_mmm^^_^_t_WM___ JB3K L IBBS •Epidemic Cholera.' JOSUN & WELLS. WC 262 JB3h 1885 34710840R NLM oSlb7flST 4 NATIONAL LIBRARY OF MEDICINE Surgeίn General's Office - - tjt-cfchnj •..:¦¦'¦,.¦¦¦¦¦ \_...-.:_y.?... i ._ THE HOMOEOPATHIC TREATMENT OF EPIDEMIC CHOLERA. Therapeutics and Repertory. B.F. JOS LIN, M.D., LL.D., With Notes and Additions Ij P "2** a^fv^^L THE HOMOEOPATHIC PHYSICIAN, Supplement No. 6, 1885. less vii CONTENTS. PAGE Preface, 3 Introduction, 13 CHAPTER I.— Early Treatment, Including that of the Premonitory Symptoms, and of the disease at its onset, with rules for the general management, 25 Treatment of Premonitory Symptoms, etc., .... 20 " at the Commencement of Cholera, ... 28 CHAPTER ll.— Hygiene and Prophylaxis. Articles hurtful to persons taking medicines, ... 30 Rules of Regimen, 37 Rules for the management of a Cholera patient, . . 40 Prophylactics, 41 CONTENTS. CHAPTER lll.— Symptoms and Treatment of the Varieties of Cholera. PAGE Law of cure, and repetition and magnitude of doses, 42 Symptoms of Diarrhceic Cholera, first variety, ... 47 Treatment of Diarrhceic Cholera, 49 Symptoms of Gastric Cholera, second variety, ... 51 Treatment of Gastric Cholera, 52 Symptoms of Spasmodic Cholera, third variety, . . 53 Treatment of Spasmodic Cholera, 54 Cuprum and Veratrum, 55 Symptoms of Dry Cholera, fourth variety, .... 57 Treatment of Dry Cholera, 58 Symptoms of Acute Cholera, fifth variety, .... 58 Treatment of Acute Cholera, 60 Symptoms of Gastro-Enteric Cholera, sixth variety, 60 Treatment of Gastro-Enteric Cholera, 61 Symptoms of Dysenteric Cholera, seventh variety, . 62 Treatment of Dysenteric Cholera, 63 Symptoms of Febrile Cholera, eighth variety, ... 65 Treatment of Febrile Cholera, 65 CHAPTER IV. — Symptoms and Treatment op the Stages op Cholera. First Stage, stage of Invasion, 67 Second Stage, stage of full Development, 69 Third Stage, stage of Collapse, 70 Fourth Stage, stage of Reaction, 71 8 CONTENTS. CHAPTER V. — Cholera Repertory for Symptoms and Groups, with the values of the medicines distinguished. PAGE Explanation of the use of the -Repertory, 75 Mental Symptoms, remedies for, 77 Head, remedies for symptoms relating to the, ... 78 Eyes, remedies for symptoms relating to the, ... 79 Face, remedies for symptoms relating to the, ... 79 Tongue, remedies for symptoms relating to the, . . 81 Nausea and Thirst, remedies for, 82 Vomiting, remedies for, 82 Pains at the Stomach, remedies for, 83 Abdomen, remedies for symptoms relating to the, . 85 Diarrhoea, remedies for, 85 Urine, remedies for symptoms relating to the, ... 88 Voice, remedies for symptoms relating to the, ... 88 Chest, remedies for symptoms relating to the, ... 89 Superior Extremities, remedies, etc., 90 Inferior Extremities, remedies, etc., 90 Skin, remedies for symptoms relating to the, ... 91 Perspiration and pulse, remedies relating to, ... 93 General and miscellaneous symptoms, remedies for, 94 ix XT PREFACE. In view of the fact that the most experienced physicians fear our country will be visited the coming summer by the Cholera, it was deemed best to supply our subscribers with a reliable and efficient guide to the homoeopathic treatment of this dread scourge. In no disease has Homoeopathy shown better its wonderful curative ability than in the treatment of Cholera. And it will ever be so if our physicians will but be true to themselves and to the better knowledge they possess. Of the value of Dr. Joslin's work, nothing need be said ; it has been tested and found reliable and of great value. The notes and additions from Dr. P. P. Wells add greatly to its usefulness. In the text, most of Dr. Wells' notes have been bracketed, so as to be distinguished from the text of Dr. Joslin. PREFACE. A word as to the doses recommended. It will be observed that most of the medicines are used in the lower potencies. At the time of the last epidemic of Cholera, experience was not so ripe as to the value of the higher potencies as it is now, hence the use of these medicines in these cruder preparations. Subsequent experience clearly demonstrates that we may safely trust our high potencies in the treatment of Cholera, as we do in all other diseases. Let each physician use such preparations as he is accustomed to use ; only prescribe carefully, and there will be little to regret. We hope this little volume may be of great usefulness, should it be needed. E. J. L. xii 2 13 INTRODUCTION. What is commonly called Asiatic, or malignant, cholera first visited Western Europe in 1831 and the United States in 1832. Its nominal," Asiatic," comes from the fact that the disease seems to have had its origin in that continent, and the epidemic which gave to European and American populations their first practical acquaintance with it was easily tracked, in its progress to these shores in 1829-30, to its origin in Northeastern Hindoostan. The alarm and excitement caused by its approach, both in Europe and this country, were very great, both with doctors and the general population, by reason of the vast numbers of the dead it had left along its pathway. The doctors, old school, were in dead earnest to study its phenomena, that when it should come before them for treatment they, with their superior intelligence, might be better able to cope with it than had been the semibarbarian doctors who had made so signal a failure in their endeavors for its arrest or cure. They studied, these European doctors, their subject with noble zeal and diligence, till they were familiar with the'habits of the epidemic, with its symptom- INTKODUCTION. atology and pathology, as they had imagined it to be, and to this study they brought the best learning and intelligence found among doctors at that day ; and to this was added the work of no mean imaginations. And with the result in their minds, they came to face the realities they had endeavored so earnestly to prepare themselves to meet successfully, that is, to cure the sufferers they had to care for. And what was the result ? Did they cure a greater proportion of their cases than had the barbarians they hoped to excel? Not at all. They found themselves powerless before the ravager, and all their labors left them, as healers of cholera, just where they were when they began their honest and earnest study. The result was that more than fifty per cent, of those attacked and treated by these learned gentlemen died. In many places the mortality was much greater than is here stated. In some all, or nearly all, attacked died. They had complete knowledge of the symptomatology of cholera. But what then ? They could make no practical use of this knowledge by reason of their utter lack of any means of connecting these symptoms with their proper curing agents ; so that, to them, symptoms were only empty voices with no words in them, and their pathology had its existence mainly in the doctor's imagination, and with this cholera had 1 4 INTRODUCTION. and would have little or nothing to do. It would not respond to their best efforts, based, as these were wholly, or so largely, on theories of their own creation, with which cholera had nothing, or very little, in common. Did they learn anything then, or in subsequent experiences with cholera epidemics, as to their defective mode of dealing with the disease as students or teachers ? Apparently nothing at all ; for in each succeeding epidemic old-school physic has only repeated its old methods and old failures. And more than this, and stranger than all, they have posed before the world as the possessors of all it contains of knowledge of " scientific" healing ; and so persistent have they been in claiming this as to cholera, that they have ever refused, and do still refuse, to be taught by those who know better. Have these gentlemen no consciousness of the defects of their methods and theories ? It would seem that they have, by their rush to accept and honor the discovery of "microbes." They needed something more. They acted as if they thought microbes the very thing they needed. Were they not shown as the cause of the whole trouble? And what had they to do now but to destroy the cause, and then would not the effect cease ? Verily, the ugly problem of cure, the solution of which had troubled them so much and so long, and on which they had labored so 15 INTRODUCTION. hard and so fruitlessly, was better than solved — so much better as prevention is better than cure. They had now but to destroy the cause, the *' microbes," and there would be no more cholera to cure. And so in the present epidemic they gave themselves to experiments for both cure and prevention on the basis theory of " microbes " as the cause, and failed both to cure and prevent, and the most remarkable thing about it is that they were so long in finding out that they had failed. They failed, as all efforts to these ends must fail which are not directed and pursued under the light and guidance of natural law. These people rejected and derided the only known natural law of relationship between sicknesses and curatives, and, as a result, failure with them was inevitable. What need had they of law ? Had they not, instead of this and better than this, their painfully, ingeniously elaborated and boasted pathology, and was not this equal to all their needs ? And, then, in this present epidemic, had they not, in addition to their pathology, the now known cause, and by the possession of both, surely now they were to be the masters, and cholera must yield to the combined power derived from both. But did it yield ? If one will be at the trouble to compare the results of allopathic treatment of the epidemics of 1831 and 1884, he may be interested 16 INTRODUCTION. when he finds the rate of mortality of cases so treated was substantially the same in the one as in the other. In these more than fifty years of opportunity for study of cholera, which they have had since the first epidemic, they have learned nothing which has given them a treatment with better results than a loss of more than one-half of those treated. The discovery of microbes has not been of the least benefit to doctor or patient. Are these men, therefore, either wiser or more humbled by this their last failure? Apparently they are neither. They are now, as in 1831, the same conceited, blinded, proud, confident rejecters of law, of which they have no need. It is only too evident, if they have had no need of law, their patients have had a sore one. For it will be seen by a comparison of cases treated under the guidance of law with those treated under that of theory and of a so-called pathology, that of every fifty deaths under this last, thirty-four of them might, and probably would, have been cured if they had been treated under the guidance of law. Verily, these patients had great need of law. It is not a little interesting if we remember, while considering the results of cholera treatment with and without law, that while in some places nearly all attacked and treated in the latter method died, there were other places where nearly or quite all treated 17 INTRODUCTION. in the former recovered ! And more than this, in many places where the means law had pointed out as protectors against attacks of this fearful epidemic were employed there were no cases to treat, or only such as were so slight that no one died of them. Does old-school physic know these facts ? Certainly. Or if not, then ignorance of them must be willful and self-imposed. How then, before these and the record of its own sad, uniform, and multitudinous failures, can it say by word or conduct it has no need of law ? This rather understates than overstates the difference of results from the two methods of treatment. In the epidemic which prevailed at Naples, Italy, in 1854-5, Dr. Eocco Rubini treated three hundred and seventy-seven cases without a single death. Most of these cases were treated in military or other hospitals, and the facts are certified to by the officers in command.* In this same city, in the epidemic of this year, under treatment without law more than seventy in every one hundred, so treated, died. We have spoken of treatment of this pest under the guidance of law. We mean the law of similars. We know of no other therapeutic law, and certainly no other has been tested as this has *See Am. Horn. Rev., Vol. VI, p. 403. 