r& '7* \ia SI ;3v •£ Jf . X ••«£*> •* "33 ^ 7 i - IL^Jk • »5r > ',"•£,* iO*> ->s>^>w?/Jp»- "ST** r*Slb MCTTSv ijefo^M* u>^» NATIONAL LIBRARY OF MEDICINE Bethesda, Maryland Gift of The National Center for Homeopathy eiftof i -*r-9-i<*r-\ LIBRARY OF THE NATIONAL CENTER FOR HOMOEOPATHY I **w*v< nOH I HOMEOPATHIC DOMESTIC MEDICINE. BY J. LAURIE, M.D, MEMBER OF THE ROYAL COLLEGE OF SURGEONS, EDINBURGH, SENIOR PHYSICIAN TO THE WESTMINSTER AND LAMBETH HOMCEOPATHlC MEDICAL INSTITUTION AND DISPENSARY. ARRANGED AS A PRACTICAL WORK FOR STUDENTS. CONTAINING A GLOSSARY OF MEDICAL TERMS. SIXTH AMERICAN EDITION, ENLARGED AND IMPROVED. A. GERALD HULL, M. D. NEW - YORK : WILLIAM RADDE, No. 322 BROADWAY. PHILADELPHIA:—BADEMACHER & SHEEK, 239 ARCH-ST. BOSTON:—OTIS CLAPP, 12 SCHOOL-ST. ST. LOUIS :—-'0. T. 'WESSELHOIFT. 185 0. LIBRARY OF THE NATIONAL CENTER FOR HOMOEOPATHY / 'J ENTERED According to Act of Congress, in the year 1847, by WILLIAM RADDE, In the Clerk's Office of the District Court of the United States for the South- ern District of New-York. fmJfc -. B. LudwiS & Co., Pointers, 53 Vesey-St, N.T. PREFACE TO THE AMERICAN EDITION. The editor recommends laymen who make use of this book, to resort to lower dilutions in the treatment of acute attacks of dis- ease in preference to those set down in the text. For example: where Aconite, Belladonna, or Chamomilla of the 24th or 30th attenuation, are prescribed by Dr. Laurie, the editor would put one drop of the tincture of either of these remedies in a tumbler full of water and give a tablespoonful at a time; but in chronic maladies the editor earnestly recommends the doses set forth in the text. The editor considers the tinctures,, and the first, second and third dilutions, when used in water, as nearly of the same medical power ; perhaps, however, it is best to put two or three drops of these di- lutions to the tumbler of water when they are applied in the place of the tinctures. When the triturations are contained in a medi- cine chest,—instead of the higher dilutions, which are preferred to them,—one grain of any of them can be dissolved in a tumbler of water, and used as above indicated. In general, it may be best to repeat the doses of these solutions at the same intervals of time as are prescribed in the work ; but the editor respectfully suggests, that in very severe cases of acute diseases, as in convulsions, or rapidly exhausting diarrhoea, or hemmorrhage, it is proper to make the intervals much shorter thanv the author prescribes. It is quite probable that the water solutions can be repeated at shorter intervals, cceteris paribus, than the pel- lets or powders; and for this reason physicians often dissolve the pellets themselves in water, and repeat the spoonful doses twice or thrice as frequently as they would give them dry. iv PREFACE TO THE AMERICAN EDITION. The editor's mode of using this work in acute diseases, then, is to put one drop of the tincture, or two drops of a first, second, o third dilution, into a tumbler of water, and to administer of this so- lution a tablespoonful to an adult, and a teaspoonful to a child as a dose. Or, again, when a trituration (a dry powder) is preferred, to stir one-third of an ordinary penknife blade full (about equal to one grain in weight) of it in a tumbler of water, and use the same doses. And finally, when the pellets are good, and are preferred by the prescriber, the editor recommends that five or six of them be dis- solved in a tumbler of water, and that they be repeated twice as frequently, as a general rule, as the dry pellets are ordered in the text. The water should be very pure, and the glasses and spoons should be scrupulously cleansed before using them for medicines. In all instances of additions made to this volume by the Ameri- can editor (as, indeed, with all the foreign works edited by him), where he has not specified his own experience or given the au- thorities, he wishes to be understood to have compiled the same from the best practical results of the school at large, without formal signs of quotation, A. G. H, PEEFACE TO THE THIRD EDITION. From the favourable reception, and the rapidity of sale, of the last Edition, the Author at first contemplated making little or no al- teration in the contents of the present one, concluding that the afore- named circumstances might be held as satisfactory indications that the work had been found sufficiently copious for domestic purposes. As, however, on the preceding occasion, he entered upon the ex- periment of bringing out the work in such a form, that it might prove of some slight service to the medical man commencing to make a practical inquiry into the homeopathic system, and having since had reason to determine that his hopes have not been dis- appointed, he has on that account been induced to change his ori- ginal intention, and will feel amply rewarded for the additional labour which he has bestowed, should he thereby be the means of leading an increased number of his professional brethren to become converts to. the all-important reformation in medicine effected by Hahnemann. In compiling this and the past editions, the Author has derived considerable aid from Jahr's 'Manual' (Nouveau Manuel de Mede- cine Homceopathique), and Hartmann's Acute and Chronic Diseases, as also from Constantine Hering's 'Hausarzt,' or Domestic Physician. It being impossible to give minute and infallible directions for the treatment of all the various forms that diseases, even of daily occurrence, are so liable to assume, the author has added, at the termination of most of the chapters, a few of the medicines which the medical reader may, in many cases, either complicated or otherwise, find useful to refer to in the Materia Medica and Chro- nic Diseases of Hahnemann,—which every student who wishes to acquire a proper knowledge of Homoeopathy ought to possess, and make a constant habit of carefully studying and consulting, if he wish to avoid falling into an indolent and unsafe method of practice. J. L. 12 Lower Berkeley Street, Portman Square. 1* PREFACE TO THE SECOND EDITION. In offering to the public a Second Edition of this work, of which an impression of upwards of one thousand copies has been sold in less than eighteen months, the Author feels that a few words of explanation are required. On a comparison with the first edition, the reader will find a great number of serious and acute affections added, some others more deeply entered into, several alterations in the potencies prescribed, and more explicit directions given for the administration and repe- tition of the different remedies. When the Author first committed this work to the press, it was simply intended to be, what its name implied, a Treatise on Do- mestic Medicine, by which individuals might be enabled to treat themselves or their families in slight affections, or even, in case of necessity, in more serious diseases, subject to the restriction men- tioned in the preface to that edition. Since that time, however, the Homoeopathic system has been daily attracting more attention from the medical world, and the want of a work which might serve for a practice of Physic for beginners, has been repeatedly a sub- ject of complaint. In order partially to supply this want, the Au- thor has materially added to the number of diseases treated, and prescribed the potencies found most useful in practice in the more severe forms of disease ; he has also given the book a more medi- cal character by the addition of the diagnosis of disease, causes, &c, and the employment of medical terms ; but in order not to interfere with the utility of the work, a glossary has been added for the non- professional reader. The non-medical public who confine themselves to their proper sphere, viz., the treatment of slight and ordinary ailments, will still find this Treatise useful as a Domestic Medicine : in such cases the globules at medium and high potencies are amply sufficient. It may be remarked, moreover, that the globules are much better adapted for keeping than the tinctures, and, with proper precautions will retain their medicinal virtues for many years. At the request of several friends, directions have been given PREFACE. Vll for the administration and repetition of the medicines in each disease ; some remarks, also, are made upon this important point; in the Introduction, to which, and the article upon the Potencies of the medicine, the attention of the reader is particularly re- quested. PREFACE TO THE FIRST EDITION. In presenting this little work to the public,, the Author may be allowed to state, as briefly as possible, the motives that have led him to the undertaking. Of these, the principle are, the present paucity* of homoeopathic practitioners ; the refutation, by a plain statement of the treatment of acute disease, of the too prevalent idea, that Homoeopathy is available only in Chronic affections ; and the hope that this work may, under proper restrictions, prove of service in cases of ordina- ry derangement, or where the advice of a homoeopathic physician is unattainable ; and by assisting in the selection of the proper re- medy, save many from having recourse to allopathic modes of re- lief, such as aperients, &c, which are so calculated to undermine the strongest constitution, and convert trifling affections into per- manent maladies. From' the first-mentioned motive, (the present want of homoeo- pathic practitioners,) the Author has found himself compelled to include many acute diseases, which fall more particularly within the province of the physician ; in so doing, he has given a range of treatment that will meet a great variety of cases, and in almost all so far obviate immediate danger, and place the malady in such a position, as to give time, when imperatively necessary, for seeking suitable advice. In cases that require prompt and decided measures, such as " Convulsions," " Croup," &c, the treatment has been pretty fully * I have sincere gratification in remarking, that even since the first publication of this work, this want has been, to some extent, diminished, by the great number of medical converts who are daily joining our ranks, and whose extensive practice, wherever they have settled holds out most cheering prospects for the future. Still, in many of the great towns and densely-populated districts of this empire, as well as in our possessions abroad, a homoeopathic practitioner would be eagerly welcomed. Much has been, but more remains to be done.—Author. viii PREFACE. gone into. In others, such as " Inflammation of the Brain and Lungs," the course to be pursued to ward off all immediate danger, has been briefly, but it is to be hoped, clearly pointed out. .Other acute or dangerous maladies, such as " Puerperal Fever," " Phleg- masia Alba Dolens," (puerperal tumid leg,) " Epilepsy," " Can- cer," &c, have been slightly glanced at, or wholly omitted; con- vinced, that to do justice to their several treatments, would carry the work far beyond its intended limits and purpose, and that an imperfect sketch would be rather productive of injury than benefit. In many instances Domestic Medicines do considerably more harm than good, by inducing individuals to rely too fully upon their own resources, and to omit having recourse to those who have made the diseases of mankind their peculiar study ; but still greater injury results from an ill-regulated perusal of elaborately written medical works, which require the previous education of the physician fully to comprehend, and his practical experience properly to apply. To the Student, still at the threshhold of our science—to the Allopathist, willing by fair experiment to put the system to the test—it is hoped that this little work may prove peculiarly valu- able. It may be here remarked, that the beautiful simplicity and har- monious uniformity of the homoeopathic system, conjoined with its invariable rule of administering only one medicinal substance at a time, have misled many into the idea, that it is so much easier of practice than the old system, as scarcely to require the qualification of a medical education : acting upon these false premises, many amateurs, after having studied a few of the leading medicines, al- though wholly destitute of other physiological or pathological knowledge, imagine themselves qualified to prescribe for every va- riety of ailments, and their presumption is generally in exact ratio wilh their ignorance. No doubt, from the inherent excellence of the system, some of these zealous individuals have cured diseases that have defied allopathic mode: but generally, from the absence of a medical education, and of a perfect knowledge of the Materia Medica, by a circuitous route ; whereas the practised mind of the physician, frequently detecting the exact nature of the disease, and at all times carefully discriminating the primary from the purely sympathetic, or secondary symptoms, is thereby enabled to make a more ready selection of a specific remedy, and save the patient from a course of needless suffering. If such be the case in Chronic, how much more so in severe PREFACE. *x and complicated Acute diseases ; such, it is evident, no individual, not fully competent, should take upon himself the serious responsi- bility of treating, unless coerced by an imperious necessity, and then with the closest attention to, and most minute observance of, the symptoms. Under such conditions, the Author hopes that this work may prove useful; and when the symptoms are perfectly in accordance with those given under the different medicines, the administration of the latter will be always marked with decided benefit. In conclusion, it may be observed that from the unfair impres- sions of the science, that have been so industriously propagated, Homoeopathy has been too frequently treated as a species of char- latanism, to which people resort only when every other mode of promised relief has utterly failed. After enduring with patience a long and ineffectual treatment under the old system, they feel dis- appointed if Homoeopathy does not work an immediate cure ; nay, in acute diseases, when danger appears to threaten, some indivi- duals fall back upon allopathic measures, and undo all that the Homoeopathic has affected: perhaps again seeking his assistance when the mischief has been rendered irremediable by their own fa- tuity. Others, who have seen members of their families (whose diseases were beyond the power of medicine) die during homoeo- pathic treatment, reproach the science with failure ; whereas their minds would have felt perfectly satisfied, had such a misfortune occurred under the old system ; forgetting that, in many instances, the patient only sought Homoeopathy as a last resource, in cases where the affection was of its own nature incurable, or had been rendered so by a long course of improper treatment. What Homoeopathy stands upon, is the simple fact of success in thousands of cases, in which every other mode has signally failed— upon the firm and irrefragable basis of a multitude of unimpeach- able and uncontrovertible proofs. - WILLIAM RADDE, 322 Broadway, New-York, Respectfully informs the Homoeopathic Physicians, and the friends of the System, that he is the sole Agent for the Leipzig Central Homceopathic Pharmacy, and that he has always on hand a good assortment of the best Homoeopathic Medicines, in com- plete sets or by single vials, in Tinctures, Dilutions, and Triturations ; also Pocket Cases of Medicines ; Physicians' and Family Medicine Chests to Laurie's Domestic (CO Remedies)—EPPS' (58 Remedies)—HERING'S (82 Remedies).—Small Pocket cases at $3, with Family Guide and 27 Remedies.—Cases containing 415 Vials with Tinctures and Triturations, for Physicians.—Cases with 240 Vials of Tinctures and Tri- turations to Jahr's New Manual.—POCKET CASES with 60 Vials of Tinctures and Triturations.—Cases from 200 to 400 Vials with low and high dilutions of Medicated Pellets.—Cases from 50 to 80 Vials of low and high dilutions, &c, &c. Homoeopathic Chocolate, Refined Sugar of Milk, pure Globules, &c. Arnica Tincture, the best spe- cific remedy for bruises, sprains, wounds, &c. Arnica Plaster, for Corns, Src. Urtica Urens, for Burns; Homoeopathic Tooth-Powder ; as well as Books, Pamphlets, and Standard works on the System, in the English, French, and German languages. HOMOEOPATHIC BOOKS. JAHR'S NEW MANUAL OF HOMOEOPATHIC PRACTICE, Edited, with anno- tations by A. Gerald Hull, M. D., from the last Paris edition. This is the fourth American edition of a very celebrated work, writen in French, by the eminent Homceopathic Prolessor Jahr, and it is considered the best practical compendium ol this extraordinary science that has yet been composed. After a very judicious and instructive introduction, the work presents a table of the Homceopathic Medicines, with their names in Latin, English, and German; the order in which they are to be studied, with their most important distinctions, and clinical illustrations of their symptoms and effects upon the various organs and functions of the human system.—Tlie second volume embraces an elaborate analysis of the indications in disease, of the medicines adapted to cure, and a glossary of the technics used in the work, arranged so luminously as to form an admirable guide to every medical student. JAHR'S NEW MANUAL ; originally published under the name of Symptomen- Codex. (Digest of Symptoms-.) This work ;is intended to facilitate the comparisons of the practitioner to discover the characteristic symptoms of each drug, and to determine with ease and correctness what remedy is most homceopathic to the existing group of symptoms. Translated by Charles Julius Hempel, M. D., assisted by James M. Q_uin, M. D. ; with revisions and clinical notes by John F. Gray, M. D.; with contributions by Drs. A. Gerald Hull, and George W. Cook, M. D., of New-York; and Drs. C. Hering, J. Jeanes, C. Neiuhard, W. Williamson, and J. Kitchen, of Philadelphia. Wilh a preface by Coustantine Hering, M. D. 2 vols. $11 00. • HAHNEMANN'S ORGANON, by Chs. Hempel, M. D. $1. RAU'S ORGANON. Translated by C. J. Hempel, M. D. $1 25. BECKER, M. D. On Consumption. Translated from the German. 1848. 38 cts. -------- On Diseases of the Eye. 1848. 38 cte. --------On Constipation. 1848. 38 cts. --------On Dentition. 1848. 38 cts. HEMPEL'S BOENNINGHAUSEN for Homceopathic Physicians. $1 75. HARTMANN'S ACUTE AND CHRONIC DISEASES, by Chs. Hempel, M. D. 4 vols, $6 00. JAHR, G. H. G., M. D. Short Elementary Treatise of the most important effects of ten of the principal Homoeopathic Remedies. Translated by Edward Bayard, M. D. Bound, 38 cts. _ HAHNEMANN, Dr. S. Materia Medica Pura. Translated and edited by Charles' Julius Hempel, M. D. 4 vols. 1846. $6. HAHNEMANN, Dr. S. The Chronic Diseases, their specific nature and Homceo- pathic Treatment. Translated and edited by Charles J. Hempel, M D., with a Preface by Constantine Hering, M. D., Philadelphia. 8vo. 5 volumes. Bound. 1845. $7. BOSNNINGHAUSEN'S Essay on the Homoeopathic Treatment of Intermittent Fevers. Translated and edited by Charles Julius Hempel, M. D. 1845. 38 cts. A TREATISE on the use of Arnica for Contusions, Wounds, Strains, &c. 19 cts. HOMOEOPATHIC COOKERY, second edition. Designed chiefly for the use of such persons as are under homceopathic treatment. 50 cts. RUECKERT'S THERAPEUTICS; or Successful Homceopathic Cures, collected from the best Homceopathic perimluals. I5v Chs. J. Hempel, M. D. Onelarge8vo. vol. $3. THE HOMCEOPATHIC EXAMINER. By Drs. Gray and Hempel. 2 vols. New Series. 1846 and 1847. Bound in i wo'volumes, $6. JOSLIN, B. F., M. D. Causes and Homoeopathic Treatment on Cholera. 50 cts. HUMPHREY'S, F., M. D. The Cholera and its Homoeopathic treatment. 38 cts. Just published: MARCY, E. E., M. D. The Homceopathic Theory and Practice of Medicine. 1850. Bound $2. 00. JAHR, BUCHNER and GRUNER'S New Homoeopathic Pharmacopcea and Poso- logy. Translated by C J. Hempel, M. D. $2 00. JAHR'S Diseases of the Skin : or alphabetical Repertory of the Skin Symptoms and external alterations of Substance. With Pathological Remarks on the Diseases of the Skin. By Dr. A.G. Jahr. Edited by C. J. Hempel, M. D. Price $1. JOSLIN, B. F., M. D. Principles of Homceopathia. In a series of Lectures. 75 cts. CONTENTS. PART I. INTRODUCTION. PAGE Regimen ..... 1 Clothing and Habits ..... 4 Potencies of the Medicaments . . . .5 Administration and Repetition of the Medicines , 9 Pharmaceutical Signs . . . . .12 Synopsis of the Rules for Diet . . . 14,20 PART II. ON THE SYMPTOMS, CHARACTER, DISTINCTION, AND TREATMENT, OF DISEASES. FEVERS. General consideration of Fever, &c. Causes . .... General Treatment and Diet Simple or Ephemeral Fever, Febris simplex Inflammatory Fever. Synocha Nervous Fever. Febris nervosa. Typhus Congestive Fever .... Putrid Fever, or Typhus. Typhusputridis Contagious Fever, or Typhus. Typhus contagiosus Accessory Treatment {during typhus). Prophylaxes, &c. Intermittent Fevers. Ague. Febres intermittentes 17 19 20 20 22 24 26 36 37 38 39 ERUPTIVE FEVERS. Scarlet Fever, Scarlatina : . 48 Purpura rubra . . • • • .55 Scarlatina Miliaris . . • . ib. Scarlet Rash . . . • • . ib. Measles. Rubeola . . . s 59 Smallpox. Variola . . . • .63 Chicken-pox. Variola spuria, Varicella ... 71 Miliary Fever. Miliaria . . . • s 72 Nettlerash. Urticaria . .... 75 DISEASES OF ORGANS CONNECTED WITH THE DIGESTIVE SYSTEM. Toothache ...... 77 Sore Throat, or Quinsy. Angina ... 81 CONTENTS. Ulcerated Sore Throat. Angina maligna Mumps. Parotitis. Angina parotidea Bilious Complaints Indigestion. Dyspepsia Want of Appetite. Apepsia. Anorexia . Derangement of the Stomach, Eructations, &c. Flatulence .... Spasms of the Stomach. Gastrodynia, Cardialgia Heartburn. Pyrosis Vomiting of Blood. Hematemesis Constipation. Obstructio Alvi Piles. Hemorrhoids Protrusion of the Intestine. Prolapsus Ani Colic. Enter algia Looseness of the Bowels. Diarrhoza Dysentery. Dysenteria Suppressed Dysentery Cholera ..... ------- Asiatic Cholorine .... Liver Complaint Acute Inflammation of the Liver. Hepatitis Liver Complaint. Hepatitis chronica Jaundice. Icterus Inflammation of the Spleen. Splenitis Inflammation of the Stomach. Gastritis Chronic ditto. Gastritis Chronica Inflammation of the Bowels. Enteritis Inflammation of the Peritoneum. Peritonitus Inflammation of the Kidneys. Nephritis. Inflammation of the Bladder. Cystitis Worms. Helminthiasis . 89 93 . 95 ib. . 101 107 . 110 112 . 119 119 . 123 128 . 132 133 . 137 141 . 148 149 . 152 155 . ib 156 . 160 161 . 162 165 . 168 168 . 175 177 . . 180 181 DISEASES OF ORGANS CONNECTED WITH THE RESPIRATORY SYSTEM. Catarrh, or Common Cold ..... 187 Hoarseness. Raucitas ... . 191 Chronic Laryngitis. Laryngitis chronica . . . 193 Cold in the Head . . . . ib. Cough . . . . . .ige Hooping-cough. Tussis convulsiva . 204 Croup. Angina membranacea .... 210 Influenza ...... 219 Determination of Blood to the Chest. Congestio ad Pectus . 221 Inflammation of the Mucous Membrane of the Bronchial Tubes. -----Bronchitis ..... 225 ------Bronchitis chronica ..... 232 Inflammation of the Lungs. Pneumonia, Peripneumonia, Pneumo- m'**» ••..-. 234 CONTENTS. Xlll Pneumonia Notha Occulta .-,... 239 Typhoid, or Congestive Pneumonia .... 240 Consumption, or Incipient Phthisis .... 241 Inflammation of the Pleura. Pleurisy, Pleuritis . . 242 Pleurodynia. Pseudo-Pleuritis ..... 251 Spitting of blood. Hamoptysis .... 252 DERANGEMENTS OF THE CEREBRAL SYSTEM. Determination of the Blood to the Head. Congestio ad Caput . 260 Apoplexy. Apoplexia ..... 266 Inflammation of the Brain and its Tissues. Brain Fever. Phrenitis Encephalitis ...... 271 Tetanus ...... 276 CUTANEOUS DISEASES. St Anthony's Fire. Rose. Erysipelas . 280 Boil. Purunculus . ..... 283 Carbuncle. Anthrax. Furunculus malignans. Pustula nigra 285 Chilblains. Perniones . . . . ib. Corns. Clavi Pedis ..... 287 Abscess ....... 288 Itch. Scabies ...... 291 Whitlow. Panaris. Paronychia .... 293 Irritation of the Skin ..... 294 Ringworm. Herpes circinnatus ..... 296 Ringworm of the Scalp ..... 297 Ulcers . . . . 301 GENERAL DERANGEMENT OF THE SYSTEM. Gout. Arthritis ..... 307 Rheumatism. Rheumatismus ..... 310 Lumbago ...... 314 Inflammation of the Psoas Muscle. Psoitis . . 315 Sciatica ....... 316 Pain in the Hip. Goxalgia, coxagra .... 318 Hip-disease. Morbus coxarius . . . 320 Determination of Blood to the Abdomen. Congestio viscerum abdomi- nis, congestio ad abdomen ..... 323 Acute Inflammation of the Eyes. Ophthalmitis . 324 Short Sight. Myopia . . . . .331 Swelling of the Lip ..... ib. Scirrhus . . . ib. Warts on the Face ..... 332 Hordeolum, Stye . . . . . . ib. Inflammation of the Ears, and Ear-ache. Otitis, otalgia . 333 Bleeding of the Nose. Epistaxes .... 337 Swelling of the Nose . . . . .340 Canker of the mouth. Cancrum oris .... 343 Scurvy. Scorbutus . 345 XIV CONTENTS. Inflammation of the Tongue. Glossitis Offensive Breath Face-Ache Feuralgia Facialis Palpitation of the Heart Cramp in the Legs .... Goitre . . . . * . Sweating Feet . ... Sleeplessness. Agrypnia Nightmare. Incubus .... Acute inflammation of the Spinal Cord and its Membranes. Palsy. Paralysis .... Rupture. Hernia .... Fainting. Swooning. Syncope . . . Headache. Cephalalgia .... Pains in the Loins. Notalgia Delirium Tremens Potatorum Epilepsy. Epilepsia Asthma ..... Myelitis , 346 . 348 349 . 351 352 . ib. 353 . 354 357 358 . 361 ib. . 367 370 . 391 ib. . 394 395 CASUALTIES. Concussion, Bruises, Sprains, and Wounds, &c. Burns and Scalds Fatigue Stings of Insects Sea-Sickness Apparent Death. Asphyxia Hydrophobia . . Poisons . Mental Emotions 403 417 419 420 420 422 426 434 438 PART III. TREATMENT OF INFANTS AND CHILDREN, AND OF THEIR PECULIAR AFFECTIONS. Introductory remarks Treatment After Birth Asphyxia Swelling of the Head Navel Rupture in Infants Meconium, Expulsion of Suckling of the Infant Choice of a Nurse Diet during Nursing Supplementary Diet of Infants Duration of Suckling and Weaning Sleep. Sleeplessness Exercise 441 442 443 444 ib. 445 446 448 ib. 449 451 452 455 CONTENTS. XV DISEASES OF INFANCY. Inflammation of the Eyes in New-born Infants Hiccough • Cold in the Head . . • ■ Crying and Wakefulness . Regurgitation of Milk • Spasmodic Asthma Milk Crust • Thrush or Aphth* . Constipation. Obstructio alvi neonatorum . Bowel Complaints. Diarrhaa neonatorum Excoriation. Excoriatones neonatorum: Jaundice. Icterus neonatorum Induration of the Cellular Tissue. Erysipelas neonatorum Lockjaw of Infants. Trismus nascentium Derangement during Teething Convulsions in children . . • • Water in the Head. Hydrocephalus Asthma of Millar . The Rickets. Rachitis Infantile Remittent Fever Atrophy. Atrophia . . ■ - Vaccination . • ■ 458 458 459 460 462 463 464 466 467 468 474 474 475 476 478 480 484 493 494 PART IV. TREATMENT OF FEMALES AND THEIR PECULIAR AFFECTIONS. Chlorosis. Emansio mensium • • • • Amenorrhcea. Suppressio mensium Amenorrhagia . Dysmenorrhea . . • • • Hysterics. Hysteria . ■■ - ■ OBSERVATIONS ON PREGNANCY. Introductory remarks • • Air and Exercise . Clothing • Diet .-• . . . ■ Employment of Mind and Habits . Influence of External Objects upon the unborn Infant Mental Emotions . DERANGEMENTS DURING PREGNANCY. Menstruation . . Morning Sickness ...••• Constipation ..•••>■ Diarrhoea ...•••■ Fainting and Hysteric Fit* • 495 498 499 501 501 503 505 506 508 ib. 509 ib. 511 512 513 ib. 514 XVI CONTENTS. Toothache Swelled Face Pains in the Back OBSTACLES TO SUCKLING. Disinclination of the Infant Excoriation of the Nipples Inflammation of the Breast Mental Emotions affecting the Milk Deficiency in the Secretion of Milk Deterioration and Discoloration of Milk Mothers not suckling their Children Glossary Index .... 515 516 Swelled Veins. Varices .... 517 518 Miscarriage. Abortus . . ib. TREATMENT BEFORE PARTURITION. Preparation of the Breasts . . . . • 524 Remedies before Labour ; 525 False Pains . . . . .526 Parturition ...... 528 Tedious or complicated Labours .... 528 Spasmodic Pains, Cramps, and Convulsions . . . 531 TREATMENT AFTER DELIVERY. Introductory remarks ...... 532 After-pains ...... 534 Duration of Confinement ..... 535 DISEASES FOLLOWING PARTURITION. Suppressed Secretion of Milk . . . 536 Excessive Secretion of Milk ... 537 Perspiration after Delivery ..... 538 Milk Fever . . . .540 Irregularities of the Lochial Discharge ... 540 Diarrhoea in Lying-in Women ... 541 Abdominal Deformity .... 542 Falling off of the Hair ..... 543 Leucorrhoea after Parturition . . . ib. Internal Uterine swelling and Prolapsus 543 Weakness after Delivery ..... 544 545 546 547 548 548 549 ib. 550 562 N. B.—^o 0r °j>, indicates: three globules of the third, or two globules of the thirtieth dilution. TABULAR INDEX OF THE MEDICINES, THEIR ABBREVIATIONS, SYNONYMES, AND ANTIDOTES.* Ac-hydr.—Acidum hydrocyanicum. Prussic acid. (Ammon-carb. Camph. Ipecac. Coff. Opium.) Ac-m.—Acidum Muriaticum. Muriatis Acidum, s. Hydrochloricum. Mu- riatic acid. (Camph. Bryonia.) Acon.—Aconitum napellus. Aconite. Monk's Hood. (Camph. Nuxvom. Wine, Vinegar, Paris.) Ac-sulph.—Acitum Sulphuricum, s. Sulphuris Acidum vitrioli. Sulphu- ric acid. Vitriolic acid, Oil of Vitriol. (Pulsatilla.) Alum.—Alumina. Argilla Pura. Aluminum oxydatum. Alumine (Bry- onia, Camph. Chamom. Ipecac.) Am-c.—Ammonium Carbonicum. Carbonas (sub) ammonii. Sal volatile Carbonate of Ammonia. (Arnica. Camph. Hepar sulph.) Am-caust.—Ammonium Causticum. Caustic Ammonia. (Dilute Vinegar.) Am-m.—Ammonium muriaticum. Murias, s. Hydrochloras Ammonii, Sal Ammoniacum. Muriate of Ammonia. Hydrochlorate of Ammonia, Sal Ammoniac. (Camph. Hepar sulph.) Ant-c— Antimonium Crudum. Stibium Sulfuretum Nigrum. Antimonii Sulfuretum. Crude Antimony. Sulphuret of Antimony. (Hepar sulph. Mercur.) Arn.—Arnica Montana. Arnica. Leopard's Bane. (Camph. Ignatia Ipecac. Ars.—Arsenicum Album. Acidum Arseniosum. Sesquioxide Arsenic.— White Arsenic. (China. Ferrum met. Graph. Hepar. Ipecac. Kali carb. Nux vom. Samb. Verat.) Aur.—Aurum Foliatum. Leaf Gold. (Bellad. China Cuprum met. Mercur.) Bar-c.—Baryta Carbonica. Carbonas (sub) Baryta? Carbonate of Baryta. (Camph.) Bell.—Belladonna. Atropa Belladonna. Deadly Nightshade. (Coffea. Hyosc. Hepar. Palsat.) Bov.—Bovista. Lycoperdon Bovista. Puff-ball. (Camph.) Brom.—Brominium. Bromine. (Coffea. Opium Camph.) Bry.—Brionia Alba. White Bryony. (Acon. Chamom. Ignat. Nux-vom.) Calc-c—Calcarea Carbonica. Calcis Carbonas. Carbonate of Lime. (Camph. Nitr.ac. Nitr. spir. Sulph.) Can.—Cannabis Sativa. Hemp. (Camph.) Canth.—Cantharis. Cantharis Vesicatoria, Meloe Vesicatorius. Cantha- rides. Lytta Vesicatoria. Spanish Blistering Fly. (Camph.) * The antidotes are in parenthesis, as : (Ammon-carb. Camph.) xviii TABULAR INDEX. Cap.—Capsicum Annuum. Cayenne, Capsicum, or Guinea Pepper. (Camph.) Carb-a.—Carbo Animalis. Animal Charcoal. (Camph.) Carb-v.—Carbo Vegetabilis. Carbo Ligni. Wood Charcoal. (Arsen. Camph. Coffea. Loch.) Caust.—Causticum. (Tinctura acris sine kali.) Caustic. (Coffea. Colo- cyn. Nitr. spir. Nux vom.) Cham.—Chamomilla. Matricaria Chamomilla. Wild Chamomile. (Acon. Coccul. Coffea Ignat. Nux vom. Pulsat) China. Cinchona Officinalis. Chinse Cortex. Quinquina. Yellow Bark. (Arnica. Arsen. Bellad. Calcar. Carb. veg. Ipecac. Sulph.) Cic—Cicuta Virosa. Water Hemlock. (Arnica. Tabacum.) Cina. Artemisia Santonica. Worm Seed. (Ipecac.) Cocc.—Cocculus. Menispermum Cocculus, Cocculus Indicus, Cocculus Tuberosus. Indian Berries. (Camph. Nux vom.) Coff.—Coffea Cruda. Coffea Arabica. Mocha Coffee Berries. (Acon. Cham. Nux vom} Colch.—Colchicum. Colchicum Autumnale. Meadow Saffron. (Nux vom. Coccul. Pulsat.) Coloc.—Colocynthis. Cucum's Colocynthis. Bitter Cucumber, Colocynth. (Camph. Caust. Coffea. Chamom.) Con.—Conium. Conium Maculatum. Hemlock. (Coffea. Nitr. spir.) Croc.—Crocus. Crocus Sativus. Saffron. (Opium.) Cupr.—Cuprum Metallicum. Copper. (Bellad. China. Ipecac. Mer- cur. Nux vom.) Cupr-a.—Cuprum Aceticum. Acetas Cupri. Acetate of Copper. (Bellad. Calc. carb. China. Coccul. Ipecac. Mercur. Nux vom.) Dig.—Digitalis Digitalis Purpurea. Common Foxglove. (Nux vom. Opium.) Dros.—Drosera. Drosera Rotundifolia. Round-leaved Sun Dew. (Camph.) Dulc—Dulcamara. Solanum Dulcamara. Bitter Sweet, Woody Night- shade. , (Camph. Ipecac. Mercur.) Euphr.—Euphrasia. Euphrasia Officinalis. Eye-bright. (Pulsatilla.) Ferr.—Ferrum. Ferrum Metallicum. Pure Iron. (Arnica. Arsen. Bellad. Ipecac. Mercur. Pulsat.) Fer-ac—Ferrum Aceticum. Ferri Acetas. Acetate of Iron. (Arsen. Bellad. Mercur. Nux vom.) Graph.—Graphites. Plumbago. Pure Black Lead. (Arsen. Nux vom. Vinum.) Hell—Helleborus Niger. Black Hellebore, Christmas Rose. (Camph. China.) Hep s.—Hepar Sulphuris. Hepar Sulphuretum. Sulfuretum Calcis. Liver of Sulphur, Sulfuret of Lime. (Acetum. Bellad.) Hyos.—Hyoscyamus. Hyosciamus Niger. Henbane. (Bellad. Camph. China.) Hyper.—Hypericum Perfoliatum. (Mesmerism.) TABULAR INDEX. xix Ign.—Ignatia Amara. Strychnos Ignatia. Faba Ignatia. St. Ignatius' Bean. (Pulsat. Chamom. Coccul. Arnica. Camph. Vinegar.) Iod.—Iodium. Iodine. (Arsen. Camph. Coffea. Phosphor. Sulph.) IPEC.—Ipecacuanha. Cephaelis Ipecacuanha,Ipecacuanha Root. (Arnica, Arsen. China.) Jal.—Jalappa. Convolvulus s. Ipomoea Jalappa, Ipomoea Macrorrhiza. Jalap. (Camph.) Kali-b.—Kali Bichromatum. Bichromate of Potash. Lach.—Lachesis. Trigoncephalus Lachesis. Lance-Headed Serpent, (poison of the). (Alum. Arsen. Bellad. Nux vom. Rhus tox.) Led.—Ledum Palustre. Rosmarinus Sylvestris. Wild Rosemary, Marsh Tea. (Camph.) Lyc—Lycopodium. Lycopodium Clavatum. Lycopodii Pollen. Club Moss. Wolf's Claw. (Camph. Pulsat.) Magn.—Magnesia Carbonica. Carbonas (sub) Magnesia?. Carbonate of Magnesia. (Camph.) Merc—Mercurius Solubilis. Mercurius Hahnemanni. Black Oxide of Mercury. (Arnica. Bellad. Camph. Hep. sulph. Iod. Laches. Sulph.) Merc-v.—Mercurius Vivus. Hydrargyrum. Quicksilver. (Vide Mer- curius Solubilis.) Mez.—Mezereum. Daphne Mezereum. Mezereon. (Camph. Mercur.) Mosch.—Moschus. Moschus Moschiferus. Musk. (Camph. Nux mosch.) Natr-c—Natrum Carbonicum. Carbonas (sub) Sodae. Carbonate of Soda. (Arsen. Camph.) Natr-m.—Natrum Muriaticum. Murias Sodae. Hydrochlorate of Soda. (Arsen. Camph. Nitr. spir.) Nit-ac—Nitri Acidum. Acidum Nitricum. Nitric acid. (Cede. Carb. Co- nium. Camph. Hep. sulph. Sulph.) Nux-v.—Nux Vomica. Strychnos Nux Vomica. Nux Vomica. (Acon. Camph. Coffea. Pulsat.) Op. —Opium. Papaver Somniferum. Opium. White Poppy. (Camph. Calc. carb. Hep. sulph. Mezer. Sulph.) Petr.—Petroleum. Rock Oil. (Acon. Nux vom.) Plumb.—Plumbum Metallicum. Lead. (Alum. Bellad. Hyosc. Opium.) Phosph.—Phosphorus. Phosphorus. (Camph. Coffea. Nux vom.) Phosph-a.—Phosphori Acidum. Acidum Phosphoricum. Phosphoric Acid. (Camph. Coffea.) Plat.—Platina. Platinum. (Pulsat.) Puls.—Pulsatilla. Anemone Pratensis. Meadow Anemone. Pasque Flower. (Cham. Coffea. Ignat. Nux vom.) Rhab.—Rhabarbarum. Rheum. Rhubarb. (Camph. Cham. Nux vom.) Rhus-t.—Rhus Toxicodendron. Sumach. Poison Oak. (Bellad. Bryan. Camph. Coffea. Sulph.) XX TABULAR INDEX. Sabad.— Sabadilla. Veratrum Sabadilla. Caustic Barley. (Camph. Pulsat.) Sabin.—Sabina. Juniperus Sabina- Savine. (Camph.) Samb.—Sambucus. Sambucus Niger. Elder. (Arsen. Camph.) Squil.—Squilla. Scilla Maritima. Squill. (Camph.) Sec—Secale. Secale Cornutum. Ergot of Rye. (Camph. Opium.) Seneg.—Senega. Seneca. Snake Root. (Arnica. Bellad. Bryan. Camph.) Senn.—Senna. Cassia Senna. Senna. (Chamom.) Sep.—Sepia. Sepia Succus. Inky juice of the Scuttle Fish. (Acon. Nitr. spir. Vinegar.) Sil.—Silicea. Silex. Siliceous Earth. (Camph. Hepar. sulph.) Spig.—Spigelia. Spigelia Anthelmintica, Indian Pink. (Camph. Aurum.) Spong.—Spongia. Spongia Usti. Spongia Marina Tosta. Burnt Sponge. (Camph.) Stann.—Stannum Pure Tin, (Coffea. Pulsat.) Staph.—Staphysagria. Delphinium Staphysagria. Stavesacre. (Ambra. Camph.) Stram.—Stramonium. Datura Stramonium. Thorn Apple. (Bellad. *Nux vom.) Sulph.—Sulphur. (Acon. Camph. Mercur. Nux vom. Pulsat.) Sulph-t.—Sulphutis Tinctura. Spiritus vini Sulphuratus. Tincture of Sulphur. (Vide Sulphur.) Ther.—Theridion Curassavicum. Black Spider of Curacoa. (Camph.) Tart-e.—Tartarus Emeticus s. Stibiatus, Antimonium Tartaricum. Tar- tras Potassii et Ammonii. Tartrate of Antimony and Potassa. Tar- tarized Antimony. Tartar Emetic. (Coccul. Ipecac. Pulsat.) Thuj.—Thuja Occidentals. Thuj., Arbor vitas. Tree of Life. (Camph. Pulsat.) Val.—Valeriene Officinalis. Valerian. (Bellad. Camph. Coffea. Mercur.) Ver.—Veratrum Album. Helleborus Albus. White Hellebore. (Acon. Arsen. ac. Camph. Coffea. China. Mercur.) Vio-t.—Viola Tricolor. Jacea. Pansea. Hearts'-ease. (Camph.) Verb.—Verbascum Thapsus. Mullein. (Camph.) Zinc—Zincum. Zincum Metallicum. Zinc. (Camph. Hep. sulph. Ignat.) Note. In the selection of the remedy,' it is not necessary that all the symp- toms noted should be present; at the same time, care must be taken, that there are no symptoms of any consequence not covered by the medicine, or more strongly in- dicative of another. » When symptoms are met with, not covered by a remedy, which nevertheless ap- pears indicated, the tabular index may, with advantage, be availed of, in order that it may be ascertained if the symptom required to complete the group, is given under the medicament in any other part of the work. In other cases, where different medicines are pointed out as useful in an affection, the table may be made use of, for, by carefully noting the symptoms given under them elsewhere, the reader may thereby be enabled to select the remedy most clearly indicated. HOMCEOPATHIC DOMESTIC MEDICINE. PART I. INTRODUCTION. The principal points we have to notice in this part are, the Regimen to he observed under treatment—Clothing, and Habits—the Administration and Repetition of the medicines —and the Potencies in general use. REGIMEN. The excellence of the homoeopathic rules on regimen has wrested approbation even from our own opponents, although at the same time they disingenuously make use of it as a handle against the science itself, and ascribe the cures effected to its observance, rather than to the efficacy of the medicines employed. To individuals unacquainted with Homoeopathy, the regi- men is represented as extremely rigid : to that assertion a plain statement of the course to be pursued in general cases will prove the best refutation ; and it may also be observed, that at the first sight the self-denial imposed seems more stringent than it would prove on being carried into effect, and that many individuals in the Author's own experience have, pursued the same system of diet, after they have had no further occasion for medical assistance, thus continuing from choice what they had begun from necessity. 1 2 INTRODUCTION. The homoeopathic regimen consists merely of the avoid- ance of medicinal and indigestible substances durirg treat- ment, both as calculated to interfere with the actions of the medicines and the proper functions of the alimentary system. Consequently, among liquids the articles generally proscribed are green tea or strong black tea, coffee, malt liquors, wine, spirits, and stimulants of every description; lemonade, or other acid or alkaline drinks, and natural or artificial mineral waters ; cocoa, unspiced chocolate, toast, rice, or barley wa- ter, oatmeal gruel sweetened with a little sugar, or raspberry or strawberry syrup, if desired, whey, milk and water, or pure milk not too recent from the cow, boiled milk, and in some instances buttermilk, or in fact any non-medicinal bev- erage, is allowable.* In animal food, pork, young meats—such as veal, lamb, &c.; and among poultry, ducks and geese—had better be avoided, particularly when derangement of the digestive function exists. Beef, mutton, venison, and most descrip- tions of game, if not too long kept (high), pigeons, larks, rabbits are allowable at discretion. (Vide Synopsis.) Ham, and neat's tongues, under certain restrictions. Fish is a wholesome article of diet, and may in most cases be partaken of without scruple, with the exception of the oleaginous species, such as eels, salmon, &c, or shell fish, as oysters, lobsters, &c. Eggs, raw, or soft boiled; butter, if free from rancid or unusual taste; cream, plain unseasoned custards, and curds. Stimulating soups and made dishes are so evidently op- posed to homoeopathic regimen, as scarcely to require fur- ther notice. Beef-tea, veal, or chicken broth, &c, thickened with rice, maccaroni, or sago, and seasoned merely with a little salt, are of course allowable. * The idiosyncrasies in some individuals in respect of diet are very re- markable ; as for example, some cannot take the smallest quantity of milk without serious inconvenience; others throw out a rash after partaking of fish; and, again, others loathe the very sight of animal food. These pe- culiarities should not only be attended to in prescribing a suitable course of regimen, but should also be taken into account in the selection of the remedies. REGIMEN. 3 Among vegetables, all of a pungent, aromatic, medicinal, or indigestible description, or greened with copper, are pro- hibited ; such as onions, garlic, eschalots, asparagus, radishes, horseradish, celery, parsley, mint, sage, mushrooms, tomatoes, beets, artichokes, parsnips, etc.; but others free from such qualities, such as potatoes, French beans, green peas or beans, cauliflower, spinach, seakale, etc., may be used with the need- ful precaution of avoiding any particular article of diet, whether of the animal or vegetable kingdom, that may seem to disagree with the individual. Lemon or orange- peel, laurel leaves, bitter almonds, peach leaves or kernels, fennel, aniseed, marjoram, are objectionable ; acids, and the ordinary condiments, such as pepper, mustard, pickles, etc., and salads, ought either to be sparingly partaken of, or en- tirely abstained from, particularly by the dyspeptic. Salt and sugar in moderation are admissible. Acid or unripe fruits are clearly objectionable, and even ripe fruits possessing little or no acidity, if fresh, or prepared by cooking, such as peaches, raspberries, sweet cherries, grapes, and dried or preserved fruits, as figs, prunes, apples, pears, should be used in moderation, particularly by dyspep- tic individuals; and by those subject to colic or diarrhoea, not at all. Cold fruits, such as melons, and raw vegetables, such as cucumbers, etc., are inhibited ; nuts of every descrip- tion are forbidden. All kinds of light bread and biscuit, free from soda or pot- ash and such like, not new baked ; also simple cakes com- posed of flour or meal, eggs, sugar, and a little good butter ; or light puddings, such as bread, rice, sago, semalino, with- out wines, spices, or rich sauces, are admissible ; but coloured confectionary, pastry, and also honey, are not so. Regularity in the hours of meals should be observed, and too long fast- ing, as well as too great a quantity of food at one time, should be avoided. During fevers and inflammatory affections, the patient must of course be kept upon a low regimen : gruel, barley- water, etc.; and at the commencement of convalescence a light pudding, with a little weak beef-tea or mutton or chick- 4 INTRODUCTION. en broth, should form the whole of the nourishment given. Nature, however, is our best guide; and when she takes away appetite, thereby intimates the necessity of not taxing the digestive functions. CLOTHING AND HABITS. Upon the first point it were scarcely worth while entering into any observations, were it not simply to remark upon the impropriety of wearing garments impervious to air, and fitting closely to the shape, and the custom of exposing the extremities and chests of young children to the chilling atmos- phere of our peculiarly variable and humi,d climate, under the absurd idea of making them hardy. The evil conse- quences arising from the check given to perspiration, by the first mentioned practice, are too well known to require any particular comment; but as the other is an error widely pre- valent, I consider it my duty to mention it; and feel assured, that if mothers will only reform their system, and clothe their children in a more rational manner, they will make no slight advance towards the prevention of serious affections, not only during childhood, but in after life. Linen, cotton, or even leather, worn next to the skin, is generally preferable to flannel. As regards habits, it may be briefly observed, that a sys- tematic course of life, avoiding ill-ventilated apartments, late hours, dissipation, over-study, anxiety, and other mental emotion, and taking sufficient air and exerercise, are the best preservatives of health. The frequent use of hot-baths is injurious, and liable to re- tard the cure under homceopathic treatment. The idea that sea-bathing is almost universally beneficial is exceedingly erroneous; there are many constitutions on whom it produces far other than a salutary effect. Medicated baths, either natural or artificial, are, it is scarcely necessary to observe, strictly forbidden. Bathing the whole frame daily with a sponge or wet towel, with cold or scarcely tepid water, and the use of the flesh-brush, are by no means objectionable, and frequently indeed strongly to be recommended. POTENCIES OF THE MEDICAMENTS. 5 The use of any medicinal or aromatic substances in the arrangement of the toilet, such as camphorated or otherwise medicated dentrifices, lip-salves, smelling salts, or cosmetics, is detrimental to the action of the medicines, and had there- fore better be avoided. The deleterious gas that flowers emit during night, renders their presence in bed-chambers highly reprehensible. POTENCIES OP THE MEDICAMENTS. In homceopathic practice there are three points which merit the most particular attention : the first and principal is the choice of the proper remedy ; the second, the potency at which it should be exhibited; and the third, its administration and repetition. I shall now proceed to the consideration of the second ; the selection of the potency, attenuation, or di- lution ; and give such directions as may serve for a guide in general cases, premising at the same time that much depends upon the discrimination of the administrator, and that it is impossible in this case to give any rule to which there are not exceptions. The principal points to be attended to are, the suscepti- bility of the patient to medicinal influence, how far modified by circumstances, the age, sex, temperament, and habits— the disease itself; and further, the nature of the medicament employed. As regards the first, the susceptibility of the patient, we find four classes: First class. Those who are comparatively insensible to medicinal influence, particularly at high potencies, upon whom the medicines show neither marked action nor re-action. Such individuals are generally of what is denominated the leuco-phlegmatic temperament; they require generally low potencies and frequent repetition : such cases are not without their parallel in allopathic practice. Also, in disease, we find some persons who appear to enjoy a peculiar exemption from infections and even contagious influence. To this rule, how- ever, of giving the low potencies in such cases, there are 6 INTRODUCTION. exceptions: I have found in practice, after a careful study of the individual, and a selection of a remedy suitable to tem- perament, a marked action and re-action produced by a very high potency, where a lower of the same medicament had failed to elicit any apparent effect, and vice versa. Second class. A marked susceptibility to medicinal action without a corresponding reflex action : such patients are gen- erally of a highly nervous temperament, exceedingly difficult to treat, and require particular study ; here the higher poten- cies are generally called for, although we frequently find benefit in resorting to the lower. Third class. Those in whom no marked or a scarcely perceptible medicinal action declares itself, but a well-marked re-action ; in such cases we must be guided by other indica- tions in the selection of the potency ; watch the effect care- fully, and avoid* too frequent a repetition. Fourth class. Those in whom the medicines show a well- marked action and re-action; here, also, we must be guided by other circumstances in the selection of the potency, so as to obtain the greatest possible benefit without materially in- creasing the sufferings of the patient. We generally find a particular susceptibility to medicinal influence, at any potency, in persons dwelling in the country, of robust frame, simple habits, and regular lives, who are not subject to any peculiar dyscrasia. In towns, particularly in large, densely-populated cities, this susceptibility is greatly developed, but the re-action less evident; however, much depending upon the individual's employment, habits, and pursuits, it is difficult to give any fixed rule. Age. In infancy and early childhood, we find a marked receptivity to medicinal influence, a decided action and speedy re-action, consequently the higher potencies are the most applicable in their diseases, and they rarely require so fre- quent a repetition ; however, in acute diseases of any of the more noble organs, we may exhibit lower potencies, parti- cularly of some of the less energetic medicines : for example, Sambucus, Ferrum, Ipecacuanha, Chamomilla, etc., a globule POTENCIES OP THE MEDICAMENTS. 7 constituting the maximum dose. Some further remarks upon this subject have been made in Diseases of Infancy. Sex. Females, for the most part, possess a higher degree of susceptibility than males, in which they approach nearer to children; for them the higher and medium potencies are generally most suitable; to this rule, however, there are many exceptions, particularly in those who are engaged in laborious employments. Temperaments. In the Sanguine temperament, there is considerable susceptibility to all the potencies, and a speedy re-action. In the Nervous, we find great susceptibility, some- times without an equivalent re-action: here we should be cautious in administering, and generally use the higher po- tencies. In the Bilious, there is generally but little suscep- tibility, but the re-action, when roused, is powerful and pro- longed ; hence a necessity for low potencies, generally given at long intervals. The Lymphatic being the least susceptible of all temperaments, the medicines may be given at low po- tencies, and frequently repeated till some effect is produced. Since these temperaments often occur in a mixed form, the rules above given must be modified accordingly. I may observe, that the remarks above made refer princi- pally to chronic and subacute diseases. The Disease.—In severe acute diseases I am generally in the habit of resorting to the low potencies, and in tinctures, from the circumstance that I have usually found them more certain in their effect in such affections. In the cases of children, an exception may be made, as already observed. In ordinary cases, the best range is from the third to the twelfth potency; this rule should, of course, be modified according to the remedy itself, the disease, and the individuality of the patient. The Nature of the Remedy. Medicaments which in their crude state possess little or no appreciable medicinal proper- ty, but whose virtues have been developed by trituration 8 introduction. and segregation of particles, such as Lycopodium, Natrum muriaticum, Calcarea carbonica, Sepia, Carbo vegetabilis, Silicea, etc., should generally be used at the higher potencies. Others also which have been found from experience to display considerable efficacy, even when greatly attenuated, such as Phosphorus, Sulphur, Lachesis, Acidum nitricum, Arsenicum, etc. On the contrary, some which have a short-lived, but well-marked action, may be used in some cases in the original substance; for example : Moschus, Valerian, and Camphor, but in exceedingly small doses. Others again have been found most useful at the first, second, or third potency : such as Tartarus emeticus, Ferrum, Ipecacuanha^ Hepar sulphuris, Stannum, Rhus toxicodendron, Opium, and in many cases Cinchona. Still, all these remedies, in peculiar cases, act well at the higher. Throughout this work I have given a variety of potencies, specifying those which the nature of the affection treated of seemed to require ; but I beg it to be understood, that I by no means insist upon a strict observance of what I have laid down, for it is undeniable, that when a remedy is correctly chosen, whatever may be the potency, it will in most instances be followed by the desired results. From the tenor of the foregoing remarks, however, as well as from what will be found stated under the succeeding paragraph, the importance to practitioners and others who make an extensive use of the homoeopathic remedies, of being in possession of several po- tencies of nearly every medicine, will be rendered sufficiently obvious. In highly perilous asute affections, and, indeed, in all cases, our great point is to obtain as speedy an effect with as little suffering as possible ; and when the physician suc- ceeds in effecting this, he may rest satisfied with himself, even although it was by the assistance of a low potency, of a powerful drug, and given in drops. But I must warn the tyro in our system not to imagine that, because with a minute dose he has done much, that by increasing it he may do more ; the faults of most beginners is to fly too hastily to very low dilutions, and repeat too frequently : patience, coolness, firm- ADMINISTRATION. 9 ness, and attentive observation, are necessary to make a good homoeopathist. For my own part, I consider the whole range, from the first attenuation to the thirtieth, and even upwards* useful, according to the nature of the case, and the properties of the remedy ; and moreover, that a rigid adherence to any particular dilution in all instances, savours rather of the em- piric than of the professor of a liberal art. ADMINISTRATION AND REPETITION OF THE MEDICINES. Upon this subject I will offer a few remarks, premising at the same time that it is almost impossible to give any general rule that will serve in all cases, much more depending upon the * Hahneman, in his latter years, was much in favour of an extension of the scale of potencies; and Grosse and other continental homceopath- ists of repute have recently spoken strongly of the striking results obtained from Arsenicum and other medicines at the 200th and even the 1800th attenuation! Their opinions and recommendations, being derived from experience, are at all events well worthy of considerate attention and careful investigation, whatever the material-headed reasoners may say to the contrary. If tinctures are used, put one drop, or three or four drops of the first dilution, into a tumbler full of pure rain water, (or spring water, if very pure,) and give of this solution a teaspoonful for a dose, which is to be re- peated according to the rules. The dose may be increased to a dessert or tablespoon, or even more, if the patient be of a strong bodily constitu- tion, and especially if he be of an insusceptible temperament.—The dose is one or two grains of the powdered remedies, according to the strength and susceptibility of the patient; and this quantity is to be mixed with twice or three times as much powdered sugar of milk. A grain is about as much as will lie on the point of an ordinary penknife blade. In cases of doubt, as to which of two or three remedies, named in this book in any given case, ought to be applied, we recommend a resort to Ja/Ws New Manual of Homceopathic Practice. Turn to the Clinical Chapter, (al- ways in VoL II.,) which precedes the tabular exposition of the effects of medicines upon the part affected in the case, and find the disease under which the patient is labouring; this chapter alone will often contain the desired information. But if it do not, the table following the Clinical Chapter must be studied, and if this do not suffice to determine the choice satisfactorily, the notices of the remedies in question contained in first volume may be read. 1* 10 INTRODUCTION. discrimination of the administrator, and a careful observance of the symptoms, than routine. However, throughout this work I have given directions for the exhibition and repetition of each medicine ; these are in- tended, of course, to be modified according to circumstances, not blindly adhered to; the following observations may, there- fore, prove useful: In acute diseases, we must carefully watch the symptoms, and when we feel assured we have chosen the proper remedy, if no perceptible medicinal aggravation or amelioration declare itself, but the disease seems to gain ground, repeat the medicine. In cases of high inflammatory action, Aconite has sometimes to be repeated every two hours, hour, or even less. If a medicinal aggravation take place, followed by ameliora- tion, we must let the medicine continue its action, until the amelioration appears to cease, and the disease again make head ; if new symptoms set in, we must then have recourse to the medicine thereby indicated. Should, however, no per- ceptible medicinal aggravation take place, but an amelioration follow, we may safely await its approach to its termination ere we again administer. If any symptoms remain, from the re- medy first selected having afforded only partial relief, we must have recourse to some other medicine which seems best fitted to meet them; but refrain from changing the remedy as long as benefit results from its employment. In chronic, sub-acute, and indeed almost all cases, when a very striking improvement takes place, it will generally be found advantageous to cease to administer the medicine as long as the improvement continues, and only to repeat as soon as the slightest symptoms of activity in the morbid phenomena re- appear. But when a sudden or marked improvement of com- paratively short duration follows the first dose of a remedy, and, on repeating the dose, the symptoms of the complaint in- crease instead of subsiding, as they did in the first instance, it may be concluded that the medicine does not answer, and that another must accordingly be had recourse to, in the selec- tion of which it will be necessary to choose one related to the remedy first prescribed. ADMINISTRATION. 11 The distinguishing of the medicinal aggravation, from that of the disease, being a point of material consequence, we will here give the usual characteristics of each. The medicinal aggravation comes on suddenly and without previous^amelio- ration; the aggravation of the disease more gradually, and frequently following an amelioration. Moreover, in the for- mer, several of the medicinal symptoms, some of which we may meet under the indications for the remedy, and not be- fore remarked, declare themselves. I feel I cannot lay too much stress upon the necessity of carefully watching the effects of each dose, as in addition to the temporary aggravation of the symptoms which sometimes sets in, a development of collateral or pathogenetic signs occa- sionally takes place, particularly after frequent repetition of different remedies in susceptible patients: by a want of atten- tion to this important point, we may incur confusion, and may be unconsciously treating a medicinal disease of our own creation. Such, unhappily, but too frequently occurs in allo- pathic practice, from ignorance of the real properties of the drugs employed. We must also guard against falling into the opposite extreme, and allowing the disease to gain head un- checked. Slight diseases are often removed by a single dose of well- chosen medicine, but more severe and deeply-seated disorders require a frequent repetition. In severe acute affections, we may often repeat the same medicine at the same dose, at regular intervals, as long as it does good; but this rule has many exceptions, and the direc- tions already given at the commencement of this article should be borne in mind. In chronic cases, by a long-continued administration of the same medicine, the patient often becomes less susceptible ; in such instances, if the improvement remains stationary, or pro- gress slowly, we may gradually increase the dose, or still bet- ter, give at suitable intervals some other remedy or remedies of as nearly analogous medicinal properties to that first ad- ministered as possible, and then return to the original reme- dy, if needful; if, on the other hand, decided amelioration 12 INTRODUCTION. follows each administration, we should allow a longer interval to elapse before repeating, by which means the system grad- ually recovers itself, and the susceptibility to the medicinal influence remains unimpaired until the cure is completed. In rare cases, this susceptibility increases ; in such instances a higher potency should be selected,—provided the remedy still appears to be appropriate,—and the intervals between the exhibitions lengthened. This occasionally occurs when the medicine has been frequently repeated, and given in solution. When the beneficial effect of a medicine is interrupted by an attack of cold, diarrhoea, &c, some other medicine must be given for the new affection, on the removal of which, the medi- cine which previously acted favourably must be recurred to. In the Selection of the Remedy, it is not necessary that all the symptoms noted should be present; at the same time taking care, that there are no symptoms not covered by the medicine, or more strongly indicating another. Remarks. When it is requisite to keep a medicine in solu- tion for some days, a few drops of proof spirit may be added to the water, which should be as pure as possible, in order to preserve it from decomposition. It may be scarcely necessary to explain the PHARMA- CEUTICAL SIGNS used in this work, to signify the poten- cy and quantum of the dose ; but as the book may fall into hands otherwise wholly unacquainted with the science, we do so as a measure of precaution ; it will therefore be sufficient to remark that Belladonna y, means two globules of the third potency, f, six of the sixth, and the same with any other medicine, In conclusion, it is necessary to state that the medicines should be taken fasting, and food or drink, as also excessive bodily or mental exertion, abstained from for half an hour to an hour afterwards, The homceopathic remedies should be kept in a clean, dry, dark place, free from odours. Every description of allopathic medicine, patent or domestic, is pro- hibited ; likewise bleedings, blisters, medicated fomentations, perfumery, and everything containing camphor. In cases of LIST of medicines. 13 obstinate constipation, recourse may be had to an enema or lavement of cold or of tepid water when the former disagrees, to which may be added, if necessary, a tablespoonful of olive oil. It has repeatedly been found that some remedies act very beneficially when administered after the previous employment of certain others. The subjoined list affords a few such examples, and may prove useful in the treatment of particular cases: the remedy to be selected must be in accordance with the symptoms. Acidum nitri. Calc, Petr., Puis., Sulp., are often used with success after Acidum nitri. Acidum phos. China, Lack, Rhus, Verat., are sometimes suitable after Acidum phos. Acidum sulp. Puis, is sometimes useful after Acid, sulph. Aconite. Am., Ars., Bella., Bryon., Cann., Ipec, Spong., Sulp., &c, will frequently be found of use after Aconite, whether given from the commencement or in the course of treatment. Alumina. Bryon. is often of great use after Alumina, when it is indicated. Ant. crudum. Puis, and Merc, sometimes answer well after Antimony. Arnica. Acon., Ipec, Rhus, Sulp. ac, are sometimes suitable after Arnica. Arsenicum. China, Ipec, Nux vom., Sulp., Veratr., will sometimes be found beneficial after Arsenic Belladonna. China, Con., Dulc, Hepar, Lach., Rhus, Seneg., Stram., Valer., are sometimes the most appropriate medicines after Belladonna. Bryonia. Alum, and Rhus will sometimes be found suit- able after Bryonia. Calcarea carbonica. Lycopodium, Nitr. ac, Phos., and SUicea, will be found most useful after Calcarea. Carbo vegetabilis. Arsen., Kali, Merc, will often be found suitable after Carbo vegetabilis. Causticum. Sepia and Stann. will sometimes be found of service after Causticum. 14 introduction. Cinchona. Arsen., Bella., Puis., Veratr., are sometimes suitable after Cinchona. Cuprum. Calc. and Veratr. are sometimes of service after Cuprum. Hepar sulp. Bella., Merc, Nitr. ac, Spong., Silicea, are sometimes suitable after Hepar sulp. Ipecacuanha. Am., Ars., Chin., Cocc, Ign., Nux, are sometimes suitable after Ipecacuanha. Lachesis. Alum., Ars., Bell., Carb. v. Caust., Con., Dulc, Merc, Nux vom., Phos. acid., are sometimes useful after Lachesis Lycopodium. Graph., Ledum, Phos., Puis.,' Silic., are sometimes serviceable after Lycopodium. Mercurius. After Mercurius, Bell, China, Dulc, Hepar, Lach., Nitr. acid., Led., Sulph., are sometimes suitable. Nux vomica. Bryon., Puis., and Ship., will frequently be found efficacious after Nux vomica. Opium. After Opium, Calc, Petr., Puis., will sometimes be found of use. Phosphorus. Petr. and Rhus will be found suitable after Phosphorus. Pulsatilla. Asa., Bryon., Nitr. ac, Sepia, are sometimes suitable after Pulsatilla. Rhus toxicodendron. Am. c, Ars., Bryon., Calc, Con., Phos., Phos. ac, Puis., and Sulph., are sometimes useful after Rhus tox. Sepia. After Sepia, Carbo v., Caust., Puis., are some- times suitable. Silicea, After Silicea, Hepar, Lach., Lyco., Sepia, are sometimes of service. Sponga. Hepar sulph. is sometimes suitable after Spongia, (in the croup.) Sulphur. Acon., Bell., Calc, Cupr., Merc, Nitr. ac. Puis., Rhus, Sepia, Sil, are sometimes suitable after Sulphur. Tartarus emeticus. After Tartar emetic, Bar-c, Ipec, Puis., Sep., are sometimes useful. Veratrum. After Veratrum, Ars., Am., Chin., Cupr., Ipec, are sometimes suitable. RULES FOR DIET. 15 SYNOPSIS OF THE RULES FOR DIET, UNDER HOMCEOPATHIC TREATMENT. ALIMENTS ALLOWED. * Soup or broth made from the lean of beef, veal and mutton, to which may be added, well boiled, sago, tapioca, vermicelli, rice, semolina, or macaroni, seasoned merely with a little salt. Meats. Beef, mutton, (poultry, rarely,) pigeons, larks, rabbits, (venison, and game in general, may in most cases be partaken of in moderation, but never when high,) plainly cooked and roasted, broiled, or stewed, in preference to boil- ed. (Ham or neat's tongue rarely.) Fish.~\ Soles, whiting, smelts, trout and flounders, broiled in preference to fried; when cooked in the latter manner, the white must alone be partaken of, and the outer or fried por- tions rejected. Vegetables. Potatoes, brocoli, green peas, cauliflower, spinach, turnips, French beans, seakale, vegetable marrow, stewed lettuce, well cooked, and prepared with the gravy of meat, where required, instead of butter. Eggs lightly dressed; all kinds of light bread not new- baked, and biscuit free from soda or potash and the like. Light puddings, such as those made from vermicelli, semo- lina, fecula of potato, sago, arrow root, rice; simple cakes composed of flour or meal, eggs, sugar, and a little good butter. Fruit. Baked, stewed, or preserved apples or pears ; al- so gooseberries, raspberries, grapes, or any other fruit not of an acid quality, fully ripe, preserved, or in the form of jelly, may occasionally be partaken of. * See Manual of Homceopathic Cookery, designed chiefly for the use of such persons as are under homceopathic treatment. New-York. Price 50 cts. f From the extensive varieties of American fish may be most safely selected—shad, king-fish, striped bass or rock-fish, Otsego bass (shad salmon,) lake trout (salmon trout,) halibut, haddock, sea bass or black- fish, sheep's head, pike, pickerel and perch.—Ed. 16 INTRODUCTION. Beverage. Water, milk, cocoa, homoxopathic chocolate, arrow-root, or gruel, made thin, toast-water, barley-water, milk and water, sugar and water, rice-water. Salt should be used in moderation. ALIMENTS PROHIBITED. Soups. Turtle, mock-turtle, ox-tail, giblet, mulligatawny, and all rich and seasoned soups. Meats. Pork, bacon, calf's head, veal, turkey, duck, goose, sausages, kidney, liver, tripe, and fat and salted meats. Fish. Crab, lobster, oysters,* and shell-fish in general ; and almost all other fish not specified in Aliments allowed. Vegetables. Cucumber, celery, onions, artichokes, radishes, parsley, horse-radish, leeks, thyme, garlic, asparagus; and every description of pickles, salads, and raw vegetables, or vegetables greened with copper. Pastry of all kinds, whether boiled, baked or fried. Spices, Aromatics, and Artificial Sauces, of all kinds; as also the ordinary condiments, mustard and vinegar. Cheese. Chestnuts, filberts, walnuts, almonds, raisins, and indeed almost the entire complement of a dessert, except what has been mentioned in Aliments allowed, under Fruit. (See also Regimen, p. 1.) Drinks. All ardent spirits, such as brandy, whisky.—Beer, porter, ale, cider, etc.—Strong bodied wines, such as port, sherry.— Liqueurs. — Green tea, coffee, spiced chocolate.— Mineral waters, etc. The above regulations are subject to considerable modifica- tions in particular cases; but only under the direction of the medical attendant. Regularity in the hours of meals should be observed; and too long fasting, as well as too great a quantity of food at one time, should be avoided. * The inhibition of the European Oyster is justly demanded on ac- count of its flavour and effects; but the American oyster, according to our experience, is one of the most valuable esculents that, at times, can be furnished, either to the invalid or convalescent.—Ed. PART II. ON THE SYMPTOMS, CHARACTER, DISTINCTION, AND TREATMENT OF DISEASES. FEVERS. Febres. GENERAL consideration of fever. CAUSES, TREATMENT, AND DIET TO BE OBSERVED. Perhaps no form of disease has more occupied the atten- tion of pathologists, or given rise to a greater number of theories, than fever. Many authors consider fever and inflam- mation as synonymous terms, others as mere modifications of the same pathological state of the system. The investigation is certainly one possessing peculiar interest, but, fortunately, in the homoeopathic system, no theory can in the slightest degree affect the practice, since in the treatment of this class of dis- ease, the external phenomena present sufficient indications for the selection of the proper remedies. Acute diseases have always been considered as the true touchstone of every system of therapeutics. Homoeopathy has been submitted to this test, and the results have at once proved the bold assertion of its founder, that its principle was a law of nature,—the minute doses in these cases act with a promptness and certainty scarcely to be credited, except by those who have either witnessed or experienced their power; under this system the disease is brought to a salutary crisis before any great expenditure of vital energy has taken place; from this and the absence of debilitating measures 18 FEVERS. the period of convalescence is greatly shortened, and in many instances scarcely perceptible, the patient being, as it were, at once restored from a state of disease to one of perfect health. Although I shall avoid entering into any of the theories respecting fever and inflammation, I cannot but render the tribute of my admiration to the gifted men who have devoted so much of their time and energies to the elucidation of this difficult point, since every new pathological discovery serves to throw light upon the specific action of medicinal substances. Practically speaking, when we find a medicine produce a change of health resembling that present in fevers, we know that in such fevers it is curative : still it would be a satisfaction to be enabled to trace the connexion more closely, and to show the perfect affinity between medicinal and morbid action. There is no doubt that, if a perfect theory of fever be ever given to the world, it will be found in perfect accordance with the homoeopathic law. In all forms of acute diseases fever is present; in fever, properly so called, there is generally functional disturbance, accelerated action of the vascular, with the participation of the nervous system, and a tendency to increased development of heat. The symptoms common to most fevers are—at first, a feeling of coldness or shivering, then heat, accelerated pulse, thirst, restlessness, and languor. Fever also possesses the property of passing from one species into another. Thus in- flammatory fever may, by severe antiphlogistic measures, be altered into a low typhus ; or, on the other hand, a simple fever, by injudicious treatment, into an inflammatory one, and that again assume the intermittent form; also one attack may pre- sent all these different phases. Fevers terminating fortunately and running a regular course, may be divided into five stages; the accession, increase, crisis, decrease, and convalescence. When the result is fatal, it may arise "from a metastasis, the exhaustation of a vital energy of the patient, or the disorganization of some import- ant function. The belief in critical days is of very ancient origin, though FEVERS. 19 there is some difference in the calculations of physicians upon that point; some counting from the day the shiverings de- clared the onset, others from the first hot fit; except in cases where a marked periodicity exists, as in quotidian and other forms of ague, such distinctions are of little value, inasmuch as the homceopathic treatment is directed to forwarding the " crisis, and thereby materially shortens the duration of the disease. Statistics prove that the average continuation of acute affections is much shorter under the homceopathic sys- tem than it is where they are treated allopathically, or left to nature ; consequently, any calculations based upon other modes of treatment are not to be depended upon, and the best plan for the physician to follow is to watch attentively the disease before him, and apply the remedies his knowledge and experience point out as best calculated to conduct it to a satisfactory issue. A crisis may declare itself by diarrhoea, profuse perspira- tion or increase or alteration of other secretions, or by the appearance of an eruption, after which, if salutary, the skin becomes moist and resumes its functions, and the pulse re- turns to its usual standard. Fevers have been differently classified by various medical writers. The arrangement we shall adopt is as follows : sim- ple irritative fever, inflammatory fever, typhus, putrid, and gastric or bilious fevers, intermittent fevers, and then erup- tive fevers, such as scarlatina, measles, etc. Although this mode of classification is adopted for the sake of convenience, the author has no intention of generalizing disease : every febrile attack presents peculiar features, and is to be treated as an individual affection, and according to the nature of the symptoms presenting themselves, not by a blind adherence to the mere nomenclature of disease. Causes of Fever. It cannot be denied but that there ex- ists in certain individuals, a particular predisposition to acute diseases, and, as before remarked, in Introduction, the san- guine, nervous, and bilious temperaments possess this sus- ceptibility in a far more marked degree than the phlegmatic. 20 FEVERS. The exciting causes are numerous. Miasms, epidemic in- fluences, contagion, powerful mental emotions, derangement of some important organ, external lesions, excess or errors in diet, heat or cold, or alterations of temperature, exposure to cold or damp, repercussed exanthemata—in fact, anything that causes derangement of the equilibrium of the system, may produce fever. GENERAL TREATMENT IN FEVER, AND DIET. The great essentials in the treatment of fever, are : Perfect rest, mental and bodily. Pure air and a cool apartment; the temperature of the patient's room should never exceed 55 degrees. Feather beds should be discarded, and mattresses substi- tuted, when practicable, and the bed-clothes be light, but sufficient. Nature herself generally prescribes the regimen to be ob- served, by taking away appetite, while the thirst present, as an eminent medical writer has well observed, may be considered as her voice calling for fluid. Water is the best diluent; no solid food, broth, or even gruel and the like, should be per- mitted in cases where the inflammation runs excessively high; and the utmost caution is to be observed, in allowing gruel or weak broths during the decrease; an error in this respect often causes irreparable mischief, and it is always safer to err a little on the side of abstinence than on that of indulgence. A little toast-water, or weak barley or rice-water, sweet- ened with a little sugar, raspberry or strawberry syrup, may be allowed when the fever is somewhat abated, though then we must still carefully avoid incurring the risk of a relapse, by giving any aliment likely to tax, in however slight a de- gree, the digestive powers. SIMPLE OR EPHEMERAL FEVER. Febris Simplex. The disease seldom presents any distinct character, and generally runs its course in twenty-four hours; as, however, it FEVERS. 21 frequently forms the initiative of other more serious disorders, it deserves attention. Before attacks of scarlatina, measles, small-pox, etc., it is generally present, although occasionally showing itself as a distinct affection. Diagnosis. Shivering, followed by heat, restlessness, thirst, accelerated pulse, general uneasiness and lassitude, terminated by profuse perspiration. In allopathic practice, unless they could trace the immedi- ate cause of the affection, for instance, indigestion, the treat- ment is occasionally hazardous ; for, if the simple fever was merely the commencement of an attack of severe inflamma- tion, they incur the risk of increasing it by using stimulants, under the idea of its being a precursor of typhus ; or acting upon the opinion of its being a forerunner of inflammation, of weakening the constitution by antiphlogistic methods, if it should unfortunely run on to the former. In this case the safer plan was to await quietly the development of the affec- tion, to see if it would terminate in a crisis, or take upon it a more virulent form, and so deal with it accordingly. Therapeutics. Throughout this work the disease will be found treated of, when arising from indigestion or cold, and found as the precursor of other affections; but when it is en- countered along with the symptoms already detailed, and can- not be traced to any particular exciting cause, and particularly when hot, dry skin is present, Aconite ")^0 or °g° may be ad- ministered * in a teaspoonful of water, which, if it be simple fe- ver properly so called, will speedily dissipate all the symp- toms; and if it be the forerunner of any more serious disorder, either at once check its further progress or materially modify its malignancy. The former is more peculiarly the case with purely inflammatory attacks : the latter holds good as far as relates to typhus, exanthematic diseases, and some other af- fections which run a regular course. * In all cases where directions for the administration of a medicine are given, the attention of the reader is directed to the article on that subject in the Introduction. 22 FEVERS. INFLAMMATORY FEVER. Synocha. Diagnosis. Shivering or chill (generally considerable) fol- lowed by burning heat; pulse strong, hard, and greatly accel- erated ; dryness of the skin, mouth, lips, and tongue ; the lat- ter generally of a bright red, in some cases slightly coated with white; thirst; urine red and scanty ; constipation ; re- spiration hurried, in accordance with the pulse ; amelioration of symptoms as the pulse assumes a more normal state. It runs its course with rapidity, rarely exceeding fourteen days, and progressing with regularity to a crisis, which shows itself in profuse perspirations, critical urine, diarrhoea, or haemor- rhages, principally epistaxis. The period mentioned is its ordinary average of duration, but under homceopathic treat ment, the perfect crisis is considerably hastened, without the long convalescence entailed by the usual antiphlogistic means. It is peculiarly apt, if not carefully treated, to change into typhus, or by metastasis to fix upon some important organ. Causes. # Sudden chill or check of perspiration, exposure to damp or wet, dry easterly winds, violent mental emotion, high living, external injury or lesion, local inflammation, and slight febrile attacks mismanaged. Individuals of what is denominated a plethoric habit are particularly subject to this disease ; it generally attacks be- tween the ages of 15 and 30 years. Under the diagnosis we have given the pathogonomic symptoms of synocha; we, however, find it complicated, in the majority of cases, with more or less cerebral disturbance, which we shall consider more in detail under Inflammation of the Brain and its tissues. Therapeutics. Although throughout this work the author purposes to confine himself to pointing out the remedies most valuable in disease, without entering into any disquisition upon their efficacy, or the principle of their employment, yet he cannot refrain in this instance, from briefly noticing a medi- cament which has so successfully superseded all the anti- inflammatory fever. 23 phlogistic measures of the old school, subduing inflammation without lowering the vital energy. No one who compares the pathogenetic symptoms of Aconite given in the Materia Medica Pura of Hahnemann, and carries in mind the princi- ple of its application, can forbear being struck with the close resemblance which they present to those of pure inflammato- ry disease ; and by this powerful auxiliary the author has no hesitation in declaring, that disease of the said description is brought so fully under the control of the physician, as to be in a great measure divested of its malignancy, and in no case is superiority of Homoeopathy more strongly evidenced. Administration.* When, therefore, the symptoms above mentioned are present, we should at once administer Aconite, six globules of the third potency, in an ounce of pure water, a dessert-spoonful to be given every quarter of an hour, every half or every two or three hours, according to the intensity of the fever, and the pulse carefully watched, lengthening the intervals according to the effect produced, till marked benefit results. A slight degree of delirium is frequently present in this affection, chiefly at night, which, unless it threatens to run on to inflammation of the brain, in which case Belladonna must be had recourse to, Aconite is of itself sufficient to subdue. When, however, during the course of the affection other symp- toms beside those mentioned develop themselves, we may find it necessary to have recourse to different remedies, such as Belladonna, Bryonia, &c. Belladonna. When there is great heat in the head, with violent cephalalgia, particularly in the forehead, and redness of the face; distention of the arteries of the neck and temples ; nocturnal sleeplessness, with furious delirium ; eyes red, shi- ning and fiery; general internal and external heat; burning thirst, and agonizing restlessness. Administration. Six globules of the third potency in an ounce of water; a dessert-spoonful exhibited every four hours until amelioration takes place, or we observe unequi- vocal symptoms of medicinal aggravation; in which latter * Vide note, page 21. 24 FEVERS. case we must cease to prescribe altogether until the reaction has taken place ; and in the former, lengthen the intervals of repetition as the improvement advances. Bryonia. This medicament is indicated when, in addition to the usual symptoms of inflammatory fever already given, we find a heavy stupifying headache, with a sensation as if the head would burst at the temples, much aggravated by movement, vertigo and giddiness on rising up or moving; burning heat, redness of the head and face, with redness and swelling of the latter; delirium ; oppression at the pit of the stomach; excessive thirst, sometimes followed by vomiting; constipation ; aching or shooting pains in the limbs, dry cough, or cough with adhesive phlegm tinged with blood, stitches in the chest, or side, and laborious breathing : when these lat- ter symptoms are present, we may infer that the pleura or lungs are affected. In the latter case the practitioner should test the diagnosis by auscultation. Administration. Six globules of the third potency may be added to an ounce of water, and a dessert-spoonful given every four or six hours; few cases are so particularly urgent as to require more frequent administration of the remedy ; indeed, when the virulence of the disease has been subdued, a single dose is generally found sufficient, and no further ex- hibition should take place as long as the patient manifestly continues improving. When inflammatory fever seems to arise from a primary inflammation of some important organ, such as the Head, Lungs, Liver, or Stomach and Bowels, the treatment will be found under the head of Inflammation of the function most evidently the seat of the disorder. It is sometimes the result of severe lesion, in which case the patient is to be treated as prescribed under External Injuries. NERVOUS FEVER. Febris Nervosa. TYPHUS. It is sometimes extremely difficult, particularly when it arises from some local affection of the more important viscera, to discriminate at the commencement between a nervous or NERVOUS FEVER, OR TYPHUS. 25 inflammatory attack, so as to give a decided prognosis. However, in such cases, the marked advantages of the hor moeopathic system is again shown : by exhibiting medicines in accordance with the symptoms that declare themselves, we run no risk of weakening the vital energies, should we err in diagnosis, and treat it on its first appearance as an inflamma- tory attack—or of stimulating the inflammation by what is commonly denominated an anti-nervous treatment, should the precursory symptoms lead us to consider it typhus, and it afterwards assume the inflammatory form. • Diagnosis. Typhus rarely sets in with such marked symp- toms as announce the approach of inflammatory fever—in- stead of severe chill or shiverings, we first find a complaint of general uneasiness, a sensation of chilliness, occasionally followed by a greater or less degree of heat. The patient either complains but little, or of pains in his head, chest, and abdomen, and frequently an unusual degree of drowsiness is present, arising from a comatose state of the brain—there is also occasionally a slight dyspnoea ; after various alternations of cold and heat, the former sensation predominates in the feelings of the patient, while to those around him he appears hot; the extremities, however, on examination, are found cold. Different characters of pulse present themselves; sometimes it is full and soft, at others accelerated, frequently about the natural standard or below it, or quick and weak, but not strong and hard as in inflammatory fever. The differ- ence between the action of the pulse ana* heart is worthy of no- tice : the former may be so weak as scarcely to be perceptible, and the action of the latter strong; the pulse also may be hur- ried and the respiration natural. As the disease progresses, the tongue, at first moist, becomes thickly coated, dry, glazed, and tremulous ; there is faintness, cephalalgia, giddiness, and vertigo: the delirium, at first slight, and manifesting itself only at night, becomes unintermitted, and is characterized rather by wandering and low muttering, than fury and vio- lence : we may also meet with spasms and convulsions. All these symptoms, if the disease is allowed to gain ground, in- 2 « 26 NERVOUS FEVER, crease in malignancy, the evacuations become involuntary, the weakness and lassitude excessive, and the patient sinks down to the bottom of the bed—an evidence of complete prostration of strength, while all endeavours to rouse him are fruitless and he is perfectly blind to all around. Tenderness of the abdomen or pain in the region of the ccecum is also frequently met with. Some only of the above symptoms may be present, or the fever may be complicated with others : when only a few of the less virulent symptoms declare themselves, it is called mild typhus; when complicated with considerable disturbance of the vascular system, great heat and quick hard pulse, in- flammatory typhus : a distinction is also found in the type, as in continuous and intermittent typhus ; in the accidental circumstances or exciting causes present, as in the gastric and catarrhal complications, which, although generally treated as gastric or catarrhal fevers with typhoid symptoms, may be considered as modifications of this affection,—this difference in arrangement can, however, make none in practice, as we must be guided by the symptoms that present themselves in selecting our remedies. The congestive fever of some authors may be considered as a variety of typhus, in which, from the balance of the cir- culation being destroyed, the blood is determined to some particular organ—the external heat of the body diminished, and the pulse becomes slow and oppressed. The symptoms vary according to the organs attacked. It may be remarked, that in most forms of this malady, the course is extremely irregular,—the precursory symptoms may precede the dis- ease only a few days or several weeks, and its duration is also uncertain. Death may take place from exhaustion of the vital ener- gies, paralysis of the whole system, or of the brain, apoplexy, disorganization of some of the nobler viscera, or a change to the putrid form. Causes. Densely populated neighbourhoods, where a num- ber of individuals are crowded into small apartments, and the OR TYPHUS. 27 air rendered impure by exhalations from decomposed ani- mal and vegetable matter, stagnant water, and a want of cir- culation, are the very hotbeds of typhus ; deficiency and im- proper quality of food are often added to the above, and are of themselves sufficient to produce it; other causes are, over- exertion, either of body or mind, or excesses of any kind, the prevalence of cold or damp weather, mental emotions, and contagion. In fact, anything tending to depress the vital energies may be productive of typhus; it may consequently arise after in- flammatory fever treated by bloodletting or other severe anti- phlogistic measures, or even by the reaction of the organism, or an imperfect crisis, after the same affection. We shall now proceed to consider the treatment of this malady, and under the indications for the different medicaments used, will be found the symptoms that declare themselves under the various phases which the disease presents. Therapeutics. At the commencement, where gastric sym- toms set in, such as headache, giddiness, nausea, vomiting, wa- tery, yellow, or greenish, slimy evacuations; particularly when attended with slight chills, alternately with heat or considerable shivering with slight heat, or marked heat with but little shi- vering, we may administer— Administration. Ipecacuanha °£° in a teaspoonful of water, and repeat it every three or four hours.* Or Pulsatilla may be selected at this stage of the disorder, when there is frequent shivering, bitter taste, whitish tongue, loss of appe- tite, nausea, vomiting of mucus, slimy evacuations, and par- ticularly when the above symptoms occur in phlegmatic sub- jects, with extreme depression of spirits, and tearfulness. Two globules of the sixth potency in a little water every three to six hours. Nux vomica. Gastric or bilious symptoms, constipation with frequent inclination and ineffectual efforts to evacuate. Nux vomica is further indicated when the spasms, which not unfrequently accompany this disease, are confined to the * Vide note, p. 21. 28 NERVOUS FEVER, stomach and intestines, particularly the rectum, a frequent cause of the above-mentioned constipation; painful pressure and tension in the epigastrium and hypochondria; sensation as if the limbs were bruised; general nervous excitability, with great nocturnal restlessness and slight delirium ; weak- ness, and exacerbation of the symptoms in the morning. Temperament, sanguine or bilious; disposition, irritable and impatient. Administration. Two globules of the sixth potency every twelve hours. When the disorder assumes the asthenic form of abdominal typhus, or when the inflammatory diathesis is more lymphatic than arterial, from the occurrence of the disease in venous- lymphatic subjects, with pale or yellowish appearance of the face, severe headache, or sensation as if a tight band were across the forehead; thickly-coated tongue ; bitter or foul taste; little thirst; sensibility of the scrobiculus or umbilical region to the touch, and distention of the abdomen ; evacua- tions, copious, watery, flocculent, and even bloody, sometimes attended with tenesmus; at first dry burning skin, followed by profuse debilitating sweats ; depressed pulse, and great pros- tration; extreme restlessness and anxiety, with constant tossing about in bed ; disturbed unrefreshing sleep, with anx- ious dreams,— Mercurius will be found a most efficient medicine. Administration. Three globules of the sixth in a little water every two hours, until the evacuations become dimin- ished in number, and improved in appearance, and the tender- ness and pain in abdomen, &c, relieved. Cinchona. This remedy is frequently of service in the first stage, or when there is paleness of the face, lancinating, rending, aching, or pressive headache, cloudiness of vision buzzing or roaring in the ears, dulness of hearing; yellow or white coating on the tongue, dryness of the mouth, insipid, clammy, or bitter taste; inclination to vomit; sensibility and distention of the abdomen; thin, yellow, watery motions occasionally intermixed with undigested substances; urine scanty, pale, or dark coloured, and cloudy ; oppression at the OR TYPHUS. 29 chest; dragging shooting pains in the limbs ; anxiety, sleep- lessness, and general coldness and shivering. In an advanced stage of the disease, China is moreover occasionally of consi- derable value, especially when the attack has become length- ened and tedious, and the following symptoms have set in : nocturnal sweats, obstinate diarrhoea, but with clean tongue, and absence of abdominal pain ; followed by Sulphur, should the sweats not yield. Administration. The globules of the third potency every six hours, until benefit result. When inflammatory symptoms declare themselves from the commencement, Aconite and Belladonna are the best remedies; when the disease becomes more developed, and still retains the inflammatory character, Bryonia and Rhus will generally be found more useful. For the employment of Aconite, we have given the fullest indication under Inflammatory Fever ; and in all cases where these decided symptoms are present, it is imperatively called for, and should be administered as there prescribed. The following symptoms indicate Bella- donna : Alternate heat and chills, or general heat externally and internally, with redness, burning heat or bloated appearance of the face; violent throbbing of the carotids, redness, spark- ling, and protrusion of the eyes, with dilatation of the pupils, extreme sensibility to light, and strabismus ; singing or noises in the ears to a greater or less degree; wild expression of the countenance, with uneasy glancing around, as if from fear, sometimes attended with a marked inclination to run away ; violent shooting pains in the forehead, or dull heavy pain, causing the patient to put his hand frequently to his head; furious delirium or loss of consciousness ; silent delirium and carphologia, or spasmodic or convulsive attacks; parched lips, soreness of the corners of the mouth, redness and dryness of the tongue, which is sometimes also foul and covered with a yellow coating; skin hot and dry; bitter taste in the mouth, intense thirst, difficulty of deglutition, especially of liquids ; nausea, pressure at the pit of the stomach; meteorismus; and constipation, or watery motions; scanty and red or amber- 30 NERVOUS FEVER, coloured urine, rapid respiration? pulse full and accelerated, or quick, hard, and wiry ; parotid glands inflamed and tumid. Stramonium may be given when, in addition to the above symptoms, we find twitching of the muscles of the face, sub- sultus, strabismus, trembling of the extremities, tremulous motion of the tongue on protrusion, burning heat of the body, suppression of the urine, fantastic gesticulation, and risus sardonicus. HYOscYAMUs,with similar symptoms, and moreover, twitch- ing of the tendons, strong full pulse, fulness of the veins, burning heat of the skin, sensation of pricking all over the body, and constant delirium; frequent but ineffectual urging to urinate. Administration. Of the three last mentioned remedies, six globules of the third potency may be added to an ounce of pure water, and a dessert-spoonful given every three or twelve hours, according to the violence of the malady or the improve- ment that ensues. When the skin continues hot and dry, and the bowels relaxed, or the motions even passed involuntarily ; or when there is phlegmonous inflammation of the tonsils ; the alternate administration of Belladonna and Aconite every two or three hours until the skin becomes moist, &c, will be attended with a desirable result. We will now proceed to the consideration of the two medi- cines, Rhus and Bryonia, whose value in typhus, in the form in which it appeared in Germany in 1813, was proved by Hahnemann's treatment of 183 patients, not one of whom died, while thousands perished under the means employed by the professors of the old system of medicine. The two medi- cines above mentioned possess many striking points of simi- larity, but also many of difference ; they may on some occa- sion be administered alternately with great advantage in the manner below described; for the several employments the indications are as follows : Bryonia. More particularly when the disorder assumes the character of a Febris nervosa versatilis, or Typhus cere. bralis, with violent stupifying headache, as from a blow, and OR ttphus. 31 pain across the temples, as if the head would burst. Aggra- vation of these sensations by movement—continued delirium, violent, with excessive febrile heats, foul thickly-coated yel- low tongue, with dryness of the mouth and great thirst, and vesicles on the mouth or tongue, furred lips, nausea, inclina- tion to vomit, or vomiting of mucous and bilious matter; tenderness of the scrobiculus when touched; general heat of the whole body, dryness of the skin, redness, of the face, and profuse perspiration during the fever; sensibility of the epi- gastric region, distended abdomen.— Constipation, or relaxed stools ; urine of a deep orange colour or bright yellow, with yellow sediment; sensation as of a plug in the throat, with difficulty of hearing; stitches in the side; drowsiness or disposition to sleep during the day; sleeplessness, fugitive heat and excessive restlessness, or continued drowsiness or coma, with startings and unpleasant dreams ; painful shoot- ings and soreness of the limbs, aggravated by movement, trembling of the hands; pulse quick, soft, frequent; or ir- regular, small, and intermitting. Petechias, ibritability, irascibility, despair of recovery. Rhus toxicodendron. This medicine is more peculiarly suitable to the debile form or stage, the Febris nervosa stu- pida, as is Bryonia to the inflammatory; but will frequently be found serviceable in all the stages of the disease, particu- larly when there is diarrhoea, and congestion to the head, and great weakness. The headache is generally of a stupifying nature, with a feeling as if from a bruise, but not so severe as that of Bryonia; the tongue presents nearly the same charac- ter, less nausea and inclination to vomit exists; violent pain is present at the epigastrium, especially when touched. Consti- pation as in Bryonia, but more particularly, copious yellowish or loose sanguineous evacuations ; the symptoms of general heat, and those of the face, resemble those given under Bryo- nia, but without the perspiration, or at most, a clammy feeling of the skin. The urine is hot, dark coloured, or at first clear, and afterwards turbid, the symptoms of the ears the same; sleep also the same; difficult deglutition of solids, as if from contraction of the throat and oesophagus; general trembling, 32 NERVOUS FEVER, debility and prostration, almost amounting to paralytic weakness of the different limbs, shooting pains in various parts of the body, aggravated when at rest or at night, and momentarily relieved by moving the part affected ; pulse quick and small, or Weak and slow. In the morale we may notice, excessive anguish, anxiety, extreme lowness of spirits, and inclination to weep. Petechias, as in Bryonia, are frequently present. Administration. As before remarked, Rhus is particularly suitable in the debile form, or low typhus; we may add six globules of the third potency to an ounce of water. In some extreme cases, however, the practitioner will find it necessary to prescribe a more frequent administration of the dose, and at a still loWer potency, (such as the second dilution, or even the mother tincture,) and administer one dessert-spoonful every three to four hours in ordinary cases, lengthening the intervals as improvement ensues, and then quietly awaiting its action. The Bryonia may be given in the same manner when it appears indicated, and in many cases it will be found useful to give these medicines alternately at six hours' interval, a dessert-spoonful of the mixture above mentioned as a dose. Arsenicum. This is decidedly one of the most important remedies in abdominal typhus, sometimes restoring the patient when almost beyond the reach of hope, and renovating the vital spark. The chief indications for its employment are extreme prostration of strength, falling of the lower jaw, open mouth, dull and glassy eyes, burning thirst, and colliquative diarrhoea, pulse scarcely perceptible and inter- mittent. ■ Administration. Six globules of the third, sixth, or twelfth potency may be added to an ounce of water, and a dessert-spoonful given every quarter, or half hour, until im- provement is perceptible, when the intervals between the doses may be extended. Carbo vegetabilis is another remedy of great utility in these desperate cases; it is indicated where we find drow- siness with rattling respiration, face pinched, sunken, and deathlike, pupils insensible to light, pulse scarcely percep- tible, and rapidly sinking, cold perspiration on the face and OR TYPHUS. S3 extremities, involuntary and offensive evacuations, deep red urine, with a cloud floating in it or rising towards the surface. Administration. Six globules of the sixth potency in the same quantity of water as the preceding, administered in the same manner. An alternate administration of these two medicines, at intervals of from four to eight hours, has been attended with the most fortunate results. Acidum phosphoricum. When at the very commence- ment of the disease, we find great exhaustion and prostration, with wandering even when awake; or in almost hopeless cases, either alone, or still better in alternation with Rhus when the patient is always found lying on the back in a co- matose state, and either gives no reply when talked to, or if he does it is in an incoherent manner ; constant loquacious deli- rium, or low muttering ; carpologia, fixed look; seeming ef- forts to escape from some alarming object; black incrustations on the lips ; dry hot skin, continued copious watery diarrhoea ,• the motions are generally passed involuntarily; sanguineous evacuations; frequent, weak, and occasionally an intermitting pulse. Should the debilitating sanguineous evacuations con- tinue, Acid, nilricum should be administered, or Cantharides, should strangury also be present. Administration. Same as the above. Sulphur may often be had recourse to with advantage when Bryonia, Rhus and Acidum phosphoricum have been fruitlessly administered; the following, however, are its cha- racteristic indications in this disease: pale and collapsed countenance, burning itching eruptions on the lips, dryness of the mouth; foul, dry tongue ; bitter taste; slimy or bilious vomiting; tenderness of the epigastrium, and pain in the umbilical region increased on pressure; borborygmus; fre- quent watery, flocculent or yellow evacuations ; cloudy urine, depositing a reddish sediment ; stitches in the chest, oppress- ed breathing; dry cough, worse towards evening and at night; sleeplessness, or, whining during sleep, dry heat during the day, with moderately quick pulse, profuse sweating at night. Administration. Six globules of the sixth in an ounce of water, a desert- spoonful every six hours. 2* 34 NERVOUS FEVER, Opium. Great drowsiness, or coma with stertorous breath- ;,lg, open mouth, half closed eyes, or fixed look, slight deli- rium or muttering ; carpologia ; the patient is in a continual state of sopor from which it is extremely difficult to rouse him, and is scarcely aroused ere he relapses into his former state; dry offensive stools, which together with the urine are passed involuntarily. Administration. Six globules of the third potency in half an ounce of water, a teaspoonful every three hours. Calcarea c. may sometimes be administered advanta- geously, alternately with Belladonna, Arsenic or Rhus, ac- cording to symptoms; it is further sometimes a most efficient remedy in cases in which debilitating diarrhoea or epistaxis will not yield to such remedies as, Ac phos., Rhus, Cin- chona, etc.: when the nasal hemorrhage does not yield to Calcarea, Hepar sulphuris is generally the most appropriate remedy to follow up with, provided the entire feature of the disease is not better embraced by Pulsatilla, Belladonna, Rhus, or Sulphur. Phosphorus. When the disease becomes as it were con- centrated in the lungs, and there is consequently congestion with extremely laborious breathing and excessive anxiety, dulness on percussion, mucous rale, stitches during respira- tion ; cough with copious expectoration of mucus mixed with blood, or even offensive pus ; more benefit may be looked for from this than from any other remedy. Administration. Six globules of the third in an ounce of water, a dessert-spoonful every four hours. Acidum muriaticum. Weakness, with a constant tendency to sink down in the bed, with groaning during sleep, al- most paralytic state of the tongue, rendering it almost impos- sible for the patient to speak, even when in a collected state, and great dryness of the mouth. Administration. The same potency and in the same manner as Arsenicum. After severe cases of Typhus, a period of debility gene- rally supervenes of greater or less duration, according to the violence of the attack. In such instances Cinchona -§■&, OR TYPHUS. 35 in a little water, repeated in five days, followed by Valerian in about four days to a week, according to the result pro- duced. Of this latter medicine, three or four globules of the third potency may be given in a glass of water, and repeated every two days, if necessary, until the desired result is at- tained.* An alteration of these two medicaments, at intervals of twenty-four hours, has also been found very useful in these cases. When debilitating sweats supervene, Cinchona should be administered, followed by Sulphur if required. Should symptoms of deranged digestion remain after the fever has been subdued, Nux vomica and Pulsatilla will be found most serviceable according to the temperament of the individual, and the symptoms present. (See article Indiges- tion.) The other medicaments mentioned under the head referred to, may also be advantageously consulted. Where a peculiar morbid state of the constitution exists, denomi- nated by some Homoepathists, a psoric tendency, a drop of the third potency of the Tincture of Sulphur in three des- sert-spoonfuls of water, one daily, and the medicine then al- lowed to act from one to three weeks, according to circum- stances, may be administered. Diet. In a disease that presents so many varieties, it is difficult to give any rules upon this head applicable to all cases. When a marked inflammatory character is present, the same abstinence should be enjoined as already noted un- der Fevers; and in all cases, either during the progress of the disease or the period of convalescence, the greatest possible care should be taken to avoid taxing the digestive functions; the diet should be light and simple, and the patient never al- lowed to indulge the appetite to its full extent. PUTRID FEVER, or TYPHUS. Typhus Putridus. We have already alluded to this form of the disease under Typhus, particularly in the indications given for the employ- * Vide note, p. 21. 36 PUTRID FEVER. ment of Arsenicum and Carbo vegetabilis; but consider it of sufficient importance to be remarked on' separately, although Of course, except in cases of decided emergency, no individual not properly" qualified would think of treating so serious an affection. Diagnosis. The symptoms of Typhus already given, run- ning on to the colliquative state ; extreme debility, pulse ex- ceedingly small and weak, so as to be scarcely perceptible ; a peculiar sensation of burning pungent heat, communicating itself to the hand when placed upon the body of the patient, heavy cadaverous smell of the whole body, putrid odour of the breath, perspiration, and secretions in general; profuse oily and clammy sweats; involuntary evacuations ; colliqua- tive oi* sanguineous diarrhoea; dark and bloody urine; epis- taxis, petechia?, and Other marked tendencies to organic disso- lution. The patient is always found lying on his back, and continually shrinks down to the foot of the bed, a sign of ut- ter helplessless and prostration. ... Therapeutics. Arsenicum corresponds closely to the foregoing symptoms, and is, therefore, our principal remedy when the disease assumes this form, particularly when we find involuntary and sanguineous evacuations and tenesmus. Carbo vegetabilis may also be with advantage alternated with it, when the symptoms already given under Typhus for the exhibition of that medicine are present; Mercurius is called for in case of great tenesmus, and when the discharge of blood is principally alvine, followed by Acid, phosph., Acid, nitr., or Cantharides, should sanguineous diarrhoea continue. (See NERVOUS FEVER, p. 29.) Administration. When Arsenicum itself is found called for, we may add one drop of the third potency to an ounce of water, and administer a dessert-spoonful every six hours, or even every hour if the patient seems sinking, until an improve- ment takes place. If, however, from the symptoms given under that medicine, an alternation with Carbo vegetabilis seem desirable, they may be thus exhibited at intervals of CONTAGIOUS fever, or typhus. 37 from six to twelve hours, according to the urgency of the case; in some instances, where Arsenicum does not produce all we could desire, this mode has been adopted with success. * Cinchona will be found useful when the more dangerous symptoms have been in a great measure subjugated, but at the same time great weakness remains from the loss of humours; it is also useful when the little nutriment the patient may have partaken of passes off undigested. Administration. Six globules of the third potency in an ounce of water, a dessert-spoonful every four hours. In those cases where Arsenicum and Carbo vegetabilis seem to fail, the employment of the Mother Tincture of Rhus, one drop in a tea- spoonful of water every three hours, has, in a number of in- stances, been found most efficacious, f CONTAGIOUS FEVER, OR TYPHUS. Typhus Contagiosus. Diagnosis. The symptoms of typhus caused by infection or contagion. Therapeutics. The same as already given under Typhus. We may, however, here remark upon one remedy of especial value in this form of the disease, namely, Opium, indicated by drowsiness or coma.—Coma somnolentum, especially,—ster- torous breathing, mouth partly open, eyes open or partially closed, loss of speech, rigidity of the limbs, smallness or in- * It may here be remarked, that Gross and others have recently recom- mended, and are in the habit of administering, Arsenicum at extremely high potencies (the 200th and even the 1600th) in typhus and other diseases, when the vital energies seem rapidly sinking. See also " Po- tencies of the medicaments," in the Introduction. f Many of the remedies, along with the indications for their employ- ment, which have been given in the preceding chapter, will also be found equally appropriate in particular cases or in certain stages of so-called putrid fever—the attention of the practitioner is therefore particularly called to them in such circumstances. 38 CONTAGIOUS FEVER. termissionof the pulse, meteorismus, involuntary evacuations, or constipations. Administration. We may add six globules of the third potency to an ounce of water : give a dessert-spoonful every three or four hours until a favourable change is observed. When in addition to the above-named paralytic affection, we find jerkings in individual limbs, we should have recourse to Hyoscyamus or Stramonium administered in the same manner, choosing the remedy which most closely approximates to the symptoms we have given for their individual use, under Ty- phus (p. 30.) It may be remarked, that whenever the symptoms given under Opium, and the other medicines, present themselves in Typhus, from whatever cause arising, the remedies are of course indicated. Accessory Treatment—Prophylaxes, &c. We need hardly insist upon what every practitioner knows to be essentially adjuvant in the treatment of this affection, a constant supply of fresh and continually renewed air. Prophylaxes, during the prevalence of Typhus. Cool pure air, thorough ventilation, the avoidance of dark or dismal- looking apartments into which the genial daylight does not freely penetrate ; and the removal of all causes generating the disease, such as stopped sewers, or collection of decaying vege- table and animal matter; a plain wholesome diet, with a mode- ration in the use of fermented liquors or wine, and total absti- nence from spirits; refraining from late hours, intense study, and excessive mentalor corporeal exertion ; exercise in open situations, with proper precautions against exposure to cold or damp; and finally, the preserving a healthy tone of mind and cheerful temper. The absurd practice of keeping the bowels constantly open by means of aperient medicines, and the use of sudorifics, can- not be too strongly reprobated; both these practices weaken the system, and predispose to the disease. INTERMITTENT FEVERS. 39 Standing between a fire or open window and the bed of the patient is to be avoided, as unnecessarily increasing the risk of taking the infection. The safest plan for the physician to pursue in epidemic or endemic typhus, is to form an aggregate of the symptoms by carefully collating those of individual sufferers, so as to present a perfect image of the existent malady, and- to choose his remedies accordingly, which should be adminis- tered directly on the premonitory symptoms declaring them- selves, without waiting for the further development of the disease. It may be remarked, that Bryonia and Rhus cover a great number of the symptoms of typhus, as met with in this coun- try ; when, therefore, this point has been ascertained, they may be given alternately, Bryonia ^ and Rhus °j° each in one dose, at intervals of twenty-four hours, which will often either check the malady at its outset, or materially modify its virulence—in some cases one of these remedies is of itself sufficient, according to the leading symptoms of the reigning epidemic; in a great variety of instances, Arsenicum may prove a valuable prophylaxis ; but at the same time, the indi- cations we have already given of the several medicaments should be carefully consulted, as the same rule holds good for them all. INTERMITTENT FEVERS—AGUE. Febres Intermiltentes. We have now to enter upon a class of fevers differing essentially from those already considered, in possessing a marked character of their own, in the simplicity of their form, the periodicity of the different stages, and the uncertainty of their duration. Diagnosis. A chill or cold fit, followed by heat, and terminating by perspiration, more or less profuse; these three stages constitute a paroxysm; after which for a certain period, 40 ' INTERMITTENT FEVERS. called the Apyrexia, the patient is generally free from suf- fering. These periods are generally of definite duration :—if the paroxysms return at regular intervals of twenty-four hours, the fever is termed a Quotidian; of forty-eight, a Tertian; of seventy-two, a Quartan; even longer intervals have been ob- served between the attacks; hence the Octanse of some writers. If two paroxysms take place within each period, the ague is said to be doubled, as a double Quotidian or Tertian. These fevers are sometimes found existing in the simple form above noted, and at others complicated with other forms of disease, as in intermittent catarrhal or gastric fevers. They are exceedingly indefinite in duration, and frequently assume a chronic form. An individual once attacked with ague is frequently liable to a return in after-life, if the disease has not been radically cured at the commencement; nay, more, any attacks of disease he may be hereafter subjected to, are peculiarly apt to assume the intermittent form. Nervous or inflammatory fever may change into an inter- mittent, or the latter take upon itself, if it continue, the character of either of the two former, or become remittent; this frequently happens in hot climates. Ague is rarely dangerous in this country, except when of long continuance, by the weakness it occasions and the in- jury it inflicts upon the constitution; it may, however, lead to obstructions and indurations of the more important viscera, particularly of the liver and spleen, or induce dropsical affec- tions. But in hot climates or in low marshy countries, this disease is exceedingly fatal; and on dissection, the brain and its tissues, the mucous coat of the stomach and bowels, the lungs and peritoneum, have been found affected; in such instances when the disease gains ground, the patient loses strength and becomes emaciated, every fresh paroxysm entails an increase of suffering, and the perspiration fails to relieve; he complains of a sense of weight in the hypochondria, particularly the right, with griping pain in the bowels, flatulent distention of the INTERMITTENT FEVERS. 