- 
ing of the window. Still she feared death, and did not like to hear 
allusions to it. In this state treatment was commenced by Dr. Gross. 
In consideration of “ the anamnesis, the hysteria with which she had 
♦Homoeopath. Yierteljahrschrift, Yol. IX., part 4. 442 
DISEASES OF THE NEKYOUS FUNCTION. 
grown up; the atony of the uterine system, and torpor of the vege- 
tative sphere, the trembling convulsively from weakness; the weak- 
ness, almost paralysis; her being always cold, though the open air did 
good, rest intolerable ; there was no vascular excitement, as during her 
manifold nervous attacks she was always pale and shivery; all of 
these symptoms indicated Platina.” 
Nov. 30, 1855, Platina 6 (decimal,) a dose given every sixth day. 
She was ordered to be treated with affectionate forbearance ; allusions 
to death to be avoided, and injudicious efforts at religious teaching 
prohibited. 
Dec. 20. She no longer prayed at night, seemed to sleep more 
calmly; was less indifferent to what transpired around her; she had 
improved in other respects. January 4th. She dressed herself; from 
January 14th she took Platinum 6, one dose a week. It was only 
towards the end of January that she began to speak. Early in March 
she is completely cured of her melancholy, remembered what she had 
done, her profuse and unjustifiable alms-giving, with the many masses 
at the expense to her family of a thaler each. 
Further Symptoms of Platina.—Pear of devils in pursuit, with 
calling for help. “Inclination to sit retired in a corner without speak- 
ing. Want of interest, absence of mind, and short, broken answers. 
Great anxiety of mind, as if death was approaching, with great fear of it.” 
Aurum.—Corresponds to religious melancholy, mortification and 
sorrow for having done wrong; grief caused by shame; sorrow and 
depression, with desire for solitude; fear that he has lost the love and 
esteem of others; with great grief and weeping; religious anxieties, 
with weeping and praying; anthrophobia and pusilanimity. 
Hahnemann says he “ cured by means of gold, several cases of 
melancholy in persons who earnestly thought of killing themselves. 
They took in all about the three-hundredth or nine-hundredth part of a 
grain of gold. I have also cured several other important affections, 
which will be found enumerated among the symptoms of gold.” 
(Chronic Diseases, Yol. I.) A further experiment showed him the 
efficacy of still higher attenuations, and convinced him that the “ ten- 
thousandth part of a grain of gold will manifest a most powerful cura- 
tive action, especially in cancer of the palate and nasal bones, 
consequent upon the abuse of the acidulated preparations of Mercury.” 
According to his experience the power of gold was still farther in- 
creased by farther trituration and dilution ; and he at last gave “ only 
the smallest part of a grain of the decillionth potency.” lie con- 
sidered Aurum as especially useful in the following affections : 
“ Hypochondriasis ; melancholy ; loathing of life ; disposition to 
suicide; rush of blood to the head; cancer of the palate bones and 
nasal bones; obscuration of sight, by black spots hovering before the OINOMANIA. 
443 
eyes; toothache from rush of blood to the head, with heat in the 
head j inguinal hernia; induration of the testes of long standing; pro- 
lapsus and induration of the uterus; rush of blood to the chest j 
falling down unconsciously, with the face becoming blue; attack of 
suffocation, with severe constrictive dyspnoea; injuries inflicted by 
abuse of quicksilver; pains in the bones at night; nodosities of the 
gout.” 
Great anxiety, proceeding to thoughts of suicide; with spasmodic 
constriction of the abdomen. Hermel says, “ Aurum has cured 
maniacal suicide.” (p. 23.) 
Aurum-muriaticum.—For the treatment of suicidal monomania, 
accompanied with extreme depression of spirits, unrefreshing sleep from 
frightful dreams, dread of some impending calamity, loss of ambition 
and energy, diminution of virile strength and a constant disposition to 
dwrell upon imaginary ailments, Muriate of Gold is a remedy 
worthy of the very highest consideration. Indeed, in cases of this 
description, no other medicines can bear any comparison with it. 
Insanity Produced by Alcoholic Drinks.—Oinomania.—The 
“ moral perversion under which many persons labor who are given up 
to inebriety, disposes some to look upon it as a form of insanity rather 
than a vicious habit. The change of character often manifest; the 
periodical abandonment of excessive drinking, till reaching a full de- 
bauch ; the penitence and promises afterwards ; the craftiness in steal- 
ing away from friends at these periods of self-indulgence ; the ultimate 
loss of self-respect in some, and disregard of duties and responsibili- 
ties of life in all; the maintaining of an irresistible impulse to drink 
to complete gratification, and when arrested in the midst of a debauch 
to return to complete it. All these are by some placed to the credit 
of mental disease, and the destructive vice of intemperance is thus 
sheltered, and in some persons excused. Unfortunately, not only in 
the medical profession, but in the pulpit, we have advocates for the 
recognition of this vice, in some of its phases, as belonging to some 
of the forms of insanity.” The term Oinomania has been applied to 
an “ irresistible impulse to drink to drunkenness, in disregard to con- 
sequences or character.”* It is only a respectable name, under which 
this vice seeks a refuge from moral responsibility, and claims the 
sympathy and indulgence of society in the gratification of an exces- 
sive appetite, self-induced. Some give way to these paroxysms of 
intemperance, claiming that the appetite becomes too powerful for re- 
sistance, others under some slight trouble because somebody has 
slighted, or wounded, or wronged them; or because they have been in 
some way disappointed; or because the world or society have failed 
to appreciate them, or because they have been weary of life. 
* Dr. Gray, N. Y. State Lunatic Asylum Report of 1800. 444 
DISEASES OF THE NERVOUS FUNCTION. 
We look upon each of these cases as the voluntary abandonment of 
self to appetite as progressive drunkenness, producing what might be 
well anticipated by vicious self-indulgence, namely, the loss of self- 
control, and the gradual but sure degradation, and final demoralization 
of the individual. There can be no doubt that intemperance produces 
insanity; but this temporary form of it should never be encouraged 
by admitting that it is in any degree excusable. True insanity is not 
characterized by “ an irresistible impulse to self-indulgence, disregard 
of consequences, and general demoralizationon the contrary, “ in- 
sanity,” says Dr. Gray, “is an immolation of self. An irresistible 
tendency exists to thoughts, feelings and actions at variance with the 
demands of the appetite, and the course of life is anything but pro- 
motive of self-gratification. In insanity there is but an apparent and 
temporary demoralization, induced by beclouding of the mind in its 
knowledge of the relations of things, and the consequent loss, more or 
less complete, of the abstract ideas of right or wrong. In insanity, 
the irresistible tendency has a motive or purpose in view above the 
simple gratification of appetite; and here disregard of consequences 
is the result of an absorbing active delirium, or a conviction that the 
wrong is, under the circumstances, right. We do not desire to with- 
draw sympathy from the unfortunates who have fallen under intempe- 
rance, but merely to disavow the theory that it is a form of insanity. 
Moral and Physical Effects of Intemperance.—M. Morel says: 
“ One class of men arrive, at length, by a series of well-marked lesions, 
physical and intellectual, at general paralysis.” Another class, al- 
though profoundly affected, as regards the innervation, remain station- 
ary at a point of invalidism, leading a miserable existence, character- 
ized physically by a special condition of cachexia and marasmus, 
morally by a manifestation of the -worst tendencies and the lowest 
brutishnessA In these melancholy cases we see displayed the capa- 
city of this potent agent in causing degeneration of all the tissues, 
including the brain and nerves; even when it is not carried so far, 
similar symptoms are conspicuous i “ The hands tremble, especially in 
the morning; at a later period the tremors continue through the day, 
being increased by slight exertion, and only relieved by alcoholic 
stimulants. There is dimness of sight, as if a veil were suddenly 
passed before the eyes; the tongue is tremulous and speech is indis- 
tinct ; the patient is troubled with frightful dreams ; sensation of in- 
sects creeping over the skin ; tremors and shuffling gait when walking; 
diminished muscular power in the lower limbs, finally, in every part; 
diminished sensibility of the skin; vertigo, staggering; hallucinations 
* On the Physical, Intellectual, and Moral Degenerations of the Human Race 
p. 113 445 
OTNOMAJSTTA. 
so startling and exciting as to banish sleep altogether. He imagines 
that he sees persons or objects, or hears voices; the pupils become 
dilated and less sensible than in health.”* 
“ The drainer of oblivion, even the sot 
Beholds blue devils in his morning mirrors ; 
And though on Lethe’s stream he seems to float, 
He can not sink his tremors or his terrors. 
The ruby glass that sparkles in his hand, 
Leaves a sad sediment of time’s worst sand.” 
The deleterious effects of alcohol are transmitted, like other blight- 
ing influences, to successive generations. M. Morel says, he never 
witnessed a cure of the disease caused by alcohol in a patient who 
derived the tendency to alcoholic excesses from hereditary predisposi- 
tion. In one family he noticed that habitual intemperance in a great- 
grandfather, entailed upon the first generation: “ immorality, depravity, 
intemperance and brutish disposition; in the second, hereditary 
drunkenness, attacks of mania, general paralysis ; in the third, sobriety, 
hypochondriasis, lypomania, systemic ideas of persecutions, homicidal 
tendencies ; in the fourth generation, intelligence was but slightly de- 
veloped ; access of mania at sixteen years of age, stupidity running 
into idiocy, and into a conditio** involving the extinction of the race.” 
Similar remarks have been made by Drs. Cox, Adams, and Whitehead.f 
M. Morel, after showing that the use and effects of alcoholic drinks 
are rapidly extending in the various countries of Europe, as England, 
Scotland, Ireland, Prussia, and also in the United States, and in Cen- 
tral and South America, thus sums up their degenerative influences 
on the race : “ They have invariably the same character in all lati- 
tudes. New maladies are generated and old ones take on increased 
fatality; the average duration of human life is lessened; the vitality 
of new-born children is less to be depended on, and the disturbances 
of the moral and intellectual nature become at length signalized by 
the highest rates of insanity, of suicide and crime.” (p. 889.) ' 
The effect of habitual intoxication on the mind is thus desoribed by 
a distinguished politician of this country, who suffered it: “ In that 
world of all that is high and noble, the human heart; that consecrat- 
ed temple of ‘glorious hopes, and generous purposes, and god-like 
aspirations and countless joys, known only to the heart of man, the 
alcoholic poison breaks up the fountains of the great deep of human 
passion, and converts the mind into a wild and distorted receptacle of 
passions, lashed into monstrous and phantom forms, by flames, which 
distil the fountains of human love, and charity, and chastity, and kind- 
ness, into the red lava of hell’s worst hate.’ And that bright princi- 
* Dr. IIuss. 
t On Hereditary Diseases, p. 31. 446 
DISEASES OF THE NERVOUS FUNCTION. 
pie of the human intellect, which comprehends the laws that govern 
the universe and our own mysterious being, instead of being blotted 
out in darkness, is transformed ‘into the wild architect of a world 
distorted and ideal, peopled with fiends, such as perverted mind alone 
can conceive, and fraught with sufferings and agonies for which breath- 
ing nature furnishes no type nor parallel.’ ” Treatment, see Delirium 
Tremens. 
GENUS III.—ALUSIA.—HALLUCINATIONS. 
1. Alusia Elatio. Sentimentalism. Mental Extravagance. 
2. A. Hypochondriasis. Low spiritedness. 
8. A. Hallucinations. Illusions. 
Dr. D’Boismont gives the following classification: 
1. Hallucinations which co-exist with a sound state of mind. 
Facts are adduced which serve to prove that the reproduction of cere- 
bral images may take place without deranging the intellect; and these 
serve to explain the hallucinations of those illustrious men who have 
been charged with insanity. 
2. Simple Hallucinations, associated with a greater or less amount 
of mental derangement. The suffevers are convinced that they see, 
hear, smell, and taste or touch things imperceptible to others. It is 
remarkable that these false impressions may exist, even where the 
organs of some of the senses are defective. Thus the Blind will say 
that they have seen angels and devils; and the Deaf repeat conversa- 
tions which they profess to have overheard, and so on. 
8. Hallucinations associated with another affection of the senses, 
to which the name of Illusions is given. Its objects exist, but they 
produce impressions different from the reality. 
4. Hallucinations combined with monomania. 
5. Hallucinations that occur in delirium tremens. 
6. Those associated with catelepsy, epilepsy, or hysteria. 
7. Those accompanied by night-mare, or dreams. 
8. Ecstacy. 
9. Those complicated with fevers and other chronic diseases. 
10. Epidemic hallucinations. 
1. ILLUSIONS OF THE SENSES. 
Optical illusions are so common that men of science have been often 
perplexed in endeavoring to account for all the remarkable cases on 
scientific principles. Dr. David Brewster remarks that, “When we 
look with one eye there is some object to which we are perpetually 
Mind. With the right eye this point is about fifteen degrees to the ILLUSIONS OF THE SENSES. 
447 
right of the object looked at. Place two white wafers three inches 
apart, on a black ground, at twelve inches distance. Look at the left 
wafer with the right eye alone, and the other wafer will disappear. 
This illusion is caused by the. parts of the retina, where the optic nerve 
enters, being insensible to light.” He supposes by this fact may be ex- 
plained some of the cases of vanishing spectres. Of such cases we shall 
here only notice such as are obviously connected with disordered health. 
A literary lady saw illusions of her husband, of distant friends; 
she saw a coach driving up, and then the whole company it contained 
changed into skeletons and ghostly visages, and then vanished. At 
the time of seeing any of these phenomena she felt a pecular sensa- 
tion in the eyes, and during the six weeks, within three of which these 
illusions were seen, she was much reduced by a cough; and long ex- 
perience proved that they were caused by disorder of the digestive 
organs. She was naturally morbidly sensitive. She could feel pain, 
sympathetically, in a part in which others said they suffered pain ; and 
can feel pain in the limb which she is told is amputated. She talks 
in her sleep, repeats long passages of poetry when in ill health, never 
failing to quote lines beginning with the final letter of the last line, 
till her memory is exhausted. She thinks she understands the philo- 
sophy of her own case. 
A gentleman, of Edinburgh, believed that he was, regularly every 
day, exactly one hour after eating, knocked down by an old witch-look- 
ing hag, like one of those that haunted the heath of fairies. Dr. 
Gregory watched him after he had dined at five o’clock. Exactly at 
six p. m., the doctor saw him fall into a fit of apoplexy, which always 
recurred at that hour. 
A gentleman of the law was wearing down under an imaginary dis- 
ease. He at first thought he saw constantly near him a black cat 
At a later time, he saw always at his side a gentleman usher, dressed 
as if to wait upon the Lord Lieutenant of Ireland; this change was 
followed by another more unwelcome—it was a human skeleton. And 
when his physician placed himself in the spot where the skeleton was 
seen, the patient said he still saw the ghost peeping over the physi- 
cian’s shoulder. At this the man of science was startled also, at the 
thought of the ghost so near. He resorted to other means of cure, 
but the patient died, having sunk into deeper and deeper dejection. 
Gleiditsch, the botanist, having charge of the Cabinet of Natural 
History at Berlin, entering the Hall of the Academy one day, saw the 
apparition of Maupertois, who he knew was dead. Dr. Brewster says 
Maupertois had long been President of the Academy, and much favor- 
ed by Frederick II., till he was overwhelmed by the ridicule of Vol- 
taire. He then retired almost in disgrace to Switzerland, and died in 
the family of Bernoulli, the mathematician. And now Gleiditsch per- 448 
DISEASES OF THE NEKVOUS FUNCTION. 
ceives him as well defined and as perfect as he ever saw him in the 
body, appearing to one who appreciated him in life, in the hall of his 
former greatness. 
Illusions of the Ear.—These are alluded to by Milton as 
“ The airy tongues that syllable men’s names, 
In groves and desert lands and wildernesses.” 
The “Wild Huntsman,” was an imaginary sound resembling that of 
hounds and the noise and other accompaniments of hunting heard in 
the forests of Germany. That alluded to in a poem of unknown au- 
thority called Albino, is something of the same kind among the Scots. 
The hunter imagines he hears the sounds of huntsmen chasing the 
deer, but can see nothing. 
“ Nor knows, o’erawed, and trembling as he stands, 
To what or whom he owes his idle fear. 
To ghost, to witch, to fairy or to fiend, 
But wonders and no end of wondering finds.” 
A case of illusion is given by Dr. Wigan,* of a man who was con- 
vinced that he was haunted by a kind of second self, who “would argue 
with him pertinaciously, and to his great mortification sometimes refute 
him, which, as he was very proud of his logical powers, humiliated him 
exceedingly. In sitting by his side, I sometimes heard him exclaim 
‘ well that takes me quite aback, I must consider a little for an answer.” 
The mental hallucinations caused by exhaustion of the nervous en 
ergies from starvation, exposure and loss of sleep, are well shown in 
the cases related of persons shipwrecked. Of 150 persons who in 1816 
abandoned the wreck of the French ship Medusa, west of Africa, and 
embarked on a raft, nearly all found their senses strangely disordered. 
M. Sauvigny twice saved his friend who rushed past him to throw him- 
self into the sea. He says: His eyes closed involuntarily, drowsiness 
came over him, and the most delightful visions floated before his imagi- 
nation. He saw around him a beautiful country covered with the 
scenes of happy life. Having still enough of reason left he took some 
wrine and restored himself to a degree of consciousness of the real situa- 
tion. Some of the party speedily became furious; others threw them- 
selves into the sea, bidding farewell to their comrades with the utmost 
coolness. Some said “fear nothing, I am going to get assistance for 
you, and will quickly return.” Some rushed on their companions sword 
in hand, demanding food to appease the hunger that was consuming 
them; others sought repose in their hammocks, thinking they were 
still on board the Medusa. One calls out that he sees ships riding in 
the harbor of a magnificent city which wTould speedily be reached. M 
* On the Duality of Mind. pp. 459, London, 1844. DELIRIUM TREMENS. 
449 
Carrard thought he was travelling through the beautiful fields of Italy. 
An officer came up to him and said, “you recollect that we have been 
abandoned by the boats, but fear nothing: I am going to write to the 
governor; and in a few hours we shall be saved.” Just then, the cries 
of confusion and disorder among their comrades roused them from the 
visions that bewildered them; when the clamor subsided, they again 
relapsed into their former condition. Next morning they awoke as from 
some painful dream ; and they asked each other if they had not during 
sleep heard the sound of combats and cries of despair. Some answered 
that the same visions and sounds had continually haunted them. Every 
one believed that he was deceived by the illusions of some horrible 
dream. At length overcome, says M. Sauvigny, “with toil, want of food 
and sleep, we lay down and reposed till the full dawn of morning light 
revealed to our revived senses the horror of our situation. Many in 
their delusion had thrown themselves into the sea, about sixty-five had 
perished during the night, of whom one-fourth had drowned themselves 
in their despair; and of those that remained the deepest dejection was 
spread on every face. Some of us shedding tears of despair, bitterly 
deplored the hardness of our fate. Some of the wretches who survived 
commenced cutting up the bodies of the dead to eat.” 
The principal remedies for illusions of the senses are: Aconite 
Bell., Stram., Cicuta, Ilyosciamus, Opium, see page 452. 
DELIRIUM TREMENS—MANIA A POTU. 
This disease was first described by Dr. Thomas Sutton, of Green 
wich, in a Tract published in 1813, under its present name. 
Causes.—The true delirium tremens is only produced by the sud- 
ien withdrawal of stimulants after they have been long used. It is 
different from delirium ebriosorum, which may be excited in any indi- 
vidual by the use of stimulants, and depends on a congested state, 
while delirium tremens is an anaemic state of the hemispherical gan- 
glions. (Blake, on Delirium Tremens.1840.) 
Many drunkards appear in the hospitals for some injury who are in 
the habit of swallowing a gallon of beer in a day, with a certain amount 
of gin to carry it off by the kidneys. On their admission to the hos- 
pital their supply is cut off; and a pint of beer extra is too small for 
them. In a few days they exhibit a slight tremor of the tongue when 
'pi'otruded; there is wildness about the eyes, unnatural quickness of 
manner in answering questions. They become busy, when alone, pull- 
ing the bedclothes or rolling up the upper sheet; the tongue not un- 
usually dry and furred as in phrenitis; the skin, bathed in sweat, the 
pulse quick and irregular in force and frequency. These premonitions 
are followed in a few hours by raving delirium. 
Vol. il—29. 450 
DISEASES OF THE NERVOUS FUNCTION. 
Diagnosis.—It is not a fierce or mischievous delirium but a “ busy 
delirium; he does it in a hurried manner, with a sort of anxiety to per- 
form it properly. While he is yet able to go about he manifests great 
impatience at any interference or advice, or assistance in his ordinary 
duties, which he sets about in a bustling bungling manner.” Loqua- 
city, extreme; he refers to matters not present before him; and while 
attending to one thing his mind wanders to others far distant. There 
is a mixture of the real and ideal in his thoughts and language; he is 
suspicious that those about him intend to injure him, or that he is sur- 
rounded by enemies; he does not sleep; is restless, rambling; the 
patient is found to have been habitually intemperate, is subject to some 
great source of care or anxiety or excitement; and has been recently 
debarred, by some cause, from his usual stimulus; being unwell, he 
has been kept on low diet; has perhaps been bled for the delirium and is 
worse for it; the tongue is moist, the skin sweating profusely; there 
is obstinate watchfulness. These cases often terminate in mental de- 
bility. 
In true delirium tremens the head and skin are generally cool and 
moist; while they are hot and dry in delirium ebriosorum. The pu- 
pils are contracted in the early stage of both, and dilated in the latter 
stage. 
Delirium ebriosorum. 
Conjunctiva, injected and red. 
Mental derangement more exalted; 
jiore excited state of intellect. 
Tongue dry, sometimes brown not 
uniform. 
Pulse uncertain ; for all inflammatory 
affections of the brain are depressing on 
the heart’s action. In this form of brain- 
disease it is not hard and wiry, never 
amounting to one acutely inflammatory. 
Delirium tremens. 
The reverse. 
Approaching depression and fatuity. 
Tongue pale and furred. Sometimes 
entirely clean. 
On the whole, there is less power in 
the beat of the artery. 
The most difficult cases to, diagnose are those accompanying injuries 
of the skull in persons of intemperate habits, as brewers, servants, &c- 
Mr. Tyrrell used to test them by beginning the treatment by such dif- 
fusible stimulants as Ammonia, the effect of which would soon pass off. 
The pulse when it alters much in rapidity or power generally indicates 
weakness rather than inflammation. Mr. Tyrrell says: a man received 
a severe blow on the head and reaction took place very slowly. Am- 
monia and porter were given him with caution and he improved. An- 
other surgeon thought the case inflammatory and bled from the arm. 
He died the next morning with serous effusion in the brain; there had 
been no inflammation or congestion. 
Symptoms.—“ The head and skin,” says Dr. Solly, “ are generally DELIRIUM TREMENS. 
451 
cool and moist in delirium tremens; dry and hot in delirium ebrioso- 
rum. The pupil varies in both according to the stage; in the early 
stage of both it is generally contracted, in the latter stage dilated. 
The conjunctiva red and injected in delirium ebriosorum; the reverse 
in delirium tremens. The mental derangement in the former is more 
allied to an exalted, excited state of intellect; in the hitter it approach- 
es fatuity and depression. The tongue is generally pale and furred in 
delirium tremens, sometimes unnaturally clean and red; in delirium 
ebriosorum it is usually dry, and sometimes brown, but this is no cer- 
tain guide. The pulse is most uncertain; but upon the whole, there 
is less power in the beat of the artery, and that more varied in deliri- 
um tremens than in delirium ebriosorum.” 
True delirium tremens is characterized by a wild expression of coun- 
tenance ; eyes fixed intently and earnestly upon some imaginary object 
in the room; constant endeavors to grasp or to avoid these visionary 
images; motions sudden and rapid; tremor of the hands and limbs, 
also of the tongue when protruded; tongue flabby and moist; pulse 
nearly natural; skin cool and often covered with perspiration; con- 
stant desire to move about; inability to concentrate the thoughts for 
any length of time; entire inability to sleep; mind wandering and de- 
lirious ; bowels regular; face bloated; absence of thirst, heat and 
other febrile symptoms ; general appearance of debility. 
Delirium Ebriosorum may be recognized by the unnatural heat 
and dryness of the skin; face flushed; conjunctiva red and injected; 
expression fierce and excited; pulse frequent and full; tongue dry 
and red, or brown; boisterous delirium ; increase of muscular strength, 
strong pulsations in the carotid and temporal arteries; pupils first 
contracted, afterwards dilated; inability to sleep night or day. 
The feelings of an inebriate when he found himself about to enter upon 
the horrors of delirium tremens, are thus described by one who felt 
them: “The leading terror of that day was the dread of the loss, the 
transformation of my nature into the being of a drunkard. Never did 
any idea break upon me in such terrific, unmingled, unutterable horror! 
Appetite—accursed, uncontrollable appetite for a fluid which I well 
knew brought ruin, madness, desolation in its fierce track, appetite 
seemed about to overwhelm reason, and I should cease to be a man. I 
would that day, that fearful day, have grasped a bar of iron heated to 
a white heat in my bare hand, till it seared me to the bone, to have 
expelled the demon that was revelling in my veins, destroying my na- 
ture, and substituting a creature for which there is no class in the 
boundless universe of God’s works.” “ It would be far less terrible to 
me to be changed into any form, to crawl a serpent and feed on the 
dust, so I carried with me the moral senses, and the intellectual prin- 
ciple, than to retain the human form animated by a principle no longer 452 
DISEASES OF THE NERVOUS FUNCTION.* 
human, guided and controlled by a sentient spirit composed of beast 
and fiend in passion; with no avenues of true communication with ex- 
ternal and beautiful nature; false yet horrible in all its perceptions; 
sensitive to all the awful and unutterable pangs inflicted by monsters 
of its own creations, yet dead to all the just impressions of reality. No, 
if I am to be transformed and yet live, give me, if you please, any 
shape, any form, but let, oh, let me retain the mind and the heart of a 
man! ” 
Pathology.—Delirium tremens is classed as an anaemic affection 
of the brain. Amongst other reasons for this conclusion, Dr. Solly 
asserts that in all cases which he has examined after death, he “ has 
invariably found the hemispherical ganglion pale and bloodless; the 
venous canals were generally full; and occasionally the arachnoid 
thickened, as if it had been the subject of chronic inflammation.” A 
judicious distinction is made by this author, and some others of recent 
date, between the delirium which is produced by the sudden with- 
drawal of stimulants after a long and free indulgence, and that which 
may be excited in any person by an excessive temporary use of stimu- 
lants. Th % former is the true delirium tremens, which depends upon 
an anaemic condition of the hemispherical ganglion ; the latter, deli- 
rium ebriosorum, depending upon a congested state of the same 
structure. 
Causes.—Excessive and protracted use of alcoholic stimulants, par- 
ticularly impure compounds, sold as wines and brandies, and abuse of 
opium. The proximate cause of the malady is the sudden withdrawal 
of the accustomed stimulant. Delirium ebriosorum arises from an 
excessive temporary use of the liquors. Alcohol being decidedly spe- 
cific in its action upon the brain, is manifestly capable, when abused, 
of producing an inflammation of this organ, and consequently, the 
symptoms which characterize delirium ebriosorum. A long-continued 
abuse of this stimulant induces an anaemic condition of the brain and 
nervous system, thus developing the legitimate secondary effect of the 
article, while its temporary abuse induces the legitimate pi'imary 
effects, which we observe in delirium ebriosorum. 
Prognosis.—The Pulse.—Though the state of the pulse is not 
always an infallible guide, it is generally safe when wTell understood. 
In this disease, when the pulse is not over 100 per minute, the case is 
not an extreme one. But, if the pulse, from its rapidity and the tremor 
of the hands, cannot be counted, the patient is in imminent danger. 
Treatment of Delirium Tremens.—In common practice this is 
directed by the diagnosis, which is often difficult. We may find that 
large doses of opium have been given to produce sleep, without effect- 
ing it. The case may be one of general anaemia, and yet there is 
hyperaemia of the brain. Under these conditions we commence the DELIRIUM TREMENS. 
453 
treatment. Depletion in either form of delirium tremens is out of the 
question. Even local bleeding, by cupping or leeching, is injurious. 
A general warm bath may be borne in few cases, at the same time that 
cold in a mild degree is applied to the head. Ice is always too cold. 
When the case is clearly one of delirium tremens, we begin to 
allow the patient a larger quantity of the stimulants than he has been 
recently using; though they have reduced the man to a beast by their 
abuse, we are compelled to resort to them again to save his life. 
Opium, Ammonia and other stimulants are remedial, because their 
action is partially similar to that of the alcohol that caused the dis- 
ease. Sufficient nutritious food must be given, and it may be solid when 
the stomach will digest it. 
The Expectant method of treatment is practised by medical teachers 
of high character. Dr. Dunglisson wrote, in 1842, that after the 
withdrawal of the accustomed stimulants, the “recuperative powers 
are generally entirely sufficient to bring about the necessary equaliza- 
tion.” He, therefore, gave neither stimilants nor opiates. “For six 
months in the Lunatic Asylum at Philadelphia, no alcohol nor opium 
were allowed.” {Amer. Med. Intelligencer.) In 1848, he said his 
practice continued the same. “ Every day’s privation from the accus- 
tomed stimulus, diminished the feeling of necessity and the desire for 
it.” 
That delirium and sleeplessness indicate comparatively harmless 
conditions of the nervous system; that they are usually symptoms of 
some disease occurring in persons of drunken habits, and they usually 
cease within a given time spontaneously; are generally known, and on 
that ground it is advised not to give any thing for them. (Edinb. 
Med. Jour., April, 1860, p. 924.) 
Nux-mmica.—Trembling of the limbs; spasmodic twitchings in 
different parts of the body; countenance pale and bloated; tongue 
white and moist; vomiting; surface covered with sweat. Constant 
uneasiness, anguish, and desire to run away; troublesome visions, pres- 
sure and burning at the stomach; constipation; vertigo; headache ; 
cold extremities; head cold or hot; sensation of debility or faintness. 
Silent; apprehensive of death; confusion of ideas; depression of 
spirits; desire to be in the open air. 
Belladonna is well adapted for the cure of delirium ebriosorum, 
occurring in individuals of a full, plethoric habit, and presenting the 
following symptoms: congestion of blood to the head; heat and pain 
in the head; flushed face; injected eyes; boisterous delirium; insom- 
nia; strong pulsations of the carotid and temporal arteries; great 
nervous erethism; the tongue and mouth red, hot, and dry; thirst; 
trembling, with cramp-like pains ; starting suddenly from sleep ; failure 454 
DISEASES OF THE NEKVOUS FUNCTION. 
of memory; pains in the neck and limbs; sparks before the eyes, 
visions. 
In the ten cases of poisoning by Belladonna berries, given by Mr 
Seaton, of Leeds, in the Med. Times, Dec. 3, 1859, we see symptoms 
characteristic of this disease. The symptoms, he says, appeared in 
the following order: “Dryness of mouth and throat; indistinctness of 
vision and dilated pupil, continuing longer than any other symptom 
then, in severer cases, delirium.” The “ delirium was of a busy, rest- 
less, vivid character, but generally rather pleasing than otherwise 
The patients appeared to think they were pursuing their ordinary avo- 
cations. One boy was eager in flying a kite; another pulled chairs 
and tables about, thinking he was working in a coal-pit. A woman 
was remarkably busy in her ordinary household duties. All their 
movements were of a quick, excited character; the skin w~as in most 
cases moderately cool, pulse rapid, but without power.” 
Stramonium and Ilyoscyamus may be exhibited in cases compli- 
cated with epileptic paroxysms, when there are: convulsive move- 
ments ; subsultus tendinum; fainting fits ; muttering delirium ; picking 
at imaginary objects ; suppression of the secretions ; extreme irrita- 
bility ; constant and rapid motions; contraction and stretching of the 
limbs; irascible; noisy and difficult to manage. 
The vapor of Sulphuric-ether, of Chloroform, and the nitrous 
oxyde gas, may be inhaled with advantage in cases which are charac- 
terized in the commencement by great mental exhilaration; increased 
muscular force; constant desire to move about rapidly, to dance, to 
sing, to leap, to fight, or do something extravagant; flushed cheeks; 
accelerated respiration, frequent pulse, succeeded in a short time by 
profound sleep, or sleep disturbed by visions; general insensibility to 
external impressions, with pallid and death-like expression of coun- 
tenance. Many cases have been cured by these remedies. 
Digitalis.—gAn English physician has published an account of his 
treatment of this malady, with enormous doses of Digitalis. The medical 
world scarcely credited it, and were slow to adopt what seemed to be 
a hazardous experiment. But the remedy was tried by some of the 
bolder members of the profession, and it exceeded their expectations. 
In what manner it acts is still a question of much doubt. Cases have 
been treated successfully with half ounce doses. 
Case by Dr. Hole.—The patient was of middle age, a German, who 
had been drinking poor whiskey, excessively. He was very furious, 
ran about the streets, trying to get away from imaginary devils, which 
he supposed were in hot pursuit. The pulse was over 100; hands and 
feet cold; head hot; eyes glossy and injected. lie was very much 
excited, tramped excessively, and could hardly be restrained. *Nux 1, 
and then Opium 1, was given with no apparent effect. Strain, and DELIRIUM TREMENS. 
455 
Hyos. were tried in vain. In the night one-quarter grain doses of 
Morphine were given every half hour, but after four grains he was as 
wild and excited as ever. Digitalis was given in drachm-doses, re- 
peated every two hours. After the second drachm had been taken ten 
or fifteen minutes, the man got up from his chair, and in trying to get 
out of the door, fell down insensible. His pulse was then firm and 86. 
He was laid upon the bed, and in about twenty minutes awoke per- 
fectly rational and calm! No other medicine was needed, and in a 
few days he was at work. 
In a case related by Dr. Carey, Opium aggravated the symptoms; 
wdiilst half an ounce of tincture of Digitalis, with an equal quantity of 
gin, caused the patient to fall into a deep sleep, which continued with- 
out intermission for twelve hours. He awoke quite rational and in two 
days was quite well. The Digitalis did not produce its alleged results, 
diarrhoea and vomiting, nor were the kidneys stimulated to increased 
action. The influence of the drug on the pulse was not such as to 
offer any barrier to its repetition. 
“The large doses of tinct. Digitalis, half ounce doses, at long intervals 
of twenty-four hours, may be given safely. The pulse falls, but ac- 
quires power and steadiness, and the tremor subsides. It is best to 
confine its use to young and robust subjects, whose strength has not 
been broken down by prolonged habits of intemperance, and to cases 
of excessive drinking. {Dr. Peacock.) 
Cimifuga.—King, in his Disp., (Art. Cimicifuga), says: “I have 
known three drops of the saturated tincture, given every hour for 
three hours, to produce symptoms in every way simulating those of 
delirium tremens.” 
And yet this same remedy is advised by all eclectic writers, and is 
used with great success in all diseases characterised by excessive 
nervous irritability. It is said to allay nervous excitement promptly, 
and ward off impending spasms ; to “lessen the tendency to cerebral 
congestion, and quiet the pulse.’ ’ In my practice small doses fulfil 
these indications admirably in many instances. {Dr. Ilale.') 
Asarum-europceum.—This plant is known in Russia as a remedy 
for the effects of alcohol poisoning. The effects required to restore 
the inebriate are various; he has been injured in the gastric mucous 
membrane; he has become a dyspeptic; the nervous centres have 
been overstrained to high preternatural exertion; and the blood itself 
has become loaded with an injurious foreign material; he has acquired 
a true dyscrasia. Whether the Asarum is capable of fulfilling all the 
indications remains to be further tested. 
It acts, 1. By partially restoring the digestive power which has been 
almost destroyed by the poison. The aromatic principle, says Dr. 
Smirnaff, has an influence in “ regulating the condition of the intestinal 456 
DISEASES OF THE NERVOUS FUNCTION. 
discharges, producing purging and vomiting when given in large 
doses.” * 
2. It restores the defective appetite. 
3. Counteracts the irresistible longing for alcohol. “ The horrible 
sensations with which drunkards awake in the morning, and which 
compels them to seek temporary and delusive relief from renewed 
intoxication, are much blunted and mitigated by means of a glass of 
the infusion of Asarum, and of some nervine, as Valerian. Its immedi- 
ate effect is often to produce vomiting, and sometimes purging; but 
the painful sensations at the epigastrium undergo relief, and the 
appetite becomes invigorated.” In cases of persons who have long 
been accustomed to alcoholic drinks, Dr. Smirnaff gives the Asarum in 
brandy, applying at the same time a counter-irritant to the pit of the 
stomach. As soon as it is possible to omit the allowance of alcohol, 
it should be prohibited. 
In persons who have long been accustomed to periodical paroxysms 
of drunkenness, with intervening intervals of soberness, the constant 
use of the Asarum has enabled the patient to postpone the periods of 
drunkenness, and the consequent delirium tremens. The patients 
themselves are sometimes surprised at the effect of the Asarum in 
lessening the injurious results of prolonged intemperance. Dr. 
Smirnaff prescribes three or four glasses a day of an infusion made 
with fii. of Asarum root, fi. of Valerian root, and fss. of Orange-peel. 
The following is also a popular remedy ip Russia for drunkenness : 
R. Ammon.-carb. fss., Aceti.-vini. lb. i., Oxymel-scill. fss. Two 
table-spoons full every two hours. 
Peopiiylactics.—liering proposes the following remedies : “ Take 
Sulphur every morning seven days. Should the craving abate and 
return afterwards, let him take Nux-vomica in the evening; if it return 
again in two or three days after, give Sulphur, repeating these reme- 
dies in the same order. If this be unsuccessful, give Arsenicum. If 
this does good but temporarily, give Nux-vomica one day, and three 
days after Arsenicum.” 
Sulphuric-acid.—Ilering also adopts this remedy from popular 
practice. One drop only in a glass of water, to be taken every morn- 
ing for two or three days, until it produces disagreeable symptoms. 
In cases where this quantity would fail, he gives it in larger quantity, 
so as to make the water taste perceptibly sour. This is to be con- 
tinued till it produces soreness of the mouth. 
Ipecacuanha, Mr. Higginbottom, (Lancet, 1857, p. 525,) says in 
emetic doses at the beginning of a fit of intemperance, removes the 
desire for intoxicating drinks. Being less debilitating than Tartar- 
t Med. Zeit., Russland, 1859, No. 8. ALCOHOLISMUS. 
457 
emetic, it does little injury if often repeated. It stimulates the whole 
system, equalizes the circulation, and promotes the deranged secre- 
tions. It is proposed to continue this practice for fourteen days: as 
Marshall said, “ If a man gets drunk, he cannot altogether get rid of 
the nervous poison of alcohol from his body in less time than a 
fortnight.” 
3. ALCOHOLISMUS.—CHRONICUS. 
Under this title, Dr. Huss, of Sweden, has explained the disease 
which results from “ prolonged and habitual dram-drinking.” In a 
work published at Stockholm, 1851, he says, (p. 18), “We give the 
natme alcoholismus-chronicus to those groups of nervous symptoms, 
which affecting alike the motor and sensorial powers, and the mental 
faculties of the individual affected, proceed generally in a slow and 
chronic course, and are not to be referred directly to any lesion of the 
nervous system appreciable during life, or discoverable on post-mortem 
examination. Such symptoms are to be met with in persons who have 
long taken ardent spirits in excess.” “There are many men who drink 
habitually six or eight glasses of undiluted spirits daily for several years 
without greatly deranging their health. I have known a few men who 
continued to be habitually intemperate to advanced age, retaining 
robust health. But these were extraordinary cases. It is much more 
usual 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 fully recovers. He begins to find his digestive 
powrers 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 hot spices. 
Dr. IIuss details one case in which all these symptoms were regu- 
larly developed; and after efforts at reform and some treatment there 
was some improvement. On resuming his former habits and again 
neglecting to take his ordinary meals, the symptoms returned, and 
digestion became more deranged than before. There was now frequent 
vomiting of tough acid mucus, with a sense of weight and distention 
at the epigastrium after taking food; there were emaciation, discolor- 
ing of the skin, which was of a dirty yellow. The sensation was now 
of ants creeping in the skin; muscular debility accompanied by 
painful cramps and startings in the feet and calves of the legs, resem- 
bling electric shocks, extending from the extremities to other parts of 
the body, and increased in severity till complete epileptic seizures, 
followed by delirium and hallucinations, were of daily occurrence. 
Vision became imperfect, the letters of a book seeming to run together 
in a confused mass: and the powrers of thought and memory were 458 
DISEASES OF THE NERVOUS FUNCTION. 
diminished. At a later period he had severe pains in the legs, resem- 
bling such as would be made by burning or cutting with knives. When 
least severe there was still great restlessness, and he continually 
moved the legs in bed. The strength declined, diarrhoea came on, he 
was perfectly emaciated ; the skin assumed the appearance of parch- 
ment. The patient sank into low-muttering delirium, and died of com- 
plete exhaustion. (See IIuss, p. 21.) 
Diagnosis.—Distinguished from lead-poisoning by the fact of the 
previous intemperate character of the patient; and the absence of the 
blue circle upon the gums, the peculiar nauseous smell of the breath, 
which are characteristic of lead-poisoning. The skin in alcoholismus 
is of a yellow hue, in lead-poisoning it is a dusky gray. In the 
former there are symptoms of gastro-enteritis, commonly preceded by 
one or more attacks of delirium tremens. 
The tremors in this disease somewhat resemble those from slow 
poison by Arsenic; but in the latter they are not relieved by a dose 
of Alcohol. They are not more severe in the morning than at other 
times, and are usually accompanied by spinal irritation. In Alcliol- 
ismus the mind is impaired; there are vertigo, ringing in the ears, 
muscae volitantes, dilated pupils, hallucinations and delirium, which do 
not occur in poisoning by Arsenic. 
Mercurial fumes from the operation of water-gilding produce nervous 
tremors, loosening of the teeth, pains in the limbs, and salivation; but 
the mind is not affected. These tremors are less benefitted by stimu- 
lants than those from Alcohol, even temporarily. Ploucquet formerly 
referred many of the symptoms of this disease to the copper-vessels 
in which distillation was carried on; but copper vessels are now less 
exclusively used, and yet alcoholic poisoning progresses with the in- 
creased consumption of alcoholic liquors in every form. 
Phosphorus.—Its fumes produce formications, tremors, muscular 
debility; and the operatives in friction-match manufactories are liable 
to a peculiar form of caries of the jaw-bones (See Phosphor-necrosis, 
p. 362.) But there are none of the characteristic cerebral symptoms of 
Alcohol. 
Secale-cornutum produces some of the symptoms of Alcohol; but 
in Secale they are more rapidly developed ; they commence with mere 
pain of the stomach, and are accompanied with colic and jerking, con- 
vulsive movements of the limbs, followed by paralysis and anaesthesia. 
Women are more often affected by ergot than men: it is likely to 
poison many persons in a community at the same time, including per- 
sons of all ages and conditions, if they have taken of the deleterious 
food. But the brain is generally unaffected; the skin has not the 
characteristic yellowish hue ; and the digestive functions after a time 
recover their tone, without the persistent gastritis. ALCOHOLISMUS. 
459 
Progressive Paralysis of the Insane presents some of the alco- 
holic symptoms; but the tremors do not appear early, tvhile faltering 
speech, retraction of the corners of the mouth and vacant expression 
of the countenance are early observed. The tremors may prevail over 
the whole body; the pupils are little dilated, sensibility to light 
remains; the symptoms are not worse in the morning; the creeping 
sensations beneath the skin are not felt, and a dose of Alcohol affords 
no relief. 
General Progressive Paralysis begins in the lower extremities 
without cramps or startings ; sleep may continue undisturbed, diges- 
tion may continue good, and the appetite may be morbidly increased. 
Sensibility becomes diminished over the whole body at once; in 
alooholismus it is first diminished at the points of the fingers and 
toes. 
Mania often begins in “monomanie ambitieuse” and maniacal 
excitement. In alcoholic poisoning there is only the muttering delirium 
towards the end. Delirium tremens furnishes the only approach to 
maniacal excitement from alcoholismus. 
Causes.—Northern nations have long been noted for drinking trge 
quantities of alcoholic stimulants. Intemperance has been more 
general in the North of Europe than the South. The severe weather 
and bad food have furnished the laboring classes with an excuse for 
regarding stimulants as a necessary of life. Hereditary predispo- 
sition has been supposed to influence the formation of this disease. 
Dr. Hubs regards this opinion as improbable, but further observation 
proves it, to some extent, true. 
The habitual use of alcoholic drinks in any form is the usual and, 
indeed, only cause of this disease. The time that may be required to 
develop it fully varies in different persons. In the cities a large pro- 
portion of the working-people drink from twelve to fifteen glasses of 
brandy or whiskey per day. At this day nearly all liquors are adul- 
terated, and their usual bad effects are in part attributable to the 
poisonous articles taken with them. Dr. IIuss says the most usual 
cause of the disease in Sweden is, the habitual use of brandy distilled 
from potatoes. To test the relative qualities of the pure and impure 
brandy, he experimented on three dogs for several months; giving to 
one purified brandy six ounces per day, and to the other two an equal 
quantity of that commonly used by the working-classes in Sweden. 
During the first three months intoxication and intense thirst were 
occasioned by each dose, but the animals were fat and appeared well. 
In the fourth month they had dry cough, and barked hoarsely, the 
eyes staring and full'of tears; hearing diminished; restless sleep, with 
jerking of the limbs. At the end of the fourth month the dogs trem- 
bled when they attempted to stand, their walk was shuffling, and there was weakness of the extremities, especially the hind-legs, and they 
remained in sitting posture to take food. They next had cramps and 
convulsive movements in the extremities and trunk, both during sleep 
and when awake and lying on their sides. The sight of other dogs 
roused them at all times from their apathetic condition, and 
endeavored to attack and bite them. Their powers gradually diminished, 
and the sensibility of the skin, especially of the ears, was remarkably 
lessened. They now lost appetite and powers of digestion rapidly, 
but their irritability towards other dogs continued till death. The fat 
was rather increased, but they all died about the eighth month. 
The disease in man is seldom developed so rapidly. Many pursue 
a course of stimulation without intoxication for several years. The 
nervous symptoms are generally preceded by derangement of the diges- 
tive organs, though the primary poisonous influence is strongly 
exhibited in the brain and nerves. 
Remedies.—Opium, Cannabis-ind., Nux-vomica, Belladonna, 
Ilyoscyamus, Stramonium, Ether-vapor, Chloroform, Protoxyd of 
Nitrogen, Ammon.-carb. 
Intoxication.—In ordinary cases, if there be no reason for haste, 
permit the intoxicated person to sleep long enough to partially recover 
from the effects of the poison. 
Cold-water. When it is necessary to arouse him it may be gene- 
rally done by dashing cold water upon his forehead with considerable 
force : it is still more effectual if poured from a considerable height. 
Opium is the proper remedy, when the dashing of the cold-water 
has only a temporary effect; if the muscles of the face are convulsed, 
or the cramp prevents the opening of the mouth, give Opium at short 
intervals till the improvement is is visible. 
Coffee, hot, and without milk, is the best restorative after recovered 
consciousness; the patient continues vomiting and retching. 
Salt-water has a homoeopathic action upon the inflamed surface of 
the inebriate’s stomach. A popular remedy for the restoration of 
drunkards after a debauch is the Water of the Blue Licks, Kentucky, 
which is highly charged with chloride of Sodium and sulphuretted 
Hydrogen. 
Belladonna and Aconite, if Opium fails. If there be torpid sleep, 
Opium is the best remedy. 
Opium.— Skin cold and covered with sweat; tongue moist and red; 
wild and staring expression; motions rapid and constant; grasping at 
imaginary visions ; pulse rather below the natural standard; tremor of 
the hands and limbs; unsteadiness in moving about; face pale and 
bloated. Tormented with frightful or fantastic visions, giddiness ; con- 
fusion of ideas; inabilitj7 to compose or to concentrate the mind, or to 
sleep; sensation of numbness or prickling in different parts of the 
460 
DISEASES OF THE NERVOUS FUNCTION. DEMENTIA. 
461 
body. Delirium: frightful or fantastic visions ; confusion of ideas; 
stupefaction; gloomy feeling; inclination to commit suicide. Of the 
effects of opium in causing illusions of the senses, De Quincy says in 
his “ Confessions: “ After several years’ experimenting on the daily 
use of opium, the torpor of the intellectual powers became a perpetual 
torment.” The worst of all were his dreams. In the middle of 1817, 
a faculty of conjuring up all sorts of phantoms in the dark became truly 
distressing. While he lay on his bed, vast processions marched before 
him in mournful pomp; sad and solemn as if they had issued from the 
tombs before the times of Troy, before Tyre, before Memphis. At the 
same time a theatre seemed lighted up within the brain which present- 
ed nightly spectacles of more than earthly splendor. Whatever he 
called up in memory traced itself in images upon the darkness, and 
transferred itself to his dream afterwards with a brilliancy insupport- 
able ; and all other changes in his dreams were accompanied by deep- 
seated anxiety, and gloomy melancholy, utterly incommunicable by 
words. (Confessions of an Opium Eater. London, 1821.) 
4. DEMENTIA. 
In this variety of insanity the intellectual faculties are all impaired; 
the power to concentrate the thoughts, to arrange and compare ideas, 
or to draw inferences is lost. The past is a blank to the unfortunate 
victim, and thus, family, friends, home, the associations of early years, 
as wrell as the cares and pleasures of maturity are all forgotten. Yet 
the irritation of the cerebral structure often incessantly impels the 
patient to move about, and to give utterance to the random and inco- 
herent images which are constantly passing through his brain. Some 
are silent and almost insensible to everything around them. If articles 
are presented or topics of interest broached for their attention, appa- 
rently no impression is produced; but the mind still pursues its inco- 
herent wanderings. 
This form of insanity is more difficult of cure than either of the 
others ; for the causes are usually so gradual and insidious that the 
cerebral mass becomes hopelessly disorganized, or the meninges per- 
manently thickened and adherent to the cranium, before serious alarm 
is taken. If, however, the malady is attacked within the first few 
months or the first year, hopes of cure may be entertained. Dr. Brig- 
ham asserts that “ insanity is rarely cured after it has uninterruptedly 
continued two years, though there is always hope if the patient is vigo- 
rous and the form of insanity varies.” 
Gradual Decay from Old Age.—The point at which it may be 
said to commence might produce much embarrassment in a litigated 
will-case. And such cases frequently occur. 462 
DISEASES OF THE NERVOUS FUNCTION. 
Old persons often grow very capricious or jealous of attentions ; and 
the artful and designing often insinuate themselves into their good 
graces, excite in them prejudices against their friends and relatives, and 
become themselves the heirs unjustly of the property by the will of 
the individual. In many of these cases it is extremely difficult to deter- 
mine whether the will so made was dictated by a clear judgment and 
correct motives, or whether its author had fallen into a real dementia, 
and was truly incapable of making a legal will. 
Pathology.—Every one knows that at a late period of life we have 
marked decay of intellectual power, and that the man falls into a second 
childhood. The pathology of this condition is revealed by the ingeni- 
ous and accurate investigations of Cauzervielh and Desmoulins, two 
continental pathologists, who have shown that a kind of atrophy of the 
brain takes places in old persons. Desmoulins found that after the 
age of seventy years, the weight of the brain was from one-twentieth 
to one-fifteenth less than in the adult. This atrophy of the brain is con- 
nected with old age, and not with any general emaciation ; for in cases 
of chronic emaciation in adults the brain is the last part to waste away; 
and this may explain the continuation of mental power in phthisical 
subjects. 
Thus every peculiarity of mental manifestation has some relation to 
the organization and degree of perfection in function of the material 
organs through which the soul holds its intercourse with the external 
world. When the labors and cares of a long life have nearly worn out 
the physical organization the tenant within becomes mentally as well 
as physically feeble. The man who has reached “ second childhood ” 
is 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.” 
Remedies.—Op., Strain., Phos., Carb.-an., Nux-v. 
5. NOSTALGIA.—Home-Sickness. 
Mountainous countries have presented the world with the most strik 
ing examples of nostalgia. Thus : 
“ The intrepid Swiss who guards a foreign shore, 
Condemned to climb his native cliffs no more,” 
Remembers in a distant land the happy home of his childhood among 
the valleys of the Alps, and desires to return to live and die there. DEMENTIA, 
463 
His mind dwells upon it with an increasing intensity till it becomes a 
deep-seated and inveterate disease,—the “ maladie de pays,”—and he 
refuses to be comforted, as the captive Jews at Babylon, “ hung their 
harps upon the willows ” and refused to sing the songs of Zion in a 
strange land, though that land was more beautiful than their own. 
The nostalgic patient “nurses his misery, augments it till it destroys 
his nightly repose and his daily peace, and ultimately devours with 
more or less rapidity his vital organs.” 
The origin of this peculiar longing of the natives of hilly countries 
to return to their native highlands has been sought for in the native 
beauty of the scenery in which their early years were passed, “ in the 
peculiar sense of freedom or liberty, and the feelings of exhilaration 
wThich the pure, bright, and cool atmosphere of highland countries 
induces, compared with the depressing effects of the lower lands.” 
When the Scottish Highlander, far from his mountain-home, hears a 
single strain of the “slogan,” or the “ Ranz des Vaches,” the memories 
of the mist-covered cliffs on which he was once happy, he is seized 
with an inexpressible desire, amounting almost to madness, to be once 
again and immediately at home. And the Swiss soldier, when far 
from the scenes of his childhood and his native cliffs, 
“Perchance he hears those airs, so sweetly wild, 
Which on those cliffs his youthful hours beguiled, 
Melts at the long-lost scenes that round him rise, 
And sinks a martyr to repentant sighs.” 
Remedies.—Cvpr., Bell., Carl).-am., Helleb., Merc., Nitr.-ac., Sil., 
Mag.-mur. 
Recapitulation of Remedies.—Insanity caused by depressing emo- 
tions, as : grief, mortification, chagrin or anger, give : Ignatia, Phos.- 
ac., Staph., Ilyos., Nux-v., Plat. 
If caused by excessive study, use: Lack., Plat., Stram.., Nux-v., 
Sulph. 
Insanity from deranged menstruation : Aeon., Bell., Plat., Puh' 
Stram., Veratr.-alb., Cupr., Sulph. 
For Mental Derangement accompanied with insanity, fear, fright- 
ful visions and thoughts, use: Bell., Ilyos., Op., Stram., Lycop., 
Nux-v. 
When accompanied by restlessness and inability to lie still or sleep: 
Bell., Ilyos., Nux-v., Op., Stram.., Verat., Aeon., Canth. 
Religious excitement manifested by moaning, begging, praying, 
kneeling, &c.: 
Bell., Ilyos., Lach., Stram., Sulph., Aurum. 
Violent raving, swearing, &c.: Anac., Bell. 
For rage, biting, spitting, tearing, &c.: Bell., Canth., Stram., Ilyos, 
Agaricus, Cannabis-ind. 464 
DISEASES OF THE NERVOUS FUNCTION. 
For illusions of fancy, visions, seeing ghosts, &c.: Stram., Bell-, 
Hyos., Opium» 
For erroneous fancies, fixed ideas, &c.: Bell., Cocculus, Ignat., 
Phos.-ac., Stram. 
For crazy mirthfulness, singing, whistling, dancing: Bell, Coffea, 
Op., Stram. 
For foolish gesticulations: Bell., Idyos., Mosch., Stram. 
For constant talking, constant working at useless labor or employ- 
ments without stopping to rest: Bell., Merc., Stram., Camph., Opium. 
GENUS IV.—FATUITY.—IDIOCY. 
Idiocy is a common affection. Cases are given by Pinel, Haslam, 
Rush, Esquirol and others, of partial idiocy. Partial idiocy is seen in 
a large scale in the Cretins. M. Fodere says, (Traite du Goitre et de 
la Cretinisme, p. 138), “It is marked by an inexplicable singularity, 
that some of these individuals, endowed with such feeble minds, are 
born with a peculiar talent for copying paintings, for rhyming or music. 
I have known several who taught themselves to play passably on the 
organ and harpsichord; others who understand, without ever having a 
master, the repairing of watches and the construction of some pieces 
of mechanism.” And yet these individuals could not read books of 
mechanics; but “ ils etaient deroutes lorsqu’ on en parlait, et ne s 
'perfectionnaient jamais.” They differ also in the kind of theii 
idiocy, and in the degree and kind of their mental power. One is all 
kindness, another full of mischief. One has a perception of musical 
harmony, another none. Pinel says, one idiot girl surpassed all he 
ever saw in imitation of the actions of others; but had not intellect 
enough to attach any idea to any sound she uttered. Dr. Rush said, 
one man had remarkable religious feelings, but was deficient in the 
other moral sentiments. 
The idiot is deprived of all reason, and his whole sentient powers 
are weak and depraved. The countenance vacant; often distorted, 
often presenting an unmeaning smile or laugh; the saliva flows from 
his mouth; the limbs hang carelessly dangling; the whole physical 
as well as mental system is in a morbid condition. 
Idiots are usually innocent or inoffensive, pusilanimous and submis- 
sive; more sinned against than sinning, and the law regards them with 
charity and commiseration. They are allowed to go at large, although 
their property is placed under the care of trustees. A will made by 
an idiot, or a marriage contract, is null and void, inasmuch is they are 
incapable, of their own free will, of performing either of these acts., 
To constitute an idiot in law the individual must be incapable of un* 
derstanding the simplest duties of life. IDIOCY. 
465 
Causes.—Idiotism is congenital, or it arises in after life: 
1. When congenital it arises from bad conformation of parents, by 
bad diet, clothing or disease. In those countries where goitre abounds 
idiots are numerous. It is proved that intermarriages between near 
relatives, by lessening the physical and mental powers, produce idiotism 
in their children. It may be caused by long-continued nervous fever, 
or any cause that can destroy the sensorial or nervous power. 
Causes.—Dr. Howe, of the Massachusetts School for Idiotic Youth, 
traced a few years ago the antecedents of 359 congenital idiots. His 
report says: “It was found that almost all these came of very poor 
and feeble stock. In every case, except four, or in 355 cases, the 
parents were closely related by blood, or one or the other of them had a 
decided hereditary tendency to mental derangement; or was of a marked 
scrofulous habit of body; or was impaired in health by disease, or by 
intemperance, or by sensual excesses—so that the idiocy of the child 
was clearly explicable upon physiological principles.” “ In the matter 
of intermarriage,” says Howe, “my experience with various classes of 
infirm children, goes to show that nature protests against it, and some- 
times with terrible vehemence. Where both parties are of sound con- 
stitutions, and without marked tendencies to any particular form of 
disease, the liability to infirmity among the immediate offspring is 
small. Where one party is of unsound constitution, the liability is 
greater. Where both are unsound it is very great. Where one party 
has a constitutional tendency to a particular form of disease, and the 
other has no such tendency, or a tendency to some other form of dis- 
ease, the diverging tendencies seem to correct each other, so that the 
liability is not great; but where both have the same constitutional 
tendency, then the danger is so great that some kind of infirmity is 
almost sure to appear in some of the offspring.”* 
Pathology.—If the mind of a child is not developed at the usual 
period, or is developed imperfectly, we infer that there must be struc- 
tural and radical defect in some part of the child’s bodily organization, 
or obstructions to the performance of its functions. We infer this as 
a watchmaker diagnoses the nature of the disease which prevents the 
watch from keeping the true time. The “ works” are out of order, or 
there has been original malconstruction or defect. In the case of the 
idiotic child there may be malconstruction or defect in the very organi- 
zation of the child and we may not be able to remove it. We can 
but partially remedy it. We cannot, like the watchmaker, put in a 
new wheel or new spring, for we have no creative power. But, if tho 
parts were all originally well constructed, and are all in their places, 
the disease is only functional and may be remedied. If we cure at 
all we must do it by acting upon this materialistic view of the estab- 
* Report of Dr. Samuel G. Howe, to the Legislature. Mass., 1854. 
Vol. ii.—30. 466 
DISEASES OF THE NERVOUS FUNCTION. 
lished laws of nature; it is characterized, like every other ordinance 
of the Creator, by divine wisdom and benevolence. 
There is a natural predisposition in the human mind to regard things 
spiritual as entirely superior to things physical; and this predisposi- 
tion is so inveterate that most people naturally believe, as if by 
intuition, that idiocy and insanity are diseases of the soul and not 
of the body. The parent of the idiotic child never tries to conceal 
its physical infirmities, but points them out, asks what can done for 
them. But the mother shrinks from the sight of spiritual or mental 
defect. She does not at once admit frankly that it is idiotic; “ she 
admits that the child cannot do this or that; cannot understand one 
thing from anotherbut then she states eagerly something else that 
it can do, or can say, and apologizes for wdiat it cannot. She begs 
not to suppose that the poor thing is an idiot, but especially not to 
suppose that it was born so. “ The mother weeps for the bodily in- 
firmity of her child, but she blushes for his mental infirmity. The 
tear is natural, and the blush is not at all conventional.” Were it 
generally known that the defect of the mind is dependent on defect 
of bodily organization, it would, perhaps, be less common than it is ; 
when it does occur it would be less distress to the parents, and they 
would be more prompt in making efforts, by treatment and education, 
to have the defect corrected. 
Prognosis.—When idiocy is accompanied by epileptic fits, severe 
and oft recurring, it is generally regarded as incurable; though several 
thus affected have been cured by correct moral and physical training. 
Among idiots the general standard of health is low. They nearly all 
belong to families which inherit scrofula or other dyscrasias. Gene- 
rally one parent at least has been of feeble structure, and of unhealthy 
condition, of body or mind. Great numbers of idiotic children die 
either in infancy or early childhood. Some die of epilepsy or other 
spasmodic fits. Later in life they destroy themselves by gluttony or 
self-abuse; or they are killed by drugs or other pernicious influences. 
Few reach maturity; fewer still reach old age. 
Treatment.—We begin our efforts by trying to correct the consti- 
tutional defect, the general dyscrasia or ill health, which in some form 
is always present. “ The growth and strength of the brain depend 
upon the health and growth of the great central organs of the trunk. 
If these are in full vigor they affect the brain favorably, which conse- 
quently attains its maximum power, and the person feels particularly 
bright; but if the great organs are in any way embarrassed in their 
functions, the brain partakes of the embarrassment, and the man who 
owns it becomes stupid.” (Dr. Howe.) There are men who, dur- 
ing early and mature manhood, are acknowledged to have a re- 
spectable share of mental power; “ but when the period of greatest IDIOCY, 
467 
intensity of automatic functions is passed over, the brain slackens in 
its action, the mental manifestations diminish, and the man is seen to 
be a weak man, if not a fool, long before he dies.” 
Diagnosis.—The idiot reveals in his language as well as in his ap- 
pearance and actions his deficiency of intellect. He does not pass 
beyond the mere rudimentary parts of language, does not comprehend 
anything more than the general forms and sensible qualities of objects. 
“ When it comes to that subtle but real transition from language ex- 
pressive of the qualities and attributes of material objects, to language 
expressive of immaterial and moral relations, they stumble at the 
threshold. An idiot may, perhaps, make the transition easily enough, 
from the pleasure of tasting sweets to pleasure in the society of 
another; he may say John or Mary is sweet, good or kind, but there 
he stops. If he goes on to acquire the more complex parts of lan- 
guage, then he is no longer an idiot. The idiot never uses the more 
complex and subtle forms of language. A few use words of all the 
common parts of speech. Some use nouns only; others are speech- 
less or use only interjectional expressions. A few read simple sen- 
tences and comprehend them. Some pronounce words pointed out to 
them without knowing their meaning. Arithmetic is studied in the 
school for idiots, and some idiots show astonishing capacity for making 
arithmetical calculations.” Dr. Howe, on this subject, says : “ Cipher- 
ing, said an eminent philosopher, is done in a small corner of a man’s 
brain, and he might have added that it may be done in a small corner 
of a very small brain. Men of quick parts are sometimes so deficient 
in the faculty of number that they can hardly understand simple 
arithmetical processes ; and some are even perplexed about reckoning 
change for money. On the other hand, there are persons of less than 
general average ability, who have what seems to be an intuitive per- 
ception of the relations of numbers, and who can see at a glance the 
result of intricate combinations, which ordinary persons can arrive at 
only by long and laborious ciphering. Some of these mathematical 
prodigies, as they are called, not only have no other faculty well deve- 
loped except that of number, but even this ceases to work after they 
pass the period of youth; and from being tolerably bright, they be- 
come intolerably stupid. Such cases go to confirm the notion of the 
independence of the faculty by which we perceive the relations of 
number.” 
The education of idiots has now been successfully tried. The Report 
of the Massachusetts School says: “ About half of the pupils study 
geography. One class can name the great divisions of land and water, 
the mountains, rivers, and the like. They can give the names of the 
States, and tell which is the capital of each. With an expert teacher, 
they can make a recitation that excites the admiration of a charitable 468 
DISEASES OF THE NERVOUS FUNCTION. 
audience. Linear drawing and writing are taught to all who are capable 
of learning. 1 The change which has been brought about in many of the 
unfortunate children is very great. Their dirty and disorderly habits 
have been corrected. They can take care of themselves in respect to 
many wants which formerly had to be ministered to by others. They 
can dress and feed themselves with much more readiness and propriety. 
Some are beginning to be useful in various ways.” See Vol. II. p.279. 
Remedies.—The principal remedies for imbecility and dullness of 
the mental faculties and senses are: Opium, Baryt.-m., Merc., Nux- 
vom., Secale, Stram., Sulph., Ilyos., Arsen., Argent.-nitr. 
Effects of Opium.—Artificial idiocy is produced in Turkey by giv- 
ing children small doses of opium. By commencing in infancy the 
stupefying effects of the poison on the sensorium prevents mental 
development, and this produces fatuity. Dr. Oppenheim, who gave the 
first authentic information on this subject says: “ The same method is 
often practiced upon adults; and it is a source of great emolument to 
some persons, by inducing this state of mind which renders the subject 
of it incapable of managing his own affairs, when their removal by 
death would be impolitic and inexpedient. 
Opium causes torpor of the intellect. DeQuincy, in his Confessions 
of an Opium Eater, 1821, says: “After he had for a time been happy 
in taking 1000 drops of Laudanum per day, reading Kant’s Critical 
Philosophy, and surrounded by scenes of domestic bliss, he was com- 
pelled to suffer the pains and penalties of the same awful agent— 
Opium. 
“ And now farewell to happiness—farewell to peace of mind, to hope, 
to tranquil dreams, and the blessings and consolations of sleep. From 
these he is summoned away for three years,, and he now arrived at the 
Illiad of his woes! 
His first misery was the torpor of the intellect. He has still his 
moral aspirations and sensibilities ; he knows and feels what is his 
duty and what he might do, but loses the power even to attempt. In 
spite of all that he ought to perform, an incubus presses him down; 
he curses the spell that chains him. He would rise and walk, but he 
is powerless.” 
ORDER II.—AFFECTING THE SENSATION. 
Structure of the Nervous Tissue.—The nervous tissue or neurine, 
has for its essential elements two forms of substance, cells and fibres. 
The cells are found massed together with intercellular matter, in col- 
lections called glanglia / the fibres, though helping to make up the 
central ganglia, are mainly placed in cords proceeding from them, 
called nerves. The colors of these two respectively give the name of 469 
AFFECTING THE SENSATION. 
“gray matter” to the aggregations of the cells, of “white substance” 
to those of the fibres. 
Other distinctive features of the nervous cells and fibres are 
revealed by the microscope. It shows that the nervous cells are not, 
as in other tissues, mere rounded nucleated bodies, having no con- 
nection with other parts, or with one another. They present emerging 
from their circumferences tails or processes of extreme tenuity— 
sometimes having one tail only, in w'hich case the cells are styled 
unipolar, sometimes possessing many, when they are styled multipolar. 
The connection of these processes with the fibres of the issuing nerves 
was first demonstrated by Van der Kolk, who gives some beautiful 
plates, drawn from microscopical survey, illustrative of the manner in 
which cells are united wfith nerve fibre and with neighboring cells by 
their processes. 
The nerve fibres belonging tp this system are divisible into two 
kinds, the tubular and the gelatinous. The former are of rounded 
shape, white color, and firm consistence; they constitute the greater 
portion of the cerebro-spinal nerves, and of the white substance of the 
inter-cranial and intra-spinal ganglia. They are composed of three 
parts. 1. The neurilemma or enveloping membrane of fine areolar 
tissue. 2. A firm tube within the neurilemma, called by Schwann the 
white substance. 3. Innermost of all the axis cylinder, which is con- 
sidered as the (physiological) prolongation of the cell-processes and 
the essential element of the nerve. 
The axis cylinder is quite distinct structurally from the other con- 
stituents of the fibre, for it is often seen projecting beyond them in a 
broken fibre. The gelatinous fibres, on the other hand, are flat, soft, 
and of a reddish gray color; they abound in the sympathetic system, of 
which they are considered by many to be the proper fibres, but are 
also found sparingly in many of the cerebro-spinal nerves. They are 
distributed to the coats of blood-vessels, and other involuntary muscles, 
whose fibres they strikingly resemble. They are homogeneous in con- 
sistence, and have numerous corpuscles resembling cell-nuclei lying upon 
them, as have the unstriped muscular fibres. All nerve fibres, tubular 
and gelatinous, lie side by side in the bundles of them, called nerves, 
without inosculation or division, in arteries, so that each fibre pursues 
its own independent course from centre to circumference. In an 
equally independent manner do they unite at their terminal extremi- 
ties with the elementary fibres of the muscles wdiich they animate. 
The nervous tissue is largely supplied with blood, the intra-cranial 
mass alone receiving one-sixth of the entire quantity in the body, to 
which its weight bears a proportion of only one to thirty-six. More- 
over, the gray matter receives by far the greater amount of this copious 
supply. 470 
DISEASES OF THE NERVOUS FUNCTION. 
Effect of the extirpation of the Nerve of a given qart.—If a 
nerve be extirpated, the part to which it is distributed loses sensibility 
to stimuli, or power of motion, or both. If the nerve be simply 
divided in its course, the same loss is manifested in the parts supplied 
by its branches given off below the place of section, but not in those 
deriving their fibres from the portion still connected with the centre. 
If the central ganglion be destroyed, the issuing nerve remaining entire, 
the same loss of function is manifested as when the nerve is divided or 
extirpated. From these facts we infer that the nervous system is the 
seat of a power which conveys the orders of the will to the muscles, 
and endows the frame with the various kinds of sensibility manifested 
by it to external impressions; and that of this power, whatever be its 
nature, the gray matter is the generator, and the white substance only 
the conductor. 
Physiological Inquiries on the Nature of the Nervous Influence. 
Both the structure and the functions of the nervous system are seen to 
bear a striking resemblance to those of a secreting gland. We have 
nucleated cells, generating a new product; we have tubular fibres 
(answering to ducts) conveying it to its destination. That these latter 
should be solid and not hollow, is only natural, since the thing gene- 
rated is not a liquid, but an invisible “ force,” i. e., “ an affection of 
matter, analogous to electricity in inorganic nature. But the third 
element in secreting glands is the fluid—the blood, from which they 
separate their peculiar product. And this too we have here in the 
large amount of blood—far exceeding that required for nutrition—sup- 
plied to the nervous centres, and in the distribution of much the greater 
part of this to the gray matter or secreting portion.” 
“ We seem then led to oonclude that the nervous system is a vast 
glandular apparatus, generating from the blood by its cells and trans- 
mitting through its fibre a power possessed of certain properties and 
uses,” and this generation and transmission, “not occasioned only, on 
the application of stimulus, but continuous and uninterrupted.” # 
Nature of the Nervous Force.—“ When electricity was supposed 
to be a material, though ‘ imponderable’ fluid, the nervous force— 
its analogue in living matter, was regarded in a similar light; hencs 
its names, ‘vital spirits,’ ‘nervous fluid,’ among the older writers. 
But with the tendency of modern science to dynamical, rather than 
to material doctrines, the nervous power must take its place with the 
physical forces generally as an affection of matter, rather then a sepa- 
rate entity.” The precise mode of its operation is uncertain. Todd and 
Bowman considered it to be of a polar character, communicated from 
molecule to molecule of its conductor, like heat and electricity. Dr 
*Dr. Hughes, British Med. Jour., June, I860. GENERAL PATHOLOGY OF THE NERVOUS SYSTEM. 
471 
Wm. H. Holcombe has endeavored to show that the nervous force rather 
resembles light and sound, and consists in the vibrations of the sub- 
stance forming the axis cylinder.” * 
The theory that makes the nervous force identical with electricity is 
in our view so far behind the present age, that we cannot devote space 
to it here. It merely supposes the brain to be a galvanic battery; the 
nerve fibres are its connecting wires (the white substance of Schwann 
being the isolator of the axis cylinder); and the blood the fluid whose 
decomposition develops electrical force. The objections to it are found 
in the following facts : 
1. The most delicate galvanometer suffers no deflection when its 
wires are connected with an excited nerve. 2. The firm application of 
ligature to a nerve stops the propagation of the nervous force below 
the point of application, but not that of electricity. The nerve 
is as good a conductor of electricity after the application of the 
ligature as before it. The same holds good when the nerve is 
benumbed by ether, or paralyzed by woorara. 8. If a small piece of 
nervous trunk be cut out and be replaced by an electric conductor, 
electricity will still pass along the nerve ; but no nervous force excited 
by stimulus above the section, will be propagated through the con- 
ductor to the parts below. 4. Nervous fibre is not so good a con- 
ductor of electricity as muscle and other tissue, and is very greatly 
inferior to copper and other metals. 
General Pathology of the Nervous System. 
The primum mobile of all physical action, says Claude Bernard, 
is seated in the nervous system. To it we owe both sensibility and 
motion, through which we hold all our relations with the external 
world. Here we see the origin and seat of all the manifestations of 
life; and also, here we find the source of all pathological action. 
1. Beginning our examination from the highest manifestations of 
life and descending to the lowest, we survey in a regular series 
“ The mighty chain of being lessening down 
From infinite perfection to the brink 
Of dreary nothing; desolate abyss ! 
From which astonished thought recoiling turns.” 
If we now review the scale of living beings by ascending from the 
lower to the higher orders of existence, we see as we progress that 
the nervous system in each animal of higher order is seen in higher 
degree of perfection and development. We also see that in each 
example of the ascending scale, diseases are more frequent than in 
that which is next below it, more variable in form, more complicated 
* Scientific Basis of Homoeop. 472 
DISEASES OF THE NERVOUS FUNCTION. 
in their nature. Increased development of the nervous system ia 
attended by increased sensibility of the nerves to external impressions, 
and these impressions, when felt to a certain extent, produce disease. 
M. Bernard undertakes to produce all the symptoms of the various 
diseased manifestations of direct irritation of the corresponding 
nerves distributed to the part that is the seat of the given disease. 
I. Affections of the Respiratory Organs.—What are the signs of 
disease of these organs ? “ Cough, dyspnoea, increase of bronchial 
secretion. These symptoms can all be produced at will by direct 
excitation of the pneumogastric nerves. Even the symptoms of 
pleurisy and pericarditis may be so produced. 
II. Digestive Organs.—Exciting the solar plexus of nerves and its 
different branches will establish both diarrhoea and dysentery, together 
with, the anatomical lesions that habitually accompany them. 
Acute peritonitis has thus been produced, and its consequent for- 
mation of pus and false membrane have been found in the peritoneal 
cavity. 
Fever, that essentially medical symptom, can be excited by a mere 
mechanical irritation of the nervous system; and the products of 
inflammation, as pus, false membranes and plastic exudations are 
called into existence in the same way. 
In an animal previously enfeebled, we can produce, directly, pleuritis, 
or purulent deposit, by the simple division of the great sympathetic 
nerve. Though to succeed in this experiment it is necessary that the 
animal’s health should previously be lowered. 
Deprive a muscle or bone of its nervous supply, and you will have 
as a consequence, fatty degeneration in one case and rickets in the 
other. If you tie the nerves that enter the nutritive canals of the bone, 
you will soon see the cells of the lamellar structure increase in size, 
the vessels become more numerous, and all the phenomena of rachitis 
or rickets follow in quick succession. We can bring about these 
results in part of a bone without interfering with the remainder. This 
was done in the case of the lotver jaw by M. Schiff of Berne. 
III. Changes in the Fluids of the Body.—A vast number of those 
alterations in the fluids of the body that occur in the course of many 
diseases may be traced to the action of the nervous system, and can 
be produced by artificial excitement. 
The Urinary Secretion.'—Albuminuria, polyuria, and diabetes 
are invariably produced by excitation of definite points of the medulla 
oblongata; and the peculiar form of the perverted urinary secretion 
will be determined by the peculiar portion which is acted on. 
It was formerly supposed that in diabetic patients the morbid state 
created entirely new conditions which gave rise to pathological pro- 
ductions, called sugar. It is now admitted that these phenomena are NERVOUS SYSTEM. 
473 
exf lained by the mere exaggeration of the normal function, in virtue 
of which glycose is generated in every individual, even in a state of 
health. Disease then here is nothing more than an exaggeration of the 
natural function. 
IV. There.are however some pathological products and manifes 
tations of disease that we have not yet been able to imitate by artificia 
excitation. It remains a question whether we shall ever be able tc 
do this ; and it remains the pathological problem of the day : Shall 
pathology ever be so perfect as to be embraced within the compass of 
scientific explanation, or shall there always remain here an unexplained 
reason; must we always refer those operations which we cannot imitate 
to a special principle, mysterious in its nature, which we may be con- 
tent to call the vital principle ? 
We have not yet been able to imitate by experiment any of the 
eruptive fevers, as small-pox, scarlatina or measles. Are these dis- 
eases expressly the property of the human subject? or is it possible 
for them to be produced in animals? Each species of animal appears 
to have some specific diseases belonging to itself: man presents a 
larger number of diseases than all other animals taken together. In 
animals we can produce ecchymosis, congestions, and glandular swell- 
ings ; tubercle, cancer, and some other morbid productions are found 
equally in animals and man. Now, since every disease which origi- 
nates morbid tissues is evidently a perversion of the nutritive function, 
who can deny that the influence of the nervous function is exercised 
over this pathological act? 
Disease does not rest upon any isolated symptom, but on a collection 
of symptoms. It is a morbid evolution, which offers a commencement, 
a middle, and an end; and a skilful and practiced observer in watching 
the first stage of a disease can predict its probable termination. 
Poisons determine real diseases which present an unbroken chain of 
symptoms; they therefore enable us to produce at will an entire class 
of diseases. 
Diseases Artificially Produced in Animals.—If you remove at 
once the two kidneys in a dog, or simply tie one of the renal arteries, 
the animal is at first not seriously affected. It continues to eat and 
digest its food for a certain time, corresponding with the period of 
incubation of most diseases. But it is powerless to expel the excre- 
mentitious product which should pass out by the kidneys, and the 
whole system is gradually poisoned. The urea which can be no longer 
eliminated by the kidneys, is expelled by the intestines, and is found, 
with the Salts of Ammonia, among the contents of the intestines, and 
even in the gastric-juice. If this process could be carried on indefi- 
nitely, death would not result, as the urea does not find its way into 
the blood. But at a later period the poisonous urea begins to disorder 474 
DISEASES OF THE NEKYOUS FUNCTION. 
ilie lining mucous membrane of the stomach and intestines. This 
canal ceases to carry it off, performing a function altogether foreign to 
it. The animal is attacked with vomiting and purging, at the same 
time the urea finds its way into the blood, and the animal dies comatose 
and convulsed. 
When this cessation of the urinary secretion is caused by ligature 
of the renal arteries, the disease caused by it may be removed or 
diminished by removing the ligatures. The same thing would occur in 
man, if there existed an obstacle to the passage of the urine, and it 
were possible to remove that obstacle. In all cases where the kidneys 
have been removed, death has followed. It seems that we can pro- 
duce some diseases artificially: there are others which depend on 
external causes, which we have not yet learned to imitate. Small-pox 
and the contagious diseases must be caused by a specific contagion, 
which always produces the same disease. In the contagious peripneu- 
monia of cattle it has been proved by experiment that the specific 
disease was transmitted to a herd of healthy cattle by permitting 
them to come in contact, or in the vicinity of those suffering from the 
disease. 
Functions of the main divisions of the Nervous Tissue.—I. Of 
the Cerebral Hemispheres. II. The Cerebellum. III. The Corpora 
Striata, Optic Thalami, and other ganglia at the base of the cerebrum 
IV. The Spinal Cord and Medulla Oblongata. V. The Cerebro-spinal 
nerves. VI. The Sympathetic System. 
I. Functions of the Cerebral Hemispheres (see page 695 to 699. Vol.I.) 
II. The Cerebellum.—The relative weight of the cerebellum com- 
pared with that of the cerebrum, in man is as 1 to 8i; in the mam- 
malia it is still larger in proportion; but large as it is, and important 
as its office must certainly be, no satisfactory theory of its functions 
has yet been proposed. 
The organ consists of two parts: 1st, The median lobe or vermiform 
process; 2d, The lateral hemispheres. The former of these is the 
primary part—it exists alone in fishes and reptiles ; the lateral por- 
tions are additions to this, and denote an advance in development. 
They are first found in birds, and become more and more complex as 
they ascend through mammals to man. Its sole communication with 
the spinal cord is through the restiform bodies, which are continuous with 
its posterior columns. Injury or extirpation of the cerebellum has 
been supposed to affect no other function than that of co-ordination of 
muscular motion. The limbs retain their power, but they can no 
longer execute the combined movements of standing, walking, leap- 
ing, &c. 
This theory based on experiments by Flourens has recently been 
jontroverted by Dr. Brown-Sequard. He says there have been many NERVOUS SYSTEM. 
475 
instances of disease, even to the extent of complete suppuration of the 
cerebellum', in which the motorial powers have continued unimpaired. 
He shows that the injury of the co-ordinating power produced by 
wounding the organ is dependent, not on the absence of its energy, but 
upon an irrelative influence on the parts of the encephalon that remain 
unaltered; for the least irritation of several parts of the intra-cranial 
mass, with only the point of a needle, may generate nearly the same 
disorder of movement that follows the extirpation of the cerebellum. 
Yander Kolk shows that ample provision for co-ordination of motion is 
found in the arrangement of the cells of the cord; and Dr. Hughes 
that “ section of the posterior columns, through which alone the cere- 
bellum can communicate with the lower limbs, produces no impairment 
in their motorial power, simple or harmonized.” 
III. Ganglia at the Base of the Brain—The Corpora Striata, 
Optic Thalami and Corpora Quadrigemina.—The corpora striata 
are supposed to constitute the centre through which the mandates of 
the will, and the influence of ideas, and perhaps emotions are conveyed 
along the spinal cord to the muscles.* The optic thalami seem to be 
the point at which the mind (through the cerebral hemispheres) be- 
comes cognizant of general impressions (as distinguished from those of 
the special senses.) The corpora quadrigemina are the ganglia pecu- 
liar to the sense of vision. Thus the corpora striata and optic thalami 
“ crown, like capitals of columns, the motor and sensory tracts of the 
spinal cord, and, by their numerous radiating fibres bring them into 
intimate connection with the cerebral hemispheres, and thus with the 
physical powers. Being themselves closely connected, they form the 
centre of what are called sensory-motor actions, in which the will takes 
ordinarily no part; but the impression made on the sensitive nerves 
travels no higher than the optic thalamus, and is there passed over to 
the corpus striatum to be transformed into an appropriate movement. 
To this class of actions may be referred the vomiting excited by many 
sensitive impressions, the involuntary laughter produced by tickling, 
and the equally involuntary abridgement of the respiratory movements, 
when their performance is attended with pain ; I say involuntary, be- 
cause this abridgement often presents itself on one side only, a limita- 
tion which the will cannot imitate. 
Morbid affections of these ganglia manifest themselves in derange- 
ments of voluntary motion, of sensibility, or of vision. Such affections 
are usually either from the pressure of an apoplectic clot, or from 
localized softening or other destructive disease. No drugs are yet 
known that act specifically upon the corpus striatum or optic thalamus; 
* A case is given in Brit. Med. Jour. May 4, 1861, in which the disease limited 
to one corpus striatum caused simple motor paralysis of the opposite side. 476 
DISEASES OF THE NERVOUS FUNCTION. 
those which affect them act through their action on the general cere- 
bral structure; while those which act directly on their tissue can hard- 
ly fail to include the whole motor or sensory tract within their sphere 
of operation. On the other hand, the corpora quadrigemina are suf- 
ficiently independent to permit us to suppose that they may have their 
specific tissue-irritants. Flourens supposed Belladonna to act specifi- 
cally upon them. It surely has a wide range in causing and curing 
derangements of vision.* 
IV. The portion of the central nervous system which extends from 
sub-cerebral ganglia to the bottom of the spinal column, consists of 
three divisions : 1. The roots of the spinal nerves ; 2. The spinal cord 
proper; 3. The medulla oblongata. 
Hoots of the Spinal Nerves.—Sir Charles Bell first proved the 
distinct functions of the two roots by which each spinal nerve takes its 
origin from the cord. He showed that division of the anterior roots so 
invariably paralyses the parts supplied by them, and division of the 
posterior roots invariably abolishes the sensibility of the same. Mi- 
croscopical anatomy confirms this distinction by showing a structural 
difference in the fibres of the two roots, as wrell as in the cells of the 
anterior and posterior horns of gray matter in which they take their 
origin; Apparent objections to this doctrine are answered by Dr. 
Hughes.f 
A. Medulla Oblongata.—The conclusions reached by Dr. Brown- 
Sequard, are: 
1. That the irritation of the medulla oblongata and parts adjacent 
(as the pons varolii, cervical spine), as well as the irritation of the 
vagi, may suspend, or suddenly diminish, the force and frequency of 
the cardiac expiratory movements. 
2. It is not to the absence of the medulla oblongata, but to the irrita- 
tion generally produced in the removal of this organ, that we are to 
ascribe the diminution or complete suspension of the movements of the 
heart. 
3. It is also in part to the irritation produced in removing the me- 
dulla oblongata entire, or its central parts (no end vital), that we are 
to ascribe the sudden suspension of the respiratory movements. 
It is also to an irritation, and not to the absence of the medulla 
oblongata, that we must attribute the absence of the convulsions of 
agony in cases of ablation or lesion of the medulla oblongata. 
Finally, wre must completely reject the supposition that the medulla 
oblongata is the focus of a pretended vital force. The physiology of 
the medulla oblongata, considered as a respiratory centre is all to be 
re-made. 
* Dr. Richard Hughes, Nervous System. London, 1860. 
t British Journal of Homoeopathy. July, 1861. p. 405. NEURALGIA. 
477 
B. The Spinal Con'd proper.—By this term is implied the colump 
of nervous matter which occupies the vertebral canal, up to the fora 
men magnum in the occipital bone. 
The spinal cord consists of gray substance internally, and of white 
fibres externally. The gray substance is arranged in a central mass 
with four horns, two anterior and two posterior, from which latter the 
anterior and posterior roots of the spinal nerves take their origin. The 
white fibres lie longitudinally around the gray substance, and are 
separated by the horns and their issuing roots into three columns on 
each side, anterior, lateral, and posterior. 
General Functions of the Spinal Cord.—It constitutes “ the chan- 
nel along which the orders of the will, and the influence of ideas and 
emotions are transmitted from the brain to the trunk and limbs.” Also 
along it travel “ the impressions made on the periphery of the same 
parts to become sensations in the cerebrum.” 
GENUS I.—NEURALGIA. 
By the term neuralgia, we designate all of those painful affections, 
in different parts of the body, of a purely nervous character. This 
disease may attack every system of nerves, and every structure of the 
organism, whether external or internal. Different names have been 
given to it, derived from the particular structures affected, but as the 
real nature of the disease is always the same, in whatever part it may 
be located, and as the points of its attack are almost innumerable, there 
is a manifest difficulty and impropriety in endeavoring to effect a 
minute classification. The most common seat of neuralgia is in the 
first, second and third branches of the fifth pair of nerves, and in the 
portio dura. When the disease is confined to the facial portions of 
these nerves, it is recognized under the name of tic doloureux; when 
its location is in the nerves of the stomach, gastrodynia / when in the 
first branch of the fifth pair of nerves, nervous headache / when in 
the nerves of the feet and legs, neuralgia pedis ; when in those of 
the mammse, neuralgia mammce j when to those of the heart, 
angina pectoris, &c. But as these various names only complica te our 
classification, and render complex what is in reality simple, we shall 
treat of all these nervous attacks under the general appellation of 
neuralgia. 
NEURALGIA. 
Neuralgia may be divided into: (See a paper by H. Lubb, Esq- 
Harviean Society—Lancet.) 478 
DISEASES OF THE NERVOUS FUNCTION. 
1. Central.—Arising from Disease of the Brain or Spinal Cord; 
2. Peripheral, divided into 
a. Idiopathic. 
b. Traumatic. 
c. Neuromatous. 
3. Reflected. 
II. a. Idiopathic Peripheral Neuralgia. 
'Description.—Stabbing, darting pain referred to the course of a 
nerve, shooting down the nerve like lightning; coming on suddenly 
lasting but a moment, and repeated at intervals. The pain is so acute 
as to be unendurable if continuous. The part or limb affected with 
this form of neuralgia is colder, and the skin supplied by the neural- 
gic nerve is more or less numb, not tender to the touch. The patient 
likes to have it rubbed, and frequently grasps it with the hand and 
presses it. If the neuralgia has lasted any time, there is more or less 
paralysis in the muscles supplied by the accompanying motor nerve. 
The nerve force is believed to be generated and distributed from the 
capillary circulation. The sentient nerve is a conductor to the brain 
of sensations taking place at the periphery. 
Neuralgia is therefore not a hypenesthesia of its healthy function. 
During health a nerve has no sensation proper in itself, and if it be 
struck, cut, or torn, the sensation is referred to parts to which the 
nerve is distributed. But in this form of neuralgia it is the nerve 
itself to which a pain is referred as darting up and down its course. 
A sentient nerve may be likened to an iron conducting-wire of a gal- 
vanic battery, which, if of a certain uniform diameter, indicates a given 
quantity of galvanism without being perceptibly affected by its pas- 
sage. But if a portion of the wire be much finer than the rest it 
becomes red-hot, being unable to conduct the whole of the galvanism; 
the remainder is correlated into heat. So in the nerve ; from mal-nutri- 
tion it is unable to conduct normal sensations to the brain. The nerve 
current, by effecting a polarity of the nerve itself, gives the idea of 
pain in that portion of the trunk of the nerve, its peripheric termina- 
tion beihg at the same time numbed. It is therefore considered that 
the indications of cure consist in increased healthy circulation, arterial 
and nervous. 
Diagnosis.—The following are the general characteristics of neu- 
ralgia : Sudden paroxysms of exceedingly acute pain in some particu- 
lar nerve, with violent lancinating pains extending along the ramifica- 
tions of the nerve in different directions, attended with turgescence of 
the blood vessels in the vicinity of the part chiefly affected, but without 
fever. The pains are so sudden and severe as to resemble electric 
shocks, and they often give rise to spasmodic contortions or twitchings 
of the muscles of various parts of the body, and especially of the 
muscles of the face, when the branches of the fifth and the facial NEURALGIA. 
479 
branch of the seventh pair of nerves are the seat of the pains. The 
pains are sometimes aggravated by the slightest movement, or by the 
gentlest touch, although firm pressure causes no pain. The particular 
nerve or nerves involved, can always be pointed out with exactness, 
because the principal seat of the attack is always in some portion of a 
nerve, and the pain radiates thence along its different ramifications; 
and from this circumstance surgeons have occasionally excised with 
success portions of nervous trunks to effect cures ; but this severe 
measure should never be resorted to when suitable homoeopathic 
specifics can be readily procured. Our esteemed friend Dr. Carnochan, 
of this city, has in several instances excised portions of the branches 
of the fifth pair of nerves, for the cure of obstinate facial neuralgia, 
and always with success. But the resources of homoeopathy should be 
exhausted before resorting to the surgeon’s knife. 
In facial neuralgia, there are often lachrymation; increased flow 
of blood; spasmodic twitchings of the mouth, cheeks and eyelids; 
spasmodic closing of the eyelids-; unusual heat and tension in the side 
affected ; stiffness in the jaw and neck ; increase of pain by light, 
noise, motion, touch, talking, or eating; heat or coldness of the body; 
vertigo ; and confusion of ideas. 
When the head is the seat of the attack, we may have violent periodi- 
cal pains in some part of the head, darting along the nervous ramifica- 
tions ; nausea ; vomiting ; extreme sensitiveness to the touch, cold air, 
sounds, and light; humming in the ears ; sense of heat and fullness in 
the affected part; floats before the eyes on the slightest attempt to use 
them ; aversion to food; confusion of ideas ; disinclination to converse 
or to listen to others. 
When neuralgia affects the superior or inferior extremities, back or 
mammae, the symptoms will be fewer, on account of the less number 
of sympathetic connections existing between these parts. In these 
instances, the violent lancinating pains occurring in paroxysms, and in- 
creased by the slightest contact, and by motion, and unaccompanied 
with actual inflammation, are the S3/mptoms which especially mark the 
complaint. A most distressing form of neuralgia has occasionally 
come under our observation, which seems to pervade the whole body— 
and is characterized by painful spasmodic twitches, or jerks, occurring 
at short intervals, sometimes affecting the lower extremities, then sud- 
denly shifting to the upper limbs, the face, neck, or chest. We have 
generally witnessed this form of the malady in elderly persons of 
weakly constitutions; but in a few instances in young inebriates. 
For the symptoms of neuralgia affecting internal organs, we refer 
the reader to the articles 0astrodynia and Angina pectoris. 
Causes.—Pathological researches have as yet thrown but little light 
upon the nature of neuralgia. Many excellent observers have institut- 480 
DISEASES OF THE NEKVOUS FUNCTION. 
ed rigid autopsical examinations, in order to ascertain its precise 
nature and location, but their labors for the most part have proved 
fruitless ; since no lesions or other marks of diseased action have been 
discovered, either in the nerves or their envelops, at all sufficient to 
account for the symptoms. Dr. MacCulloch believes neuralgia to be 
a malarious disease; this opinion is founded upon the fact of its fre- 
quent occurrence in marshy districts, and in locations where intermit- 
tent fever abounds. It is probable, however, in these cases that the 
miasmatic influence operates merely to excite or to call into active 
operation a diseased condition of the nerves, latent, it is true, but al- 
ready existing. The malaria operates in these instances, as the imme- 
diate exciting cause, and in a manner similar to impure air, errors in 
diet, excessive mental and physical labor, abuse of narcotics, or stimu- 
lants, over-excitement, fatigue, exhaustion, great loss of fluids, and the 
depressing emotions. The remote cause and the real nature of the 
disorder remain unexplained. A conclusive fact in refutation of the 
views of MacCulloch respecting the malarious origin of the disease is 
its common occurrence in New England, where intermittent fevers do 
not prevail. 
Neuralgic pains sometimes arise from the pressure of tumors, and 
exostoses, the irritation of decayed and ulcerated teeth ; and also from 
mechanical injuries. In these instances we may generally remove the 
cause by surgical means, and thus cure the disorder. 
The upper and anterior portion of the external ear and auditory 
canal derive their sensibility from the fifth cerebral nerve, which has 
direct nervous associations with the interior of the head, the forehead 
anteriorly, the temple, face, eyes, nose, teeth, and tongue ; whilst the 
posterior part and anterior part of the pendulous portion of the exter- 
nal derive their sensitive supply from the spinal nerves issuing from 
the spine between the second and third cervical vertebrae. If then, 
the pain be in one part of the ear, it is probably of a neuralgic cha- 
racter, connected with irritation of the fifth pair of nerves, and there 
is, from this cause often simultaneous concurrence of tooth-ache and 
ear-ache, as the same nerve that supplies the auditory canal also sup- 
plies anterior portions of the ear. Also pain in the anterior third of 
the tongue is a common cause of pain in the auditory canal. 
A physician suffered from an enlarged gland below the external ear, 
and had also a slight discharge of morbid secretions in the auditory 
canal. It was thought to originate in irritation from a decayed tooth; 
a decayed tooth was extracted, and the local symptoms ceased.* 
Case by Dr. Crane.—A woman had been afflicted with neuralgia for 
three years. A New7-York dentist removed a number of teeth, which1 
* Dr. Hilton. Lecture on Pain. Lancet. 1860. p. 489. 481 
TIC DOLOREUX. 
were probably the exciting cause; but this gave no relief, and the 
patient was confined to the bed for a week or more at a time, rolling 
from side to side of the bed in the greatest agony, only mitigating the 
pain by large doses of Laudanum, and wishing for relief by death. 
Leeches were applied in great numbers, and Carbonate of Iron was 
given at the rate of one ounce a day. Relief was partial but in 
two weeks the pain returned, but more deep-seated. The antrum 
maxillare was punctured, the iron resumed. The relief was more 
permanent. 
In many cases of neuralgia of the face or parts adjoining, the phy- 
sician fails to cure because he fails in detecting the cause of the 
disease. A single decayed tooth, though not painful itself, is often the 
source of irritation from which all the pain proceeds. Every diseased 
tooth must be removed, and especially all old stumps, and the tartar 
from the remaining teeth. So long as there are inflamed spongy 
gums, with old offensive stumps imbedded in them, the general health 
must be bad, digestion deranged, and severe nervous pains will be felt 
in some of the branches of the fifth pair, to which they are continually 
radiating from the diseased point. 
Physiological Characteristics of Neuralgic Affections.—1. 
They are seated in the peripheral system of nerves ; we have cerebral, 
spinal, and ganglionic neuralgia. 2. Every neuralgia consists of a 
series of paroxysms of different durations, separated by irregular inter- 
vals of ease. 3. The pain varies ; it is tearing, stitching, burning, &c. 
In neuralgia of the central nerves the pain is directed from within, out- 
wards ; in those of the ganglionic nerves it runs from the periphery 
towards the centre. 4. The volume of the affected organ decreases. 
5. The temperature of the organ decreases. 6. Discoloration takes 
place, the affected part becomes paler. The urine becomes paler, 
losing its characteristic pigment. The artery becomes thinner, and 
contracted, in proportion as the volume of the affected part decreases ; 
the current of blood is smaller, it rushes along with less force, though 
not always with less rapidity. (Chronic Diseases, 4. 22.) 
Neuralgia occurs in all climates, and has been observed at all periods 
since the days of Hippocrates. It is more frequent among women than 
men, and also more common after the age of puberty. We meet with 
it in its strictly periodical form in patients who have not been exposed 
to malaria. 
I. NEURALGIA FACIALIS.—1Tic-Doloureux. 
This form of neuralgia was first fully described by Dr. Fothergill, 
Afterwards by Andre, Darwin, Heberden, and later writers. 
The name Tic-Doloureux was first applied by M. Andre, of Ver- 
Yol. II.—31 482 
DISEASES OF THE NERVOUS FUNCTION. 
sailles. It is expressive of those severe twitching, throbbing, or oscil 
lating movements or spasms in which the patient feels as if there were 
something moving in his cheeky oscillating like the pendulum of a 
clock, and, from the proximity of the ear, actually sounding. Many 
speak of it as sounding “ tic-tic.” This sound perhaps arises from the 
implication of the auditory nerve in the deceased action; as flashes of 
light are seen in the eye when the nerves of the eye are disturbed 
[Morgan, Brit. Jour, Homoeop. 1855.) 
“ Tic-doloureux occurs in paroxysms, at irregular intervals; the 
attack is sometimes preceded by oppressive anxiety, itching, or feeling 
of coldness on the part to be attacked, formication and trembling of the 
eyelids, tension in the palate and nose, numbness of the tongue, &c. 
At first the pain is inconsiderable, like a mere prick, or a common 
toothache, but gradually it becomes more violent and piercing; the pain 
is lancinating or tearing, dragging or pressing, beating, boring, fre- 
quently accompanied with a sensation as if the face would be cut or 
sawed to pieces. The pains either follow the course of the different 
branches of one side of the trigeminus (more frequently on the right 
than the left side of the face,) or exclusively the one or the other 
branch of the nerve. If the pain be seated in the supra-orbital branch, 
it generally commences at the foramen supra-orbitale, shooting to the 
eyebrows, forehead, eyelids, and frequently, deep into the orbits ; if 
the infra-orbital branch be the seat of the affection, the pain spreads 
over the cheek, upper lip, lower eyelids, radiating to the teeth, palate, 
and tongue. A neuralgia of the infra-maxillary branch extends to the 
lips, alveolar processes, teeth, to the soft parts under the chin, and the 
side of the tongue. Frequently the pain seems to follow the ramifica- 
tions of the pes-anserinus, spreading even to the temporal region; least 
frequently the pain is seated in the lingual branch, and most frequently 
in the superior maxillary, and frontal nerves.” 
“ Reflex phenomena in the motor nerves: the muscles of the affected 
side of the face twitch involuntarily, the eyebrows a,re knit, and the 
eyelids close spasmodically, the corner of the mouth is drawn towards 
the ear, and the spasm extends even to the respiratory muscles ; the 
contractions exhibit the forms of oscillating movements, or of clonic 
spasms, or they are tonic, and of the nature of trismus ; the jaws are 
locked, as in tetanus, during the attack.” During the paroxysm there is 
redness, puffiness, and sometimes paleness and blueness of the affected 
side of the face, caused by excitement of the vaso-motoric nervous 
fibres. In some cases the cheek becomes ocdematous, and collapses 
after the paroxysm passes. The arteries of the affected side pulsate 
more strongly, and the veins swell. When the opthalmic branch is the 
seat of the affection, the conjunctiva becomes red, and the tears flow TIC-DOLOUEEUX. 
483 
profusely; in neuralgia of the maxillary branches the salivary secre- 
tion is increased. 
When the attack is violent it is usually of shorter duration, some- 
times only a few minutes, rarely over fifteen. The intervals between 
the paroxysms may last for hours, days, or even months, during which 
there is entire freedom from pain. The paroxysms usually inci'ease in 
frequency from the time of their origin ; and after some years the pain 
is seldom perfectly absent. During sleep the attacks of pain seldom 
occur. {Hartmann.) 
• The affected nerves are sometimes so sensitive that the paroxysm is 
excited by the least emotion, contact, pressure, exposure to cold air 
motion of the facial muscles by talking, chewing, yawning, sneezing, or 
even by merely thinking of an attack. {Hartmann.') We have seen in 
one case the most dreadful paroxysms excited in a lady by a fly light 
ing on the side of the face. Cannstatt says amusement may keep ofl 
the paroxysm for a time. 
Diagnosis.—Distinguished from sympathetic affections by its being 
“ confined to a certain distribution of nerves; its occurring in 
paroxysms separated by free intervals: in sympathetic pains there is 
change of seat, and extension of their range, and the pain is a mask to 
some other complaint, such as disease of the facial bones ; when this 
becomes worse, the facial pain increases in a corresponding ratio. In 
a case detailed in Yol. X. of the Jour, de Medecine, the disease origi- 
nated in a wound of the arm, and was cured after two years spent in 
torture, by cauterization of the cicatrix. The case quoted from Swan 
(p. 21), is of an analogous character.’’’ In true neuralgia of the fifth 
pair of nerves the sensibility to slight contact is exquisite; whereas 
strong pressure may even diminish the pain. This disease is extremely 
rare and confined to persons who have passed the thirty-fifth year. In 
anaesthesia dolorosa of the fifth pair the painful surface is insensible 
to irritation; in tic-doloureux the surface is morbidly sensitive to con- 
tact. {Romberg, Diseases of the Nerves. Vol. l,y>. 49.) 
Causes.'—Tic-doloureux like nearly all nervous affections is here- 
ditary ; is most common among females, near or past the middle of 
life ; it is developed by constitutional nervous irritation; chlorosis, 
hysteria, hypochondriasis; frequent and strong mental emotions, as 
chagrin, grief, care, &c.; all menstrual irregularities ; losses of blood 
or other debilitating discharges ; malaria. Local causes : wounds, con- 
tusions, &c., affecting the nerves ; splinters and other foreign bodies 
ulcers ; abuse of washes containing poisons ; affections of the teeth and 
abdominal organs; suppressed chronic eruptions, as itch, herpes, sup- 
pression of habitual discharges ; arthritis; psoric, carcinomatous or 
syphilitic dvscrasia. The chief cause of this disease is atmospheric 
change—from heat to cold, moist and dry. The face is imperfectly 484 
DISEASES OF THE NERVOUS FUNCTION. 
protected. Mental emotion often powerfully affects the nervous sys- 
tern of the face. In no disease is the face the index of internal disease 
so perfectly as in neuralgia. The pain speaks plainly and feelingly 
for itself. (Morgan) 
Pathology.—Tic-doloureux is essentially an affection of the termi- 
nal branches of the fifth pair of nerves—the trifacial. This nerve 
arises by two roots from a tract of yellowish white matter in the front of 
the floor of the fourth ventricle. It passes forward to the petrous por- 
tion of the temporal bone, where it spreads into the gasserian ganglion. 
This ganglion divides into three main branches : the ophthalmic, 
superior maxillary, the inferior maxillary. The first gives off nervous 
filaments called the frontal, lachrymal and nasal, besides other fibres tf 
parts surrounding the orbit. The superior maxillary passes forward, 
and leaves the cavity of the cranium through the foramen rotundum. 
It leaves the spheno-maxillary fossa, passes through the canal in the 
floor of the orbit, and emerges at the infra-orbital foramen, where it 
divides into branches to supply the muscles and integuments of the 
face. This nerve gives off in its course orbital, dental, muscular, and 
cutaneous branches. While crossing the spheno-maxillary fossa it 
receives two ascending branches from Meckel’s ganglion; by which 
branches the nerves of the face communicate with the great sympa- 
thetic tract. The third, or infer-maxillary, leaves the cranium by the 
foramen ovale, and divides into the internal and external branches; the 
first gives off four or five filaments which are distributed to the tempero- 
maxillary region, consisting of the masseter, temporal, buccal, &c.; the 
internal divides into the gustatory, infer-dental, and anterior auricular 
{Morgan) 
Other nerves often become involved in facial neuralgia. The portio- 
dura of the seventh pair is often affected, either by the exciting cause 
or through the proximity, intertwinings and inosculations that exist 
between this and the facial nerves. 
Romberg says, “ There is no nerve of sensation whose activity is so 
frequently called into play as the trigeminus ; the number of filaments 
at its point of insertions, allows the assumption that its cerebral con- 
nections are the most extensive of all. This accounts for the frequency 
and ease with which sympathetic affections are excited in the nerve, 
and for the difficulty of distinguishing them from genuine neuralgic 
conditions. {See Diagnosis) There are cases in parturient females 
which exhibit the true neuralgic character; and yet, which terminate 
the moment parturition is passed. [Hunt, Brit. Jour, llomoeo. 
1855. p. 589.) In some the pain in the face or temple is synchronous 
with the uterine contraction; in others the uterine contraction alternates 
with neuralgic pain in the face or head, in others again the normal con- 
traction ceases suddenly, and puerpural convulsions supervene. TIC-DOLOTTREUX. 
485 
The disease is constitutional when it attacks the system generally 
or some remote part without apparent cause. Local when seated in or 
near the affected part irritated by some foreign substance. 
1. Local Neuralgia. The infra-orbital nerve is generally the seat 
of this painful disease. The character of the pain is peculiar, and its 
course corresponds exactly with that of the nerves. The second branch 
of the fifth pair appears to betmost commonly affected. The second 
and third generally partake of the disease in its severer forms. In 
some persons the forehead, temple, inner angle of the eye of the side 
affected and even the eyeball become the chief seats of pungent agony ; 
W'hile from irritation of the lachrymal gland the eye weeps involuntarily. 
It has often resisted medical treatment for years, continuing unabated 
after division of the affected nerve. 
The branches of the facial nerve, and also the different ramifications 
of the fifth pair are the common seat of neuralgia; but it is mainly 
through the agency of the latter that the poriio dura becomes sensitive 
Recent experiments have proved beyond a doubt that the sensibility of 
the facial nerve is not inherent to it, but borrowed; for irritants ap- 
plied to the facial nerve within the cranium, before its entrance into 
the auditory foramen, give rise to twitchings only, and not to pain.* 
When pain is experienced around the alae nasi and lip, the branches 
of the superior maxillary are those involved. Pain darting across the 
forehead from the superior and inferior part of the orbit, indicates a 
derangement of the supra and inferior orbital nerves. If the loss of 
sensation affects a portion of the facial surface together with the cor- 
responding facial cavity, the disease may be assumed to involve the 
sensory fibres of the fifth pair before they separate to be distributed to 
their respective destinations-! 
Prognosis.—This disease is not dangerous, but recovery is slow, 
varying according to its duration, the manner of its origin, and age of 
the patient. It is more curable when from a rheumatic or malarious 
source than when connected with gastric derangement. Still more 
obstinate are those from suppressed impetigo, gout, or cachectic dis- 
eases. Cases‘depending on organic alterations of the nerves, brain, 
and bones are generally incurable. Those are doubtful also in which 
the attacks succeed each other rapidly. Tranquility of mind, absence 
of care, a confident, quiet mood, and intellectual amusements, facilitate 
recovery. (Hartmann, p. 26.) 
Treatment.—The principal specific medicines for the cure of neu- 
ralgia, are : Arsenicum, Belladonna, Colocynth, Nux-vomica, Aco- 
nite, China, Arnica, Bryonia, Calcarea-carb., Ilepar-sulpjh., Phos- 
phorus, Acid-hydrocyanic, Pulsatilla, Sepia, Sulphur, Spigelia, 
* Romberg, p. 31. 
f ibid, page 211. 486 
DISEASES OF THE NERVOUS FUNCTION. 
Stramonium, Afercurius, Sticta, Pulmonin, Cannabis-ind., Codeine, 
Opium, Ignatia, Agaricus-musc., Ilyoscyamus, Chamomilla, Apis, 
Cedron. 
In all its forms neuralgia generally requires large doses of the spe- 
cific medicine, including the numerous elements that arise from nervous 
irritations and intermittent diseases, especially fever and ague. 
Aconite.—Inflammatory neuralgia of-the fifth pair; pain continuous, 
throbbing, stitching in the nerve and surrounding parts, with alternate 
heat and chilliness; rheumatic cases, with intolerable pain, burning, 
tingling, stitching in the paroxysms, with great nervousness, as if occa- 
sioned by an internal ulcer. Morgan gives a case of neuralgia of the 
three branches of the fifth pair, and portio dura of the seventh in a 
lady aged forty-two, who had been treated by other systems of treat- 
ment for eight or ten years without relief. Pain confined to one side 
of the face, arteries throbbing furiously, eye sparkling, protruding, 
conjunctiva engorged, pain producing hideous contortions of features, 
bounding, buzzing pains shoot through the ear, to the temple and side of 
the neck, followed by profuse salivary discharge, head and articulation 
of lower jaw fixed; gastric derangement, constipation, fever. She was 
relieved by Aconite followed by Sulphur, and the dyspeptic symptoms 
disappeared. 
Aconite is the specific remedy for neuralgia, according to Ilempel. 
Aconite may often be employed with great advantage in neuralgias 
accompanied by great erethism of the vascular system, flushes of 
heat, congestion of the head, chest, and heart. Whenever the function 
of the heart appears to be affected in neuralgia, this remedy vrill gene- 
rally prove useful. 
Belladonna.—This medicine is well adapted to the “ diseases of 
women and children, whose nervous systems are in a state of erethism.” 
The external indications are: sanguine and choleric temperament; 
general appearance indicative of a full and plethoric habit; cheeks 
red and swollen; eyelids spasmodically closed; spasms and startings 
in different parts of the body; distortion of the face; trembling and 
frigidity of the limbs. 
Great sensitiveness to cold air and light; headache, compelling to 
close the eyes; acute throbbing pains in the forehead; semi-lateral 
headache ; pains aggravated by movement, noise, light or eold air: lan- 
cinating pains in the orbit; spasms of the eyes; violent stitches in the 
parotid gland, extending to the external and internal ear; roaring in 
the ears; paroxysms of tearing, digging toothache; toothache of preg- 
nant females ; neuralgic pains darting from the side of the face to the 
teeth and ears, of a tearing, or lancinating or digging character, with 
heat and redness of the part affected; toothache occurring after eat- 
ing, from contact with cold air, from study, from pressure upon a de- NEURALGIA. 
487 
cayed tooth, from eating, and from swelling and ulceration of the gUms; 
darting pains in the lower jaw and in the glands of the affected parts 
from a decayed and hollow tooth; toothache with drawing in the ear; 
neuralgia affecting the crural nerve; cutting, darting, and tearing in 
the left thigh when sitting; lancinating pains in the right thigh when 
sitting; tearing and lancinating pains in the region of the tibia, ex- 
tending to the calf of the leg and sole of the foot; neuralgic pains in 
the back and shoulder. 
Anguish; despondency; great irritability; vertigo; confusion of 
ideas; delirium, inclination for firm pressure upon the head, which 
affords relief, while slight touches increase the pains. 
Inflammatory and nervous cases with paroxysms of long duration, 
commencing with a troublesome itching and titillation in the affected 
part, changing to violent lancinating pain, or aching, crampy tearing, 
drawing pain in the malar and nasal bones; the pain is always seated 
on one side ; often it follows the course of the infra-orbital nerve, when 
it changes to intolerable, violent, cutting pain; it is frequently accom- 
panied with increased secretion of tears and saliva; also stitching and 
tensive pains, with spasmodic closing of the jaws, and painful stiffness 
of the neok. 
Administration.—A drop of the second or third dilution on sugar 
or water every half hour, until a decided impression is produced. 
Morgan gives several cases of neuralgia cured by Belladonna. The 
pain in all was seated in the maxillary branches of the fifth pair; and 
in some involved the portio-dura of the seventh pair, being confined in 
all cases to one side. In some the pain was mitigated the first day. 
In some- other remedies were alternated with the Bell. In one case 
galvanism, iron, quinine, chloroform, morphia had been tried, without 
benefit. Bell. 3, gave some relief but failed to cure, though nearly all 
the symptoms above given of this remedy were present. As the pa- 
tient lived in a malarious district, Arsenicum 3 was alternated with the 
Bell, every twelve or twenty-four hours for some weeks. This led to 
final recovery. 
In a large proportion of cases usually treated as neuralgia and con- 
fined to the fifth pair of nerves, we have succeeded by giving Aconite, 
of the third, fifth, or higher potencies alternated with Bell., of equal 
strength, and have generally repeated the remedies at short intervals, 
of one, three or more hours. In other cases pursue the Aconite alone 
for some hours, following it with Belladonna in the same way. 
Coffea, Coffee.—Coffee, says Dr. Teste, “ is responsible for perhaps 
six or seven-tenths of the neuralgias we have to treat daily.” That it 
does cause this morbid condition of the nerves is certain. That it does 
not do so in all is only explained by referring individual peculiarities 
to some characterestic idiosyncracy peculiar to each individual. Of 488 
DISEASES OF THE NERVOUS FUNCTION. 
this Teste says: “Notwithstanding the divided idiosyncrasies in the 
human species, with very rare exceptions, the action of each drug varies 
rather by the intensity, than by the form, of the symptoms that reveal 
it. 2. The Hahnemannian dynamization of medicines has the virtue 
of disengaging their powers, and of giving to their proper or primary 
actions the ascendant over those which consist only in simple reactions 
of the organism. Thus : “I have seen patients unaccustomed to coffee, 
unconscious of any kind of sensation from it, and who continued to 
drink it during their treatment, highly susceptible, nevertheless, to 
crude coffee in the sixth or twelfth dilution. 3. The degree, however 
variable of susceptibility to the action of drugs, or to some peculiar 
drug, does not impair the justice of the fundamental law of homoeopa- 
thy. Thus, Hahnemann, with his admirable acumen, seized and inter- 
preted those individual symptomatic shades, always independent of the 
drug experimented upon, and in which I had long apprehended an in- 
firmity in our doctrine. Hahnemann, on the contrary, enlightened by 
clinical experience discovered in them the general relations of each 
drug or group of drugs, with a certain physiological personality, sex, 
temperament, color of the eyes and hair, moral propensities, (&c.) 
Tobacco.—Dr. Van Archen of Bogota, New Granada, says there is 
a peculiar kind of neuralgia which occurs only in people who have 
worked for years in tobacco factories, and are also habitual smokers. 
In these the body becomes so thoroughly saturated with nicotin, that 
occasional twitching of the muscles of the face occurs, which ultimate- 
ly becomes an agonizing pain, making the patient scream in horror. 
He found numerous instances of it in San Domingo, San Salvador, and 
Ambalema, all tobacco countries. No antispasmodics or narcotics 
wrnre found to palliate but rather to aggravate the pain. {Am. Medi- 
cal Monthly.) 
A deranged state of the digestive organs is a universal attendant on 
this disease. Sometimes the masses of medicines given to restore the 
digestion to a healthy state become transformed into newr substances 
by the deleterious gases formed in the decaying teeth and gums. It is 
then indispensible to remove the old stumps and cure the offensive ul- 
cerated gums before the digestion can be restored or the symptomatic 
neuralgia cured. 
Arsenicum.—Temperament, leuco-phlegmatic, lymphatic or bilious 
and choleric or nervous, with disposition to melancholy ; general appear- 
ance of debility and exhaustion ; countenance pale and sunken, or 
bloated and red; features distorted, lips bluish; twitchings of the 
muscles of the face, lips and eyelids ; tongue white; coldness of the 
extremities; anasarca; emaciation; trembling of the limbs; cramps in 
the extremities ; pulse small. 
Paroxysms of excruciating pain in the head, particularly in the fore- NEURALGIA, 
489 
head over the root of the nose,—over the left eye,—in one side of tho 
head,—in one eye : pains aggravated from the slightest movement or 
touch; scalp sensitive to touch or motion of the hair; roaring in tho 
ears during the pain; mouth dry; thirst or adypsia; bad taste in the 
mouth; aversion to food; nausea; eructations ; hiccough ; pressure, 
heat or burning, or cramp-like sensations in the stomach; drawing and 
cramps in the arms and legs; cramps in the fingers; rigidity of the 
hands; violent lancinating pains in different parts of the body, aggra- 
vated by movement or touch, attended with paralytic weakness, con- 
tractive sensations, faintness, coldness, shuddering and trembling. 
Fits of violent anguish; fear; dread, with tremors ; impaired memory; 
inability to think or collect the thoughts ; dizziness ; vertigo ; general 
uneasiness. 
Administration.—A dose of the second or third trituration, every 
half-hour, until an aggravation or amelioration of the symptoms occurs. 
Rhus.-tox.—Tearing, or jerking, or prickling, or drawing, or sticking 
pains in the extremities, accompanied by stiffness or lameness, or numb- 
ness, and sometimes followed by a paralytic condition of the affected 
parts. Causticum presents a similar group of symptoms, and may be 
employed when Rhus, does not respond satisfactorily. 
Agaricus-musc.—Spasmodic,. or cramp-like pains in the limbs, 
worst when the body is at rest, relieved by motion, and the pains 
changing from side to side. Drawing or stitching pains in the head, 
shifting from side to side. 
Conium-maculatum.—Jerking, or cramp-like, or spasmodic, or 
pulsative pains in the back, or chest, or jaws, or the upper and lower 
limbs, with great depression of spirits, lassitude, and sense of exhaus- 
tion, worse during the night, and when at rest. 
China.—Neuralgia of malarious origin, “ stitching pains with pres- 
sure, or fine beating pains in the right malar bone and right side of the 
nose, aggravated by contact,” or increased to a frightful degree by it; 
nervous and rheumatic neuralgic pains ; stitching pains in the malar 
bone which disappear by pressure ; tearing with pressure, and cutting, 
burning in the upper-jaw. {Ilartmann.) 
The true sphere of China is the periodic. The attacks which 
are strictly periodical, recurring at a certain hours each day, or each 
alternate day, are perhaps always of malarious origin. In these, when 
not complicated with decayed teeth or pressure of-bone on a nerve, we 
have always succeeded with Sulphate of Quinine in one-grain doses, 
repeated every two hours. There are some forms of congestive ma- 
larial fever in which neuralgic pain of the face or temple is the most dis- 
tressing symptom in which quinine alone is not successful. (See Yol. 
I. p. 490, under Intermittent Never.) 
Neuralgia.—Intermittent form.—Remedies: Chin., Ced., Ars., Op. 490 
DISEASES OF THE NEKVOUS FUNCTION. 
Cedron. Neuralgia coming in regular periodical paroxysms. It 
is, says Dr. Casenova, one of the drugs which should be administered 
as a unit or single dose, either as a curative or prophylactic force, and 
not to be repeated, except at long distances from the first. One 
single dose of the potency suitable to the individual respectively will 
always be quite enough to produce the desired effect; whereas, if seve- 
ral doses be given, at short spaces from each other, to persons of great 
impressibility, they will surely aggravate the case, and perhaps pro- 
duce pyrexial attacks, as I have often seen.” One grain at a dose of 
the 3° decimal has often succeeded in periodical tic., or prosopalgia 
Sanguinaria, 200°, according to Dr. Wolf, “ is the remedy for that 
severe one-sided headache extending into the sinus frontalis, which 
quinine never cures. Corrosive sublimate removes it quickly; but it 
generally returns after some time in an aggravated form.” 
Veratrum.—Pain drawing and tensive, spreading over the right 
half of the face ; recurring in paroxysms; slight delirium; the part 
swrells after cessation of the pain. 
Spigelia.—Intermittent and nervous prosopalgia, deep-seated in the 
orbit, making the eyeball appear too large, especially when moving the 
eyeball or facial muscles; intense painful pressure, and digging stitching 
in the ball. The prosopalgia, properly so called, is characterized by 
pressure and burning, particularly in the malar bone ; all motion or 
contact, anguish of heart, great uneasiness, and pain felt only on one side. 
Colocynth.—Dr. Watzke remarks as follows respecting the therapeu- 
tic action of Colocynth in neuralgic affections : The curative sphere of 
Colocynth in the new system is almost confined to a. few neuralgias and 
hyperasthenice, and of these, almost exclusively those which affect the 
trigeminus, the cceliac plexus and the lumbar and femoral nerves. 
First: the hemicrania and prosopalgiae which Colocynth cures, pro- 
ceed from an exaltation of sensibility, dependent on rheumatic, gouty, 
or gastric irritation, or on congestion of the fifth pair of nerves, in all 
cases on a purely functional affection of the sensitive filaments. 
Colocynth is of no use in organic prosopalgiae, from growing out of 
the teeth, hypertrophy of the bones of the skull or face, tumors, &c. 
“ Second: The neuralgia of the coeliac plexus and its branches, are 
particularly likely to be quickly and permanently removed by Colo- 
cynth, when they occur as substantive affections, not caused by 
derangements of the stomach, but by cold, vexation, or anger, occurring 
during the period of evolution; complicated with spinal .irritation and 
neuralgia of the great nerves of the thigh, with haemorrhoids, chronic 
diarrhoea or vermicular symptoms.” 
Colocynth is adapted to dry, bilious and choleric-melancholy tem- 
peraments. It is especially suitable in cases of neuralgia confined to 
certain parts of the left side of the body. The paroxysms are usually NEURALGIA. 
491 
attended with spasms, twitchings, and contractive sensations; and the 
lancinations are sudden, violent, and extend to a distance from the 
starting point. 
Administration.—A drop of the third dilution of water, every 
hour, until its elfects are apparent. 
JVux-vomica.—Temperament sanguine or choleric ; disposition lively 
artful and malicious; face pale or highly colored; contractions of the 
hands and feet; coldness of the body, especially after drinking; 
trembling of the limbs ; fainting fits ; spasmodic twitchings in different 
parts of the body; better adapted to males than females. 
Periodical and intermittent pains; excessive sensibility of the 
affected parts to external impressions of all kinds; periodical headache 
every morning after rising, increasing until noon, then gradually 
diminishing until night, when the pain ceases ; the pains are drawing, 
tearing, compressive, affecting the whole head, or forehead, or the part 
just above the root of the nose; headache, accompanied with confusion 
of ideas, nausea, bitter eructations, vomitings, constipation; scalp 
painful and sensitive to touch or cold air; tearing pains in the facial 
and infra-orbital nerves; ringing in the ears; toothache in sound and 
decayed teeth ; pains of a sticking, drawing, tearing, jerking, or dig- 
ging character, aggravated by cold air and drinks, by study and medi- 
tation, and relieved by rest and warmth; toothache from cold, and 
from extraction of a tooth; swelling of the gums; drawing toothache 
in a hollow tooth, with pains attended with violent, cramp-like contrac 
tive and tearing pains in the stomach; pleurodynia; contractions and 
cramps in the hands, feet, and limbs; coldness of the hands and feet; 
painful contractive sensations throughout the body; faintness ; langour, 
and indisposition to mental or physical exertion; great sensitiveness 
to external impressions ; melancholy; sadness ; apprehension; anxiety; 
petulency; indisposition to mental exertion. 
Administration.—This medicine may be employed in the same 
manner as Belladonna. 
When neuralgia has arisen from excessive loss of the fluids of the 
body, we may refer to China, Phosphorus, Calcarea, Carb., Sepia. 
When the disease appears to be connected with scrofula, exostoses 
of the bones, chronic cutaneous affections, abuse of mercury, consti- 
tutional syphilis, glandular and other tumors, reference should be made 
to Sulphur-mercurius, Hepar.-sulph., Sepia, and Aurum-mu- 
riaticum. 
In neuralgic attacks of the heart or stomach, or uterus, our best 
remedies are JVux-vomica, Acid-hydrocyanic, Pulsatilla and 
Colocynth. 
Neuralgia from mechanical injuries, will commonly yield to Arnica, 
Aconite and Calendula. 492 
DISEASES OF THE NERVOUS FUNCTION. 
For a more particular description of the neuralgic symptoms per- 
taining to certain organs, and the mode of treatment, we refer to the 
diseases of the different organs and tissues in other parts of this 
worjj. 
Administration.—A wide range of attenuations should be em 
ployed in neuralgia, in order that we may adapt our remedies precisely 
to the degree of erethism present in each particular case. When the 
pains are very acute, the dose may be repeated every hour until relief 
is obtained, or until medicinal aggravation admonishes us to discon- 
tinue the medicine. 
Chelidonium.—Dr. Francesco Ferinat, of Madrid, gives some 
clinical experiences with it in neuralgia.* It may yet become as 
popular again as it was in the time of Dioscorides, when it was said to 
be used by the swallows for restoring sight to their young who happened 
to become blind. 
Dr. Ferinat says he has been successful with it in “acute inflamma- 
tion of the eyes, when the organ is swollen, injected; with a sensation 
of burning as if from a foreign body—when there is excessive photo- 
phobia, lachrymation, abundant sebaceous secretion, agglutination of 
the eye-lids in the morning, shiverings from time to time, pain, which 
generally extends not only to the forehead, but sometimes over all the 
head; this pain, beginning to be felt towards two or three, p. m., is at 
its height about eight or nine, and prevents sleep or even lying down 
till nearly day-break.” 
This author proposes to show the efficacy of Chelidonium in neural- 
gia of the temple and eye-brow, chiefly of the right side. Boenning- 
hausen thinks the action of this remedy is more fully shown on the 
right than on the left side, but Ferinat says he has seen its effects 
well marked on both sides. 
A woman, aged 64, small, lymphatic, with fair skin, gray eyes, and 
fickle character, every day about nine, a.m. She felt in the right eye- 
brow and temple a pulsative pain, which gradually increased until it 
became intolerable; it extended to the forehead, and became tearing 
round the orbit. The eye was injected, burning, watery, and exces- 
sively sensitive to the light; the eyelids were contracted. Pressure 
with the hand relieved for a little; whereas light, movement, and free 
air aggravated the pain. The patient had yawnings and shiverings 
during the paroxysm. Chelidonium removed the attack on the second 
day of its administration; it returned six months afterwards, but with 
less intensity and yielded to the same medicine; no return after, for a 
year and a half. 
From other cases Dr. Ferinat concludes, that Chelidonium is a 
* Bulletin de la Society Medicale. Brit. Journal Homoeop., Jan., 1862. NEURALGIA. 
493 
“ most useful remedy for removing neuralgic pains of the. eye-brow 
and temple, especially of the right side, but sometimes of the left 
that it is applicable to all ages, sexes and temperaments, at short in- 
tervals, between the paroxysms. The characteristics of the pain must 
be generally pulsative and burning, or less frequently lacerating and 
tearing. The attacks are periodic, preceded generally by yawning 
and shivering, occasionally continued during the paroxysm, and ter- 
minating most frequently by perspiration, sometimes sour. It “ always 
begins in the eye-brow and temple, extending chiefly, in proportion as 
it becomes more intense, to the forehead, the orbit, and the eye of the 
same side; the eye becomes injected, at times prominent, and very 
sensitive to light.” Pressure with the hand “ relieves the pain slightly; 
while light, fresh air, movements of the head, especially stooping, 
aggravate it.” 
Galvanism.—Mr. Lubb regards Pulvermacher’s chain as the only 
apparatus that can be adapted to the surface of the body, and capable 
of generating a sustained current, producing a continuous current of 
galvanic electricity of one uniform direction, mild, yet sufficiently 
energetic for medical purposes; strong enough to decompose wire, excite 
contractions of the muscles, &c. He regarded it as specific. Imme 
diately upon adapting the exciting chain to a part, the patient is aware 
of the presence of the life-giving agent, and immediately says he ia 
relieved. The neuralgia disappears, and sensitiveness of the surface 
returns. 
Electro-Magnetism. — ( See Paralysis.) Case by Dr. II. Pass- 
ing, of New-York. Madame C., aged 48 ; general health good, but of 
a delicate habit; was afflicted with neuralgia, seated in the brachial 
nerves, for three years, evidently owing to a blow from a falling brick 
she had received on the shoulder. Partial paralysis of the arm had 
also taken place. The positive pole was applied, through a wire brush, 
along the course of the external branches of the nerves of the arm 
downward, and in one direction only for fifteen minutes each day. Co- 
nium was applied externally, mild purgatives and Cinchona and Gentian 
given internally; after eight applications this patient entirely re- 
covered the use of the arm, and has ever since been free from pain. 
In rheumatism, “in conjunction with constitutional treatment, I pass 
a current through the affected parts. If the cui’rent is direct, it soothes 
and relieves the pain; and when the to-and-fro current is used, it sti- 
mulates and warms. I have found it the best local application, with 
the quickest results.” 
Cannabis-sativa.—Dr. Quin says that when neuralgia arises from 
a disordered uterine system, Cannabis, Ignatia, Pulsatilla, Thuja, and 
Veratrum are specially indicated. He gives a case: [Brit. Jour, 
Homoeop., Vol. IY.) 494 
DISEASES OF THE NERVOUS FUNCTION. 
“A woman suffered from neuralgia; the pain which was in the cheek, 
was like that of a violent and repeated pressure from a blunt instru- 
ment. The attacks were accompanied by sickness and nausea, and 
violent vomiting came on in two hours before the cessation of the par- 
oxysm. During the attack, large flow of light-colored urine; flatulence, 
distention of the abdomen and borborygmi; face pale and sallow ; she 
is very weak, tongue tremulous; catamenia much too profuse almost 
amounting to flooding, and continuing ten or twelve days. Cannabis- 
sativa 30° was prescribed. Improvement followed in a few days ; ca- 
tamenia occurred rightly, as to quantity, &c., for the first time in twelve 
years. A few doses of Aconite and Chamomilla subsequently required 
for diarrhoea, but Cannabis alone sufficed for the cure of the affection.” 
The case was considered one of “ neuralgia dependent on sympathy 
with uterine irritation, partaking of the nature of Clavus hystericus.” 
&Uictapulvionaria has been used with much success by several of 
our medical friends in the cure of facial and frontal neuralgia. It is 
especially useful when the pains affect one side, and shoot from the jaws 
to the face and side of the head. 
Apis has cured several cases of severe neuralgia of the head and 
face, accompanied or succeeded by impaired memory. 
Gannabis-indica is a valuable remedy in cases of neuralgia occur- 
ring in weakened and exhausted subjects, especially when accompanied 
by optical illusions and alternations of exalted spirits and extreme 
mental depression. Codeine and Opium are indicated in similar at- 
tacks. 
Coffea will prove highly serviceable in neuralgic affections accom- 
panied by great nervous excitability, sleeplessness, and mental activity. 
Complications of Neuralgia.—The irregular forms and compli- 
cations of neuralgia are very numerous, and may be briefly noticed. 
They often arise from some irritation, near or remote, which may be 
easily overlooked. Thus constipation, with or without gastric derange- 
ment, causes or increases cerebral plethora. Dr. Parry supposes that 
neuralgias of every form arise from increased vascularity of the 
nervous neurilemma, the extremities of which are the seat of the dis- 
ease ; others refer the pain to a similar condition of the nerve at its 
origin. Hemiplegia, though transient and partial, is often connected 
with epileptic paroxysms. Loss of some of the external senses in 
these can only be explained by reference to the state of irritation or 
congestion at the origin of the nerves. 
The face is more largely supplied with nerves than any other par 
of the body; it also exhibits more of the moral and physical pheno- 
mena of nervous irritation. 1. We see here acute pain in one point, 
caused by irritation at the root of a painless, though not insensible tooth . 
the real disease being felt at the sentient extremity of a nerve, con- NEURALGIA. 
495 
nected only through the brain with the sentient extremity of the nerve 
which supplies the tooth. 2. In cejphalea sjMsmodica, or sick headache\ 
there is a temporary cerebral plethora and pain, generally seated in 
the upper branches of the facial nerves of the same side. 3. Cephalea 
hemicrania or periodical headache is often met with in persons who 
have never lived in malarious districts, and who for years are repeat- 
edly attacked by it. 4. Neuralgia ophthalmia is one of the most pain- 
ful forms in wThich neuralgia ever appears. We have seen some cases 
which originated in the irritation of a tooth, which resisted all treat- 
ment until a slightly sensitive tooth was extracted. The sensation of 
extracting the tooth, which in one case was quite loose, was felt in the 
inflamed eye. Recovery was immediate, without any further treat- 
ment. 5. Dyspeptics are liable to spasmodic twitchings of the eyelids 
of one side, which may pass nearly into a temporary paralysis affecting 
the motor nerve only, as the affection is without pain. 6. Palsy of one 
side of the face and tongue may. appear in the same muscles that are 
supplied by the nerves which are the seat of the pain in tic-doloureux. 
The affected side loses its expression ; the cheek grows smooth and 
sinks downward; the eyelid droops and does not cover the ball in sleep; 
the tongue, when projected, turns towards one side : and the opposite 
angle of the jaw is drawn back. 
Pathology—The fifth pair of nerves, and occasionally the portio-dura, 
of the seventh pair are the seat of all these anomalous forms of 
neuralgia. They are much exposed to moral as wTell as physical 
agencies. External impressions are transmitted to the cerebral 
centres of the nerves. These central extremities are declared by Dr. 
Gall to be surrounded by a mass of cineritious matter, which seems to 
be little less than a congeries of blood-vessels. It is, says Dr. Drake, 
“ extremely probable that when a nerve is excited to perform its ordi- 
nary functions, there is an increased determination of blood to this 
cineritious substance.” And when this increased determination is fre- 
quently repeated, the point on which it is pressed receives a larger 
proportion of the sanguineous fluxion than the cineritious roots of the 
nerves. The state thus induced is one of predisposition. 
It is through this portion of the fifth nerve, which gives external 
sensations from the face to the brain, that that keen perception of 
heat and cold is communicated, by which a few drops of water in syn- 
cope revive the energies of the whole system; and, also, through the 
same channel the body and mind are invigorated by washing in the 
morning, or after fatigue. The minute fibres of the nerve impart acute 
insensibility to the teeth, associate the salivary glands with the tongue, 
endow it with the specific sensibility to form the organ of taste ; they 
give to the retina its sensibility to light, cause it to contract when 
light is too strong; and, in the nerves establish that well-known 496 
DISEASES OF THE NERVOUS FUNCTION. 
relation between the taste and smell, and preserve the Schneiderian 
membrane in a proper state for the exercise of the olfactory branches. 
[Drake, Wes. Med. and PJiys. Jour., Vol. I. p. 1.) 
Nervous headache is a sympathetic affection, and the concomitant 
result of some deep-seated disturbance of the organism. The vege- 
tative system is generally in fault—stomach, liver, bowels, and 
especially the uterus in females. It is often dependent on an overtasked 
brain. Aconite usually palliates, and generally does not prevent the 
due action of specifics. 
1. NEURALGIA FROM LOCAL IRRITATION. 
Sir H. Halford-has made some publications to illustrate the history 
of neuralgia, which he thinks is generally connected with the depo- 
sition of bone in places where it does not commonly exist, or a preter- 
natural growth of bone in a diseased state. In a case of a lady, aged 
forty, after the resources of the faculty were exhausted, a tooth was 
extracted which had no external marks of disease. A large exostosis 
wras found at its root. The neuralgia gradually subsided into a less 
severe form, returning less frequently and with less pain. An English 
nobleman suffered from this disease in its most marked and painful 
form. All treatment was unavailing for two months and a half; at that 
period a portion of the bone enclosing the maxillary antrum exfoliated 
the Duke speedily recovered, and had no return. The bone had beer 
injured by a fall from a horse many months before. The Earl of C 
endured inexpressible agony from this disease for many years ; and sub 
mitted to the excision of parts of various branches of the fifth pair of 
nerves by the hands of Sir Everard Home and Sir Charles Bell, with only 
temporary relief. At length, seized with apoplexy, he lay for some days 
insensible ; and after recovering from this he suffered less; but he was 
never cured, and only died of old age. Repeatedly did the separation 
of portions of exfoliated bone show the source of his sufferings ; and 
yet the only relief he obtained was from the apoplectic attack, which 
partially paralyzed the nerves of sensation. A distinguished phy- 
sician endured all the agonies of martyrdom during many years, and 
at last died of apoplexy. No treatment had ever afforded him any 
relief, though several branches of the nerve were divided. On dissec- 
tion the frontal bone was found of unusual thickness above the frontal 
sinuses. On the falciform process of the dura mater was found a 
small osseous substance of three-fourths of an inch in width, and a 
line in thickness. Y. Med. PJiys. Jour., 1827.) 
Extreme pain in various parts of the face may be excited by decayed 
teeth, which in themselves are not painful, and will usually cease 
entirely on the extraction of the teeth. NEURALGIA, 
497 
2. DENTAL NEURALGIA. 
Cases caused by Local Irritation or Pressure on a Nerve.—1. In 
a case of fourteen years’ standing, the anterior maxillary foramen, at 
which pain had been felt, was found to be almost entirely closed by an 
osseous deposit, consequent upon the formation of an alveolar abscess 
contiguous to it. Dr. Fundenburg, of Pittsburg, exposed the foramen 
by incision, and drilled out the bony deposit: the nerve was freed from 
pressure, and the patient entirely recovered. 
2. A well-marked case of facial neuralgia: The teeth not suspected 
as the cause of it. But, on tapping a superior bicuspis, the patient 
screamed with pain. The tooth was extracted, and a large exostosis 
was found at the end of the fang, the patient was cured. 
8. A case of two years’ standing: There was “a singular pain in the 
side of the head, accompanied by a darting pain in the lower-jaw,” 
extending down the neck and side. Pain excited by tapping an inferior 
cuspidatus—the tooth was extracted—“ a large osseous deposit was 
found on the fang,” and the patient was relieved. {Louisville Med. 
Jour., 1840, p. 386.) 
4. A colored girl, aged twenty, general health good, except pain in 
the face, near the articulation of the jaw, and forwards towards the 
angle of the mouth; side of the head and down the neck backward 
towards the trapezius muscle, and to the point of the shoulder. Pain 
paroxysmal; worse at night; no fever; clearly neuralgia, not rheumatism. 
She had been treated with purgatives, blistered by concentrated Spirits 
of Ammonia over the seat of the facial nerve; took acetated Tincture 
of Opium. Veratria Ointment was tried, 15 grains to 2 ounces of lard 
for several days. The blister had given some relief, nothing else had 
done any good whatever. She took one-twelfth of a grain of Yeratria 
every four hours, continuing the ointment. Up to the fourteenth day 
no improvement. The mouth was now examined—some decayed teeth 
on the affected side; pain produced by tapping several of the teeth. 
Most severe on the first molar above. It was extracted, and at the 
extremity of its fang was a sac as large as a pea, filled with pus; the 
root carious. Some other fangs in the same state were removed*also. 
Some soreness remained several days, but no return of the neuralgia. 
{Dr. Bayles’ Louisville Naval Hospital Deports, 1840.) 
3. TRAUMATIC NEURALGIA FROM WOUNDED NERVES. 
Mr. G. Bell, of Edinburgh, gives the case of a young lady who was 
bled in the cephalic vein of the right arm. In ten days the elbow 
stood at an acute angle, and the fingers were firmly contracted. 
Extension when attempted caused great pain. The incision in the 498 
DISEASES OF THE NERVOUS FUNCTION. 
vein had firmly united, but gentle pressure gave great uneasiness 
The pain extended downwards to the fingers; and upwards along the 
inside of the arm to the axilla and clavicle. When an exacerbation 
of pain recurred, she was seized with stertorous breathing, tremors, 
subsultus tendinum, with febrile symptoms. To arrest the progress of 
the disease every palliative measure was tried in vain, and tetanus was 
apprehended. 
Operation.—An incision, three inches long, was made over the vein, 
which was displayed and tied in two places, one inch and a half apart. 
It was then divided between these two points, which caused instant 
relief, allowed the freest motions to the wrist and elbow. The patient 
recovered perfectly. Several other cases were treated in the same 
way with success. {Edinburgh Journal.) 
4. Neuralgic Ophthalmia.—This is a form of intermittent fever 
in which the pain concentrates in the nerves of the eyes, increasing 
with terrible intensity at a certain hour every day. The exacerbation 
of neuralgic pain in the optic nerves comes periodically in the place of 
a regular chill; it increases regularly through part of the day and 
evening, then subsides during the middle of the night, and is scarcely 
felt on the following morning. Day after day it continues to recur 
until it is arrested by treatment, or is changed into permanent blind- 
ness. 
Treatment.—Of all remedies Quinine is the worst here. It re- 
quires large doses to cut short the periodical paroxysms; and such 
doses always increase the pain as wrell as render permanent the in- 
flammation of the different structures of the eyes. In this manner 
permanent blindness is very often induced. The best treatment con- 
sists in Aconite and Bell, in alternation during the paroxysm; Cam- 
phor and Opium just before the next paroxysm; a warm bath at its 
commencement; and Arsen, during the interval. 
5. SICK HEADACHE. 
General Remarks.—A distressing form of cephalalgia, occurring 
most frequently in literary or professional men, and in delicate but in- 
tellectual females. It occurs most frequently in persons between the 
age of puberty and forty or fifty years. Some are peculiarly subject 
to it for a long series of years ; and many though temporarily relieved 
by various modes of treatment, are never permanently cured. 
Description.—It is common for sick-headache to commence in the 
morning on waking from a deep and unrefreshing sleep, after previous 
fatigue, mental excitement, or irregularity of diet. There is : disturb- 
ance of vision; dull and distressingly oppressive pain of the head? 
centering in one temple, most frequently the left; tenderness and fullness HEMICRANIA. 
499 
of the eye of the same side, -extending across the forehead, and some- 
times fixing itself over the inner corner of the eyebrow ; painful sensi- 
bility to light; clammy and unpleasant taste in the mouth ; chilliness 
of the skin, cold and moist hands and feet; pulse feeble, face pale 
( Wright.) 
After the pain in the head and about the eye has become severe, 
sickness at the stomach begins, and is increased by every movement, 
especially raising up ; flatulence ; retching, shuddering and vomiting 
of the contents of the stomach, or of a thin, glairy fluid of an acrid 
sour taste. The vomiting sometimes gives partial relief; and in some 
cases antacids may restore it to a more natural state. But generally 
the nausea returns ; vomiting again ensues of yellow, nauseous, bitter 
bile, with intense feeling of depression. Some .of these attacks last 
six or twelve hours, others continue for one, two, or even three days. 
And many after recovery from one attack expect only a repetition of the 
same tortures in the course of a fewT days. 
Diagnosis.—Distinguished from hemicrania by the predominance of 
the gastric symptoms over the neuralgic. It has none of the strict 
periodicity which belongs to the intermittent neuralgic disease of the 
head and eye. {Hartmann.) From dyspeptic headache by being 
more severe, by the peculiar features of the latter which are : whitish 
coat on the tongue ; fingers and toes cold and numb ; slight nausea, 
languid pulse; indistinct vision, especially before the attack begins; 
liability to begin just after eating, though often later. It occurs to 
persons of delicate digestion who give too close attention to business, 
or are excessively fatigued, worried, or anxious. ( Wright.) 
Sanguinaria often cures this form of headache when accompanied 
by persistent nausea, redness of the tongue, burning sensation in the 
throat, chest and stomach, bitter eructations, yellowness of the face and 
eyes, loathing of food and drinks. 
Veratrum-viride is useful in cases marked by extreme nausea and 
prostration, coldness of the extremities, feeble pulse, and loss of spirits 
and courage. 
Ferrum-aceticum in the lower potencies, and continued for a long 
time, has sometimes cured obstinate cases of sick headache. 
Nitric-acid and Ferrum on alternate weeks has now and then 
cured severe cases of this malady. 
5. HEMICRANIA.—Megrim. 
This disease is a true neuralgia, and is generally caused by a dyna- 
mic disturbance of the fifth pair of nerves. The symptoms vary ac- 
cording to the seat of the affection, which is sometimes in the periphe- 
ral and sometimes in the central end of a certain branch of the nerve. 500 
DISEASES OF THE NERVOUfe FUNCTION. 
It is important also to discriminate between the primary and secondary 
symptoms, as the sympathetic and trificial nerves are in such close 
sympathetic relation that morbid affections in one frequently cause 
symptoms of disease in the other. Irritations of the viscera sometimes 
affect the fifth pair of nerves, and original affections of the same nerves 
may affect the abdominal viscera. (Tietzer, of Konigsberg.) 
The attacks are periodical. A boring pain is felt in a circumscribed 
spot near the saggital suture ; or it occupies one side of the head, the 
forehead, supra-orbital and temporal region, extending to the orbits, 
sometimes relieved by pressure, at others the part is extremely sensi- 
tive. When the paroxysm is at its height, nausea and vomiting are 
excited which give slight relief. The patient is extremely sensitive to 
light, noise, change o£ temperature, the smell of food, and every degree 
of mental agitation. The paroxysm generally commences with sunrise 
on waking, and ceases at night; sometimes it lasts longer, and termi 
nates in a refreshing sleep. The left side of the head is more fre- 
quently attacked than the right. The commencement is frequently 
preceded by vertigo, cheerful and loquacious mood, or sadness, loss of 
appetite, sour eructations, vomiting ; it generally increases gradually, 
commencing with a slight pressure or sensation of coldness in the 
threatened part, which changes to a throbbing, boring, burning, stitch- 
ing, or tearing pain. (Hartmann. Vol. 4, p. 87.) 
Diagnosis.—Distinguished by the neuralgic character of the pain, 
its periodical recurrence, absence of cerebral functional derangement 
and febrile symptoms during the" paroxysm. The disease may become 
more fully established after years of occasional recurrence, and then 
the pain becomes more constant; there is sleeplessness; painful swell- 
ing over the seat of the pain, exquisitely sensitive. 
Causes.—Nervous, irritable, or hysteric constitution; hypochon- 
driac, chlorotic females, enfeebled by hard labor or haemorrhages; 
sedentary life ; literary pursuits ; indigestion ; obstructions of the por- 
tal system; mercurial dyscrasia; menstrual derangements; excessive 
intellectual labor; excitement of the imagination. Use of coffee and 
tea. 
Treatment.—Belladonna.—Its specific action is on the cerebral 
system, which is the central point from which all its symptoms radiate 
as from a centre, in all diseases. Even the inflammations induced by 
this remedy always emanate from within outwards, by an increased 
nervous action in the central organ. Thus in the exanthemata, as soon 
as the eruption appears the severe cerebral symptoms, the headaches, 
and general febrile symptoms caused by the nervous system irritating 
the vascular, disappear. When an exanthematous eruption is suppress- 
ed, the brain is instantly the seat of a violent attack. Belladonna 
cures only those diseases of the splanchnic nervous system, or of the HEMICRANIA. 
501 
abdomen or uterus in which there is affection of the brain. In all the 
visceral inflammations cured by Belladonna we may safely conclude 
that these diseases were expulsions of inimical agents which originally 
threatened to attack the cerebral nervous system. The same remarks 
apply to all fevers, especially typhus, or the febris nervosa versatilis. 
Belladonna is then the specific remedy for the cerebral nervous sys- 
tem, especially for the fifth pair, and the vascular system under the in- 
fluence of this sphere. An inflammation or fever to which it is appli- 
cable is accompanied by symptoms peculiar to the fifth pair: “ more or 
less reddened conjunctiva, the white of the eye is injected, an unsteady 
fixed look, distorted features, turgescence of the face, confusion of the 
head, amounting at times to a loss of consciousness, congestions of the 
head, aching pain in the forehead and eyes.” 
Belladonna seems especially suited to neuralgia of the fifth pair of 
nerves, particularly of the ophthalmic branch of this nerve and its 
three sub-branches, the frontal, lachrymal, and nasal. The symptoms 
are : pain arising from the middle of the forehead, extending to the 
eye, and running along the ridge of the nose towards its point and the 
ala? ; increased lachrymal secretion. 
Particular Symptoms of Belladonna in Hemicrania:—One-sided 
pain over the eyebrows, extending towards the orbit and nasal bones, 
increased secretion of tears. Aching pain in the forehead, and on the 
eyes ; feeling of pressing asunder; increased greatly by every motion 
of the head or eyes, by a ray of light, or the walking of others in the 
room; eye injected, face flushed, increased flow of tears. Belladonna 
is the proper remedy in all cases where the primary affection is of the 
supra-orbital region, that is of the ophthalmic branch and its nasal 
filament. Arthritic hemicrania shooting deeply through the whole 
hemisphere of the brain, depriving the patient of consciousness. Be- 
lieved by two doses of Bell., in thirty-six hours. {Hartmann.) 
Nux-vomica.—From the intimate relation between the trifacial and 
sympathetic nerves, the gastric pain or derangement in hemicrania 
may have its origin in either set of these nerves, and be transmitted 
sympathetically to the other. It is only when it originates in the 
ganglionic abdominal system that these abdominal symptoms, the nau- 
sea, eructations, retching, and vomiting point to Nux as the proper 
remedy. When Belladonna has acted favorably, but a relapse has 
taken place from a continuance of the abdominal symptoms connected 
with hemicrania, Nux or Sepia will succeed. 
Nux is specially applicable to men, in affections originating in the 
ganglionic system, developing hemicrania sympathetically; wdien there 
are haemorrhoids, or pains in the sacrum, pressure on the rectum, con- 
stipation, gastric derangements ; persons of choleric temperament, in- 
temperate, leading a sedentary life of hard study, having made free use 502 
DISEASES OF THE NERVOUS FUNCTION. 
of coffee. The pain is drawing, aching, as if a nail had been driven 
into one side of the head ; the brain feels beaten or bruised ; pain early 
in the morning, immediately after dinner, or is excited by mental labor. 
Nux-vomica is the “ mistress of thq ganglionic system.” It causes 
obstructions in the abdomen, and symptoms of local plethora. In fe 
males the menses are often too early and sometimes profuse. (Tietzer.) 
The attack is marked by paleness of the face, and features distorted. 
Aconite.—Tearing, drawing, jerking, stitching pain in the head, full- 
ness and wTeiglit of forehead, throbbing in the temples, bloated and red 
countenance, the patient almost frantic with the headache; he moans 
aloud, complaining of great anguish, shortness of breath, palpitation of 
the heart. Hartmann gives the patient Aconite to smell every five or 
ten minutes. In a short time he goes to sleep relieved. 
Sepia.—Physiological Sphere.—Sepia acts on the nervous and vas 
cular system wherever there is a passive congestion connected with 
dyscrasial suffering. All diseases says Dr. Tietzer, to be cured by 
Sepia must be traced to such a source. It is peculiarly indicated in 
females in whom there is hysteria, or nervous derangements of long 
duration; in true hemicrania hysterica which is always connected 
with some disease of the reproductive system; in cases where the one 
sided pain is more stinging, with leucorrhoea in the intervals of the 
menses, frequent swreats, sudor hystericus; with a peculiar offensive 
perspiration in the axilla, and sole of the foot. The hemicrania which 
is curable by Sepia is gradually developed from an affection of the re- 
productive system; the face expresses deep suffering, features distorted, 
countenance pale, dirty yellow; wfith incipient chlorosis. Some cases 
in which Belladonna had been indicated have been neglected till the 
Sepia symptoms were developed, and it becomes necessary. It is 
necessary in those cases of hemicrania in young females in which the 
cerebral nerves have excited the sympathetic, producing a long train 
of hysterical symptoms, always aggravated by allopathic practice 
The pain in these cases is stinging, or aching, boring, tearing, throb- 
bing, sometimes piercing and twitching. Both Belladonna and Sepia 
require a congestive condition towards the brain, but in Belladonna 
the congestion is more active, in Sepia more passive; in Belladonna 
there need be no dyscrasia present, in Sepia it should never be absent. 
[Tietzer.') Sepia is indicated by stitching pains in one of the frontal 
or occipital protuberances, like flashes from without inwards, reverbe- 
rating deep in the brain for a long time,recurring often; then there is 
heat in the head, feeling of tightness, and pain on contact. In 
arthritic cases the scalp is painful to the touch, with sensation of tight- 
ness. 
Ignatia.—Its specific sphere is the spine from which all its symp- 
toms proceed. It produces nervous diseases, and especially clonic HEMICRANIA. 
503 
spasms. Its symptoms in hemicrania: cases of spinal irritation in 
which sympathetic pain is excited in the trifacial nerve. In these 
cases clonic spasms are frequent. The patient is sensitive, peevish, 
excitable, hysterical, with sanguine nervous temperament, is delicate, 
falls easily in love, is romantic, bears trials meekly, and readily falls 
into clonic spasms after mental agitation. 
Characteristic effects of Ignatia: over-excitement of the spinal ner- 
vous system, giving rise easily to nervous symptoms. In hemicrania 
of this kind the pain is chiefly pressing, sometimes stinging, the course 
of the pain being inward, not outward ; and mainly in the forehead and 
root of the nose ; outwardly pressing pain, as if a nail were pushed out 
through the temple and side of the head. The above symptoms, or 
part of them, occurring in a delicate lady, caused by vexation or grief 
are generally cured by Ignatia. (Tietzer.) 
Arsenicum.—Its physiological effects in general radiate from with- 
out inward. As under the influence of Belladonna we see a turgor of 
blood, a rush of blood to the periphery, under Arsenicum we see the 
opposite effect: rigidity of the features, collapsed face, inability of the 
nervous system to incite the vascular and direct it towards the surface. 
The field of action of Arsenic is the ganglionic system from which 
the organs of vegetative life in the abdomen receive their nerves. The 
over-action of Arsenic paralyses this system; there is an inward state 
of congestion giving rise to the highest degree of inflammation and 
even mortification. In a lower degree of its action Arsenic causes ob- 
dominal plethora. In the congestive state inwards from Arsenic the 
vascular system is deprived of the necessary impulse from the nervous 
system, sufficient to produce a common inflammation, as the ganglionic 
system,—when mortification has not already taken place,—soon be- 
comes paralysed by the over-irritation. During these processes we 
frequently find a decomposition of the blood, a tendency to the destruc- 
tion of the organic substances, the breaking up of the cohesion of 
organic particles. The form of hemicrania that is curable by Arsenic 
only is caused by abdominal plethora dependent on irritation of the 
ganglionic system and affecting the trifacial nerve by sympathy. In 
this form there is disturbance of the portal circulation, and dynamic 
not organic disease of the liver; there are frequent attacks of bilious 
colic, sometimes alternated with hemicrania. These symptoms are 
curable by Arsenic. Tietzer says he cured one such case with it which 
had been eighteen years under treatment; the pain is aching, tearing, 
stunning; patient very sensible to the open air; keeps in motion, and 
is relieved by outward warmth, feels excessively languid, chilly, and 
sometimes bloated. Hartmann says: the pain recurs regularly after 
dinner, relieved by cold water to the head, but returning on its remo- 
val, worst at evening or night; relieved by warmth or compression. 504 
DISEASES OF THE NERVOUS FUNCTION. 
Calcar.-carbonica.—In constitutions in which we see defect in the 
reproductive system; obstructions, deposits, intumescences in the lym- 
phatic and glandular systems ; dyscrasial affections of the membranous 
structures, of all the white structures which have but little vitality or 
blood, and are nourished chiefly by lymph. Obstructions in cartilages, 
tendons, serous membranes, where development is arrested ; obstruc- 
tions in the lymphatics. In early infancy these structures predomi- 
nate ; and in them Calc.-carb., is specific where there is any arrest of 
the development of the organs ; imperfect formation of the blood as in 
scrofulosis. The only cases of hemicrania curable by it are those 
caused by disease in the reproductive system, or in whom scrofula was 
visible in early life ; characteristics : large head, bloated abdomen, nar- 
row chest, flabby, poorly developed muscles ; bones containing but little 
phosphate of lime ; pain dull, aching in upper part of the head and 
forehead, increased by the open air, drawing pain in the head, which 
feels cold ; nausea; tearing in the right temple, great sensitiveness to 
the touch; throbbing in the brain; evacuations or vomiting; menses 
profuse and too early; pain most frequently radiating from the right 
side. {Dr. Tietzer Ilom. Jour., 1849.) 
Thuya.—Cases of long standing following badly treated sycosis; 
the hemicrania frequently preceded by rheumatism. Thuya, through 
the ganglionic system of nerves, produces a peculiar dyscratic, or syco- 
tic vitiation of the humors manifested by a morbid degeneration of the 
cellular tissue under the skin and between the muscles, and the forma- 
tion of a dry or purulent excrescence. Affecting sometimes the spinal 
at other times the ganglionic system of nerves, it also causes hemicra- 
nia through the trifacial nerves. Characteristics : pain mostly on the 
top or one side of the head, tearing in the forehead and face and malar 
bone ; sensation as of a nail driven in by little at a time. If, in such 
a case, we may expect the existence of hidden sycosis, the disease be- 
ing chronic, aggravated by rest and warmth, particularly in bed, pre- 
ceded by rheumatic or arthritic pains, we may consider Thuya the only 
homoeopathic remedy. 
Sypigelia.—Hemicrania on the left side of the head, face, and teeth; 
character violent, tearing or aching pressure, aggravated by stooping, 
by the open air, or slight movement; the pain of gouty origin; arthri- 
tic affections being present in various joints. 
Pulsatilla.—Pain piercing, throbbing, tearing, twitching, mostly in 
the temples and back of the head; nausea, heaviness in the head, diz- 
ziness ; humming, piercing, twitching, tearing in the ears ; loss of ap- 
petite and thirst, with chills ; pain increased in the evening, in hot air, 
by sitting, ameliorated by bandaging the head; in persons of slow, 
quiet, amiable dispositions, phlegmatic, melancholy, lymphatic temper- 
ament ; disposed to weeping; pale countenance; females in whom HEMICRANIA. 
505 
menstruation is delayed. Chlorotic, hysteric constitutions, good natured, 
sad whining mood; pains worse in the evening. 
Coffea.—The attack is excited by mental agitation or taking cold; 
the pain drawing, aching, like a nail thrust into one side of the head, 
or as if the whole brain were crushed or shattered; pain excessively 
violent causing cries and shrieks, increased by eating; patient sensitive 
to noise, is chilly, shuns the fresh air; he has an aversion to coffee 
during the attack when it originates from the use of this article. Nux 
or Bryonia after it. 
China.—Tearing aching pain in the temples, preventing sleep; 
greater in consequence of touch or exercise in a draught of wind; dur- 
ing excitement of the mind, in persons quarrelsome, obstinate, disposed 
to anger ; tearing with pressure at some spot of the head, mental ex- 
citement, restlessness, excessive activity of the fancy. 
Capsicum.—Pain throbbing, piercing; nausea and vomiting, pain 
increased by motion, stooping fonvard or moving the eyes; sensitive- 
ness to cold air, laxity of fibre and phlegmatic temperament. Hysteric 
liemicrania. 
Colocynth.—One-sided pain, drawing or pressing; sickness and 
vomiting, shortness of breath, pain more in front or left side, coming on 
towards evening, extorting cries and tears increased by stooping, lying 
on the back, motion, shaking the head, or moving the eyes or lids; pain 
produced by excitement of mind, indignation, exasperation, inward 
grief or unworthy treatment; great uneasiness and anxiety. (Tietzer.) 
Chamomilla.—Drawing beating pains in the right half of the head, 
recurring in paroxysms and excited by emotions; quarrelsome and 
vexed mood, hypochondriac, whimsical. 
Bryonia.—Pressing pain in the left frontal eminence from within 
outward, as if the part would burst open, tearing pressure in the affect- 
ed hemisphere of the brain, increased by motion; dizziness and heavi- 
ness, sleeplessness and a vexed irritable mood. 
Cyclamen.—Dr. Eidherr, of Vienna. A lady aged 37 years, menses 
deficient and irregular, delayed twTo or three months. Periodical semi- 
lateral head and face-ache for four years, appearing about every week, 
or fortnight, and lasting from, twelve to thirty-six hours, worse at the 
menstrual epoch. The skin, eyelids, lips and gums very pale, body 
lean, skin dry and cool; other organs apparently healthy. Right eye 
spasmodically closed, discharging hot tears when forcibly opened. Ig- 
natia tried for six days and failed. Atropia 4° tried for two days, 
on the third she was free from headache. After four days more, there 
was headache again with vertigo and diplopia. Cyclamen 3° cured 
her in four days, menstruation then became regular and there was no 
more headache. (Ally. Ilomoeop. Zeitungi) 
' A lady aged 27, robust, with red face, had violent pulsative pain for 506 
DISEASES OF THE NERVOUS FUNCTION. 
three days, incessant in the temporal region extending to the vertex, 
disturbed sleep, constipation. Relieved by Bell. 3°, but in place of the 
constant pain there was vertigo and intermittent headache for a week 
more. Apis 6° removed the pain on the following day, but the vertigo 
continued. After a week Cyclamen 3° was given for the vertigo, which 
after three days disappeared, but leaving obscuration of sight. The 
remedy was stopped and all the morbid symptoms ceased in a few days. 
6. CEPHALALGIA.—HEADACHE. 
Pathology.—This symptom depends on various causes, and is con- 
nected with different conditions of the circulation in the brain. In a 
majority of cases the actual condition of the vessels at the time of the 
existence of the headache is a state of congestion. Exhaustion from 
fatigue, or from loss of blood, orJfrom over-excitement by mental exer- 
tion or bodily excesses, all tend yo produce a state of debility in the 
vessels of the brain which favors congestion. Headache which follows 
apoplectic and epileptic attacks, that which torments the hysteric fe- 
male, and that which so often attends dyspepsia, all probably are asso- 
ciated with cerebral congestion, variously modified and combined ac- 
cording to the causes which give rise to it, or to the particular state 
of the constitution in which it occurs. 
In the headache of meningitis the pain in itself is not positive 
evidence of meningitis, and its absence is not proof that the disease is 
not inflammatory. Andral gives post-mortem inspections of twenty- 
eight cases of meningitis in which headache was known to exist in 
only twelve ; and the conditions found in those in whom there was no 
pain complained of “ differed neither in their nature nor their seat from 
those in which pain of the head was one of the symptoms.” The na- 
ture also of the pain where it exists is not the same in all cases. 
All the predisposing causes of headache occasion some degree of con- 
gestion and compression of the veins connected with the fifth pair of 
nerves, especially of its ophthalmic branch, in the external wall of the 
cavernous sinus. 
Cephalalgia. — 1. From determination of Blood to the Head.— 
Symptoms.—Throbbing and heat; the beating of the arteries on the 
neck being visible; vomiting as the pain increases; pain worse on 
shaking, moving the head, lying down or stooping; sometimes better 
when standing. 
Treatment.—Bathe the head with water and vinegar, moderately 
cold; bathe the feet with warm water and afterwards rub them hard, 
bathe the temples and forehead every morning and occasionally at 
other times; bathe the feet in cold water, and rub them dry on going 
to bed. HEADACHE. 
507 
Aconite. — Pain very severe; burning sensation over the whole 
brain ; forehead and face red, bloated; eyes red; incoherent talking 
or raving. 
Belladonna.—After Aconite has been tried the pain is oppressive, 
heavy, deep-seated ; face pale and haggard ; unconscious, incoherent 
talking, murmuring, drowsiness. Alternate with Aconite, but at con- 
siderable intervals. 
Pulsatilla.—The pain is dull and oppressive on one side only, com- 
mencing on the back of the head or root of the nose; mitigated by 
compression or by lying down ; worse while sitting or walking; the 
head is heavy, face pale, dizziness, agitation, disposition to cry. 
2. Headache from predisposition to Apoplexy.—This is likely to be 
excited by over-eating; there is great drowsiness, stiffness and pain in 
the back of the neck; the speech is thick; face distorted; the mouth 
drawn to one side; the limbs fall asleep. Treatment given under 
Apoplexy—Premonitions of. 
3. Cephalalgia caused by Catarrh.—The symptoms and treatment 
are given under that head. (See p. 425, Yol. I.) The headache is worst 
in the forehead, oppressive, burning, better in the morning, worse in 
the evening; the eyes are full of tears ; sneezing, dry heat in the nose, 
frequent slight chills; some cough. Treatment under catarrh, pre- 
liminary stage. Aconite, Belladonna and Stibium are the best reme- 
dies for immediate relief. To prevent the predisposition to frequent 
attacks of this same disease Arsenicum is occasionally given. 
4. Rheumatic Cephalalgia.— Chamomilla. — Rheumatic pains in 
the head ; the pains tearing and drawing, and often shifting their loca- 
tion. Alternate with Pulsatilla in the morning or Nux in the evening. 
Bathe the feet in warm water. 
Ipecac.—Pains gnawing, tearing and intensely severe, relieved by 
heat and vomiting. ' 
Ignatia.—When Ipecac, has failed, the pain is severe, worst over 
the nose, or is piercing tearing, deep in the head, better when stooping 
or lying down. 
Rhus-tox.—In alternation with Aconite, as given under Rheumatism. 
Colocynth will often succeed in severe rheumatism when other 
remedies have failed. Strong Coffee is sometimes successful. 
Sepia.—Rheumatic gout in the head, for which Ipecac., Nux and 
Bryonia have been tried without benefit. The pains are tearing and 
beating all over the head, which feels as if coming apart; there are 
agitation, restlessness, nausea, with raising of wind and retching. 
5. Cephalalgia from disordered Stomach and Bowels.—Symptoms. 
—Furred tongue, bad taste, entire loss of appetite, nausea, vomiting, at 
an early stage, increasing with the pain. If the disordered stomach 
be the cause of the headache, give the remedies for disordered sto- 508 
DISEASES OF THE NERVOUS FUNCTION. 
mach. (See p. 270, Vol. I.) If, however, the headache is of a neuralgic 
character, producing the nausea and vomiting at a later and highly 
aggravated stage, give the remedies for headache above enumerated, 
according to the symptoms of each. 
6. Headache f rom Con stipation.—Nux-vomica.—Walking or mov- 
ing the head makes the brain feel sore; pressing in the temples; no 
relief from sitting up or lying down; eyes dull, inclination to shut 
them ; sleeplessness; head heavy; feels worse on moving the eyes or 
making mental effort; wTorse in the morning, in the open air, or after 
meals ; particular loathing of coffee. 
Pulsatilla.— Shivering, with thirst, pain only on one side, with little 
determination of blood; the patient is of a mild and quiet tempera- 
ment, inclines to weep ; is easily agitated. 
Bryonia.—The head feels as if pressed together from both sides 
and on stooping, as if every thing would fall out of the forehead; the 
nose bleeds without giving relief; the eyes water and burn. 
Opium.—The pains violent, tearing, bursting sensation in the fore- 
head; visible throbbings in the temples; congestion of the brain; 
eyes restless; thirst; mouth dry; sour eructations, inclination to sour 
and offensive vomiting. 
Palliative Measures.—The motions of chewing, especially when 
no food is swallowed, act by the derivation of blood from the cavernous 
sinus, and the sub-petro-sphenoidal plexus of nerves; these communi- 
cate with the ptervgoidian masseteric and alveolar plexuses externally. 
The latter are emptied by the contractions of the pterygoid muscles 
in moving the lower jaw, and the void is immediately filled from the 
internal sinus, through the veins which traverse the sphenoidal fissure, 
the inferior maxillary, and spheno-spinous holes, the carotid canal, &c.* 
Mr. Dally gives the following movement or mechanical treatment, 
the state of the digestive organs beino; considered: 
1. Pressure with the fingers from before backwards, along the back 
of the longitudinal sinus and tranverse sinus of the dura mater. 
2. Passive torsion of the trunk, the knees being fixed. 
3. Rotation of the feet. 
4. The hand of the assistant, on the seat of the pain, resists the 
effort of the patient to incline the head on that side. 
5. Passive torsion of the head. 
6. Slight circular percussions of the head with the palms or fingers. 
7. Concentric vibration of the hands of the aid, placed one upon the 
brow, the other upon the occiput. 
By increasing the flow of venous blood as well as the air into the 
lungs yawning relieves the pain of certain headaches. The pains are 
* Aretams de Curat, morb. L. 1. c. 1. Coelius Aurelianus Morb. Chi on. L. 1. NEURALGIA CCELIACA. 
509 
less acute during inspiration than during expiration; hence an indica- 
tion to draw long and full breaths at the beginning of a headache. In 
attacks of moderate severity, a walk in the cool pure air, having the 
neck lightly dressed and the superficial veins free from compression, 
may distribute the blood from the brain, and, with further exercise, 
may re-establish the equilibrium of the circulation when no mechanical 
lesion exists. 
7. NEURALGIA CCELIACA.—Neuralgia of the Cgeliac or Abdominal 
Nerves. 
General Remarks.—It was first fully described by Autenrieth. 
After precursory premonitions, slight pains, gradually becoming better 
defined; the patient feels for some minutes, or even hours, an appre- 
hension of an impending paroxysm. Suddenly he is seized with a 
violent pain in the pit of the stomach; this is burning, gnawing, tear- 
ing, stitching, aching as if a hot coal were lodged there, or as if the 
flesh were being forcibly torn. After lasting for a few minutes or a 
half hour, with such severity as to excite perfect phrenzy or fainting, 
the pain shifts its seat, shooting upward under the sternum towards 
the neck like a flame; or, dividing into two currents, which follow the 
course of the sympathetic nerve, ascend to the neck on both sides of 
the spine; otherwise the pain suddenly branches off in different direc- 
tions, “ particularly towards the hypochondria, following the course of 
the plexus lienalis and hepaticus. As the paroxysm subsides in 
severity, partial relief is accompanied by eructations and accumula- 
tions of water in the mouth. These symptoms are followed by a feel- 
ing of emptiness in the abdomen; languor and lassitude of the whole 
body; the tongue remaining clean, the appetite and digestion good. 
The paroxysms recur at various intervals, sometimes every day, sel- 
dom oftener, more frequently at night, and in changeable weather, as 
in spring or autumn. (Hartmann, iv. p. 48.) 
Causes.—Hereditary abdominal weakness, sedentary life, suppres- 
sion, or imperfect appearance of haemorrhoids, itch, or mismanaged 
gonorrhoea. We have seen several cases in which similar paroxysms 
to that above described formed the prominent feature of intermittent 
fever. 
Treatment.—Belladonna and Aconite alternately, every half hour, 
sometimes afford prompt relief. Should these medicines disappoint 
us, we may resort to any of the following: Nux-vomica, Nux-mosch- 
ata, Arsenicum, Stibium, Colocynth, Pulsatilla, Mercurius-corrosi- 
vus, Colchicum, Cocculus, Helleborus-nig. 
Nux-vomica.—Sanguine, bilious lemperament; subject to haemor- 
rhoids ; pain of true neuralgic character, excessively severe; seden- 510 
DISEASES OF THE NERVOUS FUNCTION. 
fcary life; mind much occupied by literary pursuits; pain begins in 
the morning, and a heavy sleep follows the paroxysm, which ends in 
general exhaustion ; pain relieved by lying down. It is tearing, stitch- 
ing, hard aching; gastric symptoms, as eructations, pyrosis, &c., fol- 
lowing the paroxysm. 
Arsenicum.—Nervous melancholy temperament; the pain causing 
swooning; the paroxysms begin about midnight, and rouse the patient 
from sound sleep ; relieved by walking about; of burning charac- 
ter ; anguish extreme; nervous symptoms following the paroxysm. 