18 INTRODUCTION. by the cholera problem. By obedience to this law the best record, and much the best of successes, has been made. To repeat the successes of the past in the presence of any recurring epidemic of the plague presupposes a repetition of this obedience, and without this no practice is to claim its promised rewards. Then the importance of the answer to the question — In what does this obedience consist ? — is apparent. The reply is made up of two elements — that which is to be done, and that which is not to be done. And first, what are we to do that under law we may cure, not Asiatic cholera, but our patients whom it may have attacked ? In one word — do what the law requires and do nothing else. The first requirement of therapeutic law is, that we gather all the morbid phenomena of each case possible, and then find thesimillimum of these in the recorded effects on the living, healthy organism of some one drug agent. Give it as directed in the Organon of Homoeopathic Medicine, and have no meddling with its action by another drug or by any restless anxieties of self or patient's friends. Cast out every consideration from this second effort except the question, What is most like ? If this be so, then where does the pathology, the microbes, and the revelations of post-mortem dissections come in ? They don't come in at all, in this 19 INTRODUCTION. duty of finding the curing agent for the case in hand. But what of the cause ? — are we to have no reference to this, when our endeavor is to cure its effects ? The first answer to this is : We are not called by law to find a simillimum of the cause, but of its effects. This found and given, and we have done all the law requires for a cure, and all which may be attempted in addition to this will only damage our record as to the desired cure. The second answer is : We know very little of this cause, and nothing at all as to its essential nature — nothing whatever except what we may learn from its effects. Then what about " microbes " ? Only this: We do not see that they have any place in specific therapeutics as applied to the cure of cholera. It is certain the best record of successes in the treatment of this pest has been made with no reference whatever to them. And if, since their proclaimed discovery, they have had a place in oldschool therapeutics, it is equally certain they have not improved its record. This remains, through this last epidemic, as it was through the first, only an unbroken series of mortifying, discouraging, sad failures. " Microbes " have not helped it at all. And by this time it ought to be clear to average intelligence that nothing can help the record of a therapeusis so wholly apart from and at variance with the natural law of healing as is this. 20 INTRODUCTION. But then, are they not the cause of the disease, and for this reason is not a knowledge of them of utmost importance to us in our practical dealing with their effects ? We reply, These organisms are not cause of cholera at all. They have only been accepted as such on the assertion of their discoverer by a school of medical practitioners who, now as ever, have been in only too great haste to give attention and acceptance to any new thing, or to anything, except God's law of healing, and with this they will have nothing to do. This fact we accept as an adequate explanation of the continuous failure which has followed their labors, their applied theories, their post-mortems, and their microbes, from the beginning to the end. Have Aye not heard ad plenam, for the last tw 7 elve months, of these " germs," and of ceaseless efforts to " stamp " these "out" by use of so-called " germicides" and " disinfectants," meaning agents which kill germs ? What are disinfectants? And Avho has ever seen a well-marked disinfection of any morbid cause from the use of any so-called germicide? And what has been the result of it all ? The progress of cholera has not, so far as we know, been arrested by all this buzz and bustle, in any one instance, and where present, the number of attacks have neither been diminished nor their fatal character in the least abated. If 21 INTRODUCTION. these organisms were, as claimed, the cause of the plague, there has been abundant opportunity to show it. And yet it has not been shown. If living organisms w r ere the cause, these, it would seem, might be destroyed. And yet in no instance that we know has cholera been "stamped out," while surely there has been "stamping" enough done to have given us at least one success, if this whole idea of "germs" and "germicides," were not false in principle. " Microbes " may safely be dismissed from our thoughts in our clinical dealing with cholera, and may be, also, from our study of its etiology. Just what their importance is, if any attaches to them in the cholera problem, we are not, in the present state of our knowledge, prepared to decide, but we can safely say too much has been claimed for them when they have been put forth as its essential cause. It is not a little likely they sustain the same relation to this disease as the green, busy flies do to the dead carcass they so constantly seek and infest. No one accuses them of having hilled the horse. The sum of it all is, old-school physic has failed of success, not from want of diligence or carefulness on the part of its practitioners, but because they sought it where, from the nature of the case, it can never be found. They sought success outside and independent of law, and they failed to find 22 INTRODUCTION. it. The new school will be equally sure of finding what the old has not, only and just in the ratio of their strict loyalty and obedience to God's law. Let it do as this requires, and do nothing else, and they will have few failures to mourn. P. P. Wells. Brooklyn, N. Y„ Dec. 12, 1884. 23 CHOLERA. CHAPTER I. EARLY TREATMENT. Domestic and Professional, including that of the Premonitory Symptoms, and of the Disease at its onset, with Directions for the General Management. DOMESTIC AND PROFESSIONAL TREATMENT OP PREMONITORY SYMPTOMS AND THE SLIGHTER ATTACKS. During the prevalence of cholera in any locality, every person should consult his physician for such slight symptoms as often precede cholera. On such application to the physician, if a true homoeopathist, the disease may almost always be warded off, or, if commencing in a slight form, immediately cured, and prevented from advancing into the form of cholera proper. The most usual premonitory sympton is a foecal diarrhoea, often so slight that it would excite no apprehension in ordinary 25 CHOLERA. times. Or the evacuations may be rather copious, or in moderate quantity and milky, no other symptoms being present. In any of these forms, diarrhoea in the epidemic is called cholerine. It will be again referred to as the first stage of the first variety of cholera; yet.the importance of an early attention to it is so great, that, at the expense of some repetition, a familiar account of its symptoms and first treatment are given in this place for the convenience of such families as may use this book and physicians hitherto unacquainted with this practice. Where there is diarrhoea without any special indication for any particular remedy, give one drop of spirits of Camphor on a lump of sugar or in sugared water. Give another drop after one hour — or earlier, if the diarrhoea returns — and let it be followed by three doses of the third attenuation (or the higher dilutions, the latter at longer intervals) of Camphor at intervals of an hour, or after each evacuation, if it occurs sooner ; after this, if the diarrhoea continues, Phosphorus 30 ; if the tongue sticks a little to the finger when applied to it, give Phosphoric acid ; if it has a yellowish coat, and there is colic or dizziness, give Veratrum 30 . Whichever medicine is given, it may be repeated after each evacuation, if it is large, or after every two, if they are small. 26 EARLY TREATMENT. (For other symptoms consult the succeeding chapters, including the Repertories.)* The Camphor may also be used for a short time with advantage for most other symptoms; but if this is domestic treatment, there should be no unnecessary delay in consulting a homoeopathic physician, as the disease may reach a dangerous height before the appropriate remedy is employed. In giving pellets of any medicine in the dry state a good general rule is: Put two or three pellets in a small powder of pure sugar or sugar of milk, fold the paper, then mash the pellets, then open the paper, and mix them by moving the paper without touching the powder. Then, with the paper bent at an angle, place its edges in contact with the upper lip or teeth, let the powder slide on the tongue Avithout touching it with the paper. The patient should hold his head back, his mouth open, and his tongue out, and alloAV the poAvder to dissolve on the tongue before swallowing it. Where a number of doses of any one medicine *The principal divisions of the Repertories are in the order in which it would be most natural to examine (from above downward) those different parts of the body to which the symptoms belong; while the subordinate arrangement, that of the different parts of each section of the Repertory, is alphabetical. 27 CHOLERA. are to be given in succession, it is more convenient and equally effectual to dissolve five or six pellets in a gill of water, and give one, tAvo, or three teaspoonful — according to the patient's age — at a dose. This may be considered as applying to any case, in this or any other stage. DOMESTIC AND PROFESSIONAL TREATMENT AT THE COMMENCEMENT OF CHOLERA IN ALL ITS FORMS. When there is a decided attack of cholera, Aye resort for the first hour, or a longer or shorter time, according to circumstances, to a treatment for which, as Avell as for all the most successful modes of preventing and curing this disease, the Avorld is indebted to Hahnemann. Whatever may be the form of the attack, give one drop of the tincture of Camphor, dropped on a lump of sugar, and then dissolved in a tablespoonful of cold Avater. Repeat this every five minutes, until there is a decided mitigation of the symptoms. This Avill usually be after five or six doses. One sign of its good effect is perspiration. In proportion as the symptoms yield, let the doses be at longer intervals, as an hour, tw T o hours, twelve, and even tAventy-four hours. For these 28 EARLY TREATMENT. later doses, the third attenuation AA r ould probably be preferable. If the disease is taken in time, ten or twelve doses of the tincture are ordinarily sufficient. If the stomach will not retain the Camphor, even in ice-water, then give, before and after it, a bit of ice as large as a filbert, or reduce the dose to one-quarter of a drop, if necessary. In order to commence immediately, the first dose may be a drop on a lump of sugar ; but as soon as there is time, dissolve it as hereafter directed. The patient should continue in bed and be covered for many hours, as exertion and check of the perspiration excited by the Camphor Avould both at first tend to preA r ent improvement, and afterward to occasion relapse, even after the cure had considerably advanced. In the preparation of this spirits of Camphor, Hahnemann recommended the proportion of one ounce of solid Camphor (the gum, as it is called) to tAvelve of Alcohol. Dr. Quin used the proportion of one to six. The usual tincture of the shops is suitable. The method which is most convenient and useful, and one Avhich I have employed in many cases of severe cholera, is to put tAvelve drops of camphorated spirits in a tablespoonful of sugar, and dissolve it in tAvelve tablespoonfuls of cold Avater in a tumbler, and give a tablespoonful of this mixture cA r ery five minutes till 2* 29 CHOLERA. relief is obtained. Where there is great difficulty in retaining fluids on the stomach, let the medicine be so dissolved that a teaspoonful shall be a dose. If the Avater Avere not rendered viscid by sugar, much of the Camphor would rise to the surface, and if the spirits Avere dropped into Avater first, the Camphor Avould be precipitated at the surface. Families should be provided with the Camphor, and in case of attack administer it immediately before the arrival of the physician, Avho will judge Avhether it is to be continued. In some cases of severe spasms, it might perhaps be admissible to give the Camphor every third minute, till there Avas some mitigation. But the advantages of the Camphor treatment cannot be secured by allopathic doses, whether at short or long intervals. [This remark should be always borne in mind in dealing with so serious a sickness as malignant cholera. In treating this and all other sicknesses homoeopathically, all of the drug given more than the cure requires is only an additional cause of disease. And, if it be the nature of the drug to produce sick phenomena like to those Aye are attempting to cure, this excess only intensifies the already existing evil, and if the excess be inordinate (allopathic) the aggravation may destroy the curative effect of the best selected remedy. It 30 EARLY TREATMENT. does not matter Avhether this excess be of quantity given, or of too frequent repetition of doses, or of too long a continuance of repetitions. Neither does it matter Avhether this excess has been given by an allopathic or a homoeopathic physician or by domestic administration. It is the one thing to be remembered in all homoeopathic prescribing, by all doctors and laymen. Avoid the too muchZ] In the former case, the disease Avould be aggravated, and in the latter case, the medicinal action Avould become exhausted : in both cases, the stomach Avould be irritated. If one ignorantly attempts to correct the last effect by combining Opium or Laudanum Avith the Camphor, he, in a great measure, destroys the efficacy of the latter, besides doing direct and positive injury by the opiate. There is abundant testimony to the efficacy of the pure Camphor treatment (by small doses) from all parts of Europe. Hahnemann states that at Berlin and Magdeburg alone thousands of families, having folloAved his instructions respecting the treatment by Camphor, restored those of their members Avho Avere attacked by the epidemic — restored them often in less than a quarter of an hour. This method Avas said to be employed with certainty of success in the first hour; with probability in the followinghours. 