41 abdomen, diarrhoea, or constipation, and constant thirst; or of headache, cough and dyspnoea : the tongue is furred, and dry at the tip; the skin hot, harsh, and dry; the urine scanty, the abdomen tumid, the extremities become dropsical, and sleep is restless or broken. . Death may ensue from collapse in the cold stage, the ab- sence of perspiration, and the diseased passing into continued or remittent fever, or from disorganization of some impor- tant function, such as the brain, lungs, spleen, or liver. We shall now proceed to a general consideration of the three stages of the disease, premising that the various modi- fications of the symptoms will be found more in detail under the medicaments when we enter into the therapeutic treat- ment. Premonitory symptoms. Sense of languor, or general uneasi- ness ; yawning, headache, stupor, pains in the limbs or dor- sal region, the toes and fingers becoming numb, and the nails blue. Cold stage. Coldness of the extremities, with a feeling as of a stream of cold water running down the back, and extend- ing itself to the chest and abdomen; general prostration of strength, insupportable coldness, external and internal tre- mors, chattering of the teeth, respiration laboured and hur- ried, with inability to draw a full inspiration, and oppression at the chest. The head is variously affected, sometimes with headache, at others with coma, stupor, or delirium ; the pains noticed in the premonitory symptoms are generally present, and in some instances the patient complains of pain all over; the tongue is moist, the eyes are heavy and sunken, the fea- tures pinched, and the lips and cheeks livid; the rigors sometimes run on to convulsions. The pulse is weak and oppressed, sometimes slow, at others quick, and frequently intermitting, and often, from the se- verity of the rigors, scarcely perceptible. The heat of the body, except at the extremities, is gene- rally above the natural standard, while the patient complains of cold. Sometimes the patient feels only a slight degree of cold, without tremors, but accompanied with symptoms of func- 42 INTERMITTENT FEVERS. tional derangement, and in a few hours the hot fit declares it- self. The duration of the cold stage is from an hour to four hours ; and it runs into the hot without any marked interval. The Hot Stage presents all the characteristics of a modi- fied inflammatory attack, with hot, dry skin, and thirst, op- pression at the chest, hurried and anxious breathing, and acute pain in the head, region of the spleen, liver, &c.; there is also occasionally a degree of cerebral disturbance, or even delirium. The general duration of the hot fit is from four to twelve hours, when it terminates in the sweating stage ; when this does not take place, it is apt to run on to continuous fever, or take the form of a remittent,—a not uncommon issue of this disease in warm climates. Sweating Stage. After the hot fit has continued a longer or shorter period, profuse perspiration sets in, commencing in the forehead and extremities, and quickly diffusing itself over the whole body ; as soon as it makes its appearance, the uneasiness and other symptoms begin to disappear, and the patient, in simple ague, continues free from suffering until the next paroxysm. Causes. Marshy districts are noted as being the hot-beds of this malady ; a continuance of fish or farinaceous diet is also apt to produce it; it may, moreover, arise from taking cold, indigestion, internal obstructions, peculiar constitutional tendency, or local irritation. The medicines should generally be administered in the apyrexia or interval between the paroxysms. Therapeutics. The following remedies have been found most appropriate in ordinary cases of this affection : Cinchona, Arsenicum, Ipecacuanha, Nux vomica, Pulsa- tilla, Antimonium crudum, Bryonia, Veratrum album, Cocculus, Sabadilla, Ignatia, and Carbo vegetabilis. Cinchona. This well-known but too frequently abused remedy, is undoubtedly of the greatest efficacy in those fevers which owe their origin to the influence of marsh miasm, and are peculiarly prevalent at particular seasons of the year. INTERMITTENT FEVERS. 43 It may be given as soon as the precursory symptoms manifest themselves, when we find a degree of fever, with anxiety, palpitation of the heart, headache, sneezing, great thirst, buli- my, or nausea, and pain in the bowels. It is also indicated when the fever has set in by adypsia during the cold stage— but thirst after the heat and during the sweating. It is con- tra-indicated when thirst exists during the hot stage. Administration. When properly selected, a single dose of this medicine (three or four globules of the third potency) will generally remove the fever; but in other cases frequent repetitions and still lower potencies will sometimes be found necessary.* Arsenicum is indicated when the different stages are not definitely marked, but the fever, and heat, and shivering, appear simultaneously—or we find cold shuddering alternate- ly with heat, or a sensation of cold internally, with heat, or an imperfect development of the paroxysms ; or burning heat, as if molten lead were coursing through the veins, communi- cating an unpleasant sensation of heat {color mordax) to the hand when placed upon the body of the patient—great rest- lessness ; and excessive, almost insatiable thirst, obliging the sufferer to drink constantly, although but little at a time; depression, marked prostration of strength, and anxiety ; nau- sea, desire to vomit, retching, and even vomiting ; severe and burning pains in the stomach, and insupportable pains all over the body, especially in the limbs. A marked characteristic of Arsenicum is, that all the suffer- ings of the patient, pains in the limbs, &c, increase in intensi- ty during the paroxysm, and others develop themselves ; another is, its marked periodicity, generally either Tertian or Quartan, and the rigors generally setting in towards evening. It is therefore called for in these cases where we meet with a well-marked periodicity of imperfectly developed paroxysms, with some or any of the symptoms above mentioned. Administration. Of this medicament -§- given during the apyrexia, will be generally found a sufficient dose ; how- ever, in some cases, when the vital energies of the patient * Vide note, page 21. 44 intermittent fevers. seem insufficient to rally, and the cold fit continues, two drops of the tincture of the third potency may be added to an ounce of water, and a dessert-spoonful given every four or two hours, or every twenty minutes, according to the exigen- cy of the case. Such cases are happily rare in this country, but I have thought it advisable to touch upon the means to be employed when they do occur; in such instances also Veratrum (which see) is occasionally useful.* Ipecacuanha. This remedy will be found useful in most cases of this affection, for although it may not always prove competent to the entire removal of the complaint, yet when administered at the commencement it rarely fails to prove of considerable benefit, and in many instances, when judiciously selected, it of itself performs a cure,—the most marked results have been derived from its Administration with Nux vomica in the following mode : exhibit Ipecacuanha -§- in a. little water, and repeat the dose in three hours; Nux vomica -§- twelve hours after, and if possible, in the evening. Should, however, the apyrexia take place towards evening, lengthen the intervals, giving the Ipecacuanha every five hours, allow- ing twelve hours to intervene, and administering the Nux vomica in the evening, and if the attack be quotidian, repeat- ing the latter medicine in the apyrexia preceding it. Either of these remedies is of itself sometimes found suffi- cient to shorten the duration of the disease; the indications for Ipecacuanha are as follows : much shivering; with but little heat, or vice versa ; increase of the shivering by external warmth ; oppression at the precordial region ; adypsia, or at least, little thirst; dryness of the mouth, nausea, vomiting and other symptoms of deranged digestion. For Nux vomica. Giddiness, with feeling in the head as if from intoxication, desire to lie down, with trembling of the limbs, or a feeling of a paralytic weakness and prostration, with cramps in the different extremities, particularly the calves of the legs and feet, difficulty of breathing, anxiety, irascibility, fear of death, and even slight delirium ; gastric derangements, such as anorexia; dislike to bread ; bitter and * Vide note, p. Si. INTERMITTENT FEVERS. 45 sour eructations, tension of the abdomen, or spasms of the abdominal muscles, and constipation. During the fever: Coldness and blueness of the skin, desire to be constantly covered, even during the access of heat and perspiration; oc- casionally stitches in the side, shooting pains in the abdomen, aching in back and limbs, and dragging pain in abdomen dur- ing the rigors. During the hot fit particularly, headache, buzzing in the ears, heat in the head, face, with redness of the cheeks, and thirst. Administration. In most cases the dose before mentioned will be found sufficient; but when the disease is violent, a few globules or a drop at the third potency may be added to an ounce of water, and a dessert-spoonful taken every night to the day a return is expected. Pulsatilla, like the two remedies last mentioned, and Antimonium crudum, Bryonia and Ignatia, is an excellent remedy in Agues complicated with gastric or bilious symp- toms, whenever the slightest dyspeptic attack brings on a relapse; its more peculiar indications are: adypsia all through the fever, or thirst only during the hot fit; simultaneous heat and shivering—aggravated in the afternoon or towards even. ing; shivering when uncovered; anxiety and oppression of the chest during the shivering. During the hot stage, redness and swelling of the face, or redness of the cheeks only, and perspiration on the face. The presence of diarrhoea, and the patient being of a mild disposition, are corroborative indica- tions for its employment. Administration. In ordinary cases -•§- may be given in a dessert-spoonful of water during the apyrexia; in very se- vere attacks, a few globules, or a drop or so of the third po- tency, may be added to an ounce of water, and a dessert- spoonful given every six or twelve hours during the same period ; in some instances, it will be sufficient to give a dose about three hours before the expected attack. Antimonium crudum. The indications for this remedy closely resemble those of Pulsatilla, but it is particularly called for when the perspiration breaks out simultaneously with the accesses of heat, and then suddenly disappears, leaving the 46 INTERMITTENT FEVERS. skin dry and hot. It may be exhibited at the same potency and the same manner as Pulsatilla. Bryonia is indicated by headache and vertigo, with dry heat preceding the attacks of shivering ; by the predominance of cold or shivering ; with redness of the cheeks, heat in the head, and headache ; or marked heat followed by shivering ; by stitches in the side, excessive thirst, thickly coated tongue, bitter taste in the mouth, disgust at the sight of food, nausea or vomiting, and constipation. Administration. Bryonia may be exhibited at the same potency and in the same manner as Nux vomica, (which see,) with the distinction of administering it when practicable in the morning, instead of at night. Veratrum album is indicated by the predominance of external coldness, with heat internally, cold clammy perspira- tion, especially on the forehead, or general coldness of the whole body; or by shivering followed by heat and perspira- tion, and then relapsing into shivering; coldness, great thirst, deep-coloured urine, diarrhoea with griping, or constipation ; sometimes nausea or vomiting, and vertigo, and pains in the dorsal and lumbar regions. Administration. This medicament may be exhibited in the same manner as Arsenicum, if the cold fit continues be- yond the usual time; or may be had recourse to either singly or in alternation with that medicine, as circumstances may point out. Cocculus -f ^ in a little water, at the customary period, when, in addition to the usual symptoms of Ague, we find during the apyrexia, symptoms of spasmodic affections, par- ticularly of the stomach and abdomen, such as cramp-like pains at the epigastrium, or constrictive pinching, or tearing, burning, colic-like pains in the hypogastrium. Sabadilla has been found useful in cases where the attacks return always at the same hour, with chills of short duration, then thirst followed by heat; also where thirst is present just at the close of the cold stage, and in such affec- tions as consist entirely of chills. Administration -£- as given under Arsenicum. INTERMITTENT FEVERS. 47 Ignatia is indicated when with heat of some parts of the body there is coldness, chill, and shuddering of others, also where the heat is only external. Its best characteristic is, when the chills are easily relieved by external warmth, and at- tended with thirst. Administration, -§- at the same potency and in the same manner as Pulsatilla. Carbo vegetabilis, in constitutions with a peculiar morbid tendency, will be found a most useful remedy. It is parti- cularly indicated when thirst is present only during the shiv- ering ; and there are rheumatic pains in the teeth or limbs before or during the attack, nausea, giddiness, redness of the face during the hot fit. Administration. 5jfi2fi may be dissolved in a little water, and given morning and evening during the apyrexia. When the hot-fit continues long without perspiration super- vening, and the intermittent threatens to change into a remit- tent or inflammatory fever, we must have immediate recourse to Aconite, of which we may give -6-, and if no relief follows in three or four hours, add six globules of the third potency to an ounce of water, and administer a dessert-spoonful every hour until perspiration sets in, or the pulse is reduced. Arsenicum, Carbo vegetabilis, and Lachesis, are three of the most important remedies against intermittent fevers which return every year. The preceding are the medicines that have been found use- ful in ordinary cases of this affection ; but as the disease is frequently found complicated with other complaints, it has only been found practicable to give a general statement of the course to be pursued when met with in its more simple forms, and merely to allude to the others—there being scarcely a disease known that may not assume the intermittent type, as there is scarcely a proved medicine that does not also partake of the same character. All the author has endeavoured to do, in the preceding pages, is to give a clear idea of the treat- ment of ague, commonly so called, as frequently met with; as he feels it would be vain to attempt to enter upon the ma- ny various forms and appearances which this malady presents. 48 ERUPTIVE, FEVERS. ERUPTIVE FEVERS. Under this head, I intend to treat of those diseases possess- ing the common property of febrile symptoms, preceding an eruption which is present during a part of their course that eruption varying in character according to the nature of the affection. In this class are comprised scarlet fever, purples, measles, small-pox, chicken-pox, miliary fever, and nettle rash. SCARLET FEVER. This disease, in its simple generic character, consists of a contagious fever, with swelling of the face and a scarlet appear- ance of the skin—(hence its name)—which is of a bright raspberry colour, or of a hue resembling a boiled lobster, smooth and glossy, upon which the finger being pressed leaves a white imprint, which almost immediately disappears. How- ever, in the present day, we seldom meet with it in this sim- ple form, but more frequently complicated with severe or ulcerated sore throat, delirium, congestive or violent inflam- matory symptoms, and often with more or less deviation from the characteristic efflorescence above described. Diagnosis. Fever with extreme quickness of pulse ; a feeling of soreness or pain in the throat; and in one or more days, the appearance of an eruption of the colour above men- tioned, in large indefinitely marked patches, gradually grow- ing paler towards their margins, and often extending over entire limbs with an uniform scarlet colour ; the efflorescence disappears in five or six days, when the skin desquamates, and comes off in large pieces. We sometimes find scarlet fever with scarce any, or even no external redness, but at the same time marked angina and bright redness of the tongue; in such cases the disease, in- stead of showing itself on the skin, has fixed upon the mucous SCARLET FEVER. 49 membrane; and even the angina and redness of the tongue present in most cases of this disease may be considered as an internal scarlatina. e , Scarlatina was formerly confounded with measles from the resemblance which the two eruptions bear to each other at ^commencement; but they are easily distmguishabl* even without taking into consideration ^f^Z7- of theskin above mentioned-characteristic of the ^se by the eruption in scarlet fever generally developing itself in from twen'ty-four to forty-eight hours from the comment ment of the fever, whereas that of-easles rarely se in be- fore the third or fifth day; and moreover, by ^T^ catarrhal symptoms, such as cough, sneezing, ^^^ usual precursors of measles. The greatly f^«^^ which denotes the approach of scarlatina, is also never met with to the same extent in any other disease. Therapeutics. In those cases in which it appears; m its simple form, Belladonna is a specific remedy We m 7 dissolve four globules of the sixth potency m four ^pooa fuls of water* and administer one every six or even hree hours, if the fever run high, lengthening the intervalas. rt £ creases in intensity, only repeating when a cessa onoi the amelioration takes place. We ought to watch careful!after each administration, for if the fever increases soon alter may conclude it is a medicinal action, and avoid aggrav becomes a severe and dangerous disease, when theMi*»t i considerably affected i*^.%^^7 treated, congestive symptoms set in, which, if not proper y may assume the malignant type («^^.^^&i ed with ulcerated sore throat, extension of th^ to the air passages, delirium, spasm, &c. (Viae u sore throat.) pnitilioii in mild The fever and sore throat increase with the eruption V ^tb it« decline • but in the more severe, con- cases, and cease with its decline , uuu * Vide note, page 21. 50 ERUPTIVE FEVERS. tinue; it is when the disease appears principally to attack the head, throat, thoracic or abdominal viscera, that it becomes dangerous.* The eruption frequently does not appear before the third day, and then only in isolated patches : Belladonna should therefore be administered as soon as the throat and tongue become affected with dryness and burn- ing ; and there is desire, but complete inability, to swallow even drinks or saliva, with sense of suffocation ; further, when the throat presents a bright-red appearance, sometimes exco- riated, with white specks, or stringy mucus, or appearance like thrush; tonsils swollen, and the tongue of a bright fiery red, sometimes interspersed with dark red patches, but generally appearing later in the disease, if at all; also when delirium is present. Administration. We should dissolve six globules of the third in six teaspoonfuls of water, and exhibit a teaspoonful every four hours; to a child under twelve years of age, § in a teaspoonful of water repeated as above, which will generally be sufficient to bring about a speedy amelioration. If the disease have taken a favourable turn, we may allow the Belladonna to continue its action ; j" but if we clearly per- ceive an appearance of ulceration commencing, with increase of mucus, and swelling of the throat and tongue, we must have immediate recourse to Mercurius. Administration. One grain of the third trituration in six dessert-spoonfuls of water, one dessert-spoonful every four hours ; but when the ulcers present a livid appearance about the edges, and emit an offensive odour ; or when there is ex- cessive thirst, with great dryness of the mouth, and extreme prostration of strength, we must exhibit Arsenicum a|a in a little water, every four or six hours, according to the effect produced, and follow it with Nux vomica *&&, in the same manner, if the former prove inadequate to complete the cure. (Vide Ulcerated sore throat.) * When scarlatina anginosa occurs in complication with pneumonia, phrenitis, or enteritis, the remedies mentioned under these different heads must be had recourse to. + See the article on the " Administration of the remedy? in the In- troduction. SCARLET fever. 51 When the fever assumes a clearly inflammatory type, and the pulse runs high, we may administer Aconite,* at the same potency and in the same manner as already given under In- flammatory Fever, which see. When the quickness of pulse and other inflammatory febrile symptoms are subdued, and the affection of the throat again appears prominent, we may return to Belladonna, especially if the skin retain the peculiar scarlatina hue. Opium may follow the administration of Belladonna when there is burning heat of the skin, drowsiness, stupor, sterto- rous breathing, open mouth, eyes half closed, restlessness with vomiting, or convulsions. Administration. Six globules of the tincture of the third potency, added to an ounce of water, a dessert-spoonful every four hours; if, however, a marked improvement follow the first dose, we may allow the remedy to continue its action. We may here notice a remedy which has been found par- ticularly efficacious in a peculiar affection of the brain, that frequently declares itself in cases of repercussed exanthemata, and which if not speedily checked, may terminate in paralysis of that organ. We shall therefore treat of this remedy here, and refer to this place, when we may hereafter have occasion to allude to it. The discovery of its value in such cases is * Antimonium tartakicum. The indications for Tartar emetic, ac- cording to;Dr. Gray, are: a soporose condition from which the patient does not of itself fully arouse, and when awakened by the attendant, an- swers correctly without confusion or delirium; intense heat with nausea or spasmodic jerks or general convulsions, and varying colour of the skin from pallor to deep redness, with imperfect patchy development of the eruption. The occurrence of sweat around the mouth, with pallor of the perspiring parts, increases the balance in favour of the Antimony. The Doctor gives it when Aconite proves unavailing, the indications for the latter being present. Our own views and results fully corroborate those of Dr. Gray. Dr. George "W. Cook strongly commends the Antimony in his essay on Scarlet fever. (Homceopathic Examiner, new series, p. 183, vol. 1.) He presents the following indications for its use: convulsions which often precede the cutaneous efflorescence, colliquative diarrhoea, cold clammy skin, hurried respiration, hippocratic countenance, hoarse voice, retchings and vomiting of glairy mucus.—Ed, 52 ERUPTIVE fevers. due to Dr. Schmid of Vienna, whose formula for its exhibition we shall give herewith. Cuprum aceticum. When the eruption during efflores- cence is suddenly repercussed, the result of which is frequent- ly fatal, this medicament may be almost considered specific ; or at least the substance with which the greatest degree of certainty can save the patient; if in this condition death should happen, it is in consequence of paralysis of the brain. Symptoms indicating its employment: Quick, small, weak irregular pulse ; temperature of the skin considerably reduced, in more severe cases chilly, and covered with perspiration. Affections of the nervous system are never absent; to this be- long convulsive movements of various parts of the body, dis- tortion of the eyes, face, mouth, head, &c, spasmodic affec- tion of the chest, sometimes even eclampsia; as well as great restlessness, frequent change of position, sopor, delirium, &c. It displays its efficacy in reproducing the eruption, when the cerebral affection disappears, and the disease runs its usual course. Formula. One grain of the Cuprum aceticum triturated with one hundred, one hundred and fifty, or two hundred grains of sugar of milk previously triturated so as to feel as fine as flour ; the process should occupy from twenty to thirty minutes. Of this preparation take from three to four grains, dissolve in a tumbler of pure water, and administer in tablespoonfuls, every quarter, half, one, or two hours, accord- ing to the violence of the disease.* Pulsatilla, when derangement of the stomach and digest- ive organs is a prominent symptom, the face pale, red, or bloated; also constipation—or looseness, especially at night,— occasionally with pains in the bowels, and shivering ; dispo- sition fretful and sensitive, or melancholy. Administration. We may exhibit to an adult °£°, and * The remarks made on this medicine are taken from the translation of Dr. Schmid's paper on the subject, in that excellent and useful med- ical periodical, the British Journal of Homoeopathy, No. III., page 233, to which the reader desirous of further information is referred. SCARLET FEVER. 53 repeat in six hours if no improvement takes place ; to a child, one globule of the same potency. We frequently find this affection in a complicated form, distinguishable from pure scarlet fever by the absence of the peculiar hue of the skin, of which we have spoken at the commencement, and by the pressure of the finger leaving no white imprint. This so widely different type of the disorder will be found treated of in the succeeding chapter, under the denomination of Purpura miliaris or Scarlatina miliaris. In strumous habits, or in instances when the disease has been allopathically treated from the commencement, many troublesome sequelae are frequently left. And we may remark, that even after the desquamatory process is completed, the whole of the danger is not altogether passed, any exposure to cold or infringement of dietetic rules being likely to entail unpleasant and even dangerous consequences. Chamomilla may be employed with advantage, either alone or alternately with Belladonna, against rawness of the face, &c. Administration. Six globules of the sixth or third poten- cy in six dessert-spoonfuls of water, one twice a day. Aurum. Against the offensive and purulent discharge from the nose with soreness.and swelling of the interior. Administration. S.S.&-& in half an ounce of water, a tea- spoonful taken morning and evening. Mercurius vivus against soreness of the nose and face with swelling of the submaxillary glands; followed by Hepar sulphuris, Silicea, Sulphur, and Calcarea if necessary. Administration. Half a grain of the third trituration in six dessert-spoonfuls of water, one three times a day. Against the following, Belladonna is extremely efficacious: Puffiness of the face, swelling of the hands and feet, lingering fever in the evening, glandular enlargements, chaps about the mouth, severeheadaches, stammering, &c.; and may frequently be advantageously alternated with the medicines just men- tioned. Dropsical swellings of the whole body is not an unfrequent 54 ERUPTIVE FEVERS. sequela, sometimes requiring a most careful and discriminating treatment. The following remedies will generally be found the best adapted to the successful treatment of the same: Helleborus, Arsenicum, Belladonna, and, in obstinate cases : Arnica, Bryonia, Phosphoric acid, Digitalis, Baryta m., Sulph., Lycopod. Against Otitis, or Otorrhoea: Belladonna, Hepar sulphuris or Pulsatilla:—and in the case of Boils, Arnica followed by Bryonia and Sulphur when necessary:—Deaf- ness : Belladonna, Pulsatilla, Dulcamara, Sulphur, chiefly. Scarlet fever is chiefly dangerous when a latent constitu- tional virus is called into activity, and associates itself with the disease; in such cases, the allopathist finds himself baf- fled by an evil against which he possesses no specific remedy, and the utmost skill of the homceopathic practitioner is called into play. Such, it is evident, are far beyond the sphere of a work of this nature : We may, however, remark, that Ammonium carbonicum, Arsenicum, Secale cornutum, and Acidum phosphoricum, have been found very useful in scarlatina when it assumes the ty- phoid form; and Arsenicum in frequently repeated doses,—or Acidum nitricum, Aconitum, Lycopodium and Belladonna alternately, a dose of each remedy being given every hour, or oftener if necessary, to rouse the vital force to new efforts, for several successive hours,—in the severe and dangerous sore-throat which accompanies malignant scarlatina; the amygdalae being swollen into hard tumors, often as large as apples, with difficult, snorting breathing, enlargement of the neighbouring glands, remitting pulse, and sopor. Belladonna is valuable as a preservative against pure scar- latina when epidemic, and moreover greatly assists in modi- fying the character of the disease, in such individuals as do not wholly escape its attacks ; with children --, in a teaspoonful of water, and with adults, or robust children above ten years of age, a6a every three or four days, for from two to three weeks at farthest, which will generally be found suf- ficient to obviate any risk ; should the disease continue to rage, the treatment may in some instances be renewed : if the ruling epidemic be scarlatina in a complicated form, that is, SCARLET RASH. 55 not possessing the clear scarlatina hue, we should alternate this medicine with Aconite, one or two globules of the 6th potency, according to the age, allowing the Aconite an action of about twelve hours, and afterwards proceeding with the Belladonna as before. While taking these medicaments, the patient must adhere strictly to the homceopathic diet, parti- cularly avoiding wine and acids. We must, in administering prophylaxes, carefully watch their effects, and if a medicinal action set in, discontinue immediately. Diet. During the course of this malady, the greatest possi- ble attention must be paid to this point. In the more severe accesses of fever, no other nourishment must be given than toast-water or weak barley-water; and after the fever has abated, every care must be taken, and a return be gradually made to a more nourishing diet, as negligence in this respect may be productive of the most serious consequences. In mild attacks the patient may be allowed gruel or weak broths. PURPURA RUBRA s. MILIARIS HAHNEMANNI. Scarlatina miliaris. Miliaria purpurea. SCARLET-RASH. This affection is sometimes met with in complication with smallpox, measles, and scarlet fever, more particularly the latter, of which disease, indeed, it is regarded by many as a mere modification. It is easily distinguishable from pure scarlet fever, by the dark redness of the efflorescence, by the slight pressure of the finger leaving no white imprint, and by the small granular elevations, the cause of the dark red hue, which are felt on passing the hand over the affected cutaneous surface. This eruptive fever does not run a defined and regular course, like other exanthematic fevers. The efflorescence often disappears suddenly, and is then productive of extreme danger, frequently terminating in a fatal result. The extent 56 ERUPTIVE FEVERS. of the efflorescence does necessarily add to the danger, as the latter is often greatest when the efflorescence is scarcely per- ceptible. Sweat is only met with on the surfaces affected with the eruption, and it is consequently only when the eruption covers the whole body that the sweat is general. Those who have been affected with the disorder are by no means exempt from future attacks. Soreness of the throat is chiefly encountered when the eruption is altogether want- ing, but it is also frequently met with before the outbreak of the rash, becomes trivial during the full bloom, and again very severe on the disappearance of the same. This disease, dissimilar though it be to the true scarlatina, has yet been frequently confounded with it by careless ob- servers. It requires a totally different treatment, and Bella- donna, the specific in scarlatina simplex, will in this case neither be found to be a preventive nor an indispensable cu- rative remedy, but simply an auxiliary in some complicated cases. Aconitum. When the disorder occurs in an idiopathic form, there are few exceptions in which any other remedy but Aconite is required for the entire removal of the disorder. In administering it, we may dissolve three globules of the sixth potency in as many teaspoonfuls of water, and give a teaspoonful every three or four hours. Sometimes it is found necessary to administer a dose of Coffea (B%Q) a few hours after the first or second dose of Aconite, when the patient complains of severe pain in the head, trunk or extremities and is extremely restless, fretful, agitated, and disposed to shed tears ; and then again to return to Aconite, after a sim- ilar interval; and so on, alternately, until the cure is com- pleted ; which, under favourable circumstances, is speedily accomplished by means of these remedies. When, however, this eruptive fever occurs in complication with scarlatina, smallpox, or measles ; or when it breaks out in unfavourable seasons, during the prevalence of one or more of the said exanthemata, it generally becomes a much more serious disorder, and requires the aid of other remedies in PURPLES. 57 addition to the above mentioned. Amongst these : Ipecacuan- h'a, Pulsatilla, Bryonia, Dulcamara, Belladonna, Arsenicum, Phosphorus, and Rhus, are the most important, preceded by Aconite, when symptoms of inflammatory fever, or the follow- ing, present themselves : Slight, general fever chills, with rap- idly alternating redness and paleness of the face ; quick, full pulse ; slight confusion of ideas, increasing to a mild degree of delirium at night, combined with dryness of the mouth and lips, and thirst; eyes somewhat inflamed; oppression at the chest, short cough, sometimes attended with reddish sputa, and followed by a shooting pain under the ribs ; occasional vomit- ing ; angina pharyngea. In such cases, then, a dose or two of Aconite, at intervals of four hours, will be found of considera- ble service, if not sufficient to put a check to the further pro- gress of the affection. Ipecacuanha flaa3ftflfi-. In many instances, either at the commencement of the attack, before the appearance of the erup- tion, or during its full development, but particularly the for- mer, this is a most efficient remedy. It is indicated when there is a sensation of distressing tightness of the chest, with labori- ous breathing, and heightening of the febrile action towards evening ; with symptoms of nausea, or even vomiting ; ex- treme restlessness and agitation; deep sighing, or moaning; disposition to tearfulness or whining in children; diarrhoea, colic. When the oppression at the chest and excessive restlessness have been removed by Ipecacuanha, but considerable nausea or frequent fits of vomiting remain, Pulsatilla will generally put an early termination to the latter. Bryonia £&&£££, is frequently more efficacious than either Coffea or Ipecacuanha in relieving the extreme anxiety, rest- lessness, deep sighing and moaning, which so generally attend this affection; it should therefore be had recourse to in all cases in which these remedies fail to afford speedy relief. In some rare cases even Bryonia is not sufficient, and it is then found necessary to administer Cinchona, followed by Phospho- rus. Bryonia is further indicated when the accompanying fever partakes of a nervous character, attended with delirium 3* 58 ERUPTIVE FEVERS. and other symptoms mentioned under Bryonia in the article on Nervous Fever—which see. The excessive and continual ur- ging to urinate, which sometimes sets in, in the course of the disease, is often very readily subdued by Bryonia or by Co- nium. Belladonna^^^. When the disorder is met with during the prevalence of Scarlatina, (as also when symptoms more or less characteristic of the latter affection make their appearance in the course of purpura miliaris,) this remedy is a most effici- ent auxiliary ; it is, moreover, a mostjimportant remedy when symptoms of cerebral disturbance exhibit themselves; or when the patient complains of the throat, which, on being ex- amined, is found to be in a state of phlegmonous inflammation. Mercurius may follow Belladonna when the tonsils become much inflamed and tumefied, or ulceration supervenes ; in this latter instance, however, Arsenicum or Acid, nitricum may be- come necessary under particular circumstances. (Vide Scak- latina, p. 47 ; Sore throat, p. 84; and Scarlatina ma- ligna, p. 50.) Phosphorus s-HS-h. This remedy is very useful in cases in which there are symptoms of congestion in the chest, with extreme anxiety and oppression, and also when there is con- siderable cerebral irritability, characterized by over-excitabil- ity Qf the senses ; further, when the patient appears extreme- ly listless and apathetic, and complains of burning sensations in isolated parts, causing a frequent change of posture neces- sary. Phosphorus is often of great utility after Bryonia or Belladonna. Dulcamara £■£o^o o.^ "When severe aching or gnawing" (rheumatic) pains are complained of in the back or extremities, either in the course of the disease or at its termination, and when, in addition, there is an apparent complication of Scarla- tina with this affection, Dulcamara should be administered. Arsenicum^^2-, may be had recourse to in any advanced stage of the complaint if the vital power seems rapidly sink- ing, and the organs which perform the act of deglutition are as it were paralyzed, so that the patient is incapacitated from swallowing; or when, from a metastasis to the throat, the latter MEASLES. 59 has become so rapidly and seriously affected, as to have as- sumed a gangrenous aspect. (See Ulcerated sore throat.) When the disease, in cases of a bad type, takes on a nervous or even a putrid character, with extreme offensiveness of all the excretions, and hemorrhage from the nose, mouth, &c, the medicines mentioned under fevers of the said description, (which see, p. 32,) must here also be employed. Cuprum aceticum and Kreosote have been found useful in some of these almost hopeless but fortunately somewhat rare cases ; the former particularly, when the efflorescence appears and disappears suddenly in the course of the disease.* Administration. Six globules of the remedy indicated, at the potency mentioned, may be dissolved in about an ounce of water, and one dessert-spoonful administered every three, four, or six hours, according to the urgency of the case. The remedies required for the occasional sequelae, are the same as those enumerated at the conclusion of the chapter on Scarlatina. MEASLES. Rubeola. This disease generally reigns as an infectious epidemic, and for the most part confines its attack to children, in which cases it is seldom, when properly treated, either severe or dangerous ; when it occurs in adults, it generally assumes a more critical character. It rarely attacks an individual a second time. Measles is not to be so much dreaded for itself, as for the deleterious consequences it, under an improper mode of treat- ment, frequently entails, or, to use the technical term, the dregs it leaves after it, in many constitutions developing an inherent disposition to consumption. * Rhus and Sulphur may also be mentioned as having been found use- ful in this disorder; the former when the exanthema degenerated into a species of vesicular erysipelas, attended with lethargy, great thirst, and strangury; and the latter in cases where Belladonna had failed to effect all that could be expected In the event of repercussion of the eruption, Bryonia, Phosphorus, Sulphur, and Cuprum aceticum, have been recom- mended as the most useful. 60 eruptive fevers. Diagnosis. Catarrhal Symptoms, such as short dry cough, lachrymation, with redness of the eyes, and a degree of fever, more or less marked, preceding the eruption from three to five days, and generally continuing as long after, or all through the disease. Eruption of a number of small red spots (frequently"papu- lar), the skin in the intervals between them generally preserv- ing its natural colour, and sometimes exhibiting a faint red- dish hue. We often find them in the shape of small irregular arcs. They for the most part make their first appearance on the face and neck, become confluent, and extend themselves gradually downwards over the rest of the frame. About the sixth or seventh day from the time -of sickening, the eruption begins to turn pale on the face, and afterwards on the rest of the body, and generally entirely disappears about the ninth day, with a bran-like desquamation of the epidermis, a dis- tinguishing sign of this disease. Aconite has been regarded, in some instances, as almost specific against measles, and in its mild form will frequently be found sufficient, in a few doses, to conquer the disease, or at least materially to shorten its duration ; it is particularly indicated when the fever assumes an inflammatory form, at- tended with dry heat of the skin, heat in the head, with confusion and giddiness, redness of the eyes, intolerance of light, general weakness or prostration; and is more or less useful throughout the course of the disease, either alone or in alternation with Pulsatilla, or any of the other remedies which may be better indicated, whenever marked febrile or inflammatory action becomes prominent. ( Coffea or Hepar are frequently useful after Aconite, when there is a distressing, dry cough.) Administration, y>, or, to very young children, £, in a teaspoonful of water, every twelve hours ; or, in severe cases, exhibit it as under Inflammatory Fever, (which see,) and continue the treatment till we find an amelioration, should none of the symptoms hereafter mentioned, indicate the ne- cessity of having recourse to another remedy. Pulsatilla is also very efficacious, and even specific, in MEASLES. 61 this disease, and is frequently indicated in the commencement, from the strong resemblance which some of its pathogenetic* properties bear to the catarrh attendant upon measles, to- gether with the characteristic exacerbation of the symptoms towards evening, &c.f This remedy is moreover of great utility in bringing out the eruption when it is longer than usual in making its appearance ; but whilst the fever is high, Aconitum must be administered ; and if the febrile irritation does not diminish after a dose or two of Aconitum, Sulphur may be given; after which, if the fever return with increased force, Aconitum will rarely fail to answer our expectations. When there is great oppression at the chest, before the eruption is evolved, a dose or two of Ipecacuanha is very useful. Administration. Of Pulsatilla °-|° in an ounce of water, giving a dessert-spoonful every four hours while the same indications continue, until amelioration sets in. Pulsatilla is also valuable when any gastric derangement is present, or when the cough which so generally accompanies the disease, is worse towards evening or in the night, and is attended with considerable mucous ronchus, or copious, thick, yellowish or whitish expectoration, sometimes followed by vomiting, or symptoms of threatening suffocation; further, when there is coryza with a thick yellowish or greenish nasal discharge. (Sulphur is frequently of considerable service after Pulsatilla, particularly in strumous subjects.) Belladonna. When the inflammation attacks the throat, presenting many of the throat symptoms, we have given for this medicine under Scarlet Fever, attended with great thirst, which the patient is often prevented from indulging by the acute shooting or pricking pain in the throat produced by swallowing; and further, when there is a hoarse, dry, bark- ing, and somewhat spasmodic cough, worse at night, with mucous ronchus, great restlessness and high nervous excite- * Pathogenetic symptoms. Those caused by the action of a medicine upon a healthy individual. f Pulsatilla and Bryonia are two of the most important remedies when there is prominent bronchitic complication. (See also Bronchitis.) 62 ERUPTIVE FEVERS. ment: also in those cases of measles where no eruption de- clares itself, but simply headache and catarrh, with inflamma- tion of the eyes, which present a glassy appearance, are bloodshot, or streaked, and watery; finally, when evident signs of cerebral irritation, &c. set in. Administration as under Scarlet Fever, (which see.) Bryonia is an excellent remedy when the eruption is faint, or imperfectly developed, and the respiration much oppressed and laborious; achings in the limbs, also when there is dry cough, and the patient complains of shooting pains in the chest, increased by a full inspiration. (Vide Pleuritis.) Administration. In mild cases, 8{° ina teaspoonful of water, given when practicable in the morning, and repeated in twenty-four hours; but in severe attacks, we may find it requisite to add six globules, or in some cases a drop or so of the third potency, to an ounce of water, and administer a dessert-spoonful every six hours until improvement set in. This disease has frequently terminated fatally, from the eruption being driven in by sudden exposure to cold or change of temperature; in such cases, Bryonia, administered as above, is generally found efficacious in re-evolving the erup- tion, and preventing this disaster; if diarrhoea, with mucous discharge, follow the suppression, Pulsatilla is indicated; if the vomiting with great oppression at the chest be the more prominent symptom, Ipecacuanha should be substituted, and followed in turn by Arsenicum if symptoms of improvement do not speedily show themselves.—In the case of children, Chamomilla is to be preferred to Ipecacuanha when there is dyspnoea and diarrhoea with colic and vomiting: When symp- toms of cerebral disturbance supervene, Cuprum aceticum,* Belladonna, and Stramonium, or Helleborus niger, Arsenicum, and Sulphur, have proved of the greatest utility :—And in the case of pulmonic inflammation, Phosphorus, Bryonia, or Sulphur. In those comparatively rare cases in which typhoid symptoms manifest themselves, either during the course of the disease, or at its termination, Bryonia, Arsenicum, and Phos- * Vide Scarlatina, p. 62. SMALLPOX. 63 phorus will be found useful, where any chance of recovery re- mains. (Vide Typhus.) For the treatment of coughs which measles sometimes leave after them, Sulphur, Sepia, Carbo v., Conium, Chamomilla, Drosera, Dulcamara, Hyoscyamus, Ignatia, Nux v., Bella- donna, &c, are very serviceable. (See Coughs.) For the diarrhoea remaining under similar circumstances, Cinchona, Pulsatilla, Mercurius, and Sulphur, are in general the most appropriate : for their indications, see Diarrhosa. Otitis or Otorrhcea : Pulsatilla, Carbo v., Sulph., Merc, and Hepar sulphuris, chiefly. Parotitis : Arnica, and Phos. Tenderness of the skin : Mercurius. Miliaria alba : chiefly Nux v. Burning, itching, rash, which bleeds after scratching : Arsenicum and Sulphur. As a precautionary measure against the attacks of this dis- ease, when epidemic, we may administer Pulsatilla fi6a, in a little water, followed by Aconite -6-, three days after; allow the latter medicine to act for twenty-four hours, and continue the alternation for a fortnight, renewing it when necessary at the termination of a week or ten days. This treatment will frequently be found sufficient in warding off this disease, or, if taken, it will generally be in an extremely mild form. Diet. In this respect we may follow the rules given under Scarlet fever. SMALLPOX. Variola. This disease is, by pathologists of the present day, divided into two varieties—the distinct, when the pustules on the face are clearly defined, and do not run into one another ; the confluent, when they coalesce and form one continuous whole. When the symptoms are less severe than those properly characteristic of the disease, and the eruption on the face slight, it is called the modified smallpox. We generally find this description in such persons as have been properly vacci- nated, which precaution, although not always a preservative 64 ERUPTIVE FEVERS. from the attacks of variola, greatly lessens its virulence, and gives a milder character to the complaint when taken. Diagnosis. This disease is frequently very sudden in its attacks, commencing with chilliness and shivering, followed by febrile symptoms, with headache, severe pains in the small of the back and loins, languor, weariness and faintness ; the patient also complains of headache, oppression at the chest, and acute pain in the pit of the stomach, increased by pressure. The eruption makes its appearance at the close of the third day, first on the face and hairy scalp, then on the neck, and afterwards spreads over the whole body. Catarrhal symp- toms, as sneezing, coughing, wheezing, and frequently diffi- culty of breathing, often accompany this disease. The eruption first appears in the shape of small hard-pointed red elevations, which become depressed in the centre as they enlarge, and contain a semi-transparent fluid, with inflamed circular margin ; about the sixth or eighth day, the lymph in the pustule becomes converted into pus, and the depression in the centre disappears. When the pustules are very numerous on the face, it gen- erally becomes much swollen, and the eyelids are frequently closed up. On the first day, a small lump like a millet-seed may be felt in each of the elevations above noticed, distin- guishing this eruption from all other exanthemata. The pocks continue coming on the first three eruptive days, and each pock runs its regular course ; thus, those which first appeared are dying off, while the others are suppurating; and as the first dry and form into scab on the eleventh day from the commencement of the disease, the seventh from the appear- ance of the eruption, the general desiccation happens on the fourteenth day. When the pustules have attained their full development, they generally burst, in mild eases emitting an opaque lymph, which dries into a crust and falls off; in severe ones, we find a discharge of puriform matter, forming scabs and sores, which leave, on their healing, permanent marks or pits. Red stains, caused by increased vascular action, always remain for SMALLPOX. 65 a while after the eruption; but if no ulceration has taken place, they disappear in process of time. In Confluent Smallpox, all the precursory symptoms are more severe, the fever runs high, and frequently continues so throughout the course; the pain in the pit of the stomach, and difficulty of breathing, are more complained of, and in children the eruption is frequently preceded by convulsions and delirium; the latter symptom is frequently present with adults during the suppurative or secondary fever, which fre- quently assumes a typhoid character, and sometimes carries off the patient on the eleventh day ; and all cases in which we have a deeply-rooted morbid constitutional taint to con- tend against, require the utmost skill of the experienced practitioner to ward off a fatal result. Salivation, with soreness of the throat, and aphthae, or pus- tules on the tongue and pharynx, frequently declares itself in both forms of this disease, but more particularly the confluent. Before we come to the medicines to be administered in the different stages of the disease, we may say a few words upon the treatment of the patient. Cool and fresh air are our best auxiliaries, the variolous virus is one which rests upon the organism, and warmth is calculated to increase its activity. So beneficial is cool air found in this malady, that taking a child to an open window when attacked with the convulsions frequently present, will generally be found to afford immediate relief. Great cleanli- ness must also be observed, and the linen frequently changed. When the vesicles declare themselves, and begin to form into pustules, the room ought to be kept as dark as possible, to aid in preventing the risk of disfigurement, a precaution deducible from common experience, since we find that the parts of the frame exposed to the action of light are always those most strongly marked by the ravages of the disease. To avoid the cicatrices and consequent disfigurement left by this disease, many physicians have adopted a mask or plaster for the face, of different substances, such as gum, mu- cilage, calamine, &c. We have, however, in general course of practice, found the specific action of the medicines, and the 66 ERUPTIVE FEVERS. precaution above mentioned, sufficient materially to obviate all evil consequences of this nature. Therapeutics. In the first or febrile stage of the disorder, Coffea is valuable in allaying the nervous excitability gene- rally present. Administration. 0t0, in a dessert-spoonful of water, re- peated in four hours, if necessary.* Aconite may either follow or precede this medicine when the fever runs high, and visceral congestion threatens. Ad- ministration as in Inflammatory Fever, page 23, (which see.) Chamomilla is often of great service at this period, or during the course of the disease, in children, when there is dyspnoea and diarrhoea, with colic and vomiting; or when startings or convulsions set in prior to the appearance of the eruption; and again during the maturative stage, when the nights of the little patient are much disturbed by a trouble- some cough. Should Chamomilla afford but slight relief, Belladonna may be administered. When considerable tightness and oppression at the chest, sometimes attended with nausea and vomiting, are experienced before the appearance of the eruption, the alternate use of Ipecacuanha and Antimonium tartaricum affords speedy relief; the latter remedy is, moreover, well indicated in this disease from the close analogy which the eruption it is capable of producing, bears to that of smallpox, and may therefore be also administered with advantage during the eruptive and maturative stages, unless some other remedies should be more urgently called for by the nature of the symptoms; the existence of a hollow-sounding cough, with loud mucous ronchus, is an additional index for the employment of Anti- monium tartaricum. Administration. Three globules of the sixth potency of each remedy, in a dessert-spoonful of water, alternately every one, two, or three hours, according to the severity of the * Vide note, p. 21. smallpox. 67 symptoms, until symptoms of improvement set in. When Antimonium tartaricum is given alone, it will be sufficient to repeat the dose every three to six or even twelve hours, ac- cording to circumstances. Bryonia is sometimes useful in assisting the natural course of the eruption; it is also indicated when considerable symp- toms of gastric derangement are present, such as bitter taste in the mouth, foulness of the tongue, headache, rheumatic pain in the limbs, increased by motion, constipation and irritability of disposition ; also when there are occasional shooting pains in the chest, especially during inspiration. Rhus is equally serviceable at this stage of the disease, and particularly when the acute pains in the head, back and loins, are aggravated when in a state of rest, and tempo- rarily relieved by movement. Administration. In slight cases, -6-, in a teaspoonful of water, given every twelve hours, as the eruption continues developing itself; in severe cases, six globules at the third potency to an ounce of water, a dessert-spoonful every six hours ; it may be preceded or followed by Aconite, should there be considerable fever, with dry heat of the skin, the medicine being administered as above ordered until these symptoms are abated. Belladonna. This remedy may follow Aconite, when the latter has been indicated, should symptoms of cerebral dis- turbance have set in, characterized by flushed countenance, intolerance of the eyes to light, headache and delirium ; great thirst, nausea and vomiting ; or when there is redness of the tongue at the tip and margins ; abdomen tumid and painful, particularly at the epigastrium, with sensibility on pressure ; prostration of strength, stupor, &c. For further indication for the employment of this remedy, and the mode of exhibition, see Inflammation of the Brain and its tissues. Opium is useful when there are symptoms of stupor or strong inclination to somnolence. —-. Should vomiting set in attended with diarrhoea, we may ad- minister Ipecacuanha a3a, followed by Pulsatilla A/, if the 68 ERUPTIVE fevers. symptoms become aggravated towards evening and the pa- tient be of a mild and phlegmatic temperament. If Antimonium tartaricum and Ipecacuanha do not succeed in allaying the nausea and vomiting, and the patient complains of excessive thirst and dryness of the mouth, the tongue being at the same time very foul and dark, and the prostration of strength excessive, we may administer Arsenicum -6- in a teaspoonful of water, and repeat the dose every two or three hours, if required ; but the remedy must be discontinued as soon as decided benefit has resulted from its action. The last symptom generally occurs after the maturation of the eruption and secondary fever.* Pulsatilla is occasionally of considerable utility in conflu- ent smallpox, when an efflorescence similar to that of measles precedes' or accompanies the eruption, with nausea or vom- iting, and aggravation of all the symptoms towards evening. An occasional dose of Stramonium j-% is sometimes useful, when some pustules are already formed, in forwarding the eruption and shortening its duration. During the filling up of the pocks, a secondary or suppura- tive fever frequently sets in, particularly when the pustules are thick, and evince a disposition to run into the confluent form ; when, moreover, there is swelling of the head, inflammation of the eyes, throat, and nose, with salivation, hoarseness, and impeded deglutition ; tenderness of the stomach ; diarrhoea, with tenesmus, and sometimes sanguineous stools ; having, if called for, first attacked the more prominent febrile symptoms with Aconite, exhibited as above prescribed, we should ad- minister on the same day, Mercurius, a grain of the third trituration in half an ounce of water, a dessert-spoonful every six hours, until amelioration declares itself. When the fever runs high in confluent smallpox and threatens to continue so, * In some cases, and especially those of a bad type, livid spots or dif- fused ecchymoses are observed on the skin prior to the evolution of the eruption (variola nigra). Arsenicum is here also of considerable service, the more so when great weakness and languor, thirst, nausea, or vomiting, with pain in the epigastrium, are present. SMALLPOX. 69 as it often does throughout this form of the disease, Aconite must repeatedly be had recourse to, and given in alternation with Sulphur, when not sufficient of itself to mitigate the excessive febrile action. While the disease is running its course, particularly during the distention of the pustules, should no other remedies be imperatively called for, and also towards the period of their bursting, we may safely administer an occasional dose of Mercurius as above; in the latter case, followed by a dose or two of Sulphur to assist in the desiccation. When rheumatic pains in the back and extremities, which become worse at night, and are somewhat relieved by move- ment, are complained of at this period, Rhus may be advan- tageously alternated with Sulphur. Rhus is, moreover, ex- tremely serviceable in confluent smallpox when the fever assumes a typhoid type, attended with the signs denominated putrescent; Mercurius and Arsenicum are equally useful, however, in the latter case, when indicated by the character of the symptoms. (Vide Typhus.*) During the period of desiccation, continual laving with tepid water and bran, and gently drying it afterwards, will be sufficient; cleanliness being then the great requisite, with a careful attention to diet. Repercussion of the Eruption. When this has taken place, and the symptoms of cerebral disturbance, given under the head of the medicine about to be mentioned, (see Scar- let Fever, page 42,) set in, we must have immediate re- course to Cuprum aceticum, and employ it as there directed. Some physicians, in their treatment of the affection, divide it into two distinct stages ; we have, however, contented our- selves, when necessary, with slightly referring to them. To the practitioner they are sufficiently well known: and the * When Pleuritus or Pneumonia intervene during the progress of the disorder, the remedies mentioned under these different heads must be called to our aid. The invasion and progress of the latter disorder is sometimes so insidious, that, unless the aggregate signs of pneumonia be narrowly looked for, disorganization of the lung may take place before the existence of such a complication is detected. 70 ERUPTIVE FEVERS. non-medical administrator must be guided by the symptoms that present themselves from time to time, in the selection of the remedy, by which mode he is less likely to fall into error than he might be were he to act by mere routine. Against the cough which sometimes results from an attack of small- pox, Belladonna, Mercurius, and Arsenicum, are three of the most appropriate remedies in most cases, (the particular in- dications for which will be found" in the article on Coughs, which see,) and against asthmatic symptoms attended with mucous rattling in the chest, Tartarus emeticus, followed by Senega, should the former not effect a cure. Cinchona and Phosphorus have repeatedly been found spe- cific against the diarrhoea which occasionally results. And against the Ophthalmia, Conium, Belladonna, Hepar sulphuris, Euphrasia, Sulphur, Calcarea, Arsenicum, Pulsatilla, Mer- curius, Nux Vomica, and Rhus toxicodendron, have been found the most useful. Modified Smallpox is merely a mild description of the above, and as we have before said, is the form the disease generally assumes when it attacks those who have been pro- perly vaccinated. We must regulate our treatment accord- ing to the symptoms, being guided in the selection of the remedies by the indications before given.* Diet should be regulated by the virulence of the attack; but in all instances the beverages should be cold, as a warm regimen and neglect of the precautions before mentioned, may convert the mild into the malignant form; and after recovery it is necessary that the patient abstain for a considerable time from animal food. It may be remarked, that after recovery from an attack of malignant smallpox, the patient's constitution frequently re- * I have given in detail the treatment which has been generally adopt- ed by HomcEopathists, and with great success. But it may here be added, that Vaccinine, given internally, has obtained much repute as an important and eminently successful remedy, in the treatment of variola ; the most virulent cases having been reported to have yielded to it with a prompt- ness and certainty that afford another great proof, if such were needed, of the truth of the homceopathic law. CHICKEN-POX. 71 quires a thorough renovation, and that he should be put under a course of medicine best calculated to attain that result. CHICKEN-POX. Variola spuria. Varicella. Diagnosis. A disease bearing a considerable resemblance in its external character to smallpox, but differing in its du- ration, and symptomatically, being considerably milder, gen- erally requiring no medical assistance, but merely attention to diet, and but rarely becoming dangerous, except when it extends itself to the lungs or brain. The fever, however, occasionally runs high. When this affection attacks an individual, and smallpox is epidemic, which is not unfrequently the case, it is often mis- taken for that disorder, but it soon discovers its real character by the rapidity with which the eruption declares itself; the pustules (in many instances closely resembling those of the smallpox) being generally fully matured by the third day, and the whole eruption disappearing at the end of the fourth or fifth, without leaving any mark. Therapeutics. When much fever is present, we should check it by the administration of Aconite °g°, repeated from time to time as required, or Coffea, \°, also occasionally re- peated if there be simply extreme restlessness and anxiety. When cerebral symptoms threaten, Belladonna ; for the employment of this medicine, see Inflammation of the Brain. When attended with convulsions in children, parti- cularly during dentition, see Convulsions. Antimonium tar- taricum may be given to accelerate the eruption. Mercurius y may be given when the lymph of the pustules becomes converted into pus, as in the smallpox, and is also beneficial if strangury be present. When the eruption has been driven in, see Repercussion of the eruption in Smallpox. In anomalous cases, where other symptoms su- pervene, more closely resembling Smallpox, we may consult the remedies mentioned under that disease. 72 ERUPTTVE FEVERS. MILIARY FEVER. Miliaria, miliaria alba. Miliaris sudatoria. Sudor miliaris. Diagnosis. A great number of exceedingly small round, transparent vesicles, afterwards becoming opaque, and ending in scurf, irregularly scattered, of the size of millet-seeds, (hence its name,) which, when the hand is passed over the surface, feel as if they were small grains of sand beneath the cuticle. This affection is sometimes idiopathic, but more frequently associated with fever, and even occasionally present in various chronic diseases, in which latter instance it may generally be considered as an evidence of some internal constitutional taint; it is also not uncommon with women at that period of confine- ment, arising from the room being kept at too high a temper- ature—a frequent cause of this malady. This, like other cu- taneous affections of the same nature, is generally preceded by febrile symptoms; the eruption appears on the fifth or sixth day; from the commencement of the fever we frequently find profuse perspiration, with a putrid sour odour; previous to the vesicles evolving themselves, there is a tingling or itching of the skin, occasionally attended with a sensation of burning, to- gether with a numbness of the extremities ; the patient com- plains of a sense of oppression at the chest, sometimes with short dry cough, and stitches in the side, and not unfrequently of severe or fugitive rheumatic pains in the limbs and teeth. Low spirits are a frequent accompaniment of this affection. Therapeutics. In consequence of the numerous diseases with which it is complicated, it requires a variety of medica- ments. When it appears in a simple and apparently idio- pathic form, and is attended with anxiety and restlessness, which seem to depend upon an accelerated circulation of the blood, with great internal and external heat, Aconite is a spe- cific remedy; and when the above seems more particularly to arise from high nervous excitability, Coffea is indicated. Belladonna y, when the accelerated circulation is at- tended with considerable determination of blood to the head, and delirium. Arsenicum in a little water, repeated in twelve hours, if no amelioration takes place within that interval.* Chamomilla is a remedy particularly useful in the sore throat occurring in children, and especially when the disease has been brought about by checked perspiration, when there are shooting or burning pains, with sensation of a swelling of the throat, deep redness of the parts affected, inability to swal- low solid food, especially when lying down ; thirst, with dry- ness of the mouth and throat, swelling of the tonsils and glands before the ear and under the jaw; cough excited by constant tickling of the throat, attended with hoarseness ; fe- ver towards evening, with alternate heat and shivering, red- ness of one cheek, great excitability and tossing about. Administration. 0^0 administered every twelve hours, until amelioration takes place. Ignatia is indicated when there is a sensation as of a plug in the throat, with red and inflammatory swelling of the tonsils, or palate ; burning pains in deglutition, as if a sub- stance were passing over an excoriated surface, or partially obstruted by some foreign body in the throat. Liquids are * Vide note, page 21. SORE THROAT, OR QUINSY. 87 more difficult to swallow than solids; there are also shooting pains in the cheeks, thence extending to the ears, when not performing the act of deglutition; induration of the tonsils, or evolution of small pustules upon them. Administration. The same as Pulsatilla. Dulcamara. An almost specific remedy when sore throat, particularly in the form of tonsillitis, has arisen from expo- sure to wet. It may be followed by Belladonna or Mercu- rius, should it not wholly remove the affection, and should any of the symptoms given under these medicines present themselves. Administration. -6a repeated in twelve hours, and if no symptoms of increased pain or swelling present themselves, allowed an action of thirty-six hours from the last exhibition, during which period a marked amelioration, if not a perfect cure, sometimes preceded by a temporary aggravation, fre- quently develops itself. This medicine, if taken immediately after a severe wetting, often succeeds in preventing any un- pleasant consequences. Coffea cruda. Sometimes useful as an intermediate rem- edy : when many of the symptoms enumerated under Bella- donna, with the exception of the external swelling of the throat, are present; and also by a sensation as if the uvula were elongated or loaded with mucus, causing a constant in- clination to swallow. One of the best indications for its employment in this, as in other diseases, is an extreme over- excitability of the nervous system, characterized by sleepless- ness, great restlessness, sensitiveness, disposition to weep, and peculiar impressibility to external agents. Administration. A few globules of the sixth or thirtieth potency. Arsenicum. The indications for the employment of this remedy in sore throat have been already given under Scarlet Fever, p. 48, and under Malignant Sore Throat, p. 89. Hepar sulphuris is valuable in bringing the matter to a head, when resolution cannot be effected, and the quinsy has attained to such a height that its bursting is desirable from 88 digestive system. the painful sensation of suffocation which arises in conse- quence of the tumefied condition of the tonsils. Administration. One grain of the trituration, third po- tency, added to an ounce of water. One dessert-spoonful every two hours until the quinsy bursts. Silicea. This remedy is in some instances more efficacious than Hepar in rapidly forwarding the suppurative process, and causing the ripened abscess to burst. Administration. Six globules of the sixth in an ounce of water, a dessert-spoonful every two hours. Mercurius may follow the above medicine after an interval of a few hours, to facilitate the healing. In obstinate cases, such as are occasionally met with in bad constitutions, the healing of the cavity after the matter has been discharged goes on very unfavourably, and even fresh abscesses form in succession : Sulphur, Hepar s. and Psoricum, repeated every eight or twelve hours, have chiefly been recommended in these fortunately rare cases. Sulphur in ordinary cases : Hepar s. when the patient has been previously subjected to an abuse of Mercury under allopathic treatment, and Psoricum when Sulphur has been taken in excess.* Haifa grain of the tri- turation to an ounce of water, a tablespoonful every twelve hours. The diet of the patient must be regulated according to the degree of inflammation present. If required, the throat may be gargled with a little warm water, and when much pain is present, inhalation of the vapour from boiling water will often afford considerable relief; but at the same time, it may be observed, that all medicinal gargles, blisters, leeches, or other topical applications, are rendered unnecessary by proper homceopathic treatment. While we thus free the patient from a considerable degree of annoyance and needless suffering, we, at the same time, by a careful attention to the symptoms, and the exhibition of the proper remedy, effect a speedy cure. * Brit. Journ. of Homoeopathy, No. vii. ULCERATED SORE THROAT. 89 ULCERATED SORE THROAT. Malignant Quinsy, Malignant, putrid or gangrenous Sore Throat.—Angina Maligna, Tonsillitis Maligna, Cynanche Maligna. Diagnosis. This serious disease is also known by the name of Scarlatina Maligna, from the eruption with which it is frequently attended. It is usually epidemic, of a highly contagious nature, and generally occurs in damp and sultry autumnal seasons. It sets in with cold and shivering, succeeded by heat, and accompanied with great languor and oppression at the chest; nausea or vomiting and sometimes purging; eyes in- flamed and watery ; deep red colour of the cheeks ; the nos- trils are also more or less inflamed and secrete a thin acrid discharge, frequently causing soreness or excoriation of the nose and lips ; pulse indistinct, or very weak, small, and ir- regular ; tongue white and moist. The deglutition is painful and difficult, and on examining the throat early in the disease, it is observed to be of a bright red, and much tumefied ; but this state is very soon altered, and numerous ulcers of various sizes will then be observed to be interspersed over the parts, which become covered with a white, grayish brown, or livid coat. In some cases these ulcerations spread so as to extend over the whole fauces into the nostrils, or downwards even to the glottis and gullet, &c, and assume a sloughing appearance as they increase in size : The prostration of strength, considerable from the first, is now excessive ; the tongue, lips and teeth are covered with brown or blackish incrustations, and there is more or less delirium ; the breath is extremely fetid, and the patient himself complains of a disagreeable odour. The neck appears swollen and of a livid colour, and an efflorescence of a faint scarlet hue, or blotches of a dark or livid red sometimes intermixed with petechiae, break out on various parts of the 90 DIGESTIVE SYSTEM. body, and usually, though not necessarily, add to the danger, —as many are carried off, particularly children or persons of an advanced age, without any eruption,— when the local symptoms are severe and the fever high: But the appearance of livid spots or petechiae, and other indications of so-called putrescency, with frequent shivering, weak fluttering or inter- mittent pulse, sunken countenance, severe purging, extreme prostration, and bleedings from the nose, mouth, &c, must decidedly be regarded as symptoms of imminent danger. When the local symptoms are mild, the danger is rarely great; and even in the severe forms of the disease, when a gentle sweat breaks out about the third or fifth day, when the sloughs throw off in a favourable manner, leaving a clean florid healthy-looking bottom, and the respiration becomes more gentle and free, the expression of the face more lively, and the pulse stronger and more equal, a salutary result may be held in expectation. Therapeutics. The remedies to be employed are nearly the same as those which are commonly used in scarlet fever of a bad type, or in typhus. The following will generally be found adequate to subdue the various forms which the malady assumes, where any prospect of a cure may reasonably be entertained from the commencement: Aconitum, Belladonna, Mercurius, Acidum nitricum, Pulsatilla, Arsenicum, Lachesis, Nux v., Carbo vegetabilis, Sulphur, &c. The accompanying fever being generally of a low typhoid character, Aconite is rarely necessary in this complaint; how- ever, there are cases, and particularly when the fever runs high from the commencement, in which advantage is found to result from a dose or two of this remedy, followed by Belladonna as soon as the patient complains of dryness, with impeded deglutition and a sense of constriction or choking in the throat, which latter, on examination, is observed to be swollen and to present a florid red appearance. Belladonna is also indicated when the fever continues to run high; when the face is bloated and the eyes much in- ULCERATED SORE THROAT. 91 flamed; when the patient is affected with considerable deli- rium, and is occasionally only with difficulty to be restrained from leaving the bed or committing acts of violence; or far- ther, when the rash, which sometimes breaks out in this dis- order about the third day, presents a scarlet hue. In cases in which the symptoms are mild, or in which the above-mentioned symptoms have been reduced by means of the remedies quoted, and an increased secretion of mucus sup- plies the place of the previous dryness, while the patient is at the same time afflicted with nausea and bilious vomiting, a dose or two of Pulsatilla may be administered with effect; the progress of matters in the throat must, however, be care- fully watched, and as soon as the presence of small ulcers, or still better, their incipient formation, can be detected, a dose of Mercurius should be prescribed, followed by Acidum nitri- cum, when from the increasing size and painfulness of the ul- cers, Mercurius does not promise to arrest their progress or cause them to take on a healthy aspect. In the milder forms of this disease, the two last-named remedies will frequently be found sufficient to conduct it to a speedy and successful termination. But in those much more dangerous forms which the com- plaint so readily assumes when it rages as an epidemic, and where the patient at the commencement is seized with vom- iting and purging, attended with such prostration of strength as to render it impossible for him to leave the recumbent posture without feeling faint, and compelled to fall back ex- hausted by his efforts:—Where, moreover, the ulcerations spread with alarming rapidity, and early take on a sloughing character:—in such cases, the conducting of the disease to a happy issue becomes obviously a much more serious and dif- ficult task. Here the symptoms must generally at once be attacked by administering Arsenicum. Sometimes, however, a little benefit will be found to result from a dose of Pulsatilla at the commencement, when there is an excessive degree of bilious vomiting ; but Arsenicum must unhesitatingly be had recourse to when there is that marked "prostration of strength"11 so characteristic of this disease, ac- 92 DIGESTIVE SYSTEM. companied with nausea or vomiting; or when the ulcers pre- sent a livid hue. This important remedy is also indicated in a more advanced stage of the disease, when the ulcerations are covered with dark sloughs, surrounded by a livid margin ^ the teeth and lips encrusted with sordes ; the pulse small and irregular ; and there is delirium or constant muttering, with frequent hanging of the lower jaw; laborious respiration ; acrid discharge from the nostrils, causing excoriations; the eyes dull and glassy ; the skin hot and dry, and the thirst excessive; yet the patient drinks but little at a time, and appears to perform the act of deglutition with great pain and difficulty; finally, when the prostration of strength is so ex- treme that the patient seems rapidly sinking, and a rash of a livid colour breaks out in blotches, here and there inter- mingled with petechia. Lachesis will frequently be found very useful after, and in some cases alternately with Arsenicum, should the patient complain of great pain in the throat, which is aggravated by the slightest external pressure; or should the sloughs not seem disposed to cast off in a kindly manner; and the neck become much swollen and discoloured. When the tendency to gangrene continues, and the patient is still affected with considerable prostration accompanied with debilitating sweats, Cinchona will often be found of service. Nux vomica is fre- quently serviceable after Arsenicum when the diarrhoea has been checked, but numerous small, foul, offensive ulcers are seen in the mouth and throat,—succeeded by Carb. v., should a copious fetid ichor be discharged from the ulcers ; with ex- treme exhaustion, and small, indistinct, or scarcely percepti- ble pulse. Secale cornutum may sometimes be administered with advantage in alternation with Carb. when the latter ap- pears to afford but temporary benefit. Rhus is also occa- sionally useful in extreme cases, particularly if there be great muscular weakness, with trembling of the extremities, espe- cially on movement; sopor and other symptoms described under this remedy in the Chapter on Typhus. When from the beneficial effects of Arsenicum, or any of the other remedies above mentioned, the strength of the patient mumps. 93 becomes invigorated, the countenance more animated, and the sloughs are thrown off in a kindly manner, yet the ulcers threaten to become indolent; they will generally very speed- ily acquire a clean and florid bottom, and begin to cicatrize, on the administration of Acid, nitricum. For further particulars in the treatment of malignant sore throat, the reader is referred to page 54 of this work.* It remains but to be added, that in conducting the cure, the utmost cleanliness, combined with free ventilation, ought to be strictly observed,—for the double purpose of removing all malignant excretions and effluvia, and thereby putting a check to the ready extension of the contagion, as well as for the comfort and well-being of the patient. The diet should consist of semolina, sago, gruel, and. such like. MUMPS. Parotitis, Angina, Parotidea. Diagnosis. Inflammation with swelling of the parotid and submaxillary glands, sometimes running high, and extending to the throat and tonsils, with danger of suffocation. This affection generally affects individuals under the age of puberty, and frequently declares itself as an epidemic during the prevalence of cold damp weather. When properly treated it is rarely dangerous, but particularly apt, if not carefully attended to, to attack some more important organs by me- tastasis ; for example, suddenly disappearing in the glands mentioned, and painfully affecting those of the breast, etc.; these metastases may occur either from fresh exposure to cold, or by the application of saturnine, camphorated, or other repellent lotions. This affection is generally ushered in by the ordinary symptoms of mild catarrhal fever, after which the swelling declares itself, sometimes interfering with the motion of the jaw and by the extension of inflammation to the tonsils, affecting the hearing and impeding inspiration. * See also Sore Throat, page 81. ,94 DIGESTIVE SYSTEM. Therapeutics. Mercurius may almost be termed the specific remedy in the idiopathic form of this disease. Administration. In many cases a single dose -~ will be found sufficient to effect the cure ; in other cases it will be found necessary to repeat the dose every twenty-four hours, for three or four successive times. When Mercurius does not promise to produce much benefit after a dose or two, which is frequently the case in those who have been formerly salivated by Mercury under allopathic treatment, Carbo vegetabilis should be administered, particularly if the affection be accom- panied by a considerable degree of hoarseness. When through any neglect in taking proper precautions against cold, a metastasis to the brain has taken place, cha- racterized by a sudden disappearance of the swelling of the glands, followed by a loss of consciousness, delirium, or other symptoms of Inflammation of thje Brain, (which see,) we should have immediate recourse to Belladonna, Hyoscyamus, or Cuprum aceticum, as there prescribed. Belladonna is moreover indicated when the swelling is red and presents an erysipelatous appearance ; and should the inflammatory symptoms not readily yield to Belladonna, Hyoscyamus may be given; and after the latter, Rhus, Bry- onia, Sulph., Arsenicum, Lachesis, or Silicea, according to circumstances. Should, however, the disease in the same manner be trans- ferred to the stomach, Carbo Vegetabilis is usually a most useful remedy; when it fails to afford all the desired relief, Cocculus may be had recourse to. Administration. Six globules of the sixth potency, added to an ounce of water; a dessert-spoonful every two hours, until improvement declares itself. Should this glandular en- largement occur as a sequelae of the following disorders, the practitioner will generally find the remedies thereafter men- tioned the best adapted to effect resolution when practicable: of Typhus, Bella., Sulph., Calc. c ; of Measles, Arnica, Bryonia, Rhus; of Scarlatina, Hepar s., Dulc, Baryta, Bella., Rhus, and Arsenicum, Carb. v., Silicea, Lycopodium, Hepar, Conium, Aurum, Sulp., Calc ; in general cases, ac- cording to circumstances. INDIGESTION, OR DYSPEPSIA. 95 During the treatment of this affection, every care should be taken that the patient be kept moderately warm, exposed neither to damp, cold draughts, nor vicissitudes of tempera- ture, and the jaws and neck should be protected by a worsted or flannel bandage. BILIOUS COMPLAINTS. Bilious complaints have of late years become the popular term for almost all derangements of the digestive functions; and by common consent, all these disorders have been at once unhesitatingly ascribed to a superabundance or deficiency of the important secretion of the liver. This opinion, although sufficiently plausible on its first appearance, will, on a careful examination, be found erroneous; for although in the disease which is commonly denominated, in severe cases, liver com- plaint, this organ is powerfully affected, yet it is generally only by sympathy ; and the real seat of the disorder is in the stomach and bowels. When we succeed in restoring them to a normal state, the liver will, in most instances, again re- sume its natural functions. Having premised thus much, we shall proceed to the con- sideration of Dyspepsia, or Indigestion; under which will be found all the symptoms ascribed to the two imaginary and opposite causes of derangement: inactivity of the liver, and too great a secretion of bile. INDIGESTION, OR DYSPEPSIA. This disease appears in so many different phases, that we shall simply content ourselves with an enumeration of some of the principal exciting causes, and refer to the symptoms given under the different medicaments for its Diagnosis. The following are among the principal exciting causes: Irregularities in diet—such as an over-indulgence in the pleasures of the table, partaking of rich and indigestible food and stimulating soups, excessive use of wine, malt and spi- rituous liquors, tea, coffee, and other stimulants; imperfect 96 DIGESTIVE SYSTEM. mastication of food, irregularity of, or too long fasting between meals, indolent or sedentary habits, exhaustion from intense study, keeping late hours, mental emotions, &c The foundation of this disorder is frequently laid in early life, by the baleful practice of the administration of large doses of calomel, and other deleterious drugs ; and the evil is perpetuated in more mature age, by a continuance of the same absurd and dangerous system. Therapeutics. The principal homoeopathic remedies for the treatment of this affection are: Nux vomica, Sulphur, Pulsatilla, Bryonia, Chamomilla, Ipecacuanha, Ignatia, Carbo vegetabilis, Cinchona, and Hepar sulphuris. Of these, Nux vomica and Pulsatilla are the chief.* Administration. In dyspeptic cases we may dissolve seven globules of the third or sixth potency of each medicine, with the exception of Nux vomica, in fourteen teaspoonfuls of water, taking one morning and evening for a week, and cease its administration as long as we find manifest improvement; or if a medicinal aggravation come on, await the result. Of Nux vomica, we may dissolve three globules in seven tea- spoonfuls of water, and take one each evening on going to bed; or when people are in the habit of taking supper, from half an hour to an hour before that meal. It will be found useful in many cases to vary the potency of the medicines chosen, the high acting better upon come constitutions, and the low upon others ; but the principal point is the correct selection of the remedy, f An abuse of coffee and tea is a frequent cause of many de- scriptions of sick and nervous headache, attended with excite- ment and dyspeptic symptoms, which will frequently disap- * Calcarea carbonica is, in our estimation, one of the most valuable medicaments for Dyspepsia. It is indicated for the principal phenomena contained under Nux vomica, although, in regard to temperament, sex, «fec, it accords more generally with Pulsatilla. It is peculiarly available as a transient or long-working remedy, after the use of either of these two medicines, especially when their impressions become by repetition evan- escent.—Ed. f Vide note, p. 21. indigestion, or dyspepsia. 97 pear of themselves on the disuse of these beverages: however, should not this speedily be the case, for the effects of coffee we may have recourse to Nux vomica, Pulsatilla, Chamomilla, or Ignatia, under which the sufferer will find his symptoms indi- cated. Against the effects of tea, Cinchona will generally be found an antidote, followed by Ferrum if necessary ; in other cases, Ipecacuanha, Thuja, or Selenium, will be found useful. Nux vomica covers the following symptoms, either when they have arisen in consequence of sedentary habits, excessive mental exertion, long'watching, or the abuse of wine or ardent spirits: the head confused, with occasionally a feeling as if from intoxication, and giddiness, with sensation of turning and wavering of the brain ; headache, unfitting for,, and increased by, mental exertion ; tearing, drawing, or jerking pains in the head or cheeks, and pulsative pains, and a sensation as if a nail were driven into the brain ; congestion of blood to the head, with humming in the ears. The headaches are often deeply seated in the brain, or in the back part of the head, frequently confined to one side, or over the eyes, and at the root of the nose, coming on chiefly in the morning, after a meal, or in the open air. Eyes, yellowness of the lower part of the whites, with a mist before them ; a sensation as if one were about to fall; sparks, or small gray or black spots before the eyes; short-sightedness. Face pale or yellowish, especially about the mouth and nose, frequent headache, and redness of the face, impaired powers of digestion, with insi- pidity of food. Tongue foul, dry, while, or yellowish ; thirst with water-brash, particularly after acids or rich food, accu- mulation of slimy mucus or of water in the mouth ; metallic salt, sulphurous, herbaceous, mucous, bitter, putrid, sour, sweetish, or putrid taste, chiefly in the morning, or after meals; bitter eructations, or continued nausea, especially after meals, or even after drinking cold water or milk,—or on going into the open air after a meal ; also from acids. Heartburn, Hiccough, Acidity, Flatulence—frequent and violent vomiting of food, mucus, or bile, or ineffectual efforts to vomit. Distention and fulness in the epigastrium, with excessive ten- derness to the touch; a feeling of tightness of the clothes 5 98 DIGESTIVE SYSTEM. round the upper part of the waist; cramps in the stomach ; constipation ; reddish urine, with brick-dust coloured sedi- ment ; sleep unrefreshing, restless, either from suffering or otherwise, with disagreeable dreams, and drowsiness in the morning. See Administration, page 96. . One of the most distinctive indications for the employment of this remedy in preference to the next mentioned, is the temperament, which is restless, irritable, lively, and choleric. A disposition to Hemorrhoids is also a good indication. For Pulsatilla we have nearly the same range of dyspeptic symptoms, with the difference that it is particularly adapted for females, children, individuals with light hair and a marked predisposition to purulent exudations of the cartilage at the edge of the eyelids, or to " styes," and for mild or phlegmatic dispositions. Amongst the characteristics, we more frequently find a want of thirst than thirst; a repugnance to fat and rich meat, and suffering after taking pork and pastry ; a great dif- ficulty in keeping the hands and feet sufficiently warm ; fre- quent and loose, or difficult and loose, or slow evacuations ; hypochondriasis, hysteria. See Administration, page 96. Bryonia. Headache, burning or expansive, particularly after drinking, attended with bewilderment of the head, and vertigo ; tongue dry, coated white and yellow ; sometimes the aversion to food is so strong, that the patient cannot bear the smell of it; loss of appetite, alternately with unnatural hun- ger ; craving for acid drinks; great thirst; insipid, clammy, putrid, sweetish, or bitter taste in the mouth ; acidity and flatulence, or bitter rising after every meal, or after partak- ing of milk. Hiccough, nausea, water-brash, vomiting of food, or bile, particularly at night; tenderness of epigastrium to the touch, sensation of swelling in the pit of the stomach ; pressure, as if from a stone in the stomach, especially after a meal, or on walking; sensation of burning in the pit of the sto- mach, and especially when moving. Constipation; temper rest- less, irascible, and obstinate ; also when want of exercise or anger are frequently* the exciting cause of the derangement, or the means of aggravating the symptoms. This dyspepsia is more apt to manifest itself in summer, or in damp weather, and is frequently accompanied with chilliness. Potency 6—30. INDIGESTION, OR DYSPEPSIA. 99 Chamomilla. Headache, with sometimes semi-lateral, pulling, shooting, and beating in the head; fulness, giddiness, and staggering in the morning when getting up ; oppressive heaviness, vertigo, and sensation of a bruise ; headache some- times felt during sleep, with obscuration of the eyes ; and yel- low colour of the whites; tongue dry and cracked, with frothy mucus ; excessive thirst and desire for cold drink ; bitter taste of the mouth and of food ; want of appetite and dislike to food. Acidity of sour risings, regurgitation of food, nausea, vomit- ing of food, mucus, and bile ; acute oppressive pain in the re- gion of the heart, distention at the epigastrium, pit of the sto- mach, and upper part of the waist, chiefly after eating, and at night attended with inquietude and terror; burning pain in the pit of the stomach, uneasiness, and feeling of sinking in the stomach ; cramps in the stomach, especially when traceable to coffee; sometimes constipation, but generally relaxation of the bowels. This remedy is valuable in indigestion, brought on by aft of passion, or suppressed perspiration. See Ad- ministration, p. 96. Ipecacuanha. FAce pale and yellowish, tongue sometimes clean, at others coated white or yellow ; aversion to food, and particularly to fat or to rich indigestible food, such as pork, pas- try, &c, or dyspeptic suffering on partaking of such ; vomit- ing of food, drink, mucus, or bile, sometimes after a meal; retching or easy vomiting, generally attended with coldness of the face and extremities, and sometimes alternating with wa- tery diarrhoea; sensation of emptiness, flaccidity, and sensation of sinking at the stomach. Headaches attended with nausea and vomiting; shooting pains, with heaviness and painful pres- sure on the forehead. Both this and Pulsatilla are valuable remedies for indigestion in children, arising from imperfect mastication or improper food. See Administration, page 96. Ignatia may sometimes follow Pulsatilla to complete a cure, or even supersede it, when there is a tendency to con- stipation, and particularly in temperaments alternating from high to low spirits, or vice versa ; it is especially indicated when grief has been the inducing cause of dyspepsia, hyste- ria, and hypochondriasis, ^-f £iiL. 100 DIGESTIVE system. In chronic cases, these remedies, as indicated, are chiefly valuable in the commencement of treatment, and may be re- quired to be followed by other remedies to complete the cure. Sulphur flg£ or |£, or Tincture of Sulphur, especially use- ful after Pulsatilla and Nux vomica, in removing any symp- toms that may remain. Hepar sulphuris °|°, is a valuable remedy in some cases of dyspepsia, but particularly in those in which the patient has previously been taking blue-pill or any other mercurial preparation for a considerable time. Acidum sulphuricum,--3-°. Dyspepsia arising from exces- sive study, drinking, or other excesses, with the following, symptoms : great weakness of digestion ; acrid, foul, putrid taste in the mouth, dry tongue, burning and smarting sensa- tion in the throat, sometimes attended with pricking, espe- cially at night, and so troublesome as to prevent sleep (Py- rosis) ; offensive breath, especially in the morning (aphtha) ; renewal or aggravation of the symptoms from drinking cold water; all cold drinks appear to disagree, unless a little brandy or some other ardent spirits is added to them; accumulation of water; saliva in the mouth; flatulence; bitter risings; vomiting of a limpid fluid, or of food. It may here be re- marked, that, in cases where Nux vomica seems indicated, but the disposition is of a morose or hypochondriacal turn, Coccu- lus °j\° may be substituted with effect; when the indications for temperament are not sufficiently distinctive, Cocculus, Nux vomica and Pulsatilla may be advantageously alternated. Finally, Carbo vegetabilis \\° will frequently remove any symptoms that may remain after Nux vomica. Cinchona °-g is a valuable auxiliary in the treatment of this derangement, when there is impaired appetite with great weakness of digestion, which is more liable to be experienced on partaking of supper ; flatulence ; bitter taste; languor ; hypochondriacal disposition ; and particularly when we can trace it to debilitating losses of fluids, such as to abstraction or loss of blood, too great a drain upon the resources during lactation, prolonged use of aperient medicines, &c, also dis- orders arising from abuse of tea, or from residing in impure atmospheres, and especially such as are overl4»aded with the exhalations of decayed vegetable matter. want of appetite. 101 Natrum c. may follow Nux v., Bryonia, or Cinchona, with advantage, when a degree of weakness of digestion remains. In chronic cases, this disorder sometimes takes a critical turn, vomiting becomes excessive, everything taken is returned from the stomach, the skin is hot and dry, the patient becomes emaciated, and the countenance cadaverous. Here, it need hardly be said, the aid of the experienced physician is re- quired,—it will, therefore, be sufficient to intimate, that Ar- senicum and Lachesis will in such cases tend much to invigo- rate the sinking energies, and even,—with the occasional aid of Lycopodium, Veratrum, Baryta, Phosphorus, Conium, or some one or other of the above-mentioned remedies, where necessary,—eventually effect a cure, provided the inroads of organic lesions have not already placed the unfortunate suf- ferer beyond the reach of art. Accessory Treatment and Diet. In no other class of disorders is it more requisite to adhere strictly to dietetic regu- lations than in those where there is derangement in the digestive system, whether functional or organic: the patient so affected should, therefore, as closely as possible, regulate his regimen by the rules laid down at the commencement of this treatise, carefully avoiding, moreover, all such articles as he may find disagree with him, even if they appertain to the aliments al- lowed. He should generally abstain from soups, and every thing that has a tendency to distend the stomach, such as taking Targe quantities of warm liquids; he should not indulge his appetite to its full extent, avoid late hours, unnecessary exposure, severe mental exertion or anxiety, take sufficient exercise in the open air, and, as much as possible, keep his mind from dwelling upon his complaint, or on gloomy subjects. WANT OF APPETITE. Apepsia. Anorexia. Want of appetite being a concomitant symptom of many diseases, is treated in this treatise as such when present; but we now propose to look upon it as one of the leading symp- toms of indigestion, and as such, deserving a particular notice. It may, as in the case of dyspepsia, in a great variety of cases be considered attributable to an ill-regulated regimen, im- 102 DIGESTIVE SYSTEM. perfect mastication of food, sedentary habits, and the neglect of taking sufficient exercise. In many instances, removing the exciting cause will cure this disorder. Sufferers from this inconvenience should care- fully avoid creating an artificial appetite, or partaking of the smallest quantity of food till a healthy call from nature proves that the former has assimilated; the habit of taking tea, and even, as the expression is, " making a meal of it," within a couple of hours after removing from the dinner table, is a frequent cause of apepsia and dyspepsia. Another cause is the habit of drinking frequently, or very copiously during meals, and thereby attenuating the saliva and gastric juice, and rendering them less fitted for the pur- pose of digestion. Other causes are the customs of sleeping after dinner, par- taking of heavy suppers before retiring to rest, and indulgence in fermented, vinous or spirituous liquors, or in tea or coffee, particularly the latter. An alteration in the hours of meals, and avoiding too long fasts between them, will frequently remove this affection. In other cases, early rising, great attention to diet, avoiding rich or highly seasoned food, together with the daily use of pure, cold water,—drinking a tumblerful an hour or so before breakfast, three or four hours after dinner, and again about the hour of retiring to rest,—will suffice to restore the weakened digestive functions to a normal condition. When, however, we cannot trace this disorder to any of the above, or some other probable cause, when every attention to regimen, and even an alteration of diet according to individual peculiarities or idiosyncrasy has failed to produce any good effect, we generally find the want of appetite accompanied with other symptoms of derangement of the digestive functions, which may prove useful in aiding us to select a proper remedy to restore the natural tone of the stomach ; this will be found among the medicines most useful in Dyspepsia and Cardial- gia : namely, Nux vomica, Chamomilla, Pulsatilla, Cinchona, Ipecacuanha, Antimonium crudum, Bryonia, Arnica, Hepar sulphuris, Lachesis, Sulphur, and Calcarea. WANT OF APPETITE. 103 Administration, the same as in Dyspepsia, (page 96,) which see. Nux Vomica is the principal remedy when the want of. appetite can be traced to late hours, the habitual use of wine and coffee, sedentary and studious habits,—also when the following symptoms are present: dryness of mouth, tongue coated white with cracks or slimy mucus in the mouth, agustia, pyrosis, or inspidity of aliments, particularly meat, accumulation of water in the mouth, aversion to food, costive- ness or constipation, confusion in the head or giddiness, as if the results of intoxication, amnesia, and difficulty of fixing the mind to a train of application, weight in the occiput, tinnitus aurium, heaviness and aching in the limbs, uneasiness, and a feeling of working or dragging of the tendons in the lower extremities, or cramps, restlessness, and general irritability of disposition,—symptoms aggravated in the morning, (p. 96.) Chamomilla is frequently found useful after Nux vomica, when, although considerable benefit has been derived, the whole train of symptoms are not removed. The following are its particular indication: restless sleep, sensation of fulness and aching in the head, heat and redness of the face, a degree of fever, and tongue thickly coated, yellowish, rough and cracked, (anorexia and greenish diarrhoea,) general sensibility of the nervous system. This remedy is especially called for when a bitter taste in the mouth (or vomiting of bile, or of greenish mucus) ensues after eating. (Administ., p. 96.) Pulsatilla. This remedy is specific in the affections arising from partaking of over-rich or greasy food, or pork, or pastry, or of aliments causing flatulence, such as vegetables, or of food in the preparation of which rancid butter or lard has been used. The more immediate indications are: whitish tongue with cracks, bitter, salt, or foul taste in the mouth, sliminess of the mouth, scraping roughness or acidity at the pharynx, bitter eructations, aversion to warm food or to meat, butter, and all rich food ; loss of taste ; distention of the ab- domen, and particularly a feeling of tension under the false ribs borborygmus, retarded or difficult defecation or diarrhoea, drawing in the limbs resembling that presentment in ague, 104 DIGESTIVE SYSTEM. exacerbation of symptoms in the evening, in contradistinction to Nux vomica, which is generally in the morning. This re- medy is well adapted to the mild lymphatic temperament, and also when there is a peculiar sensibility, with a dislike to conversation, and valuable when imperfect mastication is the cause of the affection. Finally, in cases where there is a marked aversion to tobacco, even when accustomed to its use. Moreover, this remedy will be frequently found of benefit in some cases where Chamomilla has only temporarily relieved ; but should a considerable degree of nervousness, or even irritability, remain after Pulsatilla, Nux Vomica may be had recourse to. (See Administ. p. 96.) Cinchona in anorexia occurring during foggy weather, when the air is charged with unwholesome vapours, or in the vicinity of marshy lands. The following are its indications : a sensation of constant satiety, with general indifference to food, and adyspia ; tongue cracked or loaded with yellow or white coating; sensation of sinking and fluttering in the epigastrium (particularly when this symptom can be traced to the effects of tea); eructation after eating; desire for highly seasoned food, acids, pepper, and other condiments; general weakness, with inclination to assume the recumbent posture, and inability to remain long in one position ; uncomfortable feeling of dry heat, or shivering and sensitiveness in the open air; retarded or interrupted sleep ; general feeling of uneasi- ness, with moroseness and peevishness. (Adm. p. 96.) Ipecacuanha is indicated by the following symptoms : Nausea or vomiting, without foulness of the tongue, with dislike to food. Tobacco—even to smokers—has a nauseous taste, and causes vomiting. This remedy is also useful when the impaired appetite has arisen from bolting the food, parti- cularly in the cases of children, and may be followed by Pulsatilla, when only partial relief has been obtained, (p. 96.) Antimonium crudum, in cases where a great disposition to nausea and vomiting with foul tongue exists; anorexia, dryness of the mouth with great thirst, particularly during the night ; accumulation of phlegm in the throat with continual attempts to clear the throat; frequent rising, soon after meals, of WANT OF APPETITE. 105 the food last partaken of; pain or disagreeable fulness at the epigastrium, frequently with sensibility to external pressure. In cases of recent standing with the above symptoms it is very speedily efficacious ; and when relief does not quickly follow, the next mentioned remedy should be had recourse to. Bryonia in recent derangement of the stomach with ano- rexia. When we find thirst more during the day than through the night, with a sensation of dryness in the throat, extending down the oesophagus; chilliness ; yellow, dark brown, or white coated, cracked tongue, with constipation. (P. 96.) Arnica. This remedy is valuable when the loss of appetite has arisen from sitting up at night, watching at a sick bed ; from not having devoted a sufficient number of hours to the period of rest; or from intense mental exertion, or from provo- cation or excitement. When from these causes the nervous system is powerfully affected; tongue coated yellow; taste foul, bitter, or sour, or nauseous or chalybeate, with offensive smell from the mouth ; with rising of the food, or eructations of the taste or smell of rotten eggs ;* aversion to smoking and desire for acids ; sensation of fulness in the scrobiculus after meals, with inclination to vomit; distention of the abdomen, with pinching colic, relieved by doubling up the body, and renew- ed by drinking the smallest quantity of wine; passing off and then coming on, with inclination to evacuate the bowels; gene- ral irritability and impossibility of fixing the mind upon any subject; inclination to remain lying down, which relieves a heavy stupifying headache, which the least motion or even conversation increases. (See Administration, p. 96.) Hepar sulph uris is useful in chronic cases of want of appetite, with indigestion from the slightest cause, even with the most careful observance of diet. It is indicated by de- sire for high-seasoned dishes, acids, and wine; nausea, even inclination to vomit, particularly in the morning; and consti- pation, frequently with colic. This remedy is one of our * (Tartarus emet., Sulphur, Valerian, Sepia, Stannum, also cover the latter symptoms): the practitioner will therefore do well to bear the said remedies in mind when this .particular symptom is a prominent one, and does not yield to Arnica. 5* 106 DIGESTIVE SYSTEM. chief antidotes to Mercurius, and consequently one best - adapted to those affections arising from long-continued use of Calomel. Administration. One grain of the third trituration in six dessert-spoonfuls of water, one daily, fasting. In other cases, it will be found more beneficial to give a globule or two of the sixth in a little water, and not to repeat the dose until five or ten days.* Lachesis is a valuable remedy to follow Hepar sulphuris in obstinate cases, particularly when long continued constipa- tion is complained of, and the symptoms have always been aggravated by acid drinks, &c.; in the latter case Arsenicum is also useful, and may sometimes precede Lachesis with advantage. Administration. °§° in the same manner as Hepar sul- phuris. In addition to the two last-mentioned remedies we may observe, that in the same class of cases, Belladonna, Mercu- rius, Sulphur, and Calcarea may be used with considerable advantage, when the former remedies have only afforded par- tial relief. Acidum sulphuricum is a useful remedy in cases of im- paired appetite, with weakness of digestion, arising from habi- tual excess in the use of ardent spirits, or from debilitating loss of fluids, such as blood, &c, or in consequence of excessive study,—with the following symptoms : acrid or putrid taste, dry tongue, burning and smarting sensation in the gullet re- sembling heartburn ; offensive breath, especially in the morn- ing (aphthae); disagreeable sensation of pricking in the throat, frequently occurring during the night, and disturbing sleep. In other cases, the practitioner or student may consult the sub- joined remedies in the Materia Medica with advantage, either as applicable to the treatment of this affection or dyspepsia and cardialgia: Sepia, Colchicum, Ferrum, Silicea, Ruta, Ammon. c, Rhus, Aurum, Baryta c, Acid, nitr., Kali c, Natr. m. and c, Graphitis, Hyoscyamus, Ignatia, Staphysagria, * Vide note, page 21. derangement of the stomach, etc. 107 Kreosotum, Petroleum, Anacardium, Causticum, Drosera, N. mosch., Capsicum. (See Administration, p. 96.) DERANGEMENT OF THE STOMACH, ERUCTA- TIONS, &c Under this head we intend treating of a disorder which may arise in individuals of a generally unimpaired digestion—the characteristics of eructations will assist to indicate the remedy for persons subject to this unpleasant affection. The ordinary causes of this derangement are: hurried, im- perfect mastication ; an overloaded stomach; fat, greasy, in- digestible or tainted food, flatulent vegetables, ices, stimu- lants, &c, and are so well known that it is hardly necessary here to enter upon them, particularly as they will be more specially noted under the different medicines. Therapeutics. When the symptoms of approaching sto- machic derangement declare themselves immediately, or a few hours after a repast, a little strong black coffee is fre- quently a sufficient restorative. Should, however, this fail to relieve, and sick headache and inclination to vomit be present, we should assist nature by tickling the fauces with a feather, and by giving tepid water to drink until the stomach has completely evacuated its con- tents. Should, however, on the following morning, symp- toms of deranged digestion continue, such as nausea, inclina- tion to vomit, or vomiting, and disagreeable or offensive eructations, we should administer Antimonium crudum °$° in a little water, one of our most useful remedies in this af- fection, and which rarely fails to at least afford some relief. It is also peculiarly indicated when the affection has arisen from drinking sour or impure wine ; or when, in addition to the symptoms of disordered stomach, a degree of fever re- turns every second day. Ipecacuanha °|°. When a rash has been thrown out, from the effects of a disordered stomach, attended with anx- iety, oppressed breathing, and sickness, this remedy will, in 108 DIGESTIVE SYSTEM. most cases, effect speedy relief;—but should the difficulty of breathing, or a degree of nausea or other uneasiness continue, Bryonia should be exhibited. Bryonia °g°. In addition to the usefulness of this remedy in the foregoing instance, it is also very serviceable when the following symptoms are present: bitter eructations; fever, alternately with coldness and shivering; or redness of the face, heat in the head and thirst with coldness and shivering; also where diarrhoea or constipation and peevishness or ex- cessive irritability are present. Arsenicum °$ °, acrid and bitter eructations with nausea and vomiting; also dry tongue, excessive thirst, salt taste in the mouth, and burning or violent pressure in the stomach, with diarrhoea or colic, and griping in the hypogastrium, par- ticularly when arising from the effects of an ice which had been partaken of when warm, or from fruit, stale vegetables, or from acids. It may in many cases be advantageously followed by Carbo vegetabilis, which see. Nux vomica °£°, offensive eructations, constipation, and confused headache, particularly if arising from previous in- toxication, or even slight over-indulgence in wine or other stimulants; when possible, it should be taken the same night; as, taken in the morning, although eventually relieving, it frequently causes an aggravation for a few hours. Arnica -§-. Eructations resembling rotten eggs.* Pulsatilla -^-, next to Antimonium crudum, the most important remedy in recent cases of deranged digestion, with eructations of ingesta, tongue foul and covered with mucus ; chilliness and lowness of spirits; and also when a rash has been thrown out in consequence of the derangement. This remedy is, moreover, almost specific when the disturbance has arisen from the effects of rich food, such as pork or pastry, or even tainted meat, or from the effects of ices, cold fruits, or crude vegetables, acid wines, &c (Arsenicum may follow Pulsatilla, if the latter do not effectually relieve.) Aconite °f°. When the affection owes its origin to par- * See also note, p. 106. DERANGEMENT OF THE STOMACH, ETC. 109 taking of sour beejr, vinegar or other acids, particularly when we find oppressive pain in the stomach, great heat in the head, nausea, or actual vomiting of mucus, or even of blood. Hepar sulphuris -|a. When the digestion is naturally weak, and sour vomiting, attended with burning in the throat, colic and diarrhoea, is liable to ensue from the slightest error of diet, and particularly when any thing of an acid quality has been partaken of. (Lachesis is often of great service here in alternation with Hepar sulphuris, at intervals of a week or so.) Carbo vegetabilis sffi, although last mentioned, is not one of the least valuable remedies in this affection, and is often found particularly useful after Pulsatilla, Arsenicum, or Nux vomica, in removing any symptoms that may remain; it is also particularly useful where great susceptibility to the influ- ence of the atmosphere, particularly to cold, exists at the same time; or in sufferings arising from abuse of wine, ices, salt; further, in derangement of the stomach arising from having par- taken of game, or fish which has been too long kept, or meat which has been recooked while in a state of fermentation, as is liable to occur in warm weather;—in the latter instances, Carbo v. is to be preferred to any other medicine, and will rarely fail to afford relief; if any disagreeable symptoms remain, Cinchona f may be administered in a little water, and followed, if required, by Pulsatilla % in the same manner;—finally, this remedy is pe- culiarly valuable in obstinate and chronic cases of deranged di- gestion, when annoyance or inconvenience is felt after every meal, even amounting to nausea and vomiting attended with ex- cessive flatulency, and where the pit of the stomach is tender on pressure.* Administration of the medicines. A single dose, as above noted, is ordinarily all required ; when, however vomiting and other severe symptoms declare themselves, it may be better to dissolve four or five globules in eight or ten teaspoonfuls of * A small quantity of finely powdered charcoal in a little good French brandy will be found an equally efficacious mode of administering this remedy as a corrective against any unpleasant effect arising from having partaken of tainted meat or fish. 110 DIGESTIVE SYSTEM. water, and give one from time to time, according to the exi- gency of the case. FLATULENCY. Flatus, Tympanitis intestinalis. This affection and the sufferings it entails, are generally found in individuals of weak digestion, and many also suffer from it immediately on taking cold in the abdomen or feet; it is also, as well known, a common result of errors in diet, and the too frequent indulgence in vegetables and fruits : In corpu- lent individuals the sufferings arising from this complaint, such as difficulty of breathing, palpitation of the heart, trembling of the limbs, confusion of the head, and swelling of the face, es- pecially in hypochondriacal subjects, are most distressing. However, with proper attention to regimen, and suitable me- dical treatment, it is rarely very difficult to remove. As an accompaniment of deranged digestion, it has also been noticed under Dyspepsia. Against this complaint the most careful preservatives are: avoiding cold, exposure in cold damp weather, very cold drinks, or distending the stomach with a large quantity of warm fluids, particularly strong tea or coffee; each patient should also study his own digestion, and carefully refrain from partaking of any species of aliment which experience has found liable to produce flatulency. Sedentary habits also should be avoided, and a proper portion of the day devoted to exercise in the open air. Therapeutics. In the treatment of this affection, the fol- lowing medicines have been found most frequently called for: Cinchona, Arsenicum, Nux vomica, Pulsatilla, Carbo vegeta- bilis, Colchicum, Belladonna, Colocynth, and Tincture of Sul- phur. Of these, Nux vomica and Pulsatilla are most fre- quently required. Administration. In recent cases, six globules of the third potency may be given, dissolved in an ounce of water, a dessert-spoonful every half hour till relief ensues ; after which a dose of a couple of globules every four or five days or so, to counteract the tendency to this affection.* * Vide note, p. 21. FLATULENCY. Ill Cinchona £§a. When the affection can be traced to tea or warm drinks, an hour or two after a hearty meal, by which the process of digestion has been interrupted ; or to debility, loss of humours from venesection, or the continued use of purgatives; or to deranged digestion arising from flatulent food, with painful tension and distention of the abdomen ; or when, on the occasional expulsion of flatus, a sensation often. sion is felt in the umbilical region; another indication for this remedy is where coldness or shuddering is experienced after drinking. Arsenicum fl6a where the last-mentioned symptom has not been relieved by the foregoing medicine. Nux vom. Af-. In cases where the flatulence is attended with sensation of pressure at the pit of the stomaeh, causing dyspnoea and a feeling as if the clothing were too tight, or a sensation of pressure as from a stone, particularly when the affection arises from an habitual use of coffee, or sedentary habits. Pulsatilla ^Y"? wnen tne affection has arisen from having eaten of rich or greasy food, after which a copious draught of water has been partaken of, and the abdomen is swol- len with a pain as from a bruise, with borborygmus. Carbo vegetabilis is one of the most important remedies after the fore- going in chronic cases, and particularly when the inconveni- ence arises after partaking of the smallest morsel of food. Colchicum ^ £0^, when from a considerable accumulation of wind the abdomen is extremely distended, or as it might be expressed, inflated, amounting almost to tympanites, and sounds like a drum on striking it with the hand—without any marked pain, but with heat and difficulty of respiration. (This remedy is often peculiarly efficacious when the derange- ment is attributable to vegetable food.) Belladonna *■%*. In cases of flatulent obstruction, in which the transverse section of the colon is the particular seat of the accumulated flatus, and becomes protruded like a pad, this remedy should be administered; it may be followed by Co- locynth, when the relief obtained is only temporary, or when, from the manner in which the patient traces the course of his uncomfortable feelings, there is every reason to conclude that 112 DIGESTIVE SYSTEM. the flatulent distention and obstruction occupy the entire extent of the colon. When the flatulence occurs very frequently, in fact, where a marked predisposition to it exists, we must have recourse to Tincture of Sulphur A,ft0°, or one drop of the 30th potency. Although I have pointed out the remedies best suited to the cases of this affection most ordinarily occurring, and have also treated of the same subject under Dyspepsia and Colic, to which the reader is referred, I still think it advisable to add a few medicines which bear particularly upon this disorder, and deserve a careful study. They are : Lycopodium, Coc- culus, Natrum, Natrum muriaticum, Zincum foliatum, Mag- netic polus arctus, Agnus castus, Ferrum, Graphitis. SPASMS OF THE STOMACH. Gastrodynid, Cardialgia, Gastralgia. Diagnosis. Contractive and spasmodic or gnawing pains at the epigastrium, extending to the chest and back, attended with anxiety, nausea, eructation or vomiting, with faintness and coldness of the extremities; the patient is sometimes re- lieved by emission of ascending flatus, and when complicated with pyrosis, by a discharge of a quantity of limpid fluid ; occasionally headache and constipation are present. In some cases the pain is very slight, but there is always more or less, and a degree of anxiety, with nausea, increased by taking food; it seems generally to arise from an abnormal state of thenerves of the stomach, and is frequently accompanied by a disease of the liver, spleen, or pancreas, or even by scirrhus of the stom- ach or duodenum. Although the real seat and nature of this disorder may be somewhat obscure, yet upon one point we may rest perfectly satisfied, that, even where it exists as a primary and idiopathic disease, the digestive function rarely fails to be considerably impaired during its progress. The disease is a frequent attendant on gout; and it very rarely occurs be- fore the age of puberty. The paroxysms last for a longer or shorter time, and return in many instances periodically, and may be brought on by partaking of improper articles of diet, or in severe cases, by any solid food whatsoever. SPASMS OF THE STOMACH. 