n Nte, K^Kittr** # 4 i r- < in '■: % iR <~. ¥ I u JMaesimund Ibanninq yanos Library /^*L^ 19 or 74 / *0*CEO^ ^, M NATIONAL LEBRARX OF MEDICINE Bethesda, Maryland Gift of The National Center for Homeopathy rdmm wmdimmm^ iKJr£« \ .^,^;/*S'' w Smw <" ' ■' ^ y£sB$£& 3 A £ ^ # @s 5 i £ s.- •••■ \r\ -'■'<■ A w^INli^i aVa-a1 a ^raSwK « ™ Mr 6&f% ram waww ^r^-pl J dhtAufid ^J \. ' J *v.\ , v \ V \ ^ >xjAj~S I * * r •• O ^ N. \ - » f ^ 'k. •^ v ^ ^' -^ !> THE HOMOEOPATHIC THEORY AND PRACTICE t OF MEDICINE. BY E. E. MARCY, M.D., and F. W. HUNT, M.D. VOL.11. N E W - Y O R K : WILLIAM RADDE, 550* PEARL-STREET. Philadelphia: F. E. Boericke, 635 Arch-st.—Boston: Otis Clapp.—St. Louis: H. C. G. Luyties.—Chicago: C. S. Halset.—Cincinnati: Smith & Worth- ing ton.— Cleveland: John B. Hall, M.D.—Detroit: E. A. Lodge, M.D.— Pittsburg, Pa.: J. G. Backofen & Son.—Manchester, Eng.: H. Turner & Co., 41 Piccadilly and 15 Market-st.—London, Eng.: H. Turner & Co., 77 Fleet- street. 18 6 4. Entered according to Act of Congress, in the yeai 1864, by WILLIAM KADDE, In the Clerk's Office of the District Court of the United States for the Southern District of New-York. /rtLM HENRY LUDWIG, Printer and St*reotyper, 39 Centre-street. CONTENTS OF VOLUME II. Pass Genus VII.—Inflammatory Diseases of the Kidneys and Urinary Organs, 9 1. Normal Anatomy of the Kidneys, 9 Diagnosis.—Examination of the Urine, .................... 12 Composition of,.............. 16 Solids,...................... 17 Acids,...................... 20 2. Bright's Disease of the Kidney— Desquamative, Albuminous Ne- phritis, ..................... 21 Chronic Form of Bright's Disease, 27 Second Stage of Bright's Disease 28 Treatment of Desquamative Ne- phritis, .................... 29 3. Chronic Desquamative Nephritis, 44 Dropsy,..................... 46 Complications. — In the Brain, Heart,.................... 49 Liver, &c,................... 50 Rheumatic and Gouty do....... 50 Uraemia,.................... 52 Microscopic Observations,..... 57 Treatment,................... 59 4. Nephritis Simplex,............ 66 Treatment,.................. 68 Poisons thrown off from the Kid- neys, ..................... 69 5. Haematuria,.................. 69 Treatment, .................. 70 6. Haematuria following Scarlet Fe- ver, .................... I. 600 7. Disease of the Kidney caused by Surgical or Mechanical Lesions, 71 8. Disease of Capsula Renales. Adi- son's Disease,.............. 72 9. Cystitis, Inflammation of the Bladder, .................. 75 10. Dysuria, .................... 77 11. Irritable Bladder,............ 78 12. Suppression of Urine, Ischuria Renalis,................... 79 Retention of Urine,........... 80 13. Kti'resis.—Incontinence of Urine, 86 Genus VIII.— Ophthalmia. — Affec- tions of the Eye and its Appendages, 87 A. Acute Ophthalmia,............ 88 1. Affections of the Tunica Con- junctiva. Conjunctivitis,.... 89 Peag Conjunctivitis from Extension of Strumous Eczema,....... 95 2. Chronic Ophthalmia,......... 99 3. Purulent Ophthalmia,........ 101 4. Gonorrhoeal Ophthalmia, ......102 Infantile Do.................. 103 5. Granular Ophthalmia. Conta- gious Conjunctivitis. Egyp- tian Ophthalmia,........... 103 6. Opacity of the Cornea,......... 113 B. Affections of the Deeper-Seated Structures of the Eye,....... 113 1. Inflammation of the Cornea,... 113 Ulceration of the Cornea,...... 113 Conical Cornea,...............114 2. Iritis........................ 114 Treatment,................... 115 3. Choroiditis,................. 118 4. Amaurosis,.................. 120 Treatment................... 126 5. Hydrophthalmia. — Dropsy of the Eye, .................. 129 Treatment,.................. 131 6. Cataract,.................... 131 Treatment,................... 133 7. Glaucoma. Staphyloma,...... 134 Treatment,................... 135 8. Hypermetropia,............... 137 Myopia,................. 138 ,140 9. Asthenopia. Hebetudo Visus. Amblyopia Presbytique,..... 139 Squinting,................... 139 10. Fungus Haematodes and Cancer of the Eye,................ 144 C. Affections of the Appendages of the Eye,..................... 144 1. Hordeolum.—Stye,............ 144 2. Entropium. — Inversion of the Eyelids,................... 145 3. Ectropium. — Eversion of the Eyelids,................... 145 Exophthalmia................ 146 4. Puncta Lachrymalia, Diseases of, 146 Fistula Lachrymalifl,.......... 146 Stillicidium Lachrymarum,..... 147 Spasmodic Contraction of the Eyelids......■.............. 149 Trichiasis.—Inverted Eye-lashes, 149 Foreign Bodies in the Eye,..... 149 iv CONTENTS. Page Traumatic Injuries of the Ej'e,. 150 D. Strumous or Scrofulous Ophthal- mia, ..... ................. 150 Mercurial Ophthalmia,........ 155 Genus IX.—Inflammatory Diseases of the Fibrous and Muscular Sys- tem,....................... 156 1. Irritable Inflammation,........ 156 Acute Rheumatism,........... 156 Chronic Rheumatism,......... 158 3. Arthritis.—Gout...............162 Treatment,.................. 166 4. Arthritic Dyspepsia.—Dyspeptic Gout,..................... 168 Treatment,.................. 171 5. Arthropathie.— Inflammation of the Joints,................. 174 A. Diseases of the Soft Parts, .... 174 Arthropathie White Swellings, 174 1. Extra-Capsular,.......... 174 2. Intra-Capsular,........... 174 3. Specific or Blennorrhous,.. 174 4. Fungous................ 174 5. Synovial Arthropathia, ... 175 Hydrarthrus,............ 175 6. Cartilaginous do., ....... 175 7. Superficial Arthropathie of the Bones,............. 175 8. Deep-seated Arthropathie of the Bones, ..'........... 176 Treatment.............. 176 Order IV.—-Dysthetica— Cachexia. Abnormal Conditions of the Circu- lation Dependent on Deteriorations of the Blood,................... 177 Blood in Health,............. 177 Dyscrasias of the Plasma of the Blood,.................... 180 Influence of Disease,.......... 181 Proofs that the Blood becomes Deteriorated,............... 183 Septic Influence,.. . 183. Vol. I. 541 Blood Poisoning,.............. 184 Drug Poisoning,.............. 185 Latent Miasms which Originate Chronic Diseases,........... 186 Psora, Syphilis. Sycosis. Metastasis from the Mucous Mem- brane to the Skin,.......... 186 Sympathetic Relations between them,..................... 186 Hereditary Dyscrasias,........ 187 Allopathic Authorities,........ 188 Genus I.—Anaemia................ 190 Paqb Cerebral Anaemia. City Cachexia, 191 Anaemia Lymphatica,......... 191 Genus II— Haimorrhagia.—Haemor- rhages, ...................... 194 1. Traumatic Haemorrhage,...... 195 Treatment................... 196 2. Haemorrhages from Exhaustion,. 197 Treatment,.....—,,. ,»..,...,.- 198 Genus III.—Purpura,............. 199 1. Purpura Haemorrhagica, ...... 199 2. Purpura Urticans,............ 200 3. Purpura Senilis,.............. 200 Genus IV.—Toxaemia.— Blood Poi- soning, 202 1. Cachexia Mercuriale,.......... 202 2. Toxaemia from Effects of Tobacco, 203 Genus V.—Phthisis.—Consumption. Emaciation,.................. 205 1. Phthisis Pulmonalis.—Pulmonary Consumption,.............. 205 Early Stage,................. 209 Physical Signs................ 211 Pathology................... 220 Tubercle, ................... 222 Causes....................... 225 Hygienic Measures,........... 231 Choice of Climate,............ 235 Treatment,.,.................. 240 Pulmonary Haemorrhage,...... 255 2. Acute Phthisis.-Quick Consump- tion,...................... 256 Granular Phthisis,............ 256 3- Tuberculosis of the Bronchial Glands,................... 257 Genus VI.—Struma.— 1. Scrofula.— King's Evil,................... 259 Causes,...................... 269 Treatment................... 201 2. Arthrocace.—Scrofulous Disease of the Hip-Joint,......... . 261 3. Scrofulous Disease of the Mesen- teric Glapds,.............. 262 Marasmus, 262, 267, Vol. I. 884, 890 Treatment of Scrofulous Diseases, 268 4. Bronchocele, Goitre,........... 273 Thyroid Gland, Enlargement of, 273 5. Parenchymatous Bronchocele,.. 274 Treatment, .................. 275 6. Cretinism.-Struma Tyrolensium. Cagotism, ................. 278 Genus VII.—Carcinus.—Cancer, ... 280 Diseased Cell-Development,.... 280 1. Caneer.—Carcinoma........... 282 Cephaloma,.................. 283 CONTENTS. V k' Page Scirrhus,.................... 284 Fungus Hsematodes,.......... 284 Melanosis,................... 284 Ostoid, or Spina Ventoso,...... 284 Cancroid—Epithelial Cancer, .. 284 Treatment of Cancer,.......... 285 Cancer of the Lips, Cheeks, ... 287 And Tongue,................. 289 Buccal Cancer............... 289 Mucous Tubercle,.............289 Lupus,...................... 289 Cancer of the Stomach,....... 293 Cancer of the Uterus,......... 297 2. Fungus Hsematodes,........... 298 Genus VIII — Lues.—1. Syphilis,... 300 Chancre,.................... 304 Secondary Effects of the Poison, 308 1. On the Mouth, &c,............ 308 2. On the Skin, ................. 308 3, In the Bonee, i>~ Ossification of the Aorta,...... 558 4. Strabismus.—Squinting........ 660 6. Chorea.—Saint Vitus' Dance,... 661 Sycotic Affections of the Spinal Marrow and Ganglionic System, 507 Epidemic Chorea, Religious Con- CONTENTS. vii Page vuWve Affection of the 19th Century,.................. 567 6. Barbiers............... ......570 7. Beriberia,.................... 571 Order III.—Systatica.— Complicat- ed Derangement of the Sensorial Functions,..................... 572 Genus I.—Sympathetic Affections,.. 572 1. Nervousness,................. 574 2. Antipathy,................... 577 Genus II.—Dinus.—Vertigo,....... 578 Genus II.—Syspasia.—Convulsions,. 580 1. From Deranged Circulation in the Brain,..................... 580 2. From Direct Violence,.......,. 580 3. Convulsions of Children........ 582 Treatment of Convulsions,... 584 4. Epileptiform do.,............. 586 5. Cramps in the Limbs.......... 588 6. Hysteria,.....................689 7. Epilepsy,....................593 Idiopathic Epilepey,.......... 596 Sympathetic Epilepsy.........597 Nervous Affections Resembling Epilepsy,.................. 598 Convulsive Affections Occurring during Sleep,.............. 600 Theory of Epilepsy,........... 601 Causes of Epilepsy,........... 603 Treatment,...................605 Genus III.—Asphyxia.—Apnce, .... 614 1. Asphyxia from Submersion. — Drowning.................. 615 2. From Poisonous Effects^of Burn- ing Charcoal, .............. 615 3. From Strangulation. Hanging,. 616 Treatment of Asphyxia,....... 619 Apparent Death.—Swooning.— S3'ncope.—'Suffocation....... 626 4. Catalepsy.—Catochus.—Trance,. 627 Diagnosis.—Signs of Death,.... 629 6. Apoplexy,................... 633 Pathology,................... 638 Serous Apoplexy,............. 641 Simple Apoplexy,............ 642 Treatment of Apoplexy,....... 643 6. Coma.—Stupor,............... 650 Narcotism,................... 650 Treatment of Coma,........... 650 Poisoning by Opium,.......... 651 7. Anaemic Coma.-Hydrocephaloid, 654 Effects of Lightning........... 655 8. Paralysis. Palsy,............. 056 Pathology,................... 657 Page Paraplegia,.................. 659 Hemiplegia from White Soften- ing of the Brain,............ 659 Treatment of Paralysis,........ 660 Paralysis of the Auditory Nerve, 663 Deafness from,............. 664 Paralysis Metallortim,......... 666 Paralysis from Spinal Affection, 668 With Disease of the Kidneys, 669 Inflammation of the Spinal Cord 609 Mercurial Palsy,............. 671 CLASS V.—Diseases of the Re- peoductive Function. Order I.-~-Cenotica."— Affecting the Secretions,..................... 674 1. Amenorrhcea.—Retention, Sup- pression of the Menses,...... 674 Treatment................... 679 2. Dysmenorrhea, Painful Menstru- ation, ..................... 681 Treatment,.................. 684 3. Menorrhagia, Profuse Menstruation 689 Treatment,................. 69" 4. Leucorrhcea.—Fluor Albus, .... 69 Treatment. .................. 69 5. Inflammation and Ulceration of the Os and Cervix Uteri,___ 70~ Prolapsus Uteri............... 713 6. Spermatorrhoea. — Involuntary Emissions, ................ 714 Treatment,................... 716 Spinal Disease from Masturbation, 717 7. Galactorrhcea.—Tabes Lactea, .. 718 8. Chlorosis. Green Sickness,___ 719 Treatment,................... 723 Metritis,..................... 729 Order II.—Affecting the Parenchyma. Genus I.—Cyrtosis. 1. Talipes.-Kyllopodia.-Club-Foot, 780 Treatment,.................. 731 CLASS VI.—Diseases op the Ex- cernent Function,............. 733 Order I.—Affecting Internal Surfaces, 733 Absorption in Causing and Curing Disease,.................. 733 Genus I.—Hydrops.—Dropsy,...... 738 1. Anasarca.—Cellular Dropsy,.... 744 2. Ascites.—Abdominal Dropsy, .. 745 3. Hydrothorax,.............7i7. 761 4. Ovarian Dropsy, ............. 748 Treafment of Dropsy,.......749 vm CONTENTS. PAGi 5. Hydrocele Dropsy of the Testicle, 762 6. Hydrarthrus.-Scrofulous Inflam- mation of the Joints,........ 764 7. Spina Bifida.-Dropsy of the Spine, 765 8. Uraemia.—Retention in the Blood of the Contents of the Urine,. 767 Genus IL—Lithia.—1. Urinary Cal- culi.—Stone in the Bladder,...... 770 Varieties of Calculi,........... 771 2. Calculi in the Kidneys,........ 773 Nephralgia Calculosa,......... 775 Chemical Changes in the Urine, 776 Mucus as a Ferment, .. 777, 783, 798 Acid Fermentation,........... 781 Products of Fermentation,..... 783 Calculi formed from Urates,.... 785 Effects of Alkalis,............ 789 Treatment of Calculus,.........799 8. Diseases of the Bladder accompa- nying Calculus,............ 802 Genus II.—Paruria,............... 807 1. Hernia Humoralis,............ 807 2. Fistula in Perineo,............ 808 8. Diabetes..................... 808 Pathology,................... 808 Treatment,................... 814 4. Diabetes Complicated with Piar- rhjernia or Fatty Substance in the Blood,................. 815 6. Albuminuria,................. 820 Genus III. — Hydatids.-Parasitic En- tozoa,......................... 822 Hypertrophy of Cellules........823 Hydatids of the Liver.......... 823 Treatment,.................. 824 Genus IV.—Parostia.— Diseases of Bones,........................ 826 1. Exostosis..................... 827 2. Osteitis,..................... 828 3. Enchondroma,................ 830 4. Osteoid...................... 830 6. Osteoporosis,................. 830 Osteomalacia,................ 831 Osteo-Sarcoma,............... 883 6. Rachitis.—Softening of the Bones, 833 Genus V.—Adiposis.—Obesity,..... 886 Atrophy,.................... 836 Corpulency,.................. 837 Treatment.................... 888 Genus VI.— Malformations. Physi- cal Deformities,................ 839 Pagi 1. Cretinism,....................839 2. Tumors,..................... 840 Order II.—Diseases Affecting the External Surface,........................* 841 The Skin,.................... 841 Cryptogamic Parasites in their Relation to Disease, 843,.......843 Cutaneous Diseases,....... 845, 860 1. Pityriasis, Dandruff,....... 846, 863 2. Tinea Capitis—Scald Head...... 846 3. Edema.............• 848, 860, 863 4. Pemphigus,.................. 851 5. Rupia,....................... 851 6. Ecthyma,..................... 851 7. Acne.—Rosy, Drop.,........... 855 Genus II.—Papular Eruptions, Lichen, 856 Parasitic Vegetables on the Skin, 858 Porrigo,..................... 858 Baldness............. 862 861, 859 Psoriasis,.................... 857 Mycelium, Favus,............. 860 Treatment of Parasitic Skin Dis- eases, ..................... 861 Microsporon,................. 863 Genus III.—Vesicular Varieties. 1. Herpes, Tetter.—Dartre,....... 866 Diagnosis,................... 867 Treatment.................... 868 2. Lepra—Leprosy,.............. 870 Lepra Graecorum,............. 874 Lepra Antesthetica,........... 874 Treatment,................... 878 3. Scabies.—Psora.—Itch,.......879 Treatment.................... 882 4. Psora Guttata,................ 885 Genus IV.—Malis. Cutaneous Ver- mination,..................... 886 1. Malis Filiaria. Guinea Worm,.. 886 Genus V.—Ecphyma.-Cutaneous Ex- crescence,...................... 887 1. Corns,....................... 887 2. Diseases of the Nails,.......... 891 8. Onychia,..................... 894 4. Bunions,..................... 895 5. Nrevus Materni,............... 897 Genus VI.—Trichosis.-Morbid Hair, 898 1. Trichosis Pollicis.—Gray Hair,.. 898 2. Plica Polonica.—Plaited Hair, .. 899 Albino Skin,................. 901 Sclerema,.................... 901 Verruca.—Warts,............. 901 THE HOMOEOPATHIC THEORY AND PRACTICE OF MEDICINE. Genus VII.—INFLAMMATORY DISEASES OF THE KIDNEYS AND URINARY ORGANS. 1. NORMAL ANATOMY OF THE KIDNEYS. While the subject of Renal Diseases is under consideration, it may be interesting to present a brief anatomical and physiological de- scription of the healthy kidney, with the ordinary physical and chemi- cal character of normal urine. By such a course we enable the medi- cal man to compare, with facility, morbid with healthy conditions of the organ. The great advantages of this mode of procedure, in placing concisely before the reader every thing pertaining to these organs, both normal and abnormal, and the amount of time and labor thus saved in looking up reliable authorities, will be apparent to every one. Among the writers who have distinguished themselves in extending our knowledge respecting the anatomy and physiology of the diseases of the kidneys, we cite the following: Todd and Bowman, Phys., Anat. and Phys. of Man • George Johnson, On the Diseases of the Kid- ney, cftc.,' Hassall, The Urine in Health and Disease ; Thudicum, A Treatise on the Pathology of the Urine / Basham, On Dropsy, con- nected with Disease of the Kidneys / Beale, Illustrations of the Constituents of Urine, &c. / Rayer, Traite des Maladies des Reins ; Lehmann, Physiological Chemistryj Becquerel, Semeiotique des Urines, &c. / Frerichs, Die Bright'sche Nierenkrankheit und deren Behandl. / Prout, On ■ the Nature and Treatment of Stomach and Penal Diseases ; Scherer, Annal. der Chemie und Pharmacies Christison, On Granular Degeneration of the Kidneys; Bird, Urinary Deposits, &c; Bence Jones, An. Chem. in relation to Stomach and Penal Diseases; Solon, On Albuminuria. • 10 DISEASES OF THE SANGUIN0U8 FUNCTION. The researches of these authors have been so extensive, and their observations and illustrations are so minute and accurate with regard to everything pertaining to the kidneys, in their healthy and diseased states, that we shall not hesitate to avail ourselves largely of their valuable experience. The Anatomy and Physiology of the Kidneys.—Location.—The kidneys are located deeply in the lumbar region, on each side of the spine, and " directly beneath the ribs of the lumbar region." Form.—Symmetrical glands, in form much like a French bean, with their convex margins directed outwards, and their concave borders or hilums, towards the spine. Size.—From four to four and a half inches in length, about two inches in breadth, and from one to one-eighth inches in thickness. Weight.—From four and a half to five and a half ounces. Anatomical Relations.—The ascending colon lies in front of the right, and the descending colon in front of the left kidney. A small portion of the duodenum touches the anterior surface of the right kid- ney. The spleen, and the lower part of the stomach, when distended, are directly over the upper portion of the anterior surface of the left kidney,—the former organ being in actual contact with it. The posterior portions of the kidneys are in close proximity to the lumbar and psoas muscles, and in contact with the diaphragm. Renal Capsule.—A strong, fibrous membrane enveloping the kid- neys, attached externally to a bed of adipose tissues, and internally to the gland itself; giving out here and there fibrous attachments to the cortical substance and receiving in return a number of small vessels ; connected above with the fibrous layer of the pelvis, and at the hilum with the ureter. Renal Surface.—On the surface of the kidneys are eight to ten im- perfect fissures, indicating the original lobular divisions of the organ during intra-uterine life. Other lobular demarcations are perceptible, arising from a peculiar arrangement of the stellate veins upon the renal surface. These veins enter the cortex vertically from its surface, and during their passage to the hilum are recipients of blood from the venous plexuses of the tubuli uriniferi. Renal Matrix.—A tissue composed of a firm, transparent, fibro-cel- lular net-work, in which the entire substance of the kidney is embedded. The tubes and blood-vessels of the gland traverse the matrix in all directions, and, in a section of the kidney, may be recognized as deep- red oval spots, surrounded and supported by the intervening meshes of the matrix. Todd and Bowman suppose that its only office is to serve as a support for the tubes and capillary vessels. Substance of the Kidney.—Anatomists have divided the kidney into two separate portions, termed cortical and medullary. normal anatomy of the kidneys. 11 Cortical portion.—The external and cortical portion is from two to six lines in thickness, of a reddish color, soft consistence, and dotted throughout its structure with a number of minute, deep-red granular spots—the Malphighian corpuscles. It is composed chiefly of the con- voluted uriniferous tubes, and the Malphighian bodies. Tubuli Uriniferi.—These convoluted tubes consist of a delicate basement membrane, attached to the matrix, and lined with epithelial cells, whose office it is to separate from the blood, the urea, uric acid, the sulphates, the phosphates, and the other solid constituents of the urine. These tubes terminate at, and are continuous with the Mal- phighian corpuscles, and are connected below with the straight tubes of the medullary portion, which receive the urine as it is secreted by the Malphighian bodies and the cells of the convoluted tubes. Malphighian Bodies.— Are made up of small round tufts of capillaries from the afferent, and terminating in the efferent vessels, and enclosed by capsules lined at their lower thirds with epithelium. Their function is to separate from the blood the aqueous portion of the urine. Medullary Portion.—The internal medullary portion constitutes the remaining part of the gland, is less soft than the cortical substance, of a deeper red than the cortical portions, although Todd and Bowman describe it as paler, and its substance is arranged in the form of cones, named from their discoverer, pyramids of Malphighi. These cones or pyramids are made up of the straight tubes, which are continuations of the convoluted secreting cortical tubes, and appear to be simply channels for conveying the urine from the secreting cells to the pelvis of the kidney. They are lined by a thin squamous epithelium which serves to shield the basement membrane from the irritation of the pass- ing urine. As the tubes proceed from the apices of the cones to the cortical substance, they throw off numerous anastomosing branches, which become more numerous, and of smaller diameter as they ap- proach the bases of the pyramids. The. number of pyramids is usually placed at from ten to fifteen, and their apices float freely in the pelves of the kidneys. No Malphighian bodies have been observed in this portion of the organ. Renal Blood Vessels. The following is Todd and Bowman's de- scription of the vessels of the kidney: " The renal arteries divide into four or five branches, which enter the kidney at the hilum between the vein and the ureter. These vessels are surrounded with a quantity of fat. They pass between the papillae to the bases of the cones, over which they spread. From these arteries smaller branches are given off, which ascend in the cortical substances nearly to the surface, and, in so doing, give off on all sides, a number of small terminal twigs, the afferent vessels of the Malphighian bodies. Arrived within the capsule, 12 diseases of the sangltnous function. the small afferent vessel at once divides into four or five branches, each of which again divides dichotomously. The small capillary vessels form loops, which project towards the opening of the uriniferons tube. The blood is received from these vessels, which lie towards the outside of the tuft, by branches of the efferent vessels which converge towards the more central part of the tuft to form one trunk, which leaves the Malphighian body, and soon breaks up into a plexus of capillary vessels, in the meshes of which the tubes lie. The terminal arterial twigs with their appended tufts, when injected with vermillion, have been compared not inaptly to a branch of currants." Examination of Urine.— General Principles.—The first urine voided in the morning or at the period of longest fasting from food and drink, is the truest expression of the kidney secretion, and contains the largest proportion of solids. This the urine of the blood, as distin- guished from that of the food and drink. As an average, in relation to the general habit of body, or with a view to the influence of paroxysmal diseases, &c, Chossat adopted the method, afterwards approved by Lecanu, Becquerel, Lehmann, Thudi- cura, and other authorities, of collecting the whole of the urine during several days and nights consecutively, and mixing in one mass what had been voided during twenty-four hours, before proceeding to the analysis of this average urine.. Finally, an average is taken of the variations during several successive periods. Lehmami insists upon the necessity of this method, and advises, whenever it is impracticable, to confine the analysis to the solids of the urine. For practical convenience, Thudicum advises the use of a flat-bodied glass, with a narrow, tumed-up neck, and a mouth fitted to the require- ments of the sex, either funnel-shaped or elipsoid. The neck should fit into a gap in the front border and wall of the bed-pan so that the penis shall lie easily in the neck of the urinal, and no urine be lost. These urinals should be graduated upon a scale of fLuid ounces up to fifty or sixty, or centimetres two thousand, with forty divisions. For the quantitative analysis of healthy urine, see the "Practical Handbook of Medical Chemistry," by John E. Bowman, Am. ed., p. 41 \ or, " Thudicum's Pathology of the Urine," Chap. 2 'T or u Becquerel, Semeiotique des Urines" Chap. X; or "Lehmann's Physiological Chemistry," Am. ed., Vol. 2, p. 149; or "Carpenter's Human Physio- logy," Am. ed. of 1858, p. 389. Other physical properties-of urine are treated of in the same connection. For estimates of the solids of the urine, based on its specific gravity, &c, see also, Johnson, On Diseases of the Kidneys, p. 48 \ or Golding Bird, On Urinary Deposits, p. 46; or Christison, Tabler lib. 7, of Prac. Med., Lond.: 1840, vol, iv. \ or Berzelius, Lehrbuch der Ch.y 3d ed., voL x., p. 285. normal anatomy of the kidneys. 13 For a practical approximation to the specific gravity of the whole urine, test, by the urinometer, that which is passed first in the morning and last in the evening, and then strike an average. Lehmann prefers the direct weighing of equal volumes in glass flasks,—thermometric and barometric relations being taken into account The specific gravity of the glass, and the co-efficients of expansion of the air and water for a vacuum, by means of logarithms or a couple of algebraic equa- tions. See Schmidt's Entwurf einer Untersuchens-Meihode thieri- scher Safte; or Thudicum's work pre-cited, p. 33. The Pycnometer, made to facilitate this operation, contains a thermometer in its stopper. Becquerel measures the density of urine with Baume's areometer." (See p. 13.) Normal Urine.—Physical Characters.—Quantity in Health. This varies chiefly with the proportions of water, but averaging, under ordinary circumstances, about thirty ounces in summer and forty ounces in winter. The lungs and skin normally, the intestinal canal and serous membranes abnormally, may supply the function of the kid- neys in evacuating the water of the urine, but as the secretion of water is merely accessory, not essential to their function, so our chief atten- tion must be paid to the relative proportions of the different solid con- stituents. These.may normally vary from O20 to 0*80, or from forty to fifty grammes (Becquerel), or 1000 grains (Todd and Bowman), in twenty-four hours, for a man who lives freely; but less for the aged, and for women and children, whose urine is more watery. Specific Gravity.—Making a fair average, it may be placed at 1020. But, in conditions of health, its density varies from 1010 to 1025. Normal urines of 1017 have 28-5 solid parts. {Lehmann.) Aqueous urines, when not accounted for by the quantity of fluids im- bibed, or by the chill and moist state of the atmosphere, are sometimes symptomatic of emotional agitation,—of joy, fright, anxiety, or of ner- vous disorders; hence they are oftenest remarked in the female. Poly- dipsia, anaemia, diabetes, and hysteria are cited by Becquerel as the states in which the urine is most aqueous. A healthy adult passes from thirty to forty ounces of urine in twenty- four hours—the quantity in summer varying from thirty to thirty-five ounces, and in winter from thirty-five to forty ounces. Of the solid constituents of healthy urine more than one-half is urea, This is derived in part from the metamorphoses of the tissues (probably the gelatinous tissues), and in part from innutritious and unassimilated food. The proportion of urea is increased by the use of animal food and active exercise, and diminished by vegetable and other non-nitro- genous articles. In or out of the body, it is readily converted into Carbonate of Ammonia; as one atom of urea and two atoms of water 14 diseases of the sanguineus function. form two atoms of Carbonate of Ammonia. The causes which deter- mine this conversion are various. Among them may be cited: In cases of uraemia, it is an interesting question, whether the morbid effects are due to the presence of the unchanged urea in the blood, or to its conversion into Carbonate of Ammonia. A careful proving of these two substances would aid us in deciding the point, and might af- ford valuable hints in treatment. Uric-acid exists ready formed in the blood, and is found in healthy urine in the form of Urate of Ammonia. Johnson supposes that it forms less than -^Vo part of healthy human urine. Prout supposes that it is 'derived from the decomposition of the albuminous tissues; while Liebig maintains that it results from the decomposition of the nitrogenous tissues. Ammonia is another constituent of healthy urine, and is found in the form of Urate of Ammonia. 1000 parts of urine contain from 2'16 to 2*19 parts of Ammonia. Hippuric acid is another healthy constituent of healthy urine, and forms about tsVo part of the entire quantity ex- creted. This acid abounds in carbon, and is usually abundant in con- sumptive and other patients, whose blood is imperfectly decarbonized. The sulphates of healthy urine are chiefly those of Soda and Potash, although Sulphates of Lime, Magnesia, and Ammonia are usually present in minute quantities. They are supposed to be derived in part from the metamorphoses of the tissues, and in part from the food. Un- oxidized Sulphur is also found in the urine, but its precise combinations are dot yet fully understood. According to Ronalds, from two to five grains of Sulphur are excreted daily. Phosphates of Potash, Soda, Lime, Ammonia, and Magnesia, are also found in minute quantities as constituents of healthy urine. They are also derived from the changed tissues and from food. Unoxidized Phos- phorus, in minute quantities, is also present in normal urine. From the analysis of normal urine we observe, that traces of the Chlorides of Sodium, Potassium, Lime, Ammonia, and Magnesia are present, and that they are derived chiefly from the food. Color.—The color of healthy urine has been termed by different writers, amber-colored, straw-colored, sherry-wine-colored, yellow, &c. We know of no term truer or more expressive, than amber-colored. As already observed, in infants, females, aged persons, and in certain anae- mic conditions, the urine is more watery, and consequently paler in color. Red urines generally indicate an excess of acid, a high specific gravity, and the presence of a large proportion of solids. Many causes may contribute to the production of highly-colored urine in health ; like an undue elimination of the water through the pores, abstinence from drinks, and the use of highly-nutritious and highly-seasoned food. NORMAL ANATOMY OF THE KIDNEYS. 15 The use of certain drugs and beverages may also give a red tinge to the urine. Red urine is also an accompaniment of many abnormal con- ditions, like fevers, dropsies, and maladies characterized by a rapid decomposition of the tissues and the blood. The acid which gives the red color to urine is the Bi-phosphate, or Acid-phosphate of Lime, and not uric or lactic-acid, as is generally supposed. Deep-yellow urine indicates the presence of bile. Dark urines—brown, blue, or black, are observed during the pro- gress of many malignant diseases, and are due to rapid morbid changes in the tissues and to a decomposition of the blood. Black urine is sometimes voided after long-continued epileptic convulsions, in conse- quence of protracted and spasmodic muscular contraction. Brown, red, or blackish urine is sometimes due to the presence of blood. Under the microscope, the globules appear deformed and irregular, and they finally disappear. Amorphous fragments are then found similar to those observed in albuminous urine. Turbid urine indicates, first, the presence of mucus with diminished density, paler color, and, after standing a few hours, a separation into an upper and clear layer, and a lower and turbid and opaque one, with ammoniacal odor, in consequence of the decomposition of urea into carbonate of ammonia, which mucus rapidly determines. Second, turbid urine is also caused by the presence of pus. Such urine is less dense than natural, of a greenish color, clears soon after emission, and deposits a thick, whitish, and foetid sediment. Like mucus, it hastens the conversion of urea into carbonate of ammonia. Under the micros- cope, pus-cells are observed in the upper or transparent stratum, at first very numerous, but, after ten or twelve hours, (as in case of blood- globules), they disappear, and a kind of granules are found in their stead. Sediments.—The sediment of acid urines is composed of uric-acid crystals, acid urates of soda, ammonia or lime. The sediment of alka- line urines consists of carbonate and oxalate of lime, and ammoniaco- magnesium phosphates. Sediments of pus, mucus, and bloo#d-globules are not unfrequently found. The composition of urinary sediments is so various, arising from the decomposition of the urine and its waters, that we can only allude to them here, and refer the reader to Becquerel, On the Urine, and to Thudicum's Pathology of the Urine, for more minute information upon the subject. Acid Urine.—Normal urine is generally acid, as may be proved by test-paper. By standing it becomes more acid, and passes through an acid fermentation, resulting in the separation of reddish-yellow rhom- boid-shaped crystals under the microscope. Acid urine is deep-colored and dense, and the acidity is derived from the bi-phosphate, or acid- phosphate of lime, and not, as is commonly supposed, from the uric or 16 DISEASES OF THE SANGUINOUS FUNCTION. lactic acid. Liebig attributes the acidity of the urine to the presence of acid-phosphate of soda. Where great accuracy is not requisite, the urine may be tested for acidity with litmus paper. The tests should be applied at different periods of the day, and an average drawn ; since the degrees of acidity are constantly changing from the food and drink consumed, from fasting, exercise, &c. Neutral Urine.—This is only ordinary urine very much diluted, like that which is observed in anaemic subjects. Alkaline Urine.—This is rarely observed. Its sources are blood, pus, and the decomposition of urine or carbonate of ammonia in the bladder—the last being the most frequent. The most frequent deter- mining cause of this alkalinity is the action of the oxygen of the air upon the substances cited. But the urine may be alkaline at the instant of its secretion in the kidney. After standing for a considerable period, acid urine sometimes becomes alkaline, in consequence of the decom- position of urea, and the development of carbonate of ammonia, am- monio-magnesian phosphates, and phosphate of lime. This result may likewise be produced by boiling urine for several hours. Composition of Urine.—When we consider the various circum- stances which are in constant operation to modify the composition of urine, it will not appear surprising that chemists have presented us with such diverse analyses. The urines of the claret-drinking French- man, of the beer and port-drinking Englishman, of the lime-water ~ drinking Yankee, and of the fruit-consuming denizens of tropical climates, must of necessity present great diversities in chemical com- position. Even under any circumstances, the variety of food and drinks, atmospheric changes, habits of exercise, mental emotions, ex- cessive mental or physical exertion, continual modifications are oc- curring in the composition of the urine. It is evident, therefore, that any analysis which may be presented must be regarded as only an ap- proximation to the actual result. We place before our readers an analysis of Becquerel, quoted from Johnson's i' Diseases of the Kidney" p. 48, and another from Berzelius. "This analysis of Becquerel was adopted by Dr. Prout as being the most accurate. Dr. Prout took as a standard, thirty-five ounces of sp. gr. 1020, and employing M. Becquerel's data as the basis of his calculations, he obtained the results which are shown in the following table; the proportion of solids and liquids being thirty-three of the former to 967 of the latter." Composition of 1000 Pakts of Ueine. Water,........................................4. 067' Urea,.........................................' 14230 Uric-acid,....................................... -468 NORMAL ANATOMY OF THE KIDNEYS. 17 Organic matters in- r Lactic acid 1 -\ separable from each) Coloring matter, (......... 10167 other, ( Extractive matter, j r Ammonia -, Lime Soda *(■................ 8-135 Potash ; Chlorides Phosphates, Sulphates .Magnesia J 1000-000 Berzelius gives us the following table as the Composition of 1000 Parts of Urine. Water,.......................................... 933. Urea,.......................................... 30-10 Uric-acid,___................................... \- Sulphate of Potassse,............................. 371 Sulphate of Soda,................................ 3-16 Phosphate of Soda, .............................. 2-94 Chloride of Sodium,.............................. 445 Phosphate of Ammonia,.......................... 1-65 Muriate of Ammonia,............................. 150 Free Lactic-acid, -. Lactate of Ammonia, Phosphates of Lime and Magnesia, .' ............. Animal matter insoluble in Alcohol, J Fluoride of Calcium,...........a trace. Silica,.......................a trace. Mucus of the bladder,......................... 0-32 1000000 Solids of Normal Urine.— Urea. Chemical composition: C2 H4 N2 02 = 60., sp. gr. 1-35. Of the solid constituents of healthy urine, urea forms from 7\*08* part. It forms flat quadrilateral prisms, with aspect and taste like Nitre. It belongs to the class of organic bases, and forms crystalizable compounds with several of the acids; is soluble in five parts of cold or two parts of boiling alcohol—in its own weight of cold water, and in every proportion of boiling water; is in- soluble in ether; is permanent in the air; fuses at 250° F., and at a higher temperature yields by spontaneous decomposition, ammonia, cyanate of ammonia, and dry solid cyanuric-acid. According to John- son, 270 grains, or more than half an ounce of urea is excreted by a healthy man in twenty-four hours. It readily results from the trans- formations of various azotized matters, and, when not removed by the kidneys, it accumulates in the blood, and appears in the saliva, the bile, the gastric secretions, in nearly all the humors, and is so abun- dant in the sweat as to form, after spontaneous evaporation, a blueish- white crust, especially upon the face. The quantity of urea is in- Vol. il-2. 18 DISEASES OF THE SANGLTN0U6 FUNCTION. creased by all causes which determine rapid metamorphoses of the tissues. Its prolonged retention in the blood gives rise to what is termed uraemic poisoning, to which we shall refer hereafter. For excellent methods of ascertaining the absolute quantity of urea in urines, we refer the reader to JThudicum's work on the " Pathology of the Urine," pp. 52, 67, and 69—" Methods of Liebig, Bunsen, and Davy." When the quantity of excreted urea continues above or below the natural standard for any considerable period, disease may be in- ferred. Among the causes which determine its diminution in the urinary secretion are insufficient food, impaired digestion, chronic maladies, anaemic conditions and diseases of the convoluted tubes of the cortex of the kidneys. The principal causes which form the excretion of an excess of urea, are the assimilation of large quantities of nutritious food, the use of stimulants, febrile disorders, and general activity of the circulatory and digestive functions. Uric-acid.—Chemical composition : C10 H4 06 N4 = C10 H2 04 N4 -f- 2HO. Pure uric-acid, according to Brande, is a " soft, white, crys- talline powder; it is insipid and inodorous; it reddens moistened lit- mus paper. It is almost insoluble in cold Avater (requiring, according to Bensch, from 11,000 to 15,000 parts), but soluble in between 1,800 and 1,900 parts of boiling water; it is insoluble in alcohol and in ether." When it is decomposed by heat it yields carbonate of ammo- nia, hydrocyanic acid, empyreumatic oil, cyanuric acid, urea, and car- bon. It forms 468 in 1000 parts of normal urine, according to Becquerel. The average amount discharged by a healthy man in twenty-four hours is stated by Becquerel to be from 0*49 to 0*56 grammes. The proportions, however, may vary much in different in- dividuals without any impairment of the health—such variations de- pending upon the quantity and quality of food and drink consumed, habits of life, &c. Uric acid in combination with one or more bases—ammonia, soda, or lime—is one of the most common sediments of the urine. Uric- acid, being insoluble in the blood, can only exist in this fluid in the form of a urate—chiefly urate of soda—and is separated by the kid- neys, passes to the pelvis of the kidneys, to the bladder, and thence out of the body as a urate of soda. But, during the passage of the latter through the urinary organs, portions of it are often decomposed, and uric acid set free by the free phosphoric and lactic acids of the urine. This decomposition may occur in the kidney, in the bladder, or after the emission. In order to ascertain whether the urine holds in solution a urate, we add to it either nitric, acetic, or muriatic acid. If uric acid is speedily precipitated, we infer the presence of a large quantity of the urate ; NORMAL ANATOMY OF THE KIDNEYS. 19 but, if a long time elapses before a deposit is apparent, it indicates the presence of only a small quantity of the salt. In all cases of albumi- nuria either nitric or muriatic acid should be employed, as nitric acid precipitates albumen. The following is Dr. Golding Bird's diagnosis of uric acid depo- sits : " When heated in the urine, the uric acid deposit does not dis- solve, the crystals merely become more opaque. They generally be- come more distinct, from the solution of the urate of ammonia, which is frequently mixed with them, and sometimes completely conceals them from view. Hence the best mode of discovering this deposit is to warm the urine, when turbid from excess of urate of ammonia, in a watch-glass: the acid becomes visible at the bottom of the glass as soon as the urate dissolves." Creatine.—General Appearance. In its crystallized form it is a colorless, transparent, and glossy substance. Chemical Composition.—C8 H9 N3 04 + 2 Aq. Specific Gravity.—1*35 to 1*34. Quantity in Normal Urine, and whence derived.—An excremen- titious substance, derived from the muscles; excreted from the blood by the kidneys, and passing thence into the bladder and out of the body; a constant constituent of the urine, but present in very small quantities. Quantity Passed in Health in Twenty-four Hours.—Thudicum places the average quantity passed in twenty-four hours at 0*305 grammes. How Increased or Diminished.—The quantity is increased by muscular action, febrile conditions, and whatever produces rapid meta- morphoses of the muscular tissues. The causes which tend to dimin- ish it are muscular inactivity, anaemic conditions, feeble action of the circulatory and respiratory systems. Mode of Detection.—First evaporate the urine to a dry extract, then, with a solution of ammonia, dissolve out the creatine, and finally evaporate the solution of ammonia, leaving the creatine in a crystalline state. Under the microscope these crystals present themselves in various forms, but may be readily distinguished by accustomed ob- servers. (See Hassall on Urinary Diseases.) Creatinine.—General Appearance. Creatinine crystallizes in ir- regular groups of very transparent and light-colored crystals. They may be distinguished from those of creatine by their lack of lustre. Creatinine is usually present in the urine in a free state. Much of it is supposed to be derived from the conversion of creatine into creati- nine during its passage through the urinary organs, and after the urine has been evacuated. Chemical Composition.—Formula: C8 H7 N3 02. It is more 20 DISEASES OF THE SANGUINoUS FUNCTION. soluble in water than creatine—one part dissolving in 11*5 parts of water at 60° F. Its chemical character is almost identical with that of ammonia. Specific Gravity.—The specific gravity of the crystals is about equal to 1-35. Proportion in Normal Urine.—Always greater than that of crea- tine, from whence it is derived. Quantity Passed in Twenty-four Hours.—The average quantity passed in twenty-four hours in health, varies, according to the experi- ments of Thudicum, from 5*61 to 9*66. Prom whence Derived.—An excrementitious substance, derived in part from metamorphosed muscular tissue, and in part from the con- version of creatine into creatinine after the urine has been separated from the blood by the kidneys. Causes which Increase or Diminish It.—Like creatine, it is in- creased by those causes which effect a rapid disintegration of the mus- cular tissues, and diminished by those conditions which retard those muscular transformations. Mode of Detection.—Same as for that of creatine. Hippuric Acid.—General Appearance. In its crystalline state it is in the form of " delicate silky needles or rhombic prisms;" taste bitter; sparingly soluble in cold, but more readily in boiling water, and still more soluble in alcohol. Supposed by Liebig to be a con- stant constituent of normal urine, in about the same proportion as uric acid; but the observations of Duchek do not confirm this opinion. Chemical Composition.—Formula: N. C. 18. H8. 05 x Aq. It is readily decomposed by nitric acid, and converted into benzoic acid. It enters into combination with several alkaline and earthy bases to form the hippurates. Quantity in Normal Urine.—Much diversity of opinion prevails upon this point. According to Liebig, uric acid and hippuric acid are present in healthy urine, in about equal proportions ; while Hoesle and Duchek deny that the latter is a normal ingredient of this se- cretion. Quantity Passed in Twenty-four Hours.—The quantity secreted depends much upon the habits of the individual and the kind and quantity of food consumed. But the average amount may be placed at from 040 to 0*50 in twenty-four hours. From whence Derived.—It is derived principally from the non- nitrogenous elements of the food (Living). Bird supposes that it may owe its origin to an undue retention of carbon in the blood, from defec- tive action of the lungs and liver. How Increased or Diminished.—Increased by rest and by the use of fruits, like pears, plums, cherries, apples, &c, and diminished by ac- NORMAL ANATOMY OF THE KIDNEYS. 21 tive exercise in cold air and rigid abstinence from stimulants, coffee, and meats. Mode of Detection.—Turbid urine indicates the presence of con- siderable hippuric acid, while clear urine usually contains but a small quantity. For other methods of detecting it see " Thudicum on the Pathology of the Urine," p. 143. Coloring Matter of Urine.—Thudicum gives the name of uraema- tine to this substance, from the supposition that it is " derived from the pigment of the blood or haematine." In a dry state it is of a deep red color, and it is this substance which communicates to urines their various tints. Scherer supposes that it is derived from the decompo- sition of blood corpuscles. It is composed chiefly of carbon. But little is known at present of its exact character—its derivation, chemi- cal reactions, &c.; but it is doubtless an effete and excrementitious substance. Fixed Salts of the Urine.—Sulphates. Of the fixed salts of the urine the sulphates of potassa and soda are the most abundant. The average quantities of each in 1000 parts of urine are as follows, according to Berzelius : sulphate of potassa, 3*71; sulphate of soda, 346. A small quantity of pure sulphur is also present in most healthy urines. They are derived in part from the metamorphoses of the tissues. Phosphates.—Berzelius gives us the following proportions of these salts as pertaining to normal urine : phosphate of soda, 2'94, and phosphate of ammonia, 1*65, in 1000 parts of urine. Traces of phos- phates of lime and magnesia are also always present in normal urine. Free phosphorus is said to be a constant constituent of healthy urine. Derived chiefly from disintegrated muscular, brain, and nervous tissues, and from food and drinks. Increased by mental activity and cerebral irritation. Chlorides.—These occur in normal urines in the form of chloride of sodium and potassium—the proportion of the former to 1000 parts of water being 4*45, and of the latter a trace. Minute quantities of the following substances are likewise found in all normal urines : silica, free lactic acid, fluoride of calcium, hydro- chlorate of ammonia, acetate of ammonia, albumine, gelatine, and ben- zoic acid. 2. BRIGHT'S DISEASE OF THE KIDNEY. Synonyms.—Albuminuria.—Acute desquamative nephritis. (Johnson.)—Renal cachexia. (Wood).—Albuminous nephritis.—Granular degeneration of the kidneys.— Fatty degeneration of the kidneys.— Wrcemia. In 1837 the attention of the medical public was first seriously directed to this malady by Dr. Bright, of London. Although a few previous 22 diseases of the sanguinous function. writers had vaguely alluded to the disease, and thrown out some hints with regard to its probable nature, yet to Dr. Bright belongs the credit of having first presented to the profession a systematic and moderately accurate description of the symptomatic and pathological phenomena of the disease. We adhere to the term " Bright's disease" to designate the malady, because not one of the other names applied to it conveys a just impression of its actual nature. The prime cause, the ultimate essence of the malady is not located in the kidneys, but in the blood itself, in the form of retained effete matter from diseases, from the pre- sence of noxious drugs, from checked perspiration, &c. So long as these poisons remain in the blood, its normal condition is disturbed, and the entire organism suffers. Nature, always kindly in her instincts, always on the qui vive to sustain the integrity of the delicate organi- zation over which she has been placed in charge by the Great Archi- tect, strives to eliminate all disturbing agents through one or more of the natural emunctories of the body; and she always selects the most appropriate channels to throw off each deleterious substance. As examples we cite the following: When the poison of variola has infected the blood, the skin is selected as the eliminator, and the energies of the system are concentrated to throw out upon this part, suppurating pustules loaded with the escap- ing poison of small-pox. The copious discharges from the pocks usually suffice to relieve the blood of its morbid constituent, and thus enable the system to return to a normal state. But in some instances the pustules fail to perform their full duties as eliminators, the kidneys are called into requisition as auxiliaries, and, as a consequence, renal inflammation is sometimes the result. In the case of scarlatina poison, the most important eliminators are the skin- and the mucous membrane of the throat and intestinal canal. When the poison is intense, and the natural recuperative forces are feeble, these parts fail to perform their offices efficiently, and an extra amount of labor devolves upon the kidneys. During the passage of this poison through the tubuli uriniferi, an inflammatory congestion is produced, which prevents the Malphighian corpuscles and the epithelial cells of the tubes from separating from the blood normal urine, and permits the passage of albumen, fibrin, and other abnormal constituents. In measles, erysipelas, and other cutaneous disorders similar con- ditions not unfrequently obtain. So likewise in many other conditions of the system; in scrofula, psora, constitutional syphilis, the presence in the blood of poisonous substances, like mercury, phosphorus, turpen- tine, copaiba, and other drugs, retained perspiration from the action of cold, &c, the kidneys may become inflamed in their efforts to eliminate these noxious influences. During this process of elimination, if the bright's disease of the kidney. 23 poison is directed towards the skin, eruptions and cutaneous inflam- mations of various kinds may result; if it is attracted to the bowels a diarrhoea will occur; if to the liver, hepatic inflammation will ensue ; if it passes out of the blood through the kidneys, we shall have the usual phenomena of acute desquamative nephritis, with a rapid production and detachment of the epithelial cells of the convoluted tubes, inflam- mation of the Malphighian bodies, exudation of serum, fibrin, &c. When renal inflammation results from any of the causes cited, it can only be regarded as an effect of the action of the passing irritant. To this effect medical men at present direct their chief attention, almost regardless of the more deep-seated and vital derangements which originate the complaint. In a therapeutical point of view the dis- tinction we have described is important in guiding the medical man to a more comprehensive and efficient mode of treatment. Bright's disease may originate from other causes than those enume- rated. In our own practice we have on several occasions met with both acute and chronic forms of the malady, which were clearly trace- able to irritable bladder, and other chronic affections of this organ. In several of these instances incontinence of urine (especially noctur- nal) had existed for years previously to the renal attacks. It is highly probable that long-continued sympathetic irritation of the kidneys from urethral strictures, cystic calculi, and other causes of similar character, may eventually give rise to the complaint under certain circumstances. In a monograph recently published in Paris, entitled " La Fievre Jaune de La Nouvelle-Orleans," by our friend A. J. F. Cartier, M. D., it is stated that albumen is often found in the urines of yellow-fever patients, during the second and third stages of the malady. Dr. Cartier has personally verified this statement in several instances. Does not this fact go far to prove that the immediate cause of yellow fever is a blood-poison, introduced from without, the tendency of which is to pro- duce a rapid decomposition of the blood, with consequent functional derangement of nearly all the organs, and finally exudation of serum into the stomach, black vomit, general prostration and death, unless the poison be eliminated during the first stage of the malady, through the pores, the kidneys, and other emunctories ? A confirmation of thia view consists in the fact, that when the cutaneous, renal and hepatic se- cretions are kept in uniform and steady action from the outset of the disease, recovery invariably results. Albuminous urine has often been detected in cases of cholera as- phyxia, and in ship, hospital and other typhoid fevers. In these examples, as in the cutaneous maladies enumerated, the blood is con- taminated with specific morbid poisons, and during the reaction of the vital force to eliminate them, the kidneys become inflamed. One of the most common and characteristic phenomena connected 24 diseases of the sangudnous function. with Bright's disease consists in the presence of albumen in the urine; and from this circumstance it has received, from Martin Solon, the ap- pellation of albuminuria. A symptom no less common, consists in the retention of urea in the blood; from which fact other writers have em- ployed the word urmmia to designate the malady. Others still regard the complaint as dependent not only upon a depraved condition of the blood, but of the entire organism; and, in accordance with this view, Professor Wood, of Philadelphia, has presented us with the term renal cachexia, to express the disease as a unit. Another constant phenome- non connected with the disorder is a more or less rapid production and detachment of the epithelial cells of the tubuli uriniferi; in con- sequence of which Dr. Johnson has named it desquamative nephritis. From the uniform presence of albumen in the urine Bayer employs the term albuminous nephritis. One form of the disease superinduces granular formations in the kidneys, from which the designation granular degeneration of the kidneys is derived by Dr. Christison. Another variety appears to be connected with waxy deposits, and these cir- cumstances have given rise to the terms fatty and waxy degeneration of the kidneys. When we reflect that the kidneys are effected only secondarily, and that all of the conditions we have cited are only isolated symptoms of quite different primary and deep-seated causes, we shall perceive that not one of the terms which have hitherto been employed to express the malady as a unit is strictly appropriate. For this reason, and until a more just and comprehensive appellation shall be devised, we shall still adhere to the original designation of Brighfs disease. A majority of authors have made a general division of the malady into the acute and chronic forms. This general arrangement we shall adopt in the present article, although we agree with Valleix " that it is impossible to say, precisely, what are the symptoms which corres- pond particularly to the three forms admitted by Bright, or to the three degrees of Christison, or to the jive varieties of Martin Solon, or rather all of the symptoms of the malady corresponding indifferently to these forms, to these degrees, to these varieties." A single division has a real importance in pathology, like that which has been estab- lished by M. Rayer. This author has described an acute and a chronic albuminous nephritis. The first corresponds to the two first of the six anatomical forms admitted by M. Rayer, and the second to the four last.—Guide du Medicin Practicien, par F. S. P. Valleix, p. 100. Acute Form.—Acute desquamative nephritis is the appellation given to this affection by# Dr. George Johnson of London. The con- voluted tubules which compose the cortical portion of the kidneys are primarily and chiefly involved in this form of the disease, although the Malphighian corpuscles and the entire gland ultimately become con- BRIGHT'S DISEASE OF THE KIDNEY. 25 gested and somewhat enlarged. The most notable results of this in- flammatory congestion are: albuminous urine, retention of urea in the blood, and dropsical effusions. Symptoms of the Disease.—Rigors or chilliness, followed by febrile reaction; hot and dry skin, rapid and full pulse, thirst, dryness of the mouth aud throat; pain in the region of the kidneys, often extending to the groins, thighs, penis, and testicles, and tenderness of the kidneys on pressure; irritation at the neck of the bladder, and sometimes at the extremity of the urethra, giving rise to frequent desire to urinate, especially during the night; scanty, red, or smoky urine; loss of appe- tite, nausea, and sometimes vomiting, with other symptoms of gastric disturbance ; dull or acute pains in the head and limbs ; restlessness and lassitude. These phenomena are speedily succeeded by puffiness of the eye-lids and face, oedematous swellings of the body and limbs, and dropsical effusions into the serous cavities, more or less extensive. The pleura is exceedingly prone to become involved in the morbid action and to throw into its cavity undue quantities of serum, in con- sequence of which we often observe distressing paroxysms of rapid and difficult respiration, and palpitation of the heart from the slightest exertion. In all forms of the complaint these paroxysms are quite apt to recur at regular periods—usually every evening and night, and to continue for several hours with distressing severity. Urine.—Much diminished in quantity and sometimes almost entirely suppressed, usually red, from admixture with blood, or cloudy and turbid, of a specific gravity from 1,016 to 1,025. If the urine be placed in a watch-glass and slowly heated by a spirit lamp to the boiling point, an albuminous precipitate will be discovered; or, if a few drops of nitric-acid be carefully added to a small quantity of urine, the albuminous cloud appears and is soon precipitated. When both of these tests develop the precipitate, we may safely count on the presence of albumen in the urine. Under the miscroscope, the urinary sediment reveals coagulated' fibrin, " epithelial casts," epithelial cells, blood globules, and fibrinous casts from the inflamed urinary tubes. After the disease has con- tinued for two or three weeks, Dr. Johnson has sometimes observed oil-globules in the epithelial cells and on the surface of the epithelial casts. These appearances do not appear to be connected with fatty degeneration of the kidneys, and is deemed amenable to remedial measures, provided the oil-globules are in small quantities compared with the epithelial casts. Johnson asserts that this condition is far more common in adults than in children. Not unfrequently uric-acid crystals are observed in these urinary sediments, but they do not occur with sufficient uniformity to be regarded as peculiar to the disease. 26 diseases of the sanguinous function. The above symptoms, if promptly met with suitable remedies, may terminate in complete resolution and a restoration of the organs to a normal condition, or they may partially subside into a sub-acute inflam- matory condition, which may eventuate in one of the chronic forms ol the malady; or, if the acute symptoms continue to progress unchecked until a certain amount of urea has accumulated in the blood, chronic poisoning will ensue, and drowsiness, headache, general failure ot mental and physical power, stupor, and convulsions will terminate lile. Morbid Anatomy.----If a section of the kidney be made, it will be found somewhat enlarged, heavier than natural, soft, congested and bloody. The cortical portion is infiltrated with a dark, turbid fluid, and the blood-vessels are distended with a still darker fluid. Other dark spots from ecchymoses are observed in the tissue of the gland. (Rokitansky.) The cortical substance is usually thickened to the amount of half an inch. {Rayer) The pyramids are also involved and their blood-vessels are distended with dark blood. The natural dark- red color of the healthy organ is changed to a still deeper hue, and is dotted throughout its substance with the congested and dark Mal- phighian bodies. The convoluted tubuli are distended with detached epithelial cells, and are abnormally opaque. The fascia propria and the mucous membrane of the calices and pelvis are thickened, and their vessels injected with a brownish-red blood. Causes.—By far the most frequent direct cause of the affection con- sists in the passage through the Malphighian corpuscles and the secret- ing tubes of the cortex, of effete and excrementitious matters derived from the blood. In the present state of knowledge it is impossible to determine the number of diseases which are caused or are connected with deterioration or contamination of the blood, and which give rise secondarily to renal affections during the efforts of the recuperative forces to eliminate them through the urinary organs. It is highly probable, however, that many more maladies than have hitherto been .enumerated may safely be added to the list. Retained effete matters from checked perspiration, whether arising from exposure to cold or from other causes, is a common cause of acute nephritis. A less frequent, but by no means an uncommon cause of the disease, may be found in the elimination from the blood of poisonous drugs which have been administered by old-school physicians. Nearly all the resinous diuretics, like Copaibae, Turpentine, and Cubebs, as well as most other diuretics, like Nitrate and Hydriodate of Potassse, Digi- talis, Apocynum-cannabinum, Petroleum, Cantharides, and the like, are capable of producing so much irritation in their passage through the secretory tubes of the kidneys, even in small quantities, as to produce albuminous urine. A similar effect has been observed from the elimina- bright's disease of the kidney. 27 tion of Mercury, Arsenic, and other mineral substances from the blood. The abuse of alcoholic liquors, particularly those which are adulte- rated, is mentioned as a cause of the disorder. Long-continued inflammation of the neck of the bladder, from stricture, enlarged prostate, calculi, &c, occasionally tend to develop albuminous nephritis from sympathetic irritation. Several cases of this description have fallen under our own observation. Mechanical injuries over the renal region may superinduce this variety of nephritis in scrofulous, syphilitic, gouty, and other subjects predisposed to the complaint. Prognosis.—In forming an opinion respecting the probable result of acute albuminous nephritis, it is necessary to regard the actual con- dition of the patient and the nature of the exciting cause. When it occurs in healthy persons, and is dependent on exposure to cold, or humidity, or abuse of spirituous liquors, diuretics or other drugs, or the elimination of effete matters during the later periods of mild diseases, 'we may generally count on a favorable issue, provided suitable remedial measures have been promptly adopted. But when it appears as a sequence to malignant scarlatina, erysi- pelas, typhus, yellow fever, or cholera-asphyxia, and the system of the patient is much contaminated and reduced from previous disease, the prognosis must always be regarded as doubtful, and often positively unfavorable. A scrofulous, psoric or gouty diathesis, constitutional syphilis, and cancerous, mercurial and arsenical cachexias are always unfavorable concomitants in this affection. Chronic Forms of Bright's Disease.—Many attempts have been made to group together certain phenomena, and to classify them as characteristic indicators of the various forms of Bright's disease. Pathology, chemistry, and microscopy have all been called into re- quisition as aids in determining this classification, but the subject is still involved in much doubt and confusion. Many eminent continental physicians, like Frerichs and Reinhardt, regard the different forms of the disease as successive stages of one primary inflammatory con- gestion ; the first link in the chain being inflammatory congestion, the second inflammatory exudation, and the third absorption. English and American writers for the most part recognize the existence of these stages, but deny that they have any necessary connection with each other. They assert that each of these forms is often met with as an in- dependent malady, and without any previously existing acute disease either in the kidneys or elsewhere. This argument, however, loses its force when we reflect that acute desquamative nephritis sometimes 28 DISEASES OF THE SANGUINOUS FUNCTION. runs its course with symptoms so mild as scarcely to attract attention. Thus a cold, with slight febrile symptoms, high-colored urine, and tenderness and pain in the lumbar region may occur repeatedly with- out exciting a suspicion of kidney disorder; and yet these very symp- toms may be dependent on inflammatory congestion of the kidneys. It is so common a circumstance for patients to be troubled with what is vulgarly termed " crick in the back" during the existence of severe colds, that nearly all pains in this region are included under this general appellation, and are passed by unheeded. In this manner the first stage of Bright's disease often remains undiagnosed, and the more chronic stage of exudation gradually and insidiously establishes itself. How few there are who cannot recall one or more attacks of cold, with febrile reaction, scanty and red urine, nausea, and pain in the loins; and yet one of these unheeded attacks may constitute the first stage of this formidable disorder. In several instances we have met with chronic albuminuria in in- dividuals who were confident that they had never suffered from any af- fection of the kidneys; but who, after minute examination and careful reflection, have been able to call to mind previous attacks similar in character to acute desquamative nephritis. Adopting the views of Frerichs and Reinhardt, we proceed to describe— The Second Stage of Bright's Disease.—Upon the supposition that §11 forms of chronic Bright's disease have been preceded by one or more inflammations of the cortical substance of the kidneys, we sub- mit the following additional remarks: It is a well-established fact that many serious chronic maladies are but sequences, more or less remote, of previous acute inflammations. Thus many cases of uterine displacements, fibrinous depositions upon the utero-genital structure, hypertrophies of mouth and neck of the uterus, and chronic ovarian disorders are distinctly traceable to pre- vious inflammatory conditions of these tissues. These inflammations, either from negligence on the parts of patients, or insufficient medical treatment, are only partially subdued, and are allowed to subside into sub-acute or chronic states, and thus to remain as nuclei for the action of any future morbid exciting causes. One of the most common results of all acute inflammations is an exudation into, or upon the affected tissue, with a consequent thickening or hypertrophy. This may super- induce morbid irritations; or it may continue to exist for months or years almost unnoticed, when perhaps, some additional exciting cause will develop a new and more serious train of symptoms. A pneumonia may run through its course and leave the patient well, with the exception of one or more points of hepatization. A future ex- citing cause, perhaps years afterwards, may develop in the affected parts softening and consumption. The first inflammation sows the bright's disease of the kidney. 29 seeds, and a later exciting cause germinates them into a fatal chronic degeneration. So in the nephritic disorder, a primary inflammation, but partially subdued, leaves the renal tissue thickened and obstructed by an exuded foreign substance; and the organ is placed in a condition to become readily affected by any future noxious influence that may be brought to bear upon it. This renal infiltration may be gradually and imper- ceptibly absorbed, or it may remain stationary for a long period with- out producing any serious inconvenience, or a second acute inflam- mation may be re-established, or the future elimination of some dele- terious substance from the blood through the oppressed gland may de- velop one of the chronic forms of renal degeneration. The kind of de- generation will be determined by the nature of the exciting cause, and the constitutional and acquired peculiarities of each case—some con- stitutions favoring the development of granulations, some fatty de- generations, others waxy or scrofulous degenerations, &c. Treatment of Acute Desquamative Nephritis, or the First Stage of Brighfs Disease. Aconite.—Symptoms. Chilliness, followed by general heat, rapid and full pulse, thirst, dry skin and tongue, nausea, vomiting, loss of appetite, general restlessness ; pains in the head, back, and limbs; pains in the loins ; sensitiveness in the renal region ; numbness in the small of the back, extending as far as the lower limbs ; restless and sleepless during the night; scanty, bright-red, hot urine without sedi- ment ; urine very scanty and turbid; retention of urine, with pressure in the bladder, or stitches in the region of the kidneys ; enuresis, some- times accompanied with profuse sweat, with diarrhoea and colic; face red or pale, and puffy. Gastric and Abdominal Phenomena.—Pressure in the stomach and hypochondria, accompanied with paroxysms of shortness of breath, and even asthmatic symptoms ; nausea and inclination to vomit—espe- cially in the pit of the stomach ; vomiting, with nausea, thirst, general heat, profuse sweat, and enuresis ; inflammation of the bowels ; perito- nitis ; the abdomen swollen and distended as in dropsy; ascites; diar- rhoea, with enuresis and colic. Pneumonic and Pleuritic Phenomena.—Shortness of breath, es- pecially when sleeping, after midnight, or when rising from the recum- bent posture ; paroxysms of suffocation, with anxiety, and aggravation of all the sufferings in the evening ; asthmatic complaints ; pneumonia and pleuritis in their first stages, with active febrile symptoms. Cardiac Phenomena.—Palpitation of the heart, with great anguish and difficult respiration; carditis ; palpitation of the heart, with op- pressive#aching in the cardiac region. Cerebral Phenomena.—Fullness and pressure in the head; head- 30 diseases of the sanguinous function. aches—stinging, beating, or lancinating, or contractive, with dullness of the intellect, and, finafiy, convulsions or coma. All of the symptoms are worse in the evening; pains particularly intolerable at night, and disappear for the most part when sitting; many of the symptoms appear in the evening, or early in the morning; ailments arising from colds. Pathology.—Kidneys gorged with blood; congestion of the kid- neys ; face puffy and bloated ; abdomen distended ; effusion of yeltew serum into the abdominal cavity. Clinical Remarks.—At the commencement of this malady Aconite is often a useful remedy. Its influence upon the nervous and circula- tory systems, which are always more or less seriously involved, should induce us to examine it among our first remedies. Nor is it alone use- ful against the febrile reaction of the first days of the disorder; but it possesses strong homoeopathic relations with pneumonic, pleuritic, car- diac, gastro-intestinal, cerebral, and rheumatic complications. It does not, indeed, deserve a place as a direct specific in any form of the disease; but, as a modifier and controller of many troublesome acces- sory symptoms of a febrile character, it will be held in high estimation. Among the symptoms which pertain to this form of the malady is a persistent dryness of the skin. There are but few remedies more ho- moeopathic to this condition than Aconite. Ammonium-carbonicum.—Symptoms. Chilliness, followed by fe- verish symptoms, which are especially troublesome in the evening and during the night; with nausea, pressure at the stomach and chest, eructations, thirst, restlessness, and sleeplessness ; dull, bruised, or shooting pains in the region of the kidneys; pains in the loins, in- creased by walking; violent throbbing pain in the small of the back and loins, when at rest; drawing pain from the small of the back to the thighs ; dull pain, extending from the loins and hips to the abdo- men ; face red and bloated, or pale and bloated ; drowsiness in the daytime ; weary, disturbed, and unrefreshing sleep ; mind dull and con- fused ; extreme lassitude and sense of fatigue ; spasmodic twitchings in the arms, hands, and legs. Gastric Phenomena.—Nausea, pressure at the stomach and chest, eructations, thirst; pressure at the pit of the stomach, nausea, and oppression after eating ; weakness of digestion. Thoracic Phenomena.—Dyspnoea and palpitation of the heart after every exertion ; difficult breathing at night; painful oppression of the chest; pressure at the chest, with nausea, thirst, and feverish symptoms. Cerebral and Nervous Phenomena.—Involuntary twitchings of the muscles of the arms, hands, and other parts of the body; impaired bright's disease of the kidney. 31 memory; dullness of intellect; convulsions (from injection into the veins). Urine.—Very red, turbid, and foetid; frequent urging to urinate, with scanty emission, especially at night; cloudy reddish urine mixed with blood ; involuntary emissions of urine at night; urine mostly cloudy, whey-like, very ammoniacal and musty; discharge of urine leaving chalky spots ; symptoms worse in the evening and in the open air. Pathology.—The morbid changes which this substance produces in the kidneys have not as yet been investigated. Seybert asserts that it operates specifically upon the capsules of the kidneys. From the renal pains, and the marked changes of the urine, which have been observed during its exhibition, it may be inferred that it also acts spe- cifically upon the kidneys themselves. Under its use the body becomes much emaciated, and the muscles soft and flabby. Clinical Remarks.—This remedy is indicated after the febrile symptoms have somewhat subsided, and symptoms of uraemic blood- poisoning obtain. Among the symptoms which particularly point to Ammonia are the following : pale and bloated face ; extreme lassitude ; mind dull and stupid ; dull pains in the loins ; frequent and scanty urination ; urine red and turbid, or light and cloudy; gastric disor- ders ; dyspnoea, oppression of the chest, and palpitation of the heart after exertion; involuntary twitchings of the muscles ; convulsions; coma. Apis-mellifica.—Symptoms. (Edematous swellings of the face and extremities ; paleness of the face ; face red and swollen ; febrile symptoms, with headache, pain in the loins, gastric derangement, hurried and difficult respiration; pain and soreness in the region of the kidneys on pressure or on stooping; constant dull pains in both kidneys, with a very small secretion of red urine; short, rapid, and anxious breathing at night; difficult and anxious respiration ; repeated micturition every few minutes ; frequent and painful urging to urinate, with scanty discharges of urine mixed with blood; burning in the urethra before and after micturition ; frequent and copious discharges of urine. Pathology.—From its marked effect upon the quantity and quality of the urinary secretion, and the renal pains to which it gives rise, we infer that it operates specifically upon the kidneys, and produces mor- bid alterations in them analogous to those of inflammation and conges- tion. At present we are not in possession of any pathological facts with reference to its action upon the kidneys, and must therefore con- tent ourselves with inferences derived from pathogenetic and therapeu- tical observations. Clinical Remarks.—We have employed this medicine with benefit 32 diseases of the sanguinous function. in all forms of Bright's kidney. In the acute variety we regard the fol- lowing phenomena as especially indicative of Apis ; moderate febrile symptoms, with pains in the head, back, limbs ; thirst; restlessness; nausea; short, rapid, difficult, and anxious respiration: cedematous swellings of the face and extremities ; ascites ; oedema pulmonahs; hydrocephalus; frequent urination, with small, red, and turbid dis- charges. • Against albuminuria following scarlatina it is one of our most im- portant and frequently-indicated remedies. Drs. Madden, Munger, and Barker have reported a number of cases of post-scarlatinal dropsies, with albuminous urine, cured with the third dilution. We have been informed by Dr. B. F. Joslin, Sr., that he has cured two cases of acute albuminous nephritis with Apis : one in a man thirty-five years of age, which supervened during convalescence from a typhoid fever; and the other in a girl of six or seven years of age, which probably originated from a cold. The treatment in both in- stances was commenced with pellets saturated with the tincture, fol- lowed by the sixth, then the twelfth, and, finally, thirtieth dilution. The best effects followed the use of the last-named attenuation. Apocynum-cannabinum.—Symptoms. Slight fever, with thirst, dry mouth and tongue, headache, nausea, dull pains in the region of the kidneys and in the legs, flatulent distention of the bowels, diarrhoea, restlessness, scanty urine, rapid and oppressed respiration. Pathology.—All admit the specific action of this drug upon the kidneys, but we are not in possession of any facts which enable us to determine the kind of morbid alteration which it produces. But, from the few pathogenetic symptoms which have been published, we infer that it gives rise to an inflammatory congestion of the secreting tubules of the cortex. Clinical Remarks.—At an early period of the malady, before the epithelial linings of the tubuli uriniferi have become extensively in- jured and detached from the basement membranes, this medicine may be prescribed with advantage. Its specific impression under such cir- cumstances, both upon the blood and upon the renal tubules, may be of such a character as to arrest the further progress of the disease in some instances. By some its influence is supposed to be purely me- chanical—stimulating the tubules to an augmented secretion, and thus relieving the system of any existing excess of serum; but it is by no means improbable that future provers may experience dynamic effects having important homoeopathic relations to the more interior and vital phenomena of Bright's disease. Several physicians have alluded to its efficiency in removing dropsi- cal effusions consequent upon acute and chronic albuminuria; and in bright's disease of the kidney. 33 some instances where the renal attack is slight, and the epithelium is not much impaired, it will accomplish all that is claimed for it by these gentlemen. Arsenicum-album.—Symptoms. Chilliness, followed by dry heat of skin, thirst, headache, backache, great restlessness, violent pains, oppression and burning in the stomach, nausea; short, rapid, and diffi- cult respiration ; oedema of the face and ankles ; languor; weakness ; pain and trembling of the limbs ; anxiety; confusion of ideas ; vertigo; yellow, red, or livid countenance ; general feeling of malaise; conges- tion of the kidneys; frequent desire to urinate ; scanty, red, dense, albuminous, and bloody urine ; general anasarca. Gastro-Intestinal Phenomena.—Nausea, retching, vomiting; severe pains in the stomach and pit of the stomach—burning, or pressing, or spasmodic, or gnawing, or tearing, worse after eating and on pressure; distention of the stomach ; abdomen distended; spasmodic, or cut- ting, or burning pains in the abdomen, with heat, thirst, and loose- ness of the bowels ; flatulent distention of the abdomen ; ascites ; diar- rhoea, with frequent and painful micturition. Pulmonary and Cardiac Phenomena.—Suffocative oppression and arrest of breathing at night, or in the evening in bed; anxious and oppressive shortness of breath on walking, or on making any exertion; shortness of breath and short hacking cough, increased by exercise and worse at night; palpitation of the heart, particularly at night; pulsations irregular, with anguish and oppression of the chest; dropsy of the chest, with its usual concomitant symptoms. Cerebral and Nervous Phenomena.—Fits of anguish,, with great weakness and tremulousness of the body; involuntary spasmodic twitch- ings of various parts of the body; trembling of the limbs 'T general loss of strength ; tetanic spasms ; epileptic convulsions ; coma. Urine.—Congestion of the kidneys; urine scanty, high-colored, dense, albuminous, depositing blood-disks and casts of uriniferous tubes of the kidneys, and death from tetanic spasms {Jackson, of Edin- burgh) . Frequent painful and difficult micturition ; urinary secretion diminished; suppression of urine {Christison). Urine scanty, acid, and high-colored ; renal colic extending towards the bladder, and then vesical tenesmus; urine sometimes increased and sometimes dimin- ished ; frequent urging to urinate, compelling him to rise during the night; involuntary micturition, even at night during sleep ; diminished discharge of red urine, with burning; urine turbid, dark brown, and depositing a slimy sediment. Pathology.—Kidneys enlarged and congested 'r kidneys look like tallow; thick, turbid, purulent urine in the pelvis of the kidneys ; in experiments on cats Dr. Quaglio found in the bladder greenish yellow urine containing a large amount of albumen, fat-globules, and debris Vol. ii.—3 34 DISEASES OF THE SANGUINOUS FUNCTION. of the epithelium of the urinary tubes; reaction neutral-urea, uric acid and chloride of soda notably less; kidneys double the natural size, greatly congested, especially the cortical portion which was brown-red, hard, and augmented in diameter; the cut surface exuded a red and viscid liquor. The Malphighian bodies were streaked with red and congested; the glandules filled with blood; the tubes of Bellini filled with fibrinous clots, dotted with sanguineous globules. Other samples of urine contained cylinders of fibrine, fat-globules, and albumen; diminution of urates, renal capsule slightly adherent, cortical substance yellow and friable, fibrinous exudations and fat-globules issuing from the openings of the canaliculi, their epithelium altered and filled with fat. In another case, the kidneys were enlarged, slightly hardened, but with a smooth and glossy surface ; many tubes of the Malphighian pyramids filled with fibrin. In another case, the urine in the bladder was clear and yellow, containing fat-globules; crystals of uric acid and oxalates and the debris of epithelium of Bellini's tubes. In the kid- neys, whose capsules were easily detached, there was the same fatty degeneration of the epithelium; other tubes were deprived of their epithelium; the greater part of the canaliculi were enlarged in such a manner as to form granulations upon the surface of the kidneys." {Ex- periments of Dr. Quaglio, on cats, with Arsenite of Potassce, see North Am. Horn. Jour., No. XXVIL, p. 660.) Clinical Remarks.—Arsenicum appears to correspond in a remark- able manner to several stages of Bright's disease. Its pathogenetic and pathological phenomena probably bear a closer resemblance to the symptoms and morbid appearances of Bright's kidney, than those of any other medicine. In its action upon the convoluted tubes of the cortex, it actually gives rise to inflammatory congestion, a detachment of epithelium, depositions of fatty and oily matter in the epithelial cells of the convoluted tubes of the cortex, it actually gives rise to inflam- matory congestion, a detachment of epithelium, depositions of fatty and oily matter in the epithelial cells of the convoluted tubes, and to so much derangement of function as to lead to a retention in the blood of urea, uric-acid, and other proper salts of urine, and to the escape of albumen from the blood, through the Malphighian bodies into the urinary tubes and bladder There is likewise an equally remarkable analogy between many of the secondary and constitutional symptoms of Bright's disease and those of Arsenicum. Both superinduce general anasarca, ascites, hy- drothorax. Both produce inflammation of the pericardium, and of the structures of the heart, with their accompanying disturbances. Both cause general emaciation, pallor of the skin, and a gradual diminution of vital force. Both induce inflammation of the meninges of the brain, effusions of serum into the ventricles, spasms, convulsions, coma. BRIGHT'S DISEASE OF THE KIDNEY. 35 In view of this intimate homoeopathic relation between this drug and acute Bright's kidney, we have prescribed it in several instances, after the employment of Aconite, and usually with marked success. We have used the third, sixth, twelfth, and thirtieth dilutions, and have wit- nessed prompt and unequivocally good results from all of them. And when we remember how extensively the minute capillary apparatus of the renal structures are implicated in the acute form of the malady, and how essential it is that the atoms of the remedy should bear directly upon these infinitesimally small vessels, we shall not wonder that minute atoms penetrate farther, and operate more beneficially than crude atoms of the same medicine. Asparagus-officinalis.—Symptoms.—Moderate febrile reaction, with a sense of fatigue and somnolence, especially at about three o'clock, p. m. ; general increase of heat with slightly accelerated pulse; rapid and irregular pulsations of the heart especially on exercising; slight pains in the kidneys during the afternoon; pains in the kidneys just under the false ribs; frequent and painful micturition; urine scanty, brown and without sediment; frequent desire to urinate ; haematuria; urine limpid and exhaling an odor sui-generis; yawning and somno- lency ; symptoms worse from motion. Pathology.—We are not aware that any observations have ever been reported touching the morbid alterations of the kidneys induced by this medicine. From the pathogenesis, it may be inferred that its action upon the convoluted tubes is only slight and transient. Clinical Remarks.—This remedy may sometimes be indicated, after the more acute symptoms have been subdued by.Aconite, Mercurius, Kali, Arsenicum, and other potent remedies. When the urine is still scanty, and slightly dark, and the patient is restless and hot in the af- ternoon and evening, with lassitude, somnolence, and slight pains in the renal region on moving about, a few doses of the third dilution will be likely to prove beneficial. Cannabis-indica.—In the cerebral complications which so often ac- company this malady, whether in the form of occular illusions, wander- ing, or partial delirium, mental obtuseness, or exhilaration, spasmodic twitchings, or actual convulsions, this is one of our most important re- medies. I have recently witnessed a most excellent cure of an ap- parently almost hopeless case of uraemic convulsions (post scarlatinal) with this remedy. LTnder the persistent use of the remedy at the first dilution, for four days, the convulsions gradually ceased, the urine be- came abundant and natural in color—having lost all the traces of al- bumen, blood-globules, and other abnormal appearances. We regard Cannabis-indica as the most valuable of all other me- dicines in the convulsions consequent on this disease. Copaiyje-balsamum.—Symptoms.—Chilliness in the forenoon, fol- 36 DISEASES OF THE SANGUINOUS FUNCTION. lowed by febrile symptoms in the afternoon; dull and sometimes spas- modic pains in the lumbar region; gastric derangement; nausea,vomit- ing, bitter taste, burning pain in the stomach, colic, diarrhoea; difficult respiration and palpitation of the heart on making any exertion; diur- nal somnolence; vertigo; dull pain in the head; spasmodic attacks in various parts of the body; pale and sickly appearance ; frequent desire to urinate ; urine scanty and passed drop by drop ; retention of urine ; burning pain on urinating; foaming urine; balsamic or violet odor to the urine; general languor and uneasiness; involuntary trembling, and moving the extremities, head and trunk. Pathology.—Albumen has occasionally been detected in the urines of patients who have been under the influence of Balsam-copaiv* for a considerable period. And, simultaneously with this appearance of albumen, there has usually been a diminution of the proper salts of the urine. From these circumstances it is reasonable to suppose that the medicine operates specifically upon the epithelial cells of the tubuh uriniferi, and, perhaps, the Malphighian bodies, producing in them a kind of inflammatory congestion. Clinical Remarks.—It would seem to be homoeopathic to those cases of post-scarlatinal dropsies occurring after an imperfect develop- ment, or an abrupt repulsion of the rash. Its well-known action upon the skin in developing an eruption similar in appearance to that of scarlatina, affords an additional circumstance in its favor as a remedy in these cases. Cannabis-sativa.—Symptoms.—Chills, fever, violent thirst; drink- ing causes tremor, shaking, coldness of the hands, knees, and feet, and distortion of the face ; diurnal somnolence ; disturbed nocturnal sleep ; dull, lancinating pains—slow and intermitting—in the left side of the back, under the last rib ; pulling pain in the renal region, extending to the inguinal glands, with sensation of malaise at the pit of the stomach ; obtuseness of mind; impaired memory; confusion of ideas ; pain and congested feeling in the head ; great weariness and weakness; nausea, vomiting; pains and spasmodic pressure in the stomach ; tetanic spasms of the upper limb and trunk; frequent desire to urinate, with tenesmus, sometimes accompanied with burning pains; urine red and turbid; urine filamentous, as if mixed with pus; painful and scanty discharge of bloody urine. Pathology.—Pus in the left kidney, not far below the pelvis. Clinical Remarks.—Cannabis will often be found useful in cases, which have been preceded by irritation of the neck of the bladder, ir- ritable bladder, strictures, &c. It is highly probable that the secreting tubes of the kidneys occasionally become inflamed and congested in consequence of long-continued and severe irritation in the bladder; and BRIGHT S DISEASE OF THE KIDNEY. 37 it is in such cases that Cannabis, Cantharides, Apis, and the like, will be likely to cover the totality of the symptoms. Our experience with this class of remedies, in the malady under con- sideration, is in favor of the third dilution and upwards. Cantharis-vesicatorum.—Symptoms.—Chilliness, followed by fever, with headache, pains in the back and limbs, thirst, dryness of the mouth, anxiety, frequent pulse, scanty and red urine ; face red, animated, hot, and burning; face and neck swollen, and eyes prominent; face pale or yellowish, thin and sickly; lips peeled, tongue denuded of epithelium, soft palate, of a deep-brown color; lips, tongue, and pharynx covered with vesicles; ptyalism; delirium; loss of consciousness; great forget- fulness; dozing, semi-stupid mood, indifference to surrounding objects; headache, vertigo, sensation of weight in the head, sensation of numb- ness and pressure in the head; tearing, lancinating, and burning pains in different parts of the head; dull, pressive, lancinating, or burning pains in the kidneys, sometimes extending to the abdomen and thighs, and accompanied with urethra and hypogastrium; inflammation of the kidneys ; nephritis and haematuria; general dropsy; anasarca; anasarca and ascites; attacks of convulsions; frequent convulsive movements ; intense headache and chills, convulsions and coma ; convulsive move- ments, cold sweat, agony, and death; frightful convulsions and death at the end of two days, {the post-mortem revealed deep ulcerations of the stomach, intestines, kidneys and bladder); gastric derangement, nausea, vomiting, pains of a burning, contractive, pressing, or lancinat- ing character in the stomach ; flatulent distention of the stomach and bowels; acute, burning pains in the umbilical region; colic, followed by diarrhoea; violent diarrhoea, with persistent burning pain at the anus; laborious respiration; accelerated and difficult respiration; spasmodic cough; palpitation of the heart; frequent desire to urinate, with vesical pain ; strangury ; urine bloody and passing off drop by drop ; urine scanty and dark ; urine very red and covered with a black pellicle; urine bloody, small in quantity, and vesical tenesmus; sup- pression of urine ; retention of urine, with great desire to urinate ; re- tention of urine in cholera; haematuria; general weakness; heat and sense of excoriation in all the cavities of the body. Pathology.—Redness of the medullary substance of the kidneys; redness of the pelvis of the kidneys and of the ureters; ulceration of the kidneys; suppuration of the kidneys; kidneys red and inflamed; vivid redness of the medullary substance. Clinical Remarks.—Like Cannabis, this remedy is especially ap- propriate in nephritic affections which have been preceded, or which are accompanied by cystic or urethral inflammation. We have already observed, that Bright's disease is not unfrequently preceded and ac- companied by strictures of the urethra, irritable bladder, and irritation 38 DISEASES OF THE SANGUINOUS FUNCTION. of the neck of the bladder; and that these maladies occasionally operate as exciting causes of the former affection. As a general rule, Aconite may precede this medicine with advantage to subdue the more acute symptoms; after which Cantharis may often be consulted with benefit. By referring to the above pathogenesis, it will be observed that it pos- sesses many phenomena pertaining to each form of albuminuria. Renal pains, scanty and high-colored urine, frequent micturition, and general excitement of the vascular and nervous systems, indicate its applica- bility in acute nephritis; while paleness and puffiness of the face, anasarca, dropsical effusions, dozing, semi-stupid mood, short and diffi- cult respiration, palpitation of the heart, gastro-intestinal derangements, great debility and lassitude, spasmodic twitchings, convulsions, and coma point to it as a remedy in many groups pertaining to the chronic forms of the disease. We were formerly in the habit of employing the first or second dilu- tion in water in these cases, but an enlarged experience has demon- strated the superiority of the more attenuated preparations of the drug- Digitalis-purpurea.—Symptoms.—Febrile symptoms slight; fever- ish shiverings, alternating with transient flushes of heat, accelerated pulse, and moderate tendency to perspiration; anasarca; general dropsy; general paleness of the skin: pale face; swelling of the cheeks and lips; general weakness; swelling of the feet in the day- time, going off at night. Renal Phenomena.—Bruised pain in the region of the kidneys when stooping or moving about; tearing pains and sharp stitches in the small of the back during motion. Gastro-intestinal Phenomena: white coat upon the tongue; ptyalism; nausea; vomiting; burning, or lancinating, or pressing, or spasmodic pains in the stomach; great sense of weakness in the stomach; contractive, or pressing, or cutting, or pinching, or cramp- like pains in the abdomen; light-colored diarrhoeic stools; ascites. Cardiac Phenomena: pulse frequent, (primary effect), and abnor- mally slow and weak, (second effect); organic affection of the heart (principally of the left side) especially hypertrophy, with or without enlargement of the left ventricle ; dropsy of the pericardium • ascites and anasarca, with organic affections of the heart, after scarlet fever. Asthmatic respiration and palpitation of the heart, especially when walking. Cerebral Phenomena: dullness of the head; difficulty in concentrat- ing the mind; vertigo and trembling; pressing, burning, or lancinating pains in the vertex and forehead; drowsiness; lethargy; uneasy, unre- freshing sleep ; sleep disturbed by frequent desire to urinate; general dullness of mind and inertia; spasms ; violent convulsions: convulsive bright's disease of the kidney. 39 motions and involuntary twitchings of the cheeks, and af the fingers and thumbs. Urine: continual desire to urinate, only a little at a time, of a dark brown color, and hot and burning on passing; frequent desire to urinate during the night; excessive emission of urine day and night with great exhaustion; enuresis succeeded by retention of urine; sleep disturbed from frequent desire to urinate. Clinical Remarks.—Supposed to act best upon blondes with soft and lax muscles, or upon scrofulous subjects, or upon persons of phlegmatic or sanguine temperaments. This medicine operates speci- fically not only upon the kidneys, but also upon the circulation, redu- cing the frequency and force of the pulse, and thus diminishing undue febrile action. It is, therefore, often appropriate at the outset of acute Bright's disease, either alone, or in alternation with Aconite. Rilliet and Barthez commend it highly in Bright's disease of children. These gentlemen report two cures of the chronic variety, in boys of eight and nine years of age. {Maladies des Infans, vol. 2, p. 51.) " They both took Digitalis for several days consecutively, with evident action both on the pulse and urine. The pulse considerably diminished in frequency, the urine became at the same time more copious, the anasarca disappeared, and the urine lost all traces of albumen." These gentlemen advise the persistent use of the vapor bath in con- junction with the internal use of Digitalis. Our knowledge respecting its pathogenesis and pathology is as yet quite limited and imperfect, yet its action upon the urinary glands is so prompt and specific as to render it worthy of attention in all cases of Bright's kidney. Kali-nitricum.— Symptoms: Violent chilliness, with trembling of the whole body; coldness in the afternoon or evening, with pain in the vertex; shuddering in the evening, followed by heat and sweat, with- out thirst; heat and sweat over the whole body; chilliness, heat and sweat in alternation; inflammatory conditions, with full, hard, and quick pulse.—Drowsiness ; dull, heavy, pressing pains in the head ; pulse re- duced to sixty per minute ; gastric and intestinal disturbances ; foetid breath; thirst, without appetite ; eructations, nausea, heartburn, vomit- ing ; pain and pressure of the stomach; spasms of the stomach; burn- ing, heaviness, fullness, faintness at the stomach; distention, fullness, and cutting or drawing pains in the abdomen; diarrhoea; difficult and oppressed breathing on ascending a stairs; violent palpitation of the heart, in the night, when lying on the back, or on the right side, or when moving about quickly; pain in the small of the back, in any posi- tion, continuing the whole day and night, or in the morning on waking, or in the evening, or during the night—of a bruised, or pressing, or crampy, or burning character; spasmodic, painless jerkings of the fingers, hands, and other parts of the body; sudden swelling of the 40 diseases of the sanguinous function. body, neck, tnd thighs; convulsions ; symptoms worse at night in bed ; diminished secretion of urine; frequent desire to urinate, which con- tinues through the night; increase of urine, with reddish deposits, or with a mucous sediment; frequent emission of a pale, turbid urine, urine of a specific gravity of 1030 to 1040; salts of the urine greatly increased. Pathology.—During its rapid passage through the tubuli uriniferi, it must of necessity stimulate them more or less, and eventually super- induce an inflammation, and probably an exudation into the renal tissue. Clinical Remarks.—Our attention was first called to this medicine as a remedy in Bright's kidney, by Dr. Warner, of Buffalo. This gentleman, and his partner, have been in the habit of employing it in suitable cases, for many years, and with highly satisfactory results. If we mistake not, these gentlemen have cured several well-marked cases of granulated kidney with the medium attenuation of this drug. We record our experience of its decided utility in both the acute and chronic forms of the malady, when there are: distressing paroxysms of difficult and rapid respiration, occurring during the evening and night, and diminishing towards morning, considerable gastric derange- ment, spasmodic pains at the pit of the stomach, short, hacking cough during the night, persistent, dull, bruised pains in the renal region. In such groups, we have often observed prompt and decided improvement from the use of the thirtieth attenuation. Kali-hydriodicum.—Symptoms: Chilliness, with drowsiness, com- mencing at the lower part of the back, and extending upwards and through the body; chilliness, with dryness of the mouth and thirst, in the evening; flushes of heat, with dullness of the head and malaise in the body; heat, followed by sweat in the afternoon; frequent attacks of dullness and heaviness of the head; general feeling of malaise; oedema of the eye-lids; face pale and swollen; dyspnoea; dry, hacking cough, with oppressed breathing; pleuritis; burning pain in the pit of the stomach; restless and confused sleep ; bruised pains in the small of the back, particularly troublesome at night; violent pain in the small of the back constantly; darting pains in the small of the back when sitting; nightly urination ; blood-red urine ; painful urging to urinate ; discharge of mucus from the urethra. Pathology.—From the fact that this drug, when taken internally, is rapidly eliminated through the kidneys, it may be inferred that it is capable of producing more or less irritation and congestion of the tubuli uriniferi. We know that it causes enlargement of the sub- maxillary glands, and infiltration of the surrounding cellular tissue, and it is not at all improbable that similar effects are produced upon the kidneys. bright's disease of the kidney. 41 Clinical Remarks.—We have found this remedy most frequently in- dicated towards the termination of the acute stage of the malady, after the inflammatory congestion of the renal tubes had in a great measure subsided, leaving the parts more or less thickened and infiltrated with lymph or fibrinous matters. If the case has been preceded or accom- panied by rheumatism or gout, the indications for its employment will, for the most part, be still stronger. When the renal affection is de- pendent upon a scrofulous diathesis, or upon the presence in the system of Mercury, or of syphilitic contamination, this medicine is a remedy of much value. Like Carbonate of Ammonia, it possesses the property of preventing coagulation of blood, albumen, fibrin, and milk, and of re- dissolving them when coagulated. Mercurius-subllmatus-corrosivus.—Symptoms. Febrile symp- toms not strongly pronounced; irregular febrile reaction; feeling of heat and anxiety, which prevents sleep at night; frequent, small, quick, feeble, tremulous pulse ; slow, nervous, febrile conditions, with profuse Sweats and great debility ; chilliness and colic pains on motion ; swell- ing and redness of the face ; coated tongue, fetid breath, ptyalism; nausea, vomiting, violent, tearing, or burning, or pressing, or gnawing, or darting pains in the stomach ; diarrhoeic stools ; pains in the head, back, and limbs ; shortness of breath, oppression of the chest, rapid and difficult breathing, excessive dyspnoea, palpitation of the heart; headache, drowsiness, and anxiety; general condition of anasarca, ana- sarca of the face and limbs, face red and swollen; periodical convul- sive movements of the facial muscles, arms, and feet, constant trembling and spasms of the limbs, convulsions, general insensibility; scanty red urine, which is passed with difficulty; suppression of urine ; urine red, scanty, and albuminous ; increased secretion of light and albuminous urine. Pathology.—Kidneys enlarged and congested ; cortical portion of the kidneys much thickened and of a deep-red color. Clinical Remarks.—Twenty years ago Martin Solon advised the employment of Mercury, both internally and externally, as a remedy in Bright's disease. Since the publication of Solon's work on Albu- minarie, there has been a great diversity of opinion with regard to the value of mercurial preparations, some opposing their use on the ground that they are capable of exciting inflammation of the kidneys de novo, and of giving rise to albuminous urine, thus rendering them injurious in cases where the organ is already suffering from inflammation; while others, like Wood,* commend them in all forms of the disease, except fatty degenerations and scrofulous or cachectic complications. Guided by an unerring therapeutical law the homoeopathist is not Prac. Med.,1' Vol. II, p. 584. 42 . diseases of the sanguinous function. subjected to the conflicting opinions and practices of the empinca schools. The very reasons which cause doubt and confusion in the minds of our opponents, viz., the direct local action of Mercury upon the renal glands, the production of albuminous urine, and other phe- nomena of Bright's disease, determine the homceopathist in his selection of it as the remedy. In the doses employed by the allopathist, it is not surprising that a drug having such decided homoeopathic relations with this malady, should be productive of harm rather than benefit. As large and crude doses of Belladonna or Opium would do injury in acute cerebral inflammations, so must large and crude doses of Mercury aggravate seriously acute renal affections. But in the attenuated doses of homoeopathy, the results are most happy—the delicate impressions produced not unfrequently arresting the progress of this grave dis- order. In addition to the specific influence which several of the mer- curial preparations exert upon the kidneys, we may take into account their attenuating effects upon the blood and their power of promoting absorption of plastic exudations into the parenchyma of the organ. We have found it most frequently applicable in that form of the com- plaint, termed large white kidneys, (stage of inflammatory exudation), and prescribed in attenuations ranging from the third to the twelfth. Mercurius-iodatus.—Symptoms.—Shuddering succeeded by slight febrile reaction—hot and dry skin, dull pains in the head and back, restlessness, dryness of the mouth, thirst, morbid excitability of the nervous system, fetid breath, putrid or coppery taste, general anasar- cous condition of the entire body, glandular enlargements about the neck, paroxysms of rapid and difficult respiration, and pleuritic pains in the chest, bilious or dysenteric discharges from the bowels, scanty, red and hot urine; urine scanty and loaded with solid constituents, dull pain in the region of the kidneys. Pathology.—In the absence of any definite facts with regard to the morbid alterations produced by this substance in the kidneys, we can only infer that changes are induced similar to those referable to the action of Mercurius-sublimatus-corrosivus. Both Iodine and Mercury administered separately, operate specifically upon the entire glandular system, superinducing inflammation, congestion and plastic exudations, and there is no reason to suppose that when in a state of chemical union, these peculiar properties are destroyed. Climcal Remarks.—Unfortunately there has not yet appeared a respectable proving of this valuable medicine. Even the few patho- genetic phenomena which we have recorded have been derived from observations during its administration in other maladies. But ab usu in marbis, we infer that it is one of our most valuable remedies in several forms of the disease under consideration. Especially in those forms which appear to be connected with scrofula, and constitutional bright's disease of the kidney. , 43 syphilis, it must always hold a high rank as a remedy. When the af- fection is complicated with hypertrophies, or hepatic disorders, it is also strongly indicated.—The lower attenuations of this medicine have proved most efficient in our practice. Mercurius-solubilis.—Symptoms.—Nightly febrile paroxysms; in the evening and night, chilliness, followed by heat of skin, restlessness, frequent emissions of urine, and involuntary jerking, twitching, and tossing of the head and limbs, during sleep ; chilliness and heat alter- nating, especially in the face, back, chest and arms ; febrile symptoms, with profuse perspiration; chilliness, followed by heat, and violent thirst; febrile paroxysms, cnaracterized by a predominance of chilly sensations, sweats, and general feeling oft. malaise; drowsiness in the day-time and sleeplessness at night; general weakness, languor, and lassitude; puffiness of the face; dropsical swellings of the feet and legs; ascites; fetid breath; tongue coated with a white fur and some- what swollen; nausea, increased by eating; bitter vomiting; great sensitiveness and painfulness at the pit of the stomach, particularly to the touch; shortness of breath and dyspnoea, especially on ascending a stairs or in walking; stitching or burning pains in the chest; bruised, or cramp-like, or stitching pain in the small of the back ; visible twitch- ings of the fingers and hands; frequent desire to urinate, with scanty discharge; frequent desire to urinate during the night; scanty, fiery- red urine; urine dark-red or brown; urine turbid, even while leaving the urethra, and depositing a sediment; floculent discharges at the end of urination; symptoms worse during the night. Pathology.—We are not aware that any examples are recorded il- lustrative of the morbid changes superinduced in the kidneys by this mercurial preparation; but from its pathogenetic and therapeutical action upon the system, it would seem to resemble the other prepara- tions of Mercury in producing renal disorders. Clinical Remarks.—It has been found most useful in cases of Bright's kidney, which have been accompanied with secondary sy- philis, diarrhoea, and dysentery. Terebinthina.—Symptoms.—Rigors, succeeded by feverish heat throughout the whole body, pulse hard and frequent, headache, red face, pain in the back, thirst, and sensation of dryness of the mucous mem- brane; dropsy.; anasarca; ascites; general languor and loss of strength; drowsiness ; confusion of ideas, relieved by copious and rapid micturi- tion ; dyspnoea; difficult and laborious respiration, as if from congestion of the lungs; aching pain in the left kidney; pressure in the kidneys when sitting, going off during motion; sensation of heaviness and pain in the region of the kidneys; pain and feeling of increased warmth in the kidneys ; fleeting drawing in the right kidney, and thence proceed- ing to the right hip ; violent burning, drawing pains in the region of 44 diseases of the sanguinous function. the kidneys; urine scanty,red, and sometimes bloody; scanty and red, or clear and profuse urine; complete suppression of urine ; the urine deposits a thick, muddy, light-yellow sediment, like wine, and has the smell of violets; the urine deposits a slimy sediment twelve hours after micturition ; haematuria; profuse menstruation; albuminous urine. Pathology.—Inflammation and congestion of the cortical portion of the kidneys; kidneys somewhat enlarged, softened, and of a dark- red color, (on animals). Clinical Remarks.—Professor Henderson has cured several cases of both acute and chronic albuminuria with this medicine. Several medical gentlemen of our acquaintance are in the habit of using it as their principal remedy in the acute form of the disease, and commend it in the highest terms. We have found the second dilution of this remedy of eminent service in many cases of both acute and chronic albuminuria. It will be ob- served that we have designated the second dilution. A large experience in this malady, with almost every strength of the medicine, has con- vinced us, that the best results can be obtained from this dilution. We regard Terebinthina as one of the very best remedies in Bright's disease. 3. CHRONIC DESQUAMATIVE NEPHRITIS. (Johnson) Second Stage of Brighfs Disease. Inflammatory Exudation. (Frerichs.) Large White Kidney. This form of the disease not unfrequently exists for many months without attracting any special attention, and without any apparent renal symptoms. We have known cases to advance within a few days of a fatal termination with no abnormal phenomena except slight pallor of the skin, lassitude, and the occasional occurrence of dyspeptic symp- toms. In allusion to the insidious manner in which it sometimes becomes fully established, Dr. Johnson remarks as follows :* "A reference to case No. 13, will show that a patient may go to bed apparently in good health, and without having experienced any symptoms which had led him to suspect that his kidneys were unsound. In the nio-ht he is seized with symptoms of suppression of urine, and of severe abdominal inflammation. After an illness of a few hours he dies, and his kidneys are found to be so far disorganized by a disease, evidently of a chronic nature, that the wonder is, not that they ceased to act when they did, but that they had continued to discharge their functions so long. '•'Again, in case No. 14, there was precisely the same disorganization of the kidneys as in the instance just alluded to. The patient was *" Diseases of the Kidney,'' pages 170 and 171. bright's disease of the kidney. 45 seized, after a slight indisposition, with palsy of one side, followed bv complete insensibility, which soon ended in death. There was no ap- pearance in the brain which would explain the symptoms, but the kid- neys were in precisely the same state of chronic disease as those in the case just alluded to. The bladder was empty; no urine had been passed for several hours before death; and the patient's friends had often noticed that his urine was scanty, but he had appeared to be in tolerable health, and his medical attendant was not consulted before the last fatal attack." These slight ailments may continue for an indefinite period—usually from two to eight months, when shortness of breath is observed after ascending a stairs, or other exertion, either accompanied or soon suc- ceeded by the following symptoms : pale and waxen appearance of the skin ; considerable emaciation; oedematous condition of the face, limbs and often of the entire body ; usually some tenderness in the region of the kidneys on pressure, though this symptom is sometimes {always according to Becquerel) absent; dull aching pains in the lumbar re- gion are occasionally, but by no means generally, present; frequent desire to pass water, especially during the night; gastric, intestinal, cardiac, and pulmonary disorders are quite prone to obtain; rapid and difficult respiration on making the slightest exertion, and often very distressing paroxysmal attacks occurring every evening and night, lasting from ten to fifteen hours, and rendering it impossible to retain a recumbent position for an instant during a paroxysm; de- bility ; nausea; occasional vomiting; urine variable in quantity, color, and chemical and microscopical characters (See below); drowsiness ; obtuseness of the mental faculties; convulsions; coma and death. During the course of the disorder, a great variety of symptoms, not strictly pertaining to the malady, are often observed. Among these we have noticed, burning heat in the head, particularly on the vertex, relieved by copious applications of Bay-rum, Cologne, &c.; a peculiar white appearance upon the tongue, mostly on the sides and under part, looking as if it had been par-boiled,—sometimes accompanied Avith burning, smarting, and soreness of the furred part, appearing and dis- appearing, and generally accompanied with an amelioration of the other symptoms during its continuance, and for a short period after its dis- appearance ; putrid, sickening odor of the breath; pulse sometimes frequent; weak and irregular (in cardiac complications), and at other times normal in frequency and volume; spasmodic twitchings of the muscles of different parts of the body, usually worse at night; severe paroxysms of pain at the pit of the stomach, apparently of a spasmodic character. Johnson alludes to the frequent occurrence of nose-bleed- ing and menorrhagia, and believes them to be in some way connected with the renal affection. 46 DISEASES OF THE SANGUINOUS FUNCTION. Becquerel asserts that the disease has usually the following three modes of commencement: a. Chills, fever, vomiting, lumbar pains, pulmonary congestion, cough, rales, dyspnoea. b. Fever and infiltration, which shows itself in all parts of the body at once. This mode of attack he considers most frequent. c. The disease advances stealthily, and would remain unknown even though mortal, without an examination of the urine. Alterations of the Urine,—In quantity it is variable—usually more abundant than in health, but sometimes less. In color it is mostly light, or colorless, varying from a smoky water-color to a dirty brown hue. It very rarely contains blood-globules, but when it does the urine assumes the color of dirty broth. Its density is less than that of the acute form, although greater than that of normal urine. The specific gravity varies from 1005 to 1015. It has an acid reaction, and the usual tests precipitate albumen. By the microscope we may detect epithelial cells, amorphous granu- lar fragments, granular epithelial cylinders (the fall of the epithelial sheaths of the tubuli), termed by Dr. Johnson "granular casts," and in a very few instances, blood-globules. These blood-globules, according to Johnson, become more unfrequent the farther the disease advances from the acute stage, until in the third stage (small contracted kidneys) they are never to be found. Robin asserts that epithelial cylinders are occasionally found in normal urine, so that these appearances alone would not determine the existence of Bright's Kidney. Becquerel supposes that the quantity of albumen in these urines varies from toW __LJL_ 1 u U U< Prominent Concomitant, or Secondary Phenomena. Dropsy.— As soon as the normal epithelium of the convoluted tubes has become so far degenerated and disintegrated as to be incapable of separating from the blood urea, uric-acid, and the other normal solids of the urine, they accumulate in undue quantities in the blood, and nature strives to eliminate them through other channels—the skin, the serous-mem- branes, the intestines, the lungs, the liver, and all other available out- lets. During these vicarious processes of elimination, the capillaries of the tissues acted on, become obstructed, and their circulation im- peded in such a manner as to permit exudations of serum through their walls, and thus dropsical effusions in various parts of the body. At the same time the congested Malphighian bodies allow the escape of undue quantities of serum, thus causing disalbumination of the blood from the normal standard of 70 or ru!o to 10 and even ToW. It is evident then that two morbid conditions constitute the most direct causes of dropsical effusions,—by retention of excrementitious urinary constituents and disalbuminution of the blood. Further on we shall BRIGHT'S DISEASE OF THE KIDNEY. 47 again allude to this subject. Dropsy is not invariably present in this form of the disease, especially when the renal secretion is abundant, or when there are frequent and copious discharges from the bowels, by which the poisonous blood accumulations may be evacuated. In other instances the constitution appears to possess the power to resist for a long time the deleterious action of the retained urinary constituents, without the supervention of dropsy or other troublesome symptoms. But in general, nature asserts her rights, and opens every available channel in order to expel the noxious matters from the vital fluid, even at the risk of irritating, and of producing serous effusions from these new and unused tissues of elimination. The water appears to accumu- late in one or another place without apparent cause. Perhaps it is earlier and oftener observed in the face than elsewhere; and in pa- tients of active habits wre generally find infiltration of the limbs and ascites. Effusion into the cavity of the chest is an early and rather frequent result of this disease ; but we very rarely meet with ventricu- lar dropsy. The composition of the infiltrated water is the same as that of the serum of the blood diluted with much water. Of one thousand parts, the solid constituents constitute only from ten to fifteen parts, instead of eighty to one thousand, as in the serum, and forty to fifty to one thousand, as in affections of the heart. In health, the proportion of albumen in the blood is from seventy or eighty to one thousand parts. In acute desquamative nephritis, the proportion is reduced below i"i, at which point infiltration must occur. In the chronic forms this disalbuminution must be still greater, to give rise to dropsy. These dropsical accumulations sometimes become so extensive as to cause very serious inconvenience, and not unfrequently danger to life. Pleural, ventricular and peritoneal effusions are the most dangerous. Infiltrations of the extremities and of the scrotum often become very extensive and troublesome ; but they may be readily and safely relieved by delicate scarifications. We have often adopted this mode of tempo- rary alleviation, and always with success and safety. Respiratory Apparatus.—Among the vicarious channels for the elimination of the excrementitious renal accumulations in the blood are the pulmonary structures. In the act of elimination the capillaries of the pleura, the pericardium and of the cellular structure of the lungs often become engorged, and effusions more or less extensive occur. Some of the first symptoms, therefore, which arrest the attention of both patient and physician, are shortness of breath, increased to a painful extent from the slightest exertion, and a sense of oppression throughout the entire thoracic region. In the first instance there is only pulmonary oedema with effusion into the air-cells of the lungs; but 48 DISEASES OF THE SANGUINOUS FUNCTION. in more advanced stages of the disorder, large and dangerous accumu- lations occur in the thoracic cavity. In robust and plethoric indi- viduals, pneumonias and bronchial affections are likely to be superin- duced. In scrofulous subjects hemoptysis and tubercular consumption are not unfrequently developed. We have already alluded to the periodical recurrence of evening and nightly paroxysms of dyspnoea. This symptom has been observed in both the second and third stages of the malady. It usually commences in the afternoon and evening, and continues with such severity as to prevent the patient from taking a moment's rest in the recumbent pos- ture, until some time in the morning, when there is generally a remission for a few hours. During the existence of this stage, if the patient takes cold, or is subjected to the influence of a cold and humid atmosphere, pleurisy or pericarditis may occur; although these attacks are far more common in the stage of absorption. Albumen has often been detected in the urines of children suffering from membranous croup. The rationale of this phenomena has not yet been fully explained. Digestive Apparatus.—Another channel for the elimination of the retained urinary excrements, is the gastro-intestinal mucous mem- brane. The influence exerted upon the stomach is two-fold; first in the form of irritation of the gastric mucous membrane, and consequent symptoms of indigestion, like nausea, occasional vomit- ing, eructations, acidity, flatulent distention, heart-burn, oppression, gastric sensitiveness, &c, and secondly upon the nervous apparatus of the stomach, producing a train of severe neuralgic symptoms. The stomach sometimes becomes so seriously involved that the mucous membrane becomes thickened, softened, and in rare instances, ulcerated to a considerable extent. Severe paroxysms of neuralgic pains—usu- ally at the pit of the stomach, are not an unfrequent attendant upon the malady. We have known cases run through the entire second and third stages to a fatal issue, with scarcely a pain or other unpleasant symptom, except those which have been referred to the stomach—some- times by both patient and physician. The action of the urea, ammonia, &c, upon the intestinal mucous membrane produces flatulency, sensitiveness of the bowels, and diarrhoea • and post-mortem examinations now and then reveal redness ulcerations and softening of portions of this structure. Bernard detected ammonia in large quantities in the stomachs and intestines of dogs whose kidneys had been extirpated. This ammonia is supposed to arise from the conversion of urea, either in the blood- vessels or in the digestive canal, from contact with the secretions it here meets with. BRIGHT'S DISEASE OF THE KIDNEY. 49 Brain and Nervous System.—Drowsiness, convulsions, and coma usually terminate the life of the patient. These symptoms approach gradually and increase in intensity for a period varying from a few hours to several days, when convulsions or complete coma extinguish life. In two instances we have noticed the frequent occurrence of involun- tary spasmodic twitchings in various parts of the body. These attacks are somewhat painful, mostly confined to special parts, but sometimes affecting several portions of the system at once. As a general rule, cerebral lesions are not found in these cases, not- withstanding the very grave character of this complication. The direct cause of these cerebral phenomena is uraemic, or according to Frerichs, ammoniacal contact with the cerebral tissues, or serous effusion into the ventricles. The immediate effect of uraamic or ammoniacal poisoning upon the cerebral and nervous tissues, is to impair their vitality and to depress their ordinary manifestations. This is evident from the insidious ap- proach and progress of the symptoms; general indifference to sur- rounding objects; somnolence ; slowness of speech ; the patient is with difficulty roused to a full appreciation of what is transpiring around him, and seems to fall asleep in the midst of a conversation, with his eyes open; deep and slow respiration; temporary confusion of ideas ; sluggish performance of all the functions. Cardiac Complications.—At an early period, Dr. Bright observed that an intimate connection existed between granular kidney and heart- disease. He supposed that the eardiac affections were for the most part due either to the stimulant action of the poisoned blood upon the heart itself, or upon the capillary circulation, affecting it in such a manner " as to render greater action necessary to force the blood through the distant subdivisions of the vascular system." Johnson, Rees, and other eminent English writers adopt the latter explanation. Hypertrophy and dilatation are the most common organic changes of the heart super-induced, or connected with chronic desquamative nephritis. And from the circumstance that valvular lesions are quite uncommon in these cases, it has been inferred that the abnormal blood constituents in their continual passage through the heart have stimu- lated its muscular structure into hypertrophy or dilatation. When the renal malady exists in gouty or rheumatic subjects, we shall sometimes find valvular lesions, fibrous depositions, and other serious organic changes which had been produced by these maladies before the existence of the kidney-disorder. Such instances render cases still more complicated and dangerous, both from the local and remote symptoms to which they give rise. It is highly probable that the kidneys and the heart often become affected simultaneously, and voi. n.-4. 50 DISEASES OF THE SANGUINOUS FUNCTION. from the same cause, in individuals suffering from gout. The action of the excessive quantity of uric acid, the urates, &c, in their constant passage through the heart, producing organic changes in this organ, and during their elimination through the kidneys, congestion of the tubuli uriniferi. In examples of this kind, both organs are affected with equal promptness and severity, and they should both receive prompt and efficient attention from the physician. Hepatic and Spleenic Complications.—These organs sometimes become involved during the existence of renal disease. For reasons similar to those which obtain in the production of pulmonary, gastric, cerebral and cardiac affections, the liver, and in all probability, the spleen take on morbid actions of various kinds, according to the con- stitutional, or acquired peculiarities of patients. Examinations of the alvine discharges during the progress of albuminuria, always indicate more or less disorder of the hepatic secretion. And if the same at- tention were to be given to the minute changes caused by the retained urinary excrements upon the liver and its secretion as has been be- stowed upon the kidneys and the urine, we have no doubt that much additional light would be thrown upon the intimate nature of the malady; and that many morbid conditions which are at present in- explicable could be satisfactorily explained. In the act of circulation the blood-poison is constantly brought into contact with almost all parts of the organism, and operates simultaneously upon those organs and tissues with which it has affinities—as for example, the kidneys, the skin, the liver, the lungs, the digestive apparatus, the serous membranes, &c. The results of these impressions are derangements of function or organic lesions, according to the amount of retained foreign matters in the blood, the nature and importance of the tissues involved, and the constitutional peculiarities of patients. And as a disordered function of one organ is often compensated for by extra and vicarious labors of other organs, a mutual morbid reaction is established between various tissues of the body for the general good. Each structure strives to ex- pel the noxious invader, each shares the general danger, and each re- ceives more or less injury. Johnson asserts that the liver is affected in a large proportion of cases of chronic nephritis, and assigns as a reason the frequent common origin of the two diseases, viz., high living and intemperance in the use of alcoholic liquors. This gentleman re- gards cirrhosis as the most common hepatic complication in these cases, although he has occasionally met with contraction and induration of the liver, with its usual concomitant ascites. Rheumatic and Gouty Complications.—The frequent occurrence of chronic nephritis in gouty subjects has been noticed by many writers. Upon the supposition that the renal affection was always associated with, and dependent upon a gouty diathesis, Dr. Todd gave to the third bright's disease of the kidney. 51 stage of the malady the designation of Gouty Kidney. This hypothe- sis of Dr. Todd is doubtless erroneous ; but it is nevertheless true that the same abnormal blood constituents which produce the phenomena of gout, are also capable, under favorable circumstances, of developing desquamative renal disease. But as this is only one of many cases possessing similar powers, the designation of Dr. Todd is manifestly inappropriate. The renal affection is by far the most common in those cases of gout which appear to be associated with chronic eruptive dis- ease, especially porrigo and eczema. The skin and the kidneys are the two chief eliminators of the morbid blood-constituents, in both gout and rheumatism; and it is for this reason that we so often find cuta- neous and renal complications in old cases of this description. The passage of the urates, uric acid, &c, through the cutaneous capillaries obstructs and retards their action, rendering them incapable of throw- ing off the effete matters presented to them, and thus causing the ac- cumulating matters to force their way out of the blood, in the form of vesicular or pustular eruptions. In passing through the kidneys the same substances often cause chronic nephritis. When brought in contact with the smaller joints they give rise to gout. Less frequently the renal affection has been associated with chronic rheumatism, and for the same reasons as those just adduced with reference to gout. Uterine Complications.—Of eleven cases of chronic albuminuria in females which have come under my observation, all but one had sup- pression of the menses during the continuance of the disease. This exceptional one had frequent and exhausting attacks of menorrhagia, which contributed much to hasten a fatal result. Johnson, while al- luding to the general absence of the menses in these cases, has observed ♦menorrhagia in so many instances as to deem the circumstance worthy of special mention. Not unfrequently a sudden check to menstruation is the first link in the morbid chain of symptoms, which lead to al- buminuria; and it is not impossible that a vicarious menstruation through the kidneys may in some instances develop in them the malady in question. Rayer suggests that the constant drain from the blood of its haematosin, induces such a condition of anaemia as to arrest men struation from pure lack of vitality necessary to sustain this function. Alterations of the Blood.—In estimating the composition of the blood in albuminuria, regard must be had, firstly, to the primary causes of the blood-contamination, and, secondly to their effects upon the kidneys, and the further alterations of the blood from renal obstruction. If the original blood-poison be one of a transient nature and easy of elimination, the issue will probably be favorable; but if the primary cause is of a chronic character, persistent, deep-seated, readily reproduced, and diffi- cult of removal, our opinion respecting the final result must be unfavorable. In the first category may be included retained perspiration, scarlatinal, 52 diseases of the sanguinous function. erysipelatous, typhoid, choleraic, alcoholic, and other similar agencies; while in the latter class we may place chronic gout and rheumatism, certain chronic cutaneous affections,, constitutional syphilis, scrofula, incurable hepatic, cardiac, and pulmonary disorders, deleterious drugs, &c. Healthy blood may be said to consist of three separate elements, viz: 1, the red glo b ides, suspended in their colorless liquor; 2, f'brine; 8, serum, composed of albumen dissolved in alkaline water. Besides these principal elements it contains phosphates of magnesia, ammonia, and lime, lactates of soda and magnesia, and common salt. The analy- sis of Dumas of 1000 parts of healthy blood gives 790 of water, 127 of globules, 3 of fibrine, and 80 of solid constituents of the serum, of which 8 are inorganic. Any material alteration of these normal con- stituents induces more or less derangement of the general health ; and the presence of either of these elements in the urine is a sure indication of serious renal lesion. So any addition to the blood of substances foreign to it, must of necessity give rise to more or less disturbance, according to the nature of the contaminating agent. The most pro- minent alterations of the blood in chronic Bright's disease are, defi- ciency of albumen in the serum, which is usually of low density, great diminution of the red globules, and the retention of certain urinary ex- crements—urea, uric acid, and the several retained salts of the urine. Andral and Gavarret made five analyses of the blood in many different cases of the disease, and with the following average result: of 1000 parts of blood, they found a considerable increase of water (837-l in place of 790; nearly the natural quantity of fibrine (2*7 in place of 3); a marked diminution of the red globules (91*8 in place of 127) ; a not- able diminution of the solid matters of the serum, and especially of albumen (68*4 in place of 80). Until a recent date it has been supposed that most of the secondary morbid phenomena incident to this affection, were due to the presence of urea in the blood, and to the action of 'this substance upon the various tissues of the organism. From this hypothesis the malady has received the designation of uramia. But the experiments of Frerichs have placed this matter in a new light. This gentleman denies that the blood-poisoning is due to urea, but attributes it to carbonate of ammonia, which has been formed from this substance within the blood- vessels. He infers this from the following circumstances: ammoniacal odor of the breath; chemical indications of ammonia in the breath; traces of ammonia in the alvine discharges, and in several secretions of the body—the perspiration, bile, and certain mucous and serous se- cretions ; and an abnormal quantity in the blood, (of which it is a natural constituent, and serving to retain it in a fluid state). As an additional confirmation of this view Frericks adduces the fact bright's disease of tZe kidney. 