THE SCIENCE OP THERAPEUTICS, ACCORDING TO THE PRINCIPLES OF HOMOEOPATHY, BY BERNHARD BiEHR, M. D. THAN SLATED AND ENRICHED -WITH NUMEROUS ADDITIONS PROM Blapka and other sources. BY CHARLES J. HEMPEL, M. D. VOL TIME I. PHILADELPHIA: BOERICKE & TAFEL. Copyrighted by Boericke & Tafel. PREFACE. The work which is here presented to the public is a work of no ordinary merit. It is to take the place of the late Hart- mann’s Acute and Chronic Diseases; but in point of scientific value and practical usefulness it is as far superior to the former as the present status of Plomceopathy is above that of Hart- mann’s time. Baehr is a man not only endowed with great scientific accomplishments, but he is likewise a man of large experience. It is our opinion that this work will be read with pleasure and profit by every physician, and we recommend it to all students of medicine who are anxious to obtain a more elevated perception of Homoeopathy. We have incorporated in this work large sections from Kafka, so that this author is also presented in these two volumes. We have likewise introduced on suitable occasions the new remedies, and have made ‘Valuable additions from our Journals and drawn upon our personal records. It is with infinite pleasure that we commend this highly useful work to our colleagues generally; we have devoted much time and persevering labor to its translation. Most respectfully, CHARLES J. HEMPEL, M. D. CONTENTS OF THE FIRST VOLUME. Page Preface. Introduction 1—55 1. The Proving of Drugs on the healthy organism 2 2. The law of Similarity 18 3. Diagnosis of the Natural Disease 28 4. Single Remedies 39 5. Size of Dose 41 6. Preparation, Repetition, etc., of Medecines 48 7. Diet 51 FIRST SECTION. Diseases of the Brain, the Spinal Cord, and the Nervous System Generally 57 A• Diseases of the Brain 57 Hypersemia of the Brain and its Membranes 57 Anaemia of the Brain 65 Cerebral Apoplexy 70 Inflammatory Affections of the Brain and its Membranes 86 1. Meningitis 86 2. Encephalitis. Cerebritis 94 8. Tubercular (granular) inflammation of the meninges. Hydrocephalus acutus 99 Hydrocephalus, [stricte sic dictus.] 109 B. Diseases of the Spinal Marrow 110 Inflammation of the Spinal Cord and its Membranes 110 Meningitis Cerebro-spinalis, Cerebro-spinal Meningitis, Spot- ted Fever 180 Spinal Irritation. Neuralgia Spinalis 135 C. Diseases of the Nervous System 139 1. Epilepsy 139 2. Eclampsia 154 a. Eclampsia Infantum 154 b. Eclampsia Parturientium 163 8. Chorea 170 4. Catalepsy 177 5. Tetanus and Trismus 178 6. Paralysis 183 7. Hysteria 190 8. Hypochondria. Hypochondriasis, Spleen 207 Contents of the First Volume. SECOND SECTION. Page Diseases of the Head 218 A. Diseases of the Scalp ? 218 Cephalaematoma, Bloody Tumor of the Scalp 218 B. Diseases of the Cephalic Nerves 220 1. Cephalalgia, Headache 220 Hemicrania or Megrim 221 2. Neuralgia Trigemini 227 Fothergill’s Prosopalgia ; Tic douloureux ; Prosopal- gia, Pace-aclie 227 8. Spasmus Nervi Facialis. Tic Convu' sif. Spasm of the Facial Nerve 284 C. Diseases of the Eye 235 1. Conjunctivitis Catarrlialis 237 2. Conjunctivitis Blennorhoica 242 a. Acute Blennorrlicea 242 b. Chronic Blennorhcea 243 3. Conjunctivitis Scrofulosa 249 D. Diseases of the Ear 257 1. Otitis Interna 258 Internal inflammation of the Ear... 258 2. Otitis externa 261 JB. Diseases of the Nose 263 1. Coryza, Catarrh, Cold in the Hend 263 2. Inflammation of the Nose, Nasitis 268 3. Epistaxis, Bleeding at the Nose 269 THIRD SECTION. Diseases of the Mouth, Fauces and Oesophagus 272 1. Stomatitis 273 2. Thrush, Aphthae of Infants 279 3. Angina 281 a. Angina Catarrhalis, Sore Throat 281 b. Angina Tonsillaris, Tonsillitis, Amygdalitis, In- flammation of the Tonsils. Quinsy 284 4. Retropharyngeal Abscess 294 5. Diphtheritis, Diphtheria 296 6. Noma, Cancer Aquaticus 307 7. Glossitis, Inflammation of the Tongue 811 8. Parotitis 314 a. Parotitis, Inflammation of the Parotid Gland, Mumps, Angina Parotidea 314 b. Parotitis Maligna 317 9. Salivatio, Ptyalism 319 Contents of the First Volume. Paste 10. Scorbutus 322 Scurvy of the Gums 322 11. Ranula 324 12. Oesophagitis, Dysphagia Inflammatoria, Inflammation of the Oesophagus 326 13. Odontalgia, Toothache 328 FOURTH SECTION. Diseases of the Stomach, Intestines, and Peritonaeum 334 A. Diseases of the Stomach 334 1. Catarrhus Yentriculi Acutus. Acute Catarrh of the Stomach 334 2. Catarrhus Yentriculi Chronicus, Chronic Catarrh of the Stomach 350 3. Gastritis, Inflammation of the Stomach 361 4. Ulcus Perforans Ventriculi seu Rotundum. Chronic Ul- cer of the Stomach 368 5. Carcinoma Yentriculi, Cancer of the Stomach 375 6. Hsematemesis, Hemorrhage from the Stomach 383 7. Cardialgia, Spasm of the Stomach 391 B. Diseases of the Intestinal Canal 404 1. Catarrhus Tntestinalis, Intestinal Catarrh 404 a. Simple Intestinal Catarrh 406 b. Cholera Sporadica seu Nostras, Cholerine 408 c. Catarrhus Intestinalis Chronicus, Chronic Intes- tinal Catarrh, Chronic Diarrhoea, Cholera In- fantum, Summer Complaint 413 d. Pebris Gastrica Catarrhalis, Mucosa et Biliosa; Gastric Fever ...., 422 2. Enteritis, Inflammation of the Bowels 435 3. Typhlitis, Perityphlitis, Inflammation of the Caecum... 440 Catarrhal Inflammation of the Rectum, Proctitis 445 Cellulitis 451 Inflammation of the Cellular Tissue of the Intes- tinal Canal 451 4. Dysenteria, Dysentery 455 a. Catarrhal Dysentery 455 b. Dysenteria Epidemica, Dysentery Proper 457 5. Enteralgia, Colic 468 6. Stenosis of the Bowels, Occlusion, Obstruction of the Bowels 479 7. Hemorrhoids, Piles 485 8. Helminthiasis, Worms 492 C. Diseases of the Peritoneum 503 Peritonitis, Inflammation of the Peritoneum 503 Contents of the First Volume. FIFTH SECTIOX. Pag* Diseases of the Liver, Spleen and Pancreas 520 A. Diseases of the Liver 520 1. Hypersemia of the Liver 522 2. Hepatitis, Inflammation of the Liver 528 a. Hepatitis Acuta, Acute Inflammation of the Liver 529 b. Perihepatitis, Inflammation of the Capsules of the Liver, Capsular Hepatitis 531 c. Pylephlebitis, Inflammation of the Vena Porta 532 3. Hepatitis Chronica, Chronic Inflammatory Affections of the Liver 537 4. Icterus, Aurigo, Jaundice 554 5. Colelithiasis, Biliari Calculi 564 6. Carcinoma Hepatis, Cancer of the Liver 569 B. Diseases of the Spleen 572 Splenitis, Inflammation of the Spleen 573 C. Diseases of the Pancreas 578 SIXTH SECT I OX. Diseases of the ITropoetic System 580 A. Diseases of the Kidneys 580 1. Nephritis, Inflammation of the Kidneys 586 2. Morbus Brightii, Bright’s Disease of the Kidneys 596 8. Hemorrhage in the Kidneys 609 4. Renal Calculi, Gravel 614 5. Diabetes Mellitus, Melituria, Glycosuria 617 B. Diseases of the Bladder 625 1. Cystitis, Inflammation of the Bladder 625 2. Hematuria, Bloody Urine 629 3. Enuresis Nocturna, Wetting the Bed 631 4. Cystospasmus, Spasm of the Bladder 632 5. Cystoplegia, Paralysis of the Bladder 634 INTRODUCTION. Hartmann’s attempt to apply the doctrines of Homoeopathy to special Pathology has, so far, remained solitary and alone in the literature of our school; that is, if we do not include in the list popular publications or such as only refer to one part of Pathology. However strange this may seem to any one who is not familiar with Homoeopathy, yet this absence of all pathological treatises after the example of Hartmann, is in perfect accord with the spirit of this doctrine, as we shall show by-and-by. A system of special Therapeutics never was, nor ever will be, a necessary, scientifically founded requisite of our doctrine, hut will always depend upon the necessity of mediating between us and our therapeutic antipodes and opponents. In this way they will find it easier to institute clinical experiments with our system of treatment, and to form correct opinions concerning its scientific value. Starting from this stand-point it becomes indispensable, as a preliminary step, not only to explain the general principles of Homoeopathy, hut likewise to show in what manner this new system of treatment affects the science of Pathology. In this respect our general s}Tstem of Therapeutics must necessarily differ ffom that of other therapeutic manuals; our position in the domain of medicine, which is still of a polemic character, compels us to touch certain questions which, though not necessarily included within the range of Therapeutics, yet are of essential importance to ourselves. Among these questions, the question, What is Homoeopathy ? What is its aim and object ? occupies a prominent place. But few physicians who are not homoeopaths, will be able to answer this question satisfactorily. Let us hasten to add that this is in a great measure the fault of the homoeopaths themselves. Rashly and improperly the unessential points are made prominent points of doctrine; the essential points are pressed into the background. U nder these circumstances, we cannot wonder that our opponents should imitate our example, and, worse still, should charge upon us the most nonsensical fables and absurdities. In many respects, 2 Introduction. Hahnemann, the founder of our doctrine, furnishes them the au- thority for their conduct; and many of his successors have been but too anxious to multiply the reasons for their justification. In the course of this introduction we shall have an opportunity of laying bare the mistakes that have been committed by our own adherents. First, let us answer the question: What is Homoe- opathy ? It is the doctrine of the effects of drugs upon the animal organism as applied, according to an uniformly valid law, to the doctrine of the morbid changes of the organism. As such, it is not antagonistic to Medicine considered as a scientific whole; on the contrary, it constitutes a necessary completion of this science, inas- much as the homoeopathic system establishes one part of Medicine, which had hitherto been abandoned to the crudest empiricism, upon a scientific basis. Accordingly, it shares with the ancient science of Medicine all the suppositions necessary to a knowledge of pathological changes, and is distinguished from that science only by the mode in which it leads to a knowledge of the remedial agent, and brings this knowledge in union with the curative object. This is accomplished in accordance with two fundamental principles, the principle of proving drugs on the healthy organism and the thera- peutic law : Similia similibus curantur. 1. The Proving of Drugs on the healthy organism. In order to perceive very fully and clearly how far this principle exerts an influence upon the arrangement of our Materia Medica, we shall have to examine, in the first place, the manner in which a knowledge of drugs has been obtained hitherto, and is still sought to be obtained. Casting a retrospective glance at the beginning of Medicine, we have to admit that the first physicians obtained their knowledge of drugs from the people to whom, while using them for their com- plaints, accidental experience revealed some of their virtues. By partaking of a plant or fruit indiscreetly, vomiting or diarrhoea was caused; the same substance was afterwards employed for the pur- pose of exciting similar evacuations. In performing such thera- peutical experiments, it was likewise found by mere accident that, together with these troubles, certain other affections for which the medicine had not been administered, disappeared simultaneously, on which account the same medicine was afterwards employed for these incidental affections. Thus it was that, gradually, a whole series of facts was collected which were utilized by physicians as a Introduction. 3 fountain-head of Therapeutics. W e need not attempt to show the gaps which must disfigure a knowledge of drug-etifects thus ob- tained ; what was particularly injurious was that all that was known of a drug was its relation to some particular morbid condi- tion, without any corresponding knowledge of the kind of action which the drug really exerted. This crude empiricism was not only peculiar to the most remote periods, but it has continued even to the present period, although in a somewhat different form, care being had, by resorting to systematic forms, an adequate nomencla- ture, and other little artifices, to clothe this empiricism in a more scientific garment. All that was known was a series of exceedingly equivocal facts whose connection was so little ascertained and which very often seemed to contradict each other to such an extent that they gave rise to the most insane hypotheses. Experiments on the sick organism did not yield any more satis- factory results. The boldness, or, if we did not know that physi- cians had acted in good faith, we might even say, the want of conscientiousness, with which, even to this day, therapeutic experi- ments are instituted with substances of whose virtues really nothing is known ; the extraordinary perseverance with which these experi- ments are conducted; the numerous victims that have been sacri- ficed, ought to have been crowned with better success than the creation of a Materia Medica which is of no use to anybody. This may seem an exaggeration ; yet that it is not, can be shown very easily. If the employment of an unknown drug in a given case of disease is to have a definite result, a preliminary knowledge of this case, in every direction, is indispensable. What disease is there which we can diagnose so surely, or, even if this were at all possi- ble, whose course we can predict with so much positive certainty, that this knowledge should enable us to deduce the effects of the drug with mathematical accuracy ? And even if we had the means of obtaining this knowledge in single cases; even if we had observed the same effect in a hundred cases, who guarantees to us that the one hundredth case will run the same course? May we not have to consider a variety of circumstances which cannot be determined in advance? For instance, is not one patient more sensitive to medicinal influences than another? Are there not indeterminable idiosyncrasies which we are in the habit of de- spatching under this name ? Does not the influence of the weather, and of other external agents, act an important part ? If any one is disposed to deny this, let him read attentively our medical journals. 4 Introduction. We will quote a recent example. A French physician hits up»>n the idea—how he was led to it we are not informed—to employ Ipecacuanha for intermittent, fevers: lie treats two hundred eases, one hundred and sixty of which with good sitccess. He concludes that this drug is a panacea for intermittent fever, and urges its employment accordingly. Some dozen physicians, imitating his example, suddenly raise a cry against his assertion, not having had any success with Ipecacuanha. Who is right ? In our judgment both parties are right, for the reason that Ipecacuanha only cures one class of intermittent fevers. How far is the Materia Medica benefited by this kind of experimentation? The same course is pursued with Arsenic in the same disease, and with other drugs in other diseases. Who is to be believed ? The only way to obtain certainty would he to repeat all these experiments. Is there no danger in random experimentations with large doses ? Does it not argue a want of conscientiousness to experiment upon patients who expect from us either a mitigation or a cure of their sufferings ? Deside the real or apparent curative results, we likewise find such drug-effects recorded as manifested themselves simultaneously with the curative results. Is a deception in regard to these new symp- toms or drug-effects much more probable than in regard to the curative results ? How are we to decide whether these results were not exclusively due to the peculiar course of the malady or to individual circumstances ? It is true that in this manner a number of fixed facts have been obtained, hut in proportion to the number of drugs, more particularly as regards single drugs, these facts are too few to enable us to assert that we are fully acquainted with a single drug in every direction of its therapeutic range. Read the article Opium in some of the more important works on Materia Medica. There is scarcely a drug with which experiments have been multiplied as with Opium; yet there is no drug concerning which our Materia Medicas are as full of absurd contradictions as concerning this agent. The necessity which is becoming more apparent from day to day, of obtaining a more correct knowledge of our drugs before using them in the treatment of disease, has led long ago to experiments upon animals; so far, a vast number of dogs, cats, frogs, etc., have fallen victims to pharmacological investigations. But even in this respect the gain has been inconsiderable. The reasons for this are quite obvious. The organism of the beast differs from that of man in many essential particulars; even the organisms of many classes Introduction. 5 of animals differ among themselves. A dog frequently bears sub- stances which are decidedly hostile to man; whereas other sub- stances develop violent reactions in the canine organism. This being the case, how is it possible to draw reliable conclusions from experiments on dogs or other animals regarding the human organ- ism ? But, supposing even that such a proceeding is not entirely absurd, the profit which it yields is exceedingly small. The animal is unable to indicate subjective sensations according to their form, locality or intensity ; we only become acquainted with objec- tive changes. These changes have their value, but even they are generally obtained in an improper manner. They are sought to be obtained rapidly and fully developed by means of large doses of the drug, which, after all, only produce phenomena of the coarsest character. The most we learn is the maximum effect of a drug, nothing of the less marked, and yet so essential, shades of its action. How far do such coarse experiments advance our knowledge of a drug in its capacity as a remedial agent ? Only a very little. Moreover, this kind of experimentation exposes us to great decep- tions, for most drugs, when administered in large quantities, pro- duce effects very different from those which are produced by con- tinued small doses of the same drug. By what means do we obtain a knowledge of the latter effects which are our sole proper guide in determining the therapeutic uses of a drug? We are far from denying the value of experiments upon animals; but this value is limited, and acquires a certain importance only when judged in connection with other experiments. The same remarks apply to cases of poisoning observed on human beings. The circumstances which render such accidents less in- structive, or ill-adapted for the purposes of a scientific Materia Medica, are the following: In the first place, the poisoning is not under our control. Accident may furnish a number or none at all, within a limited space of time; a hundred may be furnished by a single drug, whereas a hundred other drugs may not furnish one. We possess the history of a large number of cases of poisoning with Arsenic, but of how many cases with Gold? This depends upon the degree of accessibility of a poisonous substance to crime or indiscretion. Moreover, in every case of poisoning of a human being, the re- sults are necessarily more or less obscure, since we are obliged to employ every means of saving or relieving the patient. What symptoms are, in such cases, chargeable to the poison, what other 6 Introduction. symptoms to the action of the antidote? These two series of symptoms are very frequently mixed up with a good deal of reck- lessness. How many cases of poisoning are recorded in our journals, as having been occasioned by a single substance, whereas they were really caused by two or three! How much can we learn from such cases for the benefit of our patients? Finally, the same objection occurs to us here that has already been mentioned, when speaking of experiments upon animals. Large doses of a poisonous substance only furnish the massive outlines, not the finer shades of a drug-picture. However, we should commit the most crying injustice against the tendency of our scientific opponents, if we were to assert that they have contented themselves with the above-mentioned partially accidental and partially unreliable means of building up their Materia Medica. This is not the case. Other sources of knowledge have sometimes been sought and employed with an amazing energy and great sagacity. We may mention Chemistry, from which, to this day, the most important yield has been expected for the Materia Medica. Without wishing to lessen the importance of chemical investigations, we must nevertheless confess that Materia Medica is under very slight obligations to Chemistry. It is well to know the constituents of vegetable substances; but to use this knowledge for the purpose of determining approximatively their effects upon the sick, seems a hazardous enterprise, and has never yet led to favorable results. The speculations based upon Chemistry have likewise engendered many errors in theory and practice. We mention the use of Iron in chlorosis. Iron does not always cure chlorosis, and, where it does cure, often entails a disturbed diges- tion. We admit that Chemistry has shed light upon the nature and connection of a number of facts, but a Materia Medica can never be created by chemical analysis. As a rich and memorable source of a knowledge of drugs in the domain of ancient Medicine, we have to mention Homoeopathy. Not only have many drugs, especially recently, been taken from the store-house of Homoeopathy, and applied to the cure of diseases, often, it is true, in a very wrong way, but the very road upon which the homoeopath arrives at a knowledge of drugs, has been pursued by old-school physicians. Such a course, it is true, has only been pursued by a few, most systematically by Schroff, of Vienna. This is not the place for a more particular examination of his labors; they contain a great deal that is good, but too little of it when Introduction. 7 compared to the immensity of his efforts. His effort to obtain a powerful medicinal effect as rapidly as possible, is the cause owing to which his labors have produced such inadequate results. By and by we shall point out the road that has to be pursued by those who are desirous of obtaining a large yield of drug-effects by means of pure experiments; those who take an interest in such matters are invited to contrast our views with Schroff's method of investigation, in order to find out what we censure in his pro- ceedings. By employing the means and ways above mentioned, the present science of Medicine has been perfected in the course of centuries. Upon examining it more closely we only find the most striking, because most massive and crudest effects of drugs, recorded on its pages; the more delicate shades of the drug-picture are wanting. In accordance with these coarse drug-effects, drugs were divided into classes, the names of which indicated the leading effects of the drugs enumerated in each class. What such classifications, in the gross, amount to, can easily be seen by comparing certain manuals with each other, where the same drug is found recorded under the most diversified heads. How embarrassing it must be for a con- scientious physician who wishes to employ a narcotic, and has to hunt it up among thirty or more other drugs, without having a single point of support to lean upon in the selection of his special agent. This is simply a blind-catching process, not a conscious act in accordance with a rational motive. It is indeed remarkable that modern Medicine which has been so active in investigating physiological and pathological processes, seems to have utterly neglected a corresponding investigation of the curative sphere of drugs. The subtle diagnosis of modern pathologists is certainly not adequately responded to by an exceed- ingly general random selection of a remedial agent. The defects of the Materia Medica exert even a pernicious reaction upon the diagnosis. To a scientific physician, the diagnosis cannot be suffi- ciently accurate; but from the moment he abandons the practical side of diagnosis, he becomes content with the vaguest diagnostic generalities, for the reason that they are sufficient to secure the selection of a remedial agent. Thus it is that science and practice have become sharply divided in Medicine, to the detriment of physicians, still more than to that of patients. Quite recently we have heard a Viennese physician exclaim, how strange it was that, in their lectures, Skoda and Oppolzer should despatch a 8 Introduction. whole lot of drugs against a given case of disease, with the utmost contempt and with a pitiful smile; whereas, at the bedside of patients, they prescribe quantities of these despised drugs. Does the fault rest with the physicians, or with the drugs? Is it be- cause the drugs are powerless, or is it rather because the physicians do not know how to employ them? This latter question we have to answer in the affirmative, for we have the evidence of it in our hands, and shall exhibit it to our readers in the course of this work. Hahnemann was the first who endeavored consistently and per- severingly to obtain a knowledge of the effects of drugs, and to apply it to practical uses in accordance with a definite law. lie found the sources of remedial agents, which had been valid up to his time, either insufficient or deceitful and false, and he set up the doctrine that a knowledge of the true effects of drugs could only be obtained by experimenting upon the human organism, and that these experiments must be instituted upon the healthy organism; since the organism in disease develops and substan- tiates too many illusory views and perceptions. Ilis extraordi- nary energy gave birth to the Materia Medica Dura, a work to which the most censorious mania cannot deny the tribute of admiration in spite of the isolated defects with which this noble work is tainted. When did a single human being ever succeed in treading a new path without committing a single mistake, or making a single false step? Let it suffice that so far nobody has ever produced greater results by entering upon a new road of in- vestigation. Provings upon the healthy constituting the very central point of Homoeopathy, which could not exist without them, we shall ne- cessarily have to submit the manner in which such provings are conducted to a more rigorous examination. In the first place, we have to inquire how the provings are con- ducted, and, in the second place, how the results of these provings are improved for the benefit of the Materia Medica. Only such persons are fit for the business of proving who enjoy physical and mental health, and are possessed of a capacity to de- scribe their sensations with clearness and precision. In opposition to this first requisite, it may be said that perfectly healthy in- dividuals are very scarce; an assertion which is certainly not ex- aggerated. By the term “health” wre do not mean to designate the absolute harmony of the physiological processes, but the existing Introduction. 9 equilibrium of the organic activity of the body. While proving, the bodily functions of the experimenter should not be disturbed in any respect, and, in order to obtain the greatest possible certainty on this point, it may be well to subject the prover to a careful ex- amination. The physicians themselves are always the best provers. If the provings are instituted by other parties, the physician should never cease to exercise strict control in order to prevent unes- sential symptoms from being assigned a prominent place in the list, or essential symptoms from being described too superficially. In order that a proving should yield a complete list of symptoms, it has to be conducted by as large a number of individuals as pos- sible, of different ages, sexes, social positions and habits. This con- dition need not be dwelt upon any further; it is of self-evident necessity. We will add that even children may be included among the list of provers. However, they have to be watched much more carefully, for the reason that they are much less capable of de- fining the subjective symptoms developed by the drug. Shortly before, and even during the whole course of the trial, even some time after the last dose of the drug had been taken, the prover should observe a simple and regular conduct. All medi- cinal substances have to be avoided ; likewise every exposure by which the bodily equilibrium might be disturbed, such as excessive bodily or mental exertions, violent emotions, too much or too little sleep, irregular eating or drinking. Such articles of diet which we know to have an injurious influence upon his bodily health, have to be avoided with particular care. If possible, the mode of life which we have to lead during the trial, should be commenced some time previous to the beginning of the trial, so much more since, in order that we might pursue a correct mode of living, habitual dishes or beverages have to be discontinued; otherwise many changes which originate in this very circumstance, might be charged to the action of the drug. It is likewise necessary, before the trial commences, to examine the beats of the heart, the quality of the pulse, the quantity of the urine, as well as the temperament and other peculiarities. Of the drug to be proved, we must make sure of obtaining a reliable preparation. It is best to employ it in form of a tincture or of triturations with sugar of milk, in case it should not be feasible to take the drug in substance. This mode is preferable for the reason that tinctures and triturations constitute the leading preparations of drugs in homoeopathic practice. The dose to be proved, has to 10 Introduction. vary. A commencement may be made with the smallest doses, even with the thirtieth attenuation, from which we may gradually descend to the stronger and more substantial preparations. The doses should not be repeated in too rapid succession; it is best to first allow all the morbid phenomena of one dose to pass away before a second dose is taken. If no effects are produced, the dose is progressively increased and repeated more frequently. These pre- cautions concerning the dose are of essential importance, for the reason that the susceptibility to medicinal impressions varies ex- ceedingly in different individuals, and it is impossible to determine beforehand how large or feeble the dose should be in order to elicit the smallest possible medicinal symptoms. A good deal depends upon these feeble beginnings; they serve as starting-points in ac- counting for subsequent more marked phenomena of drug-action. It is a good plan to let every prover take the same preparation of the drug; in order to prevent also in this respect the possibility of a mistake. The best time to take the drug is undoubtedly before breakfast, for the reason that we are better able to observe the symptoms manifesting themselves in the first hours subsequent to taking the drug; and that the medicine is moreover introduced into an empty stomach. However, it is likewise advisable to swallow a dose of the drug some evening before bedtime, in order to observe possible differences of action. Finally, special rules are required in order to regulate the conduct of the prover, with reference to the medicinal symptoms that may become manifest. Above all things the prover should attentively observe all changes in his feelings, without watching himself on that account with anxious solicitude; what is most particularly to be avoided are fanciful illusions. If the prover is a physician, it is well that he should remain ignorant of the drug he is proving. All changes in the ordinary condition of the patient, even the least and most insignificant, are to be noted down. This should be done as soon as the symptoms are perceived. Accessory circumstances should be carefully recorded. The period of the appearance of the symptoms, their duration, aggravating or ameliorating circum- stances, locality and quality of the sensations, etc. These written reports have to be revised by the physician as often as possible, in order that he may have an opportunity of completing defective records by appropriate questions, of clearing up obscure statements, adding objective symptoms, etc. It is more particularly objective symptoms which render a physician’s control during the trial in- Introduction. 11 dispensable. It is well known how wrongly objective symptoms are sometimes described by lay-provers upon their own persons, such as efflorescences upon the skin, changes of the tongue, alvine discharges, urine; on which account great injury is often done to the provings, since it is precisely these objective symptoms that are the most important, because they do not admit of deception. The physician should moreover accompany the symptoms with annotations referring to circumstances, which either confirm the medicinal symptoms or cast a doubt upon them. If the prover, for instance, is disposed to catarrhal affections of the Schneiderian membrane, and he should be attacked with such an affection during the trial, the physician has to institute inquiries in order to find out whether he has to deal with a medicinal symptom or not; and if a doubt should prevail, he has to mark this symptom with a note of interrogation. As a general rule, the physician should apply to an investigation of the drug-disease all the means of diagnosis that he brings to bear upon an investigation of natural maladies. The changes in the different secretions, especially in the urine, are par- ticularly noteworthy. A systematic arrangement of the symptoms elicited by such provings constitutes the basis for a full picture of the drug-disease. We say, intentionally, the basis, for an exhaustive proving can never be instituted on a human being, since it is impossible to in- crease the doses of a drug to the point of poisoning ; at any rate it is only with a very small number of drugs that we shall dare to saturate the system, so as to develop their medicinal effects in all their intensity. These provings are (o be considered as a basis for the additional reason that, starting from them and by them, it becomes possible for us to apply to practical uses whatever else we may be able to learn of the drug in question through other chan- nels. Experiments upon animals, comparatively valueless, without corresponding provings upon human beings, show us, by the objec- tive symptoms which they develop, how a variety of phenomena in men have to be interpreted, both according to their origin, as well as according to their final course; and conclusions by analogy, from animals to men, can now be made without any great danger of being deceived, since we are now in possession of the most positive points of departure. For these reasons, experiments upon animals are really of decided benefit and importance only to homoeopaths. Starting from the above-mentioned basis, the poisonings of human beings, with which our toxicological treatises are replete, 12 Introduction. obtain their true value, yea, they become important contributions to our Materia Medina. Poisonings which do not terminate too rapidly in death, and whose characteristic symptoms are not effaced by the intensity of their course, are particularly instructive. Poisons which produce fatal results too rapidly are of but trifling- importance even for the toxicologist, inasmuch as their toxical re- sults only denote in almost every case the symptoms of a violent local irritation. In other respects, cases of human poisoning, even if we do not draw any conclusions from analogy or expose our- selves to the danger of deception, as we have to do in making experiments upon animals, furnish us an explanation why the alterations obtained by our pro vers with small doses should have a definite significance, and why the effects of small doses should, in their turn, shed light in many cases upon the effects of poisonous doses. Of particular value are likewise the material post-mortem changes, which alone render it possible in many cases of a most subtle pathological diagnosis to determine what drug- diagnosis corresponds to it very fully. In cases of poisoning, we should, of course, observe the greatest caution, in order to preserve the distinction between the toxical symptoms and the effects of such antidotes as may have been administered in the case, and the symptoms of a previously existing disease, for which purpose the symptoms elicited by provings on healthy persons will again fur- nish us a safe standard of comparison. In other respects the relation of the toxical to the pathogenetic symptoms is best ascer- tained by comparing the toxical symptoms, caused by one of our well-proved drugs, with the symptoms recorded in our Materia Medica. It is but seldom that a symptom will not be found re- corded in the latter; on the contrary, it will be found that the toxical symptoms constitute a drug-picture, whose sharp features are reflected by the drug-pictures elicited by our provings in dimmer and more shadowy outlines. And finally, upon the basis of the pathogenetic series, clinical experience can be made available for the benefit of our Materia Medica, although only conditionally. This experience either con- sists in the observation of new symptoms not belonging to the disease, which manifest themselves after the administration of the remedial agent, or ill the changes which existing morbid symptoms undergo, either for the better or the worse. The former category is of less importance; in many cases it furnishes a valuable confir- mation of our provings on healthy persons, and, which is of the Introduction. 13 ul most importance, makes us acquainted with the doses that have to be employed in order to effect a cure without aggravating the symptoms of the disease. However, the custom of incorporating these new incidental symptoms in the pathogenetic series, and which has been practised in more than one case, should be aban- doned. The second category, in so far as it refers to an aggravation of existing morbid phenomena, yields a further basis for the determination of the proper dose which is capable of effecting curative results, without any precursory aggravation of the symp- toms. The homoeopathic doctrine of dose rests exclusively upon such observations. When reaching the question of dose, we shall again revert to this subject. Our observations concerning the curative action of remedial agents, by confirming the principle in accordance with which the cure was effected, constitute the true system of homoeopathic Therapeutics. They show us by the practi- cal result what’drug-effects are of real use in determining the cura- tive indication. In a previous paragraph we have already alluded to the deceitful character of clinical observations, and have to apply this remark likewise to observations made in accordance with the principles of Homoeopathy. We should add, however, that Homoe- opathy lias done every thing that can possibly be done to diminish uncertainties and to avoid deceptions. If the experience obtained of the effect of a medicine is applied in every case, in accordance with the same principle, the results must necessarily be more homogeneous, than they could be imagined under any other therapeutic proceeding. It is from the different sources that have been indicated so far that the Homoeopathic Materia Medica has obtained its material, and, in accordance with this origin, it alone is justly entitled to the attribute of physiological. Viewed in its integrity, from its origin throughout its whole development, it is a working represen- tative of progress in the domain of Medicine in the presence of the great improvements which have been effected in other departments of this science; ignorance alone can deny it the character of a perfect scientific structure. Nevertheless, in so far as a want of completeness is a necessary attribute of every science which can never be conceived as a perfect whole, no longer capable of a progressive development, and which, in reality, only becomes a science through an unceasing and system- atic struggle after a more perfect form; our Materia Medica is neither a perfectly rounded, nor, in its present shape, a complete and 14 Introduction. faultless whole. As a closed science it could only be considered in case it should contain every thing that can be used as medicine, a thing that is utterly inconceivable. It would only be a closed and perfect science if every medicinal substance had been so completely and so exhaustively investigated, and determined in the different directions of its therapeutic efficacy, that nothing could be added to the domain of its usefulness. This likewise is inconceivable. Inde- pendently of these extreme requisites of completeness, we have to point out defects, which we shall subject to a short discussion in the present place, because an equally suitable opportunity may not present itself at a subsequent stage of our work. It would be un- reasonable to entirely omit a consideration of these defects, since it is isolated defects that so readily frighten beginners away from the study of Homoeopathy, and furnish points of attack to our oppo- nents. In the following paragraphs, unless special quotations are made, we refer exclusively to Hahnemann’s Materia Medica Pura, and to his Chronic Diseases; if we introduce subjects in this discus- sion with which every one familiar with Homoeopathy has been perfectly acquainted for a long time past, our excuse must be that this Introduction is not so much written for the accomplished practitioner, as for those who are only now becoming initiated into our science. In his Materia Medica, Hahnemann gives us the results of his own provings as well as those of other pro vers. He only furnishes the final results, saying nothing of the manner in which they were obtained, nothing of the material which has yielded these results. This constitutes the main, perhaps the only defect of his Materia Medica, since all its other defects spring from this one. In the shape in which Hahnemann has left us the results of his great labors, they are like a dense, large forest. Upon first entering it, it seems impossible to find one’s way through it; he who is ac- quainted with the forest, finds his way without any difficulty. The symptoms are pressed into a certain scheme, to accommodate which the symptoms are torn into fragments and numbered without any connection. ¥e are far from censuring this scheme, which, in spite of all the criticisms that have been passed upon it, has after all proved the best possible arrangement; even the splitting of the symptoms for the purpose of accommodating them to this scheme, would do no harm provided Hahnemann had left us the key to it, that is, a record of each single proving that has been made use of in the list of symptoms. This defect is exceedingly grave, and, Introduction. 15 what is worse, cannot be remedied satisfactorily. Re-provings have helped out in the case of single remedies, and, in many places, very satisfactorily; but to institute a re-proving of every drug that has been proved by Hahnemann, is an enormous task of very difficult solution. It is incomprehensible that Hahnemann, in spite of his accustomed sagacity, should have committed this sin of omission. It seems as though he had fallen into one extreme, in order to avoid the opposite one; he was opposed to every kind of generaliz- ing in Medicine, and, for fear lest he should give rise to it, he omitted reports of his provings, in consequence of which he made it much more difficult for his successors to follow his example. As a matter of course the effects of a drug, in accordance with their importance, their origin and course of manifestation, can only be learned by studying the record of each single proving; by this means a knowledge of drugs is obtained very easily. In this way we become acquainted with the starting-point of drug-diseases, what organs and systems are first acted upon by the drug, and what disturbances of the general organism arise from these begin- nings ; and, in order to obtain a reliable knowledge of drug-diseases, it is just as important that we should be acquainted with the origin and succession of the morbid changes as in any other nat- ural malady. The defect becomes still more serious in conse- quence of our remaining unacquainted with the individual condition of the provers, their sex, age, temperament, etc., how long a time the drug required to develop its effects, what quantities it took in order to produce them. The remarks which Hahnemann has added to single symptoms, and which often have the appearance of being snatched from an adventurous fancy, can only be accounted for by a knowledge of the different provings; it was expecting too much that his successors should accept all such statements upon the faith of their master. That Hahnemann did not arrange his Materia Medica without critical judgment is evident from similar remarks, and from his introduction to some of his drugs; never- theless it was wrong that he should have cut off his successors from the possibility of an independent criticism, and should have placed his work before them with the apodictic authority of an ipse dixit. Lastly we are unable to decide what symptoms in the list of Hahnemann’s provings belong to the respective drugs as constant and hence characteristic symptoms, since it is only exceptionally that we are told whether a symptom was observed by all the provers, or only by a few, or by one alone. All these defects of the 16 Introduction. Materia Medica Pura are still more salient in the Chronic Diseases, where even new ones appear in addition to the former. The circum- stance that in this last-mentioned work the medicines were proved almost exclusively Avith small doses, has occasioned a certain uni- formity which cannot possibly be justified in a scientific point of view, and diminishes the number of the objective symptoms, upon which, however, the selection of a remedial agent principally de- pends. A number of symptoms are moreover taken from observa- tions on the sick; this course might appear justifiable, if all such symptoms had been designated as such. But this has never been done. Hor can we pass silently by the fact that the quotations in both the above-mentioned works are disfigured by great mistakes, erroneous interpretations and defective rendering of the original text. In spite of these defects, Hahnemann’s work remains one of unusual importance and significance. A human work can scarcely be found anywhere that does not bear more or less the imprint of human imperfection. It is the duty of subsequent generations to remedy these defects. Many efforts have been made with occa- sional success to perfect Hahnemann’s work; but a good deal remains yet to be done; only a partial reform has as yet been achieved. We need not show in this place what has already been accomplished, and refer to such works as those of Hirschel, (Die Homceopathie, eine Anleitung zum Selbststudium,) where a correct statement of these new reforms can be found. -Beside the efforts to render Hahnemann’s Materia Medica more accessible, and to purge it of all defects, a good deal has been done in the way of proving new drugs, either by individual provers or by Provers’ Unions. These new provings have been conducted so as to avoid Hahnemann’s faults entirely. This is not the place to discuss these new efforts ; we have to consider the results of such efforts rather than their history. These results are found recorded in journals, in essays, and exceptionally in larger works, like Hering’s, but at all events in a very scattered form. This scattered mode of publication entails great injury. If any one should ask us where he might obtain a complete Homoeopathic Materia Medica, we should not know what to say to him, except giving him the names of a whole list of publications. We do not yet possess a complete collection of provings, on which account the study of our Materia Medica is rendered much more difficult. The labor of collecting all these provings would undoubtedly be a gigantic enterprise ; if it has not yet been undertaken, it is undoubtedly Introduction. 17 because new additions are continually expected. When will the period arrive when our Materia Medica shall be completed? As long as we are deprived of the means of studying our Materia Medica trom original sources, we have to content ourselves with works whose object it is to lay the symptoms elicited by our prov- ings before us in a more concise form, that can be easily looked over and comprehended. Among these works, the following oc- cupy the first rank: Jahr’s Symptomen Codex, and ISToack and Trink’s Materia Medica, both, however, of too remote a date not to omit a multitude of new facts, and being, moreover, adapted to the necessities of the practitioner rather than to those of a mere student. What road had better be pursued in studying Materia Medica cannot well he pointed out more clearly than has been done by Ilirschel, in his above-mentioned publication, to which we refer the reader. An example of a model-proving, in accordance with the principles of Homoeopathy, is furnished by Watzke in his treatise on Colocynth, in the first volume of the “ Oesterreichisehe Zeitschrift,” where the difficulties of producing a complete proving are likewise laid bare. At the same time, this treatise will likewise satisfy any reader of the tendency of true homoeopaths to elaborate the science of Pharmacology from a genuinely scientific stand- point. Having thus far enumerated a variety of defects in our Materia Medica, we now have to show how far, in spite of all these defects, it surpasses the Materia Medica of the dominant School in practical usefulness. The existing material enables us to obtain a thorough knowledge of a large number of drugs; those that are proved less perfectly, give us a tolerable picture of their leading properties. We admit that such a study requires a great deal of labor and per- severance ; but by this means we are placed in possession of the great advantage of becoming acquainted with the instruments with which we have to operate in the sick chamber; of learning to ex- amine critically their noxious as well as their saving properties, and of being protected against the possibility of inflicting direct injury where help was expected at our hands. Let us now examine the law according to which we have to prescribe the medicine of whose therapeutic virtues we have acquired a correct knowledge. Previously, however, we will here record a piece of advice that has been frequently given, but cannot be repeated too often. We have shown that Homoeopathy, or rather Materia Medica itself, rest3 upon the proving of drugs upon healthy individuals; as a 18 Introduction. matter of course it is the duty of every partisan of this doctrine to complete and perfect it by proving drugs upon himself and others. Those who wish to obtain a knowledge of Homoeopathy should regard it as an indispensable condition to prove at least one drug upon themselves. Only he who has made such a proving upon himself is capable of obtaining a complete and familiar knowledge of Materia Medica; a proving upon one’s self facilitates a compre- hension of the provings of others a great deal. This is an undis- puted and an indisputable truth, for whose sake we warmly urge the above-mentioned advice upon every lover of our doctrine. Before defining this law, we cannot refrain from casting a glance at the laws prevailing in the domain of Medicine, or the rules that have to be observed if we wish to eftect the cure of a disease by artificial means. An examination of this kind is necessary in order to comprehend to some extent the position of Homoeopathy in opposition to the other methods of cure, and in order to show that the law of similarity alone has claim to a more general validity and completely responds to all scientific demands. The therapeutic methods of the ancient systems of Medicine can be ranged, without resorting to any forcing process, in the follow- ing categories: 1. The disease is cured by removing the cause that produces it. Whenever this method can be pursued, it is undoubtedly the simplest and generally the safest, which, for the matter of that, no physician will neglect. But how small is the number of diseases whose causes we are able to trace with positive certainty! and, among this small number, how few diseases are there the known causes of which we are able to remove 1 Considering, moreover, that in many cases the disease, even after the cause is removed, still continues to exist as an afiection that has acquired an independent existence, we must confess that such causal treatment can never acquire an uni- versal validity. 2. The disease is removed by exciting an artificial condition directly contrary to the natural malady, in other words: Contraria contrariis curantur. At first sight, this principle seems to be re- markably applicable to all cases; but a closer examination compels us to admit that it cannot be applied in every case to the treatment of diseases. A disease is a complex of various functional disturb- ances of the organism; it is only in very few cases that we meet 2. The Law of Similarity. Introduction. 19 with diseases confined to only one organ. How can we manage to apply the above-mentioned principle to a complex of phenomena, such as occurs in pneumonia or typhus ? Individual symptoms or groups of symptoms can he treated in accordance with such a prin- ciple ; hut their removal does not imply a cure of the whole disease. Constipation can he momentarily removed by a purgative; hut this does not secure a cure of the disturbance which engenders the con- stipation in its course, and keeps it up. Nevertheless, diseases are treated in most cases in accordance with this maxim, hut the cure is generally only apparent, for, in the present condition of the Materia Medica, it is next to impossible to find a contrarium for every disease. In the same manner as the authors of Materia Medica have endeavored to range drugs in certain general categories, depending upon a few single massive drug-effects: upon the same basis physicians resort to these categories, for the purpose of con- ducting a totally symptomatic treatment by opposing these coarse drug-effects to isolated prominent symptoms of the pathological dis- ease. Owing to this gross method of treatment, such irrational gen- eralizations have been introduced in Old-School Therapeutics, as we see them embodied in the history of any case of disease. Thus it is that the maxim “ Contraria conlrariis” is not only defective and insufficient in the treatment of diseases, but it has become decidedly hurtful to pathological science. 3. The disease is sought to he extirpated by alterations excited in non-affected organs or systems by artificial means, the revulsive method. This method of treatment is an imitation of the mode in which Nature herself often seeks to reniove diseases. It cannot he denied that a cure is often achieved by pursuing this method; but we are as yet without a guide for such therapeutic imitations, since we are as yet unable to determine, with any thing like certainty, the connection in consequence of which one organ exerts a certain definite influence upon the other. This knowledge has not even been fully acquired with reference to the normal organism ; much less are we acquainted with the changes which morbid derange- ments cause in the relation of one organ or system to another. "What is known on this subject are isolated observations which are partially utterly unreliable and certainly illy adapted to founding a law of universal validity. It is the more impossible to pursue such a rpad to a cure, the more the whole organism is affected by the disease. 4. More recently the more perfect development of organic Chem- 20 Introduction. is try has given rise to a new method of treating many morbid conditions medicinally. One or the other organic constituent was either found diminished or increased, and it was supposed that the disease could be counteracted by supplying deficiencies or by re- moving the excess by neutralization or some other proceeding. It is undoubtedly true that in some cases this method has proved successful, but in most cases this chemical method of treatment was soon found to have no higher value than that of a speculative theory, and that it is not sufficient to introduce the required con- stituent into the organism, but that, in order to produce a favor- able effect, the constituent has to be introduced in such a form and quantity as the organism requires for its special use. It is likewise self-evident that the curative attempts depending upon chemical indications can only be applied to a small number of diseases. A system of Therapeutics, based upon such doctrines as we have described, would be tolerably perfect, provided the methods men- tioned in the preceding numbers should coalesce in such a manner that one of them would help where the others leave us in the lurch. Much a mutually completing process does not, however, take place, and a tolerable number of morbid affections remain against which we have to proceed upon the basis of the purest empiricism, where every species of treatment is no better than a bold attempt at curing without any fixed principles whatsoever, except perhaps a few morbid conditions for which tolerably fixed remedies have been discovered that are designated as specific remedies without any apparent reason. This appellation is erroneous for the reason that these remedies are not specifically curative of a definite species of diseases, which, as specific agents, they should be. For this reason, we declare such a system of Therapeutics defective, without any scientific basis. In opposition to these vague gnd defective doctrines, Hahnemann fi rst set up a maxim alike applicable to the treatment of every kind of disease: Similia similibus curantur, the law of similarity: in other words, a disease is cured most safely, speedily and easily by a drug Avhich, when acting upon the healthy organism, produces all the symptoms of the disease in their greatest possible similarity. It is well known that Hahnemann was first led to conceive the possibility of such a law by observing that Cinchona is capable of developing on persons in health all the symptoms of intermittent fever. In order to change a mere possibility into certainty, he commenced to make a trial of all kinds of drugs upon persons in Introduction. 21 health, and to employ them for purposes of cure in accordance with the maxim he had started. The uniform success obtained by this method of treatment satisfied him that this maxim had all the dignity of a natural law. We, too, might content ourselves with referring to thousands of cures as a proof of the validity of this law, without troubling ourselves about any further explanation. But inasmuch as cures can be disputed, and such testimony is not within everybody’s reach, w'e prefer showing, a priori, why such a law must necessarily be of universal applicability. The literature of Homoeopathy is replete with attempts to explain the law of similarity, from Hahnemann down to the present period. We cannot possibly undertake an enumeration of all these different views and opinions, more particularly since they would not possess any essential interest in this place. If anybody desires more special information on this subject, he will find it in the above- mentioned work by Ilirschel. A brief record of the leading views will be sufficient in this instance; independently of all support de- rived from experience, the main point is, that the homoeopathic law should prove universally valid in practice. Even if Hahnemann could have been reproached, with an appearance of justice, with having abstracted a natural law from a single fact, this reproach can no longer be applied to the Homoeopathy of the present day, which might very justly abstract a law from facts of universal and re- peated occurrence, even if it were impossible to account for this law a priori arguments. Hahnemann himself explains the law of similarity by accepting a natural and an artificial disease, the latter of which, being the stronger, annihilates the natural malady, whereas itself is hushed up by the vital forces. This explanation is not satisfactory, more particularly for the reason that it is founded upon hypotheses which cannot possibly be proven. Who can prove the superior force of the medicinal disease, an essential condition upon which Hahnemann’s explanation rests? What a hazardous hypothesis to suppose that the natural malady is annihilated by the vital forces, for no better reason than because, after the natural malady is cured, the drug- disease is no longer perceptible! Hoes it not seem as though this extinction of the drug-disease ought to take place simultaneously with that of the natural malady ? It is undoubtedly wrong to base one hypothesis upon a number of others. Hahnemann’s view has indeed been abandoned, and has given rise to the most decided opposition. In order to overcome the difficulty that a similar disease 22 Introduction. is overcome by a similarly acting drug, it was said that a drug occasions in the sick organism opposite effects from what it does in the healthy. This mode of arguing simply substitutes one diffi- culty for another; such a behavior on the part of the drug can only be accounted for by an entirely wrong conception of the pri- mary and secondary effect of a drug. This designation of primary and secondary has led to many embarrassments, not only in this particular explanation but in Homoeopathy generally, by diverting our attention from the conception of drug-action as a morbid process progressing in accordance with an inherent law of necessity, and setting up an arbitrary separation of drug-effects which can never be carried out in practice. Nor can we admit another view as correct according to which the drug excites the sound portion of an organ against its diseased portion, occasioning by this means an elimination of the disease. This explanation does away with the idea of similarity. For if the effects of the drug and those of the disease are similar through- out their whole course, the medicine must necessarily have affected the same organs and parts of organs as the disease, since without such a supposition the law of similarity cannot be thought of. [Tow does it happen that, in effecting a cure, the medicine suddenly excites the sound parts into action? We know nothing of an action upon the latter. Nevertheless we shall show by-and-by, that, with a slight variation, this explanation has a good deal of probability in its favor. The supposition of a special predisposition to disease which is hushed up by the medicine, is likewise an unproven or, at any rate, a hazardous hypothesis. How do we understand that by extir- pating the predisposition the disease must necessarily be cured ? To account for a cure upon the basis of a chemical neutralization is likewise too hypothetical. If the greatest possible similarity between the disease and the drug-action proves, as it undoubtedly does, their mutual affinity; even if they neutralize each other after the fashion of bodies between which chemical affinity prevails, we shall have to inquire by way of following up the simile, what becomes of the product of neutralization? For the action of two agents upon each other can certainly not result in a nothing. This explanation, like many others, is faulty in this respect that it regards the disease as an entological entity in the organism. In our opinion, the following explanation comes nearest to the truth, for the reason that the suppositions which it implies are few Introduction. 