31 CHOLERA. Now, it sometimes fails, oftener among children. I recommend the trial of pellets, and not loAver than Camph. 1 , even for adults. Probably the Camph.° Avill soon be less used. ( Vide note at bottom of page 33.) Hahnemann at first advised the external, in connection Avith the internal, use of Camphor, but subsequently found it unnecessary. Indeed, it not only is useless, but fills the room with effluvia which interfere Avith subsequent treatment. But as it is often difficult to persuade the friends of the patient to wait for the action of the remedy, they may be allowed to rub Avith a flannel, either dry or moistened Avith Alcohol, or — what is better — Avith their dry hands. They may also be allowed to place a warm brick at the feet of the patient — if they are cold — although it is of no positive use. Though Camphor has not, on the whole, lost any reputation in the epidemic of 1849, yet I have been informed of several instances of its failure, even when given under the above favorable circumstances, and apparently in cases to which it Avas appropriate — and ha\ r e seen it and other remedies fail, where Laudanum had been previously given, and several hours had elapsed before the homoeopathic physician Avas called. From the general utility of the early employ- 32 USES OF CAMriIOR. ment of Camphor, it is not to be inferred that the homoeopathic physician will usually commence Avith it, Avhere the family, instructed in its use, has given many doses of it previously to his arrival. His course Avill be determined by a consideration of the totality of the symptoms. Though the Camphor should produce immediate relief, it is not to be relied on for a permanent cure where one or more other medicines are subsequently indicated by the symptoms — as Avill often be the case. After such improvement, the patient Avill be safe with other appropriate treatment, but not always without it. Camphor is a remedy which is imperfectly proved as to the symptoms Avhich it is capable of producing in the attenuated and even in the crude state ; and our school has more experience of its use in cholera in the former than in the latter condition. These are reasons for employing it in a form less attenuated than that adopted for other medicines.* * The prevalent opinion that Camphor is a medicine which does not bear much attenuation has not been established by experiments. Of the high attenuation, I know of no other proving than the following : In 1849, on Tuesday evening, February 22d, at twenty minutes of ten, I took a few dry pellets of Boenninghausen's Camphor 200 , and administered the same dose 33 CHOLERA. [It may be questioned whether the notion that Camphor is more reliable as a curative in cholera or other diseases in the crude than in the potentized form is Avell founded on fact or experience. Its use in the crude form in cholera has probably come from the notion that so violent and rapid a disease requires a "strong" medicine, and from this point of view, of course, the crude Avas "stronger" than the "attenuated." The term "attenuation" is a misleading and unfortunate one, not expressing at all the fact of "potentization." " Strength " Avhich cures does not depend on the quantity of the matter of the drug employed, but on its right selection, the proper degree to Dr. H. H. Cator and Mr. (now Dr.) Brown. In twelve minutes I had cold perspiration, especially on the forehead and chest. The same symptom was simultaneously experienced by the two other provers. In the epidemic of the following summer, Dr. B. F. Bowers employed Camph. 200 with success in many cholera cases, and was as Avell satisfied of the reality of its curative action as of that of any other remedy. He frequently took it himself when he experienced any premonitory symptoms, but never in any other form than the 200 th, during the epidemic. In the present month, April, 1854, I have administered Camph. 30 with immediate and complete success for cholera diarrhoea with milky discharges. The 30th and lower potencies of Camphor have been employed successfully by Drs. Barlow, Bayard, and Kirby. 34 USES OF CAMPHOR. of potentization, the employment of the right quantity of this, and then on the right management of the doses to be given. In these is the " strength " which cures. — For microbes sec Introduction.] In conclusion I must add, that the large doses of Camphor used in popular and allopathic practice, dangerously oppress the stomach and brain and frustrate the cure. 35 36 CHAPTER 11. HYGIENE. ARTICLES AVHICH SHOULD NOT BE USED BY PERSONS AVHO ARE TAKING HOMOEOPATHIC MEDICINES, EITHER DURING THE PREVALENCE OF CHOLERA OR AT OTHER TIMES. Ist. RaAV vegetables — such as celery, lettuce, etc. ; 2d. Unripe or sour fruits and acids in general ; 3d. Food Avhich has any medicinal qualities — such as onions and tomatoes, and bread prepared with soda ; 4th. Coffee, green tea, and distilled and fermented liquors ; sth. Condiments (except salt), as vinegar, pickles, pepper, spices, and mustard ; 6th. Camphor, hartshorn, cathartics, herb-teas, and other medicines (Avhether external or internal), except those prescribed by the physician ; 7th. Tobacco in great quantities, especially by chewing ; and in any quantity unless the individual has been long accustomed to it. None of the forbidden articles (except coffee, HYGIENE. and Camphor, and other medicines) need to be suddenly and totally abandoned if the individual has been long accustomed to them. In that case, he may, unless forbidden by his physician, use them, though in great moderation. Great and sudden changes in regard to the use of condiments should not be made after the epidemic has actually commenced in the place. Let the reform commence earlier. HYGIENIC RULES IMPORTANT TO BE OBSERVED BY PERSONS IN GENERAL DURING THE PREVALENCE OF CHOLERA, AND USEFUL AT ALL OTHER TIMES. Ist. Use Avarm clothing, and in cool or changeable weather, flannel ; but put a cotton or silk garment under it, unless you have been accustomed to flannel next the skin. 2d. Avoid taking cold or becoming chilled. 3d. Use no cold, nor hot, nor even tepid baths ; but use cool baths, those which feel like a summer breeze, or sponge the body with Avater of such a temperature. This, with different individuals and different modes of using the Avater, may range from 75° to 80 D Fahrenheit. 4th. Remain in the water not longer than a 3 37 CHOLERA. minute ; and wash and wipe yourself dry as soon as possible ; and if in the least chilly, put on extra clothing. Use this ablution once a week, or twice in summer, and Avash the feet and other more SAveaty parts of the body daily. sth. Endeavor to encourage good temper, hope, and cheerfulness in yourself and others. 6th. Use moderate and even active exercise, but avoid great fatigue. 7th. Avoid all kinds of fasting when there is appetite.* Bth. Let the diet consist partly of animal food, and partly of good bread or some other preparation of Avheat flour.f Use a good proportion of fresh beef, mutton, venison, or fowls, and if it agrees Avith the stomach, soup made of one of these meats. Fish, eggs, good milk, butter, sugar, and molasses are not hurtful to persons in general Avhen used in moderation and with a due proportion daily of some of the meats above mentioned. 9th. Avoid all indigestible food, everything which you have found to oppress your stomach, whether it be cabbage, turnip, or other succulent * I will not deny that any man has a right to punish himself by abstaining from hurtful luxuries ; but he has no right to punish himself by injuring his health. f This last, possessing considerable azote, has some chemical similarity to animal food. 38 HYGIENE. vegetables, and especially fibrous vegetables and fibrous fruits, as some kinds of radishes and pineapples, also fresh bread, rich pastry, old or toasted cheese, meat too fatty, veal or other young meats, sausages, pork, geese, lobsters, shell-fish, eels, or other fish Avhich have not both fins and scales. The articles enumerated in this paragraph are of doubtful character for most dyspeptics at all times, and for most persons when cholera prevails. 10th. Eat with moderation ; take care not to overload the stomach with food of any kind. 11th. Masticate the food thoroughly. If possible, observe regular and early hours for eating and sleeping. Avoid late suppers; but if compelled to defer the evening meal till a late hour, eat sparingly. 12th. Drink water, cocoa, pure unspiced chocolate, toast-water, barley-water, or AA T eak black tea. 13th. Avoid as far as possible all alcoholic drinks, Avhether distilled or fermented, but especially the former. Use neither coffee nor green tea. 14th. Keep your room properly ventilated, but in such a manner as not to expose yourself to currents of air when sitting still. 15th. Do not continue long in small rooms that are crowded with people. 39 CHOLERA. 16th. If practicable, avoid sleeping in basements, or with many persons in the same room. Peculiarities of constitution and inveterate habits, and the disadvantages of making great and sudden changes after the commencement of the epidemic, will justify some modification in the above rules by some individuals. In food, some concessions must be made to taste. DIRECTIONS FOR THE GENERAL MANAGEMENT OF A CHOLERA PATIENT. Ist. Apply no Camphor externally, and use no external applications of any hind. 2d. Give no drinks but cold water, unless the patient prefers warm toast Avater, Avhich is the case in but very few instances. 3d. Ice Avater may be taken as frequently as the patient desires it. It is useful for extreme thirst, cramps, colic, vomiting, and cold skin. 4th. The food should consist of mutton or chicken broth, with no seasoning except a moderate quantity of salt. Beef broth will answer. Oyster soup is not allowed. Great care should be used in regard to diet during convalescence. sth. The patient should lie in bed, with comfortable coA r erings. 6th. If the weather is cool, there should be a 40 PROPHYLACTICS. good fire, which Avill alloAV the AvindoAvs to be kept open for ventilation. 