53 ti-'vt large quantities of urea are sometimes detected in the blood of patients who remain free from all cerebral, and other symptoms, which are supposed to be peculiar to uraemic poisoning. Injections of urea into the blood-vessels of dogs have also been made without producing its supposed characteristic effects upon the organism; while similar in- jections of carbonate of ammonia have speedily induced convulsions. Another circumstance confirmatory of this opinion of Frerichs, may be found in the fact that the pathogenesis of carbonate of ammonia cor- responds very closely with the phenomena of Bright's Disease. The following symptoms from"Jahr's" Symptomen-" codex," page 67, de- monstrate this: "dropsical swellings; the head feels muddled, dull, stupefied; great difficulty of breathing, especially in ascending a few steps, or on making the least exertion; frequent palpitation of the heart; severe dyspeptic symptoms ; great emaciation of the whole body; comatose conditions; convulsions." Both urea and carbonate of ammonia are normal constituents of healthy blood, the latter in all probability being converted from the former by the action of the albu- men of the serum within the blood-vessels, and so long as the proper proportions are maintained, no disturbances or derangements of function occur; but when urea in excess pervades the blood, it is rapidly con- verted into carbonate of ammonia, the blood becomes poisoned, and the Secondary effects of chronic nephritis due to the action of carbonate of ammonia, manifest themselves. When we remember with what facility urea may be converted into carbonate of ammonia by contact vith fermentescible substances like albumen, mucus, and certain al- kalies, and that several of these substances are always present in the blood of patients suffering from albuminuria, the hypothesis of Frerichs will not appear unreasonable. So long as the normal composition of the blood remains unchanged, only the necessary quantity of ammonia to retain it in a fluid state, is converted from the circulating urea; but when this condition becomes changed, and new elements are added to the blood, other affinities occur, new chemical action takes place, in- ordinate quantities of ammonia are formed, and ammoniacal poisoning results. Schetlein and Renling object to this hypothesis, because that am- monia (CO2 Az H3) is expired during the course of many diseases, typhoid fevers, yellow fever, cholera-asphyxia, malignant erysipelas, small-pox, scarlet-fever, and similar maladies, and also in tkie death agony. In these instances the ammoniacal breath is caused by an actual loss of vitality and consequent decomposition of the^ blood, by which the ammonia which holds it in solution, is set free and allowed to escape through the lungs. In chronic nephritis quite a different condition obtains, since there is no actual decomposition of the blood, and no diminution of the normal amount of ammonia; but a constant 54 diseases of the sanguinous function. • £ excess of this substance derived from the retention and conversion 01 urea. Nature strives to eliminate this superfluous agent through the lungs, the intestinal canal, the skin, and perhaps other channels. It is doubtless true that urea also exerts a deleterious influence upon the system when existing in excess in the blood; but its toxical properties are much less important than those of ammonia. Other retained urinary substances are likewise capable of poisoning the blood. Gallois has repeatedly demonstrated this fact with regard to an excess of uric acid in the blood. This agent poisons in a less dose when injected into the blood than when taken by the stomach. It causes acceleration of breathing, trembling of the limbs, jerking of the muscles, subsultus, convulsions, tetanus and death. Pathological Condition of the Kidneys.— The following is an excellent general description of the condition of the kidneys in this form of the disorder. "The kidney is still much larger and heavier than is natural, and smooth on its surface; but the sanguine congestion is diminished, or gone; while the inflammatory exudation into and among the proper tissues of the glands is great and manifest. This exudation, by its presence and its pressure within and around the tubules, empties the capillary vessels of their blood, and keeps them empty. The cortical portion of the kidney, still unduly broad, loses its red color, becomes pale or yellowish, and contrasts more strongly with the red lines of the pyramidal bodies. Gradually the matters exuded suffer further change, and sometimes undergo a fatty degeneration. The tubules lose their uniform cylindrical shape, and bulge a little here and there; their epithelial cells enlarge, become opaque, contain granular matter, and perhaps oil-globules ; finally, they crumble down, and are partly washed away with the aqueous portion of the urine which proceeds from the Malphighian bodies."* The kid- neys are generally enlarged, slightly deformed, and a little augmented in consistence. Granulations on red or grayish ground of the size of millet-seeds, accumulated or isolated, and appearing whiter than the rest of the tissues—more abundant at the two extremities, and towards the outside of both kidneys. The cortex thickens at the expense of the tubular substance. Authors have differed so much respecting the classifications of the various forms of the disease, that some confusion exists in their symp- tomatic and pathological description. Thus, Dr. Bright recognizes three forms or varieties: Martin Solon admits five degrees or varieties: M. Rayer- makes a general division of the malady into acute and chronic albuminous nephritis, and then subdivides these into six other forms—two pertaining to the acute, and four to the chronic stage of * "Watson's Practice of Phys.," p. 1028! bright's disease of the kidney. 55 the disorder: Christison admits only three degrees of the disease, the two first characterized by similar anatomical conditions of the kidneys, viz., a deposit in the cortical substance of a grayish yellow matter, slightly granulated in the first degree, and decidedly so in the second degree, the granular substance resembling cheese, and involving chiefly the cortical substance. He usually found more sanguineous congestion in the first, than in the second degree. In the third or last degree, the morbid deposit gradually invades the remaining tissue of the kidneys, impairing to a greater or less extent their normal structure and functions. By this it will be perceived that Christison recognizes only one kind of morbid change for all of his three degrees, the differences consisting in the extent rather than the kind of morbid action. Bright denies «the existence of any morbid deposit in the first form: but as- serts that the cortical substance is transformed into a granular tissue in the second form. In this second form he always found the kidneys still larger than natural, and that he could render the granulations more distinct by maceration. The third, fourth, and fifth forms of Mr. Rayer, and the second and third degrees of Martin Solon, cor- respond with sufficient accuracy for practical purposes, to the second stages of the English writers. In all instances, the volume and weight of the kidneys are above the normal standard, the red and marbled spots peculiar to the acute form, have diminished or entirely disap- peared, granular deposits are found in the cortical substance, and some- times in the tubular cones, more or less thickening of the mucous membrane of the pelves and calices of the kidneys, the external sur- face of the kidneys is ordinarily of a pale yellow color, but is now and then dotted with milk-white spots, and glossy, or, in a very few cases, with a few brown or slate-colored spots. One of the most direct and important effects of the disease upon the renal glands, is the partial or total destruction of the epithelial lining of the convoluted tubes. During the earlier periods of the affection, the cells are not ordinarily detached in very large quantities, and as these are washed off rapidly by the watery portion of the urine from the Malphighian bodies, the renal function is only moderately disturbed. But after the desquama- tive process has continued for a considerable period, a greater or less accumulation of epithelial cells takes place in the tubes, and they be- come so much choked up and obstructed as to prevent their reformation. In the mean time they become disintegrated, the tubes are distended, pressure is made against the remaining epithelial linings of the tubes and the Malphighian bodies, thus adding an additional cause of irritation to the renal structures. " A microscopic examination shows that some of the tubes become so completely filled by their epithelial contents, that a further formation of cells within them is impossible for want of room, so that the re- 50 diseases of the sangulnous function. production of epithelium appears to be entirely arrested."* After this process of desquamation and disintegration have continued for some time, "the basement membrane of the tube is thus left quite denuded, or with only a few broken particles of epithelium scattered over its sur- face."! Dr. Johnson describes another process by which the tubes become destroyed without any actual desquamation of epithelium. This process is denominated disintegration of the epithelial cells. In the process of desquamation the cells are thrown off from the basement membrane into the convoluted tubes, entire, and are either washed out of the tubes by the watery part of the urine, or accumulate within them to their injury. "Disintegration may occur, however, either in the cells which have accumulated in the tubes after being shed in an entire form by a process of desquamation," or in those still attached to the tubes. "With reference to the two processes, already alluded to," remarks Dr. Johnson, "by which the epithelium becomes disintegrated, I have observed that only the true desquamative process leaves the tubes quite denuded, and that the disintegration of the epithelium, unaccom- panied by desquamation, destroys the tubes without a previous denuding process."......Apparently the most common "result of the destruction of the epithelium, is the gradual wasting of the tube."......" The materials which are occasionally found in the degeneration of the tubes are, first an unorganized fibrinous or albuminous material; second, oil; and third, serum."$ Johnson supposes that this fibrinous or albuminous material is secreted by the basement membrane after the destruction of its epithelial cells." After the convoluted tubes have become denuded by the destruction of their epithelium, they occasionally become dilated into transparent cysts, containing serum, and sometimes thick and discolored liquids. In other and rare instances, some of the denuded tubes become lined with transparent nucleated cells, which are supposed by Johnson, to serve as a substitute for the normal epithelium, and whose office is " to secrete a serous or watery liquid." Respecting the condition of the blood-vessels, they become distended with blood of a vitiated quality, their linings become irritated and thickened, and their entire structures become so enfeebled as to impair or suspend their normal functions. In allusion to this subject Johnson remarks: §"the ap- pearances which I have observed in the blood-vessels are such as in- dicate an impediment to the circulation through the inter-tubular capil- laries, and a consequent increase of pressure upon the vessels which, in the order of the circulation, lie behind these. The Malphighian * ,l Diseases of the Kidney," by Geo. Johnson, p. 212. f L°c- cit- t Johnson. § Diseases of Kidneys, p. 228. bright's disease of the ktdney. 57 capillaries and the arteries have their coats remarkably thickened, while the walls of the inter-tubular capillaries and of the emulgent vein present no appearance of hypertrophy or thickening." "We consider the nature of Bright's disease* to consist in an in- flammatory process, which proceeds from a stage of hyperaemia to one of stasis, and then gives rise to a product, which is not only remarkable by its peculiar character, but which, in well-marked cases, by its ex- cessive accumulation, causes a singular alteration in the appearance and structure of the kidney. It commonly runs, as we have already stated, a chronic course, with occasional exacerbations, but it is some- times acute." The following are among the pathological degenerations observed with the microscope by Kolliker in Bright's disease, f " The membrana propria is frequently thickened to O'OOl, or even 0*002 of a line, when it often presents, on the inner aspect, very delicate, closely approxi- mated, transverse striae. The epithelial cells, particularly in the cortical substance, frequently contain oil-drops in considerable quantity, so as often to present a deceptive resemblance to the cell of a fatty liver, and at the same time they are usually enlarged to a diameter of 0#02 of a line. Together with the oil, pigment granules (of the coloring matter of urine ?) occur in them (also in the straight canals), whereas the concretions of uric acid and calcareous salts, which are so frequently met with in the canals of the tubes in the vertebrata, have not as yet been demonstrated with certainty in the cells themselves. Colloid- like, bright yellow masses are very frequent in the epithelial cells, which then most usually increase in size, dilate into slender cysts as much as 0*05—0*072 of a line long, and finally, by bursting, empty themselves of the colloid substance, whence the latter is found free in the uriniferous ducts, and also in the urine."...... " The Malphighian bodies may also expand into cysts, in which, to- gether with a clear fluid, the atrophied glomerulus is often visible on the wall." "The tubuli uriniferi contain fibrine, in cylindrical masses, corres- ponding to the cavities of the tubules, and also the above-mentioned colloid-like substance ; concretions in the ducts of Bellini, consisting, in the adult, chiefly of carbonate and phosphate of lime: in new-born infants, of uric-acid salts, which give the pyramids a brilliant golden- yellow color, and, if not exclusively, still only occur in children who have already respired (between the third and twentieth day after birth)." Diagnosis and Prognosis.—The principal phenomena which pertain to chronic albuminuria are the following: urine pale and watery, some- * Rokitanski's Path. Anat., Vol. I. p. 155. t Diseases of the Kidneys, p. 228. 58 DISEASES OF THE SANGULNOUS FUNCTION. times slightly turbid, or smoky—usually augmented in quantity of a diminished specific gravity—of an insipid odor resembling beef- broth—persistently frothy on agitation—albuminous—deficient in urea and the normal salts, and containing "granular casts," scattered portions of disintegrated epithelium, and a few entire epithelial cells; oedema of the feet and ankles, afterwards extending to the legs and thighs, and often general infiltration of the cellular tissue, and effusions into the serous cavities; unusual paleness of the skin, in consequence of the poverty of red-globules in the blood; excess of urea, carbonate of am- monia, and urinary salts, and a diminution of albumen and red-globules in the blood; and in a majority of cases dyspeptic symptoms, dryness of the skin, and habitual dyspnoea, especially on making any exertion. From acute albuminuria it may be distinguished by the lighter color of the urine, its greater quantity, its lower specific gravity, the pre- sence of granular casts, and scattered bits of disintegrated epithelium, absence of blood-globules, less renal irritation and pain, less febrile disturbance, and the less rapid progress of the malady. From hepatic, cardiac, and other forms of dropsy, as well as from other maladies having similar symptoms, it may be recognized by the presence of albumen, and disintegrated epithelium in the urine. The prospects of recovery will depend upon the duration and extent of the renal affection, the secondary complications to which it has given rise, and the curability or removal of the acting cause. If the con- voluted tubes have entirely lost their epithelial lining, and other formations have taken their place, like cysts or morbid deposits; or if the tubuli often having been denuded of epithelium, have shrunken and become nearly obliterated, a cure must not be expected. This con- dition will be indicated by the gradual diminution in the urine, of epithelium, the continued absence of urea and the normal urinary salts, the persistent diminution in the density and lightness of color of the urine, paleness of the skin, great emaciation, dropsical infiltrations and effusions, and other secondary ailments. A sudden diminution of the urinary secretion, especially in advanced stages of the disease, indicates immediate danger. The most common and dangerous of these se- condary affections are inflammations of the serous membranes of the thorax, abdomen, and brain, or effusions into their cavities. Of these the cerebral complication is the most alarming, and the one which most frequently terminates life. Next in importance to this are effusions into the pleural and peri-cardial cavities, from whence proceed the distressing paroxysms of dyspnoea and palpitation of the heart which so often afflict the subjects of this malady. When one or more of these serious complications are present, and the abnormal conditions of the urine above alluded to obtain, the prognosis will be unfavorable. But when the exciting cause, is susceptible of ready removal, like BRIGHT^ DISEASE OF THE KIDNEY. 59 abuse of alcoholic liquors, and exposure to a cold and humid atmosphere, and the renal desquamation has not been of long-standing or extensive, a reasonable expectation of cure may be entertained. Valleix in his " Guide du Medecin Practicien" p. 154, presents us with the following diagnostic table. Chronic Bright's Disease. Urine pale, smoky, and having an insipid odor. Its density is diminished ; and it has lost most of its salts and urea. Albumen in considerable quantity, and always present. (Edema almost always commences in the loioer limbs ; and ascites comes after- wards. Other slight symptoms of Bright's dis- ease. Acute oe Cheonic Bright's Disease. No fever (chronic form) or slight fever (acute form.) Dropsy. Never Suppuration, Pain in the kidneys wanting or slight. No painful retraction of the testicles, nor pains in the grandes levres, &c. Albuminous Urine of Bright's Disease. No purulent globules. Urates and phosphates in less quantity than natural. 0 ther symptoms of Bright's disease. No pellicle {cremor) on the surface. Other Chronic Affections "which produce Dropsies. Urine of a normal color, and preserv- ing a urinous odor. Density normal; salts and urea normal. Albumen in small quantity ; and only appearing transiently. In diseases of the liver, ascites pi-ecedes oedema. Characteristic symptoms of diseases of the heart, liver, &c. Simple Acute or Cheonic Nephritis, with Albuminous Urines. Always pi'etty well marked fever. No dropsy. Often terminates in suppuration. Pain in the kidneys more or less severe. Painful retraction of the testicles, and pain in the grandes levres, &c. Urine rendered Albuminous by the Pressure of Pus. Purulent globules, distinguishable by the microscope. Salts often more abundant than in the normal state. Symptoms of inflammation of the urinary passage. Pellicle (cremor) on the surface, after a few hours repose. Treatment.—Aconitum-napellus.—Symptoms: face pale, sunken and bluish ; stupid expression of countenance ; skin of a deep yellow, or white color; heat and dryness of the skin ; coldness of the extremities ; sleepless and restless at night; sudden sinking of strength; paroxysms of suffocation with anxiety, and aggravation of the difficulty in the evening ; respiration short, imperfect, irregular, with feeble pulsations of the heart; shortness of breath, especially when sleeping, after mid- 60 diseases of the sangutnous function. night, or when rising from the recumbent posture; pressure in the stomach and hypochondria accompanied with paroxysms of shortness of breath, and even asthmatic symptoms; pleuritic, pneumonic, and cardiac complications; nausea, vomiting, thirst, general heat, profuse sweats, and enuresis; peritonitis; ascites; pains in the loins; sensi- tiveness in the region of the kidneys; numbness in the small of the back, extending as far as the lower limbs; drowsiness; he sleeps while sitting in his chair with his head bent forward; dyspnoea, convulsions, paralytic weakness and death; general convulsions ; convulsive move- ments of separate parts, the cheeks, extremities, &c.; stupor with con- vulsive motions of the facial muscles, and the eyes closed; loss of con- sciousness during the convulsions; copious discharge of urine, which deposits a red sediment after standing; retention of urine; enuresis, sometimes accompanied with profuse sweat, diarrhoea, and colic. Pathology.—See page 29 of this volume. Clinical Remarks.—When the renal affections become complicated with disease of the serous membranes, like pleuritis, peritonitis, and arachnitis, Aconite will prove an important remedy. So likewise, in hepatic, pneumonic, enteritic, and other inflammatory complications, it must always be regarded as one of our most valuable medicines. In such cases it must be looked upon in the light of an auxiliary rather than as a direct local specific. The symptoms are usually worse in the evening and early in the morning. Ammonium-carbonicum.—Symptoms: face pale and bloated; pale- ness of the face with physical and moral weakness ; muscles soft and flabby; impaired memory; mind dull and confused; drowsiness in the day time; uneasy, disturbed and unrefreshing sleep at night; extreme lassitude and sense of fatigue ; weakness of digestion; pressure at the stomach, nausea, and oppression after eating; dyspnoea and palpitation of the heart after every exertion; difficult breathing at night; painful oppression of the chest; pain in the small of the back, increased by motion or walking; bruised or shooting pains in the region of the kid- neys ; violent throbbing pain in the small of the back and in the loins when at rest; drawing pain from the small of the back, extending to the abdomen and hips ; spasmodic twitchings of the arms ; convulsions ; fre- quent urging to urinate especially at night; involuntary emissions of urine at night; urine turbid, whey-like, and very ammoniacal and musty smelling; discharge of urine leaving chalk-like spots ; cloudy, reddish urine mixed with blood; symptoms worse in the evening and in the open air. Pathology.—Lining membrane of the kidneys inflamed and thick- ened ; kidneys enlarged, soft, of a light-yellow color, and the convoluted tubes obstructed with detached epithelial cells (in animals). Clinical Remarks.—This medicine has proved very beneficial in bright's diseasb of the kidney. 61 albuminous nephritis following scarlatina, typhoid fevers, malignant erysipelas and small-pox. In such cases we have observed unequivocal benefit from the employment of the lower attenuations. A reference to the pathogenesis above given will enable the physician to determine its homoeopathic relations with special groups of morbid symptoms. Apis-mellifica. — Symptoms: paleness of the face; oedematous swellings of the face, and extremities; nausea, eructations, heart-burn, rapid breathing at night; difficult and anxious respiration after exer- cise ; hurried and difficult respiration with fever and headache ; pain and soreness in the region of the kidneys on pressure or on stooping; con- stant dull pains in both kidneys, with very small secretion of red urine; frequent and copious discharge of urine; repeated micturition every few minutes ; burning in the urethra before and after micturition; fre- quent and painful urging to urinate, with scanty discharges of urine mixed with blood. Pathology.—(See Apis, p. 31, this Volume.) Clinical Remarks.—This is undoubtedly one of our most valuable remedies in both the first and second forms of Bright's disease. If ad- ministered in doses sufficiently attenuated, it will often afford marked relief, and sometimes effect permanent cures. It is to be regretted that more careful experiments have not been made with reference to its special action upon the kidneys, and the morbid alterations it produces upon the secreting tubes and other portions of the renal tissue, as well as in the urine. This defect in proving, applies to most other drugs as well as to this1 one. Apocynum-cannabinum.— As a palliative in removing the dropsical accumulations consequent on this form of renal disease, this medicine is held in high estimation by many physicians of our school. Several medical men of this city are in the habit of prescribing " Hunt's de- coction," and, as they assure us, with much success. (See Apocynum- cannabinum, p. 32, this Volume.) Arsenicum-album.— Symptoms: face pale and sunken; or lead- colored, or bluish, or yellow, livid and disfigured; face swollen from anasarca; face bloated, puffed, and red, or pale. Emaciation. General anasarca. Dropsy of the chest with the usual concomitants, suffocative oppression, and arrest of breathing, in the evening, or at night in bed; anxious and oppressive shortness of breath on walking, or on making any exertion; palpitation of the heart, particularly at night. Abdominal dropsy with the usual concomitants, indigestion, oppressive respiration, &c. Nausea, vomiting, eructations, distention and burning of the stomach after eating, sensation of faintness at the stomach, tremulous- ness of the body. Pain in the kidneys, extending towards the bladder, and then vesical tenesmus. Sense of fullness and congestion in the renal region. Turbid urine which deposits a sediment and looks like 62 diseases of the sanguinous function. clay. Urine alternately increased and diminished. Thick, cloudy, pus-like urine. Frequent urging to urinate, especially during the night Involuntary micturition, even at night during sleep. Urine colorless, turbid, albuminous, and depositing a slimy sediment. Fre- quent, painful, and difficult micturition. Urinary secretion diminished or suppressed. Spasms. Convulsions. Coma. Symptoms worse in the evening, at night, and after eating. Pathology.— A reference to the pathology of Arsenicum will de- monstrate from a pathological point of view, its strong homoeopathic relations to this form of renal disease. Both the morbid alterations of the glands and of the constituents of urine, bear a most striking analogy of the present malady. Clinical Remarks.—We have already alluded to the remarkable homoeopathicity of this medicine to acute Bright's disease. It will be found equally appropriate in the chronic varieties of the affection. Indeed, when the renal disease is accompanied with dropsical effu- sions, or serious gastro-intestinal disorder, we regard Arsenicum and Apis as our two most reliable remedies, for they correspond not only to the local and immediate symptoms of the renal disorder, but to tjhe more serious and secondary constitutional phenomena. These maladies act best at the medium and higher attenuations. Asparagus-officinalis.— Symptoms.—Drowsiness, lassitude, and dullness of intellect. Rapid and irregular pulsations of the heart, worse on exercise. Oppression of breathing, aggravated by exercise. Slight pains in the kidneys, felt mostly during the afternoon. Emission of a small quantity of pale, yellow urine, which soon becomes turbid and filled with a whitish dust, which settles after a few hours, leaving the urine clear: after the vessel has been emptied and rinsed, a fatty substance was observed to adhere to its walls. Urine abundant, limpid, and exhaling an odor sui generis. Frequent and painful micturition. Pathology.—See page 35, this Volume. Clinical Remarks.—This drug possesses but few symptoms which correspond to this form of the affection. In the few instances where it has apparently afforded some relief, it has been employed in from the third to the twelfth dilutions. Astacus-fluviatilis.—Symptoms: face and eye-lids puffed, great prostration of strength, and slight delirium. Drowsiness and tendency to stupor—internal coldness, great sensitiveness to the open air. Trem- bling in the right renal region. Sudden tearing pain in the right renal region, when sitting down. Emission of a large quantity of pale, yellow, and acid urine. Urine containing ?nuch albumen. Urine of a deep-yellow color and leaving a deposit. Clinical Remarks.—We have prescribed it with benefit in one case of chronic albuminuria, which appeared to be connected with gout and bright's disease of the kidney. 63 chronic eczema. A persistent use of the sixth dilution of this remedy for a period of four weeks, twice daily, appeared to ameliorate all of the symptoms. Digitalis-purpurea.— Symptoms: paleness of the face; general paleness of the skin. Anasarca. Emaciation of the body. Puffiness of the cheeks and lips. Dull, heavy pain in the head; difficulty of concentrating the mind; pressing or burning pains in the vertex or fore- head ; vertigo and trembling; drowsiness or lethargy; uneasy, unre- freshing sleep ; sleep disturbed on account of frequent desire to urinate. Great weakness. White fur upon the tongue; nausea, vomiting; ptyalism; burning, or lancinating, or pressing, or spasmodic pains in the stomach; sense of great weakness in the stomach. Contractive, or pressing, or cramp-like pains in the abdomen; ascites ; diarrhoeic stools. Pain in the region of the kidneys as if bruised, when stooping or mov- ing about. Frequent desire to urinate during the night; excessive emission of small quantities of watery urine; frequent and copious emission of watery urine. General dropsy with hypertrophy of the heart, and other organic affections of the heart. Dropsy of the chest. Ascites. Ascites and anasarca with organic affections of the heart. Rapid and difficult respiration on exercising. Asthmatic respiration on walking. Pulse frequent, or slow and weak. Involuntary twitch- ings of the fingers, thumbs, and other muscles of the body. Spasms Convulsions. Pathology.—See Digitalis, p. 38, this Volume. Clinical Remarks.—It is supposed to be especially useful when there is a tendency to waxy or fatty degeneration of the kidney. When the renal disease is associated with an organic affection of the heart, it is often an indispensible remedy. It is supposed to operate favorably in patients of scrofulous dyscrasias, or in those who have been enfeebled by injudicious allopathic medication. Kali-iiydriodicum.—Symptoms: face pale and swollen; oedema of the eye-lids. General feelings of malaise. Frequent attacks of dull- ness and heaviness of the head. Restless, confused sleep. Burning pains in the pit of the stomach. Dry hacking cough, with rapid and oppressive breathing. Pleuritis. Bruised pain in the small of the back, particularly troublesome at night. Darting pains in the small of the back when sitting. Painful urging to urinate. Nightly urina- tion. Frequent and copious emission of pale and watery urine. Dis- charge of mucus from the urethra. Diminution of the red globules of the blood. Emaciation. Pathology.—See page 40, this Volume. Clinical Remarks.—Especially appropriate in renal disorder con- sequent upon chronic rheumatism, or gout, or which appears to be con- nected with constitutional syphilis, mercurial cachexia, or scrofula. It 6-1 diseases of the sangutnous function. is more frequently indicated in the stage of inflammatory exudation, than in the acute stage. Its action upon the exudated matter is such as to promote its absorption, and upon the obstructed tubuli, to restore their impaired function. Kali-nitricum.—Symptoms: drowsiness; heaviness, pressure, and dull pains in the head. Gastric and intestinal derangements ; foetid breath. Sudden swelling of the body, neck, and thighs. Oppressed breathing on ascending a stairs; violent palpitation of the heart, and dyspnoea in the night, when lying on the back, or on the right side, or when moving about quickly. Pain in the small of the back in any po- sition—constant, or in the morning on waking, or in the evening, or during the night, of a bruised, or pressing, or cramp-like, or burning character. Spasmodic, painless jerkings of the fingers and hands. Pulse below the natural standard. Frequent emission of a pale, turbid urine; increased urine with reddish deposits, or with a mucous sedi- ment; urine of a specific gravity varying from 1030 to 1040. Clinical Remarks.—This is certainly a valuable remedy against the distressing paroxysms of oppression of the chest, and difficulty of breathing, which so often afflict patients suffering under granulated kidney. But it does more than afford relief to the dyspnoea, and other symptoms arising from dropsical accumulations; as several physicians have observed that patients have occasionally been permanently bene- fitted after the use of the remedy. Its best effects will be derived from the medium and higher attenuations. Mercurius-iodatus.—Symptoms: face pale, waxen, and chlorotic in appearance. General anasarca. Paleness of the skin; dryness of the skin. Irritation and ulceration of the mucous membrane of the air-passages. Foetid breath; putrid or coppery taste. Paroxysms of rapid and difficult breathing, and pleuritic pains in the chest. Nausea* vomiting; eructations; bilious diarrhoea; dysenteric discharges from the bowels. Scrofulous degenerations of the glandular system. Morbid excitability of the nervous system. Dull pains in the renal region. Urine either increased or diminished in quantity, and of high density. Pathology.—See page 41, this Volume. Clinical Remarks.—Owing to the paucity of pathogenetic observa- tions, physicians have been obliged to employ this medicine more or less empirically. In my own practice, I have regarded its pathogene- sis as similar to that of the other mercurial preparations, and have nre- scribed it in accordance with this general resemblance. This mode is neither scientific nor accurate, but the good results I have observed from the remedy have induced me to persist in its use. That it exer- cises a special control over this condition of inflammatory exudation modifying favorably both the morbid state of the kidneys themselves and of the blood, and thus ameliorating, and in some instances curing bright's disease of the kedwey. 65 the totality of the symptoms, we entertain no doubt. Indeed, we be- lieve it to be equal, and, in some cases, superior in value to Arsenicum, Apis, or corrosive Mercury; and it is highly probable that future ex- perimenters will confirm this opinion pathogenetically, pathologically, and therapeutically. MERCURius-suBLrMATUs-coRROsrvus.—Symptoms: pale, waxen color of the skin of the entire body; paleness of the face ; bluish paleness of the face ; puffiness of the face ; swelling of the head and face ; anasarca of the face and limbs. Deranged digestion : nausea; vomiting, and burning pains in the stomach; foetid breath. Shortness of breath; ex- cessive dyspnoea; palpitation of the heart. Disposition to stupor; transitory soporous conditions; headache. Spasms in all the limbs. Urine increased in quantity, light, and albuminous; urine scanty, red, and albuminous; suppression of urine. Pathology.—Kidneys enlarged, soft, and somewhat congested. Clinical Remarks.—The marked specific action of this medicine upon the kidneys, its power in promoting absorption of exudated mat- ters into the renal tissues, and its influence as a modifier of the morbid action peculiar to this stage of Bright's disease, render it a highly ap- propriate remedy. For the reasons adduced when alluding to this drug, we advise the employment of the medium attenuations. Mercurius-solubilis. — Symptoms: general paleness of the face and of the skin; white, clay-colored face. Puffiness of the face. Drop- sical swellings of the feet and legs. Drowsiness during the day, and sleeplessness at night. General weakness, languor, and lassitude. Tongue covered with a white fur, and somewhat swollen. Foetid smell from the mouth; nausea increased by eating; bitter vomiting; great pain at the pit of the stomach, worse when pressed upon. Ascites; shortness of breath, and dyspnoea, especially on ascending a stairs, or on walking. Bruised, or stitching pain in the small of the back. Spasmodic twitchings of the fingers and hands. Frequent desire to urinate, with scanty discharges; frequent urination during the night; urine turbid even while leaving the urethra, and depositing a sediment; flocculent discharges at the end of urination. Symptoms worse during the night. Pathology.—The morbid renal alterations induced by this mercurial, are probably similar to those of Mercurius-sublimatus-corrosivus—en- largement, softening, and slight congestion. Clinical Remarks.—Chiefly applicable in syphilitic, hepatic and diarrhoeic or dysenteric complications; but quite secondary in im- portance to the two preparations last described. Mercurius-vivus.—Symptoms: face lead-colored and bloated. Ptyalism, exhaustion, delirium, convulsions and death. Bad digestion; putrid breath; nausea; vomiting; white, apthous-like fur upon the Vni. TI.—5 m DISEASES OF THE SANGUINOUS FUNCTION. tongue, extending to its under side. Debility, languor, pains in the limbs, emaciation. Dull pains in the small of the back on walking, or lifting any thing. Pathology.—Probably like Mercurius-corrosivus, it is capable of giving rise to enlargement, softening, and congestion of the kidneys; but there are not a sufficient number of facts at the present time to en- able us to determine its precise pathological relations with these glands. Clinical Remarks.—This medicine has been found useful in chronic albuminuria of children, complicated with marasmus and bowel affec- tions, or with constitutional syphilis. In a few eases of this kind it has appeared to ameliorate the morbid group with more promptness and certainty than the other forms of mercury. If the little patients are emaciated, weak, languid, without appetite, and troubled with bilious or dysenteric discharges, it will be certain to afford relief. Terebinthina.—Symptoms: face pale and sunken. Anasarca ; as- cites; general dropsy. Stupefaction, and deep sleep; confused and languid on waking; relieved by copious and rapid micturition. In- creased menstruation. Dyspnoea; difficulty of breathing, with a sense of congestion of the • lungs. Sensation of heaviness and pain in the kidneys ; pain and sensation of increased warmth in the loins ; pressure in the kidneys when sitting, and going off during motion ; aching pains in the left kidney; drawing or burning pains in one or both kidneys, extending to the hips. Urine clear, watery, and profuse ; enuresis ; urine of a wine color, of the odor of violets, and depositing a thick, muddy, light-yellow sediment; urine depositing a slimy sediment twelve hours after micturition. General languor and loss of strength. Pathology.—See page 43, this Volume. Clinical Remarks.—Several distinguished homoeopathic physicians have commended this medicine highly in both the first and second stages of Bright's kidney. We have found it most serviceable in those cases which appear to have been associated with chronic irritations at the neck of the bladder, strictures, and irritable bladder. 4. NEPHRITIS SIMPLEX.—INFLAMMATION OF THE KIDNEYS Diagnosis.—Inflammation of the kidneys commences with the or dinary febrile symptoms, like slight chills, hot and dry skin; thirst* frequent and hard pulse, either accompanied from the first or speedil ' succeeded by deep-seated, aching pain in the region of the kidneys which soon becomes acute and pulsative; urine scanty and hio-b' colored; entire inability to lie upon the healthy side, or upon th stomach; position mostly upon the back when reclining, or on the af BRIGHT'S DISEASE OF THE KIDNEY. 67 fected side, with the dorsal and lumbar muscles flexed; inability to lie on the diseased side with the muscles extended; severe pains upon rising up to the erect posture, or from the concussions arising from riding, walking, or running. When the disease is strongly pronounced, there are : absolute inability to walk, or even to stand upon the feet; pressure over the inflamed kidney does not cause pain, but any motions which call into exercise the deep-seated dorsal or lumbar muscles ex- cite acute pain; the inflammation generally attacks the left kidney; both kidneys are rarely affected at the same time in the first instance; the pain at first is aching, compressive and dull, but often becoming, in severe cases, violent and lancinating; the pains extend along the ureters to the bladder, or follow the spermatic cord to the testicles; the urine is very scanty, bloody, purulent, or red, or watery; constant desire to urinate; there are nausea, eructations, vomitings, flatulence, constipa- tion ; pains in the rectum from contiguous sympathy ; tenesmus ; swell- ing and heat over the affected side, when complicated with calculi; there will be retraction of the testicle, numbness of the thigh, anxiety, and more severe constitutional disturbance. Nephritis may readily be distinguished from lumbago, inflammation of the psoas muscle, and neuralgia by the character and direction of the pains, which follow the ureters to the vesicular seminales, or the spermatic cords to the testicles ; also by the nausea, vomiting, constant desire to urinate; the partial and in some cases almost entire sup- pression of the urinary secretion; the sympathetic pains in the rectum; and the increase of pain whenever any of the muscles which bear upon the kidneys are extended. The terminations of nephritis are resolution, suppuration, induration, scirrhus, or gangrene. The duration of the acute stage is usually from six to nine days, when one of the above terminations usually obtains. Its termination in resolution is indicated by a gradual return of all the functions to a more healthy state; increased secretion of urine, which deposits an abundant sediment; moderate and general perspira- tion ; subsidence of the pains; ability to lie on either side, or to walk without difficulty. When suppuration has taken place, the pains become less severe; there are chills or shiverings; dull throbbing in the region of the kid- neys ; sometimes appearance of pus in the urine ; a sensation of numb- ness and weight in the affected side; a partial subsidence of the febrile symptoms; and occasionally ah abscess which may be recognized by swelling and fluctuation in the part. The purulent matter may be discharged by the ureters into the bladder, or find its way between the lumbar or internal crural muscles, to the thigh, or it may find its way by ulcerations into the cavity of the spleen, the liver, or the colon, or it may burst externally. 68 DISEASES OF THE SAN'Gl'INOUS FUNCTION. In these cases fistulous passages are apt to remain for a long period giving issue to the pus and urine. In a very few instances, after the acute symptoms have subsided, there remains a chronic induration of the kidneys, which in the end degenerates into a true scirrh us. In other rare instances, when the inflammation has been exceedingly violent, and suitable remedial measures have not been employed, the vitality of the part becomes destroyed and gangrene is the result. The occurrence of gangrene is recognized by the pale, sunken, and death-like expression of counte- nance, cold, clammy sweats, universal prostration, constant vomiting, delirium, small and frequent pulse, absence of pain, hiccough, and dark and foetid urine. Whenever either of the last-mentioned occurrences take place, no hopes of cure should be entertained. Causes.—External injuries ; strains from violent exercise or lifting heavy weights ; the irritation of calculi in the kidney; sudden check of the perspiration from cold; abuse of medicinal or poisonous sub- stances which operate specifically upon the kidneys. Treatment.—Frequent external applications of cold water over the inflamed kidney will be of great service in reducing the superfluous animal heat, and thus allaying the inflammation. The water should be applied quite cold and repeated until the temperature of the part is permanently diminished, and the pain has in a measure subsided. The specific medicines are: Cantharides, Cannabis, Tussilago- petus., Aconite, Copaivw, Terebinthince, Belladonna, Arnica, N ux- vomica, and Pulsatilla. As soon as we are called to a case of nephritis we should have im- mediate recourse to Aconite, either alone or in alternation with one of the other specifics, and continue it until the febrile symptoms have subsided. In slight cases Aconite alone as an internal remedy, together with thorough external applications of cold water will suffice. If the inflammation be of a severe grade, and there are tearing, drawing, and pulsative pains in the region of the kidneys, extending to the bladder and testicle, constant desire to urinate, scanty secretion of high-colored urine, inability to lie on the affected side, tenesmus, colic- pains, urine tinged with blood, painful micturition, Aconite in alter- nation with the third dilution of Cantharides, or Cannabis, or Tere- binth, or Tussilago-petus., or Bals.-Copaivce may be exhibited. Tartar-emetic.—Sharp stitches in the region of the kidneys, burn- ing from the rectum through the urethra, violent pressure in the bladder, scanty emission of urine slightly tinged with blood, accompanied with pain in the bladder, inflammatory red urine, depositing bloody red filaments when standing; dark turbid urine, watery urine with mealy sediment; urine leaving white spots (antimonial urine); increased secretion of urine; burning after micturition. Very severe, lancinating INFLAMMATION OF THE KIDNEY. 69 pain in the lower part of the bladder similar to that caused by calculous affections (third day). Severe burning in the urethra after urinating (third day); wakes in the night with great thirst and urgent desire to urinate, but passes but little urine. (Second night.) Tartar-emetic in acute cases of Nephritis equalizes the circulation, subdues inflammatory action, and restores the functions of the skin. Mercurius.—In a case in which Nitrate of Mercury was rubbed on the hip and thigh, Professor Syme* says: " intense pain immediately followed, and afterwards shivering; the urine was suppressed five days, without any insensibility, and during its suppression urea was detected in the blood; ptyalism appeared on the third day, became very pro- fuse, and was followed by exfoliation of the alveolar portion of the lower jaw." Recovery took place slowly. (See p. 64, this Volume.) Apis-mel.—In a case of oedema of the left leg, with inflammation of the lymphatics, which were hard as cords, and tender to the touch, improvement was speedy, and manifested by increased flow of urine— a sign that denotes the curative action of Apis. The cure was com- plete. In a case of amenia, in which the periodical flow had been sup- pressed for five years: rush of blood to the head, with delirium, occa- sionally ; the urine had been deficient for five months ; oedema, dysp- noea. After taking Apis the flow of urine was at once increased; the oedema was lessened ; the dyspnoea relieved. The catamenia appeared for three hours ; the medicine was suspended till the time for the next period, when the discharge occurred black and clotted. The next time it was nearly normal, and her general health was much improved. v Arnica is suitable for inflammation of the kidneys caused by exter- nal injuries, concussions, sprains from lifting, &c. When there is reason to suspect that suppuration is about com- mencing, Sulphur, Sepia, and Lycopodium may be used with' advantage. Nephritis can sometimes be cured by Aconite alone. In all cases this medicine should be kept in view, since the local phenomena are usually accompanied by a violent fever. {Kreussler, Therap., p. 105.) 5. HvEMATURIA. Haematuria is a common result of effort to throw off by the kidneys morbid matters from the blood. The organs whose office it is to depu- rate the blood are the epithelial cells, which line the uriniferous tubes, and wdiich surround the Malphighian tufts of the kidney. Most physiologists believe that certain toxical elements contained in the circulation and brought by the blood to the kidneys are liable to produce disease in them. {Trans. Med. Chir. Soc, London, 1857.) * Edinburgh Med. and Surg. Jour., Vol. XLlV. 70 DISEASES OF THE SANGUINOUS FUNCTION. Thus Mr. Simon, in a paper "On sub-acute inflammation of the kid- ney," calls attention to the fact that to task these organs with the elimination of zymotic causes from the blood may give rise to structural disease in them, and indirectly account for the presence of abnormal elements in the urine. He says: " The morbid material which thus stimulates the kidney in its struggle for elimination will sometimes consist of products of faulty digestion—the lithates or the oxalates; sometimes of matters cast upon the kidney in consequence of sup- pressed function in other organs—the skin or the liver; sometimes it will be the mysterious ferment of a fever poison—typhus, or scarlatina. .......The following conclusions have been reached by pathologists: 1. That the kidneys are designed to depurate the blood, not only of those post-organic and saline elements of the urine which would prove deleterious if they were retained in it, but also to eliminate certain morbid poisons which serve to infect the blood and give origin to the class of zymoses. 2. That among those of the latter class each poison, to whose action the kidney is susceptible, impresses that organ in its ow7n peculiar manner, invariably causing its own especial variety of structural and functional lesion. Treatment.—Arsenicum,.—Case by Dr. Frascr, of Hull.—A man of previous good health and constitution, some days after a feverish attack with some eruption on the skin, complained of painful micturition, scanty secretion, slight oedema of the face. Antiphlogisties and diuretics failed to arrest these symptoms. Pain in the back ; headache; nausea; loss of appetite; dry, harsh skin; parched mouth; little thirst; constipation; urine scanty, and containing blood-globules, albumen, fibrinous casts and various forms of epithelia. $■ Tr. Arsenicum Album 3°. 20 drops. Spts. Vin. q. s. Water 6 oz. Mix. Take a table-spoonful every four hours. Next day no improvement; can not lie down ; restless and uncom- fortable ; difficulty in breathing ; short, rapid respiration; dropsy in- creasing ; urine very red; secretion in twenty-four hours eight ounces * microscopic appearance the same. Fourth day.—Dropsical condition the same; general symptoms slightly alleviated ; urine increased to twelve ounces ; its color deep- brown, smoky, as in ordinary haematuria; contains less albumen ; blood casts not so perfect in outline as before; casts of the tubuli and epi- thelial cells more altered, broken as if indicating the arrest of further extravasation. The medicine continued. Sixth day.—The patient can dress himself and move about with DISEASE OF THE KIDNEYS CAUSED BY LESIONS. 71 comfort. Quantity of urine increased to twenty-five ounces in twenty-four hours. Three days later the improvement was plain. Appetite good, bowels regular; sleep good; swelling rapidly disappearing ; quantity of urine increased to two quarts in twenty-four hours. The urine con- taining much less albumen; its specific gravity 10*15, and containing uric acid. Twelfth day.—No constitutional disturbance whatever; urine has only a slight brownish tinge. Sp. gravity 10-16, quantity above two quarts in twenty-four hours. Sixteenth day.—Urine has only a very slight shade, produced by heat and Nitric-acid. The few casts that appear under the microscope quite transparent. Twenty-first day.—Secretion of urine reduced to forty ounces in twen- ty-four hours. Dropsy quite gone ; patient can walk out daily. Twenty-ninth day.—No trace of albumen in the urine; no blood- discs or casts discovered. Symptoms which led to the selection of Arsenicum in this Case.— Leucophlegmatic temperament of the patient; general restlessness; uncomfortable feeling ; parched condition of the mucous membrane, un- attended by increase of thirst; condition of the urine, and frequent scanty micturition. The action of remedy seemed not so much on the kidney as on the general condition of the absorbents. Case by Dr. Henderson.—Terebinth.—A married woman, having haematuria for four days, took one-twelfth of a drop every four hours. In twenty-four hours the sanguine appearance in the urine was quite gone, but there was much irritability of the bladder, pain in the region of the kidneys, and shootings down the limbs. Several weeks after- wards she had a return of the disease caused by indiscretion in diet, &c. She was directed to take one-hundreth of a drop of Turpentine for a dose every few hours. The effect on the secretion was slower; it took five days to overcome the morbid state, but, then, no painful conse- quences were produced by the weaker doses. 6. HEMATURIA FOLLOWING SCARLATINA. (See Vol. I., p. 600.) From Pulmonary 03dema. (See Vol. I., p. 785.) 7. DISEASE OF THE KIDNEY CAUSED BY SURGICAL OR MECHA- NICAL LESIONS. Claude Bernard {Led. III.) says: "If you simultaneously remove the two kidneys of a dog, or simply tie the renal arteries, you immediately produce a general disturbance in the entire economy. The animal is powerless in expelling the excrementitial product which should pass off by this channel, and the whole system becomes gradually poisoned. At first the animal is not seriously affected; it continues to eat and 72 DISEASES OF THE SANGULNOUS FUNCTION. digest its food for a certain lapse of time, which corresponds to the period of incubation in diseases; at a later time it is attacked with vomiting and purging, shortly after which it dies. "What takes place in a case like this ? Let us endeavor to explain it. During the first period the urea, which can no longer be eliminated by the kidneys, is expelled by the intestines. It is found, together with the salts of ammonia in the animal's excrements, and even in the gastric juice. If this new mode of elimination could be prolonged in- definitely the animal would not become diseased—it would not die; but very soon the mucous membrane of the intestines, irritated by the constant contact with the ammoniacal salts, undergoes morbid changes. On the other hand, as long as the urea is eliminated by the intestines, it does not find its way into the blood. This fact has been demonstrated experimentally by M. M. Prevost and Dumas, who have not, however, succeeded in explaining it. Now at a later period, when the mucous lining of the intestine refuses to continue this function, which is altogether foreign to it, the urea finds its way into the blood, and the animal soon expires, comatose and convulsed. " When the cessation of urinary secretion depends on the ligature of the renal arteries, this state of things may sometimes be obviated by removing the ligatures; the self-same thing would also take place in man, if there existed an obstacle to the passage of the urine, and if it were possible to remove that obstacle; but in all cases in which the kidneys have been removed death has always supervened. The de- struction of the animal has been the invariable termination of the morbid series. Here then, we have a disease which can be artificially produced. If you remove only one kidney, the animal continues to live * the remaining organ becomes enlarged, and plays both its own part and that of its fellow. If you only make a division of the nerves of the kid- neys the animal dies. During the first few days which follow the operation albuminuria is produced, shortly after, inflammation of the kidneys begins. These organs then mortify and become decomposed * so that finally, they act on the economy like a septic poison, which inevitably leads to death. Such I consider to be the natural ex- planation of this apparently mysterious fact." 8. CAPSULA RENALES—ADDISON'S DISEASE OF THE SUPRA RENAL CAPSULES. Leading Characteristics.—Anaemia, general languor and debility remarkable feebleness of the heart's action, irritability of the stomach and a peculiar change of color in the skin, occurring in connection with a diseased condition of the supra-renal capsules. CAPSULA RENALES. 73 General Remarks.—The disease displays its characteristic fea- tures very slowly: the patient gradually fails in health ; he becomes languid and weak, indisposed to bodily or mental exertion; appetite impaired or lost; whites of the eyes become pearly; pulse small and feeble ; or, if large, excessively soft and compressible ; the body wastes, but without exhibiting the dry and shrivelled skin and extreme ema- ciation common in malignant diseases ; slight pain or uneasiness in the region of the stomach; occasional vomiting; sometimes disturbed cerebral circulation. These symptoms are common in anaemic diseases; but they do not point to the seat of the local affection, and throw no gleam of light on the real nature of it. We may expect some malig- nant or strumous disease ; but we find no enlargement of the spleen, thyroid, thymus, or lymphatic glands, no evidence of renal disease, of purpura, previous diarrhoea, ague, or exposure to malaria. But, in con- nection with the above symptoms, we observe a most remarkable and characteristic discoloration of the skin, which has attracted the atten- tion of the patient and friends. It pervades the whole surface of the body, but is commonly most conspicuous on the face, neck, superior extremities, penis, axilla, and around the navel. The color is peculiar, being dingy, smoky, with various tints or shades of deep amber or chesnut brown. In one instance the skin was so universally and deeply darkened as to resemble that of a mulatto. In some cases the discoloration occurs in patches, or the surface presents a mottled or speckled appearance, in one instance being in- terspersed with whitish spots. This irregular distribution of pigment- cells, in some cases, is observed in internal tissues, as the peritoneum, mesentery, and omentum. In the progress of the disease the discoloration of the skin increases ; the anaemia, languor, failure of appetite, and feebleness of the heart become aggravated; a darkish streak appears under the commissure of the lips; the body wastes, but without extreme emaciation or dry harsh condition of the skin; pulse smaller and weaker; without special pain or uneasiness the patient gradually sinks and expires. In one acute case, in which both the supra-renal capsules were found univer- sally diseased, on dissection, the mottled appearance of the skin was very manifest, the anaemia and gastric derangement were very strongly marked; but the pulse was not small and feeble as usual, but was large, soft, and extremely compressible, and jerking on the slightest exertion or motion, and the patient soon died. Mr. Addison, from whose elaborate descriptions we have condensed this view of this little known disease, proposes by the concurrence of the above symptoms, to distinguish the destructive disease of the supra-renal capsules ; and he asserts that, whether the disease be acute or chronic, it will inevitably 74 DISEASES of the sanguinous function. terminate in death when the lesion involves the destruction of both organs, (pp. 4 to 7.) Diagnosis.—The distinctive features are the peculiar discoloration of the skin. Mr. Hutchinson, in furnishing an analysis, of twenty- seven cases {Med. Times and Gazette), says jaundice may be dis- criminated from the bronzed skin caused by disease of the supra-renal capsules, by its own peculiar tint, by its uniform diffusion, by its presence in the matrices of the nails and in the conjunctivae. Brown- ing from exposure to the sun may be recognized by its occurrence in those situations only which are habitually exposed. Patches of pityriasis versicolor sometimes resemble those of bronzed skin. They are distinguished by "their limitation to the abdomen and chest, their defined outline, their furfuraceous surface, the slight itching which attends them, their contagious character, and, above all, the microscopic examination of the cuticle." {Med. limes and Gazette. The bronzed color resembles that of a bronzed statue from which the gloss has been rubbed off, and is not changed by pressure. The extreme and peculiar feebleness is the next most striking symptom. The patient is liable to faintings, loses energy, is unable to exert either body or mind; flabbiness of the muscles rather than extreme emaciation. Causes.—No others have yet been pointed out than those which usually originate general chronic disease, disease of the kidneys or spine, though none of these diseases seem necessarily connected with the bronzed skin or the peculiar debility. Pathology.—The diseased conditions of the supra-renal capsules hitherto observed in connection with the bronzed skin are : 1. Acute and recent inflammations, ending in abscess ; 2. Atrophy, with fibro- calcareous concretions ; 3. The conversion of the viscus into a sort of fibroid structure, with great enlargement and induration; 4. The de- posit of tubercle, or of a fibroid material resembling tubercle; 5. The growrth of cancer. Sometimes the affection of the glands, especially of a cancerous nature, is secondary to disease in other parts; but it is observed that in many cases these organs were the only part of the body in which the disease was detected. When the disease of these glands is only partial, the severity of the general symptoms and the bronzing of the skin are all proportionate to the amount of the disease in these bodies, but have no relation whatever to the nature of that disease. {Hutchinson.) It is not yet sufficiently demonstrated whether the disease in one of the organs is the cause of the morbid changes in the other, and of the general symptoms; or " whether the supra-renal disease and the affec- tion of the skin, like the intestinal ulceration and cutaneous rash of inflammation of the bladder. 75 typhoid fever, are concurrently the efflorescence of some more deeply- seated mischief." {Brit, and For. Med. Chir. Rev., Oct., 1856, p. 318.) From the researches, then, of Mr. Addison and others, it seems to be proved that there is an intimate connection between the disease of the capsules and the morbid condition of the skin; that such a con- dition of the skin as has been already described "is diagnostic of the disease of the supra-renal capsules ;" and " that disease of the supra- renal capsules is the cause of that discoloration of the skin, and, we may add, of the symptoms that co-exist therewith." Prognosis.—Such a large proportion of all the published casos of this disease have terminated fatally, that we can scarcely be justifiable in holding out assurances of recovery in any case in which the bronze- colored skin and the accompanying debility are strongly marked. In cases less clearly defined in their nature, and not advanced to a hope- less degree, it may still be found curable. The most efficient remedies hitherto employed are, Apis, Arsenicum, Bryonia, Mercurius-corr., Terebinth, Apocynum, Hellebore, Kali-hyd., Cantharis, Thuja, Buchu, Uva-ursa, Cubebs, Cuprum-aceticum, Gallic- acid. The best effects have been observed from the lower attenuations of these medicines, repeated at long intervals. 9. CYSTITIS.—INFLAMMATION OF THE BLADDER. Diagnosis.—Inflammation of the bladder commences like nephritis, with shiverings or chills; frequent pulse; hot and dry skin; anxiety ; thirst; urine scanty and high-colored; nausea; vomiting; eructations, and constipation. In a short time the patient, experiences deep-seated lancinating pains in the hypogastric region ; frequent desire to urinate, each effort giving rise to increased pain, great anxiety, and uneasiness. As the inflammation extends, the pains become more severe, and there are painful pulsations, a continual burning sensation in the bladder, with acute pain on making pressure in the vicinity of the inflammation, and when attempting to urinate, a sense of weight in the hypogastric re- gion; acute or dragging pains in the loins, the ureters, the perineum, and the anus; swelling and distention of the abdomen; great difficulty in voiding the faeces, on account of the sympathetic inflammation of the rectum ; all movements of the muscles which bear upon the bladder ex- cite increased pains ; and finally rigors, cadaverous expression, cold extremities, delirium and convulsions. If the inflammation be confined to the neck of the bladder, there will be an almost entire suppression of the urinary discharge ; constant ineffectual and exceedingly painful efforts to urinate ; and violent pain in the perineum. If the ureters be- come involved, pains are frequently felt as high as the kidneys; the 76 DISEASES OF THE SANGUINOUS FUNCTION. secretion of urine becomes more deranged, the suppression is more de- cided, and the attempts to void the urine still more painful. When the whole interior surface of the bladder is affected, the urine is red and tinged with blood, and a severe burning and throbbing is experienced. Occasionally the external surface of the organ becomes inflamed, either on one side, on its anterior or posterior, or its superior or inferior part; in which case the symptoms will be in correspondence with the location of the malady. Cystitis may terminate in chronic inflammation of the bladder, in resolution, suppuration, or gangrene. The signs which indicate these different terminations are similar to those described under Nephritis. Causes.—Injuries resulting from childbirth, from the use of instru- ments during accouchement; from blows, concussions and falls; from gravel, stone, abuse of diuretics, metastasis of erysipelas, rheumatism, or gonorrhoea, the use of stimulating injections into the urethra, prolonged retention of urine, introduction of catheters or sounds into the bladder, suppression of the menses, and extensive inflammation (spreading) from neighboring parts. Treatment.—Aconite, CantJtarides, Cannabis, Thuya-occiden, Terebinthina, Copaibae, Tussilago-farfar., and Asparagus are our best specifics. They may be employed at the first, second and third attenuations, either alone or in alternation with Aconite: and the doses repeated as the urgency of the symptoms demand. Aconite.—In the dysuria and fever which accompanies cystitis, espe- cially when it is of a synochal character, repeated doses of Aconite are indispensible. {Hartmann, Ther. LLomceop.) Cases of ordinary cystitis, says Hering, "with painful and very scanty micturition, or rather the discharge of a few drops only, of deep- red, turbid urine, &c, can almost always be cured with Aconite, especially in women and children, and by repeating the dose whenever the pain recommences. We ought always to consider Aconite when with urinary tenesmus and pains in the bladder, this region is swollen, with aggravation of the pains on urinating, urine of a blood-red color, or mixed with small clots of blood. {Domestic Med.) Schwarz gives a case of a man aged thirty, with firm muscles, and black hair, who after wetting his feet experienced the following symptoms: violent chill and afflux of blood to the head, with extreme pain immediately under the symphisis pubis, as well as behind and be- neath the scrotum; continual and urgent desire to urinate; urine burn- ing, red, mixed with blood, and only emitted drop by drop; pubic region tense, painful to the touch, and a little hot; burning lancinating pain extending to the base of the urethra; disagreeable sensation at the meatus uri^arius, decided fever; pulse a little full, hard, 115 per minute * DYSURIA. 77 tongue red and dry; skin dry and hot. Aconite 18th, one drop every three or four hours. At the end of twenty-four hours there was a de- cided remission of all the symptoms. Pulse 95. Inflammation visibly diminished, urine less red. On the third day the pulse was 75, and there was no fever. The few remaining symptoms were cured by Pul- satilla. {Exper. Horn., p. 95.) Symptoms particularly indicating Aconite. — Vesical region swollen and painful; urinary tenesmus; urine scanty, red, bloody, and only emitted drop by drop ; aggravation of the pains on urinating ; strong inflammatory fever. {Jahr.) In cystitis as well as in nephritis Aconite may be employed with success; for, although the principal indication for this remedy is the violent fever which accompanies the local affection, yet it acts Avith equal efficacy upon the latter. It often suffices to cure the entire af- fection. {Kreussler, Ther. Horn., p. 111.) Triticum Repens*—Inflammation of the Bladder produced by inflammation of the prostate and neck, in pain and spasms from cal- culus and stricture. In all of these painful affections, Triticum-repens is a useful remedy. We usually employ the tincture in water. 10. DYSURIA. Diagnosis.—In this complaint the urine can be voided at will, but it usually passes away in a small spiral or divided stream, or drop by drop, each act being attended with burning and cutting pains at the neck of the bladder. There is a frequent inclination to urinate, and sensations of pressure and tenesmus, which constantly urge the patient to void his urine. The inflammation is confined to the neck of the bladder, and does not often give rise to constitutional disturbance. Causes.—Perhaps the most common cause of dysuria is the absorp- tion of Cantharides. This substance exercises a specific influence so decidedly upon the neck of the bladder, that even a sufficient quantity may be absorbed from the external application of blisters to cause the malady. A family was poisoned by a servant, who put a tea-spoonful of Cantharides powdered into a quantity of ground coffee; and they all suffered for several days. A medical student took five or six pills of blistering plaister in the course of a day or two for gonorrhoea. Severe dysuria, with excessive burning in the urethra ensued and in- creased till the urine could only be voided drop by drop, and a small quantity of blood was mixed with it; after the pills were discontinued the suffering gradually subsided. Symptoms of Cantharides.—Retention of urine with ineffectual ef- * Known to farmers as Dog's-grass, Couch-grass; grows two feet high, with stem trailing at the lower joints. 73 diseases of the sanguinous function. forts to urinate, is one of the most common and painful evils which Cantharides produces. It ought therefore to be a salutary homoeopathic remedy. Hahnemann enumerates all the preceding authors who had tried it and shows that they all found it successful, though Huxham read the theories of-the schools against it, and dared not try it. The painful micturition, scalding urine, and inflammation of the urethra are the symptoms of the early stage of dysuria. Nitrate of Potash.—la. small doses it causes frequent desire to pass water, accompanied with pain and heat. When this condition exists as a consequence of disease or absorption of cantharides from a blistered surface, a dilution of Nitre is found to be a remedy. Other causes are, stimulating injections, abuse of stimulants and condiments, onanism, extension of gonorrhocal inflammation, cold, tur- pentine, worms in the rectum; gravel, and calculi. Treatment.— Camphor is the specific against dysuria caused by the absorption of Cantharides. When it arises from other causes, Cannabis, Uva-ursi. Scovolo, among many others, cured a case where the urinary discharge was puriform, by Arbutus-uva-ursi; which never could have been performed, if this plant had not the property of exciting heat in the urethra with discharge of mucous urine. Belladonna.—Its effect on the urinary mucous membrane.—It causes frequent, painful, and scanty micturition, sometimes going on to strangury and haematuria; urine diminished in quantity, often after- wards increased. Its use in this condition extends only till actual in- flammation begins; then Cantharis and Therebinthina supersede it. Apis is a remedy of great value in dysuria. 11. IRRITABLE BLADDER. This affection arises from long-continued inflammation, which in the end so impairs the function of the bladder that the presence of a very small quantity of urine forces it to contract, and thus forms an incon- tinence of urine. Although this condition of the bladder may arise from numerous causes, which have already been enumerated, it not un- frequently proceeds from extension of urethritic inflammation to this organ, and from protracted use of diuretics. The malady is readily distinguished from stone by the relief which always follows the eva- cuation of the bladder, while this operation aggravates the painful sensations in the latter affection. This disease generally baffles all the resources of allopathy; we shall endeavor to show that the same remark is not true of the results of homoeopathic treatment. Treatment.—The principal remedies are, Aeon., Camphor, Can- nabis-sativa, Cantharides, Digitalis, Apium, Sulphur, Nux-vom., and suppression and retention of urine. 79 demulcent drinks, of which an infusion of water-melon seeds is one of the best. 12. SUPPRESSION AND RETENTION OF URINE. The causes capable of giving rise to suppression or retention of urine are so various and diversified, and the circumstances attending the course and progress of different cases so numerous, that our description must necessarily be confined to the more prominent symptoms and oc- currences connected with the malady. By the term retention of urine we mean to include all those cases in which the urine is secreted by the kidneys as usual, but where the power to evacuate the bladder is lost; while suppression of urine cor- responds with the affection known as ischuria renalis, in which the se- creting function of the kidneys is either partially or totally destroyed. Ischuria renalis is always attended with danger, from the peculiar tendency which exists in the brain £0 take on diseased action. When there is an entire suppression of the urinary secretion, from the paraly- sis of the kidneys, coma and effusion upon the brain occur very speedily. In cases of this description the saliva, the sweat, the pul- monary exhalations, the bile, the pancreating and gastric fluids, become impregnated with a fluid possessing the appearance, taste, and odor of urine. It has also been observed, that the liquid effused upon the brain, possesses a decidedly urinous smell. In cases of the disease dependent on inflammation of the kidneys, we shall have febrile symptoms, hot and dry skin, thirst, nausea, vomiting, rapid pulse, tenderness of the abdomen on pressure; swelling and pain in the region of the kidneys, frequent desire to urinate, and the passage of the small quantity secreted, causing great pain, urinous taste in the mouth, urin- ous odor of the sweat, anxiety and general uneasiness. If the sup- pression be total, the symptoms will be still more grave, and there will be early indications of serious cerebral disorder, in the form of delirium, rapidly succeeded by coma and effusion. On the other hand, in suppression depending upon paralysis of the kidneys, the febrile symptoms may be very slight, and there may be an entire absence of pain and uneasiness in the region of the kidneys or in the abdomen, and no desire to urinate. In these instances, the dan- ger is no less imminent than in the other variety, for fatal oppression of the brain almost invariably ensues, if the malady persists more than two days. Cases, however, are reported of almost total suppression for two or three months, in which the patients have been restored to health; but such instances are of rare occurrence, and should only be considered in the light of exceptions to the general law of the disease. Suppression now and then occurs from the presence of calculi or 80 DISEASES OF THE SANGULNOUS FUNCTION. gravel in the structures of the kidneys, thus causing a mechanical ob- struction to the healthy performance of their functions. In these cases the foreign bodies may operate by causing inflammation, spasms, in- duration or ulceration. They give rise to swelling, pains, sensation of weight and uneasiness in the vicinity of the kidneys, to numbness of the thighs, retraction of the testicles, abdominal tenderness, constipa- tion, frequent inclination to urinate, pain and tenesmus in passing water, anxiety, irritability, febrile symptoms, nausea, vomitings, hiccoughs, pain in the lumbar region, pain and tension in the perineum, scalding in the urethra, pulse full and frequent, difficulty of breathing, sighing, delirium, convulsions. Ischuria may be distinguished from retention of urine from the circumstance, that in the latter disease the bladder is distinct, and rises up above the pubis, offering to the pressure of the hand a firm and resisting body, while in the former complaint this vis- cus is empty, falls down below the pubis, and affords no resistance or fluctuation. Retention of urine may arise 'from inflammation, from stricture of the urethra, from paralysis of the bladder, from enlargement and in- flammation of the prostate gland, from mechanical injuries to the blad- der, from abuse of stimulating diuretics, from inflammation of the rec- tum, from the pressure of tumors, from displacement of the uterus, from calculi, from the lodgment of gravel or a stone in the ureters or in the urethra, from thickening and obstruction of the ureters, from too long- continued retention of urine, and from spasms. The general symptoms of retention are, distention of the bladder, and its elevation above the pubis, pains in the region of the bladder, with pressing desire and ineffectual attempts to urinate, anxiety, general uneasiness, and more or less constitutional disturbance. As retention is generally but a symptom of some other malady, we are often presented with constitutional disturbances during an attack in no way dependent upon this affection. We may cite as examples of this kind, diseases of the brain and spinal marrow, which may have pre- ceded the retention for months, protracted calculous affections, chronic inflammations of the bladder and prostate gland, constitutional effects of onanism, retroversion of the uterus, and the effects of previous mechanical injuries. From these facts it is apparent that there may exist an almost endless variety of symptoms during the progress of the different cases of retention which are constantly occurring. When the malady arises from simple inflammation of the neck of the bladder, not complicated by any previous disease, the symptoms are, hot skin; frequent and hard pulse ; thirst; pain in the region of the bladder and in the perineum, increased by pressure; restlessness; anxiety; constipation ; frequent inclination to pass water, with violent painful and ineffectual straining; shooting pains extending up the SUPPRESSION AND RETENTION OF URLNE. 81 ureters towards the kidneys, or along the spermatic cords towards the testicles ; headache ; nausea; oppression at the praecordia; and gene- ral feeling of fullness and distention of the abdomen. Retention caused by paralysis, on the other hand is accompanied by but few of these symptoms. Indeed many cases are recorded where the accumulations of urine have reached an enormous amount before the patients were aware of it. Other instances are mentioned where the distention has been so gradual and painless as to cause it to be mis- taken for ascites, and in more than one instance of this description, paracentesis dbdominalis has been resorted to as a curative measure. In cases like these, fifteen or twenty pints have occasionally been drawn off by the catheter at a single operation. It is not an uncom- mon result in these over-distentions, for the bladder to become united by adhesive inflammation to the umbilicus, and afterwards to discharge itself through this part by ulceration. The same occurrence some- times takes place into the rectum, vagina, and even into the abdominal cavity. In these cases, the danger from peritoneal inflammation and from gangrene is imminent. Retention may arise from spasmodic contractions about the neck of the bladder, giving rise to most violent and painful attempts to urin- ate, bearing-down pains, frequent painful erections, great sensitiveness of the urethra and perineum. In this variety of retention, it is always very difficult and sometimes absolutely impossible to pass a catheter, without previously allaying the irritation by fomentations or by the employment of suitable medicines. Spasmodic retention, although sudden and violent in its onset, is not usually a dangerous affection. The essence of the disease consists in an irritation about the neck of the bladder, and is dependent upon in- flammation of the prostate of the rectum, of the urethra, or some other neighboring structure, from which it has been propagated by contiguous sympathy. But the most difficult cases of retention with which the physician meets, are those caused by strictures of the urethra, and enlargements of the prostate gland. The practitioner during his professional career, will sometimes be called to cases of each of these maladies, where nothing but an incision into the membranous portion of the urethra, through the stricture, or the puncture of the bladder, will save life. In these cases, great judgment, decision and surgical skill are indispen- sable to the safety of the patient. This will be conceded when we think of the rapidity with which retention may terminate in fatal cerebral disease, ulceration and gangrene. By these observations we by no means desire to deter the physician from the employment of every me- dicinal means in his power, so long as they can be applied without en- VOL. II.—6. 82 DISEASES OF THE SANGUINOUS FUNCTION. dangering the life of the patient; but there is a point beyond which we cannot safely pass without resorting to one of the operations just alluded to; and in making up a correct decision upon this point the best judgment and the highest professional knowledge are requisite. The following case will illustrate this subject: Mr. B., aged forty years, of robust constitution, had been operated upon fourteen years previously, for stricture in the membranous part of the urethra. An incision had then been made through the strictured part, a catheter introduced and allowed to remain a good portion of the time for several weeks, but for some unknown reason the opening made by the knife did not heal, and a fistulous passage was formed, through which the urine has passed for the most part of the time since that period. For two or three years previous to his coming under our care, this fistulous passage has been gradually contracting, and he experienced, at times, retention, which could only be obviated by baths, formentations, injections, relaxing medicines, and the skillful use of the probe. Several times, however, we succeeded in relieving him of the attacks by these means; but on one occasion, being in the country, and'having contracted a cold from wet- ting his feet, the retention recurred, accompanied with unusual inflam- mation and tumefaction in the fistulous tract. Persevering efforts were made by his medical attendant to allay the inflammation, relax the parts, and to draw off the water by means of catheters and probes, for nearly two days, but without success. The symptoms now becoming very urgent, he returned home and placed himself under the care of Drs. Brigham and myself. We found great distention of the bladder, constant desire to urinate, bearing-down pains in the region of the bladder, expression exceedingly anxious and care-worn, eyes sunken, mouth and throat dry, thirst, pulse rapid and feeble, great prostration, nausea, hiccough, delirium, frequent sighing, exhalation from the sur- face of the body of a urinous smell, coldness of the extremities, and a sluggish and unhealthy appearance at the orifice of the fistula. After resorting to the usual remedies in such cases, and making re- peated attempts with the catheter and probe, we decided, although it was then midnight, that an incision must be made through the perineum without further delay. This was speedily effected, and the patient's life thus saved, while had we delayed a few hours more, gangrene or congestion of the brain would probably have resulted. We also have in mind a case of retention from enlargement of the prostate, which proved fatal in consequence of the absolute refusal on the part of the patient to submit to the operation of puncturing the bladder. In this instance, the swelling and inflammation of the gland were so great, together with a constant tendency to spasmodic contraction of the neck of the bladder, whenever the catheter came in contact with the part, that all efforts at introduction, aided by baths, fomentations SUPPRESSION AND RETENTION OF URINE. 83 and relaxants were of no avail. Here a timely puncture of the bladder would have saved the patient's life. We are well aware of the practical skill and tact necessary to effect an introduction of the catheter in these cases, and of the importance of securing the services of a skillful and experienced surgeon; but cases sometimes occur which baffle the most eminent surgeons in their at- tempts to pass a catheter by an enlarged prostate. Retention sometimes occurs from obstruction of the ureters by gravel, calculi, by thickening and induration of their walls, by hydatids and other unnatural formations, by the pressure of tumors in their vici- nity, and by occlusion from adhesive inflammation. The following signs indicate the existence of this variety of disease; unusual fullness, pain and sensation of weight in the vicinity of the kidneys, tension along the track of the ureters; nausea, vomiting, retraction of the testicles, pain along the spermatic cord, collapsed state of the bladder, no resistance to the introduction of the catheter; absence of urine in the bladder, and more or less constitutional disturbance. When the obstruction is complete, the ureters and the kidneys become so much dilated that urine to the amount of two or three pints sometimes accumulates in them, before congestion, ulceration, or gangrene supervene. Retention not unfrequently arises in females from a retroversion of the uterus, from the presence within the vagina of polypi, hydatids, of scirrhous enlargements, from injuries arising during difficult accouche- ments, from the irritation caused by acrid secretions, from the presence of hardened faeces in the rectum, and from adhesion occurring between the walls of the vagina, in consequence of inflammation and sloughing of the mucous membrane. Causes.—The most frequent proximate cause of retention, is inflam- mation of some portion of the bladder. Amongst the more prominent causes of this inflammation, are: metastases of gout and rheumatism, abuse of diuretics, strains, and extension of inflammation from neighbor- ing parts. The causes which rank next in importance are strictures of the urethra. They occur at all periods of life, and always require the in- terference of the surgeon for their removal. Enlargement of the Prostate Gland, is a frequent cause of re- tention in old men. The remote cause can generally be traced to ex- cessive sexual indulgence in early life. This gland may become en- larged from mere inflammation and engorgement of its structure, or from scirrhous degeneration. Affections of the prostate are usually called into activity by undue exposure to cold and wet, by abuse of stimulants and by neglect of timely urinary evacuation. Other causes, some of which have already been alluded to, are, re- troversion of the uterus, obstruction of the ureters from foreign bodies, 84 DISEASES OF THE SANGUINOUS FUNCTION. occlusion of the ureters from adhesive inflammation, paralysis of the bladder, from injury or disease of the brain or spinal marrow, from un- due retention of urine, from mechanical injuries, from abuse of drugs, from metastases of gout, thickening of the mucous membrane of the bladder, tumors and excrescences near the neck of the bladder, repcr- cussed eruptions, pressure upon the bladder by tumors in its vicinity, scirrhus of the bladder or rectum, accumulations of hardened faeces in the rectum, suppression of the menses, phymosis, ulcers, external in- juries, blows, contusions, and falls, leucorrhoea and gonorrhoea. Treatment.—In all cases of suppression or retention, where there can exist a possible doubt in regard to the true nature of the case, we should avail ourselves, without delay, of the use of the catheter. If this instrument passes without difficulty into the cavity of the bladder, and no discharge of urine follows its introduction, we may be certain that the cause and seat of the difficulty is not in this viscus ; while, if a free discharge takes place through the catheter, affording immediate relief to the distention, pain, and other unpleasant symptoms which had previously existed, we may be assured that the bladder, the pro- state gland, or some part of the urethra, is the seat of the complaint. To ensure an accurate diagnosis, then, we in the ^7^ instance as- certain whether or not a catheter can be passed into the bladder. Second.—If it can be, whether easily or otherwise. Third.—How large an instrument can be passed. Fourth.—If a discharge of urine follows the introduction. Fifth.—If the operation is attended with pain. Another important step in forming our diagnosis, consists in procur- ing from the patient or his friends, a minute history of his case, and every circumstance connected with the individual, which might have a bearing upon it. Thus, if we are called to an old man whose malady has approached gradually, who has had no febrile symptoms and little pain, where no resistance is offered to the introduction of a full-sized catheter, and where a large quantity of urine flows off, affording im- mediate relief to the uneasy feelings, we may with confidence pro- nounce the cause, paralysis of the bladder. The same law obtains in cases of retention succeeding injuries or diseases of the spinal marrow. If we have a case where the catheter passes into the bladder with great difficulty, on account of some obstruction near its neck, we then inquire whether there exists a stricture, a spasmodic contraction of the bladder, or an enlarged prostate gland. The following circumstances will enable us to decide the question satisfactorily: Stricture approaches gradually, as is indicated by the gradual con- traction of the stream of urine, the frequent and sometimes constant presence of a gleety discharge, and a sensation, after passing water, as if a few drops still remained behind. SUPPRESSION AND RETENTION OF URINE. 85 Enlarged prostate occurs, for the most part, in old men, is attended with pulsative pain over the bladder, weight in the perineum, constant inclination to urinate, with much straining, fever, and general uneasi- ness. By introducing the finger into the rectum we may often detect the enlargement by actual touch. Spasmodic contraction of the neck of the bladder usually proceeds from inflammation of some neighboring structure, as the prostate gland, the rectum, and the urethra. Spasms of this part may arise also from the irritation of gravel and calculi. The previous history of the case will enable us to decide as to the real nature of the affection. Retention, from stricture of the urethra, can only be permanently cured by the gradual dilatation of the contracted part by bougies. Temporary relief may sometimes be afforded by the use of medicines, but the only permanent cure is by artificial dilatation. But much may be done towards effecting cures in cases of diseased prostate, by a judicious employment of specific medicines. Many cases of this de- scription owe their origin to scrofula, or to a venereal taint, or to abuse of mercury, or to scirrhous degeneration, for which reason our pre- scriptions should be made with reference to these peculiar states of the system, as well as to the more immediate symptoms of the complaint. With regard to other causes of retention, the importance of minute investigation into all the circumstances of each case, can not be too strongly insisted on; for much of our success will depend upon an early removal of those causes which have operated to induce the re- tention, and which perhaps continue to exist to perpetuate the malady. If a retention has been caused by a metastasis of gout or rheuma- tism, our selection of remedies should be made with reference to these general diseases, as well as to more urgent local symptoms. If the cause can be traced to a displacement of the uterus, to impacted faeces in the rectum, to inflammation of any of the surrounding tissues, to the presence of ascarides in the rectum, to excrescences about the neck of the bladder, to imperforate hymen, to unnatural adhesions within the vagina, to the impaction of a stone in the urethra, our attention should be immediately directed towards the removal of these remote causes. Treatment.—The following medicines will cover all of the symptoms which occur in suppression or retention of urine: Cannabis, Uva- ursi, Solidago-virga-aurea, Acid-phosphoric, Rhus-radicans, Aco- nite, Pulsatilla, Nux-vomica, Arnica, Belladonna, Oleum-tere- binthina, Tussilago-pertuss, Camphora, Agnus-castus, Arsenicum, Sulphur, Lodine, Electro-magnetism, Cantharides. *. Cantharides and Cannabis, are indicated in suppression from chronic inflammation of the kidneys, and in retention from long- continued irritation of the neck of the bladder. They may also be em- ployed in suppression and retention from acute inflammation of the 86 DISEASES OF THE SANGUINOUS FUNCTION. kidneys and bladder, after the febrile symptoms have been subdued by Aconite. Hahnemann advises them in retention from paralysis of the neck of the bladder, and in cases of chronic retention arising from thickening and induration of the mucous membrane. Arnica is our best remedy when the functions of the kidney and bladder have been impaired or suspended by mechanical injuries, falls, contusions, sprains, blows, and concussions, or by the irritation of calculi. Rhus-radicans, Belladonna, and Solidago-virga-aurea are appli- cable when the disorder has proceeded from metastases of gout or rheumatism. These medicines may be alternated with Aconite when the inflammatory symptoms run high. Agnus-castus is an excellent specific in retention in consequence of paralysis of the bladder. Nux-vomica, Tussilago, Arsenicum and Oleum-terebinth are remedies which should command attention in paralytic retention. Spasmodic retentions are readily cured by Camphor, Belladonna and Aconite. When gravel or calculi are the exciting causes of the affection, we advise the employment of Uva-ursi, Solidago-virga-aurea, and Bella- donna. Affections of the prostate gland may be met by Pulsatilla, Sulpjhur, Aconite, Rhus-rad., Arsenicum, and Iodine. Retention from onanism, from excesses in venery, are treated best with Acid-phosphoric, Agnus-castus, Cantharides, Cannabis, Rhus- radicans and Arnica. Administration.—The lower attenuations should be employed in these affections, and the doses repeated every two, three, or four hours, until the medicinal effect is perceptible. Auxiliary to the above medicinal treatment, we (may) make a thorough use of warm baths, fomenta- tions, bland, diluent drinks, injections by the rectum, and lastly, though not the least important means, electro-magnetism. This powerful remedy should only be employed after the inflammatory symptoms have been reduced, and then with extreme care and moderation. 13. ENURESIS.—INCONTINENCE OF URINE. Diagnosis.—This affection may be recognized by a partial or total loss of power to retain in the bladder the secreted urine. When the loss of voluntary power over the muscles concerned is total, the urine continues to dribble away as fast as secreted, becoming thus an in- cessant source of trouble and annoyance. If the loss of power be only partial, the urine can be retained until a given amount is accumulated, when the patient is suddenly com- OPHTHALMIA. 87 pelled to yield to the pressing demand, sans ceremonie. In other in- stances, the incontinence is troublesome only during sleep, and appears to be excited by dreams, constrained positions, &c. The malady is unaccompanied by febrile symptoms or pains, and usually occurs as a symptom of some other disease. Causes.—Complete eneuresis may be caused by paralysis of the sphincter of the bladder from constitutional causes, from external in- juries, from tedious and protracted labors, from the pressure of tumors, from calculous deposits and from abuse of diuretics. Partial eneuresis is a common complaint amongst children, and is particularly troublesome in the night during sleep. It has too often been attributed to habit, and negligence of proper efforts to restrain the discharge and punishment has been tried as a remedy, but generally without advantage. The disease in these cases is undoubt- edly associated with irritation at the neck of the bladder, originated by acrid urine, gravel, the irritation of worms in the rectum, &c. Treatment. — Cantharides, Cannabis, Uva-ursi, Nux-vomica, Oxalic-acid, Gallic-acid, Cicuta-vir., Sulphur, Calcarea-carb., Pul- satilla, and Rhus, are the chief remedies. For the cure of paralytic enuresis, recourse should be had to Cantharides, Nux-vomica, Rhus, and Uva-ursi. When the disease occurs in children, our best remedies are Cantha- rides, Calcarea-carb., and Sulphur. When from external injuries, difficult accouchements, or the irritation of calculi, we may prescribe Arnica, Pulsatilla, Rhus, and Cicuta- virosa. Administration.—The remedies should be used at the first or se- cond attenuations, and a dose given twice daily as long as necessary. Genus Vm.—OPHTHALMIA. INFLAMMATORY AFFECTIONS OF THE EYE AND ITS APPENDAGES. The eye, in the immediate vicinity of the brain, connected with this organ by the optic nerve, endowed with numerous delicate membranes, nerves and blood-vessels, with its lens, its aqueous and vitreous humors to conduct and modify the luminous rays in their passage to the retina, —all disposed in the most consummate manner to serve the end de- signed,—may be looked upon as a most complex and perfect optical instrument. It is the mirror in which are reflected the various tableaux of external objects for the satisfaction of the soul within, causing it to respond to such impressions, so that the most indifferent spectator may look into its depths, and see the manifestations of the perceptive faculties. 88 DISEASES OF THE SANGUINOUS FUNCTION. The impressions of external objects derived through this medium, constitute our principal sources of knowledge and pleasure. Without this faculty we learn only by vague comparisons, suggested by touch, taste, smell, and hearing, by which all our conceptions are more or less perverted and indefinite. It is through the medium of vision, that the child first acquires a just idea of colors, distance, proportion, magni- tude, &c, and begins to reason and act by a comparison of his different impressions. It is through the eye alone that we appreciate the in- finite variety of expression in the "human face divine" and become in- cited to sympathy, love, pity, charity, admiration, fear, hope, hate, anger, and other emotions; that we enjoy the beauties and sublimities of nature ; that we become acquainted with the wonders of art and science; and by contrasting objects with each other, that we are able to enrich our minds with whatever elevates us in dignity of being and capacity of happiness. The eye is, perhaps, more delicate of organization, and yet from its situation more exposed, than any other, to external cause of disturb- ance. How important then that we obtain accurate ideas relative to its structure and functions, and the disorders to which it is liable, that we may be able to protect it when well, and promptly to cure it when dis- eased. In our description of the diseases of the eye and its appen- dages, we shall adopt this classification: First.—Affections of the tunica conjunctiva, or outer covering of the eye, including: 1. Acute ophthalmia; 2. Chronic ophthalmia; 3. Purulent ophthalmia; 4. Gonorrhoea! ophthalmia; 5. Strumous, or scrofulous ophthalmia; 6. Granulated lids; and 7. Opacitity of the cornea. Second.—Affections of the deeper-seated structures of the eye, in- cluding : 1. Inflammation of the cornea; 2. Inflammation of the iris [iritis); 3. Amaurosis; 4. Hydrophthalmia, or dropsy of the eye; 5. Cataract; and 6. Glaucoma, Hypermetropia, Asthenopia, fungus hcematodes, and Cancer of the eye. Third.—Affections of the appendages of the eye, including: 1. Hor- deolum, or stye; 2. Eutropium, or inversion of the eyelids; 3. Ectro- pium, or eversion of the eyelids; and 4. Fistula lachrymalis. This classification is deemed sufficient for all practical purposes, and much less liable to lead to confusion than one more extended. We shall point out the prominent affections of each structure of the eye, and endeavor in enumerating the causes, to make the reader acquainted with every thing of interest connected with each particular subject. Ophthalmia May be primitive or symptomatic, acute, or chronic,—and its causes may be local, or constitutional. Its manifestations may also be con- AFFECTIONS OF THE TUNICA CONJUNCTIVA. 89 fined to the eye itself, or sympathetic symptoms may declare them- selves in the head, stomach, and other parts of the economy. These developments will depend much upon the constitution, temperature and habits of the patient, the causes which have operated to produce the malady, the severity of the inflammation, and the tissue of one eye dis- eased, the corresponding structure of the other eye is exceedingly prone to •$ similar morbid action, from sympathy. This may be accounted for from the fact that the eye receives its nerves and blood-vessels directly from the brain, by which the sympathetic communication be- tween the two organs is rendered very rapid and intense. Finally, we direct special attention to the therapeutical connection, existing between morbid conditions of particular tissues and primitive medicinal symptoms upon the same tissues, in health. We have al- ready a few specifics which impress certain structures only, and we trust that the time is not distant when medicines will be discovered capable of acting surely and specifically upon each separate part of the eye or its appendages. Fortunately, a few of our drugs have a wide range of action upon the visual organs, so that we shall be able, even now, to find specifics which correspond with almost any morbid symptoms that may present themselves. 1. AFFECTIONS OF THE TUNICA CONJUNCTIVA. A. CONJUNCTIVITIS.-ACUTE OPHTHALMIA. Conjunctivitis.—This may be 1. simple, 2. eruptive, 3. catarrhal, 4. purulent, 5. gonorrhoeal, 6. conjunctivitis of new-born infants. Catarrhal Form, Dr. Williams* in both the acute and chronic stages depends upon a solution of Sulphate of Zinc in proportion of from two to four grains to the ounce of water, or rose water. In the more obstinate or chronic cases, an additional local applica- tion should be made by the physician himself,—the crayon of Sulphate of Copper, prepared as heretofore described and lightly passed over the inner surface of the upper lid, which is the original seat of the disease. Catarrhal ophthalmia usually begins with a reddening and swelling of the carunculce and plica semilunaris; the lining membrane of the lid exhibits the vessels increased both in size and brightness of color. Next the ocular conjunctiva becomes inflamed, and in severe cases the fine net-work of the vessels extends quite up to the edge of the cornea. It is only when this form of ophthalmia is not fully and completely cured in its acute stage that it lastly attacks the upper lid. Diagnosis.—One of the first local signs of simple inflammation of * On Diseases of the Eye, p. 40-41. 90 DISEASES OF THE SANGULNOUS FUNCTION. the conjunctiva is an injection with red blood, of a number of the ves- sels which naturally admits only white fluid. This gives to the eye that slight appearance of redness and distention of vessels which characterizes the first stage of acute ophthalmia. The eye now be- comes more than usually sensitive to light, smoke and dust; tears are easily excited; a feeling is experienced similar to that produced by particles of sand or dust lodged under the upper eyelid, causing- the patient to constantly rub the eye, in order to remove what he supposes to be a foreign substance; a sense of heat, fullness, stiffness and ting- ling is felt in the globe and edges of the lids ; and slight pains begin to shoot through the eye. At first but a part of the vessels become in- jected, but as the inflammation increases, the anastomosing branches become involved, until finally the whole eye presents a uniform appear- ance of deep redness, swelling and turgidity. At this period of the disease, the functions of the eye are all more or less perverted; there are acute pains in the ball; great intolerance to light; a profuse se- cretion of scalding tears ; disordered vision; agglutination of the lids in the morning from matter secreted by the meibomian glands ; intense pain on moving the lids; distressing sense of distention, weight and rigidity of the whole organ. The symptoms thus far detailed, are purely local and include all the symptoms which are present from the commencement to the ter- mination of many simple cases of acute ophthalmia. But in the ma- jority of instances the whole system sympathises with the local affec- tion, and we are presented with the following additional train of con- stitutional or sympathetic symptoms ; acute pains extending from the eye into the temples and anterior portion of the brain; slight chills, followed by accelerated respiration and circulation; hot and dry skin; determination of blood to the head and face ; nausea; loss of appetite ; lassitude; general irritability; physical weakness; and other indi- cations of general fever. During the progress of the inflammation a peculiar appearance is often observed above the cornea, in the form of a circular elevation termed chemosis. This arises from the precaution which nature has taken to protect the cornea from the injurious effects of ophthalmia, by fixing the conjunctiva more firmly upon this portion of the globe than upon the other parts. By this peculiar construction, the distention of vessels and effusions resulting from violent inflammations, are princi- pally manifested in the first instance, without the cornea, and thus in some measure protecting this important part from, the injury it might otherwise sustain. The severity of the symptoms will depend much upon the constitution of the patient, and the nature of the exciting cause. The disease may terminate in a cure, without any marked alteration in the appearance AFFECTIONS OF THE TUNICA CONJUNCTIVA. 91 of the eye, or it may result in effusion, causing an elevation of the con- junctiva above the cornea; or in adhesion of some portion of the conjunctiva covering the cornea, and giving rise to those appearances known as nebula, albugo, leucoma, and opacity; or in suppuration, from the surface of the conjunctiva; or in ulceration of some part of the cornea; or in sloughing of the cornea. These appearances will be more particularly described in our article on opacity of the cornea. Causes.—Undue exposure to intense heat or cold; inordinate use of the eyes by a glaring or dim light; the application to the edges of irritating foreign substances ; mechanical injuries; extension of con- tiguous inflammations to the eyes; sudden changes of temperature; metastases of gout and rheumatism. Prognosis.—If appropriate remedies are administered in the early stage of the disease, and before any organic lesion has taken place, we may generally predict a speedy and perfect cure. On the contrary, if effusion, ulceration, or the adhesive process of the conjunctiva over the cornea has commenced, we must be more guarded in our prognosis, for under these circumstances the malady often ends either in impaired vision, or a total loss of sight. Much information may be derived respecting the probable termination of the malady, by a careful examination of the causes, which have been or may still be in operation, and of the temperament and constitution of the patient. For example, an individual of an irritable and nervous temperament, and of a delicate organization, may be affected with the most violent local and constitutional symptoms for a considerable period, without endangering the integrity of the eye; wdiile a sanguine, ple- thoric, and robust patient might experience no constitutional effects, and but moderate local symptoms, and yet speedily suffer from serious disorganization of one or more of the tissues. Much will also depend upon our ability to remove all causes which may have conduced to the complaint, and to enforce upon our patients the necessary restraints and attention during the treatment. Treatment.—The first therapeutical indication is to confine the patient to an apartment in which the light is mostly excluded. It must be remembered that this natural stimulus of the healthy eye becomes, during an acute inflammation of its tissues, a powerful irritant—a morbid agent capable of aggravating and perpetuating the disease. As the inflamed stomach can not tolerate its natural stimulus, the food, so the inflamed eye cannot endure with impunity, its ordinary stimulus, the light. Perfect cleanliness should be enjoined, and, in an exclusion of all dust, vapors, smoke, and bright rays of light. In making ap- plications to the eye, great care should be taken to avoid compression of the inflamed part, in order that the circulation may remain unob- structed, and that sufficient air may be admitted to the parts. 92 DISEASES OF THE SANGUINOUS FUNCTION. Respecting local applications, we entertain the most exalted opinion of cold water. This may be applied by means of a few folds of soft linen cloth, which may be frequently dipped in the water, and after being partly wrung out, laid loosely over the eye and the surrounding parts. This application may be persisted in at suitable intervals, until the active symptoms have subsided, and a state of sub-acute inflam- mation occurs, when recourse may be had, if deemed necessary to Col- lyria of a slightly stimulating character, like weak solutions of Zinc, Nitr.-argenti, lead, or copper. In making use of these last named articles, we should only employ a strength sufficient to create a decided medicinal action, and omit the application when this effect is apparent, and so long as the consequent reaction or amendment continues; for external remedies when judiciously employed are subject to the same laws ofprimary and secondary action, as when administered inter- nally. We shall say more upon this subject under chronic ophthalmia. The medicines to which we call attention, are: Belladonna, Aconite, Arsenicum, Sulphur, Digitalis, Euphrasia, Pulsatilla, Arnica, Spigelia, Mercurius-sol., Graphites, Lycopodium. Belladonna.—-Redness, swelling, and protrusion of the ball of the eye; chemosis; swelling of the lids; frequent discharge of hot salt tears, or dryness of the eyes; spasmodic closure of the lids; flushed cheeks ; throbbing of the carotid and temporal arteries ; full and rapid pulse; hot and dry skin. Great intolerance to light; pain, burning, and smarting in the eyes; heaviness, pressure and throbbing to the ball and lids; sharp pains in the orbits, extending into the brain; tearing pains in the eyes from within outwards ; dimness and obstruction of vision; spasmodic sensa- tions in the eyes. Nervousness; irritability; disinclination to mental labor. Belladonna is suitable in ophthalmia occurring in sanguine and ir- ritable persons, from congestions of blood to the eyes in consequence of exposure to cold, excessive use of the eyes, metastases of rheumatism and gout. It is particularly useful when constitutional symptoms show themselves in the form of acute or throbbing pains in the head and temples, hot skin, rapid pulse, flushed cheeks, dilated pupils, and per- verted vision. Pathogenetic effects of Belladonna:— First.—Irritation of Mucous Membranes. — Dr. Richard Hughes says of the effects of this remedy :—The conjunctiva is generally in- jected in Bell, poisoning, sometimes partially inflamed. The remedy does well in alternation with Aconite in catarrhal ophthalmia, also in the strumous form. Second.—Throat—It produces dryness, heat, soreness, and redness in this order. See its use in scarlatina and erysipelas. AFFECTIONS OF THE TUNICA CONJUNC'ITVA. 93 In another paper Dr. Hughes inquires why Opium contracts and Belladonna dilates the pupil; and he comes to the conclusion that Opium contracts the pupil by depressing the sympathetic nerve and Bell, dilates the pupil by exciting the sympathetic nerve. Sensibility of the eye to Bell, is shown by Dr. De Ruyter, who states that a drop of a solution, containing not more than -nrsVinr part of sulphate of Atropine, when kept for some time in contact with the eye of a dog, sufficed to produce a dilatation of the pupil lasting for twenty hours. A solution of -rsVr produces a powerful dilatation in ten or fifteen minutes which disappears only at the end of four days. Of the single drop employed in this manner perhaps not one-fiftieth part is absorbed. Aconite.—Vessels of the conjunctiva injected with red blood; lips red and swollen; chemosis; dilatation of the pupils; lachrymation, worse on the slightest exposure to light, dust, or smoke; photophobia; flushed cheeks; hard and rapid pulse; hot and dry skin, and other febrile symptoms. Very great intolerance to light; pressing, stinging, burning, or ex- ceedingly acute pains in the eyes; eyeball feels bruised, and pressed into the orbit; stinging and smarting of the lids; eyes very hot, and filled with scalding tears, or preternaturally dry; pressure, or sharp, beating or stinging pains in the head and temples; impaired vision, as from gauze before the eyes; general febrile disturbance. Much mental excitement; fear and apprehension in regard to proba- ble result of the case. Remarks.—This remedy is particularly called for when the local inflammation is very intense, and the constitutional symptoms run high. It operates most happily in plethoric, bilious, and sanguine individuals, who are subject to determinations of blood to the face, head and lungs. It is appropriate in opthalmias caused by colds, by the introduction of foreign substances kito the eye, and by rheumatism and gout. Arsenicum.—Conjunctiva much congested, and of a dark red color; oedematous swelling of the lids ; profuse lachrymation; tears hot and corrosive to the cheeks ; lids dry and red ; eyelids partially closed from the great swelling; nightly agglutination; spasmodic movements of the lids, on exposure to light; ulcers on the cornea. Sensation as if sand had become lodged in the eye; tearing, burning, or stinging in the ball and lids, aggravated by motion, or on exposure to light; throbbing in the eyes when lying down; impaired vision; weakness, weariness, and tremor of the lids; great intolerance to light; constant inclination to rub the eyes. Mind weakened, and whole system rendered nervous and irritable by pain and suffering. Arsenicum is applicable to those cases which arise in weakly and 94 DISEASES OF THE SANGUINOUS FUNCTION. nervous constitutions, where the pains are severe, and the disease is unusually obstinate. In this variety of ophthalmia, the local and sympathetic symptoms are very troublesome, but there is much less danger of serious organic lesions than in most other forms of the malady. It is advised in ophthalmia arising from cold, rheumatism and gout. Sulphur.—Injection of the vessels of the conjunctiva; redness and swelling of the lids; lachrymation, or preter-natural dryness of the eyes; morning agglutination of the lids; photophobia; eyes swollen and prominent; cornea dim; lids oedematous; distention of the con- junctiva from effusion. Pressure of the eyeballs, worse on moving them; pressure, burning, and itching of the lids; intolerance to the rays of the sun ; twitching of the lids; trembling of the eyes; painful dryness of the margins of the lids; bruised feeling of the eyes, on motion; sensation of sand under the upper lid, on motion; dimness of sight. Sensitive ; despondent; out of humor. Remarks.—Sulphur is adapted to lymphatic temperaments—a scro- fulous or psoric dyscrasia; and may be employed in ophthalmia caused by repelled eruptions, abuse of mercury, or irritating matters introduced into the eye. Cases treated in the Onondago County Orphan Asylum.—(1860, Amer. Horn. Rev. Vol. 2, p. 125.)—Dr. Morgan reports that its in- mates, averaging in number 125, had been severely afflicted by ophthalmia characterized by: Intense redness and swelling, profuse secretion of mucus and tears, excessive photophobia. New cases wTere constantly occurring, and new comers were almost sure to be attacked in spite of all precautions. The investigations failed to discover the cause of the malady; but a large majority were scrofulous subjects; the gums were more or less affected, some with scarcely perceptible redness and swelling, whilst others were extensively ulcerated. Spongy, easily bleeding, teeth loosened, breath offensive, salivation, &c. The treatment that succeeded after former failures.—Give Sulphur 30, once a week to all well children. All affected with the ophthalmia were immediately placed under Bell, and Merc. Sol. in alternation; at- tenuations ranging from 3d to 12th. Repetition according to the severity of symptoms from every hour, to two a day; with occasionally a dose of Sulphur 30. This course of treatment was crowned with the happiest effects. No cases of the disease remained under treatment when the disease was made. Vision was not impaired in a single instance. Cantharides.—A man who was standing over a pan where Cantharides was boiling was affected with inflammation of the eyes, coryza, and swell- ing of the nose. Camphor was given. Next morning every thing appeared AFFECTIONS OF THE TUNICA CONJUNCTIVA. 95 to him yellow, which is a symptom of poisoning by Cantharides: he was well in three days. Camphor is the antidote of Cantharides. The case of Wm. H. Prescott, the historian, is given in a late publica- tion by Dr. James Jackson,* of Boston, which revives the melancholy sympathy which long ago pervaded all minds that had been enlightened or influenced by his works. Mr. Prescott lost an eye by accident, when he was on the point of finishing his studies at Harvard; and the other being compelled to perform double duty, was soon weakened, and its power was never recovered. Devoting himself to historical researches, he, by the aid of an amanuensis, composed those historical works, which have in all countries been regarded as among the highest of American literary productions ; and after much suffering from disease, especially from the eyes, he died January, 1859, in his sixty-third year. The medical treatment he received near the close of his life is given in this work. It seems that for the relief of a violent inflammation of the eye, which turned out to be rheumatic, more than seven pounds of blood were drawn in the course of five days, besides which he "was" says Dr. Jackson, "purged abundantly, was blistered freely, was kept in the dark, and on the lowest diet; also, the vessels of the conjunctiva were divided twice. It is not for the purpose of commenting upon this treatment that we have quoted the author's exposition of it. Our creed differs from his, and it could not be expected that we should harmonize with him in measures which were, without doubt, conscientiously employed by him. Conjunctivitis from Extension of Strumous Eczema.—Case.—A boy, aged eight years, had eczema covering the face; secretions of lymph and pus, with blood from capillary lesions from crusts on the suppurating surface; the head and face swell; eyes are concealed by oedema of the lids ; conjunctiva injected, papillary granulations; tarsi agglutinated; photophobia excessive; lachrymation; the globe remain- ing sound. The boy, who had been bright, became stupid and irritable. Was treated nine months by an oculist without benefit. Iodide of iron caused restlessness at night and fever. Dr. Hirschell, of Dresden, pre- scribed Graphites 2°, one grain twice a day. On the eighth day the crusts began to drop; soon left the skin smooth. Light became daily more tolerable. On the seventeenth day inflammation had vanished. A daily glass of Kreuznach waters (containing Bromine). A relapse occurred in winter but was promptly arrested by Graphites. A year after the boy continued well. Graphites.—Acrid heat in the eyes; painful swelling and redness of the lids, and burning itching at their angles with muco-purulent se- cretion agglutinating the lids; also dry irritation of their margin; the light is insupportable. Adapted to ophthalmias evolved from a strumous * 'Another Letter to a Young Physician,'1 &c, Boston, 1861. 96 DISEASES OF THE SANGUTNOUS FUNCTION. diathesis. Lymphatic swellings, especially in subjects with light hair pale complexion, and deeply perverted moral symptoms. In vesicular eruptions as eczema, impetigo, pallae and ecthyma, clematis fails; though it succeeds better in scrofulous eruptions, acne and sycosis. In the purely conjunctival form of catarrhal ophthalmia nitrate of silver is almost a specific ; whereas, in ophthalmia involving the sclero- tica, and the cornea it is useless, even injurious. In the former of these affections the best of allopathic physicians sometimes arrest the disease in a week which by the older system of bleeding, blistering and starving, sulphate of zinc and saccharum saturnia would have employed months. By the use of the crayon of sulphate of copper it is possible to de- stroy the inflammation without any of extreme results of nitrate of silver. The latter sometimes " destroys the tissues to such an extent as to cause adhesion of the entire lid to the globe, or produce indelible stains, which often ensue when the agent is employed for a consider- able time.*' Dr. Williams says: " Having charge, at one time, of a large number of ophthalmic patients in a public institution comprising many cases of chronic granulation of the lids, I repeatedly applied the crayon of sulphate of copper to one eye, and solutions of nitrate of silver of various strength to the other eye of the same patient." " In every instance recovery was more rapid in the eye to which the crayon had been applied," and in some it was necessary to resort to it in those eyes in which the nitrate of silver had been tried. In the conjunctivitis of new-born children the nitrate of silver should be avoided, as being less safe and less useful than the other means al- ready described. Calcarea.—Diseases of the eyes in scrofulous subjects, affected with glandular swellings. Dr. Guinness gives a case {Brit. Jour. Homceep. Vol. 5):—"A boy, aged three years, who had been ill twelve months, could not bear the least ray of light; eyelids puffed ; flow of hot tears ; much purulent matter discharged; face swollen, pale, unhealthy; ab- domen large ; dejection of spirits. He wished to sit by himself in the dark; an eruption on the legs. Sulphur 30°, a dose every morning was given to him for three weeks. This produced decided benefit. Cal- carea 30° was next given, with still greater advantage. Then Sulphur was given one week and Calcarea the next, and so on during alternate weeks; and the child was cured." Digitalis.—External Indications.— Intense redness of the con- junctiva ; inflammation of the meibomian glands ; swelling of the lids * constant and profuse lachrymation; photophobia; dryness of the nose * morning agglutination of the lids; tears hot and corrosive ; countenance bloated. Physical Sensations.—Aching, throbbing, burning, pressing, or AFFECTIONS OF THE TUNICA CONJUNCTIVA. 97 stitching pains in the affected eyeball, worse when moving or touching it; feeling as of sand under the lids; discharge of hot and irritatino- tears, on exposure to the open air or to light; intolerance to light; dim- ness of sight; eyes constantly hot and painful; objects all appear un- natural ; visions before the eyes. Mental and moral Symptoms.—The predominant mental traits are, despondency and mental languor. Remarks.—Digitalis is suited to sanguine temperaments and also to persons of a scrofulous habit. It has been successfully employed in ophthalmias consequent on colds, scrofula, and gout. Euphrasia also corresponds to most of the symptoms of Digitalis, and may sometimes be substituted to advantage in place of this last remedy, when the desired effect is not promptly produced. If, as Murray asserts, Euphrasia cures lippitudo and a certain form of ophthalmia, how could it otherwise produce this effect, but by the faculty it possesses of exciting a kind of inflammation in the eyes, as has been remarked by Lobelius. The old practice of applying rose water externally in ophthalmic diseases, looks like a tacit avowal, that there exists in the leaves of the rose some curative power for diseases of the eye. This is founded upon the homoeopathic virtue which the rose possesses, of exciting a species of ophthalmia in persons who are in health, an effect, which Echtius, Ledelius, and Rau actually saw it produce. {Hahnemann.) Pulsatilla is appropriate in catarrhal or rheumatic ophthalmia, at- tended with pressure and burning in the eyes, as if from sand; redness and swelling of the conjunctiva and lids; coryza; profuse lachrymation in the wind or open air; burning and itching of the eyes, inducing a disposition to rub them; photophobia; inflammation and secretion of mucus from the meibomian glands; dimness of sight; morning ag- glutination. Arnica is indispensable in ophthalmic inflammations caused by mechanical injuries of the eye, or of the parts in its vicinity. The re- medy may be used externally and internally. Spigelia is especially adapted to rheumatic and arthritic ophthal- mia ; the pains are of a pressive or stitching character, and aggravated by movement; the vessels of the conjunctiva are much congested; the cornea is dim; aching pains are experienced in the eye when touched, extending deep into the orbit; the upper lids swollen and stiff. Mercurius-sol. is proper in catarrhal and rheumatic ophthalmia. Its indications are: Inflammation of the eyes, attended with burning, smart- ing, heat and pressure, worse in the open air; sensation as if sand were under the upper lid; profuse lachrymation; photophobia; darting pains in the eyeballs; redness and swelling of the lids; dimness of Vol. II.—7. 98 DISEASES OF THE SANGUTNOUS FUNCTION. vision; pains worse when moving or touching the eye; boring pains in the eyes and surrounding parts. Other remedies are, Graphites, Lycopodium-, Nux-vomica, Calca- rea-carb., Colocynth, Rhus, Cocculas, Cannabis, and Dulcamara, to which the reader is referred. Administration.—In very acute cases we advise the third attenua- tion, and a repetition of the dose every two hours until the desired im- pression is produced. In more mild forms of the disease we use the first or second attenuations, and repeat every six or eight hours, as long as is deemed necessary. Nitrate of Silver.—The common abuses of this potent remedy are well set forth by Dr. Williams in a recent American work on Diseases of the Eye.* When local applications are to be made to the eye, he says : Solutions are preferable to any other form, as their strength can be graduated to the proper degree. No ointments of any kind should ever be used inside the eyelids. They are liable to vary in strength, to be- come rancid or decomposed, and their fatty substance is ill suited for distributing the medicinal agent over the affected surface. He has "seen most serious results from the incautious use of Nitrate of Silver ointment in {he hands of physicians" as well as in those of "well mean- ing friends." (p. 16.) " The abuse of strong solutions of Nitrate of Silver" is another evil to which I feel bound to call attention. It is apparently considered by some a specific for all the diseases which eyes are heir to, and is so lavishly employed that we not only observe, as results, a disagreeable olive stain of the conjunctiva, but in some instances, destruction of the folds of this membrane and adhesions between the lid and the globe, where solutions approaching to saturation have been incautiously ap- plied. It frequently aggravates the symptoms, and I can assert, as the result of many comparative trials, where the Nitrate in solutions of different strengths has been used for one eye, and solutions of Sulphate of Zinc, with perhaps the crayon of Sulphate of Copper for the other equally diseased eye of the same individual, that I have always found recovery slower in the eye to which the Nitrate of Silver was applied, and often been compelled to abandon its use and substitute the treat- ment under which the other eye had already recovered." The Nitrate of Silver may still be resorted to in certain cases, but he has lono- ab- stained entirely from using it inside of the lids ; and thinks, "it would be a gain for ophthalmic therapeutics, if its use should become far less general; and when its application is followed by recovery, the same result would have been attained had milder means been trusted to " (P* 18*)__________________________________________________ * A practical Guide to the study of Diseases of the Eye ; their Medical and SurgjI cal treatment. By Henry W. Williams, M. D, &c. 8vo. pp.317. Boston, 1862. CHRONIC OPHTHALMIA. 99 The Crayon of Sulphate of Copper is capable of replacing with great advantage the Nitrate of Silver, in most of the cases where this has been in favor, especially in the treatment of conjunctival inflammation and granulated lids. It does not, like the Nitrate in substance or strong solutions, act as a caustic, destroying the surface of the conjunc- tiva, but as a powerful astringent. To obtain good crayons, which is exceedingly important, it is almost essential to procure crystals from a laboratory, or to recrystallize a quantity of the Sulphate ; as when sent to market, the crystals are so much broken, that it is difficult to find suitable pieces. The part to be selected is the hard portion free from water of crystallization, near the apex of the crystal. This is to be carefully cut with a pocket-knife, or sawn into the desired shape, which should be that of an ordinary crayon of large diameter. It may be rendered as smooth as a piece of glass by rubbing with a wet rag, and fitted in a port-caustique. If the selection has been well made, the crayon will appear perfectly smooth, and if carefully wiped after each application, may be used a great number of times, and for various patients, without danger; though, of course, as a precaution, the physi- cian should be provided with several, if he has to employ them upon those whose diseases are highly contagious. It should usually be very lightly applied over the whole surface of the conjunctiva of the everted lid. Too heavy a touch should be avoided, as, if clumsily used, it causes much more pain, and acts as an over-stimulus." ( Williams, p. 19.) " When the eyelid is covered with small, hard and pale papillae, or as they are termed granulations, the best effects are seen to follow the light application of the Sulphate of Copper." {Frederick Tyrrel. London. Vol. I., p. 137.) As regards the large and flabby form, the cure is slow, and is but little assisted by local scarifications and the application of strong solutions of Nitrate of Silver, though applied by a camels-hair pencil to the inverted eyelid, and carefully wiped with a soft sponge. The application of the Copper, even lightly, gives grea"t pain; and the patient should be always allowed after it to wash the eye freely in cold or warm water. 2. CHRONIC OPHTHALMIA. Chronic ophthalmia may arise in consequence of the subsidence of the active symptoms of the acute form of the disease, and the persist- ence of a condition of sub-acute inflammation, or from causes which operate gradually, and induce an atonic state of the parts, and a low grade of morbid action. It may continue in this chronic state for years, without causing any notable organic derangement, the only difficulty experienced being a weak, sensitive and irritable condition of the eyes. Diagnosis.—When chronic ophthalmia succeeds the acute, it will be 100 diseases of the sanguinous function. found that a part of the vessels of the conjunctiva have recovered their tone and now circulate only the white blood, as formerly, while the larger vessels remain injected with red blood. These larger vessels, during the progress of the disorder, become so much distended by the intromission of the red globules, that a varicose dilatation often re- mains for a long period after the acute stage has been passed, and thus establishes the chronic malady. One of the prominent local symptoms, therefore, of chronic ophthalmia, as distinguished from the acute variety, is the moderately congested state of the vessels, which renders the conjunctiva partly red and partly white. The eye is also much less sensitive to light, dust, and smoke; tears are not so easily excited; vision is improved; there is an absence of pain, burning and heat; tears are not so hot and acrid; the swelling of the lids is diminished, and febrile and sympathetic symptoms have disappeared. But the eye is more sensitive than natural to light; the edges of the lid are red or purple; nightly agglutination occurs ; the patient is unable to use the eyes long at a time; objects often float before the eyes, obstructing vision; the lids itch and tingle, mostly in the morning on rising; flow of tears, caused by cold air, light, wind, smoke, dust, and vapors. Causes.—Acute inflammation: habitual intemperance ; constant ex- posure to irritating vapors ; metastases of rheumatism and gout; ex- ternal injuries; repelled eruptions; protracted exposure to cold in a region of snow ; excessive use of the eyes by a strong or dim light. Prognosis.—Unless adhesions have taken place between the con- junctiva and cornea, or ulcers, cicatrixes, or effusions have formed, so as to obstruct the rays of light, we may expect a ready cure of the disease. If however disorganization has already occurred and vision has become obstructed, we may predict a cure of the morbid inflam- matory action, but only a partial restoration of sight. Habitual chronic ophthalmias, proceeding from intemperance, constant exposure of the e'yes to stimulating vapors, &c, may readily be cured by removing the exciting causes, and having recourse to the appropriate local and inter- nal remedies. Treatment.—It is in this variety of ophthalmia that we may expect to derive most benefit from the use of stimulating Collyria. The object of all remedies, as has before been observed, is to create a healthy medicinal action in the diseased part, which shall supersede the morbid action, and thus secure a cure. But we have also seen, that this medi- cinal effect must be two-fold in order to prove curative; or in other words, there must be a prim,ary and a secondary effect, the former analogous to that of the disease, and the latter the reverse, or cura- tive. Whenever these two conditions result from the application of remedies, internal or local, a cure may be expected. Care, however, must always be observed, that the medicines be so adapted to the nature PURULENT OPHTHALMIA. 101 of the case, that the primary symptoms shall be of short duration, and suc- ceeded by the legitimate, opposite, or curative reaction. (Vol. I. p. 112.) In deciding, therefore, respecting the proper strength of a local ap- plication to an inflamed eye, we may follow the maxims of Hahnemann, or, what will answer as well, adopt the following rule inculcated by Sir Astley Cooper, in regard to the use of Collyria, viz : " To judge how far the stimulus may be carried, the criterion is exceedingly simple; if you find that a certain degree of smarting and pain is produced, which soon subsides and leaves the patient much more easy than be- fore, you may be convinced that the Collyrium is beneficial; if on the other hand, the patient experiences a great degree of pain, which does not subside speedily, and the vessels become turgid, you may be as- sured, that the Collyrium is doing harm, and that the quantity of stimu- lus ought to be diminished." The best local stimulus we ever employed in clearly pronounced chronic inflammation of the eyes, is the wine of Opium {vinum opii), a single drop to be introduced into the eye once or twice in twenty-four hours, until there is a permanent reaction. When the secondary symp- toms do not speedily appear after the application, we may then have recourse to a weak solution of Sulphate of Zinc, or of Nitrate of Sil- ver. If these fail, a solution of Aconite may be tried. The internal remedies are: Arsenicum,Belladonna, Calcarea-car- bonica, Sulphur, Rhus, Silicea, Nux-vomica, Graphites, Phos- phorus. The indications for the use of these different medicines will be found under acute ophthalmia. The principal difference between the two forms of the malady consists in degree rather than in the quality of the symptoms. Respecting the administration and repetition of doses, we prefer the first, second, and third attenuations, and advise a repetition once in twenty-four hours until an impression is produced. 3. PURULENT OPHTHALMIA. Diagnosis.—This variety of ophthalmia is more violent and destruc- tive, and runs its course with much greater rapidity, than that which we have described. It is characterized by a profuse purulent secretion from the conjunctiva, which collects and hardens about the lids and o-lues them together, and in this way acts as a constant irritant to the inflamed part. The disease commences like the simple acute ophthal- mia, with itching, stinging, or burning sensations in the lids and globe, lachrymation, sensitiveness to light, redness of the conjunctiva, which soon increase to an intense villous redness, as swelling of the lids, sen- sations as if foreign substances, like sand or sticks, were in the eye, 102 DISEASES OF THE SANGULNOUS FUNCTION. and more or less indistinctness of vision. These symptoms augment very rapidly in intensity, the tingling sensations change to severe pains through the eye, sometimes extending to the temples, and even the brain itself; there is chemosis, the lachrymation becomes changed into a pro- fuse secretion of pus, either yellow or greenish; the intolerance to light becomes more marked, the lids are very much swollen, and discharge much purulent matter; and there is almost a total obstruction of sight. Constitutional symptoms frequently occur, as in simple ophthalmia, in the form of headache, nausea, quick pulse, hot skin, general prostration, &c. This acute stage terminates in a short period in a sub-acute in- flammation, or in ulceration and sloughing. When the former termina- tion happens, there is a gradual subsidence of all the symptoms, and the disease remains for an indefinite period in this atonic state, after which the eye may recover its tone and healthy function. But if sloughing takes place, the destructive process may run on to a total destruction of the part, unless energetic measures are used to arrest its progress. Causes.—Sudden alternations from heat to cold ; endemic and epi- demic influences; the irritation of hot sand introduced into the eyes ; metastases of rheumatism, gout, scarlatina, small pox, and measles; abuse of Mercury; the morbid vaginal secretion to which the eyes of new-born children are sometimes exposed 4.' GONORRHEAL OPHTHALMIA. Diagnosis.—This variety of inflammation attacks the conjunctiva also, and is attended with symptoms very similar to those of purulent ophthalmia, but of much greater intensity. This disease is supposed to be the most violent and destructive of any to which the eye is subject, and it is not uncommon to see it proceed to the entire destruction of vision, notwithstanding the most early and energetic attempts to cure it. There is especial danger, in gonorrhceal ophthalmia, of a speedy formation of ulcers of the cornea, and of rapid sloughing through the tunics of the eye. When, however, we are called to a case of this de- scription, with intense inflammation and redness of the eyes, greatly swollen lids, very abundant discharge of pus, or of a dry and burning state of the conjunctiva and lids; excruciating pains in the eyes and head; chemosis; great intolerance to light; hot skin; nausea; thirst; and other febrile symptoms; it becomes us to exercise the utmost vigi- lance in our remedial measures, in order to save the eyes from ulcera- tion and sloughing. Farther on we shall detail a method of treatment which will generally be found successful, even in the most severe cases. Nothing, however, but the strictest attention to every minute symptom GRANULAR OPHTHALMIA. 