23 m number, and the most probably correct. The medicine stimu- lates certain organs or systems, and, by acting upon sound parts, necessarily produces morbid phenomena, whereas, by acting upon the diseased organ, it produces the stimulation requisite for a cure. This explanation does not imply a contrary action, but the effect remains the same, only that in its union with the morbid action it gives rise to a different product from what it does when acting upon sound tissues. This view likewise renders it possible to account for aggravations occasioned by too large doses. Our view of accounting for the modus operandi of homoeopathic agents, leads us to an explanation of the law of similarity, which seems to us, more than any other, to satisfy the demands of logic and the necessary thoroughness in deducing it from known physio- logical facts. This explanation was originated by Wislicenus, and may be found in his work entitled: “ Entwicklung eines wahrhaft physiologischen Ileilverfahrens.” Leipsic, 1860. In stating the fact that the object of this work is to show the correctness of the law of similarity in a series of logical deductions, we can only mention the chief points of this work in a few concise passages. For this reason many a proposition will necessarily appear disconnected and prob- lematic, because the intermediate links are omitted, and many of our readers may find our short extracts insufficient: So much the more we invite all, in the warmest manner, to read this book. The necessary consequences of the law of similarity, so far as the prac- tical business of the physician is concerned, are moreover so fully developed in this work from the leading maxims of Homoeopathy that the book is not only invested with a purely scientific but a directly practical interest. In order to be correctly understood, we have to premise certain statements of physiological facts that con- stitute an integral portion of our argument. Health depends in every organic being upon an inherent endeavor to preserve the equilibrium of its organic functions. This endeavor is designated by physiologists as an organic tendency of persistence, or as a physiological antagonism, or as an organic power of reaction. By virtue of this reactive power the organism equalizes the noxious influences acting upon it from without. As long as this equaliza- tion is continued regularly and imperceptibly, we call the organism healthy. But if the disturbances are too powerful to be at once and imperceptibly conquered by the reactive force of the organism, in other words to be equalized, we call the organism sick. In pro- portion as the struggle between these two factors is more or less 24 Introduction. violent, more or less extensive, we call the disease acute, sub-acute or chronic. The triumph of the reactive power over the disease is designated as a cure, the triumph of the disease leads to death. If the transition to recovery or cure is marked by tumultuous phe- nomena, we designate it as a crisis ; if the process of equalization is gradual, without any violent symptoms, we call it lysis. In so far as the organic reaction is engaged in a struggle with the disease, it is termed the vis medicatrix naturae. Like any other organic ac- tivity, it is based upon the nervous system, without which it can- not exist. But inasmuch as the disease is not a strange something that becomes mixed up with the tissues; inasmuch as it is simply the consequence of a change in the reciprocal relations and func- tions of organs, disease can likewise not exist without involving the nervous system, a derangement of the nervous functions being the starting-point in every disease. Every disease arises from the action of some external noxa upon the organism, the difference of one noxa from another, together with the peculiarities of the organ- ism, determine the different forms of diseases, and, inasmuch as these two factors may differ from each other in a variety of ways, it follows that there must he a variety of forms of disease. Disease is only recognized by the phenomena it presents to our senses. It is only from these phenomena that we can draw conclusions regard- ing the morbific agent and the opposing endeavors of the reactive force. Hence it becomes necessary to investigate every trifling cir- cumstance in the picture of the disease in order to obtain a knowl- edge of its true character, and to use it for the purpose of becoming acquainted with the road which Nature follows in order to free itself from the derangement of its functions, and likewise of obtain- ing light, by an analysis of the external phenomena, regarding the internal processes which these phenomena reflect. This result can only be obtained if each case of disease is placed before us as a sepa- rate individual case; for it is only in this way that we learn to know how far the organism is capable of equalizing the disturbance of its functions by its own unaided efforts, and when it becomes necessary to assist it in this endeavor. Experience shows that in many cases the organism is capable of throwing off the disease without any external aid, whereas in many other cases the reactive energies of the organism are insufficient and the disease triumphs over the former. It likewise shows that, if the morbific agent acts upon the organism with great intensity, the elimination of the morbific agent takes place slowly and with Introduction. 25 great difficulty. The desire of accelerating this natural curative process, of facilitating it or bringing it about, induces us to institute a search after remedial agents capable of answering this purpose, and all such remedial agents are called medicines. We have shown in the preceding chapter how we have to proceed in order to obtain a correct and full knowledge of their effects ; all we have to do here is to inquire how we have to apply the drugs with whose effects we have become acquainted, to the actual treatment of diseases. It is an old rule, which cannot be followed too strictly, that a physician should be the servant, not the master of Nature, minister, not inagister Natures. If, as such, he means to help the organism, he is under an obligation to examine above all things the road which Nature pursues when endeavoring to free itself from disease; he is bound to try to effect a cure by means of the organic reaction which he has to reinstate into possession of its lost superiority over the morbific agent. Moreover, in order to act with as much directness as possible and to effect a cure as speedily as possible, he has to affect that portion of the nervous system which is the seat of the organic reaction in the present case, likewise in the direction which the curative effort of Nature is disposed to take. But, as the process of every natural cure is governed by an universally valid law, so should the medicinal influence upon the nervous system likewise be regulated by a law of universal and admitted validity. This must be the law of similarity as Wislicenus shows indirectly by his refutation of other methods of treatment, and afterwards directly by the following mode of reasoning: Our drug-provings have shown that a medicine produces a characteristic drug-disease peculiar to itself. If this drug-disease resembles a natural malady in all its essential points, it must necessarily proceed from the same essentially similar processes in the interior of the organism. If, in addition to the natural malady, we excite an essentially similar drug- disease, the former experiences an addition as regards quantity, and likewise an extension as regards quality; for the question is not whether the morbid processes are equal but similar. In the same manner, by adding the medicinal disease, the existing reactive efforts are not simply heightened but qualitatively extended and in- creased, in consequence of new reactive endeavors characteristic 01 the medicine having been excited, which, however, are necessarily intimately connected with the existing reaction of the organism. Experience teaches that the drug-disease, when caused by a moderate quantity of the drug, is easily overcome by the organism 26 Introduction. which, even after the disappearance of the original disturbance, oscil- lates in the direction of the opposite medicinal phenomena, which may be regarded as a remnant of the natural curative endeavor directed against the drug. For by this union of the medicinal and natural diseases, the excess of the reactive endeavor of the drug- disease must necessarily go to the credit of the natural disease, since in both the drug-disease and the natural malady the reaction bears upon the same portions of the organism. This cannot take place where the drug-disease and the natural malady are not similar, consequently are deprived of the numerous and essential points of contact existing in case of similarity. From the foregoing remarks we infer that it is only the after-action by the drug which deter- mines the cure, for it alone represents the reactive endeavor of the organism that we have to call into play. In as far as a disease can only continue as long as the organic reaction remains too feeble to control it, and must disappear as soon as the reactive force becomes superior to it, and in as far as we are capable of securing such a superiority by the most similarly acting remedy: just so far the law of similarity precludes the idea of an incurable disease, provided we are able to discover a similarly acting remedial agent. We have it in our power to acquire this knowledge; all we have to do in order to accomplish this object is to continue our provings with persistent energy and correctness, and to unceasingly increase the number of the drugs to he proved. All this shows that the law of similarity necessarily requires the most careful proving of drugs ; for it alone enables us to contrast the most comprehensive diagnosis of a natural disease with an equally comprehensive diagnosis of drugs, which, after all, is the main requisite to a cure. The law of similarity invests every apparently insignificant drug-effect with a degree of importance, since it becomes an element in our thera- peutic series. On the other hand, the preceding.statement regarding the necessity of instituting careful and comprehensive provings likewise argues in favor of the law of similarity, which alone renders it possible to use all the results of our provings for therapeutic purposes. This explanation of the law of similarity likewise facilitates the explanation of an idea that has heretofore been used very improperly by many physicians: we allude to the expression of specific. If the old system of Medicine applies the term specific fo such drugs as had been found to be specially curative against certain morbid processes in a manner that it was beyond the power of analysis or Introduction. 27 observation to investigate: all that such an appellation accomplishes is to cause us to condemn, a priori, every investigation of the causes of therapeutic results as useless; the thing has been given a name, this is all. We know very well that this name has no meaning, and that it does not designate a constant curative effort. There are no specific remedies for entire genera of diseases. If we content ourselves with the definition that a remedy is specific with reference to a cer- tain form of disease; if it exerts under all circumstances a curative influence upon the disease, our previously developed explanation gives us the privilege of applying the term specific to the similarly or rather to the most similarly acting drug. At the same time our explanation shows that there are specific remedies only for indi- vidual cases of disease, not for whole categories, and that the so-called specific remedies of the Old School are specific only in so far as they correspond, under the application of the law of similarity, with individual cases in the category. It is only by accepting this explanation of the term specific that Homoeopathy can be called the doctrine of specific remedies, the specific curative method. Speaking of names, we may as well add a few words concerning the term Homoeopathy. More recently as well as years ago, at- tempts have been made to alter this name. It matters not, and we need not inquire whether this name is in strict accord with the rules presiding over the formation of words ; but we doubt whether another name can be found indicating the distinction between the homoeopathic and other curative methods. The term Homoeopathy has become fixed by usage, and will only disappear with the princi- ples of this doctrine. If this name is either erroneously or mali- ciously associated with notions that have rendered it somewhat odious, we need not concern ourselves about this, provided we en- deavor to do the name honor, and do not expect the name to confer honor upon us. We have already stated in previous paragraphs that an explana- tion of the law of similarity has only a purely scientific value with- out influencing the practical treatment of diseases, although it does exert such an influence in many respects. In conclusion, let us now present a point of view which must satisfy every one of the import- ance of our law without any further demonstration. If we are called upon to treat an affection of a certain organ or system, it is evidently of the first importance that we should find a remedy which acts adequately and definitely upon the diseased organ or system, and more particularly upon the parts where the morbid pro- 28 Introduction. cess is going on. Setting aside the modus operandi, the law of similarity alone can reveal to us the existence of such a drug. Con- sidering for the present every kind of treatment as empirical, and imagining ourselves restricted to clinical cases, we must admit that so far we are not acquainted with a single method that leads so surely to the knowledge of a drug exerting a definite action upon a definite locality as the law of similarity based upon physiological provings of drugs. It is with the remedy thus found that we shall have, at all events, to attempt a cure. The correctness of the pro- ceeding may afterwards be deduced from the result, in case oppo- nents should neither be willing nor able to concede this correctness, a priori. From this point of view it would seem as though any one who professes to be a physician must consider it as a matter of conscience to try the homoeopathic method of treatment. Let us now consider the consequences resulting, with more par- ticular reference to practice, from the two cardinal maxims that have been discussed in the preceding paragraphs. These conse- quences are, in the first place, the mode in which the disease has to be diagnosed; and, secondly, the manner in which the remedial agent has to be applied to the treatment of any given case of disease. 3. Diagnosis of the Natural Disease. Here too we quote as literally as may be Ilahnemann’s views as he lias expressed them in his Organon, in order afterwards to ex- plain what changes they had to undergo in the course of time. Hahnemann says: “ It may readily be supposed that every dis- ease presupposes a change in the interior of the organism. These changes, however, as far as they are revealed by the morbid symp- toms, (and these are the only data by which we can be guided in non-surgical diseases,) can only be apprehended by the understand- ing obscurely and at the risk of being mistaken. The essence of these changes cannot possibly be recognized in its inmost nature, nor can it be recognized at all without fallacious conclusions. The totality of the symptoms is the only aspect of the disease laid open before the eyes of the healing artist; this is the chief part of the disease which he can know and need know for purposes of curing. The physician may be aided in his work by a knowledge of the probable circumstances that induced the acute disease, or by an investigation of the most significant points of interest in the his- tory of a chronic malady, and finally by a study of the constitution of the patient so far as it is amenable to observation, a knowledge Introduction. 29 of his character, business, mode of living and habits, his social posi- tion, age, sexual functions, etc. This externally reflected image of the internal essence of the disease is the chief and only channel through which the disease can indicate the remedy it requires for a cure, the only means of determining the selection of the proper remedial agents. From this truth we infer with absolute certainty that the totality of the symptoms in every individual case of disease is the only indication by means of which the true remedial agent can he found out.” We will add to this quotation the manner in which a patient should he examined: “The individualizing; examination of a case of disease, for which I here give only general directions, and of which the examiner may use whatever he may require for a present case, demands of the healing artist nothing hut presence of mind and sound senses, at- tention in observing phenomena, and fidelity in drawing the image of the disease.” “ The patient describes the history of his troubles; his family relate his complaints, his conduct, and whatever has come within the range of their observation ; the physician sees, hears and notices throug’h his other senses whatever unusual changes have taken place in the patient. He records every thing in the same language in which the patient and his friends have described his trouble. Without saying a word he allows them to finish their statement; he only interrupts them if they lug in unessential trifles, (for such interruptions disturb the mental process of the relator;) all he does is to request slowness of speech in order that he may he able to note down the statemens of the speaker while he utters them.” “ With every new statement of the patient or his friends he com- mences a new paragraph, for the purpose of obtaining a successive list of the symptoms in detached series. In this way he is enabled to make subsequent additions to that which at first seemed to him vague but afterwards was stated more clearly.” “After the parties have said all they intended to say of their own accord, the physician then seeks to obtain more precise definitions of their statements by instituting the following proceeding: He peruses each symptom that has been described to him, and inquires in regard to each symptom in particular: When did this symptom appear? Previous to his taking the present remedy? While he was taking it? Or only a few days after discontinuing it? What kind of pain, wdiat sensation was it, which was experienced at this spot? (These pains and sensations have to be minutely described.) 30 Introduction. What was the precise spot? Did the poin occur in isolated, inter- mittent paroxysms, at different times? Or was it continued, not intermittent? How long did it last? At what time of the day or night and in what position of the body was it worse, or did it in- termit entirely ? Give an exact statement of this or that symptom or circumstance as it did occur or was felt.” “ In this manner the physician elicits a more circumstantial description of every single statement, without, however, suggesting an answer at the same time that the question is asked, so that all the patient would have to do is to either answer yes or no; other- wise he might he induced to state that which is either false or only partially true, or to give an affirmative or negative answer, which- ever might seem to suit the views of the questioning physician; all of which would lead to an incorrect delineation of the disease and suggest improper remedies for its cure.” “If, in making these voluntary statements, nothing was said regarding several parts or functions of the body or the condition of the mind, the physician then inquires what has to be stated with respect to these parts and functions, and likewise with reference to his mental and moral condition; but all such inquiries have to he couched in very general terms, so as to compel the respondent to express himself in very definite and precise language.” “After the patient, who is, after all, chiefly to be trusted with respect to his sensations, except in diseases where he naturally seeks to dissimulate, has’furnished all proper information to the physician by these voluntary and indirectly suggested statements, and has completed the image of the disease with a tolerable degree of accuracy, the physician, if he should be satisfied that he is not sufficiently informed of the condition of his patient, may then ■address more special and definite questions to the latter, such as: IIow often have the bowels been moved? What was the nature of the stools ? Did the whitish stool consist of mucus or fseces ? Was the evacuation attended with pain or not ? What kind of pains and where ? All the other symptoms have to be more pointedly examined in a similar manner.” “If the physician has recorded all these statements, he then notes what he himself has observed in his patient, for instance: How the patient has acted during the physician’s visit; whether he was peevish, quarrelsome, hasty, whining, etc.; whether he was soporous or wide awake; how he talked; what was the color of Introduction. 31 his skin, tongue, etc., and inquires how far these conditions differ from what they were in health.” “In chronic diseases an investigation of the above-mentioned and all other morbid symptoms has to be conducted with particular care and circumstantial detail, even to the minutest particulars, partly because in chronic diseases the symptoms are of a more peculiar, strange character, are least like the symptoms of diseases running a rapid course, and, if a cure is to be successful, cannot be noticed with sufficient care, partly because patients become so accustomed to long suffering that they pay little or no attention to lesser, incidental symptoms which, however, are often very signifi- cant and characteristic, and even decisive in the selection of a remedial agent. Trifling deviations from the normal equilibrium are even regarded by such patients as a part of their necessary con- dition, even as a state of health, the true perception of which a suffering of fifteen or twenty years duration has caused to be for- gotten ; they scarcely imagine that these trifling symptoms, these smaller or greater deviations from a state of health, have any con- nection with their main affection.” Except a few unessential omissions which we may discuss in sub- sequent paragraphs, we have here given an outline of Hahnemann’s ideas concerning the diagnosis of diseases, and how he intended it should be carried out. We here feel bound to subject his views to a brief critical examination from the present stand-point of medicine. Let no one imagine that, by offering this criticism, we intend an insult to Hahnemann or mean to underrate his labors. If we consider the time when the above-stated rules were laid down; if we consider to what extent, at that time, Medicine was lorded over by speculative theories, we must wonder that Hahne- mann, in opposition to the tendency of the age, did not go over to the crassest empiricism. Since then, a good many changes have taken place: in diagnostics the most powerful levers have been set in motion with the greatest success; hence a good deal will have to be modified in Hahnemann’s instructions. The first point we have to examine is the assertion that the physician has only to deal with the externally reflected image of the disease. At Hahnemann’s time this proposition seemed per- fectly correct. The progress of Medicine has divested it of all such pretensions. Physiology, pathological Anatomy, Chemistry, and even Physics, have furnished us so many points of support by means of which the externally reflected phenomena lead us on the 32 Introduction. road of rational deductions, very frequently with absolute cer- tainty, to a knowledge of the inner process, that, by neglecting these diagnostic resources, we would commit an equally great wrong as that with which we reproach our opponents for neglect- ing our diagnosis of drug-effects. With reference to present claims on Homoeopathy we have to formulate the above-quoted passage from Hahnemann’s instructions far differently, as we shall show by-and-by. In discussing Hahnemann’s doctrine of psora, we "shall show that he was not so very serious in trying to limit our knowledge of disease to a mechanical delineation of its outward image. The second point is Hahnemann’s assertion that, in examining the patient, the physician requires only presence of mind, sound senses and attention. These requisites may have been entirely sufficient in his time, but in our own time they are utterly insuffi- cient. We assert that, without a knowledge of the above-men- tioned collateral sciences, it is impossible to institute a thorough examination of the patient or to obtain an exhaustive diagnosis of his disease. An incoherent juxtaposition of symptoms is not what is required ; we have to inquire into their origin, combination, etc.; we should endeavor to have a clear view of the internal pathological process upon which all external symptoms depend, as well as of the laws according to which this process, if there is no interference on our part, will develop itself, and either expand or become ex- tinct. It behooves us, by every known means at our command, to find out what symptoms are the more important and characteristic of the disease, since it is after all upon these symptoms that the determination of the true remedial agent will depend. Where the existing means of diagnosis are not sufficient, it becomes our duty as much as that of any other physician to procure new sources of information or to complete those we have. Hahnemann’s proposi- tion must therefore encounter a decided condemnation at our hands. His doctrine of psora shows most conclusively how little import- ance Hahnemann attached to a rigid adherence to his views of disease, or rather, how deeply sensible he was of the defects of his own teachings. Chronic diseases had driven him, in some meas- ure, into a strait; anxious to solve the knot, he at most made the attempt in cutting, but he failed in accomplishing his purpose. The language in which the deep thinker reveals his invention to Introduction. 33 the world has a peculiar sound about it; we quote the passage referring to it from the Organon. “ Heretofore syphilis had been known to some extent as a chronic- miasmatic disease, that, unless cured, only becomes extinct in death. Sycosis, which, unless cured, is equally unconquerable by the vital force, was not known as an internal chronic-miasmatic disease, sui generis; it was supposed that a cure consisted in destroying the cutaneous excrescences; the internal malady, which continued its course, remained unobserved.” “Of immeasurably greater extent and importance than these two chronic miasms, is the chronic miasm of psora. Whereas the former miasms reveal their internal malady, one by the venereal chancre, the other by cauliflower-excrescences: the psoric miasm, after having infected the whole internal organism, reveals its exist- ence by an intolerable, titillating, voluptuous itching, and by a specific odor. It is this miasm which constitutes the fundamental cause and fountain-head of the numerous, or rather innumerable forms of disease, which, under the names of nervous debility, hys- teria, hypochondria, mania, etc., figure in pathological treatises as idiopathic, independent diseases. It took me twelve years to find out the source of an incredible number of chronic affections, to investigate and substantiate this great truth that had remained un- known to our ancestors, as well as to our contemporaries, and, at the same time, to discover the anti-psoric remedial agents which, together, will in most respects prove a match for this hydra- headed monster of disease in its diversified forms and manifesta- tions.” This quotation may suffice, since everybody may learn from it what Hahnemann intended to accomplish. By contrasting this quotation with the above-mentioned propositions, their contradiction must appear self-evident to everybody. In these propositions we are told that the phenomenal image of the internal disease is our only object of cure, and that after its extirpation, health must remain; whereas, in the above quotation, the opposite is presented to us as the truth, moreover with a feeling of ostentation, and as the fruit of a persistent labor of twelve years. Hahnemann sets up the boldest and most unfounded hypothesis in order to get over a difficulty which he had prepared for himself. Practice soon showed that Hahnemann’s view of diagnosis of disease caused prac- titioners who sought to cure chronic diseases of every kind, to stumble upon difficulties; that something more was required than 34 Introduction. the possession of sound senses and a practised hand; that it was necessary to investigate the internal nature of the malady, espe- cially in cases that had hut a few symptoms: all these difficulties were to be remedied by the authoritative assumption of a secret morbific agent, for which purpose the itch, whose true nature was still enveloped in mystery at Hahnemann’s time, proved a welcome expedient. We should scarcely deem it worth our while to pur- sue this subject any farther, except to show Hahnemann’s inconsis- tencies, if psora did not continue to play an important part with many homoeopaths, not by any means to the advantage of our doc- trine. Our own opinion of the itch will be stated when we come to treat of this disease. In this place we will simply ask the question w hy the itch, after all its morbid manifestations are removed, should still continue in the organism as a disease, and why, upon the same ptinciple, a flea-bite, which likewise causes an efflorescence upon the skin, should not continue to flourish as a secret malady? Hoes an explanation of the peculiar processes of chronic diseases render the supposition of the existence of a secret agent at all necessary? This we cannot believe; and, in order to substantiate our belief, wre fall back upon our explanation of the law7 of similarity. Consequently vTe accept the proposition that, in a therapeutic point of view, disease is an aggregate of the sensually perceptible morbid symptoms, and that, where no symptoms are seen, a disease does not exist. To these sensually perceptible symptoms belong the results obtained by means of auscultation and percussion, or by any other means of physical diagnosis, as well as by the aid of Chemistry. Besides we should endeavor, by means of this external knowledge, to determine the internal processes upon which the perceptible phe- nomena depend as their generating cause. That this is not possible in all cases, and never will be altogether, is a defect with which all human knowledge is tainted. So far as it is possible, we are bound to initiate our reason into the internal processes of disease. Speak- ing of individual affections, we have shown that it is owing to the light which pathological Anatomy has shed upon internal changer that we have become enabled, in many diseases, to pursue the coi rect road to a cure, to prove which we refer the reader to our chapters on apoplexy, acute hydrocephalus, affections of the spina’ cord, as illustrations of our statement. Accordingly we give it as our opinion, that, together with Hahnemann’s requisites, an exhaustive diagnosis of disease implies an intelligent knowledge of the physiological connection of the individual phenomena. Introduction. 35 Tliis is not favoring hypothesis; Physiology rests upon facts to which alone it is indebted for its very existence. The phys- iological connection of the symptoms is the means of arriving at a diagnosis of chronic diseases, without having to lug in invisible, impalpable, incomprehensible morbiiic agents; this connection not only demands an investigation of the present malady, but likewise, and as an absolute condition of success, a consideration of previous diseases, of peculiar conditions in life, habits, abnormal mental phenomena and characteristics, of all causative, favorable or unfavorable, ameliorating or aggravating circumstances, peculiar local conditions, etc. Nobody will probably wish to deny that such a deeper investigation of the malady must be of great value in practice. If Hartmann informs us in his in- troduction that the modern science of diagnostics avails the homoe- opath only in so far as it enables him to arrive at a speedier and more certain cognition of diseases, but is of no avail in the treat- ment of diseases, since no definite plan of cure can be suggested by it, until provers apply these modern diagnostic contrivances in their provings, and mark the internal changes caused by the drug: he contradicts himself to some extent, since he does not accept the proposition that the sensually perceptible phenomena constitute the sole image of the disease. Besides, he errs if he insists upon a cor- responding drug-proving, before such diagnostic resources can be made available for purposes of cure. We admit that it would be desirable, and that it is necessary to a complete elaboration of our Materia Medica, that our modern diagnostic contrivances should be applied to our drug-provings, but we cannot admit for all that, that our present Materia Medica is not adequate to an exhaustive diag- nosis of the natural disease. For in the drug-disease we lay no less stress upon the physiological connection of the symptoms than in the natural disease. In the drug-disease, likewise, we have to pos- sess a lucid apprehension of the relative value and significance of the symptoms, of their origin, succession, final tendency, in short, of all the circumstances a knowledge of which we have to acquire in the case of a natural disease. Though a good deal may still be wanting, yet such a want should not deter us from doing our duty as far as possible. It is very probable that wre may make many mistakes, but it is likewise certain, that by pursuing the road we have pointed out, we shall err much less frequently than those who strictly adhere to Hahnemann’s course. Errors committed by fol- lowing our own plan have this advantage, that we acquire a lucid 36 Introduction. perception of the defects in our Materia Medica so far as the what and the wherefore are concerned, whereas Hahnemann’s method leads hut too easily to a perfect stagnation in the investigation of drug-effects. The history of Homoeopathy has shown this to our perfect satisfaction. As regards the diagnosis of disease, the following proposition is the only one that we can recognize as correct: Investigate by all possible means and contrivances all the changes developed hy the disease with reference to their cause, form, origin, course, connec- tion, and succession; in a like manner investigate the symptoms and changes of the drug-disease, and you will be in possession of the two conditions necessary to achieve a cure by remedial agents. The less perfectly these two conditions are fulfilled, the less sure can we he of effecting a cure. It is readily seen that this proposition includes all covering of symptoms, but in addition requires something else. It cannot be denied that in the present condition of our remedial resources it may often happen that we shall have to select a remedy exclusively according to the similarity of symptoms without any knowledge of their connection or origin, and that such a course will likewise lead to favorable results. However, it would be a mistake, if from a few favorable results of this kind we would draw conclusions re- garding all possible cases of disease, and jump at the inference that we must treat diseases exclusively upon the basis of symptomatic similarity; for where a disease manifests itself only with a few morbid phenomena, the selection of the remedial agent can he de- pended upon as certain and infallible, if the symptoms are strongly marked and characteristic; not otherwise. Covering the symptoms can only lead to a cure hy way of exception, not as a rule; in addition to the uncertainty involved in the selection of a remedial agent, such a proceeding is, moreover, highly unscientific. Our demands relative to a complete and practically reliable diag- nosis of disease can only be satisfied in accordance with our pre- vious statements, if the diagnosis remains purely individual, in other words, confines itself to the case in hand, without regard to other similar cases that may have occurred before, or without re- gard to a general similarity with other cases of the same category. Therapeutically speaking, the homoeopath knows of no categories of diseases, of no classifications based upon individual phenomena were they ever so essential, of no names such as are used in Pathology for the purpose of attaching to them equally general therapeutic rules. Introduction. 37 Generalizing is the enemy of every correct treatment, more particu- larly when conducted in accordance with the principles of Homoe- opathy. It would be going too far if we would condemn all patholo- gical forms. So far as the study of disease is concerned, great benefit is derived by starting from the general phenomena and combining with them the more special symptoms which are pecu- liar to the individual case. Pathology, for instance, reveals to us the characteristic symptoms peculiar to all cases of pneumonia, but not by any means the symptoms by which one case is distinguished from another, and which are of the utmost importance in practice. The fact pneumonia suggests to us a whole series .of drugs, all of which may be useful in this disease; but it does not, at the same time, inform us what remedy may be the best in the present case. Our Therapeutics cannot, therefore, either be united with, or applied to the commonly received Pathology. As it enjoins upon us a rig- orously individual diagnosis and selection of remedial agents, so should a manual of Therapeutics, rigorously speaking, occupy itself with individual cases of disease; it should really be a collection of single cases, and yet, in spite of all its completeness, it would even then be only fragmentary, and would, moreover, be such a bulky and unmanageable fragment, that nobody might feel anxious to wade through it. Such a work could not possibly be perfected by one man; it would have to engage for a long time the energies of a number of co-laborers, and even then it would not answer the de- mands of a really scientific work. Inasmuch as with an exhaustive diagnosis of disease, and a complete knowledge of drug-effects, we are placed in possession of all the requisites of Therapeutics, we might really do without any special system of this science. Up to this time we have not yet reached this point. We are neither in possession of the means to complete our investigations of disease, nor are we thoroughly acquainted with the effects of drugs. This last point we have endeavored to explain in a former paragraph; the former does not require any further argument to demonstrate its correctness. This fragmentary knowledge compels us to avail ourselves in many cases of disease of such knowledge of the action of drills as we have obtained from their clinical use; eonse- quently, it is this kind of knowledge that has to constitute the chief contents of a manual of homoeopathic Therapeutics, for the reason that it completes the knowledge in which we are as yet deficient. At this stage another difficulty meets us that cannot be over- come. A. knowledge of practical results can only he obtained from 38 Introduction. a collection of complete, carefully recorded cases of disease, which we have to search for in the literature of our School. In surveying the whole field of our literature we cannot help confessing that it contains but very little material available for our purpose, more particularly if we consider that a sure conclusion can only be drawn from a large number of homogeneous facts. Upon the whole, all cases of disease recorded in our literature show, with not very numerous exceptions, a want of complete diagnosis, and, for this reason, cannot safely be depended upon, more especially in morbid conditions which, without a rigorous diagnosis, would lead to the most momentous misapprehensions. By way of example we mention the following three conditions which are very different and yet so often resemble each other symptomatically: meningitis, acute hydrocephalus, and typhus. In the sequel we have never failed to direct the reader’s attention to such defects. In conclusion we have to explain the points of view starting from wdiich this work has been composed. The object of the work, to serve beginners in Homoeopathy as a guide in the treatment of diseases, rendered it necessary to follow up a strictly pathological system, and to range, in parallel series writh the pathological catego- ries, a whole-number of remedies that occupy the first rank in the treatment of diseases. To those who may consider the number too small, we have to reply that too much material confuses the beginner, without doing much good to those who are thoroughly conversant with Homoeopathy. In order to satisfy the claims of Medicine regarding diagnosis, we have deemed it necessary to describe diseases as completely and accurately as possible, so much more as, in this respect, Homoeopathy is as yet guilty of many sins of omission. Most likely many will blame us for having done too much in this direction. The therapeutic chapter contains but sel- dom a list of individual symptoms; such lists are only furnished in cases where the symptoms seemed to have a special value, or where a splitting of the symptoms in the Materia Medica might have given rise to a wrong apprehension of their import. In mentioning single remedies, their relation to the disease in point has been described in a very general manner, to which we have added various items that are not found in the Materia Medica and which have been derived from the usu in morbis. By this means we be- lieve we have made it impossible for any one to imagine that the statements made in any given case of disease are sufficient for prac- tical treatment. What we intended to accomplish was, to furnish Introduction. 39 a guide to a knowledge of the Materia Medica, on which account we have indulged in as few special indications as possible, in order that everybody should be obliged to study the special symptoms in the Materia Medica, which is really the true Therapeutics of Homoeopathy. In order to facilitate such a study by means of a comparative arrangement of the materials, we have endeavored, instead of adopting the classification of other writers, and more particularly the confused and confusing classification of Hartmann, to follow the plan of the Materia Medica and to adapt to it our arrangement of particular diseases. In this way a comparison of the different drugs among each other bearing upon one and the same anatomical locality, is very much facilitated. As to the dose, it has been mentioned only now and then in the special part of this work. We shall discuss our views concerning this subject in this introduction, in order afterwards to avoid giving offence, on this account, in view of the great divergency of opinions on this subject. Next to the two leading maxims of Homoeopathy, this subject is undoubtedly the most important. We generalize as follows: Every drug must be administered without the admixture of any other medicinal substance. If Hahnemann had done nothing further than to start the previously expressed proposition, more particularly at such a time as he lived in, he would not only deserve our grati- tude, but likewise our admiration. It is undoubtedly this law which has exerted the greatest influence upon Medicine generally. In proof of this it is well known that apothecaries have heaped upon Hahnemann their bitterest curses for introducing this reform. We do not consider it necessary either to defend or to explain this law any further. This lav/ is an inevitable consequence of the law of similarity. We might be answered that mixed drugs might be proved and employed accordingly. In reply to such an objec- tion we suggest that it would be improper to prove mixtures, whereas so many single drugs still remain unproved, and to employ mixtures where single remedies are sufficiently curative. And then, definite mixtures that have been proved would be like single remedies, since they would have to be prescribed in every case in the same identical combination. So far as we are concerned, we regard medicinal mixtures with a great deal of disfavor; we believe that we do not assert too much, if we maintain that the mixing of drugs has been the main reason why Old-School Therapeutics has 4. Single Remedies. 40 Introduction. not progressed or been improved. We even go so far as to assert that every physician who has an eye to practical results, must be- come a homoeopath from the moment he binds himself as by a law never again to prescribe a mixture of drugs. It is only by pursu- ing this course that he will be able to obtain results from which he can draw conclusions for himself and others, and upon which he can erect the edifice of experience. It is impossible to comprehend that even homoeopaths could have sinned against the doctrine of a single remedy; alas, it has been done, and is even done at the present time in two different ways. In the first place two homoeopathic medicines have been mixed together with a view of obtaining in this manner a simillimum, one part of the symptoms being arbitrarily separated from the other part in order to decide upon the proper remedies. We need hardly show that this proceeding is contrary to the laws of our system of treatment; it has but few apologists. The custom of administering two remedies in alternation is much more common and widespread, especially with our English colleagues. Much may be said in its favor, still more against it; nor do we share Hartmann's opinion when he calls the alternation of drugs an improvement in our system of Therapeutics. The method of alternating drugs can be excused under certain circum- stances, but can never be defended as scientific. We very fre- quently meet with cases where it is difficult to at once hit upon the right remedy on account of the inherent difficulty of establishing a correct diagnosis; nevertheless the imminence of the danger may require prompt help. In such a case the use of two drugs in rapid alternation may be excused until our diagnosis is satisfactorily cleared up. Croup may serve as an example. As soon as our diagnosis is perfectly certain, there is no further reason to excuse the alternate employment of drugs; after this it becomes a mistake that weighs so much more heavily, since it renders our observations obscure and unreliable. In cases where we have to depend upon written reports for a selection of drugs, we may be excused for em- ploying two drugs in alternation, but only until we obtain a correct knowledge of the disease. What we have said shows that the alternate use of drugs is either a forced or self-indulgent palliation of a want of knowledge either of the drugs or of the diseases, or is even a matter of conve- nience. As a general rule we shall find that homoeopaths who are equally well versed in Materia Medica and Pathology do not favor Introduction. 41 an alternation of drugs. We more especially warn beginners against adopting this custom; it will render their path much more difficult since they cannot place any reliance upon an experience derived from such a source. 5. Size of Dose. No subject has been discussed by homoeopaths with more invet- erate and even bitter persistence, and no subject has furnished our opponents so many opportunities for scientific and unscientific attacks as this subject of the size of the dose. In setting up this subject as the fifth cardinal maxim of Homoeopathy, we may at the same time indicate thereby the rank whicli this maxim holds in relation to its four predecessors. We omit quoting Hahnemann, whose teachings concerning the size of the dose have never acquired any general validity, and are, moreover, couched in language that would require a commentary for its proper elucidation. We will briefly state that Hahnemann, observing that the employment of large doses of similarly acting drugs aggravated the disease for which the medicine was pre- scribed, diminished the size of his doses more and more, by which means he was led to the discovery that a quantitative diminution of the drug did not necessarily involve a corresponding diminution of its curative power. Starting from the idea of a so-called homoeo- pathic aggravation, he finally hit upon a dose which would be suffi- ciently powerful for curative purposes, but too weak to occasion any medicinal aggravations. For all that it was a mistake to announce the thirtieth potency as a normal dose, as we shall shortly endeavor to show. The question of dose is a purely practical question, whose solution can only be approximated and achieved by thousands of experi- ments ; for the action of a medicinal substance upon the human organism is not regulated by a uniform law, but depends upon a number of accessory circumstances. We cannot expect ever to derive the same effect from the same dose, either among sick or healthy individuals. These modifying circumstances are of three different kinds, according as they are founded in different degrees of susceptibility to medicinal impressions, or in differences of the morbid conditions, or of the remedial agents. The difference in individual susceptibility to medicinal impres- sions is shown by every proving that is instituted on different individuals, and likewise by the number, be it ever so small, of 42 Introduction. observations on the sick. We cannot form an a priori judgment regarding the degree of susceptibility, even if experience should have satisfied us that certain points may be regarded as fixed. Ex- perience has shown that children, nervous and irritable natures, and men who live as nearly as possible in accordance with the laws of Nature, and with strictness and regularity, are. more susceptible to medicinal action than those who pursue an opposite course; that the susceptibility decreases in proportion as the general reactive energies of the organism diminish, in consequence of the persistent use of large quantities of medicinal substances, etc. Daily experience likewise points to the fact that the size of the dose depends upon the peculiar character of the pathological pro- cess. We see that affections of the nervous system do not require such large doses of medicine as affections of the circulatory organs; that contagious or miasmatic diseases require larger doses, etc. Everybody may likewise see that different drugs, when admin- istered in the same dose, do not manifest the same decree of inten- sity of action. A grain of Arsenic, of course with reference to the effects peculiar to this poison, acts more powerfully than a grain of the Nitrate of Potash or of Mercury; a drop of Belladonna more powerfully than a grain of Chamomile. Looking at the subject from these three points of view, a normal dose, be it small or large, is an assertion that cannot be proved- -a mere theory that can never be substantiated by practice. If many of our homoeopaths still continue to adhere to a normal dose, we have to regret so much tenacity as a damaging mistake, as a direct violation of the spirit of Homoeopathy. Upon the same principle that Homoeopathy demands the strictest process of individualization in diagnosing a disease; that it even insists upon a rigorous indi- vidualization of drug-effects: upon this same principle it likewise demands as a strictly logical consequence, that the dose shall be rigorously individualized in every case by adapting it to the nature and the special circumstances of the case in hand. To meet these requirements we have an universally valid law in Homoeopathy, which we shall discuss more particularly in the subsequent para- graphs. Every cure which a physician is expected to perform is to be conducted in accordance with the principle: Tuto, cito et jucund£ curare. In other words: Every conscientious physician will see to it, without impairing the certainty and rapidity of the cure, that, in addition to the existing complaints, the medicine employed in the Introduction. 43 case, shall not cause additional sufferings to the patient. By pre- scribing a tolerably large dose of a drug in accordance with the law of similarity, we shall almost always develop a more or less consid- erable exacerbation of the symptoms, the so-called homoeopathic aggravation. Everybody can easily satisfy himself that such an aggravation is not an imagination or vague theory; on the other hand, it is certainly an imagination, if many homoeopathic physi- cians profess to see an aggravation after every dose below the omiu- ous thirtieth potency, remaining in this respect much too literally the faithful followers of Hahnemann. The fear of a homoeopathic aggravation led Hahnemann to the great mistake of setting up the thirtieth potency as the normal dose. It is certain that the obser- vations of his successors have not confirmed the statements of their teacher. How, inasmuch as a homoeopathic aggravation—although if it does not manifest itself with too much violence, it is generally a proof of the correctness of our choice of the true remedy in the case—yet is not altogether in accordance with the requirement of “jueunde curare,” we are bound to avoid the aggravation by les- sening the dose, and to continue this lessening process until we reach a point where the fullest possible curative action of the drug is no longer followed by an aggravation of the symptoms, even if this course should lead us to the thirtieth and even higher potencies. Beside the homoeopathic aggravation, we observe from large doses purely medicinal effects, that is to say, effects that are caused by the medicine outside of the range of the natural pathological symptoms. This medicinal aggravation only sets in after propor- tionally large doses, whereas the homoeopathic aggravation may occur after very small doses. That such an aggravation may some- times he excited by very small doses, in individuals endowed with an extraordinary sensitiveness to medicinal action, is a welcome proof of their efficacy. We have treated a very sensitive lady, in whom the sixth attenuation of Mercury always excited profuse, though short-lasting ptyalism, accompanied with a metallic taste. The patient, of course, never knew what medicine she was taking. Evidently a purely medicinal aggravation is more than any other opposed to the “jueunde curare,” and should, therefore, he avoided with the greatest care. According to what we have said, the dose should be determined in accordance with the following rule: The dose should he of a size not to develop any medicinal symptoms while the healing process 44 Introduction. is going on, nor, if possible, any homoeopathic aggravation. We use the term “ if possible,” because it is impossible to avoid a homoeo- pathic aggravation in every case, which, after all, deserves our attention only in case it should set in with much violence. It must be evident to every one that the rule which we have ex- pressed regarding the dose, cannot be applied without any further thought in every disease, since both the homoeopathic and the medicinal aggravations depend upon the above-mentioned relative conditions of the patient, the disease, and the medicine. Practical observation has suggested a few more or less deUnite and fixed rules bearing upon this subject, which we shall at once proceed to point out. Previously, however, we will briefly explain how it is possible that such small doses as are employed in homoeopathic practice, do at all manifest any curative virtue. Regarding this point a whole legion of explanations has been furnished, which we could not possibly discuss without being carried too far. AVe avoid such a discussion so much more readily as all explanations of this point never lead to any convincing result. We have already stated in a previous chapter that the small doses of Homoeopathy have been suggested by the purest empiricism, and we here add that it is only the practical ex- periment that can furnish evidence of their efficacy. If any one can- not or will not believe in the efficacy of these small doses—and we do not blame any one for it—let him try them in practice, and ob- tain practical evidence concerning a subject that seems incredible to his abstract understanding. In view.of the tendency now prevailing to observe the course of diseases without the use of drugs, we deem it much more natural and conscientious to find out with how little medicine cures can be effected than to determine how much medicine a patient can bear without being injured or killed by it. If, with reference to the question of dose, the old system of Medicine is in direct opposition to Homoeopathy, no unprejudiced person can doubt to what party the palm of discretion and conscientiousness should be adjudged. We know that most diseases terminate in recovery even without our aid;—if this be so, is it not a piece of unscrupulous boldness to operate with large doses of powerful drugs?—A\re ho- moeopaths are entitled to backing up our mode of administering drugs by the experience of thousands of cases and practitioners; but who is justified, without instituting a final trial, in arrogating to himself an apodicfic judgment concerning things which he rejects for no better reason than because he is unable to compiehend them Introduction. 45 with his purely human imperfect understanding? The actual ex- periment establishes the belief in small doses much better than a purely theoretical explanation. Are the small doses of Homoeopathy the sole thing in Nature which surpasses our comprehension ? Should we deny results for no better reason than because we marvel at the road upon which they have been reached ?—As we have stated, it is useless to undertake to argue against those who are not willing to believe; we prefer repeating to them Hahnemann’s words: “Imitate my example, but imitate it correctly I” We pity those whom mere prejudice prevents from trying small doses; they do not injure Homoeopathy, only themselves and the patients who confide themselves into their hands. In other respects, general propositions are best attached to each of the following truths which experience alone has taught us: 1st—Every medicine which is administered in accordance with the law of similarity, has to be administered in proportionally small doses. In order that this proposition should be clearly understood, we have to determine in the first place what we understand by large and small doses. The term small can only be understood with refer- ence to the doses that are generally employed in Medicine; hence we might state the case in this way, that medicines prescribed according to the law of similarity can never be given in the same quantity as the same medicines are prescribed according to any other law of cure. If small is to be understood with reference to Homoeopathy, the rule then is worded in this wise: The dose should never be large enough to develop either a medicinal or homoeopathic aggravation. The proportionate smallness of our doses is founded in the totally different views that guide us in the use of drugs. What we intend to accomplish by means of the drug is to excite the reaction, not to divert the reaction from its natural course. Inasmuch as we intend to excite this reaction within the limits of the parts affected by dis- ease, we do not prescribe the medicine in such a large dose that, in addition to the existing symptoms of the disease, it is able to de velop its own inherent drug-effects ; this would envelop other organs and symptoms within the range of the pathological process. That only small doses are necessary to excite the reaction, is not only taught us by practice, but we are led to such a conclusion a priori, since a diseased organ is much more sensitive to the action of an artificial stimulus than the same organ in health. 2d—The limit up to which the dose of a remedy prescribed in 46 Introduction’. accordance with the law of similarity can be diminished, without being divested of its curative power, has not yet been fixed up to this time. Hahnemann had decided in favor of the thirtieth potency as the dose sufficient in all cases; finding even this dose too strong in some cases, he was led to the notorious custom of causing patients to smell of the prescribed drug. Most of his successors have decided in favor of the lower potencies, employing the thirtieth potency only in exceptional cases. Another not altogether insignificant party has carried the potentizing process much higher than Hahnemann. If the partisans of the high potencies profess to have obtained bril- liant curative results from the two thousandth or even the ten thousandth potency, those who think differently are certainly not authorized to deny these results without further proof; it is just as rash to brand such curative results as absurd, as it would he rash on the part of the high potentialists to reject as improper the more material doses of their opponents. We admit that high potencies exert a curative influence. Hut there is no evidence that they act better than the lower potencies up to the thirtieth. It is certain that a remedy in a lower potency, which is unable to overcome a disease, will not overcome it any more if given in a higher. Inas- much as no one can pretend having seen the thirtieth potency pro- duce a homoeopathic, much less a medicinal, aggravation, which must necessarily determine the degree beyond which a medicine need not be attenuated, we cannot comprehend why the immense labor of manufacturing high potencies should be undertaken. Since they do not yield any advantages worth mentioning, this innovation, which carries the “ mysticism” of Homoeopathy to the utmost ex- treme, had better be abandoned. For this reason, we can neither invite nor encourage the trial with high potencies. On the other hand, if we adhere to Hahnemann’s scale up to the thirtieth as the normal series, we deem it inconsistent and unscientific for any one to use the first numbers of this scale and to reject the higher num- bers nolens volens as absurd. The practical trial being alone capable of deciding, every one should satisfy himself by actual experiments whether high or low potencies are preferable. This is the only way of arriving at a final and conclusive result. It may suffice in this place to say that we consider it proven that the thirtieth potency is still capable of effecting decidedly curative results. 