7th. The patient should not,hoAvever,be exposed to cold air. If compelled to rise, he should be coA T ered, and the AvindoAvs closed. Bth. He should rise no oftener and move no more than necessary, as motion is hurtful. He should, if practicable, be provided with a bed-pan, instead of being compelled to rise. 9th. No glass or spoon Avhich has been used for one medicine should be used for another, until it has been rinsed Avith clean hot Avater (without soap), then, while hot, Aviped dry Avith a clean towel, and alloAved to stand till cool, and thus become more perfectly dried by its own heat. Or Avhen convenient, it should be Avashed Avith hot water and wiped, then heated near a fire, and again allowed to cool before being used for another medicine. PROPHYLACTICS. The homoeopathic preventives of cholera are Cuprum-m. and Veratrum-alb., taken alternately, in doses of two or three pellets once or tAvice a Aveek. The method which Hahnemann recommended, and which many employed Avith success, Avas to take Cuprum 30 , then Avait one Aveek, and take Veratru 30 ; then, after a week, the Cuprum, and so on. 41 CHAPTER 111. SYMPTOMS AND TREATMENT OP THE VARIETIES OF CHOLERA. LAW OP CURE, AND REPETITION AND MAGNITUDE OF DOSES. The skillful homoeopathic physician does not neglect the teachings of clinical experience ; but he relies mainly on the law that any disease, in its curable stage, can be cured by a medicine Avhich is capable of producing a sufficiently large group of symptoms similar to those which the disease itself presents. Judgment is required in regard to the relative importance of symptoms; but it is important to consult repertories and materia medicas with regard to a great number of the symptoms of a case, and to combine as many as possible, and thus eliminate the false remedies and arrive at the true remedy for the whole group, and consequently for the disease of Avhich that group is the index or exponent. The popular error, that a knowledge of the name, essential nature, and principal seat of the disease is prerequisite to a successful treatment of it, is founded upon the 42 THE LAAV OF CURE. blind nature of allopathic therapeutics. [The treatment, medicinally, of "Asiatic cholera," is Avhat a friend Avould certainly call a "fatal error," and he would be right. The name of a sickness is not of the least importance to the specific prescriber. He deals Avith his patient and Avith the sick phenomena he presents, and adapts his means to these, as the IaAV requires, and this he may always do Avith utmost indifference to names. Treating cholera in the recent epidemic in Naples resulted in over seventy deaths in every hundred so treated; Avhile in a previous epidemic of this disease in the same city, one physician, who treated three hundred and seventy-seven patients according to the IaAV of therapeutics, lost not one/*] Allopathy has no guide but the name, the supposed nature, and the supposed seat of the malady ; and if any one Avho has received some homoeopathic light alloAvs himself to be still led by the blind, he will fall into the same ditch. The usual intervals between the doses of attenuated medicines for the more severe varieties of cholera are half an hour, one hour, and an hour and a half, according to the violence of the disease. In some violent cases the medicine may be repeated in fifteen minutes. [The frequency of the repetition of the dose is to be decided by the * Am. Horn. Rev., Vol. VI, p- 403 et seq. 43 CHOLERA. severity of the attach. The more severe this is, the shorter are the intervals betAveen right managed doses. The reason for this is, in these violent attacks, the medicinal action of the given dose is rapidly exhausted, and this in the ratio of this violence. There have been cases where the intervals were as short as three minutes, and the treatment Avas successful. In these cases, however, there should be no excited alarm, but only and always the best care and judgment in deciding how often and when to stop.] But we are not to suppose that the good effect is ordinarily increased by this greater frequency, or that too frequent a repetition is harmless. Again, we are not to suppose that the operation of an attenuated medicine will be frustrated by the occurrence of vomiting at the end of several minutes after it has been swallowed. It is not like a crude drug. Some portion of it has already gone to every part of the body; and the portions Avhich have entered the circulation have nearly as much poAver as the Avhole close. [This paragraph seems to have had its origin in a notion prevalent Avhen it was written, that it was the matter of the drug Avhich cured, and that the known greater curing power of the drug as found in the form employed by the homoeopathists Avas owing to the greater division of its particles, so 44 REPETITION OF DOSE. that a greater number of these Avere in a given dose brought into contact Avith the living surfaces. Hence, by the term " dilution " was meant a greater number of active molecules in the dose, though it actually contained less of the drug matter. This was Dr. Joslin's idea. We do not noAV receive this explanation, but believe the Avord "potentization" better expresses the facts of experience.] Vomiting after such an interval does not render a repetition of the dose necessary. Neither are we to suppose that the dose requires to be repeated on account of the patient's having taken food or drink Avhich is slightly medicinal or antidotal. It is not probable that the action of an attenuated medicine can be entirely frustrated by antidotes taken in the crude form . The attenuations have peculiar poAver. Every experienced and observant homoeopathic physician knoAVS that less than a billionth part of a grain of common salt will manifest its specific effects in an indi\ddual Avho is taking many grains of crude salt at every meal. The rule of three fails to explain the effect of such an infinitesimal increase in the quantity. The inference is inevitable, that the homoeopathic process has developed immense poAver. The existence of great curative poAver in the homoeopathic attenuations is manifested by their effects on cholera. The attenuations used in former epidemics are, in most of them, the 45 CHOLERA. 12th or 30th ; but subsequent experience slioavs the value of the higher. They may be given dry, in loaf sugar or sugar of milk, or in solution in iced Avater. Iced water is itself a remedy, and it may be given to the patient in most cases. In regard to the repetition of attenuated medicines, a rule applicable to all cases of cholera is — discontinue the administration of medicine as soon as there is amendment and as long as this is progressive. In the case of Camphor, as compared Avith other medicines, the dose is large and the repetitions frequent ; for it is unlike all other medicines in not requiring attenuation and in being exceedingly transient in its action. Hahnemann directed one drop of the tincture every five minutes, the tincture being made by dissolving one ounce of Camphor in twelve of Alcohol. Dr. Quin happened to use, in his oavu case, tAVO-drop doses of the tincture, made in the proportion of one to six, and finding it to succeed, used it for others. Hartmann recommends the proportion of one to twenty, and the dose one or two drops, every two or five minutes. The tincture directed by the allopathic pharmacopoeias and found in the drug stores is generally one to eight, sometimes one to sixteen. There is probably no better rule than to dissolve one ounce of Camphor in ten ounces (i. c., 21 gills) of Alcohol. The ordinary dose will be one drop every five 46 DIARRHCEIC CHOLERA. minutes. In some cases the dose may be increased to two drops, or the intervals reduced to t\vo or three minutes. Give the tincture in sugared Avater, iced, or at least cold. As Camphor is one of the most powerful and general antidotes to other medicines, the patient must not take these from any glass or spoon which has contained it, nor must the odor of it be in the room after he commences other medicines. The forms described in this chapter are those Avhich the cholera most frequently presents. Some of them are occasionally combined. The homoeopathic physician will knoAV hoAV to adapt his treatment to the different shades and combinations of these varieties. He Avill apply the materia medica and the haw similia similibus curantur. The accompanying repertories will aid in the selection of the remedies. SYxMPTOMS OF THE FIRST VARIETY, CHOLERA DIARRIKEICA INTESTINAL, OR DIARRHCEIC CHOLERA. This is the form in Avhich diarrhoea is a prominent symptom. At first there is a simple diarrhoea ; lassitude in the legs ; rumbling ; tongue moist, clean, or a little coated ; sometimes it is pasty, or gluey, so as to adhere to the finger when applied to it. The evacuations, at first composed 47 CHOLERA. of digested food or feculent matters, shortly become yellowish-brown or watery; after a feAV hours or a feAV days, they have the appearance of barley-Avater, rice-Avater, or of whey with little flocks of soap distributed through it, or of milkporridge mixed Avith Avater. The whiteness appears to depend on minute flocculi of whitish mucus, Avith some larger lumps of the same, sometimes as large as a pepper-corn and of a yellowishwhite color. Each stool is preceded by great noise and movements in the intestines. The noise is sometimes like the rumbling of gas, at others like that of a running liquid. There is a livid circle around the eyes, or dark color of the Avhole face, coldness of the hands or tongue, prostration of muscular strength, and feebleness of pulse ; sometimes nausea or cramps. Some vomiting may take place after the diarrhoea has continued a considerable time without appropriate treatment. If this form of cholera, although it should amount only to a slight cholerine, is mistaken for an ordinary diarrhoea and improperly treated, there is great danger of its suddenly assuming a much graver form ; vomiting and violent spasms may set in, and collapse and death close the scene. This alarming revolution in the disease may occur Avhen the evacuations have not caused much debility or interfered with the usual avocations. In 48 DIARRHCEIC CHOLERA. Europe and America, this diarrhoeic form is the most frequent, especially in places and times in which cholera docs not rage in its greatest intensity. The most perfect and severe forms give no such warning, even in Europe and America. In one sense, the premonitory diarrhoea is a part of the diarrhoeic variety of cholera. If a line can be drawn between them, it is probably where the discharges change from the foecal to the liquid character. The treatment is similar. TREATMENT OF DIARRHCEIC CHOLERA.* If Camphor does not soon give' relief, Aye are to resort to other medicines, generally to Phosphorus, Phosphoric-acid or Veratrum. I have employed them all with success. The Phosphoric-acid is to be preferred Avhen there is a gluey matter on the tongue, or cramps in the upper arm or fore- arm or in the wrists or hands, or if the stools are yellowish and the evacuations painless. Give Phosphorus Avhen there is a white or brown coat on the tongue and the evacuations attended with griping or colicky pains, or Avith nausea. Give Veratrum Avhen the coat on the tongue is yellow and the *See also chapter I, section Ist, p. 25, fjr the treatment of its first stage. 49 CHOLERA. diarrhoea painful. In some cases, Arsenicum, Mercurius or Secale may be indicated. However, Phosphor, Phosphoric-acid, or Verat. generally cure ; and they may often be given at first, Avithout the previous administration of Camphor, in this form of cholera. When the evacuations are very copious, liquid, and frequent, Camphor should not be given so many times before resorting to other medicines. Put two or three globules of the thirtieth attenuation of Phosphorus, or of the third attenuation of Phosphoric-acid, in a little sugar of milk, and place them on the patient's tongue ; or give them in solution, in the manner described in chapter I. After two or three doses of Phos-ac. 3 , if the indications for Phos-ac. remain, it will often be useful to employ the thirtieth. [Why the thirtieth after the third, and not before it, or instead of it? There is a seeming, in this direction, of an imagined greater medicinal force in the third than in the thirtieth, as if the more matter implied more force. This, in potentized drugs, is certainly not true, especially when the process of potentization has been carried to the extent that predicating matter of them is no less than absurd. And yet, such potencies cure, and often cure surprisingly well. The idea seems to have been, to avoid danger from excess of action, in the continued use of the drug, still required for 50 GASTRIC CHOLERA. the cure, by going from a greater to a less force in the doses given. This is in accord with the old vieAV of the material nature of the drug force which cures. Dr. J. entertained this view, as did most of our best minds at the time this treatise on cholera Avas Avritten. We have no hesitation, in the light of more recent experiences and observations, in holding this vieAV as an error, as these have, to our mind, clearly established the dynamic nature of that which cures, and that the development of this nature by the process of potentization has increased, rather than diminished, its poAver. If this be the case, then why not give the higher at the first ? And then, Avhen this treatise Avas written, there Avas prevalent Avith many of our best men the notion that acute diseases were best treated with low numbers, and chronic by high ones. The thirtieth was then the highest. This view, now so Avell known to be erroneous, Avas the reason for recommending the lower numbers to be given first.] A close of the appropriate remedy may be given after each evacuation, if it is copious, or every second evacuation, if they are small. SYMPTOMS OF THE SECOND VARIETY, CHOLERA GASTRIC A, GASTRIC CHOLERA. This form of cholera is characterized by frequent or almost continual vomiting, but is often 51 CHOLERA. accompanied by many symptoms of other varieties. The matters at first thrown out consist of the food which the stomach happened to contain, or the liquids Avhich had been swallowed. They are usually thrown up with a sudden jerk, Avithout previous retching. The vomiting is sometimes preceded for a short time by nausea. There is no diarrhoea, or only one or two evacuations at the onset. The urine is scanty. The gastric variety of cholera is neither the most frequent nor the most dangerous. When the epidemic prevails, this form may be excited by flatulent vegetables or other indigestible food. TREATMENT OF GASTRIC CHOLERA. The principal remedies are Camphor and Veratrum. Camphor will ordinarily be proper at the onset ; one drop every five minutes. If relief is not soon obtained, give Veratrum, at the usual intervals, unless some other remedy is more indicated by the character, conditions, or concomitants of the vomiting.