103 of the case, and a constant watch over medicinal effects will ensure success. The cause of this affection is unquestionably the application to the eyes of gonorrheal matter, and not, as some suppose, a metastasis of the disease to the eyes. Another variety of purulent ophthalmia to which it is proper to allude, is that which occurs in infants shortly after birth. This disease is sup- posed to arise from the contact of the vaginal secretion of the matter with the eyes of the child during parturition. The symptoms generally first make their appearance in about two weeks after birth, but they may occur before, or several weeks after this period. The symptoms are similar to those of purulent ophthalmia; but for the most part, the inflammation is less intense, and there is much less danger of the speedy supervention of ulcers of the cornea. It is quite true that ulceration and sloughing ultimately occur in these cases; but a longer time is afforded for our remedial efforts to take effect, and of course the prospect of cure thus enhanced. 5. GRANULAR OPHTHALMIA. Contagious Conjunctivitis. Egyptian Ophthalmia. Granular Ophthalmia. In 1825, two regiments of Neapolitan soldiers were ordered from Messina to Palermo in Sicily. They had scarcely taken up their quarters when a large number became affected with sore eyes. It was soon found to be rapidly extending, and many soldiers were losing their eyes. The king of Naples sent Quadri, the famous oculist, to investigate the disease. He at once decided that the disease was contagious, and called on any man who doubted it, to test bis faith by applying some of the matter from a soldier's eye to his own. His opinion of the disease was this: "This is the so-called Egyptian ophthalmia, which is conta- gious, and seated in the conjunctiva; it was brought to the sick of these two regiments by some soldiers who had been drafted into them before complete recovery, and propagated by one to another by careless use the same towels." The characteristic peculiarity of the disease at its commencement consists in an exudatory process, and the secretion which is here formed during the inflammatory process, is confined to the palpebral conjunctiva, and serves as a vehicle for the contagion, The serum also which accompanies the chronic form, or the so-called granulations can be a constant medium for spreading the disease further." Symptoms.—It begins as a contagious catarrhal inflammation of the conjunctiva, with tension in the neighborhood of the eye, and the organ itself feeling as if sand or dust were in it; dimness; intolerance of light; watery appearance, and somewhat increased secretion of tears ; 104 DISEASES OF THE SANGUINOUS FUNCTION. slightly injected conjunctiva, and corresponding redness of the eyelids; with tumefaction, ancl a collection of mucus in the corners of the eyes and in the lashes. On everting the lid one could find the commencing granulations in crowded prominences, especially in the corners of the lid. When the disease had proceeded either slowly or rapidly from the first stage to the second, all the morbid appearances greatly increased; the characteristic secretion of mucus was more abundant; a thinner mucus, like white of egg, mixed with tears, flowed down the cheeks, but with a tendency to harden upon the cilia, and in the corners of the eyes, and to form crusts on those parts, so that, on waking the patient, the eyelids might be found stuck fast together. The intolerance of light and the pain increased, the latter reaching the orbits and side of the head. There is now intense, tensive, lancinating, and particularly burning pain in the eye, increased on each movement of the eyeball. The eyelids are bright red, swollen; and frequently an erysipelatous swelling extends upwards towards the forehead. When the swelling is somewhat abated, and the eyelid is turned outwards the conjunctiva is seen studded with watery, sponge-like excrescences, which are dilated with blood, and either look dry or hold in their interstices mucus or a puriform secretion. These excrescences sometimes bleed when touched. The conjunctiva over the sclerotic is found much reddened and injected with blood and sometimes even thrown into a kind of wall around the cornea. The palpebral conjunctiva, especially the upper portion, is often so swollen that it projects dark and distended through the pal- pebral tissue. These appearances, the hindrance to the escape of mucus, and consequent cloudiness of the cornea, the contraction of the pupil from sympathetic irritation of the iris, and finally, the febrile re- action, characterize the second stage of the disease. Third Stage.— The thin mucous secretion in the eye becomes changed into a thick, yellow pus-like matter, which after a time, so in- creases in quantity, that it escapes from beneath the upper eyelids, flows down the cheeks, and often causes them to ulcerate. At this point all the other symptoms attain their greatest intensity; the redness and swelling of the conjunctiva increase more and more; and the redness of the upper eyelid becomes of a livid hue; the tumefaction enlarges, spreads to the orbital ridge, becomes dark and hard, and so overlaps the lower lid that the patient is no longer able to open the affected eye. The pain in the eye becomes more acute, spreading to the eyelids, and also to the globe, the orbital cavity, the forehead and temples; it is in- tense, burning, lancinating, penetrating, intermitting, and often ac- companied with evening exacerbations, reaching their intensity about midnight. The patient complains that he is holding his eyes over red- hot coals; and others say they feel the pain like to electric shocks GRANULAR OPHTHALMIA. 105 transmitted through the eye. The intolerance of light is intense, the pupil remaining contracted strongly and motionless. The swollen con- junctiva of the upper lid is now often projected considerably through the palpebral fissure and prevents the escape of the pus from the eye. The inner surface if now examined, shows the palpebral and ocular con- junctiva much injected and swollen, and running with pus and mucus; the vascular meshes were in this stage no longer distinguishable; round the margin of the cornea appeared a pale red, soft, irregular, mottled swetting, in which the cornea appeared to be buried, and was almost lost sight of. By drawing aside the red folds which were around the cornea, and which appeared on the surface smooth and level, they were often found to cover granulations seated on the conjunctiva. When the iris could be seen, it was observed to be rigid, and the pupil motion- less ; the whole system is excited by intense fever, accompanied in ir- ritable subjects by delirium at night. In this stage is recognized the third form or the contagious blepharo-blennorrhcea. When much swelling appears in the lower lid it has the effect of displacing it and producing ectropium. Attempts to open the eye often give rise to temporary ectropium. Towards the termination of this period there is extravasation of blood from the vessels of the palpebral conjunctiva, and this is followed by diminution or change in the secretion, and some- times by its complete cessation. Duration of the Disease.—The first stage lasts for a few hours or several days according to its severity. The latter stages are often prolonged for weeks. The nature of the products of inflammation is different in different degrees of intensity of the disease. After the acute form, morbid alterations and, hypertrophy of the conjunctiva rarely remain. The chronic form is followed by a variety of products. Some of these are, warty growths, spongy, filamentous or cauliflower- like excrescences with which the conjunctiva is studded; these are fissured and contain pus in the interstices; though they are often dry, distended with blood, and softer ones bleed when touched. These granulations sometimes remain for a long period, resembling transparent milky vesicles, or milky yellowish knots with a pearly lustre, bathed in serum. The growths on the conjunctiva assume various forms; the brush-like watery exudations are usually firm and hard, of fibrinous character; more commonly found on the upper lid. Those on the tarsal portion small and in rows side by side. In other parts they are in groups, which in some remain a long time stationary. This roughness of the conjunctiva, or "trachoma," indicates the chronic condition of the membrane which is the immediate cause of the roughness apparent. Pathology and Diagnosis.—Dr. Baertl says "the peculiarity of granular ophthalmia in its commencement consists of the exudation of organizable plasma beneath the conjunctival epithelium in the form of 106 DISEASES OF THE SANGUINOUS FUNCTION. small, distinctly translucent, light, and subsequently distended vesicles, which arrange themselves in rows like a string of pearls behind the tarsal margins, or may be found scattered with equal abundance over the whole surface ; and further, the vesicles seated on the tarsal surface are smaller, flatter, and less regular in form. In many chronic cases they may remain for weeks with scarcely any abnormal vascularity of the conjunctiva, and without pain or uneasiness more than for heaviness of the lid. In the eye there is then no increase of mucus, and but slight cloudiness can be detected in the eye, which is only moist or slightly oedematous. On the other hand, in the acute attack the process has commenced before the patient suffered from pain or redness of the eye. Its duration is only a few hours before a notable congestion of the part takes place, with burning pain, feeling of sand in the eye, increased secretion of tears and mucus. The lids become oedematous, the conjunctiva dis- tended, infiltrated with simple serum, and traversed by fine, closely netted blood-vessels; the vesicles, clear at first, become opaque, yellow or gray, and finally red. Subsequently a deposit of plastic exudation take place into the parenchyma by which the conjunctiva is increased in thickness and thrown into folds; the membrane between the vesicular granulation is thickened; and growth and exudation occur at the same time, and also in the finer vesicular meshes that supply the papillae. Diagnosis.—Fleshy elevations sometimes occur on that portion of the conjunctiva which lines the eyelids, resembling in all respects granulations, and by their irritating effects upon the ball of the eye, give rise to troublesome inflammation, ulceration, and now and then to loss of sight. This affection has more frequently baffled the surgeons of the old school, than any other pertaining to the eye. Vene- section, leeching, cupping, blistering, moxas, cathartics, alteratives, stimulating collyria, and caustic applications have all been found en- tirely inefficient in its treatment, and the patients are generally doomed to a wretched existence for one or more years, until disorganization of the eyes by ulceration, leaves them in perpetual darkness. By homoeo- pathy, however, a new and healthy action can be created in the affected structure, which shall overcome and supersede the morbid action. These morbid granulations usually arise from an acute or sub-acute inflammation of the conjunctiva, occurring in individuals whose con- stitutions have become impaired and tainted by protracted syphilitic, gonorrhoeal, psoric, or scrofulous complaints. The granulations are rough and uneven, secrete an abundance of pus, which serves to irri- tate and weaken the eyes, and on every motion of the lids, operate on the balls as foreign substances; thus keeping up a perpetual inflamma- tion, and sooner or later leading to ulceration of the cornea. The dis- CONJUNCTIVITIS. , 107 ease is for the most part confined to the upper eyelids, although we have seen, in some instances, the conjunctiva of the lower lids rough and granulated. Occasionally we may detect the true character of the complaint by the thickness of the lids, and their roughness and unevenness to the touch; but the only certain method of investigation consists in turning over the lids, and thus exposing the palpebral conjunctiva to the sight. This disease very often proceeds to a fatal disorganization of the eye, without a true knowledge on the part of the physician, respecting the nature of the case. It is usually mistaken for one of the varie- ties of purulent ophthalmia. SIMPLE CONJUNCTIVITIS. CONTAGIOUS CONJUNCTIVITIS. CATARRHAL INFLAMMATION. 1. Edges of the eyelids are partly or 1. In contagious blenorrhoea the first entirely hard, sensitive, and swollen ; symptoms of inflammatory swelling are but the swelling does not extend beyond confined to the palpebral conjunctiva on the margins. the tarsal surface. The inflammation does not extend from without inwards, but from the point of origin, both out- wards and inwards. 2. The vascular injection is uniform, and the single vessels indistinguishable, for the whole eyeball is red, the con- junctiva as if broken down, and of an opaque lustre. 2. The capillary injection is in irre- gular branching meshes, rarely in the eyeball entirely red, as in contagious ophthalmia, and even then it only appears after long duration and maltreatment of the disease or after repeated relapses. 3. The disease in the mild form is distinguished by the formation of phlyc- tenae and abscesses, which always arise side by side, on a patch of connected parallel vessels. 4. The secretion contains epithelial cells in the earliest stage of development, and fatty globules from the meibomian follicles; and it is moderate in quantity through the whole course of the disease. 5. Serous infiltration of the sclerotic conjunctiva and of the eyelids is rare, and if present is always moderate. 6. None of the neighboring parts ex- cept the nose are implicated. 7. Conjunctiva only slightly swollen and velvety. 3. The inflammation in the mild form confined to the palpebral conjunctiva. In the more advanced state, a delicate homogeneous net-work of closely-packed vessels is formed over the sclerotic. 4. The secretion contains fully de- veloped epithelial scales, a few mucous corpuscles, and no fat globules, but abundance of pus corpuscles. 5. The serous infiltration and conse- quent bulging around the cornea, are al- ways present, and the swelling of the eyelids is considerable. 6. The parts around the eye, and espe- cially the cheeks, are puffy, and the temporal region is often erythematous. The nose is only implicated when scro- fula is present as a complication. 7. The conjunctiva swells so much, as the serous infiltration increases, that it projects through the fissure of the lids and causes ectropium of the lower lid. 108 « DISEASES OF THE SANGUINOUS FUNCTION. 8. The pain is in the first instance stinging and itching, principally in the corners of the eyes and on the lids; subsequently it is burning; in conse- quence of the over-distention of the ca- pillaries. 9. The flow of tears is increased and continuous; the tears scalding ; intoler- ance of light considerable, and lasting as long as the excessive secretion of tears. 10. Generally the result of atmos- pheric changes, especially sudden vari- ations of temperature, mists, damp re- sidence, &c, most common in spring and autumn. 11. Sometimes contagious though not always so. 12. Never exhibits the characteristic vesicles. 13. Lower lid usually first affected. 8. A feeling of sand or dust under the lids is here characteristic, and depends on the inflammatory swelling in the tunic of the conjunctiva. 9. Flow of tears diminished coinci- dently with the photophobia. Intoler- ance of light very great at the commence- ment and at the height of the disease. 10. Occurs in hot and moist weather, during great electrical changes, at which times pre-existent disease is apt to in- crease in severity. 11. Always and under all circum- stances contagious. 12. The vesicles are always from the first distinctly visible on the conjunctiva of the eyelids. 13. The upper lid is first attacked. Microscopic examination by Hawr, an oculist of Lemburg in Galicia, showed that in the vesicular granulations the exuded plasma is charged with young epithelial cells, and the epithelium itself is considerably in- creased in thickness by stratified deposits of new elements. In the case of red granulations he describes numerous vascular loops in the mass of young cells, which loops appear to owe their origin to increased development and projection of the deeper papillary bodies into the mass of young cells as to a new growth of cells. If granular ophthalmia be not checked at the commencement, the vesicles become organized into granules; still later, both forms of granulation increase in number and organization, under the influence of the constant friction and repeated infiltration; and at last they pre- sent the forms known as sarcomatous growths. Unfavorable products of granular conjunctivitis: acute blenorrhoea, ectropion, hypertrophy of the tarsus; conversion of the soft into hard fibrinous feebly vascular excrescences ; partial or complete atrophy of the conjunctiva in consequence of the pressure from the exudation upon the normal conjunctival tissue; synblepharon posticum, and entropium in consequence of this atrophy; pannus as a consecutive disease, caused by the friction from the rough inner surface of the lids. Causes.—It is usually ascribed to insufficient covering, consequent congestion of the head, followed by exposure to chills ; but the chief source of the disease must always be the contagious principle, a peculiar morbid product which spreads the disease from one man to another. Other causes which promote its development are: crowding of many CONJUNCTIVITIS. 109 soldiers together; unfavorable climatic influences; bad location of the camp; exposure to high temperature; consumption of large quantities of spirituous drinks, &c. The disease may be epidemic in character instead of contagious. Prognosis.—The persons most liable to attack are those most in- timately associated with the sick; those exposed to other common causes of disease ; and those especially in whom, with the naked eye, we can detect in everting the upper lid, a small red elliptical spot seated in one or other, rarely in each angle, whilst the rest of the con- junctiva is normal, and in the centre of this spot a red projection of the membrane with one or more little eminences (commencing granu- lations), the patient all the while complaining of nothing else. A mild form of the disease is seen in cases in which there is congestion of the conjunctiva with diminished secretion. In a severe attack the granulations arise over the whole surface of the conjunctiva and cornea, and the secretions are more rapid, and profuse. The most serious cases of all are those in which not only a constant discharge of pus exists, but often also ulceration and its consequences, appear in the course of a few hours or days. Convalescence is evidenced by our discovering in the conjunctiva no abnormal change; by the blood recovering from its morbid condition. Treatment.—The earliest efforts at treatment have generally been directed to the extermination of the above described vesicles, and thus to the bringing of the disease speedily to a termination at its first stage, and whilst it is curatively local. The patients who first become the subjects of granular ophthalmia in any locality should be immediately separated from all healthy and convalescent persons; the eye must be protected from light, draughts of air, and dust; forbid all stimulants in drink or food; no linen but fresh and clean must be used, and the towel he touches must not be used by others. Medical Treatment.—Aconite, Bell, Apis, Argent.-nitr., Arsen., Euphras., Digitalis, Mercur., Lycopod., Rhus, Sulphur, correspond to this disease. Local-Remedies.—The best local specific is the sulphate of copper in substance, a small piece of which is to be smoothly polished, and rubbed lightly over the granulations once or twice a day, following application with a camel's-hair brush filled with pure water. A per- severing use of this substance will, as we know from experience in these cases, cure the most inveterate forms of the complaint. Among the modes of treating this disease Nitrate of Silver carefully applied in substance has held the first rank. It is directed to hold the stick of the fused Argentum-nitricum between the fingers as a pencil, 110 DISEASES OF THE SANGULNOUS FUNCTION. introducing it carefully between the eyelid and the globe, while the patient looks upwards, and thus, to rub it lightly on the vesicles, and on them alone, till they are destroyed. The burning pain which follows is to be alleviated as it may be by washing the eye, applying wet cloths, &c. That the Argent.-nitricum is homoeopathic to the inflam- matory condition is not questioned; but many homoeopathists have ob- jected to this heroic application of it. General experience in this pe- culiar form of ophthalmia has sanctioned it; and it will most probably maintain its ground. In conjunction with the above means, we may employ one of the following medicines: Sulphur, Calcarea-carbonica, Hepar-sidphur, Iodine, Graphites, and Acid-nitric, as internal remedies. In selecting our internal remedy, regard must be had to the cause as well as the symptoms of the disease. We advise the first attenuations, and the dose to be repeated once in twelve or twrenty-four hours, as long as necessary. Sulp/hur.—Commencing catarrh; tension as if sand in the eye; dry- ness of the eyeball; itching in the eyes and lids; disagreeable heat and burning as if the eye were about to inflame, accompanied by redness of the eye and swelling of the lids; lachrymation, and closure of the eye. Aconite.—Inflammatory and febrile symptoms commencing. The pain, redness, burning and heat increasing. Cold Lotions.—Ice-water, fomentations, &c. Belladonna.—The pain in the eye becoming intense and throbbing. In alternation with Aconite. Digitalis.—Pain in the eye tensive. In alternation with Mercur. in gonorrhoeal ophthalmia. Followed at the end by Lycopodium. Argent.-nitr.—Appears to be indicated in most forms of this disease and has in many cases induced a rapid cure. In contagious catarrhal ophthalmia commence with one drop of the sixth dilution, in water, twice a day or oftener. If improvement is not soon seen, try the third dilution, a drop in a tea-spoonful of water. At the same time the af- fected eye should be wTashed over with the medicine in water. At first ten drops of the first dilution may be tried, afterwards, a solution of one grain of Nitrate of silver in the ounce of water may be used by ab- sorption in a pledget of linen, folded and laid over the eye, and renewed occasionally. In blepharo-blenorrhoea the same local use of this article may be tried, even to the strength of three or four grains to one or two ounces of water; diminishing the strength as the severity of the disease subsides. In addition to this application, the eyes should be washed repeat- edly with warm water; the surface of the cornea should be kept as- CONJUNCTIVITIS. Ill clean from pus as possible ; often needing washing every half hour to prevent the accumulation of pus and exudations. In hard fibrinous granulations the morbid growths may be touched over with lapis infernalis, followed by cold fomentations. Dr. Hawr treated blepharo-blennorrhoea with drops of a solution con- taining five to ten grains of nitrate of silver in the ounce (after washing the eye) and generally with astonishingly good effects. In granular ophthalmia, even when accompanied by highly inflammatory symptoms, redness, swelling of the conjunctiva palpebrarum, redness of the eyeball radiating from the corneal margin, photophobia, lachrymation, spasm and headache, and, undeterred by the inflammatory symptoms, he touches with lapis infernalis the characteristic vesicles in conjunction with the lid, in order to avert the chronic state. A milder preparation consists of two parts of Nitr. silver, and two of pure nitre, and its use wTas soon followed by abatement of the symptoms and a speedy convales- cence. Dr. Hawr said this treatment was better, quicker and more certain, even if not more pleasant than the old antiphlogistic plan. By cauterizing the granulations he usually got rid of the photophobia lachrymation, cramp and pain; he would cut off sarcomatous growths and then cauterize the raw surface. The Russian military surgeons pursue a similar practice; employing nitrate of silver six to twenty grains to the ounce of distilled water. Arsenicum.—The pain in the eye is unbearably scalding, and the eye- ball feels like a red hot coal in the orbital cavity. This may be in the early stage; and it may be used during the use of the cooling lotions. Arsenicum is also useful in the second stage of blennorrhoeal inflam- mation with suppuration of the eyelids. When the conjunctiva forms a wall around the cornea, the secretions are accumulated in the centre, so as to endanger that structure, the pains extend to the neighboring parts, it is proposed to cut out a portion of the conjunctiva with a pair of curved scissors; first raise a piece of the puffy membrane with the forceps, and then cut with the convex surface of the scissors. If the conjunctiva of the upper lid is puffed and pro- truding so as to prevent the opening of the eye and the necessary wash- ing, no harm is done by cutting off a portion, as the swelling of the eye- lid is at the same time diminished. Rupture of the Cornea.—The local application of Belladonna is the principal reliance. Three grains of the extract may be dissolved in two drachms of water, and once or twice daily dropped into the eye. By this means the pupil is retained in a permanent state of dilatation, and the sight thus preserved after the cornea is healed. Intense Ulceration of the Eye.—Remedies:—Arsen., Alum., Ba- ryta, Bellad., Calc, Carbo-veg., Hepar, Lycopodium, Mercur., Natrum-mur., Ptdsat., Rhus, Sepia, or Sidph. 112 DISEASES OF THE SANGULNOUS FUNCTION. Spots on the cornea-nebulae, remaining after inflammation has ceased, may be removed by the use of Apis, Arsen., Calc, Cannabis, . Conium, Kali-iod., Lycop., Mer., Staphys. Purulent Ophthalmia, or Blennorrhcea JEgyptiaca, as well as the ophthalmia neonatorum are of sycotic origin. The first appears parti- cularly after re-vaccination among the soldiery. Dr. Wolf proposes Thuja as the remedy, though he has tried it in but few cases. He suc- ceeded in some with Aconite and Apis. The same treatment will also cure chronic ophthalmo-blenorrhoea. The greatest danger is produced by the localization of the sycotic poison in the brain, where it causes all the symptoms of the most acute inflammation; and yet after death no sign of inflammation is found. Such cases are of rare occurrence, though they originate in the suppression of a fresh blennorrhcea, or of a catarrh in children after vaccination, or in scarlet fever. In such cases Apis, Belladonna and Stramonium fail; Thuja promises to be the effectual remedy. In doubtful cases Aconite or Apis may be tried; and if the fever still progresses, one dose of Thuja 300°. Sclerotitis.—Though the sclerotica may be specially inflamed it is not commonly much diseased, except in connection with inflammation of other tunics or structures, which are more delicate and more essen- tial to the safety of the sight; therefore, in the complicated inflam- mations which involve the sclerotica more serious disease generally is going on in other structures. Thus injection of the vessels of the sclerotica takes place whenever the cornea or iris are seriously affected, or when the entire globe is attacked, or an abscess forms within it; its structures may become thinned from disease of the choroid; but in all these circumstances the alterations in other parts precede those in the sclerotica, and are the important objects of our attention. The sclero- tica in all of these cases calls for no special care, but the treatment necessary for the whole case depends rather on the nature and degree of the disease of the associated structures. 6. OPACITY OF THE CORNEA. Diagnosis.—Opacities or specks upon the cornea vary much in size and appearance. Various appellations have been given to these dif- ferent opacities, as : nebula, leucoma, albugo, &c, depending upon the nature of the cause, and the particular tissue affected. The opacity may consist of slight misty or opaque spots, diffused over a part or even the whole of the cornea, of a light color, such as are caused by a per- verted secretion of the inner lamina, and termed nebula ; or of small and circumscribed spots, of a pearl color, and entirely opaque, caused by a kind of false membrane under the conjunctiva, and termed leu- INFLAMMATION OF THE CORNEA. 11 n 10 coma; or of cicatrices resulting from the healing of ulcers and wounds of the cornea, and termed albugo. When the disease consists of a simple diffused nebulous opacity, we can distinguish through it the pupil and iris, and the rays of light pass to the retina so as to give rise to imperfect vision; but the other kinds of opacity do not permit the passage of luminous rays, and, conse- quently, when situated in front of the pupil, destroy or seriously impair vision. The two first varieties are caused by purulent ophthalmia and granu- lated lids, and are results most to be dreaded, especially in constitu- tions tainted with scrofula, syphilis, psora, or mercury. Treatment.—The best local stimulus is a collyrium, composed of one grain of Sulphate of Zinc to four ounces of water. A few drops of this may be put into the affected eye, from two to four times in twen- ty-four hours, until the opacity begins to disappear, when we should omit it as long as the amendment continues. The internal remedies most to be relied on are: Calcarea-carb., Iodine, Mercurius, Sulphur, Sepia, Arnica, Hepar-sulphuris, Acid- nit ricum-, Aurum-muriaticum. Attenuations and repetitions the same as in chronic ophthalmia. II. AFFECTIONS OF THE DEEPER-SEATED STRUCTURES OF THE EYE. 1. INFLAMMATION OF THE CORNEA. Diagnosis.—Inflammation of the cornea may exist as an independent affection, or it may occur during the progress of iritis, and other acute derangements of the internal textures of the eye. Soon after the in- flammation sets in, a number of the serous vessels are observed to carry red blood; the cornea loses its brilliancy; the eyes become sensitive to light; a profuse secretion of tears is induced from exposure to cold, air, light, dust, and smoke; tension and pains are experienced in the eye; yellow spots, composed of pus, are observed between the lamellae of the cornea, by looking obliquely through the eye ; these abscesses, if the disease continues, eventually burst internally, and discharge their contents into the anterior chamber, or externally, and form those trouble- some ulcers of the cornea, which so often endanger sight. When these ulcers are small and confined to the anterior portion of the cornea, they may often be cured without material injury te the eye; but when the ulceration pervades the whole lamellated structure of the cornea, it is' not uncommon for the aqueous humor to escape through the opening, and even the iris itself to protrude. Ulceration of the Cornea.—Case by Dr. Alex. Walker. {Month. Horn. Review. Vol. 5, p. 268.) A lady, after three miscarriages, &c, Vol. IL—8. 11-4 DISEASES OF THE SANGUINOUS FUNCTION. and extensive hoemorrhage, found, two months after, the left eye be- coming weak and dim; lachrymation ensued; finally ulcers appeared on the cornea; these were accompanied by excessive suffering, loss of rest and appetite ; considerable fever. In the course of a few months the eye seemed slightly improving; but metastasis took place to the right eye. The diseased condition persisted for sixteen years, during which eighteen different physicians and oculists in succession en- deavored to cure it without success. Stimulants had been prescribed in full variety. The patient was found sitting with her back to the window; the blinds all down, room darkened; photophobia excessively distressing. Seven ulcers were visible on the cornea; lachrymation so extensive as to saturate four or five handkerchiefs in a day; inflam- mation higher at night, pain and suffering preventing sleep till four or five next morning; sclerotica and conjunctiva fiery red; meibomian glands much ulcerated ; outer ring of the iris dusky red ; violent pains in the supra-orbital and temporal regions, increasing toward evening; great nervous debility; depression of mind; flatulence; constipation, indigestion. The patient inherited a rheumatic diathesis. The latter fact influenced the prescription. Stimulants discontinued. Bryonia was given twice a day, and a dose of Aconite at bed-time. Weak collyrium of Bryonia to the eye. This was continued for five days, and then omitted for two. At the end of the first week the inflammation of the cornea, iris, sclerotica and conjunctiva was much reduced. After the third night some refreshing sleep, and improved digestion, less flatulence. Cold water was used in the morning and after dinner, cold bath in the morning; diet simple, plain but nourishing ; suppers forbidden. In the course of the treatment under which she recovered full health in a few weeks, she took Sulphur, Calcarea-carb., Mer.-sol, and, occasionally, Aconite. The remedies were generally employed in the sixth and third potencies. Some patients are powerfully affected by the high potencies, others who are insensible to the high are satisfactorily cured by the low. Conical Cornea.—Mr. Bowman's operation for relief of this affec- tion consists in "puncturing the cornea near its lower margin, drawing out the iris by means of a short blunt hook, and securing it outside of the corneal wound by a fine ligature." 2. IRITIS. Diagnosis.—This peculiar affection of the eye is by no means easy of detection, on account of the situation of the iris, and the small num- ber of external symptoms which characterize the complaint. Inflam- mation of this texture is, however, more productive of constitutional or febrile symptoms than affections of the external tunics. This may in IRITIS. 115 part be owing to the loose attachments of the conjunctiva to the eye, and the more ample scope for effusions into the subjacent cellular tissue. Iritis commences with a dull, pressing, heavy, and deep-seated pain in the orbit; contracted pupil; change in the natural color of the iris to a dark, greenish, or reddish color; a moderate rose-colored blush of the conjunctiva; diminished power of vision, and considerable sensibili- ty to light. As the disease advances, the pains become acute, and extend from the eye into the temples and to the top of the head; the contraction is more strongly pronounced ; sparks and luminous flashes pass through and before the eyes; the nervous system is excited; the pulse accele- rated ; the skin hot and dry; the intestinal and urinary secretions are partially suppressed, and there are other indications of constitutional disturbance. After these severe symptoms have continued some time, the iris pre- sents an irregular, angular, and thickened appearance, and is covered with specks of yellow lymph. Small abscesses now form on the iris, which ultimately burst into the anterior chamber, which is afterwards usually absorbed. If extensive adhesions have formed between the iris and the capsule of the lens, or if the more deep-seated parts have be- come involved in the disease, an almost total loss of sight is the com- mon result. In some instances the inflammation extends from the iris to the re- tina, the choroides, the cornea, and finally involves the whole internal structure of the eye, wdien the malady will present symptoms character- istic of the inflammation of these different structures. In cases of this description, the symptoms are of the most violent character, the pains are exceedingly acute and painfully throbbing; there is a very rapid contraction of the pupil, the sight is speedily extinguished, the consti- tutional signs are very urgent, and the patient is always in imminent danger of rapid loss of vision. Causes.—The most common cause of iritis is the abuse of Mercury. Syphilis has been often assigned as a cause of it, but we believe, with- out just reason. It has often been observed during the treatment of syphilis by Mercury; but, we think, never in syphilitic diseases where Mercury has not been employed. Other causes are: mechanical in- juries, rheumatism, gout, excessive use of the eyes over minute objects. Treatment.—The most appropriate remedies are : Hepar-sulph., Acid-nitr., Muriate of Gold, Cocculus, Calcarea-carb., Nux-vomica, Belladonna, Conium,, Lycopodium, Staphysagria, Arnica, Aconite. Hepar-sulphuris, Nitric-acid, and Aurum-muriaticum are cura- tive in iritis arising from abuse of Mercury, with aching, throbbing and tearing pains in the orbit, sometimes extending to the top of the 116 DISEASES OF THE SANGUINOUS FUNCTION. head; pains in the bones about the eyes ; fiery sparks before the eyes; intolerance of light; contracted pupil; partial or entire loss of vision; dark or greenish color of the iris; spots of yellow lymph, or ulcers on the iris; febrile disturbance. Cocculus, Nux-vomica, and Belladonna are indicated in arthritic and rheumatic iritis, accompanied with deep-seated, lancinating, tearing, or'con tractive pains in the ball, and extending to the top of the head; involuntary, spasmodic movements of the globe; irregular contraction of the pupil; discolored and puckered iris; photophobia; pains ag- gravated on moving the eyes, or stooping; luminous specks or dark ob- jects float before the retina; greatly impaired vision; effusion of blood and matter into the anterior chamber of the eye ; indications of gastric derangement, and of general constitutional disturbance. Calcarea-carbonica, Conium, Lycopodium, and Staphysagria are appropriate in iritic inflammations connected with a scrofulous diathesis. These remedies cover: greenish or yellowish color of the iris; pupil much contracted and distorted; ulcers which have opened internally or externally; outward distention of the iris ; adhesions of the iris to the capsule of the lens ; moderate participation of all the structures of the eye in the morbid action; photophobia; vision destroyed or much impaired; difficulty in distinguishing the iris from effused lymph and pus into the anterior chamber of the eye; great general irritability; aching, throbbing, lancinating, or pressing pains in the eye; rapid and irritable pulse ; restlessness ; hot skin; loss of appetite ; mental and physical prostration. Arnica is necessary when the disease can be traced to a wound, or to any mechanical injury of the eye. It may also be properly employed in cases which proceed from sudden exposure of the eyes to an intense and glaring light Aconite will often be required, either in alternation with one of the other remedies, to control undue febrile excitement, and to remove the violent, congestion, which now and then occurs in iritis. Mercurius-corrosivus.—Case by Dr. Henderson, of Edinburgh.— A gentleman in May, 1852, had inflammation of one eye, declared rheu- matic by an eminent oculist in Glasgow. Bleeding, Calomel, and Opium rapidly improved the eye, but the mouth and tongue became sore and inflamed, which confined him to the house for a month, part of the time in bed. He afterwards relapsed several times within the month, though the attacks were not severe. During the winter he was well, but in March, 1854, he had a new and severe attack. The sclerotica around the cornea was closely and densely injected with vessels and so deeply colored as to present the appearance of ecchy- mosis ; ashing pain in the eyeball; the iris dull color ; pupil regular IRITIS. 117 though somewhat dilated. The disease had lasted four days when the second homoeopathic dilution of corrosive sublimate was prescribed one drop every four hours. Each dose therefore consisted of only the ten- thousandth part of a grain of the medicine. In four days the eye was nearly well, and on the fifth day of the treatment the patient was in perfect health. He had taken five doses per day of the medicine. In a few weeks he had a slight relapse, which was cured by the same re- medy without confining him to the house. No mercurial disease ac- companied this mercurial treatment. Clematis.—Rheumatic iritis ; sensation of pressure upon the eyes, with photophobia and lachrymation, particularly in the open air; lids forcibly contracted in the morning, with sensation of heat. Administration.—The remedies may be employed at the first, second and third attenuations, depending upon the age and susceptibility of the patient, and the violence of the inflammation. The dose should be repeated in acute cases every two hours, until we are certain of a medi- cinal impression upon the diseased texture. In less urgent cases, a re- petition will suffice once or twice in twenty-four hours. Belladonna, and its alkaloid Atropine, are among the most powerful re- medial agents in acute iritis. Mercurius, which is also truly homoeo- pathic to this disease, agrees very well in alternation with Belladonna. It also acts well internally while Belladonna is applied externally. Graefe advises in the slighter cases of acute iritis the application of a solution of Atropine (four grains to one ounce of water), six, eight, or ten times a day, and in severe cases as often as twenty times in the twenty-four hours. When synechia posterior with broad and extensible adhesions exists, the tendency to the recurrence of iritis is so great, that the patient and doctor are both ready to adopt the severest measures—even extirpating the eyeball, to get rid of the ever-recurring torment, and to prevent the sound eye from participating sympathetically with the diseased one. In such cases Grsefe performs iridectomy by excising a small portion of the iris. This treatment he has found efficacious in apparently the most desperate cases, where the anterior chamber was almost effaced, the iris discolored and bulging very much forwards, and the globe of the eye softer than natural and perfectly atrophied. He has repeated the operation on the same eye sometimes as often as six times, and with great advantage. The iris regains its healthy appearance, the anterior chamber refills with aqueous humor, and the whole globe becomes firm. The sight too is restored more or less perfectly. The rationale of the cure in these cases is not very clearly made out. Von Grsefe says: " The increased power of vision was in no way dependent on re-absorption of the pupillary exudations, but was 118 DISEASES OF THE SANGUINOUS FUNCTION. entirely to be ascribed to an improvement of the choroidal compli- cations" Mode of performing the Operation of Iridectomy.—The lance- shaped knife is introduced into the sclerotic, at the distance of half a line from its junction with the cornea, and pushed forwards into the anterior chamber. Through this wound the forceps is introduced, the iris seized and dragged out, and a portion, amounting to a fifth or even a third of the whole, cut away. The remains of the prolapsed iris are left in the wound.* 3. CHOROIDITIS. The commencement of organic disease of the choroid, though unat- tended by marked symptoms of inflammation, is still a serious matter, as inflammation often breaks out suddenly. The existence then of the network or gauze, or appearance of large spots in the field of vision, unaccompanied by pain or uneasiness, or any other evidence of increased action in the vessels of the conjunctiva or sclerotica should meet with prompt attention. The organ should have perfect rest and be kept from exposure to bright light. Counter-irritation in the vicinity has been found par- tially successful; stimulating drinks are to be avoided; food should be regulated to that extent that the patient's condition may direct. The patient's general health must be corrected. Bleeding has formerly been considered indispensable ; but in many other cases those who have tried it, found the bleeding to aggravate the disease; in young, delicate females, Mr. Tyrrell {Encyclopedia of Surgery, p. 90) saw "the continuance of the depletory treatment most injurious in augmenting the morbid action and hastening the disorgan- izing process." Unfortunately, as relief frequently follows the local abstraction of blood, the patient on every fresh attack or relapse is de- sirous of resorting to the same treatment again; still finding the relief of short duration ; the same course is resumed with temporary benefit, but the powers of the patient are successively reduced, and the local disease makes progress in disorganization; each relapse promotes fur- ther inflammation, and the anti-phlogistic treatment lessens the powers of the system to resist the progressive amaurosis; and, eventually, vision is completely destroyed, and the general health is at the same time materially injured. Mr. Tyrrell says: "I have seen several dis- tressing cases of permanent amaurosis resulting from such treatment, and I have also known many instances in which the disease has been * Memoirs on certain forms of Iritis, Choroiditis, and Glaucoma. Sydenham Society. 1859. CHOROIDITIS. 119 arrested and vision preserved by raising and maintaining the general powers" and pursuing a proper medical treatment Treatment.—Ipecacuanha.—In one case the following symptoms were presented: A lady, aged 47, had excessively painful shootings in the eyeballs, could not gaze on any object without copious flow of tears; blue and red halo around the flame of a candle ; pupils neither dilated nor contracted, and moved freely; vessels of the palpebral conjunctiva slightly injected without pain; conjunctiva and cornea uninjured; con- stipation ; no known cause for the inflammation. At the end of six weeks Dr. Tamhayn, in remembering the resemblance of the symptoms to those produced by the dust of Ipecacuanha on a pill-maker employed in a druggist's shop, prescribed that article. Jan. 15th, 1858. Ipecac, twelfth dilution, two globules in 200 gram- mes of water; a table spoonful three times a day for six days. Jan. 22d, the suffering was less, gazed on objects with less difficulty; the halo around the candle less visible; bowels improved. Ipecac'sixth dilution, two globules. Jan. 29th, improving. The patient can read and work in the daytime. Continued improvement, though some occasional shoot- ings in the eyes, more in the left eye or that first affected. Diarrhoeic evacuation about every morning. Ipec. twelfth dilution, two globules. Dr. Heniel, of Paris, gives a case in which there were lancinations excessively painful in the optic globes, copious flow of tears on looking steadily at any object. Blue and red aureoles surround the flame of the candle; pupil mobile ; no external inflammation, slight injection of the palpebral conjunctiva. Such symptoms had been caused in a drug- gist, pounding Ipecac, and it was prescribed Ipec. 12°, a two globules in water, three times a day for six days. The first week after there was improvement; constipation removed. A week later, could see to read and sew in daylight. {PArt Medical) Ammoniac.—"A glittering appearance before the eyes as of molten metal." {Dr. Hleinert.) In .this case, inflammation of the deeper- seated parts, the choroidea, &c, is present, with which amaurosis often commences. Traces of the change must be perceptible in the provers by the aid of the ophthalmoscope. Muriatic-acid.—Perpendicular hemiopia; thus partial paralysis of the optic nerve, perhaps exudation—extravasation of blood on the choroidea. Alumina causes vision of yellow, perhaps perceptible on the cor- pus vitrei and the aqueous humor,—a purely icteric symptom which may appear on other parts of the body. Mercury.—Amaurosis consequent on chronic choroiditis, is often if not always pathologically identical with mental imbecility conse- quent on chronic meningitis. In the first case the delicate structure of- the retina, vesicular neurine which is expanded on the optic nerve, 120 DISEASES OF THE SANGUINOUS FUNCTION. has been pressed upon by its vascular serous membrane, and the choroid and membrani Jacobi are thickened by a morbid deposit. In the second the vesicular neurine of the hemispherical ganglion is pressed upon by the thickened pia-mater and arachnoid. The success of treatment in inflammations of the eye should encourage us to make efforts equally persevering in the treatment of chronic meningitis. Mr. Tyrrell cured most obstinate cases of amaurosis by persevering in the use of minute doses of the gray mercurial powder every night or every second night for twelve months, taking care in all this time that it should never af- fect the mouth. He even said that he had often seen the cure ar- rested, and sometimes entirely defeated by salivation, in cases in which it occurred through the impatience of the invalid, who was too anxious to be speedily cured. By long persistence he said he had " restored many a poor fellow to sight whose case had been considered hopeless." 4. AMAUROSIS. Impaired vision coming on suddenly or gradually, and the loss of sight more or less complete; it may be permanent from its first ac- cession, or transient, varying in degree, and returning only at inter- vals, sometimes in the day only or in the night only. It sometimes comes on after great exertion of the eyes with minute or very bright objects, or when the digestive powers are greatly disordered. In some cases the loss of sight is confined to a part of the field of vision; or ob- jects appear crooked, distorted, mutilated, changed in size, or inverted; flashes of light; shining stars, globes of light, or muscae volitantes, are common when the retina is inflamed; when the vital energies of the organ are exhausted, as in dyspeptics or debilitated persons; motes, black specks, muscae volitantes and thick mists of clouds are seen; double vision is caused by disease within the cranium. At a later stage the vision is obscured by clouds, or a net-work of gray, black, or white silvery, luminous red, luminous in the dark. In some cases pain is felt in the eyes, in others there is only a desire for stronger lio-ht, in others there is dryness of the eyes and nostrils; the constitution generally presents some peculiarities indicating hereditary disease, or functional derangement of important organs; there is a staring, un- meaning look in the eyes; an unsteady, uncertain gait; the motions of the eyes or eyelids may be impeded or palsied; the eyes unusually prominent; the sclerotica bluish, or ash-colored, and, in some, covered with small varicose veins; the eyeball is firmer to the touch or softer than natural. After vision is extinct, the pupil is more or less expand- ed and motionless, though when only one eye is amaurotic, the pupil of that eye follows the motions of the sound one. Sometimes both eyes AMAUROSIS. 121 are amaurotic, and yet the motions of the iris continue under the nervous influence of subsidiary nerves, particularly of the branches of the third and fifth pair. The iris may contract irregularly, may pro- trude towards the cornea or be pressed inwards. Diagnosis.—Distinguished from cataract by the dimness, or loss of sight, being either sudden or partial, presenting the appearance of fly-spots, or motes covering parts of an object. In cataract, the diffi- culty of sight increases very slowly, and is compared to a diffused mist, thin cloud, or gauze, intervening between the eye and the object. Amaurosis, if in its first stages a cloud or mist be visible, goes on in- creasing till sight is extinct; but complete deprivation of sight never occurs in cataract. In cataract the opacity generally commences in the centre of the lens, and the misty appearance is most noticed when looking directly forward, vision being most distinct when he looks sideways; this seldom occurs in amaurosis. In amaurosis the patient desires strong light; in cataract strong light contracts the pupil and renders vision less perfect, as the rays have to pass through the central opaque part of the lens. Amaurosis is usually connected in its origin with headache, vertigo, and disease of the digestive organs. Cataract has seldom any such association. In amaurosis the pupil is either jet- black in health, or a pale greenish color visible when examined in a particular light. {Copland. Vol. I., p. 65.) In amaurosis with glau- coma the opacity is always greenish, in incipient cataract it is always grayish. In the former the opacity seems at a considerable distance behind the pupil; in lenticular cataract it appears close behind the pupil. In posterior capsular cataract the opacity is streaked, in glau- comatous amaurosis it is always uniform. In the former the opacity seen through a double convex lens appears slightly rough; the glau- comatous opacity is smooth and polished. In the former the eyeball is of the natural degree of firmness; in glaucomatous amaurosis it is firmer than natural. Glaucoma progresses slowly, occupying several years ; in cataract the sight rapidly declines. In incipient cataract the contractions of the pupil are as extensive and rapid as in health; in amaurosis it is dilated and fixed, or its motions are limited and slow. In cataract the movements, eyeballs and eyelids are perfect; in amau- rosis they are imperfect and difficult, there is a want of direction to the eyes, and sometimes a slight degree of strabismus. {Mackenzie, on Diseases of the Eye) Symptoms.—The partial or total loss of sight which particularly characterizes this disease, is principally dependent upon a diseased condition of the optic nerve and retina, although other structures oc- casionally participate in the disease. Amaurosis occurs at all ages, and in both sexes, but is most common at the period of the cessation of the menses in females, and at the age of forty or fifty years in males. 122 DISEASES OF THE SANGUINOUS FUNCTION. The chief circumstances which predispose to it, are: a plethoric and sanguine temperament; hereditary pre-disposition; tendency to san- guineous congestions to the head and eyes ; and an impaired constitu- tion from the abuse of drugs, stimulating drinks, and venereal excesses. Physicians of the old school are much divided respecting the nature and treatment of amaurosis; some suppose it to be a debility requiring tonics and stimulants, while others describe it as an inflammatory af- fection, demanding an antiphlogistic course of treatment. In view of these discordant opinions, and the empirical modes of treatment based upon them, it is not surprising that so few amaurotic patients are cured by allopathic treatment. Amaurosis may be imperfect or perfect. In the former there is a partial, and in the latter a total loss of sight In the first, the patient sees as through a gauze, or but half of the object, or double, or only when the eye is in a particular position, with respect to the object; while in the last, the patient cannot distinguish day from night. The signs of the approach of the disease are: pain in the forehead and temples, diminishing with the advance of the amaurosis, and ceas- ing when it has become complete; vertigo; weakness and cloudiness of vision, apparent when looking at distant or at minute objects ; sparks and moats, or muscse volitantes, float before the eyes, annoying the patient, and impairing the sight; in reading or writing, a stronger light than usual is demanded; a slight diminution in the brilliancy of the pupil. After these precursory symptoms, the loss of vision gradually becomes more complete, until after months or years there remains a condition of settled and more or less perfect amaurosis. In other instances, the disease advances with rapidity, and terminates in partial or total blind- ness in a few days. But it is not an uncommon occurrence for com- plete amaurosis to follow instantaneously, leaving the victim in blind- ness so profound that he cannot distinguish light from darkness. When either of these three conditions obtains, there are usually but few signs which indicate the presence of so serious an affection; the principal symptoms being only a dilated and immovable pupil, a loss of contrac- tile power in the iris, and occasionally slight strabismus. But even these signs are not uniformly present; for cases of complete amaurosis are reported, in which the pupil remained natural, or became preter- naturally contracted, and mobile on exposure to light, and in which the iris and all other visible parts of the organ were in a normal condition. The color of the pupil in this disease is ordinarily jet-black, with, per- haps, a very slight diminution of its natural brilliancy, but it sometimes presents a red, greenish, or white and cloudy appearance. Cases of this last description are often mistaken for incipient cataract, and when the loss of sight is but partial, it is not easy to distinguish between the AMAUROSIS. 123 two maladies; but the following characteristics will afford us material assistance in deciding the matter. In cataract, the dense white ap- pearance is situated immediately behind the pupil, while in amaurosis the cloud is more deep-seated. In the former the flame of a candle ap- pears to be surrounded by a thin, white, diffused mist or cloud, " which increases with the distance of the light," while in the latter, "a halo or iris appears to encircle or emanate from the mist, the flame seeming to be split when at a distance." {Stephenson^ The shape of the pupil is usually round, but somewhat more dilated than in the normal state, thus allowing a large number of luminous rays to enter the eye. In a few cases it loses its circular form, and becomes angular. Amaurosis is attributed by most writers to a paralytic condition of the optic nerve, retina, or to some disease of the thalami nervorum; but does not the peculiar immovable condition of the pupil and iris, when their natural stimulus, the light, strikes them, indicate a loss of sensi- bility and contractility in these structures ? And does not the partial loss of voluntary power over the globe, which occurs during the pro- gress of the disease, indicate a loss of tone in the whole organ ? 3 We have mentioned, as one of the precursory symptoms of amaurosis, floats and muscae volitantes before the eyes. In the imperfect form of the disease, these appearances vary much in their character, and are a source of great annoyance to the patient. Sometimes a single black speck obstructs the sight; sometimes there is an appearance as if a dark gauze or net-work were before the eyes; sometimes as if flies, small objects of different forms, sparks, fireballs, and various colored lights, were moving in various directions. The objects are more trouble- some in a strong light than in dark situations, being in the former of a black or sombre color, and in the latter presenting themselves in the appearance of sudden flashes of light or fire. We are occasionally presented with the disease in an intermittent form, and, in rare instances, as a temporary attendant of some particular morbid condition of the system, like pregnancy, disordered menstruation, hysteria, worms, and the irritation of indigestible food. In addition to the symptoms already described, we sometimes observe in young and plethoric amaurotics, strongly pronounced determination of blood to the head and eyes, a constant stupefying headache, more or less redness and congestion of the eyeballs, sensitiveness of the eyes to light, a full and hard pulse, a sense of fullness, tension, and pain in the affected eye. It is a point worthy of note, that black eyes are far more subject to amaurosis than blue or gray eyes. Beer supposes that where one blue or gray eye becomes amaurotic, at least twenty-five or thirty black ones 124 DISEASES OF THE SANGUINOUS FUNCTION. suffer. No satisfactory explanation has ever been suggested for this comparative exemption of blue or gray eyes. Characteristics.—Distinguished from cataract by the dimness or loss of sight being either sudden or partial, resembling a fly, spots or motes covering parts of an object. In cataract the difficulty of sight increases very slowly and is compared to a diffused mist, thin cloud or gauze inter- vening between the eye and the object Prognosis.—When the cause of the disease is evident, and which can be removed, the patient young, constitution good, and the attendant disease curable, partial or entire recovery may be hoped for. When it has been suddenly induced, the pupil being only slightly dilated and still moveable, of the natural form and the eyeball not altered in structure, the prognosis is more favorable than when the pupil is fixed in a state of either expansion or contraction, or when the eyeball is either soft or preternaturally hard, or when the back part of the eye presents a greenish opacity. If the attack has been sudden, the vision perverted, power over the muscles of the eyelids lost, there may be disease within the brain. If the symptoms have been gradually de- veloped in succession, there may be a tumor, cyst, or exostosis within the cranium; and in all such cases the prognosis must be unfavorable; and also in all cases in which the cause has been long in operation, the loss of sight has been very gradual, the constitution is much im- paired, and the cause cannot be speedily removed. Amaurosis depending on morbid growths within the orbit or cranium, may be considered incurable; but wrhen it depends upon a slight effu- sion upon the brain, or the pressure of a tumor upon the jugular vein of the neck, we may often effect a cure by causing the effused fluid to be absorbed or removed by an operation, or the extraction of the of- fending tumor. We once cured a case of several months duration by removing from the neck a tumor of the size of an orange, and thus re- newing the free course of blood from the head. The sight returned almost immediately after the operation. The loss of sight which some- times accompanies pregnancy and intermittent diseases, often subsides spontaneously after parturition, or the cure of the disease, on which the blindness depended. A favorable prognosis may commonly be entertained in those recent cases which depend on congestion of the optic nerve, retina, or thalami nervorum opticorum, arising from general plethora, suppressed menstruation or haemorrhoids. The effects also of mechanical injuries, lacerations, contusions and blows upon the eye, may frequently be cured. Causes. — First. — Predisposing. — Hereditary disposition; dark eyes; insolation; forced mental or physical exertion; excesses of pas- sion; pregnancy and the puerpural state; habitual stooping; indigestion ; abuse of stimulants; suppressed discharges; menstrual derangements; AMAUROSIS. 125 gout, rheumatism or scrofula; retrocession of eruptions; habitual con- stipation; chronic diarrhsea; typhoid fevers; use of snuff; long con- tinued grief; nursing too long continued; leucorrhoea; masturbation; excessive exercise of the sight on minute objects or in bright glaring light; strumous ophthalmia. Second.—Exciting Causes.—Over-exertion of the sight; very bright light, working with minute objects by lamp or gas light at late hours ; strong shocks of electricity, as lightning; long continued over-excite- ment of the eye; or mechanical injuries producing contusion or con- cussion of the retina; strong poisons as stramonium, belladonna, poison- ous fungi, and fish-poison; epileptic or other convulsions; apoplexies or paralysis ; injuries of the fifth pair of nerves; gastric or intestinal irritation, from wrorms or other causes; hypochondriasis ; accumulations of bile ; frights ; neuralgia, with or without carious teeth; drying up of old ulcers ; cessation of the menses ; typhoid fever or scarlatina; metas- tasis of gout or rheumatism; syphilis and abuse of mercury. The causes of amaurosis may operate upon the brain itself, upon the optic nerve, or the retina. They may be divided into constitutional, and local causes. In the first class we include : repeated and protracted determinations of blood to the head and eyes, by unusual physical or mental exertion; pregnancy; suppression of natural or habitual dis- charges ; violent vomiting; excessive indulgence in venery; masturba- tion ; unbridled anger, grief, and other passions; abuse of stimulants; large doses of opium, lead, belladonna, hyoscyamus, stramonium; abuse of bitter medicines, as quassia, cinchona, chamomilla, chicory, &c; exer- cise in a hot sun; general debility; derangement of the digestive organs; the depressing emotions; the pressure of tumors upon the vessels of the neck in such a manner as to prevent the return of blood from the brain. We include in the second class of causes, morbid growths within the orbit: mechanical injuries of the eye; sudden transitions from darkness to a brilliant light; lightning; frequent use of optical instruments, like the telescope and microscope ; exostoses within the cranium; sanguine- ous effusion upon the brain; injuries of the head. Pathology.—First.—Amaurosis is perhaps always dependent on some physical change in the structure of the eye, though this is not always perceptible on dissection. Functional amaurosis, says Beer, proceeds from direct depression of the vital sensibility of the eye ; or from inordinate excitement, and consequent exhaustion of this property. Mackenzie thinks that in all these cases there is a certain degree of organic derangement, even when dissection does not reveal it. In nearly all cases there is sensible organic derangement. Second. — Congestive or inflammatory state of the retina or parts adjoining:—Varicose states of vessels; unusual injection of the 126 DISEASES OF THE SANGUTNOUS FUNCTION. minute arteries of the adjoining coats and of the retina; complete re- tinitis ; exudations of lymph under the choroid ; inflammation of the external surface of the sclerotic ; injection of the choroid and adhesion of the retina to it; thickening, morbid density of the retina; change of color and ossification or wasting of the retina. Third.—The optic nerve may be compressed or otherwise affected by structural changes in parts contiguous to it. {Copland, Vol. I, p. 59.) Fourth.—Disease of the Brain or its membranes may cause amau- rosis by impeding the functions of the optic nerves, although the structure of these nerves be uninjured. The most common of these are : organic lesions of the pineal and pituitary glands, sanguinous and serous effusions, tumors, abscesses, softening of the brain. Treatment.—A complete removal of all suspected causes is the first step. When the general symptoms denote debility; when there is languid circulation, muscce volitantes, or dark spectra, an alterant, though supporting treatment is required; light, nutritious, invigorating diet, change of air, moderate exercise, vegetable and mineral tonics, with the usual means of improving the secretions constitute the usual measures for restoring the nervous energies of the debilitated organ. When the disease is obviously connected with inflammatory action it is of that character which is not always benefitted by depletion. Per- haps the most common form of amaurosis is that consequent on chronic choroiditis, which is believed to be pathologically identical with that which exists in the brain in mental imbecility, consequent on chronic meningitis. In the former case, says Mr. Solly {On the Brain, p. 357), " The delicate structure of the retina, the vesicular neurine which ex- pands on the optic nerve, has been pressed upon by its vesicular and serous membrane, the choroid and membrani Jacobi, thickened by morbid deposits." In imbecility from chronic meningitis the vesicular neurine of the hemispherical ganglion is pressed upon by the thickened pia mater and arachnoid. This view of the pathology in many cases of amaurosis has led Mr. Tyrrell, of London, to a successful course of treatment. By persevering in the use of extremely small doses of Mercury every night or every second night for twelve months, Mr Tyrrell has succeeded in curing most obstinate cases of amaurosis. By employing such minute doses that no drug symptoms are produced, Mercury will often restore the sight in amaurosis, even when the per- ception of light is destroyed ; it is not entirely hopeless if the globe re- tains its natural consistency; neither abnormally hard, or soft and shrunken; when the disease is of very long continuance, then the re- tina and vitreous humor become sometimes implicated in the morbid action and partial atrophy ensues. Tyrrell says: "The safety of the treatment and its efficacy depend greatly on the support of the general powers; for while this is properly AMAUROSIS. 127 sustained, the remedy can not produce any general injurious effect, though its operation on the local disease may proceed most beneficially." If the general powers are not maintained "the effects of mercurial action on the system are extremely distressing and injurious, and it can rarely be continued long enough to remedy the amaurosis." Case by Mr. Tyrrell.—" A man, aged thirty-eight, had been amau- rotic for seven years. He had lost the perception of light; the globes possessed their natural firmness and elasticity; the pupils were clear, but irregular, from many points of adhesion between the pupillary margin of the iris and the anterior capsule of the lens; the irides were discolored and dull, and he had the vacant aspect of a blind person. Mercurial treatment was tried with good diet; but the mouth became tender and sclerotitis occurred. But the treatment was continued, and Belladonna was applied night and morning to each eyebrow. He so*on became sensible to light, and gradually acquired the power of discern- ing objects ; and the adhesions between the irides and capsules of the lens began to give way; the pupils to assume their natural figures; by degrees the vision improved, inflammation subsided; the pupils became regular and the irides brilliant. The Mercury was continued for above sixteen weeks, when the amaurosis was completely subdued, and vision perfect" In this case it is evident that Mercury in an attenuated form would have cured the amaurosis and left the patient in a better con- dition for permanent health. In brain affections we should be guided by similar principles. Treatment.—The specifics for the different forms of amaurosis are: Belladonna, Nux-vomica, China, Phosphorus, Ruta-graveolens, Stramonium, Sidphur, Euphrasia, Arnica, Cannabis, Hyos- cyamus, Stramonium, Opium, Secale. Belladonna.—External Indications. — Pupil dilated and immov- able ; strabismus; pupil black and round or angular; partial or total loss of vision; listless expression. Physical Sensations. — Power of vision diminished or extinct; sensation of weight and pressure in the eyeball; throbbing or stupefying headache ; objects appear double, or wrong side up, or half concealed, or blurred, or surrounded by a fog or mist; dark, fiery and red bodies float before the eyes ; bright flashes before the eyes ; the candle seems surrounded by a halo of different colors; but in which the red pre- dominates. Mental and Moral Symptoms. — Mood generally irritable, but high spirits alternating with despondency. Remarks.—This remedy is called for in amaurotics of full and plethoric habits, and where the malady has been caused by inflam- mation, congestion of the optic nerve, retina, or some part of the brain. 128 diseases of the sangutnous function. Nux-vomica.—External Indications. — Pupils contracted, some- times dilated; spasmodic motions of the eyeball; photophobia. Physical Sensations.—Intermittent obscuration of vision; black or gray moats before the eyes; stupefying headache ; weakness of sight, worse in the light of day; luminous vibrations on the side of the eye; vertigo. Mental and Moral Symptoms. — Disposition melancholic and hypochondriacal. Remarks.—Nux is applicable in amaurotic complaints arising from excess of study and abuse of stimulants and opium. It is also indicated for temporary loss of sight, which sometimes accompanies intermittent diseases. China.—External Indications.—Pupils dilated and insensible, or slightly contracted; a white cloud deep within the eye; photophobia. Physical Sensations.—Indistinct and confused vision; muscse voli- tantes ; sudden obscurations of sight; only the outlines of objects can be discerned; general debility; irritability; morbid sensitiveness of the whole system. Mental and Moral Symptoms.—Disposition cheerful and languid. Remarks.—China will apply when the disease is of a purely atonic character, and* has originated from excessive loss of blood or pus, or from protracted chronic or acute diseases. Phosphorus.—External Indications.—Pupils and eyes natural. Physical Sensations.—Sudden attacks of blindness during the day; distant objects appear to be enveloped in smoke or mist; black spots before the eyes; diminished vision; he sees as through a net-work or gauze; sparks before the eyes in the dark; tremulous vision; luminous vibrations before the eyes; the flame of a candle seems to be surrounded by a green halo. Mental and Moral Symptoms.—Spirits gloomy, dejected, and with- out any cheerful reaction. Remarks. — In amaurosis consequent on masturbation, loss of animal fluids, and in impoverished old people, Phosphorus is an ex- cellent remedy. Ruta-graveolens.—External Indications.—Pupils contracted; in voluntary movements of the balls of the eyes ; spasms of the lids. Physical Sensations.—Sense of weight and pressure in the eye- balls ; weakness of the eyes; inclination to read or write by a very strong light; muscae volitantes; red halo surrounding the flame of a candle ; cloudy vision; weariness of the eyes. Mental and Moral Symptoms.—Indifferent, irresolute and peevish. Remarks.—Amaurotic complaints arising from abuse of the eyes with optical instruments, in reading fine print, or working at small ob- hydrophthalmia, or dropsy of the eye. 129 jects, and also from contusions, and other mechanical injuries, will re- quire the use of Ruta. Stramonium.—External Indications.—Pupils dilated and immov- able ; eyes staring, and somnolent or glistening. PJiysical Sensations.—Sense of weight and tension in the eyes; ob- scuration of sight; objects appear small or double; black colors appear gray; sparks and specks float before the eyes ; objects seem surrounded with a red or light border; cloudy vision ; vertigo; headache. Mental and Moral Symptoms.—Disposition irritable and touchy; hysterical and cataleptic. Remarks.—Stramonium is suitable in paralytic affections of the optic nerve and retina; connected with deranged menstruation, hysteria, epilepsy and catalepsy. In incipient amaurosis, and frequent and sudden and short attacks of blindness, we may refer to Sulphur, Euphrasia, Arnica, Canna- bis, Hyoscyamus, Conium, Aurum, Digitalis. Administration.—We are in the habit of employing from the first to the sixth attenuations. Repetitions should not be made more than once or twice in the twenty-four hours. As soon as an impression is apparent, we should await the result before administering again. 5. hydrophthalmia, or dropsy of the eye. Diagnosis.—This disorder proceeds from the formation of a preter- natural quantity of the aqueous or the vitreous humors, while the ab- sorbent vessels convey into the circulation only their customary amount of these secretions; or the humors may be formed as usual, but owing to some defect or loss of power of the absorbents, the natural quantity is not taken up and carried into the circulation. But it is highly proba- ble, in most cases, that the disease is dependent on a morbid condition of both the secerning and absorbent vessels, and the normal equilibrium between secretion and absorption becomes thereby destroyed. This idea receives confirmation from the fact, that most dropsies of the eye can be traced to previous inflammation of the internal textures of the organ. The unnatural accumulation may be confined to the aqueous humor in the anterior chamber, or to the vitreous humor in the posterior chamber, or both humors may be affected at the same time. When the aqueous humor is alone involved, the disease may be recognized by the following marks: dimensions of the cornea larger than natural; increased size of the anterior chamber of the eye; turbid appearance of the aqueous humor; partial or total loss of motion of the iris; pupil natural and immovable ; iris less brilliant than natural; sense of weight and tension in the eyeball; weakness of sight; perversion of vision, Vol. ii.—9. 130 diseases of the sanguinous function. either in the form of presbyopia or myopia: general loss of voluntary motion over the ball; partial or total loss of vision. When there is a preternatural accumulation of the vitreous humor, the enlargement of the globe is more deep-seated; the ball assumes a conical shape; the cornea is unusually prominent; the pupil is con- tracted; there is a diminution of vision; myopia; deep-seated pains; tension and heaviness; impaired motion of the ball; and eventually, total blindness. When the disease consists of an unnatural accumulation of both humors, we shall have a combination of symptoms including nearly all described under the aqueous and vitreous varieties of dropsy. After the vitreous humor has been for some time affected, its character is changed, and it acquires a soft and usually a watery appearance. In many cases, the eye attains a size so enormous as to protrude far from the orbit, and it is thus rendered quite impossible to close the lids over it. In this condition the patient has a frightful appearance, and the organ itself, from its exposure, is constantly irritated and in- flamed. Causes.—The immediate cause of dropsies of the eye is an undue action in the arteries which secrete the humors, and a diminished action of the absorbent vessels; or, sometimes an inordinate aqueous or vitreous secretion, with a normal action of the absorbents. Hydrophthalmia is generally supposed to depend upon some con- stitutional cause, like general dropsy, hydrocephalus, chlorosis, or se- condary syphilis; but, as a general rule, it may be traced by some pre- vious inflammation of the internal structures of the eye. In infants and young children, it is often exceedingly difficult to discover the real cause, especially when the external indications are obscure, and, on this account, the earlier history of the case can rarely be ascertained; but in adults, we shall often be able to discover previous sub-acute in- flammation in the internal structures. Prognosis.—The allopathists deem this disease, when fully formed, incurable. They find that no shedding of blood, no punishment of stomach, bowels, salivary glands, skin, or other inoffensive parts of the body, can cure or palliate it. That the prognosis is unfavorable we do not deny; but we believe the disease may often be cured in its early stages. We have treated but two cases homoeopathically; and but one with a favorable result. This was of six months standing, confined to the aqueous humor, and with but moderate distention of the cornea; the other case involved both humors, had continued more than a year, and had arrived at the condition termed "ox eye," when the treatment was commenced. In this instance paracentesis became necessary, and the patient ultimately lost his eye. So long as the disease is confined to its incipient stage, and even CATARACT. 131 after the unnatural accumulation has commenced, provided no serious disorganization has taken place in the important tissues of the eye, we may predict a favorable result; but if organic lesions have occurred, and the accumulation in the anterior or posterior chamber is consider- able, with total loss of sight, our prognosis must be unfavorable. Treatment.—If the dropsy depends upon a constitutional fault, our remedies must be addressed to the remote difficulties. So long as these continue, mere local means will be inadequate to accomplish our object; but constitutional and local remedies may be used in alternation with probable advantage. If the eye be much distended, and medicines do not act with sufficient promptness and energy, the operation of para- centesis may be made to evacuate the superabundant humors, after which the remedies will generally prove sufficiently powerful. We believe the following to be the best at present known: Bella- donna, China, Pulsatilla, Mercurvus, Hyoscyamus, Stramonium, Conium,, Nux-vomica, Arsenicum, Plumbum, Aconite, Sepia, Sulphur. It is doubtful whether either of these exercises a positively specific in- fluence upon the secretory and absorbent vessels affected in hydroph- thalmia, but they are capable of acting upon the generally morbid con- dition upon which the local disorder depends; they thus aid in arresting its progress, and occasionally in effecting cures. Administration.—In the same manner as advised in amaurosis. 6. CATARACT. Diagnosis.—Strictly speaking, this disease belongs to the province of surgery rather than that of medicine ; but as homoeopathy promises results somewhat important in a medicinal point of view, we take the liberty of presenting a few words respecting the malady in this place. By the term cataract is understood, an opacity of the crystalline lens, or its capsule, which causes an obscuration, or a total loss of vision. Authors recognize and describe several varieties, both of the lenticular and capsular cataract, and among the most common are:— First.—The firm or hard cataract, peculiar to old people, and re- cognized by its amber color, small size, and by its density and hard- ness. Vision is never totally destroyed in these cases, and the struc- tures of the eye retain their natural contractility. Second.—The fluid or milky cataract, caused by a change of the lens into a white and semi-fluid mass, of so large a size as to nearly obliterate the posterior chamber, impair the motions of the pupil, and prevent the admission of rays of light. Third.—The soft or caseous cataract, which presents an appear- ance somewhat similar to the last variety, with the lens much enlarged. 132 diseases of the sanguinous FUNCTION. of a cheesy consistence, and of a light gray or sea-green color, oblite- ration of the posterior chamber, impaired motion of the pupil and ins, and either partial or total blindness. The lens in this variety, always presents an appearance of more firmness and consistence than in the milky cataract, aud the dark irregular spots or lines which sometimes traverse it, remain the same in all positions of the head, while those which are now and then observed in all the milky variety, change their location with every motion of the eyes. Fourth.— Capsular cataract, consisting of an opacity of the capsule of the crystalline lens. The opacity commences at the margin of the pupil, in the form of "distinct, white, shining points, specks or streaks; its color, therefore, is always very light, and never altogether uniform, even when the disease is completely formed." {Beer.) When this kind of cataract occurs in children at or soon after birth, it is called con- genital cataract. The capsular cataract does not generally continue for a long period before the lens becomes involved also in the opacity. When the dis- ease has been preceded by a good deal of inflammatory action, we may find cohesions of the anterior capsule of the lens with the urea;'or of the wdiole of the capsule with the lens; or all the three species of ad- hesion may exist together." {Beer, p. 318.) Cataract is sometimes complicated with amaurosis. This complica- tion is not always easy of detection, on account of the symptoms of these diseases bearing so close a resemblance. When the lens or its capsule are alone affected, the opacity is immediately behind the pupil, the iris and pupil possess some degree of mobility, and there is some little appreciation of light; but when amaurosis is conjoined with cata- ract, we have the same appearance of the lens or capsule, but a dilated and immovable pupil, an insensible and immovable state of the iris, and an absolute loss of vision. The first intimation we have of a forming cataract, is defective vision when attempting to read fine print, or to look at minute objects. As the disease advances, all objects appear indistinct; a mist is con- stantly before the affected eye; a strong light is required to read or write; a small speck now commences just behind the centre of the pupil, and .continues to extend until the opacity entirely obstructs the passage of rays of light to the eye ; when the opacity is complete, a black ring is seen around the edge of the pupil and the sight continues to diminish until blindness is complete. Causes.—Frequent and long-continued use of the eyes in reading fine print, writing, or looking at minute objects by a strong light; con- gestion of blood to the eyes, from exercise in the hot sun, in furnaces, and other places where hot and bright fires are kept; exposure of the eyes, irritating fumes and vapors, like sulphurous acid, chlorine and CATARACT. 133 other gases, and the vapors of sulphuric ether, nitric, sulphuric and muriatic acids, hereditary predisposition, mechanical injuries, wounds of the capsule or lens. Prognosis.—When the cataract is confined to the lens, or to its capsule, and no complications exist from unnatural adhesions, from amaurotic symptoms, or from serious constitutional disturbance, a favorable issue may be expected. On the other hand, a dilated pupil an immovable iris, a profound blindness, which has been disproportion- | ate to the gradually forming opacity, unnatural adhesions of the capsule, and an irritable and vitiated constitution, will render our prognosis unfavorable. Treatment.—Before resorting to the operation of couching, or ex- traction, as is so often done by the old school surgeons, we should al- ways give our medicines a fair trial. It is quite true that we have but few remedies which simulate this affection in their pathogenesis, yet the successful results which have been observed from the use of medicines in a few cases, render it incumbent on us to avail ourselves of them on all proper occasions. After a thorough trial with medicines, like Silicea, Graphites, Kali- hyd., Merc.-hyd., Calc-carb.-ac, if there is no prospect of amendment, the patient should be turned over to the surgeon for the necessary operation. In a few cases of incipient cataract, much benefit has followed the local employment of sulphuric ether vapor to the eye, and should our internal remedies prove fruitless, there can be no objection to a trial of this substance. As internal remedies we suggest: Silicea, Graphites, Iodine, Merc- Jiyd., Conium, Pulsatilla, Magnesia-carb., Sulphur, Cannabis, Phosphorus, Digitedis, Spigelia, Euphrasia. Conium and Cannabis may be employed where the cataract has arisen from a wound or other injury to the eye. Magnesia-carbonica, Pulsatilla, Digitalis, and Phosphorus, have proved curative in capsulo-lenticular cataract, either with or without abnormal adhesions, also in opacity of the lens or capsule alone. These remedies are useful when the disease has been accompanied with ophthalmia. Sulphur is appropriate in those cases which seem to be connected with a scrofulous or psoric diathesis. It has also been found curative in cataract complicated with amaurosis. Euphrasia, or Spigelia may sometimes be alternated with Sulphur with benefit. Administration.—The same as in amaurosis. A case is given by Dr. J. Mouremans,* of a lady, aged 77 years, * L'Homceopathe Beige. 134 DISEASES OF THE SANGUINOUS FUNCTION. who had been blind four years. She is small, emaciated, of sallow complexion, mother of three children. Vision had become impaired gradually several years ago after inflammation of the eye. She then saw snow-flakes and spider-webs in the atmosphere. In 1856, April 29th, she could hardly distinguish light from darkness; pupils dilated and mobility of the iris partially impaired, crystalline lens obscured, of whitish color, and uniformly shaded; no pain; inability for four years to continue her occupation. Euphrasia 30th, May 16th, improvement, continue Euphrasia, higher potency, three globules at once. Aug. 4th. Begins to distinguish objects but they look distorted. Cannabis 30, continued till Dec. 1. Condition not changed. Sulph. 200, three globules given at once. March 2d. The crystalline lens appeared less clouded. Could distinguish persons though as in a mist Causticum 200. April 30th. Still saw black spots before the eyes; but vision im- proving, Silicea 30. At the end of May, the patient overjoyed at her condition, can readily distinguish all objects; could recognize the letters in a book; that she could devote herself again to her former oc- cupation. Sees a halo around the light of a candle. Phosphorus 30. Two months later, she came to render thanks for the benefits she had received. Her vision was so far improved that she could thread a needle, could sew and could read with ease. Three years afterwards the sight continued good. 7. GLAUCOMA. Mr. Hancock says he does not regard the disease merely as a choroiditis, or irido-choroiditis, with infusion into the vitreous and aqueous humors, as this view seems to regard results rather than causes. He believes "that glaucoma, whether acute or chronic, is es- sentially a disease of the blood and the blood-vessels, and that the ef- fusion or infusion, as it may be described, is the result of this condition, which if not arrested, sooner or later destroys sight" He does not rely on any operation for the cure of glaucoma, relying mainly upon constitutional remedies. "In acute glaucoma," says Mr. Hanson, "the eyeball is constricted and marked by a circular depression at the point corresponding to the ciliary muscle, whilst the vessels around this part are gorged to a great degree. The eyeball is elongated in its antero-posterior diameter, and the cornea lessened in all its diameters, and rendered more conical than natural; whilst, when the patient turns his eyeball sideways, irregular bulging of the sclerotica (Staphyloma), is exposed to the view. In one or two cases, also, in which I performed iridectomy, the pupil was dilated to excess, and the iris so tense and rigid that it resembled a cat-gut, and could with difficulty be drawn through the wound." The GLAUCOMA. 135 pathology is not clear. This author thinks he can " readily under- stand that the lateral expansion of the eyeball being, in a great degree, prevented by the constriction of the ciliary muscle, the force of the compressed fluid acts more powerfully in the antero-posterior direction; hence the puckering and cupping of the retina, the irregular bulging of the choroid, the alteration in the shape of the cornea, and elongation of the eyeball." A more careful examination of the pathological appearances led this observer " to suspect that the ophthalmoscopic and pathological ap- pearance of the blood-vessels were greatly enhanced by, if not in some instances entirely due to, the obstruction of the circulation caused by the undue and excessive constriction exerted upon them by the spas- modic or extreme contraction of the ciliary muscle, analogous to the spasm so often observed in the muscular fibres of the urethra, as well as in the sphincter muscle in certain affections of those parts. "This supposition was strenghtened by the character of pain so often described by patients as ushering in the attack of acute glaucoma; in one case, a lady who had been exposed to a very strong light at a party, felt upon her return home, as though she had received a violent blow upon her eye." {Lancet, Feb., 1860.) Pathology.—In glaucoma the pupil is dilated, of a sea-green, bottle- green, or dirty-green color; the cornea is somewhat flattened anteriorly, and nearly as sensitive as in the natural state; the iris is rather con- vex anteriorly; the globe of the eye is harder than usual; the sight is diminished from slight amblyopia to complete blindness; the ophthal- moscope, shows the papilla of the optic nerve, as it enters the globe and spreads out into the retina, to be concave, in place of convex, as it is normally; it likewise demonstrates pulsation of the arteria centralis retina?. Von Grsefe attributes all these symptoms to increase of the intra-ocular pressure. He divides glaucoma into acute and chronic. Acute glaucoma, is considered to consist in a choroiditis (or irido- choroiditis) with diffuse imbibition of the vitreous body and aqueous hu- mor, and in which increase of the intra-ocular pressure, compression of the retina, and the well-known series of secondary symptoms, are produced by the increased volume of the vitreous humor. Treatment of Glaucoma.—This disease, previously regarded as in- curable, has been treated with partial success by Von Graefe by the operation of iridectomy. J. W. Hulke, assistant surgeon to the London Ophthalmic Hospital, &c, has reported two cases thus treated. It is claimed that "the hardness of the eyeball, the peculiar progressive contraction of the field of vision, the paralyzed dilated pupil, the in tense throbbing pain, the excavation of the optic nerve entrance, and pulsation of the retinal vessels," are consequences of "excessive tension 136 DISEASES OF THE SANGUINOUS FUNCTION. of the eyeball, produced by a superabundance of fluid within it, which is probably exuded from the choroidal vessels and distends the vitreous humor." "The eye being an organized living tissue, having a locular or cellular arrangement, the distention of its loculi with dense fluid, as serum, would give the whole tissue an unnatural turgidity, and stiffness. The fluidity of the organ, which occurs later in the disease, depends upon the breaking up of its dissepiments, when it shares the atrophy which finally involves all the ffcular structures." Von Grsefe long ago demonstrated a flattening of the cornea in this disease, " by comparing the size of the image which the flame of a candle forms upon the glau- comatous cornea with that which it form^ upon the healthy cornea of the other eye;" it is "immediately apparent that the glaucomatous cornea furnishes the larger image, proving that its outline has a larger (flatter) curve. " The excavation of the optic nerve entrance" is explained in the Jacksonian prize essay on "Diseases of the Retina," Dec. 1860. {Archiv fiir Ophthalmologic.") It is there shown that "the optic nerve entrance constitutes the weakest, the most yielding point in the fundus, where the first visible effects of excessive pressure would naturally be ex- pected." {Medical Times and Gazette, Sept. 1, 1860, London Lancet, Feb. 1861, p. 144.) Surgical Treatment.—Von Grsefe first attempted to treat it by paracentesis of the eye, and he accordingly performed this operation repeatedly in a large number of cases; but of these only two were per- manently cured, though there was temporary amelioration in most. He next attempted to produce "permanent diminution of the intra- ocular pressure" by iridectomy; but the general result was not very satisfactory; it seemed only to cause rather a refilling of the atrophied or softened eye. The result, however, of the same operation "in ulce- rations and infiltrations of the cornea" gave hopes of further advantages in the other cases. Cases, in which this operation was performed.—First:—In the premonitory stage of glaucoma. In this it was successful, even when this stage had lasted a long time. Second:—Early stage of acute inflammatory glaucoma. "Vision was perfectly restored in all cases in which the operation was per- formed before the termination of two weeks from the occurrence of the inflammation." Some of these cases were perfectly desperate, for every trace of the qualitative perception of light had been already ex- tinguished." Third:—Later period of acute glaucoma. Here improvement was obtained, though less apparent; the improvement was considerable, even after the inflammation had lasted many weeks, ilprovie, by taking hold of the eye-lashes and raising the lid in such a way as to expose its whole under surface to sight The offending sub- stance is then likely to be brought into sight, and can easily be re- moved by brushing it off with a corner of a light handkerchief, or a piece of soft blotting paper, rolled into a small soft brush. If wet with saliva it may be pushed far enough back into the eye to fulfil the desired object. A particle of iron flying into the eye from a blacksmith's anvil ad- heres closely where it lights. It may be removed by thrusting a bent hair beyond it under the lid and then drawing it forward; if visible it can be removed by the roll of paper, or corner of a linen cloth. Avoid rubbing the eye, soothe it with milk-warm water; and if the particle is not visible, try to sleep; the substance will generally come out of itself. If the eye be red and inflamed give Aconite. In scrofu- lous persons Aconite needs to be followed by Sulphur or Calcarea. {Hering, p. 122.) Acetum.—Particle of quicklime in the eye. Bathe the eye with diluted vinegar and wash it out. Traumatic Injuries of the Eye.—Injuries of the crystalline lens from blows, general opacity is observed to follow in a few weeks from the reception of the blow, and in cases of such injury the prognosis given should be guarded. In one instance, says Dr. Williams, the ap- pearance of cloudiness was delayed for eight years—when cataract made its appearance and required an operation for its removal." The medical treatment of injuries of the eye is simple and will be governed by the principles laid down under Ophthalmia and Injuries, p. 689.) IV. STRUMOUS OR SCROFULOUS OPHTHALMIA. This disease is characterized by extreme sensitiveness of the af- fected organs to light. Even the slightest ray causes intense pain • and the little patient makes every effort to avoid exposure. During the inflammation an eruption usually makes its appearance on the cheeks, in the vicinity of the eyes, and which often extends to the very organs themselves, thus giving rise to troublesome and dangerous STRUMOUS OR SCROFULOUS OPHTHALMIA. 151 ulcers. These ulcers not unfrequently extend until the structure of the eye becomes so far impaired, that total blindness ensues. Diagnosis.—Scrofulous ophthalmia presents several symptoms which are quite characteristic, and by the aid of which we may always form a ready and accurate diagnosis. The disease occurs in subjects of a scrofulous habit, and, in addition to the local symptoms, is accompanied with the general symptoms peculiar to scrofula, of which we will speak elsewhere. (See Scrofula, Index.) Indeed, these general marks will often aid materially in forming our opinion, particularly in slight cases. The light and clear complexion, blonde hair, blue eyes, tendency to glandular swellings of the neck, the tumid upper lip, eruptions during childhood behind the ears and upon the head, sensitiveness to cold, dis- position to cough after colds, frequent pains and discharges from the ears, indicate the strumous dyscrasia, which often determine and de- velop inflammations of the scrofulous kind. The peculiar symptoms which distinguish scrofulous inflammation of eyes, are, the almost absolute intolerance to light; the violent spas- modic closure of the lids on the slightest exposure of the eyes to it, and the strumous eruptions which generally make their appearance in the neighborhood of the eyes. The light is commonly so painful, and the dread of exposure to it is so great, that it is exceedingly difficult to make a thorough examination in children, and as a general rule it is better to trust the voluntary efforts of the patient, in a moderate light, rather than to resort to much violence in attempting to force open the eyes. Usually, by obtaining the confidence of the patient we can per- suade such a display of the globes as will sufficiently satisfy us in re- gard to the case. The vessels of the conjunctiva are generally much injected; there is a considerable discharge of purulent matter; the balls are stiff and painful; the lids swollen; vision impaired by the in- flammation, or by ulcers on the cornea; one or more ulcers form on the conjunctiva covering the cornea; and, if the symptoms continue to in- crease, the sight is finally destroyed. The disease varies much in its progress; is sometimes attended with but little redness of the conjunctiva, but slight pains in the globes, and but a moderate secretion of pus; at other times, during the formation of an ulcer, all these symptoms increase in intensity, until the case nearly resembles one of acute purulent ophthalmia. It is of far more common occurrence in children than in adults. Causes.—The constitutional cause, as we have seen, is a strumous dyscrasia. The local, or exciting causes are atmospheric vicissitudes; undue exposure to cold, light, dust, smoke, and irritating vapors; neg- v lect of cleanliness. Prognosis.—Severe purulent ophthalmia under the most favorable circumstances, for the application of remedies is highly dangerous. The 152 DISEASES OF THE SANGUTNOUS FUNCTION. A- chief peril against which we have to guard, is ulceration of the cornea. Before this has taken place, and especially if the cornea appears bright, we may entertain hopes of a favorable termination of the case; but if these opaque specks form while the inflammation retains its intensity, we must be prepared for a partial or total loss of vision. Of the diffe- rent kinds of ophthalmia, the gonorrhoeal is unquestionably the most rapid in its progress, and dangerous in its character. Here, nothing but the most consummate judgment and coolness, with constant atten- tion can avert serious consequences. The other varieties of the malady are not quite so rapid and destructive, but they demand the most skillful and energetic efforts to ward off injurious results. As a general rule, if we are called during early stages of the com- plaint, and exhibit the appropriate specifics judiciously and boldly, little difficulty will be experienced in inducing a speedy and happy issue to either of the varieties; unfortunately, however, the physician is rarely called until the disease is so far advanced that ulceration can not be prevented. It is evident, then, that the prognosis will depend upon the intensity of the disease, the complication which has occurred, the time it has existed, the constitution of the patient, and the remote and exciting causes. Treatment.— The only local application which can be advanta- geously used during the acute stage of purulent ophthalmia, is pure water, either cold or tepid. This may be employed as a lotion to the parts, during the course of the acute symptoms, as the judgment of the adviser shall dictate. When the chronic stage has set in, recourse may occasionally be had to stimulating collyria, like the Vinum-opii, solu- tions of Sulph.-zinc, Nitr.-argenti, Sulph.-cuprum, Acetat.-plumbi, and Aconite; but in regard to these applications, the same rules apply with full force here, that we have presented under the head of simple acute ophthalmia, when alluding to the use of collyria. The following remedies cover all of the symptoms which obtain in the different varieties of purulent ophthalmia: Arsenicum, Belladonna, Sulphur, Rhus-toxicodendron, Calcarea-carbonica, Aconite, Mer- curius-sol., Graphites, Phosphorus, Spigelia, Digitalis, Acid-nitr., Hepar-sulphur, Causticum. Arsenicum will prove curative in purulent ophthalmia, with much vascular congestion of the conjunctiva; swelling of the lids ; nightly agglutination; photophobia; pressure and burning pains in the eye- balls, aggravated by moving the eyes; nebulous spots, and ulcers on the cornea. Belladona is an admirable remedy in scrofulous inflammation of the eyes, with very great intolerance to light; a constant inclination to remain in the dark, or to plunge the eyes into a pillow or some other soft article; purulent, discharge ; great swelling of the lids ; spasmodic strmmous or scrofulous ophthalmia. 153 closure of the lids on exposure to light; chemosis ; tearing, throbbing, smarting, or stitching pains in the eyes; roaring in the ears; hot dry skin; thirst; nightly agglutination; throbbing of the carotid and tem- poral arteries; pains in the temples and head; ulcers on the cornea; dimness of vision. We have cured several cases of purulent ophthalmia of infants, characterized by great intolerance to light, intense inflam- mation, throbbing of the carotid and temporal arteries, flushed cheeks, hot skin, and other indications of inordinate vascular excitement, with Belladonna, succeeded by Mercurius. We deem Belladonna one of our most valuable medicines in nearly all of the acute inflammations of the eye. The effects arising from the application of a small quan- tity of the extract to the eyebrows or temples are sufficient to demon- strate its marked specific action upon the structures of the eye. We have found it eminently serviceable in ophthalmia neonatorum, and in acute ophthalmia. Sulphur is an invaluable remedy in several kinds of purulent oph- thalmia. It is adapted to the chronic forms, with atonic distention of the conjunctival vessels; swollen and oedematous condition of the lids, with purulent discharge; suppurating ulcers on the cornea; sensation of itching, burning, and heat, in the eyes and lids; troublesome ag- glutination in the morning; diminished power of motion of the upper lids ; pustules of the cornea ; sensitiveness to the light of the sun; swollen upper lip; eruptions behind the ears, and on the scalp and face ; pressure and burning pain in the eyes ; impaired vision. Sulphur is one of those remedies which will be required more or less frequently in all varieties of ophthalmias, not only to combat those lo- cal symptoms which especially correspond with it, but to correct mor- bid conditions of a more general and latent character, Sulphur may occasionally be used with decided advantage in alternation with re- medies which appear to cover all of the manifest symptoms, but which do not produce prompt impressions when given singly. Rhus-tox, is useful in rheumatic, scrofulous, and catharral oph- thalmia, with much inflammation and swelling of the lid; redness of the balls of the eyes; profuse secretion of mucus or pus from the eyes and lids; oedematous swelling of the lids and the parts surround- ing the eyes; morning agglutination, with increased redness of the eyes; pain on turning the balls; lachrymation; photophobia. Rhus-toxicodendron.—This is one of the most important remedies in catharral, erysipelatous, scrofulous, and exanthematic ophthalmia. Many allopathic physicians commend the tincture of Rhus in scro- fulous ophthalmia. We can bear witness to the value of this medicine in scrofulous ophthalmia, and in chronic ophthalmia which is kept up by a discrasia of erysipelatous character. Calcarea-carbonica has been successfully employed in every variety 154 DISEASES OF THE SANGUINOUS FUNCTION. of purulent conjunctival inflammation. Its chief indications are: in- flammation, redness, and purulent secretion from the eyeballs; swell- ing and redness of the eyelids; nightly, and sometimes daily aggluti- nation of the lids; great intolerance to light; nebulous specks and ulcers on the cornea; inclination to keep the eyes in darkness ; scrofu- lous eruptions upon the face and scalp; glandular swellings of the neck; swelling of the upper lips and nostrils; pustules on the cornea; pressing or aching pains in the eyes; corrosive inflammation in the edges of the lids, acrid lachrymation, general appearance indicative of the scrofulous dyscrasia. Dr. Dudgeon expresses the opinion that Calcarea " is one of our most important ophthalmic remedies and is surpassed by none in its applicability to the generality of cases of scrofulous inflammation, whether of the eye itself, or its lids; and is indispensable where there is marked scrofulous diathesis indicated by swelling of the glands," &c Aconite may often precede other remedies in every variety of puru- lent ophthalmia, when the inflammation runs high, and gives rise to febrile symptoms. Intense redness and swelling of the affected parts; acute pains ; accelerated circulation; violent photophobia; headache ; hot and dry skin; thirst; flushed cheeks; throbbing of the arteries about the neck, head and face; loss of appetite, " and perverted vision, point to the employment of Aconite." In some instances it may be alternated with Belladonna to advantage. * Mercurius-sol. has proved successful in our hands in gonorrhceal, scrofulous, and infantile ophthalmia; the remedy having been pre- ceded by Aconite. The symptoms were : violent inflammation and redness of the eyes ; great intolerance to light; profuse acrid or puru- lent secretion from the balls and lids; heat in the eyes; cutting and burning pains in the parts ; ulcers on the cornea; cornea dim and misty; sight impaired ; frequent agglutination of the lid ; gummy and scurfy matter on the edges of the lids. Graphites is one of the best remedies in scrofulous ophthalmia, with excessive intolerance to light; chronic congestion, of the con- junctiva ; purulent secretion from the balls and lids ; frequent aggluti- nation of the lids; ulcers on the cornea; porrigo in the face ; eyelids much inflamed, red, and painful; inability to open the eyes before a strong light; constant desire to keep the eyes covered; symptoms worse by day-light than by candle-light; general appearance indica- tive of a scrofulous diathesis. Phosphorus is sometimes useful in obstinate and protracted cases of atonic ophthalmia, which have resisted the ordinary remedies. There is generally inflammation and moderate redness of the eyes; considerable secretion of viscid mucus; sensitiveness of the eyes to light; heat, burning and itching of the eyes; lachrymation during the STRAMOUS OR SCROFULOUS OPHTHALMIA. 155 day ; frequent and sudden attacks of blindness during the day ; floats before the eyes ; weakness and indistinctness of vision. Spigelia.—Purulent inflammation, principally affecting the eyelids, with sharp pains in the lids ; pressure and pains in the eyeballs, during motion ; distention and paralysis of the upper lids; painful ulceration of the edges of the lids ; dimness of the cornea ; general loss of power over the eyes. Rummel speaks highly of Spigelia in rheumatic and gouty inflammations attacking the cornea. Digitalis.—Conjunctival ophthalmias arising from colds, with acute inflammation, redness, sharp stitches, photophobia, secretion of puru- lent matter, and obstruction and dryness of the nose. Nitric-acid and Hpar-sulph. are the best specifics for the re- moval of mercurial ophthedmia, following the abuse of this drug in syphilis and other diseases. The symptoms are: inflammation, swell- ing and redness of the conjunctiva and lids ; secretion of viscid mucus or pus ; burning and smarting sensation in the eyes ; photophobia, dark and unhealthy ulcers on the cornea; paralysis of the upper eyelids; tears easily excited; nightly agglutination; muscae volitantes and sparks before the eyes ; difficulty and pain in moving the eyes; pains in the bones and soft parts of the forehead and face. Chininum-sulph. has been employed with success at the first tritu- ration in several cases of strumous and chronic ophthalmias. When the malady assumes an intermittent character it will generally prove promptly curative. Euphrasia was given by Lobethal with much success in cases of rheumatic, strumous, and catarrhal ophthalmia, where there was "con- siderable mucous secretion in the inflamed organ; as also in blennor- rhoeas of the eyes, in all of which cases we employ Euphrasia at once, internally and externally; in the former case, one drop of the pure tincture; in the latter as a collyrium, from two to five drops in four ounces of water." Lycopodium is well adapted to scrofulous or catarrhal ophthalmia, and in obstinate cases of ophthalmia neonatorum. Hahnemann men- tions nocturnal agglutination and lachrymation by day, " as prominent indications for the use of Lycopodium." We have employed Aurum with excellent effects in several cases of ophthalmia of mercurial and syphilitic origin. Some authors re- commend it highly in scrofulous ophthalmia. Other remedies are, Qausticum, Sepia, Silicea, Staphysagria, China, and Chamomilla. Administration—In acute cases, we prefer the first, second, and third attenuations, and in the chronic stage the first attenuation. The remedy should be repeated in the more violent forms of the complaint^ every half hour, until we are satisfied with the impression produced; 156 DISEASES OF THE SANGUINOUS FUNCTION. but in chronic inflammations, a repetition once in twelve or twenty-four hours will suffice. During the treatment we should never neglect the external use of pure water, or milk and water, either cold or tepid. Genus IX.—INFLAMMATORY DISEASES OF THE FIBROUS AND MUSCULAR SYSTEM. 1. IRRITABLE INFLAMMATIONS. In these diseases the blood-vessels are much less affected than the nerves. The patient may feel agonizing pain when no local disease is discoverable. A lady had an irritable inflammation in the foot. Various remedies were tried without effect. She went to the sea-coast and used a steam bath, after which the pain quickly subsided. The eyes are very subject to this form of disease. But it is more common in the breasts of young females; the lightest touch pierces to the shoulder, and down the arm to the fingers. It is usually connected with amenorrhoea and may be cured by perfect restoration of the menstrual function. It sometimes attacks the testicles which become exquisitely tender without any visible enlargement. Sir A. Cooper says he had to remove. the testicle in three cases. One of these was in a gentleman from South Carolina. After the surgeons of London had exhausted their skill on him, the torturing part was removed, and the patient went home quite well. When this disease is seated in the bladder the pain often resembles that from stone, and blood is discharged with the urine. The difference is, that the irritable bladder is most painful when distended, and that which contains the stone is most painful when emptied. On dissection the irritable bladder has been found red and resembling velvet. P. 78. This disease sometimes attacks the rectum. The best remedies are: the high attenuations of Cantharis, Apis, Cannabis-sat., Lod., Prenanthus. These medicines will always palliate, and often cure the most severe cases of this kind. 2. ACUTE RHEUMATISM. Diagnosis.—Acute rheumatism usually commences after an abrupt suppression of perspiration, in consequence of exposure to wet, cold, or a highly variable temperature. It first manifests itself in the form of slight chills, lassitude, and general uneasiness, which are soon suc- ceeded by swelling, redness, pain, and augmented heat in the part af- fected. The pains vary much in character, being sometimes aching and gnawing, at others lancinating and darting, or dull and throbbing, ACUTE RHEUMATISM. 157 or numb, pungent, and prickling, and aggravated by movement, by ex- posure to drafts of cold air, and by the pressure or touch of the hand. In the first instance, rheumatism seizes upon the fibrous textures, but as the inflammatory action becomes developed, other tissues become in- volved, the capillaries of the neighboring parts become distended with red blood, and the usual phenomena are present. The larger joints are more subject to rheumatic inflammation than other parts of the body, although it is not uncommon for the inflammation to commence in the head, neck, chest, arms, or legs, and gradually extend into the neighboring joints. The more common accompanying symptoms of acute rheumatism, are: bitter taste in the mouth, coated tongue, rapid and full pulse, moderately hot skin, thirst, scanty, high-colored and sedimentitious urine; intense pain on moving the affected part; anxious and distressed expression of countenance, and occasional perspiration. Rheumatic inflammations are liable to shift from joint to joint, and sometimes to fix upon important internal organs, like the brain and its membranes, the pulmonary structures, and the heart and its appendages. So long as the malady confines itself to the joints, or to the external parts of the body it is unattended with danger to life; but when metas- tases occur to important internal organs, the disease becomes in an eminent degree perilous. Rheumatism .consists in a specific inflammation of a constitutional dyscrasic or psoric character, but which varies in its manifestations according to the anatomical structure in which it happens to locate it- self. Thus it may be called:— First.—Muscular Rheumatism, in which the specific inflammation is chiefly seated in the muscular structures; Second.—Articular Rheumatism, in which the inflammation is chiefly confined to the synovial membranes of the joints or to the liga- ments in their immediate vicinity; Third.—Rheumatic Neuralgia; the force of the disease being chiefly spent upon the nerves and their fine investing membranes. Rheumatism in either of the above forms may be either acute, sub- acute, or chronic. First.—Acute Muscular Rheumatism. The pain from sudden movement of the part is extremely great. Second.—Acute Articular Rheumatism is one of the most painful and trying of all febrile diseases, and movement of the joints produces intense suffering. Third.—In Sub-acute Rheumatism there is little febrile action, little redness or tumefaction of the parts; the pain is less intense and agonizing, although the movement of the affected part in certain direc- tions may excite severe pains which may be either lancinating or spas- modic. 158 DISEASES OF THE SANGUINOUS FUNCTION. Causes. — Acute rheumatism occurs for the most part in young, healthy, and robust subjects, and can be generally traced to undue ex- posure to cold, or to a wet and variable atmosphere. There is, how- ever, in most persons, who are habitually subject to rheumatism, a con- stitutional dyscrasia, often hereditary. Of the theory of the mode of transmission nothing clearly true has been written. It is argued by Sir Henry Holland * that the series of actions or changes peculiar to those diseases which occur but once during life, and are sufficient to prevent their recurrence, have their seat in the blood and are carried on everywhere by the circulation; authors who accept this view of the subject have supposed that the "rheumatic, or uric acid diathesis, im- pressed its peculiar characteristics upon the blood, and that this fluid being contaminated, it became the channel through which the morbific cause must affect the health and well-being of posterity." {Dr. Lvdlam) There is in some persons a rheumatic condition of the system which is little noticed till it rises to the height of acute disease. It originates in the free use of animal food and fermented liquors. If neglected it often results in violent and destructive inflammation of the organs. The point of attack will be that which is congenitally the weakest or which has become so by long-continued excitement; if the subject of attack be one who has long struggled with difficulties the brain is involved. A number of diseases may be termed rheumatic, as arising from a rheumatic condition of the system; we may therefore have rheumatic bronchitis, rheumatic diarrhoea; rheumatic inflammation following in- juries or surgical operations. Chronic rheumatism differs from the acute form in many respects; as for example, absence of febrile symptoms; the fixed character of the pains; no perceptible swelling or redness in the affected parts; the pains sometimes aggravated, and at other times ameliorated by walking, and other exercises ; great sensibility of the diseased tissues to changes of temperature, to humidity, and to cold; dryness and inactivity of the skin; rigidity in the parts, most apparent when attempting to move, or walk, after having been quiet for a considerable period; sedimentitious urine ; weakness, trembling, or numbness of the parts. Treatment.—We enumerate, as the principal remedies:—Rhus, Bryonia, Aconite, Colchicum, Belladonna, Pulsatilla, Dulcamara, Mercurius, Nux-vomica, Phosphorus, Ccdcarea-carbonica, Yera- trum, Hepar-sulphur, Arnica, Colocynth, Lycopodium, Sulphur. Rhus-toxicodendron.—The integuments about the joints swollen and red; pulse frequent and hard; urine dark, or red, and turbid. Physical Sensations.—Drawing and tearing, or tensive stinging and dragging pains in the affected parts, increased by exposure to cold, by * " Medical Notes and Reflections," p. 85. ACUTE RHEUMATISM. 159 rest, and by movement after having been for some time quiet; rigidity, lameness, and weakness of the muscles in the vicinity of the diseased textures; increase of the febrile symptoms, and of the pains, at night in bed ; perspiration, especially during the pains ; pains alleviated by exercise; throbbing and burning in the knees, or ankles; painful in- voluntary contractions of the muscles of the calves of the legs ; chronic rheumatic pains occurring early in the morning, and disappearing on moving about. Intellect unimpaired; disposition irritable and impatient. Administration.—One drop of the first dilution may be given in a dessert spoonful of water, every two or three hours, until the pains be- gin to subside, or until a medicinal action is produced upon the in- flamed tissue. Bryonia.—Swelling and redness of the inflamed textures : counte- nance pale or-sallow, or flushed and hot; tongue covered with a white or yellow fur; hot and dry surface, or perspiration of an acid character after exercise; considerable thirst, frequent and soft pulse; red or yel- lowish urine; position such as to relax the muscles bearing upon the diseased parts ; pains of a tearing, throbbing, or lancinating character, aggravated by movement, by the touch, by the contact of cold air, and by eating ; a relaxed state of the muscles ; perfect rest affords almost entire relief from suffering; bitter taste, or dryness of the mouth, with thirst; nausea; bilious vomiting; severe pulsating headache ; morbid sensibility of the touch; stitching pains in the region of the liver, and in the intercostal muscles; symptoms worse during the night; general uneasiness, anxiety, and irritability ; sleeplessness. Administration.—The second or third dilution may be employed — a dose every two, three or four hours according to the violence of the dis- ease. For the active febrile symptoms which occasionally accompany the affection, we usually prescribe Aconite and Bryonia in alternation with satisfactory results. Colchicum is a valuable remedy in both acute and chronic rheuma- tism. The pains are lancinating, jerking, tearing, worse at night, and increased by care, anxiety, or movement; or there may be only stiff- ness and lameness in the joints, when attempting to walk, with oede- matous swellings of the parts in the vicinity of the inflammation. Dr. Schroen commends Colchicum in those cases which resist the clearly indicated medicines, provided the skin is moist, and the urine turbid. Dr. S. advises it to be given in the form of vini seminis Colchici and in doses of twelve drops daily. We have found a single drop of the first dilution, repeated once in from three to six hours according to the acute or chronic nature of the case, very efficacious in several ob- stinate cases which had resisted the action of other medicines. It has been observed that Colchicum produces the symptoms of tym- panitis in goats which feed on this plant in pastures, Dr Meyhoffer 160 DISEASES OF THE SANGUTNOUS FUNCTION. says " in at least fifty cases of tympanitis in cattle, sheep and goats, I gave the strong tincture of Colchicum, two or three drops at a dose, and always with success. The dilutions disappointed me." Belladonna will prove an excellent remedy, in rheumatic attacks accompanied with a high degree of nervous irritability, and a morbid activity of the cerebral organs. The pains are very severe, especially at night, increased by touch, or by remaining too long in one position. Pulsatilla is indicated when the pains shift rapidly from one part to another, and are unattended with any great swelling or redness of the integuments; also, in chronic rheumatism characterized by Aveakness, rigidity, coldness, and sensation of weight in the disordered structures. Dulcamara often proves speedily curative in rheumatic inflamma- tions which have been caused by exposure to cold and dampness. The affected parts usually feel as if bruised or beaten, and after remaining for some time in one position are attacked with severe pains which do not subside until the patient moves about. The pains are most common in the back, and in the joints of the arms and legs. In cases of frequently-recurring rheumatism, of scrofulous or psoric subjects, we must use one or more of the following medicines : Cal- carea-carbonica, Sulphur, Lycopodium, Mercurius. When the disease has become chronic and inveterate, and abnormal depositions occur about the joints, with thickening of the membranous tissues, and permanent rigidity, weakness, and tenderness on motion, a persevering employment of Rhus, or Hepar-sulphur, or Nux, or Phosphorus, or Veratrum, or Lachesis will induce curative results of the most satisfactory character. Other medicines which have occasionally proved successful in rheu- matic affections, are: Colocynth, Lodine, Ferrum, China, Arsenicum, Arnica, Carbo-vegetabilis, and Hyoscyamus. Administration.—In the acute form of the malady, we employ from the third to the sixth attenuations, and repeat the doses every two hours until a medicinal impression is evident. In chronic rheumatism, we prefer the first attenuation and prescribe a dose once or twice daily. Actea-racemosa in Acute Rheumatism.—Dr. F. R. McDonald, of Edinburg, has made some rapid and surprising cures with this remedy. He gives twenty-five to forty drops of the tincture three times a day. Dr. Hale says: " Our provings show it to be homoeopathic to many forms of rheumatism, chiefly muscular. 'It affects, in preference the muscles of the back, neck, chest and uterus. The first dilution, or two or three drops of the tincture repeated every hour or two, has in my hands acted magically in acute rheumatism of the parts above named." Dr. E. A. Guilbert says he has found that cases treated by topical use of remedies recover much more rapidly and are less liable to re- lapses than others treated by internal remedies only. Actea-racemosa, hydrophthalmia, or dropsy of the eye. 161 Aeon., Rhus-rad,, Rhus-tox., Bell, have been tried, of these Actea is the most powerful. Two teaspoonsful of the tincture may be added to a pint of soft water, and used warm or cold, as the patient's feelings may direct; after using the selected remedy for twelve hours, it is better to change for another. Propylamine.—Dr. Awenarius, of St. Petersburg, says he used this remedy in 250 cases of rheumatism, and in every case the patn and fever disappeared the day after its administration. Propylamine is prepared by distillation from herring-brine. The dose was twenty drops, every two hours. Tartar-emetic.—Rheumatic pain, burning and obstinate, in the back, left shoulder blade on turning the neck; in sacro-lumbar region before rising from bed: Weakness of cervical muscles that she can not hold her head up. {Hahnemann?) Pain in the shoulder; trembling of the hands ; cold hands; icy coldness of the fingers; jerking of the muscles of the arms and hands; eruption of pimples in the forearm resembling itch; disappearing on scratching; flea-bites on the hand; ends of the fingers feel dead, dry, hard, without feeling for many days; dark-colored spots on the fingers: rheumatism connected with porrigo or other eruptive diseases, particularly such as have been repelled. Itching pustular eruptions in the arms and hands: Tartar-emetic sometimes requires to be preceded by Sulphur-hepar, or other antipsorics. Lower Extremities.— Heaviness in the loins; rheumatic pain in the lower region of the knee; cold feet; very painful cramps in the calves of the legs in the afternoon, which disappear on walking. The thighs spasmodically contracted towards the bowels, weakness of the legs ; coldness of the extremities; cases in which the patients have been reduced by protracted, watery diarrhoeas : extremities become cold and powerless ; frequent cramps in the calves of the legs. The third attenuation of this remedy is perfectly homoeopathic to this condition. Review of Allopathic Treatment. The different modes of treatment in use in some of the various schools are: 1. Bleeding.—The temporary palliation of symptoms from bleeding is always followed by chronic rheumatism of long duration; extreme anaemia from which the patient scarcely ever recovers- 2. Moderate Bleeding and Diaphoretics.—The relief is but slight and transient, but the evil is decided. The tendency of the disease is to impoverish the blood of red globules, increasing the tendency to chronic rheumatism, prolonging convalescence, increasing the danger of internal inflammations; of internal effusions into the pericardium and pleura, and to the synovial sacs of the joints, Dr. Todd (in his Cli- VOL. ii.—II. 162 DISEASES OF THE SANGUINOUS FUNCTION. nical Lectures p. 28,) says, this treatment "also produces troublesome cases of delirium which do not occur under other treatment; it also pre- disposes to carditis and endo-carditis; and these affections, arising in a case in which bleeding has been practiced, are much less manageable than in others who have not been bled. 3. Calomel and Opium to the extent of Ptyalism.—This is the alterant system of treatment; exciting one disease to cure another, and the new disease worse than the old. Dr. Todd thus describes the patient after being thus "cured": he has "loose teeth, ulcerated gums and all the painful and offensive accompaniments of ptyalism; as bad or worse than the original disease. And then it does not in the least guard the patient against the accidents of internal inflamma- tion, pericarditis, endo-carditis, pneumonia, pleuritis, peritonitis." He has often seen these come on patients who were already salivated. The effects of Mercury are so various on different persons that the re- sult can not be foreseen: and it offers no assurance of speedy cure or speedy convalescence. 4. Colchicum.—Is a chief reliance in the schools for both gout and rheumatism. Dr. Todd says, in rheumatism he found it of no use. 5. Treatment by Opium.—This is lately revived. It is claimed that Opium soothes the pain, calms the nervous system, promotes dia- phoresis, does not diminish the eliminating action of the kidneys, and that the disease causes remarkable tolerance of the remedy. Lime Juice.—Dr. Inman, of the Liverpool Northern Hospital, pro- poses this remedy in inflammatory rheumatism. His conclusions from large experience are: 1. That the worst rheumatic cases are those in which perspiration is most profuse. 2. In such he has only seen lime juice fail in one case. 3. Great improvement follows diminution of perspiration, which is not an eliminative effort of nature to be encouraged. 4. That in rheumatism the blood is as poor in globules as it is in consumption or Bright's disease or anaemia. The worst cases inherit a constitutional dyscrasia. ARTHRITIS.—GOUT. Although rheumatism and gout are described by authors as different diseases, it is altogether probable that the nature of the inflammatory action is the same in both instances. When this peculiar inflammation seizes upon the young and robust, and pervades the larger joints and the muscular structures, it receives the name of rheumatism ; but when individuals advanced in life, are the subjects of attack, and it appears in the small joints, it is recognised as gout. ARTHRITIS—GO UT. 163 A fit of the gout is almost always preceded by some gastric or in- testinal derangement like impaired appetite, furred tongue, bitter taste, acid or bitter eructations, flatulent distention of the stomach and intes- tines, and occasionally diarrhoea. The inflammation is, for the most part, situated in the ball of the great toe, but it may attack any of the smaller joints, and as the disease advances, the veins in the vicinity of the pain become distended; the integuments swollen, oedematous, and of a bright scarlet color; the pains become severe, of a darting throb- bing, or a persistent aching and burning character, increased by contact or by movement; there is an almost entire loss of muscular power of the affected parts; the pains are worse during the night, and ac- companied during this period by active febrile symptoms; nearly all the functions of the organism are sympathetically deranged; the urine is small in quantity, high colored, and becomes turbid on standing: the patient is restless, irritable, and morbidly sensitive to moral and physical impressions. The disorder usually arrives at its maximum of intensity, in two or three days from the commencement of the inflam- mation. At this period, the whole toe, and sometimes the foot itself, becomes oedematous, and numbness and prickling are frequently expe- rienced in the swollen textures, especially during the day; the pains and the nightly febrile exacerbations now commence subsiding, until at the end of from seven to ten days the active inflammatory symptoms have disappeared and left the patient with a debilitated and oedematous limb. When the paroxysms of acute gout occur very frequently, they serve, after a time to impair the constitution, and to cause permanent thickenings of the articular membranes, or cretaceous deposits about the joints, and to induce that condition of the parts which leads to chironic gout. This form of the complaint is characterized by dull,. burning, or tensive pains, oedema, thickening of the membranes of the affected joint, with rigidity, weakness, and partial loss of muscular power; more or less gastric derangement, augmented sensibility of the mind and body to external impressions, depression of spirits, and general restlessness and irritability. Causes.— Gout is generally supposed to be hereditary, although cases are constantly occurring in which no natural predisposition can be traced. There is no doubt, however,, that in the majority of in- stances, a hereditary predisposition exists. The exciting causes of gout, are: high-living, want of sufficient exercise, abuse of stimulants, especially wines, and general irritability of the nervous system, from loss of rest and irregularity in eating. Dr. Wolf says :—Gout in its worst and most intractable form, is the consequence of the sycotic dyscrasia. Tuberculosis, which has spread fearfully in this century, has also a relation to sycosis. Tubercles ou the placenta are only found in the cases in which the parents are sy- 164 diseases of the sanguinous function. cotic or tuberculous. Tuberculosis and warts have a near relation, as is proved by the tuberculous matter producing warts by inoculation. '"Goitre and nodosities in the breasts also depend on sycotic dys- crasia and are to be antidoted as early as possible by one dose of Thuja. Goitre is in most cases a kind of critical deposition, of which tuberculosis becomes latent; but, if interfered with by the common remedies, tuber- culosis of the lungs is often the consequence. The same holds good of the nodosities of the breast; their operation favors cancerous destruction.'' A.timely dose of Thuja is the remedy proposed to prevent these evils. " Health and long life," says Sir Wm. Temple, " are usually blessings of the poor, not of the rich ; and the fruits of temperance, rather than of luxury and excess. And, indeed, if a rich man does, not in many things, live like a poor one, he will certainly be the worse for his riches; if he does not use exercise, which is the only voluntary labor; if he does not restrain appetite by choice, as the other does by ne- cessity; if he does not practice sometimes, even abstinence and fasting, which is the last extreme of want and poverty; if his cares and his troubles increase with his riches, or his passions with his pleasures, he will certainly impair his health, whilst he improves his fortunes, and lose more than he gains by the bargain; since health is the best of all human possessions, and without wThich the rest are not relished or kindly enjoyed."— (Sir Wm, Temple's " Works," Lond., 1770, Vol.III., p. 278) Pathology.—Concerning the nature of the calcareous degeneration in the arteries of gouty subjects, Dr. Garrod says (" On the Nature and Treatment of Gout" London, 1859, p. 246):— " I have carefully examined those found on the valves of the heart, and the atheroma from the aorta of several gouty patients, having ex- tensive chalk-stones, but have always failed to discover the least trace of uric acid; but the tabular crystals of cholesterine were often present in such matter." He remarks (page 510): "To consider the calcareous deposits as a proof of gouty inflammation, is altogether an error; for I have shown that in gouty subjects, with concretions of urate of soda in nearly all the joints, the deposits from the aorta were of a different character, consisting either of phosphate or carbonate of lime, or of cholesterine and fatty matter." Calcareous degeneration of the arteries has long ago been observed. Mr. H. Watson {''Medical Commentaries," \o\. I., 1782) found, in the body of extremely gouty subjects the thoracic aorta healthy; but this vessel in the abdomen was ossified from the diaphragm to the iliacs. Morgagni (Vol. IL, p. 619) gives the case of Cardinal Cornelli, who died in his sixty-fourth year from metastasis of gout to the heart He wras exceedingly corpulent. After death, the gall-bladder was found to contain a calculus; the right kidney contained eleven calculi, most of them of considerable magnitude. The cartilages of the trachea were ARTHRITIS.—GOUT. 165 hard; the aorta was somewhat dilated in the thorax, and in its course through the thorax and abdomen some ossification had taken place. Dr. Saunders (Edinb. Med. and Surg. Journ., Vol. XXX., p. 167) de- scribes the case of a baronet, who died in his sixty-fifth year, and who had been "the subject of severe paroxysms of gout and politics for many years." The coronary arteries of the heart were completely os- sified, and the inner surface of the aorta also exhibited ossific forma- tions in different stages. Dr. Cheyne says of one gouty subject, aged sixty years, that "the aorta was studded with steatomatous and earthy concretions." The post-mortem examination of George IV., King of England, whose habits of life, frequent attacks of gout, and great corpu- lence, during the latter years of his reign, were matters of notoriety, revealed the effects of gout on an extensive scale. It was found that the " three semilunar valves at the beginning of the aorta were ossified throughout their substance, and the inner coat of that blood-vessel presented an irregular surface and was in many parts ossified." Signed: Henry Halford, Matthew John Tierney, Astley Paston Cooper, B. C. Brodie.—(" The Times," Friday, July 2d, 1830.) Dr. Garrod discovered urea in the blood in 1847. Since that time the following general results of chemical discovery have been reached : First.—The quantity of urea or uric acid contained in the blood in health is so small that it is hardly possible to discover it Second.—In gout the blood contains it in considerable quantities in the state of urate of soda. It can be separated from the blood in acicular needles or rhombic crystals of uric acid. Third.—In acute rheumatism the blood contains no more uric acid than in health. Fourth,—In a person under gout the serum of an ordinary blister yields uric acid, except when the part to which the blister is applied is affected with a gouty inflammation. Fifth.—Perspiration seldom contains uric acid secreted from the blood in gout, instead of being greater, is less than usual. In the re- gular stage of acute gout, the return is scanty and the uric acid measured by the twenty-four hours' secretion is also diminished. That this acid is thrown out in much larger quantities as the disease is pass- ing off, and it then may amount to even far above the patient's daily average. In chronic stages of gout the excretion of uric acid becomes much faster decreased, the urea remaining but little affected; the deposits of urates are now more rarely seen, and the urine frequently contains a little albumen. Even in the intervals between the attacks, it is noticed that a deficient elimination of uric acid may point out that the kidneys have undergone some structural change. The chief fact arrived at by these late researches, is this: that in 166 DISEASES OF THE SANGUINOUS FUNCTION. every instance gouty inflammation is accompanied by a deposition of urate of soda in a crystalline form; and this is considered a pathogno- mic phenomenon, seeing that it is not found after rheumatic nor any other inflammation. Numerous examinations have been made of sub- jects who had had gout in every degree, from the most severe and in- veterate form to those who had only suffered in a single joint; and this particular condition was present in them all. Treatment.