3d We consider it an established fact that the lower potencies show a more rapid, momentarily more intense, but less persistent, Introduction; 47 effect than the higher potencies, which develop theii effects more slowly and gradually, but more persistently; and that, for this reason, the lower potencies are more suitable where rapid aid is required—the higher potencies, on the contrary, where the effect can be awaited without any great hurry. We have purposely avoided lugging in, in this proposition, the idea of acute and chronic diseases. Such a separation is always more or less impractical, since we shall always have transition-forms which it might be very difficult to classify, so much the more as the question of dose would have to be settled in accordance with such a classification. Moreover we have acute affections where higher potencies may be more useful than lower, and, vice versa, there are chronic affections where lower potencies will prove more beneficial than higher. The former class, for instance, comprehends all dis- eases running a definite course, such as typhus, contagious exan- thems, or such chronic affections as frequently show an acute ex- acerbation of the symptoms. It is our opinion that in selecting a drug we should be guided by the urgency of the reaction to be obtained, and we prefer this more general definition to special rules which it is impossible to furnish for all cases ; in pursuing this course we shall of course be guilty of many sins of omission. 4th—The more similar the chosen remedy to the disease, the more surely may we expect curative results even from the smallest dose. This proposition is easily explained by what we have said before in explanation of the law of similarity; it likewise accounts for a fact which is common to all homoeopathic practitioners: that is, the more familiar they have become with the Materia Medica, the more correct their knowledge of the curative virtues of our drugs, the more habitually they prescribe smaller doses. This shows that in selecting a drug, its similarity to the natural disease is the first and most important condition, and that the quantity of the dose plays an entirely subordinate part. 5th—In determining the dose, the peculiar nature of the drug demands special consideration. In a previous section already we have shown that this point is somewhat essential. We have many medicinal substances that do not display their therapeutic power until they have been commi- nuted. This number includes all inorganic substances that are in- soluble either in water or alcohol. These it is which the process of trituration has first to convert into remedial agents; it is therefore 48 Introduction. impossible that such drugs, when prescribed in material doses, should manifest any curative power. In the case of soluble inorganic and of vegetable substances we have likewise to consider the intensity of the effect. Corrosive Sublimate, for instance, or Phosphorus, Nux vomica or Ignatia can never be given in as large a dose as Chamomile or Sambucus, comparatively large quantities of which can be administered without any injurious effect. In this place we cannot well classify drugs with reference to these inherent differ- ences of medicinal power, and therefore refer the reader to the. Materia Medica. 6tli—The peculiar nature of the sick individual requires to be carefully considered in the selection of a drug. This point has likewise been alluded to before; here we add the following to our previous remarks. It is always difficult, when taking charge of a new patient, to determine a priori the degree of reaction against medicinal impressions he may be endowed with. In such cases we have to proceed with a great deal of caution, the more so the younger the patient. It is only a protracted observation of individual peculiarities that can afford us a more or less certain basis for a correct judgment. ¥e believe that the foregoing general propositions have ex- hausted the question of dose as far as this is possible in the present position of our science. We have intentionally omitted every thing that might convey the suspicion of party-predilections. We deem it just as wrong on the part of those who prefer the lower potencies to deny the efficacy of the higher, as on the part of those who prefer the higher potencies to condemn the lower as though they only produced toxical results. The former generally pronounce judgment without having made sufficient trials, the latter condemn under the influence of a pitiable one-sidedness. It is therefore fortunate that the dispute about doses which was formerly carried on with so much foolish zeal and repulsive vehemence, has yielded to a temporary armistice. Let both parties first gather up good material, after which they may wage a war of annihilation. 6. Preparation, Repetition, otc., of Medicines. Under this head we range various points of subordinate import- ance, which, however, with reference to practice, cannot remain unnoticed. In his instructions for the preparation of the different medicines we likewise are led to admire Hahnemann's great practical tact. Introduction. 49 He considered it a physician’s duty to prepare all his own medicines, and, in order to do this, the preparation of drugs had to he a very simple affair. Hahnemann’s rules in this respect have undergone but few alterations, indeed only such as have been suggested by our superior knowledge, particularly of inorganic substances or by a difference in our views concerning doses. Particulars may he found in Jahr and Gruner’s Homoeopathic Pharmacopcea, (Hew York: Wm. Radde.) The following are the general rules to he followed in the preparation of drugs. Organic substances in as fresh a condition as they can he obtained, are extracted by means of concentrated alcohol. This yields us the mother-tincture. One drop of this tincture shaken up with nine drops of alcohol, gives the first attenuation, (potency or dilution;) one drop of this first attenuation diluted in a similar manner, gives the second attenuation, and so on. This is the decimal scale which is now in almost general use. Hahnemann followed the centesimal scale, where one drop of the tincture is shaken up with ninety-nine drops of alcohol. Many prefer this scale as superior, doubtless with- out any sufficient reason. The decimal scale yields evidently a more exact, a more uniform attenuation of the drug, and the differences of the single numbers of the series are of less consequence. The centesimal scale is more suited for one who always uses the same potency in his treatment of diseases. Inorganic substances are best attenuated by trituration. To this end one grain of the chemically pure and, if possible, amorphous substance is rubbed up for one hour in a mortar with nine grains of sugar of milk. This yields the first trituration, one grain of which, rubbed up in the same manner with nine grains of sugar of milk, yields the second trituration, etc. The triturating process is usually continued only up to the third or sixth potency, after which liquid attenuations are prepared by mixing one grain of the triturated substance with ninety-nine grains of diluted alcohol. Some drugs have been triturated up to much higher numbers; this practice has not been generally applied to all drugs. Organic substances, that can only be imperfectly extracted by alcohol or not at all, have likewise been triturated; likewise such vegetable substances as can only be obtained dry. Soluble, inorganic substances, on the contrary, are prepared in a liquid form at the outset. For convenience sake—and it is asserted on account of their better preservation—small globules of sugar have been moistened 50 Introduction. with a few drops of an attenuation, which are afterwards allowed to dry again. These globules are excellently adapted to pocket- cases ; however, there is no reason why they should he preferred to the liquid form. Medicines may he administered to the sick in form of drops or powder, or in the shape of globules, or dissolved in distilled water There are no fixed rules with regard to this point. These statements show at once how simple and yet how bulky such a preparation of our drugs must he. Inasmuch as it is impos- sible to exercise any control over the intrinsic value of the attenua- tions, it is evident, that they either have to he prepared by the physician himself, or by a reliable apothecary. From this dilemma the bitterest struggles have arisen for Homoeopathy, for it involves the necessity of self-dispensation for every physician who cannot avail himself of the services of a reliable apothecary. This is not the place for an elaborate discussion of this subject; let it suffice that we deem it of the utmost importance and advantage for every physician to dispense his medicines to the patient directly, even if he should have a reliable pharmacy to fall hack upon. As regards the repetition of drugs, Hahnemann advises not to repeat the dose until the former has exhausted its action. This sounds simple enough, but is of very difficult application in practice. At all events, in chronic affections nothing is lost by waiting a reasonable length of time ; in acute affections, on the contrary, such waiting is very often out of place, and would only be admissible if we could always he sure of the simillimum, and in possession of sure signs by which we could decide when the medicine ceases to act. Let every one ask himself whether he can be certain of this in a given case; we do not believe it, and look upon Hahnemann’s rule as a correct theory that cannot he carried out in practice. Hor was Hahnemann quite as indisposed to repeat the dose as it might seem; if he prescribes a tablespoonlul of the same solution in frequent doses, this too is a repetition of the medicine. As a general rule all practical homoeopathic physicians act upon the principle of repeating the dose the more frequently the more intense the disease. In violent attacks of croup or cholera, for instance, the mediciue may he repeated every ten minutes; it is even well to do so. In affections which, although acute and very intense, run a definite and more extended course, a less frequent repetition of the dose is perfectly appropriate. In chronic affections where no great changes Introduction. 51 take place, one or two doses a week generally advance the cure more than frequently repeated doses. Frequent changes of medicines are contrary to the spirit of Homoeopathy. In acute affections where the life of the patient is in imminent danger, it may be both necessary and pardonable to resort to a rapid change of medicine, since, after all, we are not mathematically certain of having chosen the right remedy; in affections running a less rapid course our best plan is to select a remedy with great care and afterwards to give it a fair trial by continuing it for some time. We should always keep in mind what we intend to accomplish with our remedies; this will induce us to persevere in the proper use of one drug. What we intend to accom- plish is to assist the organic reaction and to enable it to restore the equilibrium of the disturbed functions by a normal process; we do not intend to expel the disease from the organism by violent means. This has to be considered more particularly where the disease has developed morbid products of some magnitude, or has produced other material alterations. A pneumonic exudation, an apoplectic effusion, a considerable deposition of pus, etc., cannot possibly be removed within twenty-four hours; it might even be injurious to the organism if it should develop such an extraordinary reactive activity. If we desire to proceed truly physiologically in such cases, we must not indulge in frequent changes of medicines. 7. Diet. The so-called homoeopathic diet such as it was insisted upon in former times, has not been of particular advantage to Homoeopathy. In the first place it has deterred a number from adopting homoeo- pathic treatment; the fear of the rigid homoeopathic diet is still haunting the public mind; in the next place it has furnished the opponents of Homoeopathy a handle they are even now making use of for the purpose of denying the efficacy of our drugs. Experience has shown that these two disadvantages are not by any means counter-balanced by adequate gains. It is perfectly absurd to attempt to furnish stereotyped rules of diet, as is sought to be ac- complished by our notorious diet-papers. As we allow Physiology full swing, in all other medicinal injunctions, so we should in diet which should likewise be rigorously adapted to the necessities of individual cases. This kind of dietetic individualization requires us to consider the circumstances in which the present generation lives. If we would 52 Introduction. change our mode of living even to a natural system, we should change our whole surroundings, our occupations, our mental and bodily labor. Such a dietetic Utopia is and will remain a religious desire the fulfilment of which is not even looked for by those who entertain it. Habit is a wicked tyrant and yet so ami- able that, in spite of our better judgment, we are unable to shake off his yoke. What wine-bibber would want to renounce his wine? what woman her coffee ? what smoker his cigar ? Before opposing such habits, we had better inquire first how far they are an ob- stacle to a cure, and whether it is not possible to attain our object in spite of them. In most cases we shall certainly be able to do so. The so-called obnoxious habits are not hurtful or at least equally hurtful for everybody; with many they constitute a necessity resulting from the conditions of life. Persons who are constantly occupied mentally, and whose nervous system is bad, require coffee as a stimulant; if they are deprived of it, they feel quite sick. For a state of mental and bodily depression, wine is a perfect panacea; physicians knew this perfectly well by their own personal ex- perience. What shall we say of tobacco? Are we not compelled to put up with it, unless we wish to make tobacconists as well as druggists our mortal enemies? Many habits can easily be put off, but it is best not too suddenly. Among them we range for instance the use of a number of spices, a want of exercise, too warm cloth- ing. Such habits haA7e to be changed, but very cautiously; as regards other habits, they had better be left unchanged at the be- ginning of the treatment. Our remedies act in spite of them, and, we believe just as well, unless the habit should happen to antidote the medicine, such as coffee the vomic nut. Our advice therefore is, do not prescribe a set diet, and do not prohibit too many things in order to secure a more perfect obedience to our positive demands; this may not seem very consistent, but of what avail is all consistency against a secretly sinning patient? In treating of the different diseases, we have generally indicated the proper diet, and cannot indulge in any further details in' this place. We repeat, Physiology gives us sufficient hints what rules we ought to adopt in regard to diet, and likewise points out the reasons why we cannot deem a strictly homoeopathic diet necessary to the successful action of our remedial agents. The maxims of Homoeopathy which have been discussed so far, show that in the treatment of diseases this science pursues an en- tirely different road from that pursued by the Old School. Let us Introduction. 53 now briefly inquire whether under certain circumstances it may not be necessary or possible that Homoeopathy should approximate to or coalesce with other curative methods, and what, in general, is the relation of each curative method to Homoeopathy. We hear it said very frequently that more recently the views of homoeopaths and non-homoeopaths approximate to each other more and more. This can be admitted with great propriety, since all physicians simplify their prescriptions more and more, and, some of them at least, diminish their doses. Homoeopathy cannot make any concessions if it means to remain what it is. Hence it is absurd to suppose that a physician can treat a patient liomoeo- patliically at one time or by some other method at some other time. A physician who pursues this course is either a mere beginner in Homoeopathy or a common impostor. We do not mean to assert that we alone are able to achieve a cure; we admit that a cure may be wrought in some other way; what we claim for Homoe- opathy is, that it achieves at least as much as any other curative method, and in most cases assuredly more. Hence we are not under the necessity of seeking help elsewhere; all we require to do is to use earnestly and consistently what we possess. Of course our op- ponents will never admit this, but what matters it ? As regards surgery, it stands to reason that necessary surgical operations are likewise indispensable to homoeopaths; yet it cannot be denied that the number of necessary operations has been very much circumscribed by Homoeopathy. There are very many affec- tions which it is not necessary to treat surgically, since they can be managed just as well and better by internal means; such are various kinds of swellings, incarcerated hernia. ISTor will we have to decline the use of external, indifferent auxiliary appliances. Cold and warm fomentations, compresses, etc., are indifferent things in a medicinal point of view, but of sufficient importance for the allevia- tion of many sufferings to deserve the consideration of homoeo- pathic practitioners. These auxiliary means are likewise very fre- quently used by us homoeopaths differently from what is generally the case. Balneo-therapeutics promises in time to become a curative means of great importance. For the present we are confined with few exceptions to the narrowest empiricism, and it would be desirable if homoeopathic physicians were less anxious to subject their patients to a cure whose indications and results are so uncertain. In this matter fashion has unfortunatelv enforced her behests and has 54 Introduction. caused many a one to forget that a medicine should not he em- ployed before we are well acquainted with its physiological effects. As regards artificial mineral waters, all we can say is that they belong in the category of medicinal mixtures, consequently are in diametrical opposition to the spirit of Homoeopathy Of particular importance to homoeopaths is the hydropathic system of treatment. Its successes are sufficiently striking to ex- cite universal attention. It would be well if physicians could only learn from this method of treatment that it is not always and per- haps never necessary to attack diseases with an excessive quantity of substances that are inimical to the body, and that these diseases are removed much more easily by careful nursing and an awakening of the reactive energies of the organism. Watercure treatment aims in general at what Homoeopathy seeks to accomplish by more special means, leading the organic reaction hack to its normal condition. For this reason we regard the former treatment as of special importance to Homoeopathy, cold water being the only truly constitutional remedy which is not antagonistic to any of our medi- cines. Our literature furnishes abundant evidence that the value and importance of water as a curative agent have been recognized and appreciated by homoeopaths at a very early period. However, we would warn our readers against imitating the extravagances of the modern hydro-therapeutic treatment. Equally important to a homoeopath as the watercure treatment is the movement-cure. If we cannot hesitate to admit that gym- nastic exercises are of incalculable importance to the preservation of the normal condition of the body, we must infer from this as a necessary consequence that methodical exercises must exert a power- ful influence upon the restoration of the physiological equilibrium. In employing this treatment we have likewise to caution the patient against excesses, especially in diseases that do not admit of an in- creased acceleration of the circulation. Gymnastic exercises do not merely feed the muscular powers, but likewise exert an all-powerful influence upon the nervous system generally as well as upon diges- tion. The Swedish movement-cure possesses the undoubted advan- tage of rigidly circumscribing the mechanical treatment within proper limits, and concentrating its effect upon definite and separate portions of the muscular system. The treatment by electricity is still so recent that it is as yet im- possible to decide for what affections it may prove useful. The experiments which are as yet being made with electricity are more Introduction. 55 or less empirical; even if it is not otherwise directly antagonistic to Homoeopathy, yet so far it is too little founded upon a rational basis to enable homoeopathic practitioners to derive positive advantages for their patients from the electro-therapeutic treatment. We have endeavored to show by this short survey that there are many remedial methods which, though not borrowed from Homoe- opathy, yet are not contrary to it in any shape or manner. We repeat, however, that no homoeopath should ever avail himself of any remedial agent the use of which cannot be justified upon the principles of Homoeopathy. Every therapeutic experiment is justified before the tribunal of reason, which is founded upon a knowledge of the remedial agent, and is instituted with all the precautions necessary to render it a standard rule, be the dose otherwise ever so large or ever so small. Experiments without a principle should always be repudiated with becoming energy. FIRST SECTION. Diseases of the Brain, the Spinal Cord, and the Nervous System Generally. A. DISEASES OF THE BRAIN. Hyperfemia of (lie Brain and its Membranes. Even up to a recent period, doubts have been entertained whether a true hyperaemia of the contents of the skull is possible or not, and a number of reasons were well calculated to favor such doubts. Recent physiological experiments, however, have shown satisfactorily that the volume of blood within the skull may differ, and we will refrain from taking sides in this purely pathological question, except so far as to pronounce in favor of the opinion according to which hyperfemia of the brain is not only possible but likewise of frequent occurrence. By hyperfemia of the brain we understand a condition of this organ where the cerebral vessels contain more blood than the nor- mal quantity. This abnormal increase of the volume of blood may be occasioned by three different causes. In the first place, the flow of blood from the brain being normal, a larger quantity of blood returns to the brain. In the next place, the flow of blood from the brain may be abnormally diminished, whereas it may be returned in a normal quantity. Finally, the cause may be located in the brain itself, the cerebral parenchyma may become atrophied or softened, or the capillaries of the brain may become enlarged. Hyperfemia of the brain is either confined to a limited locality, or extends throughout the whole organ. It will scarcely ever be found possible to establish, during the life of the patient, a sure diagnosis regarding the special seat and the extent of the hyperse- mia, for the reason that congestions of limited extent frequently excite much more striking symptoms than more extensive conges- tions. So far as Therapeutics is concerned, such a diagnosis is 57 58 Diseases of the Brain. scarcely ever of much importance. Even a post-mortem inspection does not always show hypersemia with absolute certainty, since a sanguineous engorgement is often supposed to exist where there is not any, and, on the other hand, localized or apparently not very marked stagnations are often overlooked. In this respect the meningeal membranes are very apt to lead one into error. On the contrary, the post-mortem signs become much more apparent in consequence of a frequent recurrence of the congestion, since this causes a dilatation of the vessels. By this means the vessels of the meningeal membranes are made to look like varicose veins, having a strongly marked serpentine course, while the substance of the brain, on its cut surface, exhibits more or less numerous bloody points, and even assumes a reddish tint. It often happens that the most unmistakable signs of a high degree of cerebral hypersemia have been present during life, without any corresponding alterations being discovered after death. The most important terminations of cerebral hypersemia, which impart to it a higher significance in practice, are: Sudden death from paralysis of the brain in consequence of excessive pressure of the blood; dilatation of the vessels, especially the capillaries, by which the tendency to congestion is increased; exudation and extravasation. The causes of cerebral hypersemia are various and important in a practical point of view, since in most cases they determine the selection of the suitable remedy. These causes are of two kinds, causes which affect the brain directly, and indirect causes, by which, through the operation of influences that are partially unknown to us, the brain becomes involved in an affection more or less remote from the brain. Among the direct causes affecting the brain, the most prominent are: Concussions of the head by a fall, blow, etc., continued, persevering and excessive mental exertions, emotional excitement, exposure to excessive heat of the sun (insolation, coup- de-soleil) or to artificial heat, likewise to excessive cold, more par- ticularly if the influence of cold is suddenly succeeded by the action of intense heat. In the second category we may range, according to circumstances, almost all kinds of febrile affections, since almost all of them may be associated with cerebral liyperaemia; in this place we will content ourselves with mentioning pathological processes where cerebral congestions are almost always present; they are: Erysipelas of the face, angina, parotitis, inflammatory affections of the eyes and ears, irregularities of the teething process. Hyperaemia of the Brain and its Membranes. 59 Among the more or less chronic affections that may be mentioned in this connection as causal circumstances, the most prominent in the list of those that impede the flow of blood from the brain are :• Defects of the right heart, emphysema, tumors on the neck; in the list of those that occasion a general increase in the impulse of the circulation: Anomalies of the left ventricle, suppression of habitual losses of blood, (menses, piles.) In this last category we likewise range, without doing any great violence to the natural order, the cerebral hypersemias occasioned by the abuse of alcohol or of other narcotic substances, such as Opium. Without doubt, there like’ wise exists a tendency to cerebral congestions, in which case they may take place without having been excited by any perceptible pathological alteration. This tendency is identical with the so- called apoplectic habitus, but cannot be recognized with any certainty, a priori, by definite diagnostic signs, but has to be deter- mined in most cases, a posteriori, by the actual fact; it is a certain fact that it is not alone indicated by a thickset frame and a short, thick neck. On the other hand, the idea of a probable occurrence of cerebral hyperEemia suggests itself, a priori, in the case of individuals who, while consuming quantities of nourishing food, do not take bodily exercise in a corresponding ratio, and in whom this mode of. living develops a condition that may be justly termed plethora. We have already stated in a former paragraph that the frequent repetition of attacks of hyperemia leads to a dilatation of the vessels, which increases the disposition to renewed attacks. Generally speaking, the prognosis in this affection is favorable, since a fatal result need not be apprehended unless some other com- plicating affection should supervene. In one respect it depends upon the age of the patient. Whereas, in persons of middle age, the danger is not very serious : it is, on the contrary, much greater in the case of children and old people. In the case of children, death takes place very frequently in consequence of the cerebral paralysis occasioned by the hypersemia; in old people, the vessels are gener- ally so fragile that they readily tear, and their contents become effused upon the brain. The apparent violence of the hypersemia is no adequate criterium of the danger caused by it. On the other hand, the more frequently the congestion occurs, the more dangerous it becomes. Where it depends upon pre-existing derangements, the prognosis depends almost exclusively upon the character of these derangements. . The symptoms by which hypersemia manifests itself vary proba- 60 Diseases of the Brain. bly according as one or the other locality of the brain is the seat of the affection, and according as the pressure upon the brain is more or less violent. The head feels heavy, confused, or as if encircled by a tight band ; the headache, which is scarcely ever wanting, is almost always throbbing, and is aggravated by stooping, unusual exercise and every mental effort. Buzzing in the ears, sensitiveness of the eyes, even seeing of sparks and obscuration of sight, are generally present. Vertigo is seldom wanting; if arising from anaemia, a characteristic sign of this kind of vertigo is to become aggravated by stooping, but more especially by looking up, by which, for that matter, any other complaint in the head is made worse. Generally the patient feels drowsy, without, however, being able to sleep, or else the sleep is anxious, disturbed, full of dreams. The patient feels very languid, and his gait is rendered insecure by a want of firmness of the lower limbs. The pulse may continue normal, and, if the congestion sets in as an idiopathic disease, febrile phenomena are entirely absent. This mildest form is combined in other cases with a prevailing disturbance in the emotive sphere, characterized by constant rest- lessness and gloomy ideas; sleep is disturbed by anxious dreams, which, in the more violent cases, do not even entirely disappear while the patient is awake; they even assume the character of hallucinations, and, if the trouble continues without being checked, a permanent mental derangement will not unfrequently result. Palpitation of the heart, ill-humor, distrust, total indisposition to work, fitful mood, are almost always present. This form of liyperse- mia mostly befalls individuals who, while indulging in good cheer, take little bodily exercise, but perform a large amount of mental labor. The foregoing symptoms are almost characteristic of hyper- semia consequent upon suppression of certain forms of haemorrhage. The trouble is much more dangerous if it sets in as an acute affection, and, although very violent at first, continues to increase in intensity until it terminates in death. In such cases the face looks dark-red, the eyes are injected, the vessels of the head and neck pulsate violently, the pupils are almost always contracted, the organs of all the senses are very sensitive, the headache is madden- ing. Furibond delirium is apt to supervene. This type is most prominent in hypersemia occasioned by sunstroke, and, not unfre- quently, is an accompaniment of mental derangement. Not very unfrequently the above-described symptoms are sud- Hyperemia of the Brain and its Membranes. 61 denly succeeded by all the signs of apoplexy, regarding which the diagnosis cannot be established with any positive certainty until the proportionally rapid course and the sudden disappearance of the symptoms of paralysis have satisfied one that no extravasation of blood can have taken place, since the fluid could not have been reabsorbed so soon. In this category belong most likely all the cases that are said to have been cured so rapidly. Cerebral hyperpe- mia may likewise, though erroneously, be supposed to exist during an epileptic attack; here the course of the attack alone gives us perfect certainty concerning its true nature. Among children hyperpemia is an almost habitual accompaniment of all febrile affections, and not unfrequently conceals the symptoms of the true primary affection, for the reason that the course of the hypereemia is marked by the more violent symptoms. In every considerable congestion convulsions of one or the other kind almost always supervene ; they are accompanied by drowsiness even to sopor, delirium, excessive restlessness and anxiety, and vomiting is almost always present. However threatening such a condition may seem at first sight in almost every case, yet it passes off speedily and without leaving a trace behind, so that the hyperpemia seldom lasts longer than thirty-six hours, and generally abates already after the lapse of twelve hours. Treatment, Belladonna.—Among all the remedies of our Materia Medica there is not one which, in its physiological action upon the organism, reproduces the image of cerebral hyperpemia in all its degrees and forms as completely as Belladonna. If is of importance to refer to the many evidences of Belladonna-poisoning where a post-mortem examination reveals a more or less considerable sanguineous engorge- ment in the vessels of the brain. If nowhere else, it is certainly in cerebral hyperpemia that Belladonna is calculated to show the correctness of the homoeopathic method of cure, since, in most, especially uncomplicated cases of this affection it affords relief with wonderful rapidity. It would be useless to detail, in this place, a list of the principal symptoms of this drug, for the reason that their vast number and physiological differences render it necessary that the provings of this drug should be subjected to a special and most careful study. However, it may be of import- ance to place a few more general points of view more promi- nently before the reader. As regards temperaments, the sanguine temperament is more especially adapted to our drug. Plethoric 62 Diseases of the Brain. constitutions, disposed to rush of blood, together with a nervous system, endowed with a high degree of sensitiveness, likewise child- hood and the female organism, constitute the more special sphere of action for Belladonna. The greater the tendency to cerebral congestions, and the more frequently the patient has been attacked by them, the more Belladonna will be found suitable. Hence, it will be found particularly useful in the more important periods of development of the body, during dentition and the period of pubescence, but likewise during the critical period. The more the congestion sets in like an independent disease, the more surely it will yield to Belladonna ; by which proposition is not to be under- stood that, if the congestion depends upon other primary affections, such as angina or scarlatina, for which Belladonna is the truly homoeopathic remedy, such affections impair the homoeopatliicity of our drug to the symptomatic congestion. Having thus indi- cated, in a few leading traits, the general views that determine the selection of Belladonna as the remedial agent in the case, we do not mean to convey the impression that other temperaments and constitutions are not likewise accessible to the action of Belladonna; such a teaching would be in direct antagonism to the experience of our practitioners. Among the special symptoms, we quote more particularly the delirium which, in the case of Belladonna, is gen- erally furibond, and the characteristic excessive sensitiveness of the organs of sense. Contraction of the pupils does not counter-indicate Belladonna, dilatation of the pupils not being a constant effect of this drug, although much more common than the opposite. Bailor ot the face, or even deficient redness, are more reliable counter- indications. Where there is doubt whether Aconite or Belladonna should be given, I have always found that a disposition to perspire constitutes, cseteris paribus, a valuable indication in favor of the latter drug. Aconite, in its action upon the organism, is so closely related to Belladonna that it is sometimes very difficult to choose between the two agents. I have just now indicated a distinctive sign, that has never deceived me. Practically, we have found that a genuine hypersemia of the brain does not constitute the true field for the action of Aconite. The case is different where the cerebral hyperse- mia is a mere symptom of a disturbance of some other organ; in such a case, the hypersemia does not contra-indicate Aconite, among whose symptoms those of cerebral congestion hold a prominent place. According to Hartmann, Aconite is the best remedy for Hyperaemia of the Brain and its Membranes. 63 Cerebral congestions that have been caused by violent emotions, such as fright or mortified feelings. This somewhat specific effect may be accounted for by the fact that in such conditions the action of the heart is peculiarly excited, and that Aconite, as we shall show more particularly by-and-by, exerts a remarkably calming influence upon cardiac excitement. Hyoscyamus and Stramonium, in their relation to the brain, are closely related to both Belladonna and Aconite, especially the former ; we think that it will be sufficient to merely indicate them in this place. Opium is a more important remedy than either of the two last- mentioned drugs, and its action upon the brain is much more cor- rectly delineated. Judging from the scantiness of our clinical records, it would almost seem as if very little use were made of it in congestion of the brain ; yet it deserves special commendation, as any one may see, even from a superficial survey of its pathogenesis. The following symptoms constitute characteristic indications for the employment of this drug: Continual sopor, with insensibility of all the senses ; dark redness of the face, with paleness and coldness of the rest of the body; slow pulse, slow respiratory movements, stertorous breathing. Such phenomena indeed do not often occur in simple hypersemia of the brain; they occur more generally in hypenemia constituting the commencement of more intense affec- tions of the brain. We must not forget to mention two drugs whose employment as therapeutic agents is limited, in consequence of their being so commonly used as articles of daily consumption, but which acquire importance from the fact that their habitual use is very apt to induce cerebral congestions. These drugs are coffee and tobacco. The effects of coffee upon the brain are much better known than those of tobacco ; nevertheless, the use of tobacco causes, in many individuals, the most obstinate congestions, from which they can only be freed by renouncing their habit, which is supposed to be harmless. This may, likewise, show the necessity that, in the presence of habitual congestions, wTiich we are called upon to remove, the use of such agents should be strictly forbidden. For such congestions as are very apt to attack sensitive individuals, in consequence of some joyful event and which generally last some time, Hartmann recommends a few dessert-spoonfuls of ordinary coffee, provided the patient is not an habitual coffee-drinker, in which case Cojjea cruda should be given. However, it may be 64 Diseases of the Brain. doubtful whether Cojfea cruda has any effect upon coffee-drinkers any more than a drop of Tabacum has any effect upon habitual smokers. Nux Vomica.—This agent will scarcely be suitable in simple liyperamiia, but is important in such hyperaemias as are caused by a sedentary mode of life, excessive mental labor, and more espe- cially by the frequent use of spirituous beverages. In such cases, the selection of the remedial agent will depend upon the digestive de- rangements with which such patients are always afflicted. It is only at the commencement of the trouble that Nux will render good service; whereas, if the cerebral affection manifests itself at a later period, as a more independent disease, Sulphur and Natrum muriaticum will prove more efficient aids, to which remedies we therefore direct the reader’s particular attention. Arnica is admitted to be the best remedy for hypersemia conse- quent upon concussion of the brain by a fall, blow, etc., or by other mechanical impressions. So far as the wounded locality is con- cerned, it may be well to apply Arnica externally, but this will not be of any special benefit to the congestion. [After exhibiting Belladonna for twenty-four to thirty-six hours, giving a dose of the third attenuation every half hour or hour, without any perceptible improvement, Ivafka resorts to the Sul- phate of Atropine, third trituration, giving it in the same manner as Belladonna. If this agent produces no favorable result within twenty-four or thirty-six hours; if the patients start or cry out frequently and suddenly during their slumber; if they are tor- mented by a variety of frightful optical illusions, which cause anxiety and trembling; if symptoms of incipient compression of the brain, such as sopor, apathy, slight reaction to light and sound, etc., begin to show themselves, and the determination of blood to the head still continues, Kafka has seen happy results from Apis 3, in solution, giving a dose every hour or two hours ; and, if an active delirium predominates, attended with sleeplessness, rest- lessness, disposition to escape, violent throbbing of the carotids, great heat in the head, Glonoin 3, in the same dose and form, is recommended by this author. Apis is particularly recommended when symptoms of cerebral depression prevail; Glonoin, on the contrary, for symptoms of cerebral exaltation. Veratrum viride is one of the most powerful remedies for cerebral hypersemia. It is extensively used by American physicians for this condition, both in private and hospital practice. The symptoms Hyperaemia of the Brain and its Membranes. 65 which call for Yeratrum viride are almost the same as those that indicate Belladonna: fulness and heaviness of the head, violent headache, heat and throbbing in the head, violent throbbing of the carotids, sensitiveness to sound and light, flushed countenance, heavi- ness, and a tingling or prickling sensation in the lower limbs, and the preliminary symptoms of apoplexy generally. Regarding the dose, it is the general experience of our physicians that a compara- tively large dose, say a few drops of the strongest tincture, in half a tumbler of water, is necessary to develop its therapeutic effects. Gelsemnium Sempervirens, or the Yellow Jessamine, is appropriate in hypersemia during dentition. In hypersemia from sunstroke, applications of ice to the head, and frictions with ice along the spine and extremities, are indispensable to reawaken the paralyzed reaction of the organism, after which Aconite, Grelsemiuum or Belladonna may have to be given. II.] Among the other remedies the following deserve particular attention: Agaricus, Baryta, Ignatia, Rhus tox., Staphysagria and Vercitrum. Regarding the general conduct of such patients, we shall offer but few remarks, since the diet is easity agreed upon. The local application of cold of course affords momentary relief to the patient, but if the cold is applied too energetically and persistently, it may prove hurtful rather than useful; the case is the same in this re- spect as with the general or local sanguineous depletions. If the application of cold affords great relief to the patient, he may apply for a short time cold-water compresses which, however, should never be left too long, and should be renewed quite frequently. If the patient is not confined to his bed, derivation by the application of warmth to the feet should never be attempt el. Foot-baths are de- cidedly out of place. As a matter of course, the stomach should not be overcrowded with food, for the reason that even in the normal condition of the organism, the digestive process is attended with a certain degree of congestion. On this account it is highly im- portant that, where there is a tendency to congestion, a horizontal position or sleeping immediately after a meal should be strictly- avoided. Anicmia of tlse Brain. In treating of this affection we shall pursue the same course as in hypenemia of the brain, ancl, without discussing the admissibility of the hypothesis of a diminished flow of blood to the brain, we shall take this for granted as a fact. In most cases cerebral anaemia 66 Diseases of the Brain. is not sncli a separate affection as to require a separate chapter. This, however, may find its excuse in the great importance that attaches to it in consequence of the ease with which it is confounded with other affections, and of the dangerous consequences based upon a correspondingly erroneous treatment. . Cerebral ansemia either consists in a diminished volume of blood in the brain, or in a supply of blood to the brain destitute of red globules. In the former case it is caused by constriction or com- pression of the arteries through which the blood courses toward the brain, and by any other circumstances in consequence of which the space within the skull is narrowed; in the second case all the causes of anaemia come into play, whereas the deficiency of blood consequent upon sanguineous losses will have to be counted in both categories, since it is not only the quantitative decrease of the volume of blood, but likewise, and perhaps still more, the qualita- tive alteration of the blood that determines the anaemia. And finally there is no doubt that circumstances with which we are not yet perfectly acquainted, probably changes of a spasmodic nature, may induce a sudden decrease of the volume of blood in the brain, a lesser degree of which we may very frequently observe in con- sequence of powerful mental excitement. The symptoms of cerebral anaemia differ a good deal according as it develops itself more or less rapidly. In the former case we have the most perfect image of syncope: consciousness, the sensus communis, voluntary muscular movements are suspended, most generally amid slight convulsions, and both the breathing and the pulse are slower. This condition is most prominently seen during metrorrhagia in confinement. Evidently such accidents are attended with great danger to life.—If the anaemia sets in more slowly, the sinking of the cerebral activity is always preceded by symptoms of stimulation which are almost always similar to the phenomena of hyperaemia. Here as well as in hyperaemia we have violent head- ache, great irritability of the organs of sense, buzzing in the ears, obscuration of sight, vertigo, and it is only from the course and the etiology of these phenomena that we obtain light regarding their probable cause. At a subsequent and more or less remote period symptoms of paralysis supervene. Such conditions are most readily misapprehended in the case of children, where they often set in in consequence of exhausting diarrhoea. They are likewise very apt to deceive when they occur in the further course of morbid pro- cesses involving a rapid loss of animal fluids, in which case they Anaemia of the Brain. 67 are but too easily mistaken for an entirely new and more recent affection of the brain. It is characteristic of most cases of anaemia that the symptoms either abate or disappear in the horizontal posi- tion, and that the inhibition of food or stimulating substances causes an improvement.—That syncope is generally determined by a suddenly arising anaemia of the brain, and not, as is generally supposed, by a semi-paralysis of the heart, results even from the great resemblance of syncope to anaemic phenomena, and is more- over confirmed by the fact that the same remedies are applicable in either case. The course and duration of this disorder depend of course upon the determining pathological processes, upon which the prognosis likewise depends. What is certain is that the appearance of pheno- mena of cerebral anaemia is always a very bad symptom, especially in the case of children. Treatment. Inasmuch as in subsequent chapters we shall have to revert more than once to cerebral anaemia, and more particularly in the general chapter on Anaemia where this subject is more specially treated of, we should have to indulge in useless repetitions, if we would furnish particular descriptions of every variety and modification of cerebral anaemia. For this reason we refer the reader to that chapter, contenting ourselves in this place with men- tioning the most prominent remedies for anaemia of the brain when manifesting itself as an independent, and more particularly in the form of an acute disease. Ammonium carbcnicum. Notwithstanding its decisive action upon the brain, this remedy has not yet been employed to any very great extent in affections of this organ, more particularly for the reason that its cerebral symptoms have been falsely interpreted. These symptoms resemble in a very high degree those, of hypersemia, whereas a comparison of all the phenomena shows most emphat- ically that they characterize a condition of ansemia. As far as we know, no special accessory indications have as yet been enumer- ated for this agent which, at all events, is deserving of special consideration. Camphora. This medicine shows a great contrast between exalta- tion and depression of the cerebral functions, the last-named con- dition being the most permanent symptom. Even a superficial view of the pathogenesis of this drug must satisfy everybody that it is remarkably suitable for anremia. The effect of Camphor setting in and passing away again very rapidly, we shall have to depend upon 68 Diseases of the Brain. it more commonly in eases where anaemia takes the form of syncope, more particularly when consequent upon sanguineous losses. An essential condition for its employment is that the organic reaction should not yet be extinct; on the contrary, that it should still he very active. It being known that the action of this medicine is of short duration, the doses should be given in rapid succession. Ipecacuanha, as a cerebral remedy, is particularly suitable for children and after rapid losses of animal fluids, if symptoms of con- vulsion are present, together with more or less complete coma. In haemorrhages it is likewise recommended by a number of practi- tioners ; hence such accidents would not counter-indicate the use of this agent. Secale cornutum deserves particular notice in the metrorrha gia of parturient females, and the resulting anaemic phenomena; here it acts in a twofold direction, against the haemorrhage itself and, as is shown by a comparison of its physiological effects, against the symptoms emanating from the brain and the spinal marrow; upon both these organs it acts in a very marked manner. Cuprum is only suitable in cases where the whole process is de- veloped gradually, and is more especially characterized by spasmodic phenomena. It would hardly be applicable in cases of genuine ansemia; in general, excessive losses of animal fluids do not come within its ransre. O Other remedies deserving special consideration in this disorder are: Arsenicum, Calcarea carbonica, Colchicum, Digitalis, Tartarus emeticus, Veratrum, Zincum, Silicea. Some of these remedies have been mentioned as suitable for hyperemia, a circumstance that may seem singular. This is in the first place partly owing to the fact that the pathogenesis of such drugs is not sufficiently distinct, and, in the second place, to this other fact that the same drug may mani- fest its action in two opposite directions, like Arsenic for instance, which not only occasions extraordinary symptoms of reaction, but likewise a complete prostration of all vital energies. In both these directions Arsenic can be used with great effect, which is likewise true of other medicines the successful application of which, in a variety of different pathological processes, shows that the whole series of pathogenetic phenomena, even the so-called phenomena of alternation, may serve as guides in selecting a remedy. In simple syncope medicinal interference will scarcely ever have to be resorted to, except where its frequent recurrence is owing to the existence of some other affection against which the treatment will have to be Anaemia of the Brain, 69 directed in such a case. A perfectly horizontal position is the simplest remedy against syncope, by which the attack is always considerably shortened; at the same time this may serve as evidence that the abnormal distribution of the blood is most generally the cause of syncope. This is the most appropriate place to speak of a condition which is of importance to a practitioner for the reason that it is exceedingly troublesome and sometimes obstinate: it is vertigo. It is not our intention to give a list of the different kinds of vertigo and the numerous causes from which it maj'' arise; we will confine ourselves to the vertigo about which old people so frequently com- plain, and which most generally seems such an isolated symptom that it is difficult to decide what causes occasion it. Under all cir- cumstances it is a certain fact that it only emanates front the brain; but whether it is caused by hypersemia or anaemia, is often as diffi- cult to decide as it is on the other hand essential to do so, since such a decision exerts a most important influence upon the selection of the most efficient remedial agent. In order to arrive at such a decision, the most trifling symptoms are to be observed with the utmost care, and the circumstances under which the vertigo makes its appearance are to be considered with the most scrupulous atten- tion. This course will show that the trouble arises from cerebral anaemia much more frequently than from hyperaemia. In such a case the former results from a defective condition of the cerebral arteries, in consequence of which the supply of blood is impeded, and the cerebral parenchyma is deprived of its proper nourishment, owing to which it may even become atrophied. This explains that anaemia may cause attacks of cerebral congestion, since atrophy of one portion of the brain deprives the other portion of the power to offer a normal resistance to the afflux of the blood. We will here mention a few of the distinctive diagnostic signs. The hyperaemic vertigo is seldom present early in the morning, is made worse eating a little more than usual, particularly after the use of such stimulants as wine, coffee, etc.; it abates by persevering exercise, patients have to sit in a half-recumbent position; mental labor and excitement aggravate the vertigo, open air diminishes it, and it is generally accompanied by a slight headache. Anaemic vertigo, on the contrary, generally makes its appearance in the morning, is caused, or at any rate increased by exercise, particularly in the open air, is improved by the use of food and stimulants and likewise by exciting mental labor, and very soon disappears in a quiet recumbent 70 Diseases of the Brain. position; it is very seldom attended with headache, nor need the patient exhibit any pallor of countenance. The remedies for hyper- semic vertigo are generally the same as those that have been men- tioned for cerebral hyperaemia. At the head of the list we have Belladonna, which alone will remove it in most cases, beside which we have Arnica, Nax vomica and Lachesis. For anaemic vertigo the best remedies are: Silicea, Baryta carbonica, Graphites;—Lycopo- diumi, Arnbra and Fluoris acidum likewise deserve our attention.— After what we have stated it is self-evident that a suitable diet is a matter of course. In hyperaemic vertigo all overloading of the stomach and the use of stimulating substances have to be strictly forbidden, and habitual exercise has to be enjoined ; while in anaemic vertigo a nourishing diet, the use of moderate quantities of wine, and mental and bodily rest are indispensable.—The fear of an apo- plectic attack which is fully justified during the presence of hyper- aemic vertigo, could only lead to false measures during the presence of anaemic vertigo, the employment of which would entail so much more injury as the apprehensive solicitude of the patient, which is already very troublesome, would be uselessly increased by such a proceeding. [Aconite is suitable for hyperaemic vertigo, with nausea; the patients have sallow, dark complexions, or are plethoric indi- viduals with flushed faces. Digitalis is excellent in vertigo, with slow, intermittent and irregular pulse. II.] Cerebral Apoplexy. We apply this name to a condition of the brain where, in conse- quence of some cause or other, an extravasation of blood takes place from the cerebral vessels into the substance of the brain. That such an extravasation can only take place from the arteries or capillaries, will not be doubted by any one who takes the laws of the circula- tory process into consideration. The influences occasioning the apo- plectic extravasation must always be of such a nature as to bring about an overpowering impulse of the sanguineous current over the resistance of the walls of the arteries, since it is only in this manner that the rupture of the blood-vessel is possible. In this respect we have to consider four points of view.—The structure of the blood- vessel may have become altered in consequence of its walls having lost their elasticity and having become brittle by the atheromatous process. In the next place the cerebral substance surrounding the vessel may have become altered in its consistence, so that the Cerebral Apoplexy. 71 counter-pressure exerted by the brain may have become diminished or partially suspended, and resistance against the current of the blood is exclusively confined to the walls of the blood-vessel. This condition of things takes place in softening of the brain, and in apo- plectic effusions undergoing the process of resorption. An entirely analogous condition exists in the atrophy of the brain peculiar to persons of an advanced age, and may constitute as frequent a cause of apoplexy as the atheromatous process. A third cause is the inherent weakness of the walls of the vessels that cannot be recog- nized by any peculiar diagnostic signs, and in consequence of which the vessel is lacerated by the violent impulse of the sanguineous current. Finally as a fourth cause may be viewed an alteration in the blood itself, this fluid becoming so thin that its principal constit- uents penetrate the walls of the vessels. This arrangement is most distinctly noticed in purpura where the petechiae form upon the skin without any laceration of the vessels. Even if this last-men- tioned form of extravasation does not constitute apoplexy in the rigorous acceptation of the term, yet, for the sake of analogy, this seemed the most suitable place to mention it. The extravasation at times takes place from one, at other times from several, at times from smaller, at other times from larger vessels, is more or less considerable, and sets in with more or less suddenness. The quantity of effused blood generally, but not always, corresponds to the size of the blood-vessel. In accordance with these circumstances we distinguish two kinds of apoplectic effusion. The first kind is capillary apoplexy where the blood is effused from the finest vessels. In this form the apoplectic centres are generally present in larger number, are very small like ecchy- moses, and scattered over a large surface. If they are so closely crowded together that they seem to constitute a single apoplectic locality, they form an apoplectic focus. The second kind of apo- plexy is termed the apoplectic insultus, where a considerable quantity of blood is effused into the cerebral parenchyma from one or more larger vessels. The larger the vessel which pours out the blood, the more rapid the haemorrhage, which is checked in proportion as the brain is capable of resisting the effusion of the blood. More blood is poured out where the brain is atrophied, or its volume had become lessened by contracting cicatrices remaining after former apoplexies; whereas, with a normal size of the cerebral mass, the flow of blood is arrested much more speedily. The haemorrhage may likewise take place by fits and starts, so that a large coagulum 72 Diseases of the Brain. may be gradually formed by the blood discharged from a vessel of proportionally small size. The changes which the cerebral mass undergoes in consequence of the extravasated blood, do not differ in degree merely. If the apoplectic coagulum is small, the fibres of the brain may retain their normal structure, and are only pressed asunder by the blood; in such a case a complete restoration of the af- fected portion of the brain may be considered certain as soon as the coagulum has been absorbed. But the more considerable and the more sudden the apoplectic attack, the more the affected portion of the brain becomes more or less completely disorganized, so that the cere- bral fibres project, into the coagulum as so many shapeless shreds or are mixed up with it in the form of a shapeless pap, (so-called red softening of the brain.) Such apoplectic coagula are surrounded by a more or less extensive infiltration of blood and ichor. If death does not take place immediately or very soon after the apoplectic effusion, the effused fluid undergoes certain definite changes. Either — and this is of more frequent occurrence—the blood is gradually absorbed except its solid constituents, the apoplectic coagulum be- comes smaller and finally forms only a cicatrix of a yellowish or brownish tint, several of which are often seen in the same individual in different stages of development. Or else the portion of brain surrounding the effused blood reacts so powerfully that it becomes inflamed, and the exudation proceeding from it coniines the blood as within a capsule. In such a case, likewise, a gradual metamor- phosis of the blood takes place, leading to the formation of a cyst filled with a clear serous liquid. As a third possible result which is of the least frequent occurrence, it may happen that the irritating action of the extravasated blood develops an inflammation which, instead of leading to the formation of a cyst, causes suppuration, in which case all such causative influences come into play as will here- after be mentioned when ,we co.ne to treat of encephalitis. Death either takes place in consequence of the pressure exerted by the extravasated blood upon the brain, or, even if the pressure is pro- portionally slight, in consequence of paralysis of such portions of the brain as are absolutely necessary to the preservation of the vital functions. Although apoplexy may take place in any portion of the larger as well as the smaller brain, yet it occurs most frequently in the large brain, and here again more particularly on the confines between the white and gray substance. As causes of cerebral apoplexy we may regard, in a general sense, the same as those that have been mentioned under cerebral hyper- Cerebral Apoplexy. 