113 The chief articles to be avoided by an individual suffering from this malady are : crude, uncooked vegetable substances, such as salads, cheese, new bread, sweetmeats, cherries, nuts, olives, and roasted chestnuts ; and stimulants of all kinds, whether tea, coffee, alcoholic or fermented drinks. The causes are: long fasting between meals, very hot or cold drinks and habitual use of ardent spirits, of indigestible food, worms, and in some instances, perhaps, exposure to cold or damp weather. It is a more frequent affection of the female than the male sex, frequently occurring after the cessation of the usual monthly discharge, or from any interruption of its usual course : in such instances it is frequently accompanied with hysteria, syncope, and may pass on to vomiting of blood. Notwithstanding the usually intractable nature of this affec- tion, it has been treated with marked success by the method about to be pointed out. Therapeutics. Nux vomica is the principal, and in most cases, the most appropriate remedy against spasms of the stomach, and particularly in cases where this affection can be attributed to the long-continued use of strong coffee, or to an excessive indulgence in spirituous liquors ; it is, moreover, of essential service in many cases of the same disorder which have arisen after the suppression of chronic or hemorrhoidal discharges, or when the party affected is liable to fits of hys- teria or hypochondriasis. The following are the immediate symptoms which call for the administration of this medicine : Constriction, pressure, squeezing, or spasm in the stomach, accompanied with the sensation as if the clothes were too tight at the waist, or as if flatus were pent up in the hypochondria. This sensation, as well as the pains before mentioned, become generally increased after a meal, or after partaking of coffee ; in addition to which, a feeling of depression or constriction is experienced at the chest, which, in many cases, extends to between the shoulders and the lower part of the back. Fre- quently also nausea, accumulation of clear water in the mouth, or risings of sour bitter fluids, attended with a sensa- tion of burning in the throat and gullet (pyrosis); sour or putrid taste in the mouth, vomiting of ingesta, flatulent dis. 114 DIGESTIVE SYSTEM. tention of the bowels, constipation, aching in the forehead, palpitation of the heart, and anxiety. When these symptoms are liable to be excited by a fit of passion, or become aggra- vated in the morning, or when the patient is occasionally awakened out of his sleep by the spasmodic attack, this remedy is still more certainly indicated. Administration. °g° in a dessert-spoonful of water, and repeated in six hours if necessary; or in chronic cases with a constant pain, six globules of the same potency maybe dissolv- ed in four dessert-spoonfuls of water, and a dose taken every evening until finished. Of this as of all the other medicines, we may administer a dose from two to four hours before an ex- pected paroxysm, when the Cardialgia returns periodically, or when from some imprudence in diet we have reason to appre- hend an attack. This precaution, if it fails altogether to check it, will often greatly modify it. Should Nux vomica merely af- ford a temporary benefit, followed by renewed aggravation, and in cases where the disorder returns again after it has been for a time suppressed by Nux, we should repeat that remedy ; and if it then fail to afford relief, Carbo vegetabilis will generally complete the cure. Should this fail, particularly where the affection is traceable to the suppression of some chronic erup- tion, Tincture of Sulphur ought to be administered. This medicine, as well as Pulsatilla and Sepia, whose value in such cases we shall notice under their several heads, is par- ticularly useful in gastrodynia in females, arising from any disturbance of the menstrual function. Vide note, p. 21. Administration. Of the Carbo vegetabilis we may dissolve -a-1-2-~ m eight teaspoonfuls of water, and give one morning and evening until finished. Of the Tincture of Sulphur, ooo^ooa jn t^e same manner. In some cases, also, where no improvement results from the exhibition of Nux Vomica, the following should be con- sulted : Chamomilla, Belladonna, Cocculus, Ipecacuanha, Pul- satilla, Sepia, Ignatia amara, Cinchona, Staphysagria, Stan- num, Bryonia, Plalina, Senega, Ratanhia, and Arnica montana. Of course, also, a preference should be given from the first to that medicine whose symptoms approach most closely to those under which the patient is suffering. SPASMS OF THE STOMACH. 115 Chamomilla °$ °. For the employment of this remedy the principal indications are : pressure, as if from a stone in the pit of the stomach, or painful pressure at the precordial region, as if the heart would be crushed; flatulent distention at the same part, as also of the hypochondria and abdomen, with shortness of breath, anxiety, and throbbing headache: Miti- gation of the above symptoms on partaking of coffee, a dis- tinguishing mark between the indications of this remedy and those of Nux vomica; on the other hand, as in the case of the latter, it is also indicated when the symptoms, as described, are liable to be brought on by a fit of passion. Colocynth is more efficacious than Cham, in the latter case, and especially when the fit of passion is accompanied by in- dignation. In obstinate cases, where Chamomilla fails, not- withstanding the apparent similarity of the symptoms, Bella- donna °£° ought to be substituted for it: also when we meet gnawing pressure, or spasmodic tension in the pit of the sto- mach, relieved on bending backwards and holding in the breath ; further, spasms of the stomach, which recurs daily during dinner, or else pain of so violent a nature as to deprive the pa- tient of consciousness. Carbo v. may be preferred to Bella- donna, however, when the most prominent symptom remain- ing consists of a sense of aching and pressure at the pit of the stomach and the praecordial region, causing a sensation as if the heart were about to be crushed. (See Chamomilla.) Cocculus »°|,0,in many cases of this complaint are par- ticularly indicated, when in addition to the usual symptoms there are constipation and constrictive pains over the entire abdomen, with flatulency and accumulation of water in the mouth, and alleviation of the sufferings on the recurrence of the latter symptoms. Ipecacuanha Af -, is also useful in cases of this affection, when the paroxysms are accompanied with nausea, vomiting, dull darting pains in the pit of the stomach, and sensation of excessive uneasiness in the same region. Pulsatilla °|°. In cases with shooting pains in the sto- mach, which are aggravated by movement, and particularly by making a false step. Pulsatilla is also one of the most appro- 116 DIGESTIVE SYSTEM. priate remedies when the attacks are followed by vomiting, or accompanied by violent tension and squeezing, or throbbing and sensation of anxiety about the pit of the stomach, increase of pain after eating, or more particularly a feeling of pressure and pinching after dinner, with a relaxed state of the bowels, or a disposition thereto. Disposition to hysteria or hypo- chondriasis. It is, as well as Sulphur and Sepia, called for in cases of this affection arising from suppressed menstruation. When Puis, does not afford much relief, the desired result is often attainable through Ignatia. Sepia. f£ Gastrodynia arising from suppressed or diffi- cult menstruation, and may in general cases advantageously follow Pulsatilla; it is indicated by most of the sufferings that arise, taking place after a meal, by pressure in the stomach as from a stone, and by a burning pain in the epigastrium and scrobiculus ; by restoring singly, or in conjunction with Pulsatilla and Sulphur, the menstrual flux, it frequently re- moves the cardialgia, and hysteria consequent upon this de- rangement, or at least places the affection in such a position that it is easily cured by some other medicine, closely cor- responding to the remaining symptoms. Ignatia amara 0j°¥0 is indicated under nearly similar cir- cumstances as Puis., with the exception of the state of the bowels, the Ignatia being more appropriate to cases' attended with costiveness, and where the inclination to vomit is absent, or when the affection has been caused by grief, anxiety, &c., or occurs in hysterical or hypochondriacal individuals. Cinchona °£° is of great service in most cases of spasms of the stomach with general weakness, arising from loss of humours, the result of bloodletting, or repeated hemorrhages, abuse of emetics of aperients, too long continued suckling, &c ; and is further indicated by great weakness of digestion, disten- tion and uncomfortable weight, pressure, or pains in the sto- mach after eating, so that the patient feels much easier when fasting; these latter are the more immediate indications for the employment of this medicine. (Nux v. and Carbo v. may follow Cinchona, should the latter not remove all these symptoms.) Staphysagria °#°. This is useful in some cases of this SPASMS OF THE STOMACH. 117 complaint, and is particularly applicable when there is acute pressive tension and squeezing about the pit of the stomach, which sometimes obstruct the breathing, but which is relieved by bending the body forward. When the pain partakes of a marked tensive character and extends to the region of the navel, with sensibility of the region of the stomach on ex- ternal pressure, shortness of breath, anxiety and nausea, Stannum \\ will be found more appropriate. Bryonia0^0 . This medicine is more particularly adapted to the milder cases of cardialgia, with painful pressure, or a feeling of disagreeable fulness in the stomach after a meal, which occasionally becomes converted into a feeling of con- striction, cutting or pinching, and is relieved by er ctation and external ressure. This remedy is moreover still more clearly indicated when the symptoms are generally accom- panied with severe headache or painful compression in va- rious parts of the head, and particularly at the temples, which are liable to be excited whenever any article of diet disagrees in the slightest degree ; increase of the sufferings by move- ment ; habitual costiveness. Platina §°. Spasms of the stomach in females, occurring particularly at the monthly period, (Chamomilla, Pulsatilla, Nux v., and Cocculus, are equally efficacious at such periods when the symptoms are as indicated under these remedies,) and especially when the catamenia at the same time are gen- erally very copious, and of too long duration. Senega °^° will be found efficacious in cases with painful pressure and burning in the stomach, especially at night. Ratanhia °-| °. Spasms of the stomach, or painful con- strictive pain, relieved by eructation, with loss of appetite, hiccough, distention of the abdomen, costiveness, and fre- quent micturition. Arnica Montana ° ° y ° °, in spasms or pains in the stomach which have originated in the effects of a strain, or from a blow, &c, will be found specific. It is, however, also an excellent remedy when there is a sense of pressure as from a stone, or of fulness in the stomach and scrobiculus, constrictive pain in the stomach and in the precordial region, shooting 118 DIGESTIVE SYSTEM. pain in the pit of the stomach, with painful pressure or aching, extending to the back, and tightness of the chest, increased by eating, drinking, and external pressure. Bismuthum °£ °. Cardialgia, with tenderness on pressure at the pit of the stomach, in hysterical females. This remedy is further often of great service in some of the most obstinate cases, particularly when there is a sensation of great weight or pressure, with indescribable pain and uneasiness in the stomach. Arsenic. Periodic pains in the stomach of a burning char- acter, and with acrid, sour eructations, vomiting of ingesta, or of mucus, even of blood; anorexia, extreme debility, emaciation. Lycopodium j-%. Squeezing or compressive pains proceed- ing from each extremity of the stomach, with flatulent dis- tention ; want of appetite ; pains in the back and loins, (con- stipation) ; exacerbation of the symptoms in the open air, after a meal or in the morning. Cardialgia in lymphatic females, with too copious catamenia. Lachesis -£|. Spasms of the stomach, particularly in per- sons addicted to excessive indulgence in wine or ardent spi- rits, relieved by partaking of food; flatulence, constipation, numbness, and paralytic weakness of the extremities. Sulphur -65. Frequently an indispensable remedy in chronic cases, attended with heartburn; aggravation of the pains after a meal; constipation, hemorrhoids. Calcarea ® §■. In obstinate cases, occurring in individuals who are habitually addicted to the abuse of wine or ardent spirits, Calc. will generally be found of great service, especially after the previous employment of Nux v., Lach. and Sulph. It is further a valuable remedy in the cases of plethoric females subject to nasal hemorrhage, or to excessively copious menstru- ation ; and is generally indicated when the paroxysms of pain come on usually at night, or after a meal; in which latter instance vomiting sometimes results, or nausea and acidity with painful sensibility or pressure at the epigastric region; constipation, hemorrhoids, or chronic looseness of the bowels. Administration. In most cases these medicines may be exhibited in the same manner as already noted under Carbo vegetabilis and Sulphur. (See also remarks upon Nux vomica. VOMITING OF BLOOD. 119 In severe cases, six globules of the potency named may be dissolved in eight dessert-spoonfuls of water, and one given every two, four, or six hours, according to the results ob- tained ; for example: in individuals of delicate organization, it may sometimes be needful to give a less number of glob- ules, and to select a higher potency, the thirtieth.* These are the principal remedies to be employed against the ordinary cases of Cardialgia ;f but in some cases may be called for : Sanguin., Graph., Gratiol., Magn., Nitr. sp., Sil., Stann., Stront., Am. c, Cupr., Daph., Kali c, Euphorb., Kreos., Natr., Natr. m., Asaf. In hysterical or hypochon- driacal subjects : Ign., Nux v., Calc, Grot., Cocc, Stann., Bism., Digit., &c. HEARTBURN. Black-water. Water-brash. Pyrosis. This is not an affection of the organ which its name would imply, but a painful or uneasy sensation of heat or acrimony about the pit of the stomach, sometimes extending upwards. It is frequently accompanied with anxiety, nausea, and vomit- ing ; or a violent gnawing spasmodic pain in the region of the stomach, from which the patient experiences no relief until he succeeds in ejecting a quantity of limpid fluid. The remedies required for the treatment of the disorder are the same as those mentioned under Dyspepsia, Flatulence, Spasm of the Stomach, according to symptoms : of which, Nux v., Puis., Sulphur, Acid, sulphuricum, Carbo v., Cinchona, or Calcarea, will be found the most appropriate in ordinary cases. (See the aforesaid derangements for particular indications.) VOMITING OF BLOOD. Hasmatemesis. Diagnosis. Blood evacuated by vomiting, sometimes pure, (generally venous,) of a dark colour, but sometimes of a bright red; it is occasionally mixed with bile, food, &c ; the quantity varies ; blood is occasionally discharged in coagula by stool. Premonitory symptoms. Weight, pressure, fulness or tensive « Vide note, p. 21. t Vide Dyspepsia, p. 95. 120 DIGESTIVE system. pain or spasm in the hypogastric or hypochondriacal regions ; griping and colic; burning heat in the region of the stomach; anxiety, particularly on partaking of food or drink, or on pressure on the stomach; saltish taste in the mouth ; impaired appetite and nausea; giddiness, syncope, cold perspiration; sometimes also an intermittent pulsation is perceptible at the scrobiculus. Some only of the preceding symptoms may be present previous to the attack, and others during its course when very severe, or frequently renewed. We often find wild de- lirium or wandering, accompanied with spasms and a gradu- ally increasing weakness, and remission of pulse with frequent syncope. The most frequent causes of this affection are the sudden suppression of any sanguineous discharge, and the consequent determination of blood to the stomach; it is consequently apt to declare itself after a stoppage of the haemorrhoidal flux, and is a very common affection in females, from the suppression or cessation of the catamenia; in which case, as before remarked under that affection, it is frequently preceded by Cardialgia. Other causes are : scirrhus of the stomach, internal lesions or injury of that organ from swallowing sharp substances, or from worms; poisons, drastic purgatives, or emetic drugs, external contusion, obstruction of important viscera, or a change in the constituent principles of the blood itself; the direct cause is the bursting of some of the vessels of the stomach. The dangers arising from the use of powerful astringents are : inflammation or subsequent induration of the stomach, or putrid gastric fever. Therapeutics. Although it is unlikely that any one, not properly qualified, would think of treating a severe case of this affection, unless compelled to do so from the difficulty of ob- taining medical advice, yet it may be advisable to point out such remedies as experience has proved to be most serviceable in it as ordinarily met with,—premising, however, that when it arises from any organic disease, of the existence of which the experienced practitioner can alone determine, a different course may be necessary. VOMITING OF BLOOD. 121 When it occurs in females from the non-appearance or sup- pression of the monthly discharge, or from its final cessation, see articles Chlorosis, Amenorrhea, Cessatio Mensium; from worms, see Helminthiasis ; poisonous substances, see Poisons ; disease of the spleen, consult Splenitis. We may now proceed to the consideration of the remedies above alluded to. Aconitum. When the premonitory symptoms above given declare themselves, and particularly when a considerable de- gree of fever precedes the attack. Administration, o o e_o o o m an ounce 0f water, giving a dessert-spoonful, repeating in half an hour, and then every hour, till the fever abates; in this mode, if taken in time, we may often, by calming the circulation, prevent an attack. Nux vomica. In a decidedly plethoric constitution with a marked (venous) stomachic or abdominal congestion, and tendency to constipation ; particularly when arising from sup- pression of hemorrhoids, or of the menstrual flux, or from in- dulgence in vinous, spirituous, or fermented liquors, and still further indicated by irritability of temper. Administration. ^°- in a teaspoonful of water, repeated in from three to twelve hours, according to the exigencies of the case. Pulsatilla. The value of this remedy is noticed in the diseases of females above mentioned; it is also in many cases found more suitable than Nux vomica for males when of lym- phatic temperament and mild disposition. Some of the best indications for this medicine will be found under Dyspepsia, Cardialgia, and Derangement of • the Stomach. Admin- istration the same as Nux vomica. Cinchona. When a quantity of blood has been already vomited, this remedy, from its power of restoring the energy of the system after debilitating losses, is clearly indicated ; it should also be chosen when the patient has had a severe at- tack of hasmatemesis, which has ceased of itself, but still left great weakness. Administration. ^%° in about a teaspoonful of water, after which, if a slight aggravation ensue, we must wait quietlv 6 122 DIGESTIVE system. until it passes off, and while improvement continues progress- ing, refrain from repeating ; and after forty-eight to seventy- two hours, we may give a second dose ; but if no marked alteration of any kind declare itself, or if the disease advance, we may repeat it from four to six hours, the same dose. Arnica. One of our most important remedies in severe cases, and especially when occurring in individuals of a robust constitution, of a sanguine temperament and choleric disposi- tion. It is further indicated when the patient complains of pains, resembling the results of a contusion, in all the extre- mities. Administration. Six globules of the third potency in an ounce of water, a dessert-spoonful every three hours, desist- ing if a medicinal action declare itself, and lengthening the intervals according to the amelioration that takes place. In mild attacks, ^ in a little water, repeated every six or even every twelve hours, have been found sufficient. Tincture of Sulphur is useful in strumous habits, or when the affection has arisen from suppressed haemorrhoids ; its value, also, in cases of abnormal menstruation, will be pointed out in the proper place. Administration. --6--, in four dessert-spoonfuls of water, one morning and evening for two days, and if no severe symp- toms direct our attention to another remedy, it should be allowed to continue its action for a week or fortnight, as long as a gradual improvement is going on ; in fact, in such con- stitutions we should take every opportunity between the in- tervals of the attacks, of giving a dose or two of this medi- cine, should no other better calculated to combat this ten- dency appear to merit a preference. The following remedies also deserve a careful study : Phos- phorus, Belladonna, Arsenicum, Lycopodium, (may be ranked next to Nux v. in cases arising from abdominal congestion,) and Hyoscyamus, (which, with Belladonna, is particularly useful in cases with Spasmodic action,) Lycopodium, Arsenicum, Phos- phorus and Secale cornuium (Schirrus.) Finally, Carbo vegeta- bilis, Millefolium, Cantharides, Calcarea carbonica, Nalr. mu- riaticum, Zincum and Causticum, under peculiar circumstances, and as tending to eradicate the predisposition to such affections. CONSTIPATION. 123 The application of dry cupping-glasses to the abdomen and under the ribs, or of a cloth which has been dipped in mode- rately cold water, to the lower region of the abdomen, some- times form useful auxiliaries in arresting the hemorrhage. See also Hemorrhage from the Lungs, under Hemoptysis. Diet. The rules already given under Dyspepsia should be observed, but with still greater strictness; no solid food must be partaken of; all drinks should be cold; animal jellies, pre- parations of milk, light puddings, and broths, merely tepid, may be allowed in cases where the patient may require such nourish- ment ; but nothing more must be taken than is absolutely ne- cessary for that purpose; immediately after an attack, no food should be given for some hours, and then very cautiously and in small quantity. It is evident that, in such cases, absolute rest, both mental and bodily, is essentially requisite. CONSTIPATION. COSTIVENESS. OBSTIPATION. Obstructio Alvi. We have now to treat of an affection which so frequently baffles the skill of the practitioners of the old school; their leading cause of failure is their ignorance of the great curative principle, and consequent proceeding upon a system opposed to the operations of nature. This affection is generally sym- pathetic with some other derangement of the organism, and, consequently, in our treatment of different diseases, we have had frequent occasion to allude to it. One of the leading causes of aggravation and excessive obstinacy in the Constipa- tion, most closely approaching to an idiopathic form, is the practice of flying to aperient medicines on the slightest ap- pearance of costiveness, under the absurd idea that keeping the bowels open is a species of panacea against disease of every description. Many mothers are so possessed with this idea, that they are continually administering physic to their chil- dren, without the slightest apparent call for it, and thus lay the foundation of dyspepsia and other visceral derangements in after-life. Many a slight case of costiveness which, if left 124 digestive system. to nature, would have disappeared of itself, leaving no ill con- sequences, has, by an ill-judged administration of aperients, been converted into obstinate Constipation, embittering ex- istence and predisposing the constitution to a variety of dis- eases in after-life. To prevent misconception upon this point, we may remark, that we by no means undervalue a regular state of the bowels; but when costiveness shows itself, we happily possess remedies calculated to restore the balance of the system ; and in obstinate cases do not content ourselves with simply alleviating the symptoms, but mainly direct our attention to the permanent removal of the affection. Many of the principal causes of this disorder, besides that mentioned, are the same as those particularized under Indigestion or Dyspepsia. Therapeutics. In trivial cases it will be found sufficient to pay proper attention to diet, to avoid too dry or indigestible food, masticate properly, to partake of meat only once a day, and to take sufficient exercise in the open ah*.* Should this course not have the desired effect, we must choose one or more of the following remedies : namely, Opium, Alumina, Bryonia, Nux vomica, Pulsatilla, Platina, Natrum muriaticum, Plumbum metallicum, or Carbonicum, Sulphur, Lachesis, Ve- ratrum, Lycopodium, Sepia, Veratrum, Silicea. Opium is chiefly to be selected in recent cases when Con- stipation is not habitual, but is also, like Nux v., and other remedies, serviceable in cases of a more chronic character when arising from sedentary habits. In old people, it is gener- ally more useful than Bryonia and Lachesis, although these and the other remedies must be borne in mind and adminis- tered when called for by the nature of the symptoms. The more immediate indications for Opium are : want of power to relieve the bowels, with a feeling of constriction in ano; pul- sation and sense of weight in the abdomen, dull, heavy pain in the stomach, parched mouth, and want of appetite, determi- nation of blood to the head, with redness of the face, and head- ache. * See also the concluding remarks of this Chapter. CONSTIPATION. 125 Administration. -3a, in a little water, repeated in twelve hours, if no benefit result. (Vide note, p. 21.) Alumina. Constipation from an apparent absence of peris- taltic motion; faeces hard, dry, broken, evacuated with con- siderable exertion of the abdominal muscles and forcing, and sometimes streaked with blood ; constipation from travelling. Administration. Same as Nux v. Bryonia is especially useful in constipation occurring in warm weather, and in persons of dark complexion and an irri- table or obstinate disposition, with a tendency to be easily chilled, and subject to rheumatism; it is further indicated when constipation arises from disordered stomach, and is attended with determination of blood to the head, and headache. Administration. — in a little water, repeated in twenty- four hours, even if partial relief ensue. In chronic cases, two globules to be taken daily for a week or so until benefit result, or a change ensue which may render the selection of another remedy, appropriate to the modified symptoms, necessary. Nux vomica. This remedy is particularly useful when con- stipation results from too heavy a meal, indigestible food, and stimulating liquids; or in chronic cases arising from long- continued indulgence in vinous, fermented or spirituous drinks, or coffee, or from sedentary habits or excessive study. It is peculiarly adapted to persons of irascible and lively temper, with determination of blood to the head, and headache, unfitness for exercise, disturbed sleep, and a feeling of general op- pression or heaviness ; frequent and ineffectual efforts to re- lieve the bowels, attended with sensation of stricture and sometimes frequent, painful and difficult emission of urine. It is, as remarked under Dyspepsia, particularly indicated for individuals subject to hemorrhoids. Administration °f°, taken in a little water towards evening. In chronic cases 05§ °. Diarrhoea arising from fright or from cold, followed, if required, by Dulcamara in the latter case. For other indications, vide Mental Emotions. Lachesis. Diarrhoea from acid drinks, or sour unripe fruits, with severe griping ; diarrhoea with ingesta. Sulphur -~ is a most valuable remedy in diarrhoea, par- ticularly during the night, occurring in strumous habits, or in very obstinate cases. In adults predisposed to hemorrhoids, or in children, when the diarrhoea is attended with excoriation and papular eruptions, it is particularly efficacious; also in cases where the slightest cold brings on a relapse or an at- tack ; or when milk disagrees and causes a looseness. Calcarea ^oo. may ^e had recourse to after Sulphur. Acidum phosphoricum. In obstinate cases, with portions of undigested food in the evacuations ; or occasional involun- tary evacuations. Phosphorus °-6a°. In chronic, painless diarrhea, with gradual prostration of strength ; diarrhoea with ingesta. Diet. Acids or acidulous wines, beer, coffee, strong tea, and fruits, whether raw or cooked, should be carefully avoid- ed. Solid food proscribed, as tending to keep up the intes- tinal irritation ; and gruel, fresh milk in moderation, broths, and light mucilaginous food substituted. DYSENTERY. Dysenteria. Diagnosis. Constant urgency to evacuate the bowels, tenesmus, violent pains in the abdomen, a greater or less degree of fever, and stools of mucus or blood, or both. It may appear suddenly, but is frequently preceded some time by loss of appetite, costiveness, flatulency, nausea or slight vomiting, with chills, followed by heat of skin and accelerated pulse, then dull abdominal pains and increased 142 DIGESTIVE SYSTEM. evacuations; after a time no faeces are discharged, but white mucus, which may afterwards change to blood (bloody flux) ; stools, particularly when fever is present, very frequent and fetid; if not checked in time, the disease may terminate in ulceration or gangrene, or the patient may sink from ex- haustion. This affection is very frequently complicated with rheu- matic pains, which will be noticed under the different reme- dies, as an additional indication for their employment. The exciting causes are: checked perspiration, particularly in warm weather; low or marshy situations, local irritations, such as worms, scybala, &c, and suppression of hemorrhoids, metastases, and sometimes, in infants, difficult dentition. Therapeutics. The principal remedies found useful in treatment are: Aconitum, Chamomilla, Pulsatilla, Ipecacu- anha, Colocynth, Mercurius vivus, Arsenicum album, Carbo vegetabilis, Nux vomica, Cinchona, and Sulphur, Staphys., Sepia, etc. Aconitum. This remedy is peculiarly adapted to the fever frequently present, and in young and plethoric patients is gen- erally required in the commencement or in the course of the disease. It is indicated by full and hard pulse; severe pains, generally in one spot; abdomen tense and painful when touched, denoting the commencement of inflammation', also valuable when we find pains resembling rheumatism in different parts of the body, with shivering, or excessive heat and thirst. Administration. As in Inflammatory Fever, which see. Chamomilla. If, after the administration of Aconite, we still find violent heat and thirst, rheumatic pains in the head, and constant agitation and tossing. This remedy is also useful when this disease seems to take for its proximate cause gastric impurities formed in the primae viae; or when it has arisen from exposure to a cool atmosphere when in a state of perspiration. When we find foul tongue, with clammy, bitter taste in the mouth, bilious stools, and before tenesmus declare itself, this evidently points out the remedy as more useful in the first or diarrhceal stage ; it may be followed by Pulsatilla,when the symptoms given under that remedy present themselves. DYSENTERY. 143 Administration. s a^, in a little water, repeated every six hours until improvement takes place, or indications for an- other remedy present themselves.* Pulsatilla, when the gastric symptoms noted under Cha- momilla are present, but the stools consist entirely of mucus striated with blood. (Dysenteria pituitosa.) Administration, same as Chamomilla, but at the sixth po- tency. The three remedies, above mentioned, are also valuable in dysentery arising from cold, or what is commonly denominated rheumatic catarrhal dysentery, Rheumatismus intestinorum. Ipecacuanha. This remedy is serviceable when the dysen- teric affection seems fairly established; when the stool con- sists of slimy matter containing white flocks, followed by eva- cuations of sanguinolent mucus. Administration, same as Chamomilla. Colocynth. In cases attended with violent colic, and ex- cessive distention of the abdomen, shivering with chills, appa- rently extending from the abdomen over the whole body, ex- cessive agitation and restlessness, tongue coated white ; slimy, and sometimes bloody evacuations ; it is sometimes found useful to follow Ipecacuanha or Mercurius.}; Administration, asg-* o m six teaspoonfuls of water, one every hour until improvement declares itself, when the inter- vals between the doses may be lengthened.^ Mercurius vivus in the red dysentery or bloody flux, * Vide note, p. 21. f A successful procedure in our practice has been the alternate admin- istration of Colocynth and Mercury for very many forms of dysentery. The general indications permitting, we have given the first trituration of the Colocynth apple (rubbed dry with Sugar of Milk) every two, three, four or more hours during the day, and Mercury at evening or during the night. In some cases, however, where the griping pains and tenesmus were intense, we have alternated the Colocynth and Mercury during the night, at such intervals as the urgency of symptoms demanded. After a favourable impression from these drugs, the disease sometimes re- maining stationary, especially during the autumn or prevalence of febrile miasms, we have found a dose or two of Colchicum to awaken anew the susceptibility of the system to the above or other indicated remedies.—Ed. X Vide note, page 21. 144 DIGESTIVE SYSTEM. when we find severe tenesmus or straining, with evacuation merely of a little mucus, sometimes succeeded by or accompa- nied with protrusion of a portion of the intestine and increased discharge of pure blood, or of putrid, corrosive, greenish, yel- lowish, or frothy mucus, intermixed with blood, and some- times followed by the evacuation of small hard substances (scybala) after much straining ; burning in ano : severe griping and lancinating pain before, during, and even after the motions ; increased urgency to stool after each evacuation.* In cases with the above symptoms, Mercurius may almost be considered a specific, or will at all events prove so efficacious a remedy, that any remaining symptoms will, in general, be re- moved with facility, either by.means of Colocynth, Acidum phos- phoricum, Acidum nitricum, (the two latter especially in the event of a continuance of the sanguineous stools,) or any of the other remedies which may seem more appropriate according to the indications for their employment, as given in this chapter. Administration. A grain of the third trituration in an ounce of water, a dessert-spoonful every three hours until the symp- toms are mitigated, when the intervals may be lengthened. Bryonia is frequently called for in those cases in which it has been found necessary to administer Aconite at the commence- ment of the disease; but is more particularly indicated when the attack has occurred during the heat of summer from the effect of a chill, and is attended with a typhoid fever of the in- flammatory form ; with loose evacuations of a brownish colour and putrid odour, occasionally containing lumps of coagulated mucus resembling undigested substances, or also small hard lumps or balls (scybalous faecal matter) with griping during, and burning in ano after the act of evacuating, aching pains in the limbs, aggravated by movement. When the disease has attained an advanced stage, and the accompanying fever is of a low typhoid type, the patient much exhausted and distressed with severe rheumatic or aching pains in the loins and extrem- ities when reclining or sitting still, and the stools of a slimy, * Mercurius sublimatus corrosivus is sometimes more speedily effica- cious than Mercurius vivus or Merc, solubilis against the above symp- toms. DYSENTERY. 145 frothy, white, gelatinous, or sanguineous nature, passed in- voluntarily at night in bed : Rhus not unfrequently gives a favourable turn to the disorder. Administration of Bryonia and Rhus. Six globules of the third potency in about half an ounce of water, a teaspoonful every two hours until an alteration is effected. Arsenicum. Dysentery of epidemic or contagious origin with fever of a typhoid or putrid type :* dysentery arising from exposure to noxious exhalations in marshy situations, &c. This remedy may, however, be selected in all cases, from whatever cause arising, when great weakness and even pros- tration exists from the commencement, with burning pain in evacuating the bowels, thirst and aggravations of the sufferings after drinking ; or, on the contrary, adipsia :—also when the disease threatens to assume the ulcerative or gangrenous cha- racter—characterized by previous severe pains, particularly burning, which suddenly cease; hypocratic expression of countenance ; rapid sinking of the vital energies ; pulse small and intermittent; coldness of the extremities ; highly offen- sive, putrid, and cadaverous smelling evacuations, both of faeces and urine ; unconscious passing of stools; offensive breath and petechiae in different parts of the body. Administration. Six globules of the third potency in an ounce of water, a dessert-spoonful every two, three, or six hours, according to the urgency of the case, carefully watch- ing the effects, and shortening or lengthening the intervals accordingly. Carbo vegetabilis is a most useful remedy in these des- perate cases, when the breath is cold, the pulse almost imper- ceptible, and the patient complains of severe burning pains : its indications closely resemble those of Arsenicum, wi^h the exception of the thirst, and the aggravation caused by drink- ing. It may be given with benefit when that remedy has failed, or only partially relieved, and in this, as in other af- fections, many instances might be cited where a judicious al- * Dysenteria putrida. 146 digestive system. ternation of these two remedies has effected benefit—where neither of them might have been singly adequate to the ex- igency of the case. Administration. Six globules of the sixth or twelfth po- tency exhibited in the same manner as Arsenicum. Nux Vomica. When Arsenicum has diminished these symptoms and warded off the danger, but we find that the faeces still retain a highly putrid odour ; also at any period du- ring the course of the disease, when the following symptoms are present:—Frequent scanty evacuations of mucus or sanguine- ous mucus, and occasionally small, compact, hard faeces (scy- bala) attended with violent cutting or griping pains in the re- gion of the navel; borborygmus, pains in the loins, tenesmus, burning or sensation of excoriation in the anus, and sometimes protrusion of the intestine ; great heat and excessive thirst. Administration. Same as Pulsatilla. Cinchona. In cases where the disease has an endemic character, occurring in marshy countries, and in many cases when a state of putridity remains in the faeces after the ad- ministration of the remedies above mentioned. Administration. Same as Chamomilla. Cantharides. Sanguineous stools mixed with whitish mu- cus or solid substances like false membranes ; strangury.* Administration. Six globules of the third in an ounce of water, a dessert-spoonful every four or six hours. Sulphur. When the more marked symptoms are amelio- rated by the use of the foregoing remedies, but the Dysentery still continues obstinate, and especially when the disease occurs in subjects who have previously been long affected with he- morrhoids ; or when it has from time to time been subdued, and afterwards returned with greater or less violence ; or even when the apparently best selected remedial agents have failed to check its course. It will frequently be found most efficacious in all these cases, since when this occurs we may * Colchicum autumnale is preferable to Cantharides when the symp- toms are as described, and the disorder rages epidemically during the au- tumnal season, dysentery. 147 suspect some latent constitutional cause is baffling our efforts. In the instance first noted by its removal, the affection is ter- minated ; in the second, the predisposition to a return of the attack is obviated; and in the third, the constitutional taint alluded to being controlled, the organism becomes suscepti- ble to the specific action of the other medicaments. Administration. -6-, in a little water, repeated at first every twelve hours until an effect is produced, then discon- tinued for a time and allowed to act. In conclusion it must not be omitted to add, that when the disease is of long standing, and has become, so to speak, habitual, a cure is often effected by means of Phosphorus. Administration. Two globules of the third potency in a little water daily, until a favourable change sets in.* Rules of Conduct and Diet. In this affection it is of great importance to keep up a moderate degree of warmth around the abdomen, which is best obtained by flannel worn outside the linen. During the course of treatment cold drinks are to be avoid- ed, barely sufficient nutriment to keep up the strength of the patient allowed ; and the more severe the inflammatory symptoms, the more strict must be the abstinence. No solids should on any account be given ; but the diet should consist principally of mucilaginous or demulcent -fluids, such as thin barley-water and gruel; in comparatively mild cases, weak chicken-broth or beef-tea, at the discretion of the physician, may be allowed. Even after convalescence this course of diet should be for a short time observed, especially when the disease is raging in an epidemic form, and a return to the usual diet gradually brought about. Wine and alcohol are absolute poisons in this affection. Having thus given the best mode of treatment for this dis- ease, ordinarily so fatal, we may remark, that in a great ma- jority of cases, the homoeopathic method checks it at its com- mencement, without allowing it to assume the more frightful forms portrayed in the instructions of its treatment; and it * Vide note, pasre 21. 148 DIGESTIVE SYSTEM. passes off leaving the patient in sound health; in the most violent cases where it has already made head, and seems ap- proaching a fatal termination, it may almost be said to be the only system which offers a chance of salvation to the suf- ferer ; and in strumous constitutions, where, under the old mode of procedure, the results are commonly so unfortunate, it gently mitigates the violence of the symptoms, and safely conducts the patient through his perils. Suppressed Dysentery. When the dysenteric evacuations have been suddenly checked by allopathic means, and a vio- lent inflammatory or spasmodic action declare itself, such as severe pains, anxiety, dyspnoea, nausea, and empty retchings, or distention and tenderness of the abdomen ; suppression both of faeces and urine; coldness of the face, tongue, and extremities; breath also cold; with spasms of various kinds in different parts of the body, which are renewed by any ex- ertion, either of speech or movement—the following remedies will be found useful: Aconitum. Against any inflammatory symptoms that may present themselves, to be repeated according to the rule al- ready given until relief follow.* Cuprum aceticum. When spasms or cold sweats pre- dominate. Administration.- -6fi, in a little water, repeated in three to six hours, according to the effect produced. Belladonna, against inflammatory colic, or if symptoms of abdominal inflammation set in, see article Enteritis, and also Colic, and administer accordingly. Colocynth. Violent colic and distention of the abdomen, see Colic. Veratrum album. Coldness of the body and extremities, and retching. Administration. Six globules of the sixth potency in an ounce of water, a dessert-spoonful every two to six hours. Carbo vegetabilis in extreme cases, with scarcely percep- tible pulse, and cold breath. * Vide note, p. 21. cholera. 149 Administration, as already given in the foregoing article. The use of clysters of warm water has in many instances been found serviceable in promoting an evacuation of the bowels, and bringing back the suppressed discharge. When the patient has escaped the serious consequences above noticed, chronic complaints frequently are the result of Suppressed Dysentery ; the most frequent are Dropsy, Paralysis, and Rheumatism. CHOLERA. By the term Cholera Morbus was formerly understood a dis- ease attended with nausea, griping, purging and vomiting, gene- rally prevalent towards our summer months, and at the season when fruit was plentiful. But it has now become a generic term, under which are included two varieties—the Cholera Morbus, properly so called, and the Asiatic Cholera. Diagnosis. The first named, sometimes called the Spo- radic Cholera, generally commences with a sudden feeling of nausea and griping, followed by purging and vomiting; in severe cases accompanied with coldness of the body, parti- cularly the extremities, and anxious and hurried breathings, excessive thirst, a feeling of cramping in the legs, sometimes in the arms, with spasmodic contractions of the abdominal muscles, shrinking of the features, and a hollow expression about the eyes ; pulse weak, sometimes scarcely perceptible ; thin, watery and fetid, or bilious evacuations, sometimes with dark bilious vomiting, anxiety and tenesmus. Causes. The most frequent are worms, gall-stone, indi- gestible substances, fruits or crude vegetables, alterations in temperature, moist or marshy situations, or damp weather, dentition or parturition. Therapeutics. In the treatment of Cholera in its sporadic form, (i.e., when the disease arises from occasional causes, such as cold, fatigue, &c.,) the following remedies will be found to be the most efficacious: Cham., Ipecac, Nux v., Veratrum album, Arsenicum album, Cinchona and Pulsatilla. Chamomilla is almost specific when the attack has been 150 digestive system. excited by a chill or a fit of passion, or great dread of being attacked during the prevalence of the disease. The following are the symptoms which particularly indicate its employment: acute colic-like pains, or heavy pressure in the region of the navel, sometimes extending to the heart, with excessive anguish; bilious diarrhoea, cramps in the calves of the legs ; tongue coated yellow, and sometimes vomiting of acid matter. Administration. A few globules of the third potency to half an ounce of water, a teaspoonful every two to six hours, according to circumstances. (Vide note, p. 21.) Ipecacuanha may be administered after the above, should the attacks of vomiting become more prominent; or it may be selected from the commencement, should vomiting predominate, or at least assume as marked a character in the complaint as the diarrhoea. Other indications are : sensations of weakness, or softness, (flaccidity,) coldness in the face and limbs, sense of shivering in the abdomen ; slight cramps in the calves of the legs, and in the fingers and toes. (Nux v. after Ipec. when anxiety, pain in the abdominal parts, frequent small evacuations and tenesmus, frontal headaches, horripilation with internal chills.) Administration. Same as Chamomilla. Veratrum album. Should the disease increase, notwith- standing the administration of the preceding remedy, and assume the following characteristics, violent vomiting with se- vere diarrhea, excessive weakness, and cramps in the calves of the legs; eyes hollow or sunken, countenance pale, and ex- pressive of acute suffering and intense anguish; coldness of the breath and tongue, excruciating pain in the region of the navel, tenderness of the abdomen when touched; dragging pains and cramps in the fingers, shrivelled appearance of the skin on the palms of the hands. This is also one of the best remedies in both varieties of this disease. Administration. Six globules of the third potency in a teaspoonful of water, repeated in half an hour or even less, should there be no change of any kind for the better ; or one or two drops of the third tincture may be added to an ounce of CHOLERA. 151 water, a dessert-spoonful every half, one, or two hours, accord- ing to the severity of the symptoms ; when amelioration has taken place, lengthening the intervals. Arsenicum is useful when this malady assumes a severe character from the beginning, but it is more particularly indi- cated when the disease is attended with rapid prostration of strength, insatiable thirst, excessive anxiety, loss of articulation, with fear of approaching death, burning sensation in the region of the stomach, almost constant discharge from the bowels, or renewal of the discharge on every occasion that the desire for drink is gratified ; suppression of urine or scanty micturition, followed by a burning sensation; violent and painful vomiting, tongue and lips dry, cracked and blueish, or black; hollow cheeks, pointed nose, pulse almost imperceptible, or small, weak, intermittent, and trembling; severe spasms in the fin- gers and toes ; clammy perspiration. Administration. Six globules of the sixth potency in a teaspoonful of water, to be repeated in the same manner and under the same conditions as described for veratrum. Cinchona is chiefly most useful against the weakness which remains after cholera, but is also serviceable occasionally during the course of the disease, particularly when there is vomiting of ingesta, and frequent watery and brownish evacuations containing particles of indigested food ; also when there is op- pression at the chest with eructations which afford temporary relief; severe pressure in the abdomen, especially after .par- taking of the smallest portion of food; great exhaustion, some- times amounting to fainting. This remedy is particularly marked when the disease has been excited by indigestible substances, such as unripe fruit, &c, or by inhabiting a marshy situation. Administration. °f °, repeated every four, six, or twelve hours according to circumstances, until amelioration result. Pulsatilla, in mild cases, cases where there is mucous diarrhoea and dyspeptic symptoms. It is also useful when the disease has been excited by the use of indigestible articles of diet. (Vide Diarrhcea and Indigestion.) Administration. °#°, repeated every four hours, until a favourable change takes place. 152 digestive system. ASIATIC CHOLERA. This disease generally commences with vertigo, headache, and singing in the ears, a sensation of flatulence in the stomach, griping pains, and a feeling of weight and oppression in the region of the heart. In some, but not all cases of Asiatic Cholera, we find the lips, nails, and sometimes the whole skin of a blue colour, but in almost every instance the frame loses its power of genera- ting heat; the pulse and pulsation of the heart are almost unfelt, circulation of the blood becomes stagnant. Patients who have escaped through the second stage are fre- quently carried off by a typhoid fever in the third. When the premonitory symptoms of this disease, as above noted, exhibit themselves, its complete development is fre- quently prevented, by the administration of the saturated so- lution of Camphor, one part of Camphor to twenty of spirits of wine. Administration. One or two drops of the above every five minutes in a teaspoonful of cold water, until a cessation or amelioration of the symptoms take place, when the inter- vals between the repetition of the dose may be lengthened to every two, then every four or six hours. In many cases also we may succeed in checking the disease at its commencement by Ipec. and Nux v., or the remedies already mentioned under Sporadic Cholera, p. 150, adminis- tering, however, more frequently, say every hour at first. But when Cholera sets in in all its frightful forms, we should have immediate recourse to Veratrum. Administration. A few globules of the third in a tea- spoonful of water every quarter of an hour : should no im- provement set in after several doses, and the cramps change to spasms and convulsions, with spasmodic constriction of the chest, which obstructs respiration, Cuprum must be had re- course to in the same manner as • described for Veratrum. Arsenicum should be alternated with Veratrum, when an intense burning sensation is experienced in the stomach and bowels, with extreme prostration of strength, great thirst, etc. (Vid. Indications, page 150.) Carbo vegetabilis may often be given with advantage CHOLERA. 153 when the patient is reduced to a state of almost complete as- phyxia, with scarcely perceptible pulse ; or when, on the cessa- tion of vomiting, diarrhoea, and cramps or convulsions, con- gestion to the head and chest ensues, with oppressed breath- ing, coldness of the breath, and redness or lividity of the face, (which is covered with clammy sweat,) and lethargy:—Should the pulse become stronger under the action of Carb. v., but the pain, vomiting, cramps, etc., return, Veratrum must again be had recourse to. Phosphorus (followed by Acidum phosphoricum, should great clamminess of the tongue supervene) is particularly use- ful in cases of diarrhea, Which are so liable to occur during the prevalence of cholera, and which, if neglected, are but too prone to pass on rapidly to confirmed cholera. Administration. A few globules of the third potency every four or six hours.* Phosphorus is further indicated in the course of congestion " in the chest" during the course of the disease ;—finally, it is one of the most serviceable remedies against the obstinate diar- rhea which sometimes remains after an attack. In conclu- sion, it may be added, that a few doses of Cantharides, 3, will be found useful when there is great irritation and pain in the bladder. Rhus, Bryonia, etc., when Typhus fever re- sults (vide Typhus). Belladonna, followed, if required, by Opium and Lachesis, when there is Congestion of the Brain. Aconite, Phosphorus, Bryonia, Belladonna, etc., in the event of Congestion to the Chest ; and Aconite, followed by Nux v., Bryonia, or Mercurius, etc., when the stomach and intes- tines become the seat of congestion (vide Congestion to the Abdomen). Secale cornutum is very useful in cases of colourless diarrhea, with pains in the extremities remaining on the ces- sation of the vomiting, but is also valuable after Veratrum and jCuprum, when the cramps or convulsions do not yield to these remedies. Cinchona against the weakness,—and Sulphur and Phosphorus are two of the most important remedies against irritation or weakness in the alimentary canal, characterized * Vide note, p. 21. 7# 154 DIGESTIVE SYSTEM. by frequent attacks of or nearly, continual looseness occurring after cholera. The foregoing, then, are the principal reme- dies employed by homoeopathists in cholera, and when the treat- ment is had recourse to from the commencement, it generally yields without difficulty ; the disease rarely passing into the second stage, and almost never into the third. The best preservatives against infection are Veratrum, Cu- prum, and Camphor; an occasional dose of the preparation mentioned under the latter medicine, at page 152, has fre- quently been found sufficient to ward off an attack; it is more particularly during the first stage of the disease itself, however, under whatever form it sets in, that the greatest reliance is to be placed on this remedy. Veratrum and Cuprum are the prophylactics which have been employed with the greatest success. One drop of the tincture at the third dilution, or a few globules of the same potency of each medicine, may be taken alternately every third day, in a little water, fasting; avoiding, moreover, excesses of all kinds, late hours, exposure to night air, and melancholy thoughts, or fear, which are all strongly predisposing causes to attacks of this malady. When the disease happens to break out, notwithstanding these pre- cautions, it is almost invariably in the mildest form. It may also be remarked, that during the prevalence of this affection the clothing should be sufficient to preserve the body at an equable temperature, and care taken to avoid chills or check- ed perspiration, or cold and wet feet; those who are affected with considerable perspiration in their feet should change their stockings at least once daily; a flannel bandage worn round the abdomen is also a useful precaution, and it should not be hastily laid aside when the danger seems to have pass- ed away ; also constant exercise should be taken during the day in the open air. Adherence to the homoeopathic rules is a sufficient dietetic guide; raw vegetables and cold fruits, for example, melons, should be carefully abstained from, and even the more wholesome varieties and all cooked vegetables, ex- cept potatoes, be used in extreme moderation; pure beer and non-acid wines are not objectionable for individuals not at- tacked with the same limitation. It may appear almost super- CHOLERINE.--LIVER COMPLAINT. 155 erogatory to observe that purity of air and thorough ventila- tion is highly necessary. Accessory Treatment. The patient should be kept in a room of a warm temperature, the bed should be heated by ar- tificial means, and bottles of hot water applied to the feet if necessary. The observance of this rule greatly facilitates the action of the medicine employed ; anything which might dis- turb the equanimity of the sufferer, such as noise or contradic- tion, should be carefully avoided, and his spirits should be sus- tained as much as possible. Cold water is the best drink, but the patient should not be allowed to take too much at a time; the occasional administration of a small piece of ice, if possible, is often attended with benefit; and injections of iced water are sometimes serviceable in relieving the colic and cramps in the intestines. During the convalescence following this disease we must be careful not to indulge the patient to the full extent of his appetite. Remarks. When this disease is raging as an epidemic, we not unfrequently find individuals suffering under many symptoms bearing a marked resemblance to those of cholera, but with constipation instead of diarrhoea, and retching in place of vomiting; this affection being closely analogous to Suppressed Dysentery, the reader will find the treatment under that head, article Dysentery. CHOLERINE. This affection being merely diarrhea, occurring during the prevalence of cholera without any of the more severe symp- toms of the disease, consult that article for its treatment. LIVER COMPLAINT. This disease is divided into the Acute and Chronic; the latter generally goes by the name of Liver Complaint, although a careful diagnosis will generally discover that the real disease is in the stomach and intestines; however, in many cases the liver itself becomes much affected from this cause, and in itself deserves considerable attention. 156 DIGESTIVE SYSTEM. When the disease has been for a long time unchecked, and the inflammation becomes deeply seated in the substance of the liver, an abscess frequently forms, bursting either exter- nally or internally ; in the latter case not unseldom proving critical, or bringing on hectic fever. ACUTE INFLAMMATION OF THE LIVER. Hepatitis. This disease is much more common in tropical climes than with us. There, a high mode of living, exposure to heavy dews or damps in the evening, and the powerful rays of the sun by day, are among its principal exciting causes; but it may also arise from violent mental emotions, the use of stim- ulating or alcoholic drinks, suddenly suppressed evacuations, strong emetics or purgatives, the use of Mercury, gall-stones, external lesions, or injury of the brain. Diagnosis. This differs according to the seat of the in- flammation : when on the outer surface, or convex side, the symptoms closely resemble those of pleuritis ; there is gene- rally a violent pain in the right hypochondrium, sometimes resembling stitches, at others burning—shooting to the sternum, the right scapula, and point of the shoulder, and even affecting the right foot, with sensation of numbness or tingling in the arm of the same side, the pain increased by inspiration ; a short dry cough, and the symptoms of inflam- matory fever ; bowels irregular, generally constipated, and evacuations in most instances of an unnatural colour. In this form the patient can only lie on the left side. When the seat of inflammation is on the inner or concave side of the liver, the pain is much less, and the patient com- plains rather of a sensation of pressure than actual pain, but the whole biliary system is much more affected. The eyes and countenance become yellow, and sometimes complete jaundice declares itself; the urine is orange-coloured, the evacuations mo-tly hard, and generally of a whitish or gray colour. We also find bitter taste in the mouth, vomiting, and considerable distress—the patient can only lie on the right side. Inflammatory fever is also present in this form, and in ACUTE INFLAMMATION OF THE LIVER. 157 both, the right hypochondrium, on examination, will'usually be found hot, tumefied, and painful on pressure. Inflammation of the liver, unless well treated, is apt to assume the chronic form ; it may also end in suppuration ex- ternally, or internally by a communication either with the lungs or intestinal canal, or by a vomica in the substance of the organ itself; in indurations or other alterations of struc- ture, in gangrene, or in the formation of adhesions. The disease may terminate by resolution, critical metastases, hemorrhoids, diarrhoea, epistaxes, or cutaneous, particularly erysipelatous eruptions. Therapeutics. The following remedies are those most required in its treatment: Aconitum, Belladonna, Mercurius, Lachesis, Bryonia alba, Chamomilla, Nux vomica, Pulsatilla, and Sulphur. Aconite is especially indicated in the commencement of the attack, and may always precede the other remedies, when there is violent inflammatory fever, attended with insupportable shooting pains in the region of the liver, with tossing, restless- ness, and great anxiety and anguish. Administration. °oo^>oo in an ounce of water, a dessert- spoonful every three hours. (Vide note, p. 21.) Belladonna may be advantageously administered after Aconite has subdued the preceding symptoms, or from the commencement, when the following indications present them- selves : oppressive pains in the region of the liver, which ex- tend to the chest and shoulders; distention of the pit of the stomach, sometimes extending across the epigastrium, produc- ing a sensation of tension, with difficult and anxious respiration; determination of blood to the head, with cloudiness and giddi- ness, sometimes causing faintness ; great thirst, tossing about at night, and sleeplessness. Administration. Six globules of the third potency to an ounce of water, a dessert-spoonful every three or six hours, according to the violence of the attack ; being careful, if a marked medicinal action declare itself, to allow it to pass off before repeating the medicine, and also to lengthen the inter- vals according to the amelioration produced. 158 DIGESTIVE SYSTEM. When Belladonna fails to remove the whole of these symp- toms, we frequently find that Mercurius will have the desired effect; this medicament is too well known as an allopathic remedy in the cure of this disease, and the consequences pro- duced by its abuse are frequently so great, as to render the dis- ease almost incurable. It is generally administered, even when not indicated, until its marked pathogenetic symptoms declare 'hemselves, and consequently the patient, in addition to the original malady, has frequently to contend with a medicinal disease. The following are some of the principal indications for its employment: Painful sensations in the region of the liver, with shooting, burning, or oppressive pains, not allowing the patient to lie long on the right side, sometimes augmented by movement of the body or part affected; bitter taste in the mouth, want of appetite, thirst, and continual shivering, sometimes follow- ed by sweating, but without relief, with well marked yellow colour of the skin and eyes ; also when there are enlargement and induration of the liver, or where we have reason to sup- pose the formation of matter. (Also, Ars., Hep. s., or Silic. The alternate employment of Bell, and Bry., when the liver remained tumid and painful after the removal of the fever: Phos. and Bry.; when dull pain with dyspepsia : Carb. v. and Bry.; when eructation, constipation, jaundice : Carb. v. and Nux v. in alternation.) Administration. A grain of the third trituration to an ounce of water, a dessert-spoonful every three to six hours, according to results, and with the precaution specified under Belladonna. Lachesis. In subacute cases, or in those in which Bella- donna or Mercurius have merely afforded partial relief, La- chesis is often of great service. It may also be administered with advantage alternately with the said remedies in obsti- nate cases occurring in drunkards. (Administ., see Puis. 159.) Bryonia, when the pains in the region of the liver are mostly shooting, or consist of an obtuse pressure, with tension and burning, increased by touch, coughing, or respiration, and especially during inspiration; also much exacerbated by move- ment; also when the symptoms are attended with violent ACUTE INFLAMMATION OF THE LIVER. 159 spasmodic oppression of the chest; rapid and anxious respira- tion, bitter taste in the mouth, tongue coated yellow; constipa- tion present. Administration, Same as Belladonna. Chamomilla, when there are pressive pains, pressure in the stomach, oppression of the chest, and a sensation of tightness under the ribs ; yellow colour of the skin, pains not aggravated by motion, &c; tongue foul and yellow, bitter taste in the mouth ; paroxysms of great anxiety. Chamomilla is also almost a specific when the above symptoms have been brought on by a fit of passion. Administration. Same as Bryonia. Nux vomica is particularly indicated when the pains are shooting and pulsative, and attended with excessive tenderness at the region of the liver to the touch, pressure in the epigas- trium and under the ribs, with shortness of breath ; constipa- tion ; also when enlargement and induration occur; and in the chronic form, when there are marked symptoms of gastric derangement. (Vide Nux vomica, art. Indigestion.) Administration. Same as Bryonia. Pulsatilla. Sensation of tension in the region of the liver, and pressure or dull pain in the epigastric region; oppression at the chest, bitter taste, yellow tongue, nausea ; loose, green- ish and slimy stools; excessive anxiety, especially towards evening or during the night. Administration. Six globules of the sixth in an ounce of water, a dessert-spoonful every six hours. Sulphur is valuable to follow any of the preceding medi- cines, which, although apparently indicated, does not speedily declare a decided action, or when the disease continues, al- though in a diminished degree ; it is particularly efficacious after Nux vomica, to combat the sequelae of the disease. Administration. When to assist the action of the medi- cine, a single dose ^ in a teaspoonful of water may be given, and followed by the remedy judged most appropiate to the case in the space of six or twelve hours, according to circum- stances ; when employed to combat the sequelae of the disease, four globules at the same potency may be dissolved in four 160 DIGESTIVE SYSTEM. dessert-spoonfuls of water, and one exhibited morning and evening, and so on until relief is obtained, or another remedy is called for by an alteration in the symptoms. Diet. The same as under Fevers, modified according to the violence of the disease. LIVER COMPLAINT, OR CHRONIC INFLAMMATION OF THE LIVER. Hepatitis Chronica. In this form of the disease we find many of the foregoing symptoms, but in a modified degree; further, a continued pain or uneasiness in the right side seldom leaves the patient, who gradually falls off in flesh and loses strength ; and there is not unfrequently present an occasional cough with expectoration ; sometimes considerable perceptible enlargement of the liver, either continual or returning periodically, with a number of dyspeptic symptoms ; high coloured or red urine, yellow tinge of the skin and eyes, occasional febrile symptoms; the pulse, except during these attacks, generally quick but regular. Nux vomica §° and Sulphur §°r are ^wo 0I"tne principal remedies in this affection, which, however, frequently requires a careful discriminative treatment, and all the acumen of the practised physician, to conduct it to a happy issue. For the indications of these remedies, see Acute Inflamma- tion of the liver. Administration. As in Indigestion, which see; under which also will be found directions for the regulation of Diet. Carduus marianus. This remedy is indicated by most of the symptoms which have been described under Bryonia and Nux v. in the preceding chapter, but it is more particularly called for when there is bitter taste with dull pain or occasional shooting or pricking in the right hypochondrium, increased by inspiration, yellow hue of the skin ; short dry cough, or cough with expectoration of mucus streaked with blood; slight feverishness. Aurum, Hepar s., Lycopodium, Magn. m., Natrum, Silex, Cinchona, Alumina, and Calcarea, have also been found use- ful in particular cases. 161 JAUNDICE. Icterus. Diagnosis. Yellow colour, varying in shade from a pale saffron to a dark-brown yellow, first in the eves, then extending over the surface of the whole body; hard whitish faeces; orange- coloured urine; symptoms of deranged digestion, sometimes tensive pain or pressure in the region of the liver. In severe cases even the perspiration will impart a yellow hue to the patient's linen. The disease frequently declares itself without being plainly referable to any exciting cause ; the principal are: affections of the liver, indigestion, poisonous substances, taking cold, powerful mental emotions, emetics, or drastic purgatives or internal obstructions, such as gall-stones, or even worms ob- structing the biliary duct. Among the predisposing causes may be enumerated a too sedentary or irregular mode of life, indulgence in spirituous liquors, or frequent use of aperients. It may also be remarked that this disease frequently assumes the intermittent type. Jaundice is not of itself to be considered as a dangerous dis- order, but rather as an indication of some internal derangement, which, if neglected, may entail serious consequences, for exam- ple, dropsy, hectic fever, or general atrophy. Mercurius and Cinchona are two of the best remedies in the treatment of this disorder, particularly the former; but in cases when the patient has suffered from the abuses of that mineral substance, Ave give a preference to Cinchona, especial- ly when we can trace the disease to have arisen from parta- king of indigestible substances, or where it appears in an in- termittent form. In cases which have been excited by a fit of passion, as we have before noted—no unfrequent cause—we should have re- course to Chamomilla, or Nux vomica, should the bowels be confined, or alternately confined and relaxed. Nux vomica is also indicated when sedentary habits, over- study, or indulgence in spirituous liquors, appear to be the predisposing, or partly the exciting causes. 162 DIGESTIVE SYSTEM. Pulsatilla. Lassitude, great weakness and anxiety, es- pecially towards evening, obtuse pressure, but sometimes also pricking or shooting pain in the region of the liver, ex- tending occasionally upwards towards the right shoulder; whitish stools. Digitalis. • A most important remedy in many cases of this disease; the following are the principal indications for its employment: nausea, retching, or vomiting; tongue clean, or coated white; pressure at the pit of the stomach and region of the liver; sluggish state of the bowels, with white, gray, or clay-coloured evacuations, alternate heat and chills. (Icterus Spasmod. s. Spast.) Aurum is frequently an excellent remedy in obstinate ca- ses after Pulsatilla, when the disorder occurs in young females. Administration.* In general cases, four globules at the sixth potency, in four dessert-spoonfuls of water, one exhi- bited morning and evening; in cases of very young children we may substitute one for four globules in the same quanti- ty of water. (See remarks upon this subject in the Introduc- tion to Part III.) Should Jaundice be accompanied with symptoms of inflam- mation, and pain and pressure in the heptic region, see Acute Inflammation of the Liver ; and that accordingly in the majority of such cases, Aconite, followed if needful by Bella- donna, Mercurius, or Chamomilla, as best indicated, will be found of essential service. In very obstinate icterus, the alternation of Sulphur, He- par sulphuris, Lachesis, and Acid, nitricum, has been found successful; but as these cases frequently arise from obstruc- tions, atony, or a spasmodic or irritable state, they require considerable skill and discrimination in their treatment. INFLAMMATION OF THE SPLEEN. Splenitis. Diagnosis. Sharp pressing or shooting pains in the region of the spleen; in most cases a high degree of fever, with * Vide note, p 21. inflammation of the spleen. 163 general derangement; sometimes enlargement and tumefac- tion ; and when very severe, hematemesis. It declares sometimes in hot seasons, when it is notjainfre- quently mistaken for other affections. It may, however, arise in individuals of delicate constitutions, or in children when ex- posed to the influence of marsh miasms, particularly when to that cause has been added insufficient clothing, want of exer- cise, of proper nutriment, and long-continued mental disqui- etude. The value of Cinchona in this malady and the power it dis- plays of developing an affection closely similar, affords a beau- tiful exemplification of the truth of the homceopathic law. From our very imperfect knowledge of the physiology of this viscus and its relation to the other organs, this disease, except when it presents itself in the tangible form above men- tioned, is extremely difficult to diagnose. Its best character- istics are tenderness or sensibility on pressure in the splenic region, with general debility ; paleness of the complexion, bloodless appearance of the conjunctiva, languid circulation, and tendency of the extremities to become cold. Therapeutics. The chief remedies in this affection are Cinchona and Arsenicum, which are useful not only in its treatment, but against the tendency to dropsy, which not un- frequently develops itself; this can but rarely occur, however, where the proceedings of the physician are guided by the ho- moeopathic law, inasmuch as the very remedies employed to combat the disease itself, are the surest preventives against such a result. The other medicines most frequently required are : Aconi- tum, Arnica montana, Nux vomica, and Bryonia alba. Aconitum. Against the fever generally present, if the disease be severe. Administration.* ooo_ooo to an ounce of water, adminis- tering one dessert-spoonful every half hour, hour, or four hours, according to the exigency of the case. Cinchona. When the inflammatory symptoms have abat- ed or if no fever of any moment existed from the commence- * Vide note, p. 21. 164 DIGESTIVE SYSTEM. ment, particularly if the disease owes its origin to marsh mi- asm, or if the accompanying fever present an intermittent type,'to which case it should be administered during the Apyrexia. Moreover, if impaired appetite and general de- rangement be present, see this medicine under Apepsia. Also if the patient have been weakened by hematemesis, or diarrhoea, (see these articles.) Administration. In general cases we may dissolve ° °g° ° in four dessert-spoonfuls of water, and give a dose morning and evening, and so on until improvement results. Arsenicum, also useful where the disease assumes an inter- mittent character, or is complicated with that affection, (see Cinchona, and this remedy, in Intermittent Fever.) And further, when the patient complains of a violent burning pain in the region of the spleen, and a constant pulsation at the scrobiculus, attended with great anxiety ; also watery or san- guineous diarrhoea, and burning at the anus; excessive weak- ness, and oedema of the feet. Administration, same as Cinchona. In some cases it has been found advantageous to alternate these two remedies, giv- ing a dose of the medicine selected morning and evening, al- lowing an action of one, two, or three days, according to cir- cumstances, and then exhibiting the other in the same manner. Arnica, indicated by pressing pain in the left hypochondri- um, causing dyspnoea, and when the vomiting of blood is very severe. Rhus is useful when severe corporal exertion has produced the disease. Administration. °g°, in a teaspoonful of water, repeated in six hours, if necessary ; but when the vomiting of blood is present, exhibit as under Hematemesis. Nux vomica is chiefly indicated by the symptoms of de- ranged digestion, constipation, &c, which remain after the more threatening symptoms are removed. Administration. °|° in a little water, at night, repeated every twenty-four hours while necessary. Bryonia is found useful in milder cases, where an aching, shooting pain is in the splenetic region, which is much aggra- vated by the slightest movement, or when the patient com- INFLAMMATION OF THE STOMACH. 165 plains of a constant stitch in the side, or the left hypochon- driac region, and general gastric derangement with constipa- tion exists. Administration, y in a little water, repeated as the above until benefit results. The preceding are the remedies which have been found most useful in the treatment of the disease in the acute form. Chronic enlargement and indurations of the spleen require a long and judicious course of treatment for removal, or even amelioration. I shall, therefore, briefly direct the attention of the reader to those remedies which have proved most suc- cessful in these instances—namely, Sulphur, Calcarea carboni- ca, and Baryta carbonica (particularly when the mesenteric glands have become affected), and further, Lycopodium, Carbo vegetabilis, Plumbum, Ferrum, Mezereum, Platina, Stannum. INFLAMMATION OF THE STOMACH. Gastritis. As there is some difference among medical authors as to the application of this term, it may be as well to state clearly the disease intended to be treated of in this place. By gastritis is here meant inflammation of the mucous mem- brane of the stomach, which frequently involves the submu- cous tissue, and sometimes the muscular coat. Diagnosis. Burning, pricking, or shooting pain in the gas- tric region, increased by pressure, inspiration, or the passage of food. Swelling, considerable heat, and tension over the whole stomachic region, sometimes with pulsation; nausea, inclination to vomit, retailing, vomiting, great thirst, increased or brought on by the smallest quantity of food or drink; sometimes with hydrophobic symptoms (hydrophobia sympto- matica) ; soreness of the throat, with inflammation of the fau- ces ; hiccough, sobbing, great restlessness, anxiety, and pros- tration of strength; coldness of the extremities; tongue gene- rally red at the tip and round the edges, foul, rough at the centre and towards the root; frequently also syncope, violent spasms, convulsions, even tetanus; small, sometimes scarcely perceptible, and remittent pulse; sunken features, with ex- 166 DIGESTIVE SYSTEM. pressions of anxiety, constipation, but frequently diarrhoea or alternations of these two states. Death may ensue from gangrene, in which case the pains suddenly cease, the coldness of the extremities increases, and the pulse becomes scarcely perceptible and remittent; or from paralysis of the nervous system during the attacks of the spasms or syncope. When this disease has been impro- perly treated, if the patient has the good fortune to escape with life, it may pass into chronic inflammation, scirrhus, or ulceration of the stomach. Causes. One of the most frequent is partaking of cold drinks or ice-water, when heated or during hot weather, and also acid or poisonous substances taken into the stomach; le- sion from any rough-pointed body swallowed, external contu- sion, ardent spirits, suddenly checked secretions or evacua- tions, abuse of emetics, metastases. Therapeutics. The remedies which have been found the most useful in the homceopathic treatment of Gastritis, are: Aconitum napellns, Belladonna, Ipecacuanha, Nux vomica, Antimonium crudum, Pulsatilla, Bryonia, Ranunculus bulbo- sus, Euphorbium, Cantharides, Hyoscyamus, Arsenicum. Aconite °§° is requisite in those cases in which synochal fever is developed,—and must be repeated until relief is ob- tained or an alteration in the symptoms calls for the selection of another remedy.* Ipecacuanha °f° is useful when the vomiting is excessive, the epigastric region considerably distended, and the patient affected with great anxiety, restlessness and difficulty of breath- ing. Antimonium crudum °^ may fdflow the former remedy, or be given in preference thereto, if the tongue be much load- ed. Bryonia may be administered after any of the foregoing remedies, should they have afforded only partial relief, and particularly if the disorder has been excited by a chill from cold drinks when overheated. Nux vomica °^° is one of the most important remedies in Gastritis mucosa of drunkards, and in the same affection when occurring as a metastasis from suppressed haemorrhoids; * Vide note, p. 21, INFLAMMATION OF THE STOMACH. 167 finally, Nux vomica has been found efficacious after the pre- vious administration of Aconitum, Bryonia, Ipecacuanha, and Arsenicum, Qg-0, when the disorder has been caused by a chill from drinking iced water when overheated. Lachesis and Ar- senicum may, in some instances, be advantageously adminis- tered in alternation with Nux. v., in the idiopathic gastritis mucosa of drunkards.* Pulsatilla °|° has been recommended in the subacute form of gastritis, arising from the sudden suppression of some secretion, such as the menstrual flux, &c; and also in cases proceeding from a chill in the stomach from ice, particularly after the previous employment of Ipecacuanha or Arsenicum. Ranunculus bulbosus, Euphorbium, and Cantharides have been recommended in the more violent forms of the disease, and especially when the burning pain, so commonly attendant on this disease, is well marked: When, however, in addition to the said symptom, there is excessive prostration of strength; thirst with violent vomiting immediately after drinking; small, quick, and occasionally intermittent pulse; anxiety, restlessness, and apparent sinking of the vital energies,—Arsenicum must at once be had recourse to, whether the disease may have arisen from a chill in the stomach or any other cause, (excepting, of course, poisoning by that remedy, in which case the treatment to be followed will be found under the head of Poisons.) The alternate administration of Aconitum with Arsenicum has been found useful in some cases ; in others, Veratrum and Arseni- cum : The former, at an earlier state of the disorder, with ac- companying inflammatory fever, and the latter where the ex- tremities have become cold, the pulse small, features sunk and expressive of great anxiety; hiccough, thirst, vomiting on par- taking of the smallest morsel of food, solid or liquid; extreme debility, and other symptoms mentioned in the diagnosis. In certain cases the attention of the practitioner may be directed to the following: Belladonna 00^°.—Inflammation of the fauces with redness of the tongue at the tip and margins; hy- drophobia symptomatica. Hyoscyamus 9^.—Stupor, or confu- * Opium also may be included with advantage here. 168 DIGESTIVE SYSTEM. sion of ideas with incoherent speech; convulsions, sympto- matic hydrophobia. Lachesis, Stramonium and Cantharides may likewise prove useful in cases in which the latter symptom is present (see Hydrophobia. ) Finally, Colocynth, Mercu- rius vivus, Sulphur, and Chamomilla may be mentioned as like- ly to prove serviceable auxiliary remedies in some instances. Arnica should be borne in mind, if the attack can be traced to lesion of the stomach from any rough or pointed substances having been swallowed, or also if from external contusion. When the disease has passed into the chronic form, Natrum m., Lach. and Nux v., may be administered in alternation with great advantage : followed, if required, by Lycop., Colch., Sulph., Phosph., also the alternate employment of Sulphur and Carb. v., &c, Sep., Plat., Plumb., Kali c, Magn. c, Rhus. Vide Cardialgia (which chronic gastritis nearly re- sembles) and Dyspepsia. INFLAMMATION OF THE BOWELS. Enteritis. Diagnosis. This disease is comparatively of rare occur- rence in the idiopathic form, and appears much more fre- quently as a symptomatic affection, particularly in the course of some fevers—such as low Nervous Fevers, Scarlet Fever, Measles, &c; also in all diseases attended with hectic fever. It much more frequently occurs in the subacute or chronic than in the acute form. In the acute form of the disease, in- volving the submucous tissue and peritoneal coat, as well as the mucous membrane, the symptoms are usually as follows : Intense burning or pungent pain, generally in one spot of the abdomen, especially in the region of the navel, increased by the slightest pressure and by movement with tightness, heat, and distention of the abdomen ; sobbing, anxiety, and violent thirst with aggravation of suffering from cold drinks ; obsti- nate constipation ; violent vomiting, first of slime and bile, and sometimes even of excrements (Ileus miserere); small and contracted pulse, inflammatory fever, flatulence, and fre- quently obstruction of urine. In the subacute form of the disease, or in simple enteritis INFLAMMATION OF THE BOWELS. 169 mucosa, the pain is often very slightly felt, in comparison with that which accompanies inflammation of the peritoneal coat, and generally consists of a diffused soreness over the abdomen, which is commonly, though not always, increased on pressure ; but cold drinks or indigestible food almost invariably causes an aggravation of pain. The tongue is often red and smooth, though not invariably so; generally speaking, however, there is more or less redness at the tip and margins, however foul the centre may be. Loss of appetite, indigestion with nausea and vomiting, more or less prominent, according to the por- tion of the intestinal tube affected ; being greater the nearer the seat of the inflammation is to the stomach. When the infe- rior parts are implicated (as is indicated by pain or soreness in the iliac regions and in the course of the colon), there is usu- ally diarrhoea,, the stools being frequently slimy and mixed with blood, in severe cases consisting of pure blood, particu- larly when the rectum is involved, in which case there is, moreover, considerable straining. The pulse is quick, the thirst sometimes excessive, with a greater or less degree of fever and extreme languor. Unless resolution take place, it may terminate in indura- tion of the intestines—laying the foundation of chronic consti- pation, suppuration, or gangrene. The signs of approaching gangrene, or of its having set in, are the same as in gastritis, with the difference of situation. Among its exciting causes are cold in the feet and abdomen, suppressed discharges, cathartics, worms, metastases, partu- rition, indigestible or highly stimulating food, prolonged use of acids, sour wine or beer,-&c. The state of the atmosphere appears to have some share in producing it, from the circum- stance that the disorder sometimes prevails almost as an epidemic. Therapeutics. Arsenicum, and where required, Veratrum, are the principal remedies in the first described variety of this disease as well as in the severest forms of gastritis, to which latter indeed, it bears a strong resemblance; but the treatment must necessarily be commenced with Aconite when the accom- 8 170 DIGESTIVE SYSTEM. panying fever is intense, and the skin hot and parched. For the selection and administration of these two remedies, see Gastritis. Opium and Plumbum are the principal remedies against Ileus miserere, asnoticedin the Diagnosis. (SeeHcrnid.) In the subacute form of the complaint, a few doses of Aco- nite are often serviceable ;—but as soon as the marked in- flammatory symptoms have been subdued, one or more of the following remedies must be selected to complete the cure : Belladonna, Mercurius, Acid, nitricum, Bryonia, Colocynth, Chamomilla, Nux v., Pulsatilla, China, Opium, Cantharides, Colchicum, Rhus, Phosphorus, Sulph., Silex. Belladonna.* Tongue red and smooth, or coated white, or yellowish brown in the centre with intense redness of the tip and margins, and inflammatory redness of the papillae; skin hot and dry, intense thirst, with occasional delirium, espe- cially at night; sensation on soreness or of exoriation in the en- tire abdomen, with tenderness on pressure, and sometimes con- siderable distention, particularly in the region of the arch or transverse section of the colon. Nux vomica. Redness of the margins of the tongue, with yellow or whitish coating in the centre ; sensation of soreness, with burning heat in the abdomen ; loss of appetite ; indiges- tion, with vomiting after partaking of food, and aggravation of the abdominal pain after drinking ; flatulence, constipation, or constipation and looseness alternately ; scanty watery Stools, orstools consisting of a small quantity of mucus, some- times tinged with blood, and attended with straining. This remedy is especially useful when the above symptoms have been caused by the sudden suppression of an hemorrhoidal flux or from indigestible food, &c. Sulphur is frequently of great value in completing the cure after Nux v. Mercurius is a most important remedy in this disease, even in the most serious cases, and especially after Aconite and Belladonna, or Arsenicum, should that remedy have been call- ed for. The following are its principal indications : tongue *The alternation of this remedy with Mercurius, the indication per- mitting, cannot be too strongly urged in this dangerous disease, especi- ally when the symptoms are fearfullyprominent,—Ed. inflammation of the bowels. 171 very foul, coated white or dark brown ; it is sometimes dry, but more frequently covered with thick mucus ; excessive thirst; abdomen hard, tense, distended, and very tender to the touch ; copious watery, bilious, and highly offensive stools ; but more frequently there is constant urging to stool, followed, after severe straining, by the evacuation of a small quantity of mucus tinged with blood ; at other times, of pure blood in considerable quantity ; extreme prostration of strength, chilli- ness and shivering, with tendency to sweating at night, which, however, brings little or no relief Acidum nitricum. The indications for this remedy are much the same as those described under the foregoing ; it is therefore of great service in completing the cure when Mercu- rius has only produced partial relief. It is an invaluable medicine in chronic cases, attended with abdominal tenderness and tenesmus, and especially when the disorder occurs in in- dividuals who have been previously subjected to an abuse of Mercury under allopathic treatment. Bryonia. After the previous employment of Aconite, Bry- onia is occasionally a useful remedy here, when the patient complains of severe headache, with constipation, and pain in the abdomen after meals ; it is also indicated, however, when, after Aconite, there remains dark redness of the tongue, or whitish or yellow coated tongue, with parched mouth and considerable thirst; loose offensive evacuations, particularly after partaking of food or drink ; nausea and vomiting after eating. Pulsatilla. When the acute inflammatory symptoms of enteritis, arising from the sudden suppression of some habitual discharge, such as the catamenia, or the hemorrhoidal flux, or occurring as a sequela of measles, have been subdued by Aconite, and the following symptoms remain: tongue loaded with a thick white, grayish, or yellow coating ; adypsia, or, on the contrary, excessive thirst, deranged digestion, loss of appetite, with nausea and vomiting after partaking of a little nutriment; sensibility of the abdomen on pressure, or on every movement; flatulence. 172 DIGESTIVE SYSTEM. Colocynth. In cases where the large intestines are the seat of the inflammation, attended with tympanitic distention of the abdomen, soreness and sensibility to the touch ; tormina and diarrhoea, with increase of pain followed by urgent desire to go to stool after eating or drinking ; nausea, or vomiting of bilious matter : frequent discharge of flatus. Chamomilla. Is peculiarly well adapted to the treatment of the disorder as it is likely to occur in children, or in highly nervous and excitable females, who are extremely sensitive to pain, and complain loudly from trivial suffering ; it is indi- cated, moreover, by a sensation of soreness in the abdomen, as if arising from internal excoriation or ulceration, accom- panied with painful tenderness on slight pressure, and slimy, whitish, watery, or greenish or yellowish diarrhoea of an offen- sive odour. Cinchona. Is frequently useful after Aconite or any of the foregoing remedies, when there is a tympanitic distention of the abdomen ; diarrhoea, aggravated after a meal, with un- digested food in the evacuations ; thirst, extreme weakness of digestion, and great debility. Cantharis. In very serious cases, with discharge of pure blood at stool, and strangury ; or in an advanced stage of the disorder, with evacuations of mucus and solid substances, like shreds of membrane, this remedy will frequently be found of considerable service. Colchicum. Will also be found useful occasionally in ad- vanced stages of the disorder, with tympanitic distention of the abdomen, diarrhoea, the stools consisting of white or transpa- rent gelatinous mucus, or of blood mixed with substances resembling false membrane. "Rhus. When eruptions break out about the mouth, and there is redness of the tongue, with pain as if from soreness or ulceration in the abdomen, and tenderness on pressure ; wa- tery, slimy, frothy, or sanguineous stools ; low fever, with noc- turnal delirium. Rhus is chiefly used in symptomatic enteri- tis, such as frequently occurs in low Nervous Fever, which see. The chronic stage of the complaint, which is chiefly char- acterized by fixed pain, fulness, or uneasiness and oppression INFLAMMATION OF THE BOWELS. 173 in the lower part of the abdomen, increased, after meals or after cold drinks; appetite impaired or capricious ; thirst, particularly after dinner or at night ; bowels constantly re- laxed, or there is constipation alternately with diarrhoea ; fe- tid and discoloured evacuations ; skin hot, harsh, and of an un- healthy hue ; pulse rather quick ; tongue loaded, but red at the tip and margins,—or redness of the entire tongue, with large and elevated papillae, especially at the root; emaciation, weak- ness, and languor. Here the foregoing remedies described for the acute and subacute variety, but more particularly Bella- donna, Nux v., Bryonia, and Rhus, together with Acidum nitricum, Phosphorus, Sulphur, Silicea, and Arsenicum, will in most instances be found among the most serviceable. Acidum nitricum. Is particularly indicated when there is thirst, attended with pains in the bowels or other uneasiness after drinking; impaired appetite, tenderness of the abdomen, fetid diarrhoea and tenesmus ; greenish stools, with ingesta ; skin dry and harsh during the day, sometimes with nocturnal sweats. Phosphorus. Soreness in the abdomen, with tenderness on pressure, and distressing distention after meals ; obstinate diarrhoea, or constipation and diarrhoea alternately ; stools containing ingesta; pulse rather quick and hard ; weakness and emaciation. Sulphur. This remedy is one of the most useful in ente- ritis, arising from the suppression of some accustomed dis- charge, such as the hemorrhoidal, &c. ; as also in cases ari- sing from the driving inward of a tetter, or sudden healing up of an ulcer; tongue red, or loaded ; thirst; pain, as from exco- riation, in the abdomen, with tenderness on pressure ; or ful- ness and uneasiness in the abdomen, increased by cold drinks or after meals ; diminished or fastidious appetite, with aver- sion to meat; fetid diarrhoea, frequently containing ingesta ; constipation, or constipation alternately with diarrhoea; flat- ulence ; skin yellow or otherwise unhealthy looking, or dry and pealing, but often covered with perspiration at night, or towards morning ; pulse quick and hard; emaciation, with considerable debility. 174 DIGESTIVE SYSTEM. Silicea. When the disorder has been excited by the sud- den suppression of the perspiration of the feet, or the rapid healing up of a chronic ulcer, Silicea is one of the most im- portant remedies. The following symptoms are some of the more immediate indications for its selection : dryness of the mouth, loaded tongue, great thirst, with diminished appetite, and sometimes disgust at meat, or cooked and hot food, with desire for cold food and drinks; abdomen hard, hot and tense and painful to the touch; constipation, or extremely fetid watery stools ; borborygmus, especially on movement; skin dry and parched during the day, and covered with sweat to- wards morning ; pulse quick and hard. Arsenicum. Has already been noticed as the principal remedy in acute cases of a violent character; it is, moreover, a remedy of considerable service in some of the chronic vari- eties of enteritis, with a sensation as from excoriation, or of burning heat in the abdomen, attended with nausea, want of appetite, and great thirst; increase of pain after cold drink ; borborygmus ; diarrhoea, sometimes with ingesta; fetid, dis- coloured stools ; skin parched, hard, and of a yellowish, un- healthy-looking hue ; emaciation, with extreme debility. Lachesis, Lycopodium, Natrum muriaticum, Secale cornutum, Hepar sulphuris, Sepia, Calcarea, Graphites, Carbo vegetabilis, Causticum, Antimonium crudum, and Ipecacuanha, may also be of considerable service in some cases—the two last named have occasionally been used with advantage after Aconite against the vomiting in acute cases. When we have reason to suspect worms as the cause of this affection, the patient must be treated accordingly. See Invermination, p. 181. Administration of the Remedies. In the acute form of the disease, a few globules of the third potency of the reme- dy indicated may be added to an ounce of water, and a dessert- spoonful of the liquid given every three hours, lengthening the intervals as soon as improvement sets in. In the sub- acute and chronic form, the sixth, and in some cases the thir- tieth, potency may be substituted for the third, and the doses INFLAMMATION OF THE PERITONEUM. 175 administered at intervals of from six to twelve hours and up- wards.* Diet. In acute cases of inflammation, either of the stomach or bowels, the regimen must be placed under the same restric- tions as described at page 17 (Fever) ; and in subacute and chronic cases the food should be very light, and given in small quantities; raw fruit, green vegetables, and sometimes potatoes, must be strictly prohibited ; the drink should consist solely of toast-water or barley-water, or the like. INFLAMMATION OF THE PERITONIUM. Peritonitis. i Diagnosis. Painful tension and tumefaction of the abdo- men, with a sensibility to the touch even more acute than that in Enteritis; so much so that the patient cannot bear the pressure even of a sheet upon the abdomen; frequently con- stipation or ischuria, and the symptoms of enteritis. Causes. General causes of inflammation, and moreover external injur js, parturition, chill of the abdomen, and me- tastases. Therapeutics. In the first place, it will generally be found beneficial to administer three or four doses of Aconitum at the third potency, exhibited at intervals of time varying according to the exigency of the case, until the fever and in- flammation lower. This remedy has been found in many cases sufficient of itself to remove the affection, and in all it ma- terially modifies its violence. When the cause is external lesion, we should administer Arnica °g°, and repeat it in twelve hours, and at the same time apply bandages wetted with a diluted tincture, as given under External Injuries in cases of contusion. Sometimes vomiting and other symptoms closely resemblin g those of enteritis are present, and frequently constipation and * Vide note, p. 21. 176 DIGESTIVE system. ischuria ; and other times merely the marked sensibility of the abdomen and tumefaction with gastric derangement; but, physiologically considered, these symptoms arising from the intensity and extent of the inflammation, and the sympathy of the other organs, our chief care must be to lower the in- flammation, which being in a great measure brought under control by the medicine above noted, we will find considerable benefit from the employment of Nux vomica and Mercurius to combat any remaining symptoms. Nux vomica. When there is distention of the abdomen with tendency to the predominance of gastric symptoms and ischuria. Administration. -6-, repeated every six to twelve hours, according to the severity of the symptoms. ■ Mercurius is more particularly suited to the advanced stages of the disease, with weak, quick pulse, nocturnal ' sweats, and great weakness. When the inflammation extends to the pleura, and the breathing becomes affected with acute shooting pain, we should have recourse to Bryonia -£ °, as described for Aconite. (See also Pleuritis.) When the peritoneal coat, or upper portions of the alimen- tary tube or of the stomach itself, becomes affected, evidenced by an increase in the intensity of the disease, the pain extend- ing higher—vomiting, generally a rare symptom, becoming severe and continual—collapse of the features, small pulse, and a rapid sinking of the vital energies, closely resembling gastritis —we should have recourse to Arsenicum. Administration. -^, in a little water every four to six hours, until relief is obtained. In cases where there are evidences of the brain being affected, Belladonna may be had recourse to. (See Phrenitis.) In other instances, Cantharides, Chamomilla, Bryonia, Rhus, Ly- copodium, Colocynth, etc., may be found necessary. As this is a disease whose care devolves more particularly upon the experienced and professional man, I have contented myself with stating the remedies most likely to be called for in ordinary cases : in many instances the symptoms are so close- inflammation of the kidneys. 177 ly analogous to those which are met with in Gastritis, that most of the remedies which have been described applicable to the treatment of that disease will generally be found equally useful here.* INFLAMMATION OF THE KIDNEYS. Nephritis. Diagnosis. Pressing, pungent pain in the renal region, shooting along the urethra to the bladder, dysuria, strangury, and ischuria (when both kidneys are affected), hot and high- coloured or red-urine; drawing up, swelling, and pain of the testis on the affected side; numbness and spasms of the foot on the same side; nausea, vomiting, colic, and tenesmus; ly- ing on the part affected and motion aggravate the pains. Causes. Excessive use of stimulants ; shocks of the body, falls, or strains, external injuries; long lying on the back, abuse of diuretics or cantharides, suppressed hemorrhoids or menstruation, metastases or calculi. Therapeutics. The principal remedies in this affection are, Aconitum, Cantharides, Nux vomica, Pulsatilla, Belladonna, Hepar sulphuris, Cannabis, Mercurius, Arnica moniana. Aconite. In the inflammatory stage of this affection, this remedy should be administered in repeated doses, in the same manner as in Inflammatory Fever; after which, in the majo- rity of cases,— Cantharides will be found most efficacious in the further treatment, and more particularly when the urine passes off in drops or is tinged with blood, or when micturition is exceed- ingly painful, with burning pain in the urethra, and when the general symptoms of shooting, cutting, and tearing pains in the loins and region of the kidneys are present, or even in ca- ses of complete strangury. * In Peritonitis Puerpuralis, Aconitum, Ipecacuanha, Bryonia, Ar- senicum, Veratrum, Chamomilla, and Pulsatilla, are the remedies which have chiefly been used; but some'of the others which have'been men- tioned in the treatment of Gastritis may be found serviceable in parti- cular cases. 8* 178 DIGESTIVE SYSTEM. Administration. Six or eight globules of third or sixth potency to an ounce of water, a dessert-spoonful every one, two, or three hours till benefit result.* The proved value of this medicine when used homoeopathi- cally, in the cure of this painful disorder, is another of the many beautiful exemplifications of the truth of the homoeopa- thic law; and its power of causing diseases of the urinary or- gans, even when applied in the form of a blister, is so well known, that in all medical works it has been noted as an ex- citing cause of this affection. Nux vomica. When the affection can be traced to a sup- pression of a hemorrhoidal discharge, determination of blood to the abdomen, excess in wine or stimulants, and seden- tary habits, and where we find constipation, feeling of faint- ness, nausea, vomiting, distention of the abdomen, drawing up of the testis and of the spermatic cord. Pulsatilla. In females of phlegmatic temperament, when arising from irregular or suppressed menstruation. Administration, y, of the last-mentioned remedies, re- peated every twelve hours, while necessary.| Belladonna. When shooting pains in the kidneys are pre- sent, extending to the bladder,—this medicine is further indi- cated when nephritis is accompanied with colic and cardi- algia, heat and distention in the region of the kidneys, scanty micturition of an orange yellow, or sometimes of a bright red, depositing red or whitish thick sediment; anxiety, restless- ness, and periodical aggravation—constipation. Administration. Same as Cantharides. Hepar sulphuris is useful when we have reason to appre- hend the formation of an abscess or the commencement of suppuration; here the diagnosis is difficult, and the profes- sional student must be careful not to mistake the apparent al- leviation of suffering for the subjugation of the disease. The following symptoms may serve as a guide in these cases : ces- sation of the acute pain ; a sensation of throbbing and a sense of weight in the region of the kidneys ; alternate chills and slight flushes of heat and copidus perspiration. Vide note, p. 21. f Ibid. INFLAMMATION of the kidneys. 179 Administration. A grain of the third trituration to an ounce of water, a dessert-spoonful every three or four hours, lengthening the intervals according to the results. Mercurius is also valuable in this stage, but more parti- cularly when diarrhoea and tenesmus are present. Administration. Same as Hepar sulphuris, at intervals of from six to twelve hours. Cannabis. When a dragging pain or sensation as if from excoriation is experienced, extending from the region of the kidneys down towards the groin, with painful urination. Administration. Same as Cantharides, but at somewhat longer intervals. Colchicum. When in addition to the usual symptoms of this disease there is excessive nausea with tympanitic disten- tion of the abdomen, and painful and scanty emission of bright red urine. Administration. Same as Cantharides. When the disease has assumed a chronic form, and indu- ration of the kidneys has taken place, Mercurius °£°, in a teaspoonful of water, will often be found useful, a dose once a week for three or four weeks, followed by Aurum °$°, a dose once a week, unless some marked indication call for the employment of another medicine. In Nephritis arising from contusions or violent concussions of the body, Arnica is the principal remedy. Administration. fi6a, repeated in twelve hours, and a lo- tion applied externally. (See External Injuries.) In cases arising from the abuse of Cantharides in blister- ing, an occasional drop or so of the saturated solution of Cam- phor in a little water, and the inside of the thighs to be rubbed with the same preparation, twice a day, until relief is attained. Observation. This disease sometimes arises from the presence of calculi in the kidneys; in which case the symp- toms of fever do not occur until a considerable time after se- vere pain has been experienced ; further, a numbness of the thigh, and a retraction of the testicle of the affected side, are considered as distinguishing marks of the existence of a cal- culus in the kidney or ureter:—Here the use of Nociatiana 180 DIGESTIVE SYSTEM. rustica has repeatedly been found an useful palliative, admin- istered at a low potency -^- every half hour. In conclusion, the following remedies, whose utility in various forms of ne- phritis or nephralgia, clinical observation has confirmed, may be pointed out as meriting the attention of the professional student: Calc. c, Lycop., Capsicum, Phos., Sepia, Uva ursi, Sarsap., Kali c. and Graphit. In the event of suppuration : Hep. s, Ars., Sulph., Silic, Kali n. Sarsap. Patients suffering from Nephritis should strictly avoid wine, malt liquor, and spirits. INFLAMMATION OF THE BLADDER. Cystitis. Burning pain in the region of the vesica, with tension, heat, pain when touched, and external tumefaction; frequent and painful discharge of urine, or suppression, and generally tenes- mus ; fever, and sometimes vomiting, as in Nephritis. The causes closely resemble those of Nephritis, but it also occurs more frequently in parturition than the former affection. Therapeutics. We should have recourse to Aconitum, as in Nephritis when a considerable degree of inflammatory fever is present, followed by— Cantharides, which here, as in the above-mentioned dis- ease, is the leading remedy. Nux vomica. When attributable to an indulgence in wine or spirituous liquors, this remedy, timeously administered, will in many instances check its further progress ; also, when it results from suppressed hemorrhoids or dyspeptic derange- ments : Nux v. may be followed, if required, by Sulphur and Calcarea. The two last named are well adapted to the treat- ment of the chronic form of the complaint. Pulsatilla. Valuable in checking the development of the affection when arising from suppressed menstruation.* * Pulsatilla is, moreover, serviceable in all cases, from whatever cause arising, when occurring in individuals of phlegmatic temperament, with the following symptoms: frequent desire to urinate, painful and scanty emission of slimy or sanguinolent urine, which deposits a purulenUook- ng sediment; burning and cutting pains in the hypogastrium, with exter- nal heat and tumefaction ; suppression of urine. WORMS. 181 Hyoscyamus. When difficult urination is present, but the disease is not far advanced, particularly when we have reason to suspect that this symptom arises from spasmodic con- striction of the neck of the bladder, or when in fact it is more of a spasmodic than inflammatory character. Digitalis is also valuable when, in addition to the ischuria, a constrictive pain is felt in the bladder. Arsenicum and Carbo v. have been found very serviceable in allaying the burning in the urethra during urination. When Sulphur, Calcarea, or any of the foregoing remedies have not succeeded in arresting it. Administration of the first named remedies, the same as in Nephritis ; Hyoscyamus, Digitalis, Sulphur, Calcarea, Arse- nicum and Carbo v. in the same manner as Nux v. and Pulsa- tilla. When this disease has arisen from the application of Cantharides as a blister in allopathic practice, Camphor must be administered as ascribed under Nephritis. When the disease arises from the presence of STONE or GRAVEL, the same remedies as those mentioned at the ter- mination of the preceding chapter are the most useful. INVERMINATION. WORMS. Helminthiasis' The existence of worms in the intestinal canal, in the majority of cases, evidently arises from a peculiar constitutional taint in- ducing a certain diseased state of the mucous or lining membrane, and thereby giving rise to the formation of these parasites ; and although no period of life is wholly exempt from their presence, yet infants and children appear to be much more subject to this affection than adults, on account of the predominance of nutri- tion at that age. Weakness of the digestive function, accumula- tion of mucus in the intestines, an ill-regulated diet, and a degree of moisture in the atmosphere, also favour their generation. The three species most generally met with in the human sub- ject are, the ascaris, lumbricus, and tenia or tape-worm ; of the la tter there are two varieties,—the solitary tape-worm, composed of long and slender articulations, which has been known to ex- ceed the length of thirty feet; and the common tape-worm; which varies from three to ten feet, seldom comes away entire, but in joints, which are considerably broader and thicker than those of the variety first mentioned. 1*2 DIGESTIVE SYSTEM. The presence of worms, unless when passed, is not always easy of detection, since subacute inflammation of the mucous membrane from other causes will frequently present nearly the same range of symptoms ; but here, (as in the treatment of many of the most serious acute diseases), Homoeopathy presents two manifest advantages over the old system. In the first place, if acting upon the certainty of the existence of worms, we administer a remedy specific to the affection ; in the next, when we are uncertain as to the true character of the complaint, and select a medicament distinctly indicated by the united symptoms, it will be found applicable to the affection, from whatever cause it arises; and a careful observance of the known pathogenetic powers of the remedies selected, will materially assist us in tracing the disease to its proper source. Diagnosis. Worms, and especially ascarides, frequently exist in the intestines without occasioning any disturbance, and their presence is only known by their being observed in the evacuated faeces; but when the alimentary tube becomes irritated by them, a number of symptoms are developed, of which the following are the principal: Pallor and sickly ap- pearance of the countenance, and sometimes flushing; livid circles round the eyes, dilated pupils, headache or vertigo, ir- regularity of appetite, fcetidity of breath, acrid eructations, oc- casional nausea and vomiting, foul tongue, tensive fulness of abdomen, with a sensation of gnawing and burning at particu- lar parts of the intestines ; hard and tumid belly, great thirst; discharge of mucus from the rectum, bladder, (and vagina;) heat and itching at the anus ; slight febrile symptoms, and nocturnal wakefulness, with low spirits or irritability of tem- per, and gradual emaciation : we also generally notice an in- flammatory redness of the nostrils, with great disposition to picking or boring at the nose, especially in children, with sud- den screaming, when waking, and grinding of teeth. In addition to the above general symptoms of this affection, we frequent- ly meet with severe colic-like pains, with slimy and bloody evacuations; involuntary discharge of saliva, especially when asleep; convulsions in children, and epileptic attacks, combined with cerebral affections in adults; inflammation of the boAvels. WORMS. 183 In tenia, in addition to the above, we find a sensation as of something rising into the left side of the throat, and then falling back ; or a feeling of a lump on either side, with an undulatory motion; feeling of sugillation in the abdomen, creeping torpor and numbness in the fingers and toes. Therapeutics. Acon., Ignat., Sulph., Calc. c, China, Ferr. m., Marum ver., Cina, Nux v., Merc, Valeriana, Spigel., Bellad., Sabad., Silic, Cicuta v., and Filix mas. Of these, Acon., Ferr., Ignat., Merc, Nux v., Valer., Marum v., Cina, and Sulph tinct., are the most appropriate against Ascarides. Cina, Nux v., China, Bellad., Merc, Spig, etc., against Lum- brici. And Graph., Calc, Sabad., Frag, vesca, or Sulph., Merc, Calc, also Carb. an., Carb. veg., Kali c, Magn. m., Natr., Phosph., Petrol., Plat., Tereb., Fil. mas., Punica gran., Stannum,, against tape-worm.. Aconitum. When considerable febrile irritation exists with restlessness at night, fever, and irritability of temper, con- tinual itching and burning at the anus, and at times a sense of crawling in the throat. Administration.* y, to an infant T%, in a little water, repeated in six hours if necessary ; when it has lowered the fever, we must have recourse to some other remedy. Ignatia amara, in most cases, which is also particularly indicated by spasmodic twitchings in one of the extremities, or in individual muscles. Administration. -§- in four dessert-spoonfuls of water, one twice a day; for an infant, ^ in four teaspoonfuls, one night and morning. Sulphur, in case the annoyance still continues after the lapse of two or three days. Administration. 0^A6°-£° in an ounce of water, a tea- spoonful morning and evening until finished ; for infants, f f in the same manner. Calcarea Carbonica and Silicea may be administered in like manner, should no marked amelioration ensue; allowing an interval of about a week or ten days to elapse between the different remedies. * Vide note, p. 21. 