—Diet. — This should be very light, chiefly amylaceous ; diluents should be freely used; alcoholic stimulants should be avoided, except under peculiar circumstances. Dr. Garrod recommends simple alkaline medicines in alternation with small doses of Colchicum. Sesqui-carbonate of Ammonia.—When the vital powers are at a low ebb, and there exist great vascular and nervous depresssion. At the same time omit the Colchicum or use it in small doses. {Braithiv. Retrosp., No. 41, p. 36.) Local Applications.—Covering the part with cotton batting over which is spread oiled silk to protect the joint. Employ all the agents capable of promoting the excretions, especially the kidneys and skin; restore the digestive organs to a healthy state, they being in all cases deranged. Carbonate of Lithia.—Lithia possesses the remarkable property of possessing the most soluble salt of uric acid that is known. And, seeing that the insolubility of the acid and many of its salts leads to the formation of gravel and calculus, and probably to the deposition in gout the salts of this alkali offer a most promising remedy. Dr. Gar- rod says he has used them to considerable extent. {Lancet, 1859, p. 645.) The principal remedies for acute gout, are: Bryonia, Nux-vomica, Colchicum, Bell., Aconite, Rhus, Pulsatilla, Actea-spicata, Actea- racemosa, Guiacum, Arnica, Arsenicum, China, Ledum, Sabinn, Cantharides. For chronic gout, the best remedies are: Calcarea- carbonica, Sulphur, Phosphoi-ic-acid, Aurum-muriate, Iodine, Hepar-sulphur, Phosphorus, Mercurius, Sepia, Silicea. It will very commonly happen that several of these medicines will cover most of the manifest symptoms which are usually present in gout, but in making our selection, the strictest regard should be had to all the remote and exciting causes which may have exercised an influence in originating the malady, in order that we may strike deeply at the foundation of the disturbance, as well as at the more immediate and visible phenomena. In prescribing for gout, we may be governed by the general indica- tions for the different medicines, as pointed out in the last section. Sabina.—Red shining swelling, accompanied by haemorrhage of a ARTHRITIS.--GOUT. 167 bright red color. Dr. Hendricks, of Germany, said, he cured a case of this kind by means of two doses of Sabina. Boenninghausen says, he found Sabina the most efficient remedy in gout. And, since it produces condylomata, it may be suspected that this malady so much dreaded by our fathers may have a sycotic anamnesis. Colchicum is an irritant cathartic, emetic, and diuretic; it has some sedative action on the circulation, and has been long regarded as the specific for gout and rheumatism. Effects of large doses : it is an energetic, acrid, narcotic poison, producing severe vomiting, urgent diarrhoea; dryness and burning of the throat, excessive colic and heat in the abdomen, great depression of the circulation and sometimes sup- pression of urine. In some cases death results from exhaustion follow- ing inflammation of the bowels; death sometimes preceded by head- ache, delirium, stupor and insensibility, showing its action on the ner- vous system. All of these symptoms have been caused by two drachms. It was introduced into general practice by Sir Everard Home as a re- medy for gout. It acts specifically in small doses, increasing the ex- cretion of urea, even when it does not increase the urine ; it is observed to produce all its best effects when it operates without purging. Given in the large doses usually thought necessary for gout it often removes the local symptoms of pain and inflammation; but it has a tendency to " leave the disease much stronger in the system, and leads to still more calamitous, because still more constant pains of the chronic form of the disease." {Seudamore, On Gout, p. 108.) We have often seen its action prompt, and, at least temporarily, beneficial. When given in doses short of such as excite purging in acute cases, it apparently moderates the local inflammation and arterial excitement, makes the pulse smaller, softer and less frequent; mitigating considerably the severity of the pain. Mr. Haden, in a work on Colchicum (1820) says, it " controlled the action of the heart and arteries, curing those states of the constitution called diseases of excitement" Sir H. Halford, in a communication to the Royal Society, says from his long experience, there is no disease for which he prescribed with so much confidence as gout. He found the disease common in every part of the body, the eye, the kidneys, urethra, prostate gland, tonsils; it may appear as angina tonsillaris. An eminent physician tried lono- to cure one such case, and at last plunged a lancet into the tonsil. Only a little blood flowed; but in a few minutes the disease seized violently on the ball of the great toe, and the angina was forgotten. Colchicum was his exclusive remedy. The celebrated Eau Medici- nale, a secret remedy for gout was composed of it. Rhus-tox.—Gout or rheumatism occurring in the spring season: symptoms aggravated by external heat, and generally by rest, and manifested by evening and night. See p. 158. 168 DISEASES OF THE SANGULNOUS FUNCTION. 4. ARTHRITIC DYSPEPSIA.—DYSPEPTIC GOUT. Causes.—Gout in its irregular forms usually occurs in persons of constitutions naturally feeble, or those weakened by debauchery and excess, or worn out by the cares, fatigues, and accidents of life. It has commonly been supposed that the gouty diathesis depends upon a morbific matter which was in some way eliminated from the system. But this theory, though easily constructed, has furnished little practical proof of its correctness. More recently it has been held to have its origin in dyspepsia; but the best writers have shown that, although symptoms of disturbed digestion are frequent, if not invariable attendants upon gout, they are themselves originated by the same remote cause on which is based the gouty diathesis with all its attendant manifesta- tions of disordered health. Dr. Gairdner (On Gout, its Causes and Cure, London, 1849, pp. 232), says: "One of the most remarkable results of arthritic in- digestion is the presence of acid in nearly all the excretions of the body. This has of late been called the uric acid diathesis." But the term diathesis should be applied to denote a condition of the constitu- tion, " not a simple affection of certain fluids of the body." Though this acid condition is very general; since Dr. Garrod has proved the existence of uric acid in the blood, and Wollaston found it in the joints; Landerer discovered it between the coats of the aorta, and others have shown that it constitutes a part of various fluids of the body in a state of disease; but we still object to the term expressed in " uric acid diathesis," for various other acids h&ve also been found in the secretions. Berthollet thought that the acid of the sweat was the phosphoric, Berzelius and Anselmino showed it to be lactic. Thenard found it acetic; and in cases of dyspepsia we have, no doubt, the hydrochloric, the lactic and the acetic in the stomach. Again, we have urates in the urine, not only in gout, but from indigestion, ephe- meral fever, and other diseases. Dr. Prout says " the lithate of am- monia in the urine is one of the most common attendants of slight dyspepsia from errors of diet." In the course of severe, general dis- eases, the same substance appears in the urine in a less transient form; "when no food has been taken into the stomach, and when therefore its formation can only be attributed to secondary mal-assimi- lation of the albuminous contents of the blood and albuminous tissues." Gairdner says, there are also durable deposits of urate of ammonia without much constitutional disturbance, where there was no disintegra- tion of the tissues, and no probable interruption of ordinary wholesome nutrition. He also says that he has often seen cases of true regular gout, in which there was no evidence of excess of urates in the urine; DYSPEPTIC GOUT. 169 he therefore believes " that the expulsion of urates from the system through the urine, and of other acid and earthy matters through this and others excretions, is to be looked upon only as one of the many consequences or symptoms of gout." It can not then be doubted, that uric acid, as well as urea, is a constant and necessary ingredient of pure and healthy blood; that though derived from the food, they are not imbibed with it, but are formed within the body, and enter the blood in the earlier stages of assimilation. It is not known that they serve any useful purpose, and" they are probably refuse or effete matters, which, if not duly eliminated from the blood by the kidneys, are productive of much disturbance to health. The disappearance of these substances in the urine and their accumulation in the blood are merely frequent symptoms and consequences of gout, which is itself, again, the cause of other important phenomena. Among these are:— The general cachectic condition seen in gout, causing distressing headaches, somnolence, and indifference; the various shades of dyspep- sia, with wdiich the gouty are afflicted; and sometimes sudden trans- lations of diseased action to vital organs, as the heart or stomach, caus- ing such violence as to result in sudden death. It was the opinion of Liebig and Woehler that uric acid was the parent of the urea; but Dr. Gairdner was convinced by long-continued observations that the explanation of many morbid phenomena will be found in the altered relation of the urea and the uric acid to each other; and that in certain morbid states of the system, the nascent urea becomes uric acid during the assimilation of the food; and in pro- portion as the amount of uric acid in the urine is increased, that of the urea is diminished. Dr. Gairdner therefore believes that in a state of health, the elements necessary for the composition of urea are separated from the blood; but that, under the influence of the gouty diathesis, the secretion of uric acid takes place in greater abundance. The chemical composition of uric acid is such that to convert urea into it the chief change required is the addition of carbon. We may now suppose, says Dr. Gairdner, that uric acid and urea are formed during the process of respiration, and circumstances in the condition of the patient may cause the one or the other to preponderate. In the history of gout we find many symptoms which show that decarbonization of the blood is deficient: thus we have " the blue lips, the swollen veins, the bloated complexion, the skin diseases, and general cachectic condition." " When the blood is perfectly oxygenated, the heart and vessels are roused to energetic contraction;" but when the expiration of carbonic acid has been incomplete, the absorption of oxygen diminished, and a portion of venous blood carried forward into the arterial system, the circulation is slackened, a depressing influence is exercised on the brain and nervous system, congestion takes place in the vessels, and 170 DISEASES OF THE SANGUINOUS FUNCTION. the condition already pointed out as favorable to the creation of a gouty diathesis is speedily brought about. This state of things is promoted by all circumstances which diminish the exhalation of Carbonic-acid from the lungs, as repose of body, sleep, confined air, intense and long-continued mental employment, anxiety and depression of mind. In one case given by Dr. Gairdner in which thirty-six ounces of urine were passed in twenty-four hours, four parts of urea in one thousand of urine had disappeared, thus " sixty-eight grains of urea were suppressed in the urine, to reappear in the system in some noxious form or other." And to this change in the secretions of the body, the suppression of a healthy evacuation, and its reappearance in a more noxious form, and the retention in the blood of a poisonous in- gredient is attributed the formation of the urates and all their inju- rious effects. The correctness of this theory is confirmed by compar- ing the quantity of urine secreted during sleep with that passed in the day; the condition of urine in an asthmatic patient breathing with difficulty; that passed by males and females; and that passed by in- dividuals living on different kinds of food. Exciting Causes.—Gout being a disease of the sedentary, the su- pine, the luxurious liver, and frequently of the student and over-taxed man of business, all its exciting causes are such as increase the mass of the circulating fluids, while they impede the full arterialization of the blood, and cause its accumulation in the venous system. Chronic dis- eases are mere modes of decay of the system. This is true whether they depend on original defect, errors and habits of life, or of declining age; but no disease more remarkably exemplifies the progress of de- cay than gout Originating often in the luxurious indolence of a sen- sual ancestry, its characteristic symptoms are chiefly exhibited in the decline of life; but it lies concealed in the constitution of the young. The diseases of children and growing youths often give indications of the presence of arthritic disease; through succeeding years its progress is gradual but steady and certain, if its great causes be permitted to continue their operation. Pathology.—Since the days of Dr. Brown, the pupil of Cullen, gout has been regarded by many as an asthenic or non-inflammatory disease. That inflammation is not essential to gout is rendered probable by its rapid occurrence and dispersion in different localities ; the languid cir- culation of gouty persons; the rare occurrence of the disease at that period of life when inflammation most commonly occurs, and also in robust individuals. Its appropriate subjects, according to Dr. Gairdner, are: " The heavy and corpulent, those who have loaded viscera and languid circulation ; persons of inactive temperaments and lazy habits; those in whom other diseases assume indolent and cachectic forms." "It shuns the stout and healthy laborer; it siezes the fat and dull farmer. DYSPEPTIC GOUT. 171 It seldom visits the active and athletic sportsman; it revels in the blood and joints of the exhausted debauchee." " Were gout essen- tially inflammatory, it might be presumed that inflammation would be its primordial local symptom, and in this case we should surely expect that it would sometimes run the ordinary course of phlegmonous dis- ease. Not only is this not the case, but there is something in the na- ture of the disease which prevents the inflammation that supervenes in gout ever running into the suppurative process. I never saw but one instance of phlegmon in gout, and I never saw a more ill-conditioned and offensive discharge." "The terminations of gout, and its vicarious and cognate diseases also mark its nature. They are suppression of the natural evacuations, spasm, cramp, dispepsia, melancholy, apoplexy, and dropsy." [Gairdner on Goitt.) The first condition essential to the formation of the gouty diathesis seems to consist in venous congestion. The capillary and nutrient vessels, distributed on the extreme and sentient fibrillse of the nerves, being in the same distended condition as the larger venous trunks, and being bound down by the firm fasciae in which the gout has its usual seat, caused by their pressure upon the nerves, the painful phenomena that attend the disease. The contents of the over-distended vessels being compressed between the power derived from the heart and arte- rial system, urging it forward on its course, and the antagonistic resis- tance of the great veins leading to the right auricle, cause occasionally, the capillaries to give way, causing a true haemorrhage in the part affected. If the rupture takes place in a minute capillary, carrying the serous portion of the blood only, oedema is the consequence, but if the burst vessel be one carrying red blood, a true ecchymosis is formed. (Gairdner, Amer. Jour. Med, Sci, Oct. 1849. p. 427.) The essential pathology of gout appears then to consist in an in- creased pressure of the blood from its accumulation in the great veins and an altered state of that fluid leading to the formation of uric acid instead of urea; these results depending on too copious an assimila- tion of nutriment, on defective respiration, and on a deficiency of the evacuation from the liver, kidneys and skin. The plethoric state thus created causes in strong constitutions the painful manifestations of re- gular atonic forms of the same disease. The mystery of hereditary influence in developing gout through those causes of disease which in better constitutions would only have produced a phlegmonic inflam- mation may not yet be clearly understood. But it is unquestionable that this disease, though revealing itself by the outward manifestations called gout, is indeed due to a particular tendency of the constitution of which no explanation has yet been given. Treatment.—Prophylactic.—This is chiefly hygienic. As the in- cipient signs of gout are visible in infancy, in those families in which 172 DISEASES OF THE SANGUINOUS FUNCTION. gout is a more certain inheritance than the patrimonial estate, it is im- portant to commence from birth a rational course of eclectic and hy- gienic treatment that may extinguish or prevent the development of the concealed "family curse". The diet of children who are known to be heirs of this " heritage of woe," should be regulated with great care. They should always be allowed the temperate use of a wholesome, nourishing diet; should abstain from heating drinks, take active exercise in the open air, parti- cularly the free pure air of the country; cheerfulness of mind and the avoiding of every sensual excess from puberty upwards; and the cheer- ful labors and active exercise and excitement of a country farm life, are among the principal means of preventing the occurrence of gout. In a form of gout in old persons manifested by swollen articulations of the hands, with slight derangement of the stomach, faltering in the action of the heart, and intermissions of the pulse, iron is the best and perhaps the only remedy. The Saccharine-carbonate (Edinb. Pharmacop), citrate and tartrate are the best forms. Cold Water.—This is always dangerous when applied externally, es- pecially when it has any chilling effect. Colchicum.—This has the reputation of a specific ; and not without some foundation, since it is known to cause the more free expulsion of urea from the system. It is found that the increase of urea is accom- panied by diminution of urates in the urine. The action of Colchicum is supposed to be through the nervous system. Colchicum is most beneficial in cases of regular gout without injury of the organs. Cases of atonic gout are less relieved by it; and in them it often produces low and depressed feelings. It is most useful after the disease has expended its first violence, when the fever has abated, the oedematous swelling of the part is es- tablished, and the bowels relieved. Persons who have gone through a regular fit of gout should seek to pass a holiday of perfect rest in the pure bracing air of the country, with as much exercise as their feeble state will enable them to take. The lungs should be thoroughly expanded, the assimilation of food should be perfected, and a pure, well oxygenated blood should be worked into the organic textures and moving structures of the body by active exercise in a high and healthy region, at some fashionable watering place, on the sea coast or the springs. Irregular Forms of Gout.—In sudden and alarming attacks which sometimes arise from metastasis of gout from distant points to more im- portant organs it is difficult often to decide upon a prompt, successful, and safe mode of treatment. Opium and powerful stimulants are often too freely used when they are unnecessary; and very frequently the most painful and alarming symptoms excited by some mental emotion, ARTHRITIC DYSPEPSIA. 173 disturbance of the circulation, or more commonly, indigestion, subside on their causes being removed. To discriminate between these cases, and those in which prompt measures of the heroic character are ne- cessary, requires the highest degree of judgment But in any event the physician best merits the confidence of the people who is never without resources, which are both palliative and safe; and who never suffers himself to be hurried into a decision by the clamor of patients or their friends. If there be little change in the pulse, though there be intense suffering and vomiting, the case admits of some delay and deliberate action; whereas, those in which the action of the heart is greatly depressed, and where there is little acute pain, are the cases that call most imperatively for prompt and effectual aid. Metastasis to the Heart.—The patients in whom this frequently takes place are seldom free from structural disease of that organ; there are earthy formations disturbing the action of the valves and injuring the functions of the coronary arteries, by which the nutrition of the heart is impeded; or a fatty degeneration of the muscular substance, leading to dilatation of the cavities. Treatment.—The first of these is incurable, though the homoeo- pathic remedies we shall propose for it may be tried. The fatty degeneration, it is believed, may be removed by putting an end to the secretion of oil globules within the fibres of the muscular structure of the heart, and by restoring that of fibrin. For this purpose a diet composed of little hydrocarbonaceous matter, and furnishing the albuminous elements of the blood, that is a more animal diet with pure air, and well-regulated exercise are recommended. Neither Colchicum, purgatives, nor laxatives are suitable to such cases ; but the use of tonics, continued for months, has been often successful. Gallic acid has been used with great benefit. Metastasis of Gout to the Head.—" It occurs with every degree of suffering; the headaches from which those persons suffer in whom the excretions of urates and urea have, from any cause, been suddenly di- minished or temporarily arrested, are only a commencement of this affection, which may well be likened to the effect of a poison. I believe that the substance of the brain itself is the part usually affected in these cases; and my reasons are that they are never attended with de- lirium or wandering, but always accompanied by stupor and somnolency; and that when they terminate in apoplexy, the ruptured vessel is found in the cerebral substance." (Gairdner.) Treatment.—Colchicum in minute doses is useful by increasing the urea carried off in the urine. Mild purgatives may be useful when given with caution. See Remedies, p. 166. Belladonna is probably the most potent remedy in this form of me- 174 diseases of the sanguinous function. tastatic gout. When there are decided febrile symptoms present, it should be alternated with Aconite or Gelseminum. Cannabis-indica is also a remedy of great value incases of this kind. 5. ARTHROPATHIE.—INFLAMMATIONS OF THE JOINTS. ARTHROPATHIE.-WHITE SWELLINGS. The Diseases of the Joints are divided into two grand divisions: A. Diseases of the Soft Parts. External. t White swellings of Bell; and diseases referred n rna \ , Brodie to the ligaments. Capsular I TT , . r ( Hydarthrus. B. Cartilaginous, superficial, bony and deep-seated or parenchymatous bony arthropathie. All of these forms of arthropathie may be, either rheumatic, scro- fulous, tuberculous, syphilitic, scorbutic, cancerous, &c.; or simply in- flammatory. 1. Extra Capsular Arthropathie.—Stiffness, pain, irregular swell- ing, without effusion into the joint. This is generally a slight disease requiring some treatment corresponding with other phlegmonous, erysi- pelatous affections, or mere engorgement of the subcutaneous tissue, perhaps the bursae mucosa. If purulent collections are discovered we have to use the bistoury. 2. Pure Capsular Arthropathie.—Caused by sprains, external vio- lence or rheumatic affections accompanied with pain on certain move- ments, aud sometimes increased by pressure. These causes produce a swelling of the extracapsular layers, which leads to internal effusion. It is a more serious lesion than the preceding; and it often proceeds forward to more serious disease yet to be described. It requires the most careful but efficient medication. Allopathic treatment involves " resolvent ointments, large blisters, compression and mercury." 3. Specific orBlenorrhous Arthropathie.—This comes on suddenly ; it is soon characterized by an abundant effusion; with little pain in the first stage, it acquires all the characters of an acute arthritis in the second. The common treatment is rather evacuant and revulsive than antiphlogistic; blisters, mercurial frictions, compression, evacuants, embrocations. They are never successful. 4. Fungous Arthropathie.— This is sometimes a primary, though oftener a consecutive disease ; always mild, little painful. It is an- nounced by an elastic, thickened enlargement, sometimes rolling under the finger, like a foreign body; occasionally, without effusion, the joint may acquire an enormous volume, without absolute hindrance to loco- ARTHROPATHIE. 175 motion. It is generally serious from its obstinacy, sometimes resisting every thing. It never yields to bloodletting. The surgeons rely chiefly on blisters, resolvent ointments, cauteries, moxas, setons, escharotics, compression and debilitating doses of calomel. Brodie speaks of this case as one of " morbid change of structure," which he thinks to arise from " morbid action in the synovial membrane, which loses its natural orga- nization (like the fungus articuli of the German writers,) becoming con- verted into a thick pulpy substance of a light brown or reddish color, intersected by numerous white lines. The disease seems to be peculiar to the synovial membranes having some affinities with tubercle, scirrhus, and fungus haematodes, in all of which the natural character is destroyed and a new one added. This change is most common in the knee-joint, where it .is usually attributed to cold or sprains. In some cases we find what are called loose cartilages. 5. Pure Synovial Arthropathie.—Hydarthrus.—This is a dropsy of the joint from inflammation of the synovial membrane, and subse- quent effusion. It is essentially characterized " by a serous effusion without pain, or sensible thickening of the articular envelops, slightly hindering the movements of the joints. Here the surgeon has generally resorted to purgatives, mercurials, Colchicum or diuretics, associated with large blisters and resolvent frictions," and generally with very little success. All of these forms of disease have the common character of swelling and superficial pain from the beginning; and they never last long without changing the form of the part. The synovial membrane is proved to extend over the cartilages of the incrustation and the inter- articular fat, as the conjunctiva covers the cornea; and it has a strong functional and anatomical resemblance to the serous membranes. It seems that the disease seldom or never originates in the ligaments, but almost always in the synovial membranes, which are quite as often dis- eased as any part of the body. Cruvelhier says (Diet. De. Med) the dis- ease consists in nineteen out of twenty cases, of a chronic inflammation, commencing in this membrane, even when other tissues become involved. B. 6. Cartilaginous Arthropathia.—This consists in an ulceration of the articular cartilages and of the synovial membranes investing them. There is a mechanical affection embracing ulceration and contusion of the cartilages and ulceration of the synovial membrane ; or from the pressure of the cartilaginous surfaces on one another: it may be com- pared to a crushing, wasting, or excoriation of the organic plates. It comes on suddenly, and is announced by a crackling and by acute pain that ceases entirely while the limb is still, and recurs on certain move- ments. It is sometimes complicated by extending to the bones. A cure is commonly effected by absolute repose, or after the disappearance of the cartilaginous rugosities. 7. Superficial Arthropathie of the Bones.—This is generally over- 176 DISEASES OF THE SANGUINOUS FUNCTION. looked, as its cause is internal. It is announced by a dull pain where the joint is at rest, and acute intolerable pain is excited by the smallest motion. The effusion, swelling, &c, are secondary. The surgeons usually begin its treatment by bleeding, cups, leeches, mercurial pur. gatives. All of these measures, however, fail to give relief, and they resort to embrocations, blisters, or compression; then to moxas, the cautery, and, especially, absolute rest. They generally resort at last to amputation, or the inflammation terminates in anchylosis. 8. Deep-seeded Artropathia of the Bones.— Scrofulous Disease of the Joints.—When it involves the epiphyses and not the shafts of the bone it is regarded as having its origin in the cancellous structure of the bone and has a malignant character. There is a dull deep pain during motion as well as when at rest; worst at night; there is no heat or swelling at first It may last for months or years without effusion ; sometimes it invades the cartilages of the incrustation, producing an excessively painful affection. It often embraces the head of the bone, where it gives rise to symptoms of mild acute inflammation, and finally assumes the character of exostosis with inflammation or ostitis. It is al- ways tedious, often requiring amputation, and never ending happily until the elimination of the necrosed or altered tissue. It requires internal re- medies. The common treatment consists of blisters, cauteries, moxa, but avoiding compression and other topical applications. Pain, the primary symptom of disease of the hard parts may exist for weeks or months without swelling. (M. Vdpeau, Memoir sur les Tumeurs Blanches. Exposition nouvelle de ces Maladies, par Gustave Jeanselm, Paris) Treatment.—The appropriate remedies in these cases are, Sulphur, Silicea, Calcarea-carb., Iodine, Rhus-tox., Arsenicum, China, Phosphorus, Acid-phos. In order to prove effective these medicines must be given in the hio-h attenuations, and be repeated at long intervals, in strict accordance with the directions of Hahnemann. An expert selection of the remedies, high potencies, very rare repeti- tions of the doses, and patience, have often enabled homoeopathic physi- cians to perform cures which have amazed the surgeons of the old school. In these cases such a regime should be enjoined as shall promote the general health and rigor of the system. Compression is a resource of great power. Apply a roller bandage so as to fill up all external inequalities; begin the application below the joint and extend a few inches above it. Blisters, ointments, &c, can be used at the same time. We may make permanent compression by pasting each surface of the bandage by starch or paste, and apply in cr pieces of paste-board, as is often done in dressing fractures of the ex- tremities. The patient may now rise and walk; and it is almost im- possible for the joint to swell again. • DYSTHETICA. 177 ORDER IV.-DYSTHETICA. - CACHEXIA. - ABNORMAL CONDITIONS OF THE CIRCULATION DEPENDENT ON DETERIORATIONS OF THE BLOOD. Microscopical Examination of the Blood.—The red globules in man are small round discs, of w%ich the central part of each appears shadowed or transparent, according as it is approximated to or re- moved from the focus of the lens. The central part seems to be the thinnest of the globule, which is depressed on both sides ; and when placed on the field of the microscope, it presents the appearance of an elongated 8. The edge forms a thick ridge all around, more colored than the central part. The size of the blood globules varies in dif- ferent animals. The elephant has the largest globules, among the mammalia, and the ruminantia the smallest. (Mandl. Anatomy and Physiology) The blood globules are suspended in a colorless fluid called plasma liquor sanguinis, or serum. In frogs it can be separated from the globules by filtering, though human blood can not be filtered. White Globules. — These are small colorless finely granulated corpuscles, soluble in water, and strong refractors of light. Some are round and include two or three granules; these are true lymphatic globules, arising at least in part from lymph mixed with blood. The other white globules are also generally round, though sometimes oblong, or irregular, wit^i edges slightly serrated. They are the product of the coagulation of the fibrin. (Mandl.) State of the Blood in the Vessels.—Many authors have believed that the blood possessed some mysterious powers of vitality. Ac- cording to the observations of Kolk, Treviranus, and others, the globules of blood possess a rotatory motion during life, independently of the motion arising from the impulse of the heart; and this motion continues till coagulution takes place. Schulz of Berlin has shown that the blood globules have a power " by which they move on by themselves, surrounded by envelops of coloring matter, and keeping at a distance from each other." Copland imputes this force to the influence exerted by the ganglial nerves on the interior of the ves- sels on which they are distributed. (See Vol. I. p. 843.) To this force of mutual repulsion we attribute the fluidity of the blood; but there is another force by which the blood globules are attracted by the tissues when brought in contact with them in passing through the minutest vessels. This latter force, first examined by Schultz, "may be com- pared to a vortex, whence globules constantly pass from the arterial or terminal capillaries, and are lost in the different tissues. So that although the vital endowment of the blood is manifested by its fluidity Vol. IL—12. * 178 DISEASES OF THE SANGUINOUS FUNCTION. in the vessels, it assumes an opposite manifestation in the capillaries, where this fluid is brought within the sphere of the vitality of the dif- ferent structures ; each one attracting from it those constituents of which itself is formed, and which are always present in healthy blood." " Thus we see organization commencing in the chyle, advancing further in the blood, and reaching its acme in the vital attraction of the constituents of the tissues from the blood circulating in the capillaries which supply them. At this part of the circle, where the arterial capillaries, with the fluid circulating through them, become, as it were, confounded with the tissues in which they are distributed, there ap- pears to be not only a constant attraction of particles by the tissues from the blood, but also an equal extrication of other particles from them into the blood received by the radicles of the veins." (Schults) Coagulation of the Blood. — In the process of coagulation the red globules of the blood are principally concerned; "it being chiefly the result of the loss of the vital motion which these globules possess in the vessels, and of the attraction existing between the coloring en- velops and central bodies. As the vital attraction which keeps the red substance fixed around the whitish corpuscles, ceases soon after the removal of the blood from the veins, these bodies can then obey the force which tends to unite them, and they then form a net-work, in whose meshes the liberated red particles are entangled, and thus produce the phenomena of coagulation. If the coagulum be exposed to a stream of water, the colored matter is washed away, while the ag- gregates formed by the colorless corpuscles remain jn the form of filaments in which may be recognized an analogous structure to mus- cular fibre, and constitute the fibrine of the blood. The phenomenon of the coagulation of the blood, is due to the eva- poration of its ammonia, on exposure to the air. The blood is retained in a liquid state in the blood-vessels by the pressure of ammonia; and just in proportion to the loss or diminution of this substance, will it retain or lose its fluidity. This may be readily demonstrated by draining blood from the arm into an exhausted receiver. Thus excluded from the oxygen of the air, it remains fluid; but if we expose it and collect the products of evaporation, it coagulates, and ammonia is found as one of the products of evaporation. This coagulated blood may be again redissolved, by incorporating ammonia with it at the proper temperature. A knowledge of this fact may prove useful in many maladies which are accompanied with more or less decomposition of the blood, as diphtheria, typhus, malignant scarlatina, yellow fever, &c Plasma.—Constituents of Plasma.—Water, fibrin, albumen, color- less corpuscles, votatile matter, fatty compounds, and salts. Plasma passes through all the capillary vessels, permeating all or- ALTERATIONS OF BLOOD IN DISEASE. 179 gans and tissues; and at various points the glands or deporatino- or- gans, remove from it the substances that if retained would injure its qualities. Many fluid substances, received by the stomach, enter the plasma and mingle with the fluid of the blood. These substances pos- sess medicinal power of some kind, and they effect one organ or an- other, according to their specific properties. 1. The poisons taken into the stomach produce symptoms which manifest themselves in some one organ or more, but they do not cause the production of contagious matter in the blood. 2. Poisons inhaled from the atmosphere by the lungs often produce contagious matters in the blood. Thus showing that the two parts of the blood have distinct pathological relations. Experiments show that large quantities of some substances can be thrown into the blood with- out great injury, if not in some cases, with benefit. In 1831 and 1832 the effort was made to replenish the exhausted blood-vessels of patients sinking from cholera by injecting saline substances into the veins. In one case five gallons of saline liquid -was injected into a vein in the course of four days : nine and a half pounds thrown in the space of 18 minutes (May 29), and a few hours afterwards 10 pounds more with 4 ounces of albumen. In a few hours 10 pounds, with 10 grains of sulphate of quinine ; 10 pounds more of the solution the same day. June 2, six and a half pounds with six drops of solution of Morphia. June 19th, the patient was reported as well, and left the hospital. Such facts, with the varying aspects of the people we meet with every day, show that the blood is constantly changing in its composi- tion ; and no two efforts at chemical analysis present similar results. That the blood may be maintained in its highest state of perfection, and fitter for the supply of all the materials requisite for maintaining the system in health, and those materials only, it is necessary that the functions of sanguification, nutrition, depuration, secretion, and absorption should be kept in the most healthful condition. As they by their combined action convey into the general circulation the sub- stances necessary for the supply of the waste of the body, or carry out of it those materials which are unfit for its purposes ; so, also they may derange health by throwing into the blood poisonous matters taken up from the different absorbing surfaces, or by retaining within the blood these worthless or deleterious substances which the welfare of the body requires should be rejected and thrown off. Changes in the Quality of the Blood.—The chemical constituents of the blood vary in different states of disease. The relative proportion of Albumen is increased in cases of active dropsy, and in most of the exanthemata, especially before the eruption appears. In many in- flammatory diseases the quantity is twice as great as in health, and the blood feels viscid to the touch. (G^ndrin, Bright, Blackall, c&c.) The 180 DISEASES OF THE SANGUINOUS FUNCTION. watery portion of the blood varies from the influence of depletion, many fevers, and other chronic diseases. The coloring matter in the blood is changed in some febrile and malignant diseases, and after the operation of some virulent poisons, or morbid secretions.—The fibrine varies according to the extent to which blood-letting may have been pre- viously carried, and the degree of vital energy present, or the febrile or inflammatory action prevailing. It varies in its quality in the last stages of some chronic diseases, in the cold stage of congestive fevers,. and after exposure to extreme cold, forming fibrinous concretions on the lining coats of the blood vessels. In pestilential cholera, asphyxia and hydrophobia the blood of the arteries has been found resembling venous blood. The electrical state of the blood is also changed by disease; and its temperature has been observed to vary from 86° to 104°, according to the degree of nervous power in connection with vascular action. — (See Vol. I. p. 175.) The buffy coat seen on the surface of blood drawn from patients suffering from inflammation is only conspicuous in inflammations of the serous membranes, the lungs, and other viscera; it is less strongly marked in children, in pregnant or puerpural females wTho have been often bled, in rheumatic subjects, and when drawn from a large-sized vein. The buff is also seen in some cases of anaemia and chlorosis; the blood in these diseases having lost its globules and retained its fibrin. In general anaemia there is a deficiency of blood globules ; in health they exist in proportion 119 to 1000 parts of blood; whereas in anaemic patients they may be reduced to 65 parts in 1000. When anaemia arises spontaneously, says Andral, and also in pregnancy, and diseases produced by lead, the globules alone are deficient; but where this condition is produced by repeated blood-letting the blood comes to be deficient also in fibrine and albumen. In plethora the blood globules are increased from 119 parts in a thousand in health to 141 parts, the fibrine remaining in only the normal quantity. (See Andral " On the Blood in Disease," 1844.) But other changes in the intimate nature of the blood, which chemis- try has no power to detect, occur in the course of various diseases. In many recorded instances the blood has been proved to have poison- ous qualities; and terrible effects have resulted from its contact with the skin, cellular membrane, or wounded parts of persons previously in health. Even the foetor from the blood of diseased persons has often caused malignant and fatal diseases. Distemperature or Dyscrasias of the Plasma of the Blood.—There are many varieties of changes of health, moods, tempers, feelings, de- pendent on the qualities of the blood. They may be caused by bad diet as well as other causes, and may be cured by attention to proper diet, good air and the proper regulation of the various functions; the ALTERATIONS OF BLOOD IN DISEASE. 181 plasma having been changed in character, is restored by proper management, food or medicines, which restore to a healthy state the skin, kidneys, bowels. While the unhealthy state of the blood con- tinues, the simplest wounds fester and ulcerate; there are eruptions, pustules or boils on the skin, slight external injury provokes chronic and ulcerative forms of inflammation with or without fever, appearing as scrofula or scurvy. In sailors at sea dieted on salt provisions, who walk about the ship in a hot climate with the feet exposed, every mosquito bite ulcerates and the wound increases in size daily, resisting all local treatment till the diet is changed. Under proper food, and cooler air the wounds heal spontaneously. In some hospitals, bad diet, and air cause fractures to remain long without uniting, on removing to better air recovery takes place. After formidable surgical operations, if the blood is in good condition, free from any constitutional taint, there is early and safe recovery. In unhealthy subjects trifling wounds degenerate into chronic ulcerations. In the latter case it is asked, (says Addison, Braithwaite's Retrosp., No. 41,) which constituent of the blood is diseased ? Is it the plasma, or the portion from which the elements of repair are taken? Mr. Hunter says : " A person may have a sore upon the leg which is granu- lating freely, when all at once the granulations shall lose their life and fade away. New granulations may afterwards spring up and these shall undergo the same process, and so they will continue to go on, if some alterations in the nature of the parts be not produced in the plasma of the blood. The nature of the granulations will be deter- mined by differences in the quality of the plasma." It is thus shown that forms of inflammation, suppuration and ulcera- tion are produced and kept up by distemperature or unhealthiness of the blood, more particularly of its plasma. And that a depurative operation is often performed in the plasma by forms of local inflam- mation may be argued from the eruption of small-pox. In scarlet fever it is supposed from the properties of the particles of the exfoliating epidermis that the contagious matter from the blood is discharged by the vesicular action. In gout, that the offending matter is discharged from the blood by the local inflammation is also concluded from the morbid material deposited in the parts inflamed. Further evidences of the truth of this view are found in the great work of Roki- tansky on Pathological Anatomy, and in the Lectures of M. Paget In ordinary inflammation the speedy separation of the plasma, or sinkino- of the corpuscles Avhich occasions buffed blood indicates a change in the relative qualities of the two parts of the blood. We have accordingly the yellowish, greenish, purplish hues, and the floccu- lated appearance like curdled soap in the plasma of buffed blood before its coagulation, in different cases of inflammation. 182 DISEASES OF THE SANGUINOUS FUNCTION. The microscope reveals differences between the blood constituents when taken from the sphere of the inflammation or exterior to it. (Addison, on Inflammation.} In the act of sloughing or separation of dead matter from the ad- junct texture blood-vessels are severed by the process, and they are separated without bleeding. In abscesses and ulcerations from thorns or other foreign bodies impacted in the flesh, great changes may occur without bleeding. (Brit. Med. Journ., April, 1859.) In all cases of repair where exudations and new growth appear, the blood-vessels undergo the change from fibrous to corpuscular. Their component elements retrograde. This change is exemplified in granula- tions, the vessels of which bleed on the slightest touch, and we believe that in places of inflammation from disordered qualities of the plasma, the coats of the blood-vessels undergo the same changes. Now as the plasma is the part of the blood that plays a conspicuous part in these changes, so it is not difficult to comprehend how it may be relieved of hurtful materials by inflammation. "That sores give rise to very different kinds of pus," says Hunter, "is very evident to the naked eye; and that the different parts of which the blood is composed, will come away in different proportions, we can make no doubt; and we find that whatever is in solution in the blood comes away more in one kind of pus than another." It may then be presumed that inflammation exercises a therapeutical action in dis- ordered conditions of the blood. Zimmermann and Simon regard the fibrin as an exuvial matter or ex- cretion of the corpuscles. Is there any incongruity in finding it to be an essential material, used in the maintenance and repair of the com- mon blood-distributing tissue? How does matter pass from the corpuscles into the Plasma f — Addison says it can be shown by experiment that molecular and tailed forms of some material substance may be seen issuing out of them and passing into the plasma, without much alteration of their form or color and to any one who witnesses the experiment there can be no difficulty in concluding that the corpuscles, in their natural state, discharge matter into the plasma. He therefore concludes :—That the corpuscles of blood are sustained in their vital and chemical qualities by the plasma and the air; and also that their excretions are passed partly into the plasma and partly into the air; and these properties of the corpuscles being established, there are some broad and acknowledged facts respecting venous blood which claim our attention." (Brit. Med. Jour., Ib59, p. 352.) Causes of Changes in the State of the Blood.—First.—Causes which vitiate the fluids from which the Blood is formed.—Unhealthy food deranges the digestive function and poisons the circulating fluids. ALTERATIONS OF BLOOD IN DISEASE. 183 The long-continued use of salt provisions, when too exclusively used, produces scurvy. Diseased rye causes chronic arteritis and gano-rene of the extremities, diseased or putrid flesh has often induced malignant diseases; and the blood after death has been found fluid, dissolved, or blackish. The habitual use of any article possessing medicinal powers has an influence on health. Acids, alkalis, turpentine, and all the chemical salts change the character and composition of the blood. The dried stale fish, used so extensively in some of the extreme parts of Northern Europe, produce diseases of that order which always arise from an im- pure state of the blood; and eating freely of fresh animal food, by increasing the fibrine and richness of the blood also predisposes to dis- ease but of another order. Excesses in eating and drinking cause a large amount of disease in civilized life. An imperfect performance of the functions by which morbid sub- stances are expelled from the blood is one of the "principal causes of disease. Perfect health requires a full performance of all the functions of depuration, including respiration, perspiration, and secretion by all the organs whose office is to eliminate effete or injurious substances from the blood. Proofs that the Blood itself becomes poisonous in some diseases.— The blood in some diseases undergoes vital changes by which a poison capable of reproducing itself is originated. Dr. Home communicated measles by means of blood taken from persons affected with that disease. Duhamel gives the case of a butcher, who, having put in his mouth the knife with which an over-driven ox had been slaughtered, had his tongue and throat swollen a few hours afterwards, and an eruption of black pustules over his body. He died in four days. Another person having wounded himself in the hand with a bone of the same ox, was seized with inflammation of the arm, followed by mortification and death. Two females experienced gangrenous inflammation from a few drops of the same animal having fallen upon the hand of the one, and on the cheek of the other. By numerous experiments it has been proved that inoculation with the blood of diseased animals, or simple contact with it, may produce the malignant pustule in men. Dupuy and Leuret introduced blood taken from a horse affected with malignant carbuncle into the cellular tissue and veins of a sound horse and thus communicated to him the same disease. The serious effects which follow wounds received in the dissection of bodies recently dead, as well as in those in which putrefaction has commenced, are quite common. " The septic influence of certain animal secretions and poisons on the tissues to which they are applied and on the frame generally; are among the most important phenomena.of disease." See Vol. I. p. 541. 184 DISEASES OF THE SANGUINOUS FUNCTION. Louis de Castro says the blood of two plague patients infected the air of their apartment with a foetid odor; Zacutus reports the history of three persons who were struck dead by the odor exhaled from the blood drawn from the vein of a person infected with the plague. Muralt states that a cadaverous foetor emanates from the blood of persons af- fected with this malady; and Baglivi mentions that a nearly similar phenomenon was observed in the blood of patients in the advanced stages of a very fatal epidemic fever. Haller refers to a case of fever, in which he predicted from this symptom alone a fatal result. In- stances ha,ve been published by Zurinus, Alprunner, and Vater, in which physicians were dangerously infected by the foetor of the blood ab- stracted from the veins of persons in malignant diseases. Many have suffered in slighter degree from the same cause in more common dis- eases. Pringle says, an individual who had inhaled the blood of a dy- senteric patient which had stood for some time, was attacked by the same disease. Morton has given the case of a woman in malignant fever whose blood was so offensive, when taken from the arm, that the surgeon and assistants fainted from breathing the odor. The blood of cattle affected with " the spleen''' is so poisonous that if the blood of such an animal only falls upon the hand it may cause dangerous disease; and the skinning or tanning the skins may have a similar effect. Their flesh, though salted and smoked, is a poison, and always produces death or lingering, incurable disease. Symptoms of Spleen in Cattle.—The animal looks sad and dull; it stumbles and trembles, particularly after drinking; the skin is hot, breath short; and while the symptoms progress, inflammatory tumors are formed. The Treatment of Cattle in this disease is hitherto confined to throwing cold water on them. Hering says, if this does not save them, they must die. The use of cold water is depended on to preserve other inimals from the infection; those which die are buried in a deep pit without being touched with the hands. Every thing that has been in contact with the diseased animal is to be burned, buried, or purified with chloride of lime-water. When this disease is communicated to man the infected person be- gins to feel "melancholy, weak, and chilly; red spots, black in the centre, show themselves on different parts of the body; these soon be- come bluish tumors, and, eventually, inflammatory gangrenous ulcers. The treatment is not satisfactory. Bleeding is dangerous; warm and moist poultices also do harm. It is thought best to rely on quiet, strict diet, drinking plentifully of cold water, and frequently throwing it over the patient, drying him quickly afterwards. Internally give Arsenicum, not too frequently." (Hering.) In 1770, Fontana instituted a series of experiments on the effects of ALTERATIONS OF THE BLOOD IN DISEASE. 185 the poison of the viper on animals. He procured 3000 vipers and em- ployed 4000 animals which were bitten by the vipers in his presence, or otherwise subjected to the operation of the poison. From his six- thousand, experiments, he deduced the following results: In many instances, on injecting the poison into the jugular vein of rabbits, employing seven seconds in the operation, the animals cried out the moment the venom entered the vessel, were seized with violent con- vulsions and died in two minutes or le ss. The blood in all the large vessels and also in the heart and auricles was black and coagulated. The action of the venom and its effect on the blood are almost instantaneous. The color of the blood is suddenly changed, and becomes from bright red immediately black; this effect is succeeded by the sudden coagulation in the heart, auricles, liver and large venous trunks. Thus "the circulation is totally stopped and the animal dies." The poison of a serpent applied to a naked nerve diffuses its influence with instantaneous rapidity. Dr. Mead says, the bite of a rattlesnake killed a dog in a quarter of a minute. Such is the close connection between the sanguiferous and nervous system that pain and irritation will effect a change, even in the appearance of the blood. Many drugs have shown, when regularly taken for a certain period, the power to produce degeneration of the blood, altering its composi- tion and appearance, thus producing dyscrasias or cachexias, each pre- senting its own peculiarities. Thus, Mr. Sharp, in a late work (London, 1861), gives the effects of Titanium in causing and curing "Blood Dis- ease." He found it to operate upon: First.—The Stomach, bringing on nausea, loss of appetite, and feeling of discomfort. Second.— The Brain and Nerves: giddiness, imperfect vision, the peculiarity being that half an object only could be seen at once; desire to keep the eyelids closed. Third.—The Blood:—a perceptible derangement of the whole system, which could not, without danger, have been carried further." He also " found Titanium a most valuable remedy for certain cases of degeneration of the blood, for which no good remedy was known before." LATENT MIASMS OR BLOOD-DYSCRASIAS WHICH ORIGINATE OR PERPETUATE OBSTINATE CHRONIC DISEASES.-PSORA—SYPHI- LIS.—SYCOSIS. Hahnemann says (Organon, §. 204, p. 183): " If we except all chronic maladies which depend upon a mode of living habitually unhealthy, as well as those innumerable factitious diseases, (V. §. 74), which arise from the senseless, protracted, the assaulting and ruinous treatment, even of slight diseases,.by allopathic physicians, then all the remainder, without exception, are occasioned by the development of these three 186 DISEASES of the SANGUINOUS FUNCTION. chronic miasms, viz. internal syphilis, internal sycosis, but especially, and in an infinitely greater proportion, internal psora. Each of these is in possession of the entire organism, and has penetrated it in all its parts, before the respective primary representative and local symptom makes its appearance, which prevents the bursting forth of its corres- ponding miasm in another form, and is manifested in psora by a pecu- liar eruption, in syphilis by chancre and bubo, and sycosis in condylo- mata. Either of these chronic miasms being deprived of its local symptoms will, sooner Or later under the influence of natural causes, become developed, burst forth, and multiply the incredible multitude of chronic diseases which for ages has afflicted the human race." We perceive that the observation made by Hahnemann led him to believe that some one of these latent miasms or poisons constituted the basis of all chronic diseases; that these miasms might remain latent whether derived from inheritance or from infection; that there was no limit to the duration of their action; nor could revulsives ever by turn- ing: the vital force into new channels effect a real cure. This mode of proceeding might give the disease a new outward form, but it would only render the system more feeble and less able to react. Hahnemann says : " The more I examine the ordinary cures, the more I am convin- ced that they are not direct transformations of disease converted into health, but revolutionary disturbances of the order of things by medi- cines, which, without being actually appropriate, possessed sufficient power to give matters another (morbid) shape : these are what are called cures. " The hysterical ailments of yonder lady were successfully removed by me." "No! they were only changed into a metrorrhagia." After some time I am greeted by a shout of triumph. " Excuse me ! I have also succeeded in putting a stop to the uterine hoemorrhage." But do you not see, on the other hand the skin has become sallow, the white of the eye has acquired a yellow hue, the evacuations from the bowels have become grayish white and the urine orange-colored. "And thus, the so-called cures go on like the shifting scenes of one and the same tragedy." The frequent metastases of disease from the mucous membrane to the skin and its sudden recession to the internal surface have long been familiar to medical men. The identity of structure of the skin and the internal mucous mem- brane as well as their identity of use is so well known that we may easily perceive that the eyes of pathologists could not avoid perceiving the possibility of the frequent metastasis of disease from one of these surfaces to the other. Wilson says: " The skin is the exterior investment of the body, which it serves to cover and protect. It is continuous at the apertures of the internal ALTERATIONS of blood in disease. 187 cavities with the lining membrane of those cavities, the internal skin or mucous membrane. Mucous membrane is analogous to the cuta- neous covering of the exterior of the body, and resembles that tissue very closely in its structure. The epithelium is the epidermis of the mucous membrane. Throughout the pharynx and oesophagus, it resembles the epidermis, both in appearance and character. That they exchange physiological functions is shown by Carpenter: " It is interesting to observe that when a portion of the cutaneous sur- face has been turned inwards, so as form part of the boundary of one of the internal cavities (as in plastic operations for the restoration of lips, eyelids, &c), it undergoes a gradual modification of character and comes,after a time to present the appearance of an ordinary mucous membrane." It is well known also that "when a portion of the mucous membrane is in the same manner turned to the surface, it assume, the appearance and the functions of the true skin." M. Trousseau, of Hotel-Dieu, Paris, thus gives in the Gaz. des Hop. 1857, p. 550) the fullest admission of the truth of Hahnemann's doc- trine of psora: " The herpetic, syphilitic and strumous diatheses are equally manifested by cutaneous lesions and by those of mucous mem- branes. For the syphilitic diathesis, this is universally conceded: for the dartrous, do we not daily witness the transition of affections from the skin toward the internal organs, in gradation from the more super- ficial to the deeper, revealing unity of origin and cause ? An eczma first appears upon the lip or nose; next, in the form of a chronic coryza or ozoena, as it traverses the sinuosities of the nasal fossae; next the coryza may become an angina, taking the granular character of a her- petic angina. Women who suffer with uterine catarrhs the most intract- able, have a chronic eczema of the uterus as others of the skin. And why should we shut our eyes to similar manifestations in the bronchiae, or gastro-intestinal canal, betrayed in each site by functional derange- ments peculiar to the organ attacked ? How often do we not witness the coincidence, or rather succession, of these internal lesions upon the ces- sation of herpetic manifestations on the skin ? " " How often have sul- phurous waters, so potent in bronchial and uterine catarrhs, cured them only by reaching the herpetic diathesis ? At Cauterets, Bagneros, Luchon, Enghein, Aix-la-Chapelle, among the patients under treatment for chronic catarrhs by these mineral springs, you will find that the greater number have had, if not through their lives, at least in their youth, decided herpetic manifestations; and that whenever they reap- pear upon the surface, the internal organs cease to suffer. "A dartrous subject may have to day no tetter: a strumous subject no scrofula; but the dartrous or strumous diathesis exists potentially, even during a latency of five, ten, twenty or forty years. " Diatheses are impressed upon the constitutions of patients; they 188 DISEASES OF THE SANGUINOUS FUNCTION. descend to the child with the organic likeness of his parents; and as the child having reached his fortieth year, will then bear the greatest physical resemblance to his parent at forty, so the dartrous diathesis, until then latent but hereditary, may make its first appearance on the skin." "Hence the indication for a prophylactic treatment against diathesic affections. The best recent work on this subject is that of Mr. Gastier. Complications of Diseases.—M. Trousseau says: "A herpetic sub- ject, having actually no dartre, takes a cold, gets a sore throat; the herpetic element is awakened by this irritation, takes possession of the field and occasions a dartrous angina. In an arthritic subject, the dia- thesic expression may supervene upon a sprain, however slight, which serves as a pretext for the localization of a regular attack of gout. The child of strumous parents may not reveal his scrofula until an ar- ticular rheumatism degenerates into white swelling. In all of these cases the treatment must of course be general, and directed against the diathesis. We can bring from all standard allopathic authors instructive obser- vations which prove the truth of Hahnemann's opinions. Dr. Budd* ex- presses the common opinion that a morbid material within the organism produces the various skin-diseases and says that this morbid matter is liable from many causes, to be repelled from the surface, and, in conse- quence, produce various internal disorders. Willan says :f "The peculiar morbid matter of the disease, which was before detained in the part af- fected and held in union with it, being now suddenly loosed and set afloat in the general circulation, has become free to fix on internal organs — or, circulating any where with the blood, to affect the system at large." The repulsion of these morbid miasms is just as important to the pre- sent popular allopathic pathology as it was to Hahnemann's. According to Dr. Budd, Pujol, and Schoenlein, important internal organs, as the lungs and the blood-vessels, are liable to become most seriously diseased from this morbid matter locating upon them, after being set free from the external surface. In this way they account for the occurrence of consumption, and many other local affections commonly called scrofulous. Prof. Schoenlein, of Berlin, gives the case of a weaver aged thirty-four, who at the age of nine years took the itch which lasted three years. He was then cured by Sulphur ointment. Nine months ago he began to suffer from oppression of the chest, difficulty of breathing, weariness, palpitation of the heart, &c, on running, ascending the stair-case. In four months the disease became more violent, becoming established as an affection of the aortic valves, hypertrophy of the left ventricle, with simultaneous enlargement of the left lobe of the liver, and commencing hydrops. * Medical Gazette, 1850. Med. Chir. Trans. 1842. f Cutaneous Diseased STRUMA.--SCROFULA. 189 The cause of this disease is referred by the author to the repelled itch at nine years of age. He says, Authenrieth directed attention to the q/^r-diseases of the itch in 1807, before Hahnemann. He says he admits the existence of the acarus insect, as he has seen it, but it does not invalidate the old dogma of sequela to the itch. " How does the itch develop itself? Small spots first exhibit themselves, from which the itch pustules are formed. The existence of the acarus of the itch has not been proved; we might then call this a fllius ante patrium. An evident contradiction. Again, the disciples of Raspail do not go so far as to assert that all itch-pustules are provided with this insect. If the acarus be the cause of the disease, why is not this in- sect present in every pustule ? " He has " no doubt respecting the existence of after or secondary diseases of the itch." " It may not be generally known that an ulceration of the skin, of a peculiar kind, forms, especially in old people, principally about the knuckles or joints of the lower extremities, in consequence of the itch (the secretion of which ulceration is contagious), and which has obtained the name Ulcus pso- ricum, and no one will assert here that this ulceration was so formed by the itch insect; now, if this ulceration is caused to heal up suddenly, internal diseases of a peculiar character are produced, not only such as are created by the drying up of old sores, but peculiar forms of disease. This fact appears to me one of the most striking features in • favor of the possibility of after-diseases resulting from the suppression of the itch." And " I confess that the reasons above given have im- pressed me with the most perfect conviction that itch is capable of pro- ducing after-diseases." It is evident that Hahnemann did not intend to restrict the term psora to the special disease designated by Schoenlein and others as " the itch," but embraced a wider field including scaly, tettery, papular and other eruptions. Hahnemann cured the pustular eruptions he re- ferred to with very minute doses of sulphur. It is known that the specific disease caused by the acarus is not so easily cured. It is not certain that Sulphur alone is a true remedy for it. The whole allopathic school regard repelled diseases as capable of causing dangerous manifestations on internal organs; but they never go far enough to recognize the existence of the poison if it has never ma- nifested itself on the surface in a visible eruption. Hahnemann goes beyond them all in discovering " the latent poison lurking within the organism, never having manifested its presence by any external signs," though able there to "seize upon the springs of health as surely as though it were repelled from the circumference." (Adams, U. S. Jour. of Homoeop., Vol. I., p. 471.) The signification he himself attached to the term psora must be learned from his own words. Hahnemann says: "I call it psora, with a view of giving it a general 190 diseases of the SANGUINOUS FUNCTION. designation." He never taught that the psora cause of disease was limited in its application to the itch. He says: " I am persuaded that not only the majority of the innumerable skin-diseases which have been described and distinguished by Willan, but also almost all the pseudo- organizations, &c, are with few exceptions, merely the products of the multiform psora," He evidently meant to teach that the great number of chronic diseases which afflict our race, " are due to a poison or miasm, latent in the body, acquired by the individual, or in some in- stances both, which becoming roused into action, ultimates in consump- tion, dyspepsias, haemorrhoids, asthmas, epilepsies." * This same miasm, as he called it, when thrown out towards the circumference, and ultimated upon the outer surface of the body, manifests itself in the form of boils, carbuncles, cancers, scald-head, tetters," &c. " The term psora is a term of ancient origin, being used quite indiscriminately to designate every variety of chronic cutaneous disease." Hahnemann's psoric doctrine was familiar to all the old writers; and is equally fami- liar to the modern pathologists under the term of dyscrasia. Genus I.—ANAEMIA. General Remarks.—According to Trousseau the existence of a certain proportion of iron is essential to the perfection of the blood in its different offices of supplying the proper nutritious materials for the support of the body and stimulating the various organs to perform their proper actions. The quantity of iron is smaller in women and children than in men, and women are most subject to anaemia. Causes.—Uterine haemorrhage; losses of blood from any cause; im- perfect digestion and assimilation of food; variable appetite; constipa- tion alternated with diarrhoea; menorrhagia. Treatment.—When anaemia arises from recent haemorrhages or other debilitating losses, it may be remedied by Ferrum, China, Natrum-mur., Nux-vom., dec. Ferrum has always been successful in pure cases of anaemia where the paleness and debility were dependent on an impoverished state of the blood, unconnected with local irritation or obscure inflammation. The remedial powers of iron in various forms have long been known. In all cases of anaemia from losses of blood or other fluids the soluble forms of iron are most successful, as they are styptic as well as tonic. Trousseau gives the carbonate, or limatura ferri, incorporated in bread, and continues it long after the countenance has resumed its florid color. It is appropriate in any form in chlorosis and in the paleness and de- * Prof. Adams, St. Louis, U. States Jour. Horn., Vol. I. 468. Hahnemann, Chronic Diseases Vol. IV. CEREBRAL anjsmia. 191 bility which precede the deranged menses; and it cures scarcely any disease that is not connected with defective constitution of the blood. It is improper in all phlogistic cases. Iron is proper in all anaemic cases cf amenorrhoea ; dysmenorrhoea; in dropsies dependent on impoverished state of the blood; in intermit- tents in which there is predisposition to haemorrhages, congestions, or dropical infiltrations. We have seen many cases of this kind cured by chalybeate mineral waters and many more by Prussiate of iron. (Ferro- cvanate of Iron.) For the Abuses of Iron see Remarks on Ferrum, under Phthisis pulmonalis. 2. CEREBRAL ANAEMIA.—"CITY CACHEXIA." Morbid conditions of the brain of an anaemic character occur from long-continued dyspepsia, confinement in impure atmosphere. This cachexia of the great cities presents the following symptoms: Loss of appetite, confusion, giddiness in the head, violent sickness; sleepless nights; horrid dreams; waking suddenly in the night: noises in the head and ears, like the singing of a tea-kettle, or like something struck close to the ear, or water thrown on a hot iron, or a muffled drum at a distance ; falling to sleep and suddenly awakened by a feeling as if a sky rocket had rushed through the brain; occasional deafness; head- ache ; black and bright spots dance before the eyes; languid, weak, ir- ritable pulse; cold skin ; pale flabby tongue. Occasionally there is partial loss of memory; sudden startings up in the night; giddiness of the head; depressed spirits. Treatment.—Better, though restricted diet, change of air; exercise without fatigue. Remedies. — Nitro-muriatic-acid, Pyro-phosphate of Ferrum,, Cinnabar in scrofulous cases, Sulphur 30th, one dose, repeating only at long intervals. Sulphuric-acid. 3. Ancemia LympJw.tica.—In six cases of this affection given by Dr. Wilkes, in the Guy's Hospital reports, a " uniformity of lesion existed, too remarkable to constitute merely a coincidence of lesion between the lymphatic glands and the spleen, and therefore, there is without doubt a peculiar form of affection involving these organs, accompanied by anaemic cachexia, prostration and death." Pathology.—There is no excess of white corpuscles, but deficiency of the red, with the usual signs of progressive anaemia in either sex alike in the treatment. The glands enlarged were, the inguinal, some- times the cervical, or axillary, or all at once progressing along the ab- dominal and thoracic glands to a fatal termination. A chain of tumors is sometimes encircling the arch of the aorta, or accompanying it along 192 DISEASES OF THE SANGUINOUS FUNCTION. the spine to the pelvis. The structure is fibro-nucleated, or fibro- plastic (Med. Chir. Trans., Vol 17.) The spleen is not merely enlarged, but exhibits a lardaceous depo- sit, white or yellow, either finely disseminated or seeming to compose a large portion of the mass of the organ. Its duration may extend over several years. Treatment.—In all cases recorded, the hospital treatment, consist- ing chiefly of iron was unsuccessful. A homoeopathic use of the Iodide of iron, Iod.-potassium, Mercurius-hyd., or a general antipsoric treat- ment would be attended with better results. A general anti-psoric treatment should be employed in the first in- stance. A favorable change, and perhaps a complete cure, may follow this course. The medicines should be used at high potencies, and repeated but rarely. Should a cure not result in a reasonable time, we should consult Ferrum-hydriod., Kali-hydriod., Mercurius-hydriod., and Iodine. These last remedies may be prescribed at the first, second, or third attenuations 4. Other Forms of Chronic Disease associated with a Latent or Repelled Dyscrasia.—Hahnemann, in his efforts to unravel the mys- tery of chronic diseases, explored a few thousand of the volumes wdiich contained what was then called the medical experience of the world, and found an immense number of cases recorded in which the suppression of skin-diseases originated other maladies equally obstinate and much more serious. In his work on "Chronic Diseases," published in 1828, he gives a large collection of cases from various authors in which the following, among other chronic and some acute diseases were obviously originated by the repulsion of psoric affections from the skin: First,—asthma; suffocating catarrh; asthma with bloating and blueness of the face and general swelling; asthma with hydrothorax; pleurisy and inflam- mation of the chest; pleurisy and cough; obstinate and violent cough; haemoptysis; consumption; collections of pus in the chest; collections of pus in the mesentery; great disorganization of various viscera; cerebral degeneration; hydrocephalus ; ulcers in the stomach; sphacelus of the stomach and duodenum; general dropsy; ascites; enlargement of the scrotum; swelling and redness of the whole body; jaundice ; swelling of the parotid glands ; swelling of the cervical glands; dimness of sight and presbyopia; ophthalmia; cataract; amau- rosis ; deafness; enteritis; haemorrhoids and haemorrhage from the rectum; pains in the abdomen; diabetes ; suppression of urine ; erysipe- las ; acrid, ichorous discharges; ulcers; caries of the bones; osseous swelling of the knee; pains in the bones; rachitis and marasmus in in- fants; fever with disorder of the kidneys; fever following external cure TREATMENT OF BLOOD IN ITS MORBID STATES. 193 of the scald head; fever with opisthotonos ; fever with throat disease; tertian intermittent fever; quartan intermittent fever; vertigo and total prostration of strength; epileptic vertigo ; epilepsy with dizziness; con- * vulsions in many forms ; apoplexy; paralysis ; melancholy and delirium. We select the following cases in which repelled eruptions caused disease of the eyes: First.—Dimness of Sight and Presbyopia.—A girl, aged thirteen, had the itch, covering the limbs, face and other parts. It was removed at length by ointments, containing zinc and sulphur. Immediately after- wards her sight became gradually weak. Dark bodies passed before the eyes, which were seen from without, floating in the aqueous humor of the anterior chamber. At the same time the patient could not dis- tinguish small objects without the aid of glasses, and the pupils were dilated. (Hoffmann, Consul. Med) Second.—Ophthalmia from repelled Eruption.—A young woman had an abundant psoric eruption on the legs, with large ulcers below and behind the knee. The small-pox with which she became infected, freed her from this exanthem. There ensued during two years a moist inflammation of the whole eye, and of the eyelid, with itching and ul- ceration, and the perception of dark bodies moving before the eyes. The patient became infected with itch by wearing for three days the stockings of another child. The third day she was attacked with fever, dry cough, tension in the chest and tendency to vomit. Next day there was perspiration with erysipelas of both legs which soon degenerated into the real itch, from which time the sight improved. ( Wedel, Snetter, Hallmann. 1776, Koenigl. 210.) Third.—A man, in whom the psoric eruption had been removed, but who was in other respects well, became affected with cataract. (Ludwig, Advers. II. 157.) Fourth.—A repelled itch, excited amaurosis, which ceased on tne reappearance of the psoric eruption. (Northof, Diss, de Scabie, 1792.) Fifth.—A robust man who had been treated for the itch by repel- ling it from the skin became affected with gutta serena, and remained blind till his death at an advanced age. (Ludwig.) Sixth.—In another case amaurosis, with frightful headache, was caused by curing itch on the surface. (Fabricius, Cent. II. obs, 39.) Treatment of Morbid States of the Blood. The usual means generally resorted to to furnish the best materials for the formation of the blood: are the expulsion of impure matters from it through the secretory functions; the support of the vital energies; the evacuation from the prima-via of all morbid secretions; and the restoration of general healthy action through the influence of tonics. Besides all of these results homoeopathic remedies aim at the Vol. II.—13- 194 DISEASES OF THE SANGUINOUS FUNCTION. more deeply-seated causes of disease, and strike at the hidden sources of hereditary evils and transmitted maladies. Though old school men aim at the same thing, they defeat them- selves by excessive medication, and thus produce aggravations instead of satisfactory cures. On this point Hahnemann says: " When the patient afflicted with itch, after taking Sulphur, complains that the cutaneous eruption grows worse, the physician who is ignorant of the cause, consoles himself by saying that the itch comes out entirely before it can be cured; in reality the exanthema is caused by the Sulphur, and assumes an appearance similar to aggravated itch. Leroy says, viola-tricolor commences its action by rendering the cutaneous eruption of the face worse, though it subsequently effected a cure. The dose was too large, though the remedy was homoeopathic. Lyssons says (Med. Transac, Vol. IL, London, 1772): the skin-dis- eases which yield with the greatest certainty to elm-bark, are those which it first aggravates. If he had given smaller doses he would not have caused the aggravations. In chronic (psoric) diseases the aggravation produced by homoeo- pathic remedies (antipsorics) occurs from time to time for several days ; after remedies whose action continues long we may see during the first six, eight or ten days some apparent aggravations of the original malady. " When these days are past, the curative effect of the remedy continues for some days longer." We are often called upon to prescribe for the results of disease, as well as for disease actually existing; even here, however, we are governed by all perceptible symptoms now existing, whether they evidence present diseased action or show where diseased action has been progressing at a former time. We find these results of former diseass in all protracted cases, in all chronic diseases. It has been already shown that remarkable,diminution or exhaustion of nervous energy generally renders the blood dark-colored, prevents its fibrinous particles from adhering into a coagulum when removed from the veins, causes a disposition of the coloring matter to separate from the central corpuscles, and occasions a diminution of its saline in- gredients. It has been also seen that various articles received through any channel into the blood change its chemical and physical character. We may then be able to correct diseased states of the blood by intro- ducing medicinal agents through the same channels. Page 178. Fvrst.—Treatment of cases, in which buffy or inflammatory blood is present.—Gelseminum, Aconite, Stibium, Ipecac, Bry., c&c. Second.—Blood with loose Coagulum, dec.—This state arises from weak, nervous influence and vascular action, and is usually treated with tonics, or stimulants, chalybeates, mineral acids, and metallic salts. When the blood is of a dark color, Ammonia, Arsenicum, HEMORRHAGES. 195 Carbo-veg., China, are to be considered. In diseases, in which the blood is thin and dissolved as in scurvy, also in malignant and adynamic diseases, vegetable acids, as the citric acid, or vinegar, are the chief remedies. Vinegar was used by the Carthaginians and Romans in all their campaigns; and it has a tendency to prevent the attenuation of the blood caused by excessive fatigue. The power of citric acid is now well known in preventing scurvy. (See Copland, Vol. I. p. 248.) Genus H.—tUEMORRHAGIA.—HEMORRHAGES. Bichat made the first real advances into the field of pathology which is now so extensive ; and to him we owre the first rational generalization of facts in the study of haemorrhages. He showed that there are general features which are common to all spontaneous Sowings of blood, and classifies them according to the organs in which they occur. We proceed to notice the most important forms of haemorrhage. 1. TRAUMATIC HEMORRHAGE. Treatment of Hcemorrhage from Wounds.—A wound, well closed and dressed, generally ceases to bleed. When there is danger of bleed- ing a compress may be applied over it and retained by a bandage. Cold water, immediately applied, will stop bleeding from small vessels. When the bleeding vessel is larger, as some about the throat, thigh or arms, the whole limb or side of the neck may be compressed by pla- cing a finger on the trunk of the bleeding vessel. If it be an artery the fact is known by the blood being of a light vermillion red color, flowing out in jets at intervals as the pulse beats. In this case the danger is greater, and the best surgical measures are imperiously required. Temporary safety may be procured by binding a bandage tight around the limb between the wound and the heart so as to compress the bleed- ing artery, the location of which is known by its beating. If the bleeding does not at once cease, find the exact site of the artery, feeling for the pulsation with the finger, place directly on the spot a piece of cork and press it down upon the artery till the bleeding is effectually stopped. A bandage applied around the limb, so as to compress the cork firmly on the artery, will restrain the flow of blood till better means can be obtained. Give only cold drinks, keep the limb elevated; place no unnecessary dressings over the wound; keep it cool with cold water. If fainting occurs it is beneficial, as it permits coagulation of the blood. If the faintness comes on after great loss of blood, the patient becomes blue 196 DISEASES OF THE SANGUINOUS FUNCTION in the face, has twitching of the limbs, there is danger. Give China. If he does not revive sufficiently give good wine. (Tiering) When the loss of blood is likely to become serious, the tying of the bleeding artery is the only reliance. This even when the vessel is small requires some skill and knowledge of general surgical principles. These have been greatly improved within the present century. It wTas a maxim of Hunter to "take care of the vasa vasorum," and of Scarpa, Crampton and Travers, that we should "never cut the arterial tissue." Physic and Cooper improved the practice by using a ligature possessing the property dissolubility. Cooper first used it in 1814. And A. Cooper in 1817 tied the femoral artery of a man aged 80, and healed the wound by the first intention; which proved the great superiority of this method over that of Scarpa. It has been proposed to combine all the advantages of former me- thods. The rule of avoiding the cutting of the true vasa-vasorum is good; these minute vessels should not be strangulated with the liga- ture. To avoid this, and yet secure the vessels, Cooper directs the ligature to be made of buckskin, very soft, and a little broader than the thickness of the skin; and it should not be to tightly drawn. The wound will generally heal by the first intention; and, if it should not, there will be no suppuration and the wound will soon close; and a capsule will surround the ligature if the capillaries are not too much injured; or the ligature will be surrounded by lymph, and will soon be dissolved. After using the animal ligatures several years no second- ary haemorrhage has resulted; the ligature never slipped, other appli- cations were never necessary; and the wound nearly always healed by the first intention. As traumatic haemorrhages arise for the most part, from strictly local injuries, the treatment cannot be regarded as with the scope of any general therapeutic law. The local appliances of the surgeon will therefore be regarded in these cases. But when the general system becomes involved, and diseased action becomes developed, then our law of cure comes in play, and the appropriate homoeopathic medi- cines must be prescribed. Styptic for Local Application.—The following formulae has been published by M. Hannon: (Bulletin Gen. de Therap.) Benzoic acid, 1 part: Sulphate of Alumina and potash, 3 parts ; ergo tine of bonjean, 3 parts ; water, 25 parts. Mix. The whole is to be boiled for half an hour in a porcelain capsule, constantly stirring, and replacing the evaporated water by hot water. Evaporated with the constant agitation to the consistence of an ex- tract, it presents a chocolate-brown color, strongly astringent taste, and an odor of ergotine. This, says M. Hannon, is the most ener- HEMORRHAGES FROM EXHALATION. 197 getic styptic at present known, whether applied externally or admin- istered internally. Creosote.—When this is not at hand, take the black glutinous drops which hang in old chimneys where wood is burned. A portion as large as a pea may be dissolved in a table spoonful of brandy, then diffused in a glass of water, and dropped into the wound. Leech Bites ought never to be inflicted on suffering children; but many people will use them, and some will neglect the patient long enough afterwards to permit him to bleed to death. To stop leech bites from bleeding it is sufficient to hold the finger for a considerable time on the wound, and apply over it a good plaster of some adhesive plaster or sticking wax, such as that used by gardeners or shoe- makers. (Hering) Punctured Wounds made with blunt and rough instruments do not heal well from the bottom unless they are thoroughly cleansed; and they often require to suppurate, for which they need poulticing or some slightly stimulating embrocation. Some of those mentioned under ulcers will answer. If the external aperture is small it may close up before the interior part is well. If the closing can not be otherwise prevented insert into it a tent made of a smooth piece of the bark of Ulmus-fulva, or slippery elm. It is inserted without pain; and it expands gradually, thus enlarging the aperture. Causes of Spontaneous Hemorrhages. Dr. Joslin, in an article on the Meteorology of Haemorrhage, in 1843, showed, that in many cases of bleeding from the lungs and uterus the barometer was generally fall- ing on the days of attack in a greater proportion of instances than could with any degree of probability be attributed to accident: thus out of 54 cases, it was falling in 35, at the time of the attack, rising in 18, and stationary in one only. Treatment.—For active haemorrhages, we should examine Aconite, Gelseminum, Millefolium, Ipecac, Veratrum-viride, Digitalis, Arnica, China. For passive, and venous haemorrhages, the more commonly indicated medicines are, Hamamelis, Collinsonia, Secale, Sabina, Ferrum-hyd, Calendula, Ammonium-carb. For haemorrhages occurring during the progress of maladies of a typhoid or malignant character, we must refer to Arsenicum, Ammo- niacum-carb., Carbo-veg., China, Muriatic-acid, Gallic-acid, Rhus-tox., Secale. 2. HEMORRHAGES FROM EXHALATION. 1. Haemorrhage from exhalation may happen wherever exhalents terminate; and they have their seats in the mucous surfaces, as the nasal passages, bronchia, stomach, intestines, bladder, &c. They also 198 DISEASES OF THE SANGUINOUS FUNCTION. occur in the serous membranes, as we sometimes find bloody serosity in the intestinal cavity ; and also in the cellular tissue. Such are those which produce scorbutic spots. Those of the skin are of rare occur- rence. Finally, glands have been observed to exhale blood. Haemorrhages by exhalation in mucous membranes, as elsewhere, are of two species: passive and active. Active, when they are ac- companied with development of the vital forces; thus they have this character in the nasal passages when we notice a titillating sensation, together with a slight pain and redness. At other times they are en- tirely passive, as when they occur near the close of some organic af- fection characterised by debility. Symptoms of Excessive Loss of Blood.—The loss of blood mani- fests itself in paleness, coldness of the surface ; dimness of sight is a prominent symptom. Marshall Hall describes a case of a lady dying from uterine haemorrhage. The pulse was imperceptible and she was "tossing in that restless state which is so fatal a sign in these terrible cases. She asked: 'Am I in any danger? How dark it is! I can't see!' The light of the window was shining full upon the bed. The pupil was completely dilated and motionless before the light." When women recover from this state, or have lost much blood, they will probably have distressing headache with throbbing of the head; noise in the ears, colorless complexion ; quick weak pulse, all of which symptoms are greatly increased by exertion. For such symptoms some formerly tried bloodletting; if they found relief for a few hours it was always followed by renewal of the nausea, throbbing headache worse than before. Indeed, the condition is one of anaemia; it is the acute state of what is otherwise called chlorosis ; that pale-faced amenorrhoea which occurs either in puberty or after life, and is cured by a similar treatment. Ipecac.—Many old authors succeeded in curing haemorrhages with Ipecac, while others, as Murray, Scott, and Geoffroy saw haemorrhage caused by it. If F. Hoffmann praises the efficacy of Millefoil in various cases of haemorrhage; if G. E. Stahl, Buchwald and Loeseke have found this plant useful in excessive hcemorrhoidal flux; if Quarin and the Editors of the Breslauer Sammlungen speak of the cure it has ef- fected in haemoptysis ; and finally, if Thomasius, (according tollaller,, has used it successfully in uterine hoemorrhage; these cures are evidently owing to the power possessed by the plant of exciting in- testinal hoemorrhage and hcematuria, as observed by G. Hoffmann, and more especially of producing epistaxis, as confirmed by Bcecker. Haemorrhage from the Lungs. See Vol. I. p. 797; Haemorrhage from the Stomach. Vol. I. pp. 413, 866. Haemorrhage from the Teeth. Vol. I. p. 237. PURPURA HEMORRHAGICA. 199 Haemorrhage from the Kidneys. Vol. I. pp. 785, 600. Vol. II. p. 70. Haemorrhage from the Rectum. Vol. I. p. 392. Haemorrhage from the Nose. Vol. I. p. 430. GENUS III.—PURPURA. This name is applied to an efflorescence consisting of small, distinct, purple specks and patches, attended by general debility, but with little appearance of fever. The efflorescence depends upon an extravasation of blood from the fine vessels under the cuticle. The only form of it that deserves our attention is : 1. PURPURA HEMORRHAGICA. Diagnosis.—The disease is characterized by the appearance on the ' skin of petechia, or purple spots of large size interspersed with vibices and ecchymoses, resembling the marks made by the stroke of a whip, or by violent bruises. They appear first on the legs, afterwards on the thighs, arms and trunk of the body; the hands are seldom marked with them and the face remains free. On their first appearance the spots are of a bright red color, but they soon become purple or livid; and when about to disappear they change to a brown or yellowish hue; the. cuticle over them appears smooth and shining, but is not sensibly elevated, except in a few rare cases in which it has been seen raised into a sort of vesicle containing black blood, especially on the tongue, gums, palate, and inside of the cheek. The gentlest pressure on the skin, as that of feeling the pulse, will often leave a purple blotch like that left after a severe bruise. Purpura haemorrhagica occurs in persons who have a constitutional tendency to haemorrhages, from all the surfaces covered by the de- licate epithelium as well as from the skin; they are therefore subject to large losses of blood which are often rapidly fatal. Sometimes the haemorrhage occurs every day at a stated hour; at other times there is a slow, but almost incessant oozing of blood from the gums, nostrils, throat, inside of the cheeks, tongue or lips; sometimes from the lining membrane of the eyelids, the urethra or external ear; also from the internal cavities of the lungs, stomach, bowels, uterus, kidneys and bladder. Symptoms.—The appearance of the disease is preceded by great lassitude, faintness, pains in the limbs, though in some cases the pa- tient had been in previous good health. The feelings most complained of are extreme debility and depression of spirits; the pulse is feeble and frequent; and there are heat, flushing of the surface, perspira- tion and other accompaniments of fever. When the disease has con- 200 DISEASES OF THE SANGUINOUS FUNCTION. tinued for some time the patient becomes sallow and emaciated; the lower extremities show oedematous swelling which afterwards extends to other parts of the body. The duration of the disease is in some cases limited to a few days, in others it has continued for months, and even years. It occurs at all periods of life, but is more common among women, and in boys before the age of puberty. Causes.—Depressing influences which operate by depressing the vital powers; sedentary occupations; residence in close crowded situa- tions ; consequences of acute exanthematous diseases, as small-pox, measles, or puerpural confinement; the ancients attributed the haemor- rhages which attend purpura haemorrhagica to morbid enlargement of the spleen. In children it is often originated by insufficient or im- proper food; in nursing women its causes are similar to those which in other persons produce stomatitis materna. (See Vol. I., p. 740.) Treatment.—When it occurs in women and others too rmich con- fined within-doors or imperfectly nourished by food, the treatment will be commenced by improving the diet and prescribing change of air, exercise, travelling, at least by being carried abroad. When there has been no restriction of diet, no close confinement, and no debilitating disease has preceded, a different course may be suggested which in its details will be regulated by the peculiar circumstances and features of the individual case. 2. Purpura Urticans.— Diagnosis.— This form of purpura com- mences with the appearance of rounded and reddish elevations of the cuticle resembling the wheals of nettle-rash, but without the itching and tingling of that disease. The tumors gradually dilate, but within one or two days they subside to the level of the surrounding skin; their hue be- comes darker, and finally livid. They are most common on the legs where they appear with petechiae, but they also appear on the arms, thighs and breasts. It usually occurs in summer, and lasts from three to five weeks. It is occasionally preceded by stiffness and weight of the limbs, and some oedema accompanies it. 3. Purpura Senilis appears principally along the outside of the forearm in elderly women, in successive dark-purple blotches of an irregular form, and various in size. Each of these continues for seven or ten days, and then the extravasated blood is absorbed. Treatment.—The principal remedies are: China, Hamamelis, Ar- senicum, Sulphur.-acid, Gallic-acid, Ammonium-carb., Secale, Carbo-veg. Acetate of Copper.—A girl aged seven years and a half, has had on her skin for eight days, dark red spots from the size of a millet-seed to that of a shilling; the spots especially occupied the upper half of the body, the chest, upper arms, face, and mucous membrane of the. mouth. Otherwise the health seemed undisturbed. The urine in nor- mal condition. For five days the chloride of iron was administered, but PURPURA HEMORRHAGICA. 201 the spots only increased in size. On the forehead, both eyelids, and elbows, bluish ecchymoses of the circumference and height of half a walnut arose. From one alveolar process from which the child had herself extracted an incisor tooth two days before, blood constantly flowed; her cheeks and lips were pale ; her strength gone. Something of the acid order was given which checked the haemorrhage; but after eight days' trial it was given up, for fresh spots appeared; and a boil of the size of a moderate apple developed itself on each shin-bone. The acetate of copper was given in solution, (a few drops per hour,) July 9th, and it at once arrested the progress of the disease. July 13th. A smart itching of the spotted portions set in; this was followed by the usual change of the purple hue of the ecchymosis shining through the skin which became green and yellow. And by a week more all morbid symptoms had disappeared. (Dommes.) 2. A child aged seven years, complexion dark blond, showed a great number of dark purple red (but not bleeding) spots of various sizes, which had made their appearance twenty-four hours before, and occu- pied almost exclusively the upper part of the body, including the tongue. General health not otherwise changed, urine of ordinary color and chemical properties. Arnica was tried, but it failed to do good, and produced visible aggravation. After four days (or Oct. 31st, 1848,) frequent bleedings of the tongue commenced; the strength decreased. Acetate of copper employed after this (in a solution of gum water and cinnamon water) produced in this case also a rapid and perfect cure, preceded by the same itching of the skin and change of color. (Dommes.) 3. Dr. Marx, of Cologne, court physician, reported the following: "A man of melancholic temperament, who had been taken ill on a jour- ney, consulted Dr. Marx in 1772. He complained of feebleness and want of appetite, had a dry cough, not very severe, and at times expec- torated blood. On various parts of his skin bluish red spots were seen, and reddish blue stripes under the tongue. Pulse small and irregular; blood occurred in the urine and stool and also in the saliva. Respira- tion difficult, with cold and hot fits. The above solution of copper vitriol in cinnamon water. In three weeks all morbid symptoms had disappeared, and the patient was able to continue his journey. (British Jour. Horn., 1860, p. 542.) 4. Case by Dr. Searcy. (Transaction of the Med. Society of Ten- nessee.) A girl aged twelve years, after fever for nine days, was con- valescing. Was very pale and feeble; fainted on being raised; sur- face unnaturally cool; restlessness ; thirst; headache; tongue pale and flabby; pulse scarcely perceptible and extremely frequent; tender- ness of epigastrium; bowels constipated ; and constant oozing of blood from the nares and throat for forty-eight hours, causing extreme ex- 202 DISEASES OF THE SANGUINOUS FUNCTION. haustion. On the face a few red and blue patches; also on other parts, as the limbs, inside of the lips and cheeks, from the size of a pin-head to a five-penny piece. She has always been delicate, is nervous-sanguine, bleeds often from the nose in health. Haemorrhagic tendency or scrofula not known in the family. She took small doses of Saccharum-saturni, every hour for seven hours, at which time the bleeding ceased. Solution of the same injected into the nares. A blister was applied to the back of the neck and to the calf of each leg. The pulse became stronger; still there is thirst, tender epigastrium; tongue pale and flabby. Under the use of elixir-vitrol, lemonade, light food, &c. She recovered. Sulph.-quinine and the mineral acid perhaps insured the favorable result. Under them the purpural patches ceased to appear on the skin and the old ones faded away as strength improved. GENUS IV.—TOXAEMIA.-BLOOD-POISON. 1. Toxaemia Mercuriale.—Persons long exposed to breathing mer- curial vapor suffer depression of the vital powers; the process of animal calorification is imperfect; and it is quite common for such persons to be affected with ulcerations of the mouth and fauces, and with " pain- ful or rheumatic affections of the periosteum, joints, limbs and liga- ments, particularly after exposure to cold." Eruptions occur on the surface of the body with other phenomena, " to which the term pseudo- syphilis has been applied; as well as many of those symptoms usually denominated cachectic." The same effects occur from what is called " a mild, but long-continued mercurial course." The poisonous influence of Mercury was exhibited on a grand scale on board the British ship referred to at Vol. I, p. 95. Thirty tons of the liquid metal was picked up and confined in bladders placed in barrels stowed away in boxes in the bread room. The bladders were wet and soon decayed; the heat of the weather caused them to burst; and the greater portion of the metal was secured in casks, though a large quantity escaped and found its way into the crevices in the lower parts of the ship, where being covered with bilge-water it soon began to be decomposed. Then efforts were made to purify the ship by removing the bilge-water, provisions and stores, and washing every part of the suspected surface: and every man employed in this work or in the stew- ard's apartment, was speedily affected with the poison. Ptyalism be- gan among the officers and men, and further attacks continued to occur for two months or more. Nearly all the sheep, pigs, goats, poultry, mice, cats and dogs speedily died. Canary birds, fed on food corked up in bottles, also died. Many persons suffered from severe ulcerations of the mouth, partial paralysis, bowel complaints. Old ulcers previously ANAEMIA. 203 healed, broke out again, and assumed a gangrenous appearance. The mercurial vapor developed phthisis pulmonalis in three men who had never before been on the sick-list; they all died. Two more were left at Gibraltar with confirmed phthisis. In two ptyalism degenerated into gangrene of the cheeks and tongue and ended in death. A woman confined with a broken limb lost all her teeth, and many exfoliations took place from the upper and lower jaws. The poisonous effects were then attributed to mercury soaked in the bread, and 7,940 pounds of biscuit were condemned as unfit for use; but it was afterwards ascer- tained that the poison was chiefly received into the system in a state of vapor. When gradually introduced into the system, mercury produces: tu- mors that are slowly developed; severe ptyalism, gangrene and ulce- ration of the mouth and throat; palsy, various nervous and inflammatory affections in different parts of the body; protracted dysentery. The effects observed on the slaves who work in the quicksilver-mines of Almaden, are: Swellings of the parotids, aphthous sore throat; sali- vation, eruptions, pustules ; scurvy and tremors. Merat mentions one death from profuse salivation and gangrene, and two others from mer- curial marasmus. A barometer-maker and his assistant slept in a room in which mercury in a pot on a stove was heated by a fire made by mis- take. The latter lost all his teeth by salivation, the former was affected with shaking palsy which lasted the rest of his life. Ptyalism is sometimes excited by a warm bath containing an ounce of corrosive sublimate in twelve gallons of water repeated every three days. The effect is seen after the third bath, if not sooner. This power- ful agent is sometimes applied as an escharotic for the removal of can- cers. In the case of a lady on whom we had declined to make an appli- cation of this kind an itinerant practitioner applied a plaster of this poison an inch and a half in diameter on the surface of a cancer on the breast. He encouraged her to endure the agony it inflicted by assuring her that the swelling mammary veins were only the " the roots" of the cancer (" the crabs claws " ), which were being rapidly extracted. She lived several days under the local torture of the burning escharotic and the irritative fever; and then died under the constitutional effects of mercury, including the gastric inflammation and dysentery caused by the poison when taken internally. 2. Toxemia—from the Poisonous Effects of Tobacco.—In 1849, the French Minister of the Interior requested the Academy of Medicine to appoint a Commission to examine and report upon the health of workmen employed in the manufacture of tobacco. Dr. Melier was appointed to perform that duty. His Report says : " The manufacture of tobacco effects, in the long run, upon a certain number of workmen, a profound and specific change deserving all at- 204 DISEASES OF THE SANGUINOUS FUNCTION. tention. There is a peculiar alteration of the complexion—not simple discoloration or mere pallor, but a gray sallowness—a mixed shade between chlororis and certain cachexiae. The physiognomy is so far modified by it, that a practiced eye might with some exceptions, recognize those who have long worked in tobacco. " The preparations of Iron remedy this state, and restore to the workmen their primitive color. Mr. Hunteaux, the physician attached to the Gros Caillon hospital, has remarked that workers in tobacco, when bled, in the cases where bleeding appears to be indicated, do not present a buffy coat upon the blood; or if there be one, it is usually very soft. Is the blood then modified to such a point that a part of the fibrine has disappeared ? " They fall away and change rapidly. We have seen a fine-looking soldier, aged 29, who, on leaving the first Lancers, entered the factory a year ago fresh and fleshy. Now he is thin, and his complexion has the peculiar sallow; he has lost his strength. Another mentioned that he had lost ten pounds in a short time. It is believed that the average of life is shortened among workmen employed in tobacco. Most of the aged workmen are asthmatic, or at least short-breathed. " The first impression has something more or less painful for work- men-who enter the factory, and they have, nearly all, a certain diffi- culty in accustoming themselves to it. Many can not become inured to it, and have to leave the factory. We have known but one out of five who was able to remain, of those who entered during our visits. One out of five ! these are figures that deserve to be noted. But this is certainly not the case with smokers. They suffer,—indeed their first sensations are intolerable; but a kind of silly pride resists dis- gust and pain. They suffer, but they smoke; then the disgust les- sens, the pain is blunted, the habit formed, and the evil takes its course. Hence we often meet, among habitual smokers, men who, by reason of their temperament, or of certain innate peculiarities, would certainly have been obliged to renounce the frequentation of the fac- tory, and to whom tobacco must be especially hurtful." (Journal de Societ. Gallicane) Dr. Teste of Paris says many of the ordinary infirmities of the votaries of tobacco are attributed by themselves to some other origin. Thus, one digests badly; another has palpitations ; a third finds his sight failing in the evening, or can read only by closing one eye, as if he squinted; a fourth complains of itching with red or yellowish spots on his chest and shoulders ; a fifth has stitches in the side, darting pains in the temples, or buzzing in the ears, &c, or corns on his feet so painful as even to prevent sleep at night. Though many organisms bear for a long time the poisonous powers of tobacco, they are never secure acainst the sudden outbreak of acute symptoms. Beyond the PHTHISIS PULMONALIS. 205 point of saturation there is every thing to be feared. In one case a gentleman aged forty-two who smoked seven or eight cigars a day from his twentieth year without inconvenience. He complains now of "ir- ritation of the bowels, has considerable emaciation, especially of the lower extremities; general sense of weakness ; chilliness; absense of fever; the pulse rather weak, but regular, never more than seventy or seventy-two, even after meals ; temper mild though keenly anxious about his condition; sleep bad, often interrupted by cough or colic; skin natural, tongue clean; appetite great; faintness when the meal is delayed; fits of canine hunger; does not spit even in smoking; pinching of the stomach after a meal; followed by diarrhoeic stool, recurring three or four times during the day; irritation of throat or wind- pipe ; violent spells of dry cough especially at night; dull pains in the sides, alternating with sore throat; stools often diarrhoeic, often violently so, with hard gripings, sometimes lasting several days, followed by constipation. In this case all treatment failed till smoking was abandoned, " and then almost immediately the digestive functions returned to their nor- mal state. In another well-marked case in which the derangements caused by tobacco were very extensive and the army physicians had diagnosed cancer of the pylorus. Dr. Teste failed with all his remedies. In the course of two years he found the patient in perfect health. To the inquiry " how he had been cured the patient replied, as if confiding a secret: " I smoked—you did not know that, perhaps. One fine day I stopped smoking, and from that day my cure dated." (Jour. Soc. de Gallicane.) For other Drug Diseases see their Names.—Index. PHTHISIS PULMONALIS.—CONSUMPTION. The Name.—Phthisis (from, Qduo, to consume.) Synonyms.—Tabes Pidmonalis, of Cullen, Marasmus Phtliisis of Good. It has been defined to be " a depraved constitutional state, tend- ing to the deposition of tubercle in the air-cells of the lungs." Prominent Symptoms.—Emaciation; debility; cough; hectic fever; purulent expectoration. Diagnosis, Progress and Termination.—The most common period for the occurrence of phthisis is between the ages of eighteen and thirty; and it is probable that more deaths occur in persons under the age of eighteen, than after thirty. It is calculated by Drs. Forbes and Clark, "that above one-quarter of the individuals who die before the age of puberty, die of tubercles! " It is also estimated by the latter gen- tleman, " that the maximum of mortality in this disease is at thirty, and that from this point it gradually diminishes." No age, however, is exempt from it; for infancy, childhood, youth, manhood, and extreme 206 DISEASES OF THE SANGUTNOUS FUNCTION. old age, are all more or less subject to its withering influence. Be- tween the ages of two and fifteen years about three-fifths of the deaths occur in tuberculous subjects. From this age to twenty-five the vic- tims embrace the young of both sexes, particularly those who possess the finest and rarest moral and mental endowments, and the subtlest intelligence. To the young female, just reaching " the verge of woman- hood," when Hope comes to her with the most enchanting promises, the angel of ill approaches also, in the guise of consumption ; and the two contend until the last is the victor, and his triumph is celebrated with all the displays of unaffected wo. Many a young man who has scaled the difficult heights that obstructed an ambitious vision, is about to grasp the prize upon which his eagle-eye has been steadily fixed through years of varying toils and storms ; but the moment he dares to dream of rest, the enemy that has dogged his steps, unseen, through half his career, is disclosed, and leads him from the presence of Hope to that of Despair. With what a profound interest must the physician contemplate a disease of which the path is constantly thus marked! Tubercular phthisis, when once fully developed, is beyond question incurable by medical means. The physician may palliate symptoms, and often protract for a considerable period the fatal termination of the malady; but he can not remove those foreign accumulations which constitute tubercles, either by a gradual absorption or in any other manner, so as to prevent the formation of ulcerous excavations ; nor can he heal these ulcerous cavities when once formed, since they are constantly being disturbed and irritated by the incessant motions of the lungs. The few instances of spontaneous cures of ulcerated lungs reported by Laennec and others, are only exceptions to the general principle which we have advanced. Much, however, may be done in the early stages of phthisis, while the tubercles are yet small, and but slightly irritated to retain them in a latent condition for an indefinite number of years. We are aware that in some instances there will be great difficulty, even on the part of the physician, in detecting the insidious advances of the disease at this early period, but by watching with great care every slight indication of disturbance connected with the respiratory organs, by ascertaining whether any hereditary pre- disposition exists in the family, by examining the physical conforma- tion of the chest, the respirations, as relates to their strength, free- dom, number per minute, and whether unduly increased by exercise; and finally, by investigating minutely the previous history of the indi- vidual, in order to be able to judge whether any cause may have been in operation which might originate the disorder, we may be able to advise such measures as shall retain the tubercles in a latent and un- developed condition, and thus for years prolong life. Development.—Stages of the Disease.—1. State of crude tubercle.— PHTHISIS PULMONALIS. 207 Small disseminated tuberculous deposits. 2. Stage of abundant de- position, involving solidification, followed by softening. 3. Stacre of excavation,—the tubercles having softened and, in discharging formed cavities. The laws observed by tuberculosis in its progress are the following: In a vast majority of cases the deposit takes place at or near the apex of the lung: beginning on one side before the other lung is attacked; but the opposite lung is subsequently affected in a vast majority of cases. In the far greater proportion of fatal cases it is found that both lungs have been affected, but the deposit is most extensive on the side first involved. Precursory Phenomena.—The positive appearance of tubercle in the lungs is preceded by a period of ill health, frequently well marked, and capable ef being easily recognized. The constitutional cachexia manifests itself before its most dreaded consequences have become ap- parent. Louis asserts that "tuberculization commences from six months to two years before its announcement by cough or any obvious pectoral symptoms." Dr. Hogg thus sums up the symptoms of this stage: "Emaciation, susceptibility to bronchical catarrh, mental lassitude, failing of bodily strength, shortness of breath, weakness of sight, falling off of the hair, frequent perspirations, occasional palpitations or unsatisfactory state of the digestive organs and the alimentarycanal."* The incipient stage of consumption is thus characterized: " a slow but marked diminution of bodily vigor for which no good reason can be assigned, compels the individual to abandon many of his accustomed pursuits; the spirits, nevertheless, are good, and not only is the idea of consumption never entertained, but any allusion to it is at once ri- diculed. So general indeed is this hopeful condition—this almost instinctive blindness to the real cause of distress—that in their absence, however suspicious certain symptoms appear, these may, with much probability of accuracy, be pronounced unconnected with phthisis. In phthisis, when fully established, the features are somewhat sharpened; the movements of the body are hurried and anxious ; the mental con- dition is irritable and capricious, whilst every act betrays an effort— sometimes instinctive, and at other times voluntary—to conceal the presence of disease. (Dr. Cotton.)—The appetite is uncertain; and there are frequent indications of imperfect digestion as well as tendency to passive diarrhoea and headache. The pulse varies in different cases, but is generally small, and easily excited. The sleep is restless, un- refreshing, and occasionally attended by perspirations. Loss of weight is of invariable occurrence; sometimes the decrease is so rapid that it will attract the attention of the friends ; at other times the patient * Practical Observations on Prevention of Consumption. P. 42. 208 DISEASES OF THE SANGUINOUS FUNCTION. needs to be weighed at considerable intervals to detect it." In a few instances the emaciation has been so rapid that several pounds have been lost within a few days. It is when a number of the above symp- toms are found together, when " the patient's antecedents, his occu- pations and habits of life, or any other circumstances, seem to be con- ducive to phthisis," that the physician is reluctantly compelled to re- gard the sum total of the evidence presented to his mind as conclusive that consumption is becoming positively established. Females are more subject to consumption than males,* and their education, habits of life, their absurd modes of dress and the require- ments of civilized society are well calculated to excite this disease. In New-York the proportion of deaths from consumption was : For the year I860.—Whole No. of Deaths 22,710. From Phthisis 3,186. " " " 1861.— " " " " 22,117. " " 3,025. " " " 1862.— " " " " 21,214. " " 3,170. Of these, in 1860, Males 1,627.—Females 1,559. " " in 1861, " 1,576.— " 1,449. But no general conclusions can be drawn from these statistics, as of 3,025 of the above deaths from phthisis, only 950 occurred in persons born in the United States. Symptoms that precede the Formation of Tubercle. — Shorter breathing, less breath motion, feeble and shorter inspiratory sounds, and particularly the vesicular more or less general over both lungs. Expiration is quick, forcible, and perfect; deep inspiration, though possible, is not effected until the attention of the patient is directed to it; and commonly after repeated trials, the air is diminished in ordinary breathing. General atonic Condition of the Body.— Sense of weakness and languor, loss of flesh, and weight; loss of physical strength; pulse and respiration increased in frequency; complexion denoting mal- nutrition ; irritability of the mucous surfaces ; the chest is flattened in original conformation, or becomes so during the progress of the disease; the features from being round and placid acquire a sharp and faded look, especially in the morning, when the eye lacks expression; there is dullness of sound on percussion ; cough and haemoptysis exist in some cases though not in all; bowels constipated or unnaturally relaxed; the urine deposits lithates; and nervous and dyspeptic symptoms appear, f "The existence of tubercles can not always be positively determined by physical examination, as they may be so minute or so partially clustered as not materially to interfere with vesicular respiration." " But," says Scudamore, " if a patient have lost strength and flesh with- out apparent cause, have recently become short-breathed on slight * See Reports by Louis, Forbes, Skoda, Laennec, Andral, Clark, Young &c. t Dr. Smith.—Brompton Hospital for Consumption. PHTHISIS PULMONALIS. 209 exertion, especially on making a slight ascent; if there be more or less dry cough, quick pulse, night-restlessness and perhaps some dullness on percussion here and there in the upper parts of the chest, we have rea.son to fear that tubercles are formed. If others of the family have died of the same disease the suspicion is painfully increased." As the disease progresses there is a slight increase of arterial action, the pulse ranging from 80 to 90, increasing towards evening, and being, also, small and quick; the equilibrium, too, of the circulation is disturbed, causing coldness of the hands and feet, and in the case of young females this unequal distribution of the blood often occasions irregularity, dimi- nution, or even total suppression of the menses, as if nature made an effort to economize " the blood/' being conscious of its vast importance.* The patient in whom this disease is insidiously fixing its grasp, breathes when in repose more frequently than in full health; the ex- pirations and inspirations are unequal in point of time ; and he is put out of breath by the slightest exercise; his chest is neither large, full, nor well developed; its movements are unnatural during inspiration or expiration; there is tightness or pain in the thorax; he inherits a psoric or scrofulous constitution; he has cough from the slightest ex- posure, especially in the morning; his chest is inclined to become con- tracted, hence he stoops when sitting or walking. Amongst the first signs which should lead us to suspect latent phthisis, are, an ill-formed thorax, respirations above the natural stand- ard, and greatly accelerated on slight exercise, and the existence of a hereditary taint. Whenever these signs obtain, the chest should be at once explored by auscultation and percussion, so that if tubercles are discovered, immediate measures may be taken to keep back or prevent their development. Sometimes a slight dry cough, with tightness and pains in the lungs, are the first symptoms which announce the affec- tion ; at other times the disease supervenes suddenly, after a pleurisy or an influenza, or some other acute malady. In the majority of in stances, however, the symptoms occur in the order enumerated, viz. habitual shortness of breath, especially after exertion, short and drj couo-h, burning in the palms of the hands and soles of the feet, con striction and pains in the chest on inspiration, sensitiveness of the lun^s to cold. These symptoms may remain stationary for months 01 years, when from some exciting cause the pulse becomes unnaturally frequent, there are febrile exacerbations in the evening, and generally about noon, the respiration becomes more rapid and laborious, being often executed by the diaphragm; the anterior and lateral parts of the chest dilate unequally during inspiration and expiration, particularly in the recumbent posture ; the catameniain female subjects cease, a mucous * Scudamore on Phthisis. Vol. IL-14. 210 DISEASES OF THE SANGITNOUS FUNCTION. expectoration occurs; profuse night sweats and diarrhoea set in; the body wastes away; the expectoration becomes gradually more purulent and abundant; the body is bent forward; as the tubercles soften, the gurgling or rattle of the matter may be heard either with the naked ear or through the stethoscope ; the cough is cavernous; the respiration and rattle also become cavernous, and pectoriloquism is heard as soon as the softened tuberculous matter is thrown off, and the cavity be- comes empty; the sound on percussion still continues dull, but now and then a peculiar metallic sound is evident. As the disease progresses towards the last stage, and the cavities acquire a large size, the re- spiration, voice and cough give forth the peculiar hollow, metallic sound or buzzing, termed amphoric resonance. The whole body now presents the appearance of extreme emaciation, the face is pale, cadaverous, and frequently tinged with a waxen or lemon hue, the lips and roots of the nails are bluish, the nose pointed, the voice becomes hoarse, the mouth and throat aphthous, the feet oedematous ; occasional delirium at night; and there is a continual failing of the powers of life until death ensues. After the development of tubercles the same symptoms continue, and to them are added evidence of obstruction in certain localities; this condition is manifested by the wavy or jerking respiration, or prolonged expiration; there is less clearness of sound on percussion, showing ob- struction and solidification. The lessened vital capacity (say 100 cubic inches at the earliest moment of recognized tubercle) is far greater than the tubercle yet deposited (in the earliest moment we could re- cognize it) could cause by displacement of air. The alae nasi become slightly dilated; and the mouth takes a peculiar drawn expression, readily recognized. The predisposition to tubercle may exist for years, perhaps even from birth; but in many cases it is of short duration, the disease being originated by many causes in healthy persons. The cir- culation becomes accelerated towards evening, when the eye acquires an unnatural degree of brilliancy; and the constituents of the blood, which in health administer to the support and growth of the body, are converted into a morbid material. Respiratory Sounds.—In the earliest stages they are more feeble than in health, for an uncertain period before flattening of the chest occurs. The respiratory sounds in health are limited to the bronchia and to the air vesicles. The bronchial sounds in health are only heard over the large bronchia; in disease they are heard over their smallest ramifications. The vesicular sounds are heard wherever there are air vesicles in action; they are feeble when the vesicular action is feeble; and they must be in some degree feeble to permit the bronchial sounds to be heard. Lessened vesicular action is evidence of lessened move- ment of the lungs. Lessened chemical and physical change in respira- tion, after the flattening of the chest is added, vesicular respiration PHTHISIS PULMONALIS. 211 bronchial or harsh respiration, with flattening of the chest, all exist be- fore tubercle is deposited. Physical Signs.—Percussion.—Tubercular deposit occasions dimi- nution of normal vesicular resonance, as soon as the disease begins to manifest its existence by other symptoms. The existence of small dis- seminated collections of tubercle is revealed by "simple dullness,slight or moderate in degree, and more or less extensive, at the summit on one side, compared with the resonance on the other side. To deter- mine the fact of slight or moderate relative dullness, percussion is to be practiced on both sides alternately, at corresponding points. Ob- serve the symmetrical conformation of the two sides of the chest. If there be spinal curvature, natural defect of form, remains of preceding pleurisy which disturb the symmetry, the value of percussion is de- stroyed. In well-formed persons in good health, the region of the apex of the left lung, below the clavicle, gives a more sonorous sound, more vesicular and of lower pitch than on the right side. If then we find distinct dullness at this point on the left, it is more significant than it would be on the right side. All physical explorations of the chest require not only a natural good perception of sounds, but also that it be cultivated. A good musical ear will detect a variation in the pitch of the sound which an- other person would not perceive. Diagnosis.—One of the first symptoms which announces the ap- proach of phthisis, is an undue shortness of breath after exercise. If, in addition to this, there are haemoptysis, wandering pains, constriction and tightness at the chest, great sensitiveness of the lungs to cold air, a dry morning cough, a dull sound in the clavicular region on percus- sion, and a partial or total absence of the respiratory murmur, the most serious apprehensions may be entertained. Let all remember, also, that it is only at this early stage of the malady, that our preventive and remedial measures can be brought to bear with any assurance of success, and on this account we shall dwell particularly upon these primary indications, trusting that we may in this way impress upon the minds of all their vital importance. In all of our investigations of diseases of the chest, it is a matter of importance in the first instance, to ascertain whether any hereditary predisposition exists on the part of the patient to tuberculous affections, secondly, whether from occupation, previous habits, excesses, protracted mental anxiety and depression, and frequent exposure, without a sup- ply of wholesome, nutritious food, the patient has not acquired those peculiarities of constitution which render him susceptible to attacks of phthisis; and thirdly, whether the physical development of the chest is such that the lungs can have ample room to exercise their functions. In making up our diagnosis in the early stage of any given case, 212 DISEASES OF THE SANGUINOUS FUNCTION. much will depend upon the presence or absence of these remote causes, for most of the symptoms enumerated may exist in a man with a large and well-formed chest, and with no hereditary or acquired predisposi- tion to the malady, and yet excite no serious apprehensions, while the same symptoms in an individual with a narrow, flat, and ill-shaped .thorax, with a predisposition to the disease, would induce us to form a diagnosis of an entirely different character. Commencing then, with the primitive symptoms of consumption, we shall notice first:— The Respiration.— "Healthy respiration," according to Marshall Hall, " is performed with ease and freedom, and without the aid of the auxiliary muscles, in any of the usual positions of the body. It is ef- fected by a nearly equal elevation of the ribs, and depression of the diaphragm, except in females, in whom the thorax is observed to move more than in men; each side of the thorax moves also in an equal degree, and inspiration and expiration occupy nearly equal spaces of time." Laennec considers the respiration natural "when the anterior and lateral parts of the chest dilate equally, distinctly, yet moderately, during inspiration, and when the number of inspirations in a state of repose is from twelve to fifteen in the minute." Andral puts the mean average of respirations in a healthy adult, at more than sixteen or eighteen in the minute, Magendie at twenty, and some writers even as high as twenty-six. Taking then the mean number of respirations of a healthy adult to be eighteen per minute, and bearing in mind the natural movements of the healthy thorax during inspiration and expiration, we shall be en- abled to form a pretty satisfactory opinion respecting the condition of the respiratory organs, by judicious comparisons of different stages of disease with the supposed natural standard. We are convinced from much observation, that Laennec, Andral and Louis, have laid quite too little stress upon this important indication; for, although individuals may now and then be short-breathed who have no tendency towards diseases of the lungs, yet, when taken in con- junction with a hereditary predisposition, unusual susceptibility of the lungs to cold, slight, dry hacking cough, narrow, or flat chest, or occasional wandering pains in the chest, we may be certain that mis- chief is threatened. A very fleshy person, or one afflicted with disease of the heart, and certain other maladies may be short-breathed after slight exercise ; but these cases can never be mistaken by the observing physician as phthisical, since the history of the case, as well as the general aspect of the patient, sufficiently mark the distinction in all instances. Whenever, therefore, an individual has more than the usual number of respirations during repose, the expirations and inspirations beine % PHTHISIS PULMONALIS. 213 unequal in point of time, and he is put out of breath upon the slightest exercise, it is the duty of the physician to ascertain the cause of this unsound action, and whether consumption is not insidiously approach- ing. Is his chest large, full, and, well developed,—are its movements natural during inspiration and expiration,—is scrofula hereditary in his family,—is he troubled with tightness or pains in the thorax,—is he sub- ject to cough upon the slightest exposure,—is he inclined to stoop when sitting or walking,—is his respiration sighing,—has he a slight morning cough,—finally, is the sound in the clavicular region, or in any other part of the chest, dull on percussion, and is the natural re- spiratory murmur absent at this, or any other point ? Upon the presence or absence of these symptoms will depend our diagnosis. Taken as a whole, they indicate clearly the existence of phthisis pulmonalis ; and where there is a family tendency to phthisis, even dull sound on per- cussion, and absence of the respiratory murmurs, with dyspnoea after ascending the stairs, or other moderate exercise, will warrant the opinion that tubercles exist in the lungs. If, furthermore, one or more of the other signs enumerated obtain, our opinion must be still more decided and unfavorable. Auscultation.—The more important diagnostic criteria are the modified respiratory sounds. If the respiratory sounds are free from any abnormal modification tuberculous deposit can hardly exist. When small, disseminated tuberculous deposits exist they produce the modi- fied respiratory sounds designated as broncho-vesicular respiration. It embraces all the elements of bronchial respiration, except that the inspiratory sound is not wholly tubular, but presents the tubular and vesicular qualities combined, called by some authors " rude, by others harsh and dry respiration. If all the characters of the broncho-vesi- cular respiration are present, we shall have an inspiratory sound, neither purely tubular nor vesicular in quality, but a mixture of both (broncho- vesicular), the duration somewhat shortened (unfinished), the pitch raised; a brief interval, followed by an expiratory sound, prolonged, frequently longer and more intense than the inspiration, and higher in pitch. In making all explorations, auscultation as well as percussion is to be practiced at the summit of the chest on both sides, and the phenomena carefully compared. Broncho-vesicular respiration, in conjunction with other signs and with symptoms, is diagnostic of a tuberculous deposit not producing complete solidification, extending over a considerable space, at or near the apex of the lung. A skillful auscultator will nearly always be able to detect this condition when it exists. It must be remembered that on the right side in front at the summit the inspiratory sound is fre- quently less intense, less vesicular, and higher in pitch, than on the left side, and that a prolonged expiration on the right side, occasion- 214 DISEASES OF THE 8ANGUINOUS FUNCTION. ally more intense and higher in pitch than the inspiratory sound, and sometimes existing alone, is observed in healthy persons. Thus the broncho-vesicular respiration indicates, more clearly, tubercular deposit, if heard at the apex of the left than at that part of the right lung. Broncho-vesicular respiration continues limited to one side of the chest, even when tubercles exist in both, until the deposit of tuber- culous matter becomes abundant; it is observed that the " pitch and vesicular quality of the inspiration, the relative intensity, duration and pitch of the expiration" are nearly or quite normal in the lung least affected. This is accounted for by supposing that " when the Increased density at the summit of one lung is sufficient to occasion a distinct modification of the respiratory sound, the activity of the other lung is sufficiently increased for the normal character to be maintained, notwithstanding the presence of a certain number of tubercles, without giving rise necessarily to a well-marked exaggerated respiration, " though this does occur in, comparatively," few cases. Dr. Flint gives the following " Summary of the Physical Signs belonging to Pulmonary Tuberculosis : "Diminished vesicular resonance on percussion at the summit of the chest, varying in degree from slight dullness to a near approach to flatness ; present on one or on both sides, but in the latter case more marked on one side; the dullness, in general, proportionate to the abundance of the tuberculous deposit; increased sonorousness oc- casionally observed at the summit of the left side, due to transmitted gastric resonance, the sound tympanitic in quality and high in pitch; the vesicular frequently replaced by a tympanitic sound on either side, when the sonorousness is not increased, constituting tympanitic dull- ness. " An increased sense of resistance in proportion to the amount of crude tubercle. A tympanitic resonance over a circumscribed space at the summit, present and absent at different examinations, in some cases presenting an amphoric and the cracked-metal intonation, con- stituting the evidence afforded by percussion of the existence and situation of tuberculous excavations. " On ausculation, the broncho-vesicular and the bronchial respiration, the latter denoting tuberculous solidification. Frequently, with these modifications, diminished intensity of the respiratory sounds; oc- casionally suppression of all respiratory sound; interrupted; or jerkin" respiration. Exaggerated vesicular murmur on the side, either healthy or least affected; the crepitant, sub-crepitant, sibilant, or sonorous, mucous, and crackling, or crumpling rales, occurring as contingent signs, their significance dependent on their being found within a cir- cumscribed area at the summit of the chest; abnormal transmission of PHTHISIS PULMONALIS. 