73 femia; in addition to which another very frequent cause is the change caused in the texture of the cerebral vessels by the atherom- atous process. From the circumstance that apoplexy is not of sufficient occurrence to justify the belief in epidemic apoplexy, we are authorized to draw the conclusion that atmospheric influences favor such accidents; however, it is not, by any means, certain what kind of atmospheric impressions are favorable to apoplexy, although we are pretty well satisfied that a low range of the barom- eter is a marked indication of the presence of such influences. Hence it has been observed that most apoplexies take place about the time of the equinoxes. Since cerebral haemorrhages may take place in every age, no age can be regarded as exempt from. such dangers, though small children are very seldom attacked. It occurs most frequently in persons beyond the age of fifty, and its occur- rence becomes more frequent in proportion as they advance in years beyond this period. This is naturally owing to the above-mentioned changes in the vessels of the brain, and in the cerebral mass itself. We have purposely devoted more space to the pathological por- tion of this section than the object of this work required. We have done this for the purpose of opposing Hartmann’s own peculiar views, (vol. II., page 311, &c.) In accordance with the formerly pre- vailing views about apoplexy, he adopts four kinds of this disease, apoplexia sanguined, nervosa, serosa, and gastrica, starting at times from the cause and, at other times, from the effect as a principle of classification, whereas the pathological process in the brain is, after all, the same.—That nervous apoplexy is possible, may be admitted, though not in Hartmann’s sense, but we need not care from what cause it arises,—(it is said to have been observed to take place in consequence of crushing mental emotions;)—since, on account of the suddenness of the fatal result, it can never become an object of cure. The other divisions are equally valueless in a therapeutic point of view, especially when the treatment is conducted in ac- cordance with homoeopathic principles, since under this treatment the determination of the pathological process in the brain implies an examination of all the exciting and co-operating circumstances with a view of selecting the proper remedy. If we would enumer- ate corresponding categories, they would be almost endless. The symptoms by which an attack of apoplexy manifests itself differ a good deal. In many cases the attack is preceded by well- marked precursory symptoms of various kinds, very much like the symptoms denoting cerebral hypersemia. Very frequently abnormal 74 Diseases of the Brain. precursory symptoms are entirely absent, unless we mean to regard, as such, symptoms that are peculiar to the age of the affected per- son. If the haemorrhage sets in suddenly, the activity of the brain is suddenly paralyzed, the patient falls down without uttering a sound, is unconscious, insensible, partially or totally paralyzed, so that stool and urine pass off involuntarily; the breathing is ster- torous, slow, the expirations are characterized by the blowing move- ments of the mouth; the pulse is at times full, hard, and slow, at times so feeble that it can scarcely be felt; the pupils are at times dilated, at others contracted, sometimes quite normal, the eyes are staring and glassy; speech is suspended, and one corner of the mouth is drawn down paralyzed. Not unfrequently there is vomit- ing ; the face may neither be flushed nor hotter than usual.—If the extravasation is proceeding slowly, the patients first complain of headache, or even only of a disagreeable sensation in the head, they feel languid and indisposed to any thing, they sometimes have to vomit. They are not yet deprived of the power of motion. Soon, however, according as the extravasation is more or less extensive, symptoms of paralysis set in, with which all the above-described symptoms may become associated. How long it may take before the attack is complete, has been shown me even a short time ago. It was the case of a man who experienced the first symptoms early in the morning; about noon he called at my office, after having walked a long distance. One arm was already semi-paralyzed, and it was late in the night when the whole of one side became para- lyzed.—If the quantity of effused blood is small, the symptoms often consist only in paralysis of one side of the body, especially of the tongue or of one arm; or the brain is deprived of the faculty of performing a certain function of the mind, so that the patient has to stutter or is unable to find single words or his memory is lost. These changes often happen to old people who often retire in the evening in good health, and wake in the morning partially paralyzed. If the patient was not struck with death at the outset, the attack runs a very slow course, such as must necessarily be expected con- sidering the nature of the pathological process. Small effusions are re-absorbed without leaving any perceptible derangements, and the symptoms of paralysis which they had superinduced often disap- pear again with surprising rapidity. If the effusion of blood is con- siderable, the paralysis can only disappear partially, for the reason that the destruction of the fibres of the brain causes an unavoid- Cerebral Apoplexy. 75 ably incurable paralysis; months may elapse before the cure reaches its highest point. As a general rule, it is at the commencement that the progress in the improvement is most distinct, and con- tinues so, as long as those portions of the brain which surround the coagulum, continue to divest themselves of their infiltration, which takes place in a proportionally rapid manner. At the commencement of the attack, it is very difficult to give a satisfactory progtios's. Although it is true, as a general rule, that the danger to life is greater in proportion as the paralysis ex- tends, beside involving the mental functions, over a larger portion of the body, and that it is greatest if the respiratory and circulatory organs are involved in the paralysis, yet it not unfrequently hap- pens that patients who seem to have been struck beyond all chances of recovery, recover their consciousness and a proportional restora- tion of the bodily functions, whereas other cases of much more favorable appearance terminate fatally. If the patients live through the first twenty-four or forty-eight hours without any increase of the symptoms, their restoration may be expected so much more certainly. Frequent recurrences of an apoplectic attack render the prognosis of each following attack more dubious; patients who have been attacked once, have constantly to be on their guard against a recurrence of the attack. Treatment. Before giving a more circumstantial account of the remedies that may be advantageously employed in apoplexy, it behooves us in the first place to answer the question what effect we expect of the remedies prescribed and what expectations we may entertain of their curative action.—Apoplexy of itself is no disease in the same sense as the idea of disease is generally conceived; it is only the last link, at least in the larger number of cases, of a chain of pathological alterations that are made manifest by the prelimin- ary stage. It is only in a very small number of cases that these preliminary symptoms come within the range of professional ob- servation, for the reason that they generally seem unimportant, often last only a short time, and still more frequently are of such a nature that even the physician is unable to recognize them with positive certainty as the precursory symptoms of apoplexy. Most generally the physician is sent for when the apoplectic effusion is in full tide of progress or has even reached its limits. In the former case we have to determine whether the causes of the attack are still in operation, with a view of meeting them and arresting the continuance of the hsemorrhage. In the second case our inquiries 76 Diseases of the Brain. have to be confined to what remedies will bring about the absorp- tion of the extravasated blood in order to free the brain from this pressure. It is of the utmost importance that this result should be reached as soon as possible, inasmuch as the probability that the disabled parts of the brain will again resume their functional activ- ity, depends in a great measure upon the speed with which their deliverance from the abnormal pressure is accomplished; if this should take place too slowly, we have to apprehend atrophy of these parts, and the number of the paralyzed parts remains much larger than if the extravasated blood had been reabsorbed more speedily. This is one of those cases where the existing symptoms are not sufficient to determine the proper remedial agent, but where the internal process with whose nature we are acquainted from analogous cases, must necessarily serve as our guide. For this reason it is perfectly useless to undertake to cure paralysis of years’ standing, that had remained after apoplexy; such paralysis is, and will always remain incurable, since we cannot well expect to re- place material tissues that are lost, by internal treatment. Although discussions about the results of other methods of treat- ment are not within the province of this work, yet we cannot re- train from offering a few words of comment upon the favorite remedy in apoplexy, local or general sanguineous depletion. Al- though in latter years important authorities among our therapeutic opponents have pronounced against blood-letting in apoplexy, yet this expedient is still so generally resorted to by physicians and so devoutly worshipped by laymen that genuine courage is required to criticize. And yet it can be shown a priori that its effect can only be injurious; in no case its employment has as yet resulted in an undeniable cure, whereas, on the contrary, it is highly probable,— we have not the means of saying absolutely certain,—that deple- tion does not diminish the apoplectic extravasation and subsequently facilitates a more rapid resorption.—In one respect the effect of every sanguineous depletion is of short duration, since the impulse of the current of blood is depressed only for a few hours. Viewed from this point, blood-letting may seem an excellent remedy for an apoplectic effusion of blood. But in another respect the loss of blood causes a decrease of the solid constituents of the blood, with- out occasioning a corresponding decrease of the fluid constituents whose loss is repaired very rapidly. Hence the fluidity of the blood increases, and the blood not only exudes or extravasates much more easily, but it loses the faculty of coagulating and arresting the Cerebral Apoplexy. 77 hemorrhage by the formation of clots in proportion as more blood is drawn off by the artificial depletion. Even if the process of ex- travasation should still be going on, the usefulness of depletion is, to say the least, counter-balanced, if not outweighed, by the previ- ously mentioned disadvantages. If this were not so, why should not sanguineous depletions have been resorted to for the purpose of arresting other haemorrhages, from the uterus, for instance; in a case of this kind the ancient theory of blood-letting might either easily be confirmed or else demonstrated as mischievous and absurd. Even if in some or even many cases the patient experience a mo- mentary relief, a short suspension of the haemorrhagic process, this apparently favorable result is abundantly neutralized by the usually considerable reaction succeeding the brief period of rest. The same thing takes place here as in pneumonia, where the depletion, gener- ally speaking, is likewise followed by an abatement of the symp- toms, which is very soon succeeded by a so much more considerable aggravation. Resorting to such evanescent expedients implies not only a deception of one’s own judgment, but likewise a disappoint- ment of the poor patient’s expectations. But, we will ask in con- clusion, does not blood-letting favor the resorption of the extra- vasated blood ? To effect resorption a certain amount of vascular activity is undoubtedly required. That resorption is not favored by a loss of animal fluids; that it is effected most rapidly in the normal condition of the organism ; that it becomes slower and more insufficient in proportion as the patient is more enfeebled: is noticed in so many cases more immediately accessible to observation, that we may conclude with certainty the action of the brain is similarly affected. Under all circumstances the whole body is weakened by a loss of blood which depresses vascular activity and acts in opposi- tion to the very conditions upon which a rapid resorption depends.— The reasons we have mentioned seem to us sufficient to reject a resort to sanguineous depletion in every case of apoplexy. Even if we were willing to concede to blood-letting in this affection an ap- pearance of usefulness or even of active aid, after all it would only be against the hypercemia that accompanies and as it were occasions the apoplectic attack. Where the apoplexy is an accomplished fact, blood-letting seems to us like a crime. All the previously men- tioned reasons derive a higher significance from the circumstance that the individuals who are struck with apoplexy are generally very far advanced in years, in whom the functional equilibrium, if once disturbed, is restored much more slowly than in young people. 78 Diseases of the Brain. We have already stated that the preliminary stage generally presents the symptoms of a more or less violent cerebral hyperaemia, on which account we may content ourselves with referring for the treatment of this stage to our statements concerning the treatment of hyperaemia. The other functional derangements with which the preliminary symptoms may be complicated, present such a great variety that it is impossible to furnish even an approximative enumeration of all imaginable cases; in such cases which rank un- doubtedly among the more serious, the study of the Materia Medica itself can alone come to our aid. The remedies mentioned under hyperaemia have such an extensive range of action that it is only in rare cases that one of them will not be found available; in order to be convinced of this fact, all that we shall have to do, will be to institute a careful comparison of the special symptoms. If, in the following paragraph, we repeat some of the remedies that have been mentioned for hypertemia, it is because in every case of apo- plexy it may still be necessary to first act against the hyperaemia that may continue to exist; it is less important to aim at a resorp- tion of the fluid that has already become effused than to prevent a further spread of the extravasation. Belladonna. There is scarcely one case of apoplexy where this remedy is not suitable and sometimes has a magic effect. What we have stated above regarding the constitutions that are a suitable spdiere of action for Belladonna pioints to apoplexy. But inasmuch as the symptoms of hyperaemia are much more characteristic of Belladonna than the subsequent symptoms of apoplexy, it will be found more particularly indicated in cases where the apxqdectic effusion is still attended with violent symptoms of congestion. Belladonna is more particularly indicated by the following symp- toms : red and injected conjunctiva; sparkling, glistening eyes; greatly dilated pupils; dip>lop>ia; excessive restlessness of the ex- tremities ; great anxiety; illusions of the senses. It is not likely that this remedy will have any direct influence over the extra- vasated blood itself, and will therefore have to be given within the first twelve hours of the attack. But inasmuch as, according to our previous remarks, the extravasated blood may, according to circumstances, excite a powerful inflammatory reaction, Belladonna will, although rarely, come into play even in the further course of the attack. In this last-named condition it competes with Aconite, which we do not think possesses any special power in hypersemia or ap>oplexy, but which ’s in its p>lace, and preferable to Cerebral Apoplexy. 79 Belladonna, if a process of exudative inflammation should have to be overcome. This alone shows that it is only in a few cases of apo- plexy that Aconite will be found indicated. Of Coffea, Hartmann says that it deserves especial notice in cases of apoplexy that have been caused in very sensitive individuals by a variety of violent emotions. According to this author the effect of Coffea is evanescent and only palliative. This remedy is partic- ularly suitable in cases characterized by extreme irritability of the organs of sense and of the nervous system generally, sad and whin- ing mood, sleeplessness on account of excessive mental and bodily excitement, frequent flashes of heat in the face, anxiety and a head- ache as if the brain had been bruised, or vertigo, with a sensation of heaviness in the head, excessive sensitiveness of hearing on the days preceding the attack. Opium is undoubtedly a remedy of particular importance in most cases of apoplexy. We do not think that the characteristic indi- cations for this remedy in apoplexy can be given with more precision than by copying the essential parts of Hartmann’s own statement: “ Opium corresponds to all those forms of apoplexy whose symp- toms resemble those that we notice in drunkards. This drug is of great use were it for no other reason than because in apoplexy the vital force is so much depressed that even the most appropriate remedies do not excite any organic reaction and hence remain with- out any effect whatever. Opium possesses the important and peculiar faculty of supplying this deficiency of reactive power in very many cases and rousing the vital forces from their lethargic condition. In order to attain this object a single small dose is often sufficient; sometimes more than one dose is required. Since Opium has a limited sphere of action and seems to exert a beneficial influence only in cases of recent origin, it is evident that its exhibition in apoplexy must not be delayed too long if we expect to derive benefit from its employment. The following symptoms are in every case characteristic indications for its use: Comatose sopor, with stertorous and rattling breathing, and depression of the lower jaw; impossi- bility to rouse the patient; or he can at most only be roused enough to cause him to gaze around unconsciously without answering a single question; the face is flushed, bluish-red, bloated; the patient moans, groans, moves his lips continually as if he were talking; the pulse is large and slow, the breathing oppressed and anxious; the fa< e is covered with a profuse and cold sweat; the head feels 80 Diseases of the Brain. heavy; if the patient attempts to raise it, it immediately sinks back upon the pillow ; the temporal arteries pulsate strongly and visibly.” In real apoplexy Hyoscyamus may not often be found suitable; Hartmann mentions as a characteristic sig-n of this drug : suddenness of the attack, the patient falls down at once with a violent cry, fol- lowed by convulsive motions, and rattling and snoring. The patient looks wild and livid. Laurocerasus. Without contradiction no poisonous agent, in its physiological as well as toxical effects, exhibits so much similarity to apoplexy as this one. In the lesser grades of poisoning with Laurocerasus a very marked hypersemia of the brain is one of the most constant phenomena; in the higher grades this hypersemia in- creases until paralysis results from it. A post-mortem examination almost always shows a copious extravasation of blood in the cra- nium. There is scarcely a more characteristic image of apoplexy to be found anywhere. Nevertheless, our literature does not furnish any evidence that this drug is used much in apoplexy, certainly much less frequently than it ought to be. Special characteristic indications are nowhere to be found. In Hartmann’s recommen dation that the drug should be used if the attack sets in suddenly, without any precursory symptoms, and the patient is struck down suddenly as if dead, there is scarcely any thing characteristic to be seen; moreover such case-s are very rare, nor do we see why the signs of cerebral congestion that necessarily precede the extinction of nervous activity, should be entirely overlooked in such cases. The effects of Prussic acid, on the contrary, give us the image of a peculiar form of apoplexy; we subjoin a description of these effects for the reason that this knowledge will facilitate a determination of the cases where this remedy will prove suitable. As soon as the poison is swallowed the individual experiences a sensation of ex- cessive and unconquerable muscular debility, vertigo, stupefaction, inability to stand. The pupils become dilated, the visual power is extinct, the patient is seized with violent anguish and palpitation of the heart. The skin becomes cold, moist, insensible, the pulse can scarcely be felt. At this stage convulsions frequently set in, the more readily, it would seem, the smaller the quantity of the poison that had been swallowed; these convulsions affect more particularly the muscles of the face or represent peculiar rotatory movements of the trunk; trismus is almost always present, in some rare cases opisthotonos. Very frequently, however, all convulsive symptoms are absent, and the poisoned individual is struck down as by the Cerebral Apoplexy. 81 hand of death a few seconds after the poison had been swallowed, and without uttering a cry. This concise picture contains a few symptoms that are undoubtedly calculated to determine the choice of this agent; they are the following: palpitations of the heart while the pulse is almost imperceptible; a cold and moist skin, trismus, convulsions of the facial muscles. Coma consequent upon poisoning with Prussic acid has this peculiarity that it completely resembles a deep, very quiet sleep. By these symptoms it would seem we might easily decide where this drug is suitable or not in a case of apoplexy. Nux vomica. If we include this drug in the list of remedies for apoplexy, it is not because we place much reliance upon it in this affection, but in order to satisfy the numerous recommendations of other practitioners. Except the paralytic depression of the lower jaw, no symptom is indicated that would justify the selection of this agent. Its being suitable to wine-bibbers and coffee-drinkers is probably mere theory. Considering the totality of its toxicological effects they do not point to apoplexy, but, on the contrary, to simple hypersemia. The following drugs are likewise worthy of mention in this place: Ipecacuanha, Cocculus, Veratrum and Fhosphorus. For a chronic disposition to apoplexy, with danger of a frequent recur- rence of the attack, Kafka likewise recommends Glonoin. We shall now turn to the remedies that have to be employed against the apoplectic effusion in order to effect or rather accelerate its resorption, or to oppose the excessive reaction of the organism. Many who are as yet unacquainted with the practical results of Homoeopathy, will scarcely be willing to admit, on account of all sorts of theoretical reasons, that the resorption of the extravasated blood can be affected at all by such small doses of internal remedies; We shall not attempt to refute their theoretical arguments by other theories, but we claim the full right to refer to our practical results. It is true that in apoplexy these results can scarcely ever be pre- sented as incontrovertible facts, since opponents can fall back upon the expedient of attributing all such cures to the healing powers of Nature. But if in other cases of exudation, the existence of which can be demonstrated by physical investigation, the effused fluid has been re-absorbed under the influence of small doses of internally administered medicines, we have a right to conclude from analogy that, in a case of apoplectic extravasarion, tlie internal employment 82 Diseases of the Brain. of medicines is not only founded in reason, but must likewise lead to successful results. Among all the medicines belonging to this category, Arnica oc cupies the first rank. Even in the Old-School Materia Medica it is recommended as an excellent remedy for apoplexy. To a homoeo- pathic physician its physiological effects reveal its important action upon the brain, since these effects contain all the signs of violent congestion; moreover we are justified in concluding from what we witness of the action of Arnica in injuries complicated with external sanguineous extravasations, that this agent possesses an extraordi- nary power of determining the re-absorption of the extravasated blood. It is most suitable for individuals not too far advanced in age, with a full habit and vigorous frame, and it is rather im- portant, if we wish to secure a favorable result from this drug, that its employment should not be delayed beyond the period when the process of extravasation in the brain may be considered terminated. The presence of slight febr'le reaction constitutes an additional in- dication for Arnica in persons of that descri; tion. As a matter of course no immediate improvement can be expected after its employ- ment, hence it will be well to continue its use for some time before other remedies are resorted to. Sulp'iur comes into play in apoplexy where the action of Arnica terminates. This statement defines very exactly the relative posi- tion of Sulphur in the list of remedies for such an accident. Hence it is applicable in the subsequent stages of the apoplectic effusion. Its employment in apoplexy is sufficiently justified by its extraordi- nary eficcts in other depositions of long standing. The remedies that compete with Sulphur, and are of special importance in cases where, from reasons that we are unable to account for, this agent remains without effect, are Silicea and Baryta carbonica. The latter is particularly suitable for old people. Hartmann relates a brilliant instance where Baryta caused a great improvement in the organs of speech. lodium is not indicated in simple, uncomplicated apoplexy; at any rate it yields the palm to the other remedies that have already been mentioned. If the reaction becomes so marked that it has to be regarded as depending upon an inflammation of those parts of the brain that surround the extravasated coagulum, Sulphur comes into play. We shall revert to. this subject when speaking of meningitis to which we refer. These remarks likewise apply to Mercurius. Hone of the remedies that we have named are capable of healing Cerebral Apoplexy. 83 an apoplectic attack where a good deal of blood has become extra- vasated and a portion of the brain is destroyed, so that the func- tions of the brain will be completely restored. Isolated symptoms of paralysis will remain, the removal of which we may pronounce a very questionable task, but which, especially in cases of some- what recent standing, ive ought not to give up without trying all proper means of effecting a cure. In many cases we have often suc- ceeded, contrary to our expectations, in removing such derange- ments either totally or at least partially. The medicines upon which we shall have to depend in such cases have not so much any immediate connection with apoplexy as with the subsequently remaining paralysis. Causticum here occupies very properly the first rank. Although this drug has been regarded with suspicion, especially in former times, and although many homoeopaths continue to regard its action as questionable and problematical when judged from a purely theor- etical stand-point, yet its practical results are so surprising that this fact alone compels us to believe in its efficiency. In cases of par- alysis belonging to this range, Causticum, even after every other drug has been tried in vain, will still show good results which, it is true, are often enough confined only to a very slight improve- ment. It is most suitable in paralysis of the extremities, especially when complicated with muscular contraction; it is less suitable in paralysis of the organs of the head, such as the tongue, pharynx, eyelids. Among the derangements of the mental functions it is an inability to select the proper words, for which this remedy may he prescribed. Zincum is particularly indicated in cases where the senses remain disturbed after the attack ; complete paralysis does not come within the therapeutic range of this drug; it is even doubtful whether any thing can be done for the hemiplegia when manifested by con- stant involuntary movements. Cuprum. Everybody knows how constantly paralysis is present in poisoning with copper. It has this peculiarity that the motor power is extinct and the paralyzed part grows thinner, while the nerves of sensation preserve their normal functional power. Copper does not affect the functions of the senses in the least, the mental functions remain undisturbed; total or partial paralysis of the tongue, on the other hand, occurs very frequently, and shows itself by a stuttering or deficient speech. In accordance with these in- dications it will be found easy to determine the cases where copper 84 Diseases of the Brain. is indicated. We may add that violent, almost unyielding contrac- tions or chorea-like paroxysms and automatic movements constitute additional indications for the use of this au-ent. O Plumbum is still more characteristic in its effects than the pre- viously mentioned drug. We believe that we can do no better than to give a connected list of the principal symptoms of lead-poisoning, by which means they will become much more comprehensible than by a perusal of their scattered record in our ordinary treatises on pathogenesis. We have obtained the symptoms from various cases of poisoning which are described with marked accuracy in some of our journals. We have: hypochondriac, peevish, indifferent, de- sponding, apathetic mood; the consciousness is blunted, dull, not wanting altogether ; loss of memory, complete absence of volition ; the speech is impeded and interrupted ; single syllables are omitted, or the patient is unable to combine syllables which he had spelt, into words; mimic spasms of the mouth and face when speaking; trembling of the tongue when it is put out; semiparalysis of the buccinator muscles and of the velum palatinum, which manifests itself by violent snoring ;—sleeplessness, fear of death ; the organs of the senses are torpid and insensible, the eyes are principally af- fected ; the eyelids droop as if paralyzed; the pupils are almost constantly and considerably dilated; all objects seem smaller and farther removed from the focus of vision; they may be seen as through a gauze; diplopia; the pulse is always slow, fifty to sixty in the minute; sometimes it feels even hard and tense like a wire; all the muscles may be pai alyzed; in partial paralysis the left side is more frequently attacked, a phenomenon that may be connected with the marked heart-symptoms caused by lead;—the paralysis affects equally the motor and the sentient nerves, is often attended with violent pains in the paralyzed parts, likewise with consider- able contractions of the paralyzed parts, especially of the extensor muscles which feel hard as wood; in other cases the spasms are tonic which, if they reach their full development, run into com- pletely epileptic convulsions. The muscles of the affected parts become atrophied. If the paralysis is not complete, the patient’s gait is unsteady, with particular tendency to fall forward. Even the respiratory muscles seem to be susceptible to the poisoning action of lead, on which account such individuals are often attacked with a high degree of dyspnoea. The sphincters are scarcely ever paralyzed; if they should be, death is imminent. This description of the essential features of lead-poisoning not only shows very fully Cerebral Apoplexy. 85 and clearly where lead comes into play after an attack of apoplexy, but it likewise shows the characteristic differences between a poison- ing by lead and one by copper. Lead might suggest itself at the very outset of an apoplectic attack, if we merely look at the symp- toms without considering the mode and manner ot their origin; this poison never acts instantaneously, or in every case with a certain degree of rapidity ; on the contrary, a long time intervenes between the commencement of the intoxication and the fatal termination, from which we infer that the medicinal action must likewise be very slow. This may likewise serve as a hint that the drug should not be discontinued too soon. If we deviate in this instance from our purpose to omit all re- marks concerning doses, and allow a suggestion bearing upon this point to slip in, we have to justify this exceptional proceeding by the importance of the subject. The last-named medicines act much better in paralysis when given in high than when given in low potencies. If one of them has not effected any thing in the lower preparations and still seems indicated by the symptoms, it should by all means be tried in the higher potencies and in less frequent repetitions before it is dismissed as not suitable. We have seen too many cases where good results were not obtained until this change was made, to justify our urgent advice. The following remedies may likewise be added to the present list: Argentum, Graphites, Rhus toxicodendron, Anacardiurn. Regarding dietetic and other rules, it seems hardly necessary to offer any suggestions. We would warn, ho\vever, against the diet being too severely restricted in every case of apoplexy. Though this should undoubtedly be done in the case of well-fed or perhaps too well-fed individuals, yet apoplexy may likewise befal persons with impoverished constitutions; in their case it would certainly be wrong if we were to deprive the body of the diet which it requires in order to restore the normal equilibrium of its functions. As we have previously contended against sanguineous depletions, we here contend against applications of cold water or ice. In simple congestion these applications refresh the patient a good deal, and certainly do not do the least harm; but in a case of apoplexy we deem such applications both useless and hurtful, so much the more the older and feebler the affected individual, and the greater the difficulty of restoring the lost warmth. 86 Diseases of the Brain. Inflammatory Affections of the Brain and its Membranes. The phenomena of most of the inflammatory affections of the brain resemble each other so much in all their general character- istics that it is sometimes impossible to point out, during the life- time of the patient, the precise locality of the brain that is the seat of the affection. We may dispense with the almost useless trouble to specify the particular processes, so much more as it is of no part- icular use in practice. Viewed from this point we shall discuss only three kinds of the inflammatory processes as being distinguished from each other by essential characteristics: meningitis, a partial inflammation of the cerebral substance, and granular meningitis. 1. Meningitis. This species of inflammatory affection of the brain is by far the most frequent; it is seated in the pia mater, but most generally the arachnoid and even the brain become involved in the pathological process. Regarding its origin, it is scarcely ever a genuine primary, more frequently a secondary affection. In the former case the caus- ative circumstances which we have mentioned already as causes of cerebral hypersemia, are likewise applicable to meningitis, more especially the poisoning by alcohol and excessive mental exertions, nor ought we to omit mentioning sexual excesses as an exciting cause. Very often no opportunity is given for ascertaining the par- ticular causes of the inflammation. It may set in in the form of a secondary affection as a continuation and complication of other pathological processes within the cranium, for instance of inflam- matory affections of the ears, or it may constitute a continuation of a neighboring inflammation to the brain, as in erysipelas, or it may exist as a complication of the inflammation of other important organs, as in pneumonia, more particularly if the serous membranes of these organs are the seat of the inflammation, (pleuritis, pericar- ditis, etc.,) or finally it may set in suddenly as a most serious com- plication during the period of convalescence or, at any rate, during the decrease of some important disease of the general organism. This is most frequently observed during the course of acute exan- thems from whose sudden disappearance we are too easily disposed to derive the opinion that the inflammation has a metastatic origin, to which subject we shall refer more fully when treating of the exanthemata. We may likewise mention that in France an epn Inflammatory Affections of the Brain and its Membranes. 87 demic meningitis has been observed, the more immediate cause of which is still enveloped in obscurity. In almost all cases the seat of meningitis is the convex portion of the brain, scarcely ever the base, which, however, may become involved in the inflammatory process in a more or less intense de- gree. The pia mater is found injected in various degrees of intens- ity and extent, the arachnoid is covered with a layer of exsudation, and the subarachnoideal space is filled with an exuded substance, most generally of the consistence of jelly. If the brain is involved in the inflammation, the cortical substance is alone affected. In chronic meningitis the pia mater is found dim, thickened, adhering more or less firmly to the brain; the subarachnoideal space con- tains a small quantity of a badly colored exuded material. Sff mplorns and Course.—The symptoms of incipient meningi- tis differ according as it sets in as a primary or secondary affection. In the former case the disease often commences like other inflam- mations of important organs, with a violent chill, which is very speedily succeeded by a great increase of temperature, or the attack may he preceded by a precursory stage where, beside a gen- eral feeling of sickness, disturbed appearance of the countenance and violent headache, no other local symptoms are yet present. As soon as the disease has reached its full development, the most striking symptom is an unusual increase of the temperature and an equally unusual frequency of the pulse, as high as 160 beats in the minute. The headache increases to an almost intolerable degree of intensity, the organs of the senses are extremely sensitive to exter- nal stimuli, the eyes more particularly are sensitive to the light, touching the skin even causes pain. The face shows a peculiar ex- pression of anxiety and tension, the look is restless and confused, the conjunctiva is strikingly injected. Sleep is restless, disturbed by frightful dreams from which the patients are frequently roused with a loud cry; or else the patients are completely deprived of all sleep, and during the few moments of slumber they may sink into, the observer is struck by a constant motion of their hands. There is consciousness, but it is confuse, and the patients are apt to give uncertain, tardy answers. If there is sleeplessness, delirium of a light character often sets in during the waking state of the patient. Respiration is very irregular, at times strikingly hurried, at other times unusually calm. At this stage the pupils are generally con- tracted. Vomiting is not unfrequent. In this condition, which has few characteristic symptoms peculiar to it and sometimes seems so 88 Diseases of the Brain. little threatening that no apprehension is felt regarding a change for the worse in the next stage of the disease, the patients continue sometimes one, and at times even eight days, when all at once the more dangerous symptoms break out, usually attended with short- lasting convulsions, a prominent feature of which is a contraction of the cervical muscles. The delirium now becomes more continu- ous, at times furibond, at others more muttering, consciousness disappears more and more, the patient’s look becomes staring and tixed. Paroxysms of clonic as well as tonic spasms set in. In pro- portion as the other threatening symptoms increase, the pulse does not increase in frequency, on the contrary it becomes slower, some- times irregular and intermittent, the cutaneous temperature be- comes unequal, hands and feet are often icy-cold while the rest of the body feels burning-hot. The patient sometimes falls very sud- denly into a deep sopor from which he wakes only for a few brief moments half-conscious or delirious; the features sink as if col- lapsed. The headache evidently still continues, the patients grasp at their heads, which now begin to feel cold whereas their bodies continue hot. At this stage the pulse almost always becomes slower, either resuming its normal frequency or sinking even below it; the irregularity of the respiration likewise becomes a very prominent symptom. Symptoms of paralysis sometimes make their appearance, occasionally with rigid contraction of single bundles of muscles; whereas the bowels are obstinately confined, the urine passes off involuntarily. While these threatening symptoms develop them- selves, an apparent improvement sometimes takes place which is, however, deceptive. Death ensues during the sopor, sometimes after a previous acceleration of the pulse and the respiration, scarcely ever beyond the third week. If the disease runs a favor- able course, the improvement commences with a deep sleep during which the pulse and the respiration have to improve if this sleep is to be regarded as a favorable prognostic. In such a case the patient wakes restored to consciousness which, however, is not entirely free; in general, recovery from this disease takes place very gradu- ally. The diagnosis of this disease is not, by any means, absolutely reliable. In the first stages it is easily confounded with simple hypersemia or acute anaemia. This, however, would only be of im- portance in regard to anaemia, whereas in hyperaemia the treatment is pretty nearly the same as in the first stages of meningitis. It is much more important, however, if meningitis is confounded with typhus. That such a mistake can be easily made and for a long Inflammatory Affections of the Brain and its Membranes. 89 time, lias been shown us by the case of onr own child, which the many physicians who saw it, diagnosed as meningitis, whereas the true character of the affection was only revealed during the period of convalescence, when everybody who had nursed the child had a more or less violent attack of abdominal typhus. The only symp- tom which induced us to adhere to our opinion that the child had typhus was a diarrhoea that lasted a fortnight. Whatever favor- able an opinion we may entertain of a purely symptomatic treat- ment, we certainly shall have to investigate the real origin o± the symptoms, since it cannot be regarded with indifference whether we treat a case of typhus or meningitis even if the symptoms should be ever so similar. Of the other affections that may be confounded with meningitis, We mention uraemia and an acute attack of tuber- culosis. It is likewise difficult to establish a sure diagnosis in cases where meningitis sets in from the start as a complication ot inflam- mations of important organs, such as the lungs, pleura or pericar- dium. In such a case the inflammation of the brain is very readily overlooked in consequence of the absorbing interest excited by the inflammation of the other organs. As a secondary affection the disease sets in very gradually ; the patient at most complains of headache, after which the symptoms of exudation break out quite suddenly, the patient becoming dull, indifferent, the features collapse, a light delirium sets in, the ex- tremities become less movable, the pulse decreases in frequency. Death ensues amid a continual increase of the sopor and the para- lytic phenomena. The prognosis in this affection is always very dubious, generally very unfavorable, the more so the more marked and extensive are the symptoms of paralysis. Nevertheless we know that, under homoeopathic treatment, a cure is still possible in every stage ot the disease; whereas physicians of other Schools declare that, in the stage of exudation, recovery is so little possible that, where it is supposed to have been accomplished, it is almost certain that some other affection had been mistaken for meningitis. Statistical evi- denee in meningitis and diseases of the brain generally, is very little reliable, since an absolutely certain diagnosis can only be estab- lished in very few or fatal c&ses. In homoeopathic statistics a number of cases would undoubtedly be impugned as incorrect: is this not done by our opponents even in regard to cases whose diag- nosis has become a thing of absolute certainty to every educated physician ? On the other hand it cannot be denied that in our 90 Diseases of the Brain. literature many cases are described as meningitis which, in reality, are simple hyperaemia of the brain; all we have to do, in order to be satisfied on this score, is to compare Riickert’s short extracts, (Klinische Erfahrungen, vol. I., page 105, etc.) If all these cases had been cases of incipient meningitis, it would imply that we pos- sess much more efficient remedies for meningitis than we do for other inflammations whose diagnosis we are able to watch and establish at every step with perfect certainty. Why do we scarcely 6ver hear of pneumonia cut short ? Is it more difficult to cut such an inflammation short ? It is undoubtedly proper to treat all such lucky and successful cures to a good dose of scepticism. Treatment. Belladonna is one of the medicines that is most frequently resorted to at the commencement of a supposed meningitis. In Riickert’s above-mentioned work, loco cit., we find the reports of a number of strikingly successful and rapid cures which excite in our minds most particular doubts. An attentive comparison will show that in those cases only the remedy acted in a marked manner where a sure diagnosis was not yet possible, whereas in inflammations that had progressed to a higher degree, the improvement was cither slower or else was not at all due to the sole action of Belladonna. A number of reasons prompt us to believe that Belladonna is no remedy for meningitis, or, at any rate, that we possess better remedies for this disease. This opinion is confirmed by the results of post- mortem examinations incases of poisoning with Belladonna, where we indeed find a high degree of hyperaemia, but never a trace of exudation; it is likewise a known fact that the lighter cases of poisoning with Belladonna, having no fatal termination, recover in a proportionally short period of time in spite of the severest cere- bral symptoms. Nevertheless, in spite of all opposing arguments, the symptoms of incipient meningitis will first and foremost point to Belladonna, and almost any one who is familiarly acquainted with the Materia Medica, will first exhibit this remedy without laying particular stress on a precise diagnosis. That the Belladonna enables us to establish such a diagnosis, may be asserted without fear of contradiction. This medicine exerts so positively a curative in- fluence upon hyperaemia when simulating meningitis, that, where it does not cure, it at least causes an improvement within at most twenty-four hours with so much certainty, that to most cases we may apply the rule: where, in apparently inflammatory conditions of the brain, Belladonna is not succeeded by, at least, a striking Inflammatory Affections of the Brain and its Membranes. 91 improvement within twenty-four hours, no hyperremia is present; in such a case it should be discontinued, and some other remedy should be given in its stead. Another symptom which counter- indicates Belladonna to some extent, is an extraordinary frequency of the pulse, which is very seldom present in hypersemia of the brain. Aconitum. At the commencement of meningitis this remedy is almost as important a remedy as Belladonna at the commencement ot hyperremia. It is almost always suitable to the previously ex- pressed conditions, where Belladonna seemed indicated, hut had no curative effect, namely in the initial stage of meningitis; if menin- gitis can he arrested in its course by any one remedy, it is by Aconite. Corresponding as it does to the whole process of the in- flammation, the improvement caused by Aconite cannot be as rapid and complete as the improvement caused by Belladonna in hyper- remia. This remedy is in its place as long as no symptoms of exu- dation have made their appearance. As soon as the pulse becomes slower and the intensity of the general symptoms increases; as soon as the first symptoms of paralysis set in, Aconite is no longer in- dicated. Opium. In so far as this drug is recommended as a remedy for meningitis, we have to apply to it the remarks which we have offered in a previous paragraph concerning Belladonna. At a later stage of the disease, when sopor sets in, it frequently acts very favorably against this condition, and, when given as an intercurrent remedy, it paves the way for other medicines, as has been observed more fully when speaking of apoplexy. Rhus toxicodendron. In simple primary meningitis a case will never occur where this medicine is indicated; on the other hand it may prove indispensable in erysipelas of the face which sometimes develops itself as a secondary disease in the course of meningitis, if this disease assumes a typhoid character and is attended with un- usually violent symptoms. In such cases Apis may have to he con- sidered. However, our clinical experience with this agent is as yet insufficient to enable us to furnish more particular indications for its use. Arnica. Meningitis is more frequently than is generally believed a consequence of slight injuries or mechanical concussion of the head. Arnica not only meets this general indication in most cases most fully, hut the symptoms of the drug represent most perfectly the image of meningitis, both in the congestive and exudative 92 Diseases of the Brain. stage. The absence of all signs of reaction contra-indicates this agent most decidedly. [Concussion of the brain may result from a very slight me chanical injury, and the symptoms of meningitis caused by the in- jury may not develop themselves until two or three weeks after the accident had happened. A lady standing by the mantel-piece, dropped a match. She stooped to pick it up, and on raising her head rather suddenly, she knocked it against the sharp edge of the mantel-piece. Concussion ensued which developed meningitis four weeks after the accident occurred. The case terminated fatally in the hands of the late dis- tinguished Valentine Mott. A boy of twelve years while running after his sister, stumbled against the mantel-piece. Concussion of the brain took place which resulted in meningitis about a fortnight after the occurrence of the accident. It was a bad case, but the patient recovered in a fort- night in my hands. IL] Bryonia. The pathogenesis of Bryonia embodies a characteristic image of meningitis. Moreover we know from practical experience that Bryonia is a capital remedy in all serous inflammations, lienee also in meningitis. As a general rule the selection of this drug is determined by the period when Aconite ceases to be indicated ; in other words, when symptoms of incipient exudation are beginning to set in. At a later stage of the disease, its favorable action be- comes doubtful, more particularly when all symptoms of reaction which constitute essential indications for the use of this drug have become effaced by paralysis of the affected organ. The most im- portant indications are: a livid, flushed face, a high temperature of the body together with readily breaking out, copious sweats, nausea, with desire to vomit, and obstinate constipation, with dis- tention of the abdomen; scanty and painful secretion of urine. Helleborus niger is one of the most important remedies if the meningeal exudation may be considered as having reached its climax. Although we do not altogether agree with Wahle’s sanguine recommendation who promises good results from the use of this drug even in a few hours; on the other hand, if success is still possible, no other medicine is more likely to achieve it than Helleborus niger. The proper period for its application has arrived if reaction has almost entirely ceased and the symptoms of paral- ysis are more or less completely developed. Sulphur has been exhibited with success in many cases. Its cm- Inflammatory Affections of the Brain and its Membranes. 93 ployment is governed by general considerations of analogy rather than by its physiological action upon the tissues. It will only he found appropriate as a means of assisting the delaying resorption of the exuded fluid, hence in the stage of paralysis after it has continued for a time without any perceptible change. As a matter of course no certain result ought to be expected in the presence of such an unfavorable prognosis; but the important and practically ascer- tained action of Sulphur upon the absorbent system in other organs (we mention more especially pneumonia and peritonitis) furnishes sufficiently adequate reasons for its employment in the exudative stage of meningitis. Of the other remedies that belong to this category, we mention as particularly noteworthy: Hyoscyamus, Stramonium, Digitalis, Iodium, Mercurius, Tartarus stibiatus, Zincum. In the order in which these remedies have been mentioned they will very generally be found to constitute the successive series in which their use may be required in the management of a case. [In the place of Iodium, Kafka recommends the Iodide of Potas- sium as better adapted to effect the resorption of the exuded fluid, and to ameliorate the constitutional diathesis. If Belladonna does not effect a speedy improvement, he generally recommends the Sulphate of Atropine 3 to be given in solution, a spoonful every hour or two hours. II.] As regards the management of such patients in other respects, we must not omit to notice several important points. With refer- ence to sanguineous depletions we refer the reader to what we have stated in this respect in our remarks concerning apoplexy; we have to condemn them likewise as hurtful and therefore useless in the management of meningitis. The effect of cold applications to the head is at all events very uncertain; with some patients they dis- agree very decidedly. If such applications are to be resorted to at all, it has to be done with a good deal of discretion. In the stage of exudation when the vital activity of the organism is depressed to a dangerously low degree, it is certainly a hazardous proceeding to continue the application of external cold. At the commencement of the disease when the fever is high, the patients refuse of them- selves every thing except fresh water. Abundant draughts of this beverage should be given the patient during the whole course of the disease. If the vital turgescence is lowered, we need not fear to administer milk and water, and beef-broth ; these things are even imperatively necessary. It is likewise proper and pleasant to the 94 Diseases of the Drain. patient that the action of the skin should be stimulated by fre- quently and cautiously used cold ablutions followed by friction of the moistened surface. During convalescence the utmost caution has to be used in eating and drinking as well as in regard to mental labor. In the case of children it is well to converse with them as little as possible, (a precaution which is unfortunately too often neglected;) to keep all objects and persons that might excite the patients, away from them. Adults had better be kept strictly isolated. 2. Encephalitis. Cerebritis. Inflammation of the substance of the brain never extends over the whole brain, but is always confined to single localities. It occurs proportionally very rarely. It may occur in every age, but is most frequently met with in persons of middle age. It is not always possible to determine its causes with absolute certainty; the most frequent causes are: mechanical injuries, (which often seem trifling,) the irritation caused by extravasated fluid, tumors, dis- eases of the skull-hones, (especially of the mastoid process,) morbid conditions, with decomposition of the blood. The inflammation may be located anywhere in the brain, but it occurs chiefly along the boundary between the white and gray, substance. Encephalitis commences with exudation between the fibres of the brain, some- times confined to a very small space and at other times extending over a space of the size of a hen’s egg. Owing to the peculiar structure of the brain, an exudation of this kind results in softening and disorganization of its fibres; red softening of the brain sets in, which afterwards, through resorption, assumes a more yellow color. Or else, in consequence of influences which it is difficult to account for, the exuded fluid changes to pus and an abscess forms in the brain. Such an abscess may have various terminations: it may be- come circumscribed and a gradual resorption may take place, or it may penetrate into the ventricles or work up to the surface of the brain, thus causing meningitis and speedy death. The abscess generally results from an injury, but need not necessarily correspond to the locality of the injury. Lastly encephalitis may terminate in the formation of a cyst in consequence of the definitely circum- scribed localization of the inflammatory process. The destruction of the walls of the vessels permeating the inflamed portion of the brain may likewise readily lead to apoplectic extravasations. Symptoms. The phenomena of encephalitis are remarkably Inflammatory Affections of the Brain and its Membranes. 95 vague and uncertain. There are numerous cases where the first symptom of the disease indicates a meningitis breaking out suddenly and running a rapid course; or where death takes place quite suddenly in consequence of effusion into the ventricles, or apoplectic extravasation. In such cases the inflammation is not necessarily confined to a limited space, but may be quite extensive, showing in a most striking manner that large portions of the brain may become disorganized without its functions being correspond- ingly or even to any considerable extent impaired. But even in cases where encephalitis sets in with a whole series of symptoms, they are not sufficiently definite at the first outbreak of the disease to enable us to establish a positive diagnosis upon such an uncertain foundation. All we can do is to conjecture with more or less cer- tainty the character of the disease from the few circumstances that may be positively known to us. In such cases the phenomena of a gradually, never tumultuously increasing pressure on the brain be- come manifest, such as : headache generally violent and continued, and attended with vertigo; disposition to fainting fits ; deep dis- turbance of the emotive sphere; heaviness in the limbs and an un- steady gait without any decided symptoms of paralysis; sensitive- ness of the organs of sense; wandering pains in the extremities. These symptoms are very speedily followed by more general symp- toms of depression, the organs of sense become duller, the extremi- ties lose their sensibility, the paralysis of the motor system of nerves becomes more apparent. The mental functions are almost always impaired, and from the very commencement of the disease exhibit characteristic signs of depression: the \ atients are apa- thetic, drowsy, think slowly, the memory is weaker, the speech is interfered with, and is either heavy or is no longer serviceable as a means of distinct utterance. In the further course of the disease it often happens that the patient is troubled with vomiting, syncope, epileptiform convulsions; the pupils become dilated, the pul e and the respiration become slower; according as one or the other portion of the brain is affected, paralytic conditions of very limited extent may supervene. If the disease runs a slow course, with occasional momentary periods ol distinctly perceptible ameliorations, the morbid process may continue for months before the increasing paral- ysis or the supervention of other affections terminates the patient’s sufferings. Complete recovery can only take place in the first period of the disease; a partial reco very takes place when consequent upon the formation of a cyst or the localization of the abscess within a 96 Diseases of the Brain. definite capsule, the phenomena of paralysis depending upon the disorg mized portion of the bra.n, of course remaining unchanged. In a number of cases the symptoms of paralysis are so little per- ceptible that the cure may he considered complete and that ihe evidence of a previously existing inflammation can only be traced to the cicatrix which a subsequent post-mortem examination of the brain may reveal. As has already been stated, in many cases it is impossible, and in other cases difficult to diagnose encep ialitis ; hence it may not be unp ofitable to enumerate some of ihe leading diagnostic signs of this disease. The gradual development of the symptoms of pressure on the brain precludes the idea of apoplexy as well as of meningitis, except perhaps chronic meningitis, from which, however, encephalitis is distinguished by the presence of striking symptoms of partial paralytic conditions. Tumors in the brain are the least easy to diagnose, which likewise are very fre- quently attended by symptoms of a gradually increasing compres- sion of that organ. The uncertainties attending a case of this kind are more or less cleared up by the fact that the paralytic symptoms of encephalitis are character.zed by more or less marked remissions which are entirely absent in the case of tumors. The prognosis is doubtful in every case, the chances being de- cidedly rather against the patient than in his favor. If the patient recovers, the recovery is generally only partial. The position of the physician in such cases become-; still more complicated by the cir- cumstance that the malady runs such an extraordinarily protracted course. Treatment. We cannot unfortunately point to any cases of encephalitis in our literature calculated to shed light on the treat- ment of this disease. Hence we have to confine ourselves to a few cases in our own practice all of which terminated fatally; it is true they were intrusted to our care only after the disease had been pro- gressing for some time towards its final termination. As a rule the patients should be kept free from all violent excitement; such signs of congestion as may manifest themselves have to he counteracied at once by appropriate remedies. The diet has to he regulated with as much strictness as possible. The most suitable remedies for this affection almost all belong to the category of inorganic medicines. It is only at the beginning of the disease, more particularly if it can be traced to external injuries as their primary cause, that Arnica is the most appropriate remedy. Other remedies which, however, we mention, without any further part.cular indications for the reason Inflammatory Affections of the Brain and its Membranes. 