* If, by the effect of the Veratrum or Ipecac, the vomiting cease, but the other symptoms remain, and there is great weight at the stomach and pains in the intestines and head, then * Examine the repertories to decide between these, or to determine whether some other remedy is preferable. 52 SIASMODIC CHOLEIIA. have recourse to Nux 30 . But if the disease is not checked, give Verat. 30 , or other medicines according to the indications. To cholera excited by anger, and attended Avith either vomiting or diarrhoea, Cham. 12 is appropriate. SYMPTOMS OF THE THIRD VARIETY', CHOLERA SPASMODICA, SPASMODIC CHOLERA. This form is especially characterized by cramps and other spasms. The principal symptoms are contractions and cramps in the toes and fingers ; aftenvard, cramps in the calves, or convulsive movements in the muscles of the fore-arm, and legs; then spasms in the upper arms and thighs, and sometimes fixed spasms in the chest, neck, and jaw, resembling those of locked jaw or tetanus. The constriction of the chest is preceded by vomiting. Neither vomiting nor diarrhoea frequently occur in this variety ; but it may succeed a neglected diarrhoea, and be ushered in by a single copious vomiting, and attended by occasional retchings. In some cases there are first cramps in the calves of the legs ; then tonic spasms of the whole of both inferior extremities, soon extending in succession to the abdomen, stomach, chest, and throat ; the inferior limbs remaining spasmodically extended 3* 53 CHOLERA. and extremely stiff and hard, and affected witli excruciating pain ; a hard swelling at the stomach ; spasms of the muscles of the jaw, attended with grating of the teeth ; respiration almost arrested ; sense of extreme suffocation ; apprehension of impending dissolution ; deglutition difficult, sometimes impossible. The spasms at length relax, and the patient for a few minutes is free from pain. Then the spasms and the pain return Avith their former severity. TREATMENT OF SPASMODIC CHOLERA. The principal remedies are Camphor, Cuprum, and Veratrum. Give a drop of Camphor every five minutes. During the paroxysms, if they are extremely severe, we may give two drops at a dose, or repeat one drop every two or three minutes. The remedy next to be employed for removing the remains of the spasms and preventing their return is ordinarily Cuprum 30 . Give it in solution, or dry in doses of two or three globules, and repeat it many times at intervals of half an hour, or an hour, if its salutary effect is not manifested. If necessary, then give Veratrum (12th then 30th) in repeated closes, or other medicines according to the different indications. Cuprum may be given at the onset of the spasms, provided their charac- 54 CUPRUM AND VERATRUM. tcr and concomitants indicate its use decidedly more than that of Camphor. Vide Cholera Repertory. [Cuprum and Veratrum are often mentioned as curatives for cholera, and often in circumstances someAvhat similar, without such differentiation as to enable one Avho is inexperienced to say which he should give. The symptoms by which these drugs are related to cholera are very similar. Both haA T e vomiting,* purging, cold sweat, cramps, exhausted life-force, blue color of face, sunken face and eyes. But there are differences also. Cold sAveat is more profuse with Veratrum. It may cover the whole body or be more copious on the face. The cramps of Veratrum are more in the extremities, those of Cuprum are more in the chest and abdomen. The blue color is more intense Avith Cuprum, though Veratrum has it, but in less degree. The sunken features are Avith both, but with copper it is more marked at the eyes, which have blue rings around them ; Avith Veratrum it is more of the cheeks, and the nose is peaked. The differences of the two drugs should be carefully studied, as notwithstanding their * If the vomited matter be green give Cuprum, in a case where other symptoms leave choice letween this and Veratrum doubtful. 55 CHOLERA. great similarity it is not a matter of indifference Avhich shall be selected for a given case. If the Avrong one be given there may be no time to correct the error. With cholera, more than any other disease, it is of the greatest importance that the right remedy be given every time. So rapid is its destructive course that it may give us no time to mend a mistake. The first prescription must be right, or there may be no opportunity to make a second. There is one fact often witnessed Avhere cholera atmosphere is present, which we think should be incorporated with the premonitory symptoms of the disease. We refer to the singular, panicky fear of the disease, which often takes entire and irresistible possession, of the mind of the unfortunate individual, unfitting him for the duties and depriving him of the comforts of life. The fear is not to be reasoned Avith, nor controlled by any other consideration or interest. It is but too evidently a part of the train of the morbid phenomena Avhich are soon to culminate in a fully developed attack of the disease, and as such should be dealt with medicinally, as other symptoms are. By moral means it cannot be reached. If practicable, a change of residence to an uninfested locality should be advised, while at the same time proper medication should not be neglected. 56 CHOLERA SICCA. There can be no doubt that Colchicum will be found a valuable curative of cholera. It should not be forgotten in dealing with any epidemic of the disease. Its place will probably be found immediately after Camphor, if a case has in spite of this passed to its second stage. It may in some cases be called for at the beginning. For a picture of singular likeness to the symptoms of malignant cholera, see Am. Horn. Rev., vol. 11, p. 124 et seq., cases of poisoning by Colchicum, from Frank's MagazineZ] SYMPTOMS OF THE FOURTH VARIETY, CHOLERA SICCA, DRY CHOLERA. There is no diarrhasa nor vomiting. Sometimes the attack is first manifested by a blackish color of certain parts, as the ends of the fingers, whilst the general strength is not seriously impaired. In the severer forms, there is a sudden prostration of the vital powers ; the urine is suppressed ; tongue sometimes blue or blackish; the eyes upturned and fixed; coldness of the surface of the Avhole body, Avhich becomes covered with a cold, sticky SAveat; the face and limbs have a violet blue color. The voice and pulse fail. This variety requires the most prompt attention. 57 CHOLERA. TREATMENT OF DRY CHOLERA. The first remedy, as in other varieties of cholera, is Camphor. In this variety it is especially required for arousing the nervous system. Repeat it in doses of one or two drops every five minutes. Then, if necessary, give Veratrum every half hour, or hour, or hour and a half. If the cramps and vomitings have entirely ceased, if the patient is cold, blue, and pulseless, i. c., collapsed — Carbo-v. 30 , two or three globules. In this state of complete asphyxia, some recommend Hydrocyanic acid, third attenuation, every hour or two. We recognize the effect of these medicines by the pulsations becoming sensible, and sometimes by a return of the cramps, vomitings, or diarrhoea ; symptoms Avhich are then to be treated by Veratrum or Cuprum, or some other remedy, according to the indication. SYMPTOMS OF THE FIFTH VARIETY, CHOLERA ACUTA, ACUTE CHOLERA. In this variety the nervous centres seem to be effected in the first stage. Yet in its course it simulates the form of some other varieties, and like them, unless checked, ends in asphyxia and death. The patient at first feels as if he Avere stunned 58 CHOLERA ACUTA. or lias a sensation of AA'eight in the head, or vertigo, oppression of the chest, numbness of the arms and legs. AfterAA T ard there are rumblings in the intestines, heat of the body, pulse rapid and feeble, nausea, retching or vomiting, bilious or watery diarrhoea, suppression of urine, tongue cold, voice altered; face yellowish, with a dark blue circle around the eyes; prostration ; spasms, at first in the feet and hands, afterward extending to the arms and legs, which become dark-blue and cold; the eyes tarnished and sunk in their orbits. The diarrhoea and cramps cease, and the disease in its later stage runs into the form of dry cholera, characterized by cold sweats, insensible pulse, and general blueness — i. c., by collapse. The above descriptions of the dry and acute cholera are extracted mainly from the treatise of Dr. F. F. Quin. In both, the strong impression of the poison on the nervous system seems to produce an unusually great and early change in oxygenation and the constitution of the blood. There is probably no impropriety in applying the term acute to most of those cases Avhich without being dry, are sudden in their invasion and rapid in their course. Such cases not unfrequently present complications which prevent their being embraced in any other single class, unless Aye should add a ncAv one to those here enumerated. 59 CHOLERA. TREATMENT OF ACUTE CHOLERA. Give Veratrum ; at first the 12th, in persons of vigorous constitution,* and after three doses, the 30th, in the quantity and at the intervals before described. In cases of persons of feeble constitution, give one dose of the 12th, and folloAV it by as many of the 30th as shall be necessary. If in this or in any other variety of cholera there is severe burning in any part of the alimentary-canal, with violent colic, and great Aveakness or restlessness, give Arsenicum 30 . If the colic proves obstinate, give an enema of ice water. Though Veratrum is in general the grand remedy for this somewhat complicated variety, yet it will often be necessary to consult the repertory, and determine the remedy by groups of symptoms.f SYMPTOMS OF THE SIXTH VARIETY, CHOLERA GASTRO-ENTEBICA, GASTRO-ENTERIC CHOLERA. This is a kind of combination of the gastric and diarrhoeic varieties ; yet being not unfrequent in its occurrence, it merits a distinct consideration. It is characterized by vomiting and diarrhoea, *See Note on p. 50.— Wells. f The treatment of the dry and acute varieties is taken mainly from the treatise of Dr. F. F. Quin, of London. 60 GASTRO-ENTERIC CHOLERA. almost simultaneous in their commencement and nearly equal in their intensity and duration. These evacuations from the stomach and intestines agree in another respect : viz., in consisting at first of the usual contents of those cavities respectively (i. c., food being vomited and foecal matter dejected), and in soon becoming thinner, after- Avard Avatery, and ultimately assuming the ricewater appearance. Although this combination of upward and dowmvard discharges is characteristic of this variety, there may be some cramps, and great coldness of the body, and the patient may be, within a few hours after the attack, in the blue and pulseless condition of collapse. TREATMENT OF GASTRO-ENTERIC CHOLERA. The principal remedy is Veratrum, in the doses and at the intervals before mentioned.