215 the heart-sounds, especially at the right summit; increased vocal resonance when situated on the left side at the summit; an acute and more or less intense souffle, or bellow's sound, accompanying whis- pered words, especially if present on the left side ; broncophony, and occasionally transmission of speech, complete or incomplete, over- tuberculous solidification, a friction sound, limited to the summit of the chest "The cavernous respiration, occasionally observed, alternating with suppression or gurgling, occasionally amphoric, and very infrequently, pectoriloquy, constituting the evidence, afforded by auscultating the respiration, of the existence of and situation of the excavations; the characters of the cavernous and bronchial modifications of the re- spiration, sometimes combined (broncho-cavernous respiration); splash- ing, an impulse, seen and felt, existing within a circumscribed space at the summit—signs of cavities furnished by the act of coughing ; occasionally, when the cavity is very large, metallic tinkling. " By inspection, flattening, or depression, at the summit, either con- fined to one side, or more marked on one side than on the other; the clavicle generally more prominent, but occasionally receding with the ribs ; diminished expansibility with the act of inspiration; the range of motion found to be lessened, as well as size of the chest at the sum- mit, by mensuration. "Disparity at the summit of the chest in vocal fremitus, provided it be found to be greater on the left side. A splashing succussion-sound in some cases a very large exca- vation."—(Diseases of the Respiratory Organs, p. 501.) Dr. Mac Limont claims that simultaneous percussion and auscul- tation can be employed with great benefit, and that the double stetho- scope of Dr. Cammann (which permits the auscultator to face the patient) removes all the obstacles to the combined use of these two means of investigation at the same time. " The advantage of this is very great, the sound elicited by percussion is thus intensified to an extraordinary decree, and conveyed to both ears with a distinctness very different from the vibrations that reach the auditory nerve in the usual way, i. e. through the medium of the atmosphere." " By this method, far better than any other, we may discover that earliest indication of or- ganic lesion in phthisis, a certain obscurity of sound arising from a condensed pulmonary parenchyma; but no less satisfactory is it as a means of establishing a differential diagnosis in those cases in which we are sometimes at a loss to distinguish whether the dull sound is due to effusion or to induration of the pulmonary tissue; as also in cases of cavities, in which it may be desirable to ascertain whether they contain air or liquids, or both : if air only, then auscultatory percussion yields a far clearer sound than can possibly be got by the ordinary 216 DISEASES OF THE SANGUINOUS FUNCTION. method; but if, as is most commonly the case in large cavities, air and fluids co-exist, then by this means the hydro-aeric sound may be heard very distinctly; while for recognizing that valuable evidence of a pul- monary vomica, the " bruit de post feU," there is no means so accurate as the one I am now recommending. As a mode too of ascertaining the exact size and form of some of the internal organs, the liver, kidneys, heart, spleen, ovarian cyst, fibrous tumors of the uterus, &c, auscultatory percussion promises to be of signal service."* " When the object is to ascertain the size or condition of an organ far removed from the surface, and where the impulse has to be communicated through an external covering of some thickness—as in percussing the abdominal organs," then the solid cylinder of cedar, as used by Dr. Cammann, or the pleximetre, should be preferred to the double stethoscope. Progress of Phthisis in its later Stages.—When the disease has advanced to the stage in which the febrile exacerbations, and the rapid respirations, the profuse night-sweats, the mucous expectoration and exhausting diarrhoea show the inevitable termination of the patient's sufferings not far distant; he knows himself to be failing from week to week; but still he daily describes his condition as being " better." In females menstruation has already ceased and emaciation progresses. " As the tubercles soften, the gurgling or rattle of the matter found may be heard with or without the stethoscope. The cough is caver- nous ; the respiration and rattle also become cavernous; pectoriloquism is heard as soon as the softened tuberculous matter is thrown off, and the cavity becomes empty: the sound on percussion still continues dull; but now and then a peculiar metallic sound is evident. As the disease advances towards the last stage, and the cavities acquire a large size, the respiration, voice and cough give forth the peculiar hollow metallic sound or buzzing termed amphoric resonance. The whole body now presents the appearance of extreme emaciation ; the face is pale, cadaverous, and frequently tinged with a waxen or lemon hue; the lips and roots of the nails are bluish, the nose pointed, the voice becomes hoarse, the mouth and throat aphthous; the feet oede- matous ; there is occasional delirium at night; and continual failing of the powers of life until death ensues. M. Beau, of La Charite, mentions in addition to the premonitory headache, a more reliable symptom, which he says is very constantly found: a peculiar " pain felt on pressure in the popliteal region, or on the thigh a little above the knee." Second Stage.—Signs of the existence of Tubercle.—Obstructed breathing; wavy or jerking inspiration, and prolonged expiration, in- * British Journal of Homceop. July, 1864, p. 432 PHTHISIS PULMONALIS. 217 creasing locally as the accumulation increases. The obstruction re- quired to produce these signs must be partial and lateral, as opposed to complete and terminal: that is, it must occur in the course of the airway and leave a portion of the conduit open, so that the air may be forced beyond it. After an uncertain period there will be further moist sounds, indica- tive of air passing through fluid which is then softened tubercle. The softening of the tubercle is not a corroding process like that of ulce- ration, but is simply the imbibition by endesmosis of fluid by which the tubercular mass softens; it obtains the fluid by which it is softened from the walls of its cell. The process may be non-inflammatory; but exode of pus corpuscles always occurs at some period, and that is presumed to be the result of inflammatory action. The reason for the destruction of the tissue is not simply the softening of the tubercle, nor any in- flammatory or ulcerative action; but the basement membrane and ca- pillaries, having ceased to act for a time, lose their vitality, and are ready to decay, and they only wait for a partial emptying of their con- tents in order to break down. Destruction of the tissue is indicated by moist, fine, crepitant rales in the tubercular mass. The softening of the tubercle and the destruction of the cell-walls having begun, it only re- mains that those processes shall go on until all the tubercles have been eliminated, and a cavity results; and the whole are but steps to one process, and in truth are one stage of the disease. With softening, the bronchia are reopened, and the air is admitted which produces the moist sounds, and ultimately all the signs which are indicative of a cavity; but, with the restoration of respiration, there is no increase of respiratory changes, since the air-cells in that part are destroyed, or perhaps removed. With the formation of a cavity the lung falls in, as do also the parts of the chest immediately covering it, and the dull sound on percussion will in part have disappeared. Thus the essential signs of the three stages of consumption are :* 1. Lessened action; — 2. Obstructed action; — 3. Destroyed lung. In proportion as structural disorganization progresses in the disease there is reaction or compensatory effort set up by nature, by which one part of the lung is made to do a double share of duty when another part becomes incapable of performing its function; and the entire system quietly accommodates itself to the newly-induced condition. Conditions of the Throat in Phthisis.—1. There is a state of pallor without injection of the vessels and without desquamation or inflamma- tory action. It is common in the early stages, particularly in persons engaged in public speaking, and is shown by dryness and disposition to cough ; sensation generally referred to the fauces, pharynx and upper * Smith, Braithwaite's Retrospect, July, 1857, p. 67, &c. 218 DISEASES OF THE SANGUINOUS FUNCTION. part of the larynx alone. It is most annoying in the early morning, and on changes of temperature demanding frequent efforts to " clear the throat, causing hoarseness, rawness." The surface does not always appear dry, but it is smooth and shining, and the parts are attenuated. The anterior arch is atrophied, whilst the posterior stands out in sharp relief and the intervening space is large and excavated from the ab- sorption of fat from the areolar tissue, and oftentimes from diminution in the size of the tonsilar glands. The latter organs seem to be of a looser texture, and to have their superficial follicles projecting. This condition is one of lessened tonicity with increased sensibility, and with a diminution in the secreting function of the epithelium and mucous follicles. It may or may not be associated with derangement in the excretory organs, and is amenable temporarily to local treatment, as well as to the influence of constitutional remedies. In this stage, the lungs are not positively diseased and the study of the rational signs is attended with difficulty. • Second Condition.—Pallor of various parts of the fauces, injection of defined vessels in some parts with more or less diffusion in others, and at each the parts appear to be loose and relaxed. The distended vessels are most evident in the uvula, and the diffused redness on and between the arches and upon the tonsils. Enlarged mucous follicles are very marked in many instances, chiefly in the pharynx, uvula and arches, as colored vegetations. Ulceration of some of the follicles of the tonsil, and chiefly at its upper part, the uvula is enlarged and elon- gated. In this condition there is less sensation of dryness and irritability of fauces than the last; but there is a troublesome sense of constriction or irritability at the lowest part of the trachea in the neck. There is a sensation of phlegm adhering to parts about the fauces which keeps up cough to detach it: There is disordered action of the alimentary canal or the liver. Third Condition.—Desquamation, Fibrinous Deposition, or Ul- ceration.*—The desquamation occurs in patches, with, or without fibri- nous exudation, and chiefly in the pharynx or arches of the fauces. The fibrinous exudation lies as a layer upon the denuded mucous sur- face and may be partially removed by a brush; the parts are of a reddish and dull hue, and hoarseness progressively increased in inten- sity. Most complaint of the throat after, not during a meal. The tonsils are enlarged and red, the fauces laterally contracted; there is soreness on pressure on the sides of the pomum Adami. State of the Alimentary Canal in Phthisis.—There is an excess of acidity which more than neutralizes the alkaline secretions of the * Dr. Smith, Braithwaite, July, 1857, p. 68. PHTHISIS PULMONALIS. 219 saliva and pancreatic juice. These fluids are therefore incapable of "transforming the carbonaceous constituents of vegetable food into oil, or of so preparing fatty matter introduced into the system as will render them easily assimilable. In consequence, more albuminous than fatty matters enter the blood, and the accessary waste of structure is sup- plied by the absorption of the adipose tissue of the body,—hence the emaciation Avhich characterizes the disease.* " The body is not nour- ished," says Dr. Paris. " The patient having, lived as long as one particle of fat remains that could be absorbed for his support, dies of atrophy." " In the meanwhile the lungs, not having so much carbon to excrete in the form of carbonic-acid, become especially liable to local congestions, leading to exudations of an albuminous kind which is tubercle."* Pulmonary Symptoms.—As emaciation progresses and strength declines, cough makes its appearance; with increased breathlessness haemoptysis occurs; pains in the chest; nocturnal perspirations ; dys- peptic symptoms become more troublesome; percussion denotes con- solidation of some portions of the lung, in a vast majority of cases at the apex; auscultation now proves that at this part air is but feebly and with difficulty permeating its structure. During the second stage, the stethoscope gives evidence of the softening of the tubercular masses; during the third and last, the presence of a cavity is, by the same means, rendered manifest. The general symptoms are those of the first stage, only in much greater intensity. The cough becomes attended with expectoration, varying alike in its quality and degree. As the dis- ease advances the pulse rises, emaciation becomes extreme, and all the symptoms point to a rapidly fatal termination. (Dr. Pope, Brit. Journ. Horn., Jan. 1862, p. 19.) Urinary Secretion.—The urine in phthisis and in all lesions of the nervous centres is deficient in urea. There is therefore an equivalent excess of this constituent in the blood, as in Bright's disease. (Rey- noso) Functions of the Skin.—These become impaired, and the skin becomes pale as well as moist and clammy, while the inability to take a proper amount of active exercise has a tendency to produce engorgement of most of the internal viscera, and consequent disturbance of their func- tions ; while the non-elaboration of healthy blood produces badly assi- milated chyle, " which is supposed to favor the formation of tubercle, which is deposited in the lungs or other organs. When the lungs pre- sent the point of attraction and become the probable seat for tubercu- lous deposition, the patient begins to be specially subject to colds, ca- tarrhal attacks, after the least exposure. In these catarrhal affections originate that obstinate bronchitis which so generally precedes or accompanies phthisis." * Bennet.—Gelston. 220 DISEASES OF THE SANGUINOUS FUNCTION. Incompatible Diseases.—M. Beau, of La Charite, in a recent lecture speaks of the rare occurrence of phthisis in hysterical subjects. The same immunity from phthisis has been observed in persons suffering from asthma and emphysema of the lungs. This immunity is not universal. Tubercle causes increased density in the lung in which it is.deposit- ed. The first deposits, called miliary tubercles, are in the form of small isolated patches separated from each other by intervening parenchyma in a healthy state. The density of these morbid patches may be but slight; but the obstruction of the air from their pressure on the small bronchial tubes, abridging the respiratory processes on the parts af- fected, causing collapse of the cells not filled with tuberculous matter, increases still further the density. When the deposits enlarge, by con- stant accretion they form more solid continuous masses called tuber- culous solidifications. When the tubercular accretions are small and the intervening parenchyma becomes solidified by inflammatory exuda- tion, the physical signs are the same, showing solidification; and the crepitant rale will prove pneumonitis, which under the attendant circum- stances will be evidence of tubercle. In the progress of softening, ulceration and evacuation of the liquefied tuberculous matter is liable to be attended with symptoms of the deposition of fresh material in the surrounding parenchyma, which gives signs of solidification while crude tubercle is being deposited throughout the whole lung; the physical signs then vary as the excavations become larger in propor- tion to the solidified part. Circumscribed bronchitis may be taken as evidence of tuberculosis; and the presence of fluid in the tubes, produced either by bronchitis, or derived from cavities in connection with the bronchia furnishes im- portant indications. The lung as it solidifies by deposition of tubercle becomes less and less expansible: and the succession of attacks of circumscribed dry pleuritis over the points of the lung occupied by tubercle contribute to the establishment of the fact that tuberculosis is positively advancing. Pathology.—The primary nature of phthisis is not understood, and widely different views of its pathology have been given by different authors. A late writer, Dr. Cotton, says: " It is a peculiar and ob- scure condition of the whole system, in which, instead of the healthy nutritive material required for the growth and reparation of the body, there is produced in the blood a morbid substance which sooner or later appears as tubercle, or tuberculous matter in the pulmonarv structures." This state of the system he regards as identical with that known as struma or scrofula: "In consumption, as in many other maladies, we are permitted to recognize the disease only in its effects. It is evident that there must be something which constitutes the malady: but it would be vain to PHTHISIS PULMONALIS. 221 search after it; it has no individuality; — it is a process which, like many others, is so subtile and far removed, even from our conceptions, that it seems destined to remain forever beyond our reach; we are al- lowed to do nothing more than study its laws, and, in some measure control its actions " (p. 2 and 3). We regard consumption, with a vast number of chronic diseases as a product of some latent dycrasia, which, through generalized by Hahnemann under the generic name " psora,'' may present peculiarities in individual cases; but they can only be cured by constitutional remedies. Dr. Epps defines phthisis to be a disease depending upon a cachexia differing in different cases, each case of phthisis having a " special cachexia," of its own. Dr. Hogg considers it as depending on "constitu- tional debility, on a want of power in the system, on an impaired state of the digestive" organs—in a word, "on a strumous diathesis." (p. 8.) Dr. Bennett considers phthisis to consist of " a mal-nutrition arising from imperfect assimilation." Dr. Turnbull says he believes the con- dition which causes the development of tubercles to depend on " a state of imperfect nutrition; a condition in which the digestive organs are unable to manufacture from the food a perfect kind of blood, capable of nourishing every part, without allowing some imperfectly-formed par- ticles to escape at the time."* This author elsewhere gives the opinion that "imperfect digestion, combined with deficient oxydation or a want of uniformity in the action of the oxygen on the blood, and through this fluid in the whole system, is the main cause.f Dr. Pope thus con- cludes : " Mal-nutrition of the tissues is undoubtedly one of its earliest features as it is one of its most fatal characteristics; but in order to the development of tubercle, the imperfect digestion producing it must occur while the constitution is under the influence of a cachexia peculiar in its nature, tending under certain circumstances to the production of tubercle. Dyspepsia, however severe and intractable, does not necessa- rily culminate in phthisis. (Brit. Jo urn. Horn. No. LXXIX., p. 18.) Dr. Gregg, of Canandaigua, K. Y., regards the tuberculous deposit as " simply the result of a perverted secretion of the mucous mem- branes; and says this is equally true, whether such perversion has originated in the individual who is suffering, or whether he has inherit- ed the predisposition or taint from his ancestry." He thinks his ex- perience proves "that the great natural law discovered by Hahnemann, when "properly applied, is amply competent not only to stay and cure the disease in cases where it has not yet extensively broken down the structure of the lungs, but also, so to eradicate the tuberculous tendency as to cut off all transmission of this tendency by inheritance.'1 * An Inquiry how far Consumption is curable. t Progress of Improvement in the Treatment of Consumption. By James Turn- bull, London, 1853. 222 DISEASES OF THE SANGUINOUS FUNCTION. Development of Tubercle.—Tubercle, the proximate cause of phthi- sis, says Dr. Mac Limont* is " a material formed and deposited from the blood, and the condition of this fluid most conducive to its pro- duction consists in an excess of fibrin and a diminution of the red globules." But every.person in this condition is not in a state of in- cubative tuberculosis; for "in addition to all this and much more, there is required for the production and deposit of tubercle, a remote cause —a diathesis—hereditary and not acquired "—the deposit of tubercle is the result of depraved innervation, and that the main chance of benefitting the patient consists in the early discovery of the symp- toms," and bringing to bear upon them all the curative influences within our power. The appearance of the tuberculous formations vary in different sub- jects, some being small as millet-seeds and irregular in shape, either distinct, or running into each other, of the consistence of cheese, and of a light yellowish color. This variety, which is by far the most com- mon, has been termed the miliary tubercle. Another variety is called the granular tubercle, which according to Laennec, is only the ordinary tubercle in its first stage. Bayle believed the miliary granulations to be distinct from tubercles, while Mackin- tosh supposed them to be genuine tubercles, but sui generis. Bayle, Laennec, and others, also assert that they have met with a few cases which they term encysted tubercle. Other writers speak of the occasional occurrence of this variety of tubercle, it being semi-trans- parent, whitish, and in consistence like hard cheese. Laennec describes, likewise three kinds of tuberculous infiltration, viz : the irregular, the gray, and the yellow. This infiltration is gene- rally formed around tuberculous excavations, but it may exist where there are no tubercles. It is something found in large masses," oc- cupying the whole lobe of the lung, and having no connection with the miliary tubercle." (Mackintosh.) Respecting the nature of these tuberculous formations, there is a wide difference of opinion. Broussais supposed that " irritation, or inflammation, were only degrees of the same affection, and that they may produce, indifferently, tubercles, encephaloid cancer, melanosis, fibrous, bony, cartilaginous growths, &c." Laennec and Andral maintain that they are liaccidental productions, foreign to the natural organization of the lungs," and caused by an aberration in the nutrition of the organ. Others are of opinion that tubercles are primitively hydatids. In the first stage of development tuberculous matter is "a gray, * Brit. Journ. Homceop., No. 77, p. 429. PHTHISIS PULMONALIS. 223 semi-transparent substance, which gradually becomes yellow, opaque, and very dense. Afterwards it softens, and gradually acquires a fluidity nearly equal to that of pus ; it being then expelled through the bronchia, cavities are left, vulgarly known by the name of ulcers of the lungs, but which I shall designate tubercular excavations? (Laennec) The exposition of the origin and development of the matter of tubercle given by Dr. Curtis* has at least the merit of clearness and plausibi- lity. He traces "the first link in the chain of morbid action," not to the blood nor result of inflammation but to " the ultimate cell struc- ture." " Here, in the ultimate cells the first perverted action is found —a molecular and cell growth, whose function and development is ab- normal and degenerative, and which has a power of producing in other tissues, the same morbid peculiarities that characterize itself. But whence originated the mother cell of this perverted mass? It could not have sprung from the blood, because the blood has no direct forma- tive power—neither could it have had a spontaneous development; it must have been derived from a once normal cell; but, in order for such a derivation, the normal cell must have undergone a transforma- tion so as to become abnormal. And we can account for it in no other way than by regarding it as originating in some peculiar revolution that has taken place in the parent cell, by which its function has been perverted and its physical and vital tendencies changed. Such a re- volution could not have been produced excepting through a disturbance of the just equilibrium existing between the vital and chemical forces acting within it, and by which its functional and reproductive revolu- tions are governed. This change in the character and products of a once normal cell having taken place, other cells resembling it in every particular, the offspring of the first, would necessarily be produced in a very short time, on the principle that' like produces like.' And in accordance with the law of molecular motion, these abnormal cells would have the power of imparting their own motion to other cells with which they might be in contact. Thus we can readily perceive how this morbid action may readily extend and increase locally. And by the unnatural and depraved products of perverted function being ab- sorbed into the circulation, ' the life of his blood is touched corruptibly,' and the morbid material becomes diffused through all the tissues of the body, and thereby sooner or later eventuates in death." Bearing upon this point, and in opposition to the doctrine of " free cell development," Prof. Virchow says: " Even in pathology, we can now go so far as to establish, as a general principle, that no develop- ment of any kind begins de novo, and, consequently as to reject the theory of equivocal, (spontaneous) generation just as much in the his- * St. Louis Medical and Surg. Journal, Sept. 1861. 224 DISEASES OF THE SANGUINOUS FUNCTION. tory of the development of individual parts as we do in that of en- tire organisms. Just as little as we can now admit that a taenia can arise out of saburral mucus, or that out of the residue of the decom- position of animal or vegetable matter an infusorial animalcule, a fun- gus or an alga, can be formed; equally little are we disposed to con- cede, either in physiological or pathological histology, that a new cell can build itself up out of any non-cellular substance. Where a cell arises, there a cell must have previously existed (omnis cellula e cellula,) just as an animal can spring only from an animal—a plant only from a plant" Anatomical Character of Tubercle.— Rokitansky showed that tubercles originally occur in the lungs in two forms : 1. "The in- terstitial tubercular granulation, round grayish bodies found discrete or collected into heaps: their seat is the interstitial tissue between the smaller lobuli and the cells of the lungs and on the walls of the cells themselves. This is the most common form of deposition.—2. Tuber- culous infiltration. This consists in a deposition in the pulmonary cells, as a result of the process identical with common pneumonia, ex- cept that the lymph deposited in the cells, instead of being resolved or running into pus, becomes, from the influence of tubercular diathesis, the yellow tuberculous matter, thus constituting hepatization by means of a tuberculous deposit This form is always the result of a high degree of the peculiar tubercular diathesis." (Dr. Gelston, Brit. Med. Jour. Oct. 1860, p. 603.) Microscopical Structure.—Tubercular matter "consists of corpus- cles which are characteristic of tubercle, " and of granules and mi- nute molecules. The corpuscles have no nuclei, and are considered to be undeveloped cells, which approach more or less nearly to the exudation or plastic cells of healthy inflammatory deposits. The miliary tubercle has some appearance of cells and fibres, but the crude yellow tubercle has no appearance of organization, and during soften- ing the corpuscles swell, burst and discharge granules." Chemical Character of Tubercle.—"The formula of tubercle ac- cording to Simon, is : C 43 II 35 N6. 014, Caseine: Prot 10 S. 1."* The organic component parts of tubercle, as given by Vogel, Cerutti and others, are: caseine, with some fat and a little albumen. Others have found albumen, gelatine, and fibrine, cholesterine, &c., showing that the composition is not always precisely the same. It is supposed by Fletcher and others to be " an organized mass." " Tubercle," according to Simon, Anel and Rokitansky, consists in a misdevelopment of the protein ingredients of the lymph and blood the essence of which lies in the solidification of something which *Dr. Gelston. Brit. Jour. Homoeopathy. Oct. 1, 1860, pp. 598, 599. PHTHISIS PULMONALIS. 225 should remain fluid: this is due to the proteine ingredient precipitated in combination with oxygen. Hence most likely to take place in the glands where lymph is brought into combination with arterial blood, and in the lungs where it meets with the oxygen of the air, it may arrive any where when chemical reaction occurs with a nutritive blastema. In accordance with this, all the great leaders of modern pathology agree on the formula that' venosity of the blood excludes tubercle."* It also explains the beneficial effects of dietetic measures, cod-liver oil, spirituous liquids, and the " carbonaceous atmosphere of swamps in arresting or retarding tubercular development." Tuberculous blood is " defective in vital qualities ; the red globules are deficient in number and defective in structure; the globulin, haemetin, and iron are all deficient. The serum of the blood is vitiated in quality: the water, albumen and lime in excess." The albumen may be defective in a tendency to be converted into casein, which does not exist in the blood in its native state. The fibrine is deficient in quantity and imperfect in quality; also the fats, alkaline and earthy salts, especially the chlorides and phosphites of potassa and soda. The quantity of albumen in proportion to other ingredients in the blood has been remarked to be more nearly uniform than that of any other prin- ciple, being about 70 or 80 parts in 1000. " It would seem," says Gairdner, " as if nature had found it necessary to have at hand some- thing like an unvarying stock of the raw material out of which all the other principles of the blood might be fashioned, according to the va- rying states and requirements of the organism. One particularly interesting point in connection with this view is found in the fact that, relatively, the albumen and the blood globules appear to alternate with one another in their several proportions—"if the globules fall off in amount, the albumen is increased; and vice versa, when the globules abound, the albumen is diminished." Causes of Phthisis.—The causes of consumption may be divided into: first, the constitutional; second, the accidental; third, the exciting. 1. Under the first head may be included, first hereditary scrofulous taint; second, hereditary impurities of the blood of a syphilitic, erysipelatous or psoric character; third, imperfect organization of the thorax, feeble constitution; and fourth, a melancholic nervous tem- perament. The principal causes which induce consumption, are: hereditary transmission from parents who have themselves inherited the disease, or who, originated it in their offspring by becoming enfeebled. 2. The most prominent accidental causes, are, confinement in close * N. Am. Jour Homoeop. May, 1857. vol. II.—15- 226 DISEASES OF THE SANGUINOUS FUNCTION. crowded, and ill-ventilated apartments, protracted mental depression, insufficient nourishment, unwholesome food, intemperance, damp and unprotected habitations, masturbation, the habit of stooping, and thus contracting the capacity of the chest, light clothing, late hours, over-excitement, abuse of drugs, especially mercury and opium, want of exercise and abuse of tobacco, neglect of proper clothing and cleanliness; excessive labor;" mental depression, anxiety and care, which exhaust the nervous force; too early marriage or excessive sexual indulgence, which lays the foundation of premature decay in parents, and scrofula in children. Fonteret* says : " If the exhaustion consequent on debauchery is not always a cause of sudden death, it is infallibly attended with the loss of strength necessary to labor, and develops a peculiar aptitude to certain diseases. How many affections of the spinal cord, how many forms of paralysis, of disease of the chest, cancers of the cervix uteri, &c, arise from vicious indulgence ?" The children born under " concubinage are few in number," are " puny, scrofulous, and are liable to a mortality greater by one-half than legitimate children." A large proportion of the cases of con- sumption . seen among young men arise from the vice of masturbation. A higher and purer physical and spiritual education than boys or young men now anywhere receive is one of the most imperious demands of this progressive age. 3. Exciting Causes.—Those which determine the local deposition of tuberculous matter after constitutional predisposition is established are \ confinement in early life to close, crowded, ill-ventilated resi- dences, factories, work-shops, or school-rooms ; deficient or improper diet; irregularities of various kinds; over-taxing the mental and physical powers of children in schools. Experiments on rabbits prove that insufficient nourishment, damp air and the exclusion of light favor the development of tubercular deposits. Certain kinds of food favor the development of scrofula, of these pork is the worst that is in general use. Leavened bread, whether made light by yeast or any other process, which requires the dough to stand and sour before baking, aids in developing scrofula, dyspepsia and a long train of nervous diseases. 4. The exciting causes are : atmospheric vicissitudes suppression of the perspiration by cold, imperfectly subdued acute diseases of the pulmonary organs, repelled cutaneous eruptions, inhalation of irritating vapors, &c, external injuries. Of these proximate causes, cold is considered by most authors as by far the most common and dangerous. * Consumption, its Nature, Prevention and Homoeopathic Treatment. By Wm. Hitchman, M.D., F.L.S. Phila. 1859. Hygiene physique et morale, &c, of Workmen in Large Towns, &c. By A. L. Fonteret. PHTHISIS PULMONALIS. 227 It is probable, however, that cold of itself is by no means so injurious as has been generally supposed, but that the sudden alternations from heat to cold which obtain in the temperate latitudes, exert far more in- fluence in engendering phthisis, than the severe but steady cold of more northern regions. Indeed, some recent writers have strongly re- commended a change from temporate to cold latitudes, as far more advantageous to consumptive subjects than a warm climate. In this opinion we do not coincide, since the highly condensed air of the for- mer must act as a constant and powerful stimulus to the already irri- table tubercles. We much prefer a warm, mild, and equable climate in these cases. Phthisis is promoted among females by the erroneous education and habits of life of the women of the civilized countries. Born and reared during infancy in hot-houses, where the invigorating breath of heaven rarely penetrates ; their childish intellects crammed with ideas which they are unable to understand, while their physical frames are per- mitted to wither in the crowded school-room, without that free and abundant exercise and indulgence in childish sports, which are so ab- solutely essential to their growth and well-being; submitted at the period of puberty to those instruments of torture and distortion, stays, in order that the symmetrical figures which God in his wisdom has given them, may be contracted sufficiently to meet the ideas of an abominable fashion ; rejecting constant and vigorous exercise in the open air, early hours, regular habits, and all those means which tend to promote physical strength and vigor: is it strange, in view of these things, that the seeds of phthisis are so often and so early planted? There are habits also prevalent among the youth of the male sex, which conduce in an alarming degree to generate and develop physical af- fections. The vice to which we allude, from false delicacy, from its solitary nature, and from the very gradual manner in which it impairs the nervous system and undermines the constitution, has either been entirely overlooked, or but slightly touched upon by writers. But un- less we are much deceived, a very large number of consumptive cases, especially in young men, are attributable to masturbation as their re- mote cause ; and we are sure that those who have minutely investigated the previous histories of consumptive patients, will fully coincide with us. It is quite true that there are many other habits and customs which pertain to refined society that also have their effect in engendering phthisis, but we believe that the cause just touched upon has been productive of more evil amongst the youth of the male sex than any other causes combined. This cause applies to some slight extent to females, but, compared with the male sex, it is trivial and unimpor- 228 DISEASES OF THE SANGUINOUS FUNCTION. tant, for the reason that women are by nature purer, less sensual and less addicted to gross carnal thoughts, than a majority of the other sex. Let parents, then, banish all mawkish delicacy upon the subject, and caution their children against this dreadful evil. Let them talk plainly, and display before their minds the inevitable consequences, in the form of consumption, idiocy, lumbar abscess, &c, to which an indulgence in this degrading and pernicious vice so surely leads. Physical Conformation of the Thorax.—One of the causes which especially favors the formation and development of tubercles, is a small, flat, and contracted chest. This want of symmetry and pro- portion may be owing to natural organization, or it may be acquired from indulgence in sedentary habits, stooping, a neglect to keep the body in the erect posture, and to breathe in that full, free, and vigorous manner which is so essential to the development and well-being of the lungs. If the thorax is naturally contracted and ill-shaped, a suitable course of physical culture should be promptly adopted and persisted in until it has acquired sufficient size and symmetry. This result is practicable in all cases by steady perseverance and energy on the part of the patient. The means of accomplishing this-desirable end, are, gymnastic and other exercises, which particularly bring into action the muscles of the chest, constant exercise with the body erect, in the open air, the habit of taking long, free and full inspirations, in order that all portions of the lungs may receive a due proportion of air, and thus execute their functions properly, and lastly, the use of tubes for the purpose of exer- cising more efficiently the pulmonary organs. By a regular and syste- matic employment of these means, the size of the chest may be in- creased to a surprising extent, and the lungs made to acquire a degree of strength and vigor which could have been attained by no other method. There are other instances where well-formed chests are contracted and weakened, by the wearing of tight clothing, stays, &c, and by sedentary occupations and habits, with the body constantly inclined forward and bent over. These pernicious habits are so commonly in- dulged in, and have become so much a part of our social system that their importance influences,—their baneful consequences upon the most vital part of the organism, are almost entirely overlooked. Yet no one who reasons at all can be unaware of the dangerous and undermining effects of these things; and to those whose pride, or indolence or im- becility, still prompts them to persist in such habits, we would say, and without much sympathy for their sufferings, " you have sown the wind and you shall reap the whirlwind." Hereditary and acquired Predisposition to Phthsis.__An PHTHISIS PULMONALIS. 229 alarming circumstance connected with the history of any individual, even when no symptoms point to an approaching consumption, is here- ditary predisposition to tuberculous disease of the lungs. To know that the seeds of a dreadful malady are implanted in the system, liable at any moment to be roused into activity by the numerous exciting causes which prevail, is enough, one would naturally suppose, to call forth all the energies of the individual in order that he may escape the threatened evil;—yet how few under such circumstances use proper means of prevention, and exercise that care and attention towards themselves which these cases require! But the root of the evil must be traced further back to those inju- dicious marriage connections, where one or both of the parties are la- boring under a scrofulous taint. It appears singular that intelligent persons of this description should be willing to enter the matrimonial state when they are so certain of entailing upon their offspring disease, misery, and an early death; yet how often do we see the desire for temporary self-gratification, for riches, display, or pride, outweigh the potent reason named, and induce the unfortunate victim of the malady, to herself and her children into almost certain future suffering! A predisposition to phthisical affections is often acquired by con- stant exposure in small, damp, and ill-ventilated habitations, insufficient clothing, scanty and unwholesome food, free use of pork, incessant oc- cupation in close rooms and constrained positions, masturbation, pro- tracted depression of spirits, and certain occupations, as those of the stone-cutter, scythe-grinder, &c. All of these causes exert a powerful influence in bringing the system into that condition which renders it peculiarly susceptible to tuber- culous formations in the lungs, and for this reason should be avoided as much as possible by individuals, and should receive the attention of all benevolent men. Contagion.—Dr. R. Rogerson.* Phthisis is certainly not infectious through the atmosphere as small-pox or scarlet fever, but when the strong and vigorous come in contact wTith the phthisical breath, it must have some effect in giving rise to the disease. Sleeping in the same bed, breathing the same polluted atmosphere in the same bed-closet, and inhaling the very breath which the diseased lung is giving off, in fact the effluvia from the diseased lung coming in actual contact during inspiration with the healthy lung: and such a state of matters existing for weeks and months, must undoubtedly prove injurious and detri- mental, and may be expected to leave some traces behind. The tuber- cular emanations coming in contact with the blood through the medium of the lungs, alter the chemical composition of the blood, and thus pre- * British Journal of Homceop. Oct. I860, p. 689. / 230 DISEASES OF THE SANGUINOUS FUNCTION. dispose to tubercular disease. The individual who has in this way been predisposed to consumption is more liable to have the pulmonary organs affected from other ordinary causes of disease. If these causes, whether consisting of malaria, putrid exhalations or contagion, operate with dynamic power when received through the lungs, it is not possible the putrid gases evolved from the lungs of the consumptive can be in- nocent In the case of other infections the conditions of attack or immunity from the effects of the invisible poison consist in the quantity breathed and in the degree of physical resisting power. Whatever vitiates the blood, obstructs the functions of the lungs, debilitates the system, and predisposes to tubercular disease. Prognosis.—Consumption has been generally regarded as an incur- able disease. Cases of cure have been published; but the favorable termination has in nearly all of them been ascribed to the restorative powers of nature acting under circumstances in which unfavorable in- fluences were accidentally withdrawn. Dr. Hughes Benett gives one of these cases in the Edin. Month. Med. Jour., March, 1850. This author refers to various others who have published cases in which " all the functional symptoms and physical signs of the disease, even in its most advanced stage were present, and yet, the individual has survived many years and ultimately died of some other disorder; and on dis- section, cicatrices and concretions were found in the lungs." (Practice of Medicine, p. 717.) How far this happy result of treatment or of nature's unaided powers has ever been brought about by remedies, and how far the common fa- tal termination of phthisis is really caused by active treatment may remain for the present undecided. Allopathic authors agree that the practice that prevailed a half century ago, and even that which is not yet entirely abandoned by some of their number, never succeeded in curing any, and must have shortened the lives of the annual thousands who have died in their hands. Homoeopathy promises at least to do no injury: some of its practitioners claim to do much better. Dr. Epps in his work on " Consumption, its Nature and Treatment" p. 111.) says : " The alleged incurability of phthisis is the declaration of an error. It is the creation of an impossibility out of a difficulty." He regards the disease as certainly curable because the Hahneman- nian Law of Cure is inflexible in its results when its application is understood; but we fear all his cases will hardly be recognized as cases of true phthisis; and men of every school willingly admit that many alarming cases have been known to recover without any treatment whatever. Dr. Flint reported twenty-four cases of " arrest" of consump- tion of whom thirteen recovered fully. The result in all was attributed to: Avoidance of depletion, mercurials, emetics, low diet, and con- finement, and other changes in the habits of life. \ PHTHISIS PULMONALIS. 231 Haemorrhage from the lungs so often occurs in phthisical patients that phthisis is generally represented as the consequence of the haemorrhage ; but this is not always true. M. Louis says ; " no pro- position is at the present day more satisfactorily proved, in the opinion of all accurate observers, than the extreme rarity of haemoptysis of any amount, unless as a dependence upon tubercles. It is impossible, then in the existing state of things to regard haemoptysis as a cause of tubercles.* Dr. Evans, of Dublin, says, his observations show that when profuse the haemoptyses, which are sometimes observed in young people may give rise to the phthisical predisposition, and thus operate as the cause of tubercle.f The rarity of haemorrhage at an advanced stage of phthisis was shown by Laennec to depend upon obliteration of the vessels in the neighborhood of cavities. It has been established by the inquiries of Van der Kolk and Giullot, that the branches of the pulmonary artery stop short at a certain distance of one, two, or three lines from tubercles of gray granulations; and the more these adventitious productions increase in size, the further do the divisions of the artery stop from their perimeter. To such a degree is this true, that when tubercles are of large size or have given place to cavities, they may be surrounded by a sort of involucrum, ten lines broad into which no ramification of the artery makes its way. Hygienic Measures.—The most important are: Laborious exercise in the open air, conjoined with agreeable mental occupation. It is generally advisable to avoid long-continued confinement to any one business. It is well known that consumptives almost uniformly enter- tain sanguine expectations of recovery, but they expect to be cured without their making any efforts themselves. The disease creates hopes that are never to be realized, at the same time that it takes away the strength, the energy and perseverance necessary for accomplishing even all that might be done by faithful and persistent efforts. " A passive expectation of recovery and calm acquiescence in the prospect of a fatal termination " are characteristic of curable cases. And among these it seems that recovery was the result of exertions involving un- usual energy, or innate force of character, or of physical and mental efforts made under circumstances peculiarly calculated to call them out. Exercise is only useful in the open air, which promotes digestion, and improved secretion; and the disease is much more prevalent among persons who follow sedentary and in-door occupations, than among those employed in the open air. Dietetic Treatment.— In undertaking to "contend with success against the most cruel enemy of the human race,"J: " we immediately * Researches on Phthisis, p. 506. f Lectures on Phthisis, p. 193. 1 Louis on Phthisis. 232 DISEASES of the sanguinous function. perceive the importance of fortifying well all the outposts. As the chief pathological characteristic of consumption is seen in mal-nutri- tion or mal-assimilation, no mode of treatment has ever succeeded in curing it that co-operated with the disease by starving the patient. The phthisical invalid should be encouraged to eat, not all he can and whatever he pleases, but all he can digest and assimilate. In choosing the articles to be allowed and the quantity of each, the skill of the physician will be as severely tested as it will in selecting specific re- medies. The powers of the patient should never be lowered by a re- stricted diet; but a selection should be made from such simple and plain articles as are found in the patient's daily experience to be highly nutritious, and, at the same time easily digested, producing the least possible gastric or abdominal irritation. It is not only necessary that all the material constituents of the body shall be taken in the food in sufficient quantities, but that the digestive and assimilative powers shall be kept up to the standard of healty action. Each individual case requires careful study: it is desirable to allow considerable variety; to cause it to be taken at some well considered, but nearly regular intervals ; after food is taken rest should be allowed for a sufficient time to permit digestion to proceed without disturbance; and exercise should be afterwards enjoined as far as the patient's strength will allow. Active exercise increases strength as much by promoting digestion as by compelling the lungs to perform full breathing. The ends to be attained are: 1. The removal of the cachexia on which the progress of the dis- ease depends. 2. The consequent arrest of the disease; and 3. Promotion of the process of restoration. As all of these ends are attainable by general measures which de- velop and strengthen the physical powers of the system, we will con- sider them separately. Selection of Food.—Animal food is indispensable to the consump- tive, whatever may be the theories or experience of persons in better health. The patient must endeavor to suit his taste and digestive powers by testing the properties in succession of a few such articles as the following: milk, eggs, pure cream, beef-steak, fresh fish, &c, at the same time, taking a due proportion each meal of the best bread, sago, rice, cocoa, sugar, with small quantities of tea or coffee, or beer, but taking a full supply of fluid in free drinks of pure water. Of a few important articles it is necessary to speak separately. Pork.—It has been believed from the earliest ages that swine's-flesh was injurious to human health. Among the Hebrews it was considered as a cause of scrofula, and hence was prohibited by the law of Moses, and PHTHISIS PULMONALIS. 233 to this prohibition is still attributed the exemption of the Jews and Mahometans from scrofula and consumption. In America the merits of pork have been tested on the largest scale, and the preponderance of authority is evidently against it. The filthy habits of the hog; the fact that he has always been known to be subject to tubercular disease; the significance of the name scrofula or " swine disease," translated from the Greek name of the same signification; extensive observation in a country in which more hogs are produced and eaten than in any other country, all conspire to convince us that pork should be avoided by all persons, especially by invalids and such as have consumptive or scrofulous tendencies. Milk, the first article furnished by nature for the use of the higher order of animals, and " the only material throughout the range of or- ganized being so prepared"* is a complex mixture of saccharine, oily, and albuminous principles. It is too complex a mixture to suit the views of a theorist; but it is " a kind of prototype of what an alimentary substance should be, and its character was established before theories were invented."! When digestion is reasonably good it is as nutritious as any other article. In dyspeptic cases the coagulum formed of it in the stomach by the gastric juice is too heavy and solid. Sweet cream is better, but should be taken in small quantity. In large cities nearly all milk is rather doubtful; that from cows kept in stables should never be allowed. Milk originally pure, condensed by " dessication," is the best we have tested in New-York city. The relative degree of digestibility of a few common articles is thus given as ascertained by experiment. Rice, well boiled, requires for digestion one hour. Sago, 1 hour 45 minutes. Tapioca, 2 hours. Milk, boiled, 2 hrs. Venison steak, 1 h. 35 m. Turkey (wild), 2 hrs. 18 m. Lamb, fresh, 2 hrs. 30 m. Eggs, raw, 2 hrs. Eggs, whipped, 1 h. 30 m. Trout, fresh, 1 h. 30 m. Oysters fresh, raw, 2 hrs. 55 m. Fresh beef, rare, roasted, 3 hrs. Pork, fat and lean, roasted, 5 hrs. 15 m. Pork, stewed, 3 hrs. Mutton fresh, roasted, 3 hrs. 15 m. Bread, wheat, fresh baked, 3 hrs. 30 m. Potatoes, boiled, 3 hrs. 30 m. Soup, beef, 4 hrs. Chicken soup, 3 hrs. Oyster do., 3 hrs. 30 m. Barley do., 1 h. 30 m. Bread. All invalids, but especially consumptives and dyspeptics, should rely much on bread; and they ought never to eat any that is not free from all poisonous or impure elements. We have often spoken against the use of bread made light by yeast and leaven, still so much in use.*}: Pure bread is the desideratum; and it must be free from the poisonous fungi of which yeast and leaven consist There are now se- * Prout. f Graves' Lectures. Dublin. J See North Amer. Journal of Homceop., Feb. 1859. Also U. States Journal of Homceop., Vol. I., p. 293. 234 DISEASES OF THE SANGUTNOUS FUNCTION. veral resources which enable us to avoid these old-fashioned poisons, 1. The "Aerated or Unfermented Bread," (Broadway and Thirty-fourth street,) New-York, which we have found satisfactory in mahy cases. 2. The "Acid Phosphate of Soda." 3. There is also a " prepared flour " which is said to contain the same ingredients as the last. 4. The bread made light by the effervescence of muriatic-acid and bi-carb. of soda, described in the article already referred to. By restricting the patient to bread made according to some of these modes, with unleaven- ed crackers, sea-biscuit, &c, we should be able to bring him up to a better grade of health and strength than he would ever reach under the old poison diet of "stale bread." Fish contain most of the essential elements of a nutritious diet, as fibrine, gelatine and albumen, with much phosphorus and hydrogen. They therefore possess some stimulating powers which render them "rather irritating than plethoric and substantial."* Fresh fish are better suited for the phthisical than for the dyspeptic. Sugar. The carbonaceous elementary principles have been shown to be beneficial in supporting the failing strength and flesh of consump- tives; the operatives of the sugar-houses are said to enjoy a compara- tive immunity from phthisical disease. The syrups so much in popular use owe much of the little good they do to the sugar they contain. Whatever selection we may make for the proper physical support of the failing or threatened invalid, it is an imperative duty to support and develop his powers by nourishing food which will agree with him, whether it would suit another or not. No patient's life was ever pro- longed by vain efforts to starve out the fever that seems to be con- suming him. 4. As an important means for promoting a healthy action of the skin, and equalizing the circulation, too much can not be written in praise of external applications of cold water. These applications should be employed daily, either in the form of baths, sponging, or the wet sheets; in many instances the greatest service will be derived from using cold water applications to the chest in such a manner as to bring out an eruption. The effect of this remedy is to impart tone and vigor to the cutaneous structures, and to allay in a decided manner nervous irritation. 5. Another valuable preventive, as well as remedial agent in lung affections, consists in the cultivation of a cheerful and happy disposi- tion. The invalid must never brood over his ailments; for by gloomy ponderings upon his case, he is quite prone to exaggerate symptoms, imagine complaints which have no existence, and thus detract from his prospect of recovery*. * Brillat Savarin. PHTHISIS PULMONALIS. 235 Laennec ranks the depressing emotions as among the most prominent accidental causes of phthisis, and we are quite satisfied that he has not over-estimated their importance. 6. (And finally,) we recommend a strict avoidance of all excesses, whether in the pleasures of the table, wine, and liquors, or in the indul- gence of any thing that over-stimulates and fatigues the mind or body. Treatment.—In all cases when it is well ascertained that tubercles exist in the lungs, either in a latent or partially developed state, the following course should be adopted, as far as circumstances will ad- mit, viz: 1. First, an immediate removal to an equable, mild, dry and healthy climate. In making this selection, we should choose the interior of the country, rather than the coast, in order, as far as possible, to be away from the influence of the breezes which blow from the ocenn. " The advantage of a mild and sunny climate, is that daily exercise in the open air can be taken; and so not only can the natural spirits, but the functions of digestion, respiration, and the skin be kept up to a comparatively natural and healthy standard." But there are other con- siderations which in late years have led many to doubt the real su- periority of a warm over a cold and dry climate; and there is scarcely any northern country that has not, by somebody, been recommended as furnishing a favorable residence for consumptives. It is true that even diseased lungs will bear a cold, dry climate much better than one in which the conditions of cold and damp are combined; and in some cases in whom disease is really, though slowly progressing, a cold, dry and bracing air is much more salutary than a warm, humid and re- laxing one. Still the preponderance of authority is in favor of sending the patient in whom phthisis has been detected in the incubative stage, for the winter months to a climate where he may enjoy " mild dry, and somewhat tonic air," particularly if he is of a lymphatic tem- perament. Dr. Mac I.imont who spent a sufficient length of time at various places noted for possessing peculiar advantages, mentions Mentone, Nice, Cannes, and Hyeres ; but, upon comparing his descriptions of the claims of these places, we can see no special merit in any of them. Nice seems to be preferred for patients "with whom a sea-air agrees." The more advanced cases of disease, as well as those in which a con- siderable amount of acute inflammatory action exists, being charac- terized b}T dry cough, accelerated pulse, and much feverishness, will derive more benefit from a softer and more sedative air than that pos- sessed by either of the places above named; and Madeira, Egypt, Malaga, Rome, and Pau, offer these advantages. Madeira possesses "an atmosphere free from extremes and sudden alterations, of "Teat barometrical and thermometrical uniformity, a winter temperature 236 DISEASES OF THE SANGUINOUS FUNCTION. averaging 64°, and totally exempt from cold winds. " But on the other hand, Madeira is undoubtedly relaxing, predisposing to various af- fections of the stomach and bowels, and altogether unsuited for chil- dren and healthy adults." (British Journal of Homoeopathy. July, 1861, p. 441.) Egypt possesses, " like Madeira, a high winter and spring tem- perature, great uniformity, and absolute freedom from high and cold winds, yet though quite as mild and balmy, it is neither damp nor relaxing." In Upper Egypt the climate is " so free from rain and moisture, so balmy yet invigorating and restorative, as not only to prove highly curative in diseases of the respiratory organs from its direct action thereon, but is well calculated to improve the general health and spirits, and to repair the waste which so constantly follows in the train of these diseases." But unfortunately it is too far off; it costs too much of health and money to reach it or to stay in it; and few invalids can avail themselves of its blessings. Rome has a " still, serene, soft, bright atmosphere during the winter months, but it is subject to great and sudden atmospheric alternations in the spring. It is of all the others most relaxing, liable to produce disturbance of the stomach and bowels, gastric and bilious affections, diarrhoea, dysentery, and malarious fever. Pau, is colder in winter than any of the above; considerable rain falls at this season; but in spring the weather is "dry, mild, sunny, and remarkably free from the disturbance of winds." The air is very soothing, and is well suited to invalids of a nervous and irritable tem- perament; but it disagrees "with persons subject to irritable bowels, or those of a lymphatic and strumous habit." In England, particular localities have had their advocates. Dr. Pope recommends " the hills of Malvern or Ilkley as infinitely better adapted to the early stage of the disease" than the " warm, moist and relaxing atmosphere of the Southern Coast" Dr. Epps recommends the village of Warlingham, situated among the Surrey Hills, about 16 miles from London. There, he says, there is no water except at the depth of 300 feet* and the water used is rain-water; and a walk or a drive exposed to the sun on the south-west and protected on the east by a high hedge, " affords the means of exercise even on a cold and sunless day." (P. 218.) The climate of the United States presents all the varieties of the temperate zone, without furnishing a single retreat to which we are able to point as a safe asylum for the consumptive, though the com- parative advantages of diff'erent localities have been often urged upon our attention. The trance-dream of the invalid is a climate of uni- form temperedure; and in search of it he examines the claims of all PHTHISIS PULMONALIS. 237 the four continents and the five zones of the earth, to find that it no- where exists. America does not pretend to furnish a spot that can approximate freedom from " sudden changes." We have now the means of comparing one point with another, as we have accumulated meteorological observations on the largest scale; but observers are not yet agreed on the lessons taught by these voluminous tables. We will contrast the highest and lowest points of the thermometer for two successive -winters as observed at places remote from each other, as given in Blodgefs " Climatology of the United States .*' Months. 1855-56. 1855-56. 1855-56. FOBT SXELLIXG. FORT COLUMBUS, N. Y. fort independence, Boston. Max. Mm. Range. Max. Min. Range. Max. Min. Range. O O O O O O O O o December, 44 30 77 52 14 38 52 7 45 January, 32 34 64 36 6 42 36 5 41 February, 42 31 73 40 4 36 41 1 32 1856-57. 1856-57. 1856-57. Max. Min. Range. Max. Min. Range. Max. Min. Range, . O O O O O O o o o December, 35 15 50 47 4 43 54 13 41 January, 28 35 63 36 5 41 54 9 45 February, 42 35 77 60 6 54 45 6 39 Years. FORT SNELLING. NEW-YORK. BOSTON. Max. Min. Range. Max. Min. Range. Max. Min. Range. O O O O O O O O O 1855. 96 33 129 92 6 98 98 5 103 1856. 95 32 187 95 6 101 98 5 103 1857. 91 35 126 91 15 76 91 13 104 It will be seen by comparing the statistics, says Dr. Lewis, of St. Paul, Min., that, although "uniformity is not characteristic" of the climate of either the Atlantic Coast, or that of Minnesota, "the range of temperature for both is limited to very different points on the thermometric scale." At New-York "the Mercury vibrates fitfully from a point above to one below freezing." In Minnesota its vi- brations are from one freezing point to another—its more usual range in winter being from 15° below to 15° above zero." It does not usually rise so high as the freezing point during the winter months. It is therefore claimed, that the climate of Minnesota, though colder than that of the Atlantic Coast presents less variation between freezing and thawing ; and that fluctuations of temperature between one point and another in a dry cold atmosphere has little influence on health.* Of the relative advantages of one part of our country over another we have many learned essays, but we must omit any comparison between * Amer. Med. Times. Vol. IV. p. 162. 238 DISEASES OF THE SANGUINOUS FUNCTION. them. The following remarks by Dr. Dunham, of Newburgh, N. Y., are important. He says, the treatment of phthisis in Brooklin was in his hands most unsatisfactory ; but he finds it in Newburgh to be " very amenable to treatment, and although in cases in which the disease is far advanced, he can boast of no cures, yet the relief afforded even to such cases is very remarkable, constant, and enduring for a period to which his previous observations of the disease offers no parallel." On the climate of the Bahamas, he says : " Nassau enjoys a climate totally different from any portion of the United States or of the West Indies proper. There are utterly unknown " the sudden alternations of temperature, the searching damp chilliness suddenly succeeding a scorching heat, the humid penetrating north-east winds sweeping down our Atlantic Coast on the west edge of the Gulf Stream—which make the climates of Charleston, Savannah, and St. Augustine so trying to invalids with pulmonary and rheumatic diseases." The climate of Nassau is remarkably uniform—being free from the oc- casional cold of the Florida coast, and from the extreme heat of Cuba and Santa Cruz. Yellow fever has been long unknown, intermittents are never seen, and bilious fevers are rare; phthisis though not un- frequent among the blacks, is rare among the whites.* For incipient phthisis this climate permits the invalid to spend his whole time in the open air; the bracing trade-wind prevents him from falling into the lassitude common to tropical regions. Here within four or five days sail, by steam of New-York, the invalid can find English society, refinement, and hospitality aloof from the usual seat of epidemic and contagious diseases, and the variable land climate of the American Continent. In the months of February and March, which might be expected to furnish the greatest vicissitudes of tem- perature, there is only an average daily range of the thermometer of 5£° for March. While at Pau, in the south of France, it is 7^°, at Nice 8-£°, and at Rome 11°. At Nassau in February the lowest temperature was 71° and the highest 85° on the 28th, and the ascent from the one to the other was uniform. Wherever the patient may reside, it is agreed by men of every shade of opinion that the patient should constantly enjoy " a pure, warm, dry air, a constant and free in-door ventilation, at the same time that he is supplied with a higbly nutritious food. It is claimed that attention to these points alone have often led to the removal of the tubercular predisposition. It is advised to " avoid the places at which consumptives are congregated; but to seek such as afford incitements and resources for physical exertion/' and to encourage travelling abroad, not as a task, but as a means of mental gratification. *Amer. Homceop. Review. Sept. 1859, p, 550. PHTHISIS PULMONALIS. 239 Daily exercise should be taken in the open air. By this we do not mean that snail-like moping around, with the body coiled up, and a countenance the picture of melancholy and despair; but that vigorous, free and cheerful exercise which invigorates and expands the physical powers, and cheers the mind. Exercise, to be beneficial, should be employed in such a manner as to bring all of the muscles into moderate and agreeable action, and as a pleasant recreation, rather than a ne- cessary task. By this means the organism is strengthened, the cir- culation equalized, the "blue-devils" exorcised, and the pulmonary organs placed in the best possible condition to recover themselves. In pursuing this course of physical exercise, regard should be had to those gymnastic and other sports which tend to expand and strength- en the thorax. Too much can not be said with reference to the im- portance of this subject, also the erect position of the body, and the habitual custom of taking deep and free inspirations; for the muscles of the chest, as well as of the other parts of the body, waste away and become enervated without constant exercise in a natural manner. In connection with this course, we must strongly advise the frequent use of breathing tubes. Having experienced decided benefit from employment of this kind of exercise of the lungs, and having often .seen it adopted by others with prompt and marked advantage, we speak confidently of its efficacy in debility of the pulmonary organs. Systematic employment of physical movements is now accepted as an efficient means of averting consumption. The contraction of the chest in phthisical patients is in part owing to hereditary confor- mation, but it is generally increased by indolent and sedentary habits. However it may have originated, much can be done towards correcting it, and in correcting a defective conformation many other accompani- ments of imperfect respiration will be removed. A systematic course of exercises which shall especially bring into play the muscles of the chest and keep the body erect, will greatly enlarge the capacity of the chest; the lungs may be made to receive a much larger quantity of air; but it is necessary that this course of health-giving exercises shall be commenced before hopeless structural disease already exists, and that it be so directed as not to give " fatigue and exhaustion in the nervous system out of all proportion to the effect upon the muscles." The general indication, says Dr. C. F. Taylor, * " will be met by employing the muscles in such a manner that, while they are made to act with more or less force, no greater demand shall be made upon the nervous system than can be easily and healthfully responded to. "The first thing to be attended to and never to be lost sight of for * Theory and Practice of the Movement Cure, p. 212. 240 DISEASES OF THE SANGTTINOITS FUNCTION. a moment, is the circulation of the blood. Feebleness of the heart's action, imperfect respiration, poor quality and small quantity of the blood, and especially want of affinity between the blood and the tissues, all conspire to produce the livid countenance, cold extremities, and consequent pectoral congestion and oppression so characteristic of pulmonary consumption." The specific movements by which these conditions may at least be greatly improved we will not here describe in detail. It is advised to " act almost wholly and very perseveringly on the extremities, by rotations of the feet, hands, arms, and legs, and by flexions and extensions of the same," but "there should never be any attempts to expand the chest, till after the peripheric circulation has been improved." After a proper distribution of the fluids has been secured and maintained, improved health is sure to follow. Medical Treatment.—The great danger is that of over-medication. The invalid who to-day is acknowledged to be in the incipient stage of consumption is already suffering from the effects of many agents taken as remedies; and each after a fair trial has been condemned. When the true remedy is selected it is quite common to defeat its good effect by frequent repetition, by alternating with other remedies, or to change speedily for something else. We are much more likely to succeed by carefully selecting the most appropriate remedy and give only a single dose. In some cases we should wait for perhaps a few days, in many cases even several weeks before repeating. But few patients or phy- sicians have patience for such long delays. We may hope, in curable cases, to succeed with some of the following remedies: Jecorus-aselli, Sulphur, Ilepar-sulphur, Calcarea-carbonica, Mercurius, St annum, Ferrum, Silicea, Sepia, Phosphorus, Phosph.-acid., Lobelia, San- guinaria, Acid-nitricum, Drosera, Lycopodium, Hypophosphite of Lime, Lachesis, Iodine, lod.-polassce, Arnica, Sambucus, Bella- donna, Hamamelis, China, Alcohol. Preliminary or First Stage. — Ascllum-jecoris or Cod-Liver Oil.—It has been believed in all ages that oleaginous substances have some beneficial influence in the treatment of consumption, whether their action was to be attributed to their medicinal or to their nutritious properties. It at least supplies nutriment in a concentrated form, and it also holds in solution a fine attenuation of Iodine. Cod-liver oil is usually easily digested; when the stomach will not digest it, Pulsatilla or Creasote may correct the weakness of this organ. When cod-liver oil acts beneficially we accept its aid, but we do not accept the reasonings of those who have tried to explain its mode of operating. Dr. Madden, (British Jour. Homeep., Vol. VI., p. 433.), shows that the effects of the oil are quite similar to those obtained by the provers of Iodine. Dr. Pope, in a later number of the same Journal, considers that this oil "presents us with food, in the shape of oil, of a PHTHISIS PULMONALIS. 241 highly nutritious easily assimilable character, and at the same time with a medicine homoeopathic to the tubercular diathesis," and by it the most happy curative effects are often produced. Though it be rendered probable that Iodine is the only real curative agent in these cases it is by no means improbable that its medium, the animal oil, which is composed principally of carbon and hydrogen, may serve the purpose of neutralizing a portion of the inspired oxygen, which would otherwise act upon the weakened lungs themselves. It is at least re- garded as one of the most efficient remedies known; but it is admitted on all hands that it can only cure in earlier stages, and that it needs to be long persisted in; Dr. Turnbull continued its use for several years. Symptoms.—" The patient is thin, loses flesh rapidly; the complexion is pale, the cheek frequently surmounted by a pink flush; the lips ex- sanguine ; the appetite very deficient; the power of digestion feeble; the bowels easily deranged; a sense of languor or weariness is felt after slight exertion; respiration short and hurried; when tubercular deposit takes place in the lung, the cough speedily becomes trouble- some and the physical signs of disease rapidly defined." If the history of the case shows hereditary predisposition to tubercle, Iodine alone is homoeopathic to these cases, both before and after tubercles are formed. The quantity varies according to the digestive powers of the patient; "but a dessert-spoonful of the pure, clear, pale-colored variety will accomplish all that can be obtained from it."* It is to be regretted that so few positive specifies have been dis- covered for the cure of tubercular phthisis, but we are sanguine in the belief that many such remedies will sooner or later be found. Cod-liver oil is still given in the third stage in some cases with success; it is believed to be less suited to those presenting the follow- ing characteristics; emaciation not strongly marked; complexion pale and heavy looking; cheeks puffy; muscular tissue flaccid; the areolar tissue distended with serum; appetite capricious, rather than deficient; nutrition perverted rather than positively checked; bowels inclined"to constipation rather than to diarrhoea, but often extremely irregular; cough slight but decided; difficulty of breathing often well marked, especially on going up-stairs or walking rather more rapidly than usual; there is also in general palpitation. These cases show a here- ditary predisposition, and evidences of phthisis are visible in childhood; development of the frame seems prevented by some depressing consti- tutional influence; the complexion is pasty, the muscles soft and flabby ; the bones are inclined to curve; the circulation is languid ; strength is feeble and all the usual physical energy of early life is absent. Here likewise * Pope, p. 35. Vol. IL-16. 242 DISEASES OF THE SANGULNOUS FUNCTION. Calcarea-carbonica is suited for the symptoms detailed under the last-named remedy. In similar cases which have advanced to the second stage, Lycopo- dium or Nitric-acid will generally be found more useful than Calcarea. Sulphur.—This is perhaps the most perfect specific for phthisis in its unmixed psoric form, not only when it follows pneumonia, but also when the disease is hereditary, and in the period of purulent expectoration. In cases of incipient phthisis it should only be given at long in- tervals, a single dose should be allowed to operate for several weeks undisturbed. Dr. Nunez, of Madrid, says, he has cured some cases of confirmed phthisis by this remedy. Teste says, "if it has not cured phthisis it has at least retarded it for several years." * Hahnemannf regarded phthisis pulmonalis as a psoric disease, and Sulphur as the first of antipsoric remedies. He refers to six cases in which consumption was caused by the repulsion of psora from the skin; later writers have admitted that Sulphur is a specific for itch, and also for the diseases caused by its recession. Sulphur is specifically suited for phthisis in psoric constitutions, of lymphatic temperament subject to venous plethora and haemorrhoids. There is predisposition to take cold from slight exposure, running into chronic catarrh; eruptions resembling those of scrofula appear on the skin; rheumatic pains without swelling; drawing pains in the limbs; unsteady gait and tremor of the hands: great general prostration; nervous exhaustion following debilitating losses; numbness of different parts, paralysis and emaciation ; pains worse at night, relieved by ex- ternal warmth ; drowsiness, and disturbed sleep; disturbing dreams; hallucinations, timidity. The patient curable by Sulphur has generally some eruptive disease of the skin or has had such affection (not necessarily the itch), repelled from the surface at some former time ; he is subject to abscesses, boils, or swelling of the glands; hectic fever followed by night sweats, or profuse sweat from slight heat or exercise. There is hypochondriac sadness,; disposition to weep ; irritated taciturn disposition ; the head is dizzy.; intolerance of light. The face is pale, wan, blanched, sickly, bloated, with wrinkled coun- tenance ; blue margins around the eyes; hepatic spots in the skin; swelling -of the gums; dryness of the tongue ; favus on the skin. The throat is dry.; mucous expectoration ; sore throat, vesicles on the surface ; pressure in the throat as if from a lump ; tonsils red, swelled; uvula elongated. Putrid taste in the morning, ravenous appetite or loss of appetite ; acidity of stomach and sour eructations ; heartburn; morning nausea; waterbrash ; acid vomiting. * Materia Medica, p. 108. t Chronic Diseases, Vol. II., p. 325. PHTHISIS PULMONALIS. 243 The stomach is painful on pressure ; swelling, burning, and cramplike contraction or spasm of the stomach; malaise before a meal; nausea after eating. In the abdomen there is pain, with sensitiveness of the surface; spasmodic contractive colic ; cutting pain and nausea followed by diar- rhoea and tenesmus; haemorrhoids; constipation with pain and pressure on the rectum as if it would protrude; mucous stools streaked with blood, passed with ascarides or lumbrici; strangury; foetid urine. The throat feels rough, the larynx dry, sore, its sides swollen and feeling; as if something lodged there. Hoarseness or loss of voice. Catarrh, fluent coryza, rawness or spasmodic constriction of the chest Cough drv, short and hacking, and after a meal exciting retching or vomiting. At a later stage the cough is looser, raising thick mucus, then greenish masses ; the cough excites violent headache, which in the occiput is pulsative ;. spitting of blood. The breathing is spasmodically arrested; asthma excited by a long or rapid walk, or ascending the stairs ; suffocative paroxysms, especially coming on at night; talking causes weak feeling of the chest; oppres- sion or contractive pain there. Neuralgic stitches of the chest, extend- ing to the sternum or back. Palpitation of the heart; anxious throb- bing with flush of the face, or rush of blood to the head; leucorrhcea ; irregular menstruation; cold hands and feet. It may not be proved that Sulphur has cured confirmed phthisis in advanced stages ; but, savs Teste, "there is no doubt, however, that serious affection of the air passages have frequently been arrested by its use; affections, which, without being tuberculous phthisis, would nevertheless have been equally fatal."* Sulphur and Hepar-sulphur should always be selected when the pulmonary affection can be clearly traced to abruptly suppressed psora, whatever may be the general character of the symptoms. If, however, symptoms are present which point strongly to some other medicine^ an alternation may be resorted to. Hepar-sulphuris.—Dr. Busch, of Strasburg, in 1860, reported, cures of phthisis effected by Hepar and Aconite, others have, used it with success in incipient cases. The patient has an unhealthy skin which cracks or chaps and runs into suppuration or ulceration from slight in- juries ; is subject to pimples and blotches ; he sweats from the slightest exercise, and also profusely at night. He is mentally irritable,. \m^ patient; has vertigo with pain in the head; falling off of the hair; erysipelatous eruptions of the face. In the throat theore is a feeling of something sticking, or rough scraping or stinging &t*te-hes ; rawness of the fauces, swelled tonsils; expectoration mixed with blood. * Materia Med., p. 168. 244 DISEASES OF THE SANGUINOUS FUNCTION. Putrid taste in the mouth, loathing of food; eructations without smell or taste, vomiting, water-brash. Cough with rawness and scraping of the throat and oppression of the chest. Violent deep cough with retching; dry cough in paroxysms, worse at night; haemoptysis; short breath; suffocative cough and asthma, and palpitation of the heart. Teste* says, Hepar has cured cases in which there were " stitches in the eyes; photophobia; dis- charge and fetid pus from the ear, erysipelas of the face; dryness of the throat; scraping of the throat, with difficulty of talking; canine hunger, eruptions; paroxysms of nausea with coldness and paleness; swelling and pressure or pain at the epigastrium," &c. Hahnemann says, it cured cases in which mental symptoms were prominent; as, dissatisfaction with one's self and others; unpleasant recollections; dreamy atrabilious mood; a ferocious malignant spleen, though occurring in a person of benevolent and merry disposition-! Calcarea-carbonica.—Hahnemann attributed important anti-psoric powers to this remedy. It is said to apply more than any other re- medy to diseases of the reproductive system; it is especially useful in the diseases of childhood and is the best reliance for the correction of mal-nutrition. It acts specifically on the mucous membranes, on the fibrous and osseous system; on the nervous, the serous, the venous and the lymphatic systems. Persons curable by it are of lymphatic temperament, scrofulous or rickety, show plethora of the veins ; easily take cold, are frail, poorly fed but tend to grow fat. Its application in consumption is chiefly restricted to cases in which these features predominate. The patient is feeble in body and mind, though in some cases mentally precocious, and often regarded as a genius; he is subject to depression of spirits ; weeping mood; restless and anxious ; has no hope of recovery, is hypochondriacal; the hair falls off; the eyes are feeble ; can not bear gas-light; and he suffers from all possible de- rangements of digestion; the nervous system becomes excessively ir- ritable especially in females; there is hysteria a fault-finding mood; nervous exhaustion, especially menorrhagia, in males spermatorrhoea, or exhausting emissions. It is proper in the stage of purulent ex- pectoration, especially after Sulphur or Nitr.-acid. Silicea.—This remedy embraces most of the symptoms that belong to the phthisical dyscrasia, consequently, it is a remedy of value for the constitutional condition in congenital or hereditary cases. The dyspeptic symptoms peculiar to consumption are also nearly the same as under Hepar. The symptoms that show themselves in the respiratory system are thus given: roughness and sore feeling in the larynx, with dry hacking cough, causing soreness of the chest. Hoarseness with cou»h, * Mater. Med., p. 293. t Chronic Diseases, Vol II., 283. PHTHISIS PULMONALIS. 245 suffocative night cough; excessive, continual cough, with discharge of translucent mucus or bloody mucus. Vomiting of purulent matter when coughing. Ulceration of the lungs. Discharge of clear, pure blood with deep hollow cough; the chest painful as if bruised. Short- ness of breath, felt on walking or exercising. Weakness and oppression of the chest; aching pain in the sternum: congestion of blood in the chest, with chilliness of the surface. Oppressive heaviness in the region of the heart and palpitation when sitting still. Stannum,—Several authors have cured a species of phthisis, hectic fever, chronic catarrh, mucous asthma with tin, And Stahl has ob- served that it is capable of producing a species of phthisis. Consumption occasionally arises in those whose lungs are naturally weak and irritable, in consequence of violent and protracted syphilitic attacks. In these instances the most suitable remedies are, Mercurius, Acid-nitr., Potassce-iodide, and Hepar-sulphur. When phthisis is threatened during the progress of chlorosis, or in consequence of anaemia, some form of Ferrum is indicated. Ferrum.— Dr. Muller has recommended Ferrum as a remedy for phthisis, and it is now becoming popular in Germany. (Report. Dis- pensary, Leipsic, 1852.) Dr. Luther (Brit, Journal of Homceop., April, 1860, p. 335), says that at a village of four hundred inhabitants, near Wittenberg, in Prussia, "consumption is unknown; and other forms of scrofula are of the rarest occurrence, whilst in neighboring villages that lie higher, these disorders are common." This valley is supposed to owe its protective in- fluence against phthisis to a large number of chalybeate springs, some of which contain carbonates, and others strong sulpho-aluminous chalybeates. The inhabitants attribute their freedom from phthisis and their notorious good health and longevity to this chalybeate water which they use for all purposes. We can not suppose that the unlimited use of iron in any form can be safe to consumptives. It first became popu- lar upon the recommendation of M. Trousseau more than thirty years ago. He has since discovered that though there was apparent improve- ment in his hospital cases of chlorosis and anaemia, they all afterwards died of phthisis, hastened to a fatal termination by his treatment. In December, 1859, this author, finding the profession still following the wrong trail on which he started them thirty years ago, thought it ne- cessary to publish at length his confession and recantation of the pro- fessional sins of his earlier years.* For twenty years he has been di- minishing his doses. He is now afraid to give iron in any quantity in any case in which constitutional tendencies to phthisis are suspected. The profession at large can not countermarch so easily. We hope that * Gazette des Hopitaux. Dec. 22, 1859. 246 DISEASES OF THE SANGUINOUS FUNCTION. within the next quarter of a century they will learn to come back to the true ground of safety and efficiency. M. Trousseau has proved, what homceopathists knew before, that iron is a remedy for consumption, because it is capable of exciting it In our doses it is able to cure the symptoms which in his doses it caused in so many cases. The cases in which Ferrum is specially valuable are those in whichf " the patient is usually between twenty and thirty years of age; his family history is free from any hereditary taint or tubercle; he is of a sanguine temperament, of a florid complexion, with an active circula- tion, and an easily-excited nervous system; the disease has been ex- cited by neglected catarrh, causes which originated mal-nutrition with frequent inflammatory attacks upon the pulmonary organs. Epistaxis, haemoptysis, headache, congestions in various parts are easily excited; hectic fever runs high, and the loss of strength is very rapid, there is dyspnoea, vomiting of food, or lienteria. For this form of phthisis, Dr. Clotar Muller very confidently recommends the Perchloride of Ferrum, in doses of one to three drops, of the first to the sixth decimal dilution. See a translation of his paper, British Journal of Homceop., Vol. 18. The form of iron with which we have succeeded best, is the Pyro- phosphate. In the third trituration it has always improved anaemic, dyspeptic, or chlorotic cases. The second stage of these cases is best met by Phosphorus or Bro- mine. The frequent attacks of congestion and inflammation which mark their course are best met by Aconite, Bryonia, and Belladonna. In the third stage Dr. Muller recommends the Iron again. Lobelia-inflata.—Lobelia has been used empirically on such a large scale in the United States, that its powers are well known. When proved homceopathically it develops a train of symptoms ana- logous to those of Sulphur. In phthisis it corresponds to the consti- tutional psoric symptoms generally, to all the stomach derangements that are common in the later stages, to the catarrhal fever of the first stage and to the intermittent hectic of the second. Besides these im- portant features it presents the following bronchial symptoms: Burning in the throat; dryness of the throat; burning prickling in the throat, increased secretion of viscid saliva, nausea and eructations. Sensation of a lump in the pit of the throat, impeding deglutition. Sen- sation in the oesophagus, as if something were rising in it. Titillation in the larynx, with frequent short, dry cough. Sensation of a foreign body in the throat impeding the breathing and swallowing. Tightness of the chest, with short and laborious breathing. Chronic dyspnoea ; paroxysmal asthma; pains in the chest increased by deep inspiration ; deep-seated pain in the region of the heart. Its special sphere of t Dr. Pope. PHTHISIS PULMONALIS. 247 action has been assigned to the pneumogastric nerve. It certainly affects promptly all the organs supplied by this nerve. It also operates decidedly upon the skin, producing a peculiar form of herpes, formerly called " James River Tetter." It was common on that river and cured by Lobelia.* Sanguinaria-canadensis.—This is one of the best agents we have for the prevention, if not the cure of consumption. In allopathic doses it acts as a tonic, narcotic, stimulant, or emetic, according to the dose employed. In doses of from eight to twenty grains it produces nausea, heat in the stomach, faintness, often vertigo, indistinct vision and finally emesis. In smaller doses, after continuing its use five or six days, its effects on the pulse resemble those of Digitalis. We have long been familiar with its powers in many forms of pulmonary, bronchial, hepatic and gastric disease. We have used it with success in patients who were subject to distressing affections of the chest, re- peated attacks of pneumonia, haemoptysis, and spasmodic attacks re- sembling pertussis. Also in protracted catarrhal fever which leaves obstinate cough and threatening consumption. The cough has generally been mitigated, the pulse diminished in frequency, the powers of the whole digestive system increased; the appetite is always improved, or regulated in cases where it has been morbidly great. Symptoms.—Coryza, rawness of the throat, pain in the breast, cough, salivation, looseness of the teeth. Dryness of the lips; the tongue feels sore as if burned; white-coated sore feeling of the epigastrium, increased by eating; burning heat in the stomach, with headache; gastritis ; nausea, vomiting with headache, periodic nausea, nausea and chill, diarrhaea, torpor and atony of the liver with colic; throbbing, beating in the abdomen; flatulent distention of indurations in the ab- domen, haemorrhoids. Chronic dryness in the throat; continual severe dry cough, with pain in the chest and circumscribed redness of the cheeks, tormenting cough with expectoration. The peculiar cough, emaciation and hectic fever of pulmonary consumption. Hydrothorax, asthma, pneumonia, and pneumonia typhoides; pain in the chest with cough and expectoration. Burning and pressing in the breast and back; palpitation of the heart, burning of the palms of the hands and soles of the feet at night In chronic forms of pneumonia the first stages of phthisis, in hepati- zation of the lungs and bronchitis; putrid sore throat. We have had much allopathic experience with this remedy in dis- eases presenting the above symptoms and do not like to acknowledge that all former successes were gained in violation of law. It has ap- • Transactions of Amer. Institute of Homoeopathy. Vol. I. 248 DISEASES OF THE SANGTJINOU8 FUNCTION. peared to us that the remedy is truly homoeopathic to all symptoms enumerated and a vast number more; but that it sometimes produces its curative effect by a local primary action, and in other cases it cures by its secondary action. Phosphorus.—Jn incipient as well as confirmed phthisis in persons of meagre, slender form; fair complexions, and strong sexual feelings. When in the lower lobes and of an asthenic type, in children and young girls of delicate constitutions, with dry short cough, shortness of breath, great emaciation, tendency to diarrhoea, or perspiration, it is useful. Case.—Dr. Fincke gives (Amer. Homoeopathic Review, Mar. 1861, p. 285) the case of a woman aged thirty-four years, " dark complexion and sanguino-nervous temperament," who had " hard cough, hurting her chest and head, with a pressing forward of the eyes; and thick yellowish purulent expectoration, excited by burning pains in the pit of the throat, which continued during the coughing; dullness under the right clavicle ; mucous rattle in the right upper lung anteriorly, in expiration and in- spiration : puerile respiration in left upper lung; pains under the ster- num when sewing; great emaciation; sallow countenance; hollow sunken eyes with dark rings around; irregular chills." Phos. tsVo. Seven days later: " Patient much improved; she still coughed hard es- pecially in cold weather. Phos. -ruVw. After that all the symptoms disappeared." It is well known that Phosphorus is a necessary constituent of all healthy nerve structure. And in some conditions of low nervous vigor its employment may be of service. As it enters largely into the com- position of most nutritive kinds of grain, and was not placed there without purpose. It is no specific for phthisis, though it acts usefully on certain states of lowered nervous energy. The hypo-phosphites have not yet established their claim to the title of specifics for consumption; and they never will, especially in allo- pathic hands. " Ignorant of the homoeopathic action which is the true cause of the success of specific remedies when properly administered, they give quantities so great, as, in most instances to aggravate the symptoms of the malady. Occasionally these medicines give indi- cations of their value in successful results, simply because the physi- cian exhibits by accident a small dose, or finds a patient not very accessible or responsive to homoeopathic action." Phosphorus has been known for half a century to be a remedy for consumption; but allo- pathic experience soon proved it not always safe. Dr. Churchill then brings it up in a combination which is safe; but it is speedily pro- nounced inert Our experience with the hypo-phosphite of lime has not been entirely unsatisfactory. In the course of three or four years we have generally succeeded in obtaining as good results from it as from Calcarea-carbonica in cases not widely different from those in PHTHISIS PULMONALIS. 249 which the latter is known to be specific. In small dose% of the third trituration it certainly improves digestion and assimilation. We have not found it a specific for tuberculosis. Its precise sphere of action has not yet been pointed out. Drosera-rotundifolia — Sun-dew. Vic at (Treatise on the Poi- sonous Plants of Switzerland) says, the Droseras are " acrid and corrosive; they cause ulceration of the skin and injure the teeth. Triturated with salt they are used as vesicatories. The sun-dew is sold in the shops as a useful remedy in coughs, asthma, ulceration of the lung, &c.; still it is certainly poisonous for sheep ; it affects their liver and lungs, and causes a cough, that makes them waste away slowly." Hahnemann refers to Borrhichius to prove that "it causes a very vio- lent cough among sheep." Several medical men of former times em- ployed it in " cough and in phthisis with purulent expectoration." The plant was first described and figured by Dodoens, of Belgium, in the sixteenth century, under the name of rorella prrima major. Linnaeus directed the acrid juice for application to warts and corns; Haller says it causes excoriations and ulcers of the skin. A German botanist, named Siegesbeck, in 1716, says, the plant is injurious to sheep, particularly by exciting a cough, which is often fatal. He and also Heermann (Erfurt 1715) found it to allay asthma, remove hoarse- ness, and restore the lost strength. The tincture was found useful in catarrhal fevers (influenza), epidemic whooping cough (as that of 1712.) Auscultatory Signs.—Cases in which it was successful: dullness more or less extensive, weakness of the respiratory murmur, roughness of inspiration or expiration, respiration in several impulses, prolonged expiration, souffle behind the capsula. Functional Signs : Cough generally dry, oppression, spitting of blood, thoracic pains, night-sweats, emaciation. Under the influence of Drosera, when the general state of the patient was good, Dr. Curie says, he has seen all these symptoms disappear. The cases in which it promises little are, those in which thef ever is of a continued character; where the food is not duly assimilated, as is often the case with phthisical patients who have large cavities, and some others where the stethoscopic signs were not strongly marked. Even in these, it gave relief for the first week, and when it failed the patient died more quietly. , Dr. Eugene Curie read before the Academy of Sciences of France, September 2, 1861, the results of his experiments on the physiological and therapeutical properties of the Droseras.* He says : He chose the domestic cat as an animal to experiment upon, from * Bulletin de la Societe Medicale Homceopathique de Paris. Nov. 1861. 250 DISEASES OF THE 8ANGUIN0U8 FUNCTION. the opinion ttiat tubercles had never been found in them. He gave to one cat fifteen centigrammes per day of Drosera, triturated with sugar of milk, and killed him with it at the end of six weeks. He gave to an- other at first a drop at a dose, which was afterwards increased till it amounted to 1600 drops per day, of the spirituous tincture evaporated in the air, and latterly in vacuo. This animal was killed at the end of one year. A third has been using the drug for six months, and shows the same symptoms as the two former. Symptoms Produced.—All three had diarrhoea at the commence- ment, and a marked weakness of voice was noticed after six weeks. They could utter sounds but they could not be heard, though at the commencement their cries gave great annoyance to the neighbors. Appearances on Dissection.—In the two animals dissected. The first on being opened showed beneath the pleura some almost ge- latinous deposits surrounded by an anomalous redness. The changes in the lungs were not such as revealed tubercle to the eye but they were plainly revealed by the microscope; and Dr. Gratiolet, of the Museum Department, satisfied himself that these deposits were of a tubercular nature. There was also in this animal considerable en- largement of the mesenteric glands. The second cat killed after one year of experimental treatment, showed " lesions consisting of small white granules, the size of a pin's head, situated beneath the pleura, and surrounded by a very red in- jection that penetrated into the pulmonary tissue, but was unaccom- panied by induration. These granules were only found under the pul- monary pleura. None were noticed in the parenchyma of the lungs. These gray granulations were moderately hard : they could be crushed on the glass, and showed under the microscope the following characters: irregular corpuscles, granular internally and externally ; the external granulations brilliant and somewhat characteristic. Most of the corpuscles were six seven-thousands of a millimetre in diameter, almost unaffected by acetic acid. Though some other accessory elements were met with, the attention was chiefly confined to the tuber- cular structure which constituted the principal mass of the granulation, and left no room for doubt as to its character. There was also enormous development of the submaxillary glands, the hypertrophy of the glands of Peyer ; and the shut vesicles of the large intestine, which contained an opaque fluid that showed under the microscope granular corpuscles. In the spleen they were " so much developed that they could be seen through the exterior covering ; and the spleen, when cut into, seemed to be formed entirely of them. They were decidedly larger, than a large pin's head, and contained in the interior a mass of glandular corpuscles. It then appears that Drosera causes the production of tubercular PHTHISIS PULMONALIS. 251 elements in the lungs, and acts at the same time on the lymphatic system in general, thus presenting the analogy recognized in all ages between the tubercular affection and the lymphatic, not to say scrofulous temperament. In these experiments the hypertrophy of the lymphatic organs was a hypertrophy of the proper elements of the organs, and was unaccompanied by any plastic deposit. Use in Tubercular Disease.—Dr. Curie says, Drosera has been used with success in doses of from four to twenty drops of the tincture in twenty-four hours. Lycopodium,—A case by Dr. Gregg, (On Phthisis, dec. Canan- daigua, N. 1., 1859, p. 56). A young lady, aged twenty-four, in whom»a strong hereditary tendency to consumption existed, had " severe pain through the left lung, with soreness, cough, and considerable emaciation. These symptoms had continued some weeks and were increasing in severity. Lycopodium corresponded most nearly with her symptoms, and was given for two weeks. There were then " dis- covered hard lumps or knots in the muscles upon her shoulder-blades, whom proved to be boils that were very painful, and which, when they came to discharge, left pits in the flesh a half inch to three quarters in depth. The pain and soreness of the lung were both relieved as soon as the boils began to form, while the cough subsided with the pain." The pulmonic symptoms disappeared, returning only once afterwards from taking cold, and were promptly relieved by the same medicine. The author is confident that there was tuberculous matter already deposited in the left lung when first examined; the symptoms gave full evidence of the fact, and the patient had lost two brothers within two years by consumption. Lycopodium.—Phthisis developed by neglected catarrh or pneu- monia; there is hectic cough, with purulent expectoration. Tubercular consumption following haemoptysis, suitable after Calcar., Sil., Phos. Cuprum is said to hasten the suppuration of indurated glands, and thus to be unsafe in advanced cases. But, says Dr. Kissel,* it is possible that the inflammation set up round the tubercles may be curable by Copper, as it is in some cases by Nitre, or Ferrum. The bursting of vomica in the lungs otherwise healthy " may be hastened by Copper, and the unhealthy suppuration made healthy so that the cure is thus made possible." He gives a case of a boy, aged eleven, in whom "a slight, unfrequent, dry cough," became gradually stronger and more troublesome. The expectoration became thicker, at length yellow and sweetish in taste. The boy wras confined in bed and wasted away. For weeks he had chills and heat in the evening, and sweats in the morninc Complexion sallow, eyes deep set; skin moist and flaccid, pulse small and frequent. Percussion yielded a dull sound below both * British Journal of Homceop. Oct. 1860, p. 540. 252 DISEASES OF THE SANGUINOUS FUNCTION. clavicles, and beneath the scapulae, and the respiratory murmur was in these places indistinct and scarcely audible; by very deep inspira- tion there was a slight ronchus sibilans. Tongue clear, and taste natural; appetite bad. Daily five to eight very foetid, watery, brownish stools. There was no hereditary predisposition to tubercles. Ordered six drops of tincture of Acetate of Copper every hour. Four days later it was seen that the diarrhoea had ceased and the appetite had returned; the morning sweats and evening fever were more moderate, the cough was less frequent, and the expectoration diminished. The Copper was continued for fourteen days more, when there remained no more morbid symptoms. The percussion and auscultation symptoms had vanished; and the patient continued well. We have often seen good results from the third trituration of Cuprum- sulph. in advanced cases of phthisis. In a recent case, though it failed to save life, it produced such palliation of the cough and restlessness that the intelligent attendants were afraid to give the minute powder in solution as often as it had been ordered. They thought it must be strongly sedative. In curable cases in psoric constitutions we have found the general dyscrasia and debility slowly removed. " Its effects are best shown where there is great and permanent structural change in the stomach. Excessive vomiting with great exertions, and ex- tremely oppressive anxiety. Violent pain in the stomach ; oppression of the stomach, colic, obstinate constipation; diarrhoea; nocturnal emissions."* In the third stage, Arsenicum and Sulphur will be found appropriate. Dr. Pope says: In a well-marked case of acute tuberculosis, of ap- parently hopeless character, in a girl of a highly strumous constitution, Arsenicum and Calcarea, given alternately produced a most rapid and unexpected change resulting in complete recovery. Kreosote.—Constant, spasmodic, violent cough accompanied by violent retching: the expectoration copious, mucous and purulent; the patient can not lie down without great distress; stitching pains in the chest; bitter taste in the mouth; cadaverous breath; frequent green- ish, watery diarrhoea; hectic fever; copious secretion of the mucous membranes and abscesses which are excessively offensive in character, accompanied with depression of nervous power. In these conditions, says Dr. Kurtz, Kreosote is much more effectual than Arsenic, which is usually prescribed.—(Hygea) China, is given in the third stage of phthisis. In a discussion on this disease reported in Transctctions of the British Homoeopathic Society, No. 3, Drs. Kidd and Yedham spoke most highly of the results they had obtained from the pure tincture of China in the ad- vanced stage of phthisis. The power of China and the Sulphate of * Noack aud Trinks. PHTHISIS PULMONALIS. 253 Quinine in arresting the destructive metamorphosis of tissues is only beginning to be appreciated. See Vol. I., p. 488. Bromine.—An article in the Monthly Horn. Review, Nov. 1861, recommends Bromine as a valuable remedy in acute tuberculosis. Phosphorus in combination with Lime.—Dr. Churchill in his paper in the Dublin Hospital Gazette, Aug. 18, 1847, states that the "proximate cause, or at all events, an essential condition of the tubercular diathesis is the decrease in the system of the Phosphorus which it contains in an " oxygenizable state :" of the Hypo-phosphites of Lime and Soda, he says : These articles are soluble and assimilable. They induce " manifest increase of nervous power, sometimes even from the first day of their administration, together with an unusual feeling of comfort and strength. At the same time the nervous symp- toms, if they have any, disappear; also functional derangements, irri- tation of the intestinal mucous surfaces. The appetite increases often in an extraordinary manner. The evacuations become regular and more abundant; the perspirations, if they have existed, cease ; sleep becomes calm and profound." He reported in 1858, thirty-five cases, all of whom, he says, were in the second or third stage of phthisis. Of these "nine were completely cured, eleven experienced great amelioration, and fourteen died." The experiments of Dr. Churchill have now been repeated on a large scale in Europe and America, and a great amount of experience has been published. The hypo-phosphite of Lime, when successful at all, is so in minute and attenuated doses; we give it, not to supply either Phosphorus or Lime to the blood, but as the means of dynamically correcting functional derangements, and thus enabling the system to select from the food the various basic elements necessary for the blood. Alcohol in Large Doses.—Alcohol in phthisis is often capable of affording transient relief from symptoms which might not long require its use ; it is also useful in small doses in nearly all cases; but it is a perilous remedy when prescribed in large doses for conditions which we know will demand its constant repetition for a long period. Its in- fluence is proved to be curative to a certain extent, but there must be some limit to the size of the dose. It is prescribed by some practi- tioners in this city on the presumption that there is something in consumptive diseases to give the debilitated sufferers perfect immunity from the bad consequences of this poison.—If we had only to look to the lungs and the general tubercular condition we might safely give lar^e quantities of alcohol; but the stomach is also the seat of disease in nearly all consumptives. For weeks or months before death they suffer from pain and tenderness of the epigastrium, loss of appetite, thirst, frequent vomiting of acid matters. These symptoms often cause 254 DISEASES OF THE SANGUINOUS FUNCTION. more difficulty than the pulmonary disease ; and after death, M. Louis found the stomach softened or partially destroyed in texture in about one-fifth of the fatal cases; and he supposed this change to be the result of inflammation. It is probable that he was mistaken in his opinion on this point, and that the solution of the coats of the stomach is effected by the action of the gastric fluid which has retained its digestive power after death. But can it be possible that burning, irritating draughts of alcohol even largely diluted, can exert any soothing or invigorating influence upon a patient affected with any of the symptoms just enumerated? See Vol. I., 668. 861. The influence of Alcohol on the liver must not be overlooked. In all the commonest cases of phthisis in every stage, the liver is in a state of torpor or congestion; the blood which should flow rapidly through it from the stomach finds its course obstructed; the capillaries of the mucous membrane of the latter organ are congested; the appetite, though sufficiently craving, is capricious, morbid. If strong brandy can be taken without sensible and immediate injury, it is because the case is not a bad one. If it be long continued it must increase and render incurable the structural disease that already exists. If in large doses it does not intoxicate, it can only be that our patient has al- ready reached that deplorable condition in which he finds it " impos- sible to get drunk;" if it does intoxicate, it shows that the patient has already entered upon that downward course of physical and moral de- gradation in which recovery of health is impossible; and if it were possible, to the patient whose earthly existence is thus prolonged, life itself would be of little value. In the effort to support the strength of a consumptive patient by stimulants, wo encounter a danger which in acute diseases is not feared. The patient who has passed the crisis of an acute disease sustained by stimulants can bear to have the dose repeated at intervals for the pur- pose of keeping up uniform action, since we know that it will not long be needed. In chronic cases, if w*e attempt to avert the depression which follows the exhilaration of each dose, we may indeed effect it for a time; but the augmented reaction is increased in force each time it is postponed; and it becomes at last so painfully depressing that the patient can not resist the instinct that prompts to the effort to put it off again, though at the expense of rendering recovery hopeless.* So de- cidedly has Alcohol been seen to produce injurious effects in all the febrile forms of the disease, that many authors have decidedly forbidden all stimulating drinks#; as Dr. Epps (p. 237.) says, "Wine is poison in this disease and so is ale (in reference to the sick, pale ale) is deep- dyed delusion." Haemorrhage from the lungs is supposed to occur in more than half * Brit, and Foreign Med. Chir. Review. PHTHISIS PULMONALIS. 255 the whole number of patients affected with phthisis. When profuse, and the blood of a bright arterial color, we have almost uniformly relied on Hamamelis, alternated with Aconite. Millefolium is often effectual. In a case in which the life of the patient seemed endangered by mental excitement, we gave a solution of Tannate of Quinia 3; followed by almost instantaneous curative effects. See Vol. I., p. 800. Aconite and Arnica are the medicines commonly prescribed, and these are our best remedies when the haemorrhage is active.* Acetate of Lron has given more prompt and marked results than any other remedy—a drop or a two-drop dose every twenty minutes ; or less frequently, in proportion to the severity of the attack. This preparation is an uncertain one, and subject to rapid chemical decomposition on exposure to the air, or on being united with water. The Per-chloride is more manageable and perhaps equally effica- cious. All the salts of Iron seem to be similar in their mode of action. Ipecac, is often given with success. Dr. Kidd says Turpentine, five or six drops every six hours, is a most efficient remedy. Mr. Yeldham relies greatly on China. In the form of Tannate of Quinia, as mentioned ahove it acts almost instantaneously, and is unob- jectionable in a patient saturated with ague poison, and in momentary dread of death. The most absolute rest and silence; cold applications to the chest; a small piece of ice held in the mouth, are recommended as highly im- portant. Acalipha-indica.—Introduced to the profession in this country by Dr. Tonnieire, of Calcutta, in a letter to Dr. W. E. Payne. While taking it for jaundice it seemed to bring on cough and haemoptysis; it was then used in consumptive cases with haemorrhage; in three cases it promptly checked the bleeding. Dr. W. H. Holcombe says, a negro had pneumonia for which he was treated by cupping and blistering, Aconite and Phosphorus. " He got up and about, but remained weak and spiritless, had no appetite, and was constantly hawking up mouthfuls of fluid red blood. There was little or no pain in the chest or cough, no night sweats, but some emaciation, and remarkable slowness of pulse." Ipec. 3. and Hamamelis 3. lessened the red blood for a day, but the next it was red as ever. " The crepitant rale was heard over the upper half of both lungs, and there was slight"' dullness on percussion." For three or four weeks the disease resisted all treatment devised, and was growing worse: " constant and severe pain in the chest, on distressing cough, pulse one hundred to one hundred and twenty, expectoration of liquid blood more profuse ; dullness on per- * Dr. Pope, p. 37. 256 DI8EASE8 OF THE SANGUTNOUS FUNCTION. cussion increased, emaciation progressing; the patient gloomy and de- spairing, though very unwilling to die; pains in the chest; nightly cough and the bloody expectorations were distressing. Gave Acalipha-indica, twenty drops of seventh dilution in a glass of water, — a spoonful every two hours. Next morning the bleeding had ceased, pain and cough greatly de- creased. In a day more, pain, cough and expectoration all gone. Ten days later the man felt perfectly well, fine appetite, perfect secretions; walked five miles home. 2. ACUTE PHTHISIS—ACUTE CONSUMPTION. GRANULAR PHTHISIS.-PHTHISIS GRANULEUSE. Though ordinary consumption is eminently a chronic disease, lasting several months or more, we frequently meet with cases which pass ra- pidly through all its different stages, and end fatally. Dr. Flint says, one patient had been in good health when he was attacked by haemor- rhage from the lungs. He passed rapidly into confirmed phthisis, and died in seventeen days from the first attack. But in these cases there is perhaps always a predisposition and often a latent tubercular deposit already existing, as in that same case, in which there had also been a slight haemorrhage several months before, though the subsequent hack- ing cough without expectoration was so slight as to excite no appre- hension. In true acute phthisis there is no known or suspected tubercular de- posit till the acute disease begins; but, after that time, the deposit is remarkahly abundant, extensive, and it undergoes the changes of soften- ing and expectoration with great rapidity. More correctly still is this name given to the form of the disease, in which there is an accumulation in great numbers of gray semi-trans- parent granulations, either remaining isolated, or coalescing, and giving rise to a species of infiltration. This is thought to be essentially distinct in its nature from ordinary phthisis. The granular deposit may effect both lungs, and death may ensue before there is time for softening and excavation. Diagnosis.—The tubercular deposit being developed in both lungs so equally, the dullness on percussion is not so distinctive as in chronic phthisis. Auscultation may only furnish such phenomena, as the vibrat- ing and bubbling sounds, and sub-crepitant rale, belonging to acute bronchitis. There are not the exaggerated resonance, broncophony and fremitus that denote tuberculous solidification. Symptoms.—Chills, followed by some degree of fever; pulse rapid1 with heat and dryness of the surface; great muscular prostration; BRONCHIAL PHTHISIS. 257 notable increase in the frequency of the respirations, with or without great suffering from dyspnoea; lividity of the prolabia; towards the end of the disease, quiet delirium; subsultus tendinum and sometimes incontinence of urine may occur before death; pain in the chest not severe; cough more or less violent, dry, or with small expectoration, sometimes bloody. The progress is so rapid that emaciation does not occur to the extent it does in chronic phthisis. Acute Phthisis is less strongly marked than chronic phthisis. If the positive symptoms of the latter form of disease are present in an inferior degree, but the case is progressing rapidly, then acute phthisis may be suspected. From the frequency of respirations, dyspnoea, lividity and rapidity of circulation we might infer disease of the heart; but the latter ought to be positively known by conclusive physical signs, and thus distinguished. Acute phthisis is distinguished from pneumonitis by the latter having physical signs which show solidification over the whole lung (in adults) commonly the lower lobe, and it travels from lobe to lobe. In the former the disease is developed simultaneously in both lungs, the upper portions of the lungs being most affected. Treatment.—Our main reliance must be placed upon the following remedies in this malady: Aconite, Phosphorus, Stibium, Bryonia, Stannum, Mercurius-hydriodicum, Ammonium-carbonicum, Kali- hydriodicum, Digitalis, Lobelia-inflata. For the most part, we pre- scribe these medicines at the first attenuations. TUBERCULOSIS OF THE BRONCHIAL GLANDS.—BRONCHIAL PHTHISIS. Enlargement of the bronchial glands is a common accompaniment of pulmonary tuberculosis, though the symptoms during life do not always suggest this condition. In the cases in which tuberculosis is limited to these glands they may increase considerably in size; they may go through processes similar to those which they undergo in the lungs, producing cavities communicating with the bronchia, or the oesopha- gus, or even the pleural cavity. The glands primarily affected are those situated near the bronchia; thence the disease extends to the glands imbedded in the lungs, in the direction of the bronchial sub- divisions, also to those in the pericardium, the oesophagus, and the large vessels in the anterior mediastinum. It is only when the bronchial glands are the seat of tuberculous de- posit, when at the same time tubercles are not present in the lungs, that the disease gets the appellation of bronchial phthisis. It is a disease peculiar to childhood, and is rare then, for generally cases be- ginning in this form soon run into true pulmonary phthisis. Vou IL-17. 258 DISEASES OF THE SANGUINOUS FUNCTION. Prognosis. Recovery takes place in a few cases only: the rest are fatal, generally by progressing into confirmed phthisis pulmonalis. Diagnosis.—This is difficult, as explorations of the chest are with difficulty made in children's cases; it is difficult in them to distinguish this disease from true tubercular consumption. Bronchial Phthisis is common after bronchitis, and its symptoms continue to appear. The cough assumes a paroxysmal character like that of whooping-cough. There may be oedema of the face and swell- ing of the veins of the neck, arising from the pressure of the bronchial glands on the vena cava. Respiration more or less hurried; loss of flesh observable, but with great fluctuations in degree.* Lymphatic glands of the neck frequently enlarged. Physical Signs.—Pressure of enlarged bronchial glands on one of the bronchi may produce feebleness or suppression of the respiratory sound on one side. Dullness in the interscapular region on percussion ; broncial respiration remains in its ordinary site, the interscapular space behind, and in the neighborhood of the sterno-clavicular junction in front, and there it may be exaggerated. Mucous rales, and perhaps gurgling sounds in the same vicinity. If phthisis pulmonalis exist it will be re- cognized by the persisting cough, cinneration, night-sweats, &c, cha- racterestic of that disease. In simple acute bronchitis there is generally disparity of resonance between the two sides on percussion; and the bronchial rales are less marked, but more manifest at the summit of the chest; less abundant expectoration; dyspnoea and increased frequency of respiration, greater than in ordinary acute bronchitis, but less marked, less dan- gerous, and the course of the disease longer than acute general capil- lary bronchitis. Acute Bronchitis. Generally not present, except diarrhoea, which may occur in the latter stages, when the tuberculization affects the intestines. There is no eruption. Accelerated breathing a marked fea- ture, with dyspnoea more distinct and severe than in any case of typhoid. No sudh preliminary stage. Mental symptoms less marked, appear later. Typhoid Fever. Has characteristic abdominal symp- toms : as tj'mpanitis, iliac tenderness, gurgling, diarrhoea. The Typhoid eruption is positive when well marked ; but is not always present. This only present when it is compli- cated with pneumonitis, which physical signs should detect. Preceded by a preliminary stage; mental characteristic phenomena appear early and are very prominent. Pul- monary symptoms only show them- selves at a late period, not at the be- ginning. * West on Diseases of Children, p. 283. SCROFULA. 259 In that very rapid, and generally fatal form of phthisis, described as acute pulmonary tuberculosis, or tubercular pneumonia, the symptoms correspond to Phosphorus. Iodine or Hepar-sulphur. Phosphorus in health produces emaciation, glandular affections, scrofula, hectic fever, night-sweat, falling off of the hair, dry and burning throat, hawking of mucus, chronic looseness of the bowels, aphonia, cough with rawness and hoarseness, cough with purulent expectoration, also of blood or tenacious mucus, heavy fullness and tightness of the chest, palpitation of the heart, pneumonia, phthisis. Treatment.—Our principal remedies in this disease are, Phospho- rus, Iodine, Kali-hyd., Kali-bichrom., Bryonia, Kali-phosphite, Sanguinaria, Carbo-veg., Jlepar-sulph., Calcarea-carb., Amm,onia- carb., Senega, Mercurius-hyd., Drosera, Belladonna. We have witnessed the best results from the first and second at- tenuations of these medicines. Prussiaie of Potash.—We find this remedy strongly recommended for phthisical catarrh and also in pulmonary tuberculosis attended with "excessive cough and expectoration; inordinate action of the heart and hectic fever." (Dr. Butcher, Med. Reporter, Vol. VIIL, p. 408. Lancet, Cincinnati, Feb. 1362. Dr. Smart, Maine Amer. Jour. Med. Sci. No. 13.) Permanganate of Potash.—This is a new remedy not yet well proved. It is the best of all known disinfectants and is believed to possess the depurative and other useful properties of other preparations of Potassa. GENUS VI. —STRUMA. 1. SCROFULA.—KING'S EVIL. This disease was described by the Greeks under the appellation iwTpa.dec from %oipoc, hog, and by the Latins scrophules, (from scro- pha, female swine.) This name had its origin in the well-known fact, that scrofula was a disease peculiar to the above-named animal. The blood of scrofulous subjects has been found to differ materially from that of healthy individuals. In the former, there is a super- abundance of serum and a deficiency of the fibrinous portion, and the solids which are generated from this blood are, in consequence, lax, feeble, and incapable of resisting exposure, fatigue and disease. Scrofula is for the most part hereditary, but the physician is fre- quently presented with well-marked cases of the acquired disease. The circumstances which favor the formation of an original scrofulous dyscrasia, are: cold and damp habitations, want of healthy and nutritious food, constant confinement at labor in close and ill-ventilated 260 DISEASES OF THE SANGUINOUS FUNCTION. rooms, and finally, the use of pork in all its forms, as a principal article of food. Respecting this last cause, we submit to a few re- marks : Since the time of Moses, a large portion of mankind have looked upon swine as an impure animal and unfit for food. Its im- purity consists of a disorder of a purely scrofulous character which is inherent in this animal and peculiar to it, and is constantly being de- veloped, especially during confinement and subjection to the ordinary modes of feeding. Recent observations show that the new disease called trichinasis originates in the use of flesh of hogs, which, though appearing healthy, have in their flesh the germs of the living flesh-worms or trichina. When pork containing them is taken into the stomach the calcareous capsule which invests the parasite is digested: the flesh- worms are set free ; and in one day or less they begin to multiply in vast numbers. They then irritate the mucous intestinal membrane, pierce the walls of the intestines and ultimately make their way to the muscular fibres which they eat and destroy. On one occasion in Ger- many all persons who ate of the sausages prepared from a single hog, "died the slow death of exhaustion from nervous irritation, fever, and loss of muscular power. No case was benefitted by medical treatment." It is absurd to argue that flesh contaminated with the scrofulous miasm, can not communicate to the healthy body, after digestion, its morbid particles. The poison pervades every atom of the affected flesh, and no washing or digestion can destroy or banish the noxious quality. Scrofula is most common in temperate latitudes, where the changes of temperature are abrupt, and where the atmosphere is much of the time loaded with moisture. The miasm operates upon almost every struc- ture; glands, skin, ligaments, membranes, muscles, and bones, all succumb to its attacks. Diagnosis.—The signs which are supposed to indicate the scro- fulous habit, are : precocity of intellect; blonde hair; light com- plexion ; blue eyes: soft and delicate cheeks ; lips thick and red; " frequent swelling of the upper lip and nose," edges of the eyelids red and prone to inflammation; scurf and eruptions on the scalp; large head; sensitiveness to cold ; ends of the fingers blunt instead of ta- pering ; muscles soft and flabby ; morbid sexual propensities. These marks are generally supposed to characterize the scrofulous habit, but it has occurred to us to witness far more cases of scrofula in individuals the very opposite of this description; but whether or not this is the result of accident or whether an erroneous impression has prevailed upon the subject we will not now attempt to decide. Amongst the most common and simple manifestations of scrofula may be ranked glandular swellings of the neck. SCROFULA. 261 These enlargements may occur very frequently during childhood, in the form of what are vulgarly termed " kernels," on different parts of the neck. They are excited into activity by taking cold, by currents of air upon the neck, by measles, scarlatina, and whooping cough, and either remain for a long time stationary and inactive, or run on to more violent inflammation and suppuration. These swellings sometimes attain a very large size, involving most of the glands of the neck, and remain in this condition for many years. More frequently, however, owing to injudicious allopathic treatment, the swellings are dispersed by external applications, the malady is forced to embody itself upon the lungs, and a fatal phthisis pulmonalis is the result. The next form of scrofula to which we shall call attention, is that in which the joints become affected. The most important of these affec- tions are the 2. WHITE SWELLING. (ARTHROCACE,) AND THE HIP-DISEASE. The approach of these maladies is commonly gradual and insidious. Occasional pains are complained of in the diseased joint, after exer- cise ; the motions of the limb gradually become impaired, and vague pains are experienced in the neighboring joints, which induce the be- lief that healthy parts are the seat of the inflammation. As the disease advances, the ligaments, cartilages, and other structures composing the joint become so much thickened by the inflammatory action, that the limb after a time becomes stiff, and the joint immovable. In some instances the inflammation is arrested at this point, the suppurative process is prevented, and a recovery by what is called anchylosis, takes place. But in the majority of cases the disorder proceeds on to suppuration, the whole structure of the joint becomes involved in this action, a profuse discharge of matter takes place from the part, constitutional disturbance is manifest in the form of emaciation, de- bility, night-sweats, and other symptoms of hectic fever, and the patient soon succumbs. Scrofulous affections of the joints are very difficult of detection in their early stages. The pains are so vague and indefinite, as scarcely to attract attention: there is little or no swelling or discoloration over the disordered part; and there is no derange- ment of the general health which indicates that the organism is suf- fering under a serious malady. It is for this reason that the disease is allowed to make serious progress before its true nature is suspected. Like its near relative, the consumption, it strikes silently, but deeply and fatally. See p. 176. Another scrofulous disease, common in infancy, is known as 262 DISEASES OF THE SANGUINOUS FUNCTION. 3. STRUMOUS DISEASE OF THE MESENTERIC GLANDS. The characteristic signs of this malady, are : Wasting of the limbs, pale and alternated appearance of the skin, tumefaction and tender- ness of the abdomen, sunken eyes ; irregular state of the bowels, variable appetite, passage of partially digested food, general irritability. After the disorder is seated, the process of absorption is suspended, so that only a small amount of nutriment arrives at the blood, and the sufferer is soon reduced to that condition which medical men recognize as 7narasmus. See Vol. I., p. 884, 890. Although the mesenteric glands sometimes suppurate, yet much more frequently the victims to mesenteric disease die from actual star- vation. The only hope of cure in these cases is in a detection of the malady at its onset, and the services of a thoroughly, competent physician. In a previous chapter we have already treated of another, and per- haps the most dangerous form of scrofula, under the head of phthisis pulmonalis, or tubercular consumption, to which we refer the reader. There are other scrofulous affections of the different parts of the jrganism, as the brain, the liver, the skin, the spleen, and the spinal marrow. The Index under proper heads may be consulted with refe- rence to this subject. Hahnemann has included scrofula as a form of psora, but evidently on insufficient grounds. Psora is contagious, scrofula non-contagious. The matter of psoric eruption is capable of communicating its simili- tude by inoculation; that of scrofula is innocuous when inoculated. Psora, in its specific development upon the skin, assumes the appear- ance of a vesicular eruption; scrofula makes its appearance in the form of extensive ulcers, abscesses, &c. The psoric miasm exercises its specific affinity upon the skin; the scrofulous miasm upon the glandular system. Psora is no respecter of persons, but attacks all constitutions, temperaments, and organizations alike ; scrofola is sup- posed to select its subjects from those who are daintily formed, and possess peculiarities of organization ; psora is readily cured by anti- psorics; scrofula always requires much time, and is often absolutely incurable by any course of treatment. Psora can not be artificially acquired, by any particular mode of life, or any particular food : with scrofula it is the reverse. Finally, the development of the psoric miasm, when it is clear and apparent, is always specific and uniform, viz: in the vesicular eruptions of a peculiar appearance upon the sur- face, and the malady is unequivocally contagious; while the develop- ment of the scrofulous miasm is subject to very great variations, but for the most part attacking the glands, rather than the skin, and de- cidedly non-contagious. SCROFULA. 263 Causes.—The scrofulous habit is, in most instances, inherited. In its hereditary subjects we may notice from birth radical unsoundness of constitution, an irritability, sensitiveness to slight exposures, prone- ness to catarrhal difficulties, and an inability to resist diseases, which is non-apparent in healthy children. The acquired scrofulous habit is generally amongst the poor, who are ill-fed, clad, and housed. We have before alluded to the causes which especially induce this variety of the disease; they are also the chief exciting influences of the hereditary dyscrasia. Atmospheric vicissitudes, abuse of stimulants, venereal excesses, masturbation, intestinal irritation, excessive mental and physical occupation, scarlatina, measles, abuse of mercury, iodine and other drugs which unduly stimulate the glandular system, also ex- cite the latent disorder. Treatment.—It has been observed that scrofulous persons are pe- culiarly sensitive to cold, and that abrupt changes from heat to cold, in a moist region, are especially calculated to call into active operation the latent malady. For this reason it behooves those who are liable to tiiis affection, whether by hereditary or acquired predisposition, to dwell, if possible, in a warm and equable climate. When the lungs become affected, this course will often be necessary in order to save life. In all scrofulous diseases, too much stress can not well be laid upon the importance of a mild, dry, and uniform temperature. The food of scrofulous subjects should always be of the most nutri- tious character, in order that a due proportion of fibrine may be intro- duced into the blood. Fresh meats, like beef, mutton, venison, fowls, and veal should constitute the principle articles of food; and bread, rice and other farinaceous substances should be made to take the place of watery and succulent vegetables. Porter, ale, and light wines may also be used moderately with advantage. Much exercise in the open air is also essential. In taking exercise, it is of the utmost importance that the mind should be agreeably occu- pied, for if we walk or ride as a task, we shall obtain very little benefit. Bathing, both in fresh and salt water, is also a means of securing a healthy action of the skin, and of imparting tone and vigor to the whole system. The clothing should always be adapted to the season, and in tem- perate and cold latitudes we strongly advise the buckskin wrapper to be worn over thin linen, silk, or Canton-flannel under-shirt. We com- mend the use of these garments during the winter from personal ex- perience. Vol. I., p. 197. The remedies most deserving of confidence in the treatment of scro- fula, in its various forms, are: Sulphur, Hepar-sidph., Mercurius, Io- dine, Baryta, Dulcamara, Conium, Belladonna, Lycopodium, Sepia} 264 DISEASES OF THE SANGUINOU8 FUNCTION. Calcarea-carb., Rhus-tox., Aurum-muriaticum, China, Ferrum- iodide, Mercurius, Oleum-jecoris-aselli. Sulphur.—Scrofulous ulcers on different parts of the surface; humid eruptions behind the ears; purulent discharges from the ears; scrofulous ophthalmia of children, with eruptions about the eyes, and ulcers on the cornea; chronic enlargement of the tonsils ; enlarged ovaria; swelling of the axillary glands ; swelled nose; frequent nose- bleed ; swelled upper-lip; swelling of the glands under the lower jaw; enlargement and suppuration of the inguinal glands ; swelling of the posterior cervical glands; white swelling of the knee; emaciation; chronic inflammation of the eye-lids; scrofulous ophthalmia, attended with great intolerance of light, and sense of fullness and distention of the lids; pulmonary cough, with sticking pains in the chest, and co- pious purulent expectoration ; inflammation and pain in the knee and hip-joints; itching pimples upon the scalp, and pain at the roots of the hairs ; stitching pains in the ears and in the parotid glands ; pain- ful swelling of the upper-lip and aim of the nose; pain in the region of the liver after exercise; pain in the abdomen on pressure, and in the inguinal glands ; sensation of weariness and fatigue in all the limbs; want of vitality, sensitiveness to cold; pains worse during cold weather; despondency, alternating with gaiety; irritable, insolent and dis- contented. Administration.—One grain of the third trituration every twenty- four hours, until the beneficial effects are visible. In the treatment of scrofula, as in all chronic diseases, we generally succeed best with the remedies given in the higher dilutions and re- peated at longer intervals than we usually depend on in acute cases. On this point Dr. Lutze says: " In cases of chronic diseases, or diseases which run a long course, have existed for years, and deeply taint the organism, as deafness, blindness, gout, paralysis, old eruptions, open sores and old ulcers, fistulas, herpes, curvatures of the back and bones, caries of the bones, the medicine should never be frequently repeated, nor should the same medicine be given twice in succession. Each dose should be allowed sufficient time to develop its full effect, since it is the subse- quent action of the drug that achieves a cure." In such cases the practice of the author now is to dissolve " three to fi/ce pellets of the 30th potency in a cupful of fresh water, of which I give a swallow morning and evening for four or five days, after which I allow the medicine to act for three or four months, sometimes even for five or six months, or even longer, if the improvement continues: if it should cease, and three months should have elapsed, I then give another remedy. " The reason why I do not give another remedy under three months SCROFULA. 