97 that their useful effect in this disease is very questionable, are: Mercurius, lodium, Cuprum, Sulphur, Zincum, and more especially Plumbum. lodium has obtained some reputation in chronic affec- tions of the brain even in the hands of our therapeutic opponents who, on the other hand, very frequently furnish us material for toxicological observations. I have been treating for years a young man who had been afflicted with constitutional syphilis. After having been treated both internally and externally with a quantity of mercurial preparations, his physicians decided to subject him to a rigid course of Iodine treatment. I was unable to ascertain how large a quantity of Iodine-preparations he had used. After the treatment had lasted about a fortnight, he was attacked with vio- lent headache and some fever. Continuing the Iodine by direction of his physician, he lost in a few clays almost suddenly all conscious- ness, and his left lower extremity became paralyzed. This case offers a striking picture of partial encephalitis. We may observe that in this case the paralysis still continues in the form of hemiplegia. We beg leave to refer to Plumbum among the remedies for apoplexy; to the indications we have furnished in that paragraph we here add the following post-mortem appearances: head and brain hypercemic; in the left hemisphere, at the base of the middle lobe, a prominence of the size of a hen’s egg and of a yellowish color, is perceived, very soft to the feel and surrounded by dark-red places. An investiga- tion revealed within the swelling four smaller nuclei of a yellowish softening, separated from each other by normal cerebral substance that merged into the softening without any definite boundary. This abscess had formed in the space of several years in consequence of gradual poisoning. This is an appropriate place to mention a pathological process which is closely related to, or rather identical with, encephalitis: we allude to yellow softening of the brain properly speaking. Its origin is as yet enveloped in great obscurity. It generally occurs only in indi- viduals of an advanced age, and looks very much like the spon- taneous death of the cerebral substance; in rare cases it is met with in young subjects of a cachectic habit of body. It may exist in the brain as an isolated affection, or side by side with a distinct in- flammatory softening or apoplectic effusions, wflth which, however, it has no immediate connection. It is principally met with in the large brain. The phenomena which the yellow softening develops are almost identical with those of encephalitis. The curability of 98 Diseases of the Brain. this disease is very questionable; the remedies that may be em- ployed against it are the same that have been indicated in the pre- vious paragraph. [In encephalitis, when the symptoms of cerebral hypercemia still predominate and the disorganizing metamorphosis is progressing, Kafka has been for some years in the habit of employing Glonoin 1 to 2, with the best success, giving children six to eight drops of the second attenuation in half a tumbler of water, of which solution they take a teaspoonful every two hours. To adults he gives one or two drops of the first or second attenuation on sugar of milk two or three times a day. The effect is truly surprising; in twenty- four or forty-eight hours the turgescence, heat in the head and the engorgement of the vessels diminish much more promptly and safely than could be accomplished by means of sanguineous deple- tions, cold applications or the use of purgatives. This treatment secures moreover the incalculable advantage that the strength of the patient is spared in the fullest measure, and the disease is enabled to institute its retrograde metamorphosis without being arrested in its course. Kafka relates the following case, which we reproduce as worthy of note. A man, sixty-five years old, who had had an apoplectic attack two years previous, in consequence of which his left side remained paralyzed, was, at the time we undertook his treatment, in a condition of cerebral hypencmia, so that his relatives appre- hended momentarily and very properly another apoplectic attack. Side by side with the symptoms of cerebral hypenemia, (see this chapter,) those of cerebral softening, with progressive increase of the morbid phenomena, likewise co-existed. We prescribed Glonoin 1, two doses a day, with the most marked success; the congestive phenomena disappeared entirely. The patient being robust and corpulent, lodium 2 was exhibited in two daily doses. Until the end of March, 1865, the patient who had first come to us in Decem- ber, 1864, remained in a condition of tolerable ease and comfort; the hypenemia of the brain did not return, and the speech, sensi- bility and motor-powers of the patient improved very strikingly. At that period a death took place in the family which made a deep impression upon the patient; the liypersemia returned and was im- mediately followed by convulsions. They were of a clonic nature. While the face and the extremities were thus convulsed, the patient uttered a roaring cry. The consciousness remained unimpaired. Inflammatory Affections of the Brain and its Membranes. 99 When asked why he roared so horribly, he answered that the roar- ing was involuntary and that he could not help it. Our explanation of this phenomenon was that the roaring was a violent expulsion of air produced by a spasmodic contraction of the diaphragm or a sudden and spasmodic compression or contraction of the bronchia. For the convulsions with cerebral hypersemia we prescribed Bella- donna 3, and, no improvement having taken place in forty-eight hours, Atropinum sulph. 3, likewise without any result. Looking into Dr. Clotar Mueller’s Repertory, we found, page 18, art. “ Clonic convulsions attended with cries,” Arsenicum mentioned as a chief remedy verified by clinical experience. After giving a few doses of this drug, one every hour, the spasms as well as the cries ceased, nor have they so far occurred again, end of August, 1865. II.] 3. Tubercular (granular) inflammation of the meninges. Hydrocephalus acutus. This disease is one of the most important affections of the brain, partly on account of its relative frequency and partly on account of its extraordinary tendency to a fatal termination. It is only recently that a more correct discrimination between tubercular and simple meningitis has become possible, whereas formerly by tuber- cular meningitis was simply understood an inflammation of the brain attended with profuse exudation. The difference, however, is not merely founded in the granular character of the disease, hut these two forms of meningitis differ even with regard to their local- ity, a difference that accounts very fully and satisfactorily for many distinctions in their symptomatic manifestations. Granular meningitis is more particularly located at the base of the brain; only in rare cases the convex portion of the brain be- comes involved. As in simple meningitis we find in the subarach- noideal space an exudation of a jellylike consistence; in the pia mater we see the millet-sized yellowish-white granulations which sometimes occur in simple miliary tuberculosis without exudation. The ventricles contain a more or less copious quantity of exuded serum, in consequence of which these cavities not only become very much distended, but the adjoining parts become softened to an extraordinary degree. It is this circumstance which has led to the designation of acute hydrocephalus. Granular meningitis is very rarely an entirely primary affection, but most generally constitutes a partial manifestation of a more general tubercular process, especially of pulmonary tuberculosis ; or' 100 Diseases of the Brain. it is a sequel of previous affections, more particularly of measles, typhus and whooping-cough, after which diseases the tubercular inflammation at the base of the brain frequently develops itself as the first symptom of constitutional tuberculosis. It chiefly invades the infantile organism between the ages of two and ten years, very rarely older children or adults. It may be inferred from these remarks that, perfectly healthy children are scarcely ever attacked by this disease as a primary malady, although the presence of tuber- cles may sometimes remain hidden until they are revealed by a post-mortem examination. Either the children exhibit at a previous period more or less prominent symptoms of a scrofulous taint; or they are delicate subjects, the offspring of tuberculous parents, stunted in their bodily development, but endowed with a good deal of mental quickness, and distinguished by a precocious intellect. This precocity is very apt to induce parents to stimulate the mental powers prematurely, and thus, by this continued stimulation of the brain, to hasten the outbreak of this malignant disease. As in sim- ple meningitis, so in this disease, external injuries, a fall, blow, etc., may, if the organism is otherwise endowed with the necessary con- stitutional predisposition, constitute the proximate causes of an actual manifestation of the malady; at any rate it will often be remarked that the change observed in the conduct of the patient prior to the outbreak of the disease dates from the time when some external force had exerted upon the skull only a slightly disturbing impression. Very frequently, however, all perceptible causes to which the disease might be attributed are wanting, and the out- break takes place with an unexpected suddenness. Symptoms. The disease scarcely ever begins without any mor- bid phenomena, in a manner that would justify one in conjecturing an affection of the brain at all with any thing like positive cer- tainty. For a longer or shorter period the outbreak of the disease is preceded by precursory symptoms which not unfrequently are so slight that they are often overlooked even by the nearest relatives who afterwards are reminded of them when the more violent symp- toms begin to develop themselves. However, inasmuch as it is necessary, for a timely correctness of the diagnosis, that the pre- liminary stage of the disease should be accurately known, the phy- sician should never content himself with a general denial of all morbid symptoms by the relatives, but should institute minute in- quiries into all the particular circumstances of the case. The chil- dren who have hitherto been of a bright and playful disposition, Inflammatory Affections of the Brain ana its Membranes. 101 seem changed, avoid play, become taciturn and, contrary to their former habit, sit by themselves in some remote corner, their sleep is restless, and they are tormented by many anxious dreams. If their intelligence is sufficiently matured, they complain of headache at an early stage of the disease, although not all the time. There is no marked fever, the appetite vanishes, or, in rare cases, is occa- sionally very much increased, and an incipient loss of tlesh cannot be overlooked. The complexion is not all at once altered, pallor of the countenance generally predominates. Even at this period an unsteadiness in the gait of children becomes noticeable; they incline to fall more readily than before, (which is regarded by the parents as accidental,) and are indisposed to walk any considerable distance. Very frequently the beginning of these phenomena dates from a fall or from some violent emotion. The patients sometimes remain in this condition for weeks without any more dangerous symptoms supervening. If we consider these symptoms as the preliminary stage, the real first stage of the disease most generally sets in with the first par- oxysms of vomiting. This does not occur as a consequence of indi- gestion, or in a quiet posrure of the body, or soon after a meal, but particularly when rising from a recumbent position, walking about or while the children are carried round. During the attack the abdominal walls exhibit almost constantly a peculiar tension and depression. At this stage the headache greatly increases in inten- sity ; the higher organs of sense become abnormally sensitive, some- times to a high degree; slight in, the patient starts frequently as if frightened, is very nervous and excited, the mind seems to dwell on one idea which the patient utters to himself repeatedly; the sleep becomes restless, with frequent gritting of the teeth; the patient is tormented by frightful dreams from which he wakes with a piercing cry without being able to free himself at once from the disturbing phantasm. The pupils now are generally contracted, the pulse is accelerated or at times quicker, at other times slower; other prominent febrile symptoms are wanting. The face is usually pallid, or else pallor and flushes suddenly alternate ; the expression of the countenance is peculiarly altered, it is an expres- sion of suffering. The bowels are confined, the urine is scanty, satu- rated and generally turbid. The peculiar cry, however, the nature of which cannot possibly be misapprehended, is not by any means a characteristic symptom of tubercular meningitis, but is likewise peculiar to other affections of the brain. It may be heard, for in- 102 Diseases of the Brain. stance, in cases of simple hyperaunia; and in the case of typhus, of which mention was made in our chapter on meningitis, this cry was as characteristic and occurred as frequently as it is possible to do in the most marked case of tubercular meningitis. It seems to be extorted from the patient by the paroxysmal exacerbations of the headache. Contractions ot the posterior cervical muscles which cause the peculiar boring with the head into the pillow, generally initiate the second stage and henceforth continue to the end. After the first stage has lasted for a few days, the second stage generally commences with convulsions of various degrees of inten sity, at times partial, at other times general, and scarcely ever entirely wanting; these convulsions are followed immediately by symptoms of incipient paralysis. Consciousness vanishes more and more; the children no longer complain of pain, hut grasp very fre- quently at the head, from which it is evident that they experience an intense pain in that region; they are generally restless, and the peculiar cry continues unabated. The vomiting ceases almost en- tirely in most cases. The eyes become completely insensible to in- tense light, and the little patients no longer hear even if spoken to in the loudest tone of voice. The pupils become dilated, generally unequally, and squinting sets in. On one side the extremities are often rigidly contracted, while on the other side they are completely paralyzed. The pulse generally becomes slower than natural, and even falls below sixty beats; on the other hand, however, it often retains a frequency of one hundred and twenty beats, and even higher It may likewise assume an intermittent character, hut this is not a characteristic symptom. Bespiration is always unequal, at times very feeble and inaudible, and then again a deep sighing moan is heard. The coma becomes more and more persistent, there is no longer a trace of lucid intervals; the eyes either remain open or are only half closed, the upper lid being evidently paralyzed. Convul- sions continue to set in in paroxysms of more or less intensity, gen erally on one side. The urine is discharged involuntarily, the bowels remain confined. This stage continues variously, sometimes only a few days, and at other times several weeks. We frequently observe during this stage sticking remissions of single symptoms, which, however, have no favorable meaning; they may even take place with a certain typical regularity ; or a striking improvement in the condition of the patient may delude us for a time, for it will soon enough he superseded by a change for the worse. The last stage lasts seldom longer than forty-eight hours. It com- Inflammatory Affections of the Brain and its Membranes. 103 mences about the time when the pulse rises to an extraordinary number of beats, even one hundred and eighty and upwards; at the same time the number of respirations increases considerably, Avhere- as the temperature of the skin decreases and a profuse perspiration breaks out. The paralysis has now reached the highest degree; it is only now and then that the possibility of motion is made mani- fest by short paroxysms of convulsions. The remarkable changes in the pulse and respiration are evidently consequences of incipient paralysis of the vagus. The breathing becomes rattling, during which death relieves the patient. Recovery may take place in every stage of the disease; in the last stage, however, after the pulse has risen in frequency, the chances of recovery are undoubtedly very slim. It can scarcely be said that the patient ever recovers entirely, for the reason that the disease scarcely ever attacks perfectly sound individuals and is generally complicated with tubercular deposits in other organs. Health can therefore at most be restored only to what it was previous to the attack. Very frequently isolated symp- toms of paralysis remain, owing probably to the circumstance that the effused fluid in the ventricles is not completely re-absorbed. Even if the disease runs a course ever so favorable, it must be ex- pected to break out again sooner or later after it has once taken hold on the organism. The diagnosis of acute hydrocephalus is undoubtedly a ticklish point. Even from simple meningitis the tubercular form cannot always be readily distinguished, particularly in the first and even in the second stage. The affection is not by any means recognizable by absolutely characteristic symptoms, on which account great im- portance is to be attached to the preliminary stage, which scarcely ever has a longer duration in simple meningitis. As a matter of course a correctly discriminating diagnosis in these two forms of meningitis is of the utmost importance. The tubercular process in granular meningitis has to be managed very differently from simple inflammation of the meninges. As regards other affections of the brain, they will scarcely ever be confounded with tubercular men- ingitis. The possibility of this disease being confounded with typhus ha3 already been alluded to in the chapter on simple meningitis. Under all circumstances the prognosis is involved in a great deal of uncertainty and doubt, so much more as it is very questionable whether, what was supposed to be a cure of tubercular meningitis in the first stage, was not rather a case of simple meningitis or even only of cerebral hypersemia. However, even though we should have 104 Diseases of the Brain. to eliminate a number of cases reported in our books as cases of tubercular meningitis, on account of their questionable character, a sufficient number of cases undoubtedly remain to substantiate the fact that this generally fatal disease can be cured with homoeopathic remedies. The sooner the suitable remedies are employed against the disease, the better the prospect of effecting a cure; the more generally and completely the symptoms of paralysis have become manifest, the more questionable will be the final result. Where the pulse has risen to the above-mentioned frequency, recovery can scarcely be expected. Treatment. The management of this disease is without doubt one of the sorest trials to the feeling physician. If he succeeds in effecting a cure, he is haunted by the thought that he has been mistaken in his diagnosis ; if the patient dies, the fatal result simply tends to corroborate his bitter conviction that the disease is in its very nature an incurable malady. The distressing condition of the patient may continue for months without a ray of hope shining athwart the gloom of the sick-chamber; night and day the physi- cian’s mind is filled with anxious thoughts concerning the little patient, all imaginable drugs have been tried, and yet the case runs onward towards a fatal termination. The painfcdness of the situation is increased by the circumstance that children who are attacked with tubercular meningitis have become an object of in- tense parental affection on account of their bright intellect and sensitive disposition. Assuredly this is a situation where the phy- sician has it in his power to show that he is such in the noblest acceptation of the term. Under these circumstances we cannot sufficiently guard against an untoward influence which is apt to creep in and complicate the case. The frequent visits both friendly and professional, which it may be necessary to make, but too frequently tempt the attending physician to change the medi- cine, a proceeding that entails more injury in this affection than perhaps in any other. Inasmuch as the nature of the morbid process renders it impossible for any remedy to effect a rapid and decided change in the symptoms, we should be loth to abandon a remedy if it does not effect a striking improvement in the first twelve or twenty-four hours. Such an improper change of medicine has not only the immediate but likewise the general disadvantage of depriv- ing us of the opportunity of acquiring certainty regarding the action of our drugs and that this lack of positive experience leaves us as ill-advised in all subsequent cases of this kind as in the former. Inflammatory Affections of the Brain and its Membranes. 105 We may likewise just as well observe at the outset that it will be found extremely difficult to select a remedial agent in all such cases in strict accordance with the symptoms, and that such a purely symptomatic selection would afford very little probability for a successful treatment. On the contrary, in selecting our remedy it is of paramount importance not only that the peculiar nature of the exudation and the pathologico-anatomical alterations should be kept in view, but that our selection should be made with special refer- ence to such pathological products and changes. This is likewise conceded by Hartmann, who does not exactly favor this mode of selecting a remedy. Hence if, in the subsequent paragraphs, we leave medicines that had been recommended in other affections of the brain, unnoticed, it is simply because a more general mode of reasoning has satisfied us that they are out of place in this disease. Definite indications for the treatment of each special stage of this disease have likewise been deemed inappropriate by us, and we prefer considering each medicine separately in its relation to the general features of the disease. Bryonia alba. We have already made mention of this drug in speaking of simple meningitis, and we likewise enumerate it among the remedies for granular meningitis for the reason that we have witnessed the most striking effects from its use in other forms of the tubercular disease. It is in all respects adapted to the pre- liminary stage, more so perhaps than to the more fully developed disease. The precursory symptoms undoubtedly point to the fact that the exudative process has already set in, and it is for this period that we have likeAvise recommended Bryonia in simple meningitis. In order to do justice to the symptoms we call to mind the resemblance of the preliminary stage to an incipient typhus where Bryonia is very frequently the only prominently in- dicated remedy. In our opinion the therapeutic efficacy of the drug is bounded by the first manifestation of the paralytic symptoms. Arnica montana. This drug shows likewise in every respect a striking correspondence with incipient granular meningitis, except that the characteristic disposition to vomit is not found in the pa- thogenesis of this agent. It is preferable to Bryonia in cases pri- marily originating in mechanical causes and where the febrile symptoms are more marked. Arnica, however, is not, as in simple meningitis, endowed with a specific influence over the tubercular exudation. 106 Diseases of the Brain. Veratrum album corresponds in every respect to the symptoms of the primary stage of this disease. Among the characteristic indica- tions we note more particularly: great inequality in the distribution of animal heat; vomiting and great increase of the cephalic distress when raising the head; proportionate ease in a recumbent posture; the least motion causes nausea and vomiting; considerable un- steadiness of the extremities; rigidity of the posterior cervical muscles ; disposition to convulsive movements; peculiar alteration of the features and pallor of the countenance, or else flushes on one cheek only. This characteristic combination of symptoms will scarcely be met with as fully in the pathogenesis of any other drug. Our literature exhibits only a few cases confirmatory of the good effects of Veratrum album in this disease. Digitalis purpurea is likewise one of the most important remedies in acute hydrocephalus. This remedy is not so much indicated by its symptomatic similarity to the disease as by the circumstance that it develops the most characteristic symptoms of acute hydro- cephalus even in the same successive series as the disease itself. Hence this remedy will appear suitable in every stage of the dis- ease, from the precursory symptoms to the paralysis of the vagus. For a detailed statement of the gradually increasing action of Digi- talis in this disease, we refer to the Materia Medica, contenting our- selves in this place with furnishing a series of the most characteristic indications: mental depression, interrupted by short periods of ex- citement ; predominant sensation of coldness irrespective of the character of the pulse, with heat and pallor of the face; vomiting at every movement of the body; coma, with twitchings and con- vulsions ; the pupils are either dilated or contracted; rapid emacia- tion, without any correspondingly profuse abnormal evacuations; increase of all the symptoms when abandoning the horizontal pos- ture ; semi-lateral twitchings, especially in the face; continued con- stipation and diminished secretion of urine. To these highly charac- teristic symptoms we have to add the character of the pulse. After small or -even larger doses the pulse appears at first accelerated, small and feeble; after large doses, or after the drug has continued to act for some time, the pulse becomes abnormally slow, or, after the organism has been thoroughly impregnated with the action of the drug, the pulse becomes so rapid that it can scarcely be counted, and is moreover, if not intermittent, at least continually irregular. No other drug has this characteristic peculiarity of the pulse in granular meningitis as fully as Digitalis. As regards the tuber- Inflammatory Affections of the Brain and its Membranes. 107 cular diathesis generally, we know that Digitalis is extremely effi- cacious in scrofulous as well as in tubercular affections, and that it possesses a special affinity to the lymphatic system; and that its physiological effects likewise embody very fully the symptoms of pulmonary phthisis in the first and second stage of the disease. And lastly we must not omit to state that Digitalis is one of our best remedies for acute serous effusions to which this disease is indebted for its name of acute hydrocephalus; whereas, on the contrary, its curative action in chronic dropsies still continues doubtful and ex- ceedingly uncertain. Zincum is recommended by Hartmann very urgently in the irri- tative stao-e, with the assertion that he has often seen a decided im- provement set in in twelve or twenty-four hours after its first employ- ment. AYe are perfectly certain that these cases where such a rapid improvement was noticed, were not cases of tubercular meningitis; on the other hand we do not doubt that Zincum may be adapted to the preliminary stages of the disease; of the symptoms which charac- terize any of its subsequent stages as prominent symptoms, only a few are found in the pathogenetic series of Zincum ; it is much more suitable in simple meningitis, although even in this disease we do not regard it as one of the leading remedies. lodium will scarcely ever be selected in this disease on account of its symptomatic similarity, although it has a few symptoms that might serve as starting-points in our selection of the drug. It is when judging by analogy, that the choice of this agent will appear much more justifiable. Ho one can doubt its extraordinary efficacy in scrofulous affections ; of its importance as a remedy for phthisis we shall speak when treating of this disease. Coupling these gen- eral indications with the symptoms of the drug, we shall obtain sufficient reasons for its practical application. Cuprum is one of the most noteworthy remedies in granular meningitis. It will scarcely ever be indicated in the first stages of the disease, but will be found so much more applicable in the stage of decided exudation when convulsions have begun to set in. This is one of the few remedies that cause great irregularity of the pulse which may likewise, like the pulse of Digitalis, fall considerably below the normal standard. This circumstance alone is calculated to direct our attention to this agent whose pathogenetic symptoms do not by any means contra-indicate its use. If one of the remedies we have named has effected an improve- ment, but if some of the functions of the brain continue to remain 108 Diseases of the Brain. disturbed, it is advisable to continue the drug that had effected the favorable change, in less frequent doses until the remaining symp- toms of the disease are removed or until the appearance of other new and striking symptoms renders a change of medicine impera- tive. Owing to the diversity of the symptoms that may manifest themselves, it is impossible to determine a priori what this new medicine may be. Among the remedies which, in addition to those above described, may still be required, we mention: Mercurias, Helieborus, Plumbum. Beside these, other medicines have been urged upon the Profession, probably without any adequate reason, since the cases where these medicines are recommended are not distinguished by very accurate diagnostic statements. At all events we would most likely fall back upon the following series of drugs: Pulsatilla, Belladonna, Aconi- tum, Stramonium, Hyoscyarnus, Opium, Gina, Artemisia, Rhus toxico- dendron. As regards the last-named drug, it probably owes its recommendation by Hartmann and others to its successful employ- ment in typhus which, as we have stated before, is so easily con- founded with granular meningitis. So far as the dose is concerned, our best observers unite in affirming that frequently repeated doses of low attenuations are preferable in this disease. [In the place of Iodium, Kafka often substitutes the Iodide of Potassium, especially if a constitutional tubercular diathesis lies at the foundation of the cerebral disease. Glonoin, Apis and Atropin are likewise recommended, for the particular indications of which we refer the reader to our chapter on simple meningitis. H.] It is scarcely necessary to allude to any dietetic rules during the management of the disease, since the patients, in their almost un- interrupted state of unconsciousness, are scarcely able to swallow during the whole course of the disease. As long as deglutition is possible, it would of-course be ill-advised to refuse the patients strengthening nourishment; on the contrary, it is of the utmost im- portance to sustain the struggling vitality means of broth and milk diluted with water. Fresh water is the best beverage to quench the thirst which torments the patients, although they may not manifest it by any perceptible signs. External applications can- not be of any possible use in this affection, nor can they afford any relief. During convalescence the digestive process has to be nursed with the utmost care, and the physical and mental wants of the patient generally have to be attended to with unrelenting discre- tion, since we ought to be well aware that the fundamental cause Hydrocephalus. 109 of the trouble, the tubercular deposit, is still present, and, even if no relapse is caused by imprudences, will sooner or later break out again as an actual disease in some other organ. In the case of such individuals a dose of Calcarea carbonica or phosphorica given from time to time for a certain period of time, may accomplish a great deal of good. Above all things, mental exertions, excessive study, excitements of the fancy are strictly to be avoided; children who are often the most eager to learn, should be kept away from their books, if necessary by main force. Hydrocephalus, (stricte sic dictus.) In a general sense we understand by hydrocephalus every ab- normal accumulation of fluid in the cavity of the skull. It may either be acquired or congenital. Acquired hydrocephalus is always seated in the ventricles; it is seldom an idiopathic affection, but is generally symptomatic of some other constitutional affection. It becomes an important symptom when the disease sets in as chief complication of granular menin- gitis ; or when it develops kself so rapidly that it acts like apoplexy and speedily terminates fatally, (serous apoplexy.) The diagnosis of this disease is always very uncertain; its symptoms are the same as those of granular meningitis. It scarcely ever necessitates a special treatment, nor is this feasible. If therapeutic means should have to be used, the remedies that have been mentioned for tuber- cular meningitis will have to be resorted to. Congenital hydrocephalus is likewise seated in the ventricles. It commences already before the child is born, but may increase after birth. The quantity of the accumulated serum may be very large, and hence the skull may acquire an extraordinary volume. Its effects upon the child are sometimes imperceptible, at other times very decided; the mental functions of the brain are mostly in- volved ; it is only in very fully developed cases that the motor system is affected, a more or less complete paralysis se ting in. The life of the patient is not absolutely threatened; it may even be ad- mitted that hydrocephalic ch ldrcn who have got over the period of infancy, have pretty nearly escaped the most imminent danger of death. However, they always remain weakly, irritable and un- usually disposed to frequent and malignant diseases. Hydrocephalus is a curable disease, but such a cure is mostly spontaneous, taking place in proportion as the bodily development progresses. A cure may indeed be facilitated by artificial means, but not by medicines. 110 Diseases of the Spinal Marrow. A main point is to bring up such children with great care, to accustom them to l ght and nourishing food and to active exercise, and not to excite their mental faculties prematurely by a forced development. Among medicines we may select Calcarea carbonica and Arsenicum, but in small and rarely repeated doses. Bandaging the head with strips of a Ihesive plaster, which has been recom- mended by some pathologists, has seldom been of any use, hut has very frequently been attended with the most dangerous conse- quences, either in consequence of the violent compression exerting a dangerous pressure upon the br.dn, or even in consequence of the activity of the vessels of the pericranium being materially inter- fered with. Judging by analogy, it is indeed not only possible but even probable that a cautious use of this method of treatment may be followed by favorable results. B. DISEASES OF THE SPINAL MARROW. The spinal marrow is essentially liable to all the morbid processes that occur in the brain, the structure of both these organs being essential!}7 the same. All these processes may be found described, theoretically rather than practically, in pathological manuals, with- out it being possible to establish a proper diagnosis at the sick-bed and to initiate a treatment based upon it. For this reason we are not disj osed to furnish a detailed description of the manifold patho- logical conditions of the spinal cord, and shall treat only of two of the best known and most important of them, inflammation of the spinal cord and spinal irritation. Most of the other conditions can be attached to the former as accessories. Inflammation of tlie Spinal Cord and its Membranes. This disease is one of the rarer sort, hut is very likely considered bo because it is not always properly diagnosed and is often mistaken for another affection. The inflammation may be seated exclusively in the meninges, hut if the spinal cord itself is inflamed, the accompanying meningitis is never wanting. The course of the dis- ease is either chronic or acute. The acute form extends mostly over a larger surface, depositing an exudation in the subarachnoideal space, and rarely invading the spinal marrow. The chronic form leads to thickening of the membranes and a more or less copious accumulation of serum in the vertebral canal. Inflammation of the Inflammation of the Spinal Cord and its Membranes. 111 substance of the cord leads very speedily, as in the case of the brain, to softening and disorganization of the fibres of the spinal marrow, likewise to the formation of an abscess ; it is generally not very extensive, but always results in an inflammatory affection of the meninges. If we may believe what is sakl regarding the causes of spinal meningitis, they are manifold. Among the most certain causes we enumerate: mechanical injuries, a shock, blow, fracture of the ver- tebrae ; affections of the vertebrae, especially spondylarthrocace; apoplectic extravasations; extension of inflammatory affections of the brain to the spinal cord. Less certain causes are: acute exan- thems ; suppression of haemorrhages; sexual excesses. In many cases, however, the inflammation seems to arise quite spontaneously. Symptoms. The symptoms of meningitis spinalis are almost the same as those of myelitis ; slight differences will be pointed out. In most cases the disease begins with a chill like all other inflam- mations of more important organs. The chill recurs quite frequently m paroxysms of shivering. At the same time the patient experi- ences a local pain at some spot in the vertebral column, which can be pointed out with definiteness; the pain is aggravated by press- ure, and is increased to a most violent and even intolerable degree of intensity by moving, and especially by rotating the spinal col- umn. These symptoms are attended with a not inconsiderable fever. As a general rule, the patient complains of pains at the very beginning of the attack ; very often these pains constitute the first manifestation of the disease. Very soon the first symptoms of in- cipient paralysis supervene, consisting in the first place of painful contractions, or twitchings of the correspondingly involved bundles of muscles, or even of tetanic convulsions, after which the paralytic symptoms increase to paraplegia with more or less rapidity. A cer- tain degree of anaesthesia is scarcely ever wanting, commencing with a sensation of pithiness or numbness and gradually increasing in intensity. According as one or the other portion of the cord is inflamed, the symptoms exhibit considerable differences. If the superior portion of the cord is involved, as a matter of course the parts to which nerves are given off by the more deep-seated portion of the cord become paralyzed. Paralysis of the respiratory muscles is particularly inconvenient and dangerous, since an accident of this kind may speedily terminate fatally. If the lumbar portion is the seat of the disease, violent paroxysms of colic are experienced by the patient. The bladder and rectum are almost always more or 112 Diseases of the Sr>inal Marrow. less paralyzed. Very peculiar, although not of constant occurrence, are the convulsive shocks in the paralyzed parts, which bear a great resemblance to the reflex-movements consequent upon poisoning \Vith Strychnine. In cases where the disease dees not run a too rapid course, all these symptoms exhibit distinct remissions and exacerbations. If the cord is alone affected, the consciousness remains undisturbed; the patients are, however, unusually excited, and are either deprived of all sleep or else their sleep is very restless. The disease may terminate fatally very speedily, especially when seated near the brain, but may likewise last weeks before the patient dies of exhaustion. Recovery from this disease is scarcely ever com- plete, especially if the substance of the marrow itself is involved, in which case various paralytic symptoms always remain behind. It may likewise pass into the chronic form. Before treating of this form, we will describe the symptoms by which meningitis is dis- tinguished from myelitis. In meningitis the pain spreads over a larger surface and is very much aggravated by motion, whereas in myelitis the locality of the pain is circumscribed within very nar- row limits, and the pain itself is essentially increased only by press- ure. In meningitis the fever is more violent. In myelitis paralysis sets in rapidly and totally, whereas in meningitis it develops itself gradually. As has been said, the chronic form may develop itself out of the acute. If it arises without any previous acute attack, the pains are less violent, and there are no febrile symptoms. These pains are scarcely ever as severe at the place where the inflammation is seated as in the corresponding parts of the periphery, especially in the lower extremities, and at the commencement of the disease resemble altogether rheumatic pains. The paralysis sets in so slightly that it is scarcely perceived, and its increase is just as gradual. Here likewise as in the acute form, anaesthesia is never altogether want- ing. As the disease progresses, the bladder becomes paralyzed. This accident, together with the gangrenous destruction of the dorsal integuments, most commonly results in a fatal termination. Chronic myelitis differs somewhat in its phenomena, especially if, as is generally the case, the meninges are not involved. The local pain as well as the pain at the periphery, is less violent, sometimes quite dull and undefined, only slightly aggravated by pressure and motion. The patient experiences a peculiar sensation as if his body were encased in a tight hoop round about. This pathological pro- cess is always accompanied by a higher or less degree of amesthesia. Inflammation of the Spinal Ctrl and its Membranes. 113 Convulsive twitchings need not necessarily be present. The paral- ysis of the motor sphere commences as a vague feeling of heaviness in the extremities, by which the process of walking is very much interfered with. The gait exhibits a peculiar unsteadiness. The patient raises his foot high from the ground, throws it far out, then sets it down as if it had the appearance of falling down, and sets it down a good deal farther back than he seemed disposed to do when first throwing the foot forward; sometimes the foot is set down outside the straight line. It is a peculiar feature of this disease that the patients are unable to walk with their eyes closed. Amid a gradually increasing waste of the tissues the patients die, as in chronic meningitis, of cystitis and gangrenous destruction of the dorsal integuments. Complete recovery is rare; all that can be accomplished in most cases is a partial improvement or even a mere arrest of the disease. In acute spinal meningitis the prognosis, so far as a fatal termina- tion is concerned, depends more particularly upon the seat of the affection; the nearer to the brain the paralytic phenomena make their appearance, the more rapidly the disease terminates fatally. Under any circumstances the physician has to be very guarded in his promises to effect a complete cure, since partial paralysis is apt to remain in most cases. A good deal is gained in many cases if we succeed in changing the acute to the chronic form of the disease. Simple meningitis justifies the hope of much more satisfactory results than myelitis. In the chronic form the prognosis is par- ticularly dubious after the disease has lasted for some time and the paralysis is complete. Treatment. The proper selection of drugs in this disease is just as much involved in obscurity as the certain diagnosis of the patho- logical process itself. Our literature contains only a very small number of cases; in Ruckert’s Collection we find only a single case of chronic myelitis. This paucity is certainly not owing to the small number of cases—or else the author of this work must have been very fortunate in not having had any more cases to treat— but rather to the circumstance that the therapeutic results have been very unfavorable, and that unsuccessful cases from which a good deal, however, might be learned, are but too seldom published to the world. This affords an additional inducement to lay before the reader a case that came under our observation in the course of last summer, and which, although the patient resided in a distant locality, took such a characteristic turn that there is no reasonable 114 Diseases of the Spinal Marrow. ground li ft for misapprehension. A farmer, 60 years old, who had hitherto enjoyed the most robust health, was attacked with dysen- tery in the month of August. To make sure of the diagnosis, he had kept some shreds of mucous membrane which he had passed with the stool. lie had taken some domestic remedy, after which the evacuations ceased and obstinate constipation took place. On the fourth day after the cessation of the discharges we first visited the patient, who, at first sight, did not seem to be suffering much. Be complained of violent pains in the left lower extremity, which resembled ischias, extended from the tuber ischii to the knee, in- creased in paroxysms, and were made worse by the warmth of the bed. The patient was restless, had no sleep, the pulse was normal, there were no febrile symptoms. We gave him Colocynthis. Two days after the exhibition of this drug the patient reported his pain and whole condition worse. This written report induced us to administer Belladonna. No improvement resulting, we visited the patient a second time five days after our first visit. The disease now presented a very different form. The patient was lying part- ially turned over on his left side. He felt the pains in both lower extremities, not very acutely except in paroxysms; there were twitchings of single muscles or of the whole extremity; violent, but sometimes remitting pains in the lumbar region, the lumbar vertebrre, however, not being very sensitive to pressure. During the night these pains increased to a fearful degree of intensity. Tingling formication in the skin from the pelvis to the feet; the lower extremities felt very cold to the patient. Paralysis of the bladder; the sphincter of the rectum was unable to prevent the emission of flatus. For the last thirty-six hours the lower extremi- ties had been paralyzed so that he was unable to stand without support; if he tried to put on his shoes, he put the foot forward beyond the place where the shoe stood ; he was unable to ex- cept by hanging on to two persons, one on each side. Some fever. Stool normal. Appetite scanty. Almost, complete insomnia, with the following characteristic peculiarity. If, late in the evening, the patient did not drink a small portion of not very strong coffee, he remained perfectly sleepless. On walking after having slept a few hours, he was unable to fall asleep again unless he partook of a little more coffee, which acted almost immediately like an opiate. He had tried for some nights to sleep without taking any coffee, but had remained sleepless until he took coffee. A\re prescribed Mercurius third trituration, requesting him at the same time to con- Inflammation of the Spinal Cord and its Membranes. 115 tiime the coffee, the soporific effect of which seemed to act so bene- ficially upon the patient; at the same time, however, suggesting the propriety of trying every now and then to sleep without the previous use of this beverage. The patient continued the remedy for nine days, after which we visited him again. He was now able to move his legs off the bed alone and rapidly, introduced his feet into his slippers at once and without missing, and walked across the floor six times by means of a cane upon which he, however, leaned only by way of precaution. The pains had abated quite consider- ably, the anaesthesia had almost entirely disappeared, the bladder and rectum were no longer paralyzed. The coffee had continued its good effect during the whole of this period, but had no longer been required for the last two days. We now prescribed Vercitrum album. The improvement continued and the patient recovered per- fectly. Ilis disease affords undoubtedly a perfect picture of mye- litis. About the same time a second no less marked case of chronic myelitis came under my treatment. The affected locality was be- tween the shoulder-blades. So far the treatment, having now lasted five months, has been unsuccessful, but the distress has not in- creased. Perhaps we may be able to furnish further details con- cerning this case before this work leaves the hands of the printer. Among the remedies which may have to be used in this disease, the first place should undoubtedly be assigned to Mercurius. So far as we know, this remedy has not as yet been used to any great ex- tent in this disease. We should think, however, that a single case like that of our farmer, ought to entitle this drug to the most care- ful consideration in this disease, so much more as other remedies, to our knowledge at least, have not as yet been used with any great success in this affection. The mere inspection of persons whose organisms have been impregnated with Mercury shows, even in the absence of all pathogenetic symptoms in our Materia Medica, that this agent must have some specific affinity to the spinal cord. But we do find all the characteristic symptoms of spinal meningitis enumerated in our Materia Medica ; if the drug-picture of this dis- ease should be judged incomplete, we can easily complete the list of symptoms from the many reports of chronic mercurial poisoning which may be found scattered in great abundance through our trea- tises on toxicology. They show that among the toxicological effects of Mercury we may find recorded all the different phases of par- alysis of the lower extremities, of the bladder, rectum, with dispo- sition to the peculiar convulsive shocks; violent pains in the spina) 116 Diseases of the Spinal Marrow. cord aggravated by motion; the restlessness and sleeplessness which is equally characteristic of Mercurius as of myelitis; and finally the anaesthesia of the skin. In the case of our farmer the aggravation at night, while lying in bed, was eminently indicative of Mercurius. [We think Baehr is mistaken regarding the fact that this farmer was cured by Mercurius or Veratrum. The domestic remedy which this farmer had taken undoubtedly contained Opium, as all such domestic preparations for dysentery do, and the checking of his dysentery by Opium was tantamount to a case of poisoning with Opium. Or, if we please, the case presented a case of Opium- meningitis. This is the reason why coffee, as the antidote to this Opium-poisoning, acted so beneficially. It is coffee which, in this case, effected the cure. Neither Mercurius nor Veratrum had any thing to do with it. The true remedial agents in this case would have been remedies that antidote the action of Opium, namely, Aconite and Belladonna. If Aconite had been administered alone, or Aconite and Belladonna in alternation, a cure would have been effected in a much shorter space of time. EL] Secale cornutum. There is scarcely a medicine which has such characteristic symptoms of myelitis, more particularly of the utter extinction of the functional activity of the cord, as Secale. We have the convulsive twitcliings and shocks, painful contractions, tetanic phenomena, complete paralysis side by side with continued and even increased reflex action, violent pains in the back, espe- cially in the sacral region, the most complete anaesthesia, paralysis of the bladder and rectum, and lastly the peculiar tendency to gan- grenous disorganization which in myelitis is represented by the gangrenous bedsores. Unfortunately we have no post-mortem appear- ances of individuals that have died of ergotism. This remedy is not only suitable in the acute, but likewise, and perhaps still more specifically, in the chronic form of this disease. lodium is recommended as a remedy for affections of the spinal marrow, probably for the reason that it antidotes Mercury, which so often produces them. Its effect seems to be concentrated upon the brain, on which account it arrests the paralytic symptoms in the extremities. lodium has not yet been known to produce anaes- thesia. Nux vomica. So many of the symptoms of myelitis are contained in the pathogenesis of Nux that it almost seems as though this medicine ought to be the main remedy for that affection. It has Inflammation of the Spinal Cord and its Membranes. 117 been urgently recommended by a number of practitioners. It is, however, very doubtful whether such a recommendation will be corroborated by clinical facts. There are few medicines of w hich we possess as many toxicologico-physiologieal experiments, as of Nux vomica, more particularly its alkaloid, Strychnine; but in not one of them do we see any form of myelitis, although a strongly marked, venous hypersemia of the meningeal membranes is men- tioned in most of them. This circumstance is undoubtedly str king. Nux vomica has not so much a paralytic condition at the perij ry, as violent tetanic contractions; instead of anaesthesia it has rather excessive hyperaesthesia with increased reflex action, which latter phenomenon is rather the exception than the rule in myelnis. Hence it is our opinion that Xux vomica is rather adapted to non- material affections of the spinal cord and that, among the inflam- matory affections of this organ, it is at most suitable in spinal meningitis before the disease has progressed to the stage of actual exudation. Rhus toxicodendron is at all events a noteworthy remedy in mye- litis. Although it is possible to derive the pathogenetic symptoms pointing to paralysis from the decomposition of the blood which is peculiar to Rhus, this point of view does not justify a one- sided application of Rhus as a therapeutic agent in this disease. In the first stages of myelitis the slight fever would rather counter- indicate Rhus, except perhaps in cases where the affection is occa- sioned by an acute exanthem. On the other hand the stage of complete paraplegia will be found much more adapted to Rhus, both in chronic as well as in acute cases. For myelitis caused by exanthems, Hartmann recommends Dulcamara as a specific remedy; only the symptoms which he enumerates, as symptoms of myelitis, do not seem to be the disease of which he supposes them to be characteristic indications. Veratrum album is one of the most suitable remedies in this dis- ease, and is especially adapted to the symptoms of the second stage. In the above-mentioned case of our farmer it helped very decidedly to bring about a favorable termination. Whether it will prove suitable in chronic cases, wall have to be verified by practical ex- periments. Plumbum has evidently as marked an action upon the spinal marrow as we have shown it to have upon the brain in our article on encephalitis. It is to be regretted that the poisonous action of Plumbum upon the spinal cord has not been ascertained by post- 118 Diseases of the Spinal Marrow. mortem examinations, which would have revealed with positive cer- tainty the portion of the cord that is morbidly affected by this agent. The known effects of Lead upon the brain justify us to conclude by a process of reasoning from analogy, that it is the mar- row itself which is invaded and destroyed ; otherwise the paralytic phenomena would not be so completely developed. Owing to the slowness of its action the drug is not adapted to acute cases; in chronic cases a characteristic feature of the paralysis for which Lead is indicated, would be the speedy emaciation of the paralyzed parts which are at the same time violently and painfully contracted. Colicky pains proceeding from the spinal cord would likewise point to Plumbum as a leading remedy. Cuprum. If it is generally difficult to discriminate between the effects of Copper and Lead, this discrimination is so much more difficult with special reference to the spinal cord. It is admitted that among the symptoms of Copper the paralytic symptoms are less clearly defined and that the spasmodic symptoms prevail, whereas in the case of Lead the opposite effects are observed. Both these medicines act decidedly in the same direction, with this differ- ence, that Cuprum is more suitable at the beginning, and Plumbum at the termination of the series. Hence Plumbum may have to succeed Cuprum with tolerable certainty, whereas the reverse will scarcely ever be the case. Cocculus is another exceedingly praiseworthy remedy, especially at the commencement of myelitis. If we were to select a remedy according to the locality of the disease, Cocculus would be more adapted to inflammation of the lumbar portion of the cord, less to such portions as are nearer the brain; however it still remains dif- ficult to determine whether Cocculus does not, like Nux vomica, rather modify the functional activity of the marrow without caus- ing any material alterations. We must not omit to make mention of a few other remedies which have either been urgently recommended by physicians or which, at any rate, seem suitable. As regards Belladonna and Aconite, it is our belief that their employment involves a loss of time without producing any curative results. In myelitis the reac- tion is never sufficiently violent to oblige us to control the febrile symptoms by means of either of these two drugs. Neither has a marked affinity to the spinal marrow. Ignatia occupies pretty much the same position in this affection as Nux vomica. Phosphorus is said to be excellent where the inflammation has been superinduced Inflammation of the Spinal Cord and its Membranes 119 by sexual excesses. Sulphur may be thought of in cases »vh ire the disease has been arrested and where we desire to act upon the remaining exudation in the spinal canal with a view of improving the paralytic symptoms. Sulphur is here a very important remedy, as is shown by the good effects of Sulphur baths in paralytic con- ditions remaining as consequences of myelitis. We are acquainted with a lady who is nearly sixty years old and has been suffering for the last ten years with chronic meningitis. The disease seems to exacerbate once or twice in the course of a year, is seated in the lower thoracic portion of the medulla, but does not seem to affect the substance of the medulla very deeply, since the paralytic symp- toms are not very distinct, except in the arms; moreover, as is often noticed in spinal hemiplegia, we observe in her case a general increase of her embonpoint, except on the paralyzed parts. Every summer this lady uses weak artificial Sulphur baths with decided benefit; even the paralysis of the arms improves every summer very visibly. We have likewise treated in the same place an em- ploye of a company, whose lower extremities had been completely paralyzed for two years, in consequence of myelitis of the lumbar portion of the cord, and who had been using for some time various remedies, among others Sulphur, without any further benefit than that he was enabled to move about on two crutches with great dif- ficulty. He was sent by his employers to the Sulphur springs at Eilsen, where he remained for some three months, after which lapse of time he was able to walk with a cane. Ilis recovery is not com- plete. Cases of this kind show that Sulphur has a decidedly cur- ative action in myelitis, where it may possibly be much more effi- cacious when used in the form of baths than when taken internally. Calearea earbonica deserves attention, if the inflammation is caused by diseases of the vertebrae, not so much because this medicine has a direct action upon the cord as because it acts in opposition to the causative disturbance. Among the springs which undoubtedly exert an influence upon spinal paralysis, we have to mention Gastein, Pfeffers and Wildbad; of course they should not he used until the inflammatory symptoms have entirely disappeared. They doubtless afford the most help in cases depending upon sexual excesses as their primary causes. [We do not think that Brehr’s condemnation of Aconite in this disease is justified by experience. In the acute form of meningitis we have succeeded with Aconite alone in effecting a perfect cure in a comparatively short space of time. But we neither give high nor 120 Diseases of the Spinal Marrow. middle potencies in this disease, but a few drops of the tincture or no higher than the first decimal attenuation of the root in ten or twelve tablespoonfuls of water, of which mixture the patient is given one or two teaspoonfuls every half hour or hour until an incipient improvement renders it desirable to lengthen the inter- vals. If the spine is very hot, tender to the touch, with throbbing, stinging or lancinating pains, we do not hesitate to apply to the spine linen or flannel compresses soaked with a solution of a tea- spoonful of the first decimal attenuation of Aconite root in half a pint of water. Gelsemimim causes hypersemia of the spinal cord and has been used with good success by our physicians in congestive and inflam- matory affections of the spinal cord. The consciousness is not much impaired. There is either general or partial paralysis. The patient shows a remarkable tendency to close his eyelids. The pulse is feeble and the temperature of the body very much depressed. Veratrum v I ride is administered with more or less special reference to the condition of the pulse. If the pulse is rather full and bound- ing, of more than ordinary frequency, or else feeble and rapid, and the patient complains of fulness and pain in the head, feels very much prostrated, and the extremities feel numb, twitch and are threatened with paralysis; or if the spinal congestion is attended with a general typhoid state of the system, drowsiness, indistinct consciousness, restlessness, Veratrum viride will induce a very speedy and favorable reaction, if given in quantities of two or three drops of the strongest tincture in ten tablespoonfuls of water, a good teaspoonful at a dose every half hour or hour until an im- provement sets in. It is often desirable to alternate Veratrum viride with Belladonna. Kafka, in his “ Homoeopathische Tlierapie,” has an interesting chapter on inflammation of the vertebrae (spondylitis) which we have deemed it advisable to transcribe literally for the benefit of the American reader. “Chronic myelitis as occurring in the course of spondylarthro- cace has been for years an object of our most careful observations and therapeutic investigations. The results which we have ob- tained, being exceedingly favorable, we feel induced to commu- nicate the important facts that we have been able to gather up in this domain of medical science. Inflammation of the vertebrae, (spondylitis,) in consequence of which the meninges of the spinal marrow and the marrow itself Inflammation of the Spinal Cord and its Membranes. 