Sahadilla.—Burning pain at the pit of the stomach, flashing up- 
wards in the chest towards the throat; intolerable oppression of the 
breathing, threatening suffocation immediately upon waking; con- 
strictive sensation deep in the fauces ; eructations and emptiness of the 
abdomen, general languor after the paroxysm. 
Cicuta-virosa.— In nervous irritable females; burning-stitching, 
throbbing pain in the pit of the stomach, with spasmodic and ungov- 
ernable hiccough. 
Aconite in all neuralgias, with general nervous irritation and hys- 
teria. 
8. CARDIALGIA. 
1. Idiopathic Cardialgia.— This is a primary affection of the 
Stomach without general fever or much constitutional disturbance. A 
predisposition to it may be hereditary; it is most common among 
females possessing irritable nerves, who are feeble, hysterical or chlo- 
rotic, much disposed to spasms at the menstrual periods, or about the 
time of life when they are about to cfisappear. 
Cardialgia, as we have seen, is usually a symptom of dyspepsia, al- 
though writers have classed it as a distinct malady, having no neces- 
sary connection with this disorder. The intimate relation between the 
nerves and membranes of the stomach and liver, and those which their 
functions sustain towards each other, incline us to the opinion that 
derangement of either of these parts of the,organism must involve, to 
a greater or less extent, each of the others. The seat of cardialgia 
.s in the nerves of the stomach ; and as the healthy tone of the mucous 
membrane, &c., is dependent upon the normal integrity of the nerves 
which supply this organ, their mutual dependence will be readily 
perceived. 
Diagnosis.—Pinching, gnawing, and cramp-like pains in the stomach 
often extending into the back and loins, relieved on pressure of the 
opigastrium, or when the abdominal muscles are relaxed, faintness, 
inxiety; appetite natural, or but slightly impaired, pulse natural, 
food may be taken into the stomach with impunity; pains of a more CARDIALGIA, 
511 
severe character than those which occur in chronic gastritis, although 
there is no-feeling of heat or thirst. 
CJausks.—Abuse of cathartics; highly seasoned, and indigestible food; 
food kept too long after being cooked; soured food, sour wine, beer, 
fruit, fat meats, pastry, &c.; abuse of stimulants, as coffee, tobacco, 
irregularity in eating; suppression of cutaneous eruptions, foot sweats, 
or habitual discharges of blood; sudden emotions ; mental anxiety; 
exposure to cold when the body is heated; in the most unmanageable 
cases there is organic disease of the stomach. 
Pathology.—This disorder has been supposed to be dependent on 
an abnormal condition and disturbed function of the sympathetic and 
par vagum; upon perforating ulcer of the stomach; commencing 
schirrhus ; an altered condition of the coats of the organ; and upon 
disease of the pancreas, with which wre are at present but imperfectly 
acquainted. None of these opinions have been established as generally 
true. Dr. Meyer says he has “most strictly examined each case of 
cardialgia.” In only a few of the cases was he satisfied of the pa- 
thology. “Certainly, when there has been an induration in the epi- 
gastrium, with the characteristic vomiting, the constitutional affection 
and the external appearance, I have ascribed the disease to the car- 
cinomatous diathesis; and to an ulcer of the stomach, when there has 
been frequently recurring vomiting of blood.” In twenty-five cases 
treated at the Polyklinik, at Leipzig, “ there was only one in which 
existed considerable enlargement of the liver.” In the rest he “ could 
not discover any organic change, and was, therefore, justified in con- 
sidering the gastralgia as a primary disorder.” 
Treatment.—Nux-vomica.—This is the counterpart of the above 
train of symptoms. The patient has been long dyspeptic, is sometimes 
hungry without appetite, and is at the same time disgusted at the sight 
of food ; has a distaste for his favorite coffee, increase of thirst; the 
tongue covered with a whitish mucus, bad taste, putrid or sour; after 
eating, a swollen state of the stomach, with occasional pain on pres- 
sure ; when he has putrid taste and sour eructations after eating; 
nausea early in the morning when fasting; frequent retching; stools 
hard, and not as usual daily; sleep disturbed by nightmare: when he 
complains, occasionally, of a pressing aching pain in the forehead, on 
awaking in the night, when he is of a depressed or excitable humor, 
without any remarkable decrease of strength; Nux hardly ever fails 
in these cases, though it often makes a slow “ symptomatic process, 
especially noticeable in drunkards.* Often, in cases of constipation, 
says Meyer, “ I have seen the greatest benefit from Nux-vom. SO3, when 
the first and second had failed. 
* Dr. V. Meyer, Wissenschaftlicher Bericht der hom. Poliklinik zu Leipzig, 1857 512 
DISEASES OF THE NERVOUS FUNCTION. 
Nux-vomica is appropriate for cardialgia caused by abuse of coffee 
or by suppressed eruptions, even if of several years’ standing; the 
cardialgia of drunkards, which is only partially relieved by vomiting; 
heartburn, and hysteric cardialgia, or that caused by the use of coffee 
or chamomile tea. 
Symptoms by which it is indicated.—Contraction, pressure, cramp, 
griping or spasm of the stomach, feeling of oppression from the pres- 
sure of clothing; pain from flatulence retained by spasmodic contrac* 
tion of the stomach or duodenum, increased by taking coffee or food; 
oppression and constriction of the chest, spreading to the spine, be- 
tween the shoulders or small of the back, and feeling like a band 
drawn round the chest. Pains early in the morning, rousing the pa- 
tient from sleep; nausea during the attack; accumulation of Avater i» 
the mouth ; eructation of sour or bitter fluid ; vomiting of partially di 
gested food, or ineffectual retchings, with burning cardialgia; palpita- 
tion of the heart; anxiety; sour, putrid taste in the mouth; constipa- 
tion ; flatulent distention of the abdomen; hemicrania ; sick headache ; 
cardialgia, beginning in females at the time of too profuse menstrua- 
tion. (Hartmann, &c.) 
Chamomilla.—Cardialgia in persons of irritable nerves, easily ex- 
cited by anger; pain in the pit of the stomach, or under the short 
ribs, as if a stone were there; pain attended by shortness of breath 
and anxiety; worse at night, causing loss of sleep and great distress 
pain in the top of the head; partial relief from rising from bed, from 
sleep, by bending double, or from drinking coffee when the pain has no 
been caused by it. When the cardialgia has been caused by drinking 
chamomile tea, Ignatia, Pulsatilla, and Coffea. 
Pulsatilla.—Absence of thirst; complete loss of appetite, com- 
bined with aversion to flesh-meat, and longing for sour things; the 
bitter taste not constantly present, but depends much upon the kind of 
food and the occasionally occurring eructation, with, at times, risings 
up in the mouth. When, further, the white or yellow coating of the 
tongue is adhesive and difficult to remove, the region of the stomach 
is not distended, the patient only complaining of an uncomfortable 
feeling, when there is neither nausea nor retching, but shivering after 
each meal, especially towards evening, the patient feeling worse at that 
time. 
Aconite.—In most cases, says Ilempel, cardialgia is a simple state 
of venous congestion, which yields to Aconite and the application of 
warm flannel to the stomach. 
Bryonia.—The taste is more insipid, the tongue presents only a 
slight coating. The prominent symptom is dryness of the mouth, either 
constant or occurring shortly after eating, without much thirst, unless 
for cold drinks. Appetite deficient, not entirely wanting; eiuctations CARDIALGIA. 
513 
often cause the remains of the food to rise into the mouth; pain, pres- 
sure, and shooting in the stomach present only in a slight degree, but 
increased by motion; bowels generally constipated; general health 
tolerable, disposition not much changed; when there is headache it is 
generally one-sided. 
Phosphorus.—“Gastritis complicated with heartburn, which, after 
it had ceased, annoyed the patient with an invincible scratching in the 
throat. It is especially useful when there is “ loss of appetite, accom- 
panied with a feeling of emptiness and want, together with an impos- 
sibility of eructating, apparently seated at the orifice of the stomach, 
with tendency to diarrhoea. 
China.—Healthy appetite always absent; the patient can, never- 
theless, eat on making an effort, though quickly satisfied. When there 
is appetite, it is capricious. Notwithstanding the absence of any desire 
for food the tongue is clean, the taste normal, or sometimes bitterish. 
There is an uncomfortable feeling after eating, without any assignable 
cause. This uneasy feeling is somewhat relieved by eructations, with 
the taste of food taken. Pain in the stomach not present, though in 
rare cases there was a feeling of coldness, a symptom common to 
China and Berberis. Debility is peculiar to China. 
Belladonna.—Cardialgia in females of irritable nerves; gnawing 
pressure, spasmodic tensive pain in the pit and region of the stomach, 
inducing loss of consciousness or fainting, (hysterical,) usually con- 
nected with wind in the stomach, torpid state of the bowels ; sleepless- 
ness and increased thirst, which aggravate the pain. 
Anti-Psoric Treatment.—Carbo-vegetabilis—Burning sensation in 
the stomach ; painful pressure in the stomach, with anxiety, aggravated 
by contact; contractive spasmodic sensation in the stomach, obliging 
the patient to bend double, arresting the breathing, heartburn, nausea, 
loathing of food, constipation ; feeling worse when lying down. 
Carbo-animalis.—Fullness, malaise, and coldness of the stomach 
after a slight mea,l, relieved by laying the hand upon the stomach. A 
state of debility of the stomach, in which everything eaten gives 
distress. 
Nitrum.—Burning pain in the stomach, with violent stitches, con- 
tinuing after the paroxsym is over; or feeling as if ice were in the 
stomach ; externally painful to the touch. 
Calcar.-carbonica.—Weak digestion; cutting, compressing, spas- 
modic, pinching or choking pains, with great anxiety. 
Graphites.—Weak digestion; wrenching and griping in the stomach, 
relieved by eating; accompanied with nausea and accumulation of 
water in the mouth. 
Nitric-acid.—Cardialgia with diarrhoea, or following syphilis, 
vol. ii.—33. 514 
DISEASES OF THE NERVOUS FUNCTION. 
treated with Mercury; spasmodic wrenching in the stomach and pit of 
the stomach, ascending to the chest and oppressing the breathing. 
Casto-reum.—Bitter, sour regurgitations after a meal; sickness at the 
stomach, ptyalism, tightness and weight in the stomach; contractive 
pain under the sternum; ulcerative pain in the pit of the stomach, flatu- 
lent distention of the abdomen, constipation, urgings to stool ineffectual. 
Lobelia-injlata.—Pressing constrictive sensation in the pit of the 
stomach after a meal, especially at night, extending to the back and 
inter-scapular region; bilious vomiting, oppression, and anguish in the 
chest, and in the small of the back. Nervous agitation. 
Natrum-muriaticum.—Contractive cramp in the stomach, com- 
mencing after dinner, and continuing till evening; feeling of coldness 
in the back of the stomach. 
Alumina.—Cardialgia with constipation. 
Carb.-baryta.—Scrofulous subjects; fullness after slight meal; 
hardness of the stomach perceptible externally; pressure and wreight; 
disorganization of the stomach. 
Sejgia.—Delicate nervous females, with fine skin, and liable to get 
angry; oppression and weight, with cramp in the stomach; sour eruc- 
tations, indifference to life, occasional nausea, constipation, amenorrhoea. 
Nerves deranged by onanism. 
9. GASTRALGIA. 
Increased irritability of the nerves of the stomach, inducing spas- 
modic contraction of the muscular fibres. 
Diagnosis.—General symptoms : neuralgic pain in the epigastrium 
extending to the hypochondria. The pain occurs in paroxysms, 
varying in intensity, and subsides partially or completely in the inter- 
vals. It is peculiar in its character, violently constrictive, twisting, 
turning, cutting, tearing, gnawdng, or beating; and it is often most 
severe in the locality of the right or pyloric orifice of the stomach, at 
other times the pain is greatest at the cardiac orifice. Sometimes it 
extends from the pit of the stomach to the back, breast or scapulae, 
though in others it is confined to the epigastrium. As the disease is 
usually not inflammatory, the pain is frequently relieved by external 
pressure, as by pressing the stomach against hard bodies; though in 
many cases slight pressure cannot be borne. The attacks last from 
a quarter of an hour to a full hour, and subside soonest when the par- 
oxysms are most severe. As the disease advances the paroxysms 
increase in intensity, and occur more frequently, and often last a 
whole day; or returning from trifling causes, such as light food that 
easily sours in the stomach, fatigue or change of weather. We have 
observed the exacerbations worse when the stomach was empty, as GASTRALGIA. 
515 
before eating; they are considered worse in the afternoon ; and they 
generally subside more completely during sleep. 
Sympathetic Symptoms.—Pain in the region of the last dorsal 
vertebra of the spine, extending to the scapula; spasmodic action of 
the gastric muscular fibres, causing vomiting, or ineffectual muscular 
efforts; eructations, gnawing, spasmodic contraction of the abdominal 
muscles, or diaphragm. The pit of the stomach is drawn inward 
toward the spine ; hiccough, obstinate constipation, strangury, feeling 
of excessive anguish, palpitation of the heart, constriction of the 
fauces ; loss of voice ; the stomach is distended by flatulence, which 
rises toward the throat, and is there arrested by spasmodic contraction 
of the oesophagus, forming the “ globus hystericus.” In some cases 
the stomach is relieved by the raising of green bile, or an acrid-sour 
or slimy mucous secretion from the mucous membrane. The pulse is 
small and contracted, and the skin cold. The vomiting, though it 
gives great distress at the time, is generally followed by relief; the 
sweat breaks out as the pains abate, and the pulse rises. 
In the most severe paroxysms the pain may terminate for the time 
in spasmodic fainting, tremor, delirium, extreme debility, convulsions, 
or tetanus. {Hartmann, Vol. IV., p. 69.) 
A prominent feature, in which gastralgia surpasses almost every 
other form of physical suffering, is the terrible gloom and feeling of 
despair that accompanies it in all its severe paroxysms. The sufferer 
from real gastralgia not only endures a degree of actual pain equal, 
at least, to that of tic-doloreux, but is weighed down by a feeling of 
despondency so terrible, that life, with all its accompaniments, is only 
regarded as a burden and a curse, instead of a blessing. The mental 
agony pervades the whole being, and poisons with bitterness all the 
fountains of health and peace and happiness on earth. 
Treatment.—In the treatment of this disease in all its forms, homoe- 
opathy has gained many of its grandest triumphs; “it offers,” says Meyer, 
“amidst the frequent uncertainties of diagnosis, the great advantage of 
contending with the disease with tolerably certain weapons. This becomes 
more apparent, if we glance at the miserable therapeutic apparatus of 
the old school, and see how uniformly it tries ■ one after another, in 
every case of spasm in the stomach, the same two or three remedies 
that have once or twice been of use ; and when at last even the Opium 
panacea will do no good it stands helplessly by, and in order to conceal 
its ignominious defeat, declares the case to be incurable.” 
“No where is the necessity and utility of accurate individualization 
more clearly shown, no where is allopathy taught the uselessness of its 
pottering minuteness in reference to the diagnosis of diseases, while 
neglecting the much more important diagnosis of medicines, than in 
our treatment of cardialgia.” 516 
DISEASES OF THE NERVOUS FUNCTION. 
Remedies—Nux-vomica.—The many-sided action of Nux-vomica 
on the ganglionic system, and especially on that portion of it which 
influences the functions of the stomach, explains the frequency of its 
success in spasms of the stomach. So frequently has it succeeded, 
that it is too often relied upon alone on the ground that it is the spe- 
cific for every form of cardialgia. On this point Boenninghausen 
says: “ that Nux-vomica is often improperly used, and powers are 
attributed to it, which, from its sphere of action, it cannot possess.” 
It is, however, true that the gastralgia which presents the parallel of 
Nux-vomica is that most often met with. It exibits: 
Aching pain in the stomach, commencing with tension and increas- 
ing to a squeezing, pinching pain, which occurs after any heavy meal, 
or even after taking the slightest quantity of food. The pain then 
frequently spreads over the wdiole extent of the stomach, and occasion- 
ally implicates the cardia, where there is felt a sensation of con- 
striction, and as if the food had to be forced through the orifice; 
often, however, the pains extend far above the epigastrium, and give 
rise to oppression of the breathing. An objective symptom thereupon 
presents itself, viz.: the stomach is distended, and the scrobiculus 
cordis is arched forwards. As a consequence of this abnormal irri- 
tation and inordinate pressure upon the muscles and nerves, there 
occurs tenderness of the external coverings of the stomach, which is 
increased by slight pressure, but diminished by strong pressure. “This 
physiological sign is quite characteristic of Nux-vomica, and is yet 
more distinctly expressed by the fact, that the pains are momentarily 
relieved by bending the body forward, i. e., by strongly compressing 
the stomach. The effort of nature to get rid of this abnormal state, is 
especially shown in the process of elimination. It has often occurred 
to me that the essential nature of most so-called nervous cardialgias 
consists in a spasmodic closure of the pylorus, which impedes or 
obstructs the passage of food into the intestines. The stomach, filled 
with wTind, is first freed of its excess of ballast by eructation, which is 
either tasteless or accompanied by the taste of the food, or when there 
is at the time catarrh of the stomach, it may be sourish or putrid. 
Occasionally the attempts to eructate are at first ineffectual or painful, 
in consequence of the spasmodically constricted cardia through which 
the wind has to pass; but at the same time the eructations give transient 
relief to the cardialgic pains. It often happens that by the eructa- 
tions, after they have lasted some time, and have pretty well evacuated 
the stomach of its gaseous contents, a fluid tasting of the food, is pro- 
pelled into the oesophagus or mouth, by a kind of regurgitation. Nausea 
soon sets in, with or without flow of water into the mouth. After 
more or less severe retching, whereby at first only (sour) mucus is 
brought up, the contents of the stomach are emptied by vomiting GASTKALGIA. 
517 
which recurs again and again, until the last morsel of food is rejected 
from the stomach, -whereupon the pains go quite away. Except during 
the actual paroxysm the patient has no pain, except perhaps that 
there may remain some tenderness of the external coverings of the 
stomach or scrobiculus.” The spasm of the stomach for which Nux 
is suitable is not of a regularly intermitting character, for it is only 
caused by partaking of solid food. Liquids do not, as a rule, cause it, 
but it is worthy of observation that coffee may occasion or increase not 
only the exciting cause, but when taken in excess or in too weak infusion, 
the disposition to the disease. The cardialgia curable by Nux 
seldom occurs in the morning before eating, and hence this condition, 
which is generally characteristic of the medicine in question, is only 
deserving of attention in this disease where the other symptoms point 
to Nux. After a late supper the attacks may occur in the night also, 
for, as a rule, the pains do not come on until some time after eating. 
It is not necessary that the cardialgia for which Nux is suitable 
should be conjoined with gastric states, on the contrary we generally 
find the tongue clean and the appetite good. The bowels may also be 
in a normal state, although habitual or accessary constipation, which 
often accompanies spasm of the stomach, gives an indication the more 
for Nux-vomica. The gastric complication is most frequently observed 
in the spasm of the stomach of drunkards, where Nux, unless there 
exists some important contra-indication, is generally the appropriate 
remedy. The reflex phenomena sometimes arising from cardialgia, as 
headache, vertigo, &c., are only important for the choice of Nux, 
when, in addition to accompanying the other symptoms, they show 
peculiarities corresponding to those of the drug. 
In such cases as embraced the above characteristics, Dr. Meyer says 
he had persevered with Nux even when improvement did not imme- 
diately appear. The improvement -was perhaps delayed in many of the 
earlier cases by the using of low dilutions and their too frequent repe- 
tition ; whereas the proper potencies given at longer intervals effected 
more rapid and more permanent cures. 
Arsenicum.—The cardialgia suitable for Arsenicum must have 
reached a great height. The pains are excessively severe, sometimes 
so much so as to cause despair, in rare cases fainting. The salient 
quality of the pains is burning, often as if from red hot coals; but the 
burning often passes into gnawing and cutting, or it is combined with 
aching, which latter sometimes, though more rarely, occurs alone. 
Along with these torments there is external coldness and violent thirst, 
but only small quantities of liquid can be drank without increasing tbo 
pains. The stomach seems to be distended and enlarged; from it the 
pain may extend upwards, when it causes great anxiety, or downwards 
into the abdomen, or backwards, when some of the vertebrae may some- 518 
DISEASES OF THE NEKVOU8 FUNCTION. 
times be tender. There is sensitiveness of the gastric region to slight 
and also to strong pressure. “Vomiting is a constant Arsenic symptom 
in gastralgia ; it occurs either early or with great effort, and consists 
either of the food taken, or of thick, yellowish green, gelatinous looking 
mucus. The vomiting does not completely relieve the pains as happens 
in those cases for which Nux is the remedy, on the contrary, they per- 
sist a considerable time after the vomiting, in a greater or less degree. 
The eructation that sometimes precedes the vomiting is generally very 
loud, and sometimes becomes hiccough. The cardialgic symptoms occur 
either immediately after eating and drinking, or in rarer cases not till 
a few hours thereafter. Frequently, however, the pains and the whole 
paroxysm occur without ascertainable cause, as often happens after 
midnight. If this kind of gastralgia has already lasted some time, 
the patient gets a cachectic look, at the same time there gradually 
occurs a chronic catarrh of the stomach, often attended by occasional 
diarrhoea, which reduces the patient’s strength. Under such circum- 
stances we may easily suspect that the malady is caused and kept up 
by some organic disease (round ulcer, scirrhus), but this suspicion 
should not contra-indicate Arsenicum. In the above enumerated cases 
of this character, I found Arsenicum very useful.” 
Phosphorus.—When there is reason to believe that a perforating 
ulcer of the stomach is the cause of the cardialgia. There is occa- 
sional show of blood in the ejected matter; painless intervals brief; 
the emaciation and anaemia favor the suspicion of perforating ulcer. 
If, however, there is no reason to presume upon organic lesion, Phos- 
phorus is indicated by: excessive formation of acidity (the heartburn, 
sour eructation, sour vomiting), when, also, the vomiting occurred soon, 
often immediately after a meal, or rather of the nature of regurgitation 
of food, and the patient can not retain in the stomach a morsel of food. 
The thirst is not great and tormenting as in the cases corresponding to 
Arsenic, but yet the pains are aggravated by drinking. If the pains 
are of a gnawing character, and sometimes extended to the back,—if 
the gastric region is very sensitive to the touch,—if this sensitiveness 
is increased by walking,—Phosphorus was found by Meyer “ a most 
successful remedy.” 
Colocynth.—The spasm of the stomach begins from two to three 
hours, or more, after a meal, especially if the meal consisted largely of 
sweets. The cutting pain is slight at first, but gradually increases, 
until it attains the greatest intensity. It now extends to the bowels, 
where the patient feels as if he were being cut with knives, and into 
the back, which seems to him to be broken. The patient feels as if he 
must vomit, without being able to do so at first; it is not until the 
lapse of considerable time that vomiting occurs, and then only of the 
food that has been taken. After the stomach is completely emptied, GASTRODYNIA NEURALGICA. 
519 
the pain suddenly ceases, as if it were suddenly arrested, and the 
patient feels as if commencing a new life. Occasionally the vomiting 
is preceded by a violent rigor, with chattering of the teeth, goose-skin 
&c. The intervals between the attacks are usually very long, perhaps 
weeks or months. The patient can take any sort of food without in- 
jury until again unexpectedly the paroxysm makes its unwelcome ap- 
pearance. 
Predisposing Causes.—Eating too many sweets, mental emotions, 
especially vexation, before, during, or after a meal. 
Bryonia.—Not generally successful in pure gastralgia. Meyer 
only succeeded with it when the case embraced also hepatic affections. 
In the case of a man aged twenty-seven, with hypertrophy of the liver, 
it succeeded. “ There was violent pain in the stomach and scrobiculus 
cordis always soon after eating; eructations with the taste of the food; 
flow of water into the mouth; headache and vertigo. On examination 
nothing was found abnormal in the region of the stomach ; but the liver 
was much enlarged below the last ribs, the abdomen tense, with dull 
(hepatic) sound on percussion. After the violence of the pains, and 
especially the excessive tenderness of the scrobiculus, had been d* 
minished by Atropine, the hypertrophy of the liver diminished gradually 
under the use of Bryonia ; and in proportion as the size of this organ 
diminished, the pains in the stomach decreased, and were at length 
completely removed by China.” Some irritability of the stomach 
remained. 
10. GASTRODYNIA NEURALGICA. 
Dr. Kissel says he cured eleven cases of this disease with Cuprum. 
They all occurred in women whose menstruation was sometimes nor- 
mal, sometimes deficient, sometimes excessive. In some metrorrhagia 
preceded; several had already exhibited symptoms of gastric catarrh, 
after the removal of which the gastrodynia remained unaltered. This 
gave very severe pains in the praecordium, which extended from thence 
as far as the spine, and lasted one or more hours. Then the intermis- 
sion was complete, till the fits returned after some hours. In most 
cases, the third and fourth dorsal vertebrae were painful on pressure. 
Scarcely any pains arose from pressure on the gastric region, which 
was neither hard nor tumid, but rather drawn in. Stool, urine, appe- 
tite, &c., presented nothing abnormal. All the patients had pale com- 
plexion. Cuprum-aceticum, as well as Sulphurica-ammoniatum soon 
brought relief, and, by persevering in their administration, complete 
cure. Lembke reports (in the Allg. Horn. Zeitung, B. 45. No. 6), of 
a case of gastrodynia which had lasted four months, and was associated 
with nausea, oppression of the chest, trembling of the hands and feet, 520 
DISEASES OF THE NERVOUS FUNCTION. 
and feebleness. This case was treated by Cuprum-metallicum, second 
trituration, as much as would lie on the point of a knife, four times a day 
Other remedies, see page 516. 
11. NERVOUS DISEASES OF WOMEN. 
Symptoms.—Low spirits, nervous feelings / on feeling the pulse 
there is perceived a tremor of the hand with acceleration and sharp- 
ness of the pulse, arising chiefly from mental agitation. When the 
attempt is made to encourage her she burst into a flood of tears. She 
says she has gradually lost health and spirits, is easily fatigued; her 
heart beats irregularly, flutters and palpitates ; impressions are made 
on her mind disproportioned to their cause. She is prone to weep, 
has transitory feelings of alarm or dread. Both mind and body are in 
a morbidly sensitive condition; and general distress is depicted in her 
pale and dejected countenance. 
In these cases there is usually some irregularity, some pain, or other 
difficulty of menstruation and leucorrhoea in the intervals. This con 
dition has perhaps long existed without its influence being suspected 
and the patient has already taken a load of tonics without benefit, 
though they were expected to give strength and cure dyspepsia, which 
has been in many cases the head and front of the case. The dyspep- 
tic symptoms are: flatulency, lasting for weeks or months; repeated 
vomitings, irregular or inverted action of the oesophagus; ascent of 
flatus obstructed in the throat (globus hystericus), almost threatening 
suffocation. Other nervous sensations : an inverted action attended with 
rumbling noise in the stomach or abdomen. An inverted action passing 
from the stomach up the oesophagus and pharynx, ending in a hysteric 
paroxysm, involving the brain and entire nervous system. This mys- 
terious communication so closely allied to the aura epileptica may re- 
sult from some irritation in the alimentary canal through the pneumo- 
gastric nerve. The breathing is also affected in a remarkable manner. 
In short, in these complicated nervous cases every nervous symptom 
may meet in an individual case, the whole uniting to compose the true 
hysteric paroxysm; and blended with all we may have various neural- 
gic sensations, varying from the slightest irritation to the most exquisite 
torture. 
These neuralgic pains are often treated as inflammation; and always 
without success. The prominent of the local pains manifesting them- 
selves in the ganglionic system of nerves distributed on the abdominal 
viscera are: 
1. A pain seated under tbe left mammae ; 2. A pain under the mar- 
gin of the ribs on the left side ; 3. In the course of the descending 
colon; 4. In the course of the ascending colon toward the right hypo- NERVOUS DISEASES OF WOMEN. 
521 
chondriura, 5. In the abdomen generally ; 6. Pain in the stomach; 7 
Pain in the region of the kidneys extending down to the bladder. 
It is not always easy to locate the pain so as to know precisely what 
organ is the exact seat of the pain. The site it most frequently occu- 
pies is under the left breast; it may last for weeks or months, often of 
doubtful location. In one aggravated case the patient died suddenly; 
the post-mortem revealed only a very delicate ring of enlarged blood- 
vessels around the cardiac orifice of the stomach, such as might be 
caused by a spasm. 
2. The pain under the margin of the ribs of the right side is per- 
haps seated in the duodenum, as it is always aggravated by mercurial 
purgatives, and it is often attended by a jaundiced appearance of the 
skin. Though it is increased by pressure, and often treated as hepatitis, 
it is not inflammatory. The rest of these obstinate local affections are 
all neuralgic in character. 
3. The pain in the stomach is a true gastralgia. The suffering it 
causes is the most extreme that can be imagined. It sometimes comes 
on suddenly, and the patient screams in agony, is sometimes drawn for- 
ward almost double, then intermits, returning in spasms. Though ten- 
der on pressure there is no inflammation. 
Treatment.—1. Correct the morbid condition of the uterine system. 
2. Remove or mitigate violent symptoms. 3. Restore tone and vigor to 
the general system. 
Homoeopathic Remedies, see pages 485, 508, 511. 
It has been common to treat these debilitated subjects with tonics, in 
the vain hope of restoring strength. The results have been disgrace- 
ful to practical medicine. Dr. Gooch selected all the cases in which 
there was tenderness of the os-uteri, and prescribed, with much timidity 
and distrust, “ general bleeding, cupping from the loins, leeches from 
the pubic region, purgatives, anodynes, warm baths, and the recumbent 
posture even for months at a time.” No satisfactory results followed 
these depressing measures. Dr. Addison, of Gray’s Hospital, attribut- 
ed the nervous symptoms to a sympathetic irritation o.f the uterus re- 
flected to the remote points where the pain is felt. On this idea he 
treated them all by local astringent lotions applied directly to the 
uterus itself. The lotion used must be one capable of producing a 
similar degree of irritation ; and then in a proper degree of dilution it 
will be found homoeopathic to the local irritation and the sympathetic 
nervous affections arising from it. The solution of Sulphate of Zinc 
just strong enough to excite a slight sensation of pain, is one of the 
best applications. If the pain be unpleasant, let the strength be 
diminished. In many cases cool water alone is the best application. 
All lotions should be frequently repeated, perhaps two or three times 
per day, ceasing to use them shortly before the menstrual period. 522 
DISEASES OF THE NEKVOCS FUNCTION. 
12. INJURIES OF THE SPINE. 
Spinal Disease from Traumatic Lesion.—The spinal corl is as 
liable as the brain to derangements of nutrition, as well as to concus- 
sion or compression; while its intimate connection with every part of 
the organism, through nerves arising from, or communicating directly 
with it, will render any injury to its delicate structure almost certain to 
originate a serious train of morbid and anomalous symptoms. Thus : 
Mechanical injury of the spinal column may cause either excess or 
deficiency of the cerebro-spinal fluid ; and thus give rise on the one 
hand to dropsical effusion, and on the other to a partial atrophy or 
wasting away of the tissue. This latter form of spinal disease may 
run a latent course for months or years, the obscure cause of the infir- 
mity dating back to some trivial injury sustained by the spine or skullj 
and which has passed by unnoticed, or has been entirely forgotten. 
1. Concussion of the Spinal Marrow.—A common case is thus 
described:—A gentleman falls, without violence, with his back upon 
the hard ground or soft tuff. There is no mental confusion, no cere- 
bral disturbance—he feels a transient, peculiar sensation, called pins and 
needles, in his hands and feet; he gets up, walks or rides home ; feels 
little or no inconvenience, makes arrangements for the morrow ; but 
in the morning is unable to get up, because, he says, he is in pain all 
over, he feels sore and stiff, just as if he had been bruised, making it 
painful for him to move his limbs. 
Now, what is the pathology of this case ? It is possible that the spinal 
marrow, obeying the law of gravitation, may, as the body falls, precipitate 
itself in that direction—may fall backwards towards the arches of 
the vertebrae, and be itself concussed in this way ; or the little filaments 
of the sensitive and motor nerves, which are delicately attached to the 
spinal marrow, may for the moment be put in a state of extreme ten- 
sion ; because, as they pass through the inter-vertebral foramina, they 
are fixed there by the dura mater, and if the spinal marrow be dragged 
from them, the intermediate parts must necessarily be put upon the 
stretch, producing at the same time the ‘‘pins and needles sensation.” 
This patient has not caught cold, has no rheumatism ; nor has he been 
bruised, or received any blow where the pain is felt. The stiffness he 
feels is not the result of local injury. The sensitiveness of the surface 
which creates pain on being touched, and the stiffness which he expe- 
rienced are the result of some structural disturbance of the motor, as 
well as of the sensitive nerves, or of some mischief in the interior of 
the spinal marrow; but the precise nature of this mischief is not al- 
ways ascertainable. When the spinal marrow has been impaired by a 
blow, or direct force, or by a shake, or by a to-and-fro movement, as 
occurs in railway collisions, the spinal marrow is protected by the lono CONCUSSION OF THE SPINAL MAKKOW. 
523 
and substantial textures around it, but there is still some immediate 
deterioration of function, and this is to be attributed to the shock j and 
the appropriate treatment will be directed according to this idea. 
The first point in the treatment is the enforcement of perfect rest. It 
has been supposed that the best way to get rid of the effects of a con- 
cussion of the brain or spinal marrow is “ to walk it off.” A gentleman 
at Epsom had a fall upon his back from the giving way of a scaffold. 
When he fell he experienced a sensation of pins-and-needles in his 
legs. He was a most energetic man, he immediately set off' and ran 
six miles, as he said he had been before told to do. In a short time 
he began to have spinal marrow symptoms, which resulted in complete 
paraplegia, which was never cured. If he had given nature a fair 
opportunity by immediate and complete rest, he would no doubt have 
recovered. Tne opposite course, exercise immediately after the shock 
to the spinal marrow, leads to inflammation and softening of the spinal 
marrow, which remains incurable. See Yol. I. p. 689. 
Soldiers who have suffered some spinal concussion, have continued 
active exercise, without necessary rest, have experienced, on resuming 
ordinary duties, some little difficulty in walking. In a few days, or a 
week or two, the legs become feeble; there is a little jumping of the 
legs at night on going to sleep, some sense of coldness in the limbs, 
slight dullness of sensation on the surface of one or both limbs.. Per- 
haps he is thought to be a malingerer, and is ordered by the surgeon 
to increase his exercise. This adds to the exhaustion of the spinal 
marrow, and the plan, if persevered in, leads to paraplegia, which 
might have been avoided by continued rest for a sufficient length of 
time. Some patients only recover from spinal injuries after many 
months, or a year or two of perfect rest. In other cases the recovery 
is rendered incomplete by persistent loss of sensation, or wasting of 
some part; and this persistent loss is supposed to be connected with 
some distinct defect of structure in some minute filaments, either of 
the spinal marrow or the nerves themselves. 
Ilypericum-perfoliatum.—Dr. Ludlam says this plant is reputed 
to be as appropriate to traumatic lesions of the nervous tissue as Arnica 
is to those of the muscular or vascular systems. He gives two cases 
which illustrate the efficacy of this remedy,* and also the morbid 
results of cerebro-spinal injury developing themselves after consider- 
able time had elapsed. 
Dr. Muller has given a proving of this remedy, which shows it toi 
possess considerable power to induce an irritation of the nervou8 
centres, with vascular erethism and congestion. He says it acts par- 
tially upon the head, causing heaviness therein, with a sensation as if 
* Transactions of the Chicago Homoep. Med. Society, No. I., p. 9.—Brit. Journal 
Homcep., No. XYIL, p. 523. 524 
DISEASES OF THE NERVOUS FUNCTION. 
the head were elongated. It may also occasion violent cerebral con- 
gestion, flushed, bloated face, changeable mood, &c., as well as weak- 
ness and trembling of all the limbs. It seems to act in a specific 
manner upon the cerebellum, regulating its function of coordinating or 
associating the different voluntary movements. Dr. Ludlam pre- 
scribes it in the second attenuation.* 
2. CONGESTION OF THE SPINAL CORD. 
Treatment.—Brown-Sequardf says : “ the two remedies most 
powerful in diminishing congestion of the spinal cord are Belladonna 
and Ergot of Rye. These two remedies are powerful excitants of 
unstriped muscular fibres, in blood-vessels, in the uterus, in the bowels, 
in the iris, &c. Both of them dilate the pupil; both are employed 
with success to produce contractions of the uterus; but each of them 
has more power in certain parts than the other. So that we find Bel- 
ladonna acting more than Ergot on the blood-vessels of the iris, 
(which is the principal cause of dilatation of the pupils,) on the blood 
vessels of the breast, (which is the principal cause of the cessation of 
the secretion of milk,) on the muscular fibres of the bowels, (which 
is the mode of its action in strangulated hernia,) on the spincter 
of the bladder, which is one of the causes of success against noc- 
turnal incontinence of urine, &c. Ergot “acts more than Belladonna 
on the muscular fibres of the uterus, on the blood-vessels of the 
spinal cord,” &c. 
“ The excitability of smooth fibres, as well as that of striated 
muscles, varies exceedingly in different parts of the body. An excit- 
ing agent, as galvanism, cold, heat, or Belladonna and Ergot, will 
produce powerful contraction in some places, and hardly any in others. 
The smooth fibres of the uterus contract more than those of the 
bowels or the bladder, and less than those of certain blood-vessels 
when stimulated by galvanism; the smooth fibres of certain blood- 
vessels contract more than those of the uterus under the excitation of 
cold; still more, the blood-vessels of the cerebral lobes and the face, 
which contract so much when their nerve (the cervical sympathetic) 
is irritated, contract but very little when excited by Belladonna and 
Ergot, while these two excitants produce powerful contractions in the 
blood-vessels of the spinal cord.” 
“Not only have I seen the diminution in the calibre of blood-vessels 
of the pia-mater of the spinal cord taking place in dogs after they have 
taken large doses of Belladonna or Ergot of Rye, but I have also 
ascertained that the reflex power of the spinal cord (most likely as a 
*N. Am. Jour. Homoep. Yol. X., p. 690. 
j Lecture on Myelitis, Spinal Meningitis and Spinal Congestion. CONGESTION OF THE SPINAL COED. 
525 
consequence of the contraction of the blood-vessels) becomes very 
much diminished under these two remedies, which in so doing act just 
in the opposite way to that of Strychine.” 
A knowledge of the above facts led Brown-Sequard to employ Bella- 
donna and Ergot of Rye in cases of paraplegia, due to a simple con- 
gestion or a chronic inflammation of the spinal cord and its meninges, 
and writh an encouraging degree of success. “It is now certain that 
these agents have really a great power in diminishing the amount of 
blood in the spinal cord and its membranes.” 
Treatment of Irritation of the Vaso-Motor Nerves of the Spinal 
Cord.—M. Brown-Sequard says [Lecture, &c.) : “ Led by the view that 
erosions, ulcerations, and sloughs on the nates, sacrum, &c., are chiefly 
due to an irritation of the vaso-motor nerves, producing alterations in 
the nutrition of certain parts of the skin, I have thought that alter- 
nate applications of cold and heat to the parts where there is a threat- 
ening of sloughing, by acting on the blood-vessels, so as to pro- 
duce in them considerable contractions and dilatations, might prevent 
the effects of the irritation of the vaso-motor nerves in the spinal 
cord.” In cases of fracture of the spine occurring in animals, followed 
by myelitis, he tried “ the alternate application of pounded ice in a 
bladder for thirteen minutes or less, and followed by a warm poultice 
for an hour. The success of this treatment rendered the correctness 
of the theory probable. 
Lateral Curvature of the Spine.—Pathology.—This is exceed- 
ingly simple. “ It is invariably produced, in the first instance, by the 
unequal action of the muscles, generally, but not always accompanied 
by muscular weakness. 
“ The spinal column consists of twenty-four vertebrae—little blocks 
of bone, piled one on top of the other, with the intervening cartilages 
as elastic cushions between each, and held strongly, but not immov- 
ably, together by various ligaments, the whole forming a very flexible 
column, with little power to sustain itself in the upright or any other 
position in which it may be placed, without the aid of the muscles. 
The spinal column is necessarily so formed, in order to allow flexion 
in every direction, to accommodate the various motions of the body, 
and to secure pliability and elasticity in connection with firmness and 
strength—qualities, in this particular instance, necessary to coexist in 
the same organ; the latter to enable it to sustain the burdens imposed 
upon it, and the former to secure immunity from shocks and the opera- 
tion of counter forces. 
“ The muscles of the trunk secured to the pelvis below as a base, are 
attached all along the spine as ‘ guy-ropes’; and in several layers and 
groups, by their coordinated action sustain the spine in place, or move 
about in any required direction, in the most symmetrical and perfect 526 
DISEASES OF THE NERVOUS FUNCTION. 
manner. Excepting the slight curvature forward in the lumbar, and 
backward in the dorsal regions, the position of the spine and shape of 
the spinal column at any moment in health depends on the muscles. 
“ When the muscles act in harmony—the different groups being 
properly set off by their respective antagonists—then the spinal column 
whether at rest or in motion, is always where it should be. But if the 
action of certain muscles is not properly antagonized, for some mus- 
cles do not act with the same degree of force as their mates, then this 
harmony and coordination are lost, and the spine makes a greater 
flexion toward the point where is the stronger muscular action, if this 
action is in the transverse direction, as of the scapular muscles acting 
at the middle of the flexible column; but from the stronger muscular 
force when acting from one side at the ends of the flexible column 
longitudinally. That is, the sjpinal muscles act like a string to a bow; 
and if they contract more on one side, the ends of the spine are made 
to approximate towards that side, making the spine to swell out towards 
the other side; but the scapular muscles, acting at the middle, would 
draw the spine towards themselves, and thus this unequal muscular 
action may cause the spine to deviate to the right or left, to or from 
the stronger muscles, according as they may happen to be those that 
act longitudinally or transversely.” {fill. F. Taylor, M.D., 1861.) 
GENUS X.—MYOTICA.—AFFECTING THE MUSCLES. 
Theory of Muscular Contraction and Convulsive Diseases.—The 
commonly-received opinion respecting muscular action is, that “ muscle 
is endowed with a vital property of contractility, and that the state 
of contraction is brought about when this property is called into action. 
That is to say, when the muscle contracts, this vital property of con- 
tractility is supposed to be roused or excited, or stimulated into 
action; and the more the muscle contracts the more is this property 
supposed to be acted upon.” A doubt was thrown over the correctness 
of this opinion by Charles Bell, wrho said that he had been led to 
suppose that muscular relaxation might be the act, and not contraction ; 
and that physiologists, in studying the subject, had too much neg- 
lected the consideration of the mode by wdiich relaxation is effected. 
D. West, in 1832, (London Medical and Surgical Journal, Vol. I.,) 
said, “ nervous influence is imparted to muscular fibre for the purpose 
of restraining its contraction; and the action of the will, and of al 
other disposers to contraction, is simply to withdraw for a while this 
influence, so as to allow contractility (the peculiar property of nervous 
force,) to show itself.” This view of the modus operandi of the motor- 
nervous influence is adopted by Dr. Charles Radcliffe, in the Gulstonian 
Lecture for 1860. lie holds that “the true type of muscular contrac* THEORY OF MUSCULAR CONTRACTION. 
527 
tion is to be found in rigor mortis—that the muscle contracts, not 
because a vital property of contractility lias been roused into activity 
by a stimulus, but because some antagonizing influence has been 
withdrawn, which previously prevented the free action of common 
molecular attraction in the muscular tissue.” Professor Duges, of 
Montpellier, France, maintains that muscle contracts in virtue of its 
elasticity, just as a piece of gum-elastic may contract when set free 
from a previous state of extension. Professor Matteucci, of the Uni- 
versity of Pisa, in 1847, advocated the same general idea. In 1848, 
Dr. Louis Mackall, of Georgetown Heights, Columbia, S. C., endea- 
vored to show that nervous influence determines a state of active elonga- 
tion in muscle, and that contraction proceeds from ther withdrawing of 
this influence. The protrusion of the tentacles of the snail and 
bryozoon, of the tongue of the chameleon, of the head and limbs of the 
tortoise, the movements of muscular vessels and tubes—even muscular 
movements generally — are unintelligible without the aid of this 
hypothesis. He thinks, however, that contraction, as well as elonga- 
tion, are vital states of the muscle to which there is nothing analagous, 
either in physics or chemistry. In 1851 experiments were made by 
Mr. Brown-Sequard, which seemed to show that the influence of the 
blood of the animal system is exercised in counteracting the rigor 
mortis, which occurs when the vital influence is withdrawn. Later 
observations led him to think “that the office of arterial blood is to 
minister to the contractile and other forms of power; and that the 
the office of the nervous blood is to supply a stimulus by which the 
power derived from the red blood is called into action.” 
But all observation disproves the old theory that referred muscular 
contraction to any stimulation through the blood, or otherwise derived 
from the nervous system. The permanent contraction which comes on 
sooner or later in all paralyzed parts, is not in any way dependent on 
nervous influence. After the spinal cord has been destroyed in the 
lumbar region of a pigeon, says Dr. Radcliffe, the muscles of the para- 
lyzed parts are at first soft; in a few days they become somewhat hard; 
in a few days more they pass into a state of permanent contraction, by 
tvhich the legs are kept extended and divergent. 
The cause of this contraction is the suspension of the aotion of the 
nervous system; and the contraction is permanent, because the action 
of the nervous system is never restored. 
The bearing of these facts on the pathology and treatment of con- 
vulsive diseases is well illustrated in the convulsions produced by 
haemorrhages, which we cannot believe to be associated with undue 
stimulation on the part of the nervous system. The vessels are at this 
time almost empty of blood; the heart is nearly still, and the action of 
the nervous system must be at the lowest point compatible with the 528 
DISEASES OF THE NERVOUS FUNCTION. 
existence of life. Recent observations render these experiments still 
more important and conclusive, Drs. Kussmaul and Tenner, (Unter- 
such. z. Naturlehre des Menschen u. d. Thieve, von J. Moleschottfld o\. 
II. Frankfort, 1857), passed threads behind the common innominatse 
and the left sub-clavian arteries of a rabbit, and left these threads 
so that they could be tied and untied in a moment. On tying the liga- 
tures, the animal was violently convulsed; about one minute later, 
when the convulsions were raging at their height, by untying the liga- 
tures the convulsions were instantly suspended. Thus it is seen that 
convulsion is instantly brought on by preventing the flow of blood to 
the brain, the medulla oblongata, the upper part of the spinal cord, and 
the cervical ganglia of the sympathetic nerve; and these convulsions 
are instantly suspended by allowing the blood to return to these organs. 
Convulsions, then, seem to be connected with a state of inaction of one 
or more of the nervous centres named. 
In another experiment, the ligature was placed around the neck of 
the aorta a little beyond the opening of the left subclavian artery. The 
blood now, instead of being cut off from the head and neck, was cut 
off from all the rest of the body below. As the condition of things 
produced was the opposite of what existed in the former experiment, 
the result was precisely the opposite. There was immediate paralysis 
of the part behind the ligatures, but no convulsion, or any thing ap- 
proaching to it; and it was shown that this absence of convulsion was 
not due to paralysis of the spinal cord from want of blood—for on com- 
pressing the carotids, so as to prevent the flow of blood to the brain 
the animal was instantly seized Avith violent convulsions. 
An indirect argument in support of the inferences drawn from these 
experiments is derived from the fact “that drowsiness, and not, con- 
vulsion, is the consequence of that capillary injection of these cen- 
tres, arising from the division of the sympathetic motor in the neck, 
or of that venous engorgement brought about by tying the jugulars, 
}r of that double arterio-venous congestion which happens when the 
sympathetic nerves are drnded in the neck, and the jugular veins tied 
in the same animal.” 
Recent Discoveries and Views on Reflex Action.—So far as this 
mode of action concerns only the muscles of motion—voluntary and in- 
voluntary—the subject has been exhaustively worked out by Marshall 
Hall and his disciples. But later researches, especially those of Dr. 
Brown-Sequard, have led us to extend reflex action also to sensitive, 
vaso-motor, and tissue nerves, and have thus brought a large number 
of facts in physiology and pathology, hitherto imperfectly understood or 
vaguely styled “ sympathetic,” under this head. From the researches 
of Dr. Brown-Sequard, (see his Lecture 10.) It may be easily seen 
that an irritation conveyed along a centripetal nerve-fibre to the cranio- GA8TRALGIA. 
529 
spinal axis, may be reflected from it in four directions. 1st. Upon a 
musculo-inotor nerve, causing contraction of a muscle or muscles. 2d. 
Upon a sensitive nerve, giving rise to neuralgia. 8d. Upon a vaso 
motor nerve, causing a contraction of blood vessels. 4th. Upon a tissue 
nerve, producing a secretion or an alteration of nutrition, as the tissue 
it supplies is glandular or simple. It is also easy to perceive that 
each of these modes of reflex action may play an important part in 
the normal and abnormal processes of the organism. 
1. Of the abnormal actions falling under the first head, we see 
“ Spasms,” partial or general, produced by eccentric irritation. The 
vomitings of pregnancy, the convulsions of dentition, the laryngismus 
stridulus caused by enlarged bronchial glands, and the spasmodic asth- 
ma of gastric irritation, are instances on a lesser scale; while the fright- 
ful spasms of the throat, or of the whole frame seen in hydrophobia 
and traumatic tetanus owe their origin to the same cause. That the 
stoppage of the heart’s action which results from a sudden blow upon 
the stomach, or a rapid draught of cold water when heated is due to a 
reflex excitation of the vagus through the splanchnic nerves, has been 
shown by the experiments of Dr. Brown-Sequard. For after dividing 
either the splanchnic nerves, the spinal cord, or the vagus, no gastric 
irritation could affect the action of the heart. 
2. It is not so common for a centripetal irritation to be reflected on 
a sensitive nerve, yet cases are on record in which reflex neuralgia has 
been produced by a cicatrix, a stricture of the urethra, a carious tooth 
or an injury of a nerve. The supra-orbital hemicrania caused by gas- 
tric irritation falls under this head.” 
3. If the centripetal irritation be reflected upon a vaso-motor nerve, 
we shall have a contraction of the blood vessels supplied by it. It is 
improbable that such a process plays an important part in the normal 
actions of the organism; but it is a fruitful source of many forms of 
disease. We have seen that excitation of the motor nerves of a gland 
in a full state of activity will immediately check its secretion, by cut- 
ting off the normal supply of blood. NowT considering the nervous cen- 
tres as so many glands generating nerve force from the blood, and 
transmitted through the nerves to its destination, it becomes obvious that 
a sudden or chronic cessation of their activity may be produced by 
contraction of their blood vessels by a reflex excitation. Thus we may 
have from this cause (a.) loss of consciousness; (b.) paralysis; (c.) an- 
aesthesia, according to the functions of the part of the nervous system 
affected; (d.) sudden contraction of the arteries of the brain proper, 
by an irritation sent, appears in all cases to be the starting point of an 
epileptic fit. The extreme pallor of the face which appears as the pa- 
tient falls, results from the same cause. The same irritation, falling 
Vou IL—34. 530 
DISEASES OF THE NERVOUS FUNCTION. 
upon the laryngeal, cervical and thoracic respiratory muscles, brings 
them into a state of tonic contraction, thus impeding the arterializa- 
tion of the blood. From hence proceeds the purple hue which suc- 
ceeds the primary pallor of the face and the general clonic convulsions 
throughout the frame. In the so-called petit mal the cerebral arteries 
alone feel the irritation and loss of consciousness, without laryngismus 
or convulsions, results. A less degree of contraction will give rise to 
the vertigo to which epileptics are so subject. 
Modus Ojperandi of Counter Irritants in removing Disease.— 
Each component element of the body maintains a sympathetic relation 
with the other parts of it. There is no organ and no tissue situated 
beyond the pale of this influence. As the natural consequence, when 
one organ is morbidly affected, the disease is reflected upon others 
which are distant; on this account, local injuries are quickly followed 
by constitutional symptoms. A fractured limb excites fever and deli- 
rium. An irritated wound propagates its irritation to the spinal cord 
and invokes traumatic tetanus. The troubles of dentition are not con- 
fined to the pain of the distended gum, but excite diseases in almost 
all parts of the body. A large and superficial blister, such as is fre- 
quently produced by a burn or scald by reflecting its irritation upon 
the upper portions of the intestines, may terminate fatally by ulcera- 
tion and perforation of them. The local irritation occasioned by the 
presence of intestinal worms may escape observation and yet be suffi- 
cient to produce epilepsy. A suppurating breast has been known to 
he the exciting cause of consumption, into which state the patient has 
suddenly lapsed. These lessons do not instruct us to hope that a local 
irritant will attract any other elements to itself; on the contrary, they 
demonstrate that injuries primarily of a local character, through means 
of the sympathetic system, are reflected upon distant and healthy parts, 
in which secondary diseases are established. When the physician, 
therefore, has recourse to a counter-irritant, it is not for the purpose 
of attracting the disease to the spot artificially. The application 
of the Spanish fly has nothing whatever to do with the morbid 
elements which may be present as the result of the natural disease ; it 
is healthy serum, which can be called to the surface at any time, and 
in any person willing to submit himself to the disease-producing pow- 
ers of cantharides. The popular impression is adverse to this. The 
error into which they fall is a natural one, and not unfrequently medi- 
cal men play upon their credulity and encourage them to regard the 
redness in the one case and the blister in the other, as a certain 
amount of the disease brought to the surface.” But “ when an artifi- 
cial disease is purposely developed in the hope of relieving the sick, it 
must be reflected upon an organ already diseased, that organ is at once 
placed under the influence of two morbid processes, namely the pri- TETANUS. 
531 
mary or natural disease, and the secondary or artificial one.” But, in 
accordance “ with the well known physiological law” which even the 
Lancet recognizes as true, no two actions can go on in the same part 
at the same time, and the greater must destroy the lesser. “ The cu- 
rative action of a counter-irritant is therefore equivalent to the direct 
action of a drug-specific to the part. In the one case we depend upon 
a drug which from experience is known to exercise a specific ac- 
tion on the diseased organ; in the other we excite an artificial dis- 
ease in a distant part, and hope that its influence may be reflected 
upon the disease which we wish to cure; counter-irritation, although 
uncertain, when successful, is certainly homoeopathic in principle.”— 
(Drummond, 65, Holcombe, North Amer. Jour. Homoeopathy. Feb. 
1858, Art. XXVII.) 
1. TETANUS. 
Tetanus.—This disease consists of violent tonic spasms of the vol- 
untary muscles, the powers of sensation and of thought remaining un- 
impaired. When the diseased manifestation is confined to the muscles 
of the jaws and of the throat, the affection is called trismus or locked- 
jaw. 
We understand by the term tetanus, sudden morbid contractions or 
cramps of many muscles of the body, with rigidity and loss of volun- 
tary motion in the affected parts. This morbid contraction and rigidity 
may affect the muscles of almost every portion of the body, or it may 
be confined to the muscles of a single part, like the lower jaw, when 
the affection receives the name of trismus ; or to the extensors of the 
back, giving rise to recurvation of the body, when it is termed opis- 
thotonos j or to those of the front part of the body, causing incur- 
vation, termed emprosthotonos j or the muscles of the side, causing a 
lateral curvature, and called plearthonos. 
Tetanus is much more common in hot than in temperate latitudes, 
and generally selects for its victims individuals of a nervous and irri- 
table temperament, or those whose constitutions have been impaired 
by the abuse of stimulants, or exposure to a vitiated atmosphere. 
There are two varieties of tetanus, the traumatic and the idiopa- 
thic. The usual exciting causes of the former are, punctured and la- 
cerated wounds, causing injury or partial division of the nerves; and 
of the latter, general debility of the nervous system from long-continued 
illness, or protracted derangement of the different functions of the or- 
ganism. 
Diagnosis.—This malady generally commences with uneasiness at 
the praecordia ; stiffness and tension in the muscles of the back of the 532 
DISEASE8 OF THE NERVOUS FUNCTION. 
neck, back and loins, and some difficulty in deglutition and in articu- 
lation. This contraction and stiffness gradually increases; the sen- 
sation of uneasiness in the chest becomes changed to violent and pain- 
ful contractions about the ensiform c artilage ; the pains and cramps 
extend to the back, jaws, and limbs ; the appetite fails; the counte- 
nance assumes a flushed and anxious appearance, the bowels are con- 
stipated ; the mind remains sound until the last stage of the disease, 
and the body will be rigidly drawn into such a position as will enable 
us to decide what particular class of muscles are affected, and which 
of the varieties of tetanus is present. 
Traumatic tetanus is always a dangerous affection, but hopes of 
cure may be entertained when unusual pains in the wound or cicatrix, 
with pains extending along the limbs in the direction of the contracted 
parts, ocour simultaneously with the first symptoms of the complaint. 
But if the symptoms continue to make steady progress, while the ori- 
ginal wound is cicatrized, and no pain or disturbance is experienced 
either at this point, or extending from it the case may be looked upon 
as highly dangerous. 
Idiopathic tetanus proceeds from constitutional causes, and is far 
less dangerous than the traumatic variety. Its approach is also more 
gradual, and attended with less pain, but when the contraction and ri- 
gidity of the parts takes place, they remain in this condition a longer 
time than in the other form of the disease. The violent contractive 
pains about the ensiform cartilage, and in the nape of the neck which 
are so characteristic of traumatic tetanus, are also absent in this va- 
riety. Indeed, we have seen cases where no pains or uneasy sensa- 
tions were experienced in any part of the body, except from the con- 
strained parts affected with the morbid contraction. 
Causes.—Punctured and lacerated wounds which partially divide 
one or more nerves, are the most common of causes. The admission 
of cold air into wounds, sudden checks to the perspiration after long 
and fatiguing exercise under a hot sun; the irritations of splintered 
bones, or other foreign substances in contact with nerves and tendons; 
amputations and blows upon the spine, are all occasional causes of 
traumatic tetanus. 
The exciting causes of idiopathic tetanus are: suppressed menstrua- 
tion, or other habitual discharges, low fevers, over-exertion of mind or 
body, too close confinement in small and ill-ventilated apartments, sit- 
ting in unnatural and constrained positions ; tight lacing; contused, 
lacerated, or punctured wounds. It is said to follow more frequently 
wounds in which the nerve is partially divided or lacerated. Plenk 
relates a case of the disease excited by the insertion of an artificial 
tooth. Others have caused it by passing a ligature round an artery so 
as to include a nerve. TETANUS, 
533 
Pathology.—No pathological changes have been noticed in the 
brain or spinal cord which can be said to be the cause or consequence 
of the disease. It has been called “ functional disease of the spinal 
cord ” for want of a better name. In traumatic tetanus, the minute 
nervous twigs have been discovered diseased at the seat of the wound 
Mr. Erichsen (on Tetanus, Lancet, Yol. I., 1859, p. 355,) says : “There 
is in traumatic tetanus, always a certain condition of the nervous sys- 
tem to be met with, if carefully looked for, namely, an unhealthy state 
of the nervous branch, or twig, running from the wound. This twig 
will be found implicated in some way, congested, inflamed, infiltrated; 
its neurilemma thickened, softened and discolored, often for a con- 
siderable distance from the wound. I have never failed to find this 
when it has been carefully looked for. In one instance (which is quite 
common) a cutaneous branch was found lying bare, and inflamed in the 
bottom of the issue-wound.” 
The mischief commences in a minute nervous twig, and by reflex 
action those powerful changes are effected which characterize the dis- 
ease. Though the disease be called lock-jaw, or trismus, this symptom 
is not always the first striking symptom, though it is an early one. It 
is often manifested by twitching of the muscles of the trunk or ex- 
tremities before lock-jaw is developed. It then becomes a prominent 
symptom. The explanation of this early appearance of this local 
symptom is thus given by Dr. Hilton, of Guy’s Hospital: “ Experiment 
indicates that the gray matter of the interior of the spinal marrow is 
probably the local seat of tetanus. The fifth nerve, or nerve of mas- 
tication—the one involved, and which must be the direct cause of tris- 
mus—has a larger connection or continuity with the gray matter of the 
spinal marrow than any other nerve in the human subject; and in this 
fact, perhaps, lies the explanation of the early symptoms of lock-jaw; 
and no doubt the firm closure of the lower upon the upper jaw depends 
on the relative greater strength of the muscles closing the mouth, as 
compared with those depressing the jaw. It is curious to observe the 
gradual ascent of the cause of tetanus—to see how the disease en- 
croaches upon the higher or anterior nerves of the base of the brain, 
ultimately reaching the third cerebral nerve. Then the muscles which 
are supplied by this nerve become tetanic and cause retraction of the 
eye-balls, deep into the bony orbits, so far that in some cases, especially 
animals, we almost lose sight of the eye as the tetanus goes on.” 
This symptom is one of great danger, for it points to the great extent 
of the structural lesion of tetanus, though the exact nature and char- 
acter of the pathological state is not yet explained. 
Amonir the remedies to which the cure of individual cases have 
been attributed are : Tobacco, Nicotine, Aconite, Atropine, Belladonna, 
Conium, Henbane, Cannabis-indica, Opium, Camphor, and stimulants. 534 
DISEASES OF THE NERVOUS FUNCTION. 
Dr. Williams gives a case cured by 110 bottles of Port wine in forty- 
two days. Mr. Ilott cured a case with two gallons of brandy in eight 
days. Mr. Simon cured a case in St. Thomas's Hospital, in 1858, with 
Nicotine. Patients have been cured by division of the trunk of the 
affected nerve high up in the limb, so as to act beyond the sphere of 
local irritation. This is not always practicable, and when tried has 
sometimes failed. (Mr. Ferguson, of King’s College Hospital. Lancet, 
Nov., 1860, 412.) 
Aconite.—A case at the Middlesex Hospital recovered under the 
care of Mr. De Morgan, treated with Aconite. A boy aged fifteen, 
trod on a rusty nail, which pierced the thin shoe and penetrated the 
ball of the foot. The nail was extracted, the wound bled but little, 
and healed in a few days. On the seventh day stiffness commenced 
in the neck and lower jaw; he entered the hospital on the seventeenth 
day, with well-marked rigidity of the muscles of the neck and jaws; 
abdominal muscles tense; pain in back and neck; sleepless for two 
nights ; bowels natural; perspiring, pulse 80, moderately full. A 
hard cicatrix in the sole of the foot was excised. Strychnine, in doses 
of one-tenth, and then of one-twentieth of a grain was tried; but the 
spasms increased. There were twitchings in the thighs, great diffi- 
culty of respiration, finally severe opisthotonos. 
On the twenty-first day of the case, tincture of Aconite was given, 
five minims every two hours, then eight minims. This continued 
seven days ; dose then given every four hours, and next day every six 
hours. The diet throughout was the most nourishing that could be 
given, consisting of beef tea and similar articles. Turpentine ene- 
mata were used; but the severity of the paroxysms diminished imme- 
diately after the Aconite was given. He progressed gradually and 
slowly. First the general spasms and opisthotonos ceased, then the 
convulsive twitchings of the extremities, which lasted only twro or three 
minutes longer. By the thirty-second day he could sit at the table 
and separate his teeth half an inch; he ate and slept well; expression 
of the face almost natural; fifty-third day could walk about; some 
stiffness still visible in the jaws. (Lancet, 1860, p. 414.) 
Homoeopathic Tkeatment.—A preliminary step in the treatment 
of tetanus should always be to remove, as far as possible, whatever 
causes may have operated towards inducing the disease, or which may 
continue to exert an irritating effect after its full formation. The 
causes of this character are: the presence of irritating spicula of 
bone, of needles, of dirt, or rust, or any other foreign substance, in 
contact with the nerves and tendons ; abuse of stimulants, the wearing 
of too tight clothing, foul air, exposure to sudden changes of tempera- 
ture, especially intense heat, to coldness and humidity. When there 
is reason to suspect the presence of a foreign body in a cicatrized TETANUS. 
535 
wound, after the appearance of tetanic symptoms, we should at once 
cut down and endeavor to extract the obnoxious substance ; and in 
case nothing can be found, to apply spirits of turpentine, or some 
escharotic, in order to insure suppuration in the wound. This impor- 
tant surgical resource should always be resorted to in cases of this 
description, for it is not an uncommon occurrence to perceive the im- 
mediate disappearance of incipient tetanic symptoms bn the removal 
of a foreign substance from the wounded part. 
The remedies most appropriate for the treatment of tetanus are: 
Nux-vomica, Belladonna, Arnica, Stramonium, Cicuta, Hyoscyamus, 
Opium, Pulsatilla, Sulphur. 
Nux-vomica, from its decidedly specific action upon the spinal mar- 
row, and its membranes, as well as from its pathogenesis, and the ap- 
pearance of individuals who have been poisoned with it, is evidently a 
remedy of importance in this dangerous malady. It is especially 
called for when the spasms are frequent and short, consciousness is 
perfect, and there are cramp-like pains in the region of the stomach, 
constipation, and loss of appetite, and when the patient has been 
addicted to the abuse of stimulants. 
When we find great rigidity of the extremities, contraction of the 
thumbs or fingers, wild or fixed look, painful and difficult respiration 
and deglutition, we may give Stramonium in alternation with Ilyos- 
cyamus or Cicuta. 
Many writers speak in favorable terms of warm baths in the treat- 
ment of this affection. We have seen the most unequivocal advantage 
follow general bathing, and a thorough application of fomentations to the 
affected parts, and to the spine. We can call to mind two cases where 
life was apparently saved by the persevering application of these 
hot fomentations, together with frictions along the course of the spine. 
We take occasion in this place to suggest to the profession the use 
of the saliva of rabid animals as a remedy in this affection. It has 
been found by Majendie and Breschet, that if the saliva be introduced 
under the skin, or into the blood of animals, that the animal so im- 
pregnated contracts the hydrophobia. Why should it not then be 
employed in those maladies which are characterized by symptoms 
similar to those of rabies ? 
Other remedies which may demand attention are : Veratrum, Mos- 
chus, Phosphorus, China, lynatia, Lachesis, Acid-hydrocyanic, 
Camphor, Plumbum. 
Administration.—We advise from the third to the sixth attenua- 
tions in this affection; a dose every hour until the system responds in 
a satisfactory manner, after which we must be governed by circum 
stances. 536 
DISEASES OF THE NERVOUS FUNCTION. 
Carbonate of Potash.—Fritz (Hufeland's Jour., 12, p. 116,) saw a 
species of tetanus produced by a bath impregnated with Carbonate of 
Potash, and A. Yon Humboldt, by the application of a solution of 
Salt of Tartar, increased the irritability of the muscles to such a 
degree as to excite tetanic convulsions. The curative power which 
caustic potash exercises in all kinds of tetanus, in which Stiibz and 
others have fouYid it so useful, could it be accounted for in a more 
simple or rational manner than by the faculty which this alkali pos- 
sesses of producing homoeopathic effects ? {Hahnemann.) 
Woorara—Curare.—Woorara is known as an energetic poison when 
introduced into the blood, though twrenty or thirty times the same 
amount may be introduced into the stomach without injury. Dr. Ilarly 
says, (Braithw. Petros]?., No. 41, p. 48,) Its superiority consists in its 
peculiar power of paralysing the motor and not the sensory nerves. 
It can be so administered as to destroy the power of voluntary motion 
without impairing the consciousness of the animal. He would, there- 
fore, give it to animals in such quantity as is sufficient to paralyze 
all the muscles except those of respiration. In this wTay he was able 
to allay the tetanic spasm, without destroying the intelligence, or 
arresting the performance of the organic functions; and, by thus con- 
tinuing the moderated action of Woorara until the kidneys have time 
to eliminate the strychnine from the system, he has been able to save 
the life of the animal. In tetanus we should endeavor to keep the 
spasms from killing the patient by their violence, until the morbid state 
that called them into play has exhausted its powers. 
Woorara or Curare has lately been brought into notice as a remedy 
for tetanus. Mr. Lloyd, of St. Bartholomew’s Hospital, tried it in the 
case of a boy, aged ten years, attacked with trismus seven days after 
inflammation of the left great toe from a contusion. The genuine 
Woorara wras introduced hypodermically every fifteen or twenty minutes, 
beginning with one-twentieth of a grain, and gradually increasing the 
dose, until a grain had been injected two or three times, to six grains 
in all. Though the spasms wrere diminished and the boy able to swal- 
low, and the spasms did not come on after drinking; yet he suffered 
so much from the puncturing of the skin that the treatment was dis- 
continued, and the boy died the next day. 
Nux-vomica as an antidote for Curare.—The conclusion we reach, 
after analyzing the results of the experiments of Messrs. Martin, Ma- 
gron, and Buisson* are “ that Curare and Strychnine differ in their ac- 
tion only by shades, which generally disappear with the doses employed 
and the mode of administration.” Curare, like Strychnine, determines 
convulsions by augmenting the excitability of the cord. Recent ex- 
* U. S. Jour. Homoeop. Yol I. p. 16., Mater. Med. TETANUS. 
537 
periments by Signor Yella, of Turin, also show, that, so far as either of 
these two agents is a similimura of the other, just so far it is an anti- 
dote for the train of morbid phenomena which it is capable of producing 
This is just what a homoeopathist would expect to find, and the French 
Academy have listened to the details of his experiments. He says he 
had learned from Bernard’s experiments that the effect of Curare (or 
Woorare) was to produce paralysis of the motor nerves. He has 
therefore been trying for several years to cure paralysis with it. In 
a series of ninety-seven experiments, he poisoned dogs by compelling 
them to swallow doses of Strychnine known to be fatally poisonous, and 
then attempted to antidote this poison by throwing small quantities of 
Curare into the jugular vein, whenever the tetanic symptoms showed 
themselves; and he thus continued his experiments till the poisonous 
power of the Strychnine was exhausted, and the animals completely 
recovered. 
In a second series of experiments, the two poisons were mixed in 
certain determined proportions, and no effect whatever was produced, 
and the life of the animal was undisturbed. When Strychnine alone 
(two-thirds of a grain of hydrochlorate of Strychnine in six drachms 
of water) was injected into the stomach of a middle-sized dog, fasting, 
it produced in fifteen minutes violent tetanic convulsions. A solution 
of Curare was then injected into the jugular vein, and the muscular 
spasms ceased. When the spasms returned the Curare was repeated 
in succession until the dose of two-thirds of a grain dissolved in half 
an ounce of water had been taken into the circulation. The whole ex- 
periment lasted three hours. The dog was well. Three days after- 
wards the same dose of Strychnine given to the same dog, without the 
antidote, and the dog died in sixteen minutes. 
In a third series of experiments Sig. Vella employed a mixture of 
one-thirty-third of a grain of Strychnine, and one-fourth of a grain of 
Curare in fifteen minims of water. Injected into the jugular vein of 
a large dog, it produced no effect. At another time the same dose of 
Strychnine, not antidoted by Curare, was given, and the animal was 
killed in the space of ten minutes. 
The experiments of Signor Piria, a chemist of Turin, show that the 
antidotal effect of these two deadly poisons on each other does not 
depend on the chemical decomposition of one by the other; for, on 
mixing them, no chemical decomposition takes place, “nor is any ap- 
preciable alteration noted; on the contrary, the two drugs preserve 
their individuality indefinitely.” This fact, says the correspondent of 
the Lancet, “ renders the modus operandi of these, in the process of 
mutual neutralization, all the more obscurer We regard them as dy- 
namic, not merely chemical agents. And now, having seen that one 
is almost a perfect similimum of the other, we find pleasure instead 538 
DISEASES OF THE NERVOUS FUNCTION. 
of perplexity in witnessing the additional power of the one over the 
deadly effects of the other. See U. S. Jour. Horn., Vol. II., p. 534. 
Strychnine—Case of Poisoning.— G. Bennett,.Sydney, Aus- 
tralia.—A lady, aged forty-two, took a large quantity of Strychnine 
with design to poison herself. Dr. Bennett gave Sulphate of Zinc, 
and tried to use the stomach-pump, but the violence of the spasms 
prevented. They increased to such an extent that life appeared ex- 
tinct ; face and hands livid; eye-balls protruded ; violent opisthotonos ; 
pulse imperceptible. Tincture of Iodine in water was given in one of 
the intervals. Spasms returned with violence; she was thought to be 
dead; when able again to swallow, thirty drops more given in ten or 
fifteen minutes from the first. Another fit less severe followed. Io- 
dine-tinct. thirty drops repeated in ten minutes more. The convulsive 
fit now ceased. In ten minutes more, violent vomiting came on, was 
promoted by warm diluent drinks, till the stomach wTas emptied of the 
poison. The author thought the Iodine acted by forming with the 
Strychnine, the insoluble compound of Hydro-iodate of Strychnine, 
and by relieving the system from the spasmodic action of the poison 
upon the spinal nerves, the emetic previously given was enabled to act. 
A few slight twitches of the muscles were afterwards noticed, but she 
continued improving. The patient had uttered no cries of pain, and 
said she had only felt inconvenience from the spasmodic drawing of 
the legs so rapidly downward; she said she was conscious of all that 
transpired, but could not speak. 
Camphor.—Dr. Paddock, of London, says: “The antidote for Strych- 
nine is Camphor. Five grains dissolved in mucilage puts a stop to 
the tetanic spasms, and gives time for the action of the stomach-pump, 
or emetics, if any poison has been retained. {Lancet, Dec. 31, 1859, 
p. 66.) 
Strychnine.—Tests of—I. Class, Color, Tests, depending on the 
color produced by the action of different re-agents on Strychnine. 
1. Bichromate of Potash, discovered by Lefort. 2. Ferro-cyanide of Po- 
tassium, discovered by Dr. Davy. (Braithw. lietros., No. 41, page 
303.) 
These articles in conjunction with strong Sulphuric-acid, produce 
with Strychnine a most beautiful purple color, and are the most deli- 
cate test yet discovered. De Vry and Der Burg, of Rotterdam, say 
they are able by this means to detect the sixty-thousandth part of a 
grain of Strychnine. 
In the search for Strychnine in the contents of the stomach or other 
tissues of the body, the Strychnine is first separated from the other 
structures with which it is mixed up. This has been recently effected 
by the use of chloroform. By this means Strychnine has been de- 
tected in the blood, liver, stomach, and tissues of animals poisoned by TETANUS. 
539 
it. In one case the animal was interred for two years; showing that 
the Strychnine had not undergone decomposition as had been hitherto 
supposed. De Vry and Der Burg conclude: That if death has been 
caused by Strychnine, this poison can only be detected in the body 
provided it has been administered in quantity more than sufficient to 
cause death; but if the poisoning by Strychnine has been chronic, and 
has resulted from a quantity not greater than just necessary to cause 
death, it cannot be detected by the chemical examination of the sto- 
mach and intestines; and that it is probable that that part of the 
Strychnine which has destroyed life is decomposed in the living 
body. 
Marshall HalVs Test.—Physiological effects of Strychnine.—A 
frog was placed in a very dilute solution of Strychnine; in a short 
time it became tetanic and showed evidence of Strychnine poisoning. 
He found that one-four-hundredth part of a grain of Strychnine dis- 
solved in six drachms of water caused the frog to be violently tetanic; 
and in two other experiments he detected quantities, in one case of 
one-five-hundredth, and in another of one-one-thousandth of a grain of 
Strychnine. Dr. Harley, of the University of London, says the phy- 
siological test is the most reliable one known. He applies it by in 
jecting the fluid into the thoracic duct or the abdominal cavity. When 
the poison reaches the lungs, it is rapidly absorbed through the pul- 
monary capillaries. He says a solution containing so small a quan- 
tity as one-sixteen-thousandth part of a grain of the pure alkaloids in 
jectcd into the lun'gs of a small frog, caused it to be violently tetanic 
in nine and a half minutes, and it died in two hours ; though frogs 
may be tetanized by other means than by Strychnine, this test is the 
most delicate known, and of great value when employed in connection 
with others. 
Motor Nerves.—Belladonna.—It acts as a depressor or paraly- 
zer; action only local, paralyzes the stomach, relaxes the sphyncters ; 
does not produce general paralysis. 
Homoeopathic use.—It gives relief in enuresis, involuntary micturi- 
tion and defecation ; the second or third dilution rarely fails. It is 
used antipathically as a local application to spasmodic strictures; 
rigidity of the os-uteri in parturition or dysmenorrhoea ; stricture of the 
urethra, retention of urine, chordee, &c. 
Sympathetic.—It is used to contract the arteries in some inflanv 
mations Avhen it can be made to operate through the vaso-motor nerves. 
Mammary abscess may be prevented by the local application of Bell, to 
the inflamed breast. But in substance it may increase the pain as it 
does that of a boil. 
Belladonna, succeeded by Pulsatilla, may be given in idiopathic 
tetanus which has arisen from deranged menstruation, or other causes 540 
DISEASES OF THE NERVOUS FUNCTION. 
connected with the utero-genital system, and wdiere the extremities are 
for the most part affected with the morbid contractions. It may also 
be sometimes given in the last stages of traumatic tetanus, when there 
is delirium, dilated pupils, and great mental anguish. 
Arnica should be used both internally and externally, in all injuries 
which threaten to tend to tetanus. This remedy possesses the powrer 
of wrarding it off, wdien it might otherwise have occurred without its 
use, and should always be resorted to when danger is anticipated from 
a wound. 
Trismus following an Injury ; Ignatia.—The patient begins to 
manifest trismus or lock-jawr, by stretching of the limbs, complaining of 
much pain in the neck, or of stiffness in the neck or the back; he soon 
has cramp or pain resembling the joints of the jaw, in the cheeks near 
the ear; he has constant inclination to yawn, but is unable to open his 
mouth sufficiently; he is fretful, irritable, difficult to please, grows 
worse when he is touched and handled. Give it every two hours. 
Mercurius—After Ignatia has been tried,and the lock-jaw has com- 
menced ; the back is stiff and rigid. 
Belladonna—When the face is red, and the rigidity great. 
Aconite—The patient gmvs red and pale alternately. 
Bryonia, or Veratrum—Where the patient becomes cold. 
Secale—When warmth makes him worse. 
Hypericum—When the original injury is affective. 
Bata—A redness first appears round the wTound. 
Chloroform.—Case by Dr. Dick, of Buenos Ayres.—A mulatto 
sailor, aged thirty-two, admitted to the British Hospital with two slight- 
ly incised wounds, one on the scalp, the other on the hand, inflicted five 
days before. Tvro days after admission, symptoms aggravated; fre- 
quent spasmodic attacks amounting to opisthotonos (backward); the 
least touch or breath of air excited the paroxysm ; pi'ofuse perspiration. 
Chloroform, ten drops every twrenty minutes, administered through the 
vacancy left by a missing tooth. The paroxysm soon ceased, but tense- 
ness and rigidity of the cervical and abdominal muscles continued. 
Next day pressure on the abdomen did not excite the paroxysm, though 
it had done so before. Chloroform, thirty drops every half hour. Next 
day no paroxysm, muscles hard and unyielding. Chloroform con- 
tinued for several days. There was no paroxysm till the twelfth day 
of treatment. The Chloroform had been omitted by mistake, and he 
had a very severe attack of eclampsia. Neglect was guarded against 
and there was no return. Fourteenth day, slept for the first time since 
the beginning of the disease. The bowels (which Croton Oil had fail- 
ed to regulate before) now began to act naturally; and from this time 
the symptoms began to be mitigated. He had less difficulty in swallow- 
ing; cervical and masticatory muscles became slightly moveable. On TETANUS. 
541 
the twenty-third day the pulse was feeble, and he desired animal food. 
The Chloroform thirty drops every two hours till midnight. Thirtieth 
day, muscular movements free and almost natural, save occasionally a 
convulsive twitch in the wounded arm. Speech not quite natural. lie 
remained feeble but otherwise in good health. 
Tetanus Chronic.—Case by Dr. J. II. Payne.*—Mr. C. H., aged 
twenty-six, dark complexion, intelligent and temperate, had haemorr- 
hage from the lungs at seventeen, supposed to have been caused by a 
fall two months before ; hut for near two years preceding he had 
chronic eruptions (scabies); itching and burning, especially at night. 
From a few small pimples it increased and covered the whole body. 
This eruption was entirely suppressed by treatment—supposed to he 
cured by a mercurial ointment. After this suppression, cough and 
haemorrhage continued from seventeen to near nineteen years of age 
He then began to have cramps in his hands and feet. In Jan. 1847, 
Jan. 20, cramps more severe ; the head drawn forward, then backward, 
the muscles rigid and inflexible, face livid, with frightful contortions 
and great distress. The attacks would last from a few days to six 
months, then leave him after having the severest ones; after an inter- 
val of uncertain length they would return as bad as ever. 
In 1849 he had cholera; this relieved the spasms for four months 
They then returned with new vigor. In 1852 the joints were dislocat- 
ed ; first the lower jaw, then the shoulders, lastly the hips, then all 
three would be dislocated in a spasm. He tried the treatment of the 
best hospitals in Boston, Rio, New-Orleans, San Francisco, was given 
up as incurable. Rigid diet, traveling, sea voyages, mineral waters? 
hot and cold baths, turpentine in large doses, issues, setons, blisters, 
bleedings, enemas of tobacco, and narcotics of all kinds were fully 
tested, without benefit. His physicians often gave him jive ounces of 
laudanum in one hour in advance of the cramps, with but little effect. 
Six ounces of chloroform administered in an hour and a half rather 
made the spasms worse. In 1855, April 27, he came under the care 
of Dr. Payne. The patient would then be seized with the spasms 
without warning; face and knees drawn together in an instant with 
great force (emprosthotonos.) All the flexor muscles of hands, feet 
and body contracted, inflexible, rigid, whole person presented the form 
of a large ball. Spasms of the intercostal muscles, diaphragm and 
abdomen so intense that they produced a large cavity at the base of the 
horax, apparently displacing all the internal organs of the body; face 
suffused by a dark livid flush, and miserably disfigured by the perverted 
action of the muscles. After the distortion continued from two to 
twenty minutes, in an instant his condition was reversed. The head 
* Amer. Horn. Rev. Yol. 2, p. 278, &c. 542 
DISEASES OF THE NERVOUS FUNCTION. 
thrown backward, striking his feet with violence. The feet would p iss 
the head nearly a foot, which curved the body in the shape of a hoop 
or ring. This curvation was so sudden and so forcible, that he would be 
thrown far from the bed, if not held by assistants. All the extensor 
muscles of the body were rigidly contracted and inflexible, at the same 
time in a continued spasmodic twitching motion. 
“ During these severe contortions, both shoulders, the lower jaw, and 
sometimes one of the hip-joints would be dislocated, requiring each 
time much strength to reduce them. The head was drawn back, the 
larynx forward, the tongue dragged down the throat, or convulsively 
protruded, nearly causing suffocation. The blood at times gushing from 
the mouth and nostrils in large quantities ; the eyeballs spasmodically 
rolling, producing a frightful distortion of the face, expressing the 
greatest agony.” In the course of twenty-four hours “ both shoulder- 
joints and the lower jaw were dislocated twenty-seven times, and one or 
the other of the hips five times, requiring to be reduced each time 
causing distinct snaps when the bones returned into their sockets 
And when the head was raised from the nuchse, a distinct snap could 
be heard in any part of the room; during the severest spasms he was 
always delirious, or unconscious, the pulse not perceptible, and respira- 
tion nearly ceased, having the appearance of a person in a fit of epi- 
lepsy. The spasms left him greatly prostrated, his limbs and flesh 
sore as if badly bruised; sometimes heavy sleep followed. He was 
greatly reduced in flesh and strength; the face of a yellowish sickly 
look, the eyes deeply sunken in the head ; tongue coated yellowish 
brown; no appetite, continued thirst; constipation ; stool only once in 
nine or ten days; evacuations small, dry and dark colored; urine 
scanty, without sediment, brown-red color, voided with burning pain. 
He was melancholy, morose, depressed; easily enraged; nothing 
pleased him ; despaired of being cured ; confusion, drawings, shootings 
in the whole head. 
This case was treated by Dr. Payne first with Stramonium, thirtieth, 
April, 27, 1855, at intervals, for eighteen days. During the action of 
the Stramonium there was a change in the symptoms : “ The pains be- 
came more acute, the spasms drew him differently, and he felt differ- 
ently from what he had ever done before. The spasms were postponed 
to a later hour, they did not last so long, and the time between them 
was shorter. The symptoms having assumed the form of epilepsy, 
with violent congestion, face more livid and purple than ever before, 
foam at the mouth, and a heavy sleep after the spasms, Bell, sixty-fifth 
was given in alternation with Saccharum-lactis for four weeks, or till 
June 15. There was then improvement in all the symptoms; fewer 
spasms, less severe ; joints not so often dislocated, and he had passed 
several nights without any spasms. The congestion decidedly better 543 
HYDKOPHOBIA. 
On learning fully the history of the case, it was considered that the 
psoric affection was the cause of all the trouble, and now (June 20th, 
1855,) Sulphur 100° was given, two tea-spoonfuls from a solution every 
eight hours for five doses, Sac.-lactis for a week, and repeat the Sulphur 
as before. Continued this for six weeks longer. Then gave Sulphur, 
200°, in the same manner. Under the use of Sulphur he improved 
rapidly. The spasms gradually decreased in frequency, remaining ab- 
sent one, two, three, or more days at a time. After Nov. 1st., he had 
no severe spasm. After a few weeks a large number of small, dark, 
livid abscesses appeared on the face, and then on different parts of the 
body. These were a long time in suppurating; some were as large as 
a quarter of a dollar, and left without discharging. Some continued 
for six months. 
2. HYDROPHOBIA. 
“ So bends tormented Tantalus to drink, 
While from his lips the refluent waters shrink. 
Again the rising stream his bosom laves 
And thirst consumes him ’mid circumfluent waves.” 
The name hydrophobia, or dread of water, is given to that dreadful 
malady which follows the bite of a rabid animal, and the introduction 
of its saliva into the blood. A dread of water is commonly a promi- 
nent and characteristic symptom of the disease ; but it is by no means 
one that is invariably present. Cases are reported by Hunter, Frank, 
and Eberle, in which no unpleasant consequences followed the use of 
drinks, from the commencement to the fatal termination of the disorder. 
We ourselves have seen a rabid dog, that would, without hesitation, 
plunge into the water and drink during the whole course of the disease, 
without excitmg spasmodic contractions, of any other disagreeable 
symptom. 
Rabies originates spontaneously in animals of the canine species, 
like the dog, the fox, the wolf, &c., and appears to consist of a morbid 
deterioration of the saliva. The precise nature of this deterioration, 
or of the specific poison which this fluid contains, is at present entirely 
unknown; but in regard to its specific action upon some portion of the 
nervous centres there remains no doubt, although pathological anato- 
mists have hitherto failed to detect the peculiar diseased appearances 
to which it gives rise. Perhaps this may be accounted for when we 
call to mind the proneness of pathologists to regard congestion of the 
blood-vessels, redness, effusion, softening or induration as the only mor- 
bid appearances indicative of previous disease, while, in point of fact, 
as shown by the pathological investigations of Dr. Hugh Bennett, by 
means of the microscope, “ important changes may take place in the 544 
DISEASES OF THE NERVOUS FUNCTION. 
cerebral substance, spinal marrow, &c., inappreciable to the naked eye, 
but clearly discernible with the microscope. (Ed. Med. and Sui'g. 
Jour.) Yol. LVIII., p. 58 and 60.) 
The redness of the fauces and oesophagus which is often observed 
in men and animals dead of hydrophobia, is attributable rather to the 
irritation consequent upon the intense and unindulged thirst which was 
present during the attack, than to any specific action of the virus upon 
those parts. The virus of rabies is formed and is active, for the most 
part in the saliva, but a sufficient quantity is absorbed into the general 
circulation to produce the morbid impression upon the spinal marrow 
which constitutes the chief fact of the disease. Could we confine the 
virus to the saliva of the mouth, and prevent its admission into the 
circulation, no evil effects would result; but place the smallest quan- 
tity in a position where absorption can take place, and it will be con- 
veyed with unerring certainty to the part which possesses a specific 
affinity for it, and there produce its legitimate morbid impression. 
Some writers suppose that the poison does not enter the general cir- 
culation, because the North American Indians, the inhabitants of the 
country of Mantoa, &c., eat the flesh of hydrophobic animals with 
impunity; but this proves nothing, for the lacteals and absorbents of 
the digestive apparatus, reject this substance as an irritant, and it is 
carried oft* with the fasces, without producing any impression. 
Mackintosh supposed that many cases of tetanus were mistaken for 
hydrophobia, when dread of liquids is one of the symptoms of the 
former; and when we reflect that the teeth of dogs usually inflict such 
punctured or lacerated wounds as often give rise to tetanus, the opin- 
ion seems plausible. 
Hydrophobia usually makes its appearance in from twenty to sixty 
days after the bite, although well-authenticated cases are recorded in 
which the virus has remained dormant in the system for years, when it 
has finally developed itself from some constitutional disturbance, and 
the patient has succumbed with all the symptoms of hydrophobia. 
Diagnosis-.—At an uncertain period, varying from three to nine 
weeks from the reception of the wound, the first symptoms of hydro- 
phobia make their appearance, usually in the bitten part, which 
presents a livid and slightly swollen appearance, and attended with 
burning heat or shooting pains, which dart from the seat of injury to 
the neighboring parts. These symptoms are speedily succeeded by 
rigors, lassitude, great depression of spirits, anxiety, watchfulness, 
irritability, giddiness, eyes red, brilliant and sensitive to the light, 
uneasy sensations at the stomach, tension at the chest, difficulty of 
deglutition, and slightly oppressed respiration. As the disease ad- 
vances, the cramps about the throat, neck, and chest, become more 
violent, until the mere sight of a liquid, or of a shining substance, will HYDROPHOBIA. 
545 
produce tlie most painful paroxysms; there is a viscid saliva con- 
stantly secreted, which compels the victim to be continually spitting, 
while at the same time he is tormented with a dryness in the mouth 
and throat, and an intense thirst which he is unable to allay, on account 
of the spasmodic contractions which occur whenever drinks are pre- 
sented to him. The skin is hot and dry, the cicatrix opens and 
presents an unhealthy appearance, the respiration becomes more and 
more difficult, the voice becomes changed, the pulse nearly natural, the 
body affected with tremors or slight spasmodic twitchings, vague pains 
extend up from the lower part of the spine to the head, and finally 
the countenance becomes pale and haggard, the eyes sunken, yet still 
brilliant; there are palpitation of the heart, wandering delirium, con- 
stant inclination to bite, extreme anxiety and uneasiness, sinking of the 
pulse, loss of voice, clammy sweat, and finally the sufferer sinks into 
a lethargy, or into convulsions and dies. 
The disease commonly terminates in from two to eight days from 
its approach. Dr. Thatcher gives the following theory of hydrophobia* 
* The poison being infused into the contexture of the living solids, acts 
primarily as a local poison: the whole nervous system partaking of the 
irritation, is brought into general sympathy, even the functions of the 
stomach, brain, heart, and lungs suffer directly by its influence, and by 
a continuance of the morbid action, the structure of the living fabric is 
destroyed, or the principle which is essential to its natural action 
becomes dissipated, and the entire extinction of the vital principle is 
ultimately completed.” * 
The recent researches of Claude Bernard furnish the following 
results : It would appear that in several diseases the noxious sub- 
stances causing disease prevail throughout the economy; in other 
cases it is found only in certain fluids. The virus that occasions 
hydrophobia resides only in the animal’s saliva. We have not yet 
learned whether any one of the salivary glands is its peculiar seat, or 
whether it is indifferently secreted by all of them. No experiments 
have beentried on this point. “But it has been experimentally proved 
that the peculiar venomous principle does not exist in the blood; 
transfusion does not convey the poison from a mad dog to a healthy 
one.” 
It is a singular fact, and one which preeminently deserves our atten- 
tion, that in so general a disease, the virus, which alone is capable of 
transmitting the affection, should be exclusively localized within one 
single apparatus, without existing in the blood at large. But the same 
thing in principle may be seen in other cases; pepsine, ptyaline, and 
the active principle of the pancreatic juice are each secreted by a 
Vol. II—35. 
* Ou Hydrophobia, p. 10S. 546 
DISEASES OF THE NERVOUS FUNCTION. 
special gland, and the venom of the serpent, which does not exist in 
the blood, is produced by a special apparatus. The virus secreted by 
the salivary glands of the mad-dog, is secreted by this apparatus alone, 
for the same reason. In glanders and some other diseases the poison 
is in the blood. 
Treatment.—The most certain preventive means after the bite of 
a rabid animal, is to excise immediately and thoroughly the wounded 
part. This severe measure can only prove available unless resorted 
to within a very short period—say fifteen or twenty minutes after the 
infliction of the bite. If a longer time than this has elapsed, we 
should advise free incisions upon the wounded points, and after they 
have bled freely, and been suitably washed and cleansed, the applica- 
tion of the caustic alkali. Some surgeons speak in slight terms of the 
red-hot iron, of the butter of antimony, of Corrosive Sublimate, of 
Chloride of Zinc, &c.; and, certainly, the prompt use of the knife, 
and of the Caustic Potash, will prove more efficient and less painful 
than the other applications. A New-York physician writes as fol- 
lows: I had occasion, a few years ago, to test the 'practical opera- 
tion of these severe measures upon my own person. In July, 1844, I 
was bitten in the leg, without provocation, by a dog, which came tear- 
ing past me at a furious rate, with fierce and brilliant expression of the 
eyes, tail pendant between the legs, foam at the mouth, and hair stand- 
ing erect upon the back. Without any delay, I excised the bitten 
part, and applied Caustic Potash to the wround in the most thorough 
manner; after which I dressed and bound up the limb, congratulating 
myself on my promptness and probable escape from the most dreadful 
malady. Inquiries were now instituted to ascertain something re- 
specting the whereabouts of the “mad-dog,” when, to my surprise, and 
and, indeed, I may say indignation, I was informed that the animal was 
not rabid, but “ dreadful ugly.” The course adopted, however, was a 
prudent and safe one, and I should most certainly do the same thing 
under similar circumstances, on the principle that “ an ounce of pre- 
vention is better than a pound of cure.” As the matter actually 
turned out, I was tormented with a painful limb for twro or three 
months unnecessarily; but had the animal proved to have been rabid, 
then the result would have been the saving of my life.” 
No specific has yet been discovered for the cure of hydrophobia, 
although many articles have been at different periods brought into 
notice by the old school; as, for example : Mercury, Burnt Lichen, 
Black Pepper, the Purple-foioered Anagallis, Oil of Valerian, 
Opium, Musk, Ignatia, Camphor, Cantharides, Stramonium, Nux- 
iiomica, and Belladonna. 
Belladonna.—Professor Munch has given this article to several 
who have been bitten by rabid dogs, and not one was attacked with HYDROPHOBIA. 
547 
# 
rabies. Hahnemann also administered it with success, both as a pro- 
phylactic and curative remedy. 
In consulting the pathogenesis of Belladonna, we find amongst the 
most prominent symptoms to which it gives rise, dryness and con- 
striction of the mouth and fauces, accumulation of a tough mucus 
about the mouth, deglutition difficult or even impossible, injected and 
glassy eyes, articulation difficult, voice changed, giddiness, trembling 
and weakness of the whole body; mouth and jaws spasmodically 
affected, intense thirst, nausea, and finally, previous to death, “ a feeble 
pulse, cold extremities, subsultus tendinum, tremors, deep coma or 
delirium, and sometimes convulsions. 
From the above description, it is apparent that this medicine in- 
duces a close correspondence to the most marked symptoms of hydro- 
phobia, and, therefore, it is entitled to our earnest consideration, when 
called to cases of this description. Hahnemann says of it: 
Belladonna—“ Among the symptoms produced by Belladonna, 
when administered to a person of sound health, are, those which, taken 
collectively, present an image greatly resembling that species of hydro- 
phobia caused by the bite of a mad dog, a disease which Mayerne, 
Munch, Bucholz, and Neimihe cured in a perfect manner with this plant, 
homoeopath ically. The patient in vain endeavors to sleep, the re- 
spiration is embarrassed, he is consumed by a burning thirst, at- 
tended with anxiety/ the moment any liquids are presented to him 
he rejects them with violence / his countenance becomes red, his eyes 
fixed and sparkling, (as observed by F. C. Grimm); he experiences 
a feeling of suffocation while drinking, (Camerarius and Sauter); 
for the most part he is incapable of swallowing anything, (as affirmed 
by various authors.) lie is alternately actuated by terror and a desire 
to bite those about him, (as seen by Sauter, Dumoulin, Buchare, and 
Madorf j; he spits everywhere around him ; endeavors to make his 
escape, and there is continual moving about of the body, as has been 
observed by various other authors.” 
Dr. Richard Hughes thus speaks of the tissue-irritant power of 
Belladonna on the brain: “Belladonna first excites the cerebrum and 
perverts its functions ; hence delirium, insomnia, mania. Its prolonged 
use produces congestion, inflammation, and effusion. For the cure of 
such conditions it is one of the best known remedies. 
“ On the cerebellum it acts by producing loss of the co-ordinating 
and balancing power in the muscular system, especially in the lower 
limbs.” See remarks on this remedy under Chorea. 
On the Medulla Oblongata.—Belladonna has produced spasms of 
the larynx and pharynx, difficult articulation and deglutition and spas- 
modic cough. An excited state of the medulla oblongata may give 
rise to many diseases. If its influence fall on the blood-vessels of 548 
DISEASES OF THE NERVOUS FUNCTION. 
the brain, we have epilepsy. In this disease Belladonna is, ’ aftei 
Hydrocyanic-acid, comparatively our best remedy,* and it is Dr 
Brown-Sequard’s chief remedy at the hospital for the paralyzed and 
epileptic. If the laryngeal and pharyngeal nerves be mostly af- 
fected, we have laryngismus, pertussis, or hydrophobia (so far as the 
throat symptoms are the principal ones.) In laryngismus stridulus 
Bell, has not been tried, and Aconite rarely fails to arrest it. In per- 
tussis, Bell, has been in use by both schools. In alternation with 
Drosera it is the best remedy in the second stage of the disease. 
If hydrophobia w'as ever cured the credit is due to Bell. ( Watson, 
Practice, &c., Yol. I., p. 629.) In China, Stramonium is regarded as 
a sovereign remedy for it. In some cases of stammering it may be 
useful, by acting on the hypo-glossal or motor nerve of the tongue. 
Lastly, when the excited state of the medulla falls most severely on 
the pulmonary branches of the vagus, we may have spasmodic asthma, 
for which Stramonium is a remedy in the old school. In all of these 
cases, Bell., if useful at all, acts by producing a degree of irritation 
on the medulla oblongata. 
On tlie Corpora Quadrigemina.—These organs—the centres of 
vision—when irritated by Bell., manifest its effect in the visual hallu- 
cinations which are common in Bell, poisoning, even when the retina 
is paralyzed to all actual objects. Hence the use of Bell, in delirium 
tremens, and other derangements of vision from causes within the 
cranium. 
Case.—Pell. — An instance is given in Ilufeland’s Journal, in 
which a rabid man bit several others, all of whom died from rabies 
except two, Avho were treated with Belladonna. Dr. Casanova says he 
has treated several cases with this remedy, without excision or cauter- 
ization of the bitten part, and has succeeded in restoring them all to 
health except one, who had been barbarously treated with knife and 
fire. As a prophylactic, he gave one dose a week for a period of forty 
days after the bite is inflicted. The period of incubation has in many 
cases been much longer than this. Hartmann says, even “ for years.’’f 
Rabies—Intermittent—quotidian form. Dr. Casanova gives a case 
of a girl, age fifteen, of delicate constitution, with incipient tuberculosis, 
who was bitten on the arm by a girl nine years old. The wound was 
inflicted on the middle and posterior part of the right fore-arm, pene- 
trated only the epidermis, and only a few drops of blood flowed. Next 
morning erysipelatous inflammation extended from the wound toward 
the shoulder, but this was cured by a few doses of Belladonna; the 
wound healed in four or five days. Forty-one days after the injury, 
* See cases by Dr. Russell, Brit. Jour. Horn. Yol. 15. 
t Therap. Horn , Chap. XIII. HYDROPHOBIA. 
549 
the phenomena of rabies appeared in a frightful form. In the midst 
of a paroxysm that had lasted four hours, ending at three, p. m., she 
was found “ lying in bed on the right side, face covered with both 
hands and a handkerchief; refused to answer questions, though con- 
scious ; sobbing profoundly, with catching the breath; breath cold; 
sobbing quick, convulsive, audible to the street. Hurried respiration, 
feeling of suffocation in the throat; discharge of thick mucus from the 
mouth ; general convulsions at short intervals; pulse and heart rapid, 
intermittent, impossible to reckon the strokes; pain all along the 
spine; headache; eyes with peculiar unsteady glistening appearance 
and intolerance of light; buzzing in the ears; tongue dry, cold, whit- 
ish ; no appetite; no aversion to water; wished some every few min- 
utes ; cold extremities; very anxious, restless, and timid; no bells 
allowed to ring in the house; sudden starting, excited by the slightest 
noise; dread of persons entering the room. After three hours these 
symptoms all subsided ; she rested quietly till eleven o’clock next day. 
A paroxysm then commenced by sIoav tremor all over the body; hur- 
ried respiration, gradually increased till general convulsions were 
manifest in the same degree of intensity as on the previous day; the 
attack lasted two hours. Cedron 1° was given after the paroxysm, 
and repeated at seven next morning.” 
The paroxysm returned earlier next morning, and was repeated with 
increased severity at four, p. m., and was attributed to “ the active forces 
■of the drug.” Cedron 3°, and then the 10° was tried, “ which also 
proved aggravating.” The double paroxysm returned on the two fol- 
lowing days. Tartar-emetic was given in the apyrexia to remove the 
mucous rales and rattling phlegm, which threatened suffocation. Ce- 
dron 30° then checked the paroxysm, promptly and permanently. 
There was no return. In cases where “periodicity” is a prominent 
feature, Cedron may with propriety be employed in preference to 
Belladonna. 
Lobelia is said to have power to counteract the poison of hydropho- 
bia. It is directed to give a dose at the appearance of the first symp- 
tom of the disease. This is to be repeated “ dose after dose, till the 
system is completely prostrated and the patient is utterly unable to 
lift a hand.” Whether this powerful agent shall yet prove itself a 
specific antidote for the most dreadful of all animal poisons, remains 
to be seen. 
When the disease is fully formed, and there are severe convulsions, 
with sense of impending suffocation, dryness of the mouth and fauces, 
extreme difficulty of deglutition, dread or horror even at the sight of 
liquids, delirium, rage, and fury, we may likewise consult Stramonium, 
Nux-vomica, Ilyoscyamus, Lachesis, Cantharides, and Veratrum. 550 
DISEASES OF THE NEKVOU8 FUNCTION. 
The medicines may be administered in the same manner as advised 
in tetanus. 
Review of Empirical Treatment of Hydrophobia.—We pass over 
the ancient imaginary remedies. It is not necessary to describe the 
method of preparing the “ boiled liver of a mad-dog,” nor the virtues 
of the endless number of useless articles; we come to those which 
have been trusted to in later times. 
Anagalla-arvensis—Pimpernel, Chickweed.—Laws have been 
passed in foreign countries to preserve this plant, and its virtues have 
been celebrated by learned physicians in classical Latin; but these 
are now forgotten. Its use was revived by Mr. Kittering, in Pennsyl- 
vania, who for thirty years maintained a high reputation in this dis- 
ease, extending into different States. In March, 1802, when he had 
reached the age of 75 years, the secret having been stolen from him, 
he made it public to a committee of the legislature. They reported 
that he had come from Germany at the age of 11 years, that his 
mother brought with her the seeds of the red Chickweed. Ilis treat- 
ment was: Of the powdered herb, one drachm or a scruple to an adult 
He said he had given it to many persons several weeks after they had 
been bitten ; he never gave but one dose, and in thirty years he never 
failed in one. In Germany, the usual dose was thirty grains of the 
powder, four times a day, continued for one week, washing the wound 
with the decoction. Mr. Kittering received no reward from the State 
but the honorable mention of his name. The public thought they had 
not gained much, as'failures of the remedy were soon reported. 
Webb's Remedy.—In 1807, De la here P. Blane, a Veterinary Sur- 
geon, of London, gave, in the Medical and Chirurgical Review, an, 
account of his remedy. The medicine had been dispensed for more 
than a century by the Webb family. It was said that for thirty-five 
years there had not been a single failure. The author says he tried 
it in his own case, though he excised the part and used a potent cau- 
tery at the time. The receipt, as given 150 years before, and sworn to 
by James Webb, was tried by Mr. Blane, who directs : fresh leaves of 
Box-tree, two ounces ; fresh leaves of llue, two ounces ; of Sage, half 
an ounce. Mr. Blane says he gave it a fair trial. In no instance was 
it certain that it cured, but it was found a preventative, as out of ninety 
animals bitten, only one went mad, and this not on his hands. 
Crous's Remedy.—In 1806, the legislature of New-York, purchased 
of John M. Crous, his mode of curing hydrophobia, which he said he 
had employed for more than twenty years, with success, in curing 
canine madness. This remedy consisted of Verdigris, one scruple, 
such as rises on the surface of an old penny, by lying on the moist 
earth; those of George I., or George II., were the best, as the purest. 
The other ingredients are too ridiculous to mention, though they were HYDROPHOBIA. 
551 
to be mixed intimately; the ounce of calcined jaw-bone of a dog an- 
swered as forming the Verdigris into a good first trituration of the latter 
and increased its efficacy and safety. An adult took a tea-spoonful a 
day. Half of the above quantity was to be used for a child, to be 
taken in a small quantity of water. Next morning, before eating, to 
repeat the same. This, if taken after the bite and before the symp- 
toms appear, will prevent it. But if the symptoms appear: “ a physi- 
cian must be called, who must gjve 180 grains of the above mixture, 
the bulk being more than doubled by another addition of animal sub- 
stance, and half an ounce of Calomel at one dose; no fear being en- 
tertained of the large dose of poisons, as the poison of the disease 
was sufficient to neutralize it. In three hours, if not completely re- 
lieved, to take four grains of solid Opium. He must be careful to 
avoid the use of milk for several days after taking the above.” To the 
success of this prescription, as the only one he used in the course of 
his more than twenty years’ successful practice, Mr. Crous made an 
affidavit before Chief Justice Kent, at Albany, March 24th, 1806; and 
for the disclosure of his method the State paid him $1,000. 
Dr. David Hosack wrote of it, that he would be inclined to try it all 
except the Calomel. The chief ingredient being copper, which the 
books show to have great power in epilepsy, and other diseases of the 
nervous system. He had learned from Governor Lewis that the testi- 
mony in favor of Crous’s remedy was very respectable. He thought 
the power of one poison might be expended in counteracting the other. 
“ Let us not despair of finding some stimulus that will counteract 
hydrophobia.”* Of Verdigris, the old authors say: “Large portions 
of four or five drachms, or more, have been swallowed with no other 
inconvenience than the present vomiting; yet, in smaller quantities, 
besides the vomiting, it excites pain in the stomach, griping in the 
bowels, tenesmus, ulcerations, bloody stools, difficult breathing and 
contractions of the limbs, which often terminate in death.f Copper, 
swallowed in its pure state, is inoffensive.”^ 
/Scutellaria Laterifolia.—Skull- Cap.—Flowers late in August, stem 
square, root perennial; flower violet, small, in racemes; intermixed 
with small leaves. The species galericulata has axillary flowers, in 
pairs, and large corolla. A Mr. Lewis long practiced in Westchester 
County, New-York, in the treatment of hydrophobia with this plant. 
He gave a single powder at a dose, and tested its powers by giving it to 
some animals bitten, and leaving others bitten by the same dog to 
die. He said two ounces of the plant given in several portions would 
cure man or beast. It was claimed that more than one hundred cases 
were cured by the Lewis family. Dr. Vandever, of Raritan, N.-J., said 
* Medical and Philosophical Register, Vol. I. 
t Parr’s London Med. Dictionary. f Thatcher on Hydrophobia, p 214. 552 
he had cured more than three hundred, and lost but one. Cases of 
cures were published in the N.-Y. Evening Post, May, 23d, 1811 
other cases, Dec 21st. (Thatcher, p. 229.) 
The Mad Stone.—The belief in the absorptive power of certain 
kinds of stone to extract poison is still common. Dr. Mease examines 
their claims in the Medical Museum (Yol. V.), and denies their having 
any virtue whatever. In India the people still believe in them. 
In Tonquin, persons bitten by serpents press out the blood and apply 
a small stone, called a serpent stone, which is said to draw out the 
poison. When full it drops off; is washed in lime water and reapplied. 
Dr. Mease says some of these stones are in the cabinet of the Philo- 
sophical Society, brought from India. They are more than an inch 
long, ten lines broad, of a bluish-slaty color, and flattish shape. A 
gentleman in Virginia offered to sell one for two thousand dollars in 
shares of ten dollars each; the amount was made up in five counties, 
and a meeting of the stockholders placed it in the hands of a physi- 
cian for safe-keeping. 
DISEASES OF THE NERVOUS FUNCTION. 
3. ANGINA PECTORIS.—STERNALGIA. 
This disease was fully described by Ileberden, in the Medical Trans- 
actions of the London College of Physicians (Yols. II. and III.,) though 
it is mentioned under ‘other names by a great number of ancient 
authors. It appears in several different forms, being sometimes pre- 
ceded by derangement of the digestive organs, and sometimes without 
any, or very slight premonition. 
I. Acute Angina Pectoris.—Sudden seizure with painful constric- 
tion of the chest, which is most severe in the cardiac region, near the 
lower part and left side of the sternum. The pain sometimes extends 
to the right side of the chest, then to the shoulder, arm, wrists, and 
sometimes the fingers. In mild cases the pain may be of short dura- 
tion. 
In more severe cases, the patient experiences occasional sharp pains 
in the region of the heart, especially after active exercise, or Avhen 
putting the muscles of the chest upon the stretch. After a time, the 
pains recur more frequently, continue for a longer period, and are ac- 
companied by palpitation ; attacks of syncope ; sense of suffocation 
and tightness in the chest, and great difficulty of breathing. The 
attacks are usually excited by violent physical exertions, mental emo- 
tions and deranged stomach, from abuse of stimulants, and of indi- 
gestible food. i 
In more violent attacks, the pain and the sense of constriction of 
the chest and pain in the arm involves both sides of the chest and both 
arms; and the agony is so excruciating that it is compared by Laennec STERNALGIA. 
553 
to the piercing of nails, or the laceration of the claws of animals : there 
is a sense of syncope, with suffocation, orthopnoea, convulsive dyspnoea 
palpitations, extreme anxiety, and a sense of approaching death. The 
stomach is affected with flatulent distension and great irritation, relieved 
by eructations. The pulse is sometimes weak, irregular, intermittent, 
or full, active and strong. When the attack has been excited by ex- 
ercise, the patient suddenly stops, and feels that life would be termi- 
nated by any effort to proceed. The paroxysm varies in duration as 
well as in severity, lasting sometimes a half hour, and very often 
several hours. It may at first be slight in degree, and the paroxysms 
may occur at long intervals. They afterwards occur more frequently 
and from slighter causes. In very severe cases there are almost con- 
stant dyspnoea, pains extending down the arms and into the back; 
very frequent and alarming attacks of syncope and suffocation; pale 
and haggard, or livid and exceedingly anxious expression of counte- 
nance. If the disease is not arrested, the patient generally expires 
suddenly in one of those distressing paroxysms. 
When angina pectoris proceeds from hypertrophy of the heart, we 
shall observe, in addition to the symptoms just named, powerful pulsa- 
tions of the heart, which are visible at a distance; full and vibrating 
pulse, and dull sound on percussion. 
If the disorder has arisen from dilatation of the ventricles, there 
will be swelling and visible pulsation of the jugular veins, a loud and 
distinct sound on applying the ear over the fifth and sixth ribs, vertigo, 
frequent turns of syncope, palpitation and dyspnoea; pulse weak and 
tremulous. 
When angina pectoris is connected with disease of the valves of 
the heart, the following signs will be present: great dyspnoea on the 
slightest exertion; frequent and violent palpitation; pulse feeble and 
irregular; livid and unnatural appearance of the countenance; oede- 
matous swelling of the feet and ankles; and “ a permanent sawing or 
rasping, or filing sound over the valves of the heart, especially after 
depletion and rest.” (Swett.) 
II. Chronic Angina Pectoris.—The paroxysms recur frequently, 
from trifling causes; they begin during sleep, are of long duration, 
though less violent; sometimes it lasts several days; palpitation of 
the heart; irregularity of the pulse may continue through the intervals 
as well as in the paroxysm. The disease may commence without 
warning, with a feeling of intense agony and approaching dissolution, 
palpitations, irregularity of pulse; the pain sometimes involves both 
arms, and ascends to the throat and lower jaw. It is aggravated by 
the slightest movement, assuming the erect posture, reading aloud, 
coughing or sneezing. A neuralgic pain continues under the sternum, 
extending to the arms after the more distressing feelings have sub- 554 
DISEASES OF THE NERVOUS FUNCTION. 
sided, (Copland. Diet., Vol. L, p. 71, &c.) During the paroxysm 
consciousness is generally retained; but the face and extremities are 
cold, covered with cold sweat, and the features spasmodically distorted. 
The effects of the paroxysms when they occur at long intervals are 
not generally serious so long as the general health remains good. 
But when the attacks become frequent, are severe or protracted in 
duration, the digestive organs become disordered; the stomach becomes 
irritable, the bowels irregular, the respiration impeded, countenance 
anxious; the integuments become flabby; the circulation deranged; 
the face and other parts of the body become oedematous and dropsical. 
The patient often sinks under a complication of organic derangements, 
or dies suddenly from the violence of a paroxysm. “ In nearly all 
cases the attack is preceded or attended by more or less derangement 
of the alimentary canal, manifested by flatulence, sour eructations; 
cramps and costiveness;” and ‘'the pain goes off’ reversely” from the 
order in which “ it comes on, subsiding first at the extreme point, and 
the paroxysm closes with belchings, &c.” (Amer. Cyclop. Pract. 
Med. and Surg., Vol. I., p. 556). Phila., 1834. 
Diagnosis.—Distinguished from asthma by the acute and peculiar 
pain in the sternum and left arm, by the difference between the phe- 
nomena attending on each ; the paroxysms of asthma come on at even- 
ing or during the night; they are characterized by heavy dyspnoea, 
wheezing, and cough, relieved by expectoration aud exposure to fresh 
air, and subside towards morning. The dyspnoea of asthma depends 
on the spasmodic contraction of the muscular fibres and their ramifi- 
cations. The stethoscope gives no peculiar signs of angina pectoris 
except when it is complicated with organic lesion of the heart and 
lungs, or effusion in the plural or pericardial cavities. The neuralgic 
character of the pain in this disease and its severity form the most 
striking features to distinguish it from other diseases. 
Causes.—1. Predisposing. More common in males than females; 
in middle aged persons, or those still older; in persons of gouty or 
rheumatic diathesis, of indolent, studious, or sedentary habits, of 
anxious minds, indulging in a full diet and stimulating drinks. Chap- 
man refers its origin very generally to hereditary causes, especially 
to transmitted gout. {Amer.-Jour. Med. Sci., Vol. XIII., p. 67.). It 
evidently arises from various other causes. 
2. Exciting Causes.—Active exercise, walking against the wind, 
up hill, or ascending the stairs, with the stomach distended. We have 
seen a case in which it was brought on by the labor of digging up 
large fruit trees. The patient was a farmer of sixty years of age, and 
recovered. In a severer case, excited by exposure to extremes of heat 
and cold, nearly every symptom above enumerated was present. The 
patient ultimately died of organic disease of the heart. In some sus« STEEN ALGIA. 
555 
qeptible and irritable constitutions, tliis disease may be excited by 
the most trifling causes: as eating too much, strong emotions, talking, 
yawning, sneezing, or any other sudden exertion. 
Angina pectoris may proceed from some organic disease connected 
with the heart, like ossification of the coronary arteries, or of the valves 
of the heart, dilatations or hypertrophy of the heart, obstructed circu- 
lation from an accumulation of fat about the organ, from the pressure 
of the tumors, or from asthma. Very often, however, it is a purely 
sympathetic affection, and entirely disconnected with any structural 
disorder of the heart or its appendages. In these instances the nerves 
which supply the heart are affected in such a manner that slight ex- 
citing causes, as errors in diet, mental emotions, or ascending a flight 
of stairs, induce the paroxysms. 
Pathology.—In some cases no pathological change is discoverable 
after death; and lesions found in others have presented the greatest 
diversity of appearance. Of forty-five fatal cases, says Dr. Forbes, of 
London, thirty-nine exhibited organic disease of the heart or great ves- 
sels. The most common changes observed are : ossification of the coro- 
nary arteries; ossification of the valves of the heart or of the arterial 
trunks ; enlargement of some of the cavities of the heart, with increased 
or diminished thickness of their parietes; softening, paleness and 
tenuity of the muscular structure ; deposition of adipose matter to the 
extent of impeding the heart’s action ; effusions of serum or blood into 
the pericardium or pleura ; in many cases the traces of disease found 
on dissection, are remote from the part which was the principal seat 
of suffering. The symptoms of this disease clearly show that none of 
these pathological states can be essential to its production, though 
some of them are often found to attend it. Chapman and many late 
writers, regard the real nature of the disease as spasmodic; and it is 
considered a “species of neuralgia, generally commencing in the 
pneumogastric nerve and spreading in different directions as other 
nerves become involved.” Chapman refers the origin of the disease to 
an irregular or misplaced gout, and adduces the particulars of six cases 
in which recovery took place from the use of measures which developed 
real gout in the extremities. It is not true, however, that angina pec- 
toris partakes always of the nature of gout, though its neuralgic char- 
acter is unquestionable. Copland says four-fifths of all the recorded 
cases of which dissections have been recorded exhibited disease of the 
heart or large vessels. “ But whether these lesions were rather the 
consequence than the cause of the disease, may be disputed.” Dr. 
Lee considers the disease as a pure neuralgia, though it may not be 
seated exclusively in the cardiac plexus. “ Its true seat would rather 
seem to be the sensory portion of the spinal cord, opposite the lower 
cervical or upper dorsal vertebra and respiratory ganglia.” (Note te 556 
DISEASES OF THE NERVOUS FUNCTION. 
Copland, Yol. I., p. 75.) Kneeland has shown more at length {Amer. 
Jour. Med. Soi., Jan. 1850, p. 45-63,) that the seat of angina pectoris 
is “ not in the circulating, the respiratory, or the digestive systems 
hut that it is “an affection of the nerves supplying these systems 
and that its seat is “ in the par vagum, or pneumogastric system of 
nerves, its branches, terminations and communications.” These nerves 
may be affected by neuralgia, rheumatism, or neuritis. 
Prognosis.—Regarding angina pectoris as essentially a nervous or 
dynamic disease, and not necessarily dependent on organic lesions of 
the heart, we may hope to remedy it where the evidence of the exist- 
ence of structural disease is not strong. Laennec says the disease “in 
a light or moderate degree is extremely common, and exists very often 
in persons who have neither an organic disease of the heart, nor of the 
great vessels.” He has seen many who have had very violent attacks, 
but of short duration, who have recovered. (Auscult, tom. II., p. 747.) 
“ If the disease be neuralgic,” says Kneeland, “ recovery may be com- 
plete without any organic change. If it be rheumatic, recovery might 
leave behind it a predisposition to cardiac disease.” Even if one pneu- 
mogastric nerve be disorganized, restoration to a moderate degree of 
health is not impossible. When the case has become inveterate from 
neglect, or organic disease has been established; when it occurs in 
advanced age, or presents symptoms of effused fluid within the thorax 
or oedema of the extremities, a fatal termination may be anticipated 
sooner or later. 
Treatment.—During the Paroxysm.—The patient should be 
placed in a state of tranquility, in a supine or reclining position. When 
the symptoms are urgent, the patient plethoric or vigorous, the pulse 
full and strong, nearly all authors have sanctioned the practice of 
prompt bleeding from the arm. {Dr. Dead, Dubl. Med. Trans., Yol. I., 
p. 105, also Parry, Burns, &c.) In more questionable cases, where the 
pulse is weak and countenance collapsed, all depletion must be avoided, 
and leeches can hardly ever be appropriate. Dry cupping between 
the shoulders is almost always safe, and often very effective, as it gives 
all the benefits of depletion without expending the vital fluid. In one 
case in which inflammatory rheumatism of the extremities was sud- 
denly transferred to the heart and the parts supplied by the pneumo- 
gastric nerves, I succeeded in relieving the oppressed organs by ap- 
plying large glasses to the cardiac region, and between the shoulders 
at the same time, in all cases of violent congestion of important or- 
gans, the most immediate relief may be given by cupping, which acts 
not only as a revulsive measure of great power, but as a counter-irri- 
tant, much more prompt and effectual than blisters. When a large 
glass is skilfully applied, the skin instantly rises a full inch-and-a-half STERN ALGIA. 
557 
within it, and, in forty minutes or less, a blister of that depth, full of a 
thick, yellow serum is formed. 
Internal stimulants, opiates and carminatives, are always given with 
some temporary benefit. Camphor, Opium, Spirits of Nitre, Asa- 
foetida, have been effectual in giving immediate relief; but this may 
be only temporary, and we must seek for more permanent results by 
the employment of remedies more clearly specific. 
Remedies.—In the selection of remedies, strict regard should be had 
to the remote and exciting causes of each case. If the symptoms are 
the result of some organic affection of the heart, our prognosis must 
be, for the most part, unfavorable, and we can only reasonably expect to 
palliate the sufferings of the patient. But if the remote cause consists 
simply of a diseased condition of the par vagum, or of the cardiac 
nerves, which renders them liable to become morbidly excited from 
trivial causes, wTe may prescribe medicines with e-very prospect of ulti- 
mate success. The most reliable specifics in this malady, are, Aconite, 
Digitalis, Ilepar-sulphuris, Lachesis, Nux-vomica, Ignatia, Vera- 
trum-alb., Arsen. Veratrum-viride, Sepia, Sambucus, Ipecacuanha, 
and Pulsatilla. The attenuations should be selected with reference 
to the impressibility of the patient, and the medicine should be per- 
sisted in, at suitable intervals, during the continuance of the disease. 
Arsenic.—E. Alexander directs Arsenic on the ground that Tach- 
enius, Guilbert, Preussius, Thilenus and Pyl, have seen it give rise to 
very great oppression of the chest, Gresselius to a dyspnoea almost 
amounting to suffocation. And Majault, in particular, says it pro- 
duces sudden attacks of asthma, excited by walking, attended with 
great depression of the vital powers. (Hahnemann.) 
Palpitation of the Heart.—(See Yol. I., p. 842.) 
Nervous Pulsations of the Aorta.—Predisposing Causes.—A 
weak, emaciated, delicate frame; hysteria ; accumulations of air in the 
colon or stomach; dyspepsia; morbid accumulations in the caecum; 
aneurism of the aorta, coeliac or superior mesenteric artery; disease 
of the pancreas, stomach, or mesentery ; enlargement of the vena cava 
inferior enlargement of the heart, dilatation of its right side ; adhesion 
of the pericardium to the heart. 
The morbid pulsation is generally associated with nervous or hyste- 
rical symptoms, increased or diminished without evident cause; it is 
often connected with dyspepsia, deranged menstruation ; is excited by 
strong mental agitation, by sinking paroxysms observed in delicate fe- 
males. (Copland.) Dr. Hope referred the pulsation to an anaemic or 
watery condition of the blood ; Laennec thought it was produced by 
nervous and hysterical irritability, with spasm of the aorta. 
Diagnosis.—By the stethoscope. “ A smart and vigorous jerk ” ia 
felt, and a slight whizzing sound is heard, which is different from the 558 
DISEASES OF THE NERVOUS FUNCTION. 
“gradual, steady, and strong impulse attending aneurism.” (Copland 
Hope, &c.) Dr. Mott says : “ if the pulsation in the epigastrium is 
strong, we may infer that it is not aneurismal, hut produced by one oi 
the other causes. The perfect correspondence between the pulsation 
of the epigastrium and the action of the heart, is a circumstance 
Strongly diagnostic of the aneurismatic state of the aorta, coeliac, or 
superior mesenteric artery.” {On Pulsations in Epigastrio, Physico- 
Medical Transae. New-York, 1817.) 
In the paroxysms the c-ommon treatment is limited to mild stimu- 
lants. The predisposition to it is often promoted by the habitual use 
of strong coffee or tea; and they sometimes give speedy relief in the 
paroxysm. The Valerian, Ether, Assafoetida and Ammonia, give 
present amelioration; mental tranquility, proper diet, and due attention 
to the various secretions, and sedatives constitute the usual adjuvant 
measures. 
To remove the tendency to return of these pulsations, the deranged 
functions of the different organs must be restored. This can only be 
done by judicious treatment directed to the removal of the diseases of 
which the pulsation of the aorta may be regarded as symptoms. The 
remedies most likely to effect this object, are Aeon., Pell., Camphor, 
Nux.-v., lgnatia, Lobelia, Digitalis, Laches., Verat/r-alb., Veratr- 
vivid. 
Aorta, Ossification and Rupture of.—Case of Dr. B. F. Joslin, 
of New- York.—Having reached the age of sixty-five with general 
good health, he was affected in July, 1861, with a slight attack of para- 
lysis, which soon passed off, but left a debility from which he never 
fully recovered. On the 22d December, when feeling unusually well, 
after a moderate dinner, he was attacked, while in the act of lying 
down, with a severe pain in the spine between the scapulae, prostration 
and cool perspiration. The prostration went off, but the pain con- 
tinued ; it prevented him from lying down, and seemed to induce him 
to move, as he walked up and down the room for four or five hours. 
Then walking up-stairs, he lay on the bed, or walked alternately, until 
7 p. m., when the pain became so intense as to extort cries, and as they 
increased, apparently took away his breath ; as respiration ceased, 
action of the heart stopped, he became bluish in color, and pulseless. 
Profuse cold sweat broke out generally; spasms drew the head to the 
right, eyes were fixed, and he seemed to be dying. He gradually 
recovered, but was much prostrated, and it was some time before hi 
mind became clear. Next day the pain was moderate ; on the 24th he 
had three paroxysms; the three days following he was more comfort- 
able ; 28th, a threatened paroxysm was prevented, next night restless, 
without pain. The evening of the 30th, comfortable,listened with interest 
to the reading of a state paper; looked out some symptoms of his own STRABISMUS. 
559 
case, and then slept soundly; at 1, a. m., became more restless, at hah 
past five started up with dyspnoea, moaned as if in pain; breathing be- 
came more and more labored, and about 6, a. m., he ceased to breathe 
Post-mortem examination revealed extensive ossification of the aorta, 
and as the immediate cause of death, rupture of the aorta near its 
arch. {Dr. Bowers' Address.) 
4. STRABISMUS.—SQUINTING. 
This affection may be either acute or chronic. 
1. Acute strabismus, which is symptomatic of disease of the brain 
2. Chronic strabismus, (a.) divided into essential and consecutive, to 
eclampsia and chorea; (5.) organic shortening of the muscles of the 
eye, which may be congenital or consecutive to a traumatic lesion. 
2. Chronic strabismus, (a) essential strabismus. 
Remedies: Alumina, Belladonna, Hyoscyamus, Stramonium, Taba- 
cum. 
The symptoms we enumerate relate mainly to the eye, but the total- 
ity of the symptoms should be considered in each case. 
Belladonna, for scrofulous patients. 
Strabismus upwards (rectus superior muscle) ; or, outwards (rectus 
externus.) The left eye drawn upwards (rectus superior muscle,) 
whilst the right eye is drawn upwards and outwards (rectus externus 
and rectus superior.) 
Exophthalmia (obliquus, major and minor.) 
Convulsions of the eyelids, tending to separate them. 
Pupils contracted, then dilated, and lastly, insensible to light 
Presbyopia (the four recti muscles ?) 
Scotopsia, diplopia; amblyopia,amaurosis, blindness; he sees objects 
variously. 
Alumina.—Strabismus of both eyes (of which muscles ?) ; convul- 
sions of the eyelids ; ptosis ; paralysis of the upper eyelid ; ophthal- 
mia ; blepharitis scrofulosa; lippitudo ; frequent styes ; photophobia; 
amblyopia; the patient sees objects yellow. 
Hyoscyamus.—Strabismus inwards (rectus internus muscle); stra- 
bismus upwards (rectus superior muscle,) strabismus upwards and in- 
wards (rectus internus and obliquus minor muscles.) Myopia (obliquus 
major and minor muscles;) triplopia ; great congestion of the eyes, 
which are sparkling, haggard, bright, or dull and dim. Look stupid 
and dull. 
Dr. Gallivardin gives the case of a child aged twelve years, of lym- 
phatic temperament, a fair-haired blonde, who had strabismus for eight 
years. When two years old she had two convulsions, each lasting ten 
jr twenty minutes. At four, when playing with a pitcher, she fell, and 560 
DISEASES OF THE NEKYOUS FUNCTION. 
it broke and cut her hand. After the fright the right eye was found te 
squint strongly inwards ; half the pupil disappeared behind the nose 
The rectus internus, habitually contracted, was sometimes tremulous 
with slight clonic motion. 
Sulphur 30° was given thrice a day for one week. In a month there 
Was no improvement. She then took Ilyoscyamus 3° for eight days, 
three doses per day. It was then well. Some slight relapses after- 
wards occurred and were always promptly removed by Ilyoscyamus 3° 
Eight years after this treatment she continued well. The author says 
he tried this remedy in some other cases, but without success. (Jour 
de la Soc. Gallicane.)* 
Cyclamen.—Case by Dr. Eidherr, of Vienna.—A child aged two 
months and a half, fell from the table to the floor without receiving ap- 
parent injury. A few days afterwards it was attacked with measles 
after recovering from which it was noticed that it squinted. Arnica 
failed to cure it. Cyclamen was directed for ten days. It became en- 
tirely well from this medicine. 
Dr. Wurmb, of Vienna, also cured a coachman of strabismus by 
Cyclamen. 
Stramonium.—Strabismus in every direction (elective action on all 
the motor muscles of the eye); fall of the upper eye-lid, apparently 
produced by a spasm of the orbicular muscle. Pupils contracted, dilat- 
ed, and lastly, immovable, as if paralyzed; myopia, diplopia. 
Visual hallucinations respecting the color and position of objects. 
Tabacum.—Strabismus upwards (rectus superior muscle.) Th< 
eyes are deeply sunk in the orbits (all four recti.) Convulsions of one 
or the other eyelid, sometimes only of the orbicular muscle; pupils 
contracted, dilated, and at length insensible to the light; ocular and 
palpebral ophthalmia; hallucinations of the sight, photophobia; am- 
blyopia, blindness sometimes only transient. 
Phosphorus.—Dr. Tavignot gives two cases treated successfully 
with it. He saysf he is usually successful in cases of paralysis of both 
the third and sixth pair of nerves, by giving Phosphorus internally, and 
applying it locally around the eye. He applies around the eye a lini- 
ment containing twenty centigrammes of Phosphorus, to one hundred 
grammes of Oleum-nucis, and twenty-five grammes of Naphtha ; and 
of an emulsion containing 0.10 centigrammes of Phosphorus to Oleum- 
amygdalus-dulc. 10 grammes, Syrup ninety grammes, gum two 
grammes, he gives a tea-spoonful or two daily. He says he cured by 
this mode, in twenty-five days, a case of complete ptosis, strabismus 
externus, mydriasis, &c., in which electricity had been employed for 
two months without effect. Another case was that of a rich land pro- 
* Mcniteur des Hopitaux. CHOREA. 
561 
prietor, who had spermorrhoea with paralysis of the right branch of the 
sixth pair of nerves. He was cured with Phosphorus of the paralysis 
in ten days. When about to send the patient elsewhere to be treated 
for the spermorrhoea, it was found that the Phosphorus had cured this 
also. 
Other Remedies for Strabismus.—Digitalis.—Both eyes incline 
to turn to the left side; when turning them to the right side, they feel 
painful, and then he sees all things double; at the same time the face 
is bloated. 
Camphor.—Spasms of the muscles. The balls of the eyes are 
turned upwards. 
Veratrum-alb.—The eyes are distorted or protruding, or turned 
back that the whites cannot be seen. 
Aconite.—Distortion of the eyes; the eye squints upwards. 
Secale.—Frightful spasmodic contortion of the eyes, with contraction 
of the pupils, which are sometimes closed. Squinting. 
Spigelia.—Involuntary motion of the eyes. Distortion of the eyes 
accompanying spasmodic affections from worms. 
Spasms of the Eyelids.—Ruta Graveolans.—Spasms of the 
orbicularis muscle; spasms of the lower lid, the tarsal cartilage moves 
irregularly; followed by water running from the eyes. 
When medicines fail to cure strabismus we must resort to: 1. Spec- 
tacles properly made. These have in place of glasses, plates of metal 
or pieces of card, with very small orifices in the centre of each plate, 
exactly in the axis of normal vision. 
The use of spectacles ad hoc acts in a way analogous to the method 
of Ling’s method of Swedish gymnastics. This system is founded on 
an exact knowledge of the anatomy of the muscles, and when properly 
understood, enables the practitioner to bring into action any given 
muscle, singly and in succession to any other one. (Jour. Soc. 
Gallicane.) 
5. CHOREA.—ST. YITUS DANCE. 
Chorea occurs, for the most part, in girls of feeble constitutions and 
of irritable nervous temperaments, aud between the ages of five and 
fourteen. The disease is recognized by almost constant involuntary 
movements of the muscles affected, while in the waking state, either 
with or without derangement of the intellect. From its resemblance 
to raphania, it has sometimes been confounded with it. It also pre- 
sents many marks of similarity to epilepsy and hysteria, and is proba- 
bly somewhat analogous to these maladies in its location and nature. 
The afiection is not usually attended with danger, and terminates at 
Vou IL—36. 562 
DISEASES OF THE NERVOUS FUNCTION. 
the period of puberty; but when it has existed for a number of years 
accompanied by perversion of the intellectual faculties, permanent 
idiocy, or at least an impaired understanding may be feared. Finally, 
the disease may occasionally occur at any period of life, and in indi- 
viduals of both sexes. 
Diagnosis.—Generally for months previous to the occurrence of the 
involuntary motions which characterize this disease, it will be found 
that the child has suffered from constipation, oppression in the region 
of the stomach, and chest, vertigo, and other bad feelings in the head, 
appetite morbidly increased or depressed, occasional flushes of fever 
during the night, palpitation of the heart, nervousness, irritability and 
coldness of the feet. The involuntary motions commence by slight 
twitchings in the muscles of the face; which soon become strongly 
pronounced, and extend to a greater or less extent to other parts of 
the body, as one entire side, or one arm or leg. When the limbs are 
affected, the walk becomes awkward and unsteady, and the arms fail 
to obey the commands of the will, while involuntary gestures and mo- 
tions are continually made without reason or point, thus causing the 
individual to present a most ludicrous appearance. The patient may 
remain in this condition for years, without the occurrence of any other 
serious consequences, unless the intellect becomes impaired, when a 
total loss of mind may result. Some cases are attended with difficult 
respiration, dysuria, vague pains in the limbs, confusion of ideas, and 
failure of memory. 
Causes.—A naturally delicate constitution or one which has been 
impaired Oy the abuse of medicines, and a nervous temperament, are 
conditions most favorable to the production of chorea. Probably the 
most frequent exciting cause is the repercussiou of some chronic cuta- 
neous eruption. Many facts are on record which go to prove this ; as 
for example, the cases cited by Hahnemann, Stapf, Pouchet, Frank, 
&c., where the malady has arisen in consequence of sudden drying up 
>f tetter, plica polonia, herpes, scald head, psora, or some habitual dis- 
charge. Other exciting causes are: the depressing passions, fear and 
terror, masturbation, irritation of the bowels from worms and faecal ac- 
cumulations, cold, insufficient nutriment, and excessive loss of blood. 
Treatment.—In all cases of chorea the patient should be removed 
to the country, where she may enjoy pure and salubrious air, abundant 
exercise, and a plain, but highly nutritious regimen. 
The remedies for chorea are, Stramonium, Belladonna, Cuprum 
acet., Sulphur, Calcarea-carb., Ilyoscyamus, Rhus, Nux-vomica, 
Ignatia, lycopodium, Phosphorus, China, Ferrum. 
If the disease has been caused by fright or terror, and we find great 
contortions of the face, eyes, and limbs, head thrown back, or drawn 
frequently to the left side, oppressed respiration, wild and staring ex- CHOKEA. 
563 
pression, convulsive laughter or weeping, restlessness, convulsive twitch 
ings of the muscles, anxiety, pale face, features sunken, small pulse, 
and delirium, we may select one of the following medicines: Stramo* 
nium, Belladonna, Hyoscyamus, and Ignatia. 
In the early stage the remedy should be selected from Belladonna, 
Stramonium, Ignatia, Cocculus, ALc<m. and Nux-vomica. 
Belladonna.—Agitation and continual movements; unceasing mo- 
tion of the head and hands; feebleness, and uncertain gait, paralysis 
of one side of the body, so the patient draws one leg after him. These 
symptoms are characteristic of chorea proper. In more confirmed 
cases we see convulsive movements of the lips and risus sardonicus ; 
absurd grimaces, feebleness and trembling of the tongue. Children 
poisoned by it showed: “ continual agitation; they could not keep still 
nor remain erect; they threw themselves forward, extending their 
hands towards the ground; constant catching at small objects which 
they let fall; choreic convulsions. 
Mr. Edwards gives in the London Lancet a case of poisoning by 
Belladonna which confirms the common observation of its power of 
producing a partial or imperfect paralysis, shown only in a want of due 
controlling power, almost confined to the lower limbs, and lasting some 
days after the other symptoms had subsided. Orfila found it to pro 
duce weakness of the posterior limbs ; Pereira saw seven cases at the 
London hospital. 
Symptoms affecting the nerves: “paralyis, sopor, or coma, power 
of the mind or of the will, over the muscles disordered, muscular move- 
ments irregular, causing staggerings and jerkings, weakened or paraly- 
tic condition of the muscles. Some French physicians have endea- 
vored to show that chorea has its seat in the cerebellum. (Watson's 
Practice^ol. I., p. 672.) Dr. Fuller gave Bell, to twelve choreic chil- 
dren in St. George’s Hospital; in seven cases its action appeared de- 
cidedly curative, in two it failed to affect the spasms; in the other 
three cases the improvement was ascribed to other causes. 
Stramonium.—The child totters in walking ; vacillation of the 
limbs in walking or remaining erect; uncertain walk; he does not feel 
his legs under him, thinks he touches the ground when yet some dis- 
tance off, causing false steps : precipitate seizing and losing the object 
he wishes to grasp; when holding it, he does not perceive it in his 
hand; babbling loquacity. Jahr has given some cures by Stramonium, 
hut his cases are not clearly distinguishable from hysteria and other 
nervous diseases. 
Hyoscyamus-niger.—Has only a few chorea symptoms; twitchings 
of the tendons, and choreic movements. (Roth. Materia Med., 753. 
Par.) 
Calcar'M-carbonica.—Hahnemann observed under its use “indis- 564 
DISEASES OF THE NERVOUS FUNCTION. 
tinct twitehings and movements, either in isolated” or associated mus- 
cles. Jahr says: “Continual movements of the muscles which are 
under the control of the will, so that the patient cannot remain sitting 
or standing; the head turned first to one side and then to the other, 
gait shuffling and leaping; remission at night, renewal on awaking; 
incapability of seizing the object he may want; confused, tongue bitten 
in the effort to speak.” The earlier symptoms here relate to the dis- 
ease at an early stage; the later ones to it as fully formed. 
Causticum.—Partial convulsions of the limbs, and of the muscles of 
the face. Jahr says: This is a principal remedy in serious cases, 
“ Emaciation at first, with pallor, gait tottering; loss of memory and 
power to fix the attention; later, singular movements of the head, eyes, 
hands and feet; by degrees the patient forgets how to write, count, or 
talk with distinctness; finally, there is almost complete paralysis of 
the left side, with frightful convulsions of all the muscles, day and 
night. General convulsions occurring in the course of chorea, and 
continuing day and night, are unfavorable symptoms. Jahr says 
this remedy has been successfully employed in chorea, succeeding a 
retrocedent eruption of the head. {On Nervous Diseases.) 
lihus.—Twitchirigs in the extremities and muscle, unsteadiness of 
the limbs, vascillation of the extremities when attempting to stand or 
walk. Chorea occurring after a cold bath, or repelled measles. 
Sulphur.—Sudden suppression of an acute chronic eruption having 
caused the disease. 
Strychnine.—M. Trousseau administers a syrup of Strychnine, which 
he seems to have learned from Hahnemann, though he rejects the 
small doses. This we regret, as although he makes some fine cures 
he has certainly hastened the death of some of his patients. (See 
Inaugural Thesis of M. Moynier, Casa, p. 60.) This girl died from 
medicinal aggravation of the disease by an over-dose. We also learn 
from the same thesis, (p. 113,) that “choreic agitation augments from 
the beginning of the treatment, which should cause no uneasiness; 
reaction promptly supervenes, followed generally by rapid improve- 
ment.” 
Ignatia.—Extreme precipitation, involuntary lifting of the knees in 
walking; is obliged to sit down; tottering walk, liability to fall, false 
steps at the slightest obstacle. There are early symptoms of chorea. 
Hartmann recommends Ignatia in recent cases of chorea. It also 
produces “ trembling of the whole body with pruritus and convulsions, 
so that he can hardly stand; convulsions greatest in the jaws, obliging 
the patient to distort the mouth, as in moderate laughter. 
Nux-vomica.—Symptoms similar to the last; uncertain gait, with 
fear of falling; feebleness of the knees; trembling of one knee and 
one leg. Like Ignatia, it presents the remarkablo phenomenon of CHOREA, 
565 
augmentation of distress by movement; which is diminished by repose, 
and disappears by lying down, a feature of chorea proper. 
Cocculus.—Has medicinal relations with Ignatia and Nux. The 
Coque of the Levant produces partial convulsion, incomplete paralysis, 
difficulty of walking, &c., like the preceding. In homoeopathic doses 
it has cured the following symptoms: absurd movements and gesticu- 
lations, sometimes of the hand or left foot; also of the facial muscles 
at each effort to speak, babbling gaiety, face puffed, red, and bluish* 
cessation of convulsion on going to bed, (<Jahr. Nervous Diseases, 
p. 76.) Thus we have good reasons for using Cocculus, Ignatia, and 
Nux-vomica in chorea. We distinguish in our selection between the 
peculiarities of constitution of each case. While M. Trousseau uses 
Sulphate of Strychnine in the most dissimilar of cases, and in 
dangerous doses. 
Agaricus-muscarius.—Dr. Clifton, of Northampton, Eng., gives a 
case, with the following symptoms: Miss B., aged sixteen, amenia, 
six months ago showed spasmodic twitching of upper lip and winking 
of right eyelid; then twitching of fingers of right hand; then move- 
ment of right arm and hand, and turning of it inward, so that she 
could not feed herself. The twitching and spasms all ceased during 
sleep; a little spinal tenderness in lower cervical vertebrae. Agaricus, 
6° (centes.), twice a day. No improvement. It was changed for 
Agaricus, 2° (centesimal), twice a day. In a month she entirely 
recovered, and remained well a year or two after. 
Agaricus is useful in spasmodic affections, ceasing during sleep. 
In several cases of spinal irritation and tenderness in youths; in 
spermorrhoea, not the result of abuse, with pains and weakness in the 
thighs; also as a lotion for frost-bites on the feet of children, tincture 
one drachm to a pint of water; internally also. 
Case by Dr. Bloede. A boy, aged ten years, sanguine temperament, 
merry disposition, had chorea at the age of ten years. Four months 
ago showed impediment in his speech ; drags his right foot; losing 
control over the muscles of right arm and leg; limbs were in incessant 
motion; involuntary jerking; pushing or pulling in all directions; 
motions continuing all day and ceasing during' sleep. Strong appetite; 
bowels natural; passed two long worms some time ago. Cannot con- 
trol the muscles employed in talking, eating or drinking, or walking; 
disposition inclining to fun and mischief. Hyoscyamus was tried a 
week without benefit. Agaricus-muscarius, 3°, exhibited a slow 
but decided action upon all the symptoms at the end of a week’s trial. 
Four weeks later he walked out alone, dressed himself without assist- 
ance ; could drink alone ; but muscular action of the mouth disorderly • 
speech and walking improved. Agaricus, 4°, gradually restored him 
to perfect health. (U. S. Jour. Horn., Vol. II., p. 120.) 566 
diseases of the nekyous function. 
Case by Dr. Leopold.—A girl, aged twelve years, has had chorea 
for two weeks. The whole body and every limb in violent motion. 
After one dose of Agaricus-muscarius she slept for six hours. She 
continued to take it for eight weeks, four drops of the tincture, four 
times a day. The disease gradually abated. But she quickly got 
worse when she tried Ignatia or Stramonium. She had great appetite, 
Slept for eight or ten hours at night, the bowels were regular, the mind 
clear, and the power of speech returned. She gained flesh, her cheeks 
rosy. She continued well. 
Cuprum.—Hartmann and Jahr recommend this remedy in chorea: 
but their description of the disease is too vague for safe practice. 
Copper lias the following symptoms suitable for true chorea: “Agita- 
tion of the body and limbs; convulsions of the face and eyelids.” 
Gross cured with Copper a case of chorea produced by fright. “ There 
were involuntary movements of the right arm and leg, passing grad- 
ually to the other limbs; so that while awake the patient was violently 
agitated; this was sometimes accompanied with loss of speech. 
Iodium.—The occasional cure of a case of chorea with Iodine and 
Iodide of Potassium, call our attention to these articles. Iodine pro- 
duces, says Hahnemann, “very great excitability; uncertain and 
vacillating gait; trembling in the lower limbs; zig-zag movements of 
the hands; muscular feebleness and incomplete paralysis ; head con- 
fused and incapable of serious thoughts; when carried still further it 
gives the symptoms of a grave case of chorea, which is usually fatal— 
“trembling of the hands, arms, feet, and back, vacillating and uncer- 
tain gait; he can carry nothing direct to the mouth; zig-zag move- 
ments of the hands; motion painful; circulation accelerated; pulse 
Aliform. Dr. Pells gave the Tincture of Iodine in solution for three 
doses. M. Guersent cured a child with Iodide of Potassium in thir- 
teen days, in which sulphur baths and exercise had been unsuccessfully 
treated. 
Iodine is more appropriate in scrofulous cases; but it cures only 
according to the Ilahnemannian law of similars. 
In the later stages of chorea any of the remedies indicated in the 
first stage may be proper; though Calcarea, Causticum and Iodium 
will be preferable. 
Macrotrys-racemosa.—We have known one case cured by this 
remedy. It is the basis of a successful secret remedy for chorea. 
Argentum-nitrieum.—Allopathic cures of chorea have often been 
accidentally made with Nitrate of Silver, and Dr. Gross, of Regens- 
burgh,* gives some cases of great severity cured rapidly with this 
remedy by homoeopathists, used at the fourth and also at the twelfth 
* Allg. Horn. Zeit., Yol 64, p. 123. CHOREA. 
567 
potency. He compares it with Cuprum, Stramonium, Ilyoscyamus 
and Cina. He says the abuse of the remedy in local application to 
the os and cervix uteri often produces symptoms in the regions of the 
eye, and respiratory apparatus, which point to its specific action on 
these organs, and suggest to us its therapeutic use. 
When the symptoms have followed the drying up of chronic cutane 
ous eruptions, Gupi'um-acetate, Sulphur and Lycopodium, will be 
called for; if they have set in after measles, Calcarea-carb. is proper. 
If the cause can be traced to masturbation, Phosphorus and China are 
applicable; if they have arisen from constipation and collections of 
faecal matter in the intestines, Nux-vomica and Sulphur are the best 
remedies; if the malady has been induced by excessive loss of blood, 
or by general debility, wre advise Ferrum, Chinct, Acidphosph., Acid- 
nitr. and Rhus-toxicodendron. 
Administration.—In chorea, the whole nervous system is in a mor- 
bidly impressible condition, and will generally respond regularly to 
the higher attenuations. We usually commence with the twelfth dilu- 
tion, and administer a dose once or twice daily, until a suitable im- 
pression is made upon the symptoms. 
The Spinal Marrow and Ganglionic System are also affected by 
the sycotic poison; lightning-like, lancinating pains in the face and 
neck and along the spine; deadness of single parts; inarticulate 
speech, and, where the par vagum and glosso-pharyngeus are affected, 
we find a want of feeling of repletion; inability to digest, with normal 
taste; tympanitis, hernia, and prolapsus uteri and vagina, and of the 
rectum; paralysis of the urinary organs; impotence, with strong 
sexual desire. All of these sufferings are the result of the sycotic 
poison, and can be removed by Thuja, when in the earlier stages.— 
(Dr. Wolf.) 
There are also some cramps, wfith great tendency to paralysis, and 
with remarkable variability. Also, the progressive atrophy of the 
muscles, being often the cause of some kinds of curvature of the spine 
and some forms of hip disease. 
Epidemic Chorea.—Religious Convulsive Affection of the 19tli 
Century.—(Hr. Barton’s Med. Journal, 1805, Yol. II.,p.87.) This epi- 
demic in religious chorea commenced in the summer of 1803, in Ten- 
nessee, only three years after the institution of the Camp Meetings, 
in which large crowds of people were collected together, encamping 
on the ground and remaining a "week or two. The convulsive mani- 
festations greatly increased till the end of that season, and afterwards 
continued to appear for a quarter of a century, when they gradually 
subsided. It was looked upon as the effect of a divine religious influ 
ence. It began among the Presbyterians, afterwards the Baptists, and 
then other denominations were involved in it. None were affected 568 
DISEASES OF THE NERVOUS FUNCTION. 
with it but such as had attended the religious meetings, and nearly all 
took it before leaving the ground. They were of all ages up to sixty 
years, though the majority were young persons, more females than 
males. Scarcely one girl in ten between the ages of twelve and twenty 
escaped it. The affected were generally of the healthy of both sexes. 
None took the jerking convulsions in sleep. It had intermissions, but 
they were irregular, but lasting during absence from public worship; 
the attack might occur on sudden surprize, serious reflection, or de- 
pressing spirits. The subjects of it continued in good health, though 
some females appeared weakened. The paroxysm lasted a half hour 
or hour ; though in some the spasm was momentary. At its first ap- 
pearance, the effect on men was different from that on women. Men 
would tremble so as to make the seats at a distance shake ; in some 
there followed what appeared to be painful writhings of the limbs 
or body, and tumbling about on the ground. At other times they began 
with one or more perpendicular vaults, as high as any man could rise 
in health ; and this often attended with a deep loud sudden groan, as 
if from dreadful pain. After the first year or two, these manifesta- 
tions were less marked, and in their place came a new symptom called 
the “jerks.” This consisted in a sudden jerking backward and for- 
ward of the shoulders ; the primary motion being chiefly in the breast. 
The men generally had but one jerk in several minutes, while in wo- 
men the succession was as rapid as every second for fifteen minutes, 
each second the hair whipping the ground alternately before and 
behind. They were sometimes with a single jerk and a loud groan; 
involuntary laughing was a common symptom in 1803 and 1804. 
The Running Exercise was common. The person starts suddenly, 
and, with remarkable swiftness runs fifty or a hundred yards, and then 
falls apparently lifeless; after the full length of one breath, he rises 
perfectly well. Others made, involuntarily, various gesticulations, 
dancing or singing. 
The dance is a perpendicular motion of the body and limbs when 
erect, in some the feet moving alternately, in others, both moving at 
once; the hands and arms generally protruded and elevated, the head 
suddenly thrown back, the eyes closed by turns, and the movements 
are made with a graceful softness and elasticity. The subject now 
commences a tune which is uniformly in a flat key, not rising more 
than one-fourth of a note from the key note. The women in the be- 
ginning of the epidemic commenced with convulsive agitation of the 
breast, difficulty of breathing, with lamentations, cries, and ejacula- 
tions ; to this succeeded the “ silent exercise,” involving a total extinc- 
tion of perceptible breathing, during which the complexion was florid 
for half an hour; the mind was perfect but in a morbid state of excite- 
ment. CHOEEA. 
569 
Premonitory Symptoms. — Compression or weight on the chest 
about the heart; motion gives relief; no other complaint of pain is 
made; the subjects of it are pleased with it and do not wish it to stop 
They have an uncontrollable desire to attend religious meetings of a 
social kind. They always have peaceful pious feelings and emotions; 
and the desire of praying overcomes the bashfulness and timidity of 
all persons of all ages or sexes; they say it gives them relief. They 
all have an astonishing friendship for each other, and for all in a simi- 
lar situation. Memory and even judgment are astonishingly strong 
during the fit. All the acts of their lives, particularly their bad ones, 
crowd with rapidity upon the mind. 
The “Physical Manifestations,” which accompanied the religious 
excitement of 1858 and 1859, in the North of Ireland, were morbid 
phenomena, having some affinity with those seen in hospitals among 
hysterical patients, and among females in all communities, in crises 
of excitement and agitation. 
Symptoms: Insensibility; sudden relaxation of muscular power; 
prolonged convulsions ; foaming at the mouth ; rolling of the eye-balls; 
fixed and glassy stare; wild dreams; incoherent ravings. These 
phenomena are viewed by the friends as evidences of religious regene- 
ration, but they are rather the indices of hysterical and epileptiform 
seizures, consequent on an overwrought condition of mind, and an en- 
feebled state of body, favored by prolonged abstinenoe and great men- 
tal excitement. The condition is one of induced disease, which in 
many will progress to insanity. 
Pathology. — Chorea — associated with Serous Apoplexy.—A re- 
markable case is given in the Medical Repository for 1804. A robust 
man aged 40, began to complain of irregular or convulsive motions of 
the head, mouth and hands, which had been long observed in a slighter 
degree. After trying various remedies without effect (1801) he was 
affected with coma and stupor. Bleeding and purgatives relieved the 
latter symptoms, but the convulsive motions continued. A month after 
this he died. 
No disease found anywhere except within the head. All the vessels 
of* the brain were turgid with blood, and twelve ounces of fluid found 
within the ventricles. There had been no pain in the head, no strabis- 
mus, nor dilated pupils; it was therefore thought that the water had 
slowly accumulated. There was an enlarged state of the foramen ovale 
which connects the ventricles, which readily admitted the little finger. 
The cause of death was a sudden effusion to which the brain could 
not accommodate itself, by which serous apoplexy was produced. 
There was seen a general turgid state of all the vessels of the brain, 
for many vessels that carry only pellucid lymph in health were filled 
with red blood. The brain had accommodated itself to the slow effu- 570 
DISEASES OF THE NERVOUS FUNCTION. 
sion which had been long taking place; but it could not bear any 
Budden addition. 
In remarking on this case, Dr. J. Redman Coxe, of Philadelphia, 
says: “ Chorea then is not an idiopathic affection, but arises from the 
long-continued action of water on the brain; that is from chronic 
hydrocephalus. The hydrocephalus is generally rapid, but is some- 
times chronic. This is when it comes on slowly, a portion of the fluid 
may be taken up by the absorbents, and the brain adapts itself to the 
pressure on the ventricles. When this is too slowly done, any sudden 
increase may be followed by various grades of serous apoplexy, palsy 
epilepsy, and occasionally St. Vitus’ dance.” 
Causes.'—Hydrocephalus and chorea may arise from the same causes 
They may follow inflammatory fever or blows on the head, and both 
may be accompanied with symptoms of fatuity. Too rapid growth of 
the body in early life may determine to the brain and produce other 
diseases—sudden check of accustomed secretions. The muscles of the 
face are affected in both diseases, producing spasmus cynicus, risus 
sardonicus, &c. 
Both diseases may be caused by intestinal irritation, as by worms 
Neither disease is necessarily fatal, though either may be when the 
accumulation of water is rapid. Other animals are subject to both 
diseases, as is seen in hogs, dogs, horses, which have “the staggers.” 
Remedies for both chorea and hydrocephalus are: Aeon., Bell., 
Helltiborus-niger, Ilyoscyamus, Stramonium, Cuprum, Zinc, Sulpha 
zinc. Of these Zinc and Stramonium are about the best. 
Barbters.—A species of palsy frequently seen in India, Ceylon, 
Java, and the West Indies. 
Definition.—Tremor, with pricking, formicating pain; numbness of 
the extremities, principally of the lower, followed by contractions and 
paralysis of the limbs, inarticulation or hoarseness of voice, emaciation, 
and sinking of all the vital powers. 
Symptoms.—A formicative pricking pain begins in the muscles of 
the lower extremities, with numbness, tremors, and an imperfect com- 
mand of the powers of locomotion. Both lower limbs are always 
equally affected, in some cases the fore-arms, hands, and powers of 
articulation are subsequently similarly seized. The patient becomes 
unable to walk steadily. Standing or walking aggravates the uneasi- 
ness of the limbs; he loses the use of the arms, sleeps imperfectly, 
becomes sluggish and inactive. The limbs afterwards lose all feeling 
and natural warmth; the extensor muscles become paralytic, and the 
limbs contracted. There is loss of appetite, indigestion, emaciation] 
the pulse gradually becomes frequent, thready, or fluttering; the vital 
powers become depressed, and death supervenes. BERIBERIA. 
571 
Duration.—It presents various grades of severity, and may be pro- 
tracted for many months. 
Causes.—Exposure to cold and moisture; intoxication, irregularities 
and excesses ; violent exercise in the sun ; lying down in the open air 
during the heat of the day ; cold chilling winds or dews; sudden ob- 
struction of the perspiration by currents of air; long fasting, and 
whatever exhausts the vital energies. On the Malabar coast it attacks 
persons who sleep exposed to the land winds, particularly of January, 
February, and March. (Clark on Diseases of Long Voyages and 
Hot Climates.) 
Treatment.—Change of climate ; restorative invigorating regime, 
but in association with a regulated diet; frictions of the surface ; baths ; 
electro-magnetism or galvanism; warm clothing, including flannel next 
the skin ; a sea voyage. 
JVux-vomica, Ignatia. 
BERIBERI A.—Hymtors Asthmaticus. 
Definition.—Oppressed breathing; paralytic weakness, numbness, 
and stiffness of the lower extremities ; general oedema, with a swollen 
and bloated countenance. 
Symptoms.—The patient feels for some days weakness and indispo- 
sition to exertion ; then follows pain, numbness and stiffness of the 
lower extremities, with oedema; there is then muscular weakness and 
dyspnoea, numbness, fullness, oppression, and weight at the scrobiculus 
cordis; extension of the oedema over the body, leuco-phlegmatic 
tumescence of the countenance; the lips become bluish and livid, lower 
extremities more numb and paralytic; stomach irritable; bowels con- 
stipated, urine scanty, high colored, almost suppressed; pulse small, 
quick, hard, subsequently irregular or intermittent. The dys- 
pnoea becomes more distressing, with great anxiety and a peculiar 
fluttering about the heart, sinking and palpitations. The patient now 
cannot lie down without causing palpitations, he sleeps uneasily, feels 
like suffocating; then come spasms of the muscles of the thorax and abdo- 
men ; the countenance becomes livid, the extremities cold, vomiting 
incessant, and the patient dies nearly in a state of suffocation. 
The disease runs its course in three or four weeks, but it varies in 
intensity and duration ; in the most severe forms the patient dies in a 
few hours, or a day or two. 
Pathology.—Leucophlegmatic appearance of the surface; oedema- 
tous effusion in the sub-cutaneous cellular tissue ; paleness of the 
muscles ; watery obesity and deposition of fat in the abdominal regions ; 
fluid effused between the membranes of the brain, and in the ventricles ; 
vascularity of the encephalon ; slight congestion of the spinal canal j 572 
DISEASES OF THE NERVOUS FUNCTION. 
serum in the pleural cavity, sometimes in the pericardium; lung? 
gorged with black blood, their structure oedematous. Old adhesions 
in the pleura; heart soft, enlarged, and flabby; peritoneal sac con- 
taining serum; liver large, deep red, engorged with black blood. 
Spleen soft, large, loaded with black blood. Congestion of the veins 
and effusion of fluid within the spinal canal. 
Diagnosis. — Characterized by the paralytic symptoms, constant 
dyspnoea, universal oedema, leucophlegmatic intumescence of the 
countenance. It is a form of acute dropsy, distinguished from Bar- 
biers', which is a species of paralysis, though they are often associated 
with each other, or barbiers becoming more severe assumes the form 
of beriberia. 
Causes.—Beriberia is almost peculiar to India, to Ceylon, and the 
Malabar coast, and from Madras to Ganjain, extending not more than 
forty miles inland. It is most prevalent when the air is damp and 
cold; when changes of temperature are sudden ; caused also by low 
diet, bad water; a strong and hot land wind. In Ceylon it is endemic 
in some districts, developing itself after a residence of some months. 
Mr. Dick found it most prevalent amongst intemperate soldiers who 
had taken much Mercury for venereal complaints; prolonged exposure 
to march exhalations.* 
Treatment.—The British surgeons have employed all the means 
known to them in the cure of ordinary dropsies, and with but little 
success. We may rely on the same general measures, and the same 
remedies as we employ in the treatment of other forms of dropsy and 
oedema. Arsenicum, Apocynum, Sambucus, China, JScilla, Solanum- 
nigr. Ferrum are the best remedies. 
ORDER III.-SYSTATICA. 
COMPLICATED DERANGEMENT OF THE SENSORIAL FUNCTIONS. 
Sympathetic Affections.—All the functions depend on each other • 
if one is disordered the rest must suffer in a greater or less degree. 
When the circulation becomes irregular in persons of irritable habit, 
every slight degree of it will often disorder the nerves of particular 
vessels or viscera when they are either approached suddenly, and, to a 
painful degree, by an over-proportion of blood thrown upon them, or 
when they are suddenly deprived of a moderate distending power 
which keeps them in due tone. The distention may be too great in 
some vessels, and too little in others ; hence the alternate rigors and 
flushings, and great inequality of pulse and exertions, not only in ner- 
vous fever but in chronic diseases. This quick succession of extremes 
* Duncan’s Medical Commentaries. Yol. X. p. 207. SYSTATICA. 
573 
of distention and relaxation causes the debility which arises in nervous 
fevers. Females are subject to symptoms of depraved sensibility about 
the time that the menses are about to cease altogether. Spasms 
always increase the irregular circulation in which they originated. 
The manner in which sympathetic communication is maintained be- 
tween distant parts is'well illustrated by the effects of decayed teeth in 
exciting neuralgia of the face. (See page 497.) When there is pain 
in the knee from a diseased hip the sympathy displayed is between the 
irritated part and the sentient extremity of the nerve. 
Sometimes after introducing a bougie into the urethra there is a 
sickness of the stomach, pallor, faintness, and sometimes a single 
paroxysm of ague. A contusion on the epigastrium is often followed 
almost instantly by the most alarming symptoms, and even by death; 
and yet, on dissection no visible lesion of any organ is found. We 
therefore refer the fatal result to the shock given to the semilunar 
ganglion, and the various important nerves which radiate from that 
sensorium abdominale. In compound fracture of the legs there is 
sometimes pain in the loins, extending up the spine to the head; there 
is also restlessness, anxiety, furred tongue, nausea, vomiting, deranged 
secretions, perspiration, &c. The sensorial powers are greatly dis- 
turbed ; and the patient dies of irritative fever, if the exciting irritation 
be not allayed by proper treatment. 
“ When there is an external injury of importance received,” says 
Sir A. Cooper, “ nature at once stops all the secretions and collects the 
resources of the system, the circulating fluid, within the heart and 
large vessels. These propel it with great force towards the injured 
part, to restore it by the process of inflammation. Sometimes her 
efforts are excessive and need to be checked; and, in doing this, it has 
been common for physicians to run to the opposite extreme.” When 
the secretions are too promptly restored the restorative operations of 
nature may be checked. If we interfere by adding to the excitement, 
it is quite likely we shall develop an excessive reaction. This more 
frequently follows injuries of young persons and children than in older 
subjects. 
The abscesses of the liver which are so frequently found associated 
with wounds of the head, have been referred by Baron Larrey to “ the 
sympathetic irritation of the viscus from the inflammation in the 
fibrous membranes of the cranium, the bones of the extremities, and 
determination of ichorous miasm to the liver.” (Surgical Memoirs of 
the Campaign of 1812.) 
Sympathy between the mucous surface of the Prima-via and the 
Skin.—The office of the alimentary canal, or the internal surface of 
the body is analogous, says Wilson Philip, to that of the external or 
akin. And such is the sympathy between these two surfaces, that if 574 
DISEASES OF THE NERVOUS FUNCTION. 
one is languid the other is generally affected in the same way. If we 
excite either, we at the same time affect the other in a greater or less 
degree. If the bowels are constipated we find the skin dry and shrunk; 
as soon as the bowels are restored to action the skin becomes soft and 
moist. When the secretion of the surface is suddenly checked, the 
fluid which should have passed off by it is thrown upon the internal 
organs, applying to the intestinal emunctories a stimulus which closes 
them, or lessens their activity. (On Fevers, p. 190.) In this way that 
constipation is produced which is the forming stage of dysentery. 
(See Johnson on Hot Climates. Cutaneo-Hepatic Sympathy.) 
Nervousness.—Coffee.—According to Liebig, Theine and Caffeine 
constitute the essential elements of Tea and Coffee. They each con- 
sist of the chemical equivalents C8, H5, N2, 02. From this exhibition 
of the composition of coffee it is evident that it possesses some of the 
nutrient or plastic and calorifacient elements, and consequently is an 
aliment. But as ordinarily used it contains but little of value for the 
support of life ; and its stimulating powers are chiefly dissipated in the 
process of its preparation. 
Among the poor, especially in cities, weak coffee is one of the com- 
mon ingredients of their meals, which are made up entirely of the 
poorest and cheapest materials attainable. The degree of stimulant 
found in the hot drink is accepted in place of that more healthful ex- 
citation nature designed to furnish in more substantial food. The 
blood ceases to form a concentrated solution of all the organic pro- 
ducts and elements of the healthy economy; the waste of the tissues 
exceeds the repair; disintegration of structure predominates over the 
process of reconstruction. When this condition has lasted for an in- 
definite time, the structure of the organ becomes changed, their func- 
tions are impaired, and there is an approach to inferior organisms and 
to that of cold blooded animals ; or the system is kept permanently in 
a state corresponding to anaemia, in which there is a constant tenden- 
cy to collapse as in the last stage of a febrile disease. 
Persons in this condition suffer a variety of vague and indefinable 
symptoms, anomalous in their character and perplexing to physicians: 
The animal heat is defective; “the dynamic force, identical with heat 
is equally depressed;” the mechanic or muscular power is low; the 
circulation is feeble, the digestive movements slow and defective; the 
patient is languid and exhausted; exercise augments the evil by ex- 
pending the forces more rapidly than they can be produced; and the 
nervous functions are perturbed and depressed. These results are 
produced by a slow inanition or starvation which is not suspected, be- 
cause a full supply of food is taken into the stomach. But the blood 
is deficient in the elements of heat and nutrition. It cannot be restored 
by medicine alone, but may be gradually renovated by appropriate SENSITIVENESS. 
575 
diet assisted by such remedies as may improve the digestive functions. 
The number of cases of this character has progressively increased from 
the time that the habitual use of tea and coffee became common among 
the laboring classes as well as the wealthy and indolent. Neuralgic 
forms of disease affecting the stomach and other viscera, formerly al- 
most confined to the wealthy and luxurious order of people have since 
become equally common among the hard-working poor; and it is gene- 
rally observed that the greatest sufferers are among those who rely 
most on tea and coffee as articles of food. 
Influence of Coffee and Tea on Children.—In the early periods of 
life, the food should be made up of materials rich in the plastic ele- 
ments, capable of furnishing the principles for forming the highest 
organic structures, and most readily favoring growth and development. 
“In the first fifteen years, nature is employed in constructing and per- 
fecting the mechanism of life, fitting it for the conflicts, the exertions, 
the labors it must encounter and undergo in the struggles and difficul- 
ties of the great arena of the world, as well as with exterior malignant 
influences.” Without good materials a good fabric cannot be produced. 
(Jackson, Amer. Med. Jour. July, 1849, p. 85.) It is known that a 
large proportion of the human race die in infancy; and the bills of 
mortality show fearful ravages in the early years of life from cerebral 
disease. In cities especially, children begin life bearing the accumu- 
lated sins of their ancestors ; and nature employs the few short years 
of their existence in abortive efforts to build up substantial organs from 
the most meagre supply of materials. In their earliest years nutritive 
action is perverted by over-excitement from excess of stimulus fur- 
nished in nerve-exciting drinks, or over-seasoned food. 
Sensitiveness—Irritability of Temper.—Cojfea.—Persons liable to 
be agitated by the most trifling emotion, when there is inward vexation, 
sleeplessness, and disposition to weep for trifling imaginary causes. 
Nux-vom.—Great irritability of the nervous system, agitation, in- 
clination to lie down, aversion to fresh air; stubborn refractory dis- 
position; in females menstruation irregular. 
Pulsatilla.—Persons of tranquil disposition, easily moved to tears, 
menses too late, insufficient or suppressed. 
Chamomilla.—Patient very peevish and passionate. 
Aconite.—When with anger there is fear, quick hard pulse. 
China.—Patient subject to take cold and feel the influence of the 
weather; he becomes flighty or distracted from excessive pain, and is 
worse for being touched. 
Yeratrum.—Delirium and madness from the excessive pain. 
Opium.—The best known action of Opium is to produce great tran- 
quility of the system and to induce sleep. The opium-eater takes it 
for the purpose of excitement; and literary men occasionally acquire 576 
DISEASES OF THE NERVOUS FUNCTION. 
the habit and become confirmed opium-eaters, in order to produce 
wakefulness and enable them to prosecute their studies during the 
night. De Quincy, whose interesting “ Confessions” are well known, 
used Opium for this purpose. 
Thuja.—Deafness, without any organic lesions, often alternating 
with acute hearing, being often inherited by children. Thuja alone 
corresponds with this evil. ( Wolf.) 
Sleeplessness without apparent cause. This, says Dr. Wolf, grows 
more and more frequeint, and resists all other remedies; and is only 
cured by Thuja. 
The Eyes are affected with a peculiar kjnd of photophobia, amblyo- 
pia, amaurosis, sensation of a cold wind, either blowing out of the or 
bits or into them; partial paralysis of the upper eyelid, occasional 
squinting, with a peculiar shy unsteady look, &c. Similar affections 
of the eyes are only the consequences of small pox or sycotic gonorr- 
hoea, and are also cured by Thuja. 
Tea.—A strong infusion of tea produces anxiety and palpitation of 
the heart, in persons who are not in the habit of drinking it; on the 
other hand, if taken in small doses it is an excellent remedy for such 
symptoms when produced by other causes. (Rau.) 
Effects of loss of Sleep.—Remedies calculated to correct them.— 
Cocculus.—In persons who are much injured by sitting up at night 
feeling weaker if they only lose one hour's sleep; the head trembles 
is light, face flushed, blue circle round the eyes; mouth dry withou 
thirst, loathing of food; nausea and fainting; sad ; bad dreams. 
Phosphoric-acid.—Better suited to some persons for the same 
symptoms. 
Nux-vomica.—Sitting up occasions headache; injurious effects of 
coffee, wine or spirits; determinations to the head; worse in the open 
air, with a shaking sensation; head heavy; buzzing heavy feeling in 
the forehead; pale haggard countenance; nausea; chilliness; weak 
and irritable. 
Ipecac.—The patient unable to lie down; headache from derange- 
ment of stomach. 
Pulsatilla.—Mild disposition, headache worse in the evening, better 
in the morning, determination of blood to the head, sense of heaviness 
when moving the eyes, the head feels light as if empty; he cannot 
bear the light; better in the open air. 
Arnica.—Feeling of soreness over the whole body. 
China.—Patient greatly excited in the evening; does not sleep well, 
is weary when rising. ANTIPATHY. 
577 
GENUS I.—ANTIPATHY. 