265 (except in case acute symptoms supervene,) is, because I have noticed that the primary action of the drug is sometimes not developed under two or three months, after which a cure takes place, which could not have been accomplished if I had not waited a sufficient length of time to allow* the medicine to manifest its full action, or if I had interfered with it by the untimely repetion of the dose. " The curative process should not be viewed as materially as it very frequently is. The properly-selected remedy starts the cure, the natural curative power finishes it." Sulphur.—Case by Dr. Lutze.—"Mr. H. from Holstein. Age 40 years. Almost constant pain in the left side of the chest; frequent yawning, sneezing and eructations. Occasional pain and swelling in the pit of the stomach, empty eructations when pressing upon this region. Deaf of the left ear from his infancy. Swelling at times of the left cheek, at other times of the mouth, nose and eye. Stiffness in the nape of the neck. Drawing pains in the left thigh. Weakness of the stomach and nerves. In former years, inflammation of the glands and lungs. He had the itch when young, which had been removed with an oint- ment. I sent him four powders, to be taken in eight weeks. No. 1 containing four pellets of Sulphur 30, which were to be dissolved in a cupful of water, a swallow to be taken morning and night for four days. After eight weeks the following report was sent to me: A few weeks after taking the medicine, all the symptoms grew worse, but in three weeks a general improvement set in. The left ear began to discharge again, which had not been the case for years, and the flatulence and pains in the chest have abated, so that the patient feels much better. I sent four powders of Sugar of Milk, for the effect of Sulphur now first began to show itself. The next report being still more favorable, I continued the non-medicinal powders. Twelve months after the com- mencement of the treatment, I received the following report: ' The hear- ing of the left ear, which had been deaf these thirty-two years, is re- stored, and I am cured, except a small swelling near the left eye and some stiffness of the nape of the neck.' Another non-medicinal dose completed the cure. One dose of Sulphur 30 did all this in the space of four months." After some other cases as strong or stronger in the testimony they give in favor of the principle contended for by Dr. Lutze, he thus con- cludes this section: "These cases show that no second dose of a remedy should be given as long as the first dose has not exhausted its action, and in cases where no effect is observed, as in case of deaf and dumb patients, we allow a dose to act at least for three to five months; since it is impos- sible to know what is going on in the interior of the organism, and it is so easy to injure the salutary action of a drug by the untimely exhibi- 266 DISEASES OF THE SANGUINOUS FUNCTION. tion of another remedy of which we have had repeated instances in the case of externally perceptible ailments." Iodine.—Hahnemann (Chronic Diseases Vol. II.) says : " Iodine is particularly indicated by the following symptoms: Dizziness in the morning; beatings in the head; smarting in the eyes; buzzing in the ears ; hardness of hearing; coated tongue; salivation; taste of soap in the mouth ; sour eructations with burning; heartburn after eating heavy food; canine hunger; nausea; shifting of flatulence; meteorism; con- stipation ; wetting the bed; delay of the menses; cough; old morning cough ; difficulty of breathing; external swelling of the neck ; lassitude of the arms in the morning, in the bed; numbness of the fingers; dis- tortion of the bones ; dryness of the skin; night sweat." Teste says, these are only the secondary symptoms of Iodine, and that the primary ones are exceedingly similar to Ipecac. The effect of excessive doses may be seen in a case given by Dr. Gairdner in a work on Iodine : A young English lady had bronchocele for which Iodine was prescribed. For a time the action was favorable and the tumor was diminished; but a gnawing pain commenced in the stomach; great oppression and anx- iety. The remedy was pressed further. In a week she became ema- ciated; there were vomiting, pain in the abdomen most severe; thirst distressing ; alarming diarrhoea; excrutiating pain in the stomach; vio- lent cramps and convulsive actions of the muscles, arms, back, and legs; vomiting and purging of feculent, thin, bloody, slimy, or dark green matters, streaked with blood; tongue loaded with thick crust of the same color; countenance pale, contracted with peculiar expression, denoting abdominal suffering; pulse small, hard, frequent, scarcely to be numbered; inability to swallow. She was only relieved by repeated warm anodyne embrocations to the pit of the stomach and feet; hot bath. For ten days she had frequent attacks of diarrhoea, with intense abdominal pain; arms and body became almost fleshless; the breasts, which had been large, were almost flat; calves of the legs almost dis- appeared; thighs little larger than the wrists in health. Dr. Gairdner says, he never before saw such rapid and complete emaciation; and the French nurse exclaimed " de Charnee /" She was subject to re- lapses for many months, with frequent, violent spasms of the stomach. Her nervous system was so deranged that she never enjoyed one hour free from the most wretched depression of spirits. A work by M. le Dr. Labourdette, shows the therapeutic advantage of the milk of animals, medicated by digestive assimilation, in passing certain drugs in an infinitesimal form through their bodies. This work was discussed in the French Academy of Medicine, April 26,1859, in the course of which M. Trousseau proclaimed the dynamic action of drugs and showed that their curative power in the smallest doses was not de- pendent on contact of the drug in its crude form with the living organ- SCROFULA. 267 ism. Iron, he said, was now known to be only assimilated in infini- tesimal proportions, and was chiefly useful in stimulating the assimilative organs to help themselves from the common food ; that milk from a cow or nurse will act by virtue of dynamic properties, imparted by the gene- ral state determined in the animal, irrespective of the quantity of mercury which it contains. M. Chatin gives in the Gazette des Hopi- taux cases of goitre, cured by the administration of vegetables, con- taining Iodine, after Iodine in a crude state had failed. Makasmus.—Iodine.—M. Grange having advised the use of iodized food for goitrous patients. M. Rilliet of Geneva, where goitre is very prevalent, made a trituration of Hydriodate of Potash, to be given in the food in the proportion of one .part to a thousand, which was supposed to be perfectly innocent; and thus seasoned the food of those for whom he prescribed. But he soon found unsatisfactory results. * " Two ladies, past 60, and a gentleman, past 45, belonging to differ- ent families," were attacked by "emaciation, palpitations, accelerated pulse, general trembling, great nervous mobility and diminution of strength." M. Rilliet had forgotten his iodized food, and was perplexed. Was it " incipient heart-disease, latent diabetes, or a chloro-anaemic state, due to causes undetermined?" He had seen similar symptoms follow the use of Hydriodate of Potash, in doses of -^ of a grain daily; made out the nature of the new disease; and cured his three patients in the course of several months. One relapsed by going to the sea- side, came near phthisis, and recovered after a country residence and drinking asses' milk. Another lady near 60, by a short residence on the seaboard, " returning to Geneva, she was excessively thin, her pulse at 130, and her nervous system highly excited. She recovered in two months under change of air and drinking asses' milk. These two pa- tients had taken no Iodine, and must have inhaled it in the sea air. M. Rilliet concludes in opposition to the authors who had recommended iodized food: 1. "That the long-continued absorption of small doses of an iodized salt, whether mingled with water, air, or food, is not free from danger. 2. That the inhabitants of certain localities are more than others ex- posed to iodic toxication." 3. That this special susceptibility depends on the Iodine in the air, water, or aliments furnished in these places. 4. That iodic poisoning is more to be dreaded when given in small than in large doses. 5. That these results are more to be feared in persons advanced in life; and when Iodine is taken by persons past the fortieth year, it should be suspended on the first symptoms of saturation. These symptoms are: "Canine appetite, emaciation, palpitations, nervous sus- ceptibility." Dr. Rilliet might have saved himself and his patients some trouble * Gazette Hebdomadaire. 268 DISEASES OF THE SANGULNOU8 FUNCTION. by studying the pathogenesis of Iodine long ago, given by Hahnemann: * " Over-excitement of the whole nervous system; ebullition of blood and pulsations over the whole body, increased by any effort; trembling, tottering gait; great debility; atrophy; extreme emaciation; general oedema. Pulse accelerated, hard and small; consumptive fever; vari- able appetite—either excessive or absent; digestion very feeble ; dys- pepsia ; suffocation; is blown on going up-stairs, with violent palpitations and cramp-like pains about the heart on the least effort." Exercise.—Muscular Motion.—This being a disease in which the lymphatics are specially implicated, and these vessels having no central organ of impulse, like the heart, to propel their contents forward, the support given to their walls by the feeble tissue surrounding them is but small, and some additional aid to propel the fluid is necessary. The lymph itself is imperfect, arising from imperfect nutrition; and all these circumstances conspire to cause stagnation in the lymphatic vessels, and those glandular enlargements characteristic of scrofula. Muscular con- tractions, when not accompanied by nervous exhaustion, propel the lymph forward and toward the general current of the venous circulation. The walls of the lymphatics are supported by the tonicity of the adjacent tissue; and the lymph itself is more perfect, because the functions of the muscular and glandular systems are more perfectly performed. Animal Magnetism.—This disease was called centuries ago the " King's Evil," because it was believed that the sovereign was imbued with a peculiar virtue, by which he could cure it by the laying of his hand on the diseased person. The first king of England who was sup- posed to have this virtue, was Edward the Confessor.f The power was transmitted to his successors. In the reign of Charles the Second, in the course of fourteen years, no less than 92,107 patients were touched by the king's hand; and according to Dr. Richard Wiseman, Sergeant Surgeon to the king, the most of these were cured or benefitted. % The power of Edward the Confessor to cure scrofulous disease by the " laying on of hands," was so fully believed in by the people of England that Shakspeare introduces it as a feature in that monarch's character in the tragedy of Macbeth. (Act IV., Vol. I. p. 334). Mal- colm inquires of the doctor: ----------"Comes the king forth, I pray youl Doctor. Aye, sir: There are a crew of wretched souls That sir : his cure. Their malady subdues The great essay of art, but at his touch, Such sanctity hath Heaven given his hand, They instantly amend. Malcolm. I thank you, Doctor. * Materia Medica Pura. t Million of Facts. % " Surgical Treatises on Tumors, Ulcers, &c" SCROFULA. 269 MacDuff. What is this disease he means 1 Malcolm. " 'Tis called ' The Evil!' A most miraculous work in this good king; Which often, since my here-remain in England, I have seen him do. How he solicits Heaven Himself best knows ; but strangely visited people, All swollen and ulcerous, pitiful to the eye, The mere despair of surgery he cures ; Hanging a golden stamp about their necks, Put on with holy prayers. And 'tis spoken, To the succeeding royalty, he leaves The healing benediction. With this strange virtue, He hath a heavenly gift of prophecy ; And sundry blessings hang about his throne That speak him full of grace." Rhus-tox.—External indications : Tinea capitis ; soft tubercles on the hairy scalp; scrofulous ophthalmia, with photophobia, and an eruption about the eyes ; chronic swelling and induration of the parotid gland, the axillary, and other glands; enlargement of the bones ; herpetic and moist or dry scurfy eruptions in different parts of the body ; swell- ing and other signs of inflammation in the hip and knee-joints. Pain in the hip-joint, increased on pressing the trochanter major, and attended with the shortening of the limb, and alternating pains in the knee; pains of white-swelling, and scrofulous affections of the ankle-joint; scalp painful to the touch, or from moving the hair back- wards ; inflammation and tenderness of the edges of the eye-lids ; eyes sensitive to light; eye-lids itch and feel swollen ; crusty eruption in the nose, and about the mouth; repugnance to bread and other food; stitches in the side; short, or anxious, and painful cough; oppression of the chest; glandular swellings, painful when touched; stiffness and lameness of the limbs; very sensitive to the open air; pains worst during inaction, or in the cold air. Ill humor; languor; disinclination to all mental or bodily exertion. Administration.—A drop of the third dilution each day, as long as may be seemed necessary. Iodine.—Enlargement of the cervical parotid, thyroid and tonsil glands: scrofulous inflammation of the knee, with swelling, heat, and redness; elongated and enlarged uvula; induration of the os uteri; glandular indurations in different parts of the body; rough and dry skin; general emaciation ; hectic appearance. Physical Sensations.—Catarrhal affections of the mucous mem- branes depending on scrofula ; swelling and pain in the liver; inflam- mation in the knee, with stitches and burning, and increased pain on motion of the joint or from pressure; contraction 'of the oesophagus from enlargement and inflammation of the glands and mucous mem- 270 diseases of the sanguinous function. brane, with stitching pains during deglutition; enlarged mesenteric glands; tumid abdomen with pains on pressure; swelling and pain in the bronchial glands; glandular swellings about the neck and axilla, painful, especially on pressure; itching and pimples on the arms and chest; general debility; hectic fever; pains aggravated by exercise, by contact and by warmth. Nervous irritability and increased sensi- tiveness to external impressions. Administration.—Same as Rhus. Baryta-mur.—Chronic induration of the cervical glands ; scrofulous eruptions and ulcerations; tinea capitis ; enlargement of the liver, of the testes, and of the mammae ; chronic inflammation of the eyelids. Physical Sensations.—Itching eruptions of the scalp ; general ema- ciation and debility ; scrofulous disease of the throat, aggravated after cold; scrofulous affections of the ears, attended with throbbing and itching, and discharge of purulent matter; inflammation and suppura- tion of the tonsils; pains in the affected joints and in the long bones; liability to sore throat after every cold; disease of the mesenteric glands in children; pains, mostly on the left side, when sitting, and re- lieved by exercise in the open air; adapted to old men and young children. Imbecility ; absence of mind ; impaired intellectual powers. Administration.—The second or third attenuation may be given— a dose daily—until the requisite impression is produced. Dulcamara. — External Indications. — Moist and suppurating herpes, forming crusts, or scurvy, branlike eruptions ; swellings of the cervical and submaxillary and inguinal glands; swelling of the calf of the leg; emaciation; scrofulous inflammation of the eyelids. Physical Sensations.—Pains in the enlarged glands, particularly on motion; great susceptibility to cold ; pains in the joints on exposure to cold; pains Avorse during rest; paralysis of the upper eyelids; phthisis pulmonalis, before the tubercles commence softening ; pulmonary symp- toms brought on by repeated colds; pains in the chest; febrile symp- toms ; lassitude; bruised sensations. Disposition restless, angry, and quarrelsome. Administration.—In the same manner as Baryta. Conium-maculatum.—Swelling, induration, and suppuration of the external glands ; malignant scrofula ; caries of the bones ; scrofulous photophobia; diseased mesentric glands in children; enlargement and induration of the liver and pancreas. Scrofulous swellings, which evince a disposition to run into schirrous degenerations; pains in the bones and in the malignant ulcerations; inflammation, swelling and pain in the ovaries; painful swelling of the uterus; pain in the region of the liver, when walking; purulent expectoration from softened tubercles; intolerance to light, in consequence of scrofulous ophthalmia ; dull pain in the knee, when stepping; bruised and sore feeling in the calves of SCROFULA. 271 the legs ; pains worse during rest and in the night. Dullness of intel- lect ; want of memory; irritability. Remarks.—For indurated glands, Dr. Johannsen asserts that " Co- nium in the second dilution stands highest as a remedy, and next to it Mercurius-solubilis" Clematis-erecta.—(Boenninghausen) Clinical indications for this remedy:—Indurations, resulting from inflammation; glandular indura- tions of inguinal glands; of the testicles ; of the penis ; of the urethra; interrupted emission of urine ; purulent urine ; purulent deposit in the urine; general eruptions ; squamous exanthemata; squamous tetters ; herpes, with shooting pains ; horror of bathing one's-self; exacerbation from application of lotions (in diseases of the skin); the same from warm fomentations. Clematis is particularly suited to persons of mature age, to those of florid complexions ; of relaxed, cachectic, and scrofulous constitutions. Administration.—We advise the third attenuation—a dose daily until its effects are apparent. Belladonna.—Glandular swellings, with suppuration; ulcers ; ema- ciation ; inflammation and swelling of the bones; eyelids inflamed; ulcers upon the cornea; photophobia; swelling of the lips, nose, tongue, uvula, tonsils ; bleeding at the nose; swelling and spongy gums. In- flammation and pains in the enlarged glands, and in the periosteum and bones; diseased mesenteric glands, with atrophy; inflammation of the eyes, with heat, redness, and great intolerance to light; pain in the ball of the eye; double vision; roaring in the ears ; painful swelling of the parotid gland; soreness of the throat; impeded deglutition; lame- ness of the limbs, when moved; smarting and burning pains in the hip- joint, increased by contact or motion, and during the night; painful ulcers on the skin ; sensitiveness to cold air; adapted to the scrofulous affections of children and females of a mild temper. Irritability; amorous, nervous, excitable, talkative. Administration.—Same as Conium. Lycopodium.—For the scrofulous dyscrasia, and especially where the periosteum, bones, and cervical glands are affected. This remedy is adapted to lymphatic constitutions. Sepia will be found an efficacious remedy in scrofulous females who are troubled with irregularities in the menstrual functions. It has been employed successfully in indurations of the uterus, corrosive leucorr- hoea, and in pulmonary phthisis with profuse purulent expectoration. Calcarea-carb.—According to Hahnemann, Carbonate of Lime is indispensable in those cases where the menses appear too early and are too profuse. It is also appropriate in young persons of scrofulous hab4ts. In children presenting the usual marks of the scrofulous dys- crasia, it is one of our most valuable remedies. It is highly recom- 272 diseases of the sanguinous function. mended likewise in the scrofulous ophthalmiae of children, particularly after ulcers have formed on the cornea. Also in marasmus, arising from diseased mesenteric glands, it is an admirable remedy in alterna- tion with Iodine. Scrofulous eruptions and ulcers of children often yield to this remedy, after Sulphur, Mercurius, and Hepar-sulphuris have been used in vain. Hepar-sulphuris is adapted to the cure of scrofulous ophthal- mia with profuse lachrymation, and much mucous discharge from the meibomian glands, and in morbus coxarius or coxalgia, after a purulent discharge has occurred. This medicine is proper for scrofulous and lymphatic constitutions. " Arsenicum is one of the most important remedies in scrofula, for removing indurations of the glands and deformities of the bones, for regulating the discharges from the bowels, and for restoring the skin to a healthy state. Also in scrofulous ophthalmia it is of great ser- vice." (Dr. Johannson, Homeopathic Journal, Vol. I., No. 11.) Administration.—As a general rule, the first to the third attenua- tions should be selected, and the doses repeated once or twice daily, until a satisfactory impression is produced on the affected structure. Mercurius.—This remedy is advised by Hahnemann in scrofula, combined with syphilis. The glandular inflammations will be charac- terized by a diffused redness, much swelling and gnawing, stinging or darting pains, worse at night in bed. It should be consulted in affec- tions of the bones, the joints, the eyes, and in eruptions and ulcers upon the surface. The following preparations of Mercurius we es- pecially commend in scrofula: Merc-sol, Merc.-iod., and Merc.-pro3- cip.-rubrum. Aurum-mur., Ferrum, and China are worthy of consideration in protracted and obstinate cases, where the strength of the patient has become much impaired, and but little impression has been made by the previous remedies. Hartmann observes that he has derived essential benefit from Oleum- jecoris-aselli, (cod-liver oil) in every form of the disease, especially in the precursory stage, when no particular organ was affected; the patient looked pale, emaciated, the muscles became flabby, the patient showed an aversion to meat and vegetables, and wanted to eat bread and butter all the time. I gave it in tea-spoonful doses, morning and evening, almost always with success. In scrofulous affections of bones it likewise proved useful, but less so in other forms of the disease." (Hartmann's Chronic Diseases, Vol. III., p. 54.) Dr. J. H. Bennett, of London, has found the cod-liver oil of great service in scrofulous cases characterized by general or local atrophy. But in scrofulous affections in which the general health continues unimpaired, and the digestive functions are not deranged, Dr. B. BRONCHOCELE. 273 advises Iodine. We have employed the oil in doses of a drachm, three times daily, with eminent success in almost every form of scrofula. For scrofulous ulcers with callous edges, and fistulas, Silicea alone, or in alternation with Phosphorus, Acid-phosphoric, and Conium were found by Dr. Johannsen most useful. When the ulcers are greenish and offensive, Carb.-veg., or Mer- curius-dulc. is advised. In scrofulous ophthalmia, indurated glands, and diseases of the bones, Arsenicum, Conium, Mercur.-sol., Hepar-sul. and Aurum, are the best remedies. BRONCHOCELE.—GOITRE. This disease is characterized by a tumor on the front of the neck, seated between the trachea and the skin, occupying principally the typhoid gland. It is a true hypertrophy and is divided into three prin- cipal forms, accordingly as the vascular, glandular, or connective tissues are involved. 1. Vascular Goitre.—a. Congestion of the Thyroid Gland.— This gland is abundantly supplied by large vessels distributed in lax cellular tissue ; and it is the organ, next to the spleen, most liable to considerable changes of size from congestion. The effects of congestion generally go no farther than simply to engorge the gland with blood. Sudden turgescence of the gland during life, is often found to have originated from suppressed menstruation, and in young persons from masturbation. In some cases it becomes permanent, especially after puberty in females subject to amenorrhoea. b. Thyroidean Apoplexy.—Excessive turgescence of the gland may cause a rupture of a vessel, and the effusion of blood. M. Bach says, he has found coagula of blood enclosed in a dense cellular pouch. The coagulum undergoes the same changes as in other apoplexies, and may lay the foundation of what is called cystic goitre. The vessels of the gland may become atrophied by the pressure. The goitre may become smaller and harder. A cicatricial tissue may form and extend into other tissues and render the gland extremely hard. A calcareous deposit may be found in this cicatricial tissue. c. Aneurismal Goitre.—This has been described, but is extremely rare. d. Yascular Parenchymatous Goitre,—The part becomes isolated from the sound parts by condensed cellular tissue, so that the de- generated lobules may be easily enucleated. The lobule is deep red, the granular structure disappearing. The vessels are sometimes dilated and gorged with blood; the vessels toward the centre are dilated, tho 274 diseases of the sangutnous function. surrounding tissue becomes denser, the capsules almost disappearing. The minute vessels of the capillary system become encrusted with cal- careous matter. (Ecker.) 2. Parenchymatous Bronchocele.—This consists of hypertrophy of the thyroid gland, properly, an abnormal development of the glandu- lar capsules distended by a gelatinous fluid. Dr. Bach found some capsules containing within them others, the inner being separated from the outer one by a fluid, and being formed of cells like those constitut- ing the normal contents of the capsules almost all containing a nucleus, some enclosing one or more young cells. The centre of the capsule appears hollow and contains young capsules. When these are a half millimetre in length they are already diseased. Gelatinous snbstance enters the capsules by endesmosis and distends the anhistous membrane. The young capsules are formed of cells by endogenous generation, and are clothed later by an anhistous membrane. The young cells of the young cysts only acquire nuclei at a later period. Rokitansky says, the thyroid gland is endowed with great powers of reproduction. This hypertrophy of this gland is often endemic ; it may exist at-birth. The child respires long and deeply, with a feeble plaintive tone, heard at considerable distance; expiration is painful; drinking may be im- possible. Bach saw a child suffocated by the pressure of the external part of the gland so far as to produce irritation on the pneumo-gastric nerve. A symptom indicating this was the excretion of an enormous quantity of bronchial foam. He thinks some cases of thymus asthma are due to a posterior development of the thyroid. Treatment.—Aconite in acute cases ; in chronic enlargement of the gland give Iodine, Iodide of Potash, Calcarea. 3. Transformations in the Structure of the Thyroid Tissues. —The stroma of this gland is a fibro-cellular tissue in which ramifies a net-work of blood-vessels. It is liable to be changed in part into fibrous tissue, and its primordial texture is the same as that of normal fibrin. One of the characters of accidental fibrous tissue is its retractihility; it may also undergo the fatty, osseous, or cretaceous (chalky) transformation. Air may also be effused amidst the cellular tissue, and other new products may be there developed. a. Cellular Goitre,—Hildenreich saw a goitre which grew very rapidly in a man aged sixty. It consisted of cells irregularly shaped, some of their cavities intercommunicating, and their walls containing cartilaginous or osseous matter, and consisting mainly of new fibrous tissue. The fluid within them was serous, gelatinous, and bloody. The glandular element was not visible. b. Emphysematous Goitre.—Larrey's " aerienP It is produced by rupture of some portion of the air-tube. c. Cystic Goitre.—A cyst is developed in the midst of the normal BRONCHOCELE. 275 elements of the thyroid gland, and contains new fluid or solid for- mation. It may originate from a pathological blastema, inflammation, the transformation of an apoplectic coagulum, or the degeneration of glandular capsules. Scirrhus, Encephaloid, tubercle, and hydatids of the thyroid have not yet been proved to exist, though Larrey, and others, have described some of them. The walls of the cystic goitre consist of a layer of cellular tissue amidst which fibres are deposited. New vessels are developed within the walls, and its internal surface is lined with epithelium. Posteriorly the walls are very thin and transparent. The vessels pressing the wall forward become weakened and are often rup- tured from evacuation of the cell-fluid. The wall may pass into a state of cartilage, (enchondroma,) and in the course of years may become ossified. The contents of the cyst may be : 1. Serum from blood effused, or endesmosis; but it contains no fibrin, is. incapable of or- ganization, but may be absorbed. Other products may be formed as the serosity disappears,—such as crystals of cholesterine, and salts of lime. 2. Colloid matter, a colorless or yellowish gelatinous mass, containing no cells. (Bach. Mem. Imper. Acad. Med.) Causes.—Bronchocele is an endemic disease, being remarkably prevalent in certain localities, as Derbyshire, England, and the deep damp valleys of the Alps. But the precise physical peculiarities of these localities has not yet been ascertained. It is not confined to certain elevations or latitudes, and has been observed in every climate in both hemispheres. Its origin is usually ascribed to the water used by the inhabitants of the region where it most prevails. Popular belief refers goitre to the use of mow-water, and we have seen the goitrous tumor enlarge during the use of snowT-water in winter; but certain fountains and rivers are more notorious as sources of this disease, of which the Saskatchawan river, in British North-America, is one of the most remarkable. Dr. Richardson attributes its influence to the presence of magnesian lime-stone, which he found in that river. (Nar- rative of Franklin? s Expedition to the Polar Sea, &c) Dr. M'Clelland has endeavored to show, that goitre in India is everywhere found in the localities in which the water is impregnated with carbonate of lime. In the United States we find lime-stone water in every part of many states, and in almost every locality we meet with cases of en- larged thyroid gland. They are more common in women, and especially those subject to ovarian activity. Treatment.—At a moderately early period of this malady, we entertain no doubt, respecting the entire success of an expert homoeo- pathic treatment. The influence of minute doses of carefully selected remedies, over these glandular enlargements, is often truly astonishing. But to prove most efficient the higher potencies must be employed. 276 DISEASES OF THE SANGITNOUS FUNCTION. The principal remedies are: Iodine, Calcarea-carb., Kali-hyd., Merc.-hyd., Hepar-sulph., Arsenicum-hyd., Kali-brom., Sepia, Silicea, Bromine, Conium, Spongia. We usually prescribe Iodine, Calcarea, Hepar, Arsenicum, Sepia, Silicea, Conium and Spongia in the high attenuations repeated at long intervals. Kali-hyd., Kali-brom., and Mercurius-hyd., at the first and second triturations, and the dose repeated two or three times a day. Iodine.—Its best powers are displayed in causing the absorption of the products of exudation, and of capsules in process of transformation into colloid matter. It never causes the absorption of voluminous cystic goitres containing colloid matter; it exerts no action on those cysts containing serosity, or such as have undergone tertiary trans- formations. It has no effect upon cellular goitre or in that accompanied by carcinomatous or other morbid products. Iodine may be expected to be successful in dispersing "the parenchy- matous cystic goitre, on condition that this is principally due to the degeneration of the capsules, and that the vascular element does not predominate." (Mem. Imper. Acad, de Med, Paris, 1855.) Dr. Henderson said in his first edition, that Iodine was known as a remedy for goitre before it was known to be capable of causing it; and homoeopathists prescribed it as a homoeopathic remedy, " because they believed, and had no doubt that experience would ultimately prove that its curative action was dependent on its capacity to produce the disease ; though the circumstances necessary for such a pathogenetic effect have not yet been discovered." In his second edition he says: The expectation expressed in his former edition has has been ful- filled. A man taking five grains of Hydriodate of Potash twice a day, after eight days became affected with "a rapidly growing swelling of the thyroid gland." (Brit. Jour.) Spongia.—In the thirteenth century roasted sponge was employed in this disease by Arnold de Villeneuve. It is used homceopathically for the following symptoms : Moral and physical debility; tendency to start; paroxysms of anguish: sense of weariness in the upper portion of the body, and numbness in the lower portion ; alternate sad- ness and mirthfulness ; fever with shuddering in the back and coldness all over, followed by dry heat, or accompanied with sweat; dryness in the day-time; sleep full of dreams and fantastic visions, which some- times continue after waking; frequent waking with a start; itching of the skin, as if sweat would break out; red spots ; rush of blood to the head ; vertigo as if one would fall sideways or backwards; oppressive headache, at the top of the head, at the occiput or temples; stitch in the temples; oppressive pain in the forehead from within outwards; fullness of the head, with heat, which is perceived by the hand, and sometimes sudden flow of saliva; semi-lateral headache ; sensitiveness BRONCHOCELE. 277 and itching of the hairy scalp; stitches in the eyes; redness and burning of the eyes ; lachrymation; heaviness and nightly agglutina- tions of the lids ; myopia; constrictive otalgia ; retention and thicken- ing of the nasal mucus; nose-bleed; pale face, with sunken eyes and anxiety in the features; crampy pain in the articulations of the jaw ; blisters at the edges of the tongue, and in the inner surface of the cheeks; stitches in the throat; pricking sensation above the throat- pit; induration of the submaxillary glands and of the thyroid body; sickness at the stomach; sensation of sickness and faintness at the stomach, as if one had drunk a quantity of warm water; sour re- gurgitations ; vomiting ; constrictive pains at the stomach ; pinching in the abdomen. Cutting colic after a meal; crampy pains in the groins; swelling of the inguinal glands; diarrhoeic stools, with tenes- mus ; hard stools ; formication in the rectum; smarting at the anus ; increase of the urinary secretion; urine with a white yellow or grayish sediment; crampy pain in the testicles; induration of the testicles; premature and profuse menses. Great dryness of the larynx with short and barking cough ; embarrassed breathing as if the larynx and trachea were narrower; pain at the larynx when touching it; hoarseness, dry, hollow, wheezing cough, worse in the evening; excited by a sense of tickling and burning in the larynx and trachea; crampy pains in the whole chest; vascular excitement on the chest on performing the least movements, with dyspnoea ; anxiety, nausea and weakness, as if one would faint; anxious pain on the region of the heart; crampy pain in the cervical muscles ; stitches in the shoulder-blades ; wrenching pains at the shoulder-joint; bearing down at the elbow; drawing stitches in the fore-arms and hands; swelling of the hands ; numbness at the end of the fingers ; twitching of the glutei muscles ; acute stitches in the thighs, above the knees and in> the feet; stiffness of the lower ex- tremities. Spongia acts for several weeks, and is still more than Iodine a specific for goitre ; Hahnemann says: (Materia Medica Pura, Vol IL), " The particular swelling of the thyroid body to which the name goitre is given, and which is peculiar to the inhabitants of low valleys and the adjoining plains, depends upon a conjuncture of circumstances, which, although mostly unknown to us, yet seem to remain pretty much the same, and for that reason, constitute a disease which remains es- sentially the same, and against which a drug which has once effected a cure, ought to show itself efficacious, it would seem in every case." Teste says, he found many cases of goitre to resist Spongia, and he treated them with Ipecac, Iodium, and Bromine. Camphor is said to antidote Spongia. Calcarea.—As we have seen that calcareous waters cause goitre, it is also found to be a remedy. A case of diarrhoea of eighteen 278 DISEASES OF THE SANGUINOUS FUNCTION. months' duration in a child, in which physical development was con- siderably retarded was cured by Calcarea 30. Another rickety child was transformed into a healthy one by taking pounded egg-shells mixed with the food. Other cases might be given. Case by Dr. Croserio : — "A boy aged fifteen, extremely scrofulous, was stunted in his growth, and very thin. His limbs were slight, and his head too large for his body. He suffered from violent headaches when attempting to make any mental exertion. He was very timid, afraid to be alone in the dark. Two doses of Calcarea, after one of Sulphur, at the interval of four or five days, between the doses, brought about so favorable a change that in six months he gained great increase of height and strength as well as size of limb. " The specificity of Calcarea on the system of nutrition indicates its general usefulness during the general period of development, and in diseases accompanied by excessive emaciation or obesity." Ipecac.—Dr. Teste gives occasional doses of Ipecac, writh marked success in the treatment of goitre. For aggravations caused by it he regards Veratrum-album as the best antidote. 5. CRETINISM.—STRUMA TYROLENSIUM.—CAGOTISM. Description.—Imperfect formation or development of the body, es- pecially of the cranium; mental imbecility and physical deformity in various degrees; the organic or vegetative functions remaining in full activity; goitre present in some cases, though not in all. The stature of the cretin is seldom above four and half feet, gene- rally less; cranium deformed and of a conical shape,—the forehead being thrown backwards, narrowed and flattened; frontal sinuses large ; the occiput nearly on a line with the neck, as in ruminating animals; flesh soft and flaccid; face broad and short; skin wrinkled, yellowish or pale and cadaverous, dirty, and covered with chronic eruptions ; the ears large, standing out from the head; the tongue is thick, hanging out of the mouth, which is large, open and slavering; the lower jaw elongated strong and prominent; eyelids thick; eyes red, small, but prominent, watery, far apart and squinting; pupils contracted but not sensible to light; nose flat; and the whole countenance is idiotip, void of expression, or expressive only of lasciviousness ; the chest is narrow; the abdomen and mammae large and pendulous; the neck is short and thick or long and thin ; limbs crooked, short, distorted; the lower limbs shorter than the upper; fingers long; the gait imperfect and waddling. The senses are generally defective, hearing and speech imperfect; in- tellect absent or only partially developed; cretins are in all respects slovenly sensual, gluttonous and beastly. They die early, generally be- cretinism. 279 low the age of thirty, before which time they present the appearance of advancing age. Causes.—Cretinism, like goitre, depends for its origin on endemic causes, In the deep, narrow, damp, malarious valleys of the Alps, the people reside in small filthy houses built up under the ledges of the rocks; in those which are most filthy, hot and close in the narrow ra- vines of the Valais, one of the Swiss cantons, where the air is stagnant, and the rays of the sun are intercepted or reflected from the mountains, cretinism and goitre appear in their most intense forms. "As we as- cend the neighboring mountains cretinism disappears and only goitre is seen. When we reach a certain altitude, or above 3000 feet, both maladies vanish." The principal cooperating agencies which aid in producing the disease are: poverty, bad food, drunkenness, indolence sensuality and low debauchery of the parents, which naturally result in the infirmity of their children. The water in regions where cretinism prevails, contain calcareous and other mineral substances in solution; and cretinism, as well as goitre are to a considerable extent patho- genetic effects, or drug diseases produced by these agents long-used. Treatment.—-The first remedial measure in the treatment of cre- tinism is the removal of the patient from the influence of local causes which have originated the disease. The experiment has been made on a satisfactory scale by Dr. Juggenbuhl, who has established a hospital for cretin children in a high and healthy region on the Abendberg in the Bernese Alps. By devoting his whole attention to the recovery of these mosthopeless objects of philanthropic compassion he has succeeded in restoring about one-third of all that came under his care to health and the exercise of reason, and greatly improved all others. Cretinism generally makes its appearance in the second year, and from three to six are necessary to effect a cure; though at an early stage it is effected in one or two. This institution gave to the world the first example of the power of education and health-promoting influences in removing the physical evils which accompany idiocy; and it has been imitated in this country and elsewhere in the numerous asylums for idiots. The influence of a proper physical training is no where better shown than in the cure of idiocy and cretinism. Dr. Odet, a physician of Switzer- land, who was himself a cretin, chose cretinism as the subject of his thesis, when examined at Montpellier, for the degree of M. D. In his dissertation he says, " it was by following these curative means that a learned physician, whom I am proud to own as a near relation, has been enabled to replace me in the rank of a man." " It was also by forti- fying the physical system that we were enabled to develop, little by little, the intelligence of my youngest brother, who while still an in- fant, was separated from his mother by order of his physician. Cre- tinism seized upon his intellectual faculties under the mask of some of 280 DISEASES OF THE SANGUTNOUS FUNCTION. the maladies incident to childhood. In the second stage the treatment wras commenced, but time and patience were necessary. At the age of eight years he began to make himself understood, at nine he arti- culated some entire phrases, and at eleven he was fitted to enter an academy." Case by Dr. Juggenbuhl—-M. D. of Fribourg, was five years old on his entrance. His parents were healthy, but they inhabited the lower part of the town, which was subject to cretinism; one of his brothers was also a cretin. M. was slow in learning to hold up his head, to stand and to walk. The glands of the neck were swollen. He had strabismus, a thick tongue and the rudiments of goitre. He soon learned the letters of the alphabet and to pronounce little phrases; but his memory was so feeble that he would often forget on one day that which he had learned the day previous. An exercise much prolonged could alone remedy this evil. But his physical strength progressed gradually with his moral powers' His complexion is now animated and has the tint of health; his step is firm and his body robust; thanks to gymnastic exercises and good air. He can already read a littlo and distinguish colors. Remedies.—See Scrofula and Goitre, p. 276. Genus VI.—CARCINUS.—CANCER. DISEASES CHARACTERIZED BY VITIATED OR DISEASED CELL DEVELOPMENT. The difference, says Williams, between a. primitive cell and a mass of organized structure, is not simply one of magnitude. The primitive cell, though not strictly an organized body is infinitely less complex than the mass, and constitutes the ultimate limit of organized structure. When the formative blastema assumes the attributes of organization, a cell is the first visible form under which it presents itself; it is an atom of organic matter; so that the ultimate cells of organs are the imme- diate agents of the organic processes; the elaboration of nutrient matter, in all its stages and disintegrations for the p urpose of secretion and elimination, are essentially cell-phenomena. Organic laws to which the cells, in comm,on with larger masses, are subjected.—1. A definite scale of development is assigned to the primary organic cells proper to the various structures of the body. These cells pass through prescribed gradations of growth, the duration of their life period being equally pre-limited. The typical elements of a primary cell are three only; first an external sac (cell membrane); then a smaller vesicle (nucleus), which contains a smaller (nucleolus). Apply this description to the ovum; first is the vitelline capsule—the second the germinal vesicle, enclosing the third, the germinal spot. CANCER. 281 Mr. Budge, the German micrographer, reduced a frog to a state of emaciation and then laid bare a small muscle of the leg, and under the aid of a microscope counted with precision the number of its elementary fibres. By proper feeding he now restored the animal to health, and when its size was fully restored, he counted with the same minuteness the elementary fibres of the same muscle. He found that the fibres were considerably increased, as well in number as enlarged in bulk. Primary cells propagate themselves by the reproduction of others like themselves. When the malignant tendency has been once es- tablished in a part by the organization of a cancerous primary cell, in virtue of this power inherent in the cell of multiplying its kind, the continuance of the destructive process in the part is certain and in- evitable. Diseased Manifestation of Cell-Development.—Morbid tissue is generated within the economy in strict conformity with the laws that preside over foetal development. But, as we have already seen, both nervous influence and catalytical agency, give rise to a variety of dis- eases when they are swayed by disease-causing influences from their natural course. Thus also in some cases the power of histological evolution may create positive disorder in the system. An immense and uninterrupted movement takes place within the organs of which the body is composed, for the purpose of supplying new tissue in the place of those which are no longer fit to accomplish the functions de- volving upon them; let this unceasing activity be diverted from its proper channel, and the production of tubercle, cancer, and all kinds of morbid deposits will be the immediate consequence. We here find, as in other cases, an evident connection between the phenomena of health and disease,—between physiological activity and pathological influence. It is in this light that we are led by the re- searches of Virchow to look at this subject. General View of Cell-Formation.—1. Some diseases result in the first place from total absence or considerable deficiency of normal evo- lution on a given point. The mucous membrane of the intestinal canal affords a fine example of incessant development. New layers of epi- thelium are continually being secreted to line its inner surface; but the living medium, or blastem, is necessary to their production, and whenever this blastem itself happens to be altered in its essential properties—the modification which always occurs in inflammation, the epithelium disappears, and is no longer regenerated. (See Vol. I., p. 646, and Vol. IL, p. 181.) Cholera also exhibits an example of this ; for it has been incontestibly proved that in this disease the vessels that ramify in the internal surface of the intestines are completely laid bare. * 282 DISEASES OF THE SANGUINOUS FUNCTION. 1. CANCER.—CARCINOMA. The name was given by the Greeks, and derived from KapKivog, a crab, from the large blue veins, resembling the crabs-claws, which appear upon its surface, A painful scirrhous tumor, which terminates in a fatal ulcer. (Cullen.) Conditions Essential to the Production of Cancer.—1. Consti- tutional causes which lead to the development of the cancerous element in the blood by deranging the functions which preserve this fluid in a healthy state : 2. Local causes which separate the morbid material and transform it into cancerous deposit, which may replace the proper textures of the part or become incorporated with them. The cancerous element must first exist in the general circulating fluid before the local injury, or perverted nutrition from some other, cause can produce cancer. When these proper conditions exist, any organized structure may be involved by the disease. Progress and Development of Cancer.—Its earliest condition is that of a blastema, or fluid. It is described as a firm, compact, amorphous substance, resembling coagulated fibrine, sometimes con- taining molecular granules of modified protein or fat. In this blastema, cells are developed which are supposed to be of a specific nature, presenting appearances different from the cells of the ordinary healthy tissues; the cell-wall and its nucleoli, and granules are generally larger, more varied in form, as round, oval, caudate; the cell-wall is also extremely thin and pale ; and the action of acetic acid renders it so transparent as to display the neucleus and its nucleoli distinctly. Some of the granules, nucleoli, and nuclei, are without any distinct cell-wall; they all progress to the stage of parent-cells ; each possesses amazing reproductive power, and is supposed to produce a second. In some cases a fibrous tissue is developed from the blastema, most probably from the cells; and when formed it resembles the condensed or indurated tissue of other parts ; but it is regarded as a new formation, and forms the chief portion of scirrhus, the most common variety of cancerous growth. (Southam, Yirchow, Vogel. See Brit. Med. Jour. Jan. 1858, p. 5.) Though the specific character of cancer-cells may be suspected, it has not been demonstrated; and efforts to diagnose the ultimate nature of cancerous growth by the microscope have led some observers into errors. (Nelaton, Clin. Surg., Phila. 1855, p. 457. See Yelpeau, Lebert, Robin, Mandl) The cells found in cancerous growths may then be regarded as the same as those found in ordinary healthy growths ; but, the blastema derived from the blood being in a diseased state, the cells are developed under a specific influence. The cancerous blastema being more highly organized, that of tubercle may be CANCER. 283 transformed into the caudate or fibro-plastic cells with their nuclei and granules; and these may reproduce others like themselves, or may go beyond this and form fibrous tissues of imperfect organization; and these have only a brief duration, In the ordinary effused lymph of inflammation or of healthy granular tions, the cell is endowed with the power of progressive development, from the fibro-plastic cell, into filamentous tissue, and then, into the healthy permanent structures. (Southam, Brit. Med. Jour. Braithw. Retrosp. July, 1858, p. 28.) Diagnosis.—When the cancerous action commences in a tumor which has long been inactive, it is attended with frequent shooting pains; the skin that covers it becomes discolored, and, at length ul- cerated. Pearson says, " when a malignant scirrhus or watery ex- crescence has proceeded to a period of ulceration, attended with a constant sense of ardent and, occasionally shooting pains, is irregular in its figure, and presents an unequal surface ; if it discharges sordid, sanious, fetid matter ; if the edges of the sore be thick, indurated, and often exquisitely painful, sometimes inverted, at others retorted, and exhibit a serrated appearance; and should the ulcer in its progress be frequently attended with haemorrhage, in consequence of the erosion of blood-vessels ; there will be little hazard of mistake in call- ing it a cancerous ulcer." When a cancerous tumor of the breast is ready to break open, it generally becomes prominent in some minute point, attended with an increase of the peculiar kind of burning shooting pain already felt in a slighter degree; a corroding ichor transudes through the skin forming an ulcer. Ulcers of the cancerous nature discharge a thin, acrid sanies which corrodes the parts; the lips are thick, dark colored, retorted; and fungous excrescences often grow from them, attended with excruciating, pungent, lancinating, burning pains, and sometimes with bleeding. Though every hard tumor of the female breast is not a cancer, all such as occur after the cessation of the menses may be regarded with suspicion. Pathology.—Thus far the microscope has only shown that the primary elements of morbid growths do not materially differ from those of the normal tissues; and that these constituents vary in the degree of their development, their mode of arrangement and in their relative proportion to each other. In innocent tumors the difference is slight; but in malignant growths there is a general want of order in the dis- tribution of all the elements and structures that enter into their com- position. The following division of the varieties of cancerous growths is based on the microscopic disclosures of their minute structure: 1. Gelatiniform or colloid cancer ; marked by an excess of blastema. 2. Cephaloma, medullary, or soft cancer; characterized by an ex- cess of cells. 284 DISEASES OF THE 8ANGULNOUS FUNCTION 3. Scirrhus, petrous, or hard cancer, in which the fibrous tissue pre- dominates. It forms a hard, unequal, indolent tumor, small in the beginning and increasing gradually. These different forms may occur separately or in different parts of the same tumor. The other varieties of carcinomatous disease are modifications of the above. Among them are : 4. Haematoid cancer, or fungus haematodes, in which there is an excess of blood, free or enclosed in vessels. 5. Melanosis, in which there is a superabundance of coloring pig- ment within the cells; 6. Ostoid cancer, or spina ventosa, in which the osseous tissue predominates; 7. Cancroid, or epithelial cancer, containing an excess of epithelial cells; 8. Lardaceous, or reticular cancer, in which fat-globules are infil- trated through the morbid deposit. (Southam, from WedVs Pathol, page 535.) The microscope also shows that the cancerous deposit exists in the surrounding structures where it would not be suspected. The cells and granules extend along the areolar tissue, entering into the tissue itself, and even into the nerves and coats of the blood-vessels; the natural structures being absorbed the cancerous deposit supplies their place. (Paget, Pathol?) The transformation of a tumor innocent in character into one more malignant can scarcely ever take place, though a few instances are given, by Sir Astley Cooper, and Mr. Brodie, in which fatty tumors have taken on malignant action. (Lectures, Path, and Surg., 1846.) Simple cysts sometimes become the seat of cancer, both in the ovaries and mamma as well as other parts. (Southam, Manchester Dispense Brit. Med. Jour. Jan., 1858.) The best microscopists and pathologists of the present day deny the possibility of distinguishing the cancer-cell. Virchow assures us that he has never seen a cell-formation in cancerous structures of peculiar attributes. Bilbroth, who has paid great attention to the minute structure of cancerous growths admits that it is impossible to classify tumors from their microscopic appearance. He alludes to instances in which the same structure maybe healthful in one case and malignant in another. Virchow demonstrates that simple connective tissue with its natural cellular bodies may become the focus of a structural metamorphosis; and sees no reason why one shall not change into the other. He thinks then that cancer is by no means a characteristic strictly defined, and under all circumstances the same process. In one part of the body it may at one time be a healthy structure and be CANCER. 285 cancerous at another time. The hyperplasy of cells does not apply to all forms of cancer. In scirrhus, the proliferation of cells is very scanty. Treatment.—1. External Applications.—The success claimed by the advocates for the local treatment of cancer has nearly always re- sulted from an error in diagnosis. Pretenders always claim to have some infallible specific, the composition of which they dare not reveal to the public; but they generally succeed in curing a large number of trifling sores and tumors which they declare to be cancers. Ignorant people do not question the accuracy of the impostor's diagnosis and wonder at his success. When cancer really exists it can scarcely, at any stage, be treated by local applications without hastening the progress of the suspected tumor into an active cancer. The removal of the suspected part by the knife promises nothing better. " In a large proportion," says Sir Benjamin Brodie, " of cases, in which the operation is performed, the patient is not alive two years afterwards ; and in a great many cases, instead of the operation stopping the dis- ease, it actually seems to hasten its progress ; moreover, the operation itself is not free from danger." The testimony of all prominent sur- geons of our time will be found to confirm the correctness of this opinion. It is a principle in surgical practice, says Mr. Syme, " that malignant tumors, or sores should be left free from disturbance, or completely removed, since tampering with them by irritating applications is the most certain means of exciting disease in the lymphatic glands or other textures." When the nature of the disease is settled, and its rapid progress inevitable it should be promptly removed when its lo- cality and extent are such that entire removal is possible. Even when the nature of the tumor is doubtful, it is far better to remove it when small, than to incur the risk of this most terrible of diseases ; though the disease may sometimes appear again, from constitutional tendency, or from the whole not being removed. " But when the tumor has been originated by some accident, not spontaneously; when it is not really cancerous in its nature; when the patient is other- wise healthy, when no appearance of malignancy is seen in the cancer; r when the adjacent glands and absorbents are still unaffected; and the parts involved do not require that very important nerves or arteries be cut, the operation may be expected to terminate successfully; but in such cases it is hardly possible to imagine one that would justify the use of the knife." The Treatment of Cancer by Caustics has been more generally followed than any other; and up to the present time the profession cling to it as a lingering relic of the ancient faith. The best recent authorities for a modified escharotic, or " enucleating" treatment of 286 DISEASES of the SANGUINOUS function. cancer are Drs. Mac Limont and Marston. (See the British Journal of Homosopathy. May 1864, p. 481.) After a preliminary treatment, with which we find no fault, the following "Mode of Procedure for the Removal of the Cancerous Tumcrr of the Breast" is given. " When the skin was entire, the size and bearings of the tumor were carefully ascertained and mapped out on the breast with Nitrate of Silver or Vermillion-pigment. A mixture of ice and salt was in one of the cases applied to the tumor, so as to deaden the local sensibility; this effected, and the parts carefully dried; the skin over the tumor was destroyed by means of undiluted Nitric-acid, the action of which was kept up till the skin assumed a tawny and yellow aspect; (about thirty seconds being generally suf- ficient to produce this condition.) The part was now well douched with cold water, and a piece of lint applied to the surface, spread with equal parts of a paste (composed of a strong decoction of Hydrastis root, powdered Hydrastis, Chloride of Zinc and Flour,) and Stramonium ointment. On removing this dressing at the end of twenty-four hours. a yellow, hard, and dry eschar will be found to have formed. The amount of pain following the application of the acid varied with the ex- tent of surface to be destroyed ; but the congelation of the parts very materially lessened this suffering, which might otherwise be rather severe. But we always found that much after-suffering was saved by endurance of a little temporary smarting caused by the acid ; for when applied too timidly, the skin was only partially destroyed, and the action of the paste thereon gave rise to some suffering. " On removing the dressing, a slight amount of erythema is some- times visible around the eschar, which presents a yellow, horny, and dry appearance. " Throughout the entire extent of this eschar vertical incisions are made with a sharp scalpel to the depth of about one-twentieth of an inch, care being taken not to draw blood. These incisions should be parallel to one another, at a distance of about half an inch apart, and into each is inserted a thin slip of calico smeared with the paste ; over the whole a light compress should be applied, kept in its place by a strip of adhesive plaster. The incisions are deepened and the dress- ings renewed usually every day, and this is continued until the paste has percolated the entire mass of the tumor." The depth to which the incisions are carried " must be left to the judgment of the operator. If the knife be used too freely, the bleeding will embarrass and annoy both the surgeon and the patient," as well as materially increase the pain, produced in the living tissues by the paste. On the other hand, if the scalpel be too timidly used, the action may be too circumscribed or arrested too soon." The time required for the separation of the slough varies with the CANCER. 287 size of the tumor. In general at about the end of a fortnight from the first operation a line of demarcation forms around the entire tumor, invariably commencing at its upper or least dependent portion; this deepens from day to day; the living and healthy tissues beneath gra- nulate and rise, pushing the tumor out; so that at a period verging from four to seven weeks, the entire mass is thrown off, leaving a much smaller chasm than might be expected judging from the size of the slough itself." The wound gradually takes on a clean and healthy aspect, free from even the secretion of pus which follows the removal of cancer by the knife. And not only is the evil effect of the absorp- tion of pus avoided by this method of operating, but z\[ putridity and effluvium are effectually counteracted by the antiseptic nature of the paste. The constitutional irritation which follows the operation, is but slight; the dressing of the wound after the removal of the slough consists only in the daily application of cotton-wool spread with Stra- monium ointment. It is claimed that the process of removing cancers by enucleation is applicable in many cases in which even the old surgeons would have feared to employ the knife; that it permits the removal of only such portions of the diseased part as may appear ne- cessary at the time of operating. It is only regarded as likely to be unsuccessful or injurious in cases in which cancerous disease has al- ready extended into the arm-pit, or to internal organs,—as the brain, uterus, mesenteric glands, stomach, or lungs; also in the cases in which local disease has extended to parts involving anatomical diffi- culties which would render surgical interference unjustifiable. Cancer of the Face, Lips, Cheeks, Nose and Tongue. — Medical Treatment.—Cancer is said to be more common on the lower lip, but it is often met with on other parts of the face. It de- velops itself out of a scurfy or ulcerated spot which gradually gives rise to scurfy excrescences, &c.; or a portion of the lip becomes hard and swollen; it then becomes intensely painful and breaks. The cancer gradually involves the skin of the chin, the mucous membrane of the mouth, the gums, submaxillary glands, destroying the whole lip and the bones. Some ulcers of the lip become malignant without being cancerous, especially syphilitic ulcers. Cancer of the tongue generally commences with a hard circumscribed swelling on one or the other side of the tongue; it is marked by lancinating pains, the swelling breaks, and extends rapidly. Ulcers in the spongy tissue of the tongue frequently become obstinate, or are rendered so from constant moistening by the saliva, or by the irritation of points of decayed teeth. The papilla frequently become hyper- trophied, forming spongy excrescences.—Syphilitic ulcers of the tongue often degenerate into cancerous ulcers. Cancers of these parts, as well as every other part, depend upon a 288 DISEASES OF THE 8ANGUINOUS FUNCTION. peculiar specific disposition of the organism which may be hereditary. The disease may be developed by a blow or contusion; by treating an ulcer, an induration of or excrescence of the face, lips, or nose, by ex- ternal irritating applications. It may be developed by the progress of scrofula, syphilis ; or the suppression of habitual secretions, &c. (Hartmann. Vol. 4, p. 31.) Prognosis.—When small, cancer of these parts may be cured; the prognosis is unfavorable when the cancer is large, the constitution en- feebled, and the disease has returned again after an operation. Ex- cision is generally useless, causes unnecessary suffering, and usually hastens the fatal termination. Arsenicum.—This is the most important remedy. We prefer the high potencies as we know the disease incurable by any crude medi- cines, however appropriate to the symptoms. We begin with the thirtieth dilution at least, repeating at short intervals, (every six hours) till some perceptible effect be produced. (Hartmann) Symptoms.—Burning swelling in the nose with pain on contact; tumor in the nose ; ulceration of the nostrils, high up, with discharge of fetid ichor; — ulcers in the whole face ; wart-shaped ulcer on the cheek ; dry cracked lips, brown streak in the lips, as if burnt; bleed- ing of the lower lip ; ulcerated eruption around the lips; cancer-like eruption on the lower lip, with thick crust, hard, pad-shaped edges, with burning pain, particularly when the parts become cold, and with a lardaceous bottom; spreading ulcer on the lip, painful in the evening, when in the bed, with tearing and smarting in the day-time during motion, which is worst when touching the ulcer and in the open air, disturbing the night's rest; corrosion of the edge of the tongue, in front, with smarting; the tongue is blackish, cracked. Arsenicum often needs some other remedy with it; but it is undoubtedly the principal remedy when the cancerous dyscrasia has tainted the system. It is specific for cancer of the nose, tongue, and alveolae. (Hartmann) Arsenic, says Hahnemann, is such a powerful agent that we can not decide whether it is more hurtful in the hands of the rash than salutary in those of the prudent. It has effected remarkable cures of cancer of the face, as described by Fallopius, Bernhardt, Ronnow and others. Its true power in this direction depends on its homoeopathic power of producing in healthy persons very painful tubercles, which are cured with difficulty, as witnessed by Amatus Lusitanus; very deep and malignant ulcerations, according to the testimony of Hein- reich and Knape, and cancerous ulcers by Heinze. The ancients were unanimous in their praise of arsenical plasters against pestilential buboes and carbuncles; while Degnier and Pfann saw it give rise " to inflam- matory tumors which quickly turn to gangrene" and Verzascha and Pfann saw it produce " carbuncles and malignant pustules." CANCER. 289 Buccal Cancer.—Cancer of Tobacco-Smokers.—Dr. Buisson, of Montpelier, has published sixty-eight cases occurring in smokers. The disease is becoming more frequent, having hardly been noticed in the last century. The lower lip is most frequently affected; the Spanish habit of expelling smoke through the nostrils produces epithelial vege- tations in the nostrils. Dentists now find it difficult to fix the plates for teeth in the mouths of chewers and smokers on account of the softening and degenerescence of the mucous membrane and sub-mucous tissue. A. Vogel and Reischaur, (chemists,) found tobacco-smoke in- variably to contain sulphuretted hydrogen and prussic-acid. In syphilis it is often seen that smoking localizes the syphilitic virus, producing the mucous tubercle in the part of the mouth familiarly occupied by the pipe or segar. Lupus.—At a meeting of the Central Society of Homoeopathic Physicians, of Germany, (1861) Dr. Mayer related a cure of a lupus on the lower eye-lid by Apis 6. A few months afterwards lupus showed itself again on the ala nasi, but Apis was now of no avail. Kirsch remarked, that Apis is not indicated in lupus; but Apis stands in a closer relation to the eye-lid, than to the nose. Cancer of the Tongue.—Sempervivum-tectorum. —Live-for- ever.—1. Dr. Maly, of Glatz, says: a sickly woman, at the change of life, had a swelling at the margin of the tongue, as large as a bean; burning pain on shutting the mouth; occasionally bleeding; in- tolerable at night; disturbing sleep; made worse by acids; swelling like a cyst with two small knots, one bleeding; over the swelling three varicose veins. Tried Aurum, Arsenicum, Carbo-veg., in fourth, tenth and sixth potency; but it grew harder, larger, and impeded speech. Sempervivum-tectorum juice was applied externally three times a day. It made the tumor smaller, but it afterwards inflamed and became very sensitive. Then tried two drops of the second dilution internally. This daily reduced the tumor to one-third in ten days, menstruation reappeared, which continued five days ; tumor gradually reduced in size to asmall pea; then less sensitive, and the patient did not return to the hospital, 2. General B.----had an ulcer on the tongue, left margin ; tried Alumina, and Mer.-corrosivus; ulcer three-fourths to one-half inch deep with sharp edges, hard foundation of bluish color with four knots size of lentils; two large veins, sensitive while eating. Sempervivum-tect, first centesimal dilution in water, twice a day, externally applied. Second day less painful, could eat; edges smoother. In three or four days the veins smaller; small reddish tumors paler. Fifth and sixth day they disappeared, leaving the base of the ulcer covered with whitish membrane. Seventh to ninth day, medicine omitted, sensibility greater. Tenth day repeated; ulcer smaller; veins very small. Case lost sight of. Vol. ii.—19. 290 DISEASES OF THE SANGUINOUS FUNCTION. 3. A married woman, aged twenty-seven, had for ten days pain under the tongue, impeding eating and talking. On lower surface, near the root, is a bluish-red swelling, size of a half bean, smooth, but hard; on the other side a large vein ; at one point a membranous exudation. Semperviv.-lect. sixth. Two doses, one every other day, for four days ; no pain; after eight days much smaller ; menstruation restored though pregnant six months ; in three weeks nothing remains but a somewhat enlarged vein.—(Homeecpath. News.) Hydrastis Canadensis.—Dr. Bayes, of Cambridge, states, that he "has found the Hydrastis exercise a marked influence in relieving the pain of cancer, while at the same time, it has improved the general health of the patient." But he has also seen, " that very sudden pros- tration of strength has accompanied the continued use of the remedy beyond a certain point." Dr. Bradshaw, (Brit. Journal of Homoeo- pathy. Oct., 1861,) gives five cases in which Hydrastis was used with the following results : In case No. 1. the patient suffered from " un- mistakable carcinoma" of the left breast. He " gave her one pilule of Hydrastis four-times a day," with benefit to her general health; and he speaks of the remedy as "evidently exerting an absorbing, counteracting influence over the scirrhous tumor." In another case of scirrhous tumor in the left breast the disease " remained stationary." '' In a third case of cancerous ulceration of the cervix and os-uteri, there was some mitigation for a few weeks, but, ultimately the patient died." A fourth case received no benefit. In a sixth case of cancerous disease of the os and cervix-uteri, Hydrastis was given for six months. The patient " lingers on, suffering less, and the disease seems arrested." In the second case (by Mr. Bradshaw) he says : " the medicine made the patient feel so wretchedly ill that she feared it would kill her: the heart was beating irregularly and tumultuously, and she looked nervous and ill." Dr. Bayes now says, this corresponds with his observation of " the rapid prostration which often follows the administration of too large a dose of Hydrastis." This train of symptoms he has " met with in several cases where the mother-tincture was given." He therefore thinks, that the medicine should not be administrated in too frequent doses, or in too low dilutions. The plan he has found most beneficial was " to begin with the thirtieth dilution, giving three globules every night, for a fortnight; then a pilule of the twelfth dilution twice a day, for another fortnight, followed by the sixth, the third, and finally half- drop doses of the mother-tincture, in the same way, giving a fortnight to each dilution, &c. He approves Dr. Pattison's suggestion to avoid rubbing the tumor, but to apply " a lotion over the parts by means of moistened linen rags." CANCER. 291 A cold infusion of the remedy is thus prepared: " 3ii. of the pow- dered Hydrastis to a half pint of water. Allow it to stand four days, then strain and keep in a cold place." This is said to be of great ser vice as an application to ulcerated surfaces. The later experience of Dr. Bayes with this remedy is highly im- portant: A case of cancer on the left breast in a young unmarried woman, referred to in his first paper, came under his care, March 19, 1860. " The tumor was as large as a small hen's egg; the nipple retracted and the skin puckered. She had been for two years under allopathic care, and was strongly advised to submit to an operation. The tumor soon ceased to be painful, and had totally disappeared on Feb. 20, 1861. Cases at the Cambridge Homoeopathic Dispensary. Case first. A lady, aged forty-one, married—inflamed indurated breast—found on the seventeenth Feb. to be scirrhus. Hydrastis 3. iv. gtt. in a half pint of water. A table-spoonful twice a day. Up to March twentieth no change. Hydrastis-tinet. gtt xii. Aqua-dist. 3ii. a tea-spoonful every night. This treatment was continued without much variation, till June eleventh. " The tumor has rapidly disappeared, there is still some slight pain. A pilule of Arnica every morning, Conium 30 every third night , July fourth, the breast remains quite well; some slight indigestion. Nux 6, &c. Case 2. —A married woman, has ovarian tumor of the right side, with severe pain, especially in walking. Has had a cancer excised in the right breast. May fourth, prescribed Hydrastis-can. 30. every third night Aconite twice a day. May eleventh.—Pain lessened though still severe at night. Rhus. Twenty-sixth.—Pain almost gone ; tumor still remains, and is weighty. Hydrastis 3. given three times a day. June fourth.—Still better.—Continue. Thirteenth.—Much the same. Iodine 3. gtt. in a pint of water, a table-spoonful twice a day. June twenty-sixth.—Better. Mercur.-sol. 6. every night. July fourth.—Still better. Repeat—and give Merc.-iod. 1., gr. ii. every third night. July ninth.—Discharged cured. Case 3.—Mrs. L.—July 2, 1860.—Cancer of the right breast, hard, nodulated, very painful at times ; skin had a bluish appearance over the tumor, is puckered, and adherent over a portion of the surface the size of a shilling; tumor not adherent to the ribs. December twenty-fourth.—She has been under the influence of 292 DISEASES OF THE SANGUINOUS FUNCTION. Hydrastis, and is better; the tumor under its use has decreased in size, and was scarcely ever painful, has still a bluish appearance, and is yet adherent to the skin. Occasional intercurrent remedies have been given to meet occasional symptoms. Case 4.—A widow, aged seventy-seven, has cancer of the right breast. The tumor is unattached to the skin or ribs. There is a small hard moveable tumor, also, just above the clavicle. She has occasionally severe pains. Hydrastis was used externally and internally from August 24, 1860, to October, 1861. The tumors have not increased, are less painful, and the patient is in excellent health. The Hydrastis has been used in the thirtieth dilution, also as low as the mother- tincture. A lotion of Hydrast mother-tincture gtt. x. Aq. dist fxvi., has been applied twice a day. Case 5.—Mrs. B., aged twentyrfive. Admitted Sept 12, 1860. The cervical glands of the left side of the neck are enlarged, apparently three, and have a stony, hard feeling. A tumor of similar character was excised at the Allopathic Hospital, some years since, and a deep scar remains. Some months after the operation, these glands enlarged, and are now very painful. Calcarea-carb. 30, gl. iii. every third night, &c. Oct. third.—Better. Calc.-carb. 12, a pilule every second night. Twenty-fourth.—The hardness remains ; there,is occasional shooting pain. Hydrastis, 3., a pilule every night. Nov. fifth.—Much better ; the swelling decidedly less. Continue. Twenty-third.—Better. Suffers from indigestion. Repeat Hydrastis, and Nux.vom., a pilule twice a day. Dec. seventh.—Greatly better. Repeat pil. Hydrast Twenty-sixth.—Remains better; no pain. Repeat the pilule. Feb. thirteenth.—Still better, and feels so well she is allowed to re- turn to her home, (sixteen miles away,) to remain if there be no return of the pain or increase of tumor. Hydrast. mother-tincture 3ii. Two drops in a little water twice a day when in pain. Case 6.—Mrs. D., aged fifty-five. Admitted Dec. 10,1860. Tumor on the dorsum of the foot; occasionally painful; has had it two years; it is stony-hard, the size of a walnut, and nodulated. Excision had been advised at the Hospital. Hydras.-can. 3. a pilule twice a day. Tinct Hydras. 3k Aqua-dist -ijs. to be rubbed in every night. May sixth.—The tumor was almost removed, not being larger than a pea. Case 7.—Mrs. A., aged forty-five. Admitted Dec. 10,1860. Scirrhus of the breast. Hydrastis lotion, and Arsenictftn 6; a pilule twice a /lay. This patient was suffering also from phthisis, for which she took Bryonia, Phosphorus and other medicines. The Hydrastis lotion al- CANCER OF THE STOMACH. 293 ways removes the pain in the scirrhous breast. Continues under treatment. Case 8.—Mr. G., aged fifty. Admitted April 28, 1864. Confined to bed with a large open cancer of the left breast. Under the use of Hydrastis she continued to improve till, on March 5, 1860, she was so far removed as to be able to go out daily and to do her house-work. " The cancerous ulceration has considerably diminished; it secretes a far healthier pus, and her general health has greatly improved. In her case the Hydrastis has been discontinued at times, from its pro- ducing the depressing effect on the heart's action alluded to before. Case 9.—Admitted July 21, 1860. Mr. Freeman, the surgeon's notes say: " Mrs. J., aged thirty-seven. Health good. Has stony- hard tumor in left breast, unattached to skin, perfectly moveable, the size of a large filbert, surface somewhat nodulated; suffers from lancinating pains. Had first Hydrastis 12, a pilule twice a day; after- wards, Hydrast. mother-tincture, a third of a drop, three times a day; she had intercurrently, a few doses of Nux-v. for dyspeptic symptoms. The tumor became painless and gradually lessened till a portion, like a vein filled with coagulum, the size of a crow-quill, and a third of an inch long, remained. I wished her to continue the treatment, but she thought herself well and remained away. I saw her in May, 1861, and she then was quite well, neither pain nor induration remaining." Aconite.—In several forms of cancer we have observed essential benefit from the use of Aconite. Whether its ameliorating action has been due to its influence upon the circulation, the nervous system, or the pores of the skin, we know not; but that it possesses some peculiar power in modifying the constitutional ravages of cancerous degenera- tions, we have had ample proof. We are in the habit of prescribing the first decimal dilution in water. CANCER OF THE STOMACH. General Remarks.—Cancer of the stomach may begin in an elderly person, hitherto free from dyspepsia, by at first capricious, and after- wards diminished appetite; by occasional nausea or vomiting, a sense of uneasiness and distention of the stomach. The complexion is first pale and unhealthy; it afterwards acquires a muddy yellowish, or faint greenish hue. The gastric symptoms increase, and vomiting becomes more frequent and urgent; the local uneasiness deepens into pain; and both pain and vomiting are aggravated by food. At a later period haemorrhage generally occurs. It is usually small in amount, and about the same time a tumor becomes perceptible in the middle of the epigastric region ; as the disease progresses, all of these symptoms 294 DISEASES OF THE SANGUINOUS FCNCTION. increase ; debility and emaciation follow, and these soon lead to extreme prostration, anasarca, delirium and death. In many cases these symptoms are complicated by ascites, jaundice, perforation of the coats of the stomach, fistula, or phlebitis. In others there arise symptoms showing cancerous deposit in other organs, es- pecially the lungs and liver. The disease usually advances towards its termination with a speed and severity constantly accelerating; and, perhaps, most generally ends in death in about one year from its first invasion. (Brinton. Brit, and For. Med. Chic. Rev., Oct. 1857.) Diagnosis.—In cancer of the stomach the appetite usually fails en- tirely. In ulcer of the stomach it becomes capricious; sometimes in- ordinate : but the patient learns to avoid eating as far as possible, in order to avoid the pain which follows it; though he still has some degree of appetite. WThereas, in cancer the anorexia or absence of ap- petite seems to be a specific result of the disease. As such it seems to be affected through the same nervous channels which ordinarily transmit the sensations of hunger and satiety. The anorexia, there- fore, is seen to commence at a very early stage of the deposits of can- cerous matter in the coats of the stomach ; and preceding all other local symptoms. It is most clearly marked in the younger subjects, and in the softer varieties of cancerous deposit, and is equally marked in the cases of males or females. The pain in cancer remits in violence frequently, but scarcely ever intermits. Its site does not indicate the seat of the cancer; though cancer of the lesser curvature seems to be connected with pain in the inter-scapular region, which is often peculiarly severe in some cases ; and a marked inflammation of the posterior portion of the stomach seems to cause pain ranging from the middle of the dorsal to the lower part of the lumbar region. The pain in cancer of the stomach is first lancinating; beginning at an early stage and rapidly assuming a marked severity. In the course of a few days it becomes so severe as to leave most other symptoms out of view. The pain of gastric ulcer may intermit, and is increased by food ; but that of gastric can- cer neither subsides after digestion is accomplished, nor after the stomach is emptied by vomiting. In later stages of the disease the pain sometimes subsides or changes in character. Some patients de- scribe it as a dull, slow, gnawing, or burning, with a sense of weight, oppression, tightness, and distention and soreness on pressure in the epigastrium. The dull burning belongs rather to the stage in which the process of ulceration is going on in the cancer, rather than in the stage of its deposition. It may then be increased by food, is referred to a small spot, and may be partially relieved by vomiting. The vomiting more frequently attends cancer of the pylorus than that of any other part; it often begins when the cancerous deposit is CANCER OF THE STOMACH. 295 very small, and seems to be connected chiefly with local irritation of the nerves distributed to the seat of the disease. At a later stage, when the softening and ulceration of the cancerous deposit has re- moved the mucous membrane, we have vomiting of a different order. The subjacent tissue being exposed, becomes highly irritable; and vomiting is excited by almost every thing taken into the stomach. It then generally occurs at short intervals throughout the disease, though not in every case. The matter thrown up is large in quantity, has a yeasty appearance, and contains sarcina torula and fragments of de- stroyed membrane and cancer-cells. There is often at this period of gastric cancer a torpor, or suspension of the peristaltic action of the stomach, either from paralysis of the nerves, destruction of a portion of the muscular fibres by the process of ulceration, or weakening by their undue extension. The haemorrhage occurs in, perhaps, half the cases, though some writers have observed it still more frequently. Of those in which it does occur, at least seven-eighths, show the blood so mixed with the gastric juice, food, bile, or softened cancerous substance, as to present the appearance rather of coffee-grounds than of blood. The degree of congestion which causes the haemorrhage is small in the earlier stage of the cancerous deposit; but it afterwards becomes more considerable ; and the flow of blood may then be so great as to cause death. When this occurs, dissection shows: 1. that the blood had proceeded from the sub-mucous plexuses, or from the minute capillaries of the inter- gastric surface, and not from any large arterial trunks ; 2. From ves- sels destroyed by ulceration; or, 3. From the erosion of large vessels external to the stomach. The coffee-grounds appearance may be observed in cases of ulcer of the stomach, though there is generally less of it than in cancer. The characteristic cancer-cell growth can be detected in the matters ex- pelled from the stomach, when the disease has reached the stage in which these cells are thrown off by exfoliation or sloughing. The microscopical examination can be made by diluting the fresh liquids expelled by vomiting, and placing a portion under the field of a micros- cope of sufficient power. The diagnosis may be further assisted by manual examination of the external surface of the abdomen. The tumor may at least be detected, though its nature must be made out by comparison of the various con- curring symptoms. The color of the skin in gastric cancer is " a muddy greenish pal- lor." The original or pathognomic cachexia is " regarded as the result of the humeral disease which precedes, and brings about the cancerous deposit." (Brinton.) The cachectic aspect of gastric cancer often imitates that of ulcer 296 DISEASES OF THE 8ANGUINOUS FUNCTION. of the stomach, and the resemblance is sometimes so close as to defy distinction; both diseases involve a similar general condition, the joint product of ulceration, haemorrhage, vomiting, pain, starvation. Wherever cachexia precedes these circumstances, or is present in a degree utterly disproportionate to what their aggregate influence might lead us to expect, it becomes a leading, almost pathognomonic symptom. A case was published by Dr. Porter, of New-London, Conn., of a man aged sixty-six, who had good health up to two months before his death, though he had some regurgitation of food and slight fullness after eating, but no pain. The coffee-grounds vomiting commenced Dec. 19, 1847; but he continued to attend to business till January 3, nineteen days before his death. Jan. 14, he threw off a large quantity of uncoagulated blood mixed with coffee-grounds, and this was often repeated afterwards. He had, however, scarcely any pain. Near the close of life there was an indefinable distress, a sense of sinking and emptiness, like faintness from want of food. Still there was none of the lancinating pain common in cancer, only some enlargement like a small tumor near the pylorus or duodenum. There was none of the "dingy, sallow, exsanguinous, yet opaque appearance so common in cancerous diseases." On dissection a scirrhous tumor, the size of half a small orange, occupied the pylorus and adjoining portions of the stomach, somewhat hypertrophied, mainly hard, but some ulceration had commenced. (Amer. Jour. April, 1848, p. 378.) Prognosis.—Cancer of the stomach may be regarded as one of the most hopeless forms of this most terrible of human diseases. It is dreaded, not so much because of its being almost uniformly fatal, but for the insufferable pain which attends on it throughout so much of its course. The duration, says Dr. Brinton, of cancer " may be estimated at about thirty-six months from the first appearance of the symptoms; but few cases survive the twenty-fourth, and some have sunk under extreme suffering at the end of a single month. Treatment.—This can only be palliative. The mildest measures can alone be used without injury, though Arsenicum may be tried in homoeopathic doses far enough to test its powers, which are sometimes surprisingly great Lime-water may often be employed in quieting the stomach ; but its remedial powers seem confined to the stage of ulceration from chronic gastritis. Although in fully developed cancer of the stomach, no just hopes can be entertained of effecting a cure, we may do much to palliate suf- fering, and even to prolong life, with judiciously-selected homoeopathic medicines. Among these may be cited, Arsenicum, Cicuta, Conium, CANCER. 297 Veratrum-alb., Veratrum-viride, Kreosote, Mercurius-corr., Thuja, Carbo-animalis, Ipecac, Tabac, Cannabis-ind. Clematis.—Induration of the lymphatic glands of the breast, when painful to the touch ; appearance of cancerous degeneration ; ulceration with pulsating, burning and lancinating pains along the borders of the ulcer, particularly upon being handled. CANCER OF THE UTERUS. Symptoms.—Incipient Stage.—Sharp and lancinating fugitive pains in the back and loins, across the supra-pubic region, or shooting along the front of the thigh, or along the course of the sciatic nerve, inducing numbness or debility of the whole limb. A tumor or decided fullness in one or the other iliac fossae, fixed pain or tenderness appearing to issue out of the abdominal ring, irritation of the bladder with dysuria ; sensation at the termination of the rectum like that of haemorrhoids. Menstruation may be regular, but there are often bursts of haemorrhage at the period or in the interval. After the disease has continued long the appetite is impaired, sleep disturbed, the flesh wastes and becomes softer, countenance pale and expressive of distress. The os uteri is hard at the margin, or fissured, projecting more than natural, and irregular in form. In the situation of the muciperous glands, several hard well defined projections like grains of shot under the mucous membrane; pressure on them gives pain or makes sickness at the stomach. The cervix is slightly enlarged and tender; circum- ference of the os uteri, especially between the projecting glandulae, feels turgid and presents a deep crimson color. No thickening or other alteration of the parts adjoining. At the connection with the cervix the movement is free ; no consolidation of the uterus with the neigh- boring contents of the pelvis. The morbid change seems entirely con- fined to the os uteri, with an anomalous tingling in front and inside of the thighs. These last for a few hours, or a day or two and then dis- appear, perhaps for weeks, but again and again return in the same situation, for a long time not increasing in severity. Internally the feeling of tenderness increases. There is now slight irritability of the bladder; but appetite, digestion and sleep may continue good; the pulse not changed, as in many other uterine affections of serious character. The patient does not yet anticipate danger. When the disease assumes a more dangerous form the first change takes place in and around the muciperous glandules which exist in such numbers in the cervix and margin of the os uteri. They become indurated by the deposition of scirrhous matter around them, and by thickening of their coats, in consequence of which they feel at first almost like grains of shot or gravel under the mucous membrane. 293 DISEASES OF THE SANGUINOUS FUNCTION. The further symptoms correspond more nearly with those of canoer in other organs. See p. 282. Remedies, p. 285 to 297. FUNGUS HAEMATODES. Case of Field-marshal Count Radetzky.—In July and August 1839, this distinguished Austrian general was attacked with congestion of the head and vertigo ; and soon after it passed off there commenced a pressure in the right eye, inflammation of the eyelids, lachrymation, occasional protrusion of the eye, and pressure in the forehead. He was relieved by remedies, but the under eyelid remained inflamed. In May, 1840, there was another attack of vertigo; after it he Was well except one eye. October 9th. The Marshal, on the occasion of a great review was exposed during five hours to extremes of temperature and fatigue. Towards evening his face became red, he had fever with great pain in the right side of the head; the right eye was inflamed and protruding from the orbit; pulse full and hard. He was relieved by homoeopathic remedies; but lachrymation of the right eye continued and there was a small swelling in the external angle. About the end of October further exposures were followed by the appearance of a small tumor commencing at the inner angle of the eye near the lower lid; the external tumor enlarged; the eye protruded, and there was pain in the head. Dr. Hartung, medical counsellor to his Excellency, pre- scribed the ordinary homoeopathic remedies, beginning with Aconite, and all the symptoms of immediate urgency were, for the time, removed. But the growth of the fungous tumors could not be stayed. That above the external angle assumed a purple color, that between the eye-ball and the lower lid became fungus-like, elastic, granulous, purple, and painless. The eye became protruded and turned from its normal axis of vision, so that the pupil stood looking outwards and upwards, the ball restricted in its motions, but the power of vision uninjured. At the beginning of the next year, the case beginning to be regarded as incurable, Dr. Hartung made an official report to Vienna, and fur- ther medical counsel was ordered by the Emperor. The tumors had increased to one-third of an inch each in diameter, and the fungous growth was evident around the whole circumference of the eye-ball, which began to protrude more sensibly. Vision began to suffer; towards the external angle objects were only partially visible; the conjunctiva was softened, and dark-red, approaching to blue ; lids glued together in the morning; sensibility to light increasing in the day-time; lachry- mation, heat, dryness and pain at night becoming worse. A consultation was held on the 26th of January, at which the consulting allopathic physicians, Drs. Jager and Flurer, declared the case as hopeless, " after forty years of experience." Dr. Hartung despondingly resumed FUNGUS HAEMATODES. 299 the' sole direction of the case. The distinguished patient was now eighty years of age. On the 19th of February, 1841, the appearances threatening scirrhus had changed; haemorrhage had begun, the tumors had diminished in size and were less painful. The report of this date, shows improvement in vision and general health; and diminution of pain. March 16th. The fungus which at its greatest size had been three inches in circumference had been reduced to a small tumor which was visible only on drawing down the under lid; the eye moved freely in the orbit, and the power of vision was restored. April 22d. The tumor had so far diminished that only a slight projection on the lid remained. The Marshal was employed in his usual duties, expos- ing himself to "a low temperature, and again in the increased heat of the sun. He continued in his former mode of life, without any injury to the eye. The disease was regarded as cured, and no further reports were required." The remedies used during the treatment of the Austrian Field- marshal's case are recapitulated by Dr- Hartung in his communication of June 12th, 1841. They were : Arsenicum 10° ; Psorin 10° ; Her- petin 103 ; Carb^animalis 10° ; and Thuja-occident He observed "that the first three remedies aggravated the disease." He then pre- pared Thuja 10°, one drop in three ounces of distilled water, a table- spoonful three times a day. " The first day appeared all the symptoms that his Excellency had occasionally suffered for years ; as : headache in the right side of the forehead, cough, particularly at night, slight diarrhoea, pain in the kidneys, with a sandy sediment in the urine, itching, and a reddish rash-like eruption on the inner side of the thigh; the night was quiet, with the exception of the cough. The second day the feelings were the same, but when pointed to they were gone away like a breath. Third day no more pain; itching in the inner angle, secretion of a milky and rather cream-like moisture on the whole extent of the fungus. After this the eye was moistened with the solu- tion of Thuja every two hours. On the fourth day there was no pain; the secretion increased; the fungus appeared to be diminishing ; fifth, sixth, and seventh days, no pain. The secretion increased, the lower part of the fungus diminished, to the astonishment of all who had pre- viouslv seen it. On the eighth day after the first use of the Thuja I gave Carbo-animalis 10°, 3. Effect first and second days as after the Thuja ; the pain in the forehead appeared, only it extended itself to the left side, and to the ear, like a breath passing over. The secretion continued ; no pain in the eye. The third, fourth, fifth, sixth, and seventh days, no headache; the secretion continued. I now every mornino- touched the protruding fungus with a fine pencil, moistened with the fourth dilution of Carbo-anim. The Thuja was continued on the circumference. The fungus diminished, and the eye retreated 300 DISEASES OF THE SANGUTNOUB FUNCTION. within the orbit." By continuing these two remedies in alternation every eight days, in the course of a month and a half the whole fungus had disappeared, and the eye moved as well as the other in its orbit. At the same time various other constitutional symptoms disappeared. The Field-marshal continued in good health to extreme old age ; and sent a public testimonial of gratitude to his physician. GENUS VII.—LUES.-1. SYPHILIS. This disease was unknown to the Greek and Roman physicians, as no allusion is made to it by any of their medical authors, historians or poets; and much discussion has taken place respecting its first intro- duction into Europe. All the modern authors who first described it, (collected by Luisinus, Astrue, and Girtanner) in the latter years of the fifteenth century comment upon it as " morbus novus," " morbus gnotus." Peter Pinctor traces the origin of the disease to the time of the conjunction of Mars, Venus, Jupiter, and Mercury, A.D. 1483, at which time he thinks this disease must have originated ; but Fulgosi dates it at October, 1492; Sanchez and Henslei* in 1493. Others contended that it originated in Hispaniola. It is certain, however, that it was first distinctly recognized, says Dr. Simpson, of Edinburgh, dur- ing the invasion of Italy by the victorious army of Charles VIII. of France; and it first broke out extensively at Naples when the French took possession of that city in the spring of 1495. This army carried the disease with them to France, Switzerland, Germany, Flanders, &c. In 1497, it had reached Aberdeen in Scotland. Six months later the new disease was made the subject of municipal regulation in Edin- burgh. Infected persons were banished from the town to the sands of Leith,there to remain "till God shall provide for their health." Those who took upon then the cure of the infected were banished with their patients, and if either should return to the city in violation of the edict they were to be burned on the cheek with a branding iron. James IV. who was then king of Scotland was much engaged in experimental re- searches after the philosopher's stone, or the " quinta essentia," and was withal learned in the arts of medicine and surgery. In his practice of surgery he was more liberal than any philanthropist of our noble pro- fession of these days. He not only bled his patients for nothing, but gave them eighteen shillings Scotch into the bargain. The record shows that his operations were not always successful. One woman with cataract was left entirely blind, for which a partial atonement was made by the usual eighteen shillings, Scotch. The experience of this king in the treatment of syphilis is not recorded, but the sums of money given by him to patients affected with it are regularly set down to his credit. SYPHILIS. 301 Wm. Dunbar, the Scottish poet to the royal household, who preceded Burns by nearly three centuries, employed his genius in commemorat- ing the coming in of the new plague. Gunbrecht and Brandt wrote in 1496, that the disease had already invaded France, Germany and Bri- tain. In 1502, the privy expense book of Elizabeth of York, queen of Henry VII., shows that the benevolent lady paid a surgeon for curing a certain mendicant of the French malady the sum of twenty shillings. During a great portion of the sixteenth century, it was so contagious in some parts of Europe, that it was communicated by lying in the same bed, by the clothes, gloves, money, or breath of the patient. A variety of syphilis also prevailed in Canada some years ago, of so viru- lent a nature, that it was communicated by the breath and by contact. Dr. Thompson, " thinks it probable that the disease has existed, more or less, and under different grades of severity, in all ages, and that it has thousands of times been originated de novo." Professor Simpson, from a historical review of the earliest notices of syphilis on record, arrives at the following pathological opinion: I. That syphilis was a species of disease new to Europe when it first excited the attention of physicians and historians in the last years of the fifteenth century. II. That it is a species of disease distinct and different alike, first, from gonorrhoea; and, second, from Greek leprosy, (with both of which diseases it has been occasionally confounded); for both of these mala- dies existed and were abundantly recognized in Britain long before the date of the introduction of syphilis. III. When the disease first broke out it was regarded by physicians and the public as communicable, and constantly communicated from the infected to the healthy by the employment of the clothes, vessels, baths, &c, used by those suffering with it, and by the slightest contact, or even breathing the same air with them. One of the gravest charges against Cardinal Wolsey when he was arraigned before the House of Lords in 1529, was, as given in the indictment; that "the same Lord- cardinal, knowing himself to have the foul and contagious disease of the great pox broken out upon him in divers places of his body, came daily to your grace (the king) rowning in your ear, and blowing upon your most noble grace, with his perillous and infective breath, to the marvellous danger of your highness, if God, of his infinite goodness, had not better provided for your highness," &c, &c.* For many years after its outbreak sexual intercourse does not appear to have been suspected as the mode of its propagation; the primary affections of the several organs were not noticed as constant symptoms. Their attention was chiefly directed to the secondary symptoms, such as: The hideous eruptions on the skin, the ulcers of the throat, tho * Lancet, 1861, p. 172. 302 DISEASES OF THE SANGUINOUS FUNCTION. exostoses, and nocturnal pains in the bones, &c. The rapidity with which it spread over Europe led men to suppose that it travelled as an epidemic without waiting for the slow process of communication by con- tact. It was on the 4th of Dec, 1494, that the army of Charles VIII. entered Rome; they reached Naples February 21st, 1795, and eva- cuated the city May 20th. On the 24th the Spanish general Cordova landed in Sicily. The battle of Fuornovo was fought July 5th, king Ferdinand returned to Naples the next day. The last remnant of the French army returned to France about the end of the following year. Within less than two years the Aberdeen edict was issued (April 23d, 1497), only forty-eight days after that of Paris, which was dated March 6th. The disease soon swept off vast numbers of the dissolute princes and dignitaries in all countries. The emperor Charles V., Pope Alexander VI., kings and cardinals, princes and bishops, peers and priests, are recorded among its victims. Indeed the manners of the dignitaries of every nominally Christian country were so much worse than the masses were able to believe, that they stealthily transmitted this most loathesome of all diseases so rapidly from one city to another that the malady itself was at first mistaken for a pestilential epidemic. The causes which may have conduced to vary its character at differ- ent periods, are numerous; and we suggest the following as a few of them. It has been observed that exposure of the body to a cold, humid atmosphere, excessive fatigue, changes of diet and of climate, un- wholesome food, and neglect of cleanliness, favor the rapid progress and destructiveness of the malady; while a dry, warm and equable temperature, cleanliness, nutritious food, and comfortable lodgings are circumstances which conduce to render it comparatively mild. Thus its violence during the siege of Naples in 1495 may also be explained, when we bear in mind the forced marches, the changes of climate and of diet, and the constant excitement and fatigue to which the soldiers were exposed. The same severity marked its prevalence in the British army in Portugal, while the natives themselves were but slightly affected, although exposed to similar contamination. One of our army surgeons recently informed us that the same diffi- culty was experienced among our soldiers during the Mexican campaign in 1847, and 1848; they contracted the disorder, while the Mexicans experienced but slight inconvenience, although exposed to the same virus. The argument also holds good with respect to sailors who are so constantly subjected to the vicissitudes of temperature, the noxious air of vessels, and the stale, salt provisions used at sea. May it not, then, be fairly inferred, that whatever causes impair the forces of the organism, serve also to render it less able to resist the deleterious influence of the syphilitic poison? SYPHILIS. 303 In regard to the doctrine of Hahnemann respecting the identity of syphilis and sycosis, we agree with Hartmann, that the mass of evi- dence upon the subject renders it almost conclusive that the two diseases are distinct in their nature. The origin of each is a specific morbid poison, capable of impressing the organism in a distinct and peculiar manner. Diagnosis.—There are unquestionably a great variety of ulcers which make their appearance upon the genitals, communicated by contact with diseased subjects, which are, nevertheless, not syphilitic, and which will heal over without causing constitutional symptoms, simply by the aid of mild dressings. The true syphilite chancre is now of rare occurrence, but the great majority of those intractable ulcers which are looked upon as real venereal chancres, are nothing more, primarily, than simple non-infectious sores, which have been converted into an unhealthy condition by the abuse of mercury. Who can doubt this fact when he contemplates the dreadful effects which a course of mercury often produces on the healthy organism? who could be tempted, in health to take the enormous quantities of this drug which are deemed necessary for the cure of syphilis? Let the provings of it —let the horrible consequences which its accidental absorption some- times occasions upon the surface,—in the mucous membranes,—the bones,—-the glands and the nervous system, answer. For our part, we would prefer the syphilitic poison itself, rather than the uncontrollable ravages of such an enemy as mercury in allopathic administrations is admitted to be by the fair-minded of those even who most earnestly defend its use. In order to be fully convinced that many of the effects of mercury are improperly attributed to the action of the syphilitic virus, it is only necessary to regard carefully the symptoms which are constantly presented to our observation in what are called venereal affections, and to notice the opinions of many of the most eminent medical observers. Thus, Sir Astley Cooper in his lectures, used-to observe, " do not think that it is a rare occurrence for the penis to be destroyed by mercury ; no, a chancre that has remained Weeks in a healthy state, shall become irritable, and by mal-treatment, by the injudicious and improper use of mercury shall slough and end in the destruction of the penis; this is not a rare case, and is attributed to the venereal disease, but in reality is an effect of the improper use of mercury." (Castle's Manual of Surgery, p. 280.) The great Hahnemann constantly alludes to the pernicious results of the abuse of this drug in the hands of the allopathist. There can be no question that those dreadful mutilatious of the penis, of the nose, the palate, the eyes, of the surface of the body, and the nodes and caries of the bones, which we occasionally observe, are all effects of mercury and not of syphilis; and it is in the highest 304 DISEASES OF THE SANGUDNOUS FUNCTION. degree probable that the immunity enjoyed by the Portuguese, the Mexicans, and certain other nations, from the severe forms of this malady, is attributable solely to the fact that they use no mercury in its treatment. Chancre.—The primary chancre usually presents itself on some part of the genital organs, in from three to seven days after contamination, in the form of a darkish red pimple, attended with slight itching, and surrounded by an erysipelatous blush. In a short time matter forms in the centre of the pimple, and an excavated ulcer, with a yellowish surface, hard and ragged edges, and an indurated base, makes its ap- pearance, marking the sore as a true chancre. The most common seat of primary chancre is on the inside of the prepuce and the corona glandis, but it occasionally occurs on the glans and external parts of the genitals. Many varieties of venereal chancre have been described by authors, as the simple, the indolent, the irritable, the sloughing, the in- durated, the phagedenic of Carmichael, the superficial of Mr. Evans, the Hunterian, &c.; but as these diversities in the appearance of the chancre are not owing to any difference in the character of the virus, but to the condition of the patient as regards constitution, tempera- ment, and mode of life, at the period of contamination, we should ab- stain from making those minute classifications which son^e writers have attempted. The circumstances which may operate to modify the character and appearance of a simple chancre, or which may conduce to develop primarily an intractible and destructive one, are numerous. Individuals whose constitutions have been impaired by abuse of sti- mulants, undue exposure, hardship and fatigue, and insufficient nourish- ment, are liable to be attacked from the first with that variety which is denominated the indurated sloughing chancre. Those whose systems have been loaded with mercury, and enfeebled by previous disease, are peculiarly subject to that description which is termed irritable and sloughing. Persons who go from temperate to tropical climates, are especially in danger of the phagedenic variety. Scrofula and scurvy also predispose the system to this form of it. The simple chancre is by far the most common, particularly in tem- perate latitudes, and usually occurs to individuals of a sound consti- tution. Some have supposed the cause of this variety to consist in " gonorrhoeal matter and other morbid vaginal secretions," brought in contact with the penis during coition; but of this there is no proof. The simple ulcer very often becomes converted into an irritable, sloughing, or erysipelatous one, by some excess or imprudence which impairs the vigor of the body, or by the abuse of mercury. On the other hand, so long as the constitution remains sound and unimpaired, SYPHILIS. 305 resistance is offered to the action of the virus, and the secondary im- pression which it makes will be very slight, and in some instances im- perceptible. It is in cases of this description that we sometimes wit- ness spontaneous cures of what was originally true syphilitic con- tamination. The most certain marks of a true syphilitic chancre are: the exca- vated surface, the hard, ragged edges, and the indurated base. These appearances, taken in connection with the previous history of the case, will generally enable us to decide with sufficient certainty respecting the character of the sore; but where any doubt exists, we would most strongly commend the practice discovered and successfully adopted by Ricord of Paris, of inoculating a sound part with matter from a sus- pected ulcer. In case a second chancre is produced by this operation, there will no longer remain a question in regard to the true nature of the malady. After the syphilitic poison has passed from the chancre through the absorbent glands of the groin into the blood, it possesses a specific affinity for only three parts of the body, viz.: " The mucous membrane of the throat and nose ; the skin, or surface of the body; and the bones, with their periosteal coverings," (Sir A. Cooper's lecture). Thus it will be remarked that the internal organs are never impressed by this virus; and this fact should induce the allopath to pause before he loads the system with a poison which spares scarcely a single structure during its operation. Hunter taught that " the venereal disease" presented " no variety of species," and that " no difference can be produced in the manifesta- tion of the disease by a difference in the malignity of the purulent matter; the same pus exercises, on different individuals, actions totally dissimilar from one another, the diverse nature of which depends on the constitution and the general state of the economy at the time of the infection.* M. Ricord, the most distinguished of French authors on this subject up to a recent date, held the same opinion. In his letters he says (p. 149.) " Up to the present time, we are justified in denying the existence of more than one virus."f But in his latest work which he bequeaths to posterity as his last legacy and the results of thirty years' experience, he admits that " the chancre is no longer a morbid unit, but a mixed manifestation, belonging to two distinct pathological species. The one of these is the simple chancre, the other, the indurated or infecting chancre. The latter creates consti- tutional symptoms, the former is one with soft base, an affection purely local which limits its effects to the region which attacks, which never exercises a general influence upon the system, which is never ac- companied by constitution! affections. In other words it is a * Lectures on Chancre, by M. Ricortl, 1859. p 3-4. t On Syphilitic Virus. Chap. I. Vol. IL-20. 306 DISEASES OF THE SANGUrNOUS FUNCTION. chancre which does not affect the economy—a chancre without sy- philis." Upon this theory a great number of the discrepancies in regard to the origin of the disease may be reconciled. "The simple chancre " existed in the early ages of the world and may' be the same referred to the in the Mosaic law, and also in the works of Celsus and Galen; the contagious or more malignant disease originated in the 15th century and spread as an epidemic; it consists of the infecting chancre and its constitutional manifestations.* Diagnosis between simple and infectious Chancre. Simple non-contagious chancre. "The simple chancre has a soft base, or presents only an inflammator}' thick- ening ; it does not react upon the glands, or influences them in a peculiar manner by producing almost certainly an inflam- matory, adenite, acute, mono-glandular suppuration, and furnishing most gene- rally an inoculable pus. " Chancre with edges neatly shaped, and cut perpendicularly ; the floor irre- gular and worm-eaten. " Chancre ordinarily multiple, or mul- tiplying itself by a series of inoculations of the neighboring parts. " Chancre with virulent pus, conta- gious par excellence preserving during a long period, the characters which con- stitute its specificity. " Lastly, a chancre with a destructive and invading tendency ; the form of ul- ceration the most apt to experience the phagedenic complication." M. Ricord, p. 31. A simple chancre is not found on the head. Differential Diagnosis. Br. Helmuth has gleaned from the works of M. Ricord the following characteristic symptoms of each form of chancre. Simple Non-infecting Chancre 1. Never noticed upon the cephalic region. 2. Develops rapidJy. 3. Surface irregular ; floor fretted or worm-eaten. 4. Edges neatly shaped, cut perpen- dicularly, as if cut out with a punch. Indurated Infecting Chancre. 1. Every part of the body liable to in- vasion (therefore chancre on the head may be pronounced infecting.) 2. Develops slowly. 3. Surface smooth ; floor lardaceous. 4. Edges sloping, as though made with a gouge. * Helmuth, U. S. Journ. Horn, Vol. 2, p. 476. SYPHILIS. 307 Non-infecting. 5. Edges undermined. 6. Border abrupt. 7. No induration. 8. No induration. 9. Suppurates profusely ; the suppu- ration being one of the most fertile sources from which the pus is derived. 10. Pus in the highest degree con- tagious, persisting during the entire existence of the chancre. 11. Generally multiple from its origin, or becomes so by inoculation. 12. Tendency to invade the neighbor- ing structures. BUBO. 13. Not necessarily present. 14. Mono-glandular. 15. Suppurating almost certainly, and furnishing most generally an inoculable pus. 16. No fixed period of development. Simple. 17. The simple chancre is most likely to undergo the phagedenic complication. 18. In virgin subjects transmitted in its form—that is a simple chancre. 19. Transmitted to syphilitic subjects either as a simple or an indurated chan- cre ; the form which is reproduced pro- bably depending on the nature of its ori- gin—that is to say, the chancre which gives birth to it."* Comparative number of cases Infecting. 5. Edges adherent. 6. Border gradually lost in the floor of the ulceration, giving to the ulcer the appearance of a cupola. 7. Induration surrounding the ulcer on all sides, forming for it a kind of bed (pathognomonic.) 8. Induration commences from the first, (if not produced in a few days, will not become so.) 9. Suppurates little, producing but a small quantity of serosity, most fre- quently sanious and ill-formed. 10. Pus rapidly loses its specificity, at all events for the infected subject, who in a few days becomes refractory to in- oculation with his own virus. 11. Generally solitary. Inmost cases a single chancre giving rise to contagion. 12. Inverse disposition. Its limits are soon defined. BUBO. 13. No infecting chancre without an indurated symptomatic bubo. 14. Affecting several or all the glands. 15. Extreme hardness ; independent of each other; no tendency of them- selves to inflammation or suppuration. 16. Produced in course of first or second week ; rarely noticed later ; ge- nerally coincident with induration. Indurated. 17. Rarely assumes the phagedenic deviation. 18. Transmitted in its species in vir- gin subjects ; that is to say, an indu- rated chancre. 19. Transmitted to previously infected subjects under the form of a chancre with a soft base, analogous in appearance to the complication.* 20. M. Fournier in three months at the Midi in Paris saw two hundred and fifteen cases. Of two hundred and seven of these cases sixty-five had bubo ; with- out bubo one hundred and forty-two. 20. In the same period, one hundred and twenty-six of the indurated and in- fecting. * Prof. Helmuth, U. States Journal of Homoeopathy, Vol. 2, 480, 481. 308 DISEASES OF THE 8ANGULNOUS FUNCTION. The secondary, or specific effects of the syphilitic virus, after its entrance into the blood, are: First. Upon the mucous membrane of the mouth and throat, which becomes red and inflamed, and covered in some parts with pimples, which soon degenerate into ulcers, resembling in many respects the primary simple chancre. These ulcerations extend into the nostrils, and sometimes even into the larynx itself, giving rise to loss of voice, severe cough, violent constitutional disturbance, and death. In cases which have been improperly treated, the bony palate and the nasal bones become affected, and exfoliate, and thus cause those disgusting mutilations of the nose and face which so often stare the old-school- physician in the face. Second. Manifestations of the action of the absorbed virus on the skin: — These are : Slightly elevated copper-colored elevations of different sizes, attended with uneasy or itching sensations, sometimes covered with a kind of scurf or scale, or, in other instances, with incrustations or ulcerations. These eruptions make their appearance on the face, head, breast, palms of the hands, and arms. Eruptions, which are called tubercular, often appear on the scalp, the eye-brows, the breast, back, and arms, and ultimately form very troublesome ulcers. In healthy subjects these secondary eruptions are not very troublesome, being simply copper-colored blotches, covered with a thin scurf; but in irritable and impaired constitutions they often assume the character of foul and sloughing ulcers. The particular variety of these secondary eruptions will be determined by the peculiarities of constitution in each individual case, and not from any original difference in the virus itself. Third. Action of the venereal poison upon the osseous structure, and its periosteal covering. The morbid inflammation in the first instance upon the periosteum, causing severe nocturnal pains, and some tumefaction in the affected region. If the malady continues to increase, an osseous deposit will be formed between the periosteum and the bone, constituting what is termed venereal node. This node, in its early stages, does not usually give rise to much inflammation of the surrounding skin, nor is it attended with a great amount of pain, but after it has existed for a considerable time, and particularly if the patient has been drugged with mercurial preparations, it becomes quite painful, especially during the night. The ordinary location of venereal nodes is on the anterior portion of the tibia, or on the surface of the cranial bones. We believe that the above enumerated symptoms constitute all of the legitimate effects resulting from the action of the absorbed syphi- litic virus. The great variety of eruptions and ulcerations described SYPHILIS. 309 by Hartmann and others, are attributable to other causes, operating either by themselves, or in conjunction with the venereal poison. It is of vast importance in affections of this description to distinguish, with all possible accuracy between the syphilitic action and that of mercury, scrofula, and other causes. Farther on we shall endeavor to make this distinction as clear as possible. Bubo.—Another primary manifestation of syphilis consists in an enlargement of one or more of the absorbent glands of the groin, termed bubo. This enlargement usually succeeds the chancre, and is caused by the absorption of the virus of the latter. It is rare in real syphilis that more than one gland in each groin becomes affected with the virus, although some of the other glands now and then become slightly swollen from sympathy. The swelling ordinarily partakes of an in- flammatory character, and if not opposed by appropriate remedies, runs on to suppuration, and sometimes to sloughing. The disease has been supposed to be purely local, until after the swelling in the groin has preceded to the suppurative stage; but this is evidently erroneous, from the fact that secondary symptoms not un- frequently occur, without there having been any previous enlargement in the groin. (See Bubo, Sympathetic) Bubo sometimes makes its appearance without the previous existence of a chancre, but such instances are by no means common. Swelling of a non-venereal character may likewise occur in the groin from a strain, or from too great violence or bruising of the part. But as chancre for the most part precedes the bubo, there will rarely occur any difficulty in our diagnosis. Treatment.—Mercury. Mercurial Disease.—Keller says, it can no longer be doubted, that the so-called syphilitic ulcers in the ex- tremities of the following character are the result of mercurial ca- chexia. They are characterized by their grouping and renal form, by their serpiginous advance at their convex border, and their healing and skinnin"* over at their concave border; the same is true of the so-called angina syphilitica, with serpiginous ulcers on the palate, throat, or root of the tongue, giving rise to aphonia, so often described as a characteristic of syphilis. The common reliance is on Iod.- potassa for eliminating the Mercury from the system. Hahnemann, Gross, Hartmann, Hunter, Abernethy, and many other distinguished members of the profession, entertained the opinion that the constitutional symptoms of syphilis are always progressive, and never disappear, unless opposed by medicine ; but the fact is now completely established, not only that Mercury is not necessary for the cure of either the primary or secondary symptoms, but that they often terminate in a spontaneous cure without any 'medicine. We are assured by Dr. Ferguson, and other surgeons, who havo 310 DISEASES OF THE SANGUINOUS FUNCTION. observed the disease in Portugal, that the natives cure themselves per- manently of the primary symptoms by topical applications ; and of the secondary effect?, by decoctions of sarsaparilla and sudorifics. They remark, that '* the virulence of the disease has there been so much mitigated, that, after running a certain course, (commonly a mild one) through the respective order of parts, according to the known laws of its progress, it exhausts itself, and ceases spontaneously." (Med. Chir. Trans. Vol. IV., pp. 2 — 5.) This is still further cor- roborated by the numerous cures of the primary and constitutional symptoms recorded by Messrs. Rose, Dease, Hennen, Guthrie, Good, and Whympor, without Mercury, or any other means than simple dressings. In the cases which they describe, no caries of the bones occurred, as is so commonly observed when Mercury is used; " and in no instance was there that uniform progress with unrelenting fury, from one order of symptoms, and parts affected, to another, which is considered an essential characteristic of true syphilis. (Med. and Chir. Trans. Vol. VIIL, p. 422.) Hahnemann, and most of his disciples, as well as Hunter and other eminent allopathists, entertained an opinion that the chancre is simply the vicarious symptom of the internal disease, and that by removing this ulcer by external applications, "the disease is forced to em- body itself externally, in the more troublesome and speedily suppu- rating bubo. And, after this, too, has been removed, as is foolishly done, by external treatment, the disease is forced to manifest itself throughout the organism with all the secondary symptoms of a fully developed syphilis. This unavoidable development of the internal syphilitic disease generally takes place after the lapse of two or three months."—(Hahnemann's Chronic Diseases, p. 116.) We speak advisedly when we pronounce this last assumption al- together erroneous; for we have repeatedly seen true venereal chancres cured by topical treatment alone, while the patients have remained entirely free from any secondary manifestations for years afterwards. When a student of medicine, the author passed some time at the United States Marine Hospital, Chelsea, then under the superintendence of the able and accomplished Dr. Stedman. In this institution the internal use of Mercury had been dispensed with in the cure of syphilis, for several years previous to my entrance; and I ascertained that it was a very rare occurrence to observe secondary symptoms in those who had been cured in the hospital, although patients were constantly returning with other complaints, who had been cured of chancre years previous. The treatment chiefly relied on consisted of topical applications of a mild character, the internal use of decoctions of sarsaparilla, and a rigid regimen. The ordinary SYPHILIS. 311 period for the cure of Mercury chancre, was from three to four weeks; and for bubo, from six to eight weeks. So long as the chancre exists, the matter generated in the con- taminated part continues to be re-absorbed, and so to supply new fuel to the mass of the blood; it is therefore important to change the morbid action of the ulcer, and heal it up as soon as possible. The matter formed in ulcers of the mucous membrane of the throat, which have arisen from the constitutional effects of syphilis, is also capable of propagating the disease by contact with abraded surfaces, or by being directly re-absorbed into the blood. There is reason to believe, therefore, if all these ulcers be speedily healed by topical treatment, so that the blood shall only contain a given quantity of the virus, this limited amount will gradually become diluted, by the constant addition of new and healthy blood, and by its frequent circulation through the lungs, so that its power to impress the structure is finally lost, and the parts which have already been affected, gradually recover their healthy tone. In advocating the practice of topical applications, however, we do by no means wish to be understood as placing entire reliance upon them, to the exclusion of other remedies. We only assert that local applications are capable of effecting speedy cures of chancres, thus of destroying these sources of contamination, and placing the blood in the most favorable condition to be purified by the inspired oxygen, by the newly-formed blood and by remedial agents. A morbid action is set up in the chancre, which causes it to generate matter of virulent quality. This is evident from the fact that the matter of buboes and other venereal abscesses, as well as the blood of syphilitic persons, is incapable of causing contamination in the healthy. We repeat, then, heal the chancres as soon as possible, by destroying their mor- bid action, with some local application which shall induce a healthy medicinal action, and we have already done much towards abridging the power of the disease. Our admirable specifics, will, then, readily accomplish what remains to be done in perfecting a cure. The remedial agents which we have found most useful in the management of syphilis, are :—Topical: — Nitr.-argenti, Acid-nitric, Zinc-chlorid., 'Mercur.-prcecip.-rubrum., Kreosote. Internal: The preparations of Mercury,- Aurum-mur., Thuja, Acid-nitr., Sulphur, Hepar-sulph., Sarsaparilla, Silicea, Mezereum, Hydr.-potassce. In the treatment of chancre, our attention should be directed in the first instance to the cauterization of the sore, in order to change as speedily as possible the morbid action. For this purpose, either of the first-named medicines may be employed, although in most cases we prefer the Nitrate of Silver in substance. After a healthy action Las been excited in the ulcer, by these applications, lotions of simple 312 DISEASES OF THE SANGUINOUS FUNCTION. water may be employed until the cure is established. It will be well to keep a dossil of lint moistened with water constantly upon the ulcer. This course, in conjunction with the remedies advised below, will generally effect speedy and permanent restoration. Treatment of Chancre.—In the treatment of the simple form of chancre, if we admit the correctness of the opinions deduced from the largest experience, we have a local disease, but it is a poisonous sore, which is secreting a poisonous pus, which must be destroyed. The treatment therefore is essentially surgical. As in cases where poisons have been taken into the stomach, we begin with dislodging, or neutralizing the poison before we try to cure the symptoms pro- duced by the poison, so in the case of the simple, non-infecting chancre, we must, says Ricord, " reduce the specific ulceration to the state of common ulcer, and transform a wound possessing a special principle for its maintenance into a wound which has no longer such a resource." (Helmuth) For the cure of the primary infecting sore Mercurius, third tritura- tion, in some form is certainly the most efficient agent. In the local treatment to be adopted in the simple chancre, Ricord says, we should "reject at once all mild caustics, which only act more or less as anodynes. That which is required in this instance, is a destructive agent." He says, he has successively tried the "Vienna paste, Potass, Nitric-acid, the actual cautery, &c." but proposes a new agent which is peculiarly efficacious. " This caustic consists of Sulphuric-acid, mixed with powdered vegetable charcoal in the pro- portions necessary to form a half-solid paste." It is proposed by this application to " destroy the poison, and convert the chancre into a simple wound, which will proceed rapidly to cicatrization." Dr. Helmuth says, he tried this application in eleven cases of simple chancre with " the most surprising results. Define well the chancre, find it to be certainly the non-contagious ulcer, and no internal treatment is required." Of the internal remedies, Mercury is the most important. By comparing the pure effects of the different preparations of this drug upon the healthy human organization, with the constitutional effects of the syphilite virus, it will be observed that the former are capable of causing all the symptoms of the latter, as well as may others which are peculiar to the drug. According to Pereira, the effects of Mer- cury in large doses are: First. On the mucous membrane of the nose and throat: ulcera- tions of the mouth, gums, throat, and nose, which are often followed by extensive sloughing of the parts. Second. On the skin or surface of the body : eczema-mercuriale, erythema-mercuriale, spilosis-mercurialis, miliaria-m>ercumalis, SYPHILIS. 313 and other cutarfeous eruptions which bear a close resemblance to herpes, impetigo, psydrasia, and the copper-colored eruptions of syphilis. Third. On the bones and their periosteal coverings: " inflammation of the bones or periosteum, and the consequent production of nodes (symphoresis periostei mercurialis") Of all the medicines used in the treatment of lues, says Hahne- mann, Mercury is the only one that has stood the test of experience. They coincide in their action in many points. Thus: The venereal poison produces on the skin pustules, scales and tubercles. Mercury produces similar defoedations of the skin. Sy- philis excites inflammation of the periosteum and caries of the bones. Mercury does the same. Lues produces inflammation of the iris ; the same is a very common occurrence as a consequence of Mercury. Ulceration of the throat is common from syphilis; the same often re- sults from Mercury. Ulcers on the organs of reproduction result from both the poison and the remedy; thus furnishing another proof of the doctrine of Hahnemann. Mercury, though a partial similimum to venereal disease, is not a per- fect one; and sometimes produces drug-symptoms which obstinately remain beside those of syphilis. There are frequently seen " cases of venereal chancrous disease, especially when complicated with psora, and even with gonorrhoea sycotica, which, far from being cured by considerable and repeated doses of inappropriate mercurial prepara- tions, station themselves in the organism alongside of the chronic mercurial disease, which develops itself gradually, and form together a monstrous complication generally designated by the name of masked syphilis (pseudo-syphilis,) a state of disease which, if not absolutely incurable, cannot, at least, but with the greatest difficulty, be changed into health." For, " besides the morbid symptoms analogous to those of the venereal disease, which would be capable of curing the same homoeopathically, Mercury produces a crowd of others, which bear no resemblance whatever to those of syphilis, and which, when ad- ministered in large doses, especially where there is a complication with psora, as is frequently the case, engenders fresh evils, and com- mits terrible ravages in the body." (§ 41.) By the above it will be seen that all of those parts capable of being impressed by the venereal virus, are also acted on by» Mercury. That the operation of the latter is often more violent and destructive than the former, will not at this day be questioned. Erythema, lepra, erysipelas, miliary eruptions, herpes, and impetigo are mentioned by Pereira, and others, as skin-affections, which have arisen from the ill effects of Mercury. These symptoms are: ulcerated mouth and throat, periosteal nodes, iritis, and mercurial cachexia, a 31i DISEASES OF THE SANGUINOUS FUNCTION. morbid state characterized, according to Mr. Travers, " by irritable circulation, extreme pallor and emaciation, an acute and rapid hectic, and an almost invariable termination in phthisis ;" a picture of the phenomenon following venereal infection, which possesses the truth- fulness of a daguerreotype. The capability possessed by this medi- cine of producing in a healthy individual the special and collective phenomena characterizing the venereal disease cannot be denied; consequently, when exhibited with the intention of curing the malady, the indications of the law, " similia similibus curantur" are fulfilled in every particular; yet it is used by the majority of practitioners, who sneer at homoeopathy." Erichsen, when recommending this mineral, says : " Looking, therefore, upon Mercury as the only remedy we possess that influences directly and permanently the venereal poison, I think that it should always be administered in a full course, during some period of the treatment of constitutional syphilis," (Principles and Pract. Surgery, Erichsen, p. 426.) But in addition to the symptoms just enumerated, Mercury, in large doses, causes almost innumerable other symptoms, which have no bearing upon the subject of this chapter, except as indicating its danger in the hands of allopathists. In the above quotation from a distinguished allopathic writer the analogy between the effects produced by the venereal poison and those produced by Mercury maybe seen ; and the difficulty of distinguishing between mercurial and syphilitic in the old school mode of practice may be readily inferred. For an accurate and complete description of the pure effects of Mercury upon the healthy organism we refer to the provings of Hahne- mann and other homoeopathists. Hahnemann preferred the fluid Quicksilver, carried up to the decillionth degree, over all other preparations in the treatment of both primary and secondary syphilis. For the cure of primary chancre, Hartmann recommends the first or third preparation of Mercurius-solubilis, in doses of one grain, night and morning. If no improvement occurs within the first eight days, he gives a lower trituration of Merc.-praecip.-rubrum, in doses of one-sixth of a grain, two or three times a day. In the Hunterian, phagedenic, and the elevated indurated chancres, Hahnemann em- ploys the Red-precipitate, in its lower attenuations, from the first. Dr. C. Muller, of Leipsic, is also most decidedly in favor of the Red- precipitate, or the Ilydr.-sulph.-rub., in the treatment of syphilitic chancres and buboes, in whatever state they may present themselves. He advises a grain of the first trituration to be given twice a day until the ulcers have nearly healed. For painful nodes and other syphilitic affections of the bones Hydriod.-potassce is advised. SYPHILIS. 315 We have also made use of the Precipitate at the third attenuation, with marked advantage, in uncomplicated syphilis ; and have known the best results, also, from the Hydr.-mur.