* If a dose or two of the 12th is given at first, the 30th should be given subsequently. If the treatment is commenced very early, Camphor will be appropriate, and ordinarily sufficient. Dose, one drop every five minutes. When *See page 57. Colchicum will often be the remedy for this variety. See Am. Horn. Rev., Vol. 11, page 124 et seq., from Franks Magazine, 4 61 CHOLERA. the stools become exceedingly copious and liquid, Veratrum is in most cases to be used. If there is complication of other symptoms, the groups may indicate some other remedy. SYMPTOMS OF THE SEVENTH VARIETY, CHOLERA DYSENTERICA, DYSENTERIC CHOLERA. * This variety commences Avith the symptoms of diarrhoeic cholera, and gradually becomes more dysenteric. The diarrhoea from the outset is attended Avith pain in the abdomen. The stools copious and watery, presently acquire the ricewater character. After some time they diminish in quantity, and present, in addition to the Avatery and ricey portions, some mucus, Avhich still later becomes sanguineous, but is still accompanied by ricey and Avatery portions. If the disease continue some days, the ricey evacuations are replaced by others of bloody mucus or blood. Cramps in the feet may exist early in the second stage, and even precede the attack as a premonitory symptom. Many cases of dysenteric cholera occurred in 1849. They were distinguishable from dysentery *Dr. Quin, from whom the above classification is in part taken, comprises in " Dysenteric Cholera," what is here named Diarrhoeic, if he does not restrict it to that. 62 DYSENTERIC CHOLERA. (many cases of Avhich also occurred in the same epidemic) by the cholera symptoms which predominated in the earlier stages. On account of the frequent occurrence of this form as compared Avith all others of an inflammatory character, and the peculiarity in the treatment required, there is a practical advantage in giving it a distinct consideration and name. It is therefore placed by itself in this edition. It is not usually in any remarkable degree a febrile disease ; the depression of the vital forces by the cholera proper seems in many cases to overbalance the general excitement Avhich the associated inflammation of the mucous membrane of the large intestine tends to produce. And this inflammation Avhen uncomplicated is seldom attended Avith as much fullness of pulse and pains in various parts as characterize many other inflammations and fevers. Yet there are cases Avhere this variety is complicated Avith the succeeding. There may be similar complications in the case of other varieties. lam not insensible to the defects of this and all classifications of the disease, but deem it practically useful to adopt one that is approximately correct. TREATMENT OF DYSENTERIC CHOLERA. The principal remedies for this variety are 63 CHOLERA. Camphor, Veratrum, Mercurius-vivus, and Sulphur — in the above order. There being an inflammation of the mucous membrane of the large intestine we should make but a sparing and cautious use of Camphor.* Give three or four doses of Camphor 3 , at intervals of a quarter or half an hour, or, if this is not at hand, as many quarter-drop doses of the tincture ; then Veratrum 12 or 30, until the evacuations become small and bloody ; then Mercurius 12 , followed after some time by Mercurius 30 .f After amendment of the dysenteric portion of the disease commences the cure is to be completed by Sulphur 30 . Sometimes, when there is inflammatory fever, two or three doses of Aconite will be required before the Mercurius, or during a temporary suspension of the use of the latter. * I think a similar precaution in regard to Camphor is advisable in treating children in cholera generally. Nearly all the fatal cases which I have heard of as occurring after an early use of Camphor, have been among children under twelve years of age. I would advise that in the cases of children, Camphor be not employed lower than the third dilution. f See Note on p. 50. — Wells. 64 FEBRILE CHOLERA. SYMPTOMS OF THE EIGHTH VARIETY, CHOLERA FEBRILIS, FEBRILE CHOLERA. In some instances cholera is complicated Avith fever. This is distinguishable from other febrile diseases by the Avatery and ricey evacuations or the nausea vomitings and spasms ; and from other forms of cholera by the frequency, hardness, and fullness of the pulse. The temperature of the body is generally above the normal standard, that of the hands and feet sometimes beloAV. Pains in the small of the back, hips, limbs, head, and abdomen. Redness of the eyes, tongue, or fingers. TREATMENT OF FEBRILE CHOLERA. In febrile cholera give but little Camphor. For a short time use Veratrum or other remedies adapted to the purging vomiting, or cramps, if either is severe. Then Aconitum 12 or 30 in solution, a dose once in tAVO or three hours, if the pulse is hard, full, and rapid, and there is a great thirst and heat of the skin. Othenvise use Rhusradican 30 for the rheumatic-like pains. This last remedy will be especially indicated if the tip of the tongue is red. Then Bell. 30 , Bry. 30 , or Canth. 30 , according to the symptoms and the organ affected. The accurate selection of the 65 CHOLERA. remedy in these cases can be made only by a homoeopathic physician. The foregoing varieties are in some cases well marked, in others not. There is an advantage in attending to them ; though the homoeopathic physician who prescribes for the symptoms will not deem it necessary to designate the variety. This will often be impracticable, especially if he is called when the cases are so advanced as to confound varieties which were originally distinct. In one sense the variety may change with the stage. 66 07 CHAPTER IV. SYMPTOMS AND TREATMENT OF THE STAGES OF CHOLERA. A case of either of the foregoing varieties is not usually divisible into distinct, well-defined stages ; but we may enumerate four stages ; some of them being oftener present or more distinct or durable in one variety, and some in another, They are : Ist. The incipient Stage, Stage of Invasion : 2d. The Active Stage, or Stage of Full Development : 3d. The Stage of Collapse: and 4th. The Stage of Reaction. FIRST STAGE OF INVASION. This is usually longest in the diarrhoeic variety ; in which it may continue from one hour to several days. The stools, though they may be watery and Avhitish, are not profuse. In the gastric variety, CHOLERA. this stage may present a transient nausea, or a few loose foecal stools; in the spasmodic variety, diarrhoea, or one or two vomitings ; in the acute variety, vertigo ; in the gastro-enteric variety, nausea. When cholera prevails, the above symptoms are generally due to the action of its poison. This is evident from their general prevalence during the epidemic, their amenability to cholera remedies, and the formidable and unequivocal phases which they frequently assume, Avhen nature is unaided. There are two modes of considering these symptom — either as constituting a milder form, or an earlier stage. The latter is here preferred. Some of these cases would stop in this stage, others become fully developed, and finally fatal. No poAver of diagnosis could at first separate them into two classes, founded on their inherent tendencies. Could we distinguish those Avhich would spontaneously prove abortive Aye Avould exclude them even from the first stage. But that distinction is impracticable. Without any assumption in regard to their nature, the event under treatment will subsequently decide A\ T hether they assume a form more complicated and severe; and as it requires a certain number and severity of symptoms to constitute the disease in its more formidable and popular sense, we never include in 68 SECOND STAGE. our cholera reports the cases cured in this stage of invasion.* The principal remedies in the first stage are: Camphor, Phosphorus, Phosphoric-acid, and Veratrum. SECOND STAGE, STAGE OF FULL DEVELOPMENT. This, in the diarrhoeic variety, is characterized by the profuse or frequent rice-Avater evacuations ; in the gastric variety, by the vomiting of similar matter ; in the spasmodic variety, by severe cramps or other spasms ; in the dry variety, the first two stages may be scarcely perceptible, unless the first is, by the dark color of certain parts, or the coldness of the tongue ; in the acute variety, there may be a livid appearance under the eyes, vomiting, or rumblings and liquid stools. In the gastro-enteric variety, there is profuse vomiting and diarrhoea ; in the dysenteric variety, pain and tenderness of the abdomen, and watery, ricey, and bloody-mucous discharges. The stage of full development has usually one * In an essay published in a former edition of this book, this stage is designated by the convenient term Choleroid. This term includes Cholerine, but has the advantage of greater comprehensiveness, 69 CHOLERA. of two terminations ; viz., either collapse or convalescence. In fully developed cholera, the principal remedies are : Camphor, Veratrum, Cuprum, Phosphorus, Phosphoric- acid, and Arsenicum. It is the commencement of this stage that is alluded to in chapter I,* as " a decided attack." For the details of its early treatment, the second section of that chapter is to be consulted — also the Repertories. THIRD STAGE, STAGE OF COLLAPSE. This stage of collapse may have the same character in every variety of cholera, and in its principal features it is similar in all varieties. The term collapse is used to designate a certain collection of symptoms, including pulselessness ; cold, blue, and shriveled skin ; the voice reduced to a whisper ; the urine and other secretions suppressed, and the face presenting a certain appearance called choleric. The term facies cholerica is used to denote a face cold, livid , and shrunk, and often anxious, the eyes sunk in the orbits, and upturned or fixed as if in vacant staring. The vox cholerica, which belongs chiefly to this stage, is a * Page 28. 70 FOURTH STAGE. voice hoarse, feeble, Avhispering, or almost imperceptible. The duration of the third stage varies from two hours to two days. It has one of three terminations ; viz., either death, convalescence, or a disease which is inflammatory, congestive, or typhus. When death occurs from cholera, it is usually at the termination of the third stage, sometimes of the fourth. The return of a perceptible pulse, and of Avarmth, although attended Avith a reneAval of the vomiting and diarrhoea, are favorable signs ; though even after this partial reaction there may be a relapse into asphyxia. If the collapse is complete, the principal remedies are Cuprum, Arsenicum, Carbo-vegetabilis, Nicotine, and Secale. When the collapse is only incipient or partial, Camphor and Veratrum. These may also be required for a while in complete collapse, if they have not been resorted to in an earlier stage of the same case. FOURTH STAGE, STAGE OF REACTION AND SECONDARY AFFECTIONS. The secondary affections which ensue on reaction are congestive, inflammatory, or febrile. The fourth stage proper, i. c., reaction attended with these serious diseases, has seldom any exist- 71 CHOLERA. ence after a good homoeopathic treatment of cholera proper; though there Avill, in some cases, be dysuria. The affections to be most apprehended after allopathic treatment are inflammation or congestion of the brain, stomach, intestines, or lungs, or typhoid fever. So far as there is a partial reproduction of the symptoms of the second stage, Avhich had disappeared during the collapse, a recurrence to the remedies of the second stage Avill be necessary in the fourth. But for the neAV symptoms following reaction use other remedies. For the irritation of the bladder, attended Avith painful urination, use Cantharis 30 , every hour or two, whilst the symptoms remain urgent. In most of these inflammations, however, we may give two or three doses of Aconite, at intervals of an hour, and follow it by the remedy adapted to the symptoms and the organ affected, repeating this last medicine much less frequently. If it is the brain that is affected, the remedy will generally be Belladonna 30 ; if the lungs, Bryonia 30 , in some cases followed by Rhus 30 ; if the stomach or intestines, Nux 30 , and sometimes Bry. 30 ; if the bladder, Cantharis 30 . This last is also the remedy where there is inflammation in the lower intestines, attended with burning, tenesmus, and bloody stools. For the typhus or typhoid fever, Bryonia and 72 RHUS-RADICANS. sometimes Phosphoric-acid, may be used ; but the principal remedy is Rhus-radicans.* I Avill take this occasion to make a remark on a topic, not discussed in either of the notes above referred to. The Rhus-tox. Avhich Hahnemann tried, was an exotic, and hence probably did not possess as much power as a plant of the same species found growing in its native soil in America. Dr. Wallace, a scientific oculist of this city, informs me that this is the case Avith Stramonium ; and that, on the other hand, the Belladonna of Europe is more poAverful in dilating the pupil than the exotic Belladonna of America. Again, if the shrub Rhus-tox. is a stunted variety of the same species as the vine Rhus-rad., there is an additional reason for doubting AA'hether it has as much activity; * I deem it due to the profession as well as to myself, to state that the Note on this plant, inserted without my consent or knowledge, in the Appendix to the American edition of Jahr's Symptomen- Codex, is grossly incorrect, especially where it attempts to correct my botanical description of this plant in general, and of the particular plant from which I obtained the specimen for trial. This last part of the criticism is not only incorrect, but absurd ; inasmuch as the botanical character of those particular leaves could be known only to myself and my respectable medical colleagues who engaged with me in the provings, and to whom the leaves were shown. I here re-affirm the correctness of my description, as given in the Note in the body of the same Symptomen-Codex, pages 671 and 672. 