121 participate in the inflammation, is always attended with swelling and softening of one or two, or in exceedingly rare cases, of several vertebrae. Without experiencing any pain or any feeling of illness, children who seem perfectly healthy, or else scrofulous, rickety or tuberculous children, are attacked with a crick in the spinal cob umn arising from softening of one or more bodies of the vertebrae, the body of the softened vertebra being no longer capable of carry- ing the superimposed weight of the trunk, and, having to succumb to the law of gravitation, becoming displaced to such an extent that its spinous process is turned upwards and forms a prominence which causes the vertebral column to appear curved so as to form an obtuse angle at that point. The immediate consequence of this curvature and swelling of the vertebrae is a pressure upon the spinal marrow, which becomes much more marked if exudations take place between the transverse pro- cesses and between the tendinous structures of the vertebral column, by which exudations the spinal marrow is compressed on all sides. If one of the lumbar vertebrae is atfected, the children experience at once a gradually increasing weakness in the lower extremities; they are unable to walk a long distance or for any length of time; they tind it diflicult to stand, get easily tired, prefer sitting or lying down, their gait becomes dragging, labored, they do not seem to make the least headway. Finally the lower extremities become partially paralyzed and lose their sensibility. If one of the thoracic vertebrae is the seat of the inflammation, the above-mentioned symptoms develop themselves more slowly, but, on the other hand, become associated with pressure in the epigastrium, dyspepsia, flatulence, constipation, difficulty of urin- ating, etc., according as the different abdominal viscera are in an- atomical and physiological dependence upon the inflamed portion of the spinal marrow; lastly we have paraplegia together with paralysis of the sphincters of the rectum and bladder. If the cervical portion of the vertebral column is inflamed, the curvature is in most cases located between the first and second cer- vical, or between the last cervical and the first thoracic vertebrae; in the former case the head, deprived of its point of support, leans over obliquely to the right or left side, in the latter case the head sinks down between the shoulders, and it is only with great dif- ficulty and a visible effort that it can be maintained erect. In either case the curvature is accompanied by great difficulty of breathing, or by coldness, weakness and paralytic phenomena in the upper 122 Diseases of the Spinal Marrow. extremities. The dyspnoea often increases to a high degree, and is attended with cyanosis, extensive bronchial catarrh and nocturnal cough. If the articulation of the atlas is invaded by the inflam- mation, we observe dysphagia, dyspnoea, hoarseness and a constant rigidity of the nape of the neck, without any signs of morbid affec- tion of the larynx, trachea or lungs. We have introduced this pathological statement in order to understand the connection of the symptoms as they appear be- fore us. If we are fortunate enough to he intrusted with the manage- ment of spondylitis at the very outset of the attack, we have it in our power to arrest it very speedily and thus to prevent the further progress of myelitis and meningitis spinalis. Even if the inflam- mation of the vertebrae has continued for a time and a considerable amount of fluid has become exuded, but no abscess has yet formed, if the children are so feeble that they are unable to walk, but have to lie down for the most part of the time, or if they have become dyspeptic, bloated, peevish and sullen; or if the dyspnoea, cyanosis and a wide-spread bronchial catarrh have already set in, we still may effect a decided improvement by the exhibition of Phosphorus 3, two or three doses a day. In a few days already the children be- come more cheerful and active, the weakness of the lower extrem- ities begins to yield; very soon, sometimes already in five or six days, they begin to sit up or attempt to creep about on the floor; the appetite returns, the abdomen loses its bloat, the cough dimin- ishes very strikingly, the cyanosis disappears, the dyspnoea becomes less, and in at most a fortnight the children begin to walk, their posture becomes more and more erect, and every symptom of dis- ease and feeling of illness gradually disappears. Only the vertebral curvature remains; but upon examining the vertebrae more closely, we find that their sensitiveness to pressure gradually decreases, the swelling of the vertebrae and their surroundings becomes less and the phenomena of compression of the spinal marrow disappear entirely. In the most fortunate cases, of which we might mention quite a number, we have never seen the angle of curvature oecome less obtuse owing to the circumstance that the vertebrae which had become compressed in consequence of the softening of their sub- stance, are no longer able to return to their normal size. If the improvement goes on very slowly and we have to continue the use of Phosphorus for a long time, it is advisable, after having used this drug for a fortnight, to discontinue its employment for Inflammation of the Spinal Cord and its Membranes. 123 a week, or to administer Natrum muriaticum 6, in two daily doses as an intercurrent remedy, after which period the Phosphorus may be resumed until all morbid symptoms have entirely disappeared. In a former chapter we have directed the attention of the reader to these two remedies in interstitial distention and swelling of the bones, especially the vertebrae, and, after an experience of many years, we are prepared to affirm their efficacy in these diseases. Even if the knee, tarsal and elbow-joints were the seat of these affections, we have derived good results from the use of Phosphorus and Natrum muriaticum. Both these remedies correspond to the scrofulous as well as to the rhachitic and tuberculous diathesis; only, if such conditions are present, the remedies have to be administered at long intervals, alternating them at most only every week. As soon as abscesses form, which generally break out at the above designated localities and are attended with shiverings or slight creeping chills, or with an increase of the febrile symptoms, but may likewise develop themselves without any other perceptible morbid phenomena, the curative range of the above-mentioned two remedies is closed; for now we have, to deal with soft exudations passing through a purulent or ichorous metamorphosis; these changes require a corresponding change of remedies. As long as the abscesses are small and not very tense, we give at once Silicea 6, two doses a day, ordering at the same time, especially if the patients are weak, pale and emaciated, a nourishing and strengthening meat-diet, and a refreshing beverage. If the season is favorable, we send the patients to the mountains or to a region of country with plejity of woods and meadows. Under this manage- ment the abscesses, in favorable cases, become smaller and softer, a gradual absorption may even take place, and a complete disappear- ance of the paralytic conditions, of the antesthesia and the spas- modic symptoms, may be the result. In order to obtain it, however, this kind of management has often to be continued for weeks and even months, more particularly in cases where one of the above- mentioned diatheses is present. In such cases, after having con- tinued the exhibition of Silicea for a fortnight, we are in the habit of giving Sulphur 6, one or two doses daily, as an intercurrent remedy, or we discontinue all medication for a few days, after which we resume the use of Silicea. Both remedies correspond perfectly to the above-mentioned con- 124 Diseases of the Spinal Marrow. Btitutional anomalies, and their employment is often crowned with the happiest results. In less fortunate cases resorption may likewise take place with- out it being necessary to open the abscess; the subsequent improve- ment, however, is not perfect; the extremities remain affected with a paralytic weakness, the sensibility of the parts returns only partially, and there frequently remain spasmodic contractions of the muscles, from which phenomena it is evident that the pressure on the spinal marrow has not entirely ceased, or even that structural changes have already taken place in this organ. In such cases we resort to electricity by induction, which is sometimes capable of determining a further improvement of the morbid process that had become arrested at a certain point. If the abscesses are large and tense; if they do not show the least tendency to discharge on the outside; if the patients are at the same time anaemic, feeble, emaciated, cachectic, etc., we open the ab- scesses with a bistouri, taking care that they do not discharge too rapidly and that no air penetrates into their cavity. The entrance of atmospheric air into the cavity of the abscess causes the formation of coagula on the inner walls of the abscess, in consequence of which it becomes lined with a membrane resem- bling mucous membrane, by which the healing of the abscess is impeded. If the discharge is yellow an.l inodorous, we give Silicea 6 very persistently in order to act upon the carious disorganization which the suppurative process may have initiated on the exterior portions of the vertebrae. This remedy, in conjunction with a strengthening diet, is in many cases sufficient to effect a complete cure of the caries. If the pus is ichorous and has a fetid odor, we first try to correct the quality of the secretion by means of Sulphur 6, giving two doses a day; as soon as this object is accomplished, we give Silicea. As a matter of course we never lose sight of the duty of nourishing up our patient by substantial and readily assimilated nutriment in order to make up for the loss of strength and vital fluids entailed by the profuse ichorous discharge. We have succeeded in curing cases of a far advanced caries of the vertebrae by the persistent use of these two remedies, which we are very fond of administering in alternation. It is not very long ago that surgeons were very much indisposed to plunge their lancets into a so-called cold abscess, for the reason Inflammation of the Spinal Cord and its Membranes. 125 that they were apprehensive of an unfavorable termination, most generally of the supervention of hectic fever. No later than the 1850, we had the greatest difficulty in persuading our honored friend, Professor Pitha, to plunge his lancet into a large and cold abscess in the lumbar region, which was connected with spondylitis and accompanied by a high degree of amemia, emaciation and de- bility. The quantity of the discharged pus amounted to at least four or five pounds; it was of a very thin, fluid consistence and without any bad odor. By giving two doses of Silicea every day, during periods of eight days, allowing an interval of three days between each two successive periods, the assimilative powers of the patient, a girl of six years, were so much improved that she gained rapidly from day to day in weight, strength and external appear- ance, and she soon was able to boast of a perfect recovery. The curvature of course remained unaltered, her gait as well as her general posture, movements and feelings were almost normal. The patient is now a married lady and has enjoyed good health ever since her previous sickness. We are now treating a boy of six years who, two years ago, was attacked with inflammation of the second and third thoracic verte- brae, in consequence of which he became afflicted with dyspnoea and cyanosis to the highest degree. A catarrhal rale was heard in both lungs, the respiration was short and superficial, only with great effort the patient coughed up a serous-frothy sputum. Upon ex- amining the thorax it was found to be affected with a rickety mal formation, both the anterior costal spaces below the nipples were pressed in, the sternum bulged out a great deal, and the chest itself was very flat and narrow. In consequence of this deformity the posterior and upper portion of the lungs was evidently compressed, for at the apex of the scapulse there was bronchial respiration with- out any dulness of percussion or consonant rales in the correspond- ing localities. The boy was the child of perfectly healthy and opu- lent parents and is said to have enjoyed good health until the present sickness set in. His former physicians, supposing that the lungs had become incurably oedematous, had given up ail hopes of his recovery. We gave him Phosphorus 3 in solution, a dose every hour, ordered the little patient to be kept perfectly quiet and free from all excite- ment, and gave him four times a day a weak broth, without salt and stirred up with a little ground rice or flour. Already on the third day symptoms of improvement set in; the dyspnoea became 126 Diseases of the Spinal Marrow. less, the expectoration was thrown oft' much more easily, the mu- cous rale decreased, the cyanotic symptoms disappeared more and more. In proportion as the bronchia became disembarrassed, the bronchial respiration decreased, the digestion became more active, and in about three weeks the patient was able to leave his bed and to maintain a more erect posture. Ilis gait became more steady but the bent in the vertebral column and the swelling of the verte- bra} remained unchanged. The painfulness of the vertebrae to press- ure likewise decreased very sensibly, and the trunk was moved in every direction, without pain or trouble. After the symptoms of spondylitis had been almost entirely removed, and with a view of modifying the constitutional anomaly, we put the patient for some time on &'Alicea 6, after which the patient, to our own and the par- ents’ joy, developed within a short space of time, both mentally and physically, to great advantage. This apparent improvement con- tinued for nine months. At this time the protruding vertebrse be- came again inflamed owing to frictions with oil, kneading and squeezing, which the parents had permitted to be done to prevent the boy from remaining a cripple. The consequence of this return of inflammation was paralysis of the lower extremities, with simul- taneous loss of sensibility, continual spasmodic stretching of the muscles and occasional muscular twitchings. Stool and urine were passed involuntarily. There was dyspnoea, evening and night-fever, sleeplessness and a high degree of morose temper. For this intense degree of spondylo-myelitis we again prescribed Phosphorus, and ordered absolute rest. The general condition of the patient soon began to mend; almost every morbid symptom had disappeared at the end of four weeks, only the paralysis and the phenomena inci- dental to this condition obstinately resisted Phosphorus as well as the subsequent employment of Mercurius soluhilis 3, Iodide of Potas- sium 1, Plumbum 6, Arsenicum, 3, Nux vomica 3, Strychnine 3. Even the douche had no effect. Electricity by induction diminished the anaesthesia and the spasms of the extensor muscles. During this time the exudation softened and an abscess formed. After Silicea 6 the abscess grew smaller and softer, and showed signs of incipient re-absorption. As the exudation became softer, the sensibility in the lower extremities increased more and more. Afterwards when the abscess became more tense and larger, and the Silicea had been continued together with a strengthening diet and an invigorating country-air, the first voluntary motion took place in the month of July of the same year. After opening the abscess, which discharged Inflammation of the Spinal Cord and its Membranes. 127 a fine healthy pus, the mobility of the lower extremities increased more and more. The supervention of a chronic intestinal catarrh which yielded to Phosphorus 3, caused a high degree of emaciation and debility; these symptoms were soon, however, controlled by a nourishing diet and the use of ale. At the present time the boy is able to walk without support, and is generally doing finely. We have stated this case in extenso in order to show that, under a suit- able management, even a high degree of myelitis can be reduced in intensity and improve very greatly. If we desire to effect a speedy and complete cure of spondylitis, it is necessary that the patient should be kept in a state of absolute rest. The most suitable position is on the stomach, with the extremities extended and the head raised. Where absolute rest is not enjoined, we have often seen relapses ensue, and the spondylitis spread further and further in consequence of this neglect. If the tuberculous disposition is hereditary, or the exudation as- sumes a tubercular character, the spondylitis frequently terminates fatally. The inflammation is very apt to set in again, evening or night-fever occurs every day, with profuse sweats, emaciation, pallor of the integuments and colliquative diarrhoea. The abscesses dis- charge an ichorous, badly smelling fluid, decubitus sets in and the patients die of tubercular caries of the vertebrae. If the tubercular diathesis is noticed in season, Phosphorus, Cal- earea, JSatrum muriaticum, Silicea, Podium or Sulphur, together with a suitable diet and good country-air, are capable of ameliorating the constitutional disposition so as to give a favorable turn to the disease. Hence it is of importance that in a case of spondylitis, no matter what its character, the physician should institute careful in- quiries into the hereditary or constitutional tubercular disposition. Cod-liver oil has been of use to us in the treatment of this disease. To improve the tubercular, rhachitic or scrofulous constitution, we have employed with good effect saline springs and sea-bathing; or, if a high degree of anaemia prevails, the use of chalybeate springs is highly to be recommended. Paralytic conditions and consequent ailments are treated in the same manner as the paralytic conditions consequent upon meningitis spinalis. If we have reason to suspect that the myelitis is occasioned by the presence of a syphilitic exostosis, an energetic anti-sypliilitic treatment will have to be instituted.” II.] 128 Diseases of the Spinal Marrow. In conclusion, we will offer a few general remarks concerning the treatment. We are not often called to treat a case of myelitis when the disease first breaks out; most generally the patients have already been tortured with sanguineous depletions and other losses of vital fluids before a homoeopathic treatment is determined upon. In such cases a main question will always be how far we may encourage the hope of a favorable result in the patient’s mind, and we think that our promises in this respect can never be too guarded. Sometimes we succeed in effecting an improvement even in old cases; but very often all medicinal action remains ineffectual; if the paralysis has been of long continuance it will probably always be impossible to effect a complete cure. In the former series of cases an improve- ment is undoubtedly effected by the gradual resorption of the meningeal exudation which exists side by side with the disorganiza- tion of the spinal marrow. A result of this kind alone is sufficient to constitute an essential improvement for the patient. In chronic meningitis a more or less copious accumulation of serum takes place in the meningeal space, the resorption of which is succeeded by the disappearance of a variety of paralytic symptoms. Hence it is our duty in all cases to at least make the attempt of improving the patient’s condition, only we should be cautious in promising a cure of the paralysis when superinduced by the destruction of the me- dulla. Regarding sanguineous depletions we offer the same con- demnatory remarks that have already been recorded in our article on apoplexy. Whether a patient afflicted with myelitis should remain in an exclusively horizontal posture, had better be decided by the patient himself, who is the best judge whether motion is hurtful or beneficial to him. It is certainly never productive of absolute mischief, whereas a forced recumbent position may entail great disadvantages. In chronic cases the hope of recovery is in a great measure based upon a methodical, cautious use of the para- lyzed parts, as has been, for a long time already, shown by the beneficial results obtained by the movement-cure. In conclusion we will mention a method of treatment the pernicious influence of which in this disease we have had occasion not long ago to witness in the case of a lady: we mean the cold-water treatment. Under certain circumstances it may be useful even in -myelitis, but cer- tainly not very often. The cause undoubtedly is, that in a case of myelitis the skin is in a measure deprived of its properties of sensi- bility and irritability, and hence unable to develop the degree of reaction necessary to experience the blissful effects of cold water. Inflammation of the Spinal Cord and its Membranes. 129 On this account an excess of warmth is withdrawn from the ors;an- ism, without this loss being repaired by a corresponding supply of vital warmth. In the case of the above-mentioned lady the cuta- neous anaesthesia has undoubtedly become aggravated since the application of cold water. This is a suitable place for mentioning an affection whose symp- toms bear a great resemblance to the chronic inflammatory processes in the spinal marrow: we allude to tabes dorsualis. So far the path- ologico-anatomical results of this affection have not by any means been distinctly defined. In many cases, it is true, atrophy of single portions of the cord is met with, but it is not clearly defined, whereas in other cases the atrophy is either entirely absent, or, at any rate, does not come within the ken of our observation. The most correct definition of tabes dorsualis is undoubtedly to regard it as a grad- ually increasing paralysis of the spinal marrow. The causes of such a paralysis are not by any means clearly defined, and it is undoubt- edly wrong to regard sexual excesses as the most common of them. It is undoubtedly true that they constitute a very frequent cause of the disease; but excessive exertions of the back generally may likewise superinduce a wasting and paralysis of the spinal marrow. It is not probable that paralysis of the spinal marrow is the conse- quence of inflammatory conditions of that organ; the paralysis runs almost always a painless course, and the cadaver exhibits no traces of an inflammatory exudation. The disease attacks principally men of middle age. The symptoms resemble a good deal those of chronic myelitis. The disease does not commence with pain, but with signs of weakness in the muscles of the lower extremities, such as: rest- lessness, feeling of weariness from the least exertion, tendency to drop to sleep; these symptoms are accompanied by a peculiar, but seldom painful feeling of emptiness in the spine. At an early period of the disease the condition of the genital organs becomes altered. They are not primarily debilitated, on the contrary, they are easily excited; erections and seminal emissions are very frequent, but they have not the normal vigor, more particularly during sexual intercourse, when this want of vigor is particularly apparent. In the further course of the disease the paralysis increases, spreads to the bladder and rectum, until, after the lapse of years, the paralysis of both the motor and sentient spheres of the lower extremities be- comes complete. At this stage, portions of the marrow nearer the brain become involved, even the brain becomes affected, vision be- 130 Diseases of the Spinal Marrow. comes disturbed, the memory is weakened, apathy and even com- plete stupor set in. According to most physicians the treatment of this disease is almost always unsuccessful; most authors assert that it is unsuc- cessful in every case. If taken at the outset it might perhaps he possible to effect a cure; but at the beginning the affection is not considered so very dangerous, or the patient has no proper concep- tion of the nature of his disease, and neglects, or does not persevere in, the proper treatment. If medicines are to be used, we have to select them among the number of those that have been recom- mended for myelitis, to which may be added Silicea, Causticum, Aluminium metallicum. The condition of the sexual organs points to Phosphorus, but it is questionable whether the exhibition of this agent will be attended with good results. At a later stage of the disease the main point is to maintain the strength of the patient and to see to it that it is not crushed down by excessive exertion. The duration of the disease for years, and the unsuccessful admin- istration of remedies, drive such patients from one physician to another; they generally apply to any one who promises them a cure and drains their pockets as well as their constitutions. This cir- cumstance alone renders a cure impossible, even if it might other- wise be attempted with a chance of success. [Meningitis Cerebro-spinal is, Cerebro-spinal Meningitis, Spoiled Fever. Professor Felix iNicmeyer has recently published an interesting memoir on this epidemic under the title: “ Cerebro-spinal Menin- gitis according to observations instituted in the Grand-duchy of Baden,” Berlin, 1865, in which the following concise and character- istic picture of the disease is ottered: “Without any other precur- sory symptoms the patient is at once attacked with a chill attended with violent headache and vomiting. The headache speedily in- creases in intensity, the patient becomes exceedingly restless, tosses about, the pupils remain contracted, the sensual consciousness re mains unembarrassed. The pulse rises to eighty or one hundred beats, the temperature of the body remains moderate, the respira- tions increase to thirty or forty per minute. Already at the end of the first or on the second day, much less frequently at a later period, we notice that the head is somewhat drawn backwards; the patient continues to complain of violent headache and the pain spreads from the head to the posterior cervical region and to the back. The rest- Meningitis Cerebro-spinalis, Cerebro-spinal Meningitis. 131 lessness becomes excessive, the thoughts of the patient become con- fused, the pupils remain contracted, the abdomen caves in, the bowels are constipated. The frequency of the pulsations and respir- ations now increases to about one hundred and twenty of the former and upwards of seventy of the latter per minute; the bodily tem- perature continues moderately low, increasing perhaps to 39° R., and upwards. In the course of the third and fourth day the tetanic spasms of the posterior cervical arid dorsal muscles become more and more prominent, and are sometimes attended with lock-jaw. Opisthotonus supervenes with an extraordinary degree of intensity; the consciousness is gone, but the patient still continues to toss about in the bed, the pupils still remain contracted, the bowels constipated, the abdomen sunken, the urine is discharged involuntarily or else the bladder remains distended and the urine has to be drawn off with the catheter. The patient now lapses into a profound sopor, the moaning respiration is accompanied by a rale, and death takes place with the phenomena of an acute oedema of the lungs. This picture of the disease is sometimes modified by fhe occur- rence of a short preliminary stage which is marked by slight pains in the head and back; or by the breaking out of herpetic vesicles or of scattered, dark-colored roseola-spots on the first, second or third day of the disease; or else the above-described symptoms develop themselves in a much shorter period, which circumstance constitutes one of the most important modifications of the disease, so that the consciousness vanishes even on the first day of the attack and a violent tetanic spasm of the posterior cervical and dorsal muscles begins; or finally the disease may set in with such terrible violence that a fatal termination is reached even on the first or second day.” Further on, Niemeyer writes: “This cursory picture’of cerebro- spinal meningitis and of the general course of the disease applies indeed to most, but not by any means to all cases of the epidemic. This picture does not comprehend phenomena that occur in a variety of cases, such as: deafness on one or both ears, diplopia, ptosis of the upper eyelid, softening and destruction of the cornea, and finally paralysis of the facial nerve, and of the extremities either on both or only on one side of the body.” These last-mentioned phenomena are attributed by Memeyer to the exudation resulting from the intense inflammation at the base of the brain where the exuded fluid exerts a pressure upon the ad- joining portions of the brain and nervous trunks; whereas in spor- 132 Diseases of the Spinal Marrow. adic meningitis the exudation takes place for the most part on the convex portions of the hemispheres. This epidemic has visited several parts of our own country and, under allceopathio treatment, has proved a murderous scourge. The States of New Jersey, New York, Pennsylvania, Vermont,, Massa- chusetts, Ohio, Maine, Michigan, Virginia, and the District of Columbia, have been visited by this fell destroyer. In the November number of the North American Journal of Homoeopathy an inter- esting article on this disease is published by Doctor Bushrod W. James, of Philadelphia. He professes to have treated a considerable number of cases with very uniform success, losing only one case in about sixty, which seems to us claiming a great deal, whereas under alloeopathic treatment the mortality was about fifty cases out of every hundred. In the Philadelphia epidemic prostration seems to have been a very prominent symptom. It sometimes set in with such a sudden violence that persons who were afflicted with heart- disease dropped down dead in the street in consequence of the sud- den shock. This happened in a number of cases. Many persons died twenty-four or iorty-eight hours after being seized with the chill. Operatives over-tasked in the factories of Manayunk near Philadelphia would very often die in fourteen or sixteen hours from the chill. The general features of the disease seem to have been: vertigo with headache: diarrhoea, sometimes of a prostrating and colliquative character; in other cases diarrhoea alternating with constipation; moderate fever, flashes of heat mingled with creeping chills; piercing pains through the head; soreness and stiffness of the upper portion of the spine, with aching pains in the spine, formica- tion; soreness and sensitiveness of the skin; severe muscular pains; numbness of the limbs, with partial paralysis; spasmodic twitchings of the musdular system, sometimes amounting to tetanic convulsions with lock-jaw; the consciousness was not much affected, except when the disease was at its height, when a more or less active delirium and finally coma set in; in the cases that wTe have treated the conjunctiva was more or less congested and the hearing was impaired. The pulse had a moderate frequency, averaging about one hundred per minute; the tongue remained moist and, in the course of the disease, became covered with a dark brownish fur; the respir- ation was somewhat accelerated and interrupted by moaning in- spirations; during the tetanic spasms the expirations had a hissing sound, the air seeming to be forced out with an effort; the skin had a peculiar bluish pallor in this disease owing to the general tur* Meningitis Cerebro-spinalis, Cerebro-spinal Meningitis. 133 gcscence of the venous system; the spots which have given to this disease its name broke out on different parts of the body, generally on the chest, abdomen, and thighs. Sometimes the skin had a mot- tled appearance, or the spots looked like measle-spots, or had a rose-colored tint. Doctor James regards cerebro-spinal meningitis as a very change- able and deceptive disease; “one hour the patient will seem quite well, and the next the most alarming symptoms may he present.” In the few' cases which we have treated in Michigan, this feature of the disease has never come under our observation. An admirable monograph on this disease has been published by Professor Alfred Stille, of Philadelphia, which has been very favor- ably noticed by Professor A. Flint in the January number, 1868, of the American Journal of the Medical Sciences. Doctor Stille has observed about one hundred and twenty cases of the disease in the Philadelphia Hospital. He rejects the name “Spotted fever.” According to Stille the disease is both a blood-disease and an in- flammation of the cerebro-spinal membranes combined. “The inflammatory element and the septic element are both necessary to constitute the disease; either may he in excess and overshadow the other. According to the relative predominance of one or the other, the disease assumes more of a typhoid, or more of an inflam- matory type, and it is this diversity in its physiognomy which has led to such opposite doctrines in regard to its nature and its noso- logical affinities.” The cases treated exhibit a striking uniformity of symptoms: headache, nausea, vomiting, diarrhoea or constipa- tion, thirst, hyperesthesia of the abdomen or of the cutaneous sur- faces generally, more or less act ve delirium, comatose stupor, con- gestion of the conjunctiva, tenderness of the spine, opisthotonos, subsultus tendinum, severe muscular pains, insatiable thirst, tongue covered with a whitish or brown fur, or sometimes glazed, erythem- atous and petechial eruptions. Deafness and partial paralysis some- times remained for some time as sequelae of the disease. As regards treatment, Dr. James professes to have derived the most beneficial results from the use of deodorized alcohol of the strength of ninety-five per cent. He seems to have resorted to this stimulant at the onset in every case as soon as the nature of the disease was ascertained. His mode of administering the alcohol was to add two teaspoonfuls of it to two, four, six or eight teaspoonfuls of water, according to the nature of the case, and to give a teaspoon- ful of this solution every half hour until there was a decided abate- 134 Diseases of the Spinal Marrow. ment in the symptoms. In cases threatening immediate dissolution, the dose was increased for a brief period. On the other hand, Dr. Stille objects to this indiscriminate use of the alcoholic stim- ulant. “ On the whole,” writes this author, “ we regard alcohol as a medicine which ought not to be included in the ordinary and systematic treatment of epidemic meningitis, hut as a cordial to be held in reserve against those signs of failure in the power of the nervous system, which call for its administration in diseases of whatever name.” The remedies, employed in this disease were: Aconite, Geiseminum, Belladonna, and Veratrum viride, during the congestive stage, when the congestive and inflammatory symptoms predominated. The Aconite has proved less useful in our hands than Geiseminum and Veratrum viride, both of which medicines we did not hesitate to alternate with Belladonna or Ilyoscyamus, if the inflammatory and typhoid symptoms seemed to co-exist. Belladonna and Hyoscyamus were relied on if a more or less active delirium had set in, the patient was inclined to sleep, the conjunc- tiva was found congested, the pupils were alternately contracted or dilated, or one pupil contracted and the other dilated; subsultus tendinum, opisthotonic spasms. Bryonia and Rhus toxiccdmdron were used with more or less bene- fit when the inflammatory condition seemed to give way to typhoid phenomena: subsultus, lock-jaw, incipient loss of consciousness, sopor with expression of deep suffering in the countenance; symp- toms of paralysis, difficulty of protruding the tongue, the corners of the mouth are drawn down; the muscular pains are very severe. It is very difficult to determine well-defined lines of demarcation between the respective spheres of action of these different drugs. Owing to the uncertain character of the symptoms, we have found ourselves compelled to give many of these remedies in alternation, for instance: Aconite and Bryonia, or Bryonia and Belladonna, or Veratrum viride and Belladonna, or Aconite and Geiseminum, or Rhus tox. and Hyoscyamus, or Ilyoscyamus and Arsenicum. Arsenicum, 2d or 3d decimal trituration, was given when the septic symptoms, foul discharges from the bowels, signs of decom- position of the blood, malignant looking petecliise, etc., indicated its use. Calomel was given if the diarrhoea and the hyperesthesia of the abdomen seemed to require the use of this agent. Cuprum aceticum seemed to relieve the paralytic symptoms and Spinal In nation. Neuralgia Spinalis. 135 the mental hebetude which sometimes remained as sequelae c f severe attacks of the disease. Opium was resorted to as a last resort, if the coma and tne par- alytic symptoms did not yield to Belladonna or Hyoseyamus, or showed a tendency to become more inveterate. Relapses in this disease were difficult to manage and, as a general rule, proved fatal. At any rate, this has been our experience in this part of our country. II.] Spinal Irritation. Neuralgia Spinalis. For a long time this affection has given rise to a, good deal of dis- cussion, and a number of writings have been published on the sub- ject pro and cow, until more recently physicians have adopted the general conclusion not to regard this disease as an independent pathological process, but as a symptomatic manifestation of a more general affection. By spinal irritation we understand a condition where a more or less extensive portion of the vertebral column is abnormally sensitive to pressure, and where all sorts of disturbances are manifested in the sentient and motor sphere of the nerves pro- ceeding from the affected portion of the cord. In this affection no material changes of the spinal marrow or its envelopes have as yet been discovered; and it is probably for this reason that the affection has been designated as a neuralgia, by which means the vagueness of the genuine pathological conception has indeed become more pointed and conspicuous. In many cases partial hyperaemia may be the cause of the phenomena; in other cases the cause undoubtedly resides outside of the vertebral canal, the marrow becoming second- arily irritated and sensitive. On this account we see spinal irrita- tion accompany a number of febrile as well as non-febrile affections. Very seldom we may be able to trace the phenomena of spinal irri- tation to a sensitiveness of the vertebrae as their primary cause. The disease is mostly limited to the female sex between the age of pubescence and the climacteric period; in the male organism the disease is not only seen much less frequently, but is generally much less extensive and prominent. All kinds of influences have been assigned as causes of this trouble; we shall not attempt to enumer- ate the whole list of them here, and content ourselves with men- tioning the following as the main causes of the disease: all kinds of excessive exertions affecting more specially the spinal marrow, more particularly all sexual excesses; continued losses of vital fluids, excessive nursing, leucorrhcea, exhausting diseases. 136 Diseases of the Spinal Marrow. According to the locality of the disease, the symptoms of spinal irritation differ so greatly that it is impossible to describe the whole series so as to meet every case. As a general rule the symptoms are located within the domain of the nerves proceeding from the affected portion of the marrow If the upper portion of the medulla is af- fected, the pains are principally located about the head, and may even lead us to suspect a cerebral disease, for we do not unfrequently observe illusions of the senses, amaurosis, deafness, even delirium. An affection of the lower thoracic portion of the spine, where the stomach becomes predominantly involved, is likewise of great im- portance. In a case of this kind, as in all other cases of spinal irri- tation, it is interesting to inquire whether the affection of the stom- ach or of other organs is not rather the primary, and the irritation of the spinal marrow the secondary trouble. This distinction is all the more important since the irritation of the spine not unfrequently develops symptoms that completely simulate one or the other severe affections of the diseased organ. The irritation almost always runs a slow chronic course, the duration of which is numbered by years. Usually, however, the symptoms remit, the remissions being charac- terized by a regular type to such a degree that a subsequent exacer- bation may be regarded as an entirely new disease. Indeed it is impossible to determine with perfect certainty the degree of con- nection between a simple irritation of the spine and other affections, more particularly paralytic conditions, emanating from the spinal marrow. The frequent occurrence of spinal irritation in the case of hypochondriac individuals very often leads to an increase of the mental disturbance until actual dementia results from the spinal disease. Regarding the treatment we cannot do better than to transcribe Hartmann’s own words, vol. II., pages 378 and 379: “The reader comprehends without my reminding him of it that no specific treat- ment can be indicated for the multitude of symptoms which I have described as diagnostic signs of spinal irritation, and which repre- sent more or less independent groups of diseases to which I have applied generic names. Homoeopathy cannot and should not he guided in the selection of her remedies by the essence of the disease of which we have a very imperfect knowledge in the present case; otherwise she might tumble into a vague and unsatisfactory mode of generalizing which is decidedly antagonistic to the spirit of her teachings. I do not see how such a method can be considered con- sistent with homoeopathic principles; what would it avail if I were Spinal Irritation. Neuralgia Spinalis. 137 to indicate here a number of medicines every one of which has been found useful for this or that symptom of spinal irritation ? It would not be any the less necessary to take a careful record of the totality of the symptoms and to contrast them with the medicine to be chosen. For what purpose, then, have I here introduced such a general description of the symptoms of spinal irritation? For no other purpose than to enable the reader to obtain a correct com- prehension of the morbid symptoms presented to his view, and to decide with more certainty whether a remedy had been selected in perfect accord with these externally or phenomenally reflected mani- festations of the internal disease. There is no contradiction in these statements, as might be supposed by older homoeopaths who have remained ignorant of the modern tendency of medicine and have given an erroneous interpretation to Hahnemann’s teachings in this respect, and who would fain excommunicate me on this account from the pale of orthodoxy. I think I have correctly apprehended Hahnemann’s meaning, when he says: it is only the externally re- flected image of the disease which shows the physician what is to be cured; profound thinker as he was, he knew very well what he ought to think of each single symptom; the subjective symptoms wTere as valuable to him as the objective; in his mind a generic image of the disease was involuntarily called up side by side with the spe- cial symptoms of the case; this is shown by his Chronic Diseases and by his later provings, in the preface to which he takes pains to direct attention to the general character of each special drug. Un- consciously perhaps he meant to convey the doctrine that it was necessary not only to acquire a correct knowledge of the specific symptoms but likewise of the general therapeutic sphere of a drug. May not this consciousness of the absolute necessity of possessing a general knowledge of the curative range of a drug have been awakened in his mind by the conviction that, in order to obtain a complete image of the generic disease, a full record had in the first place to be instituted of all its special symptoms? I cannot conceive of any other meaning; otherwise there would be no special use in looking at the physiological effects of a drug in any other aspect than that which is most strikingly perceived by the senses, unless it was found necessary, with a view of benefiting therapeutics, to bring Physiology into harmony with Pathology and thus to restore the faded glory of a purely symptomatic treatment. A great deal more might be said on this subject, if the size and object of this work admitted of more enlarged developments.” 138 Diseases of the Spinal Marrow. Spinal irritation is not a morbid process encompassed within defi- nite boundaries, hence there can be no treatment assigned to it. But it is important to correctly apprehend its true character as a partial manifestation of other affections, and to consider its symp- tomatic appearances with the utmost care, with a view of selecting the right remedy. In the few cases where spinal irritation seems to be the primary affection, it will always be found difficult to select the appropriate remedy; this difficulty will likewise exist where the irritation simulates a more deep-seated affection. But it is strictly impossible to indicate a priori remedies for affections of such a gen- eral character. Nor is it feasible to seek remedies for spinal irrita- tion that are generally applicable, since, after all, it is questionable whether the same treatment would apply no matter whether the cervical or the lumbar portion of the spine constitutes the seat of the irritation. Hartmann has taken pains to furnish, after the fashion of a Repertory, a series of remedies corresponding more particularly to the symptoms of the back; he takes care, however, to preface this series with the remark that he does not attach any great practical value to it; indeed, the most superficial inspection of this list shows that the symptoms mentioned in this series bear very little resemblance to the symptoms of spinal irritation. For such investigations a Repertory is the best thing to use, and will be the more available the more incoherently the single symptoms pre- sent themselves. Only one form of spinal irritation may be men- tioned in this place, because it generally appears with the same symptoms: we allude to spinal irritation caused by onanism. The patients generally complain of a pain in the lumbar portion of the spine; it is a peculiar burning pain, is principally excited by unex- pected motion, violent exertions and long continuance of the back in the same posture. The mind is generally very much involved. The sensitiveness of the vertebrae is sometimes very great. The remedies indicated in this affection are, in the first place, Nux vomica and Sulphur. Both these remedies are so specifically antagonistic to this vice that, if they do not help, it may with certainty be affirmed that the medulla is already affected with a more deep-seated disorder. [The remedies which we have more generally employed for spinal irritation are the tincture of Aconite root, Gelseminum, Arsenicum,, Phosphorus, Sulphur. For the stinging and boring, gnawing and ■wrenching pains, and for the great heat and tenderness in the spinal region, we have found compresses moistened with a solution of Aco- nite, one teaspoonful to half a tumbler of water, and applied to the back by means of bandages, very beneficial. II.] c. dis:ases of the nervous system. 1. Epilepsy. By epilepsy we understand spasmodic attacks which occur in paroxysms, are separated from each other by free intervals, and are accompanied by a complete suspension of the consciousness, sensi- bility and the power of voluntary motion. The pathological changes accompanying this disease remain enveloped in perfect obscurity in spite of all investigations and the frequent occurrence of the par- oxysms. We may consider it as proven that the medulla oblongata is the starting-point of these very peculiar nervous paroxysms; hut we have no certain knowledge of the changes taking place in the medulla or of the maimer in which other derangements atfect this organ. Epilepsy is a disease of frequent occurrence and has a very chronic course. Its causes are manifold, some of which are indeed as yet questionable, others, on the contrary, are definitely known, although the nature of the connection between these causes and the disease is still involved in obscurity and doubt. One of the leading causes of the disease is its hereditary character. Our statistics have shown that a large number of our epileptic patients are either horn of epi- leptic parents, or of parents afflicted with other spasmodic affections, and that, in transmitting the disease, the mother exerts a more powerful influence than the father. Kpr does it often happen that the disease skips a generation altogether. Females seem to he more disposed to epilepsy than males; it is more particularly the transi- tion forms between epileptic and other convulsive affections that occur among females in a larger number than among males. The disease is seldom traceable as congenital, breaks out most frequently between the tenth and twentieth year, almost as frequently between the fifth and tenth year, rarely at an earlier age, and uniformly de- creasing in intensity as patients advance in age. As regards consti- tution it is difficult to lay down definite rules, but it must appear self-evident that individuals who are endowed with a very sensi- tive nervous system are particularly predisposed to the disease. Whether a scrofulous and rhachitic diathesis entails a similar pre- disposition is questionable; whether the lower classes are likewise more predisposed to epilepsy than the higher, or whether abstemi- ousness from all sexual enjoyments favors the disease, is likewise a matter of doubt. 140 Diseases of the Nervous System. Although cases of epilepsy occur that can he traced to an affec- tion of some particular organ, yet in most cases the convulsive paroxysms can he traced with more or less certainty to abnormal conditions of one or the other organ as their starting-point. It is, however, a mistake to base upon these organic differences a classi- fication of the epileptic convulsions into.thoracic, uterine, etc., for the simple reason that the form ot the convulsions is not modified by their local origin. However, no proof is required to satisfy the homoeopath of the importance of ascertaining with positive certainty what organ is primarily affected; and what is the nature of the affection; is not the individualization of every case of disease one of the first requirements of Homoeopathy? Hence it cannot he deemed superfluous, if we state here the main facts that have become known to us in this direction, to which we would add the advice that in every case of epilepsy the possible existence of other morbid conditions be carefully inquired into, and that a simple diagnosis of the epileptic paroxysm be not deemed sufficient. Every one of the various affections of the brain may develop epilepsy, but this disease cannot be traced to any of them as its regular or pre- vailing cause. The structural changes revealed after the death of epileptic individuals may have been antecedent to, as" well as con- sequent upon epilepsy. This remark is especially applicable to hypertrophy of the brain, which has often been noticed in post- mortem examinations. It is well known that long-lasting epilepsy affects the brain, from which we may infer that it must gradually produce structural changes in this organ, which a post-mortem in- vestigation does not fail to reveal to us and which we are too apt to regard as the primary cause of the disease. It is to adventitious growths in the brain that the origin of epileptic convulsions can be traced with most certainty’. Among psychical influences, fright holds the first rank, not only as the primary cause of the first attack, but likewise as the cause of subsequent paroxysms. It is said to cause one-third of all epileptic attacks; we iiave numerous oppor- tunities of witnessing its extraordinary influence upon epileptic patients. All violent emotions, more particularly the sight of epi- leptic individuals during an attack, act, if not with the same inten- sity, at least with an unmistakable force. Epilepsy is likewise often traceable with positive directness to mechanical impressions on the brain caused by a blow, fall, or other violent injuries, or even the causes which may lead to cerebral hypenemia, excessive heat or cold, insolation, may likewise cause epilepsy. Tracing the disease Epilepsy. 141 to affections of the thoracic organs is more uncertain. The fre- quently mentioned hypertrophy of the heart may both be cause and consequence of the disease. Very frequently and positively, epilepsy may depend upon affections of the abdominal organs. We dis- tinguish helminthiasis, uterine affections, amenorrhcea, nocturnal emissions, sexual excitement, onanism. The last-mentioned cause is certainly much more frequent than is generally supposed; it is indisputable that the most obstinate cases of epilepsy are occasioned by this vice. Other evident causes of epilepsy are injuries of single nerves, pressure upon nerves by cicatrices, tumors or neuromata; epilepsy has been cured by cutting the affected nerve. Lastly we mention chronic intoxications with alcohol or lead as causes of epi- lepsy. Symptoms. Epileptic attacks show a great variety of symp- toms. It is this very circumstance that compels us to detine the pathognomonic signs of the disease in such general terms. Eor the most part, however, we can distinguish three distinct stages, the first or last of which, and still less frequently both together, are scarcely ever entirely wanting. The precursory stage is the least clearly defined. The prodromata may consist of general phenomena emanating from one or the other portion of the nervous system or else involving the whole of it. These prodromata are a general restlessness, palpitation of the heart, a peculiar anxiety, pallor of the face, great depression of spirits or else excitement of the mind which may increase to complete derangement of the faculties. Such phenomena may precede for days the real attack, and very often the patients understand per- fectly well the meaning of such phenomena. Much more frequently, however, such precursory symptoms are of short duration. They have been designated as the aura epileptica, because the patients describe the sensation of the approaching attack as a warm or cold breath moving from the periphery, especially from the lower ex- tremities, upwards. The aura is likewise described as a sensation of formication, a simple feeling of coldness or heat, as an ascending ball, or else it consists in simple vomiting. As soon as the peculiar sensation reaches a certain definite point, the paroxysm breaks cut- in one, this point is the pit of the stomach, in others the neck, heart, or the head itself. As a general rule, the aura does not last longer than a few minutes, and is frequently so short that it passes off with the rapidity of lightning. It may be stated with a certain degree of emphasis that the origin of the aura, as felt by the patient, 142 Diseases of the Nervous System. does not by any means, not even with any degree of probability, indicate the organ which produces the disease. This remark like- wise applies to the cases where psychical emotions take the place of the aura. The second stage is that of the spasm. In almost all cases of fully developed epilepsy, the spasm sets in with a cry. At the same time as this cry is uttered, the patients fall down without consciousness, so that they are entirely unable to guard against injuries which generally happen to them sooner or later in consequence of the fall. This point becomes important when we are called upon to unmask feigned cases of this disease. It is only when the aura lasts for some time that the patient may find it possible to reach a place of safety before the attack overtakes him. In most cases the cry is at first followed by a tetanic rigidity of the whole body, during which the trunk as well as the extremities are stretched out, the head is drawn backwards or sideways, the mouth is tightly closed. The eyes are fixed, the look staring, the respiration arrested in con- sequence of the spasm of the respiratory muscles. The face now begins to bloat, turns blue and the veins become turgid with blood. After the rigidity has lasted a few moments, (it is never entirely absent,) the convulsions change to clonic spasms which are some- times ushered in by violent shocks. The whole muscular system is now powerfully shaken. The face becomes distorted, the eyes are alternately closed and opened, the lower jaw is moved to and fro; at one time the mouth is opened, at other times it is closed again, sometimes with an extraordinary force, during which teeth are sometimes broken and the tongue is injured. A frothy sputum which is sometimes mixed with blood oozing from the bitten tongue is seen forcing its way between the closed lips. The head and even the whole trunk are tossed to and fro. The extremities are stretched out, twisted and bent with terrible violence; at the same time the thumb is mostly clenched and even the toes are flexed. The for- mer symptom is regarded by many, although improperly, as a characteristic sign of epilepsy ; for this symptom likewise occurs in many other convulsive attacks, whereas it may be entirely wanting in well-defined cases of epilepsy. The convulsions are not always equally violent during the whole of the attack; there -are short remissions which, however, do not point to a cessation of the attack. In consequence of the respiratory muscles being very much involved in the attack, the respiration is greatly interfered with, even in the absence of all spasmodic closing of the glottis; the inspirations are Epilepsy. 