-cor., in both the primary and secondary forms of the malady. For the cure of troublesome secondary symptoms, in the form of cutaneous eruptions, glandular enlargements, and nodes, the Protoiodide of Mercury has extraordinary power. Speedy cures have been effected by it after the other mercurial pre- parations had failed. It may be used at the third attenuation, in doses of a grain, twice a day, until the eruptions disappear. Only against syphilis, says Dr. Wolf, Mercury and Iodine are in- dispensable. " Pure syphilis requires Mercurius; for the combination of syphilis and sycosis, Iodine—only one dose 30° must be given. Where a cure is not affected by it, it is a sure sign that one or the other of the following three impediments hinders the eure : 1. Abuse of Mercury or Iodine. The first can be remedied by one dose of Mercury, 6000°, the second by Iodine one dose, 5000° ; where both have been abused, it is necessary to give, first Mercury, 6000°, and afterwards Thuja, 1000°. 2. The second impediment is the predominating influence of the psoric poison. This requires one dose of Sulphur, 30°, or in case of abuse of Sulphur, Sulphur, 6000° (after the previous dose of Mer- curius 30° has left the case unfinished.) 3. The third impediment is the predominating influence of the sycotic poison. (See Sycosis.—Index.) Syphilitic ulcers require Kali-bichro- mate, 30°, one dose, where the cure remains unfinished ; after it San- guinaria 30°." M. Diday, in advocating the treatment of infantile syphilis indirectly through the medium of the milk, (in answering the objection that chemistry is not able to detect infinitesimal doses of medicines in the milk when thus charged with Mercury, says :) "I am willing to admit that chemistry has for the present told us all it can tell. Must this infinitesimal quantity of Mercury be estimated in reference to its curative power, by that of the salts which we dissolve in our labora- tories ? An extremely small quantity of Sulphur or of Alkali con- tained in the waters of Bareges or Vichy cures, in twenty-five or thirty days, affections which had previously resisted the largest officinal doses of Sulphuret of Potassium or Bicarbonate of Soda. Has nature denied herself the same privilege in the combination which she effects in the living organism ? A vulgar adage tells us that a man lives by what he digests, not by what he eats. In the same way, it.is the re- medy absorbed, not the remedy ingested which effects the cure. And if a molecule of Mercury, reduced by the milky secretion to the state of combination most conformable to the special conditions presented by the child, and reaching the stomach continually arrives there in a 316 DISEASES OF THE SANGUINOUS FUNCTION. form and at times in which its passage into the absorbent system is ensured, — if, moreover, this molecule (as facts prove) suffices to cure it,—in the name of what science can its effects be compared to those of the portion of a salt which we force it, twice a day, to swallow re- pugnantly, without even knowing whether it will not immediately be rejected and passed off with the stools." (Infantile Syphilis, Diday, " New Sydenham Society," p. 240.) When syphilis is complicated by psora, or any other chronic disease, suitable remedies should be alternated with the mercurials. Muriate of Gold ranks next in importance to Mercury, as a re- medy in secondary syphilis. The late Taft, of New-Orleans, employed it in secondary ulcers and eruptions which would not yield to Mercury, with the most gratifying results. In syphilitic eruptions of long stand- ing, we have often administered it with entire success. The second or third trituration may be employed, in half grain doses, night and morning, as long as is necessary. Nitric-acid will be serviceable in many cases of ill-conditioned chancres, which seem to withstand the curative force of Mercury. It is also of great value in contracted secondary cases, accompanied with emaciation, debility, caries of the bones, unhealthy ulcers upon the surface, and great derangement of the nervous system. If these symptoms have been aggravated by abuse of Mercurials, the indication is still stronger for the Acid. The first, second and third dilutions are to be preferred in these cases, a dose to be given twice daily until the disease yields. Sulphur, Hepar-sulph., and Hydr.-sulph.-rubr., are the proper specifics when the chancre occurs in psoric constitutions. As a general rule, the two first should be alternated with some mercurial prepara- tions. Hydr.-potasso3, is eminently worthy of consideration in the indolent glandular swellings which sometimes originate from a combination of syphilis and scrofula. It is also an efficient medicine in the treatment of venereal nodes. Silicea, Mezereum, and Sarsaparilla are often valuable auxiliaries in syphilis complicated with scrofula. These medicines should also be given in alternation with some other suitable specific. In conclusion, we call attention to the following reliable mark of cure alluded to by Hahnemann in his Chronic Diseases: " So long as the original spot upon which the chancre had been developed, exhibits a reddish morbid looking, red, or bluish scar, we may be sure that the internal disease is not completely cured ; whereas, if the chancre has been removed by the internal remedy, the original spot of the chancre can no longer be traced, on account of that spot being covered by as healthy-colored a skin as the rest of the body." SYPHILIS. 317 Treatment of Secondary Syphilis.—Secondary syphilis consists in the introduction of a poison into the blood; and the cure of it, in the neutralization of that poison. The attainment of this object must be sought in the careful, judicious, and prolonged use of medicines ; and in the adoption of such measures, hygienic and dietetic, as are best calculated to sustain the patient's con- stitutional powers. First, then, as regards medicines. It is beyond a question that, as with the original sore, so with many of the constitutional symptoms which result from it, Mercury is one of the most efficacious remedies. We constantly meet with cases in which the primary and secondary diseases coexist, and in which the Mercury given for the one cures the other at the same time, several examples of this are reported further on. There is commonly in these instances this advantage, viz., that Mercury has not been previously administered and it is precisely in such cases that the curative action of the medicine is most decided. The same thing holds good with reference to the secondary symptoms. If Mercury has been given to any considerable extent for the cure of the chancre, the benefit to be derived from its administration in the treatment of secon- dary symptoms will be much less marked, than in those cases in which it has been given in very minute quantities, or not at all. In either of the latter instances, unless there exist some special circumstance to for- bid its use, Mercury is often of the utmost value in combatting the ear- lier secondary diseases of the skin; the erythema, papules, and squamae. Over the more inveterate eruptions, it has comparatively little power. When, therefore, a well-marked and undoubted case of secondary erup- tion presents itself, following closely, or at no great distance upon the primary disease and in which the patient has not been mercurialized, it is well to commence the treatment with one of the lower dilutions of the Iodide or Bin-iodide of Mercury—the second or third decimal, in two- grain-doses, twice a day. This should be steadily persisted in until the eruption has vanished, or until it appears certain that the medicine has effected all the good that can reasonably be looked for from it. In many constitutions these eruptive disorders are remarkably obstinate, and no remedy will exercise a sudd^p influence over them. The Mer- cury having had a fair trial, if it fail in effecting a complete cure, another medicine must be resorted to. Kali-hyd riodicum claims our next attention; this is a remedy of undoubted power in treating the secondary diseases of syphilis; and in the majority of cases of skin affections, as well as affections of other tissues, its aid is required in expediting or completing the cure. In ob- stinate cases, especially those occurring in scrofulous constitutions—and they are the most obstinate, it is a good plan to give this medicine alter- nately with the Bin-iodide of Mercury, not in alternate doses, but during 318 DISEASES OF THE SANGUINOU8 FUNCTION. alternate weeks, i. e. the Kali-hydriod. one week, the Mercurius-bin- iodidus the next and so on. Excellent results will often spring from the alternate action of these and other remedies; and the more so, the less rapid the alternations. To obtain its full curative action in syphili- tic diseases, the Kali-hydriodicum, like the preparations of Mercury, must not be administered in too small doses. " I am in the habit of giving two grains of the salt three times a day, in aqueous solution. The principal indications for its use are—a scrofulous and debilitated constitution ; enlarged glands in the groin, the throat or neck ; the previous exhibition of Mercury in excess, marked by red and inflamed gums, sore throat, foul breath, nocturnal bone-pains."—(Yeldham) It was at one time the almost universal persuasion, that secondary syphilis was incurable, and even now this opinion has its adherents. On the other hand, there are those who, more sanguine than wise, do not hesitate to promise their patients speedy and permanent cure. The truth, as in most other cases, lies between extremes. There is no doubt that in recent cases of secondary disease, occurring in good constitutions, and where the system has not been saturated with Mer- cury, complete and permanent eradication of the symptoms may be safely prognosticated. On the other hand, it is equally certain that, when the taint has once entered the circulation of persons of depraved, scrofulous, and broken-down constitutions, it may but too confidently be predicted, that, though secondary symptoms may, for a time, ap- pear to be successfully combatted, relapses will occur with more or less virulence for many years, and, possibly, for the remainder of the patient's life. "The treatment in former times, of primary syphilis with destructive doses of Mercury, by inducing the very state of the system, I have just described, had much to do with the development of secondary dis- eases in their most inveterate and intractable forms. Modern science, better instructed, obviates much of this mischief, by avoiding the use of Mercury altogether in treating some cases of primary ulcer, and by giving it in more moderate quantities, when it is employed. Still, I am convinced there is room for yet greater improvement, and that homoeopathy points out the way t^it; and to this important point we now proceed to direct our attention." The connection of psora and syphilis, says Dr. Wolf, is proved by the fact that since the appearance of syphilis the lepra has become very scarce. The syphilitic dyscrasia has three characteristic peculiarities: 1. Want of flexibility of the limbs, which refuse to obey the impulse of the will. The joints, on moving, make a painful crepitating noise. 2. Shuddering when going to stool, and, 3. sleeplessnes without apparent cause. SYPHILIS. 319 Dr. Wolf says, primary syphilis may remain stationary for twenty years; but if the chancre is treated actively, and Mercury in laro-e doses be given, and the ulcer healed by force, the slow chancrous dyscrasia is generally the result. The outbreak of the secondary symptoms is, generally, caused by taking a severe cold, often showing itself in an attack similar to acute gout. The combination of the syphilitic and mercurial poisons greatly aggravates all pre-existing morbid conditions ; the liability to take cold is greatly augmented, the worst form of coryza, with offensive corroding secretion is produced, the glands are affected, and a great disposition to parenchymatous inflammations, ulcerations, dissolution of the blood, &c, is produced. But all this suffering Mercury alone can produce, without its com- bination with syphilitic poison. Mercury and Iodine are the very worst poisons, and should never be used but in syphilis. The affections of the mucous membrane, so often treated by Mercury, will also yield to Apis. Scrofula, tubercles, tumor, and goitre will also vield to Thuja.—(Wolf) Treatment of the Diseases of the Mucous Membrane.—These diseases, as has been already suggested, are often, induced by exposure to cold. When so induced, if the patient be at the time, or has re- cently been, affected with syphilis, these cases acquire a peculiar char- acter from that circumstance—they become chronic, secrete copiously and the tonsillary glands may become much enlarged, and deeply ul- cerated. These attacks though of a syphilitic type, have their origin in catarrh and their early arrest may sometimes be effected by the usual remedies for catarrhal sore throat, viz.: Aconite, Bell, Apis, and Mer.-corrosivus. After Aconite has been exhibited to reduce any general febrile excitement, as well as to act on the local disorder, Apis is often very efficacious, in drop doses of the third decimal tincture. If it fail, Belladonna, Lachesis, and Merc.-corr. may be had recourse to. In cases of inflammation, or ulceration, of the same part, in company with other secondary1 symptoms—of the skin, for example—if Mercury have not already been administered to excess, the Iodide or Bin-iodide of that metal, in one grain doses of the second or third decimal should be administered twice a day. The throat will often get well pari- 2?assu with other symptoms ; but should the disease persist when these have vanished, the treatment may be directed against it especially. Acidium-nitricum is here a useful remedy, and may be given internally, in five-drop doses of the second decimal tincture, three times a day; and at the same time a gargle, composed of the pure acid of half a drachm in six ounces of water, may be employed locally. This though beneficial in some cases, is far less efficacious than the Argentum-nit. 320 DISEA8ES OF THE SANGUINOUS FUNCTION. " This may be applied in its solid form when practicable, or in solution, in the proportion of five grains to the ounce of distilled water; the throat should be mopped with this once or twice a day. I employ this medicine in one of these forms in the majority of cases of syphilitic sore throat, and the comfort derived from it is immense." It is beyond dispute that some persons are more susceptible than others to constitutional syphilis. It is equally certain that the scro- fulous constitution is that which is most exposed to its attack. That being so, the importance of attending to the general health of the patient, during the course of secondary syphilis, is self-evident. He should carefully observe all those measures calculated to maintain his health in the finest possible condition. In those early secondary diseases of which we have been speaking—of the skin and throat— being, as they commonly are, inflammatory and febrile, he should in- dulge in alcoholic drinks very sparingly, or not at all, at least in the earlier stages. He should live on plain, good nutritious food. In keeping with this, as well as in reference to the depression of the ge- neral powers which commonly characterize constitutional syphilis, Cod- liver oil is an agent of first-rate importance. " Possessing the advantage of not being medicinal, and therefore not interfering with the action of medicines, I find it in many cases more than a substitute for the re- nowned sarsaparilla—a medicine which, when there is no particular indication for other remedies, may be prescribed with the greatest ad- vantage. A small quantity of cod-liver oil is sufficient—a dessert- spoonful, taken every night at bed time. Larger quantities, taken at other periods of the day, are apt to do more harm than good by nause- ating the patient, and destroying his appetite. If the throat or mouth be affected, he should strictly avoid smoking. He should not over- fatigue himself. For skin diseases he should take a warm bath twice a week. He should clothe himself judiciously, and carefully guard against the common causes of cold."—( Yeldham^) The following medicines may, also, be administered with manifest benefit, viz.: Acid.-sulphur., Borax, Lachesis, Phosphorus, Hepar-sul- phuris, and Sulphur. Clematis erecta.—(Ruckert.) In one case of chronic bubo the tumor had persisted after the suppression of a blenorrhagia. It was of oval form, of the size of a walnut, and the integument was of a deep red, for five years, allopathic remedies had failed ; the Carbo-animalis, Mercurius, Hepar, Sulph., Iodium, and Silicea were given for three months without result. Clematis made a cure in eight days. Syphilitic diseases of the bones.—Syphilitic affections of the nose require Aurum 200° one dose every twenty-four hours for seven days—OrV/.) Tophi, exostoses, &c.—They are only produced by the abuse of SYPHILIS. 321 Mercury, therefore Mercury 6000° must be given. Where caries has already set in and the cure does not progress after that dose of Mer- cury, Silicea 30° is the best remedy, and this potency is the best. Where in the most severe cases Silicea cannot accomplish the cure, one dose of Sulphur 30° is yet required. Where the bone pains do not quickly yield the Mercury, Apis 30° in dilution, or Aconite and Apis in alternation will be likely to succeed. Softening of the bones, swelling and curvature, yield to Acid.- ftuoric 2000°, one dose. (Dr. Wolf.) Brittleness, dessication, and fragility of the bones. These yield to Calcarea-carb. 200° in dilution, one dose daily for five days. Nodes.—Case by Dr. Helmuth.—A gentleman applied for relief for ulcerated nostrils, enlargement of the turbinated bones, and a node which gave intense pain. The patient had been mercuralized for sy- philis two years previously. I gave him the third trituration of Aurum- mur., followed this with Mezereum, and Asafoetida, and cured him in four months. SypJiilization.—In 1844, M. Auzias Turenne, of France, commen- ced a series of experiments with the object of testing the correctness of John Hunter's opinion on the non-communicability of syphilis to the lower animals. By inoculating monkeys with chancre matter Turenne succeeded in producing a disease having all the characteristics of a true chancre; also communicated true chancre from animals to the human subject. Finally he reached the conclusion that, by a prolonged series of successive inoculations with the syphilitic poison, a constitu- tional state or diathesis was at length produced in which the system was no longer susceptible to the action of the syphilitic virus; as a person who has had small-pox cannot take the disease a second time. Though the proposition of Turenne to treat syphilis by repeated syphilitic inocula- tions was rejected by the French academy of medicine in 1850, the experiment was tried on a large scale in various hospitals.. In May, 1851, Sperino of Turin reported fifty-two cases treated by syphilization. These cases showed that by a regular course of successive inoculations, all venereal symptoms of all former infections were eradicated. All old " ulcers healed, and buboes, recent nodular enlargement of bones, and cutaneous stains or blotches disappeared altogether." Professor Boeck, of the university of Norway, in a work published in 1854, says, he has cured the "most inveterate cases of syphilis by sub- jecting the patient to a series of inoculations, at intervals of six, five, or three days, and permitting the chancres thus produced to run their usual course. This mode of inoculation consists of*making several small punctures at one time on the arms or thighs. These punctures become real indurated chancres in about five days. Before these have reached the stage of induration, others may be initiated in the neigh- voi.. ii.—21. 322 DISEASES OF THE SANGUTNOUS FUNCTION. boring parts; and thus the process must be kept up until complete im- munity is attained; and when this point is reached all the old symptoms of syphilis gradually disappear. It is not proposed by these authors to practice syphilitic inoculation for the purpose of producing immunity from new attacks, but for the purpose of curing those terrible cases of the disease in which all common measures would fail if tried, and in which extraordinary measures have proved worse than the original disease. Symptoms which have been Cured by Syphilization.—Ecthyma syphilitica of the whole body; syphilitic tubercles between the toes, in the fauces, in the angles of the mouth; pains in the legs; pains in the clavicles and in the humeral bones; psoric eruptions on the palms of the hands; general debility; large syphilitic sores on the left thigh in one case which had been treated with mercury in childhood for in- herited roseola syphilitica, and ulcers of the throat; papular syphilitic affection of the throat; syphilitic lichen; syphilitic tubercular affection with syphilitic serpinginous lupus ; fever with erysipelatous eruptions near the chancres caused by inoculation; sores on the lower limbs; roseola syphilitica on the face, breast, and thighs; mucous tubercles over the inner surface of the labia, and also on the mucous membrane of the mouth ; papular eruption over various parts of the body; ulcera- tion of the fauces and genitals; syphilitic iritis. In some cases in which mercurials and Iodide of Potassium had been tried without be- nefit, syphilization only partially carried out, has rendered the system susceptible to the curative influence of either of these remedies. In all the cases reported, there has been an evident and progressive im- provement in the general health ; and no relapses occurred. How far the process of syphilitic inoculation may hereafter succeed in eradicat- ing the venereal virus from the diseased constitutions of degenerate and suffering humanity remains to be seen. The destructive operations of four centuries of progressive poisoning are around us. M. Auzias Turenne proposes to make the chronic miasm of syphilis available on a principle analogous to that under which vaccination triumphs over and averts the ravages of small-pox. Transmission of Syphilis by Vaccination.—That the secondary symptoms of syphilis can be inoculated on persons who have never been infected with the disease, has been thoroughly proven by experi- ments and the clinical experience of a great number of observers in this country and in Europe. Until the time of Hunter, syphilis in every stage was believed to be highly contagious, and contact with any of the secretions, or even exposure to the breath of those suffering from constitutional infection, was dreaded. Hunter tested the com- municability of the secondary lesions by numerous inoculations upon those who had already suffered from syphilis, and all failing, he esta- SYPHILIS. 323 Wished the dogma that the secondary manifestations of the disease are not inoculable. It was believed to be morally wrong to inoculate per- sons with syphilis who had not already experienced it, and the errone- ous conclusion of Hunter was permitted to pass without correction. But recent and direct experiments "on persons who have never had the disease, and accumulation of evidence from clinical experience," have compelled the most persistent adherents of Hunter's teaching to acknowledge that the secondary symptoms of syphilis can be trans- mitted by inoculation to persons who have never been infected by it; and that the analogy between syphilis and some other infectious diseases is sufficiently demonstrated. Syphilis has been repeatedly communicated by means of pus from syphilitic ecthyma pustules, from the secretions from condylomata, and from specific ulcerations of mucous membranes by inoculating per- sons who never had the disease. " The blood of a syphilitic patient has also been made the means of communicating the disease by ap- plying it to a scarified surface on a non-infected subject." " It is perhaps from direct inoculation with the blood of a syphilitic patient, the lancet being charged with it, that the operation of vaccinat- ing has been the means of introducing syphilis; yet there is a consi- derable amount of evidence in favor of the possibility of inoculation through clear vaccine lymph and pus. A number of observers, mostly French, have given their attention to this subject, and the evidence certainly seems conclusive in favor of the propagation, not only when the blood of syphilitic persons had been used alone, or mixed with the virus, but when only lymph from the vesicle had been introduced. " We believe that enough has been adduced in proof of the occa- sional infection of syphilis through vaccination, be it either blood, lymph, or pus, to induce practitioners to be exceedingly cautious in the selection of virus, and it is with the object of impressing this caution that we now discuss the subject." It is not an uncommon thing, as every practitioner knows, to see ordinary eruptions on the skin of children attributed to vaccination, yet it is probable that real syphilitic disease, introduced by vaccination, has sometimes appeared, and not been recognized, because not suspected. " It should be borne in mind by observers that vaccination with pure matter is sometimes the exciting cause of syphilitic eruptions in in- fants already under the syphilitic diathesis ; in the same manner that it gives rise to non-specific eruptions in strumous subjects. The his- tory of the case, and the order of evolution of the symptoms are generally sufficient to establish the diagnosis. For instance, the ap- pearance of the eruption within a few days or weeks after vaccination, without the ordinary period of incubation of syphilis, will render it 324 DISEASES OF THE SANGUINOUS FUNCTION. probable that the disease was already latent in the system."—{Bum- stead on Yenerecd Diseases.) In regard to the selection of vaccine matter, with a view to insure safety from syphilitic taint, the following rules have been laid down : 1. Examine carefully the child from whom the lymph is taken. 2. Try to learn the state of the parents' health. 3. Choose, in obtaining lymph, such children as have passed the fourth or fifth month, as hereditary syphilis, in general, appears before that age. 4. Do not use the lymph after the eighth day of the existence of the vesicle, as the lymph on the ninth or tenth days becomes dull, by mixture with pus, which latter may be of an infectious nature. 5. In taking lymph with the lancet, avoid haemorrhage, as there is less danger with pure transparent lymph. In a recent publication a record appears of the communication of syphilis to forty-six children by vaccination in the village of Rivolta, Piedmont. In these cases the symptoms of syphilis appeared on an average on the twentieth day. The symptoms of genuine syphilis by vaccination, after a regular incubation period, would be fever and debility, papules on the skin, pustules, swelled lymphatics, ulcerations of the mucous membranes, &c. The principal appearances noted after the disease had existed some time, in the forty-six cases alluded to, were mucous tubercles on the verge of the anus and genital organs, sores on the lips and fauces, swelling of lymphatics, syphilitic erup- tions, induration of the cellular tissue, &c. — (Med. and Surgical Reporter, May 17, 1862.) Dr. Whitehead says, syphilis may be communicated through the at- mosphere. It may also be transmitted through lactation: the nurse may infect the child, and the child the nurse. It may be communi- cated by inoculation, by vaccination, and by contact of the raw surface. Bietts says, it may even be communicated through the sound skin: " that there are certain forms of syphilis with which every species of contact may prove dangerous." Tartar-emetic *is recommended by Dr. Smee for syphilis. He gives the first and second triturations every four hours. Dr. Willebrand, of Finland, says, it alone cured cases of primary chancre in from ten to twenty days ; no application but water dressing was made to the sore. In a few cases it failed where there was much induration. It has cured secondary syphilis and syphilitic eruptions, aided only by clean- liness, repose, and regulated diet. In bubo it has succeeded in reducing the inflammatory swelling. Tartar-emetic often reduces the swelling and the pain in orchitis. Nitric-acid.—Where the blood has already a great tendency to dissolution, with great want of strength, sugillations of blood, bleeding ► SYCOSIS. 325 from the nose, lungs, or intestines, with a scorbutic state of the gums, Nitric-acid is the proper remedy. In chronic cases, says Dr. Wolf, one dose 30°; in more acute cases, one dose 30° every twenty-four hours for three days; and in the worst cases, Nitric Acid 30° in dilu- tion, every one to three hours, till amelioration takes place. Inflam- mation of the lungs on syphilitic ground is also to be treated by Nitric- acid, and where this does not suffice, Sanguinaria 200°, every three hours. Lycopodium.—Where the syphilitic poison has concentrated itself on the liver, and consensually affects the spleen, kidneys and genital organs, Lycopodium 200° is the proper remedy. Magnesia-muriat. and Natrum-muriaticum only aggravate the symptoms in such cases, even where they seem to correspond to the symptoms. This explains why the sea-bath is so injurious after syphilitic affections. Lycopodium is the best remedy in those dangerous uterine haemor- rhages in syphilitic and mercurial cachexia. We give the 200° in dilution every three hours ; and the same remedy holds good in cases of bloody urine, of hypochrondriasis and hysteria, originating in the above-stated combination of the syphilitic and mercurial poisons.— (Wolf.) 2. SYCOSIS. Dr. Wolf says, " the third great impediment to the cure of syphilis is the predominating influence of sycosis, or the poison of sycotic gon- orrhoea" The sycotic poison is the result of a combination of psora and syphilis in their highest potency. " It is a dyscrasia which has spread fearfully, and in a hitherto inexplicable manner, since the beginning of the present century; so much so, that if this progression should continue on at the same rate, the very existence of mankind is in jeopardy." The sycotic poison greatly increases the disposition to all those every-day illnesses, and it renders all diseases more obstinate and pernicious. Affections produced by Sycosis on the different Organs.—Affec- tion of the teeth with loosening of the roots and falling out, with the most obstinate form of prosopalgia, alternating sometimes with the most insufferable cephalalgia; affections of the mouth, with cracks on the lower lip, with peeling of the epithelium, small flat, whitish ulcers, &c. Hypochondriasis; pain in the muscles, spasms, giddiness, dead- ness of the tips of the fingers and toes; constipation, breath smelling like carrion, affection of the mucous membrane, and inferior character of its secretions ; tubercles, warts, fungous excrescences, varicose veins, deposition of bacon-like fat, gout, chronic catarrh of the urinary or- gans, Bright's disease of the kidney, diabetes meliitus. 326 DISEASES OF THE SANGUINOUS FUNCTION. Dr. Wolf supposes small-pox to be the efflorescence of the sycotic poison, and that vaccination is the channel through which this virus is often communicated. He says the most prominent symptoms of sycosis, after syphilis or leucorrhoea, without any previous affection, are sometimes observed as the result of vaccination. There is also great tendency to self-abuse, affections of the testicles, ovaries, eyes, ears, teeth, and hairs, weakness of the nerves and head, giddiness, pa- ralytic affections, spasms, and asthma. Chlorosis, anomalies of men- struation, diabetes, tuberculosis, &c, appear as an immediate conse- quence of vaccination. And most of the above-named diseases are the standing and predominating diseases of the present day. Dr. Wolf says: Influenza, typhus, and whooping cough, with great tendency to tuberoulosis, have also become standing diseases in a hitherto unheard of manner. The " progressive paralysis," a newly described disease; and a common mental disease, described by him as " grosserwahn," are prevailing diseases following upon the continual poisoning of successive generations by impure vaccine or sycotic poison. The Egyptian ophthalmo-blennorrhoea has become a standing disease amongst the soldiery, and very often follows vaccination, and it is well known that gonorrhoeal ophthalmia and the above mentioned form bear the closest resemblance. Condylomata.—A secondary affection complicated by syphilis and sycosis. Fig Warts.—" Flatfish, pale colored, secreting a very foetid ichor, that come on almost every part of the body, as on the penis, behind the glans, on the scrotum, around the anus, on the thighs; also on the hairy scalp, the corners of the mouth, the lips, especially their red part, on the tonsils, &c. On their apices there are not unfrequently small ulcers, scabs, blisters; those on the face sometimes resemble variolous pustules. Along with them occur syphilitic symptoms in the shape of a tuberculous pustule, like acne or variola, the base of which seems to be indurated. " On the hairy scalp they had a dark red base, were covered with scabs, or had a pustule in their centre." Occasion- ally, condylomatous ulcers are present at the same time, the surface of which is spongy, dry or moist, and white, not excavated, but nearly on a level with the surface of the skin, or sometimes elevated above it, resembling a wart, and not only on the genitals on both sides, but also, like the condylomata themselves, on other situations. This form of disease is hard to cure, and when cured leaves behind it red elevated pimples, which depart gradually and often leave deep cicatrices. Treatmknt.— Tartar-emetic. — Dr. Kraul of Rastatt employed Tartar-emetic, twice a-day, in the case of a man who had extensive warty excrescences behind the glans. After a week the warts were dimin- SYCOSIS. 327 ished in size, and in five weeks a cure was effected.—(Hufeland's Journal, Vol. V., p. 241.) In the Militardrziliche Zeitung, 3d year, pp. 239, 240, is a case in which Tartar-emetic was found useful in urethritis; also in syphilitic ulcers of the throat, sore mouth, ulcers of the fauces, and primary chancre of the penis. It also cured sy- philitic cutaneous affections, and one case of paraphimosis. Of thirty cases treated by it only one had a relapse. (See also Allg. Horn. Zeitung. Vol. 21, p. 276.) Dr. Baertl* says, he began to use this remedy in such cases as the above in 1845, and has been generally successful. When condylomata could be traced to chancre and gonorrhoea, he gave the remedy, one to two grains in six ounces of distilled water, a table-spoonful every three hours. After a week he employed it externally ; from three to four grains dissolved in two ounces distilled water; the warty ex- crescences were moistened with this twice a day by means of a thick roll of lint soaked in the solution. Another piece of rag or lint wet with the same was placed over this, and the part bandaged up. The patient was kept on rather low diet, chiefly of vegetables, farinaceous food, rice, &c. He was prohibited from fatiguing exercise. The re- medy was continued perhaps for weeks, though, externally it some- times occasioned pain; but the patient found his disease improving, and bore it cheerfully. No relapse remembered. Thuja.—Dr. Wolf gives the following general results obtained from the proving of this remedy on himself as well as on more than one hundred persons of every age and sex, the entire proving having de- veloped 1,050 symptoms. General results: 1. Irritation of the mucous membrane of the genital organs, extend- ing itself over all organs. 2. Changing of the naturally mild secretion into one of an acrid, corroding infectious quality. 3. Over-irritation of the nerves, with tendency to centripetal paralysis. 4. Disturbance of the digestion and sanguification, tendency to de- struction, dissolution of the fluids, and of the whole organism. It will thus be seen that Thuja corresponds in every respect with the sycotic poison, and thus offers itself as a remedy against the following dis- eases which are the consequences of the sycotic poison. Sycotic Gonorrhoea.—The genuine poisonous figwart gonorrhaea is best cured by Thuja 30°, one dose being given. In the more recent cases a few days, seven to fourteen, are required. When, however, the disease is hereditary, or where abuse has preceded, a long time and the attenuations 300° to 1000° are required. ♦Horn. Vierteljahrsschrift, Vol. XI., parti. 328 DISEASES OF THE SANGUTNOUS FUNCTION. Iodine is the only remedy that antidotes Thuja. The actions of Thuja should be left undisturbed, and it is seldom necessary to give Aconite as an intercurrent remedy where inflammatory symptoms show themselves. In some cases the sycotic infection does not show itself by gonorrhoea, but shows itself only in irritation of the genital organs, constriction of the urethra, urging to urinate, wetting the bed, and irresistible desire to self-abuse, which has become common among small children. It has been often traced as its cause to vaccination. The best remedy is Thuja 30° one dose. Catarrh.—The continued poisoning extending from the mucous membrane of the genital organs upward produce the most severe and lasting catarrhal affection of the intestinal canal first, and afterwards of the respiratory organs. Whitish ulcerations on the corners of the mouth, cracks on the lips, and flat ulcers in the inside of the mouth, &c, characterize it. Thuja produces all of these symptoms and cures them. Psoric and Syphilitic Dyscrasia, combined with Sulphurism and Mercurialism.—It seems that Thuja (in high potency) can cure even these cases. In a sycotic ground, the scrofula is changed into tuberculosis ; caries is changed into spina ventosa. All diseases have been rendered more or less pernicious and unmanageable by the sycotic dyscrasia produced by the vaccination. The anti-psoric and anti-syphilitic remedies are without avail against these cases. The Thuja alone makes the diseases curable, and the remedies which be- fore the administration of the Thuja, were of no avail, now become efficacious. Rules for the Administration of the Thuja..—The 30th, 300th, and 1000th potencies have proved the most efficient. In fresh cases, where the patient is free from all inherited or acquired dyscrasias and medicinal diseases, and tho younger or the older the patient, the more the thirtieth potency is in its proper place. The older the dyscrasia, and the more complicated the case is, the higher must be the potency. Only one single dose of one globule must be given; and all crises, particularly severe catarrhal affections, must be left to take their course. Only in cases of great necessity, the following remedies may be used: China, against great weakness. Ferri-acet., 2 , where there is a disposition towards dissolution of the blood. Severe pains may be treated by magnetic manipulations. Fevers mostly require Aconite, Nux, and Apis. All anti-psoric and anti-syphilitic remedies must be avoided. The action of Thuja must, in some cases, be aided. This can be done by Tartar-emetic, which is also an antidote to the sycotic SYCOSIS. 329 poison, at least as far as it is the result of vaccination. Dr. Wolf says, he obtained very favorable results from Tartar-emetic in in- fluenza, whooping-cough, croup, all sorts of catarrh, typhus, chlorosis, &c. To small children, where there is no danger in delay, one dose of Tartar-emetic 30° should be given; in more acute cases, Tartar- emetic 30° in solution every one, two or three hours; in grown per- sons Tartar-emetic every two to six hours may be given. The most obstinate forms of megrim, prosopalgia and odontalgia are removed by Argentum-nitr. 200°. The following remedies act favorably in some cases, though not direct antidotes to the sycotic poison. Cyclamen.—In diplopia, and one-sided headaches. Acid-benzoicum, in some cases of diseases of the urinary organs and the heart. Anacardium in weakness of mind. The length of time required for a radical cure of sycotic disease differs greatly. In some cases from one, to three, four or five years may be required. But only by adhering to the above rules, which are the result of long and extensive experience can a satisfactory degree of success be obtained; and thus may be restored to mankind the greatest earthly boon that has yet been sought for—a sound mind m a sound body. Helminthia.—Worms in sycotic subjects are best removed by Thuja, which, by antidoting the sycotic poison, cures also the dis- position to worms. Varices, varicocele, hsemorrhoidal tumors, black stools, &c, are becoming constantly more prevalent. When they are not cured by the old remedies, Sulphur, Pulsatilla, Lycopodium or Fluoric-acid, they have a sycotic origin, and are best treated by Thuja. Painfullness and swelling of the liver and spleen ; the former giving rise to depositions of fat and pigment and to the formation of sugar; the latter causing chlorosis and leucaemia in women, and cadaverous look and hypochondriasis oftener in men; fatty tumors, the fatty liver, heart, &c, are all cured or prevented by a timely use of Thuja. The same is present in diabetes mellitus, which is often the immediate consequence of vaccination or re-vaccination, and has been observed in children before the age of puberty, a case hitherto unheard of. All these affections of the liver run their course wdthout any symptoms of jaundice. Defeneration of the skin, nails, and toes is caused by the sycotic poison * also sweating of the hands and feet, panaritium, the pains in the soles or heels not depending on any organic lesions or disorganiza- tion of the parts, corns, chilblains, &c. All of these mostly depend on the sycotic poison and are therefore curable by Thuja. The con- 330 DISEASES OF THE SANGUTNOUS FUNCTION. tinuation of the sycotic poisoning, reaching the respiratory organs, produces extraordinarily severe catarrhs of the nose, with a secretion similar in color and odor to the secretion of the sycotic gonorrhoea, and this with considerable relief to all other symptoms. Where, how- ever, this natural crisis is in some way checked, it gives rise to a bronchial catarrh, which often increases to phthisis. Thuja.—Case by Dr. Kellogg, of Troy, New-York* A man aged forty, had a protruding pedicillated sycotic excrescence, one-third of an inch in length, on the verge of the anus, secreting a foetid mucus re- quiring the changing of his cloths during the day, and frequent ab- lutions ; a great source of irritation and annoyance. It was proposed to exsiccate and cauterize it; but presenting a marked case for Thuja, both in the local affection and in a general sycotic diathesis, as the patient showed several small excrescences of similar character on other parts of the body; Thuja was given in a dose of one drop of the tincture. The sycotic fungus disappeared without receiving further attention, and was forgotten till no trace of it remained. The sycotic diathesis in this case was inherited from the mother who was subject to fatty tumors originating in the same morbid idiosyncrasy. In a case such as was here cured by a single dose of one remedy a spontaneous cure never occurs. GENUS IX.—ELEPHAN TI A. MORBUS PHCENICIENS. Morbus Phceniciens.—A disease so called from the limbs of persons affected with it growing scaly, rough, and very large, at an advanced period, like the legs of an elephant. The disease attacks the whole body, but principally affects the legs or feet, which appear somewhat like those of the elephant. Some authors describe two species: 1. Elephantiasis grsecorum. 2. E. arabicum. The first is described by Aretaeus, as beginning with tubercular swelling of the face. See Lepra Anoesthetica. 2. Elephantiasis Arabicum.—This is the true elephantiasis. It consists in a slow hypertrophy of the skin, areolar tissues and bones, and in their infiltration with a peculiar cacoplastic deposit. The epidermis is thickened and the papillae enlarged, though not much so: The true areolar tissue is thickened, its areolae expanded, and filled with oily or gelatinous looking matter. In cases which Druitt examined, "the microscopical appearances were those of hypertrophy * U. S. Jour. Homceop. Vol I., p. 57. ELEPHANTIA. 331 of the tissue involved. The bones also of the affected limb became enlarged and heavy." This is a disease almost peculiar to hot climates though we have some cases of it in New-York. The dark races are more liable to it than the fair. In India it is particularly liable to attack the scrotum which it converts into a huge tumor. In the West Indies the leg is its favorite seat; hence the term " Barbadoes leg." It begins insidiously, with feverish or aguish symptoms; pain in the leg about to be attacked; firm, doughy swelling resembling phlegmasia alba dolens; and some tenderness of the lymphatic glands. In the course of months, or perhaps of years, the patient suffers a repetition of these attacks. The limb becomes permanently swelled, and in con- firmed cases, presents a huge, misshapen, useless member like the leg of an elephant, hard and almost insensible to the touch, yet pain- ful. A foetid discharge is liable to ooze from the skin; or ulcers may form, and if not very extensive, may diminish the pain, and seem to eliminate something noxious. (Elements of Surgery.) Symptoms : The skin becomes thick, rough, wrinkly, unctuous, and void of hair, and gradually losing the sense of feeling. By many writers it is considered a species of leprosy; but it is radically distinct in its nature, and often exists many years without being accompanied with any of the symptoms characteristic of that disease. Elephantiasis comes on gradually without much previous indisposi- tion ; but generally the person is seized with a coldness and shivering, pains in the head, back and loins, with some degree of nausea. A slight fever then ensues, and a severe pain is felt in one of the in- guinal glands, which after a short time, becomes hard, swelled and in- flamed. No suppuration, however, ensues; but a red streak may be observed running down the thigh from the inflamed gland to the leg. As the inflammation increases in all the parts, the fever gradually abates, and, perhaps, after two or three days continuance, it goes off. It, however, returns at uncertain periods, leaving the leg greatly swol- len with varicose, turgid veins, the skin rough and rugged, and a thickened membrana cellulosa. Scales appear also on the surface, which do not fall off, but are enlarged by the increasing thickness of the membranes ; uneven lumps, with deep fissures are formed, and the leg and foot become at last of an enormous size. A person may labor under this disease many years without finding much alteration in his general health, except during the continuance of the attacks ; and perhaps the chief inconvenience he will experience is the enormous bulky leg which he drags about with him. The incumbrance has in- deed induced many who labored under this disease to submit to an amputation ; but the operation seldom proves a radical cure, as the other lea- frequently becomes affected. Hilary observed, that he never 332 DISEASES OF THE SANGUTNOUS FUNCTION. saw both legs swelled at the same time. Instances have, however, fallen under the notice of other physicians, in which both legs be- came of frightful and prodigious size. Causes.—Elephantiasis has generally been supposed to arise in consequence of some slight attack of fever, on the cessation of which the morbid matter produces obstruction in the lymphatics and veins of the leg, occasioning distention and tumefaction of the limb, which is afterwards overspread with uneven lumps and deep fissures. Treatment.—The usual remedy proposed is the knife ; Mr Dalton (of Guiana, Lancet, 1846, p. 453) shows, that in the earlier stages the disease may at least be controlled if not checked. Prof. Carnochan, of New-York, was the first to attempt to cure this disease by applying a ligature to the artery by which the diseased limb is mainly supplied with blood; and he has published a few cases in which he tried this practice with apparent success. Dr. Erich- sen, of London, has since pursued the same treatment by tying the anterior tibial artery to cure the disease in the foot. Other cases have also been reported, all of which are said to have been successful. (See Charleston Med. Journal, March, 1860.) In Dr. Ogier's case, that of a negro, aged twenty-six, the disease had existed for five years, and the size of the leg and foot was such, that they had be- come a burden, and amputation was desired. The femoral artery was tied with a hempen ligature. The next day the reaction was high, the pulse rising to 180 per minute. This was controlled by Veratrum- viride. The leg and foot decreased on the second day to half the size preceding the operation. Three months later they had subsided to nearly the natural size; the patient walked about and felt no pain or uneasiness. These cases, in which there is seen a gratifying result of surgical skill can not yet be accepted as satisfactory cures of disease. The original dyscrasia which existed in every case was still there; and a a long course of constitutional treatment was needed to remove it. The only remedies which have power to remove elephantia are those which have been successfully used for lepra in its different forms. These are : Arsenicum, Alumina, Carbo-animalis, Carbo-veg., Caus., Graph., Natr., Petroleum, Phos., Sepia, Sil, Sulphur. Arsenicum has hitherto been most successful. (See Lepra-Ancesthetica. Index.) Genus X.—SCORBUTUS.—SCURVY. The name scorbutus is from the German scharbock, or Dutch scor- beck, sore mouth. Characteristics.—Extreme debility; complexion pale and bloated; SCORBUTUS. 333 spongy gums; livid spots on the skin; breath offensive; oedematous swellings of the legs ; haemorrhages ; foul ulcers ;' urine foetid; stools extremely offensive. It is not yet a century since scurvy was regarded by all civilized nations as the most terrible scourge of the naval service. In those times when it was said of " Britannia" that " Her march was on the mountain wave, Her home was on the deep," how often did this disease strike down with blighting paralysis " the right arm of the nation's defence!" It was common, says Sir John Herschel, to see " death to the number of eight or ten a day in a moderate ship's company; bodies sewn up in hammocks and washing about the decks for want of strength and spirits on the part of the miser- able survivers to cast them over board." So tremendous were the ravages of scurvy, that in the year 1726 Admiral Hosier sailed with seven ships of the line to the West Indies ; and before he was able to complete his voyage he lost two entire crews, burying his entire ships' com- panies twice over, and then, in consequence, died himself of a broken .heart. Lord Anson, during his voyage round the world, lost more than four-fifths of his officers and men. Sir Richard Hawkins states, that within his own naval experience he had known more than ten thousand men perish from scurvy. In 1778, Dr. Johnson thus described a sea- life : " As to the sailor, when you look down from the quarter-deck to the space below, you see the utmost extremity of human misery,— such crowding, such filth, such stench!" "A ship is a prison with the chance of being drowned ; it is worse—worse in every respect— worse air, worse food, worse company!" Although this disease has been considered as almost annihilated from modern naval service, under exceptional circumstances it oc- casionally occurs again. During the war with Mexico, in 1846, several of the largest American ships were rendered entirely useless by the prevalence of scurvy among the officers and crew in an aggravated form. When the Raritan was ordered northward from Vera Cruz, she had on board more than two-hundred cases of the most malignant scurvy, and but few of the crew on duty were free from the disease. (Dr. Foltz's Report, 1848.) It has also appeared in some of the recent polar expeditions. Sir L. McClintock gives a melancholy narrative of the suffering of Lieut. Hobson, of the expedition in search of Sir John Franklin. Scurvy is still common in the merchant service, though the mortality is not now generally great. In 1859, of 172,506 seamen who sailed from England there were only thirty-seven deaths from scurvy. 334 DISEASES OF THE SANGUTNOUS FUNCTION. General Symptoms.—The appetite in cases of scurvy is usually good, alvine evacuations, healthy in general, though in some cases there is diarrhoea. The urine has not been found to present any ma- terial departure from a state of health, in specific gravity, alkalinity, acidity, or freedom from albumen. The patient is liable to be sleep- less at night, but has but little disturbance of intellect. In bad cases the pulse becomes very rapid, even as high as 130 or 140 per minute. There is some heat of skin, with febrile excitement and free perspira- tion at night—a constitutional condition approaching to that of hectic ; and these symptoms usually indicate fibrinous effusion. In milder cases a dry and harsh skin has been given as a characteristic; ema- ciation not generally great even in extreme cases. Diagnosis.—To the practiced eye, the external aspect frequently reveals at once the internal derangement. There is seen a " smooth or contracted brow, the passive or acting nostril, the parted or com- pressed lips, the dull or brilliant eye, the many shades of color, the expression derived from mental action, intermingled with that result- ing from perverted organic function." As in consumption, the brilliant eye, and pale or hectic flushed face alone might reveal the story of fatal disease ; in Bright's disease the puffed, waxy aspect of the victim, are strongly characteristic; in pneumonia the general capillary in- jection of the face is almost a sufficient diagnostic; amenorrhoea is seen in the chlorotic aspect; the sufferer from ague betrays the lo- cality of his residence by the sallow anaemic complexion and wearied look. Scurvy has also its peculiar characteristics. The face of the patient reveals deficiency as well as depraved blood. It is sallow, dingy, earthy, and sometimes appears dirty; the conjunctiva is clear and transparent, the eye unusually bright, with dilated pupil, and blood- less lips. The countenance is generally passive and devoid of ex- pression, though in severe cases, expressing a sense of dread. In some cases the gums are so much enlarged that there is a visible pro- jection of one or both cheeks. The smell of the breath is highly of- fensive, peculiar to this disease, but nearly resembling the smell of animal substances in a state of putrefaction. The sloughing state of the gums when present scarcely aggravates the offensive smell. The margins of the gums are spongy, forming a hypertrophied mass, pro- jecting between the teeth and much inclined to bleed; their color varies from deep-red to a livid blue or black, which contrasts strongly with the pale, anaemic appearance of the lips, tongue and inside of the cheeks; the teeth are often loosened by ulceration and even sloughing of the gums; the tongue usually presents a clean surface. The patient is generally found lying on his back, his head rather depressed, as in that position the weakened heart can best do its work; the bed-clothes are sometimes elevated by the raised, contracted SCORBUTUS. 835 knee. The surface of the body gives evidences of the damaged con- dition of blood in the exudation of its constituents—the blood discs, the fibrin, and more rarely the serum.—The colored corpuscles are extra- vasated in the form of small haemorrhagic, purpuric spots, from a small point to a large pea, of a vivid claret color, or larger bruise-like stains, commonly found on the lower extremities, of a size from that of a crown-piece to that of the length of the whole limb, and commencing around cicatrices of old wounds. Effusions of fibrin take place on dif- ferent parts, especially of the lower extremities, the fibrin being poured out beneath the skin, or between the tendons and bones of the knee and ankle-joints, and fixes them as in a splint; when in the popliteal space the effusion produces the characteristic contraction of the knee- joint; beneath the skin or around the muscles, it makes the fleshy portion of the thigh or leg indurated, and it resists pressure as bone ; on the surface of the tibia, or of other bones beneath the skin the effusion gives rise to node-like swellings, which are often tender and resemble those of syphilis, except in their not being accompanied with exacerbation of the pain at night The skin is firmly adherent to the effused fibrin, cannot be pinched up, and is generally of a brownish hue; and every part in which the fibrin is effused is painful and ten- t der. In some cases there occur passive haemorrhages from the nose, the mouth or intestines, seldom, if ever, from the lungs, stomach or bladder. A tendency to fatal syncope is a very striking feature of scurvy. Scorbutic patients, not particularly reduced in strength, or emaciated, may, on a sudden over-exertion, as on rising to the erect position sud- denly, sometimes fall down in a swoon from which they do not recover. In one instance, on board the Dreadnought, says Dr. Ward, a man in the prime of life, in fair condition of flesh, and apparent strength, " had been chatting in a loud and cheerful tone of voice, when on suddenly rising from bed to the night-stool, he fell down in a state of syncope ; and before the medical attendant could reach him he was dead." Dr. Trinks says : " The plastic exudations which give a board-like hardness, and the bleeding only from ulcers, are " to him" essential differential symptoms," by which he distinguishes scurvy from the muscular disease of Werlhof. Pathology.—The blood of scorbutic patients is deficient in red corpuscles, and super-abounds in fibrin. The former has been found reduced to 48 parts in 1000, and the latter increased to three times its normal quantity. A microscopical examination shows some of the blood-corpuscles " shrivelled or ellipsoidal in appearance." In a case already mentioned of sudden and fatal syncope, the heart was found very pale and flabby ; lungs healthy; some effusion of serum into the 336 diseases of the sanguinous function. pleura; no traces of inflammation; abdominal viscera deficient in blood; corresponding to external bruises of the tibiae, and on the inner sides of the calves, there was extensive extravasation of blood into the subcutaneous cellular tissue. Other subjects exhibit extreme anaemia and prostration ; projecting ulcerated gums; ecchymosis on the sur- face of dependent parts, &c. In an other case, Mr. Bask, of the Dreadnought, found the belly of the gastrocnemius muscle enveloped in a sheath of fibrin, a third of an inch thick, distinctly vascular, showing the texture to be a product of modified nutrition, becoming organized. Dr. Budd, examined a scorbutic node on the tibia; " On cutting down over the tibia, he found under the fascia a thin layer of coagulated blood, but no sensible extravasation of the size, and no injection of the clot. On cutting deeper, the periosteum was found separated from the bone for the length of six or seven inches by solid fibrinous effusion, or clot of chocolate-color, and a line or two in thickness. On the periosteal and osteal surfaces of this clot there was a slight extravasation of the size, but the clot itself was beauti- fully injected." The periosteum was itself thickened and infiltrated with blood, and when gently stripped from the clot, many vessels in the form of threads were seen to pass from one to the other; some of them filled with size; some vessels were also seen filled with size, coming from the clot and entering the bone. Dr. Budd found also, ecchymoses in the peritoneum, and in the mucous and muscular coats of the in- testinal canal. Dissection reveals little after death that was not equally manifest during life. Prognosis.—Of the cases under good medical treatment not more than one in a hundred die. Treatment.—This is generally confined to restoration to the food of the elements, the deficiency of which has caused the disease. Thus: some propose to cure it by giving the patient plenty of po- tatoes ; and they are most beneficial when used raw. Others give the salts of Potash. Others Sulphur, Phosphorus, &c. Others advise cheese, milk, or beef, because nitrogenous substances are wanting. Some suppose that lemon-juice acts only by restoring the potash- salts needed in a perfect diet. Citric-acid.—This is now well established as a remedy for scurvy. It seems also to be capable of causing the disease. Dr. Stevens, in his work on the blood (page 451,) says : In one instance the acid of lemon-juice produced scurvy. "The scurvy was decidedly brought on by the excessive use of Citric-acid which an American gentleman had recommended to be freely used as a preventative of yellow7 fever. SCORBUTUS. 337 His own conviction as well as mine was that the scurvy was brought on by the Citric-acid." Lemon-juice, as a remedy against scurvy was first noticed in the third Epistle of Rosseus, dated 1564. It is there stated that some Dutch sailors suffering from scurvy were returning to Spain in a ship in which were part of a cargo of lemons and oranges. They accidentally discovered that their use of these articles was the means by which they recovered their health. (Encyc. Pract. Med. Vol. III., p. 695.) It is mentioned as a remedy by Woodall, in 1636. (Military and Domestic Medicine, p. 165.) In 1600 Commodore Lancaster sailed from England in company with three other ships for the Cape of Good Hope. On reaching Saldana Bay, the Commodore's crew were in perfect health from the administration to each of his men of three table-spoonfuls of lemon-juice every morning; whereas the other ships were so sickly as to be unmanageable for want of hands, and the com- mander was-obliged to send men on board to take in their sails and hoist out their boats. Different authors wrote on the efficacy of this article in preventing scurvy. But it was not till Sir Gilbert Blane, in his first voyage as fleet-physician, in 1780, presented a memorial to the Admiralty on the subject, that any systematic effort was made to introduce it into the nautical diet. At that time the number of cases of scurvy received into Haslar Hospital was 1457; in 1806 there was but one. The dietetic treatment of scurvy rests upon the fact that protein is the basis of albumen, fibrin, casein, and these are the foundations or essential elements of all the tissues; and this starting point of the aforesaid animal principles must be obtained from similar elements in the vegetable kingdom. Liebig says: " It may be laid down as a law, founded on experience, that vegetables produce in their organism compounds of protein; and that out of these compounds of protein, the various tissues and parts of the animal body are developed by the vital force, with the aid of the oxygen of the atmosphere and of the elements of water." Chemistry has demonstrated that the blood of animals is formed from substances which contain a large proportion of protein: and we find that men, when they are compelled to subsist for a long period almost exclusively upon animal food, become diseased from imperfect nutrition, the diseases taking always some of the forms of scurvy. Analysis of the blood of a patient on board the Dreadnought Hospital ship (off Greenwich,) showed: Blood in Scurvy: Wrater 849.9; solid constituents 150.1; fibrin 6.5; albumen 84.0 ; blood-corpuscles 87.8 ; salts 9.7. Healthy Blood: Water 788.8 ; solid constituents 211.2 ; fibrin 3.3; Albumen 67.2 ; blood-corpuscles 133.7 ; salts 6.8. Vol. IL—22. 338 DISEASES OF THE SANGUINOUS FUNCTION. Lime-juice.—From two to three ounces of lime-juice with a proper amount of sugar is given daily; occasionally oranges may be eaten; milk and beef-tea, when solid food is forbidden by the soreness of the gums; otherwise allow a diet of potatoes, vegetable soup, beef and bread. When there is marked anaemia, a recumbent position must be strictly maintained, as there is great risk of fatal syncope from sud- denly throwing on the heart more work than it can accomplish. Proper diet and rest are alone perfectly adequate to the cure of the worst forms of the disease. Mental influences, such as the sense of se- curity, escape from the influences of bad diet that caused the disease, and the protection and rest of the hospital on shore give important aid in the cure of scorbutic affections. Carbonate of Ammonia.—Dr. Huxham had a patient who had habituated himself to eat large quantities of Carbonate of Ammonia. The consequence was that he brought on a hectic fever, vast haemorrhages from the intestines, nose and gums, while every one of his teeth dropped out, and he could eat nothing solid. He wasted away in flesh, and his muscles became as soft and flabby as those of a new- born infant. He broke out all over the body in pustules; after being persuaded to leave off the pernicious practice he lived only for a few months, and died in the highest degree of marasmus. Dr. Trinks has reported two cases cured by Mercurius. Dr. Kafka gives an obstinate case cured by an electuary of Carbo-ligni-tiliae. Dr. Forster, of Gorlitz, (Germany) says, he cures all his cases in the jail of that city, speedily and safely with hot baths. Chlorate of Potash.—Mr. Craner, of the Dreadnought Hospital,* says, this remedy cures sponginess of the gums more rapidly than any other. He gives it writh lime-juice, but thinks the chlorate cures more rapidly without the acid-juice than with it. Curing the gums enables the patient to take food much better. The chlorate cures all inflammations of the mouth and gums, what- ever their cause may be, except those clearly syphilitic or cancerous. He says it will cure true cancer of the mouth if taken early. In pur- pura haemorrhagica it hardens the gums and prevents their bleeding, but has no influence on the disease. It is a speedy remedy in mer- curial ptyalism. Purpura Scorbutica—This form of purpura is usually seen during the prevalence of scurvy, and is considered as belonging to that dis- ease; hence we introduce it in this place. It is characterized by "deep, brown and liver-colored blotches, varying in size from the point of a finger to the whole extent embraced from the knee to the foot, or involving the whole of the inside of the thigh." It consists of an ef- * Med. Times and Gazette, 1857, p. 476. SCORBUTUS. 339 fusion of decomposed blood in the cellular tissue, sometimes presenting the appearance of small petechia or flea bites, extending over most of the body, and attended by itching or pricking. In one case in the blockading fleet off Vera Cruz (1846,) the face of a petty officer pre- sented the appearance of having been washed with diluted ink before other symptoms of illness appeared. The patient felt well, performed his duties all day aloft, and desired to return to them, but was not al- lowed. The following day he was confined to his cot: the purpura appeared on the extremities, the gums and mouth became more sore, and severe pain racked every joint and limb. See Vol. II. p. 199. Treatment.—In addition to the dietetic treatment demanded by scorbutic influence when present, our reliance in every form of pur- pura must be placed on the following remedies: Arsenicum, Am- monium-carb., China, Hamamelis, Rhus-tox., Gallic-acid, Sul- phuric-acid, Seccde-cor., Carbo-veg., Ferrum, Sulphur, Hepar- sulph., Calcarea-carb., Phosphorus, Phosphoric-acid, Mercurius- hyd., Apis, Cantharis. When the malady has succeeded a severe attack of typhoid fever, with great debility, diarrhoea, abdominal tenderness, thirst or adip- sia, oedema of the extremities, nightly restlessness and jactitation, and great emaciation, Arsenicum, third dilution in water, will give speedy relief. Rhus-tox., at the same dilution, may often be prescribed for the same group of symptoms after Arsenicum. When the disease occurs as a sequence of small-pox, or measles, or scarlet-fever, or erysipelas, Ammonium-carb., China, Rhus-tox-, Hepar-sulph., and Apis are our best remedies. We usually employ the first and second attenuation of these drugs. Phosphorus and Phosphoric-acid have been successful in cases which were apparently connected with sexual excesses, and seminal losses. China and Ferrum will be required in chlorotic patients afflicted with the disease. We have observed the best results from palpable doses of these remedies; although cures have been effected with the higher potencies. Mercurius-hyd., followed by China, have effected cures of cases occurring in persons suffering from chronic hepatic disorders. Can- tharis is also an excellent remedy in cases of this description. The higher potencies of Calcarea-carb. and Sulphur will be de- manded in cases dependent on, or connected with a scrofulous dys- crasia. 340 DISEASES OF THE SANGUINOUS FUNCTION. Genus XL—EXANGIA.—ANEURISM. Aneurism consists in a dilatation of the parietes of an artery. It generally embraces the entire circumference of the vessel, and may extend to a greater or less distance, even to the entire length of the aorta. When all the coats of the artery are dilated but not ruptured the case is one of " true aneurisrn." The vessel is frequently thinner than natural, the middle coat is deprived of its elasticity, and the ves- sel yields like a vein to the impetus of the blood. In other cases the coats of the dilated portion are hypertrophied. Dilatation with rupture of one or more of the coats constitutes '■''false aneurism" as described by the old authors. The internal and middle coats are frequently ruptured; the blood comes in contact with the external or cellular sheath, dilating it to a pouch or sac. The tumor thus formed presses upon the surrounding cellular tissue, condensing it, and thus acquiring an additional envelop, often much thicker than the cellular sheath of vessel originally. " The interior of the sac con- tains fibrinous coagula arranged in concentric layers the more exterior of which frequently become so dense as to be distinguished with diffi- culty from the parietes of the sac." (Copland, Vol. 1. p. 132.) The parts surrounding the tumor become attached to it through irritation at first, but are afterwards worn away by absorption promoted by the pulsations. In some cases the internal arterial tunics are perforated, which is followed by haemorrhage; this may immediately terminate in death, or may be checked by the obstructions furnished by the sur- rounding tissues; when it forms " diffused aneurism" as described by various authors. Diagnosis.—Aneurism, when deep-seated, presents no positive signs of its existence. Dr. Hope says he has met with many cases in which large aneurisms existed without awakening even a suspicion in the mind of the medical attendant. Sometimes it occasions no inconveni- ence, and is only revealed by the sudden death of the patient who had considered himself in perfect health. (On Diseasas of the Heart.) Aneurism of the aorta may be suspected when there is a sense of oppression of the chest; dissimilarity of the pulse of the wrists; but these symptoms may also arise from other causes. Corvisart pointed out a "purring tremor" beneath the middle and upper part of the sternum, when the aneurism is in the descending aorta, and above the clavicles in aneurism of the arch ; but this is often indistinct and may also arise from other causes. A wheezing or sibillous respiration and a whispering or croaking voice, with anxious and laborious breathing, are caused by aneurism of the aorta when the tumor presses on the large bronchi; pressure on the oesophagus obstructs deglutition, ANEURISM. 341 renders it painful, and sometimes impossible. Erosion of the bodies of the vertebra by the pulsation of an aneurism produces a gnawing or boring pain in the spine; pressure on the brachial plexus of nerves causes aching of the left shoulder, extending to the neck and scapula, impaired power, and numbness of the arm ; pulsation beneath the ster- num, or above the clavicles, violent pulsations of the carotids ; but none of these symptoms alone are conclusive signs of aneurism of the aorta. A perceptible tumor is visible about the fifth and sixth ribs of the right side when aneurism of the ascending aorta attains a certain size; its seat varies when the aorta is enlarged in other parts. The strong pul- sations always present in the tumor indicate its nature; the indica- tions furnished by all preceding symptoms are of doubtful value. In advanced stages of aneurism of the aorta there are coughs with mu- cous or bloody expectoration, dyspnoea, spasmodic attacks of suffoca- tion, pain in the left shoulder, axilla, inner side of the arm, left side of the neck, pricking pains in the tumor, whizzing or rushing at the top of the sternum or under it; dragging downwards of the larynx, generally without fever. (Copland, Diet. Pract. Med. 1.) The distinguishing symptoms of true aneurism in the various arte- ries are: extraordinary throbbing in a particular spot occupied by a small pulsating tumor, which disappears when compressed, but returns when the pressure is removed. Without change of color in the skin the tumor increases in size, and in the same ratio the pulsation di- minishes. The coagulated blood lodged in the sac of the large aneu- rism prevents the obliteration of the tumor by pressure and lessens the communication into the artery beyond it. The pulse below the swelling becomes weak and small, and the limb becomes cold and oede- matous. There are three species of aneurism: 1. True Aneurism which is known by the presence of a pulsating tumor. 2. False or Sjmrious Aneurism in which there is always an aperture in the artery from which the blood gushes into the cellular substance. 3. Varicose Aneurism. This species of aneurism can only happen where a vein runs over an artery; as wThere the brachial artery is punctured in opening a vein. The blood from the artery rushes from the artery into the vein which becomes varicose. Causes.—Aneurism of the aorta is more common in males than females. It is caused by inflammatory irritation of the coats of the vessel by which its elasticity and vital power of resistance are dimin- ished * the habitual use of ardent spirits; augmented action of the heart produced by mental excitement and corporeal exertion ; hyper- trophy of the left ventricle consequent upon chronic inflammation of the vessel, and influenced by moral and physical causes; excessive mental 342 DISEASES OF THE SANGUINOUS FUNCTION. emotions; violent physical exertions suddenly made ; though a mor- bid state of the vessel has generally existed previously. Prognosis.—Aneurisms sometimes terminate favorably by gradual contraction of the sac and absorption of the coagula; by compression exerted upon and above the sac; by gangrene of the sac and oblite- ration of the artery; by the influence of inflammation in the vicinity, and the closure of the artery by the coagulable lymph thrown out; and by adhesive inflammation within the artery closing its calibre. When the artery involved is large, and beyond the reach of a surgical ope- ration, the danger is always great; as the aneurism is liable to be rup- tured by a trifling accident, and death usually results from haemorrhage in a few seconds. "The fatal event may be generally foreseen, as the part about to give way becomes particularly tense, elevated, thin, soft, and of a dark purple color." (Hooper, p. 67.) Treatment.—Nature's effort towards the cure of aneurism is direct- ed to the throwing out of coagulable lymph which, with the fibrine of the blood, forms a layer, more or less organized on the inner surface of the artery. The researches of John Hunter show that this effort of nature can be assisted by measures which promote the general health, and improve the vital energies, but restrain or retard the action of the heart. "Strict quietude of body and mind, a light digestible diet, the careful avoidance of spirituous and malt liquors, are indispensible auxiliary measures." " Change of air is beneficial, but all active exer- cise is hazardous ; the digestive secreting and excreting functions should be attended to. The circulation may be partially controlled by small doses of Digitcdis. The application of ice to the tumor has been advised by several European physicians. In one case re- ported in the Med. Repository^ 1817, ice was kept on the tumor night and day for several weeks, by means of an ox bladder." " The skin soon began to shrink, and by perseverance in the employment of the remedy the tumor wholly disappeared." Though in this case the dis- ease returned, and in some other cases the ice treatment has produced distress, it has been successful in some cases, in which the pressure was probably more beneficial than the coldness of the ice. A case of spontaneous cure of aneurism of the femoral artery by the concretion of its sides was reported in a letter by Dr. L. Spaldino- to Dr. S. L. Mitchell. In some cases pressure made upon the artery above the tumor has succeeded; but the only treatment relied upon by modern surgeons is that first performed by John Hunter in 1785. A ligature is applied to the artery at some distance above the aueurismal tumor; the cur- rent of blood being thus interrupted, the tumor ceases to enlarge, and may soon begin to be diminished by absorption. The artery bein" tied at a distance from the diseased point is likely to be in a sound ANEURISM. 343 state, the adhesion of its sides is more certainly effected, the wound is more simple and easily healed, the circulation is carried on through anastomosing vessels, and the system is less disturbed than by an ope- ration performed upon or near the tumor. (Erichsen's Obs. on Aneuris7n, p. 374.) Compression has been successfully employed to remedy aneurism by diminishing the flow of blood through the artery without obstruct- ing it. " A partial current through the sac enables the fibrine to be readily entangled in the parietes of the sac in the first instance, and this goes on increasing until it becomes filled: the collateral branches having been previously enlarged, the circulation is readily carried on through them." The compression is effected by two or three small " clamps" by which a graduated degree of pressure can be exerted; and when too much irritation is given in one place it is slackened while the necessary pressure is kept up by others. This treatment, proposed by Hutton in 1842, and since improved by others, has been successful in several cases. It is always safe and often applicable where the operation by ligature was contra-indicated. (Bellingham,, pp. 14. Dublin, 1845.) In 1859, Mr. Hart proposed to the Royal Med. and Chirurgical Society to retard the current of blood in the vessels of the limb by flexion of the leg upon the thigh. Cases illustrating the merit of this procedure have since been given where the formerly trusted methods had failed. Mr. Hart says : " The object in healing aneurism is not to cut off the supply of blood, or altogether at once arrest the circula- tion in it, but to cause such a retardation in it as will lead to the gra- dual deposit of fibrinous laminae in the interior, and so effect its gra- dual consolidation. The former method is uncertain and dangerous; the latter safe and permanent in its results." To attain this partial arrest of the circulation in the limb, a flannel bandage is rolled around the leg from the foot upwards, sloping below the tumor, so as not to compress it in any way. The leg is then bent on the thigh, retained in a fixed position, by means of three pieces of bandage attached to the ankle and along the leg. Confinement to bed is unnecessary, the patient can move about the room with a crutch. After a few hours the limb will require to be released from its restrained position; but, after an interval of a night, it is again bound up and retained so for several days. Absolute necessity for the retention of the flexed position will probably be gone in a week, but, as a measure of precau- tion, it is desirable that it be kept up for some days longer. To re- lieve the stiffness and aching of the knee-joinl^which results from its forced position, Mr. Hart uses a linament of chloroform .and oil. Per- haps Arnica would be more efficacious than Chloroform. The flexion should be employed with care and graduated. Some distinguished 344 DISEASES OF THE SANGUTNOUS FUNCTION. surgeons have recommended this mode of treating popliteal aneurism. Varicose Veins.—Lower Extremity.—1. Spontaneous superficial varicose in the lower extremity arise after deep-seated varicose of tie corresponding part of the same limb. 2. Varicose of the sub-muscular veins may exist without manifesting the disease in the superficial ones; but the latter always ultimately appear. 3. Phlebectasis of the lower limbs does not begin in the subcutane- ous vessels or in the saphena interna more than any other vein, but from deep-seated veins in general. They are first affected with dila- tation and valvular insufficiency, and these lesions are thence propa- gated to the sub-aponeurotic vessels. 4. Dissection shows this state of facts and the distribution of the veins of the lower limbs reveals the cause of them. 5. These facts show the reason of frequent relapses after superficial varicose veins appear to have been cured. Treatment.—Ham,amelis-virginica.—Venous Congestions.— Since 1851, Dr. H. C. Preston (N. Am. Jour. Homceop. Aug. 1857, p. 28), says he has prescribed it in about fifty cases of varicose veins of the lower extremity; and in no single instance has it failed to make a decided impression, and in a great majority of cases he has made a radical cure. First bandage the limb tightly from the arch of the foot to a little above the knee. The best bandage is an elastic silk stocking manu- factured for the purpose. Under this are compresses laid over the dilated veins and kept wet with Hamamelis tincture or Pond's Ex- tract. The same remedy is given internally three times a day, the third dilution. Some cases accompanied with indolent ulcers in the tibia have been under treatment for a year; but most cases have been cured in less than half the time. Varicose of the Spermatic Yein.—»Circocele.—This disease has been seldom cured, and only palliated by Sir Astley Cooper and others. A case is given by Dr. George Barrow, of Taunton, Mass. A merchant, of scrofulous constitution, had swollen testicle of four or five times its natural size, hard and painful. He was not benefitted by Pulsatilla, Bell., Clematis, Rhus.-tox., continued for a week. He then took Pond's Extract of Hammamelis in drop doses every two hours. The scrotum was enveloped in a bandage kept wet with a dilution of one part of the tincture of Hamamelis to two parts of alcohol and water. In twenty-fo%r hours he was free from pain, the swelling gra- dually disappeared, a silk suspensory bandage (without the collodion which he had before used;, enabled him to return to business, and he was soon quite well. ANEURISM. 345 Varicocele.—This is a similar affection of veins of the scrotum, and is a common accompaniment to circocele. It may be cured by the same treatment. Treatment.—Secale.—Characteristic symptoms. Hepatitis ter- minating in gangrene. Great feeling of coldness in the back and ab- domen.—Putrid, foetid colliquative, diarrhoea. Sudden, striking change of features with deep, sunken eye-balls, surrounded with blue margins, constant nausea and vomiting after taking the least food, frequent diarrhoea, with watery, slimy evacuations, shrivelled skin which feels cool to the hand, inexpressible feeling of burning and anxiety in tho pit of the stomach, hoarse, hollow voice, suppression of urine, cramp in the calves, paralysis of the upper extremities, scarcely perceptible pulse and unquenchable thirst. Violent drawing in the spermatic cord, so the testicles appeared to be drawn up to the inguinal ring.—Con- gestion of blood to the uterus. Excessive uterine contractions so that the uterus seemed to burst. Slow breathing, thirteen respirations in the minute. Spasm of the pleura with suffocative catarrh, speechless- ness and subsultus tendinum. The limbs become pale, cold and shrivelled as if they had been lying in water a long time. Gangrene of the limbs, the limbs becoming suddenly cold and lead-colored and losing all sensibility. The skin is dry and brittle. The skin all over looks lead-colored, the parts becoming shrivelled and insensible and not emitting a drop of blood on being cut into. Burning of the skin as if a spark of fire has fallen on it. Large ecchymosis, blood-blisters on the extremities becoming gangrenous; black, suppurating blisters. GENUS XII.—GANGREXU. 1. Raphania Gangrenosa.—Necrosis Ustilaginea.—General ma- laise, tiredness, restless sleep with dreams, anguish ; wandering pains in the back and lower limbs, spasmodic contractions of these parts; frequent attacks of violent pain and spasms, flushes of heat; pulse and appetite unchanged; abdomen distended and painful; urine clear and copious. Gradually the convulsed limb feels numb. It becomes exceedingly painful; pulse hurried, contracted; feeble; sweat on the face and head; hands and feet icy-cold, and can not be made warm. Erysipelas some- times on the extremities. At once the coldness increases, while the pains in the extremities cease. The extremity begins to show dry gangrene, in some humid; in the dry it is livid, the skin withered, wrinkled, turns yellow, then the limb becomes black, dry and hard as horn. If humid, the extremity swells; phlyctenae filled with bloody serum form in the skin; the muscles become soft, and gangrenous parts spread a foetid odor of putrefaction; pulse more and more feeble; languor becomes extreme and there is a torpid fever, features become shrunken; fainting fits, 846 DISEASES OF THE SANGUTNOUS FUNCTION. delirium, coma, exhaustive diarrhoea; and, Avhen the symptoms of gan- grene have reached a certain height, death takes place. In a few cases the dead part separates by suppuration. In many cases the diseased limbs remain mutilated, atrophied, paralysed. One loses the toes, another a foot, a leg up to the knee or a whole limb; when suppuration is profuse he dies of hectic fever. Sola?vwn-nigi'um.—Hahnemann (Lesser Writings, Vol. I, p. 162) recommended this as the most certain remedy. Dr. Gross reports several cases treated by it: 1. A farmer, afflicted with epileptic spasms and rage, was cured by Solanum-nigrum, after he was unconscious, and his limbs distorted by spasms. 2. His younger brother had painful creeping in the extremities with curvature of the hands; this was common in this district and con- sidered as incurable. Gave him four pellets of this remedy of the 30°. In a few days it was reported that he was well. Two other children were affected in-the same manner. They were cured; and also several other patients in that vicinity. 3. A boy, six years old; hands and feet bent inwards; was able to stand only a minute or two, though the involuntary contraction of the flexor muscles gave him the appearance as if he would jump, and caused risus sardonicus in the facial muscles. Gave him Solanum-nigr. 15 "J, two pellets. Next day he was unable to stand; hands bent inwards more than before; third day the same; fourth day, all symptoms of spasm dis- appeared. Raphania was epidemic in 1770, and 1771 in the district of Zelle, described by Taube in his history of it, 1783. It was then very often fatal; in this and in another epidemic there were convulsions and tonic spasms curving inward of the extremities; the wrist-joint entirely bent imvards; fingers drawn to the palms of the hands, and elbow to the chest; even tetanus. Epilepsy idiocy, rage, and risus sardonicus. All of these symptoms were removed in a few days by Solanum- nigrum. The gangrenous symptom is the one for which Ergot is the cause, and is also the probable remedy. 2. Gangrenefrom Injury of the Nerves.—SirB. Brodie, has seen the heel begin to mortify twenty-four hours after a lesion of the spinal cord, and few surgeons have not seen ulcerations and even eschars appear upon the sacrum and elsewhere, in the first week after a frac- ture or luxation of the spine. Entire section of a nerve has no such effect. Mr. Brown-Sequard says, he has " seen hundreds of animals survive whole months, the section of the cord, and present in the parts GANGRENE. 347 paralyzed no other lesion of nutrition than an atrophy, generally slow in showing itself. Gangrene after Injury.—Lachesis.*—1. A boy, aged nine or ten years. Severe injury from the explosion of a pistol held in the clenched hand, which was much torn to pieces; small finger with its metacarpal bone left hanging at the wrist by a bundle of flesh, skin and tendons; soft parts in palm of the hands loosened from the bones. Effort to save the finger. Dressed with Arnica and water. Inflammation followed, though union by the first intention took place in part of it and granu- lation progressed: " but at the junction of the finger with the hand, on the lower part of the palm, there was a spot nearly the size of a twenty- five cent piece, puffed up, of an ash-gray color, emitting an exceedingly offensive odor; gangrene had commenced. One dose of Lachesis 6° arrested the process in a few hours. The dead portion sloughed off shortly after, and the healing process went xminterruptedly to a favorable termination. 2. A young man, whose tibia and fibula were crushed under a large grindstone, ankle joint contused and lacerated. Dressed with Arnica and gave it internally. On the seventh day gangrene commenced with bluish purple vesicles for some distance round the wound, covering a dirty-ash-gray ground, and offensive odor. Amputation now the only resource of surgery. Lachesis 6° was tried in one dose. In six hours the nature of the case was entirely changed, in twenty-four hours the blisters had disappeared, swelling gone down; two days later the dead portions sloughed oft"; the wounds granulated favorably and the foot was saved. In a third case gangrene supervened on a scalded limb. A boy, aged seventeen, fell with one leg into a kettle of boiling soap, destroy- ing the skin and adipose covering of the limb to the body. The ninth day the dead portions so far as they were loose came away, exposing the fascia in places. Discharge of pus, profuse ; muscles irritable and jerking spasmodically. On the twelfth day suspicious points on the exposed fascia emitted intolerable stench. Fascia puffed up, presenting purplish brown appearance and discharging bloody sanies. Thus gan- grene had commenced. It was arrested by one dose of Lachesis 6°. Three days later the fascia sloughed away, leaving healthy ulcers which soon healed. Some other parts presented appearance of gangrene, and wrere corrected by Lachesis. The cure was complete, though with permanent flexion of the leg upon the thigh. Gangrene of the Lungs.—Divisible into two forms, both very rare. 1. Diffuse; in which a considerable extent of the lung is affected, * Dr. D. M. Dake, U. S. Jour. Homceop., Vol. I.. 60. 348 DISEASES OF THE SANGULNOUS FUNCTION. as the whole or part of a lobe, the boundaries being but imperfectly defined. 2. Circumscribed gangrene is more limited in extent and distinctly separated from the remainder of the pulmonary structure. It varies from the size of a bean to that of a hen's egg, sometimes confined to one point, often found in several. It terminates as elsewhere in sloughing. The decomposed lung substance, reduced to a dark green- ish fetid, diffluent mass, is evacuated generally through the bronchial tubes, but occasionally into the pleural cavity. The evacuation ended, a cavity remains. This cavity remains in some cases for a long time, even years in some cases; cicatrization takes place when the case does not terminate in death. In the early period of the disease the pulmonary structure is soli- dified over the inflamed part when it occurs from pneumonitis ; when the gangrene is preceded by pneumonitis exudation and oedema extend around the eschar. The cavity remaining after evacuation is distin- guished by physical signs. Bronchitis occurs in the tubes near the gangrene, which, with the fluids in the tubes, are also recognized in the same manner. The seat of circumscribed gangrene often occurs in the inferior lobes near the surface. Diffuse gangrene generally attacks the upper lobes. Diagnosis.—This is seldom made out before gangrenous matter ap- pears in the expectoration, as the disease is developed in an insidious manner. It is first suspected from the intense effluvium, rendering the atmosphere insupportable. Diminished vesicular resonance on per- cussion, or dullness is more or less marked according to the size of the gangrenous portion of the lung, and of the solidification dependent on the exudation and oedema. When the lung is inflamed preceding the gangrene the dullness extends over the entire lobe. When the gangrene is circumscribed the percussion dullness is confined to a small spot, and may not be detected. Percussion gives no evidence of gangrene when it follows pneumonitis; dullness when it exists may not be referred to gangrene. Auscultation gives the respiratory and vocal signs of solidification, viz., elements of bronchial respiration and increased vocal resonance or bronchophony during the decomposing processes, feebleness or extinction of respiratory sound may be observed, also absence of reverberation and transmission of the voice. Bubbling rales, mucous or sub-crepitant, are heard in the vicinity of the affected part, owing to bronchitis, and later to liquid in the bronchial tubes derived from ex- cavation. Cavernous signs succeed those of solidification after dis- charge. A remarkable foetor is the most characteristic trait of the disease; it is called gangrenous. Gangrene of the lungs is not a primary affection, but occurs in con- nection with fever, epilepsy, brain affections involving insanity, effects of GANGRENE. 349 intemperance. The foetor of the breath, often unendurable when there is cough without expectoration is characteristic. The matter expectorated is at first grayish white or greenish, resem- bling portions of gangrenous lung found after death. Later the matter is purulent, and less offensive in odor. The breath and expectoration furnish the diagnostics ; the gangrenous foetor is not sufficient. If the expectoration suddenly assume a gangrenous foetor, at the same time becoming copious and presenting the appearances characteristic of de- composed pulmonary substance, the existence of gangrene is quite cer- tain ; especially if prior to the eruption of this peculiar matter the expectoration has been slight or altogether wanting. The case is clearer if there had been previously ascertained circumscribed solidifi- cation, and if cavernous signs afterwards appear in the same locality. If peculiar foetor occur in the course of bronchitis it rarely ever be- comes so intense as in gangrene ; it has been developed less suddenly, little or no gangrenous matter ever appears in the expectoration; no sign of solidification preceded, none of cavernous excavation follows it. An abscess following pneumonitis may furnish purulent expectora- tion, sometimes foetid, but never so intensely so. The matter dis- charged is not the dark, sanious, liquified gangrenous lung-substance above described. Small portions of lung substance within a tuberculous cavity may communicate a gangrenous odor to the expectoration, but not to the true gangrenous extent. The previous history may distinguish the two cases. Pneumo hydrothorax may be distinguished by the symptoms given under that head. Gangrene of the lungs occurs oftenest in children, next in adults, then in aged persons. Summary of Physical Signs.—" Dullness on percussion, varying in degree and extent, unless the gangrenous portion be quite limited, and deeply-seated. Bronchial respiration, or suppression of respira- tory sound within the area of dullness on percussion ; increased vocal resonance or bronchophony and fremitus occasionally present; mucous or subcrepitant rales in the vicinity of the gangrenous portion; possi- bly, a true crepitant rale; subsequent to the occurrence of fetid ex- pectoration, cavernous respiration, gurgling, and in some cases pec- toriloquy." Remedies: Laches., Phos., Arsen. 4. Gangrena Senilis.—Spontaneous Gangrene.—A form of gan- grene which generally commences in the feet of aged persons, or at least those past the middle age of life, though younger persons have been attacked by it. But it generally occurs in aged persons in whom the arteries have become ossified, more or less contracted, sometimes obliterated. The ossification generally extends well up the leg. In some cases the femo- 350 DISEASES OF THE SANGUTNOUS FUNCTION. ral artery, instead of being ossified, has become converted into an im- pervious gristly cord; the change in all these cases seems to be the effect of a gradual degeneration of the tissue, without previous inflam- mation. Premonitory Symptoms of Senile Gangrene.—There is for some months or years before gangrene is perceived, occasional pain of the toes and lower limbs, followed with numbness and some difficulty of keeping the feet warm. After the feet have been cold and are become warm again they become quite painful with a sense of weakness in the muscles. The patient can walk quite well for a short distance, but is soon exhausted; after one or two years he finds little blood in the feet, the heart is easily excited to unwonted action by running, walking up- stairs, lifting weights, by excitement of passion; the circulation is ob- structed, the action of the heart is liable to stop, and syncope will follow. These premonitory symptoms may continue for years, and then the mortification will suddenly follow on some trifling inflamma- tion. A corn may have been cut too deep till it bleeds, and inflamma- tion and gangrene follow. Or the foot has been too cold, and then placed too near the fire to warm it; the toes inflame slightly and then mortify. Small blisters resembling those of severe erysipelas soon burst and expose dead cutis vera. The flesh though dead has not the usual black appearance of mortification; from not being supplied with blood, the dead portions often appear quite white, thus deceiving by this appearance the careless observer. The gangrene may be confined to one toe or may extend to several, or to the foot. The pain sometimes slight, at other times excruciating. When mortification begins, a little line of inflammation appears at the margin of the gangrene which slowly creeps over the toes and up the foot, and the mortification follows it; the patient feeling all the time quite well in all other respects. In the course of some months the disease begins to progress more rapidly; the inflammation followed by the gangrene extends farther up the toes and feet; a fresh attack of inflammation affects the gene- ral system; the morbid fluids existing in the diseased part begin to be absorbed; the pulse becomes feeble and rapid; the appetite fails; the skin is more hot, the patient sinks into a state of stupor, and, in a few days more he dies. Treatment.—The first idea of the old surgeons was amputation; but this was long ago given up. The only efforts now relied upon are: 1, to check the inflammation by general and local measures. 2, to relieve the pain, support the strength till the dead portions can slough off, leaving the stump to heal by granulation. Good diet, such as can be digested, must be furnished ; digestion, assimilation and exertion must be kept in as healthy a condition as GANGRENE. 351 possible. Stimulants, as ale, porter, beer, &c, must be used as far as they can be made agreeable. The patient must be confined to bed, warmly covered, first with some mild ointment, after which the best covering for diseased limbs is carded wool, as recommended by Mr. Vance, surgeon at the Greenwich Hospital. It was also tried by Sir B. Brodie with success in many cases. It should be applied in large quantities over the whole limb as high as the hip, sewing a silk hand- kerchief loosely over it to keep it in place, and kept on several days. This application ensures the quiet of the limb, protects it from changes of temperature; and even the diseased arteries gradually assume a more healthy condition*\mder its influence. It should be continued till full recovery; and then a soft woolen stocking and drawers should still be worn next the skin. When the progress of mortification is arrested the line of demarca- tion is seen separating between the living and dead parts. The sepa- ration generally progresses till the flesh is entirely detached, and after a time even the bones become loose. The tendons and ligaments may need to be cut, but neither the flesh nor the bones should be severed by an operation. Cutting off a portion of the dead flesh does no good, and an incision into the live flesh is almost certain to be followed by a spread of the mortification. To control the offensive odor of the dead flesh, employ a. wash of chloride of lime, or chloride of zinc, though carefully guarding against wetting with it the living parts. A good disinfectant is a dry powder prepared by rubbing together 100 parts of plaster of Paris with 5 parts of coal tar. This may be applied to gangrenous surfaces, or to any other that is offensive, as it makes a good dressing spread on lint. Tar water, which contains Kreosote, is also a good disinfectant. When the gangrene spreads rapidly and the life of the patient is in danger, it is advised to destroy the vitality of the surface parts of the limb in advance of the inflammation and to consolidate the dead flesh of the sloughs while they are separating, so as to allow a distinct line of separation to be established between the dead and live flesh. Strong nitric-acid appears to answer this purpose better than any thing else, though the operation is very painful. First dip a piece of wool in the acid, wipe its surface, and apply the wool to all the surface for some distance beyond the gangrene. After one or two applications of strong acid, usually, the dead portion will begin to slough off; the acid should afterwards only be reapplied where the slough does not appear readily to separate from the living flesh. When the spontaneous gangrene attacks the extremities of young persons, the arteries of the legs or feet having become plugged up with fibrinous exudations, the brain is quite liable to be simultaneously affected. The treatment consists in, horizontal position, quietude, 352 DISEASES OF THE SANGUINOUS FUNCTION. calming arterial excitement with Aconite, avoiding mental agitation and anxiety. Aconite alternated with Belladonna will control the fe- brile and cerebral excitement better than any thing else. Hitherto the reliance has generally been on Opiates to quiet the pain and irri- tation, stimulants, as Ammonia and lemon-juice, China, Lach., Arsen., &c. The application of a large quantity of wool around the limb with proper internal treatment, and good diet will sustain the vital powers till the dead parts have time to separate. 5. GANGRENE OF THE MOUTH. GANGRENOPSIS. GANGRENA ORIS. The recent order of Surgeon-General Hammond, prohibiting the use of calomel in the United States Army, recalls to our recollection the observations of former years, in which this disease as a poisonous effect of mercury was more common than it appears to be now. It does not indeed occur as a common effect of mercury in good constitutions, even when that article is injudiciously used, but is almost always pre- ceded by some other constitutional disease, as intermittent fever, scar- latina, or some epidemic. It is peculiarly liable to attack children over two years of age, or between the periods of the first and second dentitions, who are much reduced by protracted fevers, or mucous in- flammations. It has long been known that children are with difficulty salivated, hence it has been common to prescribe calomel recklessly in trifling diseases; and very often, instead of an ordinary ptyalism the physician finds on his hands a case of gangrenous inflammation. Professor Dugas of Augusta, Ga., (in the Southern Medical and Surg. Journal, Oct. 1850,) says: "there are few communities in this section of the country in which there may not be found some living evidences of the havoc of mercury upon the face." Symptoms.—The disease ordinarily appears in patients who have suffered from ague or some pernicious fever. When the original dis- ease is subsiding a foul sloughing ulcer is observed on the gums near some decayed tooth, or in points which have shown effects of mercury. The local disease extends by a process of sloughing rather than by ulceration. The surface of the ulcer is jagged, covered with dark offensive cream-colored sloughs. In some children, previous to the commencement of this disease, there is general ill health for weeks; derangement of the digestive organs; alternate constipation, bilious diarrhoea; abdomen swollen and general emaciation. The patient is suspected to be suffering from the effects of worms, and one dose after another of calomel is given. The worms are not discovered, but after some days the mouth is observed to be sore. The epithelium is sound, except in one spot, perhaps adjoining a single tooth, which has been partially decayed before. At this point the gum is converted into a GANGRENE. 353 grayish, cineritious slough, slightly receding from the body of the tooth which is becoming loose, and the investing membrane is found diseased. The case is not considered alarming, and an astringent wash is thought sufficient; but, in a few days the friends begin to be alarmed. There is now fever, pulse 100 per minute; no appearance of exhaustion, the eye is clear, and the intellect undisturbed. But the cheek and eyelid of the affected side are swollen and red over a large surface, but with a round grayish patch in the centre; and this, on looking closely, is black at the edge, and the circumference surrounded by a circle of brighter red. The centre is ashy or tawny in color, soft and slightly depressed. This circular spot is already gangrenous ; it penetrates the whole thickness of the cheek, the dark slough extends to the dis- eased part of the jaw where the first ulcer appeared, and is seen to be gradually extending on every side. Caries is extending from the tooth along the jaw. The teeth become loose and the patient sometimes plucks them out with his fingers. " I saw a child at my first visit watched by an attendant to keep it from pulling out its teeth. If not cured the disease progresses to an early termination in death; the mind remaining clear, and the child continuing to take food and drinks while the power of swallowing remains." In adults the course of the affection is about the same. It begins in persons whose health is already broken by previous disease. They have generally taken much medicine, have perhaps had mercurial sore mouth more than once to cure bilious fevers and supposed chronic hepatitis, quinine to cure agues, and hydragogue purgatives to cure drop- sical affections. The physician finds the patient in a case of this kind in a slight chill, or after imperfect reaction. Some pain in the head; tongue coated, edges red. He gives one or two purging doses of Calo- mel, with common accompaniments. The fever seems better; but all is not right; the strength does not return. The mouth is observed slightly sore, and the ptyalism is expected to finish the cure. But it does not: the breath is found very offensive; further purgatives are given, and strong astringent lotions are used for the mouth. The case goes on for some days, and all is thought to be improving. But the breath has a peculiar foetor, and some certain spot is pointed out as painful. The cheek is swollen, pale at first, then red, glossy; eyelid oedematous, nearly closing the eye. The mouth within shows a black or grayish eschar, either on the gum or inside of the cheek. Gangrene has already commenced; and it slowly but certainly extends towards the orbit, along the jaw, soon perforating the cheek. Death is on the march, though the patient says, he feels "pretty well;" the pulse is good, the fever is scarcely perceptible, and he takes sufficient food. Under any common treatment he will die in a few days. Causes.—All the malarious fevers, scarlatina, measles, and other Vol. IL—23. 354 DISEASES OF THE SANGUINOUS FUNCTION. epidemics are capable of so deranging the general health as to render the system peculiarly susceptible to the most deadly influence of Mer- cury. And there are some constitutions which naturally present this susceptibility to the influence of this poison, such persons being so sensible to its effect that they can not take the smallest particle of it without being salivated or otherwise poisoned. In them their pecu- liarity constitutes an idiosyncracy which has not originated in any of the above causes. But of all known agents Mercury itself is most destructive. The patient who has taken it oftenest for former diseases is most susceptible to its worst effects. He becomes more and more sensitive to its poisonous manifestations, until he can not take calomel in the most minute quantity without a sore mouth which keeps him in agony for weeks.—In some cases ptyalism continues for months, and its relics last through life. When excited it does not supersede the fever for which it was given. The mercurial cachexia has been developed in him by former uses of the poison; and when he is attacked by al- most any febrile disease, if we make a fair record of all his symptoms we shall find them to be precisely covered by the one hydra, Mercury. The homoeopathist asks: "Is not Mercury then the proper remedy?" It is sufficient here to say, that when the disease has not been caused by Mercury, it, in some attenuation is a proper remedy. But when the disease has been caused by Mercury, the symptoms presented by the effects of this agent do not show a disease similar to the one from which the patient is suffering. We see only the identical enemy that we have been called upon to combat. We have not proposed to treat arsenical poisoning by administering more Arsenic, and we will not now depend on Beelzebub to cast out Beelzebub. But we have evidence enough to prove that Mercury, even in attenuations, can not be given in a true mercurial disease without greatly aggravating it. And when the condition exists which simulates the premonitory stage of mercurial disease, massive doses of Mercury can only be administered at the hazard of producing that fearful medicinal aggravation in which mer- curial gangrene consists. Large doses of Mercury are bad enough anywhere, but here, where this powerful poison is the exact similimum of the disease, it always furnishes new evidence of the truth of Hahne- mann's exposition of the law which should regulate the size of doses of a remedy, which should be curative when properly administered. He says: (Organon, § 275.) "If too strong a dose of a remedy that is entirely homoeopathic be given it will infallibly injure the patient, though the medicinal substance be of ever so salutary a nature ; the impression it makes is felt more sensibly, because in virtue of its ho- moeopathic character, the remedy acts precisely on those parts of the organism which have already been most exposed to the attacks of the natural disease. GANGRENE. 355 § 276. Even a homoeopathic medicine is, on this account, always in- jurious when given in too large a dose, and hurtful to the patient in proportion to the extent of the quantity administered. But the increase of the dose itself is also prejudicial in the same degree as the remedy is homoeopathic and the potency higher ;* and a strong dose of such medicinal substance (which bears no analogy whatever to the disease) of equal strength; for in that case, the homoeopathic aggravation (see Organon, § 157 to 160.)—that is to say, the artificial malady, which is very analogous to the natural one excited by the remedy in the most suffering parts of the organism—is carried to a height that is injurious; whereas, if it had been confined within proper limits, it would have effected a gentle, prompt, and certain cure. It is true the patient no longer suffers from the primitive malady wdiich has been homoeopathically destroyed, but he suffers so much more from the me- dicinal one which was much too powerful, and from unnecessary debility." That Mercury is the common, if not the universal cause of gangrene of the mouth is generally admitted. We have now seen the reason that, while its effects are bad enough in almost any case, they are most terribly destructive in constitutions which are already in that condition of morbid sensibility to its powers which this poison is itself capable of producing. In malarious districts gangrenopsis is regarded as endemic : and in certain localities Mercury is thought more dangerous than elsewhere. Professor Dugas says, he has " a vivid recollection of a family of five children, three of whom had, during the same autumn, been suc- cessively attacked with remittent fever, and they both died, with most awful sloughing of the cheeks and lips. They were all treated with Calomel." When the two remaining children took the same fever, another mode of treatment without Calomel was tried, and " they re- covered without gangrenopsis." That all cases of gangrenopsis are caused by Mercury is generally believed, though a few cases have occurred in which it was considered certain no Mercury had been given; and in these cases it is supposed that other debilitating causes of disease may produce a condition resembling the mercurial dyscrasia. That Hahnemann understood the subject is clear from the above quotations, as well as from other state- ments in various parts of his works. That he as well as others have often cured diseases which simulated mercurial poisoning, by giving this same article in attenuated doses, is well knoAvn. * " The praise bestowed of late years, by some few homoeopathists on the larger doses, depends on this, that they choose low dynamizations of the medicine to be administered, as I myself used to do twenty years ago, from not knowing any better, or that the medicine selected was not perfectly homoeopathic." 356 DISEASES OF THE SANGUINOCS FUNCTION. Treatment.—This must be directed first, to correcting the general febrile and dyscrasial condition, and second, to the arrest of the local affection which results from the former. Generally the local affection can not be arrested till the fever is subdued. There have been a few cases which ceased spontaneously upon a gradual subsidence of the fever, with but little treatment of any kind. In one case in Indiana, a child, after the sphacelation had produced a large aperture in the cheek, seemed to be cured by the application of sweet cream to the raw surfaoe from which the mortified part had separated. Healthy granulations immediately commenced, and the destroyed structure was restored, leaving very little deformity. Aconite is one of the first remedies in the early stage, so far as it is indicated by the common symptoms for which Aconite is generally proper in all other febrile affections. We omit the symptoms here. Gelseminum has been recommended in the place of Aconite. Our observations lead us to prefer Aconite. Mercurius is a true specific for all the milder cases in which we are certain that not a particle of Mercury has been given to cause the disease. Where we can not ascertain whether it has been given or not, it is dangerous to hazard a trial of it in any of the lower triturations. How Jiigh would be safe; and whether the highest would have any power over a true mercurial gangrene of the mouth, we leave to be answered by those who have tried it. Chlorate of Potash.—This, in the language of the old books, is a powerful " siliagogue," displaying a well-known elective action on the glands and mucous membrane of the mouth and pharynx. Being in this respect a similimum to Mercury, it is perhaps the most efficient agent known for counteracting its poisonous effects. In cases where Mercury has caused excessive salivation the chlorate has often been employed to arrest it. Even men who think the extreme effects of Mercury are necessary in the cure of many diseases, often employ the chlorate of potash to "check the formidable mercurial disease, and permit the Mercury at the same time to be continued without danger." The practice is to use the chlorate in solution, wrashing the inflamed or ulcerated surface at short intervals, permitting small doses of it to pass into the stomach in a state of weak solution. At the Hopital Sainte- Eugenie it has been used largely for ulcero-membranous stomatitis and is always successful.* Dr. Dethan proposed " to employ it in the form of pastiles, so that the patient may have at hand a remedy against the injurious effects of a mercurial course." Ricord and Founder have found the remedy successful in this form. In gangrene of the mouth from Mercury and in some other diseases connected with malarial and * L'Union Medicale, 1857. GANGRENE. 357 epidemic fevers it is considered as the most efficacious remedy hitherto discovered. Mr. Fraser of England recommends it as an application to cancerous and other ill-conditioned ulcers. As a deodorizing agent it is one of the best known; and this fact indicates its appropriate appli- cation in other gangrenous conditions as well as gangrena oris. A weak solution dispersed by damp towels in different parts of the room is suf- ficient to remove the most offensive odor. For these various purposes we have often employed it. Permanate of Potash has similar powers. Iodide of Potassium.—This article is also regarded as a specific for the poisonous effects of Mercury. Symptoms.—In scrofulous constitutions subject to rheumatism, who have been injured by mercurial and other debilitating remedies: chilliness followed by general fever; dryness of the mouth followed by salivation; profuse serous discharge from the nose; inflammation of the mucous membrane of the nose and eyelids; eyelids oedematous; catarrhal in- flammation of the schneiderian membrane extending to the frontal sinuses. Paleness of the face followed by redness and swelling of the face and tongue ; lacerating pain in the jaw bones and teeth. Enlarge- ment and inflammation of the parotid and submaxillary glands; ulcera- tion and swelling of the gums. Ulceration of the tongue and mouth without salivation; otherwise ptyalism with great swelling of the tongue; excessive ulceration of the mucous membrane of the mouth; bloody saliva. Throat dry, hot, with burning, dull stinging pain; violent, continual and excessive thirst; flatulence in the stomach; nausea, vo- miting; inflammation of the stomach; burning pain at the pit of the stomach. Pain in the region of the kidneys; urine diminished in quantity, high colored, mixed with mucus or blood; progressive and rapid emaciation and anaemia; palpitation of the heart. Arsenicum.—This remedy has cured gangrenopsis in persons living in marshy, malarious districts. The symptoms are those of Arsenic generally, and the fever inclining to intermittent paroxysms. There are: blisters on the tongue; upper surface of the tongue white, mem- brane thickened; aphthae; superficial ulcers on the edge of the tono-ue ; disagreeable taste, astringent or bitter; frequent spitting; bloody saliva; heat and pain in the fauces ; oesophagus, stomach and abdomen; throat and uvula swollen and red; occasional convulsive cramps in the throat; difficulty in speaking or swallowing; want of appetite; thirst not generally remarkable; sometimes thirst with an- guish, perplexity; hopelessness; face often pale, cold, at other times red, puffy, oedematous; cachectic oedema of the legs ; inflamed surface over the parotid glands; erysipelatous redness and swelling of the face * teeth aching, margin of gums on the teeth ulcerated; great ema- ciation, such as caused by Iodide of Potassium. Cases have been cured bv Arsenicum in Fowler's solution, after the sloughing had destroyed 358 DISEASES OF THE SANGULNOUS FUNCTION. one-fourth of the lower lip ; salivation profuse. The fever had been previously reduced by other means. Some local measures have ge- nerally been tried, and part of the good result has been attributed to them. One case was treated by local application of dilute muriatic acid, camphorated Alcohol fomentations. In the absence of fever Ar- senic (in Fowler's solution), was given to the extent of producing distress of the stomach. The sloughing ceased, granulation commen- ced under cerate and lint dressings. Little deformity remained. The sloughing did not prove critical or abate the fever. Ammonia-sesguicarbonas.—Sub-carbonate of Ammonia.—This remedy has been used with success, in small doses, or in the same manner as the Chlor-potassa. Dr. Wallace, of the Dublin Hospital, cured several severe cases with five grain doses. It is also known to cause a similar disease. Dr. Huxham had a patient who made a proving of Carbonate of Ammonia on himself. He accustomed himself to eat large quantities of it. " The consequence was that he brought on a hectic fever, vast haemorrhages from the intestines, nose, and gums, while every one of his teeth dropped out, and he could eat no- thing solid. His flesh wasted, the muscles became soft and flabby, he broke out in pustules, and died in a few months." Case by Dr. Douglas of Milwaukie, October 21.—A lady, slender, and of scrofulous diathesis, suffers from " great prostration; pains of head and back; skin hot and dry; pulse 110, small and weak; the gums are swollen, red, separated from the teeth, and pus oozing from them when pressed, the edges dark, and some of the points black and gangrenous; ulcerated points on the edges of the tongue ; the left half of the roof of the mouth covered with confluent patches of superficial ulcerations, some points of which are gangrenous ; intolerable odor from the mouth. For two days has had a chill in the morning, lasting from two to three hours. Ammonium-carbonicum, 3°, two grains in four oz. water; a teaspoonful every two hours. " Oct. 22.—Mouth and gums greatly improved ; dark color disap- peared; minute sloughs have fallen off; pulse 84, full and stronger. Had the usual chill this morning for two hours, followed by fever. Continue the Ammonia-carb., alternated with Nux. On the first feeling of chill to-inorrow, take Gelseminum." The. next day the chill com- menced, but it immediately ceased on taking the Gelseminum, and in 20 minutes perspiration followed without fever. The ulcers healed in two or three days more."—(U. States Jour., Homceop., Vol. 1., Appen.p. 5.) Tartar-emetic.—This is one of the most efficient remedies for the inflammation caused by Mercury, so long as nothing but inflammation is visible. When mortification commences we no longer rely upon it. Symptoms.—Month dry, inflamed, red; tongue covered with raised papillae, bright red, dry in the centre, sometimes moist, clear, gray or GANGRENE. 359 coated white, covered with small pustules ; difficulty of protruding it; embarrassment of speech, gums spongy as in scurvy; the epithelial lining, buccal cavity, and lips and throat excoriated, swollen, red; violent salivation. We have long used it in the third or fourth dilution in curing severe salivation, and always with good result. The centre of its sphere of action is in the stomach, and not the mouth. We omit further symptoms. There are many other internal remedies suitable for this disease, but few practitioners have patience to wait on them to produce their proper effects. By their own anxiety, or the urgent solicitation of the friends, they are generally driven to try the power of local applications. There is, indeed, no good reason for rejecting topical measures, for they may be each, as Hahnemann says, " Homoeopathic to the case in its own way." The remedies which might be expected to be successful are sufficiently numerous. We can only mention a few that have succeeded. Sulphate of Copper.—Dr. Coates recommended a solution of this article, and also Tincture of Cinchona, as a lotion for the local treat- ment of this disease. Either of them will be successful in only the mild cases. The former, in a saturated solution, is often successful in those more severe. It may be tried when the previous health has not been bad; when ash-colored ulcer is first observed, and before the fatal gangrene has clearly shown its character. The ulcer may be touched three or four times a day till improvement is manifest. In the whole course of the disease suitable internal remedies must be employed. Ilydropiper (Polygonum-hydropiper) Water-pepper, Smartweed. —An infusion or decoction of this common plant has long been used by farriers for the cure of salivation in horses. On trying it for Mer- curial ptyalism, it has succeeded in all the cases in which we have known it tried. It has also cured the follicular stomatitis of nursing women. Muriatic-acid.—Symptoms.—Dryness of the mouth, followed by free salivation; the tongue becomes sore, with red, burning vesicles and blisters on the edges ; ulcers with black base and inverted edges; palate inflamed; fauces raw, burning, smarting; toothache, with pain in the malar bones, ears, and temples; burning pain, swelling, inflam- mation in the gums. Scorbutic Gums.—Hahnemann, in his Chronic Diseases, gives many more symptoms ; and we have still more scattered through the books; but amon'T them all there has been no proving carried far enough to develop the peculiar and extreme effects which this corrosive acid is capable of producing; and it is only of these extreme effects which spe- cially concerns us in treating the present disease. In cases of acci- dental poisoning we see many more symptoms applicable here, but in- 360 DISEASES OF THE SANGUTNOU8 FUNCTION. stead of collecting them now, we will bring up some clinical facts which will sufficiently illustrate the operation of the remedy in curing gangrene of the mouth. Muriatic-acid.—Van Swieten, the leading Professor of the Vienna Medical School in the middle of the last century, says he used " un- diluted Muriatic-acid with great success," as a local application to arrest gangrenous ulceration of the mouth. In this country it was in- troduced into practice by Dr. Jackson in 1826. In the Medical Recorder, Vol. XII., he says the result of its application in the cases in which he tried it:—" It presently stopped the gangrene; and soon after the eschar separated from the parts in which there was life. Nor have I ever known its application to fail me, except where the gums were entirely putrid, and the jaw-bone was affected; for then I could not prevent its being carious ; but if the soft parts only in the inside of the mouth are gangrenous, it will certainly cure them." The most instructive reported case we have seen is given by Dr. James White in the Transactions of the " Fairfield Medical Associa- tion, Ohio:—* "A boy, aged eight years, had measles, then epidemic. Fever, efflor- escence, heat of skin, slight chilliness, headache, pain in the chest, much increased by dry incessant cough; tongue coated and red at tip and edges; epigastrium very tender and tense. As a child, aged three or four years, had recently died in the vicinity from gangrene of the mouth, under all the horrible circumstances incident to that disease, no Calomel or Tartar-emetic were given in the treatment of this case. Some common measures, of which bleeding and mild purgatives were the most objectionable, were considered sufficient, and the boy was thought to be doing well when the dreaded gangrene appeared. There was first seen a superficial slough on the gums covering two of the molar teeth on the right side, upper-jaw; gums on the opposite side sound. No foetor of breath or flow of saliva; there was little danger apprehended. " In a few days the slough had increased; the periosteum of the teeth and alveolar processes were implicated, the breath was slightly foetid; some irritative fever. Common antiphilogistic treatment was tried a few days, without benefit." The Report proceeds :— " March 1st.—The gums eaten out between two teeth. 2d.—One tooth loose, ulceration continues. 3d.—Spreading rapidly, and ex- tends to the cheek. 4th.—A tooth extracted. A lotion of diluted Muriatic-acid and honey applied. 5th.—The application continued; the swelling of the cheek increased. 6th.—The application continued; * Louisville Medical Journal, Vol. 2, p. 433. GANGRENE. 361 flesh separated from the jaw-bone three-fourths of an inch by a half- inch. The lotion and charcoal applied. 7th.—The same treatment continued; another tooth extracted." The case was now considered hopeless. No case after reaching this stage had in that region been known to recover. The right cheek was tense, swollen, pallid, and glossy; intumescence extending to the right eye, which was closed, and to the lips, drawing the right com- missure to one side, from which the saliva copiously flowed. The whole expression frightfully distorted; the breath had the characteris- tic foetid odor. Caries had now seized upon the jaw, from which the teeth were extracted, and the cheek appeared internally hollowed out in space equal to half a dollar, and covered with a black, thick slough. Mortification appeared to extend from the jaw and oheek,high upwards towards the orbit, and was rapidly perforating the cheek. There was still fever, but the skin was soft and slightly moist; pulse of good strength, mind clear, apparently without pain. Appetite good: he takes chicken broth, gruel, panada. No tonics given; blisters also avoided, as in all cases in which they had been tried they had appeared to increase the general irritation, and give unnecessary pain. " March 8.— Undiluted Muriatic-acid was then applied at 4 p.m., and repeated at 6, and then every hour till 3 a.m. The mortification was then found to be arrested, and reaction and sensibility of the parts acute. Application repeated twice on the 10th; sensibility still acute. From the 11th to the 19th Tincture of Myrrh and Alum were employ- ed. The appearances favorable." It is then proved that the undiluted Muriatic-acid, locally applied, can arrest the mortification of the soft parts, and even subdue the caries of the jaw. Mode of applying the Acid.—Make a swab by wrapping a soft rag on the end of a stick. Charging this with the acid, carry it up to every part of the mortified surface. It gives no uneasiness so long as it touches only the gangrened parts, except by the inspiration of the fumes of the acid. As the parts in which vitality remains are reached, the pain begins to be felt, and soon would become intense if the wash- ing with the acid were continued. At first it only dissolves away the mortified flesh as water dissolves the snow. When it comes to the living flesh in which the inflammation is at work, the new stimulant at once excites another though similar inflammation, and under this enlivening influence the old disease gives place to the new. The wound immediately puts on a healthy appearance; granulations and healthy pus are visible, the swelling subsides, and the general health in all respects immediately improves. In the case above deiailed, some exfoliated portions of the jaw-bone 362 DISEASES OF THE SANGUINOUS FUNCTION. were removed before the process of reparation could satisfactorily be- • gin. The deformity remaining after recovery was slight. Nitric-acid has also been employed with success in the same man- ner as Muriatic-acid. The symptoms are nearly the same in regard to gangrene of the mouth. They both act by exciting a new but similar inflammation to that already existing. This new inflammation, if car- ried far enough, would end in destructive mortification of all the parts to which it is applied. But, if we stop the application of them as soon as we have dissolved all the parts already dead, and when we have only touched and aroused with the new stimulant the part that is not yet dead, but which is rapidly progressing towards it, we only bring that portion of the structure sufficiently under the dominion of the new irritant to supersede the old one. It may be regarded as crude homoeo- pathy, and exceptions may be taken to the strength of the acids em- ployed. We do not say that dilutions of some other local stimulants would not answer in the worst cases: we know that the true homoeo- pathist has many other resources that we have not yet mentioned ; and with some of them he will generally succeed without resorting to the acids at all. But he will still claim that in the local application of Arnica, Nitrate of Silver, or even Cantharides, for the prompt cure of local inflammations similar to those they are severally capable of caus- ing, he is still within the jurisdiction of the Hahnemannian Law of Cure, of which a full exposition is given elsewhere. 5. PHOSPHOR-NECROSIS. The breathing of air containing the vapor of Phosphorus, causes va- rious forms of disease, as bronchitis, and even phthisis pulmonalis, caries of the maxillary bones, abortion, &c. Dr. Dupagnier found the air con- taining the agent to consist chiefly of Hypo-phosphoric-acid, with small quantities pf Phosphoretted Hydrogen, and some Phosphoric-acid, or Phosphorus in the form of vapor. The breath of the people who suffer from inhaling it becomes luminous in the dark. Diagnosis.—The first complaint is of a slight soreness or pain in one or more teeth in either jaw. This pain varies in intensity, and soon extends to the entire maxilla. The periosteum, and in a later period, the soft parts begin to swell and become painful on pressure; the gums and cheeks swell, become tender, and erysipelatous inflammation extends over the surface of half the affected jaw, progressing towards the ear and neck. With this local inflammatory condition the general system sympathizes; the latent causes of disease, which have hitherto remained dormant in the system are roused into activity, and scrofula tuberculosis, or some other psoric or dyscrasic affection assumes its preponderating influence over the blighted and disintegrating frame. PHOSPHOR-NECROSIS. 363 Causes.—The disease originates only from Phosphorus or Phospho- ric-acid gas taken into the system by inhalation. Though the opera- tives in the match factories are employed during the day in rooms ill ventilated, and the noxious gas is brought into contact with the body generally, with the mucous membrane of the air passages as well as the whole cutaneous surface, it is only through the mucous membrane of the mouth that the poison obtains access to the bony structure which is to become the principal seat of its ravages. Microscopic researches have shown that the pathogenetic effects of Phosphorus begin in the periosteum which covers the alveolor processes, except in those very common cases in which the recent extraction of a tooth, or a large cavity in a decayed one, furnishes to the destructive agent a more direct admission to the osseous tissue. Dr. Geist says that in all cases of phosphor-necrosis, he has found one or two carious teeth, which fur- nished the first point of localization in the jaw. It is certain, however, that although there be no carious teeth, and none have been extracted, the poison, when habitually breathed in a condensed form, may be ab- sorbed through the mucous membrane covering the alveolar processes in sufficient quantities to imitate the true periostosis, which never ceases till necrosis is established in the bone beneath. The degree of rapidity with which it,progresses may be influenced by the age of the patient, and the degree of concentration of the poisonous vapor. From the mo- ment that the periostosis begins, the nutrition of the bone is impaired, the periosteum is separated from the bone, and a morbid and offensive matter is formed between them. Pathology.—In every form of caries, says Rokitansky, the sanious bone, examined in the recent state, presents various appearances, according with the progress which the disease has made. In superficial caries, the compact bone is rough and corroded under a covering of sanies; its medullary canals are unequally dilated; the tissues con- tained in them are partly reduced to a mere friable mass, or flabby, warty excrescences, which readily bleed, are developed from them, which shoot outward in considereble quantity over the rough surface of the bone. The bone always appears porous or spongy, according to the contents of the medullary canals; in the first case discolored —in the second case rough in various ways. In cases of caries of the spongy texture, when the formation of granulations is luxuriant, the bone as- sumes a dark livid redness ; it becomes soft, and resembles a piece of flesh permeated by a fine, delicate, bony texture. It is said by Delpech, Be- rard Pono-et and Sanson, that a peculiar fatty matter is produced; though according to Monret, the gelatin has not disappeared from the bone. The carious bone, in the macerated, dry state, appears rough as if corroded, and acquires a spongy, porous, worm-eaten appearance by reason of the unequally dilated medullary canals, which in several 364 DISEASES OF THE SANGUTNOUS FUNCTION. places have formed into holes, and which perforate it. The cells of its spongy substance are dilated, and their parietes are attenuated and broken down like the grating of trellis-work. The researches of Vauquelin show that, in caries, the organic con- stituents of the bone are increased, whilst the carbonate of lime is slightly diminished, and the phosphate of lime reduced in a much larger proportion. In an osteophyte-like crust deposited around a carious tibia, the phosphate of lime was still more diminished. In France and Germany this disease' has been common for several years, and it attracted the attention of the profession about 1847. In the United States it has increased rapidly since about the same period. Treatment.—Surgical.—The following case sufficiently illustrates the treatment given to these cases in the hospitals.* A wax taper dipper had been working in this business seventeen years before disease and ulceration of his gums commenced. Thirteen months ago he had pain and swelling about the lower jaw, commencing in one of the right in- cisor teeth. An abscess formed and burst externally in the neighbor- hood of the tooth. Admitted to the Royal Free Hospital, Dec. 28,1859. "His face generally was much swollen, exhibiting the peculiar pasty appearance witnessed in necrosis of the jaw arising from the fumes of Phosphorus. Several fistula? were noticed at the lower margin of the jaw, communicating with the dead bone, and giving passage to the matter. On opening the mouth the lower jaw was seen exposed, denud- ed of the periosteum, and quite black and clear; it was also slightly moveable. Operation.—April 9th, 1859. Chloroform was administered to the extent of producing complete anaesthesia. The surgeon then proceeded to saw through the symphisis of the lower jaw, within the mouth, and by the aid of the forceps, the left half of the bone was drawn out entire, without its condyle, but with the ascending ramus. The same proceeding was then employed with the right half of the jaw, which came away with equal facility, but with the condyle, which appeared to be healthy. The haemorrhage was not great, and it spontaneously ceased. For three or four days after the operation there was some pain in the face, but this gradually diminished, and soon ceased entirely. The health now be- gan to improve under a liberal diet, and appetite and strength returned. The investing periosteum, from which the old bone had been carefully separated, soon began to throw out fresh osseous material and a new lower jaw was in process of formation. The pasty appearance of the face and puffiness of the cheeks, however, still remained, and are the most prominent consequences of the affection. The patient left the hospital in a short time completely restored in health, and able to arti- culate his words with tolerable distinctness. * London Lancet. Sept. 1859. p. 241. PHOSPHOR-NECROSIS. 