1. Antipathy.—Under this title a peculiar affection has been de- 
scribed by Cullen, Sauvages, Linnaeus, Vogel, Ploucquet, Passament 
and Good. It consists in a feeling of internal horror and distress 
caused by the presence of objects which are beyond the limits of any 
of the senses ; or which, through some occult power, produce sensible 
and painful effects on persons of peculiar constitution. Among the 
cases of singular antipathy, are enumerated persons who cannot endure 
certain odors which are imperceptible or not disagreeable to other per- 
sons ; others are affected with strange feelings of horror at the sight of 
offensive but harmless animals ; thus “ a cat concealed in a room has 
been known to produce a most indescribable distress in a person who 
has perceived it by any one sense, and has been in no other way in- 
formed of its presence. Cabanis says, in some “ singular diseases cer- 
tain intellectual faculties are developed, which till that time had not 
existed. In some ecstatic and convulsive affections the organs of sense 
become cognizant of impressions to which they were insensible in their 
ordinary state, and even to receive impressions foreign to the nature 
of man.” He says he “ has seen women who might have been excel- 
lent sorceresses that “some invalids can distinguish microscopic ob- 
jects wTith the naked eye ; some can see in profound darkness ; others 
can follow persons by their track, and recognize objects they had only 
touched.” [Rapports du Rhys, et du Morale, &c.) Cases of morbid 
innervation of much more remarkable character, are of frequent occur- 
rence. Many of the best artists suffer intensely from excessive sensi- 
bility of the nerves. Dr. Moore says: “ Wilkie was often obliged to 
shut himself up in a dark room, because the light was too stimulating 
for his brain, and Paganini paid dearly for his consummate excellence 
as a musician. Speaking to a friend he stated that he scarcely knew 
wdiat sleep was; and his nerves were wrought to such almost preter- 
natural acuteness, that harsh, even common sounds, often became tor- 
ture to him. He was sometimes unable to bear a whisper in his room. 
His passion for music he described as an all-absorbing, a consuming 
one; in fact, he looked as if no other life than that ethereal one of 
melody were circulating in his veins; but he added, with a glow of tri- 
umph kindling through deep sadness, “ It is the gift of Heaven.” Ko- 
bert Burns was a remarkable example of this preternatural sensibility 
to physical and spiritual influences. 
An interesting class of cases consists of persons who have a morbid 
sensibility to the electrical or magnetic presence of others. In these 
cases there is no moral antipathy to the persons whose presence causes 
painful sensations, but simply a physical repulsion which causes ex- 
treme suffering on their sudden approach. 
Vol. ii.—37. 578 
DISEASES OF THE NERVOUS FUNCTION. 
We know some impressible persons, who, when they are reduced by 
ill health, sink into what they call “a de-magnetized state,” when 
they remain alone; and though they need the very influence which 
another person throws off-, they cannot bear to have it so suddenly 
thrust upon them. It causes spasmodic action of the muscles and ex- 
treme distress, even when the approaching person is entirely out of 
sight. When their influence is more gradually received, it is less per- 
ceptible, and is often beneficial. 
The treatment of such cases consists in the restoration of the gene- 
ral health by treatment suited for the individual case; proper diet, 
&c. Phosphorus and Hypo-phosphite of Lime, are among the best 
remedies. 
GENUS II.—DINUS.—VERTIGO. 
Dinus.—Vertigo.—Causes.—Vertigo may arise from causes which 
medicine may remove. Such causes are : disordered or foul stomach ; 
profuse evacuations ; abuse of ardent spirits ; narcotic medicines ; falls 
or blows on the head. Sometimes it is connected with other diseases? 
and is curable by measures Avhich promote the general health. 
Treatment.—A person subject to vertigo should be moderate in 
eating and drinking, should rise early, walk frequently in the open air, 
use the flesh brush at night 
Aconite.—Giddiness with nausea, eructations and vomiting, cloudi- 
ness of the eyes, loss of consciousness. 
Pulsatilla.—Disordered stomach, nausea, vomiting, repugnance to 
food, dizziness from looking up. 
Antimonium-crudum.—Similar symptoms, with greater prostra- 
tion. 
Arnica.—Vertigo after heavy meals, dimness of vision, whirling in 
the head, flushed face. 
Nux-vomica Chamomilla, Pulsatilla, Phus, or Cocculus, are 
each suitable for certain constitutions. 
Sulphur, or Calcarea, will answer well where giddiness results from 
the suppression of inveterate ulcers. 
Mercur.-virus.—The giddiness, with dimness of sight, appears only 
in the evening. 
Belladonna.—There is sparkling before the eyes when moving, in- 
creased by stooping, with partial loss of consciousness. 
Cocculus.—Vertigo increased by sitting upright in bed, or by the 
motion of a carriage. 
Phosphorus.—Vertigo, accompanied by headache, and a feeling of 
pressure on the top of the head. VERTI«0. 
579 
Nux-vomica. — Giddiness from close thinking; better on lying 
down. 
Cldna.—Vertigo better when lying still; weakness in the head. 
Rhus-tox.—Better on rising; Chamomilla, better on stooping ; the 
patient feels that he is going to fall; thinks he will die. 
Sulphur.—Dizziness, with bleeding of the nose. (Ilering.) 
Ipecac.—“Vertigo, dizziness when walking, with tottering when 
staggering,” showing its direct action on the brain. Dr. Bayard, of 
New-York, gives a case in which vertigo was produced by the extrava- 
gant use of Ipecac. 
A girl eight years old complained of vertigo. She had been sub- 
ject to croup, which had frequently threatened her life. Ipecac., in al- 
lopathic doses, was repeatedly given to her, with the effect of alleviating 
the paroxysms of croup. She was considered as being promptly cured 
by it. The mother ventured on other occasions, to give her the same 
medicine whenever the symptoms of croup appeared; and it appeared 
always to check the disease with equal promptness. The attacks of 
croup became less frequent, and the remedy was eulogized. But the 
child complained of dizziness. When walking she would have vertigo 
to such a degree as to cause her to stagger. The doctor said that it 
was an affection of the stomach, and tried his remedies ; but the ver- 
tigo continued. It was then referred to the liver, and a few blue pills 
were proposed. These being objected to, a homoeopathist was con- 
sulted. Dr. Bayard found the symptoms to correspond with the patho- 
genetic symptoms of Ipecac. He says, “ I gave the antidotes for 
Ipecac, and the child was relieved. In this case the vital current was 
determined to the throat, producing the phenomena we call croup. 
The Ipecac, in large doses, produced another disease by changing that 
current, and this relieved the croup, leaving, however, another more 
permanent disease.” 
Agaricus-rnuscarius. — Case by Dr. Leopold.—A woman, after 
cessation of the menses, was affected with partial deafness, prolapsus 
uteri, vertigo coming on so violently every day from two to six times, 
that she would fall upon the stove, at one time burning herself badly. 
Many allopathic physicians had tried to cure her without success. 
Agaricus-rnuscarius, 12°, a powder given morning and evening, wrought 
a cure. Two months after, there had been no relapse. 
Tartar-emetic — Is homoeopathic to vertigo with scintillations, 
particularly on rising up, walking, or lifting any thing ; heat in the 
head; violent headache, with vertigo and palpitation of the heart; 
pressure in the temporal region; dullness, drowsy and weary feelingj 
vertigo and nausea; weight and heaviness in the head, pressure, nau- 
sea, weakness, trembling, drowsiness, and aggravation of symptoms on 
raising the head or walking. It is given successfully in dull headaches 580 
DISEASES OF THE NERVOU8 FUNCTION. 
or vertigo arising from gastric derangements. Third trituration pre 
ferred in acute cases. 
Ilyoscyamus.—It possesses, in a high degree, the power of creating 
vertigo, as attested by many authors. {Hahnemann, Mater. Med. IV.) 
Accordingly Schenkbecher succeeded in curing a vertigo of twenty 
years’ standing with this remedy. 
Cyclamen.—Case l)y Dr. Eidherr, of Vienna.—A young lady, af- 
ter recovering from typhus fever, had constant trouble from vertigo. 
She took Cyclamen 3°, for three days, and the vertigo left her; but 
she now complained of obscuration of sight, diplopia and slight strabis- 
mus. The remedy was suspended, and in a week the cure was complete. 
Two other cases, in ladies, aged 18 and 33, both recovering from 
pulmonary catarrh, were completely cured in two days, one by Cycla- 
men 15°, the other by the same remedy, 3°. 
GENUS III.—SYSPASIA.—CONVULSIONS. 
Convulsions.—(Convulsio from convellere,11 to tear or pluck up.” 
This term is now applied to sudden spasmodic, involuntary action of 
the muscles. Convulsions are generally the result of disease, either 
functional or organic, of the eerebro-spinal axis; sometimes they 
are the effect of injury. 
I. Those dependent on derangement of the circulation of blood in 
the brain or lesion of its substance. 
II. Convulsions from direct violence done to the brain. 
The morbid phenomena which originate in diseases of the great 
nervous centres, such as epilepsy, eclampsia parturientum, chorea, 
have, says Hahnemann, one cause for them all. This cause he con- 
sidered to be psora. Later authors have considered the different 
manifestations of the disease known as syphilis, sycosis, and scrofula, 
as being dependent on different miasmas or dyscrasias. Dr. Wolf, of 
Berlin, says: /Sycosis is “ the result of the combination of psora and 
syphilis, in their highest potency.” From this combination originate: 
tubercles, warts, varicose veins, gout, chronic catarrh of the urinary 
organs, Bright’s disease of the kidney, diabetes mellitus. “Syphilis is 
an effervescence of sycotic poison. Vaccination causes much chronic 
disease, which manifests itself under the various forms to which some 
of the above names are given.” 
The following diseases of the psoric origin will be treated of else- 
where under their respective names: 
1. Rheumatism, gout; 
2. Catarrh; 
3. Morbid affections of the nervous system; 
4. Diseases of the bones. CONVULSIONS. 
581 
Pathology.—In inflammatory affections mental excitement is an 
indication of inflammation, or irritation of the hemispherical ganglion,; 
and convulsions are indications of irritation or inflammation of the 
tubular neurine, either where it is in contact with the vesicular neurine, 
or in its course to the muscles of the vesicular neurine from whence 
the power which excites the muscles emanates. 
Thus the same law holds good, that irritation of the cerebral sub- 
stance, either by inflammation or by mechanical means, first excites its 
normal action, though it may lead to its ultimate destruction. 
Many cases are given in the books in which the brain is injured, 
and convulsions attack the side of the body, the same as that injured, 
and paralysis appears on the opposite side to that injured. Some 
think the convulsions are produced by inflammation and the paralysis 
by the mechanical compression of the brain. In the convulsions 
which appear as the most serious phenomena following an injury of 
the head it is remarked, that if the convulsions occur within a few 
hours after the accident, it is generally indicative of laceration of the 
brain; if it does not supervene for some days, it is dependent on 
subsequent inflammation. 
Diagnosis—Indications of the Eye.—The iris is designed to pro- 
tect the retina as an intelligent curtain to guard it from injury. In 
diseases of the globe of the eye, the dilated pupil indicates more or 
less pressure on the retina by some cause in the globe itself, such as 
permanent turgidity of the choroid. But if with a healthy eye, in con- 
nection with a blow on the head, we find a dilated pupil, we have the 
sign of some pressure or injury to the nerve in its course within the 
skull or the ganglia in which it terminates. 
A dilated pupil, then, indicates very serious injury to the optic 
nerve or the nervous centres with which it is connected, though it 
may happen in a case of severe concussion, that the injury may be 
remedied. 
The contracted pupil, on the contrary, indicates an irritability of the 
nervous instruments, an undue excitement of their natural function, 
not an alteration of it. When we see in case of injury of the brain, 
dilation of one pupil and contraction of the other, we find the most 
severe injury of the brain on the side opposite the dilated pupil. 
Symptoms of Compression from Depression of Part of the In- 
ternal Table of the Skull.—Entire loss of consciousness ; the mental 
faculties are suppressed and he cannot be aroused. Many of the 
functions of vegetative life are less interfered with ; breathing labored, 
stertorous ; often the sphyncters are relaxed; excretions passed invol- 
untarily. 582 
DISEASES OF THE NERVOUS FUNCTION. 
3. CONVULSIONS OF CHILDREN. 
Convulsions, in some cases, result from an appreciable cerebral dis- 
ease ; in others they develop themselves spontaneously, or in the 
course of affections of a very different nature, without any connection 
being visible between the prior disease and the convulsions; and also, 
without leaving any pathological change in the structure of the brain 
appreciable to our senses. We make, therefore, the following division 
of these forms of disease for practical purposes : 
1,. Convulsions without primary lesion, or without appreciable 
changes of structure from sympathetic action originating in other 
organs. 
2. Convulsions symptomatic of lesion of the brain or its appendages. 
Diagnosis.—The diagnosis of convulsions in children is always 
involved in the question of their origin. In illustrating this ques- 
tion, M.M. Rilliet and Barthez say : “A child, from one to six 
years of age, is suddenly seized with convulsions. He is strong, 
robust, sanguine; the attack has followed a sudden fright, a blow, a 
fall, or indigestion; that is, some appreciable occasional cause. What 
is the affection he is suffering from ? You are in doubt whether the 
convulsion is primary, sympathetic, or symptomatic, or whether it is not 
a prelude to epilepsy. If the child was quite well; if the determining 
cause is well made out, if the constitution is good, and the fit not 
violent, you may suspect it is a primary or sympathetic convulsion, or 
an attack of epilepsy. You examine with care the various organs, and 
after you have assured yourself that there exists no symptom of 
pneumonia, pleurisy, &c.; you hesitate only between deciding between 
its being a convulsive or an ejpilepic attack, and are obliged to trust to 
the future for the solution of this doubt—acting in the mean time 
according to the urgency of the case, just as if you had to do with a 
simple case of convulsion.” If at the time of the attack there was 
already some disease, as pneumonia, pertussis, &c., we may decide that 
the case is evidently sympathetic of the visceral lesion; is it also 
symptomatic of brain disease? In the great majority of cases it is 
not so. The brain is suffering sympathetically, and not from any dis- 
ease of its own substance that need to cause any new alarm; though 
it may still be dangerous. 
But when convulsion attacks a child already the subject of chronic 
disease, if for weeks or months it has been losing flesh, color, and 
strength; if it has excessive appetite, irregular digestion, or vomitings 
If we learn that the parents were phthisical, or that it has been 
brought up in hygenic conditions fitted for the generation of tuber- 
cular disease ; then, although the convulsion may even be the result of CONVULSIONS. 
583 
an appreciable occasional cause, we must fear that the attack is hut 
symptomatic of some grave cerebral affection.” {Maladies des 
Enfans.) 
When the child is more than ten years old the diagnosis is much 
easier, for it is rare at this age for convulsions to be sympathetic; and 
they are, for the most part, symptomatic of disease of the brain, or con 
stitute a first attack of epilepsy. 
A most important point in the diagnosis of all cases of convulsions 
in children, between the ages of four months and three years, is the 
condition of the teeth and gums. During this whole period, the pro- 
tracted and perilous process of dentition is going on; and there is 
hardly a week or a month in which there is not a high degree of irrita- 
tion and fever excited by the inflamed gums. In a great proportion of 
the many cases of convulsions in children, wTe have seen the convulsions 
have ceased immediately after the swelled gums were freely scarified. 
Pathology.—In ordinary cases, in which convulsions suddenly 
attack a child which has been generally healthy, there is a temporary 
congestion of the brain at the time of the spasmodic paroxysm. This 
may be the case in children previously feeble and anaemic, but in them 
its duration is short, if it exist at all. In most children who have died 
from convulsions, we find traces of congestion; but in many no traces 
of hyperaenfia are discovered; and it is now well known that convul- 
sions of various forms often arise when the state of the brain is 
absolutely anaemic. 
In those cases in which traces of congestion are found in the brain 
on dissection, it is often difficult to decide whether the hyperaemia has 
preceded or followed the attack, or whether it has coincided with it. 
Many recent authors have avowed the opinion that the marks of con- 
gestion originated in the convulsive effort, and are scarcely ever the 
cause of it. But it is easy to understand that a sudden congestion 
may produce a convulsive attack, just as we see this phenomenon 
result from an effusion of blood into the cavity of the arachnoid or the 
substance of the brain. “But we maintain that frequently things 
come to pass in another manner; and besides the hyperaemia there is 
a lesion of innervation, which is the proximate cause of the phe- 
nomenon. The solution of this problem is not a mere matter of curi- 
osity. Practitioners have, in fact, but too great a tendency to treat all 
combinations by bleeding—a practice useless-, and often fatal.” {Billiet 
and Barthez. Maladies des Enfans.) 
Precursory Symptoms.—Bad humor, whining mood, sudden starting 
during sleep, sleeplessness, screams without sufficient cause, frequent 
and rapid change of complexion, sudden relinquishing of the breast, 
&c. In other cases there is heat and redness of the gums during 
dentition, fever with eruptions, vomiting, morbid appearance of the 584 
DISEASES OF THE NERVOUS FUNCTION. 
stool, acidity of the stomach. In some we see only what are called 
“internal spasms,” displayed in distortion of the eyeballs, which are 
rolled upwards, so that only the whites can be seen; the facial mus- 
cles are trembling, and the child seems to smile during sleep; the 
breathing is anxious and irregular; after a violent interruption of 
breathing, the child suddenly takes a long, deep inspiration; the limbs 
twitch during sleep, the thumbs and toes are clenched, and the feet are 
bent toward the retracted abdomen. Sometimes there is a livid color 
around the mouth and eyes; the nose and features become pointed. 
Paroxysm: distortion of the features, staring and rolling of the 
eyes; throwing the head backwards, convulsive jerking of the chest 
and abdomen; panting, breathing, hoarse cries, or moaning, rigidity 
and alternate shocks of the extremities. The face swells, becomes 
dark-blue, purple-red, gradually the whole body assumes the same 
color, and the jugular and frontal veins swell; hands and feet fre- 
quently remain cold, though the temperature of the skin is elevated. 
In this case the condition of the brain is one of hypersemia; the 
spasms are of a tonic or tetanic character. It must be distinguished 
from one in which the anaemic condition prevails; there is pale, 
sunken face and cold skin; the conjunctiva and cornea are deprived 
of blood, and are without lustre. The spasms are clonic, and proceed 
from the face, or abdomen, or chest. 
Intervals.—After the spasm has lasted a few seconds or more, there 
is relaxation and subsidence into a state of languor and comatose stupe- 
faction. This interval is commonly short, and the symptoms of 
cerebral congestion continue. We have still the hot face, injected 
eyes, restlessness or coma, fever, &c. 
Convulsions after Injury.*—A boy fell from a swing, wnich pro- 
duced concussion of the brain and spine, and he was carried home in 
an unconscious state. Arnica was given, and cold compresses were 
applied to the head ; there was headache and vomiting ; but next day 
he was thought to be well. On the fourth day afterwards while at 
school, without previous bad feeling, he was suddenly attacked with 
clonic convulsions. Dr. Trinks found him perfectly conscious and free 
from pain in the head and back. No tender spot was found in the 
spine. Convulsions occurred in irregular intervals, drawing the body 
and limbs in different directions, and lasting from five to ten minutes, 
no trismus. In the intervals the boy was tired and sleepy but could 
not sleep, pulse, breathing, stool, and urine natural. 
Stramonium 2° decimal dilution, three drops every hour in water, 
the interval to be lengthened if the symptoms subsided. The spasms 
returned in six successive paroxysms, each being weaker. He took six 
* Muller’s Homoeopathic Quarterly. 585 
CONVULSIONS. 
doses of the medicine, felt well 'with no pain in hack or limbs. In the 
evening he fell asleep, slept without symptoms of disease through the 
night, and there was no return. He had had six paroxysms each suc- 
ceeding the other in severity, occurring at shorter intervals ; after 
taking Stramonium the attacks diminished in severity, and the intervals 
grew longer till they ceased. Whether the remedy positively cured 
the disease in this case or not the physician gave it the opportunity 
wdiich many homooepathists seldom give to a single remedy. We 
think that a very common cause of failure in this day is the frequent 
repetition of remedies, giving too many articles at a time, or changing 
too frequently from one to another. By this irregular warfare against 
disease, says Dr. Trinks, “ all real observation and experience are 
made impossible.” 
Zizia-axirea.—The seed of the Zizia-aurea, or Masquash-root have 
been used in domestic practice for the cure of epilepsy. 
A gentleman chewed a piece of the root and was immediately seized 
with nausea, vomiting, spasms, general convulsions and fainting fits, 
which terminated in death in three hours. A young lady ate a root of 
it, and was soon seized with violent vomiting, spasms, swooning, and 
convulsions. She recovered after full vomiting, and rest for a few days. 
The odor of the root produces nausea, faintness, and lassitude. We 
have cured two cases of epilepsy. In one case which had lasted ten 
years, the fits occurred as often as once in eight or ten days. Drop 
doses of the third decimal dilution were given morning and even- 
ing every alternate week for two months, when he was cured as appear- 
ed three months afterwards. Taking an over-dose caused “ unusual 
exhilaration of spirits; lightness and pain in the head; sensation of 
tightness around the forehead, and at the back of the head ; increased 
physical strength, with inclination for muscular exertion.” 
Symptoms.—Intermittent severe pains in the head, coming in place 
of uterine contraction during the progress of parturition. Some 
times the pains are extremely severe and proceed to convulsions, which 
are followed by stupor. This plant is a poison producing convulsions 
of this character, followed by stupor and profound comatose breathing. 
It has been used in a case like that above mentioned. The first dose 
seemed to palliate, the second dispelled the disease. In these cases 
the spasm is preceded by a peculiar feeling at the epigastrium, and this 
occurs at the moment when there should be contractile effort of the 
uterus. It has often been dispelled by re-exciting uterine contraction 
by Ergot in small doses, and also by irritation over the fundus, through 
the parietes of the abdomen, in the manner common for stopping 
haemorrhage. 
Cedron.—Periodical Convulsions.—A female child, aged fourteen 
months, of unusual precocious development, suffered from convulsions 586 
DISEASE OF THE NERVOUS FUNCTION. 
caused by dentition. Attacks came on every day at 5, p. m., and lasted 
ten minutes; beginning with dull appearance of the eyes, livid face, 
chills, followed by convulsions of the upper and lower extremities, and 
insensibility. On recovering from the paroxysm she remained dull and 
somewhat lethargic. A warm bath and Ignatia had no effect. Two 
hours before the third paroxysm she took two globules of Cedron 30°, 
dry on her tongue. Twenty minutes before the usual time the paroxysm 
commenced, but was modified and of shorter duration; she was con- 
scious, but looked weak and depressed; repeated the remedy, gave some 
to the nurse, the dose was repeated the next day, and the child was 
cured. 
4. Epileptiform Convulsions,—Periodical,—Cedron.—A woman, 
aged twenty-seven years, of nervous temperament, in seventh month of 
utero-gestation, had regular paroxysms morning and evening, at the 
same hour;—intense pain in the forehead; tumid face, pupils much 
dilated; feeling of giddiness, resulting in her falling down in the 
most distressing convulsions; insensibility; closed teeth; frothy 
secretion of the mouth; difficult respiration, irregular pulse, palpitation 
of the heart. This state lasted for six or eight minutes. On recover- 
ing consciousness she felt weak, and discharged a large quantity oi 
clear urine. The first attack was brought on by witnessing the execu- 
tion of a criminal. After four paroxysms had been treated allopathi- 
cally by antispasmodics, Cedron 12° was given, which cured her after 
the second paroxysm. 
Dr. Casanova considers Cedron an infallible specific to certain non- 
febrile paroxysmal affections whose type is characterized by periodicity. 
This periodicity is the typo-symptom, or emblem of symptoms—a 
symptom par-excellence which leads other symptoms either in regular 
or irregular periods of time, and in a greater or lesser degree of inten- 
sity. And when a given disease is periodically governed by the recur- 
rence of the same symptoms (be they what they may) at fixed and in 
definite intervals, Cedron then meets that phenomenon homoeopathi- 
cally and specifically at once. 
Opium.—A case resembling the agonies of death, in which the 
patient was convulsed to such a degree as to deprive him of his senses, 
alternating with attacks of spasmodic breathing, sobbing, stertorous 
respiration, icy coldness of the face and body, lividity of the feet and 
hands,.feebleness of the pulse, was treated by Stiitz, without success, 
with Ammonia. He then tried Opium, which cured it in a speedy 
and permanent manner. Schweikert and others have seen the whole 
of these symptoms produced by Opium. (Hahnemann.) 
According to Vicat, Grimm and others, Opium also produces a 
powerful and almost irresistible tendency to sleep, accompanied by 
profuse perspiration and delirium. Osthoff, meeting with an epi- CONVULSIONS. 
587 
demic fever in which these symptoms were prominent, was afraid to 
give Opium, and proceeded to exhaust all his other resources. But 
failing with all, and seeing his patient at the point of death, he resolved, 
at all hazards to try a quantity of Opium; “ its effects proved salutary 
as they always must, when given according to the unerring law of 
homoeopathy.” 
Other Symptoms of Opium.—Sense of weight in the head, heat 
of skin and difficulty of perspiring; pain in the head ; burning febrile 
heat; dry harsh skin; also, profuse debilitating perspiration, hectic 
night sweats, violent headache, tension and hardness of the pulse ; dry 
and rough skin; burning heat, and extreme agitation. All of which 
are caused by the use of Opium. 
Cuprum.—The presence of convulsions in the cases of poisoning 
by Cuprum, published by different authors, might lead us to consider 
this remedy applicable in convulsive diseases. Another case is given 
by M. Julia Fontanelle. A man intentionally poisoned himself with a 
solution of copper in vinegar, previously prepared by keeping several 
sous-pieces seven days in that fluid. He was found three hours after- 
wards in a state of insensibility, with the jaws locked, the muscles 
rigid and frequently convulsed. The breathing was interrupted and 
the pulse small and slow. He eventually recovered. {Jour, de Chimie 
Medicate, V. p. 413.) 
Dr. Kissel gives a case of a girl, aged twelve. She had been in 
good health up to May 26th, when she was suddenly seized with sud- 
den twitching of all the extremities, and of the muscles of the chest 
and face, lasting for an hour, and accompanied with loss of conscious- 
ness. She afterwards complained of pain in the whole of the head, 
in the back and epigastrium. A gentle touch of the scalp or pit of the 
stomach was painful, and all the vertebrae felt great pain on slight 
pressure. Child extremely debilitated, could not raise itself in bed. 
Skin hot; pulse small, quick, 140. Coated tongue and bitter taste. 
After some treatment which removed the febrile symptoms and the 
pains in the region of the nervous centres, there was no other attack, 
but the debility continued to such a degree that another attack was 
looked for. She took Acet.-cupri, six drops, every hour. Under this 
the debility gradually disappeared, and by the time half an ounce was 
taken the child was strong and continued to be so. 
Ignatia.—We are assured by Hermann, Valentin and others, that 
Tgnatia is efficacious in the cure of convulsions. It would be impossi- 
ble to conceive why it should do so, if we did not know it capable of 
producing similar convulsions, as witnessed by Bergius, Calmelli, and 
Durius. Fritze saw Dulcamara produce convulsions, and De Haen 
witnessed the very same effects attended with delirium; on the . ther 588 
DISEASES OF THE NERVOUS FUNCTION. 
hand, convulsions attended with delirium, have yielded to small doses 
of Dulcamara. 
Lctodes-fcetida—■Skunk Cabbage. — In former years we treated 
some cases of severe epileptic convulsions, in persons not habitually 
subject to them, with this remedy; we used it only in an infusion, 
without much regard to quantity. The cases were all associated with 
fever and the treatment embraced other means calculated to cure the 
fever; but it was evident that the infusion of Ictodes had a specific 
power on the convulsions. 
This plant has been shown by Dr. Turner, {American Journal of 
Pharmacy, Vol. II., 1.) to contain a volatile fatty matter, volatile oil, 
wax and starch, besides 20 per cent, of fixed oil. The seeds and root 
are stimulant, anti-spasmodic, somewhat narcotic. In large doses they 
cause vomiting, vertigo, dimness of sight. In smaller doses it is ex- 
pectorant, a palliative in phthisis and asthma; curative in chronic 
catarrh, rheumatism, hysteria. The leaves are used to keep up the 
discharge from blisters. It becomes almost inert from drying. 
Symptoms.—Head.—Headache in different points—of short dura- 
tion. 
Mouth, Pharynx, &c. — Violent sneezing, inducing pain in the 
fauces, palate, pharynx, down to the stomach, and long-lasting after- 
pains in the region of the orifice of the stomach. Swelling of the 
cervical and maxillary glands; burning from the fauces down to the 
chest. Sensation in walking as if the bowels were shaking ; soft stool. 
Pain in the chest and under the shoulders, which seems connected 
with the burning in the pharjmx. Aching pain in the sternum; sudden 
feeling of anguish, with oppression of breathing and sweat. 
5. Cramps hi the Limbs.—Cramp in the calves of the legs, the soles 
of the feet, and in other parts of the body disturb some persons on 
going to sleep, others suffer from them during the day. 
Treatment.—Exert the muscles affected in voluntary effort; rise 
from bed and walk or otherwise exert the limb; press it against the 
wall or the bedstead; or press or rub it severely with the hands. 
Remedies.— Veratrum taken before going to bed, and repeated for 
a few nights, will generally overcome the predisposition to the com- 
plaint. When it fails try Sulphur or Colocynth. 
Rhus-tox.—Cramps which occur during the day, especially while 
sitting, as well as those which come on at night. 
Lycopodium and Sepia.—Cramps that occur principally in walking. 
Sulphur.—Attacks that come on at night. 
Colocynth.—Cramps which occur at night; also for the stiffness 
and soreness which frequently remain for some time after an attack. HYSTERIA. 
589 
6. HYSTERIA. 
Sydenham, Stahl, Van Swieten, Sprengel, and Frank regard hysteria 
and hypochondria as substantially the same disease. The two mala- 
dies unquestionably bear a very close resemblance to each other in 
many respects ; as, for example, the almost infinite variety and simi- 
larity of the symptoms which they present, and the proneness of the 
subjects of both diseases to exaggerate trivial or even imaginary ail- 
ments into disorders of magnitude. 
But there are marks of distinction between them equally important, 
which refute conclusively the opinion respecting their identity. 
Pure hypochondria almost invariably occurs in individuals of a 
lymphatic and bilious temperament. Their dispositions are generally 
gloomy and morose, and ever inclining to n look at the dark side.” 
Hope, confidence, cheerfulness, enter hut sparingly into their disposi- 
tions ; they are not addicted to “ building castles in the airnever 
behold anything bright, agreeable or desirable in the future ; but look- 
ing with distrust and aversion upon mankind, and obstinately fixing 
their thoughts upon some dreadful impending calamity, which they are 
sure will overtake them, sooner or later; they either drag out a mise- 
rable existence, suffering mentally almost every evil, or terminate their 
woes by suicide. 
Hysteria, on the other hand, usually occurs in females of a ner- 
vous, or nervous-sanguine temperament, with cheerful, lively and ardent 
dispositions, vivid imaginations, and highly impressible organizations. 
Hypochondria is uniform and continuous in its course, and presents but 
slight variations from day to day. Hysteria occurs in paroxysms, with 
intervals of greater or less duration, of passable bodily health and 
spirits. Hypochrondria is always connected with disorder of the 
stomach and liver; hysteria is owing to an irritation or erethism of 
the whole nervous system. Writers have always regarded the seat of 
hysteria as in the uterine and sexual organs, because it has usually 
been associated with derangement of the functions of these organs. 
It occurs after the period of puberty, in females of a nervous, or 
nervous-sanguine temperament, with strong sexual propensities, and is 
accompanied with deranged menstruation, dysuria, sexual excitement, 
or pains in the pelvic region. Yet the malady seems evidently to be 
of a purely nervous character, consisting of an erethism of the whole 
nervous system and capable of being brought into active operation by 
any exciting cause which may operate upon the economy, like deranged 
menstruation, the depressing emotions, fright, terror, mortification, 
dread, chagrin, disappointed love, undue excitement of the sexual 
organs, &c. This peculiarly irritable condition of the nervous system 590 
DISEASES OF THE NERVOUS FUNCTION. 
may exist for an indefinite length of time, without any actual develop- 
ment of proper hysteric symptoms, provided the above-named exciting 
causes do not operate. 
Diagnosis.—Sometimes the first symptoms of hysteria are flatulency 
pains, or distressing sensations in the stomach, bowels, chest, head and 
back; faintness, vertigo, bitter taste, eructations, dysuria, anxiety, de- 
pression of spirits, difficulty of breathing, sense of suffocation from 
something like a ball rising in the throat, (or globus hystericus,) ring- 
ing in the ears, delirium, or loss of consciousness. Symptoms of this 
kind take place in individuals of a feeble and purely nervous tempera- 
ment, and the delirium and loss of consciousness appear to take the 
place of convulsions. 
In others, of a nervous-sanguine temperament, with robust constitu- 
tions, the convulsive paroxysms come on by slight twitchings of the 
muscles of the mouth and eyes, with wild expression, eyes rolled up, 
convulsive laughing, crying, or sobbing, constant attempts to pull out 
the hair, to strike the breast or some other part, or to bite ; difficult or 
laborious respiration, succeeded in a short time by the most violent 
convulsions. 
In other instances the paroxysms are preceded by a croupy cough, 
or colic pains, or pains in the head, chest, back or pelvis. 
In some cases the paroxysms take place suddenly, without any 
warning symptoms, and the patient may suffer a series of dreadful 
convulsions, with only brief intervals of consciousness, for many hours, 
and then be restored speedily to all her mental and bodily faculties. 
It would be useless to attempt a detail of all the phenomena 
which may occur in hysteria, and we shall, in conclusion, only observe, 
that the peculiar condition of the nervous system upon which the dis- 
ease is dependent and the convulsive paroxysms to which this morbid 
state gives rise, should command our principal attention in the treat- 
ment of the malady. 
Causes.—The predisposing causes are: a delicate, nervous tem- 
perament, too much confinement in close and heated apartments, the 
frequent perusal of exciting works of fiction, attendance upon thea- 
trical exhibitions, tight-lacing, want of exercise, premature tasking of 
the mind to the neglect of the body, habitual indulgence in lascivious 
thoughts, nervousness, luxurious living. 
Amongst the exciting causes may be mentioned: violent mental im- 
ressions of any kind, whether produced by the sight of disagreeable 
bjects, or the smell of disagreeable odors, or the hearing of sudden 
noises, discordant sounds, or by terror, fright, anger, rage, grief, chagrin, 
mortification, and disappointed love or ambition. 
Hamilton supposes the presence of irritation and indigestible sub- 
stances in the intestines is a common exciting cause of hysteria. HYSTERIA. 
591 
Other exciting cases are: sudden suppression of the menstrual dis- 
charge, too profuse evacuations, uterine irritation, and leuchorrhoea. 
Hysteria has long been regarded as dependent on spinal irritation. 
From the extent of the spinal cord and its connection from one ex- 
tremity of the trunk to the other, and its connection with the cerebral 
nerves, it must exercise an extensive influence on the phenomena pre- 
sented by various diseases too often overlooked. The publication of 
Teale on Hysteria, drew public attention to the subject, and lessened 
the excessive medication and depletion which was then going on. A 
case mainly caused by that treatment is thus given: A lady aged 
twenty-six, had been bled and otherwise reduced, for inflammation of 
the lungs. She was then seen to be suffering from debility, with occa- 
sional peculiar lassitude, which compelled her to go to bed, where she 
spent most of her time; pulse natural, tongue clean, appetite good, 
bowels and skin natural. But occasionally there came on tightness 
across the chest, difficulty of breathing, which after a short time dis- 
appeared. The physician prescribed tonics for the “debility;” but 
ten days passed without improvement; at a loss what to do, he exam- 
ined the spine, and found three dorsal vertebrae quite tender, and pres- 
sure upon them caused stricture of the chest. External irritation over 
the seat of tenderness was the only treatment thought of, and in that 
case it produced such amelioration of the suffering that the lady, com- 
paring it with the result of other treatment, was grateful. It wras for- 
merly common to attempt to cure acute neuralgic attacks in hysterical 
females by bleeding; if there was some temporary palliation of the 
pain, the physician was satisfied ; when the pain returned he repeated 
the bleeding. 
Treatment.—For the cure of hysteria, arising from a torpid state 
of the bowels, and an accumulation of undigested ftecal matter, and 
attended with putrid or sour taste, bitter or acid eructations, flatulency, 
fullness, distention and pain in the epigastrium, constipation, nausea, 
weakness, languor, faintness, headache, giddiness, confusion of ideas, 
strong tendency to convulsions, Nux-vomica and Sulphur are the 
proper remedies. When the attacks appear to have been excited by 
derangement of the uterine functions, the most suitable remedies "will 
be : Pulsatilla, Sabina, and Silicea. 
If the exciting cause has been terror, fright, anger, disappointment, 
mortification, or any violent, mental excitement, Ignatia, Ilyoscyamus, 
Aurum, Belladonna, Coffea, will each cover most of the symptoms. 
Administration.—The remedies should be administered at the third 
dilution, during the paroxysm, by placing a drop upon the tongue at 
short intervals, or by smelling ; but during the intervals, a drop once 
in twelve hours, until the desired impression is produced. 
Pulsatilla.—Case by Dr. Cramoisy. A girl aged eight years, of 592 
DISEASES OF THE NERVOUS FUNCTION. 
healthy family. At the age of two years, was aroused from sleep by 
convulsive movement of the head, subsiding in a few moments, and re- 
newed on again falling asleep. As she grew older, the spasms con- 
tinued to recur, she learning to facilitate the lateral movements of the 
head, by holding it in her two hands, each spasm lasting three or four 
hours. At the end of five years she was affected by a barking cough, 
which would continue from five to ten hours incessantly. The child 
being conscious of its coming and of its disappearance. After this had 
lasted three days, Dr. Cramoisy found the case to be a neurosis of the 
larynx, constituting a symptom of hysteria, the cough simulating the 
bark of a dog. There was pain in the head and eyes, with photopho- 
bia and dilatation of the pupils. Bell., Ignatia, Cuprum, were tried 
without result. Pulsatilla 6°, was then given, two drops in a tumbler 
of water, a table-spoonful every four hours. The spasms ceased after 
the third dose, and the cure was rapid and complete. 
Hyoscyamus.—The symptoms taken collectively, as witnessed by 
many authors, present a picture of hysteria of considerable severity. 
Accordingly, we find in J. A. P. Gessner, Storck, and in the Act. Nat. 
Cur. (IV., obs. 8,) that a case of hysteria, which bore great resemblance 
to Hyoscyamus, was cured by the use of this plant. 
According to J. II. Lange, nutmeg has been found efficacious in hys- 
terical fainting fits. The sole natural cause of this phenomenon, is 
homoeopathic, and can be attributed to no other circumstance, but that 
the nutmeg, when given in strong doses to a person in health, pro- 
duces, as stated by J. Schmid and Cullen, suspension of the senses and 
general insensibility. 
Cuprum.—Chorea and Hysteria, are convulsive diseases. In two 
cases, already referred to, the breathing was impeded—an indication 
of its homoeopathicity to spasmodic asthma. From the commencement 
of the action of the poison, pain in the stomach and colic -were present 
in the majority of cases, and might induce us to select this medicine in 
a case of cramp of the stomach ; we should feel further justified in 
having recourse to this remedy, because cramps in different parts of 
the body, frequently result from long-continued use of small doses of 
the cupreous compounds. 
Caulophyllin.*—Spasmodic pain in the uterus, stomach, bowels, &c.; 
tendency to spasmodic forms of hysteria; threatened abortion. Its 
action in small doses is primarily on the uterine motor nerves, thus con- 
trolling spasmodic action of the uterus; it also affects the motor nerves 
generally. Secondarily, it acts upon the nerves of sensation, causing 
neuralgic and rheumatic pains. 
Its effects on the motor nerves of the uterus, are considered equal to 
those of Secale, though in other respects there is little resemblance 
* Leontice Thalictroides, Caulophylluin, False Cohosh. EPILEPSY, 
593 
between these agents. Caulophyllin is said to be capable of causing 
abortion ; but that it will also prevent it when threatened, if the ovum 
be not already detached. 
It is used in rheumatism, dropsy, epilepsy, hysteria, cramps, ame- 
norrhcea, dysmenorrhoea, chorea, leucorrhoea, hysteritis, hiccough, to 
hasten delivery, and to relieve after pains. In atonic conditions of the 
uterus; passive haemorrhages, and prolapsus uteri. In five grain doses 
it is said to excite uterine contraction more decidedly than Ergot. 
Epilepsy. — The name is derived from EniXa/ipavo),' to invade, 
attack, oppress. It was described by Hippocrates by the title of 
Morbus Sacer, though he rejected the idea of demoniacal possession. 
It was most fully described by Aretaeus. 
Epilepsy has been known from the most ancient times. It was 
common in the day of Hippocrates, who described it; and at the pre- 
sent day it is estimated that in every one thousand persons six are 
epileptic. 
Symptoms.—The patient, when in apparently perfect health, is 
affected with a slight flush of the face, then a scream more unearthly 
and horrible than any sound uttered by human creature. The whole 
body becomes convulsed; he falls forwards, if sitting, if standing, 
generally the same way. Sometimes there is a slight warning. The 
jaws are fixed, the tongue being frequently caught between them on 
their sudden closure, and severely bitten; expression of suffering is 
agonizing. There is bloody, frothy saliva issuing from the mouth; 
head drawn upon the chest, the body curved forward ; thighs flexed, 
hands violently clenched. One side generally more affected than the 
other; the same side always the worst; countenance livid and dis- 
torted. The carotid arteries are distended and beat violently. The 
seminal fluid generally ejected during the paroxysm by the convulsive 
action of the ejaculator muscles. 
Gradually the muscles relax; the eyes open, they are blood-shot, 
turned upward with a ghastly expression of death; the breathing 
slow, gasping, stertorous, as if approaching death. In a few jninutes 
the countenance becomes natural, breathing gradually less stertorous; 
and now, if undisturbed, he will fall into a deep and tranquil sleep; 
he wakes after half an hour or more, wholly unconscious of what has 
occurred, or of the fearful ordeal he has passed through. 
In some cases he opens his eyes and looks about him a few minutes 
after the attack, as if nothing had happened. Generally there is 
coma. If the fits succeed each other rapidly in considerable number 
the coma may last for days or a week, and is sometimes succeeded by 
7. EPILEPSY. 
vol. II.—38. 594 
DISEASES OF THE NERVOUS FUNCTION. 
complete mania. Something depends on whether the patient is kept 
awake or not. If disturbed or annoyed by seeing strange faces around 
him he is generally worse. 
Case by Mr. Solly. A gentleman had twenty-four fits in forty-eight 
hours, occurring exactly every two hours. He usually had fever fits, 
but was made worse this time by opposition of the servants, who pre- 
vented him from leaving the house, which was strange to him. He 
was afterwards insensible four days, and did not recover for a fortnight. 
Other forms of Epilepsy.—One will, when walking, stop suddenly, 
gaze for a few seconds quite vacantly, or turn and look on the ground 
as if he had lost something. 
The French call it petit mal when there is a slight convulsive move- 
ment of the face or lips and the state of unconsciousness lasts 
longer. Sometimes these attacks derange the intellect more than 
full epileptic paroxysms. 
Premonitory Symptoms.—Some have warnings at first, and after- 
wards fits come on without any. These warnings are: headaches, 
fullness of the head; one notices a most disagreeable odor for a day 
or two. Others are particularly well, clear-minded. A boy is always 
particularly mischievous and high-spirited just previous to an attack, 
and his fingers are drawn into his hands as children affected with 
crowing convulsions. This turning-in of the thumbs is a common sign 
of the approach of an attack. Some are always found lying on the 
face, a night or two previous to it. Some can tell when it is coming, 
and lie down to keep from falling, or thrust the handkerchief into the 
mouth to keep the teeth from biting the tongue. 
Some try to call to a friend, but can seldom articulate a word ; one 
has convulsive twitching for a night or two previous; some have 
always a violent pain in the stomach previous to an attack. A lady says 
she knows an attack is coming on by things “all looking different,”— 
can’t describe how, but has often tried. One man could tell by singing 
in his ears time enough to get off his horse. A young lady has 
averted a fit by pinching her nose, and can cry out beforehand to 
“pinch it.” 
Diagnosis.—The symptoms of epilepsy are exceedingly variable. 
Sometimes premonitory symptoms are present, like headache, giddi- 
ness, ringing in the ears, aura epileptica, or pricking sensation extend- 
ing from the extremities to the head, drawing inwards of the thumbs 
towards the palms of the hands, and sensation of fullness of the head; 
but more frequently the subject is struck down without any warning. 
When the attack comes on, the patient falls suddenly; there are vio- 
lent, convulsive movements, with loss of consciousness; the face and 
eyes become distorted; the tongue is often bitten, and in consequence 
we see blood and froth issue from the mouth; stertorous and difficult EPILEPSY. 
595 
respiration; the muscles of one side are often more agitated those of 
the other, and the pulse weak, frequent, and irregular ; after the par- 
oxysm has subsided, the patient usually sleeps profoundly for eight or 
ten hours, and sometimes remains for a considerable period in a feeble 
and languid state, with headache and occasional delirium; but, more 
commonly he very speedily recovers his usual state of health and 
vigor. 
Until the time of Sydenham epilepsy was confounded with “St. 
Vitus’ dance,” and even at the present day there is not always a well- 
marked boundary drawn between the different forms of convulsive 
spasmodic, or other nervous affections. Esquirol and Calmeil liav< 
correctly proposed to limit epilepsy to “ certain unchangeable character- 
istic series of symptoms” by which it shall be distinguishable from 
all other diseases which it may, on a superficial view, be found to 
resemble. 
Calmeil, unwilling to write upon the authority of others, undertook 
to bring the question of diagnosis to precision by more careful obser- 
vation than had yet been bestowed upon it. He spent a whole year in 
the Salpetriere ward, and spending his nights in that devoted to epi- 
leptics. At one time Esquirol had made up his mind that he had 
so learned the diagnostic symptoms that the best physicians would not 
be liable to simulate the disease without being immediately detected; 
and he announced that opinion to his colleagues and pupils. “Just 
then Calmeil fell suddenly on the floor, and was seized with a most 
severe epileptic attack. The bystanders endeavored to render assist- 
ance, and Esquirol himself lent his aid. ‘It is sad,’ said he, ‘for the 
poor young man; he is epileptic to a degree which scarcely admits a 
hope of his being cured.’ The words had hardly been spoken when 
Calmeil jumped suddenly up as well as ever. He turned smiling to his 
great teacher and said: “ you see, sir, that you have erred; you did 
not observe that, as I fell to the ground, at the beginning of the attack, 
my complexion was not altered.” And thus was this first character- 
istic sign of epilepsy first pointed out by Calmeil.* 
Symptoms of the Attack.—The epileptic, when he falls down, is 
deadly pale; the congested complexion shows itself not till some 
moments later. 
At the commencement of the attack, one side of the body only will 
be affected with tonic muscular spasms ; and when the spasms appear 
on both sides they are always more marked in one. 
The muscular spasms are at first always tonic: they are therefore 
at first stiff and strongly contracted; the thumbs are drawn inwards ; 
the fingers are all contracted; the arm of the affected side makes a 596 
DISEASES OF THE NERVOUS FUNCTION. 
rotatory movement, which may be even so severe as to force the joint 
out of the socket. The sterno-cleido-mastoid is strongly contracted. 
The Aura Epileptica.—This is a peculiar sensation that origi- 
nates in one of the extremities and passes upward in the course of a 
nerve to the head. It precedes the fit, and they say they feel it dis- 
tinctly until it reaches the head, when they are unconscious. Some 
describe it as a cold, others as a warm feeling, but always as a creep- 
ing sensation, like “ pins and needles.” Solly says he has seen fort} 
or fifty cases of epilepsy and has met with this but once. 
Sir A. Cooper said: the patient would be seized with a pain in the 
thumb, which extended up the arm in the course of the radial and 
brachial nerves, through the axilla to the neck and the head; the 
patient would then drop on the floor in a fit. Shortly afterwards 
he would get up and appear as well as before. The surgeon cut 
down upon the radial nerve, by the side of the flexor carpi radialis 
longus, exposed about one inch of the nerve and removed five eighths 
of it. After this the pain left the patient and he returned home com- 
pletely cured. Sauvages thinks this sensation has its origin in the 
brain, though felt in the limb, just as a man who has had a limb am- 
putated still thinks he feels his toes. 
Epilepsy may occur at any age. Though not common in infancy 
nor in extreme old age. One man of eighty was attacked and recov- 
ered, after which he lived to more than ninety in good health. It 
occurs among animals, as the dog, cow, horse, pig. It is common and 
well marked in young puppies. 
Forms of Epilepsy. A. Idiopathic Epilepsy.—Three varieties, 
(according to M. Esquirol.) 1. Idiopathic epilepsy produced by ex- 
ternal causes ; forcible compression on the cranium; contusions, frac- 
tures ; coup de soleil. 
2. Idiopathic epilepsy depending on defective organization of the 
cranium, or lesion of the meninges of the brain, or serous or sanguine- 
ous extravasation into the cavity of the skull. 
3. Idiopathic epilepsy, nervous, produced by moral affection either 
of the mother, the nurse, or the patient. 
B. Symptomatic Epilepsy.—Five varieties. 1. Connected with the 
digestive organs; indigestible matter in alimentary canal; inte itinal 
worms. In one case it was brought on, in a person who had been free 
for a year, by eating a supper of cheese and radishes. These are 
merely exciting causes, acting on an irritable brain. 
2d. Form.—Derangements in the arterial system, from suspension 
of the menses, hemorrhoids, habitual haemorrhages, abuse of stimulants> 
wrong modes of living. 
3d Form.—This has its seat in the white vessels. Pale, chlorotic, EPILEPSY. 
597 
rachitic and scrofulous persons are predisposed to it. Retrocession of 
porrigo, itch, ulcers, syphilis gout, are common exciting causes. 
4th. Has its seat in the organs of reproduction. Excited by venere- 
al excesses: masturbation, pregnancy, delivery, are the common proxi- 
mate or exciting causes. 
5th. Epilepsy Sympathetica has its seat in the external organs; it 
may be excited by any irritation of the external parts of which the 
secondary effects radiate towards the brain, produce this variety. 
Characteristic Symptoms of True Epilepsy.—The patient sud- 
denly falls down, and at first is deadly pale; but after some moments 
the complexion indicates congestion of the brain and cerebral system 
generally. The muscles generally are affected by strong tonic spasms; 
they become stiff and strongly contracted, always more marked on one 
side, and most frequently seen on one side only. The fingers and all 
the muscles of the arm of the affected side are rigidly contracted, and 
the head of the humerus is sometimes wrenched from its socket. The 
sterno-cleido-mastoid muscle is rigidly contracted, drawing the head 
downward and the face toward the opposite side. The facial muscles 
of the affected side are horribly convulsed, and the features assume an 
idiotic or ape-like appearance,—eyelids close shut, eye-ball distorted 
upward, the jaws forcibly pressed together, and the tongue bitten 
through when it happens to intervene. The convulsions of the mus- 
cles of the chest -suspend respiration, the action of the heart and 
arteries becomes imperceptible, the bladder and muscles of the pelvis 
are spasmodically contracted, urine and stools are passed involuntarily; 
short, strong tonic contractions of the muscles generally. 
When the deadly paleness and contractions of the muscles have 
continued from fifteen seconds to one minute the contractions begin to 
decline, and the visage becomes red, varying to blue-red ; the veins of 
the neck are swollen to thick cords; the beating of the heart becomes 
strong and quick, the pulse becomes full and hard, the muscles are 
alternately contracted and again relaxed, and the face and limbs move 
convulsively. These clonic movements become rapidly stronger, 
twitching, with lightning-like quickness in the face, and becoming 
more and more rapid and severe. The nostrils, lips and cheeks now 
heave and sink alternately; extraordinary grimaces are exhibited on 
the features, and the head, trunk, chest and legs are thrown from one 
side to the other. Respiratory action is gradually restored, a foamy 
saliva is forced from the mouth, often tinged with blood from the 
wounded tongue. At this time, and usually at the commencement of 
ihe attack, the sensibility is suspended. Neither the loudest noise, a 
candle held close before the eyes, Ammonia applied to the nostril, nor 
falls against the wall or pavement, arouse the patient to the slightest 
degree of consciousness. 598 
DISEASES OF THE NERVOUS FUNCTION. 
After one-and-a-half or two minutes, the redness of the face, clonic 
contractions, and convulsive movements cease ; regular respiration re- 
turns, with deep sighs or some inarticulate moanings. A profound 
sleep ensues, with snoring like that of intoxication; the action of the 
heart becomes more regular, the veins of the neck subside to their 
natural appearance, the face is again pale, and the features express 
nothing but stupor, which lasts six or eight minutes. At last he opens 
his eyes, looks anxiously around him, is quite puzzled to know what 
has befallen him, and appears quite ashamed. Headache remains 
many hours or days; irritability and unfitness for labor, &c., remain. 
Ecchymoses are observed on different parts of the body where he has 
bruised himself, and injuries of the tongue, if it has happened to get 
between the teeth. 
In many cases the fit ends with hallucination, delirium, or raging 
madness. Thus we observe: 
1. A cry, falling down, paleness of the face, tonic convulsions, a 
quarter to one minute. 
2. Redness of the face, convulsions, insensibility, one-and-a-half to 
two minutes. 
3. Stupefaction, with cessation of convulsions, three to eight minutes. 
Thus the epileptic seizure lasts from five to ten minutes, the return 
to sensibility and the premonitory symptoms not included. 
Epileptic seizures come on with premonitory symptoms of different 
kinds. Those which appear a few moments before the attack have 
been called the near premonitions ; those which present themselves 
several hours or days before the attack, the distant premonitions. 
Symptoms of the Stage intermediate between the Paroxysms.— 
Intercalary Symptoms.—The three phases, or periods, happening in 
regular successive order constitute an epileptic seizure. The periods 
may be longer or shorter, but all three must exist, or the disease is 
no epilepsy. 
Every attack that begins with loss of consciousness, insensibility, 
and exhibiting some involuntary movements is not epilepsy. In many 
shapes these affections appear, and they are by many denominated, 
though incorrectly, epileptic vertigo. 
Nervous Affections, usually but improperly styled Epileptic.—1. A 
patient suffers from attacks of palpitation of the heart. lie is pale, 
has a sensation as if he should fall down, or should die. This is not 
a nervous heart disease, nor yet an epileptic vertigo; but a peculiar 
disease, differing from both. 
. 2. A patient, whilst walking, suddenly stops ; the head falls to one 
side; the visage is distorted and takes the expression of terror or 
fury; one side of the body is stiff; respiration ceases; the counte- 
nance is red. Suddenly all this goes off—all the symptoms go off; EPILEPSY. 
599 
the patient complains only of a slight headache. This is not epilepsy, 
or epileptic vertigo, but a peculiar disease. 
3. Another suffers from involuntary chewing movements, which con- 
tinue some seconds, then suddenly is heard a noise in the throat, as is 
produced by involuntary shallowing, or as if by empty swallowing. 
This has nothing to do with epilepsy. 
4. One suddenly loses consciousness, for some seconds talks quite 
astray, to the astonishment of all about him ; or repeats the same word 
ten or twenty times in succession; or he is often seized during the day 
with attacks of hiccough, during which the complexion changes, and 
headache, wmariness and irritability succeed. All this is perfectly 
distinct from epilepsy. 
These different affections, though none of them be really of an epilep- 
tic character, may sometimes exist in persons who may become epilep- 
tic. The two diseases may then co-exist, or one of them may cease, 
leaving the other to continue. True epilepsy may originate in old age, 
as it did in the case of the Duke of Wellington, at the 70th year. It 
may be suddenly excited at any age, and may cease as suddenly, in- 
dependent of any treatment. 
Constitutional Predispositions. — 1. Hereditary transmission; 
through which relatives, in connection with other analogies of tempera- 
ment and organic peculiarities. 
2. Coincident diathesis. Strumous; psoric; syphilitic; sycotic; 
arthritic. 
3. Attractions in the fluids; plethoric, anaemic, albuminuric, melan- 
hsemic, glycosuric ? Malarial, by animal poisons, by vegetable poisons, 
by mineral poisons. 
4. State of the surface : hyperaesthesia, partial or general; special 
sensibility, to temperature, to electricity, to water; transpiration normal, 
or otherwise ; distribution of heat and its peripheric radiation. 
5. State of the viscera; especially the digestive sphere; existence 
of hepatic or renal calculi; taenia solium; lesions of the ovaries or 
testicles. 
6. Peripheric lesions as points of morbid radiation: old cicatrices, 
entanglement of a nerve; existence of foreign bodies under the skin 
or within the deeper tissues; irritations of the special senses. Visual, 
auditory, dental. 
The patient who is recovering from more severe attacks of epilepti- 
form convulsions, on opening the eyes, looks anxiously around him, un- 
conscious of what has befallen him, and feels timid or ashamed. He 
has headache for some hours or days, and is irritable and unfit for labor; 
ecchymoses appear where he has bruised himself, and he finds the 
wounded tongue sore and bleeding, leaving scars which are sometimes 
referred to as evidence of the existence of the disease (Chomel.) In 600 
DISEASES OF THE NERVOUS FUNCTION. 
some cases the fit ends with delirium, hallucination or raging mania. 
Thus the deeply-marked outlines of the attack are expressed in, first, 
a cry, falling down, paleness of the face, tonic convulsions, from a quar- 
ter to one minute ; second, redness of the face, convulsions, insensibili- 
ty for one and a half or two minutes; third, stupefaction, with cessa- 
tion of convulsions, three to eight minutes. 
II. Convulsive Affections Occurring During Sleep.—Convulsive 
affections are peculiarly liable to occur during sleep. This is attri- 
buted to the suspension of voluntary power, inducing a peculiar sus- 
ceptibility in the nervous centres, to be acted on emotionally, or by 
purely reflex stimulation. Many of the spasmodic movements that oc- 
cur during sleep, are to be attributed to the emotional state induced 
by unpleasant dreams, uncontrolled by the power of the will. In illus- 
tration of this, the following case is given :* “ A woman was affected 
with an almost perpetual tremor of the right arm and hand, which was 
always aggravated by emotion. I carefully noted that the arm and 
hand were completely still dux-ing pei’fectly sound sleep; but in im- 
pei’fect or light repose, there was a varying amount of tremor. The 
hand no less in sleep than in watchfulness, became a delicate index of 
the condition of the mind.” When the sleep was profound, not a muscle 
quivered; when the sleep was disturbed by dreams, the hand and arm, 
influenced by the varying emotions, shook very forcibly. When par- 
tially aroused, the tremors were renewed; and on relapsing gradually 
into complete unconsciousness, the voluntary muscles of the arm par- 
ticipated in the perfect tranquility of the general system. 
When the activity of the will is suspended, there is a vastly increased 
tendency to involuntary action of all kinds, “ so that it is only after we 
have removed or paralyzed the seat of volition, that we can obtain ex- 
perimental evidence of the independent reflex activity of the lower part 
of the nervous centres, whose ordinary operations are entirely under 
its control.” This principle is illustrated by numerous instances of 
various states of sleep, hybernation, paralysis, and by the condition of 
the foetus in utero. Even in the waking state, as in profound reverie, 
the withdrawal of the will leaves the same susceptibility. It is believed 
that this principle furnishes the key to the explanation of the reflex 
or excito-motor action, in which sensation is not a necessary link ; and 
also of those actions which become automatic by habit, though guided 
by sensations, and of those, further, which ai'e the expression of ideas 
suggested to the mind without any emotional excitement. 
Pathology.—The pathology is unsettled. It is regarded as a dis- 
ease of the brain; Marshall Hall refers it to the spinal coi’d. It ap- 
peal’s in two distinct forms : 
*Mr. Barlow, of Westminster Hospital, Medico-Chir. Transactions, 1851. EPILEPSY. 
601 
1. Centric Epilepsy. 
2. Centripetal Epilepsy. 
It may be induced by any disease within the brain or spinal marrow 
It may originate from fright or sudden mental emotion, ending in con- 
vulsions repeated. The true spinal marrow induces, when stimulated, 
convulsive movements in the organs appropriated to digestion, to ges- 
tation, and in the limbs. 
Diseases within the cranium, by irritating the excitor nerves, or the 
medulla oblongata, induce convulsions or epilepsy, too frequently, in- 
deed, of the incurable kind. Disease within the spinal marrow may 
prove a source of convulsions, or still more immediately, epilepsy, 
equally incurable. 
Centripetal epilepsy takes its origin in the excitor nerves of the 
true spinal system, involving the axis of this system and its motor 
nerves in their turn; functionally, not organically. This may be con- 
sidered curable, however difficult of cure. 
By avoiding the exciting causes, the attacks may be avoided, and 
the susceptibility to returns subsides; these returns become less fre- 
quent and less severe, till they cease altogether. 
Dr. Wood thus gives his views of it: 
u The disease probably consists in a morbid excitability of the brain, 
and each paroxysm in a morbid excitement or irritation. A prominent 
effect of irritation, when beyond a certain point, is first to derange, and, 
if it be still further increased, to abolish function, this law is applica- 
ble as well to the brain as to other organs. The irritation which oc- 
casions the paroxysm is sufficient to suspend all the cerebral functions 
connected with the mind—sensation, perception, intellectual action, 
emotion, consciousness, volition ; but in relation to the motor function, 
is only sufficient to derange, not abolish it. In this respect, epilepsy 
differs from apoplexy. In the latter affection, not only are all the 
mental functions suspended, but to a great extent of motion also. The 
difference may be owing to a less degree of the irritant or disturbing 
force in epilepsy, or to its more especial direction to the cortical sub- 
stance, whereby the mental functions which are probably connected 
with the latter, may suffer most while the motor functions, connected 
essentially with the medullary substance, being as it were in the out- 
skirts of the irritant influence, feel only enough of it to be excited 
into a morbid increase of action, and not enough to overwhelm it en- 
tirely.” 
Theory of Epilepsy.—The first morbid action is a sudden determi- 
nation of the blood to the brain, which expends itself on the secretion 
of that nervous power which in a state of health, is employed by the 
brain to convey volition to the muscles, and which power is, without 
doubt, analogous to electricity. This excessive secretion is carried 602 
DISEASES OF THE NERVOUS FUNCTION. 
off by the motor nerves, like a discharge from an electric battery, and 
from its quantity and excess produces excessive action of the muscles 
It is another illustration of the law that the first effect of arterial ex- 
citement in every secretory organ, is to excite to an unnatural degree 
the function of that organ. We know that mental emotion will cause 
a sudden determination of fluid to other organs, which, according to the 
nature of the part, will be followed or not by secretion. 
Blushing, erection of the penis, are instances of sudden determina- 
tion of blood to the particular part. The sudden increase of secretion 
of many glands, as the lachrymal, salivary, prostate, gastric glands, the 
testicles, and even the kidneys, and the abundant discharge from 
these glands, often show that the blood from which the secretions were 
formed, must have circulated more rapidly through the gland than in 
their ordinary state, or when they were at rest. The periodic attacks 
of mania in many insane persons, may be regarded in this fight. 
Alison says, (.Pathology, p. 554:) “ There are hardly any chronic 
or local diseases in which local determinations and congestions of blood 
do not occur.” He enumerates the principal diseased states in which 
morbid determinations of blood certainly occur, and in a great measure 
determine their extent, their intensity, and injurious results. Those 
various derangements of the functions of the nervous system, head- 
aches, giddiness, transient imperfections of sense or of memory, fits of 
epilepsy, of hysteria, or other spasms, even those of mania in those 
predisposed to these diseases; some cases of transient paralytic affec- 
tions, and many of apoplexy, appear to result from simply increased af- 
flux of blood to the brain without rupture of its vessels, disorganization 
of its texture, or even increased effusion of its serous fluid.” 
The vessels that are the seat of this morbid action in epilepsy, are 
thought by these pathologists “to be those of the choroid plexus, and 
one of the layers of the cortical substance.” The choroid plexus is 
frequently found hypertrophied in the brain of epileptics, assuming an 
ilmost fleshy appearance. This hypertrophy would very probably be 
the effect of repeated action, hypermmia. This part of the brain is 
also often the seat of small tumors, generally like hydatids. 
The mode by which determinations of blood take place to the 
head as well as elsewhere.—The middle or muscular coat of the arte- 
ries in a state of health contracts with each systole of the ventricles 
of the heart, just sufficiently to give solidity to the wall of the pipe, so 
that the force of contraction is not lost on a yielding surface. A much 
greater force is required to draw water through a leather hose than 
through a leaden tube. The middle coat contracts just enough to as- 
similate the artery physically and temporarily to a leaden tube. The 
arteries with permanent walls, like leaden tubes, would have interfered 
by their rigidity with the motions of the limb ; hence this beautiful EPILEPSY. 
603 
contrivance. When this middle coat does not contract, or only imper- 
fectly contracts, then a force of the heart dilates the tubes, and pro- 
duces congestion. 
It may be supposed then that determination of the blood to the 
head arises simply from deficient contraction of the muscular coat Ot. 
the capillaries of the brain, preceded by excitement of the heart’s 
action. 
The throb of the carotid arteries cannot arise from action of the 
vessels j it is the action of the heartfelt strongly, and even distinctly, 
because the tube yields to the impulse of the left ventricle instead of 
resisting it, like a solid leaden pipe. If the throbbing arose from the 
action of the artery it could n-ot be synchronous with the heart, which 
it is. It is the same yielding of the coat of the capillaries in an in- 
flamed limb which gives rise to the throbbing sensation which all of us 
have felt in some small spot or another. 
Why do these capillaries of the brain thus suddenly and entirely 
neglect to perform their duty? There must be some “defective inner- 
vation from the sympathetic nerves, whose office is held to be the 
regulation of the coats of the arteries, so as to produce secretions, &c., 
and, so far, I can see,” says Solly, “ much probability in the opinion of 
the Wenzels, that the pituitary gland is in fault in epilepsy,—believing 
as I do with Dr. Copland, that this gland is the cerebral ganglion o_ 
this nervous system.” Copland says, {Diet. Pract. Medicine, Yol. I., 
p. 97), in apoplexy “ the frequency of change in the pineal and pi- 
tuitary glands of pultaceous pits—have led me to infer that functional 
lesion or organic change often commences in that portion of the gan- 
glionic system which supplies the encephalon and its blood-vessels ; and 
that owing to exhaustion of its influence, the capillaries lose their vital 
tone, have their circulatory functions impaired, become more or less 
dilated, and are disposed to rupture.” 
Dr. Burrows has shown that the quantity of blood in the brain may 
be increased or diminished as it may in any other organ. Dr. Bright 
says no organ of the body is liable to such violent or frequent changes 
in the state of the circulation as the brain; in other organs the in- 
creased excitement may be in some degree limited, but in the brain it 
seems to be unlimited, “ augmenting with every increase of luxury and 
civilization.” 
Congestion of the brain exists in every case of epilepsy, though it is 
not the cause of the paroxysm. ( Watson.) 
In all cases of fatal epilepsy examined after death, the vessels of the 
brain and membranes have been found enormously distended. 
Causes.—1. The presence of indigestible food in the stomach; 
2. morbid matters in the intestines; 3. uterine irritation. Of theso 604 
DISEASES OF THE NERVOUS FUNCTION. 
causes of epilepsy, the first acts through the medium of the pneumo 
gastric nerve. The second through the true spinal system. 
“Venereal disease often fixes on the dura mater, produces periosteal 
disease, and may be cured as the disease is cured elsewhere. (See 
Syphilis—p. 308 Vol. II.) Syphilitic inflammation of the fibrous tissue 
frequently produces deposits and thickening; and more than once,” 
says Solly, “ have I seen epileptic fits apparently result from the irrita- 
tion which this disease causes.” 
Organic affections of the brain, abnormal osseous deposits within 
the cranium, ill-formed cranium, diseases of the heart, fractures of the 
skull, violent mental disturbances, secondary syphilis, mercurial affec- 
tions, onanism, suppressed eruptions, habitual discharges, and excesses 
in the use of liquors; immoderate indulgence in sexual intercourse; 
and the sight of other epileptics may cause epilepsy. 
Epilepsy may be congenital, may arise during infancy from dentition 
and various other causes. It is frequently developed during the period 
of youth, especially about the age of puberty. It may even originate 
at a late period of life, in which case it is often caused by intempe- 
rance. 
2. Drunkenness.—A large proportion of the inmates of almshouses 
pauper establishments, lunatic establishments, and idiot schools have 
been brought hither by the influence of intoxicating liquors. This is 
so commonly known that it is unnecessary to present statistics. 
3. Masturbation.—This terrible vice is often associated with glut- 
tony. The patient often loses all control over his appetite, and ceases 
to have any control over his mind. On this subject Dr. J. M. Good* 
says: The sagacity of a debauched life confirmed by habit, can only 
be cured by a total change of habit, which is a discipline that the 
established debauchee has rarely the courage to attempt. Exercise, 
change of place and pursuits, cooling laxatives, and a less stimulant 
diet than he will be commonly found accustomed to, may assist him in 
the attempt; but in general the mind is as corrupt as the body, and 
the case is hopeless. He perseveres, however, at his peril; for with 
increasing weakness, he will at length sink into all the miserable train 
of symptoms characterizing that species of marasmus called tabes 
dorsalis.” 
Though this single vice has caused a large number of the patients 
m lunatic asylums and idiotic establishments, and is found among pa- 
tients of every age from infancy to old age (when they live to ad- 
vanced life,) there is no one cause of any disease which the patients 
themselves and their friends for them will so promptly deny, and so 
persistently persevere in their denials. “ These cases, so gloomy in 
* Study of Medicine and Nosology. EPILEPSY. 
605 
their results, though numerous among the poor and otherwise degraded, 
are by no means confined to that class. They are often found among 
the educated, the wealthy, even in professedly Christian families.” 
Prognosis.—Epilepsy which occurs in infancy and childhood, from 
fright or suppressed eruptions is curable. When the cause is sexual 
excitement a cure may sometimes be effected by marriage. On the 
other hand, those cases which proceed from organic affections within 
the cranium, from long-continued masturbation, and from disease of the 
heart, more especially if they occur after the age of twenty-five years, 
or if they have continued for several years, are generally incurable. As 
a general rule idojpathio epilepsy is more difficult of cure than the 
symptomatic. 
Sympathetic epilepsy is more easily cured than any other form of 
the disease ; but it is not always curable. 
Epilepsy seldom attacks those children that have eruptions on the 
head. It sometimes disappears for years and then returns without 
cause assignable. 
Those attacked shortly after birth, if they do not “ out-grow the dis- 
ease” on reaching puberty, remain incurable. 
Those that begin between the ages of three and four years are often 
cured if properly and early treated. 
Those who become epileptic a little before puberty recover when 
that change of life is reached; those that become epileptic after pu- 
berty are sometimes cured, though Hippocrates thought otherwise. 
Genital epilepsy is sometimes cured by marriage, though it is hurt- 
ful in other forms of the disease. Pregnant women who become epi- 
leptic are exposed to great danger. When the fits occur more and 
more frequently and become more violent, death may be generally 
feared. The patient dies during the prostration after, not (luring the 
fit. When epilepsy is complicated with mania it is incurable. 
Treatment.—Certain general peculiarities have been observed in 
epileptics : they are generally remarkable for large size and high tem- 
perature of the head. 
The symptoms are those of a sudden explosion of accumulated 
nervous energy. Prom the periodical recurrence of the fits in many 
cases, it is inferred that the accumulation of nervous energy (dynamis 
neurotica) goes on for a definite time in the brain and spinal cord, till 
at length an explosion ensues upon the muscles of voluntary motion, 
which are thrown into violent action, and by these means the accumula- 
tion is exhausted. This explosion is followed by languor, and fre- 
quently by coma, or prolonged sleep—indubitable signs of exhausted 
nervous energy. 
Two measures have been proposed for preventing the gradual accu- 
mulation and sudden explosion of the nervous energy, constituting fits of 606 
DISEASES OF THE NERVOUS FUNCTION. 
epilepsy. 1. By constant exercise of the voluntary muscles. By 
this means the occurrence of the epileptic fits may in some measure 
he diverted for a considerable time—the next best thing to cure. This 
treatment has proved itself the safest and the best, where it has been 
effectually tried. In proof of which we may adduce the examples of 
the greatest military commanders that have lived in the world. In al1 
it occurred in the latter period of life, when their most active labors 
had terminated. Caesar had epilepsy at Rome, never during his cam- 
paigns. 
In the case of the Duke of Wellington, the recurrence of the fits 
■was prevented by his temperance of living, by the activity and sim- 
plicity of his habits, the hardihood and severity of his amusements. 
Ilis example is proposed to all epileptics. 
Confinement in asylums, without active exercise, is highly inju- 
rious to epileptics, as a life of inactivity favors the recurrence of 
the fits. 
The cerebral disease found in some cases after death, is the effect, 
not the cause, of the disease. It is upon the principle of arousing the 
dormant nervous energy, and promoting its expenditure, that some of 
the remedies said to be successful in the cure of epilepsy have operated 
—that is, by making an impression upon the nervous system, through 
the medium of the mind, by which the patient is roused to activity and 
consequent expenditure of nervous energy. 
The normal state of respiration is a point of aetiology in this dis- 
ease requiring careful consideration. Many epileptics have a shallow, 
contracted, and feebly-acting chest, w'hich predisposes to, and must 
keep up, the epileptic tendency. In some patients, the respiration is 
not only deficient in amount, but in number also, being less than one 
respiration to four pulsations of the heart. This feeble lung-action 
causes injury to the patient, both by tending to retain carbonic-acid in 
the blood, (and many symptoms of these cases seem referrible to this,) 
and by preventing the lungs from acting freely as diverticula to the 
cerebral circulation. Among the functional cerebral derangements 
arc headache and lethargy, which free respiration in the open air will 
often relieve entirely. 
In other cases, respiration may become extremely difficult, as if from 
sudden deprivation of nervous influence; in such cases fresh air or 
inhalation of Ether or Ammonia, and deep-forced inspirations, if they 
can be effected, are often productive of great benefit. 
Treatment during the paroxysm.—When called to a person labor- 
ing under an epileptic attack, we should at once loose all of the clothing, 
in order that the blood may have free circulation to and from the head, 
as well as in other parts of the body. We should also place a cork 
or some soft substance between the teeth, to save the tongue and lips EPILEPSY. 
607 
from being -wounded by tbe convulsive movements of the jaws. The 
patient should be placed in bed, and restrained just sufficiently to pre- 
vent him doing himself personal injury, during the convulsions. When 
the paroxysm is preceded by an aura, the attack may sometimes be 
warded off by tying a ligature firmly just above the part where the 
aura commences. 
It is a general impression amongst homoeopathic practitioners, that 
anti-psorics alone are capable of effecting a permanent cure of epilepsy. 
This is true with regard to those cases which are connected with 
syphilis, mercurial affections, and impurities of the blood; but when the 
disease has been caused by injury to the cranium, by mental excite- 
ments, by masturbation, or by excesses in liquors or venery, it is 
apparent that a different course of treatment is requisite. 
The most important remedies in the treatment of epilepsy are: 
Belladonna, Sulphur, Mercurius, Stramonium, Aconite, China, 
Ignatia, Cojfea, Phosphorus, Arnica, Opium, Mux-vomica, Ilyos- 
cyamus, Agaricus, Ipecacuanha, Cicuta, Silicea, Argentum-nitr., 
Cocculus, Cuprum, Camphor. 
Belladonna.—Hartmann has found this remedy specific for the fol- 
lowing symptoms, viz.: “great irritability of the whole nervous system, 
so that the patient is startled at the merest trifle ; he becomes peevish 
and sensitive, and is affected by tremors and twitchings in the mus- 
cles ; restless sleep, which is disturbed by frightful dreams; hyper- 
sensibility of the eyes; sparks and flashes before the eyes; also 
diplopia and myopia; stammering speech, with congestion of blood to 
the head, and nervous distention; vertigo, with roaring in the ears; 
convulsions of particular muscular parts, subsultus, distortion of the 
face,” &c. Belladonna will be generally applicable in those cases 
which have been induced by fright, or other mental emotions. 
Sulphur and Mercurius are proper when there is reason to suspect 
a psoric or syphilitic taint as the cause of the malady. These reme- 
dies should be persevered in until all trace of the impure taint has 
been eradicated. 
Stramonium, Ignatia, Ilyoscyamus, or Coffea, may be adminis- 
tered during an attack. These remedies are appropriate in cases 
caused by chagrin, fright, or mortification. 
Camphor is indicated in epileptic attacks, caused by taking cold, or 
by vexation—particularly if congestion of the brain is threatened; 
when caused by fright, Artemisia, at the first or second dilution, has 
been found curative; when occurring in sensitive children, during the 
period of detention, Chamomilla, Coffea, and Ilyoscyamus are the 
specifics ; in the epilepsies of nervous and impressible subjects, with 
distortion of the limbs and face, blood-shot eyes, foaming at the mouth, 
livid face, and protracted loss of consciousness, Cicuta and Sir a- 608 
DISEASES OF THE NERVOUS FUNCTION. 
monium are our best remedies; epilepsy induced by unusual excite- 
ments, worms, exposure to a high degree of heat, and attended with 
sudden loss of consciousness, and of muscular power, screams, violent 
convulsive movements of the limbs, gnashing of the teeth, frothing at 
the mouth, livid face and forehead; blood-shot eyes, and irregular 
spasmodic twitches in various parts of the body may generally be 
cured by Hyoscyamus, Ignatia, and Cocculus • Nux-vomica is an 
invaluable remedy when the complaint proceeds from the abuse of 
stimulants, venereal excitement, sedentary habits, undue mental exer- 
tion, disordered stomach, or worms; in the epilepsies of drunkards 
Opium may often succeed Nux with advantage; frequently recur- 
ring epileptic fits have often been permanently cured by Dr. Dunsford 
with Argentum,-nitr., Belladonna, Agaricus, Moschus, and Silicea. 
When the fit arises during the course of an eruptive fever, in conse- 
quence of a retrocession of the eruption caused by cold, we may employ 
Ipecacuanha, Cuprum, and Belladonna. 
China and Phosphorus should be given in epilepsy which has 
followed protracted masturbation, or excessive venery. The latter 
may also be used in cases proceeding from osseous deposits within 
the cranium. 
Opium and JVux-vomica.—For the epilepsies of inebriates, these 
medicines are important, and will often effect permanent cures, after 
the previous habits of intemperance are corrected. 
When the cause consists of an injury to the head, Arnica is our 
chief remedy. This medicine should be used externally as well as in 
ternally. If the paroxysms have been caused by fright, grief, chagrin, 
or from some sympathetic emotion, we may often prevent an attack 
(homoeopathically) by exercising the patient with some more potent 
mental influence, which shall supersede the action of the original cause. 
It was upon this principle that Boerhaave cured a number of epileptics 
at the hospital for orphans at Harlem, who had been attacked in con- 
sequence of fright from seeing an epileptic brought into the hospital 
during a paroxysm. In these instances Boerhaave had a red hot poker 
ready, in order, as he assured these girls, that he might apply it to 
their heads as soon as there was any indication of an attack. The 
fright caused by this idea entirely overwhelmed the other cause, and 
an immediate cure was generally the result. 
Administration.—We commonly advise the lower attenuations, and 
administer the remedy once or twice daily, until a cure is effected. 
Chronic Epilepsy.—Calcarea has a beneficial action on the nervous 
system, and is administered with advantage in chronic cases of epi- 
lepsy, and in some cerebral affections, in alternation with or after Bel- 
ladonna, Silicea and Cuprum. Calcarea resembles Silicea, and in a 
less degree Sulphur, in its beneficial action in muscular weakness, and EPILEPSY. 
609 
in rickets; also in nervous debility, such as is attendant on spinal ir- 
ritation. [Dr. Black.) 
Cuprum.—Case by Dr. Kissel. A young man aged twenty-one, 
choleric temperament and strong constitution, had, since his fifteenth 
year, suffered from epileptic spasms, which returned at intervals of four 
or five weeks. In Nov., 1823, a fit came on with severe haemorrhage 
from the lungs. Bleeding and antiphlogistic treatment was resorted 
to, but this resulted in a fit within three weeks which surpassed all 
former ones in severity. No cause of the illness wTas discovered, and 
the parents ascribed it to the patient’s passionate disposition. Pre- 
scribed Cuprum-sulphurico-ammoniatum one-half grain twice a day. 
The next fit, which came at the end of five weeks, was milder. Those 
which succeeded came at longer intervals; and after the fifth they 
came no more. Two years later he was heard from as having no sub- 
sequent return. He had taken only sixteen grains of the remedy. 
Case by Urban. A woman aged thirty-six, had from childhood en- 
joyed almost constant good health up to Feb., 1825, w7hen she was 
shocked by the sudden announcement of her husband’s death, and was 
immediately attacked by epileptic convulsions. During the first days, 
the fits recurred almost every hour. Afterwards they came on five or 
six times a day. After the removal of gastric symptoms they remained 
unaltered. Cuprum-sulphurico-ammoniatum was given, half a grain 
twice a day. This dose vras too large and produced vomiting, and the 
attacks grew more violent, after six powders had been taken. They 
were omitted for one day, and then resumed. It was soon seen that 
though the intervals between the fits continued the same, their severity 
was diminished, and their duration shorter. Nausea and vomiting re- 
turned, but only in a slight degree. The medicine was continued, and 
it was evident that the intensity of the disease was abated. The dose 
was increased to a grain of the salt of copper twice a day. By the 
time the patient had finished twTenty-six grains, the disease had disap- 
peared without leaving a trace behind, and did not show itself again. 
Cuprum-metallicum.—Violent convulsions from dentition; whole 
head bloated; face red and swelled ; the child utters crowing screams J 
the attack is preceded by loathing of food; nausea, lethargic state; a 
quantity of phlegm is forced up ; when consciousness returns, the child 
writhes, screams, the abdomen is distended; the involuntary discharge 
of thin stool; occasional convulsive movements and distortion of the 
limbs; these symptoms are followed by new paroxysms during Avhich 
the child is without consciousness. 
Hahnemann says, convulsions are caused by the administration of 
copper. And Tondi, Ramsay, Fabas, Pyl and Cosmier, saw convul- 
sions from the use of aliments impregnated with copper. J. Lazerne 
saw reiterated attacks of epilepsy from the accidental introduction 
VOL. 11 _3J. 610 
DISEASES OF THE NERVOUS FUNCTION. 
of a copper coin into the stomach; and Pfiindel saw similar attacks 
produced by the ingestion of a compound of sal-ammoniac and copper. 
These cases sufficiently show how copper has been able to cure chorea 
as reported by Willan, Walcker, Theussink, and Delarive; and why 
preparations of copper have so frequently cured epilepsy, as attested 
by Batty, Baumes, Bierling, Boerhaave, Causland, Cullan, Duncan, 
Feuerstein, Hevetias and many others.—(Hahnemann. Organon. In- 
troduc.) 
Agarious.—Dr. Leopold says: “ The cases suitable to it are very 
common during dentition; after the febrile excitement, sometimes of 
only short duration, coma supervenes ; the eyes are half open, showing 
the white ; breathing not very hurried, but often a deep inspiration 
followed by a sigh, and slight convulsive twitchings of the extremities; 
he formerly saw these cases fatal from severe convulsions; he now 
gives five or eight drops of the tincture in half ounce vial with water, 
every hour or two a tea-spoonful. He recently took two cases from 
allopaths, and restored them so quickly to health that the parents 
were very much astonished. When the hands, feet and head, are still 
hot, give Bell, in alternation with Agaricus. 
In the case of a boy, aged fourteen, with rheumatism, there was me- 
tastasis to the heart; and, in the third week, cramps in the hands and 
feet. After two or three attacks through the whole body, as if the 
poles of a galvanic battery were touching his spine, he would present 
his foot or hand from under the bed clothes, drawn and pointing in a 
shocking manner; right side oftener affected than the left; Colch. 
Yeratr. Nux-v. failed, also Secale-cor. Capsic. On the fourth day 
scarcely three to five minutes free from the cramps on both hands, or 
both feet, or in the face. He could sleep for five hours during the 
night, (never in the day,) without moving; but as soon as he opened 
his eyes, the cramps came afresh. 
Agaricus in two drop doses, at short and then in longer intervals, 
immediately wrought a change for the better. The cramps came only 
four times in the second day, and ceased entirely on the third. A re- 
lapse, after some weeks from wet feet, was speedily cured by the same 
remedy. 
Dr. Leopold says: “ A boy was epileptic for nine years; latterly 
the fits came on every day in the afternoon, though they were lighter 
than before. Agaricus was given morning and evening for one week. 
In four weeks he was quite well. He then had one relapse, for which 
he took it again. 
Stramonium in a large dose dilates the pupils very much, causes 
vertigo, delirium tremens, retching, excessive thirst, mania and convul- 
sions. The mania is most singular. It is characterized by antic ges- 
tures, screaming, laughing, crying, continual distortion of the face; EPILEPSY. 
611 
before death there is deep coma. It was introduced into practice by 
Baron Stoerck, in 1762. Dr. W. P. Barton, of Philadelphia, gave tc 
a maniac two grains of the powdered root at a dose, and continued in 
increasing quantities till “ the patient broke out all over his legs and 
various parts of his body in boils, and he was discharged cured. Dr. 
Eberle says he gave this remedy in a case of hysterical mania which 
he had treated without benefit for three weeks. On the third day the 
manical symptoms subsided, and in a few days was entirely cured. 
Cases of Poisoning by Stramonium.—A boy, aged four years, in 
previous good health, took some seeds of Stramonium, and was found 
in a most wild, frantic and convulsed condition; the pulse was rapid, 
the skin hot, the face flushed, the pupils much dilated; there was wild 
delirium, and every muscle was convulsed. It has often been given 
in epilepsy in young persons, returning at regular periods, the dose to 
be regulated by the dilatation of the pupil. In full doses it lessens 
sensibility and pain, occasions a nervous shock, attended momentarily 
with affection of the head and eyes ; some nausea and symptoms of 
intoxication ; nervous sensations referred to the oesophagus, bronchia, 
or fauces; relaxing rather than astringent effect on the bowels; little 
effect on the pulse ; dilatation of the pupil; induces sleep, chiefly by 
the tranquilizing effect on the pain. A robust man in severe suffering 
from inflammatory rheumatism, took several grain doses of the watery 
extract. Some delirium followed, pulse continued at 120 per minute ; 
no sleep except for a few moments ; pupils dilated; mouth, previously 
ptyalized, becomes very dry, stops running. He sits up all the time, 
talks incessantly, and says : “ that remedy ought to be given to nobody 
but mad-dogs.” Tetanus, with complete rigidity of the whole body, or 
of the extremities, alternating with convulsive shocks ; the patient lies 
in a deep sleep, with stertorous breathing; a quantity of urine is 
emitted. These symptoms are generally accompanied with great heat 
over the whole body; thirst; the tongue dry; the features distorted, 
as if from pain; the face is red, as if bloated; the tongue seems 
paralyzed ; deglutition difficult; eclampsia, with hyperaemia. 
Hyoscyamus.—Eclampsia from sudden fright. There is hyperaemic 
condition of the brain; congestion of the brain, characterized by un- 
usual redness and bloatedness of the face ; the child makes much noise 
in drawing the breath through the viscid fluids accumulating in the 
mouth. The abdominal muscles are spasmodically contracted; con- 
vulsive movements of the body, affecting one part and then another 
wakefulness ; involuntary emission of urine. 
Arsenicum.—Burning heat of the whole body; child constantly 
licking its dry and parched lips; the twitching of a single limb during 
sleep is a characteristic indication for Arsenic, and frequently precedes 
the convulsions. A dose of Arsenic frequently prevents the convul- 612 
DISEASES OF THE NERVOUS FUNCTION. 
sions and terminates the disease as if by magic. The child is very 
hurried in its movements; expresses anguish in his countenance. 
Periodical Epilepsy.—Cedron.—A boy, aged twelve years, had 
attacks announced by “ headache, numbness of the arms and legs; 
then flashes of light before the eyes, palpitation of the heart, loss of 
consciousness ; the patient fell, and was then affected with convulsions 
of the whole body, lasting from eight to ten minutes. The attack was 
regularly repeated every day from five to six, p. m. For this Cedron 
12° was given immediately after the paroxysm, and again at noon, on 
the day preceding the expected attack, for six alternate days.” After 
this he was perfectly well and continued so. 
Epilepsy from Deranged Menstruation. — Cedron.—In a young 
lady, aged seventeen, symptoms were manifested precisely the same d ly 
that the catemenia commenced; vertigo, tinnites aurium, and irregu- 
larity in the action of the heart; then the aura epileptica followed, 
with loss of consciousness, and falling. The patient uttered an occa- 
sional distressing cry, alternated with risus sardonicus, and slightly 
foaming at the mouth, during the attack. Cedron 30°, four globules 
each dose, dry on the tongue, given before the usual periodic discharge, 
and again after the paroxysms during two successive months cured the 
disease. 
CEnanthe-crocata, Ilemlock-water-drop-wort.—This plant when taken 
in quantity, produces epileptic convulsions. Mr. Solly says, he was 
present at a post-mortem examination of four convicts who died at 
Woolwich from eating it. “ The progressive amount of sanguinous 
effusion on the brain was in proportion to the length of time survived. 
The seizure was most striking and instructive. 
“ In all there Avas great congestion and some sanguineous effusion on 
the surface of the brain; in those that lived longest the quantity was 
in proportion as they survived the seizure. The first man died in 
about an hour, the last in about two hours. [Solly, on the Brain, p. 
437.) 
Zi.ncum.-~ Slighter paroxysms, characterized by screams, uncon- 
scious shrieking during sleep; waking up in a fright; looks about 
with great anxiety, as if frightened in a dream; skin hot in the even- 
ing ; twitching in the day-time; more on the right side than on the 
left; for several days preceding the paroxysm the child has been 
peevish, whining, eating with ravenous appetite; abdomen distended 
as from flatulence; involuntary discharge of urine. 
Stannum.—Convulsions come on whenever the child cuts a new 
tooth, increasing in violence each time; spasms more or less general; 
the child looks feeble and miserable. 
Phosphate of Zinc.—Zinc, says Dr. Barnes, of London, is known 
to be efficacious in epilepsy, and Phosphorus is known to be deficient EPILEPSY. 
613 
in all exhausting nervous diseases, in which there is a wasting of Phos- 
phorus in the brain-matter. All the nutritious cereal grains contain 
it. Phosphate of Zinc has been found useful in the convalescing stage 
of fevers which induce the greatest wasting of tissue, and of brain 
matter to such extent as to cause insanity. 
An epileptic woman took, in conjunction with other things wdiich 
should have been left out, Phospha-te of Zinc. In a fortnight the spasms 
were lessened; and in three months she was free from them. It wras 
also successful in insanity from exhaustion of lactation. It restored 
physical and mental health in three months. (Lancet, Jan. 1858, p. 119.) 
Sulphate of Zinc.—1. This cured epilepsy caused by intoxicating 
liquors and accompanied with diarrhoea for six months. 
2. It cured a case in a man in whom epilepsy came on with frequent 
fainting fits, such as in either sex are premonitory of epilepsy. The 
intellect was weakened, and he was becoming idiotic. He was cured 
physically and mentally by this remedy, and has since served in the 
army of India. 
Digitalis has cured some cases after other remedies had failed. It 
is adapted to young and excitable subjects. It was suggested by Hr. 
James Johnson ; also by Hr. Corrigan {Med. Gaz., Yol. XXXYI. p. 
1473.) It was long a quack remedy in Ireland; and “in over-doses 
its effects were terrific.” It is proposed to saturate the nervous sys- 
tem, not inducing the alarming effects; but to persist in its use till 
sickness of the stomach and dilated pupils give warning that the 
maximum dose has been reached. It is a dangerous remedy, and is 
only safe when it soothes the nerves and passes off through the kid- 
neys. When it does thus pass off it is liable to accumulate; when 
used, the pulse must be watched, counting it by the watch every 
quarter of a minute. 
Oxide of Silver.—This remedy has succeeded in some cases; in 
full doses, long-continued, it has tinged the skin below the eyes, and 
formed a dark line on the edge of the gums. 
Oleum-terebinthinoe.—Watson {Lectures, p. 427,) refers to cases of 
epilepsy caused by tape-worm, cured by expelling the tape-worm with 
turpentine. An Englishman who took it, recovered from epilepsy; after 
taking turpentine he was intoxicated. It destroyed a tape-worm, and 
he was cured. Lord Hardewick, of England, had epilepsy from tape- 
worm, and was cured in the same manner. The cases illustrate the 
eccentric form of epilepsy; and show that irritation of the stomach 
or intestines may be sufficient to cause a fit. 
Camphor.—This remedy will sometimes arrest or palliate epilepsy 
by merely smelling it when the approach of a paroxysm is perceived. 
Remedies most Serviceable in Recent Cases.—Ignatia, Bell., Cham., 
"Nux-v., Opium, Ipecac., Camphor, Hyoscyamus. 614 
DISEASES OF THE NERVOUS FUNCTION. 
In Chronic Cases of Long Standing.—Sulphur, Calcarea-carbon., 
Silicea, Causticum, Bell., Cuprum-metallicum, Hyos., Stram., Veratr., 
Lachesis. 
When the disease has arisen on repercussion of an old eruption or 
chronic discharge, Sulph., Caust., Calc.-carb., Stram., Laches. 
GENUS VIII.—ASPHYXIA.—APNCEA. 
This name was used by Hippocrates, and refers primarily to suspen- 
sion of the heart’s action (from a, without dcpvgia, to beat or leap.) 
But it is applied to a state of suspended animation, produced by arrest 
of the actions of respiration, which is soon followed by the cessa- 
tion of the motions of the heart and other vital functions. 
General Remarks.—Asphyxia, when it arises from causes which 
operate slowly, begins with difficulty of elevating the thorax; anxiety ; 
quick and short efforts to fill the lungs with air; gaping and stretch- 
ing ; vertigo; loss of consciousness and sensation; sometimes convul- 
sive movements of the limbs and trunk; immobility of the muscles of 
the thorax, and abdominal muscles; weak and languid pulsation of 
the heart, absence of pulse at the wrist; face livid, tumid, injected, 
its veins distended; reddish violet hue of the hands, feet, and face; 
similar patches on other parts. On the final cessation of the circula- 
tion, asphyxia is complete, but animal heat and the absence of rigidity 
of the muscles remain longer than after death from other causes. 
These symptoms succeed each other with more or less rapidity accord- 
ing to the causes by which they are produced, and the more or less 
perfect exclusion of the air from the lungs. The duration of life is 
proportioned to the rapidity with which these causes operate; “ as the 
more slowly the state of asphyxia supervenes the longer the person 
retains the ability of being reanimated.” 
Causes of Asphyxia.—Whatever cause may prevent the renewal 
of air in the lungs of a healthy person. Deficient expansion of the 
lungs from mechanical obstructions, external pressure on the chest; 
from injury of the pneumogastric nerve; from injury of the medulla 
oblongata, fracture, or dislocation of the spine in the cervical portion; 
paralysis of the nerves of respiration, or deficient irritability of the 
inspiratory muscles as from the benumbing influence of cold; and the 
suspended animation of new-born infants. 
The air may be prevented from entering the lungs by mechanical 
causes; as strangulation ; submersion; foreign bodies In the air-pas- 
sages. The air itself may be vitiated by the presence of deleterious 
gases; several causes of asphyxia are often in operation at the same 
time. 
Pathology.—The body after death exhibits a violet or reddish hue ASPHYXIA. 
615 
•)f the countenance, and of other parts of the surface; warmth and 
flexibility retained long after death; the blood of the skin or vascular 
tissue exhibits unusual fluidity; eyes bright and prominent; mouth 
generally natural, sometimes distorted; veins and sinuses of the brain 
generally filled with dark fluid, or semi-fluid, blood; brain otherwise 
natural; base of the tongue injected, tumefied, and papilla developed; 
mucous membrane of all the air-passages injected and red, becoming 
darker as we descend into the lungs; lungs distended; brown or 
blackish in color; parenchyma when cut and pressed gives out large 
drops of black blood ; liver, spleen, and kidneys engorged with blood; 
veins of the heart, its right cavities, venae cavae, and other large veins 
engorged with black blood. (Copland Diet. Pract. Med. I., 170.) 
1. Asphyxia from Submersion.—The first effects felt by a drowning 
person are an urgent feeling of anxiety in the chest; the pulse becomes 
weak and frequent; he struggles, rises toward the surface, the pulse 
becomes weaker, he again rises and perhaps throws out air from the 
lungs; in his efforts to inspire air is drawn in, and it excites cough and 
spasm of the glottis; as the respiration becomes less perfect the blood 
partakes more and more of the venous properties; it becomes narcotic 
and poisonous, as well as increased in bulk, thus pressing on the brain 
it occasions insensibility, loss of voluntary motion; the surface of the 
body assumes a livid color, the pulse ceases to beat, the sphincters are 
relaxed, and the body sinks to the bottom. 
Appearances on Dissection.—Dilated pupils ; clenched jaws ; semi- 
contracted fingers and thumbs; paleness of the face at first, followed 
by livid appearance of the skin; striking calmness and placidity of 
features; the point of the tongue is usually found in contaot with the 
incisor teeth ; in some cases froth is found about the mouth, sometimes 
within it, and, more rarely in the trachea; a peculiar liquidity of the 
blood is frequent, water is found in the stomach in nearly all cases of 
persons drowned, but not in those thrown into the water after death. 
(Augustine, Edin. Med. & Surg. Jour., 1837.) 
Orfila says the lungs become of indigo color, and brownish after 
exposure to air; the right cavities of the heart, the pulmonary veins 
and arteries and veins are filled with black blood, and retaining less 
contractile power than those of the left side; the color of the viscera 
is the same as after death from asphyxia otherwise produced. (Report 
to Royal Acad., Paris) 
Prognosis.—The period after which reanimation may be procured 
varies from five minutes to three quarters of an hour. (Copland) In 
one case, mentioned by Dr. Lee, resuscitation was effected after sub- 
mersion for forty-five minutes. In ordinary ca.ses restoration cannot 
be hoped for after submersion of over ten or fifteen minutes. 
2. From the poisonous effects of the vapors of burning charcoal\ 616 
DISEASES OF THE NERVOUS FUNCTION. 
In cases of suffocation from breathing the vapors of burning char- 
coal, death generally results from the poisonous action of carbonic- 
acid-gas, though in some instances some unknown noxious vapor is 
developed in the process of combustion. 
First Degree of Asphyxia.— Symptoms.—The symptoms pro- 
duced by carbonic-acid-gas are well marked, but not entirely character- 
istic, as they in some points resemble the effects of apoplexy. The 
person exposed experiences an intense throbbing headache, with 
weight and heat, especially about the occiput; strong pulsations, and 
sense of tightness across the temples; vertigo; increased action of 
the heart; and, often violent palpitations ; confusion of ideas; partial 
failure of memory; nausea; hysteric sobbing. 
Treatment.—Remove instantly from the vitiated atmosphere: place 
in a current of cool air in a recumbent position; apply bottles of hot 
water to the feet, if cold ; cold water to the head. The symptoms pass 
oft' in a few hours. 
Second Degree of Asphyxia from Poisonous Vapors.—Expo- 
sure to the vapors of burning charcoal when continued for a longer 
period produces: Buzzing noise in the ears; partial or total loss of 
vision; an undefined feeling of dread or horror, followed by an irre- 
sistible disposition to sleep, or fainting. In a short time all power of 
volition is lost. The pulse and heart, which recently beat rapidly, 
(sometimes from 100 to 200 per minute,) fall to 40 or 50; the breath- 
ing becoming more slow and laborious; surface cold and livid; lips 
blue or violet, the eyes still retaining their lustre. As the symptoms 
increase in violence there are tetanic convulsions, and raging delirium; 
white or bloody foam from the mouth and nose, followed by vomiting 
and death. In some cases the tongue is clenched firmly between the 
teeth, producing suffocation. 
Pathology.—After death, “the countenance,” says Dr. Golding 
Bird, retains the expression of placid calmness, resembling sleep, 
“ the body sprinkled with livid, bluish, or reddish-brown spots ; limbs 
flexed, or rigid fingers,often irregularly bent or stiff; arms extended or 
thrown across the chest,” after tetanic spasms; animal heat generally 
greater than after death from other causes ; in some cases the putre- 
faction is also said to be more rapid; the tongue clenched between 
the teeth, (except after vomiting,) mouth covered with white or bloody 
foam; face livid and bloated, or pale; eyes lustrous, sometimes 
injected; pupils generally dilated; the whole appearance that of calm 
repose without any distortion ; interior of the nostrils lined with a 
black, smoky deposit ; the abdomen generally distended with air. 
{Louisville Medical Journal, Sept. 1840, p. 217.) 
3. Asphyxia from Strangulation.—The first effect of the tightening 
of the cord around the neck is the suspension of respiration and ASPHYXIA. 
617 
the engorgment of the brain with blood, on the occurrence of which 
sensibility begins to decrease; epileptic convulsions, more or less 
marked ; “ turgidity, suffusion and lividity of the face, shoulders, chest, 
arms, and hands; the eyes are open, the features distorted, tongue 
thrust out of the mouth; external muscles of respiration firmly con- 
tracted, hands clenched, sphincters relaxed. When the air is not 
perfectly excluded the sufferings are prolonged ; engorgement of the 
head and face greater, brain more congested, lungs less so.” In nearly 
all cases of death by strangulation, life is suspended by the cessation 
of the action of respiration, though the engorgement of the brain 
shortens the process and lessens the suffering, which, however is very 
great for a short time; dislocation of the cervical vertebra is common 
in public executions, though rare in suicides. The action of the heart 
becomes more rapid as the death-struggle progresses, and remains a 
few minutes after the breathing ceases. In one case it rose from 
under 100 per minute to 120 three minutes after respiration was sus- 
pended, then to 155, and five minutes afterward was imperceptible. 
The air in the lungs extracted from the trachea was without oxygen, 
though the breath before the execution contained 17.84 parts oxygen 
in 100. Carbonic-acid gas increased from 2.G09 before, to 7.7 after 
execution; and nitrogen increased from 79.551, to 92.3. 
On the of the extinction of life in Asphyxia.—Dr. Paton of 
Canada, concludes from a series of well-conducted experiments: “Thai 
the time required to produce asphyxia in an animal varies according 
to its physiological condition, and the rapidity with which the function 
of respiration is effected, and that the power which a cold-blooded ani- 
mal possesses of resisting the deprivation of oxygen depends on the 
state of its system at the moment. For during the warmest period of 
the season, when the functions of the body are carried on with the 
greatest energy, if respiration be simultaneously arrested in the skin 
and the lungs of a cold-blooded animal, it will die almost as soon as a 
warm blooded one ; so powerful is the effect, that it seems to act al- 
most like concussion of the brain. Insensibility is produced, and at 
the same time, the action of the heart is depressed. 
“ What is the immediate cause of the insensibility that is thus pro- 
duced ? It does not arise from the deficient supply of blood to the 
heart and the brain, for the heart continues to beat, and dark venous 
blood to circulate through the arterial system long after the animal 
has become insensible; and if the non-aerated blood had been finally 
arrested in the capillaries of the lungs or the skin,—the seat of the 
respiratory process in cold-blooded animals—or so arrested that it 
could not be sent forward to the heart in sufficient quantity to maintain 
the circulation, these phenomena could not have been witnessed. But 
we have seen from experiment YI. that at the time asphyxia was in- 618 
DISEASES OF THE NEKVOUS FUNCTION. 
duced, the heart continued to heat at forty pulsations per minute, and, 
in another experiment the dark venous blood passed along the arch of 
the aorta when the pulsations of the heart were only thirty per minute, 
the animal remaining in a state of deep insensibility. Whereas, if an 
animal die from another cause—when the function of respiration is 
not affected, the pulsations of the heart may be reduced to ten or twelve 
per minute, and yet wTe have distinct evidence of sensation on irritation 
applied to the integuments. From these facts it appears, that it is not 
from the deficient action of the heart or diminished supply of blood to 
the brain, that insensibility, the first stage of asphyxia is produced.” 
In other experiments it was seen, that “in resuscitating an animal 
from asphyxia, the action of the heart may increase, and the circula- 
tion of dark venous blood be maintained with considerable vigor, but 
insensibility is not recovered from till there is a greater influx of ar- 
terial blood to the brain. In experiment 1, the pulsations of the heart 
rose as high as forty-two per minute, and remained at that rate for a 
considerable time: but it was only after the respirations became more 
frequent and a greater amount of oxygen was consumed, rendering the 
blood more highly arterialized, that the first signs of returning sensi- 
bility were witnessed—a fact which seems to prove that in asphyxia 
insensibility is produced by the action of dark venous blood on the 
brain.” 
“What is the immediate cause of death in asphyxia, or on what does 
the failure of the circulation depend ?” 
The experiments show that “ shortly before the action of the ven- 
tricle ceases, the blood begins to accumulate in the large veins around 
the heart: and after the circulation has been finally arrested, both the 
auricles, the venae cavae and pulmonary veins remain gorged with dark 
venous blood, whilst the aorta is comparatively empty, indicating that 
there a stop had been put to the general circulation. For if the blood 
passing through the lungs had been ultimately arrested in their capil- 
laries on not meeting with oxygen, we should expect to find at the 
moment of death the pulmonary veins and the left auricle nearly des- 
titute of blood, but the reverse is the case. And, on the same prin- 
ciple, if the circulation of the cutaneous capillaries had been equally 
impeded, neither the right auricle nor the venae cavae would have been 
distended with blood. Whatever then may be the effect which the 
non-supply of oxygen exerts on the function of respiration, dark blood 
still appears to circulate till it is ultimately arrested at the heart; and 
the whole of the phenomena presented to our view seem to indicate 
that the failure of the circulation depends on the ventricle ceasing to 
perform its functions, and transmit the blood forwards.” 
But “what is the cause of the cessation of the movement of the 
ventricle? When unaerated blood circulates through the body, the ASPHYXIA. 
619 
action of the heart rapidly falls in strength and frequency till the 
movements are arrested.” We know that venous blood has less in- 
fluence than arterial blood in stimulating the heart to contraction 
hut the venous blood “ exerts a positively noxious influence upon the 
heart, and impairs its irritability; and this influence must be greater 
when the blood is more deteriorated in quality.” Dr. Cartwright 
states that.“ the heart of an alligator loses its power of contractility 
much sooner under the influence of impure venous blood than when it 
is altogether deprived of blood as a stimulus.” “ The heart always 
lives longer than sensational phenomena continue. It will throb with 
force for hours on the slightest touch after it has been cut out of the 
body. If left in the body it will continue to pulsate for several hours 
at the rate of some three or four beats in the minute, instead of twenty- 
five or thirty; but its action ceases in about an hour, if the animal has 
been killed by suffocation.” These facts prove that the circulation 
of dark venous blood exerts a most depressing influence on the action 
of the heart, and gradually arrests its movements. 
The phenomena of asphyxia do not then depend on accumulation of 
carbonic-acid in the lungs; as it has been proved by experiment, that 
if a frog be compelled to breathe in hydrogen or in nitrogen, carbonic- 
acid is exhaled in no less degree than during respiration in atmospheric 
air, and yet the animal equally falls into asphyxia, rendering it certain 
that it is not the retention of carbonic-acid in the blood, but the want 
of oxygen from the blood, as a stimulus to the different parts of the 
body on which asphyxia depends.” 
Treatment of Asphyxia.—Resuscitation of Drowned Persons.— 
In 1794, Dr. Fothergill, in his “New Inquiry into the suspension of 
Vital Action in cases of Drowning, &c.,” originated the doctrine which 
led physicians to seek for some mode of imitating the respiratory 
movements in cases of suspended animation from drowning. He 
taught, indeed, that “ the first grand indication should be to renew the 
action of the lungs ; but practitioners found it more easy to tell what 
was wanted than to put in operation any practicable mode of reaching 
it. Mr. R. Hamilton in his “ Rules for Recovering Persons recently 
Drowned,” says: “ On taking up the body, we are not to wait for an in- 
crease of heat before we begin our operations. We are to commence 
them by expanding the lungs immediately. This is not only the first, 
but most important part of the process.” He also recommended the 
very cautious and moderate application of heat, viz.: 60° or 70° 
Fahr., but said, “it cannot supply the principle of life; this must be 
sought for from the. common atmosphere.” The desired vital principle 
was not so easily obtained “ from the common atmosphere.” The ap- 
paratus that seemed best to answer the purpose was not always at hand; 
and when it could be tried, the good effects of artificial respiration were 620 
DISEASES OF THE NERVOUS FUNCTION. 
defeated by the falling backwards of the tongue and closure of the glottis. 
It was therefore directed that the tongue should be drawn forwards, and 
the trachea pressed backwards ; and by such measures the process was 
sometimes successfully performed. 
But the difficulties to be encountered so often led to failure that 
artificial respiration ceased to be much valued. The Royal Humane 
Society let it drop from the programme of measures directed to be tried; 
though some physicians tried to do what they could by pressing upon 
the chest to induce expiration, and waiting for the natural elasticity of 
the chest walls to cause inspiration. Generally, however, the tongue 
closed the glottis, and inspiration failed from its being opposed by two 
insurmountable obstacles. In this state of the question, Dr. Marshall 
Hall took it up. He saw before trying it, that if the patient, instead 
of lying on his back, should be turned on his face, the tongue, instead 
of falling backwards would fall forwards ; he found that semi-rotation 
would effect the pressure and relaxation required; and thus, that, 
without apparatus of any kind, artificial respiration could be performed 
at once and effectually, and continued for any length of time without 
the least danger to the patient. 
The suspension of respiration being the cause of death, the effect 
of this suspension is measured by the quantity of oxygen received 
from the atmosphere, and the quantity of carbonic-acid retained in the 
blood. The quantity of carbonic-acid evolved is augmented with aug- 
mented rapidity of circulation; but if retained in the blood it poisons 
in proportion to the rapidity of circulation. Respiration is the exhala- 
tion of carbonic-acid, and inhalation of oxygen. Drowning or strangula- 
tion stops both, but exhalation is of much greater immediate value to life. 
“ A mouse,” says Dr. Hall, “ will live in an atmosphere of nitrogen 
and oxygen in which there is so little oxygen that a lighted taper is 
immediately extinguished, flame and spark; and die in an atmosphere 
of carbonic-acid and oxygen in which there is so much oxygen, that a 
taper blown out, leaving a spark, is immediately re-inflamed. It is not 
the want of oxygen, but the excess of carbonic-acid which proves fatal.”* 
There are howrever facts which appear to support the vievT that the in- 
halation of oxygen is the more important in the respiratory process. 
{Brit, and For. Med. Chir. Rev., April, 1858, p. 223.) 
The phenomena of “ blood-poisoning” from suspended respiration in 
an animal submerged in water are : “ 1. Voluntary efforts to escape ; 
2d. stillness or anaesthesia; 3d. gasping; 4th. lingering circulation, 
but apparent death.” If the animal be placed in a limited quantity of 
air, there are; 1st. nocturnal breathing, unless excited emotionally ; 
2d. “ panting;” and 3d. gasping. The anaesthesia depends on poison- 
* “ Prone postural respiration in drowning, and other forms of apnoea, or sus- 
pended respiration.” By Marshall Hall, M.D , F.lt.S., &c. London, 1857, pp 216. ASPHYXIA. 
621 
ing of the brain; the “panting” on respiration of carbonic-acid; 
K gasping” upon poisoning of the spinal centre—the latter being also 
indicated by open mouth, starts, tottering gait, and paralytic weakness 
of the posterior extremities. These phenomena proceed with rapidity, 
inversely proportionate to age, temperature, degree of activity, and ele- 
vation in the zoological scale.” 
The length of time during which respiration may be suspended, and 
the animal be susceptible of resuscitation varies greatly in different 
animals. “A lethargic bat, submerged in water at 40° Fahr., was 
uninjured after sixteen minutes; a hedgehog, submerged for twenty 
minutes, recovered under similar circumstances. But these animals 
die as speedily as other warm-blooded animals if submerged in a state 
of activity. 
The object of treatment in apnoea is, first to eliminate the carbonic 
acid already in the blood, and, secondly, to check its further accumu- 
lation. For this purpose artificial respiration is the most important 
agent. Dr. Hall says : 
“When the subject is kept in the supine position, events occur 
which render every attempt at inducing respiration absolutely nuga- 
tory ; the tongue may fall backwards, carrying with it the epiglottis* 
and close the glottis or entrance into the windpipe and air-passages 
Fluids already in the mouth or fauces, or regurgitated from the sto- 
mach, may not only obstruct the air-passages, but be forced or drawn 
back into the windpipe, and so add a new source of apnoea. “ These 
obstacles are obviated at once by reversing the position from the su- 
pine to the prone.” (p. 23.) 
It was shown by the experiments of Mr. George Webster, that when 
the body is placed in a prone position, inspiration and expiration can 
be readily produced, and continued at pleasure, by the mere exercise 
and relaxation of pressure ; and such alternations being easily accom- 
plished by rotating the body from the prone to the lateral posture. 
“ Mr. Fox, Mr. Hunter, and Mr. Bowles, of St. George’s Hospital, per- 
formed further experiments, and measuring the quantity of air respired, 
found it sufficient.” 
Upon the ideas developed by such researches as these, Dr. Hall con- 
structed his system of resuscitation of drowned persons. His rules of 
operating, which have now been often published, were first presented 
in an essay sent to the Boyal Humane Society, in January, 1856. The 
Society issued a circular to some of its members, requesting each to 
give his opinion of the new mode of treatment. From these gentlemen 
ten different answers were received, one of which was from Sir Benja- 
min Brodie ; but they ventured to give no further advice than that the 
Society should not venture to try the method recommended, until some 
body else would try it first and find it successful. 622 
DISEASES OF THE NEKVOUS FUNCTION. 
That Society, like most other large bodies, “ moved slowly ” in the 
path of improvement. In a year and-a-half more, Marshall Hall was 
dead, and he left the Royal Humane Society waiting still for somebody 
to test the value and safety of “ the Marshall Method ” of treating 
asphyxia. It had already been often tried with success. 
The length of time that a patient may remain entirely submersed in 
water, and afterwards be restored by any known means of resuscitation 
has not been determined by medical experience. 
Cases, says Marshall Hall, are recorded of the human subject being 
restored after many minutes of submersion. It might well be doubted 
whether the facts so recorded were correctly observed. 
Perhaps one of the longest well- authenticated submersions, after 
which restoration was effected, was that reported in the London Medi- 
cal Gazette, for December 23d, 1842. In that case the time of sub- 
mersion was fourteen minutes j and the efforts to restore respiration 
were continued for eight hours before the process of breathing was 
fully re-established. In ordinary cases, where the supposed time of 
submersion was much longer, the w’ant of accurate observation leaves 
the actual time a question that cannot he decided ; the witnesses, if 
any are present, are too much excited to note the minutes as they pass, 
which, under such circumstances, seem to pass slowly. One of the latest 
recorded cases is that reported by Dr. Alfred C. Garratt, in the Bos- 
ton Medical and Surgical Journal, Sept. 5, 1861. 
He says that a patient who had been immersed in ice cold water for 
twenty or thirty minutes, “some verily believing it was an hour,” was 
taken out of the water cold and apparently lifeless, and restored.” 
What are the conditions under which resuscitation is possible ? Dr. 
Paton says he has “ not been able, by artificial respiration, to revivify 
a cold-blooded animal after the pulsations of the heart had fallen be- 
low eight per minute, and the commencement of sensibility is alw’ays 
preceded by natural respiration.” Dr. Cartwright says, an alligator 
may be resuscitated half an hour after apparent death from asphyxia, 
by inflating the lungs.” Muller states, that “ in a warm-blooded ani- 
mal, dying by asphyxia, the heart will continue to contract for half an 
hour after apparent death. But undoubtedly there would be no hope 
of recovery after that period, though it has been repeatedly stated by 
physiologists, that warm-blooded animals may be recovered from as- 
phyxia, after the heart has ceased to beat.”* 
“The truth is,” says Dr. Paton, “that in all these cases where the 
circulation has been supposed to be restored by artificial respiration 
after the heart ceased to beat, it was only the first stage of asphyxia 
that had been reached, that of insensibility, and the cessation of the 
* Watson’s Lectures, Yol. I., p. 67. ASPHYXIA. 
623 
function of respiration. The heart still continued to contract and the 
venous blood to circulate, however feeble may have been the power by 
which it was maintained.” 
It is evident, then, that “ asphyxia depends on the want of oxygen 
to the bloodand that the most important remedial measure is its 
speedy restoration ; and this will be accomplished by inflating the chest 
with atmospheric air. But every precaution must be taken to employ 
no force in the use of the remedy, or it will be apt to rupture the air- 
cells and produce emphysema of the lungs.” 
Galvanism can not “ stimulate the heart to action,” nor can “ exter- 
nal heat maintain the temperature of the body if the means of supply- 
ing oxygen to the blood be neglected. This must be considered as the 
object of great and primary importance, and all other remedial agents 
must be subsidiary to it.”* 
The galvanic experiments of Dr. Ure on the body of the criminal 
Clydesdale, after he ha.d been suspended nearly an hour from the gal- 
lows, justify farther trials of this agent in cases of suspended anima- 
tion. By passing the galvanic current through various sets of muscles 
to the nerves of which the electric conductors were applied, “ the body 
was agitated by convulsive movements resembling a violent shuddering 
from cold;” the limbs were forcibly extended; full and laborious 
breathing was produced, the chest heaved and fell, the abdomen was 
protruded and again collapsed. When one conductor was applied to 
the supra-orbital nerve in the eyebrow, and the other conductor to the 
heel, and carrying the point of one conductor along the edges of the 
galvanic plates, the most extraordinary grimaces were exhibited; and 
“fifty shocks, each greater than the preceding one, were given in two 
seconds. Every muscle of the countenance was simultaneously thrown 
into fearful action ; rage, horror, despair, anguish and ghastly smiles, 
united their hideous expressions in the murderer’s face.” Some of the 
spectators were driven in terror from the apartment, “ and one gentle- 
man fainted.” In another experiment, the fingers were made to move 
nimbly like those of a violin performer, a finger extended forcibly ; and> 
“ from the convulsive agitation of the arm, he seemed to point to the 
different spectators, some of whom thought he had come to life.” (Ure’s 
Chem. Dictionary.) 
The experiments of Ure were repeated by a Committee of the Medi- 
cal Society of Lancaster County, Pennsylvania, on a criminal executed 
by hanging in 1889. They produced violent action of the pectoral mus- 
cles and established full respiratory action, the mouth opening and 
closing regularly. The breathing was so forcible that a lighted candle 
applied to the nose was blown out instantly. This was repeated five 
* Dr. George Paton, British American Journal, Dec., 1861. 624 
DISEASES OF THE NERVOUS FUNCTION. 
times in succession, and the inspiration was so strong that the flamo 
was drawn in with the breath, singing the hair in the nostrils. In other 
experiments the muscles of the face were in various directions, 
elevating the angles of the mouth, closing the eyes with tremulous 
movements; the arms and hands were flexed and extended, and moved 
from place to place; the muscles employed in mastication performed 
all the functions imitating the actions of tasting and eating. ( Western 
Jour. Med. Sciences, p. 264, May, 1840.) 
Asphyxia from Carbonic-acid Gas.—Persons will shut themselves 
up in a room in which charcoal or mineral coal are burning without a 
free draught to carry off the gases formed, or in confined places which 
old wood work has reached that point in decay in which it becomes 
phosphorescent, giving out light in the dark (called “ fox-fire”) in a 
state of very slow spontaneous combustion. Such persons have often 
been found “dead or dying, and so feeble as to be unable to go into 
the open air to open a door or window, or to call for aid. They suffer 
much and know the danger, but cannot make up their minds to move 
from the spot, as persons who in extreme cold weather, sit down to 
sleep in the cold air; they know the fate that is before them, but want 
energy to resist it.” (Ilering.) 
Symptoms of Carbonic-acid Gas.—Before animation is suspended 
there are: nausea, retching and vomiting—sometimes of blood ; a 
heavy burden seems to oppress the chest; the face becomes red, and 
at last purple and bloated; the patient is seized with involuntary and 
hysteric weeping; he talks incoherently, is seized with convulsions 
or apoplexy and falls down suddenly. 
Treatment.—Carry the patient into fresh air; rub with vinegar and 
let him inhale it. If the face is already red and beginning to rave, 
throw cold water on the head, apply warmth to the feet. Give Opium 
first, and after some trials of that, give Belladonna. If the patient 
talks much and rapidly, complains of shooting pains; or feels as if he 
were flying, feels giddy when lying down, give Coffea. 
When rooms are long shut up without ventilation, the air becomes 
stagnant and putrid, almost like the stagnant water of standing pools. 
Persons who try to sleep in such rooms are likely to be attacked by 
“ nightmare, frightful dreams, visions, depression of spirits, and fear- 
fulness approaching to horror. 
Treatment.—There must be entire purification of the air by ventila- 
tion, opening all doors and windows, and making up a blazing fire; 
place water in shallow vessels about the room. Remedies’. Aconite, 
Opium, Veratrum, Vapor of Camphor, or Ammonia. 
Oxygen Gas.—Experiments on animals show that inhalation of 
oxygen gas increases the fibrine and diminishes the corpuscles and al- 
bumen of the blood. In the treatment of disease, Dr. Erichson (Mono- ASPHYXIA. 
625 
graph on Aphyxia) says: he never succeeded in re-exciting the con- 
tractions of the ventricle by means of the inflation of the lungs, 
when only common air was employed, “ provided they had fairly ceased 
to act before artificial respiration was set up.” He was then led to 
try oxygen, and in several experiments was successful in restoring the 
action of the ventricles, after entire cessation of the heart’s action. 
Unjpleasant Symptoms of Oxygen.—Extremely small doses (inhaled) 
often cause : sense of contraction of the forehead and temples; weight 
over the centre of the parietal bones and occiput; rush of blood to the 
head; fullness, pain or oppressive sensation in the neck and base of the 
brain; sudden faintness, palpitation of the heart; spasmodic contrac- 
tion of the affected parts; violent reflex movements in the extremities 
affected with paralysis of voluntary motion; unnatural excitement of 
the entire nervous and vascular systems, lasting several days after one 
moderate dose. 
Large doses produced in thin ansemic persons, sudden or gradual 
disappearance of the pulse; pallor of the countenance ; coldness and 
partial collapse. In plethoric and sanguine persons the reverse, viz.: 
too excited a circulation; full bounding pulse; intense heat of the 
head, face, and skin; severe oppressive headache ; frequent and long- 
continued use of it has caused much emaciation. 
Beneficial Effects.—Complete relief from oppression of the brain; 
sight improved in defective vision consequent upon venous congestion; 
general warmth even to the ends of the toes and fingers, succeeding 
to great nervous depression; permanent relief given to the uterus, 
ovaries, and spine by sudden induction of long-suppressed catamenia, 
particularly at the change of life; unexpected diarrhoea of highly of- 
fensive character, with dark inspissated bile, in long-continued torpor 
of the liver and portal system; cutaneous transpiration, suddenly and 
freely induced; improved appetite and powers of digestion and assimi- 
lations, increased strength; clearer, fairer, and softer skin. 
Fainting, Swooning, Syncope.—Treatment.—Avoid all excitement, 
loosen the clothing, if tight about the neck, chest or abdomen ; place 
the patient in a comfortable situation; remove any object which might 
make a disagreeable impression on the mind when consciousness re- 
turns. Sprinkle fresh water lightly on the face, neck, back oflthe head 
or pit of the stomach. Hold Camphor to the nose. Hartshorn may 
also be tried but with caution. 
Remedies may be selected according to the supposed cause of the 
disease. 
Colocynth, Aconite, or Opium for fainting caused by fright. Aco- 
nite when caused by violent pain. 
China.—Fainting from loss of blood or other debilitating causes. 
Wine for similar cases, but give it in very small quantities. 
You II.—40. 626 
DISEASES OF THE NERVOUS FUNCTION. 
Ignaiia or Chamomilla.—Fainting from mental emotions, from 
great pain. 
—When the slightest pain causes fainting. 
Cocculus or Chamomilla.—Fainting from violent pain, preceded by 
giddiness. 
Veratrum.—Fainting after excessive pain, or after trifling exercise. 
Nux-vom.—Fainting in the morning, in persons who have used 
ardent spirits, have been injured by severe application; or fainting 
after dinner. Phosphoric-acid also for the same symptoms. 
Carbo- Veg.—When the system has been debilitated by Mercury. 
The proper remedy should give relief in ten or twenty minutes at 
most. 
Apparent Death.—In cases of apparent death too much should not 
be done nor too many things tried until some examination of the pa- 
tient and surrounding circumstances is made. There may be ap- 
pearance of death, especially after some violent injury, when the func- 
tions of life only are suspended. When there is the least uncertainty, 
and in all cases where animation has been suddenly suspended, and 
putrefaction does not commence as suddenly, nothing should be done 
that can possibly cause death. Interment should be postponed to at 
least the third day, at which time some changes will take place that 
will be decisive. If at the end of this period no marks of decay be 
perceived, all further proceedings should be delayed till putrefaction 
evidently commences, though a week should elapse. The body should 
be treated with the greatest care, giving opportunity for resuscitation 
so long as that is possible. 
Apparent death may be caused by: Hunger, a fall, suffocation, hang- 
ing, pressure of choking, from drowning, from being frozen, from 
lightening, from apoplexy. 
Apparent Death from Suffocation, Hanging, Pressure, Chok- 
ing.—Remove all tight clothing, place the patient in a proper position, 
with the head and neck high, and the neck in easy position. Then 
commence rubbing gently but steadily, with warm clothes. Give at 
once by injection a drop of tincture of Opium in a pint of water. This 
may be repeated every quarter of an hour, continuing the rubbing of 
the limbs*. When respiration begins in the slightest degree it will be ob- 
served by holding a looking-glass before the mouth and nose occasionally, 
that the dampness of the breath may show on the glass. Warm cloths, 
or hot stones wrapped in cloths may be applied to the feet, between 
the thighs, to the neck, the sides, and under the shoulders. 
Opium may be given by the mouth occasionally. Aconite may also 
be tried. CATALEPSY. 
627 
4. CATALEPSY.—TRANCE. 
This remarkable affection of the brain and nervous system is thus 
defined by systematic writers: A sudden deprivation of sense, intelli- 
gence, and voluntary motion, the patient retaining the same position 
during the paroxysm as that held at the moment of attack ; or in which 
he may be placed during its continuance ; the pulse and respiration 
being little affected, sometimes quick and small. 
The paroxysms of cataleptic seizure are intermittent, but without re- 
gard to regularity of periods. They are sometimes announced by pre- 
monitory headache, mutability of temper, yawning, tinnitus aurium, 
vertigo, palpitations, lassitude, pain or slight spasms of the limbs or 
neck, confusion of mind, &c. But in most clearly-marked cases the at- 
tack is sudden,—the patient retaining the same expression of the coun- 
tenance and posture of the body as before. The eyes are fixed, either 
open or shut; the pupils usually dilated, but contracting when a strong 
light is thrown upon them; and from their unvarying expression, and 
the unchanged attitude, the body has the appearance of a statue. Any 
position, in which the head, trunk or limbs are placed, is retained without 
deviation ; the condition of both the flexor and extensor muscles is such 
as to admit of a change to any possible position, and its retention for 
the whole term of the paroxysm. During this time the countenance is 
little changed, sometimes paler than usual, or slightly suffused, respira- 
tion little embarrassed. 
The duration of the state of unconsciousness varies from a few min- 
utes to many days. Restoration to the natural state is usually instan- 
taneous, accompanied with sighing, and followed by pain or confusion 
in the head, with a feeling of lassitude. The patient has no recollec- 
tion of what has passed during the fit; and the same ideas, and in 
some cases the same sentences which have been suspended by the 
seizure, have been resumed at the moment of recovery. No efforts to 
restore consciousness are effectual, the loudest noises, and even moving 
the body or pinching it, are not felt at the time or remembered afterwards. 
In an imperfect form of catalepsy, called catochus, the abolition of 
the senses is only partial; the patient being conscious of what is pass- 
ing, but incapable of moving or speaking. 
Case by Dr. Gooch.—A lady who was suffering from puerpural 
mania was restrained in a strait-waistcoat. Dr. Gooch says : “ A few 
days after our first visit, wTe were summoned to observe a remarkable 
change in her symptoms; the attendants said she was dying or in a 
trance. She was lying in bed, motionless, and apparently senseless. 
It had been said that the pupils were dilated and motionless, and some 
apprehensions of effusion on the brain had been entertained ; but on 
examining them closely, it was found that they readily contracted wheD 628 
DISEASES OF THE NEKYOUS FUNCTION. 
the light fell upon them; her eyes were open, hut no rising of the 
chest, no appearance of respiration could be seen ; the only signs of 
life were her warmth and pulse; the latter was weak, and about one 
hundred and twenty. 
“ The trunk of the body was now lifted so as to form rather an ob- 
tuse angle with the limbs, (a most uncomfortable posture,) and there 
left with nothing to support it; there she continued sitting while we 
were asking questions and conversing, so that many minutes must have 
passed. One arm was now raised, then the other, and where they were 
left there they remained. It was now a curious sight to see her, sit- 
ting up in bed, her eyes open, staring lifelessly, her arms outstretched, 
yet without any visible sign of animation. She was very thin and 
pallid, and looked like a corpse that had been propped up and 1 ad 
stiffened in this attitude. We now took her out of bed, placed her 1 ip- 
right, and endeavored to arouse her by calling loudly in her ears, but 
in vain. She stood up, but as inanimate as a statue. The slightest 
push put her off her balance. No exertion was made to regain it. She 
would have fallen if I had not caught her. She went into this state 
three several times. The first time it lasted fourteen hours, the second 
time twelve hours, the third time nine hours; with waking intervals of 
two days after the first fit, and one day after the second.” After this 
the disease assumed the ordinary form of melancholia, and she reco- 
vered ordinary health after three months. 
Case by Dr. Johnson, King's County Medical Society.—“A Mr. J., 
teacher, having charge of a large academy ; takes little exercise ; consti- 
pation lasting for a week at a time without movement; he would perform 
the labor of the day, and then sit up till twelve or two o’clock, a.m., en- 
gaged in solving some difficult problem, thus overtasking the mind and 
disregarding the laws of health. On one evening, when a little tired 
with travelling, while conversing with a friend, he was suddenly seized 
with catalepsy ; was thought to be dying; was perfectly unconscious ; 
every muscle was tense and rigid, hardly moveable; the limbs were in 
a straight line with the body; arms folded across the chest; no move- 
ment of the thorax, or respiration perceptible ; pulse feeble and scarcely 
felt between the rigid tendons; beating of the heart very faint; eye- 
lids closed, impossible to open them ; pupils contracted, rolled up un- 
der the lid; he is completely unconscious of pinching, pricking with 
pins; joints stiff; he was raised up by the heels so that his body was 
held in a horizontal position, the neck resting on the back of the chair 
till the assistant supporting his feet was tired, but there was no relax- 
ation of the muscles or return of consciousness. There was neither 
opisthotonos nor emprosthotonos, otherwise the case resembled teta- 
nus. Almost impossible to move the hands or feet, but they remained 
wherever placed. After remaining in this condition an hour a flutter- CATALEPSY. 
629 
ing of the heart was noticed; when spoken to, he turned wildly round 
with a confused, unconscious stare, and closed his eyes. The limbs be- 
came flaccid, and in a few minutes he became completely conscious. 
He said there was no pain. During the night a slight return, but it 
passed off, and he continued awake the whole night in spite of twelve 
m. doses of Magendie’s solution of morphine every hour. 
“ Next morning, countenance sallow, extremely bilious ; was rational 
but while conversing was seized with the same rigidity as before; to- 
tal loss of consciousness for twenty minutes. Rigidity then passed off 
and was followed by delirium, during which he would figure up large 
sums with amazing rapidity, repeating long rows of figures, and then 
coming over them again in the same order. His muscular power was 
so great that several men could not hold him, though perfectly under 
the control of a lady whom he imagined the same to whom he was en- 
gaged. He recovered after a few days.” 
Diagnosis.—Catalepsy, when it comes on spontaneously, differs from 
ecstacy, somnambulism, reverie or clairvoyance, by being always asso- 
ciated with perceptible physical disease. It is, therefore, a curable 
affection by the proper application of remedies. The latter named 
abnormal states are at this day generally produced by voluntary ef- 
fort. The propriety of making such effort, and opening the doors be- 
tween the frail inhabitant of a material body and the little known in- 
fluences formerly regarded as supernatural, must be left to the con- 
sideration of those who practice it. 
The danger of mistaking catalepsy or other abnormal conditions for 
real dissolution, renders it necessary here to review the principal points 
by which they may be distinguished. 
Symptoms of Death.—Impatience of covering; throwing off the 
bed-clothes, as if for the purpose of getting the fresh air to come in 
contact with the skin. (SymoncPs Cyclopedia of Anatomy and Phy- 
siology) It is supposed by Edwards that the air produces some 
change in the skin as it does in the lungs. This symptom is frequently 
present where there is little disturbance in the organs of respiration. 
Orfila mentions a case of poisoning by sulphuric acid, in which the pa- 
tient made constant efforts to throw off even the lightest covering. It 
is rather probable that the tossing of the arms and throwing off of the 
covering depends on a certain inexpressible anxiety at the praecordia 
or the chest; this is seen most plainly in epidemic cholera. The skin 
there is blue, and cold, and clammy, while the patient declares that he 
is “ burning up,” and throws off' all covering, pressing the hand to the 
pit of the stomach. 
On the Signs that Death has really Occurred.—Dr. Whiting pub- 
lished a book “ On the Disorder of Death” in which he gathers up so 
many horrible stories of persons “buried alive” as almost makes one 630 
DISEASES OF THE NERVOUS FUNCTION. 
afraid to die for fear he may be buried alive. In England where the 
body is usually kept several days, the probabilities of a premature bu- 
rial are not very strong ; but in this country where it is common to 
bury the dead, at most within a day or two, there is reason to believe 
that premature burial is common. Buhier has collected the details of 
fifty-two cases of persons buried alive; of fifty-three who recovered 
without assistance, after they were laid in their coffins ; and of seventy- 
two falsely reported dead. 
The signs of the total extinction of the functions of life are not so 
unequivocal as most persons suppose they are. Cessation of respira- 
tion and circulation cannot afford positive evidence, for the external 
senses are not sufficiently perfect to enable us to detect either respira- 
tion or the circulation in the smallest degree compatible with mere ex- 
istence. Foubert proposed as a test, to make an incision into one of 
the intercostal spaces and feel the heart with the finger! 
Loss of heat is not conclusive ; for life may exist and recovery may 
take place when no perceptible heat exists. 
Galvanism has been supposed to furnish a certain test. Nystau 
showed that irritability is first extinguished in the left ventricle; in 
forty-five minutes it leaves the intestines and stomach; so on after 
this the bladder; and, in one hour, the right ventricle; in one-and-a- 
half hours the oesophagus; in fifteen minutes more it leaves the iris. 
It next ceases to be perceptible in the muscles of the trunk; then 
leaves the upper and lower extremities, and lastly, the right auricle. 
The duration of contractility is shortened by a warm and humid state 
of the atmosphere. After death there is, first, softness and flexibility; 
then rigidity, which some think the last effort of vitality, others think 
it analogous to coagulation of the blood. The collapsed edge of a 
wround in a dead body, in distinction from a gashing wound in a living 
living body, is the result of a peculiar irritability. The annihilation of 
this is one of the surest signs of death. Rigidity is a pretty certain 
sign of death ; flaccidity, quite so; putrefaction, unequivocal. All 
other supposed evidences of real death have often led careless physi- 
cians and friends into the great error of mistaking a temporary trance 
for absolute dissolution. The number of persons who have revived at 
a last moment when about to be consigned to the coffin, is fearfully 
great. The number known to have been really buried alive, are al- 
ready sufficient to justify extraordinary precautions in every case. 
The opinion prevailed among the ancients that dying persons were 
gifted with some peculiar illumination by which they were able to fore- 
see the future; but modern physicians have thought the circumstances 
of each case might explain all that is really met with in such cases. 
The disease under which the dying patient is sinking, always acts in 
some manner upon the mind. Thus consumption excites the feelings CATALEPSY. 
631 
of hope and security. The consumptive always expresses himself as 
“ better,” and his conversation is of every thing but death and the grave. 
Like the swan on his last voyage, “ Floating down by himself to die,” 
“ Death darkens his eye and unplumes his wings, 
But his sweetest song is the last he sings.” 
Palsy excites feelings of fretfulness and discontent. Diseases of the 
heart arouse involuntary terrors; and some diseased states of the in- 
tellect excite morbid sharpness of the faculties of the mind. It is not 
strange, then, that the death-beds of those about to sink under diseases 
of the mind, should exhibit marked energy under bodily decay. The 
passions during life have obscured judgment, but they are extinguished 
at the approach of death. And the inferences which wisdom had 
drawn from the former experiences of life are now rendered available 
to correct the erroneous opinions which have hitherto interfered with 
the best use of the bodily powers. Milton says: 
“ Old experience doth attain 
To something of prophetic strain.” 
The explanation given by Sir H. Halford, of the prophetic power 
ascribed to certain persons at the close of life is that commonly re- 
ceived. He says “ it arises from the strength and unwonted vivacity 
of thought and solemnity of feeling, that led Aretaeus to give this ex- 
planation of it. This is particularly the case in brain-fever which) 
when its violence subsides, clears the patient’s mind and renders his 
sensations exquisitely keen. 4 He,’ says this author, ‘ is the first to dis- 
cover that he is about to die, and announces it to his attendants ; he 
seems to hold converse with the spirits of those departed from earth 
before him as if they stood in his presence. In diseases of the mind 
these phenomena observed by Aretaeus are often witnessed. The de- 
scription of the death-scene of Don Quixotte, whether true in fact or 
invented by Cervantes, is true to nature.” (.Halford's Essays on 
Death and Madness.) 
On the Length of time passed since Death was Complete.—In 
from two to twenty hours the flexibility, elasticity, heat and contrac- 
tility of the living body entirely disappear. “In from ten hours to three 
days,” says Devergie, “ we find the rigidity of the joints, pitting of the 
soft parts, change of appearance of the skin, loss of animal heat per- 
fect, and no contraction under the stimulus of electricity.” In from 
three to eight days there remains flexibility after rigidity, and no con- 
tractility. After from five to twelve days, the soft parts are puffed, 
elastic and shining. After the twelfth day, there is easy separation of 
the epidermis, and a green tint of the abdominal integuments; these 
indications give merely approximations to truth. Much depends on 632 
diseases of the nervous function. 
the temperature, as five or six hours in summer are equal to ten or fif- 
teen days in winter. 
Causes of Cataleptic Seizures.—Predisposing.—Whatever di- 
minishes vital power and increases the susceptibility of the nervous 
system; depressing passions; hereditary debility; hysterical tempera- 
ment; sorrow, anxiety; intense mental labors; nervous exhaustion, 
however induced ; nervous derangement caused by mercury. It may 
occur at any age, but is more common in females than males, and at 
or after the age of puberty. 
Exciting Causes.—Violent mental impressions ; great mental appli- 
cation ; fright, terror or dread ; suppression of the menses; concealed 
emotions; ungratified love or passion ; ovarian disease. In certain 
constitutions the trance state can be artificially induced, a proceeding 
wdiich involves the subject of it in many perils little understood by per- 
sons who permit or encourage it. 
Treatment.—The treatment of catalepsy in general, must be directed 
by the general principles which govern us in the forms of disease with 
which it is associated. 
Principal Remedies for Catalepsy.—Cham., Ipec., Plat., /Strain., 
Aeon., Agarious, Pell., Cicuta, Jlyos., Mosch., Veratr., Asafcetida, 
Camp/i., Coloc., Ignatia, Merc., Opium, Petroleum. 
Somnambulism.—Pry., Natr.-m., Silicea, Salph., Petrol., Phosphor. 
Natural Clairvoyance.—Remedies.—Phosphorus, Aeon., Pry., 
Cic., llyos. Agaricus, Mosch., Natrum-mur., tSil., Sulph., Veratr. 
Cannabis-indica.—This remedy, more than other known to us, com- 
pletely simulates in its action the phenomena of catalepsy. It deserves 
to be more fully tried in this disease. 
A Case with Uterine Complications.—A lady aged twenty-nine, 
subject from her childhood to palpitations of the heart. She has clear 
white skin, dark brown hair and blue eyes. For five years she has 
suffered from continual headache which extends over the vertex from 
the forehead to the occiput, but severest on the top of the head. She 
cannot make or receive visits, as prolonged conversation aggravates 
the headache, produces vomiting, and compels her to remain three or 
four days in perfect quiet in bed. Slight departure from prescribed 
rules in diet causes gastralgia, vomiting of acid water and eructations of 
gas. She cannot bear the taste or smell of animal food. Menses ir- 
regular, pale, and small in quantity, appearing eight days too early; 
fluor albus in the interval; colic pains preceding the next period; the 
lungs not diseased. On waking in the morning from a sound but un- 
refreshing sleep, if permitted to fall to sleep again, she goes into a pro- 
found cataleptic trance, in which state she remains for several hours. 
These “fits” come and go without the least provocation, and pass off 
without leaving any bad effect behind them. Damp weather aggra CATALEPSY. 
633 
vates all her abnormal symptoms, and causes fits of melancholy ; worse 
in the evening. She feels always chilly ; hands and feet being cold. 
Dr. Yon Grauvogl, of Nuremberg, prescribed in this case Nux- 
vomica 3°, morning and evening, and Ipecac. 3°, during the day every 
two hours. He says he knows no remedies but these which “ can pro- 
duce a more lively change in all the tissues, and thus more heat in the 
body, enabling it to withstand the influences of cold and dampness, and 
at the same time vivifying the nervous system.” He thought it neces- 
sary to give them in the same day for a week, leaving them off the next, 
and thus change the constitutional condition before any thing would 
cure the headache. Wines, coflee, fruits, vinegar and cold bathing to 
be avoided. In a month she was less chilly; the cataleptic fits had 
diminished ; headache and palpitation remaining. After improvement 
from mountain travelling, the headache was again excited by crossing 
a lake. Gave Aranea-diadema, which lessens the influence of damp- 
ness. The menstrual period was prolonged for the first time to 
four weeks, but the flow was much increased, as this remedy causes 
profuse hemorrhages, even of the lungs in females. In two weeks 
more the headaches had greatly subsided ; in a week more there were 
intervals of a day or two, and soon they ceased altogether, after having 
troubled her for six years. The palpitation of the heart still remained, 
but it was mitigated by Puls. 30°. This losing effect in a few days, 
Puls. 3° was finally effectual. The fluor albus was removed by 
Magnes.-sulph. 6° ; the patient was then perfectly cured. (.HirscheVs 
IClinih.) 
Somnambulism.:—Cedron.—Dr. Casanova.—“ A grown person and 
two children, (a girl and a boy,) who were in the habit of getting up at 
night and walking about the room in a perfect and profound state of 
sleep, were cured, in less than a wreek of that sort of periodic som- 
nambulism, by repeated doses of Cedron, 6 to 12, taken two hours 
before going to bed, and their uninterrupted sleep was restored. The 
former of these three patients could read and play on the pianoforte 
in that state. At other times she would descend from her bedroom to 
the pantry, and help herself to food, returning to her chamber without 
disturbing any one in the bouse. The little girl was in the habit of 
taking her needle-work and sewing in her bed. The boy would insist 
always in opening the front door to go, as he said, ‘ to school,’ carrying 
his books, &c., with him.” 
5. APOPLEXY. 
The word Apoplexy is derived from the Greek words ano, and 
meaning to strike or knock down; because the persons seized with 
this disease fall down suddenly. Hence the common appellation of 634 
DISEASES OF THE NERVOUS FUNCTION. 
apoplectic stroke, or stroke of the palsy. There are two principal 
forms of this disease : 
1. When it consists in a congestion of blood in the brain or within 
the cranium, it is called sanguineous ajpoplexy. 
2. In serous apoplexy the effusion within the cranium consists of 
serous fluid. The word apoplexy is generally used to denote cerebral 
pressure; and all its varieties seem to depend on the nature of the 
fluid poured out upon or within the brain, the part of that organ injured, 
and the quantity of the effused fluid. 
General Description of Apoplexy.—A man who had been in appa- 
rently good health suddenly falls down, and entirely or partially loses 
the use of all his senses, while the vital functions, as the respiration 
and circulation of the blood continue. The countenance is livid, the 
vessels of the face and head turgid with blood; the breathing is ster- 
torous, slow, and laborious, though sometimes It is more rapid and 
vigorous; the limbs lie powerless; the pulse is full, slow, and inter- 
mittent. From this state he rarely rallies, but continues to sink grad- 
ually, and, at length dies in the course of forty-eight hours. 
Ilis brain, when examined after death, is found to have been more or 
less torn and destroyed by extravasated blood. In such a well-marked 
case as this, all the essential symptoms of apoplexy appear, and all 
the effects of extravasation on the brain are produced—all the centres 
of nervous power within the cranium are effected.—(Solly on the 
Brain, p. 363-) 
Diagnosis.—Apoplexy may usually be distinguished by the general 
symptoms above given, which are more or less conspicuously present 
in every case. It is distinguished from syncope by the patient not 
being pale and cold, and the pulse is full and strong, though slow. 
The attack could not be mistaken for sleep, as it occurred too sud- 
denly, and the patient could not be awakened. 
Apoplexy may be distinguished from epilepsy by the absence of 
convulsions, and the sudden cry that usually attends them. 
Some cases are less strongly marked and might be mistaken for 
some other disease by a careless observer. 
Of the Different Forms of Apoplexy.—1. Those in which there is 
profound coma, the accompanying symptoms being less conspicuous. 
2. Those which begin with a sudden attack of headache, passing 
gradually into apoplexy, with other symptoms resembling syncope. 
3. Those characterized by palsy and loss of speech without coma. 
(Abercrombie.) The first form depends on such sudden and extensive 
effusion into the hemispheres of the brain that the powers of the 
hemispherical ganglion are at once arrested, as in the case of severe 
concussion of the brain. 
In the second form “ the patient becomes pale, sick, and faint, gene- APOPLEXY. 
635 
rally vomits, and falls down,” the body is cold, and the pulse very 
feeble. In some cases, these symptoms are accompanied by a slight 
convulsion ; in other cases the patient does not fall, the sudden shocks- 
■‘being only attended by slight and transient loss of recollection. In 
either case he soon recovers from the first elfects of the attack, is' 
quite rational, and able to walk. But, in most cases, in a few minutes, 
in others, after several hours, the memory is observed to fail; the pa- 
tient talks incoherently, and then sinks into coma, from which he 
never recovers.” [Solly, p. 305; Abercrombie, p. 204.) In some 
cases paralysis of one side occurs, but in the majority of these cases 
there is none. 
In these cases the effusion takes place “ on the surface of the vertex 
of the brain, and, being small in quantity, it gives no headache, and 
the effusion takes place so slowly that the powers of the sensorium 
are not at once annihilated“ effusion progresses till the cerebral gan- 
glia are compressed, and the patient dies comatose.” In some cases 
similar symptoms arise from extravasation in the brain produced by 
external injury; a partial recovery from the first effects of the injury 
is sometimes followed by death, which results from pressure on the 
brain, as in apoplexy. 
Apoplexy may occur as an idiopathic, or as a symptomatic affection 
and in an inflammatory or an adynamic form. We may also, with 
propriety, divide it into three varieties : the sanguineous, or extravasa- 
tion of blood upon the brain; the serous, or effusion of serum ; and, 
finally, the simple apoplexy, produced by abnormal distention of the 
vessels of the brain. The symptoms will vary according to the extent 
of the effusion, and the part of the brain in which the extravasation 
is located.. If the fluid is so situated as to make pressure upon the 
hemispheres, there will be a sudden loss of consciousness, coma, and 
stertorous respiration. If the effusion occurs upon the surface of the 
vertex of the brain, the symptoms, according to Abercrombie, will be 
moderate in the first instance, but as the effusion increases, comatose 
symptoms come on, and the patient succumbs; when the effusion 
occurs near the base of the brain, there is no coma or loss of con- 
sciousness, but we find loss of speech and paralysis. It is most common 
at the age of fifty or sixty years, but it sometimes occurs in subjects 
of twenty-five or thirty years. 
Causes.—Apoplexy occurs most frequently in large towns amongst 
the opulent and luxurious. The impure air of cities acts as a power 
ful predisposing cause, and, in conjunction with the numerous vices 
prevalent in a patrician society, as want of exercise, high living, ex- 
cesses in the use of stimulants, and the pleasures of love, afford a 
solution to the fact of its more frequent occurrence in towns than in 
the country. 636 
DISEASES OF THE NEF.VOUS FUNCTION. 
The most common proximate causes of sanguineous, and of simple 
apoplexy are: want of exercise, excesses in eating, love, suppression 
of an habitual nasal haemorrhage, unnatural fullness of the blood-ves- 
sels of the brain from any cause, violent mental emotions, excessive 
study, and great physical exertion. 
The most favorable condition for the occurrence of serous apoplexy 
is, general debility and enervation, whether from insufficient nutriment, 
excessive mental or bodily labor, sickness, old age, long-continued in- 
temperance, abuse of drugs, or the depressing emotions. 
A peculiar physical conformation, consisting in: a plethoric consti- 
tution ; full, florid, livid, or dark-red countenance; stout and short 
body, with short neck, and head disproportionably large; advanced 
age; hereditary predisposition, dependent on a similar morbid condi- 
tion of the cerebral vessels, or of the heart and its valves, corpu- 
lence, &c. 
Frank asserts that it is not rare to find serous and sanguineous 
effusion in the same brain, and he has detailed several instances of 
this kind which have fallen under his own observation. 
Secondary Causes.—Organic disease of the heart and arteries; dis- 
ease of the lungs; sudden changes in the system from cessation of 
the menses, or drying up of pus-secreting surfaces, or haemorrhoids ; 
intemperance, luxurious living, and sedentary habits predispose to apo- 
plexy, by promoting plethora at the same time that they cause dys- 
pepsia and constipation. Structural disease of the heart, particularly 
hypertrophy of the left ventricle is often found on dissection of per- 
sons who have died of apoplexy. In these cases, the blood is propelled 
forward with increased power upon the arteries of the brain, which are 
often weakened and rendered less elastic by the deposition of an 
atheromatous deposit on their interior surface. {Solly, p. 368.) Dr. 
Burrows has shown that in many cases of apoplexy there is no primary 
disease of the brain; and that hypertrophy of the left ventricle, or 
valvular obstructions in the heart will lead to lesions within the cranium 
in the manner described. (Burrows, p. 124.) 
Premonitory Symptoms of an Attack of Apoplexy.—Though the 
attack usually comes on suddenly, it is generally preceded by various 
symptoms which portend its approach. Among these are : an unusual 
tendency to sleep ; sleep unrefreshing and disturbed by dreams ; sleep- 
ing long and heavily, with laborious and stertorous breathing; con- 
stant dull pain in the head; vertigo, or swimming in the head after 
stooping; the cerebral nerves feel irritated; aching pain in the brain; 
the countenance exhibits a livid hue; the veins in the forehead become 
turgid, the carotids and temporal arteries throb forcibly; increased 
heat and redness of the scalp; ringing or buzzing in the ears; partial 
deafness or blindness; double vision, or injected state of the eyes: APOPLEXY. 
637 
mental faculties impaired; indisposition to perform mental labor; 
memory of the names of common things totally lost; recent occur- 
rences forgotten; words in common use substituted for others; great 
irritability of temper, or apathetic indifference to every thing; cold 
hands and feet; the extremities feel numb, or “ go to sleep ;” tendency 
to paralysis; falling of the upper eye-lid; imperfect articulation of 
words; drawing of the corner of the mouth from palsy of the muscles 
of the opposite side; unsteadiness of gait in walking; frequent crampa 
and numbness of the limbs, toes or fingers; derangements of the 
stomach; irregularity in diet; voracious appetite, foul tongue, bad 
breath, constipation, and other dyspeptic symptoms, which are only 
temporarily removed by purgatives; the pulse is full, slow and inter- 
mitting. Though all of these symptoms, or any of them, may be con- 
sidered as signs that apoplexy may be impending, it is also true that 
any of them may arise from other causes. When only a few of them 
concur in a single case, other symptoms less equivocal may be anti- 
cipated. 
One of the most common cases of the accession of an attack of 
apoplexy is thus described by M. Serres. In a sanguine man, with 
short neck, and devoted to unrestrained indulgence of all the passions, 
the mind becomes unusually excited; an extraordinary facility of 
thinking and readiness of expression are observed. There is some 
numbness of one side of the body or face, and a fixed pain in the 
head; there is embarrassment of the tongue, difficulty of pronouncing 
certain words or letters; the loss of memory for names is often ob- 
served in persons devoted to profound meditation, or violent and pro- 
longed sorrow. In this state any sudden excitement, or violent pas- 
sion opposed, or movement of anger may develop a sudden attack, 
for which the brain is prepared by a concurrence of various causes; 
though it may yet be averted by judicious treatment. [Sevres, On a 
New Division of Apoplexies.) 
But, if the impending shock is not promptly met by the most judi- 
cious and energetic measures, the determination to the brain proceeds 
with increasing power. The patient hears a roaring noise in the ears 
from the throbbing of the carotid arteries; he sees flashes of light- 
ning in the dark, and hears sudden sounds as of a pistol fired near his 
head ; “ woe to those who neglect such warnings.” [Serres.) 
Phenomena of an Attach of Apoplexy.—At the moment of inva- 
sion the face is unusually high colored; the cervical and facial veins 
swell, especially when there is mental excitement; the tongue first 
becomes embarrassed, the sight is troubled, the hearing impaired, and 
there is loss of sensibility, and of all the mental faculties; the patient 
falls suddenly down on that side which is soon to be stricken with 
paralysis. He immediately sinks into coma; his breathing is stertor- 638 
DISEASES OF THE NEKVOUS FUNCTION. 
ous, slow, hard; and the eye-lids hang down, as if paralyzed, though 
the eyes are staring and protruded, the pupils are insensible to light, 
and frequently dilated; the speech is impeded or entirely lost. Al- 
though the whole body is affected with the loss of motion, it, neverthe- 
less, is displayed more plainly on one side than the other; and in this 
case the side least affected is somewhat convulsed ; the mouth is drawn 
to the side opposite to that most affected by paralysis. 
Some hours after the sudden invasion of apoplexy, if the brain is 
not greatly injured, respiration becomes more slow ; the venous blood is 
mechanically abstracted, requiring increased powers of the circulation 
to propel it. As reaction advances the pulse becomes strong, quick, 
and full; the artery vibrates under the finger, and the action of the 
heart is increased according to the difficulty of respiration. M. Serres, 
who first noticed this contrast between the action of the lungs and the 
heart, says, the force and hardness of the pulse continues up to the 
moment of rupture of a blood-vessel in the brain; when, if the rup- 
tured vessel be large, the pulse becomes suddenly small and frequent. 
The breathing is equally full on both sides during some hours, and 
sometimes for the first days of the attack, but the thorax and lungs 
are unequally dilated; one side of the chest becomes motionless and 
the other redoubles its activity. On that side on which the action is 
lessened the ribs appear flattened, and on the other they are percepti- 
bly elevated. This change takes place before hemiplegia occurs; and 
by this symptom we may decide which side is about to be paralyzed, 
and, in some cases active treatment may prevent it. 
Both stupor and coma often exist in a high degree and the sensi- 
bility are equally obtuse in both sides; in some cases this is more 
observable in the side about to be paralyzed; in others the sensibility 
is heightened at the very time when the paralysis is on the point of 
appearing. Serres, who says he passed whole days and nights in ob- 
serving the progress of numerous cases of this disease, often saw the 
distortion of the mouth preceded many hours by convulsive movements 
in the side soon to become motionless. The leg usually ceases to move 
before the arm. Sometimes sensibility remains; and almost always 
its loss precedes and accompanies that of mobility. 
Pathology.—The appearances on dissection of persons who have 
died of apoplexy are varied by the extent and locality of the lesions 
found in the brain. 
1. The effects of sanguineous effusion into the medulla oblongata is 
more suddenly fatal than any other part; and this is the only form 
that might be mistaken for disease of the heart; this part is not very 
vascular and seldom becomes the seat of effusion; but effusion on the 
surface of the medulla oblongata is more common, and is equally fatal, 
as it is from this part that all the nerves of respiration and the muscles 639 
APOPLEXY. 
they command receive their power of action. Blood effused into the 
third ventricle from rupture of vessels of the thalami, or corpora 
striata, gradually finds its way down to the medulla oblongata, and is 
then speedily fatal. [Solly, p. 371.) 
2. Effusion into the pons varolii produces paralysis of one or both 
limbs, according to its extent; but, after the first effect of the effusion 
is over, it does not effect the intellect, as the lesion does not extend 
to the hemispherical ganglion. As the effused blood advances 
towards the medulla the organs concerned in respiration are more and 
more affected: first the muscles of respiration are irregularly stimu- 
lated, and the sensibilities of the respiratory passages become increased; 
at length the exaltation is succeeded by paralysis, and the patient dies 
from suffocation. 
8. Effusion into the crus cerebri produces paralysis of the extremi- 
ties on the opposite side of the body, and often of the opposite eye, 
from its affecting the optic nerve without interfering with the mental 
faculties. 
4. Effusion into the corpus striatum is invariably followed by 
paralysis, [Morgagni.) In persons who have died after paralysis of 
long duration these bodies are always greatly changed, and the stria 
nearly obliterated. The paralysis is always observed in the extremi- 
ties of the side opposite to that in which the lesion occurs. So long 
as the extravasation is confined to this part of the brain, and does not 
extend to the convolutions, the mind remains unaffected. [Solly, p. 
375.) 
The connexion between the extravasation in one side of the brain 
and hemiplegia of the opposite side of the body has been demonstrated 
by an immense number of observations and dissections. M. Serres, 
who had proposed to himself to solve the problem of determining the 
seat of effusion in any given case of apoplexy, examined the brains 
of one hundred and seventy-one persons who died of cerebral apo- 
plexy attended with paralysis of one side, found in every instance 
the lesion in the brain on the side opposite to that in which the hemi- 
plegia appeared. He dissected forty-seven hemiplegic subjects who 
died at the Hospital le Pitie, “and forty-seven times found disorganiza- 
tion of the brain opposite to the paralyzed side. In one hundred 
brains received from Salpetrie, Bicetre, and Hotel Dieu, the alteration 
of the brain was always, without exception, on the opposite side. To 
these we may add two or three thousand cases contained in the annals 
of science.” [Serres Mew Division of Apoplexies. Phil. Med. 
Journal, Nov. 1824.) 
5. Injury of the Thalamus Nervi Optici.—This part of the brain 
is seldom injured without paralysis of some part. In some cases there 
have been loss of motion when sensation continued perfect. In other 640 
DISEASES OF THE NERVOUS FUNCTION. 
cases, loss of both sensation and motion of both extremities on the side 
opposite to the injured part are the only peculiar symptoms. In none 
of these cases was the mind injured. 
6. Effusion confined to the Tubular /Substance of the Hemis- 
pheres.—After the first effect of effusion is passed, the intellect remains 
intact or only slightly disturbed, though loss of consciousness may re- 
main for some hours. 
In many cases the extreme symptoms of apoplexy leave little oppor- 
tunity to distinguish the precise part of the brain which is the seat of 
the invasion, as the violence of the attack shows the case to be hope- 
less. A patient complains of sudden and violent headache, he becomes 
pale and vomits; if he is able to walk a few steps, the headache, pale- 
ness, and vomiting continue ; the pulse is soft, consciousness is par- 
tially retained, but the patient is stupefied; by degrees the redness of 
the face and stupor increase; he answers slowly and with difficulty, 
and sinks into coma from which he can not be aroused. In these cases 
there is generally a ruptured blood-vessel from which blood is gradu- 
ally extravasated on the brain. When partial recovery from these 
severe attacks takes place, there is generally paralysis of one or both 
sides. In some cases half the tongue, face or larynx remain in this 
state after consciousness is fully recovered. 
7. Effusion into the Cerebellum.—The usual effects are: hemi- 
plegia of the opposite side of the body; sight and hearing are gene- 
rally affected, from the vicinity of the optic ganglia and auditory nerves; 
excitement of the generative organs is general, though not universal. 
In the meningeal form of sanguineous apoplexy there is extravasa- 
tion of blood on the surface of the brain. We find: 
1. Effusion into the cavity of the arachnoid membrane. 
2. Effusion into the sub-arachnoid tissue. 
In the first variety there is never such a decided rupture of the ves- 
sels as is visible to the naked eye, hence it is called an exhalation. 
But the blood extravasated coagulates in the situation in which it is 
found, and soon becomes invested by a false membrane which is so fine 
and delicate, and so closely adapted to the original serous membrane, 
that the limits of each can scarcely be defined. (Ilewitt, Hed. Chir. 
Ti *ansae., Vol. X.) 
Symptoms.—In all cases of this kind there is pain in the head ; and 
it is generally, though not always, followed by paralysis. The most 
striking characteristic is the occasional intermission of the symptoms. 
It is generally fatal, though not always so. The intellect remains un- 
changed so long as the effusion is confined to parts near the base of 
the brain ; when it extends towards the upper part of the hemispheres 
coma and insensibility ensue. The cephalalgia, redness, heat of the 
integuments of the face increase as the effusion advances. The intel- SEROUS APOPLEXY. 
641 
lect is weakened by the compression of the brain ; but, as there is no 
inflammation of the hemispherical ganglion, sensibility and the mental 
faculties remain to be obliterated together when the pain, which be 
comes more and more excruciating, is overpowered by the extension of 
the effusion. The distress from the vomiting, the depression, with the 
feebleness of pulse, the paleness and diminution of sensibility and men- 
tal power are proportionate to the danger. {/Solly on the Human 
Brain, p. 379.) 
Apoplexy, in which the effusion into the brain consists of a serous 
instead of sanguineous fluid, is usually dependent on general debility, 
accompanied by local excitement and congestion of an asthenic cha- 
racter. There is paleness and bloatedness of the face, cachectic ap- 
pearance, vomiting, fits of nausea, and a gradual setting in of complete 
or partial paralysis. 
Causes.— It may arise from any of the ordinary causes of debility: 
as, injudicious depleting treatment of a patient of intemperate habits, 
in whom a blow on the head had excited subacute inflammation of the 
brain. In such persons inflammation or strong congestion may be 
easily excited, but bleeding and active purging only produce depression 
without lessening disease. 
Diagnosis.—Inflammatory apoplexy is for the most part confined to 
individuals of a sanguine temperament, plethoric, with short, thick 
necks, vigorous circulation, and a great amount of animal heat. The 
attack is often preceded by vertigo, unusual heat about the head, face 
red and full, eyes injected and troubled with muscse volitantes. The 
invasion of the malady is so sudden that the patient is struck down in- 
stantly, deprived of all consciousness and power of motion. The re- 
spiration becomes stertorous, the cheeks and lips puffed out at each 
respiration ; the pulse is slow and full; the pupils dilated, face red or 
livid, or purplish, throbbing of the carotid and temporal arteries, eye- 
lids convulsed, either closed or half open; paralysis of the muscles of 
one side, or of the face only; and distention of the veins of the head 
and neck. After a time the breathing becomes less stertorous, the 
pulse more soft, and some signs of returning consciousness indicate 
convalescence ; or, as more often happens, these symptoms become 
more grave, and the vital forces continue to fail until the patient sinks 
under the disease. 
Some of the marks which characterize ?', ous apoplexy, are : gene- 
ral appearance of debility, face pale and haggard, pulse below the na- 
tural standard in frequency and fullness, surface cold and clammy, 
pupils contracted or dilated, loss of consciousness and paralysis of 
one or more parts. 
SEROUS APOPLEXY. 
VoL. II.—41. 642 
DISEASES OF THE NERVOUS FUNCTION. 
If the patient recovers from the more serious symptoms of this 
malady, there usually remains for a long time a paralytic condition of 
one or more parts of the body. 
A slight injury of the brain may also be so far exasperated as to 
terminate in serous effusion by injudicious stimulation. Other causes 
of serous effusion in the brain are: metastasis of various diseases; 
suppression of secretions; especially, suppression of urine caused by 
destructive disease of the kidneys. When serous effusion arises from 
the cause last named, there are symptoms referring to the urinary or- 
gans, as “pain in the bladder, strangury, or inability to retain the 
urine, which is high-colored and shows its diseased state by its chemi- 
cal constituents. Severe mental exertion often produces this disease 
in persons of exhausted constitutions. 
SIMPLE APOPLEXY. 
The last form of apoplexy to be described, has been called apo- 
;iplexia simplex, from its leaving no trace of its effects on dissection, 
It begins and terminates fatally by the pressure of the blood upon the 
brain, and, also, from the asphyxia caused by the imperfect respira- 
tion. The substance of the brain is gradually saturated with 
bonized blood which contributes to the profound coma in these cases, 
as well as in many other cases where blood or serum are effused upon 
the brain. {Solly, 390.) 
Prognosis.—In forming an opinion of the event we are guided by 
the violence of the symptoms, the frequency with which the attacks 
have occurred, and the constitution of the patient. If the disease is 
of a sthenic character, if it has been caused by extreme plethora, as- 
sisted by some accidental circumstance, as unfavorable posture, slight 
straining, and there is no evidence of disease of the heart and blood- 
vessels, the prognosis may be favorable. If the seat of the effusion 
appears to be at the base of the brain, and not too near the medulla 
oblongata, it may be remedied. In a large proportion of cases the 
treatment must be essentially the same “ wherever the effusion may 
exist, or however it may have been produced but an accurate diag- 
nosis is still of the utmost importance in directing the extent to which 
remedial measures may be carried, as w*ell as in calming the minds 
and retaining the confidence of the friends. The case may be con- 
sidered more unfavorable when the patient is advanced in age, is of an 
apopletic habit, and when the powTers of the circulation and respiration 
are paralyzed,—when the breathing is labored, stertorous, slow, super- 
ficial and irregular, when the pulse is slow, small and intermitting, 
deglutition difficult, the alvine and urinary evacuations pass involun- 
tarily, the extremities are cold, a clammy sweat appears on the upper APOPLEXY. 
643 
parts of the body, paralysis increases, and a mechanical grasping at 
one spot on the side of the head. In some cases there is a partial re- 
covery, leaving a state of mental imbecility. In others, there appears 
to be an entire recovery; but in all such cases it may be expected to 
return again on some trifling provocation. 
Treatment of Apoplexy.—1. Of the Premonitory Symptoms.—In 
all cases where any warning symptoms exist, all possible precautions 
should be taken to prevent an attack ; but all advice should be directed 
to the friends rather than to the patient himself. Every symptom of 
disorder of the digestive organs should be attended to; the general 
health should be promoted in every possible way. All habits of intem- 
perance in eating and drinking should be cautiously but effectually 
changed; the patient should take much exercise in the open air, with 
plenty of simple but nutritious food. The amount of stimulants 
should be lessened, but they should not at first be entirely prohi- 
bited. 
All mental excitement should be avoided; bronchial affections 
should be promptly treated ; congestion of the lungs which delays the 
return of blood from the brain to the right side of the heart, must be 
immediately removed by proper measures. The act of coughing may 
excite apopletic effusion. Watson says he has seen fatal apoplexy 
caused by the straining of a person to pull on his boot; and we have 
witnessed some cases where it originated in very trifling physical ex- 
ertion. One of these was a strong man of florid complexion, who drank 
freely, but was not considered as intemperate. While engaged in 
boring a hole with an auger in a block of wood on the ground, he fell 
down in an apoplectic stupor from which he could not be aroused. All 
exercises that especially exert the lungs, as coughing, blowing on wind 
instruments, loud talking, singing, as well as venereal excesses, de- 
pending posture, severe cold, or the suppression of habitual discharges, 
may, at any moment, provoke an attack of apoplexy. 
For the precursory symptoms of apoplexy, and for its incipient 
stages, the following remedies are recommended : Aconite, Nux-vomica, 
Coffea, Belladonna, Ipecac., Arnica, Bryonia, Ignatia, Mercurius. The 
choice of a remedy in an individual case must be made after an accu- 
rate review of the symptoms. 
2. Treatment of Sanguineous Apoplexy after the Occurrence of the 
Attack.—All tight clothing should be instantly removed, especially 
from the neck; carry the patient to a cool place, well supplied with 
fresh air, and place him in a position in which the head is well ele- 
vated. If poison be suspected, remove it by the use of an active emetic, 
sulphate of zinc, or the stomach pump, and antidote the poison sus- 
pected, using strong coffee for opium, (Hartman, Vol. IV., p. 4,) and 
also for Belladonna. 644 
DISEASES OF THE NERVOUS FUNCTION. 
Belladonna.—Profound coma; stertorous respiration ; face swollen, 
bluish, dark-red; spasmodic movements of the lips; distention of the 
veins of the head and neck; visible throbbing of the carotid and tem- 
poral arteries; dilatation of the pupils; injection of the conjunctiva; 
grinding of the teeth ; suppression or involuntary discharge urine; 
paralysis and immobility of one limb or one side of the body. 
If the patient is sufficiently conscious to note his sensations, Bella- 
donna will cover confusion of the senses ; vertigo; throbbing pains 
in the head; loss of memory; heaviness and pressure in the head; 
cramp-like pains in the face and limbs ; dimness of sight; double 
vision; deep-seated pain in the orbits; roaring in the ears; hardness 
of hearing ; loss of taste, or putrid taste ; constipation ; lameness and 
weakness of the extremities; painful sensitiveness of the whole sur- 
face to the touch; drowsiness, disturbed sleep; great sensitiveness to 
cold; aggravation of the pains by movement or by contact; despon- 
dency; dejection of spirits ; apathy; irritability. 
Paleness of the face; drowsiness with loss of consciousness and of 
speech, or with convulsive movements of the limbs and muscles of the 
face; paralysis of the limbs, especially of the right side ; mouth 
drawn to one side ; paralysis of the tongue ; salivation ; difficult or 
impossible deglutition / loss of sight, dilated pupils y red and promi- 
nent eyes ; glistening eyes ; muscae volitantes; double vision ; redness 
and bloatedness of the face ; vertigo with nausea and dullness of 
mind; stertorous breathing; fearful illusions of the senses ; loss of 
consciousness with convulsions of the extremities ; aching pain in the 
forehead as if the head would burst; Belladonna is the principal 
remedy shortly after an attack characterized by speechlessness, loss 
of motion and sensation, stupor and paralysis. It is useful in almost 
every form of apoplexy. It antidotes the apoplectic effects of Mercury, 
Opium, Valerian, Secale-cornutum, &c. (Jalir, Hartmann, Hull.) 
Administration.—In grave cases, a drop of the second potency 
may be given every half hour, or every hour, until the effect is mani- 
fest. When there is only a predisposition to the malady, a drop once 
in six or eight hours will suffice. 
Hartmann, who says that he has succeeded in curing many cases of 
apoplexy with homoeopathic remedies, uses Aconite in every variety of 
apoplexy, particularly when plethora and an excited circulation are 
conspicuous phenomena, or 'when the nervous system is very much 
irritated. {On Chronic Diseases, Vol. IV., p. 7.) It is peculiarly 
appropriate in those cases of “ sanguine temperament, robust constitu- 
tion,” in which is displayed, “great agitation, which nothing can calm, 
tossing from side to side, impatience, and mental excitement arising 
from fear or indignation.” ([Hahnemann.]) In all cases of “ hyper- APOPLEXY. 
645 
excitation of the nervous system/’ the use of Aconite renders the action 
of succeeding remedies more favorable. 
Aconite is indicated in the treatment of apoplexy by the following 
symptoms: A sensation of paralytic weakness in the limbs; conges- 
tion or sudden rush of blood to the head; buzzing in the ears: deadly 
paleness of countenance; vertigo, w'ith sensation of intoxication, or 
dizziness of the head; pain in the head and vomiting; piercing and 
throbbing pain in the forehead and temples ; heat and redness of the 
face ; eyes red, sparkling, convulsed, prominent; they look fixed, and 
the pupils are dilated; roaring in the ears ; the face is swollen, red, 
and hot; paralysis of the tongue ; trembling, stammering speech; 
difficulty of swallowing. 
Coffea.—Apoplexy in nervous persons, caused by violent emotions. 
In sanguineous apoplexy it acts only as a palliative. Suitable for per- 
sons habitually nervous, sad, and disposed to complain, affected by 
sleeplessness from excessive agitation of mind; frequent flushes of 
heat in the face; dizziness, heaviness of the head. 