184 DIGESTIVE SYSTEM. Ferrum metallicum, when there is frequent vomiting and accumulation of watery fluid in the mouth. Administration. A grain of the third trituration to an ounce of water, a teaspoonful once a day ; for infants, -6- in the same manner. This course of treatment, persevered in for a short time, has often proved successful in most obstinate cases, by purifying the constitution and restoring the mucous membrane to a healthy state. When excessive irritation is present, and does not appear to diminish readily under the action of the pre- ceding remedy, we may give a drop of the tincture of Urtica urens, in a little water, or on a piece of loaf sugar, every night or morning for several successive days; and should this not relieve the annoyance, we may administer an enema of a des- sert-spoonful of salt to a pint of water, of which from two to six fluid ounces, according to age, may be injected ; if this act as a laxative, a mixture of vinegar and water, in the propor- tion of one-fourth part of the former, may be used.* After this palliative course of treatment, the course above mentioned may again be resumed, should it appear necessary. Cina. This is an eminently useful medicine in the case of worms, and is generally indicated where the following symp- toms are met with: Frequent boring at the nose, great per- verseness of temper, heat and irritation, constant inquietude and restlessness, with, in children, a desire for things, which are rejected when offered; fits of crying when touched, pale- ness of face, with livid circle round the eyes ; constant craving for food even after a meal; griping, distention and hardness in the abdomen, with discharge of thread and round worms, and loose evacuations ; occasionally, convulsive movements in the limbs, weakness and lassitude. This medicine is par- ticularly indicated for Colic produced by worms. Administration. Same as Ignatia. Nux vomica is a valuable adjunct in cases of worms in which considerable derangement of the digestive function is present, with irritability of temper and constipation. * Hering's Hausarzt, WORMS. 185 Administration. -6a in a teaspoonful of water at bedtime, repeated in three or four days if called for. Mercurius. When we find diarrhoea, distention of the abdomen, and hardness in the umbilical region, with increased secretion of saliva. Administration. As Ignatia. China is appropriate when the symptoms are generally ex- acerbated at night, particularly the abdominal sufferings; or, when pressive aching pains are experienced below the umbili- cal region after every meal, and are attended with distention of the abdomen, pyrosis, pains in the epigastrium, and retch- ing ; also, when in addition to the foregoing, there is an over- excitability of the nervous system, with spasmodic twitchings of the muscles in various parts, tremulousness and debility. (Valeriana and Veratrum are also deserving of attention here.) Spigelia in extreme cases, with colic, voracity, diarrhoea, and chilliness ; or nausea in the morning. Administration. As Ignatia. Belladonna. Great nervous excitement; nocturnal de- lirium, with startings during sleep ; tendency to be startled or frightened at the most trivial cause ; also colic, headache, thirst, quick pulse, hot, dry skin ; should these symptoms not yield to Belladonna, recourse must be had to Lachesis, or to Silicea, should the febrile symptoms continue, and the patient affected be of a scrofulous diathesis. Administration. Two globules of the sixth potency in a teaspoonful of water, until the febrile action is subdued. Cicuta virosa. Worm colic with convulsions. Administration. -6-) m a ^^ water, repeated in a few hours, if necessary. In severe cases, a drop of the third, in four dessert-spoonfuls of water, once every half hour. The treatment of taenia, although similar to the above, has some modifications. In most cases we may give Aconitum, followed by Cina, after which considerable relief is often experienced; and then have recourse to Filix mas ; when anything sweet disagrees with the patient, a drop of the third potency to an ounce of water; a teaspoonful twice a day, until finished ;—also, Punica granat. has been employed with much success. 186 DIGESTIVE SYSTEM. In chronic cases, the following treatment has proved suc- cessful : Nux vomica, Mercurius, and Sulphur, each °g°, a single dose, alternated at intervals of from six to eight days. When any improvement takes place after the administration of any one of these remedies in particular, it will be well to repeat that medicine at the stated intervals, as long as it appears to do good, instead of going on to the next remedy in rotation.* Moreover, in this course of treatment, Calcarea carbonica y, may advantageously follow Sulphur, in scrofu- lous habits, at an interval of ten days. Natrum muriaticum, Lycopodium, Graphites, Baryta, or Phosphorus, have been found necessary to complete the cure in particular cases. Regimen. The food ought to be wholesome and nutri- tious ; meat, such as roast or boiled beef or mutton, once a day, in moderate quantity, and occasionally a light pudding; green fruits or vegetables must be strictly prohibited, and the utmost care should be taken to prevent children from eating raw herbs, roots, etc., which they are so prone to pick up in their rambles when not looked after. Plenty of exercise in the open air is of essential service, and must on no account be neglected. * Vide note, p. 21. DISEASES OF THE ORGANS CONNECTED WITH THE RESPIRATORY SYSTEM. CATARRH, or COMMON COLD,—CATARRHAL FEVER. This term is given to an affection which consists of a mild degree of inflammation of the lining membrane of the nostrils, windpipe, and occasionally also of the ramifications of the lat- ter ; induced by exposure to sudden changes of temperature, or to a damp or chilly atmosphere with insufficient cloth- ing, PARTICULARLY AS REGARDS CHILDREN. This Complaint is characterized by slight fever, impaired appetite, obstruction of the nose, sneezing, unusual languor, pains in the head or in the back and extremities, and subsequently hoarseness or cough, generally preceded by transitory chills or shiverings; there is also a slight degree of wheezing and difficulty of breathing. When the disease is confined to the nose and sinuses, it is termed a cold in the head ; of which latter af- fection, and moreover, Hoarseness and Cough, I shall treat separately. Therapeutics. In many instances catarrh is carried off, or runs to a salutary termination, in a day or two ; and this desirable result is frequently obtained by having timely re- course to the simple proceeding of remaining a little longer in bed, and encouraging a gentle sweat by drinking a warm de- mulcent fluid, such as gruel; bathing the feet and legs in warm water, at the temperature of about 98 to 100 degrees of 188 respiratory system. Fahrenheit, is also a useful auxiliary mode of restoring per- spiration, but the patient should go to bed immediately after- wards. Very robust persons who are accustomed to be in the open air in all weathers, but who have caught cold after hav- ing overheated themselves, will frequently prevent any bad ef- fects by drinking one or two glasses of cold water on going to bed ; when, however, they have learned by experience that little benefit is to be derived therefrom, a few globules of Carb. v. or Silicea should be taken instead. A moderate de- gree of abstinence should, at the same time, be observed; veal or chicken broth, bread, sago, or semolina pudding, and such like, instead of the ordinary diet. The drink may con- sist of water-gruel, barley-water or toast-water. All strong liquors must be abstained from. The following are the principal medicines to be employed in the majority of cases, when called for : Nux v., Cham., Coffea, Bellad., Bryonia, China, Dulcamara, Arnica, Merc, Acidum phosph., Sulph., Calc, Ipecac, Arseni., Silicea, Camphora, and Aconitum. Administration. Each medicine in a little water, at the dose specified; repeated in twelve hours, if required.* Nux vomica y- when the symptoms of common cold de- clare themselves, will often check the attack. It is also in- dicated by external pains in the head from the same cause. Tickling or scratching in the larynx, dry cough in the morn- ing, also during the day, rarely during the night. In ca- tarrhal fever, with disposition to chilliness. When convenient, it is preferable to administer this remedy towards evening. Chamomilla -6-. In the treatment of children this medicine is generally preferable to Nux vomica in arresting the attack. It is (like Belladonna, Bryonia, China, Dulcamara, Sulphur, and Silicea) extremely valuable in restoring the suppressed perspiration, and removing the following symptoms: colic with pains in the head, ears, and teeth, thirst, ill humour, and impatience. Coffea cruda °-|°. This remedy is indicated where there is excessive sensibility, fretfulness, and sleeplessness, with general pains, especially in young persons. * Vide note, page 21. COMMON COLD. 189 Belladonna -6°, when there is throbbing, bursting head- ache, attended with determination of blood to the head, in- crease of the pain from movement or exposure to cold air. Bryonia -~. Headache, particularly at the temples, with aching pains in the limbs, much increased by the slightest movement. Cinchona -§-. Aching pains in the shoulder-blades, and in the extremities, increased by the slightest pressure on the affected parts, with great restlessness and constant desire to change the position of the limbs. Dulcamara -6-, when the pain is more of a passive or dull aching description, and felt only in particular parts of the head, with humming in the ears, and obtuseness of hearing; pains in the limbs, increased when at rest, and attended with a feeling of coldness, stiffness, and numbness; or when an offensive perspiration breaks out after an attack of cold; or when the affection has been brought on by suppressed perspi- ration, from exposure to cold and damp weather. Arnica Montana -6-, when aching pains, or pains as if ari- sing from a bruise, are felt in the limbs after exposure to cold, causing excessive restlessness and constant disposition to change the position of the affected parts, and increase of pain from the slightest touch or movement. Mercurius -6-, when the pains in the limbs and joints are accompanied with profuse sweating, which affords no relief; followed by Dulcamara should the sweat continue, and be of an offensive odour. Acidum phosphoricum fl6a. Aching pains, relieved by movement. Silicea -6 . Pains in the limbs, colic and general derange- ment arising from suppressed perspiration, particularly in those who are subject to sweating at the feet. Sulphur y, in cases of swelling of the knee, or of the joints of the hand and fingers, from taking cold. It may, in many such cases, be followed by Calcarea carbonica in a week or ten days. Ipecacuanha y. Nausea and inclination to vomit, or Dyspnaza, almost amounting to suffocation, arising from hav- ing taken cold, followed by— 190 RESPIRATORY SYSTEM. Arsenicum ^°, should no amelioration declare itself in six or eight hours. Pulsatilla. Useful in cold in the head with loss of taste and smell resulting from a chill, followed or preceded by Bel- ladonna, should there be an uncomfortable sensation of heat in the eyes and head, and heat and smarting in the nose. Or by Nux v., should there be complete stuffing or dryness of the nose. (See Coryza, p. 193.) Rhus toxicodendron, general indisposition from exposure to a thorough wetting when in a state of perspiration; followed by Bryonia in a few hours, if no improvement is experienced. Camphora,* when there is unusual weariness, heaviness, and general uneasiness, attended with shivering, and dryness or coldness of the skin, will generally succeed in preventing the development of an attack either of common cold or of influenza. Administration. A drop of weak spirits of Camphor every two or three hours, until relief is obtained. Aconitum is usually called for in febrile attacks, provoked by cold,—when hot, dry skin is present,—and, when timely administered, will frequently prevent the ^affection from as- suming a more serious form. The remedies for any other effects arising from cold, will be found under the different heads, such as Sore-Throat, Diarrhoea, Cough, Hoarseness, etc. Some individuals, particularly amongst those of the fair sex, are tormented with an extreme degree of susceptibility to cold; the best corrective to which is, to rub the throat, chest, and indeed the whole body, every morning with a wet towel, until a glow of heat is produced,—drying one part be- fore another is commenced;—also to acquire a habit of going * The happiest effects will speedily follow the administration of Cam- phor in incipient colds or influenzas, when, in addition to the indications recorded above, there are: tearful eyes, snuffling nose, hoarseness and rough and sore sensation in the throat. It seems also to predispose the system to accept more readily the impression of other remedies that may be subsequently required. Our rule has been to administer a tablespoonful of weak Camphor- water, twice or thrice, at intervals of three, four or six hours.—En. HOARSENESS. 191 out every day, provided there is no inherent predisposition to pulmonary consumption ; all extremes, either of heat or cold, should at the same time be avoided, and care taken, when the body is heated, to let it cool gradually :—When these means are not sufficient to remove the tendency to suffer from the slightest exposure to cold, the practitioner will find Silicea, Carb. v., and Calcarea, administered at intervals of from two to three weeks, to have considerable power in removing this constitutional delicacy. In other cases, one or more of the following remedies must be had recourse to :—Bryonia, Bel- ladonna, Dulcamara, Nux v., China, Mercurius, Rhus, Chamo- milla, Arsenicum, Lachesis, Rhododendron, according to the character of the sufferings which are experienced after each exposure to the influence of the atmosphere. HOARSENESS. Raucitas. The seat of this affection is in the mucous membrane of the throat, (larynx,) which is extremely liable to be affected by the common causes of Catarrh; hence it is a frequent ac- companiment of this disorder. The remedies mentioned under Catarrh and Cough are those which are generally found most useful in this complaint. Amongst these, in cases of recent origin, the following deserve particular notice: namely, Pulsatilla, Mercurius, Nux v., Capsicum, Rhus tox., Sambucus nigra, Chamomilla, Carbo ve- getabilis, Drosera, Sulphur, and Hepar Sulphuris. /5V' r The indications for the employment of these medicines are as follow: Pulsatilla °y°. Almost complete aphonia, particularly when accompanied with loose cough, or thick yellow coryza. Mercurius 00g00. This remedy will be found useful in removing any symptoms remaining after the above, but is to be preferred should the hoarseness, from the commencement, be attended with thin coryza. And when a sensation of burning or tickling is complained of in the larynx, with the characteristic indication of Mercurius, namely, a disposition to profuse sweating, especially at night. 192 Respiratory system. Nux vomica °^°. Hoarseness, accompanied with a dry fatiguing cough, worse in the early hours of the morning, with dry obstruction of the nose. Capsicum °-^q-. Hoarseness and dry obstruction in the nose, attended with an unpleasant sensation of crawling and tickling in the nose ; with a severe cough, worse towards evening ; with pains in other parts of the body, such as the head and abdomen. It is also better suited than Nux vomica for individuals of a lymphatic temperament. Rhus toxicodendron ~^-a. Hoarseness, accompanied with sensation of excoriation in the chest; oppressed breathing with frequent and violent sneezing, unaccompanied by coryza, but occasionally by a great discharge of mucus from the nose during the attacks of sternutation. Sambucus nigra 5|°. Hoarseness, with deep, hollow cough ; oppression at the chest; frequent yawning ; restless- ness, and thirst. Chamomilla °^°. Iioarseness with accumulation of mu- cus in the throat; cough worse at night, continuing even du- ring sleep, and frequently with a degree of fever towards even- ing, and a great irritability of temper. This remedy is fre- quently found specific in cases of children. Drosera ££ Hoarseness, with very low, or deep and hollow voice. Carbo vegetabilis ££. Chronic hoarseness, worse in the morning and towards evening, with aggravation after talk- ing. Sutlphur §$. Hoarseness, attended with roughness and scraping in the throat; and of great value in obstinate cases, where the voice is low, and nearly extinct; particularly in cold, damp weather. (Sulphur is especially useful after Puis.) Hepar sulphuris oa6&£. An admirable remedy in chronic hoarseness, particularly in individuals who have taken large quantities of mercurial preparations ; otherwise Causticum is equally useful.* * Sulph. calcarea and Silicea are most useful remedies in obstinate hoarseness attended with coryza. HOARSENESS. 193 Administration of the Remedies.* Dissolve the glo- bules, at the potencies mentioned, in four dessert-spoonfuls of water, and exhibit one, morning and evening, for two days ; or, in some cases, continue for three ; being guided by the re- sult. Of Hepar s., half a grain, 3d trit., in the same manner. W hen we find individuals in whom this affection occurs fre- quently at different seasons, or on the slightest exposure to cold or damp, we may naturally infer that there is a constitu- tional predisposition to chronic laryngitis, a malady requiring a judicious treatment by an experienced practitioner, as, if neglected, it may eventually end in CHRONIC LARYNGITIS. PHTHISIS LARYNGEA. Chronic Inflammation of the Larynx. This is a comparatively rare disease, and, when present, there is generally a degree of ulceration. The following are its prin- cipal contents : pain in the larynx, and round the glottis; pain and difficulty in swallowing ; hoarseness, and difficulty of respi- ration ; frequent attacks of severe cough, with scanty and occa- sionally sanious expectoration ; it sometimes ends in hectic fever, which carries the patient off. The medicines to which we would particularly direct the attention of the practitioner in the treatment of this malady,are, Hepar s., Lachesis, Phosph., Carbo veg., Causticum, Acidum nitricum, Calcarea carb., Arsenicum, and Spongia. Aconite with Spongia, and Hepar sulph., and frequently also Lach., are the most useful remedies in this disease in the acute form. (See also Croup.) Administration, see Hoarseness. The patient should, in both forms of this affection, adhere rigidly to dietetic rules, avoid unnecessary exposure, and enter as little as possible into conversation. COLD IN THE HEAD. Coryza. Diagnosis. This affection is a very general attendant upon Catarrh. Therapeutics. When it is the leading symptom, or ex- * See note, p. 21. 9 194 RESPIRATORY system. ists independently of those already mentioned, the best medi- cines for expediting its removal are : Nux vomica, Euphrasia, Pulsatilla, Chamomilla, Mercurius, Hepar sulphuris, Bel- ladonna, Ammonium, Natrum, and Arsenicum, Lachesis, Silicea, &c. Administration. Three globules of the potencies named, to be dissolved in four teaspoonfuls of water, one to be taken morning and evening, unless otherwise specified.* Nux vomica. Dry obstruction, especially during the night only, with pressive heaviness in the forehead, and confusion In the head ; heat in the face, increasing towards evening. If in combination with other catarrhal symptoms, see the indications already given for its exhibition under the several heads of Catarrh, Hoarseness, and Cough. This direction equally applies to the other medicaments here quoted. Administration. Two globules of the sixth potency, to be dissolved in a teaspoonful of water, and taken towards bed- time ; to be repeated the second day following; but should an alteration in the symptoms have taken place without any cor- responding improvement, another remedy must be selected. Lycopodium °t02°? w^1 often be found efficacious after Nux v., in obstinate cases of stuffing of the nose, particularly at night, rendering it necessary to sleep with the mouth open, which causes a disagreeable dryness without much thirst, confusion in the head, and burning pain in the forehead. This remedy is frequently more or less useful in colds in the head of all kinds. Administration, same as Nux v. Pulsatilla °-|°. The discharge thick, fetid, greenish yel- low, or mixed with clots of blood ; loss of taste and smell, headaches, sneezing, chill, especially towards evening; disposi- tion to weep, lowness of spirits, heaviness or confusion of the head in a warm room. Chamomilla °%°. The affection having risen from checked perspiration, acrid discharge from the nose, causing redness of the nostrils, and excoriation or soreness under the nose; chap- ped lips; shivering, with thirst. Mercurius °-g°. Dryness of the nose, with obstruction ; * Vide note, p. 21. COLD IN THE HEAD. 195 profuse discharge, producing excoriation, swelling or redness of the nose, pains in the head and face. This is 'a valuable remedy in the generality of ordinary cases of cold in the head, and particularly when the complaint is, as it were, epidemic. * Hepar sulphuris -§-. Chiefly when only one nostril is affected, or when headache is experienced, or the complaint re- newed on each exposure to cold air ; further, in most cases in which Mercurius, though apparently indicated, has produced little or no improvement. Belladonna °£°, may follow the above, if required, but especially when the sense of smelling becomes variously affect- ed, being at one time too acute, and another too dull. Ammonium y. Stuffed nose, especially at night; swelling and painful sensibility of the nostrils ; dryness of the nose. Natrum \°. Cold in the head, renewed by the slightest chill, or exposure to a current of air ; obstruction of the nose every second day. Lachesis —• Swelling and soreness of the nose and nos- trils, with copious watery secretion. Arsenicum -6-. Obstruction of the nose, with, at the same lime, discharge of thin, acrid, excoriating mucus, and burning heat in the nostrils, &c. Suffering relieved by heat; pain in the back, feeling of general debility, or prostration of strength. Dulcamara is useful when fresh obstructions arise from- every trivial exposure to the air. Ipecacuanha may be had recourse to after Arsenicum, if the latter has only partially relieved. Graphites and also Silicea are useful in all cases which are of frequent recurrence, and always of a most obstinate character. Camphor. In the premonitory stage of the complaint, with shivering and headache, the attack may frequently be checked by a drop or two of spirits of weak camphor. Sulphur, Calcarea, Graphitis, Silicea, Natrum, and Pulsa- tilla, are the best remedies for removing extreme susceptibility * When the Secretion from the nose is excessive, and there is at the same time, confusion in the head with redness and soreness of the eyes and eyelids, and copious acrid or scalding lachrymation, Euphrasia should be prescribed. • 196 RESPIRATORY SYSTEM. to colds in the head.* Against the effects of a suddenly sup- pressed catarrh the following are the most important reme- dies : Aconite against headache, followed by Pulsatilla, and then Cinchona, if the secretion does not return ; difficulty of breathing, Ipecacuanha, followed, if required, by Bryonia and Sulphur ; against hoarseness, cough, or disease in the re- spiratory organs, arising from a similar cause, see the reme- dies mentioned under these different heads. COUGH. Tussis. Diagnosis. Forced and audible respiration without fever; or a symptom in acute diseases, such as fever, pneumonia, or phthisis ; either dry or accompanied with expectoration. Cough, although not dangerous of itself, may become so, or form an important feature of other diseases. As a precursor of phthisis, it is too often neglected. It may arise from an irritation of the air-passages or lungs; from cold or other causes, or from disease of the same organs, or be merely sympathetic or the consequence of derange- ments of other important viscera. Therapeutics. The following are the medicines most use- ful in this affection: Aconitum, Dulcamara, Bellad., Hyosc, Nux v., Pulsatilla, Ammonium carbonicum, Ammonium muri- aticum, Chamomilla, Hepar sulphuris, Ignatia, Ipecacuanha, Mercurius, Carbo vegetabilis, Capsicum, Bryonia, Rhus toxi- codendron, Arsenicum album, Drosera, Silicea, Lachesis, Causticum, Sulphur, Calcarea carbonica, Euphrasia, Sepia, Stannum, Verbascum, Arnica montana, and Squilla, &c. Aconptum -~. Violent short cough, with quick hard pulse and feverish heat; pricking in the chest when coughing, or during inspiration. See Bronchitis, p. 225. * In other cases this desirable result may be attained by the adminis- tration of Mercurius, Hepar s. and Belladonna, on each successive attack (when the symptoms resemble those which have been* described under these remedies)—and, failing these, Silicea, Sulphur, and Calcarea ; and the other remedies mentioned above as useful in removing this suscepti- bility must be had recourse to. m COUGH. 197 Dulcamara °£°. The following are indications for the selection of this remedy : moist cough, after exposure to wet, or cough with expectoration of bright-coloured blood ; aggra- vation of the cough on movement or when out of doors ; al- leviation in the recumbent posture or when within doors. Belladonna ~s-. Short, dry, barking (spasmodic catar- rhal, or nervous) cough at night in bed, and also during sleep, renewed by the slightest movement; dry cough day and night, with irritation or tickling in the pit of the throat, or sensation as if a foreign body were in the larynx, or as if dust had been inhaled ; spasmodic cough, which scarcely allows time for respiration. Finally, this medicine is sometimes useful in cough with rattling of mucus in the chest, pricking in the ster- num or in the hypochondria, and expectoration of thick white mucus, coming on especially after meals ; pains in the abdo- men ; hoarseness, redness of the face, headache, sneezing after coughing, and pain in the nape of the neck.* Nux vomica ^g2-. This is a valuable remedy in many cases either of catarrhal or nervous character, and is particu- larly efficacious where there is a dry, hoarse, fatiguing, and sometimes spasmodic cough, which occurs in an aggravated form in the morning and occasionally also towards evening, and attacks more or less during the day, but relaxes again at night. When, however, it is occasionally supplanted by op- pression at the chest, on lying down or on awaking during the night, accompanied with a feeling of heat and dryness in the mouth, if there be any expectoration it consists merely of a little mucus which is detached with great difficulty. The cough is generally excited by a disagreeable tickling or scraping, with a feeling of roughness or rawness in the throat, sometimes attended with hoarseness and feeling of roughness in the chest, but more frequently with severe headache, or pain as if from a blow or bruise in the epigastrium and hypochondria; it is frequently aggravated after meals, or by movement, not un- * Hyoscyamus frequently answers when Belladonna has only afforded partial relief, and may be preferred to the latter, when the nocturnal cough is mitigated for the time by sitting up in bed; also when there is mucus rattling in the throat. Conium in dry spasmodic cough, increased at night. • 198 RESPIRATORY SYSTEM. frequently also by reading or meditation, and is occasionally followed by vomiting. Pulsatilla °£°. Severe shaking, or catarrhal or nervous spasmodic cough, worse towards evening and at night, fre- quently followed by vomiting ; sensation of suffocation, as if from the vapour of sulphur; increase of cough when in the recumbent posture ; cough which is at first dry, then followed by copious expectoration of yellowish or whitish mucus, some- times of a salt or bitter taste ; or expectoration of mucus streaked with blood ; wheezing or rattling of mucus in the chest; the paroxysms of coughing are frequently accompanied with soreness in the abdomen, as if from a bruise or blow, or painful shocks in the arms, shoulders, or back, and some- times followed by a sensation as if the stomach became in- verted from the violence of the cough ; involuntary emission of urine when coughing ; loose cough, with aching in the chest, hoarseness, cold in the head; excited by a sensation of scraping or of erosion in the throat; shivering. Ammonium carbonicum °f°. Dry, tickling, suffocating cough, in the morning, sometimes with fever, occurring during the prevalence of a cold, stormy, bleak state of the atmos- phere, and attended with a sensation of heat or burning behind the sternum, resembling that which is occasioned by drinking spirits ; roughness of the voice ; cold in the head. Ammonium muriaticum ---. This remedy is sometimes serviceable after the former when the cough sounds looser, yet is unattended with expectoration. Chamomilla. Dry cough, excited by continual tickling or irritation in the larynx and chest, and increased by talking; the cough is most troublesome during the night, but also occurs during the day, particularly in the morning and towards even- ing ; accumulation of tenacious mucus in the throat; wheez- ing in the chest; cough during sleep, sometimes accompanied with paroxysms, as of threatening suffocation ; cough with scanty expectoration of tenacious bitter mucus. This medi- cine is well adapted to the treatment of coughs in children ac- companied with more or less of the symptoms above described, or with hoarseness, cold in the head, dryness in the throat, COUGH. 199 and thirst; great fretfulness ; fever towards evening; parox- ysms of coughing after crying, or after a fit of passion. Hepar Sulphuris °§°. Obstinate cases of violent dry hoarse cough, sometimes attended with a dread of suffocation, and ending in lachrymation. The attacks are frequently ex- cited or aggravated on any part of the body being exposed or becoming cold from the bed-clothes slipping off, and are gene- rally worse at night; also dry deep cough excited by a feeling of tightness in the chest, or by talking, stooping, or ascending stairs; hoarseness. Ignatia°£°. Shaking spasmodic cough, or short hacking cough, as if arising from the presence of dust or feather-down in the throat, which becomes aggravated the longer the parox- ysms of coughing continues; dry cough with coryza, occurring both day and night. This remedy is further particularly effi- cacious when the attacks of coughing become aggravated after eating, or on lying down at night, or on rising in the morning, and when the sufferer is of a mild and placid temper, or sub- ject to alternations of high and low spirits. Ipecacuanha °£°. Catarrhal, nervous, or spasmodic cough, particularly at night, attended with painful shocks in the head and stomach, and followed by nausea, retching, and vomiting; or dry cough, arising from tickling in the throat; or severe, shaking, spasmodic cough, with oppressed breathing, almost amounting to suffocation. In the case of children, this remedy is frequently valuable when they appear to be threatened with suffocation from the accumulation of mucus, or where the par- oxysm is so severe as scarcely to afford time for respiration, causing the face to assume a livid hue, and the frame to become quite rigid. (Calc. is often useful after Ipec) Mercurius °|°. Catarrhal cough, with hoarseness, watery coryza, or with diarrhea; or dry cough, excited by irritation in the throat, or the upper part of the chest, which becomes particularly troublesome towards evening, and at night; sometimes with slight prickings in the chest when coughing or sneezing ; excited or increased by talking ; cough in children with discharge of blood from the nose, which coagulates as it 200 RESPIRATORY SYSTEM. flows, vomiturition, and headache; dry spasmodic cough, with retching after the paroxysms, and expectoration of blood. Carbo vegetabilis ^f. Hollow cough, excited by irrita- tion, or a troublesome sensation of crawling in the throat, and attended with burning pain, and sensation as if from ex- coriation in the chest: catarrhal or nervous spasmodic cough, frequently followed by inclination to vomit or vomiting, oc- curring in paroxysms throughout the day ; cough with hoarse- ness, especially towards evening, or morning and evening, in- creased by speaking. Chronic cough with expectoration of greenish mucus, or even of yellowish pus—or with expecto- ration of blood and burning sensations in the chest (a charac- teristic indication for this remedy as well as Arsenicum). Capsicum -§-. This remedy is frequently very efficacious in cases of cough occurring in individuals of the lymphatic temperament. It is particularly indicated when the paroxysms are more severe towards evening and at night, frequently at- tended with unsettled pains in various parts of the body, and bursting headache; also painful pressure and aching in the throat and ears; cough with offensive breath, and disagreeable taste in the mouth. Bryonia. °£°. Catarrhal cough occurring in winter during the prevalence of frost and cold easterly winds, with aggra- vation of the fits of Coughing on coming from the open air into a warm room. The following are the general indications for its employment: dry cough excited by constant irritation in the throat, or as if caused by vapour in the larynx and wind- pipe, with greatly accelerated respiration, as if it were im- possible to obtain sufficient air; spasmodic, suffocating cough, after partaking of food or drinks, and also after midnight; cough with prickings in the chest, and violent bursting head- ache, especially at the temples, also with prickings in the pit of the stomach, or in the side: further, in loose cough with yellowish expectoration or slight spitting of blood this remedy will frequently be found of great service; dry nervous cough. Rhus toxicodendron °§°. Short, dry cough, worse to- wards evening and before midnight, excited by tickling in the COUGH. 201 chest, attended with anxiety and shortness of breath; cough on waking in the morning, or short cough with bitter taste in the mouth, on lying down at night and on waking in the morn- ing. Cough with expectoration of bright blood, with sensa- tion of insipidity or exhaustion in the chest, or shooting pains in the chest and sides. Arsenicum ^~-, cough with oppression at the chest, and tenacious mucus in the larynx and chest; cough excited by a sensation of dryness and burning in the larynx. Dry cough, chiefly in the evening after lying down, often with difficult res- piration and fear of suffocation, as if arising from inhaling the vapour of sulphur ; dry cough, excited by eating or drinking, or by ascending stairs, or cough which arises as soon as the open air is encountered ; thin acrid coryza; sneezing ; periodic dry cough—nocturnal cough with general burning heat; cough with expectoration of sanguineous mucus ; pulmonary catarrh in old people, also Ipec, Tart, c, Baryt. c ; or in alternation with Arsenic Drosera °Ty, in many cases of chronic cough with hoarse- ness ; or deep hollow cough, with pain in the chest and under the ribs, alleviated by pressing the hand on the side, excited or aggravated by laughing ; cough on lying down in the even- ing and during the night. Matutinal cough, with bitter and nauseous expectoration ; dry spasmodic cough, aggravated at night, or towards evening, and frequently followed by vomit- ing of ingesta, or bleeding from the nose and mouth. Silicea *%. Cough with oppressed breathing on lying on the back, or cough attended with tightness and oppression at the chest as if something stopped the respiration while speak- ing or coughing. Fatiguing, or deep hollow cough, day and night, aggravated by movement or speaking, and sometimes at- tended with aching and pain as if from a bruise in the chest; cough with copious expectoration of transparent mucus, or of pus, sometimes streaked with blood; cough with asthmatic breathing and emaciation, with dread of suffocation at night; cough excited by a sensation as if a hair were on the tongue. Lachesis °^. Fatiguing cough excited by dryness or con- tinual iicldins in the larynx or chest; or by pain or tickling in 9* 202 RESPIRATORY SYSTEM. the pit of the stomach or the epigastrium; also by the slightest pressure on the exterior of the throat; cough excited by talk- ing, laughing, or reading aloud, or anything which may tend to increase the dryness or irritation in the throat; short, dry, suf- focating cough, as if caused by the presence of a crumb of bread sticking in the throat, with ineffectual efforts to expectorate. Cough on rising from the recumbent posture, or attacks of cough always after sleeping, or on lying down to sleep; cough also during the day, or also at night during sleep, so that the patient is unconscious of it; continual hoarseness, with a sensation as if something were in the throat which could not be detached. Causticum -£-. Dry hollow cough, which even awakes one from sleep; short cough excited by tickling, crawling, or a feeling as if the throat were excoriated, or by talking and cold, attended at times with burning or a sensation of soreness in the chest, and rattling of mucus; pain in the hip, and occa- sionally involuntary discharge of urine when coughing. Sulphur -%-. In some cases of chronic coughs, and par- ticularly in dry cough, which disturbs the patient at night as well as during the day, the cough is frequently excited after partaking of food, or during a deep inspiration, and is generally attended with a sensation of spasmodic constriction in the chest, sometimes followed by inclination to vomit, or involuntary es- cape of urine, or pain as if from excoriation, or pricking pains in the chest; headache, pains in the chest, the abdomen, loins and hips; also, cough, with expectoration of thick, whitish, or yel- lowish mucus, or of a greenish yellow, fetid mucus, or pus, of a salt or sweetish taste ; feverish cough with spitting of blood. Calcarea carbonica °£°. Dry cough, aggravated towards evening, or at night, excited by tickling in the throat, or by a sensation as if there were a feather down in the throat; also loose cough, with rattling mucus in the chest, and expectora- tion of offensive thick yellow mucus ; anxiety. Euphrasia °§5. Cough, with coryza and lachrymation; di- urnal cough, with difficult expectoration of mucus; or matutinal cough, with copious expectoration, and oppressed breathing. Sepia °-££. Cough with copious expectoration of mucus of a saltish taste, of a yellow or greenish colour; also dry COUGH. 203 spasmodic cough, particularly at night, or on first lying down, attended, in children, with crying, fits of choking, nausea, retching, and bilious vomiting. This remedy is especially adapted to individuals having a constitutional taint, such as the scrofulous, scorbutic, &c.; in chronic coughs, with thick, yellowish, greenish, or even puriform expectoration, with a putrid taste, it is a valuable remedy. Stannum °§°. Cough, with copious expectoration of a greenish yellow, of a sweetish or saltish taste, attended with great weakness and disposition to sweats; or dry shaking cough, worse at night or towards morning, excited or aggra- vated by speaking or laughing, and occasionally followed by vomiting of ingesta. Cinchona -2§°. Paroxysms of cough as if excited by the vapour of sulphur, with whistling or rattling in the throat from mucus; expectoration difficult, consisting of clear tena- cious mucus, sometimes streaked with blood; pains in the shoulders, or prickings in the chest and windpipe; cough, sometimes with bilious vomitings; cough after hemoptysis. Verbascum - %-. This remedy is frequently of great ser- vice in children, though less frequently so than Chamomilla. Indications: dry hoarse cough, worse towards evening and at night: occurring during sleep. Iodium °§°. Cough in plethoric children, with copious ac- cumulation of mucus in the bronchi, and ineffectual efforts to expectorate. Phosphorus -§-. Dry cough, excited by tickling irritation in the throat or chest, or by laughing, talking, or drinking, or by cold air, and accompanied with pricking in the larynx; hoarseness, or pains in the chest as if from excoriation; cough with hoarseness, from fever and depression of spirits, some- times with apprehensions of death ; dry sounding cough, fol- lowed by expectoration of viscous or sanguineous mucus. Arnica -§- is of great value in coughs, with bleeding from the nose and mouth; headache, pricking in the chest (pleurodynia), rheumatic pains in the loins and extremities, and soreness or pain, as from a bruise, in the chest and ab- domen. 204 respiratory system. Squilla *%K In short dry cough, excited by a full inspi- ration, or chronic cough, or catarrh with copious secretion of whitish viscous mucus, which is alternately expectorated with ease and difficulty, this remedy is useful. Administration of the remedies. The dose mentioned af- ter each medicine in a teaspoonful of water, repeated in from twenty-four to forty-eight hours, as required ; in severe cases, six or eight globules in an ounce of water, a dessert-spoonful every three or four hours.* These are the principal remedies to be had recourse to in this disorder; but in complicated cases we may have to call in the aid of other medicaments. In some obstinate, nervous coughs, occurring in highly irritable, nervous, and hysterical habits, which are generally dry, or attended with scanty and difficult expectoration, consisting of a little clear mucus, change of air will frequently readily effect a cure. For cough arising from Worms, see the remedies mentioned under that heading; or from teething, see Dentition. Stomach coughs, or coughs occurring in women during the last months of preg- nancy, are to be relieved by the remedies mentioned under Dyspepsia. Unmedicated jujubes, or sugar candy, may be allowed occasionally, to moisten the throat or mouth, in cases of dry irritating coughs. HOOPING-COUGH. Tussis Convulsiva. Pertussis. This is almost peculiarly a disease of childhood, and one which few individuals escape during that period ; it generally appears as an epidemic; and is, by the majority of physiolo- gists, acknowledged to be communicable by contagion; we seldom find an instance of a person suffering a second time from its attacks. Over many the affection passes lightly, but in the majority of cases it proves a distressing, and in some a fatal malady, baffling all the ill-directed efforts of the allopathic physician to conduct it to a favourable termination. Under the old practice, not only was a great deal of valuable * Vide note, p. 21. HOOPING-COUGH. 205 time lost in endeavouring to subdue inflammation by antiphlo- gistic measures, but the patient's vital energies were weakened, and rendered less capable of contending with the disease, when it assumes the spasmodic type. On the contrary, we have it in our power, by the adminis- tration of remedies specific to the affection, to check the in- flammation at its outset, subdue the other distressing attend- ant symptoms, and shorten the duration of the complaint, with- out allowing it to leave after it any of those evil consequences, such as debility and emaciation, which oblige the patient to endure a tedious and protracted period of Convalescence. Diagnosis. Paroxysms of violent and convulsive expira- tions, in rapid succession, interrupted by long whistling in- spirations, and in young subjects a loud shrill whoop, termi- nated by the expectoration of a quantity of mucus, or a fit of vomiting, after which the attack ceases for some time. If the case is severe, the features swell and become livid ; blood escapes from the nose, mouth, and even from the ears. A complete cessation of respiration and almost suffocation takes place as if from spasm of the lungs, which lasts for minutes. The attacks return every three or four hours, more frequently in severe cases ; the least excitement brings them on ; they are more frequent and violent at night. Respiration is free during the intervals, and the patient in every respect healthy, except being weak. Pathologists generally consider this disease under three stages : the distinction between the second and third is, how- ever, not often very clearly marked. The first or febrile stage commences with the symptoms of an ordinary catarrh, attended with slight fever, which gradually increases, the breathing becomes more difficult, and is accom- panied with irritative cough and pains in the chest. In the second or convulsive stage* the febrile activity dis- appears, and the characteristic cough and other symptoms of the disease develop themselves. In the third or nervous stage there are longer intermissions * The congestive and nervous of some authors. 206 RESPIRATORY 8YSTHM. between the paroxysms, but increased weakness from the duration of the cough. Therapeutics. In the incipient, febrile, irritative, or catar- rhal stage of the cough, the most appropriate remedies are to be found amongst those we have already pointed out in the treatment of Common Cough, and must be selected according to the indications there given, and administered in the same manner unless otherwise specified. By a careful selection of these remedies it is frequently possible to check the disorder in the first stage. Accordingly, the most suitable medicaments for this purpose are : Dulcamara, Pulsatilla, Mercurius, Bella- donna, Hepar sulphuris, Chamomilla, Nux vomica, Arnica, Ipecacuanha, Aconite, Bryonia, and Phosphorus. Administration. See Cough, p. 204. Dulcamara °^°. When the attack has apparently been excited by exposure to wet, (a thorough wetting,) the cough loose, with copious and easy expectoration. Pulsatilla °|°. Cough loose, and accompanied with lachrymation, weakness of the eyes, sneezing, thick, disco- loured coryza and slight hoarseness, and inclination to vomit after coughing ; occasional diarrhoea, especially at night. Mercurius °%°. Hoarseness, watery coryza, with sore- ness of the nostrils ; dry fatiguing cough, generally occurring in two successive fits. Belladonna °£°, is one of the most important remedies in the catarrhal stage of hooping-cough, when there is dry, hol- low, or harsh and barking cough occasionally at night, or which becomes materially aggravated at that period. This medicine is also particularly well adapted to the angina or sore throat, which is not unfrequently concomitant at the commencement of the affection. Hepar sulphuris. Cough worse at night, but looser than that indicating Belladonna. This medicine is also useful in forwarding the secretory process. Administration. Half a grain of the trituration, at the third potency, to half an ounce of water, a dessert-spoonful twice a day. HOOPING-COUGH. 207 Chamomilla -^. Dry hoarse cough, or cough with dif- ficult expectoration of tenacious mucus, followed by a feeling of soreness at the part from which the mucus seems to have been detached. The paroxysms of coughing are excited by an almost incessant irritation of the larynx, and in the upper part of the chest. Nux vomica °|°, is of greater service when the cough ap proaches the second stage. It is indicated by the following symptoms: Dry, fatiguing cough, attended with vomiting, and occurring particularly from about midnight until morning, the paroxysms so protracted and violent as to produce appa- rent danger of suffocation, with blueness of the face, and oc- casionally bleeding from the mouth and nose. (Arnica is better adapted to this latter symptom when it occurs with a copious discharge of blood.) Ipecacuanha °| ° is, like the former, of great value when the cough is attended with danger of suffocation, and each inspiration appears to excite a fresh fit of coughing. It is further indicated when the fits are attended with spasmodic stiffness of the body, and blueness of the face, great anxiety, and accumulation of mucus in the chest. Aconite -§- may be had recourse to from time to time, when marked febrile or inflammatory symptoms are present, bearing in mind, that its action is of short duration, and may be followed in a few hours by any other of the remedies which appear more particularly indicated. The last mentioned remedy, Bryonia and Phosphorus, are chiefly called for when the cough threatens to become associ- ated with inflammatory action in the lungs, &c. Second or Convulsive Stage.—Therapeutics. Drosera, Veratrum album, Cuprum aceticum, Arnica, Ferrum metalli- cum, and Conium maculatum* Drosera is one of the principal remedies in the treatment of the disease when it has reached this stage; and in cases * Acidum hydrocyanicum. In some cases we have had satisfactory results from the use of this acid. It is most indicated when the cough is violent, concussive, attended by rattling of mucus, suffocating respi- ration and ejection of blood from the mouth and nose.—Ed. 208 RESPIRATORY system. where the constitution has not been enfeebled by the trans- mission of hereditary weakness or other causes, it will speedily declare its beneficial effects, and materially shorten this trying and painful period of the disorder. The particular indications for the use of this medicine are, violent paroxysms of cough, oc- curring in such rapid succession as to threaten suffocation, and attended with the characteristic shrill sound during inspiration, and sometimes fever; after each fit of coughing, vomiting of food, or of stringy mucus ; relief on moving about. Administration. 0(^>0, in six teaspoonfuls of water, a teaspoonful after each severe paroxysm of coughing.* Veratrum album is indicated when the child has become reduced in strength and emaciated ; or when it suffers from cold sweats, particularly on the forehead, with excessive thirst, involun'aiy emission of urine, vomiting, and other symptoms common to this stage; also pain in chest and inguinal region; slow fever, t Administration. The same as Drosera. Cuprum aceticum. This has been found most useful in the nervous stage, particularly when convulsion with loss of con- sciousness ensue after each paroxysm. Also when we find vo- miting after the attacks, and rattling of mucus in the chest, and wheezing at all times. In almost all cases a marked be- nefit has followed the employment of this remedy ; some- times it has been found sufficient of itself to cut short the dis- ease, and in others, has so far modified it that other remedies which had before seemed to fail, have after its exhibition acted with the most marked effect, and completed the cure ^ Administration. According to the formula already given in Scarlet Fever, a dessert-spoonful after each paroxysm. * Vide note, p. 21. f Carbo vegetabilis is frequently useful in bringing this stage of the affection to an early and successful termination after the previous use of Veratrum or Drosera, or both of these important remedies; particularly when, notwithstanding the decrease of cough, the tendency to vomit still remains. (See also Ferrum.) X Cina is also a useful remedy when there are convulsions, or tetanic rigidity of the whole body during or immediately after the fits of cough- ing, particularly in children affected with worms. HOOPING-COUGH. 209 Arnica is useful as an intermediate medicine when the epistaxis or hemorrhage from the mouth is considerable; and also in the affection itself when each paroxysm is succeeded by crying. (Hepar s. is also useful when the latter symptom follows a hoarse dry cough.) Administration. In cases of hemorrhage, a drop of the tincture, at the second potency, and repeated after the next paroxysm, if necessary. When indicated by the nature of the attack, 00-g°, in six teaspoonfuls of water, one after each paroxysm. Ferrum metallicum. This remedy will be found very useful as an intermediate when there is invariably vomiting of food on coughing soon after a meal. Administration. A small quantity, say about a quarter of a grain of the third trituration in a dessert-spoonful of water once in twenty-four hours. Conium. When the paroxysms occur particularly at night, and with great severity. Administration. A globule of any potency, from the ninth to the thirtieth, in a teaspoonful of water, night and morning. Third, or Nervous Stage. Therapeutics. The same medicines as have already been given, according to the indica- tions that present themselves. On the suppression of all the more serious symptoms, the remedies which have been re- commended in the first stage are also useful in removing any catarrhal cough which may remain behind. Change of air is likewise beneficial.* Diet. The diet must be light and of easy digestion; bread- pudding, semolino and other light puddings of this description, provided the fever be not high, in which case, weak gruel, bar- ley-water, and the like, must alone be allowed; when the more serious symptoms have been subdued, or in all mild cases, a little chicken broth, or beef tea, may be given; and so on, gradually increasing -the amount of nutriment as the disease declines. The drinks to consist of toast-water or barley-water. * In neglect, or obstinate cases occurring in delicate constitutions, Sul- phuris Tinctura and Sepia have been found useful. See also the remedies for coughs of a bad character under the head of Oough. 210 RESPIRATORY SYSTEM. CROUP. Angina Membranacea. Angina perniciosa. Cynanche laryngea. Cynanche tracheitis. s. trachealis, dfc, 6fC Diagnosis. Short, difficult, and hoarse respiration, accom- panied by a shrill, whistling, squeaking, harsh, rattling, or metallic sound, with cough of the same character; the patient throws the head back; fever, and sometimes comatose state of the brain. This well known disease is one that requires the promptest treatment to avert the danger. From the moment we are assured of the nature of the complaint, recourse must be had to the remedy most clearly indicated by the assemblage of the symptoms, so that not an instant be lost in arresting its further progress, since, if not skilfully kept in check, it some- times runs to a fatal termination within twenty-four hours ; although in the generality of cases, when such an event does take place, it happens about the fourth or fifth day. Croup consists of a peculiar inflammation of the lining membrane of the windpipe, causing the secretion of a thick, viscid substance, generally opake, of about the consistency of the boiled white of an egg, which adheres to the interior of the windpipe, and takes the form of the parts it covers; when this, generally denominated the false membrane, has been allowed to form, the case becomes extremely critical. That croup arises from inherent constitutional taint, is evi- dent from the fact of some families having a peculiar tendency to this disorder. It particularly affects early childhood. The principal exciting causes seem to be, exposure to cold or damp, and derangement of the digestive functions, from a too nutritious or heating diet, too much animal food, or stimu- lants, such as wine or coffee. It seldom attacks adults, though we occasionally see exceptions to this rule, and is not unfre- quently found in complication with other affections both of the lungs and windpipe. The attack generally commences with the symptoms of a CROUP. 211 common catarrh, such as cough, sneezing and hoarseness, with a greater or less degree of fever ; in a day or two the cough changes its character, and becomes shrill and squeaking, or deep, hoarse, or sonorous, attended with a ringing sound during speaking and respiration, as if the air were passing through a metallic tube; as the disease progresses, the cough becomes more shrill, and when long continued, resembles the crowing of a young cock. There is seldom much expectoration, and when any matter comes up in coughing, it has a stringy ap- pearance, resembling portions of a membrane. After inflam- mation has set in, considerable fever and restlessness continue, occasionally varying in intensity, but never wholly remitting ; the countenance expresses great anxiety, and alternates from a red to a livid hue; the paroxysms are followed by a profuse and clammy perspiration of the whole body, more particularly of the head and face. When danger threatens, the pulse is hard, frequent, and occasionally intermittent; the breathing, partic- ularly during inspiration, difficult and audible; the features become livid and almost purple from the sense of suffocation ; the head is thrown back; the cough assumes a veiled and husky tone ; the voice sinks to a whisper; the eye has a dull, glassy, or dilated appearance, and the whole system seems in a state of utter prostration. Therapeutics. The medicines upon which the greatest reliance is to be placed in the treatment of this affection, are : Aconite, Cham., Bryon., Spongia, Hepar sulphuris, and Lach- esis. Aconite is called for during the inflammatory period of this dangerous disease, with great febrile disturbance, burning heat, thirst, short dry cough, and hurried, laborious breathing. It may be exhibited as below specified, until these symptoms begin to abate. -~, in six teaspoonfuls of water, one every half-hour to six hours, according to the violence of the fever. After Aconite, recourse must be had to— Spongia, when there is a hoarse, ringing, hollow, and squeak- ing cough, with slow wheezing respiration, or fits of choking, with inability to breathe but with the head thrown back. Administration. -~, in six teaspoonfuls of water, one every half, or every one, two. or three hours, according to the 212 respiratory system. intensity of the symptoms, and the effects produced by each dose. Hepar sulphuris. Either when the symptoms are par- tially subdued by Spongia, or when from the commencement the cough is moist or loose, with accumulation of mucus in the respiratory organs; or when, after Aconite, there remains a dry, deep hollow cough with weak hoarse voice, and more or less distressing oppression of breathing.* Administration. One grain of the trituration, third po- tency, to an ounce of water, a dessert-spoonful every two hours, or oftener if required. It may also be advantageously alternated with Spongia at intervals of half an hour to an hour or more, according to the severity of the case and the effects produced; the administrator carefully noticing the effects of each medicine.f Phosphorus is preferable to Spongia when the inflammation threatens to extend to the air-passages and lungs, (Pneumo- nic Croup,) or when the latter are implicated from the com- mencement, and may also be given in alternation with that medicine, or follow it; and may further, in some instances, be advantageously alternated with Lachesis. Lachesis f %, in very serious and difficult cases, in which there is short dry cough with hoarseness ; great sensitiveness to the touch, the slightest pressure affecting almost to suffoca- tion ; voice very low and hollow, with a sound like that of a person speaking through the nose ; fainting ; nausea ; swoon- ing ; loss of sense ; rigidity of frame ; great prostration of strength, especially towards evening. Administration. Six globules of the sixth in about an ounce of water, a teaspoonful every half-hour, hour, or two hours, according to the intensity of the symptoms, and their abatement. After having subdued these threatening symptoms by the * This remedy is of itse^ sufficient, in many instances, to arrest the progress of the disease, if administered as soon as the incipient symptoms of the attack are observed; but Aconite, Hepar sulphuris and Spongia, generally alternately, become necessary when the affection is more deve- loped. f Vide note, p. 21. CROUP. 213 administration of the last mentioned remedy, we may, if the disease is not wholly vanquished, again fall back upon Spon- gia or Hepar sulphuris, according to the indications given for those remedies. There are other remedies which afford valuable assistance in the treatment of complicated attacks; but in truth it may be said, that in-the majority of cases, under any circumstances, Aconitum, Hepar sulphuris and Spongia, administered alter- nately, are almost always sufficient to effect a cure in a few hours. It may, however, be mentioned, that Tartarus emeticus has been found valuable in some apparently hopeless cases arising from paralysis of the lungs : Arsenicum, Sambucus, and Moschus, in complications with Asthma Millari; and Iodium, either alone in repeated doses, or alternately with Aconite, has been much recommended in obstinate cases, particularly when occurring in p'lthoric subjects. Hepar sul- phuris, Phosphorus, and Lycopodium, have been recommended as useful against a predisposition to this affection. [We are rejoiced to find that the subject of Croup has elicit- ed so much attention from the profession during the few past years, and that some expedients have been proposed with a prospect of success in these fearful cases of true membranous crou-, that have bid defiance, in the practice of every expe- rienced Homoeopathist, to the most renowned remedies of the scnool. These medicines are Ammonium causticum* (Caustic am- monia), Brominium ( Bromine), and Kali bichromatum (Bi- chromate of potash.) They have been urged principally in consequence of the correspondence of their pathogenetic effects with the pathological development of genuine croup, especially in regard to the transuded membrane. The Vapour of chlo- rine, on the testimony of Albers, has produced true croup symptoms, even to the formation of the membrane ; but to what extent this gas may be made safely available, must be determined by subsequent careful experimentation. * See note, p. 218. 214 RESPIRATORY SYSTEM. According to the " Pressburgh physicians," the following are the characteristic expressions of " CAUSTIC AMMONIA CROUP. " Deep, weak voice ; fatiguing, interrupted speech. In- creased secretion of mucus in the bronchia. Violent cough, with copious expectoration of mucus, especially after drinking. Difficult, rattling, laboured breathing ; stertorous breathing. Suffocative fits. Spasms of the chest." " BROMINE CROUP. Formation of pseudo membrane in the larynx and trachea. Spasms in the larynx occasioning suffocation. Cough with croup-sound, hoarse, wheezing, fatiguing, not permitting one to utter a word; accompanied with sneezing ; with violent suffocative fits. Respiration characterized by mucous rattling; wheezing ; alternately slow and suffocative, and hurried and superficial; laboured; painful; oppressed; gasping for air. Heat in the face. Increased secretion of urine. Pulse rather hard; slow at first, afterwards accelerated." BICHROMATE OF POTASH-CROUP. Dr. W. E. Payne, of Bath, Maine,* was induced to make trial of the Bichromate of Potash in croup, after reading Dr. Drysdale's " Summary of Pathological Appearances," pro- duced by this drug, and contained in the British Journa%of Homoeopathy. These appearances were :—'' Respiratory apparatus. " The air passages were constantly lined with a thick ropy muco-purulent fluid, when death was delayed beyond several days. In some instances the trachea was lined with a com- plete false membrane. The epiglottis, rima glottidis, trachea and bronchia, were, at different times, deeply injected. The lungs were generally healthy, and presented a remarkable contrast to the highly inflamed bronchia." Also elsewhere in the same summary : " Elastic plugs of mucus in the nostrils." * See note, p. 218 croup. 215 D r. Payne, relying on these croup-like developments, pre- scribed the Bichromate of Potash in two cases of croup, suc- cessfully. The first case presented the following phenomena, (those of an analogous case of croup that proved fatal under the usual remedies,) with this exception, " that the difficulty of breathing increased rather more rapidly, and the cough was rather more frequent." " Case 1. Boy of two years ; had enjoyed good health up to the time of this attack. A slight difficulty of breathing, when the mouth was closed, owing to one nostril being ob- structed with a plug of mucus, was observable. Pulse ir- regular and intermittent. There was a slight elevation of the temperature of the skin. Otherwise the child appeared well. He was lively and playful. This state continued for three or four days without any perceptible change, except the appear- ance of a few small sores below the nostrils, which were somewhat moist. On the evening of the third or fourth day there was, evidently, a change or increase of the disease. The respiration, though not hard, could be heard distinctly in any part of the room when the child made a deep inspiration. This did not seem to proceed, as before, from the obstructed nostril, though this remained the same, but from some difficulty about the larynx. The child would frequently carry his hand to his throat and put his fingers into his mouth. On the following day the difficulty of breathing had evidently increased. On applying the ear to the neck, a whistling sound was apparent, like that which may be produced by the passage of air through a metallic tube. Voice hoarse. Cough not frequent, but hoarse, dry, and barking or crowing. The child was restless, sleepless, and refused to drink, apparently because deglutition was painful. The tonsils and upper part of the larynx were red and swollen, and about the fauces was a small quantity of tenacious mucus. After the first day of invasion, the child could swallow his drinks without difficulty, and was thirsty. As the disease progressed, the difficulty of breathing gradually increased, causing a strong action of the abdominal muscles, the muscles of the neck and shoulder-blades. The head was 210 RESPIRATORY SYSTEM. inclined backwards. The shrill whistling respiratory sound increased, together with a tearing sound like that produced by a saw running through a dry board. The cough was mostly dry, but occasionally sounded loose and rattling. It, however, grew less and less distinct, until towards the close of the dis- ease it amounted to little more than a grunt. The child would be carried to and fro continually—not one moment would he allow his parents to sit with him. The breath became very offensive, and this offensiveness increased to an intolerant de- gree as the disease advanced. The plug of mucus remained in the nostril, but the herpetic sores gradually died away. The temperature of the skin was rather below than above the natural standard. During the last day or two of the disease the child was inclined to stupor. Though these symptoms gradually increased, yet there were occasional remissions ;— the breathing became less difficult, and the whole general appearance of the child was much better; but this apparent giving way of the disease lasted only for a short time. The breathing could be heard often in the street." Administration. One drop of the sixth dilution was mixed with half a tumblerful of rain water, and a tablespoonful of the liquid was given every five hours. In this instance the Bichromate was not administered until eighteen hours after the commencement of the attack. Dur- ing the use of this remedy, cold wet linen was applied exter- nally to the throat. After the difficult respiration became natural, hoarseness and a barking cough remained, which were subdued in three or four days by morning and evening doses of Hepar sulphuris. Case 2. The second case, similar to the one detailed, was treated early in the course of the disease, without a consen- sual application of cold wet linen to the throat, and recovered under the use of the Bichromate of Potash. IODINE. Dr. Koch, of Germany, commends Iodine as a most effi- cient agent against croup. As Aconite was employed alter- nately with this remedy in his thirteen successful cases, its specific power in his instances has been questioned. Dr. Tietze, who followed the experience of Dr. Koch, offers tes- CROUP. 217 timony in favour of Iodine in croup, and asserts that " it is only suitable in the treatment of croup as long as there is in- flammation and exudation. When this latter process has stop- ped, Iodine probably ceases to have any good effect. Hepar sulphuris then appears to be in its place." Iodine, according to its pathogenesis, applies rather to a catarrhal than a mem- branous croup, but may hold a preventive place to true croup, as Aconite, Spongia and Hepar have undoubtedly done in many instances, although Professor Ware deems the conver- sion of one form of croup into another impossible. Dr. Tietze states with apparent justice : " Although the symptoms which [ have here described may not constitute real croup, yet every- body knows that they occurred under circumstances where croup must have been the inevitable consequence of this first attack, unless met in the outset by proper treatment." Future observations of intelligent physicians will probably define these points, and especially the true position of Iodine. We add the following summary of the effects of Iodine by the " Pressburgh physicians." " *The larynx is painful. (Vogel.) * Pain in the larynx and expectoration of indurated mucus. (Hartlaub.) * Pressure in the region of the larynx, as far as the fauces, as if those parts were swollen. (Jorg.) * Aching and pricking pain in the legion of the larynx and the sublingual glands, several attacks on one day, (Jorg.) * Pressure in the throat inducing frequent hawking up of a quantity of tenacious mucus. (Hartlaub.) * Contraction and heat in the throat. (Hartl.) * Sore feeling in the throat and chest, while in bed, with wheezing in the throat and drawing pains in the lungs, which is felt regularly with the beats of the heart. (Hartl.) * Inflammation of the trachea. Roughness of the trachea the whole day, Hoarseness. (Comdet.) Hoarseness early in the morning, * The asterisk indicates that these symptoms have been removed M well as produced by this drug. 10 218 RESPIRATORY SYSTEM. Hoarseness for more than two weeks. (Hartl.) The voice becomes deeper, and finally quite deep. (S. H.) Sensation as if something were lodged in the larynx which he can bring up by hawking, the whole day and evening. Intolerable titillation in the larynx, which can only be ar- rested by hawking and coughing, with accumulation of water in the mouth, early in the morning when in bed. (Gff.) Expectoration of tenacious mucus, with pressure in the throat, as if something were lodged in it which he imagines he can swallow, early in the morning. (Hlb.) Violent titillation in the throat, inducing a desire to cough. (S.) Dry cough. (Matthey.) Violent oppression of breathing. (Golis. ) Asthma with pain during a deep inspiration; stronger, quick- er beating of the heart, and smaller, more frequent pulse. (Jorg.) * Asthma and arrest of breathing in the throat for a fort- night. (Hlb.) Loss of breath. (Gardner.) Want of breath. (Neumann.) Suffocative catarrh. (Orfila.)" To the layman we cannot too strongly urge the necessity of promptly sending for a physician on the first threatenings of this frightful malady. The physician will give close attention to the laryngeal wheezing or whizzing, and make a careful examination of the throat. The peculiar crowing tone of the larynx, and specks of coagulable lymph on the tonsils and in the throat, are sure indications of impending danger from true croup.]—Ed. Note—1. Characteristics and Physiography of croup and its varieties. Arranged by a member of homceopathic physicians in Pressburgh. Trans- lated by Ch. J. Hempel, M. D- (Horn. Exam., new series, vol. 1., p. 438.) 2.—Bichromate of Potash in Membraneous Croup. By W. E. Payne. M. D., Bath, (Me.) (Same Ex., vol, 1., p. 848.) 3.—On croup. By John Peters, M. D., (Same Exam., p. 187.) 4__On the use of Iodine in croup, [Same Ex., p. 75.) These interesting papers, which have furnished the ' staple of our remarks on croup, deserve the careful perusal of physi- pian?.—Ep, •219 INFLUENZA. Diagnosis. Catarrh appearing in an epidemic form, at- tended, in addition to the symptoms described at the com- mencement of the article, on common cold, with extreme op- pression and prostration of strength ; sleepiness, followed by shuddering and general chilliness; rheumatic pains in the head, back and limbs; and slight redness of the eyes, painful pres- sure, and sensibility to light. Therapeutics. The principal medicine in the treatment of this affection is Arsenicum, and in most cases, if not ad- ministered too late, it will be found specific. The following are the characteristic indications for its em- ployment : heaviness and rheumatic pain in the head; pro- fuse watery and corrosive discharge from the nose, causing a disagreeable burning sensation in the nostrils; violent sneez- ing; shiverings and shuddering, with severe pains in the limbs; oppression of the chest; difficulty of breathing; thirst; anxiety; restlessness; great prostration of strength, with aggra- vation of suffering at night, or after a meal; inflammation of the eyes, with sensibility to light. These symptoms may be attended with deep dry, fatiguing cough, exacerbated in the evening" at night, or after drinking, or sensations of dryness and burning, with mucus in the throat, which is difficult to detach. Administration. -6-, in a little water, repeated every six to twenty-four hours, according to the greater or less severity of the attack, until improvement sets in.* If this remedy be not sufficient to remove the disorder, we may have recourse to the following medicines: Aconitum, Nux vomica, Causticum, Mercurius, Phosphorus, Belladonna, Pith satilla, Camphor. Aconitum. When the disorder assumes an inflammatory character, with quickness of pulse, dry hot skin, and short, harsh, shaking cough. Vide note, page 21. 220 RESPIRATORY SYSTEM. Administration. 16-, in a teaspoonful of water, repeated in from six to twelve hours as required. Nux vomica. Obstruction of the nose, hoarse hollow cough, excited by tickling in the throat, and attended with severe headache, confusion in the head, giddiness, want of appetite, or sickness, thirst, aching pain in the lower part of the back, constipation, pain in the chest as if from excoriation. Administration. iy-, in a dessert-spoonful of water, re- peated for two or three evenings successively. Causticum will generally be found of great value, where Nux vomica has not produced the desired benefit, especially where the patient is of a lymphatic temperament. It is, how- ever, more particularly indicated when there are aching pains in all the limbs increased by movement; facial pains ; violent, dry cough, worse at night, with pain in the chest as from exco- riation ; constipation, disinclination for food ; vomiting. Administration. Same as Nux v. Mercurius. Dry or fluent coryza ; pains in the head, face, and teeth; sore throat; violent shaking cough, excited by irri- tation in the throat and chest; shivering or heat with profuse perspiration; aching in the bones, and slimy bilious diarrhoea, attended with tenesmus. Administration. --6-°, disolved in four dessert-spoonfuls of water, one to be taken night and morning. Phosphorus is frequently exceedingly useful after Mercu- rius ; it is particularly indicated when there is excessive irri- tation in the larynx and bronchia, with alteration of the voice, and pain during articulation. Administration. °°600, the same as Merc, but when the pulmonary symptoms give evidence of a greater degree of irri- tation, a few globules of the third potency may be dissolved in six dessert-spoonfuls of water, one to be taken every four hours. Belladonna. Dry, spasmodic cough, aggravated towards night; sore throat, excessive headache, increased by talking, moving, or bright light; fixed look ; confusion of ideas on clos- ing the eyes. Administration. \°, in a teaspoonful of water, to be re- peated in twenty-four hours, if necessary.* * Vide note, p. 21. DETERMINATION OF BLOOD TO THE CHEST. 221 Pulsatilla. Loose cough day and night, exacerbated by lying down, thick offensive coryza, tendency to relaxation in the bowels, loss of appetite, foul tongue, disagreeable or in- sipid taste in the mouth. Administration, y, in a dessert-spoonful of water, for three or four successive mornings, fasting.* Camphora. One or two drops of weak spirits of Camphor when taken at the commencement of the attack, and repeated until the chilliness or shivering begins to subside, will fre- quently check the further progress of the disease. In a more advanced stage of the affection, with (laborious) asthmatic breathing, accumulation of mucus in the bronchi, and cold, dry skin, Camphora is further of considerable service. Finally:—Arnica may be administered with advantage in some cases, particularly when pricking pains are experienced in the chest during inspiration (pseudo-pleurisy), with aching pains over the whole body, headache, and hemorrhage from the nose; Ipecacuanha after Arsenicum or any of the other remedies when there is vomiting or violent retching during or after each fit of coughing. Senega. Tickling irritation and continual burning in the larynx or throat, with loud mucous rale, and fear of suffo- cation on lying down : StannUm in neglected or protracted cases with easy but excessive expectoration of mucus, and great weakness:—Cinchona may advantageously follow the last remedy when the expectoration has been diminished. DETERMINATION OF BLOOD TO THE CHEST. Congestio ad Pectus. Diagnosis. Sensation of great fulness, throbbing, weight or pressure in the chest; and palpitation of the heart, attended with anxiety, short sighing respiration, and dyspnoea. We find that the predisposition to affections of the chest and lungs is greater during the period preceding puberty, and for some years after, than at any other epoch of man's existence. * Vide note, p 21. 222 RESPIRATORY system. As remarked in the Diseases of Children in Infancy and during very early childhood, from the disproportion between the cerebral system and the other portions of the economy, the diseases which the physician has chiefly to combat are those arising from over-excitements of the nervous organ- ization. In maturer years the tendency to abdominal con- gestion generally develops itself. This is easily explained by entering into the physiology of these different periods of hu- man life ; but as my object is rather the treatment of disease than the elucidation of these interesting points, I shall here content myself with briefly alluding to them. There is no doubt, as already remarked, that a particular period of human life is peculiarly liable to chest affections, and, among others, to this disorder, but too frequently the precursor of other more serious maladies. Some constitu- tions, however, particularly those in which a hereditary phthi- sical taint exists, exhibit a marked predisposition to pectoral congestion. Amongst the most frequent causes of this pre- disposition being called into dangerous activity, are : exposure to extremes of heat or cold; stimulants, such as alcoholic, vinous or fermented beverages, or coffee ; the abuse of nar- cotic drugs ; violent exercise, such as running, dancing, &c, or over-exertion even of the voice either in speaking or sing- ing ; sudden check of perspiration; cold or damp feet; se- dentary habits ; metastases ; repercussed cutaneous eruption ; or suppression of customary discharges, such as the catame- nial and hemorrhoidal flux. Therapeutics. Aconitum, Nux vomica, Ipecacuanha, Bel- ladonna, Aurumfoliatum, Mercurius, Pulsatilla, Spongia, Cin- chona, Sulphur, are the best remedies in general cases. Aconitum is especially indicated when there is violent op- pression with great heat and thirst, palpitation of the heart, great anxiety, and shaking cough. It will be found particu- larly valuable for plethoric females of sedentary habits, who suffer considerably from congestion before and during the ca- tamenia. In such cases it may be advantageously followed by Mercurius, to prevent a relapse. (In others by Bella- donna. ) determination of blood to the chest. 223 Administration. -£-, repeated in twenty-four hours, if necessary, and the same symptoms continue. When the con- gestion runs high, it must be administered as in Inflamma- tory Fever, whieh see. Nux vomica. When the affection has been developed by sedentary habits or by habitual indulgence in the stimulants already alluded to, or from hemorrhoidal metastasis or sup- pression, in such cases this remedy itself frequently effects a cure. Administration, f, in the same number of dessert-spoon- fuls of water, one each evening, at bedtime; adding thereto four or five drops of spirits of wine, to prevent its decompo- sition and keeping the mixture protected from the air. Ipecacuanha will frequently complete the cure, when Nux vomica has not removed the whole of the symptoms. Administration, ^f-, in a little water, repeated every twenty-four hours until improvement results. Belladonna. Oppression and throbbing at the chest, with shortness of breath and strong palpitation of the heart, extend- ing into the head; short cough, chiefly at night; internal heat and considerable thirst. Administration. £-, in a teaspoonful of water, daily until perceptible melioration arises, or an alteration of symptoms takes place which may call for another remedy. Aurum. Extreme oppression of the chest, as if suffoca- tion impended, sometimes with loss of consciousness and livid hue of countenance ; palpitation of the heart; and excessive anguish. Dose. Half a grain of the third trituration, or a few glo- bules of the sixth in half an ounce of water, a teaspoonful every four, six or twelve hours, according to circumstances. Mercurius, as already remarked, is valuable after Aconi- tum on certain occasions, (see that remedy ;) and also when there is burning heat and oppression at the chest, and frequent desire to take a deep inspiration; or, cough with expectora- tion streaked with blood, and palpitation of the heart. Administration. °£°, in a teaspoonful of water, repeated in twelve hours, after which we may lengthen the interval, 224 RESPIRATORY SYSTEM. and only repeat again should a cessation of improvement take place; in many instances it may be exhibited in the same manner as Nux vomica. Pulsatilla. Ebullition of blood in the chest with exter- nal heat; constriction in the chest with impeded respiration ; palpitation of the heart; anxiety and aggravation of the symp- toms towards evening, also when pectoral congestion has arisen in phlegmatic subjects from hemorrhoidal suppression, or in females from stoppage of the menstrual flux. Administration. fj, in a teaspoonful of water, repeated in twenty-four hours, if necessary; but in the majority of cases it may be administered in the same manner as given under Nux vomica, with a difference in time, taking a dose half an hour before breakfast. Spongia tosta. When the symptoms are provoked by the slightest exertion or even movement, and are attended with anguish, sensation of threatened suffocation, nausea, prostra- tion and fainting. Administration. Same as Aurum. Bryonia. Burning heat in the chest with a sensation of tightness, dyspnoea, and anxiety; palpitation of the heart; occasional prickings in the chest during inspiration. Administration same as Pulsatilla. Cinchona. When we can trace the affection to debilitat- ing losses, with palpitation of the heart and oppressed breathing. Administration. The same as Pulsatilla. Sulphur. Ebullition of blood, weight, fulness and pres- sure in the chest, aggravated by coughing, palpitation of the heart, dyspnoea, chiefly on lying down at night; it is also most serviceable in suppressed hemorrhoids, after Nux vo- mica or Pulsatilla, and after the latter remedy in checked catamenia. Administration. -6-, repealed every five days until a marked alteration for the better take place, or the symptoms assume another form, calling for the employment of some other more appropriate remedy. Phosphorus. In some obstinate cases th;s remedy is fre BRONCHITIS. 225 quently successful in affording speedy relief, particularly when in addition to the more usual symptoms, shooting or pricking pains are frequently experienced on laughing, speaking, or walking quickly ; palpitation of the heart, anxiety, sensation of heat extending from the chest into the throat. Administration. A few globules of the third, night and morning, discontinuing as soon as decided relief is obtained. Some one or more of the preceding remedies, if judiciously selected, and timely administered, will generally check the disease, and prevent it assuming a more dangerous form; for example, running into hemoptysis, phthisis, pneumonia, car- ditis, &c. The following, among others, have also been found useful in peculiar cases: Rhus toxicodendron, Sepia, Natrum muriaticum, Phosphorus, Carbo vegetabilis, Acidum nitricum, Ammoniacum carbonicum, and Ferrum metallicum. INFLAMMATION OF THE MUCOUS MEMBRANE OF THE BRONCHIAL TUBES. COLD ON THE CHEST. Bronchitis. Pulmonary Catarrh. This disease consists of a greater or less degree of inflam- mation of the mucous membrane of the bronchi, and is divided into acute and chronic. Of the former it is intended more particularly to treat. The disorder is of frequent occurrence, both as an idiopathic affection, and as a concomitant of mea- sles, scarlatina, smallpox, hooping-cough, &c. Diagnosis of Acute Bronchitis. Chilliness, succeeded by fever ; hoarseness ; difficulty of respiration ; severe, frequent, and distressing cough, at first dry or with scanty expectoration of frothy or viscid mucus, which subsequently becomes co- pious and sometimes streaked with blood ; constriction at the chest with a feeling of oppression ; general weakness, foul tongue, and loss of appetite; rapid pulse, increase of the dif- ficulty of respiration, which sometimes approaches to a feel- ing of suffocation ; paleness of the lips, cadaverous and anx- ious countenance, loud wheezing, and o» applying the ear to 10* 22G RESPIRATORY SYSTEM. the chest, a louder sound than the natural respiration, either rattling, whistling, or droning, or harsh and broken, according to the advance of the disease.* In the cases which terminate favourably, the first symptom of improvement which sets in is a greater freedom of breathing, with remission of the fever, and an alteration in the expecto- ration, which becomes thicker, whiter, and diminished in quan- tity. But when the disease takes an unfavourable turn, the difficulty of breathing increases, a state of excessive debility and collapse supervenes ; the face becomes livid, the body cov- ered with a cold and clammy sweat; the mucus accumulates rapidly in the bronchial tubes, and the cough, which has be- come feeble through the exhausted and sinking energies of the patient, is insufficient for its ejection; aeration of the blood in the cells of the lungs is prevented ; cerebral symptoms declare themselves from impeded circulation, or the effect of unarterialized blood circulating in the brain, and the patient is carried off in a state of asphyxia. In many, and the most dangerous cases of acute bronchitis, although a degree of oppression at the chest be present, no particular pain, heat of skin, nor fever, may exist: this is the most insidious form of the disease, in which it is but-too fre- quently neglected until beyond the power of the physician's art; this occurs most frequently in children who may appa- rently be only troubled with a slight wheezing, of which scarce- ly any notice is taken or any medical aid called in, until sud- denly suffocation threatens, or some organic lesion is produced, so that an affection which probably might have been easily subdued at the onset, is now beyond control. The frequency of the disease in infancy and early life de- serves a particular notice. It generally commences, as in adults, with the symptoms of a common catarrh ; the breath- ing becomes quick and oppressed, and from the increased action of the diaphragm, the abdomen becomes prominent; both the shoulders and nostrils are in continual motion, but the wheez- * Sibilant and sonorous rhonchi, in the early stage, and mucous or bub- bling rhonchus when the secretion becomes increased, indicate both the nature and extent of the disease. bronchitis. 227 ing is often more marked than the difficulty of respiration, and on applying the ear to the chest, a mucous rattle is heard over almost every part; expectoration sometimes temporarily re- lieves, and occasionally the mucus is expelled from the air- passages by vomiting ; the countenance is pale and anxious, and somewhat livid :—these symptoms are interrupted and relieved by occasional remissions, during which the child gen- erally appears drowsy ; but they return with additional severi- ty, and, if not checked, an accession of extreme dyspnoea en- sues, and death takes place from suffocation. When sore throat is also present, coughing produces considerable pain, and the child for that reason frequently endeavours to sup- press it. There is also impaired appetite with thirst, although when the disease has advanced, it is found difficult to take a long draught, from its impeding respiration : this is very ob- servable with children at the breast, who, after eagerly seizing the nipple, will bite it, and discontinue sucking, cry, and throw back the head, and after vomiting up the phlegm, con- tinue for some time in that position. In some cases, from the character of the voice and cough, bronchitis has been mistaken for croup. The tubes of one lobe, or of one lung only, may be affected, but sometimes those of both lungs participate. The exacerbation of suffering at night is a very remarkable symptom of this complaint. - The causes are the same as those of common catarrh. Therapeutics. The remedies about to be pointed out as most appropriate in ordinary cases of this affection are: Aco- nitum, Spongia, Belladonna, Nux vomica, Bryonia alba, Lach- esis, Phosphorus, Pulsatilla, Mercurius, Cannabis, &c. Aconitum is the remedy upon which we must place our chief reliance in the inflammatory stage of the disease, and throughout its course, as long as a febrile character exists. Its more marked indications are : hot, dry skin, with strong, hard, and accelerated pulse; hoarseness, with roughness of the voice ; short, dry, and frequent cough, excited by tickling in the throat and chest; obstructed respiration, sibilant or sono- 228 RESPIRATORY system. rous rhonchus, anxiety, restlessness, headache, and thirst, with occasionally scanty expectoration of viscid mucus. Administration. A few globules of the third potency, added to an ounce of water ; a dessert-spoonful every three hours until relief be obtained ; after which we may either lengthen the intervals, or select some other remedy more ap- propriate to the symptoms present. It will also be found occasionally necessary to return to this remedy, as above re- marked, during the course of the disease, particularly during the nocturnal febrile exacerbations. Spongia is often of the greatest service after the previous administration of Aconite, when there still remains a consid- erable degree of inflammation in the bronchial tubes, especially the larger, with sibilant or sonorous rhonchus ; and also at a more advanced stage of the disease, when the mucous rhonchus is distinctly audible ; with hollow, dry cough day and night, but worse towards evening ; or cough with scanty, viscid, ropy expectoration; heat in the chest, burning, tickling irri- tation in the larynx, quick, anxious, laborious respiration ; hoarseness. (Hepar s. is sometimes useful after Spongia when the mucous rhonchus is predominant, the skin hot and dry, and the efforts to expectorate ineffectual.) Belladonna. This remedy is useful when there is severe cephalalgia, materially aggravated by coughing ; oppression of the chest, and constriction as if bound, with rattling of mucus in the bronchi; short, anxious, and rapid respiration ; dry, fatiguing cough, especially at night, and thirst. Soreness of the throat, (see Sore Throat.) Sulphur after Belladonna. Administration. The same as Aconite, only at intervals of four, six, or twelve, instead of three hours.* Nux vomica. Dyspnoea, with excessive tightness of the chest, particularly at night; hoarseness ; dry cough, worse towards morning, attended with a sensation as from a blow, a bruise, in the epigastric or hypochondriac regions ; cough with difficult and scanty expectoration of viscid mucus ; dry- ness of the mouth and lips, thirst, constipation, peevishness. Administration. The same as Belladonna. * Vide note, p. 21. bronchitis. 229 Lachesis. Oppression at the chest, with short and hurried respiration, anxiety, and dejection ; mucous rale; dry, fa- tiguing cough, sometimes followed by the expectoration of a little tenacious or frothy mucus, after much effort, occasionally streaked with blood ; hoarseness. Administration. Same as Belladonna. Bryonia. Difficult and anxious respiration, with constant inclination to make a deep inspiration ; hoarseness; headache; cough dry, attended with a sensation of burning, or cough with expectoration of viscid sputa ; in some instances tinged with blood ; dryness of the mouth and lips, excessive thirst. When, moreover, the respiration is impeded by shootings in the chest, and this infection threatens to become com- plicated with pleurisy, this remedy is still more particularly called for. Administration. The same as Aconite. Phosphorus. This "important remedy is frequently of great utility in this affection when the more inflammatory symptoms have been subdued by Aconite, but the respiration continues much oppressed, accompanied with great anxiety? and heat in the chest; dry cough, excited by tickling in the throat or chest, aggravated by talking or laughing, and follow- ed by expectoration of stringy mucus of a saltish taste : Fur- ther, when the disease has been neglected, or when, from the phenomena which present themselves at the commencement, we have reason to dread complication, or an extension of the inflammation to the substance of the lungs, which we gene- rally recognise by crepitation and rusty sputa,—there will be additional reason for administering Phosphorus. (See Pneumonia.) Pulsatilla. Respiration short, accelerated, and impeded, attended with rattling of mucus, heat in the chest, and anx- iety ; hoarseness; shaking cough, worse towards evening, at night, or in the morning, accompanied with considerable ex- pectoration of tenacious, or thick, yellowish mucus, some- times mixed with blood; coryza with copious discharge of thick, discoloured mucus. Administration. Same as Belladonna. 230 respiratory system. Sepia may be selected in preference to Pulsatilla, when the expectoration is very copious, though somewhat difficult, and of a salt taste; exacerbation of cough in the morning and towards evening,—followed by Stann., if still profuse, but more easy, greenish, and less saline, or of a sweetish taste. Lycopodium. When the cough is materially worse at night, and attended with thirst, quickness of pulse, but moist skin or tendency to sweat; expectoration yellowish gray, and of a saltish taste; oppression at the chest. Mercurius. This remedy may occasionally be found use- ful when the symptoms of bronchitis are found accompanied by excessive perspiration; when the cough is fatiguing, worse in the evening and at night, and excited by a tickling irritation, or sensation of dryness in the chest, with quick, short, oppressed breathing, and louder respiration than ordi- nary ; hoarseness ; coryza with watery, acrid discharge ; swell- ing of the nose. Dulcamara is occasionally serviceable after Mercurius, when there is a continuance of night sweats of an offensive odour. Administration. % in an ounce of water; a dessert- spoonful every four or six hours, until relief ensues. Chamomilla may also be mentioned as a useful remedy in cases of children, after the previous exhibition of Aconite, when a slight degree of whistling or sonorous rhonchus still remains ; dry cough worse at night, occurring even during sleep. For further indications, see this remedy under the head of Cough. , Ipecacuanha. Also very valuable in the case of children, but generally at a more advanced stage of the disorder, with mucous rhonchus in the chest, and when on coughing they are almost suffocated by the excessive secretion of mucus, and become livid in the face ; shortness of breath, and perspiration on the forehead after each fit of coughing.—Administration. One globule every two hours until improvement results. There are some other remedies which have been found of great value in the treatment of this affection, namely, Tarta- rus emeticus, Arsenicum, Sulphur, &c. BRONCHITIS. 231 Tartarus emetic us is chiefly found useful in those ex- treme cases where the smaller tubes are clogged with mucus, and suffocation threatens; when the cough suddenly ceases, either from weakness or other causes. Administration. A grain of the trituration at the second or third potency in four dessert-spoonfuls of water, one every quarter, every half, or every hour, according to the severity of the symptoms or the effects produced. Arsenicum is occasionally of the utmost service in those unfavourable cases in which the pulse becomes very quick, feeble and intermitting, and the patient is reduced to a state of extreme debility and collapse. Administration, y^0, in four teaspoonfuls of water, one to be given from time to time, as required.* Sulphur is used in winding up a cure, and preventing the disease running on to the chronic form, or when the .expecto- ration has increased in quantity and become whitish and less viscid. Administration : see Arsenicum. For the benefit of the medical reader, I may add, that Hepar sulphuris, Ammonium carbonicum, Cannabis, Bromium, etc., may also be found useful in some particular cases. Opium, Belladonna, Tart, em., and Lachesis, may be found service- able against the symptoms of stupor which are so liable to set in in severe attacks of this disorder. Diet. In the severe forms of bronchitis, the diet to be observed should be the same as that mentioned under fever ; but when the febrile and inflammatory symptoms have been completely removed, the patient should gradually return to a more nutritious diet, even though a considerable degree of cough and expectoration remain. In the slighter forms of the complaint, spare diet, confine- ment to the house, in short, the simple measures laid down for the treatment of common colds in another part of this work, will frequently check or at all events materially shorten the attack. See also article Cough, in which further indica- tions will be found for the selection of the remedies required in both varieties of bronchitis. * Vide note, p. 21. 232 RESPIRATORY SYSTEM. Chronic Bronchitis : Bronchitis Chronica. This com- plaint may be the result of the acute affection, or it may arise as a gradual and insidious inflammation of the mucous mem- brane of the bronchial tubes, or proceed from the inhalation of dust or other minute particles carried into the lungs ; it may also be coeval with diseases of the heart, or declare itself after eruptive fevers. It differs from acute bronchitis chiefly in the greater mildness and longer duration of its symptoms, the continuance of which varies from several weeks or months to many years. It affects elderly persons more frequently than the young, but is of course liable to occur at all ages as the result of an acute attack, (although such a circumstance is comparatively of rare occurrence under proper homceo- pathic treatment,) the consecutive of measles, etc. A compar- ative exemption from cough, is frequently experienced during summer ; but in winter, or in inclement springs, the patient is tormented with harassing cough, and copious viscid expec- toration, especially in the morning, which in the severe forms of the disorder is peculiarly distressing. The expectorated matter in the chronic affection is of a different nature from that in the acute, being of a thicker consistence, and of a greenish or yellowish white colour; it is not unfrequently muco-purulent, and sometimes decidedly purulent, and occa- sionally streaked with blood, particularly in obstinate, invet- erate cases. There is generally more or less dyspnoea, with acceleration of pulse after slight corporeal exertion ; but in other respects the health may be good, and continue so. In the more trying forms of the disorder, an aggravated state of all the symptoms enumerated is met with; moreover, where the sputa is of a purulent nature, hectic fever, extreme ema- ciation, nocturnal sweats, and occasional attacks of diarrhoea, are frequent adjuncts; these latter are sometimes liable to cause the disease to be mistaken for tubercular consumption ; but in the majority of cases, auscultation, percussion, together with a careful attention to the symptoms and the history of the case, enable us to form an accurate diagnosis between them. In chronic bronchitis, the resonance of the chest is, on percussion, little if at all diminished. On applying the ear RONCHlTiS. 233 or stethoscope to the chest, the respiratory murmur is found to vary much in intensity, but is never permanently absent in any part of the chest, and is frequently even puerile. The mu- cous rhonchus in most of its varieties is heard in various parts of the chest at different times, and occasionally the whist- ling and sonorous rattles are discernible. When the dilata- tion of the bronchial tubes is considerable, as is not unfrequent- ly the case in this affection, a loud bronchophony is heard which is with difficulty if at all to be distinguished from pecto- riloquy, and a rale closely resembling a cavernous rattle is ap- parent in the vicinity of the dilated tube. The sound on per- cussion will, however, generally enable us to form the required distinction, the dulness of tone being not so great over a dila- ted tube, as it is in the vicinity of a vomica; the situation of the cavity of the two cases is, moreover, usually different: dilated bronchi being, as is well known, most frequently de- tected in the scapular, mammary, and lateral regions, and vo- micae in the subclavian and axillary regions. However, as before said, we must combine the history of the attack, the constitution of the patient, and the progress of emaciation, &c, with the symptoms to be heard by the ear after repeated exa- minations, in all doubtful cases, ere we come to a definite conclusion as to the exact nature of the case, where that is of material consequence; but as regards the prognosis, chronic bronchitis, with purulent expectoration, dilated tubes and hectic fever, has been truly considered to be nearly as formidable and serious a malady as phthisis itself, and hence ultimate re- covery almost as doubtful. As this is a disease which requires a long and judicious treatment for its removal, I shall content myself with a brief enumeration of the remedies hitherto found most useful in cases of this nature. These are Sulphur, Calcarea carbonica, Carbo vegetabilis, Pulsatilla, Hepar sulphuris, Phosphorus, Stannum, Sepia, Ly- copodium, Natrum carbonicum, Natrum muriaticum, Baryta c, Lachesis, Causticum, Arsenicum, Silicea, Staphysagria, Kali carbonicum, Acidum ni'ricum, and Conium maculatum. 234 RESPIRATORY SYSTEM. See, however, the article Cough, where indications for the selection of most of the above remedies will be met with. INFLAMMATION OF THE LUNGS. Pneumonia, Peripneumonia, Pneumonitis. This disorder consists in an inflammation of the parenchy- ma of the lungs. Diagnosis. Shiverings and chills, followed by heat or fe- ver ; dyspnoea; respiration short and hurried; cough, short, dry, continuous, and distressing at the commencement, after- wards attended with scanty expectoration of viscid, lumpy, and extremely tenacious mucus, generally intermixed with brick-dust sputa, (giving it a rusty colour,)* but occasionally of a bright red ; cough at every deep inspiration, or on every attempt to speak; interrupted speech, or a pause after every articulation; abdominal respiration, sometimes a dull pain in the chest, but more frequently rather a tightness than pain; pulse variable, generally full and strong and quick; but when the inflammation has run high,—hard, wiry, and greatly ac- celerated ; tongue parched and dark coloured. The patient generally, in severe cases, lies upon his back. In the first stage of many cases, when not marked by com- plication with bronchitis, on application of the stethoscope or the ear to the chest, the crepitous rale may be heard; but the sound on percussion only slightly impaired. As the inflam- mation gains ground, and the substance of the lung becomes altered in structure,! bronchial or tubular respiration is per- ceptible, with louder respiratory murmur than natural, in the sound parts of the lung, particularly in severe attacks; also bronchophony may be present; and the tone elicited by * This rusty or sanguinolent hue being ultimately combined, not in streaks: It appears usually about the second or third day, and is a char- acteristic indication of the presence of the disease in question; at the same time, it must be borne in mind, that its absence is by no means a certain criterion of the non-existence of inflammation of the lungs. f Second stage, or that of hepatization. INFLAMMATION OF THE LUNGS. 235 percussion more or less dull according to the seat of the struc- tural derangement, but rarely so complete or extensive as in pleuritis with copious liquid effusion. In the latter stages of the complaint, the face frequently becomes patch ell with red, and sometimes livid; and the pros- tration of strength is excessive.* I have remarked, that the pulse was variable, inasmuch as it has been frequently the fashion to lay too much stress upon that symptom; but the disease may run on to a fatal termi- nation without it being beyond the natural standard. Neither is a hot dry skin a sure criterion, inasmuch as in the conges- tive form of this disease from the determination of the blood to the lungs, the surface of the body is almost invariably cold. Such are the general symptoms of pure Pneumonia, but in severe cases it is often found combined with pleurisy, when the pains of the chest are intense, and mostly of an acute shooting character. Bronchitis is another and still more fre- quent complication. Therapeutics. Aconite, Bryonia alba, Phosphorus, Tar- tarus emeticus, Rhus toxicodendron, Belladonna. Aconite b-^-. In the stage of simple inflammatory con- gestions with severe inflammatory fever, whether or not ac- companied or followed by severe shooting pains in the chest, this remedy is unquestionably of great service. Administration. The same as in Inflammatory Fever. Bryonia is generally the best remedy to follow Aconite, when the more severe febrile symptoms have been lowered by that medicine ; or from the commencement, when the following indications present themselves: cough, attended with expecto- ration of viscid or tenacious mucus, of a brick-dust colour, oppression at the thorax, and acute shooting pain in the chest and sides, or rheumatic pains in the pleura, and pectoral muscles, or in the extremities, with increase of pain on move- * In the third or suppurative stage of the disorder, the tubular respi- ration and vocal resonance commonly disappear, and a gurgling mucous rale is occasionally substituted. The expectoration becomes muco-puru- lent, or converted into a brown serous fluid; and the vital energies gene- rally sink rapidly. • 236 RESPIRATORY SYS'IEM. ment; foul tongue and constipation. A complication with pleurisy, pleuro-pneumonia, indicated by increased dulness on percussion, and in some instances a double-sounding voice, central bronchial respiration, and bronchophony, is often an additional reason for the selection of this remedy. (See also Pleuritis.) Administration. One drop of the tincture at the third po- tency, in about an ounce of water, a dessert-spoonful to be administered every four, six or eight hours, or a few globules of the third in a dessert-spoonful of water, repeated at similar intervals, according to the severity of the case.* Phosphorus. This remedy has been lately almost exclu- sively employed by Dr. Fleischmann,t of Vienna, in almost every stage of pneumonia under what form soever it presents itself, and with the most marked success, even when exten- sive hepatization has taken place. Although the homoeopathic treatment hitherto adopted with Aconitum, Bryonia, &c. has proved eminently successful, yet this remedy, which seems to have such a specific influence over this serious disease, deserves a more extensive trial.J Administration. A drop of the tincture at the third po- tency, added to four dessert-spoonfuls of water, one in four hours, lengthening the intervals according to the effects pro- duced. Tartarus emeticus is chiefly valuable in promoting reso- lution after hepatization has taken place, which is indicated by the greater or less degree of dulness on percussion, the bronchial or tubular respiration, and the peculiar pectoral sounds given by the voice, and may be had recourse to when * Vide note, p. 21. f Dr. Pleischmann's preparation is made with 10 drops to the 100, ad- ministered at the third to the sixth potency, from four to eight drops, in from two to four ounces of distilled water, a spoonful three to six times a day. Hygsea, vol. viii- X It sometimes happens that, notwithstanding the early employment of this medicine, the physical signs of this disease appear to advance un- interruptedly, and it is only from unequivocal eymptoms of improvement in other respects, that we feel encouraged to persevere with the remedy, and thereby obtain the most satisfactory and triumphant results. • INFLAMMATION of the lungs. 237 the preceding remedy has not completely effected this desi- rable object. Administration. One grain of the second potency in an ounce of water, a dessert-spoonful three times a day. Tincture sulphuris may deserve a preference to the last- mentioned remedy in similar cases, in strumous habits, also where hepatization has advanced to some extent, and where Phosphorus may have only relieved ; also where there is com- plication with pleurisy, and obstinate constipation. In obsti- nate or chronic cases, Lachesis and Lycopodium have been found very useful after, or in alternation with Sulphur. Administration. A few globules of the third or sixth po- tency in a teaspoonful of water repeated in from six to twelve hours, according to circumstances,-r- if an improvement ensue, allowing the medicine to continue its action. The preceding are the principal remedies used in the ma- jority of cases of this disease ; but the following also have been found excellent auxiliaries in some instances, and merit attention. Belladonna, where the fever has returned, after having been apparently subdued by Aconite, and the difficulty of breathing and pain continue, particularly when the pain seems more at the sternum; the sputa tinged with blood and difficult of expectoration, the cheeks flushed, lips and tongue dry and scorched, leaving heat of the skin and incessant thirst. Acidum nitricum has been of service in some cases, where, after Aconite, a cessation of pain has taken place with increase of fever. Squilla has been recommended as useful in forwarding the crisis : further, in pneumonia accompanied with gastric symp- toms, and where the expectoration is copious, or in cases which have previously been treated by venesection, and China has not proved sufficient to rouse the sinking energies. Mercurius, when the fever has been lowered by the em- ployment of Aconite, but pain and difficulty of breathing re- main, copious nocturnal sweats exhaust the patient's strength, and the pulse is small and quick; also where there is promi- nent bronchitic complication:—in the latter instance Caps'cum 238 RESPIRATORY SYSTEM!. Nux v., Pulsatilla and Bryonia, have also proved efficacious : Capsicum particularly in the case of phlegmatic subjects; Nux v., alternately with Phosphorus, especially in the case of drunkards ; and Pulsatilla in chlorotic females. The indica- tions for Bryonia have already been given. Cannabis has also been found useful in this frequent complication, and in one or two cases where there was disease of the heart and large vessels, with greenish vomiting and delirium. Arnica °$°. Against effusion into the air-passages, with local congestions and hemoptysis. Rhus tox. in the congestive stage of pneumonia, with rest- lessness, palpitation of the heart and redness of the face. But with diarrhoea and clammy sweats, Arsenic. When inflammatory symptoms have been subdued, but the expectoration presents a muco-purulent appearance, and there is great prostration with nocturnal sweats, Lycopodium %% has been found very efficacious. Lachesis f # has proved beneficial sometimes in alterna- tion with Arsen. and China, in those almost hopeless cases which threaten to turn to gangrene of the lungs, (with fetid breath and sputa.) Phosph., Kali, and Lycop., %%, useful in pneumonia occur- ring in phthisical subjects. It may be useful to add a few words respecting the pectoral signs in this affection when progressing to resolution : if no hepatization have taken place, the crepitous rale, at first audible, becomes gradually less perceptible, and the natural respiration is heard, till at last the former wholly disappears ; if the lung have already partly solidified, but the disease is approaching a cure, the crepitous rale is first heard, then^radually yields to the natural respira- tion; in fact, the disease, so to speak, runs its course back again. Diet. It is scarcely necessary to remark, that during the inflammatory period, an almost total abstinence must be ob- served ; even during convalescence there is caution required, and care must be taken not to allow the patient to over- indulge his returning appetite, as any error in this respect may entail troublesome consequences. The drinks may con- sist of water, toast-water, and sometimes whey, rice or barley-water, sweetened with a little sugar if desired. 239 PNEUMONIA NOTHA, OCCULTA. This affection, which is usually most insidious in each ap- proach, is more frequently met with in old than in young or mid- dle-aged subjects, and is liable to terminate in paralysis of the lungs. Sometimes the attack is preceded by a feeling of general prostration; or comes on like an attack of common cold, with cough and alternate heats and chills. The cough is generally loose from the commencment; the sputa white, yellow, slimy, and generally blood-streaked. There is great weight or oppres- sion at the chest, with quick laborious breathing; pain only when taking a deep inspiration, and generally in a small circumscribed spot. All these symptoms are usually aggravated by any thing which calls for an increased play of the lungs, such as talking, or laughing loudly, ascending stairs, etc.; finally, particularly in the more severe attacks, lying upon either side becomes oppressive, so that the patient is generally found on his back. Pulse soft but quick, the cheeks slightly flushed, the skin moist and damp, and sometimes there is nocturnal sweating, which affords no relief; towards morning the febrile action subsides a little, and the patient feels generally somewhat easier. The voice is low and weak, sometimes dying away to a whisper. In the treatment of this affection, a dose or two of Aconite is occasionally required, when the fever runs rather high, but Mercurius is more frequently called for, even at the very commencement, and particularly when there is nocturnal sweating and moist or clammy skin during the day; after Mercurius has been administered with more or less benefit, Belladonna will generally be found useful, and especially when a short dry cough remains, attended with spasmodic constric- tion in the chest which impedes respiration, and causes an oppressive sensation of suffocation. If Belladonna does not complete the cure, and the cough is accompanied with sibilant or wheezing respiration, a dose of Aconite may be given, fol- lowed by Chamomilla and Nux v., the latter especially when there is dry cough, or cough with difficult expectoration of a little slimy mucus, and excessive tension and oppression in 240 RESPIRATORY system. the chest. In those cases in which Mercurius affords little relief, and. the breathing continues quick and laborious, and the countenance is expressive of great anxiety, Ipecacuanha in repeated doses is frequently followed by satisfactory results ; but should the extremities become cold, and the sensation of constriction in the chest, with extreme anxiety, increase, Veratrum may be administered: on the other hand, if the paroxysms of threatening suffocation become more and more distressing and the patient appears sinking from exhaustion— Arsenicum -3-0- must claim a preference, and will often succeed in restoring the expiring energies of the patient when the case has assumed a perfectly hopeless appearance. It may be added, that Arnica -f- has been found useful in some instances in the early stage of the disorder, when a bruised or beaten pain was experienced in the chest, the cough not very troublesome, but attended with blood-streaked slimy sputa; followed by Pulsat. -§- when the expectoration be- came more considerable, with melioration of the pectoral symptoms. Some of the remedies mentioned under Pneu- monia Vera, such as Bryonia, Tartarus, Sulphur, Lycopodi- um, &c. may also be found useful in this complaint under par- ticular circumstances. TYPHOID OR CONGESTIVE PNEUMONIA. In this variety of pneumonia the local spmptoms are usual- ly very obscure, and the accompanying fever is of the ty- phoid kind; the pulse quick and very weak, the skin harsh, dry, or clammy, tongue brown and parched, and the urine of greatly diminished quantity and high coloured. In some cases the following physical signs can be detected : dulness on percussion, and absence of respiratory murmur in the lower and back parts of the chest, and occasionally bron- chophony and bronchial respiration when the central or mid- dle portion of the lung is the part affected.* The remedies which have been used with the most advantage * Phosphorus deserves attention in such cases, particularly when there is bronchial respiration. PNEUMONIA NOTHA. 241 in typhoid pneumonia, are : Opium, Arnica, Veratrum, Ar- senicum. Opium ~s-. This remedy is generally the most appropriate as soon as the disease becomes clearly defined, and may be repeated once or twice, after which, if no change be effected, Arnica -§- should be administered. Should no improvement result from the foregoing remedies, Veratrum -^- may be administered, particularly when there is clammy sweat on the forehead, with coldness of the ex- tremities and great weakness, and the respiration unequal, laborious and rattling. Arsenicum °£° may follow Veratrum if the prostration and rattling respiration increase, the pulse become irregular, and the tongue dark brown or black: the alternate administration of these two remedies every half hour, to every hour or two hours, according to the urgency of the symptoms, is frequently attended with the best results; in other cases, Veratrum, Ipe- cacuanha and Arsenicum answer better. But when only temporary improvement results, a few globules of Sulphur may be administered; and then again Veratrum and Arseni- cum, or Veratrum, Ipecacuanha and Arsenicum alternately, or any one of these remedies alone from which any marked degree of improvement may previously have been observed to arise. Bryonia, Rhus and Senega will be found useful in some cases. Some of the leading indications for the employ- ment of the two former will be found under the head of Nervous Fever, (which see.) Senega is chiefly serviceable when the lungs are loaded with mucus. Belladonna will be found serviceable when temporary blindness is complained of, and Natrum m. when the prostration of strength increases, notwithstanding the administration of Arsenicum, which is generally so valuable in such cases. When galling or exco- riation (decubitus) has ensued from lying in bed, Cinchona and Arsenicum must be administered alternately; in milder cases, Arnica in the form of lotion (one part in ten) will fre- quently remove this evil. When symptoms of INCIPIENT PHTHISIS PULMONALIS supervene on pneumonia, Sul- phur is one of the most important remedies; but will in most 11 242 RESPIRATORY SYSTEM. cases require to be followed by Lycop., Lachesis, Phosph., Amnion, c. ; in others, by Kali c., Acid, nitr., Natrum m., Calcarea, Hepar sulph., Slannum, Pulsat., Carbo v., Silicea, Sepia; and Ferrum and Cinchona as intermediate remedies. A proper knowledge of the Materia Medica is indispensable to facilitate the selection of these remedies. INFLAMMATION OF THE PLEURA. Pleurisy, Pleuritis. Diagnosis. Severe pain in the side, like a stitch, or as from a stab, remaining in one circumscribed spot, interfering with breathing, and increased by inspiration ; difficult and anxious respiration, but not so oppressed as in pneumonia and bronchitis ; quick hard pulse; hot skin, particularly over the chest, or the seat of the disease; dry tongue ; scanty and high-coloured urine ; and, occasionally, cerebral symptoms. Position in bed, usually dorsal; and if the effusion be free and partial, a change to the sound side creates great unea- siness. Pleurisy seems to consist in a peculiar inflammation in the pleura, with a disposition to effusion or to the secretion of plastic lymph; and the disease may run its whole course without any of the symptoms above given declaring them- selves. At the commencement of the disease there is diminution of motion and respiratory murmur from pain (subsequently these abnormal signs arise from effusion) and a rubbing sound is not. unfrequently heard, generally about the centre of the chest, accompanying the pectoral movements. Soon after the outset of the inflammation, in the great number of cases, exudation ensues, and if not encysted, accumulates at the lowest part of the chest. When, in such instances, the quantity exuded is considerable, and the lung is not restrained by adhesions, that organ will be floated upwards to some extent, and a dull stroke sound elicited from the parts beneath it, whilst the upper will be found unusually resonant. INFLAMMATION OF THE PLEURA. 