143 unequal and forced, and in making an effort to overcome the con- traction of the glottis, the patient sometimes utters an anxious cry. The pulse is generally smaller and more rapid. Very frequently stool and urine are discharged involuntarily. Erections and even ejaculation of the semen sometimes take place. The consciousness and sensibility are entirely suspended, to such a degree that the patient remains unconscious even of the most frightful pains. It has happened that by falling against hot stoves or the like, the patients were frightfully burnt. This stage seldom lasts beyond a quarter of an hour, and is sometimes limited only to a few minutes. Very seldom the attack ceases with a sudden cessation of the con- vulsions; they abate very gradually, and the paroxysm terminates in most cases by a deep expiration. This stage passes into the third stage, that of sopor, through a scarcely perceptible transition. After the convulsions cease, the expression of the countenance becomes calm, the complexion pales, the inspirations become full and deep. In most cases this abatement passes into a sopor from which the patients wake after an interval of longer or shorter duration without being aware that they have passed through a paroxysm of convulsions. In very few cases the consciousness returns immediately after the attack; still less fre- quently the cessation of the convulsions is succeeded by a return of a perfect feeling of health. Generally the patients feel exhausted, with a dull and confused feeling in the head, unsteadiness of gait, headache, sometimes vomiting, and usually an extraordinary desire to sleep. A quiet sleep, even ever so short-lasting, generally puts a stop to all unpleasant after-feelings, and, until the supervention of the next attack, the patient is generally quite well. Not every attack, however, ends so free from all unpleasant consequences; nervous derangements often remain which are worse than the attack itself. Distinct symptoms of dementia, such as an excess of good humor, or else a dulness of perception, errors of language, fixed ideas, even a raging mania, or else an impaired memory, amaurosis, partial paralysis, sometimes remain after the attack, often for a long period, in inveterate cases they never disappear altogether. In the previous paragraph we have offered a picture of a fully developed paroxysm of epilepsy. This picture, however, does not cover all epileptic attacks. Affections of this class show transitions from other spasms to epileptic paroxysms, and from incomplete to complete paroxysms, in which cases the diagnosis is determined by the loss of consciousness. Such incomplete attacks frequently con- 144 Diseases of the Nervous System. sist only in a momentary loss of consciousness, during which the eye stares and the face turns pale without the patient falling down or a single spasm becoming visible. The attack is more complete if it begins with vertigo which obliges the patient to sit down or causes him to stagger and fall, in which case slight twitchings of the facial muscles and trembling of the hands take the place of the convul- sions. In a few minutes the consciousness returns, and the patient almost immediately feels well again. We have known a patient whose attacks always came on while he was sitting at his writing- desk, the consciousness vanished without vertigo, and an extremely fantastical and pleasant dreaminess set in, which lasted at most half a minute or a whole minute, after which he was able to resume his writing at the very word or letter where he had left oft. lie never was able to describe his reveries; all he knew was that he felt ex- tremely happy and elated. If such incomplete attacks are neglected and remain uncured, they often pass gradually, or even quite sud- denly, into severer forms, on which account they have to be watched with the greatest care. Inasmuch as no single paroxysm of epileptic convulsions, were it otherwise ever so complete, justifies the diag- nosis of epilepsy, but may be set down as a paroxysm of eclampsia, of which we shall treat in a subsequent paragraph, we deem it in- cumbent to devote a few remarks to the intervals between the par- oxysms. These intervals are of indefinite duration. It is rarely the case that epileptic convulsions set in at definite periods, (more par- ticularly about the time when the catamenia are expected;) most generally the return of the paroxysms takes place irregularly, and every new exciting cause may upset the established order. The free intervals may last for years. Sometimes, instead of a single parox- ysm, a number of paroxysms may take place in rapid succession, after which the free interval begins. Such groups of paroxysms generally imply a deep-seated character of the affection. In most cases the intervals are quite free from morbid symptoms, unless the attack leaves derangements which disappear either slowly or not at all. Epilepsy always runs a chronic course, provided always the con- vulsions are not the expression of some organic affection super- inducing a rapid dissolution. The patients may live to an advanced age, nevertheless in the course of the disease derangements result, which do not disappear again with the outbreak of the paroxysms, on the contrary, increase in proportion as the paroxysms become more frequent and violent. The mental condition must necessarily Epilepsy. 145 be affected by the disease, were it for no other reason than because there is something horrible in such attacks to every beholder. The mere thought of the horrible nature of this disease may excite in some individuals aversion to company, irritability of temper, mel- ancholy, etc., without these symptoms depending in the least upon structural alterations in the brain. Such alterations are never ab- sent in the severer forms of the disease. Gradually the patients lose their memory, the intellect and judgment become impaired, the countenance assumes a peculiar expression of dejection of spirits and subsequently of mental hebetude. We have already stated that partial paralysis sometimes remains after an attack either moment- arily or even permanently. The frequent and excessive excitement of the sexual system is a very striking concomitant of the disease. It not unfrequently happens that an increase of the morbid phe- nomena during the intervals is attended with a decrease of the frequency of the paroxysms. There are properly speaking but two terminations of the disease, either recovery or other forms of disease. Death very seldom results as the direct consequence of a single paroxysm, but only in conse- quence of the organic changes that may have been developed by the disease. Complete recovery is unfortunately a less frequent termi- nation than one is apt to suppose. Recovery can only be regarded as certain in cases where the frequently returning paroxysms either cease suddenly or become gradually less frequent and intense. Nu- merous deplorable instances show that eyen in such cases a peculiar disposition to relapses remains; it is more particularly violent emo- tions that give rise to new attacks. Even a partial recovery may be considered a great success, if the paroxysms, for instance, occur less frequently or with less violence, or without any abnormal phe- nomena during the intervals. There is no doubt that epilepsy may get well spontaneously; a spontaneous recovery may take place gradually, or may be superinduced all at once by the supervention of some acute disease, or may be consequent upon the shock caused by some startling event, or upon the disappearance of the derange- ments that had caused the paroxysms, such as retention of the menses, helminthiasis. Epilepsy may run into a variety of other diseases, but these changes are mostly confined to paralytic condi- tions of the central organs of the nervous system, among which we likewise number mental derangements, idiocy, imbecility. The prognosis is from the very start very dubious; in no case can a cure be promised with perfect certainty. A good deal depends 146 Diseases of the Nervous System. upon the age when the paroxysms first break out. Persons of middle fige are the most difficult to cure; next to these the greatest diffi- culty is experienced at the age of pubescence. The exciting causes likewise exert an influence; if these can be removed, a cure becomes much more probable. The worst cases are those that have been caused by a long-continued practice of self-abuse; epilepsy excites the sexual system with a disturbing violence, and onanism of itself is apt to superinduce changes in the functions of the brain and spinal marrow. The more recent the disease; the less important the derangements in the intervals between the paroxysms, the more promising the prospect of a cure. Ti eatmem. iiartmann has the following in his introductory remarks: “Although the homoeopathic treatment of this disease has obtained proportionally fortunate results, yet a great deal remains to be done to make our treatment a perfect success, as I can affirm from personal experience. Even if 1 were to accuse myself of my want of success,—which I do not feel disposed to do, since the treatment of epilepsy affords us an abundance of time to consult our books and select the appropriate remedy in accordance with all the individual symptoms of the case,—we may safely assert that two-tliirds of the cases of inveterate epilepsy are beyond the reach of the specific method of treatment; unfounded assertions to the contrary cannot shake my convictions on this point. Epilepsies depending upon internal causes may generally be considered incur- able, and even such as are consequent upon violent emotions pre- sent great difficulties to the practitioner, for the reason that a cer- tain predisposition undoubtedly exists in individuals thus attacked.- I do not care to decide whether the many reports of cured cases of epilepsy were really the disease; many of these cases were nothing more than violent spasmodic paroxysms, and could not be regarded as epilepsy for the simple reason that the truly pathognomonic signs were wanting, namely loss of consciousness and loss of sensibility at the very outbreak of the convulsions. It is well to know that an anti-epileptic treatment offers many difficulties even to us homoeo- paths, and that a successful cure of an inveterate case of epilepisy is just as rare under homoeopathic as under any other form of treat- ment, and that it should be more or less attributed in every case to the fortunate occurrence of accessory circumstances.” We have deemed it indispensable to transcribe this judgment of an experi- enced practitioner in order to meet at the onset the belief that we possess in our Materia Medica a number of approved remedies Epilepsy. 147 against epilepsy, and tliat we have it in our power to treat this dis- ease with comparative certainty of success. In treating epileptic patients we always have to keep in view three points: the causal indication, the treatment of the special par- oxysm, and of the disease generally. The causal indication is a subject of great importance, even under homoeopathic treatment. In most cases the diagnosis of the excit- ing cause is unfortunately either impossible or very unsafe. In cases where the attacks can be traced to disturbances of particular organs, we have in the first place to aim at remedying them. If the attacks are caused by the pressure of cicatrices upon adjoining nerves, the cause can only be removed by the knife. Cures may likewise be effected by dividing the main nervous trunk of the affected organ, provided the operation is feasible. This result has been satisfactorily demonstrated in cases of epilepsy depending upon degeneration of the testes. Menstrual derangements, helminthiasis, excessive nocturnal emissions, have to be cured before a cure of epi- lepsy can be thought of. However, even if such derangements have been removed, the stoppage of the convulsions does not necessarily follow; hidden influences may render the convulsions a permanent disease. This result may be expected with the more certainty the longer, the more frequently and more violently the paroxysms have already taken place. Moreover we should not forget that we often fancy we can trace the cause of the disease to functional derange- ments which really are mere complications of the convulsions with- out having any causal connection with them. The treatment of the paroxysm itself is not within the range of mere medicines. Where the aura is distinctly marked and the cir- cumstances otherwise permit the thing to be done, we may try to ward off the attack by applying a ligature to the extremity in- volved. It is said that in many cases this proceeding has been attended with success. In other respects, we should constantly bear in mind that the patient has to be protected in every possible man- ner against injuries; he should, for instance, not be allowed to go out alone, and, during the paroxysm, he should be placed so that he cannot injure himself. This precaution is so much more necessary as it has happened that patients have inflicted fatal injuries upon themselves during the attack. That this may readily take place is evident from the violence with which epileptic patients are thrown down, and from the terrible agitation of the muscular system, in 148 Diseases of the Nervous System. consequence of' which fractures may occur in spite of the greatest care with which the patient is placed. So far as the medicinal treatment of epilepsy is concerned, it offers, as has already been said, great difficulties, for the reason that we have not yet succeeded in assigning definitely specific remedies to corresponding forms of the disease. The cause of this is that, al- though it is certainly true that a large number of epileptic patients have been treated homoeopathically with perfect success, cures of epilepsy are scarcely ever what might be termed typical cures, and hence cannot he given to the public. Another cause is, that it is equally difficult to build up the categories of epileptic convulsions with well-defined discriminating distinctions, and that, with a few exceptions, our remedies do not enable us to construct correspond- ingly accurate diagnostic series. It is certainly wrong to place the symptoms of the actual paroxysm in the foreground. Of course they are essential; but it is equally true that phenomena occurring be- tween the paroxysms deserve a much more attentive consideration. The case is with epilepsy as with intermittent fever which is treated much more successfully with remedies chosen in accordance with the symptoms that characterize the apyrexia. This rule mainly co- incides with what we have said previously regarding the causal indication. Where functional derangements of some particular organ prevail, they should constitute the main object of our treat- ment, no matter whether convulsions are present or not. Only after the local derangements have been removed, a special treatment can be instituted against the epileptic paroxysms unless they should have previously disappeared together with the local trouble. The greatest difficulty in selecting a remedy is undoubtedly experienced in cases that seem to be of an idiopathic nature, and where the inter- vals do not show the least symptom of bodily ailment. In the fol- lowing paragraphs we will mention every remedy that has been rec- ommended for epilepsy with more or less reason; however, it will be impossible to mention every remedy that may have to be em- ployed for the different local derangements which constitute so many exciting causes of epilepsy; for a knowledge of these remedies we refer the reader to the chapters where these pathological pro- cesses are more specially described. Cuprum is one of the few remedies of which we know positively that poisonous doses cause epileptic paroxysms. This circumstance has led to the frequent use of Copper in epilepsy. A great many cures have been effected with this agent. In cases of idiopathic Epilepsy. 149 epilepsy this remedy is one of the first that will have to he used; on which account, however, it may not be any the less suitable in complicated cases. In this latter class of cases the accessory symp- toms will be found to constitute valuable and characteristic indica- tions for the use of Copper. It is more particularly when the epi- leptic paroxysms break out in the night, that Copper is supposed to possess specific curative powers, although, as we have said before, such statements are unfortunately not confirmed by a sufficient number of clinical observations. Whether Cuprum, metallicum is preferable to Cuprum aceticum is still an open question. The latter preparation is undoubtedly more effective in the lower attenuations, whereas the former had better be used in the higher potencies, and less frequently. In the treatment of epilepsy it seems generally better to employ the higher attenuations in less frequently repeated doses. We make this remark here once and forever in order to avoid unnecessary repetitions. Plumbum is very nearly related to Copper, both in its general therapeutic character as with regard to the convulsive symptoms. Hartmann says that Plumbum seems to suit epilepsies emanating from the splanchnic system of nerves, whence they radiate over the sentient and motor nerves of the spinal system and finally reach the brain and the senses. According to this statement, Plumbum is particularly adapted to epileptic attacks with a well-defined aura, or to attacks where paralytic conditions, entire or partial loss of consciousness, remain for some time after the attack. These general statements do not, however, show what special cases of epilepsy do more particularly come within the curative range of Plumbum; we shall have to content ourselves with the general knowledge that this remedy is adapted to epilepsy. More special indications will not be expected, for the reason that the peculiar nature of the dis- ease does not admit of any; hence the remedies for epilepsy will always have to be employed with more or less uncertainty as regards their strict homceopathicity. Plumbum acts very slowly as we have already stated when speaking of encephalitis; on the other hand its action lasts much longer and is much more penetrating. On this account alone, even if for no other reason, Plumbum is more particularly suitable to cases of long duration, even if struc- tural changes have already been superinduced in the brain. Calearea carbonica is highly prized by Hartmann as a remedy for epilepsy. However, he is evidently embarrassed in endeavoring to justify the selection of this drug. He bases it more particularly 150 Diseases of the Nervous System. upon the general therapeutic character of the drug and its action in persons with a scrofulous diathesis and sensitive nervous system, for the two symptoms which he mentions as characteristic scarcely account for its use upon homoeopathic principles. The influence of scrofulosis upon epilepsy has not yet been definitely ascertained; at any rate this influence is not very marked, any more than that of a sensitive constitution. Hartmann has informed us what is to be thought of the usus in morbis as applied to the treatment of epi- lepsy. There is no difficulty in admitting that Calcarea will do good service in the case of children, especially of scrofulous chil- dren ; or that, by the removal of complications, it may exert a bene- ficial effect on the course of epilepsy; but it will he found to have very little direct influence over the epileptic paroxysm generally, and in uncom; licated cases we shall have to use it with a good deal of diffidence. Hartmann applies almost the same remarks to Caustic-urn. We coincide with him in opinion in this respect; would however call attention to the fact that some cases of epilepsy have undoubtedly been cured with this agent, on which account, owing to the paucity of our anti-epileptic agents, it deserves some notice at our hands. Belladonna has among its pathogenetic symptoms the whole series of the phenomena which characterize an epileptic paroxysm, on which account it deserves to he ranked with Cuprum and Plum- bum. A careful examination of its pathogenesis reveals, however, some very essential differences. The epileptic Belladonna-convul- sions are the consequences of an intense intoxication of the organ- ism ; while running their course they may recur several times, but never in the form of a chronic affection, as is the case with Cuprum and Plumbum. Hence the Belladonna-convulsions, as we indeed know from experience, correspond rather to eclampsia, which has been very properly designated as acute epilepsy. We do not mean to imply that Belladonna should never be used in the treatment of epilepsy. There are plenty of cases where it is difficult to dis- tinguish between epilepsy and eclampsia, and where the further course of the disease has to shed light upon the nature of the exist- ing attack, although even in such a case we are often left in the dark. In all such doubtful cases Belladonna will undoubtedly often be selected and will be found efficient. A special indication for Bella- donna are the cerebral congestions occurring during and between the paroxysms. Cicuta virosa undoubtedly reflects by its pathogenetic effects a Epilepsy. 151 faithful picture of epilepsy, hut very little is said of its curative virtues in this disease. Hartmann recommends it for the following symptoms: Strange movements of the head and trunk, lock-jaw, a bloated and hluisli countenance or cadaverous pallor of the face, protrusion of the eyes, vomiting, a weak and scarcely perceptible pulse, scarcely perceptible and intermittent respiration. The attack is preceded by: Strange feeling in the head, extreme sensitiveness of the eyes to the light, delirium while walking about, slow pulse. There is no aura, properly speaking; the attack is succeeded by in- sensibility, more or less complete lethargy, the patient lies in a state of stupor In other respects, special indications for Cicuta are the prevalence of venous congestion, especially of the abdominal viscera; convulsions occurring in confinement or during the act of parturition, although they belong more properly to the category of eclampsia. Opium has among its effects the characteristic symptoms of epi- leptic convulsions, for which it is indeed recommended by many practitioners, more particularly for convulsions which occur at night while the patient is asleep. However, according to all the information which we possess concerning this remedy, it does not seem adapted to deep-seated, chronic forms of epilepsy. It has been recommended from theory rather than from practical observa- tions. Otherwise we know that Opium-eating, when continued for years, very frequently causes epilepsy which is most generally pre- ceded by an intense derangement of the mental functions, and that for this reason Opium deserves particular notice in cases where, as is so often the case, the convulsions take place in the case of insane persons as complications of the mental disease. Secale cornutum has, in our opinion, been rather slighted as a remedy for epilepsy The toxicological effects of this remedy are so striking that scarcely any other can compete with it as an anti- epileptic agent. The Secaie-convulsions with or without conscious- ness hold a high rank among its pathogenetic indications. It is difficult to understand why such a remedy is not much more fre- quently employed than others which are not near as homoeopathic to the disease. Unfortunately we are without any more specific indications in the use of this drug; all we can do is to recommend it for sudden and rapidly recurring paroxysms, with rapid sinking of strength and paralysis of the spinal nerves. Of other medicines among whose pathogenetic symptoms we have convulsions with loss of consciousness and which have been used 152 Diseases of the Nervous System. with partial success against epilepsy, we mention: Agaricus, Coc- cuius, Hyoscyamus, Stramonium, Lycopodium, Acidum nitricum, i&z- nunculus bulbosus. The number of remedies that are used for the accompanying ailments of epilepsy, rather than for the disease itself, is so large that an accidental omission of one or the other of them will have to be excused. They will be mentioned when treating of the func- tional derangements of the different organs. Some among the fol- lowing list owe their employment entirely to the crassest empiri- cism ; although we are not disposed to deny their efficacy on this account, yet they certainly do not deserve to be placed in the front rank as homoeopathic anti-epileptic agents. These remedies are: Ar- senicum, Artemisia, Argentum nitricum, Cina, Digitalis purpurea,, Ignatia amara, Indigo, Ipecacuanha, Lachesis, Nux vomica, Pulsa- tilla, Stannum, Sulphur, Veratrum album, Zincum, liana bufo. Some of these remedies enjoy such high repute, as anti-epileptic agents, that it is necessary to mention them more in detail. Ignatia and Nux vomica are among the most prominent. However, the convulsions caused by these medicines are not attended with loss of consciousness, nor are these convulsions in other respects strikingly similar to epileptic spasms; both these medicines occasion only violent rellex-phenomena, whereas in epilepsy the reflex-action is almost completely extinct. Hence these medicines can only be recommended empirically. Hartmann tries to give more definite indications for Nux, but his indications are entirely erroneous; they may indeed apply to convulsions with increased reflex action, but not to epileptic convulsions. Epilepsy may indeed arise from an excess of reflex-action; in such cases these two remedies may be used, if not in the expectation of effecting a cure, at least with a view of palliating the intensity of the paroxysms. Regarding Lachesis Hartmann says that it is regarded as one of the most efficient remedies for epilepsy, provided the recommenda- tions bestowed upon it by its advocates could be implicitly trusted: “The symptoms of the drug, however, are so mixed up, physiology and pathology are thrown together in such a confused mass, that a scientific physician finds it impossible to employ this poison in epi- lepsy without incurring the reproach of frivolity. We, therefore, content ourselves with hinting at lachesis in this disease, and refer the practitioner who wishes to make use of it to the original trea- tise on this agent.” These words do not argue much in favor of Lachesis, and are indeed based upon tru:h. Lachesis has no con- Epilepsy. 153 vulsions with loss of consciousness; what is recorded concerning it, in those forms of epilepsy for which it is deemed suitable, is not obtained by means of a carefully instituted proving on individuals in perfect health, hut has been observed on the sick, hence is en- tirely unreliable. Digitalis deserves a prominent place in the list of anti-epileptic remedies in all cases caused by onanism or excessive nocturnal emissions. There is scarcely a drug that diminishes and even arrests nocturnal emissions with as much promptitude as this one. We have employed it in many cases, and always with marked success. We are in the habit of giving the alkaloid Digitalin, third tritura- tion, one grain every two days. It produces at once a favorable effect in cases of weakness of the sexual organs caused by onanism. The remedies that have likewise to be thought of in such cases are: Phosphorus, Acidum phosphoricum, China, Nux vomica. Artemisia, whose physiological action is still uncertain, owes its reputation to the use that has been made of it in domestic practice; its beneficial results cannot he denied. Rana bufo has more recently been employed empirically rather than otherwise; but it cannot be denied that this agent has evinced decidedly beneficial effects in epilepsy. A young man whom we had been treating for three weeks, and who, in consequence of practising onanism, had become afflicted with daily paroxysms of epilepsy, received a remedy for this disease from a friend to whom it had been sent by a foreign non-professional correspondent with the assurance that a great many had been cured with it. After the first doses, the paroxysms stopped for three weeks, hut then returned again because the patient, as was afterwards found out, continued his miserable practice in spite of all admonitions. We learned after- wards that the powders contained liana bufo in some attenuated form. Observations of this kind bespeak the most careful considera- tion for this agent. [Doctor G. Cook of Buffalo, Y., reports the following interest- ing cure of epilepsy in the Am. Horn. Observer: The patient was a girl of thirteen years of age. She was attacked at intervals of seven, ten and fifteen days, usually at four o’clock in the morning, with spasms. The first admonition her mother had of an impending attack was that the girl straightened out in bed and made the noise peculiar to this disease. The face almost immediately became livid and, unless the temples and face were rubbed during the fit, dark purple spots remained for two or three days. After a few minutes 154 Diseases of the Nervous System. the muscles relaxed, and she went into a comatose sleep in evhich she remained several hours. Felt languid on awaking; head ached, and had a severe pain always at the pit of the stomach, and some- times nausea. She ate nothing for twenty-four hours and then felt nearly as well as usual. At fourteen, the catamenia appeared with- out, however, mitigating or changing the time of the spasms. She was treated allopathically for a whole year without the least bene- fit. Animal magnetism and the Acetate of Copper relieved at first, but the spasms soon returned with the former violence. The doctor now prescribed Bromide of Potassium, two drachms t o half a pint of water, a teaspoonful three times daily. Being greatly bene- fited by this prescription, she was given three-grain doses, three times daily at first, and increased until she took ten grains at one dose, all the time improving. These ten and twelve-grain doses were continued until the patient was entirely cured, in about six months. No ill effects have resulted. The patient has remained well eight months, and is now eighteen years old, and appears to be healthy; her intellect is perfectly sound. Dr. Benedict, of the Imperial-Royal Society of Physicians at Vienna, cures epilepsy by means of subcutaneous injections of Curare, on the neck; he uses solutions of the officinal preparation in the proportion of one to sixty, and injects one-eighth of a grain at a time. The injections are thrown in three times a week, and continued from six to eight weeks or more, as the case may be. Dr. Goullon reports a case of epilepsy of long standing, cured with Causticum, 3d atten., giving the medicine every alternate week. (See All. Horn. Zeit., vol. 69.) Hydrocyanic acid is undoubtedly homoeopathic to epilepsy. H.j 2. Eclampsia. By this term we understand convulsions with complete or partial loss of consciousness, which can only be distinguished from epilepsy by the general course of the paroxysm. According to the age and condition of the individual we have eclampsia infantum and eclampsia parturientium. a. Eclampsia Infantum,. Although we here class eclampsia among the diseases of the nerv- ous system, yet there is every reason to regard it as a pathological condition arising from some anomaly of the blood, since it affects more particularly the two epochs in human life where the vegeta- tive sphere is very peculiarly circumstanced, namely childhood, and Eclampsia Infantum. 155 pregnancy or rather the period of confinement; and otherwise breaks out only where the mass of blood is altered by the intensity of the morbid process, intoxications, etc. Eclampsia occurs most frequently at an age when epilepsy is least frequent, namely during the first months of infancy until the fourth year. As a general rule, feeble, impoverished children incline most to this disease; nevertheless it is likewise quite frequently met with in well-fed children with apparently robust constitutions. A heredi- tary disposition cannot be denied, in so far, for instance, as children of the same parents may all of them be subject to convulsions, with- out either father or mother being affiictcd with them; and likewise in so far as parents affiicted with the disease may transmit it to their offspring. Eclampsia is likewise said to be favored by hereditary syphilis. What is more probable, however, is that the disposition to eclampsia is acquired. This view is sustained by the more fre- quent occurrence of the disease among the poorer classes in the country, who manage their new-born babes in the most outrageous manner, and feed the children, after they are once weaned, indis- criminately with all kinds of proper and improper articles of diet- More special, etiological causes are: mental excitement of the mother or nurse; the partaking of noxious substances by either, such as spirits, narcotics which are also given to the child in order to keep it quiet. Exciting causes on the part of the child are: morbid condition of the stomach and of the digestive organs gener- ally ; dentition; febrile diseases where, however, the convulsions are of no greater significance than is, in the case of adults, the chill at the commencement of serious diseases; cerebral diseases, more par- ticularly cerebral ansemia; helminthiasis. &!f mptorns and Course of the disease: Eclampsia sets in with- out any premonitory symptoms only in cases where it constitutes the first symptom of the invasion of some acute disease. As an idiopathic disease it is almost always preceded by preliminary symp- toms. These are: ill-humor, a whining mood, obstinacy, indisposi-' tion to play, sudden starting when touched ever so lightly without expecting it; sleeplessness or restless sleep, during which the lids are not entirely closed, with a peculiar twist of the mouth, (risus sardonicus,) gritting of the teeth; change of color from the least cause; crying out without any apparent cause; sudden relinquish- ing of the nipple; uneasy, unequal breathing; sometimes a peculiar livid color around the mouth and eyes, and pointed appearance of the nose and chin. 156 Diseases of the Nervous System. After these premonitory symptoms have lasted for a time which cannot be accurately defined, the actual paroxysm breaks out with the same suddenness as an epileptic attack, only with this difference that the patient utters no cry. Otherwise the attack has all the characteristic features of an epileptic paroxysm. At the beginning the convulsions are generally for some time tonic, after which they become clonic, and, in less frequent cases, affect only one side. The features become distorted, the eyes stare, generally squinting strongly upwards; the body is tossed to and fro, nevertheless the extremities are not as rigid as they are during an epileptic attack. The respiration is very much impeded, spasm of the glottis is not unfrequently present, the abdomen becomes distended. The face either looks blue-red and bloated, with considerable turgescence of the vessels, or else it is pale and sunken; the bodily temperature is rather decreased than raised. During the height of the convulsion the consciousness and sensibility are completely extinct. Usually the paroxysm ends with a deep, moaning inspiration, after having lasted a few minutes or even a number of hours, and the patients sink into a deep sleep from which they wake in apparent health. The paroxysm does not always reach such a fearful degree of in- tensity ; eclampsia as well as epilepsy has a series of gradations, the attack being sometimes marked only by partial convulsive move- ments of the muscles, a staring look with some squinting, risus sar- donicus, etc. The consciousness remains either entirely undisturbed, or is only partially interfered with. Sometimes the attacks consist in a comatose sopor which lasts for hours, with the almost charac- teristic half-closing of the eyelids, and a few convulsive twitchings taking the place of the convulsions; even the face may retain its normal expression and color. A single paroxysm is scarcely ever the end of the trouble. In the first place there generally remains a disposition to relapses, and in the second place several paroxysms usually follow one after the other, the intervals between the paroxysms being of indefinite dur- ation, and the intensity of the attack varying in degree, sometimes increasing, at others decreasing in violence. The intervals are not always free from morbid symptoms, but the phenomena which we have designated as the preliminary stage sometimes continue more or less until the next attack sets in. Altogether the wdiole duration of the attack is very indefinite. Eclampsia may terminate in recovery, partial recovery or death. The former may take place after any paroxysm, sometimes quite Eclampsia Infantum. 157 unexpectedly, so tliat a child may he found playing about in the morning which, the day previous, was still the victim of terrible convulsions. In partial recovery some of the symptoms of the attack remain either permanently or disappear only gradually. In such cases it is a question whether such permanently remaining consequences of the attack do not rather originate in some cerebral disease which was likewise the primary cause of the attack. Among such consequences we number paralysis of the muscles of the eyes, less frequently of the muscles of the back, idiocy or only a certain degree of backwardness in the development of the mental faculties, accompanied with an unusual degree of nervous irritability. Death results either during the attack, or else the subsequent coma termi- nates in death. The only disease into which eclampsia may be transformed is epilepsy, in which case it is, however, always diffi- cult to determine whether the original affection was only eclampsia. It is likewise difficult to draw the line of demarcation between eclampsia and epileptic spasms. Nevertheless it is of essential im- portance to distinguish with accuracy between eclampsia and epi- lepsy, both on account of the prognosis as well as the treatment. As a general rule we may take it for granted that, whenever the attack cannot be traced to any definitely exciting cause, the charac- ter of the convulsions is that of epilepsy. This rule, however, is not of uniform validity. The prognosis depends upon many accessory circumstances, and is always rather doubtful. Age is an important consideration; the younger the patients, the more readily they succumb to the attack, more particularly infants at the breast. In hereditary cases the prognosis is decidedly unfavorable. The more rapidly the parox- ysms succeed each other, the greater the danger of a fatal termina- tion, more particularly if they continue to increase in intensity, and the subsequent derangements continue for a long time. The more readily the primary disturbance is quieted, the less apprehension need be entertained regarding the final result. Convulsions setting in at the commencement of the invasion of some acute disease, are scarcely ever dangerous. On the contrary, if the convulsions set in during the course of the disease, they almost always justify the most serious apprehensions; they generally mean death. The danger is greatest in the case of robust and corpulent children. Treatment. As a general rule the treatment of eclampsia is just as uncertain as that of epilepsy, for the reason that we can never be sure whether the paroxysm that had just passed is the 158 Diseases of the Nervous System. end of the disease. A number of paroxysms may succeed'each other in rapid succession, in which case, if they stop suddenly, we may feel pretty certain that the disease is cured. On the other hand, the intervals may be of long duration, in which case the certainty of a cure is of course less absolute. On this account it is not enough that the paroxysm should be ended; the subsequent developments of the case will have to be watched for a time, and the same medicine had better be continued for some time longer. In a case of eclampsia the causal indication deserves a much more attentive consideration than in epilepsy, for the reason that in the former disease it is much easier to trace the latter to its exciting cause. Although not in every case, yet in most cases this cause can be determined with tolerable certainty. The sole exceptions are con- vulsions depending upon cerebral affections. Here it may be diffi- cult to arrive at a certain knowledge of the cause. Among children, however, such cerebral disturbances seldom manifest themselves for the first time with the first breaking out of the paroxysm; we gen- erally have had opportunities, previous to the occurrence of the con- vulsions, of obtaining certainty concerning the character and exist- ence of the cerebral disease. In all cases it is of importance to direct our treatment against the exciting cause, so much more as we need not apprehend that the convulsions have become firmly rooted as is the case in epilepsy. In the subsequent paragraphs the reader must not expect to find a record of every remedy that may be indicated by the various exciting causes of eclampsia; their list will be found limited to the most important. To some extent the prophylactic treatment ot eclampsia coincides with our previous remarks. That a prophylactic treatment is pos- sible cannot be denied, for it is a notorious tact that children who are attacked with the disease, are brought up in contravention of all natural rules. It is not only a matter of importance that the child should receive the proper nourishment at the proper time, but that the disposition of the child should be managed with becoming attention from the moment of birth. It often happens that in the first years of the child’s existence the mother or nurse is subject to its tyrannical caprice, whereas it is afterwards expected to yield implicit obedience to their behests. How difficult it is to induce a mother to insist upon her will being law from the very first moment of the child’s existence. If the child cries, it has to be nursed at once, or has to be rocked or carried about. It is such practices as these that make the child restless and headstrong and have a decid- Eclampsia Infantum. 159 edly injurious effect upon the nervous system. Every child, if other- wise healthy, can easily he accustomed to do without iood at night; a little firmness will readily teach it. Our own experience should admonish us that a night’s quiet sleep, uninterrupted by the cr}hng for food, must exert a 1 eneficent influence upon the child. During the day, likewise, little children should be allowed to remain in a recumbent posture, for as long as the muscle; of the back are not strong enough to support the head, children can only he injured by being carried all the time. As a matter of course it is proper to try to harden the child within reasonable bounds; above all things it should be remembered that the head must not be kept too warm by an excess of covering. The influence of the first management of children cannot well he demonstrated by numbers, but any one who will take the trouble to inquire, whether eclampsia and various other affections do not occur much less frequently in families where children are brought up with a reasonable systematic regularity, will find that our condemnation of the faulty management of early infancy is well founded. As a prophylactic measure it is likewise important that the child’s mind should not at once be unnaturally excited as soon as the first dawn of a mental awakening is perceived; on the contrary, the child should be left to its own spontaneous tendencies. It is well known that milk drawn from the breast of a mother or nurse shortly after an immoderate excitement, more particularly anger, has a deleterious influence upon the child; mothers and nurses should never lose sight of this circumstance. Special attention should be devoted to children during the teething period, especially if they have shown a disposition to convulsions at a prior period. The period of dentition acquires additional impor- tance from the circumstance that it generally coincides with the period of weaning, not to mention the prejudices with which the physician has to contend. Lancing the gums is scarcely ever of any use, but may retard the liberation of the tooth in consequence of the formation of cicatrices. We need scarcely add that there are many cases of eclampsia which it is impossible to prevent by treatment. Before mentioning the remedies for this disease, it may be well to inquire whether it is at all proper to administer remedies during the attack. In general we feel disposed to deny the propriety of this sort of medication, more especially in cases where the convul- sions break out suddenly, without any premonitory symptoms. We are not by any means sure of hitting the right remedy, and it is 160 Diseases of the Nervous System. much better not to give any medicine until the attack is over, pro- vided the intensity of the symptoms is not attended with any im- mediate danger, or we were unacquainted with the primary cause of the convulsions. Hartmann advises to strip the little patients of all clothing, in order to make sure that the convulsion are not ex- cited by tight dresses or the prick of a pin. Not all the remedies which we shall mention, have among their physiological symptoms convulsions with loss of consciousness. The presence of this symptom which is characteristic of epilepsy, is much less so of eclampsia. Moreover in a case of eclampsia the medicines can be selected much more appropriately in accordance with the accessory symptoms, without paying particular attention to the character of the convulsions which seldom break out as an idio- pathic affection. Belladonna is without doubt the main remedy for eclampsia; most cases will be found to come within the curative range of this drug. It is particularly indicated in the case of robust and corpulent children with unmistakable symptoms of cerebral congestion. In order to show the correspondence existing between this drug and eclampsia, we here mention the symptoms of four children who were poisoned with Belladonna, which will show how constantly the berries of Belladonna produced eclampsia in these cases: Already an hour and a half after eating the berries the children were attacked with the following symptoms: complete stupor and insensibility; exceedingly restless tossing about in the bed, with occasional shrill cries as if the patients were tormented by great anxiety; frequent chorea-like movements of the arms; bright redness of the face; the pupils are dilated; the reflex motions of the lids are entirely suspended; the eyes stare and look glassy, in one case they were in constant, vibrat- ing motion ; respiration moaning, sobbing; the lower jaw was firm’y pressed against the upper; occasional electrical shocks through the whole body; the head is violently drawn backwards; the urine is voided involuntarily. These symptoms not only are remarkably characteristic of eclampsia, but they occur in almost every case of poisoning with Belladonna, and demonstrate with remarkable ac- curacy the truth of the principle of similarity as a therapeutic maxim; for it will seldom happen that a second attack of convul- sions will occur after the administration of Belladonna. Hyoscyamus acts very similarly to Belladonna. According to Hartmann the indications for Hyoscyamus are: dark redness and bloat of the face, the abdominal walls are firmly drawn in, the Eclampsia Infantum. 161 clonic spasms attack now these and then other parts of muscles, and the attack is caused by fright. Stramonium is likewise very similar in its action; the turgescence is considerable, clonic and tonic spasms occur in frequent alternation; the increase of temperature affects the whole body rather than the head. Chamomilla is employed in eclampsia more frequently than seems founded upon scientific accuracy. Hartmann agrees with us in doubting the homceopathicity of this drug to the attack itself; he recommends it for the premonitory symptoms. The question in such cases is, whether the medicine has been of any use. Cicuta virosa deserves our attention in eclampsia as much as in epilepsy; 1 he cases where it is indicated are not so much characterized by spasms, as by the circumstance that the children assume all at once a rigid and immovable appearance, which, after a short period, is superseded by a profound prostration lasting some time and attended with a comatose condition. Opium, as is well known, affects the infantile organism differently from that of full-grown persons. This phenomenon, however, is likewise peculiar to other drugs, such as Belladonna, and has not as yet been accounted for. We are in possession of a considerable number of cases of poisoning among little children, where the fol- lowing effects of Opium are almost uniformly present; the face, lips and eyelids are swollen, the color of the skin is almost violet, the temperature is depressed, especially at the nose and on the extrem- ities; deep coma with convulsions at rather long intervals which are frequently preceded by vomiting; the inspiration is slow and ster- torous, the expirations especially are very slow and protracted; the pulse is imperceptible. Attacks of eclampsia with a similar group of symptoms, are not very frequent; the symptoms, taken sepa- rately, point to acute anaemia rather than to hyperaemia of the brain, which latter, in the case of adults, is an almost constant effect of Opium, and which has caused us in previous paragraphs to mention this agent among the list of remedies for cerebral dis- eases. Practical observations have not yet enabled us to determine the cases of eclampsia to which Opium is homoeopathic, and we do not consider Hartmann’s advice in this respect as of much use. He considers Opium indicated in convulsions arising from fright when attended with fear. They are supposed to commence with trembling of the extremities, which is interrupted by starting of the body and the extremities, attended with a shrill cry; after a while a sort of sopor overwhelms the child, from which it can- 162 Diseases of the Nervous System. not be roused; such paroxysms are said to break out only at night. Igr.atia amara is a much more important remedy for eclampsia than for epilepsy; it is more particularly adapted to cases where the spinal marrow is deeply involved and where the convulsions are chiefly tonic. Such convulsions are frequently met with at the onset of febrile affections; if they are very violent, it is ad- visable to commence the treatment with Ignatia, and afterwards to give the remedy more particularly adapted to the disease. Nux vomica holds the same relation to eclampsia as Ignatia. The remedies that have been mentioned so far, except perhaps Opium, correspond to convulsions attended with cerebral hyper- aemia. These convulsions are undoubtedly the most frequent; but those which are either dependent upon, or complicated with, an- aemia, such as frequently occur among children in consequence of losses of animal fluids, are undoubtedly of more importance be- cause more dangerous. In such cases Ipecacuanha deserves the first rank. It is to be exhibited belore any other remedy, when the convulsions set in after protracted diarrhoea caused by improper or excessive feed- ing, or perhaps by the use of too fat nourishment; the face is pallid or livid, the skin is very cool, or is covered with a cold swe'at. Cuprum has already been prominently mentioned as a remedy for convulsions arising from cerebral anaemia. It is one of the most important remedies for this disease even in its most violent and dangerous forms, more particularly if the lethargy continues in the intervals between the paroxysms which follow each other in rapid succession, and if the constitution of the child has be- come impoverished in consequence of improper or deficient nour- ishment. Conditions of this kind occur most frequently as malig- nant complications towards the end of acute or subacute diseases, such as typhus. Veratrum album is very nearly related to Cuprum; it will prove particularly useful in convulsions caused by rapid losses of vital fluids during an attack of cholera or cholerine, and where the affection sets in in a very acute form. In such cases Camphor may prove serviceable. Platina is likewise recommended by Hartmann as a specific remedy for convulsions arising from anaemia; the consciousness is not suspended; the spasms are rather tonic, trismus may be Eclampsia Parturientium. 163 present. In this place Arsenicum, Stannum and Zincum deserve particular mention. The last-mentioned remedy has been more recently employed with particular success in cases of eclampsia, more especially if it semis to be symptomatic of some cerebral affection. We would have to add a long list of remedies if we were to enumerate all that have reference to the exciting pathological causes; in order to avoid unnecessary repetitions, it will be more convenient to defer their enumeration until we come to treat of the special functional derangements of the affected organs. If eclampsia ushers in some acute disease, it is scarcely ever necessary to heed the merely transitory convulsions. It is only in case the convulsions should threaten to become dangerous that a specific treatment has to be pursued. In such a case Belladonna and Ijnatia would be the most indispensable remedies. The case is different when convulsions occur in the course of acute diseases. Under these circumstances they become so threatening that the treatment has to be mainly directed against the convulsions instead of against the general affection. b. Eclampsia Parlurientium. By this term we understand convulsions that are perfectly similar to epilepsy, and which only occur during pregnancy and parturition or shortly after confinement. This accident is not very frequent, only one case to about four hundred confinements being the general average. At certain periods the disease occurs with more than usual violence without atmos- pheric or other causes being at the bottom of it. As a general rule, the disease occurs during the ninth month, and even at a later period, scarcely ever before this time, never in the first two or four months. The constitution does not seem to exert a peculiar influence in this disease; robust, plethoric individuals are said to be more readily attacked than others of opposite constitutional tendencies. By far the largest number of patients are to be found among the primiparie. The disease most frequently occurs about the time when the os tincse first begins to dilate; next shortly after the ex- pulsion of the foetus. A variety of circumstances are mentioned as etiological causes of the disease, whereas more recently Frerichs has pointed out Bright’s disease of the kidneys as the only cause of the convulsions. This question, however, is not yet decided. It is true that eclampsia most frequently attacks women afflicted with 164 Diseases of the Nervous System. albuminuria; but, whether this is a symptom of Bright’s disease is questionable, for the reason that, if the patients recover, the symp- toms of albuminuria very speedily disappear, which would not be the case if the kidneys were organically diseased. At all events, it is certain that albuminous urine, with codematous swellings, always augurs badly for parturient females, and very frequently results in the occurrence of convulsions. On the other hand, it is an admitted fact, that these convulsions may occur without the albuminuria and oedema. Proximate causes are: disproportionate dimensions of the sexual organs and the foetus, rigidity of the uterine fibres, excessive labor-pains, hemorrhage, retention of rerun nts of the placenta, ex- cessive mental excitement. When occurring- during;- confinement, convulsions generally imply the commencement of an inflammatory uterine affection. Sf/mjftoms. In many cases, but not as a rule, the true par- oxysm is preceded by precursory symptoms. The head is heavy and dull, a violent headache is frequently present; the patients show signs of mental hebetude, the memory is impaired ; photopsia, even transitory blindness, buzzing in the ears, sensation of some approaching danger, unsteady gait, heavin ss of speech, dulness of mien, attended with strikingly glistening eyes, heat about the head, painfulness of the uterine region: these are the leading phenomena from the presence of which the outbreak of convulsions may be prognosticated with a tolerable degree of certainty, more par- ticularly if eclampsia had existed during former confinements, or if the urine contains albumen, cylindrical casts, etc. The precursory stage may last indefinitely from a few minutes to some days. The paroxysm itself is very much like epilepsy, generally, however, the peculiar cry and the falling down, as if the patient were struck by lightning, at the outbreak of the convulsions are wanting, suddenly the patients become quiet and close their eyes. Very soon peculiar muscular movements are seen in the face, the eyelids are rapidly opened and closed, the eyeballs are turned in every direction, the pupils are dilated and become immovable, the muscles of the mouth begin to twitch, the lips are drawn to one side, the tongue is pro- truded between the teeth. The clonic spasms now extend to the neck which is often stretched with an extraordinary rapidity or bent to one side; then to the arms which first tremble and then are jerked out; the lower extremities are not so much affected and remain rigidly extended, they are only slightly moved to and fro. At every increasing paroxysm the respiration becomes more im- Eclampsia Parturientium. 165 peeled, it consists of mere sobs, becomes irregular, is even suspended for a short period, the movements of the heart likewise become irregular. In consequence of this interference with the action of the heart and lungs the vessels of the head and neck become turgid. In the midst of these changes the whole body sometimes starts as if struck by some electric shock. After these violent clonic spasms have lasted for some minutes, there is au apparent interval of rest, during which a complete tetanic rigidity prevails with the most diversified contractions of the limbs. For a short time the respira- tion ceases entirely, the heart works very irregularly, its beats fre- quently intermit, the skin becomes covered with a cold perspira- tion, and the discharges from the rectum and bladder are frequently involuntary. This rigidity continues for about half a minute, after which all the phenomena gradually decrease in intensity. The con- vulsive movements become less frequent, the breathing and the action of the heart become more normal, and lastly a general relax- ation takes place with which the patients lapse into a soporous con- dition. According as the paroxysms are more or less frequent and violent, this stage has a longer or shorter duration, and may even continue for three days. The consciousness gradually returns, and derangements of the senses or mental faculties sometimes remain for some time after the attack. Headache generally lasts longest. Eclampsia either terminates in complete recovery, or in other dis- eases, or death. Death seldom takes place during the convulsions, or, if it does, it is caused by cerebral apoplexy; more frequently it occurs during the stage of sopor, likewise in consequence of cerebral apoplexy; or it is caused by acute cedema of the lungs consequent upon the violent interference with the action of the heart and lungs. The affections consequent upon eclampsia generally relate to the functions of the brain: they are mania, idiocy, loss of memory, amaurosis, deafness, or muscular contractions and paralysis. Very frequently puerperal inflammations have resulted after an attack of eclampsia. Complete recovery never takes place suddenly, but more or less gradually. The effect of the convulsions upon parturition differs according to the period when the accident takes place. If it takes place dur- ing pregnancy, uterine contractions are excited by the convulsions and miscarriage takes place. If they take place at the commence- ment of parturition, the act is considerably delayed in consequence, whereas if they take place towards the end of the act of parturition, the expulsion of the foetus is considerably hastened in consequence. 166 Diseases of the Nervous System. If taking place after parturition, the uterine contractions are gen- erally arre ted, which may lead to metrorrhagia, retention of frag- ments of the placenta and consequent inflammatory affections. Par- turition influences the convulsions, in so far as they never cease en- tirely until the uterus has been entirely freed from its contents, and may even continue with less intensity for hours after the birth of the child. The influence upon the foetus is not necessarily fatal; according to Scanzoni about one-half of the chidren who are born in the midst of convulsions die; the shorter the period between the occurrence of the convulsions and the termination of the act of par- turition, the less the danger to the child. The prognosis is very uncertain. The disease is one of the most dangerous, and becomes so much more dangerous as it may develop equally dangerous diseases. If the convulsions occur at a very early period, the danger to the patient is so much greater. The later they occur, and the greater the chances of a speedy delivery, the better the prospect of a successful issue. Of course the degree of intensity of the convulsions is likewise to be carefully considered in establishing a prognosis. Treatment. Hartmann introduces his remarks concerning the treatment of this disease with an inquiry whether it is rather a dis- ease of the blood or the nervous system. This point is not yet set- tled, and, in the present state of our Materia Medica, is of very little importance. We have slightly alluded to it in a previous paragraph. Of far more importance is his advice not to leave a patient who had been attacked with convulsions, until the action of the heart and lungs has resumed its normal character, and, by this means, to pre- vent any improper interference on the side of the family, and to obtain a satisfactory certainty that the process of parturition is developing normal phenomena. No remedy responds to this disorder as completely as Belladonna. The fact, says Hartmann, that it is repeatedly mentioned in the most diversified forms of disease, should suffice to satisfy beginning practitioners of Homoeopathy of the importance of this medicine; and to invite them to study its physiological effects with an in- creasing care and accuracy, until their leading characteristics have become well defined to the general comprehension, and may be relied on as safe guides in the selection of this drug. That the action of Belladonna is similar to a paroxysm of eclampsia and has, moreover, a special affinity to the condition of a parturient female, is not only shown by our Materia Medica, in spite of the incoherent arrange- * Eclampsia Parturientium. 167 ment of its symptoms, but may likewise be learned fiom any recog- nized toxicological treatise. Moreover it is an admitted fact that Belladonna acts more penetratingly upon the organisms of children and women, and is more particularly adapted to the latter class, if the circulation of the blood is prominently active. The curative effects of Belladonna in this disease have been practically illustrated in a number of cases, and we may rely upon this agent with perfect confidence in cases where our Old-School brethren have to resort to the most heroic and most pernicious treatment. Although both Hyoscyamus and Stramonium are intimately re- lated to Belladonna in this disease, yet we believe that both these remedies are effectually superseded by the last-named agent. The difference which Hartmann has indicated between these two medi- cines, does not seem to us founded in fact, and of difficult applica- tion in practice. Aconite exhibits likewise among its toxicological effects a complete series of the symptoms of eclampsia, more par- ticularly an alternate change from clonic spasms to tetanic rigidity, and may have to be resorted to, more especially if the convulsions set in subsequent to parturition, and will have to be regarded as symptomatic of an inflammatory puerperal disease. [An admirable medicine in puerperal convulsions is the Bromide of Potassium in large doses, which is now beginning to be uni- versally used by American as well as European homoeopathic prac- titioners. It will often prove efficacious where Aconite, Belladonna or any other medicine, seem to be powerless. Some interesting cases of cure of this frightful malady by Gelseminum sempervirens have been published by Dr. Douglas, of Milwaukee, in Lodge’s Observer. See also Hale’s New Remedies, second edition, pages 444 to 448. II.] Concerning Opium Hartmann offers the following remarks which deserve to be transcribed literally: “Opium seems to me, some- times, like a veiled Goddess; I perceive general outlines, but sharply marked features, pointing to some definite characteristic sphere of action, are entirely wanting. Hahnemann’s observation that Opium can only be used with success in recent and shortly- lasting disorders, has only contributed to darken, instead of clear- ing up, the clouds hanging over the curative sphere of Opium. We can hardly suppose that physicians have been wrapt for thou- sands of years in a maze of illusions concerning Opium, without ever dreaming that this agent has a very equivocal therapeutic action! And what brilliant cures have not been accomplished by means of Opium! No, indeed! Hahnemann’s assertions regarding Diseases of the Nervous System. 