Opium.—Hartmann (Vol. IV., p. 8) says, Opium is available in apo- 
plexy when the active power of the sensorium sinks to such an extent 
that the proper remedy cannot act upon the disease. A single dose 
of Opium sometimes restores the irritability. It is appropriate in 
drunkards and in old persons. Symptoms: Stupor, coma, stertorous 
breathing; lower jaw depressed ; inability to be roused; inability to 
answer questions ; full, slow pulse ; anxious breathing, with frequent 
breaking out in profuse perspiration ; cold sweat on the face ; the head 
falls on the chest; temporal arteries tlirob visibly. Opium is proper 
when stupor, vertigo, or heaviness of the head precede the attack, and 
when there is humming in the ears, imperfect hearing, fixed look ; 
sleeplessness ; anxious dreams ; great tendency to sleep. After and 
during the attack : Tetanic rigidity of the body; face red, hot, bloated; 
head hot and covered with perspiration; convulsive movements, trem- 
bling of arms and legs; foam at the mouth. Face red, bloated and 
swollen, or pale and sunken; expression of countenance stupid and 
besotted; distortion of the mouth; dropping of the upper lip; eyes 
half close-d, pupils dilated, and insensible to light; irregular and snor- 
ing respiration; profound coma, with stertorous and rattling respira- 
tion; convulsive and spasmodic motions; bluish color of the lips and 
nails ; general relaxation of the muscles ; coldness of the extremities, 
with heat in the head. Stupidity, imbecility, and dullness of the men- 
tal faculties and senses ; drowsiness ; vertigo ; giddiness ; buzzing in 
the ears ; heaviness, pressure, and tightness in the head; congestion 
of blood to the head ; visions ; dryness of the mouth ; paralysis of the 
muscles of the throat and tongue ; constipation, involuntary stools, 
suppression of urine ; numbness and insensibility; weakness ; languor; 646 
DISEASES OF THE NERVOUS FUNCTION. 
general dimunition of power throughout the organism. High spirits, 
succeeded by depression; calmness ; agreeable reflections ; pleasant 
fancies; taciturnity; courage ; confidence ; contempt of danger; and, 
finally, by coma, with stertorous breathing. 
Administration.—A drop of the third dilution in water or on sugai 
and repeated according to the urgency of the case. 
Phus-toxicodendron and Laurocerasus are applicable in some 
cases of a dynamic apoplexy, after Belladonna or Opium. Rhus is 
specific for the secondary effects which have not been removed by the 
last-named medicines, like great prostration; paroxysms of fainting; 
bruised pains in the affected parts ; numbness; stiffness; paralysis; 
cramps; great sensitiveness to cold air; tingling and twitching in the 
limbs; irresistible drowsiness. 
Administration.—A drop of the third dilution once in six or eight 
hours. 
In the adynamic apoplexy of old people, Phosphorus is a valu- 
able remedy. The symptoms which point to its use, are: general ap- 
pearance of debility and prostration; face pale and sickly; eyes 
sunken ; torpor of the mental and physical powers; coldness ; paralytic 
weakness ; tremor of the hands, and feeble pulse. 
Coffea, Ignatia, and Nux-vomica may be given for the purpose of 
removing the premonitory symptoms of adynamic apoplexy. The 
vapor of the nitrous oxyd gas may be inhaled with advantage in cases 
which are characterized at the commencement by great exhilaration, 
increase of muscular force, constant desire for locomotion, and suc- 
ceeded by profound sleep, or sleep disturbed by visions. This remedy 
should be so administered as to produce a decided impression. 
Laurocerasus.—Sudden attack of apoplexy in which the patient 
falls suddenly without any precursory symptom, as if he had taken a 
large dose of Prussic-acid; in such cases, Laurocerasus will often 
restore the vital action. A deep sleep may follow, which becomes 
lighter. Reason may be long in returning. 
Ilyoscyamus.—The patient falls suddenly with a violent shriek, 
convulsive movements, stertorous breathing. Suitable for nervous fe- 
males in whom the paroxysm is preceded by languor, lassitude, and 
transitory loss of consciousness; disposition to sleep too often and too 
long-continued; starting up from sleep in a fright; during the sleep 
the pulse becomes remarkably small and feeble, and the whole body 
covered with profuse sweat; frequent attacks of vertigo; illusions of 
sight; concussive jerks in the brain; face livid; features distorted; 
mind sad, peevish. Subsultus tendinum; hemiplegia; staring, dis- 
torted, red, sparkling eyes, convulsively moved and protruded from 
their sockets. 
Arnica.—Apoplexy from mechanical injuries. Sanguineous and APOPLEXY. 
647 
serous apoplexy with rupture of blood-vessels. Applicable in cases of 
persons of sanguineous temperament, red face, plethoric. Symptoms : 
pulse full and strong; paralysis of the limbs, especially on the left 
side ; drowsiness ; loss of consciousness ; murmuring complaint; evacua- 
tions passed involuntarily. 
Mercury.—Mercurius-solubilis—Is appropriate in almost every 
variety of apoplexy; may he used after Belladonna; especially suitable 
for serous apoplexy. 
Mercurius and Belladonna have cured a form of disease resembling 
apoplexy, and which arises from the use of coffee and wine. Symp- 
toms : distensive pain as if the head needs to be pressed upon; o» 
gasm of blood to the brain; throbbing as seen in plethoric persons, 
constant uneasiness and heaviness of the limbs; languor and lassitude 
from the least exertion; turgid state of the eye; frequent paroxysms 
of loss of sight; vertigo; buzzing in the ears. {Hartmann, Vol. IV., 
page 10.) 
Plumbum—May follow Opium, Belladonna, or Hyoscyamus. 
Symptoms: Languor, lassitude, drowsiness, indolence; attacks of loss 
of consciousness ; feeble and slow pulse ; throbbing in the whole body, 
especially the neck and abdomen; face hot; general sensitiveness, 
vertigo, and dullness of the head. 
Veratrum.—Coldness of the whole body; sudden prostration and 
collapse; distorted and protruded eyes as in persons suffocated; con- 
stant flow of saliva; disfigured and cold countenance, as of a dead 
person; flabby muscles, locked jaws ; imperceptible breathing. 
Ipecac.—The principal remedy in gastric apoplexy, or that form 
arising from overloading the stomach by rich food, as pork and pastry. 
Precursory symptoms: Restless sleep disturbed by frequent start- 
ings ; irritable mood ; ineffectual urging to vomit. 
After Ipecac., Pulsatilla, Nux-vomica, Ignatia, And Antimonials may 
be proper. 
Hydrocyanic-acid.—In cases of poisoning by bitter almonds in 
small doses, vertigo comes on almost instantly. The features are 
spasmodically distorted, the eyes fixed and turned upwards; pupils 
immoveable ; breathing stertorous ; pulse reduced to thirty per minute; 
the breathing exhaling the odor of bitter almonds ; and death generally 
takes place in ten minutes. A woman gave some to a child to cure 
worms ; it produced colic, swelling of the abdomen, vertigo, locked-jaw, 
frothing at the mouth, convulsions, insensibility, and death in two hours. 
A drop of the concentrated acid killed a cat in five minutes by drop- 
ping it on the tongue. A single bitter almond produces violent symp- 
toms in some persons. In larger quantities they cause nausea, vomiting, 
diarrhoea; in some there is an eruption like urticaria. A laborer took 
a quantity of them and dropped down insensible; pulse imperceptible, 648 
DISEASES OF THE NERVOUS FUNCTION. 
breath exhaled the almond odor, the remains were found in the stomach. 
A gentleman swallowed some of the oil. His servant found him with 
his features spasmodically contracted, the breathing hurried and con- 
vulsed ; twenty minutes later the physician found him insensible; 
pupils immoveable ; breathing stertorous ; pulse only thirty per minute; 
in ten minutes more he died. 
The post-mortem appearances after poisoning from Prussic-acid or 
any of the vegetable products that contain it, are all the same. The 
appearances depend on the period at which the inspection is made. 
After two or three days, no traces of the poison can be detected if the 
body has been exposed to the air; the decomposition of the poison is 
hastened by the commencement of putrefaction. The effects observed 
are: the eyes remain glistening, and the features are as composed as 
those of a living person; which appearance continues eight or ten 
hours, and the pupil dilates or contracts under the influence of light, 
in the case of a physician this continued ten hours. This same glisten- 
ing of the eyes has been noticed is cases of death by asphyxia from 
carbonic-acid gas. Dr. Christison saw it in a woman who died of 
cholera, continuing for six hours. There is also a peculiar brilliancy 
of the eye in persons poisoned by strychnine, and also after death 
from an apoplectic paroxysm. 
External Ap>pearances.—The spine is generally stiff, and the ab- 
domen drawn in. On opening the body the odor of Prussic-acid is not 
always perceptible. When it is obvious it pervades every cavity, and 
is often perceptible in the blood. 
Cuprum.—Case by Dr. Kissel.—A man, aged sixty-three, had two 
years ago a threatening of apoplexy. He stepped on a stool to feed a 
bird in a cage, but found he could not bring the other foot from the 
ground ; he became giddy, deadly pale, and was carried to bed. For 
this he was bled. A similar attack afterwards occurred. The whole 
condition was from that time changed. He sat nearly the whole day 
in an easy chair and slept, and afterwards suffered from violent trembling. 
Feb. 8, 1860. He sat in the inn with his head lying on his arm on 
the table, looking as if asleep. When the police tried to wake him 
they found his right arm paralyzed. Medical treatment including 
purgatives and Arnica did not improve him. 
Feb. 11. He was in an unconscious state, was speechless ; bis mouth 
drawn to the left side; right arm completely paralyzed, without motion 
or feeling; pinching the leg made him start a little; face pale and 
sunken; breath rattling; pulse hard, unfrequent, slow; occasionally 
suspending a beat; constipation continued; he voided urine involun- 
tarily ; swallowing very difficult. Give Acet.-cuprum, per day. 
Feb. 12. Swallowing improved with each spoonful taken. He looks 
about him observing everything. The lower extremities twitching on APOPLEXY. 
649 
being pinched slightly. The upper extremity also, more severely; 
urine dark orange, clear, acid, but depositing a sediment like brick 
dust. No stool had occurred since the 8th. Cuprum repeated. 
Feb. 13. Passed, after a clyster, considerable portion of blackish 
fieoes, horribly foetid; he is becoming livelier, has taken soup with 
relish. He attempts to speak, and has some sensibility in the arm, 
and can move the leg. Has cough, raising thick clots of mucus; 
respires with more ease. Urine less dark, still turbid, depositing the 
same sediment. 
Repeat the Cuprum. Drew his weak arm out of bed, looked at it 
and the other, touched it and then began to weep violently. 
Feb. 14. He tries constantly to speak, but articulates only short 
words; can hold his arm free when it is raised, bend the elbow and 
wrist a little, but it trembles much. Large clots of mucus continually 
thrown up by the cough; can pass from the bed to the sofa with sup- 
port. Urine dark gold color, clear and acid. Repeat the Cuprum. 
15th. Walks twice daily from the bed to the sofa without his foot slipping. 
The mobility of the arm improves, but the speech gets on slowly. 
He stills throws up much mucus continually. The urine is brighter; 
tongue clean; appetite good. He could not yet put out his tongue. 
Repeat Cuprum. 
The medicine was continued, and up to the 19th the urine wras straw 
color and clear; by the 23d the cough and expectoration had ceased 
also. He now kept out of bed the greater part of the day. In the 
first days of March he began to walk about in the house; and from 
March 17th he wTent out in the open air a half hour or hour daily. In 
his walk nothing morbid is seen; but his arm trembles on the least 
stretching, and his speech is no longer fluont. (Mayer.) 
M. Trousseau* says his treatment of apoplexy consists in doing 
nothing. He says he regards the cerebral haemorrhage as a fact ac- 
complished ; and he asks, of what use can the lancet, cups, or purges 
be, in presence of a foreign clot of blood ? 
Instead of bleeding a man who has just fallen from an apoplectic fit, 
M. Trousseau encourages him to sit up, to eat, and finds more of his 
patients recover, and faster than when he used to bleed and purge 
them and keep them in bed. He cites remarkable cases where bleed- 
ing seemed to have suddenly determined the apoplectic attacks against 
wdiich it had been employed as a prophylactic. In this idea he is in 
full accord with the teachings of Cruveilhier, (Diet, de Med. et de 
Chir. Prat., p. 259,) of Andral {Clin. Med. t. IV., p. 499), of Ch. 
Robin and Beraud, who cite bleedings as among the causes of apoplexy. 
, Official science of the present day denounces bleeding also in in- 
* Trousseau, Gaz. des Hop., 1857, p. 332. 650 
DISEASES OF THE NERVOUS FUNCTION. 
flammatory affections, even in the most decided phlegmasias, which 
since the works of Andral, Garvarret, Becquerel, Rodier, are no longer 
attributed to the richness or plasticity of the blood. On the contrary, 
the idea prevails that “phlegmasias chiefly attack the debilitated. 
“ That weakness and globular anaemia predispose to them. 
“That the more blood such patients lose, the more liable they ar& 
to inflammation.” 
6. COMA.—STUPOR. 
This name is applied to a state of the brain which is a symptom of 
many diseases. We recapitulate some of them in connection with 
their causes. 
Importance of Free Respiration.—In certain states of the brain 
free and perfect respiration is indispensible to recovery of health. 
Of these are : 1. Coma, from injury or disease, sanginous or serous. 
Cases from cerebral injury are given in all the books, which show that 
death generally takes place by apnoea. In most of these life can be 
saved even in those almost hopeless. 
2. Narcotism.—The greater the insensibility in narcotic coma the 
more respiration is affected; the more, therefore, it requires to be 
watched. Coma and narcotism both kill by the lungs. They differ, 
however: 1. In the apnoea of coma death is generally (at least prima- 
rily) due to the cessation of respiratory action—not to muscular 
paralysis—but to lung paralysis, evinced by extreme and rapid con- 
gestion of the lungs, accompanied by rapid effusion into the pulmonary 
air cells and bronchial tubes. The death is apnoea by effusion, unless 
it can be warded off. The treatment for the apnoea of coma is that 
which will remove congestion of the lungs and prevent its further 
formation. But far more important is the prone position advised by 
Dr. Marshall Hall, by which an immense amount of bronchial effusion 
may be got rid of. Without the prone position the bronchial effusion 
may so accumulate that the patient may, in reality, die of narcotism, 
from non-eliminated carbonic acid gas. Artificial respiration may not 
be necessary. 
2. In the apnoea of narcotism there is neither the rapid effusion nor 
the great congestion of coma; but, if death ensues, it is chiefly from 
musculo-respiratory paralysis. The pulmonary congestion is less than 
in cases of coma, for the narcotic influence diminishes the strength 
and frequency of the cardiac pulsations, which are unrestrained in 
coma. 
In the Treatment of narcotic apnoea, no depletory measures should be 
resorted to, nor is the placing in the prone position necessary to re- 
move the effusion, but it is chiefly necessary on account of the lingual COMA, 
651 
paralysis. Artificial respiration is here of great value, hut if the 
position of the tongue be neglected it may cause suffocation. 
Tartar-emetic.—The coma that occurs in the height of febrile par- 
oxysms, especially the violent ephemeral attacks to which young chil- 
dren are subject; there is often vomiting with the fever, and irritation 
from dentition. 
Opium.—The effects of Opium vary according to the quantity given. 
In small doses it sensibly excites the nervous and vascular systems. 
The cerebral functions in particular are rendered more active and 
energetic. Volition is stronger and more prompt, and a temporary 
vigor is felt in all the voluntary organs of the body. Vivacity, joyful- 
ness, courage, ambition; indifference or rather defiance to the ills of 
life; in short, all those delightful feelings which spring from a con- 
scious energy of mental and bodily powrer, and an absence from pain- 
ful or unpleasant sensations arise from a dose of Opium of the neces- 
sary size. 
If the quantity be increased, the narcotic effect will be more con- 
spicuous. The blood is congested in the vessels of the brain; the 
mind is unsettled and incoherent; voluntary motion is performed with 
less freedom; sensation is diminished; the eyes are suffused and 
vision is indistinct. Finally, the voluntary motions are suspended. 
The sensorium commune ceases to exercise control over the animal 
functions of the system; and profound and heavy sleep weighs down 
every conscious faculty. If the dose has been large the sleep becomes 
more and more lethargie; the sensorial power is rapidly impaired, in 
consequence of which respiration is imperfectly performed, the blood 
ceases to receive its due proportion of oxygen in the lungs, which 
tends still further to diminish the cerebral functions; until, finally, 
they stop altogether; and, with them all other movements of the 
animal system. 
Symptoms produced by Excessive Doses.—A robust, muscular young 
lady, aged eighteen, took half an ounce of solid Opium. She was 
found sitting in a chair; head throwm back, face pale and ghastly; 
breathing difficult and stertorous, pulse 90, small and feeble. She 
now had forced down her throat twenty-seven grains of Tartar-emetic ; 
warm water in large quantities. She next took Sulphate of Zinc, 
thirty grains; then Ipecac., ground mustard, titillation of the fauces 
with a leather, without having emesis excited. A stomach pump was 
then employed, and the stomach emptied eight hours after the taking 
of the Opium. Then strong coffee was thrown into the stomach and 
withdrawn. She was dragged about the room and kept in agitation all 
night; she took strong coffee, carbonate of ammonia, &c. When she 
could no longer be roused, slapped with cloths wet with cold water till 
the stupor became so profound that no effect was produced by any 652 
DISEASES OF THE NERVOUS FUNCTION. 
effort. External irritation was then tried. Three gallons of hot water 
was prepared by dissolving in it one pound of table salt. This was 
used by means of rough stove brushes, kept constantly wet in the brine 
and applied vigorously to the skin. In an hour the rubbing caused 
smarting of the skin, but it was continued till the blood started after 
the brush, and the patient complained bitterly of the cruelty of her 
attendants. She drank a pint of strong coffee and soon partially re- 
covered. But there was again relapse, for which stimulants were used 
to the nostrils; after vomiting there was return to consciousness. 
More coffee was given; final, but slow recovery. 
Opium, by habitual use, loses its power to such an extent that in- 
credible quantities may be taken, and it may produce such a torpor of 
the stomach as to render it insensible to every other agent. Lord Elgin 
and his party saw, at Constantinople, in 1815, an extraordinary man, 
more than one hundred years of age, who had acquired celebrity by 
eating Corrosive-sublimate. When young, he accustomed himself to 
swallow pill's of Opium. After long practice he found it had lost its 
power. He afterwards tried Corrosive-sublimate, and for thirty years 
he was in the habit of eating about sixty grains per day. He declared 
that this poison had no effect but to produce the most delightful sen- 
sations. Never, since the days of Mithridates, have his experiments 
been surpassed. 
Ordinary Symptoms produced by Habitual Use of Opium.— 
When not under the influence of his habitual narcotic, the habitual 
Opium-taker shows every mark of physical and mental imbecility. He 
is timid, low-spirited and pale ; he has a tormenting anxiety of feeling; 
disinclined and unfit for mental or bodily exertion; he is peevish, and 
feels pain in different parts ; his extremities are cold; he suffers from 
indigestion; cannot sleep; and feels a tremor over the whole body. 
Opium is more abused in the diseases of children than any other 
remedy. The mortality of infants from injudicious use of anodynes 
is enormous. Nothing can be more uncertain than the effect of Opium 
upon infants. Very small doses are often fatal. Harris called public 
attention to the practice more than two centuries ago, and says that 
“it swelled the number of the dead and rid those who had the care of 
infants of further trouble.” In one case, one grain of Dover’s Powder 
destroyed a child’s life ; and in another one-sixth of a grain of Opium 
produced stupor for two days; a half drop of Lau lanum narcotized a 
child. A tea spoonful of a mixture of one drop of Laudanum to an 
ounce of simple syrup narcotized a new-born infant. 
Symptoms.—An infant stupefied with Opium for six, twelve, or 
twenty-four hours breathes laboriously; there is determination of blood 
to the head, or predisposition to hydrocephalus; the child cannot be 
waked to take food; absorption goes on, emaciation is rapid; debility COMA, 
653 
and death are the ordinary results. Infants often narcotized are fee- 
ble ; do not grow, and generally die of some disease before the fifth 
year. Opium produces indigestion as in adults. 
Casd.—In a fever, attended with coma, the patient lay extended 
deprived of speech, the eyes open, the limbs stiff, the pulse small and 
intermittent, respiration disturbed and stertorous, C. L. Hoffmann saw 
no remedy but Opium do any good. General experience shows that 
these symptoms are all produced by Opium. Several authors report 
cases of lethargic fevers with Opium. De Meza effected a cure in 
one case, which had resisted all other means. (Magaz. Therap.) 
Hufeland cured one that had lasted for several days. [Ilufeland.) 
Treatment of Poisoning by Opium, see p. 651. 
Sulphate of Zinc—White Vitriol.—This &alt, in its crystalized 
state, is composed of Sulphuric-acid 1, equivalent = 40; Zinc 1, = 
42 ; Water 7, equivalent = 63. Common Effects.—In doses of half 
a grain to two grains, it acts as an astringent tonic. In doses of from 
ten to thirty grains it is strongly emetic. Being more prompt than 
any other emetic it is preferred for all those cases where poisons have 
been swallowed and a speedy operation is required. As a poison, in 
an over-dose, it causes “pale and sunken countenance ; cold extremi- 
ties ; dimness of appearance of the eyes; convulsive pulse.” These 
symptoms were produced in a young lady who took two ounces of the 
substance. This extreme prostration would be followed by inflamma- 
tion, but vomiting soon ensued; the most of the vitriol was thrown up, 
and the balance was decomposed by means of fixed alkali, diluted with 
sugar water ; the vomiting then ceased, and she was in two hours free 
from alarming symptoms. (Orfila.) Where vomiting is desirable, and 
there is insensibility and torpor of the stomach, as in poisoning by 
Opium, White Vitriol is the best emetic. In such cases it is more 
likely to act than Tartar-emetic, and less injurious. 
Coffee.—After free vomiting, and the poison is known to be Opium, 
Laudanum, Prussic-acid, or any vegetable substance containing it, (as 
bitter almonds, peach kernels, &c.), Stramonium, poisonous Mushrooms, 
Belladonna, Colocynth, Valerian, Conium, Chamomile-tea, Antimonial- 
wfine, Phosphorus, Phosphoric-acid, Nux-vomica or Strychnine; in all 
of these cases Coffee is an essential remedy. See Vol. I., p. 514. 
Camphor.—This is a good remedy for poisoning by vegetable sub- 
stances ; sharp, acrid, burning poisons, which cause inflammation and 
redness; in all cases of poisoning in which there are: vomiting and 
diarrhoea; the patient cold as ice, almost senseless; when poisonous 
insects, as cantharides, have been swallowed or got into the eye; 
Camphor may be given, as recommended under cholera. In cases of 
poisoning from poisoned honey; swellings, caused by hairy caterpil- 
lars; alarming symptoms caused by the sting of insects; when stran- 654 
DISEASES OF THE NEKVOUS FUNCTION. 
gury gives rise to suspicion of poisoning by Cantharides, Camphor oi 
Bromine is the best remedy. 
7. ANiEMIC COMA.—HYDROCEPHALOID. 
If cerebral anaemia be allowed to continue for a long period, it 
will occasionally terminate in hydrocephalus, and also in the white 
softening called rainolissement. 
Hydrocephalus may be : 1. anaemic ; 2. inflammatory. 
1. Dr. Marshall Hall first showed the resemblance between the 
comatose condition from exhaustion, and that occasioned by inflamma- 
tion. The first he called “ hydrocephaloid affection of infants arising 
from exhaustion.” It commonly results from diarrhoea, from bad food, 
or long-continued use of purgatives, or from bleeding. 
The first stage is that of irritability ; the second of torpor. In the 
former there appears a feeble attempt at reaction; in the latter the 
nervous power appears more prostrate. 
Symptoms.—The infant becomes irritable, restless, feverish ; the 
face flushed, the surface hot, pulse frequent; undue sensitiveness of 
the nerves; starting on being touched, or from sudden noise; sighing 
or moaning during sleep ; screaming ; bowels flatulent and loose ; fatal 
exhaustion. The countenance then becomes pale, and the cheeks cool 
or cold; the eyes are half closed; eyes fixed and contracted by any 
object placed before them; the pupils unmoved on the approach of 
light; the breathing, from being quick becomes irregular and inter- 
rupted by sighs; the voice becomes husky, and there is sometimes a 
husky, teazing cough; eventually the strength is subdued and ex- 
hausted. 
Diagnosis.—The coma resembles that which is seen in the last stage 
of other exhausting diseases, coming on a considerable time before 
death, and while the pulse is still distinctly felt. Some children lie 
for a day or two in this kind of stupor and recover under the use of 
wine and good nourishment. It is often hard to distinguish it from 
that accompanying diseases of the brain. It attacks them after some 
continuance of exhausting diseases, such as tedious or neglected diar- 
rhoea ; and the patients lie in a state of insensibility, the pupils dila*ted# 
the eyes open and insensible, the face pale and the pulse feeble. It 
may continue for a day or two, and terminate in death or recovery. 
This affection appears to correspond with the apoplexia ex inani- 
tions of the older writers. It differs from syncope by its coming on 
gradually and in its continuing a considerable time; perhaps a day or 
two ; and is not like syncope induced by sudden and temporary causes, 
but by causes of gradual exhaustion, going on for a considerable time. 
It differs from mere exhaustion in the complete abolition of sense and ANJ2MIC COMA. 
655 
motion, while the pulse can he felt distinctly, and there is in some 
cases considerable strength. Cases have occurred in adults, but they 
are less common than in children. This state in infants is one of 
•pure coma, and only differs in appearance from that seen in the very 
last stage of hydrocephalus in “ the child lying with the eyes open, or 
half open, the pupils dilated, the face pale.” The expression is one 
of coma rather than of sinking- “ It came on after diarrhaea and not 
with any symptoms affecting the head.” 
For the purpose of arresting the exhaustive diarrhoea the measures 
recommended under cholera infantum must be employed. The diet 
and remedies must be essentially the same in both diseases. 
For the persistent coma, Opium, Wine and good nutritious, easily di- 
gested food are sufficient. There is in these cases a real congestion 
of the brain, though the symptoms be those of exhaustion. The 
symptoms before death and effusion found after it in the brain show 
this to be true. The little blood remaining stagnates within the crani- 
urn and other weak portions of the organism: hence the extremities and 
surface are bloodless, and must be kept warm by flannel and frictions ; 
the child must be kept in a reclining posture, never erect; the room 
must be well aired. 
Cases by Dr. Ilall.—1. A girl, two years old, small, delicate, has anae- 
mic appearance, coma, lies languidly dozing; pulse weak not very quick; 
takes no nourishment. Six leeches were applied to her head w hich bled 
freely and made her much worse in the evening. She wras then dead- 
ly pale; scarcely any pulse ; skin cold; pupils dilated, motionless when 
exposed to light; no squinting; seemed not to see a watch held before 
her. Circulation of the brain too languid to support the sensibility of 
the retina. She was treated only by good food. For several days her 
wasted features grew sharp; she became more fretful, uttered a faint 
squeaking cry; eye-balls sunk in the sockets like those of a corpse dead 
for a month ; skin cool, pulse tremulous, nearly imperceptible. She re- 
vived slightly for a few days, recovered sight; lived a week and died. 
Post-mortem showTed only a little more serum than usual in the ven- 
tricles. 
2. In a similar case, ten months old, there was the same unwilling- 
ness to hold up the head, the same drowsiness, languor, absence of heat 
and fever. The child had been well till weaned two months ago, but 
has since declined. It was fed with better food, taking one and a half 
pints of asses milk in twenty-four hours, and ten minims of spirit of 
Ammonia in four hours. Treatment continued two or three days, the 
child recovered. 
Apparent Death from Lightning.—A person rendered insensi- 
ble by a stroke of lightning, should be placed in a current of cool fresh 656 
DISEASES OF THE NEKYOUS FUNCTION. 
air. Fresh water should then be freely dashed over his face, neck and 
chest. 
Hering recommends that the patient be placed in a half-recumbent, 
half-sitting posture with the face turned towards the sun. Then cover 
him entirely (except the face,) with newly dug earth until there are 
signs of returning animation; after which Nux-vomica should be given 
by placing a few pellets on his tongue, and repeating the dose every 
half hour. 
8. PARALYSIS.—PALSY. 
Paralysis is characterized by a partial or total loss of voluntary 
motion or of sensation. In some cases both sensation and voluntary 
motion are destroyed. These symptoms occur without coma, loss of 
consciousness, or much derangement of the intellectual powers, if we 
except an occasional weakness of memory. It may follow apoplexy, or 
arise from disease of the spinal marrow. When it succeeds to an apo- 
plectic attack, there is usually a paralysis of side of the body, which 
is termed hemiplegia. Palsy of the lower part of the body, or para- 
plegia, may arise from disease of the brain or spinal marrow; though 
most commonly the former organ is the seat of the affection. Par- 
tial or local palsy affects some particular part of the body, as an arm, 
wrist, or the face. The muscles of the face are most often affected, this 
variety may arise from the pressure of a tumor, from mechanical injury 
or from disease of the portio-dura. We sometimes see a palsied state 
of the wrists which has been termed lead palsy from the supposition 
that it owes its origin to the absorption of lead into the system. This 
indeed is often the cause of paralysis ; but in many instances we have 
been unable to tjjace the cause of the malady to this drug; and we have 
in several instances known it to follow long exposure to cold and wet 
in the act of driving. In three cases this result occurred in individuals 
in perfect health. In one instance the exposure took place after a 
course of blue pills. 
Pathology.—Voluntary muscular motion is usually supposed to 
“ take place only in consequence of a stimulus imparted to the muscu- 
lar fibre through the medium of the nerves, and paralysis of motion or 
paralysis of innervation occurs generally, not from defect in the mus- 
cular tissue itself, but because of an interuption of this stimulus.” 
The cause, of this interruption of the passage of nervous impulse 
may be : 
1. “ Mechanical, as the pressure of a clot or effusion, with or without 
effusion of serum into any of the cavities, concussion from blows,” &c. 
2. Physiological; as the cutting off the supply of nutrition from 
chronic inflammation of the membranes, thus interfering with the ca- 
pillary circulation in the nervous substance ; ” 657 
PARALYSIS. 
8. “ Disease of tlie nervous tissue itself, as softening, tubercular de- 
posits : ” 
4. Both the mechanical and physical causes combined. 
Diagnosis.—'When there is only a loss of voluntary motion, the part 
affected wastes away, and becomes soft from want of use, while sensation 
may lemain natural, or, as sometimes happens, there will be a morbid 
sensibility, or a bruised and painful feeling in the part affected. We have 
known this morbid sensibility in two or three cases to be exceedingly 
troublesome, rendering it impossible for the patient to move, or be mov- 
ed, without great pain. In some cases, there is an entire loss of sen- 
sation, as well as voluntary motion. Often, wdien the sensibility of the 
part is only partially destroyed, formication is experienced in the parts 
affected. 
The loss of muscular power and of sensation, will in all instances bear 
a direct ratio to the extent and severity of the original affection and the 
part affected. 
Examine the condition of all the muscles of the paralyzed limbs. 
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 your 
efforts and the degree of that resistance. Sometimes the biceps alone 
resists, sometimes the triceps ; flacciditv, slight resistance, and absolute 
rigidity denote different states of the brain. 
The perfectly flaccid condition of the muscles of the palsied limbs de- 
notes cerebral lesion distinctly atrophic in its nature: the opposite oi 
inflammatory, of the low kind and one in which there is a tendency to 
wasting in which the vital powers are below jpar. 
The resistive state of the paralyzed muscles shows that the cerebral 
lesion is of an irritative kind: perhaps the small apoplectic clot with 
laceration by the effused blood of some of the healthy brain substance 
immediately adjoining it. 
When the palsied muscles are rigid, hard and almostin a tetanic con- 
dition the brain lesion is of a more distinctly irritative kind. These are 
the cases formerly considered best adapted to bleeding; and especially 
for the specific effect of Mercury. When the muscles are flaccid these 
measures are still more immediately fatal. 
Pathology.—If irritation falls upon the vaso-motor nerves of the 
motor tract of the cranio-spinal axis, “ we have reflex paralysis ; as the 
frequently-observed paralysis in connexion with disease of the kidneys 
and bladder, the paralysis of children from dental or intestinal irrita- 
tion, loss of power over certain muscles of the face from neuralgia of 
the fifth, or pair of muscles of the leg from sciatica, &c. (Dr. Hughes.') 
Distinctive Characters of this reflex Paralysis.—Dr. Brown-Se- 
quard thus gives them : “ 1. The supposed cause has always preceded 
the paralysis. 2. The changes in the intensity of the cause have 
Yol. ii 42. 658 
DISEASES OF THE NERVOUS FUNCTION. 
usually been accompanied with corresponding changes in the paralytic 
symptoms. 3. The usual remedies against paralysis have proved use- 
less. 4. The affection, in many instances, has been speedily cured 
after the cessation of the irritating cause. 5. There was no visible 
alteration of the nervous centres in several cases in which autopsy was 
made.” 
The transmission of the orders of the will is effected mainly through 
the antero-lateral columns; and a transverse section of these always 
causes paralysis of the parts below. They convey the impulse of voli- 
tion, not directly into the motor nerves, but to the cells of the anterior 
horns, which send out processes in a transverse direction to join them. 
The antero-lateral columns have been less perfectly understood by 
Sir Charles Bell and his successors. Dr. Brown-Sequard, by nume- 
rous vivisections and pathological researches, has ascertained what 
seems to be the entire office of this portion of the medulla spinalis. He 
shows that section or disease of the posterior columns alone—the pos- 
terior roots being unaffected—causes no anaesthesia, but often even 
the reverse, in the parts below and behind; while on the other hand 
disease or injury limited to the gray matter entirely deprives the cor- 
responding parts of sensibility. It Is therefore concluded that the 
conductors of sensitive impressions run to the brain in the central gray 
matter. 
Dr. Brown-Sequard has also discovered that “ while the motor fibres 
cross over in the medulla oblongata, those in the spine make their de- 
cussation almost immediately upon their entrance into the gray matter; 
so that disease or injury, limited to one lateral half of the cord, will 
cause paralysis of the same side of the body, but anaesthesia of the op- 
posite side.” He also shows that in some instances there exist more 
than one kind of sensibility, while others have been destroyed by dis- 
ease. Thus, in one case, touching, pinching, pricking, and the passage 
of a powerful electric current were unfelt; but there was sensibility 
to cold and to tickling. In another, there was no sensation produced 
by heat, though contact was sensibly felt. In the North American 
Journal of Homoeopathy, Yol. VI.,.a case of poisoning by Arsenic is 
reported in which, though both arms and legs were paralyzed as to mo- 
tion and common sensibility, the paralyzed part remained acutely sen- 
sitive to cold. 
Effect of loss of Nervous Influence upon Organic Functions.— 
The proper vital energies of a paralyzed part are not generally inter 
fered with by the defective nervous supply; burns, fractures and 
wounds, are observed to heal as rapidly in paralyzed as in other parts. 
It is with the tissues and organs generally as with the muscles: their 
own independent vital contractility is not impaired by cutting off their 
nervous supply ; but their sole normal stimulus to action being absent 659 
PARALYSIS. 
they lie idle and waste from inaction. In general the tissues being 
always in action require no stimulus ; but the glands, being intermit- 
tent in their activity, can only be roused to energy by an appropriate 
excitation. If this excitation be, as with the muscles, through the 
medium of nerves, it is evident that section of their nerves will para- 
lyze them as effectually as it would in the case of muscles. But if as 
with the glands of the stomach the normal stimulus be immediate, 
then abstraction of nervous influence will not, after the first shock is 
over, permanently injure their activity. If the pneumogastric be di- 
vided while the secretion of gastric juice is going on, the process will 
be suddenly arrested; but two or three days afterwards, (as ascertained 
by Dr. John Reid,) it will be resumed, and go on as if nothing had 
happened. Dr. Reid has compared the relation of the nervous system 
to the organic functions to that of a rider to his horse. The former 
can excite by spur and control by bridle, but the motive power is in 
the animal; and if the rider falls off, the horse may proceed without 
impairment of his activity. {Brit. Journ. Ilom., 1861, p. 667.) 
Paraplegia.—The cases of this form of paralysis are divided by 
Brown-Sequard into two groups : “ 1. Cases in which there is an in- 
creased amount of blood in the spinal cord or its membranes. There 
are always symptoms of irritation, convulsions, cramps, twitchings, 
erection of the penis, from irritation of the motor tracts; formication, 
itching, pricking, and other pains; abnormal feelings of cold or heat, 
of tightness, pressure, &c., from irritation of sensory tracts; diminu- 
tion of temperature of the paralyzed limbs, wasting of muscles, oedema, 
bed-sores, alkaline urine, &c., from irritation of the ganglionic fibres. 
2. Cases unaccompanied by any of these symptoms of irritation. In 
these there is a diminished amount of blood in the cord. The former are 
cases of inflammation or congestion; the latter are cases of white 
softening, or of reflex paralysis. In the former only those remedies 
must be used [allopathically] which diminish the amount of blood in 
the cord ; in the latter those remedies which increase it.” 
Hemiplegia from White Softening of the Brain.—Causes.— 
White softening of the brain depends on any condition which cuts off 
from the brain or a part of it a normal supply of blood. In one case, 
two days after application of a ligature to the common carotid artery, 
the patient was suddenly seized with hemiplegia of the side opposite 
without loss of consciousness. Dissection showed a state of white 
softening of the cerebral hemisphere of the same side as that of the 
carotid tied. Dr. Todd gave the history of a case of a large dissect- 
ing aneurism of the aorta in which the blood forced its way from a slit 
in the aorta, splitting up the coats of the innominata to the right com- 
mon carotid, where it coagulated and formed a plug which obliterated 
the carotid. The patient, after twro days, became hemiplegic of the 660 
DISEASES OF THE NERVOUS FUNCTION. 
opposite side, complaining only of pain in the back and chest; he lived 
eleven days, and showed on dissection white softening of all the parts 
of the right hemisphere supplied with blood by the anterior cerebral 
artery. 
Softening is most common at from fifty'to eighty years of age. 
There is generally an atherematous state of the arteries generally, 
which consists in the deposition of earthy and fatty matters in the 
walls of the vessels, causing degeneration of their tunics. 
Treatment.—We regard Iihus-tox. and Causticum as our most 
valuable remedies in ordinary paralysis. We have usually employed 
these medicines at the second dilution in water. 
The following are the principal indications for Rhus-tox.: 
Causticum.—Paralysis and various forms of facial muscles, organs 
of speech or deglutition. Numbness, deadness, or tremulous weakness 
of parts, following rushes of blood. 
Next to the above remedies in importance are Nux-vom., Ruta, 
Cannabis-ind., Agaracus-musc., Phosphorus, Cantharides, Plumb., 
Cocctdus, Sulphur, Strammonium, Belladonna, Codeine, Ignatia, 
Arnica, Mezereum. 
Belladonna.—Brown-Sequard says: “Not only have I seen the 
diminution in the calibre of blood-vessels of the pia-mater of the spinal 
cord, taking place in dogs after they had taken large doses of Bella- 
donna or Ergot of Rye, but I have also ascertained that the reflex 
power of the spinal cord (most likely as a contraction of blood-vessels) 
becomes very much diminished under the influence of these two reme- 
dies, which in so doing act just in the opposite way to the action of 
Strichnine.” 
Belladonna causes contraction of the vessels of the cord, and dimi- 
nution of the amount of blood; so do Ergot of Rye and Mercury; but 
Mercury has such a depressing influence that it is better not to employ 
it except in cases of syphilitic paraplegia. Strychnine increases the 
amount of blood in the cord, and should be used only in cases in which 
there is no sign of irritation of the cord. Ammonia, Sulphate of Qui- 
nine, Iron and Cod-liver Oil, are very useful in similar cases. Iodide 
of Potassium is one of the most powerful agents for promoting the ab- 
sorption of the effused fluids. It may be employed in either class of 
cases, but it is especially useful in cases of syphilitic paraplegia. 
(Dr. Brown-Sequard, p. 84.) 
In all the observations of accurate observers, we find important ma- 
terials for our homoeopathic use of the very remedies on which they 
have been experimenting. If we employ these remedies according to 
the homoeopathic law, on a principle exactly opposite to that on which 
they have been allopathically employed, they will be successful; and 
they must then be used in small doses. They then cure all the symp- PARALYSIS. 
661 
toms which they are able to cause by their primary action; and on 
this principle they are governed by the law of similia, and give us 
their best curative effects. There is, however, a degree of success in 
prescribing them according to the recommendations of Brown-Sequard. 
They, even in this way, cure the symptoms which they secondarily 
produce. As this mode of curing diseases requires larger doses than 
are required to cure appropriate cases according to the Hahneman- 
nian interpretation of the law of cure, it is not the mode by which dis- 
eases should be cured', there may be cases, however, in which cure 
by any legitimate mode is sufficiently satisfactory. 
Rhus-Tox. may be used in cases of paralysis when there is great 
sensitiveness to cold air; general debility; tingling or itching in the 
paralyzed parts; languor; constant desire to be hi bed; fainting fits. 
Arnica may be given to paralytics with feeble or impaired consti- 
tutions, whose pains are aggravated by motion or talking; with painful 
sensitiveness of the whole body ; tremors of the limbs; relaxation, and 
general debility; hemiplegia. Hahnemann says: “What could have 
bestowed upon the poison Sumach (as in the case cited by Alderson) 
the power of curing a paralysis of the lower extremities, attended with 
weakness of the intellectual organs, if it did not, of itself, evidently 
possess the faculty of depressing the muscular powers, and of acting 
on the imagination of the patient to such a degree, as to make him 
believe that he is at the point of death, as in a case witnessed by Zadig.” 
JVux-vomica.—is suitable for paralysis occurring in sanguine or 
choleric individuals. The indications for its use are : paralysis, espe- 
cially of the lower extremities; trembling of the limbs; painful con- 
tractive sensations; cramps and spasmodic twitchings in the parts; 
languor; heaviness and stiffness of the limbs; great sensitiveness to 
cold air; paralysis which has been induced from abuse of stimulants, 
coffee or narcotics; or where the predisposing cause has been want of 
exercise, with severe and protracted mental labor. 
Ruta has been highly extolled as a remedy for rheumatic paralysis of 
the tarsal and carpal joints. It is also indicated in local paralysis, which 
has followed surgical operations, or which is owing to injury or pressure 
upon sotne particular nerve. 
Sulphur.—In cases, says Brown-Sequard, “ of reflex paraplegia, or 
white softening of the spinal cord, in which there is no irritation of 
this nervous centre.” 
We have found Sulphur of eminent service in cases of paralysis, 
accompanied by great irritability and sensitiveness of the rectum, and 
causing excruciating pains during every attempt at an alvine evacuation. 
We also suggest Baryta-carb., Cocculus, Lachesis, Plumbum, 
Pulsatilla, Bryonia, Conium-7naculatum. 662 
DISEASES OF THE NERVOUS FUNCTION. 
Administration.—The remedies may be exhibited at from the first 
to the third attenuations,—a dose once or twice daily. 
Phosphorus.—It has been successfully employed by German phy- 
sicians in paraplegia, “ probably in cases in which there is deficiency 
in the amount of blood in the spinal cord.” As the presence of Phos- 
phorus in nervous matter gives it vitality, so its deficiency may lead to 
paralysis. It may thus act curatively by replacing the constituent 
which is deficient. 
Cantharides.—Brown-Sequard says he has “ tried it without any 
benefit in cases of paraplegia belonging to the two most distinct forms 
of this affection. It seems, however, to have been useful in some cases 
of chronic myelitis.” 
Stramonium, Hyosoyamus, Cannahis-indica.—These agents act 
more or less like Belladonna and Ergot on the blood-vessels of the 
spinal cord, and they are therefore to be used in those cases of para- 
plegia in which the amount of blood is increased in that organ. Of 
course they must be avoided in cases of wfflite softening, or of reflex para- 
plegia. “ Against insomnia in cases of paraplegia, with symptoms of 
irritation of the spinal cord, Hyoscyamus or Indian Hemp should be 
employed instead of Opium, the use of which is dangerous, as it pro- 
duces a congestion of the spinal cord.” 
Aconite is the most important of all paralytic remedies. 
Electricity.—“ Have electric and galvanic shocks ever been attended 
with any other result in such cases than a gradually increasing and 
finally absolute paralysis and extinction of all muscular and nervous 
irritability in such limbs? 
“An apothecary (in Jever) had a voltaic column, the gradual strokes 
of which gave temporary relief to persons afflicted with deafness. 
Soon these shocks caused no more effect, and it was necessarv, in 
order to produce the same results, to render them stronger, until, in 
their turn, they likewise became efficacious ; after this the most power- 
ful shocks would at first excite the patient’s hearing for a short time, 
but at length leave him quite deaf.”* 
Electro-Magnetism.—This is convenient; it furnishes an uninter- 
rupted current, adds an additional beneficial effect in the shape 
of magnetism. Various styles of these machines are in the market. 
One of the best “ consists of a helix of insulated coarse and fine wire, 
wound over small, soft iron wire for a temporary magnet, with a hori- 
zontal magnet, spring-hammer, and silver-pointed screw, to break the 
circuit connected with one of Smee’s zinc and platina batteries, to be 
excited by dilute Sulphuric-acid. These machines give six currents 
of various powers and effects; they are light, portable, clean, con- 
venient for use.” 
# Hahnemann, Organon.—Introduction. PARALYSIS. 
663 
There are also magic machines producing frictional electricity by 
a crank-motion, hut they are not very reliable or convenient. 
In all of those cases of palsy which have resisted our treatment by 
internal remedies, we should have recourse to electro-magnetism. 
This agent when properly and perseveringly applied, will often effect 
cures after all other means have failed. This potent remedy should 
always, however, be applied under the direction of a judicious physi- 
cian; for it is an agent capable of doing serious injury when improperly 
employed. 
Paraplegia.—Secale.—Ergot acts, not only on the uterine fibres 
when in a state of inertia, but also on the bladder, rectum and inferior 
extremities when these parts are in certain asthenic conditions. Its 
special primitive action is on the spinal marrow. Dr. Payen, of Aix, says : 
1. A man had paraplegia from the effect of a fall on the perineum. Local 
applications failed to benefit him. He took fifteen grains of Secale at 
once; twelve hours after the paralyzed limb was agitated by frequent 
muscular starts, and recovered strength. In six days he began to walk. 
Ergot continued in doses up to thirty grains produced gastric dis- 
turbance and wras suspended. In a month he was well. 2. A man, aged 
thirty, had paraplegia. Other treatment failed. The twTo lower limbs 
could support the body, but he could walk but a short distance till he 
fell. Left leg insensible and atrophied. Bladder has lost part of its 
contractility. Ergot every morning, fifteen grains, frictions with stimu- 
lating liniments along the spine. In eighteen days he recovered. 3. 
A workman had paraplegia, caused by working in lead. Other treat- 
ment failed. Secale succeeded. 
Paralysis of the Auditory Nerves.— Deafness.— Causes.— 
Consanguinity.—M. Boudin, of France, distinguished for his re- 
searches on medical statistics, says it is proved by his researches 
that consanguineous marriages are contracted in France at the rate of 
2 per cent.; and that deaf-mutes are the issue of such marriages in 
proportion of 28 per cent., at the Paris Imperial Institution, 25 per cent, 
at Lyons, and 30 per cent, at Bordeaux. That marriages betwreen 
nephews and aunts are contracted in France in proportion, of 14 in 1000, 
while deaf mutes the results of such marriages are 145 times 
more numerous than they should be. Marriages between uncles and 
nieces occur at the rate of 4 per 100, and the deaf mutes resulting is 
40 times greater than from ordinary marriages. Marriages between 
cousin-germans are contracted at the rate of 77 per 100, and deaf 
mutes are produced in proportion of 24 times more frequently than 
from other marriages. 
liesults of Indirect Consanguineous Marriages.—While at Berlin 
* Recueil de Mem. de Med. Militaire. 664 
DISEASES OF THE NERVOUS FUNCTION. 
the proportion of deaf mutes is but 6 in 10,000 among the Christians 
it is 27 in 10,000 among the Jews. In nearly the whole of the cases 
the deaf mutes born of consanguineous marriages have parents per- 
fectly exempt from hereditary affections. When male and female deaf 
mutes intermarry, if they are not related by consanguinity their chil- 
dren with rare exceptions, are exempt from deafness and dumbness. M. 
Boudin concludes that “ the hypothesis of the pretended harmlessness of 
consanguineous marriages is contradicted by the most evident and well- 
verified facts, and can only be excused by the difficulty, or rather the 
impossibility, of giving a physiological explanation of the production 
of infirm children by parents who are physically irreproachable.” 
Since 1831, more than 15,000 men have been exempted in France 
from military service on account of deaf-muteness, deafness, or dumb- 
ness. {Deafness from Inflammation, Vol. I., p. 727.) 
Case by Dr. C. Dunliamr—A boy, aged seventeen, small, but well- 
proportioned and of .good constitution, healthy since his ninth year, has 
been deaf since he was four years old. At the age of three years had 
an eruptive disease of the whole scalp which resisted common allopa- 
thic treatment. A tar-cap was afterwards “placed upon the head, 
and, when firmly adherent to the scabs, was violently torn off,” “ leaving 
the whole scalp raw. This raw surface was moistened with a saturated 
solution of Nitrate of Silver. The eruption did not reappear; but 
from that time the child was deaf.” 
His condition at the age of seventeen excited “ the earnest solici- 
tude of his friends. His inability to move in society, or to get a situ- 
ation in business, on account of his deafness, has produced a morbid 
state of mind. He broods over his infirmity, and secludes himself even 
from his own family.” At this time he came under the care of Dr. C. 
Dunham, of Newburg, N.-Y. 
“He is quite unable to hear ordinary conversation, has never heard 
a sermon in his life. A loud ticking lever watch can be heard at a 
distance of three and one-half inches from either ear;” or when ap- 
plied to the forehead or the teeth, he hears occasional buzzing noises 
in front of the ears. The external meatus is abundantly supplied 
with soft normal wax. The membrana tympani is white, opaque, and 
evidently thickened. On inflating the middle ear (which he accom- 
plishes with great difficulty by closing both mouth and nose and mak- 
ing a forcible expiration,) the membrana tympani becomes but very 
slightly convex, and it is impossible to distinguish its distended blood- 
vessels. There has evidently been a deposit in the substance of the 
membrane. The orifice of the Eustachian tube is free. 
This thickening of the membrane had probably been accomplished 
* Amer. Horacepathic Review, Oct. 1858., p. 23. PARALYSIS. 
665 
years ago: there were no physical symptoms that could reveal the 
2>rocess by which it had been brought about. It was necessary then 
to trace the diseased condition to its origin. It was evident that the 
deafness had commenced immediately after the removal of the scalp 
disease by the external application of Nitrate of Silver. The tinea 
capitis was a jpsoric or dyscrasic affection, and “ this affection, dis- 
turbed in its localization on the scalp, had transferred itself to the tis- 
sues of the ear.” It was therefore necessary to go back to the origi- 
nal psoric disease, ascertain its specific and peculiar features and pre 
scribe a remedy which might present a true similimum for that. The 
mother thus described it: “ Thick, whitish scabs, hard and almost 
horny covered the whole scalp. There were fissures in the scabs, 
through which, on pressure, there exuded a thick, yellowish pus, often 
very offensive. There was great itching, and a disposition to tear off 
the scabs with the finger-nails—especially troublesome at night.” 
Dr. Dunham found that the remedy most nearly corresponding with 
these syrmptoms was Mezereurn. Hahnemann, Chronic Diseases, Vol. 
IY. recommends it for moist affections of the scalp. The proving in 
the Archiv., Yol. IY. Many symptoms point to the same, especially 
itching. A new proving by Dr. Wahle, of Rome, gives the group of 
symptoms more fully: “ Head covered over with a thick leather-like 
crust, under which thick white pus collects here or there, and the hair 
is glued together; on the head great elevated irregular white scabs 
under which pus collects in quantity and becomes offensive and breeds 
vermin. The child keeps scratching its face and head at night, and 
continually tears off the scabs.” 
Mezereurn was then prescribed for the deafness in the present case, 
“just as if the scalp affection had been still in its original form, and 
had been the immediate object of the prescription.” 
“ Feb. 3, 1857, Mezereurn 30, three globules to be taken on retiring.” 
“ 24. Thinks he hears better,—every sound seems louder,—hears 
the watch at four and a half inches from the right ear, and four and a 
quarter from the left.” Sac.-lactis. 
March 1. Has not improved during last week. Mez. 30, three gl. 
“27. Hears the watch at six and a half inches from the right ear, 
seven from the left.” Sac.-lactis. 
April, 20 ; Hears the watch at a distance of ten inches with the right 
ear, fourteen from the left. Hears ordinary conversation easily, with 
attention. Sac.-lactis. 
Sept. 28. Has been steadily improving till three weeks ago, he be- 
came more deaf. Mez. 30; Jan. 26, 1858. Hears the watch at four- 
teen inches from the right ear, and twenty-four from the left. Deaf- 
ness returns if he takes cold, and disappears with the cold. Mez. 30; 
March 19. Heard the whole sermon at church distinctly, for the first 666 
DISEASES OF THE NERVOUS FUNCTION. 
time in his life; The opacity of the membrana tympani has disap- 
peared ; its elasticity is sensibly increased. 
May 24. He has obtained without difficulty a situation in a store. 
Is no longer conscious of being deaf; his father writes that the hearing 
is “ perfectly restored.” 
Paralysis Metallorum.—Plumbum.—Paralysis of the cutaneous 
muscles of the fore-arm is common among persons who work in lead. This 
is called the “ wrist-drop,” it follows colica pictonum, but occurs al- 
so in persons who never had it. Some attribute it to the continued use 
of the brush among painters, who strongly exert the extensor muscles 
in the up-stroke.” To avoid it, a London mechanic invented a brush 
with a paint vessel on the upper end to balance this weight of the 
brush at the lower end. This prevents fatigue of the wrist, but does 
not avert the paralysis, which is not produced by a mechanical cause: 
1. Because it seizes the left wrist as well as the right. 
2. Although painters are liable to it, it is not peculiar to them. All 
employed in the manufacture of white lead are subjected to it, as well as 
to lead colic ; and it has been caused by internal use of acetate of lead. 
8. The mode of treatment hitherto found successful, though effica- 
cious in the palsy from lead has no effect on that from mechanical cau- 
ses. There have been many cases of palsy of the leg caused by in- 
ternal use of minute doses of Saccharum-saturni; which also causes 
numbness of various parts of the extremities. An athletic robust man 
who took dysentery, in the West Indies, was treated with sugar of lead. 
It cured (in one way,) the dysentery, but entailed on him paralysis, 
from which he recovered after two months treatment. 
Treatment.—Dr. Pemberton ( W. Med. Gazette,) says he considers 
the disease of the fore-arm a local one. The extensor muscles are 
situated at a disadvantage, having the hand suspended at the extremities 
of their tendons. He directs a splint in shape like a battle-dore applied 
along the fore-arm and hand, taking off the weight, and giving to the 
muscles the opportunity to recover their energies. He has this splint 
worn night and day, till the disease is cured,—giving no medicine. 
Other Western physicians reported cases successfully treated in this 
manner. Some advising cold effusion of water over the arm as the mus- 
cles recover action. As improvement advances swinging weights or 
dumb-bells, at stated times daily facilitates recover}7. We give Caus., 
Nux, &c. 
Effects of Electricity, Galvanism, and Electro-magnetism.— 
They are all considered as “ excitants, counter-irritant.” Electro-mag- 
netism may be made to act as a tonic, sedative, anti-spasmodic, and 
also may be made to fill almost any other therapeutic indication. It is 
supposed to act on the economy by increasing or decreasing the 
quantity of positive, or negative electricity which the human body may PARALYSIS. 
667 
contain; and that in diminishing the positive electricity it, of course, 
increases the negative, and vice-versa. 
The Machine, its Currents and Arrangement.-After the machine is 
connected with the battery, twn posts are found at each end of the stand 
on which the machine rests. The poles on the left end (where the pis- 
ton pulls out,) furnish the to-and-fro current, which is induced through 
the entire helix, and produces a powerful sensational effect. The posts 
on the right end furnish the direct current, which is simply an intensi- 
fied galvanic current, passed through the coarse wire of the helix, and 
this furnishes a very mild sensational electro-magnetic current, of strong 
chemical power. It is this latter current only that will electro-plate, 
show chemical decomposition and act as an anaesthetic. By a connec- 
tion of the negative pole of the battery wTith the positive pole of the 
to-and fro current, four more currents, of mixed powers and effects, 
are produced, further details of which are unnecssary. 
Case.* Dr. lassing.—A sea-faring man, aged fifty-four, nervous 
bilious temperament; was suddenly attacked with 'paralysis hemiple- 
gica, shortly after laboring under a high state of nervous excitement and 
lying exposed in a draught on board of a ship at sea. There was entire 
loss of voluntary motion on the right side, coming suddenly and imme- 
diately. The eye and mouth were drawn on that side, memory and 
judgment were much impaired, and speech was indistinct; saliva flow- 
ed from the mouth. The muscles on the affected side were considera- 
bly wasted and flaccid. This gentleman has been bled, blistered, pur- 
ged by violent drastic cathartics wdthout benefit. His digestive func- 
tions and portal system are much deranged. He has since taken an 
emetic, then tonics, after these, saline cathartics ; then strong stimulat- 
ing liniments of Conium, Turpentine, Arnica, Camphor and Opium. 
Electro-magnetism wras then employed, as follows, twice every day: 
“Negative conductor immersed with patient’s right foot in a basin of 
warm salt water ; positive conductor along the entire vertebral column, 
beginning at the first cervical, and passing to the coccyx, not return- 
ing, but breaking the circuit, and commencing again at the cervix, 
thus applying it for about fifteen minutes each time. I then let the pa- 
tient hold the negative conductor in his hand, and by applying the po- 
sitive conductor at the origin of the muscles of the arm, produced con- 
tractions to which his attention was directed ; and exhorted him to 
make the same proceeding as wras had with the limb. The positive 
pole was also applied along the side of the neck and chest. With little 
variation, this treatment was persevered in for two months, the patient 
gradually improving. Also ordered exercise, gradually accustoming 
* Electro Therapeutics. By H. Lassing, M. D., Med. & Surg. Reporter. Yol 
VIII. p. 382. 668 
DISEASES OF THE NERVOUS FUNCTION. 
him to do away with crutches, canes, elastic straps, and electricity, as 
assistants to locomotion; and the patient was finally discharged cured, af- 
ter three months’ treatment. No impediment to motion is now percepti- 
ble. The muscles of the face and mouth are now again equally ba- 
lanced, and the entire effects of the paralytic attack have disappeared. 
General health good.” 
Paralysis {partial) from /Spinal Affection.—Dr. Trinks, of Dres- 
den, Saxony,* gives the case of a man, aged forty-six. He had before 
suffered from rheumatic and gastric affections, enlargement of the 
liver. In 1858, he had vomiting and diarrhoea, followed by catarrhal 
fever, which progressed to a typhoid state, affecting the brain. In 
about a month he had recovered from all the symptoms except those 
of spinal disease. In October, 1858, “ the brain was perfectly free; 
the mental faculties unaltered ; no vertigo ; no heaviness ; no dullness ; 
no headache; the organs of special sense not affected; no sign of 
pain in the whole extent of the spine, even on pressing hard on each 
vertebra; no pain perceived in the medulla itself; no heat, cold- 
ness, or formication. But sensation was obliterated in the fore- 
arms as far as the elbow, in the lower limbs from the toes to the glutei 
muscles; the loss of sensation had steadily progressed from its begin- 
ning in the tips of the fingers and toes, till there was perfect anaesthesia 
of the nerves of sensation. Motive power was also gradually lost; he 
could grasp larger objects, but could not retain them in his fingers. 
He could sit up in bed or a chair, but could not stand, the knees giving 
"way under him; he could not walk a step; the muscles of both the 
arms and legs had become flaccid, had lost their hardness and contrac- 
tion, and were wasting; temperature of the limbs was not changed; 
appetite and digestion good; alvine evacuations defective and only 
produced by cold water injections; urine natural, but evacuated too 
frequently, the sphincter having lost its power; sleep undisturbed by 
any other cause. He had now been treated by tonics, stimulating 
drinks, Apis, Nux-vom., Cantharides, but without benefit. 
The cause of the diseased condition was supposed to have been the 
previous typhoid febrile disease, which, it was thought, had induced 
atrophy of the spinal marrow. In this view of the nature of the case, 
Dr. Trinks prescribed Phosphorus. 
The patient took three drops of the second decimal dilution in pure 
water every morning and evening during two months. Improvement 
was gradually manifested. Sensation returned in the upper and lower 
limbs, the muscles gradually regained their natural tension, strength, 
and mobility. When recovery had so far advanced that the patient 
only felt weakness in the knees after walking a long time, the dose was 
* Muller’s Homoeopathic Quarterly. PARALYSIS. 
669 
reduced and taken only every evening. After two and a half months 
the patient could attend to business, take long walks without fatigue, 
No injurious effects followed the use of the Phosphorus. 
Thuja.—Progressive paralysis is characterized by the most pain- 
ful aching of the muscles, lightning-like lancinating pains in the affected 
muscular parts, trembling and want of control of the will over those 
muscles; deadness of the tips of the fingers, the toes, &c. 
Thuja produces similar symptoms and cures them. 
Giddiness coming after a meal, after exertion, even to falling—syn- 
cope, without any other morbid symptoms, resisting all seemingly 
suitable remedies, is cured by Thuja. (Dr. Wolf.) 
Paralysis of the Lower Extremities Connected with Disease of 
the Kidneys.—In cases of paraplegia from injury or disease of the 
spine, the bladder participates in the debility, and empties itself im- 
perfectly. A little urine remains undischarged, the mucous membrane 
of the bladder falls into a state of chronic irritation, and from it is 
viscid mucus or muco-purulent matter thrown off in the urine, which 
acts as a ferment in the urine leading to its decomposition. Here the 
urinary disease is merely secondary in the following form of paraplegia; 
though it is the first remarkable deviation from health. The patient 
exhibits tottering, weakness of the knees; tendency to stumble in 
going up or down-stairs; there may be some distortion of the bones of 
the spine; displacement from caries of the bodies of the vertebra, or 
ulceration of the intervertebral cartilages; some tenderness of the 
spine; symptoms of inflammation of the cord ; pressure of the tumor 
or aneurism of the cord. 
In 1883, Mr. Stanley published some cases of paralysis from nephri- 
tis in which no disease was found in the spinal column. These were 
in the kidneys. Rayer mentions similar cases. (Diseases of the Kid- 
neys, Vol. III., p. 168.) Sanson, the French surgeon, died of this form 
of disease in 1841; also Count D’Orsay, at Paris, 1852. 
Paraplegia is a frequent result of seminal emissions, and Lallemand, 
in his work on that subject has given many cases. The patients arc 
feeble, vascillate in their limbs, and become at last completely para- 
lyzed in the lower extremities; many of his cases followed urinary 
emissions also. I have seen a melancholy case in a young man who 
became dyspeptic, and then paralyzed, hypochondriacal, and he crept 
about the floor on his hands and knees. Chronic gonorrhoea, cystitis? 
enlargement of the prostate, retention of urine and nephritis are the 
antecedents of paraplegia. When the urinary organs improve, the 
limbs recover power. 
Pathology.—Inflammation of the kidneys, (Stanly, and M. Laurie,) 
with numerous small abscesses. The mucous membrane of the ureters, and 
the pelves of the kidney soft and thick, colored by injection, distended 670 
DISEASES OF THE NERVOUS FUNCTION. 
by purulent matter. The bladder, with injected mucous membrane, 
ulcerated, perforated, or hypertrophied, or thickened; prostate en- 
larged, or presenting that sort of transverse valve formed the central 
portion which so often obstructs the catheter ; or full of pus, pervaded 
by abscess ; stricture of the urethra. 
The urinary organs are largely supplied with branches of the great 
sympathetic nerve. The vertebral portion of this nerve consists of a 
number of ganglia united together by branches which pass from each 
ganglia to the one above and the one below it. There are twelve of 
these dorsal ganglia, four lumbar, and four or five sacral; and every 
one of them communicates with the coiTesponding spinal nerve. 
(Wells, Braithw. July, 1858, p. 39.) 
By this connection is explained the influence of the spinal marrow 
upon the secretion of urine. Concussions or compressions of the cord, 
injuries of the vertebrae, and inflammations of the cord or its membranes 
cause the secretion of alkaline urine or development of ammonia in the 
bladder, while the bladder itself is more or less paralyzed. The ex- 
planation of this was given by Mr. Stanley. If you disturb the normal 
condition of the sympathetic nerves supplying the kidneys and bladder, 
it may alter the condition of the spinal nerves, with which the dis- 
ordered sympathetic nerves communicate, or the condition of the mus- 
cles which derive their motor power from the spinal nerves, whose re- 
lations with the sympathetic may be disturbed. 
Disease of the kidneys also exerts an influence on the whole system 
by preventing the purification of the blood, and the nervous system 
suffers in common with the rest of the body. 
Gastric Derangements usually Connected with Disease of the 
Kidneys.—Imperfect digestion; fissured, furred, clammy tongue ; re- 
laxed, turgid fauces ; capricious appetite ; thirst; tendency to eat too 
fast; uneasiness, flatulence, and disturbance after eating; constipation ; 
all of which symptoms are explained by this connection between the 
renal and solar plexuses of nerves through the great sympathetic. 
Diagnosis.—Distinguish this form of paralysis from that depending 
on simple atrophy or softening of the lower portion of the cord by these 
symptoms : some impediment to the discharge of urine is an early 
symptom. This is connected with obstinate gastric derangement. 
Weakness or extreme debility of the limbs, rather than paralysis. 
The power of sensation is scarcely impaired, but the muscular power 
s almost lost. There is no marked atrophy of the limbs, the tempera- 
ture is but little lowered. The sphincter ani may be weak, but not 
paralysed. The bladder has some degree of contractility remaining. 
There may be no pain in the back; none in pressing the spinous pro- 
cesses, or in applying a hot sponge to them. The degree of weakness 
of the limbs varies according to the state of the urinary organs; great PARALYSIS. 
671 
amendment may follow catheterism and removal of obstruction to the free 
passage of urine. In the early stages of the disease, no cramps or 
convulsions, spasms, formication or violent neuralgic pains. 
Causes.—Smoking in excess, which impairs digestion ; cold bathing 
when injudiciously employed; sexual irregularities; excessive in- 
dulgence ; late marriages. The expensive luxuries of the present day 
cause men to postpone marriage to a late period of life, and lead many 
to prefer celibacy with its attendant evils. They then spend their 
money in irregular excess, rather than encounter the burdens of a 
household, with all the encumbrances required by the present unnatural 
state of society. 
Treatment.—In the early stages, ensure free passage of the urine 
by the introduction of the bougie ; correct the general health ; regulate 
the diet, exercise, clothing, choice of a residence; free exposure in 
the open air aids in restoring lost vigor. Advise marriage in every 
case where the circumstances render it practicable. 
In the more advanced stages, all the above considerations remain 
important. We must also correct the derangements of the digestive 
organs, the constipation by all the means mentioned under that article. 
Many are greatly injured by the practice of taking pills. Aloes and 
saline purgatives constantly increase the irritability of the urinary 
organs. Mr. Wells recommends an electric belt to be worn around 
the body. 
There should be a thorough change of the habits of life; a long sea 
voyage. 
In more advanced cases, the feebleness of the limbs is extreme. 
The patient can walk a mile or two, perhaps, but the gait is tottering; 
the urine is loaded with mucus or muco-pus and the phosphates; it 
soon becomes ammoniacal after it is passed, which is done at short 
intervals. Cannabis-indica. 
Nux-vomica is an important remedy. Though Strychnine in even 
small (allopathic) doses did only harm in the hand of Mr. Wells. 
(.Braithw. p. 42.) 
Galvanism or electro-magnetism is useful only by passing a very 
feeble current through the weak muscles every day. The patient 
may wear a weak portable battery, with a pole fixed to each limb, so as 
to keep up a constant, but mild current by day and night. 
Pyro-phosphate of Iron has been beneficial in some cases. 
Cantharides, has a specific action upon the kidneys and urinary 
passages. Dr. Seymour says it has removed serum effused into the 
spinal cavity. Mr. Wells says it restores contractile power to the 
bladder, and relieves the frequent desire to urinate. Buchu, Uva-ursi, 
and Pareira-brava are recommended. 
Mercurial Palsy.—“Tremblement Mercuriale” of French ail- 672 
DISEASES OF THE NERVOUS FUNCTION. 
thors.—Silverers of looking-glasses breathe the vapor of the metal 
and also receive it by the touch. Many can only work on alternate 
days, and many have to be absent from it for months, xSymptoms pro- 
duced by the vajpor: “Difficult enunciation, pain and constriction at 
the base of the chest, emaciation, debility, tremors; and, lastly, sali- 
vation. The gums are often wasted, and the teeth left loose in the 
sockets. As the fingers and hands are generally the parts first disor- 
dered, it appears that the primary impression is on the nervous sys- 
tem at large, and is made through the medium of the skin, rather than 
that of the lungs. Intemperate men suffer most.” * 
The approach of mercurial palsy is sometimes sudden, though it is 
generally gradual. There are slight convulsive agitations followed by 
tremors of the affected muscles, particularly of the arms, when it oc- 
curs among the workers in mercury. As it extends to the lower ex- 
tremities and other parts of the body, the patient becomes incapable 
of muscular exertion, or ceases to be able to steady his hands to any 
work requiring neatness and precision. He becomes restless, suffers 
from abdominal disorders, falling out of the teeth, constipation, a dry 
or brownish state of the skin, slight convulsions, great depression of 
nervous power, and entire derangement of general health, which con- 
tinues for years, and, generally, for life. The affection is commonly 
caused by long-continued exposure to the fumes of mercury; but it 
may be excited in a few hours by the breathing of air in which the 
deadly vapor is largely diffused, and in this highly attenuated form it 
is directly applied to the extensive surface of the bronchial tubes and 
air-cells.f 
Case.%—A workman, aged twenty, felt the trembling begin three 
days after he began silvering; the mouth became sore in six days. In 
six months he is thus described: The speech is greatly impeded; the 
limbs totter; he walks slowly and with great difficulty, and with an 
infirm and awkward step; the tremors prevent him from carrying food 
to his mouth; slight subsultus tendinum of the upper extremities; the 
tongue quivers; gums tender; pulse strong, rather quick; appetite 
diminished; sleep disturbed, body wasted; he feels oppressed with a 
load across the lower part of the chest, or as if a substance lay at the 
bottom of the lungs which had been drawn in by inspiration; breath- 
ing quick, accompanied with strictured feeling and cough. He was 
nearly thrown from a bath by the violence of the trembling, driving a 
quantity of water over the sides .of the bath, and would have been 
thrown out but for being held in it by two men. The fact of the rising 
* Observations on the Diseases of Artizans, p 112. 
f See Merat. Diet. Sci. Medicales, 1. vi., p. 32. Colson, de Trem. Metallique, &c 
J Mitchell, Med. Phys. Jour. 1831. PARALYSIS, 
673 
of mercurial vapors at the common temperature of the atmosphere is 
proved by the simple experiment of Christison.* A small piece of 
goll is suspended in the mouth of a vial which contains a small quan- 
tity of metallic mercury. In a few minutes the vapor rises and forms 
an amalgam on the surface of the gold; and this vapor is capable 
of producing the worst symptoms of mercurial poisoning if diffused in 
an apartment insufficiently ventilated. Schlopfer tried the effects of 
the vapor of corrosive sublimate in solution on rabbits, and found the 
vapor of six grains fatal in five minutes. When twenty-four grains 
were sublimed by the blow-pipe, the vapor immediately “produced 
painful constriction of the throat, with headache, sickness, and vomit- 
ing in several medical students. 
Case by Dr. Hilton. {Lancet, 1860, p. 488.) A man had lost the 
power of motion in the lower extremities, and sensation was much 
diminished below the pelvis; he complained of extra pain in the ab- 
domen and pubes, and thinks there is the seat of the disease. The 
surgeon relied upon rest. When the palsy results from injury of the 
spinal marrow the person may be completely palsied both as to sen- 
sation and motion; but little higher up than the original seat of injury 
there is exquisite sensitiveness, the patient suffering extreme pain; a 
littlp higher still .the skin is extremely sensible. In this case the nerves 
that supply the tender part of the skin are attached to the upper por- 
tion of the injured spinal marrow, which, at this moment, is in an in- 
flamed condition. In one case of this kind Tartar-emetic pustulation 
was directed to be used over the spine. The patient applied it where 
the pain was the Avorst. There it did no good, though it made extensive 
pustulation. The case was one of diseased vertebrae; he afterward 
tried hydropathy and homoeopathy, and thought he was cured by them, 
though the surgeon “ attributed the recovery to rest? 
* On Poisons, p. 391. 
Vol. n.—43. 674 
DISEASES of the reproductive function. 
CLASS V.—DISEASES OF THE REPKODUCTIVE 
FUNCTION. 
ORDER I.-CENOTICA. AFFECTING THE FLUIDS. 
1. AMENORRHCEA. 
General Description.—Many of the symptoms of this complaint 
bear a close resemblance to those of chlorosis, and it is on this account, 
probably, that some authors have confounded the two maladies. As 
retention or suppression of the menses is a very common and promi- 
nent symptom of chlorosis, it is not surprising that it has been deemed 
a cause of chlorotic symptoms, rather than as a mere symptom. But 
the fallacy of this doctrine will be evident, when we reflect that chlo- 
rosis occurs in males, in young children, and in females whose cata- 
menial functions are regular through the whole course of the disease* 
Two kinds of menstrual irregularity are generally included under 
the above head: first, retention of the catamenial flux beyond the na- 
tural period, from constitutional causes or mechanical obstruction; and 
second, partial or total suppression of already established courses; 
from phthisis, chronic hepatitis, general debility, chlorosis, fevers, and 
exposure to cold and dampness. 
It is not improbable that the same causes which contribute to the 
development of chlorosis also operate to prevent the usual menstrual 
flux at the period of puberty, and thus to establish one variety of ame- 
norrhcea. Natural delicacy of constitution, a highly impressible ner- 
vous system, and a lymphatic temperament, are general conditions 
which precede and accompany both maladies, although amenorrhoca 
sometimes occurs in the most robust females. The revolution which 
nature causes in the female organism at the period of puberty, ought 
always to become manifest in the menstrual flux; but the causes which 
often operate to retard it, and thus to thwart the kind efforts of nature, 
are numerous and diversified. 
Singular phenomena are sometimes observed at the period of pu- 
berty in relation to this periodical evacuation—for, in the place of the 
usual uterinee vacuation—there often occur haemorrhages from different 
parts ; fluxes now and then take place from the top of the head, the ends 
of the fingers, the soles of the feet, the stomach, the intestines, nose, 
the lungs, and other parts of the body, and apparently assuuiing the 675 
AMENORRHCEA. 
place of the monthly discharges. These abnormal fluxes are termed 
vicarious. Occasionally the supplementary secretion occurs in the 
form of ulcers, enlargement and irritation of certain veins and erup- 
tions. The menstrual discharge varies much in its quantity and cha- 
racter. In hot climates puberty arrives earlier, and the discharge is 
more abundant than in temperate latitudes. 
When the discharge comes on at the proper period, but is deficient 
in quantity, or is composed of serum, mucus, or pus, other parts of the 
economy suffer, as by pains in the back, pelvis, limbs, and head, until 
the period has passed, after which the sufferings abate until the suc- 
ceeding epoch and are then renewed. This deficient secretion may 
continue for months and even years, without giving rise to any struc- 
tural lesion, or any other symptoms than those enumerated, when some 
new circumstance, like marriage, a sea-voyage, or change of climate, 
may restore the function to its natural condition. 
Puberty, with its usual accompaniment, the menstrual flux, does not 
occur in cold regions until the age of fifteen or sixteen years, while in 
tropical countries it arrives at the age of eight, nine, and ten years. 
Frank records cases where the courses appeared in children of one, 
three, and four years. He also treated at Pavia a woman who had 
given birth to three children without ever having had a menstrual or 
lochial discharge.* Many cases of this kind are mentioned by other 
writers, who also allude to the masculine organization and characteris- 
tics of these women, such as firmness of muscle, harshness of voice 
and smallness of the breasts. 
From these facts we infer wTith Frank and others, that the menstrual 
function is not absolutely essential to the occurrence of conception, 
and that a woman may go through her whole term of pregnancy and 
finally give birth to a healthy child, without any development whatever 
of the catamenial function. 
Frank, in his “Practice of Medicine,” expresses the same opinion: 
li Nous conclous de ces observations que Vappararition des menstrues 
est,d laverite, un des principaux signes gui annoncent le developpe- 
ment de Vorgane uterin et Vabord du sang dans ses vaisseaux, mats 
que la conception etla nutrition du foetus peuvent egalement s'op ever 
quoique cette fonctionperiodique ne soit pas encore etablie y que la 
ficondite depend d’une autre cause, d’un principe analogue d celui 
dont elle derive chez les femettes des anirnaux ’ que la nature a 
soumis en general toutes les femmes bien organisees au tribut men- 
struel, mais qu’elle ne Vexige pas toujour avec la merne riguer sous 
peine de sterilite.” 
In regard to the natural duration of the catamenial discharge, 
* Traite de Med. Practique, Yol. II., p. 253. 676 
DISEASES OF THE REPRODUCTIVE FUNCTION. 
nothing definite can be advanced, since so much depends upon the con* 
stitution, the climate, and the habits of life; but the average duration 
is about three or four days. 
Diagnosis.—As the period approaches when the girl is to become 
a woman, new ideas, new thoughts, and new desires take possession of 
her mind. Instead of amusing herself with her doll, she prefers to 
enjoy, although with much coyness and timidity, the society of an at- 
tractive young friend of the other sex; instead of the romping freedom 
of the child, we now observe the retiring manners and the burning 
blushes of the maiden. Her physical, perfect and pleasing to the 
eye, and she looks forward into the dim vista of life, with deeper inte- 
rest, higher aspirations, and a more proper appreciation of the respon- 
sible duties she may be called to fulfil. 
If in conjunction with these physical and moral changes the cata- 
menial discharge makes its appearance naturally and regularly, the 
girl retains her health and vigor; but if the period passes by without 
the usual development of the monthly tribute we are presented with 
the following symptoms of 
Pale, wax-like, or sullen sickly appearance; furred tongue, and foul 
breath in the morning; variable and sometimes morbid appetite; nau- 
sea, general debility, lassitude, and sense of fatigue ; pains in the small 
of the back, pelvis, abdomen, head, side, and limbs; disinclination to 
mental or physical exertion, coldness of the feet; constipation; leu- 
corrhoea; depression of spirits ; sad and weeping mood ; distress in the 
stomach after eating; distention of the abdomen; faintness; palpita- 
tion of the heart after exercise; rapid pulse; headache; vertigo; 
roaring in the ears ; nightly wakefulness ; hysteric symptoms; peevish- 
ness and irritability; haemorrhages from the nose, stomach, lungs, and 
rectum; supplementary discharges from certain parts of the body. 
1. RETENTION OF THE MENSES : 
2. SUPPRESSION OF THE MENSES 
May arise from a natural cause, like pregnancy, or from general 
debility resulting from excessive loss of blood, chronic and acute dis- 
eases, inordinate mucous, purulent and seminal discharges, polypi, 
venereal excesses, constant and severe muscular exertion, and mechan- 
ical obstructions ; or it may occur suddenly during the flux from violent 
emotions of the mind, exposure to cold and dampness, cold baths, or 
any other cause which abruptly shocks the system. 
The symptoms which follow suppression are usually more acute and 
dangerous than those of retention of the menses. It is not uncommon 677 
SUPPRESSION OF THE MENSES. 
for the former to induce serious haemorrhages from the lungs and 
stomach; also inflammations and congestions of the brain, lungs, 
uterus and liver; while in the latter, the symptoms arise so gradually, 
that the organism in some measure adapts itself to the morbid condition, 
and thus escapes the inflammatory and febrile attacks which are so 
common in suppression. 
Sujpjpi'ession occurs in the most sound and robust constitutions, as 
well as in those that are weakly; retention but rarely happens in 
healthy and vigorous subjects, but follows usually as a consequence of 
original delicacy of constitution. The symptoms of the former are 
more violent than of the latter, but upon the whole less dangerous to 
life, and more readily controlled by medicines. 
In cases where the monthly secretion takes place, but is retained in 
the uterus from some mechanical obstruction, the blood often preserves 
its fluidity and freshness for a long period. This is owing to the ex- 
clusion of the oxygen of the air, the presence of which is essential to 
the process of decomposition. 
Causes. — Natural or acquired delicacy of constitution, combined 
with a lymphatic temperament, and a highly sensitive nervous system 
is by far the most common cause of retarded menstruation. A certain 
amount of stamina, of physical and nervous energy is essential to the 
healthy performance of the functions, and so long as the organism is 
without the proper supply of this force, all of the functions must be 
imperfectly executed. 
Structural lesions which give rise to profuse purulent mucous or 
sanguineous discharges, operate both as causes of retention and of 
suppression. In this class may be included tuberculous ulcerations of 
the lungs, chronic bronchitis, abscesses of the liver, and lumbar 
abscess. 
Other causes are : malformations of the uterine organs, or the vagina, 
like imperforate os-tincae, imperforate hymen, mal-organization of the 
ovaries or fallopian tubes, unnatural growths in the uterus or vagina, 
which oppose an obstruction to the passage of the menstrual secretion. 
Dr. Mackintosh divides the mechanical obstructions to the discharge 
of the menstrual fluid into two classes, viz: “ Those occasioned by 
cohesion of the sides of the vagina and labia, and an imperforate 
hymen, and those caused by an imperfect or imperforated state of the 
os-uteri itself. All these cases are comparatively rare, but few men 
can have been in extensive practice for twenty years without meeting 
with several, and, therefore, they require some notice in this place. 
In the first set of cases, in addition to the constitutional symp- 
toms and local pain already mentioned, there is great fullness, dis- 
tention, and a sense of weight in the passages, accompanied some- 
times with severe pain, and a feeling of bursting; straining at stool 678 
DISEASES OF THE REPRODUCTIVE FUNCTION. 
and micturition, together with enlargement of the abdomen which ex- 
cites suspicion of pregnancy. The nature of the case can only be 
determined by examination and can be relieved only by the knife. 
11 In the second set of cases, there is greater difficulty in detecting 
the state of the parts, from the natural impediment to an examination 
which exists at the orifice of the vagina.” Dr. M., however, mentions 
that in the only two cases of imperforate os-uteri which had fallen 
under his observation, there was no hymen, and the passages easily 
admitted the introduction of two fingers. He punctured the os-uteri 
in one of these eases, and afterwards dilated the passage with bougies, 
until the discharge found free exit, when all the unpleasant symptoms 
subsided, and the patient was restored to perfect regularity and excel- 
lent health. The other patient, whose delicacy forbade the operation 
gradually sank under her symptoms and died. We have met with one 
case of retention from adhesion of the walls of the vagina. The pa- 
tient was a healthy young married lady whose menstruations had been 
regular until she became pregnant, after which they ceased, and she 
advanced as usual until the fifth month, when she met with a miscar- 
riage ; and during the delivery of the foetus so much violence was 
done to the parts, that inflammation and sloughing of the vagina fol- 
lowed, adhesions took place between the vaginal walls, and the passage 
became entirely closed to the escape of the menstrual fluid. The pa- 
tient experienced for many months most severe pains in the pelvis, 
abdomen, back, and especially at the monthly periods; many severe 
constitutional symptoms set in, and she became reduced to a low state 
of health. A free incision through the cicatrix gave vent to a large 
quantity of fluid blood, exhibiting but slight signs of decomposition, 
and the patient speedily regained her health. 
The most harmless cause of suppression is that which arises from 
pregnancy. But, although this is a natural cause, its constitutional 
effects are manifested in the form of frequent nausea, morning sickness, 
ptyalism, Ac. These symptoms, although quite troublesome and an- 
noying to the patient, serve the important purpose of guarding the brain, 
lungs, and other vital parts, from dangerous inflammation and conges- 
tions. 
One of the most notable causes of suppression during the ilow of 
the courses is abrupt exposure to cold. This obstruction is apt to 
arise in going suddenly from a warm room after exercise, and when 
the pores are open, into the cold air. It is also caused by plunging 
the limbs or body into cold water during the period. Insufficient 
clothing and thin shoes may also be mentioned as common causes. 
Violent emotions of the mind, vehement anger, terror, sudden joy, 
intense grief, revolting sights, and electric shocks, may likewise be SUPPRESSION OF THE MENSES. 
679 
reckoned as frequent causes of obstruction or suppression of menses 
during the period. 
It has been asserted that severe physical exertion often induces 
suppression, and the fact that habitual dancers are subject to but 
slight catamenial discharges, has been adduced as a proof of the as- 
sertion. The same result may happen to females with reference to the 
monthly secretion, and yet no unpleasant consequences arise from the 
diminution or suppression of the discharge, since a sufficient amount 
of vital stimuli has already been expended in severe muscular exercise. 
Prognosis.—Retention, proceeding from a natural lack of constitu- 
tional vigor, is always difficult to cure ; but where no serious organic 
difficulty exists, we may generally hope for ultimate success. In cases, 
however, which are complicated with chronic pulmonary disease, drop- 
sical affections, or organic disease of the heart or liver, the prognosis 
must always be unfavorable. Retention from imperforate os uteri or 
hymen, and from vaginal adhesions and polypi, are all readily cured 
by surgical means. When suppression arises as a symptom of some 
chronic disease, especially if it has persisted for several months, we 
shall, for the most part, find the case incurable ; when, on the contrary, 
it has arisen from an acute disorder, the cure may be easily accom- 
plished. 
Obstructions which are consequences of anger, grief, fright, jealousy, 
or exposure to wet and cold, may also be speedily restored by suitable 
specifics. 
In forming an opinion respecting the probable termination of ame- 
norrhoea, it should always be borne in mind, that it is almost invariably 
either a symptom of some other disease, or that it owes its origin to a 
general lack of constitutional vigor. Much, therefore, depends upon 
the general condition of the system, and upon the curable or incurable 
nature of the malady which causes the menstrual derangement, as to 
whether our prognosis be favorable or otherwise. 
Treatment.—In the management of amenorrhoea, our first attention 
should always be directed to the removal of the cause upon which it 
dfepends. Most cases of retarded menstruation will derive material 
benefit from well-regulated exercise, nutritious diet, change of scene 
and of climate, sea air, sea voyages, and bathing. Retention from me- 
chanical obstructions can only be cured by surgical means. But in 
suppression or obstruction, unattended with any serious local compli- 
cation, and originating from exposure to cold, mental emotions, sud- 
denly checked perspiration, cold drinks, fevers, &c., we may afford the 
most prompt relief by the employment of suitable remedies. 
We call attention to the following medicines: Pulsatilla, Sabina, 
China, Calcarea-carb., Ferrum, Graphites, Macrotin, Borax-ven 
Conium, Serpent aria-virginica, Sulphur, Sepia. 680 
DISEASES OF THE KEPKODUCTTVE FUNCTION. 
Aconite.—Suppression of the menses from sudden cold. There 
are: Paroxysms of congestion of the head or chest, palpitation of the 
heart;- pressive, pulsative, or shooting headache; redness of the face ; 
fullness and hardness of the pulse; frequent heat, with thirst; irasci- 
bility and fretfulness. It is often successful in chronic cases also. 
Case.—Amenorrhoea of six months’ standing in a plethoric young 
girl, aged twenty-one, accompanied with dyspnoea, and oppression in 
the praecordial region, without any other notable sufferings, was cured 
by Aconite alone: a few globules of the 24th having been dissolved 
in water and given in spoonful-doses four times a day. (Malaise.) 
Pulsatilla is adapted to females of a mild, timid, and amiable dis- 
position, who are easily excited to tears or to laughter. It may be 
used in- cases where menstruation is delayed a few days beyond the 
natural period, in abrupt suppression of the menses from cold bathing, 
wet feet, sudden suppression of perspiration from cold air, violent pas- 
sions and emotions, and in fevers, in alternation with other suitable 
remedies. It is also valuable in partial obstructions, accompanied with 
dyspeptic and hysteric symptoms. The general indications are, lassi- 
tude, weariness of the limbs, unpleasant arterial pulsations in different 
parts of the body, congestion, anxiety, and oppression of the chest 
after exercise, and in the night when in the recumbent posture: vari- 
able appetite; coldness of the feet; sleeplessness, pains in the back 
weeping mood; vertigo or giddiness; colicky pains in the abdomen. 
Sabina is only useful in that irregular variety of amenorrhoea ir 
which the menses appear too soon, and too profusely for a few hours 
and are then suppressed, either temporarily or permanently. The 
kind of amenorrhoea in which this medicine is applicable, is for the 
most part induced by a hyposthenic condition of the uterus. 
China and Ferrum are especially serviceable in retarded menstrua- 
tion dependent on constitutional debility whether natural or acquired. 
The general indications for their use, are pale, sallow, or cachectic 
countenance ; emaciation; muscles soft and flabby; rapid circulation; 
rapid and difficult respiration after exercise; palpitation of the heart, 
excited by mental emotions, exercise, or eating heartily; lassitude, de- 
bility, and general indisposition to think or act; transient pains in the 
chest, back, side, pelvis and limbs; swelling and pain in the hepatic 
region; bitter taste; feeble appetite; impaired digestion; nightly 
restle&sness; leucorrhoea. 
Calcar ea-carb., Sulphur, Graphitis, Conium, and Sepia, are indi- 
cated in the catamenial irregularities of scrofulous, rickety, and syphi- 
litic subjects. The history of each case will enable us to decide re- 
specting the precise nature of the disease upon which the amenorrhoea 
is dependent, and thus render it easy to select an antipsoric which 
shall gradually remove the original cause of disorder, and cure the pa- DYSAIENOREHOEA. 
681 
tient. As a general rule, Calcarea-carb. agrees best with young per- 
sons, whose menses appear too soon, Avhile Sulphur, Graphites, Co- 
nium, and Sepia may be exhibited at any age, but for the most part 
in cases of retarded and suppressed menstruation. 
Serpentaria- Virginica.—We have often used this medicine in sup- 
pressed and obstructed menses, from cold, violent emotions, and the 
debility consequent on fevers, with marked success. A recent cure of 
amenorrhoea verging on chlorosis by this remedy, confirms our previous 
opinion that it is a remedy of much value in disorders of this character. 
As a majority of the cases of amenorrhoea have their origin in somo 
inherent constitutional vice, and are, in reality, but mere symptoms of 
some other affection, it is of importance that our attention be directed 
to all the remote and slight symptoms which may exercise an influence 
upon the economy, as well as to the more immediate and visible signs 
of the malady. 
Administration.—When the menstrual derangement has approached 
gradually, and is evidently a symptom of some general disease, like 
scrofula, chlorosis, phthisis pulmonalis, dropsy, or chronic hepatitis, 
the remedies must be selected with reference to these maladies, and 
the same attenuations and repetitions employed as advised under these 
different affections.—As a general rule, in these cases, we employ the 
first, second, and third attenuations; and repeat the dose but rarely; 
but in abrupt obstructions, occurring in females of a robust constitution, 
from undue exposures, or over-excitement, we moke use of the first or 
second attenuations, and repeat every two, three, or four hours, until 
we are satisfied with the effect produced. 
Now and then, partial or entire retention of the menses, gives rise 
to constitutional disturbance of so urgent a character, that the gradual 
process of dilatation with bougies cannot be relied upon. In such 
cases, it is now the practice of Dr. Simpson and other eminent accou- 
cheurs, to resort at once to incision through the contracted os, and 
then to keep the orifice open with bougies during the healing process. 
This operation often proves quite successful; but it is always at- 
tended with more or less danger of metro-peritonitis. 
In one case of this kind, operated on by Professor Simpson, severe 
metro-peritonitis, and an abscess upon the broad ligaments followed, 
leaving the parts morbidly sensitive for many months. 
2. DYSMENORPJICEA. 
Painf ul Menstruation.—From dvg, with difficulty and firjvofjpooa, 
the menses. Difficult or painful menstruation, accompanied with 
severe pains in the back, loins, and region of the ovaries or utems, 
It may appear in different forms, and originate from various causes. 682 
DISEASES OF THE REPRODUCTIVE FUNCTION. 
1. It may be connected with derangement of the digestive organs. 
2. It occurs in gouty or rheumatic constitutions. 3. It is of a hyS’ 
terical or neuralgic character. 4. It occurs in connexion with in- 
flammatory action of the uterus, usually the os and cervix uteri. 5. It 
arises from ovarian irritation. 
Diagnosis.—Painful menstruation is of most common occurrence in 
females of sanguineous and robust constitutions, and of ardent and 
animated temperaments. The monthly flux makes its appearance at 
the usual period, but generally in small quantity, often becoming 
entirely suppressed for several hours, and then reappearing to a greater 
or less extent, perhaps again to be suppressed. Females subject to 
dysmenorrhcea, are almost invariably troubled with constipation and 
frequent headaches, from the rush of blood to the brain in the in- 
terval between the catamenial periods. The usual symptoms attending 
dysmenorrhcea, are: severe bearing-down pain in the uterine region, 
similar to the pains of parturition, and coming on in paroxysms; con- 
stant aching in the small part of the back, the loins, the pelvis, and 
the limbs; accelerated action of the heart and arteries; flushed cheeks ; 
headache, cutting and pressing pains in the abdomen; flatulence; 
spasmodic sensation in the region of the stomach; nausea; eructations ; 
oppression in the chest; anxiety and irritability; scanty discharge of 
blood which is not coagulable, and containing lymph, and shreds of a 
membranous structure, or clots of dark blood. 
When the local inflammation does exist, it is renewed and augmented 
at the return of every menstrual period. Of late years too much attention 
has been given to the local treatment of female diseases. Local ul- 
ceration has been caused or aggravated by caustic treatment much 
more frequently than the real disease has been reached through such 
measures. 
Varieties of Dysmenorrhcea.—1. Neuralgic Form.—This occurs 
most freqently in unmarried females, or in married women who are 
childless. In these cases both the sterility and painful menstruation 
are probably dependent on ovarian disease. It is more commonly found 
in females who have passed the 30th year, and the general health 
is likely to become much involved if the disease continues for any con- 
siderable time. A state of mental and nervous excitement and mental 
irritability is induced, which is sometimes regarded as insanity by 
the physician and friends; and the patient may be consigned to a 
lunatic asylum; but this only aggravates the nervous as well as the 
uterine disease. 
2. Congestive Form.—Most common in young unmarried women, 
and sometimes cured by marriage, though it is often met with in those 
who have had children, especially such as are constitutionally strong, 
Healthy, and of plethoric sanguine temperament. DYSMENORRHOEA. 
683 
Causes.—The same general causes that produce suppression of the 
menses further derange the general health in rheumatic, nervous, or 
psoric constitutions. The severest portion of the pain depends on 
ovarialgia / it is deep-seated and neuralgic in character, amounting 
in severe cases to inflammation as well as neuralgia of the ovaria. 
This form of the disease seems to become more common in proportion 
as civilization progresses. It is entirely unknown in savage life ; and 
in that state of society which formerly existed in the frontiers of the 
Western States it was scarcely heard of. Now, it is said, by Dr. 
Tyler Smith, that “ almost all women in the better classes suffer much 
pain and disturbance from menstruationand the limits between 
pathology and physiology can hardly be defined. (Lectures in Hun- 
terian School of Hed.) In all cases the origin of the pain is in the 
ovaries, though it often extends to the uterus, and may be severe in 
the ovaries even when the uterus is wanting. The greatest distress is 
usually felt in what is called the “ bearing-down pain,” extending from 
the pubes to the knees; and it chiefly consists of a real tenesmus of 
the os and cervix uteri, analogous to the tenesmus of the intestines in 
dysentery or that of the bladder in strangury. When there is real 
structural disease of the os and cervix the tenesmus is more severe 
and needs special treatment; but the dysmenorrhoea is not in general 
caused by chronic inflammation of this surface ; the connection be- 
tween the two conditions is only one of coincidence, not of causation. 
The most frequent causes of dysmenorrhoea are : an inflamed condition 
of the secretory vessels of the uterus, an unnaturally small os-tincce, 
and inveterate constipation; it occurs in females of a full, plethoric 
habit, of fancies easily excited to activity, who are fond of the plea- 
sures of the table, of love and show, who prefer to pass their time in 
heated parlors, or crowded ball-rooms, rather than in active exercise 
out of doors. When we reflect upon the habits and modes of life which 
the customs of refined society impose upon the young females, we 
shall no longer winder that this important function of the uterus 
should so often become disordered. The foolish mother, anxious that 
her child should grow up according to the laws of a false elegance, 
with a shape of body moulded to suit the code of fashion, rather than 
in those once approved proportions which the Creator gave her, en- 
velops her in corsets and stays, pressing the abdominal viscera down- 
ward upon the bladder and uterus, and the thoracic organs upwards 
towards the throat, and thus moulds a waist sufficiently small and 
wasp-like to meet the requirements of a sham gentility. In carry- 
ing out this wicked whalebone and buckram system, the important 
functions of circulation, respiration, digestion, and menstruation are of 
no sort of consequence to the deluded victim or her friends, when com- 
pared with the imperative demands of fashion. God made the human 684 
DISEASES OF THE REPRODUCTIVE FUNCTION. 
body of precisely the right proportions for the healthful exercise of 
■ all the organs; civilized woman baffles this ordination by mechanical 
devices, and makes of the form an artificial thing, recognized and 
known as a specimen of gentility, the functions of which are subject 
to natural derangements, by consumption, chlorosis, dysmenorrhoea, 
amenorrhoea, constipation and organic affections of the heart. After 
the innocent young girl has been thus cheated, not by “ dissembling 
nature,” but by a fashionable mother, “ out of her fair proportions,” it is 
deemed necessary, in order to complete her education, to prim her up 
within the crowded walls of a boarding-school; to cram her mind with 
some ten or twelve studies at a*time, including, of course, music, and 
the current light literature; and to neglect active exercise, wit, fun, 
mirth, and other health-promoters, as vulgar. In this manner the 
cpuntenance acquires that pale aad distingue cast so much coveted, 
and the body that frail and enfeebled state so common in cities. 
Another cause which occasionally gives rise to painful menstruation, 
is an unnaturally small os-tincce. Dr. Mackintosh supposes this to be 
a very common cause of dysmenorrhoea, and details numerous cases 
of the kind which have come under his own observation. When the 
painful symptoms do not yield readily to the proper remedies, an ex- 
amination may reveal a deficiency in the capacity of the os-tincce, 
which may in some instances be enlarged by the successive introduc- 
tion of a graduated series of bougies. 
The other causes which should be particularly noticed are: collec- 
tions of indurated faecal matter in the colon and rectum, uterine polypi, 
exposure to cold, and rheumatic affections of the uterus. 
Treatment.—Abundant active exercise in the open air, regular 
hours, a plain regimen, abstinence from wine, coffee, and green tea, and 
a temperature not exceeding 68° Fahrenheit, within doors, are prime 
conditions to the successful treatment of dysmenorrhoea. By attend- 
ing rigidly to these important points, constipation will be obviated, the 
circulation of the blood equalized, the animal heat uniformly diffused, 
and all undue determinations of blood prevented. If, however, ob- 
stinate congestions have already set in, a few doses of suitable specifics 
will syon restore the organism to its normal condition. 
The medicines to which we call attention are : Aconite, Pulsatilla, 
Secale-cornutum, Belladonna, Gannabis-ind., Gollodium, 6ann., 
Cyclamen, Nux-vom., Platina, Ferrum, Cocculus, Sabina, Conium, 
Graphites. 
Dysmenorrhoea, arising from an inflammatory condition of the 
uterus, and attended with marked febrile symptoms, quick pulse, hot 
skin, thirst, rapid respiration, headache, and general restlessness, 
demand the employment of Aconite. 
If the menses are scanty, and accompanied with cutting pains in the DTSMENORRHCEA. 
685 
uterine region, abdomen, back, and loins, vertigo, loss of appetite, 
chilliness, nausea, and discharge of thick, black blood, alternating with 
short discharges of bright-red blood, we may resort to Pulsatilla. If 
the pains shift about from one point to another, the indications are still 
stronger. Pulsatilla also operates best when the derangement has 
arisen from fright, grief, mortification, or from exposure to wet and 
cold. 
When the menstrual irregularity proceeds from uterine congestion, 
and presents us the following tableau of symptoms, viz.: violent 
spasmodic or bearing-down pains from the small of the back to the 
uterus, with tenesmus and pressure on the bladder and rectum, cold- 
ness of the extremities, rapid and feeble pulse, frequent and severe 
contractions of the uterus, Secale-cornutum should be employed. 
Belladonna is an admirable remedy when the patient is of a ple- 
thoric habit and sanguine temperament, and the disorder has originated 
from some violent mental emotion, and is attended with serious deter- 
mination to the brain. It may sometimes be employed with advantage 
in alternation with Aconite. Belladonna and Cocculus in alternation 
have, perhaps, been more generally successful than any other remedies. 
Fux-romica is valuable in scanty and painful menstruation, from 
uterine congestion, arising from scybalous accumulations in the colon 
and rectum. The pains are of a spasmodic character and extend 
from the uterus to the neck of the bladder, and into the abdomen. 
Considerable gastric derangement usually attends this variety of dys- 
menorrhoea. 
Platina, Ferrum, and Sabina are applicable in that variety in 
which the menstrual discharge is sufficient, or even in ordinate quan- 
tity, but is attended with severe bearing-down pains in the uterine 
region, cutting pains in the back, loins, and thighs, pressure in the 
groins, cramps in the abdomen, blood dark, and containing membran- 
ous shreds, and too frequent appearance of the menses. 
.For uterine and abdominal spasms, nausea, faintness, impeded re- 
spiration, and a scanty discharge of coagulated blood, mixed with 
mucus, we may give Cocculus or Conium. • 
Graphites is an important remedy when the menses appear too late, 
and are too scanty. The uterine discharge is thick and dark, there 
are severe labor-like pains in the pelvis, also cutting pains in the 
abdomen, small of the back and hips, vertigo, constipation, chilliness, 
cold hands and feet, and general lassitude and debility. 
Administration.—The medicines may be employed at the first, 
second, and third attenuations, and repeated every two hours during 
the more severe symptoms. The remedy should also be given once in 
two or three days, during the intervals between the monthly epochs. 686 
DISEASES OF THE REPRODUCTIVE FUNCTION. 
Sabina.—Case by Dr. Fanning, of Brooklyn*—A lady, aged 
twenty-four, medium height, dark complexion, and hair, nervous tem- 
perament, fond of music. Dysmenorrhoea for four years, with violent 
headache; period generally delayed, flow lasting about seven days, 
coming on a few minutes at a time, then ceasing for six or eight hours 
—bright clotted, without flow. Pain begins an hour or two after the 
flow of blood begins, the pain starts in the epigastrium going to the 
back; feels generally obstruction internally; dragging pain in the 
back and deep-seated pain throughout the lower limbs; walking aggra- 
vates, warmth diminishes it. Pain in the fore-head and eyes, aggra- 
vated by stooping and walking, relieved by pressure ; nausea, occasional 
vomiting; fever, perspiration, cold hands and feet; pulse 120. Pul- 
sations through the body. Fever and pain diminish on the second day. 
Slight leucorrhoea in intervals. Directed powders of Sabina 200, two 
every week till the next period is passed. Dissolve a powder in a half 
tumbler of water, a teaspoonful every two hours while the pain con- 
tinues severe. The next period wras delayed three days ; attended by 
lighter degree of the old symptoms. Third day less feeling of ob- 
struction than usual, no unpleasant symptoms afterwards. The next 
return delayed forty-eight hours, the flow more natural, no pain or pul- 
sation complained of; feeling of obstruction lasted only two hours, no 
sensation after the first day. Third period, return just four weeks; 
flow slight for two days, lasting slightly for eight days, but no pain. 
Two weeks after, severe dragging-down pain, lasting three hours, re- 
lieved by one powder. The fourth return was perfectly regular in all 
respects. 
Cyclamen-Furopceurn, [Hahnemann's Materia Medica Puray 
Vol. V., p.40-60): Symptoms: “Sudden stupefaction, vertigo and 
dull-pressing headache; obscuration of the sight, dilatation of the 
pupils; drawing pains in the nape of the neck, and in the teeth; nau- 
sea, eructations, loathing and aversion to food, and hiccough soon after 
eating; stinging griping pains in the abdomen; sensation of general 
discomfort; flatulence and desire to urinate. Oppression of the chest, 
pressing pain in the chest, stinging and drawing in the back ; laming 
pressure, drawing and stinging in the extremities; weakness, itching, 
peevishness, sleepiness, lassitude, sleep disturbed and interrupted by 
bad dreams,' chilliness of the whole body alternating with heat; loss of 
thirst, disinclination to labor or to speak, excessive sadness, melancholy, 
occasionally joyful feeling and lively fancy.” 
The Vienna proving* adds to the above: Menstruation more pro- 
fuse. Repeated appearance of the catamenia. Menstruation attended 
by severe abdominal pains. Reappearance of long-suppressed cata- 
* American Homoeopathic Review. Vol. III. p. 31. 
t Zeitschr. des Vereins dcr hom. Aerzte Oesterreichs. 2. Bd., S. 445-488 DYSMENOKRHCEA. 
687 
menia, (curative effect.) Menstruation increased in quantity, black and 
lumpy, and attended by hard labor-like pains. 
Dr. Eidherr, of Vienna,* S3.ys : At the Leopoldstadt Hospital and at 
the Dispensary connected with it, he saw this remedy tried in thirty- 
four cases. He found it “ very efficacious with blond, leuoophlegmatio 
subjects in whom, besides retarded, suppressed, or scanty menstrua- 
tion, or complete chlorosis, there were also: “ disinclination for any 
kind of labor; fatigue from slight causes; yawning; continual sleepi- 
ness ; snoring, deep sleep, or sleep disturbed by anxious dreams; chil- 
liness over the whole body,' which no amount of covering will relieve ; 
vertigo ; sensation as if the brain wabbled about while walking; stupe- 
faction and fullness of the head; periodical congestion of blood to the 
head, with paleness of the face; stinging pain in the forehead and 
temples ; glimmering before the eyes; attacks of faintness with cloudi- 
ness or obscuration of sight; occasional diplopia; roaring in the 
ears; frequent nausea; inclination to vomit; or vomiting of food or of 
watery liquid; aversion to ordinary food, and desire for edible things; 
frequent recurring colic-like pains; strangury with fruitless efforts; 
ill humor; disposition to weep; fear of death or an illusion of being 
deserted, or persecuted by every one.” 
Case by Dr. Eidherr.—A young lady of twenty-four years, light 
hair, pale delicate skin, pale lips and gums, menses regular till two 
years ago when suddenly suppressed by exposure to rain. After many 
domestic remedies were tried they came on amid excessive labor-like 
pains, returning in the same manner, only at intervals of two to four 
months. Her condition became highly anaemic, pressive pain in the 
fore-head, vertigo, fits of fainting, chilliness of the whole body; unre- 
freshing sleep broken by fearful dreams, aversion to food, vomiting in 
the morning, and pain in the back. Cyclamen 15° (decimal) restored 
her completely. A few days after taking it the menses appeared, and 
again three days before the next period; also at the third period; 
after which she continued well. 
In this case and in two others the Cyclamen produced diplopia. 
Case 2.—A lively girl, aged sixteen, fretful and melancholy after 
suppression of the menses for a few months ; she lost all interest in tho 
ordinary concerns of the family circle, refused to walk in the open air, 
and slept unusually late in the morning. At the end of three months 
she showed swelling of the eyelids, pale lips and gums, and heart’s 
action violent; always felt tired, had frequent pressive pain in the 
forehead, vertigo, diminished appetite and constipation. Cyclamen 15°, 
continued for three or four weeks, restored the menses, and her general 
health was soon fully established. 
* Allgemeine Homooopatbisohe Zeitung. July, 1859. 688 
DISEASES OF THE REPRODUCTIVE FUNCTION. 
Macrotin. — The Macrotrys-cimifuga, Black-cohosh, Squaw-root, 
Black Snake-root, or Bugbane, is an old remedy for rheumatic diseases. 
Dr. Hale says: “ It is homoeopathic to nearly all rheumatic, neuralgic, 
irritable, congestive states of the uterine organs. It causes symptoms 
similar to those met with in pregnant women, thus: great and general 
nervous prostration, and irritability; neuralgic pains in the head, back, 
and uterine region ; feeble, slow or quick pulse, palpitation of the heart, 
sick headache, sensitiveness of the uterus; swollen, tender, and 
abraded condition of the cervix; with aching, dragging pains at each 
menstrual period. It resembles Aconite, Bry., Colch., Nux, and Bell.” 
He gives the second or third trituration. 
It is reputed to be anti-spasmodic, narcotic, tonic, emmenagogue. It has 
been successfully used in dysmenorrhoea, sterility, chorea, hysteria, 
and as a parturient. 
Given in over-doses of from three to five grains it produces: slight 
dizziness, fullness, dull aching in the head; aching in the joints. It 
has been used in neuralgia, asthma, splenitis, pertussis, delirium tre- 
mens, and gonorrhoea. Immediate Effects: Like Digitalis it disorders 
the sensorium, increases secretion and absorption; in full dose it 
prostrates to an alarming degree, producing vertigo, nausea, pains of 
the extremities, anxiety, dilatation of the pupils, quick small pulse, 
with general restlessness, uneasiness. Remote Effects,—the reverse 
of the above. It has the power of lessening arterial action, and in- 
creasing general energy. Tincture from the root: Used in chorea by 
Dr. Hildreth. (Amer. Jour. Med. Sci., Jan., 1843. Also by Dr. Kirk- 
land, ibid., 1840.) 
Aconite in States of Pregnancy, and Subsequent Conditions.—A 
woman, aged thirty-four, and in the seventh month of pregnancy, was 
attacked with vomiting so violent that she supposed herself to be 
poisoned. Ipecac., Stibium, Nux-vomica, and Cuprum were of no service. 
There were lancinating pains in the stomach; extreme, and continued 
anguish in the prcecordial region, augmented by each act of vomiting; 
vomiting of such violence that the patient in the end threw up pure 
bright, red blood. The anguish increased to an extreme point; syn- 
cope supervened, and a miscarriage was imminent. The first dose ot 
Aconite 200, produoed tranquility; the anguish and pain yielded to a 
pleasant sleep. Delivery occurred at the proper time. (RucJcert.) 
A woman of full habit suffered much during the last month of her 
pregnancy, with violent congestions of the chest. Aconite afforded so 
much relief that she could afterwards sleep tranquilly without fear ot 
suffocating. (Griesselich, Ilygea, Vol. V., p. 218.) 
Moi'bid Phenomena of the Puerpurad State.—A woman, aged 
twenty-eight years, was attacked on the third day after an artificial 
delivery with a violent shaking chill succeeded by: tumultuous febrile MENORRHAGIA. 
689 
disturbance, with a hard and frequent pulse; dry and hot skin, intense 
thirst; tongue dry and slightly coated, violent headache, fixed and 
ferocious expression; lochia arrested; breasts flaccid and without 
milk, violent pains in the bowels on the slightest touch; bowels a 
little bloated. An aqueous solution of Aconite 2, in spoonful-doses 
was prescribed every half-hour. There was an amelioration during 
two days, and then an attack of dysentery (in consequence of this un- 
necessarily large dose ? {Jahr), which was cured by Belladonna. 
{Bosch, Yol. XIX., p. 103.) 
An intelligent woman, on the eighth day after confinement, after 
having taken cold, was attacked with the following symptoms: con- 
siderable heat, and continual fever, with continued cutting and con- 
tractive pains in the bowels, tension of the bowels, and sensitiveness at 
the least touch; diarrhoeic stools every fifteen to thirty minutes; pres- 
sive and stupefying cephalagia; frequent and tense pulse; violent 
thirst; tongue dry and covered with a white fur, desire to vomit. The 
lochia were at first scanty and finally suppressed. 
3. MENORRHAGIA.—UTERINE HAEMORRHAGE. 
Diagnosis.—Profuse uterine haemorrhages may take place at any 
period of life from puberty to old age, and in every variety of consti- 
tution. But the most common kind of menorrhagia to which the at- 
tention of the physician is called, is that which happens during the 
periods of menstruation from a congestion or relaxation of the uterine 
secretory vessels. A certain amount of menstrual fluid is secreted 
each month, and this natural quantity is determined by the tempera- 
ment, constitution, and habits of life of each particular subject. Thus, 
robust and plethoric females who live richly and drink wine, may lose 
a large quantity of blood at each period, and suffer no inconvenience 
from it; while individuals of delicate and relaxed constitutions would 
immediately experience ill effects from so profuse a flow. It is when 
this healthy, natural flux becomes morbidly augmented, that we apply 
to it the designation of uterine haemorrhage, and deem it necessary to 
employ medical means. 
Dangerous uterine haemorrhages often occur during pregnancy, from 
disturbance or rupture of the membranes of the placenta, and also 
from concussions, blows, violent exercise, fright, anger, cathartics, and 
emmenagogues. The symptoms which precede menorrhagia, occurring 
at the menstrual periods, are: general uneasiness and dissatisfaction; 
petulency; lassitude and sense of oppression in the head; weariness 
and wandering pains in the back, loins, and inferior extremities ; sense 
of weight and pressure in the pelvis ; chilliness ; unnatural determina- 
tions of blood; cold feet, rapid pulse, and impaired appetite. 
Vol. ii.—44. 690 
DISEASES OF THE REPRODUCTIVE FUNCTION. 
The symptoms attendant on the flux will depend entirely on the 
nature of the case, the constitution, and the amount of blood lost in 
each instance. In light cases of menorrhagia, the patient only ex- 
periences a general sense of lassitude, debility, Aveariness, faintness, 
tired and uneasy sensations in the back and limbs, indisposition to ex- 
ercise, faint and death-like feeling at the pit of the stomach; paleness 
of the face, cold extremities, and feeble and unsatisfactory respiration. 
In more serious cases the patient becomes almost ex-sanguineous; 
the face, lips, and surface become blanched; the muscular strength 
entirely prostrated; every attempt to move or converse induces imme- 
diate syncope ; there is more or less determination of blood to the 
brain, as is evinced by sharp pains, delirium, ringing in the ears, and 
throbbings of the carotid arteries ; the vision is impaired; floats cir- 
culate before the eyes; respiration is oppressed; palpitation of the 
heart ensues from exercise or emotions; pulse rapid and extremely 
feeble ; general coldness of the surface ; great and undefinable uneasi- 
ness and nervous irritation. The blood gushes upon every exertion to 
change position, and on coughing, sneezing or vomiting. After the 
patient has become reduced by its loss to a very low state, frequent 
and protracted fainting turns come on; respiration and circulation 
become almost suspended; the blood clots at the mouths of the uterine 
vessels, and thus the flooding is temporarily arrested. As soon, how- 
ever, as the organism reacts, these clots are liable to be expelled by 
the contractile efforts of the uterus, and the flowing reappears. 
These different conditions may occur several times during the progress 
of the disorder, until finally the patient is so completely prostrate that 
there is no reaction; the clots of blood are not expelled, and time 
allowed for the uterine vessels to recover themselves sufficiently to 
resist any further morbid secretion. Cases of this description are not 
uncommon, and the cures are often attributed to monstrous doses of 
Opium and Sugar of Lead, rather than to the kind offices of nature in 
inducing syncope, and a consequent coagulation of the blood in the 
uterus. 
We have enumerated amongst the symptoms of the complaint deter- 
mination of blood to the head, and inflammation of the brain. 
These symptoms have been so often observed in connection with pro- 
fuse haemorrhages, and the question has been so often discussed, in 
regard to the propiuety of blood-letting for the cure of a cerebral in- 
flammation which has been caused by excessive loss of blood, that no 
one will deny the fact, that these symptoms actually occur as a direct 
consequence of menorrhagia. Examples of this kind should teach the 
important truth, that excessive loss of blood is always a powerful 
predisposing cause, and in very many instances a direct exciting 
cause of inflammation of the brain, lungs, and other structures. It MENORRHAGIA. 
691 
ought also to induce the exercise of a little reason in the therapeutical 
measures, rather than a persistence in the empirical routine of the old 
school of venesection, opiates, and astringents. 
Menorrhagia originating in organic derangements of the uterus, like 
indurations, cancers, tumors, and ulcers, will be accompanied with the 
symptoms peculiar to these different maladies, in addition to their ordinary 
signs. Cases of this description will require careful attention, both in 
a diagnostic and in a therapeutic point of view. Thus, if the disease 
be dependent on a scrofulous or psoric diathesis, or a syphilitic taint, 
our remedies must be directed as well to these original and general 
causes as to those which are more immediate and local. By this 
means we may strike the silent and invisible enemy, while subduing 
others which are manifest to our senses. 
Causes.—We include among the remote causes of this affection, im- 
proper physical and moral education, excesses in eating and drinking, 
insufficient nutriment, scrofulous, syphilitic, or psoric taints; pressure 
of the abdominal viscera downwards upon the uterus by mechanical 
contrivances; an ardent sanguine temperament, and a plethoric habit, 
or a lymphatic venous temperament, and a relaxed habit. 
The proximate causes are: irritation, congestion, or inflammation 
of the secretory vessels of the uterus; the various disturbances and 
injuries occurring during pregnancy, and from accouchement, cancers, 
ulcers, tumors, sexual excitement, and stimulating drinks during the 
catamenial period. 
Prognosis.—A favorable termination may be expected when no 
organic affection exists, if the patient is moderately robust, and the 
disease depends upon simple local inflammation, or the accidents aris- 
ing from pregnancy and accouchement. Many of the floodings, how- 
ever, which proceed from miscarriage, from abnormal conditions of the 
foetus and placenta, and from accidents during delivery, require prompt, 
bold and judicious efforts in order to rescue the patient from fatal 
prostration. But no woman need bleed to death under any of these 
circumstances, if there is proper knowledge and decision on the part 
of the physician. 
The circumstances which must render our prognosis unfavorable 
are: chronic induration or softening of the uterus; cancerous and 
other incurable ulcerations and tumors, and morbid growths within the 
viscus. But, even in these apparently hopeless cases, we should never 
despair, for the resources of homoeopathy sometimes surpass our most 
sanguine expectations. 
Therapeutics.—After having removed as far as possible all dis- 
turbing causes, a suitable remedy may be selected from Platina, 
Pulsatilla, Belladonna, Ipecacuanha, Sabina, Secale-cor., Ferrum- 
met., Arnica, China, Charnomilla, Sepia, Bryonia, Nux-vom., Car- 692 
DISEASES OF THE REPRODUCTIVE FUNCTION. 
bo-animal., Acid-phos., JTyoscyamus, Crocus-sativa, Creosote, Ham- 
mamelis, Collinsonia. 
Platina is particularly suited to females of a sensitive and impres- 
sible organization, and who suffer from too frequent and too profuse 
catamenia. The flow is accompanied, and occasionally preceded, by 
cutting and pressing pains in the abdomen, back, and pelvis ; dull pains 
in the groin and thighs; sensation of fullness in the uterus; chills, 
alternating with flushes of heat; unusual sensitiveness of the genital 
organs; headache; sadness; debility; restlessness ; leucorrhoea; men- 
strual discharge, red and fluid, or dark, thick and coming away in clots. 
This remedy is applicable in menorrhagia arising from induration or 
cancer of the uterus. 
Pulsatilla is useful in menorrhagia occurring in females at the 
“ turn of life,” or from scirrhus uteri, or from simple passive conges- 
tion of the uterus, or during pregnancy and accouchement. The blood 
is generally dark and coagulated, and is expelled only at intervals, but 
in large quantities. In profuse haemorrhages after delivery, when the 
uterus does not contract, and the patient is much prostrated from pain 
and loss of blood, Pulsatilla is an excellent remedy. It may also be 
given in menorrhagia characterized by inconstant and shifting pains 
in the back, loins, abdomen, and pelvis. 
Belladonna is our best remedy in superabundant menstruation pro 
ceeding from irritation and active congestion of the uterine vessels, 
and also in uterine inflammations consequent upon abortions, violent 
passions or protracted exposure. It is an invaluable remedy in cere- 
bral inflammations arising from excessive uterine haemorrhage. 
The general indications for Belladonna are: a plethoric habit; 
ardent sanguine temperament; frequent determination of blood to the 
head; strong passions; pressing pains in the small of the back and 
in the abdomen; sense of fullness in the uterus; full and rather rapid 
pulse ; vertigo and pains in the head; nausea ; ringing in the ears ; 
partial loss of consciousness; inflammation of the uterus; profuse dis- 
charge of bright-red blood ; flushed cheeks; brilliant and congested 
eyes; scirrhus uteri. Belladonna has been advised in alternation 
with Arnica and Platina, when the pains resemble those of labor, 
and there is a pro fuse discharge of bright-red blood. 
Calcarea.—Two days after a dose of Sulphur, give one of Calcarea. 
Continue at intervals to alternate the latter with Sulphur, Nux, or 
China, till the next period comes on. During the excess give the ap- 
propriate remedy, whether Belladonna, Sabina, Secale, Crocus, accord- 
ing to the indication. 
A young woman suffered from uterine haemorrhage on the least 
movement. She had also tubercular phthisis. Sabina, Silicea, and 
Chamomilla were only of temporary benefit. Calcarea permanently MEN OKRIIAGIA. 
693 
cured the haemorrhage and alleviated the phthisis. Dr. Black says: 
“ Caloarea resembles Sulphur, Belladonna, Platina and China in its ac- 
tion on the uterus; and is indicated where there is a tendency to the 
too early and too profuse appearance of the menses—a state which we 
often see increasing or producing lowness of spirits, hysteria, &c.”— 
(.British Jour. Uomoeoj9., Vol. /.) 
Ipecacuanha may be employed when the catamenia appear every 
two or three Aveeks, attended with pressure in the uterine region, and 
profuse discharges of fresh blood. 
Sabina.—Kave and Wedekind suppressed uterine haemorrhage, with 
the aid of savine, which, as every one knows, causes this disease, and 
consequently abortion in women in health. 
Sabina is indicated in menorrhagia during and after miscarriage, 
and at the menstrual period. The flooding is accompanied with bear- 
ing-down pains in the abdomen and pel\ris; abdominal spasms; pains 
in the uterus ; ardor urinas,, and profuse discharges of dark and coagu- 
lated blood, or of fluid red blood. Sabina is especially useful in pro- 
tracted uterine haemorrhages arising from a loss of tone in the vessels 
© © 
of the uterus, whether from previous disease or the weight and pres- 
sure of the foetus in utero. 
Cyclamen-europaeum. — Menstruation profuse, too frequent, too 
early, appearing Avith violent pain in the abdomen, reappearing after 
long suppression (curative effect), menses accompanied Avith labor pain, 
the blood Aoavs in large quantity, very dark and clotted. 
Secale-cornutum <—Uterine haemorrhage, Aoav profuse, debility in- 
creasing ; great prostration ; respiration becoming difficult; symptoms 
of excessive loss of blood; extremities cold, pulse becoming quicker 
and weaker. In cases of this kind Secale has a specific influence on 
the uterine contractions, and in this Avay it arrests the haemorrhage. It 
has often been speedily arrested by fwe grain doses of Secale in 
poAvder. It has also been often done by one grain doses. Indeed it is 
successful in the cases in which it is appropriate, whether the dose is 
large or small. 
Secale-cornutum is recommended in haemorrhages arising from 
passive congestion of the uterus, cachectic habit, and debility, and 
want of tone in the uterus, from difficult parturition or disease. The 
general indications are : pale face, cold surface, feeble pulse, white lips, 
pains and tenesmus in the rectum and bladder ; discharge of dark and 
offensive blood, increased on motion, cough or sneezing, great prostra- 
tion ; numbness, spasms, humming in the ears ; obscuration of vision, 
loss of contractive power in the uterus. 
Ferrum-metallicum is indicated in profuse haemorrhages after par- 
turition and at the monthly epochs. The discharge is attended Avith 
spasmodic and labor-like pains in the loins and uterine region; flushed 694 
DISEASES OF THE KEPKODUCTIYE FUNCTION. 
cheeks, hard and full pulse, hot skin, headache, hot and scanty urine, 
constipation, shudderings. 
Arnica is our chief remedy in menorrhagia originating from mecha- 
nical injuries during pregnancy or delivery, or from blows, contusions, 
strains, &c. 
China is applicable in haemorrhage proceeding from an asthenic 
condition of the uterus. It is especially useful in enfeebled and cachec 
tic females, who flow too profusely after parturition, from an atonic 
condition of the uterus and its non-contraction. A general appearance 
of debility and exhaustion ; blanched countenance, discharge of serous 
or thick, dark, and clotted blood, pale, sunken countenance; restless- 
ness, constant fainting turns ; soft and flabby muscles, coldness of the 
extremities, and the rapid and feeble pulse, point to this remedy. 
Chamornilla is adapted to bilious and nervous constitutions, and may 
be employed in menorrhagia, attended with pains and pressure in the 
pelvis ; ardor urinae; tearing pains in the small of the back, uterus 
and legs, with frequent discharges of coagulated blood. It has also 
been highly commended in uterine haemorrhages occurring at the 
change of life. Females of an angry, violent, and quarrelsome dispo- 
sition, derive most benefit from this drug. 
.Sepia may be used in cases proceeding from scrofulous and scir- 
rhous affections of the uterine organs. It is likewise advised in pro- 
tracted chronic cases, where the system has become much exhausted 
from previous disease and suffering. 
Bryonia agrees with bilious and choleric females, and is commended 
in menorrhagia attended with stitching pains in the head, back, and pit 
of the stomach, when stooping or stepping. 
Nux-vomica will apply in cases of menorrhagia from uterine con- 
gestion, accompanied with spasmodic pains in the uterus, and a dis- 
charge of clots of dark-red blood. 
Carlo-animal. has been successfully used in a few cases of moderate 
uterine haemorrhage, from chronic induration of the uterus. 
Acid-phosphor, is specific in too profuse menstruation, attended 
with swelling and pain in the liver. 
Ilyoscyamus is specific in superabundant menstruation of hysteri- 
cal females, who experience before and during the continuance of the 
flow, general spasms, convulsive laughing or weeping, twitching or 
trembling of the limbs, headache, and occasional delirium. The dis- 
charge is bright red. 
Crocus-saliva corresponds to active or passive uterine haemor- 
rhages. It is useful after miscarriage, when the discharge is very pro- 
fuse, dark, and viscid, and the patient is anxious, feeble, chilly, faint, 
sick at the stomach, restless, thirsty, and annoyed with palpitation of 
the heart, vertigo, impaired vision, vague pains in the back and pelvis, LEUCORRHCEA. 
695 
and unpleasant dreams. Movement and coughing increase the hrnmor- 
hage. 
Creosote is advised in passive uterine haemorrhages originating in 
general laxity of the uterine vessels. The menses appear too early, are 
too profuse, and accompanied with a leucorrhoeal or ichorous dis- 
charge, which irritates the parts with which it comes in contact. 
Hammamelis and Collinsonia are appropriate and very efficient 
remedies in passive haemorrhages of the uterus, dependent on an 
enfeebled and relaxed condition of the organ. 
Trillium.— Trillium, as prepared by some pharmaceutists, is regard- 
ed as a good remedy in this disease. Dr. Hale says an experience of 
many years enables him to recommend it in the most severe haemor- 
rhages ; also in profuse exhausting leucorrhoea, with atony, prolapsus 
and chronic engorgements of the cervix. Its analogues are : Crocus, 
Sabina, Secale, Erigeron, and Lycopin. 
Admixistkatiox.—In urgent cases of uterine haemorrhage, we give 
the first attenuations, and repeat every half-hour until medicinal symp- 
toms appear, or the flooding abates. In less dangerous cases, we repeat 
every two, three, or four hours, so long as is necessary. With the in- 
ternal remedies, cold water may be applied to the pelvic region by 
means of cloths. The hips must be elevated and supported, while the 
head and shoulders are lowered, and the patient be kept cool, quiet, 
and free from excitement. 
4. LEUCORRIKEA.—FLUOR ALBUS. 
Diagnosis.—This disease is characterized by a discharge from the 
utero-vaginal structure, of a muco-purulent character, of a white, yel- 
low, or greenish color, either thin and watery, or of the consistence of 
starch or gelatine. This discharge, in contradistinction to that of 
gonorrhoea arises from a benignant morbid action, and is non-con- 
tagious. The assertion of Hartmann respecting the identity of gonor- 
rhoeal and leucorrhoeal inflammations—the difference, in his view*, 
consisting only in the location of the disease—is evidently erroneous. 
This author defines gonorrhoea to consist of an inflammation of the 
female urethra and leucorrhoea of a similar inflammation of the mucous 
membrane of the vagina or uterus. The opinion falls to the ground 
when we reflect that the latter disease not unfrequently extends to the 
urethral mucous membrane, giving rise to ardor urinae, burning pain on 
passing the urine, heat, fullness, and swelling of the part, and a 
purulent discharge, which is non-contagious. Leucorrhoeal inflamma- 
tion always originates from causes which have impaired the healthy 
tone of the mucous membrane ; gonorrhoeal inflammation, on the other 
hand, may arise from the simple contact of a drop of gonorrhoeal mat- 696 
DISEASES OF THE REPRODUCTIVE FUNCTION. 
ter with the most sound and healthy membrane. The former is the 
result of an ordinary inflammation, which is analagous in its character 
to that of catarrh and chronic bronchitis: the latter proceeds only 
from the application of a specific infectious matter, which develops a 
particular inflammation and a contagious purulent secretion. 
The character of the discharge and of the symptoms will depend 
upon the location of the disease, its causes, and the amount of inflam- 
mation present. Inflammation of the cervix uteri, for example, causes 
a discharge of “ white mucus, and when the inflammation is intense, 
tinged with blood.” {Hall.) Acute vaginal or urethral inflammation 
gives rise to a purulent discharge of a yellow or greenish color, some- 
times tinged with blood. A more chronic affection of the same parts 
induces a thinner, more glairy, and muco-purulent secretion. Scirrhus 
uteri causes an ichorous, bloody, and foetid discharge. In chlorotics, 
with deranged menstruation, the secretion is thin, serous, acrid, and of 
a lightish straw color. The discharge, which often accompanies preg- 
nancy, is thick, glairy, and white or yellowish; but in some instances 
after delivery, more particularly in scrofulous and cachectic subjects, 
the matter is ichorous and highly irritating to the parts with which it 
comes in contact. In polypi of the uterus or vagina, the discharge is 
at first mucous, but when the tumors have attained some size, it becomes 
tinged with blood, and, in some cases of this kind, profuse haemorrhages 
occur. The signs which denote the existence of these tumors are, 
sense of weight and fullness in the uterus, dragging pains in the small 
of the back, bearing-down pains, and turns of profuse haemorrhage. 
In light cases of leucorrhoca, the discharge is usually thin, glairy, 
transparent and starchy; but when the disease is thoroughly estab- 
lished, and the patient is of a delicate or cachetic habit, the fluid may 
be muco-purulent, serous, sanious, and of a white, yellow, or greenish 
color. 
As a general rule, the discharge is worse about the period of the 
monthly sickness, owflng probably to the increased determination of 
blood to the parts during this natural phenomenon. 
The diseases which are ordinarily accompanied by leucorrhoea are, 
amenorrhoea, chlorosis, polypus and scirrhus uteri, dysmenorrhoea, 
menorrhagia, prolapsus uteri, and chronic inflammation of the uterus, 
vagina, or urethra. 
When the affection is inveterate and attended with an abundant dis- 
charge, the -whole system becomes injuriously affected; the face 
assumes a pale or sallow color; the eyes are surrounded with dark or 
leaden-colored circles; the functions of the stomach and bowels are 
impaired; the patient experiences a -weary, dragging sensation in the 
left side; there are also dull pains in the back, loins, and abdomen; 
cold extremities; nausea; palpitation, and dyspnoea after exercising; LEUCOKKHCEA. 
697 
lassitude; debility; feeble pulse; loss of physical and mental energy; 
partial or total suppression of the menses; increase or diminution of 
the sexual propensity. 
These are symptoms to which protracted and severe attacks of 
leucorrhoea give rise; but the malady may exist for years, in a mild 
form, without the development of any of these consequences. 
This disease is far more common in cities amongst the rich, indolent, 
luxurious, and dissipated than in the country. Indeed, the small num- 
ber of births and the frequent miscarriages occurring in large towns 
are attributable in a great measure to the very common prevalence of 
this weakness. 
Leucorrhoea has been considered one of the symptoms of prolapsus 
uteri / but we are of opinion that in very many instances, the latter is 
a consequence, rather than the cause of the former. This opinion 
derives support from the fact that fluor-albus often exists for years 
before the signs of prolapsus manifest themselves; and it is probable 
from this circumstance that the. tone of the uterus becomes impaired, 
and the muscles and ligaments gradually lose their strength and con- 
tractility. 
Leucorrhoea occurs at all periods of life, but is most common after 
puberty, and previous to the “change of life,” when so many causes 
are constantly conspiring to induce free determinations of blood to the 
utero-genital organs. 
Causes.—The conditions which predispose to attacks of leucorrhoea 
may be enumerated as follows: a lymphatic temperament; a scrofu- 
lous dyscrasia; general debility and relaxation of the muscular and 
membranous structures, whether from natural organization, or previous 
disease. 
Amongst the more immediate causes may be mentioned, an inactive 
and luxurious mode of life; immoderate sexual indulgence ; abortions; 
congestions and inflammations of the uterus and vagina; menstrual 
derangements; want of cleanliness ; a humid atmosphere; scirrhus 
uteri; polypi, and other abnormal growths in the uterus; metastases 
of rheumatism; herpes; hgemorrhoidal, catarrhal, and bronchial 
inflammations; the uterine debility and relaxation consequent on par- 
turition, and too early exercise after confinement; neglect of mothers 
to exercise the office of nursing; and, finally, according to Marshall 
Hall, undue lactation. 
All of these causes, doubtless, exercise an influence in the produc- 
tion of fluor-albus ; but in the vast ajority of cases the disease may 
be attributed to the combined operation of several of these influences, 
rather than to any single one. We may almost predict beforehand 
that the child, born of parents who have always lived in compactly 
populous cities, and who have indulged in their artificial habits, will, 698 
DISEASES OF THE REPRODUCTIVE FUNCTION 
sooner or later, be afflicted with leucorrhoea. This is but one of the signs 
which indicate the gradual but sure progress of degeneration to which 
the luxurious and dissolute habits of large towns inevitably lead. In the 
first instance, indolence, stimulating drinks, overheated apartments, ex- 
citing theatrical exhibitions, romances, pictures, statuary, &c., all tend to 
divert the mind towards sensual enjoyments. Deprived, in a great 
measure, of those pure and sublime pictures which nature has so 
lavishly scattered throughout the country to please the sight, to elevate 
the mind, and ennoble and purify the whole being; and of the thou- 
sand sources of happiness which pertain to country life; they turn to 
artificial pleasures, and reap the fruits which are ever entailed by a 
violation of natural laws. 
Is it strange then that fluor-albus is so common in cities ? that the 
degenerate offspring of these artificial human beings should grow up 
so puny, so weak, mentally and physically; so prone to disease, and so 
incapable of performing properly those functions for which nature has 
designed them ? If any one doubts the inferences which these re- 
marks suggest, let him but observe the families of the wealthy and 
luxurious, who have inhabited large cities for two or three generations, 
and he will no longer doubt. 
The Genital Organs of Females are affected by the sycotic poison 
in various modes, producing leucorrhoeas with corrosive secretion, irre- 
gularities of menstruation in regard to quality and quantity of the se- 
cretion; unnatural sexual desire and great tendency to cancerous dis- 
organization. The increasing prevalence of such manifestations of dis- 
ease furnishes employment to a host of specialists among physicians, 
wrho in their short-sightedness, treat the local affections, without pay- 
ing any regard to constitutional disease. Dr. Wolf says “ the timely 
use of Thuja can alone radically cure and obviate all the evils to which 
the now existing ill-treatment has doomed the female sex.” 
Prognosis.'—Leucorrhoea often leads to prolapsus uteri, amenor- 
rlioea, menorrhagia, abortion, anasarca, hysteria, and general debility ; 
but it very rarely terminates fatally. By impairing in a gradual man- 
ner the energies of the system, it predisposes it to take on serious dis- 
ordered action from slight causes, and thus becomes indirectly an im- 
portant morbid agent. When the complaint is recent, and occurs in 
females of a morbid constitution, from some temporary congestion, dif- 
ficult parturition, or medicinal injury, we may expect to remove it by 
the aid of suitable remedies, in a short period ; but if the patient be of 
a lymphatic temperament, of a delicate, lax and scrofulous constitution, 
and subject to irregular menstruation, the disease will most probably 
baffle our best curative efforts, and persist, with a greater or less de- 
gree of severity, during life. In individuals of this description, the 
most insignificant causes are capable of inciting and perpetuating the LEUCORRHCEA. 
699 
weakening discharge, so that in many cases it will prove a hopeless 
task to attempt to remove all the influences which exercise an in- 
jurious bearing upon the case. Even when the affection exists as the 
mere symptom of some other disease, it seldom subsides with the other 
symptoms, but is quite prone to degenerate into a chronic fluor-albus 
Treatment.—There are several conditions which are absolutely es- 
sential to the successful treatment of this disease, the most important 
of which are : abundant active exercise in the open air; avoidance of 
venereal excesses, and of the pleasures of the table; a withdrawal of 
the thoughts and affections from all exciting, spectacles, from crowd- 
ed balls and parties, from lascivious imaginings, from romances and 
intrigues; and lastly, frequent daily ablutions, in order to insure the 
most perfect cleanliness of the affected parts. 
The vast importance of this last point cannot be too strongly insisted 
upon, for without a rigid attention to cleanliness, all our efforts will 
prove futile. The morbid secretion is at best sufficiently irritating, 
but when it is permitted to accumulate and remain for a long time in 
contact with the mucous membrane, it becomes partially decomposed, 
foetid, and highly pernicious to the well-being of the parts. On this 
account, the constant and thorough use of local applications of tepid 
or cold water, as circumstances require, should be strictly enjoined. 
We may then carry out our remedial measures in all their details, with 
a reasonable prospect of success. 
We call attention to the following remedies: Calcarea-carb., Sul- 
phur, /Stannum, Sepia, Iodine, Pulsatilla, Alumina, Lycopodium, 
Phosphorus, Cocculus, Sabince, Secale-cor., China, Arnica, Bovista, 
Aconite, Mer curias, Nux-vom., Silicea, Psoricum, Copaiba), Meze- 
reum, and Manganum. 
Calcarea-carb. is suitable in chronic leucorrhoea, affecting weak, 
scrofulous and cachectic females, and particularly indicated when the 
menses are too frequent and too profuse. The discharge is milky, trans- 
parent, mucilaginous, starchy, unirritating, and accompanied with itch- 
ing of the parts, especially the pudendum; also lassitude; depression 
of spirits ; pains in the chest and back ; cough ; and general debility. 
When the complaint arises from a scrofulous, or psoric taint, anti- 
psorics, like Sulphur, Stannum, and Iodine will be required. The 
discharge in these cases is thin or yellowish, and highly irritating to 
the parts with which it comes in contact. The strength is also much 
impaired, and there are indications of pulmonary and scrofulous dis- 
order, such as hectic fever ; emaciation; loss of appetite ; wandering 
pains in the chest; cough; profuse mucous or purulent expectoration; 
feeble and rapid pulse ; night-sweats. 
Sepia is suitable for females who are naturally delicate and sensi- 
tive. with clear and transparent complexions. The discharge is mu- 700 
DISEASES OF THE KEPKODUCTIYE FUNCTION. 
cous, white, yellowish or watery, mild or acrid in its nature, most 
abundant just before or just subsequent to the menses, and attended 
with itching and stinging pains in the genital organs. 
Pulsatilla is an admirable remedy in leucorrhoea accompanying 
pregnancy. It is also useful when the disease occurs about the period 
of menstruation. 
The discharge may be thin, acrid, and burning, or thick, white, and 
tenacious, like the white of eggs. Shifting, flatulent pains in the ab- 
domen still farther point to Pulsatilla. 
Alumina has proved successful in several varieties of fluor-albus ; 
but is particularly indicated when the discharge is very profuse and 
acrid, most abundant during the day when walking, and previous to the 
menstrual periods, and attended with a burning and itching sensation 
in the genital organs and rectum. 
Fluor-albus brought on by masturbation, and occurring at intervals, 
with a milky, serous, or reddish discharge, will be best covered by 
Lycopodium, Phosphorus, or Cocculus. These remedies are suit- 
able to lymphatic temperaments, to those who are highly sensitive to 
cold, and subject to catarrhal affections, and whose nervous systems 
have been morbidly excited. 
Sabince and Secale-cornutum are proper in fluor-albus, depending 
upon weakness of the utero-va ginal structure ; also when arising from 
suppression of the menses; from miscarriage ; from severe and pro- 
tracted labors; polypi, and prolapsus uteri. The discharge is attended 
with itching of the pudendum, and inordinate sexual propensity. 
China will serve our purpose when the complaint originates from 
excessive loss of blood, or other animal fluids, extreme debility from 
fevers, acute inflammations, abuse of drugs, insufficient nutriment, and 
respiration of foul air. 
jBovista is applicable in fluor-albus occurring after the catame- 
nia, with discharge of a thick glairy, and tenacious matter of a yellow 
or greenish color, and highly corrosive. 
Arnica is indispensable in leucorrhoea originating from mechanical 
injuries during accouchement, from polypi, hydatids, and other morbid 
growths in the uterus or vagina, prolapsus uteri, and undue mechani- 
cal pressure from without. 
Aconite.—In copious and viscid leucorrhoea Aconite is sometimes 
efficacious (Molin). The indications given by Hartmann are : leucor- 
rhoea in patients who complain of a sensation of heat, with fullness and 
tension in the internal parts, continual tingling not disagreeable, but 
forcing them to scratch ; burning on urinating ; febrile svmptoms.—• 
(Therap. II. p. 154.) 
Aconite corresponds to plethoric and sanguine constitutions, and to 
females who are subject to congestions and hemorrhages from differ- INFLAMMATION OF THE OS AND CEEVIX TTTEKI. 
701 
ent organs. The discharge is purulent, yellow or greenish, and at- 
tended with ardor urinse, heat, pain and fullness in the genital organs, 
quick and full pulse, hot skin, and other febrile symptoms. 
Dictamnus. Hahnemann says: Storck, who had so intimate a know- 
ledge of medicines, was on the point of discovering that the bad effects 
of the dictamnus which he observed sometimes to provoke a mucous 
discharge from the vagina, arose from the very same properties in 
this root which enabled him to cure a leucorrhoea of long standing 
When there is reason to suspect that the discharge is from a syphi- 
litic origin, whether it he mucous, watery, or purulent, mild or corro- 
sive, Mercurius is our best remedy. 
Nux-vomica is recommended when the disease arises from irregular 
© 
menstruation, abuse of stimulants, rich and indigestible food, with a 
very profuse sanguineous or yellowish and foetid mucous discharge, 
attended with cramp-like pains in the abdomen, constipation, sinking 
at the stomach, and palpitation of the heart. 
Cases occur which will require the use of Silicea, Psoricum, Co- 
■paibce, Mezereum, Manganum, Nitric-acid, to which the reader is 
referred. 
Administration.—We advise the employment of the first, second, 
and third attenuations, the dose to be repeated once in twenty-four 
hours, until primary or secondary medicinal symptoms appear, when 
we may await the result for some days, or so long as the amendment 
continues. When the symptoms become stationary, we may again 
resort to the remedy. 
5. INFLAMMATION AND ULCERATION OF THE OS AND CERVIX 
UTERI. 
Diagnosis.—There are but few local affections which give rise to so 
great a number and variety of constitutional phenomena as ulceration 
of the uterine os and cervix. At first view it would almost seem that 
this malady constituted an exception to the truth of the axiom of 
Hahnemann, that the visible symptoms actually present in any given 
case, make up the sum total of the disease, and are only to be heeded 
in our therapeutical applications. A patient presents herself, for ex- 
ample, with pains in the back and through the hips, constipation, im- 
paired digestion, pain and pressure in the top of the head, debility, 
hysteria and hypogastric pains. These are the only apparent symp- 
toms of the case, and a number of remedies might be selected, which 
would be apparently homoeopathic, but all would prove useless. The 
fault in this, and in similar instances is attributable to a superficial 
and imperfect examination of the case rather than to any error in the 
proposition of Hahnemann. 702 
DISEASES OF THE REPRODUCTIVE FUNCTION. 
In illustration of this, let us pursue the examination still farther. 
In reply to minute queries, the patient informs us, that she has had 
leucorrhoea, more or less from childhood; but not more observable 
since the occurrence of the symptoms enumerated than at previous 
periods. As this discharge is unaccompanied by painful sensations, 
and has existed as far back as she can remember, it is not viewed as 
an abnormal symptom, and wTould be passed by unnoticed, by an in- 
competent physician. 
But the mere fact of the existence of a leucorrhoeal discharge is not 
sufficient for the homoeopathic physician, since different drugs affect 
specifically different portions of the utero-genital mucous membrane, 
producing in each instance discharges varying in color, consistence, 
and chemical composition. 
So also leucorrhoeal discharges vary in appearance and chemically, 
according to the particular seat of the discharge. Thus the mucous 
membrane of the body of the uterus is furnished with glands which 
secrete a peculiar fluid. Different grades of inflammation of this 
structure affect materially the quality and quantity of this secretion, 
and give rise to various forms of leucorrhoea. The best homoeopathic 
remedies in these cases, are those which correspond most closely with 
the various morbid conditions, both with regard to the uterus itself, 
and the discharges which it furnishes. 
The mucous membrane which lines the cervix-uteri is also furnished 
with mucous cysts or follicles, secreting a fluid composed of mucous 
corpuscles and plasma, and having a distinctly alkaline reaction. 
During the various changes to which the female organism is subjected 
during pregnancy, parturition, &c., this secretion undergoes those modi- 
fications which adapt it to the functions it has to perform. Inflamma- 
tion of this part also gives rise to abrasions, granulations, ulcerations, 
and abnormal secretions wdiich require specific remedies for their 
removal. 
The external portion of the os-uteri on the other hand, secretes a 
fluid having an acid reaction. 
So also the normal lubricating fluid secreted by the mucous follicles 
of the vagina is decidedly acid, and thus serves to retain the menstru- 
al fluid in a liquid state during its passage through this canal. It 
possesses likewise the property of preventing the decomposition of 
coagula. 
From wThat has been written it will be observed that the structures, 
which compose the utero-genital apparatus give rise, in a condition of 
health, to different secretions according to the functions they have to 
perform, and the causes acting upon them. These normal conditions 
should be thoroughly understood by the medical man, in order that he INFLAMMATION OF THE OS AND CERVIX UTERI. 
703 
may be able to appreciate exactly those various morbid conditions 
which so frequently occur in practice. 
It is not sufficient to know that the utero-genital mucous membrane 
is subject to modifications, similar to those of the same tissues in other 
parts of the organism, when acted upon by morbid influences, and af- 
fected with inflammations, congestions, abrasions, ulcerations, hyper- 
trophies, &c.; but he must be fully aware of the extensive sympathe- 
tic connections which exist between the uterine organs and other parts 
of the system. He must not only take cognizance of all visible phe- 
nomena, but he must be able to trace them to their latent, and often 
♦ 
obscure causes. He must not rest contented with a mere detail of 
symptoms, given by the patient, however minute such description may 
be, but he must trace out all sympathetic relations, which may exist 
between the uterus and remote symptoms, and by peculiar and other 
examinations, by microscopic observations, and by chemical analysis, 
ascertain the actual condition of suspected organs, as well as the 
changes which may have occurred in the fluids secreted by them. By 
so doing, all variations from the normal standard may be recognized, a 
complete picture of the malady be obtained, and our remedial measures 
applied judiciously. 
“There is scarcely an organ,” remarks Dr. Bedford, in his interest- 
ing work on Diseases of Females and Children, “ which is not, to a 
greater or less extent, through the agency of the nerves, in alliance 
with the uterus; and it is through this agency alone that we can ex- 
plain why remote parts are almost always affected in both organic and 
functional diseases of the womb, whilst the patient, in many instances, 
experiences but slight pain in the uterus itself. This is what consti- 
tutes the stumbling-block in the treatment of uterine maladies; the 
pain in the head, the disordered stomach, the uneasiness in the back, 
&c., which are but the consequences of some derangement of the 
womb, being regarded as the disease. Bemedies are applied to the 
head, stomach, &c., the patient experiences no benefit, and the prac- 
titioner derives no credit. The disease, in the mean time, is progress- 
ing insidiously, and often results in the destruction of health. The 
womb is supplied with nerves by the two great divisions of the nervous 
systems, viz., the cerebro-spinal axis, and the trisplanchnie nerves. The 
former presides over animal life, whilst the latter are essential to or- 
ganic existence. The pain in the back and head—the results of ute- 
rine disease—is conveyed through the cerebro-spinal axis, whilst the 
organic derangements, such as are observed oftentimes to occur in the 
stomach, heart and digestive system generally, are due to the action 
of the ganglionic department.” 
It is obviously the duty of the physician then, in suspected cases, to 
ascertain the condition of the uterus by means of the speculum, and to 704 
DISEASES OF THE REPKODUCTIVE FUNCTION. 
examine carefully the character of the secretions from the affected 
parts. By this means alone can he get possession of the most charac- 
teristic symptoms of the malady, and thus be able to select the most 
specific remedies. 
In affections of other mucous membranes—of the throat, the urethra, 
&c., the physician could not make a proper diagnosis without an ac- 
tual inspection of the deceased parts, and of the altered secretions 
from such parts. In throat ailments he must know whether there is 
inflammation or not—and if he finds it, whether it is acute or sub- 
acute, and whether it is benign, virulent, or erysipelatous in its charac- 
ter ; or if there exist abrasions, granulations, or ulcerations ; or affec- 
tions of the tonsils, uvula, &c. The sensations arising from these 
various morbid conditions of the throat are much alike, and were the 
physician to prescribe remedies in accordance with these sensations, 
he would be constantly liable to error. 
The same rule holds good with regard to phenomena which may be 
supposed to result from uterine derangements. Ocular examinations 
in these cases, are often essential to a thorough appreciation of mor- 
bid phenomena, as in the examples alluded to of diseases of the throat, 
urethra, &c. 
In this connection the question appropriately occurs, whether it is 
not the duty of provers to ascertain by specular examinations the 
changes which are produced upon the uterine tissues during the action 
of drugs upon the female organism, and by chemical analysis to obtain 
a knowledge of morbid alterations occurring in the fluids secreted by 
these organs ? Such examinations involve much trouble and many 
sacrifices, both on the part of the female and the physician, but the 
addition to our knowledge of uterine pathology, and of the pathoge- 
neses of drugs with reference to these parts, could not fail to prove 
immensely valuable. By no other means can perfect similies be ob- 
tained between morbid and c?/,^y-symptoms. 
Causes.—Ulcerations of the mucous membrane lining the os and 
cervix-uteri, result generally from previous inflammatory conditions 
which have been allowed to progress unchecked. In the first instance 
the inflammatory action is usually confined to the cervix; but in a 
short time it extends to the cervical canal, where it is apt to become 
permanent, in consequence of the numerous follicles contained in the 
mucous membrane of this canal, and of the monthly irritation caused 
by the passage of the catamenial fluid. The symptoms which indicate 
the malady in its incipient stage are, leucorrhoea, sense of weight 
and fullness in the uterine region, sacro-lumbar and ovarian pains, las- 
situde, disinclination to mental or bodily exertion, more or less swell- 
ing of the cervix, and tendency to hysteria. Other symptoms will be 
found in almost every case, but we have enumerated those which are INFLAMMATION OF THE OS AND CERYIX UTERI. 
705 
most characteristic, with a view of aiding the medical man in forming 
an early and accurate diagnosis. Of these characteristic phenomena, 
the copious albuminous leucorrhoea, is by far the most important, as it 
points clearly to inflammation of the cervix, and the canal. In health 
this secretion is much less in quantity, lighter in color, and of less 
specific gravity, than when local inflammation is present. In health it 
is composed of mucous corpuscles and plasma ; while the leucorrhoeal 
secretion is distinctly albuminous. In both conditions it has an alka- 
line reaction. 
Treatment.—The treatment of the ancient school in these cases, 
consists of vaginal injections, mercurials, and what they are pleased 
to term tonics. This is the course which has been pursued by the 
routinists of this school for centuries, and which is still adopted by the 
great mass of their practitioners. Unmindful of the anatomical rela- 
tions of the cervical canal and the vagina, and of the impossibility of 
reaching the former by local applications introduced into the latter, 
their local treatment has always proved inefficient, and often positively 
injurious. Commencing usually with astringents and finding no im- 
provement to result from their use, they are often induced to employ 
more active preparations like Nitrate of Silver, Creosote, Chloride of 
Zinc, &c., and thus actually producing, not unfrequently, serious in- 
flammation of the mucous membrane of this previously healthy struc- 
ture. If the true cause of many vaginal and uterine maladies could 
be made known, many a physician would have cause to blush for the 
injury he has ignorantly inflicted. 
But a few writers of recent date, having gained more correct views 
respecting uterine pathology, have repudiated vaginal injections, and 
advised the employment of remedies directly to the affected part, to 
the cervical canal itself. By means of caustics and other “vitality- 
modifying agents,” they seek to change morbid inflammatory actions 
which tend naturally to extend and perpetuate themselves into healthy 
drug-actions which tend to speedy and curative resolutions. As I)r. 
Bennett expresses himself, “ the object in view is to modify the vitality 
of the diseased tissues, and to substitute healthy, manageable inflam- 
mation for morbid inflammation.”—(London Lancet, May, 1856, p. 398.) 
This is by no means an unphilosophical, or non-homoeopathic view 
of the subject. All morbid actions consist essentially of modifications 
of the vitality of affected structures, and the tendency of such altera- 
tions is to produce functional derangements, and sometimes structural 
lesions. This accords with the expressed opinions of Hahnemann and 
other advocates of a vital theory of disease. 
So, according to Hahnemann, all specific remedies, which act upon 
diseased parts, in such a manner as to modify their vitality and thus ena- 
vol. ii 45. 706 
DISE- SES OF THE REPRODUCTIVE FUNCTION. 
Me the recuperative forces to effect curative reactions must bphomceO’ 
tWMo remedies. 
With regard to the malady under consideration, the question to be 
considered is whether the active “ vitality-modifying” applications re- 
commended by Dr. Bennett, or the vitality-modifying internal reme- 
dies of homoeopathy, are best adapted to bring about the curative re- 
actions. We believe that cures may he made by either mode, hut so 
long as the inflammation has not superinduced abrasions, granulations, 
or ulcerations, we prefer specific internal remedies. 
At present our knowledge of the pathogeneses of drugs, with refer- 
ence to the uterine structures, is very imperfect. This is due not so 
much to a lack of medicines which exercise a specific action upon 
these parts, as to defective modes of conducting provings. 
Remedies.—Against simple inflammation of the mucous membrane 
lining the cervical canal and the cervix-uteri, we recommend the fol- 
lowing remedies: 
Sepia.—Albuminous leucorrhoea. Leucorrhoea during the day, re- 
sembling milk, and accompanied with burning pain, and producing sore- 
ness between the thighs. Yellowish leucorrhoea. Watery leucorrlicea. 
Mucous leucorrhoea. Leucorrhoea with stitches in the uterus, and 
itching in the vagina. Corrosive leucorrhoea. Profuse mucous leu- 
corrhoea, having a foetid smell, with drawing pains in the abdomen. 
Prolapsus uteri, with a jelly-like leucorrhoea. Induration of the cervix- 
uteri. Discharge of blood from the vagina with prolapsus. Albu- 
minous leucori’hoea, with pain in the back, and through the hips, fre- 
quent and painful urination, bearing-down pains in the uterine region, 
and a copious deposit of lithates in the urine. Leucorrhoea with pain 
and enlargement of the ovaries. We are in the habit of prescribing 
Sepia at the thirtieth attenuation. It is one of those substances which 
is nearly inert in its crude form, but when properly attenuated becomes 
a remedial agent of great power. Having repeatedly tested this drug 
in both low and high dilutions, experience has demonstrated that its 
remedial virtues are not developed until after the twelfth attenuation. 
Secale.—Jelly-like leucorrhoea, alternating with metrorrhagia, con- 
gestion of blood to the uterus and ovaries, and bearing-down pains in 
the uterus. Albuminous leucorrhoea, with labor-like pains extending 
from the back to the uterus, incontinence of urine, and menstrual colic. 
Leucorrhoea and metrorrhagia in consequence of relaxation of the 
uterine and vaginal tissues. Albuminous leucorrhoea, with relaxation 
and swelling of the os, and spasmodic pains at the neck of the 
uterus. 
Our experience with Secale has taught us to employ it in palpable 
doses, although we have seen remarkable curative results from the 
high dilutions. 
O INFLAMMATION OF THE OS AND CERATX UTERI. 
707 
Sabina.—Albuminous leucorrhoea, foetid, and yellowish, with draw- 
ing pain in the small of the back, open os-tincce, heaviness and pres- 
sure in the pelvis, and irritation of the vagina and pudenda. Copious 
starch-like leucorrhoea, alternating with catarrh. Cramp-like pains at 
the cervix, with tenderness on pressure, severe pain during connexion, 
and sanguineo-mucous leucorrhoea. 
As a general rule, Ave prefer to use this remedy in appreciable 
doses. 
Pulsatilla.—Cutting pain in the os-tincce. Albuminous leucorrhoea. 
Thin and acrid leucorrhoea. Amenorrhoea with thick, viscid leu- 
corrhoea, vertigo, pressure on the top of the head, deranged digestion, 
draAving pain in the uterine neck, frequent and painful urination. 
Albuminous leucorrhoea before and after the menses, Avith severe pain 
in the small of the back and abdomen. 
We rarely employ Pulsatilla below the sixth dilution. 
Cocculus.—Cervical or uterine leucorrhoea, coming off with a sud- 
den gush when stooping, or making any unusual exertion, with pain in 
the uterus on pressure, tenderness of one or both ovaries, severe spas- 
modic pains in the neck of the uterus. Irregular and scanty menstrua- 
tion, Avith leucorrhoea betAveen the periods. 
In our hands Cocculus has proved most efficient at the 30th 
dilution. 
Apis-mel.—Albuminous leucorrhoea, with bearing-doAvn pains in the 
pehds, pain in the small of the back, and through the hips, urging to 
urinate, painful sensitiveness of the cervix, chronic OATaritis, conges- 
tion and tenderness of the ovaries. Thick, tenacious, and offensive 
leucorrhoeal discharge, with dragging pains in the back, pelvis, and 
hips, painful urination, and general prostration of the forces. 
We advise the employment of this remedy at a low dilution. 
Calcarea-carb.—This remedy is suitable for females of a scrofulous 
habit, and lympathic temperament, and who are prone to affections of 
the mucous membranes. Hahnemann asserts that it is most useful in 
females who menstruate too frequently and too copiously. 
It corresponds to copious leucorrhoeal discharges, Avhich have arisen 
from uterine congestion and subsequent metrorrhagia, to albuminous 
leucorrhoea from the cervical canal, with great lassitude debility, sink- 
ing and trembling at the stomach, irritability, depression of spirits, 
burning and shooting pains in the cendcal region, too frequent and 
profuse catamenia, and itching of the genital organs; also to cer- 
vical leucorrhoea in scrofulous subjects, especially those who are suffer- 
ing from phthisis pulmonalis. 
Calcarea should always be prescribed in high dilutions, as its 
remedial p< wer does not become developed until after the twelfth 
attenuation. 708 
DISEASES OF THE REPRODUCTIVE FUNCTION. 
Other drugs which exercise a specific action over cervical inflam 
mation, are Mezereum, Conium, Nitrio-acid, Petroleum, Bovista, 
Borax, Platina, Kali-Garb., Ferrum-iod., and Sulphur. 
Our attention has thus been confined to simple inflammation of the 
mucous membrane lining the cervix and its canal. We now proceed 
to glance briefly at some of the consequences of neglected inflamma- 
tion of these parts. These degenerations are, abrasions, granulations, 
ulcerations, h3rpertrophies, displacements, &c. 
It is proper to observe that there are wide differences of opinion 
among eminent men with regard to the frequency of inflammatory 
affections in the cervix uteri. Indeed, some deny altogether the exist- 
ence of these inflammations, and their sequelae, ulcerations, induration!!, 
&c. Among this number we may name Dr. Lee, of London, whose 
experience in diseases of females renders his opinion valuable. 
Others concede the frequent existence of inflammatory ulcerations 
of the cervix, but attach to them but little importance. Thus, out of 
268 females examined by Dr. West, at the St. Bartholomew’s and 
Middlesex Hospitals, he found that 125 were troubled with ulcerations 
of the cervix uteri. Dr. West, Dr. Tyler Smith, and a majority of 
European obstetrical physicians, now fully admit the frequent occur- 
rence of these lesions; but from the fact that groups of symptoms 
resembling in all respects those which are supposed to proceed from 
ulcerations are often found in females unaffected by any uterine 
disorder, these gentlemen have concluded that these lesions possess 
but little pathological importance. 
They deny therefore the necessity of directing special attention to 
this locality, and doubt the propriety of resorting to local “ vitality- 
modifying agents’’ in the form of caustics, &c., but prefer to trust to 
internal remedial agencies which tend to invigorate the general 
health. 
Another and an increasing class of practitioners no less eminent, 
deem these local lesions of the highest pathological importance, as 
being the sole cause of a large number of unpleasant symptoms and 
morbid conditions. These gentlemen have arrived at their conclusions 
after having made very numerous specular examinations during a period 
of eight or ten years. The amount of testimony which is thus brought 
out, both with regard to the frequent occurrence of these ulcerations 
and their frequent cures by the “vitality-modifying” local applications 
of Dr. Bennett and his associates, render the facts and most of the 
opinions of these medical men incontrovertible. 
Within the past five years we have had occasion to make a large 
number of specular examinations in females suffering from uterine dis- 
eases, and in at least thirty per-cent, of these cases we have found 
either granulations or ulcerations of the cervix. It is true that we INFLAMMATION OF THE OS AND CERVIX UTERI. 
709 
have examined many who had no appearance of uterine disorder, and 
yet were troubled with most of the usual symptoms of ulceration, like 
pains in the back and through the hips, headache, impaired digestion, 
great weakness and lassitude, nervousness, leucorrhoea, depression of 
spirits, &c.; but in nearly all of these instances there were short 
periods when these symptoms were absent and the patients could take 
long walks without inconvenience, as in perfect health, a condition 
which we have never observed in those who were suffering from imflam- 
matory ulcerations of the cervix. We also generally find uterine 
displacements in the latter class, as a consequence of inflammatory 
action, while in the former examples the uterus retains its normal 
position. 
The question now arises, what is the best mode of treatment to 
adopt in cases of suspected ulcerations of the cervix? As it is a 
highly delicate matter for females to submit to specular examinations 
■without a most urgent necessity, we are in the habit of employing, in 
the first instance, a judicious course of internal remedies, in conjunc- 
tion with baths, cold water applications, bracing air, and other invigo- 
rating hygienic means, with the hope that the morbid phenomena may 
gradually subside without recourse to further measures. 
The remedies which have proved most beneficial in our practice, are, 
Secale, (both internally at the 1st dilution, and by injections com- 
posed of one drachm to the pint of water, three times a day.) Apis, 
(internally and by injection.) Thuja, (internally and by injection.) 
Sabina, Prenanthus, Ferrum-iod., Mercurius-hyd., Canabis-sat., 
Cantharis, Sepia, Causticum, Calcarea-carb., Sulphur, Kali-carb., 
Kali-1yd., Acidum-nitricum, lodium. 
In our selection of remedies, it is indispensible that the utmost care 
be taken that all morbid phenomena should be covered by the drug. 
It is not sufficient that the mere sensations of the patient should be 
covered by the remedy, but the pathological condition caused by the 
medicine should correspond with those of the disease. The hind of 
morbid action should also be well considered, in order that the remedy 
may be well adapted in this respect. Thus we have occasionally met 
with mprbid conditions of the utero-genital apparatus of a distinctly 
sycotic character. This kind of diseased action gives rise to lesions, 
not only of the os and cervix uteri, but of the vaginal mucous mem- 
brane, of the most serious description. Indeed, two cases of this kind 
have come under our observation, which have been long treated as 
cancers, and finally pronounced incurable by several distinguished 
gentlemen of the other school, and which were afterwards cured by 
the homoeopathic specifics for sycosis, Thuja and Nitric-acid. These 
remedies were employed both internally and topically. Both of these 
patients had been reduced to a most pitiable plight by the empirical 710 
DISEASES OF THE REPRODUCTIVE FUNCTION. 
routine to which they had been subjected, hut they were most promptly 
benefited, and finally perfectly cured by the drugs alluded to. 
In ulcerations occurring in scrofulous subjects, it is important that 
remedies of an anti-scrofulous character should be selected if possi- 
ble, like Calcar ea, Sulphur, Kali-carb., Kali-kyd., lodium, dec. 
Now and then intractable cases are met with in persons who have 
formerly suffered from syphilis. The ulcerations in such instances 
cannot be considered as actually syphilitic, but they are so modified 
in character in consequence of the previous malady, that anti-syphili- 
tic medicines will be required to accomplish a cure. In this class of 
lesions, we often meet with hypertrophy and induration of the cervix. 
The most appropriate remedies are : Mercurius-Proto-iod., Iodine, 
Kali-kyd., Nitric-acid and Thuja. 
Obstinate cases are sometimes found which appear to be connected 
with a psoric taint. Females thus affected, are apt to complain of 
great itching, heat, and irritation of the pudenda and the vagina, and 
of itching, eczema-like eruptions in the vicinity of the labia and anus. 
We have occasionally observed an apparent connection between the 
leucorrheal discharge and the external eruption—the former being 
much less in quantity, and in acridity, when the latter was most 
strongly pronounced upon the skin, and vice-versa. 
Sulphur, Sepia, and other specifics possessing an anti-psoric influ- 
ence are manifestly most applicable in these cases. 
But by far the largest number of cases are due to simple, uncom- 
plicated, but neglected inflammatory action. Difficult and tedious 
labors, accidents occurring during convalescence, which cause inflam- 
mation of the uterus and its appendages, like sudden checks to per- 
spiration, over-exertion, lack of proper cleanliness, are amongst the 
most common causes of this affection. 
In addition to our internal remedies, suitable hygienic measures 
should always be employed; for all agencies which tend to improve 
the general health operate as indirect means of cure. They may be 
termed with propriety, indirect vitality-agents, in contradistinction to 
the topical vitality-modifying agents of Dr. Bennett. 
A pure and bracing atmosphere, and freedom from care, and from 
the necessity of exertion, should first be attained if possible. 
Although we do not believe in the efficiency of the hydropathic 
processes, unassisted by other means, yet when judiciously employed 
as auxiliaries in the treatment they are undoubtedly of much value. 
Cold hip-baths, local shower-baths, cold general baths, wet compresses 
over the uterine organs, and enemata of cold water may all be pre- 
scribed with benefit in certain cases. 
It must not be forgotten, however, that cold water is a very powerful 
agent. By its use we may allay inflammatory and other morbid INFLAMMATION OF THE OS AND CERVIX UTERI. 
711 
actions in accessible parts of the organism, and restore the tone and 
functions of weakened and relaxed organs; while by its abuse the 
vitality of the system may become so much impaired as to cause serious 
and permanent injury. 
In nearly all cases of inflammation and ulceration of the os- and 
cervix-uteri we have long been in the habit of prescribing cold hip- 
baths, cold water injections, and applications of wet bandages over the 
uterine region. When these measures have been properly carried out, 
more or less advantage has be-en derived, and we are unable to recall 
an instance of decided injury from the practice. Such is our experi- 
ence with regard to cold water applications as auxiliaries in the 
treatment of the malady under consideration. 
We now come to the question whether topical applications in the 
form of caustics, and other local vitality-modifying agents ’ are ever 
justifiable in this class of maladies. That there are drugs sufficiently 
homoeopathic to inflammatory ulcerations of the cervix uteri, to meet 
the requirements of every case, we entertain no doubt. And that 
such specifics will eventually be which exercise as 
sure a control over these morbid conditions, as Mercury exercises over 
syphilitic ulcerations, we fully believe. But at present we know of 
no medicine which has actually produced in the healthy prover inflam- 
mation and ulceration of the cervix. All of those drugs which we 
have enumerated operate in various degrees upon the utero-genital 
apparatus, and give rise to leucorrhoea, sacro-lumbar pains, headache, 
deranged menstruation, bearing-down pains, hysteria, impaired diges- 
tion, and other symptoms which are supposed to be characteristic of 
inflammatory ulceration of the uterine neck, but we are not aware that 
actual ulceration has been found, as a pathogenetic symptom, in a sin- 
gle instance. When our provings are conducted with reference to this 
point,—when the exact local changes produced by drugs are observed 
by means of the speculum, when the color, consistency, and chemical 
character of discharges caused by drug-actions shall be thoroughly 
understood, then may we expect to prescribe successfully internal 
remedies for the cure of these diseases. 
In consideration of the fact that many cases cannot at present be 
cured by any known internal remedies of our school, it behooves us to 
inquire whether wre must depart from the therapeutic axiom similia 
similibus curantur to accomplish our object. If we have a correct 
idea of the true spirit of the teachings of Hahnemann, the end may 
be attained by the employment of topical vitality-modifying agents, 
and still adhere strictly to the homoeopathic law of cure. 
In all diseases the vitality of the affected tissues is changed, the 
power of the nerves and blood-vessels, supplying them is impaired, 
their normal functions are altered, and inflammations and their seque- 712 
DISEASES OF THE REPRODUCTIVE FUNCTION. 
Ise are the results. Here morbid vitality-modifying agents, either in- 
ternal or topical, have produced the mischief. These morbid influ- 
ences are convened, either through the circulation, or directly to the 
structures to be acted on, and there produce those impressions which 
cause disease. Diseases, therefore, according to Hahnemann and 
other vitalists, consist essentially in modifications of the vitality of 
the parts involved. 
Reasoning from analogy, it might be inferred that remedial vitality- 
modifying agents should also be conveyed, either through the circula- 
tion or directly, to diseased parts, in order that impressions may be 
produced which will result in health. If it be the object so to modify 
the vitality of morbidly affected tissues by specific drugs, as to arrest 
morbid degenerations, and substitute in their place healthy medicinal 
actions, it can be a matter of but little importance wdiether we bring 
them in contact with disordered parts through the stomach, endermi- 
cally, through the veins, or by direct applications. It is manifestly 
the office of the homoeopathic physician to operate directly upon parts 
diseased, and so to alter the vital conditions of such parts, that the 
vis medicatrix natures (which is the actual curer of all maladies) may 
be able to accomplish the requisite curative reactions. In diseases 
the recuperative forces of the organism struggle to restore the im- 
paired vitality by causing, in affected localities, increased determina- 
tions of blood, increased heat, increased sensitiveness,—in a word in- 
flammations. If the morbid influence be slight, nature alone removes 
the difficulty; hut when the acting cause is more serious, the disease 
makes progress, destructive lesions occur, and the patient steadily 
sinks, notwithstanding the kindly efforts of the vis vitoe, unless a drug 
impression is made which changes the morbid to a healthy action. 
This is our platform. This is our interpretation of the ideas of Hahne- 
mann, both with regard to the essential nature of diseases and a 
curative law. 
In all cases therefore of ulceration of the os and cervix-uteri, which 
resist treatment by internal remedies and the other means wdiich have 
been enumerated, we are in the habit of cauterizing the ulcers with 
the Nitrate of Silver. These applications we repeat every four, six, 
or eight days according to circumstances, until the ulcers assume a 
healthy appearance, and the healing process becomes satisfactory 
Nor is it in ulcerations alone that Nitrate of Silver applications are 
homoeopathic; for abrasions, with destruction of the epithelium, and 
granulations of the uterine os and cervix may be produced by applica- 
tions of the solid nitrate in health, as well as cured by similar appli- 
tions when they exist as morbid phenomena. 
It must not be forgotten that in a majority of cases of leucorrhoea, 
whether accompanied or not with inflammat try ulceration of the 
* INFLAMMATION OF THE OS AND CERVIX UTERI. 
713 
mucous membrane lining the cervix, that the cervical glands are in a 
morbidly-excited condition. We shall not stop to inquire in this place 
whether this morbid condition is the “primary and essential disorder” 
as Dr. Tyler Smith asserts, or whether the morbidly-increased cervical 
secretion is the cause of inflammation, which secondarily induces 
granular conditions, ulcerations, indurations, &c. It is quite certain 
that the glandular apparatus of the cervical canal is always morbidly 
active in these cases, and that this condition exercises an important 
influence over the entire malady. Under these circumstances, we 
should endeavor if possible to select those remedies, which impress 
specifically the glandular system, like Iod., Kali-hyd., Merc.-hyd., <&c. 