243 As the fluid accumulates and ascends in the chest, the ante- cedent clearness of stroke-sound becomes impaired, as is more especially obvious on gentle percussion,—the breath-sound diminished, and respiration more impeded. When these latter abnormal symptoms are met with as high as the middle region of the thorax, the vocal resonance there, and particu- larly anteriorly becomes preternaturally distinct, and is changed to a small, sharp and tremulous note resembling the bleating of a goat, and hence termed oegophony; posteriorly the resonance partakes somewhat more of the character of bronchophony, from the greater caliber of the tubes at the root of the lung. QCgophony and all sound of the voice ceases at the affected side of the chest, as the liquid effusion increases, with exception of those portions where the lung may have been adherent, or at the space within an inch or two of the spine; percussion now gives an extremely dull sound from the lung being deprived of and rendered impermeable to air by compression, and the respiratory murmur is abolished or only heard in the interscapular and subclavicular region, par- ticularly the former. In those cases in which the effusion is very considerable, enlargement of the affected side takes place. This enlarge- ment is generally discernible only during expiration at first, but as the exudation increases, the difference can readily be detected, during the entire performance of respiration. In attenuated subjects, the intercostal spaces will also be ob- served to have become prominent instead of presenting their natural depression. But should absorption be effected after such an enlargement, the state of matters is reversed, and the side which was previously enlarged becomes abnormally con- tracted—the result of atmospheric pressure, and unantago- nized muscular action. Displacement of organs adjoining the effusion, such as the heart, liver and mediastinum, is also an occasional result of extensive effusion. On examining the sound side of the chest, in addition to the negative proofs of the absence of disease, an excess of the usual normal signs will also be-perceived, indicated by an ac- 244 INSPIRATORY SYSTEM. celerated and deeper action, together with a greatly increased degree of respiratory murmur, resembling that of children, and hence denominated puerile. The signs of improvement and approaching recovery are marked by a diminution of pain, fever, dyspnoea and enlargement of the side ; a return of the respiratory murmur, together with an increasing clearness of sound on percussion. When the result is fatal, death occa- sionally supervenes very rapidly from the compression of both lungs ; but in most cases this event is more gradual and arises from atrophy of the lungs, as also affection of the heart, and consequent dropsy, caused by the efforts required to propel the blood through the compressed lung. In all cases of pleurisy the whole of the above detailed symptoms are not to be deemed constant, or even certain diag- nostic signs ; The absence of marked dulness on percussion, is not a con- clusive test that effusion has not taken place. The greater or less degree of clearness of tone appears to depend upon the condition of the lung under the effusion, and the elasticity of the parietes that cover the latter. If the quantity of the effu- sion be very considerable, and the lung deprived of its air by compression, the sound on percussion is necessarily almost uniformly dull; but when the exudation is inconsiderable and the compression is not sufficient to deprive the lung of its air, the stroke-sound will be found to consist more of a tympanitic and frequently even a louder tone than the normal expanded lung. Subsequently, however, if the pressure be unrestrained, the lung will be deprived of its air, and the part formerly so resonant will then yield a dull sound. The auscultatory pheno- mena are in like manner naturally liable to be materially modi- fied by circumstances. Much depends on the extent of the ex- udation, and upon the state of the lung on which it rests. If the lung still contain air, both voice and respiratory sound will be found indistinct or inaudible. If, from the extent of the effusion, or from the long continuance of the disorder, the portion of lung be entirely emptied of air, weak bronchophony and bronchial respiration will be discernible; but when the amount of effusion is very great, possibly filling the whole INFLAMMATION OF THE PLEURA. 245 cavity of the pleura, no sound whatever will be audible.* On the other hand, when the quantity effused is inconsider- able, the normal sounds frequently remain unchanged. Again, the physical signs are liable to be further modified by old and close adhesions, arising from previous disease, which render the lung adherent to the walls of the chest. And upper lobes are the most subject to these adhesions; and in such cases the free portion of lung is pressed upwards by the subjacent effu- sion, against the superior part of the thorax. And although the lung may yet admit air, still, from the degree of com- pression to which its vesicular structure is subjected, both breath and stroke-sound will be bronchial, and loud broncho- phony pervade the upper part of the affected side. The lower part of the chest from whence the lung has been separated or raised upwards by the effusion will necessarily give decided dulness on percussion. Finally, it may be added that cegophony, although a frequent phenomenon in pleuritis, has no necessary connection with the presence of liquid in the pleural sac, and is consequently not to be held as an essential link in the chain of evidence in determining the existence of the disease. The same may in a great measure be said of the intercepted vibration of the voice, usually felt by the hand, when placed against the chest, for this, although a very useful and early corroborative indication of the accumulation of fluid in the cav- ity of the pleura, is yet liable to some exceptions both posi- tive and negative. The rubbing sound already referred to is an important sign; it is not so audible at the commencement of the attack as it is at a later period ; when the effusion becomes more consistent then it is rarely absent. From what has been stated, it will be seen that some of the preconceived characteristics cannot, individually considered, be taken as conclusive indications of the existence of pleu- risy. The collective physical signs, however, in the majority of cases, are far from equivocal, and are mainly to be depended on * Brit. Jour, of Homoeopathy, vol. 1, p. 42. 246 RESPIRATORY SYSTEM. in forming the diagnosis. Pain is, with few exceptions, an invariable concomitant on pleurisy, and its presence and in- tensity has been found of great use in combination with other signs, in estimating the amount as well as the quality of the effusion; for it has been found, that the greater the quantity of plastic lymph it contains, proportionally greater will be the pain.* Great rapidity of effusion is also a frequent, though not an infallible source of extreme pain. The greater or mi- nor degree of dyspnoea depends on the quantity and rapidity of the effusion, as well as the condition of the lungs ; when both sides of the chest are the seat of effusion, the oppression is usually excessive. The fever is in like manner modified by the nature and extent of the exudation being generally slight or altogether absent when the quantity is trivial, slow, and not frequently intermittent when more extensive but of a serous character, and highly inflammatory when much plas- tic lymph is contained in the effusion.f Cough is not an accompaniment of simple pleurisy ; when present, there is either bronchitis or pneumonic complication, or the case may be one of hemorrhagic-pleuritis. Therapeutics. The chief remedies are: Aconitum napel- lus, Bryonia alba, Sulphur, Belladonna, (atropa), Mercurius, Arsenicum, Arnica montana, Hepar sulphuris, Calcarea, Phos- phorus, Lycopodium clavaium, Carbo vegetabilis et animalis. Cinchona officinalis, Digitalis purpurea, Kali carbonicum, Ipe- cacuanha (cephaelis), Helleborus niger, Sabadilla, Scilla ma- ritima. Aconitum. Is an indispensable remedy in allaying inflam- matory fever, when attendant on pleurisy ; and is in many cases, indeed, when timely administered, alone sufficient to cure the disease. It rarely fails to effect the desired results, in from six to eight hours; should it not do so in that space of time, another remedy must be selected. In most instances Bryonia will be the most appropriate, but we must not he- sitate to select Sulphur in preference if called for, or indeed any other remedy that may seem more strikingly indi- cated. * Brit. Homaeop. Journ, vol. 1, p. 44. f Ibid. INFLAMMATION OF THE PLEURA. 247 Administration. A few globules of the third potency every two hours; or one drop of the tincture at the third potency to an ounce of water, a dessert-spoonful every two to three hours.* Bryonia alba should in general cases follow Aconitum when the fever has been somewhat allayed by that remedy. It is more particularly indicated, either in simple or complicated pleurisy, when the following symptoms are encountered at an early stage of the disease: aching, burning, but more especial- ly acute shooting pains in the chest, much increased during inspiration or on movement; dry cough, or dry sounding cough, followed by expectoration of dirty yellow-coloured mucus streaked or tinged with blood, and attended with aggravation of pain; oppressed and anxious respiration; palpitation of the heart; d ry, cracked, brown, or yellow-coated tongue; bitter taste, nausea, and occasionally vomiting of mucus, or of a bitter, bilious-looking fluid; aching or painful pressure at the scrobiculus and hypochondria; intense thirst, especially at night; constipation ; head confused and heavy ; giddiness on sitting up in bed ; aching and shooting pains in the head, or pain as if the head would burst, particularly at the temples, with exacerbation on coughing, or moving; fiery, or bluish red- ness, and puffiness of the face ; restless, disturbed sleep, fre- quent startings; nocturnal delirium, with alternations of coma- tose sleep; burning heat of the skin; occasionally, partial, clammy perspiration; pulse generally frequent, hard and small, but sometimes full, unequal, intermittent and weak; aching in the limbs. Lastly, when in connection with many of the above, the following symptoms are met with: dulness on percussion, particularly at the right mammary and scapular regions, with puerile respiration ; cough on lying on the right side, or im- possibility of lying otherwise than on the back.—Bryonia will rarely fail to render undeniable service, and can indeed wilh difficulty be dispensed with. (Vide Sulphur.) Administration. The same as Aconite, but at intervals of from three to four hours. * Vide note, p. 21. 248 RESPIRATORY BY'STEM. Sulphur may with advantage follow Bryonia when the pain mentioned has been removed by that medicine, and of- ten completes the cure. It is also of value when the fever continues after the administration of Aconite, and may be ad- ministered without the previous employment of Aconitum, when the fever is not violent, yet we have reason to suspect recent effusion of plastic lymph. Again, when the affection has already been of some days7 duration and is complicated with pneumonia, it is our chief stay in preventing solidification, or effecting resolution where that has already commenced, and may therefore generally be selected in preference to Bryonia, in such cases, unless the latter be otherwise strongly indicated, in which event a dose or two of that medicine previous to the employment of Sulphur may be found serviceable. Administration. A globule or two of the third potency in a teaspoonful of water every two to three hours ; or two drops of the tincture in three ounces of water, a tablespoon- ful every three hours ; or in very severe cases every hour. These three are the most important remedies in the greater number of cases of pleuritis, and are frequently found suffi- cient to effect a speedy cure. There are often occasions, how- ever, in which it will be found necessary to select one or more of the under-mentioned remedies.* Mercurius °§°. Has been found very useful in cases where the fever has been subdued, but pain and dyspnoea have not been relieved by Aconite, and the patient's strength is becoming exhausted by copious nocturnal sweats. Arnica Montana. Principally when pleuritis is caused by external injury ; but also in other cases when the more inflam- matory symptoms have been subdued by Aconite, etc., and pain in the chest, with oppressed respiration, only remain ; also to promote absorption when considerable effusion has taken place. Administration. One drop of the tincture of the third potency to an ounce of water, a dessert-spoonful every three * Belladonna has been recommended in cases where the fever returned, and pain and dyspnoea continued, notwithstanding the employment of Aconite.—Brit. Homceop. Jour., vol, i.. p. 51. inflammation of the pleura. 249 or four hours ; or two or three globules of the third, in a tea- spoonful of water, at the same intervals, until the pain begins to yield and the breathing becomes freer, when the intervals between the doses must be lengthened or the medicine dis- continued, and only resumed should the improvement proceed tardily; but if pain return, Aconitum must again be had re- course to, after which Belladonna, in repeated doses, is often extremely useful, if not sufficient to effect the desired end. In other cases, Bryonia or Sulphur will be seen to be more appropriate, and must be selected accordingly. Arsenicum -§a is our main dependence in those serious cases where serous effusion to a very great extent has taken place, and where the respiration is painfully impeded and asthmatic, with extreme prostration of strength. Hepar sulphuris °#° has been particularly recommended when the effusion is plastic, and the disease has been of some duration, (chronic plastic pleurisy,) or where, even at the commencement, there appears, from the pain, fever and dys- pnoea, continuing with but slightly diminished severity after Aconite, every probability that the case will prove extremely obstinate and tenacious. Complication with pericarditis or bronchitis is an additional indication for the employment of Hepar under the above circumstances. Phosphorus. From what has been said of this remedy in pneumonia, it will readily be suggested that it may be useful in cases of complication of pleuritis therewith, and such it has repeatedly proved to be. In complications with bronchi- tis, and in that form of pleuritis which so frequently shows itself in phthisis pulmonalis, it has further been found of es- sential service. Vide Pneumonia and Bronchitis. Administration. A few globules of the third, or a drop of the sixth, in a little water every three or four hours, or oft- ener if necessary, until the respiration becomes easier. Carbo vegetabilis is a good remedy when pleuritis is com- plicated with chronic bronchitis ; or at an advanced stage of the disorder, when the patient is much emaciated and hectic at night, presenting in short the usual symptoms of threaten- ing purulent degeneration. It is also peculiarly useful against 11* 250 RESPIRATORY SYSTEM. asthmatic sufferings resulting from an attack of pleurisy in the chronic cases. Administration same as Arsenicum, except in the latter instance, when it must be given at longer intervals. Cinchona is chiefly useful after severe depletion, to restore the energies of the patient. Administration. °§° or %y, repeated in twelve hours. Lycopodium y will be found "Serviceable in similar cases to those in which both Arsenicum and Carbo vegetabilis (or animalis) have been found applicable, also where there are considerable dropsical swellings and obstinate constipation. Digitalis °£° in lower potencies has proved useful in many cases of serous pleurisy with slow fever, small weak pulse, accelerated by the slightest movement; and coldness of the extremities with internal heat.* In conclusion, Kali carboni- cum may be instanced as serviceable in pleuritis occurring in tuberculous subjects ; and Ipecacuanha as a useful palliative against dyspnoea and convulsive cough in complications with bronchitis. Helleborus niger has been recommended in some cases of serous, and Scilla in plastic pleurisy, but they, as well as Colchicum, Lachesis, and some others which need not be mentioned here, require the test of further experience to corroborate even the little that has been adduced in their favour in the treatment of pleuritis.f When, either through neglect or otherwise, pleuritis has terminated in purulent degeneration, and become chronic, Arsenicum, Carbo, Lycopodium, Hepar s., and Kali carbonicum, will generally be found to be the remedies from which the greatest assistance is to be obtained where cure is at all prac- ticable. Pains in the chest arising from adhesions or from thickening of the pleura, after an attack of pleuritis, are often * Brit. Journ. of Homoeopathy, No. 1, p. 53. f Rhus toxicodendron has been strongly recommended in serous pleu- risy :—When low, typhoid symptoms become apparent, the said remedy will deserve an additional claim on our attention. Typhoid appearances, and important complications of any kind, a bad habit of body, or indica- tions of a purulent, sanious, or hemorrhagic effusion, are all to be held as unfavourable signs. PLEURODYNIA. 251 relieved hyRanunculus b., Euphorb., Mez., Nitr., Thuja, may also be found serviceable. Sulph., Sepia, Kali c, Am. c, Lye, and Mezer, are useful in chronic pleurisy. Diet. The same rules are to be observed as in Pneumonia. PLEURODYNIA. SPURIOUS OR BASTARD PLEU- RISY. PSEUDO-PLEURITIS. By these terms is here meant that painful affection usually referred to the intercostal muscles, which is productive of many of the symptoms described under true pleurisy, and is conse- quently liable to be mistaken for the said disease, particularly when attended with febrile excitement, as is frequently the case in hysterical females. The history of the commencement of the affection, together with the aid of auscultation and per- cussion, enable us to discriminate satisfactorily between the two diseases. When therefore we have satisfied ourselves from the nor- mal condition of the auscultatory phenomena, etc., that the case we have to deal with is one of pseudo-pleurisy, we must select a remedy from amongst the following: Arnica montana, Bryonia, Nux v., Pulsatilla, Ranunculus bulbosus, Sabadilla. In the majority of cases Arnica is the principal remedy, and is occasionally sufficient to effect a speedy cure after a single dose. In other instances, however, the disorder does not yield so readily, and one or more of the other remedies enumerat- ed must be had recourse to. Bryonia. When the pain is of an acute darting descrip- tion, as if from a sharp instrument running into the side, and is occasionally almost insupportable during inspiration or even the slightest movement of the body ; and when the party affected is of a nervous or bilious temperament. Pulsatilla. This remedy is frequently very useful in al- ternation with Arnica ; it is more particularly indicated when the pain is occasionally of a, fugitive character, moving from one part of the chest to another, becoming increased towards evening, and sometimes experienced more during expiration than inspiration. Temperament phlegmatio, Nux vomica, Shooting pains in the hypochondria increas- 252 RESPIRATORY SYSTEM. ed by the respiratory movements of the chest; especially when the affection occurs in hypochondriacal subjects or in those who are addicted to indulgence in vinous or spirituous drinks. Temperament bilious or sanguine. It is, moreover, one of the best remedies in this complaint; the characteristic indications are as follows, and show a mark- ed resemblance to the symptoms which are so frequently met with in, and are in some respects peculiar to pseudo-pleurisy; stitch in the side, or shootings, with painful sensibility of the external parts of the chest, but particularly of the intercostal spaces, aggravated by any movement, and especially by ta- king a deep inspiration, yawning or stretching. Ranunculus bulbosus. The value of this medicine in pains resulting from adhesions of the pleura has already been alluded to. (Vide Pleuritis.) In acute pains in the chest of every description of a ner- vous character, depending upon an abnormally exalted sensi- bility of the pleura, this remedy is one of primary importance. Sabadilla is also useful in this affection. Administration of the remedies. In some cases a single dose of one or two globules of the 3d or 6th potency is suffi- cient to effect a cure; in others it will be found necessary to repeat the dose every six, twelve, or twenty-four hours, ac- cording to the severity of the attack, until relief is obtained. (See note, p. 21.) SPITTING OF BLOOD. HEMORRHAGE FROM THE LUNGS. Sputum Cruentum. Hemorrhngia Pvlmonum. Hemoptysis. Diagnosis. Expectoration of blood by coughing, in great- er or less quantity, attended by symptoms more or less severe. This disease presents itself in three varieties: first, by an effusion of blood from the mucous lining of the bronchial tubes; secondly, from congestion of the lungs, with engorgement of the parenchyma from effusions; and thirdly, the rupture of a blood-vessel in the tubercular cavity of the lungs during the course of phthisis pulmonalis. It is, however, proposed SPITTING OF BLOOD. 253 to deal generally with the subject, and to point out the differ- ent remedies found useful in the treatment, according to the symptoms present. We must be careful not to confound this disease with affections of the mouth or gums, or blood from the nose escaping through the posterior nares, and returned by the mouth. When from the chest, it is almost invariably attended wilh a sensation as if it came from a deep-seated source, is warm, generally tastes sweet, and there is frequent- ly a simultaneous burning and painful sensation in the chest. When the attack is preceded by well known premonitory symptoms, the party affected should refrain from loud or pro- longed speaking, calling, singing, blowing wind instruments, violent exercise of the arms, running, ascending stairs, or in short any thing which is calculated to increase the respiratory action, or otherwise fatigue the chest. When spitting of blood occurs in a robust and healthy per- son of sound constitution, it is not very dangerous; but when it attacks slender and delicate persons of weak lax fibre, it is more serious and difficult of removal. It is, however, chiefly when the patient has had a succession of severe attacks and the blood is discharged in large quantity, that the case may be considered dangerous. The disease may present itself without any marked pains or difficulty of breathing, and pass oft" with no return of the attack ; or be preceded by dry cough, oppression or tightness at the chest, shivering, coldness of the extremities, great las- situde, and high pulse; and be accompanied by hacking or husky and distressing cough, anxiety, quick pulse, pale and livid countenance; cease and then return in a few hours, and be followed by difficulty of respiration and cough: in still more severe cases, when a marked tendency to phthisis exists, anxiety, oppression at the chest and febrile symptoms are more severe; pure blood is coughed up, and the paroxysms frequently return. The rupture of a blood-vessel is a rare occurrence, although it sometimes occurs, in phthisis. When a blood-vessel of any consequence, included in a tuberculous excavation, gives wav, the result is generally fatal. 254 RESPIRATORY SYSTEM. Causes. Indulgence in spirituous beverages, overheating the body by immoderate exertion, or too great external heat; blowing wind-instruments; contusion of the chest or back; falls ; lesions of the lungs ; breathing a vitiated atmosphere, or vapours charged with acrid substances; colds or coughs ; violent mental emotions ; diseased state of the lungs, whether from pneumonia or phthisis; a general strumous habit; sup- pressed menstrual, hemorrhoidal, or other discharges; or re- percussed cutaneous eruptions. Therapeutics. In by far the greater number of cases, the discharge or spitting of blood soon ceases of its own accord; the most important object therefore is to seek to.cure the com- plaint when the hemorrhage has ceased, and thereby prevent returns or check development of organic disease of the lungs. The principal remedies in the treatment of this affection are: Pulsatilla, Nux v., Bryonia, Sulphur, Arnica, Aconitum, Ipe- cacuanha, Acidum Sulph., Arsenicum, Opium, Cinchona, Car- bo, Ferrum met., Rhus, Phosphorus, and Sepia. These are not only calculated to arrest the hemorrhage, but also to pre- vent a relapse, where that is practicable. Administration. Unless otherwise specified, a drop of the tincture at the potency mentioned after each medicine, in an ounce of pure water, a teaspoonful every two, four, or six hours, or much oftener where apparently called for; but this being a disease in which considerable judgment and tact are required in the exhibition of the medicines, it is scarcely pos- sible to give rules in this treatise applicable to all cases.* Pulsatilla. In cases of females, arising from suppression of the monthly discharge, or in either sex, of a hemorrhoidal flux, particularly of leuco-phlegmatic temperament, and also in the other instances, with the following symptoms: expec- toration of dark coagulated blood, attended with shivering, especially towards evening, or at night, and great anxiety; pain in the lower part of the chest; feeling of flaccidity in the epigastrium, and weakness. One drop of the Potency 6. (Hemoptysis vicaria.) Administration. When from the causes first mentioned, * Vide note, p. 21. SPITTING OF BLOOD. 255 if not particularly severe, °£ ° repeated in twelve, or even twenty-four hours, and subsequently at much longer intervals, will be found sufficient; but in violent attacks the dose must be repeated every two to four hours, but discontinued as soon as improvement begins to set in. When in females, the men- ses do not return, notwithstanding the employment of Pulsa- tilla, Cocculus, Sepia, Sulphur, or any other remedy better adapted to the entire case, should be selected ; (vide Chloro- sis, Amenorrhea, or Catamenia, suppression of.) Bryonia is a good remedy in cases where the expectorated blood is excited by a tickling cough, and is often in a coagu- lated state ; oppression at the chest, with frequent necessity to take a deep inspiration ; anxiety and irascibility. Administration. Same as Nux vomica. Nux vomica °£° is adapted to individuals of an irritable temper, in whom this affection owes its origin to a hemorrhoidal suppression, a fit of passion, or exposure to cold. It is further indicated by dry cough, which causes headache, with excessive tickling in the chest and exacerbation of the symptoms to- wards morning. (Hemoptysis vicaria.) Administration. In mild cases -£-, repeated in twenty- four hours; in severe, prescribed in the case of Pulsatilla. When Nux v. does not afford speedy relief, Sulphur will gene- rally be found to succeed; but should any other remedy ap- pear to be more appropriate, it should unhesitatingly be se- lected in preference. Rhus -§-. When the blood expectorated is of a bright red, the mind much agitated, and the patient is irritable and rendered worse after the slightest vexation or contradiction. Arnica Montana -§-. Principally in cases arising from external lesion, such as a severe blow in the chest, or from lift- ing a heavy weight, or any other exertion, even blowing wind- instruments ; but also in almost all cases, where the stetho- scope detects effusion of blood into the parenchyma, attended with a sensation of constriction and burning in the chest, pain as from contusion in the scapular and dorsal region, and dysp- noea. Moreover, profuse expectoration of dark-coloured blood or coagula, brought up without much exertion, or bright frothy 250 RESPIRATORY SYSTEM. blood, mixed with mucus and clots; sensation of tickling be- hind the sternum; general heat, great weakness and syncope. (Aconite °|° is sometimes necessary before, or alternately with Arnica, &c.) Acidum sulphuricum is frequently of service after Arnica when the cough continues, and brings on fresh bleeding. Administration. One or two drops of the sixth in about a tumbler of water, a dessert-spoonful every hour or half hour. In severe cases attended with manifest danger : Aconitum, Ipecacuanha, Arsenicum, Opium, and Cinchona, are the most useful, and must, as usual, be selected according to the pre- vailing symptoms. When one of these is insufficient to check the hemorrhage entirely, another must be chosen to meet the remaining symptoms. Aconitum -~ is often found most serviceable in warding off an attack, by the great power it possesses in controlling the circulation, and is indicated previous to the paroxysm by the premonitory symptoms of shivering, with accelerated pulse, pal- pitation of the heart, a sensation of ebullition of blood in the chest, with burning and fulness in the same region ; paleness and expression of anxiety in the face; great anguish and anx- iety, aggravated by lying down, or during the attack when the expectoration is profuse, coming on in gushes, and excited by a slight dry cough. (Hemoptysis plethorica.) Ipecacuanha -§-, when a taste of blood remains in the mouth a few hours after the employment of Aconite was com- menced, when there is frequent tussiculation, with nausea, weakness, and expectoration streaked with blood. Arsenicum. When the anxiety, anguish, and palpitation of the heart increases, notwithstanding the administration of Aconite ; and when, in addition, we find extreme restlessness and general dry burning heat. Potency 6. Two or three globules in a teaspoonful of water, repeated in two hours.* The Administration of this remedy alternately with Ipe- cacuanha has been found to succeed in many instances when neither of them separately have been found sufficient to con- * Vide note, p. 21. SPITTING OF ELOOD. 257 quer the disease. Giving an occasional dose of Nux vomica as soon as the hemorrhage has in a great measure been checked, to such individuals as have been in the habit of indulging in spirituous, vinous, or fermented liquors, or coffee. Should hemorrhage return after a temporary cessation, Sulphur may be administered, followed in turn by Arnica if the desired re- sult be not thereby effected. Opium °£°. Heat, dyspnoea, with sensation of burning heat at the region of the heart; coldness, particularly of the extremities ; tremor in the arms ; dry hollow cough, with ex- pectoration of blood and frothy mucus, and sometimes also weakness of the voice ; drowsiness, Avith sudden starts; aggra- vation of cough after swallowing. It will be found useful in the most serious cases, particularly in those addicted to spiritu- ous liquors; in the latter case it is useful to follow it with Nux v. Cinchona -§- or -§-, as already mentioned in several places in this work, is one of our best remedies in restoring the vital energies of the patient after considerable loss of fluids, whether blood or other secretions ; it is therefore particularly efficacious after a severe attack of this affection, but is also indicated during its course, when the spitting of blood takes place after a violent cough, or when there is a continual taste of blood in the mouth, or when we find shivering alternately with accesses of heat, frequent and short-lived perspirations; tremor, and confusion of vision, with a sensation of vacuity or lightness in the head, weakness and desire to remain con- stantly recumbent. Administration. Same as Pulsatilla. Ferrum metallicum. May be exhibited with advantage after the last mentioned, in severe cases, or may be preferred if the expectoration follows a slight cough, and is scanty, but consists of pure bright red blood, attended with pain between the scapula?, with inability to remain long in a sitting posture : the patient feels the concomitant symptoms relieved by move- ment, but is speedily fatigued, especially by conversation. It may in some cases be advantageously alternated with Cin- chona, Carb. v., Arnica and Arsenicum,—or Sulphur may be required to complete the cure in some case*. 258 respiratory system. Administration. One grain of the third potency. Sulphur. This remedy is frequently useful in completing the treatment after the administration of other medicines ; and it is also particularly suitable for individuals disposed to hemorrhoidal affections, in derangement of the menstrual flux, or hemoptysis arising from suppressed cutaneous erup- tions, such as scabies, &c. (Hemoptysis vicaria, &c.) Administration. °|°, in a little water, repeated in four to eight days, for three or four successive times, when adminis- tered as a remedy to complete the cure ; but it may be given every tour to six hours, or even oftener, when administered to check existing hemorrhage. In other instances, particularly in the case of those who have been given to excess in the use of stimulating beverages, Nux v. and Arsenicum may be advan- tageously administered in alternation with Sulphur, at inter- vals of five or ten days. (Sec note, p. 21.) After hemoptysis has disappeared, besides having to guard against a relapse in which, as above stated, Sulphur is our chief auxiliary, we have to take every precaution lest inflam- mation arise in the part primarily affected, or the disease de- generate into Phthisis, which objects will sometimes be best attained by the administration of Phosphorus in combination with a strict observance of antiphlogistic regimen and the other rules about to be given for the conduct of the patients suffering from this affection. The almost specific action of this medicine in changes of structure of the substance of the lungs, has been already com- mented upon under Pneumonia; it may also be remarked that it is, along with Aconitum, one of our chief remedies in hemorrhages from the lungs during the course of phthisis. Sepia °£° is also useful in this affection occurring in Phthi- sis, but when it is rather to be looked upon as one of the general symptoms than forming a disease of itself; by its power over the uterine economy, it is also of great service in cases of hemoptysis arising from derangements connected with that organ. (Hemoptysis phthisica et vicaria.) The following remedies may also be noted as worthy the attention of the practitioner in peculiar cases: Belladonna, PULMONARY CONSUMPTION. 259 Bryonia, Carbo v., Hyoscyamus, Ignatia Dulc, Cocculus, Crocus, Conium m., Lachesis, Acidum sulph., Acidum nitr., Ledum, Lycopod., Millefolium, Silicea, Staphysag., and Cu- prum m., etc. Diet, etc. The rules given under Hematemesis should be observed as regards regimen; both mind and body should be kept perfectly quiet; the patient should speak as little as possible, be kept in a semi-recumbent posture, or, if his strength allow, sit upright. PULMONARY CONSUMPTION. Phthisis Pulmonalis. Short cough, which is either dry or accompanied by the ex- pectoration of a frothy mucus, slight at the commencement, but more or less constant. Shortness of breath, and symptoms of gastric derangement, etc. Hectic fever by flushing of the face (often after a meal); night sweats. In the second stage, the cough is more severe at night; after meals or at times of ex- citement, a circumscribed red patch still appears on. each cheek, but at other times the colour of the cheek is faded. In the third, the tubercles are expectorated of cheese-like parti- cles, mixed with pus, mucus, blood, etc. Acon., Bryon., Bellad., Lach., Hep. s., Spongia, Phosph., Dulc, Puis., Arsen., Nux v., Hyos., Silic, Calc c, Carbo v., Acid, n., and Sulph., are in- dicated in the first stage. In the second : Acid. «., Silic, Kali c, Sulph., Calc. c, Natr. m., Merc, Lac, Phosph., Lycop., Carbo v., Samb., Hep. s., Spong., Chinch., Ferrum, Conium, Zinc, Am. c, Lauroc, Graph., Nitr., Iod., Dros., Plumb., etc. In the third stage, the same remedies as the foregoing; also, Guaiac, Sepia, Stann., Staphys., Acid, phos., Sanguin.: see chapter on Cough. When sweats are distressing : Samb., Stann., Chine., Phosph., Ars., Carb. v., Carb. a., Silic, Merc, Nitr. Lach, Sulph., and Lycop. When diarrhoea predomi- nates : China, Ferr., Ars., Phosph., Acid, phos., Sepia : see Diarrhea. It requires a separate treatise to do justice to this disease, and therefore we refer to : Consumption, Treated Homeopathically, by A. C. Becker, M. D. Administration. °f°, or °g°, or |g. Vide Note. p. 21. DERANGEMENTS OF THE CEREBRAL SYSTEM. DETERMINATION OF BLOOD TO THE HEAD. Congestio ad Caput. This is an affection to which many individuals who lead a sedentary life are subject; intense mental application and habitual indulgence in the use of spirituous liquors, or other stimulating liquids, such as coffee, etc., are also frequent ex- citing causes, particularly in those who inherit a predisposi- tion to the disorder. Diagnosis. Fulness of the vessels of the head and neck, the pulsation of which the patient experiences through the en- tire frame ; heat, redness and turgidity of the face ; repeated attacks of giddiness, particularly on sleeping, sitting in a warm, confined apartment, or an exposure to the rays of the sun when exercising in the open air; headache, generally above the orbits, and in the forehead, increased by stooping or coughing; disturbed, unrefreshing sleep; drowsiness during the day. Therapeutics. Aconitum napellus, Nux vomica, Bella- donna, Opium, Coffea, Chamomilla, Ignatia, Arnica, Mercu- rius, Pulsatilla, Dulcamara, Cinch., Sanguinaria canad., etc. Aconitum. This is the principal remedy to commence with in all recent cases, and is alone sufficient speedily to remove the affection, particularly in children when fright and anger combined have been the exciting causes. Administration. °™, in a teaspoonful of water, repeated in six, twelve, or twenty-four hours, if necessary; for children, t§ or If, m half an ounce of water, a teaspoonful every twelve hours until relief is obtained. DETERMINATION OF bluod to the head. 201 Nux vomica. As has already been repeatedly observed, this remedy is exceedingly efficacious in complaints arising from sedentary habits, intense study, or that much more cul- pable habit, the excessive indulgence in spirituous or vinous liquors, &c; it is accordingly one of the most useful remedies in determination of blood to the head, induced by such causes; it is also very serviceable in cases arising from a violent fit of passion, and is more particularly indicated when we meet with the following symptoms: distention of the veins with violent pulsation in the head ; heat and redness of the face; attacks of giddiness, violent headache, particularly in the fore- head and over the orbits, aggravated by reflecting, or by any attempts at mental application, also by stooping or coughing; disturbed sleep; nervous excitability, and disposition to be an- gry at trifles ; constipation. Calcarea after Nux v. in obstinate cases, in persons addicted to indulgence in spirituous liquors. Administration. °^, a teaspoonful of water, repeated in twenty-four hours, and again in the same manner after an in- terval of from three to five days, if required. Calcarea will frequently be found of signal benefit after Nux v. in obstinate cases occurring in persons addicted to indulgence in spiritu- ous liquors. Belladonna. After a previous administration of Aconite, when necessary, this is one of our most important remedies in the treatment of congestion to the head. Indications: great distention of the vessels of the head, attended with severe jerk- ing burning pains in one half of the head, aggravated by the slightest movement or the least noise; by bright redness and bloatedness of the face, redness of the eyes, sparks before them, and sometimes dimness of vision; darkness before the eyes ; diplopia; buzzing in the ears; attacks of fainting; somnolency. Administration. -6-, in a teaspoonful of water, repeated in six, twelve, twenty-four hours, or at shorter or longer in- tervals, according to the greater or less severity of the symp- toms, or the effects produced by the preceding dose. Opium is of speedy service in cases arising from fright; but it is, moreover, a remedy of extreme value in the most serious eases of congestion, either arising suddenly from the effects of a draught of cold or iced water, especially when 262 cerebral system. heated, with the following symptoms : vertigo, heaviness of the head, humming in the ears, dulness of hearing, stupor; also, when from constipation, or from the effects of a debauch, pressure in the forehead from within outwards, with redness and bloatedness of the face, great depression, fugitive heat; violent thirst; dryness of the mouth; acid regurgitations, nausea and vomiting. Administration. A drop of the third potency in an ounce of water, a dessert spoonful every hour, or every two to six hours, according to the urgency of the symptoms, and the effects produced ; or a globule or two of the third or sixth in a teaspoonful of water at similar intervals. Coffea. In cases arising from excessive joy, this remedy will be found to exert a salutary influence; excessive and un- controllable liveliness; great heaviness of the head, or aggra- vation of the sensations when speaking; sleeplessness. Administration. -~, repeated in twelve hours, if ne- cessary. Chamomilla. Congestion caused by vexation, or a fit of passion, particularly in children, is speedily relieved by this remedy. Administration. One or two globules of the sixth poten- cy in a teaspoonful of water. Ignatia, when induced by a stifled vexation, or harrowing, concentrated grief. Administration. \s-, in a teaspoonful of water daily, for about a week. Arnica. In cases arising from external violence, such as severe falls or contusions, followed by stupefaction, vertigo, sensation of pressure or coldness over a small circumscribed space ; tendency to close the eyes; disposition to be fright- ened, and vomiting; the external and internal administration of Arnica, when timely had recourse to, will frequently be found specific. This remedy is, however, equally useful in other cases with the following symptoms: heat in the head with coldness of other parts of the body ; sensation of obtuse pressure on the brain; painful burning or throbbing in the cranium; humming in the ears; vertigo, with confused vi- DETERMINATION OF BLOOD TO THE HEAD. 263 sion, especially on assuming the erect posture after sitting for some time. Administration. a6£, in a teaspoonful of water, repeated every twenty-four hours until relief is obtained, or a change in the symptoms calls for some other remedy ; and a lotion of one part of the tincture to ten of water, applied to the in- jured part, in cases arising from external violence. Mercurius. Congestion with sensation of fulness, or as if the head were compressed by a band; nocturnal aggravation with darting, piercing, tearing or burning pains; disposition to sweating. After Arnica, Belladonna, or Opium, Mercurius is frequently found serviceable in completing the cure. Administration. Same as Arnica. Pulsatilla. This remedy, as will be found stated in the proper place, is well adapted in many cases of congestion oc- curring in young girls at the critical age, or in all cases occur- ring in cold, lymphatic temperaments with the following symptoms: distressing, semi-lateral pain in the head, particu- larly of a pressive character, or if the pain in the head com- mences at the occiput and extends to the root of the nose, or invertedly. Amelioration of the symptoms from exercise, or from pressing or binding the head ; exacerbation while sitting ; sense of weight in the head ; vertigo ; inclination to weep ; anxiety ; coldness or shivering. Administration. The same as described under Arnica. Lycopodium is a valuable remedy in some obstinate cases of congestion, attended with giddiness, ebullition, flatulence, anxiety, and habitual constipation. Dulcamara. Congestion attended with continual buzzing in the ears, dulness of hearing, and particularly, when the affection has arisen from getting the feet wet, or from a chill in cold, damp weather. Administration. £ in a teaspoonful of water, repeated in from twenty-four to thirty-six hours, if necessary. Sanguinaria Canadensis. Distention of the vessels, heaviness of the head, with fulness and aching as if the head would burst; pressure behind the orbits. The pains are chiefly in the forehead, sinciput and right side of the head. 264 CEREBRAL &\STEM. Cinchona. Congestion occurring after repeated blood- lettings, or hemorrhage in general, is generally relieved by this remedy. Administration. figfl, in a teaspoonful of water, repeated in four days. After the completed action of Cinchona, a dose or two of Sulphur and Calcarea carbonica, °/» at intervals of about a week, will materially tend to strengthen the impaired consti- tution when Cinchona is not of itself sufficient to effect that desirable object. Nux vomica, Veratrum and Valerian are also valuable reme- dies in particular cases arising from debilitating losses ; the attention of the student or practitioner may also be directed to the following remedies: Rhus toxicodendron, Bryonia alba, Cicuta virosa, Hepar sulphuris, Silicea; the two latter, together with Sulphur and Calcarea, are more particularly adapted to the treatment of chronic cases. See Dyspepsia and Apoplexy. In cases of giddiness simply, or when that is the prevailing symptom, the following remedies are amongst the most useful: Mercurius, when the giddines comes on only in the evening, especially on assuming the erect posture ; or in the morning on getting out of bed ; and is attended with nausea, dimness of sight, heat, anxiety, and desire to lie down. Nux vomica. Giddiness during mental application, or after a meal, or when in the recumbent posture, particularly in nervous or bilious subjects; and in cases where sedentary habits or dissipation have given rise to the affection. Pulsatilla. Giddiness, especially on. looking upwards, or when sitting, or at other times, such as during or after meals, when attended with heaviness of the head, buzzing in the ears, headache, and pale- ness of the face, sometimes alternating with heat; confusion of sight; lowness of spirits ; nausea and inclination to vomit; phlegmatic temperament. Cinchona. Giddiness on eleva- ting the head, or during movement, relieved by reclining. Rhus. Giddiness on lying down, but which becomes relieved after retaining the recumbent posture for some time, and then re- turns on assuming the erect posture, sometimes to such an extent as to occasion falling, attended with fear of dissolu- DETERMINATION OF BLOOD TO THE HEAD. 265 tion ; giddiness after a hearty meal. Chamomilla. Giddi- ness on rising, with tendency to faint; giddiness during a meal; irritability. Arnica. Violent giddiness during dinner or after a hearty meal; in the latter instance, Nux v., Pulsa- tilla, Rhus, or Chamomilla, are also very useful, and must be selected acccording as they may be otherwise indicated ; but as such cases are frequently fraught with danger, experienced advice must be sought.—Giddiness on rising from the recum- bent posture, or on stooping. Aconitum followed by Belladon- na, particularly if in addition to the foregoing symptoms there is frequently partial loss of consciousness, cloudiness of vision, giddiness from the motion of a carriage, sometimes with dis- position to faint: Hepar s. followed by Silicea, should the for- mer not suffice, or afford only a slight degree of improvement. Sulphur often very serviceable after Pulsatilla, when the attacks are most liable to come on while sitting ; or it may be selected in preference to the said remedy when the giddi- ness generally comes on whilst walking up a hill or ascending stairs ; or at other times attended with nausea, fainting, or bleeding from the nose. Lycopodium, giddines with tendency to congestion, accompanied with flatulence, headache, anxiety and obstinate constipation. Lachesis, giddiness with absence of mind, or paleness of the face, nausea and vomiting; fainting, bleeding from the nose, particularly when the attacks come on chiefly in the morning on waking. Opium, threatening vertigo, with confusion of ideas; or de- cided giddiness, with humming in the ears, and clouded vision on sitting up in bed, which renders it necessary to lie down again ; vertigo from fright. Conium. Violent giddiness, with dread of falling to one side on looking backwards. Giddiness arising from disordered stomach, with nausea or vomiting. Aconitum, followed by Antimonium crudum, and subseqently Puhatilla if necessary, from a continuance of the symptoms in a greater or less degree. Diet. The homoeopathic regimen already given in Intro- duction should be rigidly adhered to, and stimulants of all 266 CEREBRAL SYSTEM. kinds carefully avoided ; moreover, early rising, and daily exercise in the open air, should not be neglected ; the use of the flesh brush in the evening is also of some service. APOPLEXY. Apoplexia. Diagnosis. Sudden or gradual loss of consciousness, sen- sation, and motion, with greater or less disturbance of the pulse and respiration. Few diseases offer a greater number of varieties in form than the one above named; and there is scarcely a single classification of the many that eminent medical writers have given to the world, that is not more or less liable to objection. It is also extremely difficult to diagnose clearly between the different varieties, the external symptoms not always bearing a uniform relation to the internal injury ; thus all the indica- tions of serous apoplexy may declare themselves from sangui- neous extravasation ; and it is not always possible to decide in apoplexy whether effusion or simple congestion of the vessels of the brain has taken place. Premonitory Symptoms. Continued inclination to somno- lence, heavy profound sleep with stertorous breathing, incu- bus, grinding of the teeth, shocks, or cramps, a general feel- ing of heaviness or disinclination to the least exertion; fre- quentyawning and fatigue after the slightest exercise. A sense of weight and fulness, and pains in different parts of the head. Cephalalgia and megrim, or vertigo and fainting ; pulsation of the temporal and carotid arteries, with swelling of the veins of the head and forehead ; disturbance of the cerebral system evinced by loss of memory, forgetfulness of words and things, irritability of temper, or mildness and indifference, despon- dency and weeping ; infiltration of the conjunctiva, dimness of vision, specks or motes before the eyes or flashes of fire or sparks during darkness; acuteness of vision or diplopia, sometimes also the words in a line appear to run into one another; difficulty of opening or closing the eves; noises, humming, singing. &c. in the ears; dulness of APOPLEXY. 267 hearing, dryness of the nostrils, pinched appearance of the nose with unpleasant odour, sneezing and slight epistaxis; stammering, and indistinct enunciation ; difficulty of deglu- tition, numbness or torpor, or pricking sensation in the ex- tremities, with occasional partial attacks of paralysis in the face, distorting the features, and affecting the utterance, or in some of the muscles of the limbs, pains in the joints ; weak or unsteady mode of progression, difficulty of micturi- tion, &c. • Their Treatment. Against the preceding, Homoeopathy possesses remedies by whose proper application the practi- tioner may, if consulted in time, succeed in warding off the attack of this dreaded malady. The following are the medicines most appropriate to the treatment of the foregoing symptoms which are most generally called for in the treatment of the disease itself, or to Determi- nation of Blood to the Head : (see that article :) Aconitum, Belladonna, Nux vomica, Lachesis, Opium. Aconitum. In all cases, where there are evident symptoms of plethora, determination of blood to the head, characterized by redness and fulness of the face, distention of the veins of the forehead, quick full pulse, restlessnes, and anxiety. Administration, f, dissolved in six teaspoonfuls of water, one every twelve hours.* Belladonna. Should the symptoms of congestion not speedily yield to Aconite, or should only a partial degree of amelioration have taken place; or further, should the follow- ing symptoms present themselves : redness and bloatedness of the face, injection of the conjunctiva, violent beating of the carotid and temporal arteries, noises in the ears, darting pains in the head, with violent pressure at the forehead in- creased by movement, the least noise or bright light; or di- plopia and almost all the symptoms relative to the eyes al- ready mentioned; dryness of the nose, with unpleasant smell and epistaxis; difficulty of deglutition ; slight attacks of para- lysis in the face ; paralytic weakness or heaviness in the limbs. * Vide note, p. 21. 268 CEREBRAL SYSTEM. Administration. t6t, in six teaspoonfuls of water, one every twenty-four hours, or every six or twelve in more alarm- ing cases, taking care if the slightest symptoms of medicinal aggravation declare themselves, to discontinue the medicines for a time.* Nux vomica is particularly suited to cases in which the apoplexy threatens individuals of sedentary habits addicted to the use of ardent spirits, or too great an indulgence in the pleasures of the table, and also when the following symptoms present themselves: headache, especially at the right side, with vertigo, confusion and humming in the ears, nausea, and inclination to vomit; drowsiness, feeling of languor with great disinclination to exertion, either mental or bodily, cramps of the limbs, especially at night, and weakness in the joints ; constipation and dysuria, irritability of temper, aggravation of the symptoms in the morning, or after a meal, and also in the open air ; bilious, sanguine, or nervous temperament. Administration. The same as Belladonna. Opium is a most important remedy in almost all severe attacks, but particularly in old people, when we find the following symptoms: marked congestion to the head, indi- cated by stupor, vertigo, heaviness in the head, and violent pressure in the forehead, singing in the ears, and obtuseness of hearing; sleeplessness or agitating dreams, or frequent and almost overpowering drowsiness during the day, redness of the face, and constipation ; pulse slow, but full. Administration, f, in the same manner as Belladonna. Lachesis is indicated by many of the same symptoms which have been enumerated under Nux v., together with the follow- ing distinctive characteristics : frequent abstraction of mind, or vertigo with congestion, and aching pains in the left side of the head, and lowness of spirits ; pulse weak, and slow. When any of the symptoms before noticed present them- selves, is the proper time to prevent the attack running on to apoplexy; sometimes the signs are so marked that we can have but little doubt of the result, unless timely precautions * Vide note, p. 21. APOPLEXY. 269 are taken; at others, so slightly as to be almost impercepti- ble ; and in others again, the attack comes on suddenly with- out any marked premonitory symptoms whatever. See Congestio ad Caput. Apoplexy. A work of this nature is scarcely the place to enter upon the many varieties of this dangerous and com- plicated affection. Where so much depends upon the tact and promptness of the practitioner, to do the subject the jus- tice it merits, would require almost a treatise of itself. I shall therefore content myself with quoting the leading indi- cations of those remedies which have hitherto been chiefly recommended, or found most successful in the treatment of the disease itself. Opium is held as a most important remedy in all cases of apoplexy when the disease has attained considerable height. It is, however, one of the best remedies to commence with, when the attack has arisen from excess in drinking, and the symptoms are as follows : slow, stertorous breathing ; red and bloated face ; heat of the face and head, which latter is also cov- ered with sweat; insensible and dilated pupils; stupor; tetanic rigidity of the entire frame, or convulsive movements and trembling in the extremities ; foaming at the mouth. Nux v. has been found of great service in completing the cure after the previous use of the above remedy ; but may also be administered at the commencement when the attack has oc- curred in an individual of bilious or sanguine temperament, and of irritable temper, in consequence of over-indulgence in vinous or spirituous liquors ; or when the attack has resulted during or after a fit of passion, and the patient appears in a state of drowsiness approaching to stupor ; the breathing stertorous ; eyes dull and glassy ; hanging of the lower j#w, with copious secretion of saliva ; paralysis, particularly of the inferior ex- tremities (paralysis paraplegica) ; hemiplegia. Lachesis is also a valuable remedy in this disease, especi- allv when occurring in habitual drunkards ; with drowsiness or loss of consciousness, lividity of countenance, convulsive movements or tremour in the extremities ; or paralysis, espe- cially of the left side ; pulse weak and slow. 270 CEREBRAL SYSTEM. Arnica. Apoplexy after too hearty a meal, with loss of consciousness (drowsiness or stupor); stertorous breathing ; moaning or inarticulate muttering ; involuntary evacuations ; paralysis of the extremities (hemiplegia left side); pulse strong and full. Belladonna. Lethargy, loss of consciousness; the patient lies speechless with the mouth drawn to one side ; convulsive movements of the limbs or facial muscles ; hemiplegia, par- ticularly of the right side; dilated, immovable pupils; red and bloated face. Pulsatilla. Lethargy, loss of consciousness ; bloated- ness and bluish-red hue of the face, occurring after a full meal which has been hurriedly swallowed ;* or sudden loss of the power of movement; palpitation of the heart; pulse almost entirely suppressed; respiration stertorous ;' temperament phlegmatic. Baryta carbonica. This remedy, like Opium, is peculi- arly well adapted to the treatment of many of the affections of old people. It has accordingly, like the foregoing remedy, been found very serviceable when the serious affection at pre- sent under consideration is met with in patients of advanced age, particularly when the following symptoms are encoun- tered : Coma somnolenlum, with moaning and muttering; cir- cumscribed redness of the cheeks ; mouth drawn to the one side; paralysis of the tongue, or of the upper extremities ; hemiplegia (right side); confusion of ideas; childish manners. The following remedies may also be pointed out as being worthy of the attention of the experienced homceopathic prac- titioner : Stramonium, Hyoscyamus, Cocculus, Ipecacuanha, Ignatia, and Cuprum aceticum ; and in some cases, Coffea cruda,Antimoni1hn crudum, Conium maculatum, Digitalis, Mer- curius, and Tartarus emeticus ; and in the paralysis resulting from apoplexy, Belladonna, Baryta carbonica, Causticum, Nux vomica, Rhus, Silicea, Lycopodium, Graphitis, Carb. v., * Ipecacuanha is equally indicated when the attack has arisen from such a cause, and may therefore be employed after, or in alternation with Pulsatilla, should the latter remedy not afford speedy relief. INFLAMMATION of the brain. 271 Oleand., Bryonia, Cocculus, Plumbum, Stramonium, Stannum, Sulphur, Calcarea, and Zincum metallicum. I cannot conclude this article without giving expression to the gratification I, in common with the majority of the most eminent of my homoeopathic medical brethren, feel at the gradually increasing distaste to bloodletting upon the part of our opponents. Many have renounced the use of the lancet altogether; and others, while they do not wholly discounte- nance its employment, surround the cases in which it ought to be had recourse to with so many restrictions as almost to amount to a prohibition. At all events, we may hope that the time has already arrived, at least for the more enlightened of our profession, when even those who still adhere to its em- ployment in particular cases will not rashly prescribe bleeding in 511 instances of cerebral compression, where, if had recourse to before a reaction has set in, it may destroy the patient, either by his sinking under it, or by effusion, if that has not already taken place, or by increasing it if it has.* INFLAMMATION OF THE BRAIN AND ITS TIS- SUES. BRAIN FEVER. 0 Phrenitis. Encephalitis. Diagnosis. Coma, or constant delirium, or both, with signs of determination of blood to the head; fulness and red- ness of the face and eyes ; beating of the carotid and tempo- ral arteries ; sometimes attempts to grasp the head. When depending upon inflammation of the tissues, the pain is more acute than that arising from inflammation of the sub- stance of the brain. Paralysis also more frequently accom- panies the latter form. In inflammation of the brain or of its membranes, the symp- toms are exceedingly diversified; the extent and duration of the disease, the age, the sex, and constitution of the patient, * Against paralysis resulting from apoplexy, the following remedies have principally been employed with advantage: Nux v., Cocculus, Bel- ladonna, Stramonium, Zincum, Lachesis, and Sulphur. 272 CEREBRAL system. assist in giving to the affection a variety of character. Much assistance may be derived, in ascertaining whether the brain is affected or not, by examining the eyes and general expression of the countenance. The pupils in the first stages are com- monly found more or less contracted, but as-the disease ad- vances, they often become dilated. Occasionally the attack is preceded by premonitory symptoms, such as congestion of blood to the head, attended with sensations of weight, or stupi- fying, pressive, constrictive, and sometimes shooting pains in the head. In some instances slight feverish symptoms are complained of, with ringing in the ears for about the space of a week; giddiness, and a sense of weight on the crown of the head ; pulse rather quick, and the heat of the skin somewhat increased at night, attended with restlessness and a difficulty of lying long in one position; moreover, the patient is observed to be irritable and annoyed at trifles ; anomalies in the men- tal powers may next be observed, such as obstupefaction, drowsiness, with slight delirium ; or a high degree of excite- ment, in which the patient is affected by the slightest noise, and the eyes have a brilliant and animated expression, or are blood-shot, with fiery redness of the face, and violent deliri- um. According to the seat of the inflammation, or the consti- tution of the patient, the accompanying fever is of greater or less intensity ; the pulse is very variable in the course of the same day ; it may be regular, intermitting, quick and weak, or very slow and strong. A very slow or a very quick pulse, generally indicates danger. The patient frequently complains of heat in the head, whereas the extremities are cold. When there is stupor, or a tendency to it, the eyes look heavy and void of all expression ; vomiting sometimes takes place and proves very intractable ; the stupor becomes more profound, convulsions appear, and death sooner or later ensues. The peculiar and delicate structure of the brain and its membranes in children renders them much more susceptible to the at- tacks of this serious disease, and great attention ought to be paid to the following symptoms: heaviness and tendency of the head to gravitate backwards, attended with pain, of which latter circumstance we are sometimes made aware, in INFLAMMATION OF THE BRAIN. 273 very young children, by the little sufferer frequently raising its hands to the head ; alternation of temper; intolerance of light • nausea, occasionally followed by vomiting; tendency to costiveness; drowsiness; wakefulness, or starting during sleep. Secondly, continued boring of the head against the pil- low ; a high state of excitement, in which the slightest noise, or rays of light, throws the child into a fit of screaming, or a state of discontentment; heavy sleep; great heat in the head; redness and swelling of the face, with perceptible throbbing in the vessels of the head and neck ; great agitation, with continued tossing about, especially at night; eyes red, spark- ling, convulsed, or fixed ; pupils immoveable, and generally dilated. Causes. Anything tending to irritate the brain, such as extremes of heat or cold ; the abuse of ardent spirits ; exter- nal injuries of the head ; concussions from falls ; mental emo- tions, or over-exertion of the faculties; excesses of all kinds ; sanguineous congestion; metastases ; contagious diseases; repressed eruptions, &c. Therapeutics. With regard to the treatment of this dis- ease, we should have immediate recourse to Aconite at the commencement of the attack, when the skin is hot and dry, and the pulse rapid, with the ordinary indications of pure In- flammatory Fever, which is especially liable to be the case in young plethoric subjects. Administration. The same as in Inflammatory Fever. After which we may have recourse to any of the following re- medies as indicated: namely, Belladonna, Hyoscyamus, Opi- um, Stramonium, and Cuprum aceticum. Belladonna. This remedy seems to possess a certain specific influence over inflammation of the brain and its men- inges ; and is generally the one we should select when the fol- lowing, among other symptoms, present themselves: great heat of the head; redness and bloatedness of the face, with violent pulsation of the carotids; burying of the head in the pillow, and increase of suffering at the slightest noise, with extreme sensibility to light; violent shooting and burning 12* 274 CEREBRAL system. pains in the head; eyes red and sparkling, with protrusion or wild expression; contraction and dilatation of the pupils ; vio- lent and furious delirium; loss of consciousness; sometimes low muttering; convulsions, occasionally symptomatic hydro- phobia ; vomiting; involuntary evacuation of faeces and urine. Administration. One drop of the tincture at the third potency in an ounce of water, a dessert-spoonful every threer to six hours; or a globule or two of the third or sixth potency in a teaspoonful of water, at the intervals stated,—being guided by the intensity of the symptoms and the effects pro- duced.* Bryonia. This remedy will frequently be found of great efficacy in children when Aconite and Belladonna have pro- duced but trivial improvement, and the symptoms indicate a tendency to rapid effusion, in which case Helleborus may follow Bryonia if required. (Vide Hydrocephalus.) Hyoscyamus is appropriate when there is drowsiness, loss of consciousness, delirium about one's own affairs; inarticulate speech; tongue coated white, with frothy mucus about the lips; dilatation of the pupils ; fixedness of the vision ; skin dry and parched; redness of the face; and picking of the bed- clothes with the fingers. Administration. Same as Belladonna. Opium. When there is lethargic, sleep, with stertorous breathing; half open eyes and confusion or giddiness after waking ; sanguineous congestion; complete apathy and ab- sence of complaint. Administration. Two drops of the second or third poten- cy in an ounce of water, of which we may give a dessert- spoonful every hour until relief takes place, unless some other more specific remedy be called for by some alteration in the symptoms. Stramonium, when there is starting or jerking in the limbs; sleep almost natural, followed by absence of mind af- ter waking, but sometimes attended with moaning and tossing about; vision fixed, and the patient frequently appears in a *Vide note, p. 21. INFLAMMATION of the brain. 275 state of dread, and utters cries; redness of the face; feverish heat, with moisture of the skin; in many of the symptoms it bears a close resemblance to Belladonna, but with the excep- tions of being indicated by signs of more spasmodic charac- ter, and exhibiting less acuteness of pain in the head. Administration. Same as Belladonna. Cuprum aceticum. The value of this remedy in cases of repercussed exanthemata, and the consequences therefrom arising, has been already noticed under Scarlet Fever ; un- der which also some of the symptoms indicating its employ- ment are commented upon; it is also called for in a peculiar sensitive rather than inflammatory or irritable state of the brain, which not unfrequently appears in children during the course of catarrhal fever or difficult dentition, of which affection the following arc the symptoms :—At the commencement, cross- ness or fretfulness, or apathy and indifference; sleep disturbed and restless. As the disease gains ground, drowsiness, with inability to sleep; incapability of holding the head erect, and flushing of the face; dryness of the mouth without increase of thirst>; disgust of food, nausea, even vomiting; torpor of the bowels, rarely diarrhoea; shudderings followed by heat, occasional burning; seldom perspiration; pulse variable, gen- erally rather accelerated and full; exacerbations and fever (synocha) towards and at night; subsultus tendinum, and grinding of the teeth during the exacerbations. Belladonna, Rhus, Lachesis, and Mercurius, have also prov- ed serviceable in cases arising from repercussed exanthemata. Administration. As in Scarlet Fever. Cina is useful in irritation of the brain in children, appa- « rently arising from helminthiasis. Administration. As under Worms, (which see.) In chronic cases, Sulphur, Helleborus niger, Arsenicum, and Lachesis, are the most generally useful. It may be added, that Aconite, followed, if required, by Belladonna, Camphora, Lachesis, are the most appropriate remedies when the affection has arisen from exposure to the sun (coup du sohil). 276 CEREBRAL SYSTEM. Aconite,. Bryonia, Arsenicum, Hyoscyamus, when resulting from a violent chill in the head. From suppressed otorrhcea, Sulphur, Pulsatilla. External injury, Arsenica Belladonna, Mercurius. Abuse of ardent spirits. Opium, Lachesis. And when from intense mental application, Belladonna, &c, ac- cording to the symptoms. TETANUS. This is a disease characterized by a general spastic rigidity of the muscles. Its varieties are: Trismus, the lock-jaw; Opisthotonos, which is the most common, when the body is drawn or bent backwards by the spasmodic contraction of the muscles, sometimes to such a degree that the occiput touches the heels; Emprosthotonos, when the body is bent for- wards—a rare form of the disease; Pleurosthotonos, in which the body is bent to one side—a still" more rare variety. The disorder is chiefly occasioned either by exposure to cold (idiopathic tetanus), or arises from some irritation of the nerves resulting from local injury, particulary of tendinous parts, (traumatic tetanus.) It is of much more frequent oc- currence in warm than in cold climates. In this and in other climates, the amputation of a limb, or the twitching of a nerve by a ligature, are not unfrequent sources of its occurrence. When it takes place in consequence of such a cause, or of any other external lesion, the symptoms generally set in about the eighth day, and sometimes later; but when it supervenes on exposure to cold, they usually declare themselves much earlier. In some cases, the attack comes on suddenly, and with extreme violence ; but it more generally approaches in a gradual manner; a slight stiffness being at first experienced in the back part of the neck, together with an uneasy sensa- tion at the root of the tongue, difficulty in performing the act of deglutition, and an oppressive tightness is complained of in the chest, with a pain at the interior extremity of the ster- num, or the scrobiculus cordis, extending into the back; the respiration is impeded; the countenance pale, pulse small, bowels constipated, and urine high coloured ; a stiffness also 1ETANUS. 277 takes place in the lower jaw, which ere long increases to such an extent, and compresses the jaws so closely and firmly, that the smallest opening is not admitted of, and the patient is now afflicted with what is termed lock-jaw. In some in- stances, the spasmodic contractions proceed no further; in others, they return with great frequency and increased sever- ity, and also extend to the arms, the abdominal muscles, the back and inferior extremities, so as to bend the body forcibly in one or other of the directions before stated. Finally, the arms, lower extremities, head, and trunk, become rigidly ex- tended, from an equipoised spasmodic action of the flexor and extensor muscles. The tongue is also seized with spasms, and is not unfrequently injured by the teeth becoming clench- ed together, just as it happens to be convulsively darted out. As the affection advances, the eyes become fixed and im- movable, the whole countenance frightfully distorted, and ex- pressive of extreme anguish, the pulse irregular, the strength completely exhausted, and a termination is put to the suffer- ings, generally about the fourth day in acute cases, by one concentrated spasm. In some cases the fatal termination is protracted considerably beyond the stated period. The spasmodic action does not continue unremittingly, the muscular contractions occasionally admitting of some remis- sion, but is generally immediately renewed as soon as the pa- tient makes an effort to speak, drink, or change his posture. Therapeutics. The remedies which have chiefly been used in homoeopathy in the treatment of this distressing dis- ease are: Belladonna, Stramonium, Cicuta virosa, Arnica, Opium, Hyoscyamus, Angustura, Rhus, Ignatia, Lachesis, Na- trum muriaticum, Mercurius, Aconitum, Sulphur, Veratrum, Phosphorus, Camphor, Staphysagria, Moschus. Belladonna is one of the most important of these, parti- cularly in idiopathic tetanus, properly so called, or in trismus; it has also proved useful in the traumatic variety, however, after the previous employment of Arnica. It is principally indicated when a sensation of constriction is experienced in the throat, and tightness at the chest, with grinding of the 278 CEREBRAL SYSTEM. teeth, spasmodic clenching of the jaws, distortion of the mouth, foaming, obstructed deglutition, and renewal or exacerbation of the paroxysms on attempting to drink. In some cases of trismus, the alternate use of Belladonna and Lachesis, or Belladonna, Angustura, and Cicuta virosa, have been found necessary; and of Belladonna, Lachesis, Hyoscyamus, and Stramonium, in opisthotonos ; or Opium, Rhus, and Bella- donna. Arnica Montana. In cases of traumatic tetanus, which is by far the most fatal variety, this remedy is, in most in- stances, the most appropriate to commence with, and should be used both internally and externally, in the form of an ex- tremely weak lotion (about a teaspoonful or a drachm to a pint of water). Should symptoms of improvement not set in, in twenty-four to forty-eight hours, Opium and Hyoscyamus must be had recourse to. Any local irritation which may seem to have excited the disease must at the same time, if possible, be carefully removed. Opium has proved extremely useful in some of the severest forms of opisthotonos arising from cold ; but as above stated, it is also valuable in traumatic tetanus. (Likewise in teta- nus from fright.) Rhus and Ignatia have been found very efficacious in se- vere cases of opisthotonos, in which the body has been bent up in the form of an arch, and on some occasions with the back of the head touching the heels, when the complaint arose from terror. Mercurius has frequently succeeded in curing inflamma- tory trismus, with swelling of the angle of the lower jaw, and tension of the muscles of the throat and neck, from cold. These are a few general indications for the employment of the foregoing medicines. The following may also prove ser- viceable in various forms of tetanus : Aconitum, Sulphur, Ve- ratrum, Phosphorus, Camphora, Staphysagria, Moschus, Bryo- nia, Nux platina, Ipecacuanha, Secale cornutum, Cannabis in- dica, Cantharides, Cicuta virosa, Cina, Rhus toxicodendron, Gratiola, Stannum; but considerable care must necessarily be bestowed on the selection of the proper remedy. TETANUS. 279 When, from the spasmodic clenching of the jaws, it is found impossible to introduce the medicine into the mouth, the effect of olfaction must be tried; it has also been found useful to moisten the lips and nostrils with the medicine dissolved or diluted in water; and in some cases, the administration of the remedy in the form of enema (a few drops of the third potency in an ounce or two of water) has been found very efficacious. (See also Hydrophobia, Hysteria, and Mye- litis.) CUTANEOUS DISEASES. ST. ANTHONY'S FIRE. ROSE. Erysipelas. Diagnosis. The first local symptoms are : heat, tingling or pricking pains, with diffused swelling, tension, and deep redness of the affected part. This is, ere long, followed by pungent, burning, and sometimes tearing or shooting pain, which is aggravated by motion or pressure; the surface pre- sents a shining appearance. On pressure, the redness disap- pears for a moment, but immediately returns on removing the finger. The constitutional symptoms vary according to the severity of the case ; they generally consist of shiverings, succeeded by flushes of heat; sleepiness, wandering pains, dry tongue, nausea, oppression at the stomach, and headache; vesications sometimes arise on the affected parts, attended with increase of fever; (Erysipelas bullosum.) In a few days the redness changes into a yellowish hue. When the face is attacked, the features become much disfigured by the swell- ings, and delirium supervenes. The disease assumes a very serious aspect when it affects the face and scalp, and accord- ingly requires the utmost attention and discrimination in the treatment pursued. The hair often falls off after a severe attack of erysipelas of the face. Causes. Derangement of the digestive functions, exposure to cold, or powerful mental emotions; occasionally it appears dnring menstruation; certain kinds of food also provoke it in KRYS1PELAS. 281 some idiosyncrasies; for example, lobsters, oysters, or other shell-fish. Therapeutics. The principal remedies in the treatment of the ordinary forms of erysipelas are : Aconite, Belladonna, Bryonia, Pulsatilla, Rhus tox., Arsenicum, and Lachesis. Aconite, in case of much fever, or hot, dry skin. Administration. fl6-, repeated in from six to twelve hours if required, in slight cases ; but even during the disease, if the fever runs high or assumes a synochal type, exhibit as under Inflammatory Fever, (which see.) Belladonna, chiefly in Erysipelas phlegmonodes, but also in edematodes and erraticum, when the redness expands in rays, and an acute shooting pain with heat and tingling is experienced in the affected part, which is aggravated by movement. Facial erysipelas, with burning heat, excessive swelling, so that the eyes are almost closed, violent headache, thirst, dry hot skin, restlessnes, disturbed sleep, delirium. In such instances, Belladonna is generally alone sufficient to effect a cure ; but sometimes it will be found necessary to have recourse to Lachesis or Rhus toxicodendron, in alterna- tion with Belladonna; or to Hepar s., when the skin is smooth, looks less glassy and inflamed after the employment of Belladonna, but the heat, pain and swelling remain unal- tered. (See Rhus.) Administration. A few globules of the sixth, or even a drop of the tincture of the third potency, to an ounce of water, a dessert-spoonful every six hours. In mild cases ^65, repeated in twelve to twenty-four hours, if necessary.* Bryonia is frequently useful when the disorder affects the joints, and when the pain is exacerbated by the slightest movement. Belladonna, however, is equally appropriate in most affections of this nature. (Sulphur is sometimes re- quired to complete the cure after Bryonia.) Administration. Same as Belladonna. Pulsatilla, when the hue of the skin is less intense, or of a bluish red, and the morbid spots frequently disappear from one place to reappear in another, (Erysipelas erraticum.) * Vide note, p. 21. 282 cutaneous diseases. It is further indicated when the disease affects the internal and external ear, particularly in vesicular erysipelas, after Rhus tox. (Belladonna and Rhus, and, in some instances, Gra- phites, are called for in fugitive or wandering erysipelas.) Administration. —, morning and evening, until symp- toms of improvement result, or another remedy is called for.* Rhus tox. is our best remedy in vesicular erysipelas, and also appropriate in erysipelas with gradual but very extensive oedema, (Erysipelas edematodes,) particularly when the dis- ease has a tendency to extend itself to the brain Snd mem- branes, and the symptoms closely resemble those developed in Encephalitis. In some instances it is necessary to have recourse to Belladonna and Hepar sulph. to complete the cure ; or to Belladonna and Rhus alternately. (Graphites is also useful in some obstinate cases of vesicular erysipelas.) It may also be remarked, that Rhus is especially suitable to erysipelas arising from particular kinds of food in certain idiosyncrasies ; in other cases of this kind, however, Pulsatilla or Bryonia will be found equally serviceable, according to the symptoms and the temperament of the patient. Administration. 0g°; repeated in six or twelve hours, if necessary ; and in severe cases, a drop of the tincture of the third potency to an ounce of water, one dessert-spoonful every four hours until benefit result, lengthening the intervals or ceasing to exhibit, according to results. Nux vomica. In erysipelas of the knee or foot, with ex- tremely painful bright red swelling ; also successful in pseudo- erysipelas, in irritable subjects, particularly females. (Ad- ministration : see Rhus tox.) Arsenicum, when vesicles of a blackish hue, with a ten- dency to degenerate into gangrene, present themselves, (Ery- sipelas gangrenosum ;) still more clearly pointed out, if great prostration of strength be present. This medicine may also be advantageously alternated with Carbo vegetabilis ; but as such cases fall especially within the province of the experi- enced homoeopathic professional man, it will be needless to enter into the mode of administration, which must be regula- * Vide note, p. 21. BOIL. 283 ted by circumstances. (Lachesis and Rhus are occasionally of great service after, or in alternation with Arsenicum.) Cuprum aceticum. The value of this remedy, upon the testimony of Dr. Schmidt, of Vienna, has been already noticed in repercussed eruptions, when a marked metastasis to the brain has taken place. See Scarlet Fever. Sulphur and Arsenic are important remedies when erysi- pelas has terminated in ulceration. In some chronic forms of the complaint, Acidum nitricum, Euphorbium, Sulphur, Graphites, Silicea, (pseudo-erysipelas,) and Hepar s. have been found serviceable. The alternate use of Bellad., Rhus, and sometimes Laches, or Crotal., has removed permanently a disposition to erysipelas of the face. In Erysipelas Scroti, or Cancer Scroti, (Chimney sweeper's cancer,) Arsenicum is the most important remedy; Rhus, Clematis and Lachesis have also been recommended. The greatest care must be observed to avoid the risk of taking cold, even during convalescence; such an accident occurring during the disease is, as is well known, frequently attended with the most dangerous results. The troublesome itching so frequently attendant upon erysipelas, is often ma- terially relieved by the application of wheaten starch, or flour of maize. In conclusion, I may be allowed to remark, that by the fortunate discovery of remedies perfectly homoeopathic to most of the forms of erysipelas, we are now enabled to treat this affection with the same facility and certainty as we are other diseases curable by well-known specifics. BOIL. Furunculus. Abscessus nucleatus. Diagnosis. Round or rather cone-shaped hard elevations, of different sizes, slowly inflaming aud suppurating, discharg- ing matter generally at first tinged with blood, but still retain- ing a portion of morbidly-altered cellular tissue, which may form the nucleus of another after the first has healed. Causes. A peculiar constitutional tendency; they are, however, frequently critical, as in gout, following acute fe- vers or eruptive diseases, and sometimes forming the termi- nation of chronic exanthemata, such as itch, &c. 284 CUTANEOUS diseases. Therapeutics. The following are the remedies most ser- viceable in this troublesome affection : Arnica montana, Sul- phur, Belladonna, Mercurius, Aconitum, and Hepar sulphuris. Arnica is the best remedy in most cases of boils, and will frequently prevent their return ; but in the majority of cases, Sulphur is necessary to eradicate the affection, which desira- ble result is best accomplished by the use of these two re- medies at each attack, for two or three successive times. It sometimes happens, however, that the pain and constitution- al disturbance is so great that it becomes necessary to have re- course to one or more of the subjoined remedies: Administration. -6-, repeated in three days, if necessary ; in other cases it may be found more advantageous to exhibit ££- in three teaspoonfuls of water, taking one night and morn- ing until finished.* Aconitum, when the boil presents an extremely inflamma- tory appearance, and the affection is accompanied with con- siderable fever and restlessness, is promptly efficacious in subduing these symptoms, and may precede a more specific remedy. Belladonna, should the boil have an inflamed, fiery, or erysipelatous red appearance ; or, moreover, should it, if si- tuated upon the extremities, be associated with swelling and tenderness of the glands under the armpit, or upon the groin ; dry, hot skin, thirst, headache. • Administration. Same as Arnica. Mercurius. Should the swelling refuse to yield to that remedy after the inflammatory redness has been subdued. Administration. The same as Arnica. When matter has formed, Hepar sulphuris will be found conducive to bringing the tumour to a head, and thereby cur- tailing suffering. Administration. °g°, repeated in from six to twelve hours, if necessary. A tendency to frequent returns of this affection is, as al- ready stated, often obviated by the repeated exhibition of Ar- nica and Sulphur; but when from some innate taint there are * Vide note, page 21. Chilblains. 285 not found sufficient, this result is often attained by the employ- ment of Lycopod., Nux vom., Phosphorus, and Acidum nitr. CARBUNCLE. Anthrax. Furunculus Malignans. Pustula Nigra. Diagnosis. A livid, bluish, or black spot, upon an extend- ed surface, extremely painful, readily running to gangrene, and proving fatal from the extension of mortification. The disease is attended by headache, thirst, foul tongue, sickness, loathing of food, languor, jactitation, and sleeplessness. Therapeutics. The best remedies in this affection are: Lachesis, Silicea, and Arsenicum Album. Lachesis. When the anthrax presents a livid appearance, and is disposed to extend rapidly or to burrow. Administration. °y°, in four teaspoonfuls of water, twice a day, exhibiting at longer intervals, if improvement takes place.* Silicea. When administered from the commencement in simple non-contagious carbuncle, is frequently found suffici- ent to effect a perfect cure. Administration. ^_, in three dessert-spoonfuls of water, one daily,—to be repeated if required. Arsenicum. When the carbuncle threatens to terminate in gangrene; it is also the most efficacious remedy when the disease has arisen from contagion. Administration. A few globules of the sixth, or even a drop of the tincture, at the third potency, to an ounce of wa- ter, a dessert-spoonful every six, twelve, or twenty-four hours, according to the emergency of the case. In some cases Cinchona, Rhus tox., Pulsa. and Silicea, may be found serviceable in completing the cure after Arsen. CHILBLAINS. Perniones. This affection is too well known to require any particular description ; the exciting cause is exposure to transitions of * Vide note, p. 21. 286 cutaneous diseases. temperature, from cold to heat, and vice versd, but their origin is more deeply seated; the feet are the part most generally attacked, but we frequently find the hands also suffer. When they burst, and become ulcerated, they constitute an exceed- ingly painful affection. Severe suffering from chilblains is an indication of constitu- tional taint not to be neglected, and individuals so afflicted should place themselves under a proper course of treatment; for until the system is completely renovated, they are conti- nually subject to their recurrence. Therapeutics. In the treatment of this affection, the fol- lowing medicines will be found valuable : Nux vomica, Pulsatilla, Belladonna, Arnica, Chamomilla, Arsenicum, and Sulphur. Nux vomica °£°, is particularly indicated when the inflam- mation is of a bright red colour, with swelling, attended with itching, increased by warmth, and when the chilblains evince a tendency to burst. Pulsatilla g|4, when the inflammation is of a livid hue with itching and beating in that part affected, and when the suf- fering comes on or is exacerbated in the evening or towards midnight. (Sulphur is often very useful after Pulsatilla.) Belladonna f £, when the inflammation is a of bluish red (but lighter than that indicating Pulsatilla), and very consider- able, attended with a creeping, tingling sensation. Arnica °£0,* when the swelling is hard, shining, and pain- ful, attended with itching. Chamomilla fl^a, when with the inflammation and itching, a burning sensation is present, followed by Arsenicum ~, when the pains are excessively violent, at- tended with severe burning, or when the chilblain bursts, and becomes converted into an irritable sore, with a tendency to fester. Arsenicum may in some such cases be advantageous- ly alternated with Carbo vegetabilis %%. * The homoeopathic or Arnica Court Plaster, of sufficient size to cover the chilblain, is frequently of great service in mitigating the suffer- ing.—Ed. CORNS. 287 Sulph jr °§° is a valuable remedy when the inflammation and itching are very severe, and the affection has refused to yield to the foregoing. Administration. Two or three globules at the potency given after each medicine, repeated every three days, if neces- sary, until benefit results, or some other remedy becomes in- dicated. In the instance of Arnica we may also apply a lotion in the proportion of one part of the mother tincture to five of water.* In conclusion, the following remedies may also be consulted : Acidum nitricum, Petroleum, Rhus toxicodendron, Bryonia, Ledum, Mercurius, Cinchona, and Secale cornutum. CORNS. Clavi Pedis. That these troublesome excrescences not unfrequently arise from an inherent vice of constitution, is evident from the fact that many individuals who wear tight boots and shoes, which are unquestionably the principal excitant, escape them, while others, with every precaution, suffer severely. Such being the case, the main object must be, by a course of properly-selected internal remedies, to eradicate the predisposing cause; among which, Antimonium crudum, (externally as well as internally, as described under the head of Chilblains,) Phosphorus, Rhus, Bryonia, and Ammonium carbonicum, Lycopodium, Petroleum, Sepia, Acidum phosphoricum, and Sulphur, will be found useful. Great alleviation of suffering has, however, been found to result from bathing the feet in warm water, and then applying a very weak Arnica f lotion, (a drop or two of the tincture to an ounce of water,) after having previously pared down the corn carefully. * The external application of the other remedies also, is frequently very serviceable ; in which case we may dissolve a few globules, or a drop or two of the tincture of the same remedy that we are administering inter- nally, in about an ounce or so of water, and bathe the chilblains with the lotion twice a day; in addition to this, it is sometimes advantageous to envelop the affected parts in a piece of linen which has been dipped in the lotion. f The Arnica plaster may be applied to corns as to clulblains, and will often afford the greatest relief to those corns commonly called soft.—En. 288 CUTANEOUS DISEA8ES. While upon this subject, it may be remarked, that Nux vomica has been found serviceable in cases of swelling and redness of the heel, resembling chilblains, attended with acute, burning, shooting pains, materially increased by the pressure of the boot or shoe, or by walking. Arnica may be recommended as above, should not Nux: vomica be found to relieve. ABSCESS. LYMPHATIC TUMOURS AND DISEASE OF THE CONGLOBATE GLANDS. Abscess. By this term is meant a collection of purulent matter, resulting from morbid action, contained in a sac or cyst of organized coagulating lymph, furnished with absorbent and secreting vessels. Abscesses are divided into acute and chronic. The former is preceded by sensible inflammation in the affected part, which is soon followed by suppuration. The commencement of the suppurative process is evidenced by a change in the description of pain, which becomes more obscure and throb- bing, the increase of swelling, and, when matter is formed, by the perceptible fluctuation when the abscess is not too deeply seated ; lastly, particularly in idiopathic cases, when the formation of pus is in considerable quantity, the fever which attended the previous inflammation is lessened, and irregular chills or rigours supervene, succeeded in turn by heat and increase of fever. When the abscess is mature, the tumour points, or presents a sort of conical shape, generally near the centre of the cuta- neous surface; over this spot the skin assumes a reddish hue, becomes thin, and ere long gives way, and allows the con- tents of the cavity to escape. The signs of the formation or existence of a chronic ab- scess, on the other hand, are in the generality of instances devoid of any apparent disorder, either local or constitutional, until it begins to approach the surface and form an external swelling. The secreted matter is unhealthy, thin, and serous, ABSCESS. 289 and contains substances resembling curds or flakes. When the pus is evacuated, and the air admitted into the cavity, in- flammation of the cyst arises, and is productive of a salutary effect, if the abscess be small; but if it be large, great constitu- tional disturbance ensues; the cavity, instead of contracting and filling up under the process of healthy granulation or incarnation, goes on discharging copiously, and hectic fever is produced. Therapeutics. In acute abscesses we may apply poultices and warm unmedicated fomentations, and forward the suppu- rative process by the administration of Hepar sul. f, in re- peated doses. The lancet is never necessary except when the pus, by its extensive diffusion or pressure, especially when seated under ligamentous or tendinous expansions, is liable to injure important parts ; or when, from its situation, there is reason to apprehend its discharge into any of the cavities of the body. When it is necessary to effect an artificial opening by means of the lancet, the incision ought to be made at the most depend- ing point where this can be safely or readily accomplished; and when this is impracticable, in consequence of the great thick- ness of the parts between the purulent matter and skin, the most prominent or pointed part ought to be selected. When, on the other hand, this latter happens to be at the upper part of the abscess, the lancet must be laid aside, and the abscess allowed to open spontaneously, or, still better, through the in- strumentality, or at all events the important aid, of Hepar sulphuris, Silicea, and Lachesis. The former two may fre- quently be administered in alternation with advantage ; the latter is more particularly to be preferred when a considerable portion of the skin has been much distended, and presents a deep red or bluish appearance, or where its structure has been destroyed by the magnitude of the abscess. Mercurius is oc- casionally useful when there is induration.* The subsequent * Carbo a. is equally serviceable here, and may follow Mercurius when that remedy fails to answer our expectations. Baryta is also useful in such cases, particularly when there is considerable surrounding swelling as well as induration, even after the opening of the abscess. 13 .290 cutaneous diseases. treatment is generally more easily conducted, and the heal- ing of the cavity more speedily effected, when the matter has been evacuated by the aid of the appropriate medicine, instead of the lancet. In chronic abscesses, it has usually been found most bene- ficial to make an outlet for the matter as early as possible, to prevent a large accumulation, and thereby avoid the con- sequent frightful constitutional disturbance which is so prone to occur in such cases, from the extent of the inflammation after the bursting of the abscess. The opening should be made near the base of the abscess, and merely be large enough to admit of the exit of the matter. When this collection of matter is very extensive, it fre- quently accumulates again after having been evacuated ; hence it has been recommended to heal up the opening immediately and to make a new one again when necessary, but before the pus has accumulated in any considerable quantity. When the matter has been withdrawn, a dose or two of Mercurius should be administered, followed by Hepar sulph., Silicea, and sometimes also by Calcarea, and Phosphorus. Silicea and Phosphorus have been described as useful when atrophy or consumption resulted in consequence of chronic suppuration. It may here be mentioned that, in Lymphatic Tumours, Sulphur, and in Encysted, (whether steatomatous or other- wise,) Calcarea has been found very efficacious.* Further, that in enlargement and induration of the Conglobate Glands situate in the neck, under the chin, and behind the ears, such as is usually met with in scrofulous habits,—Mercurius and Dulcamara are two of the most important remedies.! When * Graphites, Silicea, Hepar s. and Sulphur, Causticum, Baryta c, Carbo v., Acidum nitricum, Lachesis, or Phosphorus, &c., may be found useful in some cases. f In old standing or obstinate cases of glandular enlargement, and in- duration, Baryta c, Staphysagria, Carbo a. et v., Hepaf a., Sulphur, Cal- carea, and Silicea; as also Kali c, Lycopodium, Iodium, Acidum nitri- cum, Bovista, or Belladonna, etc., are remedies of great utility, and must be selected accordmg to the general features of the case, when Mercurius and Dulcamara are found insufficient to discuss the swelling, . In addition to being the principal medicine in violent nasal hemorrhage from external injury, or from great physical exertion, is, moreover, an important remedy in all cases in which the hemorrhage is preceded by itching in the nose and forehead; and when the nose feels hot, and the blood discharged is red and liquid. Rhus s-^s-. Bleeding of the nose from physical exertion, such as lifting a heavy weight, or, when blowing the nose, spitting, etc., or nasal hemorrhage, which becomes aggrava- ted or renewed on stooping, or during the night. Ferrum y. Nasal: hemorrhage in debilitated subjects, with excessive paleness of the face. (Especially after China.) Sepia -/. Frequent attacks of hemorrhage from the nose, with pale or sallow complexion, especially in females with obstructed catarnenia. Sulphur, either alone or in alternation with Sepia, and sometimes Carbo vegetabilis, Graphites, and Lycopodium, is of great service in removing a susceptibility to bleeding of the nose. (See also the remedies enumerated under nasal hemorrhage from the most trivial cause.) Nux v. y. Bleeding of the nose, especially in the morn- ing, from overheating, or after drinking wine, etc., or in habi- tual drunkards. (Lachesis and Calcarea carbonica are some- times requisite here, in addition to Nux v.) Dulcamara ^f^. Bleeding at the nose after getting the feet wet; flow of hot, clear blood from the nose. Crocus -§-. Discharge of dark-coloured, thick or viscous blood from the nose, particularly in females who menstruate too copiously, sometimes followed by fainting. 340 GENERAL DERANGEMENT. Moschus *■%*-. Frequently serviceable when the nasal hemorrhage occurs in nervous, hysterical females. Ammonium c Bleeding from the nose after a meal. Silicea. Nasal hemorrhage in scrofulous subjects. When the hemorrhage is of an active kind, the patient should be placed hi the erect posture, and kept cool and quiet for some time afterwards. The diet in all cases must be low, and unstimulating. When there is reason to fear suffocation from the bleeding continuing inwardly, and getting into the throat, as is liable to happen in extremely debilitated subjects, in whom little or no reaction appears to follow the administration of the reme- dies, the anterior and posterior outlets from the nose may be plugged; the latter by passing threads up the nostrils, and bringing them out at the mouth, and then securing pieces of sponge, or small rolls of lint to the ends ; after this, the threads should be drawn back, and tied sufficiently tight so as to bring the plugs somewhat firmly against the orifices. Sprinkling or dashing cold water on the face; exposing the face to a current of cold air; placing the feet or hands in warm water; applying a wet cloth round the abdomen, and even dipping the head into a pail of iced water, or salt and water, are amongst the best of the popular means, or occasional aux- iliary modes of stopping an excessive or prolonged discharge of blood from the nose. With regard to the administration of the remedies, the re- petition of the dose, if called for, must depend upon the great- er or less degree of the severity of the attack. We ought to be in no hurry to repeat in the majority of cases. (See also what has been said on this matter in the Introduction.) SWELLING OF THE NOSE. The remedies for this, as well as all other maladies, must be selected according to the cause, where known. Thus, if the affection has arisen from a contusion, Arnica (externally and internally) must be prescribed. If the disorder is encountered in scrofulous subjects, one or more of the following must be had recourse to : Aurum or SWELLING OF THE NOSE. 341 Asafetida; or Sulphur, followed by Calcarea; or Bella- donna, followed by Mercurius and Hepar s. When the dis- ease has been excited by the abuse of mercury: Hepar s., Acidum nitricum, Aurum, Belladonna, or Sulphur, will be found the most efficacious. When attributable to the habitu- al use of spirituous liquors: Calcarea, Arsenicum, Nux v., Pulsatilla, Sulphur; or Lachesis, Bellad., Merc Hepar s. Finally, Bellad., Merc, and Hepar have been found most serviceable in cases where the tumefaction was red and very painful; in similar cases of an obstinate character: Bryonia, Sulphur, Calcarea and Rhus have proved efficacious. When black spots in the nose are met with at the same time, Sul- phur and Graphites have chiefly been recommended ; and where there are scabs, Silicea, Sepia, Carbo v., and Natrum m., for the most part. Red spots, Acidum phosphoricum. Red- ness of the point of the nose, Calc, Carbo animalis, or Rhus toxicodendron. Coppery redness, Arsenicum, and Cannabis. WARTS on the nose, Causticum chiefly ; but in some cases, also Thuja, and Acidum nitr. Against swelling of the interior of the nose (Schneiderian membrane), Teucrium merum verum especially. In CARIES of the bones of the nose, whether of a scrofu- lous or mercurial origin, Aurum is the most important re- medy. When of syphilitic origin, Mercurius is to be pre- ferred, provided the patient has not already been placed under an injurious course of that powerful medicine, in which case the affection is as likely to have arisen from the remedy as from the disease, and will consequently require to be com- bated by anti-mercurial medicines, amongst which Aurum will in this instance form the most valuable remedial agent; the other general antidotes to the injurious effects of mercury on the constitution, such as Hepar s., Acidum nitr., Sulphur, and Calcarea, or Lachesis, Carb. v., Staphysagria, Lycopo- dium, Asafetida, Acid, phosph., and Silicea, etc., may in some cases become necessary, particularly when the system gene- rally has become impaired by the cause in question. OZiENA. This disorder consists of an ulcer having its site in the nose, from which a fetid purulent matter is discharged. 342 GENERAL DERANGEMENT. It usually commences with slight inflammation and tumefac- tion about the alse nasi, accompanied with sneezing, increased flow of mucus, with which the nostril becomes obstructed, and sometimes slight hemorrhage. The ulceration soon spreads from the schneiderian membrane to the nasal carti- lages, the mucus gradually assumes the nature of pus, and if the disease be not checked, the bones become implicated, and caries results ; a thin, acrid, offensive matter or sanies is then constantly discharged, and often excoriates the lips and throat, and the sense of smelling becomes abolished ; eventually the ossa spongiosa inferior, and also the vomer, and in the worst cases, particularly when there is complication with scrofulous and venereal or mercurial disease, even the palate and su- perior maxillary bones exfoliate, the bridge of the nose falls in, and leaves a frightful deformity of countenance. Therapeutics. The remedies which have chiefly been em- ployed in this malignant disease are: Teucrium marum verum, Pulsatilla, Sulphur; or Magnes. m., Bryonia, Belladonna, La- chesis, Lycopodium, Natrum m., Causticum, in the first stage, with mucous obstruction; Mercurius and Aurum in the second, with discharge of pus, and also affection of the bones ; followed, if required, in Oz^ena scrofulosa, by Sulphur, Silicea, Acidum nitricum, Phosphorus, Conium, or Polasse bich. In SYPHI- LITIC OZjENA, Mercurius forms the principal remedy ; but if the patient has already been subjected to an injurious course of that medicine, Aurum is to be preferred, and succed- ed, if requisite, by Acidum nitricum, Hepar s., Asafetida, Lachesis, Conium, or Thuja. In disease in the Antrum Highmorianum, the following have been recommended : Teucrium marum verum, Arsenicum, Lycopodium, Sulphur, Silex, Aurum, Mercurius, Hepar s., Mezereum, Staphysagria, Carbo v., Antimonium c, Kali hydr., Phosphorus; and Spigelia, Nux, China, Phosph., as pallia- tives when the pains are very severe.* * Goullon considers Arenicum and Lycopodium as almost specific in this disease. He recommends Arsenicum to be given when the pains are excessively severe, of a throbbing and splitting, or bursting description, when at their height. Lycopodium when there is a thick and yellow dis- charge. A. H. Z. 2, 24. CANKER OF THE MOUTH. 343 POLYPUS: Teucrium, Staphysagria, Phosphorus, Sul- phur, Sepia and Silicea, have chiefly been recommended. CANCER NASI: Arsenicum, Carbo v., Aurum, Sepia, Silicea, Sulphur and Calcarea, are the remedies which have principally been pointed out as the most appropriate to combat this serious and frightful malady. CANKER OF THE MOUTH. SCURVY IN THE MOUTH. Cancrum Oris. Gangrena Oris. Stomacace. This affection consists of a fetor in the mouth, with a vis- cid, bloody discharge from the gums, which are at the same time, hot, red, tumid, spongy, very sensitive, retracted from the teeth, and subsequently ulcerated along their margins. Sometimes there is also glandular swelling, salivation, or ptya- lysm ; and usually looseness of the teeth, impeded mastication and deglutition, great debility, and slow fever. Therapeutics. Mercurius is the most useful remedy here, and may generally form the first prescription in almost every case of the kind, as it will rarely fail to prove serviceable, if not sufficient to effect a perfect cure. When, however, we have reason to conclude that the symptoms above described have in reality been created by the injurious employment of that remedy, under allopathic treatment, it will be necessary to have recourse to the appropriate antidotes to these effects of the said powerful mineral, amongst which Carbo v. will be found of primary importance ; should the improvement effected by Carbo v. be only of a partial character, the treat- ment must be followed up by Hepar s. and Acid, nitricum alternately ; or by Staphysagria if fungous excrescenses form on the gums. Carbo v. is, moreover, of great service when the disorder has arisen from unwholesome food, the daily use of kitchen-salt in excess, or the prolonged use of salt meat ;* when the gums smell most offensively and bleed * Constantine Hering recommends a drop of Spiritus tetheris nitrosi once or twice a day, in the event of Carbo v. or Arsenicum failing to bring about a favourable action in such cases. 344 GENERAL DERANGEMENT. during mastication; the teeth loose, mouth hot, tongue much excoriated, and with difficulty to be moved. After the employment of Carbo v. we may have recourse to Arsenicum, if the ulceration continues extensive, and the pa- tient complains of burning pains in the gums, with great pros- tration of strength; or Arsenicum and China in alternation, if, in addition to the foregoing, the gums present a black, spongy, and somewhat gangrenous appearance. Nux v. is an admirable remedy in this disorder, particu- larly when it occurs in meagre, dark-complexioned subjects, of bilious temperament and choleric disposition, who lead a sedentary life ; the gums presenting a putrid aspect, and so much swollen as completely to cover the teeth ; counte- nance pale and sunken, Capsicum has been found useful under nearly similar cir- cumstances, but the affected party of a plethoric habit and phlegmatic temperament. Dulcamara may be used with advantage after Mercurius, when the glands of the throat are implicated in the derange- ment ; or it may be selected in preference to Mercurius when the disease is prone to be excited by the least exposure to cold, during damp, or cold, raw, wet weather. Natrum m. is frequently a valuable remedy in completing the cure after the administration of Carbo v., Acid. nitr. He- par, etc. It is more especially indicated when the ulcers are indolent, and do not put on a healing aspect; the gums being at the same time much swollen, very sensitive to heat or cold, and disposed to bleed at the slightest touch ; more- over, when painful vesicles or blisters are observed on the tongue, inner surface of the lips, and cheeks; which impede speech, and, together with the irritable gums, render the act of mastication a work of labour and excessive torture. When notwithstanding the employment of the last mentioned re- medy, the complaint seems disposed to linger, Sulphur may be prescribed, and followed or alternated with Acidum sul- phuricum, Sepia, or any of the other medicines already treated of, if required by the bent of the succeeding changes in the features of the case, etc. Silicea, Sub-boras, Sode, Helleb. and Iodium may also prove useful in some cases. SCURVY. 345 Lemon-juice, which is well known as a most valuable rem- edy in scurvy, is equally useful as a domestic remedy in sto- macace. Sage is equally useful in some varieties of the disorder. Rinsing the mouth with brandy has also been found of service. The use of wholesome, easily digested food, with a due proportion of vegetables, must be enjoined in order to expe- dite the cure. SCURVY. (Scorbutus.) This disorder is characterized by excessive debility, pale and bloated countenance ; cedematous swelling of the inferior extremities ; hemorrhages; livid spots on the skin, or foul ulcers ; offensive urine and extremely fetid stools. The gums spongy, or otherwise diseased, as described in the preceding article. It chiefly affects sailors, or others who from circumstances are deprived of fresh provisions and an adequate quantity of ascescent food, and are exposed to cold and moisture together with fatigue. Intemperance, want of excercise, impure air, uncleanliness, with depressing emotions, further tend to pre- dispose to the disease, when combined with unwholesome food, or the before-said alimentary deficiency. In the cure, as also the prevention of this malady, it is re- quisite, in the first place, to remove the probable cause of its invasion where that is practicable : and to furnish the patient, if possible, with wholesome diet, fresh vegetables, and those fruits which furnish citric acid, such as lemon, the juice of which made into a drink forms an invaluable remedy. Sour- kraut, and other substances which have undergone the acetous fermentation ; cider, spruce beer, and the like, as also vine- gar, have, moreover, been recommended. The homceopathic medicines which may be prescribed with the most advantage against the ulcers and diseased gums are: Carbo v., Nux v., Arsenicum, Mercurius, Staphysagria, and Sulphur ; or also, Acid, nitr., Cistus, Nat. m., Ammonium c, 15* 346 GENERAL DERANGEMENT. et m., Causticum, Dulcamara, Kreasotum, Acid, mur., Sepia, etc. (See the preceding article, and also that on Ulcers.) The use of lemon or wine-juice and other acids must be discontinued during the employment of the homceopathic remedies. GUMBOIL. Silicea, Staphysagria, and Calcarea, but par- ticularly the former, are the principal remedies against this affection. When there is much inflammation, and considera- ble swelling, Belladonna may be prescribed, followed by Mercu- rius and Hepar sulph., if little relief is obtained from the former. Nux v., Pulsatilla, and Sulphur, are sometimes very useful. In swelling of the jaw, with suppuration, whether in consequence of carious teeth, or from the unskilful abstraction of a tooth, Silicea is the most important remedy. Irritation, arising from the cutting of the wisdom-teeth: Aconite and Calcarea; also Belladonna, Arnica, and Chamomilla, when there is inflammation with swelling of the face. INFLAMMATION OF THE TONGUE. Glossitis. Diagnosis. Tumefaction, with heat and redness of the tongue ; the swelling is sometimes so great as to fill the whole cavity of the mouth, rendering swallowing impossible, and threatening suffocation ; unless re-solution take place, it may terminate in induration, suppuration, or gangrene. Causes. Besides a general strumous habit, local injuries, acrid substances, rheumatism, catarrh, and metastasis! Therapeutics. The following medicines will be found most appropriate in treatment of this affection, according to the exciting cause : Arnica, Urtica, urens, Mecrcurius, Aconi- tum, Belladonna, Pulsatilla, Lachesis, and Arsenicum. Arnica, in cases of lesion of the tongue from the points of decayed teeth, etc., or of burns or scalds. (Acid, phosph. is occasionally required after, or may, in severe cases, be given in preference to Arnica ; in other instances, Silicea and Sul- phur will be required to complete the cure. inflammation of the tongue. 