365 On examining the bone, when cleaned and dried, it was found to be quite massive, and of nearly double the weight of the healthy bone. It was covered in some places with unhealthy lymph, which was under- going osseous transformation. The reproduction of bone by the natural action of the periosteum which has been left behind when the bone was removed was practically demonstrated many years ago by Professor Dudley of Transylvania University, Ky. He found that the periosteum, when carefully sepa- rated from the old bone beneath, and preserved in a healthy state, pro- ceeded at once to the act of depositing the osseous material in regular layers, thus forming a new bone to take the place of the old one. This practice has now become common, and in a considerable degree success- ful. The periosteum throws out new layers of bone, which by invest- ing the old bone, give strength if not symmetry to the mutilated mem- ber. In these cases the old bone is seen within the new formation. A jaw bone thus reconstructed by nature, in following out the intentions of art, is generally somewhat larger and more irregular in shape than that which has been removed.* Homoeopathic Treatment.—The successful treatment by homoeo- pathic remedies of some cases of caries of the maxillary bones arising from different causes has shown that our remedies when correctly em- ployed have a power over this fearful disease to an extent not yet fully appreciated. We have collected in the United States Journal of Ho- moeopathy some cases which illustrate the proper treatment. In the case of a scrofulous girl, aged nine years, in whom caries of the upper maxilla following typhoid fever was progressing, and there was pain in the bones and teeth, Aurum-muriaticum was prescribed Feb. 12. On the 18th the pain had subsided after the extraction of a large por- tion of the carious jaw bone. It was removed without pain, having spontaneously separated from the healthy portion of the bone. Muri- atic-acid wTas afterwards used ; then Angustura for deafness and ri- gidity of the masseter muscle. Silicea 3° wTas employed from March 11, to April 10, after which no medicine was needed. In a case reported by Dr. Perkins (American Homoeopathic Review, N. Y. Central Homoeopathic Dispensary) a man had necrosis of the jaw for four months. Dr. Mott had advised excision of the jaw; the side of the face was much swollen, and a discharge continued from an open abscess communicating with the diseased bone. Dec. 11th he took Phosphorus 30° in solution. On the 15th he was much better; discharge and swelling less. Repeat Phos. 30°. He continued improving, took no medicine. Jan. 30, swelling almost gone; orifice healing up; gene- ral health excellent. Feb. 15, no signs of disease. This subject is continued at length in U. States Journal of Horn., Vol. 2. p. 303 to 314. " Phosphor Xecrosis." 366 DISEASES OF THE SANGULNOUS FUNCTION. A case by Dr. Lilienthal, Northern Homoeopathic Dispensary, N. Y. A young man, aged 18. Chronic periostosis of the bones of the nose caused by working a year and a half in a match factory. He commen- ced March 15th to take in alternation Aurum and Calcarea-carb. March 22, he was better. A dilution of Nitric-acid was applied locally. The medicine was continued till April 25, when he was considered well. Several months afterwards he continued so. See Vol. L, p. 247. Ozcena.—This name is applied to any inflammatory ulceration of the Schneiderian membrane attended with a foetid discharge. The principal remedies are: Aurum, Merc, Phos., Alum., Asar., Calc, Cic, Con., Lach., Puis., Sulph. For syphilitic ozoena: Merc. If this has been too much used : Aur., Hepar, Nitric-ac, Sulph., Thuja. Aurum.—Dr. Harper, in a recent work,* gives the following: A dwarf, aged sixteen years, Avith large head, joints tumid, long bones curved, whose family was scrofulous, the father having died of phthisis, had ozoena of four years' standing. The offensive matter runs over the upper lip, is sometimes greenish or yellow, and is so acrid that it ex- coriates the skin. The smell is so offensive that no body can go near her; and she uses twenty handkerchiefs per week. The mucous mem- brane of the nose is red and inflamed, and she perspires profusely every night from the middle of the body downwards. Aurum, twice a day, is prescribed. June 23, she improved considerably in three weeks. A month later the dose to be taken only once a day. August 9th, Merc-sol. 3°, had been tried without improvement, Aurum 3° resumed. Up to Nov. 8, she gradually improved. There was still rather a large discharge of mucus from the nose, and the girl used four or five hand- kerchiefs in fourteen days, instead of fifty, as formerly. But there is now no purulent discharge, no smell perceptible, unless after taking cold. The general health is excellent. See Vol. I., p. 734. GENUS XIII.—BLENNORRHCEA.—GONORRHOEA. INFECTIOUS URETHRITIS.—INFLAMMATION OF THE URETHRA. The term gonorrhoea, derived from two Greek words, yovv, semen and pew, to flow, is very generally used by American and English phy- sicians to designate this malady. Dr. Swediaur, perceiving the errone- ous impression which this definition might convey, substituted another term no less etymologically inaccurate, blennorrhea, or blennorrhagia, derived from two other Greek words, BXevvu, mucus, and pea), to flow. But modern researches having demonstrated that the involuntary dis- charge which is characteristic of the disease, does not consist of semen or mucus, but of a purulent and infectious matter, we think the errone- * " Homoeopathy tested by Facts," Edinburgh, 1858. GONORRHOEA. 367 ous terms commonly employed to designate the complaint should be abolished. Many reasons may be adduced against naming the affection from the supposed character of the discharge; for notwithstanding, as a general rule it is decidedly purulent, cases occasionally occur where, from the intensity of the inflammation, there is no discharge at all, and constituting that form of the disease denominated by French writers " blennorrhagie seche." The matter is likewise sometimes composed of a mixture of pus, mucus, semen and blood. For these reasons we prefer to make use of the more general term urethritis. Inflammation of the urethra may indeed arise from other causes than the application of the specific gonorrhoeal infection, and present all of the symptoms peculiar to the venereal inflammation; but the malady is none the less urethritis on this account, although the secretion accompanying the in- flammation is not infectious ; so may an inflammation of the eye owe its origin to the application of venereal matter, external irritants, at- mospheric changes, injuries, scrofula, and abuse of stimulants, and yet, notwithstanding these different causes, the disease is none the less ophthalmia. All secreting surfaces are liable to be irritated when operated on by certain unnatural stimuli. The mucous membrane of the throat, the bronchia, the lungs, the nostrils, the frontal sinuses, and the conjunctiva of the eye, are all subject to different grades and kinds of inflammation, and their secretions to become changed in quality and quantity, according to the morbid cause which has been in operation. The lining membrane of the urethra is also subject to the same laws; it may become inflamed and pour out a purulent discharge from the presence of calculi in the bladder, from gout and rheumatism, from acrid urine, from the absorption of certain diuretics, from ulcers, from mechanical injuries, and finally from the application of infectious matter from a venereal subject. In a very large majority of cases urethritis may arise from the cause last mentioned. This morbid virus induces a specific inflammation in the urethra of so troublesome and inveterate a character as often to baffle all the remedial measures of the most skillful and experienced men. The inflammation is supposed by some to be of the erysipelatous kind, and generally attacks the lacunae of the urethra. All who have had much experience in this disease, will agree with us that it is one of the most intractable with which we have to deal: " Mackintosh assures us that he has been more annoyed and disgusted in conducting the treatment of gonorrhoea than of any other affection." Of the primary source of infectious urethritis we are at present ignorant, but the doctrine entertained by the ancients, and so strenu- ously advocated by John Hunter and his contemporaries, in regard to the identity of the gonorrhoeal and syphilitic virus, is now universally abandoned. The disease under consideration is one of a purely local character and if left to itsolf, under favorable circumstances, will ulti- 368 DISEASES OF THE SANGUINOUS FUNCTION. mately terminate in spontaneous recovery. It is a matter of doubt whether ulcers of the urethra ever proceed from this inflammation, when entirely uncomplicated, but it is probable that the few cases which have been reported by Sir Astley Cooper and others, in which the malady was connected with ulcerations, were attributable to. the application of the virus of both affections. We have in several instances, inoculated individuals with matter of infectious urethritis, but have never been able to produce a chancre or any well-marked constitutional symptoms. We have, in one instance, also witnessed the introduction of the gonorrhoeal virus into the blood, but without giving rise to any appreciable effects. While on the other hand, it is well-known, that if syphilitic virus be inoculated or intro- duced directly into the mass of the blood, the symptoms of syphilis speedily result. The application of gonorrhoeal matter to the eye, gives rise to a very violent and dangerous purulent ophthalmia; while the application of syphilitic virus to this organ, causes an ulcer, generally circumscribed, and unaccompanied by violent or dangerous inflammation of the surrounding parts. The application of the former to the anus causes inflammation with augmented secretion, and change in its character from mucus to pus; the application of the syphilitic poison, causes chancre and its concomitants. The susceptibility to the gonorrhoeal virus varies greatly in different persons, according to the difference in the degree of natural sensitiveness in the mucous membrane lining the urethra. There is also an acquired insusceptibility to gonorrhoea. Repeated attacks render the membrane less susceptible; and the first attack is generally the most severe. The blennorrhcea is often suspended during attacks of acute disease, but it invariably reappears again after the subsidence of the febrile symptoms. From these facts it may be fairly inferred, that gonorrhoeal matter contains a specific morbid principle, capable of producing a peculiar inflammation and discharge, when brought in contact with mucous sur- faces. This inflammation and discharge presents a uniform appearance quite unlike what occurs in leucorrhoea, in several particulars. The matter of the former is infectious, wThile that of the latter is non- infectious; the inflammation of the former is of the 'erysipelatous kind, while the condition of the mucous membrane in the latter is more allied to relaxation and debility than to inflammation; the former can only arise from the contact of gonorrhoeal matter with a mucous sur- face, while the latter never proceeds from any cause of this kind, but from constitutional weakness, confinements, venereal excesses, want of exercise, and other debilitating habits. We may also infer, from what has been observed, that the syphilitic matter likewise contains a specific morbid virus, sui generis, and only GONORRHOEA. 369 capable of exciting chancre, when applied to abraded or delicate sur- faces. It should always be remembered, that every morbid substance capable of impressing the organism, contains a certain specific morbid principle, which usually operates in a definite manner, causing a uni- form train of symptoms, and requiring a certain specific medicinal agent to affect a prompt cure. These morbid principles only exist in infinitesimal quantities in their media, and on this account we are un- able to detect or analyze them, but we ought none the less to acknow- ledge their presence, appreciate their influence, and endeavor, if possi- ble, to discover their specific antidotes. The whole course of a case of gonorrhoea, inflammation of, and discharge from the urethra, may be divided into four stages: First Stage.—Lasting from one to two days.—Symptoms: a slight tickling or tingling, at the orifice of the urethra, and the flow of a small quantity of thin, transparent mucus, or milk-like discharge. Second Stage.—Inflammatory.—The meatus of the urethra becomes red and swollen; the discharge becomes copious, thick and milky, yellow, or greenish; the act of micturition is attended with pain and scalding, whilst erections and chordee torment the patient at night. During this stage the most distressing complications occur, such as irritation of the bladder, inflammation of the testicle, and of the prostate gland. Third Stage.—Sub-acute Inflammation.—The foregoing symptoms subside. There is slight irritation in urinating and the discharge of yellow matter continues. This stage is protracted and is liable to terminate in the Fourth Stage.—Gleet.—There is usually little pain or irritation, but there is occasional emission of a transparent or milky secretion. The discharge at this stage is supposed to lose its infectious property; but the exact period at which this change in its character takes place can not be known. Diagnosis. — The ordinary period at which infectious urethritis makes its appearance after infection is from two to four days. We have known it to commence in a few instances, in eight or ten hours after exposure, and we have likewise occasionally observed an interval of six weeks to elapse before its onset. Some constitutions possess the power of resisting the action of the poison to such a degree as to constitute an almost entire exemption from the disease; others again are so highly susceptible, either from natural organization, or from abuse of stimulants, that the slightest touch of the contaminating poison speedily communicates the inflammation. The disease commences by a tingling or itching sensation at the orifice of the urethra, which is noticed especially when urinating. In a Vol. ii.—24. 370 DISEASES OF THE SANGUrNOUS FUNCTION. short time, the lips of the urethra become red and swollen; the blood- vessels of the organ are distended; the inflammation increases and extends up the passage for an inch or two; there is a burning or scalding pain on passing water; an increased secretion takes place from the part affected, at first of a mucous character, but as the inflam- mation increases presenting a purulent appearance, of a yellow color, or if the disease is violent, green and sanious. The urine, which often contains some thread-like substances, arising from the inflammatory action, flows from the urethra in a diminished, spiral or divided stream. In a first attack the inflammation does not usually confine itself to the extremity of the urethra, but extends along the canal to the pro- state gland, and even to the bladder itself. Not unfrequently it attacks the glans penis and the fraenum, in which case it often occasions an effusion between the prepuce and the glans, and phymosis. When the inflammation is intense, and extends up as far as the neck of the bladder, there is a frequent and urgent desire to urinate, the ardor urince becomes more extensive and painful, involuntary and painful erections occur, chiefly during the night, and sometimes cause distressing emissions of semen; sympathetic irritation is communicated to the perineum, occasioning painful sensations when evacuating the bowels, or the bladder ; there is more or less inflammation and effusion of lymph into the corpora spongiosa, giving rise to those adhesions and painful contractions termed chordee; the glands of the groin become irritated and enlarged, and there is a partial or even total suppression of the discharge, in which latter case the disease is termed dry urethritis, or "blenorrhagie seche." In old subjects who have often been infected the inflammation is quite prone to attack the prostate gland, and give rise to those un- pleasant symptoms enumerated when alluding to affections of this structure. If the disease be left to itself, and the patient is strictly prudent and temperate, a spontaneous recovery will eventually take place; but from improper medical treatment, undue exposure, or excesses of different kinds, the disease often terminates in gleet, strictures, ab- scesses, diseased prostate, irritable bladder, hernia humeralis, inflam- mation of the testicle and epididymis, or bubo. The acute stage of urethritis, under ordinary circumstances, ter- minates in from one to three weeks, when, if suitable remedies have been employed, the discharge ceases, and the parts speedily recover their tone ; but in the majority of instances, the acute stage runs into a chronic inflammation, when it receives the name of gleet. Fourth Stage.— Gleet,—After the inflammatory symptoms of go- norrhoea have subsided, there is a continuance of a fluid discharge, va- rying in color and consistency, hTsome cases mucous in others puru- GONORRHOEA. 371 lent. The quantity is generally small, often not more than a few drops in the course of twenty-four hours ; whilst at times it ceases entirely for days together, returning without assignable cause or in consequence of some excitement in the way of diet or exercise. Though most commonly the result of an acute attack of gonorrhoea, mild cases of that disease, also, not unfrequently run on and assume the true character of gleet. In this stage of disorder, the painful symptoms peculiar to the first period, ardor-urince, frequent inclination to urinate, chordee, spasmo- dic pains in the region of the perineum, and the heat and swelling of the penis subside, and we observe little else than an increase and al- teration in the character of a secretion from the urethra. This dis- charge, which during the acute symptoms was purulent, and of a yellow or greenish color, now presents a light mucous appearance, sometimes transparent and ropy. The character of this discharge, however, is often temporarily changed again to a purulent matter of a yellow or even green color, sometimes sanious, from over-exercise, excesses in drinking or eating, sexual intercourse, and exposure to protracted heat or cold. The discharge of a simple gleet usually proceeds from the lacunae of the urethra. Some writers have promulgated the dangerous doctrine that the matter of gleet is not infectious; but this is an error, for we have known many well authenticated instances where virulent urethri- tis has arisen from the application of gleety matter. When a gleet has been permitted to continue for a long time, and particularly if the case has been injudiciously treated by inordinate do- ses of Copaibae, Cubebs, Turpentine, and the endless train of irritating injections, there often supervenes a Stricture of the Urethra.—This consists in a chronic thickening cf the lining membrane of the urethra, amounting in some cases to stricture; in others the mere irregularity of the canal, is a common source of gleet. When, after a fair trial of other means the discharge continues, the passage should be explored with a bougie. Wrhether the stricture be only partially or perfectly formed it may soon be dispersed by the use of the bougie introduced every three or four days, and per- mitted to remain a quarter of an hour or more each time. The slight irri- tation thus induced is sufficient to cure. Too frequent introduction of the bougie excites too much inflammation, which is a medicinal aggravation. A stricture may occur during the height of acute urethritis, from tu- mefaction of the mucous membrane of the canal, or from the irritation caused by improper or unskillful introduction of bougies, and by strong injections. The obstruction in some cases of this description is so com- plete, that very painful retentions of urine, with the accompanying symp- toms supervene, requiring the most prompt remedial measures in order to ward off the necessity of puncturing the bladder. 372 DISEASES of the sangulnous function. This variety of stricture may be removed in a short time by proper medicines, without the aid of a surgeon. There is a second variety of stricture not necessarily connected with infectious urethritis, termed spasmodic stricture. The disease consists in a sudden spasmodic contraction of some portion of the urinary canal, which impedes the flow, and sometimes causes a partial retention. These spasmodic contractions may arise from mechanical injuries, diseased prostate, or stimulating diuretics, but they are for the most part connected with permanent stricture. The third variety of stricture, which is by far the most common and serious, is termed the permanent stricture. Its approach is so gra- dual and imperceptible, that individuals rarely suspect any thing of the kind until it has made considerable progress. The disease arises from a gradual thickening of the mucous membrane of the urethra, from badly-treated or long-continued inflammation. The first symptoms observable in this stricture are : a sensation after urinating as if a few drops remained behind, stream diminished in size, and issuing from the urethra in a spiral form or split in several parts; straining to pass wTater more rapidly through the obstructed canal; aggravation of all the symptoms on wetting the feet, taking cold, over-exercise, fatigue and venereal excesses. In this stricture there is always more or less discharge of a ropy kind of mucus, which is often temporarily changed by excesses, into a purulent or bloody matter. This complaint is quite apt to induce inguinal hernia, from the straining efforts employed in urinating. It is probable that two-thirds of the cases treated as simple gleets and which so frequently baffle the physician are in reality dependent, solely on this kind of stricture. In bad cases of permanent stricture, the urine is passed drop by drop, the distention and pain in the region of the bladder become very severe, much constitutional irritation occurs, and the patient is unable to rest day or night. Whenever this state of things obtains, immediate recourse should be had to bougies. The removal of a permanent stricture can only be accomplished by means of the knife, or the application of caustic, or by gradual dilation by means of bougies. The cure by the latter means is, at the present time almost universally recommended. We have found a bougie made of the dry bark of the ulmus fulva or slippery elm to possess many advantages. By holding it in warm water the surface becomes muci- laginous ; it then passes with great facility; and by permitting it to remain but a few minutes, it expands and dilates the stricture. Almost all strictures are located far up the canal of the urethra, behind its bulb, but they may occur near the extremity of the penis or three, four, or five inches above this point. An occasional consequence of stricture is disease of the prostate gland. GONORRHOEA. 373 DISEASED PROSTATE May also be ranked amongst the occasional consequences of repeated attacks of urethritis. During the continuance of the latter affection, in an acute and obstinate case, not only the urethra, but the prostate, the bladder, and the testicles receive an unusual supply of blood, in consequence of which they become irritated, and often enlarged, from depositions of coagulable lymph. This condition of things may exist without attracting much attention until the individual is advanced in -years, when a scirrhous degeneration, or an abscess, is exceedingly apt to result. Either lobe of the prostate may become enlarged separately, or the whole three may be involved; but the most troublesome symp- toms arise from an enlargement of the middle lobe, on account of its proximity to the orifice of the urinary canal. This painful and trouble- some affection usually occurs in acute and obstinate gonorrhoeas in scrofulous and irritable constitutions. The inflammation beginning at the orifice of the urethra extends upwards towards the bladder, in- volving the prostate in its course. Symptoms.—Heavy, pressive aching in the perinaeum extending often to the rectum, causing a degree of tenesmus. The patient can neither sit nor bear pressure over the prostate, which swells and may be felt internally. There is irritation of the bladder; partial or com- plete obstruction of the flow of urine, which is often mixed with blood. The gonorrhoeal discharge generally diminished or suppressed. Sir Astley Cooper was of opinion, that enlargement of this gland is attributable to advanced age, rather than disease; but from the fact, that persons who have been afflicted in this manner have almost in- variably been subject to repeated venereal attacks in early life, we may fairly infer, that a predisposition is always established in the structure, which renders it liable to take on diseased action when the powers of the organism have become impaired by age. Enlargement of the lateral lobes of the prostate may be readily de- tected by introducing the finger into the rectum. The middle lobe may always be felt by the catheter when much enlarged, and it will generally be found exceedingly difficult to pass it by the gland into the bladder. By directing the point of the instrument, (which should be of the medium size), slightly upwards, and depressing the handle at the proper time, the object may usually be accomplished. But of all others, these cases require great delicacy of touch and practical tact to enable the operator to succeed facilely, and without doing injury to the irritated parts. Diseases of the prostate are quite liable to become aggravated by over-exertion, riding, acrid urine, exposure to wet and cold, and stimu- lating drinks. 3<4 DISEASES OF THE SANGUINOUS FUNCTION. Another exceedingly unpleasant consequence of neglected or badly treated urethritis, is the disease termed sympathetic bubo. Sympathetic Bubo.—These buboes are called sympathetic, in con- tradistinction to those which proceed from syphilitic infection. The frequent occurrence of such tumors during the course of urethritis, probably first led medical men to confound this disease with syphilis. But on close examination, the sympathetic bubo will be found to be composed of several enlarged glands, while that of syphilis is an en- largement of a single gland. The sympathetic bubo is not usually attended with great pain, nor does it run on to suppuration, unless the patient is decidedly scrofu- lous ; while the syphilitic bubo is attended with much inflammation and pain, and is very prone to advance to the suppurative stage. A very large majority of sympathetic buboes subside spontaneously, and re- quire no medicinal treatment. In femcdes, all of the symptoms of the disease are lighter than in the male sex. Indeed, the similarity between this affection and leucorr- hoea is so great, that it sometimes is a matter of great difficulty to dis- tinguish between them. Mr. Travers asserts that the urethra itself is rarely affected in fe- males, but that the inflammation attacks the clitoris, the inferior com- missure of the labia and rapha, the nymphae, and the parts (Cowper's glands,) around the orifice of the urethra. (See p. 307, 309, Vol. II.) In the worst form of the complaint, as it occurs in women, the labia the nymphae, and the clitoris become swollen and painful, the inflam- mation extends to the uterus and bladder, and there will be frequent inclination to urinate, severe scalding by the water, and a purulent ir- ritating discharge. But all of these symptoms are often met with in inflammatory leucorrhoea, and the discharge itself even acquires so acrid a character as to become capable of propagating a similar disease by contact. In many instances such results have led to unfounded suspicions. The following are the surest diagnostic marks with which we are acquainted between the two diseases : Leucorrhoea is gradual in its progress, and may be generally traced to constitutional debility, or to difficult and protracted labors, or mechanical injuries, especially from the use of obstetrical instruments. It is usually accompanied also by prolapsus uteri, or dragging pain, or tired feeling in the left side, bear- ing-down pains, and general feelings of relaxation and debility. Gonorrhoeal inflammation is sudden and rapid in its approach, and attacks individuals in the soundest health : the symptoms acquire their greatest severity in one or two weeks, and the discharge causes a deep-colored (yellow or greenish) stain upon the linen, surrounded by a palish color. GONORRHOEA. 375 A careful attention to the history of each individual case, will aid us materially in forming a correct diagnosis. Pathology.—In some cases the discharge issues from the lacuna magna, situated a short distance up the urethra. In that case a drop of the discharge may at most times be pressed out of the urethra with little effort. In other cases it proceeds from chronic relaxation of the membrane higher up the passage towards the bladder, or from the prostate gland, or more commonly still from a stricture. The explo- ration with a bougie reveals the existence of stricture; if none be found on trying it, and if ordinary injections fail to arrest the dis- charge, we may infer that the disease has its origin in some irritation or relaxation of the deeper-seated portions of the urethra. Prognosis.—The duration of an attack of gonorrhoea cannot be estimated with any degree of accuracy. One case will get well in a few days, whilst another assumes the most aggravated character, de- veloping many complications, and hangs about for months. A scrofu- lous constitution, and an irritable nervous temperament are more likely to belong to those cases which take on the more serious aspects ; in some of these treatment has to be protracted " to an almost indefinite period." Treatment.—Infectious urethritis is at the present time almost universally regarded as a local disease,—confined in its first stages to a small portion of the mucous membrane of the urethra. It is true that the inflammation often extends up the urinary canal to the pros- tate gland, and to the bladder; but it is highly probable that these secondary symptoms are owing to bad treatment, or imprudence on the part of patients, rather than to the natural and legitimate tendency of the malady. We adopt this opinion from having often observed spon- taneous cures occur in six or eight weeks without medicine of any kind, and without any structure but the urethra becoming affected,— the patients having simply placed themselves under a rigid dietetic regimen. For therapeutical purposes the course of the disease may be subdi- vided as follows : First. The preventive period, or that which inter- venes between exposure and the first symptoms of the malady. The average duration of this period is about three days. Second. The forming stage, or the period which elapses from the commencement of the prickling, tingling or itching sensation, with slight redness and swelling of the orifice of the urethra, and a slight oozing of mucous or limpid matter, up to the period when the inflam- mation has extended to the fossa navicularis, and become strongly pronounced, with a purulent discharge of a yellow or greenish color. This stage usually lasts from twelve to forty-eight hours. Third. The acute or inflammatory stage, including the period which 376 DISEASES OF THE SANGUINOrS FUNCTION. commences at the termination of the last stage, and the subsidence of the ardor urince, the acute inflammation of the urethra, the swelling and tenderness of the penis, and the change of the yellow or greenish secretion, to one of a light, transparent and ropy, or a muco-purulent character. The natural duration of this stage, when proper restrictions are used as to diet, stimulants, and exercise, is from one to two weeks. Fourth. The chronic stage, or that form of the malady termed gleet. Now as our object, in accordance with the homoeopathic doctrine of cure, is to produce in the tissue morbidly affected, a new and healthy medicinal action, which shall supersede the morbid inflammation, we apply our remedies directly to the diseased part, instead of bringing them in contact with it through the stomach, blood, and kidneys. The malady is not constitutional,—there is no other structure of the econo- my affected, or upon which we wish to act,—but our sole object is to prevent or to remove a simple local inflammation. Our remedies then, during the first or preventive period, are the occasional injections into the urethra, of nitrate of silver (in the pro- portion of two or three grains to the ounce of distilled,) or of sulphate of zinc, in the proportion of four grains to the ounce of water. The occasional use of these injections after an exposure, with strict tem- perance and quiet, will usually prevent the occurrence of the disease. These remedies neutralize the absorbed virus before it has time to im- pair the function of the membrane with which it is in contact, and thus its power to do injury is summarily destroyed. Ddet.—During the acute stage the diet should be light and unstimu- lating; all stimulating drinks and active exercise should be avoided. There is also a certain and speedy cure for the second ox forming stage. The symptoms of this stage, as we have seen, are a tingling or itching at the end of the urethra, with a slight redness, and a slightly increased secretion of mucus. The remedy for this stage is a satu- rated solution of nitrate of silver, a small quantity of which is to be applied, by means of a small syringe, or by a small bit of sponge to the urethra for an inch in extent. The solution should be delicately and rapidly applied, and a quantity used just sufficient to give the portion of the membrane touched, a white cast. This causes a smart but healthy medicinal inflammation which subsides in about twenty- four hours, leaving the structure cured. This course is strictly ho- moeopathic, for we impress directly the tissue affected, produce a power- ful medicinal aggravation of the symptoms, and overwhelm the dis- ease by substituting temporarily, another inflammatory action. No un- pleasant consequences ever result from the use of this remedy, when it is employed before the commencement of the third or acute stage. Our experience with this solution has been extensive, and we therefore GONORRHOEA. 377 confidently recommend it as a perfectly safe and sure remedy in this stage of the complaint. During the third or acute stage^ it is a question whether any reme- dies, either general or topical, can be employed with any material ad- vantage, with the exception of the internal use of Aconite, which may be given to shorten the inflammatory stage. This medicine is particu- larly applicable when febrile symptoms are present. Throughout this stage, the patient should be restricted to the most rigid vegetable or farinaceous diet, to cold water, and prohibited from taking much exer- cise. Ablutions with cold water, should be often employed, in order to keep the parts as free as possible from the irritating discharge. After the urgent symptoms have subsided under the use of Aconite and the other means we have just pointed out, and the fourth or chronic stage has commenced, we may resort to injections composed of one grain of Sulphate of Zinc to s vii. of water. These injections, in order to be efficient, must be repeated every half hour during the day, until the discharge ceases. It will be of no service to use this solution three or four times in the day, for the chief object is to wash out the urethra as fast as the matter forms, and thus prevent the constant reabsorption which which would otherwise take place. The principal reason why urethritis is so difficult to cure, when once fully established, is, that the matter itself being infectious, and liable to be constantly reabsorbed, thus operates as a continual exciting cause. If at any given instant, the whole urethra could be restored to perfect health, a single drop of the morbid secretion which it had been pouring out, applied to the part, would be sufficient to re-excite the dis- ease in all its violence. It is evident, then, that the discharge must be arrested abruptly by the remedy employed, or we must use our in- jections sufficiently often to dilute and remove the virus as fast as formed, and at the same time to change the morbid action of the membrane to a healthy medicinal action. In regard to the plan of making an application to the urethra, of a medicine so powerful as to arrest the discharge suddenly, like the solution mentioned under our second head, it is attended in this stage of the affection with many dangers. The canal of the urethra is gene- rally affected so high up as to render the certain application of this or any other sufficiently powerful solution entirely impracticable. But the other method to which we have alluded is one of entire feasibility and safety, and is for the most part attended with success, when the discharge is entirely unconnected with a stricture. It is proper to observe that in all cases the patient should urinate previous to the use of the injections. Another injection which we have some- times used with marked success in this stage, is a mixture of Calomel 378 DISEASES OF THE SANGUINOUS FUNCTION. and Olive-oil, in the proportion of a drachm to the ounce, once or twice a day until the cessation of the diseased action. If however, notwithstanding the thorough and persevering employ- ment of the zinc-solution and the mixture of calomel and oil, the dis- charge still continues, recourse should be had to the introduction of bougies, either plain or smeared with a cerate containing a sufficient quantity of pulverized A'it rate of Silver. These should be carefully in- troduced two or three times a week, until they have stimulated the diseased membrane to a natural and healthy action. The following local remedies are effectual when judiciously em- ployed :— Ilydrastis-canadensis.—An infusion may be made of indefinite strength, as of an ounce of the root to a pint of water. It may be thrown into the urethra through a syringe, and retained for two or three minutes. It may be tried every night at first, and afterwards oftener if the effect is satisfactory. Liquor-plumbi-diacetas.—May be used in the same manner. Slightly cold, or tepid water alone, used as an injection, is safe at any stage, and almost always hastens recovery. The above plan of treatment we believe to be more efficient, safe, and consonant with the true principles of cure than any other which has yet been promulgated ; yet we do not claim for it infallibility. We can only assure our readers that we have thoroughly tested every theory and process which has been proposed by either school, and that after all of this practical experience, we have presented them with what we deem the best method of treatment in this disgusting malady. Dr. Blake, of California, has arrived at the following conclusions:— 1. Gonorrhoea is a purely local disease, with nothing specific about it. 2. That the principal cause of the difficulty experienced in curing it is in the contact of the urine with the inflamed surface of the urethra. 3. By always washing out the urethra after urinating we remove the cause that keeps up the inflammation, which can then be subdued by purely local means, in two or three days. 4. That there are different forms of gonorrhoea, as there are of oph- thalmia. It is proposed to wash out the urethra with injections of cold water each time after urinating. For the cure of disease, washes of sulphate of zinc; for the more severe cases, the chloride of zinc; in the most severe, of nitrate of silver. Chloride of zinc two to three grains to the ounce of water, diluting it if it cause much pain. (Pacific Med, and Surg. Journal, Feb. 1862.) Internal Remedies.— Cantharis, Cannabis, Mercurius, Tussila- go, Nux-vomica, Cubebs, Pidsatilla, Cpaibce, Sulphur, and Ferrum. GONORRHOEA. 379 The selection will generally be made by constitutional rather than by local indications. There is generally a depressed state of general health, for which Nux-vomica and Sulphur are important remedies. Cinnabaris is one of the best forms of mercury. Pulsatilla in chronic affections of the urinary organs, in phlegma- tic and scrofulous constitutions. Aconite.—In the early stages of the disease, when the inflamma- tory symptoms are rapidly developed and run high, when the scalding is severe, the discharge copious ; erections at night frequent and pain- ful, and general symptoms febrile ; Aconite in drop doses, of second or third dilution, perhaps in alternation with another appropriate remedy. Mercurius-corrosivus.—In the early stage may be alternated with Aconite ; in two or three drop doses of second or third dilution (deci- mal.) These two remedies seldom fail to subdue the more violent symp- toms. The Corrosive is apparently the most efficacious of the mercu- rials. The Merc-sol. seems less efficient. Cantharis.—In acute cases in which the membrane of a large por- tion of the urinary tract is implicated; the irritation extends from the orifice of the urethra to the bladder; scalding and burning along the passage; frequent and painful urging to urinate. It may be alter- nated with Aconite. A drop dose of the third dilution every six hours is often effectual. Cannabis-sativa.—When the more active inflammatory symptoms have been mitigated by Aconite, Merc.-corros., or Cantharis, and there still exist considerable irritation and burning in micturition, swelling and redness of the orifice of the urethra, copious white or yellow dis- charge. It seems to hold about the same place in homoeopathy that Copaiba does in the old school; but it is free from any of the incon- veniences of that remedy. Dr. Yeldham says, "to do any good it must be given in palpable doses. I am in the habit of prescribing from five to ten, or even fifteen drops of the mother tincture three or four times a day^ In my own practice the dilutions have proved nearly or quite inert." Balsam of Copaiba.—All the standard authors testify to the merits of this remedy in blennorrhagia as well as in vesical catarrh, nephritis, ulceration of the kidneys, bladder and prostate, orchitis, cephalalgia, &c. These same men say, the remedy must be "used with prudence," for it is capable of causing swelling of the testicle, obstinate cephalal- gia and weight of the head. It has also caused as well as cured haemorrhoids ; sharp pain in the urethra, inflammation in all the urinary passages, retention of urine, phlegmasia of the bladder. Copaiba is a powerful homoeopathic remedy in gonorrhoea, but it acts chiefly as a local agent; and thus, like Cannabis, it requires to be given in palpable doses, which its objectionable taste and smell, and 380 DISEASES OF THE SANGUTNOUS FUNCTION. its effects on the stomach render difficult to the patient. The best mode of giving it is in capsules, which conceal its taste. Dr. 1 eldham says, he failed entirely with it in attenuations. That its action is only local was considered to be proved by the experiment of Ricord. This celebrated author says : " In one case there was urethral fistula at two and a half inches from the meatus," blennorrhagia occurred in the vesical portion of the urethra, but it spread itself forwards to the balanic region. The use of Copaiba caused the disappearance of the discharge in that portion of the urethra situated behind the fistula, viz., that which was under the influence of the urine. But the discharge from the portion anterior to the fistula, viz., that portion of the canal which did not come into contact with the urine persisted. Injections caused its disappearance." In another case of fistula of the urethra the result of Copaiba was the same. Wtum taken in palpable doses and the urine was allowed to escape through the fistula at the middle of the urethra, the Copaiba coming in contact locally with the inflamed sur- face cured it; while the part of the urethra in front of the fistula, through which the urine with the Copaiba did not pass continued diseased as before. Afterwards when the urine was made to pass all through the canal the Copaiba diluted in it cured that portion also. These experiments show that Copaiba is a homoeopathic specific for urethritis when applied directly to the inflamed surface. Whether it has any dynamic power over the same disease in attenuations remains to be seen. Cubebs.—Dr. L. De Parseval, (Bulletin de la Societe Medicale, 1860), gives the following symptoms : Specific action on the genito- urinary apparatus producing inflammation or phlogosis of the urethra, bladder, testicles; ardent fever; ardor urinae, redness of the face ; re- tention of urine, cutaneous eruptions ; allopathic authors also say, the Cubebs produced all of these symptoms and " despite this the cure of the gonorrhoea has taken place." M.M. Trousseau and Pidoux say, Cubebs have become popular in the treatment of this disease, " which rationally, this agent must greatly exaggerate." The facts of experi- ence show, " that Cubeba acts more beneficially the sooner its employ- ment is instituted after the beginning of the blennorrhagia." Thuja.—Corresponds generally with Cannabis, and may be employed in the same class of cases and in the same stages; particularly indi- cated when there are warty growths on the corona glandis, prepuce or about the anus. The above are generally the most useful remedies. Capsicum.—When the burning along the urethral canal is intense. Nux-vomica,—when the digestive functions are disturbed, and when the irritation extends to the rectum, causing frequent and dis- tressing urgings to stool, with protruding haemorrhoids. Turpentine.—It excites inflammation of the urinary organs. M.M. GONORRHOEA. 881 Merat and Leus say, the terebinthinates irritate the mucous membranes and the organs covered by them rendering their functions painful. Continued for some time they produce painful and bloody micturition. Dr. Despres who took a large quantity in the course of fifteen days died from inflammation of the urinary organs. Turpentine produces spasm of the bladder, strangury, bloody urine, violent pain in the re- gion of this organ. It also causes pain and heat in the lumbar and hypogastric regions, especially the kidneys, (Trousseau and Pidoux,) acute cystitis, vesical tenesmus, urethral pain, ardor urinae, dysuria, smarting sensation increasing to urethritis, scanty, red, bloody urine, painful erections as in gonorrhoea, with chordee. In all of these affec- tions it has long been employed with success, also in pdrulent and foetid gonorrhoea. Barbier, Trousseau, Pidoux, &c, all expected from their doses of turpentine some aggravation, but the good results were afterwards seen. They call its mode of curative action " a substitutive irritation. In proper attenuations the curative effects are reached without the aggravation. Chlorate of Potash.—" Dr. Irwin (an Army Surgeon) uses no other remedy in urethral inflammation than Chlorate of Potash. His method of using it is as follows: one drachm of the salt, dissolved in eight ounces of water, of which an injection is given every hour for twelve hours. At the end of this time, the discharge has become changed and diminished; allowing the remedy to be gradually discontinued un- til the second or third day, when the disease will be generally found to have ceased." This method is so harmless, so little likely to injure, by excessive irritation, causing a stricture, as compared with the caustics usually employed, that its merits should be tested. "I am now using it in one case with apparent benefit." (Dr. Hale.) Tartar-emetic has occasionally cured obstinate gleets with prompt- ness. Among its symptoms are : constant sticking pain in the pos- terior portion of the urethra, flaccidity of the penis, general debility, or complete impotence ; pustules on the thighs and scrotum ; pains in the testicles. Dr. Marcy says he cured two cases of involuntary emissions which had occurred as often as once in twenty-four hours for many months. Ferrum.—Tinct. Ferri-sesquichlorid. Several drops in water three times a day, in debilitated anaemic constitutions. The pyrophosphate of iron, third decimal trituration is about the best of the iron preparations. General invigorating influences, as change of air, temperance in living, local or general bathing with tepid or cold water, are important aids in the treatment. Injections may finish the cure imperfectly accomplished by genera] treatment. 382 DISEASES OF THE SANGUINOUS FUNCTION. Complications of Gonorrhoea.—The chief of these are: Irritation and inflammation of the bladder, of the prostate gland, phimosis, chor- dee, erysipelas. 1. Irritation of the Bladder.—Symptoms: Painful and incessant urging to pass water, pain increasing at the moment after evacuation. Urine generally loaded with mucus, and in some cases intermixed with blood; suddenness of the call to urinate, usually at short intervals ; aching pain in the region of the bladder; accelerated pulse, loss of appetite, and debility consequent on the fever. Treatment.—Aconite and Cantharis in alternation will generally subdue the fever and inflammation in a few hours. Aconite may be alternated with Belladonna in ordinary febrile cases. In more chro- nic cases, Nux-vomica, Pulsatilla and Sulphur. Other chief remedies are Cannabis, Lycopodium, Terebinthina, Uva-ursi, Copaiba, and Iodine. Camphor has been used with success in six-drop doses of the tinc- ture for the violent and spasmodic urging to pass water. (See p. 75 to 78, this volume.) 2. P/iimosis.—This is less severe and obstinate than when it re- sults from chancre. In some cases the prepuce becomes thickened and constricted, is difficult to be retracted and an irritating discharge may accumulate beneath it. Ample cleansings with warm water and fine soap. The general remedies appropriate for the disease in gene- ral will be sufficient to cure it. 3. Chordee.—This gives much pain and prevents rest. The usual treatment designed for the fever and inflammation will subdue it. 4. Orchitis.—Inflammation of the Testicle.—Causes.—It usual- ly occurs after the suppression of urethral blennorrhcea, when the dis- charge either ceases entirely or becomes very slight. It arises in connection with gonorrhoea either sympathetically by propagation of the inflammation of the urethra to the testicles, or by metastasis after suppression of the discharge. The cause of the extension of the ure- thral inflammation to the testicles, is having gonorrhoea and not wear- ing a suspensory bandage when riding, dancing, &c, alcoholic liquors, coition, use of purgatives, cubebs, copaiba, turpentine, taking a chill. The cause of metastatic orchitis is often injections with cold water, or with saturnine solutions to suppress the discharge. In ordinary cases general fever begins with a hard stunning head-ache, which sometimes lasts, at least at intervals, for twenty-four hours, before the local dis- ease becomes apparent. Then begin pain, swelling, extreme tender- ness of one of the testicles which continues to increase during the first two days, and reaches the size of a small closed fist. The scrotum be- comes red and tender; the spermatic cord extending from the testicle up the groin and round the loin of the affected side, becomes painful, gonorrhoea. 383 enlarged in size. In some cases the appearance of the scrotum cor- responds with that of scrotal hernia, the pulse is small, quick, and jerk- ing ; there is shivering, thirst, and loss of appetite in some cases; be- ginning with a soft spongy feeling, the testicle soon enlarges to the size of a fist and more. Sometimes it goes from one testicle to the other. The pain in it is often shooting or pressive. The discharge from the urethra is diminished or suspended during the attack, and often returns when the inflammation subsides. The epididymis is usually most in- flamed and swollen, and an examination of the orifice of the urethra usually shows its nature. Treatment.—Our first care in this complaint should be to suspend the inflamed organ by means of a suitable apparatus, in such a man- ner as to afford complete support in all positions, and thus prevent the enlarged gland from dragging upon the spermatic cord. The recum- bent posture should be strictly enjoined, and we should have constant- ly applied to the parts cloths wet with cold water. As soon as the cloths are warmed by contact with the inflamed testicle, they should be again dipped and reapplied until the heat and inflammation have disappeared. If the disease has arisen from sudden suppression of urethritis, or from the use of powerful injections during the acute stage, we may give Mercurius, Aconite, Nux-vomica, Spongia, Clematis, or Iodine. When it has been caused by the injudicious introduction of bougies, Arnica, Aconite, and Pulsatilla, will be found applicable. In cases where the inflammation has degenerated into a chronic in- duration of the testicles, our best remedies are, Aurum, Acid-nitric, Rhododendron, Sulphur, Mercurius, Spigelia, Iodine, and Cicuta. Aconite.—When the inflammation resists Belladonna, and the fever is prominent, alternate the two remedies. It may alone overcome the disease. Case.—A man aged twenty-seven years, contracted a gonorrhoea with inflammation at first in the left testicle, and afterwards at the ex- piration of six months the right testicle became involved. Both testi- cles considerably swollen, hard, hot, and very sensitive to the touch ; scrotum red; constrictive, tensive, pressive pains, extending even into the bowels and the thighs, augmenting by jerking paroxysms, and worse in the afternoon and night; moderate fever, increased thirst, sleep disturbed in consequence of the pain—Pulsatilla, Clematis, Nux- vomica and Nitric-acid were employed without success. Aconite third one drop every three hours, effected a cure in four days. (Guyler, Arclviv de Stapf, Vol. XIX. Cah. 2, p. 156.) Bi lladonna.—The patient should be confined to the horizontal po- sition, wear a suspensory loosely attached, so that the testicle should not hang down, and a thick soft linen cloth laid under the scrotum to 384 DISEASES OF THE 8ANGUTNOUS FUNCTION. keep it in the horizontal position. With these adjuvants Belladonna has been generally successful, given only as high as the third dilution. If the pain does not rapidly yield, a cold wet compress applied to the part and renewed as often as it dries. Symptoms: the patient is ex- cessively sensitive and nervous ; there is intolerance of pain which partakes of the neuralgic character. Nux-vomica, when shooting pain in the testicle persists after the use of the preceding. Nux-v. 6, has succeeded in removing it. Pulsatilla—May follow Aconite; and these two remedies alone often cure the disease. ( Yeldham, p. 28.) Aurum—The pain in the spermatic cord is of a neuralgic character and is more severe in the cord than in the testicle, but is very distress- ing ; the cord is enlarged to two or three times its natural size, being larger toward the abdominal ring. (Yeldham, p. 29.) Arnica lotion to the painful region. Tartar-emetic.—In cases conjoined with gastric symptoms, as fur- red tongue, bad taste, eructations, want of appetite, constipation, &c. When orchitis, is very severe, Tartar-emetic has often a marked effect in reducing the inflammation and relieving the pain. Diet.—Light unirritating food similar to that allowed in ordinary inflammatory affections. When after the removal of the orchitis the gonorrhaea returns, Pe- troselinum and Sulphur may be given in alternation with advantage. When hardness of the epididymis remains, Sulphur 1, a grain daily for several days has succeeded. Iodine is often useful in alternation with Sulphur. Clematis.—Dr. Hirschel regards Clematis, as the principal remedy in the treatment of orchitis, especially when it supervenes on exposure to cold, after blennorrhagia, and if the testicle be indurated, sensitive to pressure, the scrotum red, swollen, with tearing, drawing pains, and retraction of the spermatic cords and region adjacent. Ruckert gives these indications for blennorrhagic orchitis: " painful induration with sensation as though grains of sand were disseminated upon the surface of the organ—sequence of ill-treated blenorrhagia." In a case alter oxposure to cold and damp, a blenorrhagia was accompanied with vio- lent pains in both testicles,nocturnal aggravation, with fever; testicles hard, swollen, and highly sensitive to pressure ; scrotum red and tense ; discharge nearly suspended. Clematis 12°, two doses in three days. The symptoms subsided during the interval, and the discharge re-ap- peared. The swelling of the epididymis continuing, Aurum 12°, com- pleted the cure. (Attom.yr, by Leon Simon, jr.) In another case in which, from fatigue in hunting, a blenorrhagia was succeeded by orchitis with phimosis, and ulceration of the pre- ULCER. 385 ly the left, became enormous; the scrotum red and tense as in hernia; fever intense with furious delirium. After Aconite, Clematis completed the cure. Indications : the testicle is hard, swollen and painful, with sensation of traction upon the spermatic cord. If it feels bruised to the touchy with tension of the groin, upper thigh, and scrotum, Ruckert gives Clematis 12° and Spongia 30°, or Clematis alone every twelve or twenty-four hours. Various indurations of the testicle, not of syphili- tic origin, have been cured by Clematis. Dr. Destirne disputes the power of Clematis in the above cases, and refers the recovery to natu- ral resolution. Irritable Testis.—Clematis.—A case of gonorrhoea had lasted many years. Cold had developed orchitis, the part swelling to the size of a child's head. The patient became sad and misanthropic. The following year, moist itching spots appeared on the palm of the hand, general condition improved; when the spots receded he had colics. He had intermitting pains in the left testicle, faintness and retraction when the organ was touched. Other symptoms were relieved by other remedies; the pains of the testicle were relieved by Clematis 1° for a whole summer; when they returned the year following they were dissi- pated by the same remedy. GENUS XIV.—ULCUS.-ULCER. An ulcer is defined as a purulent solution of continuity of the soft parts of an animal body; (the name ulcus, derived from s/Uoc, a sore). Ulcers may arise from any of the causes that produce inflammation, from wounds, from irritation of the absorbents by specific poisons, from any of the blood poisons already treated of, as scurvy, cancer, scrofula, or the venereal virus. Causes.—The proximate or immediate cause is an increased action of the absorbents, and a specific action of the arteries, by which a fluid is separated from the blood upon the ulcerated surface. Varieties of Ulcers.—1. Simple ulcer, arising generally from a superficial injury, as a wound, bruise, abscess, or burn. (See Volume I., p. 641; Vol. IL, p. 181). 2. Sinuous ulcer, which runs under the integuments. Its orifice is narrow, but not callous. 3. The fistulous ulcer, or fistula, a deep ulcer, with a narrow and callous orifice. 4. The fungous ulcer, the surface of which is covered with fungous flesh. 5. The gangrenous ulcer, which is livid, foetid, and gangrenous. 6. The scorbutic ulcer, which occurs in persons subject to the in- fluence of scurvy. Vol. II.-25. 386 DISEASES OF THE SANGULNOUS FUNCTION. 7. The venereal ulcer, which occurs in the course of the venereal disease. 8. The cancerous ulcer, or open cancer. (See Cancer, page 282, Vol. II.) 9. The irritable ulcer, dependent on a psoric dyscrasia in the blood, though excited by local causes. The edges of the sore are ragged, undermined, and sometimes serrated or notched. The surrounding surface is red or inflamed; the bottom of the cavity is composed of irregular hollows, which contain a thin, greenish, or reddish, acrid matter, which excoriates the adjoining skin. Instead of the healthy granulating surface, described in Vol. I., page 643, there is a white, or dark-red, spongy mass, which is irritable, extremely painful, and bleed- ing on the slightest touch. This form of ulcer occurs in persons who eat and drink too freely, or have suffered from fevers. When seated on the leg or ankle it becomes extremely painful and difficult to heal, and is called a "fever sore." (See Vol. IL, p. 181; Vol. I., p. 647). Indolent ulcers are common on the leg, in slovenly and intemperate persons. The surface of this form of ulcer is flat, has a shining ap- pearance, and is covered with a whitish or dark-gray crust, which is exceedingly tenacious. Generally there is a profuse discharge of vis- cous cohesive fluid. Tbe edges of the sore are elevated, smooth and rounded, the surrounding parts are swollen or hard, and the whole limb enlarged; but generally there is but little pain. 10. Carious Cancer, dependent upon carious bone. 11. The Scrofulous Ulcer which occurs only in scrofulous consti- tutions. It is known by its having arisen from indolent tumors, by its dis- charging a viscid glairy matter, and its indolent nature. (See Scrofu- la, Vol. II. p. 259.) 12. Varicose Ulcer.—This occurs on the inner side of the leg or thigh in persons who have varicose veins. Treatment of Ulcers.—Ulcers are always curable by the simplest dressings, and the natural powers of reparation when they occur in healthy constitutions. Obstinate ulcers are invariably the result of some dyscrasia of the organism which should become the special ob- ject of attention. Even simple ulcers should be healed slowly, and under the use of proper internal remedies this can always be done. The following are the principal remedies: Arsen., Lach., Asarurn, Bell, Calc, Carb-veg., Conium, Cuprum, Graphitesr Lycopodium, Merc, Phos.-acid, Rhus., Sil., Sulph., Canth., Chel., Clematis, Solanum. Arsenicum,.—Indolent ulcers on the leg, in old, feeble, or cachectic persons; scorbutic or scrofulous ulcers which are flat and superficial, or hard, callous and burning; ulcers which resemble cancer; fungous, ULCER. 387 varicose ulcers of gray color with red areolce, black or whitish-spotted surface ; those that bleed readily, suppurate, are inflamed, putrid, pha- gedenic and very painful, itching, smarting, burning, tearing or drawing. Lachesis.—Indolent ulcers in old scorbutic or scrofulous subjects ; effects of Mercury, fungous ulcers; deep, varicose, indented, bluish spotted, discolored, with red areolae, turning black or spotted; ulcers which bleed or become gangrenous, spread, and are surrounded by pustules. Sulphur.—Every form of indolent ulcer in psoric constitutions ; in persons subject to asthma, urticaria, herpes or scrofula; fistulous, ca- rious or cancerous sores ; fungous or varicose ulcers, with indented edges, or red areolae; ulcers which turn black, suppurate or become putrid, without pain, or with boring and throbbing pains. Carbo-vegetabilis.—Ulcers which burn and smell offensively; atonic or indolent sores in old persons ; scorbutic, fistulous, and scrofulous ulcers; those with hard callous edges; fungous, varicose ulcers of yellow or black color, which bleed and become putrid, phagedenic and painless or torpid; otherwise very painful, ichorous, burning, and foetid. Cantharides.—Redness, inflammation and gangrene of the surface; excessive debility, languor, and emaciation; exudation of a serous li- quid from a vesicated surface; itching and lacerating ulcers of the leg ; strangury, and tenesmus of the bladder. Case by Dr. Burdick, New- York.—A gentleman who had suffered from paralysis for sixteen years had a chronic ulcer on the calf of the leg. The surface presented a watery blister from which was discharged about one quart of serum per day. He was cured by the internal use of Cantharides. Solanum.—All the species of this genus of plants are good remedies in malignant ulcers as well as carbuncles. One of the best local ap- plications is the tomato. The powrers of Solanum-nigrum in gan- grene are referred to at page 346, this volume. 388 DISEASES OF THE NERVOUS FUNCTION. CLASS IV.—DISEASES OF THE NERVOUS FUNC- TION. ORDER I.-PHRENICA -AFFECTING THE INTELLECT. MENTAL DERANGEMENT. The brain and nerves constitute the master tissue of the human body. It is superiority of brain, either in structure or conformation, which mainly creates the distinction between different individuals and different races. A thorough knowledge of this wonderful structure would enable us to explain some of the most mysterious inconsisten- cies and contradictions in human character, and many of the strangest events in human history; and would also render us more capable of comprehending the grand destiny of the human family. The problem of man's objects and achievements on earth has only been partially solved by history, because historians have but partially understood his physical or mental constitution. The ancients thought him "an intelligence served by organs." Modern philosophers have set themselves to investigate the " organs," and to explain away the "intelligence" into non-entity. We shall not enter into the contro- versy between them; but will endeavor to collect for practical uses the best results of observations and experiments which may illustrate the nature and treatment of the diseases which affect the human intellect. v In estimating the probable future of our world, the mental peculiari- ties and capacities of different races and nations must be taken into the account. Modern research has shown that national characteris- tics have continued unchanged from the remotest ages. The Arabians are just what they were in the days of the patriarchs. Very recently it was declared by ethnologists, that the Hindoos had altered in nothing since they were described by the earliest writers; and we know that thirty-five hundred years have made no difference in the skin, the hair, or the features of the Negro. The characteristics of the Jew may be recognized in the sculptures of Luxor and Karnac in Egypt, where they were depicted more than thirty centuries ago; and they bear the most striking resemblance to the Jews of the present day. Neither their residence in Palestine, nor their subsequent ban- ishment into every country and climate of the world have made any sensible change in the personal frame, the form of the head, the color of the skin, or the lineaments of the countenance. (Crania Americana.) The permanence of national characteristics in the features of well- known races is displayed in Egypt for the longest period known in MENTAL DERANGEMENT. 389 history. By the researches of M. Auguzre Mariette, in 1854, the most perfect specimens of the Egyptians, as they were in the time of the Shepherd Kings and Pharaohs and the builders of the Pyramids are placed side by side with their modern descendants; and they are shown to be identical in form and every feature, though about five thousand years of time intervened between them. (See Morton, Gliddon, also Dr. Helmuth, U. S. Journal of Homceop., Vol. I.,, p. 632.) The primary origin of the diversity and peculiarity of races presents a question which we will not enter upon here. The present aspect of the nations gives reason for believing that the Caucasian race of iien are soon to subjugate the whole habitable earth. Great Britain, says Dr. Caldwell,* " is but a speck in the waves, and yet her power is felt and acknowledged in every corner of the eartn." The North American Republic exhibits a further development of the same Gothic Caucasian race, variously modi- fied by Celtic additions. Its future is not to be calculated until other elements than those which appear in past history are brought to bear upon a problem yet unsolved; it will at least be a power anions the nations, of which no one will fail to feel the influence. And what is the source of all this power? Its manifestation depends on the mental characteristics of the Anglo-Saxon mind in its union with "the largest, best developed, best conditioned brain belonging to the human family. No matter how good the forms of other parts of the body may be, they owe that also to perfection of brain." Anglo-Saxons are known to compose the most highly endowed division of the Caucasian race; ''their brains are larger, better proportioned, and, from temperament and exercise they are in better condition for efficient action." (Cald- well.) It is of the deranged action of this wonderful structure that we come now to speak. Under the general term Insanity it is common to speak of all or any of the usual perturbations of the intellect. There is no correct definition of the word. Perhaps, as Halford says, "insanity, like sense, admits of no definition." One of the best efforts at a definition is that of Dr. Wright, of the Bethlehem Hospital. ** Insanity is a dis- ease of one or more faculties of the mind, of the diseased manifesta- tion of which the individual is unconscious, or not able to control." Some of the existing definitions would nearly depopulate all the asylums ; others would confine in straight jackets, not only their authors, but nine-tenths of their readers. The Roman law spoke only of two species of mental derange- ment, Mento Capita, et furioso. The Prussian law distinguishes * Louisville Med. and Physical Journal. 390 DISEASES OF THE NERVOUS FUNCTION. maniacs and idiots. The French law speaks of amenia, insanity, idiocy, without defining the divisions. Genera and Species of Intellectual Derangement.—Morbid physioal conditions may produce derangement of the intellect in vari- ous modes and degrees, to some of which the following names may be applied: Genus I. Empathema, Ungovernable Passion. Species. 1. 2. 4. 5. Erratic Genius. Empathema entontica.—Impassioned ex- citement. E. atonica.—Depression, Absence of pas- sion. E. inane.—Hair-brained passion. E. nostalgia.—Home-sickness. Genus II. Ecphrosia. Insanity. 1. Insanity of the affective faculties. 2. Insanity of the reasoning faculties. 3. Insanity involving both the affective and reason- ing faculties. 4. Mania may include any one of the species, and indicates fury combined with insanity. 5. Melancholia,—either of the above species of in- sanity combined with fear and anxiety. 6. Monomania. I.—That the brain is the organ through which the intelligent mind carries on its intercourse with the external world need not now be proved. The great desideratum for which all men perpetually seek on earth is " a sound mind in a sound body." Diagnosis.—Mental alienation includes all cases where the mind is incoherent or deficient in comprehending those plain facts which require the least exertion of understanding, whether from natural or morbid imbecility, or morbid perversion of its faculties or operations, by which the mind becomes incapable of distinguishing between the right and wrong of certain principles, which are generally admitted. No general definition will include every case. The mind in the in- sane has either lost or perverted its accustomed powers, or never had them. We include not under the term insanity the common mental eccentricities which often appear in the strongest intellects ; they may often arise from abstraction of the mind from passing scenes and events, and are called absence of mind. Every thinking man experiences this to some extent. But when they usurp supremacy from continually revolving in one set of ideas, and overcome the judgment, and impair understanding, generally, the individual comes under the scope of mental alienation. 1. Erratic Genius.—Men of genius, in all ages of the world's history, MENTAL DERANGEMENT. 391 have very generally been in some abnormal condition; and much of what they did do has been fairly attributed to constitutional peculiari ties or to the morbid activity of some of their mental faculties. We mention a few examples only. 1. Richard Porson, Professor of Greek in the University of Cam- bridge, was distinguished for great acuteness and solidity of judg- ment, intense application, and a stupendous memory. His immense erudition had rendered him an object of general admiration; and his head, being the subject of general curiosity, was subjected to a post-mortem inspection by the anatomists. The account given of the dissection says that, " to the consternation of all phreno- logists, but to the consolation of all blockheads, his skull was found to be thicker than that of any man that had been dissected in Europe." The phenomenon was considered inexplicable, and Dr. Gall was con- sulted. The founder of phrenology regarded the case as a perplexing one, and only answered: " How so much knowledge could get into such a cranium as that I cannot indeed comprehend; but I can well under- stand that, having got into it, it would never be able to get out again." 2. Dr. Gall, the founder of the science of phrenology, died at Paris in 1828. It was thought proper that the man who had examined so many heads should have his own examined also. Again, the anatomists were astonished to find a cranium thicker than had ever been seen since the death of Porson—at least twice as thick as any other they could find—and the channels, worn by the throbbing of the arteries of the dura-mater on the inner surface of the parietal bones, were deeper than had ever before been seen. The soul had made a happy escape from a massive prison where it had long struggled with storms without and physical disease within. The last enemy that assailed it was allopathic medicine. The disease was a true gastritis which should not have been fatal. But a conclave of physicians gave him twenty grains of Quinine per day, for five days, and the tenant of the strong old castle surrendered it into their hands. 3. We find many examples among illustrious men, of intense activity of mind, accompanied by some extraordinary development of the bones of the head. Cardinal Ximenes, Archbishop of Toledo, and Prime Minister of Spain, wherever he went, whether toiling incessantly for the reform of the Spanish government, under Ferdinand and Isabella, converting the Moors to the Catholic religion, or leading a military expedition to the coast of Africa, was continually tormented with a pain in the head which no remedy would remove. The warrior states- man, in the costume of an archbishop, with a suit of armor over it, was little more than a " living skeleton." He is described as " gaunt, grace- less and unprepossessing; his austerities had reduced him to a walk- ing anatomy, though his carriage was erect, his forehead unwrinkled, 392 DISEASED OF THE SANGUTNOUS FUNCTION. his features sharp and thin, his eyes small, dark, and deep set, and the general expression of his countenance repulsive and severe. Such was the appearance of the tall and ghostly leader who stormed the Moorish fortress of Moran.in Africa, and put the garrison to the sword. When tortured with neuralgia, he governed Spain by the force of his iron will; and when asked by what authority he ruled, he only pointed to his cannon. The Cardinal died in 1517, and his head was examined forty years afterwards. It was found so compact and solid that every vestige of the sutures was obliterated, and the whole cranium formed one hard and firm bone, To this peculiarity of his skull the Abbe Richard attributed the statesman's sufferings during life. 4. The same author says that when Cardinal Richelieu died in 1642, the reason why he had never suffered from headache-s was seen ; twelve small circular perforations were found penetrating the skull; " and through these the vapors from his brain had continually exhaled." This was the statesman who carried on wars for and against the differ- ent sects and governments of Christendom, and then " covered up all his crimes with the red mantle" of murder and assassination. To such a man life is unhappy and death terrible. Baron Larrey, the chief surgeon of the first Napoleon, says his illustrious associate in the army in Egypt, Monge, made him a visit many years after the downfall of the Empire. " The good old man," says Larrey, " shed tears of sorrow" when he spoke of the loss of all his former patrons, offices, and titles. Profound melancholy and in- tolerable weariness of life darkened all his later years. After death, it was found that the arteries of his brain were ossified, many of them hardened into bone. The mind and the body had acted and reacted upon each other. Fourcroy, the chemist, closed his life, also, in gloomy wretchedness; and in his brain, also, the arteries were found ossified. Among the English poets there has been no one of whom everybody knows so much, and at the same time understands so little, as Lord Byron. The mere phrenologist inspects all the portraits, busts and memorials of the poet that can "be found, and feels but partially satis- fied. There is evidently something both higher and deeper in Byron's genius than physical conformation of the head would ever reveal. There is a loftier spirituality, as well a lower sensualism in his brilliant works, than the shape and size of the brain could alone have shown us. He had other physical peculiarities than those displayed there; he was the subject of disease through many years of his life; he in- herited a feeble, irritable constitution, and suffered all his life the pen- alties of ancestral vices; and all that he achieved or endured on earth only cultivated a morbid activity of the brain and nerves. Inspired by a misanthropic hatred of much that was wrong in his own country, and by admiration of some remnant of the ancient patri- ERRATIC GENIUS. 393 otism in the modern Greeks, he devoted his life, energies, and fortune to the liberation of the land of Demosthenes. There, under the influ- ence of malaria, great mental exertion and despondency, he exhausted the powers of his over-active brain, and died on the 19th of April, 1824, having reluctantly submitted to a "copious bleeding," which settled the question of life and death with a reasonable degree of promptness. The post-mortem examination solved many of the mys- teries of his life, and partially unravelled the perplexed web of the many contradictions in his character. The skull, like that of Cardinal Ximenes, presented the most remarkable compactness, having no sutures between the several parts of it; but all the different bones were perfectly consolidated into one, without any intermediate diploe,— the head resembling that of a man half a century older than the poet; the medullary substance preponderated largely over the cortical por- tion ; the convolutions very numerous ; the fissures deep. There were also evidences of long-continued irritation, such as could not fail to influence his mental capacities and feelings. It was this state of the brain that heightened and intensified his passions, and produced many of the wildest aberrations of his erratic genius. It was this, added to the usual morbid sensibilities of the digestive organs, and the long- persistent constipation and torpor common to literary men, that made the man who possessed the loftiest poetical genius of his time wish for death at a period of life when men, whose minds and bodies are more in harmony, are only beginning to live. Disease, which neither he nor the physicians could understand, drove him to desire severance from all the relations of a world which promised so little for humanity, and nothing for him. Ignorant himself of any rational medical treat- ment, he made no effort to relieve himself from any of his miseries. A true estimate, then, of the character and genius of Byron, can only be made by taking into the account the size, form and relative activity of the brain; the causes which operated through all his life to render him morbidly irritable; his British education and travels in classic lands ; his inherited rank and wealth; the physical constitution which he inherited, encumbered by the diseases and vices of an aristo- cratic ancestry. When we have seen some of the same passions and wayward tendencies developed by himself, and have measured the power of all the surrounding influences to cultivate all that was good and all that was evil in such a man, then, and not before, may we claim that we understand him. But the physicians of our period regard all perversions of the men- tal faculty as mere symptoms of some morbid condition of the brain. Indeed so completely have these physical causes and mental effects been classified, that the precise location and the kind of morbid action in the brain, which produce nearly all mental disorders, can be designated. 394 DISEASES OF THE NERVOUS FUNCTION. The practical medical man of to-day looks only to the material brain itself in order to solve any question of perverted or deranged intellect. He combats the ravings of the fierce and violent maniac, by throwing a dose of Belladonna upon his inflamed tubercula quadrigemina ; or the tremulous movements and the frightful visions of the inebriate, by bringing into contact with his excited brain and nervous system, Opium and Cannabis-indica; or the melancholy and despair of the hypochon- driac, by doses of Aurum and Ignatia; or the homicidal or suicidal perversions of the monomaniac by Stramonium, Aurum, Hyoscyamus, or other appropriate remedy. Intellectual perversions, which were formerly regarded as mysterious spiritual afflictions of Providence, are now known to be only symptoms of some disease of the brain and nervous system, and to be just as amenable to medical treatment as any other malady. Genus H.—DERANGEMENT OR PERVERSION OF THE REASONING FACULTIES—IN SANITY. Derangement of the intellect has always been regarded as a mysterious disease. Dr. Rush said, that in attempting to write out his own observations on the " Diseases of the Mind," he felt that he was about to venture on consecrated ground. No theory of the phi- losophy of the mind, either in health or disease, has ever been gene- rally accepted; and a question of the sanity or insanity of the mind in a given case, often presents the most difficult problem ever presented to the physician. Knowledge and wisdom have generally been confounded; and even now the distinction between the metaphysical or higher reasoning power, and that which reasons on the facts furnished by the evidence of thai senses is not generally recognized; but it is believed that the separate existence and action of these two powers of the mind admit of demonstration. A few compressed statements on the subject are sufficient for our present purpose. It has been believed by the wisest philosophers of all ages, that the human intellect possessed a higher reasoning power than that em- ployed in reasoning on the material objects around them. It was ob- served by the earliest students of human nature, that some men who could reason acutely on all questions presented to the senses could never comprehend anything of higher abstract truth; and a distinc- tion was drawn between physical or sensuous, material subjects and those which were metaphysical—-that is beyond or above the physical. It was this higher reasoning power, which was known as pure reason, which the Greeks deified under the name of Minerva, or the goddess INSANITY. 395 of wisdom. She was the impersonation of that highest faculty which perceives truth intuitively, before it has time to demonstrate it through the slow processes of the external senses. Instead of having grown up during the course of successive years through the ordinary stages of life, she is represented as having sprung forth from the brain of Jupiter, armed with the spear of victory, and the far-seeing eye of inspired Avisdom. The ancients distinguished between the higher reason and the lower reason, called by many authors judgment or understanding. Plato, Seneca, and Aristotle made this distinction; and in modern times, Leighton, Harrington, Lord Bacon, Kant, Coleridge, and all other philosophers, except such as are imbued with the materialism of Locke, have confined the understanding to the office of reasoning on the objects of the external world, and called it " the faculty of judging according to sense." Animals, say these authors, have the power of understanding, as applied to the things of time and se?ise, but they have no perception of the subjects of metaphysical or spiritual con- templation, which are the proper objects of pure reason. In its highest condition of development the nervous mechanism has a three-fold operation: 1. objective ideas, which arise in external facts; 2. subjective ideas, which exist in registered impressions; 3. impres- sional ideas, as the abstract truths of geometry, the issue of pure reason, and are therefore to be attributed to the essential nature of the soul. It is believed that an impression made upon either of the senses is conveyed by a nerve connected with it to one of the ganglia at the base of the brain. Upon the vesicular contents of this, the change, whether chemical or mechanical, is made, which afterwards in some way corresponds to the outward and material object which caused the impression. Not, by any means, that this change impressed upon the ganglia necessarily at all resembles its material correspondent in form and color, &c.; it is simply conventional with the mind, as are the letters of a book, or in the dots and dashes of the telegraphic mes- sage. The act of remembering, then, is nothing but fixing the atten- tion upon those ganglia, and thus discovering the changes which have taken place. We may conjecture that these impressions on the ganglia are finally transferred to the mind proper, and form, therefore, an integral portion of it, thus constituting the faculty usually called memory. General Symptoms of Insanity.—In total or partial perversion of intellect the concatenation of ideas is broken, as in dreams,—pro- ducing incongruous combinations, which are repugnant to reason and common reflection. The person in whom the intellect is thus deranged may manifest it in different ways, and very often it is difficult to decide 396 DISEASES OF THE NERVOUS FUNCTION. whether any of the visible symptoms constitute positive evidence of insanity. " The tearing of clothes so common in this disease was one of the usual manifestations of deep distress among the Jews, probably from its being one of the natural signs among the nations of the east. The hallooing, stamping, and rattling of chains common among mad people are designed to excite counter-impressions upon their ears, to suspend or overcome the anguish of their minds; they wound and mangle their bodies for the same purpose. Even when there is sing- ing and laughter, there is reason to believe that the heart is oppressed with sadness. The sadness and seeming apathy of manalgia are not always evidence of the absence of misery. ' The willow weeps,' says the poet, * but cannot feel;; the torpid maniac feels, but cannot weep. One insane person declared, that his sufferings from imaginary evils were vastly greater than any real ones could be." Insanity appears in various aspects, according to the causes in which it has originated. Some are gay and seemingly happy; some imagine themselves superior beings, and assume the importance of their supposed situation; some are delighted with flowers, some with play- things ; some are revengeful and furious; others are silent. Thus they drag out their miserable existence. In one respect they are all alike; all have incoherency of conception and incongruous ideas on at least one subject, which may have caused their malady. Some con- sider themselves utterly miserable, and resort to various efforts to drive out their anguish of mind; they laugh, scream, cry, and especially seek to obtain ardent spirits and tobacco. Some, though previously silent and gloomy, become lively and loquacious as soon as tobacco is given them, or ardent spirits promised; they are cunning, suspicious, alive to injury, and quick in avenging it. Insanity Involving the Affective Faculties or Feelings, while the Intellect or Reasoning Power remains sound.— Austerity of conduct and tyranical disposition often present the principal visible evidence of a grade of insanity which no defect of reasoning power betrays. " In a well-attested case, a father systema- tically persecuted his children for many years, during which time he passed in the world for a man of great talent and probity; and it was only after the history of his life had been sifted by the best physicians that a tinge of insanity could be found in it." He had started in life with impractical notions of propriety of conduct, which he failed to realize in his children. He therefore conceived such a hatred for them that he persecuted them even to destitution and charges of the worst crimes. His success in prosecuting his plans, and in common business evinced anything but insanity (Halford). A strongly-marked INSANITY. 397 case of this kind is finely painted by M. Chateaubriand in the person of his father.* M. Pinel gives the case of a man who had periodical fits of insanity, in which he was seized with incontrollable fury which inspired him to a propensity to take up any weapon he could find, and knock on the head the first person who came in his sight. He experienced a kind of internal combat between this propensity to destroy, and the pro- found horror that arose in his mind at the contemplation of such a crime. There was no mark of wandering of memory, imagination or judgment. Although devoted to the happiness of his wife, he came near killing her, and had only time to bid her run to avoid his fury. " He said to me," says Pinel, " during his seclusion, that his tendency to commit murder was absolutely forced and involuntary. All his lucid intervals were marked by expressions of melancholy and remorse ; and so great did his disgust of life become, that he often wished to put an end to his own existence. ' What reason,' said he, ' have I to wish to destroy the superintendent of the hospital who treats me with so much kindness ; and yet, in my moments of fury, I am tempted to rush upon him as well as others, and plunge a dagger into his heart.' " (Sur LAlienation Mentale, p. 202). Hospitals for the insane are never without some examples of mania, marked by acts of extravagance or even fury, with a kind of judg- ment preserved in all its integrity, if we judge of it by conversations. The lunatic gives the most just and precise answers to the questions of the curious; no incoherence of ideas are discernible; he reads and writes letters as if his understanding were perfectly sound ; and yet, by a singular contrast, he tears in pieces his clothes and bed-covers, and always finds some plausible reason to justify his wandering and his fury. Such cases have been referred to as proving the plurality of the organs of the brain. It is remarked that it is common for the insane to reason correctly, though from false premises. The man who believes himself to be composed of glass, reasons correctly in being afraid of being broken to pieces. The Prince of the House of Bourbon, who believed himself to be a plant, reasoned correctly in standing in a garden, and insisted on being watered with the other plants. The lunatic in the cell of the Pennsylvania Hospital, who thought the wheel-work of the universe ' moved only by his direction, was right in being afraid to withdraw his regulating hand from it; " for," said he, " it depends on me to move the balance-wheel of heaven, and if ever I should stop, the whole universe would stand still." The point at which the mind may be said to become unsound is not * Memoirs of M. Chateaubriand, 1861. 398 DISEASES OF THE NERVOUS FUNCTION. easily ascertained, and strange mistakes arise in trying to draw the exact line. The people of the city of Abdera believed Democritus in- sane, and sent for Hippocrates to cure him, but Hippocrates decided that not Democritus but the people of Abdera were insane. Much learn- ing was thought to have made the Apostle Paul mad, because from persecuting the Christians he became a strenuous advocate of the same doctrines he had opposed. Whatever opinions are not generally re- ceived are charged to the insanity of those who accept them, till rea- son and experience overpower our prejudices and convince us that " we the people," have for once been wrong. In religious as well as political controversies each party pities the weakness and disordered minds that can be satisfied with the creed of the opposing party. Whenever an individual is merely apparently absurd in matters of opinion which do not affect what may be called the elementary prin- ciples of feeling or conduct, we need not fear that these errors will lead to insanity. An illusion may exist in regard to particular sub- jects in the mind of a man of genius, and it may lead him to indulge in eccentric whims and fancies; whilst the points on which the illusion exists are utterly indifferent to the well-being of all about him, and on every other subject his conceptions are clear and his conclusions cor- rect. Pythagoras believed that he had lived in former ages, had in- habited different bodies, and in the shape of Euphorbus, had assisted at the siege of Troy, where he was killed by Menelaus. Tasso believed that he was visited by a familiar spirit with whom he conversed aloud. The hero of Cervantes, Don Quixotte, is a good specimen of this grade of insanity. " If," says a celebrated writer, " the circle in which this absurdity revolves is so small that it touches nobody, a man is only called singular. But if its orbit is so extended to run across the path of others, he is insane."'* When the body is healthy and the mind sound, our beliefs, emotions and actions are induced by mental processes more or less complete, more or less accurate, but in all cases there is some kind of foundation for our belief, we believe because we have evidence, good or bad. But the insane believe without evidence. Persons who have recovered from mental de- rangement, say they had no reason at all for believing as they did in ab- surd and impossible things ; there was the thought in their minds with the undoubting confidence in its truth; but how it came there they know aa little as how it went away. Some persons on the verge of melancholy say they are wretched, but know not why; that they have everything to make them happy and yet feel no interest in life, they feel a wretch- edness for which they can give no reason. Some who have murdered those who never offended them, say they are urged to it by a strange * Medical Recorder. 1827, p. 481. MANIA. 399 impulse, totally different from that which urges a sane man to commit such acts. Legal authorities say that to prove insanity it is necessary to prove " insane belief." But in what does insane belief consist ? Is it some- thinff either physically impossible or totally groundless? Many igno- rant persons, not insane, can be led to believe in physical impossibili- ties, while many of the insane are possessed with one absorbing idea for which there is a foundation in reason and in fact. The East India captain, mentioned by Gooch, who, while a law suit concerning his father's will was pending, became insane, and imagined that he had suddenly come into possession of d£l00,000 a year, had no foundation, whatever, for that belief; but he immediately acted upon it; com- menced an extravagant style of living, offered his physician a carriage and horses ; and at length went abroad to dethrone the Turkish Sul- tan, promising his friend a magnificent seraglio ; all of which, of course, failed of accomplishment. But there are other cases in which " in- sane belief" is founded upon real facts. Legal Definition of Insanity.—" It is our duty to recognize no form of mental unsoundness which is not positively the product of dis- ease." (Dr. Winslow, Lettsomian Lecture, 1855.) A " delusion" is not to be acknowledged unless it be the product of a diseased intellect. Dr. Winslow says : " No notion of the mind how- ever ridiculous, illogical, fallacious, and absurd, should be admitted to be a delusion, or evidence of unsound mind, unless it be obviously and unmistakeably the product of a diseased intellect." The test of insan- ity in all cases should be " the comparison of the mind of the alleged lunatic, at the period of suspected insanity, with its prior, natural, and healthy manifestations;" the consideration " of the intellect in relation to itself, to no artificial a priori test." This example is given:—Dr. Forbes (Brit, and For. Med, Chir. Rev., July, 1855, p. 214,) was called by a husband to certify to the in- sanity of his wife, whom he found at the first interview raving inco- herently. On further inquiry, and on a second interview, he " learned from her ordinary medical attendant that her raving was a very fre- quent and usual exhibition of uncontrolled temper, and that what at first appeared as incoherence was derived from the trifling nature of the cause of the oftence. There was nothing whatever unusual in her conduct at the time, however strange it might have appeared when com- pared with the average standard of lady-like manners." 1. M A N I A , Consists of an entire perversion and derangement of the intellectual faculties. The patient seizes at the same time upon topics the most 400 DISEASES OF THE NERVOUS FUNCTION. dissimilar, passing from one to the other, without order or arrangement, and reasons, draws inferences and forms opinions without any regard to logic or common sense. The intellect is deranged on all subjects; and the moral qualities indicate their perversion, by ferocity, unnatural hatreds, rage, quarrelsomeness, continual desire to do mischief, and an urgent propensity to carry into immediate effect any fancy which may strike the imagination. At the same time, the patient is perfectly conscious of his identity,—has a kind of idea of right and wrong, and is fully aware of what he is doing; but the mind operates through a diseased organ, the healthy equilibrium is lost, vague and absurd fan- cies take the place of true perceptions, and the individual is impelled to obey the dictates of his diseased imaginings. Mania is usually unaccompanied by fever, except, perhaps, at its very commencement, although there is a great exaltation of the mental and muscular pow- ers. It has also been observed that maniacs are capable of enduring the most severe bodily inflictions, and the most intense cold, without evincing much consciousness of pain,— also extreme and protracted hunger and thirst, without serious inconvenience. "Insanity," says Dr. Brigham, "often commences in a very insidious manner. Some appear to be deranged only as regards their feelings or moral qualities. They are noticed to be different from what they formerly were; to be more restless and sleepless, or unnaturally morose and irritable. Some manifest an unfounded dread of evil, say but little, shun society, and are suspicious of their dearest friends and relatives; while others are unusually vivacious and pleasant, or quar- relsome and abusive. Such changes of character and habits will usually be found to be subsequent to some reverse of fortune, loss of friends or sickness, and should excite alarm. Persons thus affected will converse rationally, and in company, or before strangers, will con- ceal their peculiarities; and thus are known to be insane but to very few, until some violent act leads to an investigation, and then it is found they have long been partially deranged. This is the case with most of those who commit suicide. Often insanity exists in a slight degree for months, and it is only noticed by the most intimate friends or relatives, and then suddenly assumes an alarming form, leading, in some instances, to homicide, and in others to self-destruction." Frank asserts that " mania may alternate with hypochondria, melan- cholia, or dementia; that it may be continued, remittent, or intermit- tent. Intermittent mania returns every eight days, every month, every three months, every year, every two years," &c. According to the same author, " mania may terminate by many crises, mucous or bloody stools, vomitings, ptyalism, leucorrhoea, epistaxis, re-establishment of the menses or of suppressed haemorrhoids, varices, eruptions, ery- sipelas and boils. It may terminate by continued or intermittent MONOMANIA. 401 fevers. It may degenerate into melancholia, or dementia. The dis- eases with which maniacs finally succumb, are: cerebral fever, apo- plexy, inflammation of the meninges, phthisis pulmonalis, and ulceration of the intestines." Complete exhaustion, also, of the physical and mental forces is a common termination of insanity. 2. MONOMANIA, Is characterized by derangement upon some particular subject, which constantly occupies the thoughts, to the almost entire exclusion of everything else. When the patient's attention is diverted from the subject of his insanity, he reasons correctly and converses rationally upon all other topics presented to him; and even upon the subject of his derangement he reasons correctly upon his false data. Monomania may be of a gay or of a sad character, but in a majority of instances the monomaniac dwells upon a painful train of ideas. Sometimes a prey to the most absurd fears and dreads, as of poverty, being vio- lently killed, suicide, homicide, of having committed the unpardonable sin, or of some serious impending calamity. Sometimes he imagines himself a clock, and stands in a corner of the room through the day, swinging his arms like a pendulum; or an animal, and imitates, as far as possible, its peculiarities; or that he has no legs or arms, and there- fore refuses to walk or help himself; or that he is full, and therefore cannot eat or drink any more ; or, like J. J. Rosseau, that all men are his enemies, and are seeking to ruin him. At other times he imagines himself to be the Savior, or a great prophet, or the emperor of the world, or some renowned statesman, philosopher or general, and swells about, issuing orders suitable to his fancied dignity. Monomania may exist in a light form for a long period, without attracting particular attention. We have at the present time under our care two patients who have tormented themselves a good part of the time for years, and who have reduced themselves to a wretched state of health, with the dread of committing suicide or homicide; and yet they had the firmness to conceal their morbid condition from their friends. We have known other individuals who have been thrown into phthisis pulmonalis by silently brooding for a long time over some apprehended misfortune, like loss of property. The mind, like the body, requires rest and diversion; one set of muscles cannot be constantly exercised without becoming impaired in their functions; nor can the mind dwell upon a single train of ideas exclusively and for a long period of. time without becoming deranged. This malady, like mania, may be continued, remittent, or intermit- tent. The cure is generally preceded by some crisis, either physical or moral. The physical crises are : eruptions, sweats, vomitings and Vol. IL—26. 402 DISEASES OF THE NERVOUS FUNCTION. diarhceas, tumors, fevers, acute inflammations of the brain. The moral crises consist of all those emotions or passions which, by violently pressing the brain, are capable of exciting a new action, which shall supersede the morbid affection. Under this head may be ranked sud- den and startling news, fright, rage, violent grief, &c. In some cases the reasoning power is impaired, but not wholly lost. Such persons sometimes reason with extreme acuteness, at the same time that they are deficient in the powers of perception. They reason from false premises, as we see many persons who are acknowledged to be sane, though their minds are not of the strongest. In the truly insane, the imagination very generally usurps authority over the rea- soning faculties ; and then the mind is like a ship in a stormy ocean without helm or rudder, driven before every wind. All persons in whom the imaginative faculty, or "Ideality" is very active, occasion- ally betray something of its preponderance over the reasoning power; thus,—as said by Dryden : " Great wit and madness nearly are allied, And thin partitions do their walls divide." Insanity presents itself in various aspects, according to the causes in which it has originated. Some are gay and seemingly happy; some imagine themselves superior beings and assume the importance of their supposed situation; some are delighted with flowers, some with play- things : some are revengeful and furious; others are silent. And thus, under their various delusions and imaginary joys or sorrows, they drag out the weary months and years of a blighted life. In one respect they are all alike : all have incoherency of conception and incongruous ideas on at least one subject, which may have caused their malady. Some consider themselves utterly miserable, and resort to various efforts to drive out their anguish of mind. They laugh, scream, cry, and especially seek to obtain ardent spirits and tobacco. Some previously silent and gloomy, become lively and loquacious as soon as tobacco is given them, or ardent spirits promised; they are cunning, suspicious, alive to injury, and quick at avenging it. The legal decision of the question of insanity is one of the most im- portant as well as the most difficult ever presented to a court of justice. It may involve the punishment of an individual with death for the com- mission of an act, the moral guilt of which he is, from his unhappy state of mind, unable to judge; or the imprisonment of a sane man who, driven by rage, and perhaps impetuosity of temper, may exhibit some of those manifestations which the inexperienced and ignorant may call signs of madness. In either of these cases, and a vast num- ber more, the greatest injustice and cruelty have been committed through the ignorance of physicians and the wickedness of designing MONOMANIA. 403 men. In every case we should be extremely cautious. The inexperi- enced should never give a positive opinion in a doubtful case. The probable motives by which an accused person could have been actu- ated must always be thoroughly studied, remembering that the state of mind at the time of the trial may differ widely from its condition at the time of committing the crime. The investigation of a case of insanity requires the highest degree of professional skill, the most scrupulous delicacy in approaching the subject, an exquisite tact and ingenuity in tracing symptoms to their source, the most profound knowledge of the secret springs of human action, and all the diversified considerations by which the mind may be arrested, awed or conciliated. It will only be by acquiring an almost despotic ascendancy over the individual whose intellect is " lost in the stormy desert of the brain," that the physician can penetrate to the deeply hidden fountains of mental disquietude, and secret sources of physical disease. It will only be by gaining an intimate knowledge of the reciprocal action of mind and body on each other that the mystery of a perverted intellect can be comprehended. Distinction behoeen Real and Feigned Insanity. Real Insanity. Feigned Insanity. When the paroxysm of the real mad- man is over, he tries to conceal his ma- lady ; he feels the unhappy infirmity of his nature, and shrinks from obser- vation. There is a peculiar cast of countenance which the experienced can detect, and which is difficult to counterfeit, parti- cularly the sudden transition in the ex- pression of the eye, from an unmeaning vagueness to a flushing intensity, when particular actions or passions are ex- cited. All the organs of sense are perverted : he will bear the most offensive effluvia and the most violent noises. He is wholly inattentive to physical wants, can endure long watchfulness ; though all insane patients cannot equally en- dure privations. He tries to convince you that he is not insane, and this effort furnishes the strongest evidence that he is so; he always betrays a morbid watchfulness to see if you suspect him of it. So far from endeavoring to give convincing proofs of his insanity, he The pretender to insanity is apt to overact his part. In company he is boisterous; when alone silent. He finds it difficult to sustain his assumed character for any length of time. He endeavors to give convincing proofs of his madness. Some are so acute as to deceive us in this point; but so badly does he imitate the expression, and so difficult is it to keep up the de- ception that his powers of endurance fail, where one truly insane would per- sist for an indefinite time. He finds it a difficult task to submit to the long watchings, fastings, and ex- posures to cold that the really insane endure without noticing them. He can- not avoid sleeping; he cannot mimic the solemn dignity of real madness, nor imitate the peculiar expression. 404 DISEASES OF THE NERVOUS FUNCTION. shrinks from observation ; but betrays in every look that he is afraid you think him insane, just as a dishonest man fears somebody will suspect him of dis- honesty ; and when reason returns he avoids the moat remote allusion to his malady. He feels the humiliating con- dition which it has pleased the Al- mighty to permit to fall upon him ; and instead of being clamorous and deter- mined to obtain his freedom, he seems insulted if his disease be alluded to ; he is silent, submissive, unobtrusive, and deeply humiliated. In real insanity we often see displays of astonishing intellectual efforts exhibited in a great many different aspects; but we more fre- quently see these displays in the exercise of the imaginative than the reasoning faculties. The dramatic poet Lee, wrote the Tragedy of Nero and several other plays in the Bethlehem Hospital for lunatics; and was, at times, excited to the fury of the wildest maniac And yet all his plays were acted with applause before the same people who were only beginning to appreciate Shakspeare. Another English poet wrote a poem descriptive of his melancholy situation. Christopher Smart wrote his verses on the walls of his cell. Shakspeare, the mas- ter of the human passions and of the human heart, delineates in Ham- let and in King Lear the different forms of madness arising from grief. In Lear we see the characteristics of an arbitrary monarch, defying the fury of the elements; in the beautiful Ophelia the fondness for flowers, and the various emblems of sorrow. In Hamlet we have a form of in- sanity more feigned than real, which has perplexed jurists as well as physicians. Physical Symptoms of Insanity.—The eyes are more frequently dark; and the hair dark and dry; complexion swarthy, secretion from the nose diminished. Dr. Hill says maniacs have a peculiar foetid odor emitted from the body. This is certainly not universal, but we have personally remarked it in a large number of cases. Arterial action is generally increased in the insane. Dr. Rush says it is generally stronger than in health. In 1794, two men were con- demned to die for high treason against the United States, in one of the western counties of Pennsylvania. One of these was said to have be- come insane after sentence of death had been pronounced upon him. A physician consulted declared the insanity feigned. President Wash- ington ordered a consultation of physicians. Drs. Shippen, Griffiths, and Rush examined the man and were not satisfied with the symptoms presented. Dr> Rush thought that the acceleration of the pulse "to monomania. 405 more than twenty beats above what it would be in health," would justify the decision that the man was insane. Dr. Shippen ascribed the quick- ness of the pulse to fear. We could not now accept the opinion of either of these great men as correct. But the influence of Dr. Rush prevailed with the President, and the man was pardoned. But the most difficult cases that come before the court, involving the existence of insanity, are those in which it is the desire and interest of the insane person to conceal his malady. On this point Lord Erskine on one occasion said: "It is agreed by all jurists and is established by tHe law of this country and every other country, that it is the reason of a man which makes him accountable for his actions, and the absence of reason acquits him of crime. This principle is indisputable; yet so fearfully and wonderfully are we made, so infinitely subtle is the spiritual part of our being, so difficult is it to trace with accuracy the effect.of diseased intellect upon human action, that I may appeal to all who hear me, whether there are any causes more difficult, or which indeed so often confound the learning of judges themselves, as when insanity or the effects and consequences of insanity, become the sub- jects of legal consideration and judgment." On another occasion the same great lawyer said : on one case he used every effort in vain before a court to prove an individual insane, until Dr. Sims came in and ex- plained the nature and cause of the malady. His lordship then ad- dressed the patient on that point, and he quickly evinced insanity to the full satisfaction of the court. The descriptions of melancholy by Shakespeare are always accu- rate : " I have of late, wherefor I know not, lost all my spirits,—for- gone all custom of exercise; and indeed it goes so heavily with my disposition, that this goodly frame, the earth, seems to me a sterile promontory; this most excellent canopy, the air,—look you, this brave overhanging firmament, this majestic roof fretted with golden fires— why, it appears no other thing to me than a pestilent congregation of vapors." In all the forms of madness Shakespeare's portraitures are acknowledged to be as faultless as his intuitional analysis of human characters as exhibited in men in their normal state. It has been supposed that he made the subject of insanity a particular study, as Crabbe and Scott certainly did after him. The various forms of the malady he has described—the perfect keeping of each throughout the complications of dramatic action—the exact adjustment of the pecu- liar kind of madness to the circumstances which introduce it, and to the previous character of " the sound man," leave us lost in astonish- ment. His test of madness given in Hamlet has been employed by physicians in determining the existence of the malady when other tests had failed to detect it. 406 DISEASES OF THE NERVOUS FUNCTION. " Ecstacy! My pulse as yours doth temperately keep time And makes as healthful music. It is not madness That I have uttered ; bring me to the test, And / the matter will ee-wokd which madness Would gambol from.," A case of this is given by Halford. Of the authors of our time none have more correctly described in- sanity than George Crabbe. He made it a subject of such special study that he has been styled by a philosopher " the anatomist of the human soul;" and Byron characterized him as "nature's sternest painter, yet the best." Pathology.—The pathology of insanity has perplexed all writers who have attempted it. Men afraid of encouraging materialism have represented the mind as so entirely independent of the body and so far above it, as to be entirely beyond its influence. And, finding no means of reaching the mind, except through some of the sentient avenues of the body, they have abandoned the subject of insanity as one that the physical agencies of material medicines cannot reach. Our theory is that insanity always, when not dependent on, is, at least, associated with physical disease of the body. The extent of physical derangement is different in individual cases, and hence, its mental manifestation may be various. 1. The gradual development of mind from infancy to manhood, and then its diminution in power as old age approaches, is in exact propor- tion to the development of brain, when the influence of education and disease are taken into the account. 2. Insanity is a hereditary disease, as weak digestion, deranged hepatic systems, and other peculiar organizations descend from parents to children, and no one hesitates to refer these to the organization. 3. Insanity occurs at all periods of life when the mind is at the highest activity, when the organization is most perfectly developed, and in the highest degree of activity; hence it is more liable to be over-excited and thus become diseased. 4. Bodily injuries do often produce insanity. Early dyspepsia, hard study, or labor without rest produce it. Females, during menstruation, pregnancy, and after delivery, often become insane from the influence of powerful and peculiar actions going on in the system. 5. The influence of the weather on insanity, shows it to be a disease affected by those influences which operate upon the body. The sup- posed influence of the moon on this disease gave rise to the name " lunacy." Cerebral Hemispheres.—Physiologists are agreed "that the gray matter of the cerebral convolutions is the true middle point at which PATHOLOGY. 407 mind touches matter; where impressions become sensations, and the will develops itself into action; and in whose generated force alono (in the present state of being) the intellect finds its means of opera- tion.- With the gray matter of this centre no nerve is directly con- nected ; but multitudes of white fibres pass from its cells to unite it with the motor and sensory centres, the ganglia at the base of the brain. " Morbid affections of the gray substance of the cerebral hemis- pheres alone, will manifest themselves in various derangements of in- tellect. They arise either from deficiency or super-abundance of the quantity of blood supplied to them, or from vitiation of its quality; from the irritation of various poisons, generated within or introduced from without, or from idiopathic inflammation of the substance itself. To this head belong syncope, coma, and delirium in their various shades and complications. Whenever these symptoms appear, whether as the result of disease or of drug-action, we may be sure that the cerebral hemispheres are directly or indirectly affected."* To understand these morbid conditions, if we imagine the process of secretion " arrested by cutting off the supply of blood," we have syncope. The want of blood may arise either from insufficient action of the heart, or from contraction of the cerebral arteries; the former being the cause of the syncope of Digitalis, the latter that of Hy- drocyanic-acid. On the other hand, when the cerebral hemispheres are oppressed by abnormal congestion, we have coma, not the "spurious hydrocephalus of Gooch and Marshall Hall, which is merely a state of cerebral exhaustion, for which Zinc is, perhaps, the pathogenetic analogue," but the true coma, corresponding to oppressed secretion from congestion or effusion; and it corresponds in the former case to Opium, and in the latter, perhaps, to Hellebore. Simple inflammation of the brain gives, first, increased generation of force, on account of active determination of blood, and secondly, perverted secretion through the irritation of the cells. The first effect of Opium is increased secretion without perversion; while Belladonna, with its congeners, Hyoscyamus and Stramonium, produce perverted secretion, without increase (delirium) or with increase (mania)." Induration of the brain, from long-continued sub-acute inflammation, is a frequent cause of insanity. In recent and slight cases of this malady, the intellectual faculties exhibit no very prominent derange- ment, but as the induration progresses and extends, the hallucination becomes more strongly pronounced, until eventually complete fatuity is the consequence. Solly believes that chronic inflammation of the dura mater is a very frequent cause of insanity. In post-mortem ex- * Dr. Richard Hughes, on the Nervous System, London, 1861. 408 * DISEASES OF THE NERVOUS FUNCTION. animations of those who have died demented, Esquirol has observed softening or increased density of the brain, adherence of the arach- noid, thickenings, atrophy and defective organization of the brain or cranium. See Vol. I., p. 702. In monomania, Pinel, Frank, and Esquirol assure us, " that organic lesion of the lungs and abdominal viscera, are more frequent than alterations of the brain." The latter writer supposes displacements of the transverse colon, to be amongst the most common of these derangements, and this is supposed to account for the constipation and the pains in the epigastric region, which are usually present in this variety of insanity. Many cases have been reported in which no organic lesions have been found after death, either in the brain or the abdominal cavity, and on this account some authors recognize a nervous or vital mono- mania. It is probable, however, in all cases of mental derangement, that either the brain or its membranes are in a diseased condition, although our ordinary modes of examination may not enable us in all cases to detect it. But whether our perceptions be able to detect the departure from true physical health or not, we are satisfied that every form of mental derangement is associated with physical disease of the brain. It may not in all cases, or even in a majority of cases, originate there. It is a true neurosis, at least, and often originates in the diges- tive system. The nervous system of the stomaeh is, in avery case of morbid sensibility of the stomach, reflected on the encephalon, which is then secondarily affected, giving rise to all the extravagant and in- congruous imaginations of the hypochondriac. The direct influence of the condition of the brain upon the mind may be seen in a few well- marked phenomena, observed by unquestioned authors. Sir Astley Cooper says: " A young man had lost a portion of the skull just above the eye-brow; I distinctly saw the pulsation of the brain; it was re- gular and slow; but at the same time he was agitated by some opposi- tion to his wishes, and directly the blood was sent with increased force to the brain, and the pulsation became frequent and violent." If we omit to keep the mind free from agitation, our other means in the treatment of injuries to the brain will be unavailing. (Lectures on Surgery, Vol. 2, p. 279). Effect of Sleep on the Action of the Brain.—Blumenbach saw in one case the brain sink when the patient was asleep, and swell again with blood the moment when he a,vfoke.— (Elliotson,s Edition, p. 283.) Dr. Perquin says he saw in the Hospital of Montpellier, in 1821, a female who lost a portion of the scalp, skull, and dura mater. When she was in a dreamless sleep, the brain was without motion, and lay within the cranium. When sleep was imperfect and agitated by dreams, the brain moved and protruded without the cranium, forming CAUSES OF INSANITY. 409 hernia cerebri. Vivid dreams protruded it considerably; wakefulness still more. A similar case is given in the Med. Chir. Review, (Oct., 1833, p. 336.) When excited by fear or anger, the young man's brain protruded greatly, so as to disturb the dressings, and throbbed tumul- tously. Thus the brain, like the muscles, is more fully supplied with blood when in a state of activity than when at rest. Change of Size of the Brain.—Sir Charles Bell says : (Anat. Vol. IL, p. 390), " We have found that the bones of the head are moulded to the brain; and the peculiar shapes of the bones of the head are determined by the original peculiarities in the shape of the brain." Again: " I have seen one striking instance of the skull de- creasing in size with the brain. It occurred in an individual who died at the age of thirty-two, after having labored under chronic insanity for upwards of ten years, and whose mental weakness advanced in proportion to the shrinking of the skull. The diminution of his head in size attracted his own attention during life." Cuvier is still more explicit. He says: " In all mammiferous animals the brain is moulded in the cavity of the cranium which it fills exactly. So that the description of the osseous part affords us a knowledge of, at least, the external form of the medullary mass within." " Magendie says "the only way to estimate the volume of the brain in a living per- son is to take the dimensions of the skull." Delirium characterizes inflammation of the periphery and is com- monly wanting in inflammation of the deep-seated portions. Delirium marks disease in that portion of the brain in which the mental organs are located by the phrenologists. Arachnitis.—" There is a remarkable difference between the symp- toms of arachnitis of the convexity of the brain and that of the base. The researches of some celebrated French pathologists led them, after a most careful series of investigations, to adopt this opinion, which is borne out by my own observations and appears to me to be founded in truth. In arachnitis then of the convexity of the brain, we have per- manent and violent symptoms ; early and marked delirium; sleepless- ness, and then coma. But in arachnitis of the base of the brain the symptoms are more latent and insidious; there is some pain, and the coma that follows is profound; but there is often no delirium. Patho- logy shows that we may have most extensive local disease in the central parts of the brain, that we may have inflammation, suppuration, abscess, and apoplexy, without the slightest degree of delirium." In- deed the central portions of the brain appear more connected with another function of animal life—that of muscular motion and sensa- tion.—Dr. Stokes, Dublin. Causes.—The causes of insanity may be divided into physical and moral. Physical Causes.—Injuries inflicted upon the Head.—Dr, 410 DISEASES OF THE NERVOUS FUNCTION. Winslow says; " The importance of this subject cannot be exaggerated. Repeatedly have I found cases of epilepsy bidding defiance to all treatment, tumors, abscesses, cancers, and softening of the brain, as well as insanity in its more formidable types under my care, whose origin could unquestionably be traced back, for varying periods of one, two, five, eight, ten, fifteen, and even twenty years, to damage done to the delicate structure of the brain by injuries inflicted upon the head! Injuries of this character occurring in persons of a strumous habit, or to those suffering from long-continued debilitating diseases, impaired and perverted nutrition, over-wrought and anxious minds, or inheriting a constitutional liability to mental or cerebral disease, are frequently followed by serious and often fatal results." * Poisons, <£c.—Medicinal substances capable of powerfully im- pressing the cerebral organs; irritating gases, as carbonic-acid gas, nitrous-oxyd gas; vapors of ether and chloroform; alcoholic liquors, opium; opiates, and other narcotics ; mercury, electric shocks, sun- strokes, excessive labor, violent exertions, straining, masturbation, protracted sea-sickness, exposure to great degrees of heat, sudden exposure to cold water; other diseases, repelled eruptions, excesses in sexual pleasure, drying up of old ulcers, or of accustomed issues ; turn of life, suppression of menstrual or lochial discharge, metastasis of rheumatism, gout or other disease; syphilis. Want of sleep is the " most frequent and immediate cause of in- sanity, and one of the most important to guard against." Dr. Brigham dwells upon this cause with much earnestness, and endeavors to im- press upon all, the vast importance of "securing sound and abundant sleep." "Long-continued wakefulness," says he, "disorders the whole system. The appetite becomes impaired, the secretions diminished or changed, the mind dejected, and soon waking dreams occur, and strange phantoms appear, which at first may be transient, but ulti- mately take possession of the mind, and madness or death ensues." Moral Causes.—These comprise : over-exertion of the intellectual powers, violent emotions, excessive and protracted grief or mortifica- tion, disappointed love and ambition, jealousy, remorse, anxiety, exclu- sive and protracted thought upon a single subject, or a single train of ideas, religious enthusiasm, vivid and unrestrained imagination, im- proper mental education. Importance of early Physical and Moral Education.—In order that insanity may be averted from those who are physically predisposed to it, " Great pains should be taken to form a character not subject to strong emotions, passions, and caprice. The utmost attention should be given to securing a good bodily constitution. Such children should " Obscure Diseases of the Brain and Disorders of the Mind." CAUSES OF TNSANITY. 411 be confined but little at school; they should be encouraged to run about the fields, and take much exercise in the open air, and thus secure the equal and proper development of all the organs of the body. They should not have the intellect unduly tasked. Very early cultivation of the mind, and the excitement of the feelings by the strife for the praise and the honor awarded to great efforts of mind and memory, are injurious to children, and to those who inherit a ten. dency to nervous diseases or insanity, most pernicious. In after life, persons thus predisposed to insanity should be careful to avoid engag- ing in any exciting or perplexing business or study, and should strive, under all circumstances, to preserve great equanimity of temper." (Dr. BrigharrCs SixtJi Annual Report^) Effects of Over-exertion, Mental and Physical.—The restless, en- terprising Caucasian, in his march towards the empire of the globe, finds many obstacles in his path which never trouble the lethargic brains of other less intellectual races. Civilization is endeavoring to subdue the earth at an immense expense of muscular and mental effort. We find man now more restless than ever, though the age in which we live be " The heir of all the ages in the foremost files of time ;" though it makes more rapid discoveries and advances than any former age could do; there is a general feeling of " unrest," anxiety, impa- tience, restrained expression. This " Stoic eye and aspect stern" which everywhere " mask hearts where grief hath little left to learn," may be seen in every street and thoroughfare of every city in the world. " The race of life,", says Carlyle, " has become intense ; the runners are treading on each others' heels; woe to him who stops to tie his shoe-strings." 1. The struggle for wealth, fame, and position in civilized society de- mands an intensity of effort, which none but sound minds in sound bodies can endure without exhaustion. There is everywhere over-ex- ertion of mind, without corresponding physical labor; there is effort to work the brain more and the body less; to speculate upon a small amount of borrowed capital, paying high interest, high rents, and meeting the requirements of society by making heavy sacrifices of mental tranquility, as well as of moral principle. In some walks of human industry, machinery has not yet superseded human muscles, and here we find that competition and surplus labor are ever at work in goading on the exhausted bodily powers to work against time, at over hours, or under such peculiar disadvantages as render the labor to be performed little less than a slave-like task of endurance. The hod-carriers, the coal-heavers and the factory chil- dren are wearing out their physical energies by excessive toil, and 412 DISEASES OF THE NERVOUS FUNCTION. many are endeavoring to drown mental anxiety by the use of stimu- lants ; and the barrister, the student, the editor and the author, who labor for twelve or sixteen hours per day, exhaust the powers of life in over-action of the brain, at the same time that they permit their physical powers to decline for want of exercise. In neither of these classes of persons are the deleterious effects witnessed due to physical or even to mental labor alone. Dr. Arnold, of Rugby, said, "It is not the work that injures a man, it is the vexation that does it." The labor alone might be performed without injury; but we now see it always performed under an intense pressure of emotional excitement. The men who perform the physical as well as mental labor are the subjects of restless thought; they are involved in hazardous speculations and momentous undertakings; and the sleepless hours of night, and the waking hours of anxiety by day, contribute continually to the increase of insanity observed in modern times. That this state of things will long continue, and the excessive excitement of the brain and nerves, to which all classes of our people are continually subject, will here- after increase the relative number of sufferers from this fearful disease, let us not presume to doubt. 2. Mental excitement, arising from moral, political, or pecuniary causes of anxiety, produce derangements of physical health, and these involve the brain and nervous system secondarily, if not primarily. 3. The tendency of the popular literature of our time is to cultivate a morbid activity of the imagination, which is far more injurious to physical and mental health than over-action of the reflective faculties. The reading as well as writing reflective works of fiction produce a temporary excitement, which is followed by depression; this state is succeeded by a re-actional pyrexia, much more exhausting to the vital powers than any degree of equable and continuous exertion of the reasoning faculties. Exercise of the reflecting powers upon tangible, attainable objects, whether in the investigation of questions of juris- prudence, philosophy or natural science have never caused insanity or shortened life. Of the last ten Lord Chancellors of England, begin- ning with Lord Thurlow, all lived to the average age of 76 years. The average age of the more distinguished English poets, from Spencer to Byron, was but 52. Thus musicians and poets die young. Philo- sophers and lawyers live to a greater age. Men of science, who at- tempt impossible objects, may become insane from over-effort of mind, as a machinist does in striving after the " perpetual motion." He strains his faculties to reach objects that are not in that way to be reached, while, like Hugh Miller, he exclaims : " My brain is burning!" The ambitious scholar destroys physical health in toiling for acquisi- tions he can never use. " The spirit of the times may be portrayed by an artist, as the unfortunate Kirke White, pursuing his nocturnal s. MONOMANIA. 413 study with a wet towel round his heated head, pale, faint, and trem- bling, lest his sands of life should run out before his insatiable appe- tite would be satisfied with acquisitions and praise." The effort to work the brain more and the body less, is a general cause of insanity at the present time. In every department of labor and business there is an intensity of mental effort to accomplish that which physical labor formerly toiled to perform. The mail-carrier of 1825, is de- scribed as " a merry, robust fellow, loaded with capes, top-boots, and driving at the rate of ten miles an hour." " He whistles as he goes, light-hearted wretch, Cold and yet cheerful—messenger of grief Perhaps to thousands, and of joy to some,— To him indifferent whether joy or grief." The mail-carrier of our time is " a pallid, meagre, sharp-visaged man, clad in a short blue jacket, and devoid of all superfluous clothing or impediment; but with a restless look that shows the rapidity with which he is accustomed to move, guiding hundreds through the air." This restless, reckless man, who directs the railway locomotive at the rate of thirty miles an hour is a type of the time of the ascendency of mind over matter. The man of capital is obliged to develop new powers and combina- tions of powers to enable him to compete with the numerous enter- prising and adventurous fortune worshippers who surround him. The laborer must work earlier and later ; and under this perpetual stir and agitation, the nervous systems of men and women generally are much more irritable than they were a quarter of a century ago; all the causes of insanity are thus, in the present day, on the increase. Miss Dix said, in 1860, that ten years ago she estimated the proper subjects for lunatic asylums at 1 per 1,Q00 of the population; now she estimates them at 1 to 490. The increase of insanity among American women is in part ac- counted for by the increasing number of household duties that the present demands of society impose upon women who are not able to employ a sufficient amount of domestic help. Civilization is defined as "the art of keeping up appearances." In the effort to keep up a good exterior, it is common to see the heart-broken and discouraged wife or widow, " lose in turn her appetite, her rest, and her strength; her nervous system becomes prostrated, and sinking under her burdens, she seeks rest in the lunatic asylum." The remote and predisposing causes of insanity are, in a large pro- portion of cases, traceable to " malign influences of childhood." Dr. Butler says: " When the duty of making home happy shall be better realized, we shall have in our land less of vice and crime, and much less of insanity. The neglect of physical training, and the imperfect 414 DISEASES OF THE NERVOUS FUNCTION. physical development consequent on this neglect, are strikingly evident among our female patients. The various causes of insanity usually classified under ' ill health, intense mental and bodily effort, grief, do- mestic unhappiness,' &c, may very frequently be traced, in their pri- mary influences, to the one cause of the want of physical stamina."* In a previous report the same physician says: " Not one girl in ten in these days enjoys really sound rugged health." For the correction of this state of things he knows no remedy but the enforcement through life of health-giving active exercise. This alone can give " strong, and vigorous health, perfect digestion, and no nervousness. An Eng- lish girl, accustomed to all weather and thick shoes, considers a half a dozen miles a trifling walk, and she takes it day after day. The ma- jority of American girls, with their thin shoes, would regard such a walk as nearly impossible."! Hereditary Predisposition,—Insanity is, of all diseases, most cer- tainly known to be hereditary; though the predisposition may not show itself in every family, or may not be developed into obvious dis- ease in many of its members. Though children often escape insanity, the hereditary susceptibility is seen in the grand children. It is be- lieved that the predisposition is more frequently inherited from the mother than the father. "I have seen in one hospital, two sisters from one family, and a brother and sister from another; also a father and his daughter. In New-York city there are cases of several insane in one family. I know a mother and daughter who have been in the Blackwell's Island Hospital; another daughter has been insane at times, another is always partially idiotic. They all inherit an eczema which produces insanity when it recedes to the brain." Idiosyncracy.—The word signifies an abnormal sensibility to dru»- action, or such relations to a certain drug as that drug produces in the prover symptoms that occur in no other person in a sensible degree, and which bear no analogy to the symptoms which others experience. Of such idiosyncracies we have examples in persons who are liable to attacks of " hay asthma" and " rose catarrh." As generally employed, the word idiosyncracy means only "sus- ceptibility unusually acute, but not abnormal sensibility." Some persons are peculiarly susceptible to certain influences, as to certain diseases. Some have a peculiar susceptibility to certain remedies, and may succeed in obtaining symptoms from it that others fail to perceive. Claude Bernard says, we may take it for granted that, not only mor- bid, but, also, physiological predispositions exist in man as well as in the lower animals. Even in the best health, in which the individual retains his own peculiar habit of body, he is more liable to some dis- * Report of the Hartford Insane Asylum, 1860. t Report of 1848. THEOMANIA. 415 eases than to others; and many conditions that are habitual to one individual can be mated with another, by bringing him down to a simi- lar state of health, and this is to be done by operation through the nervous system. The difference between different races of horses consists more in the difference between nerves than blood. An irritable, sensitive, highly organized nervous system is in fact the peculiarity which separates the race-horse from one of the diminutive ponies from the hilly countries. The difference between individuals may be naturally expected to be far more tensive in man than in other living beings. Hypnotism is a peculiar state which can only be produced in a small number of highly sensitive and nervous patients; and all the phenomena of somnambu- lism fall under a similar general rule. It is, therefore, evident, that idiosyncracies are only peculiar susceptibilities which exist in the normal state in various individuals. In conditions of disease, the vital powers of the living body are changed, so that medicinal agents and poisons do not produce the same effect that they do in health. In some diseases medicines, even in massive doses, have very little power: 1. Because absorption is almost suspended; and 2, because the nervous syst