Auxiliary to applications of Nitrate of Silver, the occasional use of 
astringent and tonic vaginal injections may be prescribed. By cleans- 
ing the ulcers from acrid secretions and gently stimulating the diseased 
parts we derive much advantage dnring the process of cure. 
With reference to other topical applications advised by Dr. Bennett, 
like Potassa cum Calc., Acid Nitrate of Mercury, and other mineral 
acids, the actual cautery, &c., our experience is decidedly against 
them, as being both unnecessary, and often positively injurious. The 
simple fact that their action cannot in all instances be confined to the 
ulcerated points is a sufficient argument against their employment. 
Among the sequels© of inflammation of the cervix, are hypertrophy, 
induration, and as a consequence of these last conditions, displacements 
of the uterus. Here again benefit may now and then be derived from 
local applications of Nitrate of Silver either in substance, or in dilu- 
tion. These applications, in conjunction with suitable internal remedies, 
often effect ’permanent cures of obstinate and long-standing uterine 
displacements, like retroversion, anteversion, prolapsus, &c. 
Prolapsus Uteri.—Treatment.—For the nervous and constitu- 
tional symptoms: Aconite, Bell., Cham., Coffea, Crocus, Ilyoscy., 
Tyna., Mosch., Platina, Puls., or Sulphur. Local applications of 
cool or slightly warm water; hip-baths, &c. 
The most important remedies in prolapsus are : Kali-hyd., Mer- 
curius-hyd., Baryta-carb., Calcarea-carb., Iodium, Conium, Arseni- 
cum-iodid., Nux-rom., Sepia, Aurum, Belladonna, Secale, and Po- 
dophyllum. Other remedies which have often succeeded are: Alu- 
mina,, Cantharis, Cinchona, Ignatia, Platina, Pulsatilla, Silicea, 
Stannum-zinc, Sulph.-cupri. It is often necessary to continue the 
use of the proper remedy for weeks. 
All artificial contrivances, in the form of supporters, pessaries, and 
the like, should be strictly avoided. Such appliances sometimes afford 
temporary relief, but by obstructing the venous circulation of the parts 
with which they are in contact, they are certain in the end to aggra- 
vate the complaint, and diminish the chances of cure. 714 
DISEASES OF THE REPRODUCTIVE FUNCTION. 
6. SPERMATORRHOEA. 
A disease Avhich results from an excessive secretion and discharge 
of the semen masculinum, whether it be produced by masturbation, 
excessive venery, or occur spontaneously during the night, constituting 
what is technically called gonorrhoea dormientium.” 
The effect of an unnaturally excited secretion of a product so 
highly vitalized, and which constitutes the sole contribution of the 
male towards the preservation of the species, never fails, when long 
continued, to produce a long train of disorders, of the nervous and di 
gestive, systems usually comprehended in the term, nervous exhaustion 
Symptoms.—The intimate relation of the physiological function 
which yields this product with that which pertains to the nervous sys- 
tem in all its wide range of influence, would lead us to suspect that 
the latter Avould be the first to suffer. Accordingly we find that among 
the earlier and prominent symptoms of this disorder, there is marked 
impairment of the mental faculties. The patient is unable to concen- 
trate his mind upon his business or his books; his memory becomes 
treacherous; his physical powers are Aveakened; his courage and 
energy fail; he is languid and debilitated; becomes hypochondriacal 
and misanthropic ; has the most fearful forebodings, with a want of con- 
fidence in his OAvn abilities; is dyspeptic, and prone to suffer from 
various derangements of the alimentary functions; loses flesh ; some- 
times becomes extremely emaciated*; and all this without evidence of 
real organic disease.” 
These symptoms are sometimes accounted for on erroneous sup- 
positions. One case is considered hypochondriacal, perhaps caused by 
excessive study, or excessive mental labor. 
The folloAving classification is given by Mr. Wilson {Diseases of the 
Vesiculce Seminales, London, 1856, pp. 106) : 
I. Spermorrhcea Sthenica or Entonica. 
Structure. 
Disease. 
Function. 
Variety, 
1 Testes Orchitis. 
2. Vesiculse Seminales—Vesiculitis. 
3. Prostate Gland—Prostatitis. 
{ Excessive secretion; relative 
\ deficiency of spermatozoa, 
j Excessive secretion with in- 
\ spissation. 
j Excessive secretion ; increased 
\ amount of salts. 
4. Urethra—Urethritis. 
< Excessive secretion. 
Species. 
II. Spermorrhoea Asthenica. Spermorrhoea Atonica. 
Structure. 
Disease. 
F unction. 
Variety, 
1. Testes. 
2. Vesiculse Seminales, 
Atrophy. 
| Irritability. 
j Impotence, watery secretion, 
/ absence of spermatozoa, 
i Watery secretion and salts; 
( deposit of calculi. 
3 Urethra. 
Ulceration. 
| Purulent Discharge. SPEKMATOKKHCEA. 
715 
Diagnosis.—Microscopic Appearances of the Fluid of Involun- 
tary Emissions.—A gentleman had dyspepsia for several years, with a 
great variety of nervous symptoms; was extremely hypochondriacal. 
No difficulty about the bladder or urethra, and did not believe that any 
semen passed at stool. The microscope showed the urine to contain 
many filaments of mucus, nucleated cells, and granules. When it had 
been well shaken and allowed to pass through the filter, many sper- 
matozoa were found in portions that remained upon it. When it was 
evaporated in a glass, it deposited many of the crystalizable and saline 
constituents of urine. After long standing, the microscope showed 
many vibriones, animated points, like grains of sand moving very rap- 
idly and revolving on themselves. These are said to be not often 
detected, unless in the urine of the debilitated. 
The galvanic current will often detect the presence of semen in the 
urine, in cases where the ordinary tests fail, by throwing down 
copiously the albumen of which it in so great part consists. 
Pathology.—The secretion of the mucous membrane of the urethra 
is usually acid, but at times an akaline reaction predominates, arising 
from a peculiar pathological condition of that membrane. When 
either the acid or alkaline reaction is in excess, the deterioration of the 
qualities of the fecundating fluid is likely to happen; which deteriora- 
tion by destroying the spermatozoa, will at the same time very probably 
destroy its fertilizing qualities. Conditions of excessive acid and 
alkaline secretion have been shown to be not uncommon in the mucous 
membrane of the vagina and uterus, and to this condition sterility is, 
no doubt, often to be ascribed. 
The mucus secreted by the prostate gland is charged with more or 
less of the phosphates of lime and soda; and it is secreted and 
poured out in a situation where the peculiar properties of it in neutral- 
izing salts are likely to be made available for an immediate use. It is 
not then probable that this secretion is formed without a purpose. 
Causes of Spermatorrhoea.—The excessive discharge of sjemen 
arises from an irritation established in or about the seminal ducts 
which convey the secretion from the testicle. This irritation may 
arise from “ masturbation, from excess in sexual intercourse, from 
gonorrhoeal lesions, mechanical or verminose obstructions, and irri- 
tants in the rectum, which act by pressing upon or irritating the 
vesiculae seminales, or the prostate gland; haemorrhoidal fissures, 
prostatitis, or even from a stricture @f the urethra. f 
It is not always easy to ascertain the true cause of the irritation 
on which the seminal flow depends. The patient will not always make 
a frank disclosure of the facts concerning his own case, though the 
essential ones may be known to him alone; and some who would do it 
to a physician who has at first gained his entire confidence, will be 716 
DISEASES OF THE REPRODUCTIVE FUNCTION. 
driven far from it by a common degree of abruptness or indiscretion in 
the manner of conducting the investigation. The physician should strive 
to gain the unbounded confidence of his patient, and having gained it, 
should regard it as a sacred trust which is never to be violated. 
Treatment.—Local Measures.—Hip-bath, warm or cold. Warm 
Ilijo-bath.—The patient should sit in it five minutes thrice daily ; the 
water at the temperature of 65° F. The temperature may be lowered 
after some time to 50°, using it twenty minutes at a time. Sponging 
and frictions along the spine, or dashing cold wrater from a considerable 
height on the genital organs are beneficial. 
Cauterization of the Verumontanum.—Case.—A man aged 
twenty-five had spermatorrhoea for two or three years, which produced 
vertigo, neuralgia, and a train of nervous symptoms impairing the 
general health and rendering him miserable. A sea voyage, travelling, 
chalybeates, shower-baths. The symptoms continued; he became des- 
pondent ; gloomy forebodings; imagining every possible evil; slept 
little ; tongue furred, pulse quick ; hypochondriacal. When bougies 
were introduced there was perfect want of expulsive power of the ure- 
thra. Muriated Tincture of Ferrum, Tincture Cantharides, hip and 
shower-baths were tried for a month without benefit. He was after- 
wards cured by cauterizing the verumontanum. The genital dis- 
charge became less frequent; bougie left in for fifteen or twenty min- 
utes at a time. The nervous symptoms gradually left him; he became 
cheerful; in a few months he was perfectly restored. {Dr. Charles D. 
Smith, M. Y.) A new instrument for cauterizing this region of the 
urethra was invented by Dr. Moore, of N.Y. city. 
Moral Influence.—Masturbation, when it has not been entirely 
abandoned, must be at any sacrifice; and when it is not, it may result 
in insanity, dementia, catalepsy. The cheerful and grateful influences 
of good society are indispensable. 
Mercur.—Dr. Ludlam gives a case of a German law student, aged 
twenty-four, presenting the following essential points : Masturbation 
was followed for four years, commencing at eighteen. Attempt two 
years ago at reform followed by nocturnal emissions once a week. The 
day following there was always “ great weakness, both mentally and 
physically, spirits depressed; he became hypochondriacal, had frontal 
headaches, with more or less dimness of vision, without inflammation 
of the eyes ; complete inability to study, both for mental and moral 
reasons ; he became emaciated ; from a weight of 144 lbs. he fell to 
122 lbs.; great languor and lassitude. Desires to sleep most of the 
time. Anorexia ; food does not agree with him ; tongue coated with 
a yellowish fur; complexion and conjunctiva icterode.” 
This patient abandoned study; was directed to take out-door exer- 
ciso, and was treated at the Chicago Homoeopathic Clinique. Mercur.- IMPOTENCE. 
717 
solubilis, third trituration, repeated every four or six hours. After- 
wards Phosphorus third ; hut, it increasing the hypochondriacal symp- 
toms, was abandoned for Aurum, under which he improved rapidly, 
gained four pounds of flesh in five weeks, and had more strength than 
he had before in five years. 
Digitaline.—This remedy has been successful in doses of one thir- 
tieth of a grain, night and morning. 
Lupulin has been alternated with it with success. 
Neuralgic Spinal Disease resulting from Masturbation.—Dr. 
Kafka, of Prague, gives a case of an unmarried woman, aged thirty- 
three, with robust constitution, who had been troubled in childhood in 
pudendal itching, which led to the usual bad consequences. At 
twenty-five she became a mother, after which she lived secluded, 
working as a cook. Her health became undermined by generic irrita- 
tion ; stomach and limbs became enfeebled. She was neither pale nor 
emaciated, but two or three times a day, while at work, she had gas- 
tralgic attacks, pressure in the stomach, frequent eructations, a shaking 
sensation, great flow of saliva, and puffiness of the abdomen. Then 
followed heat, red cheeks, pressure in the head and morbid excite- 
ment. Her appetite had diminished; the tongue was covered with a 
yellowish fur; bowels constipated; clitoris rather enlarged,with slight 
vaginal blenorrhoea. The spine was very sensitive in the region of 
the second, third, and fou rth lumber vertebrae, and the least pressure 
or mere friction upon them would call forth the whole series of symp- 
toms affecting the stomach, head, and genitals. Menstruation was 
normal; great weakness of the knees, and want of memory. Though 
all of these derangements had been caused by persistence in her secret 
vice, she had not been induced to abandon it. 
Treatment.—She took Nux-vomica third ; a drop on a little saccha- 
rum-lac. twice a day. With this she was cured in about four weeks. 
After being perfectly well for three months, she returned, complaining 
of her old troubles. Eight doses of Nux-vom. again restored her, and 
she continued perfectly well and had no disposition to resume her old 
habits. In this case Nux-v. produced a marked effect upon the neu- 
rosis of the stomach, and on the abnormal excitement of the sexual 
organs. Hahnemann had directed attention to Nux-vomica as an ana- 
phrodysiac. M. M. Trousseau and Pidoux {Traits de Therapeut-Nol. 
I.,) made many experiments with allopathic doses of Nux-v., and ob- 
served particularly the marked increase of sexual excitement pro- 
duced by the drug. 
Impotence.— [IlirscheVs Archiv., 1854, § 158.) Cuprum.—A fresh 
colored young man, aged twenty-eight. Entire impotence for more 
than two years ; some pain in the perineum ; rheumatism in the back 
and legs ; genitals normal. He used in small dozes, one ounce of Tine- 718 
DISEASES OF THE REPRODUCTIVE FUNCTION. 
ture of Acetate-Copper, and was perfectly well, and the pains dis- 
appeared. In other cases the tincture caused spermatorrhoea, and did 
away with the effect of Lupulin. 
Phosphorus.—Case of Dr. Spech, of Bucharest.—A gentleman of 
delicate frame, dark complexion, had been treated for phthisis. Of 
libertine habits from his fourteenth to his twenty-fifth year; had seve- 
ral times had blennorrhoea and syphilis ; was treated some years after 
marriage for impotence, by various mineral baths, without benefit. 
His symptoms were now as follows : extreme debility of all the func- 
tions ; dry, short cough; pains in the chest; the entire muscular sys- 
tem enfeebled, and the nervous system much excited; no appetite; 
severe pain in the lumbar vertebrae, and very copious alvine evacua- 
tions, while a thin, slimy, colorless fluid oozed constantly from the 
urethra. 
Treated with Phosphorus 30°. Six pellets every eight days for six 
weeks. He was then sent home perfectly restored. 
1. GALACTORRIKEA.—TABES LACTEA. 
Tabes nutricum of old authors. Redundant secretion of milk. In 
certain states of general health, and especially in scrofulous and anae- 
mic constitutions, the secretion of milk becomes deranged, and an 
excessive flow may take place which proves highly debilitating, causing 
many nervous and digestive disorders, and tending indirectly to serious 
organic diseases. 
The office of the mammary gland is to secrete and separate from the 
blood, the precise materials of structure which are necessary to the 
development of the young organism. When this process becomes mor- 
bidly accelerated it becomes exhaustive, and highly debilitating. The 
nutritive fluid is drained of its materials which had been accumulated 
for the mother’s own support, and expended where it does no good- 
All the nutritive elements needed for the supply of the system, in- 
cluding proximate principles already nearly assimilated, fats, &c., have 
been detected unchanged in this secretion. 
Treatment.— Calcarea-carbonica.— Croserio says, Calcarea in- 
creases the supply of milk when deficient. It is also effectual in cor- 
recting the secretion when it is in excess. 
A case of agonizing supra-orbital neuralgia in which was the peculi- 
arity that the use of milk always brought it on, was cured by Calcarea. 
Belladonna possesses the power of diminishing the lacteal secretion 
when excessive. 
Excellent results have also followed the use of Nitrite of Uranium, 
Cannabis-indica, and Opum, in cases of this kind. CHLOROSIS. 
719 
8. CHLOROSIS. 
General Description.—Young unmarried females of delicate lym- 
phatic constitutions, slight figures, and highly impressible nervous 
systems, are by far most liable to attacks of chlorosis. In a majority 
of instances, it will be found that chlorotic girls have been remarkable 
from birth for delicacy of organization, daintiness of appetite, feeble- 
ness of digestion, and undue sensibility of the whole system. So long 
as this nervous sensibility is not over-tasked, no important causes ope- 
rate to derange the delicate equilibrium upon which the proper opera- 
tion of the functions depends, the individual enjoys passably good health, 
but when the period of puberty arrives, and nature calls for her month- 
ly tribute from the vital fluid itself,—when new thoughts and new de- 
sires powerfully stimulate the system,—when, in fine, the important 
change of the whole organism, during the establishment of the catame- 
nial function occurs, then the frail balance is destroyed, the digestive, 
absorbent, and assimilative functions fail, and those symptoms which 
mark chlorosis make their appearance. 
The disease sometimes attacks married female-s, even when consider- 
ably advanced in years ; and it has likewise been observed in girls 
of two or three years of age ; but cases of these kinds are of extreme- 
ly rare occurrence. Men of studious and sedentary habits, especially 
those who have never taken much exercise, have been occasionally 
subjected to it. 
Chlorosis is more common in cold than in warm climates. This 
circumstance is attributable in part to the pernicious custom in the 
north, of keeping children a large portion of the year in close rooms, 
at a temperature of 75° to 80° Fahrenheit, thus preventing that free 
development of the body which would result from pure air and abun- 
dant exercise. Another reason offers itself in the fact, that persons 
of frail, nervous, and lymphatic constitutions, often cannot withstand 
the severities of the temperate latitudes, without suffering more or less 
from disorders of the glandular and membranous structures. 
Diagnosis.—The symptoms commonly observed during the forming 
stage of chlorosis are : derangement of the stomach and bowels, mani- 
fested by a pale and bloated appearance of the tongue, foul breath, 
partial or total loss of appetite, morbid craving for certain indigestible 
articles, like coal, clay, acids, pencils, &c.; torpid state of the bowels ; 
tympanitic distention of the abdomen, accompanied with occasional 
griping pains ; faecal discharges, composed of crude and imperfectly 
digested substances, unnatural in color and consistence. 
Soon after the appearance of these symptoms, if the disease con- 
tinues, the patient becomes listless, irritable, fond of solitude, and dis- 
inclined to bodily or mental exertion; the menstrual function becomes 
deranged; the face pale and tumid ; the lips lose their color, the eye- 720 
DISEASES OF THE REPRODUCTIVE FUNCTION. 
lids are swollen and surrounded by a dark, greenish, or yellowish cir- 
cle ; emaciation commences, the debility and lassitude become more 
apparent; many nervous and hysteric symptoms manifest themselves ; 
dyspnoea, and palpitation of the heart, or “ fluttering about the praecor- 
dia,” (Ilall.) occur from ascending stairs, from rapid walking, or violent 
mental emotions ; the patient is troubled with vertigo, giddiness, and 
ringing in the ears and head ; sleep is disturbed by unpleasant dreams 
the spirits become depressed, and the ambition and energy are sup- 
pressed by apathy and indifference. 
As the disease advances, all these symptoms become more strongly 
pronounced, and confirmed chlorosis is developed. The whole surface 
of the body now assumes a smooth and puffy appearance ; the skin is 
dry pale, or yellowish, or lead colored ; the muscles soft and flabby ; 
the feet and ankles oedematous, the countenance very pallid and wax- 
like ; the prolabia of a lilac color; tongue clean, bloodless, and semi- 
transparent ; conjunctiva of a clear white color, or slightly tinged with 
blue ; pulse feeble and somewhat rapid; occasional pains in the head, 
chest, stomach, side and abdomen; throbbing of the carotid arteries, 
perceptible to the sight and hearing ; violent palpitation of the heart; 
dyspnoea, and “ fluttering about the praecordia,” after the slightest phy- 
sical or mental exertion, and often during the night; catamenial se- 
cretion, superseded by a profuse leucorrhoeal discharge; slight hack- 
ing cough on rising in the morning, and after exercise; frequent loose 
discharges from the bowels of a dark or black color, and very foetid, 
extreme prostration of all the energies; marked derangement of the 
functions of the liver, kidneys, skin, and indeed of nearly every part oi 
the body. 
It is not an uncommon occurrence for some of these symptoms to 
assume a serious local aspect during the progress of the complaint, 
and thus present highly troublesome and dangerous complaints. Mar- 
shall Hall enumerates these complications as follows: 
First, pain in the back ; second, cough and dyspnoea; third, palpita- 
tion of the heart; fourth, pain and tenderness of the side ; fifth, pain 
and tenderness of the abdomen; sixth, constipation; seventh, diar- 
rhoea; eighth, melaena; ninth, menorrhagia ; tenth, tendency to haemor- 
rhage; eleventh, purpura; twelfth, leucorrhoea; thirteenth, hysteric 
affections ; fourteenth, oedema, anasarca, erythema nodosum. 
It should be borne in mind that all of these complications are nothing 
more than symptoms of the original malady, and are to be treated only 
as such. But we deem it important to call special attention to these 
symptoms, to guard the inexperienced against mistaking them for 
distinct and independent affections. When either of them is par- 
ticularly prominent, the careless diagnostician is apt to form an in- 
correct opinion of the case. Thus, frequent pains in the chest, vio- CHLOROSIS. 
721 
lent palpitations of the heart on the slightest exertion, and an irregu- 
lar or intermittent pulse, have often caused medical men to mistake an 
ordinary chlorosis for an organic affection of the heart; so have the 
cough and dyspnoea, apncea, and the gastric and abdominal derangements 
which accompany chlorosis been mistaken for phthisis pulmonalis 
and dyspepsia. 
We have included amongst the signs of chlorosis, suppression of the 
menses, but this is by no means an invariable symptom, as numerous 
cases are reported in which the catamenial secretion was perfectly na- 
tural and regular during the whole course of the complaint. We may 
safely infer, therefore, that it is not dependent on retention of the 
menses, as some writers have supposed. 
We have already seen that many of the symptoms of chlorosis 
strongly resemble those of organic affections of the heart, pulmonary 
phthisis, dyspepsia, liver complaint, and dropsy; but a minute examina- 
tion of the history and symptoms of each case, will always enable us 
to form a correct diagnosis. Thus, disease of the heart is attended 
with more pain and more febrile disturbance than chlorosis ; the ex- 
pression of the eyes and the appearance of the prolabia and tongue 
are also widely different. The pure white color of the conjunctiva, 
and the bilious and dark color of the faeces, will sufficiently mark the 
disease from chronic hepatitis. From consumption of the lungs, we 
may also recognize it, by absence of febrile exacerbations, the flushed 
cheek, the copious purulent expectoration, and the more general ema- 
ciation which occurs in that disease. There are also numerous symp- 
toms by which we may readily distinguish chlorosis from dyspepsia 
and dropsy. 
Causes.—There are several features connected with chlorosis -worthy 
of much consideration in a pathological and therapeutic point of view, 
viz : first, the prominent gastric and intestinal derangement at the 
commencement of the malady; second, the small quantity ef crassi- 
mentum in the blood; and, third, the peculiar state of the capillary 
system which gives rise to a haemorrhagic tendency. 
From the history of chlorosis it appears that the stomach and bowTels 
are the first structures to take on disordered action. For some time 
previous to the appearance of the pale, wax-like and tumid countenance, 
the puffiness of the eye-lids, the loss of flesh, suppression of the men- 
ses, and other signs of confirmed chlorosis, we observe an impaired 
and delicate appetite, flabby and coated tongue, foul breath, imperfect 
digestion of food, unnatural stools, and all those traits which charac- 
terize a feeble and imperfect performance of the digestive functions. 
The symptoms which succeed are such as naturally result from such 
gastric and intestinal derangement. 
These facts go far towards explaining the small amount of crassi- 
Vol. ii.—40. 722 
DISEASES OF THE REPRODUCTIVE FUNCTION. 
mentum contained in the blood of chlorotic patients. If digestion, 
absorption and assimilation were normally executed, would not the 
blood receive its due proportion of crassimentum, and the muscles and 
integuments their appropriate supply of the red globules ? The 
organs of the body are dependent for healthy action upon the stimuli 
of these red globules, which abound in oxygen, and serve to communi- 
cate to all parts of the organism its animal heat and vital powder. 
Whenever, therefore, any cause operates upon the digestive and ab- 
sorbent organs, in such a manner as to suspend their functions, the 
blood must fail of its due supply of red globules, and a derangement 
of all the organs ensue. 
In some chlorotic patients, there is a peculiar tendency to haemor- 
rhages of the nose, the lungs, the stomach, and the uterus. Bloody 
discharges have been known from the head, the side, palms of the 
hands, and limbs, in instances assuming a periodical form, in place of 
the menstrual discharge. On this account, the disease has been attri- 
buted by some to a laxity of the capillaries, and a consequent inability 
to exclude the red globules; but this relaxed condition of these ves- 
sels is owing to an absence of their healthy natural stimuli, the “ oxy- 
gen carriers,” rather than to any primary derangement in the capillary 
vessels themselves. 
Other causes, which may contribute to the development of chlorosis 
in constitutions predisposed to it, are : close confinement in overheated 
and ill-ventilated apartments; studious and sedentary habits; pro- 
tracted grief, anxiety, or fatigue ; parturition, and its after-effects ; leu- 
corrhoea: amenorrhoea; unsatisfied love ; masturbation ; restraints 
of celibacy; frequent haemorrhages; crude and undigested food; chronic 
inflammation of the intestinal canal; enlargement and inaction of the 
mesenteric glands. 
Pathology.—In the autopsical examinations of those who have died 
of chlorosis, the most notable signs of disease are found in the blood, the 
muscles, and the surface of the body. The blood of chlorosis appears 
to be deprived in a great measure of the red material and its place 
supplied by a superabundance of serum. This condition exists to a 
greater or less degree during the whole course of the disease, and it 
is on this account that the muscles after death present a peculiarly 
pale and bloodless appearance, and the skin a palish yellow, or wax- 
like tinge. Unnatural appearances are sometimes found in the chest 
and alimentary canal, in the form of an enlargement and dilatation of 
the ventricles of the heart, chronic inflammation of the lungs, the 
stomach, and the intestines, flabby and shrunken appearance of the 
liver and spleen, and unusual accumulations of serous fluid in the 
cavities, and in the cellular tissue. CHLOROSIS. 
723 
M. Eisenmann of Wurtzbourg,* says, chlorosis commences with 
nervous symptoms, which in some cases last for months before any 
appreciable alteration can be found in the blood. Spinal irritation is 
in many cases developed, and becomes so prominent a feature that it 
is often regarded as the essential disease. Important complications 
appear in: 1. Lesions of the spinal cord; 2. haemorrhages ; 3. ulcera 
tions of the stomach and of the vagina. The haemorrhage, so frequent 
among the chlorotic occurs from the nose, the eyes, the ears, the nip- 
ples or ends of the fingers in rare cases. It is more frequent from the 
stomach or lungs, sometimes from the brain. Death very often occurs 
in chlorosis from haemorrhage. Cases are given of death from ulcera- 
tion of the stomach. 
Prognosis.—This will depend principally upon the natural stamina 
of the patient and the severity of the local symptoms. A frail and 
delicate constitution, a highly susceptible nervous system, a decided 
predisposition to glandular and membranous disease, and an inherent 
debility of the digestive apparatus, are circumstances calculated to 
render the prognosis unfavorable. Patients of this description are 
rarely able to withstand the important changes which the economy 
undergoes at the period of puberty, without serious local disease, and 
often organic degenerations of some vital part. On the other hand, 
if the patient be of a naturally robust and sound constitution, even if 
the chlorotic symptoms are quite severe, we may generally predict an 
ultimate recovery. Here we may trace all the causes of the malady, 
and bend our efforts to their removal with a prospect of success, and 
thus restore the system to its original health and vigor; while a body 
which “ has been sent into this breathing world before its time, but 
half made up,” cannot be remodelled into one of “fair proportions” 
and vigor, by any resources of the physician, although much may be 
done towards prolonging life, and securing a moderately comfortable 
state of existence. 
Therapeutics.—In the treatment of chlorosis, we find of especial 
importance frequent exercise in the open air, either by gestation or 
moderate walking, highly digestible and nutritious regimen, and fresh 
or salt water baths. It is very desirable that chlorotic patients pass 
their winters in warm and equable climates, that exercise in the open 
air may be taken with advantage at all seasons. This is necessary on 
account of their extreme sensitiveness to the cold, which is often a 
serious obstacle against exposure to the low temperature of northern 
winters. The influence of sea air is often very beneficial to patients 
accustomed to inland districts, and vice versa. Short sea-voyages 
may sometimes be advised in the warm summer months, but caution 
should be exercised that the changes should not be too abrupt. 
* Bulletin de Therapeutique, Sep. 30, 1859. 724 
DISEASES OF THE REPRODUCTIVE FUNCTION. 
General bathing is also useful when properly employed. We should 
commence with tepid baths of fresh or salt water, and gradually dimin- 
ish the temperature as the strength will admit, until an ordinary cold 
bath can be advantageously sustained. Sensitiveness to applications 
of cold water will frequently deter the patient from a persevering use 
of this powerful remedy, and rigid directions should therefore be given 
upon the subject. 
A regimen of the most digestible and nutritious meats, as mutton, 
venison, beef, game, and fowls, with rich animal soups, should be 
enjoined. Other nutritious food, which the stomach will digest, may 
likewise be eaten. Wine, porter, and Scotch ale may be used at 
meals, if agreeable to the invalid. In brief, all of those articles which 
are calculated to enrich the blood wfith the red globules may be 
resorted to. 
The remedies best adapted to meet chlorotic symptoms are : China, 
Sulphur, Nux-vomica, Pulsatilla, Sepia, Ferrum-carb., Platina, 
Calcarea-carb., Conium, Arsenicum, Veratrum, Ferrum-aceticum. 
China.—Countenance pale or livid; lips blackish and shrivelled; 
mouth and tongue slimy; skin yellowish; oedematous swellings of 
the limbs; faeces hard or soft, foetid, mixed with undigested food, and 
of a dark or black color; offensive breath ; copious leucorrhoeal dis- 
charge ; menstrual fluid scanty, and possessing but little color; sup- 
pression of the menses ; haemorrhages from the nose, mouth and 
lungs ; pulse feeble and more rapid than natural; general appearance 
indicative of an exsanguinous and debilitated condition. 
Vertigo, when walking or during motion ; humming in the 
ears ; disagreeable taste in the mouth, generally bitter or insipid; 
unnatural appetite ; canine hunger ; pressure in the stomach after 
eating; distention of the abdomen by wflnd or water; morbid sexual 
desire, with involuntary emissions of semen ; difficult and rapid respira- 
tion ; throbbing in the sternum; palpitation of the heart; constant 
inclination to move the limbs; excessive sensitiveness of the whole 
nervous system, with general feeling of lassitude and debility; great 
dread of cold air; drowsiness during the day, but restlessness at 
night; sleep disturbed by frightful dreams. 
Nervous, irritable, dissatisfied, taciturn, out of humor; indisposition 
to mental mental exertion ; suspicious of dislike and abuse. 
Remarks.—China is eminently a specific in chlorosis, accompanied 
or induced by profuse loss of animal fluids, from epistaxis, haemoptysis, 
haemorrhoids, masturbation, involuntary emissions of semen, leueor- 
rhoea, and diarrhoea. It is one of our best remedies when the disease 
is uncomplicated by any serious local derangement, and where simple 
debility of the whole organism is its essential characteristic. 
Sulphur.—Face pale and bloated; eyes surrounded by blue or CHLOROSIS. 
725 
greenish margins; swelling of the upper eyelid; glandular swellings 
about the neck and lower jaw; mouth and tongue slimy; foetid 
breath ; distention of the stomach and abdomen ; discharges from the 
bowels brown, and mixed wTith undigested food; acrid leucorrhoeal 
discharge; profuse expectoration; short and rapid respiration; 
oedema of the feet and ankles; surface of the body covered with yel- 
lowish or brown spots. 
Vertigo, dizziness and dullness in the head ; humming or roaring in 
the ears ; putrid or bitter taste in the morning; loss of appetite; 
craving for sweet or sour articles only; pressure of the stomach and 
abdomen, and dyspnoea after eating; throbbing at the pit of the sto- 
mach, with faintness ; morbid sexual desire, with feeble procreative 
powder; frequent involuntary emissions; menses too early and too pro- 
fuse ; burning leucorrhoeal discharge; weakness of the chest when 
talking; short and difficult breathing on exercise, and on retiring to 
bed at night; frequent palpitation at the heart; stitches and pains 
in the chest when moving the arms; coldness of the feet; drowsiness 
in the day-time, but wakefulness and restlessness during the night; 
vivid dreams ; night sweats; constant inclination to change position; 
general nervous irritation ; sensitiveness to cold; internal coldness ; 
lassitude and sensations of faintness;—all of which symptoms are 
without acute( pain and are mitigated by rest and worse during 
motion. 
Sadness, despondency, and inclination to weep without cause; ill- 
humor, obstinacy, sadness, silence, and frequent moaning. 
Remarks.—This medicine is advised for chlorotics of a lymphatic 
temperament, and those subject to frequent haemorrhages. Also in 
chlorosis complicated with tuberculous ulceration of the lungs. 
Nux-vomica.—Pale, yellowish, or clay-colored complexion; sclero- 
tica natural; cheeks and eyelids swollen; tongue white ; foetid breath; 
faeces foetid and dark colored; discharges of blood from the rectum; 
moaning and incoherent muttering during sleep. 
Vertigo, giddiness, or sense of intoxication; tenderness of the 
scalp; ringing and hissing in the ears ; putrid, bitter, or sour taste in 
the mouth; aversion to food of all kinds, and to tea and coffee ; dis- 
tention and oppression of the stomach after eating; nausea ; bitter or 
sour eructations ; throbbing sensation in the region of the stomach; 
flatulent distention of the abdomen, and colicky pains after eating or 
drinking ; bleeding and painful haemorrhoids ; great irritability of the 
sexual organs, especially after waking in the morning; menses too 
early and scanty; frequent turns of nausea and faintness during the 
menstrual flow ; asthenic respiration when walking, and at night in 
bed; palpitation of the heart after a generous meal; painful shocks 
in the praecordial region; sensitiveness of the whole surface of the 726 
DISEASES OF THE REPRODUCTIVE FUNCTION. 
body; trembling in the limbs when walking; sleep disturbed by 
dreams, and so unrefreshing that the patient feels worse in the morn- 
ing than in the evening; coldness of the feet. 
Great sensibility to impressions; noise, bright lights, and strong 
odors are intolerable ; sad; anxious; quarrelsome; taciturn; appre 
hensive of death. 
Remarks.—When chlorosis is preceded and accompanied by marked 
derangements of the alimentary canal, more particularly if the patient 
is of studious and sedentary habits, and has indulged freely in wines, 
coffee, or tobacco, Nux-vomica is indicated. Those who are naturally 
somewhat robust and of quarrelsome ardent, and vehement tempera- 
ment will be more benefited by it than persons of a mild and phleg- 
matic temperament. 
Pulsatilla.—Sphere of Action.—It acts pre-eminently upon the 
vegetative system, upon the organs of reproduction and their appen- 
dages, and upon the composition of the blood, depressing the action of 
the former systems, and producing in the latter a condition similar to 
that of one form of chlorosis. We learn these facts by bringing a 
knowledge of physiology to bear upon and interpret the systems of the 
intestinal tract and of the urino-genital organs—those of the vascular 
system, and the symptoms of the head and disposition. For in these 
we have retarded digestion; staggering after eating; vertigo; audible 
pulsation of the*carotids, momentary loss of sight and hearing on sudden 
exertion ; palpitation; paleness ; retarded and scanty menstruation, 
with syncope and exhaustion; depressed, melancholic disposition. A 
hydraemic dyscrasia, corroborated by the abundant serous or thin 
mucous discharges from secreting glands and surfaces. With this 
state are connected the temporary blindness and deafness which are 
perhaps sympathetic symptoms occurring in a chlorotic patient. 
Tearing pain the hip in the afternoon, occurring in, or aggravated 
hg, a warm room and repose / chilliness, cold feet, wakefulness in the 
evening, sleepiness in the morning. 
Face pale; eyelids puffy; tongue whitened, covered with viscid 
mucus; pulsation at the pit of the stomach, perceptible to the pres- 
sure of the hand; stools loose, green, slimy or bloody; acrid, thin 
leucorrhoea; scanty menstrual discharge; rapid breathing after eat- 
ing or lying down ; coldness of the hands and feet. 
Vertigo resembling intoxication; bad taste in the mouth in the 
morning; loss of appetite ; absence of thirst; nausea; frequent eruc- 
tations of wind tasting of the ingesta; beating and fluttering of the 
stomach ; cutting pains in the side and abdomen; suppression of the 
menses with general coldness of the body and nausea; asthmatic 
oppression of the chest after eating, or when lying in the recumbent 
posture; pain and weakness in the small of the back; disagreeable CHLOROSIS. 
727 
pulsation of the arteries of the whole body; tremulousness; weari- 
ness ; restlessness during the night; palpitation of the heart after 
eating or talking; anxiety ; disgust of everything; sullenness ; whim- 
sicalness ; dissatisfaction. 
Remakks.—Pulsatilla is adapted to chlorotics who have been irre- 
gular in menstruation, and are of a mild, timid, yielding, or sad dis- 
position. When there is a total suppression of the menses, with 
much pain in the small of the back, frequent turns of chilliness and 
absence of thirst, it will be indispensable, either by itself or in alter- 
nation with some other medicine. 
Ignatia—Case by Dr. Eisenmann.—A woman, aged thirty, had 
been chlorotic for eight years, and had undergone much medical treat- 
ment. There wras oedema of the lower limbs, and ascites, but not far 
advanced. She took ten drops of tincture of Ignatia, twice a day, 
under which the symptoms disappeared in two months. He found 
this remedy most effectual in cases in Avhich the stomach was very deli- 
cate, and was much more successful with Ignatia than with preparations 
of iron. Dr. Gabalda, of EArt Medical, approves of the employ- 
ment of Ignatia, Nux-vomica, &c., in palpable doses. 
Anaemia.—Eerrum.—M. le Dr. Trousseau says, 1859,* that thirty 
years ago, when he published his first works on this subject, “there 
was not a pound of iron sold in the course of a year in all Paris. He 
has since seen the practice of giving the preparations of Iron extended 
till the profession in general have progressed so far beyond him that 
he who taught them to use too much of it, has not now influence 
enough to bring them back to safe limits. He confesses that he long 
ago went too far with it, and now “ openly reproaches’* himself with 
the fatal termination of many of his cases. He says: 
“I have seen young girls or women chlorotic, dieted with bitters and 
Iron, get a little better—then relapse as soon as the treatment had 
been discontinued. The same remedies were prescribed anew, a sen- 
sible improvement ensued, but relapse soon followed. Sometimes the 
Iron did harm. In cases where auscultation had previously revealed 
nothing normal, I saw the lungs attacked and the Iron very ill borne. 
Having quieted thoracic symptoms I have resumed the Chalybeate 
preparations, but they wrere smitten with impotence, while all the 
characters of chlorosis existed. 
“ One circumstance has painfully affected me. The daughter of a 
friend in her fourteenth year was overgrown. Menstruation super- 
vening with excessive flow, chlorosis was manifested. I gave Iron; 
the color returned, and the catamenia reddened. Next month the 
same symptoms, same treatment, same success. All the while she- 
took Iron she was lively, expansive, excited. Eight or ten days after 
* Gazette des iiopitaux, Dec. 22, 1859. 728 
DISEASES OF THE REPRODUCTIVE FUNCTION. 
the last dose, December, 15, 1840, the thermometer having fallen to 
15° (59° Dali.), she went to see Napoleon’s funeral. On her return 
she coughed a little, then was seized with an alarming haemorrhage 
from the nose, the lungs and uterus all together. At the next men- 
strual epoch, the same thing occurred. Fever lighted up quietly, but 
soon became intense. All the symptoms got worse, and this young 
girl breathed her last sigh at the end of six or eight weeks. She died 
of a galloping consumption. I was afraid my Iron was not quite 
guiltless of this deplorable result. Now, I reproach myself openly 
with it. Then I was not quite convinced.” 
Another Case.—The wife of an architect, aged between twenty-five 
and thirty, had been chlorotic from her seventeenth year, and was suf- 
fering cruelly with temporo-facial neuralgia. 
“ Believing it to be connected with the chlorotic state I gave Car- 
bonate of Iron in large doses, hoping to cure the neuralgia through 
the cure of the chlorosis. In a month strength and appetite had 
returned; the rose bloomed on her cheeks ; a general excitement had 
replaced the prostration and languor; while of the neuralgia there 
only remained the remembrance. In discontinuing my visits, I recom- 
mended the protracted use of Iron, and its occasional resumption. 
“ Six weeks later I was recalled. Cough had supervened, with some 
oppression and febrile agitation every evening. Auscultation recog- 
nized, at the summit of one lung, a sub-crepital rale, with prolonged 
and exaggerated expiratory murmur. I was frightened, and with cause. 
I stopped the iron forthwith, and began a different medication; but it 
was too late. Five weeks after this young woman was carried to her 
grave with a galloping consumption.” 
These, and similar cases, opened the physician’s eyes to the danger 
of going too far with Iron in chlorotic patients. He now believes 
“ that with individuals predisposed to tuberculous phthisis, the pro- 
tracted use of Iron only favored and hastened the evolution of the 
tubercles. This view has acquired with me the certainty of conviction.” 
The disasters encountered by Mr. Trousseau in the reckless use of 
Iron are simply the pathogenetic aggravations wdiieh a homoeopathist 
knowTs how to avoid, at the same time that he employs this identical 
remedy to cure them when they come before him in symptoms result- 
ing from disease. Our views on this subject have been given under 
phthisis pulmonalis. (See page 245, Yol. II.) 
Sepia.—Swollen and puffy appearance of the whole body; face 
puffy, pale or yellow; eyes surrounded by blue or greenish margins; 
tongue coated with a white fur; foetid breath; menses too early and 
scanty ; yellowish, -watery, or mucous leucorrhoea; cold feet and hands 
when in bed in the evening. Painful beating in the head ; roaring in 
the ears ; no appetite ; or morbid desire for all kinds of food; absence CHLOROSIS. 
729 
af thirst; pain in the side and region of the liver; great sexual 
inclination; frequent dyspnoea; cough with mucous expectoration; 
stitches in the chest and side; weakness and stiffness in the small 
of the back; restless sleep, with frequent waking; skin tender and 
sensitive; sweat on waking; sensitiveness to cold air; faint and dis- 
couraged ; symptoms worse at night and when at rest; palpitation of 
the heart and intermittent pulse; weakness of memory; inability to 
think or reason; giddiness from walking ; melancholy, discouragement, 
and irritability. 
Remarks.—Chlorosis of nervous and delicate females, with a thin and 
delicate skin, and in whom menstruation has always been irregular, 
may be cured by Sepia. If the patient sweats profusely when walk- 
ing, and is particularly sensitive to cold air, this remedy is still more 
necessary. 
In inveterate cases, attended with extreme prostration, trembling of 
the limbs, coldness of the surface, entire suppression of the menses, 
dropsical swellings, great difficulty of breathing, palpitation of the 
heart, loose state of the bowels, frequent and protracted turns of faint- 
ness, we may examine Ferrum, Arsen., and Veratrum. Calcarea-carb. 
and Platina are indicated when the menses are too frequent and 
abundant. These medicines are especially adapted to young female 
organisms. 
Administration.—The remedies should generally be employed at 
the first, second, and third attenuations, and a dose administered once 
or twice daily, until there is apparent effect. No repetition should 
then be allowed so long as the slightest amendment is perceptible. 
Ilelonin.—(Helonias dioica, False Unicorn Root.) Cases of consti- 
tutional debility, anaemia and dyspepsia, associated with irregularity of 
the uterine functions; women subject to abortion; suffering from pro- 
lapsus uteri, leucorrhoea, frequent heavy pressive pains in the uterine 
region ; uterine atony causing amenorrhoea or dysmenorrhoea. It is 
regarded by Dr. Hale and others as a uterine tonic. 
Dr. Wolf says:—Chlorosis in its present form and immense exten- 
sion depends on the sycotic poison; in many cases it is congenital, or 
shows itself first after vaccination. It resists all other treatment, or 
is at best palliated by it. Tartar-emetic partially antidotes the sy- 
cotic poison, at least so far as depends on vaccination. Thuja is 
considered best capable of eradicating it. 
Metritis.—Treatment.—If swelling, heat, pain, tenderness and 
fever furnish sufficient evidence of inflammation of the substance of 
the uterus the disease is not so uncommon as it is generally repre- 
sented by medical authors. 
Remedies.—Aconite, Belladonna, Nux-vomica, Mercury, Sepia, and 
Macrotin are the most effectual remedies in cases where there are 730 
DISEASES OF THE REPRODUCTIVE FUNCTION. 
yellow and purulent uterine discharges, whether there is superficial 
ulceration or not. 
In nine cases out of ten of metritis, or peritonitis, the alternate and 
persistent use of the first dilution of Aconite and Belladonna, will 
effect cures. After a large experience we have arrived at this oonclu 
sion. 
Macrotin exerts a most controlling influence over the uterine 
functions, but in many cases cannot be given lower than the 6° or 9° 
dilution, without aggravation, especially if the uterus is rendered sen- 
sitive by anything like active disease. I have seen it restore the men- 
strual function more frequently and more promptly than any other 
drug. Pregnancy has often followed its use, after it has been long 
prevented by functional uterine disorder, or by chronic inflammation. 
Case.—A lady, aged twenty-six, strumous constitution, had for some 
months uncomfortable sensations in the pelvis, pain in the back; has 
for a week had Jeucorrhoea, now constant, large in quantity, unequivo- 
cally purulent, but little tenderness over the pubis ; feverish in the af- 
ternoon and night; occasional night sweats ; is languid and wTeak ; the 
cervix swollen, soft and puffy; has been confined to bed for a week. 
Regarded as an inflammation of the mucous membrane of the uterus, 
secreting pus, with probable ulceration. Aug. 16. Give Mer. Sol. 3°, 
one grain morning and evening. There was progressive improvement 
for twelve days. Sept. 3, Sepia 6°, three times a day. In two weeks 
the discharge was but little; health greatly improved. Sept. 17th. 
Macrotin 3°, one grain morning and evening. In a week the discharge 
ceased. Considered herself well. A partial return two -weeks after- 
wards. Give Mao. 33, one grain three times a day. This seems to 
have made the cure permanent. {Dr. J. S. Douglas.) 
9. CYRTOSIS TALIPES.—Club Foot.— Kylloi>odia. 
Causes.—These deformities, whether congenital or acquired, have 
the generic name talipes, referring to the ankle or pastern of the 
beast. 
Varieties: 1. Vara—foot turned nrwards. 
“ 2. Vulga £‘ “ outwards. 
“ 3. The foot from extreme tension turned upon 
itself, and rests upon the ground by the superior surface. 
It has long been believed that these deformities result from irregu- 
lar conformation of the bones, or defect of equilibrium in the action of 
the muscles, or wrong action of the tendons. M. Duval, of Paris, more 
than twenty years ago proved to the French Academy that the pri- 
mary cause of club-foot was—first, in the cerebro-spinal axis, and 
secondly, in spasmodic contraction of the muscles. The child in utero TALIPES CONGENITA. 
731 
is subject to violent and protracted motions; and seems in that state 
more subject to spasmodic and nervous affections than to any other 
forms of disease ; unnatural posture may produce deformity. Mental 
emotion of the mother is considered an original primordial cause of 
deformities and marks. Hereditary descent is one well-established 
cause. Dr. Richardson, of Louisville, says: “ A young man of the 
South, with double club-foot, assured me in 1839, that there was a 
family of six or seven children, male and female, all children of a club- 
footed father.” 
The effect of position and weight of the body in walking in after life, 
need not be considered here ; we see its effect every day, especially up 
to the age of adolescence. In every position in which the foot may try 
to adapt itself to its duties, nature, true to herself, endeavors to adapt it 
to its position by forming a thick skin wherever the surface is applied 
to the ground; and if it be the top of the foot that is turned down- 
ward, that intended for the sole is turned upward, and has the delicate 
skin of the natural upper surface. 
TALIPES CONGENITA—Club Foot. 
Talipes.—Club-foot.—Treatment.—Club-foot is generally a con 
genital disease, and the treatment by which it may in a good degree be 
remedied, should be commenced at the earliest period of the birth. 
When great deformity exists in later periods of life, efforts to correct 
it by surgical interference is not always successful. The bones have 
become more unyielding, adapted to the shape assumed by the defor- 
mity, and are more firmly bound by the ligamentous bands in that po- 
sition ; operations which divide the tendons leave the tension of liga- 
ments to be overcome, with all the adaptations of the metatarsal bones 
and their peculiar articulations. If the limb be straightened by the ope- 
ration, it is also weakened in muscular power. 
The treatment should be commenced in the earliest stage of in- 
fancy in an effort to control the wayward muscles, and restore the re- 
gularity of the articulations at the earliest possible moment. While the 
tendons are flexible, and the bones and cartilages soft and yielding, 
apply some apparatus that will control the foot and bring each part in 
proper position. A small splint and foot piece may be adjusted with 
broad adhesive straps to the foot, and a small pad placed over the 
ankle joint beneath the splint, which should have a hole in the upper, 
end to tie the ends of another adhesive strip through, the broad sur- 
face of which should pass around the calf of the leg and be tightened 
at pleasure. Now place a strip of adhesive plaster so that the ends 
shall adhere to opposite sides of the thigh from the groin, and let the 
tpen loop pass a little below the knee. Wind another strip behind the 732 
DISEASES OF THE REPRODUCTIVE FUNCTION. 
ankle over the top of the foot and under the foot piece, so that when it 
is brought up and tied in the loop of the thigh strap, it will hold the 
foot in a proper position. By attending to'the proper angles of the 
splint and foot board, and tightening the two strips spoken of as they 
may require, the deformity of the bones can be prevented to a great 
degree. These dressings should be renewed once or twice a week, or 
as often as the straps fail to adhere, and care should be taken to have 
the strips as wide as possible, and not to bring any part so tight as to 
interfere with the circulation. 
Operation.—But one cutaneous incision is to be made with a nar- 
row and delicate bistoury. Avoid detaching and separating the cel- 
lular substance surrounding the tendon, and preserve as far as posssible 
the cellular sheath, which is to perform an important part in the work 
of reparation; give the least possible pain, open few vessels, thereby 
avoiding ecchymosis and serious inflammation. Commence flexion of 
the foot by the application of the appareil immediately after cutting 
the tendon; but avoid exciting pain in the seat of the operation. 
The position of the patient is on the breast, the feet and legs are 
over the sides of the bed; an assistant holds the tendon slightly tense. 
With a common bistoury a short incision is made through the integu- 
ments upon the side of the tendon in a longitudinal direction, opposite 
its greatest prominence. Through the incision just made a narrow, con- 
vex probe-pointed bistoury is introduced, with which a passage is easily 
made by separating the cellular substance without endangering the punc- 
ture of the skin on the opposite side. The section of the tendon is made, 
by Stromeyer, by introducing a convex knife in front of the tendon 
(thereby avoiding injury to the posterior tibial vessels and nerves), 
allowing the point barely to issue on the opposite side of the skin. 
The limb is now extended to its proper position, and an appareil for 
support is applied to sustain it there, trusting to the reparative power 
of nature to fill up the space between the separated ends of the tendon. 
In the same manner we cut the contracted tendon in strabismus, the 
medical treatment of which is given p. 558, Vol. II. On the second or 
third day after the tendon is divided the cellular theca or sheath is 
thickened on each side, more consistent than natural and it is open 
only on the side where the instrument entered, and embraces both 
extremities of the tendon. The internal surface is ecchymosed, 
bright red, in contact with itself, or with the tendon’s extremities. By 
the ninth day the connection is already adherent to the end of a gray 
colored substance without the appearance of fibres. Between the ends 
of the tendon is a contracted canal without an opening ; its walls are in 
contact, and generally empty, sometimes partially filled with coagu 
lated blood. ABSORPTION. 
733 
CLASS VI.—DISEASES OF THE EXCERNENT 
FUNCTION. 
ORDER I.—AFFECTING- INTERNAL SURFACES. 
ABSORPTION IN CAUSING AND CURING OF DISEASE. 
The function of absorption is one of the most important of the 
human system in a state of health; its influence, therefore, in the 
cause and cure of disease becomes equally important. As the absorb- 
ing and circulating systems are distinct from each other, their offices 
present a striking contrast and seem to be entirely opposite to each 
other. Thus, the blood-vessels possess a susceptibility to excitement 
by other agents besides the blood which flows within them, and we see 
the arteries excited to various degrees of action, from the excessive 
action which ends in gangrene to the lowest grade of direct debility. 
We see all organs except the absorbent system under the control of 
the circulation, and we measure the violence of disease by the strength 
and frequency of the pulsations of the radial artery. But the ab- 
sorbents, being unconnected with the circulation except by their at- 
tachments at their terminations, have a distinct source of independent 
action of their own. No external stimulant provokes them to high 
action, and no narcotic exerts on them any perceptible sedative influ- 
ence. The heart communicates its impulse, and impels with quicker or 
slower motion; but the absorbents never feel its influence; and they 
continue their uniform action after the heart has ceased to beat. (See 
De Puy on Uniform Action of the Absorbents, N. Y. Med. Phys. 
Jour., June, 1828, p. 220, &c.) 
The absorbents open on every external and internal surface of the 
body, and absorb and convey into the general circulation substances 
which may be presented to them without the body, as well as all the 
waste materials which are being thrown off from the various organs, 
and the products of disease formed in the textures of these organs, or 
the various secreting surfaces. 
1. Absorption on the Skin.—Contagious and chronic affections of 
the skin may be communicated to others by absorption, either through 
the entire skin, or more conspicuously, when the cuticle is removed. 
Through the same channels remedies have been often introduced by 
means of baths, lotions, fumigations and inunctions. The Sulphate of 734 
DISEASES OF THE EXCERNENT FUNCTION. 
Quinine and prepa rations of Morphia, Croton Oil, Elaterium, prepara- 
tions of Iodine, Strychnia, Prussic-acid, Tartar-emetic, &c., have been 
often introduced in to the system through the skin. 
2. Absorption from the Lungs.—Many of the causes of disease 
are received through the respiration into the lungs. In this way marsh 
miasm and noxious animal exhalations are received, and exert their 
deleterious influence on the nerves of the lungs and on the blood 
itself into which they are introduced by absorption. It is also gene- 
rally believed that foreign substances dissolved in, or combined with, 
the moisture of atmospheric air, may, when inspired, be carried from 
the surface of the lungs directly into the blood through the capillary 
veins. The specific poisons which produce malarial and infectious 
diseases are almost always received into the system through the lungs ; 
and their influence is exerted, directly, on the nerves which supply the 
respiratory organs, and indirectly, by the partial absorption of the 
causes themselves from the mucous surface of the lungs into the 
general circulation. Observation and experiment have shown that 
foreign bodies are absorbed into the system with great facility when 
the vital resistance is feeble; and that, in proportion as the vital func- 
tions are proceeding with energy, the depressing causes of disease are 
repelled or counteracted. It is also known that the deleterious pro- 
perties of vitiated air can be lessened by the dilution effected by free 
ventilation, or neutralized by disinfectant agents. 
The prophylactic and practical importance of these facts is seen in 
the therapeutical measures based upon them. Various remedies are 
introduced through the lungs, and are found advantageous in many 
diseases. (See Vol. I., p. 795 and 767.) 
8. Absorption from, the Alimentary Canal.—It is chiefly through 
the absorbents of the prima via that nutritious as well as medicinal 
substances are introduced into the blood-vessels. Of the many agents 
which cause, counteract, or remove disease, some produce their effects 
by modifying the states of the nerves and mucous tissue of the ali- 
mentary canal; others are absorbed by the lacteals or by the venous 
radicles and carried into the general circulation. The greater number 
of remedial agents produce their first impression on the nerves, begin- 
ning with those of the tongue, then those of the stomach and intes- 
tines; but they are ultimately absorbed, diffused through the general 
mass of the blood, and exert their final influence on this fluid and the 
various secretions. The structure and peculiar mode of action of the 
absorbents are such that they take up with little discrimination what- 
ever comes within their reach; unwholesome and imperfectly digested 
chyle, vitiated secretions in the intestines, or long-retained fmcal mat- 
ters are absorbed, and produce their peculiar effects upon health ; ob- 
structed secretions of the kidnevs or liver are thrown into the blood- ABSORPTION. 
735 
vessels, become sensible in other secretions, in the skin, or in the per- 
spiration, and prolong or aggravate existing diseases. 
The absorption of medicinal substances from the intestinal canal 
has been amply proved by experiments. Acid urine becomes alkales- 
cent under the free use of alkalis, and the different salts of Potash 
and Soda pass unchanged through the blood and are excreted by the 
kidneys. Prussiate of Potash passes into the bladder within ten min- 
utes after being swallowed. (Paris.) Acrid medicines are taken up 
by the lacteals as rapidly as the blandest nutriment; the vitiated 
secretions in typhus are absorbed with the products of the food; and 
in every state of health or disease these vessels seem to act with nearly 
equal energy. The process by which absorption takes place is now 
regarded as a manifestation of capillary attraction called endesmosis. 
Endesmose and Exosmose, which are two peculiar results of capil- 
lary attraction, are thus defined: Endesmose is the inward motion of 
a fluid through a membranous or porous substance, into a vessel con- 
taining a different fluid. Exosmose is the outward motion of the con- 
tained fluid through the same substance. If a vessel be filled with 
Alcohol, and a piece of wet bladder tied over the top, the whole may 
be immersed in water, with the following result: in a few hours it will 
be found that water has passed by endesmose into the vessel through 
the bladder, and that Alcohol has passed out into the water by the 
movement called exosmose. The inward current is stronger than the 
outward one; hence the water passes in faster than Alcohol escapes, 
consequently the bladder soon becomes puffed out. 
The human skin being porous, a liquid with which it remains in con- 
tact will find its way through by endesmose, and be absorbed into the 
body. Thus, if a drop of Prussic-acid be placed on the arm, a suffi- 
cient quantity will be absorbed into the system to cause death. 
4. Absorption from Diseased Organs and Structures.—In every 
abscess, in morbid states of the uterus, in scirro-cancer, fungous 
hsematodes, the poisonous products of disease are absorbed into the 
circulation ; the blood and other fluids are contaminated, and life ulti- 
mately destroyed, if the formation and absorption of the deleterious 
products continue. Their presence in the blood is recognized by the 
change they effect in the color of the skin, in the increased action of 
the heart, the failure of vital power, the morbid condition of the ner- 
vous system, deranged digestion, and the evident degeneration of the 
blood and all the fluids of the body. In some chronic diseases the 
morbid secretions produce irritation in the lymphatic glands through 
which they are conveyed; but when the quantity produced in the seat 
of disease is large the obstructions furnished by the glands is an in- 
sufficient barrier; the glands themselves become inflamed, suppurate, 
and add, by their contents, to the general source of irritation; the 736 
DISEASES OF THE EXCEKNENT FUNCTION. 
absorbents continue to take up the purulent matter and carry it into 
the blood-vessels, and the entire train of morbid processes can only be 
arrested by restoring the general health. 
Process by which Secretion is Performed.—The first complete 
demonstration of the action of the nerves of secretion was that given 
by Ludwig, in his Avork on The Salivary Secretion, in 1851. After 
having tied the carotid and vertebral arteries of the two sides, removed 
the brain, exposed and opened the duct of Steno, and di Added the trige- 
minus within the interior of the cranium, he observed the following 
results: 
1. The irritation of the peripheral extremity of the trigeminus pro- 
duced isolated movements of the jaw, and at the expiration of ten or 
twelve seconds, an abundant secretion of saliva, which continued after 
the cessations of the excitations. 
2. Irritation of the peripheral extremity of the facial provoked dis- 
tinct movements of the hairy scalp and the face, also considerable 
salivary secretion, the jaw remaining completely immovable. Irrita- 
tion of a branch of the same nerve produced the same secretion, but 
no muscular movement. 
8. Irritation of the central extremity of the glosso-pharyngeal 
caused parotid secretion, which is never produced by excitations of the 
same parts of the vagus and hypoglossus. 
4. Ko nervous branch separated from the brain and excited, except 
the inferior maxillary division of the fifth, and the chorda-tympani, a 
branch of the facial, is capable of acting upon the parotid secretion. 
Excitation of the central extremity of the glosso-pharyngeal alone 
determines salivary secretion. 
5. The will, by the intervention of the trigeminus, possesses the 
poAver of acting directly upon the secretion, by the simultaneous influ- 
ence exercised by this nerve upon the movements of mastication and 
the flow of the saliva. It does not appear to exercise the same effect 
upon the facial, for the moATements of the muscles which are animated 
by this nerve are not observed to be accompanied by salivary secretion. 
All the observations of LudAvig are comprised by him in the follow- 
ing propositions: 
1. Without the intervening operations of the trigeminus and the facial 
upon the parotid, and the gustatory division of the trigeminus upon 
the submaxillary glands, salivary secretion cannot occur. 
2. Irritation of these nerves does not produce contraction of the 
glandular vesicles, nor of the excretory ducts. The ducts being closed, 
the glands fill and enlarge during their excitation ; AAThen, on the con- 
trary, they are open, there is a slow but continuous flow of the saliva 
for some hours. ABSORPTION. 
737 
3. The pressure developed by this secretion is more considerable 
than that of the blood itself in the glands ; and, finally, 
4. The nervous irritation does not determine any modification of the 
circulation that may be considered as a special source of mechanical 
force. As regards the influence of the nerves upon the movements 
of the lymph and the secretion of the lymphatic glands, Ludwig and 
Krause being satisfied that the quantity of lymph which escaped from 
the thoracic duct of a dog was the same whether the two carotids 
were tied or not, and not less after a fast of twenty-four hours, than 
immediately or some hours after a copious meal, observed a prompt 
acceleration of the discharge upon galvanizing the lingual branch of 
the trigeminus, either at its peripheral extremity or in its course along 
the lower jaw. The increase continued as long as the irritation of 
the nerve lasted, and the discharge was three or four times the normal 
amount. We have observed a considerable augmentation of the lach- 
rymal secretion upon irritation of the gasserian ganglion. Eckard, 
on searching for the nerves which supply the mammary gland, recog- 
nized as such the glandular branches of the lateral thoracic nerve, 
which runs along the axillary border of the pectoralis major muscle, 
between the fourth and sixth intercostal space, and besides, one or two 
extremely delicate filaments, variable in their origin, which accompany 
the large vessels. Having divided all these nerves in a goat, he ob- 
served no modification in the lacteal secretion ; but he lacked the more 
important experiment of irritating these nerves. The section of the 
glandular nervous trunks does not destroy the excitability of the peri- 
pheral nervous extremities for all causes of irritation, as long at least 
as these extremities are not atrophied. 
It is believed, then, “ that there are small ganglia in the midst of glan- 
dular substance designed to establish relations between the nerves of 
sensibility and those of secretion.” As a proof of the influence of 
the nerves upon the secretion of the gastric juice, it has long been 
claimed that the gastric juice is never secreted except in consequence 
of some irritation. This idea has been confirmed by the experiments 
of Bernard, Blondlet, and Panum. Bernard, from his experiments, 
concludes that the pneumogastric serves only to transmit an irritation 
to the medulla, after receiving itself from the lung; that it is the me- 
dulla that really presides over saccharine secretion; and that the 
great sympathetic is the agent by which the medulla acts upon the 
liver. 
Dr. Samuel says, among medicines, we have a great many having a 
specific action in augmenting and diminishing certain secretions. The 
well-known action of Mercury and Delphinine in salivation may be 
regarded as among the most generally acknowledged and best demon- 
strated facts in the whole of anthropology. May not the resolvent action 
Yol. II.—11. 738 
DISEASES OF THE EXCERNENT FUNCTION. 
of Mercury (and also of Iodine) upon ganglionic lymphatic tumors be 
attributed by analogy, with what has been observed by Ludwig and 
Krause, to an irritation of the nerves which preside over the elabora- 
tion of the lymph, and to the movement of this fluid in the interior of 
the canals, &c. 
1. HYDROPS.—DROPSY. 
General Description.—Dropsy is generally but a mere symptom 
of some other affection. Its proximate cause consists in an inflamma- 
tion, congestion, or exalted action of the capillary extremities of the 
arterial vessels of the serous and cellular membranes, and a torpor or 
inactivity of the venous absorbents of the same parts. 
The remote and general causes of dropsy are excessive loss of 
blood and other animal fluids; general debility, resulting from disease, 
mechanical injuries, obstructions of the liver, spleen, kidneys, veins, 
lungs ; abuse of drugs and stimulating drinks. At first view an in- 
flammation or congestion of the serous exhalents would seem to be 
incompatible with general debility, arising from excessive loss of 
blood, and diseases of the liver, kidneys, lungs, spleen, &c., but the 
fact is now well established that these circumstances actually favor 
the formation of these very capillary inflammations and congestions. 
Some writers maintain that serous effusions do not occur until the 
active inflammatory symptoms are passing off, and a state of sub-acute 
inflammation obtains; while others, like Laennec and Johnson, lay it 
down as a fundamental law of serous membranes, “ that they begin 
to effuse the moment they become inflamed.” It is true that acute 
inflammations of serous membranes often occur and subside without 
leaving any traces of effusion, but this is owing to the fact that, during 
the general febrile excitement, the venous absorbents of the affected 
cavities, being equally irritated with the exhalents, exercise their 
functions with preternatural activity, thus conveying off the fluid as 
fast as exhaled, and securing the equilibrium between exhalation and 
absorption. After the inflammatory symptoms have subsided, if the 
exhalents and absorbents both recover their tone, health returns ; but, 
as frequently happens, if the latter remain feeble, while the former 
return to their normal state, the healthy balance is lost, and dropsy is 
the result. In health, “ the cellular tissue, and all of those cavities 
lined by serous membranes, are continually lubricated by a fluid which 
exhales from capillary extremities of the arterial vessels.” (Frank.) 
This fluid serves to render the parts soft, pliable, and mobile, arid to 
prevent the adhesive inflammation which would otherwise occur from 
friction during the movements of the body. These exhalents give out 
nearly a given quantity of vapor, and a due equilibrium is established DKOPSY. 
739 
between tlie amount secreted for the use of the organism and that 
which is afterwards taken up by the venous extremities, and thrown off 
by the skin, kidneys, salivary glands, and intestines. So long as this 
proportion is maintained, all goes on well; but whenever any of the 
serous membranes, like the peritonaeum, the pleura, the pericardium, 
or the arachnoid, secrete more fluid than is required for the wants 
of the economy, or than can he absorbed by the venous extremities, 
then drafts are made upon other and healthy parts to supply the 
increased demand. On this account the perspiration becomes sup- 
pressed and the skin dry and husky, the saliva scanty and viscid, the 
urinary secretion small, high-colored, foetid, and sedimentitious, the 
stools scanty and difficult, and the functions generally deranged. 
In cases of dropsy, arising from excessive loss of blood or starva- 
tion, the normal physical condition of this fluid is changed,—the 
impression it produces upon the structures is altered, and a supera- 
bundance of serum is poured out into the cavities and the cellular 
tissue. This increased exhalation may be due either to the greater 
affinity which the serous membranes exert upon the altered blood, or 
to an irritation of the capillary extremities which induces an exalta- 
tion of their exhaling function. The experiments of Matteucci teach 
us that different fluids pass through the animal membranes in definite 
quantities, and with certain degrees of rapidity, according to the char- 
acter of fluids used, and the condition of the tissue operated upon. 
These different phenomena are termed endesmose and exosmose / and 
it is by no means improbable that some varieties of dropsy may be 
partially dependent upon this peculiar action. 
Another very important circumstance connected with the formation 
of dropsies is alluded to by Eberle. “ I have,” says he, “ already 
observed that immediately after a profuse loss of blood, absorption 
goes on with unusual activity. The blood-vessels are rapidly replen- 
ished with crude fluids : for the absorbents being extremely active, 
nearly all the aqueous fluids received into the stomach are speedily 
absorbed into the circulation; and, this is especially favored by the 
very great thirst which almost always occurs after excessive sanguin- 
eous losses. The blood being thus inordinately supplied with a crude 
and watery fluid, becomes more irritating to the heart and capillaries, 
and diluted to such a degree as to pass off more rapidly by the exha- 
lents.” (.Practice of Medicine.) 
Direct experiments on animals have proved that artificial dropsies 
may be produced by abstracting blood and drenching them with 
water. On the other hand, Magendie and Matteucci have equally 
demonstrated that a fullness of the blood-vessels very materially 
retards, and in some instances entirely suppresses, the function of 
absorption. 740 
DISEASES OF THE EXCERNENT FUNCTION. 
We think, then, it may be safely concluded that in every case of 
dropsy there are two simultaneous morbid conditions present, namely, 
increased exhalation and decreased absorption ; and that, although 
irritation and congestion of the exhalents are generally indispensable 
conditions to this morbid action, yet that effusion may result in cer- 
tain cases simply from an alteration in the character and quantity of 
the blood by endesmose. 
Dropsies are acute or chronic, primitive or secondary, simple or 
complicated; and the character of the effusion is dependent upon the 
age, sex, and constitution of the patient, and the nature of each par- 
ticular case. Generally, however, the fluid is composed of albuminous 
matter dissolved in more or less water, with different phosphates and 
carbonates and a little sulphur, {Frank) of an oily character—of a 
citron, orange, or strawT color; and of consistency semi-gelatinous, or 
like the white of eggs. But these appearances are sometimes subject 
to variations, as cases are reported in which the liquid was brown, 
white, green, purulent, bloody, saccharine, urinous, in some instances 
containing substances like hydatids and bits of membrane. 
Much light is sometimes thrown upon the nature and causes of 
dropsy by an examination of the urine. In certain cases of anasarca, 
for example, it is found that the urine coagulates on the application of 
heat, and from this circumstance we may suspect the existence of the 
disease so ably described by Dr. Bright under the name of granulated 
kidney. The application of heat in these cases, first causes the urine 
to become milky, and afterwards to present a curdled or flaky appear- 
ance. “ In hydrothorax following scarlatina, the urine is mixed with 
cruorine; in hydrothorax depending upon degeneration of the spleen 
and liver, the urine contains a large quantity of urea and uric-acid, 
rosic-acid and purpurate.” {Hartmann) In acute dropsies the 
effusion does not occur until the active inflammatory symptoms are 
passing off and a condition of sub-acute inflammation supervenes. In 
these cases, also, the exhalation takes place with more rapidity, and 
is attended with more painful symptoms, than in the chronic varieties. 
Now and then slight accumulations take place which remain stationary 
for years, when they entirely disappear, or the morbid condition of the 
exhalents returns, and the disease advances to its full development. 
Instances of this description are often observed in hydrocele, and in 
ovarian dropsy. 
An excellent diagnostic arrangement of the dropsies has been made 
by Marshall Hall, founded upon their causes, viz : 
“ First. The History.—This form of dropsy generally takes place 
rather suddenly, and is to be traced to exposure to wet and cold.” 
“1. Inflammatory Dropsy. DROPSY. 
741 
“ Second. The symptoms consist in the appearance of diffuse, 
tense anasarca, generally with dyspnoea, and frequently with the 
signs of effusion into the head, thorax, or abdomen, and with a 
coagulahle, and occasionally a sanguineous condition of the urine.” 
“ Third. The morbid anatomy varies according as the dropsy 
is confined to the cellular membrane, or extended to the serous mem- 
branes ; in the latter case there is frequently the effusion of coag- 
ulable lymph, as well as of serum, from the serous surfaces. 
The kidneys, in protracted cases, become disorganized, granular, 
scabrous, &c.” 
“2. Exanthematous Dropsy. 
“ First. The History.—This form of dropsy succeeds to some 
exanthematous diseases, but by far most frequently to scarlatina.” 
“ Second. The symptoms are similar to those just detailed as de- 
signating inflammatory dropsy ; there is the same disposition to effu- 
sions into the brain, thorax, and abdomen.” 
“3. Dropsy from Exhaustion. 
“First. The History and Symptoms.—This form of dropsy is 
known by being traced to the loss of blood. It occurs in the form of 
anasarca, and of effusion into the cavities. I do not know whether the 
urine be coagulable.” 
“ Second. A similar form of dropsy is induced in cases of neglected 
chlorosis.” 
“4. Dropsy from Debility. 
“ First. The history and symptoms sufficiently establish and dis- 
tinguish this form of dropsy. The patient has frequently had returns 
of dropsical affections, and has a pale and cachectic appearance. The 
urine coagulates into brownish flakes by exposure to heat.” 
“5. Dropsy from Obstruction in the Flow of Venous Blood. 
“ This form of dropsy arises from— 
“ First. Diseases of the heart, especially of the valves. 
“ Second. Disease of the lungs. 
“ Third. Disease of the liver, especially of the lcirrhose.’ 
“Fourth. Pressure on, or disease of the veins themselves. 
“ The History and Symptoms.—This kind of dropsy is distinguished 
by ascertaining the seat and nature of the original disease. Like the 
rest, it assumes the form of anasarca, and of effusion into the serous 
cavities, and into the cellular membrane of the internal organs, as the 
lungs, intestines, dec. The urine is not coagulable.” 742 
DISEASES OF THE EXCEKNENT FUNCTION. 
“6. Dkopsy fkom Disease of the Kidneys. 
“ For the detection of this species of dropsy the profession and 
mankind are indebted to Dr. Bright. 
“First. The Symptoms. It is distinguished by the coagulable 
condition of the urine. The urine is apt sometimes to be san- 
guineous. 
“ Second. The Complications.—There is, in this kind of dropsy, 
occasionally, 
“ First. An attack of apoplexy ; and frequently, 
“ Second. Inflammation of the serous membranes, and especially 
of the pleura. 
“ The liver is usually found free from disease. 
“ The Moi'bid Anatomy.—Dr. Bright describes three kinds of this 
disease of the kidney. In the first, the kidney loses its usual firm- 
ness, and becomes of a yellow-mottled appearance externally. The 
size of the kidney is not materially altered. In the second, the whole 
cortical part is converted into a granulated texture, and there appears 
to be a copious morbid interstitial deposit of an opaque white sub- 
stance. The kidney is generally rather larger than natural. In the 
third, the kidney is rough and scabrous externally, and rises in numer- 
ous projections not much exceeding a large pins head, yellow, red, and 
purplish; it is hard and inclined to be lobulated, and its texture 
approaches to a semi-cartilaginous firmness ; there appears, in short, 
a contraction of every part of the organ, with less interstitial deposit 
than in the last variety.” See pp. 46, 21. Vol. II. 
General Diagnosis.—The symptoms most commonly observed in 
dropsy, are: sensation of weight, oppression, fullness, and uneasiness 
in the part affected, with more or less disturbance of the neighboring 
tissues; dyspnoea and sense of suffocation after attaining the horizon- 
tal posture, and after active exercise; general feeling of debility, and 
disinclination to bodily or mental exertion; partial, arid in some 
instances, almost total suppression of the urinary, salivary, and perspi- 
ratory secretions; impaired appetite; feeble digestion; rare and 
scanty alvine discharges ; thirst; countenance pale, sallow’, or cachectic; 
emaciation; “ diminution of animal heat, sensation, and motion.” 
{Frank;) general derangement of nearly all the functions. 
In cellular dropsy the affected part is swollen, the skin presents a 
smooth and shining appearance, with blue veins traversing it in different 
directions, and pressure writh the fingers causes a deep indentation or 
pit, which remains for a considerable time. There is also an apparent 
diminution of temperature of the part, and a sensation of weight and 
tension is experienced, rather than of acute pain. The accumula- DROPSY. 
743 
tion of serum becomes so great in some instances as to burst through 
the integuments, and thus partially discharge itself. 
In acute dropsies of the serous membranes the symptoms are more 
active. There we have general febrile disturbance ; acute tenderness 
and pain in the disordered part, especially on pressure, or contact oi 
light clothing; urgent thirst; hot and dry skin; urine very scanty and 
high-colored; saliva viscid, tenacious, and small in quantity; loss of 
appetite; furred tongue; rapid sinking of the physical energies. 
These acute symptoms often subside, and leave the inflamed membrane 
in a state of sub-acute inflammation, thus developing well-pronounced 
chronic dropsy. 
It will be observed in our previous description of symptoms that we 
have included a diminution of the urinary, salivary, and intestinal 
secretions as characteristic of this malady; but these signs are not 
invariably present, for in a few instances we have witnessed an abun- 
dant and natural urinary and salivary secretion during the continuance 
of the complaint. So, also, one or more of the other symptoms 
described may be wanting, and yet the dropsical affection proceed to 
a fatal termination; but these circumstances are rather to be looked 
upon as slight exceptions than as general occurrences. 
Prognosis.—Our prognosis must depend much upon the cause and 
nature of each particular case. Simple cellular or serous dropsies 
uncomplicated with disorganization of any of the important organs, 
are for the most part curable. In this class we may rank exanthema- 
tous dropsies, and those which have followed losses of blood, from 
acute diseases in which no serious organic derangement has occurred, 
and from abuse of mercury and other drugs. In these cases a speedy 
removal of the causes which have conduced to the disease, wflth pure 
air, a generous diet, and a judicious course of homoeopathic medicines, 
jvill generally enable us to remove permanently the morbid accumula- 
tion. 
On the contrary, if the effusion has arisen from an organic affection 
of a vital organ, like the heart, the liver, the lungs, the kidney, or from 
incurable obstructions in the veins, our prognosis must be unfavorable. 
In these cases of complicated dropsy, our remedial efforts must be 
adapted to the remote general disease, as well as to the immediate 
symptoms of the malady. Although the chances of cure are small in 
cases of this description, yet, as recoveries do occasionally take place 
in individuals of naturally vigorous constitutions and those who are 
tenacious life, we should never prostrate our patients by discourage- 
ment, and a grim visage, but constantly point them to a beacon of 
hope in the distance. By this means wTe secure a powerful auxiliary 
to co-operate with us in our efforts to bring about those changes in the 
organism which may lead to a cure. 744 
DISEASES OF THE EXCEKNENT FUNCTION. 
We come now to treat of the different species of dropsy, viz.: 
First, Anasarca, 
Third, Hydrothorax, 
Fifth, Ovarian Dropsy. 
Second, Ascites, 
Fourth, Hydrocephalus, 
Sixth, Hydrocele. 
1. ANASARCA.—CELLULAR DROPSY. 
Diagnosis.—The term anasarca is used to designate that variety 
of dropsical effusion which takes place from the exhalents of the sub- 
cutaneous cellular tissue. The malady first manifests itself in the 
inferior extremities, particularly after standing or walking for some 
time, and it gradually extends upwards until the whole sub-cutaneous 
cellular tissue of the organism becomes involved. The tumefaction is 
usually soft, doughy, and inelastic, pitting on pressure, and the skin is 
white, shining, and below the medium temperature. The swelling dis- 
appears in great measure, after the patient has been for some time in 
the recumbent position, but returns again when he has assumed the 
erect posture. Cellular dropsy may exist for years without causing 
serious inconvenience, when confined to the inferior extremities; but 
it is rare that the whole cellular surface becomes involved, unless 
some vital disorganization exists, or the energies of the system have 
become dangerously impaired. 
The cases of anasarca attended with the least danger, are those 
arising from scarlatina, pregnancy, loss of blood,-debility consequent 
upon convalescence from acute diseases, abuse of arsenic and mercury, 
enlarged inguinal glands, the pressure of tumors, or any other curable 
cause which operates to prevent the free return of the venous blood. 
Effusions of this kind may very properly be termed passive dropsies, 
for we agree with Dewees, “ that there are both active and passive drop- 
sies, or rather dropsies that depend upon an increase of action, or of 
inflammation, and others where there may be a mere loss of balance 
between the exhalation and absorption.” 
In cases of dropsy arising from venous obstruction, for example, the 
venous absorbents below the seat of the obstruction are preternatu- 
rally distended with blood, and, as a consequence, their powers of 
absorption proportionably diminished, while the arterial exhalents 
exercise their function with the usual activity. In this manner the 
equilibrium between exhalation and absorption is destroyed, and drop- 
sical accumulations obtain. So in phthisis pulmonalis, and affections 
of the heart, the blood being but imperfectly decarbonized in its pas- 
sage through these diseased organs, becomes congested in the venous 
absorbents, and thus gives rise to diminished absorption, and conse- 
quent serous accumulations. 
Anasarca is not usually attended with much constitutional disturb- ABDOMINAL DKOPSY. 
745 
ance, or with symptoms that are painful. There are present, however, 
coldness of the surface and diminished secretion of urine and sweat. 
The countenance is also pale and sallow, and the general appearance 
indicates ill-health. Not unfrequently the effusion continues to in- 
crease until the affected parts become enormously distended, and 
finally crack and give issue to the accumulated serum. When this 
happens in erysipelatous or syphilitic subjects, sloughing and gangre- 
nous ulcers sometimes supervene, which prove highly troublesome and 
dangerous. 
Causes.—The pecular condition consequent upon scarlatina, measles, 
phthisis pulmonalis, chlorosis, and diseases of the heart; venous ob- 
structions caused by the gravid uterus, by the pressure of tumors, en- 
larged glands, ligatures, and mechanical injuries, sudden and excessive 
loss of blood, abuse of stimulants, arsenic and mercury. 
2. ASCITES.—ABDOMINAL DROPSY. 
Diagnosis.—Dropsy of the abdomen may arise suddenly in conse- 
quence of acute peritoneal inflammation, and be attended with the or- 
dinary symptoms of other febrile diseases, or it may make its appear- 
ance in a gradual and imperceptible manner, unattended by any nota- 
ble constitutional disturbance. During the attacks of peritonitis, there 
is an increased exhalation from the inflamed serous vessels, from the 
very commencement of the disease, and so long as the whole organism 
labors under the exalted action incident upon the fever, the venous ab- 
sorbents dispose of this superabundance of serum ; but after the active 
symptoms have subsided, a corresponding depression obtains in all 
parts of the economy, except, perhaps, the affected membrane, in 
which there still may remain a subacute inflammation and its conse- 
quence, a preternatural effusion of serum. In vigorous constitutions 
the absorbents continue to remove the exhalation as fast as formed ; 
but in feeble, delicate, or scrofulous subjects, the function of absorp- 
tion often languishes, the equilibrium between the exhaling and ab- 
sorbing functions is destroyed, and an ascites is the result. 
The signs which characterize abdominal dropsy, are: gradual en- 
'argement of the abdomen, first observed in the epigastric region, and 
afterwards extending over the whole abdomen ; tenderness on pres- 
sure ; difficulty of breathing on taking exercise, and some time after 
lying down; distinct fluctuation on percussion ; sallow and unhealthy 
complexion ; dry skin; scanty secretion of high-colored and sedimenti- 
tious urine; foul tongue, with a small secretion of viscid saliva; im- 
paired appetite; constipation or diarrhoea, sensation of weight and 
stiffness, particularly when attempting to move about or bend the 
body ; a general feeling of languor and debility. 746 
DISEASES OF THE EXCERNENT FUNCTION. 
The only diseases which are liable to he confounded with ascites, 
are pregnancy and tympanitis; hut the history and circumstances of 
each case will enable us to distinguish with sufficient facility and cer- 
tainty between the different maladies. In ascites the situation of the 
swelling, the fluctuation on percussion, the suppression of urine, dry 
skin, and the previous history of the case, will mark the nature of the 
complaint; and in pregnancy the gradual swelling at the lower part of 
the abdomen, the suppression of the menses, nausea and vomiting; the 
absence of fluctuation on percussion, and the motion of the child, will 
render our diagnosis accurate. Nor will the acute physician ever mis- 
take tympanitic distention for ascites, for percussion, auscultation, and 
an absence of the characteristic symptoms of dropsy, will enable him 
to decide at once in regard to the real nature of the case. Indeed, we 
can hardly conceive how certain eminent surgeons should have been 
led to perform the operation of what they have afterwards facetiously 
termed the operation of “ dry tapping” when the distinguishing marks 
between tympanitic and aqueous distention are so easily recognized. 
Authors have described several distinct varieties of abdominal dropsy, 
and have named each according to its precise location ; thus, subcuta- 
neous ascites, in which the effusion takes place in a circumscribed 
cavity or sac in front of the abdominal muscles; vaginal ascites, aris- 
ing from a puncture or other injury to the aponeuroses of the muscles, 
and causing effusion into the sheath of the muscle ; peritoneal ascites, 
or effusion within the serous cavity, and in some rare instances, on the 
outside of the membrane; hydatid ascites, in which the water is 
closed in one or more thin vesicles ; also dropsy of the epiploon, of 
the mesentery, of the intestines, of the liver, of the spleen, of the gall 
bladder, and encysted ascites. This minute classification is, however, 
quite unnecessary for practical purposes, since ascites is so often com- 
plicated, not only with several of these varieties, but with hydrothorax, 
anasarca, and general dropsy. It is so very rare that wre find the 
above-named organs affected separately, that wTe question the propriety 
of recognizing in them distinct species of dropsy, although it is of 
some importance to be aware of the fact that these distinct effusions 
may occur. 
Causes.—The most common causes of ascites are peritoneal inflam- 
mation, affections of the liver, and abuse of stimulating drinks. It may 
also proceed from venous obstruction, general debility in consequence 
of disease, loss of blood, and abuse of drugs. 
Prognosis.—Our opinion respecting the probable termination of as- 
cites, will be determined by the following circumstances: old age, and 
a constitution impaired by previous disease or by excesses, must always 
render our prognosis unfavorable Dropsies complicated with incura- 
ble functional derangement of the liver or other vital organs, and DEOPSY OF THE CHEST. 
747 
venous obstructions, are for the most part beyond the reach of medi- 
cine. On the other hand, ascites consequent upon acute inflammation 
of the peritoneum, loss of blood, abuse of stimulants and drugs, and the 
debility arising from fevers and other acute diseases, may generally be 
set down as curable. When the malady occurs in young and natu- 
rally robust constitutions, our prognosis will be still more favorable, 
and in some instances may afford grounds of encouragement in highly 
complicated cases. 
3. HYDROTHORAX, or DROPSY OF THE CHEST. 
Hydrothorax is either idiopathic or symptomatic of some other dis- 
ease. By far the most common source of the affection, and one which 
constitutes a serious complication, is organic disease of the heart. An- 
other frequent cause of dropsy of the chest is protracted pleuritic in- 
flammation. Dropsy of the heart generally co-exists with hydrothorax, 
and it is for this reason that we often find the pulse very irregular. 
The symptoms are most urgent during the night, after the patient has 
remained some time in the recumbent posture. The breathing be- 
comes rapid, laborious, and grunting, with frequent sighing, sudden 
starting during sleep, anxious and distressed expression of counte- 
nance, face pallid and wax-like ; small secretion of high-colored urine ; 
puffiness of the face and extremities ; fullness of the chest; dull sound 
on percussion; dyspnoea occurring from the slightest exercise, or 
from lying down; sudden starting up with fright during sleep ; and 
irregular pulsations of the heart, will enable us to recognize the affec- 
tion without difficulty. 
Laennec assures us that hydrothorax accompanies many acute and 
chronic diseases, and that “ its presence announces the approach of 
death, which it often precedes only a few moments.” That these effu- 
sions do sometimes occur but a short period before death from organic 
affections of the heart, and possibly other organs, we entertain no 
doubt, for several cases have come under our observation strongly cor- 
roborative of the fact. 
A dropsy of the heart is so constant an attendant on hydrothorax, and 
the symptoms of each so constantly simulate each other, that it is unne- 
cessary to enter into a separate description of this malady. When the 
effusion originates from an affection of the heart, or the pericardium, 
there will always be a predominance of those symptoms which charac-, 
terize cardiac disease, and afford us a sure guide in forming our diag- 
nosis. 
Paracentesis Thoracis may, in some instances, be resorted to with 
unequivocal advantage, for the relief of purulent collections within the 
thorax, but very rarely in hydrothorax. We have in two instances 748 
DISEASES OF THE EXCERNENT FUNCTION. 
saved life by a prompt resort to this operation, where matter had accu- 
mulated in the chest and the patients were at the point of death from 
suffocation ; but in thoracic dropsies, very slight encouragement can 
be offered from its performance, although in extreme cases it is not to 
be lost sight of, since recoveries have now and then taken place after 
the operation. 
4. OVARIAN DROPSY. 
In this species of dropsy, the effusion takes place from the internal 
face of the membrane which encloses the ovarium. The swelling is 
first observed in the iliac region, in the form of a small elastic tumor, 
and unattended with pain, uneasiness, or constitutional disturbance. 
The enlargement generally progresses very slowly, extending upwards 
towards the kidney of the affected side, then crossing the abdomen to 
the opposite side, until it comes to occupy the whole abdomen. No 
serious inconvenience is experienced until the tumor has attained such 
a size as to encroach upon the bladder, stomach, diaphragm, intes- 
tines, and the larger blood-vessels, thus giving rise to difficulty in uri- 
nating, sense of weight and uneasiness in the stomach, dyspnoea, colicky 
pains in the bowels, pains in the side and chest, diminution of the secre- 
tions, and oedema of the feet and ankles. 
The tumor often remains stationary, and almost unnoticed for twenty 
or thirty years, when some sudden exciting cause will operate, and the 
swelling rapidly attain an enormous size. 
The contents of ovarian tumors vary much in their character, being 
sometimes serous, sometimes albuminous, purulent, sebaceous, or fatty, 
or composed in part of organized structures. Dr. Clapp, surgeon to 
Exeter Hospital has reported a case in which the contents of the tu- 
mor “consisted of teeth, hair, bony deposit, some transparent masses 
of a cellular structure, (as examined by the microscope,) serum, seba- 
ceous matter, and granular fat, which were contained in numerous 
small cysts. Teeth were .found in all parts of the tumor, and wrere 
counted to the number of forty-tbree; some were contained in cysts, 
others were imbedded in the semi-transparent masses, and two or three 
were growing from the walls of the parent cyst. In one part, a few 
wei*e imbedded in a mass of bone, bearing a strong resemblance to an 
upper jaw united in the mesial line.” 
Fluctuation can rarely be perceived in the swelling until it has at- 
tained a considerable size, but the location of the tumor, and the ab- 
sence of pain or other unpleasant symptoms, will enable us to form a 
correct opinion in the early stage of the disease. 
For an account of Hydrocephalus or Dropsy of the Brain, we refer 
to page 719, 724, Vol. II., of this work. OVARIAN DROPSY. 
749 
Treatment of Dropsy.—It has been already observed, that dropsy 
is usually but a symptom of some other malady. Some of the causes 
which induce it, operate for a certain length of time, and then subside 
spontaneously, together with its symptoms of effusion. Amongst this 
class of causes may be placed, pregnancy, temporary pressure of tu- 
mors, intermittent fevers, and inordinate doses of arsenic. 
Another class of causes which demands the gravest attention of the 
physician, consists of functional derangement of important organs, im- 
paired constitutions, protracted debility from excessive loss of animal 
fluids, habitual intemperance, general cachectic habit of body, chlo- 
rosis. 
The first indication of cure consists in removing, as far as is prac- 
ticable, the cause of the dropsy. To do this successfully, it is neces- 
sary to enter into a minute investigation respecting the private habits 
of the patient, as well as the present symptoms. By this means abuse 
of stimulants, of drugs, and excesses of all kinds, may be guarded 
against, which otherwise would have operated unfavorably during our 
curative efforts. 
As a general rule, pure air, moderate exercise, an agreeable state of 
mind, a light and nutritious diet, and a sufficient quantity of warm 
clothing should be enjoined. A change of location, or a s.ea voyage, 
are often powerful auxiliaries in the treatment. 
When dropsy depends upon incurable organic affections of the heart 
or liver, much may be done towards palliating the symptoms and pro- 
tracting the patient’s life, by an avoidance of all those causes which 
tend to aggravate the primary source of the disease, such as undue 
physical exertion, violent emotions and passions, &c. 
Our efforts should also be directed, without cessation, towards 
changing the morbid condition of the membrane upon which the drop- 
sy is dependent. Our remedies, therefore, must cover the remote as 
well as the proximate symptoms of the malady. 
The remedies which we deem most valuable in the treatment of 
dropsical effusions, are : Apis-mellijica, Arsenicum-aTbum, Digita- 
lis, China, Hellebore, Colchicum, Dulcamara, Asparagus, Canthar 
rides, Scillce, llydriodate-potassce, Mercurius, Uva-ursi, Elaterium, 
Apocynum-cann., Cannabis-ind. 
Apis-mellijica.—In ascites and hydrothorax, the first trituration of 
the common honey-bee has proved astonishingly efficacious in our 
hands. The influence which this remedy exercises upon the urinary 
organs, as well as upon the peritoneum and pleura, is of the most 
prompt and decided character. In large doses, it causes a sense of 
fullness, constriction, or of suffocation in the thorax; difficult and 
anxious respiration ; pain and tenderness of the abdomen, increased on 
pressure or by contact; symptoms worse* in the horizontal posture; 750 
DISEASES OF THE EXCEKNENT FUNCTION. 
great secretion of urine, which is pale or of a straw color, and deposits 
a reddish or brick-colored sediment; frequent desire to urinate, and 
strangury. 
Our method of preparing the medicine is as follows: Enclose the 
bees in a close vessel, and expose them to a temperature of 90° (Fah- 
renheit,) until all moisture has escaped from them, and they are suffi- 
ciently dry to pulverize readily: We then triturate five grains of this 
powder with one hundred grains of sugar of milk for the usual period, 
and administer the trituration in grain doses from two to four times in 
twenty-four hours. Whether the active piinciple of this substance 
consists solely of the virus connected with the sting of the insect, or 
whether other parts possess active properties, we know not; we 
incline, however, to the former opinion. 
The following case occurred in the practice of Dr. Taft, of Hartford. 
The patient, a boy of twelve years of age, was attacked in July, 1849, 
wTith dysentery ; after several w7eeks of medication under an allopathic 
physician, the acute symptoms subsided, and the evacuations gradually 
assumed their natural state; but there remained an unnatural fullness 
and tenderness of the abdomen, some difficulty of respiration, especially 
on assuming the recumbent position, a dry and harsh skin, and a ma- 
terially diminished secretion of urine. Notwithstanding the persever- 
ing employment of the usual allopathic routine of cathartics, mercuri- 
als, and diuretics, the patient continued to grow worse ; his abdomen 
becatae very much distended with serum, and very tender to the touchy 
or from even the pressure of the bed-clothes; the respiration became 
exceedingly laborious and difficult, obliging the sufferer to remain for 
a good portion of the nights in his chair; impaired appetite, an almost 
entire suppression of urine, emaciation, debility, small and rapid pulse, 
anxious expression of countenance, and other urgent symptoms in- 
creased in severity. 
In this condition he came under the care of Dr. Taft, wTho adminis- 
tered Digitalis, Arsenicum, Dulcamara, 3fercurius, China, Sulphur 
and Hellebore, as the symptoms appeared to indicate, but without any 
amelioration of the symptoms. In the meantime, the increasing diffi- 
culty of respiration, pain, loss of rest and of appetite, had reduced the 
patient to a serious condition and we were called in council with Dr. 
Taft, in order to decide respecting the propriety of paracentesis abdo- 
minis. In consideration of the urgency of the symptoms, and the in- 
efficiency of the remedies which had been used, we evacuated the effused 
fluid, amounting to sixteen pounds, and advised a second trial of Ar- 
senicum and Digitalis. No effects, however, resulted from their use; 
the secretion of urine remained the same, the skin dry and husky, the 
abdominal effusion continued to accumulate ; the oppression of the 
chest, sense of suffocation and difficulty of breathing gradually in- OVARIAN DROPSY. 
751 
creased, and signs of thoracic effusion began to be exhibited. Re- 
course was now had to the above trituration of Apis-mellifica, and 
with the most speedy and marked results. After two or three doses, 
a large quantity of urine was voided and the symptoms were all ame- 
liorated. After the remedy had been continued for two weeks, all 
traces of effusion disappeared, the appetite and strength began to im- 
prove, and the respiration became natural and easy. The patient con- 
tinued to convalesce without any further unfavorable indication, until 
perfect health was restored. We have witnessed the effects of this 
remedy in two other cases of ascites, in one case of protracted general 
dropsy, and in one case of hydrothorax, and with the same favorable 
results. The powder of dried honey-bees has long been used as a 
remedy in dropsies by the aborigines of our country. 
Homoeopathy is in ovarian dropsy, as in many other diseases, the 
dernier resort of incurables.” Consequently, though we may record 
some successes, our efforts are generally recorded on the roll of fail- 
ures. Paracentesis has generally been the last resort even of homoeo- 
pathists; and this resort is an unsatisfactory one. The fluid, in 
common cases, rapidly accumulates again; especially when the disease 
appears in the multilocular form. Dr. Simpson, in his recent lectures 
on the subject, presents it in a more hopeless light than ever. It is 
therefore desirable to cultivate all the remedial agencies within our 
reach, that in cases where the fluid can possibly be dispersed without 
an operation, it may be done. Dr. Craig gives some cases. 
1. A lady, aged 74, had twice previously submitted to the opera- 
tion, the last already some years ago. At this time, (September, 
1851,) Dr. Craig emptied the sac without difficulty in the usual way, 
and about ten pints of fluid were withdrawn. The disease did not 
return so far as to cause discomfort. In July of the following year 
she died of old age. After death the sac was found attached by a 
small pedicle to the left ovary; it was unilocular, and contained about 
three pints of fluid. Tapping and judicious homoeopathic medical treat- 
ment had prolonged her life about nine years. 
2. A young woman, aged 25, had an ovarian tumor gradually 
increasing for two years. Eight months of medical treatment had 
failed. Dr. Craig drew off fourteen pints of fluid. She then took 
Apis for four months. Again tapping was performed, and eleven pints 
drawn off. She then took Apis for a length of time; improved, mar- 
ried, and got well. 
3. A lady, aged 36, mother of three children, became greatly ema- 
ciated and the abdomen largely increased in size. An ovarian tumor had 
continued to enlarge for thirteen years. Paracentesis performed, and 
nine gallons and a half of a thick fluid were drawn off. She soon 
recovered from the shock, took Apis-mel. for a time. In July, 1857. 752 
DISEASES OF THE EXCERNENT FUNCTION. 
another operation was performed ; six gallons drawn off. Health and 
flesh then increased. In February, next year, eight gallons; and in 
August, five gallons. In April, 1859, she died. She had taken Apis 
regularly between the operations, and had always found it increase 
the urine. 
Dr. Schneider, of Germany, has reported an interesting case of an 
indurated ovary cured by Conium. (IlirscheV s Zeitschrift.) 
Arsenicum.—General appearance of exhaustion and debility; pallid 
waxen, and sickly countenance; cheeks, lips, and eye-lids bloated and 
puffy, causing a marked alteration in the expression ; dropsical swell- 
ings of the extremities and abdomen; mouth and tongue dry; tongue 
tremulous, red, bluish, or covered with a white coat; urine scanty, 
dark, and turbid or slimy; general coldness and dryness of the skin; 
general anasarca, with discharging vesicles on different parts of the 
affected surface; emaciation; dark colored spots or blisters on 
different parts of the body; pulse small, feeble, and intermittent. 
General sense of prostration; great nervous sensibility; paralytic 
feeling in the swollen parts ; palpitation of the heart; turns of faint- 
ness ; great difficulty of breathing when exercising, and after lying 
down; restlessness ; anguish and oppression in the thorax and epi- 
gastric region; humming and roaring in the ears and head; bad 
taste in the mouth; loss of appetite ; dryness of the mouth and 
tongue ; thirst; tenderness of the abdomen on pressure; difficult and 
scanty alvine discharges or slight diarrhoea; frequent desire to 
urinate, although but a small quantity is secreted ; anxious, difficult 
and rapid respiration while in the recumbent posture ; heaviness and 
stiffness of the limbs and body; disturbed sleep, from impeded respi- 
ration ; dreams; chilliness, alternating now and then with flushes of 
heat; diminution of sensation and power in the swollen parts ; symp- 
toms worse after eating, exercise, and lying down. 
General mental uneasiness; fits of anguish and discouragement; 
disinclination to remain long in one position; apprehension that it is 
impossible to recover. 
In a work by Ruckert,* there are recorded thirty-six cases of 
ascites, cured or remarkably ameliorated by homoeopathic treatment. 
(Part 26, p. 322.) 
Ascites after Scarlatina.—See scarlatina, Vol. I., p. 600.—A girl 
aged seven. Ascites after scarlatina, with albuminuria. Arsenic 
restored the urine, and Nitric-acid caused the last trace of albumen to 
disappear. 
Ascites with induration of the liver, cured by Acid-fluoric. 
Ascites with disease of the kidneys, anasarca, and hydrothorax, in a 
child aged ten years, cured by Arsenicum. 
* Klinische Erfahrungen in der Hoinceopathie. Dropsies. OYARIAJSI DROPSY. 
753 
Digitalis.—This remedy has been found curative in general anasar- 
ca, ascites, and hydrothorax originating in organic disease of the 
heart; also, paleness of the face ; blue lips; swelling of the eyelids; 
coated tongue ; scanty secretion of high-colored urine; strong and 
visible pulsations of the heart; irregularity of the pulse; general 
paleness of the skin. Digitalis in poisonous doses produces convul- 
sions, and suppresses the secretion of the kidneys. 
Vertigo; pressure in the forehead and vertex; ringing and hissing 
in the ears; want of appetite; flat taste in the mouth; thirst; pres- 
sure in the stomach ; distention of the abdomen, with stitching pains ; 
pressure at the neck of the bladder, with frequent desire to urinate ; 
throbbing in the chest; sharp stitches in the region of the heart: 
respiration anxious and difficult on walking or lying down; lassitude 
and diminished sensation in the inferior extremities; constant inclina- 
tion to sleep ; disturbed sleep ; faintness. 
Dullness of intellect; vertigo; forgetfulness ; gloomy, peevish, and 
indifferent. 
Remarks.—Digitalis has proved most advantageous in dropsy con- 
sequent on organic disease of the heart, and in anasarca following 
scarlatina. Dr. Kurtz considers Digitalis in decoction an excellent 
remedy in this complaint, and that the dilutions are useless. 
Cases.—Ascites with organic alterations.—1. A man, aged 
seventy. Disease of the spleen and abdomen, from the abuse of 
spirituous liquors, cured by Nux-vom. 100. {Stern, Journal de la 
Soc.) 
2. A woman, aged forty-six. Ascites, with displacement of the 
bladder, the uterus, and vagina. Anasarca cured by Arsenic, 
(i? eke 11.) 
3. A man, aged seventy, feeble, lymphatic ; ascites, hydrothorax 
and oedema. Apis, roVo; at first alone, afterwards alternately with 
Arsen. 50. Cured. (Riickert.) 
4. A woman, aged forty-four. Miscarriage, followed by uterine 
haemorrhage ; afterwards ascites and oedema. Arsenic relieved, and 
Helleborus-niger completed the cure. 
5. A scrofulous young man, with varices of the legs, cured by 
Arsenicum, Sulph., China, Lachesis. {Lore, Journal de la Societe.) 
Ascites from disease of the heart. The ascites yielded to Digi- 
talis 30. {Beauvais) 
A similar case recorded by M. Lore, {Journal de la Soc., Tom. 2, 
p. 41,) where Digitalis relieved and removed the symptoms. 
Ascites with multilocular cysts. Relief from Digitalis. {Escal- 
lier) 
Scillce has been employed successfully in ascites and anasarca, by 
Hartmann, Currie, Noack, and Trinks. Hahnemann did not entertain 
You II.—48. 754 
DISEASES OF THE EXCEKNENT FUNCTION. 
a high opinion of this substance as a remedy for dropsy, since its 
primary effect was to stimulate the kidneys and cause a copious 
emission of urine, while its secondary effect was always the opposite 
of this, viz., to suspend almost entirely the urinary secretion. 
China.—Countenance pale or sallow, sunken and sickly; general 
appearance of languor and debility; dropsical swellings in one or 
more parts of the body; enlargement and induration of the liver; 
emaciation; dryness of the skin, mouth, and tongue ; urine scanty, 
pale, or dark colored, and depositing a brick-dust sediment; coldness 
of the whole surface of the body; skin yellow; tremor in the limbs 
when attempting to walk. 
Exhaustion arising from protracted diseases, from excessive loss of 
blood, and from abuse of drugs; pain and tenderness in the region of 
the liver; heaviness and pressure in the head from within outwards; 
humming and ringing in the ears; bitter or flat, insipid taste ; loss of 
appetite; thirst for cold water and acids ; oppression of the stomach 
and abdomen, especially after eating or drinking; constipation ; respi- 
ration short, rapid, and at times suffocative; nights restless, and sleep 
disturbed by dreams ; great sensitiveness to cold; frequent shudder- 
ing when drinking cold water, or when exposed to the air; swelling 
and stiffness of the limbs; weariness of the limbs, with constant 
desire to change position; symptoms aggravated by contact, by eat- 
ing, and at night; low-spirited, nervous, and irritable; sometimes 
anxious, gloomy, and apprehensive of evil, and at other times indiffe- 
rent, taciturn or stupid; confusion of ideas; disinclination to physical 
or mental labor. 
Remarks.—China will be found curative in those dropsies which 
are the result of simple debility, which have been caused by loss of 
animal fluids, protracted illness, and the abuse of cathartics. It may 
also be exhibited in anasarca, consequent on attacks of intermittent 
and other fevers. 
A woman had ascites, caused by suppression of the menses, green 
leucorrhoea, pressure on the bladder, colic, and diarrhoea. Nux-vom. 
removed the abdominal symptoms ; China restored strength, and Pulsa- 
tilla brought back the menses, and caused the ascites to disappear. 
{Beauvais, Ohs. 2-52.) 
Three cases of ascites, with disease of the spleen, reported by 
Beauvais de Saint Gratien and Riickert, and collected by Attomyr, 
cured by China. 
A woman, aged fifty-two ; ascites with anasarca, depression, haemor- 
roids, prolapsus of the rectum, &c. Improved by Nux-vom., Pulsat., 
Ferrum, &c., but especially by China, which had great effect both on 
the oedema and dropsy. 
Hellebore.—Face and lips swollen, and of a pale or yellowish cast; OYARIAK DROPSY. 
755 
fluctuating swelling of the abdomen; general anasarca; spasmodic or 
convulsive movement of the head and limbs ; twitching of the eyelids; 
dullness and stupor; coldness of the surface; suppression of urine; 
throbbing or compressive pain in the head; oppression at the chest and 
stomach; cramp-like pains in the abdomen; frequent desire to urinate, 
with scanty emission; loss of appetite; nausea, and pain in the stomach 
and bowels, followed by a loose alvine evacuation; short, dry cough; 
difficulty of breathing; sharp stitches in the head, chest, and abdo- 
men ; heaviness and rigidity of the limbs; symptoms better in the 
open air; dullness of intellect; weakness of memory ; painful stupefac- 
tion of the head; frequent sighing and moaning; giddiness on rising 
up, or walking; confusion of ideas. 
Remarks.—Hellebore is particularly recommended in dropsies com- 
plicated with intermittent fever, after the fever has been cured by 
Arsenicum/ also in anasarca and ascites of children, arising from 
scarlatina. It has effected prompt cures of dropsical effusions upon 
the brain, attended with convulsive motions of the head and limbs. 
A child, aged fifteen months; ascites, cured by Helleborus, 30. 
{Ibid.) 
Colchicum.—Face yellow and oedematous ; dropsical swelling of the 
abdomen; oedema of the feet and legs; visible palpitations of the 
heart; skin dry and cold, or alternating with heat during the night; 
rapid and difficult respiration; pulse full and hard,or quick and small; 
urine scanty and dark-colored; nausea, burning and icy-coldness of the 
stomach; distention of the abdomen, with pressure, and colicky-pains; 
abdomen tender on pressure; loose and painful stools; oppression of 
the chest; tearing pains and stiffness in the back, side and limbs ; 
drowsy during the day, but restless nights; symptoms worse during 
the night, also aggravated by mental labor; tendency to exaggerate 
symptoms; absence of mind; forgetfulness; dissatisfaction from slight 
causes. 
Remarks.—This remedy is useful in dropsical swellings caused by 
atmospheric vicissitudes, excessive mental labor, sudden suppression 
of the perspiration, and in anasarca consequent upon scarlatina and 
measles. 
Of Colchicum Hahnemann says: 
“ And though the frequent experience of Storck, Marges, Planchon, 
du Monceau, F. C. Juncker, Schinz, Ehrmann, and others had not 
already established the fact, that Colchicum-autumnale cures a 
species of dropsy, still this power was to be expected from it, from the 
peculiar property it possesses of diminishing the urinary secretion, 
and of exciting at the same time a continual desire to pass water. 
It likewise causes the flow of a small quantity of urine of a fiery-red 
color as witnessed by Storck and De Berge.” 756 
DISEASES OF THE EXCEKNENT FUNCTION. 
Diuretic Action—Case from the Gentleman's Magazine for Sept 
1764. 
Dr. Storck made experiments on himself and details the results, 
Among these we notice the specific effect upon the kidneys, character- 
ized by the inclination to urinate, with inability to do so, except in 
very small quantities and wfith great difficulty. This effect induced 
Storck to carry his observations further, and he then discovered that 
the addition of acids corrected this deleterious influence on the 
kidney. He therefore prepared a medicated vinegar, analogous to the 
Acetum-colchici of the present pharmacopoeia as a diuretic in drop 
sies with a considerable degree of success. Hahnemann says: 
“ The cure of an asthma attended by hypochondriasis effected by 
Goritz, by means of Colchicum, and that of asthma complicated with 
hydrothorax, performed by Storck with the same substance, were 
evidently owing to the homoeopathic property wdiich it possesses, of 
exciting asthma dyspnoea, as witnessed by De Berge. Copabia, Tur- 
pentine and Cantharides are used in diseases of the kidneys and blad- 
der, and they act homoeopathically in all cases -where they are 
successful. 
Ascites.—After Enteritis.—A boy, aged three and a half years, 
had ascites after enteritis. Arsen., Digit., Dulcam., China, Sulph. were 
given without effect. Tapping was resorted to, and a quantity of thick, 
dark-colored serum was drawTn off. Apis did much good; the improve- 
ment continued under Merc.-sol.; and Apis, -which was again given, com- 
pleted the cure. 
After Dysentery.—A boy, aged twelve. Ascites and hydrothorax 
after dysentery. Many medicines given without benefit; tapping; 
after it Arsen, and Digitalis without effect; suffocation imminent; 
Apis relieved very rapidly and effected a complete cure. 
A woman, aged twenty-sev-en. Ascites after gradual suppression of 
the menses. Aeon, and Bell, -were given -without much benefit. Apis 
in trituration at first, increased the urine, then restored some traces 
of the menses, and a month later the menses became regular. Under 
the influence of this medicine the ascites gradually diminished. She 
left after the return of the menses. (Euckert.) 
Ascites with anasarca, and afterwards hydrothorax, cured by Apis. 
(lluckert.) 
Ascites in an aged and lymphatic woman. Cured by Apis. {Ibid.') 
A woman, aged fifty-eight, in whom anasarca preceded ascites. 
Cured by Apis. {Id.) 
Dulcamara.—Face, abdomen, and limbs bloated; urine small in 
quantity, turbid, and foetid; heat and dryness of the skin; empty 
eructations ; loss of appetite ; dry mouth and tongue ; great thirst for 
cold drinks; empty eructations after meals; nausea; restless, hot, and OVARIAN DROPSY. 
757 
feverish during the night; constipation; catarrhal symptoms, symp- 
toms worse at night, better on motion ; irritable and angry disposition; 
also scrofulous and phlegmatic constitutions, and great sensitiveness 
to cold. 
Remarks.—Applicable in dropsies which have arisen from exposure 
to cold, and general anasarca, consequent on fever and ague, scarlatina, 
and rheumatic fever. 
A child, aged eighteen months. Ascites after a tertian fever, which 
lasted some weeks. Cured by Dulcamara. (.Ruckert.) 
Asparagus.—Countenance pale, wax-like, and bloated; general 
expression of anxiety and distress; unusual fullness of the chest; 
coldness of the surface ; suppression of the perspiration; urine scanty, 
straw-colored, and offensive to the smell; visible throbbing of the heart, 
especiall}' at night; rapid, laborious, and sighing respiration; pulse 
feeble and irregular; feeble appetite; sense of fullness and oppres- 
sion after eating or drinking; palpitation of the chest, and rapid and 
difficult breathing, increased after being in bed for some time ; sleep 
uneasy and disturbed by the oppressed respiration; constant inclina- 
tion in a child to be carried about in the arms ; great languor and dis- 
inclination to physical or mental exertion ; stitching pains in the 
region of the chest; fretful and feverish; disturbed by trifles; con- 
stant anxiety and apprehension. 
Remarks.—In two cases of hydrothorax following acute attacks of 
peripneumonia in children of three and five years of age, we have 
found asparagus of signal service after several other remedies had 
failed. One of the cases was complicated with an organic affec- 
tion of the heart, and an almost entire removal of the cardiac symp- 
toms followed the cure of the dropsy. We are quite convinced that 
this remedy will prove one of great efficiency in the treatment of 
hydrothorax and general dropsy, and we respectfully urge it upon the 
attention of practitioners. It should always be advised in dropsies as 
an article of food. 
Apocynum-cannabinum.—The bark of the root is the most abun- 
dant in active matter, which is chiefly soluble in water. It has been 
given in decoction, tincture, or in substance. 
In palpable doses it has different modes of operation. 1. Emetic; 
2. purgative ; 8. sudorific ; 4. diuretic. It first produces nausea; in 
further quantity, vomiting; and soon after, copious feculent and parti- 
cularly watery evacuations from the bowels, which once excited are 
disposed to continue. It next displays its sudorific properties in a 
very remarkable manner. Copious perspiration almost invariably fol- 
lows its exhibition, and it thus exercises a powerful influence in various 
forms of dropsy. As a diuretic, in some cases, although diuresis was 
increased, it was not commensurate with the effects produced upon the 758 
DISEASES OF THE EXCEKNENT FUNCTION. 
disease. In other cases, the discharge of urine becomes free, and in 
a short time the overloaded tissues are relieved of their burden. We 
have long been accustomed to employ it in tincture and in dilutions, 
and regard it as one of the best remedies. 
Two cases of ascites and organic disease of the heart. The ascites 
removed by Apocynum-cannab. 
Ascites and hydrothorax after typhus,—pulse irregular, skin dry, 
with desquamation; urine scanty and very red, Apocynum-cannab., in 
mother tincture, two to five drops in water, a tea-spoonful every three 
hours. Cure. 
A man aged 67—ascites, anasarca, and hydrothorax—cured by 
Apocynum. {id.) 
Cantharides is recommended in dropsy caused by tonic spasm of 
the neck of the bladder, and by perverted action of the kidneys. It 
may also be administered in effusion occurring in the last stages of 
acute and chronic diseases, as a palliative. 
Ilydriodate of Potasses is adapted to the oedematous swellings re- 
sulting from the pressure of enlarged glands upon the veins. It has 
likewise proved highly beneficial when administered by us for the 
relief of dropsy arising from Dr. Bright’s granulated kidney. 
Mercurius has been used successfully in cases of chronic hydro- 
thorax,, and in ascites from diseased liver. It is worthy of attention 
in ovarian dropsy, and effusions dependent upon enlargement of the 
spleen. 
Uva-ursi has cured several cases of ascites dependent upon abuse 
of intoxicating drinks, and abuse of drugs. Its influence in restoring 
the urinary secretions is usually very prompt and satisfactory. 
Other remedies which have occasionally been found useful in drop- 
sies, are: Elaterium, Rhus-tox., lycopodium,, Bryonia, Ol.-tiglii., 
Potassce-nitr., Iodine, Solanum-nigrum, Phosphorus, Baccoe-juni- 
per, Buchu. 
A child, aged three and a half years; after scarlet fever, ascites 
and general anasarca. Cured by infusion of the root of Bryonia. 
A woman, aged forty—ascites, with oedema of the legs, cured with 
Aur.-mur. (id.) 
A child aged five—acute ascites and oedema of the lower limbs, 
convolvulus arvarsis. Cure. (Id.) 
Beauvais, (Dr. Roth), Unique Ilomceop. T. I., 326, gives the fol- 
lowing cases :—Ascites connected with chronic disease. A girl, aged 
seventeen, suffering from chlorosis, brought on by suppression of the 
menses from a fright; at the same time ascites—Pulsatilla, three 
globules 12th, produced some improvement. Cure after continuing the 
medicine six weeks. OTARI AN DROPSY. 
759 
Ascites with congestion of the liver and spleen, cured by Lyco- 
podium. (Beauvais Obs., 253.) 
A woman, aged 50; has had several children; abuse of spirituous 
liquors. Ascites cured by Lycopodium. (Id.) 
A robust man, addicted to drinking spirits—ascites with pains in 
the limbs—much relieved by Ledum-palustre. Bryonia and Arsenic 
completed the cure. (Id.) 
A child, aged fourteen, feeble constitution, having had itch two years 
before. Ascites and anasarca for nine weeks. Cured by Sulph. 6, 
followed by Sulph. 200. (Riickert.) 
After Intermittent Fever.—A girl, aged nine, had intermittent fever 
two years before. Ascites, oedema of ttfe extremities. Lachesis. Cure. 
A man, aged 79, having had marsh fever for two years fell into a 
state of cachexia. Manganum-oxidatum. Cure. 
A child, aged twelve. Effusion into all the serous cavities, cured by 
Convolvulus. (Id.) 
Ascitic effusion, with hydrothorax, anascarca and oedema of the 
scrotum. Calc.-carb. (Id.) 
A child, aged eleven. Ascites, connected with a cachectic state, 
cured by Aur.-mur. (Id.) 
A woman, aged fifty. Ascites and anasarca in connection with an 
undetermined disease of the abdominal organs, cured by Mer.-sol. 
(Id.) 
Administration.—In the treatment of acute dropsies, we advise the 
employment of the third to the sixth attenuations, and a repetition of 
the dose every two or four hours, until effects from the medicine are 
apparent. In chronic dropsies, we employ the first to the third at- 
tenuations, and repeat once or twice in twenty-four hours, until a suit- 
able impression is produced. 
Cuprum.—A case is given, by Dommes, of successful treatment by 
this remedy. A widow, aged sixty-six, on the awful night of March 
19, 1848, sprung terrified out of bed and remained sitting in a cold 
room, in her night dress, till morning. Next day her legs swelled. 
After employing in vain various aperients and diuretics, she came 
under treatment April 16. Not only the legs but the whole surface 
of the body and the abdominal cavity were distended with water; yet 
appetite and stool were normal; urine dark brown, acid. At the ori- 
fice of the aorta I heard the bellows-like sound accompanying the 
systole. The patient had two years before recovered from inflamma- 
tion of the lungs; one year ago had diarrhoea, and for three years 
suffered from occasional haemoptysis. Decoction of Digitalis seemed 
to relieve the breathing which was somewhat affected; but, after four 
days the swelling was not diminished nor the diuresis increased. As 
the urine was shown by the tests to be acid, Sal.-ammoniac was tried; 760 
DISEASES OF THE EXCERNENT FUNCTION. 
and it gave some relief to the respiration. On the 25th of May, th« 
dropsy was as extensive as it was at any former time; the strength 
was declining, the eyes sunken, face earthly pale. The acetate of 
copper was now given. At first ten drops per hour, afterwards fifteen 
This effected so rapid a cure, that on seeing her after three days, the 
physician, who had never seen her in health, scarcely recognized her. 
In two days more the secretion of urine was enormously increased. 
The strength restored, and the swelling of the feet so reduced that 
she could wear her shoes again. After one slight interruption, per- 
manent recovery. 
Chlorate of Potash.—Dr. E. J. Fountain, of Davenport, Iowa, [Am. 
Med. Monthly and -N. Y. Pe&iew,) thus sums up its virtues: “ Be- 
lieving it to be a tonic, alterative, and blood-depurant, superior in many 
respects to anything in our materia medica, I do not hesitate again to 
urge its claims upon the attention of the profession. 
From the time when (in 1851) I discovered its utility as a remedy 
for mercurial ptyalism, I have been testing its properties in many direc- 
tions, and with constantly increasing confidence in its virtues, and (in 
the language of Dr. Hutchinson) ‘ its scarcely less than wmnderful 
power.’ I believe scrofulous and every form of tuberculous diseases, 
the s'equelfe of the exanthemata, adynamic fevers, and asthenic types 
of disease with depressed vital powers, every condition involving an 
imperfect aeration of the blood, and many derangements of' the system 
resulting in abcesses, eruptions, ulcers, &c., are curable by it. In my 
opinion it* has this wide range in its application by reason of its 
oxydizing properties.” 
Soon after writing the above Dr. Fountain caused his own death by 
taking an excessive dose of his favorite remedy. He took at one dose 
an ounce of Chlorate of Potash. “ The most violent results ensued, 
first producing excessive secretion from the kidneys, then inflammation 
of the stomach and bowels. From the morning of March 22, (1861,) 
when the medicine was taken, till I p. m., a great increase of the 
urinary secretion showed the specific effect of the drug. From 5 a.m., 
of the 23d, until his death on the 29th, at 4 p. m., there was no secre- 
tion from the kidneys whatever. 
Paracentesis Abdominis, or Tapping.—This operation should 
always be deferred as long as possible, in order to allow a reasonable 
itime for the action of the medicines. If, however, the accumulation 
becomes very great, and the symptoms are so urgent as to prevent all 
exercise, destroy rest in a sitting or recumbent posture, and thus serve 
to wear out the energies of the system, the operation should no 
longer be delayed. At the same time the most judicious medicinal 
treatment should be perseveringly directed to both the proximate and 
remote symptoms of the malady. The operation of tapping is of itself HYDROTHORAX. 
761 
simple, and entirely unattended with danger, when proper precautions 
are used ; but as the effusion usually takes place with much more rapi- 
dity, after the serum has been evacuated, than before, it will be appa- 
rent that parecentesis abdominis should only be had recourse to when 
the symptoms are particularly urgent. 
On the question of the propriety of making persistent trials of inter- 
nal remedies before resorting to a surgical operation, Dr. Leon Simon 
says: “ The facts recorded by homoeopathists prove beyond contradiction 
that they can remove peritoneal effusions by internal treatment, wdien the 
remedies are selected according to the law of resemblances (similars) 
administered in a sufficiently dynamized state.” 
There is a condition, however, in which the operation should have 
precedence: “ Where the effusion having gained a considerable bulk, 
causes threatening accidents and prevents all kind of absorption by the 
compression which it exercises on the vessels of the abdomen. In these 
circumstances the action of the liquid on the peritoneum, the kind of 
maceration wrhich results from it, and the possible transudation of the 
serosity, render immediate tapping necessary. And if it happens that 
the disease arises from a simple congestion of the peritoneum, or a 
curable affection of the viscera, we should then be able to treat after- 
wards and follow the consequences pointed out by M. Geraud, in order 
to prevent the reproduction of the ascites.” 
When ascites depends on an incurable organic affection, on tuber- 
cles, degeneration of the liver, the spleen, or disease of the heart, &c., 
the operation becomes only an extreme means to be used in cases of 
imminent danger, and even then the canula left in position might be 
productive of more danger than advantage.” Here we may make ivhat 
use we can of internal remedies, hoping little or nothing from an ope- 
ration which even Velpeau considers an extreme resource.—(Traite 
de Medicine Operative, T. IV., p. 2.) 
4. IIYDROTHORAX. 
Definition.—Serous effusion in the pleura not due to inflammation. 
The effusion is composed purely of serum, unmixed with inflammatory 
products. The affection always occurs as an effect or complication of 
some other disease; and more frequently it co-exists with general 
dropsy incident to structural disease of the heart or kidneys. 
Diagnosis.—Distinguished from pleuritis by the absence of the 
inflammation of the pleura, as lancinating pain, tenderness on pressure, 
and cough. Physical signs show a quantity of liquid in the pleural 
sac, displacing the lung, perhaps causing enlargement of the inferior 
portion of the chest and depressing the diaphragm. But these symp 
toms are also present in pleuritis. 762 
DISEASES OF THE EXCEKNENT FUNCTION. 
The chief points of distinction between the two diseases are: In 
chronic pleuritis a large accumulation of liquid causes a visible 
change in the size, form, and expansibility. In hydrothorax such 
changes are not seen, for such an accumulation in both sides of the 
chest is incompatible with life. Only a moderate amount of effusion 
produces a great disturbance of the respiratory function; there is a 
higher degree of accelerated breathing, dyspnoea, lividity of the sur- 
face, &c., than belongs to chronic pleuritis in a case in which the 
whole of one side is filled with liquid. Also, the pathological condi- 
tions associated with hydrothorax, such as ascites, hydro-pericarditis, 
organic disease of the heart, general debility, render the system less 
able to bear up under a diminution of the respiratory function, than in 
a majority of cases of chronic pleuritis. 
In cases of cardiac and venal dropsy, the affection is always double. 
The causes act easily on both sides, their modus operandi being 
purely mechanical. For this reason it is impossible that the quantity 
of effusion should ever be sufficient completely to fill the chest, as 
death must result before such accumulation could take place. 
“ In hydrothorax friction sounds do not occur. The condition for 
their production, viz., roughening of the plural surface by a deposit of 
lymph, is incident to inflammation, and does not obtain in a purely 
dropsical affection. This is a negative point. A positive point is, that 
in case of non-inflammatory serous effusion, the liquid as a rule, if not 
invariably, can be made to change its level by varying the position of 
the patient; the quantity of liquid ever becoming very large, and the 
pleural surface remaining free.” This test of effusion is generally 
available, while in pleuritis it is employed successfully in a certain 
proportion of cases only. 
5. HYDROCELE, or DROPSY OF THE TESTICLE. 
A description of this disease is appropriate to surgery rather than 
to medicine ; but, as the usual method of cure serves to corroborate the 
truth of the homeeopathic law of cure, we make some allusion to the 
subject in this place. 
The fluid of hydrocele is situated within the tunica vaginalis testis, 
commenciag at the lower part of the scrotum, and gradually extend- 
ing upwards until it reaches the external abdominal ring. The tumor 
is pyriform in shape,firm and elastic to the touch, and unattended with 
pain. It is only troublesome from its bulk and weight. 
Much difficulty is sometimes experienced in distinguishing this dis- 
ease from enlargements of the testicle, and in more than one instance 
we have seen this gland destroyed by injudicious attempts to draw off 
water from chronic enlargements of the substance of the gland. Gene* DROPSY OF THE THE TESTICLE. 
763 
rally the dropsy of the testicle may he recognized by its peculiar elas 
ticity, its lightness, form, its origin at the lower part of the scrotum 
and its gradual extension upwards; and lastly, by its transparency 
By placing the swelling in front of a lighted lamp in a dark room, its 
character will be apparent from its transparency. But in some cases, 
from the great thickness of the tunica vaginalis, or the dark color and 
density of the enclosed fluid, no transparency can be perceived. In 
these instances we must be guided by the fluctuation, lightness, form, 
painlessness, and general history of the case. 
Accumulations of fluid also occur within the membrane of the sper- 
matic cord, constituting the disease known as spermatocele. This is a 
local affection, analogous in its nature to hydrocele. 
Hydrocele occasionally occurs as a congenital disease, arising from 
an imperfect closure of the tunica vaginalis, and thus permitting the 
fluids of the abdomen to descend into its cavity. 
Operation.—The most successful means of treating hydrocele is to 
evacuate the serum by means of the trochar and canula, and then to 
create a healthy medicinal action in the vaginalis with suitable injec- 
tions. Merely drawing off the fluid is seldom of any avail in affecting 
a cure, for the morbid condition of the membrane is still remaining, and 
the exhalents again fill up the cavity. Change then the morbid condi- 
tion of the structure, and supersede it by a new and different, though 
similar action, and you will cure the disease. But it will be said that 
by applying our remedies directly to the structure, we are obliged to 
create more inflammation than is necessary to effect a cure. Show us, 
then, how it can be effected by internal remedies with any kind of cer- 
tainty,—point us to a specific which will reach the case, and we will 
be the first to adopt it. 
The most reliable medicine we have ever used as an injection, is a 
mixture of one part of Tincture of Iodine to two parts of water. Let 
this be injected within the tunica, and remain for five or ten minutes, or 
until sharp pains are experienced in the gland and the spermatic cord, 
after which carefully permit the fluid to escape from the canula. The 
use of Iodine is not likely to be followed by undue inflammation or 
sloughing, yet it almost invariably suffices to effect a permanent cure. 
Other injections have been highly extolled by surgeons, as solutions 
of Alum, Sulphate of Zinc, and Sugar of Lead, Port Wine, &c.; but they 
have too often failed in our hands to inspire us with confidence in their 
virtues, while uniform success has given us every reason to be satis- 
fied with the Iodine. 
Case of Cure by Dr. Hastings.—A. boy wTas affected with hydro- 
cele almost from his birth. At the fifth year a skillful surgeon ope- 
rated upon it, discharging the wrater. In a fortnight the fluid accumu- 
lated. The surgeon proposed a second operation to be completed by 764 
DISEASES OF THE EXCEKNENT FUNCTION. 
a stimulating injection, but it was postponed till the child should be 
older. The dropsical accumulation was becoming very large, and Dr 
Hastings was permitted to prescribe. He gave Rhododendron twelfth 
dilution, three globules night and morning for three days; then pause 
three days and repeat. A lotion was applied of: 
fy. Tr. Rhodod. chrys. yij. 
Aqua font, fvi. 
Apply twice a day after fomenting the scrotum. The hydrocele wTas 
cured, and the boy, now seven years of age, has continued well. 
SCROFULOUS INFLAMMATION OF THE SYNOVIAL MEMBRANE OF 
JOINTS.—HYDRARTIIUS. 
In joints we meet only with different examples of the connective tis- 
sues,—bone, cartilage, synovial, areolar, and fibrous tissues. A con- 
nective tissue may be said to consist of “ a number of cells still retain- 
ing their nuclei, round each, or each group of which a quantity of tis- 
sue material is collected; the quantity of the tissue is derived from 
the consistence and constitution of the inter-cellular substance. Thus 
the cells of cartilage, bone, fibrous, and areolar tissue, have probably 
the same proteine contents, but are surrounded—the one by chondrine 
in a solid form, the other by lamellated bone material, the third by 
gelatine in a fibrillated arrangement, and so on. The function of these 
tissues is not vital, but mechanical; the inter-cellular substance, there- 
fore, whereon the function depends, has no vital constitution, but each 
district or band is dependent upon its own cell for its support. The 
nutrition of these tissues is kept up by the selecting and organizing 
quality ; their repair by more abundant multiplication, their absorption 
by excessive generation of the cells. Thus it is that the connecting 
tissues are capable of repair by like material through fresh formation 
of cells, which, by the law of organic descent, develop similar tissues. 
The means of this repair are the simplest form of the inflammatory 
process, as we see in the union of a wound by the second intention.” 
(Barwell.) 
A scrofulous synovitis is, in its first characteristics, not essentially 
distinct from another slow inflammation of that tissue,—but the differ- 
ence lies in the indisposition to further development. If there have 
been a breach of tissue from a wound, the gap must be filled up by 
cell-generation, which in such a case is called granulation. As long 
as the patient remains in a good state of health, the older cells—that 
is, those of the deeper layers of this formation—assume the fusiform 
shape, and form gradually into the fibrous material, which forms the 
scar; but, when the health begins to flag, the granulations do not 
change in that manner, but cells remain, generally, round, increased SPINA BIFIDA. 
765 
unduly, and form those large, flabby exuberant growths which re- 
quire repression, caustic, or other means to stimulate them to healthy 
action, and to keep down their generative tendency. 
On this principle we distinguish between the healthy and strumous 
synovitis. In the former the membrane and sub-synovial areolar tissue 
generate cells, which, if the constitution be good, form new fibrous tis- 
sue, causing some thickening, and only to a slight degree interfering 
with the action of the joint. In the latter cells also are generated; 
but, instead of making fibrous tissue, they remain in the form of spongy 
granulation tissue, and produce that form of disease which Sir B. 
Brodie has named “ Morbid change of structure of the Synovial Mem- 
brane.” The best remedies are Kali-hydrio., Mer.-iod., and 'Sul.-iod. 
8. SPINA BIFIDA. 
Pathology—In some cases the opening does not extend far into the 
canal; and the spinal marrow is not compressed or deranged in func- 
tion. Of these many may be cured. The external tumor in these 
cases is generally covered with integuments and appears very firm, not 
easily compressed, very elastic to the touch, and yet fluctuation is per- 
ceptible ; the dura mater is the only lining membrane of the cavity in 
the tumor, and the fluid contained does not extend far into the canal 
after passing the aperture in the spinal apophysis. 
In the other cases which are much the most frequent there is a thin 
almost transparent membranous covering in many parts of the tumor, 
and sometimes on the greater portion of it. The tumor is easily com- 
pressed and there is less of voluntary action in some of the muscles, 
sometimes with derangement of the secretions. Here the fluid is con- 
tained in the arachnoid membrane, and may extend the whole length 
of the canal. M. Bichat and other anatomists say it may extend even 
to the lateral ventricles of the brain. There have been some cases in 
which the head was enlarged like that of a child with chronic hydro- 
cephalus. Such cases have perhaps been uniformly fatal. 
The Ligature.—This mode of operation is preferred when the base 
of the tumor admits its application. Apply it first tight enough to 
produce moderate inflammation. Afterwards draw it closer as it does 
not then produce so much pain or so extensive sympathetic effects. 
All cases cannot be cured in this way. 
In some this treatment would destroy the child. Dr. Trowbridge 
{Louisville Med. Jour., 1840,) says he has seen about thirty cases, 
some of which were in every portion of the spine, and were of various 
sizes and appearances. ITe had tried their treatment by puncture, in- 
cision ligature, &c., and in many of them he failed. But some were 
curable. 766 
DISEASES OF THE EXCERNENT FUNCTION. 
Case by Dr. Trowbridge.—Miss B., of Jefferson County, New-York, 
aged 25, phlegmatic temperament, mind retiring, delicate, was born 
with a considerable tumor over two of the lower lumbar vertebrae. The 
tumor was protuberant, and was pronounced spina bifida; and it was 
expected to prove fatal in a few weeks from birth. For twelve years 
she suffered but little from constitutional derangement, except feeble- 
ness; the tumor enlarging with the growth of the body. From this 
time to the age of twenty-five she had much extreme pain in the cere- 
brum, disturbance of mind, with vertigo, confusion of intellect, and some 
neuralgic symptoms. The secretions were natural; and the natural 
developments of childhood and w'omanhood were without unusual delay. 
She was of middle stature, and with perfect use of all the muscles of 
the body. She was during these paroxysms of pain and nervous ex- 
citement injudiciously treated by bleeding, cathartics, and Opium; but 
the tumor continued to enlarge. Dr. Trowbridge found it fifteen inch- 
es in circumference, covering the upper part of the sacrum and four 
lumbar vertebra, of conical form, rising about seven inches, covered 
with the integuments and distended with fluid. She had managed her 
dress to prevent the deformity from being noticed. Riding in a car- 
riage had pressed and injured the tumor, adding something to the pain 
and nervous excitement; all exercise increased her sufferings ; and thus 
enlargement and concussion of the tumor continually added to her dis- 
tress as well as her danger. 
Operation. — Dividing the upper part of the tumor with a scalpel five 
inches, I encircled the prominent part of the integuments within two 
elliptical incisions. Twenty-two ounces of fluid resembling pure alco- 
hol was discharged. On its standing till cold, it did not show serum 
or lymph, but remained clear like distilled water. These incisions and 
removal of the tumor exposed its interior and bottom. It was lined 
with the dura mater, distended and enlarged by the fluid. Two of the 
lower spinous processes were wanting. A cavity was presented show- 
ing the spinal cord in its natural position. The divided parts were 
brought together by adhesive straps, and compresses were applied, 
with a bandage over them. She suffered little except from the former 
symptoms of concussion, which were troublesome for a few months. 
For the first five days there was constant secretion and discharge of 
fluid, with neuralgic symptoms, with increased arterial excitement, these 
were checked by morphine and warm fomentations over the spine. Sup- 
puration wTas free. On the tenth day there was mitigation of all the 
symptoms. There was a sound state of the parts with depression of 
the skin over the part. She had had continued good health when 
seen eight years afterwards. The proper constitutional treatment, 
which has often succeeded alone, consists of /Sulp/i., Calcarea, Calc.- 
p/ios., Kali-hyd., Silic. URJSMIA. 
767 
Iodine.—It was in scrofulous forms of dropsy that Iodine gained its 
first reputation. 
The history of Iodine, says Dr. Forget, “is very remarkable. First 
introduced as an anti-goitre medicine, it was long before it obtained 
credit in scrofula. For some years it has had a tremendous run. It 
began by curing hydrocele, then a bold hand introduced it in hyd- 
rarthus, then it passed to ascites; then to hydrothorax; ovarian cysts; 
hydrocephalus. “Ah, there is the remedy of remedies, the specific of 
the present age!” 
For centuries, says Dr. Manson, writing in 1825, “Burnt sponge was 
the chief remedy in the cure of bronchocele. [Medical Researches, 
p. 8.) Chemistry discovered Iodine in sponges.” “In not a single in- 
stance has the medicinal powers of an important remedy been made 
by science. They have all been accidental. Tradition, descending 
from periods when no medical science existed, accident, fanciful hypothe- 
sis, and hap-hazard experiments have been their sources.” [Henderson.) 
TTIDEMIA.—UR2EMIC POISONING. 
Consequences of the Retention in the Blood of the Constituents of 
the Urine. 
1. “In a variety of diseases occasionally accompanied by albuminuria, 
such as cholera, scarlatina, diabetes, &c., the constituents of the blood 
become changed by the introduction either of a poison or some other 
substance. If this occur, it is quite manifest that the blood is no longer 
normal, and because of its altered condition its elaboration in the kid- 
ney will also be modified; so that in lieu of the ordinary elements con- 
tained in the urine, we shall sometimes recognize albumen, an absence 
of urea and other pathological phenomena. May this not be satisfac- 
torily explained on the principle that the product of endosmosis will be 
modified in proportion to the changes in the fluid on which it acts ? 
Again: the blood is changed in pregnancy” by various other well- 
known circumstances. 
2. Structural or Dynamic Change in the Kidney may result in 
albuminuria, though the precise conditions on which it depends be 
unknown; the presence of albumen in Bright’s disease and scarlatina 
“ may be due to a desquamation of Bellinis’ tubes, yet this cannot be 
said of many other affections of the kidney in which albuminuria ex- 
ists, but in which no desquamation takes place. Experiments have 
been made by Segalis and by Dr. Brown-Sequard (Experimental Re- 
searches applied to Physiol, dec., Phila. 1852, p. 13,) which seemed 
to show “ that the urinary secretion is not absolutely dependent upon 
the nervous system, while on the other hand it has been satisfactorily 
shown that the nervous system may, under certain circumstances, exer- 768 
DISEASES OF THE EXCEKNENT FUNCTION. 
cise a marked influence over this secretion. Marchand “has produced 
in a dog not only all the symptoms of uraemia, after placing a ligaturo 
on the renal nerves, but also discovered urea in the blood, and in the 
matter vomited by the dog.” Albuminuria has also been produced by 
different experimental physiologists by operating on the sympathetic 
nerve of the neck, the cerebellum and the medulla oblongata ; and we 
have sufficient evidence to establish the fact of the direct influence of 
the nervous centres—when diseased or injured—“ over the urinary se- 
cretion; and it is quite possible that the irritation of the uterine nerves 
during pregnancy, and in many of the diseases, both organic and func- 
tional, of the uterus itself, may, through reflex action of the medulla 
spinalis, produce various morbid changes of the urine. The influence 
of mental emotions, as fear, grief, and anxiety have long been observed. 
3. Pressure on the Penal Veins.—Robinson, Meyer, and Frerichs 
have abundantly proved that a ligature tied more or less completely 
around the renal veins will cause albumen to pass from the blood into 
the urinary secretion ; and urea, to say the least, is not a very virulent 
poison; its excess in the blood will notperse produce uraemic intoxi- 
cation, nor will it explain the numerous phenomena which are so fre- 
quently found to accompany its presence in the circulation. May not 
these phenomena, then, be produced by some other agent which has 
generally happened to be associated with urea in the diseased condi- 
tion called uraemia. Frerichs has attempted to demonstrate that urae- 
mia depended neither upon a diminished quantity of urea in the urine, 
nor upon an excess of this substance in the blood, nor upon albminu- 
ria; but that it is traceable solely to Carbonate of Ammonia in the 
system, which, he says, is formed through the agency of a ferment 
from the urea itself: or, in other words, “ that urecemia is exclusively 
due to the transformation of urea into the Carbonate of Ammonia? 
Dr. Bedford says that “ there is no proof as to the manner in which 
this transformation is accomplished ; but the major point, viz.: depen- 
dence of uraemia on the presence of Carbonate of Ammonia seems to 
rest on strong and cumulative testimony. Some of this testimony may 
be summed up in few words: 
Orfila produced convulsions in an animal by giving it Carbonate of 
Ammonia. The animal became convulsed and died. Brown-Sequard 
has shown that Carbonate of Ammonia, injected into the stomach, does 
not poison; but it is absorbed slowly and passes off through the iungs 
with Carbonic-acid. But if it be injected in a certain amount into the 
blood, it has time to act on the nervous system and to cause convul- 
sions before it is expired. Dissection of those who have died of 
uraemia show's that there is in these cases no organic lesion of the 
nervous centres, showing that death results only from direct poisoning 
Carbonate of Ammonia has been detcctod in the stomach and intes T7R.EMIA, 
769 
tines of animals after the removal of the kidneys, and in the matters 
vomited by patients affected with cholera; also in certain cases in the 
blood, and in the exhalations; but the bearing of these facts was not 
appreciated till Frerichs demonstrated the truth of the following propo- 
sitions: 1. That in every case of uraemic intoxication, a change of 
urea into Carbonate of Ammonia takes place. 2. That the symp- 
toms which characterize uraemia can all be produced by the injec- 
tion of Carbonate of Ammonia into the blood.” In his experiments 
he “has frequently detected the alkaline salt in the expired air of 
animals deprived of their kidneys, and into the veins of which he had in- 
jected urea; these animals remained quiet and awake as long as the 
expired air was not impregnated with the Ammonia; but the moment 
the latter was observed, the various disorders of the nervous system 
characteristic of uraemic poisoning developed themselves. These 
views of Frerichs will necssarily tend to the settlement of a vexed 
question, which has called forth the ingenuity of both the physiologist 
and chemist. It may, however, be that the future wbll reveal the 
existence of other poisoning materials in the blood wdiich, to the pre- 
sent time, have eluded observation; and in their recognition we may 
find additional causes for the production of toxaemia. It has indeed 
been suggested that, in Bright’s disease, the accumulation of oxalic acid 
in the blood will develop the symptoms of uraemic intoxication. 
In cases of puerperal convulsions Brann attributes the death of 
children to the same cause as that of the mother who dies from 
uraemic convulsions, viz.: to poisoning by Carbonate of Ammonia, 
which poison is found in the foetal blood. 
In Nov. 1860, Dr. Richardson read a paper on this subject before the 
Medical Society of London, in which the following points of interest 
are presented: 
Diagnosis.—The pupil is usually fixed in uraemia, and in most cases 
is dilated, though in one case it has been seen contracted to a pin’s 
point. Frerichs has said that there is evidence of excess of Ammonia 
in the breath during the acute attack; but this is not universal, for in 
persons suffering from kidney-disease, and in whom uraemia is a 
probable occurrence, the breath at the best of times is charged with 
Ammonia to an extent greater than is normal. In these cases the lung 
is supplemental to the kidney, each organ trying to eliminate all it can 
of the accumulating poison. If such a patient takes congestion of the 
lung, the elimination from the lung is suspended, and then uraemic 
symptoms advance. In some examples the suspension of the secretion 
from the kidneys is sudden, and uraemia suddenly follows, and’ the 
breath becomes suddenly amoniacal. Another characteristic of the 
coma from uraemic poisoning, as distinguished from that by poisonous 
doses of narcotics, is that the patient under the former will often rally and 
Vol. ii. 49, 770 
DISEASES OF THE EXCERNENT FUNCTION. 
regain all his consciousness for a time, sinking again into forgetfulness 
and even dying unconscious in the end. The poison may not be simply 
urea, it may be some combination of ammonia into which carbon en- 
ters, as the carbonate. {See Diseases of the Kidneys.) 
GENUS II.—LITHIA.—URINARY CALCULI. 
A satisfactory explanation of all the phenomena attendant upon the 
formation and development of calculous concretions in the kidneys and 
bladder has not yet been given. Chemistry has, indeed, afforded us 
much accurate knowledge respecting the composition of the different 
varieties of calculi; but we still remain in ignorance of the real causes 
and nature of the abnormal action, the peculiar condition of the organ- 
ism requisite to originate this action, and of the specific medicines 
capable of effecting cures. The data upon which modern physicians 
have founded their prescriptions may be more scientific and accurate 
than those of the ancients, but we are not aware that the practical 
results which they have obtained are in any great degree more 
decided or favorable. The ancient allopathists attributed the forma- 
tion of stone to the union of the “terrestrial and tartareousparts of 
the blood with the clamminess of the vicious lympha, that continue 
ally flows by with the urine, and f urther compacted together by the 
salts with which the urine is laden” {Salmon.) And for the cure 
they prescribed venesection, opiates, mercurials, diuretic infusions, 
and decoctions, and “ lithontriptics” or “ stone-disssolving remedies.” 
Modern allopathy attributes calculous depositions to a superabundance 
of uric-acid of the phosphates of lime, magnesia, and ammonia, oxalate 
of lime, &c., in the blood and urine, and they also prescribe blood- 
letting, opiates, mercurials, diuretics, and “stone-dissolving remedies” 
but with no more success than their heathen predecessors. To what 
extent homceopathy may be able to combat this formidable disease, 
further time alone can determine; but so far as the observations and 
experience of our practitioners extend in this class of affections, our 
method of practice has been highly satisfactory. Our system is espe- 
cially adapted to correct those peculiar diatheses upon which the 
formation of calculi depends. 
Calculous affections have been observed to prevail in some countries 
more than others ; even in some portions of the same country they may 
be common, w'hile in other sections they will be unknown. The dis- 
ease is rarely seen in very cold or very hot latitudes. English surgeons 
assert that it never originates in the East Indies, and it is supposed to 
be of very rare occurrence in the Northern kingdoms of Europe. 
Children and old people are not subject to the disease, and it seizes 
especially upon those in whom gout is hereditary. Indeed, this gouty LITHIA. 
771 
diathesis is so common in individuals afflicted with calculi, that many 
suppose that the urine exercises hut little if any influence in their 
formation, but that metastasis of gout to the mucous membrane of 
the urinary passages, determines the formation of these calculous con- 
cretions. Thus, Frank, in his “ T)'aite dc Pract. de Med., p. 367, 
Yol. II., says: “The attacks of calculous affections, like those of gout, 
are preceded and accompanied by languor of the stomach, nausea, 
oppression, eructations, borborygmi. In inveterate gout, this plegmasia 
gives rise to calculous concretions, formed of a material combined with 
uric-acid, and which do not differ from urinary calculi, except in con- 
sistency and form. Suppose now that fixed gout, which produces cal- 
careous concretions in the articulations of the great toe, attacks the 
mucous membrane of the bladder, may it not become the source of 
calculi in this viscus ? ” 
Calculi have been found in the brain, lungs, bladder, liver, spleen, 
gall-bladder, uterus, the articulations, and the soft parts of nearly every 
portion of the organism; but the urinary organs are by far the most 
common seat of these formations. Several years since we saw taken 
from the upper part of the left lobe of the lung of a miller, two con- 
cretions of a chalky appearance, but hard and tough, and of the size 
of a goose-egg. Concretions of lithate of ammonia are also common 
in all parts of the body in gouty patients. 
Prout has divided the mechanical deposits from the urine into three 
classes : First, pulverulent, or amorphous sediment Second, chrys- 
taline sediments, usually denominated gravel. Third, solid concre- 
tions or calculi, formed by the aggregation of these sediments. 
The sediments of the first class are held in solution by the urine un- 
til it is discharged from the bladder, when they are gradually deposited 
in a state of fine brown or yellow powder. These sediments are gene- 
rally composed of “ two species of neutral saline compounds, viz.: the 
lithates of ammonia, soda, and lime, tinged more or less with the color- 
ing principle of the urine, and with the purpurates of the same basis, 
and constituting, what are usually denominated pink and lateritious 
sediments; arid, secondly, the earthy phosphates, namely, the phos- 
phate of lime, and the triple phosphate of magnesia and ammonia, 
constituting for the most part, sediments nearly white. The two spe- 
cies of sediments are frequently mixed together.” {Prout.) The 
sediments of the second class, or gravel, are found in the urine in re- 
gularly crystalized grains, varying in form and color in accordance 
with the constituents of which they are composed. The lithic acid 
crystals are much the most common, and may be distinguished by their 
red color. The crystals of the triple phosphate of ammonia, and of 
magnesia, are of a white color, while those of the oxalate of lime are 
black or dark green. 772 
DI8EASES OF THE EXCERNENT FUNCTION. 
Prout supposes that two-thirds of the whole number of calculi ori- 
ginate from lithic acid; and when we bear in mind the constant pre- 
sence of this acid in the urinary organs, and its proneness to form 
hard, inodorous concretions, of a yellowish brown color, the supposition 
will not appear unreasonable. 
Chemists have described many different varieties of calculi; amongst 
which the following are the most common: 
First. The lithic or uric acid calculus, formed by concentric lamel- 
lae, presenting a light-brown or reddish color, and a general appearance 
something like wood. These calculi are infusible by the blow-pipe, 
but may be slowly evaporated, until a white residue of white ash re- 
mains. They are soluble in alkaline solutions, which, on this account, 
are supposed to be valuable as remedial agents; but they are not dis- 
solved by muriatic or sulphuric acids. The lithic acid diathesis pre- 
vails in childhood and at about the age of forty or fifty, and the urine 
voided in these cases is generally acid, and the deposited sediment of 
a red color. 
Second. The calculi of most common occurrence after the variety 
last described, are those composed of a triple combination of phos- 
phoric acid, magnesia, and ammonia. They are of a lightish gray 
color, indistinctly laminated, with an “ uneven surface, and covered 
with small shining crystals.” This variety is not soluble in alkaline 
solutions, but may be partially dissolved by muriatic, nitric, and sul- 
phuric acids, and imperfectly fused by the blow-pipe. The urine in 
this case is very foetid, and the sediment deposited of a white color, 
“resembling mortar.” Sir Astley Cooper asserts that this kind of 
calculus is very apt to be reproduced after lithotomy, and on this ac- 
count advises the postponement of operations in these cases until the 
morbid diathesis is corrected. 
Third. Not a very common variety is the mulberry calculus, of a 
dark-browTn color, uneven surface, and very compact, heavy arid hard. 
It consists of oxalate of lime, and is partially soluble in muriatic and 
sulphuric acids, but the alkaline solutions have no effect upon it. 
Fourth. The phosphate of lime calculus is in a few instances found 
pure, but usually it exists in combination with uric acid and phosphate 
of magnesia and ammonia. It is laminated, polished, of a pale-brown 
color, soluble in muriatic or nitric acid, and may be fused by the blow- 
pipe. They are of small size, and are generally found in the prostate 
gland. 
Fifth. The cystic oxyd calculus is another variety of rare occur- 
rence, of a yellowish hue, not laminated, soluble in acids and alkaline 
solutions, and emitting under the blow-pipe a foetid odor. 
Sixth. There is also thz fusible calculus, composed of a mixture of 
the triple phosphate of magnesia and ammonia, and of the phosphate LITHIA. 
773 
of lime ; of a white color, and fusible by the blow-pipe. This kind of 
calculous deposit is occasionally seen between the prepuce and glans 
penis in old cases of phimosis. 
Seventh. The constituents of different kinds of calculi are some- 
times deposited in distinct alternate layers in the same stone, when it 
is called the alternating calculus. 
Other varieties have been described, like the compound calculus, 
the lithate of ammonia calculus, and some others. 
The presence in the bladder or kidneys of any solid substance, 
whether introduced artificially, or formed naturally from lithic acid 
congestions, or clots of blood, favors the formation of calculi. Whether 
the cause of these deposits in the urinary is attributable to the pecu- 
liar composition, or the compact structure, or the comparative tempera- 
ment of nuclei we are unable to determine ; but all are aware of the 
fact, that catheters, bullets, splinters, or any other solid substances 
accidentally introduced into the bladder, become speedily coated over 
wfith urinary sediments, which are converted into hard crusts. 
Calculi are more frequently observed in the male, than in the female 
sex ; but this circumstance has been attributed to the difference in the 
structure of the urinary organs. The urethra of the female being 
shorter and easily dilated, gives passage without difficulty to gravel 
and small calculi, which in the long and contracted male organs would 
be obstructed either by causing spasmodic contractions, or from an 
actual want of room to pass. 
It is said that the right kidney is far more commonly the seat of 
these formations than the left, that there form is generally spheroidical 
and that their average weight is from one to two ounces. Sir Astley 
Cooper, however, expresses the opinion that the majority of urinary 
calculi weigh less than one ounce each. 
Calculi may originate in the kidneys, the bladder, or the prostate 
gland, but the first organ is the primary seat of a large majority of 
cases, as is evident from the fact that the pains are almost always con- 
fined to the region of one of the kidneys in the first instance. It is 
probable that the nuclei of most stones found in the bladder, are first 
formed in the kidneys, and then conveyed through the ureters into this 
viscus to serve as the foundation of still further deposits from the 
urine. We have seen a stone formed on a cedar pencil. 
Diagnosis.—A calculus may remain in the kidney or bladder for a 
long time, without exciting much pain or uneasiness. The patient ex- 
periences perhaps a more frequent inclination to urinate than natural, 
and after violent exertion on horseback or in a carriage, has temporary 
pains in the region of the organ affected, but in other respects he feels 
well. This state of things may exist for an indefinite length of time, 
when, if the stone is situated in the kidney, some exciting cause may 774 
DISEASES OF THE EXCERNENT FUNCTION. 
operate, and give rise to what is denominated “ a fit of the stone.” In 
these instances the patient is usually attacked, and suddenly, with 
severe cutting pains in the region of the kidney, which increases as 
the stone passes along the ureter to the bladder, sometimes extending 
to the groin, the cremaster muscle, or along the crural nerve, as it 
passes over the nerves connected with these parts. During the par- 
oxysm, the pain is often of the most violent and intolerable character, 
and is accompanied with continual nausea, vomiting, inability to retain 
anything upon the stomach, frequent desire to urinate, high-colored 
and sometimes bloody urine, bent position of the body, with the mus- 
cles flexed as much as possible, heartburn, painful retraction of the 
testicle, irritable bladder, and febrile symptoms. There is often a re- 
mission of these symptoms for a longer or shorter period, during the 
descent of the stone through the ureters, and the paroxysm now and 
then comes on, and subsides suddenly and permanently, the stone not 
having effected an entrance into the ureter. 
After the stone has passed into the bladder, we have the following 
symptoms: frequent inclination to urinate, “ the patient making the 
first portion with ease, and complaining of great pain coming on when 
the last drops are expelled(Earle,) sudden stoppage of the cur- 
rent of urine, in consequence of the stone moving in front of the ure- 
ters; itching and tingling at the extremity of the penis; difficulty or 
absolute inability of retaining the faeces when urinating, on account of 
the sympathetic irritation of the rectum, “ sense of weight and pressure 
at the lower part of the pelvis;” dull pain at the neck of the bladder; 
bloody, mucous, or purulent urine ; pains in the region of the bladder, 
increased by exercise, especially riding on horseback or in a jolting 
carriage ; febrile symptoms, irritability, loss of appetite, emaciation, ina- 
bility to sleep or rest quietly, night or day. In boys the prepuce 
generally becomes much elongated, from their constant habit of pull- 
ing at it, to relieve the itching in the glans. After the stone ha.s con- 
tinued in the bladder for a considerable time, the organ becomes very 
much contracted, its coats become thickened and diseased, and the 
patient sinks under the constitutional derangement consequent upon 
the protracted irritation of the foreign body. 
It will be observed that all of the symptoms which we have enume- 
rated, are simulated by other affections of the urinary organs. Thus, 
simple nephritis gives rise to the symptoms of calculus of the kidneys, 
and inflammation of the prostate gland and bladder, to those of stone 
in the bladder. But in some instances the patient can actually feel 
the motion of the calculus, as he turns over from one side to the other. 
This circumstance, taken in connection with the abrupt stoppage of the 
stream when urinating in consequence of the stone getting before the 
urethra, and the occurrence of severe pain after the urine has been LITHIA, 
775 
mostly evacuated, in consequence of the stone coming into more direct 
contact with the walls of the bladder, will enable us to decide with 
much certainty respecting the presence of a stone. 
But the only positive indication of a calculus is our ability to strike 
it with a sound introduced into the bladder; and a prudent surgeon 
will never cut for the stone unless he can feel it with his sound imme- 
diately before he commences his operation. 
So long as a calculus remains in the kidney it does not always manifest 
its existence by severe or even perceptible pain; but as soon as it 
becomes dislodged from that position, and attempts to pass the narrow 
tube of the ureter on its way to the bladder, it inflicts excruciating tor- 
ture. It may have been long in the process Of formation, and yet the 
only pain which led us to suspect its presence, came on without a 
moment’s warning. It is common for it to remit as suddenly, and then 
it is presumed that the calculus has passed by the ureter into the blad- 
der. Soon after this remission of the pain it is common to find indica- 
tions, more or less distinct, of the presence of stone or gravel in the 
bladder. 
In some cases the pain occurs in frequent paroxysms, each one of 
which is regarded as a true nephralgia calculosa, and is attributed to 
the passing of a new calculus down the ureter. We have seen one 
case in which the paroxysms of pain were of the greatest severity, 
returning often with different degrees of intensity for more than two 
years. The patient, a young lady, was subjected to different systems 
of treatment without any real benefit. The frequent passing of cal- 
culi from the bladder seemed to justify the opinion of different physi- 
cians that the neuralgic pain in the region of the right ureter, which 
became more and more frequent, more and more severe, was depend- 
ent on the irritation of larger calculi, some of which passed down to the 
bladder, and that others would soon follow. At length some imperfect 
soundings were supposed to certainly detect stone in the bladder suffi- 
cient in size to account for all the remaining symptoms. An attempt 
wras made by some physicians of some reputation to triturate the stone 
into fragments, and extract it from the bladder. The effort gave much 
irritation, and ended in proving that there was no stone there. After 
this failure we first saw the patient, and found nothing but palliation 
possible. After a few we-eks she died, and we made a full post mortem 
examination in the afternoon of the following day. 
We found that death had resulted from tubercular disease of the 
kidneys, terminating in total disorganization of the right one, and leav- 
ing clear marks of the same condition in the other. 
There were no calculi in the bladder, and no accumulation in the 
ureter; but there were phosphatic calculous deposits in both kidneys, 
resembling those often seen in the lungs. 776 
DISEASES OF THE EXCERNENT FUNCTION. 
The right kidney was almost entirely occupied by a large abscess 
full of pus of the most offensive character. There had been a sponta- 
neous rupture of this abscess, and the quantity of pus found before the 
kidney was reached, w'as so large that it appeared as if coming from a 
large psoas abscess. But upon extracting the pus by a sponge, and 
cleansing the cavity, it was found not to extend into that muscle, but 
only to the cellular structure in the neighborhood of the right kidney, 
which was in the condition above described. 
Chemical Changes in the Composition of the TJrine. — The 
alkaline urinary fermentation sometimes occurs, says Lehmann, even 
before the completion of the acid fermentation, and even within the 
bladder. The conditions which favor it are: 1. A temperature exceed- 
ing 68° Fall. 2. Presence of a sediment in unclean vessels. It occurs 
almost at onc-e when mixed with urine that has become alkaline, even 
when the quantity added is so small as hardly to saturate the free acid 
of the fresh urine. We may, therefore, conclude that here, as in other 
kinds of fermentation, there is a special alkaline ferment present, 
which, as we believe with Scherer, “ can only be sought in the changed 
urinary mucus, and in the microscopical organism contained in it.” 
It would seem, then, that these chemists conceive of the mucus as fur- 
nishing two kinds of ferments, one producing the acid fermentation in 
normal urine ; the other the alkaline fermentation in morbid urine. 
“We have found,” says he, “that an alkaline urine which effervesces 
with acids, is most constantly and distinctly observable in primary or 
secondary affections of the mucous membrane of the bladder.” In the 
primary affections there is either inveterate vesical catarrh or com- 
plete suppuration of the walls of the bladder. In these cases the 
secretion of mucus is abnormal; the mucus juice which is secreted in 
augmented quantity, possessing none of the ordinary properties of 
urinary mucus,* and being decomposed with extraordinary rapidity. 
In secondary affections the vesical mucous membrane suffers only 
indirectly, as for instance, in affections of the spinal cord, when, if it 
retains its integrity, its mucus, which adheres to it on account of the 
deficient contractibility of the bladder, becomes decomposed by remain- 
ing beyond the usual time in the bladder, and to such a degree as to 
induce alkaline fermentation at once in the urine as it drops from the 
ureters. Catarrh of the bladder then supervenes from the irritation of 
the ammoniacal urine. According to the views of Scherer, calculus 
wrould be essentially a disease, or the consequence of disease of the 
bladder, itself depending solely on the character of the vesical mucus 
and the nature of the fermentative process induced by it, whether it 
shall consist of uric acid, earthy phosphates or urate of ammonia, and 
* It will be remembered that the idea of mucus being the cause of the normal 
acid by fermentation is accepted by these authors. LITHIA, 
777 
the different composition of its successive layers, equally depends on 
the changes in the secretion of the diseased mucous membrane. Leh- 
mann adopts this view, modified by the admission of a controlling cause 
in the renal secretion. He remarks that calculi generally contain a 
clot of mucus, the innermost layers invariably containing uric acid, and 
being often entirely formed of it, that every uric acid concretion irri- 
tates the mucous membrane, and thus excites to the deposition of the 
phosphates, or of water of ammonia and lime. 
Mucus considered as a Ferment.—The white sediment deposited 
in urinals is mucus or mucine mixed with the triple phosphates, urate 
of ammonia, perhaps carbonate of lime, and certain infusoria. Added 
to fresh normal urine, in the proper proportion of one part to fifty, it 
will render it ammoniacal within twenty-four hours. 
Mucine or mucocine, the ferment principle of mucus, may be 
secreted by the ureters, or even higher, and by admixture with mor- 
bid mucous secretions and obstruction in its course, the urine may 
be alkaline as it falls into the bladder. The alkaline fermenta- 
tion coincides with the decomposition of urea. Urine boiled for some 
hours becomes alkaline. Sanguinolent urine is alkaline from the nor- 
mal alkalinity of the blood. 
A vegetable diet, and especially certain acid fruits, the apple, the 
lemon, render the urine presently alkaline during some hours, but not 
ammoniacal. * The normal varieties of alkaline urines have no putres- 
cent odor. They have not the natural aromatic odor of healthy acid 
urine but a faint broth-like smell; their alkalescence is due to fixed 
alkalis and alkaline carbonates. 
Urine containing mucus in quantity becomes rapidly alkaline and 
putrescent with evolution of ammonia and deposit of its earthy salts. 
Dumas had suggested that the vesical mucus undergoing a putrescent 
change might act as a ferment inducing the metamorphosis of urea 
into carbonate of ammonia just as yeast aids the conversion of sugar 
into alcohol. 
Dr. Snow has proved that a few drops of stale urine left in the bottom of 
a vessel will always render fresh urine, dropping into it at the tempera- 
ture of 100°, alkaline within six or eight hours, while it is always acid 
at the same temperature in a clean vessel. This is an image of what 
occurs when any obstacle exists ito the complete evacuation of the 
bladder. If any urine remain, it will certainly be that which is already 
surcharged with mucus in the fundus vesicae or in the hernical sacs 
w’hich may exist, or around the foreign body which may obstruct its 
passage. This residue, if it be not already ammoniacal, will rapidly 
become'so, arid induce the same fermentation in the fresh urine as it 
drops from the ureters. 
Ammoniacal urine is an irritant to the vesical mucous membrane; 778 
DISEASES OF *THE EXCEKNENT FUNCTION. 
it causes, therefore, a hyper-secretion of mucus which, indeed, partially 
protects the coats of the bladder from its irritation; but, on the other 
hand, operating as a ferment upon the urine, determines the evolution 
of more ammonia; here is already one vicious circle. But the irrita- 
tion continuing, pus is added to the mucus, and the carbonate of am- 
monia changes this muco-pus into a viscid rope mass, which offers 
formidable obstruction to the complete evacuation of the bladder. 
Hence, no improvement can be expected unless the bladder be cleansed 
by daily injections of warm water. Pus is coagulated as well by the 
fixed alkalis as by carbonate of ammonia. 
The part which mucus plays in rendering urine ammonical is per- 
fectly established, and all observers are agreed about it. But Scherer 
assumes from these facts that the vesical mucous membrane may also 
acquire a condition within the bladder by which it predisposes the 
extractive matter to the formation of acid. This must undoubtedly be 
admitted to exist, says Lehmann, when an acid urine is secreted with 
preformed crystals of uric acid. Just the case, on the contrary, when 
there can be no possible need to suppose the intervention of any 
ferment. 
Indirect Causes of Calculous Deposits by Retention of TJrine 
faroring the Decomposing Action of Mucus and Ammonia.— 
Dynamic or Adynamic.—Rheumatic or other spasmodic state of 
the sphincter and neck of the bladder. Paralysis of the bladder from 
injuries of the spine ; of the brain; in dystocia, from renal disease ; dys- 
pepsia (with pyrosis*); mechanical obstruction by strictures of the ure- 
thra, by prostatic engorgement, by presence of foreign bodies in the 
bladder, or of calculous deposit in the bladder, ureters, or kidneys. 
Degenerescence of tissues, by fungous growths. Obstruction by pres- 
sure of cancerous or other tumors on any portion of the urinary via- 
ducts. 
Pathology.—Mucus in Relation to Calculus.—Mr. Curling has 
particularly insisted on the influence which diseased conditions of the 
mucous membranes exert in determining the alkalinity of urine within 
the bladder. The cases in which we habitually observe alkalinity, 
connected with putrescence, or in other words, with ammoniacal 
urine, are, in fact, all of them either sources or sequences of inflam- 
matory change in the mucous membrane of the urinary passages, 
among which urethral strictures and prostatic engorgement play a 
very conspicuous part. The measures employed to relieve or remove 
them, consisting chiefly in the introduction of foreign bodies, catheters, 
&c., into the bladder, contribute not a little to maintain the putrescent 
fermentation of the urine. 
* The acidity of urine bears generally an inverse proportion to the secretion ol 
acids by the stomach. LITHIA. 
779 
Mucus in excess, and indicative of local irritations, is more viscid 
than in normal urine, and will not re-dissolve by agitation nor become 
diffused through the mass like the pus with which it is often asso- 
ciated as long as the urine remains slightly acid. In chronic 
cystitis or cystorrhea it ropes, often entangling large air-bubbles. 
Mucus may become opaque by admixture with a sediment of the 
earthy phosphates, without the presence of pus, from which, in this 
case, the microscope may be needed in order to distinguish it. Any 
obstruction to the passage of urine, especially urethral strictures, 
which have propagated an irritative change upward and backward 
from the original lesion to the prostatic mucous membrane and neck 
of the bladder, is liable to occasion chronic hyper-secretions of mucus 
and muco-pus. 
Chemical Characters of Mums.—Stecker’s analysis of mucus gives: 
Carbon, 52.1 52.14 
Hydrogen, 7.0 6.974 
Nitrogen, 12.5 12.82-2- 
Oxygen, 28.4 28.1 14 
100.0 1004 
on 02 
«s- 
2. <? 
IIA 
H C/> 
J'S’g 
rs* 
Of white ash, alkaline carbonates, and phosphate of lime, 4.114. 
The mucus deposit in urine is generally alkaline or soon becomes 
so; and even while the supernatant urine is still acid, the mucus will 
restore the blue color of faintly-reddened litmus paper. The alkalinity 
of mucus, and its aptitude to undergo and induce putrefaotive fermen- 
tation, is increased by the influence of inflammation on the surfaces 
which secrete it. 
Mucus in Ukine.—The proportion of mucus in normal urine for the 
1000 parts is stated by Berzelius as 0.31, (the whole solid residue, 67.) 
Lehmann, with solid residue, 
62.318 found mucus 0.112 
65.998 found mucus 0.101 
67.981 found mucus 0.110 
Golding Bird found mucus in proportion of three parts out of one 
hundred and fifteen solid parts; but he does not state the propor- 
tion of water. Considerable variations exist without exceeding the 
normal limits. 
More mucus appears in the urine of the night than of the day, more 
in concentrated than in dilute urine. Its quantity is doubled by the 
irritation of very acid urine on the mucous surfaces. Certain ingesta, 
viz., benzoi-c acid, may cause this hyper-secretion of mucus or the acids 
of the dyspeptic stomach. Golding Bird observed a case connected 
with scirrhous duodenum. 
* Pus has a neutral or acid reaction and is slow to putrefactive changes. 780 
DISEASES OF THE EXCERNENT FUNCTION. 
Large quantities of muriatic, of lactic, and other acids, are liable to 
be secreted in morbid states of the digestive system, and to be excreted 
through the kidneys; the organs which receive an acrid urine, on its 
passage endeavor to protect themselves against its irritation by throw- 
ing out mucus. On the same principle are explained the accumula- 
tions of viscid mucus that imbed foreign bodies, calculi, &c., maintain- 
ing a permanent irritation of the bladder. 
Mucous TJrines.—Normal Appearances.—At rest in a tall, slen- 
der glass, the mucus of urine is barely visible as a light-grayish cloud, 
easily dilfused by agitation without rendering the mass turbid. Urine 
may be clear, however, without being normal. 
Mixed with the mucus, near the bottom of the glass, is occasionally 
found some epithelium, chiefly from the bladder and urethra. 
Laudre Beauvais (Semeiotique des Urines) distinguishes two clouds, 
one of superior suspension, below the surface ; the other inferior, about 
the lower third of the column, called the eueorema. The persistence 
of the upper cloud during several days has been regarded as of evil 
omen in acute diseases, menacing spasms, delirium, &c. The humoral 
pathologists argued that the organism was unable to effect the coction 
of its peccant humors, on the occurrence of which the urine deposits 
sediments, and both the mucus suspended above and that of the 
eueorema subside to the bottom. 
Bence Jones found the urine remaining clear and acid in delirium 
during forty days after being passed, and even longer, refusing to 
undergo at all that series of decompositions to which normal urine is 
subject, and which mucus accelerates. Question as the mucus con- 
tained in this urine, its character, and quantity. 
The cloud of mucus in normal urine may be separated by filtering, 
and remains on the filter paper of fine textures in a thin, varnish-like 
layer. 
The cloud of mucus, though in excess, leaves the edges nearly 
transparent as it settles towards the bottom; pus, besides its deposit, 
renders tbe whole of the urine somewhat opaque; it is generally 
mixed with altered rope-mucus when diseased. 
The urethral mucous membrane, mostly columnar, has the squamous 
epithelium towards the orifice, the deeper cells of which are elongated 
as in the bladder. 
The urethra also contains racemose glandules like those of the 
bladder, though somewhat larger and more closely grouped. The 
vaginal epithelium consists of large pavimentous cells. It is evi- 
dent that the appearance of the epithelial cells found in association 
with mucus in the urine may furnish an important indication as to the 
part of the urinary organs which is the seat of tbe disease; especially 
when we knowT that the secretion of urine normally occurs without for- LITHIA. 
781 
mation or dissolution of cells, so that epithelium is rare in healthy 
urine, and what little is found is chiefly from the bladder and urethra. 
I have known Mr. Robin make his diagnostic between urethral 
blennorrhcea and vesical catarrh simply by the microscopic inspection 
of the mucus in urine. In inflammations, haemorrhages, exudations, 
fa.tty kidney, we find, says Kolliken, pus corpuscles, oil-drops, blood- 
globules, blood-fibrinous coagula moulded in the tubuli uriniferi in the 
forms of cylindrical casts, and epithelium from the tubuli isolated or in 
continuous strings or tubes. (Dr. 21. E. Lazarus.) 
The particles of pus present under the microscope similar appear- 
ances to those of mucus, but are more numerous and more granular, 
with young pus-cells growing within the old ones and globules con- 
stantly found, while in mucus there are none. 
The mucous membrane of the pelvis of the kidney (represented 
in Kolliker’s Microscopical Anatomy, Am. ed., p. 606), has the tes- 
selated epithelium cells of very unequal size, some of which have 
nucleated corpuscles interiorly. 
The ureters have laminated epithelium, the most deeply-seated 
cells rounded and small, the middle cylindrical or conical, 0.01-0.02 
of a line in size, and the superficial rounded polygonal scales 0.006- 
0.04 of a line in size or more, flattened and reaching a diameter of 
0.02. The frequent occurrence of two nuclei in these cells is a strik- 
ing fact, as well as of clear darkish-colored round granules 0.001- 
0.002 of a line in size, which often assume the aspect of nuclei. 