347 Administration. A few drops of the matrix tincture to a • cupful of water, rinsing the mouth with the mixture two or three times a day. Urtica urens has been recommended in preference to Ar- nica, in burns and scalds of the mouth. Administration. The part affected slightly touched with a soft brush dipped in the tincture. Mercurius is almost specific when it presents itself in the form of a disease of the tongue, attended with excessive in- flammatory swelling or induration. Administration. Half a grain of the third trituration to an ounce of water; a dessert-spoonful of the mixture every two, three, or twelve hours, according to the violence of the disease. Aconitum may with advantage precede the above remedy should the inflammation be very intense. Administration, y ; if needful, repeated in two hours, followed by Mercurius in from three to six hours. Belladonna. When the affection does not speedily yield to Mercurius, or when the inflammation is of an erysipelatous or active phlegmonous nature. Administration. A few globules of the sixth potency to an ounce of water; a dessert-spoonful every six to eight hours, until the inflammation abates ; after which we may, in many cases, return to Mercurius. Pulsatilla has been found useful in cases arising from suppressed hemorrhoidal and arthritic affections. Against indications of threatening gangrene, Arsenicum and Lachesis are the principal remedies. They may both be given at the sixth potency, and repeated according to results. In some cases when, from great tumefaction of the tongue, suffocation threatens, we must have recourse to longitudinal incisions ; and after having thus warded off the more pressing danger, exhibit Cinchona, and then fall back upon the more specific remedies. In some extreme cases of this nature, where the disease hav- ing made head before the arrival, it may be found necessary to resort to tracheotomy. This is. however, a dangerous 348 general derangement. mode of relief from the risk of consequent tracheal inflamma- tion ; but, when it has been found absolutely necessary, we may, by the exhibition of Arnica, y, internally ; and in the form of lotion, in the proportion of four minims of the mother- tincture to a hundred of water, materially diminish the risk of this taking place. In cases of soreness or ulceration of the tongue : see Ulcers. Such cases will, however, rarely, if ever, occur to the homoeo- pathic practitioner, if the disease be taken in time, and his remedies judiciously selected. OFFENSIVE BREATH. The most frequent causes of this unpleasant affection are : uncleanliness, leaving particles of food in the teeth; and ac- cumulation of tartar ; or carious teeth; a diseased state of the gums ; aphthae in the mouth ; derangement of the sto- mach ; or an abuse of mercury. Therapeutics. When there is reason to suppose that the first named circumstance is the chief cause of the complaint, its removal will be readily effected by proper attention, rins- ing the mouth with tepid water, and brushing the teeth with a moderately hard brush night and morning, as also after every meal. When attributable to the second cause, a dentist of known skill and respectability ought to be consulted. Lastly, when the annoyance can be traced to any of the remaining sources enumerated, the remedies given under those different head- ings ought to be had recourse to. When, on the other hand, no apparent cause of derange- ment can be assigned or detected, benefit will often be derived from one or more of the following medicines : Nux v., Silicea, Pulsatilla, Sulphur, and Chamomilla; or Arnica, Bellad., Hyos., etc. If the heaviness or fetor of the breath is chiefly perceptible in the morning: Nux v. and Silicea will frequently be found successful in affording relief. Arnica, Bellad., and Sulph., have also proved effectual in similar cases. If after a meal, Nux v., succeeded by Chamomilla and Sulphur. If in the evening, or during the night, Pulsatilla or Sulphur. FACE-ACHE. 349 Mercurius, Bryonia, Arsenicum, Hyoscyamus, Agaricus, Ambra, Carbo v. et a., Sepia, Lycopodium, etc., may also prove useful in particular cases. In young girls at the age of pu- berty, Aurum is often the most appropriate ; but occasionally Pulsatilla, Sepia, Belladonna, or Hyoscyamus, will be found preferable here. When the abuse of mercury has evidently been the cause of the evil: Aurum, Carbo v., Lachesis, Sul- phur, Hepar, Belladonna, or Acidum nitricum, etc., will be found the most suitable. FACE-ACHE. FACE-AGUE. Neuralgia Facialis. Tic Douloureux. Prosopalgia. This distressing malady consists in an excruciating pain, which has its seat in the branches of the fifth pair of nerves, and is accordingly experienced with great acuteness under the eye, and sometimes before the ear, from whence it shoots over the entire half of the face, and frequently into the orbit and cranium. The paroxysms occasionally continue, with shorter or longer intervals, for several days or weeks in suc- cession, and when at their height, are frequently accompanied with spasmodic twitchings in the facial muscles. The disease is unfortunately generally of great obstinacy, and, in some melancholy instances, utterly incurable. In its idiopathic form, the remedies which have hitherto been em- ployed in homoeopathic practice with the most success, are : Belladonna, Platina, Lycopodium, Colocynth, Arsenicum, China, Mezereum, Veratrum, etc. Belladonna. When the pain chiefly pursues the course of the infra orbitary nerve, but sometimes also the other branches of the fifth ; and is prone to be excited by rubbing the usual seat of the sufferings ; darting pains in the cheek- bones, nose, jaws, or zygomatic process; or cutting and tensive pains, with stiffness at the nape of the neck, and clenching of the jaws ; twitches in the eyelid, or violent shooting and tearing and dragging pains in the ball of the eye; convulsive jerking in the facial muscles, and distortion of the mouth ; heat and redness in the face. The pain is generally 350 GENERAL DERANGEMENT. preceded by itching and creeping in the affected side of the face, and at times becomes so severe as to be almost insup- portable. Platina. Feeling of coldness and torpor in the affected side of the face, with severe spasmodic pain, or tensive pres- sure in the zygomatic process, with a sensation of creeping or crawling, and aggravation or renewal of the sufferings in the evening, and when in a state of rest; lachrymation ; redness of the face, etc. Lycopodium is often useful when the symptoms are much the same as described under the preceding remedy, with the exception of the torpor and creeping, but particularly when the right side of the face is the part affected. Colocynth. Violent rending and darting pains, which chiefly occupy the left side of the face, are aggravated by the slightest touch, and extend to the head, temples, nose, ears, teeth, etc. Arsenicum. When there is a tendency to periodicity in the attacks or paroxysms, and the pains partake more espe- cially of a burning, pricking and rending character, and are experienced chiefly around the eye, and occasionally in the temples, the sufferings being occasionally of so severe a de- scription as almost to drive the patient distracted ; great an- guish ; excessive prostration, with desire for the recumbent posture; sensation of coldness in the affected parts; exacerba- tion during repose, after fatigue, in the evening when in bed, or after a meal; temporary melioration from external heat. China. Also, as in the instance of the foregoing remedy, when there is a tendency to periodicity in the attacks, and when the pains are excessive, attended with extreme sensibil- ity of the skin, and consequent aggravation from the slightest touch ; sensation of torpor and paralytic weakness in the af- fected part; great loquacity, with ill-humour, paleness of the face, frequently followed or alternated with redness and tran- sient heat of the face. Mezereum. Pains which occupy the left zygomatic process, consisting chiefly of a spasmodic stupifying description, and extending to the eye, temple, ear, teeth, neck, and shoulder. FACE-ACHE. PALPITATION OF THE HEART. 351 with exacerbation from partaking of warm food or drink, or on coming into a warm room after being in the open air. Veratrum. Insupportable pains which almost drive the patient to distraction ; excessive weakness even to fainting ; general chilliness; exacerbation of suffering on getting warm in bed, or towards morning; temporary relief on moving about. Spigelia is frequently a useful palliative remedy in all cases when the pain is excessive. In other cases : Lachesis, Phosphorus, Hyoscyamus, Mags. arc, Manganum, Merc, Rhus, Ignatia, Arnica, Capsicum, Causticum, Staphysagria, Coffea, etc., may be found useful. When the malady is symptomatic of derangement of the di- gestive functions,—Nux v.. Pulsatilla, Bryonia, Chamomilla, or Lycopodium, will usually be found the most serviceable. In Rheumatic Face-ache, or prosopalgia,—Aconitum, Bryonia, Rhus, Causticum, Mercurius, Phosphorus, Pulsatilla, Mezereum, Sulphur, Nux v., Lachesis, etc., are those that have generally proved the most effectual. In Arthritic,—Nux v., Rhus, Colocynth, Mercurius, Caus- ticum, etc. Face-ache from the effects of mercury will chiefly require the employment of Aurum, Hepar, Carbo v., Sulphur, China, etc. Finally, in prosopalgia generally, the following have proved more or less useful: Aconitum, Arnica, Verbascum, Sulphur, Calcarea, Capsicum, Pulsatilla, Stannum, Conium, Thuja, Baryta c, Coffea, Kali, Camphora, etc. PALPITATION OF THE HEART. Palpitatio Cordis. When this disorder occurs in plethoric individuals, Aconitum, Belladonna, and Nux v. will be found the most appropriate remedies, followed by Sulphur. Should the affection prove obstinate, Arsenicum and Veratrum alternately are sometimes useful after Sulphur, when the palpitation has resulted espe- cially in consequence of the suppression of an eruption, or the sudden healing up of an old sore. Causticum and Lachesis are also occasionally useful in the latter case. 352 GENERAL DERANGEMENT. When it results after debilitating losses, such as hemorrhage, etc., China is the principal remedy, but may require to be followed by Acid, phosph., Sulphur, Calcarea, or Nux v. Palpitation of the heart from ajfright, usually yields read- ily to Opium ; from fear or anguish, to Veratrum; after sud- den joy, to Coffea: and if from contradiction, or a fit of pas- sion, Acon., Cham., or Nux v., and Ignatia. When the derangement occurs in nervous individuals, and particularly hysterical females, Pulsatilla, Coffea, Cocculus, Veratrum, Lachesis, Chamomilla, and Asafetida will generally be found the best adapted to afford relief. In other cases, Aurum, Coc- culus, Phosphorus, Spigelia, Ferrum, or Acid, nitr., etc., will be required. CRAMP IN THE LEGS. Veratrum, Nux vomica, Sulphur, Calcarea, Lycopodium, Acidum nitricum, Sepia, Camphora, Argilla, Colocynth, and Rhus, are amongst the best remedies for cramps in the calves of the legs. Veratrum has been recommended as one of the most useful remedies in eradicating the tendency to frequent returns of this painful and troublesome disorder, succeeded by Sulphur and Colocynth, should it not suffice to effect a cure. Rhus when the attacks occur during the day when sitting, as well as at night. Sepia, Lycopodium, and Acid. nitr. when it occurs chiefly in walking. Sulphur, after Nux v., or Rhus, when the attacks occur chiefly during the night. Calcarea when stretching out the limb brings on the cramp. Argilla in cramps on crossing the legs, or even on descending stairs. Colocynth is ^frequently beneficial when stiffness and pain are always experienced in the limb for some time after the attack. GOITRE. BRONCHOCELE. This disfigurement arises from a tumefied state of the glan- dula thyroides, a large glandular body situated on the front of the throat (upon the cricoid cartilage, trachea, and horns of the thyroid cartilage.) As the enlargement increases, it GOITRE. SWEATING FEET. 353 is productive of a considerable degree of obstruction to free inspiration, from the pressure which it exerts against the windpipe. The disorder is most frequently encountered amongst the inhabitants of mountainous districts. Women are more prone to be afflicted with it than men, and particu- larly those who have suffered from severe labours. An in- herent constitutional taint seems, however, to be the chief predisposing cause. In the treatment of this affection, Spongia marina has been found the more generally useful remedy, administered in repeated doses, from the sixth potency downwards. In cases of long standing, one or more of the following remedies may prove of service in materially diminishing the size of the tumour, if not sufficient to disperse it entirely : Calcarea, Staphysagria, Lycopodium, Iodium, Ammonium c, Causticum, and Natrum c. etm. ; or Ferrum, Sepia, Thuja. SWEATING FEET. Some individuals are much troubled with a disagreeablej clammy sweating of the feet, to such an extent as to render it necessary to change the stockings several times daily. This evil is, moreover, a source of extreme annoyance to others, from the offensive odour which is usually exhaled at the same time. The utmost attention to cleanliness is insuf- ficient to remedy the state of matters; and to attempt to sup- press the secretion by cold water, or powerful astringents, is highly culpable, from the dangerous consequences which are liable to ensue from a sudden suppression thereby effected. Amongst the homoeopathic remedies, through the instru- mentality of which a safe and permanent cure has most fre- quently been brought about, Rhus tox. and Silicea merit priority of notice. A few globules of the first named may be taken every four days for a fortnight or three weeks ; at the expiration of which period, a few days may be allowed to elapse, and if improvement then set in, the medicine may be continued at intervals of increasing length until the cure is effected. But should no melioration result, Silicea may be 354 GENERAL DERANGEMENT. had recourse to in the same manner. After Silicea, Rhus may again be resorted to, if required. These two remedies are also the most appropriate to be administered against the de- leterious consequences of a suddenly checked foot-sweat. Other remedies may be required in obstinate cases of this complaint, or in those where derangement of the system gen- erally coexists. The following may therefore be pointed out as worthy of being referred to in such cases : Mercurius, Baryta c, Graphites, Kali c, Cyclamen ; or Sulphur, Calca- rea, Lachesis, Carbo v. Lycopodium, Sepia, Acid, nitr., etc. SLEEPLESSNESS. Agrypnia. Sleep is essential to renew the vital energy which has been exhausted during the day, as also to assist the function of nutrition. When, therefore, anything occurs to deprive us of this indispensable necessary for a protracted period, or, at all events, so materially to disturb it as to render it inadequate to fulfil its requisite purpose, the health will, as an all but invariable rule, eventually give way under the deprivation. The average duration of sleep is from six to eight hours ; but it is liable to variation from several causes. Some, from peculiarity of constitution, require less, others a little more. Habits of idleness, etc., tend to prolong it; and it may here be remarked, that when not restrained within proper limits, instead of repairing, it exhausts the strength; and is, as well as the derangement of which it is our object at present to treat, consequently productive of serious diseases, such as madness and idiocy,—these distressing maladies having un- questionably been traced, in some instances, to indolent habits of prolonging sleep beyond the period required for healthy recreation. In almost all cases, sleeplessness is but symptomatic of some other disease, and can only be remedied by the removal of the abnormal source. It frequently, however, forms so prominent a feature as to render it necessary that we should treat it as an idiopathic disease, and direct our attention to the selection of medicines conformably. SLEEPLESSNESS. 355 Intense mental application, continued up to the period of going to rest; sedentary habits; the habitual use of coffee, (often for the express purpose of warding off inclination to sleep,) also weakness of the digestive functions, are frequent causes of sleeplessness. Under such circumstances, Nux v. will generally be found the most appropriate remedy ; but, unless the acquired habits above detailed are given up, or materially altered, no permanent benefit can be expected from the employment of the remedy referred to. Overloading the stomach, particularly towards night; the habitual employment of stimulating, or rich, indigestible food; thereby producing constipation, excessive flatulence, and other signs of derangement in the digestive functions, are additional fertile sources of disturbed sleep, which can only be obviated by the observance of a more simple mode of living. The attainment of the desired relief may, however, be considera- bly forwarded by means of a dose or two of Pulsatilla. Mental emotions often originate sleeplessness. When excessive joy is the assignable cause, Coffea is a useful remedy. When from dejection, caused by grief, un- pleasant ideas, vexation, etc., Ignatia. If attributable to fear, or fright, or when the sleep is disturbed by fantastic or fright- ful visions, Opium; followed, if required, by Belladonna in the latter instance; and when anxious, annojing, or agitat- ing events disturb or retard sleep, Aconitum. Sleeplessness arising from nervous excitement in sensitive or irritable subjects will often yield to Hyoscyamus, or to Belladonna where there exists a strong but ineffectual desire to obtain sleep. The latter medicine is further indicated when agitation or anguish, with frightful visions, timidity or terror, apprehension of real objects, etc., are complained of; or when the sleep is disturbed by frequent starting, and is attended with extreme sleeplessness early in the evening, or towards morning. Moschus is a useful remedy in sleeplessness occurring in hysterical or hypochondriacal individuals, arising from nerv- ous excitement. Acid, phosph. and Sepia are also occasionally useful in such cases. 356 GENERAL DERANGEMENT. Stanncm has been recommended as a general remedy (?) in sleeplessness.* Sleeplessness in old people can scarcely be considered a disease. But when it occurs in children, it almost invariably arises from some bodily ailment, which ought to be attended to and removed as early as possible, if practicable, as depri- vation of sleep is more detrimental during infancy and child- hood than at any other period of life. (See Sleeplessness in Children, Part III.) Coldness of the feet is a frequent cause of retarded or dis- turbed sleep. Daily exercise in the open air is here, as in most other cases, to be recommended; also gentle and gene- ral friction, when there is at the same time, chilliness or stiff- ness of the limbs. The application of a vessel containing hot water to the feet is the only mode of obtaining any refresh- ing sleep in some cases, when coldness of the feet is the dis- turbing cause: — This languid state of the circulation is often capable of being permanently removed by means of homceopathic reme- dies, combined with appropriate exercise. Ammonium m. and Carbo v. ct a.; as also Graphites, Kali c, Nux v., or Sulphur, etc., will generally be found the best adapted to the attain- ment of this. When, on the other hand, sleep is prevented or retarded by burning heat in the feet,—Lachesis, and, in other cases, Pulsatilla, Acid, phosphoricum, Stannum, Lycopodium, Kali c, Sepia, or Secale c, etc., must be selected. Sleeplessness from a harsh, dry, and imperspirable state of the skin, may be remedied after the removal of the said cause, when not impracticable from too long continuance, etc., by means of Graphites, Natrum c, Silicea, Sepia, Acid, nitr., or Calcarea, etc. (The warm bath forms a useful palliative, occasionally.) Sleeplessness and other derangements resulting from tea, require the employment of the antidotes to that drug for their removal. Of these, Cinchona will usually prove the best; * A.H. Z. No. 12. Band 28. NIGHTMARE. 357 should it not be adequate to effect the purpose required, Fer- rum will often succeed. (Cofiea is to be preferred in recent cases of indisposition from green tea; but it must be followed by the exhibition of Cinchona, if relief is not soon obtained.) When from coffee, Nux v., as has been already remarked, is the principal remedy ; on other occasions, Chamomilla will be required, particularly when sleeplessness and other sufferings, such as headache, colic, etc., occur in nervous, highly excitable, and irritable subjects, who are extremely impatient under suf- ferings even of a description that would be deemed trivial by ordinary people. Ignatia, particularly in the case of mild, sensitive, or changeable dispositions. Cocculus, in nearly simi- lar circumstances as described under Chamomilla, with the dis- tinction of a sensation of emptiness or lightness in the head. NIGHTMARE. Incubus. Ephialtes. When this well-known and distressing disturbance occurs very frequently in an aggravated form, it becomes necessary to prescribe for it. The homceopathic remedies which have chiefly been employed against it to the best advantage are: Aconitum, Nux vomica, Pulsatilla and Opium. Aconitum. When there is considerable febrile excitement, with quickness of pulse, thirst, palpitation of the heart, op- pression at the chest, anxiety, and agitation. Nux v. When nightmare is occasioned by sedentary ha- bits, the habitual indulgence in spirituous or malt liquors, etc. Pulsatilla. When there is derangement in the digestive functions, arising from gross living, heavy suppers, etc. Opium is a remedy of importance in all cases of a severe character; but particularly when, during the attack, the re- spiration is nearly suspended, or stertorous, the eyes only half closed, the mouth open, the countenance expressive of extreme anguish, and bedewed with cold perspiration; subsultus ten- dinum. When any of the foregoing remedies, but especially Nux v. and Pulsatilla, are insufficient to effect a cure,—Sul- phur or Silicea may be resorted to in repeated doses. In other cases, one or more of the following may prove useful: Phosphorus, Ruta, Valerian, Ammonium c, and Hepar. Any 358 GENERAL DERANGEMENT. apparent exciting causes of the attacks must at the same time be avoided ; the diet should be light and wholesome; suppers altogether abstained from, and a glass of cold water partaken of instead, on retiring to rest. Daily exercise in the open air, the shower-bath, or spong- ing with cold water every evening, are useful preventives, or auxiliaries during treatment. ACUTE INFLAMMATION OF THE SPINAL CORD AND ITS MEMBRANES. Myelitis. Meningitis spinalis. This affection is indicated by pain, more or less severe, in some cases of an intermittent character, either confined to the lumbar, dorsal, or cervical region, or embracing the entire length of the spine. The pain is aggravated by the slightest movement, and an exalted sensibility of various parts of the cutaneous surface is often perceptible in the dread and shrink- ing which the patient exhibits at the slightest touch. Sharp pain at the epigastrium, sometimes spreading over the whole of the abdominal region, and increased on pressure; palpita- tion of the heart; sensation of constriction and weight in the fore part of the chest, with oppressed respiration; small, quick, hard pulse,—are symptoms which are generally encountered in the course of the disorder. When the inflammation occupies only a part of the cord, the symptoms vary according to its locality. Thus, when the commencement, or the cervical portion, is principally affect- ed : spasm of the pharynx, trismus with loss of voice, spasm or other abnormal conditions in the muscles of the neck, chest, and superior extremities, with general clonic convul- sions, declare themselves. When the dorsal portion of the cord is the seat of the inflammation, opisthotonos usually re- sults. And when that of the lumbar region is seized: reten- tion of urine, or paralytic or spasmodic affections of the pel- vic viscera generally, are met with. In each of the latter cases, the inferior extremities are commonly either convulsed or paralyzed. ACUTE INFLAMMATION OF THE SPINAL CORD. 359 When the membranes of the cord are principally or solely affected, the sensibility of the surface is said to be always increased, and the spasms more frequently general, and of a tonic character; while, in inflammation confined to the substance of the cord, the sensibility is usually lessened, the muscles of the extremities affected, with clonic spasm or paralysis, and only those of the back in a state of tonic con- traction. In the former, moreover, the bowels are for the most part constipated,—while in the latter, diarrhoea has almost uniformly been found to predominate. Finally, ac- cording as the interior or posterior columns of the spinal cord happen to be the seat of the inflammation, so, it may be con- cluded, will the power of motion or the sensibility be abnor- mally altered. Causes. Exposure to cold and damp, and external inju- ries, appear to form the leading causes of this inflammation. CHRONIC INFLAMMATION of the spinal cord and its coverings is generally accompanied with a trivial degree of local pain, and its prominent features chiefly consist in de- rangement of the functions of the viscera, deprivation or dimi- nution of the sense of feeling, paralysis, cramp, and emacia- tion. The chronic variety is even more dangerous than the acute. The disease, when confined to the substance of the cord, may terminate in softening (ramollissement); induration; suppuration ; gangrene. And in effusions of serum, pus, or blood; or in thickening of their structure, when the mem- branes have been the seat of the inflammation. Therapeutics. Aconitum must be prescribed in repeated doses, in all cases where the accompanying fever is intense ; and on the completion of its beneficial action, recourse must be had to Belladonna, Dulcamara, Arsenicum, Digitalis, Pul- satilla, Bryonia, Nux v., Cocculus, Rhus, Ignatia, Opium, Vera- trum, according to the portion of the cord which is evidently attacked. Belladonna is the most important remedy when the upper part is the seat of the disorder. If, from the invasion of deli- 360 GENERAL DERANGEMENT. rium, etc., there is some reason to apprehend an extension of the inflammation to the brain, this remedy will still be the most appropriate, and that on which we must rest our chief hope in so serious a complication of a malady already suffi- ciently dangerous. Hyoscyamus, Stramonium, Bryonia, and in some instances Sulphur, may be found necessary, however, and prove useful in warding off a fatal result. (\ ide PHRENITIS.) Dulcamara* may follow Aconitum and Bel- ladonna, when the more acute symptoms of spinitis have been removed, and particularly when the disease has been excited by exposure to cold and wet. Arsenicum, Pulsatilla and Digitalis, have been recommended as useful auxiliary reme- dies when the thoracic viscera are prominently affected, evi- denced by laborious and anxious respiration, palpitation of the heart, &c. ; and Veratrum, Nux v., Cocculus, and Ignatia, when the abdominal viscera are seized with coldness and spasms. Should opisthotonos result from inflammation of the dorsal division of the cord : Belladonna, Rhus, Ignatia and Opium are chiefly to be recommended. Again, when the inflamma- tion is restricted to the lumbar portion of the cord: Nux v., Cocculus, Digitalis, and Bryonia; or Pulsatilla, Rhus, Vera- trum, and Sulphur. In general tonic spasms resulting from inflammation of the entire cord, or rather its enveloping mem- branes,—Belladonna, Lachesis, Hyoscyamus, Opium, Natrum m. and Ignatia, are the remedies from which, in general cases, we may expect to derive the greatest benefit. Arnica, Hyos- cyamus and Opium may claim a preference in myelitis arising from external injury; but we must be guided in our selec- tion by the nature of the symptoms, and not hesitate to have recourse to one or more of the above-mentioned medicines if called for. (Vide HYDROPHOBIA and TETANUS.) In the chronic form of the malady, the medicines from which the most benefit may be looked for when the disease has not reached an irremediable stage, are, in addition to most of those required in the acute variety,—Sulphur, Silicea, Lache- sis, Baryta c.. Stannum, Causticum, etc. * Rhus is perhaps more appropriate than Dulc. in such cases 301 PALSY. Paralysis. This affection consists in the abolition or diminution of the power of voluntary motion. It usually comes on suddenly, but in some instances it is preceded by numbness, coldness, paleness, and slight convulsive jerking or twitching in the parts. The treatment must be regulated according to the originating cause. When it results from apoplexy, see that article. When occurring as a sequel of lheumatism: Arnica, Ferrum, Ruta, as also Bryonia, Rhus, Lycopodium, Sulphur, and Causticum. When in consequence of debility from loss of fluids: China, Ferrum, Baryta c and Sulphur. From the sudden suppression of an eruption, or of a wonted discharge : Sulphur and Causticum. And when it is attributable to ex- posure to the fumes of lead, or the constant handling of white- lead : Opium and Belladonna; or Platina, Alumina, Pulsa- tilla, and Nux v. ■ (These remedies are equally useful in LEAD COLIC, colica pictonum.) With reference to the parts which are affected with the disorder: Belladonna, Graphites, and Causticum are chiefly recommended in paralysis of the facial muscles. Belladonna, Opium, Hyoscyamus, Stramonium, Lachesis, Graphites, and Causticum, in that of the tongue. Belladonna, Nux v., Coccu- lus, Lycopodium, Calcarea, Silicea, Opium, Zincum, Ruta, etc. in paralysis of the upper extremities. And in that of the inferior extremities, Cocculus, Nux v., Opium, Sulphur, Sili- cea, Slannum, and Oleander principally. Electricity or galvanism, in moderation, is frequently of considerable service in facilitating the cure, or at all events, in promoting improvement in obstinate cases. RUPTURE. Hernia. By this term is understood a swelling occasioned by the protrusion of some of the viscera from the cavity of the abdo- men. In most cases, the displaced intestines are included or 16 362 GENERAL DERANGEMENT. contained in a bag, derived from the peritoneum, which they push before them in their descent. The situations in which the swelling most commonly makes its appearance are the groin, the navel, the scrotum, the labia pudendi, and the upper and interior part of the thigh. It also occurs in the vagina, perinseum, foramen ovale, and sciatic notch, and occasionally at every point of the fore part of the abdomen. The viscera which are most frequently protruded are the omentum, and the small and large intestines, or a portion both of omentum and intestine. But the stomach, liver, spleen, bladder, uterus, and ovaria, etc., have been known to enter into the formation of hernial tumours. In consequence of the tumour escaping at the above-mentioned different situations, it has received the appellations of inguinal * umbilical,-\ scrotal r\ prudendal,\\ cru- ral, orfemoral, vaginal, perineal, thyroideal,§ ischiatic, and ven- tral, etc. Further, from containing different kinds of viscera, it has been designated epiplocele, when its contents consist of a piece of the omentum only; enterocele, when of a fold or portion of intestine ; and enlero-epiplocele if both intestine and omentum contribute to form the swelling. A hernia or rupture, for the most part, appears suddenly after some vio- lent corporal exertion, and presents an indolent, usually soft and elastic tumour, at some of the points or situations al- ready referred to, but most frequently at the lower and la- teral part of the abdomen (the groin) ; or towards the inner part of the bend of the thigh, or at the navel (descending from the abdominal ring in the first mentioned instance ; from be- low Poupart's ligament in the second ; and out of the umbi- licus or navel in the third.) The swelling is subject to a change of size, being smaller, or quite imperceptible, when in the recumbent position; larger or only apparent on assum- ing the erect posture, and particularly when taking a full breath, coughing or sneezing, also on walking or standing long after a hearty meal. It is frequently diminished, or caused to recede completely, when pressed, but returns as soon * Or a bubonocele. 1 Or an exomphalos. Omphalocele. T Or an oscheocele. § Or a bubonocele. X Or hernia foraminis ovalig. RUPTURE. 363 as the pressure is removed. Vomiting, constipation, colic, and other signs of a deranged state of the stomach and intes- tines, are frequent concomitants of rupture, arising from the abnormal situation of the viscera. The nature of the contents of the hernial tumour are gene- rally known by the following distinctions: if the case be an enterocele, the swelling is smooth, elastic, rendered tense by coughing, or by holding the breath ; is in general very easily returnable, and is usually attended with a gurgling noise when ascending. An epilocele, or omental hernia, is on the other hand, of a more uneven and doughy or flabby feel; it is neither made tense, nor receives any impulse from cough- ing ; is more compressible, and if large, or in the scrotum, is more oblong and heavier than enterocele; it recedes very gradually, and its reduction is unaccompanied by any gurg- ling noise. An entero epiclocele, or a hernia composed both of intes- tine and omentum, has the characteristic marks less clear than eitfter of the preceding cases; when reducible, in pressing back the contents, it is known by the gurgling noise which attends the ascent of the intestinal portion, while that of the omentum is reduced without noise, and with greater difficulty ; otherwise, the feeling communicated to the touch is sufficient to render this variety distinguishable from the others. Causes. The predisposing causes of hernia are : general relaxation, or unusual largeness of the natural openings of the abdomen. When any such proclivity exists, particularly in children and the aged, the viscera are occasionally protruded by trivial circumstances, such as crying, coughing, sneezing, or even by the act of a somewhat full inspiration; but in other ca- ses, or where there is no marked predisposition, the protrusion only takes place under great bodily exertion. When rup- ture ensues in consequence of predisposition, or seems to take place spontaneously, its formation is very gradual; but when it results from extreme corporal exertion, it appears very suddenly ; and if the opening through which the bowel pro- trudes be small, as is generally the case in such instances, there is much danger of strangulation. 364 general derangement. Hernia is termed reducible, when it can at any time be rea- dily returned into the abdomen, and when, in an unreduced state, it is productive of no pain, or hinderance to the per- formance of the intestinal functions ; irreducible, when it can- not be replaced in consequence of its bulk, or from the con- traction of adhesions ; and strangulated, when the protruded parts are not only incapable of being returned, but are more- over affected with constriction, pain, and inflammation, attend- ed with nausea, frequent retching, or vomiting, tension of the abdomen, obstruction of the bowels, quick, hard pulse, and more or less fever. If the return of the intestines be not affected under such a state of matters, an aggravation of all the said symptoms at first ensues, and subsequently the vo- miting is exchanged for a convulsive hiccough, with frequent bilious eructations ; after the abdominal tension, fever and extreme restlessness have continued for a few hours in an in- creased degree, the patient suddenly becomes relieved from pain, the pulse low, feeble, and intermittent, the eyes dim and glassy, the belly ceases to be tumid and tense,*and the skin, particularly that of the extremities, cold and moist; the hernial swelling disappears, and the skin over the part often changes to a livid hue, but invariably conveys an emphyse- matous feel or crepitus to the touch, indicative of the estab- lishment of gangrene ; finally, spasmodic rigours and con- vulsive twitching in the tendons supervene, and death soon terminates the scene. Therapeutics. When the disease has not been neglected, or is not of long standing, it may be cured by the action of in- ternal homceopathic remedies. No truss should be applied until the hernia is completely reduced, and care should be taken that the truss fits properly, as it is intended only to keep the hernia from protruding, and not for effecting the cure. In effecting the reduction of a hernia by the taxis, the pa- tient should be laid upon his back, and a pillow placed under the chest and pelvis, so as to curve the trunk of the body, and thereby relax the abdominal muscles. If the case be one of inguinal or femoral hernia, the muscles, etc., of RUPTURE. 365 the thigh must also be relaxed, by putting the limb in a state of flexion, and rotated inwards, then gently compressing the tumour, and pushing upwards and outwards in the case of in- guinal hernia; and first backwards and then upwards in the case offemoral, if the tumour be small; but first downwards, and then backwards and upwards, when it is large and reflect- ed over Poupart's ligament.* In most cases, the following simple method may be pursued by the uninitiated: place the left hand on the swelling as if for the purpose of grasping it, then introduce the fore and middle fingers of the right hand between the thumb and fingers of the left, on the top of the tumour, and rub and press it gently ; persevere softly and pa- tiently for half an hour and upwards when the hernia is con- siderable, f The palm of the hand should also be occasionally employed, by giving it a rotatory motion combined with gra- dually increasing pressure, especially when the tumour begins to diminish in bulk, or when it has been small from the first. Even strangulated hernia is capable of being reduced by the taxis with facility, after the employment of the proper reme- dies, particularly Aconite and Nux vom., and the operation, which is always more or less dangerous, thereby avoided.— When the rupture is painful, and very tender to the touch, medicine must first be prescribed to remove the irritability; after which the protrusion has often been found to recede of itself. In some cases, the application of warm fomentations to the part reduces the hernia, and the general relaxing effects of a warm bath are well known as being useful in facilitating reduction. The following treatment has been strongly recom- mended when tne symptoms encountered are as described. Aconitum -§-. When there is considerable fever, with quick, hard, full pulse, inflammation of the affected parts, with excessive sensibility to the touch; violent burning pain in the abdomen; bi'ter, bilious vomiting ; agonizing restlessness and cold perspiration. A second dose to be given, if required, an hour after the first. In the majority of cases, marked benefit has resulted after the administration of the first dose of Aco- * In Umbilical1 hernia the pressure is to be made directly backwards. \ Hering's Hausarrt. 366 GENERAL DERANGEMENT. nilum, under the circumstances mentioned ; but when no change for the better resulted after the third exhibition, or when the bilious eructations and vomiting become converted into an acid character, Sulphur must be prescribed, and if the patient fall asleep thereafter, he should be allowed to re- pose quietly. When the tumour is not so painful or tender to the touch as above mentioned, and the vomiting less severe, but the re- spiration oppressed and laborious, and the strangulation has arisen from errors in diet, the effects of exposure to cold, from being overheated, or from a violent fit of passion, etc., Nux v. is to be preferred, and may be repeated every two hours or so.* If no change results in about two hours after the second dose of Nux v.,—Opium should be prescribed, or this remedy may be had recourse to from the first, and repeated every quarter of arr hour until improvement takes place, should there be hardness and distention of the abdomen, putrid eruc- tations, or even vomiting of fecal matter. (Plumbum may be given after the third or fourth dose of Opium, if no decid- ed change for the better become perceptible.) When there is retching and vomiting, with cold moist skin and coldness of the extremities,—Veratrum should be admin- istered, and repeated in from half an hour to an hour or so; and in the event of no favourable turn taking place after the second dose,—Belladonna should be prescribed. When the case has been neglected, or the progress of the malady already advanced so far on reaching the patient, that the integuments over the rupture have assumed a livid hue, and there is reason to apprehend the invasion of gangrene, the patient may yet be saved by the administration of Lache- sis in repeated doses ; if no relief follow in the space of about two hours, Arsenicum may be tried. Rhus has also been spoken of as being serviceable in extreme cases. The opera- tion should not be delayed when symptoms of a serious cha- racter do not speedily yield to the remedies indicated; but the latter should always be tried first, as no bad consequences * Vide note, p. 21. FAINTING. 367 will result from the delay under the precautions stated; on the contrary, the subsequent manual treatment has been found to be thereby facilitated. FAINTING. SWOONING. Syncope. Individuals of weak nerves and delicate constitutions^fc1- ticularly of the female sex, are frequently subject to fainting fits, which, although rarely dangerous, yet when utterly neg- lected, or inappropriately treated by violent or very debilita- ting means, arc prone to become serious, and even fatal. The usual causes are: sudden transitions from cold to heat; breathing vitiated atmospheres ; great fatigue; loss of blood ; long fasting; grief, fear, and other mental emotions. When fainting occurs, let the patient be immediately re- moved to where a stream of pure fresh air can be obtained, and let all tight clothing about the neck, chest, and abdomen be loosened ; the patient should at the same time be placed in a comfortable position, with the head low. If the foregoing prove insufficient to effect restoration, sprinkle cold fresh wa- ter on the face and neck, and, if necessary, on the pit of the stomach. Should there still be no marked benefit produced, or if the patient becomes cold, a little spirits of camphor may be applied to the nose. When the fainting has arisen from fright, the best medicines for the consequences are Aconite or Opium, and sometimes Colocynth. (See Mental Emotions.) After great depletion, or other debilitating causes,—Cinchona, and, in some instances, Nux v., Carbo v., and Veratrum ; also a little wine in very .small quantities at a time, or a little bread or biscuit, soaked in wine, and sometimes a little strong soup, may be administered. Should the fainting arise from mental emotions, Ignatia and Chamomilla are the reme- "dies in general cases. (See Mental Emotions.) When slight pain causes fainting, Hepar sulph. Fainting from vio- lent pain, Aconite, Chamomilla, or Cocculus. If liable to re- sult from even the most trivial degree of fatigue, Veratrum. From excessive mental application, or in those who have been addicted to the use of ardent spirits, Nux vomica. 368 GENERAL derangement. In other cases, the following remedies have beer eccm- mended where the symptoms met with are as described. Aconitum ^§a. When there is palpitation of the heart, with determination of blood to the head, humming in the ears ; or when the paroxysms come on usually on assuming the erect posture, and are accompanied with shivering and flushing of thjfbce, succeeded by deadly paleness. Coffea -§- may be prescribed after Aconitum in highly excitable or nervous subjects, when the fainting fit has arisen from fright, and the last-named medicine has not relieved much. Hepar Sulphuris, when the fits generally come on towards evening, and are preceded by vertigo. Lachesis -6°. When the fainting fits are either preceded, accompanied, or followed by asthmatic symptoms, vertigo, pale- ness of the face, nausea, vomiting, convulsions, spasms of the jaw, rigidity of the body; bloated appearance of the face; epistaxis ; aching pain or stitches in the fore-part of the chest; cold perspirations. (See Veratrum.) Moschus ^-^. Fainting fits, attended with spasms in the chest, or succeeded by headache, and occurring towards even- ing, during the night, or in the open air. Veratrum °|a, when the attacks are excited by the slight- est fatigue; or when they are often preceded by a feeling of extreme anguish and excessive dejection, or despair, and ac- companied by spasmodic clenching of the teeth, and convul- sive movements of the eyes and their lids. Nux v. is a beneficial remedy when the fits take place par- ticularly in the morning, after a meal, or after taking exercise ; and there is nausea, with paleness of the face ; also, when the patient complains, on recovery, of pain in the stomach, sparks before the eyes, or dimness of sight, together with a feelin j; of anxiety; and is, further, affected with anxiety, trembling, and congestion in the head or oppression at the chest. Acidum phosphoricum \& has been found useful after Nuv v., when that remedy has not removed or diminished the ten- dency to suffer from fainting fits after a meal. When, as is frequently the case, the fits of swooning or FAINTING. 369 fainting take place in hysterical females, the remedies wThich will commonly be found the most appropriate are: Ignatia, Nux moschata, Cocculus, Chamomilla, Nux v., Natrum m., or Arsenicum, etc. In conclusion, it maybe added, that Caladium, in addition to Acon., is useful in cases that are liable to come on alter assuming the erect posture. Kreasolum and Spigelia, when occurring from the heat of the room. Lycopodium and Silicea, when in the recumbent posture. Caladium, when engaged in meditation. Carb. v., Natrum m., Kreasotum, in addition to Nux v., when in the morning. When writing, Caladium. If the attacks are attended with asthmatic symptoms, Kre- asotum, and Berberis, in addition to Nux v. When accompa- nied with headache, Lycopodium, Moschus, Graphites, Natrum m., Stram.; loss of consciousness, Lycopodium, Oleander, Ar- nica, etc. Creeping or crawling in the limbs, Nux v., Borax. Humming, buzzing or tingling in the ears, Aconitum, Nux v.. Petroleum, etc. Paleness of the face, Berberis, Natrum m., Pulsatilla, etc., in addition to Nux v. Copious perspiration or sweating, Calcarea. Pain in the heart, Lachesis, etc. Be- numbed limbs, Natr. m. Coldness or shivering, Aconitum, Calcarea, Colocynth, etc. Vertigo, Sulphur, Arsenicum, Ber- beris, Lachesis, etc. Vomiting, Lachesis, Nux v.. Pulsatilla, Kali c, etc. Those who are subject to fits of fainting or swooning should, if possible, strictly avoid those frequent causes of fainting fits, which have been alluded to at the commencement of this chapter ; as also, where practicable, any other cause known by experience to be productive of the attacks ; otherwise the cure will be rendered difficult, or even hopeless. Administration of the remedies. The dose may generally be repeated in from five to ten minutes, or if after the second or third dose no effect is produced, another remedy must be selected.* °£° or °|°. * Vide note, p. 21. 16* 370 HEADACHE. Cephalalgia. Ccphalea. Cephalalgia Arlhritica. Cephalal- gia Nervosa. Hemicrania (megrim). Clavus Hystericus. Headache is often but symptomatic of disease, and in such cases is only to be cured by the removal of the primary affec- tion. When, therefore, it arises from derangement of the stomach, or dyspepsia, constipation, cold in the head, mental emotions, congestion of blood in the vessels of the head, etc., the remedies most appropriate to the treatment of these dif- ferent di^brders must be had recourse to. In the treatment of nervous headaches, hemicrania or me- grim, the following remedies have generally been found the most useful : Nux v., Veratrum, Colocynth, Pulsatilla, Sepia, Ignatia, Bryonia, Rhus, Ipecacuanha, Chamomilla, Coffea, He- par, China, Sicuta, Belladonna, Arsenicum, Arnica, Acid, nitr., Petroleum, Sulphur, Silicea, Platina, Causticum, Graphites, Natrum m., Phosphorus, Zincum, etc. Rheumatic headaches : Aconitum, Chamomilla, Mercurius, Nux v., Pulsatilla, Lyco- podium, Spigelia, Sulphur, Bryonia, Belladonna, China, Ig- natia, Phosphorus, etc. Arthritic : Bryonia, Nux v., Bella- donna, Colocynthis, Sepia,Ignatia, Veratrum, etc. Hysterical: Ignatia, Moschus, Platina, Veratrum, Valerian, Sepia, Aurum, Acid, nitricum, Magnesia c et m., Cocculus, Phosjihorus, etc. Against headaches occurring in extremely sensitive individu- als : Aconitum, Ignatia, Chamomilla, Coffea, Spigelia, Verat- rum, Cina, or Ipecacuanha, have usually proved the most appropriate. Headaches arising from the habitual use of Coffee are generally curable by means of Nux v., Chamomilla, or Ig- natia. Those from long-continued, excessive menial, applica- tion : Nux v., Opium, and Sulphur, chiefly ; but also, Lache- sis, Pulsatilla, Calcarea, Aurum, Natrum m., Silicea, Lyco- pod., etc. If from sitting up late, or prolonged watching at the bed- side of a sick person: Cocculus, Nux v., or Pulsatilla. When headache is always excited by exposure to a current of air: Aconitum, Belladonna, Colocynth, Nux v., or Cinchona, have HEADACHE. 371 often been found successful either in removing the said sus- ceptibility, or in shortening the attacks, and rendering them of a much more bearable character. And when cold, damp, or boisterous weather is generally productive of headache : 'Bryonia, Nux v. and Carbo v. : these last named medicines, together with Silicea, are frequently equally useful, if head- ache is always experienced during hot, sultry weather,—the air being overcharged with electricity. Against headaches arising from the effects of mercury in large doses : Carbo v., Pulsatilla, Cinchona ; or Hepar sulphuris, Acidum nitricum, Aurum, or Sulphur. Headache after drinking cold or iced water, etc.: Aconitum, Arsenicum, Opium, Belladonna, Pulsa- tilla, Sulphur, and Natrum. In general cases, the subjoined remedies will prove useful, and may be selected according to the indications given : Belladonna -|a. When headache is periodic, or nearly constant, and the pain is increased by the slightest movement either of the head or body, and particularly on stooping, or by moving the eyes ; or when a bright light or the most trivial noise tends to aggravate the pain, which consists 'of a dull pressure at the vertex, or is of a lancinating description, and occupies either the entire head (cephalsea), or merely one side (hemicrania), extending from the occiput into the orbit and root of the nose, and is then described as a violent, screwing, piercing, bursting or tearing pain, sometimes attended with great heat at the vertex ; or the seat of the pain is in the fore- head, and is of a dull, aching or cutting description, attended with a sense of fulness, or a feeling as if the brain would be forced through the forehead in stooping. At times these pains become so violently increased as almost to deprive the patient of consciousness whilst they last; or the headache attended with extreme restlessness, sleeplessness and delirium; falling off of the hair in consequence of the headaches. Platina an- swers well, in some cases, after Belladonna, when the pain is chiefly lateral, and of the same description ; or when there is at the same time, coldness of the one half of the face, etc. with humming or buzzing in the head. Mercurius and Hepar s., and in very obstinate cases, Sepia and Silicea, are fre- quently very useful after Belladonna. .) i z GENERAL DERANGEMENT. Bryonia *«. Aching, piercing, or digging, tearing pain, at a small fixed spot (clavus hystericus) ; or piercing, aching pain in the forehead daily after a meal, or coming on in the morning, and afterwards becoming lancinating; or pain com- ing on in the morning, disappearing in the afternoon, ana returning again in the evening with great violence, when it is attended with a sensation as if the head were pressed to- gether ; burning, tearing pain over the entire head ; shootings in one side of the head. The pains are increased by move- ment, and are attended with irascibility, and disposition to chilliness or shivering; they are sometimes relieved or ter- minated by a fit of vomiting. Nux v. and Rhtts often serve to complete the cure of the foregoing symptoms, or, at all events, to curtail or remove each attack after the previous administration of Bryoniz. Rhus -f -. Shooting and rending pains, extending to the ears and root of the nose ; burning or pulsative pains ; head- ache after a meal, with desire to assume the recumbent pos- ture, and remain quiet; fulness and weight in the head ; re- newal of the headache at the slightest contradiction, or on going into the open air; undulation of the brain at every step; or sensation as if water were in the head, or as if the contents of the cranium were in a relaxed or loosened state, and shifted about with every movement of the head ; feeling of creeping or crawling in the head. Sepia -6-. Periodic cephalalgia, aggravated by mental emotion, particularly in hysterical subjects ; the pain is either of a lancinating description, and affects the whole head, or is merely seated under the eye, or occupies the one half of the head or forehead ; in the latter case, the pain is experienced chiefly in the morning, and is frequently attended with ex- treme sensibility of the eyes to the light. Sepia is also very efficacious in cases of chronic hemicrania, with violent pierc- ing or rending pain, intermingled with lancinations, so excru- ciating that the patient is afraid to move, and can only obtain a trivial degree of relief by remaining perfectly quiet, with the eyes closed; at other times, the pain is so violent as to cause the patient to scream out, and is attended with heat in HEADACHE. 373 the head, or faintness and giddiness, followed by nausea and vomiting. Silicea \°, is especially useful where a sensation is expe- rienced as if the brain were about to protrude through the forehead or orbits ; or pain so severe as if the head would split; or semilateral, shooting, rending pains, commencing at the temple and extending to the nose, the upper and lower jaw-bones, and teeth of the same side. When there is a ten- dency to frequent sweating of the head, or when there is frequently great tenderness of the scalp, Silicea is further indicated ; as also in cases where the parties affected are subject to the formation of small tubercles on the head. Hepar sulphuris fig - is also a good remedy to follow Bel- ladonna in the treatment of headaches, when only partial relief has been obtained from the said medicine, or it may be admin- istered alternately with Silicea in cases where there are pain- ful tubercles on the head. The pains chiefly piercing, gene- rally aggravated at night, and frequently limited to a small fixed spot, with a sensation as if a nail were being driven into the head. Against this latter species of headache, (clavus hystericus,) Nux vomica, Igna'ia, Coffea, Mosch., Magn., and Staph., are also most important remedies; the former may be selected when the following symptoms are complained of: Pain commencing with a slight pressure, or a sensation, of coldness at the part which is subsequently affected ; succeeded by throbbing, and then art intense shooting, piercing, rending or stunning pain, confined to a small space which can frequent- ly be covered with the point of the finger, and is extremely sensitive to the touch; or the pain causes a sensation as if a nail were driven into the head ; at other times, the pain ex- tends over the nose down to the lip, and also to the gums; or, on the other hand, it commences at the eyelid or the orbit, causing constant lachrynfation, and extends over the forehead and temples to the ears, back of the head, and nape of the neck ; or it is seated in the crown of the head, and produces a sensation as if the head would 'split, or were being opened at the coronal suture ; intense, piercing pain, confined to a small place which can frequently be covered with the^>oint of the 3/4 GENERAL DERANGEMENT. finger ; or rending, aching pain, affecting only one side of the head, sometimes combined or alternating with shootings; the pain becomes heightened to such a degree occasionally, and more particularly in the morning, as well nigh to drive the patient to despair, or deprive him of consciousness ;* great heaviness of the head, and sensation as if the brain were bruised or lacerated ; tenderness of the scalp. The pains are aggravated by movement, such as walking or stooping, or by reflection; also after eating, or on going into the open air, and are frequently attended with considerable giddiness or confu- sion in the head; the headache is generally attended with extreme irascibility, and is renewed or aggravated after par- taking of coffee, the constant habit of drinking which is not an unfrequent cause of the complaint; sudden attacks of it are frequently excited by a fit of passion, a fright, the effects of a chill, or an overloaded stomach. Ignatia fl^a is, as already stated, also an excellent remedy in cases in which the pain is confined to a small space, and causes a sensation as if a nail were driven into the brain; nau- sea ; dimness of the sight, and sensibility of the eyes to light; paleness of the face, and temporary alleviation from change of posture; aggravation from noise or strong odours, or after partaking of coffee. Ignatia is sometimes serviceable in completing the cure after the previous administration of Nux v. or Pulsatilla. It is especially applicable to nervous, hys- terical females of a mild and sensitive disposition. ^ Coffea °§<>. In cases of megrim, brought on by medita- tion, vexation, or exposure to cold, attended with irritability, sensibility to noise, great anxiety; and chilliness, and a sen' sation as if a nail were driven into the brain, or a feeling as if the brain were bruised, occurring in individuals who are ex- tremely impatient under suffering, and who are not habituated to the use of coffee, this remedy is frequently a very effica- cious one. Pulsatilla *§*. Megrim, characterized by rending or shooting pains, with heaviness of the head, dimness of the sight sensibility to light; or buzzing or singing in the ears, and ear- * Compare with Belladonna and Arsenicum. headache. 375 ache ; nausea ; paleness of face, lowness of spirits; headache with pain in the nape of the neck; aggravation of the head- ache, with chilliness towards evening, during repose, or par- ticularly when sitting; melioration in the open air. Dispo- sition mild ; temperament phlegmatic. China -53--. Headache worse at night, accompanied with a sensation as if the head would split; or dull, aching, pressive, or boring pains, particularly at the crown of the head, in- creased by movement, or by the open air; tenderness of the scalp ; great sensibility to pain; taciturnity and obstinacy. Veratrum fl|-. Headache preceded by coldness and shiver- ing ; pain in the head as if the brain were bruised or lacerated ; or lateral aching, constrictive, and throbbing pains, some- times attended with a sensation of constriction or tightness in the throat; feeling of coldness at the crown of the head, as if ice were placed upon it; and sensation both of coldness and heat on the exterior of the head, with deep-seated or in- ternal burning heat; headache with paleness of the face, nau- sea and vomiting, and preceded by a copious discharge of colourless urine; headache, with pain at the pit of the sto- mach, or painful stiffness of the neck; headache with extreme weakness and melancholy, painful sensibility of the hair to the touch; chilliness, with general cold perspiration. Ar- senicum and Acidum phos. are sometimes useful after Veratrum. Lachesis -6-. Deep seated pains in the head, or severe aching pain in the occiput, in the sockets of the eye or above the orbits, with stiffness of the neck, particularly at the nape ; heaviness and feeling of expansive pressure, sometimes to such an extent as if the head would burst; tension in the head as if caused by strings or threads drawn through the occiput towards the eyes; lancinations in different parts of the head: headache every morning on waking, or after dinner, or at every change of weather. Mercurius -§-. Rending and burning or lancinating and piercing pains, generally lateral, sometimes extending to the teeth and neck, with shootings in the ears; tightness round the head ; excessive nocturnal aggravation of the headaches, often accompanied by profuse sweating. 376 GENERAL derangement. Colocynth 00300. Nervous headaches attended with smarting in the eyes; excruciating lateral action; rending, dragging pains ; nausea and vomiting ; feeling of compression in the forehead, increased by stooping or lying on the back ; headache every afternoon or evening, with great anguish and excessive restlessness, rendering it impossible to remain in the recumbent posture ; offensive perspiration; profuse dis- charge of colourless urine during the headache. Chamomilla °§°. Headaches occurring in individuals who are extremely impatient and suffering, and whom the slightest pain exasperates or calls forth symptoms and ex- pressions of suffering apparently uncalled for by the nature of the complaints; the headaches are often confined to one side of the head (hemicrania), and the pains are of a rending, aching, or shooting character, and sometimes extend into the upper and lower jaw ; sweating at the head is a frequent con- comitant symptom. Chamomilla -%-, is further occasionally very useful after the previous administration of Coffea when not called for from the commencement. Or in hemicrania attended with ex- treme excitability arising from the daily use of black coffee, but which is generally relieved for the time by partaking of a cup of coffee, will generally be materially relieved, if not cured, by Chamomilla ; sometimes a subsequent dose or two of Nux is required to complete the cure. Sulphur -~. Chronic headache; headaches occurring daily, or every eight days ; worse in the morning, or during the night, and attended with heaviness of the head, aching or pressive pains in the forehead above the eyes, (causing the patient to knit the brows, or keep the eyes closed,) or over the entire head ; incapability of mental exertion from the pains in the head; pains as if the head would split, or rend- ing, shooting, dragging, jerking, pains on one side of the head; aggravation of the headaches from meditation, the open air, or from movement; extreme tenderness of the scalp to the touch; falling off of the hair. Calcarea "■£ . Chronic headaches frequently attended with a sensation of extreme coldness, either interiorly or on the HEADACHE. 377 scalp; the pains either affect the entire head, or merely the forehead, the side, or the crown of the head, and are chiefly of a stunning, aching, throbbing, or hammering description, compelling the patient to retain the recumbent posture ; at times the head feels as if compressed in a vice; or the fore- head feels as if it would burst open, particularly when in the open air; headache, with humming noise in the head, confu- sion of ideas, with aggravation from intellectual employment, or from movement; falling off of the hair ; Calcarea is gene- rally very useful after Sulphur; and Silicea, Lycopod., Ac nitr. after Calc. Arsenicum -§ . Headaches so intolerable as almost to drive the patient to despair, occurring periodically and aggra- vated by partaking of food; the pain sometimes extends to the gums, where it is so excruciating as to render it impossi- ble to fall asleep; tenderness of the scalp to the touch; tem- porary amelioration of the headaches from the application of cold water. Aurum -f-. Headaches in hysterical persons attended with buzzing or other noises in the head; and pain as if the head had been bruised, especially on rising in the morning, or during mental occupation. Eugenia fl§-. Severe one-sided headache (megrim) com- ing on in the evening, attended with a sensation of pressure or forcing outwards behind the eyes, lachrymation, and some- times nausea and vomiting which produce exacerbation; ach- ing pains in the entire head at night (cephalasa) with burning in the eyes, thirst, and copious discharge of urine. One remedy is seldom sufficient to effect a cure of cepha- lalgia of long standing, particularly when of a nervous cha- racter : in some cases of this description, it is only possible to effect a degree of melioration. In comparatively recent cases, the medicines may be repeated at intervals from an hour to six or twelve hours,* when the headache is excessive- ly severe; but in those of a more chronic and obstinate na- ture, in which it is necessary to have recourse to such reme- dies as Sulphur, Calcerea, Silex, &c, considerably longer in- * Vide note, p. 21. 378 general derangement. tervals must be observed between the doses, when our object is to attempt to eradicate the disorder, or destroy the suscep- tibility to headache from trivial causes. HEADACHE.—ADDENDA.* Headache is one of the most frequent and annoying ail- ments with which the human organism is afflicted. It re- quires distinct consideration. Although it is generally asso- ciated with or dependent on other maladies, it so often pre- dominates that its phenomena should no doubt occasionally control the selection of the appropriate remedy, which should, however, include as far as possible the totality of the suffer- ing. It may also depend on accidental causes; still the reme- dy, while antidotal to them, must carefully embrace all the existing symptoms. Again, it may occur perfectly independ- ent of any assignable cause, and thus • render the following arrangement of the remedies essential to the successful selec- tion of the therapeutical agent. Congestive Headaches, or those attended with pressure of blood to the head. Examine carefully the symptoms of Congestive Headache under the following remedies : Aconite, Arnica, Belladonna, Bryonia, Coffea, Ignatia, Mercurius, Nux vomica, and Pulsatilla. Catarrhal Headache. Examine Aconite, Belladonna, Mercurius, Nux vomica, and Pulsatilla. Rheumatic Headache. Aconite, Belladonna, Bryonia, Chamomilla, Mercurius, Nux vomica, and Pulsatilla. Nervous Headache. Aconite, Arnica, Belladonna, Bry- onia, Chamomilla, Coffea, Ignatia, Nux vomica, and Pulsatilla. Digestive or Gastric Headache. Antimonium crudum, Bryonia, Nux vomica, and Pulsatilla. * In the British edition of Laurie, from which the third American was reprinted, no article on Headache was inserted. We supplied the omis- sion at the time, and although Dr. Laurie has furnished a chapter for his last edition, we do not find it sufficiently complete to obviate, in all. respects, the repetition of our own paper. We consulted Hahnemann, Hering, Jahr, and other best authorities of our school in its composition. —Ed. HEADACHE. 379 Headache from Heat. Aconite, and Bryonia. Headaches from Changeable Weather, Currents of Air, Cold, Cold Drinks, and Bathing. Aconite, Antimo- nium crudum, Belladonna, Bryonia, Chamomilla, Nux vomica, and Pulsatilla. Headache from Tobacco. Aconite, Antimonium crudum, and Ignatia. Headache from Suppressed Eruptions. Antimonium crudum, and Sulphur. Headaches from Mechanical Injuries. Arnica and Bel- ladonna. Headaches from Debauch and Spirituous Drinks. Bel- ladonna, Coffea, Nux vomica, and Pulsatilla. Headache from Coffee. Chamomilla, and Nux vomica. Headache from Anger. Chamomilla, Ignatia, and Nux vomica. Aconite. Aconite deserves attention in headaches connected with Congestion to the head, Catarrh, Rheumatism, Neuralgia, and those caused by Heal, Currents of Air, Cold, Bathing, or Tobacco ; and for females, children, and nervous invalids. Aconite is indicated in Congestive headaches, when a violent throbbing pain seizes the forehead and temples, with a sensa- tion of ardent heat through the entire brain, red and bloated face ; redness of the eyes, visible pulsation of the neck, exces- sive sensibility to the least noise or movement, and, some- times, great irritability or delirium. When congestive headaches are habitual, the patient should sponge the forehead and temples every morning with cold water, or take a shower-bath and drink one or two tumblerfuls of cold water on retiring and rising, night and morning. In Catarrhal headaches the indications are : dull, pressive, and constrictive pains and heat in the forehead, especially above the root of the nose, with flowing from the eyes, run- ning at the nose, but more frequently obstruction of the same, dry heat in the nose, buzzing in the ears, colic, frequent chilli- 380 GENERAL DERANGEMENT. ness, alternating with feverishness, occasional cough; amelio- ration of the symptoms in the morning, and in the open air; aggravation in the evening, and from speaking and exercise. The Rheumatic headache is characterized by darling or rending pains, sensitive to the touch, which fly from one part of the head to another, as from the nape of the neck to the ears, temples, vertex or forehead, are sometimes connected with rheumatism of the neck and shoulders, are attended with active fever, dry and hot skin, thirst, redness or varying pallor and redness of the cheeks, are insupportable at night with mental disquietude and vexation, are palliated by sitting, and aggravated or renewed by wine, stimulants, or great mental excitement. The Nervous headache generally occurs above the root of the nose or on one side of the head. The pains, which are in- tolerable, especially at night, are throbbing, darling, and sling- ing, producing, by their intensity, lamentations, inconsolable anguish, fear of death, and, at times, temporary insensibility, and are attended by thirst, flushed cheeks, small, quick, weak, and occasionally, intermittent pulse, and intolerance of touch, light, and sound. Headache from exposure to Heal usually assumes the characteristics of the Congestive, which are re- corded above. The headaches which arise from Currents of Air, Cold, or Bathing, are in every respect, analogous to the sufferings we have described as Catarrhal. The Tobacco headache, whether from chewing or smoking, is very similar to the Congestive headache of Aconite, marked particularly by sensation of great weight on the vertex and over the eyes, nausea and amelioration in the open air. All the preceding forms of headache to which Aconite is appli- cable, have the distinctive peculiarities of an increase of suf- fering from motion, rising from a recumbent position, speaking and drinking; and a diminution in the open air. Administration -§-. The Aconite may be repeated in severe forms of headache every two or three hours ; in milder forms, from six to twelve hours, increasing the intervals in pro- portion to the improvement effected. We have acquired great service from Aconite in acute paroxysms of headache, by usino- HEADACHE. 381 it as a precursor to, or in alternation with, Arnica, Belladon- na, Bryonia, Chamomilla, Nux vomica, Pulsatilla and Vera- trum. Thus a single dose of Aconite may precede the admi- nistration of these remedies some two or three hours, or may be alternated with them every three or four hours. Antimonium crudum. Antimonium crudum °£° has been used for headaches de- pendent on Chills, Suppressed eruptions, Tobacco, or Indi- gestion. They are characterized by a pain in the forehead as if it would burst, or dull, boring, rending, piercing, spasmo- dic pains in the forehead, temples and vertex, with a sensation as if in the bones of the head, especially of the vertex. The pains are increased by ascending stairs, and mitigated in the open air. If the headache arise from Tobacco, it is attended with dizziness. If it depend on Indigestion, it is frequently preceded by nausea, want of appetite, aversion to food, eruc- tation, and efforts to vomit. It is sometimes followed by loss of hair. The Antimonium may be taken every twelve or twenty-four hours, and is often more efficient after the use of Pulsatilla, especially for the headache of Indigestion. Arnica. Arnica is indicated in headaches connected with Conges- tion to the head, Neuralgia, and in those caused by Mechani- cal injuries. The Congestive headache is characterized by a spasmodic pressing in the forehead, as if the brain were contracted into a hard mass, principally when near the fire, whirling dizziness with nausea, heat and burning in the head with coldness of the remainder of the body, and occasional prickling or numb sensations in one or more of the extremities. The Nervous headache manifests itself by crawling, prick- ing, and slinging pains in one or both temples, or on one side of the head, which feel as if they had been bruised, or by an intense pain, as if a nail had pierced the brain. The headache which follows Mechanical injuries, such as 382 GENERAL DERANGEMENT. blows, falls, or strains, in the same as the Congestive, at- tended, at times, by pressive sore pain in the part injured or over one or other eye, and green vomiting. This remedy is the more appropriate when the sufferings are aggravated at evening or night, after eating, or by menial or physical exercise. Administration. --3°- Arnica follows and alternates ad- mirably with Aconite when the febrile action is prominent, and may precede the use of Bcllalonna, Calcarea and Rhus. The rule of repetition is the same as that given for Aconite. Belladonna. Belladonna obtains in headaches, complicated with Conges- tion to the head, Catarrh, Rheumatisms, Neuralgia; and those from Heat, Spirituous drinks, Mechanical injuries, Cold, and" Currents of Air. It is especially suitable for females and children. It is appropriate in Congestive headache when the indica- tions given for this form of suffering under Aconite, are not promptly or permanently relieved by that remedy ; also if the pains are more deeply seated, are violent, pressive, heavy and full, as if the brain would protrude through the forehead or side of the head, with pale, haggard face, drowsiness, loss of consciousness, murmurs, and delirium ; or if this form of headache develop itself after eating, with great lassitude, drowsiness, painful stiffness of the nape of the neck, imperfect speech, distortion of the face, especially of the mouth, and other symptoms of Apoplexy. The Catarrhal headache is marked by pressive aching in the forehead, and congestive feeling of the entire head, as if it would split open, with sneezing, swelling, redness, and exco- riation of the nose, profuse flow of acrid water from the nose, or flowing from one nostril, or alternating with stoppage of the nose, smell too acute, especially for tobacco smoke, or too obtuse, shivering, or feverish heat, thirst and pains in the limbs. (Hepar sulphuris or Mercury may precede or follow Bella- donna for this variety of Catarrhal headache.) Rheumatic headache is attended by violent shooting and headache. 383 burning pains, especially of one side of the head, congestion to the head, swelling of its veins and visible pulsation of its arte- ries, redness of the eyes and face, and fever. The Nervous headache is characterized by burning, shooting pains, generally of one side of the head in the mildest form of attack, attended by sensitiveness of the scalp, distention of the veins of the head and hands, roaring and buzzing in the ears, and clouded sight. In a severe form, the pains become pressing, burning, shooting, rending, and distracting, appear- ing on one side of the head or above the eyes and nose, with a sensation as if water fluctuated or undulated in the head. The Neuralgic pain may also commence very gently, increae in intensity through one side of the head, producing irritabil- ity, lamentations, and delirium. The headache which arises from Heat is similar to the Con- gestive, and indicates Belladonna, especially, when the head seems as if it would split open and the suffering is increased by walking and mental excitement, and is attended by hot fe- ver, thirst, vomiting, sleepiness, anxiety, tears, lamentation, despair or rage, and delirium. Spirituous drinks produce pressing aching in the forehead with congestive fulness of the entire head, red and bloated face, loss of appetite, especially for meat, thirst and feverish- ness. The headache from Mechanical injuries is similar to the Congestive, and requires the Belladonna, most frequently, af- ter the previous use of Arnica. The effects of Cold and Currents of Air accord with the ■ Catarrhal headache, attended at times by imperfect vision, sore throat and indigestion. All these symptoms of Belladonna are aggravated chiefly at night, also about three or four o'clock in the afternoon, and after sleeping, also by the warmth of the bed, recumbent posi- tion, motion, especially that of the eyes, the slightest touch, shock or noise, open air or currents of air, contradiction, even the slightest, and mental excitement; they are mitigated by flexing the head backward and supporting it. Administration --£-. Belladonna is frequently preceded 384 GENERAL DERANGEMENT. by, and alternated with Aconite, and Mercury. Its rule of repe- tition and alternation is the same as that directed for Aconite. Bryonia. Bryonia is available in headaches associated with Conges- tion to the head, Derangement of the stomach, Neuralgia and Rheumatism, and those caused by Heat and Changeable weather. Congestive headache is manifested by severe pain in both sides of the head, pressing from without inwardly, with a sensation as if the contents of the skull would protrude through the forehead, especially on stooping ; bleeding at the nose, affording no relief; burning of the eyes, effusion of tears, and constipation. The Bryonia is of the greatest value if this form of headache occur with Constipation of the bowels. It is generally worse in the morning. For headaches of the Stomach, see Indigestion. Nervous headache has pressing, burning, rending and shoot- ing pains, as if a tumour were forming under the skin, and as if the brain would press through the forehead, which seize the forehead, dart to one or other side of the head, or extend to the cheek-bone, shooting and pulsating at times violently; rheu- matic and passionate patients suffer most from this form of headache. Rheumatic headache is complicated with local or general rheumatism, manifested by rending and shooting pains which fluctuate from the nape of the neck, sides of the head, and •forehead, attended by coldness or shivering, or fever and per- spiration of the head or entire body, and aggravated by the least movement and at night. Changeable weather frequently excites the Rheumatic headache. Headache from Heat is marked by pressing pain and ful- ness of the entire head, attended by want of appetite, espe- cially in the morning, nausea, vomiting and diarrhea, thirst, fever, agitation, trembling and apprehension of the future. The Bryonia may be used in alternation with Belladonna, when that remedy is not promptly efficient for headache from heat, as described under Belladonna. HEADACHE. 385 The headaches of Bryonia appear most frequently in the morning and after meals, and are aggravated by motion, walk- ing, stooping, &c., and touch. Administration. 00500. Nux vomica may be used after and alternated with Bryonia. The repetition and alternation of the dose the same as directed for Aconite. Chamomilla. Chamomilla is useful for Digestive, Nervous, and Rheuma- tic headaches and those caused by Coffee, Anger, and Cold; and for females, children, and persons excited by the slightest pain. For Digestive headache, see " Indigestion." Nervous headache is characterized by drawing, rending and pulsative pains of one side of the head which extend to the jaw, sometimes attended by a benumbed'sensation, or sensi- bility which renders the touch intolerable; acute shooting pain in the temples, heaviness and throbbing above the nose; bloated face, redness of one cheek and paleness of the other ; hot perspiration of the head and scalp, and painful and con- gested eyes. Rheumatic headache is similar to the above, occurring in persons of a rheumatic habit or labouring under rheumatism. Headaches dependent on Coffee and Anger are recognised by the same peculiarities. The headache from Cold is marked, in addition, by weeping eyes, sore throat, hoarseness and catarrhal irritation of the chest. Administration. • y °. Chamomilla may be used after Aco- nite and Coffea, and may precede Belladonna and Pulsatilla. Coffea. Coffea is applicable to Congestive and Nervous headaches, to those caused by Debauch or Spirituous drinks, and to ner- vous persons and children. Congestive headache may arise from excess of joy, is attend- ed by lively exaltation of the mind, heaviness of the head, with occasional violent pain of one side, redness of the eyes and sleeplessness, and is exasperated by speaking. 17 380 general derangement. Nervous headache is marked by a sensation as if the brain were bruised and rent, or by severe rending pains of one side of the head, as if pierced by a nail, which seems insufferable ; frequently caused by Debauch or Spirituous drink, meditation, vexation, and influenza; attended by extreme sensitiveness to noise and music, by agitation, great anguish, tears, cries, dis- traction, throwing about, chilliness, aversion to fresh air, and distaste for coffee. Administration. -|£. The Coffea may be repeated fre- quently, from half an hour to two and three hours, according to the relief afforded. Ignatia, Nux vomica and Pulsatilla may precede, and Aconite and Chamomilla succeed the use of Cof- fea. Ignatia. Ignatia °£° relieves Congestive, Hysterical, and Nervous headaches, those dependent on Grief, Anger, and Tobacco, and those of nervous persons and children. Congestive headache is characterized by a painful sensation of fulness and expansion of the head, as if it would burst, espe- cially when conversing, reading, or listening to another; also by a pulsative and deep-seated pain, especially in the forehead, and above the root of the nose, attended by trembling of the body, palpitation of heart and great despondence. Hysterical headache is generally owing to a high degree of mental excitement, and particularly Grief or excessive An- ger, and is marked by piercing, darling pains, which pene- trate the brain deeply, either in the forehead or on one side of the head, by alternations of extravagant gayety, and laugh- ter, and extreme despondence and tears, imperfect sight, ve- ry red or pale face, nervous agitation and physical restless- ness. Nervous headache is attended by rending, boring, throbbing, and lancinating pains, which seize the forehead as if a nail were driven through it deep into the brain; or pressing pain in the forehead and above the nose, which progresses from with- out inwardly and is mitigated by stooping; paleness of face, nausea, darkness before the eyes, intolerance of light, profuse headache. 38'. colourless urine, fickleness of disposition, sensitiveness, strong fears, taciturnity, sadness, mildness, &c. Ignatia may be used as an antidote to a headache caused by Tobacco, when the symptoms are similar to those we have given as characteristics of Ignatia. The headaches of Ignatia are aggravated by coffee, tobacco smoke, brandy, noise, and strong smells; aggravated or miti- gated by stooping ; mitigated by lying doom and change of position; and are renewed after a meal, lying down in the evening and rising in the morning. Rule of administration the same as for Aconite. It may be used to advantage after Chamomilla, Pulsatilla and Nux vom. Mercurius solubilis or vivus. Mercurius solubilis or vivus, is most efficient in head- aches connected with Catarrh, Congestion of the head, and Rheumatism. The Catarrhal headache frequently prevails epidemically, and is distinguished by pressing, aching pain in the forehead, frequent sneezing, profuse discharge of serous mucus, which is offensive at times, redness and excoriation of the nose with itching and aching pains on pressing the nose, chills or fever, nocturnal perspiration, violent thirst, pains in the limbs, and increased suffering from either heat or cold. (It may precede or alternate with Belladonna in this form of headache.) Congestive headache has a full and crowded feeling of the head as if the forehead would fly apart, or as if the head were firmly bound by a band, especially with aggravations at night, when the pains become boring, burning, rending and darting, and are attended by easy, frequent and profuse perspiration which affords no relief. (Here it is useful after Belladonna and Opium.) Rheumatic headache is attended by burning, shooting, throb- bing and rending pains, which affect one side of the head, ex- tending to the teeth and neck, with pulsatory dartings in the ears. The pains seem to be imbedded in the bones, and the external flesh is frequently tumefied. It may be used before or after Belladonna or Bryonia. 388 GENERAL DERANGEMENT. It is a distinct peculiarity of the Mercurial headaches, that they are aggravated at night, towards morning, by the warmth of the bed, damp and cold air, heat and touch ; and are attend- ed by profuse perspiration, which affords no relief. Administration £f *-. The Mercury may be given in ex- treme cases every four hours, and in alternation with Bella- donna every three or four hours. In ordinary cases it is pre- ferable to adminfster a single dose in the evening. m NUX VOMICA. Nux vomica is a very prominent agent of cure in Catarrh- al, Congestive, Gastric, Nervous and Rheumatic headaches, and those dependent on Coffee, Spirituous drinks, Intellectual labour, Anger, Chills or Currents of air, Prolonged watching, and Constipation.* Catarrhal headache is marked either by heaviness in the forehead or shooting and rending pains; obstruction in the nose, or else fluent coryza of a mucus which is sometimes brown and corrosive in the morning and dry in the evening or at night, with parched mouth and absence of thirst; bruised sensation throughout the body; burning heat and redness of the cheeks; heat of the head and entire body, and alternations of chills and fever, especially in the evening ; and hard faeces or consti- pation. Gastric Headache: vide Indigestion. Congestive headache is attended by excessive heaviness of the head, especially on moving the eyes, and during mental exercise, with a feeling as if the skull would fly apart; painful sensitiveness of the brain, either from motion or external pressure; pressure on the temples; imperfect sight, with de- sire to shut the eyes, and inability to sleep; and aggravated in the morning and open air. Nervous headache appears in the form of rending, shooting and jerking pains principally on one side of the head, as if pierced * The Nux is most indicated in persons of a lively temperament, red face and full habit, who make a free use of Coffee and Liquors, and espe- cially in those who lead a sedentary life and suffer from Constipated ha- lit. headache. 389 by a nail, with nausea and vomiting of sour water ; also, prick- ing, stinging, or oppressive sensation of one side of the head, which commencing in the morning, gradually increases in in- tensity, until the patient becomes distracted and insensible; also, as if the brain were rent asunder, with pale, haggard face, dizziness when walking, buzzing noise, excitation, &c. Rheumatic headache is marked by tensive drawing pains af- fecting1 the forehead on one side of the head, attended by a bruised sensation of the head, and similar pains in the back, loins and joints, a sensation of torpor or paralysis in the parts affected, wilh cramps and plapitaiion in the muscles ; shivering and constipation. (It is mainly indicated for Rheumatic headache after Aconite, Chamomilla, Ignatia, or Arnica.) The headaches dependent on Coffee, Spirituous drinks, In- tellectual labour, Anger, Prolonged watching, or Constipation, are Congestive or Neuralgic, and require a careful study of their respective indications. The headache from Chill or Currents of air, is Catarrhal, which see. The Nux headache is aggravated in the morning, after meals, by coffee, wine, tobacco smoke, noise, bright light, meditation, watching, and windy and chilly weather; it is mitigated by sitting or lying down without change of position. Administration -^a. The Nux may succeed Aconite, or alternate with it every three or four hours in acute febrile conditions. It may precede or alternate with Bryonia or Pul- satilla by the same rule. Administered singly, the interval of repetition should vary from 4 to 24 hours, according to the severity of the case. Pulsatilla. Pulsatilla applies to Catarrhal, Gastric, Congestive, Ner- vous and Rheumatic headaches, and to those caused by De- bauch, Spirituous drinks, Intellectual labour, Chill, Bathing, or Cold drinks. It is especially suited to females, and persons of phlegmatic temperament, mild character and lymphatic constitution, with pale complexion, light hair, blue eyes, &c. Catarrhal headache is marked by dull heavy aching in the 390 GENERAL DERANGEMENT. root of the nose, forehead, or over one eye, or confusion of the head, and is attended by loss of appetite, taste and smell; swelling and obstruction of the nose ; discharge of blood or of a thick and offensive mucus, sometimes yellow and some- times green; and absence of thirst, with chilliness. For Gastric headache, see Indigestion. Congestive headache manifests itself by wearying, debili- tating and oppressive pains, which seize one side of the head ; or progress from the occiput to the forehead or root of the nose, or conversely proceed from the root of the nose to the occi- put : attended by heaviness of the head, dizziness, paleness of the face, agitation, and inclination to weep. Nervous headache offers rending pains, in single spots or in every part of the head, which are augmented toward evening; or throbbing, darting and pricking pains, after rising in the morning or lying down in the evening ; or jerking, rending, darting and pricking pains in one side of the head only; attend- ed by heaviness of the head, frequent dizziness, obscure vision, intolerance to light, sickness at the stomach, buzzing, darting, rending, and pricking in the ears, paleness and varied expression of the face, loss of appetite and thirst, agitation and chills, bleeding at the nose, and palpitation of heart. Rheumatic headache is characterized by similar pains to those of/the Nervous; and are connected with rheumatic pains of the body, which pass rapidly from one joint to another, with sensation of torpor in the parts affected, dartings and coldness on change of weather, and shiverings increasing in proportion to the intensity of the suffering. For headaches arising from Debauch, Spirituous drinks, and Intellectual labour, carefully consult the indications of Nervous and Congestive headaches; and from Chill, Bathing, or Cold drinks, look to Catarrhal headache. The Pulsatilla headache is aggravated or renewed in the evening after lying down, or at night, or in bed in the morning ; at rest, especially when seated; and mitigated in the open air, by movement, walking, external heat, and firm pressure. Administration. °f • Pulsatilla follows, and is of great service in alternation with Aconite; may precede Bryonia and PAINS IN THE LOINS. DELIRIUM TREMENS. 391 Nux, and succeed Chamomilla and Ignatia, with which it may occasionally alternate. The repetition and alternation the same as advised for the Aconite.—Ed. PAINS IN THE LOINS. Notalgia. As these pains are frequently purely symptomatic, the treatment must be directed against the disease from whence they originate. Thus, as Hemorrhoids, Leucorrhea, Metri- tis, Myelitis, etc., are frequent sources of the complaint, the reader is referred to the treatment of these affections in their respective chapters. When they arise from the habitual indulgence in wine or spirituous liquors, coupled with confirmed sedentary habits, as late hours, an occasional dose of Nux v. (three to four globules of the sixth potency in a teaspoonful of water) will generally afford relief; and when a strain from lifting a heavy weight or from any sudden twist on turning the body, or throwing up a window, etc., has given rise to the pain, Rhus tox. must be had recourse to ; followed, if required, by Sul- phur and Calcarea. (Vide also Lumbago, Rheumatism, p. 314, etc., and for pains in the back, or lumbosacral pains, occurring in females during pregnancy, see that article, Part IV. p. 518.) DELIRIUM TREMENS POTATORUM. This malady consists of an affection of the. brain, and is nearly peculiar to drunkards, hence its name. There are a few instances on record in which it has arisen from exhaus- tion caused by excessive depletion ; from the effects of lead, and also from the prolonged use ofopium. The intemperate use of ardent spirits, vinous or strong malt liquors, is, how- ever, beyond comparison, the exciting cause in by far the major number of instances. The disease generally comes on in drunkards in a state of prostration which ensues when they have in a great measure given up, or been suddenly deprived of their accustomed stimulus. The first symptoms of the malady are generally indicated 392 general derangement. by extreme irritability of temper, weakness of memory, but constant activity of mind, anxiety, and incontrollable rest- lessness with increased muscular mobility. The appetite is often pretty good, but more frequently im- paired in consequence of the previous habits, and the tongue sometimes foul and moist. Soon after these premonitory signs, vigilance sets in, and little or no sleep can be obtained ; or it is unrefreshing and disturbed by frightful dreams, im- aginary visions and sounds. Fixed ideas then take firm pos- session of the patient's mind, such as the supposition that some one is bent upon poisoning him or doing him some other grievous injury, etc., yet he generally dreads -being alone. The speech is frequently stuttering and inarticulate ; the countenance quick, wild, and exceedingly variable, ac- cording to the prevailing impression on the mind; the face in most cases pale or sallow ; the eye rolling, expressive, and restless, and the conjunctiva blanched ; the skin damp, or covered with sweat, chilly and relaxed, very rarely above the natural temperature; the hands are commonly tremulous, and muscular twitchings are often observable. As the dis- ease advances, sleep is completely banished ; loquacity with perpetual bustling occupation becomes incessant; and when it is fully developed, delirium supervenes. The pulse is soft and compressible, and rarely quick when not agitated by the struggles or exertions of the patient, for his corporal activity keeps pace with that of the mind, and it is difficult to confine him to his bed or apartment; at the same time, exhaustion is liable to come on very rapidly after great exertion, and the patient is prone to drop down from fatigue. Occasionally convulsions take place, but though sometimes serious, they are usually not of a fatal character. The history of the case, together with the distinctive nature of most of the above de- scribed symptoms, enable us to discern this disorder from that of inflammation of the brain or its membranes. Therapeutics. Nux v., Opium (provided, of course, the attack has not been excited by the effects of Opium or its alkaloid, in large doses), Aconitum, Belladonna, Lachesis, Hy- oscyamus, Sulphur, and Calc, form our main remedial agents, DELIRIUM TREMENS. 393 Nux v. is particularly useful in the first stage of the dis- order, and may frequently be the means of arresting its fur- ther progress when administered at that period. The 1-aA, or -°-*p, or 0T°3°th potency may be used, and the dose repeated in from six, twelve, to twenty-four hours, according to the effects produced.* But when the disease has become fairly established, and the patient is affected with delirium or convulsions, and an ag- gravated degree of all the symptoms remarked at the com- mencement of the attack, we must have recourse to Opium, (potency °§° or <>§0,) in frequently repeated doses. The cu- rative properties of this drug, in this malady, do not, as is erroneously supposed by the majority of allopathic practi- tioners, arise from its property of producing sleep, but from its homeopathicity or specificity, if I may use the expressions ; the pathogenetic properties which it possesses being exactly similar to those which are developed in the course of the dis- ease as it occurs in drunkards. In some cases, particularly where the patient exhibits ex- treme irritability of temper, with more or less derangement of the digestive functions, considerable advantage will be at- tained from the alternate employment of Nux v. and Opium. In some rarer varieties of the affection, which are more liable to occur in young, robust, or plethoric subjects, we meet with symptoms indicative of active cerebral congestion, which call for the administration of a dose or two of Aconite, follow- ed in a few hours by Belladonna, or by Belladonna and Lache- sis alternately, if only partial benefit is obtained from the ac- tion of Belladonna alone, and the trembling of the hands and arms forms a very prominent symptom. Hyoscyamus may be prescribed in preference to Belladonna, when the patient's insanity is more particularly apparent in the exhibition of excessive and uncalled-for jealousy. In extremely obstinate attacks, Sulphur, Opium and Nux v. may be given in alternation, at longer or shorter intervals ac- cording to the greater or less severity of the symptoms. Cal- carea is also a remedy of considerable importance in such * Vide note, p. 21, 17* 394 GENERAL DERANGEMENT. cases, but more especially in plethoric habits. Finally, Stra- monium may be mentioned as likely to be useful when Bella- donna, Hyoscyamus, and even Opium, fail to do much good, and the spasms or convulsions are very severe. Coffea and Camphora have likewise been named as likely to prove ser- viceable against the vigilance, or the mental and bodily activi- ty, when the remedies already enumerated fail to answer ex- pectation. But it may safely be averred, that there are few in- stances in which Nux v. and Opium, when timely administered, will not succeed in subduing the more violent features of the disease; and Sulphur, Opium, Nux v. and Calcarea, in re- moving any inveterate sequelae. These medicines, together with Arsenicum and Acid, sulphuricum, administered at inter- vals of from four to eight days, have also been recommended as useful in correcting the vice which gives rise to this disease as ordinarily met with. Delirium tremens arising from expo- sure to the vapour of lead, chiefly requires: Opium, Bella- donna, and Nux v.; and that from poisonous doses of Opium: Nux v. and Belladonna chiefly. (See Poisons.) EPILEPSY. Epilepsia. Morbus sacer. This well known and truly distressing complaint would re- quire a treatise of itself were we to enter minutely into the treatment of the different forms in which it shows itself; it must therefore be sufficient for our purpose, at present, merely to enumerate the various remedies which have been employed against it with the most success. In cases of recent origin the following are generally the most appropriate : Belladonna, Ignatia, Chamomilla, Nux v., Opium, Ipecacuanha, Camphor, &e. In chronic: Sulph., Cal- carea, and Silicea; or, Causticum, Cuprum, Stannum, Bella- donna, Hyoscyamus, Stramonium,^Veratrum, Cicuta, Zincum, Lachesis, Hepar, Arsenicum, Agaricus, &c. When the reper- cussion of an eruption, or the suppression of an accustomed discharge has given rise to the malady : Sulphur, Calcarea, Causticum, Lachesis, Stramonium, Ipecacuanha, have chiefly been recommended. When the disorder is symptomatic of ASTHMA. 395 other diseases, such as derangement of the digestive func- tions, worms, teething, etc., our attention must necessarily be directed to the treatment of the primary malady. During the epileptic seizure, all that is usually requisite is to take true measures to guard against any injury accruing to the patient in his struggles ; further, to remove anything which is calculated to obstruct the circulation, from the neck. A dose of Aconite ° § ° followed by Belladonna if relief be not speedily obtained, is necessary in some recent cases, when the fit occurs in plethoric subjects, and is attended with strongly marked signs of congestion of the vessels of the head and neck. ASTHMA. This affection is characterized by the following phenomena : difficulty of breathing, recurring in paroxysms, attended with a sensation of suffocating constriction in the chest, cough, and wheezing. The paroxysm is frequently preceded by a sense of coldness, languor, headache, heaviness over the eyes, sickness or flatulence, and a sense of oppression in the chest. During the attack, the patient feels much worse in the recum- bent posture, and consequently sits up, requests the door or window to be thrown open, to admit more air into his apart- ment, and uses every effort to dilate and empty the lungs. There is great restlessness, and frequent attempts to force something out of the air-passages which he thinks impedes the breathing, by coughing. The face is pale or livid, and wears an anxious expression. The extremities, and even the nose and ears, are frequently cold, and the face and chest covered with cold perspiration ; the heart palpitates; the pulse is in various states, sometimes quick and full, small and quick, or weak and irregular ; often intermitting. These symptoms continue with a greater or less degree of violence for some hours or even days, until expectoration takes place, which af- fords relief as it increases in quantity. A remission also sometimes takes place soon after the occurrence of an acces- sion of copious perspiration, or a profuse discharge of urine. 396 GENERAL DERANGEMENT. The disease is more frequently met with at an advanced than an early period of life, and oftener in men than women. The attacks occasionally come on in the afternoon or on retiring to rest,but much more frequently during the night, and in the midst of a sound sleep, from which the patient is suddenly awoke by a sense of suffocation. The recurrence as well as the duration of the attacks is very various. One attack generally leads to another, and the paroxysms commonly become more and more frequent and distressing; still, if no organic disease result, patients who are subject to returns in considerable frequency, sometimes survive to an advanced age. But this is unfortunately not often the case : for unless the disease be arrested, the repeat- ed obstruction and disturbance which is offered to the respi- ration and circulation, seldom fails, in the majority of cases, to induce organic lesions of the heart and large vessels of the lungs, with the usual concomitants of water in the chest or abdomen. The quantity of expectoration is small, and even entirely absent in some cases of asthma, whilst in others it is exceedingly copious ; and hence, the disease has been divi- ded into dry and humid asthma. In the former (Asthma sic- cum), the attack is usually sudden, violent, and of short dura- tion ; the cough slight; the expectoration scanty, appearing only towards the termination of the fit, and in some instances entirely wanting. In the latter, (Asthma humidum), the pa- roxysm is gradual and protracted ; the cough severe ; the ex- pectoration supervenes early, is at first scanty and glutinous, and afterwards copious, and productive of great relief. Therapeutics. In nervous or convulsive asthma (Asthma sicca) the remedies which have been employed with the most satisfactory results are: Arsenicum, Cuprum, Ipecacuanha, Nux v., Bryonia, Pulsatilla.—Opium, Tartarus, Sambucus.— Aconitum, Belladonna, Phosphorus.—Sulphur, Lachesis, Sam- bucus.—Ferrum, Veratrum, Moschus, Stannum, Hyoscyamus, Stramonium, Chamomilla, Carbo v., Aurum, Lycopodium, Acidum nitr., Ignatia, Kali, Ambra, Mercurius, Silicea, Calca- rea, Dulcamara, Coffea, Lobelia inflata, etc. In moist, humid, ASTHMA. 397 pituitous asthma, (asthma humida): Pulsatilla, Dulcamara, Slannum.—Sulphur, Sepia, Tartarus, Cuprum, Sambucus.— Ipecacuanha, Belladonna, Bryonia.—Ferrum, Calcarea, La- chesis, Graphites, China, Silicea, Hepar, Baryta c, Conium, Camphora, Zincum, Mercurius. In flatulent asthma: Nux v., Cinchona, Carbo v., Lycopodium, Chamomilla, Phosphorus, Sulphur, Opium, Zincum, &c In asthma spasmodica, Pul- monary spasm (cramps in the chest) : Cuprum, Nux, Bryonia, Belladonna, Hyoscyamus, Arsenicum, Lachesis, Stramonium, Cocculus, Nux m., Sambucus, Tartarus, Zincum, Sulphur, Kali, Causticum, Sepia, Stannum, Lycopodium, &c. Asthma arising from exposure of irritating vapours (asthma vaporosum), such as copper or arsenic: Ipecacuanha, Mercurius, Hepar s. —Camphora, Cuprum, or Arsenicum. From the vapour of Sulphur: Pulsatilla chiefly ; and when caused by the con- tinued inhalation of stone-dust, and other irritating particles : Sulphur, Calcarea, Silicea, Hepar, have principally been re- commended ; and in some cases, also the following : Arseni- cum, Belladonna, Nux v., Phosphorus, Ipecacuanha, and Cin- chona. Where the repercussion or retropulsion of an erup- tion, or the suppression of a habitual discharge has been the occasional cause (asthma metastasicum) : Sulphur, Carbo v., Arsenicum, Bryonia, and Phosphorus, are the most appropri- ate in the majority of cases. If from suppressed catarrh : Arsenicum, Ipecacuanha, Nux v., &o. Where a chill has given rise to an attack of asthmatical breathing, Ipecacuanha, and Arsenicum ; or, Dulcamara, Aconitum, Belladonna, Bryonia, Chamomilla. And when mental disturbance has brought on a paroxysm of dyspnoea : Aconitum, Chamomilla, Ignatia, Coffea, Nux v., Pulsatilla, Veratrum. When Congestion of blood in the chest forms the occasional cause of dyspnoea, see that article. When the disorder occurs as a sequela of bron- chitis, see Bronchitis. The remedies which are best calculated to afford relief dur- ing a paroxysm of asthma are : Ipecacuanha, followed by Arsenicum if the former produces but little benefit. In other cases : Cuprum, Moschus, Opium, Tartarus, and Sambucus; or, Nux v., Bryonia, Chamomilla, Belladonna, Cinchona, Nux 398 GENERAL DERANGEMENT. moschata, or Pulsatilla, will prove more useful. And those which have principally been recommended to eradicate the tendency to suffer from repeated recurrence of the disorder, where that is practicable from the absence of serious organic disease, &c, are as follows : Sulphur, Calcarea, Arsenicum, Nux v., Antimonium.—Stannum, Sepia, Silicea, Cuprum, La- chesis, Carbo v.—Lycopodium, Causticum, Graphites, Acidum nitricum, Phosphorus, Ammonium c, Ferrum, Zincum, Tussi- lago. In ordinary cases the subjacent remedies will be found serviceable, when the leading symptoms are in accordance with those which are described. Ipecacuanha °£°. During the paroxysm of acute asthma, this remedy is one of the most frequently useful, whether the attack occurs in children or adults. It is more especially in- dicated when the patient is awoke from a sound sleep, with a suffocating sensation of constriction in the windpipe, with quick, laborious breathing and gasping for breath; wheezing and mucous rattling in the chest; short dry cough; paleness and coldness of the face, sometimes alternately with heat and red- ness ; coldness of the feet; anxiety and dread of suffocation ; feeling as if dust were inspired during the act of respiration, and caused the suffocating feeling in the chest; spasmodic rigidity of the body, and livid hue of the face. After a dose or two of Ipecac, it is occasionally requisite to have recourse to Arsenicum to afford further relief. In other instances, Nux v. or Bryonia will be found better adapted to remove the re- maining symptoms. Arsenicum ■*§-. Is chiefly called for (either in acute or chronic asthma) when, during the attack, the respiration ap- pears to become more and more laborious, and is attended with extreme agitation, moaning, and jactitation ; great ex- haustion, and anguish, as if at the point of death, with cold perspiration. In confirmed asthmatics, it forms a most im- portant remedy when the breathing is liable to become much oppressed when walking rather quickly, or when going up a hill, or ascending stairs ; and when, particularly in the case of old people, even the effort of laughing, or the exertion of getting into bed, brings on a fit of dyspnoea. Arsenicum, as ASTHMA. 399 well as Ipecacuanha, is further indicated when the paroxysms of asthma are most liable to occur on retiring to rest, or be- fore midnight, the patient being disturbed from sleep by a sense of spasmodic constriction in the chest and larynx, which is soon followed by laborious, panting, and whistling respiration, with gasping for breath. These symptoms are occasionally re- lieved by remissions, but the attack is prone to recur on using the slightest exertion ; for the most part, however, the parox- ysm continues with more or less intensity until relieved by the accession of a fit of coughing, with expectoration of vis- cid mucus filled with vesicles. Arsenicum, though princi- pally called for incases in which the attacks come on at night, is also useful when they are prone to be excited during the day, on exposure to a cold bracing air, or on going out du- ring the prevalence of disagreeable, damp, or stormy weather; likewise when changes of temperature or tight and very warm clothing, are likewise liable to cause a fit of dyspnoea. Sen- sation of burning heat in the chest during the fit of asthma, is an additional indication for Arsenicum. Bryonia &£a. As already mentioned, this medicine is fre- quently useful after the previous employment of Ipecacuanha. The indications are chiefly : Obstructed respiration at night or towards morning, with frequent cough, pains in the hypo- chondria, and inability to recline on the right side, and not without inconvenience on the left, so that the patient is con- strained to lie on the back; frequent coughing, with expecto- ration at first frothy, and subsequently thick and glutinous, and frequently attended with retching or vomiting; aggrava- tion of the dyspnoea from talking or from the slightest move- ment ; frequent efforts to obtain sufficient air by deep inspi- rations, accompanied with moaning, palpitation of the heart, and great anxiety. The attacks are often attended by shoot- ings in the chest, on taking a full inspiration, also on cough- ing, or after any movement of the arms or trunk. At other times there are eructations of the taste of the food partaken of, colic, irritability of temper, and disposition to find fault with everything. (Bryonia and Nux v. are often adminis- tered with great advantage in alternation.) 400 GENERAL DERANGEMENT. Nux vomica °£°. Nocturnal attacks of suffocating tight- ness, especially at the lower part of the chest, preceded by dis- agreeable or anxious dreams ; also when the paroxysms are prone to occur in the morning, or after a meal, and are at- tended with anxiety, aching and pressive pains in the pre- cordial region, as also in the hypochondria ; feeling of dis- tention in the abdomen and epigastrium ; flatulence ; tension, pressure, and aching in the chest; palpitation of the heart; short hacking cough, with difficult expectoration ; inability to bear the slightest pressure from the clothing, particularly around the chest and waist; the clothes seem to fit tightly and increase the difficulty of breathing, when in reality they are quite the reverse ; dyspnoea when walking and convers- ing in the open air, especially if the temperature be some- what cold; dyspnoea after trivial corporal exertion of any kind. Melioration of the asthmatic sufferings when reclining on the back, or on changing from one posture to another, such as sitting up, and then lying down again, or turning from one side to the other. Disposition irritable and passionate. Pulsatilla -§-. Oppressed, rapid, and laborious breath- ing from a feeling of spasmodic constriction in the chest, es- pecially at the inferior portions; or suffocating feeling in the windpipe, as if caused by the vapour of sulphur; tension and sensation of fulness, pressure and aching, attended with mu- cous rattling in the chest; short fits of coughing in rapid succession, and appearing to threaten suffocation; or cough with copious expectoration of mucus. The attacks usually coming on at night, or in the evening when in a horizontal pos- ture ; extreme anguish, palpitation of the heart, and sometimes lancinating pains in the chest during the paroxysms. Pulsatilla -fs-, is generally more suitable for hysterical fe- malesor individuals of a mild, timid, sensitive or fretful disposi- tion'. In dyspnoea, with mucous rattling, and cough, occurring in children from taking cold, it is likewise amost useful remedy. Tartarus emeticus. °£°. Dyspnoea with suffocating cough and anxious oppression at the praecordia, arising from an ex- cessive secretion of mucus in the bronchi; this remedy is fre- quently of great service, either in aged persons or in children. Opium *{*. Obstructed breathing, either from congestion or asthma. 401 from pulmonary spasms, with suffocating cough and livid hue of the face, loud mucous rattling in the chest, with extreme anguish from dread of suffocation; dyspnoea during sleep re- sembling nightmare (incubus). China °| °-. Paroxysms of asthma at night, as if caused by an accumulation of mucus in the windpipe ; wheezing in the chest during insp'ration; difficult expectoration of thick trans- parent mucus ; oppression at the chest, palpitation of the heart, and inability to breathe, unless the heads and shoul- ders are propped up with pillows; great weakness, and ten- dency to copious sweating at the slightest exertion, or when too warmly clothed. Sambucus °^°. Rapid and laborious respiration, with loud wheezing ; oppression at the chest as if from a weight, at- tended with anguish and dread of suffocation, and sometimes swelling and livid hue of the face and hands, general heat, tre- mour, inability to talk much above a whisper; suffocating cough; aggravation of the symptoms in the recumbent posture. In the case of children this remedy is often of great service, when, in consequence of a chill, they are seized with spasm in the chest, and awake from sleep with a start, and exhibit many of the symptoms detailed. (See Spasms in the Chest.) Moschus °£°. Acute asthma occurring in hysterical fe- males, or in children from exposure to cold ; sense of spas- modic constriction in the larynx and bronchi; or oppression at the chest with paroxysms of suffocating feelings, as if caused by the inhalation of the vapour of sulphur, commencing with a fit of coughing, and succeeded by distressing oppressive con- striction, sometimes to such a degree as almost to drive the patient to exasperation and distraction. Belladonna ^|5. Difficulty of breathing, particularly when ocurring in females of an irritable habit, and subject to spasms, with tension in the chest, and lancinating pain behind the ster- num ; dry cough at night, with moaning respiration which is sometimes deep and full, at otliers, short and rapid, with gasp- ing for breath and great efforts to dilate the chest to the utmost to obtain a sufficient supply of air ; sensation of constriction in the larynx, and feeling as if suffocation would ensue on putting 402 GENERAL DERANGEMENT. the hand to the larynx, or on turning the neck ; paroxysms of asthma, with loss of consciousness, etc. Lachesis °£°, is often useful when only partial relief has been effected by the action of Belladonna. Veratrum ^ip, in violent attacks of acute spasmodic asth- ma, with symptoms of threatening suffocation, cold perspira- tion, coldness of the nose, cars and lower extremities, this remedy will often afford relief when Cinchona, Ipecacuanha and Arsenicum have failed to do so. Dulcamara °ft°. In moist asthma (asthma humida) this medicine is one of the most useful remedies, and particularly when the attacks are liable to be excited by a cold and damp state of the atmosphere. In severe dyspnoea, with loose-sound- ing cough, rattling of phlegm in the chest, and copious expec- toration, arising from exposure to wet, it is likewise a valu- able remedy. Stannum y. Humid asthma with obstructed respiration and fits of shaking, particularly at night, or on preparing for bed, but also when the paroxysms come on during the day, and render it necessary to loosen the clothing. The attacks are attended with oppression at the chest, and mucous rat- tling ; cough, with copious expectoration of viscid or grumous, or transparent and watery, or yellowish mucus of a sweetish or saline taste. Phosphorus, Sulphur, Calcarea, Sepia, and Lycopodium, are also of much value in humid asthma, and of great service in some of the most obstinate cases. In chron- ic, asthma, a dose of the medicine required may be taken at intervals of from four to eight days or so; but in acute cases, or wrhen the remedy is prescribed during the paroxysm, the dose may be repeated at intervals of from half an hour to two hours and upwards, according to the severity of the case. When the medicine first prescribed affords no relief after from two to three repetitions, another must be selected, preference being given to that remedy which corresponds the nearest to the existing symptoms.* * Vide note, p. 21. 403 CASUALTIES. CONCUSSION, BRUISES, SPRAINS OR STRAINS, WOUNDS, DISLOCATIONS, AND FRACTURES. In Concussion of the brain, (which may arise from a violent shaking of the brain or of the whole body, without any direct violence having been offered, such as a severe blow or fall on the head,) the symptoms vary according to the degree of in- jury which the brain has sustained. When the concussion is very severe, there is immediate deprivation of sense and power of motion, and death is the general result; but when slight, a temporary stunning or confusion, with some head- ache, is produced, followed by increased action of the pulse, vertigo and sickness. When, on the other hand, the violence done is greater than in the latter instance, though not so se- vere as to cause the fatal termination alluded to in the first, the patient is rendered insensible and incapable of movement; his limbs become cold; the pulse weak, slow, and intermit- tent ; the respiration laborious, but usually without stertor. (This has been denominated the first stage of concussion.) As the patient begins to recover from this condition, the pulse and respiration improve, and warmth begins to be felt in the extremities; the sensibility to touch then returns, and the contents of the stomach are in most cases rejected ; still he continues to remain in a dull, confused state, and inatten- tive to, or almost unconscious of slight external impressions (second stage). On the gradual subsidence of the first effects of the concussion, the patient becomes enabled to respond to questions spoken in a.loud tone. When, however, the stupor has considerably or entirely abated, inflammation of the brain, of an active character, will, in many cases, then begin to develop itself (third stage), with all its wonted symptoms, (see Phrenitis,) and if not checked, suppuration or effusion within the head, preceded by rigours, will result. 404 CASUALTIES. Therapeutics. In all cases of injury arising from external violence, Arnica is the specific remedy, and its timely adminis- tration in cases of concussion of the brain, will, in most in- stances, if the injury be not very severe, suffice to remove all traces and evil consequences of such misfortunes. We may administer internally two globules of the sixth potency, in a teaspoonful of water; and, if there be an external wound, we may bathe the injured part with a lotion, in the proportion of a few drops of the Tincture of Arnica to an ounce or about two tablespoonfuls of water, twice or thrice a day ; should the swelling, pains, and other symptoms, increase, after one or two applications, we must discontinue the lotion, but will al- most always find a marked improvement follow such aggra- vation. When, however, the contusion has been serious, and extreme restlessness or jactitation, and irritability of temper with sensi- bility of the eyes to light, small quick pulse, delirium, or sub- sequently rigours, etc. supervene, the same treatment must be pursued as that wdiich has been described under Inflamma- tion of the Brain, and also Hydrocephalus, which see.* After an injury to the head, particularly if it has been of a somewhat severe character, the patient ought not to be allowed to partake of any stimulating liquids, such as wine, spirits, &c, until at least three or four weeks have elapsed, even although he appears to have entirely recovered from the effects of the accident; he ought likewise to be kept quiet, and not be per- mitted to expose himself to excitement of any kind, otherwise the most serious consequences may be the result. When the chest has been injured by a contusion or violent concussion, etc., and soreness or a sensation as if from incipient suppura- tion, with heat and throbbing, is experienced in some particular spot; fever or alternate chilliness and heat followed by fever which becomes aggravated in the evening; sleeplessness or * In fracture of the cranium the same treatment must be pursued ; but when compression of the brain takes place attended with its usual con- comitants, such as stupor, stertorous breathing, etc., from the effects of a depressed portion of bone, the trephine must be employed, if the symp- toms continue unabated notwithstanding the use of the medicines in- dicated. wounds. 405 disturbed sleep, with general heat, and sometimes perspiration towards morning; short dry cough which increases the pain, or cough with spitting of blood ; further, when the pain in the chest is rendered more acute by taking a full inspiration, laughing or sneezing, or when pricking pains or a sensation of fulness or pressure, as if caused by extravasated blood, is experienced, together with a feeling of constriction that ob- structs the freedom of respiration—it will be necessary to have immediate recourse to Arnica and Aconitum alternately, at in- tervals of from three to six hours, until an improvement in the symptoms becomes manifest; but should a degree of fever continue after the exhibition of several doses of the foregoing remedies, attended with a sensation as if there were an internal excoriation or wound, Pulsatilla should be administered. In the event of a continuance or even an increase of cough, with expectoration of thick, yellow mucus, occasionally streaked with blood, Mercurius must be prescribed; if, on the other hand, the expectoration has a sweetish taste, and is accompa- nied by difficulty of breathing, Nux v. is to be preferred. When a degree of delicacy of chest remains behind, after the employ- ment of any of the preceding medicines,with tendency to suffer from shortness of breath, and a short dry cough, combined with paleness of the face, impaired appetite, and restless un- refreshing sleep, Cinchona has been strongly recommended. In other cases, especially those which have been neglected, where we have reason to apprehend the development of Phthisis pulmonalis, the employment of Stannum, Acidum ni- tricum, Silicea, Kali c, or Phosphorus, Sulphur, Calcarea, and Lycopodium, may yet enable us to arrest the progress of that ruthless malady. The effects of a shock to the nervous system, with pains in the limbs, &c, from stumbling or making a false step, are gen- erally relieved by Bryonia or Pulsatilla. When the accident has been accompanied with fright, Opium-%- maybe prescribed in the first instance, Aconitum -§- when there is syncope, and Chamomilla fi§ft when from extreme pain convulsions ensue.