73 CHOLERA. furthermore, the provings afford evidence that it has not. So far as the clinical experience of many physicians for some years can show, the Rhus-rad. is as efficacious as Rhus-tox. or more so, in those cases to which the latter is applicable. Like several other physicians, I prefer it. Wherever in the repertory, the generic term Rhus is used alone, it may be considered as including both Rhus-rad. and Rhus-tox. If great debility follows the cholera, and there are no other symptoms which require special attention, the appropriate remedy is Cinchona. The final remedy for the more complete restoration of health will frequently be Sulphur, given in a single dose, and alloAved to act a long time without repetition. When a homoeopathic physician is called in any stage to any case of cholera Avhich has been under allopathic treatment, he is first to antidote the former treatment by Camphor. Give it but a short time, if there is any inflammation. He can judge if other antidotes are necessary ; as they frequently Avill be in the course of the treatment; for calomel and crude drugs— and even the undiluted colored tinctures of the homoeopathic shops — are so durable in their mischievous action, as to require for their correction something more durable in its curative action than Camphor. 74 CHAPTER V. REPERTORY. CONTAINING THE IMPORTANT SYMPTOMS, AND THE USUAL GROUPS AND THE MEDICINES TYPOGRAPHICALLY DISTINGUISHED AS TO THEIR RELATIVE VALUE IN CHOLERA. Believing that the success of homoeopathic treatment in cholera is such that this book will be used by many physicians Avho have had little or no experience Avith this kind of practice, I deem it proper to explain the best mode of using the Repertory. Select tAvo important symptoms of the case to be treated, and ascertain Avhat remedies are common to both. If these be too numerous to be retained in the memory, Avrite them doAvn. Then compare this reduced list Avith the remedies as given in the Repertory for some other important symptoms, and thus discover Avhat remedies are common to the three. Then select a fourth, etc., and continue this process until there is only one remedy left. This will generally be the remedy for the case, especially if the symptoms selected are really the most important. 75 USE OF REPERTORY. In using this method and this Repertory in the treatment of cholera, it will generally save labor to omit, at every step of the process, all those medicines which are not emphasized in at least one of the two lists. Such medicines will almost always be eliminated before the above-described process is completed. No medicine which is printed either in Roman or in italics, in every place in which it occurs in this Repertory, is, in the present state of our knowledge, known to have much power in the first three stages of noninflammatory cholera ; and hence the use of such medicines in cholera, except by a very skillful practitioner, would be unsafe. If such remedies should not all be removed by the process above described, the only safe course (at least for a beginner) Avould be to commence anew and repeat this process with other important symptoms, combining them Avith each other and with some of those previously selected, and in general, the making of various combinations and in various orders will give greater security in the selection of the remedy, If there be two remedies Avhich apply to all the known symptoms of the case, the selection may be determined by the type in which their names are here printed. If the remedy still be doubtful, and there is time for study, consult a reliable work on the materia medica, 76 MENTAL SYMPTOMS. One object in the construction of this Repertory has been to save part of the above-described labor, by occasionally combining the symptoms into such groups (of two or three) as the disease more frequently presents. The degree of emphasis has been determined by the clinical experience of the school in cholera. I have, hoAvever, italicized some medicines Avhich rank high for the symptoms in general, but are not known to be useful in cholera. The emphasis given to the medicines in this Repertory has no reference to the fourth stage, nor to the inflammatory variety, except Avhere it is so stated. The concomitant symptoms in any one section of this Repertory are generally arranged in the same order as the sections themselves. Where symptoms relating to different parts of the body are in the same paragraph, those of the superior parts are put first and the more general symptoms last. The paragraphs are arranged alphabetically ; but where the same symptom (as cramp) refers to different parts of the body, these parts are put in the natural typographical order, from above downward. MENTAL SYMPTOMS. Anguish, anxiety, or inquietude : Aeon, ant-t. Ars. bell. bry. camph. carb-v. caus. chain, cic. 4* 77 HEAD coff. cupr. dig. hyos. ign. ipec. kali. lach. laur. lye. mere. natr. natr-m. nitr-ac. nux-v. petr. phos. phosac. puis. rhus. sec ale. Sep. stram. sulph. verat. Apathy, or indifference : Ars. bell. calc. cham. chin. cic. hyos. lach. lye. mere, natr-m. phos. piiosac. Sep. staph, verat. Fear of death, with internal burnings, and tossing in the bed : ARS. Taciturnity, or repugnance to conversation : ARS. bell. bry. calc. cham. cic. coloc. cupr. ign. lach. mere, natr-m. nux-v. phos-ac. puis, rheum, stann. staph, sulph. sulph-ac. VERAT. HEAD. Confusion in the head : Aeon, ant-t. ars. bell, bry. calc. camph. caus. chin. dig. mere, nux-v. op. phos-ac. puis, rheum, rhus. secale. Sep. sulph-ac. VERAT. Heaviness, or pressure in the head : Aeon, ant-t. am. ars. bell. bry. calc. CAMPH. carb-v. cham. chin. cic. dulc. ign. ipec. lack. laur. lye. mere, natr-m. nux-v. op. petr. phos. phos-ac. puis, rheum, rhus. Sep. sil. stann. sulph. verat. Vertigo : Aeon, ant-cr. ant-t. am. ars. bell. bry. calc. CAMPH. carb-v. caus. cic. cupr. dig. ferr. graph, hepar. hyos. ign. ipec. kali. lack. laur. lye. mere. natr. natr-m. nux-v. op. petr. phos. piios-ac. 78 EYES — FACE. puis. rhus. secale. Sep. sil. stram. sulph. sulph-ac. thuja. VERAT. Vertigo with nausea and thirst : VERAT. Vertigo with stupor: Ant-t. ars. bell. bry. calc. caus. kali. laur. lye. mere, natr-m. nux-v. op. phos. phos-ac. puis. rhus. secale. sil. spig. stram. sulph. VERAT. EYES. Eyes sunk in the orbits, with livid semicircles under them : Ars. calc. camph. cic. cupr. kali. laur. PHOS. PHOS-AC. SECALE. Sulph. VERAT. Eyes sunk in the orbits, with hoarse voice : Ars. calc. camph. cic. cupr. kali. laur. phos. phos-ac. SECALE. Sulph. VERAT. Eyes upturned and fixed : Camph. cic. verat. Pupils contracted : Ars. bell. cham. camph. cicut. nux-v. puis, secale. Sep. VERAT. FACE. Bluish color of the face : Aeon, ant-t. ars. bell, bry. CAMPH. cham. cic. con. CUPR. dig. dros. hepar. hyos. ign. ipec. lach. lye. mere. op. phos. puis, samb. spong. staph, stram. VERAT. Bluish and pale face : Ant-t. ARS, bell, bry CAMPH. cic. con. CUPR. dig. dros. hepar. hyos ign. ipec. lach. lye. mere. op. phos. puis, samb spong. stram. VERAT. 79 FACE, Bluish color about the eyes : ARS. calc. cham. chin. cupr. ferr. graph, hepar. ign. ipec. kali. lach. lye. mere. natr. nux-v. oleand. phos. phos-ac. rhus. sabin, SECALE. Sep. spig. staph, stram. sulph. VERAT. Blueness of the lips : Ang. ars. camph. caus. berb. chin-sul. cupr. dig. lye. phos. Blueness of the lips, with corrugated and withered appearance of the skin : Ars. camph. CUPR. lye. phos. Blueness under eyes ; sleeps Avith eyes open : ipec. phos-ac. sulph. verat. Blueness of the face and lips ; coldness of the lips : ARS. cupr. VERAT. Blueness of the face ; vomiting after drinking ; pulse sloav ; sweat clammy : VERAT. Cold perspiration on the face : Carb-v. rheum, nux-v. rhus. verat. Gold perspiration on the forehead during the evacuation : VERAT. Gold perspiration on the face and limbs : Carb-v. Coldness of the nose: Am. bell, plumb, verat. Coldness of the nose and hands: Bell. VERAT. Fades cholerica ; Ars. camph. carb-v. cupr. ipec. laur. phos. phos-ac. rhus. secale. verat. Face choleric; voice hoarse: Ars. camph. carb-v. cupr. laur. phos. phos-ac. rhus, secale. VERAT. 80 TONGUE. Spasm of the jaw: Bell. cham. CAMPH. cic. CUPR. hydro-ac. lach. laur. op. rhus. secale. VERAT. TONGUE Coats on the tongue. BroAvn : Bell, carb-v. hyos. piios. rhus-rad. sabin. sulph. Mucous : Bell. cupr. dulc. lach. mere, phos-ac. puis, sulph. Viscid: PHOS-AC. White : Ant-cr. am. bell. bry. calc. carb-v. cupr. dig. ign. ipec. mere. nitr. nux-v. petr. puis, sabin. secale. Sep. sulph. Yellowish : Bell. bry. carb-v. cham. chin, coloc. ipec. nux-v. plumb, puis, rhus-rad. verat. Coldness of the tongue : Ars. bell, camph. laur. natr-m. secale. VERAT. Coldness of the tongue and breath : Ars. carb-v. camph. verat. Coldness of the tongue, with dryness of it and of the mouth : Ars. bell, camph. laur. secale. VERAT. Coldness of the tongue, Avith cold sweat on the body : Ars. camph. secale. VERAT. The same symptoms in a more advanced state of collapse: Ars. camph. carb-v. cupr. secale. Verat. 81 nausea — vomiting. Redness of the tongue: Ars. bell. bry. cham. hyos. lach. nux-v. rhus. stann. sulph. verat. Redness of the tip of the tongue, in the febrile variety, or in the fourth stage : RHUS-RAD. Tongue red, and coated yellow: Bry. cham. nux-v. rhus-rad. VERAT. Tongue red; pulse slow: Bell, rhus-rad. Verat. NAUSEA AND THIRST. Nausea with thirst: Bell. Phos. VERAT. Nausea with vertigo : CAMPH. mere, verat. Nausea with continued pain at the pit of the stomach: Aeon, ant-t. ars. bell, camph. cham. cupr. mere, natr-m. nux-v. piios. puis. rhus. sulph. VERAT. Nausea Avith diarrJicea : Ars. ipec. mere, piios. Thirst, violent : Aeon. ARS. bry. camph. carb- V. cham. cic. cupr. ipec. laur. mere, natr-m. nux-v. phos. phos-ac. secale. stram. verat. Thirst with nausea : Phos. VERAT, VOMITING. Vomiting after a meal; blueness of the lips: Ars. phos. Vomiting after drinking; with blueness of the face: ARS. VERAT. Vomiting after drinking: Am. ars. bry. nux-v. puis. VERAT. 82 STOMACH. Vomiting frothy : VERAT. Vomiting of a ivatery liquid, analogous to that of the stools, Avith pieces of mucus: Ars. bell, camph. cupr. ipec. jatroph. secale. strain. VERAT. Vomiting with pain in the stomach: Ant-t. ars. bry. camph. cupr. ipec. lach. nux-v. piios. sulph. stram. VERAT. Vomiting with colic : Ant-t. ars. cupr. nux-v. piios. puis, strain. VERAT. Vomiting Avith diarrhoea: Ant-t. ars. cupr. jatroph. ipec. phos. secale. stram. VERAT. Vomiting Avith colic and diarrhoea: Ant-t. ars. cupr. phos. stram. VERAT. Vomiting Avith lassitude: Ars. camph. ipec. phos. VERAT. PAINFUL SENSATIONS AT THE STOMACH AND PIT OF THE STOMACH. Anxiety, distention, and pressure at the pit of the stomach : Ars. Burning in the stomach : ARS. bell. bry. camph. canth. carb-v. chain, cic. jatroph. laur. mere, nux-v. phos. phos-ac. secale. verat. Burning in the pit of the stomach : Aeon. ars. bell. bry. laur. mere, nux-v. piios. secale. verat. Burning heat in the stomach or pit of stomach : ARS. CAMPH. HYDRO-AC. PIIOS. Burning sensation in the stomach and intestines, 83 STOMACH. sometimes extending along the oesophagus to the mouth: ARS. Cramp in the stomach : Bell. bry. carb-v. cham. CUPR. natr-m. nux-v. phos. secale. VERAT. Pressure and anxiety at the pit of the stomach: ARS. CAMPH. cupr. ipec. NUX-VOM. verat. Continued pain at the pit of the stomach Avith nausea: Aeon, ant-t. ARS, bell, camph. cham. cupr. mere, natr-m. nux. phos. rhus. sidph. VERAT. Pain in the stomach, with vomiting: Ant-t. ars. camph. cupr. ipec. phos. VERAT. Continued pain in the pit of the stomach with rumblings in the intestines: Aeon, ant-t. ars. bell. camph. carb-v. cupr. jatroph. mere, natr-m. nux-v. phos. phos-ac. puis. rhus. secale. sulph. VERAT. Pressive or aching pain at the pit of the stomach with liquid stools: Ant-t. ars. camph. cupr. phos. secale. verat. Pressive or aching pain at the pit of the stomach, with cramps or other spasms in the extremities or elseAvhere: Ant-t. camph. cupr. phos. phos-ac. natr-m. secale. VERAT. Sensibility and swelling of the pit of the stomach : Hepar. lye. natr-m. sulph. Painful sensibility of the pit of the stomach, with spasms of the extremities: Ant-t. ars. camph. cupr. natr-m. phos. phos-ac. verat. 