168 Opium are of the same paradoxical character as so many other views, opinions and notions of his, that had not yet become settled in his mind, and which he either favored or rejected according as they agreed or disagreed with his purposes; if he was unable to loosen the Gordian knot, he cut it with an authoritative assertion. Opium fared similarly in his hands; his provings of this agent did not develop any symptoms of pain, and hence he decreed: Opium docs not cure pain! lie took many Opium-symptoms from old authors who had observed them in Opium-eaters, and had found that the continued use of this drug develops, even in young people, symptoms that hear a close resemblance to the ailments incident to old age; hence his decree: Opium cures the ailments incident to old age! The long-continued use of Opium causes nervous irritability to such a degree that Opium-eaters start at the least urp/ise; hence he decreed: Opium removes the bad effects of flight! It is easily seen that morbid conditions of this kind are not obtained by means of regular p: ovings on persons in health, hut in consequence of the long-continued and energetic use of the drug, as is the case with a number of others; but then it is wrong to infer that the medicine can only be properly used for a very limited number of symptoms, ±e~ the reason that it is only capable’of occasioning a small number of ailments which are, moreover, of a very general character. In such cases the medi- cine, if it is experimented with for a sufficient length of time, will undoubtedly develop a number of fine symptoms that may prove highly valuable in the treatment of diseases. Of course we must not obstinately and foolishly reason in this wise: Because many drugs will cure diseases when administered in high attenu- ation, therefore all drugs will he capable of accomplishing the same result. By no means; one medicine will cure in small doses whereas other medicines may have to be given in larger quantities. Opium belongs to this latter category. It will scarcely ever prove efficient in the tenth, twentieth or much less in a hig ier potency, but will almost always have to be given in larger doses, without forfeiting, on this account, its position as a homoeopathic agent. Not till I cut myself loose from Hahnemann’s decree con- cerning: the normal dose, did I learn to make a correct use of many medicines, and even Opium has enabled me to do a great deal of good with it, which will ever remain inaccessible to those who swear by the words of the Master. In eclampsia, Opium is an admirable remedy in the case of robust parturient females when Eclampsia Parturientium. 169 the attack was, perhaps, excited by a sudden fright or even an unexpected joyful event during the process of parturition. Even if the effects of Opium were only palliative, the medicine would still be of inestimable value, for the reason that the disease only has a few paroxysms which the physician is called upon to hush in order to save two lives; a protracted treatment is anyhow un- necessary inasmuch as the exciting cause of the disease is only of short duration, and the circumstances which favor and feed the pathological process, very soon disappear. I am not able to furnish a list of the special symptoms the presence of which is necessary to justify the use of Opium in this disease; the reader will have to contrast the symptoms of the case with those of the Materia Mediea, and will perhaps feel grateful to me for giving him now and then an opportunity of depending upon his own judgment, instead of being held in leading-strings by another whose advice, after all, may be fallible like that of other mortals.” To these words of Hartmann we will add the following remarks: Under allopathic treatment Morphium aceticum is considered the only reliable remedy for eclampsia, but it is given in such enor- mous doses—Scanzoni gives one-sixtli to one-fourth of a grain every half hour, together with injections of twenty to thirty drops of the tincture of Opium—that it seems almost criminal to pursue such a course of treatment. The disease is, of itself, very apt to superinduce mental derangements, and the medicine may cause a chronic loss of memory. Unfortunately we have no statistical data to show that mental derangements are more readily, more frequently and more permanently caused by the allopathic use of Morphium than by the use of this agent in homoeopathic hands. Large doses of this drug should never be given by a homoeopath at the commencement of his treatment, they should only be re- sorted to as a last resort. Of Laurocerasus we have no clinical records as far as we know; if it should be used, it will be necessary to administer it in com- paratively large quantities. Of other medicines belonging to the present list, the most important have already been mentioned in the chapter on eclampsia. Digitalis may be found useful more particularly if hemorrhages are present; if not indicated at the commencement of the paroxysms, it may be an appropriate remedy for the subsequent derangements. Of great importance to the successful treatment of eclampsia is the correct management of the process of labor. Scanzoni gives 170 Diseases of the Nervous System. the following advice bearing upon this point: If the convulsions occur during pregnancy without causing labor-pains, artificial delivery is only justified in case the spasms steadily continue to increase in duration and intensity, and the life of both mother and child is threatened. If the parturient woman is already dy- ing, it is better to perform the Cesarean section immediately after her death than to resort to a forced delivery, because the latter jeopardizes the life of the child much more than the former. If, at the onset of the disease, the os tincse is sufficiently dilated an,d there are otherwise no counter-indications, the forceps may at once be resorted to; this should, however, be avoided if labor has so far advanced that a few more pains will accomplish the ex- pulsion of the foetus. If the paroxysms continue after parturition, the placenta should be removed as soon as possible. As regards the sanguineous depletions which are so universally recommended in this disease, we will express our opinion in a few words. Eot unfrequently eclampsia is the result of hemorrhages or causes them; how then are we to account for the fact that sanguineous depletions can be of any benefit in this disease? Or what pos- sible explanation of the use of depletions can at all be given in this disease? IIow can the usefulness of such depletions be main- tained when so many other heroic remedies are employed at the same time? The usefulness of a remedial agent cannot be prop- erly contended for until it has produced satisfactory clinical re- sults, without its action being obscured by a combination with other drugs. As regards the dietetic treatment of eclampsia, it seems to be unnecessary to go into details. Such patients require the same nursing as any other women whose confinement is perfectly free from untoward complications. All excesses of any kind should be carefully avoided. 3. Cliorea. By chorea we understand spasmodic movements of the voluntary muscles taking place contrary to the will of the affected individual. It has different names: Chorea St. Yiti, Choreomania, Epilepsia sanatoria, St. Yitus’s dance. Chorea is a disease of the latter years of childhood. It is very seldom seen previous to the sixth year of age, rarely after the fif- teenth, it occurs most frequently between the tenth and four- teenth year. Females and individuals with very irritable nervous Chorea. 171 systems are more particularly inclined to this disease, whereas the bodily constitution otherwise seems to be without any influence over the disease. The etiological causes are involved in obscurity ; one fact is well ascertained: the disease occurs most frequently dur- ing the second period of dentition and at the age of pubescence. Other exciting causes are: a desire to imitate (in some cases the habit of unusual motions has led to the disease) emotions, espe- cially fright, helminthiasis, onanism. It is frequently met with among individuals with tuberculous constitutions, or with strik- ingly developed chlorosis. The classification in chorea minor and major is altogether founded upon the degree of intensity of the morbid phenomena, and is so much more unimportant as the two degrees frequently pass from one into the other. For this reason we have taken no special notice of this classification in the present instance. Symptoms and Course. A preliminary stage, properly speak- ing, seldom occurs in chorea; what has been considered as such, generally has already the peculiar character, the involuntary mo- tions of chorea. At first the patients show a certain unsteadiness in their movements, and an unusual hurriedness; these symptoms are accompanied by a certain depression of spirits and irritability of temper, which may, however, result rather from the rebukes which the child receives on account of its apparent carelessness in handling things. It is only after some time that the child’s parents become aware of the existence of some nervous disorder. After the symptoms have become more fully developed with a more or less gradually increasing intensity, a real paroxysm suddenly breaks out. It is generally excited more immediately by some violent emotion, fright for instance. The involuntary motions now begin, being either confined to single bundles of muscles or affecting the whole muscular system, in such a manner that the upper extremi- ties are more violently affected than the lower. The face shows every possible contortion, even the eyeballs are rolled about in' every direction; the arms and hands are at times flexed, at other times extended ; objects can no longer be held firmly, the patient is no longer able to eat alone, or else has to bring the food to his mouth by a very circuitous route; the gait becomes unsteady be- cause the legs can no longer be put down with sufficient steadiness, and even the strength is wanting to keep them straight. Not all the limbs are always affected together; sometimes only those on one side are affected, sometimes only the arms or the face, very 172 Diseases of the Xervous System. rarely the lower extremities alone. A striking feature of the dis- ease is that the movements beeome so much more violent the more steadily the patient fixes his attention upon them. Eating seems likewise to exert an aggravating influence upon chorea. If the disease increases in intensity, the spasms which, in a milder degree, are continuous, often occur in paroxysms, and with various but distinct symptoms of impairment of the mental func- tions, sometimes even with total loss of consciousness. The move- ments now assume the form of strange leaps, dancing, turning or rolling the body while the patients utter the most varied sounds, sing, laugh and even roar like wild beasts. The intervals between the paroxysms are scarcely ever free from all spasmodic symptoms: on the contrary, the phenomena which we have designated as the milder degree of chorea, continue. If the disease lasts for a length of time, the assimilative functions suffer, and even febrile symptoms make their appearance. Sleep is impaired ; on account of the mus- cular spasms the patient is prevented from falling asleep; during sleep all abnormal movements become suspended. It is peculiar to the disease that even excessive muscular motions do not fatigue the patients. On the other hand they do not unfrequently complain of pains in the joints which generally increase in bed, and, in a measure, are most likely excited by the spasms, but may likewise be felt in parts not affected by the convulsions. A sensation of numbness and formication in the limbs is not caused by the attack itself. To- gether with the assimilative functions the mental faculties become depressed; the teasing character of the disorder renders the patients exceedingly irritable, dejected and peevish, or even disposed to fits of rage. This is so much more to be deplored as these ebullitions of temper are apt to provoke an attack. After a gradual increase of the symptoms, the disease reaches its acme, where it remains stationary for a period, lasting a few weeks or even several months, and sometimes terminating in recovery either quite suddenly or only gradually. The cases where the con- vulsive motions become habitual, are very rare, yet single derange- ments are very apt to remain, such as partial paralysis, decrease of the mental faculties, general weakness of the limbs. Death is a rare termination of the disease. A great tendency to relapses gen- erally remains, on which account the patients have to be carefully guarded. That injuries, even fractures, may occur during a violent convulsive paroxysm, is self-evident. According to what we have said, the prognosis is almost alwaj’s Chorea. 173 favorable; even if the convulsive movements outlast the genuine chorea-paroxysms, they likewise disappear after a while. Where the convulsions denote the existence of a cerebral disease, the prog- nosis depends, of course, upon its own nature and importance. Treatment. Inasmuch as most cases of chorea generally get well of themselves, although the process of recovery may proceed very gradually, it is always advisable not to interfere too busily with violent means. Reports of cures with medicinal agents should be received with a great deal of caution; a great deal of experience is required to determine whether a case of chorea has yielded to the medicines employed, or whether the disease has terminated spontaneously. Hence we shall only furnish very brief indications regarding the drugs that are adapted to this disease. Cuprum metallicum is one of the leading remedies in this disease. Unless the existing symptoms contraindicate its use very decidedly, this drug will generally deserve our tirst consideration. This agent has sufficed in our hands to cure most cases of chorea; under its use the disorder continued very rarely longer than three or four weeks. It is, however, more suitable to chorea minor than chorea major; in this latter form of the disease the violent symptoms which characterize the paroxysms, may require some other remedy before Cuprum is employed, until the spasms are mitigated and have assumed the milder form of chorea minor. Stramonium is more particularly indicated if the whole body is involved in the spasms and the patient is compelled to perform the most grotesque leaps, dancing motions, etc., and at the same time utters the above-described peculiar sounds. According to Hart- mann, Stramonium is indicated by the following symptoms: The attack is for some time preceded by formication and a feeling of weight in the extremities, attended with melancholy mood. The disorder inclines to break out about the equinoctial periods, and the convulsions have the characteristic feature of affecting the parts of the body crosswise, for instance the left upper and the right lower extremity, whereas the two other extremities remain unaf- fected; on the other hand, the muscles of the head and neck are very much agitated. Altogether Stramonium has a number of symptoms that point to chorea. According to Hartmann it has likewise a good effect in the mental derangements remaining after chorea. Here too we cannot forbear to range Belladonna and Hyos- cyamus side by side with Stramonium, only that the last-mentioned drug seems to be more adapted to chorea and the two former to 174 Diseases of the Nervous System. eclampsia. Belladonna is moreover said to deserve more especial consideration if the flexor muscles are particularly affected. Ignatia amara deserves mention in this affection, probably with more propriety than in any of the previously mentioned diseases. It is more particularly indicated by the following general consider- ations: The disorder is caused by fright or by some violent mental agitation; the attacks are worse after eating, and abate when the patient lies on the back; the patient is very irritable and peevish. Hartmann is of opinion that many cases of chorea major have been cured with Ignatia with a remarkable rapidity, that were mistaken for epilepsy by the attending physician. The diagnosis, however, is scarcely ever so intricate that the misapprehension could have lasted for a long time; it is more likely that such pretended cures of epilepsy were rather so many cases of eclampsia instead of chorea. At all events the therapeutic value of Ignatia is not impaired by the fact that it is equally curative in affections which resemble each other so closely. Zincum. We do not understand why Hartmann has not men- tioned this drug in his list of chorea-remedies. Zincum enjoys a well-earned reputation against chorea; the cures of this disease which have been effected by the use of Zincum, can all be traced to the homceopathicity of this agent to the chorea-spasms. Homoe- opathic physicians likewise have employed this agent with success. It is particularly indicated where the convulsions are attended with a deep feeling of illness and the mind is very much depressed. A merely superficial glance at the symptoms of Zincum will at once show that it deserves our attention in chorea, more especially in the minor form, and is pre-eminently suitable in the subsequent morbid changes of the mind. Beside the above-mentioned remedies the following have likewise been employed or recommended: Asafoetida, Secale cornutum, Gina, Crocus, Graphites, Rhus tox., Iodium, Pulsatilla, Sulphur, China, Coccidus. We cannot afford the space to furnish all the particular indications for the use of each of these agents, nor does this seem necessary, since a case will scarcely ever present itself where these remedies may have to be used. If after the termination of the more violent spasms, convulsive motions of single parts of muscles remain for some time, or if such remnants of the disease are for the first time entrusted to our pro- fessional care, the result of our treatment will always be more or less doubtful and uncertain. The remedies which have to be used in Chorea. 175 such cases, and always at rather protracted intervals, are: Cuprum, Causticum, Graphites, perhaps also Cocculus, and A/ms tox. A proper hygienic and dietetic regimen should not he lost sight of. In chorea the selection of the remedial agent is less dependent upon accompanying complications and determining circumstances than in eclampsia and epilepsy, for the simple reason that chorea is a much less important disease. On the other hand it is of great importance to consider existing complications in case of relapses or where relapses are tolerably certain to occur. Three conditions have to be more particularly dwelt upon. First, the age of pubescence and its but too frequent accompaniment: onanism. It is often dif- ficult to exert a controlling influence in this particular, for the reason that we do not always succeed in obtaining a frank confes- sion from the patients. Nevertheless, an absolute cessation of this horrid practice is indispensable to a cure; onanism causes that general irritability of the nerves, and the deficiency of mental energy by which the original disease as well as relapses are excited. Anaemia is another important complication; it occurs but too fre- quently, even before the age of pubescence, and is undoubtedly pre- maturely excited by self-abuse, but may likewise owe its existence to other circumstances that will be mentioned in subsequent para- graphs. The third and worst, although not the most frequent com- plication, is tuberculosis. In a case of chorea we should investigate the existence of tubercles for this additional reason that convulsions very often constitute the first striking symptom of tubercles which it may be possible to cure at such an early age. When giving special indications, we shall mention the remedies that are suitable to such conditions. To the aforesaid three determining causes we may add a fourth, namely a morbid irritability of the nervous system gener- ally. We admit that this may be hereditary; but in most cases it is the result of a faulty education. Premature mental efforts, ex- citement of the imagination while condemned to a sedentary mode of life, are the great defects of our modern systems of education and the direct causes of the excessive nervousness which has be- come fashionable among the young ladies of the higher classes and is one of the principal causes of the many weaknesses with which our y oung women are more than ever afflicted, anaemia, tubercu- losis, convulsions, etc. A long chapter might be written on this theme. To what extent a morbid nervousness—not to mention the desire of imitation inherent in all children—predisposes to convul- sions, is shown by daily experience without having to quote Beer- 176 Dis eases of the Nervous System. haave as authority for this statement. In one of our young ladies’ seminaries for the higher classes, spasmodic attacks, especially dur- ing the hours devoted to prayer-meetings, constitute a rule; scarcely ever a case occurs singly, generally several at once. From what we have said, the measures that will have to he taken in order not only to cure or prevent chorea, but many other ail- ments attendant upon this disorder, may easily be inferred. Relapses may likewise be prevented by such measures. Premature mental development, or too great a variety of mental labor, or too persistent a strain on the mental faculties, should be prevented not only in the case of older children hut likewise of those who have entered upon the period of their second teething. An excessive activity of the fancy should be prevented by every possible means. A proper development of the muscular powers and exercise in the open a:r should be well attended to. Gymnastic exercises are the best means for this purpose: they not only strengthen the body, but likewise invigorate the mind. Such exercises are not only a preventive means, and excellently adapted to the cure of subsequent ailments, but they likewise render efficient service against the convulsive movements themselves. In France especially they have been vari- ously employed with a great deal of success in the treatment of chorea, sometimes in connection with music, either on account of the influence of the rhythmical measure, or because music has a strikingly beneficial influence over a number of such patients. Gymnastic exercises are particularly advisable in cases where auto- matic movements of single muscles threaten to remain and to become chronic. [In recent cases of chorea, Aconite and Gelseminum are the best remedies that can often he used. A case of chorea of the left arm that had remained after pneumonia of the left lung, the patient, a girl of ten years, having been treated allopathically, yielded at once to a few doses of Aconite. A case of chorea of the upper ex- tremities in a very scrofulous child, and having come on spontane- ously, was speedily cured by means of a few doses of the tincture of Aconite in water. A case of the lower extremities brought on by fright, yielded with equal promptitude to the tincture of Aconite. A terrible case of chorea was cured with Phosphoric acid. The patient was a girl of ten years. For some time she had allowed things to fall out of her hands, cups, plates, etc., which the parents attributed to carelessness, and for which she was duly scolded. Catalepsy. 177 Gradually the spasms began to set in with increasing violence. Every part of the body, from the head to the feet, became affected. The convulsions wmre frightful to behold. The patient had to be strapped to her bed. She was scarcely able to swallow a drop of liquid. The spasms lasted uninterruptedly day and night. She was utterly unable to articulate a single word. The patient was brought to town from the country, when I had a fair chance to examine her. I had been trying various remedies without success. As soon as the patient had arrived in town, I examined her urine and found it loaded with albumen. She now was placed upon the officinal Phosphoric acid, beginning with five-drop doses three times a day, and gradually increasing the dose; after taking the acid for six weeks she was completely restored to health. An improvement in her condition became perceptible already on the second day of this treatment. H.] 4. Catalepsy. We mention this disease which has remained enveloped in a mysterious obscurity up to this moment, in order not to be accused guilty of a sin of omission. By catalepsy we understand a condi- tion during which the consciousness and the voluntary mobility of the muscles become suspended, though they retain the faculty of passive motion. There are but few well established cases of this affection on record; a most striking case is the one in Skoda’s Clinic in the winter of 1851 to 1852, which we had an opportunity of witnessing. It continued for months and was the most interest- ing phenomenon in the large hospital. A detailed description of this case may be found in the “ Zeitschrift der Gesellschaft der Aerzte in Wien,” vol. VIII., 1852. A second undeniable case oc- curred in our own practice; the patient was a lady who had been magnetized. Skoda’s case likewise is said to have originated in magnetism. As an accompaniment of other affections, when it is generally of short duration, we meet the cataleptic condition in epilepsy, eclampsia, hysteria and other diseases of the general nervous system. It will scarcely ever be necessary to institute a medicinal treat- ment against this disease; such a treatment must always be uncer- tain, because it is impossible to determine how soon the cataleptic condition might have terminated spontaneously. Skoda’s report of his case embodies everything that was done for the patient, but 178 Diseases of the Nervous System. fruitlessly. Cataleptic patients may be safely left without treat- ment, for the reason that no case of catalepsy, to our knowledge at least, has as yet terminated fatally. The greatest difficulty in chronic cases is the impossibility to induce patients to swallow; in- jections and the stomach-pump have to be resorted to. 5. Tetanus and Trismus. By the term tetanus we designate tonic spasms of the voluntary muscles of more or less extent, without the consciousness being suspended; by the latter term we designate a tonic spasm of the muscles of deglutition. Tetanus is more particularly a disease of hot climates, hut is like- wise frequently met with in our own climate, more particularly as trismus and tetanus neonatorum. Its main causes are wounds, especially such as are complicated with contusions, and are located on the extremities or in the face. It is not quite certain whether it is indispensable to the supervention of tetanus, that a nerve should be ligated, torn or involved in a cicatrix. Tetanus may undeniably be caused by sudden and violent exposure to a keen wind and other catarrhal influences. This form of tetanus has been termed rheu- matic, in contradistinction to the traumatic form. Tetanic convul- sions do not often, like eclampsia, occur at the onset of violent diseases, such as typhus and contagious exanthemata. Robust individuals, and men generally, are more readily attacked by the disease. Symptoms and Course of the disease. The convulsions are generally preceded by some slight premonitory symptoms, generally of a rheumatic character, on which account they are confounded with rheumatism so much more easily as the patients generally complain of having taken a violent cold. Side by side with slight febrile symptoms the patients complain of stiffness of the nape of the neck, difficulty of deglutition, drawing and tearing pains in the extremities. If there is a wound, it generally assumes a bad look. Either gradually and with paroxysms of rigidity of single muscles, or else suddenly the tetanic convulsion sets in with a violent shock, at times invading the whole body, at other times single localities, particularly the dorsal muscles, the muscles of the jaws, and the extensor muscles of the extremities. In the more violent and more extensive cases not all the muscles are seized at once, generally the spasm progresses from above down- wards. The picture of a case of this kind is furnished us with Tetanus and Trismus. 179 every epileptic paroxysm; in tetanus, however, the face, in conse- quence of the extraordinary stretching of the muscles, assumes a still more frightful aspect. Owing to the contraction of the dorsal muscles the back is at times bent backwards, (opisthotonos,) or laterally, (pleurothotonos,) or forwards, (emprosthotonos,) or is stretched erect, (orthotonos,) according as one or the other mus- cular locality, or all the muscles together, are invaded by the tetanic spasm; as a general rule, opisthotonos is the most frequent form. Most usually the posterior cervical muscles first become rigid, after which the trunk and lastly the extremities are seized. In propor- tion as the phenomena increase in intensity, the respiratory and ab- dominal muscles, and the muscles of deglutition likewise become involved in the attack ; convulsions of the last-named organs render the attack particularly dangerous. In cases which run a rapid course, death takes place by asphyxia, and in cases running a less rapid course, death takes place in consequence of starvation and deficient oxygenation. For the more violent the paroxysms be- come, the more easily the least motion excites them, so that it be- comes utterly impossible for the patient to swallow; even all arti- ficial introduction of food has to he abandoned. From the very beginning of the paroxysm the muscles are perfectly rigid and remain so; nevertheless exacerbations and more or less distinct remissions take place, the latter becoming shorter and more and more incomplete in proportion as the convulsions increase in inten- sity. The contracted muscles are exceedingly painful, and every new attack often increases this painfulness to an extraordinary de- gree. Otherwise, so far as the body generally is concerned, no mor- bid phenomena of any consequence can he perceived. The skin is cool, the pulse is not more rapid, but harder, the patients experience hunger and thirst, alvine evacuations take place, the conscious- ness remains unimpaired; only sleep is disturbed, the exhausted patients only slumbering now and then for a few moments at a time. As the convulsions increase the pulse becomes more rapid, smaller, intermittent, the symptoms of sopor become more and more prominent, probably in consequence of the stupefying action of the carbonic acid gas which, owing to the impeded respiration, is no longer neutralized by the atmospheric oxygen; the tongue becomes dry. Tetanus most generally terminates in death. It either takes place at the very beginning in consequence of sudden suffocation (spasm of the glottis,) or in consequence of acute oedema of the lungs, or sometimes in consequence of cerebral apoplexy. Or if the 180 Diseases of the Nervous System. disease lasts any time, the patient dies of asphyxia by carbonic acid gas, starvation and thirst. Recovery is always gradual, sometimes taking place with copious sweats; the paroxysms tirst become shorter, less violent and frequent, and the muscles gradually lose their rigidity. Weeks, however, may pass away leiore this mus- cular rigidity disappears entirely, and an equally long period of time sometimes elapses before the patient recovers his strength. If the disease terminates fatally, it may last from one day to three weeks, but in most cases death takes place on the third day. In traumatic tetanus the prognosis is generally unfavorable. Tetanus neonatorum is essentially the same disease as traumatic tetanus, from which the former is distinguished only by the pecu- liar features of infantile age. The cutting and tying of the umbil- ical cord here takes the place of the wound. That this is really so, cannot be doubted; the accident generally takes place in the first week of the child’s existence, and the umbilicus is almost always found in a state of suppuration and discoloration. In the form of trismus the disease is likewise, though seldom, met with among older children. In the case of children the symptoms vary somewhat from those of adults. In the case ot infants likewise the disease seldom begins all at once; in the first place the infants lose their ability to nurse, although the hurried manner in which they seize the nipple, be- trays hunger; they have a sick and sunken appearance. Derange- ments of the digestive functions are not always, hut generally pres- ent. In a day or so the paroxysm sets in with rigidity of the mus- cles of deglutition, in consequence of which the lower jaw becomes immovable although not firmly pressed against the upper, from •which it remains separated by a narrow interval. The tetanic rigidity now gradually spreads from above downwards, the same as in traumatic tetanus; however, it is frequently mingled with paroxysms of convulsive starts resembling violent electric shocks. At first the attacks are short, with intervals which frequently last for days; but the former keep constantly increasing in duration whereas the latter are as constantly growing shorter. Death takes place more or less rapidly by starvation and impeded respiration. The prognosis is much more unfavorable than in the tetanus of adults. Treatment. To judge from the paucity of the cases of tetanus which are recorded in our literature, homoeopathic practitioners have had but few cases of this disease to treat. We have reports Tetanus and Trismus. 181 of eases where tetanic symptoms were present, but of genuine tetanus we have only one case recorded by Bethmann in the tenth volume of the uAllg. Horn. Zeitung.” If a case should occur in our practice, we should rely upon the curative effects of Nux vomica and of such other medicines as contain Strychnine. The similarity of the poisonous effects of Strychnine to tetanus not only extends to muscular rigidity and to the extraordinary increase of reflex action, but even to the most trifling circumstances. The spasms of Nux vomica have distinct intermissions which grow shorter and more indistinct in proportion as the paroxysms occur more frequently and with more violence. The respiration is very much interfered with; the sensibility and the mental functions remain intact. The effects of Nux generally correspond equally fully to single organs and systems. According to these statements Nux vomica must be an ex- cellent remedy in tetanus, if there is any truth in the homoeopathic law. We do not deny that there are other remedies homoeopathic to tetanus, but many of those which are mentioned in manuals and repertories, are undoubtedly very doubtful. The characteristic phe- nomena of the disease have to be found in the pathogenesis of the drug, otherwise its choice would not be justifiable; in tetanus these characteristic phenomena are the rigidity of the muscles, the in- crease of reflex action and the preservation of the consciousness. Now with what right can Opium be recommended as a remedy for tetanus, since the Opium-convulsions, although they may resemble tetanus to some extent, are always attended with loss of conscious- ness ? The same question might be asked in regard to other reme- dies which have been recommended for tetanus probably for the mere reason that a few tonic spasms are found among their physio- logical effects. Although we are willing to admit that, at the pres- ent time, we are not yet able to get along without drawing con- clusions from analogy, yet they should not be too bold. Arnica has been mentioned among the remedies for traumatic tetanus, probably for no better reason than because it is traumatic; for, with the ex- ception of the increased sensibility, Arnica has no symptoms.corres- ponding to tetanus. Besides, the wound itself is not the real cause of tetanus, but it is an unknown something which sometimes does not sup2rvene until the wound has lasted for weeks. Rhus is said to deserve attention in tetanus caused by a violent cold; isolated phenomena speak indeed in favor of this drug, but they are not characteristic. Among other remedies we have to select those that have a decided influence over the spinal marrow, such as: Cicuta 182 Diseases of the Nervous System. virosa, Verati um, Lachesis, Secale cornutum, {Aconite, tincture of the root, and Bryonia should not be forgotten. II.] Tetanus neonatorum is, as we have already mentioned, quite similar, symptomatically, to the tetanus of adults; it is probably a form of traumatic tetanus and therefore requires the same treat- ment. Moschus is particularly recommended for tetanus neona- torum, more especially if the dyspnoea is very great. Aconite is a drug which hitherto had not been known to cause tetanic phenomena. In the December number, 1880, of the British Journal of Homoeopathy we find a case of poisoning by Aconite. After eating a few Aconite-roots, a girl was attacked with tetanus and trismus which gradually decreased in intensity, after which she recovered. Trismus alone occurs much more frequently than tetanus; it is most frequently met with among small children, seldom among adults. Together with the remedies that have already been men- tioned, we direct the reader’s attention to Camphora and Bella- donna. With the last-mentioned drug we have effected a rapid cure in the case of a girl, fourteen days old. We need hardly suggest that, in order to effect a genuine cure, it is necessary to avoid all the circumstances that might possibly excite an attack. Deglutition may have become so much impeded that it may be impossible to introduce medicines by the mouth; in such cases we have to resort to the hypodermic method. From the British Journal of Homoeopathy we transcribe the following extract from the New Sydenham Society’s Year-book of Medicine: u Haughton cured three out of five cases of tetanus with Nicotine, one-lialf to two drops, three to six times a day. It lowers the pulse, and causes an immediate relaxation of the spasms of the muscles of expression, deglutition, respiration, back and ab- domen, cessation of delirium, and relief from agonizing pain, profuse perspiration with smell of snuff, tendency to sleep. Ghesini cured a case of traumatic tetanus by subcutaneous in- jection of Curare. As much as forty-seven grains of Curare were injected in sixty single and thirty-two double and treble injections. The treatment was commenced on the fifth day, and the patient was convalescent on the seventeenth. Cannabis indica in large quantities has cured tetanus in the hands of Dr. O’Shaughnessy of Calcutta; he gave it in doses large enough to produce narcotism. [This treatment seems purely palliative or antipathic. IL] Paralysis. 183 6. Paralysis. Under this name we comprehend so many different conditions that it is necessary to justify this classification. Paralysis is almost always a consequence of a variety of other affections; nevertheless it is not always possible to recognize the primary affection, so that a paralysis is frequently supposed to he an idiopathic affection when it is in reality something else. We should have been obliged to resort to endless repetitions if we had chosen to treat of paralysis when speaking of the functional derangements which may occasion the attack, and again to describe the disease with reference to its locality. For this reason we have deemed it preferable to devote a special chapter to this class of accidents. By paralysis generally we understand a suspension of nervous action. It may differ in character according to the number of nervous trunks involved, or according to their characteristic func- tions and anatomical arrangement. Hence different names have been applied to different kinds of paralysis. By paralysis we under- stand the complete cessation of both motor and sentient nervous action; if either the sentient or motor nerves are paralyzed, we term this condition incomplete paralysis, or paresis; if only one side of the body is paralyzed, we designate this condition as hemi- plegia; whereas by paraplegia we understand a transverse paralysis, of both upper and lower extremities. Besides this, the paralysis may be universal or partial, the last of which is again differently named according as one or the other part is affected, such as blepharoplegia, glossoplegia, &c. The etiological causes of paralysis are various. The most im- portant are: Suspension of the cerebral activity in consequence of apoplexy, inflammation, softening and other morbid processes of the brain impairing its functions; suspension of the action of the spinal cord by the same causes. There are, however, many other influences to wdiich paralysis may be traced as their direct result. The main causes of this class are: excessive exertions of the parts to which the paralyzed nerve is distributed, in which category we have to number paralysis occasioned by convulsions; continued and excessive pains; interruption of the nervous current from the brain to the periphery by swellings, neuromata, ligatures; a stroke of lightning; rheumatism, hysteria, gout, pregnancy; violent acute diseases, among which contagious and miasmatic diseases occupy the first rank; such as scarlatina, measles, variola, typhus, dys- 184 Diseases of the Nervous System. entery; and finally poisoning by vegetable, animal and more partic- ularly inorganic substances. The symptoms of paralysis may readily be inferred from the functional nature of the organ to which the paralyzed nerves are distributed; we can only meet with difficulties in cases where the paralyzed organ is not directly accessible to our vision. The prognosis depends upon the nature of the exciting causes and upon the possibility of removing them. Where apoplectic effusions or other pathological processes of the brain or spinal cord constitute the primary disease, recovery is much more uncertain than where paralysis depends upon some cause at the periphery or is a remnant of some acute disorder. That the prognosis is rendered much more doubtful by an advanced age, an enfeebled constitution, and an extension of the paralytic phenomena over a large surface, is a matter of course. Treatment. Paralytic attacks being almost without an excep- tion secondary affections, it is evident that, in treating them, it is of the utmost importance to investigate the primary affection with the utmost care. There are indeed many cases where every diag- nostic inquiry into the causes of an attack leaves us in the dark; these cases are, however, rare, and, whenever they occur, the paral- ysis generally depends upon a single nervous trunk. Such cases are the most difficult to treat, for the reason that it is exceedingly difficult to select the proper remedy in accordance with symptom- atic indications. Inasmuch as diseases of the brain and spinal marrow are the main causes of paralysis, we refer here more espe- cially to the chapter treating of these diseases where the most important remedies have already been mentioned, and we avoid by this means all unnecessary repetitions. In other respects our best course undoubtedly is to mention the remedies appertaining to this category, in a concise series, for which purpose we shall, although not literally, transcribe Hartmann’s own arrangement. Cuprum is one of the most efficient medicines in paralysis. When spe&king of apoplexy and the other diseases of the brain, we have treated extensively of Cuprum, and shall here add only a few short remarks. It is not only to the convulsive paroxysms themselves, but likewise to the remaining paralysis that Cuprum is essentially adapted; it likewise deserves attention in paralysis remaining after cholera, typhus, dysentery, etc. Plumbum has to be ranged next to Cuprum as being most nearly related to it. The last-named remedy is more prominently adapted Paralysis. 185 to paralysis of the motor nerves, sensation is not extinguished, the assimilative process is frequently disturbed, though never in a very high degree, and the paralyzed parts frequently show signs of convulsive twitehings. In the case of Plumbum, on the contrary, both motion and sensation are suspended, the paralyzed parts emaciate very rapidly, and their temperature decreases con- siderably. With Cuprum the consciousness and the cerebral func- tions are less disturbed; with Plumbum, on the contrary, always and even violently. Both agents are specially related to the functions of the tongue and, in paralysis of this organ, they undoubtedly occupy the first rank. Rhus toxicodendron. Concerning this medicine, Hartmann offers the following remarks: In former times, when the homoeopathic Materia Medica was not as well stocked with medicines as it is at the present period, I have made several cures of paralysis of the lower extremities with Rhus tox., even when the paralysis remained after typhus. If I place this remedy in the front rank, it is not because I have a particular preference for it, but because I am anxious to recall this powerful anti-paralytic to the attention of physicians, lest it should be overlooked in the presence of more recently introduced remedial agents whose importance I do not, however, mean to undervalue. Among the primary effects of Rhus, we note a disposition to extinguish organic activity even to the degree of paralysis; a sensation of numbness and a decrease of sen- sibility in the affected parts constitute chief symptoms of Rhus. Although crampy and contracting sensations, as from shortening of tendons, do not particularly come within the category of paral- ytic symptoms, yet it cannot be denied that they are to some extent dependent upon a diminished activity of single nervous trunks. This is likewise the case with the bruising and dislocation pains caused by Rhus, and which have often been removed by this agent. It is not always paralytic ailments that we have to combat at the very onset, but it is distressing and gradually increasing drawing pains in the extremities while in a state of rest and the removal of which' requires the affected limb to be moved the more vigorously, the longer it had persevered in a state of rest. These pains have the peculiarity of leaving after their disappearance a sort of lameness in the affected part, which, in proportion as the pain lasts longer, becomes more and more intense and permanent, and distinctly points to incipient paralysis. Is not the feeling of weariness and numbness 186 Diseases of the Nervous System. which. Rhus causes, a lower degree of momentary paralysis? A leading symptom of Rhus is: lameness in the extremities with stiff- ness of the joints, worse when rising from a seat; or complete paralysis, hemiplegia as well as paraplegia, with dragging, slow, difficult gait. According to these statements, Rhus is not adapted to paralysis of the central organs, hut rather to paralysis at the periphery, and to such as remains after typhus. It is, moreover, par- ticularly useful in rheumatic paralysis, to which the whole series of the pathogenetic symptoms of Rhus corresponds with great accuracy. Arnica has been extensively mentioned as a remedy for cerebral diseases. It is not onl}7 suitable in paralysis depending upon cere- bral exudations, but likewise in any other form of paralysis depend- ing upon exudations of any kind. Causticum is an important remedy which penetrates the organism very deeply, and has been found particularly efficacious in chronic maladies. The reputation of this drug has been somewhat im- paired by the circumstance that its primary effects manifest them- selves more slowly than those of other long-acting remedies. In paralytic conditions Causticum is at all events one of the most im- portant remedies; its usefulness has been tested on too many occa- sions to be disputed at this late day. Hartmann has seen the best effects from it in partial paralysis caused by a keen draught of air, and in hemiplegia after suppressed eruptions, attended with striking coldness, especially of the head and feet. After apoplexy he recom- mends it, when the proper paralytic symptoms are accompanied by frequent congestions of the head, with anxiety, vertigo and a cloudy feeling in the brain. In paralysis of one side of the face, paral- ysis of the facial nerve, it has been found curative by Hartmann as well as by other physicians. In paralysis of the tongue it is un- doubtedly a prominent remedy, although we do not by any means mean to say that every case of this kind can be cured with it. It is well known that this form of paralysis is particularly inaccessible to remedial influences. As a general rule Causticum is more effi- cient in the paralysis of single nervous trunks than in general paralysis, more efficient in paresis than in complete paralysis, for where Causticum is indicated, the sensibility is generally unim- paired. According to Hartmann Cocculus is most efficient in paralysis of the lower extremities. It starts from the small of the back, and is supposed by the patient to be owing to a cold. As a general rule Paralysis. 187 it is recent cases that are particularly suitable to Cocculus, especially when the paralysis is accompanied by violent pain in the paralyzed parts, or when symptoms of spasm show themselves in these parts. Paralysis of the tongue, face and pharynx is likewise adapted to the curative action of Cocculus. Sulphur. If we do not reproduce Hartmann’s statements regarding the action of Sulphur in this disease, it is because his views and our own do not agree. This is not the proper place to discuss the question of latent psora; enough has been said on this point, and very uselessly. We are not one of the believers in the psora-theory, which we simply regard as a convenient means of getting over diffi- culties that we do not know how to solve, and over which we glide with vague generalities. It might be very difficult to show what practical benefit has been derived from this theory. Whether a par- tisan or an opponent of this theory, Sulphur will prove eminently useful in the hands of either, and not simply because it facilitates the action of remedial agents employed after Sulphur. This agent corresponds more particularly to paralysis based upon material changes. In this respect it acts similarly to Arnica, with this dif- ference, that Arnica is more particularly indicated in recent, and Sulphur in more chronic cases. In paralysis remaining after acute diseases, Sulphur will likewise prove curative, probably for the reason that it exerts a favorable influence over exudations, as in typhus, that had not yet been absorbed. Baryta carbonica is undoubtedly one of the most distinguished remedies for paralysis after apoplexy, and for paralysis of old people, where a want of steadiness, a feeling of debility in the whole body, giving way of the knees and pain in the lumbar portion of the spine had been complained of for some time previous. This agent is well known as a remedy for the ailments incident to old age, and this reputation of our drug has likewise been verified in the paralytic conditions of old people ; on this account, however, it is not excluded as a remedy for paralysis of young people ; we refer more particu- larly to paralysis of the tongue, which is seldom cured without the use of this agent. (Hartmann.) Secale cornutum is a remedy of some importance in paralysis; its sphere of action is, moreover, more distinctly defined than that of many other drugs. All sorts of spasms come within the category of morbid conditions to which this agent may be adapted. It is well known that long-continued or frequently-returning spasms of the same parts often lead to paralytic conditions and even actual 188 Diseases of the Nervous System. paralysis of single limbs, where art has to interfere even though the spasms should have entirely ceased. It is to these forms of paraly- sis that Secale corresponds ; if the lower extremities are the seat of the disorder, involuntary discharges of the fseces and urine are fre- quently present, and the paralyzed parts emaciate very rapidly. (Hartmann.) Aluminium metallicum is still of too recent use to admit of definite indications of its use in the treatment of diseases. Bcenninghausen’s recommendation, which he backs up with clinical results, may suf- fice to claim our attention to this new agent. A drug; which is useful in tabes dorsualis, in genuine progressive spinal paralysis, must certainly possess a prominent effect upon the nervous system; our stock of remedies for paralysis being anyhow limited, Alumi- nium is so much the more to be thought of as a remedial agent in this class of disorders. Dulcamara seems to have been a favorite remedy with Hartmann, lie says in reference to Dulcamara: It is certain that this remedy is used much too little by modern homoeopaths, and that it is even ignored by many of them as an useless medicine. Nevertheless it has the same medicinal virtues now that it manifested in such a striking degree at a former period, and its curative virtues become so much more manifest, the more familiar we become with the use of this agent. How many paralytic attacks are caused by exposure to intense cold or to wet, or even to the suppression of scrofulous eruptions, where a latent psora is evidently the fruitful soil in which the susceptibility to paralytic attacks is rooted. It is this class of paralytic attacks where Dulcamara constitutes a real specific, and where it will almost always be found curative in alternation with Sulphur. For this reason it is adapted to almost every form of par- alysis, as its symptoms show. Moreover we find Dulcamara useful for paralysis of the arm, with icy coldness, as if the patient had been struck with apoplexy; paralysis of the upper and lower ex tremities; paralysis of the tongue and bladder, where Dulcamara is of prominent importance. Arsenicum, Mercurius and even lodium, after a long-continued use, cause paralytic symptoms, as we know to our perfect satisfaction from a number of cases of poisoning; however, we are not able to specify the particular indications by which we might be guided in the use of these remedies, and we have to content ourselves with the general knowledge that these three medicines exert a powerful influ- Paralysis. 189 ence over the nervous system, and hence may prove powerful auxili- aries in the treatment of paralysis. Other medicines that may be classed in the category of anti-para- lytic agents are: Oleander, Stannum, Colchicum (for rheumatic par- alysis), Lachesis, Cantharides (for paralysis of the bladder), Anacar- diumn, Zincum, Veratrum album, Staphysagria, Silicea, Phosphorus, Natrum muriaticum, Stramonium, etc. For the sake of having a cursory view of the different remedies adapted to the different forms of paralysis, we here subjoin their list: Paralysis of the tongue: Baryta, Cuprum, Plum,bum, Stramo- nium, Dulcamara, Acidum muriaticum, Cocculus, Belladonna, Caus- ticum. For paralysis of the facial nerve: Causticum, Cocculus. For paralysis of the pharynx: Cantharides, Stramonium, Belladonna. For paralysis of the bladder: Belladonna, Dulcamara, Cantharides, Lycopodium, Natrum muriaticum For paralysis of the rectum: Lycopodium, JRuta graveolens. Paralytic caused by poisoning require the employment of suitable antidotes, and subsequently remaining ailments have to be treated with smaller doses. The most frequent kinds of paralysis from this source are: Paralysis caused by Mercury: Stramonium (Hartmann), Acidum, nitricum, Staphysagria, Sulphur. Paralysis caused by Arsenic: China, Ferrum, Graphites. Paralysis by lead : Opium, Cuprum. [It is beyond our comprehension why homoeopathic practitioners who are acquainted with the pathogenesis of Aconite, and with pathology, do not assign to this agent a prominent rank among the remedies for paralysis. We have cured with it time and again the most violent attacks of paralysis of internal organs as well as of the extremities. The causes are various: Violent emotions, a sudden fright, exposure to keen winds, humidity, draughts of air, etc. The symptoms which indicate Aconite, are: a full and slow pulse, or sometimes an accelerated and small, thready pulse; numbness, a pricking sensation; sense of coldness in the part, or the opposite sensation of increase of temperature, with heaviness and aching pains in the part; sensation as if the part were swollen. The symp- toms of course vary according as one or the other organ is affected. We have: paralytic ischuria caused by exposure to a current of air, wet or by suppression of the perspiration; paralysis of the rec- tum and anus; paralysis of the tongue, with a pricking sensation and a sensation as if the tongue were swollen, increase of tempoia- ture in the tongue; paralysis of the optic nerve with intense pain 190 Diseases of the Nervous System. as if caused by pressure; paralysis of the face, of the oesophagus, etc. Very many attacks of this kind, if caused suddenly by ex- posure to rheumatic influences, yield to the use of Aconite in a very short period of time. In some cases we use the tincture, a few drops in half a tumbler of water, in other cases we have got along with attenuations. We recommend these observations to the care- ful consideration of practitioners. II.J As regards dietetic and other measures in the management of paralytic patients, we find it impossible, in view of the great differ- ences prevailing among the different forms of paralysis and their various degrees of intensity, to furnish specific directions; we will content ourselves with indicating one auxiliary agent which has an important bearing upon the treatment of paralysis, namely the movement-cure. Cautious, moderate, as far as possible active, or even passive movements of the paralyzed parts have effected an im- provement even in inveterate and desperate cases. It seems as though the paralyzed nerve remained in a state of inaction simply because it is deprived of an unusual stimulus to action, which the movement-cure is to supply Hence this cure is much more useful in chronic paralytic conditions than in those of recent origin. In spite of the sanguine expectations of its friends, electricity has accomplished much less in the treatment of paralysis than the movement-cure. This lack of success may in a measure result from an imperfect use of this agent, but an imperfect use cannot be the onty cause of a want of success. The disappointment in the use of the electric current is in a great measure owing to the impatience of the practitioner as well as of the patient. Great effects are ex- pected already after a few days’ treatment, whereas it often requires weeks before a favorable change can be expected. An interesting case of this kind may be read in “ Hirschel’s Zeitschrift,” 1861, Nov. 15th, where magnetism was likewise used with effect. The electric current should never be used with too much force which is always more hurtful than useful. The current should only be felt as a slightly unpleasant sensation, but should never be received as a shock. 7. Hysteria. It is not only difficult but almost impossible to furnish a satis- factory and sufficiently comprehensive definition of hysteria. The most diversified phenomena are ranged under this name, and a rigor- ous definition of the term hysteria is subject to so many different Hysteria. 191 individual views and opinions that it seems impossible to generalize them, except in the most comprehensive series. Considering the term hysteria from this general point of view we understand by it a modification of the nervous functions which is almost exclusively peculiar to the female sex, the motor as well as the sentient nerves, the psychical as well as the vegetative activity of the female organ- ism are involved in this modification, sometimes with, at other times without any material changes. Hysteria is a disease of the full-grown woman. Hence it mani- fests itself between the periods of pubescence and. a change of life; it may outlast the latter period, hut is scarcely ever distinctly mani- fested previous to the former. Men, too, are said to be liable to attacks of hysteria. This, however, is questionable for the reason that the term hysteria is not defined with absolute precision. Hys- teric symptoms in the case of a man do not justify the term hys- teria, the true definition of which has been more obscured by the fact that men also have been supposed amenable to the Protean forms of this disease. The etiology of hysteria is not as yet clear. Many material changes which are regarded as causes of hysteria, may just as well he consequences as causes of hysteria; it would be strange if so many different etiological influences should he capable of producing the same disorder. What is an undeniable fact, is that the trouble is roofed in the sexual sphere of woman, for this circumstance is proven by the fact that it breaks out exclusively among full-grown females; hut what changes are necessary to the production of hys- teria, can only be pointed out with partial positiveness. The most frequent causes seem to be ulcerations of the os tincse, and displace- ments of the uterus, likewise pathological changes of the ovaries. There is much less confusion in determining the mental than the material causes of hysteria, or in tracing this disorder to a ming- ling of both. Onanism, abstemiousness, or an excessive irritation by sexual intercourse, may cause hysteria. Among t,h§ mental causes we number all those that impress a wrong direction upon the psychical life of woman, and more particularly feed her fancy to excess, as is unfortunately the case by our modern systems of edu- cation, which favor all sorts of fantastical and morbid tastes and extravagances. We should be carried too far if we would investi-