The mucous membrane of the bladder has also a laminated or scaly 
epithelium, 0.03-0.05 of a line thick, whose deeper elements are usually 
fusiform, conical, or cylindrical; the more superficial rounded, polygo- 
nal, or flattened, the cells differing like those of the pelvis and ureters 
remarkably in size. Stellate and dentate forms are produced by de- 
pressions of various depth on the under surface of the uppermost cells 
to receive the ends of the deeper elongated cells. 
The lining of the neck of the bladder and towards the fundus is fur- 
nished with simple pyriform follicles, grouped sometimes in simple 
racemose glands from 0.02 to 0.24 of a line in size, having orifices 
0.02 to 0.05, a cylindrical or columnar epithelium,, and contain clear 
mucus, when healthy whitish. 
All normal urine without sediment at a mean temperature undergoes 
an acid fermentation under the influence of the mucus contained in 
it (says Kolliker), and whilst fermentation and filamentary fungi are 
developed. It forms from the decomposition of the urinary coloring-mat- 
ter, lactic, or acetic acid, in consequence of which a corresponding pro- 
portion of uric-acid is set free from its soluble compounds with ammonia 
and the alkaline earthy bases, and deposited in the form of rhombic 
or prismatic crystals, colored yellowish or reddish by the coloring-mat- 782 
DISEASES OF THE EXCERNENT FUNCTION. 
ter of the urine. Sooner or later the acid disappears, and from the 
decomposition of the urea, perhaps also of the coloring-matter, for the 
color pales, the urine becomes ammoniacal and alkaline, with large, 
colorless, pyramidal prisms or needles grouped in a stellate fashion, 
and soluble in acetic-acid, or the triple phosphate of magnesia and 
ammonia which, intermixed with numerous infusoria (vibriones and 
monades), form a superficial pellicle of greasy and vari-colored refrac- 
tion of light, and with granules of urate of ammonia, and it may be 
carbonate of lime, a white sediment. 
Acid Urinary Fermentation.—The different kinds of urine vary 
solely in respect to the rapidity with which any one kind of mor- 
bid or normal urine undergoes acid fermentation sooner than another, 
and thus gives rise to the formation of the insoluble sediments of uric 
acid. Every normal non-sedimentary urine when exposed to the ordi- 
nary atmospheric temperature, begins, after a longer or shorter time, 
to separate uric-acid, and to exert a stronger reaction on litmus 
paper. 
The increase of free acid in the urine is also demonstrated by the 
volumetric method, which corresponds to the akali-metric. 
Faintly alkaline-urine, such as is passed after vegetable food rich in 
alkalis, or after several doses of Acetate or Tartrate of Potash, ac- 
quires, after a short time, an acid reaction which increases so much 
under favorable conditions that any turbidity which may have arisen 
from the separation of earthy phosphates disappears, and crystals of 
uric-acid are separated. 
Scherer, and subsequently many other observers, have noticed that 
jaundiced, brownish-yellow, faintly-acid urine becomes strongly acid, 
and that in place of this color it assumes a green tint, owing to the 
peculiar action of the free acid on the bile pigment. 
The acid fermentation of the urine continues to increase, accord- 
ing to Soherer, for four or five days. Lehmann, in a temperature of from 
50° to 60° (Fahrenheit), has seen the acid of the urine increase for two 
or three weeks, and then not disappear for six or eight weeks. Both 
he and Liebig have observed the presence of acetic-acid as well 
as lactic-acid, on which Scherer insists. Acid-earthy phosphates, 
remarks Lehmann, must be present whenever lactic or hippuric-acid 
constitutes the acidifying principle of the urine. 
Scherer (Untersuch., S. 1—17) was the first who recognized and 
attentively followed this process of acid-urinary fermentation. He 
attributed it to the mucus of the bladder, acting as a ferment upon the 
extractive pigment which it metamorphoses into lactic-acid. 
Lehmann suggests that the acid thus formed may extract an equiva- 
lent of base from the simple urate of soda, and thus give rise to the LITHIA. 
783 
formation of the urate of which the ordinary sediment of acid urine 
consists. 
The neutral muriate of soda Na 0. C5 II N2 024-H0 crystalizes in 
wart-like masses, dissolves in 80 or 90 parts of boiling water, is slightly 
soluble in alcohol, and insoluble in ether; at 100° it loses its water of 
crystalization. 
Bi-urate of Soda, Na O. 05 H. N2 02 + II O 0& II. Na Oa+HO, 
crystalizes in short hexagonal prisms or in thick six-sided (micros- 
copic) tablets, which commonly arrange themselves in star-formed 
masses, the individual crystals of which are larger and can be more 
distinctly made out than in the microscopic aggregations of the am- 
monia salt. It begins to lose its water of crystalization at 170°, and 
is soluble in 124 parts of boiling and 1150 parts of cold water. 
The acid fermentation of the urine, says Lehmann, may be impeded 
or interrupted by most of the conditions which in other cases obstruct 
fermentation, as for instance, by the addition of a little alcohol; by 
boiling the urine, (when the formation of an acid is retarded for a pro- 
longed period;) and finally by removing the mucus by filtration, of 
which the influence is obvious from the fact that a species of fermenta- 
tion globules or yeast fungi are generated in and from the mucus 
during the process of acid fermentation. These fungi are filamentous, 
similar to the myeoderma cerevisise, only smaller, (-rhr to -sin,) having 
a spherical rather than oblong shape, and a distinct, eccentric, round 
nucleus. When the urine begins to lose its acid reaction, they appear 
upon its surface and probably contribute towards the formation of the 
membrane which covers it. They are followed by confervae arid algae, 
which co-exist with them while the urine has still an acid reaction, and 
afterwards while it becomes neutral and finally alkaline. When innu- 
merable vibriones and monads in addition to vegetable products, in whit- 
ish-gray membranes, coincide with the ammoniacal and putrid stench. 
Chemical Examination of Mucus.—Under the addition of a few 
drops of acetic acid, the cloud of mucus in normal urine condenses 
into viscid flakes like a thin semi-opaque corrugated membrane, re- 
dissolving in concentrated acid with the aid of heat. This test suffi- 
ces also in morbid urines to distinguish mucus from pus. Boiled with 
concentrated acetic acid mucus is copiously precipitated from solution 
by Ferro-cyanide of Potassium. Dilute tincture of Iodine precipitates 
and colors mucus. 
Alcohol coagulates mucus and precipitates mucine from the fluid in 
flakes and threads. The dilute mineral acids determine precipitates, 
easily soluble in excess of acid. Strong nitric acrid, if hot, colors 
mucus yellow. Heated with hydrochloric acid, and exposed to the 
air, it turns blue. Gallic Acid and Basic Acetate of Lead precipitate 784 
DISEASES OF THE EXCERNENT FUNCTION. 
solutions of mucus, while neutral Acetate of Lead, Bichloride of Mer- 
cury, and Sulphate of Alumina render them only turbid. 
Mucus does not coagulate like albumen by heat and nitric acid. 
(Pus always contains albumen in quantity, and therefore does coagu- 
late.) Agitated with ether, mucus gives up but mere traces of fat. 
(Pus yields oil-globules, yellow, like butter on solution in ether and 
evaporation of the ether.) 
Mucus dissolves readily in dilute alkalies, more slowly in concen- 
trated solutions. Pus, by the addition of liquor Potassae in equal quan- 
tity, forms a dense translucent gelatinous mass adherent to the test 
tube. Mucine, according to Lehmann, is also capable of being gela- 
tinized in strong alkaline solutions, and is then rendered denser and 
opaque by addition of water. Pus is also coagulated by Carbonate of 
Ammonia, which is set free in urine by the action of mucus at the 
temperature of the body, and still more rapidly under free access 
of air. 
Mucine has never yet been completely separated (Lehmann in second 
edition) from molecular granules, intestinal and cellular formations, 
vibriones, microscopic fungoid growths, nor from other chemical mat- 
ters, organic or inorganic. Different mucous juices behave differently 
towards individual solvents and reagents. 
Scherer has observed occasionally a mucus which, contrary to the 
general behavior of this substance, dissolves in water, and may be 
separated by filtration from the morphological substances. 
The analysis given page 779 is of mucus thus obtained, and taken 
from a sac between the trachea and oesophagus, probably an abnor- 
mally dilated bursa mucosa. This mucine was precipitated from 
aqueous solution with alcohol, and repeatedly boiled in alcohol and 
ether. 
Julius Vogel finds albumen in varying quantity in the mucus secreted 
when catarrhal inflammation exists. 
Virchow and Rokitansky find albumen with the mucous fluid of col- 
loid oysts, and Tilamus wdth that of the synovia. 
Lehmann does admit the identity of mucine with pyine. 
Calculi.—Principles of Diagnosis.—Let us distinguish here a 
pathology exclusively medical, and therapeutics exclusively prophylac- 
tic, from the surgical pathology of calculi already formed, the discern- 
ment of their nature in view of the mode of operation to be preferred, 
and the details pertaining to operative surgery. 
Signs drawn from the Different Kinds of Pain.—Here we have 
to distinguish the pains characteristic of the descent of renal calculi 
previous to the symptoms of vesical irritation which they afterwards de- 
termine, and the pains of vesical calculi as compared with those cxpe ■ 
rienced in other diseases of the bladder LITHIA, 
785 
Urolithes or calculi in general may co-exist with albuminuric granu- 
lations of the kidney, hypertrophy of the kidney, with saccharrhoea, 
obliteration or obstruction of any portion of the urinary passages, 
either above or below the bladder; sacculated bladder or hernia of the 
mucous membrane ; hypertrophy or atrophy, contraction or dilatation, 
congestion, inflammation or ulceration of the vesical tissues, abscesses 
and cysts; muco-pus, blood, and all the products of their alteration, 
and gouty concretions in the joints, very frequently. From the pre- 
ceding considerations it results that when in view of the solution or 
prevention of calculous deposit, diuretic indications exist, the urine 
will be increased by those agents which specifically tend to augment 
and modify the renal secretion, only on condition of removing any a 
;'priori obstructions in the liver and portal system (indicated by pre- 
sence of purpurine in the urine), or in the action of the heart and great 
vessels (dilatation, contracted mitral orifice, &c.) In the last case, and 
dropsical effusion thereon consequent, G. Bird attaches high value to 
the Tr.-ferri-sesquiehloridi M. xv., with Infusi-Digitalis jij., every five 
or six hours, the bowels being kept freely acting. The indication pur- 
sued was to combine with an arterial sedative a haematonic agent. It 
is perfectly physiological to diminish the velocity, while improving the 
quality of the blood by whatever agencies this result be obtained. Nor- 
mal proportion in urine, .001, increased by animal diet from 1.1 gr. to 1.4. 
Diminished by vegetable diet from from 1.1 to 1.00 ; less influenced 
than urea by food. Fourcray found more in winter than summer. Schul- 
tens, in the cool, damp climate of Holland, .21 to .67. Lithiasis un- 
known in the tropics. Lehmann did not find the uric-acid reduced in 
the summer during continuous perspiration. It is increased either 
together with the other solids of the urine, or at their expense in cases 
of indigestion, especially when food or spirituous liquors not spiced 
were taken shortly before bed time. Augmentation, but not necessa- 
rily deposit of uric-acid, occurs in fevers. The sediment from acid 
urine in fever and febrile diseases generally, is Urate of Soda, with 
very small quantities of the Urates of Lime and Ammonia. It dissolves 
(the Urate of Soda) at 50° ; then urine made turbid by it clears. 
There is no such thing as a well-defined Uric-acid diathesis cogniza- 
ble, like the syphilitic for instance, by regular series of symptoms, 
but the deposition of Uric-acid is sometimes known only by the local 
irritation it produces, and however constantly an attendant on gout, is 
observed in various morbid states having little or nothing else in com- 
mon with each other, and which have proved amenable to the thera- 
peutic measures differing as widely. 
There is for example no uniform system of diet to be recommended, 
although the physiological indication to avoid much flesh and wine, is 
to be observed in the absence of special reasons of exception. 
Vol. IL—50. 786 
DISEASES OF THE EXCERNENT FUNCTION. 
It is especially during childhood that the urethra manifests great 
sensitiveness to the contact of Uric-acid crystals, with frequent desire 
to urinate, passage of very small quantities, and sometimes wetting the 
bed at night, and evident uneasiness. 
Uric-acid crystals are found in the calices of the kidney as well as 
in the bladder, when, in consequence of morbid changes, atrophic, can- 
Cerous, &c., which have diminished the contractile power of the pelves 
of the kidneys and sacs of the infundibula, they are unable completely 
to expel their contents. This condition is only found in later life. 
Its presence in fresh urine is very rare, and denotes some extremely 
severe morbid process. It is after urine has been exposed to the air 
for an hour that Uric-acid crystals often begin to appear. It nomi- 
nally exists in the blood of men, dogs, frogs, &c. It is increased in the 
blood invariably during arthritis, and often in Bright’s disease, but not 
in acute articular rheumatism. Scherer found it as a normal consti- 
tuent in the juice of the spleen. Mr. Henry Gray repeated his expe- 
riments without success. Bence Jones finds healthy urine to retain 
its acid reaction until the eleventh day ; and, if separated from its 
mucus by very fine filtering paper, until the 15th day, after which it 
becomes alkaline. He does not state the temperature, which wras no 
doubt moderate (London),,but on which the time occupied in fermentative 
change mainly depends. It is the more important that this element of 
the calculation should be accurately observed, because it is a diagnostic 
character in various diseases. B. Jones found the urine in fever 
become neutral in twenty-four hours, while in severe delirium it re- 
mained acid forty-two days, and in other cases the alkaline decomposi- 
tion never occurred at all. 
Tests ofi the Relative amounts of Acidity and A Ikalinity in the 
Urine.—B. Jones.—A long graduated tube, accurately divided into 
100 measures, 144 of which would dissolve in distilled water, 12 
grains of dessicated pure carbonate of soda, iV gr. x 100=8Ar grs. 
to the 100 measure test glass. One thousand grains of urine (a 
known weight,) is heated to 130°, kept so, and stirred while the test 
solution is dropped in until the reaction on test paper shows the neu- 
tral point. The number of measures is then observed. In order to 
apply this test to the alkalinity of urine, prepare another test solu- 
tion containing so much dilute sulphuric-acid that each measure shall 
neutralize one of the test alkaline solution. (/See Philos. Trans., p. 
49, Part II.) 
Alkaline urine from the ingestion of vegetable salts decomposed in 
the system. Tartrate or citrate of potash or soda. Woehler has shown 
that the neutral salts formed by the combination of the alkalies with 
vegetable acids are oxydized in the animal organism, in precisely the 
same manner as if they were burned in oxygen gas; alkaline carbo- LITHIA. 
787 
nates pass into the urine and render it alkaline, it consequently becomes 
turbi I from the separation of earthy phosphates and naturally effer- 
vesces w ith acids. 
The alkaline carbonate appears in the urine often very quickly, 
but both the time and the quantity requisite to render the urine 
alkaline vary widely among individuals. Lehmann observed that half 
a scruple of acetate of soda generally sufficed for persons living on a 
mixed diet, while two drachms never succeeded in rendering alkaline 
the urine of vegetarians. Active exercise and purgation both prevent- 
ed alkalinity of the urine. 
The acids or alkalis of tho urine being derived directly from the 
blood, it follows that the alkalinity of the blood will be greatest just be- 
fore the first alkaline urine is secreted; hence at meal-times, when this 
increased alkalinity is accounted for by the separation from it of the 
gastric acids, and will be greatest when animal food is used, because 
this requires acids for its digestion, and the acids at any given moment, 
will naturally be least in the urine when they are most in the stomach, 
because both are drawn from the same fountain, the blood. In certain 
irritable dyspepsias, a large excess of acid is secreted by the stomach 
and is presently separated by the kidneys from the blood into which 
the acid chyle has passed. It is also not impossible that such dys- 
pepsias may originate in an acid constitution of the blood which may 
determine simultaneously the separation of acids by the gastric mu- 
cous membrane, and by the kidneys, often becoming alkaline while the 
largest secretion of acid was made in the stomach. 
With vegetable food acidity was marked during digestion, but great- 
est before meals. 
The sub-acid fruits—apples, strawberries, currants—after eating 
baked plums ( Wcehler) and other fruits containing ortrates or malates, 
the urine became alkaline. (G. Bird.) Tartaric-acid increases the 
normal acidity of the urine considerably, hence the effect of the acid, 
wines and beers. Exercise did not appear to affect materially the 
quantity of uric-acid excreted. 
In dyspepsias characterized by pyrosis, large quantities of acids, hy- 
dro-chloric, lactic, &c., were secreted and finding their way to the kid- 
ney, then determine the precipitation of uric-acid from the urine. This 
is liable to occur very frequently, and coincides with the very large pro- 
portion of calculi, of which uric-acid is the nucleus or a chief consti- 
tuent. 
Triple Phosphate occur either in granular amorphous deposit or in 
three-sided crystals with bevilled ends, distinct from the irregular 
rounded shapes of the urates under the microscope. 
Phosphate of lime is rarely crystalline. Chemical tests suffice to 
distinguish these earthy salts, which, oppositely to the urates, dissolve 788 
DISEASES OF THE EXCEKNENT FUNCTION. 
in acid and deposit in alkaline urines. They are never found together. 
(.Barclay.) The triple phosphates are found not exclusively in decom- 
posed ammoniacal urines, but also in conditions of depressed vitality. 
Visible deposit of the phosphates only proves that the urine is alka- 
line, only the quantitative analysis can inform us whether there be ex- 
cess of phosphoric-acid. Besides the transient alkalinity of dietetic 
origin and the decomposition of urine it may be alkaline from secretion 
of ammonia by the kidneys. This has been called the phosphatic 
diathesis, and belongs to states of vital depression. 
The transient alkalinity by fixed alkalis is often dependent on acid 
dyspepsia, and feeble stomachs give the greatest variations of acidity 
and alkalinity during digestion. Deposits of earthy phosphates in the 
urine correspond with alkalinity. 
There is only one questionable case in which a deposit of phosphate 
of magnesia is compatible with an acid reaction from the presence of 
chloride of ammonium, the former being nearly insoluble with the lat- 
ter, which does not, however, oppose the solution of phosphate of lime 
It is to be considered in examinations of urine where pellicles of 
phosphates are found in one stratum, that this stratum, whether the 
superficial, rendered alkaline by the air, or the underlying, consequent 
on the superposition of acid urine of less density is to be separately ex- 
amined. It will always be found alkaline if it contain a deposit of 
phosphates. 
These deposits have no tendency to spontaneous cohesion and can- 
not form calculi without the presence of mucus, blood, pus, or some 
foreign substance as a nucleus and irritant of the bladder. 
This condition co-existing with alkaline urine, the phosphate of lime 
is deposited identically, whether the alkalinity depend on ammonia re- 
sulting from the decomposition of urea in the urinary cavities or on 
fixed alkalies drawn from the blood, either with or without morbid 
changes. The phosphate of magnesia differs in its composition accord- 
ing as its deposit has been made for the fixed alkalis, or has been effect- 
ed under the influence of ammonia. In the latter case, it takes up 
one equivalent of ammonia and water of crystallization, forming the 
ammoniaco-magnesian phosphate. 
If the precipitate of earthy phosphates be entirely amorphous, 
the alkali causing it is not ammonia, which determines crystals of the 
triple phosphate. Crystals of the ammonio-magnesian, or triple phos- 
phate are insoluble in water, and present a peculiar glistening glass- 
like lustre. 
Crystallographic characters—(Thudicum, p. 206.) Before the 
blow-pipe the triple phosphate gives off the smell of ammonia, swells up, 
gradually becomes gray, and ultimately fuses, leaving a mixture of 
phosphate of lime Th. 205,)and pyro-phosphate of magnesia. (Th. 200.) LITHIA 
789 
A series of experiments were made, says Lehmann in his laboratory 
by R. Buckheim of Dorpat, among others, with the view of determin- 
ing the quantities of alkaline carbonates, tartrates, citrates, &c., which 
are necessary to destroy the free acid of the urine, and farther, to 
ascertain the quantities of free tartaric and citric-acid which must be 
taken at one time tc allow of a portion remaining unchanged in the 
urine, but notwithstanding every attention to the quality and quantity 
of the food taken during equal intervals of time, the bodily exercise 
and other physiological relations, these observations have failed in 
leading us to any sharply-defined numerical results. 
An infinite quantity of organic acids and carbo-hydrates may be 
reduced by one and the same quantity of alkaline carbonates into car- 
bonic-acid and water, for scarcely is an alkaline carbonate decomposed 
by a substance of this kind and deprived of its carbonic-acid before it 
is reconverted into a carbonate by the combustion of the organic 
substance. 
The rapidity wdth w'hich properly adjusted doses of saline bodies 
reach the urine varies from many causes, but chiefly from the influ- 
ence of the ingesta, and is greatest wrhen fasting, the digestive func- 
tions being normal and the assimilative powers in fair vigor. 
Mr. Erichsen’s experiments on a case of congenital extroversion of 
the bladder in a lad, (139,) healthy, give considerable variations in the 
time required by the alkaline citrates and tartrates for appearing as 
carbonates in the urine. He states: 
Time since last meal. 
Salt given. Time elapsing before alkalinity of urine. 
3i hours, 
Citrate of Soda, 
28 minutes. 
5 hours, 
Citrate of Potass., 
40 minutes. 
12 hours, 
Tartrate of Soda, 
84 minutes. 
2 hours, 
Tartrate of Soda, 
47 minutes. 
In the first two experiments the urine remained alkaline for several 
days after the administration of the salts. 
In Mr. B. Jones’ experiments, the urine which became alkaline 
during the digestion of animal food, and neutral after pure vegetable 
food, rendered but slightly less alkaline during digestion by nine 
drachms of dilute Sulphuric-acid in three days and not more acid 
before meals. Tartaric-acid in large doses, 354 grains in three days, 
considerably increased the acidity, but without rendering the effect of 
digestion on the reactions of urine less apparent than when no acid 
wras taken. Liquor Potassse in large doses diminished the acidity with- 
out rendering the urine constantly alkaline, and its effect was soon 
dissipated. 
The Acetate or Tartrate of Potash, or other bodies intended to 
reach the kidneys, can act only if absorbed, and can be absorbed only 
if largely diluted. Otherwise these and other salts are shown by the 790 
DISEASES OF THE EXCEKNENT FUNCTION. 
experiments of Poisseuille, Bernard, and others, to purge by determin- 
ing exosmose of serum on the intestinal passage. The same effect 
results from morbid irritability of the gastro-intestinal mucous mem- 
brane as in cholera. 
The alkaline reaction of the urine disappears in proportion as sub- 
stances causing it are removed from the body; hence, as a general 
rule, it continues the least time after those have been taken which are 
most easily soluble. After taking two drachms of Acetate of Potash 
it has continued only ten hours, after three drachms of Bicarbonate of 
Soda, it remained alkaline for three days. The same differences may 
be, however, observed between individuals who have taken the same 
salt in the same quantity. 
B. Jones found one hundred and twenty grains of pure dry Tar- 
trate of Potash, dissolved in fiv. aq. destil., make the urine alkaline in 
thirty-five minutes; the alkalescence had disappeared in two hours, 
but reappeared after the next meal. Twenty-four hours after a much 
larger quantity, 10 ounces of the Tartrate, taken during three days, 
modified little, if at all, the acidity of the urine. 
Urea, U=C2 H4 N2 O2, is the chief product of metamorphosed nitro- 
genous food, incapable of higher oxydation, and excreted by the kid- 
neys in order to prevent its topical accumulation in the blood. 
It is formed artificially from the decomposition of uric-acid by 
oxidyzing agents, such as peroxyde of lead, or by the evaporation of 
Cyanic-acid mixed with Ammonia, or from the decomposition of 
Creatine, which is the juice of flesh, C8 II9 N3 04 + 2 Aq. 
It yields in decomposition when fused with Potash, or treated with 
concentrated Sulphuric-acid, or heated in the presence of water, Car- 
bonic-acid, and Ammonia, C2 H4 N2 02 + 2110 = 200-2+ 2NII3. 
It gives the measure of disassimilation or of the most important 
changes of tissue in the system ; more is produced during the waking 
hours than when asleep, more during exercise than at rest, and more 
in fever than in the normal state. 
It is subject to decomposition in the bladder by retention and the 
ferment of mucus or muco-pus, and then its ammonia combines writh the 
acid urates in precipitation. The ammonia normally present in urine 
previous to the decomposition of urea is never sufficient to render it 
alkaline. Normal urine does not become alkaline within twenty-four 
hours after emission. Heat and dilution favor the alkaline fermentation, 
while urine, rich in urea but abounding also in acids, like the urine of 
fever, will, if decanted clear from its deposits, retain its normal aspect 
and acidity during several days. 
Within the bladder urine incysted, or sacculated, or filling the pores 
of foreign bodies, and retained in these or other circumstances, as in 
vesical paralysis, or spasm of the neck of the bladder, undergoes LITHIA. 
791 
the alkaline fermentation, and continues to act as a ferment on all urine 
subsequently entering the bladder. This Dr. Snow has experimentally 
demonstrated. There are two kinds of alkalinity of which urine is 
susceptible. The precited, depending on a volatile alkali, is distin- 
guished by the reddening, as it dries, of violet test paper, which had 
turned blue on being wet with alkaline urine. If fixed alkalies be 
present, the paper will remain blue. Either will effervesce with acids 
or lather if albumen be present. Fixed alkalies do not render the 
urine turbid or stinking like the other. Ammoniacal urine is an irri- 
tant that ulcerates any mucous surface on which it lies. Calculi not un- 
frequently cause no suffering unless attended with this complication. 
Hence the necessity of closely watching cases in which any predis- 
position to retention exists. Besides those which are organic, social 
etiquette, and an idiosyncrasy of the insane often determine retention. 
The presence of volatile alkalies in the urine is always pathological, 
but that of fixed alkalies may fall within the range of perfect health. 
Many of the acid fruits, especially lemons and apples, whose digested 
juices are, by an increment of oxygen, converted into the carbonate-s 
of their respective bases, give the urine promptly an alkaline reaction 
during a few hours. This does no harm, but if the alkalinity be con- 
stant it is generally associated with anaemia. Pale urine, which is apt 
to be alkaline, resulting from defective nutrition indicates a tonic 
treatment, with the discontinuance of alkaline medicines. The Phos- 
phates of Lime, or of Lime and Magnesia, are the precipitates of the 
fixed alkalies, the Ammoniaco-magnesian Phosphate from the volatile. 
The urates are deposited from saturated urine in the bladder, when 
its retention determines the absorption of its water. They may be 
redissolved by the ingestion or the injection of diluents. The nearly 
solid urine of serpents and birds is composed of the undiluted urates, 
and that of gouty subjects has been seen by Dr. Prout to re- 
semble it. 
The urates dissolve by heat in alkalies and are precipitated by 
acids. They occur either in the granular amorphous or crystalline 
form in acid and neutral urines. Their crystals are imperfect, in 
rounded masses, of refractive power so high as to have been mistaken 
for oil globules. These are frequently associated with uric-acid crys- 
tals, and i ay show an approach to the pathological states in which 
uric-acid is deposited. 
The urates, when dependent on gastric derangement, are paler than 
when produced by some excess, pinkish—supposed to be connected 
with biliary derangement. 
Urate of Ammonia found in brownish-black round clusters, studded 
with sharp needles, may be formed along with the white deposit of crys- 
tals of triple phosphate, uric-acid (f), infusoria, and fungi in urina 792 
DISEASES OF THE EXCEKNENT FUNCTION. 
that has undergone the alkaline fermentation in long exposure to the 
air, was believed by G. Bird to be the sediment from febrile urine, 
which Lehmann and Heintz maintain is urate of soda chiefly. Uric-acid 
very seldom occurs as a sediment in fresh alkaline urine, even with 
paralysis, and never in other cases, then in white opaque granules 
appearing under the microscope as dark globules studded with acicular 
crystals. 
Urate of Soda.—In gouty concretions, yellowish-white, soft masses 
speckled here and there with-red spots, hardening on exposure to the 
air, exhibiting under the mioroscope beautiful tufts of crystals. 
Urate of Soda in Gout.—Lehmann agrees with Garrod that there 
is a constant and marked diminution of uric-acid in the urine before the 
paroxysm in acute gout, and always in chronic gout with arthritic 
deposits, while in rheumatism, especially in acute articular rheumatism, 
the amount of uric-acid in the urine is very much increased. 
Planes of refracted light cross the square surface of the oxalate 
crystals, diagonally, disappearing and re-appearing as the surface is 
altered. 
It probably never composes by itself alone. Even the mulberry 
calculi, it is generally, if not always, associated with uric-acid, and 
these often constitute the nuclei of larger concretions. 
It is especially observed in deranged states of health connected 
with deficient respiration and vicarious function of the kidneys, which 
eliminate carbonic-acid in the form of oxalic-acid. (Draper.) 
It is not significant of either disease or perverted function of the 
kidneys. {Barclay) 
The component elements of vastly the greater number of all calculi 
exist in the normal urine. Their excess at any time may favor their 
deposit from solution, and their deposition may coincide with a calcu- 
lous formation; but they may exceed their normal proportion without 
forming deposits in the urinary organs, and may be deposited without 
forming calculi. Let us examine in reversing this order the conditions, 
1st. Of calculous formation in general, the determining causes. 
2d. Of the deposit by the urine of its solids as accessary to forma- 
tion and growth of calculi. 
3d. Of the excess in the urine of particular constituents, to which, 
when habitual, the term diathesis has been applied, thus we hear of the 
uric-acid diathesis, the phosphatic diathesis, &c., generalizations not 
entirely baseless, but often crude, hasty, and illusory, as analysis will 
prove. 
“ Calculi always contain in addition to the ingredients of which they 
mainly consist, more or less animal matter, such as dried blood, vesical 
mucus,” &c. {Bowman.) 
These constituents, which for the chemist are but trivial accessories, LITHIA, 
793 
are for the physician of the highest significance. Without their inter- 
vention, either mechanical or chemical, no calculus could he formed, 
because its materials would he evacuated either in an amorphous state 
or in minute crystals before aggregation could occur. Mucus and 
blood furnish the mortar that binds the particles of earths and the 
minute crystals in mass, as well as the ferments that cause deposition 
of the elements of calculi in the bladder, the prostate, the pelves or 
ureters where they become in turn causes of farther obstruction, irri- 
tation, and more copious deposits. 
The Acid Reactions of Urine.—Fresh normal urine of density 
1.03 is acid, and distinctly reddens litmus paper, provided the diet be 
either mixed or animal. For exceptions, see page 787. On vegetable 
diet it is sometimes acid, sometimes alkaline. 
The acidity of normal urine has been attributed by Berzelius* to the 
presence of lactic-acid. Lehmann admits this, as well as hippuric- 
acid in many analyses of fresh urine, either healthy or morbid, but 
attributes the chief acidifying part to the acid phosphate of soda. 
Common or tribasic phosphate of soda has the property of yielding to 
the weakest acids, for instance to uric-acid, one of the two atoms of its 
fixed base, and of being converted into an acid phosphate. (.Lehmann, 
Vol. I., p. 395; G. Bird, 96.) 
Heller has ascribed the acidity of fresh urine to the basic phosphate 
of soda. Liebig controverted this in favor of the acid-phosphate. 
This is the view to which Dr. Bence Jones also inclines. 
Dr. G. Birdf recognizes with Prout the weight of chemical evi- 
dence in favor of the acid-urate of ammonia, though not to the exclu- 
sion of the acid-urate of soda, and shows the fallacy of M. Bequerel’s 
objection. He then cites Liebig’s researches showing the mode of for- 
mation of the supei'-phosphate of soda, by heating uric-acid with a 
solution of the tribasic of phosphate. Finally, (§81,) he states experi- 
ments which lead him to the following deduction : 
u Uric-acid, at the moment of separation from the blood, comes in 
jontact with the double phosphate of soda and ammonia, derived from 
the food, forms urate of ammonia, evolving phosphoric-acid, which 
thus produces the natural acid reaction of urine. If the whole bulk 
of the urine be to the urate of ammonia formed not less than about 
2.701 to 1, the secretion will, at the ordinary temperature of the air, 
remain clear; but if the bulk of fluid be less, an amorphous deposit of 
the urate will occur. On the other hand, if an excess of uric-acid be 
separated by the kidneys, it will act on the phosphate of soda of the 
double salt, and hence on cooling the urine will deposit a crystalline 
sediment of acid sand, very probably mixed with amorphous urate of 
♦Ann d. Ch. u. Pharra. Bd. 50, § 161—196. f Urinary Deposits, §7H and 79, 794 
DISEASES OF THE EXCERNENT FUNCTION. 
ammonia, the latter usually forming a layer above the crystals which 
always sink to the bottom.” 
The point at issue mainly is; what is the form in which the pre- 
cited elements exist at the moment of their disengagement from the 
blood. Allowing Mr. Bird’s data of the ammonio-phosphate of soda 
and uric-acid, it is easy to mix them in solution out of the body and 
to show the evolution of phosphoric-acid with formation of the urate ol 
ammonia, which in urine on cooling deposit with the coloring mattei 
in the ordinary amorphous sediment; then if a fresh quantity of uric- 
acid be heated in the supernatant fluid, more of the urate of ammonia 
will be deposited up to a certain point, wThen it will be succeeded by 
the urate of soda. This on cooling, deposits fine prismatic crystals of 
impure uric-acid due to a reaction with the free phosphoric-acid. 
They contain chemically combined some phosphate of soda, of which 
neither boiling water nor hydrochloric-acid can deprive them. In 
order then to account for the natural acidity of healthy urine, we have 
only to consider the 0.398 grs. of uric-acid (average quantity in 1000 
grs. of urine) as dissolved with about 2.5 grs. of tribasic phosphate of 
soda, (proportion found by Simon in 1000 grs. of healthy urine.) 
According to the experiments of Bence Jones, endorsed by G. Bird 
and Thudicum, and substantially coinciding with those of Vogel, who 
examined the quantities of free acid for every hour in the twrenty-four, 
the greatest acidity was found during night, or while fasting, the lowest 
in the forenoon, three hours after breakfast or five or six hours after 
dinner. Immediately before each meal the urine was most acid, that 
passed during digestion is three or four times less acid, the difference 
greatest after a meal of animal food only. 
Uric-acid Sediment consequent on the Acid-ferrocy.—The color of 
the Uric-acid sediment is, with few exceptions, yellow, like its micros- 
copical crystals, but when the deposit is white it exhibits not only the 
crystals of triple phosphate, infusoria, and fungi, but also the brownish- 
black round clusters of Urate of Ammonia,1* studded with sharp needles. 
The urine effervesces strongly with acids and then hardly exhibits any 
yellow color, the pigments being consequently for the most part 
destroyed. 
Question, as to whether normal urine is acid or alkaline at the mo- 
ment when the first crystals of urate of ammonia are found deposited? 
Uric-acid is a normal ingredient of the blood and urine, in propor- 
tions varying from 0.02 to 1.0 gramme in the twenty-four hours. Bee- 
querel says, average 8.1 grains. This increases in inflammatory and 
zymotic diseases. In chlorosis and pulmonary emphysema, Becquerel 
found it below the average, above in phthisis, and highest in icterus and 
milk fever. 
* But Urate of Ammonia is snowy white. See Thudicum, p. 17. LITHIA. 
795 
For 35.0 grammes of urea secreted in twenty-four Lours 0.5 grammes 
of uric-acid are discharged. Their fluctuations in disease are generally 
parallel. All causes that interfere with the secreting power of the 
kidney cause retention of uric-acid proportionally with that of the 
other constituents of urine. Thudicum observes an exception in scar- 
latinous albuminuria, where uric-acid has continued in excess while 
the urea had fallen to about half the normal average. 
Physical Characters of Uric-acid Concretions.—Gravel from A inch 
diameter and upwards, until too large to pass ureters or urethra, gene- 
rally rough, especially if formed in the pelvis of the kidney, a pisiform 
variety is generated in great numbers, often in the pelvis of the kidney 
or in the ureters. 
Internal texture, invariably crystallized and usually lamellated. 
Form more or less globular, surfaces sometimes flattened, or faceted, if 
formed in ureters. Color ranging through shades of yellow, reddish, 
and dark brown. Weight may reach that of six ounces or more. 
Texture.—It generally forms from the urate of soda, in urine, after 
exposure to the atmosphere. Lehmann has never found it in fresh urine. 
Chrystallography. See Schmidt. Entwurf. W. S., 28—34, for the 
complete analysis. Lehmann, Vol. 1, p. 191. 
Uric-acid is always met with when occurring in the blood, arterial 
as well as venous, in the form of acid-urate of soda, lime, or ammonia, 
and retains the same form after passing the kidneys. Any urine de- 
ficient in water will deposit its excess of urates. Nearly a fourth of 
all calculi contain urates and 8.69 per cent, have urates as their nuclei. 
Urates are deposited either from excess or from alkaline decomposed 
urines, being less soluble in solution of carb.-ammonia than in fresh 
acid urines. 
The contact of uric-acid crystals, even microscopical in size, suffices 
to cause spasm at the sphincter, even when the crystals were ovoid, 
much more when they are jagged. In elderly gouty subjects the urate 
of soda is sometimes copiously secreted, especially at night, as thick 
as mortar and plugs up the urethra. 
Uric-acid Secretions—Sand and Gravel—Crystalline Sediments. 
—The common pulverulent deposit is composed of single crystals, the 
exception in which is to find crystals, twin, crossed and hanging toge- 
ther in a variety of ways. The term gravel applies to a zeolithic 
arrangement in which the crystals group with their predominant axis 
round a common centre, like the rays around the luminous body whence 
they emanate, one or two large crystals usually forming the basis of 
these globular masses. Viewed by transmitted light under the micros- 
cope, the globules are opaque and the superficial crystals of uric-acid 
of a dark brown, faintly transparent. To the naked eye the deposit is 796 
DISEASES OF THE EXCERNENT FUNCTION. 
of a brownish red. This is sometimes met with in the pale watery 
urine of early infancy. 
Uric or Lithic Acid.—Ci0 II4 06 N4-f-4aq.—When pure is white, 
in irregular rhombic plates or light powder, of satiny lustre, without 
taste or smell, nearly insoluble in cold water, sparely soluble in hot 
wrater, and not more in blood than in water. One part is dissolved in 
fourteen or fifteen thousand parts of water at 68 F. (20c.) and faintly 
reddens litmus paper. Soluble without decomposition in sulphuric- 
acid, and precipitated by wTater. Is easily dissolved in a solution of 
the common or tribasic phosphate of soda and of other alkaline salts, 
giving rise to the form of acid salts. Dissolved in dilute nitric-acid 
it gives alloxanthine, which, wThen ammonia is added to its wTarm sol 
vent produces a purple reaction due to purpurate of ammonia or mur- 
exive. Heat decomposes without fusion, but wTith extrication of hydro- 
cyanic acid. 
TJrate of Soda.—Amorphous and impalpable yellow sediment of 
Prout. The characteristic sediment in febrile diseases. (.Lehmann 
and Ileintz) Uric-acid extracts soda from alkaline lactates and 
other salts of organic acids, forming acid salts which acidulate the pre- 
viously neutral fluid. The urate of soda then separates from a pure 
mixture in a crystalline form, but from a solution like urine, contain- 
ing extractive matter, in an amorphous state and redissolves at 50°. 
Its presence in the urine increases inversely to the pulmonary lioema- 
tosis and the sediment in that of animals deprived of normal exercise. 
It is found in pulmonary emphysema, in heart diseases, enlarged liver, 
&c., associated with obstructions to the circulation, of which haemor- 
rhoids and gout are symptomatic. It is found in large masses only 
with the true granular liver. 
Oxalate of Lime.—Pathological History.—The introduction of 
uric-acid into the organism by the primae vice, or by the veins, 
was followed by the augmentation of urea and oxalate of lime in the 
urine. In fevers and other disturbances in the circulation and respi- 
ration, oxalate of lime and lactic-acid are increased along with uric- 
acid. 
There are no acute and fewT chronic diseases, in which the oxidation 
of the constituents of the blood is not diminished or impeded, and 
there is no disease characterized by a too sudden or rapid oxidation of 
the blood. 
The decomposition of uric-acid into urea and oxalic-acid, may be ar- 
tificially effected by the peroxide of lead.* 
In its formation, oxalite of lime exists, but seldom in a visible sedi- 
ment, closely connected with the separation of uric-acid; the abun- 
# Wohler and Frerichs ; Ai n d. Ch. u. Pharm. Bd. 65, S 333-342. LITHIA, 
797 
dance of its crystals is proportional to the rapidity with which acid 
fermentation is induced, and the consequent early deposition of free 
uric-acid (elsewhere, which always forms the nucleus or enters into the 
composition of the nucleus of oxalate of lime calcali). Its urine, as 
well as that of free carbonic-acid, is increased by the use of drinks 
conta ining a, large quantity of carbonic-acid. It is much increased by the 
ingestion of uric-acid urea is then also augmented by injection of the 
urates into the veins. 
The microscope affords the only means of detecting with certainty 
the presence of oxalate of lime. (Barclay.) It generally occurs in 
ootohedral crystals, to be distinguished from the very short square 
prisms of uric-acid which closely resemble it. 
Breed and A. Winter, quoted by Lehmann, showed as a mean of 
several experiments, that between 3.7 and 5.1 grammes of phosphoric- 
acid, were eliminated by the urine in twenty-four hours. The amount 
was greatest at noon and after meals; least in the morning. 
The alkaline secretions of the pancreas and liver, in the digestion of 
amylaceous and fatty food, must predominate over the gastric acid, 
whose special action is exerted over nitrogenous food. These alkaline 
secretions from the blood correspond to the acidity of the urine ob- 
served by Bence Jones during the digestion of vegetable food ; but the 
blood, whose constitution is naturally alkaline, does not give up pro- 
portionally the alkalis of the chyle, hence the urine while fasting is 
more acid when the diet is vegetable, amylaceous, than when it is ani- 
mal (nitrogenous). 
Some persons cannot bear the use of free or carbonated alkalies 
without suffering severely in health, nor is their protracted use with- 
out ill effect. A flabby state of the muscles and an ansemiated condition 
of the system frequently result from persistence with alkaline reme- 
dies, and their injudicious employment may indeed possibly induce the 
formation of oxalic acid. 
The urine cannot be rendered alkaline for any length of time 
without risk of precipitating the phosphates of lime and magnesia, 
thus giving the patient a change of evils, instead of removing them. 
In reading the accounts of real or imaginary calculous affections a 
century ago, treated by the celebrated alkaline remedy of Miss Ste- 
vens, it is impossible to avoid noticing how very much of the sabu- 
lous and fetid state of the urine of her patients was obviously engen- 
dered, not by the disease, but by the remedy. ( G. Bird.) 
We are also to consider in this connection the abnormal states cover- 
ed by the following resume of Dr. Barlow’s, given as a means of diag- 
nosting the seat of obstruction in cases of inseparable constipation. 
If a sufficient quantity of urine cannot be received into the small in- 
testines, or the circuit through the portal system in the vena cava 798 
DISEASES OF THE EXCERNENT FUNCTION. 
ascendens, or thence through the lungs and heart, if the systemic cir- 
culation, be obstructed, or if there be extensive disorganization of the 
kidneys, the due secretion of the urine cannot be effected. 
Whenever stricture or other obstruction exists in the course of the 
small intestines sufficient to prevent the ready passage of fluids, the 
urine will be diminished in bulk in the direct ratio of the proximity of 
the obstruction to the pylorus ; nearly absolute suppression occurring 
when the stricture is so high up as to allow but a small quantity of the 
fluid contents of the intestines to pass forward into the caecum and 
colon. 
Origin of the Mucus.—The secretion of mucus is not limited 
to the mucous follicles, which do not exist in the mucous membrane of 
the antrum highmorianum of the frontal and sphenoidal sinuses, the 
cavity of the tympanum, the ovula nabothi, the synovial sacs, nor in 
abnormal formations, as hygroma, cysts, &e. But all mucous mem- 
branes are invested, as Tilanus has shown, with an epithelial layer, 
whose cells are probably integral components of mucus; though epi- 
thelium is absent from the colloid matter of cysts of the thyroid gland, 
and of the liver, kidneys, and ovaries, which Virchow and Rokitanski 
have shown may be converted into mucus. The gelatin of Wharton is 
convertible into mucus just as permanent cartilage into glutin. 
Normal mucus, however, consists of epithelium, held together by a 
pellucid juice. The ciliated epithelium is rarely found perfect, how- 
ever, even in abnormal secretions. 
Mucous corpuscles may always be found on a careful examination of 
the cloud in normal urine. They are abortive epithelial cells. 
Berzelius found the nasal mucus rich in alkaline chlorides, especi- 
ally of soda. 
Nasse found also alkaline sulphates and phosphates. 
Lehmann cites an analysis of the mucus of acute catarrh, rich in 
mucous corpuscles, and containing some granular cells, which yielded 
more potash and less soda in the ash of the mucus than in that of the 
blood serum. 
The secretion of earthy phosphates has been ascribed to the mucous 
membrane of the bladder in a state of irritation. This is a question 
now subjudice. 
Mr. Coulson relates that a wax bougie that had been introduced 
into the vagina was found covered with a layer of phosphate of lime 
and magnesia, and that a concretion formed of adipocere and crystals 
of phosphate of lime, have been found in the uterus; hence he finds it 
probable that similar effects may arise from irritation of the vesical 
mucuous membrane. 
The distinctions between pus and mucus which have so largely attract- 
ed the attention of the physicians of an earlier day, have lost all their LITHTA, 
799 
supposed importance since modern physiology has shown that the two 
fluids are separated only by the most gradual transitions, and that the 
mucus in inflammatory affections of the mucous membrane gradually 
presents large numbers of cystoid corpuscles, together with albumen, 
and thus acquires great similarity, if not a perfect identity with pus, 
both in respect to its physical and chemical characters. Even the 
quantity of fat in the purulent fluid secreted by the mucous membrane 
in a state of inflammation, is very often equal to that of genuine pus. 
The pus of mucous membranes commonly retains the property possess- 
ed by mucus of gelatinizing on the addition of water or acetic-acid. 
Pus is rarely acid in the living body. That of congestive abscesses 
generally undergoes an alkaline fermentation, resulting in carbonate of 
ammonia and triple phosphate, besides a large amount of sulphide of 
ammonium. This is the more remarkable, as pus out of the body and 
exposed to air and warmth takes on a decidedly acid reaction, while 
its corpuscles have swollen and become more transparent, bringing the 
fissured nuclei more distinctly into view, until at last they are isolated 
without a trace of cell walls. Interspersed among these nuclei and 
the few perfect corpuscles are innumerable granules with here and 
there tablets of cholesterine and a confused mass of threads of mar- 
garin. At a later period (some months) the fats appear ensiform, 
lily-leafed, and intersecting bundles of crystals of margaric-acid. 
The pus corpuscle swells, and its nucleus is rendered more distinct 
by the addition of water, of iodine one to nine thousand of water, of 
very dilute mineral acids (hydrochloric, one part in two thousand eight 
hundred of water; nitric, one to two thousand;) or tolerably dilute 
organic acids (acetic, lactic, tartaric, oxalic, racenic, or citric.) There 
is no more granular appearance with acids ; with water there is often 
instead of a distinct nucleus an aggregation of granular matter with 
no distinct outlines, with fine granules in a state of active molecular 
motion. Strong iodine solutions coagulate the serum. The acids cause 
rupture of the capsule. 
Strong Alcohol, Ether free from Alcohol, solutions of the caustic 
alkalies, especially when dilute, those of the neutral alkaline salts, and 
of the alkaline carbonates or borates, all prevent microscopical exami- 
nation of the pus corpuscle; strong Alcohol coagulates the serum, 
weak Alcohol renders it turbid and the corpuscle appears caudate or 
pointed; likewise in Ether. Alkaline solutions cause their gradual 
disappearance. 
Treatment.—Our therapeutical measures may be classed under 
four heads. 
First. To correct the diathesis on which the morbid sediments 
depend. 800 
DISEASES OF THE EXCERNKNT FUNCTION. 
Second. To relieve the distress and suffering attendant on the pre- 
sence in the urinary organs of gravel or stone. 
Third. To dissolve the stone. 
Fourth. To extract it, either by lithotomy or by the aid of Civiale’s 
lithontriptor. 
The first object may he attained by removing the causes upon which 
the diathesis depends. Some of the more prominent of these causes 
are, errors in diet, including quality of food and irregularity in hours 
of taking meals ; abuse of stimulants; use of water abounding in 
lime; excessive mental or bodily fatigue; undue exposure to atmos- 
pheric vicissitudes; insufficient nutriment; the depressing passions ; 
tendency to gout and rheumatism; dyspepsia, and disease of the 
urinary organs. 
When the depositions depend upon a lithic-acid diathesis, every 
thing of an acid nature should be avoided; a large quantity of animal 
food should be enjoined, and baths, frictions, and abundant exercise 
taken, to ensure a healthy action of the skin. 
The Dhosphatic Diathesis may depend upon a loss of tone in the 
digestive organs, too free use of animal food, profuse sweats, use of 
lime water, and over-exertion, mental or physical. Here a farinaceous 
and vegetable diet, and a free use of fruit and acids should be advised. 
If the depositions arise from gout attacking the mucous membrane of 
the bladder, the suitable medicines will speedily dissipate the morbid 
condition. When the diathesis appears to proceed from general de- 
bility, or derangement in the digestive or assimilative functions, our 
dietetic regulations, as well as our medicines, should be prescribed 
with reference to these conditions. 
In all calculous affections a cheerful state of mind, with country air, 
or a sea-voyage to a hot or cold latitude, will prove serviceable. 
To fulfil the second and third indications as far as possible, we 
shall, further on, point out those remedies which we deem most suita- 
ble. But it is a matter of much doubt whether there are at present 
any remedies known capable of dissolving a calculus in the urinary 
organs after it has attained a considerable size. We may be able to 
correct the diathesis upon which the morbid sediments depend, and to 
enable the urinary organs to expel calculi of small size ; but the disso- 
lution of a large stone in the bladder has never yet been effected. 
Such can only be removed by crushing them according to the method 
of Civiale, &c., so that the fragments will pass off by the urine, or by 
the operation of lithotomy. For the details of these important opera- 
tions we refer the reader to the standard works on surgery. 
The principal medicines in the treatment of urinary concretions are : 
Cannabis, Uva-ursi, Nux-vomica, Sarsaparilla, Lycopodium, Cal- LITHIA. 
801 
carea-carb., Phosphorus, Asparagine, Monarda-punctata, Alche- 
milla-arvensis, Chininum-sulph., Alisma-plantago. 
Cannabis and Uva-ursi are excellent remedies during a fit of the 
gravel, accompanied with painful micturition ; discharge of slimy, puru- 
lent, or bloody urine ; burning in the bladder and urethra during and 
after micturition ; and itching at the extremity of the glans penis. 
Dr. Gross has highly commended the employment of Nux-vomica 
and Sarsaparilla for the cure of calculous affections. So far as the 
former remedy is concerned, our own experience coincides with that of 
Dr. Gross. We have, in several instances, prescribed Nux-vomica with 
unequivocal benefit in calculous affections which apparently originated 
from chronic derangement of the digestive organs. In one case, like- 
wise, where the patient experienced the most severe spasmodic pains 
from the passage of a calculus from the kidney to the bladder, with 
constant nausea, vomiting, painful and bloody micturition, and high- 
colored urine, the most prompt and happy results followed the use 
of Nux. 
This remedy is decidedly indicated when lithiasis arises from dys- 
peptic symptoms, abuse of stimulants, excesses in eating, and also for 
the acute constrictive and spasmodic pains which proceed from the 
irritation of a calculus when passing from one point to another. 
Lycopodium is adapted to patients of a lymphatic temperament, 
and who have been subject to chronic affections of the mucous mem- 
branes. The Lycopodium pains occur mostly in the urethra and peri- 
neum, and are of a burning, smarting, or cutting character during 
micturition. The urine is of a dark color, very foetid, and deposits a 
red or yellowish sand. 
Calcarea-carb. is suitable for the calculous affections of scrofulous 
or chlorotic children. It is indicated when the pains in the urinary 
organs and the desire to pass water are worse during the night, and 
the urine is of a dark color, foetid, and deposits a white sediment. 
Calcarea is also indicated in debility of the assimilative functions, 
emaciation, and great weakness and exhaustion of the whole system. 
Phosphorus may be given in lithiasis occurring in broken-down 
constitutions from loss of fluids, and in old and debilitated subjects. 
The Phosphorus symptoms are characterized by loss of power over the 
urinary organs, involuntary passing of urine and faeces at the same 
time, sudden interruptions of the course of the urine, desire to uri- 
nate, with dull pains in the hypogastrium, emission by the urine of an 
ammoniacal odor, and deposits of a whitish or brick-dust sediment. 
We have exhibited Asparagus in two cases of lithiasis dependent 
upon a gouty diathesis with marked success. In one of these cases 
the calculous symptoms all disappeared in a few weeks after com- 
mencing the medicine, and the morbid character which the urine had 
You IL - 51. 802 
DISEASES OF THE EXCERNENT FUNCTION. 
presented for several years was entirely changed to a healthy condi- 
tion. We are inclined to believe that Asparagus is a remedy of much 
greater power in urinary affections and in dropsies than has ever been 
attributed to it. Our experience with it in these maladies has been 
somewhat extensive, and generally of a most satisfactory character. 
It is especially called for when there is frequent inclination to 
urinate ; burning and cutting in the urethra and kidneys ; dull draw- 
ing pains in the groin ; tenderness and pain in the perineum ; sensa- 
tion as if urine was passing off after all has been discharged; urine 
straw-colored or brown, with a very offensive smell and a whitish sedi- 
ment ; palpitation of the heart; rapid and oppressive respiration on 
the slightest exertion. 
Monarda-punctata, Alchemilla-arvensis, and Alisma-planiago 
also cover most of the symptoms enumerated under Asparagus, and 
may sometimes succeed this remedy with advantage. 
Chininum-sulph. is recommended when there are minute crystal- 
lized grains in the urine of a reddish or yellowish color; increased flow 
of acrid and offensive urine; emaciation; irritability and much consti- 
tutional disturbance. 
Administration.—During the violent paroxysms which occur in 
calculous affections, we may employ the medicines from the first to the 
third attenuation, and repeat every hour until the desired impression is 
produced. But, under ordinary circumstances, a dose once in twelve 
or twenty-four hours will suffice. 
Malignant Tumors of the Bladder.—Civiale regards the long- 
continued irritation of calculi as not without influence in the develop- 
ment of fungoid and other tumors about the neck of the bladder. On 
the other hand, the irritability of the bladder, which usually is developed 
by the growth of tumors, is like pain, not constantly present either 
with tumors or with calculi, and whenever the urine is allowed to 
remain in the bladder, or when the tumor in preventing the complete 
contraction of the bladder provides for the permanent retention of 
mucous blood and earthy sediment in the fundus or about the base of 
the tumor, this will have become an efficient cause in the production 
of calculi. 
The Urine during the Early Stages has been but imperfectly 
observed. During the advanced stages, in the few cases, says Coul- 
son, which have been accurately examined, the urine was offensive, 
sometimes acid, sometimes alkaline, it contained in the former case 
lithate of ammonia, in the latter crystals of triple phosphate; it also 
contained pus and blood-globules with organic shreds, apparently of 
mucus and fibrine. In a few cases, cells and cancer elements were 
discovered under the microscope. 
“The peculiar structure of villous cancer and the quantity of LITHIA. 
803 
nucleated cells collected on the surface of the dendritic vegetation, ren- 
der it certain that these cancer cells may be discovered in the urine, 
independently of the discharge of fragments of morbid growth itself. 
They should be sought for in the urine passed during severe par- 
oxysms, especially -when attended by copious haemorrhage. This is 
the only element of diagnosis available when complications with calculi, 
with enlarged prostate, or irritability of the neck of the bladder render 
direct explorations deceptive or impossible. Mr. Owen Rees also 
affirms from many years’experience in these examinations, the value and 
reliability of a diagnosis by the characteristic of cancer cells in the 
urine. 
Carcinoma of the Bladder, either Primary or Consecutive on 
that of Neighboring Organs.—Fibrous Cancer occurs but rarely. Its 
tendency is to spread over large surfaces, up and down the sides of 
the bladder, implicating the female urethra and cartilaginous induration 
and metamorphosis of the muscular coat. 
Medullary cancer occurs in nodules, between the coats of the 
bladder perforating the mucous membrane and sometimes producing a 
carcinomatous ulcer with raised edges. 
The cauliflower vegetations soft, furred, vascular, generally bluish- 
red, and bleeding at the slightest touch, present the most frequent 
form; they have a rounded, flattened peduncle, arising from the mem- 
brane and sub-raucous areolar tissue, with delicate fibres, and develop a 
very fine membranous tissue within, in which a whitish, or reddish-white, 
creamy or medullary (encephaloid mass is formed. They are either 
isolated or grouped, and at last coalesce so as to form a very large 
loose-figured succulent, globular fungus, which fills out the bladder, in 
proportion as the latter becomes hypertrophied and contracted, con- 
sequent upon the permanent irritation. The fungi occupy chiefly the 
neck and fundus, the trigone, and parts near the urethral orifices. 
Here the largest growths are found, and from these first developments 
they spread over the entire inner surface of the bladder. They some- 
times occupy diverticula in the bladder, descending from the fundus 
to the rectum and perineum. They are occasionally inflamed, covered, 
and interlaced wflth lymphatic exudation, and gangrenous. Their 
development gives rise to progressively increasing haemorrhage. 
This variety of cancer frequently coincides with the cauliflower ex- 
crescences in other organs, occurring upon anomalous, serous and fibro- 
serous membranes, and upon the inner surface of the compound 
cystoidea, or of the peripheral follicles of areolar cancer that have been 
converted into large sacs. It is also allied to erectile tumors or 
epithelial formations on the mucous membranes. 
The Characters of Haemorrhage in Malignant Tumors of the 
Bladder.—In every case, says Mr. Coulson, with wThich I am ac- 804 
DISEASES OF THE EXCERNENT FUNCTION. 
quainted, more or less has been discharged from the bladder in the 
course of the disease, and with a constancy which no other lesion 
of the bladder presents. The first symptom may be a discharge of 
pure blood from the bladder; and when this is soon followed by excessive 
pain and difficult micturition we have a strong presumptive sign 
of the existence of a vascular tumor. In other cases the urine is 
merely tinged with blood, at first the haematuria being accompanied by 
only slight symptoms of vesical lesion. These, however, quickly be- 
come more severe, present little or no remission, and the loss of blood 
increases. It may again diminish, and the urine become even clear 
for a time, but it it is sure to recur again and again, until the end. It 
is not confined to the time of making water, but may even occur while 
the patient is at rest with the bladder empty. 
Detection of Blood in the Urine.—Presumptive evidence is afforded 
by the coloration of the urine. When the quantity effused is too small 
to have changed the color of the urine more than to render it hazy, if 
it be allowed to repose in a white china vessel the blood-corpuscles 
will collect at the bottom in the form of a rusty-brown sediment. This 
is the general appearance in haemorrhage resulting from organic dis- 
ease of the kidneys. {Barclay) A little more blood gives to the 
whole mass of urine a smoky hue. The urine, if pale and wratery, 
becomes pink, like flesh-washings. 
From veins or arteries ruptured in the bladder itself, the blood appears 
in irregular clots, which will in passing have caused more or less stran- 
gury. If they have been retained a short time in contact with dilute 
urine, they will have parted with their coloring-matter and have been mis- 
taken for fibrinous casts of the urethra. These little maggot-like coagula 
are in fact generallly moulded in the ureters and denote renal haemor- 
rhage. 
Microscopic appearances and reactions of blood-corpuscles. (Thu 
dicum, 228.) 
The non-granular surface, yellow color, and uniform size are charac- 
teristic. If the admixture of the blood wflth the urine have not been recent, 
the globules appear deformed, irregular; finally they disappear, and only 
amorphous fragments are left, such as occur in albuminous urine. In the 
chemical testing of urine, albuminous from the presence of blood, heat 
precipitates less than nitric-acid, as is usual with alkaline urines. 
Urine may have all the shades of light and dark, red and yellow, 
without admixture of blood. Groundless apprehensions may be re- 
moved by the knowledge that the fruit of the prickly pear, red beet- 
root, madder, some varieties of the strawberry, logwood, sorrel, and some 
other substances stain the urine red; alkaline urine is reddened by 
rhubarb and senna, and large quantities of bile make a yellow that 
deepens towards blackness. This indicates a morbid state, but not in LITHIA. 
805 
connection with calculi. The pink tint appears in the urine of obstinate 
dyspepsia with organic lesions. 
Blood may be voided black from the presence of melanic-acid. {Mar- 
cet and Prout.) 
Blood and its proximate elements considered in their relations 
with Calculous Deposit.—The least clot of blood or other organic mat- 
ter remaining in the bladder may become by its mechanical as well as 
chemical effects, the nucleus of stone. As it is the part of the physi- 
cian to anticipate the surgeon, so it behoves us here to examine under 
■what conditions such nuclei are liable to be deposited, the means of 
diagnosing and of removing them. 
Causes of Sanguinolent Urine. 
1. Traumatic: 
a. Falls or blows, rough jolting in vehicles or on horseback, espe- 
cially in connection with the presence of calculi. 
b. Lesions by perforating bodies, accidental or by instruments, sur- 
gical. 
c. Catheterism or other explorations of the urethra, neck, of the 
bladder and fundus. 
d. Irritation by passage of calculus from the kidneys along the ure- 
ters, tearing the mucous membrane. 
e. Foreign bodies lodged within the bladder, and the efforts made to 
expel them. 
2. Morbid states of the kidney. 
a. Highly acute nephritis (rheumatic?) 
b. Chronic nephritis with ulceration of mucous membrane. 
c. Pyelitis Avith calculi. 
d. Malignant tumors. 
e. Tubercles in process of softening (very rare.) 
f. Sanguine exhalation, spontaneous. 
3. Morbid states of the bladder. 
a. Chronic cystitis with ulcerations. 
b. Highly acute cystitis, especially when caused by cantharides, 
either taken internally or absorbed from blistered surfaces. 
c. Other drugs of analogous action, turpentine. 
d. Fungous granulations. 
e. Malignant tumors. 
f. Haemorrhoides vesicae, rupture of enlarged veins. 
Most of the causes which determine the presence of blood in the 
bladder will have increased the secretion of mucus. This will naturally 
adhere to the blood clots, and mechanically by its viscidity, chemically 
as a ferment, will combine to form with it a solid plug and a nucleus of 
deposits which its presence in the urine determines. 
The strangury occasioned by its obstruction to the passage of urine 806 
DISEASES OF THE EXCERNENT FUNCTION. 
reacts on the increase of mucus secreted from irritated membranes. 
In order to ascertain by inspection, the presence of small quantities of 
blood in urine, Bence Jones recommends to let it stand for twelve 
hours, giving time for the blood globules which are insoluble in the 
saline urine to subside and form a layer at the bottom of the glass, 
whose character the naked eye can appreciate. The microscope tells 
this more quickly and at the same time discerns the co-existence possi- 
bly of fibrinous moulds of the ducts, proving that the haemorrhage is con- 
sequent upon congestion of the cortical structure of the kidney. If this 
constantly exist, Bright’s disease is present and the low specific gravity 
and excess of albumen in the urine will generally confirm this inference. 
If in sanguinolent urine we find crystals of uric-acid or oxalate of 
lime, the specific gravity high, and no fibrinous moulds, there is probably, 
a calculus present in one kidney. Perfect rest will be indicated and will 
help to enlighten this diagnosis. The presence of pus globules, (no 
chronic irritations of the bladder or urethra existing) may proceed 
either from pyelitis with renal concretions, or malignant tumors. 
4. Pain, though a frequent, is not an invariable concomitant of blood 
from the passage of renal calculi. There are generally painful sensa- 
tions during their passage, becoming violent like colics, from their 
arrest and strangulation. Renal haemorrhages in general are attended 
with local sensations of painful heat and weight and with rigors. The 
passage of calculi on previous occasions enlightens the diagnostic. 
5. Morbid State of the Prostate and Neck of the Bladder.— 
a. Irritation induced by the granular state of the mucous membrane, 
often associated with the presence of stricture below, or with chronic 
urethral inflammations, and with seminal emissions. 
b. Psoric manifestations, sometimes metastatic. 
c. Strangury, spasm of the external sphincter, generally of rheu- 
matic origin and attended with presence of uric-acid in excess. 
6. Ulcerations of the cervix uteri, &c. 
7. General affections of the vascular system and changes in the 
composition of the blood itself, with reduction of fibrine. 
U. Chronic scorbutis. 
b. Acute scorbutis, purpura haemorrhagica (less frequent.) 
c. Fevers malignant, or presenting the haemorrhagic type, viz: 
scarlatina, rubeola, variola, typhus, plague, intermittents. 
d. Epidemic haematuria. 
In all cases where there exists great obstruction to the elimination of 
carbon as in well-marked affections of the portal circulation, especially 
when connected with organic disease of the liver or spleen, or less 
frequently when suppuration, particularly of a strumous character, is 
going on in the body, the urine is generally found to possess, in many 
instances, a deep purple or copper color, often verging on crimson, so HERNIA HUMORALIS. 
807 
as to have led to the idea of blood being present. These deep tints 
appear to us to depend upon the presence of an excess of purpurine, 
which, on account of its solubility in water, never occurs as a deposit 
unless the urates are present. A deposit of urates colored by pur- 
purine presents a tint varying from the palest flesh-color to the deepest 
carmine. Purpurine reciprocally favors the deposit of the urate 
of soda, it is also found coloring hippuric-acid when precipitated by 
hydrochloric-acid from concentrated urine. It interferes with the 
ready solubility of the urates on the application of heat, unless they 
be freely diluted with water. The deposit of pink urates, sometimes 
mistaken for blood, will, when dried on a filter, give up its purpurine 
to alcohol, and the absence of blood discs on microscopic examination 
will leave no room for doubt. 
jBilious Urine.—Urine containing bile, tested by nitric-acid, be- 
comes green. Bilious urine is essentially clear, though very deep- 
colored like porter. If, when examined in a slender glass, it still 
appears opaque, this must be from the combination of bile with pus 
or the other elements of the whitish urines, or if of deep brown 
opacity, from the admixture of blood. 
Purulent Urine.—Pus renders the whole of the urine more or less 
opaque, but forms a distinct sediment when allowed to stand, very often 
carrying with it some portion of earthy salts. Urine mixed with 
leucorrheal discharge, and that which is altered from decomposition 
are both wholly opaque. 
GENUS II.—PARURIA.—1. HERNIA HUMORALIS. 
During the acute stage of urethritis, the inflammation sometimes 
extends even to the spermatic cord, the epidydimis, and the testicle. 
This is very apt to occur when the discharge is suddenly arrested by 
irritating injections, especially when the inflammation pervades the 
whole extent of the canal. When the substance of the testicle be- 
comes involved, the pain is very severe, and febrile symptoms more or 
less severe set in. This inflammation may terminate in resolution, 
suppuration, or chronic enlargement and induration. In those instances 
where suppuration occurs the abscesses usually break externally, and 
form fistulous passages which are difficult to cure, on account of the 
continual irritation kept up by the secretion of semen, a portion of 
which is constantly being discharged through these ulcerated openings. 
Chronic enlargements of the testicles should command our early 
attention on account of their strong tendency to terminate in scirrhous 
degeneration. 
In urethritis, and other affections of the urino-genital apparatus, the 808 
DISEASES OF THE EXCEED ENT FUNCTION, 
prudent physician will always advise the use of the suspensory band- 
age, as a precautionary measure. 
When the urethritis is so severe as to affect the lymphatic glands 
of the penis, the inflammation may be propagated to several of the glands 
of the groin, when we have bubo. (See p. 307.) 
2. FISTULA IN PERINEO. 
When the contraction is so gi’eat as to cause considerable obstruc- 
tion to the passage of the urine, this fluid is forced by the frequent 
and violent efforts at expulsion, into the parts back of the stricture, in 
such a manner as to form a kind of cal de sac, which, from constant 
distention, eventually ulcerates an opening externally, and perineal 
fistula is formed. 
Abscesses also arise sometimes from inflammation and tumefaction 
of the lymphatic glands in other parts of the urethra. These little 
swellings may open into the urethra, or discharge themselves externally. 
The most common seat of these abscesses is near the fraenum or 
opposite the scrotum. 
Pathology.—Numerous hypotheses have been offered respecting 
the seat and nature of this singular malady, but no one of them ap- 
pears to afford a satisfactory explanation of all its phenomena. The 
affection has been referred to a morbid condition of the kidneys alone, 
also derangement of the stomach, of the liver, to a defect in the fluids, 
to suppressed perspiration, to an imperfect animalization of the blood, 
to the retrograde action of the lymphatics, and to an unnatural waste of 
the body, thus calling into increased activity the digestive and assimi- 
lative functions to supply the waste. Galen, who saw but two cases 
of diabetes during his life, supposed that it was caused by an inflam- 
mation of the kidneys, “ which made them draw much serum from the 
emulgents.” Aretaeus attributed it to a feeble and relaxed condition 
of the'kidneys, “which weakens the retentive faculty.” iEtius be- 
lieved that the cause consisted in “ an afflux of sharp or salt humors, 
which continually stimulated the veins to expulsion.” Van TIelmont 
attributed it to a paralysis of the muscles of the bladder. Willis, who 
first pointed out the saccharine character of the urine, thought it was 
caused by “ the dissolution and over-lax frame of the blood, whereby 
it loses its serum before it has done its office.” Sylvius says, “ the 
disease arises from a sharp volatile salt, either received from without, 
or in-bred in the parts.” Cullen, Rollo, and Home, regarded 
the affection as “dependent primarily on a disordered state of tho 
3. DIABETES. DIABETES. 
809 
digestive organs, in conjunction with a defect in the assimilating 
functions.” 
This last opinion is partially correct, and much credit is due to 
Bouchardat for having first pointed out the changes which certain 
aliments undergo in consequence of this disordered state of the diges- 
tive apparatus. Dr. B. broached the opinion that “ in diabetes, starch 
was converted in the intestines into sugar, which passed into the blood 
and urine.” Hence, a diet composed chiefly of neutral azotized sub- 
stances, to the exclusion of starch, has been recommended for the 
cure of this disease, and in some instances, with success. 
It may, then, be safely assumed, that the primary cause of diabetes 
consists, first, in a morbid state of the digestive and assimilative organs, 
which favors the formation of dextrine or sugar, from the starchy or 
farinaceous substances introduced into the alimentary canal, and its 
absorption into the blood and urine. The following are a few of the 
reasons for this opinion: Diabetes is nominally attended from the first 
with a disordered state of the digestive organs, as is indicated by un- 
easy sensations in the stomach after eating, impaired or morbidly in- 
creased appetite, eructation, nausea, vomiting, bad taste, and dryness 
of the mouth and tongue. 
The function of the stomach is exceedingly complicated, and is 
affected, perhaps, more than any other organ of the body, by the na- 
tural or artificial circumstances which constantly operate upon living 
beings. When the organism is in a sound condition, and no disturbing 
causes exercise an influence, the digestive apparatus elaborates 
thoroughly a certain amount of chyle, and the assimilative organs 
take it up and appropriate it in a certain manner. But these functions 
may be impaired, suspended, or even unduly increased by moral and 
physical causes. Ill news, grief, chagrin, mortification, disappoint- 
ment, anger, fear, dread, apprehension, and disagreeable sights often 
suspend both digestion and assimilation. These functions may also 
be impaired or suspended from the abuse of drugs, stimulants, tobacco, 
coffee, tea, sedentary habits, excessive bodily fatigue, want of sleep, 
the irritation of vitiated bile, or of the gastric fluid, or of acids, ex- 
cesses in eating, or the use of indigestible food, inflammation, &c. 
They may also be morbidly increased by tonics and stimulants, liko 
bark, the preparations of iron, the bitter infusions, wine, alcoholic 
liquors, cordials, and condiments. 
In the malady under consideration, the digestive organs are in a 
peculiar condition. The thirst is intense, and the appetite voracious, 
yet the digestive function is perverted, the aliments are imperfectly 
converted into chyle, a superabundance of saccharine matter is ela- 
borated, while the activity of the absorbents is astonishingly increased. 
j That farinaceous aliments are really converted into sugar in the 810 
DISEASES OF THE EXCERNENT FUNCTION. 
stomach of diabetic patients, is evident from the fact that traces of it 
have been detected in the matters ejected by them after the use of 
farinaceous food. It is also proved from the circumstance, that when 
this kind of food is withheld, both the secretion of urine, and its sac- 
charine character is materially diminished. 
Matteucci has demonstrated, that “ starchy substances, when intro- 
duced into the stomach and intestines of diabetic patients, are con- 
verted into dextrine, or sugar, by the saliva, or the pancreatic juice, 
and are then absorbed directly into the blood, either in this form, or 
after having been converted into lactic-acid. 
The experiments of Dutrochet, Cuna, and Matteucci have proved 
that different liquids may pass through the stomach, membranes, skin, 
and other animal tissues, by absorption, imbibition, endesmose, or ex- 
osmose, the activity and direction of these phenomena depending upon 
the character and position of the fluid used, and the physiological con- 
dition of the structure acted on. Thus, “ azotized neutral substances 
dissolved in the stomach by the acid liquid or by the catylic action of 
pepsine, pass into the blood merely by the imbibition of the coats of 
the capillary blood-vessels of the stomach.” Water, and alcoholic 
drinks introduced into the stomach, are also absorbed; they do not 
pass beyond this viscus, nor are they to be found in the chyle, yet 
they reach the blood. 
In diabetes, the digestive organs appear to have lost the power to 
elaborate healthy chyle, and also the absorbents of resisting the 
entrance of the saccharine fluids formed by this perverted action. 
Whether the nature of this morbid condition is of an inflammatory or 
non-inflammatory character, whether dependent upon exalted action or 
laxity, loss of tone or paralysis of the affected parts, is somewhat pro- 
blematical, although Ave incline to the opinion that the disease is essen- 
tially dependent upon a relaxed and enfeebled condition of the diges- 
tive and assimilative functions. 
But an objection will be urged to the above views, on the ground 
that the quantity of sugar found in the urine of diabetic persons is not at 
all proportionate to that of fec>ula taken as aliment; but this objection 
falls to the ground Avhen Ave reflect that the uric-acid and the urea 
derived from the rapid metamorphosis of the tissues, are likewise 
converted into sugar, and pass, Avith the fluids arising from these 
changes, through the blood and kidneys, thus contributing to make up 
the enormous quantity of saccharine fluid Avhich is observed in this 
affection. Prout has shown that the constituent element of urea and 
and sugar are the same, and exist in similar proportions, from which 
fact we can readily comprehend the change from one substance to the 
other, and the affinity exercised by the saccharine fluid circulating in 
the blood upon the urea arising from the transformation of the tissues. DIABETES, 
811 
Second. As a consequence of this primary derangement of the di- 
gestive and assimilative functions, the saccharine fluids formed are 
transmitted rapidly through the blood, absorbing during their course 
the changed area, and finally eliminated by the kidneys. It is the 
oflice of the kidneys to separate from the organism all the substances 
incapable of further use, whether such useless substances are the pro- 
duct of the natural secretions, or of the transformation of the tissues. 
Now, as sugar is a substance foreign and injurious to the blood, it is 
taken up as fast as formed, and conveyed speedily to the kidneys, 
which separate it after it passes off through the bladder. This is evi- 
dent from the fact, that when a solution of vinegar is injected into the 
veins of an animal, it does not remain in the blood, but makes its ap- 
pearance very speedily in the urine. It is on this account that it is so 
difficult to detect sugar in the blood of diabetic patients, although 
traces of it have been found by Dr. Capezzouli, not only in the blood, 
but in the contents of an abscess of a diabetic patient. 
When more saccharine matter is absorbed than can be speedily eli- 
minated by the kidneys, it is highly probable that it passes off through 
the liver, the salivary glands, the pancreas, and even into the abscesses, 
rather than remain in the mass of the blood. 
Third. The kidneys themselves being constantfy acted upon by a 
fluid unlike their natural stimuli, become irritated, their vessels en- 
larged, and thus excited into unnatural activity. This fluid also gives 
rise to an inflammation about the orifice of the urethra. 
Diagnosis.—In tracing the progress of diabetes, and noting care- 
fully the symptoms which are especially characteristic, it will be found 
that a very intimate connection necessarily exists between these symp- 
toms and the pathological conditions above described. 
In the first instance, there are indications of derangement of the di- 
gestive apparatus, as morbid appetite, distress in the stomach after eat- 
ing, flatulent distention, acidity, eructations, nausea, heartburn, lassi- 
tude, and debility. 
When the disease is fully formed, the prominent symptoms are 
urgent and insatiable thirst, voracious appetite, hot and harsh skin, 
and the elimination of an unusually large quantity of urine abounding 
in saccharine matter. 
As the disease advances, the tongue is clammy and white, or clear 
and red; there is distress after eating; a peculiar hay-like odor issues 
from the body and lungs; there are pain and weakness, and sometimes 
swelling in the loins ; anxiety, peevishness, despondency, impaired me- 
mory, vertigo, constipation ; inflammation about the penis and the ori- 
fice of the urethra; rapid and great emaciation ; loss of strength, im- 
potence, coldness of the extremities, difficulty of breathing, dropsical 812 
DISEASES OF THE EXCEENENT FUNCTION. 
effusions, weak and frequent pulse; great prostration of all the 
powers. 
The diabetic patient, wrho daily receives a few pints of fluid, may pass 
three gallons of urine every twenty-four hours for weeks together. Dr. 
Watson mentions a boy who, though restricted to one and a half pints 
in twenty-four hours, passed during that time ten and a half pints, 
without losing flesh or weight. On one occasion the boy was weighed 
immediately after emptying the bladder. Three hours afterwards, 
although he had taken neither food nor drink, his weight was increased 
by one pound, and he voided then sixteen ounces of urine, which Dr. 
W. ascribes to absorption from the air. 
Diabetic urine is of a straw color, of a disagreeable odor, and a 
sweetish taste. The quantity voided in different cases varies very 
much; some patients voiding as much as fifty, or even one hundred 
pounds in twenty-four hours—while others pass only eight or ten 
pounds during the same period. The average quantity voided in 
twenty-four hours may safely be placed at about fifteen pounds. 
Diabetes usually continues for months, and sometimes years, before 
it terminates fatally. Hitherto it has been almost invariably fatal; but 
may we not hope that the discoveries which are still being made in 
organic chemistry, as well as in the practice of medicine, will enable us 
yet to understand and conquer this singular malady? 
The more recent researches on the Pathology of Diabetes show that 
the liver is supplied with blood through the medium of the hepatic 
artery and portal vein ; in the lobules of the liver the bile is separated 
from the blood and sent off through the biliary ducts. During the pro- 
gress of the blood through the liver, sugar is formed / and it is con- 
veyed with the venous blood to the heart and lungs, through the me- 
dium of the hepatic veins which pass it into the vena cava inferior, 
and to the right auricle of the heart, from which it passes into the 
right ventricle, and from this into the lungs. The mode by which 
these operations are conducted is extremely intricate, requiring for its 
elucidation a clear knowledge of the cerebrospinal and the sympathe- 
tic nerves.* 
Analysis of the blood by Lehmann, as seen in his experiments on 
animals, shows : 
1. That blood taken from the portal vein before it enters the liver, 
contains fibrine, albumen, fat; a small quantity of blood-globule-s, but 
no sugar. 
2. That the blood in the hepatic veins, after passing out of the 
liver, contains a large quantity of sugar, some blood-globules, no fibrine, 
and no fat, the fat having passed on through the biliary organs; and 
* Dr. Geary, of Phila., N.A. Jcur. Homoeo., Yol. 10, p. 627. DIABETES. 
813 
the fibrine has entirely disappeared, having in fact been converted into 
sugar in the liver. 
And this is found to be the case whatever be the character of the 
food, whether vegetable, animal, or indeed composed of sugar itself; 
but the presence of fever arrests the production of sugar. The sugar 
created in the liver passes with the blood to the heart and lungs, but it 
disappears in its passage through these organs, since none or scarcely 
any is found in the arterial blood. It is thus seen that the liver Torms 
sugar and transmits it through the heart to the lungs ; and that the 
lungs convert it into some other material, supposed by Bernard to be 
lactic-acid, though it may not yet be known what the character of the 
new product is. The bearing of the facts already reached on the nature 
of diabetes is highly important, when the relations of the liver to the 
nervous system are remembered. 
The liver is principally supplied by the pneumogastric nerves. 
These nerves originate in the medulla oblongata, very near to the res- 
tiform bodies, and pass downward to enter the thorax, sending off a 
branch called the recurrent nerve, to the lungs; proceeding forwards 
to the stomach they disappear in a plexus of nerves; and from this 
plexus they spread over the liver. 
Experiments of M. Bernard.—1. Having cut the pneumogastric 
nerves in the neck, he killed the animal next day, and found no sugar 
in the liver. 
2. He divided the branch of the same nerve that comes off from it, 
at a point below the origin of the pulmonary branches, leaving intact 
the connection between the lungs and the liver. After this opera- 
tion the formation of sugar in the liver went on as usual. 
3. By a series of experiments with a sharp-pointed instrument, he 
produced an irritation of the spinal cord, at the spot where the pneu- 
mogastric nerves arise, which in a very short time had the effect of 
making the urine diabetic. 
4. After the jvrst experiment he passed a current of galvanism down- 
wards to the liver, which had no effect; but when the same current 
was passed upwards towards the origin of the nerves, sugar was 
formed in the liver, but in a proportion far less in excess of the normal 
or healthy condition. 
These experiments prove that the vital force passes from the brain 
through the pneumogastric nerves to the liver, and enables this organ 
to convert the fibrine of the blood into sugar; but the liver can only 
form the sugar when in telegraphic communication with the lungs; 
and a deranged condition of the nerve-centre, either by disease or 
injury,produces a surplus quantity of sugar, which not being consumed 
by the lungs, passes on into the renal arteries to the kidneys which 
separate the extra sugar with the urine; and 5th, It is proved that 814 
DISEASES OF THE EXCERNENT FUNCTION. 
diabetes is caused by a diseased state of that part of the brain in 
which the pneumogastric nerves are immediately connected; and there- 
fore no change in the diet of the patient can alone cure this disease. 
Treatment.—If either of the above theories advanced respecting 
the nature of diabetes be correct, it is still true that one of our most 
important therapeutical indications consists in pointing out a proper 
system of dietetics. We have seen that through a perverted action 
of the digestive apparatus, all the farinaceous or starchy substances 
consumed become converted into sugar, and thus afford material 
for the perpetuation of the malady. A rigid abstinence from every- 
thing of a feculent nature should, therefore, be insisted on, while, at 
the same time, a diet as nutritious as possible should be enjoined, con- 
sisting of beef, mutton, venison, fowl, game, fish, animal soups, jellies, 
and articles of this nature. We commend most strongly as a valuable 
auxiliary means in this affection, sea-voyages, and frequent applica- 
tions to the whole surface of the body, of salt-water. The free use of 
ice, in small quantities, gradually dissolved in the mouth, will also 
prove serviceable in allaying the extreme thirst which consumes the 
patient. 
The internal remedies which have been found most serviceable in 
this disease are : Acid-phosphoric, Carbo-vegetabilis, Nux-vomica, 
Acid-muriatic, Baryta-muriate, Belladonna, Uva-ursi, Rlius-radi- 
cans, Conium-maculatum, Digitalis, and Opium. 
Kreasote.—A man, aged twenty-eight, discharged in twenty-four 
hours twenty quarts of urine, containing twenty ounces and nine 
drachms of sugar. He was cured by Dr. Michalsky, by the continued 
use of Kreasote pills and a rigid prohibition of all vegetable food. 
(Prague Ver. Ztng., No. I., 1855.) 
M. Piorry says a woman passed ten quarts of urine daily. She ate 
120 grammes of sugar-candy and two portions of meal, with scarcely 
any liquid nourishment. She was losing nearly 700 grammes of sugar 
in twenty-four hours. After this the urine diminished to quarts 
per day, on treating the other symptoms and keeping up the supply of 
sugar. 
Dr. Geary gives two cases of diabetes.* In one of these a lady who 
had -‘■he disease as a consequent of cerebral irritation and apoplexy— 
dietetic regulations made the disease worse rather than better. The 
second case, a boy, aged eleven, had diabetic symptoms always when 
affected with fever. After one attack he had intense thirst, con- 
siderable fever, and passed from eighteen to twenty pints of water 
in the twenty-four hours; the color was light, the odor natural, gravity 
1010, without any trace of sugar.” In view1 of the cerebro-spinal view 
* N A. Jour. Homceop., Yol. X., p. 629. DIABETES MELLITUS. 
815 
above given, he was treated with Aeon. 2, and Arsen. 6, which produced 
slight improvement. The improvement being but slight, Ignatia 2, 
and Bell. 2 were given alternately every hour; and a powder of Cu- 
jprum-acet. every six hours. The patient immediately improved, and 
in about eight days was free from every trace of the disease. 
4. DIABETES MELLTTUS, COMPLICATED WITH PIARRILZEMIA, or 
FATTY SUBSTANCE IN THE BLOOD. 
Dr. Coote, of the Middlesex Hospital, London, on reporting one case 
and reviewing the authorities on this disease, concludes: 1. “ That 
piarrhsemia consists in an excess of saponifiable fat in the blood, not in 
the mere liberation of fat from its combinations. 
2. The excess of fat in the blood may be the result: a, of the 
excessive ingestion of fat (as in piarrhaemia during digestion;) or, b, 
of the diminished elimination of the same, (as in hybernation and pul- 
monary diseases). It is not clear to which of these categories alcohol- 
ism belongs. It is conceivable that its elements may be directly 
converted into fat by deoxydation; but it seems more probable that 
the conversion is effected indirectly, the hydro-carbon of the alcohol 
attracting to itself the free oxygen which would otherwise have been 
employed in the combustion of the fats of the food, and so permitting 
the accumulation of the latter in the blood. 
3. Fat, if directly ingested, may enter the blood with the chyle 
through the thoratic duct; but it is clear from the present case that it 
may also be elaborated in, and absorbed directly from, the liver. 
4. Piarrhaemia is not a result of diabetes mellitus, for either may 
exist without the other. Both seem to be the consequences of the 
same derangement of the functions of the liver, which overloads the 
blood, sometimes with excess of sugar alone, sometimes with an ex- 
cess of sugar and fat combined. 
Why the liver should deal so differently in different cases with 
hydrocarbons submitted to its influence it is hard to say. It seems 
not improbable that sugar alone is elaborated in the first instance, and 
that the excess of fat is the result of de-oxidation of this substance; 
the conversion of sugar into fatty substances is not only capable of 
being effected experimentally, (as in the production of butyric-acid 
by fermentation of sugar under the influence of casein,) but has been 
shown to take place in the animal economy, in the formation of wax 
by bees fed only on sugar. (Miller’s Chemistry, Vol. III., p. 738.) 
5. The pathology of blood, milky from molecular albumen, must be 
considered as still almost wholly negative. “ It is probably never an 
independent affection; but neither is it a mere accidental consequence 
of piarrhaemia. Its apparent relation to albuminuria seems to point to 816 
DISEASES OF THE EXCERNENT FUNCTION. 
some organic change in the constitution of the plasma of the blood 
itself.” (London Lancet, Nov. 1860, p. 411.) 
CHEMICAL EXAMINATION 
OF URINE IN DIABETES AND RELATED DISEASES. 
Diabetic TJrine.—Diabetic urine always contains in addition to free 
grape sugar, the compound of this sugar with common salt, and it 
frequently happens that this is the only compound which separates in 
crystals from diabetic urine. This fact is to be considered in relation 
with the common instinct to add much salt to amylaceous food which 
during digestion yields much sugar. 
Sugar is also met with in no inconsiderable amount in the blood of 
the carnivora, and must therefore be dependent upon some other source 
besides the carbo-hydrates introduced into the body from without. 
Mialhe has suggested that diabetes mellitus depends solely on the 
absence of the necessary quantity of alkali in the blood for the oxida- 
tion of its sugar. It would certainly seem probable, says Lehmann, 
from careful examination of the chemical facts in our possession, that 
this simultaneous action of the alkali and of the free or imperfectly 
fixed oxygen upon readily oxidizable substances might afford an ex- 
planation of the entire process of oxidation in the animal organism. 
But this is by no means the case. So far as my direct investigations 
of the blood of diabetic patients extend, the most careful ash analyses 
do not show that there is any such diminution of the alkali, nor do the 
analysis of the serum exhibit any diminution of the albuminate of soda. 
Injecting grape sugar into the veins of dogs and rabbits, Bernard 
formed the urine alkaline and no sugar in it, but Lehmann in thirty- 
seven cases always found sugar and the urine acid, often intensely acid, 
and even when rabbits had been fed before and after the injection with 
cabbage leaves, carrots, grass, and other substances rich in alkalies. 
But sugar can only be separated from the blood when there is ex- 
cess of water in the latter, then it is separated so rapidly as to appear 
in the urine five minutes after its injection and that when only 0.1 of 
a gramme has been injected. 
When one equivalent of sugar with 1, 2, or 8 equivalents of caustic 
potash, or its carbonate was injected, or when the sugar and potash 
compound artificially prepared from alcoholic solutions, was injected in 
such quantities that 0.1 of a gramme of sugar reached the blood, the 
urine remained alkaline for at least ten minutes after the injection, be- 
coming then decidedly acid, in which state it continued for at least 
five hours, even when the animals had been fed in the interval on green 
food. In the seventh hour the free acid diminished when food of this 
kind had been taken. In all cases sugar could be detected in the DIABETES MELLITIJS. 
817 
urine from the first five minutes after it was injected, to the eighth and 
often to the eigtheenth hour. The acid produced is certainly neither the 
phosphoric nor hippuric, but I have been unable, from the small amoun 
of material for investigation, to decide what it is. 
Ammonia*—Physiological origin. This question is still in the do 
main of debatable science. Neubauer has settled it, however, that in 
case of taking into the stomach the hydro-chlorate of ammonia, this salt 
passes unchanged through the system and is discharged in the urine.* 
It remains to be shown whether ammonia in other forms and combina- 
tions is thus eliminated, and whether or not it is spontaneously gene- 
rated in the organism, whether by its normal or pathological acts. One 
test, the formation of white vapors on cont act of the breath with a glass 
rod dipped in hydro-chloric-acid frequently fails, says Thudicum, in 
cases with the most marked symptoms of uraemia. Here, as in putrid 
or septic fevers, analysis of the blood and secretions, especially of the 
urine, are necessary, in order to establish the relations of ammonia with 
toxaemia or septicemia. The ammonia sometimes found in the urine 
may have been introduced either by our food and drink or by the air 
which we breathe. 
Radishes are rich in ammonia, so is tobacco smoke and the fumes 
of barn-yards, of privies, and of dissecting-rooms. 
Bence Jones found that after the salts of ammonia had been taken 
internally they did not re-appear identically in the urine, but their 
highest product of decomposition, i. e. that of nitric-acid ; a discussion 
on this subject between Jones and Lehmann will be found in Lehmann's 
Phys. Chem., p. 127 of Yol. II., and Proceedings of the Royal Society, 
Yol. VII., p. 91. 
In typhus, scarlatina, variola and other severe forms, of fever ammo- 
nia often exists largely in the blood, but not constantly. 
The presence of ammonia in normal urine is supported by the ana- 
lysis of Boussingault, and especially those of Neubauer with Sclos- 
ing’s method for the volumetrical analysis of ammonia in the urine. 
See also the analysis of Heintz, with the chloride of platinum, and the 
researches of Baecker and He Yry. Liebig, Scherer and Lehmann 
have expressed their doubts. Dr. Richardson in his Astley Cooper 
Prize Essay for 1856, “ On the Cause of Coagulation of the Blood,” has 
endeavored to show that ammonia is a regular constituent of the 
blood and the solvent of fibrine in the living body. 
Demonstration of the presence of the Ammonia in Urine, f — 
Liberated from urine by admixture with the milk of caustic lime, 
ammonia is made to rise as gas in a vacuum at 40° to 50° of tempera- 
ture, into a solution of sulphate of silver and arsenious acid. It 
* Journal fur. prac. Chem. Bd. 64, p. 281. 
f Neubauer, Journal fur practisclie Chernie, Bd. 64, p. 177, and Anleitung, § 56. 
You n—52. 818 
DISEASES OF THE EXCERNENT FUNCTION. 
causes a precipitate delicate, dense, yellowish white, constituted by 
arseniate of silver, and easily soluble in the slightest excess of acid. 
Urea is not decomposed by such treatment. For the quantitative de- 
termination of ammonia, see Thudicum, 220 and 225. 
Ammonia is non-existent in fresh urine. In mentioning the experi- 
ments of Boussingault, Lehmann questions whether the colored ex- 
tractive and other nitrogenous matters of the urine, more easily de- 
composed than urea, may not have furnished the ammonia appreciated. 
Ammoniacal Urine the Result of Spinal Lesions.—The idea that 
deficient nervous energy in paraplegia was the direct cause of decom- 
position, (converting the urea into carbonate of ammonia) is now aban- 
doned, says Mr. Barclay, in his treatise on “Medical Diagnosis.” Does 
he mean that the urine is found ammoniacal in the paraplegic and other 
non-inflammatory conditions, merely on account of having been per- 
mitted to remain in the bladder long enough to undergo its normal 
changes at the temperature of the living body ? Normal urine kept, 
after being voided, at a temperature of 98°, F., becomes ammoniacal in 
a few hours. Such would be the length of time required for the 
retention of urine in the bladder in order that it should in the first in- 
stance become ammoniacal, and thus be prepared to act as a specific 
ferment on fresh urine. 
Here Dr. Snow’s experiments seem to show that urine of various 
dates, not yet alkaline, shortens the period of ammoniacal change for 
fresh urine mixed with it gradually. So that normal urine at 100°, F., 
dropping from one vessel into another, is constantly acid in the upper 
vessel, which is washed every six or eight hours, constantly alkaline 
in the lower vessel, in which a few drops of stale urine are left each 
time. The access of air accelerates the ammoniacal change in this ex- 
periment, or contact with the healthy living bladder would retard it, as 
is seen in cases of enlarged prostate, where the urine evacuated arti- 
ficially only twice a day is still acid. 
Dr. Gr. Bird observes that mechanical obstruction, to the complete 
evacuation of the bladder, as by viscid mucus or by a clot of puriform 
mucus once gelatinized by the carbonate of ammonia, ensures the am- 
moniacal change in the urine and deposit of its earthy phosphates with 
carbonate of lime, even though the bladder retain contractile power 
sufficient for complete evacuation of its ordinary or normal contents. 
Hence when the washing out of the bladder by injections is neg- 
lected, the patient, whose innervation has been improved, may still 
continue to suffer from the effects of a foregone cause. 
There are differences of opinion as to whether spinal lesions impair- 
ing the innervation of the urinary organs, cause ammoniacal urine 
merely by determining the incomplete expulsion of the contents of the 
bladder, or by directly determining an unhealthy secretion of mucus, DIABETES MELLITUS. 
819 
alkalescent like that of inflamed mucous membranes. Mr. Curlin°: in- 
dines to the latter opinion, adding that the extension by continuity of 
tissue, or by the general lesion of innervation of this irritable state of 
the bladder to the kidneys may cause the urine to be actually secreted 
in an alkaline state. Mr Bird has observed the change from alkaline 
to normal urine in a case of complete paraplegia, effected by the simple 
precaution of washing out the bladder with warm water injections, a 
measure imperative in such cases, whether it be regarded as a pro- 
phylactic or merely as palliative of an incurable state. Still G. Bird 
regards the depressed vitality of the bladder as the initiative in the 
alkaline fermentation of urine. The reduction of the vesical sensibility 
probably coincides with sub-acute inflammatory change, by abstracting 
the control of the sympathetic nerves over the vascular system, a-s ob- 
served in the numerous experiments on the cervical plexus and else- 
where where sections have been made, isolating a given part of the 
body from this ganglionic innervation. The eye becomes immediately 
suffused by congestion, while the iris no longer dilates consensuously 
with the needs of the retina. The lesion of organic sensibility here 
as in the bladder coincides with modifications in the vascularity and 
consequently in the secretion from the capillary vessels. 
Alkaline urine from nervous exhaustion, watching, mental exertion in 
study, mental exertion in the forum, &c., sexual excesses, sperma- 
torrhoea, will be appreciated on the same general principles with defi- 
ciencies of the sympathetic innervation through lesions of the spinal 
cord. Whatever depresses the nervous vitality opens the tissues to 
vascular inundation; as on the other hand, all that depresses the cir- 
culation and reduces or deteriorates blood globules, gives the signal 
for spontaneous manifestations of neuralgia, spasm, or other forms of 
hypergesthesia. 
Owen Rees has shown the benefit of alkaline treatment where the 
alkalinity of the urine is due to irritation or inflammation of the 
mucous membranes. 
Dr. Simon states from observations made under the authority of 
Prof. Schonlein, of Berlin, that in continued fever, about the end of the 
second week, and in severe typhoid, at the period when comatose 
symptoms set in, the acid and deep-colored urine becomes pale and 
alkaline, containing carbonate of ammonia in solution. This general 
observation is not confirmed by G. Bird or Becquerel, but G. Bird 
observed it to be the case in one epidemic of maculated typhus 
and Dr. Graves, of Dublin, has made similar remarks in sporadic cases 
where great exhaustion existed. 
The researches of Drs. Sutherland and Rigby on the urine of the 
insane, appear to authorize the assumption that central lesion, inde- 
pendent of any obvious implications of spinal mischief may induce 820 
DISEASES OF THE EXCERNENT FUNCTION. 
the conversion of urea into carbonate of ammonia. They found the 
urine effervescent on the addition of Acetic-acid in thirty-four per 
cent, of cases of dementia, thirty per cent, of melancholy, and sixteen 
per cent, of mania. 
The urates often coexist with free uric-acid, oxalate of lime, pus, or 
blood. Such deposit will be diminished by heat, which dissolves the 
urates. Uric-acid appears in visible yellowish-red crystals, which 
behave as before-mentioned, and are not affected by acetic-acid. Pus 
and blood are both albuminous; they are made to deposit by the same 
heat and nitric-acid tests which dissolve the urates and phosphates, 
and uric-acid; they in turn are dissolved and gelatinized by alkalies* 
Blood contains haematine, which pus does not. If difficult of recogni- 
tion on account of its dissolved state in ammoniacal urine, cautiously 
neutralize this with a trace of acetic-acid in excess, heat in a water- 
bath at 151 F., when all the albumen will be found in form. 
We have already treated of albuminous nephritis at p. 21, of this 
volume. Dr. Joslin details some eases of this disease* by homoeopathic 
attenuations, which are thus summed up : Case 1. A New-York merchant, 
temperate, aged thirty-three; found to be subject to this disease. 
Nov. 13, 1857. A month before spent some nights at a country-seat 
in a malarious district, where he took intermittent fever, from which he 
recovered under Bry. 30. * After dropsical symptoms appeared he was 
treated for a month with little effect, while the enlargement of abdo- 
men and limbs increased; by the 25th of{November his ordinary 
clothes would not button round him, the feet, legs, and abdomen were 
distended, breathing becoming difficult. 
December 13. The face pale and yellowish, the abdomen much dis- 
tended, and the pressure of the liquid, especially against the diaphragm, 
rendered the respiration laborious. No oedema of the abdomen, but it 
had pervaded the whole subcutaneous areolar tissue of the inferior 
extremities, feet, legs, and thighs; urine reddish brown, and after 
standing, turbid ; cough. 
The following symptoms have been produced, by Apis-mellifica.f 
“Paleness of the face; abdomen full, swollen ; with swollen feet and 
scanty secretion of urine ; scanty, highly-colored urine ; cough in the 
morning; breathing difficult.” For the above symptoms Apis 2 was 
prescribed in water every four hours. 
In the first day the abdomen increased in circumference three- 
fourths of an inch, and a general aching through the head, unusual 
*o the patient. These two symptoms were regarded as medicinal 
5. ALBUMINURIA. 
* Amec- Horn. Review. Yol. IT. p. 260. f Hering. Brit- Jour. Horn. Vol. IX HYDATIDS, 
821 
symptoms. On the next day the abdomen was diminished half an 
inch, and as much more the next day. There was no change in size 
of abdomen in two days under Apis tV ; in the next two, under the 
same, decidedly reduced; and by the same amount in the next three 
under Apis 2. This last was continued four days longer, and the 
ascites was slightly reduced, that of the extremities also lessened, that 
of the thighs gone. In the three succeeding days, much reduction of 
swelling, especially in the feet, under the prolonged action of Apis 3 
previously given. In the following week, beginning Dec. 31st, the 
improvement continued under Apis 12: the upper half of the legs 
became normal and the fat reduced. In the next thirteen days, under 
the same, a great improvement in general strength and flesh, and limi- 
tation of effusion to the lower part of the legs, where only a very small 
quantity remained. In eight days more the oedema was entirely 
removed under Apis 30. After two years neither the encysted nor 
cellular dropsy had in any degree returned. 
In a second case treated by Dr. Joslin, the urine was half albumen. 
The dropsy increased in three days under Apis 12. In the next two 
days, under Apis 10, the peritoneal dropsy increased with a rapidity 
unprecedented in the case, whilst a little improvement occurred in the 
thighs, and more in the urinary secretion. Two days afterwards, under 
Apis 3, the albumen was found to have entirely disappeared, the 
ascites to be greatly, and the oedema of the whole inferior limbs decid- 
edly reduced, and the urine to present a remarkable violet hue. In 
the next two days, under Apis 3, diluted one hundred fold, the ascites 
slightly improved, and the oedema decidedly reduced, the albuminuria 
remaining cured. In four days, under Apis 12, the ascites and the 
dropsy of cellular tissue were entirely removed. Some tinge of violet 
was observed in the urine till after the action of Apis 30, but no drop- 
sical symptom, nor any evidence of albuminuria had appeared a year 
afterward. 
GENUS III.—HYDATIDS. 
Hydatids are found in serous cavities, the alimentary canal, in the 
passages that open into the cellular tissue between the muscles, and 
in the proper substance of dilferent organs. They are found in mam- 
malia, all reptiles, birds, and fishes; though they are not known to 
exist in insects. In the human subject no period of life is exempt from 
them, from an early stage of uterine existence. {Portal.) 
Hydatids are parasites. They have no genital apparatus, no 
organs for respiration or circulation, and no apparent nerves. They 
only live in the interior of other animals, perish within a year or two 
after development, and often in less. Few only can be excited by 822 
DISEASES OF THE EXCERNENT FUNCTION. 
stimulants to distinct movements. The cystercus whirls itself about 
in wTater, protruding its suckers. 
Hydatids are divided into two classes, cephalocysts and acepha- 
locysts. 
I. Cephalocysts.—Divided into, 
1. Cystercus, or bladder-tailed hydatids. 
2. Polycephalus, or many-headed; not found in man. 
3. Dicerus, or two-headed. 
4. Echinococcus, rough hydatids, very rare. 
II. Acephalocysts.—These are more common in man, in various 
organs and of all sizes from a mustard seed to a large orange. Gene 
rally spherical, composed of a white, clear, limpid, semi-opaque, pulpy 
vesicle. This vesicle, which forms the hydatid proper, is from i of a 
line to £ of an inch in thickness, often separable into two or more 
tunics, and so delicate as to yield to the slightest pressure; its own 
contents often break through the thin w'alls after removal from the 
body. After being ruptured it sinks into a soft, irregular, pulpy mass, 
of opaline color, which swims in water, and resembles coagulated 
albumen. Sometimes the acephalocyst contains several smaller ones, 
each within another. Each one having arrived at maturity, produces 
another within itself, each successive production being smaller 
(Gross.) 
Causes of Acephalocysts.—“In Cincinnati,” says Dr. Gross, “there 
are annually killed more than one hundred thousand hogs, of which 
not one-tenth are free from this disease.” Whole droves, of several 
hundred, on being brought from the rich prairie-districts of Ohio, Indi- 
ana, and Kentucky, “ are highly fed for six or eight weeks with corn, 
a strong food, which keeps the portal circulation in a state of conges- 
tion which tends to inflammatory irritation and development of acepha- 
locysts in the liver. The irritation thus set up is of a specific nature, 
or, what is the same thing, a sort of plastic lymph is deposited; the 
particles of this lymph arrange themselves in such a manner as to 
create an inferior being, an entozoic parasite.” There is probably no 
inflammatory action generally, but the origin of the parasites is cer- 
tainly connected with the excessive use of a strong diet. 
Serous Cysts.—These bear some resemblance to the acephalocysts, 
but they differ from them in being attached always to surrounding tis- 
sues which supply them with blood. They are sometimes solitary and 
simple, or with a single cavity. Others are divided into many com- 
partments, each containing a peculiar fluid. In some cases a large 
number of serous cysts maybe aggregated into one cavity, attached 
directly to its parieties or joined together. (Drake, Louisville Medi- 
cal Journal, 1841. P. 294.) 
These cysts, says Gross, are a new formation caused by a perverted HYDATIDS, 
823 
Btate of nutritive function. Others appear to be formed out of existing 
textures, sometimes of serous, at others of a mucous nature. To the 
former belong the cysts of the ovaries, enlarging the vesicles of De 
Graaf; to the latter kind belong those developed in the kidneys and 
female breasts from the obstruction of the excretory ducts. In this 
situation it may receive no accidental covering from the organ in 
which it is located. In the ovaries we generally find that the cyst is 
easily provided with thick, dense parietes, separable into three distinct 
layers, the internal of which consists of the capsule of the vesicle of 
De Graaf, the second of the albuginous, the third of the peritoneal 
coat. The same thing occurs in the spleen and liver. When the cyst 
is formed out of existing mucous membrane, it generally in a short 
time assumes all the properties of the serous texture. (Elements of 
Pathological Anatomy.) 
These cysts may be said to be secreting surfaces without excretory 
ducts, hence their great size, increasing by the stimulus of distention 
and may arise to the bulk of the gravid uterus, presenting externally 
all the characteristics of ascites. Dr. Drake mentions two cases in 
which ovarian cysts so filled the abdominal cavity that their character 
could only be known from their previous history. (Louisville Medi- 
cal Journal.) 
Mr. Owen (Lectures Compar. Anat., p. 45) regards the common 
hydatid rather as “ a morbidly enlarged organic cell, than as an inde- 
pendent animal even of the simplest kind.” He says “ the tunic of the 
acephalocyst is usually studded with more in less numerous and minute 
globules of a clear substance, analogous to the ‘ hyaline/ whose remark- 
able properties in reproductive cells Dr. Barry has recently described, 
and from which the young acephalocysts are developed.” Hydatids 
have no voluntary contractile property, and no function but the assimi- 
lation of the surrounding fluid, and the development of new cells from 
nuclei of hyaline. 
Serous Cysts, when they are not natural cavities enlarged, but are 
adventitious productions, are in all cases allied to those semi-solid,, 
atheromatous, and steatomatous tumors called wens. Even these 
may be natural cellules in a state of hypertrophy, reinforced in 
their parietes by new deposits of nutritive matter, or by condensation 
of surrounding cellular tissue. In this way an obstructed follicle 
may, in the opinion of Sir A. Cooper, expand into an atheroma, and 
the fatty tumors generally may be nothing more than hypertrophied 
adipose vesicles. {Drake.— Gross, Pathol. Anat) 
Hydatids.—These tumors are more common in the liver than in any 
other organ. They are common in various animals, especially sheep, 
and the liver with them is the organ most likely to be their seat. 
When one sheep of a flock is affected with them all the rest of the 824 
DISEASES OF THE EXCERNENT FUNCTION. 
flock will become so. They are more common in wet seasons and in 
pastures where the ground is too wet. 
The contents of hydatids are usually transparent and limpid as 
water; though the fluid is so acrid and irritating to the serous mem- 
branes that when, from the bursting of a hydatid cyst, the contents 
are effused into the peritoneal cavity, rapid and intense inflammation 
is excited. Mr. Hawkins gives several cases in which the fluid from 
hydatid cysts in the mammae caused sloughing and fungoid ulceration. 
In some cases the cyst contains more solid matter, consisting of phos- 
phate of lime, a little carbonate, and albuminous substance. 
When there is a hydatid tumor in the liver, there are often others 
in the lungs, spleen or some part of the mesentery. In some cases, 
thousands of hydatids are found under the peritoneum, and between the 
folds of the mesentery. 
Hydatid tumors, when once established, throw off new tumors which 
grow to a larger size and become the parent cysts of others like them- 
selves. It is often difficult to determine the point in which the parent 
tumor originated. The largest one, with the thickest walls, is gene- 
rally found in the liver when others are found in the lungs, or in the 
spleen or mesentery. It is supposed that single germs may pass 
through a branch of the hepatic or portal vein, or into one of the lym- 
phatics, into the lungs, or into other parts of the liver, or into the 
mesentery. This view of the movement of the germ hydatids requires 
that they should pass backward against the current of the blood in 
the veins that uniting form the vena portae. But it is still true that 
the largest, and apparently, the parent cyst found any where is usually 
in the liver. (Budd, On the Liver, p. 354.) 
The only specific remedies known to have affected the destruction 
of these entozoa are: 1. Iodide of Potassium; 2. Chloride of 
Sodium. The exemption of sailors from hydatids was attributed by 
Mr. Bush, of the Dreadnought Hospital, to the influence of sea air. 
The effort to remove hydatids by puncturing them to discharge their 
contents has in a few cases succeeded, but in many more the most 
disagreeable consequences have resulted. The effort should not be 
made unless the urgency of existing symptoms calls for immediate 
relief. (Caesar Hawkins.) 
The disease called the rot, in sheep, depends on the existence in the 
liver and gall-bladder of the parasites, known as liver flukes, distoma- 
hepaticum and distoma-lanceolatum. 
The putrefaction of animal substances does not consist in chemical 
decompositions alone, but in the formation of minute animalculse, called 
infusoria. These exquisitely small, but living and organized beings, 
consist, at first, of only “ one or more small globules, grouped together 
side by side, and endowed with a sort of creeping or rotatory motion.” HYDATIDS 
825 
The animalcule called vibrios, are found in various animal fluids, and 
may almost always be seen by examining, with a microscope, the mat- 
ter that accumulates between the teeth. Lieuwenhock has shown that 
“ scarcely any animal substance putrefies without becoming the food 
of myriads of animalcule.” 
In every article of food, that is permitted to stand only a few hours 
in a warm place, putrefaction commences by the spontaneous formation 
of minute living animals. A boiled potato, in a small quantity of 
boiling water, left to stand in a glass vessel well covered, was found by 
Mr. Ellis, after twenty-four hours, to be alive with moving animalcule ; 
and another raw potato, similarly situated, and by its side for an equal 
length of time, had undergone the same change. The animalcule 
were “ of the linear shape, very distinguishable, moving to and fro with 
great celerity, so that there appeared to be more particles of animal 
than of vegetable matter in each drop.” The same result followed 
in every experiment made, whatever kind of water was used. Minute 
living creatures were formed, which “ moved rapidly in different direc- 
tions, turning themselves quickly round at the same time that they 
moved rapidly forward.” (jPkilos. Transactions, Vol. 59, 1767.) 
Experiments have been made by Buffon, Reaumur, Ingenhouz, under 
great diversities of situation, and in all of them microscopic animal- 
culm were developed, in all infusions of animal or vegetable matters. 
They put boiling veal broth into a vial, previously heated in the fire, 
and, hermetically sealing it, they left it three or four days. When 
examined, they found in it the same development of living infusoria. 
And it will everywhere be found that, wherever vegetable or animal 
matters are permitted to stand a few hours, under favoring circum- 
stances, vegetable fungi or animalcular infusoria will be developed, 
with a rapidity proportioned to the temperature. Even the mucus that 
adheres to the teeth almost always contains them; and it has been 
shown, by M. Mandl, that the tartar on the teeth “ consists almost 
entirely of the skeletons of dead vibrios, cemented together by dried 
mucus.” 
The difficulty of accounting for the origin of organized living pro- 
ducts, in situations in which it would seem impossible that seeds or 
oviform matter could be deposited, does not destroy the force of well- 
attested facts. The filaria, or thread-worm, originates, in some way 
m the eyes of horses, and grows to an inch in length, as large as a 
sewing-thread, and moves rapidly about in the aqueous humor. It 
causes inflammation, opacity of the cornea, and may be extracted. 
(Lawrence on Disease of the Eye, p. 532.) These thread-worms have 
found in the eyes of cattle, sheep, pigs, frogs, lizards, fishes, birds, and 
even in the human eye. Dr. Guetner extracted one, called a Guinea 
worm from the eye of a negro girl, in the West Indies. The process 826 
DISEASES OF THE EXCERNENT FUNCTION. 
by which they originate, is not our present object. Many philosophers 
have supposed that living organized beings of the lowrest orders may 
be produced by a spontaneous vital process, which at first extends 
only to the formation of the simplest and lowest grade of animal life. 
Infusoria and vibrios are reproduced by solitary propagation, by one 
cell growing on and detaching itself from its parent. From this low 
beginning they rapidly improve, as the species advances to more per- 
fect forms. “ To suppose,” says Darwin, “ the eggs of former micros- 
copic animals to float universally in the atmosphere, and pass through 
the sealed glass vial, is so contrary to apparent nature as to be totally 
incredible! and, as the latter are viviparous, it is equally absurd to 
suppose that their parents float everywhere in the air, seeking an op- 
portunity to leave their young in paste or vinegar.” Berutti endea- 
vored to show that infusoria are developed by spontaneous generation, 
lie considers the acarus scahiei the product, as well as the cause of 
itch; and says that zoosperms “ are not genuine animacules, but or- 
ganic molecules, formed in the minute extremities of the spermatic 
tubes, by the effect of an exuberant nutrition.” In the same wTay we 
may account for the origin of intestinal worms, which nowhere exist 
in the outer world. The sarcina ventriculi, found in the stomach, 
have a similar origin. It is no longer believed that all animal exis- 
tences, found in unusual places, must necessarily have been produced 
from eggs introduced from without. We see “ worms found in seeds, 
and nuts, in woods, in stones, on leaves and plants, and in them. We 
see clouds of flies suddenly rising in new localities, and ‘ army worms’ 
emerging from the ground and marching in solid phalanxes, over the 
the neighboring fields, spreading destruction before them; and also 
the most minute creatures developed in offensive waters, sour wines, 
pestilential air; and we see offensive effluvia and exhalations rising 
from plants, earths, and stagnant waters, in which noxious animalculse 
are developed.” Thus, wherever dead animal or vegetable substances 
exist, in combination with heat and moisture, we see these substances 
speedily invaded by the destroying legions of cryptogamie plants, or 
living infusoria. We see that the disorganization of these substances 
is effected, not by chemical laws, but by the rapid growth of these 
mysterious living creatures, which constitute the lowest order of organic 
existence. We treat them all with antipsorics, as the kidney worms in 
hogs by Arsenic. 
GENUS IV.—PAROSTIA.—DISEASES OF THE BONES. 
Composition of Healthy Bone.—From the researches of Berze- 
lius, arid more recently those of Marchand and Frerichs, it seems that 
the healthy bones are composed of about fifty-three parts of phosphate DISEASES OF BONES. 
827 
of lime, and ten and a half parts of carbonate of lin.e, deposited in a 
gelatinous net-work of cartilage, composing about thirty parts in the 
hundred of bone. The remaining six or seven parts is made up of 
phosphate of magnesia, soda, muriate of soda, oxide of iron, oxide of 
manganese, fluoride of calcium. From all the analyses made it is in- 
ferred : 
1st. That the quantity of lime contained in the bones of different 
parts of the body of the same individual, varies considerably. 
2d. That the fixed salts are so much the less in proportion as the 
medullary canals and cavities increase, and accordingly less in the 
spongy bones than in those more compact. In the spongy bones the 
membranes and vessels which line the medullary cavities and canal are 
larger in quantity. 
3d. The inorganic constituents increase with age. From early in- 
fancy to adult age, the phosphate and carbonate of lime increase (ac- 
cording to Schreyer,) from sixty-three per cent, to sixty-eight. 
Diseased Bone.—Character and Internal Structure.—From a 
condensation of the observations of Ragsky, Marchand, Ephraim, 
Nasse, made up by Rokitanski, the following observations are col- 
lected : 
1. Exostosis.—A compact bony protuberance which appears as a 
plano-convex knob which has been glued on. It frequently exceeds in 
hardness and density the bony substance to which it is attached; this, 
from the commencement of its formation, possesses equal density, so 
that the very smallest miliary excrescences are as dense as the 
largest. They never appear spongy, but the newest formed strata soon 
pass into the state of ivory density. They vary in size from that of a 
millet seed to that of a hazel-nut; their surface is generally even. 
Some are also, uneven, but always smooth and apparently polished. 
Sometimes they grow in the form of a horny knob, and some into a more 
or less cylindrical form. The color of these compact knobs is white, 
yellowish white, often whiter than the bone from which they grow. 
2. Spongy Exostosis.—A tumor of cellular texture, filled with mar- 
row, and lined by compact lamella, as a covering. It is developed 
sometimes from the compact—sometimes from the spongy bone ; the 
external covering passes into that of the bone itself. In some cases the 
spongy exostosis exhibits not only its spongy tissue within the compact 
external covering, but also a regular medullary cavity which communi- 
cates with the proper medullary tube. After the spongy exostosis has 
continued a considerable time in its proper structure, the mass in- 
creases, a sclerosis takes place in it, in various degrees, and to various 
extent; it acquires a compact external covering of considera le den- 
sity by a stratum of spongy substance, or a regular medullar cavity is 
enclosed; it becomes also equally compact to a considerable depth in 828 
DISEASES OF THE EXCERNENT FUNCTION. 
several places, and in some cases through its whole extent. Accord- 
ing to Valentin and Lassaigne, the quantity of phosphate of lime in an 
exostosis is diminished (from forty-one to thirty,) Avhile that of carbo- 
nate of lime is considerably increased. 
3. Osteophyte.—This can only be distinguished from exostosis by its 
appearance as a bony structure, which generally involves extensive 
portions of a bone, and covers it in various forms. The osteophyte ap- 
pears velvet-like and villous wdien it covers the bone like a ring, or a 
stratum from one to two lines thick, which consists of fine fibrils and 
lamellae, and thereby pats on the appearance of velvet, or of a fine 
felt. As it continues to grow thicker, it acquires a smooth external 
covering, perforated by numerous fine pores, and, at some depth it ac- 
quires a lamellated structure. Its color in the recent state is blue, 
rose-red, inclining to yellow, a dirty white, or of a color blending white 
with a silken or asbestos-likeTgloss. The osteophyte presents the splin- 
tery-leaved appearance, when it covers the bone in the form of conical 
excrescences or lamellae several lines in length, which, beneath a fine, 
porous, compact, external covering, contain a large-celled osseous 
structure, or even one simple cavity. The watery osteophyte forms 
wart-like excrescences, with a broad, narrow base, consisting of a 
chalky, white, and very brittle substance. This is most frequently 
found in the hip-joint, and its arthritic metamorphosis. The osteophyte 
which appears in the form of smooth, styloid, knotty prolongations, 
simple or ramified, pedunculated and round, is hard, and of a thick 
texture. Another form of osteophyte appears in the form of a long 
mass poured upon the bone; it looks as if it had been solidified, as it 
were, at the moment of its flowing, with generally an even and a 
smooth surface; and it is also compact and hard. 
4. Osteitis.—Inflammation of Bone.—This may arise from external 
or internal causes, though the latter are more particularly connected 
with unhealthy states of the system. It has its seat sometimes in the 
spongy substance. 
Phenomena of Osteitis.—A moderate degree of inflammation throws 
out gelatinous exudation, which passes from a dark-red through the 
yellow-red into a reddish-white, and ultimately into a white color. In 
consistence this exudation passes from the gelatinous state to that of a 
pliant, flexible cartilage, and of a reddish white, succulent bone. This 
covers the old bone as a scarcely perceptible white porous growth, or 
as a very fine felt or velvet, and is connected internally with the bone 
as with the periosteum. When the inflammation is very violent, has 
occurred repeatedly, or is of a specific and severe character, it gives 
out more copious exudations of the form above-mentioned, whereby the 
periosteum is increased sometimes to a fibrous callous of enormous 
thickness, as is occasionally observed on the front of the tibia. He- DISEASES OF BONES. 
829 
Death the periosteum, the base of the ulceration, there is found a 
growth or secretion, consisting of curled or straight osseous plates 
placed on the bone, into the interstices of which the periosteum gives 
off prolongations. When the inflammation has its seat in the inner 
lamella of a tubular bone, the medullary cavity is narrowed by the ex- 
udation given out. A higher degree of inflammation causes a fibri- 
nous product, or a purulent product, varying from a thin to a thick 
fluid, of a yellow or reddish color, or a product of a greenish, brownish, 
discolored and sanious appearance. In such inflammations as run a 
very rapid course, the periosteum over the bone seems to be displaced, 
and frequently distended by pus into a fluctuating sack; in correspon- 
dence with the effusion which is poured out into all parts of its struc- 
ture, the bone presents an ash-colored, dirty, yellowish, or reddish, 
green appearance. In case the effusion is sanious, the surface of the 
bone is rough and corroded. (Rokitanski.) 
“ The bones,” says B. B. Cooper, “ fall more slowdy into disease than 
the softer parts, and their restoration is proportionately more tardy; 
and hence -it is that disease or injury to the periosteum immediately 
affects the bone itself, a circumstance that must be ever borne in mind 
by the surgeon wThen operating upon bones, for it is scarcely possible 
that any very extensive destruction of periosteum can occur without 
exfoliation of the bone itself.” (.Lectures on Osteology.) 
Treatment.—(See p. 365, Vol. II.)—Whether the inflammation be 
acute or chronic, common or specific, the strict antiphlogistic regimen 
and counter-irritants are the usually trusted remedies. But our reliance 
must be chiefly on Silicea, Calc., Phos., Calc.-carb., Caust., Asafoet. 
See also Vol. II. pp. 175, 176, 308, 321. 
When the inflammation has subsided or terminated by resolution, a 
thickness of the inflamed bone remains for a considerable time, and 
the absorption of the adventitious earthy parts can be but slowly ef- 
fected. 
When the inflammation goes on to the formation of pus, its existence 
is indicated by symptoms similar to those which attend on suppuration 
in the soft parts. Though there are no external symptoms a correct 
diagnosis will be reached by observing the rigors, with increased sense 
of weight in the diseased part, and a remission in the severity of the 
pain. 
In abscess the part of the bone affected soon becomes swollen, its 
periosteum becomes thickened, caries supervenes, and the matter is 
discharged by a process similar to the discharge of pus from the soft 
parts; but the progress and reparation are slower. 
Morbid Structures.—1. Formation of Cysts.—The simple cyst, 
with serous or synovial contents, are found chiefly in the bones of the 
face. These, with the compound cystoids, and the acephalocysts, arc 830 
DISEASES OF THE EXCERNENT FUNCTION. 
very rare. The latter have been seen in the humerus, tibia, os-ilium, 
and in the deploe of the thigh bone. Rokitanski describes a specimen 
preserved in the Vienna collection in which the left os-ilium was 
changed into a serous sack as large as a man’s fist; and this was filled 
with numerous pieces of bone of different sizes, adhering to the inner 
wall of the sack, and with echinococus cysts, some being the size of a 
millet-seed, some that of a nut. 
2. Fibrous Tumors.—These sometimes grow to a large size, and in 
doing it distend the bone to a cyst, or crush it in such a manner that 
dismembered fragments of bone are found in the substance of the 
tumor, one part being separated from another. The structure of the 
fibroid is sometimes thick, sometimes loose, white and elastic. 
3. Fnchondroma.—This occurs more frequently in the bones than 
other parts, and is most common in the bones of the fingers, toes, ribs, 
and sternum. It continues like the permanent cartilages for a long 
time, even during life in its original state ; in some cases it becomes 
ossified; sometimes it is attacked with inflammation from the sur- 
rounding soft parts, and then it often suppurates. (Rokitanski) 
Osteoid.—This is characterized as a bone developing itself from an 
ossifying cartilaginous element of new structure in the old bone, in the 
form of a round tumor which is distinguished from the normal bony 
structure by a different elementary texture. (A case of this disease 
given by Simon, Med. Chir. Rev., Jan. 1844, p. 97.) Lastly, among 
the morbid formations have been classed the very rare affections of: 
choleostoma, tubercle, sarcoma, carcinoma. 
Osteosarcoma, so called from its resemblance to both bone and fat 
in texture, often appears in the lower maxillary bone. It begins in 
the periosteum, or the alveolar socket, and the bone is soon implicated. 
It generally occurs in depraved habits, and may be excited by extract- 
ing teeth or by other operations. As the disease advances, the tooth 
becomes looser and is then a source of irritation. Ivoecker says it 
always originates in diseased roots or in the teeth, but this does not 
appear to be the fact. The remedy in the early stage consists in the 
removal of the loosened teeth, which will be sufficient. If the disease 
is more advanced there is no resource but in extirpation.* 
5. SOFTENING OF BONES. 
Osteoporosis.—An excessive development of the marrow, or of th 
tissues which fill the medullary canals and cells of the bone, causes an 
increase of volume of the bone by rarifying its tissue. The parietes 
of the dilated interstices of the bone are so much attenuated that gaps 
* U. S. Med. Surg. Jour., March, 1836, p. 336. DISEASES OF BONES. 
831 
tr chasms take place at length in the interior and in the external 
covering, where oy the cavities in the bone enter into communication 
with each other. The higher the degree of the disease is, the more 
soft, porous, and spongy the bone becomes, until it yields to the pres- 
sure of the finger, and is easily cut with a knife; its spaces become 
filled with a dark-red medulla which collects in gre'at quantity, and is 
soon transversed by dilated vessels. 
First form of Osteoporosis—Osteo-Malacia.—In this disease the 
bones diminish in size, and the change consists in osteoporosis with 
atrophy, a soaking of the bone in fat, and in a reduction of the bone 
to its cartilaginous element. In this cartilage the bony corpuscles ap- 
pear empty, the lamellar structure has disappeared; at the same time 
the cartilage undergoes a peculiar change in its chemical composition, 
as the general extract obtained by boiling is distinct, both from 
chondrin and from gelatine of bone. (Roikitanski.) 
The chemical changes that occur in the composition of the bones in 
rickets and osteo-malacia are about the same. The earthy salts are 
very much diminished; and at the same time five or six times the 
usual quantity of earthy phosphates is found in the urine. Berzelius 
showed that phosphate of lime is dissolved rapidly by lactic-acid. As 
in scrofula and in scrofulous bones an excessive quantity of acid is 
generated in the prima-vise, it may be that more acid reaches the cir- 
culation than in health, and becomes the cause of the solution of bone- 
earth in the bones. When the quantity of alkaline salts in the blood 
is too small to saturate the acid, the bone-earth becomes dissolved. 
This idea may be applied in the treatment of rachitis by a suitable 
antacid diet, avoiding the articles that form lactic-acid; as sugar 
starch, and gum. (Marchand.) 
Softening of the bones in adults is the result of a specific dis- 
ease ; and is either caused by some specific dyscrasia different from 
all others, or from some of those wrell known, as scurvy, syphilis, rheu- 
matism, or of the more terrible vice of the constitution called carcinoma. 
It seems that in every case of osteo-malacia, before the softening of the 
bones is observed, some of the above psoric affections have been 
manifested. 
Osteo-malacia begins with deep-seated pains in the bones, progressing 
slowly. In some cases it is only fully developed in many years, even 
twenty or more. In general, it does not begin in all bones at once, 
but by fractions only of individual bones; and it does not progress, 
like rachitis, from below upwards. Before it is far advanced, some 
bones are alone involved; and some portions of these will be softened, 
indirect contact with other parts of the same bones. Many instances 
have occurred of this in patients suffering from cancer of the stomach, 
breast, or uterus. 832 
diseases of the excernent function. 
Diagnosis.—This disease is essentially different from rachitis. In 
the one the osseous tissue is truly softened as if carnified in places, 
and it no longer retains anything of the consistence or the texture of 
the healthy bone; it is as if one had poured upon the seat of the 
softened part a powerful liquid, having the property of at once dispers- 
ing every trace of the cellular matter completely, so as to leave 
nothing but a fibro-cartilaginous, or even fleshy net-work, presenting 
here and there layers of areola like the venous sinuses of the liver; 
this net-work is sometimes of a yellow or rosy hue, sometimes reddish 
or of the color of wine-lees, always elastic, very cut with a knife, 
but sometimes incrusted as it were with some other portions of the 
sound tissue. This circumscribed state of the disease is far from con- 
stant; at a more advanced period it often happens that the skeleton 
partakes of the softening, and, as appears from many reported observa- 
tions, there no longer remains any appearance of the primitive organi- 
zation of the bones. The termination of osteo-malacia, which is always 
unfortunate, adds another distinguishing trait between it and rachitis. 
Treatment of Osteo-malacia of Adults.—In the treatment of 
this affection, regard must be had to the predisposing and exciting 
causes. 
Cases resulting from constitutional syphilis will require Mercurius 
hydriodicum, Kali-hydriodicum, Mercurius-solubilis, Phosphorus, Cal 
carea-phosph., Mezereum, Graphites, Iodine, Calcarea-carb. Here als< 
the higher attenuations must be selected, if we would secure successfu 
results. 
In all cases of softening of the bones, those articles of food must be 
selected which abound in lime, phosphorus, and other normal consti- 
tuents of the bones. When the disease occurs in children, the use 
of the unbolted flour of the cereals, like corn, wheat, rye, oats, &c., 
are of the highest importance. 
Second Variety—Rachitis.—Rickets.—In this disease we have an 
osteoporosis, with the anomaly of a reduction of the bone to its car- 
tilaginous element, with or without a disturbance in the chemical com- 
position of the same ; the bones are, accordingly, not brittle, but qasily 
bent; they are subject to curvatures, are liable, not exactly to fractures, 
but to cracks. 
In rachitis the bones appear swollen, the angular shafts of the long 
bones becomes round, cylindrical; the articulations of the same, and 
the broad bones, as those of the pelvis, become unusually thick. The 
texture of rickety bones is affected: First, with osteoporosis, accom- 
panied with an increase of volume. In this case, a pale, yellow, red- 
dish jelly is effused into the dilated canals and cells; the vascular 
bone appears dark-colored and somewhat red; and this state some- 
times goes so far that the cells of the spongy bone, and those in the RACHITIS. 
833 
interior of the medullary tubes, run together into a larger cavity in 
consequence of the excessive distention of their parietes, and entirely 
disappear. 
Secondly. The bone sometimes become so poor in the amount of 
its fixed salts, that it becomes entirely reduced to its cartilaginous 
element, and comes to resemble a bone treated with acids; the long 
corpuscles are empty; the lamellar structure is obliterated in some 
places, and in other places the lamellae have apparently receded from 
each other, and the long corpuscles between them are almost en- 
veloped by them. 
The principal remedies for these affections of the bones, are, Cal- 
carea-carb., Phosphorus, Calcarea, Hypo-phosphite, Silicea, Hepar- 
sulphur. 
These remedies must all be prescribed in the higher attenuations, or 
very little benefit will result from their use. From much experience 
we have arrived at the opinion that highly dynamized medicines alone, 
are capable of arresting the progress of this class of maladies, and 
ultimately affecting cures. 
When these remedies are expertly selected, and the doses are re- 
peated at long intervals, the most astounding curative effects are often 
observed. 
6. RACHITIS.—RICKETS. 
General Observations.—I. Rachitis is peculiarly an affection of 
infancy, characterized by alteration or perversion and also suspension 
of the process of development and of reparation of the organism, par- 
ticularly of the osseous system. 
II. The progress of rachitis as an affection of the skeleton com- 
prizes three distinct periods. 
1. That of incubation. 
2. That of deformity. 
3. That of resolution or eburnation. 
Each of these periods manifests its peculiar characters and altera- 
tions of the osseous tissue. 
III. The existence of rachitis is manifested by four distinct orders 
of facts: 
1. Deformity; 2. alteration of tissue; 3. arrest of development; 4. 
delay of ossification. 
IV. Rachitic deformity is developed from below upwards; from the 
bones of the legs to the thigh-bones, then to the pelvis, then to differ- 
ent portions of the upper limbs, the thorax, and, lastly, to the spine 
and cranium. Deformity of any one part always implies that of the 
parts below. 
Y. Most of the rachitic bones are less developed than healthy ones, 
Vou II.—53. 834 
DISEASES OF THE EXCERNENT FUNCTION 
both in length and breadth. The shortening, independent of deformity 
is always marked successively from above downwards. This is observed 
in a regular series. In any given case, if we know the dimensions of a 
single bone, we may approximate that of all the other bones. 
VI. The greatest reduction of the inferior compared with the supe- 
rior members, establishes between these parts relations of length 
which repeat and perpetuate those of the age at which the malady is 
developed. 
VII. The shortening of the bones considered in rachitic adults is 
a result composed of the arrest of development of the bones under the 
direct influence of the disease and of the consecutive slowness of its in- 
crease, subsequent to the commencement of the disease. 
VIII. The texture of the rachitic bones presents entirely different 
characters according as they are observed during the period of incuba- 
tion, deformity, or that of resolution; they differ at the beginning, and at 
the end of each of these periods, and are different, lastly, accord- 
ing to the age and progress of the affection. 
IX. During the period of incubation an effusion of sanguinolent mat- 
ter takes place in all the interstices of the bones, the cells of the 
spongy tissue, the medullary canal between the periosteum and the 
bone, the concentric lamellae of the interstitial diaphyses between the 
joints, the epiphyses, the epiphasary neuclei, and their cells in the short 
and flat, as well as the long bones; in a word, in every part of the 
skeleton and all the points of the osseous tissue to which the radicles 
of the nutrient vessels are distributed. From this effusion result the 
exfoliation of the parts composing the tissue and the swelling and 
enlargement of the different portions of the skeleton. 
X. During the third period, that of resolution, the newly-formed 
tissue in the long bones passes into the condition of compact tissue, 
and has a tendency to confound itself with the old tissue, which retains 
its primary hardness. This addition of the new to the old tissue gives 
a very great increase of thickness, and especially of width at some 
parts of the bones which had been the seat of the organization of the 
new spongy tissue of the preceding period. 
XI. In rachitic consumption, which results from an aggravated de- 
gree of the disease, the unfolding and the separation of the part com- 
posing the tissue are so great that, their reunion has not been effected 
nor the organization of the effused matter taken place. In this con- 
dition the partitions and the osseous lamellae have continued separate 
and the consistence of the primitive bone has been so much reduced 
that its external layer is formed sometimes by nothing more than a thin 
pellicle. 
XII. The texture of rachitic bones in adults, when the disease hag 
been partially dissipated, presents a compactness and hardness superior RACHITIS 
835 
to that of the healthy state. In this state, Avhich wTe call rachitic 
eburnation or resolution, one can no longer discern any trace of the 
union of the elements of the old with the new bone. 
XIII. The deformities of the spine, wrhich happen towards the age 
of puberty, and all those wffiich have not been preceded by deformities 
of the inferior limbs, are not of the rachitic nature. 
XIY. Rachitis is an affection essentially different from scrofula or 
from tuberculous affection of the bones, as well as from every species 
of softening of the bones observed in adults ; for this latter affection 
osteo-malacia must be exclusively reserved. 
Table exhibiting the ratio of dimensions of the limbs of a wellformed, as contrasted 
with a rachitic female: 
Healthy Adult Female.* 
Radius and Humerus. 
18.10 inches. 
Femur and Tibia 
27.6 inches. 
Ratio, 
as 1:1.47 
Rachitic Female. 
15.7. “ 
21. « 
as 1:1.35 
In healthy children, from 1 to 3 years old. the re- 
lation of the upper to the lower limbs are: 9 in. 2 lines. 
12 inch 3 lines. 
as 1:1.34 
Preparations of Lime and Soda, in sensible doses, have been com- 
mended as expediting the union of diseased and fractured bones. 
Experiments by Milne Edwards and others, however, have proved 
that union occurs sooner without this practice than with it. 
In rachitis Phosphate of Lime has been tried. The result of Mr. 
Mourie’s experiments showed a mortality of one-sixth among seventy- 
one children under one year of age. According to official statistics, 
the deaths from this malady amounted to one-fourth. In private prac- 
tice the result is often better than Mourie obtained in the hospital. 
Rachitis.—Case by Dr. Reisig.—1. A boy, aged three and a half 
years, rickets, treated by Oalcarea-carb.; was almost well in ten months. 
2. A boy, with angular projection of the spine, was much relieved in 
three months. In the course of the time he took Calcar.-earb., China, 
Hepor, and Assafoetida. 
When the malady is connected with abuse of Mercury, appropriate 
remedies will be found in Kali-hydriodicum, Hepar-sulphur, Calcarea- 
carbonica, and Iodine. 
Scrofulous complications will demand Sulphur, Calcarea-carbonicum, 
Silicea, Phosphorus, and the Salts of Lime and Phosphorus at high 
attenuations. 
4. Rachitis cured by Lycopodium, by Dr. Marweg.—Ignatz M. 
four years old, suffered since his birth with soreness between his thighs, 
so that he never yet had attempted to walk. He w7as scrofulous in 
* Memoii of the general characters of Rachitis, read before the Royal Academy 
of Sciences of Paris, by Julius Guerin, M.D. 836 
DISEASES OF THE EXCEKNENT FUNCTION. 
the highest degree. Never had the slightest desire to drink. Between 
three and four p. m., irritability of the whole nervous system, with cry- 
ing spells, on account of pain in left ankle. I found here the bones 
softened and discharging a safron yellow water, with tendency to sup- 
puration. His face was literally covered with freckles. Every thing 
tasted to him salty. I ordered cold water ablutions at bed time, and in- 
ternally Lycopod 30, five pellets twice a day on the tongue for four days, 
followed by Lycop. 12, three drops in six ounces of water, every four 
hours a teaspoonful. The secretion between his thighs increased for 
the first few days, then stopped entirely, with increased urinary secre- 
tion. Improvement continued steadily under Sach.-lact. and in four 
weeks he was able to take exercise. To increase his bodily vigor 18 
now received a few doses Graphites 30, restoring him to perfect health. 
A common feature of rachitis is curvature of the spine. Whether 
protuberant or lateral, it generally displaces the liver and disorders its 
secretions. The bile becomes defective in quantity, pale in color; the 
countenance assumes a sallow hue, the appetite fails and digestion is 
imperfect; the abdomen is tumid and painful, the bowels are obstinate- 
ly constipated, and haemorrhoids are very commonly present. All of 
these symptoms are gradually removed by removal of the curvature. 
This subject has been treated of already, p. 525, Vol. II. 
GENUS V.—ADISPOSIS.—OBESITY. 
The adipose tissue may be diminished or increased far beyond the 
healthy standard. 
A. Atkophy.—Emaciation occurs naturally in very aged persons, 
and is hereditary in certain families, being most marked in persons 
of peevish, anxious irritable temper. It is commonly seen in pulmo- 
nary diseases, and all others in which the powers of assimilation are 
impaired or the supply of nutrition interrupted. It is a symptom of 
all diseases which impair the vital energies by morbidly increasing the 
secretions and evacuations, as in diabetes, diarrhoea, dysentery; it also 
results from long fasting. It is merely temporary when the causes 
that produce it are temporary, and occur in early or middle life ; but, 
in advanced life, and in active, peevish, irritable persons it is likely to 
be permanent. In all these cases the absorption of the fatty matter is 
being accomplished by the veins, and perhaps, in some degree by the 
absorbents, more rapidly than the nutritive powers can supply it. The 
oily matter is found in blood in variable quantity, showing that it has 
been but recently taken up, and has not yet been changed by passing 
through the absorbent glands. 
Certain substances appear to possess the power to increase the 
formation of adipose tissue, like Arsenic, Ferrum, China, &c., while other ADIPOSE TISSUE. 
837 
articles, like Sugar of Lead and Iodine have a direct tendency to reduce 
the deposition of the tissue. 
B. Adiposis.—Obesity.—Excessive deposition or hypertrophy of 
this tissue is common, and effects either the whole system or a part. 
Some persons reach the weight of 500 or 600 pounds. It is more com- 
mon in childhood, and about the fortieth year, and among females 
or eunuchs. It is sometimes caused by excessive venereal indulgences 
in early life, with high living and indolence. It is accompanied by 
languid circulation, weak digestion, craving appetite, defective secre- 
tions and excretions, indisposition to perform mental or physical labor, 
and is often hereditary. The extent to which obesity may exist with- 
out being regarded as a disease varies in different constitutions. Or- 
dinarily fat forms one twentieth part of the body. 
It is promoted greatly by a full diet containing fatty substances, as 
sugar, spirituous and malt liquors, used freely by persons whose vital 
energies are diminished, at the same time that the appetite remains 
unimpaired, or is excited by stimulating drinks; the formation of chyle 
into blood does not take place so rapidly nor so perfectly as in health; 
a large portion of the oily matter of the chyle is deposited in the adi- 
pose tissue, which tipis becomes one of the emunctories of the frame; 
and a material which cannot readily be carried out of the circulation 
by any other organ is set apart for the purpose of future absorption 
and nutrition, as the ivants of the system may require ; thus preventing 
its hurtful accumulation in the circulating fluid. In many persons ap- 
parently healthy, the excessive accumulation of fat is often one of the 
earliest and most remarkable signs of diminution of the vital energies 
of the frame. 
Persons who become very fat have proportionately small arteries; 
they bear no losses of blood, breathe imperfectly, are dull and sleepy; 
and are highly susceptible to atmospheric influences. They sweat 
easily, take cold often, and are predisposed to gout, apoplexy and es- 
pecially to dropsy. They are great sufferers from dyspepsia; and 
having little muscular power, they cannot take the necessary amount 
of exercise. As the adipose tissue enlarges still further it encroaches 
on every other structure. The blood is lessened in quantity and more 
and more diluted. The increased size of the body increases the de- 
mand for more blood to fill the distant enfeebled capillaries: and the 
deficient supply with the diminishing power of the circulation causes 
atrophy of important organs. In some cases there are dilatations, fatty 
deposits in the heart, or other degenerations of its structure. The 
heart, instead of becoming stronger by the large addition to the size 
of the body is really weakened in muscular power by the imperfect 
aeration of the blood ; and yet it has the extra labor thrown upon it of 
propelling the diluted blood to the remotest extremities and surfaces 838 
DISEASES OF THE EXCEKNENT FUNCTION. 
of the corpulent body. The balance then between the systemic and 
pulmonary circulation must be destroyed, the lungs becoming also un- 
equal to the task of excreting such an excessive quantity of carbon be* 
yond their natural capacity. The blood then becomes continually more 
venous, more liable to form congestions, and to dilate the cavities of 
the heart by its retarded pace. 
Treatment.—The selection of a proper diet is the first thing to be 
considered. It is proposed to restrict the patient not only in quan- 
tity, even though it be admitted that this restriction alone is never 
effectual in diminishing the superabundant fat; but we may gain some- 
thing by making such a selection of articles as may give the necessary 
amount of support, without a proportionate addition to the adipose tissue. 
Thus mutton is easily digested, and contains but a minute amount of 
fat, while beef is infiltrated with fat throughout the leanest parts. 
Other articles then best suited for corpulent persons are cod-fish, had- 
dock, whiting among fish and the flesh of rabbits among animals. 
Acids.—Vinegar is said to have the property of removing fat or pre- 
venting its accumulation. It has been used in large draughts, and in 
some cases with success. Thus it is said that a Spanish general who 
wras excessively corpulent diminished the amount of fat so rapidly by 
drinking large quantities of vinegar “ that he could wrap the skin 
around him like a cloak.” But this course has not succeeded with 
others. It is complained that the strong acid produces dyspepsia. For 
• some persons the remedy is a good one, but it cannot in them be used 
with safety in quantity without being greatly reduced in strength. 
When used in quantity, in full strength, it inevitably causes a medicinal 
aggravation, or poisonous symptoms. It is only when it is taken to 
the extent of causing uneasiness, cramps, colic, and gradually de- 
stroying the texture of the stomach and its digestive functions that 
vinegar causes emaciation. 
Ammonium-muriaticum.—The following case is given in Frank’s 
Magazine : A man aged 50 years, of middle stature, large head, broad 
neck, and a face increased in breadth by a large mass of fat hanging 
beneath the skin ; and a fatty mass extended from one ear to the other. 
His small ears were pushed forward and outward by fatty enlargement. 
The eyes and face were sallow; cheeks lax, and hair thin. The bony 
frame was delicate; hands and feet small and thin; arms and le^s 
' O 
scantily nourished. But on each arm was a large mass of fat, com- 
mencing at the deltoid muscles, passing over the shoulders to the nape, 
forwards upon the chest, and filling the arm-pits. The abdomen was 
flabby and protuberant; the nates extremely large. 
He was treated with Mur.-ammonia for six weeks, when the drug 
disease of “ the seven-day fever” was established, and continued to re- 
cur on every succeeding Thursday. After every paroxysm of the CRETINISM AS PHYSICAL DEFORMITY. 
839 
seven-day fever the diminution of the fatty swellings was too evident 
and remarkable to admit of doubt, while the improvement of his gene- 
ral health was equally striking and satisfactory. 
Ilydriodate of Potassium is one of the best proved remedies in all 
hypertropic diseases. 
Malformations.—The greatest evil of psora is that it reproduces 
itself and descends to posterity. The children of psoric parents are 
born with some of its manifestations. Thus:—Malformations, as 
tumors on the head, yellowish, sallow color of the skin; head too large; 
phthisical conformation; itch eruptions ; they are liable to scald-head, 
&c. Towards the end of the 15th century psora culminated in syphilis, 
since the appearance of which lepra has nearly disappeared, though 
it still remains in a fewT countries. (See Lepra) 
GENUS V.—PHYSICAL DEFORMITIES. 
CRETINISM. 
We have already spoken of this terrible infirmity of human nature 
in its relations to imperfect development of the mind; it is proper to 
refer to it here as a physical deformity. The cretin is a blighted spe- 
cimen of humanity. His stature is not more than four or five feet, 
often less; the head is deformed in shape and is too large for the 
body ; skin yellow, cadaverous, or of a mahogany color, wrinkled, pallid, 
or marked by eruptions; the flesh is soft and flabby; the tongue large 
and often hanging out of the mouth; the eye-lids thick; the eyes red, 
prominent, squinting; the countenance is void of all expression except 
that of idiotism; the nose is flat, the mouth large, gaping, and con- 
stantly permitting the saliva to flow over the elongated lower jaw. The 
abdomen is pendulous, the limbs crooked, short, and so distorted as to 
prevent any but a “ waddling” progression. The external senses are 
often imperfect,—many are deaf and dumb,—and the whole aspect pre- 
sented is that of premature old age. Such is the disgusting physical 
exterior of the apparently wretched, but, perhaps, completely happy 
cretin. 
His moral picture is still more humiliating. The intellectual facul- 
ties are suspended, while the lower animal propensities are in a state 
of increased activity; the cretins are voracious eaters, and addicted 
to the lowest animal passions. Their chief pleasures are to eat and 
sleep; or, after eating, to bask in the sun, insensible to every stimulus 
that agitates the mind of savage or civilized man. “ Goitre, on such 
a scale as we see it in the valleys of the Alps is bad enough, but cretin- 
ism is a cure for the pride of man, and may here be studied on a large 
scale and in its most frightful colors.” (Johnson, on Change of Air.) 840 
DISEASES OF THE EXCERNENT FUNCTION. 
Tumor.—A Tumor on the Face.—Case by Dr. Kenyon, of Buffalo.— 
It began with a pimple in the middle of the forehead, where the skin 
had been broken by a scratch. It looked like a watery excrescence 
and bled when touched. The lady was of light complexion, ner- 
vous temperament, had never been sick much, no hereditary disease 
perceptible. 
She took Thuja 6° in the morning; Thuja 30° in the evening. Next 
evening Thuja 200°. And afterwards one dose Sacchar.-lact. each eve- 
ning. In one week it ceased bleeding, and was diminished one-half its 
size. In two wreeks all trace o-f it was gone, no spot left where it had 
been. 
Wens are considered endemical in certain regions, generally moun- 
tainous, as Switzerland, Bohemia, and the Pyrenees in Europe, and the 
Andes in America. Dr. Guyon publishes the history of the family of 
a Belgian consul, who went from Lima to Santiago, in Chili. When 
they had been there fifteen months, it was observed that the two 
daughters (aged 11 and 13) presented incipient wens growing upon 
their necks. The physicians of the country unanimously advised 
change of climate; and the mother embarked with the children for 
Europe. The voyage was protracted to 110 days, during which time 
they suffered much from sea-sickness and change of temperature in 
passing from the latitude of Cape Horn to the Equator. The children 
acquired the habit of passing their hands over their necks, and soon 
perceived that the tumors were visibly decreasing. When they reached 
Cherbourg they were half gone; and by the time they arrived at Brus- 
sels the last vestiges of the affection disappeared. It seemed to be a 
common prescription of the physicians of Santiago, as one known to 
be efficacious. Dr. Guyon says, a considerable number of Swiss emi- 
grants, from the Valois, in 1853, settled in Algeria. Of these the 
most, especially the women, had wens. But they had not been a 
year in the country before they became aware of a considerable de- 
crease in the size of the wens; and by the and of 1856 they had all 
disappeared. We suspect these wens were of a goitrous character. 
Tumor of the Face, caused by Aneurism of the Arteries.—Mr. 
Ferguson gives a case in the Lancet for 1842-3 : A lad, aged 19, had 
a tumor about the size of a duck’s egg, on his cheek, which the sur- 
geon supposed to be a cyst. Mr. Fergussen, of King’s College Hos- 
pital, proceeded to remove it, “ but was greatly astonished to find that 
it w'as supplied with numerous lnrge vessels, and that it had many of 
the characteristics of the formidable disease called aneurism by anas- 
tomosis.” lie applied ligatures as speedily as possible, with the dou- 
ble object of arresting the bleeding and causing the tumor to slough 
away. (Practical Surgery, p. 147.) THE SKIN. 
841 
ORDER II.—DISEASES AFFECTING EXTERNAL SUR 
FACES. 
THE SKIN.—DERMIS.—CUTIS. 
The skin, though apparently a simple membrane, is in reality com- 
posed of several different laminae or layers, one within another. The 
outermost lamina is termed the scarf skin or cuticle ; the second has 
the name among anatomists of rete mucosum. After these two are re- 
moved, we come to the outer surface of the cutis or true skin. 
The application of a mild blister to the skin, of a negro, for a few 
hours, raises the transparent gray cuticle from the layers beneath ; 
and under it we find a clear serous fluid. On removing the scarf skin 
and the fluid, the surface beneath appears black. The black surface 
now consists of the rete-mucosum, a double membrane, the lower la- 
mina of which is gray and transparent, and the appearance of a black 
web, resembling the pigmentum nigrum of the eye. The rete-muco- 
sum, gives the color to the skin; is black in the negro; white, brown, 
or yellowish in the European. It has been supposed that the design 
of Nature in giving the black skin to the negro has been to defend him 
against the tropical rays of the sun; and the purpose of a similar 
membrane behind the retina in the eye, appears to be not only that of 
absorbing the superfluous rays of light, but like the amalgam, behind 
the looking-glass, it may enable the retina to reflect the rays, in order 
to perfect vision. In our own climate the skin becomes brown when 
exposed to the rays of the summer sun,—a process which seems also 
designed to defend the body against the access of too great external 
heat. 
Functions of the Skin.—Regarded as a protective covering, the 
skin possesses the united advantages of toughness, resistance, flexibi- 
lity, and elasticity. The areolar frame-work of the cutis is the part 
chiefly conferring these properties, but they are also due in some mea- 
sure to the epidermis. These structures are thickest on all the points 
in which the skin is liable to come with most force and frequency into 
contact with external objects; thus they are thickest on the palms of 
the hands and soles of the feet, on the back of the trunk, and on the 
outer surface of the limbs ; thinner on the front of the body and on the 
inside of the limbs. 
The skin is employed in the two opposite functions of absorption and 
secretion. Absorption is performed by the net-work of lymphatics 
and the minute capillaries. Secretion is carried on at every point of 
the surface of the cutis; whilst the cuticle is merely a deciduous pro- 
duct which is constantly in course of separation from the cutis. But 842 
DISEASES DF THE EXCERNENT FUNCTION. 
the principal agents in secretion are those glandular offsets from the 
skin which lie scattered in numberless multitudes beneath it. Thus the 
actual circumference of the internal surface of these secreting glands 
exceeds in extent the surface of the whole body; and the quantity of 
the waste material which it is their province to eliminate from the 
body is enormous. And this immense glandular structure is widely 
distributed over the whole external surface; and thus, more than any 
more compact glandular structure, it is subject to the vicissitudes of 
external temperature, acting upon the cutaneous blood vessels ; there- 
fore, general health would be much more frequently deranged than it 
is if a coordinating apparatus far within the body had not been pro- 
vided in the kidneys. Thus, when the secreting function of the skin is 
imperfectly performed in a cold day, the kidneys arouse to an extra 
degree of activity, and throw off from the blood an increased quantity 
of the excrementitious materials, the presence of which the system can 
no longer tolerate. 
The Sebaceous Glands of the skin are chiefly employed in the pro- 
tection and health of the skin itself; and, like the sweat glands, they 
are widely distributed over the whole surface. On most portions of 
the body they are as abundant as the hairs themselves; and they are 
employed in eliminating from the system hydro-carbonaceous matters, 
which pass off in the form of an oily material which serves the pur- 
pose of lubricating the surface of the cuticle. 
Finally, the skin performs the essential and important office of fur- 
nishing the surface on which is extensively expanded the peripheral 
extremities of the nerves of sensation, thus constituting it the organ 
of touch. The contact of foreign bodies is perceived as occurring at 
the point at which they actually strike the organ of touch, whether 
that point be within the sphere of operation of any other sense or not; 
and this perception is transmitted to the brain through the nerves as 
received. In general, touch is most acute in regions best suited, by 
their structure, for easy and diversified contact with external sub- 
stances : for the power of nicely determining the position, direction, 
and amount of pressure upon the organ of touch is essential to the 
perfection of the sense. The experiences of a life-time teach the will 
how to excite and check the contractions of the muscles, and to regu- 
late their force and duration with wonderful precision. We also pos- 
sess a muscular sense, through which the mind is able to appreciate 
the state of contraction of a muscle by impressions originating in the 
nerves supplied to its fibres. This power, both of recognizing and 
governing the muscular movements, is from our earliest infancy brought 
into association with the impressions derived from the organ of touch, 
and made subservient to the faithful performance of its function ; “and 
the perfection to which habit brings the sense of touch is chiefly due THE SKIN. 
843 
to an improved capacity it confers of appreciating the impressions 
made on the organ, in connection with the niceties of muscular 
movement.” 
Minute Cryptogamic Parasitic Plants in their Relations to 
Diseases of the External Surface.—Nearly all the diseases to which 
plants are subject are the result of encroachments by parasitic mush- 
rooms, fungi, or lichens, and every species of plant, in a diseased state, 
presents us with some minute specimens of tins order. Wheat is 
infested and greatly injured by the rust—a highly-organized fungus, 
called by the botanist uredo linearis—and by that called smut, or 
uredo segetum. Blight, dry rot, and all the fungi that retard the 
growth of trees and plants are of this character. 
The rapidity with which the fungi reproduce themselves, and spread 
over objects which furnish the proper food for their development, con- 
stitutes one of their most remarkable features. Some species “ pass 
through their whole existence in a few minutes, from the invisible spore 
to the perfect plant.” 
The number of known species of fungi is so great that their number 
has never been estimated. Fries, the Swedish naturalist, counted two 
thousand species within a space equal to one-eighth of a mile square; 
and he also estimated ten millions of sporules “ in a single individual 
of the reticularia-maxima, so minute as to look like smoke as 
they rose in the air. Webster says, in his History of Epidemics, that 
during the prevalence of a malignant fever in 1795, sound potatoes 
were destroyed in his cellar in the space of thirty-six hours. They 
were overrun and pervaded by the parasitical fungi which were rapidly 
diffused through every part. The peculiar state of the atmosphere 
favored the development of the germs, which were furnished from an 
unknown source. He also says, that during the pestilential season of 
1798, “he saw a cotton garment covered with dark-gray colored spots 
of mildew in one night; and that such cases were then common.” An 
instance is given in the Philosophical Transactions, in which a split 
melon was observed to be rapidly pervaded by “ a green mould, which 
required only three hours to sprout, six to ripen, and produce, and let 
fall new seeds.” The Sanitary Commission of Liverpool reported in 
1844, that in the dwellings occupied by the poor, the impurity of the 
air was so great that “ food became tainted in a single night.” 
When we descend to examine the vegetablo productions of the 
smallest size, the microscope shows them in visible growth. A drop 
of yeast, placed in the bottom of a watch-glass, may be seen swelling 
up, as the tortula cerevisice unfolds itself, and exhibiting a forest of 
fungi, where, but a few minutes before, only a spore or two were 
visible. 
The exact process by which the yeast-plant propagates itself is im- 844 
DISEASES OF THE EXCERNENT FUNCTION. 
portant. The globules are rather egg-shaped, and, when examined by 
aid of the microscope, a small point may be seen on the surface of a 
globule fully formed, and, after some hours or more, it becomes asso- 
ciated with others. Sometimes several globules cluster around one of 
the ordinary size and whirl about with it, when the fluid in which the 
mass floats is shaken. In the smallest quantity of yeast a number of 
isolated cells are seen, and from the surface of each cell others shoot 
forth. These become cells like the parent, and, in their turn, origi- 
nate others. 
The serum of blood, when introduced into a vessel hermetically 
closed, is found to contain, after a few days have elapsed, a large num- 
ber of yeast cells, probably produced from the grape-sugar dissolved 
in this liquid; yet this same serum, when examined with the micro- 
scope immediately after coagulation, did not contain a single nucleus 
or cell. 
Every globule of yeast, as well as each individual spore of all the 
microscopic fungi, is perfect in itself. It absorbs its food from every 
part of its surface, assimilates it, and respires the air as perfectly as 
the highest flowering plant. When the fermentation is going on, “ the 
small globules of yeast become agitated in all directionssmall pro- 
tuberances shoot out on all sides, which grow to their full size and 
separate from the parent plant. It is believed that there is, in this 
process, a truly vital reproduction, like that of buds in the vegetable 
kingdom. 
The substance known as leaven furnished the most ancient nations 
wflth the simplest mode of making light bread, and it is still in general 
use. When bread remains unbaked in a warm place for a very short 
time, it speedily acquires a sour taste, and the microscope reveals a 
forest of small fungi, resembling those that constitute yeast, and 
equally capable of reproducing themselves. This is really the first 
stage of putrefaction. 
The peculiar plant called mould, or mucor stercorea, consists of a 
true and highly-organized microscopic plant. It may be seen with a 
magnifying glass on the surface of all putrefying vegetable or animal 
matter, and the plants soon become visible to the naked eye. They 
possess the root, stalk, flower, and all the essential parts of the per- 
fect plant. 
Mildew and blight consist of minute parasitic plants, of which the 
seeds are so small that they can enter the pores on the straws of wheat, 
which are open in hot weather. In warm, showery weather, each pore 
upon a straw may produce from twenty to forty of these poisonous 
parasites. They may rapidly be distributed over a whole field from a 
few diseased plants, as the seeds are not much heavier than the air. 
In the growth of these small parasites, and in that most minute aerial 845 
CUTANEOUS DISEASES. 
fungus called red snow, or gory dew of the Arctic regions, we see the 
development of vegetable life in its simplest form, and discover the 
first steps of advance in organic structure. 
CLASSIFICATION OF CUTANEOUS DISEASES. 
I. Secreting diseases, a. Serosity.—Eczema; Pityriasis rubra acuta; 
Eczema lichenoides.—Scabies (gale.) Herpes phlyctenodes, 
Pemphigus. 
b. Purulent Serosity.—Rupia, Ecthyma cacliecticum. 
d. Pus.—Impetigo—Acne scabies (gale.) Ecthyma; Sycosis. 
e. Fatty Matter.—Acne sebacea,—Acne punctata. 
II. Non-secreting Diseases, f. Transitory redness, (i. e. disappearing 
under pressure of the finger. — Erythema. Urticaria.— 
Roseola.—“ Couperose erythemateuse.” 
g. Permanent redness. Purpura; Scorbutus. 
h. Redness with a Papular State of the Shin.— Lichen. 
Strophulus. 
i. Circumscribed redness with furfuraccous Scales, and fret- 
ted state of the Shin.—Herpes circinatus. Herpes nummu- 
laris. 
j. Diffused Redness with a furfuraceous State of the Shin.— 
Pityriasis rubra. 
k. Redness with Scales and Induration of the Shin.— 
Psoriasis.—Lepra vulgaris. 
l. Scales without Redness.—Ichthyosis. 
m. Papulae without Redness.—Lichen chronica. Prurigo. 
n. Vegetable Productions.—“Favus or Tinea; Favus scutellata; 
F. Lupinosa; F. Granulata; Porrigo decalvans; Herpes 
tonsurans. 
o. Animal Productions.—Pedicular disease. And that which 
originates the pulex or flea. 
A. In scabies the serosity is contained in minute isolated vesicles. 
In herpes phlyctenodes it is within bullae, that are either distinct 
and separate, or are situated so near to each other as almost to touch. 
In Pemphigus the bullae are still larger. 
B. Eczema impetiginodes is the only disease in which the secre- 
tion is partly serous and partly purulent at the same time. The pro- 
duct of this secretion is a crust of a yellowish-gray color. 
C. In rupia and ecthyma cachecticum. the secreted matter is partly 
purulent and partly sanious. In the former, the crust that is subse- 
quently formed, has an ill-favored appearance—being formed of pus, 
ichor, and blood—and is more or less irregular in its form. In the 
latter, the crust exhibits the same characters, but it rests upon an in- 846 
DISEASES OF THE EXCERNENT FUNCTION. 
flamed base, and retains the rounded shape of the pustule which pre 
ceded it. 
D. Impetigo is the most common and important among the cutaneous 
diseases in wdiich pus alone is secreted. Its crusts are ahvays puru- 
ent, superficial, and of a gold-yellow color, resembling concrete honey. 
Acne.—The pustules are hard at the base, and elevated; in puru- 
ent scabies, they are flat and more uniform. 
In ecthyma the pustules are flat and of a large size, and exhibit in 
the middle a dark point, which gradually becomes more and more 
depressed, so that at length they are umbilicated as in small-pox. 
1. PITYRIASIS —Dandruff. 
Simple pityriasis is most commonly confined to the hairy scalp, and 
displays itself in the form of a superficial, bran-like scurf, wdiich may 
easily be removed by a comb or a brush, but which is speedily repro- 
duced. In mild cases, and with ordinary care, the disease may con- 
tinue with but slight annoyance for many years, or it may be roused 
into a more active and troublesome form by general debility, attacks 
of eruptive fever, and by the relaxing effects of a hot climate. 
Treatment.—We consider Sulphur, Iodine, Conium, Calcarea, 
Carbo-vegetabilis, and Sepia, the best remedies for the above dis- 
ease. Arsenicum, Graphites, Acid.-nitr., Phosphorus, Lycopo- 
dium, ATatrum-mur., Copaibce, Argenti-nitr., Aurum-mur., and 
Hepar-sulph., have likewise been employed with success. 
Administration.—The first, second, and third attenuations should 
be employed—a dose each day, until the morbid action is subdued. 
A cutaneous disease characterized by small ulcers at the roots of 
the hairs of the head, which produce a friable wrhite crust. 
Diagnosis.—Circular red-colored patches covered with numerous 
small yellowish points or pustules appear on the skin, but do not rise 
above its level. These pustules soon break and form thin scabs. The 
patches frequently unite wTith adjacent patches and assume an irregular 
form, and extend, in some cases over the wThole head. The incrusta- 
tions accumulate and become thick and hard; when removed, the sur- 
face beneath is left red and glossy, but studded with slightly elevated 
pimples. When the eruption continues long, the hair is entirely de 
stroyed. The disease is more common in children between the age of 
two years and that of puberty. It is worst on the scalp ; but it ap- 
pears on, or extends to other parts of the body. 
Pathology.—Tinea capitis is characterized by small ulcers at tho 
2. TINEA CAPITIS.—SCALD HEAD—Favus Scutellata. TINEA CAPITIS. 
847 
roots of the hairs of the head, which produce a white crust. M. Gruby 
submitted this white crust to inspection under a powerful microscope, 
and found that “ tinea consists of millions of mycodermatous plants. 
They spring from an amorphous mass of which the periphery of each 
capsule is composed, and give off towards its centre oblong or rounded 
homogeneous corpuscles which are the reproductive spores.” The 
seat of these vegetations is in the cells of the epidermis. The cutis is 
compressed, not destroyed, and the bulbs and roots of the hairs are 
only secondarily affected. Dr. Bennett, of Edinburgh, found crypto- 
gamic plants of extreme minuteness growing in the matter of tubercle 
found in the lungs of different persons suffering from disease of those 
organs. Similar growths have been seen growing on the skin of a 
mouse, and also on that of a living gold-fish,which was in a languishing 
state some time before death. {Medico.-Chir. Review, April, 1844, 
p. 458 ) Vegetable parasites have been observed growing in various 
parts of the human body and in fluids ejected from it. Bennett found 
them growing on the coating of the tongue, and also on the gums in 
yellow fever. Berg examined the crusts or. the surface of the tongue 
and mouth in aphthae of children, and found them composed of the 
fungi called favus. Bcehm, Cawdill, and Rusk found the same parasite 
in the intestinal canal of cholera patients. Others have found them in 
the scales which compose the chief part of the mass which forms the 
crust in porrigo. The same vegetable grovth has been observed on 
blistered surfaces, on the inside of the oesoplagus, in ulcers of the in- 
testines in typhus, and in various cutaneous eruptions. They have 
been seen in a cerebral tumor in a boy, in a chronic ulcer of the leg, 
in a scrofulous affection of the ear, in cariois teeth, in expectorated 
matter in pneumonia, in the stomach of an iiteric subject in yellow 
fever, and in a large number of other diseases {London Jour. Med., 
Nov., 1849.) 
Treatment.—The chief homoeopathic reredies are: Rhus-tox., 
Staphysagria, Dulcamara, Bryonia, HeparsulpK,, Arsen., Antim.- 
crud., Calcar.-carl)., Sulphur, Graphites, Lyop)odium. 
Clematis-erecta. — Hahnemann prescribed it with success in the 
exanthemata with serpiginous crusts, especidly papula, acne, and 
sycosis; also, in pustular diseases. Hirsche succeeded with it in 
eczema, impetigo, the bullae, ecthyma; and Lon Simon in malignant 
tetter. {Scrof. Diseases, Archiv., Tom. VI., p448.) 
Jahr {On Diseases of the Shin) says: “ Clmatis is useful princi- 
pally in the dermatoses produced by solar action in those characterized 
by an inflamed condition of the skin; in hypertophy of the dermis, in 
the bullar variety; in cutaneous affections accoipanied with emacia- 
tion; in psoriasis; psoriasis inveterata; psora plmaris and plantaris; 
in chronic discharging eruptions, particularly o the legs; in psora, 848 
DISEASES OF THE EXCEENENT FUNCTION. 
implicated with small ulcerations; in impetigo-figurata and phage- 
denic tetter. Generally Clematis will be indicated if there be a scaly 
crust upon the thigh, from which exudes a yellowish, ichorous and cor- 
rosive humor, and resting upon a red and excoriated base, discharging, 
and covered with numerous vesicles, which increase, and the discharge 
from which forms new crusts, attended with intolerable itching, emacia- 
tion and enlargement of the inguinal glands, redness and tumefaction 
of the skin, and scabby pustules all over the body. At the increase 
of the moon the eruption is red and moist; and at its decrease pale 
and dry.” 
Storck should, moreover, not have been astonished that he was able 
to cure a general chronic eruption, (humid, phagedenic, and psorie,) 
with Clematis, having himself ascertained that this plant has the 
power of producing a psorie eruption over the whole body. 
Acetic-acid.—Apply the acid diluted with three times its weight 
of water to the skin, in all the most diseased patches, for three or four 
minutes. A single application is sufficient in a majority of cases. A 
crust grows up with the hair, which may be removed with scissors, 
when they can be put under it. 
Boenninghausen says it is dangerous to treat these eruptions simul- 
taneously by the same rerredies applied both externally and internally. 
The external part is superfluous, and often leads to a false cure or 
obscuration of the external and often most important symptoms. 
In cases like malignaat tinea capitis, the symptoms are generally 
few, and those derived fr)m the anamnesis or constitutional dyscrasia 
are deserving of specia attention; consequently it is necessary to 
give occasional doses of Sulphur or Thuja, or more rarely Mercurius. 
Viola-tricolor.—A case resembling tinea capitis in an adult: erup- 
tion of numerous conical but distinct cones, as large as a split pea, 
but more prominent, confned to the scalp. On removing a crust, there 
was a yellowish or wateip deposit beneath ; crusts have a dark reddish 
base; eruption, itching aid irritation very disagreeable. Viola-tricolor 
12th for seven or eight then Viola-tricolor 6, for a week more. 
There was then scarce! a crust left; they separated from the skin, 
leaving only a red mark ehind, which soon disappeared. (Dr. Pomeroy, 
Detroit, Mich., Am. Hen. Jdev., Vol. III., p. 32.) 
The most common dieases seen on the scalp of young children are; 
1. Eczema ; 2. lmpetio ; 3. Eczema Impetigoides. The last haying 
relations to both the preeding. 
1. Eczema is the mst common between the ages of three or four 
months, and two or thre years, or during the period of the first denti- 
tion, and is by many ensidered salutary in its influence, the child ap- 
pearing well the wholctime, and suffering if cured soon. It may stop 
of itself, seldom causft the hair to fall off, and never permanently. ECZEMA. 
849 
The eruption consists of a common inflammation of the vessels of the 
part, which may continue for an indefinite period, but never propa- 
gates itself by contagion. It may he traced to common causes of dis- 
ease. The same applies to Impetigo and Eczema Impetigoides. 
In Eczema, the serous secretion oozes from a red surface, by myriads 
of little canals or openings, in the form of minute drops, or fine mois- 
ture. 
In acute pityriasis the serous oozing is a sort of sweat, but without 
any perceptible punctuated state of the skin. 
In Eczema-lichenoides the serosity proceeds from a rounded patch, 
which is sprinkled over with a multitude of papulae that render the 
surface somewhat rough. The discharge is exhaled between the 
papulae. 
Crusia-lactea—Milk-scall.—Milk-crust.—An affection of children, 
characterized by an eruption of numerous small, white pustules, ap- 
pearing in clusters upon a red ground, full of a glutinous liquor, which 
scabs when they are ruptured. The pustules generally ap- 
pear first on the face, especially cheeks and forehead, from whence 
they spread over other parts, sometimes involving a large portion of 
the surface of the body. There is redness and swelling of the sur- 
rounding parts ; troublesome itching; the child is fretful, restless, rubs 
the affected parts constantly, thus tearing off the scabs and aggravating 
the disease. 
Treatment of Eczema, Crusta-Lactea, &c..—Phus-tox., Arse- 
nicum, Sepia, Sulphur, Croton-tig., Petroleum, Mezereum, Calcarea- 
carb., Ilepar-sulph., Stibiu?n, Apis-mel., Lycopodium, Graphite, 
Cuprum-acet., Podophyllum. 
Aconite.—Rash appearing in small red, smooth spots, not elevated, 
but visible in heat and cold; itching and biting at night, disturbed 
sleep, shivering in the evening, heat during the night; the child uneasy, 
irritable, and crying much. Redness and inflammation of the skin; the 
patient is feverish, restless, and uneasy. 
Phus-tox.—After Aconite has reduced the fever. 
Sulphur.—After the effects of Rhus have been tested. 
Hepar-sulphur or Arsenicum will be likely to cure the psoric cases 
which are obstinate and complicated. 
Lycopodium, Sepia, and Graphites, also in tedious psoric cases. 
The different forms of cutaneous eruptions, or the rash on the skin 
so common in childhood, are caused by derangement of the digestive 
organs, and they are curable by correcting those organs. We gene- 
rally succeed in removing the internal disorder, as well as the external, 
by giving Cinnabar, Mercurius, Ipecac., Sulphur, or Calcarea. In 
critical cases, when convulsions are threatened, we may give Cuprum- 
sulph. Hering gives Cuprum-aceticum 3, a grain in a wine glassful of 
Voi. il—54. 850 
DISEASES OF THE EXCEKNENT FUNCTION. 
water, every fifteen or twenty minutes, till relief is obtained. When 
the eruption is not well defined, when there is trembling, sickness of 
the stomach, faintness, or diarrhoea, Ipecac, will either correct the in- 
ternal disorder, or promote the eruption in its full appearance on the 
surface. 