84 ABDOMEN — DIARRHOEA. ABDOMEN. Pains in the abdomen, ivith diarrhtxa : Aut-t. ARS. cham. ipec. laur. mere, merc-c. natr-m. nux-v. phos. rhus. stram. sulph. VERAT. Rumblings in the intestines: Aeon, ant-t. ars. bell. bry. canth. caeb-v. cupr. jatroph. laur. lye. mere, natr-m. nux-v. phos. phos-ac. plumb, puis. rhus. secale. stram. sulph. verat. Rumblings in the intestines, Avith continued pain in the pit of the stomach : Aeon, ant-t. ars. bell, camph. carb-v. cupr. jatroph. mere, natr-m. nux-v. phos. phos-ac. puis. rhus. secale. sulph. VERAT. Rumblings in the intestines, with liquid stools : Ant-t. ars. jatroph. nux-v. petr. PHOS. PHOSAC. puis. rhus. secale. VERAT. Tlirobbings in the abdomen : Ant-t. caps. ign. op. plumb, sang. DIARRHCEA. Diarrhaia, Avith a pasty tongue, which stichs to the fingers: PHOS-AC. Diarrhcea with nausea : Ars. ipec. mere. phos. Diarrhoza with vomitings: Ant-t. ars. cupr. jatroph. ipec. phos. stram. verat. Diarrhcea, with vomiting of the food eaten, and of watery liquid: ARS. cupr. ipec. phos. VERAT. 5 85 DIARRHCEA— STOOLS. Diarrhoea, with aching or pressure, at or near the pit of the stomach: Camph. cham. cupr. mere, natr-m. phos. phos-ac. secale. VERAT. Diarrhoea, with pain in the abdomen : Ant-t. ars. cham. ipec. laur. mere, merc-c. natr-m. phos. stram. sulph. VERAT. Diarrhcea, occasioning great prostration of strength: Ars. bry. chin. con. mere. phos. rheum. secale. Sep. sulph. verat. Diarrhoea, occasioning great prostration of strength, in aged persons : Con. SECALE. Stools brown : Ant-t. ars. camph. merc-c, sulph. VERAT. Stools greenish : Ars. bell, canth. cham. ipec. laur. mere, nux-v. PHOS. phos-ac. sulph. verat. Stools gray or slightly whitish : Aeon. ars. bell, carb-v. cham. lach, mere. PHOS. PHOS-AC. puis. rhus. sulph. verat Stools liquid : Am. ars. carb-v. chin. cic. jatroph. lach. meph. phos. phos-ac. secale. verat. Stools liquid and whitish : Ars. camph. cupr. jatroph. PHOS. phos-ac. secale. verat. Liquid and whitish stools, with white coat of tongue : Cupr. PHOS. secale. Liquid stools, Avith continued pain at the pit of the stomach : Ars. camph. chin. cupr. phos. VERAT. Jjiquid stools, with rumblings in the intestines : 86 DIARRHCEA — STOOLS. Ant-t. ars. jatroph. nux-v. petr. PHOS. PHOS-AC. puis. rhus. secale. sulph. verat. Stools liquid ; evacuation painful (attended with colic) : Ars. carb-v. PHOS. spig. staph. VERAT. Stools liquid ; evacuation painless : Ars. carb-v. chin. cic. PHOS. PHOS-AC. secale. spig. verat. Stools mucous and watery : Ant-t. ars. bell. chin. ipec. nux-v. PHOS. PHOS-AC. puis. rhus. secale. sulph-ac. VERAT. Rice-water stools, or stools like whey or Avater, Avith whitish or grayish flochs in it : Ars. camph. cupr. ipec. jatroph. PHOS. PHOS-AC. secale. verat. (If there is inflammation, consult also, aeon. bry. and rhus.) Rice-voater stools, or watery, grayish, whitish, and floculent stools, Avith great thirst : Ars. camph. cupr. ipec. phos. phos-ac. verat. (If in the febrile variety, or in the 4th stage : aeon. bry. or rhus.) Stools whitish : Aeon. ars. camph. bell. cham. chin. cupr. ipec. jatroph. mere, nux-v. PHOS. PHOS-AC. secale. sulph. verat. Watery and white flocky stools, Avith cramps and thirst : Aeon. ars. bry. camph. cupr. ipec. phos. phos-ac. rhus. secale. VERAT. Watery and white-flocky stools with clonic spasms : (spasmodic movements) and thirst : Aeon. ars. bry. camph. CUPR. ipec. phos. phos-ac. SECALE. VERAT. 87 URINE — VOICE. Whitish flocks in serous stools with pulse scarcely perceptible : Aeon. ars. bry. camph. PHOS-AC. rhus. SECALE. VERAT. Liquid stools with white flocks and grains, having the consistence and color of tallow : PHOS. Stools yellowish: Ant-t. ars. cham. ipec. mere. phos. phos-ac. puis, verat. Yellowish stools, especially in an early stage of the disease : Ant-t. ars. cham. ipec. mere. phos. PHOS-AC. VERAT. URINE. Retention of urine : Camph. cantii. lach. merc-c. op. plumb. VERAT. Retention of urine, with ineffectual desire to urinate; at the commencement of the stage of reaction : CANTH. verat. Urine scantily secreted, or suppressed : Ars. camph. carb-v. cupr. ipec. secale. stram. verat. The same symptom in the consecutive fever : Bell, carb-v. rhus. stram. Secretion of urine diminished; Avith cramps in the calves of the legs : Ars. calc. camph. cann. carb-v. coff. coloc. con. CUPR. graph, hyos. lach. lye. mere. natr. nux-v. petr. rhus. secale. Sep. sil. sulph. VERAT. VOICE. Voice hoarse: Ars. bell. bry. calc. camph. CARB-V. caus. cham. chin. cic. cupr. dros. 88 80 CHEST. graph, hepar. laur. mere, natr-m. hux-v. PHOS. phos-ac. puis. rhus. secale. spong. sulph. verat. Voice hoarse , face choleric : Ars. camph. carb-v. CUPR. laur. phos. phos-ac. rhus. secale. verat. Voice lost (aphonia) : Ant. bell. CARB-V. caus. eham. chin. CUPR. dros. hepar. kali. lach. laur. mere, natr-m. nux-v. petr. phos. puis. Sep. sil. spong. stann. sulph. verat. CHEST. Anguish in the chest: Aeon. ARS. bell. bry. camph. carb-v. cic. cupr. hydroc-ac. ipec. jatroph. laur. natr-m. phos. phos-ac. rhus. stram. VERAT. Breath cold : CARB-V. (And, according to some clinical observations : ars. camph. verat.) Constriction (spasmodic) of the chest : Camph. caus. CUPR. ferr. ipec. lach. nitr-ac. nux-v. op. phos. phos-ac. puis. spig. stram. sulph. verat. Cramps or tonic spasms in the chest : Ars. bell. camph. caus. CIC. CUPR. ferr. graph, hyos. ipec. kali. mere, nux-v. op. phos. phos-ac. puis. SECALE. Sep. stram. sulph. VERAT. Cramps in the muscles of the chest, Avith continual vomitings, and with the eyes turned upward : Camph, CIC. verat. Respiration laborious ; cold and blue shin : ARS. camph. carb-v. cupr. ipec. secale. verat. EXTREMITITIES. SUPERIOR EXTREMITIES. Cramps in the upper arms : Phos-ac. secale. Cramps in the fore arms : Laur. phos-ac. secale. Cramps in the wrist : Phos-ac. Coldness of the hands : Aeon, ant-t. bell. cham. ipec. nat-m. nux. petr. phos. sulph. verat. Cramps in the hands: Bell. calc. cann. coloc. graph, laur. phos-ac. secale. stram. Cramps in the fingers : Am. ars. calc. cann. coff. dros. ferr. lye. nux-v. phos. phos-ac. secale. stann. staph, sulph. verat. Cramps in the fingers, Avith clamminess of the tongue and skin: Phos-ac. Cramps in the fingers, with clammy perspiration : Ars. ferr. lye. nux-v. phos. phos-ac. verat. INFERIOR EXTREMITIES. Coldness of the feet : Aeon, ant-t. bell. calc. eaus. dig. graph, ipec. hali. lach. lye. mere. natr. natr-m. nitr-ac. petr. phos. plat, plumb, rhod. rhus-rad. Sep. sil. sidph. verat. Cramps in the nates : verat. Cramps in the hips : Coloc. phos-ac. Cramps in the thighs: CAMPH. cann. hyos. ipec. mere. petr. phos-ac. rhus. Sep. verat. Cramps in the hams : Calc. cann. phos Cramps in the legs: Carb-v. coloe. CUPR. JATROPH. p>hos-ac. 90 SKIN, Cramps in the calves of the legs : Ant-t. ars. bry. calc. CAMPH. cann. carb-v. cham. coff. coloc. CUPR. graph, hyos. jatroph. lach. lye. mere, natr. nitr-ac. nux-v. petr. phos. rhus. secale. Sep . sil. sol-n. staph, sulph. VERAT. Cramps in the calves of the legs, Avith burning heat in the stomach, or pit of stomach : ARS. CAMPH. PHOS. Cramps in the calves of the legs, Avith diminished secretion of urine: Ars. calc. CAMPH. cann. carb-v. coff. coloc. CUPR. graph, hyos. lach. lye. magn. mere. natr. nux-v. petr. rhus. secale. Sep. sil. staph, sulph. VERAT. Cramps in the calves; coldness of \hefeet : Ant-t. calc. graph, lach. lye. mere. natr. nitr-ac. petr. piios. rhus-rad. Sep. sil. sulph. VERAT. Cramps in the feet : CAMPH. caus. graph, lye. natr. nux-v. secale. stram. sulph. Cramps in the feet, with burning in the stomach or pit of stomach : CAMPH. Cramps in the soles of the feet : Calc. carb-v. coff. ferr. hepar. petr. phos-ac. plumb, secale. sil. staph, sulph. Cramps in the toes: Calc. ferr. hepar. lye. mere, nux-v. phos-ac. secale. sulph. SKIN. Blueness of the skin : Aeon, am, ars. bell. bry. calc. camph. carb-v. cupr. dig. lach. mere, natr- 91 SKIN m. nux-v. op. phos. phos-ac. plumb, puis. rhus. secale. sil. spong. thuja, verat. Blueness and withered appearance of the skin in different parts : Ars. bry. calc. camph. cupr. mere, nux-v. phos. phos-ac. SECALE. sil. spong. VERAT. Coldness of the skin: Aeon, ant-cr. ant-t. am. ars. bell. bry. calc. camph. cann. canth. carb-v. caus. cham. chin. cic. cupr. dros. dulc. ferr. graph, hell, hepar. hyos. ign. ipec. kali. lach. laur. lye. mere. mez. natr. natr-m. nitr-ac. nux-v. op. petr. phos. phos-ac. plumb, puis. rhus. sabad. sabin. secale. Sep. sil. spig. spong. stann. staph, stram. sulph. thuja. VERAT. The medicines which correspond both to coldness and blueness (of the skin) respectively or collectively, are: Aeon. am. ars. bell. bry. calc. camph. carb-v. cupr. lach. mere, natr-m. nux-v. op. phos. phos-ac. plumb, puis. rhus. secale. sil. spong. thuja. VERAT. Skin cold and bluish, and covered with cold perspiration : ARS. camph. carb-v. CUPR. ipec. secale. VERAT. Coldness of the skin Avith mental indifference or tranquillity : Ars. ipec. natr-m. verat. Withered or wrinkled skin: Ant-cr. ars. bry. calc. camph. cham. chin. cupr. ferr. graph, hell. hyos. iod. kali. lye. mere, mur-ac. nux-v. phos. 92 PERSPIRATION. phos-ac. rheum. SECALE. Sep. sil. spig. spong. stram. sulph. VERAT. The medicines Avhich correspond, respectively or collectively, to blueness, coldness, and shriveled state of the skin, are : Ars. bry. calc. camph. cupr. mere, nux-v. phos. phos-ac. SECALE. sil. spong. VERAT. The medicines Avhich, on the ground of clinical experience, have been more especially recommended for this combination of symptoms in the stage of collapse in cholera, are : ARS. camph. carb-v. CUPR. hydroc-ac. jatroph. SECALE. VERAT. PERSPIRATION. Perspiration, cold: Aeon, ant-t. ars. bell. bry. calc. camph. canth. carb-v. cham. chin. cm. coff. cupr. dulc. hell, hepar. hyos. ign. ipec. lach. lye. mere. natr. nitr-ac. nux-v. op. petr. phos. phos-ac. plumb, puis, rheum, rhus. sabad. secale. Sep. sil. spig. stram, sulph. thuja. VERAT. Perspiration, viscid, clammy: Ars. camph. carbo-v. daph. ferr. hepar. jatroph. lach. lye. mere, nux-v. phos. phos-ac. plumb, secale. verat. Perspiration clammy, Avith sloav pulse : Camph. mere. VERAT. Perspiration clammy, with spasmodic movements of the jaw : Camph. mere, nux-v. phos. plumb, secale. VERAT. 93 MISCELLANEOUS SYMPTOMS. PULSE Pulse feeble and frequent: Ars. carb-v. lach. nux-v. rhus-rad. Pulse feeble and slow in the Ist stage: CAMPH. cann. dig. laur. mere. puis, rhus-rad. VERAT. Pulse feeble and slow in the 4th stage : Camph. cann. dig. laur. mere. puis. RHUS-RAD. verat. Pulse feeble and small: Ars. camph. chin. dig. lach. nux-v. PHOS-AC. puis. rhus. VERAT. Pulse scarcely perceptible, Avith wedery and ivhiteflochy stools: Aeon. ars. bry. camph. phos-ac. rhus. SECALE. VERAT. GENERAL AND MISCELLANEOUS SYMPTOMS. Burning internally, and tossing, Avith fear of death: ARS. Burnings in the stomach and abdomen, with anguish and tossing : ARS. CAMPH. Cholera followed by cerebral and abdominal affections : Bell. Collapse so complete that no vomiting, diarrhcea, or spasms remain, though some or all of them have existed previously : ARS. camph. CARB-V. CUPR. hydro-cy. aur. nicotin. verat. Colhpss, without previous or present vomiting 94 MISCELLANEOUS SYMPTOMS. or diarrhoea: CAMPH. CARB-v. hydro-ac. laur. VERAT. Cramps or other spasms at night : Ars. camph. calc. cina. CUPR. hyos. ipec. kali. lye. mere. op. SECALE. Cramps in the stomach and extremities, Avith coldness of the body in an early stage, Avith but little diarrhoea: CAMPH. Spasms, clonic (convulsions) : Ant-t. ars. bell. bry. calc. camph. canth. carb-v. caus. cham. cic. con. CUPR. hyos. ign. ipec. kali. lye. mere, natr-m. op. phos. phos-ac. plat. rhus. secale. Sep. sil, stann. STRAM. Sulph. VERAT. Spasms, severe and clonic, with but little diarrhoea or vomiting : Ars. camph. CUPR. ipec. secale. VERAT. Spasms, tonic (tetanus cramps, etc.): Ars. bell. caus. cham. cic. CUPR. ign. ipee. lye. mere. petr. phos. plat. rhus. secale. Sep. stram. sulph. VERAT. Spasms, severe and tonic, with but little diarrhcea or vomiting: Camph. cupr. ipec. secale. verat. Spasms or cramps in the extremities or elsewhere, Avith Aveight, pressive pain or aching, at the pit of the stomach: Ant-t. camph. cupr. natr-m. phos. phos-ac. secale. VERAT. Spasms of the extremities, with painful sensibil- 95 TIME, ity of the pit of the stomach ; Ant-t. Ars. camph. cupr. natr-m. phos. phos-ac. verat. Spasms return at night : Cuprum, secale. Excessive and sudden debility: Ars. carb-v. cupr. ipec. lach. laur. nux-v. PHOS. phos-ac. secale. VERAT. The patient worse after midnight, or early in the morning: Aeon, ant-t. ars. bell, canth. carb-v. cupr. kali. lach. mere. natr. natr-m. nux-v. petr. PHOS. phos-ac. rhus. secale. stram. sulph. verat. The patient made worse by movement: Aeon. ant-t. ars. bell. bry. camph. canth. carb-v. cic. cupr. dig. hyos. ipec. kali. lach. laur. mere, natr-m. nux-v. petr. phos. phos-ac. plumb, rhus-rad. secale. stram. sulph. verat. 96 WC 262 JB3h 1885 34710840R NLM DSIbVfiST M NATIONAL LIBRARY OF MEDICINE