* * Ignatia Hfes also been recommended in the event of convulsions; and Coffea when uncontrollable agitation and agonizing jactitation result. 406 CASUALTIES. But in almost all such cases, Arnica may be employed with advantage, either subsequently or at the commencement; in the event of headache resulting from a contusion or from stumbling, and Arnica does not afford much relief, Belladon- na -§- may be given ;* the patient should at the same time remain quiet, and avoid any exertion, whether of the body or mind, until the pain is removed. SPRAINS. In the treatment of these troublesome casual- ties, at the commencement, prescribe a lotion of Arnica, when there is much tumefaction and redness, with great pain on the slightest movement. After the employment of the Arnica, we may have recourse to Rhus toxicodendron, which is, pro- perly speaking, more specific to this description of external injury, in the same manner, and two or three globules of the third or sixth potency may also be taken internally. If se- vere pain continue, notwithstanding the employment of Ar- nica and Rhus, the following remedies have been recom- mended : Bryonia, Ammonium c. and Ruta, and in some in- stances, Belladonna, Pulsatilla, Nux v., Agnus, or Silicea 3 5 U1 8 " STRAINS. When pricking or other pains are experienced in the back, &c, after a strain caused by any powerful or sudden exertion, such as lifting a heavy weight, or throwing up a window, with aggravation from the slightest movement of the arms or trunk, Bryonia should be exhibited, and suc- ceeded by Sulphur, if only partial relief is obtained. When headache results from a similar source, or when the pains are confined to the extremities, or if at all in the back or loins, are equally, if not more severe, during rest as well as on movement, Rhus may be prescribed, followed in turn by Calcarea y, if the sufferings remain almost unmitigated. When sickness and great pain in the abdomen are produced by the effects of a strain, Veratrum °£° has been recom- mended as being speedily serviceable. * -Cocculus, Cicutafor Add. phosphoricum, may be required to remove prolonged headache arising from the above-named causes. •(See also Ce- phalalgia.) ' WOUNDS. 407 WOUNDS are divided into incised, lacerated, contused, punctured, poisoned, and gunshot wounds. By an INCISIVE WOUND, is meant one which has been produced by a sharp instrument, as a sword, knife, etc., and is not accompanied with any contusion or laceration. Incised wounds, although more liable to be attended with a greater degree of hemorrhage, are, generally speaking, the least dan- gerous and the most easily healed. LACERATED WOUNDS are those in which themuscular fibres, instead of being divided by a sharp cutting instrument, have been torn asunder with some violence; the edges, instead of being even and regular, are jagged and unequal. They are commonly attended with little or no bleeding, rarely heal without suppurating, and are frequently succeeded by violent inflammation. The terms CONTUSED WOUNDS, or BRUISES, are ap- plied to those wounds which are occasioned by some blunt in- strument, or hard blunt surface, being brought in violent collision with a part of the body. When severe, they are dangerous, from being prone to terminate in mortification and sloughing. PUNCTURED WOUNDS are those which have been caused by pointed instruments : they partake more of the na- ture of lacerated than incised wounds, and are dangerous from the great depth to which they frequently penetrate, and the serious consequences they often entail by occasioning vi- olent inflammation of the fascia, and tetanus. Therapeutics. In the treatment of wounds of all kinds, our first object is to arrest the hemorrhage. This is to be done by means of the tourniquet, by compression, by the lig- ature, by cold water or ice, and astringents, &c, according to the degree and source of the discharge. Weunds of the arteries are for the most part the most se- rious : they are to be distinguished by the bright colour of the blood, which moreover issues very rapidly and in jets -/while that from a vein flows in a smooth, uninterrupted stream, and has a dark or deep purple hue. When the injured vessels are of a small size, they sponta- 408 CASUALTIES. neously cease to bleed, or do so, at all events, as soon as the wound is dressed ; but when the hemorrhage is considerable, one or more of the arresting measures above alluded to must immediately be put in requisition. When, therefore, there is reason to conclude that an artery has been punctured, a tour- niquet should be applied around the limb to check the flow of blood; the external wound must then be closed, covered with a graduated compress, and firmly secured with a bandage. When a proper tourniquet is not at hand, its place may be tolerably well supplied by a handkerchief bound round the limb, and tightened by two or three turns of a stick passed under the handkerchief; or the substitute may consist of a cork cut longitudinally, and securely fixed over the artery, the site of which is readily to be found at the inner surface of the limb, in spare or emaciated subjects, by its pulsation ; but as the finding of the artery is not so easily accomplished in the robust and muscular, it will be advisable first to tie a hand- kerchief, or non-elastic garter, tightly round the limb, above the wound ; this will have the effect of rendering the artery more prominent. In order to make the compression of the cork the more effectual, several plies of lint or linen, or a piece sufficiently large to form a few inches square and one in thickness, should be placed over the cork, (which should be held firmly in the required position during the preparation of the compress,) and the whole then tightened, and retained as long as may be requisite. The application of ice to the wound, or of cold water frequently renewed, is also of une- quivocal service. Compression may in some cases be effec- tually applied by pressing a piece of sponge (which has been dipped in beeswax and stiffened) down upon the bleeding vessels, then adding compresses of lint and a roller. When the hemorrhage comes from a large artery, it must sooner or later be stopped by ligature. In wounds of veins, or when the bleeding is from any small arteries, also when it is from a vessel which lies over a bone, or when it proceeds from ves- sels situated too deeply for the convenient application of the ligature, compression, with the aid of ice or cold water, is the method to be adopted for the suppression of the hemorrhage. WOUNDS. 409 Bleeding from wounds, &c, in the mouth, sometimes re- quires the application of styptics, such as alcohol, and kreosote water, &c. The same may be said of slight superficial wounds, as also of fungous tumours, and other diseased sur- faces, when cold water fails to answer the purpose. Arnica, Diadema, or Phosphorus, internally and externally, have like- wise been strongly recommended in such cases. Copious hemorrhage after the extraction of a tooth is usu- ally readily suppressed, by pushing a compress of lint into the hollow space left; or by the aid of styptics, and the medi- cines above mentioned, when requisite. A simple, and some- times extremely efficacious mode of checking this current of blood, is by replacing the extracted tooth, and keeping it there until the risk of further hemorrhage is obviated. When severe syncope, with deadly paleness of the face, or when the face assumes a livid appearance, and subsultus ten- dinum and other signs of extreme exhaustion set in from ex- cessive loss of blood, Cinchona ought to be prescribed; and if the patient should not exhibit any indications of rallying thereafter, a little wine may be given, and subsequently Ar- nica ; but if the stimulating effects of the wine prove only of temporary service, another dose of Cinchona must previously be had recourse to. The next step to be taken in wounds of every description, after the hemorrhage is stopped, is to remove all extraneous matter, as sand, fragments of glass, splinters, shot, rags, &c.; then relax the muscles so that the wound may not gape; final- ly, to place the lips of the wound in accurate contact, and keep them so by bandages, plasters, sutures, &c. Bandages are usually indispensable in deep, and even in small, superficial, incised wounds, but care must be taken not to apply them too tight, nor when there is excessive inflammation. Sutures are commonly requisite in wounds of the face, ab* domen, and sometimes of the hands, and in old people gene- rally. In the young and vigorous they are seldom necessary, and even improper, when the patient is of an irritable habit of body. Strips of adhesive plaster, cut narrow in the cen- tre or portion which is to oross the wouiid, and sufficiently 18 410 CASUALTIES. long that they may retain their hold the more firmly, and act with the required compressive power, form, in the majority of incised wounds, the most frequently useful means of bring- ing the sides into close approximation and effecting adhesion. It sometimes happens, however, that even incised wounds, particularly when deep and of considerable magnitude, termi- nate in suppuration : it is consequently necessary to leave in- tervening spaces between the strips of plaster, to admit of the exit of the matter in such an event. Again, when it is found impracticable to cleanse the wound of all foreign sub- stances, it ought to be only lightly, and so to speak, incom- pletely dressed, as it will be necessary to renew the dressings repeatedly. In some cases it is necessary to dilate the wound, to obtain the abstraction of a splinter, &c. With regard to the constitutional treatment of wounds of all kinds, we should commence with the administration of Arnica, of which a few globules at the sixth potency should be given, as soon as the patient shall be made as comfortable as circumstances will admit. The patient should at the same time be kept cool, free from anxiety or exertion, and as quiet as possible. He should live abstemiously, avoid every thing of a heating nature, and drink cold water. If he be ro- bust and strong, and sympathetic fever run high, a dose of Aconite, at the third or sixth potency, should be prescribed; followed, in the course of from three to six hours, by Arnica, and so on alternately as long as may be found requisite ; in favourable cases one dose of each is often found sufficient. The local application in the first instance, if required by ex- cess of pain, heat, and swelling, should consist simply of lint dipped in cold water, and frequently remoistened. In the treatment of LACERATED WOUNDS we must, after having carefully cleansed them, closely approximate all the parts that will admit of the process, and retain them in their place by means of plasters and an appropriate position of the body or limb for the purpose of endeavouring to unite them by the first intention. Should the wound become in- flamed, attended with much pain and swelling, dress it with WOUNDS. 411 lint dipped in cold water, which must be frequently renewed. If, on the other hand, copious suppuration ensue, and the pain be very severe, the cold water must be discontinued, and Chamomilla exhibited, followed by Hepar s.; and should these remedies fail to bring oji an early healing action, Silicea will generally answer; or Silicea and Sulphur in alternation to promote granulation. (See Ulcers.) In CONTUSED WOUNDS (or BRUISES) Arnica must be given internally, and cold water applied externally, in the first instance. When there is considerable extravasation of blood, the tincture of Arnica* must be applied as a lotion, of the strength of a teaspoonful of this tincture to a teacupful of water, to stimulate absorption and otherwise forward the cure.t In the event of an Abscess resulting from the effects of a contusion, see that article. Whea-joTnts4 or the synovial membranes, are injured by a Contusion, Rhus has been particularly recommended; in some cases Silicea will be found of great utility, as we can testify from experience. If the periosteum be affected, Ruta is said to be useful; we would however recommend an incision to be * "We have already remarked, that this useful medicament, when em- ployed as a lotion to wounds, should always be discontinued whenever any aggravation of the pains, S. 421 afford great relief. As soon as decided improvement is expe- rienced, the remedies must be discontinued, or taken at much longer intervals.) Should, however, a feeling of giddiness, or a sensation of emptiness in the head, be experienced, shortly after going on board, attended with headache, nausea, and inclination to vomit, as the motion of the vessel increases, which is aggra- vated by standing erect, Cocculus °|° may be had recourse to, and repeated every one, two, or. three hours, as those symptoms recur. (This remedy has also been found useful in sickness arising from travelling in a carriage.) Tabacu.m ^^l^. Excessive giddiness attended with dis- tressing nausea, headache, and deadly paleness of the face; ot nausea, with sickness, or a sensation of burning in the stomach, renewed by the slightest movement of the head or body. This remedy is further indicated, when the symptoms are some- what relieved by exposure to the fresh air. Arsenicum iS4641Jl, is extremely valuable when the sick- ness becomes excessive, and is attended with a feeling of utter prostration and helplessness, violent retching, bnrning sen- sation in the throat, and the other severe concomitants of this malady. It should be administered between the paroxysms, and will rarely fail of relief. This medicine may be followed by Tabacum or Cocculus, to dissipate the symptoms of nau- sea and swimming in the head that may supervene. Ipecacuanha090^00, is useful in attacks of vomiting un- attended with the great prostration of strength given under Arsenicum. Of course, in order to avoid interfering with the action of the medicines, the homoeopathic regimen should be carefully observed during the period of their administration. Petroleum,* Silicea and Therideon, from the close ana- logy of their symptoms to those of the ordinary forms of this distressing malady, deserve a trial. °V°- Administration of the above remedies : six globules of the medicament, at the potency mentioned, in an ounce of water, a teaspoonful every hour, and then until relief is experienced. * Dr. Chase found that Petroleum is the best specific for sea-sickness. 422 APPARENT DEATH. Asphyxia. Apparent death. Asphyxia. In every instance that an individual has to all appearances suddenly expired from ex- ternal causes, animation may only be suspended ; there are many cases of course where sudden death is no mere suspen- sion of animation, but there are others where apparent death is far from uncommon^ in all cases where there is the least uncertainty, care should be taken to do nothing that may cause death, and interment should be avoided until certain signs of putrefaction set in.* Apparent death from hunger. Give small injections of warm milk repeatedly ; great care must be taken to give the food, when the patient begins to rally, in the smallest possible quantity at a time. Milk may be given drop by drop, and gradually increasing it to a teaspoonful, and after some inter- val a small quantity of beef-tea and a few drops of wine. Af- ter a sound sleep has succeeded, but not till then, a small meal may be given, but it is best that the patient should eat little at a time, but often, so that he may gradually return to his natural mode of living. It must be borne in mind, that in all persons suffering from starvation, eating too much and too quickly, is in the highest degree dangerous. Apparent death from a fall. Place the patient cautiously on a bed, with his head high, in a place where he can remain quiet; put a few globules of Arnica on his tongue, and wait till a medical man visits him to see if there is any fracture, or whether there are still signs of life ; a bleeding here may be sometimes of benefit, but it requires great caution. Arnica may be repeated, and also Arnica in injections. If the pa- tient has been bled, give China ; but it is obvious that if much blood has been lost by the fall or wound, venesection would be injurious. * The subjoined directions have chiefly been taken from Hering'* Hausarzt. APPARENT DEATH. 423 Apparent death from suffocation, (hanging, pressure, chok- ing.)^ Remove all tight clothing. Put the patient in a proper position, the head and neck rather high, the neck quite easy, not bent forward. Begin by rubbing gently but constantly with cloths, give an injection of a dozen or two globules, or a drop of Opium, dissolved in half a pint of water, and injected slowly. This may be repeated every quarter of an hour, whilst the ribs are being rubbed gently. Hold from time to time a mirror before the mouth, to see if the breath dims it; open the eye- lids, and see if the eyes contract; put warm clothes on; hot stones wrapped in blankets to the feet, between the thighs, to the sides, neck and shoulders. If in an hour no change is produced, take a bitter almond, pound it fine, mix it in a pint of water, put a few drops into the mouth, or into the nose, and give the rest in injections. Apparent death from lightning. The body should be im- mediately removed into a current of cool fresh air; cold water dashed frequently on the neck, face and breast. If the body be cold, warmth with friction must be employed in the same manner as recommended for the drowned; as well as the means therein adopted for inflating the lungs. A few globules of Nux v. may be put upon the tongue, and repeated in half an hour ; if no effect is produced, a little Nux v. in wa- ter rubbed on the neck, and some injected, may be of service. It has also been recommended to place the patient in a half- sitting, half-recumbent posture, and to cover him over with newly-excavated earth, (leaving the face alone exposed, which should be turned towards the sun,) until the first signs of re- turning animation become apparent, after which Nux v. is to be had recourse to as above directed. Apparent death from drowning. Observe the following cautions : 1, lose no time ; 2, avoid all rough usage ; 3, never hold up the body by the feet; 4, do not roll the body on casks ; 5, do not rub the body with salts or spirits ; 6, do not inject smoke or infusion of tobacco, though clysters of warm water and salt, or spirits and water, may be injected, and the following means should not be delayed :— 424 CASUALTIES. 1. Convey the body carefully with the head and shoulders in a raised position to the nearest house. 2. Strip the body and rub it; then wrap it in hot blankets, and place it in a warm bed in a warm room, or in warm sand or ashes. 3. Wipe and cleanse the throat, mouth and nostrils. 4. If the foregoing measures produce no reaction, place a few globules of Lachesis on the tongue, and in injections, and resume the rubbing. Solanum mamosum has also been recom- mended, and may be tried after Lachesis, when that remedy fails to do any good. 5. Again, should our efforts still fail, or should the medi- cines quoted not be at hand, we may, in order to restore the natural heat of the body, move a heated covered warming-pan over the back and spine. Place bottles, or bladders filled with hot water, or hot bricks, to the pit of the stomach, the armpits, between the thighs, and soles of the feet. Place the body in a warm bath, in the sun or at a proper distance from the fire; use friction with hot flannels, flour of mustard, or other stimulants; rub the body briskly with the hand; at the same time do not suspend the use of other means. To restore breathing, introduce the pipe of a common bel- lows into one nostril, carefully closing the other and the mouth, at the same time drawing downwards, and gently pushing backwards, the upper part of the windpipe, to allow a more free admission of air; blow the bellows gently in order to inflate the lungs till the breath be a little raised, the mouth and nostrils should then be set free, and a moderate pressure made with the hand upon the chest; continue this process until signs of life appear. 6. Electricity, or a stream of galvanism passed through the chest, promise to be of great service. 7. Apply pungent salts, as sal volatile or spirits of harts- horn, to the nostrils. These means should be persisted in for several hours, and till there are evident signs of death. When the patient shows signs of life, and can swallow, small quantities of warm • wine or spirits and water may be APPARENT DEATH. 425 taken ; but till then, nothing should even be poured down the throat, either by a flexible tube or otherwise. At this period the patient should never be left alone, as some have been lost for want of care who might otherwise have been saved. Apparent death from being frozen. When an individual is found in a state of frost-bitten asphyxy, arising from exposure to intense cold, he should be removed with great gentleness and caution to guard against any injury, as fracture, etc., to a place of shelter, such as a barn or unhealed apartment, since e^en a moderate degree of heat might annihilate all hope of restoring animation; at the same time the patient ought to be protected against the slightest draught. l]p should then, especially if the limbs have become stiff- ened by the frost, be covered over with snow to the height of several inches, the mouth and nostrils alone being left free, The patient ought to be put in such a position that the melted snow may run off readily, and its place supplied by fresh. When there is no snow, a cold bath, the temperature of which has been reduced by ice, (or a bath of cold sea or salted water,) may be substituted, and the body immersed therein for a few minutes. The process of thawing is by these means to be effected, and when every part has lost its rigidity, the patient should be undressed by degrees, and the clothes cut from the body if requisite. As the muscular or soft parts become pliable, they may be rubbed with snow until they become red; or the body wiped perfectly dry if snow is not to be had, placed in flannel in a moderately warm room, and rubbed with the warm hands of several parties simultaneously. In the event of no signs of returning animation declaring themselves soon after the foregoing treatment, small injections containing Camphor may be administered every quarter of an hour. As soon as any symptoms of approaching restoration become perceptible, small injections of lukewarm black coffee (coifee without milk) may be thrown up; and as soon as the patient is able to swallow, a little coffee may be given, in the quantity of a teaspoonful at a time. 426 CASUALTIES. The measures above detailed ought to be persevered in for several hours. Against the excessive pain which is generally experienced when life is restored, Carbo v. should be pre- scribed in repeated doses,* and if it fails to relieve the suffer- ings, Arsenicum may be given. The party rescued must avoid subjecting himself to the heat of the fire or stove for a con- siderable length of time after his recovery, as serious con- secutive ailment, and particularly disease of the bones, • is liable to result therefrom. Apparent death from noxious vapours. The treatment con- sists in removing the body into a cool, fresh current of air ; dashing frequently cold water on the neck, face, and breast; if the body be cold, apply warmth, etc., recommended to^the drowned ; inflation of the lungs; early and judicious applica- tion of electricity or galvanism,—after life has been restored, give Op. or Acon. • HYDROPHOBIA, It is acknowledged that no allopathic cure has hitherto been found for this disease when fully established : the plans of treatment which have been reported to have been successful in some few instances having generally failed in all others ; thus rendering it probable, that in these supposititious cases of success, the persons bitten might have escaped without any treatment whatever. But it is not to my purpose to enter into the multitude of ineffectual remedies which have been recommended by the Allopathists. Hydrophobia is a disease which arises in consequence of the bite of a rabid animal, and sometimes spontaneously, particularly in the course of some other disease; in which form it is known under the term of symptomatic hydrophobia. Ere proceeding to the homoeopathic treatment, a few re- marks, descriptive of the disease as it appears in the human subject, may not be misplaced. The first symptoms that * Vide note, p. 21. HYDROPHOBIA. 427 show themselves in a person who has been bitten, are usually, general uneasiness, anxiety and disturbed sleep ; the eyes are glassy, inflamed and sensitive to light; there are also ringing in the ears, giddiness, and paleness of countenance; frequent paroxysms of chilliness ; oppressed respiration and quickness of pulse, which latter is usually at the same time small, con- tracted and irregular, and loss of appetite. These symptoms generally come on at some indefinite period, occasionally after the bitten part seems quite well. In the second or convulsive stage, the wound, which may have already become completely cicatrized or healed, begins to assume a somewhat inflamed ap- pearance, and a slight pain and heat, now and then attended with itching, are experienced in it. It now breaks out afresh, and an ulcer, with elevated margins of proud flesh, which se- cretes a dark-coloured and offensive discharge, is subsequently formed ; and wandering, drawing, and shooting pains from the lacerated part upwards towards the throat, present themselves. These symptoms, with the state of testiness and anxiety, in- crease daily ; and the patient complains of a state of confusion in the head, or giddiness, wdth sparks before the eyes ; is af- flicted with sudden startings, spasms, sighing, and is fond of solitude; the pulse is small, irregular, and intermittent; the breathing laborious and uneasy ; the skin cold and dry, and general chilliness, especially in the extremities, is complained of; then hiccough, colic and palpitation come on; the patient looks wild, and the eyes have a fixed, glassy, and shining ap- pearance ; the act of deglutition is impeded by a sense of pres- sure in the gullet, which occasionally renders every attempt to swallow liquids impracticable ; convulsions also take place in the muscles of the face or neck. In this stage, however, the deglutition of any solid substance is performed with tolera- ble ease. In ordinary cases the sufferer remains affected in the above manner for a few days, after which, the disease passes into the hydrophobic stage, in which it is utterly impos- sible for him to swallow the smallest drop of liquid ; and the moment that any fluid, especially water, is brought in contact with the lips, it occasions the individual to start back with dread and horror, although he may, at the same time, suffer 428 CASUALTIES. the most excessive thirst; even the sight of water, or the very noise produced by pouring it from one vessel into another, in fact, anything that tends to remind him of that fluid, produces indescribable anxiety, uneasiness, convulsions, and even fu- rious paroxysms of madness ; he dreads even to swallow his own saliva, and is constantly spitting; vomiting of bilious matter soon comes on, succeeded by intense fever, great thirst, dryness and roughness of the tongue, hoarseness and fits of delirium or madness, with disposition to bite and tear everything within reach, followed at intervals by convulsive spasms. These attacks commonly last for a quarter or half an hour, and at their expiration, the patient is restored to reason, but remains in a state of great despondency ; finally, the paroxysms come on more violently and frequently, and in some instances a fit of furious delirium closes the frightful scene; in others, nature sinks exhausted after a severe attack of convulsions. The disease may be communicated to the human subject, from the bites of cats and other animals not of the canine race, which have been previously inoculated with the virus. It may be remarked in this place, that the best and most experienced of our writers upon this subject consider the hu- man species as the least susceptible of contagion from the hy- drophobic virus ; scarcely one out of twenty, or even thirty, of those actually bitten by an animal in a state of rabies, suffer- ing from its effects. I consider it my duty, while making this statement, which I hope may prove a means of relieving the minds of many from painful apprehensions, to enforce at the same time, the necessity of taking those precautions which are about to be pointed out against the danger. It may also be added, before proceeding to the treatment of the malady, that the possibility of the poison being commu- nicated through the medium oi the epithelium is exceedingly questionable; but scarcely a doubt exists of the incapacity of the cuticle to absorb it. As .many have been made wretched from having allowed a dog who has afterwards shown symp- toms of rabies to lick their hands, it may be stated with con- fidence, that if no abrasion of surface exists, there is not the slightest danger. HYDROPHOBIA. 429 In the homceopathic treatment of this disease, and its pre- vention, the following are the principal remedies employed : Belladonna, Lachesis, Hyoscyamus, Stramonium, and Cantha- rides* * The use of dry or radiating heat in this disease, and in envenomed wounds by snakes, etc., is recommended by Dr. Hering of America, whose directions for the treatment of envenomed wounds in general, are as fol- lows : Envenomed wounds. The best remedies against the bites of venomous serpents, mad d>gs, repeated in from half an hour to an hour or so.* Aconitum is the appropriate remedy when the system is labouring under the joint influence of fright and passion ; and especially when there is headache, feverishness, heat, in the face and head, (congestion,) fear. Administration. &£, in the same manner as Opium. Pulsatilla, in cases of fright, fear, or timidity, particularly where accompanied with an effect upon the stomach and bow-els, as also heat of the body with coldness of the extre- mities ; or passion in people of generally mild temper; it is also suitable for highly nervous but not easily irritable tem- peraments. Administration, f §, repeated if required in from six to twenty-four hours. Belladonna |£, where there is present particular liability to be startled by trifles, or extreme general nervous excite- ment, after a fright, &c. Administration. Same as Aconitum. Ignatia where the cause is gnawing, inward grief. Acid. phosphoricum and Staphysagria are sometimes requisite after Ignatia. Administration. fi,^, every three or four days: watching the effect. Chamomilla, where suffering has arisen from vexation, or a disposition to irritability, or great anguish and mental de- pression are present. Administration. Same as Pulsatilla. yivx vomica, suffering arising from a sudden fit, or outbreak of passion or rage. Administration. —„-, repeated from six, twelve to twenty- four hours if necessary. Staphysagria W0. Anger and vexation, arising from just cause. Administration. Same as Nux vomica. Arsenicum is useful where passion is followed by great weakness and dangerous prostration of the vital powers. * Vide note, p. 21. 440 CASUALTIES. Administration. Same as Ignatia. Bryonia §£, is indicated where a fit of passion is followed by coldness and shivering over the whole body, great irasci- bility, want of appetite, nausea, vomiting, and bilious suf- ferings. Administration. In the same manner as Pulsatilla. Colocynth -§-. Where indignation accompanies the above described effects of a fit of anger. Against the injurious effects which occasionally result after excessive joy, such as headache, trembling, and tendency to fainting, Coffea *§- is the most useful remedy. But when the consequences are more serious, and violent headache, with congestion to the head, vomitings, diarrhoea, swooning, &c, result, Opium must be given. Hyoscyamus -§a is the most useful remedy against any in- jurious consequences arising from jealousy, or disappointed love. In the latter instance Ignatia, and Acid phosphoricum are also beneficial. Against the effects of mortification, or wrounded vanity or self-esteem : Colocynth, Ignatia, Staphysagria, Pulsatilla, Platina, or Belladonna, have proved useful, A~ or -^SL. Sambucus °§°. When oppression at the chest, with ster- torous breath, has ensued in consequence of a fear or fright, and not yielded to the influence of Opium. END OF PART II, PART III. TREATMENT OF INFANTS AND CHILDREN; and or THEIR PECULIAR AFFECTIONS. INTRODUCTORY REMARKS. The homoeopathic system of medicine possesses many ad- vantages in the treatment of the diseases of infancy and child- hood. In the first place, when any constitutional taint exists, by the selection of suitable remedies, it meets disease upon the very threshold of life, and destroys it in the germ ; it substitutes a rational mode of treatment for the nostrums of the nursery, since the application of the remedies requires, even in the most trifling cases, a certain degree of education, and a careful study of medicinal action. How many lives, sacrificed by the overweening self-confidence and prejudices of those intrusted with the life of man, at the most precarious period of his existence, might have been preserved, had this system been more extensively known and acted upon! As before remarked in the Introduction, to which the reader is referred, the receptivity of the infant organism to the influence of homceopathic remedies, has been established by experience. Here again our system possesses the faculty of modifying the energy of the remedial agents used, and to administer them of sufficient power to overcome disease, without incurring the risk of danger. The tasteless nature of the medicaments is another point of no small importance in affections of infants and children, and by means of which, nausea and annoyance are avoided. This has been touched upon in another part of this work. In such complaints as occur at all periods of life, and which have been treated in the Second Part of this work, we should be guided in the selection of the dose by the age of the patient; 19* 442 treatment of infants. with infants we may use the highest potencies, and rarely ever in acute diseases give more than a single globule ; children from four to eight years of age may take about one-fourth to one-third of the dose prescribed for an adult, and above that age one-half to two-thirds. A great deal, however, depends upon the constitution of the patient, whether delicate or ro- bust, and upon their susceptibility to medicinal influence, a point only to be determined by experience: in very acute diseases wre may sometimes be called upon to administer as low as the sixth potency, a single globule ; from the great re- ceptivity, however, of the system, above remarked, we should be particularly careful in repeating the medicines. TREATMENT AFTER BIRTH. As soon as the child is born, it should be wrapped in fine flannel, with a piece of soft linen rag inside, the flannel itself being too rough for its delicate skin ; the wrapper should be heated to a temperature of 98 degrees, as it is only gradually that the infant becomes inured to the temperature of the sur- rounding atmosphere. The skin should be gently washed with a little lukewarm water and bran, applied with a sponge, taking care not to continue the first washing too long, for fear of irritation ; soap must on no account be used ; the room should be kept rather dark, and perfectly quiet, and all strongly scented substances removed. After washing, the body ought to be dried immediately, to avoid the risk of taking cold ; the child should be bathed twice a day, to keep up the action of the skin, gradually lowering the temperature of the water, after weaning. The best time for bathing the infant is in the morning, when taken out of bed, and again on returning to it for the night; immersing the whole body, with the exception of the head, is preferable to any other mode of washing, as the practice of placing it in a tub, with part of the frame alternately laved with tepid water, and exposed to the action of the atmos- phere, is apt to bring on a chill. Nothing can be more evidently opposed to nature, and the dictates of common sense,—although like many of the absur- dities bearing thejmpress of custom,—than the practice of *Pr-HYX» V. 443 swathing and bandaging the tender bodies of infants, and load- ing them with a superfluity of clothing, which, by its weight and length, presses upon their lower extremities and is the frequent cause of deformity and weakness in after-life ; in this opinion we are fully borne out by the corroborative testimo- ny of the most eminent practitioners of the old school. ASPHYXIA. The first danger that the infant incurs on its entrance into life is Asphyxia. Diagnosis. Suspension of the functions of vitality, of res- piration, circulation, and motion. Causes. Natural debility ; difficult parturition ; injury "from the forceps ; pressure of the umbilical cord round the neck; tying the navel string too tightly ; accumulation of mucus in the throat; too sudden an alteration of temperature, the respiratory action of the lungs not having commenced. The usual mechanical means, under the direction of a compe- tent person, must, of course, be instantly had recourse to ; I shall, therefore, simply content myself with pointing out the homoeopathic remedies most useful in such cases. They are : Tartarus emeticus, Opium, Cinch., and Aconitum. Tartarus emeticus, Administration of. A grain of the first trituration in eight ounces of water, a few drops into the mouth of the child every quarter of an hour. Opium. If after half an hour no change for the better take place, and the face is livid and bluish. Administration. A few globules of the third, in a wine- glassful of water, a few drops into the mouth of the child every ten or fifteen minutes, until some effect is produced. Cinchona -§-. If the face be pale, also when the infant is reviving and respiration commencing—if the same indication presents itself. Administration. Same as. Opium, Aconitum. When the child is reviving and beginning to breathe, if the face has been previously flushed red or of a bluish tint. Administration. £ on the tongue, repeated if necessary, after a shorter or longer interval, according to the effects produced, 444 TREATMENT OF INFANTS. SWELLING OF THE HEAD. Immediately after birth, the head of the infant appears more or less swollen; this is in most cases but a trifling affec- tion, and generally goes off of itself. The administration of Ar- nica &2, or £,, will materially hasten its disappearance ; should, however, the swelling be at all excessive, bathe the part affected in a weak lotion consisting of three drops of the tinc- ture of Arnica to a wine-glassful of water. Occasionally a considerable swelling in the larger mould, (fontanel,) consisting of fluid, is observable; this is of greater import than the other, though seldom dangerous; if it does not disappear in a day or two, we may administer Rhus tox- icodendron 3°d in globule to the infant. Calcarea carbonica ,fl8 repeated in six days, in cases where the fontanel is long in closing. In some instances Silicea or Sulphur is also requi- site in addition, if not in preference to Calcarea. NAVEL RUPTURE IN INFANTS. In cases where there is an evident tendency to navel rup- ture, we may take the half of a nutmeg, cover it with very soft linen, like a button, and sew it to a bandage, with the base of the cone in the centre ; then press the apex into the umbilical opening, and secure it there by the bandage, which should be of sufficient length to pass two or three times round the body of the child. This mechanical process * will usually prove sufficient to effect a cure ; if not, we must exhibit Nux vomica 3S, dissolving it in six teaspoonfuls of water and administering one, which, if no alteration takes place, may be repeated in the same manner in five or six days, and if no effect declare itself, * The following is a simple and commonly efficacious mode of applying a compress:—Take a piece of lint, just sufficiently large, that when folded five or six times, it will cover the ruptnre effectually; then press in the protrusion, and keep it reduced with the hand until the compress is rightly adjusted and secured in its position by means of two strips of adhesive plaster (which have been previously warmed by being held at the fire, so as to make them adhere) placed over the compress in the form of a cross. (It is still better, however, to get an efficient bandage made to measure by an intelligent and experienced maker.) meconium. 445 again repeat, bearing in mind the directions upon the Repeti- tion of Medicines given in the Introduction; if, however, we discover no amelioration from the administration of Nux v., we may have recourse to Veratrum ■£$ in the same manner. Obstinate cases are frequently found to yield to the applica- tion of the North pole of the Magnet.* All these medicines are equally useful in those cases of inguinal hernia, or rupture in the groin, we occasionally meet with, generally effecting a cure with wonderful promptitude. (See Hernia, Part II., p. 361.) This disease being frequently brought on by the violent fits of crying that delicate children are subject to, the bandage may be worn, and retained for some time after the cure, as a precautionary measure against its return. In cases of sore- ness of the umbilicus or navel, remaining after the falling off of the ligature, or even before, we may give Sulphur f^, a single dose, and repeat In six days. If, however, during that time no amelioration has been observable, we should exhibit Silicea -£%, which, if marked benefit resulted, may be at the same interval repeated with advantage. MECONIUM, EXPULSION OF. After having been permitted to sleep for five or six hours undisturbed, the infant should be applied to the breast as soon as the mother feels herself sufficiently recovered to permit it, which is generally from six to eight hours after delivery, and should never be deferred, as we elsewhere observed, longer than twelve ; the milk of the mother exciting a mechanical action of the alimentary canal, and assisting in the expulsion of the meconium. Here again we cannot too strongly repro- bate the too general practice of administering' laxative medi- cines for this purpose, possessing, as they do, a most dele- terious effect upon the tender organism of the infant, and, if not productive of jaundice—a too frequent consequence of their repeated administration—at least laying the foundation of bowel complaint, debility of the stomach, and a host of diseases in after-life. * Chamomilla, Aurum and Sulphur, are occasionally found necessary, particularly tile last-named, in order to effect a permanent cure. 446 TREATMENT OF INFANTS. Mothers need not be under apprehension should a tempo- rary delay occur in the passing of the meconium ; far greater evil results from the violent methods taken for its expulsion, than could possibly occur from its continuance in the alimen- tary canal for a few hours later than ordinary. Should, however, an unusually long period elapse, and the child appear costive, which in many instances arises from the mother having indulged in the use of ptisans, such as chamo- mile tea, &c, or in coffee, the administration of a few teaspoon- fuls of warm sugar and water will generally answer every purpose ; if it fail of immediate relief, we may then make use of a lavement of equal parts of sweet oil (or pure honey) and water ; if these simple means do not effect the desired object, and the infant appear to suffer from inconvenience, more par- ticularly when the origin of the constipation seems to be from the mother or the nurse, we may administer Nux v., Bryonia, Tinctura sulph. .3-Q or Opium §• to the female herself—for the indication of which medicines, see Constipation. SUCKLING OF THE INFANT. While upon this subject, we shall quote the expressions of a well known writer, in whose opinion, in this respect, we perfectly coincide. " Unless very peculiar urgent reasons prohibit, a mother should support her infant upon the milk she herself secretes. It is the dictate of nature, of common sense, and of reason. Were it otherwise, it is not probable that so abundant a sup- ply of suitable food would be provided to meet the wants of an infant, when it enters upon a new course of existence. " It is difficult to estimate the mischief resulting from in- fants being deprived of their natural nourishment; for, how- ever near the resemblance may be between food artificially prepared and breast-milk, still reason and observation demon- strate the superiority of the latter to the former."—(Con- quest's Outlines of Midwifery, p. 193.) And again :— "As a further inducement, it should be remembered that medical men concur in their opinion, that very rarely does a r-rr-KLTVr,. 447 constitution suffer from secreting milk; whilst the health of many women is most materially improved by the performance of the duties of a nurse." (Ibid., p. 194.) Upon the same subject he says in another place: "But few mothers, comparatively, are to be found who, if willing, would not be able to support their infants, at least for a few months, and parental affection and occasional self- denial would be abundantly recompensed by blooming and vigorous children. " Presuming that the laudable determination is formed to in- dulge the child with that nutriment which is designed for its support, it becomes necessary to state, that unless very strong objections should exist, twelve hours should never elapse before the infant has been put to the breast. Instinct directs it what to do, and the advantages of allowing it to suck soon after birth are many and important, both to the mother and child. " By this commendable practice, the patient is generally preserved from fever, from inflamed and broken breasts, and from the distressing and alarming consequences resulting from those complaints. " If the breasts should not have secreted milk previous to de- livery, the act of sucking will encourage and expedite the se- cretion. Thus the mother will be saved from much of the pain connected with distended breasts. Besides which, if the infant be not put to the nipple till the breasts become full and tense, the nipple itself will sometimes almost disappear, on account of its being stretched; and without much, and often ineffectual labour on the part of the child, it cannot be laid hold of; and even then the pain endured by the mother is exquisitely severe, and not unfrequently the cause of sore nipples." (Ibid., p. 195). Having premised thus much upon the advantages resulting to both mother and child from following the law of nature, which enjoins the female to nourish her own offspring, and having, moreover, elsew here noted some of the causes which may prevent its being fully carried into effect, we shall now proceed to that important point—for those who do not intend nursing their own children—the choice of a nurse, and the regi- men to bo observed, which is equally applicable to both parties. 448 treatment of infants. THE CHOICE OF A NURSE. In the selection of a nurse, the medical attendant ought generally to be consulted; the following points merit parti- cular attention: She should be apparently of sound health,full and moderate plumpness, with a fresh complexion, and clear eyelids free from any appearance of redness, scurfiness, or thickening. She should be thoroughly exempt from glandular enlargements; possess deep red lips without cracks, sound white teeth; and well formed, moderately firm breasts, with nipples free from excoriation or appearance of eruptions ; the child of the nurse is one of the best criterions to judge by—its being plump and healthy is a great point in her favour. We should also en- deavour to discover if she is free from any hereditary taint; she should, moreover, be of a mild, patient and equable tem- per, not irritable, nor disposed to fits of passion, or nervous ; of regular and temperate habits, neat in person, and fond of children. She ought also to be about the same age, and de- livered about the same time, oiT, at least, within three months of the same period as the mother ; with respect to the age, we must, of course, avoid extremes. A woman, having given birth to a child very late in life, should choose a nurse seve- ral years her junior, and fully qualified for her duties; the re- verse of the rule applies to extremely young mothers. DIET DURING NURSING. As regards her diet, it should be simple and easily digested, and she ought to live upon a proper proportion of animal and vegetable food. Nature generally provides for the increased call upon her powers, by the suppression of the menstrual discharge, and moderate increase of appetite, which may be safely indulged ; but all food of a highly concentrated, nourish- ing nature, is injurious, causing the milk to become too rich, and unsuited to the delicate digestion of the infant; the best guide is the regular homceopathic regimen, which may be consulted with advantage. SUPPLEMENTARY DIET OF INFANTS. 449 I cannot too strongly repudiate the too prevalent, but deep- ly erroneous idea, that women, during the period of suckling, require stimulants to keep up their strength; under this impres- sion, both wine and malt liquors—and, among the latter, more particularly porter—are frequently resorted to. Porter is not only injurious from its stimulating properties, but thedeleteri- ous effect of the different ingredients which enter into its compo- sition has upon the milk, forms one of the most prolific causes of the many evils that attack infancy. My opinions in this re- spect are corroborated by the physicians of the old school, though, I regret to say, not to the same extent. I shall here content myself with a single quotation from a well known medical writer: " There is an evil too generally prevalent, and most perni- cious in its consequences on individuals and society, and by no means confined to mothers in the lowest classes of the community, which cannot be too severely reprobated : it is the wretched habit of taking wine or spirits to remove the languor present during pregnancy and suckling. It is a practice fraught with double mischief, being detrimental both to mother and child. The relief afforded is temporary, and is invariably fol- lowed by a greater degree of languor, which demands a more powerful stimulus, which at length weakens, and eventually destroys the tone of the stomach, deteriorates the milk, and renders it altogether unfit to supply that nutriment which is essential to the existence and welfare of the child." SUPPLEMENTARY DIET OF INFANTS. Unfortunately,, some mothers do not possess sufficient milk for the proper nourishment of their offspring; if this arise merely from a deficiency in the secretion, and the female is in other respects healthy, we must have recourse to supplemen- tary diet, to make up for the diminished quantity of the natural nutriment. Goats', asses', and cows' milk, are excellent substi- tutes, especially the latter, diluted with one third of water ; goats' milk being apparently objectionable from its peculiar aroma. The milk, therefore, of the cow ought, when possible, to be obtained, and, if given undiluted, boiled ; cows' milk be- 450 TREATMENT OF INFANTS. ing generally considered too heavy, which boiling in a great measure obviates; it ought also to be slightly sweetened, so as to resemble as closely as possible that of the nurse ; it should, moreover, be about the same temperature; say nine- ty-six to ninety-eight degrees, a point less regarded than it should be, and easily determinable by the thermometer. If any constitutional taint exist in the mother, the sooner the child is transferred to another breast, the better for both par- ties ; if a nurse be not procurable, the above will generally prove sufficient nourishment until the front teeth appear, which is a clear indication that the digestive organs are pre- pared for more solid food ; if, however, the milk diet appears to disagree with the infant, we may mix a little thin arrow- root, rusk, or well-toasted bread in water, to which the milk may be afterwards added ; such alterations in diet are, how- ever, but rarely required. We may remark, that no portion of the milk ought to be re- tained for a subsequent meal, from the quickness with which it becomes sour; the same remark applies to any of the above preparations in which milk forms the principal ingredient. In the cows' milk, wrhich w^as at first diluted, wo may, after two or three weeks, gradually diminish the quantity of water, as the digestive organs become stronger; but we cannot too stringently press the point, that where it is at all practicable, the child ought to derive as great as possible a portion of its nutriment from the breast, as no food can sufficiently supply the place of that which nature intended for it at its birth. When it is necessary to give supplementary nourishment, a suckling-bottle ought to be used, as the best imitation of na- ture in giving the food slowly; particular care being taken to observe the utmost cleanliness. The child ought, in feeding, to be kept in a reclining, not supine, position, as the latter fre- quently causes it to incur the risk of suffocation; and when it evinces disinclination to its food, no more should be offered. When the front teeth appear, which is about the fifth or sixth month in healthy children, an alteration may take place in the diet; and a well made panada, diluted milk sweetened, and thickened with a small quantity of arrow-root, sago, semolino, or rusk, may be given twice a day. When milk, even prepared DURATION OF SUCKLING AND WEANING. 451 with farinaceous substances, disagrees, barley-water, fine well- boiled gruel, or weak chicken-broth, and beef tea, may be sub- stituted, adhering to that which seems best to agree with the infant, and taking care to vary as circumstances require it, as too long an adherence to barley-water may occasion looseness in the bowels, while the animal diet is liable to lead, if too long continued, to a contrary result; the best precaution in these cases, when the predisposition becomes evident, is an immedi- ate change of aliment. The child should be accustomed to take its nourishment from each breast alternately; as, if this precaution be not adopted, inflammation is likely to arise in the one not used, and the child is apt to become crooked from being always re- tained in the same position. The physician is frequently asked, how often the child ought to be applied to the breast 1 The best rule is to give it when the infant appears to desire it, and to withdraw it when it appears satisfied. As it increases in strength, it may easily be accustomed to regular hours, giving it the breast late at night, and again early in the morning ; but during the first six weeks or two months, three times during the hours of rest, late in the evening, middle of the night, and early in the morn- ing, will generally be found sufficient. DURATION OF SUCKLING AND WEANING. The period of suckling ought seldom to last longer than forty weeks ; but in this we must be guided, in a great measure, by the constitution of the infant; weak, illconditioned children, in whom the teeth are long in making their appearance, it has been recommended to continue at the breast for eighteen months, or even a longer period. Weaning ought, in fact, to be regulated both by the constitution of mother and child ; the full development of the front teeth, which in healthy children is from nine to ten months, but in delicate or scrofulous constitu- tions, is delayed for several months later, is the best indication for weaning. If, however, the strength of the mother appear unequal to the task, and the supply of milk begin to fall off, the child may be gradually weaned, even before the teeth appear; 452 TREATMENT OF INFANTS. but if the infant is healthy, a continuance of suckling beyond the tenth month is injurious to both parent and child. Wean- ing should not take place suddenly, but the infant should be gradually accustomed to other food, and a less frequent ad- ministration of the breast, till entirely weaned ; the time to commence this gradual course, is from the first appearance of the front teeth, so that the weaning terminate with their full development; thereby the secretion lessens by degrees, pre- venting all evil consequences of swollen or inflamed breasts, and the child also becomes quietly reconciled to the depriva- tion. Weaning ought not, however, to take place, if the child suffers considerably from the irritation of teething, or any acute infantile disease. When, however, it is found ab- solutely necessary to wean, Belladonna ^% should be given as a precautionary measure against the inconveniences and not unfrequent dangers which sudden weaning entails. Among these may be mentioned : restlessness, sleeplessness, fretful- ness, and excitability, nay, even a degree of irritability some- times amounting to inflammation of the brain. The value of this remedy in affections of that organ has already been com- mented upon in several parts of this work. Although, per- haps, slightly out of place, it may be remarked that Phospho- rus is the remedy best calculated to prevent inflammation of the breasts consequent upon a sudden cessation of suckling.* See the articles relative to thissubject inPart IV., Treatment of Females and their peculiar Affections, p. 496. After the child has been weaned, his nourishment should generally consist of the same simple food before mentioned, with an occasional light pudding, without spice or eggs, made from semolino, tapioca, or other farinaceous substance. The transition to a more substantial diet ought to be extremely gradual and guarded, and no material alteration made, till after the appearance of the eye-teeth. SLEEP. SLEEPLESSNESS. The sleep of the child is the next consideration ; from the inability of the infant itself to maintain a proper degree of * Vide A. H. Z, p. 8., No 23. SLEEP. 453 warmth, it should sleep by its mother's or nurse's side, for at least the first six weeks, particularly during winter or early spring. Care must be taken not to over-burthen it with bed- clothes, and to place it in such a position as to prevent it slipping under them, and thereby becoming exposed to the risk of breathing a vitiated atmosphere, or even of suffocation; after six or eight weeks, when the organism becomes stronger, and able to preserve a proper degree of natural warmth, placing it in a separate bed or cradle, will be more condu- cive to its thriving ; this change of arrangement will be found beneficial to both parties—to the child, by its breathing a purer air, and by the continual appetite for the breast being diminished ; and the mother being freed from the necessary watchfulness and restlessness consequent upon its sleeping with her, will enjoy better health, and be more likely to secrete good and nutritious milk. Moreover, it is generally known, that sleeping in the same bed with an adult, is detrimental to the health and proper development, not only of infants, but even of children : a child sleeping in the same bed with a very old per- son will very soon begin to exhibit signs of a falling off'in its ge- neral appearance. With regard to the kind of bed best suited for the infant, the suspended cradle seems the most eligible ; we must, how- ever, be careful not to allow the nurse to abuse its use by con- tinual rocking, which frequently causes irritation of the brain ; it should not be closed up with curtains, but the room may be a little darkened ; in cases wThere there is danger of draughts, a screen will answer every purpose. As to the length of sleep allowed, the chief business of the first months of its existence being sleep and nourishment, we may safely leave the point to nature, and not attempt to co- erce the inclinations of the child; if the infant is lively on wak- ing, we may conclude it has not slept too much ; as it increas- es in vigour, with longer intervals of wakefulness, we may pro- ceed (recollecting that night is the proper period for sleep) so to regulate its habits of taking its food and rest, as to accustom it to a uniform system, and particular hours. Children, up to two years of age, require rest during the day, and the nurse ought 454 TREATMENT OF INFA.VI>. to endeavour to get them into the habit of taking it in the forenoon, for if in the afternoon, it generally interferes with the night's sleep. Whether by night or day, we must carefully exclude both light and noise from the nursery, for although they may be insufficient to arouse the infant, still they cause its sleep to be disturbed and unrefreshing, and by acting upon the nervous sensibility, predispose it to convulsions or spas- modic attacks from slight accidental causes. It is true, that during the first month, the infant sleeps im- mediately on leaving the breast, and no evil consequences en- sue ; but it must be borne in mind, that it takes but little at a time, and the tenuity of the milk is at that time wisely adapt- ed to its delicate digestion; but as the secretion becomes richer, and suited to the increasing power of those organs, it is in- jurious to put the child asleep immediately after a full meal; his rest is then restless and disturbed, from the process of digestion being interfered with, more particularly when nur- ses foolishly endeavour to force nature, by resorting to the baneful practice of rocking. Nothing causes greater annoyance, and even anxiety, to the mother, than a disposition to wakefulness on the part of her infant. A healthy child should always be prepared for its rest at the usual hours ; if, instead thereof, it appears restless, fretful, and disinclined for its accustomed sleep, it is an evident indication of some derangement of its general health ; frequently through ignorance, nurses, instead of attending to this warning^'oice of nature, which by the sleeplessness of the infant demands appropriate relief, endeavour to stifle it, and sometimes to free themselves from a little temporary annoy- ance, administer opiates, which induce an unrefreshing slumber and not unfrequently a deep stupor, mistaken for sleep, while the original evil still continues to make head against the vital power. Thisbaneful practice has not only been the ruin of many constitutions in after-life, but to it, conjoined with diet, drinks, carminatives, and other quack medicines, together with the highly erroneous practice—sanctioned though it be by names of medical repute—of a frequent administration of that active mi- neral preparation, calomel, in infant maladies, to say nothing of fcXERODsE. 455 laxatives, an infinite number of diseases and deaths are yearlv attributable. Every mother should not only caution her nurse against the use of opiates, but use her utmost vigilance to de- tect any breach of her injunctions, which should be visited with the immediate discharge of the person offending; for she must be truly unfitted for such an important trust who, after being warned of its injurious tendency, will persevere in a prac- tice placing in jeopardy the life of her infant charge. Amongst the homoeopathic remedies which have been found the more generally useful in removing i-estlessness and sleep. lessness in children, Coffea, Opium, Chamomilla, and Bella- donna, deserve notice. Coffea ^\, is very efficacious when the child seems unusually lively, restless, and wakeful; but will commonly fail to answrer its purpose when the nurse is in the daily habit of taking coffee as a beverage. In such cir- cumstances, Opium | may be substituted, particularly if the face of the child looks red. Chamomilla r\ will do good when the child is tormented with flatulence, and distention of the bowels, and appears to suffer from colic, indicated by drawing up the legs, screaming, etc. Against the sleepless- ness after weaning, Belladonna § is the most efficacious remedy. When these remedies do not seem indicated, or fail to relieve, an experienced homoeopathist ought to be con- sulted. (See also Crying and Wakefulness, p. 462.) EXERCISE. Fur the first six or seven months the great business of na- ture seems to be the proper development of the infant organ- ism, and of the respiratory and digestive functions. During this period the cartilage is gradually forming into bone, and its delicate mdtcles acquiring power and strength. We find also that consciousness is yet indistinct, and the infant evinces no anxiety to indulge in voluntary motion, the muscles of the neck and back not possessing sufficient power to support the head, or to keep the body in an erect position; for this reason, children during this period should, when carried in the arms, be kept in a reclining position, so as to avoid an un- 456 TREATMENT OF INFANTS. due pressure upon the vertebral column ; a neglect of this precaution, and a premature carrying of the infant in an up- right position, are a too frequent cause of deformities of the spine, and derangement of the internal functions in after life. As its powers gradually develop, the infant seems inclined to exercise them, and evinces a desire to sit upright, which we may safely indulge, taking care that they be not overtasked by keeping it sitting up during the greater part of the time it is awake. A careful attention to nature in this, as in all other cases, is the best guide. The practice of dandling the child in an upright position, seems rather to proceed from the pleasure of indulging the feeling of parental affection, than from any benefit the child can, by any possibility, be expected to derive from it; in fact, it is highly injurious, even at a rather more advanced period, as exciting a premature involuntary exercise of the muscles, and consequent deformity. The act of respiration bringing into play a great variety of muscles, occasionally crying seems sufficient active exercise during this period. In milds pring and summer weather the child may, after the first fortnight has elapsed, be carried out into the air for a quarter of an hour, and the period of exercise gradually in- creased ; in fact, if the weather be fine, it can scarcely be too much in the open air. Should its birth occur in winter, ad- vantage may be taken of a fine day, after it is a month or five weeks old, as the frame is gradually acquiring the power of generating heat; but at the same time great care must be ta- ken to prevent its catching cold ; and should it exhibit the slightest sign of being affected by the atmosphere, the practice should be immediately discontinued, and it should be carried up and down in a well ventilated room, the nurse moving it quietly in her arms from side to side. Many children are lost through a foolish idea of making them hardy, by accustoming them to endure cold ; this can occur only through ignorance, for nature, in early infancy, does not possess sufficient energy of reaction to overcome the power of a sudden or long-protract- ed chill. We recommend an occasional gentle friction of the hand over the body and limbs, which materially assists in the EXERCISE. 457 promotion of the circulation of the blood, and will, in un- favourable weather, serve in some measure as a substitute for exercising the infant out of doors. In carrying the child, it should be from time to time trans- ferred to different arms, as a continuance on one side is a fre- quent cause of deformity, and in some cases of squinting. The child, as the organization develops itself, seems to evince a desire for independent movements, in which it may very pro- perly be indulged, by removing every impediment in its dress, and allowing it to roll about, or crawl upon a soft carpet. The practice of assisting children to walk, or of exciting them to a premature exercise of their powers, is highly reprehensi- ble, causing curvature of the limbs, the bones not being yet sufficiently formed to bear the burden imposed upon them. By allowing nature to act, the infant's powers will become more gradually, but at the same time, more fully developed, its carriage will be more firm and erect, and its limbs straight and well-formed ; moreover, it will walk with greater confi- dence and independence by the expiration of the first year, than those who have been taught to walk by the assistance of the nurse, leading strings, or mechanical inventions. When the period at which a child should make attempts to walk is retarded by evident debility of constitution, Homoeopathy affords us the means of obviating this evil, by acting against the constitutional cause. Dr. Gross has found Calcarea 3*0, very useful in a case of this nature; and Dr. Hartmann has frequently administered Causticum £-0, with great effect. (Silicea, Sulphur, Belladonna, Mercurius, or Staphysagria, etc., may be required in particular cases.) 20 458 DISEASES OF INFANCY. f ___ INFLAMMATION OF THE EYES IN NEW-BORN INFANTS. A sudden exposure to the strong light of day, or the glare of a fire, is the general cause of this affection ; and no doubt many children who are, what is vulgarly denominated born blind, owe their misfortune to the neglect of those precautions which we have so strongly enforced under the head of Treat- ment of Infants, in many cases the external indications of this affection being so very slight as to escape observation. As soon, however, as, on a careful examination, we become aware of the existence of this evil, we should administer Aco- nite 2-4, which will generally be found promptly efficacious in its removal, When, from the constitution of one or both of the parents, we have reason to suppose that the exposure to light has been merely the exciting cause, but that the real origin of the evil is more deeply seated ; or if the Aconite seems to produce no effect, and the disease continues to aggravate, we may have recourse to Tinctura sulphuris 3% and in some cases Cal- carea 3-0, alternating them every eight or ten days, if we find it necessary to resort to the Calcarea—the Tincture of Sul- phur having been found in many cases to act as a specific. Chamomilla jj, is useful some weeks after birth, when the perceptive faculties are more developed, and the child exhib- its great intolerance of light; also when redness, swelling, and agglutinations of the eyelids, with other indications, given un- der Acute Inflammation of the Eye (Part II., p. 324), are present. Lycopodium may also be named as a useful reme- dy in some inveterate cases. HICCOUGH. This affection, though in itself of slight importance, frequent- ly causes no small degree of uneasiness to young mothers; it HICCOUGH.--COLD. 459 generally arises from exposure of the body, even in a warm room, to the atmospheric air, even during the operations of dressing and undressing the new-born child; wrapping it warmly in the bed, or, better still, applying it to the breast, will frequently lead to its cessation ; should it, however, con- tinue, the administration of a small quantity of white sugar as much as will cover the end of a teaspoon, dissolved in a teaspoonful of water, will effectually abate the evil. COLD IN THE HEAD. CORYZA. This affection frequently becomes exceedingly distressing to the infant, when it appears in the form of an obstruction of the nose, impeding the action of the suckling, by not allowing the breath to pass through the nostril, obliging the infant to release the nipple frequently in order to breathe, causing it to become fretful and irritable, sometimes leading to irrita- tion and excoriation of the nipple, and thus in its repeated efforts to suck causing suffering to both itself and the nurse. Whilst this state continues, it operates considerably against the infant's thriving, both by hindering it from taking a suffi- cient quantity of nutriment, and by the impediment it causes to respiration, preventing the child sleeping at night. When the nose is dry, and the secretion of mucus suspended, we may, while administering a remedy calculated permanently to remove the evil, afford relief, by imitating the natural se- cretion by the application of a little almond oil or cream to the interior of the nostrils with a feather. This malady is often excessively obstinate, and presents itself under many different phases, which of course demand remedies suited to the entire group of the symptoms. Among these, Nux vomica ^, has been most frequently successful, particularly when the following symptoms are present:— Obstruction of the nose, with dryness or nocturnal obstruc- tion, slight discharge during the day; irritability and peevish- ness. Sambucus niger, $, is frequently efficacious when Nux v. fails to relieve ; but is also of service in cases when there is an 460 DISEASES OF INFANCY. accumulation of thick and viscid mucus in the nostrils; or when, in addition to the cold in the head, there is a suffocat- ing cough, with wheezing, in the chest, and quick laborious breathing, Tartarus should be had recourse to if Sambucus does not soon relieve the latter symptoms; and if no ameli- oration quickly appear, we may without hesitation have re- course to a globule of the first dilution, and repeat the dose every four to six hours, or oftener, if apparently called for,* until improvement is effected, or another remedy required. Chamomilla, t%, is very useful when there is cold in the head, with a watery discharge from the nose, more particularly when there are febrile symptoms, soreness of the nostrils, and redness of one cheek. Carbo v. is chiefly useful in obstinate cases, and particu- larly when the cold in the head becomes aggravated towards evening. Calcarea, when the nose is stuffed with mucus, and the affection occurs in stout, lymphatic children. Pulsa- tilla, thick discharge from the nose, attended with frequent sneezing. Administration. The doses already given repeated in from one to two days. (See also Coryza, Part II., p. 193.) CRYING AND WAKEFULNESS OF NEW-BORN CHILDREN. As we have already remarked, the occasional crying of new-born children is a wise provision to bring the respiratory organs into play, and to expand the chest. When, however, the crying becomes excessive, and threatens to prove injuri- ous, we must, in the first place, endeavour to discover its origin, which frequently will be found to be some mechanical cause, such as derangement in the infant's dress, or a pin sticking into its flesh, etc. Therapeutics. When, however, no exciting cause or guiding symptoms of disease presents itself, and the infant is peevish and irritable, with incessant whimpering and wakeful- Vide Inteoductory Remarks. Crying and wakefulness. 461 ness, or prolonged fits of crying, Belladonna, ^ * will fre- quently be found sufficient to remove the evil. When a fit of crying comes from the child having been ir- ritated or excited by any cause, such as suddenly rousing it from its rest, and when it seems willing to sleep, but finds a difficulty in composing itself to slumber, Coffea cruda, g-, will prove efficacious. (A conitum, ^\, may follow Coffea when there is considerable heat of skin, and extreme restlessness.) Chamomilla, ~, is often more efficacious than Belladonna when the infant is of a very spare and delicate habit; or when we can trace the fits of screaming and wakefulness to a de- rangement of the digestive functions, and the child appears to suffer from griping pains, indicated by contortions of the body, drawing up of the little limbs upon the abdomen ; and when a whitish, yellowish, or greenish, or watery excoriating diar- rhoea is present. Jalapa, |, in similar cases, but without diarrhoea, or with motions tinged with blood. In other cases, when the screaming and vigilance are at- tended with colic and flatulence, Senna, £, will answer best. Rheum, £ is more appropriate when in addition to scream- . ing and wakefulness, combined with griping, there are also ineffectual efforts to relieve the bowels by frequent straining, or when, at the utmost, only scanty, sour-smelling motions are passed, of grayish appearance, and seem to afford no relief. When flatulent colic, accompanied by constipation, appears to be the source of the disturbance, Nux v. -g%, will common- ly succeed in restoring ease to the little sufferer. Pulsatilla, 3-0, is very efficacious when it arises from overloading the stomach, or improper food, and the crying or wakefulness is accompanied with flatulence and diarrhoea, or with constipation. Remarks. The milk of a nurse who has suckled for some months previously is much too heavy for a new-born infant; * See the Introductory Remarks to this Part of the work, as also those in the Introduction, (Part I.,) for directions as to the repetition of the dose, etc. 462 DISEASES OF INFANCY. here, the only alternative is a change of nutriment. When, however, the above-named or any other infantile derangement arises from congenital weakness of the stomach, the most use- ful remedies in addition to Nux v. and Puis, are Sulphur, Calcarea carbonica, and Baryta c, |. REGURGITATION OF MILK. ACIDITY, FLATU- LENCE, ETC. Children, in sucking, sometimes overload their stomachs, a"nd regurgitate a portion of their milk ; so far, mothers have no cause for uneasiness, nor is medical assistance requisite; but when this changes into vomiting, and the whole of the nu- triment is returned from the stomach, or when sickness and regurgitation of food occur in children who have been weaned, at times followed by mucus and watery fluid, and even bile, it must be looked upon as a disease, and treated accordingly. Therapeutics. Ipecacuanha, £, will generally afford re- lief, and may be repeated, if not followed by some amend- ment, giving the medicine from twelve to twenty-four hours to allow time for its action.* In the case of spoon-fed infants, or in children at a more advanced age, this remedy is equally efficacious, when the derangement is evidently owing to their having been over-fed, (a most culpable error, which most nurses are prone to fall into by cramming the stomach of their little charges, and but too often with food of an indigestible nature, whenever they are seized with a fit of crying.) Should the vomiting or flatulence, and also the diarrhoea when present, not decrease after some doses of Ipecacuanha, Pulsatilla T0^ may be exhibited in a similar manner, and succeeded in turn by Antimonium Crudum, ^ or ^8, if the symptoms continue, though in a mitigated form. Nux vomica, 3°„, in the same manner as the above, and that failing, Bryonia, 3£0, in case the disease is attended with flatulence, constipation, uneasiness, or irritability of temper. Gentle friction with the extended hand, which has pre- • viously been warmed, is a simple and frequently efficacious * Vide note, p. 21. SPASMODIC ASTHMA. SPASMS IN THE CHEST. 463 mode of affording temporary relief in cases of flatulent disten- tion of the stomach and bowels. But permanent relief is only to be attained from Pulsat., Nux v., Chamomilla ; or Carbo v. and Sulphur, when the former are insufficient. The diet must at the same time be attended to, and altered if of an indiges- tible nature and the undoubted cause of the mischief. When there is diarrhoea and excessive flatulency, China is very useful. Chamomilla. Same dose as described for Ipecacuanha, when attended with convulsions, or diarrhea, as described elsewhere under this medicine. (See those articles). A single dose of Sulphur, 3-0, followed by Calcarea carb. ■g\, in from five to ten days, and then again one or more of the preceding remedies, according to indications, will often be the means of effecting a cure in inveterate cases. SPASMODIC ASTHMA. SPASMS IN THE CHEST. Children are sometimes seized during the night with sud- den attacks of suffocating spasm in the chest. The little pa- tient suddenly awakes from sleep, and utters a shrill cry, in consequence of the feeling of suffocation which is expe- rienced. The countenance soon assumes a livid hue, and is expressive of extreme anxiety. A dull, hollow-sounding, dry cough, usually accompanies the attack, and the breathing is rapid, very laborious, and painfully distressing to wit- ness. In such cases a globule or two of Ipecacuanha (po- tency 3 or 6) ought immediately to be dissolved in about a wine-glassful of water, and a few drops of the liquid put into the mouth of the patient. If relief follows, the medi- cine must be allowed to act, and only repeated when the symptoms threaten to become worse again. But in the event of no favourable signs resulting in from a quarter of an hour to half an hour or so, according to the severity of the symptoms, Sambucus may be given in the same manner. In other cases, Arsenicum § will be found more efficacious than either of these; or the employment of Ipecacuanha and Arsenicum alternately every ten or twenty minutes, until im- provement takes place. Whenever a sudden aggravation 464 DISEASES OF INFANCY. ensues after the administration of any of these remedies, nothing further should be done', as on waiting patiently for a. few minutes, if the change arise from the effects of the medi- cine, the symptoms will subside, and gradually give way to unequivocal signs of improvement. (See Asthma of Millar, p. 486.) Some children are liable to be seized with obstructed re- spiration or asthma, although otherwise in good health, when- ever they are exposed to sudden changes of temperature, or to a cold and high wind. This form of asthma is always attended with considerable, hard, distention of the pit of the stomach and region of the lower ribs ; the child affected is at the same time thrown into a state of great anxiety and uncontrollable restlessness, attended with crying or screaming, tossing about, etc. Against this indisposition Chamomilla # has repeatedly proved to be an effectual reme- dy. A dose ought, therefore to be given as soon as the attack declares itself. MILK-CRUST. MILK-SCAB. Crusta lactea. Porrigo larvalis. Tinea faciei. This affection, as ty' occurs in infants at the breast, usually consists of an eruption of numerous small whitish pustules, which appear in clusters upon a red ground. These generally show themselves in the first instance on the face, particularly the cheeks and forehead, but sometimes spread over the whole body. The lymph contained in them soon becomes yellow, dark, or even sanguineous, and, on their bursting, forms into thin yellowish crusts. Frequently there is considerable surrounding redness and swelling, writh distressing itching, which renders the little pa- tient excessively restless and fretful, and causes it to keep con- tinually rubbing the affected parts, by which the discharge and crusts are repeatedly renewed, often increased in thick- ness, and often to such extent, that the whole face becomes covered ; the eyes and nose alone remaining free. The eyes MILK-CRUST. MILK-SCAB. 465 and eyelids, as also the parotid and mesenteric glands, occa- sionally become inflamed, and sometimes marasmus super- venes. Therapeutics. The following medicines have been found serviceable in this affection : Aconitum, Rhus toxicodendron, Viola tricolor, Sulphur, Belladonna, Hepar sulphuris, Euphra- sia, Staphysagria, Arsenicum, etc. Aconite ^°r, should commence our treatment, when we find excessive restlessness and excitability produced by this affec- tion, and when the skin around the parts is red, inflamed, and itching. As soon as we have found beneficial effects result from the administration of the above remedy, we may follow it up with Viola tricolor, which is often sufficient to effect a cure in the simple uncomplicated form of the disease. Administration. -^-, in four teaspoonfuls of water, one night and morning. The prescription to be repeated in four days, or another remedy selected, if the affection threatens to extend, or otherwise become worse. Rhus toxicodendron may sometimes succeed or super- sede Viola tricolor, when the scalp is considerably affected and thickly studded with incrustations. Administration. -j%, repeated in two to three days, if the same appearances remain. If, after the employment of Rhus, the affection is found to have made but little favourable progress, as not unfrequently happens in debilitated or in strumous subjects, Sulphur 7°7, may be given and repeated in four days. The alternate use of Rhus and Sulphur every four or five days, has been found very efficacious in cases of the aforesaid description, and when the eyes are a good deal affected. Administration. ^, dry upon the tongue. Sarsaparilla and Mezereum have also been strongly recom- mended in Crusta lactea; also Arsenic, 307. The former in the earlier stage of the malady, when small, burning, itching pus- tules appear on the face. Mezereum, when from the bursting and discharge of the contents of the pustules, incrustations have formed from which an acrid exudation flows, and gives 20* 466 DISEASES OF INFANCY. rise to a fresh eruption of vesicles wherever it comes in contact. Graphites, as also Sepia, Hepar, Baryta c, Lycopodium, etc. have been recommended as likely to prove of service in com- plicated cases. But the remedies above mentioned will rare- ly fail to cure the affection as ordinarily met with, if had re- course to in due time. (See also Scald Head.) THRUSH, or APTILE. This disease commences by the formation of small isolated, round, white vesicles, which, if not checked, become conflu- ent, and sometimes present an ulcerated appearance, filling the whole of the cavity of the mouth, and in severe cases ex- tending to the throat. This affection, although of itself neither malignant nor dangerous, frequently causes not only con- siderable suffering to the child by preventing it from sucking, but great pain and inconvenience to the mother by its being communicated to the nipples, and causing excoriation, etc. The complaint is most generally produced by the want of a proper attention to cleanliness, both as regards the constant personal laving of the infant, but especially from the suck- ling glass, when employed, not having been carefully washed after use. Improper aliment is another of the principal causes; thus we find that children who are what is commonly called reared by the hand, either partially or wholly, are more liable to this affection than those whose sole nourishment has been from the breast. One of the remedies in this affection, although perfectly ho- moeopathic in its action, has long been in use, in its external application, by practitioners ofthe old school, namely, Borax ; and a weak solution applied to the mouth with a brush has not unfrequently been found efficacious. Or we may pre- scribe this remedy, to be taken internally, as follows: We may dissolve a few globules of the third or sixth po- tency in an ounce of water, and administer one teaspoonful morning and evening for two days, then allow an interval of three days to elapse ; if at that period no amelioration has taken place, we must have recourse to Sulphur £s, given dry. CONSTIPATION. 467 In cases where there is much salivation, and the thrush indicates an inclination to ulceration, we may administer Mercurius solubilis t°2, twice in forty-eight hours, followed, m a few days, by Sulphur, and then Acidum sulphuricum 3°^, after a similar interval if necessary. In very bad cases, when the apthae assume a livid, blue, or violet appearance, attended with excessive weakness and diarrhoea, Arsenicum 3fi0, is high- ly useful. Great cleanliness ought to be observed in all cases. When the disease frequently, notwithstanding every precau- tion, reappears in infants at the breast, we may safely infer that it arises from some virus in the constitution of the moth- er, or nurse, who ought to be changed, or immediately put through a proper course of treatment, under the direction of an experienced homoeopathic practitioner. CONSTIPATION. Obslructio Alvi Neonatorum. This generally appears in children who are either wholly or partially reared by the hand, and also in those whose mothers or nurses are similarly disposed, which if it arises from a pecu- liar diet or want of exercise, such as too much animal food, &c, on the part of the last mentioned, may be removed by a proper attention to these points ; but in many instances it is necessary for them also to have recourse to proper remedial agents at the same time with the infant. Therapeutics. Nux vomica, Bryonianlba,and Opium, are the principal remedies ; and in more obstinate cases, Sulphur, Veratrum album, Lycopodium and Alumina. ' Most of the medicaments have been already mentioned un- der Constipation (Part II., p. 123), which see. Administration. a-ff of the three first-mentioned remedies, every three to four days, until relief is obtained, or another remedy called for; * and of the last, the same dose at inter- vals of a week. An enema of tepid water may be occasionally had recourse to, if required, until the medicine has remedied the irre- gularity. * Vide note, page 21. 468 DISEASES of infancy. BOWEL COMPLAINTS OF INFANTS. Diarrhea Neonatorum. Diarrhsea, like constipation, is to be regarded merely as a symptom, not as a disease ; the real disease here consists in irritation or inflammation of the mucous membrane of the in- testines, arising from the effects of aperients, indigestible food, cold, fright, &c. I have already mentioned, (article Meconium,) that much mischief is too often occasioned by the deleterious practice of administering laxative medicines, and even drastic purgatives! to the tender new-born infant, for the purpose of hurriedly ex- pelling the blackish green-looking matter, technically known by the name of Meconium, that collects in the large intestine of the foetus during the last month or two of its uterine exist- ence. This unwarrantable and extremely reprehensible con- duct is frequently persevered in even for some time after the expulsion of the first discharge has taken place, and is in many cases the undoubted cause of bowel complaints and other suf- ferings in infants. I cannot, therefore, refrain from again ex- pressing a warm disapprobation on the subject, and am con- vinced that in so doing, I but give utterance to the conjoint opinion of every experienced and enlightened practitioner, even of the allopathic school. The introduction of unappropriate, indigestible food such as thick gruel, &c, into the delicate stomach of a new-born infant, is another very frequent source of intestinal derangement; this unpardonable error is not unfrequently committed by ig- norant nurses, in order, as they say, to keep it from starving during the few hours of necessary repose to which the mother is left after delivery. This disturbance is, moreover, likely to be excited in those cases in which, either from a deficiency in the secretion of milk or other causes, it becomes incumbent to administer supple- mentary diet to make up for the diminished supply ; and again at the period of weaning, when serious disturbances are occa- sionally produced in the stomach and bowels, from, want of proper attention and caution in the selection and administra- BOWEL complaints. 469 tion of the food. (See art. Supplementary diet of infants, p. 451.) ' Fright and exposure to cold are, as already noted, two other most frequent exciting causes of the disorder. Therapeutics.- A healthy infant on the breast soils on an average, from four to six napkins in the twenty-four hours, but in some instances the evacuations are more frequent, yet, without in any degree affecting the health of the child, (as is likewise often the case when a constipated state of the bowels exists ;) in such cases then little or no interference ought to be made so long as the stools remain free from fetor, pos- sessing merely the slightly acid smell peculiar to the infantile state, and are evidently unattended with pain, or any other abnormal indication. When, however, the stools become green and watery, or yellow and watery, brown and frothy, or white and frothy, as if fermented, mixed with mucus, or consist entirely of mucus, and emit an offensive odour, and are generally preceded or accompanied by signs of suffering, it becomes imperative to have recourse to remedial aid. As already observed, the minuteness of the doses, and the ab- sence of all nauseous taste in the homoeopathic medicines, not to mention their other more important virtues, render them peculiarly wrell adapted to the treatment of children, and there- by spares many an affectionate and anxious parent the pain and difficulty which is so frequently encountered in inducing the little sufferer to swallow the nauseous allopathic drugs. The following are the principal remedies employed in homceopathic practice against this derangement: Aconitum, Belladonna, Chamomilla, Rheum, Pulsatilla, Ipecacuanha, and also Mercurius, Nux vomica, Arsenicum alb., Sulphur, Sepia, Opium, and Verat. alb. When there is inflammation, the constitutional symptoms are pretty clearly indicated by heat of the surf ace of the body, quickness of pulse, and by rigours; in this case, we must have immediate recourse to Aconit. -§>-i, and follow it if necessary by Belladonna ; when the more acute symptoms have been removed, but the infant continues to suffer much and scream constantly. (Lachesis may be preferred to Belladonna, when 470 diseases of infancy. constipation suddenly supervenes, attended with swelling and apparent tenderness to the touch over the entire abdomen, but especially at one particular spot. Mercurius may follow La- chesis if the symptoms do not yield to the latter remedy. Administration, ff, in six teaspoonfuls of water, one every six to eight hours, until relief is obtained. * Chamomilla is one of the most invaluable remedies in the treatment of the diseases of children, and particularly in bow- el-complaints, whether arising from irritation caused by indi- gestible food excited by a chill, or occurring during teething; when the following symptoms are apparent: redness of the face, or of one cheek, hardness and tension, and fulness of the abdomen, attended by severe colic, which is indicated by the state of peevishness, restlessness, constant crying, and drawing up of the legs towards the abdomen, sickness, frequent evac- uations of a bilious, watery, slimy, or frothy description, of a whitish, yellowish, or greenish colour, sometimes bearing a resemblance to beat-up eggs, of an offensive odour, similar to that of rotten eggs. Chamomilla may be preferred to Bella- donna after Aconite in cases of inflammation, when any of the above symptoms present themselves. (See also Infantile REMITTENT, p. 488.) Administration. £, in four teaspoonfuls of water; a tea- spoonful every six hours, until benefit results.f Rheum is another remedy of great utility in the treatment of this affection, provided the disorder has not been actually excited by frequent use of this medicine itself in allopathic doses, in which case it will be necessary to have recourse to Pulsa- tilla, Chamomilla, Mercurius, as antidotes, according to the nature of the symptoms. Rheum is particularly appropri- ate when acidity or bilious derangement has been generated by indigestion, or has arisen from the prolonged use. of antacids, such as magnesia, &c, and when there is flatulent distention of the abdomen, colic, crying, restlessness, tenesmus before and after the evacuations, which are either of the consistence of * Vide note, p. 21. f Ibid. BOWEL COMPLAINTS. 471 pap, or watery and somewhat slimy, occasionally of a gray- ish, or of a brown colour, and when a sour smell is emitted from the body of the infant. It is sometimes necessary to give Chamomilla, after Rheum, to complete the cure. Administration. £, in the same manner as Chamomilla. Pulsatilla. Diarrhea, arising from " indigestion," or from a chill, with watery, slimy, whitish, or bilious, greenish- looking evacuations, occurring chiefly at night; want of appe- tite, fretfulness. Pulsatilla, as stated, is also very serviceable in obstinate cases, where the affection has been brought on by the abuse of Rhubarb, or by Rhubarb and Magnesia, when the symptoms are as above described; it is further often efficacious under similar conditions, when fright has been the exciting cause, and Opium has not sufficed, or has been administered too late. (See Veratrum, p. 474.) Administration. j\, in six teaspoonfuls of water, one every twelve hours, until improvement ensue. Ipecacuanha is particularly valuable when the diarrhoea is excited at the period of weaning, (weaning brash,) from the sudden change of food, which the stomach is unable to digest; and when the following symptoms result in consequence : bilious derangement, with repeated attacks of vomiting, pale- ness of the face, frequent crying, diarrhoea with stools of a bilious, slimy, or greenish yellow, sometimes blackish, or streaked with blood, and of a putrid odour; on other occasions, evacuations resembling matter in a state of fermentation, or containing substances like white flocks or flakes, followed by straining. When this remedy is insufficient to effect a com plete cure, we should have recourse to Pulsatilla or to Anti- monium crudum, should the vomiting not speedily subside. Administration, j}, in four teaspoonfuls of water, a tea- spoonful night and morning. Mercurius. This medicine will be found very serviceable in some cases where the irritation owes its origin to the abuse of aperients, such as Rheum, etc., or when it has arisen from a chill. The following are the principal indications : watery, slimy, or bilious stools, (sometimes streaked or mixed with blood,) of ablackish, "greenish," or of a whitish yellow colour: 472 diseases of infancy. frothy, or having the appearance-of beat-up eggs; attended with symptoms of severe colic, and frequently also with severe tenesmus and protrusion of the intestines. Administration. t(W. in the same manner as Chamomilla. It is necessary to state, however, that the employment of mercury in the form of calomel, or some other mercurial preparation, in allopathic doses, is a fruitful source of bowel complaints in children; when, therefore, the complaint is at- tributable to the abuse of that powerful mineral, the homceo- pathic Mercurius must of course be avoided, and its place supplied by an antidote, which will generally be found in Hepar sulph., or Acid, nitricum should the former not suffice. Dulcamara. This is an admirable remedy in derange- ments of every description arising from exposure to wet; and is indicated in cases of diarrhoea from this cause, with the following symptoms : Watery, bilious, or slimy evacuations, of a greenish yellow colour, and occurring chiefly at night. Administration. § or ,-2, in a teaspoonful of water, and repeated in twenty-four hours, if necessary. (Merc, or Cham. may be required to complete the cure in some instances.) Nux vomica is very useful in cases arising from a chill, or from indigestible food at the period of weaning, or earlier; it is also useful in some cases in which the. disorder has been created by the frequent employment of laxative medicines. Its indications are: very frequent but scanty evacuations of watery, slimy, whitish, or greenish stools, attended with colic and tenesmus, sometimes followed by protrusion of the intestine; extreme fretfulness. This medicine is also of great service in many cases when the diarrhoea alternates with constipation. Administration, ^\, in three teaspoonfuls of water, one each night at bedtime. Bryonia is a useful remedy in cases of diarrhoea which recur whenever the weather becomes very warm. Administration. -|, repeated in from twelve to twenty- four hours. (Carbo v. has been found efficacious when only temporary benefit resulted from Bryonia, in diarrhoea during the heat of summer.) excoriation, jaundice. 473 Arsenicum. This medicine becomes indispensable in neg- lected cases, or in those at an advanced stage of the disorder, when there is reason to fear that it will terminate in marasmus. The following are its characteristic indications : Watery or slimy stools, of a greenish, whitish, dark, or brownish colour, or of a putrid or gangrenous odour, taking place chiefly during the night, or after drinking or partaking of any kind of food, great thirst, sleeplessness, paleness of the face, sunken cheeks, and blue circles round the eyes, enlargement of the abdomen, with extreme weakness and excessive emaciation. 3°^, in four teaspoonfuls of wrater, one night and morning.* Sulphur is an invaluable remedy in protracted cases or in those occurring in children who are the offspring of delicate parents,—when there is great weakness, emaciation, distention of the abdomen, and excoriations between the thighs and neigh- bouring parts. (Calcarea is required to complete the cure after Sulphur. ) In other cases, Sepia, Hepar s., Acid, sulph., Magnesia or Veratrum may be required. (See DiJIirhosa, Part II., p. 137.) /7. in four teaspoonfuls of water, one night and morning. Opium, as has been stated in another part of the work,f is a most valuable remedy, when immediately employed, for averting the bad results which sometimes arise in consequence of a sudden fright. When convulsions, with derangement in the stomach and bowels, are excited in children by such a cause, we ought to administer Opium y, followed by Vera- trum f, should Opium prove insufficient, and the vomiting and diarrhoea become excessive ; or we may select a remedy from amongst those above mentioned, in preference, such as Pulsa- tilla, &c, if the symptoms correspond. Smell of the Alvine Evacuations. Acid : Rheum., Merc, Sulph., Calc, Graph., Natr. ; or Cham.. Am., Hep., Sep., Phosph.—Cadaverous : Bismuth.—Mouldy : Coloc— Eggs, rotten, resembling : Cham.—Fetid, putrid: Ars., Ass., Carb. v., Puis., Sil., Sulph.; or Am., Bry., Air,:, Calc, Cam., China, Graph., Nux v., Phosph. a., Dulc, Sep.—Involuntary * Vide note, p. 21. f Vide Mental Emotions. 474 diseases of infancy. discharge of fseces : Phosph., Phosph. a., Verat., Ars., Bell., Ac mur., Natr. m., Sulph.; or Rhus., Bry., Nux v., China, Staph., Dig., Merc, Puis., Sep., Zinc—When urinating : Ac mur.—When expelling flatus : Ferr. mag.—When sleeping : Rhus., Puis., Arn., Moschus. Diet. When the derangement can be traced to any par- ticular kind of food, an alteration in the diet becomes imper- ative ; at the same time the quantity of food or drinks must be diminished until improvement sets in. EXCORIATION. Excoriationes Neonatorum. Against this affection cleanliness is the best preventive; however, we frequently find it proceed to such an extent as to require the aid of medicines for its removal. Chamomilla will be found, in most instances, speedily ef- fective, when we are certain that the disease is not the medi- cinal rwmlt of chamomile-tea taken by the nurse or child, in which instance Ignatia, Pulsatilla, Borax, or Carbo veg., at the same potency, have been recommended to be given. Administration. % or 4^ repeated in three days. Mercurius. When a yellow colour of the skin is present, which Chamomilla has not removed, and when the excoriation is extensive and severe. In very obstinate cases we may have recourse to Carbo v. 30, followed in four to six days by Tinc- tura sulph., at the same potency. Acidum sulph.., Graphites, Silicea, Lycopodium, and Sepia, are also us"eful in this malady. Administration. ,-2 in the same manner as Chamomilla. JAl NDICE. Icterus Neonatorum. This disease, as we have before observed, frequently takes its rise from the mischievous practice of administering aperi- ents immediately after birth; exposure to cold is also one of its exciting causes. When it has arisen from the last mentioned, and when there is, together with the distinguishing characteristic of the dis- ease—a yellow hue of the skin—considerable distention of the stomach, the administration of Chamomilla will be found cellular tissue. 475 prompt in affording relief. Mercurius may, in many cases, follow this remedy if it has only partially relieved; after which, if any symptoms still remain, we may exhibit Cinchona. N ex vom., when the complaint is combined with costiveness, and the little patient appears generally of irritable temper. Administration of the remedies :—A globule in four tea- spoonfuls of water, one night and morning ; again repeating, or selecting another remedy, after an interval of from three to five days, if the case seem to require it. (See remarks on this point in Introduction : Article, Administration and re- petition OF THE MEDICINES.) For more particular indications for the medicines above given, and further information, see article Jaundice, in part. II. p. 161 of this work. INDURATION OF THE CELLULAR TISSUE. Erysipelas Neonatorum. Diagnosis. Fever with red spots, generally appearing first upon the nates, but sometimes on the extremities, afterwards upon the abdomen and genital organs, accompanied with in- duration of the skin and even of the maxillary muscles, which prevents the child from uttering other than a dull sound ; the skin at last becomes as dry and hard as parchment. Some- times, instead of fever, the induration is accompanied with cold. This affection generally presents itself in the first two months of infancy ; its duration is from four to fourteen days, and if not promptly treated, it is generally fatal. Therapeutics. The remedies principally required in this affection are : Aconitum, Belladonna, Rhus toxicodendron, Ar- senicum album, Lachesis and Sulphur. Aconitum. At the commencement, when fever is present. Administration. °-°-°, in four teaspoonfuls of water, one every six hours, until diminution of the febrile symptoms ensues. Belladonna, may follow the exhibition of Aconitum, par- ticularly when the spots present an erysipelatous appearance. Administration. §, in a teaspoonful of water ; to be re- 476 DISEASES of infancy. peated in twelve to twenty-four hours, and so on if the same indications continue, but at shorter or longer intervals, ac- cording to the effects produced, * Rhus toxicodendron, if the appearance of the skin ex- hibits a vesicular character. Administration. Same as Belladonna. (In some cases Belladonna and Rhus alternately may be found necessary.) Arsenicum, should the dryness and hardness of the skin re- main undiminished, or become increased ; should we also find rejection of food from the stomach, evacuations green, watery, acrid, and very offensive; moreover, when there is a tendency to gangrene with livid spots and vesication. Administration, --j, repeated as Belladonna. Lachesis may in some cases be called for after Belladonna, when that remedy does not appear sufficient to combat the malady; or it may occasionally be advantageously exhibited in alternation with Arsenicum. Administration. 3°^, in the same manner as Belladonna. Sulphur may be usefully employed against the sequelae of this affection, such as torpidity of the intestines, and is also in- dicated where we have reason to suspect some constitutional taint. Graphites, Hepar s., or Clematis may also prove useful. The body during this disease must be kept as dry as possi- ble, and lint applied to the parts affected ; when practicable, the infant's only nourishment should be from the breast, to which it should be frequently applied, but only allowed to suck little at a time. LOCK-JAW OF INFANTS. Trismus Nascentium. This serious, and so generally fatal disease, under the old mode of treatment, usually occurs in the first few days of in- fant life; at first the child vainly attempts to suck, and even if it succeed, the milk is returned. On examination, from stiffness of the masticator muscles, the lower jaw cannot be depressed—the jaws gradually close, the whole frame be- comes rigid, and death ensues. The duration of the malady is from two to four days. * Vide note, p. 21. heat spots. Causes. Foul air; vitiated milk ; taking cold ; and local irritation ; for example, the umbilical cord being too tightly tied. Therapeutics. We must in the first place remove the causes where known. When local irritation has given rise to the attack, Arnica ought to be immediately given internally ; at the same time the seat of the injury may be bathed once or twice with a weak lotion, a few drops of the tincture to a wine- glassful of water. When we can trace the occasional cause to a bad state of the milk, Lachesis, 30, may first be given, and followed by Belladonna, 30, (which, it may be observed,- is to be held as a most important remedy in all cases where the affection cannot be assigned to any particular cause,) if no signs of improvement transpire after the first or second dose. Mercurius, 12, may also prove useful in similar cases. If cold or sudden chill has evidently given rise to the disorder, Chamomilla, §, may first be administered, and then Belladon- na, if required ; or Nux v., 3-0, may be given in preference to Chamomilla when catarrhal symptoms are present and indicate that remedy especially. (See Cold in the Head, Parts II., p. 193, and III., p. 461.) Hyoscyamus,—or Belladonna, La- chesis and Hyoscyamus in alternation, may be useful in some cases. (See also Trismus and Tetanus, Part II., p. 276.) Administration. One globule of medicine chosen may be inserted, if possible, between the gums, or dissolved in a little water, of which a drop or two may be let fall upon the joining of the gums, if closely locked ; repeat in from three to twelve hours, according to results. HEAT SPOTS. New-born infants and young children with an eruption con- sisting of small vesicles filled with a pellucid or slightly tinged fluid, surrounded by an inflamed base. When the vesicles break, they generally form into thin incrustations, but often the parts are inclined to ulcerate. The eruption is attended es- pecially at the outset, by more or less fever. Warm weather, or a warm room, and an excess of clothing, favour the develop- ment of the eruption. The daily use of the bath, with atten- tion to ventilation and clothing, remove the disorder; if con- 478 DISEASES OF INFANCY. siderable fever, restlessness, § of Aconite may be dissolved in three teaspoonfuls of water, and a teaspoonful given every twelve hours. Rhus § may follow Aconite after 12 or 24 hours, when the eruption is extensive. Sulph. or Ars. g, if the erup- tion should still increase. Cham. § after Aconite when the child is fretful and much excited; Bryon. & vvhen it is peev- ish, sleepless, and cannot bear to be moved. DERANGEMENTS DURING TEETHING. As already stated, about the fifth or sixth month the teeth generally begin to protrude. Under a proper system of treat- ment, if a due attention has been paid to the rules for exer- cise and diet which we have already laid down, and the child is free from any constitutional infirmity, we may calculate upon the period of dentition being exempt from much suffering. Broths and jellies should, during the acute stages, be whol- ly prohibited, and its food, if it take other nourishment than the breast, be of the lightest and simplest description. The mother or nurse should pay particular regard to her regimen, and avoid all substances of a stimulating and indigestible nature. Here, we remark, that the indulgence in vinous or fermented liquors is, from their irritating properties, one of the most frequent causes of the suffering of children during this period. During dentition there is always a tendency of blood to the head, which from simple irritation may, if not quickly checked, terminate in inflammation of the brain ; the best rem- edy against this affection is keeping the head perfectly cool. In order, as much as possible, to allay the anxiety of parents, who may be led to mistake the natural symptoms attendant upon dentition for those of disease, we shall in the first instance briefly enumerate those which frequently take place in healthy children, and may be safely left to nature; and afterwards proceed to point out in what cases, from any of the symptoms diverging from the usual track, it may be necessary to have recourse to medicines, or to call in a physician. During the teething, the child is more restless than usual, especially at night; has flushes of heat, alternating with pale- ness ; the gums gradually swell and become hot; it evinces a derangements during teething. 479 difficulty in sucking, sometimes forcibly bites, and frequently lets go the nipple; it drivels at the mouth, and its bowels be- come relaxed ; the twro latter symptoms may in some measure be looked upon as a wise precautionary measure of nature, to prevent a congestion to the head and lungs, to which all chil- dren are at this time more or less disposed; and the sudden cessation of either after having once set in, is a sign of de- • rangement of functions demanding prompt attention. Therapeutics. The medicines most generally required are: Coffea, Chamomilla, Nux v., Bellad., Cuprum acet., Calc. carb. When the child is in an excited state, and unable to sleep,' irritable, liable to start, and difficult to soothe, a globule of Coffea may be administered; if the symptoms remain without alteration, we may have recourse to Aconitum. When benefit results from either one or the other remedy, the dose must only be repeated in the event of a threatening relapse. Chamomilla may be given after the foregoing remedies when they are merely productive of partial relief; or it may be given in preference thereto, if the following symptoms are encountered : extreme excitability; the infant starts at the slightest noise; evinces great thirst; spasmodic twitches or convulsions in the limbs during sleep ; short, quick and loud respirations, sometimes with a hacking cough; excessive diar- rhoea, with green, whitish, or watery evacuations; and espe- cially when the mother has been in the habit of taking coffee, which we have already so strongly reprobated as an article of diet to women nursing. Mercurius and Sulphur are some- times requisite after Chamomilla against the diarrhoea. (See Diarrhoea.) Administration. §, in a teaspoonful of water, repeated at first in twenty-four, then in forty-eight hours, but oftener if called for. When in the assemblage of these symptoms, constipation takes the place of diarrhoea, we may administer Nux vomica, 3^0' repeated in from two to three days if necessary. When strong symptoms of cerebral irritation exist, we should have instant recourse to Belladonna, or 480 DISEASES of infancy. Cuprum aceticum f. When marked cerebral sensibility declares itself, and the child almost spasmodically clenches the spoon or cup with its gums when drinking. Administration, according to the formula given under Scarlet Fever, one fourth of the dose there specified. When the irritation seems to arise from difficulty of teeth- ing, we may administer Calcarea 3fi0, repeating it every eight days for about a month, which will materially assist the pro- • trusion of the teeth. When obstinate constipation is present, see that article in this part of the work. See also Convulsions in Children. CONVULSIONS IN CHILDREN. Early childhood is, from various causes, peculiarly predis- posed to this distressing malady. They generally arise from the anatomical and physical peculiarities of infancy, in the pre- ponderance of the nervous and cerebral systems over the other parts of the frame; hereditary predisposition called into activity by dentition—repelled eruptions, irritating substances in the stomach, intestinal worms, mechanical injuries, fright, and lastly, from some occult cause, frequently a derangement of the organic structure, in many instances bidding defiance to the powers of medicine. When no physician or medicines are at hand, and the danger is imminent, we may, in the first place, recommend immersing the lower extremities up to the knees in water, as hot as can be borne with safety to the infant, for the space of eight or ten minutes, until the paroxysms seem in a measure subdued; after which, the child should be wiped per- fectly dry, and placed in a warm wrapper; if the first immersion be followed by no relief, it should be repeated; at the same time pour a small stream of cold water upon the crown of the head, until reanimation becomes apparent,when the child ought again to be warmly covered up; this course, frequently repeated, has been found to restore children, although the prior attempts have proved inefficient. When improper food or foreign sub- stances in the stomach or intestines are the causes, lavements of equal parts of sweet oil and warm milk should precede the CONVULSIONS IN CHILDREN. 481 foot-bath ;* if homoepathic medicines be not immediately at hand, the careful administration of Camphor by olfaction, or a drop or two of the tincture, considerably diluted, placed on the tongue, will frequently be found effiacacious in giving relief, awaiting the arrival of a physician. Therapeutics. Chamomilla, Belladonna, Ignatia amara, Cina, Mercurius, Cicuta virosa, Arsenicum, Bryonia, Sulphur, Nux vomica, Pulsatilla, Arnica, Opium, Stramonium, Secale cornutum, and Hyoscyamus, are the most important remedies.^ Among these, Chamomilla stands in the first rank, particu- larly in very young children, when the convulsions have been excited by dentition, as well as for children who have passed that period, who are of a nervo-sanguine temperament, ex- tremely sensitive, and peevish, or when the attacks have been excited by fever, colic, a chill, or a fit of passion, or vexation. The characteristic indications for its administration are : rest- lessness, fretfulness, and disposition to drowsiness, when awake; one cheek red, the other pale ; diarrhoea ; (if this rem- edy be exhibited at this stage of the disorder, it will frequent- ly prevent the fit from becoming fully developed ;) eyes half- closed ; great thirst; quick and loud breathing; rattling in the throat; moaning ; cessation of consciousness ; twitches of eyelids and muscles of the face ; contortion of the eye-balls ; jerks and convulsions of the limbs, with clenched thumbs ; con- stant rolling of the head from side to side; loss of conscious- ness. (Belladonna may be substituted after Chamomilla, should this fail to do much good.) Administration. We may, for very young children, dis- solve one globule of the sixth potency in four teaspoonfuls of water, and administer one at the commencement of the attack; if fresh paroxysms come on some hours after, but decreased in intensity, we ought not to repeat the remedy, but allow it to exhaust its action; if the covulsions increase, on a second or * Some useful remarks upon this subject may be found in the " Ho- meopathic Examinee," (published in New-York, voL i., No. 2.) \ I may remark, that in plethoric, well-nourished children, great advan- tage will frequently be derived from administering a dose of Aconite prior to any of the other remedies. 21 482 DISEASES OF INFANCY. third attack, we may give another spoonful; unless other symp- toms declaring themselves, intimate that; we ought to have re- course to any other of the undermentioned. Belladonna, besides being useful in cases of suppressed eruptions, is more particularly indicated when the child starts suddenly, when asleep, or stares about wildly ; the pupils are much dilated ; the body or individual members become rigid ; the forehead and hands dry and burning ; occasionally followed by clenching of the hands; involuntary micturition after re- turning to consciousness; the slightest touch will sometimes provoke a renewal of the attack. This medicine is also indica- ted when the paroxysms are preceded by smiles or laughter. Administration. 