Chamomilla will generally succeed in children for similar symptoms. 
Sulphur is proper in most cases of this kind. The remedy that 
relieves generally produces perspiration. 
The London Lancet, (March 13, 1858,) says; “ That Arsenic pro- 
duces a form of eczema, demonstrates that metal to possess the power 
of influencing the nutritive processes in the skin; and common sense 
would suggest that when the skin is morbidly nourished, a drug proved 
to have such power should be tried, in preference to one not known to 
act on the skin at all.” 
Vesicular Eruption on the Hands—Petroleum.—A woman had 
a vesicular eruption on both hands every winter for several years; 
both hands and wrists covered with vesicles on an inflamed base, with 
cracks here and there on the back of each hand, discharging a great 
quantity of watery fluid, excoriating the parts around; no appetite; 
no thirst; sinking at the stomach; bad taste in the mouth in the morn- 
ing ; rising of food. Croton-tiglium improved them; but after a 
month the hands remained very dry and cracked, 3°, was 
given twice a day. This cured the hands, and they remained well. 
{Dr. Clifton.) 
Rhus.-tox.— Vesicular Exanthem, from Injury.—Vesicles appeared 
on the skin, inside of the knee, seven weeks after a kick from a horse; 
they contained alkaline and corrosive serum : the joint which had been 
stiff and swollen recovered freedom of motion ; painful itching con- 
tinued to recur at every new moon, later, every fortnight over the 
face, ears, and hands. Eruption, ushered in by agitations of the limbs 
and thighs, itching and tingling over the whole body, persisting through 
the night; at one time genitals and anus painfully swollen. Face so 
swollen that he could not open his eyes ; skin of hands had a psoriform 
aspect, dry and entire, excepting a few fissures; burning pains 
here and there, with darting itchings. A millet-sized pustule, enlarg- 
ing, discharged a little and left a raw surface ; for three or four weeks 
slight lancinating pains of face and ears, complexion slightly yellow. 
Phus.-tox, 2° ; two drops every eight days for many months. The 
patient was cured. (Dr: Potlis Clinique Obs., 1299.) 
If, as asserted by Pet. Rossi, Van Mons, J. Monti, Sybel, and 
others, the I'oison-sumach, Rhus-vernix, has the faculty of producing 
pimples which gradually cover the entire body, it may be easily per- 
ceived how this plant is capable of effecting a homoeopathic cure of 
various kinds of herpetic eruptions, which it really has done, accord- PEMPHIGUS. 
851 
mg tc information furnished by Dufresnoy and Van Mons. And 
it would be in vain to seek amid the vast domain of hypothesis the 
cause that renders Dulcamara so efficacious in a species of herpes, as 
witnessed by Carrere, Fouquet, and Poupart. Nature, which requires 
the aid of homoeopathy to perform a safe cure, sufficiently explains 
the cause, in the faculty possessed by Dulcamara of producing a cer- 
tain species of herpes. 
Acetum.—Herpes prseputialis, venereal vegetations, &c., have been 
cured by the application of a lotion of Acetic-acid. 
Pemphigus.—Diagnosis.—This is also a vesicular affection, charac- 
terized by the appearance of single vesicles of large size upon the 
legs, and occasionally upon other parts of the body. The vesicles are 
filled with a yellow or straw-colored fluid, and are seated upon an 
inflamed, hard, and red base. This disease occurs during the course 
of fevers, or in old and enfeebled persons, after undue exposure to 
cold, or improper indulgence in stimulants, or indigestible food. “ I 
have frequently seen,” says Macintosh, “ large bullae take place in the 
course of slight as well as severe fevers; but instead of considering 
them thereby entitled to any specific character, I have always looked 
upon their occurrence as an accidental circumstance, and have made 
no difference in the treatment of the original disease. The appear- 
ance of the vesicles is sometimes preceded by slight chills, followed 
by transient flushes of heat, and other signs indicative of mild con- 
stitutional disturbance. In these instances the integuments at the 
base of the vesicles are hard, swollen, and painful. The ordinary 
duration of the eruption is from one to two weeks; but in some in- 
stances the vesicles continue to appear for months. 
Treatment.—Sulphur, Dhus, Arsenicum, Dulcamara, Iodine, 
Acid-nitr., and Mercurius. 
Administration.—They may be employed in the same manner as 
advised under herpes. 
Rupia is another pustular affection, often resembling very closely 
ecthyma. Bateman describes it as an “eruption of flat, distinct vesi- 
cles, with bases slightly inflamed, containing a sanious fluid, the scabs 
accumulating sometimes in a conical form, easily rubbed off, and soon 
reproduced.” Although this author describes the eruption as vesicular, 
it is now generally conceded that the disease is for the most part pus- 
tular. The eruption may be distinguished from that of ecthyma, by the 
appearance of scabs and the ulcerations which frequently occur. 
Several varieties have been described, which we do not think neces- 
sary to specify minutely, since their general character is the same, 
and the eruption is sufficiently marked to enable the careful observer to 
detect its true nature without difficulty. 
Treatment.—The medicines usually employed in the above com- 852 
DISEASES OF THE EXCERNENT FUNCTION. 
plaints are, Sulphur, Sepia, Mercurius, Dims, Antimoniuwrtavt 
Silicea, Ilepar-sulph., Au/rum-murArsenicum, Iodine, Calcarea- 
carb., Dulcamara. 
Administration.—Attenuations and repetitions of doses, the same 
as in scabies. 
Ecthyma.—Diagnosis.—This disease originates from a morbid con- 
dition of the skin, which supervenes during the course of eruptive and 
other fevers, venereal diseases, scrofula, scurvy, &c. The pustules are 
of considerable size, seated upon swollen, bright-red, and painful 
bases, and never running together, but always preserving a distinct 
character. After a few days the pustules become covered with hard 
and dark or greenish scabs, which in one or two weeks dry up and dis- 
appear. Ecthyma has been subdivided into several distinct varieties, 
on account of some trifling and unimportant modifications which the 
eruptions occasionally present, from peculiarities of age, constitution, 
disease, and habits of life. The most common of these varieties are: 
1. Ecthyma Vulgare.—“ Consisting of a partial eruption of small, 
hard pustules, on the neck, shoulders, or extremities, which is com- 
pleted in about three days. They enlarge and inflame from pus, and 
form scabs. These eventually dry, fall off, and leave no mark behind. 
They are chiefly seen in young persons whose health has been im- 
paired.” 
2. Ecthyma Luridum, with pustules, “larger, more diffused, more 
repeated and fixed upon a hard, elevated base of a peculiar dark-red 
color.” {Ilall.) 
3. Ecthyma Infantile, occurring generally in infants of delicate or 
scrofulous constitutions, or in those whose systems have been enfeebled 
by abuse of drugs. 
4. Ecthyma Cachecticum, peculiar to individuals who are suffering 
under a venereal, scrofulous, or psoric taint. 
IMPETIGO. 
Diagnosis.—The eruption consists of clusters of small pustules, 
vesicular in the first instance, but soon becoming purulent. After a few 
days the pustules burst, and thick and dark-yellow scabs remain. The 
skin around the pustules is somewhat swollen, inflamed, and painful, and 
when the secretion from the ruptured pimples is acrid, the patient is 
often annoyed with an exceedingly disagreeable burning and itching 
sensation. Willan, Bateman, Rayer, Schroen, and several other emi- 
nent writers on cutaneous affections recognize five different varieties : 
1. Impetigo Figurata, occurring generally in children during den- 
tition, and in “young men and women of lymphatic or sanguine-lym- 
phatic temperaments.” Rayer advises Lycopodium, Sepia, Sulphur, ' IMPETIGO. 
853 
Rhus-tox., Graphites, Calcar ea-carb., Dulcamara, and Petroleum m 
this form of tlie disease. 
2. Impetigo Sparsa.—In this variety the pustules are isolated, and 
dispersed over the shoulders, buttocks, face, scalp, or legs. It gene- 
rally “ appears in the fall and winter, and disappears in spring and 
summer.” (Bateman) Mercurius, Sulphur, Cicuta, and Lachesis 
will be found specific in this form. 
3. Impetigo Eipsipelatodes.—The eruption is generally a disease 
of the face, and bears some resemblance to erysipelas in the first in- 
stance, but soon changes to a pustular character. The scabs which 
form on the pustules are of a dirty-yellow or greenish color, and are 
kept soft by the secretion which is under them. Schroen considers 
Belladonna, Rhus-tox., Mercurius, and Arsenicum the proper reme- 
dies for this form. 
4. Impetigo Scahida.—This is a severe form, attended with more 
inflammation and pain in the affected parts, and more extensive ulcera- 
tion and discharge than either of the other varieties. We may em- 
ploy Ilepar-sulph., Mercurius, Arsenicum, and Iodine. 
Impetigo Larvalis, or Crusta lactea—“ Common amongst young 
nursing children; characterized by an eruption upon the cheek of 
superficial, more or less confluent pustules, united in groups, attended 
with slight itching, and followed by yellowish and green—generally 
thin and lamellated, at times, however—with thick and soft crusts, that, 
when loosened, leave a red and inflamed surface, which is quickly cov- 
ered with new crusts. 
Treatment.—The best remedies are, Sulphur and Rhus-tox., 
(Schroen) or Dulcamara, lycopodium, and Sepia, (Knorre) or Gra- 
phites and Mezereum. (Lobethal.) 
Administration.—In the sanm manner as in eczema. 
Sulphur.—Dr. Guilbert, of Dubuque, says, Sulphur is the leading 
internal remedy, and is necessary at intervals, even when some one of 
the following is preferred : Clematis-erecta, Phytolacca-decandria, 
Arsen.-Dulc., Croton-tiglium, Conium, or Ilepar, but whatever inter- 
nal treatment is relied on, they recover soonest under some application 
of the proper remedies topically. 
Mercury.—Specific effects of Mercury on the Skin.—Pearson de- 
scribes an eruption which he has named mercurial eczema. It is 
also to be observed that Calomel is a common prescription for eczema. 
Erasmus Wilson directs Calomel one grain with one of sugar of milk 
for a young infant. “ After the first dose, the Calomel may be repeated 
according to circumstances, once a week, twice a week, every other 
night, for a few nights, or even every night.” (Skin Diseases, E. Wil- 
son, p. 177.) In an attenuated form the remedy is a good one. 
Mercury is proved to be homoeopathic to “iritis: periostosis,paraplegia, 854 
DISEASES OF THE EXCERNENT FUNCTION. 
hemiplegia, and shaking palsy,” in all of which allopathists have long 
employed mercurials. 
4. Crusta Serpiginosa.—This form resembles crusta lactea, but is 
marked by the appearance of small vesicles behind the ears, which 
burst, forming a thin, dark-colored scab, from which an acrid fluid is 
seoreted. The face, neck, arms and trunk, eventually become in- 
volved. For the cure of this form Schroen advises /Sulphur, Clematis- 
ereeta, Calcarea-carb., Lycopodium and Arsenicum. 
Causes.—By many the disease is supposed to be owing to the pre- 
sence in the skin of minute animalculae of the species acarus scabiei. 
It has likewise been attributed to want of cleanliness, and the use of 
unwholesome food. The remedies should be given in the first or 
second attenuation, and repeated two or three times a day until the 
eruption disappears. In recent cases, Hartmann, Schroen, and Schmid, 
employ the tinctures and the first dilutions; but in obstinate cases 
they employ from the third to the sixth attenuations. 
Is another pustular affection, making its appearance generally upon 
the nose, face, forehead, and shoulders, first in the form of a thicken- 
ing redness and induration of the integuments, from which eventually 
proceed suppurating points or tubercles. The parts affected often ac- 
quire a depth of redness and a conspicuousness which much annoy the 
patient. Plumbe supposes that the malady consists in a diseased con- 
dition of the sebaceous follicles, induced by excessive indulgence in 
the pleasures of the table, sedentary habits, &c. Sometimes it is vio- 
lent, and extensive inflammation and suppuration occur. Acne con- 
sists of hard inflamed tubercular tumors of the face, neck, shoulders, 
or upper part of the thorax, most common in young persons, suppurat- 
ing slowly or subsiding after a few days. In the simplest form it 
begins with small, hard and inflamed tubercles of the size of a pin’s 
head, reaching their greatest size in eight days. They are then dark- 
red, smooth, prominent, shining, hard and painful; in two or three 
days more a small speck on the apices of some of them, shows the ter- 
mination in suppuration; a thin humor flows from the surface, dries, 
and is gradually removed. 
A second variety has the tubercular pustules larger, more indurated 
and permanent. They are numerous, conical or oblong in form; some- 
times rose-colored; some suppurate at their apices; others remain 
hard and elevated, giving the name of “ stone pock.” Acne simplex is 
generally connected with some derangement of the general health, oc- 
curring most commonly in females, who sutler from menstrual irregula- 
rities, especially dysmenorrhcea. 
-ACNE, ACNE, 
855 
Acne Rosacea. —Rosy Drop, Carhuncled Face,—Commonly begins 
at the end of the nose, and spreads from its sides to the cheeks, cover- 
ing only a part of them. It consists of small tubercles which suppu- 
rate slowly, exhibiting a shining redness and an irregular, granulated 
appearance of the skin. At first it is pale in the morning, and be- 
comes intensely red from excitement. The cuticle is gradually thick- 
ened, and its surface diversified by cutaneous veins, which become vari- 
cose and suppurate. Acne rosacea occurs later in life than the former 
species, and is often caused by the intemperate use of stimulating 
drinks. In the worst cases the nose is enormously enlarged, the tuber- 
cles suppurate and form ulcers which are cured with great difficulty. 
Acne Punctata.—Crimones.—Maggot Pimple.—A number of 
black points, surrounded by a very slightly elevated border of cuticle. 
It proceeds from concreted sebaceous matter accumulated in the follicu- 
lar glands, and may be squeezed out of these glands or their ducts. They 
sometimes inflame and form small tubercles which suppurate partially. 
Acne Syphilitica.— Venereal Acne.—Only caused by the consti- 
tutional influence of secondary syphilis. It resembles the acnea rosa- 
cea, appearing on the forehead, face, neck, and upper part of the 
trunk. The vari are round, conical, inflamed, with a copper-colored 
tubercular base and areola. 
Treatment.—Acne in intemperate persons: Nux-vom., Ledum, 
Sulphur. 
Acne Rosacea : Causticum, Rhus, Sepia, Carb.-.animalis. 
Acne Punctata: Bell., Ilepar, Natrum, Nitric-ac., Sulph., Sepia. 
Sepia operates especially on the portal system, retarding the circu- 
lation and causing an overloading of the vascular system with venous 
blood. A plethora venosu gives rise to most of the symptoms of 
Sepia. [Meyer) It is appropriate in all cases where this pathologi- 
cal state causes pustular eruptions, complicated with derangements of 
the digestive and uterine organs. 
Ilydriodate of Potash.—Acne punctata in young females, pimples 
thickly strewn over the face, especially the vicinity of the alee of the 
nose: two grain doses repeated three times a day. A well-marked 
case improved in ten days. Cures entirely in seven weeks. (Banks, 
N. A. Jour. Ilomoeop., 1857, Aug.) 
Mercurius-corrosivus.—This remedy, which has so long been em- 
ployed in the syphilitic form of acne, as well as in obstinate cases of 
other skin diseases, is much more successful in homoeopathic practice. 
In the third trituration, repeated every four or six hours for some 
weeks, some obstinate cases have been cured. In many others due at- 
tention to the digestive and uterine functions have been sufficient. 
Belladonna.—Acne in young persons, with uterine derangements, 
dysmenorrhoea, and determinations to the head. 856 
diseases of the excernent function. 
Carbo-vegetabilis—The pustules itching, suppurating, with burning 
pain, in lymphatic temperaments. 
Ilepar-Sulph., Sulphur, in psoric cases. 
Rhus.-radicals.—Red-inflamed tuberculoid elevations on the skin. 
PAPULAR VARIETIES.—1. LICHEN. 
Diagnosis.—Many kinds of this malady are described by writers, 
although the general character of the eruption is in all instances the 
same. Willan gives us seven different forms; and other authors de- 
scribe even a greater number. But the propriety of these minute 
sub-divisions is very questionable, since some slight distinctions might 
be made in almost all cases which occur; and thus lead to a very ex- 
tensive and inconvenient classification. 
The eruption consists of numerous small papillae upon the breast, 
arms, and limbs, in the first instance, which afterwards spread over the 
whole surface of the body, attended with a tingling, and itching, espe- 
cially when exposed to heat, or when covered up warmly in bed. The 
eruption is generally preceded by slight febrile excitement, and symp- 
toms of gastric or intestinal disorder. The basis of the papillae are 
red, inflamed, and painful, but they do not often suppurate, or become 
filled with serum, but continue about eight or nine 'days, when they dry 
up, and fall off in the form of scurf. 
The eruption which is so often seen in infants during the period of 
dentition, and known as “ the red gum? is a form of lichen. In these 
cases the color of the papillae may be red or white. 
Sometimes the eruption appears in the palms of the hands, the arms 
and legs, when it receives the vulgar appellation of “Salt-rheum 
The eruption now and then comes out in a mild form upon the trunk 
or extremities, attended with heat, and troublesome itching on becom- 
ing heated, or from rubbing or scratching, but entirely unattended by 
febrile excitement. This variety is familiarly known under the desig- 
nation of prickly heat. 
Causes.—Irritation of the stomach and intestines from errors in 
diet, worms, and teething. Also protracted exposure to a hot fire; 
going into the cold air after long exertion while in a profuse perspira- 
tion, or sometimes from entering a hot apartment after having been 
exposed for a long time to intense cold. 
Treatment.—The folloAving medicines will suffice to cure all forms 
of this oomplaint: Sulphur, Graphites, Calcarea-carb., Sepia, Iodine, 
Antimonium-tart., Copaibce-bals., Acid.-phos., Chamomilla, Dulca- 
mara, Rhus-tox., Hepar-sulphur. 
Administration.—Same as for eczema. PAPULAR VARIETIES. 
857 
2. HERPES CIRCINATUS.—RINGWORM. 
A common affection of children. It consists of an eruption of small 
circular rings of red spots, the skin within the ring having a natural 
appearance at first; but, subsequently, it becomes rough, of a reddish 
hue, and scales off as the eruption dies away. It generally appears 
on the face, neck, arms and shoulders, generally disappearing of 
itself after two or three weeks’ duration, though it often lasts much 
longer. 
Treatment.—Sepia.—A dose or two of this remedy will generally 
remove the disease. When it fails, the alternate use of Rhus-tox. and 
Sulphur, every four or five days, will cure all common cases. 
Calcarea, Causticum, and Sulphur may succeed in more obstinate 
cases. 
Ring-worm of the Scalp.—This is supposed to be a contagious dis- 
ease. It affects the hair, though temporally ; it never produces per- 
manent baldness. It resists ordinary remedies with great obstinacy. 
Diagnosis.—Characterized by patches, more or less circular, vary- 
ing in size, which when first discovered are not larger than a pea, but 
may extend so as to reach the diameter of two or three inches, and 
even more ; they are covered with dry mealy desquamation, with the 
hair broken off at irregular distances from the surface. It may last 
four weeks or months. It is said to be very common in England, 
though rare in France. It seems more common now in America than 
formerly. 
3. PRURIGO. 
Diagnosis.—Prurigo is believed by some authors to be a severe form 
of lichen. The papillae are, however, larger, “ more isolated and dis- 
tinct, and scattered over larger surfaces” than those of that affection. 
The eruption is sometimes of a red, or pinkish color, at other times 
white, like the surrounding skin, and attended with the most intense 
itching and stinging. The papillae are most commonly distributed 
about the labia pudendi; but the disease is not unfrequently observed 
in other parts of the body. 
The causes and treatment are the same as those described under 
lichen. 
4. PSORIASIS. 
Mackintosh regards psoriasis as an aggravated form of lepra. Ac- 
cording to Hall, it “ ditfers from lepra chiefly in the irregular form, in 
the diffusion of the scaly patches, and in the absence of its inflamed 
borders, depressed centres, and regular oval or circular forms. The 
subjacent surface is also more tender, more easily denuded, and more 858 
DISEASES OF THE EXCERNENT FUNCTION. 
prone to become affected by fissures.” The disease attacks the scalp, 
face, the arms, the legs, the palms of the hands, the lips, the prepuce 
and the scrotum. Occasionally the inflammatory action runs so high 
that the parts become much swollen and highly painful. In these 
cases there is usually a considerable secretion from the eruption. 
5. PORRIGO. 
This is a contagious disorder, and presents itself in the form of 
!i straw-colored pustules, sometimes circumscribed, sometimes diffused ; 
generally, but not always confined to the head; the pustules break 
and give issue to a fluid which concretes into yellowish or brownish 
thin, or thick, crusts or scabs.” {Hall.) It commonly makes its ap- 
pearance upon the scalp and face, but may occur in any other part of 
the body. The disease has been subdivided into several varieties, but 
the divisions are of no practical utility, and tend directly to create 
confusion and embarrassment. We restrict the term porrigo to the 
contagious form of the disease. 
Characteristics.—Scabs, peculiar in their shape and color, odor, 
process of formation, &c., producing permanent baldness. 
Porrigo appears in two forms: 1. Porrigo Favosa.—Scabs or 
incrustations of a sulphur-yellow or bright-fawn color, when recent; 
scaly in their shape, hollowed out in their centre in the form of a cup ; 
dry and almost pulverulent, firmly implanted in the epidermis, so that 
the depression is left when they are removed; so adherent as some- 
times to remain for months and even for years ; having a peculiar odor, 
which has been compared to the urine of a cat, or more properly to a 
place where mice have been. It is most often seen on children from 
seven to eight years of age. It is commonly on children of depressed 
physical and intellectual power. It never ceases spontaneously unless 
for want of material on which to act. It may last twenty years, resist 
ordinary remedies, and always producing permanent baldness of the 
the parts affected. No tendency to periodical returns. 
Causes.—Contagion; imperfect nutrition and other depressing agents. 
The history of porrigo involves that of other parasitic growths com- 
mon on the skin, which demand consideration at some length. 
Treatment.—(See Eczema) 
PARASITIC VEGETABLES ON THE HUMAN SKIN. 
Ten varieties are enumerated as growing on the human skin. 
I. Tinea tonderes or Tricophyton tonsurans.—First described by 
Gruby, in 1844, as accompanying the disease called rhizophyte. It 
exists in the hairs of herpes-tonsorans, and in plica-polonica. It eon- PARASITIC VEGETABLES ON THE HUMAN SKIN. 
859 
sists of “ oval transparent spores, which give rise to articulated fila- 
ments. Its anatomical seat is in the interior of the roots of the hairs. 
The hairs and fungi simultaneously increase ; the former seem larger 
than usual, are paler in color, lose their elasticity, soften and break off 
when they have risen some one or two lines above the surface of the 
scalp; in the short cylinder then left the fungus grows still more 
rapidly, so that the normal structure of the small stump of hair soon 
becomes indistinguishable. Sometimes the hair breaks off before 
emerging from the skin, the fungus, epidermis, and sabaceous matter 
fill the ends of the piliferous conduits, and form the little prominences 
which can be seen by the naked eye, and give the skin a rough, anser- 
rine appearance. The sporules and mycelium of the plants can some- 
times be seen in the form of a white powder, on the roots of broken 
hairs ; sometimes the cutis becomes congested and thickened, and then 
the plant is mixed up with scales of epidermis, with fatty and albu- 
minoid granules, with pus, &c.; and crusts are formed of greater or 
less thickness, in which the growth of the fungus can go on. It is 
believed that, though this disease is communicable by contagion, and 
has been communicated from the horse to man, it is dependent on some 
constitutional cause which is essential for the growth of the plant, as 
it sometimes dies without having been subjected to any treatment. Its 
most characteristic feature consists in the baldness in circular spots, 
arising from the brittleness of diseased hairs. 
Great Size and Rapid Growth of some Fungi.—Dr. Lowe says, 
an agaric, growing under a stone of more than 100 pounds weight, 
raises it from its bed to a height of several inches. The cells of that 
agaric are not widely different from those of parasitic growths. Again, 
Harvey says, the mycelium of the fungus, probably identical with that 
found in skin diseases, has been known to raise a cask of wine to the 
top of the cellar, the fungus feeding on the wine as it leaked from the 
cask. Surely the cell force which is capable of affecting such opera- 
tions as this must be of some moment when exercised, although to a 
much less extent, and in a delicate living tissue. It must be capable 
of exciting inflammation and actually producing eruption, which is 
coeval with the development of the parasite. 
The mode of spreading is annular or centrifugal in form: for, be- 
yond the irritation produced by mere mechanical pressure, there is 
another source by which inflammation is engendered, viz.: the produc- 
tion of irritant acids and gases by the chemical action of the vegeta- 
ble cell. Now a vegetable cell cannot undergo development without 
exciting a chemical decomposition in the pabulum on which it feeds. 
The different stages in the growth of the plant give rise to alcoholic, 
acid, and putrefactive fermentation. Of the latter we have examples 
in many skin' diseases, but especially in favus; the odor of which 860 
DISEASES OF THE EXCERNENT FUNCTION. 
closely resembles that of some methylamine compound. It can admit 
of little doubt that all these compounds are irritants. 
An amount of fungus that will simply produce the death of the hairs 
in one person or part of the body, will, in another, produce irritation, 
eruption, or even violent inflammation. The causes of this difference 
are: 1. constitutional peculiarity; 2. peculiarity of structure, density; 
leat, moisture, and chemical composition of the part; 3. variation in 
the different amount of irritability in different parts of the body. Dr. 
Lowe, in 1857, Mr. Hogg, in the Microscopical Journal, and Mr. 
Robin, in his faithfully executed and beautiful work, show that these 
parasitic growths are all specifically identical. Mr. Hogg claims to 
describe acccurately the fungus growths in six specific diseases: 
psoriasis, lepra, eczema, spilus, ichthyosis, and lichen. Of these Mr. 
Lowe describes lichen, and this only as a parasitic disease. 
Causes of Disease by Fungi.—1. It is a general law that vegetable 
parasites only attack bodies in a lowered state of vitality, or com- 
mencing decomposition. 2. They cannot grow without producing de- 
composition, the products of which, in contact with living tissue have 
a tendency to excite irritation. 3. Mycelium growing amongst living 
structures excites inflammation. Mycelium spreads centrifugally, and 
the ring of the inflammation spreads to the same extent. 4. The fungi 
formed in all skin diseases are to be ascribed to one or two common 
species, the slight variation in their structure being due to the different 
conditions under which they grow, especially with regard to light, 
heat, moisture, electricity, chemical requirement, and density of struc- 
ture. 5. Parasiticides are often capable of removing the disease with- 
out constitutional treatment; but this must be when the disease is 
purely local. The parasite has been often plainly seen by Robin and 
other observers. 6. When it occurs in other diseases it is merely in- 
cidental ; and then it does not produce its specific action, owing to the 
absence of one or more of the requirements for its development. 7. 
There have been numerous cases of direct contagion from one subject 
or part to another. 
In cases in which psoriasis, pityriasis, lichen, tinea, favus, and sycosis 
have been communicated very recently by contagion, it may be possi- 
ble to cure the case by local treatment alone, as Mr. Lowe proposes, 
as he says he succeeded by only painting the part over with tincture 
of Iodine once a day, a drachm to the ounce, w'hich he thinks the best 
parasiticide. But we cannot sanction his practice in any case, though 
even of short standing. On the conditions of health which favor the 
production and growth of parasites, M. Claude Bernard says: 
“ When frogs have been kept for a long time in captivity, their health 
declines, and ulcerations arise around the nose and mouth. The ner- 
vous system being in this case considerably depressed, the animal is of PARASITIC VEGETABLES ON THE HUMAN SKIN. 
861 
course found to resist much longer the action of strychnine and simi- 
lar poisons, whilst parasitical affections spread with fearful rapidity. 
Frogs are subject to the growth of parasitical fungi, which after a cer- 
tain lapse of time occasion the animal’s death. Now if the healthy frog 
is placed in a jar containing others affected with the above-mentioned 
disease, the new comer sets contagion at defiance ; while if another frog, 
affected with ulcerations in the vicinity of the natural orifices, be in- 
troduced into the jar, the parasitical vegetation covers it at once. It 
has been found that similar affections always have a strong tendency 
to arise on animals in a low state of health. The itch, a disease that 
frequently prevails among horses and sheep, is not often found to attack 
animals in good condition; and in man, the lower classes are a pr 
to vermin, especially in childhood and old age. While persons who 
live under more favorable circumstances are scarcely ever affected with 
this inconvenience, except towards the latter end of long-continued and 
painful disease. It is generally in such cases that the morbus pedi- 
cidaris has been observed.” 
Dr. Wolfe says, that “baldness becomes more and more prevalent, 
even in young people, where the common causes, psora, syphilis and 
the abuse of Mercury and Iodine have had no share in its production.” 
Treatment.—Allopathic treatment has been confined to local appli- 
cations by which the fungus may be destroyed. The hair (where the 
skin is not already bald), is removed by pincers, or by some depilatory 
chemical application. For this Dr. Bazin (On the Nature, and Treat- 
ment of Tinea') recommends an unguent of “ Lime and Carbonate of 
Soda, each one part, lard thirty parts.” The Oil of Cade is said to 
be the best depilatory known. After the removal of the hairs, a 
“parasiticide” solution is applied on the skin. Bazin uses.a solution 
of one part of Bichloride of Mercury to 250 parts of water; or an 
ointment of Acetate of Copper, (1 part to 500 of lard.) Others use a 
solution of Per-nitrate of Mercury, (1 part to 40 parts of water.) This 
is likely to blister the scalp and should only be used after further dilu- 
tion. Another effective agent in destroying the parasites is composed 
of Sulphate of Copper 1 part, Alum 3 parts, and lard 30 parts. A 
better and safer agent is Sulphurous-acid. This must be diluted with 
water to the extent that no irritation of the skin will result. 
The homoeopathist will never rely upon local treatment of cutaneous 
affections even when he has seen such treatment apparently success- 
ful. The general psoric, sycotio, or other dyscrasie condition of the 
system in every case demands internal constitutional remedies. Under 
the use of Sulphur, 30°, or sometimes lower ; Cinnabar 3°, or higher, 
continued for some weeks ; Calearea, sometimes alternated or followed 
with Ilepar, or Thuya, we place the system in a condition that it 
ceases to furnish the proper soil for the propagation of these parasites 862 
DISEASES OF THE EXCERNENT FUNCTION. 
in which the essence of this whole group of diseases consists. We 
uniformly succeed in eradicating such offensive and inveterate affec- 
tions by the ordinary antipsoric remedies. As we have already treated 
of these constitutional blood dyscrasias and of numerous remedies 
adapted to each of them, it is only necessary here to refer to pages 
261,264, 272, and to present the claims of a few more which we regard 
as especially useful. Any constitutional treatment to be effectual and 
permanent must be continued for a considerable time. 
Tartar-emetic.—Porrigo, eczema, and herpes are quite prone to 
attack the penis and scrotum ; the itching and burning which they 
occasion are almost intolerable. One of our most efficient remedies 
in these cases is a high dilution of Tartar-emetic. It may often be 
succeeded or alternated with the 12th dilution of Croton-tiglium with 
much advantage. Administered at the first triturition it has often 
cured obstinate gleets with promptness. In this form, and by being 
given nightly for several weeks, it has in two cases cured seminal 
emissions, which had occurred as often as once in twenty-four hours 
for many months. 
In one case of obstinate porrigo, affecting both hands, and accom- 
panied by intense burning and itching, with acrid exudation on scratch- 
ing or rubbing the parts, we prescribed the Tartar-emetic ointment 
externally, until its characteristic eruptions should be produced. Its 
appearance was accompanied with much pain, although more tolerable 
than the porrigo irritation. In about the usual period this antimonial 
eruption passed of!', carrying wTith it all symptoms of porrigo, and 
leaving the hands cured. 
Internally, it is appropriate for itching pustular eruptions upon the 
arms and hands. In such cases it sometimes proves promptly curative, 
after Sulphur, Ilepar, &c., have failed. We employ it from the 6th to 
the 12th attenuation. 
General Symptoms.—Spasmodic movements and twitchings of the 
arms and hands; violent clonic spasms with loss of consciousness; 
lock-jaw ; paralysis; relaxation of the muscles and great prostration; 
languor; exhaustion; collapse; loss of speech and coldness of the 
body. Cholera-morbus; contraction of the pupils. Strong, violent 
convulsions and spasms; tetanus; extreme restlessness and anxiety. 
Cold; pulseless ; speechless. Thirst and burning sensation through 
the prima via. Prostration of strength ; insensibility; faintness ; pro- 
longed trembling of the head and hands, at every movement, like para- 
lytic trembling. Symptoms worse on being seated, or manifesting them 
selves in that position. Watery diarrhoea, with extremities cold, power- 
less, with cramps in the calves of the legs. 
Porrigo Pecalvans.—Dr. Carter, an army surgeon, says he has 
often succeeded in restoring the hair which had fallen out from the PARASITIC VEGETABLES ON THE HUMAN SKIN. 
863 
abuse of Mercury, or from acute disease. He used five grains of 
Tartar-emetic to the ounce of distilled water. 
Two cases of partial baldness were cured bv Beauchamp. In one 
case the solution was too strong and brought out a crop of pustules on 
the head and the whole body, attended with fever. The fever soon 
subsided and the pustules disappeared, except on the head, where they 
coalesced and formed an immense scab, resembling tinea capitis. 
Hahnemann mentions a variolous eruption on the chin, attended by 
itching, as a symptom of Tartar-emetic. Porrigo, eczema, and hepatic 
eruptions on the face are often relieved by the 6th dilution of Tartar- 
emetic. It is sometimes successful in old hepatic eruptions of the 
face when employed in the form of a mild unguent. 
Arsenicum.—Dr. Banks, of New-York, gives a case. A young man 
of high life in New-York had a horrible itching surrounding the anus, 
perineum, &c. Some parts dotted with papules entirely denuded 
with hair, and of a coppery color, resembling secondary syphilis. Ar- 
senious-acid, one twentieth of a grain, three times a day internally; 
and unguent of Iodide, of Arsenic, tepid baths externally, moderate diet, 
exercise. In three weeks every trace of the disease was effaced. 
2. Mycrosporon circumscripta.—This parasite differs from the pre- 
ceding by “ its numerous waved filaments and by the extremely small 
size of its sporules. It is not found in the interior of the root of the 
hair, but forms round each hair a small tube ; the hair then becomes 
opaque, softens and breaks off. The hair rapidly falls off; the dermis 
is not congested, and the epidermis is thin and smooth. 
3. Microsjporon mentagrophyta.—Differs from the last by possess- 
ing larger spores and filaments. Its seat is between the bulb of the 
hair and the follicle in which the bulb is seated, and never extends be- 
yond the surface of the skin. Treatment the same as already given. 
4. Microsporon furfur.—Discovered by Eichstedt in 1846. It is 
the cryptogamic plant which forms with the epidermic scales, the yel- 
lowish brown scurf seen in pityriasis. 
5. Achorion Schmileinii.—This is the mycodermatous fungus which 
constitutes the characteristic of tinea, favosa, [porrigo favosa. This 
is an affection of the skin usually confined to the scalp, but occasionally 
found on the trunk, limbs, or face; almost invariably occurring before 
the seventeenth year, and peculiar in old countries and cities to the 
poorer classes. 
Symptoms.—“Favus is an affection characterized by the presence 
of more or fewer crusts, which at first, are of a uniform sulphur-yellow 
color, having their superior surfaces slightly concave and pierced in 
the centre by a hair, and their edges slightly depressed beneath the 
level of the cuticle; they are surrounded by skin which, for some time 
previous to their appearing, presents a glazed red, and vascular look, 864 
DISEASES OF THE EXCEKNENT FUNCTION. 
and is more or less covered with, desquamated epidermic scales. The 
crusts, when isolated, have a more or less distinctly round or oval 
figure, and have in their upper surfaces a depression in form like that 
of a lupus seed (porrigo lupinosa); but where numerous and confluent, 
they acquire, from contact with one another a hexagonal or honey-comb 
appearance, and hence the term porrigo favosa. In the progress of 
development, the edges of the crusts become prominent, and marked 
by several concentric rings, whilst their upper surfaces gradually lose 
the concave and assume the convex form. In course of time, there is 
observed in the centre of each capsule a whitish spot, which slowly ex- 
tends into the surrounding deeper yelloAV portion, and ultimately 
reaches the edges of the crusts, which gradually sink to the level of 
the skin, and frequently present numerous cracks or splits. There 
speedily commences in this central white portion a loss of coherency, 
or a process of crumbling down into a coarse gritty powder; and when 
this, in the progress of the disease, has extended to the edges, the 
capsules lose all definite form, and become broken or split up into nu- 
merous pieces presenting the appearance of one continuous crust, irre- 
gularly fissured on the surface. The diseased mass crumbles down, and 
communicates to the fingers, on trituration, a feeling, compared by 
some to that caused by the crushing of dried putty; becomes a favor- 
ite site for vermin and their eggs, and exhales a peculiar odor which 
has been likened to that of mice. For some time the disease occasions 
little uneasiness; but ere long the part affected becomes the seat of a 
disagreeable itching, which gradually increasing, at length becomes so 
intolerable that the patient cannot resist incessantly scratching and 
tearing at the diseased mass, the consequence of all which is, that in 
cases of some standing, we usually meet with more or less sanguineous 
or serous effusion, with secondary pustular eruptions, and at times 
with violent inflammation, which in a few cases terminates in suppura- 
ration, and in other instances in unhealthy ulceration.” 
Pathology.—When a recently-formed favus crust is carefully ex- 
amined, it is found to consist of a capsule of epidermic scales, coated in 
the interior with a granular matter, constituting a soil on which arise 
multitudes of a peculiar fungus, named by Gruby in 1841, achorion 
Schamleinii, in honor of Schoenlein, of Berlin, its discoverer. From the 
granular mass sprout numerous cylindrical tubes (thalli), which ex- 
tend themselves towards the centre of the crust, and, branching dicho- 
tomously, contain at their extremities (mycelia) numerous spherical or 
oval bodies termed sporidia. The thalli frequently contain numerous 
molecules or granules, and are most numerous near the exterior of the 
crust; whilst the mycelia and sporules, mingled with more or less 
granular matter, abound at the centre, the whitish color of which has 
been ascribed to the aggregation of the sporules. In course of time PARASITIC VEGETABLES ON THE HUMAN SKIN. 
865 
the thalli and sporules enter the hair-follicles, cause atrophy of the 
hair-bulbs, and consequently the baldness observed in the subjects of 
favus, and, as may be witnessed under the microscope, at times extend 
into the body of the hair. “ The sporules are the bodies from which the 
plant is developed; and from the observations of Remak and others, it 
appears that, in the process of elimination, their investing membrane 
gives off shoots or prolongations which ultimately become tubes, en- 
closing at their extremities sporules, which in time are pressed out 
and become free.” 
Dr. Pirrie says, that from the observations he has made on this dis- 
ease he hfis reached the conclusion, “ that the peculiar matter of favus 
is an exudation on the surface of the derma; that this exudation be- 
comes the seat of peculiar phytaceous growths, which in the progress 
of development, penetrate the epidermis and become encysted by its 
scales; and the hair-follicles are not the seat of the disease, but only 
become secondarily affected.” 
Chemical Composition.—In analyzing the matter of favus, Thenard 
found in 100 parts—albumen, 70; gelatine, 17; phosphate of lime, 5; 
water, 3 ; and loss, 5 parts. 
Cause.—Extensive examinations of the works of authors who have 
written on this disease reveal only the extent of the discrepancies of 
opinion that exist among medical men on its nature and origin. While 
it is shown to be contagious in many cases it does not appear to be 
always so. The opinion given by Dr. Pirrie is most nearly in accord- 
ance with the philosophy of our school, and is thus given : “ The im- 
pression produced in my mind by the histories and symptoms of the 
cases that have come under my notice is, that the f ungus, although it 
occasions a certain amount of irritation, is not the sole or the original 
cause of the eruption, but a mere accidental growth upon a congenial 
soil formed of an exudation, which is itself a mere local manifestation 
of a peculiar constitutional state / in short, that the disease is owing 
to a blood dyscrasia ; that from the blood is formed an exudation 
which is essential to the existence of the fungus; and that, until this 
peculiar matter be exuded, sporules of the plant applied to the integu- 
ment must remain inert and undeveloped.” Among all the experiments 
to produce the disease by inoculation, in no instance yet reported was 
the attempt successful, till, from irritation caused by prolonged close 
application of the favus matter, either redness, pain, suppuration, or 
some other sign of the inflammatory process, had manifested itself.” 
Erichsen says the essential nature of the disease consists in the de- 
position of the matter of tubercle. Erasmus Wilson thinks that “de- 
fective nutrition is the real cause of the disease. Bennett considers 
favus to be “ essentially a form of abnormal nutrition with exudation 
of a matter analogous to, if not identical with that of tubercle, which 
Vol. n—55 866 
DISEASES OF THE EXCERNENT FUNCTION. 
cons titutes a soil for the germination of cryptogamous plants, the pre- 
sence of which is pathognomonic of the disease. Hence is explained 
the frequency of its occurrence in scrofulous persons, and amongst 
cachectic and ill-fed children.” 
Dr. Pirrie gives the following summary of his views of favus: 
1. That it is essentially characterized by the presence of fungus, 
which is easily discovered by the microscope. 
2. That it is peculiar to the young, and confined chiefly to the poor. 
3. That it is most commonly met with in the scalp, but occasionally 
on other parts of the body. 
4. That the hair follicles are only secondarily affected. 
5. That it is by no means a rare disease in Scotland, being exceed- 
ingly common in Edinburgh, and having been more so for several years 
past in Aberdeen than in Glasgow. 
6. That it is considered more common in Ireland than in England. 
7. That it is a blood disorder, and that the fungus is not the sole 
nor the original cause of the eruption. 
8. That many are insusceptible to it; and that it is feebly contagious, 
and very often arises independent of contagion. 
9. That the previous state of health has an important bearing on its 
outbreak. 
10. That it is intimately connected with the strumous diathesis. 
11. That want of cleanliness strongly predisposes to it. 
12. That for its removal, general as well as local treatment is neces- 
sary.” 
Treatment of Porrigo and Eczema.—Phus-tox., Arsenicum, 
Croton-tig., Sepia, Stibium, Sulphur, Uepar-sulph., Petroleum, 
Mezereum, Apis-mel., Kali-hyd., Calcarea-carb., Mercurius-hyd. 
Occurring in gouty or rheumatic subjects, Phus and Kali, in the 
higher attenuations, are especially indicated. 
When a psoric taint is suspected, Sulphur, Calcarea, and Hepar, 
in the higher dilutions, will be required. 
Cases connected with secondary syphilis, will demand Mercurius- 
hyd., Mezereum, and Kali-hyd. in the lower potencies. 
The local treatment recommended by Robin, Bazin, &c., as given 
above, might be to some extent useful if our common treatment after 
a reasonable trial shall be found to need auxiliaries, which they will 
perhaps never do when they are intelligently used. 
VESICULAR VARIETIES —1. HERPES.—TETTER. 
Diagnosis.—The eruption consists of groups of small vesicles, 
situated upon red and inflamed bases, and separated from each other 
by sound portions of skin. As the vesicles increase in size, the color- HERPES. 
867 
less fluid which they contained in the first instance, becomes gradually 
opaque, and in two or three weeks dries up into thin crusts, which scale 
oft'. When the eruption makes its appearance, there is an unpleasant 
burning and crawling sensation, which soon settles into a deep-seated, 
and in some cases, severe pain. It may be confined to a single point, 
or extend in clusters of different sizes, over a large surface. 
Another variety of tetter, is often observed to commence in the form 
of broad and irregular clusters of small vesicles, sometimes seated on 
swollen and inflamed bases, and shortly becoming confluent; or the 
eruption may appear in distinct groups and unattended with any inflam- 
mation or swelling of the surrounding skin. In the first form, when 
the inflammation is somewhat active, the vesicles often burst and dis- 
charge their contents, leaving troublesome ulcers at their base. This 
variety is sometimes described under the term eczema, or humid tetter. 
According to Bateman, most kinds of herpes pass through a “ regu- 
lar course of increase, maturation, and decline, and terminate in 
about ten, twelve, or fourteen days. The eruption is preceded, when it 
is extensive, by considerable constitutional disorder, and is accompanied 
by a sensation of heat and tingling, and sometimes by severe pains in 
the parts affected.” 
Herpes has been divided into many different species, on account of 
presenting some points of distinction when attacking different parts of 
the body. Thus when vesicles appear upon the lips during colds, 
fevers, and inflammations of the mucous membranes of the pulmonary 
or digestive apparatus, the disease is called herpes labialis. The erup- 
tion, in this instance, is usually of a more inactive and unhealty charac- 
ter, than when it appears in other parts of the body. The matter 
which escapes from the vesicles is purulent or sanious, and concretes 
into black crusts. 
When the eruption consists of a narrow belt of vesicles, extending 
partly around the body, or over the shoulder, it receives the appella- 
tion of herpes-zoster, or shingles. 
Another, and very common form, is thus described by Schroen : “ An 
inflamed red ring, commonly perfectly circular, and upon which numer- 
ous small globular vesicles appear, wrhich, though at first perfectly 
transparent, soon become turbid; these burst, and discharge a thin 
fluid, which forms a slight lamellated crust that soon becomes 
detached, leaving a bright red mark. Sometimes the fluid is absorbed, 
and the vesicles fade and fall off in thin, scurfy, exfoliations. The 
duration of the disease is about seven or eight days for each ring; 
but as successive rings appear and go through a similar course, it may 
last between two or three weeks.” Schoenlein supposes that a repulsion 
of this eruption predisposes the patient to fungus hcematodes. This 
variety is called herpes circinatus or ring-worm. 868 
DISEASES OF THE EXCERNENT FUNCTION. 
Other subdivisions have been made into herpesprceputialis, herpes 
iris, herpesphlyctenodes, &c., but since the nature of the malady is 
the same in all thesej-varieties, and as the modifications which occur are 
dependent in a great measure upon the peculiar structure of the affected 
parts, we do not deem it necessary to enter into a more minute ex- 
planation of the details pertaining to each species. 
Causes.—Errors in diet; immoderate use of fat, rich, and indi- 
gestible food; a morbid condition of the cutaneous execretion; local 
irritations from external injuries, and the application of acrid sub- 
stances. It has been observed that those who have suffered from 
attacks of syphilis, scrofula, scurvy, or who have taken much mercury, 
are most prone to the disease. In these cases, a predisposition is es- 
tablished in the skin, so that from slight causes herpetic eruptions are 
excited. See Yol. I. p. 285. 
Treatment.—When the eruption attacks the face, head, body, or 
extremities, our best remedies are, /Sulphur, Calcarea-carb., Silicea, 
Carbo.-veg., Sepia, JRhus-tox., Belladonna, Lycopodium, Iodine, 
Graphites, Aurum-mur. 
Herpes of the lips should he treated with Arsenicum, Acid.-phos., 
Graphites, Phosphor, Ilepar-sulph. 
If the eruption appears upon the scrotum or prepuce, the appro- 
priate remedies are, Mercurius, Arsenicum, Sulphur, Calcarea-carb., 
Conium, Tihus-tox. 
Nearly all cases which occur may be cured by Sulphur, Calcarea- 
carb., Sepia, and Mercurius/ but should these remedies disappoint 
us, there will he no difficulty in making an appropriate selection from 
the medicines first enumerated. 
Administration.—For the most part, we rely upon the first, second, 
and third attenuations; and prescribe drop-doses of the dilutions, or 
grain-doses of the triturations, twice daily, until a satisfactory amend- 
ment is evident. 
Dr. Wolf says, the sycotic tetters have the greatest resemblance to 
the bark of a tree. The crusts have a dingy color, or they have a 
more marked white appearance, like the bark of young birch trees, 
with continual itching and peeling off, with the odor of blennorrhoeic 
secretion, &c. This is only cured by Thuja. 
Staphysagria.—Dr. Roth. Eruption, covering part of the thigh of a 
child, aged ten years; it appears in summer only; enlarged after- 
wards, covering the upper part of the thigh with a scaly crust, accom- 
panied with heat; a corrosive pus exudes from the interstices; scales 
fall off from time to time, leaving a moist surface covered with vesicles, 
increasing and secreting, as before; the pus forming new vesicles 
wherever it touches ; eruption then reached the breast, arms, and 
hack ; momentary relief from scratching only; glands of groin and HERPES. 
869 
axillae swollen and hard; body emaciated; muscles soft and re- 
laxed ; face anxious and full. Staphysagria, 30, produced aggravation 
of the itching for two days; it then diminished, vesicles dried up; 
bluish, tense, rough skin was formed. After seven weeks Clematis, one 
drop of the 6th dilution; the thighs and body covered; the scaly 
crusts fell, a few vesicles remained, but caused no irritation. After two 
weeks there was still roughness of the skin, new vesicles appearing; 
with itching and burning. Rhus., 9°. This dried up the vesicles, leav- 
ing the skin first dry and red, but it afterwards became soft and white; 
an occasional dose completed the cure. 
Calcarea.—Croserio says: Calcarea is generally suitable in dry 
skin diseases, accompanied with itching. In one case, “ there was dry 
ring-worm, with swelling of the cervical glands, and mesenteric disease. 
The patient was cured in four months with Calcarea, a dose every 
morning. 
Cuprum.—This remedy is a specific for herpes, but only in those 
cases in which the eruption is the external manifestation of the blood 
disease, for which Cuprum is the specific; other forms of it depend on 
idiopathic disease of the skin or kidneys. Rademacher cured with it 
some cases of chronic, moist herpetic eruptions which spread over a 
great part of the body. 
A Case.—A young man had for more than a year a moist herpetic 
eruption, which had resisted several internal and external remedies. 
The extent Avas so great that the extremities could not be moved. He 
was growing thin and weak; sleep bad; he had much pain in the 
limbs and in the broken out parts, so that he was unfit for work. He 
took Acetate of Copper, several drops six times a day. After three 
days of this treatment the patient felt less prostration of strength ; and 
continued to daily improve in health and strength. At first there was 
no improvement in the eruption; but the itching gradually became less 
troublesome, and it at length ceased entirely.” The eruption then 
began to change in appearance; the redness grew paler, the oozing 
gradually dried up, while the cuticle scaled off, and was replaced by 
new and healthy skin. In three weeks the cure wTas complete. 
Herpes Scrotalis, and Prceputialis, Swollen Glands and Ilyperee- 
mia of the Liver.—Dr. Kissel says, a man, aged thirty, of weak con- 
stitution, had been ill twelve months. First he had jaundice, then 
swelling of the lymphatic glands of the neck and axillae, followed by 
herpes on the scrotum and prepuce; and afterwards herpetic vesicles 
on the lips; he had pressure on the praecordium, eructation, pains in 
the loins. Tongue clean; appetite good; stool bright yellow; urine 
deep yellow, clear, very acid, with red amorphous sediment of uric- 
acid. After trying Chelidonium for eight days, with no improvement 
but in the diminution of the pressure on the praecordium, Cuprum was 870 
DISEASES OF THE EXCERNENT FUNCTION. 
given also. At the end of eighteen days the herpes was everywhere 
cured, and the glands were becoming smaller. The stool was now 
consistent and brown, the urine bright yellow, clear, and normally 
acid; in twelve days more all the morbid symptoms had disappeared. 
Skin Affections caused by Compression of the Nerves.—M. Brown 
Sequard says: Science abounds in facts showing that the complete 
section of a nerve is followed by no other alterations in nutrition than 
an atrophy slowly produced in all the paralyzed parts. Experiments 
on animals show also the same absence of alteration of nutrition after 
the section of the nerves of the limbs. The effects of the compression 
of nerves is quite different. A man had fracture of the lower extremity 
of the radius, after this was cured, the medium nerve was compressed. 
The thumb, index, and medium fingers ulcerated, resisting all treat- 
ment, and were only cured by relaxing the parts by which the pres- 
sure was taken from the nerve. When the pressure was renewed the 
ulceration commenced anew. A man who had been shot in the fore- 
arm, by which certain nerves were injured on the internal part of the 
fore-arm in parts supplied by these nerves, an eruption resembling 
zona appeared on the same parts deprived by sensibility.* 
2. LEPRA.—LEPROSY. 
The increase of some forms of this disease in some parts of the 
Western hemisphere has led to renewed investigations concerning 
its nature and history. It was once universally knowTn and dreaded; 
from the sixth to the fifteenth century it attracted a large share of the 
attention of law-givers and philanthropists. Many ordinances were 
passed for the regulation of their civil rights ; and lazar-houses were 
erected in all the countries of Europe. The lepers were regarded in 
law as civilly dead; their funeral obsequies were performed, and 
masses said for the benefit of their souls. The marriages of lepers 
were void in law, though they wrere allowed to marry other persons 
affected with the same disease. 
In the fifteenth century, leprosy prevailed over all Europe ; but from 
that period it gradually declined before the advance of civilization and 
the improvement in the condition of the poor. In England it has pro- 
bably been unknown for between two and three hundred years; in 
Scotland it lingered to within the memory of persons yet living. In 
Shetland it was not extinct at the close of the last century. In 1798 
a case from Shetland was in the Edinburgh Infirmary. In the middle 
of the sixteenth century the governments of Germany, France, and 
Italy suspended the leper houses. A few cases are yet reported in 
the south of France, in Catalonia; in Sardinia about sixty cases re- 
* “ L>es Lois de l’Endemicite.” LEPROSY. 
871 
main. The disease still exists in Asia Minor, Arabia, the East, and at 
the Cape of Good Hope. In Surinam and Demerara it has been do- 
mesticated through the importation of slaves from Africa; in the 
British West India Islands it is continually introduced by the Chinese 
Coolies; in the Faroe Isles it has gradually declined since the six- 
teenth century and is now extinct; in Iceland it lingers in a few spots 
on the coast where the inhabitants live only by fishing. The lepers 
were very numerous before 1707, when the great small-pox epidemic 
swept off most of the leprous families. In 1768, 280 lepers were still 
in the Island, and there was a law which still exists, prohibiting the 
marriage of lepers. In 1846, they were reduced to 66. In Sweden, 
leprosy is nearly extinct; in Norway it still prevails. It is most com- 
mon in the vicinity of Bergen, where there has been a hospital for 
lepers since the year 1277. The Hospital St George (the building) 
is 160 years old, and its entire arrangements have continued unchanged 
for three centuries. There is a true “ leper house” and the true leprosy 
of the middle ages. 
In Norway, leprosy has been on the increase for at least more than 
thirty years. In 1836 there were but 659 cases; in 1845 the number 
was 1122; in 1853 the number was 1782. They are found along the 
whole coast from Stavanger to Hammerfest, a distance of 800 miles. 
The number in 1856 was 2000. Tho subject of prohibiting the mar- 
riage of lepers has been since debated for four months at a time; and 
the decision has been that the subject is not well enough understood 
to justify any legislation on the subject.* 
By the laws which have existed from the times of Moses, the in- 
habitants of Palestine affected with leprosy are isolated from all actual 
contact with their fellow-men. The quarters of the lepers is a melan- 
choly place. A traveller says: “Near the gate of Zion, on the way 
to Bethlehem, I saw many of them sitting on the rock, their hideous 
faces uncovered, thrusting forth their scaly hands for alms. Their 
huts are rudely constructed of earth and stones, seldom more than one 
apartment, and this so filthy and loathsome that it seemed unfit to be 
occupied by swine. There they live from generation to generation.” 
“ I passed when the rays of the sun were cold and the light was dim; 
and there came out from the reeking hovels, leprous men, gaunt with 
famine, and they bared their hideous bodies and howled like beasts; 
and women held out their loathsome and accursed babes, and tore 
away the rags that covered them, and pointing to the shapeless mass 
shrieked for alms. All was disease and sin, and sorrow wherever I 
went.” Such is the leper: “ death gnaws at his vitals, and unceasing 
* See “ The Spedalsk Disease: its Causes, Cure, and Prevention.” By D. C 
Danielssen. 1854. Norsk Mcigazin, parts IX. and X. 1850. 872 
DISEASES OF THE EXCERNENT FUNCTION. 
tortures are in his blood; he is cast out from the society of his fellow- 
men, and forbidden to touch, in friendship or affection, the hand of the 
untainted.” And yet, life such as that, he thinks worth having, and 
struggles to perpetuate it. 
Geo. K. Kendall, in his narrative of the Texan Santa Fe Expedition 
(Yol. II., p. 220), describes the lazarinos or lepers of the Hospital San 
Lazaro. He says it appears in many different aspects. 
In 1844, the existence of leprosy in New-Brunswick attracted the 
attention of the provincial government, and a medical commission was 
appointed to investigate it. The report of the Committee clearly 
shows that the disease was the Greek leprosy, having no affinity with 
elephantiasis. 
Causes.—Drs. Boeck and Danielssen have maintained that leprosy 
is a thoroughly hereditary disease,—that it descends from generation to 
generation; they think it descends more by the collateral branches 
than by immediate succession; and that it frequently skips over one, 
two, or three generations, to reappear with fearful severity in the fourth. 
The belief in hereditary transmission was so general in Norway, 
that a proposition was laid before the Storthing, in 1754, to prohibit 
the marriage of all lepers, and of their immediate descendants ; the bill 
was debated but was rejected. Dr. IJjort thinks the disease not 
entirely propagated by contagion. 
Contagion.—Denied by Iljort, Danielssen, and Boeck; but Hoegh, 
in his report, 1855, is inclined to admit a secondary infection through 
the acarus scabiei, so frequent on the skins of lepers. He says the 
crusts and horn-like elevations that, in many cases of spedalsked, cover 
the arms and face, are now found to be composed entirely of the re- 
mains of acari closely agglutinated together; and,on removing forcibly 
these crusts, living acari are to be found on the ulcerated surfaces 
beneath. In one family, residing at a height of 2,000 feet above the 
sea-level, a female, aged twenty-five, of a family not related on either 
side to any leprous subject, by associating with a leprous girl, became 
a year after affected with leprosy; she then communicated it to her sis- 
ter, her brother; then her mother. 
Other External Influences.—Dr. Iljort attributes the increase of 
leprosy in Norway to extension “of the great sea fisheries” on the 
coast of Norway, “exactly in those parts of the coast where the 
spedalsked is most prevalent.” In the last century there existed large 
fisheries on the coast of Sweden, and leprosy was very common there. 
In 1807, the herring shoals left the coast, and immediately showed 
themselves on the coast of Bergen; leprosy declined on the Swedish 
coast, and in 1837, the hospital of Uddevalla had hardly a single leper, 
but since the transfer of herring fisheries to the coast of Norway, 
leprosy has gradually extended. LEPROSY. 
873 
It is a disease of the sea-coast, but extending up along the fiords or 
inlets which descend towards the sea, and along which the fishermen 
are congregated. There the air is damp, loaded with sea-fog, though 
the winter cold is intense; swampy land, stagnant waters, the water 
intolerable. The houses are small, with small windows, little light; 
windows always nailed down, never opened, or the house aired or swept 
once a year. The dog and pig live in the hut with the family, who eat, 
cook and sleep in the same room. The children go without shoes to 
herd the cattle on the hills from which the snow is melting; they en- 
dure the storms of spring, the rains of summer, and the heavy mists 
of autumn; they sleep in their unchanged clothes, which are rarely if 
ever washed; face and hands may be washed twice a week, the feet 
once a year; the rest of the body, never. 
From the first of January to the end of March, the hardest period 
of the northern winter, the men are engaged in the herring-fishery. 
They spend the night on the bare ground under an upturned boat or a 
sail spread as a tent. The men are packed together, lying side by 
side upon the floor in their wet clothes. The condensed vapor from 
the breath and that from the wet clothes drips upon them from above; 
and the air, filled with offensive exudations, is unfit for respiration; 
cleanliness is totally neglected. The greater part of the day is 
passed at sea, half frozen in an open boat. 
From the first of February to the middle of April, the Norwegian 
peasants 
“ Throng the shores where dread LofFoden 
Whirls to death the roaring whale : ” 
Not less than 3,500 boats, each manned with six men, assemble at 
these fishing stations 
“ Around the shores where runic Odin 
Sings his death-song to the gale.” 
To these dreary isles, beyond the Arctic Circle, they make their voyages 
and return in the course of two weeks, having neither changed nor 
dried their clothes in the time,having slept on “the soft side of boards” 
for beds, twenty men in a lodge that had no chimney to favor the escape 
of smoke; the floor is never swept, and the accumulating filth is never 
removed. 
The food of these people, among whom leprosy is increasing in the 
midst of the advancing light of the nineteenth century, consists chiefly 
of fish.—Salt fish, imperfectly preserved, having lain too long on the 
shore waiting for a purchaser. When no purchaser comes, the half- 
putrid fish are partially salted, and after a lapse of some weeks they 
are “ pickled,” that is, soured by becoming half-rotten. A vitiated taste 
acquired by long use, leads the peasant to prefer the tainted fish to 874 
DISEASES OF THE EXCERNENT FUNCTION. 
those fresh from the sea; and they seldom eat any until the process of 
decay is far advanced. Other meats, if used in Norway, are hung up 
in a salted state for years. 
Definition.—Dusky-red or livid tubercles of various sizes on the 
face, ears, and extremities; thiokened or rugous state of the skin; 
diminution of its sensibility, and falling off of the hair, excepting that 
of the scalp; hoarse nasal or lost voice ; ozoena,—ulcers of the sur- 
face, and extreme foetor. 
Tubercular Lepra of the Middle Ages.—This is the true lepra 
anazsthetica; lepra tuherculeuse of the French; lepra graecorum of 
the middle ages. Dr. Valentine Mott says he examined this disease at 
Athens, in 1842, and found it to resemble syphilis, though it is a “more 
formidable and apparently more chronic affection than syphilis.” 
He thinks the ancient leprosy of the Jews, “the progenitor of them 
all;” and that on more thorough investigation, the ancient leprosy and 
the modern syphilis will be found to be more nearly related than has 
yet been supposed. Mercury and Arsenic were found the best reme- 
dies for both.—(Travels in the Mast, 1842.) 
The Greek leprosy is a hereditary and contagious disease.* It was 
introduced into Western Europe at the time of the crusades. It has 
gradually disappeared in the lapse of centuries, though it is still endemic 
in Egypt, Java, some parts of Norway, and Sweden. It is character- 
ized by, “ hard, insensible tubercles, which appear upon the skin, and 
are accompanied by a progresive insensibility, and the loss of the voice. 
The tubercles appear on different parts of the skin; they are hard, 
rough, and numerous, and cause the loss of the hair at the places where 
they appear. They finally terminate in ulcers, which penetrate even 
to the bone, producing a caries. They also cause the separation of 
parts of the body,—the toes and fingers, for example, dropping off. 
There is also languor in the motions, a dullness in the senses, a change 
in the voice, offensive breath, and lethargy. It appears in three forms: 
1. The squamous or scaly. 2. The crustaceous, in w hich the skin is cov- 
ered with crusts. 3. The tuberculous. 
LEPRA GRAECORUM. (ELEPHANTIASIS OF THE GREEKS.) 
It commences in spots or patches, which are of a somewhat lighter 
shade or color than that of the adjoining surface in blacks, and a 
tawny color in whites. These patches appear first in the feet, hands, 
legs, and arms, and seldom on the face and trunk, till a more advanced 
period. They sometimes seem slightly prominent, from the thickening 
LEPRA ANAESTHETIC A. 
* See “ Good’s Study of Medicine.” Doane’s Edition, 1840. LEPROSY. 
875 
of the several tissues of the skin; and they are rough, and apparently 
wrinkled, from minute indented lines; but the wrinkles do not run into 
the surrounding skin. The hairs, if any have previously existed in 
the seats of these patches, fall out or cease to grow in them. The 
patches are insensible, and extend slowly over the legs and arms to 
the trunk, until the extremities, and sometimes also the greater part 
of the surface of the body, are more or less affected and deprived of 
feeling. The affected surface is unperspirable, and neither itchy nor 
painful, nor swollen. As the disease advances, the pulse becomes slow 
and soft, and the bowels constipated; the toes and fingers are be- 
numbed, as if with cold,—shining, slightly swollen, and stiff. 
Dr. Danielssen {Norse Magazin, Christiana, 1852) reports seventy 
cases of “ spedalsked,” or lepra grsecorum, of whom eleven had it in 
the anaesthetic form. Of the anaesthesia of the extremities, he says: 
“ It is the result of inflammation of the sheaths of the nerves, indi- 
cated by excessive sensibility of the skin; and this is followed by the 
deposit of the whitish-yellow albuminous matter between the fibrils of 
the nerves, compressing them, and at length producing total loss of 
feeling in the parts to which the nerves are distributed.” When the 
cutaneous nerves are inflamed in this manner, “ they can be felt as 
hardened cords beneath the skin; and where there is hyperaesthesia 
of the hands, the ulnar nerve at the elbow is so extremely sensible that 
the patient almost faints with pain if it is slightly compressed.” These 
symptoms show that the disease is an inflammatory affection ; but it is 
a dyscrasic inflammation, having a constitutional cause, over which 
antiphlogistic measures and local treatment have no control. Dr. 
Danielssen says, there is an excess of albumen and fibrin in the blood, 
and to this point his treatment is chiefly directed. He restricts the 
patient to a vegetable diet and steam baths. Other measures have 
been tried with little result, as it seems that out of seventy cases 
Iiardly one was cured. Iodide of Iron was his principal dependence 
in the anaesthetic form of the disease. 
Oxalic-acid has been extensively tried since 1851, but it had no per- 
ceptible effect, though continued for many months. One girl, aged 
fifteen, took 2 to 2-J drachms daily of the pure acid with perceptible 
effects. When seven or eight grains were given every two hours, the 
pulse in some cases suddenly dropped to seventy beats per minute. 
Leprosy, says Dr. Danielssen, “is a disease which, left to itself, never 
dies out; it follows its prey through successive generations, even to 
the last scion of the race.” 
Some cases of this disease, generally from the tropical parts of 
America, have been treated by physicians of New-York. One of these 
is described by Dr. H. M. Smith, in the American Homoeopathic 
Review, Nov., 1862 : 876 
DISEASES OF THE EXCEKNENT FUNCTION. 
W. T. aged twenty-four, born in Demarara, of English parents, was 
one of twenty children. Was vaccinated when a few months old; in- 
stead of the true vaccine pustule, small black sores appeared, which 
discharged thick black pus. From this beginning the leprous affection 
extended throughout the system; resisted all treatment—at home, in 
Barbadoes, and England. He now presents the following appearance: 
“ Thumb and fingers of the right hand are gone from the metacarpo- 
phalangeal articulation, and all the phalanges of the fifth finger are 
gone. All that remains is about half of the first phalanx of the index 
finger, one-third of the first phalanx of the fourth finger, and the first 
phalanx of the third finger. He has lost the toes of both feet, from 
the metatarsal phalangeal articulation, with the exception of the first 
phalanx of the left fifth toe, which was then denuded and coming off. 
On the hands are a number of hard red pustules, from one-eighth to 
three-eighths of an inch in diameter. With this exception the skin 
appears smooth and dry, and over the three remaining joints of the 
left hand are deep fissures; where the fingers have been the skin has 
healed, as over a stump after amputation. There is no sensibility of 
the arms below the elbow, nor has there been for years; the legs are 
likewise'insensible from the knees down. The feet differ in appear- 
ance from the hands: instead of the skin being dry and cracked, it is 
soft and moist, and has disappeared on the soles—leaving ulcers on 
each foot its entire breadth. Otherwise than this disease of the hands 
and feet, he says his health is good. In cold damp weather he is 
troubled with a cough, but this is always relieved by homoeopathic 
medicine. The patient is intelligent, and has received a common 
education.” 
The concentration of the constitutional affection upon the extremi- 
ties seemed to be effected by a bruise in the palm of the right hand; 
a swelling was observed the next morning, which was lanced, and dis- 
charged freely. From this time he had no use of his hand; the fin- 
gers became flexed, and he was unable to open them except by taking 
the fingers of the other hand. After coming to this country, “ a fissure 
in the skin was observed on the distal end of the index finger of the 
right hand; the nail came out, and the fissure spread, making ‘ four 
slits,’ as far as the last joint. The phalanx became circumscribed with 
dry skin, which was poulticed with bread and water, and peeled off 
until the bone was denuded, and was knocked or fell off. In this way 
the third phalanges of all the fingers of the right hand were lost. The 
fifth finger of the left hand was not affected, the disease extending no 
further than the second joint. The disease then returned to the right 
hand, this time extending only half the length of the second pha- 
langes ;—next the thumb of the left hand became affected, and healed 
The right foot was attacked next; wThat was supposed to be a corn LEPROSY. 
877 
appeared on the sole of the foot, between the first and second toe,—a 
piece of bone came out and the foot healed.” 
After further operations on the fingers of both hands, the disease 
returned to the foot previously diseased; commencing in the joints of 
the toes, which “ sloughed away, leaving the ends hanging. The ves- 
sels were seen ‘ like strings,’ which soon disappeared, when the hang- 
ing portions fell off. All sensation left the foot soon after the sore 
disappeared.” 
Dr. J. R. Andrews, of New-Jersey, who treated this case for some 
time, says of him, that “ under the use of Arsenic, Ilepar, Conium., 
Silicea, Merc.-iod., Rhus, Lachesis, Nitric-acid, Sulphur, Kali, &c., 
the parts assumed a more healthy appearance; they gradually improved, 
and entirely healed.” 
It is said, that this disease is common in Demerara, but confined to 
the black population. In Africa it is well known and regarded as con- 
tagious. A missionary, who visited an island to which the lepers are 
banished, describes their efforts to support themselves by laboring with 
their mutilated hands. One man, who had hands, but had lost his feet, 
was sowing barley on the field, being borne on the shoulders of a com- 
rade who was so fortunate as to retain his feet, though his hands had 
both fallen off; between them the work was performed. 
Treatment.—There is a tradition, according to Pliny, of the an- 
cient Egyptian kings bathing in human blood to cure leprosy. There 
is also a similar story of the Emperor Constantine; but it seems he 
was restrained from the experiment by a vision, and was afterwards 
otherwise miraculously cured. It is at least certain, that in ancient 
times great virtues were attributed to the blood of children and inno- 
cent persons in the cure of leprosy. The remoter traces of the belief 
in the expiatory or healing properties of pure blood ramify into the 
most ancient periods reached by tradition or history. The cure of 
this particular disease by the blood of animals in association with cer- 
tain symbolical ceremonies is mentioned by Moses. 
During the middle ages the belief of the curative powers of the 
blood baths was universal, though the cures were remarkably rare—a 
fact which is thus accounted for by the historians: It was in some way 
ascertained, that no blood would prove efficacious but that of children 
and pure virgins, wrho freely and voluntarily offered themselves for the 
purpose of saving the life of a beloved sufferer. Such a case is re- 
corded in the poetical history of the Suabian Knight, “ Poor Henry,” 
which is said to be one of the finest poems of the thirteenth century. 
The history of Amicus and Amelius is another, based upon the general 
belief of the same superstition in those times. Louis XI., of France, 
after a life of cruelty and crime, endeavored to avert his approaching 
death by the use of the blood of children. The incident was employed 878 
DISEASES OF THE EXCERNENT FUNCTION. 
by a poet to exalt the horrors of his tremendous version of the tradi- 
tion of Faust. Sprengel says, the story is true, and he also describes 
the blood baths as actually employed; though the fact was never set- 
tled on unquestionable authority. 
Treatment.—The most important remedies in this malsfdy are, Sul- 
phur, A rsen icurn-iod., Arsenicum-alb., Thuja, Carbo-animalis, 
Kali-hycl., Rhus-tox., Podopliylline, Sepia, Graphite, Silicea, Sti- 
bium, Calcarea-carb., Cicuta. 
The best effects will be derived from the highest attenuation of 
these drags. 
Vapor baths and fumigations of Iodine and Sulphur are excellent 
auxiliaries in the treatment. These means should precede the use 
of the internal medicines. 
Arsenic.—Dr. Ilunt, of Margate (England), says he has employed 
it for thirty years in lepra, eczema, psoriasis, acne punctata, and im- 
petigo, and has never failed in any one of these diseases where the 
remedy was fairly tried. His rules for using it are : 1. Begin the use 
of the Arsenic after the active cutaneous inflammation has subsided. 
2. Dilute it with the food and drink ; give it wrhen the stomach is full— 
not empty. 3. Give three or four doses daily with the greatest regu- 
larity,—four or five drops to begin with, equal to fifteen drops per day. 
Still this dose is liable to produce medicinal aggravation: conjunctivi- 
tis commencing, warns to stop. But when the minimum dose is dis- 
covered, persevere with this for many months, in cases that have lasted 
for years. The advance of the disease, when the remedy is intermitted, 
shows the power of the remedy over it. Abstain from all external 
applications. All the advantage of this course is more completely 
gained by giving the attenuated preparations of Arsenic. The third 
trituration may be long continued if given in a large quantity of water. 
In lepra anaesthetica, or elephantiasis Graecorum, Arsenic has been 
used for centuries in India. The celebrated “ Tanjore pill,” which is 
considered by the natives of India as a specific for this form of lepra, 
is thus prepared: Take 105 grains of Arsenious-acid, and six times 
that quantity of pepper; make into small pills, and take one morning 
and evening. This is also regarded as specific for the bites of venom- 
ous serpents. In framboesia, or yaws, of the West Indies, Arsenic 
has also succeeded in many cases. In both of these diseases much 
benefit has been obtained by washing the affected parts with pure 
acetic or pyroligneous acid. In using any local treatment interna 
remedies should always be given. 
Other remedies: Alum, Oarb.-an., Carb.-veg., Graph., Petrol., Sepia, 
Sulph., Phos., Sil. PSORA, 
879 
3. SCABIES.—PSORA.—ITCH. 
Diagnosis.—The great diversity of appearances which this disease 
is constantly presenting, renders a complete description almost impos- 
sible. It has been regarded by some writers of note as papular, by 
others, as pustular, but by the majority as vesicular. It consists of 
a pustular, papular, or vesicular eruption, generally situated between 
the fingers, on the wrists, near the joints, but sometimes extending over 
the whole body. The eruption is attended with almost constant itch- 
ing, which is aggravated by scratching, or by the heat of a fire, or of 
the bed. The disorder is decidedly contagious in its character, and 
according to Schroen, “ never gets well of itself; but will last for years, 
and may exist upon the skin a whole life-time, if its cure is neglected.” 
Itch vesicles ordinarily make their first appearance between the 
fingers and in the palms of the hands; and their presence is more 
evidently manifested by a violent stinging and itching, which is in- 
creased at night. This exacerbation is attributed to the changes of 
temperature to which the animalcule is subjected during the process 
of undressing and exposure of the skin to the air, and also to getting 
warm again in bed. 
The vesicles are prominent, and where the skin is thin, as between 
the fingers and upon the inside of the arms and thighs, are conical in 
shape, quite firm to the touch, and filled with a transparent fluid, which 
often becomes milky or puriform. 
“ As the disease progresses, the skin becomes rough and scaly, with 
numerous scattered vesicles, and is often complicated with other vesi- 
cular pustulous or papulous diseases; indeed it is not unusual, after 
the characteristic appearances of scabies have disappeared, to find 
other forms of cutaneous maladies established in their stead.” 
Causes.—We have already given the views of Hahnemann on the 
latent constitutional miasms which he embraced under the general 
name of psoea, (see p. 185, Vol. II.) The signification attached by 
him to this word will be seen at page 189. Its derivation is thus 
given: “ The word psora which he selected to represent the almost 
universally prevalent base of chronic diseases, is from the original He- 
brew—tsorat—signifying venom or malignity. This term the Greeks, 
in their translations from Hebrew writers, rendered psora, the original 
meaning of which during the lapse of ages, degenerated first into cu- 
taneous diseases generally, then into itch? (Dr. Morgan, Araer. IIo- 
meop. Review, Yol. V., p. 54.) How far Hahnemann accepted the com- 
mon opinion that the disease known to us as scabies depends always on 
the existence of the minute insect called acarus scabiei is not per- 
fectly clear. It is proved that he was acquainted with that insect at 
least thirty-six y jars before the publication of his Psoric Theory of 880 
DISEASES OF THE EXCERNEN1 FUNCTION. 
Chronic Diseases. We have already shown (see p. 192,) that he did 
not attribute chronic diseases to the suppression of this identical form 
of skin eruption, though he gives a large number of cases from the 
books to show the danger of suddenly repelling cutaneous eruptions of 
any kind by treatment merely local. 
The true nature of scabies still continued to be a debated question, 
so long as few persons could find the acarus when they looked for it. 
Albin Gras, a pupil at the St. Louis Hospital reported five experi- 
ments in which some living acari were placed on the skin and protect- 
ed there. In no case did the insect effect any thing but a slight local 
irritation. ( Wilson on Diseases of the Shin, p. 246.) In one in- 
stance the acari were artificially destroyed on the seventeenth day; in 
all, symptoms disappeared in a few days. 
In 1807, Dr. Adams published in England, some observations made 
in the Island of Madeira on the disease produced by a parasitical ani- 
malcule called by the natives oucoes. In June, 1800, he made the ex- 
periment of inoculating himself between the fingers with the oucoes 
with the following results: “For more than three weeks little or no 
inconvenience was felt. From that time began frequent itchings in 
different parts of the body and arms, but no eruption could be discover- 
ed. In less than a fortnight later, (or five weeks from the commence- 
ment of the experiment) my arms and belly were covered with a gene- 
ral efflorescence, but few vesicles appeared. At this time two oucoes 
were extracted from my arm, but not from the vesicles.” In August, 
“ his whole body, arms and thighs, were covered with an efflorescence 
at the same time but few vesicles appeared.” “ In the mean time,” he 
says, “my health suffered exceedingly, not only from the inconvenience 
produced from the itching, but about noon a quotidian fever began, 
with slight shivering, succeeded by a headache, dry heat, thirst, loss of 
appetite, and considerable exacerbation of the itching.” This eruption 
is always attended by fever, and the remedy for it as for other fevers 
of the coast of Africa is “ Bark.” 
The parasite which is capable of giving all this irritation is described 
as being sufficiently large to be easily detected and extracted, and their 
removal arrests the disease. Dr. Adams saw them “ crawling on his 
nail,” and remarked their power “ of leaping with a force not less than 
that of a flea. Such was the case with one while it wms being ex- 
amined under the lens.” This description was accepted as settling the 
question of the existence of the itch insect; but it differs entirely from 
any correct account of the acarus disease as known to European and 
American authors. The latter disease wras also well knowm to Dr. 
Adams, and discriminated from that which he described as a new affec- 
tion hitherto unknown. 
The failure of many observers to discover the itch aearus in the PSOKA, 
881 
skin, and their want of success in the use of minute doses of supposed 
specifics has led many recent writers to doubt the existence of the in- 
sect. The description of Raspail, who demonstrated it fully in 1834, is 
accepted by later authors as correct. 
“ The acarus is never found in the vesicle, neither does it bear any 
numerical relation to the number of vesicles. The insect is sometimes 
found upon the hands, and no where else, while the patient is suffering 
from itching vesicles distributed over the body.” Wilson says the lo- 
cation of the insect is “at a small dark point at the end of a whitish 
line, called the cuniculus, about a quarter of an inch in length, and 
leading from one of the early vesicles; this point is usually somewhat 
elevated above the skin, and upon inserting a needle therein, the para- 
sites may be withdrawn clinging to the instrument.” 
“ The insect is less than half a millimetre in diameter—that is, less 
than a quarter of the height of one of the letters of this text.” Ob- 
served by the microscope its back presents the appearance “ of certain 
fish whose four anterior paws and mouth represent the radical appen- 
dices which implant themselves in the skin; the back-piece has the 
sinuous contour of the scales of a fish ; and is marked by the concen- 
tric and netted stria which form a fusiform net-work. Upon this net- 
work of lines, -which produce a play of colors as would luminous frin- 
ges, there may be seen a number of small round and shining points ; 
and upon each of these is implanted a stiff, white, blunt hair; the two 
rows which go from the back to the interior and to the sides of the 
arms have the longest hairs. The beak is purplish, flat and round, 
carrying four acute hairs, which are directed from behind forward; the 
beak is inserted and may be concealed under the back piece. The four 
feet are purplish, transparent, and show three of their four or five ar- 
ticulations, beset with hairs; each is terminated by an ambulacre, 
formed of a rigid stem and spread at the extremity. Towards the 
posterior part of the body are seen four long hairs which belong to 
four pair of feet which are concealed under the belly. 
The acarus when walking has the appearance of a tortoise from its 
general organization and its torpor. Its transparency and whiteness 
give it a soft appearance under the microscope ; but on taking it on 
the point of a needle, it is found hard and of such a horny texture in all 
its parts, besides its stiff hairs, that it requires more force than the prick 
of a pin to crush it. 
Authors recognize several distinct forms of scabies : 
1. Scabies Sicca, pimply, or dry itch, most common in adults. This 
form, when repelled, often gives rise to a “ nervous apoplexy,” ascites or 
chronic hydrocephalus, and it is best treated by Sulphur, Mercury, 
Causticum, Carbo.-veg., Psoricum, Sepia, Lachesis, and Veratrum. 
2. Scabies vesicularis, or common itch, occurring commonly in high 
Vol. ii.—56. 882 
DISEASES OF THE EXCERNENT FUNCTION. 
lands, very rarely in low, swampy districts. When this form is abruptly 
repelled, it gives rise to serious affections of the cerebral and pul- 
monary organs, and to the nervous system. Sulphur is undoubtedly 
the appropriate specific, and should be given in the first trituration. 
In obstinate cases we may employ one or more of the following medi- 
cines : Psoricum, Sepia, Ilepar-sulph., Arsenicum, Rhus., Mercur 
Iodine, Copaibce, Calcarea-Carb. 
3. Scabies Purulenta, appearing in the form of a yellow and promi- 
nent pustules between the fingers and toes. In this form, Schroen 
advises Sulphur, Antimonium-tart., Sepia, Cicuta, Lycopodium, 
and Mercurius. 
Mercurius-sol.—Itch-like or rash-like eruptions, which easily bleed ; 
pustulous eruptions, with nightly itching and raging pain in the fore- 
head ; eruptions on the abdomen and thighs; eruption resembling 
scabies on the lower limbs, sexual organs ; on the bends of the knees, 
neck, and abdomen; pustules raised, red and itching, dry eruptions. 
Swollen spot, on which a gray, flat scurf gradually makes its appear- 
ance, without moisture; after the eruption the swelling and pain which 
preceded disappeared. 
Sulphur.—This is undoubtedly the principal specific for acarous 
itch, or true scabies. It must be given for a considerable time in high 
or low attenuations. 
It i* not claimed in this day that it will soon exterminate the dis- 
ease when given internally alone; but it is evidently safer to give it in 
some form for a considerable time before any external applications be 
tried. That it will, when locally applied in strength, cure the true acarous 
disease is not disputed; but it is common to mistake eczema, impetigo, 
and other itching eruptions for the true scabies, and these itch-like 
affections are not curable by external applications of Sulphur or indeed 
of anything else. They are always curable by proper internal treat- 
ment, and there is therefore no excuse for hazarding the perils of the 
repelled eruption without any benefit in return. Concerning the 
(external use of Sulphur in true scabies Jahr says: “ This acarus itch 
admits of a more external treatment with the Sulphur-ointment, with- 
out exposing the patient to the danger of contracting secondary dis- 
eases.” He would not be understood as sanctioning “ the treatment 
by external applications, of the various itch-like eruptions where the 
acarus is not present. These are the eruptions to which Hahnemann’s 
psora doctrine should be applied, and the suppression of which by 
washes and salves will induce the various secondary affections enu- 
merated by Hahnemann and Autenrieth.” 
All the popular modes of using Sulphur for itch include its combina- 
tion with lard. It is well known that the lard without the Sulphur is 
certainly destructive to the acarus or any other insect. Ilebra and PSOKA, 
883 
C tliers found inunction with lard as efficient without Sulphur as with 
it. In the same manner anointing with oil was formerly relied upon 
to cure the plague as well as other epidemic and contagious diseases. 
It has been tried in scarlatina with a success that may warrant further 
trials. 
If local applications must be made to destroy the acarus in itch, an 
effectual one, which is, perhaps, the least offensive of any of them, is 
found in a lotion of Chloride of Lime, first proposed by Derheims. 
A solution, containing one-fiftieth of its weight of the Chloride applied 
frequently during the day allays the intense itching in a few hours, 
and accomplishes a cure within a few days. We have succeeded with 
it in several itch-like eruptions which had defied internal remedies. 
In Germany, the use externally of the Schmier-Seife is universal. 
It is prepared by boiling fish or other animal oils with an excess of 
lye, composed of caustic Potash and the crude Carbonate. It is com- 
mon to employ it by saturating a coarse cloth with it, then thoroughly 
rubbing over every part as a soap, then rubbing dry. Repeat every 
evening till the itching ceases; which will be in three or four days. 
The Vienna-salve.—Sapon.-virid, Axung aa, 3 parts, Flor.-sulph. 
Picis-liquid aa, 1^*; Creta.-alb., 1 part. 
Ilebra’s TJnguent for Scabies.—Flowers of Sulphur, Oil of Beech or 
Cade, aa fij.; Schmier-Seife, Axung., aa ?xvj.; Chalk is added when 
necessary to remove the epithelium more rapidly. In some cases he 
uses Alcohol instead of fat. The Alkaline Soap, when applied to a bur- 
row, produces at once an exudation into the same, which causes its 
immediate recognition. Its later effects are to dissolve the epithelium, 
and allow the Sulphur to come directly to the animals. The Tar, 
Beech, or Juniper Oils are added to prevent the production of excoria- 
tion or eczema by the excess of alkali and friction. 
Btyriasis Versicolor.—The intolerable itching betrays the exist- 
ence of the fungus—the microsporonfurfur. The itching imme- 
diately ceases after a few applications of the Schmier-Seife, which 
causes the death of the fungus; its effect upon the patches is wonder- 
ful. A soap (says the Boston Medical and Surgical Journal, Vol. 
LXI., p. 229,) which should be both cheap, cleanly and effectual, is 
“ certainly a long-looked-for desideratum in this class of diseases.” 
Glycerine Ointment—Proposed by Professor Simon, as a most ele- 
gant excipient, is composed of five parts of Glycerine and one part of 
Amylum. It forms a smooth, butter-like substance, free from smell, 
exciting no chemical action, and unaffected by temperature. It is pre- 
ferred to any other substance for its elegance, freedom from repulsive 
odor, does not irritate tender skins, can be kept in large quantities for 
a long time, extracts and soluble salts may be mixed with it, and their 
absorption thus promoted. It does not spread beyond the parts to 884 
DISEASES OF THE EXCERNENT FUNCTION. 
which it is applied, and can he removed with great facility Varges, 
Zeitschrift, Dec. 1860, p. 412.) 
Mercurius-vivus.—In our earlier years, of practice, we met with the 
following case: In a malarious neighborhood two sisters (twins) aged 
fifteen months, were attacked with intermittent, following remittent 
fever; both had convulsions at the access of the paroxysm, which was 
an imperfect chill with imperfect reaction. The chills recurred daily, 
and were, after some days, suspended with Quinine in impirical hands. 
The two children had thus far progressed equally towards recovery; 
in their future course they diverged widely. One seemed perfectly 
relieved of fever and brain irritation by an eruption over the whole 
scalp, (a thing common as a sequel of intermittent.) The other girl 
had no eruption on the skin; and, though she recovered perfectly from 
the fever, she continued to have returns of the convulsions; became a 
confirmed epileptic ; and grew up a hopeless idiot. We saw them four- 
teen years after the attack of fever. The idiot had become the larger 
of the two; her hair and figure were fine, but intelligence was entirely 
wanting. Her sister was intelligent, but her head continued destitute 
of hair; the head was entirely covered with a moist, scaly eruption, 
in many places raw and bleeding. It was supposed that any effort to 
cure the external disease would consign this girl to the same condi- 
tion as her epileptic, idiot sister. 
We made the effort to cure the constitutional dyscrasia by giving a 
fine trituration of metallic Mercury in such a form that the quantity 
of Mercury given was equal to one-eighth of a grain of blue-pill four 
times a day; and this course was kept up for two months. By this 
time the appearance of the scalp was so much improved that we ven- 
tured to use some external lotions which hastened the formation of the 
new skin. The hair grew at first very fine and soft; in a few months 
it was of the usual length and appearance. Her general health instead 
of being injured by curing the “ scald head” was perfected by it, and 
years afterwards she continued well. 
Apis-mel.—Case by Dr. Bayard.—A gentleman, aged thirty, re- 
turned to New-York from a tour in the West. He was much troubled 
with an eruption of a vesicular nature between the fingers, with intense 
itching, and inclined to ulcerate. The rest of the body was covered 
with a dry, red, raised eruption, attended with uncomfortable itching. 
Lycopodium 30° and Sulphur 30° were tried for a few days, at the 
end of which time he returned, complaining that he had no rest at 
night from a stinging, burning eruption, which almost set him dis- 
tracted. Three globules of Apis-mel. 30° were given in the evening, 
the dose to be repeated every third hour for three times. In a half 
hour from taking the first dose he was relieved from the burning and 
stinging sensation. It was permitted to act ten days, aft rvhich FSORA guttata. 
885 
there was a slight return of the symptoms. Under the use of a few 
globules of the 200th dilution of Apis, the disease gradually disappeared. 
Psoka Guttata.—Arsenicum.—Mr. Hunt, of Margate, England, 
published in 1847, a volume on certain intractable forms of chronic 
skin-diseases. He says (page 14), that he cured permanently a case 
of psora guttata in a family of delicate habit, intolerant alike of all 
mineral medicines. His remedy was one-fourth of a drop of Fowler’s 
solution of Arsenic, taken three times a day for a few weeks. Fowler’s 
solution is a solution of Arseniate of Potash, in which Arsenious-acid 
and Potash are present in about equal quantities. The British and 
Foreign Review (allopathic) says, each of the above doses contained 
only the 480th part of a grain of white Arsenic or Arsenious-acid ; or 
perhaps equal in comparison to the weight of the person as one to 
705,600,000. Perhaps doses still smaller would have answered as 
well, but they were not tried. 
Pustular Eruption.—Apis.—Case by Dr. Bishop. It commenced 
with small pustular formations just under the cuticle, with burning, 
smarting, stinging sensation; on coming to maturity, deposition of dry, 
scabby matter in a laminated form, scaly, brownish, and sometimes straw- 
colored ; looseness of the bowels for three or four weeks. No abate- 
ment in symptoms followed the use of Rhus or other antipsorics. Apis 
1, to be taken every twelve hours, caused a speedy and effectual cure 
of both the diarrhoea and eruption. There was no return of either. 
Remedies applicable in various Affections of the Skin.— 
Lycopodium.—Itching eruption at the anus, painful when touched. 
Freckles on the skin. Yellowish humor behind the corona glandis, 
with dark-red, soft elevations, which smart and itch; pimples on the 
arms filled with pus, burning pimples between the scapulae; red pirn-' 
pies around the neck, with itching. 
Graphites.—Tinea, humid and dry; erythema; humid eruption on 
the scrotum; itching pimples; small red itching pimples, with their 
tips full of pus, frequently appearing on the skin; they bum after 
scratching, and disappear on the following day. Small pimples without 
sensation at night, all over the body, passing off again in the morning. 
Itching pimples full of acrid water here and there. 
Rhus-toxicodendron.—Scurfs over the body; eruption on the scro- 
tum, with swelling of the prepuce and glans; inflamed blotch on the 
middle of the finger, with itching-burning pain, sometimes passing into 
a stitch. Small vesicular tubercles like the bites of insects, in the 
joints of the hands,feet, particularly around the outsides of the ankles; 
tubercles and vesicles on the knees, and shoulder joints; tubercles 
here and there. Zona or shingles. 
Rhus-vernix.—Hard elevated blotches, with watery vesicles on the 
hands. Itching blotches in the palms of the hands, deep under the skin. 886 
DISEASES OF THE EXCERNENT FUNCTION. 
Kali-bichromicum.—Small red elevations, with a dark centre and 
elevated circumference, itching and slightly painful; papular eruptions 
on the fore-arms, lasting a few days, recurring frequently. Heat and 
itching of the skin, at night in bed, followed by the breaking out of 
reddish hard knots on the thighs and legs, from the size of a pin's 
head to that of a split pea, with a depressed dark scurf in the centre 
surrounded with an inflamed base, declining in twTo or three days. 
Ammonia-carl).—Red tubercles around the elbow, cutting and pain- 
ful, sometimes ulcerated, also on the neck. 
Ammonia-mur.—Large blotches and indurations deep under the 
skin, upon a hard base; itching first, then burning after being scratch- 
ed ; inflamed, with red-brown scurf which remains inflamed for a long 
time, with swelling of the part. 
Juglans.—Violent burning and itching on the right fore-arm near 
the bends of the elbow; violent burning and iti hing on a red spot as 
large as a dollar, in the centre of which a little ubercle was formed; 
next day the spot had disappeared, the tubercle had grown and was 
painful; it gradually dispersed without breaking. 
GENUS IV.—MALIS.-CUTANEOUS VERMINATION. 
1. MALTS FILIARIA.—GUINEA WORM. 
Filaria.—A genus of the class vermes, order Intestina.—Body 
cylindrical, filiform, equal and quite smooth. Mouth terminal, more or 
less perceptible, simple, with a roundish concave lip. There are about 
eighteen species. 
Filaria medinensis, the thread wTorm, is found both in the East and 
West Indies ; it is often seen in the morning dew, from which it enters 
the naked feet of the slaves, and creates a troublesome itching, fre- 
quently accompanied with inflammation and fever. There is great 
difficulty in extracting it from its hold ; the only method is, by cau- 
tiously drawing it out by means of a piece of silk tied round its head; 
for if, by being too hast}-, the animal should break, the part remaining 
under the skin grows with surprising vigor and occasions an alarming, 
sometimes fatal inflammation. It is generally twelve feet long and 
not larger than a horse hair. 
The explorers of Africa in the last century attributed the Guinea 
worms in their bodies to the water they drank from the ponds; and as 
a prophylactic they drank sea-water brought up by divers from a depth 
of fifteen or twenty feet. They described the worm as about one foot 
long, the size of a hair. They cause intense pain; the patient could 
neither sit or lie, walk or stand with any comfort; some were affected 
with a fit of insanity. In some “the symptoms begin with cold shiver- CORNS 
887 
ings, in others with burning heats. In some there comes a large 
swelling, under which the worm can be plainly seen; in others they 
break out in carbuncles and ulcers, which are largest in the parts that 
are most muscular. The negroes did not use any remedy, but permit 
them to come out, and then they wash the part with salt water and 
fresh butter mixed with salt. When-the worm appears so that it can 
be taken hold of, they fasten its head to a small stick to prevent its 
returning when it moves forward. In winding the worm round the 
stick, if the animal should break, the wound becomes dangerous, and 
is often fatal. Sometimes when one worm is extracted another shows 
itself at the same place, and many persons have several of them at a 
time in different parts, causing a degree of distress that is not to be 
described. One writer says, “ The pain produced by these worms is so 
excessive that a man would renounce all the prospects of profitable 
trade on this coast rather than endure it.” 
GENUS V.—ECPIIYMA.—1. CORNS. 
Corns are excrescences or thickenings of the skin of the toes or feet, 
caused and perpetuated by continued pressure; this produces hyper- 
trophy of the papillae of the derma, which hypertrophy is kept up by 
the irritation induced by the pi’essure and friction of the affected part. 
Varieties.—1. Soft Corns.—These are always located between the 
toes. They never become hard, are never deeply seated, do not pro- 
ject much above the surrounding surface, but are kept flat by the pres- 
sure to which they are constantly subjected. They are caused by the 
pressure of the joint of a toe to the side of a toe next to it, by a shoe 
too narrow. When the pressure is very great it produces inflamma- 
tion and even suppuration. The soft corn begins with a burning or 
scalding feeling between the toes. A blister is formed, and the escap- 
ing serum irritates the surrounding skin, inflames it, and a new, thick 
series of layers take the place of the cuticle, and thus the corn is pro- 
duced. It now feels as if a gravel or seed was between the toes, and 
sometimes causes a crack in the skin. If a soft corn is not removed, 
ulceration often follows, with inflammation of the foot, which is pain- 
ful and may extend up the leg. 
Treatment.—Remove the thickened skin with fine sand paper, or 
extract it when sufficiently developed. Then when the spongy part 
has been removed and the surface looks quite red, the pain will 
cease. Lint should be worn between the toes to avert pressure. When 
the disease has lasted long the spongy structure becomes a regular 
growth. In bad cases, direct perfect rest, and fomentation of the limb 
may be necessary. For slight inflammations between the toes a piece 
of lint, wet with cold water will be beneficial; it may be inclosed by a 888 
DISEASES OF THE EXCEKNENT FUNCTION. 
strip of oiled silk passed round both toes. The application of violent 
remedies, as nitric-acid or aromatic vinegar should be avoided. 
Festered Corns.—The toes have in some instances been drawn out 
of their natural position, so that the joints become prominent; the 
skin over the joints becomes thin and stretched; severe pressure or 
friction on these projecting points produces a painful and troublesome 
festered corn. The skin over the joint first becomes red and sensitive; 
it then becomes slightly thickened, semi-transparent; inflammation fol- 
lows, and then suppuration under the whole extent of the hardened 
surface. The corn formed in the centre of the induration seldom ex- 
ceeds in size the head of a large pin, decreasing inwardly to a thin 
thread-like point. This excites vascular irritablility and rapidly causes 
suppuration in the bursa beneath. When the corn is extracted a part 
of the sac of the bursa adheres to it. When the bursa is diseased 
without any thickening of the outer skin, the only external ap- 
pearance is the redness and swelling of the toes, with a very small 
white spot, having a minute speck in the centre, usually situated upon 
the most prominent part of the joint; the serous fluid effused now causes 
great irritation, excruciating pain, and violent inflammation, extending 
even to the whole foot. 
The treatment is generally limited to soothing local applications, 
cooling lotions, rest in the horizontal position, until the inflammation 
subsides. 
Mr. Dowie, of Charing Cross,* and Dr. Meyer, of Zurich, have pub- 
lished works which propose to save the suffering caused by badly con- 
structed shoes. The work f of the latter shows that, in the external 
shape of the foot, a straight line drawn through the centre of the great 
toe, if prolonged to the heel, would pass through its centre ; and he 
says, the sole of the shoe, in order to fit the normal foot, should be so 
constructed as to allow the great toe to have its normal position in the 
shoe. In the sole of the shoe, as usually constructed, a straight line 
drawn through the centre of the great toe as it lies in the shoe falls to 
the inside of the heel. The great toe thus pushed out of its proper 
position is injured at its metatarsal-joint, its ligaments strained, the 
joint itself partially dislocated; the bruise over the joint produces 
bunions; and in the case of a gouty subject, the common seat of the 
gouty attack is this much injured portion of the imprisoned toe. 
Nervo-vascular Corns form on the projecting part of the toes of 
persons whose skins are unusually vascular. They readily inflame from 
the slightest pressure; the covering of the affected part becomes thick- 
ened, semi-transparent, showing villi, or nervous fibres clearly visible, 
* The Foot and its Covering. By James Dowie. London : 1861. 
f Translation. Edinb. : 1863. COENS, 
889 
running in zig-zag whitish lines within the induration, and small corns 
appearing between them like white specks, corresponding in form to 
the cells or depressions they occupy. 
Although the outer skin of these corns is as insensible as any other 
thickening, the intermingled nervous filaments are so exceedingly sen- 
sitive to pressure, that the softest leather of any shoe can scarcely be 
borne, and the least touch in attempting to remove any part by an 
operation gives the most excruciating pain. The reason for this ex- 
treme tenderness is the severe degree of pressure which causes a more 
intense inflammation than that which produces the ordinary thicken- 
ing ; the whole portion of the true skin subject to compression partici- 
pates, and its vascular structure, together with the nervous fibres, be- 
come enlarged to such an extent that when the inflammation has been 
partly subdued by the removal of the shoe, by poultices, or by any 
other means, the enlarged structures do not return to their normal con- 
dition but constitute a net-work within whose meshes is deposited the 
adventitious matter produced by the thickening of the skin that is con- 
tinually going on, and which, becoming condensed, forms small corns 
situated between the nervous fibres. When the inflammatory action 
has entirely ceased, the nervous filaments remain completely matted 
within the outer skin. 
This species of corn, cut unskilfully or improperly treated, often pro- 
duces serious consequences, even ending in some cases in death follow- 
ing on mortification; the persons most liable to this termination are 
those advanced in life, in whom the circulation of the lower parts is 
enfeebled. 
The Treatment relied on consists of palliatives ; as : application of 
lint dipped in cold water, and covered with oiled silk or gutta percha; 
this with rest, the avoidance of pressure, soon diminishes the irritation. 
The thickening skin may then be carefully removed without giving 
much pain, if the fibres of the nerves are not touched by the instru- 
ment ; pressure of the shoe must also be avoided. 
In the chronic form there is not much inflammation, but the skin is 
much thickened, and must be scraped off until the white lines and in- 
termediate specks are visible. The corns can then be carefully picked 
out from between the filaments, great care being taken in the opera- 
tion to avoid pricking them or producing haemorrhage, as that would 
give excruciating pain, and might cause inflammation. Apply wet 
lint for a few days; afterwards a soap cerate plaster may be worn as 
long as necessary. This treatment after some time causes the nervous 
filaments to disappear, leaving only a slight thickening, which causes 
little or no pain. 
Vascular Corns.—Painful vascular excrescence on the soles of the 
feet, under the side of the heel, on the little toe, or by the edge of the 890 
DISEASES OF THE EXCEKNENT FUNCTION. 
nail of the great toe. .t more resembles a wart but they come on 
parts not subject to pressure, are seldom painful and grow without ap- 
parent cause; but this excrescence is always caused by pressure, oc- 
curs neither in childhood nor old age, seldom in females, and is always 
painful. It is deep-seated, spongy or vascular, forming a circumscribed 
tumor projecting a little above the level of the thickened skin. The 
whole surface becomes studded with red or black specks, and the sur- 
rounding skin inflames and swells, becomes very sensitive, aches and 
throbs. When the minute extravasations are not distinctly defined, the 
excrescence appears as a softened tuft composed of apparent vascular 
fibres of unequal length. The effort at extermination by the knife 
causes considerable haemorrhage from the wounded vessels. 
Treatment.—This form of corn, not being malignant in its nature, is 
cured by the application of nitrate of silver and never returns. It 
should be incised superficially before each application. 
Laminated Corns.—The lamina of the epidermis are distinctly ap- 
parent, in some cases the different strata are of different colors as light 
or dark brown or black, the different colors being caused by the effu- 
sion of serum or of blood under the epidermis or among the epidermial 
cells which are not absorbed; the ecchymosis being carried towards 
the surface by the formation of new layers, changes color, and fades 
or remains quite dark. 
Fibrous Corns, are caused by continuous pressure upon the promi- 
nent portion of a common or hard corn, that has long continued until 
the pressure has caused absorption of the papillae, and a part of the 
structure of the derma. Continued pressure produces a cup-shaped 
depression, the skin becomes thin under the corn, the papillae are re- 
moved by absorption, the skin becomes horny, and of a darker color, 
the edges of thickened epidermis rise as the central part is depressed, 
and the corn appears to be composed of fibres. 
Treatment of ordinary hard corns. Soak the foot for a long time 
in warm water, after which much of the thickened epidermis can be 
carefully cut away with a sharp instrument. The corn must be pro- 
tected from pressure, either by laying on it successive strips of adhe- 
sive plaster having a hole cut in each piece to let the corn project 
through it; or a piece of soft sponge cut out over the corn can be tied 
on the toe ; or thick soft buck-skin may be tried. A piece of amadou 
is better. Cleanliness is highly important. 
The thickened epidermis may be removed by scraping, filing, rasp- 
ing with fine sand-paper, or cutting; alkaline caustics and various plas- 
ters have been recommended; but they are all too powerful, except, 
perhaps, Acetic-acid. When the corn is very soft, solid Nitrate of 
Silver is applied to its surface to harden it, and then the file or knife DISEASES OF THE TOE-NAILS. 
891 
may be ised without pain. Hard corns are softened with a warm 
alkaline foot-bath. 
The mode of extirpating corns by chiropodists is to cut and tear out 
the central portion, leaving the external portion to take olf the pres- 
sure from the more tender part at the centre. Some use Tincture of 
Iodine, but without real benefit. Acetic-acid is better; it may also be 
used after extirpation by some other means. When a sinus forms 
under a corn, or there is suppuration, or the formation of a bursa 
between the corn and the bone, remove the corn; and then dip the 
point of a stick in strong Nitric-acid, and apply it in the sinus or over 
the newly-forming granulations. The application must be made with 
caution when the bursa is near the bone. 
When a corn is under the nail, remove the whole or a part of the 
nail to get rid of its pressure, and treat it as before directed. 
For local treatment of corns the people have many remedies as: a leaf 
of ivy saturated with vinegar, bound on the corn; lint soaked in a fluid 
composed of Muriate of Ammonia, 1 ounce, dissolved in 4 fl. ounces 
of water; or a powder composed of Savine-leaves, 2 ounces ; Verdigris, 1 
drachm; red-precipitate, 2 ounces, pulverized and bound on and kept 
on all night; also, Diachylon-plaster, and yellow-wax, equal ports each. 
Sir Humphrey Davy’s Solvent.—Potassa, 2 parts ; Salt of Sorrel, 
reduced to a fine powder, mixed; a small quantity with a bandage every 
night for several nights. 
Corns on small children can be picked out after the feet have been 
well bathed. 
When large sinuses form under corns situated over the bone, and 
the skin and parts surrounding the sinus are much thickened, the 
sinuses being the result of suppuration of a bursa under the corn 
which is unable to form healthy granulations, it is necessary to enlarge 
the sinus and excite new action in it. For this purpose it is best to 
enlarge the sinus by incision, and then to destroy its entire cavity by 
means of strong Nitric-acid applied on the point of a stick of wood, 
only being careful not to injure the bone or the joint that may be be- 
neath the corn. If the periosteum has already ulcerated away, apply 
the acid to the surface of the bone, repeating daily till new granula- 
tions commence. 
2. DISEASES OF THE TOE-NAILS. 
The peculiar structure of the nails renders them liable to curvature, 
bending under the influence of heat, of moisture or pressure. Pres- 
sure of the shoe may force them into irregular shapes. When a nail 
has been injured by disease, it is liable to continue in an irritable con- 
dition until it has time to grow off, being followed by the new nail 892 
DISEASES OF THE EXCEKNENT FUNCTION. 
coining on behind it. The usual time for the growth of a new nail is 
from four to six m mths, according to the condition of general health. 
In cases of accidents from violent collision of the toe against a stone 
or other hard substance, extravasation will immediately follow the blow, 
and be attended with great pain ; if the injury is very severe the nail 
becomes loosened and falls offj and a new and perfect nail will be pro- 
duced. If the whole nail has not been detached, the loosened part 
is sometimes cut away, and this may be followed by a deformed 
growth. It is better, if possible, to avoid cutting the nails in any 
other direction than that in which they are ordinarily cut when too 
long. Cutting off at the edges is often followed by abnormal growths, 
which tend to grow into the side of the toe. 
The injury caused by the falling of a heavy weight, or the stepping 
of a horse on the toes, is one of the most painful to which they are 
exposed. The soft part of the bruised extravasation extends to the 
secreting vessels at the root of the nails, inflammation involves the dif- 
ferent layers of which the nail is composed ; they lose their adhesion to 
the root, and cease to furnish support to its further growth. The injury 
when very severe is followed, when the inflammation subsides, by early 
falling off of the nail; the parts beneath are exquisitely tender till the 
damaged secreting glands at the root of the nail have time to supply 
a new nail, which is likely to be a very ill-formed and imperfect one. 
In-growing Toe-nails.—This most painful of the diseases of the 
nails is most common in the great-toe. It is caused by the improper 
manner of cutting the nails, or by the flap of flesh being forced up 
against the edge of the nail, from wearing shoes too narrow or badly 
made, or from the edge of the nail becoming curved, or beginning to 
grow in a wrong direction after being trimmed on the side. 
When pain begins to be felt at the side of the toe, it is commonly 
thought to result from the nail having grown too long and too wide at 
the corner. Trimming gives temporary relief; but the pressure of the 
shoe continues to press the side of the toe against the corner of the 
nail, the edge of which is rougher than before, the pain and uneasiness 
is increased, but lower down and nearer the root. The flap thickens, 
is pushed upward still farther, and partially covers the nail, which, as 
the pain continues, is again and again cut, until the scissors can no 
longer reach the part that is supposed to cause the suffering. The 
consequence is, that a point is left which penetrates the flesh, keeps 
up and increases the previously existing irritation, produces severe 
pain and ulceration, and, if neglected, fungus sprouts forth from the 
parts most affected. 
In other cases, the nail forms such a decided curve under the flap that 
its edge along the whole length of the toe is imbedded in the soft parts, 
which become so inflamed and so much swollen, that not above one- IN-GROWING TOE-NAILS. 
893 
half of the nail can be seen. Walking will increase the inflammation, 
and ulceration will take place in the whole length of the furrow. 
Under improper treatment or neglect this will continue with many 
persons for months, until the whole is covered with fungus, or what is 
denominated proud flesh. The pain will then be so severe that the 
weight of the body cannot be sustained upon the toe, and the patient 
is compelled to rest the limb. 
The treatment generally relied upon in these cases has not been 
quite satisfactory. We omit all notice of the various mechanical means 
that have been resorted to, as they have failed to cure permanently, 
even when they palliated for the time. Nitrate of Silver, rubbed 
freely arid repeatedly between the nail and flap, with the intention of 
destroying both, has sometimes succeeded when the disease did not 
arise from a point or sharp edge of the nail protruding into and irri- 
tating the flesh, and when the ulceration is not very extensive. This 
experiment has, howTever, been carried too far : a piece of caustic has 
been laid in between the nail and the flap of skin where it excited 
violent irritation and constitutional derangement without any benefit. 
When the nail has penetrated into the flesh and ulceration has com- 
menced, these measures are of little benefit; and the only question 
generally considered is the best mode of excision of a part of the 
nail. We have still some promising resources to be tried before we 
resort to a painful surgical operation. 
M. Wahn, principal physician of the Military Hospital of Nice, suf- 
fered for a long time from this affection, and was disabled from walk- 
ing ; after trying many remedial measures, he says: “ I examined 
again, for the twentieth time, the seat of the disease, and was struck 
with the idea that if I could dry up, or even tan the diseased surface 
so that the ulcer might be converted into a firm surface, capable of 
resisting the cutting action of the edge of the nail, I might obtain com- 
plete cicatrization, and consequently a cure. Running over in my 
mind the most energetic tanning substances, I decided on employing 
the Perchlorure de Fery {Perchloride of Iron). I obtained some 
in a powrdered form, and insinuated it as deeply as possible between 
the free edge of the nail and the ulcer. I felt almost immediately a 
moderate sensation of pain, accompanied by a feeling of constriction 
and a strong burning sensation. After a quarter of an hour I 
attempted to walk, and to my great satisfaction, I found that I could 
bear my weight on my foot throughout its entire length, without the 
least pain • a thing I had not done before for many months. The fol- 
lowing day I carefully examined the diseased parts, and found them, 
mummified, and as hard as wood. I applied a fresh quantity of Per- 
chlorure de Fer, which I allowed to remain for a quarter of an hour, 
but I have reason to believe that this application was useless, as the 894 
DISEASES OF THE EXCEKNENT FUNCTION. 
mummification was complete by the first process. I continued tc 
walk without the least thought of my ongle encarne, and about three 
weeks after was able, by means of a foot-bath, to remove the hardened 
layer of skin, under which I found a tissue of new formation, which 
erfectly resisted the pressure of the edge of the nail. Shortly after 
he whole had returned to its normal condition, and more than twTo 
years have since passed without a return of the disorder.” 
The modes of removing the nail proposed by surgeons are too bar- 
barous to be mentioned. 
TJlcer caused by In-growing Toe-nails.—This is generally caused 
by cutting the nails close at the sides and round the corners, which 
starts that part of the nail to growing faster, and in a short time the 
corner begins again to project into the flesh. The nail should be cut 
frequently, but not at the corners. Bathe the feet often, and wrear a 
shoe sufficiently wide at the toe. 
3. ONYCHIA. 
This disease of the nails of the fingers and toes consists essentially 
of inflammation of the matrix of the nail. It may not extend beyond 
the matrix, or it may, and usually does, extend so as to involve the 
adjacent soft parts. 
It may be caused by an external injury, as a bruise by a pressure 
upon the end of the nail from a shoe or boot, by a foreign body 
passed under the nail, as a splinter, or by some constitutional derange- 
ment, as syphilis, scrofula, or eczema. It may be confined to one toe, 
or, if the cause be constitutional, several toes may be affected at the 
same time. The amount of inflammation may be slight, or so exten- 
sive as to produce suppuration, ulcerations, funguous granulations, with 
ichorous, sanious, or foetid discharges, with loss of part or the whole 
of the nail, or even of death after loss of one or more bones of the 
toe. This disease is always troublesome, painful, and difficult to 
cure. 
Treatment.—When caused by external injury, the treatment must 
be conducted writh reference to the degree and nature of the injur}". 
If pus forms beneath the nail, it oan be let out by carefully making 
an opening through the nail. A foreign body beneath the nail must 
be removed. If caused by pressure of a hard boot or shoe, the pres- 
sure must be removed, and the patient kept quiet in the horizontal 
position, and treated as for in-growing nail. 
When onychia depends on general eczema, the treatment proper 
for that disease must be followed in connection with proper local 
treatment. BUNIONS. 
895 
When the constitution is scrofulous, the onychia usually begins at 
the nail. This form is more commonly seen on the fingers. 
Syphilitic onychia is also most common on the fingers, and is accom- 
panied with syphilitic eruptions on other parts of the body. The matrix 
of the nail frequently turns red, swells, suppurates, and ulcerates. 
The skin around the nail becomes puffed and swollen, and the entire 
extremity of the toe becomes enlarged, while the suppuration, ulcera- 
tion, and fungous growths at the edge of the nail increase so as to 
partly overlap the nail, and give the toe an appearance as of the 
ordinary nail. The nail may at the same time become discolored, 
brittle, altered in thickness, rough, and even fall oft’. 
As the general disease is cured, the local affection disappears, or 
becomes easily manageable. 
When onychia appears in the malignant form, there is very great 
pain from the first, and destruction of the periosteum, with disease, and 
perhaps death of the bone, without any apparent cause, either local or 
constitutional. When onychia is the result of in-growing of the nail, 
that condition must be cured. 
Local applications may be useful to correct foetid discharges; those 
already mentioned for other diseases of the feet may be used. Muri- 
ated Tincture of Iron will often be beneficial. 
In all psoric and dyscrasic constitutions the specific remedies for 
such specific diseases will be necessarily employed. In eczematous 
onychia the Benzoated Oxide of Zinc-oinment is recommended by 
Wilson and others. Scrofulous and syphilitic cases require the 
specific treatment proper for those diseases. In extreme cases the 
amputation of the toe has been recommended. 
4. BUNIONS. 
The word bunion should be restricted to an enlargement over the 
first joint of the great or little toe, produced by pressure or by some 
other cause effecting a change in the position of the joint. 
The common cause is the wearing of shoes too short and with a nar- 
row sole; this gives too much pressure to the toes, and throws too 
much of the body’s weight upon the articulation of the hones of the feet, 
impeding the action of the muscles, causing pain and inflammation, 
malposition of the great toe, and the ultimate formation of a bunion. 
It often occurs in persons of constitutional derangement, with feeble 
mints, and subject to pain in the joints of the foot after walking; gouty, 
rheumatic, and scrofulous constitutions show this form most frequently. 
In such persons the synovial tissues, the tendons, &c., are liable to 
this disease. The great toe becomes distorted in position, pointing 
obliquely across the other toes, leaving the shoe to press upon the 
joint. In persons advanced in life, the synovial membranes of the 896 
DISEASES OF TUE EXCERNENT FUNCTION. 
joints become worn and secrete less fluid than is needed in a healthy 
joint; they become stiff, painful on motion; partially anchylosed. 
A bunion consists in an enlargement or thickening of the integuments 
over the first joint of the great toe, generally only of one foot. The 
pain is generally trifling at first, but it becomes more painful as in- 
flammation involves the joint; the skin thickens in layers or scales 
over the surface, and is studded with clusters of small superficial corns ; 
if the iiritation of a tight shoe be continued, the bursa between the 
skin and the bone will become enlarged, the fluid effused causes swell- 
ing over the joint; the pain increases and extends to surrounding parts ; 
suppuration may take place within the bursa, which progresses slowly 
and with pain; the ichorous fluid may extend into the cellular tissue 
before it bursts externally. It may even cause caries of the bones or 
exfoliation of the joint. 
Treatment.—Sensitive and delicate persons may suffer from pain 
in the joints of the feet when there is little enlargement or evident in- 
flammation. The skin is tender, soft, moist, clammy. In this stage 
the disease may be easily relieved by a lotion slightly stimulating or 
an anoydne in which the foot may be bound up by a roller of two or more 
thicknesses. Tincture of Arnica or Belladonna will answer. Another 
slight affection is a small tumor on the instep, caused by a boot too 
tight; it is under the skin hard and immovable. In some cases it may 
progress to the extent of forming a small but sensitive corn. 
The treatment of these distortions of the joints, whether confined to 
the great toe or to the small one opposite, is often confined to placing 
between the toes flexible sheets of lead, not too thin, so as to keep the 
toes nearly in their natural position. 
Tumors about the toe-joint have been produced by gout or rheuma- 
tism. These are cured by wearing loose shoes of buckskin or flannel; 
and then the common treatment for the general disease. 
A true bunion in its first stage appears inflamed, but is not attended 
with much swelling; the pain in the joint is mostly felt when the shoe 
is Worn; in a few days it subsides, but is liable to reappear when the 
short, small, or badly made shoe is worn. Removing the shoe is 
usually relieved by changing it for a large soft one, and bathing with 
an alcoholic lotion. 
If the irritation is continued the pain and tenderness will gradually 
increase in proportion as the foot is used, and is felt more in the joint 
under the ball and along the toe, over the instep; the skin becomes 
thickened, forms in scales or layers, and one or more small corns form 
on the surface. 
This case is best treated by rest and cooling, soothing lotions; after 
carefully extracting the corns, a plaster of Soap-cerate and adhesive 
plaster may be applied over the joint. If the great toe is unduly in- NJ2VUS MATERNI. 
897 
dined inwards towards the others, apply a piece of sponge or pledget 
of linen between it and the next toe will carry the toe outward and re- 
move pressure from the joint. 
A bunion on the outer side of the foot begins with itching, heat and 
pain increased by pressure of the boot. For this, the pressure must 
be removed, a loose cloth wet with an anodyne lotion; and, for a final 
cure, a soap-plaster, worn for some days. 
In many cases there are constitutional derangement, influenced by 
changes of weather, which may cause the whole disease without irri- 
tation. In some of these cases the attack is sudden, resembling an 
attack of gout. In all of these cases constitutional treatment must be 
the chief reliance for cure. 
When the bursa under the bunion is inflamed, confine the patient 
to a couch, and subdue the inflammation; and if an abscess forms, 
cause it to be opened; after w'hich heal it by soothing dressings. If 
the inner surface of the bursa does not granulate, apply a minute quan- 
tity of strong Nitric-acid on. the point of the probe. This will start a 
new' action and the bursa will heal. 
Ganglions, are usually the result of inflammations of a bursa mucosa. 
They may appear on the surface of the foot or instep, and may cause 
contraction of the extensor tendons of the toes, great inconvenience 
and lameness in walking. 
When the ganglion is inflamed and filled with fluid effused, this 
should be let out by puncture, and the foot kept at rest. If the fluid 
hardens and will not flow, the orifice must be enlarged and the impli- 
cated tendon may be divided. In all operations on ganglions and 
bursm it is only necessary to make a small opening and then rely on 
local measures of a soothing character, with general homoeopathic 
treatment. 
5 NA1YUS MATERNI. 
Pathology.—These tumors or “ marks” are formed in the erectile 
tissue, and are divided into: 
1. Noevus in which there is a predominance of veins. 
2. Nsevus in which there is a predominance of arteries. 
3. Mole. 
Treatment.—John Bell advises to cut the tumor out He says, 
u you must cut them out,—not cut into them.” Sir Astley Cooper cut 
into one as large as a hickory nut on the back of a child’s neck; the 
child bled to death in four hours. 
Dr. Mott objected to cutting out; and also said the use of the 
Kalipurum was unsafe. , 
Yoi. IL—57. 898 
DISEASES OF THE EXCERNENT FUNCTION. 
2. The next mode to cutting out was by using red-hot needles. , This 
caused little pain. 
3. The next method is to transfix the tumor with needles, at right 
angles, and strangulate them with twisted suture. 
4. Collodion.—Cover the naevus with a solution of gun-cotton in 
ether. We prefer this to any of the above. (Amer. Jour., Oct. 1849, 
p. 555.) 
5. Tartar-emetic.—It is proposed to rub the naevus with a solution of 
Tartar-emetic in Olive-oil. It soon becomes covered with pustules 
which become confluent, and are removed by poultices. If the granu- 
lations look favorably inclined, they are touched with Nitrate of Silver. 
Third species of Naevus.—Mole.—On one occasion, Dr. Mott, in a 
lecture on this subject, said he knew no cure for a mole. A note was 
sent to him recommending Labarraque’s, Sol.-chlorur-sodium. Dr. 
Mott accepted the suggestion, and said he was not too old to learn. 
Acetic-acid.—Apply strong Acetic-acid to the small flat naevus, 
following this by compresses soaked in vinegar. This coagulates the 
blood in its vessels, the naevus becomes hard and yellow, and is thrown 
off from the parchment-like layer by a process of exfoliation. ( Wilson. 
p. 836.) 
Alum.—Apply a wet compress kept moist for a considerable time. 
The naevus becomes white and flat. 
GENUS Y.—TRICIIOSIS.—MORBID HAIR. 
The hairs, like the cuticle, are beautifully organized, and maintain a 
vital, though not a vascular connection with the body. Some evidence 
of their retaining a degree of vitality is found in the fact, first pointed 
out by Mandl, and verified by Todd and Bowman, that hairs have a ten- 
dency to become pointed after having been cut short off. The process 
is very slow, and seems to consist in a further condensation and elon- 
gation of the elementary cells at the new extremity. 
1. TRICIIOSIS POLLICIS.—GRAY HAIR. 
Well-authenticated instances have occurred in which the hair has 
grown white in a single night, from the sudden influence of grief, or of 
some other depressing passion; it is thence supposed that fluids cir- 
culate through them. It is rather probable that this phenomenon re- 
sults from the secretion at the bulb of some fluid,—supposed by Vau- 
quelin to be an acid,—which may percolate the tissue of the hair, and 
chemically destroy the coloring matter. The ordinary gray hairs of 
aged persons resemble other hairs in every respect but color; and the 
process of changing from dark to gray seems to take place rapidly in 
each individual hair. MORBID HAIR. 
899 
According to Yauquelin, the color of hair depends on the presence 
of a peculiar oil, which is of a sepia tint in dark hair, blood-red in red 
hair, and yellowish in fair hair. When extracted, as it may be by 
alcohol or ether, the hair is left of a grayish yellow. The color is de- 
stroyed by chlorine, and probably otherwise resembles closely that of the 
cuticle in the dark races. The substance of hairs is similar in chemical 
composition to that of horn. After being softened by maceration in 
cold Nitric-acid, it is soluble in boiling water, and the solution after 
evaporation becomes a gelatinous mass on cooling. The horny matter 
is said to be distinguishable from coagulated albumen or fibrine by its 
being readily soluble in caustic fixed alkalis, but not in caustic ammo- 
nia. The ashes amount to one-and-a-half per cent, of its weight; and 
contain oxide of Iron, a trace of oxide of Manganese, of sulphate, 
phosphate, and carbonate of lime, an I of Silicea. Black hair contains 
most iron, and light hair least. 
2. PLICA POLONICA.—Plaited Hair. 
The most remarkable of all the diseases connected vrith vegetable 
growths on or within the human body is the plica polonica, which has 
its name from its most prominent symptom—the entangling of the 
hair into a confused mass. It is generally preceded by violent head- 
aches and tingling in the ears ; it attacks bones, joints, and nails, split- 
ting them longitudinally. It often ends in blindness, deafness, or 
melancholy distortions of the limbs. As it progresses, the individual 
hairs swell at the root, and a slimy fat substance exudes, mixed with a 
noisome suppurated matter. The hairs now grow more rapidly; pos- 
sess increased sensibility; when advanced farther, the hairs will bleed 
if cut near their base, others say at any part of their whole length; 
they twist themselves together inextricably, and become plaited into a 
“confused, clotted, disgusting-looking mass.” Sometimes they form 
into a series of cords like ropes; and in one instance, in the case of a 
lady, the diseased hair grew into a long agglutinated mass fourteen 
feet long. Disgusted and distressed with such an unpleasant appen- 
dage, patients were treated by cutting it off, but it was found that 
this only resulted in the most terrible consequences. “Blindness, dis- 
tortion of the limbs, cramps, death or insanity speedily followed the 
cutting off of the hair, and it was found that the hair while so oppres- 
sive itself, was merely contributing to the cure of the constitutional 
disease, by being the channel through which the corrupted matter is 
carried off from the body.” From the moment the hair begins to en- 
tangle itself the painful symptoms which marked the beginning of the 
disease begin to disappear. Having discovered the relief which fol- 
lows the entanglement of the hair, the peasants promote the process 900 
DISEASES OF THE EXCERNENT FUNCTION. 
of nature by increased filth, carelessness, and even soaking the hail 
with oil or rancid butter. After the disease has run its course the 
hair becomes gradually dry, healthy hairs begin to grow up under the 
plica, and at last they push it off. Sometimes it requires months and 
years to separate of itself, but at this stage it will bear to be cut oft'. 
Many have suffered from the premonitary symptoms of plica and sought 
relief in other countries without finding it; on returning to their owrn 
country they have been cured by the outbreak of this horribly disa- 
greeable disease. Its origin has been generally sought in uncleanli- 
ness and unhealthy food; others regard it as epidemic in Poland and 
Livonia, in some parts of Russia. It is supposed to have originated 
in Tartary, and been introduced by the Tartars into Europe, in their 
invasion at the end of thirteenth century. (.Russell’s Tour in Ger- 
many, Encycl. Amer.) It is easy to understand, says Carpenter, 
{Physiology, 551,) from the analogy of cellular plants, in which no 
vessels exist, how the fluid that is supplied to the base of the hair may 
find its way upwards; and there seems reason to believe, from the 
well-known fact of sudden change of color in the hair under the influ- 
ence of strong mental emotions, that in its healthy state, fluid secreted 
at the base may be conveyed to its extremity. As the peasants of 
Northern Europe have observed a host of anomalous symptoms disap- 
pear on the eruption of a plica polonica, and from this, believe that it 
is a preservative against all other diseases, they, therefore, adorn 
themselves by inoculation, with “cultivated Weichselzopf”. The 
fact that it can in that way be communicated, proves the correct- 
ness of the views already given of its nature and origin. 
So numerous have been the facts which have been accumulated by 
the observations of a few years, which can only be explained on the 
cryptogamic theory of the origin of many familiar diseases, that many 
authors have concluded that all diseases must maintain themselves in 
the bodies they infest in the same way. Dr. Jahn, in the Archiv. de 
la Med. Beige, 1844, closes an elaborate article with the following 
summary of his views: {Med. Chirur. Rev., Jan., 1845, p. 567.) 
“ It is now ascertained that in fermenting fluids there become de- 
veloped vegetable productions of an inferior order, and in putrescent 
animal matter certain infusoria, which, in the opinion of some distin- 
guished naturalists, are generated by spontaneous formation; although, 
when once formed, they may propagate themselves by a process of 
vegetation. Now it is probable that not unfrequently those morbid 
conditions,—which consist in the supervention of similar decomposi- 
tions in some part of the body, in the crystoblasterna, or in the primi- 
tive molecules of the fermentation and putrefaction,—and consequently 
the chemical elements of tne crystoblastema or of the molecules, ex- 
perience a derangement in the attraction, which is indispensable to the WARTS, 
901 
continuance of the organization in a healthy condition; this derange- 
ment being occasioned by certain external agencies which entirely 
overpower the dominion of the general vital powers. Among these 
derangements we may enumerate various diseases, gangrenescences, 
putrescencies, &c.” But in these conditions there may possibly be 
developed, by spontaneous generation,—that is by the “ ever-acting 
creative power of Nature on organic matter in a state of decomposi- 
tion certain powers or properties,” as are shown in fermentation or 
putrefaction. 
Albino.—Selma Adams, of the Brothernout tribe of Indians, resid- 
ing near Clinton, New-York, gradually became white during the last 
thirty years of his life, retaining his mental faculties in full. The 
change commenced soon after an attack of rheumatism in a small 
white patch on the pit of the stomach, and it gradually extended; other 
spots appeared in other places and spread to other points. He tried 
the effect of the mineral springs to arrest the change in his skin; but 
finding no effect from the wTaters, he finally resigned himself to his fate, 
saying he was compelled to submit to become “ like the white men in 
everything but their dishonesty.” (Letter from Hr. Bissel to the Ed. 
Eclectic Jour., Columbus, Ohio.) 
Sclerema.—A boy in the Hospital des Enfans Malades, at Paris, 
showed the surface of the chest as firm to the touch as a cuirass. The 
general health seemed good; there was no fever or pain; on pressure 
the skin, over every part, except the palms of the hands, soles of the 
feet, the ears, lips, and eye-lids, gave the feeling given out by “ a mem- 
brane of considerable power of resistance on the tight stretch.” There 
was no change of form, no swelling, nor pitting on pressure. The boy 
said he only felt a little stiffness for a week back. The heart gave a 
strong mitral bellows-sound; the urine nothing abnormal; no albumen, 
sugar, or excess of any ingredient. It is probably an extraordinary 
condensation of the cellular and adipose tissues. 
Warts.—Acetic-acid.—They may be effectually removed by the 
strong acid. First carefully pare it down, then apply the acid with a 
camel’s hair brush, and subsequently apply compresses soaked in 
vinegar in contact with the part. 
Bichromate of Potash has often cured warts on the face. 
Malignant Warts.—Arsenicum.—Dr. Leon, then of New-Orleans, 
gave * a case of a lady, aged thirty, who had six painful warts on the 
back of the right hand, which prevented rest at night. They were of 
the size of a pea, very red and angry-looking; pains burning and pul- 
sating, extending up the arm to the axilla, rendering the arm useless. 
Gave six globules of Arsenicum, J8°, dry, on the tongue. On the 
* U. S. .Tour. Homceop., Vol. I., p. 43. 902 
DISEASES OF THE EXCERNENT FUNCTION. 
second day after taking the remedy all pains had ceased, on the fifth 
day the warts began to assume a blackish aspect and to shrivel up. On 
the tenth day they all fell off, and left a perfectly healthy surface. A 
year after there had been no return of the warts. 
Internal Remedies.—Causticum will frequently cause warts to dis- 
appear when they are fleshy or seedy. 
Antim.-crudum.—Warts flat, hard and brittle. 
Dulcamara.—Warts on the back of the fingers. 
Calcarea-carb.—Warts on the sides of the fingers. INDEX. 
Not*. —II. indicates Vol. 2. Where there are no Roman Numerals, 
!, Vol. I. Is meant, 
A. 
Abdomen, dropsy of, II., 745. 
Abdominal Respiration, 420. 
Abdominal Viscera, diseases of, 256. 
inflammatory do., 852. 
sensorium, II., 573. 
Typhus, 557,treatment,547. 
Tympanitic, 894. 
Dropsy, II., 745. 
Neuralgia of, II., 509. 
Cramp in, 311. 
Abdominal Plethora, II., 503. 
Abnormal Tissues, 646. 
Abortion, II., 593. 
Abscess of the Kidney, II., 775. 
Abscesses, Metastatic, 926. 
Diagnosis, 655. 
Abscess, common 652, treatment, 656, 
658. 
Abscess of the Liver, 925, rupture of, 
928, of antrum maxillare, 241, 263. 
scrofulous, 654, consecutive, 654, 
658. 
Abscess, 652. 
Absorption, II., 733. 
Absorption, some remedies known to 
act from, 130. 
Absorption of Nutritive Materials, 
221, 884. 
Abstinence, 258, in preventing dis- 
ease, 258, influence on health, 259. 
inanition, 282. 
Absurdity of Opinion, II., 398. 
Acalipha Indica, in Haemorrhage, II., 
255. 
Acarus Scabid, II., 879, II., 881. 
Acclimation, 480, 483. 
Aceto-nitrate of Copper, Uipthena, 
772. 
Acephalocysts, II., 822. 
Acetic-acid in Typhus, 547, Skin Dis- 
ease, II., 848, in naevus, II., 898. 
Acetum in Burns, 681, Erysipelas, 
681, foreign bodies in the eye, II., 
149, in Obsesity II., 838. 
Achillea Millifolium, 800. 
Achorous Exanthems, 615. 
Acidity of the Stomach, 256. 
Acids in Obesity, IT., 838, ill effects ofi 
312, poisoning by, 857. 
Add, Phos., in Pneumo Typhus, 585. 
Acid Reactions of urine, II., 781, 
II., 783. . 
Acid, Uric, II., 785. 
oxalic, II., 796. 
Acid, Acetic, 547. 
Acne, II., 854. 
Aconite in Gout, II., 173. 
in Cancer, II., 293. 
in Syphilis, II., 319. 
in Grangrenopsrs, II., 356. 
in Gonorrhoea, II., 377, 379. 
in Orchitis, II., 383. 
in effects of fear, II., 429. 
in Insanity, II., 434, II., 435, 
II., 438. 
in Alcoholism, II., 460. 
in Neuralgia, II., 485. 
in Hemicrania, II., 502. 
in Vertigo, II., 578. 
in Tetanus, II., 534. 
in Nervousness, II., 575. 
in Apoplexy, II., 644. 
in Palsy, II., 662. 
in Amenorrhoea, II., 680. 
in Dysmenorrhoea, II., 684. 
in Leucorrhcea, II., 700. 
in Metritis, II., 730. 
in Crusta Lactea, II., 849. 
Aconite, its sphere of action, 651. 
in Pleurisy, 824. 
in Urticaria, 613. 
in Fever, 651. 
in Toothache, 234. 
in Infantile Fever, 525. 
in Pleuritis, 824, Carditis, 842, 
Aconite in Puerpural Fever, 892, 
Pneumonia, 808, Croup, 
7 7 7,Haemoptysis,800,Ptyal- 
ism, 251, Typhus, 550, 
Yellow Fever, 577, Pneu- 
mo Typhus, 584, Measles, 
606, Urticaria, 613, Miliary 
Fever, 616, Small pox, 631, 
in Encephalitis, 710, 706, 
903 904 
INDEX. 
722, in Diphtheria, 764, 
Tonsilitis, 748, Bronchitis, 
789, Sun stroke, 692, in 
in Hepatitis, 930, in Bright’s 
Disease, II., 29, 59, in Ne- 
phritis, II., 68, Cystitis, II., 
76, Gastritis, II., 856, in 
in Ophthalmia, II., 93, II., 
149,its sphere of action,651, 
650, Scrofulous, II., 154, 
in Teething, 228, Tooth- 
ache, 235, Dysentery, 906, 
Affections of the Mouth,251, 
in Obstruction of the 
Bowels, 336, in Cholera, 
373, Jaundice, 410, Folli- 
cular Enteritis, 888, in Cory- 
za, 425, Hoarseness, 434, 
Ephialtes, 454, Spotted Fe- 
ver, 529, Synocha, 532, 
Scarlatina,5 95, Measles,606, 
Miliary Fever, 616, Small- 
pox, 631, Peritonitis, 892, 
Actea Racemosa, in Rheumatism, II., 
160. 
Action of Remedies, 110. 
Acute Diseases, 211. 
Acute Rheumatism, 864, II., 156. 
Adeps in Typhus, 544, in Itch, II., 882, 
in Scarlatina, 599. 
Adhesive Process in Inflammation, 
643, Inflammation of the Liver, 923. 
Adiposis, II., 836. 
Adipose Diarrhoea, 349. 
Adjuvantia, 151, 375. 
Addison's Disease, II., 72. 
Administration of Remedies, 162, 
Hahnemann’s Practice, 162. 
Adolescence, 203. 
JEsculapius, 37. 
Affective Faculties, Deranged, II.,396. 
Agaricus in Insanity, II., 437, in 
in Neuralgia, II., 489, in 
in Chorea, II., 565. Vertigo, 
II., 579, Epilepsy, II., 610, 
growth of Agaricus, II.,860. 
Age, influence of on disease, 199. 
“ “ childhood, 202. 
“ “ youth, 203. 
“ “ adolescence, 204. 
Aggravations, theory of, 155, 914. 
instances of, II., 194, 
I., 147, II., 314, Mer- 
cury, II., 354. 
Agnus Castus, in Ischuria, II., 86. 
Agrypnia (sleeplessness), 712. 
Ague, 472, varieties of, 475. general 
course of, 473, critical days, 
476, causes, #477, prognosis, 
480, treatment, 485, complica- 
tions, 515, Spleen, affections of, 
515, Catarrh, 515. 
Albino-skin, II., 901. 
Albuminous Nephritis, II., 21, II., 
820. 
Albuminuria, II., 23, II., 820 
Alcohol, as a Remedy and Nutri- 
ent, 301, 708, 861. 
in Delirium Tremens, II., 453. 
Alcoholism, 862, 863, II. 444, a 
cause of Gastritis, 861. 
872, its effects on the 
Liver, 923 to 925, in 
Phthisis, II., 253, moral 
and physical effects of, 
II., 443. 
Alcoholismus Chronicus, II., 457, 
treatment, II., 460. 
Alexandrian School, 41. 
Alienation,Mental, II., 389. 
Alimentary Canal, diseases of, 172, 
213, 226, inflammatory, 852. 
Alkalis in Gout, II., 166. 
Alkaline Urine, II., 788, II., 789, II., 
797, Foot-bath, 665. 
Allopathic Medicine, present position 
of, 65, 96,100. 
Allopathic Admissions, 118, 321, IL, 
314,11,660. 
Allopathy, 86, objections to, 91, II., 
186, in chronic diseases, 
II., 186, in Cholera, 362, 
370, 375, in Typhus, 538. 
Almonds, Bitter, II., 647. 
Aloes in Haemorrhoids, 398. 
Alterant Action of Mercury, 403. 
Alternation of Remedies, 156. 
Alumina in Strabismus, II., 559, 
Leucorrhoea, II., 700, in 
Choroiditis,, II., 119, morbid 
Saliva, 249. 
Alum in Haemorrhage, II., 196, in 
Colic, 322. 
Alusia, I., 446. 
Alvine Worms, 380. 
Amaurosis, II., 120. 
Amblyopia, II., 139. 
Amenorrhaea, II., 674, IT., 612. INDEX 
905 
Ammonia in Aphonia, 434, in Croup, 
779, in the urine,II., 816,II.,818. 
Ammonia-carb. in pneumo-typhus, 
585, in Skin diseases, II., 886, 
in Variola, 633, Scarlatina, 600, 
in Bright’s Disease, II., 30, II., 
52, 60, in gangrene, II., 358. 
Ammonia, Sesqui-carb., II., 166, in 
Gangrene, II., 358, in Uraemia, 
768. 
Ammonia Causticum in Diphtheria, 
779, in Bronchitis, 795, in 
coagulation of the blood, II., 
178, in Delirium Tremens, II., 
453, II., 456, in Palsy, II., 660. 
Ammonia-mur. in obesity, II., 838, in 
eruptions, II., 886. 
Ammoniac in Choroiditis, II., 119. 
Anacardium in Sycosis, II., 329. 
Ancemia, II., 180, 190, Treatment, 
11.. 190, II., 245, City Cachexia, 
713, II., 191, Lymphatic, II., 
191, Chlorotic, II., 727, Leu- 
cot hyaemia, 942, Mercurial 
Cachexia, 404, II., 202, from 
Tobacco, II., 203, from Haemor- 
rhage, II., 690, Cerebral II., 
191, Delirium Tremens, II.,449. 
Ancemic Coma, II., *654, 
Ancesthetics, local, 238. 
Anagella Arvensis, in Hydrophobia, 
II., 550. 
Anal Worms, 381. 
Anasarca, II., 744. 
Anatomy, ancient study of, 42, Kid- 
neys, II., 9. 
Anetus, Ague, 473, stages, 474, va- 
rieties, 475, causes, 482, 570, 
treatment, 485. 
Aneurism, II., 340, treatment, II.,342, 
dissecting, II., 660, Tumor 
from, II., 840. 
Anger, II., 430. 
Angina Pectoris, II., 552, treatment, 
11., 556, Tonsillaris, 746, Paro- 
titis, 742, Maligna, 592. 
Anhelation, 440, Dyspnoea, 440. 
Am, Prolapsus, 398. 
A nimals, Parasites on, II., 847. 
Animal Heat, 188. 
Animal Magnetism in Scrofula, II., 
265. 
Animal Food, 189, 191. 
Anima, of Stahl, 44. 
Animalcules, development of, II., 824. 
Anise in Colic, 322. 
Anorexia, see Dyspepsia, 271. 
Anteversion of the Uterus, II., 713. 
Anthelmintics, 386. 
Antim.-Cruclum, 504, Tartarizatum, 
767, in Pneumonia, 808 to 811. 
Antim.-Crudum in Diphtheria, 770, 
in Vomiting, 270, Vertigo, II., 
578. 
Antrum Maxillare, Abscess of, 241, 
Fungous Tumor of, 243. 
Anthrax, 669, causes, 670, treatment, 
670. 
Antidotes, 149, 159, Hahnemann on, 
160, 161. 
Antipathy, II., 577. 
Anthelmintics, 386. 
Anthracia, Pestis, 637, II., 184. 
Anticipation of Disease, 492. 
Antiphlogistic Treatment, II., 106, 
II., 161. 
Aconite, 651. 
Antipsorics, in Diphtheria, 771, see 
Psora, II., 185, Dyscrasias, II., 
163, in Insanity, II., 438, Car- 
dialgia, II., 513. 
Antipsorics in Diptheria, 771. 
Antiscorbutics, II., 336. 
Antrum Maxillare, Diseases of, 241, 
Abscess of 241, Purulent Se- 
cretion of, 242, Fungous Tu- 
mor of, 243. Treatment, 244. 
Anus, Symptoms of, Prolapsus, 398. 
Anxiety, II., 428. 
Aorta, Ossification of, IT., 558, Inflam- 
mation of, 847, Aneurism of, II., 
660, Pulsations of, II., 557. 
Aortitis, 847. 
Aperients, 295. 
Aphonia, 433, from Defect of Organs 
of Speech, 433, Disease, 434, 
Caustic Vapors, 434. 
Apis-mel. in Bronchitis, 794, Ague, 
495, in Dropsy, II., 749, 756, 
Otorrhcea, 732, Scarlatina, 598, 
Insect Bites, 669, in Bright’s 
Disease of the Kidney, II., 61, 
31, Nephritis, II., 69, Croup, 
782, in Prairie Itch, II., 884, 
Bronchitis,794, Dysentery, 911, 
in Syphilis, II., 321, Ovarian 
Disease, II., 707, in Albumi- 
nuria, II., 820. 906 
INDEX 
Apnatica, Ephialtes, 454. 
Apnxa, II., 614. 
Apccynum-Cannabinum in Bright’s 
Disease, II., 32, II., 61, in 
Dropsy, IL, 757. 
Apoplexia ex Inanitione, II., 654. 
Apoplexy, II.. 633, Serous, II., 634, 
II., 638, II., 641, with Chorea, 
11., 569, Pathology, II., 638, 
Treatment, II., 643, Pulmon- 
ary, II., 802. 
Apostema, Abscess, 652. 
Apparent Death, II., 626, from a Fall, 
691, Suffocation, &c., II., 625, 
from Lightning, II., 655. 
Appendages of the Eye, II., 144. 
Appetite, Want of, 271, Depraved, 
264, Canine, 256. 
Aphtha,, 737, Infantile, 738, Crypto- 
garnic Plants in, 739. 
Aqua Calcis, 867. 
Arabian Elephantia, il, 330. 
Arabian Physicians, 47. 
Arachnoid, Effusion into, ii., 640. 
Arachnitis. See 698, ii., 409, Con- 
vexity of the Brain, il, 409, its 
Base, ii., 409. 
Aranea-Diadema, ii., 633. 
Archaus of Van Helmont, 44. 
Aretceus, 44. 
Argentum-nitr., in Yellow Fever, 
579, in Diphtheria, 772, Croup, 
781, in Toothache, 236, Stone- 
bruise, 665, in Opthalmia, il, 
96, 98, in Sycosis, ii., 329, in 
Chorea, ii., 566, Inflammation 
of the Os Uteri, il, 712. 
Aristotle, 40. 
Armies, Health of, 483. 
Arnica, in Ague, 498, Injuries, 489, 
Sprains, 662, Haemoptysis, 800, 
Pleuritis, 827, Carditis, 843, 
Nephritis, ii., 69, in Retention 
of Urine, ii., 86, in Opthalmia, 
11., 97; in Hoarseness, 435, 
Stone-bruise, 665, in Tetanus, 
ii., 540, Loss of Sleep, ii., 576, 
Vertigo, ii., 578, Apoplexy, ii., 
646, Palsy, ii., 661, Menor- 
rhagia, ii., 694, Leucorrhoea, ii., 
700. 
Arsenicum in Asthma, 444, in Ague, 
492, Congestive Intermittent, 
515, Infantile Remittent, 526, 
Toothache, 236, Typhoid Fe- 
ver, 547, Yellow Fever, 576, 
Scarlatina, 597, 605, Variola 
632, Abscess, 656, Erysipelas, 
671, Diphtheria, 768, Cceliac 
Neuralgia, n., 510, Iodide of, 
768, in Bronchitis, 795. 
Arsenical Inhalations, 795. 
Arsenicum in Bright’s Disease, ii., 33, 
ii., 61, in Epilepsy, ii.,611,Drop- 
sy, ii., 752, in Diabetes, ii., 815, 
Porrigo, n., $63, in Nephritis, 
ii., 70, Haematurioe, in Ischuria, 
ii., 86, Ophthalmia, n., 93, in 
Scrofulous Opthalmia, n. 152, 
in Toothache, 236, in Vomit- 
ing, 270, in Colic, 320, Angina 
Pectoris, n., 557, Diarrhoea, 
346, Cholera Morbus, 353, in 
Cholera Asiatic, 370, in Coryza, 
425, Chronic Cough, 438, Spot- 
ted Fever, 529, Synoclia, 532, 
Carbuncle, 670, Gangrene, n., 
357, Gastritis, 854, Ulcer of the 
Stomach, 867, Dysentery, 908, 
Enteritis, 882, Colitis, 918, 
’Scrofula, n., 272, in Cancer, n., 
286, in Ulcers, il, 386, Alco- 
holism, ii., 458, in Neuralgia, 
n., 488, in Hemicrania, il, 503, 
in Gastralgia, ii., 517, in Lep- 
rosy, ii., 878. 
Arteries, Diseases of, 848, ii., 165, 
Aneurism, ii., 340, Ligature 
of, ii., 342, Atheroma of, il, 
660. 
Arthritic Dyspepsia, ii., 168. 
Arthritis, ii., 102. 
Arthrocace, ii, 261, ii., 174. 
Arthropathie, Inflammation of Joints, 
il, 174. 
Arthropathia, II., 156, II., 174. 
Arthrosia, White Swelling, iL, 174. 
Articular Affections, II., 156. 
Arum-tnphyUum, 598. 
Asafoetida in Disease of the Bones, 
II., 321. 
Asarum in Abscess, 676. 
Asarum Europaum in Delirium 
Tremens, II., 455. 
Ascarides, 381. 
Asclepiades, 42. 
Ascites, II., 745. 
Asiatic Cholera, 354. INDEX 
907 
Asparagus-offwinalis. In Kidney 
Diseases, II., 35, and II., 62. Bright’s 
Disease, II., 63. 
Asparagus in Dropsy, II., 757. 
in Calculus, II., 801. 
Asphyxia, II., 614. 
Theory of, II., 619. 
from Strangulation, n., 619. 
Treatment, II., 619. 
Astacus-Jluviat, II., 62. 
Astacus, in Bright’s Disease, II., 62. 
Aspidium-filix-mas, 389. 
Assimilation, 224. 
Asthenopia, II., 139. 
Asthma, Diagnosis, 442. Seo Urticaria, 
612. 
Asthma, Causes, 443. Prognosis, 443. 
Treatment, 444. Puls., 444. 
Ipec., 444. Bry., 445. Nux., 
445. Bell., 446. 
Cham., 446. Lobelia, 446. 
Thuja, 447. Bromine, 
448. Calcarea, 448. 
Asthma Millarii, 448. 
Asthma Thymicum, 448. 
Causes, 549. Pathol., 450. 
Treatment, 451. 
Asthmatic Dropsy, II., 571. 
Asylums for the Insane, II., 422. 
Defects of, II., 423. 
Atheroma, II., 823. 
Atmosphere, Choice of for Consump- 
tives, II., 238. 
Atrophy, 177, II., 836. From Wean- 
ing, 310. 
Atrophy of the Spleen, 938. 
Chronic Atrophy, 884, 890. 
II., 262, 267. 
of the Brain, 701. Senile 
do., 702. 
of the Mammae. Iodine. 
Atropine in Ophthalmia, II., 93. 
in Iritis., 117. 
Attenuation of Remedies, 142. II., 
261. 142, 146. 
Attenuations, 150. 
Attenuations employed by Hahne- 
mann, 161. 
Attenuations, Effects produced by 
Different, 154. 
A ttenuations, Advantages of, 167,121. 
Attenuated Medicines, Reasons for 
Using, 121. 
Attenuations, Choice of, 142. 
Aura Epileptica, II., 596. 
Auditory Nerve, Palsy of, II., 663. 
Auris (Imposthume,) 725. 
Aurum in Caries, 247. 
in Liver Disease, 934. 
in Syphilitic Disease of Bones. 
II., 321. 
in Phosphor Necrosis, II., 365, 
in Ozcena, II., 366. 
Orchitis, II., 384. 
in Suicidal Monomania, II., 
442. 
in Spermatorrhoea II., 717. 
Aurum-mur. in Iritis, II., 116. 
in Scrofula, II., 272. 
in Syphilis, II., 316. 
in Ozcena, II., 365. 
Monomania, II., 443 
In Dropsy, II., 758. 
Auscultation, 420. In Phthisis, II.,213. 
Austerity of conduct, II., 396. 
Autumnal Fevers, 472, 468. 
Localities, 468. 
Types of, 471. 
Extensive Prevalence of in 
New Countries, 472. 
Autumnal Intermittent, 473. 
Avenbrugger, 420. 
Avicenna, 47. 
Axilla, Affections of. 
B. 
Baldness, II., 859. „ 
Bambalia, Stammering, 435. 
Barbiers, II., 570. Treatment, II., 
571. 
Baryta, Carbonate of. Diphtheria, 
769, in Quinsy, 748. , 
Baryta, Muriate, in Scrofula, II., 270. 
Bastard Venereal, in Cardialgia, II., 
514. 
Baths, Cold, 466. 
Beaumont's Experiments on St. 
Martin, 215. 
Bed Strap, in Treatment of the In- 
sane, II., 427. 
Belief, Insane or Absurd, II., 399. 
Belladonna, in Asthma, 446. In- 
fantile Remittent,5 25. 
Ague, 499. 
in Croup, 780. Bronchitis, 790. 
in Diphtheria, 765, 770. Oph- 
thalmia, II., 93. 
Belladonna, in Too.hache, 234, 908 
INDEX 
Ptyalism, 251. Typhus Cerebralis, 
544. 
Belladonna, in Yellow Fever, 575. 
in Measles, 607. In Scarlatina, 
593. Poisoning by, 593. 
in Small-pox, 631. Abscess, 
658. Antidotes, 595, 514. 
in Inflammation of the Brain, 
704, 710, 722. 
in Pneumonia 808. Peri- 
tonitis, 992. 
in Hepatitis, 930. Ischuria, 
IL, 86. 
in Ophthalmia, II., 93. In 
Iritis, II., 117. 
in Fungus Hannatodes of 
the Eye, IT., 144. 
in Amaurosis, II., 127. 
in Scrofulous Ophthalmia, II., 
152. 
in Rheumatism, II., 160. 
in Gout, II., 173. 
in Teething, 228. 
Toothache, 234. 
in Ileus, Obstruction of the 
Bowels, 341. 
Pathogenetic Effects, 342. 
Belladonna, Pertussis, 593. 
Spotted Fever, 529. Synocha, 
532. 
Chorea, II., 563. Measles, 607. 
Small-pox, 631. 
Vertigo, II., 578. Erysipelas, 
679. Tetanus, II., 539. 
Epilepsy, II., 606. Sun-stroke, 
692. Parotitis, 744. 
Apoplexy II., 643. Tonsilitis, 
748. In Follicular Enteri- 
tis, 888. 
Palsy, II., 660. In Peritonitis, 
892. 
Dysmenorrlioea, II., 685. In 
Scrofula, II., 271. Orchitis, 
II., 383. 
Menorrhagia, II., 692. In 
Brain Disease, II., 407, II., 
428. 
In Milk-flow, II., 718. In 
Brain Disease, n.,407, it., 428, 
Anaemic Delirium, II., 453. 
Metritis, II., 730. Effects of 
Passion, II., 428, II., 430. 
Insanity, II., 436. On the 
Spinal Cord, II., 524. 
in Delirium Tremens, II., 453. 
Alcoholism, II., 460. Neural- 
gia, IL, 485. Its Sphere of 
Action, II., 500. 
in Headache, II., 500, II., 507. 
in Cardialgia, II., 513. Hy- 
drophobia, ii., 546. 
Strabismus, n., 559. 
Benzoic-acid, Sycosis, il, 329. 
Beriberia, n., 571. 
Bex (Cough)., 436. 
Bezoar Stone, 379. 
Bibron's Antidote, 666. 
Bi-chromate of Potash. Diphtheria, 
763, 766. In Strychnine Poisoning, 
ii., 539. 
Bi-chromate of Potash in Croup, 779. 
Bile, 220. 
Bilious Cholera, 352. Cholera 
Morbus, 352. 
Bilious Fever, 516. Bilious Typhoid, 
530. Phos-acid, 530. Bry., Rhus, 530. 
Bilious Colic. 314. 
Bilious Complaints, 311. 
Bilious Catarrhal Fever, 865. 
Bilious Derangements of the Sto- 
mach, 270, 311, ii., 507. 
Bilious Diarrhoea, 346. Bilious 
Pneumonia, 805, 810. 
Bi-sulphate of Soda, 306. 
Bites of Insects, 668. 
of Serpents, 666. Rattle Snake. 
666, Collodion, Brom., Apis, 
Bibron’s Antidote, 666, 668. 
Black Death, 635. Description and 
History, 635. Causes 636. 
Black Jaundice, 411. 
Black Skin, 411. 
Black Vomit, 567. 
Bladder, Affections of. Inflammation, 
ii., 75, ii., 76. 
Bladder, Treatment, n., 76. 
Dysuria, il, 75. Canth., n., 77. 
Catarrh of, (Cystitis), il, 76. 
Irritable, ii., 78, ii., 382. Hae- 
morrhage from, ii., 69. In 
Syphilis, ii., 325. 
Paralysis of, ii., 84, ii., 81. 
Polypi of, 
Neck of Diseased, ii., 806. 
Prolapsus of, 
Spasm of, ii., 77. 
Suppuration of il, 807. Blas- 
tema Morbid, 646, 647. INDEX 
909 
Bleeding Gums, 237. Bleeding, 
Effects of, il, 118, ii., 690. 
Bleeding, From AVounds, ii., 195, in 
Brain Disease, 683, 703. 
Rheumatism, n., 162. In 
Apoplexy, II., 619. 
Blennorrhoea, n., 366. 
Blennorrhoca Seche, il, 370. 
Blennorrhous Arthropathia, II., 174. 
Blindness, 
From Amaurosis, II., 120. 
Cataract, II., 131. 
Bloated Face, ii., 738. 
Blood in Typhoid, 565. In Dysentery, 
902. 
Blood, 222. II., 177. Losses of, IL, 690. 
Blood, Deficiency of Normal Elements 
in, 943. 
Blood, Diseased Conditions of, II., 177, 
179. IL, 51. See Yol.,II., p. 175. 
p. 540. Treatment of, II., 194, 
193. 
Blood Baths, II. 877. 
Blood Globules, II., 177, IL, 722. 
In Urine, II., 803. 
Blood Globules in Diabetes, IL, 812. 
Composition of, 223, IL, 177. 
Bloody Urine, II., 325. 
Blood Poisonous in some Diseases, ii., 
183, 184. 
Blood Poisonous in Scurvy, il, 337. 
Uraemia, ii., 767. 
Blue Licks, ii., 460. 
Body, its Influence on the mind, 842. 
Bcenninghausen's Treatment of 
Croup, 781. Case, 782. 
Boerhaave, 51. 
Boils, after Small-pox, 633. Boils, 
Treatment, see Carbuncle, 669. 
Bones, Diseases of, il, 826, ii., 175. 
Reproduction of, ii., 365. 
Bones, Deep-seated do., ii., 1 / 6. 
Nodes, ii., 321. 
Bones, Syphilitic Disease of, IL, 308, 
il, 321. 
Bones, Swelling, Softening, Fragility, 
Curvature, n., 321. 
Bony Tumor, il, 830. 
Bougies, in Stricture, il, 372, ii., 378. 
Bowels, Flatulent Distention of, 313. 
Griping in, 311. 
Haemorrhage from Dysentery, 894. 
Bleeding Piles, 392. 
Protrusion of, 392, 394, 398. 
Bowels, Looseness of, 345. 
Obstruction of, 334. 
Constipation of, 323. 
in Typhoid Fever, 564. 
Bovist a, in Leucorrhcea, n., 700. 
Brain, Functions of Different Parts, n., 
475. 
Brain, Cerebellum, n., 4'74. 
Base of the Brain, il, 475. 
Bell on, ii., 476. 
Brain, Diseases of, 681, n., 388. 
Superiority of the, n., 388. 
Brain, Injuries of, 687. Treatment, 
689. 
Brain, Congestion of. Fullness of 
Blood to the Head. Ac., Nux, Bell., 
691. 
Brain, Coup de Soleil, 692. Glonoine, 
692. 
Brain, Inflammation of. Encephalitis, 
695. 
Brain, Inflammation of the Hemis- 
pheres, 695, 697. 
Brain, with Paralysis, 711. 
Diagnosis, 595. Treatment, 703. 
Brain, Atrophy of, 701. Senile do., 
702. 
Brain, Concussion of, 687. Treat- 
ment, 689. 
Apparent Death from a Fall, 691. 
Brain, Induration of, 702. 
Softening of, 713. 
Aberration of Mmd without Pain, 
699. 
Dropsy of, 719. 
Otitis, 700. 
Extravasation of Blood upon, il 
638. 
Sleeplessness, 712. 
Effusion of Serum upon, II., 638. 
London Cachexia, 712. 
Brain, Membranes of, 698. Dura 
Mater, 700. 
Brain, Osseous Deposits, 700. Thick 
Skull, 701. 
Brain Affected in Kidney Disease, n., 
49. 
Brandy, 528, 302, 708. (Wines), 
773. Diphtheria, 862. Gastritis, 
872. Spotted Fever, 529. From 
Potatoes, ii., 459. 
Bread, ii., 234. I., 285, 312. 
Breast, Abscess of, 652. 
Scirrhus, il, 290. 910 
INDEX 
Bnast, Pang, ii., 552. 
Breathing, Affections of, 418. 
Breath, Shortness of. 
Dyspnoea, 440. 
Bright's Granulated Kidney, ii., 21. 
Acute ii., 21. Chronic do., il, 44. 
Symptoms, n., 46. Treatment, 
ii., 59. 
Brittleness of Bones, il, 321. 
Bromine, in Asthma, 448. In Rattle 
Snake Bite, 666. 
Bromine, in Insect Bites, 668. 
Diphtheria, 769, 773. 
Croup, 778. 
in Phthisis, ii., 253. 
Asthma, 448. 
Bronchial Effusion, il, 650. Phthi- 
sis, ii., 257. 
Bronchitis, 784. Acute, 784. Diag- 
nosis, 784. Chronic, 788. 
Capillary. 785. 
Bronchitis with Emphysema, 786. 
Bronchitis, Pseudo-membranous, 787. 
Treatment, 789. 
Bronchi, Dilatation of, 789. Ulce- 
ration of, 789. 
Bronchocele, il, 273. 
Broussais, 63. 
Bruises, Injuries, 689. 
Bryonia, in Dyspepsia, 292. Asthma, 
445. Ague 495. 
Bryonia, Infantile Remittent, 526. In 
Bilious Typhoid, 530. 
Bryonia, Typhus Fever, 545, 549. 
Yellow Fever, 576. In Measles, 
608. In Varioloid, 633. In 
Abscess, 658. In Diphtheria, 
768, 770. 
Bryonia, in Bronchitis, 790. Pneu- 
monia, 808. 
Bryonia, Pleuritis, 824. In Heart 
Disease, 843. 
Bryonia, Hepatitis, 930. In Cor- 
neitis, ii., 114. Rheumatism, il, 159. 
Bryonia, Constipation, 329. Asthma, 
445. Spotted Fever, 529. 
Synocha, 532. Pneumo-ty- 
plius, 584. Scarlet Fever, 597. 
Miliary Fever, 616. Varioloid, 
633. Sun Stroke, 692. Hydroce- 
phalus, 722. Heart Disease, 
843, in Liver Disease, 930, in 
Hemiplegia, ii., 505, Cardialgia, 
• ii., 512, in Gastralgia, ii., 519, 
Bryonia, in Menorrhagia, n., 694, 
Dropsy, it., 758. 
Bubo, ii., 307, 309. 
Sympathetic, it., 374. 
Buccal Cancer, n., 289. 
Buffy Coat on the Blood, n.f 194, 
and 180. 
Bulimia, 256. 
Bunion, ii., 895. 
Burial, Delay of, ii., 626. 
Burns, Gastritis from, 856, 857. 
Superficial, Acetum, 681. 
Bursa, Enlarged, ii., 897. 
Burying. Alive, Danger of, n., 629. 
Byron, Lord, Case of, n., 392. 
c. 
Cachexia, Blood Diseases, n., 177, 
180, City Cachexia, 713. See 
ir„ 191, i., 558, from Mercury, 
403, ii., 202, from Tobacco, 
ii., 203, from Malaria, 477, 
469, Depraved Appetite, 264, 
Renal, n., 21. 
Ccecum, Disease of, 272, 920, Obstruc- 
tion of, Iliac Passion, 334. 
Caffeine, ii., 574, 
Cagotism, n., 278. 
Calcarea in Amenorrhcea, n., 680, 
Menorrhagia, n., 692, Leucor- 
rlicea, ii., 699, Uterine Disease, 
ii., 707, in Milk-flow, ii, 718, 
in Calculus, n., 801, in Rachitis, 
ii., 835, in Epilepsy, n., 608, 
in Diarrhoea, 351, in Asthma, 
448, in Ague, 508, its Sphere 
of Action, ii., 504, Typhus, 555, 
Chorea, ii., 563, Urticaria, 614, 
Follicular Enteritis, 888, Op- 
thalmia, ii., 96, Corneitis, n., 
114, Trichiasis, ii., 149, Iritis, 
ii., 116, in Scrofulous Opthal- 
mia, ii., 153, in Toothache, 228, 
in Haemorrhoids, 396, Asthma, 
448, Infantile Fever, 525, Hjt- 
drocephalus, 724, Stomatitis, 
741, Parotitis, 744, Dysentery, 
913, in Consumption, H., 244, 
in Scrofula, ii., 271, in Goitre, 
ii., 277, in Hemicrania, n., 504. 
Calcareous Degeneration of Arteries, 
ii., 165. 
Calcar ea-muriatica, in Carbuncle, 671. INDEX 
911 
Calculi, TJric-acid, rr., 785, Diagnosis, 
ii., 784. 
Calculi of the Bladder, n., 770, of 
the Kidneys, Effects of, 308, il, 
773. 
Calendula in Wounds, 671, Carbun- 
cle, 670. 
Calmness and Tranquility, ii., 431. 
Calomel, in Gonorrhoea, n., 377, in 
Cholera, 376, Yellow Fever, 
578, in Duodenal Inflamma- 
tion, 578. 
Camphor, 508, in Typhus, 5 51,Yellow 
Fever, 575. 
in Small-pox, 632, Ague, 508. 
in Ischuria, n., 86. 
in Ophthalmia, n., 95. 
in Vomiting, 270. 
in Cholera, 365, 366, 369. 
in Sleeplessness, 713. 
in Strychnine Poisoning, il, 538. 
in Epilepsy, il, 607, n., 614. 
Narcotism, &c., il, 653. 
Camp Diarrhoea, 917. 
Cancer, Development of, ii., 280, 282, 
Diseased Cell Formation, 646, il, 
181, il, 280. 
Treatment, ii., 285. 
Cancel', Medullary, il, 803. 
Cancer of the Nose and Face. Treat- 
ment, ii., 287. 
Of the Tongue, ii., 287, il, 289. 
Of the Stomach, Gastritis, 865, 
IL, 293. 
Hydrastis, ii., 285, ii., 290. 
Epithelial, ii., 281, 284, ii., 289. 
Cancer of the Rectum, 921, of the 
Bladder, ii., 803. 
Of the Liver, 936. Treatment, 937. 
Of the Uterus, ii., 297, il, 692. 
Of the Eye, ii., 298. 
Face, tl, 287. 
Mediastinum, 829. 
Brea ii., 290. 
Cancroid, n., 284. 
Canine Madness, ii., 548, Canine 
Appetite, 256. 
Cannabis-indica, 229, Neuralgia, n., 
494. 
in Heart Disease, 843. 
in Bright’s Disease, ii., 35. 
in Retention of Urine, ii., 85. 
in Cataract, ii., 133, Neuralgia, 
ii., 493. 
Cannabis-indica, in Gout, n., 174. 
in Toothache, 229, Catalepsy, n., 
632. 
Palsy, ii., 662, Galactorrhoea, n., 
718. 
Cannabis-sativa, in Bright’s Disease, 
ii., 37. 
in Nephritis, ii., 68, in Gonorrhoea, 
ii., 379. 
Cantharis, ii,. 37, in Nephritis, ii., 68. 
Dysuria, ii., 77, Spotted Fever, 
529. 
Suppression of Urine, n., 85. 
Ophthalmia, n., 94, Yellow Fe- 
ver, 579. 
Dipththeria, 771. 
in Gonorrhoea, ii., 379. 
in Ulcer, n., 387. 
Palsy, ii., 662, ii., 671. 
Dropsy, ii., 758. 
Capillaries, Structure of, 637. 
Condition in Inflammation, 191, 
195. 
Capillary Bronchitis, 785. 
Capsicum in Hemicrania, ii., 505. 
Capsicum in Ague, 505. 
in Diphtheria,769, in Diarrhoea, 
346. 
in Hoarseness, 435, Pertussis, 
440. 
in Gonorrhoea, n., 380, Passions, 
ii., 428. 
Capsula Renales, n., 72. 
Capsular Inflammation, ii., 174. 
Carbo-animalis in Venous Plethora, 
413. 
in Cardialgia, ii., 513, Menor- 
rhagia, ii., 694. 
Carbonate of Bead. 681. 
Carbo-vegetabilis, in Ague, 503. 
in Typhus, 552. 
Yellow Fever, 579. 
Flatulency,267, in Cholera, 373. 
Sun-stroke, 692, in Cardialgia, 
ii., 513. 
Carb.-ammonia, n., 52, in Scurvy, 
ii., 338. 
Carbonate of Baryta, in Diphtheria, 
769. 
Carb.-potash, in Tetanus, ii., 535. 
Carbonic-acicl Gas, ii., 615, n., 624. 
Carbuncle, 669, Causes, 670, Treat- 
ment, 670, Mur.-calcar., 671, 
Solanum., n., 387. 912 
INDEX 
Carbunculated Face, n., 855. 
Carcinoma, it., 282. 
Carcinoma of the Rectum, 921, of 
the Bladder, ii., 803. 
Carcinus, ii., 280. 
Car dialgica, 266. 
Car dialgia, Heartburn, 266, Neural- 
gic, ii., 510. 
Carditis, 838, Diagnosis, 838, Causes, 
839,846,Lower Jaw,247,Teeth, 
230, 232, After Small-pox, 633, 
from Syphilis, n., 821, from 
Phosphorus, n., 363. 
Carminatives, in Flatulence, 267. 
Carotid, Artery, Effect of Tying, n., 
660. 
Cartilages, Ulceration of, 665, ii.,175. 
Castoreum, in Cardialgia, ii., 514. 
Castor-oil, in Diarrhoea, 349. 
Catalysis, 541, n., 183. 
Catamenia, Deranged, n., 674. 
Cataract, ii., 131, n., 193. 
Catarrhal Ophthalmia, ii., 89. 
Catarrh, Cold in the Head aud Chest, 
423, Diagnosis, Treatment,425, 
Epidemic Influenza, 832, Suf- 
focative, 785, Sycotic, n., 328, 
of the Stomach, 865, Compli- 
cated with Ague, 515. 
Catalepsy, n., 627, Case, 262. 
Catheter, ji., 84, Eustachian Tube,480. 
Catochus, ii. 627. 
Cattle, Disease of, n., 184. 
Caucasian Race, n., 389. 
Califlower Vegetations, n., 803. 
Caidophyllin in Hysteria, n., 592. 
Causes of Disease, general, 182, Ef- 
fects of Heat, 183, of Cold, 
184, 464, 466, Impurity of 
Air, 185, Hereditary Tendency, 
186, Influence of Climate and 
Modes of Living, 188, 258, Hot 
Climates, 193, Cold, do., 194, 
199, Vicissitudes, 184, Inflam- 
mation, Perverted Nutrition, 
196, Influence of Dress, 197, 
Power to Resist Disease, 199. 
Causes of Fever, 461, Typhoid, 557, 
Typhus, 539. Intermittent, 477, 
468, Yellow Fever, 570, of In- 
flammation, 649 (remote). 
Caustics in Cancer, n., 285. 
Causticum, in Hoarseness,435, in Neu- 
ralgia, ii., 489, Chorea, ii., 564, 
Cauterization in Syphilis, n., 311, in 
Spermatorrhoea, n., 716. 
Cayenne in Hoarseness, 435. Capsic. 
Cedron in Ague, 505, in Bronchitis, 
795, in Neuralgia, n., 490, 
Convulsions, u., 585, Hydro- 
phobia, ii, 549, Epilepsy, u, 
612, Somnambulism, n., 633. 
Cell formation, 641, 647, ii., 280,281. 
Cell-formation, Diseased, 647, n., 181, 
281, Malignant, 589,in Phthisis, 
ii., 223. 
Cell-formation of Nervous Structure, 
ii., 469. 
Cellular Inflammation, 658. 
Cellular Inflation, 842, Dropsy, n., 
744. 
Cellules, Hypertrophy of, n., 823. 
Celsus, 43. 
Cenotica, n., 674. 
Centripetal Epilepsy, n., 601. 
Cephalea-spusmodica, ii., 495. 
Cephalalgia, n., 499, ii., 506, Patho- 
logy, ii., 506. 
Cephalitis, 695. 
Cephalocysts, n., 822. 
Cephaloma, ii., 283. 
Cerebellum, Functions of, n., 474 
Ganglia at the Base of the 
Brain, ii., 475, Effusion into 
ii., 640. 
Cerebral Ancemia, 713, Cerebral Hem- 
ispheres in Insanity, n., 406. 
Cerebral Typhus, 547. 
Cerebritis, 695. 
Cerebro Spinal Meningitis, 527, 
Symptoms, 527, Causes, 528, 
Pathology, 528, Treatment, 
528, Brandy, 528. 
Cerveau, Ramollissement du, 713. 
Cervix Uteri, Ulceration of, n., 701, 
ii., 707. 
“ Chain of Being,” n., 474. 
Chains in Treating the Insane, ii., 
421. 
Chamomilla, in Asthma, 426, 446, 
Toothache, 235, in Miliary Fe- 
ver, 616, Sleeplessness, 711, in 
Liver Disease, 930, in Teething, 
228, Flatulency, 267, in Vom- 
iting, 270, in Colic, 320, 823,. 
in Diarrhoea, 347, in Cholera 
Morbus, 354, in Hoarseness, 
435, Asthma, 446, Infantile INDEX 
913 
Fever, 525, Hepatitis, 931, Ef- 
fects of Passion, II. 431, in 
Hemacrania, ii. 505, in Cardi- 
algia, ii. 512, Nervousness, n. 
575, Menorrhagia, n. 694. 
Chancre, ii. 304, Simple, n. 306, In- 
fecting, ii. 303, Treatment, ii. 
312. 
Changing the Remedy, 159. 
Characteristic Symptoms, 907. 
Character of the Medicine to be 
employed, 167. 
Carbon, 668. 
Chateaubriand, ii. 397. 
Charcoal in Paste for Chancre, n. 
321, Death from Vapor of, ii. 
615. 
Cheeks, Cancer of, ii. 2, 287. 
Chelidonium, in Neuralgia, n. 492. 
Chemical Theory of Cures Ansiver- 
ed, 140. 
Chemosis, ii. 90. . 
Chenopoclium Anthelmin., 387. 
Chest, Diseases of, (Respiration Dis- 
eased,) 420, 423, Congestion of 
in Children, 803, Tabular View 
of Disease of, 834, Inflamma- 
tion of Organs within the, 784, 
Defective Conformation of, n. 
228. 
Chicken-pox, 624. 
Chick-iceed in Hydrophobia, n. 550. 
Chilblain, 659, Frost-bites, Treatment, 
660. 
Childhood, Diseases of, 202, 1 99. 
Chills, Sinking, 510. 
Chill and Fever, Ague, 472. 
Chilliness, n. 633. 
China, in Neuralgia, n. 489, in Cal- 
culus, ii. 802. 
China, in Hercrania, ii. 505. 
Cardialgia, n. 513, Menorrhagia, 
ii. 694, Loss of Sleep, ii. 576, 
Epilepsy, n. 608, in Dropsy, II. 
754. 
China, in Ague, 486, Ophthalmia, n. 
155, Quinine, 488, 487, Spotted 
Fever, 529, in Chlorosis, ii 724, 
in Phthisis, II. 252, II. 255, in 
Flatulency, 267, in Dysentery, 
912, Colitis, 91 8, in Pleuritis, 827, 
Irritability, ii. 575, in Amaurosis, 
II. 128, Amenorrhcea, II. 680, 
Leucorrlicea, II. 700. 
Chlorate of Rote sh, in Scurvy, n. 
333, in Ptyalism, n. 338, in 
Gonorrhoea, n. 381, in Gau- 
grenopis, ir., 356, in Dropsy, 
ii. 760, Poisoning by, n. 760. 
Chlorides in Urine, n. 21. 
Chloride of Dime in Itch, n. 883. 
Cholesterine, 407. 
Chololithus, 407, Diagnosis, 407, Pa- 
thology, 408, Cases, 408, 409, 
Treatment, 408. 
Chordee, n. 382. 
Choroiditis, ii. 118. 
Chorea, n. 561, Treatment, n. 562, 
Religious, n. 567. 
Chorea with Serous Apoplexy, n. 569. 
'Chronic Diseases, Psoric Origin of, 
ii. 185, ii. 192, Metastasis of, 
ii. 186, il 192, Sycotic, n. 
326. 
Chronic Diaarhcea, (see Colitis,) 351, 
Ophthalmia, n. 99, Pleuritis, 
827. 
Chyle, 221. 
Chylous Diarrhoea, 350. 
Chymification, 215, 218. 
Cibaria Colic, 311, Causes, 312, 
Symptoms, 312. 
Cicatrization, 641, Diseased States of, 
645, Warty Affections of, 646, 
Wounds of, 646. 
Cicatrices, 642, n. 181. 
Cimifuga, 509, in Delirium Tremens, 
ii. 455. 
Cina, in Ague, 504, Worms, 387, in 
Infantile Fever, 526. 
Chlorine in Laryngismus, 451. 
Chloroform in Toothache, 238. 
Carbuncle, 670. 
in Delirium Tremens, ii. 454. 
in Strychnine Poisoning, n. 
540. 
Chlorosis, n. 719. 
See Leucosis, 943. Treatment, 
ii. 723. 
Cholera Asphyxia, or Spasmodic, 354. 
History, 354. Diagnosis, 356, 
Prognosis, 362. Causes, 357. 
1st Stage, 358. Treatment, 362, 364. 
2d do. 359. do. 366. 
3d do. 360. do. 369. 
370, 372. 
4th do. 361. do. 373. 
Prophylactics, 365. 
vol. ii—58. 914 
INDEX 
Hahnemann’s Treatment. 363, 
364. 
Allopathic do. 362. 375. n. 179. 
Cholera Morbus, 352. 
Cholerine, 376. 
Cholerine Ague, 499. 
Cholera Infantum, 883. 
Cinchona, Abuse of, 99. 117. Symp- 
toms produced by it, 487. 
Quinine. Its action, 498. In- 
jurious Effects, 490. 
Cinnabar, in Gonorrhoea, ii. 379. 
in Skin Diseases, n. 849. 
Circocele, 801. ii. 344. 
Circulation of the Blood, 48. 457. 
Cirrhosis, 925. Cities, Miasms of, 558. 
Citric-acid, in Scurvy, n. 336. 
Civilization, Perverted, n. 226. n. 683. 
Clairvoyance, n. 630. 
Classification of Diseases, 211. 
of Fevers, 467. Of Skin 
Diseases, n. 845. 
of Nutritive Substanoes, 210. 
Clap, 300. 
Clematis, in Ophthalmia, n. 96. 
in Scrofula, ii., 271. 
in Iritis, ii., 117. 
in Cancer, ii., 297. 
in Syphilis, n., 320. 
Orchitis it., 384. 
in Irritable Testis, n., 385. 
Skin Disease, il, 847. 
Cletgyman's Sore Throat, 749. 
Climacteric Decay, 217. The Brain, 
702. 
Climate, Choice of, n., 235. 
Effects of Cold, 190. 
Increase of Animal Food re- 
quired, 191. 
Clothing, 197. 
Club Foot, ii., 730. 
Coagulation of the Blood, n., 178. 
Coagidable Lymph, 640. 
Cocculus, in Ague, 502. Dysphagia, 
254. 
in Iritis, n., 116. 
in Vomiting, 270. 
Grief, &c., ii., 428. 
Chorea, ii., 565. 
Vertigo, n., 578. 
Sleeplessness, n., 576. 
in Dysmenorrhceu, ii., 685. 
Leucorrhoea, n., 700. 
Ovarian Disease, n., 707. 
Cod-liver Oil, it. In Consumption, 
II. 240. 
in Scrofula, n. 272. 
in Syphilis, n. 320. 
in Palsy, II. 660. 
Codiac Neuralgia, n. 509. 
Codiaca, 213. 
Coffea, Nervousness, &c., II. 574. 
in Ague, 507. Teething, 228. 
in Apoplexy, II. 645. 
in Toothache, 228. 
in Diarrhoea, 350. Pertussis, 440. 
in Sleeplessness, 712. 
in Irritability, n. 575. 
in Alcoholism, n. 460. 
in Opium Poisoning, ii. 652. 
in Neuralgia, n. 487. II. 494. 
in Hemicrania, H. 505. 
Cohush, ii. 592. ii. 686. 
Colchicum, in Rheumatism, n. 159. 
in Gout, ii. 167, ii. 172. 
in Dyspeptic Gout, ii. 171. 
in Colic, 320, Gastritis, 856. 
in Dropsy, n. 775. 
Cold Dash, in Apparent Death from 
Lightning, u., 655. 
Cold as a Cause of Disease, 184, 464. 
Recovery from Extreme, 660. 
Effects of Intense, 190, 466. 
Effects on Different Persons, 19t>. 
in Ophthalmia, n., 92. 
Susceptibility to, ii., 633. n., 723. 
Cold Water Bandage in Croup, 783. 
Cold Water in Typhus, 543. Brain 
Disease, 704. Alcoholism, n., 
460 in Chlorosis, ii., 724. 
Cold Plague, 582. 
Colic, Bilious, 811. 314. Malarious, 
315. Flatulent, 313. Treat- 
ment, 317. Painter’s, 316. In 
Children, 322. Various Forms 
of, 322. 
Colitis, 917. 
Collodion, in Insect Bites, 668, in Nse- 
vus, ir., 898. 
Colloid Cancer, n., 283. 
Collyria, n., 100. 
Colocynth, 267, in Colic, 318, in Diar 
rhoea, 347, in Cholera Morbus, 
354, in Dysentery, 907, in Co- 
litis, 918, in Neuralgia, n., 491, 
in Hemicrania, ii., 505, in Gas- 
tralgia, ii., 518, in Crumps, n, 
588. INDEX 
915 
Colon, Obstruction of, 336, Malignant 
Ulceration of, 920, State of, in 
Dysentery, 899. 
Color of Clothing, 198. 
Coma, from Uraemic Poisoning, n., 769. 
Coma, ii., 634. ii., 642. n., 650. 
Coma Anaemic, ii., 650. 
Compression, in Disease of Joints, n., 
176, in Aneurism, n., 343. 
Concussion of the Spine, ii., 522. 
Concussion of the Brain, 687, Treat- 
ment, 689. 
Condylomata, n., 326. 
Congestion in general, 180, 638. 
Congestion, 464. 465, Preceding In- 
flammation, 638, of the Sto- 
mach, 414, of the Spinal Cord, 
ii., 524. 
Congestion of the Chest in Children, 
803, Brain, 694. 
Congestive Fever, 522. 
Congestive Intermittent, 510. 
Concretion, Salivary, 250, Intestinal, 
377. 
Confidence in one’s self, Want of, 842, 
847. 
Conium, in Ischuria, it., 86, in Cata- 
ract, ii., 133, in Iritis, n., 116, 
in Scrofula, n., 270, in Neural- 
gia, ii., 489, in Palsy, n., 662. 
Conjunctiva, Granulations on, n., 104. 
Conjunctivitis, n., 89. ii., 95. Con- 
tagious do., 103 Chronic, ii., 99. 
Constantinople, Medicine in, 14. 
Constrictive Dysphagia, 252. 
Consanguinous Marriages, il, 663. 
Consanguinity, n., 663. 
Constipated Colic, 314, 323. 
Constipation, 323, Causes, 324, Pa- 
thology, 326, Treatment, 327, 
Bryonia, 329, Nux-vom., 330, 
Adjuvantia, 328, Enemata, 
329, complicated with He- 
patic Disease, Graphites, 332, 
Lycopodium, 333, Intestinal 
Obstruction, Headache from, 
H., 508. 
Constipation in Children, 333. 
Constitution, Feeble, 186. Inherited, 
ii., 187. < 
Consumption, n.205, Diagnosis, n.205, 
Causes, u., 225, Treatment, il, 235. 
Contagion, 186. 539. 542. 558, 588. 
do. of Typhoid, 557, Yellow 
Fever, 571, Contagious Fevers, 
557. 558. 589. 
Continued Fever, 53U, Typhus, 536, 
Typhoid, 557. 
Contrast between the Old and New 
Schools, 145. 
Contusions, 662. 
Convergent Strabismus, n., 139. 
Convex Glasses in Hypermetropia, ii., 
138. 
Convolvulus, in Dropsy, n., 758. 
Convulsions, in Small-pox, 638. 
From Religious Excitement, 
11., 567. 
Convulsive Affections in Sleep, 454. 
From Brain Affection, n., 580. 
From Carb.-ammonia, n., 768. 
Convulsions, ii., 580, Treatment, n., 
584. 
Convulsions of Children, n., 582, Pe- 
riodical, ii., 585, Puerperal, ir., 
762. 
Convulsive Affections, after Injury, 
11., 584, After Small-pox, 633, 
Epileptiform, il, 586. 
Convulsive Diseases, Theory of, n., 
526, Caused by Debility, n., 526, 
By Haemorrhage, n., 527. 
Cookery, Effects of, 209. 
Cool Air and Water in Gonorrhoea, n., 
378. 
Copaiva, Balsam, in Bright’s Disease, 
11., 35, in Nephritis, n., 68, in 
Gonorrhoea, ii., 379. 
Copostatris, Constipation, 323. 
Copper-acetate, of, in Purpura, n., 
200, Cases, il, 201, in Phthi- 
sis, II., 251. 
Corn, ii., 887, Festered, n., 888, 
Nervo-vascular, n., 888, Fibrous, 
ii., 890, Laminated, n., 890, 
Hard, n , 883, Ammonia-muriati- 
cum, ii., 883, Vascular do., n. 889. 
Cornea, Ulcer of, n., 113. 
Opacity Qf, ii., 113. 
Corneitis, n., 113. 
Cornea, Coni-cal, ii., 114. 
Corpora Striata, n., 475, ii., 639. 
Corpuscles of the Blood, ii , 182. 
Corjndency, ii., 837. 
Correllation qf Forces, 473. 
Corrosive Poison, 857. 
Coryza, 423, Diagnosis, 423, Patho- 
logy, 424, Prognosis, 424, 916 
INDEX 
Treatment, 425, Effects of Sup- 
pressed, 423. 
Cough, 436, Sympathetic, 437, 
Chronic, 438, Sanguinaria, 438, 
Arsenicum, 438. 
Whooping, 438, Causes, 439, 
Treatment, 439, Tart.-emet, 
439, Trifolium, 439, Capsicum, 
440, Coffee, 440. 
Cow,nter-Irritants. Modus Operandi 
of, ii., 530. 
Counter Irritants, in Diphtheria, 773. 
Coup de Soleil, 692. 
Cowardly Disposition. See Heart 
Disease, 838, 840. 
Cow-pox, 617. Vaccination, 617. 
Cramp, n., 588. 
Crop on of Sufph.-copper in Ophthal- 
mia, ii., 96, 98. 
Creatine, n., 19, n., 790, Creatinine, 
ii., 19. 
Creosote, in Toothache, 236, in Hae- 
morrhage, (Kreosote) in Phthi- 
sis, ii., 252, Gangrene, n., 
351. 
Cretinism, n., 278, ii., 889. 
Critical Days, 476. 
Crocus in Menorrhagia, n., 694. 
Cfotalus-horridus, in Yellow Fever, 
580, inoculation, 580, Bite of, 666. 
Croup, 774, Croupal Diphtheria, 793. 
Croton-tigl., Diphtheria, 771. 
Summer Complaint, 890. 
Crowded Apartments, 484. 
See Typhus, 540, 541. 
Crowing Disease, 448, Causes, 449, 
Pathology, 450, Treatment, 
451. 
Crusta Lactea, n., 849. 
Cryptogamic Theory of Yellow Fever, 
570, of Thrush, 739, Ague, 482. 
Crystalization of Calculi, n, 788. 
Cubebs, in Gonorrhoea, ii., 380. 
< ullen, 52. 
Curative Power of Drugs, 12. 
Cures, Nature of Homoeopathic, 134, 
140. 
Accidental, 74. 
Curvature of Bones, Syphilitic, ir., 
321. 
Cuprum, 320. 
Aceto-nitrate of, 772. 
Sulphate of Copper in Ophthalmia, 
96, 98,99, in Phthisis, il, 251, 
Colic, 320, in Diarrhoea, 349, 
in Cholera, 368, Scarlatina, 
598, in Gangrenopsis, IL, 359, 
in Diabetes, il, 815, Chorea, 
11., 566, Epilepsy, il, 609, in 
Dropsy, n., 759. 
Cuprum, in Gastrodynia, il, 519, in 
Impotence, il, 717, Convul- 
sions, IL, 587, Hysteria, II., 
592, Apoplexy, il, 648. 
Cuprum-aceticum in Heart Disease, 
845, in Porrigo, II., 861. 
in Hydrophobia, il, 550. 
Curare, orWoorara in Tetanus, li. 536. 
Curvature of the Spine, il, 525. 
Cutaneous Blush. Erysipelas 673. 
Termination, il, 886. 
Cutaneous Diseases, 587. 
Febrile, 587. 
Chronic, il, 841. 
Cutis, il, 841. 
Cyclamen, Diplopia, il, 329, il, 505, 
in Hemicrania, IL, 505, Stra- 
bismus, II., 560, Vertigo, 580, 
Dysmenorrhoea, il, 686, Mo- 
norrhagia, il, 693. 
Cynanche Laryngea, 750, 749. 
Maligna, 592. 
Tracliealis, 774. 
Cyrosis, il, 731. 
Cysts, Hydatid, il, 821. Bony do., 
il, 829. 
Cystic Goitre, ii., 275. 
Cystitis, ii., 75,ii., 76. 
Dampness, Effect of, n., 633. 
Dance of St. Vitus, n., 561. 
Dandruff, n., 846. 
Dartre, Tetter, ii., 187, il., 865. 
Day-mare, Epliialtes, 452. 
Deafness, from Inflammation of 
Meatus, 727, Paralysis of Au- 
ditory Nerve, II., 663, Case of, 
11., 664. 
Death, Apparent from a Fall, 691. 
Death from Lightning, ii., 655. 
Death, Decision of the Question of 
Life or Death, II., 629, Different 
Modes of, 648, II., 420 , As- 
phyxia, ii., 617. 
Death, Evidences of, II., 629. 
Debility, Convulsions of, ii. 527. 
Debility, 188, in Dyspepsia, 274, in 
Phthisis, IT., 208. 
Decay from Old Age, n., 461. INDEX 
917 
Decline of Life, 702, Atrophy of the 
Brain, 702. 
Decussation of Nerve-fibres, ii., 658. 
Deficiencies in the Blood, True Mode 
of Restoring, 140. 
Deformities, n„ 839. 
Degeneration of the Human Race, 
ii., 444. 
Deglution, 215, Difficulty of, 252. 
Delirium Tremens, n., 449, Prophy- 
lactics, ii., 456. 
Delirium Ebriosorum, n., 449. 
Delirium, n., 407, ii., 409. 
Delphinine, in Exciting Secretion, ii., 
737. 
Delusions of Insane Patients, in- 
dulged in some cases, II., 433. 
Demagnetized State ofNerves, n. 5 7 7. 
Dementia, II., 461, Pathology, II., 
462, Treatment, ii., 462. 
Democritus, n., 398. 
Dental Neuralgia, n., 497. 
Dentition, 226, Influence of, on Health, 
227, Treatment, 228, Opera- 
tions, 237. 
Deobstruents, (Homoeopathic,) 792. 
DeOrsay, Case of, ii., 669. 
Depilatories, n., 861. 
Dep/raved Appetite, 264. 
Depuration of the Blood by Diseased 
Action, II., 181, Imperfect, a 
Cause of Disease, II., 183. 
DeQuincy, Case of, ii., 461; ii., 468. 
Deranged Digestion, 271, Causes, 
279, Treatment, 284. 
Derangement, Mental, n., 388. 
Dermis, ii., 841. 
Despondency, 842. 
Desquamation, in Measles, 605, in 
Scarlatina, 602. 
Desquamative Nephritis, n., 21, 
Chronic, II., 27. 
Deteriorations of the Blood, n., 177. 
Determinationof Blood to the Head, 
ii., 602, ii., 506. 
Development of the Powers of Reme- 
dies, 127, of Cells. See Cell 
Formation, 589, 641, 647, ii., 
223, ii., 280. 
Dewberry, in Diarrhoea, 350. 
Diabetes, n., 808, Irritation of Nerves, 
ii., 472, ii., 813, Treatment, II., 
814, Nitr.-uranium; Per - Ma ny ~ 
Pot. 
Diabetes with Piarrhcemia, II., 815. 
Diagnosis, of Bright’s Disease, II., 
59, of Chest Diseases, 834, 
General, 166, Importance of, 
175, Figure and Attitude, 168, 
Fashionable Dress, 169, the 
Tongue, 171, Nervous System, 
172, Temperature, 175, of Fe- 
vers, 460, Diphtheria, 757, 
Pneumonia, 804, Pleuritis, 821. 
Diaphragmatic Hernia, 337, Diag- 
nosis, 338. 
Diarrhoea, 345, Feculent, 345, Treat- 
ment, 345, Bilious, 346, Mer- 
cury in, 346, Nux-moschata, 
348, Purulent, 917, Serous, 
350, Chronic, 351. 
Diarrhoea Adiposis, 349. 
Diarrhoea of Camps and Hospitals. 
See Colitis, 917. 
Diathesis, 646, Iodic, 646, Cancerous, 
646, Gouty, II., 169. 
Diary, Fever. See Fever, 467. 
Diathesis, Hereditarily Impressed on 
the Constitution, II., 187, Con- 
firmations from Allopathic Au- 
thorities, ii., 188, Iodic, Can- 
cerous, Ac., 646, of Gout, II., 
161, 169. 
Dictamnus, in Leucorrhcea, n., 701. 
Diet, Influence on Disease, 263, 258, 
188, in Diphtheria, 773, in 
Cholera, 366, in Phthisis, II., 
231, in Scurvy, II., 334. 
Difficult, Deglution, 252, 254. 
Diffused Aneurism, n., 340. 
Digestibility of Food, 209. 
Digestive Function, Diseases of, 213. 
Digestion, Physiology of, 213, 215, 
Mastication, 213, Saliva, 214, 
Deglution, 215, Chymification, 
215, Gastric Juice, 215. 
Digestion, Derangement of, 256, Slow, 
275. 
Digestive Organs, Diseased by Irrita- 
tion, ii., 471. 
Digitaline in Spermatorrhoea, n., 
717. 
Digitalis in Heart Disease, 842, 
Bright’s Disease, II., 38, II., 63, 
in Ophthalmia, II., 96, Scrofu- 
lous, do., ii. 155, in Bronchitis, 
795, on the Brain, II., 407, 
in Delirium Tremens, n., 454, 918 
INDEX 
Epilepsy, Ii., 613, Dropsy, il, 
753. 
Dilatation of the Bronchi, 789. 
Dimness of Sight, ii., 193. 
Dinus, ii, 578. 
Dioscorides, 14. 
Diospyrus in Diarrhoea, 350. 
Diphtheria, Diagnosis, 752, Distin- 
guished from Croup, 757, 
Scarlatina, 759, Erysipelas,760, 
Prognosis, 763, Pathology,761, 
Treatment, 763 to 772. 
Diplopia, Sycosis, ii., 329, II, 505, 
ii., 687. 
Dipsosis, Thirst, 255. 
Direct Action vs. Counter-irritation, 
136. 
Discoveries, Mode in which they have 
been made, 24. 
Discovery of the Principle of Ho- 
moeopathy, 20. 
Discouragement, 842. 
Diseases, Classification of, 211. 
Disease,Nature of, 75, an Exaggeration 
of the Nervous Function, II., 
473, Common Causes of, 185. 
Diseases of the Cutaneous System, 
Inflammatory, 637, Causes,649, 
Digestive Function, 213, In- 
Inflammatory, 852, Respiratory, 
do., 418, 834, Circulatory, 457, 
Brain and Nervous System, n, 
388, Spinal Marrow and its 
Membranes, II., 475, Urinary 
Organs, it, 9, Infectious, II., 
366, Fibrous and Muscular 
System, II., 156, Serous Ex- 
halant Vessels, II. 739, of the 
Eye and its Appendages, II., 
87. 
Disintegration, 224. 
Disintegration of Nerve Tissue, 
Action of Quinine, 488. 
Dislocations, 662, Lower Jaw, 246. 
Displacements of the Uterus, ii., 
709. 
Dissection Wound, 667, ii.. 183, La- 
chesis, 667. See Vol. It, 541. 
Dissecting Aneurism, ii., 660. 
Dissonant Voice, 435. 
Distemper in Cattle, ii., 148, Conta- 
gion, ii., 184. 
Divisibility oj Matter, 139. 
Dizziness, Vertigo, ii., 578. 
Doctrines, Medical, 8, 9, 40, 71, 
Respecting a Vital Principle,40. 
Don Quixotte, ii., 398, il, 630. 
Doses, Repetition of, 168, Size of, 149, 
137, 147, 513, 650, Subordi- 
nate Importance of the Question 
of the Size of Doses, 162. 
Small Doses have Remedial 
Power, 123, of Quinine, 514. 
Dress, Influence on Health, 169, 197, 
481. 
Drivelling, 248, n., 278. 
Dropsy, II., 738, Inflammatory, II,, 
740, from Debility, II., 741, 
from Kidney Disease, II., 46, 
11., 21, il, 742, ii., 820, of the 
Brain, 719, Chest, II. 747, 
Cellular, ii., 744, Scrofulous of 
the Spine, il, 765, Abdominal, 
11., 745, Thoracic, II., 747, of 
the Eye, n.f 129, of the Joints, 
II, 175, of the Ovaria, II., 748. 
Testicle, il., 762, after Scarla- 
tina, 600, Pathology, 602. 
Drosera in Pertussis, 440, in Con- 
sumption, ii., 249. 
Drowning, Death from, Asphyxia, II., 
615, Treatment, il, 619. 
Drugs, Primary and Secondary Ac- 
tion of, 112. Seep. 650. 
Drugs, Attenuations of, 154. 
Drug Poisoning, ii., 185. ii., 202. 
Druid Priests, 43. 
Drunkards, Cardialgia of, n., 511, 
Eruptions on the Face of, 
Brain Fever of, ii., 449, In- 
sanity of, il, 443, Epilepsy of, 
11., 604. 
Dry Gangrene, il, 345. 
Dry Urethritis, ii., 370. 
Dry Rot in plants, il, 843. 
Dulcamara, in Scrofula, ii., 270, in 
Infantile remit., 526, in Urtica- 
ria, 614, in Rheumatism, ii, 
160, Diarrhoea, 345, in Coryza, 
425, Synocha, 532, Dysentery, 
912, in Dropsy, ii., 756. 
Dumbness, 433. 
Duodenal Jaundice, 405, Catarrh, 
516. 
Duodenitis, 875, Treatment, 876, 
410, 574. 
Dura Mater, Inflammation of, 672, 
700, 709, Deposits from, 700. INDEX 
919 
Duration of Life, 208. 
Dying, Different modes of, 648, Symp- 
toms of, il, 630, in Insanity, 
IL, 420. 
Dynamic Influence, 67, 683. 
Dyscrasia, il, 163, 180, 185, i., 771, 
II., 220, 228, Syphilitic, IL, 
318, Chancrous do., II, 319, 
Psoric and Syphilitic, II., 328, 
in Insanity, II., 434, in Skin 
Diseases, II, 865. 
Dysenteria, 894, Pathology, 897, 
Prognosis, Diagnosis, 895, Pa- 
thology, Large Intestines, 899, 
Intestinal Follicles, 900. 
Dysmenorrhxza, ii.. 681, Treatment, 
ii., 684. 
Dyspepsia, 271, from Deficiency of 
Gastric Juice, 271, Diagnosis, 
272, 276, Causes, 279, Treat- 
ment, 284 to 296. 
Dyspepsia, Dietetic Management of, 
355, Fermentation, &c., 282. 
Dyspepsia, Purity of Food, 285, Ex- 
ercise, 288. 
Dyspepsia, Arthritic, il, 169. 
Dyspeptic Gout, ii., 169. 
Dysphagia, 252, from Mechanical 
Injuries, 252, Foreign Bodies in 
the Throat, 252, Constricta, 
252, Causing Apoplexy, 254, 
from Nervous Irritation, 253, 
from Spasmodic Constriction, 
254, Treatment, 254. 
Dysphonia, 434, Causes, 434. 
Dyspncea, Embarrassed Respiration, 
440, Healthy Respiration, 440, 
from lessened passage for air, 
441, Solidification of the Lung, 
441, increased flow of Blood to 
the Lungs, 442. 
Dysuria, ii., 77, Cantli., ii., 77, n., 78. 
Dysthetica, Cachexia, ii., 177. 
Dystoma, ii., 824. 
E. 
Ears, Symptoms of, 725, after Sup- 
pressed Eruptions. 
Ear, Inflammation of, 725, Induration 
of'Membrana Tympani, Foreign 
Bodies in, 725, Diagnosis of 
the Meatus, &c., 725, Abscess 
of, 729, Membrana Tympani, 
727, 722,Funguous MemoraiiC 
in, 727, Ulceration, 729, Rup- 
ture of, 730, Relaxation of, 731, 
Morbid Tension of, 731, Indura- 
tion of, 733, Otorrhoea, 729, 
Treatment, 732. Hardness of 
Hearing from Cinchona, 490, Po- 
lypus of the External Surface 
of the Mucous Membrane, 731. 
Eating too much, 281. 
Ebriotic delirium, II., 449. 
Eccentric Irritation, Spasms of, n., 
529. 
Ecchymosis, 689. 
Ecstacy, n., 627. 
Ecphyma, n., 887. 
Ecthyma, il, 852, Sul.-merc., II., 852. 
Ectropium, (eversion of the lids,) il, 
145. 
Eczema, n., 848. 
Eczema Mercuriale, n., 312. 
Eczematous Opthalmia, n., 95. 
Education, Physical, 461, 170, il, 
239, il., 259, of Idiots, il, 467, 
of Cretins. II., 279. 
Effects of Medicines, 79, 82. 
Effusion of Coagulable Lymph, 640, 
Serous do., 642. 
Egypt, Climate of, il, 236. 
Egyptians, 34. 
Egyptian Ophthalmia, il, 103, Treat- 
ment, il, 109. 
Elaterium, 393. 
Electricity, the Analogue of Nerve 
Force, II., 471, IL, 601., in 
Palsy, IL, 662. 
Electro-Magnetism, in Ischuria, il, 
86, in Intestinal Obstruction, 
337, in Neuralgia, II., 493, in 
Palsy, il., 662, Application of, 
IL, 666. 
Elephantiasis, il, 330, Grsecorum, 
Lepra, il, 874. 
Emaciation, Oxygen Gas in, it., 624, 
Marasmas, 887, 890, Calcarea, 
IL, 278, Phthisis, it., 205. 
Embarrassed in company, 842. 
Emesis, 268. 
Emetics, Action of, 268. 
Emissions, Involuntary, il., 714. 
Emotions and Passions, il, 427, n. 
431. 
Empathema, il, 390. 
Emphysema, 832, 834, with Bron- 
chitis, 786. 920 
index 
Empirical Treatment of Hydropho- 
bia, ii., 550. 
Empirical School, 42. 
Empty sis, Achorous Exanthems, 615, 
Inflammation of the Brain, 695. 
Emprosthotonus, ii., 531. 
Empyema, 831, Diagnosis, Treatment, 
841. 
Empyesis, 627. 
Encephalitis, 695, Treatment, 703. 
Enchondrosis, ii., 175, Cartilages, 665, 
IL, 830. 
Endemic Fevers, 559. 
Endesmose, ii., 735, ii., 809. 
Endo-carditis, 844. 
Enecia, 530, Continued Fever, 530. 
Enemata, Constipation, 329, 335, 341. 
Eneuresis, ii. 86, 87. 
Eneuresis, ii., 86. 87. 
England, Climate of parts of, ll., 236. 
Enteralgia, ii., 509. 
Enterica, 213. 
Enteric Fever, 557, Causes, 557, Diag- 
nosis, 560. 
Enteritis, 876. 881, Mucous do., Chro- 
nic do, 892, Peritoneal, 882, 
Treatment, 882. 
Enterodynia, ii., 509. 
Enterolithus, 377, Intestinal Calculus, 
377, Diagnosis, 378, Causes, 
* 378, Bezoar Stone, 379, Scy- 
bala, 379, From Constipation, 
379. 
Entozoa, n., 821. 
Entropium, (Inversion of the Eyelids), 
ii., 145. 
Enucleation of Cancers, ii., 286. 
Enuresis, ii., 86. 
Epanetus, Remittent Fever, 516. 
Ephemera, 467. 
Ephialtes, Nightmare, 456, Incubus, 
452, Causes, 453, Treatment, 
454. Apnoetica, 454, Pathology, 
455. 
Epidemic Catarrh, 832. 
Epidemic of the 14tli Century, 635. 
Erysipelas, 674. 
Epidemic Diseases, 211, 588, Some- 
times Contagious, 590. 
Epidemic Chorea, ii., 567. 
Epidermis, il, 841. 
Epigastrium, Blow on, ii., 529. 
Epileptiform, Convulsions, ii., 586. 
Epilepsy, Diagnosis, ii., 529, IL, 593, 
II., 597, Diseases resembling, ii., 
596, II., .598, From Amenorrhoea, 
II., 612, Theory of, II., 601, Pe- 
riodical, II., 612, Treatment, il, 
605, Chronic, IL, 608, Convulsive 
Affections, During Sleep, 600, 454, 
Respiration in Sleep, 454. 
Epithelium, 647. 883, In Calculous 
Urine, II. 780, Anatomy, Growth 
of; 883. 
Epithelial Cancer, il, 281. 284. 
Erethism of the Brain, 887. 
Eruptions of Children, il, 849, do 
Repelled, II., 663. 
Ergot on the Spinal Marrow, II., 524, 
Secale in Palsy, ix. 660, 663, Me- 
norrhagia, ii. 693. 
Erratic Genius, n. 390, Erratic, Men- 
struation, ii. 674. 
struatiou, il, 674. 
Eruption of Scarlet Fever, Recession 
of, 597. 
Eruptions, 587, Dangers of Repelled, 
IL, 193, I., 612. 
Eruptive Fevers, Typhus, 560, 538. 
Eruptive Diseases, Acute, 587, Chro- 
nic, il, 841, Disease caused by 
Syplnlitis, ii., 308. 
Erysipelas, 672, Diagnosis, 673, Phleg- 
mouodes, 674, (Edematous, 678, 
Neanatorum, 674, Epidemic, 
674, Causes, 676, Treatment, 
676. 
Erythema, (see Erysipelas, Mercu- 
rial, il, 312. 
Ether Sulph , in Cataract, ii., 133, in 
Ascarides, 388. 
Eupatorium, 496. 
Euphrasia, Ophthalmia, ii., 97, in Ca- 
taract, IL, 133, Scrofulous Oph- 
thalmia, II., 155. 
Eustachian Tube, Catheterism, 430. 
Evening, Influence of, 206. 
Eversion of the Eyelids, ii., 145. 
Evils resulting from the Use of Medi- 
cines Not Specific, 119. 
Exangia, il, 340, True do., ii., 340, 
False, ll., 340, Diffused, II., 340. 
Exanthemata, 587, Exanthematous 
Eruptions in the Intestinal Ca- 
nal, 740. 
Exanthesis, (Eruptive Fevers,) 587. 
Excision of Cancer, il, 285, Of Bones, 
ll., 364. 
Excernent Function, ii., 733, In Hy- 
drophobia, ii., 546. INDEX 
921 
Excretions of Blood Corpuscles, n. 182. 
Excrescent Gums, 240. 
Exercise, 288. 461, In Scrofula, II., 
264. 268, In Phthisis, II., 239, 
Epilepsy, II., 606. 
Exerting the Eyes, Weakness from, 
11., 99. 
Exhalation Increased, ii., 739. 
Exophthalmia, ii., 146. 
Exosmose, ii., 735. 
Exostosis, ii., 827. 
Experience, Medicine of, 100. 
Exsanguinous State, ii., 690. 
External Irritants, ii., 652, Theory 
of their Action, il, 530. 
External Signs of Disease, 173. 
External Applications, 680, ii., 166. 
External Surface, Diseases of, ii., 841. 
Extravagance, Mental, ii., 416. 
Eye-lids, Inversion of, II., 145, Ever- 
sion of, ii., 145, Treatment, il, 
146, Spasms of, ii., 149. 
Eye and its Appendages, ii., 87, 
Classification, ii., 87, Append- 
ages, il, 144, Diseases of, II., 
87, Acute Inflammation of, n., 
88, 89, Chronic do., ii., 99. 
Purulent do., ii., 101, ii., 102, 
Gonorrhoeal, ii., 102, Infantile 
do., il, 103, Scrofulous, il, 150, 
152, Brilliancy of, ii., 648, 
Dropsy of, ii., 129, Treatment, 
II., 131. 
Eye, Indications of, ii., 581, Fungous 
Haematodes of, ii., 142, Cata- 
ract, ii.,131, Amaurosis, ii., 120, 
il, 126, Granulated Lids,ii. 103. 
Eye, Foreign Bodies in, il, 49, In- 
flammation of, il, 88, Opacity 
of the Cornea, ii., 113, Injuries 
of, il, 150. 
Eye -lashes, Inverted, ii., 149. 
F. 
Face, Neuralgia of, ii., 481, Cancer of, 
11., 287. 
Factory Life, Evils of, 264. 
Facies Hippocratica, ii., 630, Chole- 
rica, 360. 
Fainting, il, 625. 
Fall, Apparent Death, 691. 
Fals Aneurism, n 340. 
False Membranes, Diphtheria, 761. 
Fames Canina, 25i. 
Far Sight, (Hypermetropia) II., 137. 
Fasting, Long, 258, Treatment, 262. 
Fashionable Dress, 169. 
Fatigue, 187. 
Fatty Diarrhoea, 349, Degeneration 
of the Heart, il, 173, of the 
Liver, 934, of the Kidneys, IL, 
21, of the Blood, II., 815, 
Caused by Irritation of Nerves, 
II., 472, II., 815. 
Fatuity, il, 464, Idiocy, il, 464. 
Fauces, Affections of, 252. 
Favus, ii., 846. 
Fear, Ailments from, n., 429, II., 430. 
Febrile Eruptive Disease, 587. 
Feculent Diarrhoea, 345. 
Feigned Insanity, ii., 403. 
Feet, Diseases of, ii., 887. 
Felon, periostosis, 663. 
Females, Diseases of, ii., 674. 
Female Sterility, ii., 682. 
Fermentation of the Contents of the 
Stomach, 282, Treatment, 289 
to 296, Do. with Sarcinae, 303, 
Diagnosis, 303, Pathology, 304, 
Treatment, 305, 284. 
Ferments in the Blood, 542, in the 
Urine, ii., 776. 
Fern, Male, in Worms, 389. 
Ferri-phos, in Palsy, il, 671. 
Ferri Percyanid-um, Ague, 507. 
Ferrum, in Ague, 507, in Anaemia, il, 
190, Consumption, ii., 245, in 
Chlorosis, ii., 727, Trousseau, 
IL, 727, in Gonorrhoea, ii., 381, 
in Palsy, ii., 660, Amenhor- 
rhcea, II., 680, Dysmenorrhoea, 
il, 685, Menorrhagia, il, 693. 
Ferrum-acet., in Haemorrhage, ii., 255, 
per Chloride, ii., 255. 
Fever Sore, (Ulcers,) ii., 181. 
Fever, 485, Functions deranged in, 459. 
Fever, Diagnosis, 460, distinction be- 
tween Fever and Inflammation, 459. 
Fever, Ephemeral, 467. 
Fever, Definition of, 458, Causes, 182, 
461, Pathology, 460, Classifica- 
tion of, 467, Forms of, 467. 
Fever, Causes of, 461, Acclimation, 
480, Intermittent, 472, Critical 
Days, 476, Treatment, 485, 
Yellow, 566, Bilious Typhoid, 
530, Continued, 530, Malig- 
nant Intermittent, 510, Remit- 922 
INDEX 
tent, 520, Infantile Remittent, 
524, Irritative, 523, Fever 
caused by Irritation of Nerves, 
II., 471, Worm Fever, 382, 
Typhus, 536, Causes, 539. 
Fevers of Irregular Reaction, 534, 
from Functional Derangement, 
531, from Congestion, 510, 
522, Remittent, 516, of Inflam- 
mation, 531, Inflammatory,531, 
Synocha, 531, Scarlet, 590, 
Sequelae,600, Lung, 803, Brain, 
(Encephalitis,) 695, Miliary, 
615, Puerperal, 891, Treat- 
ment, 892, Effects of taking 
Food in Fever, 245. 
Fibrin Converted into Sugar, ii., 
813. 
Fibrous Tumor of the Bladder, il, 
803, of Bones, ii., 830. 
Fibrous and Muscular System, Dis- 
eases of, II., 156, Inflammation 
of, il, 156. 
Fifth Pair of Nerves, n., 484, ii., 
495. 
Fig-warts, ii., 326. 
Figure and Attitude, 168. 
Filiana, Guinea Worm, ii., 825, il, 
886. 
Fisheries, Leprosy increasing near, il, 
873. 
Fistula Lachrymalis, ii., 146, in 
Perineo, ii., 808, of the Urethra, 
il, 380, Salivary, 250. 
Flannel Clothing, 197. 
Flatulency, 266, Pain caused by, 299. 
Flatulent Colic, 358. 
Flesh brush, il., 652. 
Flexible Tube, Use of, 881, 914, in Ob- 
struction of the Bowels, 344. 
Flexibility of Bones, ii, 833. 
Flexure of the Limb in Aneurism, 
II., 343. 
Fluids, Loss of, ii., 195, Changes of, 
180, Changes of by Irritation 
of Nerves, n„ 472. 
Fluor-albus, il, 695, ii., 632. 
Fluoric-acid, 393. 
Foetid Odor of the Mouth, 249, of 
the Ears, 725, 729. 
Follicles in Dysentery, 900. 
Follicular Enteritis, 883, Patholo -v, 
883, Rreatment, 884. 
Fomites, 588. 
Food, Quantity necessary to support 
Life, 222, Purity of, 285, YoL 
II., 182, Stimulating, 189, Di- 
gestibility of, 209, in Scurvy, 
11., 337. 
Foreign Bodies in the Ear, 725, in 
the Eye, ii., 149, in the Larynx, 
431, Diagnosis,432, Treatment, 
433. 
Fourcroy, Case of, il, 392. 
Fowler's Solution, 445. 
Fox-Fire, ii.,624. 
Fractures, Lower jaw, 246. 
Fragility of Bones, Syphilitic, n., 
321. 
Framboesia, n., 878. 
Frasera, in Stomatitis, 742. 
Freezing, 659, Treatment, 660. 
Fright, Effects of, il, 430. 
Frogs, Parasites on, it., 860. 
Frost-Bites, 659, Treatment, 660, 
Fumigations, IL, 878. 
Fungi, Cryptogamic, as a Cause of 
Fevers, 570, 571, on the Skin, 
ir., 860. 
Fungous Disease of the Joints, n., 
174, of the Membrani Tym- 
pani, 727, 728, Medullar, il, 
143. 
FungusIlcematodes, il, 284, n.,298, 
11., 867, Treatment, n., 144. 
Fungus, 243, Tumor of the Antrum, 
of the Eye, il, 142, Treatment, 
244. 
Fungus Cerebri, 690. 
Furuncvlus, (Carbuncle,) 669, 633. 
G. 
Gait, Tottering, 661. 
Galactorrhova, il, 718, Secale, il, 
146. 
Galen, 45. 
Gall, Dr., Case of, ii. 391. 
Gall-bladder, Rupture of, 893. 
Galloping Consumj)tion, ii., 245, ii., 
728, Inflammation of, 928. 
Gall-stone, 407,Sympathetic Effects of, 
407. 
Galvanism, 228, in Neuralgia, ii., 493, 
Asphyxia,II.,623, Experiments, 
ii., 623, in Palsy, il, 671, in 
Diabetes, ii., 813. 
Ganglion, ii., 897, Semilunar, ii., 573, INDEX 
923 
Ganglionic System, Affections of, 
il, 567. 
Gangrena, il, 345. 
Gangrena Oris, Grangrenopsis, n., 
352. 
Gangrene of the Lungs, il 347. 
from Injury of Nerves, il, 347. 
Gangrenous Inflammation, n., 345. 
Gangrene, Hospital, II.345, Dry,n.345. 
Gangrena Senilis, ii., 349, Treat- 
ment, il., 350. 
Gangrena Ustilaginea, n., 345. 
Gangrenopsis, ii., 352. 
Gastralgia, 289, II., 514, Treatment, 
ii., 515. 
Gastric and Hepatic Disease, 272. 
Gastric Colic, ii., 519, Gastric Irrita- 
tion, ii., 529. 
Gastric Derangement, 311. 
Gastric Fluid, 215, 281, Effects of 
after Death, 868, Causes of De- 
ficient Secretion, 279, Increased 
by Irritation of the Brain, 870, 
Excess of, 871, Diminished 
Power of, 872. 
Gastric Disorders from Pththisis, 
307, Gall-stones, 407, Abscess 
of the Liver, 407, Disease of 
the Brain, 308, Disease of the 
Uterus, 308, in Nervous Fe- 
males, 308, in Young Children, 
309. 
Gastric Remittent Fever, 519, Llcer, 
417. 
Gastrodynia, 289, Neuralgic, ii., 519. 
Gastritis, from Boiling Water, 856, 
Acute, 852, Chronic, 860, from 
Alcohol, 861, from Indigesti- 
ble Food, 857, Melted Lead, 
856. 
Gastro-malacia. 867, Treatment, 868. 
Gastro-enteritis, 876. 
Gastroto/ny, in obstruction of the 
Bowels, 340. 
Gelatinaform Cancer, 283. 
Gelseminum in Fever, 532, in Gan- 
grenopsis, II., 356, in Gout, IL, 
174. 
General Diagnosis, 166. 
General Principles of Medical Sci- 
ence, 65. 
Generic Symptoms, 905. 
Genius Erratic, ii., 390. 
George IV., Case of, ii., 165. 
Giddiness, n., 669. 
Glanders, 541. 
Glandular Affections, 247 (Salivary). 
Ptyalism, 248. 
Glasses far Strabismus, il, 561. 
Glaucoma, ir., 134. 
Gleet, ii., 3 70. 
Globus Hystericus, il, 590. 
Glonoine, in Coup de Soleil, 692. 
its Sphere of Action, 692, 694. 
Glossitis, 735. 
Herpetic, 737. 
Glottis, (Edema of, 749, 785. 
Spasm of, 785. 
Glutinous Ophthalmia, ii., 103. 
Glycerine Unguent, ii., 883. 
Glycogenous Matter in the Blood, 
648. 
Goitre, Broncocele, ii., 273. 
Treatment, il, 275. 
Gold, Muriate of, in Syphilis, il, 316, 
n Iritis, ii., 116, in Scrofula, II., 
272. 
Gonorrhoea, ii., 366, Diagnosis, il, 
369. Treatment, n., 375. 
Complications, il, 382. 
Gonorrhoea Dormientium, il, 714. 
Gonorrhoeal Ophthalmia, n., 102. 
Infantile, ii., 103. 
Gout, Irregular forms of, ii., 172. 
Metastasis, il, 173. 
Gout, ii., 162, ii., 163, Pathol., ii., 164, 
Urea, n., 165, Treatment, ii., 166. 
Dyspeptic, ii., 168. Gouty Dia- 
thesis, ii., 169. 
Complications of (Kidney), ii., 50. 
Gouty Kidney, ii., 51. 
Granulation of Wounds, 643. 
Diseased, il, 181. 
Granulated Lids, ii., 103. 
Granular Degeneration of the Kid- 
neys, ii., 21. 
Granular Phthisis, n., 256, 
Graphites, in Constipation, 331. 
Haemorrhoids, 396. 
in Ophthalmia, ii., 95. 
Scrofulous do., ii., 154. 
in Amenorrhcea, ii., 680, Dys- 
menorrhcea, ii., 685. 
in Rickets, ii., 836. 
in Eruptions, n., 885. 
Gravel, il, 770. 
Gray Substance of the Hemisphe ~es 
II., 407. 924 
INDEX 
Green, Objects Look, 411. 
Complexion, 411. 
Greeks, 37. 
Green Sickness, 411. 5. 
Grief, Effects of, (Heart), 842, ii., 427. 
Griping in the Bowels, 311. 
Guinea-worm, ii., 825, il, 886. 
Groups of Symptoms Connected by 
Pathological Relations, 158. 
Gum-boil,, 240. 
Gums, Lancing, 230. 
Gustatory Nerve, ii., 736. 
Gutta Serena, See Amaurosis, it., 120. 
Diarrhoea, 351. 
Hcematoid Cancer, ii., 284. 
Hcematuria in Pulmonary GSdema, 
785, Nephritis, ii., 69, Treat- 
ment, ii., 70, Syphilis, ii., 325, 
Following Scarlet Fever, 600. 
Hcematemesis, 413, Mucous Mem- 
brane, 413, Diagnosis, 413, 
Causes, 415, Congestion of the 
Stomach, 415, Strangulation, 
415, Epilepsy, 415, Organic 
Disease of the Liver, 415, Of 
the Heart, 415, Amenorrhcea, 
416, Treatment, 416. 
Hcemoptoe, see Hcemoptysis, 797. 
Heemoptysis, 797, Treatment, 799, 
Prognosis, 413, Causes, 414. 
Hcemorrhage, ii., 195, Causes, ii., 197, 
Treatment, ii., 196, Division of 
Haemorrhages, u., 195, Trauma- 
tic do., il, 195. 196, From the 
Bowels, 392, Bleeding Piles, 
392, do. Lungs, 797, ii., 231, 
Diagnosis, 798, Treatment, 799, 
Stomach, 413.866, Kidneys, in 
CEdema of the Lungs, 785, 
Urethra, ii., 803, u., 69, Uterus, 
ii., 689, In Syphilitic Subjects, 
il, 325, From the Teeth, 237, 
Nose, 430^ 
Hemorrhage from Exhalation, il, 197, 
In Phthisis, ii., 255, Sponta- 
neous, il, 197, Symptoms caus- 
ed by, ii., 198, Convulsions by, 
il, 527. 
Hemorrhoids, 390, Structure of the 
Rectum, 390, 1st, Haemorrhoi- 
dal Diathesis, 391, Case by Dr. 
Escaflier, 391, 2d, Piles, 392, 
Bleeding do., 392, Case by Sir 
B. Brodie, 393, llaemorrhoidal 
Tumor, 393, Causes, 394, Treat- 
ment, 395, Sulph., Nux, 396, 
Aloes, 328, Hamamelis,397.800 
Hahnemann, n. 719, His Publications 
57, Discovery of the Principle of 
Homoeopathy, 54, The Great 
Law of Cure, 55, His Treat- 
ment of Insanity, 56, u., 421. 
422, ii., 424, Of Cholera, 58, 
His Death and Character, 59. 
60, His Theory of Medicine, 60, 
His Preparation of Medicines, 
122. 
IIair, Diseases of, n., 858, il, 893, 
Gray, n., 898. 
Ilair-Worm, Filiaria, n., 886. 
Hallucinations, il, 446. 
Hamamelis, In Haemoptysis, 800, In 
Circocele, 801, Varicocele, 801, 
Milk Leg, 801, Purpura haem., 
801, In Phthisis, u., 255, In 
Haemorrhoids, 397, 800. Vari- 
cose Veins, 801, n., 344. 
Hanging, Death from, il, 616. 
Hard Skin, il, 901. 
Hardness of Hearing, see 727. 731. 
Harvey, The Circulation of the Blood, 
48. 457. 
Head, Symptoms of, see Brain, 781, 
Enlarged in Children, see Hydro- 
cephalus, 719, and Rachitis, II. 833. 
Head ache, Sick, n., 495, ii., 506, From 
Dyspepsia, &c., il, 506. 507, 
Vol. I. p. 270, Threatened Apo- 
plexy, ii., 507, Rheumatic-ca- 
tarrhal, 507, From Constipa- 
tion, ii., 508, Gastric Irritation, 
ii., 529. 
Head, Injuries of, il, 409. 
Health and Disease, 36. 
Health of Armies, 483. 
Hearing, Hardness of, See Diseases of 
the Ears, 725, Sensitiveness, 
Humming in the Ears, 725, 
Illusions of, II., 448. 
Heartburn, 266. 
Heart and Appendages, 457, Physio- 
logy, 457, Diseases of, 838, II* 
636, Dilatation of, 841 to 844, 
Sternalgia from, ii., 553, Disease 
of the Valves, 838 to 844, In- 
flammation of, 838, Palpitation 
of, 842, il, 721, Mental Influence 
on, 842. INDEX 
925 
Heart, Broken, 842. 
Heart, Hypertrophy of, 840, II., 553, 
Fatty Degeneration of, n., 173, 
Affected by Kidney Disease, il, 49. 
Heated, Effects of being, 183. 
Hebetudo Visus, it., 139. 
Hebrews, 35. 
Hectic Fever, 586, Causes, 586, Treat- 
ment, 587. 
Hellebore, Encephalitis, 708, Hydro- 
cephalus, 722, In Effusion on 
the Brain, ii., 407, In Dropsy, 
II., 754. 
Helminthia, Worms, 380, Taenia, 380, 
Tricocephalus, 380, Ascarides, 
381, Lumbricoides, 381, Dis- 
eases connected with, 385, 
Diagnosis, 381, Causes, 383, 
II., 329, Pathology, 384, Con- 
ditions of Worm Development, 
385, Verminous Diarrhoea, 386, 
Treatment, 386, Sympathetic 
Effects of Worms, 382, Treat- 
ment of Worms, 386. 
Helonin, il, 729. 
Hemicrania, n., 499, Treatment, ii., 
500. 
Hemiplegia, ii., 659. 
Hemispheres, Effusion on, n., 640, In- 
flammation of, 697, In Insanity, 
11., 406, il, 407. 
Hemlock- Water-Drop- Wort, il., 612. 
Hepar, In Ague, 507, In Croup, 778, 
In Bronchitis, 791. 795, In Iritis, 
IL, 115, Ophthalmia, ii., 155, In 
, Coryza, 425, In Quinsy, 748, In 
Consumption, II., 244, In Scro- 
fula, ii., 272, Syphilis, ii., 316, 
Milk-Scall, II., 849. 
Hepatic Colic, 314, Jaundice, 399, 
Eruptions, ii., 863. 
Hepatitis, 921, Acute, 922. 923, Chro- 
nic, 932, Treatment, 923. 
Herculaneum and Pompeii, 44. 
Hereditary Disease, Tendency to, 186, 
Diatheses, 646, ii., 171, In Gout, 
11., 171, Psoric Disease, il, 187, 
ii., 663, Insanity, ii., 414, Ef- 
fects of Intemperance, n., 445. 
Hernia, Diaphragmatic, 337, Diagno- 
sis, 338, Humeralis, it., 807. 
Herpes, Dartre, ii., 865, Metastasis of, 
ii., 187, Treatment, ii., 868. 
Herpes Labialis, ii., 867, H. Circina- 
tus, ii., 867, II. Scrotal is, n., 
869. 
Herpetic Glossitis, 737. 
Hesitation of Speech, 435. 
Hippocrates, 39, His Materia Medica, 
40, His Successors, 43. 
Hippuric Acid, n., 20. 
Hip-Disease, n., 261, n., 174. 
Hip Joint Symptoms, ii., 261. 
History of Medicine, 33. 
Hoarseness, 434, Symptoms, 434, 
Treatment, 434, Puls., Arnica, 
Cham., Mercur., Caustic., 435, 
Sulph., Cinna., 435. 
Hoffmann, 51. 
Hollow Teeth, 230. 
Home Sickness, ii., 462. 
Homoeopathy, 105. 
Homoeopathic Method of Curing Dis- 
ease, 106, confirmed by Allo- 
pathic Authors, it., COO. 
Homoeopathic, Remedies only par- 
tially, 375. 
Hooping Cough, 438, Treatment, 439. 
Hope, Influence of, ii., 427. 
Hordeolum, n., 144, Treatment, il, 
145. 
Horses, Thread Worm in, n., 825. 
Hot Drinks, 231, 232. 
Hot Stage of Fever, 512. 
Humeral Hernia, il, 807. 
Humid Scall, il, 848. 
Humid Asthma, 442. 
Hunger, 213, 285. 
Hunter, John, ii., 431. 
Huskiness of Voice, 434. 
Hydatids, ii., 821, of the Liver, ir., 
823, of the Uterus, Spleen, il, 
824, Mesentery, ii., 824. 
Hydarthrus, ii., 175, il, 764. 
Hydrastis, in Stomatitis, 742, in Can- 
cer, ii., 285, inGonorrhoea, ii., 
378. 
Hydrocyanic Acid', ii., 407, in Apo- 
plexy, ii., 647. 
Hydriodate of Potash, (Kali-Hydrio- 
dicum,) 507. Ague, 507. 
Hydriodate Potdssa, in Ague, 507, 
in Diphtheria, 767, in Bright’s 
Disease, n., 39, in Marasmus, 
11., 263, in Syphilis, it., 316, 
Secondary, it., 317, in Dropsy, 
11., 758. 
Hydrocele, il, 762. 926 
INDEX 
Hydrophobia, n., 543. Treatment, il, 
546, 552. 
Hydrops, ii., 738. 
In Diphtheria, 767. 
Hydrops Asthmaticus, il, 571. 
Hydrophthalmia,u., 129. 
Hydrothoiax, 834, Pneumo-hydro- 
thorax, 815. 
Hydrocephalus, 719, spurious, ii., 
407, Chronic, 724, Anaimic, ii., 654. 
Hydrocephaloid Disease of Infants, 
310, ii., 654. 
Hydropiper, in Gangrenopsis, il, 359. 
Hydrothorax, ii., 747. 
Hygiene, 75, in Phthisis, ii., 231. 
Hymen Imperforate, n.,677. 
Hyoscyamus, in Ague, 507, in Teeth- 
ing, 228, Toothache, 234, in 
Sleeplessness, 712, in Spasm of 
the Eye-lids, ii., 149, in Tooth- 
ache, 235, in Brain Disease, il, 
407, Grief, &c., ii., 428, Fever, 
il, 429, Insanity, ii., 435, De- 
lirium Tremens, it., 454. Stra- 
bismus, ii., 559, Chorea, ii., 563, 
Vertigo, ii., 580, Hysteria, n., 
592, Epilepsy, ii., 611, Apo- 
plexy, il, 646, Palsy, ii., 662, 
Menorrhagia, ii., 694. 
Hypercemia, 639. 
Hyper cemia of the Spleen, 938. 
Artificially induced, 196. 
Hypericum Perfoliatum, ii , 523. 
Hypermetropia, n., 137, Treatment, 
ii., 138. 
Hypertrophy, 177, of the Testicle, ii., 
807, of the Coats of the Sto- 
mach, 873, Causes, 873. Of 
the Heart, 838, of the Liver, 
934, of the Spleen, 937, of 
Adipose Tissue, ii., 837. 
Hypertrophy of the Heart,, ii., 553. 
Hyper-Sul.-soda, in Sardine, 306. 
Hypo-phosphates, Reason of their effi- 
cacy, 943, of Potash, 944, of 
Lime, in Phthisis, il, 253, 248. 
Hypopion See ii., 113. 
Jlypochondriasis, il, 442. 
Hypochondrium, Symptoms of, 921. 
Hysterics, n., 589. 
Hysteritis, Metritis, n., 729. 
hysteria, n., 589, Causes, ii., 186, 
Sycosis, n., 325, Pain in hys- 
teric women, II., 520. 
I. 
Icterus, from sudden Suppression of 
the Biliary Secretion, 401,Diag- 
nosis, 402, Causes, 402, Jaun- 
dice, Treatment, 410, Plios- 
acid, 410, Sanguinaria, 402, 
Aconite, 410, Mercury, 403, 
Jaundice without Organic Dis- 
ease of the Liver, 405. 
Ichthyosis, ii., 860. 
Ictodes Foetida, ir., 588. 
Ideality, n., 402, n., 404. 
Ideas, ii., 395. 
Idiocy, ii., 464, Education of Idiots, 
11., 467. 
Idiopathic Typhoid Fever, 529, Di- 
agnosis, 529, Treatment, 529. 
Idiopathic Tetanus, n., 532. 
Idiosyncrasies. 186, (under Insanity,) 
H.414, Artificially induced, 649. 
See Gout, n., 171, Mercurial, 
Gangrenopsis, n., 354, in Men- 
tal Disease, n., 414. 
Idiotism, ii., 464. See Cretinism, n., 
278. 
Ignatia, in Ague, 507. 501, Teething, 
289, in Urticaria, 615, in 
Toothache, 229, Sleeplessness, 
712, in Grief, ir., 428, il, 430, 
Anger, n., 431, in Insanity, n., 
434, in Hemicrania, its Sphere 
of Action, ii., 502, in Tetanus, 
n., 540, Chorea, ii., 564, Con- 
vulsions, ii., 587, Epilepsy, ii., 
607, Apoplexy, il, 646, in 
Chlorosis, n., 727, in Diabetes, 
11.. 815. 
Ileus, 334, 340, Iliac Passion,334,340. 
Illusions, ii., 446. 
Illusions of Sight, it., 446. 
Illusory Sounds, ii., 448. 
Imagination, n., 404. 
Imbecility, n., 464. 
Impalpable Contagions, 589. 
Impetigo, ii.. 846, ii., 852. 
Imponderables admitted to hai\. 
Power, 12 7,Typhoid Contagion, 
557. 
Impotence, it., 715, ii., 717. 
Improvement of the Materia Medica, 
164. INDEX 
927 
Impurities in Preparing Medicines, 
150, of Food, 285. 
Inaction, Waste of Limbs from, n. 
659. 
Inanition, 263. 
Incarcerated Hernia, 388. 
Incisions, 663, 070. 
Inconsistent Reasonings, 88. 
Incontinence of Urine, n., 86. 
Incrustation of the Teeth, 239. 
Incubus, 452, Treatment, 454. 
Incubation of Inflammation, 638. 
Indigestion, 271, Dyspepsia, 271, 
Treatment, 284, 289, 296. 
Indolent Ulcer, il.. 386. 
Induration, 178. 
Induration, of the Brain. 702, ii., 
407, of the Uterus, n., 694, il., 
692, of the Cervix, it., 710, of 
the Parotid Gland, 745, of Mem- 
brana Tympani, 733, of the 
Liver, 933, Testicles, n., 383, 
Infancy, Diseases of, 199. 
Infants, Affections of, 199. 
Inf antile Jaundice, 410, Aphthae,738, 
Remittent Fever, 524, Diag- 
nosis, 524, Causes, 524, Treat- 
ment, 525, Ac., Bell., Cham., 
Ipec., 525, Arsen., Nux., Bry., 
Dulc., 526, Puls., 227. 
Infections Communicated from An- 
imals, ii., 184. 
Infectious Urethritis, ii., 366. 
Inflammatory Diseases, 637, Remote 
Causes of, 649. 
Inflammation, Treatment, 649. 
Inflammation, Nature of, 196, 637, 
Phenomena of, 638, Products 
of, 640, Seats of, 640, Objects 
of 643, Adhesive Process, 643, 
Granulation, 643, Cicatrization, 
Disease of, 645. 
Inflammation of the Brain, 695, 
Membranes, 698, Bronchia,784, 
Bowels, 882, Bladder, n.. 75, 
Organs connected with the Di- 
gestive System, 735, of the 
Ear, &c., 725, Membrani Tym- 
pani, 728, Eye and its Ap- 
pendages, ii., 87, Heart and its 
Appendages, 838, Joints, Cartil- 
ages, 665, ii, 174, ii., 764. 
Inflammation of the Kidneys, n., 
21, ii., 66,Chronic, do.,ii., 44. 
Liver,921, Acute, 923, Chronic, 
932, Eye, il, 87, Lungs, 303, 
Treatment, 808, Ovaries, II., 
706, Parotid Gland,742,Pleura, 
819, Periosteum, 663, Peri- 
toneum, 891, Prostate Gland, 
II., 83, Gall-bladder, 928, Spi- 
nal Marrow and its Membranes, 
II., 523, Spleen, 937, Stomach, 
852, Chronic, 860. 
Inflammatory Affections of Parts 
within the Thorax, 784, from 
Loss of Blood, II., 690, Testes, 
11., 382, Tonsils, 746, Tongue, 
735, Urethra, n., 366, Blad- 
der, ii., 75, Uterus, n.,729, Os 
Uteri, II., 701, Pancreas, 941. 
Inflammatory Blush, 762. 
Inflation, in Obstruction of the 
Bowels, 344. 
Influenza, 833. 
Infusoria in Putrefying Substances, 
11., 824. 
Ingrowing Nail, ii., 892. 
Inhalation of Arsenic in Bronchitis, 
795, in Diphtheria, 767. 
Injuries of the Brain, 687, il, 409, 
of the Eye, il, 150, Concus- 
cussion, &c., 687, Orchitis, 
ii., 325.' 
Inoculation of Poisons, il, 183, in 
Syphilis, ii., 321. 
Insane, Paralysis of, il, 459, Insane 
Belief, ii., 399. 
Insanity, ii., 389, 394, Symptoms, ii., 
395, Diagnosis, ii., 419, n.,403. 
Insanity, Causes, ii., 409, Symptoms, 
IL, 395, Moral Treatment, ii., 
422, il, 427, Mental Emotions, 
Passions, ii , 427, Legal Defini- 
tion of, ii., 399, Pathology, ii., 
406, ii., 409, Influence of the 
Body on the Mind, n., 427, 
Mind on the Body, 842,(Heart,) 
ii., 427. 
Insanity from Alcoholic Drinks, ii,, 
443. 
Insects, Bites of 668, Collodion, Brora. 
Apis, 668. 
Insensibility to Medicine, 116, 376. 
Inspection of the Chest, 814. 
Intellect, Affections of, n., 388, Seat 
of, 698. 
Intemperance, Moral and Physical 928 
INDEX 
Effects, ii., 443, Prophylactics, 
ii., 456. 
Interference, Medicinal, 95,163,166. 
Intermittent Fever, 472, Varieties 
of, 475, Critical Days, 476, In- 
flammatory,475,Quotidian,475, 
Tertian, 475, Complications, 
515, Congestive, Intermittent, 
Malignant, Sinking Chill, 510, 
Prophylactic Measures, 480, 
Treatment, 485. 
Intestinal Canal, Diseases of Diges- 
tion, 213, Obstruction, 334, 
Prognosis, 334, Treatment, 
334, Intussusception, 340, Ene- 
mata, 335, Treatment, 340, 
Aconite, 336, Obstruction in 
the Colon, 336,Gastrotomy,340, 
Bell.,341, Plumbum, 344, Flex- 
ible Tube, 344. 
Intestines, Inflammation of, 882. 
Intestinal Concretions, 377, Calculus, 
377. 
Intestinal Intussusception, 340. 
Intestinal Fever, Typhoid, 557, Ob- 
struction, 334. 
Intoxication, ii., 460. 
Intuition, ii., 394. 
Inversion of the Eyelids, n., 145. 
Iodic Diathesis, 646. 
Iodid.e~P otas., in Ptyalism, 249. 
Involuntary Emissions, n., 714. 
Iodide of Mer., in Diphtheria, 763, 
765, in Syphilis, n., 315, Indu- 
rations of the Cervix, ii., 710, 
of Arsenic, 768. 
Iodide of Potassium, 249, in Ptyal- 
ism, 249, in Gangreuopsis, ii., 
357, in Palsy, ii., 660, in Hy- 
datids, ii , 824. 
Iodine, in Scrofula, ii., 261, Maras- 
mus, ii., 263, in Goitre, n., 
276, Gastritis, 856, in Scrofula, 
ii., 262, 266, 269, in Strych- 
nine Poisoning, n.,538, in Cho- 
rea, ii., 566, Leucorrhcea, ii., 
699, in Exciting Secretion, ii., 
738, in Hydrocele, ii., 763, in 
in Spina Bifida, ii., 766. 
Ipecac, in Asthma, 444, Ague, 494, 
Depraved Appetite, 267, Mea- 
sles, 608, Urticaria, 615, Mili- 
ary Fever, 616, Croup, 782, 
Haemoptysis,800, Haemorrhages, 
ii., 198, Toothache, 228, Fla- 
tulency, 267, in Vomiting, 270, 
in Cholera Morbus, 354, Infan- 
tile Fever, 525, Synocha, 532, 
Yellow Fever, 575, Scarla- 
tina, 596, in Follicular Ente- 
ritis, 890, in Dysentery, 909, 
in Choroiditis, ii., 119, in 
Goitre, ii., 278, in Drunken- 
ness, ii., 456, Sleeplessness, ii,. 
576, Apoplexy, n., 647, Ver 
tigo, ii., 579, Susceptibility to 
Cold, ii., 633, Menorrhagia, n., 
692. 
Iridectomy, ir., 117, il, 134. 
Iris, Affections of, ii., 114. 
Irrationality, il, 389. 
Irresolute, 840. 
Irritability, 82, 117, 137, n., 575. 
Iritis, ii., 114, Treatment, il, 115. 
Iron, Ferrum, in Palsy, il, 660. 
Irritable Bladder, n., 78. 
Irritable Inflammation, n., 156, Ul- 
cer, ii., 386. 
Irritative Fever, 523, Treatment,228, 
525. 
Irritation of Nerves, Effects of, n., 
529, Eccentric, il, 529, Gas- 
tric ii., 529, in Diabetes, ii., 
813. 
Ischuria Renalis, n., 79. 
Itch, ii., 879, i., 185, 189. 
J. 
Jalap in Colic, 322. 
Jaundice from Obstruction of the Ex- 
cretory Ducts, 407, Biliary De- 
rangement,3 99, Phos.-acid,410, 
Aconite, 410, Mercury in, 403, 
without obvious Organic Dis- 
ease, 405. 
Jaundice, Treatment, 410. 
Jaundice, Black, 411. 
Jaw-bones, Diseases of, 241, Caries, 
247. 
Jaw, Lower, 244, Inflammation, 246, 
Injuries, 246. 
Jecoris Aselli, in Phthisis, ii., 240. 
“Jerks," from Religious Excitement, n., 
567. 
Joints, Inflammation of, ii., 174,White 
Swelling of, n., 174, Scrofu- 
lous Inflammation, ii., 174, of INDEX. 
929 
the Synovial Membranes, n., 
175, ii., 764, Ulceration of the 
Cartilages of. 665,Cartilaginous 
Dropsy of the Joint, ii., 175. 
Joy, Effects of, n., 427. 
Judgment Distinguished from 
Reason, ii., 394. 
Juglans in Eruptions, ii., 886. 
K. 
Kali-Carb. in Haemorrhoids, 396. 
Kali-hydriodicum, Bright’s Disease, 
11., 40, ii., 63, Dropsy, n.,758, 
in Ague, 507, Diphtheria, 767, 
in Scrofula, ii., 264, in Syphi- 
lis, ii., 316, in Secondary, do., 
11., 317. 
Kali-Nitricum in Bright’s Disease, ii., 
39., II., 64, in Cystitis, ii., 78. 
Kali-Bichrom. in Diphtheria, 763, 
766, in Croup, 779, in Skin 
Diseases, ii., 886. 
Kalmia Latifolia, 844. 
Kidneys, Anatomy of, ti., 9. Bright’s 
Disease of, il, 21, Acute, il, 
21, 24, Symptoms, 25, Granular 
Degeneration, il, 21, Causes, 
11., 22, Chronic, n., 27, Second 
Stage, ii., 28, Treatment, il, 
29. 
Kidneys, Disease of, with Paralysis. 
Diseased in Scarlatina, 602. 
Disease Caused by Surgical 
means, ii., 71, Connected with 
Palsy, ii., 669, Bleeding From, 
785, From Pulmonary CEdema, 
785, Removal of, il, 71., ii., 
473, Inflammation of, n., 9, 
Effect on the Stomach, n.,670, 
Abscess of, n, 775, Suppuration 
of, ii., 775. 
Kidneys, Influence of, ii., 427. 
King's Evil, il, 259, Magnetism in 
ii., 265. 
Knee and Uip-jomt, See Scrofula, ii., 
259. 
Kreosote in Haemorrhage, il, 197, in 
Phthisis, ii., 252, in Toothache, 
236, in Softening of the Sto- 
mach, 868, in Gangrene, il, 
351. 
Deafness. Menorrhagia, ii., 
695, in Diabetes, ii., 814. 
Kyllopodia, ii., 730. 
Vol. ii.—59. 
L,. 
Labor-like Pains, il, 681. 
Laborious Menstruation, il, 681. 
Lachesis, in Diphtheria, 770, in He- 
patitis, 630, in Ague 502, in 
Ptyalism, 251, in Measles, 608, 
in Dissection Wounds, 667, in 
Pleuritis, 827, in Affections 
of the Mouth, 251, Ague, 502, 
in Gangrene, it., 347, in Ulcers, 
II., 387, Grief, &c., il., 428, 
Dropsy, il, 759. 
Lachrymal Gland, Affections of, n., 
146, Fistula, n., 146. 
Lactation Deranged, n., 718. 
Lacteals, 221. 
Laennec, 421. 
Lameness, il, 158. 
Lardaceous Cancer, n., 284. 
Laryngeal Catarrh, Laryngitis, 749. 
Larynx,, Inflammation of, 749. 
Larynx, Polypus of, See Polypus, 426, 
Foreign Bodies in, 431, Diag- 
nosis, 432, Treatment, 433. 
Laryngismus, Crowing Disease, 448, 
Causes, 449, Pathology, 450, 
Treatment, 451, Chlorine, 451. 
Lamjngitis, 749, Chronic do., 750. 
Latent Pneumonia, 805, Latent 
Chronic Diseases, n., 185. 
Lateral Curvature of the Spine, n., 
525. 
Laughing Gas, Delirium Tremens, il, 
454. 
Laurocerasus, in Ague, 507, in 
Cholera, 373, Apoplexy, il., 646. 
Laiv of the Least Quantity of Ac- 
tion, 163, 148. 
Lead Palsy, n., 666. 
Lead Colic, 358. 
Lead, Melted, Effects of, 858. 
Leaven, il, 844. 
Leech-bites, il, 197. 
Legal Definition of Insanity, ii., 
399. 
Legs, Cramps in, il, 588, Debility of, 
ii., 670. 
Legs, Palsy of, II., 669. 
Lemon Juice, in Scurvy, n., 337. 
Lenticula, ii., 885. 
Leontice, ii., 592. 
Lepidosis, Pityriasis, ii., 863. 930 
INDEX. 
Leprosy, il, 870. 
Lepra Graecorum, ii., 874, Anaesthe- 
tica, il, 874. 
Leptandra-virginica, 932. 
feucorrhoea, il, 695, Treatment, IL, 
699. 
Leucom,a, Opacity, ii., 113. 
Leucosis, 943. 
Leucophlegmasia, White Swelling, il, 
156. 
Leucothyeemia, 942. 
Libraries, 47. 
Lichen, ii., 860. 
Lids, Granlated, n., 103, Affections, 
of, il, 144, Everted, II., 145, In- 
verted, II., 145. 
Lienteric Diarrhoea, 346, 917. 
Life, Principle of, 40. 
Ligature of Arteries, n., 196, in 
Aneurism, ii., 342, Spina 
Biflda, II., 765, of the Head, 
IL, 628. 
Lightning, Effects of, n., 655. 
Light, Causing Pain in the Eye, II., 
87, Want of, Effects of, ii., 91. 
‘ Like that Cures." What is it? 
152. 
Lime Juice, ii., 162, in Scurvy, il, 
337, ii., 338. 
Lime, Muriate of, Carbuncle, 671. 
Limestone Water, ii., 275. 
Limosis, Affections of Digestion, 256. 
Dysphagia, 252. 
Lips, Deformity of, Diseases of, Cancer 
of ii., 285. 
Literature, its Influence on the Mind, 
il, 412. 
Lithia, Calculi, ii., 770, Lithic-acid, 
tl, 772. 
Lithia, Carbonate of, ii., 166, 
Liver, Decarbonizing Power of, 399. 
Minute Anatomy of, 399, 406. 
Abscess of, 926, Congestion, of, 
922, in Diabetes, n., 812, Af- 
fected by Kidney Disease, ii., 50, 
Adhesive Inflammation of, 924, 
Cancer of, 936. Causes, 925, 
ii., 869, Gall-stones, 407, Gall- 
bladder, Inflammation of, 929, 
Ulceration of, 925. Functional 
Derangement of the Liver, 399. 
Liver, Chronic Inflammation of, 933, 
Treatment, 930, Suppurative In- 
flammation of, 926, Enlargement 
of, 934, Fatty Degeneration o£ 
934. 
Living Bodies Indigestible, 219. 
Lobelia, in Dyspepsia, 293, Asthma, 
446, in Bronchitis, 793, in Ob- 
struction of the Bowels, 341, in 
HaBmorrhoids, 393, Heart Disease, 
846, in Phthisis, ji., 246, in Car- 
dialgia, n., 514, in Hydrophobia, 
ll., 549. 
Local Applications, n., 166, I., 680, 
in Cancer, n., 285, Inflammation 
of the Cervix Uteri, n., 712, 
in Gangrene, il, 360. 
Local Action of Copaiba, ii., 380. 
Local Neuralgia, n., 496. 
Lock-jaw, ii., 531, Treatment, ii., 534. 
Longevity, 217. 
Long Sight, ii., 137. 
Looking Glass Silverers, n., 672. 
Looseness of the Bowels, 345. 
Loquacity, ii., 428. 
Losses of Blood, il, 198, il, 195. 
Louis, M., 63. 
Love, Ailments from unhappy, il, 437. 
Low Spiritedness, il, 442. From 
Heart Disease, 838. 
Lower Jaw, Diseases of, 244, 246. 
Caries, 247, Luxation, 246, 
Fracture, 246. 
Lues, Syphilis, n., 300. 
Lumbago, Rheumatism, ii., 156. 
Lumbar Region, Affections of, n.,156. 
Lum brief 381. 
Lung Fever, 803. 
Lungs, Absorption in, IL, 734, Conges- 
tion of, 797, 803, Haemoptysis, 
797, Gangrene of, n., 347, Tu- 
bercles of, il, 221, (Edema, 
after Scarlatina, 602, Inflamma- 
tion of, 803, Irritation of, ii., 
471, Paralysis of, ii., 650, (Ede- 
ma of, 796, Summary of Dis- 
eases of, 834. 
Lupulin, il, 717. 
Luxations, 662. 
Lupus, ii., 289. 
Lycopodium, in Ague, 507, in Urtica- 
ria, 614, in Scrofulous Affec- 
tions, il, 155, in Phthisis, il, 
251, in Constipation, 333, in 
Scrofula, il, 271, Cramps, il 
588, in Syphilis, ii., 325, Leu- 
corrlicea, il, 700, in Dropsy, n.. INDEX. 
931 
759, in Calculus, ii., 801, in 
Rickets, il, 835, in Eruptions, 
ii., 885. 
Lymph, 222, Coagulable, 640. 
Lymphatic Constitution, in Scrofula, 
ii., 264. 
Lymphization, 640. 
Lyssa, Rabies, n. 543. 
M. 
Macrotin, Ague, 509, Chorea, ii., 566, 
in Dysmenorrhoea, n., 688, 
Sterility, Hysteria, &c., il, 686, 
Macrotrys, do., ii., 688, Metritis, ii., 
730. 
Macular Skin, ii., 886. 
Madeira, Climate of, n., 235. 
Madness, n., 399. 
Mad Dogs, Bite of, ii., 543. 
Mad Stone, ii , 552. See also Vol. l, 
379. 
Magnesia-carb., Cataract, ii., 133. 
Magnetism, Animal, in Scrofula, ii., 
268. 
“ Maladie de Pays," ii., 463. 
Malaria, 477, 461. 
Malarious Fever, 468. 
Malis, il, 886. 
Malformations, ii., 839. 
Malignant Cell Formations, 589, 
646, ii., 181. 
Malignant Intermittent, 510, Dou- 
ble Tertian of the Miss., 529. 
Malignant Sore Throat, 592, Tumor 
of the Bladder, n., 802, Scar- 
latina 592, Diphtheria, 760, 
Pustule, 668, Diagnosis, 669, 
Warts, il, 901, Ulceration of 
the Colon, 920. 
Mammary Abscess, 652. 
Mammce, Affections of, 652, n., 718. 
Manganum, in Leucorrhcea, ii., 701. 
Mania, ii., 399. 
Mania-a-potu, n., 449. 
Manipulation, in Obstructions of the 
Bowels, 340. 
Marasmus, 884, 890, Treatment, ii., 
263, from Weaning, 310, from 
Scrofula, ii., 267. 
Marriages, Consanguineous, it., 663. 
Mastication, 213. 
Masturbation, n., 604, ii., 717. 
Maxillary Bones, 241, Antrum Max., 
241, Lower, 244, Caries, 247. 
Maxillary Glands, Ptyalism, 248. 
Measles, 604, Causes, 606, Treatment, 
606, Aeon., 606, Puls., 607, 
Lachesis, 608. 
Meatus Externus, Inflammation, 725, 
729. 
Mediastinal, Tumor, 829. 
Medicine 200 years ago, 49, 50. 
Medical Jurisprudence, Insanity, ii., 
399. 
Medical Doctrines, 40. 
Medicated Milk, n., 315, n., 263. 
Medicines, Classification of, 111. 
Medicinal Aggravation, n., 354. 
Mercury, ii. 354. 
Medicinal Interference, 149,‘284. 
Medicinal Action, 82. 
Medical Revolutions of the 19th cen- 
tury, 62. 
Medulla Oblongata, ii., 476, n., 638, 
in Diabetes, n., 813. 
Medulla Spinalis, ii., 477. 
Medullary Substance, 695. 
Medullary Fungus, ii., 142, or Soft 
Cancer, ij., 283, ii., 803. 
Megrim, n., 499, Sycotic, n., 328. 
Meibomian Glands, Inflammation of, 
II., 145. 
Melancholy, ii., 442, Hypochondriasis, 
from Heart Disease, 838, Re- 
ligious, II., 415. 
Meltena, 411, Diagnosis, 411, Treat- 
ment, 411, 412, Case by Dr. 
Nunez, 411. 
Malanosis, n., 284. 
Melted Lead, Gastritis from, 858. 
Membranes, False, Diphtheria, 752, 
762. 
Membrana Tympani, 727, Relaxa- 
tion, 731, Tension, 731, In- 
flammation of, 727, 728, Fun- 
gus of, 727, Induration, 733, 
Thickening, II., 664. 
Membranous Group, 775. 
Merncny, Weakness of, Loss of, n. 
395. 
Mental Influence on Disease, 70,282. 
Meningitis, 692, 699, from Sun- 
stroke, 710, Tubercular, 885. 
Menstruation, Profuse, u., 689, Re- 
tention, ii., 674, ii., 676, ii., 
721, Suppression of, n., 674. 
ii., 676, Painful, il, 681. 
Menorrhagia, n., 689. 932 
INDEX 
Menorrhagia in Syphilitic Subjects, 
it, 325. 
Mensuration of the Chest, 818. 
Mental Derangement, it, 388. 
Mental Extravagance, it, 416. 
Mental Superiority of Individuals 
and Races, it, 388. 
Mental Origin of Diseases, it, 432, 
Invisible to Anatomists, it, 432, 
Effects of Intemperance, it, 443. 
Mephitis Putorius, 440, in Pertussis. 
Mercury, Ptyalism from, 248, 250, in 
Brain Diseases, 709, 711, Abuse 
of, 95, 403. 
Mercurial Poisoning, it, 202. 
Mercurial Stomatitis, 739. 
Mercurial Fever, 533, 403, 533. 
Mercury in Diseases of the Liver, 
• 403, Anaemia from, 404, it, 
202, Symptoms, 234, Diseases 
of the Teeth, 233. 
Mercur., in Pneumonia, 813, Diseases 
of the Liver, 403, in Hepatitis, 
930, its Mode of Action, 403, 
Albuminuria, it, 41, Nephritis, 
64, 69, in Choroiditis, it, 119, 
Amaurosis, it, 126, in Tooth- 
ache, 228, in Affections of the 
Mouth, 250, Syphilis, it, 303. 
Mercurial Ophthalmia, it, 155. 
Mercurial Parotitis, 744, Eczema, it, 
3i2. 
Mercury in Secondary Syphilis, it, 
317, in Syphilitic Caries, it, 
321, in Gangrene of the Mouth, 
Ii., 354, in Depressing Passions, 
n„ 428, Alcoholism, it, 458, 
Vertigo, it, 578, Palsy, it, 660, 
Leucorrhoea, it, 701, Sperma- 
torrhoea, II., 716, in Exciting 
Secretion, II., 737, Dropsy, II., 
758, Tolerance for, 652. 
Mercur.-corros., in Bright’s Disease, 
it, 41, it, 65,in Ptyalism, 248, 
in Dysentery, 909, Iritis, it, 
116, in Syphilis, it, 319, in 
Gonorrhoea, it, 379, as a Para- 
siticide, it, 861, Carbunculated 
Face, it, 855. 
Merc.-Cor., 248, Mercury in Yellow 
Fever, 577, Varioloid, 634, in 
Scarlatina, 596, Small-pox, 632, 
in Bronchitis, 796. 
Mercur.-hydriod., in Diphtheria, 763. 
Merc.-per-nitrate, n., 861. 
Merc.-vivus, in Scald Head, n., 884. 
Merc.-Sol., in Glossitis, 736, Diph 
theria, 763, in Aphthae, 741. 
Merc.-sol., in Bright’s Disease, II.. 43, 
II., 65, in Ophthalmia, II., 97, 
Iritis, II., 115, Scrofulous, II., 
154, Colic, 323, in Diarrhoea, 
346, in Cholera, 376, Coryza, 
425, Fever, 533, Hepatitis, 931, 
in Itch, II., 882, Primary 
Effects, 533, in Typhoid Fever, 
533, 551, Typhus, 547, Yellow 
Fever, 577, Calomel, 578, Scar- 
latina, 596, Measles, 608, Small- 
pox, 632, Varioloid, 634, Hy- 
drocephalus, 723, Dysentery, 
909, 916, Apoplexy, II., 647. 
Mercur.-iodatus, it, 64, Bright’s Dis- 
ease, in Dysentery, 911, Scrofula, 
II., 272, in Diphtheria, 765, in 
Syphilis, it, 315. 
Mercury, Crude, in Obstruction of the 
Bowels, 344, in Hoarseness, 435, 
in Dysentery, 910. 
Merc. Vivus, it, 55. 
Mercurial Diseases, 303, 911, it, 
309, it, 328. 
Mercurial Dyscrasia, Gangrenopsis, 
II., 354, Palsy, it, 671. 
Mesenteric Glands, it, 262, 267, 
Scrofula, it, 262, Vol. I., 884, 890. 
Mesentery, Turgescence or Venous Ple- 
thora, 412. 
Mesmerism, susceptibility to, it, 578. 
Metaphysical Reasoning Power, it, 
394. 
Metastasis of Gout, it, 173. 
Metastasis of Skin Diseases, it, 186, 
of Disease of the Heart, 844, 
of Gout, it, 173. 
Methodic Sect, 42. 
Method of Improving the Materia 
Medica, 181. 
Metrorrhagia, it, 186. 
Metritis, it, 729. 
Mezereum, in Syphilis, iin 321, in 
Psoric Skin Disease, it, 665, 
in Leucorrhoea, it, 701, in 
Ague, 507, in Abscess, 658, 
in Scald Head, it, 664. 
Miasms in the Blood, Psora, Syphi- 
lis, Sycosis, it, 186, Latent, it. 
185. INDEX 
933 
Mizsmata, 477, Imponderable, 125, 
Development of, 558. 
Microscopic Examination of the 
Blood, ii., 177, of Cancer, il, 284. 
Migraine, Megrim, il, 499. 
Mildew, ii., 844. 
Mild Disposition, ii., 726. 
Millar's Asthma, 749. 
Miliary Fever, 615, Treatment, 616, 
Aeon., Cham., Ipec., 616. 
Milk, Medicated, II., 263. 
Milk as Food, ii., 232, in Sjphilis, ii., 
315. 
Milk-flow, Morbid, ii., 718. 
Milk Beg, 801. 
Milk Scall, ii., 849. 
Milk Sickness, 877, Cause, 879, 
Treatment, 880. 
Millefolium., in Haemoptysis, 800, in 
Haemorrhage, il., 198, Phthisis, 
11., 255. 
Millet Rash, 615. 
Mind, Influence on the Body, ii., 432, 
on the Heart, 842, in Dyspep- 
sia, 275, 278, 282, Superior to 
the Body, il, 466, IL, 388. 
Minerva—Pure Reason Deified, ii., 
394 
Minute Division of Drugs, 154. 
Mirthful, ii., 454. 
Misenunciation, 435. 
Miscarriage, Abortion, il 593. 
Miserere, 316. 
Mislactation, ii., 718. 
Mistakes in Diagnosis, 176. 
Modern Civilization, Evils of, n., 
412. 
Modes of Treating Disease, 71, of 
giving Remedies, 162, Hahne- 
mann’s Latest Rules, 177. 
Modified Small-pox, 633. 
Modus Operandi of Medicines, 110. 
Moisture, 485. 
Mole, ii., 898. 
Monge, Case of, n., 392. 
Monomania, ii., 401, Suicidal, n., 
439. 
Moral Causes of Insanity, n., 410, 
11., 432. 
Moral Insanity, n„ 417, ii., 418. 
Moral Treatment of Insanity, ii. 422. 
Moral Sentiments Perverted, ii., 
418. 
Moral Therapeutics, il, 427, in Mono- 
mania, n., 439, in Spermator 
rhcea, n., 716. 
Morbid Appetite, 264. 
Morbid Sensibility, il, 577, of Sight, 
11., 87, Hearing, 725, of the 
Stomach, &c., 271 
Morbid Saliva, 249. 
Morbilli, 604, Cause, 606, Treatment, 
606. 
Morbus Coxarius, n., 264. 
Morning, Influence of, 206. 
Mortality at Different Periods, 208, 
Duration of Life, 208, Influ- 
ence of Periods of the Day on, 
208. 
Motion, Voluntary, il, 475. 
Motor-Nerves, il, 525. 
Mould, il, 844. 
Mouth, Anatomy of, 226, Epithelium, 
883, Symptoms of, 241.250, In 
flammatory Affections of, 735, 
Inflammations of, see Ptyalism, 
248, Syphilitic Effects of, il, 
308, Gangrene of, n., 352, 
Foetid Odor of, 249, General 
Remedies for Affections of, 250. 
Movement Cure in Headache, il 508 
Mucine, n., 777. 
Mucous Enteritis, 915, Chronic Ul- 
ceration of the Intestines, 915. 
Mucous Membranes, Affections of, 
423, 832, Catarrhal Inflamma 
tion, 832. 
Mucous Membrane of the Stomach, 
862, 883, 887. 
Mucous Membrane o,nd the Skin, 
Relations of, n., 186, 187,Diar- 
rhoea, 310, Dysentery, 915. 
Mucous Membrane, Syphilitic Dis- 
eases of, il, 319. 
Mucous Urine, 310. 
Mucous Follicles, 884. 
Mucous Ferment in Urine, il, 776, 
11., 779. 
Muguet, Thrush, 737. See Diph- 
theria. 
Mumps, 724. 
Muriate of Gold in Syphilis, ii., 316, 
Ammonia in Obesity, ii., 838. 
Muriate of Irime in Carbuncle, 671. 
Muriatic-acid in Scarlatina, 596, in 
Choroiditis, ii., 119, Typhus, 
553, Stomatitis, 742, in Gan- 
grenopsis, ii., 359. 934 
INDEX 
Muscee Volitantes. See Amaurosis,, 
II., 120. 
Muscular Contraction and Convul- 
sions, ii., 526. 
Muscular Power, Comparative, 208, 
209. 
Muscular and Fibrous System, In- 
flamed, ii., 156, Exercise in 
Scrofula, 268. 
Muscles, Diseases of, II., 526. 
Muscular Twitching of the Face, 
ii. 636. 
Musk, in Sleeplessness, 712. 
Mustard and Counter-irritants, ii., 
530. 
Mycelium, ii., 860. 
Mycrosporon, n., 863. 
Myopia, ii., 138, 140. 
Myotica, ii., 526. 
N. 
Ncevus Materni, n., 997. 
Nails, Diseases of, n., 891, In-Growing, 
ii., 892, Fungous Growths, il, 
893, Perclilorure de Fer, n., 893. 
Names of Diseases, 212. 
Napoleon I., n., 863. 
Narcosis, ir., 650. 
Nares, Symptoms, 430, Nasal pas- 
sages, 430. 
Nassau, Climate of, n., 238. 
National Characteristics, n., 388. 
Nausea, 268. 
Natrum-mur., Dyspepsia, 305, 306, 
in Ague, 504, in Urticuria, 614, 
Splenitis, 516, Stomatitis, 741, 
in Cardialgia, ii., 514, in Hy- 
datids, il, 824. 
Nature of Disease, 37, 55. 
Nature of Homoeopathic Cures, 106. 
Nebula, (Cornea,) n., 113. 
Necrosis, Phosphor, il, 362. 
Necrosis, Ustilaginea, it., 345. 
Nephralgia Calculosa, n., 775. 
Nephritis, n., 66, Treatment, ii., 68, 
Scarlatinal, 600, Desquamative, 
II., 21, Chronic, II., 44. 
Nerves of the Stomach, 278, Cell 
Formation of, n., 469. 
Nerves, Extirpation of, ii., 470, Irri- 
tation of, Causing Disease, ii., 
472, II., 497. 
Nerve Force, Nature of, il, 470. 
Nerves, Roots of, II., 476. 
Nervous Exhaustion, ii„ 226, nM 
714. 
Nervous System, Diseases of, il, 388, 
Pathology of, 471, Symptoms 
in Diagnosis, 172, Anatomy 
and Pathology of, il 468. 
Nervous Power and Electricity, n., 
601. 
Nervous Quinsy, 253. 
Nervous Fluid, il, 471. 67. 
Nervous Impressions, 71, in Diabetes, 
II., 813, Nervous Irritation, II., 
472, ii., 529, il., 736. 
Nervous Influence, Physiology of, II., 
470, Loss of, II., 659. 
Nervous Diseases of Women, n., 
520. 
Nervousness, ii. 574, ii. 777. 
Nervous Fever, Typhoid, 555, 557. 
Nettle Rash, 610, Diagnosis, 6i0, 
Causes, 612, Treatment, 613. 
Neuralgia, n., 477, Diagnosis, II., 
478, Reflex, ll., 529, Causes, 
IT., 483, Pathology, II., 484. 
Idiosyncracies, ii., 487, Tic 
Doloreux, II., 478, Treatment, 
11., 485, Complications, n., 
478, ii., 494, Dysmenorrhcea, 
11., 682,' Local Irritation, il., 
496, Injuries, II., 497. 
Neuralgia Coeliaca, n., 509. 
Neuralgic Ophthalmia, 495. 
New Diseases may sometimes Sus- 
pend Old Ones, 80. 
New-York, Climate of, ii., 237. 
Night-mare, 452, Causes, 453, Treat- 
ment, 454, Ephialtes Apnceatica, 
454, 455. 
Night, Influences of, 207. 
Night-sweats, n., 587. v 
Nitro-mur.-acid, 249, in Croup, 781. 
Nitrate of Silver, in Toothache, 236, 
Yellow Fever, 579, in Ophthal- 
mia, 96, 98, in Egyptian Oph- 
thalmia, ii., 109, in Yellow- 
Fever, 579, in Syphilis, il, 
311, Syphilitic Dyscrasia, ii., 
328, in Gonorrhoea, ii., 376, 
in Chorea, ii., 566, Tinea, ii., 
664, in Inflammation of the 
Cervix-uteri, ii., 712. 
Nitrate of Uranium a Remedy in 
Diabetes. INDEX 
935 
Nitrate of Uranium in Milk-flow, n., 
718. 
Nitrate of Potash in Dysuria, n., 
78. 
Nitric-acid, in Effects of Mercury, 
249, in Urticaria, 614, in Iritis, 
ii., 115, Scrofulous Ophthalmia, 
ii., 155, in Ptyalism, 249, in 
Coryza, 425, in Diphtheria, 
769, Dysentery, 909, 912, in 
Syphilis, ii., 316, ii., 319, in 
Orchitis, ii., 324, in Gangre- 
nopsis, ii., 362, a Remedy for 
Prolapsus Ani, in Leucorrhoea, 
ii., 701. 
Nitrogen in Food, 225. 
Nitro-muriatic-acid, 932. 
Nitro-muriatic-acid, in Ptyalism, 
249. 
Nitrous Oxide Gas, in Delirium Tre- 
mens, ii, 454. 
Nodes, Venereal, ii., 308, n., 321. 
Non-restraint Treatment of Insanity, 
ii., 425. 
Nose, Inflammation of, 735, Bleeding 
from, 430, Cancer of, ii., 287, 
Lupus on, ii., 289, Caries, ii., 366, 
Operations on the Nasal Passages, 
430. 
Nosology, 211. 
Nostalgia, il, 462. 
Nostrils, Foreign Bodies in, 734. 
Notation, Homoeopathic, 163. 
Numb-feeling, il, 637, ii., 470. 
Numerical Method, 63. 
Nursing Sore Mouth, 740. 
Nutmeg, 348, ii., 592. 
Nutritive Substances, Classification 
of, 210. 
Nutrition, 224, Results of Imperfect, 
647, 648, Cell-formation, 647, 
Perverted in Inflammation, 196, 
Imperfect in Dyspepsia, 276. 
Nux-vom., in Dyspepsia, 289, Asthma, 
445, in Ague, 497, Sphere of 
Action, 598, Ptyalism, 251, De- 
praved Appetite, 267, in Yel- 
low Fever, 577, in Bronchitis, 
790, in Hepatitis, 930, in Quin- 
sy, 748, in Arthritic Dyspepsia, 
in Ischuria, ii., 86, in Iritis, il, 
116, Amaurosis, ii., 128, in 
Affections of the Mouth, 251, 
in Colic, 319, 323, Constipa- j 
tion, 330, in Diarrhoea, 347, in 
Haemorrhoids, 396, in Coryza. 
425, Hoarseness, 435, Asthma, 
445, Ephialtes, 454, Spotted 
Fever, 529, Synocliv, 532, 
Blood to the Brain, 692, Ver- 
tigo, II., 578, in Spinal Irrita- 
tion, ii, 717, in Softening of 
the Brain, 717, Gastritis, 855, 
Dysentery, 916, Spermator- 
rhoea, II., 717, in Chlorosis, 
it., 725, in Calculi, IL, 801, 
Gonorrhoea, IL, 380, Orchitis, 
II., 384, Effects of Passion, ii., 
431, Insanity, IL, 435, in Deli- 
rium Tremens, IL, 453, Neu- 
ralgia, II., 491, Neuralgia, 
Cceliaca, II., 509, Gastralgia, 
II., 511, II., 516, in Tetanus,ii., 
535, Nux, an Antidote to 
Woorara, ii., 536, in Chorea, 
IL, 564, Hysteria, ii., 591, Irri- 
tability of Temper, II., 575, 
Sleeplessness, II., 576, Vertigo, 
579, Epilepsy, II., 608, Apo- 
plexy, IL, 646, Palsy, IL, 661, 
Dysmenorrhoea, II., 685, in Leu- 
corrhoea, ii., 701. 
Nux-moschata in Diarrhoea, 343, in 
Hysteria, ii., 592. 
O. 
Obesity, ii., 278, n. 837. 
Obstipation, 340, 334. 
Obstructed Menstruation, n., 774. 
Obstruction of the Bowels, 334, 340, 
of the Colon, 336. 
Odontalgia, 230, Sycotic, IL, 328. 
Odontia, 230, Stuporis, 239. 
Oedema Glottidis, 749, 785. 
CEdematous Inflammation, 749, 
Erysipelas, 678. 
(Edema of the Lungs, 796, After 
Scarlatina, 602. 
(Esophagus, Constriction of, 252, Me- 
chanical Injury of, 250. 
(Enanthe, ii., 612. 
Oinomania, ii., 443. 
Old Age, Decay of Mind from, n, 
461. 
Old Age, Influence of, 216, on the 
Brain, 702. 936 
INDEX 
Old and New Schools, Points of Dif- 
ference, 135. 
Old Authors, 684. 
Oleum Ricini, in Diarrhoea, 349. 
Ol. Olive, in Gall-stones, 408, in Go- 
norrhoea, ii., 377. 
Omentum., Congestion of, 412. 
Onanism, ii., 338. 
Oneirodynia, Incubus, 452. 
Onychia, 663, ii., 894. 
Opacity of the C-ornea, ii., 113. 
Opththalmia, il, 87, ii., 193, Acute, 
IL, 88, 89, Chronic, II., 99, 
Nitrate of Silver in, n., 96, 98, 
109, Sulph.-cupri., ii., 98, 99. 
Case of W. H. Prescott, II., 95, 
Granular do., ii., 103, Scrofu- 
lous do., ii., 150, Treatment, ii., 
152. Purulent do., II., 101, 
Gonorrhoeal, ii., 102, Infantile, 
II., 103, Egyptian do., 103, 
Mercurial, ii., 155, Neuralgic, 
IL, 495. • 
Opinions, Absurd, n., 398. 
Opisthotonos, ii., 531. 
Opium, Abuse of, 96, 113, ii., 651, 
II., 100, Poisoning, 514,11., 652, 
in Opthalmia, n., 101, in Peri- 
tonitis, 893, Scarlatina, 597, in 
Ague, 506, Constipation, 328, 
Remittent Fever, 520, Spotted 
Fever, 529, in Typhus, 545, in 
Epliialtes, 454, in Small-pox, 
633, in Varioloid, 634, in Dis- 
ease of the Brain, 706, 710, 
712, in Perforation of the In- 
testine, 894, in Coma, II., 407, 
11., 651, Fear, ii., 429, Fright, 
IL, 430, in Insanity, ii., 435, 
Delirium Tremens, II., 453, in 
Alcoholism, IL, 460, Dementia, 
11., 461, in Causing Idiocy, ii., 
468, Nervous Irritability, il, 
575, Convulsions, il, 587, Epi- 
lepsy, ii., 608, Apoplexy, ii., 
645, in Children’s Diseases, ii., 
652, in Galactorrhcea, il, 718. 
Optic Thalami, n., 475. 
Oppression of the Chest, 440. 
Orbit, Affections of. See Ophthalmia, 
il, 87. 
Organic Disease, 640. 
Organic Disease of the Colon, 919. 
Orchitis, Syphilitic, ii., 324, Gonor- 
rhoeal, ii., 382, Irritable Testis, 
ii., 385. 
Osseous Deposits, 700. 
Osteophyte, n., 828. 
Osteitis, ii., 828. 
Ostoid, ii., 284, ii., 830. 
Osteo malacia, il, 831. 
Osteo-sarcoma, ii., 833. 
Osteoporosis, ii., 830. 
Os-uteri, Ulceration of, il, 701. 
Otalgia, 725. 
Otitis, 725, 728, 700. 
Otorrhaea, 729, Treatment, 732. 
Ovaries, Affections of, ii., 706, Inflam- 
mation, ii., 729. 
Ovarialgia, il, 683. 
Ovarian Dropsy, il, 748. 
Over-lifting, 662. 
Oxalic-acid, in Gastromalacia, 868. 
Oxygen Gas, in Resuscitation, ii„ 624 
Oysters, Ailments from eating, 612. 
Ozama, simple Catarrh, 423, 734. 
Pseudo Ozoena, 734. 
Ozoena, from Phosphorus, il, 366. 
P. 
Padded Room for the hisane, n., 
426. 
Paganini, Case of, ii., 577. 
Painful Menstruation, ii., 681. 
Pain, Indications of in Diagnosis, 122. 
Painter's Colic, 316, Palsy, il, 666. 
Palpation, 834. 
Palpitation, 842, il, 576. 
Palsy, ii., 656, Partial of the Face, ii., 
495, il., 656, Prognosis, Treat- 
ment, n.660, from Lead,II., 666, 
Mercurial, il, 671, with Kidney 
Disease, il 669, Metallic, n. 666. 
Paludal Fever, 473. 
Panaritia, Whitlow, 661. 
Panaris, 660. 
Pancreatic Fluid, 220. 
Pancreatitis, 941. 
Pancreas, 941, Diseases of, 941, 
Treatment, 942, 
Papulous SJci?i, ii., 856. 
Paralis, 240. 
Paracelsus, 47. 
Paracentesis, Peritonitis after, 894. 
in Dropsy, ii., 750, il, 751, il, 
760. 
Paralysis of the Bladder, il, 84. 
Paralysis, Diagnosis, 717, il, 636 INDEX 
937 
from inflammation of the 
Brain, 711. 
Paralysis, ii., 656, Diagnosis, ii. 657, 
Treatment, ii., 660. 
Paralysis of the Nerves by Strych- 
nine, ii., 637, the Lungs, II., 
650, Tongue, it, 650, from 
Lead, it. 666, Mercury, it,671. 
Paralysis from Apoplexy, it, 639. 
Paralysis, Progressive, it, 326, it, 
459, II., 669, of the Insane, 
It, 459, from Spinal Disease, 
II., 668, with Kidney Disease, 
it, 669, 
Paraplegia, it, 659, Treatment, ii., 
663, from White Softening of 
the Brain, it, 659, from Spinal 
Affection, 713. 
Parabysma, 412. 
Parasites within the Body, Hydatids, 
it, 821. 
Parasitic Vegetables on the Human 
Skin, ii. 843, II., 847, it, 858, 
in other Positions, 739, it, 
860. 
Paracusis, Deafness, 727, it 663. 
Parithmitis, 742. 
Parotid Gland, 742, Inflammation of, 
742, Mercurial, do., 744, Indu- 
ration of, 745. 
Pare, Ambrose, 49. 
Paroniria, Somnambulism, it. 633. 
Paronychia, 661. 
Paropsis. See Amaurosis, it, 120. 
Paruria, it, 807. 
Paste for Chancre. it, 312, 
Parturition, Macrotin in, it, 688. 
Par Vagum, 158, 418, Section of, 
it, 659, Irritation of, it, 
813. 
Parostia, it, 826. 
Parotid Gland, Inflammation, 745, 
Induration of, 745. 
Parotitis, 742, Mercurial, 744. 
Passio Iliaca, 333. 
Passions, Their Influence on Disease, 
it, 427. 
Passion, Ungovernable, it, 431. 
Pathology, Observations on, 177, Al- 
teration of Solids, 177, of 
Fluids, 180. 
Patience, Influence of, it, 427. 
Pathology, 117, Solids, 117, Fluids. 
180. 
Pau, Climate of, 236. 
Peculiarities of Races and Individ 
uals, ii., 388. 
Peevishness, 847, 842. 
Pelagra, 525, Causes, 627 
Pemphigus, n., 851. 
Pepsine, 300. 
Percussion, 421, 422. 
Percussion, iu Pneumonia, 805 to 
807. 
Perforation of the Stomach, 867, of 
the Intestine, 894. 
Pericarditis, 838, 846. 
Perineal Fistula, it, 808. 
Periodical Insanity, n., 397. 
Periodicity in the Animal Economy, 
204, Different Periods of the 
Day, 206,204, of Life,208,199. 
Periosteum,Sympathetic Disease of,it., 
308, Action of in Reproducing 
Bone, ii., 365. 
Perioslosis, 663, Diagnosis, Treat- 
ment, 663, Incisions, 663, from 
Phosphorus, it, 362, Treat- 
ment, ii., 36.4 
Peri-pneumonia Notha, 785. 
Peri-pneumonia, 803. 
Peritoneum, Inflamed, 891. 
Peritoneal Enteritis, 891. 
Peritonitis, lrom rupture of Abscess, 
928. 
Peritonitis, 891. 
Peritonitis, Chronic, 892, Treatment, 
892, Puerpural, 891. 
Permanence of National Character, 
it, 388. 
Permanganate of Potash, ii. 259. 
Pernicious Fever, 510, 522. 
Pernio, Chilblain, 659. 
Persimmon, in Diarrhoea, 350. 
Personal Restraint of the Insane, it, 
425, it, 426. 
Perspiration, Diseased, it, 219. 
Perverse Hearing, 725. 
Pertussis, 438, Treatment, 439, rela- 
tion to Exanthemata, 609. 
Pestis, 637. 
Petechia, in Typhus, 536. 
Petechial Scurvy, it, 339. 
Petit Mai, it, 530, it, 594. 
Petroleum in Skin Diseases, it, 850. 
Peyer's Glands, in Typhoid, 567,886. 
Phagadenic Ulcers, ii., 386. 
Pharyngitis, 748, Tart.-emet., 749 938 
INDEX 
Pharynx Constriction, 251, Foreign 
body in, 254. 
Philosophy of Drug Action in Cur- 
ing Disease, 110. 
Phimotic Phlegmon, n., 382, from 
Gonorrhoea, n., 382. 
Plebitis, causing Disease of the Liver, 
926. 
IJhlegmon, 652. 
Phlegmasia Dolens, Hamamelis, 
801. 
Phlegmatic, Lazy, ii., 264. 
Phlogistica, 637. 
Phosj)hates in the Urine, n., 21, n., 
787, ii., 800. 
Phosphorus, in Apoplexy, it., 646, in 
Palsy, ii., 662, ii., 668, Leucor- 
rlioea, ir., 700, Spermatorrhoea, 
11., 717, Impotence, 718, Calcu- 
lus, ii., 801, Epilepsy, n. 608, in 
Pneumonia, 812, Pneumo-Ty- 
phus, 584, Pleuritis, 826, Amau- 
rosis, ii. 128, Cataract, n. 133, 
Colic, 320, in Synocha, 532, 
in Necrosis, ii., 365, Scrofulous 
Ophthalmia, il, 154, in Phthi- 
sis, ll., 247, Scrofula, ii., 273, 
Necrosis from, n., 362, Ozoena, 
11., 365, Alcoholism, n., 458, 
in Cardialgia, Flatulence, II., 
512, in Gastralgia, ll., 517, ll., 
518, Strabismus, II., 560, Ver- 
tigo, H., 578. 
Phosphoric Acid in Bilious Typhoid, 
530, in Pneumo-Typhus, 585, 
in Pneumonia, 814, in Cholera, 
366,370, Gall-stones, 410,Grief, 
ll. 428, Menorrhagia, II. 694. 
Phosphor Necrosis, n., 362, Treat- 
ment, ii., 364, il, 365. 
Photophobia, n, 88, 
Phrenica, ii., 388. 
Phrenitis, 695. 
Phthisis Pulmonalis, n., 205, Causes, 
11., 225, Hereditary, n., 228, 
Predisposition, Dyscrasia, II., 
220, Treatment, it., 235, Acute, 
11., 256. Also Iodide of Iron, 
Kali-hydr., Amm.-carb. 
Phyma, (Ecphyma,) ii., 887. 
Physical Deformities, ii., 839. 
Physical Reasoning Power, n., 394, 
Symptoms of Insanity, il, 404. 
Physical Education, 461, 462, Move- 
ments in Consumption, n. 239. 
Cretinism, II, 275. 
Physical and Moral Causes of In- 
sanity, II. 410. Over-exertion, 
II., 411, ii., 413. 
Physiological Test of Strychnine, n. 
539. 
Pica, Depraved Appetite, 264. 
Piarrhcemia, in Diabetes, n. 815. 
Piles, 390. 
Pimpernel, in Hydrophobia, n. 550. 
Pimples on the Face, ii., 854. 
Pinel, ikT. 63. 
Piorry M., 421. 
Pituitary Gland, n. 603. 
Pityriasis, ii. 846, n. 863. 
Plague, 637. 
Plants, Diseases of, n. 841. 
Plastic Membranes, Diphtheria, 752, 
762. 
Plasma, Contents of, ii. 178, Diseased 
States of, it. 180, a Receptacle of 
the Corpuscles, II. 182, it sup- 
ports them with the Air, n. 142, 
Causes of changes in it, n. 182. 
Platinum, in Grief, &c., n. 428, in 
Suicidal Monomania, n. 440, n. 
442, Dysmenorrhcea, n. 685, 
in Menorrhagia, n., 692, Uterine 
Cancer, ii. 692. 
Plato, 40, ii. 432. 
Plearthotonos, n. 531. 
Plethora, ii., 175, 177, Venous, of the 
Portal Circle, 412, Abdominal, 
ii. 503. 
Pleuralgia, Diagnosis, 823. 
Pleuritis, 819, Acute, 820, Diagnosis, 
821, Ausculatiou, 822, Chronic, 
827, Diagnosis, 828, Retrospec- 
tive Diagnosis, 830, Conse- 
quences of Pleuritis, 830. 
Pleurisy, 819, Diagnosis, 819, Causes, 
820, Treatment, 824. 
Pleurodynia, 823. 
Pleximetre, 422. 
Plica Polonica, n. 899. 
Plumbum, in Colic, 318, in Obstruc 
tion of the Bowels, 344, in 
Diarrhoea, 318, 347, in Apo- 
plexy, ii. 647. 
Plum.-diacetas, in Gonorrhoea, n. 378, 
Pneumono-gastric Nerve, per Vagum, 
158, 418, Section of, ii. 659, 
in Diabetes, ii. 813. INDEX 
939 
Pneumonia, Latent, 805. 
Pneumonia, 805, Diagnosis, 804, 
Treatment, 808. 
Pneumo typhus, 584. 
Treatment, 584. 
Pneumoniq-typhoides, 582, Causes, 
583, Treatment, 584. 
Pneumo thorax, 815. 
Pneumo-hydrothorax, 815, Diagnosis, 
815, Yocal Phenomena, 817, 
Symptoms, 818. 
Pneumonitis, 803. 
Pneumorrhagia, 802, Post Scarlatinal 
Dropsy, 601. 
Podagra, Gout, ii. 162. Treatment, 
ii. 166. Other Remedies: Colch. 
Digit., Verat.-vir.,. Aeon., Gels., 
Also, Avoid Bread, Milk, Butter, 
Sugar. 
Podophyllin in Hepatic Disease, 931, 
in Diarrhoea, 347, Gall-stones, 
409. 
Poets on Insanity, n. 40$. 
Poisons, 83, Mineral, 859, ii, 183, on 
the Brain, ii. 410, Adipic, 287, 
Poisons thrown off by the Kid- 
neys, ii. 69, Alcohol, 862, 
872, Opium,714, ii. 651,Clilor.- 
potash, H.760, Stramon. n. 611, 
Prussic-acid, ii. 647, Titanium, 
II. 184, Strichnine, II. 538, 
Arsenic, 547, Merc., ii. 202, 
Camphor, n. 607, Tobacco, 
II. 203, Bell., 593, II., 454, 
Slow, 863. 
Poisoned Wounds, 666, 667, 668. 
Polypus, 426, of the Ears, 731, of 
the Nose, 426, Treatment, 426, 
of the Uterus, Teucrium, 427. 
Polysarchia, Obesity, n. 836. 
Pons Varoli, n. 476, n. 639. 
Doric, Objections to, n. 232, II. 260. 
Porphyra, (Scurvy,) n. 332. 
Porrigo, n. 858. 
Porrigo Decalvans, ii. 859, II. 862. 
Posology, 149. 
Dor son, C*se of, ii. 391. 
Potash-Bichrom, 764, 766, Hydrio- 
date, 767, in Ptyalism, 249. 
Potash, Permanganate of, Disinfectant, 
ii. 259; also a Remedy in Dia- 
betes, 
Potatoes, Antiscorbutic, ii., 236, Bran- 
dy from, ii., 459. 
Potencies, High in Croup, *781, in 
Scrofula, n., 261. 
Potentization, 149. 
Power to Resist Disease, 199. 
Prairie Itch, ii, 884. 
Predispositions to Disease, 649, to 
Insanity, ii. 414. 
Premature Burial, ii. 629. 
Present Position of Regular Medi• 
cine, 126. 
Pregnancy, State of, Aeon., ii. 688. 
Preparation of Medicines, 163. 
Presbytique Amblyopia, ii. 139, n. 
193. 
Prescott, W. II., Case of, 95. 
Presentiment of Death, ii. 438. 
Pressure on the Chest, 442. 
Primary and Secondary Action of 
Drugs, 112. ii. 100. 
Prisons in Treating the Insane, n. 
421. 
Proctalgia, 885. 
Tenesmus, 895. 
Proctica, 390. 
Profuse Perspiration, 586. 
Progress of Homoeopathy, 57, 59. 
Progressive Paralysis, ii. 459, n. 
326. 
Prolapsus Uteri, ii. 709, ii. 713. Ani, 
398, Causes, 398. Treatment, 
399. 
Propylamine, ii. 161. 
Prone Respiration, n. 650. 
Prosopalgia. See Toothache, 230, 
ii. 328. 
Prostatic Fluid, ii. 715, Disease of 
from Gonorrhoea, n. 373, in 
Calculous Disease, ii. 806. 
Prostate, Diseases of, ii. 83. 
Protein, ii. 337. 
Protuberant Eye, n. 146. 
Proving of Drugs, 164. 
Proximate Principles, Classification, 
210. 
Prurigo, n. 857. 
Prussic acid, n. 407, in Apoplexy, 
it. 647. 
Pseudo-Membranous Bronchitis, 787. 
Pseudo-Membranes, Diphtheria, 752, 
762. 
Pseudo- Ozoena, 734. 
Psillismus, 435. 
Psora, ii. 185, n. 879, Psorio, Skin Dis- 
eases, ii. 187, Hahnemann on, 940 
INDEX. 
ii, 185, Urticaria, i. 612. See 
Dyscrasia, ii. 228, ii. 665. 
Psoriasis, n. 860. 
Psora Guttata, ii. 885. 
Psoas Abscess. See Abscess, 652. 
Ptosis, ii. 560. 
Ptyalism, 248, Chronic, 248, Mercury, 
248. 
Puberty, Voice of, 203. 
Pulse Suppressed, 454. 
Pulsatilla, in Asthma, 444. 
Pulsations of the Aorta, n. 557. 
Aortitis, 847. 
Puerpural Convulsions, n. 769. 
Puerpural Inflammation, 891. 
Puerpural Fever, 891, ii. 688. 
Pulmonary Consumption, Diagnosis, 
836,11. 205. 
Pulmonary Oedema, 602, 796. 
Pulmonary Apoplexy, 802, 834. 
Pulsatilla in Asthma, 444, in Ague, 
500, in Infantile Remittent, 
527, Toothache, 235, Depraved, 
Appetite, 267, Measles, 607, 
Urticaria, 614, in Scarlatina, 
596, Abscess, 658, Bronchitis, 
791, Hepatitis, 930, in Oph- 
thalmia ii. 97, Insanity, ii. 
434, in Rheumatism, n. 160, 
in Teething, 228, Hemicrania, 
ii. 504, Toothache, 235, in 
Flatulency, 267, In Vomiting, 
270, Constipation, 331, 333, 
in Cholera Morbus, 354, 
Hoarseness, 435, Ephialtes, 
454, Synocha, 532, Measles, 
C07, Urticaria, 614, Sleepless- 
ness, 712, Tonsililis, 748, Gas- 
tritis, 856, in Dysentery, 908, 
Gonorrhoea, it. 379, Orchitis, 
Ii. 384, in Cardialgia, ii. 512, 
in Tetanus, ii. 539, in Irri- 
tability, ii. 575, Loss of Sleep, 
ii. 576, Vertigo, n. 578, Hys- 
teria, ii, 591, Amcnorrhcea, ii. 
680, Dysmenorrhoea, n. 685, 
Menorrhagia, n. 692, Leucor- 
rhoea, n. 700, Ovarian Diseases, 
II. 717, in Chlorosis, its Sphere 
of Action, ii. 726, in Dropsy, 
n. 758, Also in Gout Flying 
from Place to Place. 
pulsations in the Aorta, n. 557. 
Pulse in Dyspepsia, 274. 
Puncta Lachrymalia, Diseases, el 
146. 
Punctured Wounds, 11. 197. 
Pupils, Contracted, Dilated, ir. 581. 
Purgatives, in Intestinal Obstruction. 
£35. 
Purity of Food, 285, 312. 
Purulent Urine, n. 317. 
Purple Face, 530. 
Purpura Hcemorrhagica, n. 199, 
i. 801. 
Purpura Senilis, ii. 200, Treatment, 
ii. 200. i. 801. 
Purpura Urticans, ii. 200. 
Purpura Scorbutica, n. 338, Treat- 
ment, ii. 339. 
Purpurine in Urine, n. 807. 
Purulent Diarrhoea, See Colitis, 917. 
Ophthalmia, ii. 101, Secretion 
of the Antrum, 242, Treatment, 
243. 
Pus, Different kinds of, ih 182, Ab- 
sorption of ii. 735. 
Pus and Mucus Distinguished, n. 
798. 
Pusillanimous, 847. 
Pustular Lxanthem. p. 627. 
Pustules on the Face, ii. 854. 
Pustule, Malignant, 668. 
Putrid Sore Throat, 592. 
Putrid Blood Diseases, 542. 
Pyloric Valve, Diseases of, See Dys- 
pepsia, 271, &c., in Gastralgia, 
ii. 516, Hardness of, 863. 
Pyrectica, Fevers, 458. 
Pyrosis, 267. 
Pythagorus, n., 398. 
Qualmishness, Nausea, 268. 
Quantity of Food, in Dyspepsia, 
284. 
Quarantine Laws and Yellow Fever, 
571. 
Quarrelsome, n., 431. 
Quartan Ague, See Intermittent 
Fever, 467, 472. 
Quick Consumption, it. 256, n, 727. 
Quinine, 486, Symptoms, 486, 487, 
488, its Action on the Nerve 
tissue, 488, on the Circulation, 
489, Defibrination, 489, In- 
jurious Effects, 514, 490, Pro- 
phylactic Power, 491, Size ol INDEX 
941 
the Dose, 513, Congestion of 
the Spleen, 516, in Palsy, II. 
660. 
Quinsy, 746, Nervous, 253. 
Quintessences, 215. 
R. 
Rabies Canina, n., 543, Treatment, 
ii., 546. 
Races of Men, Relative Superiority of, 
ii. 388. 
Rachialgia, (Neuralgia, &c.,) n. 478. 
Rachitis, n. 831, ii. 833, n. 472. 
Radetsky, Marshal, n. 298. 
Radiating Power of Woolen, 197. 
Rage, ii., 431. 
Ramollissement of the Brain, 713. 
Treatment, 717. 
Ranida. See 249, 250. 
Raphania, ii., 345, Gangrenosa, n. 
345. 
Rash on the Face, ii. 854. 
Rattling Respiration, 430. 
Rattle Snake, Bite of, 666, Poison in 
Yellow Fever, 580. 
Raucitas, 434. 
Reaction of the Organism against Me- 
dicinal Action, 82. 
Real and Feigned Insanity, n. 403. 
Reason, n. 394, Perverted, ii. 394. 
Reasoning Faculties, ii. 394, fnm 
False Premises, n. 397. 
Recession of Eruptions, 597. 
Rectum, Structure of, 390. 
Rectum, Stricture of, 398. 
Rectum, Symptoms of, Ani-prolapsus, 
398, Haemorrhoids, 390,Torpor 
of, (Constipation,) 323. 
Red Gum, ii. 856, Red Snow, ii. 
845. 
Red Precipitate, in Syphilis, ii., 314. 
Rejlex Action of the Spinal Cord, ii. 
525, ii. 528, Eccentric Irrita- 
tion, ii., 529, Centripetal Irrita- 
tion, it. 529. 
Reflex Neuralgia, ii. 529. 
Reflex Excito-motor Action, n. 
600. 
Reflex Operation of Counter Irri- 
tants, ii. 530. 
Regimen and Diet, 263, 258, 188. 
Regular Medicine, 49, 65, 135. 
Religious Melancholy, ii. 41 5, Mania, 
.i. 415, Chorea, n. 567, n. 569. 
Remedial Agents, Specific Effects of, 
110. 
Remedial Action, 110. 
Remittent Fever, Bilious, 516, Infan- 
tile, 524. 
Renal Calculi, ii. 774. 
Renal Capsules, Disease of, n. 72. 
Renal Cachexia, n. 21, Reparation of 
Injuries, 643. 
Renal Veins, Pressure on n. 768. 
Repelled Diseases, Danger of, n. 189, 
186, ii. 193, Tinea Capitis, n. 664. 
Repetition of Doses, 154, it. 261. 
Reproduction of Bones, n. 365. 
Reproductive Function, n. 674. 
Repetition of Doses, 154. 
Respiration, Artificial, n. 620. 
Respiration, Suspended causes Death, 
ii. 619. 
Respiration, 187, 418, Importance of, 
ii. 606. 
Respiratory Organs, Diseases of, 418, 
Dyspnoea, 440, Nervous Rela- 
tions of, 418, Affecting the 
Lungs, 436, Cough, 436, In- 
flammatory, 784. 
Respiration, Importance of, ii. 650, 
Suspended, Ephiates from, 454, 
Inflammatory Affections, 784. 
Respiratory Function, Diseases of, 
418, Sympathies of the Lungs, 
Heart and Stomach, 418, Gene- 
ral Observations on, 419, Treat- 
ment of, 419, Diagnosis of, 420, 
Abdominal Respiration, 420, 
Thoracic Breathing, 420, Aus- 
cultation, 420, Percussion, 421. 
Respiration in Consumption, n. 239. 
Retention of Urine, ii. 80, Treat- 
ment, ii. 82, 84, from Paralysis, 
II. 81, Spasmodic do., n. 81, 
of the Menses, n. 764. 
Retching, (Emetics, 268.) 
Reticulating Cataract, (See n. 131. 
Retina, Affections of, (Amaurosis,) n. 
120. 
Rest, in Injuries, n. 523. 
Restraints in Treating the Insane, 
ii. 425, II. 426. 
Resuscitation of Drowned Persons, 
II., 619, Marshall Hall’sMethod, 
II. 619, Possibility of, II. 622. 
Rete-mucosum, n. 841. 
Reticular Cancer, n. 284. 942 
INDEX 
Retroversion of the Uterus, ii. 713. 
Rhazes, 47. 
Rheumatic and Gouty Disease of the 
Kidneys, n. 50. 
Rheumatism, Metastasis to the Heart, 
844. 
Rheumatic Fever, ii. 156, Catarrhal 
form, also Sticta-pulmonaria. 
Rheumatism, Scarlatinal, 601. 
Rheumatism, Inflammatory, n. 156, 
Yol. i., 844, Acute, li. 156, 
Chronic, n. 158, Causes, II. 
158, Treatment, ii. 158. 
Rhododendron, n. 764. 
Rhus-radicans, 711, Pleuritis, 827, 
in Retention of Urine, n. 86, 
in Rheumatism, n. 158. 
Rhus-tox., in Ague, 506, Bilious Ty- 
phoid, 530, Yellow Fever, 576, 
Carbuncle, 670, Urticaria, 614, 
Abscess, 658, Paralysis after 
Brain Inflammation, 711, in 
Bronchitis, 790, Pneumonia, 
814, Pleuritis, 827, in Rheuma- 
tism, ii. 86, ii. 158, in Scrofu- 
lous Ophthalmia, II. 154, in 
Gout, n. 167, in Cholera, 373, 
in Haemorrhoids, 397, Cramps, 
II. 588, in Typhus, 543, 546, 
Abdominalis, 550, Erysipelas, 
676, Dysentery, 912, in Neu- 
ralgia, ii. 489, Chorea, n. 564, 
Apoplexy, il 646, Palsy, n. 
661, Crusta Lactea, ii. 849, ii. 
850, ii. 885. 
Rkus-rad., n. 86, also in Gout of the 
Stomach. 
Rhus-verniz, n. 850, n. 885. 
Richelieu, Case of, n. 391. 
Rickets, ii. 831, ii. 833, ii. 472, caus- 
ed by Irritation of Nerves, II. 472. 
Rigidity, n. 629. 
Rigor-mortis, ii. 527. 
Ring-worm, n. 867. 
Rome, Medicine at, 42, Climate of, n. 
236. 
Ronchus, 430. 
Roseola, 610, Syphilitic, ii. 322. 
Rosy Drop, 389, Ii. 855. 
Rot in Sheep, n. 824. 
Rough Skin, n. 289. 
Rubeola, 604. 
Rubuli, (Yaws,) II 878. 
Rosseau, n. 416. 
Hubus- Ccesius, in Diarrhoea, 350. 
Rupia, ii. 845. 
Rupture of the Membrana Tympani, 
730. 
Rush of Blood to the Head, Conges- 
tion, 464, Fullness of Blood to 
the Head, 691. 
Rust on Wheat, II. 843. 
Ruta Graveo/ans in Sprains,QQi, in 
Amaurosis, II. 128, in Par- 
alysis, ii. 661. 
S. 
Sohadilla in Ague, 502, in Neural- 
gia Coeliaca, ii. 510. 
Sabina, n. 166, Amenorrhcea, n. 680, 
Dysmenorrlioea, n. 686, Menor- 
rhagia, ii. 693, Ovarian Dis- 
ease, ii. 706. 
Saccharine Urine, ii. 808. 
Sac-Saturni, ii. 666. 
Sadness, n. 442, from Heart Disease, 
838. 
St. John's Wort, in Injuries, n. 523. 
St. Martin, Case of, 215, 862. 
Saint Vitus’ Dance, ii. 561. 
St. Anthony’s Fire, 672. 
Sal.-ammoniac in Obesity, n. 838. 
Saliva, 214, Secretion of, ii. 736. 
Salivary Glands, 248. 
Saliva, Salt Taste of, 249, Affections 
of, 248, 249. 
Salivary Fistula, 250, Concretions, 
250. 
Salivation, 248, from Mercury, 248. 
Salt Rheum, (Lupus,) ii., 289, Blue 
Lick Water, ii. 460. 
Salt Water, Externally, ii. 652. 
Sambucus, in Laryngismus, 451,Ague, 
507, in Bronchitis, 795. 
Sand in the Fye, Feeling of, Granu- 
lar Ophthalmia, ii. 103. 
Sanguification, 222. 
Sanguiferous, Function, 457, the 
Heart, 457, Circulation, 457. 
Sanguinaria, in Dyspepsia, 229, in 
Bronchitis, 791, in Croupal 
Diphtheria, 793, in Jaundice, 
402, in Polypus, 429, in Phthi- 
sis, ii. 247, Syphilitic Disease 
it. 325, in Neuralgia, n 490. 
Sanguineovs Plethora, il 177. 
Sanson, Case of, n. 669. 
Santoninc, (in Worms,) 388, INDEX 
943 
Saidnce in the Stomach, 303. 
Sarcomatous Tumor, n. 833. 
Sarsaparilla in Calculus, n. 801. 
Satiety, Sudden on Eating. See 215. 
Savin, n. 166, n. 693. 
Scabies, ii. 879. 
Scald Head, ii. 846, Following Con- 
vulsions, ii. 664, ii. 884. 
Scale Skin, n. 846, ii. 863. 
Scalp Affections of, n. 846, ii. 863, n. 
664. 
Scarf Skin, n. 841. 
Scarlet Rash, 600. 
Scarlatinous Angina, 591, Diagnosis, 
Diphtheria, 579. 
Scarlatinal Nephritis, 600, 602, 
Scarlatinal Rheumatism 601. 
Scarlatina, 590, Dropsy After, 600. 
Scarlet Fever, 590, Causes 593, Con- 
tagion, 593, Simplex, 591, Angi- 
nosa, 591, Maligna, 592, Treat- 
ment, 693. 
Schmier-Seife in Itch, ii. 883. 
Scilla, in Dropsy, n. 753. 
Scirrhus, ii. 284, of the Breast, n. 
290. 
Scleroma, ii. 901. 
Sclerotica, Irregularity of, (Staphyloma) 
ii. 344. 
Sclerotitis, See Ophthalmia, n. 88., &c. 
Scorbutus, ii. 332, Pathology, it. 335. 
Sciatica, Neuralgia, &c., n. 478. 
Scilla, in Pleuritis, 827. 
Scirrhus, ii. 280, of the Eye, See ii. 
142, of the Uterus, n. 297, 
Stomach, Case of Napoleon I., 
863. 
Scrotum, Dropsy of, n. 762, Herpes 
of, ii. 869. 
Scrofula, it. 259, Causes, n. 259, 
Treatment, it. 261. 
Scrofulous Ophthalmia, n. 150, 
Treatment, ii. 152, Disease of 
the Mesenteric Glands, n. 262, 
Joints, it. 176, ii. 764. 
Scurvy, ii. 332, Pathology, ii. 335, 
Treatment, n. 336. 
Scutellaria, in Hydrophobia, ii. 551. 
Scybala, 379, in Syphilitic Orchitis, 
ii. 325. 
Sea-sickness, 270. 
Sea-scurvy, ii., 332. 
Sebaceous Glands, n. 842. 
Secale, in Exophthalmia, II. 146, in 
Vomiting, 270, in Cholera, 370, 
in Varicocele, n. 345, in Gan- 
grene, ii. 345, Alcoholism, n. 
458, On the Spinal Marrow, n. 
524, in Palsy, n. 660, Menor- 
rhagia, ii, 693, in Leucorrhoea, n. 
700, Ovarian Disease, n. 706. 
Seche, Blennorrhoea, il 370. 
Secondary Syphilis, ii. 308, n. 317. 
Secretion, ii. 736. 
Sedentary, 938. 
Selection of Food, 285. 
Self-Digestion of the Stomach, 868. 
Selection of the Proper Remedy, 152, 
Senega. Bronch., 793, the 
Second Remedy, 156, 905. 
Self-abuse, n. 328. 
Semeiology, 165. 
Seminal Flux, n. 561, n. 714. 
Semilunar Ganglion, n. 573. 
Semen, Loss of, n. 714. 
Sempervivum, in Cancer, n. 289. 
Senile, Atrophy of the Brain, 702. 
Senile, Gangrene, n. 349, Treatment, 
ii. 350. 
Senna, in Colic, 322. 
Sensation, Diseases of, n. 468. 
Sense, Acuteness of, n. 577. 
Senses, Reasoning according to, ii. 
394, Illusions of, ii. 446. 
Sensitiveness, ii. 575, to Cold, n. 723, 
of Temper, n. 575. 
Sensile Antipathy, n. 577. 
Sensorial Function, n. 572. 
Sentimentalism, n. 416. 
Sensitive Temperament, n. 575. 
Sequelce of Scarlatina, 600. 
Sequelce of Variola, 632. 
Sepia, in Portal Venous Plethora, 412, 
in Ague, 506, in Haemorrhoids, 
397, in Scrofula, ii. 271, in 
Neuralgia, its Sphere of Action, n. 
502, in Gastralgia, n. 514, in 
Amenorrhcea, n. 680, Menor- 
rhagia, ii. 694, Leucorrhcea, ir. 
699, Ovarian Disease, it. 706, 
in Chlorosis, ii. 728, Acne, n. 
855. 
Septic Diseases, 541, n. 183, in 
Blood Poisons, n. 183. 
Serous Apoplexy with Chorea, II., 
569. 
Serous Diarrhoea, See Diarrhoea, 345. 
Serous Effusion, 642. 944 
INDEX 
Serous Exhalent Vessels, Disease of, 
ii., 739. 
Serous Cysts, n. 822. 
Serpcntaria, n. 681. 
Serpents, Bites of, 666. 
Servetus, 48. 
Sexual Function, Diseases of, n. 674, 
Female, n. 674, Male, ii. 714. 
Sexual Power Feeble, 717, Emissions, 
ii. 714. 
Shaking Palsy, n. 671. 
Shaking of the Brain During Mo- 
tion, ii. 495. 
Sheep, Disease of, II. 824. 
Shingles, il 867. 
Shipwrecked Persons,—Mental Suf- 
ferings, ii. 448. 
Shock, Effect of in Concussion, n. 522. 
Short Sight, See Hypermetropia, II. 
137. 
Shrieking, ii. 430. 
Shuddering, 474. 
Sick-headache, 694, n. 495. 
Sickness of Stomach, 268. 
Side, Neuralgic Pain, in Women, II. 
520. 
Sight, Derangements of. See Amauro- 
sis, ii. 120, Cataract, II. 131, 
Illusions of, ii. 446. 
Silent Mood, ii. 431. 
Silicea in Teeth, 238, in Pleuritis, 
827, Infantile Fever, 525, in 
Consumption, n. 224, in Scro- 
fula, ii. 273, in Syphilis, n.316, 
in Syphilitic Caries, IL 321, in 
Rickets, n. 835. 
Silly Demeanor, ii. 464. 
Silver, Oxide of, n. 613. 
Simple Hcemorrhoids, 392. 
Singing, n. 454. 
Sinking Chill, 510. 
Single Remedy, Reasons for Giving, 
157, 161. 
Sinuous Ulcer, n. 181. 
Singultus. See II. 515. 
Size of tlce Brain, n. 409. 
Skeiv-sight, Seen. 139. 
Skepticism in Medicine, 66. 
Skin, ii. 733, ii. 735, ii. 841. 
Skin, Acute Diseases of, Fibrile, 587, 
Chronic, do., Latent, ii. 186, 
Syphilitic Disease of, ii. 308, 
Disease caused by Compression 
of the Nerves, H. 870, its Sym- 
pathy with the Liver, 399,340, 
Prima Via, n 573, n. 186 
Skunk's Cabbage, ii. 588. 
Skullcap in Hydrophobia, n. 551. 
Sleep, Symptoms of, n, 650, Respira* 
tion in, 454. 
Sleep-walking, n. 633. 
Sleep, Effects of on the Brain, n. 408. 
Sleeplessness, 712, ii. 410, n. 576. 
Sleep, Want of, ii. 410, Effects of, n. 
576. 
Sloughing of the Cornea. See 
Cornea, n. 113. 
■ Small Doses, Objections to, Answered, 
137, Action of in Disease, 120, 
123. 
Small-pox, 627, History, 627, H. 326, 
Variola, 627, Treatment, 631. 
Smoking of Arsenic, 444. 
Smut on Wheat, n. 843. 
Snoring, 430. 
Soda Bi-Sulph, in Dyspepsia, 306, 
Compounds of, in Urine, n. 
796. 
Softening of the Brain, 713, n. 659, 
of Tissues, 117, of Bones, it. 
831, Syphilitic, II. 321, Kid- 
neys, ii. 775, Stomach, 867, 
Treatment, 868. 
Solanum Nigrum, in Gangrena, ii. 
346. 
Solanum in Ulcers and Carbuncles, 
ii. 387. 
Solidago-virgo-aurea in Ischuria, n. 
86. 
Solitude, Dread of, n. 430. 
Somnambulism, n. 633. 
Sopor., ii. 650. 
Sore Throat and Larnyx, 749. 
Soreness of the Skin, 423. 832, of the 
Stomach, 861. 
Sore Mouth, 248, Nurse’s, 740, Scor- 
butic, II. 338 
Spasms of the Glottis, 785, Theory 
of, ii. 526. 
Spasmodic- Jaundice. See Jaundice, 
407. 
Spasms of the Rectum, 895, of the 
Uterus, ii. 681. 
Spasm of the Eyelids, n. 149. 
Spasms from Eccentic Irritation, n. 
529. 
Specific Effects of Remedial and 
Morbific Agents, 79, 906. INDEX 
945 
Spectacles in Hypermetropia, n. 
138. 
In Squinting, n. 141. 
Speech, Defects ofj 435, Stammering, 
ii. 561. 
Spermatozoa, ii. 715.' 
Spermatorrncea,ii. 561, II. 714. 
Spigelia in Ophthalmia, n. 97, 
Scrofulous, do., ii. 155, in 
Worms, 387, Infantile Fever, 
526, in Neuralgia, II. 490, in 
Hemicrania, II. 504, Convul- 
sions, 390. 
Spina Bifida, n. 765. 
Spina Ventosa, ii. 284. 
Spinal Cord, Proper, n. 477, Func- 
tions of, ii. 698. 
Spinal Irritation, ii. 589, it. 723. 
Spine, Injury of, (Concussion of the 
Brain,) 687, 689. 
Spinal Cord, Nerves of, Origin, ri. 
476, Sycotic Affections of, n. 
567, Irritation of, n. 813, n. 
818. 
Spine, Curvature of, n. 525, n. 836, 
Congestion of, n. 524, Dropsy 
of, ii., 765, Concussion of, 
(Treatment of Concussion of the 
Brain) 689, h. 522, Treatment, 
il 523. 
Spinal Marrow, Inflammation of, n., 
523, ii. 669, Cerebro-spinal 
Meningitis, 527, Action of Bell. 
Ergot, Strychnine, n. 524, Re- 
flex Power of, ii. 525, Vaso- 
motor Nerves of, n. 525. 
Spiritualism, ii. 631, it 632. 
Spleen, Diseases of, 938. 
Spleen, in Cattle, it, 184. 
Spleen, Turgescence of, 516. 
Splenitis, 937, 512, 516. 
Spleno-phlebitis, 938. 
Splenitis, from Ague, 512. 
Spongia, in Croup, 777. 
Svongia, in Goitre, n. 276. 
S'lKmtaneoas Development of Animal- 
culce, ii. 826, ii. 825. 
Spoiadic Cases, 211. 
Sporadic Cholera, 351, 352. 
Spots before the Eyes. Amaurosis, ii. 
120. 
Spotted Fever, 527. 
Sprains, 662. 
Srnrzheim, Case of, 555. 
feu IL—6A 
Squamous Diseases, see Pityriasis, &c., 
n. 846. 
Squaw Root, Macrotin, 509, n. 686. 
Squill, ii. 753, in Dropsy, also in Dia- 
betes. 
Squinting, n. 139, n. 559. 
Staggers, n, 570. 
Stannum, in Phthisis, n. 245, Epi- 
lepsy, ii. 612, in Leueorrhcea, 
u. 699. 
Stammering, 435. 
Staphyloma, n. 134. 
Staphysagria, in Ague, 506, in Tooth- 
ache, 235, Typhus, 553, De- 
pressing Passions, ii. 428, Anger, 
&c., ii. 431, in Herpes, II. 
868. 
Starvation, 258. 
Starting of the Limbs, n. 561. 
Steatoma, II. 823. 
Sterility, n. 682, n. 715. 
Sternalgia, n. 552, Chronic do., II. 
553. 
Stertor, 430, II. 635. 
Stibium. See Tartar-emetic, Antimony, 
83, 631, &c. 
Sticta Pulmonaria, in Neuralgia, II. 
494, Also in Catarrh. 
Stiffness of the Limbs, Rheumatism, 
II. 158. 
Stillicidium-lachrymalis, n. 147, 
Urinse, n. 77, 78. 
Stimulants in Delirium Tremens, 
II. 453. 
Stimulants in Diphtheria, 773, in 
Gangrene, ii. 351. 
Stomacace, 737. 
Stomach, Derangements of, 256, Sym- 
pathetic Affections of, 307, Self- 
Digestion of, 668, Congestion 
of, 413, Fermentation in, 282, 
303, Treatment, 289, Morbid 
Sensibility of, 282, &c., Acidity 
of, 256, Overloading of, 281, 
857, Cancer of, 863, Inflamma- 
tion of the Lining Membrane 
of, 853, from Indigestible Sub- 
stances, 857, Acute, 852, from 
Melted Lead, 858, from Boiling 
Water, 856,Acids, 857, Chronic, 
860, Hydrocephaloid Disease, 
in Children, 310, Ulcer of, 
866, Softening of, 867, Neu- 
ralgia of, II. 514 Gout of the, 946 
INDEX 
Remedies, Colch., Bry., Puls., 
Nux-vom., Coloc., Bell., Rlius- 
tox, Arn., Guiac. Hypertro- 
phy of the Coats of, 873, Gas- 
tralgia, ii., 514, Heat in, feeling 
of, 861, 862. 
Stomach, Deranged by Organic Dis- 
ease of the Uterus, 308, from 
Kidney Disease, II. 670, from 
Disease of the Brain, 308, from 
Injury, n. 529, Oppression of, 
II. 514, Pain or Aching in, II. 
514, II. 519, Deranged, with 
desire for suicide, 275, in Ner- 
vous Females, 309. 
Stoma*',h Pump in Poisoning, n. 
652. 
Stomatitis Materna, 740, Treatment, 
741, Pathology, Diphtheria, 
752, Ulcero-Membranous, do., 
739, Mercurial, 739. 
Stone in the Bladder, ii. 770, Causes, 
ii. 778, Formation of, n. 792. 
Stone-bruise, 664. 
Stoppage of the Nose, Catarrh, 423. 
Strabismus, n. 560, Convergent, n. 
139. 
Stramonium in Amaurosis, n. 129, 
Synocha, 532, Sleeplessness, 
712, in Brain Disease, ii. 407, 
Delirium Tremens, it. 454, in 
Tetanus, il 541, Strabismus, 
560, Chorea, n. 563, Convul- 
sions, ii. 584, Epilepsy, 607, 
610, Poisoning, n. 611, Palsy, 
ii. 662. 
Strangulation, 415, Congestion of 
Stomach from Asphyxia,n.616. 
Straining Effects of, 662. 
Strangury, it. 77, 78. 
Stretching, 474. 
Stricture of the Rectum, 398,Urethra, 
ii. 83, 84, 85, Spasmodic, ii. 
372, from Gonorrhoea, ii. 371. 
Stridulous Breathing, Laryngismus, 
448. 
Strophulus, See Papular Skin, n. 856. 
Structural Disease, 640, 919. 
Struma Scrofula, n. 259, Treatment, 
II. 261. 
Struma, Tyrolensium, ii. 278. 
Strumous Disease of Mesenteric 
Glands, n. 266. 
Strumous Ophthalmia, n. 150. 
Stupefaction, n. 650, II. 652, Stupid 
ity, ii. 464. 
Stupor, ii. 650. 
Strychine on the Spinal Cord, n 
524, Poisoning by, ii. 538, in 
Tetanus, II. 536, in Palsy, II. 
660, Tests of, ii. 538, Physiolo- 
gical Test, ii. 539. 
Stye, il 144. 
Styptic to Stop Bleeding, n. 196. 
Submersion, Asphyxia, il 615. 
Substitutive Action of Mercury, 403. 
Subsultus Tendinum, 547. 560. 
Succession in Diagnosis, Pneumo 
Thorax, 818. 
Sudor Anglicus, n. 219. 
Suffocation, il 615. 
Suffocative Catarrh, 785. 
Suffocative Paroxysms, 441. 
Sugar, ii. 234, formed in the Liver 
ii. 813. 
Suicidal Monomania, il 439. 
Sulphate of Copper in Ophthalmia, 
96, 98, 99. 
Sulphur in Ague, 503, in Epilepsy, il 
607, Toothache, 234, Ptyalism, 
251, Measles, 608, Small-pox, 
632, Urticaria, 613, Bronchitis, 
798, Pheumonia, 814, Pleuritis, 
827, Aggravation by, il 194, 
in Hepatitis, 930, Ophthalmia, 
II. 94, Corneitis, ii. 114, Ver- 
tigo, ii. 579, in Cataract, n, 
133, in Scrofulous Ophthalmia, 
ii. 153, in Scrofulous Diseases, 
ii. 261, in Toothache, 235, 
Hysteria, n. 591, in Affections 
of the Mouth, 251, Constipa- 
tion, 331, 333, Diarrhoea, 347, 
in Cholera, 366, in Haemor- 
rhoids, 397, in Coryza, 425, 
in Hoarseness,435, in Ephialtes, 
454, Infantile Remit. 525, in 
Yellow Fever, 579, Stomatitis, 
742, in Dysentery, 913, in Con- 
sumption, it. 242, in Syphilis, 
II. 316, in Caries, ii. 321, Or- 
chitis, it. 384, Ulcers, ii. 387, 
in Amenorrhoea, it. 680, in 
Leucorrhoea, ii, 699, in Chloro- 
sis, ii. 724, in Dropsy, ii. 759, 
Milk-scall, n. 849, in Itch, ii. 
882, Depressing Passions, n. 
428, Insanity, ii. 438, Delirium INDEX, 
947 
Tremens, ii. 456, in Tetanus, 
ii. 542, Strabismus, n. 560, 
Chorea, ii. 564, Palsy, n. 661. 
Summary of Allopathic Doctrines, 
121. 
Summary of Diseases of the Lungs, 
834.' 
Summer Complaint, 883. 
Suppression of the Metises, n. 674, of 
Urine, n. 79. 
Sulphuric-ether in Cataract, n. 
133, in Worms, 388, Delirium 
Tremens, n. 454. 
Sulphuric-acid in Diarrhoea, 348, 
Stomatitis, 742, Yellow Fever, 
580, Dysentery, 911, Syphilis, 
ii. 312, Calculus, n. 789. 
Sulphurous-acid in Dyspepsia, 306, 
in Porrigo, n. 861, in Delirum 
Tremens, il 546. 
Sun-stroke, 692. 
SurgicalTreatment of Co.ncer,u.285. 
Surfeit, 311. 
Susceptibility of Organs Increased 
by Disease, 116, Mercury in 
Gangrenopsis, n. 354. 
Suspended Animation from a Fall, 
691. 
Suspicion, n. 428, it. 429. 
Swallowing, 215, Difficult, 252. 
Sweat, Morbid, n. 219. 
Swelling of the Bones, Syphilitic, n. 
321. 
Swimming in the Head, n. 578. 
Swiss, Nostalgia of, ii. 462. 
Swooning, n. 625. 
Sycosis, ii. 325, in Chronic Diseases, 
ii. 326, its Influence, n. 326, 
Vaccination, ii. 326, Thuja, u. 
327, 328, Condylomata, it. 
326. 
Sycotic Nervous Disease, Small-pox, 
634, Miasm, See 619, n. 185, 
ii. 330, ii. 698. 
Sycotic Gonorrhoea, il 327, Affections 
of Spine, &c. n. 567. 
Sydenham, 50. 
Sympathy of the Liver with the 
Skin, 399, Kidneys, do., n. 
842, Internal Mucous Mem- 
brane and the Skin, il. 180, il. 
573. 
Sympathetic Affections of the Sto- 
mach, 307. 
Sympathetic Nerves, n. 603, Vomit- 
ing in Phthisis, 307. 
Sympathetic Actions Reflected to 
other Organs, il 530. 
Sympathetic Aflections, n. 572, n. 
573. 
Sympathy, 418, n. 572, Pneumogas- 
tric Nerve, 158. 
Symptoms of Disease, 165. 
Syncope, n. 407, n. 625, from Loss of 
Blood, ii. 690. 
Synocha, 531, Diagnosis, 531, Causes, 
532, Treatment, 532, Gelsem. 
532, Mercury, 533, 403. 
Synovial Inflammation, ii. 175, n. 
764. 
Syjrtiilitic and Mercurial Aflections 
of the Eye, n. 155, Roseola, ii. 
322. 
Syphilis, ii. 300,Effects of Mercury, n, 
303. 
Syphilis Infantile, n. 318, n. 103, 
Caries from, n. 321, Transmis- 
sion of, by Vaccination, n. 322, 
Treatment, n. 309, Mercury, n. 
309, n. 319, Evidence of Cure, 
II. 316, Secondary, ii. 308, 
II. 317, Nodes, ii. 321. 
Syphilitic Diseases of the Mucous 
Membrane, n. 319. 
Syphilitic Discrasia, ii. 318, II. 
328, Inoculation, n. 321. 
Syphilization, n. 321. n 322. 
Syspasia, ii. 580. 
Systatica, n. 572. 
T. 
Ttzbacum, in Obstruction of the Bow- 
els, 341, Strabismus, it. 560, 
Blood-poisoning, it. 203. 
Tabes-kictea, n. 718. 
Tabes-dorsalis, n. 714, n. 717. 
Table of the Action of Remedies, 110. 
Taciturn, ii. 441. 
Tcenia, 380. 389. 
Talipes, n. 731. 
Treatment, ii. 731. 
Tanjore Pill, n. 878. 
Tannate of Quinine in Hcemrr- 
rhage, ii. 255. 
Tape Worm, 380, 389. 
Tar Cap, in Tinea, ii. 664. 948 
INDEX 
Taraxacum, 506, Ague. 
Tar axis, (Ophthalmia.) il 899. 
Tartarized Antimony, Tartar-emetic, 
83, in Ptyalism, 249, Small- 
pox, 631, Varioloid, 634, Ence- 
phalitis, 708, Hydroceph., 723, 
Pharyngitis, 749, Diphtheria, 
767, Croup, 779, Bronchitis, 
789, Pneumonia, 808 to 811, 
Pleuritis, 826, Heart Disease, 
843, Nephritis, n. 68, Rheuma- 
tism, il 161, Synoclia, 532, 
Yellow Fever, 579, in Orchitis, 
ii. 324, Syphilis, ii. 324, in Sy- 
cosis, il 326, in Gangrene, ii. 
358, in Gonorrhoea, ii. 381, Or- 
chitis, il. 384, Insanity, II. 438, 
Vertigo, il. 579, in Chlorosis, il 
729, Porrigo, il 862. 
Tartrate of Potash, in Calculus, n. 
789. 
Tartar of the Teeth, 239. 
Tar Water, n. 351. 
Tasso, ii. 398. 
Taste, 214. 
Tea, 111 effects of, n. 574, on Children, 
ii. 575. 
Teeth, Diseases of, 226, Inflammation, 
230, Causes, 230, Treatment, 
254, 255, Tartar of, 239, Neu- 
ralgia from, n. 497. 
Teething, 226, Process of, 227, Treat- 
ment, 228, Influence on Health 
and Disease, 227, 201, Wisdom, 
229, Operations on, 237, Caries 
of, 230, Symptoms, 227. 
Teeth, Temporary, 237. 
Temper, Irritable, ii. 575. 
Temples, Ancient, 37. 
Temperature of the Body, 175. 
Tendons, Division and Healing of, n. 
731. 
Teneotomy, ii. 731. 
‘Tenesmus, 895. 
Tenesmus of the Cervix, ii, 683. 
Terebinthince, in Bright’s Disease, il 
43, ii. 66, in Nephritis, II. 68, 
in Ischuria, II. 86, in Worms, 
388, in Hajmorrhage, IL 255, 
in Gonorrhoea, n. 380, Epilepsy, 
II. 613. 
Testes, Inflammation of, il. 383, II. 
324, Dropsy of, II. 762. 
Testicle, Inflammation of, il 383, n 
324, Induration of, n. 383, IL 807 
Tetanus, II. 531, Treatment, il 534 
Ciironic, Case of, II. 541. 
Tetter, il, 865. 
Teucrium in Polypus, 427, 428. 
Thalami Optic, il 639. 
Theine, n. 574. 
Theomania, il 415. 
Theories of Homceopathy, 127. 
Theory of Cure, not yet perfect, 134- 
Therapeutics, 75. 
Thick Skin, il 901. 
Thirst, 255, Excessive, 255, Morbid, 
255, Loss of Thirst, 256, Re- 
medies, 256. 
Tight Lacing, Effects of, 169, n. 683. 
Thoracic Dropsy, il 791. 
Thorax, Dropsy of, il 761, Inflamma- 
tory Affections of parts within, 
784, Defective Conformation of, 
II. 228. 
Thought, Rapidity of, il 394. 
Thought, Deranged, associated with 
Physical Disease, n. 406. 
Thread Worm, n. 825. 
Throat, Symptoms of, in Phthisis, n. 
217, Inflammatory affections of, 
748, Ball, as if Rising in the, n. 
589, Burning in, 749, Choking, 
441, Constriction, 253, Inflam- 
mation of, 749, Ulcers in, 592, 
Foreign Bodies in, 252, Effects of 
Syphilis on, il 308. 
Throbbing Headache, il. 506. 
Throbbing in the Aorta, n. 557. 
Thrush, Stomatitis, 737. 
Thuja, in Polypus, 429, Asthma, 447, 
Ague, 506, in Small-pox, 634, 
in Haemorrhoids, 396, Croup, 782, 
in Syphilis, II. 315, in Urticaria, 
615, Diarrhoea, 347, in Sycosis, 
il, 327, Proving of, II. 327, II. 
329, II. 330, in Gonorrhoea, IL 
380, in Hemicrania, il. 504, in 
Spinal Affections, n. 567, Sleep 
lessness, II. 576, Palsy, n. 669 
Leucorrhoea, II. 698, in Porrigo, 
II. 861, Herpes, II. 868. 
Thyroid Gland, Enlarged, il 273, 
Transformation of Structure, n. 
274. 
Tic Doloreux, Neuralgia, n. 477, 
Treatment, il 485, From Local INDEX. 
949 
Irritation, ii. 496, Abnormal De- 
position, ii. 496. 
Tinea Capitis, n. 846, ii. 863. 
Tired or Fatigued, Fever from, 471. 
Tissue, Morbid, 647. 
Titanium, Poison of the Blood, ii. 185. 
Tobacco, Poisoning by, ii. 203, in Ob- 
structions of the Bowels, 341, 
in Neuralgia, ii. 488, Strabis- 
mus, ii. 560. 
Toe Nails, n. 891. 
Tongue, Diseases of, 735, Palsy of, ri. 
650, Inflammation of, 735, 
Cancer of, IL 287, ii. 289, Indi- 
cations of in Fevers, 520, in 
General Diseases, 171. 
Tonsils, Affections of, 746, Inflamma- 
tion of, 746. 
Tonsilitis, 746. 
Tooth Edge, 239. 
Toothache, Symptoms of, 230, Caries, 
230, Causes, 230, Treatment, 
232, Local Remedies, 236, 
Anaesthetics, 238. 
Topical Applications in Syphilis, n. 
310, in Gonorrhoea, ii. 376. 
Torpor, Asphyxia, it. 614. 
Touch, Organ of, n. 842. 
Toxcemia, From Merc., ii. 202, From 
Tobacco, 203. 
Trachealis, Cynanche, 774. 
Trachea, Affections of, 774, Foreign 
Bodies in, 431. 
Tracheitis, Croup, 774, Diagnosis,774, 
Causes, 776, Non-membranous, 
775, Treatment, 776, Membran- 
ous, 775, Remedies 776. 
Tranquility, ii. 431. 
Tracheotomy, 751. 
Trance, ii. 627. 
Transfusion of Blood, 541, Catalysis, 
Saline Fluids into the Blood, 
ii. 179. 
Transformation of Tissues, 179. 
Traumatic Rcemcrrrhage, ii. 195. 
Neuralgiia, ii. 497. 
Tetanus, il 532. 
Trembling, Mercurial, it. 671. 
Trichosis, ii. 898. 
Trichiasis, n. 149. 
Trichiniasis, ii. 260. 
Tricocephalus, 380. 
Trifolium-infcena, 439. 
Trigeminus, ii. 481, n. 495, Irrita- 
tion of, ii. 736. 
Trismus, ii. 531, Treatment, ir. 534. 
Trituration and Succussion in Pre- 
paring Medicines, 150. 
Tubercle, n. 221. 
Tuberculosis, n. 220, i. 836. 
Tuberculosis of Bronchial Glands, 
ii. 257. 
Tumid Leg, Elephantia, n. 331. 
Tumor, n. 823, n. 840. 
Tumor, Fibrous, n. 803, Fatty do., rt. 
823, Haemorrhoidal, 393, ol 
the Bladder, n. 802, ir. 803. 
Turgescence of the Viscera, 412. 
Turks, 47. 
Turpentine, (Terebinthin®,) in Gouor 
rhcea, 380. 
Tussilago, in Nephritis, n. 68. 
Twitching of the Muscles, ii. 561. 
Tying Large Arteries of the Head, 
ii. 528. 
Tympanitic Abdomen, 313, 892. 
Tympanum, Diseases of, 727, ii. 664. 
Typhoid Fever, 557, Causes, 557, 
Diagnosis, 560, Pathology, 564‘ 
Treatment, 547, 566, Arsenic, 
547, Bell., 549, Bry., 549, 551, 
553, Aeon., 550, Opium, 550, 
Rhus, 550, 555, Merc., 551, 
Camphor, 551, Plios.-acid, 551, 
Rnus-tox., 552, Carbo.-veg., 
552, Muriatic-acid, 553, Calc.- 
carb., 555, Case of Dr. Spurz- 
heim, 555. 
Typhus Fever, 536, Treatment, 543, 
Water. 543, Adeps, 544, Diag- 
nosis, 538, Causes, 539, Crowded 
Rooms, 540, Catalysis, 541, Sep- 
tic Diseases, 541, Fermentation, 
541, Putrid Affections, 542, 
Cerebralis, 544, Bell., 544, Bry., 
545, Aeon., 545, Opium, 546, 
Rhus, 546, Merc., 547, Acetic- 
acid, 547. 
Typhus Abdominalis Treatment, 
547, Arsenic, 547. 
Typhus, Pneumo., 584, Treatment, 
584, Abdominal, 587, (Typhoid,) 55 7. 
Tyrolese Struma, il 278. 
Ulcers, ii. 181, ii. 385, see Cicatriza- 
tion, r. 641, Syphilitic, ii. 308. 
Ulcers of the Surface, n. 385, Indolent, 
ii. 386. 
Ulcers, Typhus, of Pever's Glands, 565 950 
INDEX. 
Irritable, it. 386, Treatment of, 
ii. 386, of the Cornea, n. 113, 
of the Throat, il 308, from In- 
growing Nail, ii. 894, Stomach, 
866, Treatment, 867, n. 723, 
Aqua Calcis, 867. 
Ulceration of the Larynx, 749, of the 
Bronchi, 789, Throat, 592, of 
the Intestines, 917, Colon, 915, 
917, Malignant, 919, of Car- 
tilages of Joints, 665. 
Ulcus Ulcer, n. 385. 
Understanding, Distinguished from 
Reason, n. 394. 
Unguent for Scabies, il 883. 
United States, Climate in parts of, n. 
236. 
Urate of Soda, ii. 166 
Urates in Calculi, ii. 791, n. 807. 
Uraemia, n. 21 to 27, u. 767, and n.52 
Uranium-nitr., n. 718, also in Dia- 
betes. 
Ureters, Obstruction of, n. 83. 
Ure, Experiments by, n. 623. 
Urethra, Stricture of, ii. 83, n. 84, ii. 
85, ii. 371, Spasmodic do., n. 
372, Burning in, n. 77, Hemor- 
rhage from, ii. 69. in Syphilis, 
ii. 325, Inflammation of, ii. 77. 
Fistula of, il. 380. 
Urea, ii. 17, in Gout, ii. 165, ii. 473, 
in Calculus, il. 790, Changed to 
Carb.-ammonia, II. 769. 
Urethral Running, ii. 366, Stricture 
in causing Calculus, II. 778. 
Urethritis, II. 77, Dysuria, il. 77. 
Urethritis, Infectious, n. 366, Dry, n. 
370. 
Urging to Stool, Tenesmus, 895. 
Uric-acid, n. 18 and n. 54, in Gout, 
ii. 165, 171, Calculi, ii. 772. 
Urging to Urinate, il 77. 
Urinary Organs, Diseases of, n. 9, 
Infectous, ii. 366. 
Urinary Calculi, n. 770. 
Urine, Suppression of, ii. 78, 79, Ne- 
\ phritis, ii. 66, Retention of, n. 80, 
Incontinence of, il. 86, Bloody, 
II. 69, II. 325, H. 803, il. 805, 
Scalding of, II. 77, Increased 
Secretion of, il. 808, Bloody, 
785, GSdemaof the Lungs, 796, 
Albuminous, II. 23, Chemical 
Changes in, II. 776, Saccharine, 
n. 812, ii. 816, Bilious, n. 807, 
Purulent, n. 807, Production 
of Disease by Mechanical Le- 
sions, n. 76. 
Urine changed by Irritation of Nerves, 
ii. 472, ii. 670, Acid Reactions 
of, ii. 18, 20. 
Urine retained in the Blood, II. 767, 
Uric-acid do., ii. 18, Quality of, 
Examination of, n. 12, Fixed 
Salts in, n. 21, II. 46. 
Urticaria, 610, Diagnosis, 610, Causes, 
612, see Asthma, 442, Treat- 
ment, 613. 
Uteritis, n. 729. 
Uteri Prolapsus, ii. 713, Cervix, Ul- 
ceration ot, ii. 701. 
Uterine Complications of Kidney 
Disease, ii. 51, Contraction, 
Misplaced, n. 585. 
Uterus, Affections of, ii. 674, Inflamma- 
tion of, ii. 729, Haemorrhage 
from, ii. 689, in Syphilitic Sub- 
jects, ii. 325, Scirrhus, ii. 297, 
Indurations, ii. 297, Prolapsus 
of, ii. 709, ii. 713, Polypi of, 
427, Congestion of, ii. 681, 
Spasms of, n. 681. 
Uva Ur si, in Ischuria, IL 86, Dropsy, 
ii. 758. 
Uvula, Affections of, 437. 
V. 
Vaccination, 617, Mode of Perform- 
ing, 617, Successful, 618, Re- 
vaccination, 623, Permanence 
of Protection, 622, 633, Diag- 
nosis, 620. 
Vaccinia, 616, Objections to, ii. 326, 
II. 322, Irregular, 619, 624, 
Diagnosis, 620, Evidence of 
Successful Vaccination, 618, 
Transmission of Syphilis by, II. 
322, Rules to avoid it, II. 324. 
Vaccinin, 630. 
Vagaries, Fanciful, ii. 446, n. 464. 
Vagus, Pneumogastric, 158, 418, IL 
529. 
Valves of the Heart, Diseases of, 838, 
840, Sternalgia from, II. 553. 
Varicose Veins, 801, llamamelis, 801, 
ii. 344, Spermatic Vein, 801, 
II. 444. 
Vapors, Effects of Noxious, II. 614. INDEX 
951 
Varicella, 624. 
Varicocele, Hamamelis, 801, II. 345. 
Variolin, 630. 
Varix, 801. 
Varioloid, 633, Treatment, 633, Merc., 
634, Opium, 634, Thuja 634, 
Tart.-emet., 634. 
Variola, Small-pox, 627, Varieties, 
628, Eruptive Stage, 629, 
Causes, 630, Treatment, 631, 
Aeon., Bell., Tart.-emet, 631, 
Mer. 632, Camph. 632, Sequelae, 
632, Boils, 633, Caries, Con- 
vulsions, 633, Opii, 633, Ar- 
sen., Ammon, 633. 
Vascular Nerves, 859. 
Vegetations, Cauliflower, n. 803. 
Veins, Varicose, ii. 344. 
Velum., Pendulum Palati, 737. 
Ventilaticrn, Neglect of, n. 624. 
Ventricles, Disease of, Vol. I. 841. 
844. 
Verruca, Wart, it. 901. 
Venereal Disease, n. 300, Node, n. 
321. 
Venesection. See Bleeding, in Iritis, 
ii. 118. 
Venous Plethora of the Viscera, 412, 
in Gout, ii. 171. 
Veratrum, Album., in Ague, 499, in 
Colic, 320, in Cholera Morbus, 
353, in Cholera Asiatica, 368, 
369, Synocha, 532, Yellow 
Fever, 575, 578, Gastritis, 855, 
Cramps, II. 5S8, Summer Com- 
plaint, 890, Dysentery, 913, 
Enteritis, 882, Neiralgia, II. 
490, Nervousness, n. 575, Apo- 
plexy, ii. 647. 
Veratrim Viride, 508, Ague, in 
Pneumonitis, 815, also in Car- 
diac Gout, Endo-carditis, and 
Rheumatism. 
Verdigris, in Hydrophobia, ti. 550. 
Verminous Diseases, 380, 386. 
Vertebree, Diseased, n. 673. 
Vertigo, 694, il 578, Cyclamen in, n. 
505. 
Vernmontanum, Cauterization of, n. 
716. 
Vesicular Fever, Pemphigus, n. 851, 
Eruptions, 850, n. 866, Herpes, 
ii. 866. 
Vibrations through the Body, ae 
from Sound, il 575. 
Vibriones, in Fermenting Substances, 
ii. 825. 
Vicarious Menstruation, ii. 674. 
Vicious or Depraved Appetite, 264. 
Vienna Salve, n. 883. » 
Vinegar, n. 195, in Obesity, n. 838. 
Villous Cancer, n. 802. 
Viola Tricolor, n. 848. 
Visceral Venous Plethora, 412, 
Sepia, 412. 
Viscera, Abdominal Diseases of Func- 
tional, 256, Inflammation, 852. 
Visions, Illusions, n. 446. 
Vis Medicatrix Natura, 193. 
Viper, Bites of, See Serpents, 666, 
Blood Poisoned by, n. 184. 
Vital Principle, Doctrines Respect- 
ing, 41, ii. 473. 
“ Vital Spirits,” Nervous Fluid, &c., 
ii. 471. 
Vitiated Cells, Formation, 646, Appe- 
tite, 264. 
Vitus, St., Dance, ii. 560. 
Vivacity, 96. 113. 
Vocal Avenues, Affections of, 423. 
Voice, Affections of, 433, 434, Loss 
of, Aphonia, 433. 
Volition, ii. 475. 
Voluntary Motion, n. 475. 
Vomiting, Process of, 268, Sympa- 
thetic in Phthisis, 807, From 
Effects of Gall-stones, 407, of 
Blood, 413. 
w. 
Wakefulness, 712. 
Walking, Difficulty in Learning to, 
ii. 831. 
Want of Breath, 440. 
Warts, Malignant, ii. 901. 
Warts, ii. 901, The Face. n. 901, on 
Cicatrices, 646, Sycotic or Fig- 
warts, ii. 326. 
Waste of the Body, 224, from Inac- 
tion, ii. 659. 
Watching, Effects of, n. 410. 
Water, Effects of Drinking, 297, on 
Bronchocele, ii. 275,as a Reme- 
dy, 297, in Alcoholism, n. 460, 
in Typhus, 543, Cold Watei 
Bandage in Croup, 783, Use of 952 
INDEX 
Diseases Connected with, 385, 
Treatment, Spigelia, 387, Cina, 
387, Santonine,888, Ascarides, 
388,01. Terebinth, 388, Taenia, 
Sulph.-acid, 389. 
Wounds, Poisoned, 666, 667, 668, 
Bleeding from, II. 195, Dissec- 
tion, Wound, 667, Punctured, 
II. 197, Mode of Reparation 
in,640, Lymphization,640,Cica- 
trization, 641, Cell-formation, 
641, Adhesive Process, 643, 
• Granulation, 643. 
Wounded Nerves, n. 497. 
Wrinkling of the Skin, 261. 702. 
Wrist-drop, n. 666. 
Wrist-joint, n. 666. 
X. 
Ximenes, Cardinal, Case of, II. 391. 
Y. 
Yarrow, in Haemoptysis, 800. 
Yawning, 474, n. 508. 
Yaws, ii. 878. 
Yeast, Growth of, n. 844. 
Yellow Complexion, 311. 
Yellow Fever, 566, History of, 566, 
568, Premonitory Symptoms, 567, 
Causes, 570, Contagion, 570, 
Former Epidemics, 568, Treat- 
ment, 574, Crotalus, 58. 
Youth, Influence of on Disease, 203. 
z. 
Zinc, Chloride of, in Cancer, n. 285. 
Zinc, in Scarlatina, 596, Phos., in 
Brain Softening, 719, Congestion, 
Spurious Hydrocephalus, il 407, 
Epilepsy, n. 612. 
Zinc, Sulphate of, Opacity of the Cornea, 
ii. 113, in Epilepsy, n. 613, in 
Gonorrhoea, n. 376, 377, in 
Opium Poisoning, n. 653. 
Zinc, Phosphate of, n. 612. 
Zizia-aurea, in Convulsions, il 585. 
Zona, Herpes Zoster, ii. 867. 
Zymotic Diseases, 588. 
in Gonorrhoea, n. 377, it. 378. 
Water-brush, 267. 
Water-pox, 624. 
Weakness of Mind, Anacar. n. 829, 
of Limbs, n. 670. 
Weaning, 201, Marasmus from, 310. 
• Wear and Tear Malady,” 279. 
Weeping, Spasmodic, n. 589, Ailments 
from, ii. 589. 
Weight and Dimensions of some 
powerful Agents unappreci- 
able, 133. 
Wellington, Case of, 606. 
Wens, ii. 823, n. 840. 
Wetting the Bed, n. 86. 
What is the “Dike that Cures," 152. 
Wheezing, 430. 
Whining Mood, ii. 434. 
White Steel ling, ti. 174, it, 261, Soft- 
ening of the Brain, 713, il. 
659. 
White Lead in Erysipelas, 681. 
White Kidney, ii. 44. 
Whitlow, 661. 
Whizzing in the Head, 691. 
Whooping Cough, 438, Causes 439, 
Diagnosis, 438, Treatment, 439, 
Tart,-em.Trifolium, 439, Capsi- 
cum. 440, Coffee, 440, Relation 
to Exanthemata, 609. 
Wild Feeling in the Head, 691. 
Wild Huntsman, n. 448. 
Wind-broken, 430. 
Wines, 708, 302, in Apoplexy,n. 647. 
Winter, Complaints of, 204. 
Wisdom, Personified in Minerva, ii, 
394. 
Wisdom Teeth, Evolution of, 229. 
Women, Nervous Diseases of, ii. 520, 
American, Increase of Insanity 
Among, it. 414. 
Wood, Complaints of Workers in, 
Wool, Application of, Grangene, ii. 
351. 
Woorara in Tetanus, ir. 536, on the 
Motor Nerves, n. 537. 
Worm seed, 387. 
Worms, 380, n. 329, Causes, 383,