5^, in the same manner as Chamomilla. It is frequently found that Chamomilla and Belladonna answer in alternation, and that when one has alleviated the evil, the other, sometimes followed by the one first adminis- tered, will dissipate the remaining symptoms. In cases that withstand the exhibition of these two reme- dies, particularly during dentition, we frequently find Ignatia successful, more especially in children that appear of a melan- choly temperament, or in pale, delicate infants, of peevish dis- positions, with alternations of vivacity and sadness, and laughing and crying almost in the same breath. Administration. Same as Belladonna. The characteristic symptoms are:—The infant, while repos- ing in a moaning, light slumber, becomes suddenly flushed with burning heat, awakes, and springs with a convulsive start, and the utmost soothing scarcely quiets the excitement; a tremor of the entire body, attended by violent crying and ago- nizing shrieks; and the muscles of single limbs seem con- vulsed. Ignatia is further indicated when the fit returns every day at a regular hour, followed by fever and perspiration, or every other day at variable hours. (In other instances Belladonna will be found requisite after Ignatia.) Ipecacuanha is useful when great difficulty of breathing, nausea, aversion to food, vomiting, either precede, accompany, or follow the attacks ; and when the child has a constant in- clination to remain in the recumbent posture. CONVULSIONS IN CHILDREN. 483 Cina is useful, particularly during the second teething, for children of a melancholy temperament, scrofulous constitution, and who are troubled with worms, or habitually wet the bed ; the characteristic symptoms are : spasms, commencing with constriction of the breast, followed by stiffness of limbs, pal- lor, and rigidity of the whole frame. Administration. As Chamomilla. But in some cases it will be found useful to prescribe % every four days for a week or a fortnight, in order to remove the susceptibility to the attack. Mercurius in spasms which are caused by the presence of worms; the stomach is swollen and hard before, during and after the fit; the child is attacked with painful eructation, and a species of salivation ; the limbs tossed and convulsed, at- tended by fever and moist skin ; after the paroxysms the child lies for a long time exhausted and apparently dying. Administration. Same as Chamomilla. The foregoing are the more generally useful in ordinary cases ; but the subjoined are sometimes called for in the par- ticular instances specified. Cicuta virosa is exceedingly serviceable when there is a clear indication of the.presence of worms ; when the child is first attacked with severe griping and colic, terminating in con- vulsions ; the characteristic features of the fit are : tremour of the limbs ; jerks like electric shocks, terminated by insensi- bility. Administration. Same as Cina. Arsenicum has proved very valuable in severe cases of convulsions, during dentition, when a burning heat diffuses it- self over the whole body of the child ; it stretches its feet out, and the hands convulsively backwards, then throws its hands. about, and rolls over with violent shrieks; changes its position, and bends forward with clenched fingers and extended thumbs; it is irritable, restless, and perverse; evinces insatiable thirst, but drinks little at a time ; with diarrhoea, sometimes of undi- gested food ; frequently vomits immediately after taking food; the paroxysms recur frequently, and all attempts at soothing seem only to irritate the child. Administration. Same as the foregoing. 484 diseases of infancy. Bryonia is valuable in convulsions arising from suppressed measles. (See Measles, p. 59.) Administration. Same as Arsenicum. Sulphur is particularly indicated in spasms arising from repelled chronic eruptions ; but such cases should be confined to experienced medical care, as until the disease is completely eradicated, the constant liability to such attacks still exists. When the disease arises from indigestible substances being taken into the stomach, Nux vomica or Pulsatilla may be given according to the symptoms and disposition for which the indications have been already given in different parts of the work, to which the reader is referred. (See tabular Index.) In cases of mechanical lesion, Arnica, |-, and externally in lotion, where any wound or contusion exists. In cases of convulsions from fright, we may have recourse to Opium, § or g, when the following appearances are present: general trembling ; throwing about of limbs ; vacant stare ; cries seemingly unconscious ; stertorous breathing, and final insensibility. Stramonium %, when the child becomes suddenly convulsed and senseless from fright. Secale cornutum, t\, in alternation with Stramonium, in cases where the latter does not afford relief. Hyoscyamus, ,a2, when sudden fright causes very violent convulsions. (See Mental Emotions, Part II., p. 438.) WATER IN THE HEAD. Hydrocephalus. This fatal and frequent disease is liable to be excited by a variety of causes, and is particularly prone to take place in scrofulous children, who are born with unusually large heads, and in whom the fontanels remain long unclosed. The symp- toms are sometimes so mild and insidious, that parents are thrown off their guard, and attribute the apparently slight in- disposition of the little patient to some comparatively trivial circumstance ; such as teething, or gastric derangement. In other instances, the symptoms are much more striking, and in many respects strongly resemble those described under In- flammation of the brain. In general, the skin is hot, pulse * WATER IN THE HEAD. 485 rather quick, chiefly at night, and the child becomes peevish whenever it is raised from the horizontal position; at other times it is affected with fits of screaming; grinding of.the teeth ; redness of the face and eyes ; peculiar expression of countenance ; convulsion and stupor. Therapeutics. The most appropriate remedies are : Aco- nifc, Belladonna, Bryonia, Helleborus, Mercurius, and Sul- phur, or Sulphuris Tinctura. The indications for the two former have already been given under Inflammation of the Brain, Part II., p. 271. Administration. Two globules at the potency mentioned, in four teaspoonfuls of water, one daily; in severe attacks every six or twelve hours, carefully studying the effects of each dose, and acting accordingly.* Bryonia, f, may be administered after Aconite, or Bellad., if necessary, or may be given at the commencement, when there is heat in the head, with dark redness of the face, and great thirst; eyes convulsed, or at one time closed, and at another wide open or fixed ; delirium ; sudden starts, with cries, or constant inclination to sleep ; continual movement of the jaws as if engaged in chewing ; tongue coated yellow ; abdomen distended ; urine suppressed, or the passing of urine appears to cause pain ; great thirst, especially at night; skin hot and dry; respiration hurried, laborious, and anxious ; constipation. Helleborus niger §. This remedy, as stated by Dr. Wahle,f will generally prevent a fatal termination, when Bry- onia merely produces only temporary benefit. The same authority quotes it as being the most important medicine in all serious cases, and that it should be given in these at the very commencement in preference to all other remedies ; fol- lowed by Sulphuris Tinct. when danger is not removed within a few hours, and when spasms are present. Mercurius, l-2, will sometimes be found useful after Bella- donna, or previous to that remedy when the bowels are much relaxed. Hyoscyamus, Opium, Cina, and Stramonium, may * Vide note, p. 21. \ Brit. Journ. of Homoeopathy, No. vii., p. 286. # 486 diseases of infancy. likewise prove valuable in cases wherein the indications corre- spond with those described in Part II., and in some cases, Lachesis, particularly when the disease has reached an ad- vanced stage. Kali hydriod., Digitalis, Arnica, and Conium, have also been named as likely to prove serviceable in this malady. In chronic cases, Dr. Wahle recommends Helle- borus, Arsenicum, and Sulphur in particular. ASTHMA OF MILLAR. Laryngismus Stridulus. This affection is by some denominated the Spasmodic Croup, or Acute Asthma of infants ; it bears a considerable resemblance to croup, but differs from it in many respects, by the extreme suddenness of the attack, while that of croup is generally preceded one or two days by tioarseness and a slight cough, and by the cessation from suffering the patient enjoys between the attacks ; while, when croup has once set in, the excitement is permanent; moreover, this disease generally attacks in the evening or at night, whereas croup in most ca- ses makes its first appearance during the day. Croup, as we mentioned in the article upon that subject, is an inflammation of the membrane of the windpipe, exciting the formation of a peculiar secretion, which if not checked, con- cretes into an abnormal membraneous tissue, constituting what is-technically called the false membrane of croup ; whereas, in the Asthma of Millar, the suffering appears to arise from a spasmodic contraction of the lop of the windpipe, impeding the progress of respiration. The attack commences with a sudden spasmodic inspiration,. with a species of stridulous or crowing noise ; if the fit con- tinues, the face becomes purple, and the extremities partake of the same hue, frequently accompanied, as in convulsions, with a clenching of the thumbs inside the palm, and spasmodic constriction of the toes, giving an appearance of distortion to the foot; if proper means are not promptly taken, these at- tacks recur frequently, and at short intervals, and occasionally the little patient perishes during one of the paroxysms. The disease rarely occurs except in infants of delicate consti- tution, which due means should be taken to endeavour to era- ASTHMA OF MILLAR. 487 dicate by a proper course of treatment; it is a frequent ac- companiment of the period of dentition, and excited by simi- lar causes to those bringing on convulsions. Therapeutics. Aconite, Ipecacuanha, Arsenicum, Sambu- cus, Moschus, or Pulsatilla, are the medicines which have been employed by homoeopathists with the most successful results. Administration. A globule every one or two hours, ac- cording to symptoms. Aconite, ^, when a suffocating cough comes on at night, with shrillness and hoarseness of voice ; respiration short, anx- ious, and difficult, more particularly if any marked febrile symptoms be present, or we have reason to dread determi- nation of blood to the head. Ipecacuanha, £, when there is rattling in the chest, from an accumulation of mucus, with spasmodic constriction, and symptoms as from suffocation; anxious and short, or sighing respiration, with purple colour of the face, and cramps, or ri- gidity of the frame ; it may be advantageously followed by Arsenicum, 3°0, when many of the above symptoms are still present, or in a measure subdued ; also if we find great an- guish, cold perspiration and considerable prostration of strength, during and after the paroxysms ; when these last indications are particularly prominent, Arsenicum may supersede Ipecac- uanha at the commencement. Sambucus, §. Lethargy, or ineffectual inclination to sleep, with oppressed respiration and wheezing; livid hue of the face, agonizing jactitations, dry heat of the trunk ; no thirst; pulse small, irregular, and intermittent. Moschus, §■, is frequently of value in cases that occur at a more advanced period of life, when a constriction in the larynx, as if caused by the vapour of sulphur, is complained of; diffi- cult respiration and short breathing ; severe spasms in the chest, with inclination to cough, after which, (especially in children,) the paroxysms become much exacerbated. Pulsatilla, j^, will often be found successful in cases in which the foregoing remedy fails in producing the desired effect. 488 DISEASES OF INFANCY. THE RICKETS. Rachitis. This malady almost invariably begins to show itself at the tender age of from one to two years, and is distinguished by great development of head, abnormally prominent forehead, projecting sternum, flattened ribs, enlarged abdomen, with emaciation of the extremities, and extreme general debility. As the disease progresses, the muscles become more flaccid, the epiphyses of the limbs increase in size, the bones and dor- sal spine become more or less distorted, the bowels relaxed and the motions frequent; and frequently, if the disease be not arrested, slow fever, with cough, oppressed breathing and atro- phy supervene, and a fatal termination results. Therapeutics. The remedies which have hitherto been employed with the greatest success in the treatment of this distressing affection by homceopathists are : Belladonna, Mer- curius, Arsenicum, Sulphur, Calcarea, Silicea ; also Asafetida, Acidum phosphoricum, Phosphorus, Baryta muriatica, Staphy- sagria, Lycopodium, Acidum nitricum, Mezereum, Petroleum, and Rhus* (See Atrophy, p. 493.) INFANTILE REMITTENT FEVER. By infantile remittent is here chiefly meant that form of fever which occurs in infants and children, arising from mor- bid irritability, inflammation or even ulceration in the mucous membrane of the stomach and bowels. The affection is usually preceded by languor, irritability of temper, want of appetite, nausea, thirst, slight heat of skin, and very restless nights. Ere long these symptoms present them- selves in a more aggravated form, together with an acquisition of abnormal phenomena, such as hurried and oppressive breath- ing, quickness of pulse, with occasional flushes in the face, vomiting of food or bile, distention and tenderness of the abdo- men; obstinate constipation ; sometimes diarrhoea, or frequent desire to go to stool with but little effect; motions discoloured, * The author begs to refer the reader to a somewhat interesting case of Rachitis, which he published in the Brit. Journ. of Homoeopathy No. 10, p. 105. INFANTILE REMITTENT FEVER. 489 fetid, often mixed with mucus, and occasionally with blood. The hands and feet are often cold while the rest of the body is parched; the head hot and heavy, or attended with symptoms resembling hydrocephalus, such as coma, etc. The tongue, at first moist, loaded, and occasionally very red along the margins, often becomes dry over a triangular spot at the point. When the febrile exacerbation takes place at night, it is ac- companied by vigilance and jactitation ; when during the day, there is, on the other hand, drowsiness and stupor. An annoy- ing cough with bronchitic indications, succeeded by wheezing and expectoration^ sometimes appears; although, as is charac- teristic of remittent fever, the febrile symptoms never entirely subside, still the patient will frequently appear to be steadily recovering for a time, and the unwary or inexperienced may consequently be led to pronounce an unduly favourable prog- nosis, which will too often be contradicted by the occurrence of a relapse, followed perhaps again by another encouraging but deceptive remission; and so on, unless the progress of the disease be checked until either the mesenteric glands become affected, dropsical effusion into the cavity of the abdomen en- sues, unequivocal signs of cephalic disease become established, or the little sufferer is so emaciated and reduced by protracted disease, that the vital powers give way, and he sinks exhausted. Therapeutics. In mild attacks occurring in tolepibly healthy children, the disease is generally readily subdued in a few days, by means of one or more of the following remedies: Ipecacuanha, Pulsatilla, China, Nuv v., Aconitum, Belladonna, Mercurius, Bryonia, Lachesis, Chamomilla, and Sulphur, com- bined with light farinaceous diet. Solid food must be strictly prohibited, even although the appetite should be good, which it occasionally is, and even ravenous at times. With regard to the indications for the remedies quoted, Ipe- cacuanha may be given if, as is generally the case, the attack has been excited by over-feeding, or by indigestible food, and particularly when the patient has contracted a habit of bolting the food without having previously masticated it properly, and the symptoms encountered are as follows : general dry heat, or harsh and parched skin, especially towards evening ; thirst, ■>1* 490 DISEASES OF INFANCY. extreme restlessness, burning heat in the palms of the hands; perspiration at night, quick oppressed breathing, foul tongue, nausea, vomiting, or fastidious appetite with sickness after eating ; greatlanguor, apathy, and indifference. Should these symptoms remain unaltered after several doses of Ipecac, or should the bowels become very relaxed, the motions fetid, whitish, bilious, or of variable colour at different times, and accompanied with griping and distention of the abdomen; fever during the night—Pulsatilla must be prescribed, fol- lowed, if required, by Cinchona, especially if the nausea or vomiting has subsided, but the bowels remain relaxed, and are considerably distended, or tense and tympanitic. Nux vomica | is also a most efficient remedy in mild cases, or in the early stage of the disorder of any variety, when the bowels are confined, or very costive, with frequent inclination to go to stool; or when there is tenesmus, followed by scanty watery motions, generally mixed with mucus, or occasionally with a little blood ; abdomen tumid and rather painful; fur- ther, when the child is excessively peevish and ungovernable; the tongue foul; appetite impaired, or there is nausea with disgust at food ; restlessness; fever towards morning, but also in some degree during the night. Chamomilla £ is sometimes useful after Nux v. when burn- ing Ifeat of skin continues, or when bilious vomiting or diar- rhoea supervenes; the tongue red and cracked, or coated yel- low ; sleep lethargic, or restless and agitated, attended with frequent starts and jerkings of the limbs ; flushes of heat in va- rious parts of the body. Also when the little patient is of a plethoric habit, or in all cases in which the head is hot and heavy, the skin dry or parched, face flushed, pulse quick; and when there is thirst, foul tongue, nausea, bilious vomiting; no motions, or frequent and scanty evacuations, with tenesmus. Belladonna § may succeed the former remedy if the head continue hot, the pulse excessively quiet and full, the tongue loaded, or coated white or yellow in the centre, and very red at the edges; thirst; nausea or vomiting ; great heat of the ab- domen with tenderness on the slightest pressure; oppressive breathing. If the more active inflammatory symptoms yield to INFANTILE REMITTENT FEVER. 491 the action of Belladonna,—Mercurius § will often serve to complete the cure ; but more particularly when the following symptoms remain : loaded tongue, nausea or vomiting, with continued tenderness of the abdomen ; thirst, sometimes with aversion to drinks when offered ; no motions, or diarrhoea with excessive tenesmus. If, on the other hand, the head continue hot and heavy, the pulse quick, the tongue foul, and other symptoms of gastric derangement prominent, together with a tumid and painful state of theabdomen, constipation, excessive restlessness, and quick, laborious respiration, particularly at n'ght, with drowsiness during the day, Bry. is to be preferred. Lachesis g may follow Bellad. %, or £ Merc when the signs of intestinal irritation or inflammation continue with but li Ltle abatement. Or it may precede these remedies, when the tenderness and distention is more marked at one particular spot (the most trivial pressure there being intolerable) than over the entire abdomen ; and when the fever is highest at night. Sulphur § may be given with advantage to complete the cure in many cases, after the previous employment of any of the foregoing medicines. It is, however, when the attack is characterized by the following features that this remedy is more directly called for : feverish heat, especially tow^ps evening, but also in the morning, or during the day ; flushes alternately with paleness of the face ; dryness of the skin ; hurried and laborious breathing; palpitation of the heart; nocturnal perspiration ; languor and great weakness, particu- larly in the inferior extremities ;^tense, tumid and painful abdomen; dry, hard, or loose and slimy motions. These, then, are the more generally useful remedies in cases of the above description, and will materially tend to facilitate recovery, and prevent the disease from assuming an obstinate character. When, however, the malady occurs in children of relaxed and feeble habits, or of a decided strumous diathesis, it becomes, especially if neglected, and not checked at the commencement of its course, a most intractable and frequent- ly fatal disease, from the proneness which it then has to be- come complicated, and terminate in one or other of the seri- ous forms alluded to in the diagnosis. 492 DISEASES OF INFANCY. The remedies from which the most benefit is to be antici- pated under such unfavourable circumstances are, in addition to those previously mentioned : Silicea, Sulphur, Calcarea, Biryta c, Arsenicum, Cocculus, Cina, Sabadilla, etc. Silicea §, when there is great emaciation, languor and de- bility, paleness of the face, want of appetite, or craving for dainties ; shortness of breath on movement; feverish heat in the morning or towards evening. This remedy is also a most important one when the patient is afflicted with worms, and when the disease is in a great measure attributable to inver- mination. Cina and Sabadilla may likewise be found useful along with Silicea in the latter instance. (See Invermination.) The indications for Sulphur have already been given. Calcarea §. Great debility, with flabbiness of the mus- cles, dryness of the skin, and excessive emaciation ; frequent flushes, or general heat, followed by shivering towards even- ing ; exhaustion, or dejection after speaking; impaired, fas- tidious appetite, with weak and slow digestion, or, on the contrary, extreme voracity ; perspiration towards morning, hard, tense, and tumid abdomen. (Baryta c is sometimes useful after Calcarea.) Arsenicum §. Extreme prostration of strength, and ema- ci^ion with desire to remain constantly in the recumbent pos- ture ; dry, burning heat of the skin, with great thirst, but desire to drink little at a time, or merely to moisten the lips, which are frequently parched ; impaired appetite, and some- times excessive irritability of stomach, so that very little food can be retained ; hard and tense abdomen ; restless un- refreshing sleep, and frequent starts, or subsultus tendinum ; fretful and capricious disposition. Cocculus |. Great weakness, with excessive fatigue, de- pression, and tremor, after the slightest exertion ; heavy, ex- pressionless eyes ; flushes of heat in the face ; nausea, or. aver- sion to food, distention of the abdomen, constipation ; op- pressed respiration; perspiration on attempting any trivial exertion ; lowness of spirits ; mildness of temper. Belladonna, Lachesis, or Baryta c, will be required when tha head becomes much affected. The former especially when there is heat, heaviness, flushing and delirum; or deep and atrophy. 493 protracted sleep with subsultus tendinum, coldness of the hands, pale cold face, small quick pulse, hot, tumid, and tense abdomen. Lachesis :—Either, before or after Bella- donna, when we encounter deep prolonged sleep ; grinding of the teeth; or somnolency alternately with sleeplessness; tre- mulous, intermittent, or scarcely perceptible pulse. Baryta. ^, Lethargy, jactitation or agitation, moaning and muttering, feeble and accelerated pulse. (See Hydroce- phalus.) Other remedies, such as Antimonium, Acid, phosphoricum, Phosphorus, Hepar s., Kali, Acidum nitr., Lycopodium, Rhus, etc., may be required according as the symptoms happen to vary ; we have merely given some of those medicines which have been found of valuable service when the indications were as above given. It may be added, that when the skin is hot and parched, the sleeplessness and restlessness is often tempo- rarily removed by sponging the body with tepid water : this is, however, only to be had recourse to when the remedies fail to afford this relief, and that in a more permanent degree. (See also Atrophy.) ATROPHY. Atrophia. The medicines from which the most appreciable assistance has hitherto been obtained in this serious malady* are:— Sulph., followed by Calcarea; also Ars., Bar. c, Bell:, Chin., Nux v., Phosph., and Rhus. Sulphur, § in almost all cases at the commencement of treatment; craving appetite; enlargement of inguinal or axil- lary glands ; slimy diarrhoea or obstinate constipation; pale complexion, sunken eyes, &e. Calcarea, g. Great emaciation, with craving appetite ; en- largement and induration of the mesenteric glands; great weakness, clayey evacuation, a dry and flabby skin; too great a susceptibility of the nervous system. Arsenicum, £. Dryness of skin, which resembles parch- ment ; hollow eyes ; desire to drink often, but little at a time; excessive agitation and tossing, especially at night, short sleep interrupted by jerks ; faeces of greenish or brownish colour, with evacuations of ingesta ; extreme prostration. 494 DISEASES of infancy. Baryta, £. Enlargement of the glands of the nape of the neck; continual desire to sleep ; great indolence, and aver- sion to exertion and amusement. Bell., f. Capriciousness and obstinacy; nocturnal cough, with rattling of mucus; enlargement of the glands of the neck; unquiet sleep; precocity of intellect, blue eyes, and fair hair. China, f. Excessive emaciation ; voraciousness ; diarrhoea at night, with frequent white evacuations, or of ingesta; fre- quent perspirations, especially at night; unrefreshing sleep. Cina f. Vermiculous suffering; wetting the bed. (See Worms.) Rhus. Slimy or sanguineous diarrhoea ; debility, voracity. In children past the age of infancy, great attention should be paid to the diet; pure air and exercise are also of great importance. VACCINATION. This is an operation purely homceopathic, and one which, from its efficacy in the prevention of a disease exhibiting anal- ogous symptoms, has been frequently quoted by our great Founder and his disciples, as one of the best illustrations of the imrojitable law of similia similibus curantur. Vaccination, when the child is strong and healthy, may be safely performed during the fourth and fifth month; but when the smallpox is rife as an epidemic, we may have recourse to this prophylax with infants of a still more tender age. If, however, we are allowed a choice of time, summer is the best period for performing the operation, as then the infant, after having taken the infection, incurs least risk of catching cold. It is of the utmost importance to obtain the lymph from a perfectly pure source, as experience has too truly proved, that other diseases have, from a neglect of this precaution, been frequently transmitted to healthy children. For this reason, a child that has suffered from eruptions of the skin, affections of the glands, or soreness of the eyes, or one born of scrofu- lous parents, is an unfit subject for taking the vaccine matter from, although at the time apparently in health. 495 PART IV. TREATMENT OF FEMALES, AND THEIR PECULIAR AFFECTIONS. CHLOROSIS. Emansio Mensium. This complaint generally declares itself in young females about their fourteenth year. Its proximate cause is an ob- struction of the first menstruation; a disease very similar may be produced by great loss of blood. Diagnosis. Pale blanched complexion and lips (sometimes with flushes of heat and redness), a depravity of appetite, a longing after innutritious substances, such as chalk, &c, and a general languor both mental and physical; the patient com- plains of weariness, lassitude and debility, and becomes emaci- ated ; the lower extremities frequently assume an oedematous appearance, generally attended with cold in those parts, and headache, with flatulent distention of the abdomen, particu- larly after meals, and in the evening ; bowels irregularly con- fined ; sometimes at a later period very easily irritated and relaxed ; a harsh harassing cough, occasionally with periodical expectoration of dark-coloured coagulated blood, and hurried respiration, frequently declares itself, if the affection has been allowed to proceed unchecked ; and to an inexperienced eye, the sufferer appears to be on the verge, or even passing through the different stages, of a decline. Therapeutics. The predisposing causes of this affection are very remote; we shall therefore be satisfied with confining ourselves to the treatment of the complaint in its more simple stage, as when we find an extremely obstinate case, we may feel confident that it requires a regular course of treatment, or 496 TREATMENT OF FEMALES. originates in some organic derangement. The medicines hitherto found most useful in ordinary cases of this affection are : Pulsatilla, Sepia, Bryonia, Sulphur, and Natrum m. Administration. Six globules of the.potency mentioned after each medicine, in six tea-spoonfuls of water, one daily; and so on until benefit results, or it is found necessary to choose another remedy.* Pulsatilla, °Tn2°' or in light cases, three globules taken dry, when the complaint has been the effect of dampness, or caused by damp or cold air, or when it is accompanied by frequent at- tacks of semi-lateral headache, with shooting pains, extending to the head and teeth, sometimes shifting suddenly to the other side; also when we observe aching in the forehead, with pres- sure at the crowm of the head, and salloxc complexion, alterna- ting with flushes of heat; difficulty of breathing, and sense of suffocation after the slightest movement; palpitation of the heart; coldness of the hands and feet, often changing to sud- den heat; disposition to diarrhea and leucorrhea; pains in the loins; sensation of weight in the abdomen ; spasms in the stomach, with nausea, inclination to vomit, and vomiting; peri- odical expectoration of dark coagulated blood ; hunger, with repugnance to food, or want of appetite with dislike to food ; great fatigue, especially in the legs. This medicine is pecu- liarly adapted to females of mild or phlegmatic disposition, disposed to sadness and tears. Graphites, -3-0-, when there is retention of the period with congestion of the vessels of the head and -chest; dark red flushing of the face, oppression of the chest; and a feeling of anxiety when in the recumbent posture. Graphites, together with Causticum, form two of the most important remedies in scanty, insufficient menstruation. Belladonna is often called for when the congestion of the head and chest is of an active character, with violent throbbing of the carotids. Sepia, °sy, is also a very valuable remedy in this affection, when many of the above symptoms are present, with, at the same time, hysterical megrims ; complexion sallow, with dark- coloured spots ; frequent colic and pain as of a bruise in the * Vide note, p. 21. chlorosis. 497 limbs. When the above symptoms declare themselves, advan- tageously follow Pulsatilla, if the latter have failed to relieve. Bryonia -§u. Frequent congestion in the head or chest; bleeding at tlie nose ; dry cough ; coldness and frequent shiv- ering, sometimes alternated with dry and burning heat; constipation or colic; bitter taste in the mouth, tongue coated yellow, sense of pressure in the stomach, as if from a stone; irascibility. Sulphur, a£a, is more particularly indicated when there is pressive and tensive pain in the back of the head, extending to the nape of the neck; or pulsative pain in the head, with de- termination of blood ; humming in the. head ; pimples on the forehead and round the mouth ; pale and sickly complexion, with red spots on the cheeks; voracious appetite; general emaciation; sour and burning eructations; pressive fulness and heaviness in the stomach under the lower ribs and in the abdomen; bowels irregular ; difficulty of breathing ; pjjp in the loins and fainting; excessive fatigue, especially in the legs, with great depression after talking; great tendency to take cold ; irritability, and inclination to be angry; or, sadness and melancholy, with frequent weeping. In some cases, one or the other of the following medicines : Conium, Kali carb., Phosph., Ferrum, Ignatia, Lycopod., Acid, nitr., etc. Calc. carb. s-^-, has often completed a cure in the worst cases, with oedema of the extremities and extreme dyspnoea. It is necessary to follow up the treatment, on the disappear- ance of the more important symptoms under the employment of Calc, wdth Ferrum carb. in repeated doses, to prevent are- lapse. Ferrum is required when the pale, sicklv hue of the face continues, notwithstanding the previous use of Calc. When Ferrum was given at the commencement, it did not aggravate the anxiety, cough, and other pectoral symptoms. Where there is a complication with tubercular diathesis, accompanied by cough, etc., coeval with the first appearance of chlorosis, Sulph. aud Calc often prove beneficial in alternation. During the employment of Calc, a dose of Lycop. is required, when there is constipation and extreme languor, or Sepia, when there is oppressive headache. Sometimes the menses do not 498 TREATMENT OF FEMALES. appear for some time afterwards, although health may have been renovated. Valeriana sfa., has been found of great service in daily- repeated doses, when a feeling of constriction was experienced in the gullet or chest, accompanied with signs of threatened suffocation, and followed by frequent yawning, as soon as the patient sat down to dinner. Natrum muriaticum, potency Af-, -,-/, or \\^-, is a most valuable remedy in many obstinate cases, either exhibited as above described, or by giving a dose twice or thrice a week. Plumbum aceticum has been found useful in cases with dyspnoea, oedema, and anasarca. AMENORRHEA. Suppressio Mensium. Suppression of the menses occasionally takes place sud- denly from some accidental cause, such as exposure to cold, po\dft-ful mental emotions, &c. In other instances the sup- pression is symptomatic of some other disease, either organic or functional, and can only be removed by the cure of the pri- mary malady. It is of the former that we here propose to treat. When a suppression takes place from the sudden effects of a chill, we may have recourse to Pulsatilla, if the symptoms generally correspond to those of that remedy as detailed un- der Chlorosis. In other cases arising from this cause, Nux moschata, Dulcamara, Sepia, or Sulphur, may be necessary. (See Chlorosis, for indications for Sulph. and Sep., which are remedies of great service in a large number of cases, when the affection becomes chronic.) When a sudden fright has given rise to the affection, Acon- itum should be immediately administered, followed by Lyco- podium, Opium, or Veratrum, if the bad consequences which frequently result do not yield, or if only partial relief is ob- tained from the employment of Aconitum. (See Mental Emotions, Parts II. and III.) In chronic cases occurring in weak or debilitated individuals, in addition to Sulphur and Sepia, the following remedies are useful: Natrum m., Conium, Arsenic, Cinch., Graph., Caust. Iodium. Whilst in those which occur in plethoric subjects MENSTRUATIO NIMIA. 499 whether of a chronic or recent description, Acon., Bellad., Sul- phur, Bryon., Nux v., Sabina, Opium, Platina, &c, will chiefly be found the most serviceable. When there is not a com- plete suppression, but the menstrual discharge is scanty and insufficient, Graphit., Causticum, Kali, Conium, Natrum m., Phosph., Pulsat.., Sulphur, Lycopod., Magnesia, Silicea,Vera- trum, or Zincum, are the most important remedies. Dose : see Administration, under Chlorosis. MENSTRUATIO NIMIA. MENOCHASIA. MENORRHAGIA. The quantity of the menstrual discharge varies a good deal in different women. Considerable influence is for the most part exerted by climate, constitution, and the manner of liv- ing. The duration of the discharge and the period of re- turn are also variable. In some, it continues from four to ten days, in others, it lasts only a few hours; from three to six days is, however, the most usual. The regularity is, in many, exact to a day, or even an hour, while in others a vari- ation of several days is a usual occurrence, without the slight- est disturbance to the general health resulting there- from. When the discharge is excessive, and attended with pains in the back, loins, and abdomen, resembling those of labour, it becomes necessary to prescribe remedies calculated to arrest it. and to correct the tendency thereto. Amongst these the following are of great utility : Ipecac, Crocus, Sa- bina, Cinch., Nux v., Cham., Platina, Sulph., Calc, &c. Ipecacuanha is generally useful in severe cases of this de- rangement, as well as in flooding after labour, and may in most instances be administered first, unless there are strong indi- cations for a preference being given to any of the others. Administration. -£-. repeated in from six to twenty-four hours.* Crocus is more especially called for when the discharge is of a dark colour, viscid, and very copious ; and the menses have appeared before the usual time. Administration. Same as the above. * Vide note, p. 21. dfc 500 TREATMENT OF FEMALES. r Sabina, when the discharge is excessive, of a bright colour, and occurs in plethoric females who are prone to miscarry, rheumatic pains in the head and limbs; great weakness; pains in the loins similar to those of labour. Administration. s-%s-, repeated in from six to twenty-four hours. Cinchona is of considerable utility after the previous em- ployment of the foregoing, and in all cases where there is great debility in consequence of more copious menstrual dis- charge than natural. Administration. -/, repeated in twenty-four hours. Nux v., when the discharge is of too frequent occurrence, too profuse, and of too long duration ; and when it commonly stops for a day or so and then returns, attended with spasms in the abdomen ; sometimes nausea and fainting, especially in the morning ; pains in the limbs ; restlessness ; irascibili- ty. Nux v. is especially serviceable when the above symp- toms occur in females who are addicted to the daily or fre- quent use of coffee, liqueurs and other stimuli. Administration. -■£ or £-| during the existence of the menstrual discharge, and a globule or two in a teaspoonful of water every fourth day during the interval before the next periodical return. Chamomilla is frequently useful after Nux v., but particu- larly when there is a discharge of dark, clotted blood, with severe colic, or pains like those of labour ; great thirst; pale- ness of the face, and coldness of the limbs. Administration. Same as Nux. Ignatia is of considerable service when the derangement happens in hysterical females. Administration. f£ or \% during the period; the dose to be repeated once during the interval. Platina. Preternaturally increased menstrual discharge, with painful bearing-down pains, and venereal orgasm; thick dark-coloured menstrual blood ; great excitability. Administration. fl°a during the discharge ; to be repeated in flfciity-four hours if the pains continue. dysmenorrhcea. hysterics. 501 Veratrum. Too early or too copious menstrual discharge, always attended with diarrhoea. Administration. ^ or\\~, repeated in twenty-four to forty-eight hours, if required. Sulphur administered thrice during the intervals, allowing ten or twelve days to elapse between the second dose, and followed by Calcarea, in the same manner, has frequently been found successful when any of the previous remedies afforded but temporary relief. In other cases, Belladonna, Bryon., Natrum m., Magnesia m., Sepia, Silicea, or Phospho- rus, &c. may be useful. Dose : same as Nux v. DYSMENORRHEA. In painful and difficult menstruation, or menstrual colic, the most important remedies are the same as those enume- rated under Menorrhagia and Chlorosis, but particularly Chamom., Pulsatilla, Belladonna, Nux, Coffea, Sulph. and Calc, &c* when the disorder occurs with great vehemence at the critical age (tour d'dge). Lachesis is of invaluable assistance, and particularly when diarrhoea, attended with almost insupportable tormina, usu- ally sets in before and after the menstrual period; but the following are likewise of considerable utility : Pulsatilla, Sepia, Sulphur, Cocculus, Ruta, Conium. Against uterine spasms, Cocculus, Pulsatilla, Ignatia, Platina, Cuprum, form the most valuable remedial agents; but in some instances, Nux v., Cinchona, Sulphur, Graphites, Conium or Natrum m., &c. may be more appropriate. Dose : see Administration under Chlorosis. HYSTERICS. Hysteria. Passio Hysterica. This disease appears in paroxysms, is preceded generally by depression of spirits, anxiety, effusion of tears, dyspnoea, nausea, and palpitatio cordis; also with pain in the left side, which seems to advance upwards till it gets to the throat, when it feels as if a ball were lodged there, (globus hystericus ;) if it * We have derived immediate relief from Sabina when all other expe- dients proved inefficacious.—Ed. 502 treatment of females. advanced further, there is sense of suffocation, stupor and in- sensibility, with spasmodic clenching of the jaws ; the trunk of the body is moved about, and ffie limbs agitated ; alternate fits of laughing, crying, and screaming; incoherent expres- sions ; the foaming mouth ; relief ensues generally with eruc- tation, and frequent sighing and sobbing, followed by a sense of soreness over the whole body. Hiccough is sometimes a concomitant, and a very distressing one, in hysteria. These are the usual symptoms accompanying this disease, but the complaint appears in a great variety of forms ; and in many cases the patient is attacked with a violent spasmodic pain in the back, which extends from the spine to the sternum, and eventually becomes fixed at the epigastric region, and is often so intense as to cause clammy perspiration, a pale, cadaverous countenance; coldness of the extremities ; and a feeble thread- like, or scarcely perceptible pulse. Hysteric affections are more frequent in single than in mar- ried life, and usually occur between the age of puberty and that of thirty-five, and generally about the period of menstruation. The disorder is readily excited in those who are subject to it, by sudden mental emotions. They have been known to arise from sympathy and imitation. Women of delicate habit and of extreme nervous sensibil- ity, are chiefly prone to be affected with hysteria, and are predisposed to the attack by an inactive or sedentary life, distress of mind, suppression or obstruction to the periodical illness, excessive depletion, or constant use of spare or un- wholesome diet. Those of a nervous, sanguine or plethoric temperament are chiefly liable to this disease. The best medicines against hysterical affections are: Aurum Bellad., Calc, Caust., Cocc, Con., Ignat., Lach., Mosch., N. mosch., Nux v., Phosph., Plat., Puis., Sepia, Sil, Stram., Sulp., Veral., Valeriana, etc. When the affection arises from Chlorosis or Amenorrhcea see the remedies mentioned under these headings. When from Menorrhagia; see that article. Mental Emotions ; see the same. When the attacks are attended with clenching of the jaws observations on pregnancy. SOS or general spasms, coldness of the extremities, and clammy sweat, particularly on the face and forehead, Veratrum is a valuable remedy. (See also the remedies mentioned under Tetanus, and likewise Lockjaw in Infants.) When violent spasmodic hiccough predominates : Nux v., Bellad., and Stramonium :—Hyoscyamus, Veratrum, Ignatia, Pulsat., Cicuta, Bryonia, and Sulph. will be found the most frequently useful. Dose : see Administr. under Chlorosis. OBSERVATIONS ON PREGNANCY. This period may be looked upon as one of the most inte- resting eras of a woman's life. She is now no longer acting for herself alone, but becomes invested with a new and serious responsibility, and upon some of the most apparently trifling of her actions may depend the future health and happiness of a being bound to her by the fondest ties. From the mass of evidence, collected by careful observers of the operations of nature, we are warranted in drawing the conclusion, that the actions of the mother exercise a great influ- ence over, not only the constitutional and physical, but also the mental organization of her offspring. Keeping this fact in view, we shall endeavour to point out the course that mothers, who prefer the welfare of their future offspring to their own indulgence, should pursue, from which they will derive a dou- ble benefit,—an improvement in their own health, with ex- emption from suffering, and the delight of seeing their children pass safely through the anxious period of infancy ; while in after life beholding them flourishing around them, in the full enjoyment of health and vigour, they will reap the rich re- ward of a slight temporary self-denial, in the delightful con- sciousness of having performed their duty. The leading causes of a weak and sickly offspring are, ill health, or constitutional taint of both or either of the parents; very early or late marriages ; great inequality between the 504 observations on pregnancy. ages of the parties; errors in dress, diet, and general habits of life ; and lastly, powerful mental emotions. The first of these causes, medicine, under the present en- lightened system, possesses powers considerably to obviate, not only by materially modifying or destroying the hereditary taint in the parents, but also by nipping it in the bud when transmitted to the infants. While upon this subject, we may remark, that in many families hereditary diseases are fostered and even exacerbated in virulence by intermarriages between their different members, sometimes disappearing in one gen- eration, and again declaring themselves in the next; but when the habits or mode qflife of communities become more adapted to the natural law, and Homoeopathy, as it must do eventu- ally, completely supersedes the present erroneous system of medicine, we may safely calculate upon the gradual extinction of all hereditary diseases ; and so far, at least, children shall not have to suffer for the follies and faults of their progenitors. Females should seldom, at least in this country, enter into the marriage bond before their twenty-first or twenty-second year ; prior to that period, their organization is scarcely ever fully developed; those who marry at sixteen or eighteen years of age incur the risk of a severe after-suffering them- selves, and of giving birth to weak and delicate children- How very often we see the first children of such marriages perish in infancy, or, after contending through a childhood of continued delicacy, sink into a premature grave ! Women who marry late in life incur considerable personal risk and se- vere suffering in giving birth to children, and the offspring is seldom healthy. The children of old men, although by a young wife, are very often extremely delicate and susceptible to illness ; they not unfrequently precede their father to the grave, or linger on earth but to drag on a miserable and wearisome existence. In concluding these observations, we may remark, that so far is the period of pregnancy from being destined for one of suffering or danger, that nature has taken every precaution for the protection of the female and her future offspring. While pregnancy runs its equable and uniform course, the expectant AIR AND EXERCISE. 505 mother enjoys an almost complete exemption from the power of epidemic or infectious diseases, and chronic complaints are frequently suspended; in fact, with the exception of some slight morning sickness, and occasional trifling uneasiness, a well-constituted organism should enjoy as good health during pregnancy as at any other time ; and many pass through this period, and give birth to vigorous children, without even the most trifling inconvenience. Though, as we have said, nature seems during this period to adopt every possible precaution for the health and preser- vation of the parent and her future offspring, yet are her wise arrangements, in too many instances, rendered nugatory by a direct contravention of her laws. The expectant mother should therefore bear in mind, that the incumbency of a regular, sys- tematic course of life, so essential to every individual, devolves upon her with double force, since every neglect or breach of these ordinances of nature upon her part, is frequently visited with fearful energy upon her yet unborn infant. AIR AND EXERCISE. Nothing tends more to the preservation of health than a proper attention to these* two important points, and yet, unfor- tunately, there are perhaps few more completely lost sight of. Neither air nor exercise is individually sufficient, and those of the more opulent classes in this country, who merely take the air in their carriages, and shun the slightest physical exertion, from long-continued habits of acquired indolence, and who feel any attempt of the kind at this period attended with increased inconvenience, can scarcely expect to enjoy the benefit that nature has annexed to the observance of her laws in a course of pregnancy free from suffering, and the production of a fully- developed and healthy organized offspring. During this epoch, passive or carriage exercise is not suffi- cient ; walking brings not only the physical, but the whole of the organic muscles into play, and communicates the increasing vigour of the mother to her offspring ; on the contrary, contin- ual passive exercise in a carriage has been found particularly injurious during and towards the end of the second period of 22 506 OBSERVATIONS ON PREGNANCY. pregnancy ; and is frequently the cause of premature and ab- * normal births ; exercise on horseback, even not taking into consideration the risk of fright or accident to the rider, and the fearful consequences that may thence result, is still more objectionable for many reasons. A second class, that of thrifty housewives, take a great deal of exercise, yet without a corresponding benefit, from their work occupying them wholly in-doors ; this is a strong proof of the inutility of exercise of itself, unless combined with pure air. Moreover, these females, from too great activity of tem- perament, and others, coerced by hard necessity, frequently over-fatigue themselves, go to bed late, rise early, and some- times unrefreshed, and thus in a manner deaden the energies of the organic powers, to their own injury, and that of the unborn child. A third class of females injure their health, and frequently induce miscarriage, through their excessive levity and thought- lessness, by unrestrained indulgence in active exercise, riding on horseback, but more particularly dancing. A female ought to recollect, that, if through her own folly she has brought on miscarriage, the greatest possible care is necessary to prevent its recurrence; that a second attack increases her liability in future ; and that she who has suffered twice or thrice from this misfortune, even when she escapes it, rarely attains her full time. Moreover, continued casualties of this nature not unfrequently terminate in premature death, from that serious and painful disease, uterine cancer. The best exercise, therefore, for a female during this epoch is walking every day (when the weather permits it) in the open air. In order to prove beneficial, and not to interfere with the process of digestion, exercise ought to be taken two or three hours after a moderate meal, about mid-day, or in the afternoon, except during hot weather, when the evening may be preferred, care being taken to avoid the night damps, by not remaining out too late. CLOTHING. The dress of the female should of course be suited to the season, and if she pass from a warm into a cold atmosphere CLOTHING. 607 she ought to have her neck and throat well protected, so as to avoid any risk of taking cold ; but a point of far greater im- portance is the adaptation of her clothing to the form, so as, as much as possible, to preclude any pressure upon any part of the frame calculated to interfere with the functions of those important organs destined for the birth and nourishment of the infant; therefore lacing, at all times most objectionable, is particularly so during this period, inasmuch as it cramps the natural action of the body, and acting directly upon the abdominal muscles, the blood-vessels, lymphatics, and the whole intestinal economy, produces narrowness of the chest, disturbed circulation, and induration or other derangements of the liver, and exercises a most baneful effect upon the breasts and uterus. We should bear in mind that a pressure upon these organs during development, is acting in direct contra- vention of the operations of nature. Females, in their efforts to preserve the elegance of their shape during pregnancy, are little aware that the constringing force exercised upon the ab- dominal muscles, destroys their elasticity, prevents a proper retraction after parturition, and thus proves one of the most common causes of permanent abdominal deformity; moreover, to the culpable vanity of their mothers, many, it is probable, owe their club-feet and other malformations. In addition to these evils, this practice not unfrequently deranges the posi- tion of the foetus, which displacement, with the consequent want of energy in the muscles, and the parts concerned, ge- nerally brings on protracted and dangerous labours. Besides this, continual pressure on the uterus is liable to produce pre- mature labours. To tight-lacing also may be attributed the difficulty many women of the present day experience in suck- ling their offspring, from the incipient process for the subse- quent secretion of milk being deranged from the unnatural pressure on the beautifully constructed mechanism of the mamma?; from this also sometimes result those dangerous in- durations, cancers, and other affections of the breast, and re- traction and diminution of the nipple, from which the act of suckling is rendered difficult, and in some cases impracticable. Young girls of seventeen or eighteen are frequently found 508 OBSERVATIONS ON PREGNANCY. with pendulous breasts, from the artificial support having taken the office of the muscles, intended by nature for that purpose, and throwing them out of employment. Garters too tightly bound are generally injurious, more particularly to pregnant females, for the pressure thereby ex- ercised upon the blood-vessels encourages the development of varicose vessels in the inferior extremities (to which affec- tion the system is already sufficiently predisposed), which in many instances become exceedingly painful and troublesome. DIET. The greatest simplicity should regulate the diet of the preg- nant female ; she should avoid taking too great a quantity of nourishment, because any excess in this respect, besides caus- ing dyspepsia and general uneasiness, has a bad mechanical effect upon the future offspring; and, moreover, the foetus shares in the derangement of the mother. Much depends upon the quality of her food ; nothing should be taken that is not of a simply nutritive nature, and every thing possessing a medicinal property avoided. Coffee and strong tea should be laid aside. Wine, liqueurs, malt and other stimulating beverages, are also injurious. If the female has been long habituated to wine, it may be taken, if of good quality, in extreme moderation and diluted with water; but better far if stimulants of every kind are altogether avoided; indeed, the usual homoeopathic diet (for which see the article Regimen, in Introduction) should be adopted as closely as possible during pregnancy.) EMPLOYMENT OF THE MIND AND HABITS DURING PREGNANC It is not sufficient that the body may be in perfect health; the mind must also be kept in a state of serenity. An easy cheer- fulness of temper is essentially useful in promoting the well- being of the unborn infant. Experience has presented us with many instances, in which the predominant feeling on the mind of the mother during pregnancy has influence on the future mental organization of the child. This shows how essential it « MENTAL EMOTIONS. 509 is for females to keep their minds well employed during this period, to avoid both improper meditation, dissipation, and reading works not calculated to improve their understanding. Nothing can act more effectually against the future mental and corporeal health of the unborn infant than an oscillatory state of intellect, in combination with physical indolence; the late hours, turning day into night, and other practices of fashiona- ble life, injurious as they are to the most robust constitutions, are doubly reprehensible on the part of the expectant mother. INFLUENCE OF EXTERNAL OBJECTS UPON THE UNBORN INFANT. The effect of any unpleasant or unsightly object upon the imagination of the mother, and its transmission of that effect to the offspring, evidenced in various mental or physical pe- culiarities after birth, is a theory as old as tradition ; without entering JBon the various arguments brought forward both for and against it, we would simply advise females to keep as much as possible out of the way of such objects, to preserve both body and mind in a state of health, which will lessen eve- . ry fear of being affected by such occurrences ; and endeavour, as constantly as possible, to direct their attention to pleasing subjects; as it must be perfectly evident that brooding over such unpleasant impressions can scarcely fail of being both physically and mentally injurious. MENTAL EMOTIONS. This subject has already been treated of in Part II., to which the reader is referred, as the remedies there mentioned are equally applicable to affections arising from these sources in either sex. A not unfrequent symptom during pregnancy, is great de- spondency of mind, and uneasiness about the future; some females, whose spirits are generally good at other times, suf- fer much from this affection during this period; and with others, we find the same feeling and excessive low spirits dur- ing the time of nursing; although not permanent, and when 510 observations on pregnancy. • commencing early in gestation, usually disappearing before delivery, without material injury to the general health. Therapeutics. As this affection is apt to create some un- easiness, both to the sufferer herself and her friends, we have thought it advisable to mention it, and point out remedies which will frequently be found efficacious. Such are Aconitum, Bryonia alba, Nux vomica, Natrum muriaticum, Phosphorus, Calcarea carbonica, and Cinchona. Administration. Four globules of the potency mentioned after each medicine in four dessert-spoonfuls of water, one dai- ly, after which the medicine may be allowed to exhaust its ac- tion ; in the case of those who are known or found to be ex- tremely susceptible to the impressions of the medicines, one or two globules may be given, and only repeated after an inter- val of from four to eight days or so, according to the effects produced.* Aconitum 6. If the state of despondency is meceded by one of excitement, marked by heat of skin, and frequency of pulse, attended wilh apprehension and presentiment of ap- proachiug death. Bryonia 30. Great inquietude and fear of the future, at- tended with irascibility and derangement of the digestive functions. Nux vomica 30. Morning sickness and melancholy, with great uneasiness, impaired appetite, constipation, fretfulness. Natrum muriaticum 30. Melancholy, with weeping, un- easiness about the future, also obstinate cases of morning sickness, not yielding to Nux vomica. When this affection comes on during lactation, arising from an over-secretion of milk, so that this fluid escapes involunta- rily, and is attended with great emaciation, melancholy, and apprehension for the future, we may give Phosphorus 30. Calcarea 18, is also efficacious when the above symptoms present themselves, and more particularly so, when there is excessive dejection with great lassitude. * In the treatment of pregnant woman of exalted nervous sensibility, considerable caution is frequently requisite in the repetition of the dopes. (See also the rules laid down for the repetition of the dose in ordinary cases, in the Introduction, Part I.) MENSTRUATION. 511 This remedy is further very serviceable when there is sup- pression of the secretion, and also excessive obesity, or the individual is of plethoric habit. Both these remedies are also valuable when there is a disposition to consumption. \\ hen there is lowness of spirits, attended with dyspepsia, which may arise from the energies of the mother being too severely tasked in the nourishment of her offspring, either from keeping the child too long unweaned, or from rearing twins, we may administer Cinchona 6. The practitioner will further find occasion to select the following remedies in particular cases : Belladonna, Pulsatilla, Veratrum, Stramo- nium, Platina, Aurum, Cuprum, Lachesis and Sulphur. DERANGEA1ENTS DURING PREGNANCY. MENSTRUATION. . Virtual diseases during gestation are of rare occurrence but when they do happen, they ought to be treated accord- ingly. A continuance of menstruation is not an actual disease, but rather an exception to the general course of nature ; nor must we here mistakipheir operation for an indication of the utility of the lancet, for neither in this nor in any other case, can the artificial supply the place of natural bleeding; however, when the female appears to suffer from the continuance of the men- strual flux, wemust call in the assistance of medicaments, among which the principal are : Cocculus, Phosphorus, and Platina. Administration. ^ repeated every twenty-four hours until improvement takes place, or another remedy appears called for. (Vide note, p. 21.) Cocculus. A sanguineous mucous discharge, and very severe spasmodic pains in the lower part of the abdomen. Phosphorus. Discharge of blood, with decisive pains in the back, and occasionally vomiting. Platixa. Discharge very profuse, attended with a severe pain and bearing down. (See also the remedies given under Painful and difficult menstruation. Excessive menstruation.) 512 derangement during pregnancy. MORNING SICKNESS. Morning siekness, nausea, vomiting, and heartburn, are the most distressing symptoms attendant on the course of preg- nancy ; these .troublesome complaints harass women most upon their first rising from a horizontal position in bed. They generally disappear soon after quickening, but sometimes continue during the whole period. The numerous palliative remedies reco mmendedlby Allopathists—leeches, cupping- glasses, blisters, aperients, sedatives, etc. etc., unfortunately too often fail in effecting their object; and in severe cases, when the stomach becomes enfeebled, the hazardous resource of artificially produced premature labour is resorted to. Therapeutics. The homceopathic treatment of this de- rangement, at once simple, prompt, and efficacious, has in al- most all cases been stamped by the signet of success. In in- stances free from complication, with a tendency to relaxation of the bowels, Ipecacuanha is generally sufficient. Administration. - j-, in four teaspoonfuls of water, one morning and evening. (Vide note, p. 21.) Nux vomica. When there is nausea or vomiting every morn- ing on rising; heartburn, depraved appetite, or craving for chalk, earth, beer, etc., constipation and irritability of temper. Administration. Q3Q0fl, repeated every foi^fch day, but if no improvement results after the second or third dose, another remedy must be substituted, such as Pulsatilla or Natrum m., etc., and then again Nux v., if required. Arsenicum. Excessive vomiting after eating or drinking, with attacks of fainting ; great weakness and emaciation. Administration. Same as Ipecacuanha, but at the twelfth or thirtieth potency. Pulsatilla. Nausea after every meal; vomiting of ingesta, heartburn, depraved appetite, or longing for particular articles, such as acids, beer, wine, etc. Disposition peevish and sensi- tive, though naturally mild.- Conium, Acidum nitricum, Magnesia, Phosphorus, Bryonia, and Lycopodium, etc., will also be found useful in particular cases. When this affection shows itself in a mild form, it may be CONSTIPATION. DIARRHC3A. FAINTING. 513 left to nature, adopting at the same time the homceopathic rules for regimen, and be careful not to overload the stomach. In severe cases depending upon^plethoric tendency, Aconitum is an excellent substitute for the venesection recommended by the old school. CONSTIPATION Is a very common attendant upon pregnancy, and those usu- ally suffer most who are naturally of a costive habit; when it does not arise from a mechanical cause, active exercise in the open air, and partaking frequently of cooked or fully ripe sub-acid fruits, (at the same time avoiding coffee and other stimulating liquids,) are generally sufficient. When nature requires further auxiliary :— Nux Vomica y5°, taken at bed-time, will often answer; if after the completion of the action, there still remains some inconvenience, Ignatia, -,fi2-, should be given as an interme- diate, followed by a lower potency of Nux vomica (°|°); in other cases, when Nux vomica does not show a marked im- provement, and the temper is extremely irritable, Bryonia °|° will sometimes cure, or Opium °|°, which is especially in- dicated to follow Nux vomica when there appears to be a weight in the stomach, dryness of the mouth, and deep flushing of the face. In other cases, Sepia, Lycopodium, Alumina, etc., will be found useful. (See Constipation, Part II., p. 123.) Dysuria. Pulsatilla, Cocculus, Nux v., and Acid, phospho- ricum, as also Sulphur and Conium, have chiefly been recom- mended. DIARRHOEA DURING PREGNANCY. See Diarrhoea, Part II., p. 137, and Diarrhoea in Lying- in Women, in this division of the work. FAINTING AND HYSTERIC FITS. Many delicate and nervous females are frequently attacked with fainting fits during pregnancy. The attack generally passes over easily and without deleterious consequences; ex- ercise in the open air, and attention to the rules of regimen, 22* 514 DERANGEMENTS DURING PREGNANCY. are the best safeguards; but in cases where these are insuffi- cient, and the attacks prove distressing, we must endeavour to ascertain their origin. If ftpm tight-lacing, warm rooms, or any other obvious excitant, its simple removal is sufficient; should the sufferer remain long insensible, the speediest means of revival is sprinkling the face with cold water. W hen aris- ing from plethoric habit, returns of the attack may be pre- vented by Aconite, of which we have had occasion to speak several times as a general regulator of the circulation. Chamomilla °t02°, when the fainting is excited by sudden fits of anger. Nux vomica -3-a-, when from general irritability of system, and consequent gastric derangement. Belladonna -3£u-, when there is determination of blood to the head, with simultaneous flushing of face and perceptibly increased action of the arterial system. (Alternately with Aconite when required.) Cinchona ^4, when arising from general weakness, and especially from loss of blood. Pulsatilla ff. General excitability and disposition to hysteria, with hypochondriasis and great general susceptibility. Coffea. Abdominal spasms, with oppressed respiration, subsultus tendinum, cold perspiration, and uncontrollable agi- tation and jactitation. When the symptoms are generally preceded by a pain which proceeds upwards from the lower part of the bowrels, left side, into the stomach, and from thence into the throat, where it creates a disagreeable and suffocative sensation as if a ball were lodged there, Lachesis, Belladon- na, Sepia and Plumbum, or Ignatia, Sulphur, Nux v., Conium, etc., will prove useful, a preference being given to that rem- edy which corresponds the most closely to the whole features of the case. Ignatia f §, when the patient suffers from severe headache, as if a nail were driven into the head; sadness ; concealed sorrow and sighing. (See Swooning.) Administration of the above remedies. The dose is given repeated, if necessary, every two to four days, according to the urgency of the symptoms, until relief is obtained, or an- other remedy required. (Vide note, p. 21.) toothache. 515 TOOTHACHE. Is a frequent affection with pregnant women, and is some- times too valuable an indication of some taint lurking in the constitution to be neglected ; the female should, as soon as she is in a proper state, put herself under a course of treat- ment, as until this tendency is eradicated, no remedies can prove otherwise than palliative. We must particularly cau- tion females in this situation against having teeth extracted, as the affection frequently occurs in sound ones. Therapeutics. To relieve the sufferings, the following medicines may often be given with advantage : Sepia, Calca- rea, Alumina, and Magnesia carbonica. For the Administration of the remedies, see Toothache, Part II., where, moreover, other useful remedies will be found. Sepia -3ft0-, is particularly indicated when there is pulsative shooting, drawing toothache, with pain, extending to the ears, or to the arms and fingers, excited by compressing the teeth, or by cold air, and attended by repeated respiration, swelling of the cheek and enlargement of the submaxillary glands. Calcarea —-, when it is excited or aggravated by cold air, or any thing hot or cold,and attended with painful sensation of the gums, and pulsative gnawing or shooting pains, which are aggravated by noise. Alumina ^°0-, when the pains are excited by mastication, or in the evening in bed, and when of a tearing nature, extend- ing to the cheek-bone, temple, and forehead. Magnesia carbonica —-. Nocturnal pains in the teeth, insupportable when lying down, and compelling the patient to get up and walk; pains generally boring, burning, drawing, tearing, and resembling those of ulceration, attended with swelling of the cheek of the side affected; throbbing and shooting in the teeth after a meal; pain aggravated by a cold. The above are the four leading medicines, though there are others which are demonstrable by peculiar symptoms. (See TooTHACHE,Part II., p. 77.) 516 DERANGEMENTS DURING PREGNANCY. SWELLED FACE. Tumefaction of the cheek arises from different causes ; fre- quently it is the consequence of toothache, and will then be cured, or at all events much diminished, by the remedy given for the removal of that affection. Sometimes it happens, nevertheless, that from the employment of the proper remedy the toothache diminishes, but the swelling of the cheek remains unaltered. In this case Arnica is generally of great service, especially when the swelling is hard and stiff. If this treat- ment is of no avail, we may have recourse to Pulsatilla -^ or to Mercurius vivus °6°, which is of especial service if the swelling of the cheek is accompanied by a drawing, tearing pain, and increased flow of saliva, and considerable erysipe- latous redness; followed by Belladonna and Hepar s. *$-, if the inflammation threatens to extend. (See Erysipelas.) Cham, Bryonia, y, etc,, are also occasionally of service. Should we have neglected to employ the appropriate reme- dy at the proper time, or should the swelling have been mal- treated by some external application, the swelling is frequent- ly rendered of an obstinate character. In most cases, however, the dispersion of the tumour, or, when matter is forming, the speedy completion of the suppu- rative process and consecutive bursting of the abscess, will be. readily enough effected by means of Hepar sulphuris, one grain of the third trituration, repeated if necessary in from six to twelve hours. In obstinate cases, Lachesis and Hepar, or Mercurius and Hepar, in alternation, are sometimes required; and occasion- ally Silicea, particularly in strumous habits. The application of a poultice to the cheek, or a fig boiled in milk and placed in the mouth between the affected cheek and gums, is some- times useful. If the tumour has burst, and the opening is in- ternal, no especial care need be taken of it; but if it has burst externally, a simple bandage, smeared with melted suet or fresh butter, must be applied. Dose &%*, twice a day. VARICES. 517 VARICES, OR SWELLED VEINS. Many females suffer much during pregnancy from distention of veins in the thigh and other parts, which becoming more exacerbated, eventually cause great pain and inconvenience. These varicose veins generally arise from obstructed circula- tion caused by the pressure of the gravid uterus upon the bloodvessels, but are also frequently a sure indication of the existence of constitutional debility, particularly when they occur in an aggravated form. They, are much increased by partaking of stimulating liquids, which should consequently be avoided. Considerable alleviation is experienced by con- stant bathing with water, or with diluted alcohol; also by bandaging from the foot upwards with a gentle and equable pressure, and by preserving a recumbent posture, which is requisite in severe forms of the complaint accompanied with considerable swelling of the feet, ankles, &c. For consider- able relief, we may have recourse to the following remedies : Pulsatilla Af fa is one of the most useful medicines, par- ticularly when there is excessive pain and swelling, with a good deal of inflammation, or when the veins are of a livid colour, which is imparted to the whole limb. Should Pulsatilla give some relief, but the swelling and livid discoloration continue in much the same state, Lachesis may be substituted. Arnica is of material service when the occupations of the patient render it impossible for her to lay up or avoid much standing and moving about in discharge of her domestic duties. Ar- nica and Pulsatilla in alternation, every six or eight days, have been found of great efficacy in such cases. Nux vom. -%~, when attended with constipation, hemor- rhoids, and irritability of temper. Sulphur is sometimes very beneficial after Nux v. Arsenicum °§%°, when the veins are of a livid colour, and are attended with severe burning pain. Carbo veget. 9%%°, where the former is not sufficient to subdue the constant scalding or burning. Belladonna fl|p. Varices, with considerable erysipela- tous inflammation. Lycopodium °§£°, has been employed with success in some inveterate cases. 518 derangements during pregnancy. Administration. Four globules of the potency named after each medicine in as many teaspoonfuls of water, one to be taken night and morning. (Vide note, p. 21.) The simultaneous application of the remedy employed, is occasionally attended with benefit. For a permanent eradication, a course of treatment is re- quisite, in which—Sulphur, Graphites, Carbo veg., Sepia, &c, are useful. (See Ulcers, Part II.) PAINS IN THE BACK DURING PREGNANCY. Lumbosacral Pains. Some females suffer much from pains in the lower part of the back during pregnancy, which occasionally prove extreme- ly distressing, particularly when they occur during the night, and tend to disturb sleep. They generally consist of an al- most indescribable aching, or of an obtuse, heavy pressure, as if caused by a dead weight resting on the affected part. Kali carb. has repeatedly been employed against them with the most satisfactory results, especially when they partake of the character described. In other cases, Bry., Rhus, Sulph., Lycop., Pulsa'., Nux v., Sepia, or Caust., &c, may be given with advantage. If hemorrhoidal sufferings become added to these troublesome pains, and Kali c prove insufficient to relieve the complaint in this complicated form, Nux v., Sulph., or Sepia, may be prescribed with advantage. See Hemor- rhoids ; as also the indications given for the remedies under the heading of False Pains. Dose: °|° or °|°. MISCARRIAGE. Abortus. From the increasing number of homoeopathic practitioners in this country, a point already alluded to in the Preface, we are justified in looking forward to a period, not far distant, when there will be no difficulty in obtaining professional assistance in misfortunes of this nature. I shall here endea- vour, as briefly but at the same as clearly as possible, to point out the treatment best to be pursued, both in prevent- ing its occurrence, and in obviating the consequences it en- tails when medical aid has been called in too late, or when it has been found impracticable to avert the evil. MISCARRIAGE. 519 Women who have once suffered from this affection are ex- ceedingly obnoxious to its recurrence, and this liability is still further increased if the event have taken place a second or third time. It may occur at any period between the first and seventh month, but in the majority of cases takes place about the third or the beginning of the fourth. When before or about this period it is frequently attended with but little pain or danger, although repeated miscarriages, from the great dis- charge that is generally present, break down the constitution, and frequently develop severe chronic diseases. When mis- carriage takes place at a more advanced period, it assumes a very serious complexion, and is often accompanied with a con- siderable degree of peril to the sufferer. The premonitory and accompanying symptoms of miscar- riage vary much in their nature ; sometimes the discharge is exceedingly profuse, at others moderate or inconsiderable; the pains, in many instances, extremely severe and protracted, are in others very slight and of short continuance. Sudden mental emotions, or great physical exertion, mechan- ical injuries, a luxurious mode of life, fashionable habits, pow- erful aperients, neglecting to take air and exercise, are a few of the exciting causes of this affection, which is particularly apt to occur in both highly plethoric or delicate and nervous habits. An abnormal condition of the constitution is un- doubtedly the predisposing cause. Miscarriage is, in most cases, preceded and attended by the majority of the following symptoms :—A sensation of chill, followed by fever, with more or less bearing down, particular- ly when occurring late in pregnancy ; also, severe pains in the abdomen, drawing and cutting pains in the loins, or pains fre- quently bearing close resemblance to those of labour; dis- charge of viscid mucus, and blood, sometimes of a bright red, not unfrequently mixed with coagula, at others dark and clot- ted, followed by the emission of a serous fluid. The miscar- riage generally takes place during this discharge, which occa- sionally continues, if not properly checked, to flow for hours after, placing the sufferer in considerable jeopardy. When the pains increase in intensity, and the muscular contractions be- 520 DERANGEMENTS DURING PREGNANCT. come generally established, with their characteristic regular throes, and efforts to dilate the mouth of the womb, miscar- riage is almost inevitable. . Therapeutics. As preventives of this affection, the princi- pal remedies are: Sabina, Secale cornutum, Kali c, Lye, Sep., and Calc When the premonitory symptoms declare themselves, Cha- momilla, Nux vomica, Ferrum metallicum, Ipecacuanha, Sabina, and Calcarea. The same with the additions of Hyoscyamus, Crocus, and Secale cornutum, after the misfortune has taken place. Cinchona is also valuable when the indications which we shall givq^br that medicine are present. In cases where there is an evident disposition to miscarriage, or where, from a variety of reasons, it is apprehended, the administration of Sabina, -aa, in the early stage of pregnan- cy, will frequently prevent its occurrence. Administration. We may allow four or five days to elapse between the first and second dose, and gradually lengthen the interval for each successive administration, until the period of danger be past, being careful, however, on watching the effect of each dose, discontinuing the medicine whenever any indi- cations of its actions on the system become apparent, and not repeating until the symptoms attributable to the medicine have passed away, and then only with increased caution, and at longer intervals. Hartmann* strongly recommends Secale cornutum ff as useful in similar cases, but particularly when this misfortune has already occurred more than once; it should be adminis- tered every fourteen days, commencing immediately after the cessation of the monthly period, and continuing until the pe- riod at which miscarriage usually occurs is past; one dose more, at the utmost, being allowed after this period. Both these remedies are also extremely valuable after mis- carriage has taken place, the latter particularly in weak or ex- hausted persons, or in those cases of hemorrhage in which the discharge consists of dark liquid blood, and is followed by con- ♦Hartmann's Acute Diseases, by Chs. Hempel, M. D., vol. iii.,p. 164. MISCARRIAGE. 521 siderable debility ; this remedy is also efficacious in cases of inevitable miscarriage, attended with feeble expulsive efforts ; the former (Sabina) when there are dragging and forcing pains, extending down the back and loins ; profuse, bright-coloured hemorrhage, sensation of sinking or faintness in the abdomen; frequent desire to relieve the bowels; diarrhoea ; nausea or vomiting; chilliness and heat, with fever. Lycopodium and Kali carbonicum °|° have also been re- commended as useful preventive remedies against habitual tendency to abortion, the latter especially when the symptoms are always preceded or attended by severe pain in the loins. We shall now treat of miscarriage when the premonitory symptoms have set in, giving, under the same head the indica- tions for the use of the medicaments, where the result is una- voidable or has already taken place, as even in these cases their administration is decidedly beneficial in obviating further in- jurious consequences, and in alleviating the sufferings of the patient. The remedies in these cases are, in addition to the two above mentioned, Arnica, Chamomilla, Nux vomica, Ipe- cacuanha, Hyoscyamus, Belladonna, Crocus, Ferrum metalli- cum, and Calcarea. Arnica -§-. When the symptoms have been excited by an accident, such as a fall, blow, or concussion, etc., this re- medy should be immediately administered. Chamomilla, -§- when there are present: excessive restless- ness, convulsions, twitching in the back and limbs ; severe pains in the loins and back, worse at night, generally of a sharp cutting description, extending downwards, strongly resem- bling those of labour ; sometimes also abdominal spasms, with a species of sanguineous discharge; or discharge of deep red or dark coagulated blood; frequent yawning; coldness and shivering. Nux vomica -%-. Obstinate constipation, with a varicose condition of the internal organs of generation ; also when the patient has been accustomed to a stimulating diet, and the use of coffee; severe burning, or wrenching pains in the loins; painful pressure downwards and mucous discharge. (Bryonia is sometimes of benefit, when Nux v. fails to do muoh good.) See also Calcarea. 522 DERANGEMENTS DURING PREGNANCY. Ipecacuanha £^. Chill with heat; violent pressure down- wards ; flooding; cramp and rigidity of the frame ; some- times convulsions; vomiting, or desire to vomit; disposition to faint whenever the head is raised, cutting pains in the um- bilical region. (Platina or Cina have been recommended when Ipecac, fails.) Hyoscyamus y0°, when the convulsions are very severe, with cries, great anguish, oppression of the chest, and loss of consciousness. Belladonna -§-, is perhaps more frequently required either at the commencement, or subsequently, than any other re- medy. The following are its leading indications : great pains in the loins and entire abdomen; severe bearing down, as if the wdiole of the intestines would be pressed out; pain in the back, as if it were dislocated or broken ; bruised pain in the sacral region; sensation either of spasmodic constriction, or of expansion in the abdomen. It is also particularly valuable in cases of profuse hemorrhage, the discharge of blood being neither very bright nor dark-coloured after miscarriage. Pla- tina is sometimes to be preferred to Belladonna, when, along with bearing down pains, there is a thick and dark-coloured discharge, attended with venereal orgasm. Ferrum metallicum °§°, is a useful medicine in cases of miscarriage attended with fever, labour-like pains, and consi- derable sanguineous discharge. Crocus -§a, is especially indicated in cases which are at- tended or followed by discharge of dark, coagulated or viscid blood, with a sensation as of something moving or fluttering about in the umbilical region, and increased sanguineous dis- charge on the slightest movement. This remedy is frequent- ly useful in obstinate cases, after the employment of one or more of the above mentioned remedies. Cinchona flga, is valuable in the restoring the exhausted energies, after the hemorrhage, or materially assists in check- ing the discharge should there be spasmodic pain in the womb, or bearing-down sensation, with considerable discharge of blood at intervals. Calcarea -f -, is a remedy of considerable importance in the miscarriage. 523 treatment of cases where the affection has apparently been induced by a varicose state of the veins of the parts. It is also of value as a preventive, and especially where the patient is of a plethoric habit, with a tender or irritable skin, and other strumous appearances. Sepia, §^. In threatening attacks of abortus from general plethora, or from local congestions and obstructed circulation, with sensation of weight in the abdomen, determination to the head and chest, and excessive nervous excitability, this remedy has been employed with success. When Mental Emotion has given rise to the symptoms of miscarriage, see the remedies given under that heading, Part II. Administration. A few globules, or, where necessary, one minim in an ounce of water, a teaspoonful every few minutes to half hour, hour, or only every three or four hours, according to the nature of the case, lengthening the intervals or discon- tinuing the medicine when decided benefit, or a stoppage of the hemorrhage is effected. When a favourable effect does not follow after the second or third dose in serious cases, another remedy must be had recourse to. Vide note, p. 21. When violent hemorrhage is present, and does not cease under the employment of any of the before-mentioned medicines, Acid. nitricum may be administered. Cold water is also useful. I have thus enumerated some of the principal homoeopathic remedies which are employed in the different stages of this misfortune, and have endeavoured to point out the peculiar indications for the selection of the proper medicament as succinctly, and at the same time as fully, as it is possible to do in a work like the present. In concluding the subject, I shall briefly notify a few precautionary measures that the pa- tient ought to observe while threatened with, or after having suffered from the affliction. When miscarriage is threatened, the individual must as- sume the recumbent posture, and in some cases, indeed, should be strictly confined to bed, sleeping with few bed- clothes ; the apartment should be kept cool, and every means must be employed to ensure perfect tranquillity of mind. 524 TREATMENT BEFORE PARTURITION. The diet prescribed in cases under homoeopathic treatment should be closely followed, and warm fluids generally avoided. When the misfortune has proved unavoidable, or has actually taken place, before assistance has been sought, the patient ought still to be confined to bed for a few days, lest a fresh discharge should be brought about by too eaiiy a change from a horizontal to an upright posture ; and on future occasions, when a similar period comes round, great care should be ta- ken that the mishap may not again occur; in the attainment of this desirable object, we feel confident that nothing will tend so fully to ensure success, as a timely exhibition of one or other of the preventive remedies already commented on. TREATMENT BEFORE PARTURITION. PREPARATION OF THE BREASTS. Young mothers frequently find great difficulty in suckling their children, in consequence of organic defect or incapacity of the nipple. In every case, a preparation of the breasts is necessary some weeks before delivery, in order to prepare them for their future offices. In many instances the structure of the breasts is disorganized from an ignorant nurse having compressed them in childhood, from the idea that such a pro- cess was needful for the expulsion of some matter in the breasts of the child—a vulgar error—a practice against which mothers ought to be particularly watchful. Inability of function is also likely to occur from the pressure of stays in after life, by which the cuticle is rendered so tender, as to preclude suckling. The first two cases are beyond the power of art. If suck- ling be attempted, induration of the nipple and mamma ensue, attended with severe suffering; when, however, a simple ten- derness of the epidermis exists, this evil is much alleviated when the nipples are bathed with brandy twice a day, for several weeks anterior to delivery. Another difficulty, fre- REMEDIES BEFORE LABOUR. 525 quently accompanying this state, is a shortness or retraction of the nipple, so that the infant cannot take hold of it; this defect is frequently the cause of the first, from the ineffectual efforts of the child to suck injuring the part; in this case ap- propriate shields of soft wood may be applied to accustom the nipple to elongate and protrude, so as to present sufficient hold for the infant, when the period for sucking arrives, when the efforts of the child will still further contribute towards the effecting of this object. In this case also, bathing with brandy will naturally tend to correct any tenderness of the skin, and prevent subsequent excoriation. It may also be here remark- ed, that when any tenderness exists during the period of lac- tation, between the intervals of the infant being applied to the - breast, the shield should be resumed, and the bathing contin- ued, due care being always taken to lave the nipple carefully with tepid water, before it is again offered to the child.* REMEDIES BEFORE LABOUR. Many things are recommended by the old school previous to labour, such as frequent bloodlettings and aperients; but these, instead of promoting the object desired, have a contra- ry effect, by lowering the energies requisite at such an event- ful period, and by placing the nervous system in an abnormal state of irritation and excitement; when this loss of humour is brought about in the first period of pregnancy, it defeats its own ect, by what are commonly called plethoric symp- toms, induced by the reaction in the organism, to supply this uncalled-for waste, and this always taking place with a cor- respondent expenditure of vital power. It is a species of in- fatuation to disturb the regular course of nature, by the ill- directed efforts of art, where an evident plethoric state exists; this object is much more safely and effectually attained by the internal administration of a specific remedy, such as a dose or two of Aconite 00-°, which may be followed by Belladonna, * When severe pains are experienced in the breast after each applica- tion of the infant, the employment of Phellandrium aquaticum has been found advantageous. 526 TREATMENT BEFORE PARTURITION. should there be symptoms of active congestion with fiery redness of the face, accelerated action of the carotids, etc. An artificial evacuation, previous to delivery, may be ob- tained by a lavement of lukewarm water, repeated, with a small quantity of linseed oil, when necessary, from a failure in the first attempt to obtain the desired effect. FALSE PAINS. Before proceeding to notice parturition, a few words may be said upon the so-called false, spurious, or intestinal pains brought about by congestion of blood to the uterus, errors in regimen, emotions of the mind, effects of chill in the ab- domen, and a variety of other causes :—they sometimes pre- cede labour but a few hours, but in many cases come on some days, and even weeks before delivery ; they chiefly differ from labour pains in the irregularity of their recurrence, in being unconnected with uterine contraction, and chiefly confined to the abdomen, with sensibility to touch and movement, and in not increasing in intensity as they return; sometimes, from their close resemblance, it is extremely difficult to dis- criminate between them and the real labour-pains, but in such cases we must be chiefly guided by the period of gestation ;* and our safest mode of procedure is, to endeavour to miti- gate the patient's sufferings, if they be considerable, or come on a wreek or two before labour is expected, by the adminis- tration of a proper remedy, as, if we allow them to proceed unchecked, they not unfrequently continue till the moment of delivery, rendering the labour much more painful, exhausting, and difficult. Therapeutics. The following medicaments may be had recourse to with effect: Bryonia, Nux vomica, Pulsatilla, Dul- camara, and Aconitum,—selecting the one most suitable for the affection, according to the causes and symptoms. Bryonia, when there are pains in the loins resembling a dragging weight, attended with constipation and irritability, much increased by motion, with abdominal pains preceding * If the os uteri be found unaltered, and consequently not enlarged or elongated, it may with certainty be concluded that the pains are spurious. FALSE PAfNS. 527 those in the back. (This remedy is more particularly indi- cated when the above symptoms have been excited by a fit of passion.) Administration. •»y»») jn four teaspoonfuls of water, one morning and evening, or oftener if necessary, until relief is obtained. (Vide note, p. 21.) Nux vomica. Similar pains in the abdomen, and back; also when there is pain in the region of the pubis, as if from the effects of a bruise ; the symptoms arise chiefly at night. YV hen the exciting cause appears to be constipation, or men- tal irritation, or when a too luxurious mode of living, stimu- lants, coffee, or spirituous liquors, there is additional reason for selecting Nux v. Administration. ££, taken in a little water at bedtime, re- peating it in six, twelve, or forty-eight hours, according to ne- cessity, if required. Pulsatilla, £§. Similar abdominal pains; pains in the loins resembling those from continued stooping, or the pres- sure of a tight bandage, attended with a sensation of rigidity, and painful dragging and aching in the thighs ; constipation or relaxation; mildness of temper or great sensibility. This re- medy is particularly valuable when these pains appear to have arisen from indigestion brought on by rich, indigestible food. Administration, Same as Nux v. Dulcamara f f, is chiefly useful when the origin may be traced to cold, and the pains are of a violent shooting and drawing nature, situated in the small of the back, generally coming on at night. When spurious pains arise from emo- tions of the mind, we may consult Mental Emotions. Aconitum. When these pains occur in young plethoric subjects, attended with accelerated and strong pulse, flushing of the face, and increased temperature of the skin. Administration. •»y« °, in four dessert-spoonfuls of wa- ter, one every six, twelve, or twenty-four hours, according to the relief obtained or the violence of the symptoms. The employment of this remedy completely obviates vene- section. 528 TREATMENT BEFORE PARTURITION. PARTURITION. Natural labour takes place at the end of the ninth month of pregnancy ; the uterine contractions are regular and effect- ive, and the whole process does not continue beyond twenty- four hours, rarely above twelve, and very frequently not longer than six. Were it not for the acquired habits of civilized life—improper diet—the proportions of the female frame be- ing distorted by tight lacing, &c.,* and their regular functions thereby disturbed—diseases generated by the want of proper air or exercise, or both—hereditary maladies, &c, parturition would be comparatively free from pain and remote from danger, as in fact it is, even at the present day, generally found amongst savages. TEDIOUS OR COMPLICATED LABOURS. When labour is protracted beyond the normal period stated, or is attended with an excessive degree of suffering, as is more prone to happen when the female is of a slender form and of a highly nervous and sensitive habit, it becomes incumbent on us to avail ourselves of all the means which art affords, in order to endeavour to alleviate those sufferings as much as possible. Amongst the medicines best suited to attain this desirable result, we shall frequently find Coffea cruda of considerable service in mitigating the pains when they are extremely vio- lent and occur in rapid succession, scarcely allowing the fe- male an interval of ease, and are attended with excessive agi- tation, bordering on despair. When Coffea ^§a affords but little relief, which is generally the case when the patient has constantly or frequently been in the habit of using coffee as a beverage, Aconitum should be resorted to, followed by Chamom. °§°, if required. Administration. Four or five globules of the remedy se- * It is to be regretted that the attention of moth rs is not mo?e particu- larly directed to the development of the female frame by means of calis- thenic exercises, instead of distorting its symmetry by means of stays and tight lacing; health being destroyed for the sake of that fashionable and unnatural absurdity-—a thin waist! TEDIOUS labours. 529 lected, in two tablespoonfuls of water, of which a teaspoonful may be administered every five or ten minutes, until some relief is experienced. If little or no benefit ensue after seve- ral doses, another medicine may be prescribed. When we find that the throes are insufficient to accomplish their object, and the female becomes exhausted by the protracted nature of the labour,—Belladonna, •*?, has been found of the greatest value, and will generally prove serviceable in almost every case of tedious labour which arises from the rigidity and unyielding state of the parts, (as is so frequently the case with elderly females giving birth to their first child;) but it is more particularly where labour is protracted by a spasmo- dic contraction of the inferior portion of the uterus, owing to which circumstance, notwithstanding the existence of power- ful throes, the os uteri does not become correspondingly dilated, that the Belladonna is indicated. On the other hand, this valuable remedy is further of equal efficacy, when, on the es- cape of the waters, an almost complete cessation of the labour- pain ensues, or the uterine contractions are rendered so feeble as scarcely to be perceptible, and are only made known to the patient by a periodic sensation of pressure and aching at the sacral region—while the dilatation of the os uteri is found, as in the above instance, to make no further progress. The following remedies will also occasionally claim atten- tion : Nux v., Pulsatilla, Secale cornutum, and Opium. Nux v. °f- , when the labour is somewhat protracted, from the irregularity and insufficiency of the pains, and the female complains of a continual urgency to relieve nature. Pulsatilla °^°, where the labour-throes are imperfect, and frequently extend upwards from the sacral to the epi- gastric region, attended with spasm of the stomach and vo- miting ; or when they are almost unfelt, and at long inter- vals, attended with acute pains in the loins, and painful draw- ing sensations in the thighs, which tend much to weaken the woman, without furthering the labour. When Pulsatilla has not had the desired effect, and there is a continual deficiency of uterine contractile power; or when the labour pains return every quarter of an hour, not increasing in 23 530 TREATMENT BEFORE PARTURITION. intensity, Secale cornutum § or g ought to be administered. Again, when we find the pains, although powerful at first, sud- denly cease, followed by a tremour of the whole body, occa- sionally interrupted by violent jerkings, and when the patient falls into a sort of lethargic slumber, with open mouth, sterto- rous breathing, eyes half closed—and there is great difficulty in arousing the sufferer, even by violent means, Opium °f is indicated. Administration. A few globules of the remedy at th potency mentioned, may be dissolved in about an ounce of water, and a dessert-spoonful given between each pain, until benefit results, or a marked action of the remedy calls for a pause. When the pains suddenly dissappear without other indications, one or two drops of the Mother Tincture of Cin- namon have proved of service, especially when the labour is far advanced. We have now, in a great measure, treated of the course to be pursued when nature seems to call for our assistance to further her exertions ; but we must at the same time repro- bate a rash and ill-advised interference with her operations ; and we cannot, in common with most men of eminence of the other school, too strongly reprehend the practice of administer- ing spirituous beverages, or stimulants, such as chamomile tea, and other ptisans, coffee, and even opium, under the ab- surd impression of thereby facilitating delivery. Spirituous liquors are objectionable, from their accelerat- ing circulation, and consequently producing difficult labour, and too great a loss of blood ; Coffee, from its causing high nervous excitability ; Chamomile, from its pathogenetic pro- perty of producing or creating a tendency to metrorrhagia; ptisans, whose peculiar properties we need not enter upon here, are all more or less of a stimulative or irritative nature. Opium, given merely as a palliative of the severity of the throes, materially retards delivery. As a general rule, every substance, possessing a medicinal property, administered upon the false premises above noticed, tends to injury, and must therefore be carefully avoided. With regard to the after-birth, when common, gentle and SPASMODIC PAINS. 531 rational mechanical.means* for its expulsion fail, we may have recourse to Belladonna, Pulsat., Secale corn., or Opium, -§-, selecting by the symptoms already mentioned, and will rare- ly be disappointed in our expectations or their beneficial effects. When the parturition is complete, the Administration of Arnica -f-, in a little water, is always followed by the happiest results, frequently preventing much severe after- suffering ; and we are convinced, that many critical cases of inflammation, &c, might thereby be warded off. In instances where the labour has been very protracted, the Arnica in lo- tion, one teaspoonful of the Tincture to two ounces of tepid water, applied externally, will be found to afford great relief. SPASMODIC PAINS, CRAMPS, AND CONVULSIONS. We sometimes, in complicated labours, find spasmodic pains set in, which occasion considerable suffering without advanc- ing the birth. Therapeutics. The principal remedies against these affec- tions are: Chamomilla, Belladonna, Hyoscyamus, Stramonium, Cicuta virosa, Ignatia, Ipecacuanha, and Cocculus; with re- gard to their Administration, two globules of the potency men- tioned may be administered in a teaspoonful of wTater, and re- peated after a shorter or longer interval if necessary, accord- ing to the effects produced, being guided in their selection by the following symptoms: * "We do not understand by the said term the exercise of brute force ; it is truly melancholy, and almost impossible to conceive, that men who have undergone a medical education, and have had opportunities both of reading and hearing the warnings of enlightened and experienced obstetric practitioners, against the distressing and serious consequences which almost inevitably result from the employment of harsh and inconsiderate measures whenever the expulsion of the placenta happens to be somewhat tardy, could be guilty of the perpetration of such culpable and infamous conduct. Some of these reckless individuals do not appear to wait for any signs of tardiness, but as if in anticipation of an obstinate and prolonged retention, they set to work with their ruthless proceedings immediately, and are consequently, but too frequently, the authors of all the mischief, danger, and even the fatal termination, which sometimes result after the natural process of labour. 532 TREATMENT AFTER DELIVERY. Chamomilla, *,*> where there is extremely acute pain, chiefly of a cutting description, extending from thelumbarto the hypogastric region, attended by spasmodic convulsions ; redness of the face, especially of one cheek; excessive sensibil- ity of the nervous system, and excitement. Belladonna, s6°, when the bearing down is excessive, as if the entire contents of the abdomen were about to be protruded ; convulsive movement in the limbs ; great agitation with con- tinual tossing ; occasional throbbing and distention of the ves- sels of the head; bloated redness of the face, with profuse sweat. (See also the indications of this invaluable remedy at page 528.) Hyoscyamus, &g, when the convulsions are still more se- vere, accompanied with great anguish and cries; oppression of the chest and loss of consciousness. Stramonium, q6°, convulsions, without loss of consciousness, and trembling of the limbs. Ignatia, -6-, spasmodic and compressive pains, with sensation of suffocation ; confused feeling in the head. Cicuta virosa, \-, general convulsions ; or cramp-like con- tortions of the limbs ; pallor or sallow hue of the face. Ipecacuanha, °^, spasmodic convulsions; paleness or bloat- edness of the face, occasionally with desire to vomit. Cocculus, °g°, cramps or convulsions of the limbs and whole body, more especially in the lower parts of the abdomen, with heat, redness and puffiness of the face. Acidum hydrocy- anicum, Platina and Cina, have also been recommended against convulsions during labour. Dose : °§° or °§°. TREATMENT AFTER DELIVERY. After the termination of delivery, both body and mind must be kept in a state of perfect repose ; every thing which may tend to arouse the excitability of the patient, such as noise, strong light, and odour, must be carefully avoided, and the AFTER-PAINS. 533 room kept at a moderate temperature. After the birth, the female should be allowxd to enjoy that slumber, which in natu- ral cases generally follows,without interruption; but it is com- mendable to feel the pulse from time to time, to ascertain if a healthy action is going on. Sometimes this desirable state of rest is kept off by great nervous excitement on the part of the female, with incessant tossing in bed and restlessness. A few globules $f Coffea cruda will often suffice to dissipate these symptoms, and to procure a refreshing slumber ; should it fail, and any febrile symptoms be present, Aconite will generally produce the desired effect. When these remedies, which an- swer in the majority of cases, fail of their accustomed success, we must endeavour to trace the cause, and will generally dis- cover symptoms, pointing out a different remedy, which, if ju- diciously chosen, will, with almost absolute certainty, afford a satisfactory result. The practitioner will generally find but little difficulty in the selection of the fitting medicament; but there are so many circumstances to guide his choice, that it would be wholly foreign to our purpose, in a work of this kind, to enter upon the several contingencies applicable to in- dividual or isolated cases. (See the article Sleeplessness, Part II.) Here again, we must severely reprobate the practice of ad- ministering stimulating, and even spirituous, beverages, to fe- males after delivery, which, far from possessing a strengthen- ing property, tend only to excite and irritate the whole ner- vous system. For some time after parturition, nature calls for but little nourishment; it should be given only when the female herself expressly feels the want of it, and then be of the lightest and most digestible kind, and in very small quan- tities. It is highly reprehensible to endeavour to induce a female to partake of food, under the absurd idea of strength- ening her. We must allow nature to pursue her own course, which prescribes but little nourishment for the first five or six days after delivery, and thereby avoids the necessity of calling the bowels into action, which "state of Constipation (if it may so be called) is ordained for the wisest purposes, and attended with the most beneficial results ; while the temporary inactiv- ity of the alimentary canal is compensated by the vicarious 534 TREATMENT AFTER DELIVERY. action of the skin (demonstrating itself by increased perspi- ration), and the balance of the system thus kept up. We cannot, therefore, sufficiently condemn the use of aperients, which only tend to promote irritation, and bring on puerperal fever, and other evil consequences; in many cases, also, this artificial relaxation interferes with the proper secretion of milk. After the fourth or sixth day, nature generally acts spontane- ously, and when it appears necessary to afford mechanical as- sistance, we may do so by the application of warm friction to the abdomen, or the employment of a simple lavement, con- sisting of tepid water, with a little linseed oil or thin gruel. When this state, which seldom happens, continues so long as to cause inconvenience, Bryonia, or Nux vomica, Pulsatilla, and Opium, may be resorted to. (See article Constipation.) Dose : »•» or ^K AFTER-PAINS. These pains are considered salutary, and perhaps justly so to some extent; at the same time, when they occur in an ag- gravated form, and are unduly protracted, as frequently occurs in females of exalted nervous sensibility, they tend to deprive the female of her rest, and ought, under such circumstances, to be subdued as speedily as possible ; their early mitigation, in all cases, by means of homoeopathic remedies, is, moreover, never attended but with the most satisfactory results. In many instances the employment of Arnica, internally and likewise externally, as a lotion, (a few drops of the tincture to an ounce or so of tepid water,) when the labour has been somewhat severe, is sufficient to prevent their excessive de- velopment, as also in most cases to wrard off fever and inflam- mation.* But when the pain still continues, and the patient is highly excitable and sensitive, we should give a few glo- bules of Chamomilla in a little water, followed in about an hour by Nux v. if no change is effected by the former. If the * The soothing effects of Arnica are properly appreciated by those fe- males who have had opportunity and occasion for its employment; and we believe there are few, who having once experienced the beneficial ef- fects of the homooeopathic treatment generally, during the entire period of confinement, would willingly return to the old method of treatment. DURATION OF CONFINEMENT. 535 pain is of an insupportably intense description, or followed by convulsions, coldness and rigidity of body, Coffea cruda ought to be selected. We may give Pulsatilla when the convulsions do not supervene, but the pains are protracted and the patient is of a mild and gentle disposition, but sensi- tive and easily alarmed about herself. Again, when the after- pains are very severe, and there is a continual inclination to relieve the bowels when in a recumbent posture, passing away when rising, followed by spasmodic pains in the lower parts of the abdomen, they are usually readily relieved by Nux vomica. Dose: fl£°,or °£°. Secale cornutum and Cuprum metallicum have been strongly recommended in preference to any of the foregoing remedies, in severe and protracted after-pains occurring in females who have already borne many children. Administration. With regard to the dose, we may dis- solve a few globules at the potency named, in a wine-glassful of water, and give a teaspoonful every hour, or only every three or four hours, according to circumstances; carefully watching the effect produced, and discontinuing the medicine as soon as relief is afforded ; in many cases a single dose will suffice. When, on the other hand, no improvement follows af- ter a dose or two of the same remedy, another must be selected. In the event of flooding, the following remedies must be had recourse to: Ipecacuanha—or Crocus, Platina or Sabina; also Belladonna, Chamomilla, Cinchona, in particular cases accord- ing to the symptoms. (For indications, see Miscarriage.) DURATION OF CONFINEMENT. Even in strong and healthy females, during the first five days, the patient should remain in bed ; in the four following, if she feels herself perfectly strong, and desirous to rise, she may gradually accustom herself to longer periods of sitting up; the great risk is from the extreme susceptibility of the system to cold. After this period, females who still find themselves weak and languid, should prefer the horizontal to the half-recumbent posture ; and if this prove wearisome, she may sit up for an hour or two, but not so as to fatigue her- 53 DISEASES FOLLOWING PARTURITION. self. The diet should be extremely light, and not of a very nutritious quality; she ought only gradually to partake of food of a more nourishing nature, never having recourse to any thing in the least degree stimulating ; and all strong odours from flowers, or other aromatic substances, are to be carefully avoided, the mind kept in a state of perfect tran- quillity, and the room dark. DISEASES FOLLOWING PARTURITION". SUPPRESSED SECRETION OF MILK. It is of paramount importance that the normal operations of the organism peculiar to this state, proceed with due regu- larity. Among these, the secretion of milk takes a prominent position, and its sudden suppression is apt to be followed by internal and local inflammation, determination of blood to the head, and the usual array of symptoms which form the dis- ease commonly denominated puerperal fever, which however also results from internal injuries, consequent upon difficult or protracted labour ; but if the precaution of administering Arnica, already enjoined, has been taken, that source of dan- ger will almost always have been effectually guarded against. When, however, puerperal fever arises or threatens to set in, from a sudden suppression of the lacteal secretion, the im- mediate administration of Pulsatilla -§fl or °Ty in a tea- spoonful of water, repeated in six, twelve, or twenty-four hours, according to necessity, wdll frequently be found suffi- cient to check it at the outset, restore the flow of milk, and re-establish the equilibrium of the organism ; if any unpleas- ant symptoms still remain, they will, in most cases, yield to the administration of Calcarea —- followed by Zincum , Natrum muriaticum $>, and Carbo vegetabilis 3ft0, Sepia 3ft0, Lycopodium -5%, and Calcarea t6b. The latter, particularly in those cases in which the lochial discharge has proved very profuse, or in which the catarnenia are generally too abundant. With regard to the other medicines, we would in most instances recommend a commencement with Tinctura sulphuris. LEUCORRHCEA AFTER PARTURITION. A third evil is Leucorrhcea, which, although at the commence- ment merely a consequence of the relaxation of the internal uterine economy, after the completion of the lochial discharge, and at first of an innocuous character, frequently proves exceedingly trouble- some, and finally puts on a morbid appearance, becoming acrid, and productive of excoriation. We generally find a predisposition to the disease in scrofulous, torpid, and leuco-phlegmatic tempera- ments ; in some families this malady is hereditary, and only to be removed by a careful course of anti-dyscratic treatment. It is frequently of a very obstinate character, requiring the exercise of considerable study and attention on the part of the medical attend- ant, on the one hand, with much patience and strict attention to dietetic rules on that of the patient, on the other, ere a successful result can be attained. The remedies which have been found the most efficacious against the affection, either occurring after parturition or at other times, are: Pulsatilla, Sulphur, Sepia, Bovista, Calcarea, Lycopodium, and Carbo v., Causticum, Conium, Mezereon, Natrum, Magnesia c and m., Ammonium c, Cannabis, Iodium, Petroleum, Stannum, etc. Dose: °f> or °&°. INTERNAL UTERINE SWELLING AND PROLAPSUS- A swelling of the interior economy is frequently the result of a 544 DISEASES FOLLOWING PARTURITION. difficult labour, and in some cases of mismanaged parturition; we sometimes find it complicated with uterine or vaginal prolapsus; if the precaution of exhibiting Arnica , in as many teaspoonfuls of water, a tea- spoonful to be taken every six or eight hours, until improvement follows. When, however, a degree of induration still remains, Mercurius solubilis, °S, should be given, and repeated from two to three days; in more severe cases, x\cidum phosphoricum should be resorted to> or Hepar sulphuris, when suppuration has already commenced. Administration, of the latter, one grain of the third trituration in an ounce of water, a dessert-spoonful to be given three or four times a day, in order to forward the suppurative process, when it becomes absolutely necessary to bring the matter to a head as speed- ily as possible. 548 obstacles to suckling. In instances in which we find a fetid and serous discharge, which is frequently brought about by neglect or by improper treatment, such as the application of deleterious salves, etc., Silicea °3°£, re- peated in five or six days, will generally be amply sufficient to re- store the breast to its former condition ; in some extreme cases, however, it will be found necessary to follow up the treatment with Phosphorus, Calcarea, or one or more of the remedies above men- tioned, such as Mercurius and Hepar sulphuris. If this disease evidently arise from the effect of a sudden chill, Dulcamara f% ought to be given immediately, and will frequently obviate all injurious consequences. In cases where the disease has arisen from external injury, Ar- nica °-§° should be administered, and a lotion, one part of the tinc- ture to seven of pure water, locally applied. In strumous habits, Tinctura sulphuris, Calcarea, and Graph- ites, will occasionally be found necessary to complete the cure, after Belladonna has removed the active inflammatory symptoms. MENTAL EMOTIONS AFFECTING THE MILK. It is a well known fact, confirmed by numerous examples, that MENTAL EMOTIONS have a most powerful effect upon this se- cretion, in a moment changing it from a source of nutriment into a substance most injurious to the infant. Mothers ought to bear this in mind, and after having suffered from fright, passion, etc., should desist from suckling until they are perfectly composed ; and ere the infant be again applied to the breast, a portion of the milk should be drawn off. Fortunately, for evils arising from these causes, Ho- moeopathy presents prompt and efficacious remedies, (for which, see Mental emotions,) which, if at hand, should be administered immediately, according to the cause and symptoms. DEFICIENCY IN THE SECRETION OF MILK. SUPPRESSED SECRETION OF MILK. Sometimes a deficiency of milk is found to arise from a want of energy, either functional or general. For disturbance of the secre- tion arising from an inflammatory action, Vide Inflammation of the breasts. When the deficiency or suppression arises from the first cause, the chief medicines useful in restoring a proper and healthy flow of milk, are Pulsatilla, Calcarea, and Causticum. The physician is the best judge in the application of these remedies, as there are many minute symptoms by which his choice must be guided in the mothers not suckling their children. 549 selection—in eimple cases, Vitex agnus castus and Pulsatilla will frequently be found efficacious ;.but it is more generally requi- site for the female to undergo a complete course of treatment, if she is anxious to persevere in nursing, in which the two latter, to- gether with Aconitum, Bryonia, Chamomilla, Belladonna, Sulphur, Sepia, Iodium, will be found of great value. Dose : °^° or °f°. DETERIORATION AND DISCOLORATION OF MILK. If the milk becomes too clear and watery, (or otherwise deterio- rated in quality, or is repugnant to the child,) Cina°§° and Mercu- rius solubilis ;5 /.f]